Currently, Indonesia is in the 5th rank of the highest tuberculosis prevalence over the world. The treatment of tuberculosis is going complicated due to the side effect experienced by the patients. The four combination of antituberculosis agent used in minimally 6 months of treatment could stimulate the hepatotoxicity as the one of the dominant side effect in tuberculosis treatment. Thus, it is important to do the Therapeutic Drug Monitoring (TDM) to optimize the tuberculosis treatment. This study is aimed to validate the TDM of pyrazinamide in human plasma using High Performance Liquid Chromatography-UV. We recruited 6 TB patients in the validation of pyrazinamide study. The C18 column shim-pack VP-ODS (250 mm x 4.6 mm, id 5 µm) and aquabidest-acetonitrile as mobile phase were applied in this study. We used Shimadzu HPLC system with a model AT LC20 LC 10AT pump, detector SPD 20A and LC solution software. We performed the analysis for linearity, system appropriateness, accuracy and recovery to develop the validation method. This study has been approved by National Ethics Committee of Health Research. Our study shows that the linearity is good with value of r2> 0.99 and the equation y = 16740.876x - 2953.615. The CV TR and CV peak area for system suitability are 1.46% and 0.29%, respectively. The LoD and LoQ value are 2.532 and 7.672 µg/mL, respectively. The accuracy on the concentration of 1.00, 8.00, 60.00 ug/ml are 108.80 %, 92.57 % and 100.98 %, respectively for intraday accuracy and 103.18 %, 92.44%, and 94.94%, respectively for interday accuracy. Furthermore, the precision on the concentration of 1.00, 8.00, 60.00 ug/ml are 1.17%, 3.57%, 3.32%, respectively for intraday precision and 3.66%, 1.37% and 1.59%, respectively for interday precision. In conclusion, the method which we applied in this study was sensitive and reliable for routine TDM of pyrazinamide.
Due to the nature of the disease, end-stage renal disease (ESRD) patients suffer from dysfunction of the adaptive immune system, which leads to a poorer response to vaccination. Accordingly, it is crucial to evaluate the efficacy and safety of management strategies, including vaccinations, which could potentially reduce the risk of respiratory diseases, such as pneumonia, influenza, or COVID-19, and its associated outcomes. We searched PubMed, CENTRAL, ScienceDirect, Scopus, ProQuest, and Google Scholar databases using designated MeSH keywords. The risk of bias was assessed using ROBINS-I. The quality of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Relative risk (RR) and 95% confidence interval (CI) were calculated. Heterogeneity was investigated using forest plots and I 2 statistics. This systematic review included a total of 48 studies, with 13 studies of influenza (H1N1 and H3N2) vaccination and 35 studies of COVID-19 vaccination. H1N1 vaccination in ESRD patients undergoing hemodialysis induced lower seroconversion rates (RR 0.62, 95% CI: 0.56–0.68, p <0.00001) and lower seroprotection rates (RR 0.76, 95% CI: 0.70–0.83, p <0.00001) compared to controls. H3N2 vaccination in ESRD patients undergoing hemodialysis yielded lower seroconversion rates (RR 0.76, 95% CI: 0.68–0.85, p <0.00001) and lower seroprotection rates (RR 0.84, 95% CI: 0.77–0.90, p <0.00001) compared to controls. Twenty-nine studies demonstrate significantly lower antibody levels in ESRD patients undergoing hemodialysis compared to the controls following COVID-19 vaccination. This review presents evidence of lower seroconversion and seroprotection rates after vaccination against viral respiratory diseases in patients with ESRD undergoing hemodialysis. Since hemodialysis patients are more susceptible to infection and severe disease progression, a weakened yet substantial serological response can be considered adequate to recommend vaccination against respiratory diseases in this population. Vaccination dose, schedule, or strategy adjustments should be considered in stable ESRD patients on maintenance hemodialysis. Trial registration: Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021255983 , identifier: CRD42021255983 .
Latar belakang: Penggunaan nevirapine (NVP) dan efavirenz (EFV) sebagai basis terapi antiretroviral memiliki efikasi klinis yang sama, namun berbeda efikasi virologi. Kedua obat tersebut dinyatakan mampu menekan jumlah virus dan meningkatkan jumlah CD4 pada pasien terinfeksi HIV, namun tidak diketahui manakah dari kedua obat tersebut yang memiliki respon imunologi yang lebih baik untuk meningkatkan jumlah CD4. Penelitian ini membandingkan respon peningkatan jumlah CD4 menggunakan terapi antiretroviral (ART) berbasis NVP dan EFV pada pasien terinfeksi HIV. Metode: Penelitian dengan desain retrospective cohort study. Data penelitian diperoleh dari rekam medis pasien terinfeksi HIV di RSUD Dr. Haji Moch. Ansari Saleh Banjarmasin, dari Desember 2004 sampai Januari 2015. Pasien dianalisis adalah pasien yang memenuhi kriteria inklusi dan eksklusi yang telah ditetapkan. Dilakukan pengukuran peningkatan jumlah CD4 ≥25%. Hasil: Seratus limabelas pasien (115) memenuhi kriteria inklusi dan eksklusi, terbagi atas 66 pasien menerima ART berbasis NVP (47 pasien mengalami peningkatan CD4 ≥25%, 1 pasien meninggal dunia), dan 49 pasien menerima ART berbasis EFV (33 pasien mengalami peningkatan jumlah CD4 ≥25%). RR ART berbasis NVP terhadap ARV berbasis EFV adalah 1,08 (CI 95% 0,85-1,38; p>0,05). Rerata peningkatan CD4 dari baseline pada masing-masing kelompok berbeda signifikan (p 0,05). Waktu yang dibutuhkan untuk meningkatkan jumlah CD4 ≥25% adalah 12 bulan setelah terapi menggunakan basis NVP (CI 95% 6,62-17,38), dan 11 bulan setelah terapi menggunakan basis EFV (CI 95% 8,50-13,50). Tidak terdapat perbedaan bermakna pada waktu yang dibutuhkan meningkatkan jumlah CD4 ≥25% (p>0,05). Kesimpulan: Baik penggunaan ART berbasis NVP, ataupun berbasis EFV mampu meningkatkan jumlah CD4 dari baseline secara siginifikan, namun tidak terdapat perbedaan peningkatan rerata jumlah CD4 secara bermakna antara kedua kelompok basis terapi ARV.
It was estimated that patients with ischemic stroke and post-stroke cognitive impairment (PSCI) have been increasing. In addition, this PSCI is often late diagnosed when it has already developed into post-stroke dementia. Only a few studies have developed a scoring system of predictor factors cognitive impairment (CI) for post-acute ischemic stroke in Indonesia. This study aimed to develop a scoring system of predictor factors of CI for post-stroke ischemic patients. The patients included were >18 years old diagnosed with acute ischemic stroke who underwent mini-mental state examination (MMSE) and clock drawing test (CDT) examination on day-30 at Bethesda Hospital Yogyakarta. It was retrospective cohort study design and samples were obtained from the stroke registry and medical records. Patients who had a history of CI and incomplete medical records were excluded. The results of MSSE and CDT at day-30 were the outcomes of this study. To evaluate the relationship between the independent variable and the dependent variable, chi-squared tests were perforemd followed by multivariate logistic regression analysis with Hosmer-Lemeshow tests with backward likelihood-ratio (LR) method and by assessing the final area under the curve (AUC) model. The final model was transformed into a scoring system to determine the value of probability prediction of PSCI, the optimal cut-off point, the sensitivity value and specificity value of the cognitive impairment scoring system at day-30 after acute ischemic stroke. A total of 140 subjects were included in the study with an average age of 62.8 years, 86 (61.4%) males and 54 (38.6%) females. Ninety-one subjects (65%) experienced post-stroke CI. The multivariate analysis showed age >70 years, education level ≤6 years, modified ranking score (mRS) >3 at diagnosis, Barthel index score ≤4 at diagnosis, the number of multiple lesions and the location of lesion in the cortex were independent predictor factors affecting CI 30 days after acute ischemic stroke. The developed predictor score obtained AUC discrimination value of 82.6% (95%CI:0.757-0.896) and calibration value of p>0.366. The scoring system had a value range of 0-7, and with a cut-off ≥1, it had a sensitivity value of 86.8% and a specificity value of 59.2%. It can be concluded that the predictor score has a good performance in predicting the occurrence of PSCI at day-30 after acute ischemic stroke.
Rotavirus diarrhea causing gastroenteritis in children under five years is an important issue that urgently needs to be addressed globally. Delay in management of rotavirus diarrhea can be fatal. Diagnostic tool for detecting rotavirus is, therefore, needed. However, until now the gold standard diagnostic tools are expensive, often not available and affordable in health care settings. The aim of the study was to compare the Vesikari clinical severity score of rotavirus-positive with rotavirus-negative in hospitalized children with acute gastroenteritis. Furthermore, the difference of the level of treatment between rotavirus-positive with rotavirus-negative was also evaluated. This was a cross sectional study that using secondary data from medical records of five general teaching hospital in Indonesia. Subjects were children aged <5 years with acute watery diarrhea admitted to the hospital. Statistical analysis used was chi square test, U-Mann Whitney, and Kruskal Wallis. The results showed that the patient with rotavirus positive have higher dehydration (80.2%) compared to rotavirus negative (70%). The severity level of clinical feature was higher in diarrhea due to rotavirus positive than non rotavirus (11.47± 2.89 vs 10.41 ± 2.70; p<0.000). The level of treatment was higher in rotavirus positive. The majority had treatment plan C (47.7%) higher than plan B and A (45.6% and 30.9%; p<0.050). This was opposite with patient with rotavirus negative that majority had treatment in plan A (69.1%) higher than plan B and C (54.4% and 52.3%) (p<0.001). In conclusion, the severity of gastroentrities in children under 5 years using vesikari score are higher in diarrhea due to rotavirus positive than non rotavirus. The treatment level plan C is higher than plan B and A in diarrhea due to rotavirus. This is opposite with non rotavirus majority have treatment in plan A higher than plan B and C.
Abstract Inflammatory response in COVID-19 contributes greatly to disease severity. Mesenchymal Stem Cells (MSCs) have the potential to alleviate inflammation and reduce mortality and length of stay in COVID-19 patients. We investigated the safety and effectiveness of normoxic-allogenic umbilical cord (NA-UC)-MSCs as an adjunctive treatment in severe COVID-19 patients. A double-blind, multicentric, randomized, placebo-controlled trial involving severe COVID-19 patients was performed from January–June 2021 in three major hospitals across Java, Indonesia. Eligible participants (n = 42) were randomly assigned to two groups (1:1), namely the intervention (n = 21) and control (n = 21) groups. Either NA-UC-MSCs or NaCl placebo were administered daily. The primary outcome was the duration of hospitalization. Meanwhile, the secondary outcomes were radiographical progression (Brixia score), respiratory and oxygenation parameters, and inflammatory markers, in addition to the safety profile of NA-UC-MSCs. NA-UC-MSC administration did not affect the length of hospital stay of severe COVID-19 patients, nor did it improve the Brixia score or mMRC dyspnoea scale better than placebo. Nevertheless, NA-UC-MSCs led to a better recuperation in oxygenation index (120.80 ± 72.70 baseline vs 309.63 ± 319.30 D + 22, p = 0.038) and oxygen saturation (97.24 ± 4.10% vs 96.19 ± 3.75% in placebo, p = 0.028). Additionally, compared to the placebo group, the treatment group had a significantly smaller increase in PCT level at D + 22 (1.43 vs. 12.76, p = 0.011). No adverse effects, including serious ones, were recorded until D + 91. NA-UC-MSC therapy is a very safe adjunct for COVID-19 patients. It improves the oxygenation profile and carries potential to suppress inflammation.
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
Aim To evaluate the effect of a letter intervention that was send to both the participants of a population screening and their general practitioners. We also tested what predicting variables influenced the GP to actually prescribe blood pressure lowering drugs (BPLD) or lipid lowering drugs (LLD). Method The study design was cross sectional, in the PREVEND outpatient clinic in Groningen University Hospital, the Netherlands. We used the clinical data of the 8592 subjects that participated in the first screening of the PREVEND study. Data on drug use was collected from community pharmacies. Drug use was measured the year before and after the screening with the subsequent intervention letter. As control population without intervention, we used the data from the InterAction DataBase (IADB) standardized for the population characteristics of the intervention group. The letter intervention was sent to participants who had shown after screening to have either an elevated blood pressure or plasma cholesterol, and the letter contained the advice to use a BPLD or LLD. Main outcome measures were proportion of patients prescribed BPLD and/or LLD in the year before and after the intervention, and variables that influence the GP to prescribe BPLD and LLD. Results Data from the community pharmacy were available from 7567 (88%) subjects. 397 participants (5.2%) received a letter with advice to start a BPLD, and 326 participants (4.3%) received a letter with advice to start a LLD. The prevalence of patients who were using BPLD and LLD before the intervention was not significantly different between the intervention and control group, 16.6 (CI 95% 15.8 –17.5) vs 16.0 and 4.8 (4.4–5.3) vs 4.6, respectively. After the letter intervention, the prevalence of BPLD use was higher in the intervention group compared with the control group (19.4 [18, 5–20, 3] vs 17.0%), as was the prevalence of LLD use (7.1[6.5–7.7) vs 5.4%). The same held true for the incidence of BPLD (3.4[3.0–3.8] vs 2.5%) and LLD use (2.1 [1, 6–2, 4] vs 1.0%), respectively, in the year after the intervention. Univariate and multivariate analysis showed that a higher blood pressure and cholesterol level, but not the presence of other cardiovascular risk factors, were associated to with a greater percentage use of a BPLD and a LLD. Conclusion A population survey followed by a letter of intervention to both the patient and GP are effective to improve the use of blood pressure and lipid lowering drugs as a primary prevention in patients with hypertension and hyperlipidemia. Our therapeutic advice however, was followed only in about one of the three subjects with hypertension and one of the four subjects with hyperlipidemia. The levels of blood pressure and plasma total cholesterol are important variables influencing the GP to prescribe a BPLD and/or LLD.
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