Objective: To evaluate the volume of blood transfusion requirements as well as hemolytic and oxidative biochemical variables in transfusion-dependent β-thalassemia patients supplemented with vitamin E.Material and Methods: A prospective, double-blind, randomized, placebo-controlled, crossover study was undertaken between December, 2012 and September, 2014 in the Pediatric Clinic of Songklanagarind Hospital. The participants were β-thalassemia major and Hb E/β-thalassemia patients aged between 5 and 18 years. A random allocation sequence was generated to receiving either 6 months of vitamin E or placebo followed by a 3-month washout period and then switching to another drug for 6 months. The outcome variable measurements were the volumes of the transfused packed red cells, and the hemolytic and oxidative biochemical variables.Results: Thirty-nine patients were enrolled into the study. All of them had significantly low levels of vitamin E and reduced glutathione levels, as well as high levels of oxidative stress shown by significantly high levels of malondialdehyde, superoxide dismutase, and glutathione peroxidase. The vitamin E levels became normal after the 6-month period of 200-400 milligram per day of oral vitamin E intake. All of the measured oxidative stress parameters did not improve except for the glutathione peroxidase level. Moreover, there was no difference in the volumes of transfused packed red cell requirements as well as hemolytic parameters like aspartate transaminase, lactate dehydrogenase, reticulocyte count and total bilirubin levels. Finally, no adverse reactions to oral vitamin E were found.Conclusion: Vitamin E supplementation normalized the vitamin E level and possibly partially reduced oxidative stress, but there was no difference in the volume of transfusion requirements or the hemolytic parameters in transfusion-dependent β-thalassemia patients.

Purpose Potential adverse outcomes of Proton pump inhibitors (PPIs) have increasingly been reported. The potential risks to PPIs include hypomagnesemia and chronic kidney disease (CKD). Unlike a real-world electronic medical record (RW-EMR) with active-comparator design, claim databases and special population cohort with non-user design, using in previous studies, resulted in a wide range of strength of association with indication bias. This study aimed to measure the total effect of association between PPIs use and CKD incidence using Thai RW-EMR. Patients and Methods A retrospective hospital-based cohort was applied into this study. Electronic medical records and administrative data of out- and inpatient were retrieved from October 1st, 2010 to September 30th, 2017. On-treatment with grace period as well as propensity score matching was used in data analysis. Cox proportional hazard models were applied to evaluate the PPIs-CKD association. Results Of all 63,595 participants, a total of 59,477 new PPIs and 4118 Histamine 2-receptor antagonist (H2RA) users were eligible for follow-up. As compared with H2RA, the PPI users were non-elderly and more likely being female. The association of PPIs with CKD was statistically significant (adjusted hazard ratio [HR] = 3.753, 95% CI = 2.385–5.905). The HR were not statistically different by concomitant use PPIs with NSAIDs and by medication possession ratio levels. Conclusion The association between PPIs and CKD incidence was statistically significant in this hospital-based cohort. However, self-treatment with over-the-counter PPIs, as well as, smoking, drinking alcohol and body mass index could not be fully retrieved, affecting the estimation of treatment effect.

PurposePupillary dilatation with three types of eye drops is used regularly in the clinic; however, a mixture of these drops in a single bottle may be more beneficial in reducing workloads and resources. This study compared the efficacy in pupillary dilatation between two protocols of dilating drop instillation.MethodsThis prospective, randomized, comparative study included 30 eligible Thai patients. The patients randomly received preoperative pupillary dilatations by either the conventional protocol (1% tropicamide (T), 10% phenylephrine (P) and 0.1% diclofenac (D) in three separate bottles) or the fixed combination (TPD) protocol which had the three types of eye drops mixed in a single bottle in a ratio of 4:3:3. The chi-square test and independent t-test were used to analyze the data.ResultsThe conventional protocol group and TPD protocol group each had 15 patients. Sixty minutes after the initial instillation, all patients in the TPD protocol and 13 patients (86.7%) in conventional protocol achieved at least 6 mm in the shortest diameter. The mydriatic rate between protocols showed no difference. In patients who received the TPD protocol, the systemic effects on the mean arterial blood pressure and pulse rate decreased over time.ConclusionThe mixture of tropicamide, phenylephrine and diclofenac had a comparable efficacy for a pupillary dilatation to the conventional dilating drops in separate bottles. The systemic complications on blood pressure and arterial pulse of the TPD mixture were less than the conventional protocol.Trial registrationTCTR20130325001.