Lethal ventricular arrhythmia due to entrectinib-induced Brugada syndrome: a case report and literature review.

Entrectinib, a multikinase inhibitor of ROS1 and tropomyosin receptor kinases, is recommended to treat ROS1-positive metastatic non-small cell lung cancer (NSCLC). In a previous study, entrectinib-related cardiotoxicity occurred in 2% of patients; however, lethal arrhythmias remain understudied. We encountered a case of fatal arrhythmia due to drug-induced Brugada syndrome caused by entrectinib. An 81-year-old Japanese male with lung adenocarcinoma harboring ROS1-fusion gene was treated with entrectinib. The patient developed lethal arrhythmias three days after drug initiation, including ventricular tachycardia with Brugada-like electrocardiogram changes. Echocardiography and coronary angiography revealed no evidence of acute coronary syndrome or myocarditis. Following the termination of entrectinib, the electrocardiogram abnormality improved within 12 days. Hence, paying special attention to and monitoring electrocardiogram changes is necessary. In addition, it is also necessary to consider early therapeutic interventions and discontinuation of the drug in cases of drug-induced Brugada syndrome.

Daidzein promotes glucose uptake through glucose transporter 4 translocation to plasma membrane in L6 myocytes and improves glucose homeostasis in Type 2 diabetic model mice.

Daidzein shows estrogenic, antioxidant and antiandrogenic properties as well as cell cycle regulatory activity. However, the antihyperglycemic effect of daidzein remains to be elucidated. In this study, we investigated the in vitro effect of daidzein on glucose uptake, AMPK phosphorylation and GLUT4 translocation on plasma membrane in L6 myotubes and its in vivo antihyperglycmic effect in obese-diabetic model db/db mice. Daidzein was found to promote glucose uptake, AMPK phosphorylation and GLUT4 translocation by Western blotting analyses in L6 myotubes under a condition of insulin absence. Promotion by daidzein of glucose uptake as well as GLUT4 translocation to plasma membrane by immunocytochemistry was also demonstrated in L6 myoblasts transfected with a GLUT4 cDNA-coding vector. Daidzein (0.1% in the diet) suppressed the rises in the fasting blood glucose, serum total cholesterol levels and homeostasis model assessment index of db/db mice. In addition, daidzein supplementation markedly improved the AMPK phosphorylation in gastrocnemius muscle of db/db mice. Daidzein also suppressed increases in blood glucose levels and urinary glucose excretion in KK-Ay mice, another Type 2 diabetic animal model. These in vitro and in vivo findings suggest that daidzein is preventive for Type 2 diabetes and an antidiabetic phytochemical.

Antihyperglycemic effect of equol, a daidzein derivative, in cultured L6 myocytes and ob/ob mice.

SCOPE: Molecular mechanisms for the potential antihyperglycemic effect of equol remain to be elucidated. In this study, we investigated the in vitro effect of equol on glucose uptake, AMP-activated protein kinase (AMPK) phosphorylation, and glucose transporter 4 (GLUT4) translocation to plasma membrane in L6 myocytes, and its in vivo antihyperglycemic effect in obese-diabetic model ob/ob mice. METHODS AND RESULTS: Equol was found to promote glucose uptake, AMPK phosphorylation, and GLUT4 translocation detected by Western blotting analyses in L6 myotubes under a condition of insulin absence. Equol (0.05% in diet) suppressed the rise in serum glucose, cholesterol, triglyceride, and lipid peroxide concentrations and the hepatic triglyceride level as compared with those in the control group. Moreover, equol treatment suppressed the rises in fasting blood glucose level and improved the impaired glucose tolerance in ob/ob mice. Furthermore, equol treatment was demonstrated to improve expression of hepatic gluconeogenesis- and lipogenesis-related genes in terms of glucose and lipid metabolism. CONCLUSION: The hypoglycemic effect of equol is related to increased GLUT4 translocation to the plasma membrane via AMPK activation. In addition, equol suppresses the fasting blood glucose level and gene expression of hepatic enzymes related to glucose metabolism. These results strongly suggest that equol has antidiabetic potential.

Anti-invasive activity of α-tocopherol against hepatoma cells in culture via protein kinase C inhibition.

Effects of α-, ß-, γ- and δ-tocopherols on the proliferation and invasion of AH109A hepatoma cells and their modes of action were investigated. Four tocopherols inhibited the invasion as well as the proliferation of AH109A cells. Their inhibitory effects were more prominent on the invasion than on the proliferation. At 1 µM, α-tocopherol showed most potent anti-invasive activity without any influence on the proliferation. We have previously demonstrated that reactive oxygen species increase the invasion of AH109A cells. α-Tocopherol suppressed the reactive oxygen species-induced invasion but failed to suppress the reactive oxygen species-induced rises in intracellular peroxide level. GF 109203X, a protein kinase C inhibitor, decreased the invasive activity of AH109A cells. In contrast, phorbol-12-myristate-13-acetate, a protein kinase C activator, increased the invasive capacity of AH109A cells. α-Tocopherol suppressed the phorbol-12-myristate-13-acetate-induced increase in the invasion, and canceled the phorbol-12-myristate-13-acetate-induced rises in protein kinase C activity and phosphorylation of extracellular signal-regulated kinase. These results suggest that tocopherols, especially α-tocopherol, possess inhibitory effect more strongly on the invasion of AH109A cells than on the proliferation. They also suggest that the anti-invasive activity of α-tocopherol is raised through suppression of PKC/ERK signaling.

Effectiveness of communication campaign on iron deficiency anemia in Kyzyl-Orda region, Kazakhstan: a pilot study.

BACKGROUND: In 2004, wheat flour fortification (WFF) with iron was implemented in Kazakhstan as a public health strategy to increase the iron intake of all women of childbearing age and of children. In 2003, before starting the flour fortification program, a communication campaign on health education took place in a region with a high prevalence of iron deficiency anemia (IDA). The present study aimed to evaluate the prevalence of anemia, iron deficiency and IDA before and after the campaign. In addition, knowledge about IDA and its prevention, as well as awareness about fortified wheat flour, was assessed. METHODS: The subjects of the study were women aged 15-49 years and children aged 2-14 years. The study was carried out in urban and rural areas of Kyzyl-Orda region in 2003 before (March) and after (December) the campaign. Blood samples were collected in order to measure hemoglobin and serum ferritin. In March 80 women and 57 children in the urban area, and 41 women and 41 children in the rural area, participated in the IDA testing. The corresponding participants in December numbered 62, 52, 52, and 57, respectively. The impacts of the communications and information received by participants during the campaign was surveyed with a questionnaire for 195 women in March and 198 women in December including some who participated in the IDA testing. RESULTS: In March, the prevalence of anemia was 52.0% among 121 women and 58.1% among 98 children, and those with low iron reserve were 63.6%, 49.1% and IDA 40.5%, 11.0%, respectively. In December, the prevalence of anemia had significantly decreased among rural women (from 65.9% to 48.0%, p < 0.05) and among urban children (from 63.1% to 11.5%, p < 0.001). The prevalence of iron deficiency was significantly reduced among the children (from 51.1% to 24.8%, p < 0.001). IDA prevalence was meaningfully decreased among women in urban and combined areas (from 37.5% to 15.0% and 40.5 to 14.8%, respectively, p < 0.001) and among urban children (from 7.1% to 2.1%, p < 0.05). The surveys found that most women knew about IDA and its prevention and that the numbers were similar both in March and in December. The knowledge of the anti-anemic effect of wheat fortified flour improved significantly over the period of the campaign among women both in urban (from 48.5% to 80.9%, p < 0.001) and rural (from 69.8% to 88.6%, p < 0.001) areas. CONCLUSION: The study demonstrated that the communication campaign before implementation of WFF program was effectively carried out, giving a biological impact on hematological indices.

PAI-1 expression levels in gastric cancers are closely correlated to those in corresponding normal tissues.

BACKGROUND/AIMS: To investigate the mechanism of PAI-1 overexpression in gastric cancers, the PAI-1 expression levels in gastric cancers were compared to those in the corresponding normal tissues. METHODOLOGY: A quantitative RT-PCR for PAI-1 gene was performed in gastric cancers and corresponding normal tissues, and evaluated the association between the PAI-1 expression levels in gastric cancers and those in corresponding normal tissues. RESULTS: There was a significant correlation between gastric cancer and corresponding normal PAI-1 expressions with a Spearman's rank correlation coefficient of 0.74 (p < 0.0001). PAI-1 expression levels in corresponding normal tissues increased significantly with tumor stage [stage I, -8.04 +/- 0.72; stage II, -7.71 +/- 0.61: stage III, -6.81 +/- 0.51; stage IV, -4.95 +/- 0.20 (p = 0.0022)). CONCLUSIONS: Previous studies found that PAI-1 overexpression was significantly associated with malignancy of gastric cancers. Taken together, PAI-1 overexpression in gastric cancers might be originated from higher PAI-1 expression in corresponding normal tissues and result in a malignant phenotype of these cancers.

Healthcare waste management in the capital city of Mongolia.

Inconsistencies are present in the management options for healthcare wastes in Mongolia. One of the first critical steps in the process of developing a reliable waste management plan requires the performance of a waste characterization analysis. The objectives of this study were an assessment of the current situation of healthcare waste management (HCWM) and characterization of healthcare wastes generated in Ulaanbaatar. A total about 2.65 tonnes of healthcare wastes are produced each day in Ulaanbaatar (0.78 tons of medical wastes and 1.87 tons of general wastes). The medical waste generation rate per kg/patient-day in the inpatient services of public healthcare facilities was 1.4-3.0 times higher than in the outpatient services (P<0.01). The waste generation rate in the healthcare facilities of Ulaanbaatar was lower than in some other countries; however, the percentage of medical wastes in the total waste stream was comparatively high, ranging from 12.5% to 69.3%, which indicated poor waste handling practices. Despite the efforts for the management of wastes, the current system of healthcare waste management in Ulaanbaatar city of Mongolia is under development and is in dire need of immediate attention and improvement. It is essential to develop a national policy and implement a comprehensive action plan for HCWM providing environmentally sound technological measures to improve HCWM in Mongolia.

A highly sensitive method for the detection of p16 methylation in the serum of colorectal cancer patients.

BACKGROUND: For the purpose of early detection of carcinomas, detection of p16 hypermethylation by methylation-specific polymerase chain reaction (MSP) in the serum of many kinds of malignancies has been introduced. An attempt to increase the sensitivity of this assay is reported for colorectal cancer. MATERIALS AND METHODS: DNA samples were subjected to limiting dilution before being divided into ten smaller samples. Subsequently, hemi-nested MSP was performed on those ten samples. The limiting dilution-MSP (LD-MSP) provided a 10-fold increase in sensitivity of the detection of methylated DNA compared with conventional MSP. RESULTS: Of 44 colorectal cancer patients, 30 (68%) exhibited abnormal promoter methylation of p16 in their serum DNA by LD-MSP, while 13 (30%) exhibited it by conventional MSP. As a control, the serum DNA of 50 patients with colorectal carcinomas whose corresponding tumor DNA had no methylation in the p16 promoter was screened for aberrant methylation. No methylation was found in the serum DNA of this control group by LD-MSP or conventional MSP. CONCLUSION: The high sensitivity of LD-MSP makes it possible to detect smaller amounts of tumor DNA in the serum than conventional MSP. This technique also has great specificity and no abnormal methylation in serum has yet been observed if the corresponding tumor does not exhibit methylation. This observation supports the idea that LD-MSP could be applied in clinical use for the detection of tumor DNA in serum.

Adjuvant immunochemotherapy with protein-bound polysaccharide K for colon cancer in relation to oncogenic beta-catenin activation.

PURPOSE: Protein-bound polysaccharide K is an immunotherapeutic agent that promotes apoptosis by inhibiting nuclear factor-kappaB activation in cancer cells. We previously showed that oncogenic beta-catenin activates nuclear factor-kappaB and inhibits apoptosis by up-regulating beta-transducin repeat-containing protein. We investigated whether the activation state of beta-catenin in the primary tumor is associated with differences in survival rates of patients with colon cancer undergoing immunochemotherapy with 5-fluorouracil plus polysaccharide K vs. chemotherapy with 5-fluorouracil alone. METHODS: We assessed the activation states of beta-catenin and nuclear factor-kappaB in the primary tumors of 202 colon cancer patients, and analyzed the data in terms of the clinicopathologic characteristics and survival of patients undergoing the two forms of adjuvant therapy. RESULTS: We found two distinct patterns of nuclear accumulation of activated beta-catenin in the tumor cells: diffuse nuclear accumulation in 89 cases (44 percent) and selective nuclear accumulation at the tumor invasion front in 18 cases (9 percent). Nuclear factor-kappaB activation was found in 64 cases (32 percent). In patients with diffuse nuclear accumulation-type beta-catenin activation, immunochemotherapy significantly improved recurrence-free survival, cancer death survival, and overall survival rates compared with patients receiving chemotherapy alone. No survival benefit was found in cases with nuclear accumulation at the tumor invasion front-type beta-catenin activation or no activation. Similarly, immunochemotherapy favored the survival of patients with nuclear factor-kappaB activation. Multivariate analysis established the TNM stage and administration of polysaccharide K as independent prognostic factors in the patients with diffuse nuclear accumulation-type beta-catenin activation. CONCLUSIONS: The presence of diffuse nuclear accumulation-type beta-catenin activation identifies patients with colon cancer who respond better to immunotherapy with polysaccharide K.

Effectiveness of implementation of gastric and duodenal ulcer clinical protocol in the Kyrgyz Republic.

The introduction of a clinical protocol for the treatment of gastric and duodenal ulcer (GDU) may be one of the solutions for the high morbidity and complications of these diseases. This descriptive study was carried out to evaluate the effectiveness of the implementation of the GDU clinical protocol in the Kyrgyz Republic introduced in 2002. The effectiveness of the introduction of the clinical protocol into primary health care practice was assessed by the numbers of hospitalizations and operations due to GDU. As the result of the clinical protocol implementation for the treatment of GDU, the numbers of hospitalizations and operations have decreased in Kyrgyz Republic. The total number of hospitalized GDU patients was reduced in 2003 by 12% from the 2001 level. The number of operations due to GDU complications decreased in 2003 by 30% compared with 2001. The protocol-driven approach showed the potential to become a feasible method to improve the quality of health care in Kyrgyzstan. However, the prospective long-term effects, including their cost-effectiveness, should be evaluated in Kyrgyzstan.

Avoidable mortality measured by years of potential life lost (YPLL) aged 5 before 65 years in Kyrgyzstan, 1989-2003.

There is considerable willingness in the entire medical society of Kyrgyzstan, which was directly involved in the reform process, to obtain reliable information about changes in population health that have occurred in the last decade, as well as about changes in mortality, which is the basic component of population health. The objective of this paper is to introduce the Year of Potential Life Lost (YPLL) in Kyrgyzstan caused by avoidable mortality in the population between 5 and 65 years of age during 1989-2003, and to provide a basis for setting the priorities for the reducing YPLL in the coming years. YPLL was calculated using data from the annual mortality tables according to causes of deaths and age for 1989, 1996, 1999 and 2003. YPLL is defined as the summation of the difference between 65 years of age and the age at death from the age of 5 and before 65. In 2003, the total number of YPLL due to avoidable mortality among those who died was 216,860, which represents a decline of 5.0% in comparison with 228,266 in 1989. During the study years, the largest proportion of YPLL in the population between 5 and 65 years of age resulted from injury and poisoning. In 2003, this proportion represented 41.5% of the total amount of YPLL due to all the causes studied here, followed by infections and parasitic diseases (12.0%), circulatory disturbance of the brain (11.5%), chronic liver diseases and cirrhosis (11.4%), diseases of the respiratory system (9.2%), and malignant neoplasm of the upper airways and digestive tract (4.6%). The decline in avoidable mortality caused by injury and poisoning, infections disease, malignant neoplasm of the female breast and uterus has to be priority-driven direction for developing Health Policy in the coming years in Kyrgyzstan. Attention also has to be given to reducing of avoidable mortality caused by malignant neoplasm of the female breast by implementing screening programs.

Current problems in national hospitals of Phnom Penh: finance and health care.

The current problems in Cambodia's national hospitals subsist in a geographic imbalance in the location of staff and health facilities, and low staff motivation largely due to inadequate payment. This paper aims to investigate the associations among hospital performance, hospital finances, and other related issues in five national hospitals in Phnom Penh, using annual reports of the five hospitals and annual statistics of the Ministry of Health, from 2000 to 2004. The bed occupancy rates (BOR), average lengths of stay (ALS), hospital mortality rates (HMR), maternal and neonatal mortality rates, numbers of patients, main health problems of inpatients, numbers of health personnel, staff incentives, and annual hospital income were used in this study as indicators of five hospitals in Phnom Penh city. The ALS varied from 3.8 to 9 days. The numbers of health personnel (physician, medical assistant, secondary nurses, primary nurses, secondary midwives, and primary midwives) per 100 beds were from 114 to 282. Supplemental salary per staff also differed greatly among these hospitals; the salaries were the highest at Calmette hospital (US$ 212.8) and the lowest at Preah Kossamak (US$ 12.4). In the five hospitals, the average BOR was 58.8%, and the mean of total annual income was US$ 1,427,852 per year. Although not significant, there was a tendency for higher supplemental salaries to be associated with higher BOR (Spearman rank correlation coefficient 0.70, p = 0.188). This study showed the differences in the hospital indicators among five national hospitals in Phnom Penh city, and the tendency of higher BOR in the hospitals paying higher supplemental salaries to the staff. Higher supplemental salary to the staff seemed to contribute the better hospital performance.

HIV prevalence and factors associated with HIV infection among male injection drug users under 30: a cross-sectional study in Long An, Vietnam.

BACKGROUND: Sufficient targeted HIV prevention activities aiming at reducing HIV transmission within and from an extremely marginalized population of injection drug users (IDUs) must urgently and efficiently be implemented in Vietnam. This study was conducted to facilitate the development of such activities by describing transmission risks of young IDUs and evaluating factors in association with HIV infection. METHODS: Thirty clusters were selected from 29 hotspot communes in Long An province by probability proportional to size (PPS) sampling method. The snowball technique was used for enrolling participants in each cluster. The cross-sectional association of factors obtained during direct structured interviews to 248 male IDUs aged 14 to 29 years old and with their HIV test results were examined. RESULTS: The HIV prevalence among the studied IDUs was 32%. Age range of 18-20 years old, low educational level, sharing injection equipment or injection drug use in the other cities were independently associated with HIV serostatus in the multivariate analysis. Sexual behaviors did not differ between HIV-positive and -negative IDUs. Among HIV seropositive IDUs who had sexual contact with primary (n = 37), casual (n = 6), and commercial (n = 15) partners, only 5.4% (n = 2), 33.3% (n = 2), and 46.7% (n = 7), respectively, responded that they had used condoms every time. CONCLUSION: About one-third of young IDUs aged less than 30 identified in the hotspot communes in Long An, Vietnam was found to be infected with HIV, and socio-demographic and injection-related factors might account for the infection risk. Prevailing risky sexual behavior of this extremely marginalized population highlights the need to reduce their high transmission risks as a public health priority.

Smoking cessation rate 12 months after a group counseling program in Mongolia.

Mongolia is one of the top ten countries with the highest smoking rates of men and women combined, so that tobacco control, especially creating effective smoking cessation programs, is essential issue of the government. The present study aimed to assess an effectiveness of a free group counseling program by trained medical doctors and health educators based on "5A" (Ask, Assess, Advise, Assist, and Arrange) with 12 months follow-up in 2002 and 2003. Participants were 517 smokers with an intention to quit smoking in three big cities (Ulaanbaatar, Darkhan, and Erdenet). We found that 65.0% of them were not smokers 12 months after the program. The cessation rate was significantly higher in 2003 than in 2002, indicating that the effectiveness of the program had improved over time. Group counseling based on the "5A" approach by medical doctors and health educators seems effective for smokers with an intention to quit smoking. The present approach may be more appropriate in Mongolian conditions than nicotine replacement therapy.

Laparoscopy-assisted total gastrectomy for a case of MALT lymphoma: a case report.

A case of laparoscopy-assisted total gastrectomy with regional lymph node dissection for MALT (mucosa-associated lymphoid tissue) lymphoma is reported. The patient was a 45-year-old male with MALT lymphoma. Eradication of Helicobacter pylori as the initial therapy had failed to halt progression of the tumor. Considering certainty of the second therapy, he was transferred to surgical treatment. Total gastrectomy was required and this was performed by the laparoscopy-assisted approach. The postoperative course was satisfactory and the patient has been disease-free for 5 years after the operation. Laparoscopic operation could be a useful option in the second-line treatment for MALT lymphoma after failure to eradicate H. pylori.

Aberrant methylation of the CHFR gene in digestive tract cancer.

BACKGROUND: Recently, aberrant methylation of the CHFR gene associated with gene silencing has been reported in several cancers. The methylation status of the CHFR gene was examined in primary esophageal and gastric carcinomas. MATERIALS AND METHODS: The methylation status of the CHFR promoter region and mRNA expression in cancer cell lines were examined first. The methylation status of the CHFR gene in 38 esophageal and 53 gastric cancers was subsequently examined and the correlation between CHFR methylation and the clinicopathological findings was investigated. RESULTS: Aberrant methylation of the CHFR gene was detected in 9 out of 38 (24%) primary esophageal and 16 out of 53 (30%) primary gastric cancers. After methylation analysis of all the samples, the clinicopathological data were correlated with these results. There was a significant difference according to gender (p = 0.0404), indicating that female esophageal cancers were more frequently methylated than male. On the other hand, abnormal methylation was found in esophageal and gastric cancer patients at all clinical stages. CONCLUSION: Aberrant methylation of the CHFR gene was frequently shown in esophageal and gastric cancers. In addition, abnormal methylation was found in these cancer patients at all clinical stages, suggesting that this cancer could be methylated at an early stage.

TAOS1, a novel marker for advanced esophageal squamous cell carcinoma.

BACKGROUND: TAOS1 (tumor amplified and overexpressed sequence 1) was recently cloned and found to be possibly important in driving the amplification of 11q13 in oral squamous cell carcinoma (SCC). MATERIALS AND METHODS: Quantitative RT-PCR was performed to determine the possible relationship between TAOS1 gene expression levels and clinicopathological features in esophageal SCC. RESULTS: TAOS1 overexpression was observed in 7 out of 38 (18%) esophageal SCCs and CCND1 overexpression was observed in 4 out of 38 (11%), suggesting that TAOS1 was more frequently overexpressed than CCND1 in esophageal SCC. The examination of the correlation of TAOS1 overexpression with the clinicopathological features revealed a significant difference in lymph node metastasis (p = 0.014) and a trend towards advanced TNM stages (p = 0.074). CONCLUSION: The present results suggest that TAOS1 might serve as a new marker for predicting the malignancy of esophageal SCC.

Plasminogen activator inhibitor-1 as a potential marker for the malignancy of gastric cancer.

To test the hypothesis that plasminogen activator inhibitor-1 (PAI-1) may serve as a candidate marker for the malignancy of gastric cancer, we carried out quantitative reverse transcription-polymerase chain reaction for the PAI-1 gene and evaluated the possible relationship between PAI-1 gene expression levels and clinicopathological findings in gastric cancer. A significant increase in PAI-1 expression scores was observed in lymph node metastasis-positive gastric cancers (2.11 +/- 0.35) compared to metastasis-negative cancers (0.33 +/- 0.49) (P = 0.0048), as well as in distant metastasis-positive gastric cancers (3.68 +/- 0.58) compared to metastasis-negative cancers (1.20 +/- 0.32). The PAI-1 expression score markedly increased with tumor stage (P < 0.0001; ANOVA test). Moreover, multivariate analysis revealed the PAI-1 expression score to be a strong and independent prognostic factor for gastric cancer (P = 0.0450). These results suggested that PAI-1 might serve as a new and promising parameter for the prediction of prognosis in gastric cancer.

PTCH gene expression as a potential marker for esophageal squamous cell carcinoma.

BACKGROUND: The PTCH expression level in esophageal squamous cell carcinoma (SCC) was examined. MATERIALS AND METHODS: To test whether PTCH can serve as a candidate marker for esophageal SCC, a quantitative reverse transcription (RT) -PCR for the PTCH gene was performed and the possible relationship between PTCH gene expression levels and clinicopathological findings in esophageal SCC was evaluated. RESULTS: A low PTCH expression score was observed in 18 out of 29 (62%) esophageal SCCs and it was significantly correlated with a poor prognosis in esophageal SCC patients (p = 0.0073). CONCLUSION: These results suggest that PTCH might serve as a new parameter for the prediction of prognosis in esophageal SCC.

Rational use of drugs: prescribing and dispensing practices at public health facilities in Lao PDR.

PURPOSE: To evaluate the rational use of drug (RUD) patterns with a focus on prescribing and dispensing practices for providing information to the policy makers for further planning and identifying intervention strategies. METHOD: A cross-sectional study conducted by interviewing 370 presenting outpatients, checking records of 900 out- patients with any cases and 798 outpatients with tracer diseases such as simple diarrhea, pneumonia and non-pneumonia (Flu) within 30 public health facilities (HFs) of five geographical areas with different socio-economic statuses grouped into high, middle and low. The WHO Operational Package for Monitoring and Assessing Country Pharmaceutical Situations indicators were used for data collection. RESULTS: Among the 3 items of drugs prescribed per average encounter, 97% were dispensed from HFs, of which 67% were adequately labeled, 84% were on the national essential drug (ED) list, and 78% were prescribed by generic name. Seventy-four percent of patients knew how to take the drugs they received, 47% of them received antibiotics (ABs), and 18% received injections. Forty-seven percent of under-five children with simple diarrhea received ABs, 77% received Oral Rehydration Salts (ORS) and 5% received anti-diarrhea drugs, and 91% of such under-five children with mid/moderate pneumonia received one of first line ABs, 15% received more than one ABs, and 41% of non-pneumonia (flu) patients of any age received ABs. CONCLUSION: The use of drugs in Laos was not fully appropriate in terms of rationally prescribing and dispensing practices. Since prescriptions for AB, injections, non-ED, and non-generics are still high, information on drug use provided is insufficient. Therefore, continuous health education programs among both health staff and public are needed.