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BackgroundStevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), caused by allopurinol therapy, are strongly associated with the human leukocyte antigen (HLA), HLA-B*5801. Identification of HLA-B*5801 genotype before prescribing allopurinol offers the possibility of avoiding allopurinol-induced SJS/TEN. As there is a paucity of evidence about economic value of such testing, this study aims to determine the cost-effectiveness of HLA-B*5801 testing compared with usual care (no genetic testing) before allopurinol administration in Thailand.Methods and FindingA decision analytical and Markov model was used to estimate life time costs and outcomes represented as quality adjusted life years (QALYs) gained. The model was populated with relevant information of the association between gene and allopurinol-induced SJS/TEN, test characteristics, costs, and epidemiologic data for Thailand from a societal perspective. Input data were obtained from the literature and a retrospective database analysis. The results were expressed as incremental cost per QALY gained. A base-case analysis was performed for patients at age 30. A series of sensitivity analyses including scenario, one-way, and probabilistic sensitivity analyses were constructed to explore the robustness of the findings. Based on a hypothetical cohort of 1,000 patients, the incremental total cost was 923,919 THB (USD 29,804) and incremental QALY was 5.89 with an ICER of 156,937.04 THB (USD 5,062) per QALY gained. The cost of gout management, incidence of SJS/TEN, case fatality rate of SJS/TEN, and cost of genetic testing are considered very influential parameters on the cost-effectiveness value of HLA-B*5801 testing.ConclusionsThe genetic testing for HLA-B*5801 before allopurinol administration is considered a highly potential cost-effective intervention in Thailand. The findings are sensitive to a number of factors. In addition to cost-effectiveness findings, consideration of other factors including ethical, legal, and social implications is needed for an informed policy decision making.

These findings indicate a preliminary safety evidence of our developed cleansing lotion containing the natural AHAs and can be used as cumulative evidence for supporting the future home use study of this product in human.

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Cleansing lotion containing 8% w/w tamarind pulp extract was prepared and tested for its clinical effects on skin properties. The study was performed using 38 healthy Thai female volunteers, and consisted of a home-use, doubleblind, randomized side of face and placebo controlled trial. The test product (emulsion with the extract) and the placebo product (emulsion without the extract) were applied and gently massaged on each side of facial skin for 2 minutes twice daily for 8 weeks and the difference in skin colour between test and placebo side of face was measured. In addition, redness, moisture content, pH and transepidermal water loss (TEWL) of skin, adverse events, subject's satisfaction, and compliance of volunteers were assessed. We found that the melanin value on the side where the test product was applied was significantly less than that of the other side at week 4 (p < 0.015). The mean differences between the test and the placebo side of all skin parameters including melanin value, pH and moisture content elasticity were not significant (p > 0.05) at the end of study (week 8). Erythema and TEWL of the skin were not different between the side on which the test was applied and the placebo side indicating that the product was safe. In addition, most volunteers were satisfied with the cleansing effect of the product containing the extract.

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A LT H 1 7 ( 2 0 1 4 ) A 7 1 9 -A 8 1 3 regression model was used to determine difference of the number of hospitalization among groups of severity and health insurance. Costs were converted to $US using 30.59 Thai-baht per $1US. Results: Among 1,982 patients included, the average age was 40.3±24.0 years with 60.7% male. A total of 1,936 patients were non-high risk patients, while 46 patients were high-risk patients. There were 1,293 patients under universal coverage schemes (UCS), 264 patients under social security schemes, and 626 patients under civil servant medical benefit schemes (CSMBS). The average annual cost/patient was $598±871. In adjusted analyses, the health care cost of highrisk patients was $67 higher than that of non-high risk patients (95% confidence interval (CI); $64-$69). The cost of patients under CSMBS was $109 (95%CI; $105-$113) higher than that of patients under UCS. ConClusions: The health care costs in a cohort of patients with asthma were substantial and were higher in high-risk patients and patients under CSMBS.objeCtives: This study aims to propose an appropriate statistical method to analyse the longitudinal health-related quality of life (HRQoL) data. Methods: This was a longitudinal HRQoL study conducted among new smear positive pulmonary tuberculosis (PTB) patients diagnosed at the chest clinic of Penang General Hospital between March 2010 and February 2011. Eligible patients (i.e., literate and 18 years and above) were asked to self-complete the SF-36v2 questionnaire (either in Malay, Mandarin, Tamil or English) at the start of the treatment, after the intensive phase and at the end of the treatment. The mean physical component summary (PCS) and mental component summary (MCS) scores, ranging from 47-53, were considered equivalent to the general population norms. Repeated measures ANOVA (with single imputations) and linear mixed model were used to analyse the data. Results: A total of 216 patients completed the questionnaire at the start of their treatment. Out of these, 177 and 153 completed the questionnaire at the second and third follow-ups, respectively. Throughout the treatment, the mean PCS and MCS scores for the patients were less than 47. In repeated measures ANOVA analysis, level of education, diabetes, being alcoholic and cough with sputum were the significant predictors of PCS, whereas none of the covariates explained a significant variance in the MCS scores. In linear mixed model, ethnicity, marital status, being a smoker, productive cough and ≥ 3 TB-related symptoms were the significant predictors of PCS. Similarly, covariates such as ethnicity, hypertension, being a smoker, monthly income ≥ 1000 MYR and ≥ 3 TB-related symptoms significantly explained variance in the MCS scores. ConClusions: The study's findings indicated compromised health among the study participants even at the end of treatment. According to different findings obtained from both methods and the limited assumption in applying repeated measures ANOVA, linear mixed model was preferred to analyse this...

Cyclooxygenase (COX) ‐2 is a key enzyme in the conversion of arachidonic acid (AA) to prostanoids . Inhibition of COX‐2‐dependent prostanoids by nonsteroidal anti‐inflammatory drugs (NSAIDs) (both traditional(t) and selective for COX‐2, named coxibs) is involved in their efficacy in affecting pain and inflammation and in reducing the recurrence of colorectal polyps. However, the use of tNSAIDs and coxibs is associated with a small but consistent increase of cardiovascular (CV) risk which is believed to be due to the reduction of the biosynthesis of endothelial COX‐2‐dependent prostacyclin (PGI 2 ) . Novel knowledge on the biology of COX‐2 show that endocannabinoids may be the substrate for the COX‐isozyme. Endocannabinoids and endocannabinoid‐derived products of COX‐2‐mediated oxidative metabolism serve a variety of regulatory functions. Interference with endocannabinoid metabolism by NSAIDs might contribute to their pharmacological effects. Key Concepts: COX‐2 is overexpressed in inflammation and cancer mainly through posttranscriptional mechanisms involving stabilisation of its mRNA. Enhanced cytoplasmic levels of RNA stability factors, such as HuR, and reduced levels of microRNAs govern COX‐2 mRNA stability and translational efficiency. The constitutive expression of COX‐2 in endothelial cells plays an important role in cardiovascular homoeostasis through the generation of prostacyclin. COX‐2 is the target of NSAIDs, traditional and coxibs, thus leading to therapeutic effects and cardiovascular hazard, in some individuals. The major mechanism of action of NSAIDs is through the inhibition of the conversion of AA to biologically active prostanoids. Novel knowledge on the biology of COX‐2 shows that the activity of the COX‐isozyme may be involved in the generation of novel biologically active lipid mediators through the metabolism of endocannabionids. COX‐2 might affect endocannabinoid tone by contributing to its reduction. Endocannabinoids activate cannabinoid receptors to serve a variety of regulatory functions. These novel actions of COX‐2 may suggest their contribution to the therapeutic effects of NSAIDs. The (R) enantiomers of ibuprofen, naproxen and flurbiprofen, which are inactive to inhibit the metabolism of AA by COX‐2, are potent substrate‐selective inhibitors of endocannabinoid oxygenation. The discovery of these novel effects of (R) enantiomers of NSAIDs opens the way to develop novel analgesic drugs based on this mechanism of action.