Mahasarakham University

Pictograms are widely used in pharmacy practice to enhance patient understanding, especially in contexts where language or health literacy barriers exist. However, limited data are available on the comprehension of United States Pharmacopeia Convention: Drug Information for the Health Care Professional (USP-DI) pictograms among Thai undergraduate students. This study assessed the understanding of USP-DI pictograms and medication-use literacy, and explored factors associated with pictogram comprehension.

A cross-sectional survey using a structured questionnaire was conducted among 637 university students between August 2023 and April 2024. The Medication Use Literacy Test (MULT) assessed literacy, and the USP-DI pictogram comprehension test evaluated visual understanding. Binary logistic regression was used to identify factors associated with comprehension levels.

Among the 637 participants, the MULT revealed high literacy, with over 90% of questions answered correctly. The mean score for USP-DI pictogram comprehension was 21.82 ± 3.82. Students in health sciences programmes demonstrated the highest proficiency in both tests, followed by those in social sciences and science and technology programmes, with statistically significant differences (P < 0.05). Logistic regression analysis revealed that students aged >20 years had lower pictogram comprehension than younger students (odds ratio [OR] = 0.47; 95% confidence interval [CI]: 0.25-0.88; P = 0.02). Students with a Grade Point Average <3.00/4.00 (OR = 0.55; 95% CI: 0.32-0.96; P = 0.04) and those from non-health science faculties (OR = 0.04; 95% CI: 0.02-0.08; P < 0.001) also showed significantly lower comprehension levels.

This study highlights disparities in pictogram comprehension among Thai undergraduates and affirms the influence of academic discipline, age, and academic performance. The findings support the need for targeted educational strategies to enhance medication-use literacy and pictogram understanding.

TDF/3TC/DTG (TLD) has been adopted as the first-line therapy for all people with HIV according to the WHO 2019 and Thai HIV guidelines. As a result, people with HIV in Thailand on TDF/FTC/EFV are switched to TLD. However, increasing data demonstrate the efficacy and renal safety of the TDF-sparing dual therapy with DTG + 3TC compared with TDF-based combination ART (cART) as a switching therapy. A direct comparison of estimated glomerular filtration rates (eGFR) among people with HIV treated with TDF-based regimens who switch to TLD vs. DTG + 3TC is yet to be made.

We enrolled virologically suppressed people with HIV aged ≥18 years currently on TDF + FTC + EFV to either switch to TLD or DTG + 3TC at two tertiary care hospitals. The switching regimen was chosen at the physicians' discretion. The primary outcome was the change in eGFR, calculated by creatinine at 24 weeks. Secondary outcomes included changes in LDL, body weight, and BMI at 24 weeks.

Among 53 recruited participants, 28 and 15 completed the second follow-up in the TLD and DTG + 3TC groups, respectively. The mean age was higher in the TLD group compared to the DTG + 3TC group (Table 1). The median time from HIV diagnosis to switching was 8.5 years. The eGFR reduction was significantly greater in the TLD group than in the DTG + 3TC group: -17.24 ± 9.24 vs. -8.4 ± 9.03 mL/min/1.73 m² (p = 0.004). All participants in both groups achieved virological suppression. There was no significant change in CD4 counts between the two groups. Switching to DTG + 3TC was associated with a significantly smaller decline in eGFR post-switch (mean difference: 6.216 mL/min/1.73 m²; 95% CI 0.169-12.263; p = 0.044) compared to those who switched to TLD.

There was a significant reduction in eGFR among people with HIV who switched to TLD compared to those switched to DTG + 3TC. Changes in LDL and BMI were comparable between groups. Dual therapy with DTG + 3TC may be a preferred switching option over TLD for individuals with renal safety concerns. Further randomized prospective trials with longer follow-up are warranted to confirm these findings.

Ibuprofen and diclofenac are nonsteroidal anti-inflammatory drugs widely used worldwide. Spontaneous reporting often results in an underestimation of the incidence of adverse drug reactions (ADRs), and a few studies have been conducted in community settings, particularly in community pharmacies. This study aimed to determine the frequency and characteristics of short-term ADRs associated with ibuprofen and diclofenac in community pharmacy patients.

This prospective cohort study was conducted in 15 community pharmacies. A questionnaire from a previous study was modified and tested for content validity. Community pharmacists distributed the questionnaire after dispensing ibuprofen or diclofenac and followed non-responders via telephone and online media platforms. The returned questionnaires were assessed for causality by a pharmacist and three researchers. Descriptive analyses and comparisons between reports on ibuprofen and diclofenac were performed using chi-square and independent t-tests for appropriate outcomes.

Of the 590 distributed questionnaires, 279 were included in the analysis. The percentage of participants who reported ADRs to ibuprofen and diclofenac was 33.3%. Among participants with suspected ADRs, the average number of suspected ADRs from diclofenac was higher than from ibuprofen; however, no significant difference was observed (5.5 ± 8.9 and 3.1 ± 3.0, p > 0.05). Of the 347 self-reported ADRs, 45.2% were assessed as probable and possible ADRs. The highest rate of suspected ADRs was in Mental Health (14.4%), followed by the Nose, Throat, Neck, or Voice (9.8%), and the Stomach or Digestive Systems (8.9%), respectively.

Diclofenac showed more suspected ADRs than ibuprofen in a community setting. Almost half of the self-reported ADRs were assessed as probable or possible. Strategies for sustaining community pharmacists in monitoring patients and reporting ADRs should be supported.