The Journal of Chulabhorn Royal Academy

Pharmacogenomics and the Treatment of Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitors (EGFR-TKIs)

Panudda Dechwongya — 2024-09-30

The mutation of the epidermal growth factor receptor (EGFR) on the surface of cells plays a crucial role in the growth, proliferation, and survival of various cancer cells. About half of non-small cell lung cancer (NSCLC) cases, particularly among Asian patients, have this mutation. Studies have demonstrated that treatment with targeted drugs that specifically inhibit EGFR is more effective than traditional chemotherapy. Therefore, EGFR tyrosine kinase inhibitors (EGFR-TKIs) have become the first-line treatment for NSCLC patients with EGFR mutations. However, genetic variability and different types of cancer cell mutations result in varying responses to EGFR-TKIs. Furthermore, genetic variations in normal body cells affect both pharmacodynamics and pharmacokinetics, influencing drug levels in the target cells and clinical response. This article discusses the importance of pharmacogenomics in treating patients with EGFR mutations using EGFR-TKIs. It covers the study of the relationship between genetic variations and drug response, pharmacodynamic and pharmacokinetic properties, factors affecting drug response, and the occurrence of adverse drug reactions.

Telemedicine for Patients with Advanced Cancer

Ruechuta Molek — 2024-09-30

Advanced cancer is a devastating disease that can cause various complications in different body systems. Patients with advanced cancer require sustained care to slow down the aggressive disease and relieve their symptoms. While high-tech medical interventions can provide support, they are often not sufficient to improve outcomes, as the death rate remains high. However, telemedicine has emerged as a promising solution to provide comprehensive and continuous care to these patients. By leveraging internet networks via digital technology, telemedicine enables patients to consult with specialists and multidisciplinary teams directly, covering all aspects of their care at the real-time fashion. Moreover, telemedicine can reduce unplanned hospital visits and readmission rates, alleviate overcrowding in hospitals, and save time and money while improving patient and caregiver satisfaction. Nonetheless, amidst the widespread adoption of telemedicine in clinical practice, all healthcare personnel must be aware of and adhere strictly to societal values, ethics, and professional etiquette.

A Path to Improving English Proficiency for Registered Nurses

Patcha Hortrakul — 2024-09-30

Nursing practice is a medical profession that maintains a close relationship with patients, often more so than other healthcare professions. In Thailand, which is emerging as a medical hub in Asia, nurses must possess skills, knowledge, and an understanding of English at an international level to optimize patient care for a diverse, global patient population.

However, due to Thailand’s historical independence from Western colonization, the emphasis on foreign language acquisition has been limited. Although English language courses with native speakers are available, their high cost restricts access and learning achievement, particularly for nurses in remote rural areas who often lack the opportunity and confidence to practice and improve their English communication skills.

Recognizing the ongoing challenges in English proficiency, this article explores advancements in teaching methodologies through digital technology innovations, such as computer-assisted instruction, online educational resources, and research databases. These tools not only reduce time and travel expenses while supporting social distancing measures but also empower nurses to engage in self-directed learning, consistently review lessons, retain knowledge, and build confidence. Ultimately, this approach enhances their ability to use English effectively in a professional healthcare setting, thereby improving the overall quality of patient care.

Development of Chitosan Patch Containing Herbal Extract from Traditional Thai Medicine Scripture

Ketchada Chotpool — 2024-09-30

Background: Herbal remedies with abscess-poultice properties are interesting to test for antibacterial activity and development in an easy-to-use form. Objectives: This study aimed to determine the chemical identity of the herbal remedy extract using Thin layer chromatography (TLC), tested for antibacterial activity against Staphylococcus aureus ATCC25923 and developed a chitosan patch containing an herbal extract. Methods: The remedy extract was prepared from 4 species, namely, Terminalia bellirica (Gaertn.) Roxb., Strychnos lucida R. Br., Sapindus rarak DC and Gloriosa superba Linn. All crude drugs were extracted with 95% ethanol by maceration method and then examined the TLC chemical identity with the mobile phase system; Toluene : Ethyl acetate : Methanol : Formic acid : Acetic acid (15 : 15 : 1 : 4 : 1) and evaluated for antibacterial activity with inhibition zone, MIC, and MBC methods. Results: TLC chemical identity testing revealed that the extract had a band with an hR_f at 55, matching the hR_f of Gallic acid standard. The S. aureus antibacterial activity testing showed an inhibition zone of 7.74±0.20 millimeters, MIC and MBC of 12.5 and 25 milligrams per milliliter, respectively. The study developed the best patch formula based on the evaluation of its properties. The best formula consists of 1.25 grams of chitosan, 10 grams of sorbitol, and the extract is mixed twice the MBC value, resulting in a patch with acceptable properties. Conclusions: Gallic acid is the principal compound in the remedy extract, which has antibacterial properties against S. aureus. The extract can be utilized to develop patches for further medical use.

Utility of 18F-FDG PET/CT Combined With Dedicated Brain PET/MRI in Determination Of Brain Metastasis From Lung Cancer

Supanida Mayurasakorn — 2024-10-17

Background and Purpose: Diagnosing brain metastasis is important in managing lung cancer. We compared ¹⁸F-FDG PET/CT combined with dedicated brain PET/MRI and ¹⁸F-FDG PET/CT alone in diagnosing brain metastasis from lung cancer and investigated the quantitative parameters affecting the positivity of PET scans. Methods: This study included 89 patients (age: 43–88 years; 58% men) with pathologically confirmed lung cancer who underwent whole-body ¹⁸F-FDG PET/CT and dedicated brain PET/MRI with gadolinium contrast enhancement. Imaging data acquired between October 2020 and February 2021 were retrospectively collected, and MRI findings were used as the reference standard for diagnosing brain metastasis. The detection of brain metastasis was compared between ¹⁸F-FDG PET/CT alone and ¹⁸F-FDG PET/CT combined with dedicated brain PET/MRI. Quantitative parameters were analyzed to determine factors affecting the positivity of the PET scan results. Correlations between these quantitative parameters were also examined. Results: Per-patient and per-lesion detection of brain metastasis on PET/CT alone versus that combined with dedicated brain PET/MRI with gadolinium contrast enhancement showed ratios of 0.64 and 0.17, respectively. Quantitative parameters with the highest areas under the curve from receiver operating characteristics analysis were the maximum tumor-to-background ratio and the size of the metastasis. The optimum maximum tumor-to-background ratio cut-off, with the highest area under the curve, for PET positivity was 1.83. The minimum and mean lesion sizes for detection on PET were 0.3 cm and 1.45 cm, respectively. Conclusions: PET/MRI can augment the detection of brain metastasis from lung cancer compared with PET/CT alone. High FDG background activity in the brain parenchyma may hinder the positivity of PET results. Therefore, MRI is important for detecting brain metastasis.