Mahasarakham University

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.

This paper reports the employment of natural montmorillonite (Cloisite Na⁺) and sodium alginate (Alg) to fabricate sorbent beads and applied for extraction and preconcentration of carbamates (CBMs) based on micro-solid phase extraction (μ-SPE) method prior to analysis by ultraperformance liquid chromatography coupled with a photodiode array detector (UPLC-PDA). Cloisite Na⁺/Alg composite bead was synthesized by ionic gelation method using calcium chloride as a cross-linking agent at ambient temperature. The biocomposite sorbent bead was then characterized by various techniques, including scanning electron microscope (SEM), Fourier transform infrared spectroscopy (FTIR) and thermogravimetric analysis (TGA). The parameters affected the extraction efficiency were investigated and optimized. Based on the optimal extraction conditions, the method provided linearity in the range of 1.0-1000 μg L^-1, with determination coefficient greater than 0.99. The limits of detection ranged between 0.7 and 10 μ g L^-1 for all analytes. The relative standard deviation was less than 4.6 % and 6.2 % for intra-day and inter-days, respectively. Finally, the μ-SPE-UPLC-PDA method was successfully used to CBMs residue detection in food and environment samples. The percentage recoveries were found in the range of 70-117 %. Moreover, the result in real sample found that no residue of the studied carbamates was observed in sample studies. The application of greenness and blueness assessment tools (AES, AGREE, and BAGI) confirmed that μ-SPE can be considered a green chemistry method. The proposed investigated method offers advantages such as low cost, simplicity, reduced solvent consumption, and minimal environmental impact, making it a promising alternative to conventional methods for carbamate pesticides analysis.