EVALUASI DOSIS DIGOKSIN PADA PASIEN GAGAL JANTUNG DENGAN DISFUNGSI GINJAL DI RSUP DR. SARDJITO, YOGYAKARTA

Digoksin merupakan salah satu obat dengan kisaran terapi sempit yang paling banyak digunakan terutama pada penyakit yang berhubungan dengan jantung. Penyesuaian dosis digoksin pada pasien yang mengalami penurunan fungsi ginjal mutlak dilakukan agar kadar obat di dalam darah tepat. Penelitian ini dilakukan untuk mengevaluasi dosis digoksin pad a pasien gagal jantung dengan disfungsi ginjal. Penelitian ini merupakan penelitian retrospektif sekaligus prospektif pada pasien gagal jantung dengan disfungsi ginjal di RSUP Dr. Sardjito Yogyakarta periode Januari 2010 - Maret 2011. Pengumpulan data dilakukan menggunakan rekam medik pasien rawat inap. Analisis data dilakukan secara deskriptif. Hasil analisis dari 43 kasus yang diperoleh, pasien laki-laki mempunyai persentase yang lebih besar dibanding pasien perempuan (56 % : 44 %). Persentase pasien berdasarkan kelompok usia terbanyak pada pasien 50 - 59 tahun sebanyak 34,88 %. Pada perhitungan dosis secara farmakokinetik ditemukan bahwa dosis digoksin yang digunakan oleh pasien ada yang melebihi kadar maksimum digoksin di dalam darah. Dari 19 pasien wanita, 11 pasien menggunakan dosis yang melebihi kadar maksimum digoksin sedangkan dari 24 pasien pria, 14 pasien menggunakan dosis yang melebihi kadar maksimum digoksin. Metode perhitungan dosis ini menggunakan data literatur khususnya untuk nilai parameter farmakokinetika s eperti volume distribusi, waktu paro eliminasi, dan kliren digoksin. Oleh sebab itu, besar dosis yang tepat seperti yang dianjurkan dalam tesis ini dapat dianggap sebagai nilai teoritis. Selanjutnya ditemukan juga pasien tidak mendapatkan dosis muatan digoksin yang sesuai. Namun oleh karena penggunaan dosis digoksin bersifat individual maka dari keseluruhan ditemukan bahwa outcome clinic pasien umumnya membaik. Digoxin is a medicine with narrow therapeutic index. Digoxin is widely used for heart failure treatment. Adjustment of digoxin dose is needed in patient with renal dysfunction. This research were done to evaluate digoxin dose in heart failure patient with renal dysfunction. This research was retrospective and prospective research, performed in Dr. Sardjito hospital during January 2010 to March 2011. Data were collected from patient medical record and then evaluated with descriptive method. From 43 patients, percentage men compare to women were 56 % : 44 %. Most patients come from age of 50 - 59 (34.88%). Dose calculation based on pharmacokinetic concept found that some of digoxin dose in patients were exceed digoxin therapeutic concentration. From 19 women patients there were 11 patients use digoxin dose exceed djgoxin therapeutic concentration when calculate by pharmacokinetic while from 24 men patients there were 14 patients use digoxin dose exceed digoxin therapeutic concentration when calculate by phannacokinetic. Dose recalculation method was mostly based on literature data particularly for pharmacokinetic parameter values i.e. volume distribution, half life, and clearance. Therefore, the corrected doses suggested in this thesis should be regarded as theoretical estimates. Furthermore, it was also found that patients did not get appropriate lomling dose of digoxin. However, drug dosing for digoxin were individual dose, therefore overall found that patient clinical outcome was generally better

PENGARUH VARIASI MEDIA QUENCHING HASIL PENGELASAN MIG (METAL INERT GAS) TERHADAP KEKERASAN DAN STRUKTUR MIKRO PADA ALUMINIUM 6061-T6

Aluminium merupakan logam yang memiliki banyak keunggulan. AL banyak digunakan untuk komponen kendaraan, tetapi banyak kendala dalam proses penyambungan. PWHT (Post Weld Heat Treatment) adalah salah satu cara yang banyak digunakan dalam pengerjaan logam. Penelitian ini ditujukan meneliti proses pengelasan Aluminium dengan treatment PWHT dan Quenching. pengelasan menggunakan metode Gas Metal Arc Welding (GMAW) dengan kampuh single V Butt Joint 60°, material diberi treatment PWHT dan Non-PWHT (sebagai pembanding). Temperatur 450°C pada furnance dan ditahan selama 1 jam selanjutnya dilakukan Quenching dengan media Air Mineral, Cairan Minyak Rem DOT3 dan Pasir. Hasil pengujian membuktikan bahwa proses Quenching dan PWHT sangat berpengaruh pada nilai kekerasan dan struktur mikro AL 6061. Pengujian kekerasan pada 3 area las yaitu yang pertama pada Weld Metal (WM) nilai kekerasan tertinggi dicapai dari media Quenching Pasir dengan nilai sebesar 82.67 HVN, dan nilai kekerasan terendah terdapat pada media Quenching Cairan Minyak Rem DOT3 sebesar 74.37 HVN. Yang kedua pada area Heat Affected Zone (HAZ) diperoleh nilai kekerasan tertinggi pada Quenching Cairan Minyak Rem DOT3 dengan nilai sebesar 81.30 HVN, kemudian nilai kekerasan terendah dari area HAZ terdapat pada Quenching Pasir sebesar 74.07 HVN. Ketiga pada area Base Metal (BM) diperoleh nilai kekerasan tertinggi pada Quenching Air dengan nilai kekerasan sebesar 87.63 HVN, sedangkan nilai kekerasan yang paling rendah pada BM yaitu terdapat pada media Quenching Pasir dengan nilai sebesar 86.17 HVN. Hasil dari struktur mikro memperlihatkan adanya struktur butir yang berbeda dari masing-masing media Quenching yang digunakan, material tanpa perlakuan PWHT memiliki struktur butir Al+Mg_2 Si yang lebih besar dibanding material yang di-PWHT serta di Quenching. Kata Kunci : Aluminium 6061, Pengelasan GMAW, Variasi Media Quenching, Kekerasan, Struktur Mikr

Literature-based discovery of diabetes- and ROS-related targets

Abstract Background Reactive oxygen species (ROS) are known mediators of cellular damage in multiple diseases including diabetic complications. Despite its importance, no comprehensive database is currently available for the genes associated with ROS. Methods We present ROS- and diabetes-related targets (genes/proteins) collected from the biomedical literature through a text mining technology. A web-based literature mining tool, SciMiner, was applied to 1,154 biomedical papers indexed with diabetes and ROS by PubMed to identify relevant targets. Over-represented targets in the ROS-diabetes literature were obtained through comparisons against randomly selected literature. The expression levels of nine genes, selected from the top ranked ROS-diabetes set, were measured in the dorsal root ganglia (DRG) of diabetic and non-diabetic DBA/2J mice in order to evaluate the biological relevance of literature-derived targets in the pathogenesis of diabetic neuropathy. Results SciMiner identified 1,026 ROS- and diabetes-related targets from the 1,154 biomedical papers (http://jdrf.neurology.med.umich.edu/ROSDiabetes/). Fifty-three targets were significantly over-represented in the ROS-diabetes literature compared to randomly selected literature. These over-represented targets included well-known members of the oxidative stress response including catalase, the NADPH oxidase family, and the superoxide dismutase family of proteins. Eight of the nine selected genes exhibited significant differential expression between diabetic and non-diabetic mice. For six genes, the direction of expression change in diabetes paralleled enhanced oxidative stress in the DRG. Conclusions Literature mining compiled ROS-diabetes related targets from the biomedical literature and led us to evaluate the biological relevance of selected targets in the pathogenesis of diabetic neuropathy.http://deepblue.lib.umich.edu/bitstream/2027.42/78315/1/1755-8794-3-49.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78315/2/1755-8794-3-49-S7.XLShttp://deepblue.lib.umich.edu/bitstream/2027.42/78315/3/1755-8794-3-49-S10.XLShttp://deepblue.lib.umich.edu/bitstream/2027.42/78315/4/1755-8794-3-49-S8.XLShttp://deepblue.lib.umich.edu/bitstream/2027.42/78315/5/1755-8794-3-49-S3.XLShttp://deepblue.lib.umich.edu/bitstream/2027.42/78315/6/1755-8794-3-49-S1.XLShttp://deepblue.lib.umich.edu/bitstream/2027.42/78315/7/1755-8794-3-49-S4.XLShttp://deepblue.lib.umich.edu/bitstream/2027.42/78315/8/1755-8794-3-49-S2.XLShttp://deepblue.lib.umich.edu/bitstream/2027.42/78315/9/1755-8794-3-49-S12.XLShttp://deepblue.lib.umich.edu/bitstream/2027.42/78315/10/1755-8794-3-49-S11.XLShttp://deepblue.lib.umich.edu/bitstream/2027.42/78315/11/1755-8794-3-49-S9.XLShttp://deepblue.lib.umich.edu/bitstream/2027.42/78315/12/1755-8794-3-49-S5.XLShttp://deepblue.lib.umich.edu/bitstream/2027.42/78315/13/1755-8794-3-49-S6.XLShttp://deepblue.lib.umich.edu/bitstream/2027.42/78315/14/1755-8794-3-49.pdfPeer Reviewe

Fall Detection Analysis Using a Real Fall Dataset

International Conference on Soft Computing Models in Industrial and Environmental Applications (13th. 2018. San Sebastián

Measurement of hepatic insulin sensitivity early after the bypass of the proximal small bowel in humans

Objective: Unlike gastric banding or sleeve gastrectomy procedures, intestinal bypass procedures, and the Roux-en-Y gastric bypass (RYGB) in particular, lead to rapid improvements in glycaemia early after surgery. The bypass of the proximal small bowel may have weight loss and even caloric restriction independent glucose-lowering properties on hepatic insulin sensitivity. In this first in humans mechanistic study, we examined this hypothesis by investigating the early effects of the duodeno-jejunal bypass liner (DJBL; GI Dynamics, USA) on the hepatic insulin sensitivity using the gold standard euglycaemic hyperinsulinaemic clamp methodology. Method: Seven patients with obesity underwent measurement of hepatic insulin sensitivity at baseline, one week after a low-calorie liquid diet and after a further one week following insertion of the DJBL whilst on the same diet. Results: DJBL did not improve the insulin sensitivity of hepatic glucose production (HGP) beyond the improvements achieved with caloric restriction. Conclusions: Caloric restriction may be the predominant driver of early increases in hepatic insulin sensitivity after the endoscopic bypass of the proximal small bowel. The same mechanism may be at play after RYGB and explain, at least in part, the rapid improvements in glycaemia

Screening of DUB activity and specificity by MALDI-TOF mass spectrometry

Deubiquitylases (DUBs) are key regulators of the ubiquitin system which cleave ubiquitin moieties from proteins and polyubiquitin chains. Several DUBs have been implicated in various diseases and are attractive drug targets. We have developed a sensitive and fast assay to quantify in vitro DUB enzyme activity using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry. Unlike other current assays, this method uses unmodified substrates, such as diubiquitin topoisomers. By analyzing 42 human DUBs against all diubiquitin topoisomers we provide an extensive characterization of DUB activity and specificity. Our results confirm the high specificity of many members of the OTU and JAMM DUB families and highlight that all USPs tested display low linkage selectivity. We also demonstrate that this assay can be deployed to assess the potency and specificity of DUB inhibitors by profiling 11 compounds against a panel of 32 DUBs

The association between balance and free-living physical activity in an older community-dwelling adult population: a systematic review and meta-analysis

Abstract Background Poor balance is associated with an increased risk of falling, disability and death in older populations. To better inform policies and help reduce the human and economic cost of falls, this novel review explores the effects of free-living physical activity on balance in older (50 years and over) healthy community-dwelling adults. Methods Search methods: CENTRAL, Bone, Joint and Muscle Trauma Group Specialised register and CDSR in the Cochrane Library, MEDLINE, EMBASE, CINAHL, PsychINFO, and AMED were searched from inception to 7th June 2016. Selection criteria: Intervention and observational studies investigating the effects of free-living PA on balance in healthy community-dwelling adults (50 years and older). Data extraction and analysis: Thirty studies were eligible for inclusion. Data extraction and risk of bias assessment were independently carried out by two review authors. Due to the variety of outcome measures used in studies, balance outcomes from observational studies were pooled as standardised mean differences or mean difference where appropriate and 95% confidence intervals, and outcomes from RCTs were synthesised using a best evidence approach. Results Limited evidence provided by a small number of RCTs, and evidence from observational studies of moderate methodological quality, suggest that free-living PA of between one and 21 years’ duration improves measures of balance in older healthy community-dwelling adults. Statistical analysis of observational studies found significant effects in favour of more active groups for neuromuscular measures such as gait speed; functionality using Timed Up and Go, Single Leg Stance, and Activities of Balance Confidence Scale; flexibility using the forward reach test; and strength using the isometric knee extension test and ultrasound. A significant effect was also observed for less active groups on a single sensory measure of balance, the knee joint repositioning test. Conclusion There is some evidence that free-living PA is effective in improving balance outcomes in older healthy adults, but future research should include higher quality studies that focus on a consensus of balance measures that are clinically relevant and explore the effects of free-living PA on balance over the longer-term

Predictors of well child care adherence over time in a cohort of urban Medicaid-eligible infants

<p>Abstract</p> <p>Background</p> <p>Changes in well child care (WCC) adherence over time have not previously been examined. Our objective is to describe adherence rates to WCC over time in a low-income urban population of infants 0-24 months of age, and to identify predictors of WCC adherence in this population.</p> <p>Methods</p> <p>This is a secondary analysis of a cohort of Medicaid-eligible children followed from birth to 2 years between 2005 and 2008 with structured telephone surveys to assess maternal well-being, social support, and household and demographic information. For the 260 children attending 4 urban pediatric practices, WCC adherence was assessed based on visit data abstracted from electronic medical records. A random-intercept mixed effects logit model clustered on subject was used.</p> <p>Results</p> <p>92% of the mothers were African-American, 27% had not finished high school, 87% were single, and 43% earned < $500/month; mean age was 23. WCC adherence decreased from 88% at 6 months to 47% (12 mo), 44% (18 mo), and 67% (24 mo). The difference across time periods was statistically significant (p < 0.001). Married (OR 1.71, p = 0.02) and primiparous (OR 1.89, p < 0.001) mothers had significantly greater odds of adherence, along with women who reported having been adherent to prenatal care visits (OR 1.49, p = 0.03) and those with the lowest household income (OR 1.40, p = 0.03).</p> <p>Conclusions</p> <p>Maternal education efforts should emphasize the importance of establishing WCC, especially for mothers of more than one child. Further studies using larger, more broadly defined populations are needed to confirm our findings that efforts to increase WCC adherence should be intensified after 6 months of age, particularly for children at higher risk.</p

Increased oxidative stress associated with the severity of the liver disease in various forms of hepatitis B virus infection

BACKGROUND: Oxidative stress can be defined as an increase in oxidants and/or a decrease in antioxidant capacity. There is limited information about the oxidative status in subjects with hepatitis B virus infection. We aimed to evaluate the oxidative status in patients with various clinical forms of chronic hepatitis B infection. METHODS: Seventy-six patients with hepatitis B virus infection, in whom 33 with chronic hepatitis, 31 inactive carriers and 12 with cirrhosis, and 16 healthy subjects were enrolled. Total antioxidant response and total peroxide level measurement, and calculation of oxidative stress index were performed in all participants. RESULTS: Total antioxidant response was significantly lower in cirrhotics than inactive HbsAg carriers and controls (p = 0.008 and p = 0.008, respectively). Total peroxide level and oxidative stress index was significantly higher in cirrhotic (p < 0.001, both) and chronic hepatitis B subjects (p < 0.001, both) than inactive HbsAg carriers and controls. Total antioxidant response was comparable in chronic hepatitis B subjects, inactive HbsAg carriers and controls (both, p > 0.05/6). Total peroxide level and oxidative stress index were also comparable in inactive HBsAg carriers and controls (both, p > 0.05/6). Serum alanine amino transferase level was positively correlated with total peroxide level and oxidative stress index only in chronic hepatitis B subjects (p = 0.002, r = 0.519 and p = 0.008, r = 0.453, respectively). CONCLUSION: Oxidative stress occurs secondarily to increased total lipid peroxidation and inadequate total antioxidant response and is related to severity of the disease and replication status of virus in hepatitis B infection

Exercise capacity in children with isolated congenital complete atrioventricular block: does pacing make a difference?

Item does not contain fulltextThe management of patients with isolated congenital complete atrioventricular block (CCAVB) has changed during the last decades. The current policy is to pace the majority of patients based on a variety of criteria, among which is limited exercise capacity. Data regarding exercise capacity in this population stems from previous publications reporting small case series of unpaced patients. Therefore, we have investigated the exercise capacity of a group of contemporary children with CCAVB. Sixteen children (mean age 11.5 +/- 4; seven boys, nine girls) with CCAVB were tested. In 13 patients, a median number of three pacemakers were implanted, whereas in three patients no pacemaker was given. All patients had an echocardiogram and completed a cardiopulmonary cycle exercise test. Exercise parameters were determined and compared with reference values obtained from healthy Dutch peers. The peak oxygen uptake/body mass was reduced to 34.4 +/- 9.5 ml kg(-1) min(-1) (79 +/- 24% of predicted) and the ventilatory threshold was reduced to 52 +/- 17% of peak oxygen uptake (78 +/- 21% of predicted), whereas the peak work load/body mass was 2.8 +/- 0.6 W/kg (91 +/- 24% of predicted), which was similar to controls. Importantly, 25% of the paced patients showed upper rate restriction by the pacemaker. In conclusion, children with CCAVB show a reduced peak oxygen uptake and ventilatory threshold, whereas they show normal peak work rates. This indicates that they generate more energy during exercise from anaerobic energy sources. Paced children with CCAVB do not perform better than unpaced children.1 april 201