Wednesday, January 28, 2015

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 4th and 6th 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 5th Cycle Birthday Anniversary 2nd April 2015.” One birth cycle is 12 years, which corresponds to the zodiac. Therefore, the 5th cycle means the beloved Princess is celebrating her 60th 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 6th 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! 

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