The pharmacokinetics of diclofenac after a single oral dose (50 mg) were studied in 10 healthy adults on two occasions separated by 2 weeks, once in the morning (dose administered at 07.00 h) and once in the evening (dose at 19.00 h). Peak serum drug concentrations as well as the area under the drug concentration-time curve were significantly less during the night compared with the day (Cmax: 1886 +/- s.d 901 vs 2791 +/- 1565 ng ml-1 and AUC: 2807 +/- 1376 vs 3681 +/- 1986 ng ml-1 h). However, the time to reach peak concentration (tmax) and the half-life of diclofenac (t1/2) were not significantly different on the two occasions. We suggest that the extent of diclofenac absorption is slightly lower following administration in the evening compared with administration in the morning.
Late stage breast cancer presents with malignant wound causing skin infiltration, pain, bleeding, and malodour, which affect quality of life (QoL). Palliative mastectomy aims to eliminate wound symptoms and requires prolonged wound care to improve QoL. This study aimed to prospectively investigate QoL differences in 2 alternative reconstructive methods: keystone flap and rotational flap.Twenty-four late stage breast cancer patients with symptoms of cancer wounds were included in this study. They were divided into 2 groups: keystone flap and rotational flap. Each patient's QoL was evaluated using EORTC QLQ-C30 and QLQ-BR23 before and 3 weeks after surgery.Global health post-surgery was significantly improved compared with pre-surgery in all patients (P < 0.001), across both the keystone (P = 0.018) and rotational groups (P = 0.007). Breast symptoms post-surgery were also improved compared with pre-surgery in all patients (P = 0.035). However, when analyzed per group, breast symptoms were only improved significantly in the keystone group (P = 0.013) but not in the rotational group (P = 0.575). When compared between 2 groups, future perspective post-surgery in the keystone group [100 (0-100)] was better than the rotational group [66.7 (0-100)], (P = 0.020).Reconstructive surgery after mastectomy improves QoL in late stage breast cancer patients. The keystone flap is superior to the rotational flap in improving global health and breast symptoms.
Background: This study was to investigate the effect of long term use of Renin-Angiotensin-Aldosterone System(RAAS) blocking agents on the incidence of Contrast-Induced Nephropathy(CIN) on patients with Diabetes Mellitus(DM) and renal insufficiency underwent Percutaneous Coronary Intervention (PCI).
Methods:A total 281 of subjects were included in this study and divided into two groups based on prior use of RAAS blocking agents (RAAS +, n = 146; RAAS -, n = 135). CIN was defined as an increase of ≥25% in creatinin over baseline value 48-72 hours after PCI.
Result: Total incidence of CIN was 14,95%. There was no difference in the incidence of CIN between 2 study groups (p = 0,952) and relatif risk for CIN was 1,02. Left Ventricular ejection Fraction (LVEF) ≤ 40 % (OR 2,300; 95% CI 1,028 – 5,143; p = 0,043), anemia (OR 2,628; 95% CI 1,274 – 5,422; p = 0,009) and Glomerular Filtration rate (GFR) pre PCI ≤ 60 mL/menit (OR 2,782; 95% CI 1,293 – 5,987; p = 0,009) were important predictors of CIN.
Conclusion: Long term use of RAAS blocking agents do not increase the incidence of CIN on patients with DM and renal insufficiency underwent PCI.
Latar belakang. Prosedur aman pemberian obat (medication safety practice/MSP), khususnya kemoterapi, dari sudut pandangmanajemen sangat penting dikaji dengan harap luaran yang lebih baik pada pasien kanker anak.Tujuan. Mengetahui pemahaman perawat terhadap MSP pada pemberian kemoterapi untuk pasien kanker anak dengan LLA diRSUP Dr. SardjitoMetode. Dilakukan penelitian dengan rancang bangun pra dan pasca kuasi eksperimental. Subjek adalah perawat yang melakukanpelayanan pasien kanker anak. Intervensi berupa sosialisasi kebijakan, buku panduan, dan pelatihan MSP. Diukur luaran tingkatpemahaman perawat sebelum dan sesudah intervensi dengan menggunakan kuesioner.Hasil. Tidak ada perbedaan karakteristik subjek (24 pra dan 23 pasca intervensi). Dibandingkan pra intervensi, pada pasca intervensididapatkan peningkatan jumlah perawat yang mendapat materi MSP (82% vs 46%, p=0,027), pemahaman MSP (87% vs 42%),dan implementasi MSP (100% vs 71%, p=0,019). Pasca intervensi juga didapatkan peningkatan tindakan identifikasi pasien, prinsip6 benar cara pemberian obat, perencanaan pemberian dan peresepan kemoterapi sesuai protokol, penggunaan formulir pemesanandan peresepan obat kempoterapi yang standar, dan labelisasi obat kemoterapi yang standar.Kesimpulan. Pemahaman perawat mengenai MSP meningkat setelah dilakukan pelatihan dan sosialisasi buku pedoman. ImplementasiMSP mengalami peningkatan di beberapa jenis tindakan, namun masih diperlukan peningkatan pemahaman khususnya pengertianMSP dan jenis tindakan MSP. Diperlukan metoda pelatihan yang lebih spesifik untuk meningkatkan pemahaman MSP khususnyaperawat.
Objective: This systematic review and meta-analysis was performed to determine the protective effect of omega-3fatty acids in fish consumption against breast cancer in Asian patients. Methods: The authors conducted a meta-analysisof published research articles on protective effect of omega-3 fatty acids in fish consumption against breast cancer inAsian patients published between January 2000 and July 2018 in online database of PubMed, ProQuest and EBSCO.Pooled odds ratios (OR) were calculated by using fixed and random-effect models. Publication bias was visuallyevaluated by using funnel plots and statistically assessed in Egger's and Begg's tests. Data were processed by ReviewManager 5.3 (RevMan 5.3) and Stata version 14.2 (Stata Corporation). Results: This study reviewed 913 articles.There were 11 studies which conducted systematic review then continued by meta-analysis of relevant data with totalnumber of samples were 130,365 patients. The results showed there was protective effect of omega-3 fatty acids in fishconsumption against breast cancer in Asian patients (OR = 0.80 [95% CI 0.73-0.87, p <0.00001]). There was not anystudy with significant publication bias included. Conclusion: This analysis confirmed the protective effect of omega-3fatty acids in fish consumption against breast cancer in Asian patients.
Suatu penelitian intervensi analitik telah dilakukan dengan tujuan untuk mengevaluasi cost-effectiveness terapi pasien rawat jalan hipertensi di empat rumah sakit (RS) di Kota Yogyakarta. Penelitian dilakukan dengan metode grafik scatter-plot; aksis-X dan aksis-Y menunjukkan selisih tekanan darah (TD) dan biaya antar kelompok. Pemberian umpan balik TD diberikan kepada dokter spesialis perlakuan sebanyak empat kali setelah informed consent, sementara dokter kontrol menjalani terapi secara alamiah. Pasien dari dokter subjek >18tahun, menerima antihipertensi, Askes *, ≥4 kali kunjungan, dan ≥1 kali TD sistolik (TDS) ≥140mmHg diikutkan penelitian. Data terapi, TD, dan biaya terapi pasien dikumpulkan selama 8 bulan secara prospektif sejak intervensi pertama dari catatan medik pasien dan klaim pembayaran RS kepada Askes. Seluruh biaya terkait hipertensi dan kardiovaskular dengan perspektif RS diikutkan analisis. Data diperoleh dari rekam medik dan klaim biaya terapi oleh RS kepada PT. Askes. Hipotesis: proporsi pasien di kuadran kanan grafik mencapai ≥90%. Kuadran kanan menunjukkan TDS perlakuan lebih baik. Hasil penelitian menunjukkan pasien perlakuan (n=379) dan kontrol (n=266) tidak berbeda bermakna untuk umur, jender, TD, dan jumlah antihipertensi. Pasien perlakuan memiliki TD diastolik lebih baik, biaya antihipertensi per kunjungan lebih tinggi (p<0,05) tetapi sama untuk obat kardiovaskular serta biaya total (p>0,05). Proporsi pasien kuadran kanan sebesar 56,2%. Analisis subgrup pada perempuan, tanpa umur 80–90tahun, TDS final≤160mmHg, rerata TDS ≤150mmHg, dan antihipertensi 1–3 item diperoleh proporsi kuadran kanan 66,9% tetapi belum mencapai 90%. Pemberian umpan balik TD kepada dokter meningkatkan proporsi pasien di kuadran kanan meskipun belum mencapai proporsi yang diharapkan. *Askes pada saat sekarang ini sudah berubah menjadi Jaminan Kesehatan Nasional oleh BPJS Kata kunci: Biaya terapi, cost-effectiveness, hipertensi, umpan balik tekanan darah kepada dokter The Effect of Blood Pressure Feedback Intervention to Doctors on the Change of the Hypertensive Patient Therapy Cost An analytical intervention study has been done with the aim to evaluate the therapy cost-effectiveness among the hypertensive ambulatory patients at four hospitals in Yogyakarta city. The study was done with the scatter-plot method; x-axis and y-axis were for the difference of blood pressure and therapy cost between groups respectively. Blood pressure feedback intervention was delivered monthly for four times to the specialists in the intervention group since the informed-consent approval. The control specialists preceded the natural practice. The included patients were the specialist’s subjects with the following criteria: >18 years, “Askes” -insured, ≥4 visits, and ≥1 visit with systolic blood pressure (SBP) ≥140mmHg. The medication profile, BP level, and therapy cost profile were collected prospectively for eight months since the first intervention from medical record and the hospital claim to Askes. All hypertensive and cardiovascular therapy cost with the hospital perspective were included in the analysis. Hypothesis: the patient proportion in the right quadrants of the graph reached ≥90%. The right quadrants of graph indicated lower mean SBP of intervention group. The result showed that the intervention (n=379) and control (n=266) groups were similar for age, gender, BP, and items of antihypertensive medicine. The intervention group had only improved diastolic BP and higher antihypertensive medicine cost (p<0.05), but similar for cardiovascular medicine and the total therapy cost (p>0.05). Patients in the right quadrant were 56.2%. Sub-group analysis for female only, without 80–90 years, final SBP ≤160mmHg, and mean ≤150mmHg, and 1–3 antihypertensive items resulted 66.9% of right-quadrant patients but it was lower than 90%. Feedback intervention improved the proportion of patients in the right-quadrants of the graph though it was lower than the expected proportion. Keywords: Blood pressure feedback to physicians, cost effectiveness analysis, cost of therapy, hypertension
Background: Breast cancer is the most common cancer type in women not only in world but also in Malays ethnicity between Malaysia and Indonesia. Breast cancer has varying incidence in every country, but genetic factor by family history influence the incidence of breast cancer. This systematic review and meta-analysis was performed to determine family history of breast cancer and breast cancer risk between Malays ethnicity in Malaysia and Indonesia. Methods: This meta-analysis was conducted on published research articles on family history of breast cancer and breast cancer risk between Malays ethnicity in Malaysia and Indonesia published between Jan 1999 and Jul 2018 in the online article databases of PubMed, ProQuest and EBSCO. Pooled odds ratios (OR) were calculated with fixed and random-effect models. Publication bias was visually evaluated by using funnel plots and statistically assessed through Egger’s and Begg’s tests. Data were processed using Review Manager 5.3 (RevMan 5.3) and Stata version 14.2 (Stata Corporation). Conclusion: This analysis confirmed the association of family history of breast cancer and breast cancer risk between Malays ethnicity in Malaysia and Indonesia.
BACKGROUND: Dry socket is the most common post-operative complication following a dental extraction and one of the most studied complications in dentistry. Many researchers have attempted to find a successful method for its primary prevention. However, this area remains controversial as no single method has gained universal acceptance. Therefore, secondary prevention of this case is still needed to prevent the continuing effects of dry sockets and other complications resulting from inadequate dry socket treatment. One of the most common treatments of dry socket is a combination of butyl aminobenzoate, eugenol, and iodoform. The presence of this medicament in a healing socket also has been shown to cause a foreign body reaction, delayed healing, and prolonged pain.
AIM: The objective of the study was to compare the treatment results of dressing with a combination of butyl aminobenzoate, eugenol, and iodoform and other treatments for dry socket regarding the result of pain’s relief and healing of sockets.
METHODS: Searches were conducted in the following electronic databases: PubMed, ProQuest, and EBSCO. The inclusion criteria were randomized controlled trial with a minimum of 10 patients, published from 2009 to 2019, and written in English. The exclusion criteria were case reports and non-human studies.
RESULTS: Ten articles were found in an initial search, of which six were selected for a systematic review. Alternative treatment identified included zinc oxide eugenol (ZOE), a combination of polymyxin B sulfate, tyrothricin, neomycin sulfate, tetracaine hydrochloride, freeze-dried pledget containing acemannan hydrogel, plasma rich in growth factors, and low-level laser therapy, Er:Cr:YSGG, and laser diodes.
CONCLUSION: All treatments included in the review have the aim to relief the patient’s pain. Given the heterogeneity of interventions and the type of measurement scale, the results are difficult to compare. The combination of butyl aminobenzoate, eugenol, and iodoform is superior compared to ZOE for pain relief and socket healing. For socket healing and pain relief from the 2nd day after the extraction, it appears that several alternative treatments are superior to the combination of butyl aminobenzoate, eugenol, and iodoform.
