มะม่วง [mango]

Our first day back in Bangkok was wonderful, but we greatly miss our friends at Mahasarakham University already. In our many moments of reminiscing lately, we realized we forgot to blog about one of the most hilarious stories we’ve ever heard! Our friend Prim told a story at our farewell dinner that had us rolling with laughter. Friday morning, she picked up ‘take-away’ pork and rice for breakfast at a local shop and was waiting to cross the street to meet with her research advisor when a monk came up and took her bag of breakfast, since he thought she was crossing the street to make merit by bringing the monk breakfast. Essentially, a monk stole her breakfast!! She had to go back to the store and buy herself another breakfast of pork and rice! As our Thai friends say, 555555.

Back to our life in Bangkok—we decided to name our first day back “Tiger Thursday” in honor of all the sleep we got (tigers sleep 18 hours a day) and the Auburn pharmily reunion we had!  After a long tiger snooze, we finally woke up at 11 AM. We opened the curtains to look out over our awesome view of the hustle and bustle of somewhat smoggy Bangkok while we enjoyed our morning coffee and Cliff Bar (yay America) breakfast in bed. After a few hours of catching up on emails and enjoying very hot showers, we ventured out into the city and found a little side street lined with street cart food vendors and hotels, and decided to pop into a café that had lots of English on the menu for a snack and free WiFi. This ended up being a great choice since our mid-afternoon food and drinks here were delicious. Megan had an amazing mango smoothie and Erin had an espresso frappe. We finally had our first sandwich since we have been in Thailand (over a month!). The cheesey, fresh tomato basil sandwich that we shared really hit the spot! We enjoyed spending the afternoon feeling like we truly lived in Bangkok, just sitting in the city catching up on things we needed to do!  

Breakfast in Bed/View from our Bangkok Hotel

Hanging out in the city for the afternoon

For dinner we met Dr. Kelli Johnson, a 1999 alumna of the Auburn University Harrison School of Pharmacy, at Outback Steakhouse in the Siam Discovery Mall. This was just a short walk away from our hotel. Dr. Johnson is currently a missionary in Bangkok and connected with us via email after seeing our blog posted on Facebook! This was by far the swankiest Outback to which we have ever been. It was on the 6^th floor of the mall and overlooked the house of one of the princesses of Thailand. The food didn’t have quite the same taste as Outback in America, but it was still wonderful to have some steak and potatoes! It was fun to have a War Eagle moment and hear about Dr. Johnson’s pharmacy career in pediatric oncology (a potential interest area for Erin and Megan) and her role as a missionary first in Bolivia and now in Bangkok for the past 2 years working to help women in the sex industry. She is an incredible example of faithfulness to God’s direction for your life! Dr. Johnson was also very gracious and interested in our adventure across Thailand, pharmacy school experience, and pharmacy career plans. We talked together over dinner for almost 4 hours! Being a part of the Auburn family truly is a gift and we are very thankful to have had the opportunity to meet Dr. Johnson!

Dr. Kelli Johnson, HSOP 1999

On Friday morning we woke, grabbed breakfast at the hotel, and ventured on the BTS Skytrain to Bumrungrad International Hospital to learn about their pharmacy practices. We were very excited to see this private hospital where they have several medications that are not available or can only be prescribed by specialists in other areas of Thailand – like carvedilol (Erin’s favorite beta-blocker!). This hospital facility and pharmacy practices were phenomenal and very impressive. Bumrungrad International Hospital is Thailand’s first Joint Commission International Accredited Hospital and serves over 1.1 million patients a year, 520,000 of which are international patients. The facilities include 580 inpatient beds and a 12-story outpatient clinic building providing world-class care to 5,500 patients each day. We met one of the hospital pharmacists, Mr. Pat, in the main hospital lobby, which was 2 floors and elegantly decorated with floral arrangements, an incredible gift shop, and familiar restaurants like Au Bon Pain (brought back meal plan memories for us from our Auburn undergraduate days) and Starbucks.

Main Hospital Building

Lobby

Mr. Pat lead us first to the IPD (inpatient pharmacy department) where pharmacists transcribe and verify orders that are written by physicians and scanned into the computer system and also check the prepared medications before they are sent to patient care units (called wards). This was an impressive area that had a robotic dispensing machine, the Swisslog PillPick System for tablets and a few injectables, as well as an area where sterile preparation was preformed. An IV compounding area for chemotherapy agents was on a separate floor. The IPD utilized the tube system for sending medications to the floor throughout the day and prepared medication carts every evening with medications that patients would need for the next day. There are also two pharmacists responsible for medication reconciliation located in the IPD. The medication reconciliation process at Bumrungrad consists of nurses conducting medication reconciliation by interviewing the patient when they arrive to their room and scanning their findings to the medication reconciliation pharmacists, who then compare to hospital records. This is a newer service that the pharmacy department is offering and a huge area that pharmacists in hospitals across the United States are seeking to be involved in to improve patient care. The IPD pharmacists also participate in the adverse drug reaction (ADR) monitoring, which involves one pharmacist visiting the patient when an ADR is reported to assess whether this event was truly related to a medication. Then the pharmacists contacts the physician, records the findings and a drug allergy alert in the patient chart.  

Automation/Informatics in Action

Inpatient Pharmacy Department

After seeing the IPD, Mr. Pat dropped us off for the next part of the morning at the office of the Pharmacy Practice Specialists (clinical pharmacists) responsible for therapeutic drug monitoring (TDM) and discharge counseling (DC). Ms. Sasiluk provided us with a PowerPoint presentation on their TDM service, which has been offered since 2003. As part of the TDM, two pharmacists work as part of a team with physicians and the laboratory specialists to evaluate the 20 to 30 patients a day who are receiving vancomycin and the aminoglycosides amikacin and gentamicin, as these antibiotics require accurate dosing and careful monitoring. Physicians can also consult the TDM service for other medications such as the anticonvulsants valproic acid and phenytoin.  Each morning the pharmacists utilize a drug monitoring worksheet for each patient and then in the afternoon complete rounds on the wards. We also discussed how these pharmacists make their interventions to physicians and learned that this is similar to practice in the United States where they call the physician to discuss the recommendation, or speak to the face-to-face, or leave a pharmacy note in the patient’s chart. The pharmacists feel that this service works well to decrease adverse drug reactions and maximize efficacy and patient outcomes, but the only downside is that this is not a 24-hour service, as they do not have enough staff to provide such coverage.

Inpatient Pharmacy Consulting Area

PK Monitoring Form

Next we discussed the discharge counseling service. One pharmacy practice specialist is responsible each day for going to specific patients’ bedsides to dispense and counsel the patients on all medications the patient will be taking when they are sent home from the hospital. This service is provided to patients who are receiving anticoagulants (warfarin, apixiban, dabigitran, rivaroxaban) and patients with diabetes mellitus, chronic kidney disease or were admitted for an MI, stroke, or underwent a transplant (mainly kidney tranplants). A nurse can also make a request for other patients and the pharmacist leaves a slip in patients chart to request that the nurse alert them before a patient is sent home. The pharmacist shared that because this is an international hospital, they see patients from all over the world and often the biggest challenge is having an interpreter available who is able to help convey the information to the patient and his/her family. All in all this seemed like a very well run service!

Outside the Outpatient Pharmacy and DI Center in the Main Hospital Building

The Pharmacy Practice Specialist then led us to one of the four ICUs within the hospital. Bumrungrad has 3 adult ICUs, 1 CCU (cardiac care), 1 PICU, and a Level III NICU. There is a satellite pharmacy within one of the adult ICUs, where a pharmacist and technician enter and verify all orders for the ICUs and have stock medication for stat orders. There are two Pharmacy Practice Specialists that remain in ICU 1 and 2 and participate in the interdisciplinary care of these patients. We also learned that there is a satellite pharmacy within the Emergency Department, where a pharmacist is responsible for dispensing activities and assessing adverse drug events. This was the first healthcare facility in Thailand that we have heard of having a satellite pharmacy in the ER and ICU.   

   

Then it was time to walk over to the Outpatient Clinic Building, where we meet with the pharmacist conducting the Anticoagulation Clinic located on the Cardiac floor. A physician refers patients to this clinic and the pharmacist sees about 4 to 10 patients a day and is on call 24 hours a day. This reminded us a lot of the pharmacist-run anticoagulation clinic we have seen within the Veterans Affairs Health System in the United States. The patients taking warfarin (brand name Orafin in Thailand) first come and have their INR taken by a CoaguChek point-of-care INR device at the lab or check on their home CoaguChek and call in to the pharmacist if they are international. The pharmacist then completes a patient assessment of their knowledge of their medication (a pre-test) and then provides patient education and completes a post-test to track the patients understanding. Then the pharmacist is able to adjust the patient’s warfarin based on a protocol and provides each patient with a guidebook and warfarin alert card for the patient to carry. It was interesting to learn that the largest problem pharmacists face at this clinic is patients who have drug interactions with the herbal products so prevalent in Thai and Chinese medicine (ginseng, garlic, ginkho biloba) causing supratherapeutic INR levels.  

Our next visit was to the Medication Therapy Management service within the OPD (outpatient pharmacy department) in the Outpatient Clinic Building. The MTM pharmacist provides education, compliance assessment, and collaborates to resolve any drug-related problems to patients seen at the outpatient clinics who have diabetes mellitus, chronic kidney disease, or take more than 10 medications daily. The pharmacist typically sees at least 10 patients a day and documents all finding on an interdisciplinary note within the patient’s chart. This MTM service was awarded 1^st Prize for Outstanding Poster in 2011 at the International Pharmaceutical Federation for research on the correlation between improvement in patient knowledge and adherence and interaction with an MTM pharmacist.    

Outpatient Building waiting area

Outpatient clinic building

Outpatient clinics

Our last visit of the day was to the Drug Information Center (DIC) located within the Outpatient Pharmacy in the main hospital building. This was a busy time of day and we were thankful the pharmacist took a few minutes to speak to us. The DIC is open for 9AM to 7PM daily and the one pharmacist receives 40 to 50 questions a day via email or phone calls from patients and healthcare staff. The DIC has a 95% success rate of completing a response to a question within 15 minutes. We were impressed! The DIC records each request on a Drug Information Request/Response form in the computer and uses familiar resources to answer their questions such as Lexicomp, Micromedex, and Trissel’s Handbook of Injectable Drugs. We were curious to know where they get information about Thai Traditional Medicines and learned that Mahidol University has a website database for traditional medicines. 

It was wonderful to see the advanced clinical services the pharmacists at Bumrungrad provide. Plus, we adored their smart pharmacist uniforms with teal skirts or dresses and well tailored, embroidered white jackets! It was also neat to learn that pharmacists do not require any additional training prior to obtaining a position at Bumrungrad. They are simply partnered with a senior pharmacist who trains them in their respected area for several months upon starting the job. Also, the pharmacists rotate days of providing dispensing services and clinical services in any area they are trained in. This seems like a great place to practice pharmacy!

On our way back towards the BTS Skytrain from Bumrungrad, we spotted some mango with sticky rice (with the added bonus of coconut milk and peanuts) from a street cart and couldn’t resist! It was so delicious as always, and we felt like such residents of Bangkok when we stopped to eat this on little seats outside the Siam Square shopping area after exiting the Skytrain. When we got to our hotel to take an afternoon break, we decided to eat some substantial food and tried the club sandwich which had intrigued us since our first stay in Bangkok, since one of the ingredients was called red oak. We discovered red oak is a mushroom and loved this chicken sandwich! We were both excited for the surprise slice of avocado on the sandwich too and realized how badly we miss Chipotle.

Just two girls in the big city

In the afternoon we saw our first drops of rain since being in Thailand through our hotel window. The weather has been hot and muggy the past two days, so hopefully this rain will bring us a beautiful day tomorrow for our day-trip we have planned to Ayutthaya. This is the ancient capital of the kingdom of Thailand, also know as the “Venice of the East” in the 1700s. Since we are in the shopping mecca of Bangkok, close to MBK, Siam Square, Siam Centre, and Siam Paragon, we decided to see if we could find a fun new outfit for our tour.  Megan was able to find a great maxi skirt on sale at Workshop in Siam Centre, so we will both be politely dressed for the temples tomorrow. Then we walked over to Siam Paragon, where the more high-end stores are (i.e. Louis Vutton, Maserati cars, Hermes, etc.) We spotted an adorable, fancy teashop called TWG Tea Boutique and the menu had our mouth watering. Erin is an avid tea lover, so we treated ourselves to the most wonderful tea and dessert for dinner! TWG had an extensive and descriptive Tea Book that accompanied the menu. (Note: Erin is a huge nerd and loved pouring over these pages, learning all about the different kinds of tea. If anyone wants to buy it for her...Hi Mom and Dad...she wouldn't complain). For our wonderful and girly teatime, Erin opted for a pot of blue tea called Jasmine Oolong and Megan had a blend of green and blue tea from Thailand called the Secret of Siam. Both were fabulous and we enjoyed tea infused mango crumble, which was served with a wonderful mango and tea ice cream, as well as split 4 melt-in-your mouth macaroons! After a little more window-shopping we headed back home.  We’re excited to pop a bag of popcorn and catch up on the latest episode of Greys Anatomy and fall asleep dreaming of our delicious tea!  

"A reminiscent delight, this alluring tart is filled with fresh mango wedges and a light coconut cream infused with Vanilla Bourbon Tea topped with crumble biscuit and served with a scoop of Alfonso Tea ice cream."

Macaroons!!

Purple: Grand Wedding Tea, Passion Fruit, and Coconut

Black: Napoleon Tea and Caramel

Blue: Vanilla Bourbon Tea and Kaya

Pink: Bain de Roses Tea

Update upon posting blog: Sadly, even though we can access ABC online through the Auburn VPN, the Internet connection isn’t strong enough to load the video. No one spoil this episode for us please!!! 

เคมี [chemistry]

It was good to be back “home” at our dorm in Marasarakham after our weekend vacation in Chiang Mai. However, it felt so strange spending Monday night alone here! Walking past rooms 201 and 202 just wasn’t the same with Hannah and Camellia gone to Bangkok, and Risa and Airi home in Japan. We miss our exchange student friends and are so grateful for the time we spent together. Hopefully we can plan a trip to Japan one day, and we look forward to seeing Hannah and Camellia back in America on the residency interview trail!

After we unpacked and settled into the condo, we realized the MSU Internet server was down and we did not know our plan for Tuesday yet! Luckily, Erin had written down the phone numbers for Beauty and Tony just in case. We had quite the nighttime adventure at the dorm searching for a Thai phone to borrow. Finally, a sweet girl lent us her cell and we were able to call Tony to figure out the plan. We think we surprised him because he wasn’t ready to think/speak in English over the phone! It is amazing how since we have been here, all potentially stressful situations end up in laughter instead. It is fun to have to think outside of the box a little as well to overcome these small hiccups! 

The lack of Internet was a blessing in disguise; with the inability to work on projects or Facebook, we went to sleep at a decent hour and got almost a full 8 hours of rest! We woke up Tuesday morning, made some coffee, and prepared for our patient case presentations. We also finished writing thank you notes and wrapping our Auburn themed gifts for our teachers, the Dean, and all of our hosts and hostesses. We couldn’t wait to give them out later…we both love gifting and think that is a special part of the culture here. No words or gifts can truly express how grateful we are for this experience, but we are glad to be able to do a little something for them!

We enjoyed walking to school in the always-perfect weather, and arrived a little earlier than our teachers and student friends. Tuesday was Interview Day at the University, where all high school students who have passed their exams come for admissions interviews. The traffic was heavy and campus was bustling! It was fun to just sit in the Faculty of Pharmacy and watch all of the action around us. We also saw some of our 4^th and 6^th year friends in the hallway, which was a pleasant surprise! Our presentations ended up being rescheduled to the afternoon due to the hectic morning schedule with interviews and classes, so we journeyed to one of our favorite local coffee shops, Chompoo, for breakfast and some free WiFi. It was relaxing and fun to sit around with Beauty, Fern, Best, and Tony…it kind of felt like an afternoon in the library at Auburn! Upon leaving the coffee shop, we ate lunch (garlic chicken and rice) at a really nice outdoor restaurant where we had the pleasant surprise of running into Tina. We are both really going to miss constantly being outside.

After lunch we returned our bikes to the campus bike shop. We were in business skirts for our presentations, so Tony and Best actually returned our bikes and we rode with Fern in the car to pick them up…we truly have the best hosts and hostess in the entire world! We then rode back to the Faculty of Pharmacy on the backs of the boys’ motorcycles and felt like such Thai students!! This was Megan’s first time on a motorcycle and we are glad we had this authentic experience before leaving!

In the afternoon, we gave our patient case presentations to Ajarn Pattarian, Fern, Mint, Best and Tony. Erin’s clinical question, whether thromboembolism primary prophylaxis for patients with nephrotic syndrome is safe and efficacious, pertained to an ambulatory care patient she had seen on her Kirklin ClinicChronic Kidney Disease rotation. Megan’s clinical question, whether vaptan agents are safe and efficacious therapy for hyponatremia in cirrhosis patients, pertained to an acute care patient she had seen on her Internal Medicine rotation. We enjoyed giving these presentations, both for the opportunity to revisit some clinical concepts and primary literature analysis, and for the chance to teach our Thai hosts and hostesses. It is extremely rewarding to teach them, as they are very receptive and eager students! They are all also SO smart and it is obvious how much they care about learning. One of the greatest compliments we have received so far on this trip is that they think we are good teachers. Little do they know, it is a learning experience for us as well! We have to truly evaluate the words we choose and the best way to convey concepts. Our 30-minute patient presentations took a combined three hours to present because we took additional time to truly explain what we do as American pharmacy students and why we do it. We also explained certain concepts of the medical record, such as acronyms they don’t use in Thailand (PERRLA, CTAB) and drugs that aren’t available in their country (Xifaxan). After we would introduce a new or difficult concept, Ajarn Pattarin would explain/teach the students in Thai as well. Not only did these presentations help us focus on language and our ability to teach, but it also made us critically evaluate our own presentations to see how far we have come since we first gave them on our early rotations, and the best ways to approach patient care. We agreed that in America and Thailand there should be more focus on incorporating primary literature analysis and journal clubs into the curriculum earlier. We also realized that both healthcare systems have a more acute focus—if a patient presents with liver failure, doctors in the hospital are not always going to assess if his diabetes is managed appropriately at home. We agree that in both healthcare systems, the pharmacist can provide comprehensive disease management and have a role in transitions of care to prevent hospitalizations and enhance primary care access.

After the presentations, we presented Ajarn Pattarin with gifts for all of our professors. We gave the Dean an Auburn water bottle, and our three professors Auburn pens and notepads. We also wrote everyone notes to express our heartfelt thanks. In turn, she gave us adorable elephant-patterned makeup bags and mirrors. We were so surprised because the entire Faculty of Pharmacy has done more than enough for us over the past month, and these sweet gifts were the icing on the cake of a fabulous exchange program.

We felt a little sad when we left our school classroom for the last time Tuesday night. Tony and Best took us back to the condo on their motorcycles so we could change and get together our presents for our hosts and hostesses. Then, we journeyed to talla noi for one last adventure in ordering food using our Thai language from our favorite Pad Thai lady and Pla Thong Koe (delicious dough with pandan sauce) man. 

We were joined by all 10 of our friends, and it was an absolutely perfect going-away dinner. We were so happy they loved their gifts (Auburn water bottles for the boys, Auburn pens/notepads and elephant keychains for the girls and thank-you notes for all). We were also astonished at the incredible generosity we received with parting gifts from each host and hostess. In no particular order, our amazing friends gave us:

• ·       Elephant slippers from Champ, Toy and Honey
• ·       Picture boxes from Prim
• ·       Elephant money purses from Fern
• ·       Black Forest Cake from Beauty
• ·       Calendars/Planners from Honey
• ·       Pictures and animal keychains from Boss
• ·       A wooden canvas portrait of our mountain sunset group picture from Tony, Best, Tina
• ·       Snacks and flower candles from Mint
• ·       Sweet notes, candy, tea from Airi and Risa
• ·       Mug, pens, notepad, and notes from Hannah and Camellia

The only thing that kept us from crying is the sense that we will absolutely return at some point to this incredible country and see these wonderful individuals again. To cap off a perfect night, we drove to the edge of campus and took a picture by the main Mahasarakham University sign. You know we love a good picture, and especially one so similar to our infamous “picture by the Auburn sign” moments at home! Best even taught some other students who were around the area how to take panoramic photo on his phone so that we could capture the entire sign and so that all of us could be in the picture!

Not ready to completely say goodbye yet, we went back to the Red Cross Festival with Tina, Best, and Tony on a mission to get Mahasarakham University t-shirts. We were so excited when we found pretty teal ones that have our University name written in Thai on them and a picture of a bicycle. Truly the perfect souvenir! We tried a new snack tonight: oreo-flavored creamy icees with sprinkles. A unique spin on the American milkshake! It was an awesome night wandering around the fair, discussing more English and Thai phrases (note: we discovered pleasure and pressure are another difficult distinction for them…those tricky R’s and L’s!), and exploring the games. We were super disappointed when we were told we were too big to ride the carousel and decided to leave at that point to go to a Vietnamese restaurant nearby, because Tina still needed to eat dinner.

Leaving the fair provided us with our last random moment of joy with our sweet friends. As we walked up to Tina’s car, we realized a truck had completely parked her in and there was no way she could back out of the spot. Within a minute, eight parking attendants came to our rescue and immediately started trying to help. Eventually, the solution to the problem was having all eight men physically pick up Tina’s car and move it so that we could drive out of the spot! It was such a random, hilarious, and memorable moment…but we realized these are pretty typical during our Thailand days :)

Before we went home for the night, the boys helped us print our boarding passes (thank you!!) and we had the added bonus of seeing Peanut one last time so he could give us gifts to bring back to Jessica and Zach. He also surprised us with notes and keychains from his recent trip to Singapore! We are so grateful we had the chance to meet him and become his friend as well…he even said goodbye wearing his Auburn t-shirt! Saying our goodbye to Tina was very difficult, but we know we will see her soon as well. There is nothing this awesome girl can’t do if she puts her mind to it, and we have no doubt she’ll be making a trip to America in the future!

It didn’t really sink it that it was our last night in the condo until we woke up the next morning. Packing went pretty smoothly because we never really unpacked from our trip to Chiang Mai….oops/yay?! If we haven’t made it clear how great our friends are - Tony set 7 alarms to ensure he was back at our condo at 6:30 AM to say goodbye to us this morning AND he brought us our favorite breakfast (fried dough with pandan sauce)!! All of the others came too, and it was so wonderful to see everyone one last time, exchange many warm hugs, and of course take many pictures!

After our sad goodbyes, we hopped in the school van around 6:45 AM with Boss and Beauty to travel to Khon Kaen for the 1st International Conference on Herbal and Traditional Medicine (HTM 2015). Of course our hour-long journey to Khon Kaen would not be complete without a quick stop at Café Amazon for some take away espresso frappes!

The conference was hosted at the Pullman Khon Kaen Raja Orchid Hotel, which was quite luxurious and built in the shape of a traditional Isan music instrument! We checked-in upon arrival, got our nametags, and hung the presentation poster of our Mahasarakham University professors. The poster hall was set up exactly like an American pharmacy conference. There will be 45 posters and 22 oral presentations over the course of this three-day conference. There was also an exhibit hall of sorts set up near the registration area, where different researchers and Universities sold their herbal products. Attendees from over 10 countries, 11 international guest speakers, and a total of around 200 participants were present. Dean Juntip Kanjanasilp and acting President of MSU Dr. Supachai Samappito gave speeches during the opening ceremony. We learned that this conference is a collaboration of four Faculties of Pharmacy, with Mahasarakham University serving as the major host! The other Faculties include Khon Kaen University, Ubon Ratchatani University, and Prince of Songkla University. The goal of the conference is to “share and exchange knowledge and experiences to improve the research area focusing on the development of producing effective and safe herbal and traditional medicines for mankind.” The key areas for research include extraction, formulation, synthesizing and purifying herbal compounds for medical use. It was very unique to hear about local wisdom and gain greater understanding of the synergy of traditional and western medicinal practice in Thailand. This conference also wins the prize for coolest complimentary gift—they put all programs and paperwork in adorable handmade cloth elephant bags!

Throughout the day we sat with Boss and Beauty in the large conference hall and listened to several keynote presentations, as well as oral presentations. An interesting fact we learned, due to sign at the conference, is that 2015 is the year of  “The celebrations on the Auspicious Occasion of Her Royal Highness Princess Naha Chakri Sirindhorn’s 5^th Cycle Birthday Anniversary 2^nd April 2015.” One birth cycle is 12 years, which corresponds to the zodiac. Therefore, the 5^th cycle means the beloved Princess is celebrating her 60^th birthday in April! Educational and promotional events throughout Thailand will honor her all year long. This princess is one of four children of the king—three daughters and one son. She is the most loved because of her unfaltering dedication to Thailand.   

The first keynote presentation, “Library-based Discovery of Bioactive Natural Products—From Screening to Medicinal Chemistry,” was given by Dr. Matthias Hamburger, the Head of the Institute of Pharmaceutical Biology at the University of Basel in Switzerland. His work focuses on the prioritization of active extracts of herbal compounds and provides preliminary SAR information for these compounds. His lab utilizes HPLC-based activity to engage in compound profiling in combination with library based screening to best utilize valuable, expensive resources for identifying new compounds. Using this method, his lab has identified compounds that modulate GABAa receptors, have antiprotozoal activity, and activity against the HIV virus. They can identify versions of chemical structures that have more “pharmacological promiscuity,” or that are non-selective in nature and act on multiple receptors. By identify these structures, the researchers can extract the purest and cleanest form of the chemical compound to be used for medicinal purposes. He also spoke to us about the big picture of discovery, which starts with a chemical “hit” and transforms into a lead, and eventually a clinical discovery! The general process involves extracting a chemical, using HPLC to separating the microfractions (activity profiling), running bioassays and mass spec to determine structural information, and then utilizing the library system of more than 3,000 plant and fungal extracts to run a database search to assess for duplication and identification of compounds. This results in hits and leads that eventually lead to new chemical compounds. It was very cool to gain insight into the drug discovery process!

The second keynote presentation, “Multifunction of Saffron and its Components in Brain,” was given by Dr. Yukihiro Shoyama from the Department of Pharmacognosy at the Faculty of Pharmaceutical Science of Nagasaki International University in Japan. It was fascinating to learn about the many pharmacological aspects of saffron, including its anti-tumor/cancer, anti-lipid, antiplatelet properties. The compound is mostly studied and published in the areas of anti-blood stasis activity, treatment of mild to moderate Alzheimer’s Disease, and its sleep-promoting ability. It leads to improvement in learning, memory, and liver function. Saffron can even decrease the volume of cerebral infarcts! The plant contains over 150 compounds and is the most expensive spice in the world; one kilogram in a Japanese market costs $8,300 USD! One compound contained in the plant, picrocrocin, is responsible for the flavor. The major medical component of saffron is crocin (also the pigment responsible for the deep red color), which is extracted from the pistle of the Crocus sativus flower. Iran produces 90% of the world’s saffron and ships it to manufacturing plants. In 1903, Japan developed a new method to cultivate the crocin from saffron, which involves treating the plant in hypoxic conditions to best retain chemical activity. They have been utilizing this for over 100 years to perfect herbal medicines. The main work of Dr. Shoyama’s department is to incorporate crocin into the PC-12 neuronal cells of the brain. This blocks GSH from activating the nSMAse component of the neuronal cell wall. Once activated, ceramide is formed, which leads to JNK and caspase-3 formation, resulting in neuronal cell death. When crocin blocks the GSH activation of nSMase by increasing the activity of gluthathione reductase, there is no production of ceramide and the cell survives! They have proven less memory and learning errors in mice that are treated with crocin. They believe this herb also enhances long-term potentiation in the hippocampus region of the brain, and suppresses locomotor activity to enhance sleep. Antiproliferative in vitro activity against cancer cells has been exhibited as well. Interestingly enough, Dr. Shoyama’s lab is also working to develop a monoclonal antibody to use AGAINST naturally occurring bioactive compounds such as crocin.

After the first two presentations, we had a fabulous Thai buffet lunch break. The hotel restaurant was very fancy and the four of us felt really special to be included in the Conference! We are among the only students present. We enjoyed discussing the national pharmacy exam that the 6^th year pharmacy students take before graduating and learning even more Thai phrases over lunch from Beauty and Boss. Even at such an elegant buffet, the sticky rice was served in the traditional woven baskets of Isan culture. We love seeing the blend of tradition and modern—just like we are learning about incorporating traditional with Western medicine! (Note: there is also hot coffee and tea available, a conference staple that is executed exceptionally in Thailand).

After lunch, the third keynote presentation, “Preparation of Alpha-Mangostin Rich Extract Using Green Extraction Concept,” was given by Dr. Pharkphoom Panichayupakaranant from the Faculty of Pharmaceutical Sciences at Prince of Songkia University in Thailand. His research involves extracting xanthones (alpha-mangostin) from the Garcinia mangostana L. plant and the focus on pure extraction. This compound is traditionally used for skin infections, wounds, dysentery, and diarrhea. It has anti-inflammatory, antibacterial, antifungal, antiviral, anti allergy, antioxidant, and antitumor properties. Pure extracts have greater efficacy and stability than crude extracts, but involve many purification steps that unfortunately have a very low yield and high cost. To engage in green, or a more pure form of extraction there are six main principles: renewable resources, by-products, reduce unit operations, reduce energy consumption, biodegradable, and discover alternative, non-toxic solvents.  Boss’ research mentor presented this speaker with his gift at the end of the presentation, which was fun for him and us to see!

The fourth keynote presentation, “Medicinal Plant Biotechnology for Yield Improvement of Bioactive Secondary Products,” was given by Dr. Wanchai De-Eknamkui from the Department of Pharmacognosy and Pharmaceutical Sciences at Chulalongkorm University in Thailand. This presentation focused on the successful cases of plant engineering to produce biopharmaceuticals and small chemical molecules (terpenoids). Terpenoids are the largest group of natural compounds that have biological activity and are used for the treatment of human diseases.  Plant engineering is the idea that you can custom design a green plant to product a desired product and yield a plant that functions independently as a small biofactory for medicine/bioactive compounds. They use agrobacterium, a gram-negative rod, to incorporate bacterial genes into the plant genome to create “transgenic plants” for biopharmaceutical production. For small chemical molecules or terpenoids, they manipulate the two main metabolic pathways of plants, the mevalonic acid pathway and the MEP pathway, to produce terpenoids of interest. The mevalonic acid pathway is the same pathway in humans that synthesizes cholesterol, which we block by using statins! The most important example of this engineering is how they created Golden Rice, or a rice plant that produces beta-carotene. Beta-carotene is a precursor of vitamin A, and vitamin A deficiency is a huge problem for children and women of child-bearing age worldwide. By incorporating this vitamin into their main dietary staple, these herbal companies are able to address international health problems.

The remainder of the afternoon consisted of the opportunity to explore the poster session and listen to various oral presentations on individual research topics. The oral presentations, given by graduate students and professors, were each 15 minutes long to provide a brief background of their research and an explanation of the results. These were fascinating—it was a very new learning experience to hear about how chemical compounds are extracted from plants and manipulated for medicinal use. The presenters were also from all over the world, hailing from countries like Egypt, The Philippines, India, and of course Thailand. We had to leave the conference at 4:00 PM to head to Khon Kaen airport and catch our flight to Bangkok, so we unfortunately missed the Welcome Dinner. We flew Air Asia for our brief 50 minute flight, which went smoothly since we know now to pre-print our boarding passes and pre-pay for our total baggage weight. Luckily the max amount on Air Asia is 40 kg per person, and they assess weight by the combined total of your bags rather than per individual bag. Therefore, packing for Bangkok was quite easy but we’re a little nervous that our Chiang Mai shopping excursion will make packing for America a bit of a challenge! Also, as a note for future travelers, we preferred Nok Air to Air Asia for flying domestically, but if you know the rules of Air Asia both airlines are easy to navigate. All-in-all airports in Thailand are way less stressful than in America and we are grateful that all of our domestic flights have gone smoothly.

After a metered taxi ride from Don Mueang Airport to our hotel later, we were officially back in Bangkok. Traveler reminder from earlier posts: ensure the taxi drivers run the meter and that they start the meter at only 35 Baht!! It is illegal for them to start the meter higher or refuse to run the meter! Also remember that if you take the freeway, you have to pay around 75-100 Baht in tolls. We decided to again stay at the Hotel Ibis near Siam Center for our last week in Bangkok since we had such a pleasant experience with this hotel earlier in our trip. It is relatively affordable ($50/night!), and we are familiar with the area. You just can’t beat the proximity to the BTS station and the shopping, either! It is weird and a little sad to be settling in for the last portion of this amazing journey, but we are excited to be back in Bangkok and ready to work in the International Hospital and Community Pharmacy here! We will post about these experiences later in the week, but for now we are going to enjoy the accessible WiFi and hot shower of our quaint hotel. Goodnight!