Clinical characteristics and treatment outcomes of patients with Brugada syndrome in northeastern Thailand

<p><b>INTRODUCTION</b>Brugada syndrome (BrS) is a common genetic cause of sudden cardiac arrest (SCA) due to polymorphic ventricular tachycardia and ventricular fibrillation. The current recommended therapy for high-risk BrS patients is the use of an implantable cardioverter defibrillator (ICD). The present study aimed to report the clinical characteristics and treatment outcomes of BrS patients in northeastern Thailand.</p><p><b>METHODS</b>Patients who were diagnosed with BrS or had a Brugada electrocardiogram (ECG) between 2005 and 2012 at Khon Kaen University's hospitals were enrolled in the present study. Patients' clinical characteristics, ECG type, laboratory results and treatment were reviewed.</p><p><b>RESULTS</b>A total of 90 eligible patients were enrolled. Of these, 79 (87.8%) patients were symptomatic--65 (82.3%) had documented SCA and 14 (17.7%) had unexplained syncope. The remaining 11 (12.2%) patients were asymptomatic with Brugada ECG. A majority of the patients enrolled were born in northeastern Thailand. The mean age of the symptomatic patients was 44.49 ± 8.55 years. Among the symptomatic patients, a majority were male (n = 77, 97.5%) and 23 (29.1%) patients had a family history of SCA. Almost all BrS patients who were symptomatic (96.2%) received ICD treatment for secondary prevention. The number of patients who received appropriate ICD therapy was 4.2 times of those who received inappropriate shocks. Only 3 (3.8%) symptomatic BrS patients refused ICD treatment.</p><p><b>CONCLUSION</b>Clinical characteristics did not distinguish between symptomatic BrS patients and asymptomatic patients with Brugada ECGs. The clinical characteristics and treatment outcomes for the symptomatic BrS patients with SCA and unexplained syncope were similar. Among the BrS patients implanted with secondary prevention ICD in Northeastern Thailand, nearly one-third had received appropriate ICD therapy, far exceeding the incidence of device-related complications and inappropriate therapy.</p>

Bioequivalence of Clozapine Tablet in Thai Schizophrenic Patients

Background: Clozapine is an atypical antipsychotic drug that has been used world wide for the treatment of schizophrenic patients. Several generic formulations of this drug are now available.\  In order to assure about the efficacy and safety of the generic formulation, it is necessary to compare the bioavailability between the generic and the reference formulations after administration to the patients.Purpose: To compare the bioavailabilty of two clozapine formulations, Clozapin (Pharmasant Laboratories Co., Ltd., Thailand) and Clozaril (Novartis Pharmaceuticals, UK) when administered to schizophrenic patients in the dose of 100 mg every 12 hr until the drug reach steady state.Study design : Multiple dose steady state, randomized crossover study under non-fasting condition.\  The study was approved by the Ethics Review Board of the Khon Kaen University and the Food and Drug Administration, Ministry of Public Health.Subject : 18 Male Thai schizophrenic patients Methods: The subjects received 100 mg of either the Clozapin or Clozaril\  per oral bid for 7 days. At day 7 of each study phase, the drug levels were reached the steady state/\  Two hour after meal, the drug was administered and\  blood samples were collected at 0, 0.5, 1, 1.5, 2, 2.5, 3, 4, 6, 8, 10 and 12 hr. Plasma was separated and stored at \–80oC until assay. The plasma concentration of clozapine was determined by high performance liquid chromatography. Pharmacokinetic parameters were calculated from the plasma-concentration time profiles. The bioequivalence between the two formulations was assessed from the peak plasma concentrations (Cmax) and area under the concentration-time curve (AUC0-12 ) ratios.\  Results: All subjects well tolerated both clozapine formulations. No serious adverse effects were reported. The Tmax, terminal half-life and the total plasma clearance of clozapine observed in the present study were comparable to those observed in other previous reports. All of the evaluated pharmacokinetic parameters between the Test and Reference formulations were of comparable. The 90% confident interval for the ratio of means for the LnCmax (0.9453-1.1182) and LnAUC0-12 (0.9734-1.0889) are within the guideline range of bioequivalence (0.80 to 1.25). Conclusion: The result demonstrated that the Test formulation, Clozapin was bioequivalent to the Reference formulation, Clozaril when orally administered in multiple \–dose to schizophrenic patients.

Bioequivalence and Pharmacokinetic Study of Sildenafil in Healthy Thai Male Volunteers

Background: Sildenafil is a popular drug used for improving penile erectile function that has been commercially available through several manufacturers and distributors in Thailand. Therefore, it is necessary to study bioequivalence of the drugs obtained from the original manufacture and from a local manufacturer to ascertain that they can be medicated interchangeably.Objective: To determine whether two sildenafil preparations: Test (Erec®, Unison Laboratories, Co., Ltd., Thailand) and reference, (Viagra®, Pfizer Pty Limited., Australia) are bioequivalent.Design: Single oral dose and double-blind randomized two-way crossover.Population and samples: Fifteen healthy Thai male volunteers.Setting: Department of pharmacology, and Srinagarind Hospital, Faculty of Medicine, Khon Kaen University.Methods: The subjects received either 100 mg of the reference or test formulation. Blood samples were collected from catheter at several time points after sildenafil administration up to 12 hours. The bioequivalence between the two formulations was assessed by comparison of the peak plasma concentrations (Cmax) and area under the curve of time, from 0 to the last measurable concentration (AUC0-t last).Results: All subjects were well tolerated and presented no serious side effect. Statistical analysis revealed that the 90% confident intervals (CI) for the ratios between test and reference drugs of the log transformed the Cmax (0.8377-1.1985) and AUC0-t last (0.8610-1.1590), are within the Food and Drug Administration Guideline range of bioequivalence (0.80 to 1.25).Conclusions: It can be concluded that the 100 mg formulation of Test (Erec®) is bioequivalent to the Reference.Keywords: sildenafil, bioequivalence