HUBUNGAN FAKTOR KOMORBIDITAS, INTENSIFIKASI TERAPI, DAN PENGENDALIAN TEKANAN DARAH

Abstract: Background: Therapy intensification (TI) is the most important factor in bloodpressure control among the adherent patients. The TI is the physician prescription behavior toadd the item(s) and/or the dosage of hypertensive medicine when the patients' BP was ?10mmHgabove the target. Comorbid patients have 10mmHg lower BP target. Aims: to evaluate the effectof comorbidity on TI score and blood pressure control; and to correlate the variables of TI and BPcontrol. Method: retrospective cohort study done in 4 hospitals in Yogyakarta for 5 months. Thesubjects of age 18 years, hypertensive out-patient covered with Askes insurance, and ?1 visitwith uncontrolled BP were included. Hemodialysis subjects were excluded. Subjects weregrouped into with/without comorbid. The BP profile was analyzed with T-test, repeatedmeasurement Anova, and odds ratio. Results: subjects consisted of without (WO) (n=268) vs.with comorbid (W) (n=401) patients. Comorbid subjects had older age, more male proportionand more visits (p0.05). The profiles of final SBP/DBP in WO vs. W subjects were as follow:148.9/89.1 (WO) vs. 143.8/86.1mmHg (W) (p0.05); TI score (-) 0.360.26 (WO) vs. (-)0.380.24 (W) (p0.05); the final SBP: worse BP control 20.9 (WO) vs.16.2% (W), notcontrolled in all visits 38.1 vs. 45.9%, improved 17.5 vs. 23.9%, and good controlled in all visit23.5 vs.13.2%; proportion of subjects reached BP target 40.7% (WO) vs. 37.4% (W) (p0.05);the different of final minus target SBP: (-)9.018.5 vs. (-)13.917.4mmHg (p0.05); correlationbetween TI and variables of SBP (p0.05) with the coefficient (r) at 0.4-0.6 (medium).Conclusion: comorbidity had no effect on TI score; but subjects with comorbid had worse BPcontrol (p0.05); TI score correlated in medium level with SBP.Keywords: Comorbidity Factor, Therapy Intensification, Blood Pressure Contro

THE EFFECT OF THE BLOOD PRESSURE FEEDBACK INTERVENTION TO PHYSICIANS ON THE IMPROVEMENT OF THE BLOOD PRESSURE CONTROL

The study aimed to assess the effect of the blood pressure (BP) feedback intervention to physicians on the improvement of the blood pressure control of hypertension subjects. The study was done with controlled repeated intervention design. The adult hypertensive non-hemodialysis subjects from 4 Indonesian hospitals were included as intervention and control subjects. Outcomes were measured as the improvement of systolic BP (SBP). The subjects in intervention (n=385) vs. non-intervention (n=271) groups had similar age and proportion of males (p>0.05); proportion of cardiovascular comorbid 78.7% vs. 91.5% (p<0.01) and the baseline SBP at 144.1±15.8 vs. 139.6±13.8mmHg (p<0.01). The final SBP 138.2±17.2 vs.140.6±15.4mmHg (adjusted p<0.01); the difference between (∆) final-baseline SBP: 5.9±20.3 vs. (-)0.9±20.0mmHg (adjusted p<0.01); ∆final-target SBP: (-)6.1±17.3 vs.                     (-)9.6±15.5 (adjusted p<0.01). There were more intervention subjects with good controlled final SBP; odds ratio (OR) 1.4(CI95%:1.0-1.9, adjusted p<0.05). Based on the ∆final-baseline SBP, the ∆final-target SBP, and OR SBP reached the target; theintervention subjects had significant SBP improvement

Pharmacogenetics of isoniazid-induced hepatotoxicity

Tuberculosis is still a major problem in some developed and developing countries. The poor compliance to the treatment of tuberculosis patients due to the adverse events was supposed to be an important factor contributing to the high prevalence. This review aims to clarify the role and the pharmacological mechanism of the genes involved in the isoniazid-induced hepatotoxicity. We selected English articles of studies in human from PubMed up to May 2014 with the keywords pharmacogenetic, isoniazid and hepatotoxicity, N-acetyl transferase 2 (NAT2), CYP2E1 and glutathione S transferase (GST). Polymorphisms of NAT2, CYP2E1 and GST1 could increase patients’ susceptibility to isoniazid-induced hepatotoxicity. The rapid acetylators of NAT2 and rapid metabolizers of CYP2E1 showed increased concentrations of hepatotoxic metabolites. However, the rapid metabolizers of GST1 could decrease the concentration of hepatotoxic metabolites. Some studies of human leukocyte antigen ( HLA) , Uridine 50-dippho-spho (UDP) glucuronosyltransferase (UGT), nitric oxide synthase (NOS ), Broad complex, Tramtrack, Bric-a-brac (BTB) and cap’n’collar type of basic region leucine zipper factor family (CNC) homolog (BACH) and Maf basic leucine zipper protein ( MAFK) polymorphisms showed their roles in isoniazid-induced hepatotoxicity by modifying the expression of antioxidant enzymes. A better insight into the role of polymorphisms of HLA, UGT, NOS, BACH and MAFKin addition to NAT2, CYP2E1 and GST1in the hepatotoxicity of isoniazid may support physicians in monitor-ing patients hepatotoxicity symptoms and laboratory data and optimizing pharmacotherapy. Future studies about the role of such polymorphisms in different ethnicities are suggested

Hubungan Faktor Komorbiditas, Intensifikasi Terapi, dan Pengendalian Tekanan Darah

Background: Therapy intensification (TI) is the most important factor in blood pressure control among the adherent patients. The TI is the physician prescription behavior to add the item(s) and/or the dosage of hypertensive medicine when the patients\u27 BP was ≥10mmHg above the target. Comorbid patients have 10mmHg lower BP target. Aims: to evaluate the effect of comorbidity on TI score and blood pressure control; and to correlate the variables of TI and BP control. Method: retrospective cohort study done in 4 hospitals in Yogyakarta for 5 months. The subjects of age >18 years, hypertensive out-patient covered with Askes insurance, and ≥1 visit with uncontrolled BP were included. Hemodialysis subjects were excluded. Subjects were grouped into with/without comorbid. The BP profile was analyzed with T-test, repeatedmeasurement Anova, and odds ratio. Results: subjects consisted of without (WO) (n=268) vs. with comorbid (W) (n=401) patients. Comorbid subjects had older age, more male proportion and more visits (p<0.05). The profiles of final SBP/DBP in WO vs. W subjects were as follow: 148.9/89.1 (WO) vs. 143.8/86.1mmHg (W) (p<0.05); TI score (-) 0.36±0.26 (WO) vs. (-)0.38±0.24 (W) (p>0.05); the final SBP: worse BP control 20.9 (WO) vs.16.2% (W), not controlled in all visits 38.1 vs. 45.9%, improved 17.5 vs. 23.9%, and good controlled in all visit 23.5 vs.13.2%; proportion of subjects reached BP target 40.7% (WO) vs. 37.4% (W) (p>0.05); the different of final minus target SBP: (-)9.0±18.5 vs. (-)13.9±17.4mmHg (p<0.05); correlation between TI and variables of SBP (p<0.05) with the coefficient (r) at 0.4-0.6 (medium). Conclusion: comorbidity had no effect on TI score; but subjects with comorbid had worse BP control (p<0.05); TI score correlated in medium level with SBP

Hubungan Faktor Komorbiditas, Intensifikasi Terapi, dan Pengendalian Tekanan Darah

Background: Therapy intensification (TI) is the most important factor in blood pressure control among the adherent patients. The TI is the physician prescription behavior to add the item(s) and/or the dosage of hypertensive medicine when the patients\u27 BP was ≥10mmHg above the target. Comorbid patients have 10mmHg lower BP target. Aims: to evaluate the effect of comorbidity on TI score and blood pressure control; and to correlate the variables of TI and BP control. Method: retrospective cohort study done in 4 hospitals in Yogyakarta for 5 months. The subjects of age >18 years, hypertensive out-patient covered with Askes insurance, and ≥1 visit with uncontrolled BP were included. Hemodialysis subjects were excluded. Subjects were grouped into with/without comorbid. The BP profile was analyzed with T-test, repeatedmeasurement Anova, and odds ratio. Results: subjects consisted of without (WO) (n=268) vs. with comorbid (W) (n=401) patients. Comorbid subjects had older age, more male proportion and more visits (p<0.05). The profiles of final SBP/DBP in WO vs. W subjects were as follow: 148.9/89.1 (WO) vs. 143.8/86.1mmHg (W) (p<0.05); TI score (-) 0.36±0.26 (WO) vs. (-)0.38±0.24 (W) (p>0.05); the final SBP: worse BP control 20.9 (WO) vs.16.2% (W), not controlled in all visits 38.1 vs. 45.9%, improved 17.5 vs. 23.9%, and good controlled in all visit 23.5 vs.13.2%; proportion of subjects reached BP target 40.7% (WO) vs. 37.4% (W) (p>0.05); the different of final minus target SBP: (-)9.0±18.5 vs. (-)13.9±17.4mmHg (p<0.05); correlation between TI and variables of SBP (p<0.05) with the coefficient (r) at 0.4-0.6 (medium). Conclusion: comorbidity had no effect on TI score; but subjects with comorbid had worse BP control (p<0.05); TI score correlated in medium level with SBP

Translation and validation of EORTC QLQ-C30 into Indonesian version for cancer patients in Indonesia.

The Indonesian version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 can be used as a questionnaire to assess quality of life in Indonesian cancer patients with high-emetogenic treatments

The Predicted Quality Adjusted Life Years (QALYS) Using ST George Respiratory Questionnaire (SGRQ) in Indonesian Tuberculosis Patients

Abstract: Tuberculosis (TB) disease is one of the chronic diseases which could influence the patients’ quality and quantity of life. The quality and quantity of life may be affected by the disease itself or the disease’s treatment due to the adverse effect. The purpose of this research is to predict Quality Adjusted Life Years (QALYs) value before and during the treatment using Indonesian version of St George Respiratory Questionnaire (SGRQ) instruments which has been validated. This study used a cross sectional design conducted prospectively in 91 new patients diagnosed as pulmonary TB in Pulmonary Clinics, province of Yogyakarta on November 2013 until April 2015. Patients filled out the SGRQ and the total score was counted to predict the QALYs.We found that the predicted QALYs before and during the treatment significantly different with value was 0,691 before the treatment and they were 0.805; 0.846; 0.877; 0.892 and 0.899 during the first until fifth month of treatment respectively (p<0,05). The TB treatment can improve health status from index number 0.691 to 0.899 which is 0.208 during the treatment will produce 2 QALYs. We conclude that the predicted QALYs of TB patients during the treatment are good and show that the patients experience significant improvement of quality of life. Keyword: Tuberculosis, Saint George Respiratory Questionnaire (SGRQ), Quality Adjusted Life Years (QALYs)