Hubungan Trombositopenia, Parasitemia serta Mediator Pro dan Anti Inflamasi pada Infeksi Malaria, Timika 2010

AbstractTrombocytopenia is related with severity of malaria. Parasitaemia and immune system have important roles for the reactions that occur in malaria infections including thrombocytopenia. Therefore, we conducted a study to determine the association between thrombocytopenia, parasitaemia and cytokines in Plasmodium falciparum and P.vivax. This was a cross-sectional and hospital based study at Mitra Masyarakat Hospital,Timika, Papua, in 2010. Subjects were all age groups with uncomplicated malaria. On admission, characteristics subjects were recorded, parasitaemia was calculated by using microscope, platelets were measured by Hematology analyzer (Sysmex), and cytokines were measured by Multiplex Flow Cytometry Assay (Luminex).Thrombocytopenia was defined if platelet count <150,000/mm . Cytokines were presented in ratio of TNFα/IL10, IFNγ/IL10, and IL12/IL10. The association thrombocytopenia, parasitaemia and cytokines were determined by logistic multivariate analysis. A total 76 subjects were recruited, 51.3% infected with P. falciparum and 48.7% infected with P. vivax infection. The mean age of subjects was 15 (range: 5 – 55) years and 82.9% with thrombocytopenia (platelet range:18958-341123/mm ). The geometric mean of parasitemia was 3393 (43–412503) /mm , while the median of ratios TNFα/IL10, IFN γ/IL10 and IL12/IL10 were 1.05; 0.99; and 0.99, respectively. Bivariate anaylsis showed that trombocytopenia was associated with low level of TNFα/IL10 (p=0.015) and IL12/IL10 (0.020). The multivariate anaysis data also showed a relationship between thrombocytopenia and ratio of TNFα/IL10 with adjusted OR of 7,33 (95%CI: 1,5–35,8), p=0.014. Thrombocytopenia is associated with low ratio of TNFα/IL10 in patients with uncomplicated infection of P. falciparum and P.vivax. AbstrakTrombositopenia berhubungan dengan tingkat keparahan malaria. Parasitemia dan sistem kekebalan tubuh memiliki peran penting pada manifestasi infeksi malaria termasuk trombositopenia. Oleh karenanya penelitian ini bertujuan untuk menentukan hubungan antara trombositopenia, parasitemia, dan sitokin pada Plasmodium falciparum dan P.vivax. Disain studi adalah potong lintang, dilaksanakan di Rumah Sakit Mitra Masyarakat, Timika, Papua pada tahun 2010. Subjek penelitian adalah semua kelompok umur dengan malaria tanpa komplikasi. Pada perekrutan, karakteristik subjek akan dicatat, parasitemia dihitung dengan mikroskop, trombosit diukur dengan Hematology analyzer (Sysmex) dan sitokin diukur dengan Multiplex Flow Cytometry Assay (Luminex). Trombositopenia didefinisikan jika jumlah trombosit < 150.000 mm . Sitokin yang dipaparkan adalah rasio TNFα/IL10, IFNγ/IL10, dan IL12/IL10. Hubungan trombositopenia, parasitemia, dan sitokin ditentukan dengan analisis multivariat logistik. Sebanyak 76 subjek malaria mono-infeksi direkrut, 51,3% terinfeksi P. falciparum dan 48,7% P. vivax. Rata-rata umur subjek adalah 15 (kisaran : 5-55) tahun dan 82,9% dengan trombositopenia (kisaran : 18.958-341.123/ mm 3 3 ). Rerata geometrik parasitemia adalah 3393 (43-412503)/mm , sedangkan median masing–masing rasio TNFα/IL10, IFNγ/IL10 dan IL12/IL10 yaitu 1,05, 0,99; dan 0,99. Analsis bivariat menunjukkan bahwa trombositopenia berhubungan dengan rendahnya tingkat TNFα/IL10 (p = 0,015) dan tingginya rasio IL12/ IL10 (p=0,020). Hasil analisis multivariat menunjukkan adanya hubungan antara trombositopenia dan rasio TNFα/IL10 rendah (< 1,05) dengan OR: 7,33 (95% CI: 1,5-35,8), p = 0,014. Trombositopenia dikaitkan dengan rendahnya rasio TNFα/ IL10 pada pasien infeksi dari P. falciparum dan P. vivax tanpa komplikasi

FACTORS AFFECTING INDONESIAN PUBLIC HEALTH CENTERS' HEALTH WORKERS' INCOME ADEQUACY

Background: Dissatisfaction, additional work, and desired compensation are related to the needs and perceptions of civil servant health workers to increase their income. However, the probability and influencing factors regarding the income adequacy of civil servant health workers in Indonesia are still unknown. Aims: to find out the factors related to the income adequacy of health workers. Methods: This observational study with a cross-sectional design uses data from the Employment Research in the Health Sector (RISNAKES) 2017 in Public Health Centers in Indonesia. Probit analysis was conducted to assess the probability of income adequacy. Results: A total of 963 respondents were analyzed. The study found that changes in each variable, including income, official residence facilities, training facilities/ seminars/ training, motivation, and job satisfaction of a unit, would increase the probability of income adequacy ranging from 2% - 81%, except for the age variable. By referring to high job satisfaction of > 75% and taking into account the probability of 80%, the presumed adequate income is no less than IDR 28,800,000. Conclusion: The probability of the monthly income adequacy of civil servants in the health sector is influenced by job satisfaction, ability to save, official residence facilities, facilities to attend seminars, age, and income. Increasing and reformulating the amount of income must be done to optimize the performance and productivity of health workers. Keywords: health workers, income adequacy, public health center, savin

Efficacy and safety of medical cannabinoids in children with cerebral palsy: a systematic review

The increasing popularity of cannabinoids for treating numerous neurological disorders has been reported in various countries. Although it reduces tetrahydrocannabinol psychoactivity, it helps patients tolerate higher doses and complements the anti-spasmodic effects of tetrahydrocannabinol. One of the most important potential of cannabinoids are related to its potential to help children with cerebral palsy, a contributor of lifelong disability. Therefore, this systematic review aimed to assess the efficacy and safety of medical cannabinoids in children with cerebral palsy. Methods: This review adhered to The Preferred Reporting Items for Systematic Reviews and Meta-analysis 2020 guidelines. Seven databases, namely, Scopus, PubMed, EBSCO Host, ProQuest, Google Scholar, Semantic Scholar, and JSTOR, were used to identify relevant studies. Studies examining pediatric patients with cerebral palsy and reporting the efficacy and safety of medical cannabinoids through clinical trials, observational cross-sectional studies, or cohort designs were included. The outcomes of the studies included the efficacy of medical cannabinoids administered for spasticity, motor components, pain control, sleep difficulties, adverse effects, and seizure control. Results: Of 803 identified articles, only three met the inclusion criteria for data synthesis. One study exhibited a moderate risk-of-bias. A total of 133 respondents, mainly from Europe, were investigated. Overall effectiveness and safety were considered good. However, the results are inconsistent, especially regarding spasticity treatment variables. Conclusion: The anti-spasticity, anti-inflammatory, and anti-seizure properties of cannabinoids might be beneficial for patients with cerebral palsy, although their effectiveness has not been widely studied. Further studies with larger sample sizes and various ethnicities are warranted. Prospero database registration: (www.crd.york.ac.uk/prospero) under ID CRD42022358383. Keywords: Cannabinoids; Child; Cerebral palsy; Efficacy; Safety; Patient safet

Peran Standar Operasional Prosedur Penanganan Spesimen untuk Implementasi Keselamatan Biologik (Biosafety) di Laboratorium Klinik Mandiri

Standard Operating Procedure (SOP) is a reference laboratory guideline in daily laboratory activity and must meet criteria one Good Laboratory Practice (GLP) as well as the laws and regulation. SOPs is also related to risk assessment of biological safety (biosafety), mainly related to preventive measures (safety precaution) in the laboratory. This paper aims to identify the ownership/presence or absence of SOP and evaluation of the SOP owned in the private clinical laboratory (PCL) in Indonesia associated with the implementation of the safety of biologics (biosafety), which in this paper is associated with the incidence and complications when taking blood.The study design followed the Research Health Facility (Rifaskes) 2011 which was a cross sectional. The methodology by approaching directly each PCL which fits the inclusion criteria, and conduct interviews using structured questionnaire, observation and recording of secondary data is required. In total, 15 SOP variables were analyzed according to Rifaskes question in 2011. Total 782 PCL were recruited in 2011 Rifaskes, only 695 of PCL were analyzed for ownership/presence of absence SOP and 504 PCLs for evaluation of SOP. The analysis showed that only 49.3% PCL have SOP and 51.8% of them are evaluating the SOP. The PCLs have and evaluate the SOP ≥ 75% more common in Java and Sumatera. The punctured needle accident, spilled chemicals and infected materials infectious were recorded frequently in the group ownership/presence or absence of SOP and evaluation of SOP < 75%. Complications hematoma, unconscious, and bleeding more reported by the group ownership/presence or absence of SOP and evaluation of SOP ≥ 75%. The analysis of multivariate show ownership/presence or absence SOP and evaluation of SOP ≥ 75% protection from complications related to bleeding in the laboratory. The conclusion of the study is the ownership SOP and evaluation SOP on PCL in Indonesia < 75%, so it needs to be improved to be able to apply the principles of biological safety at large.   Abstrak Standar Operasional Prosedur (SOP) merupakan acuan laboratorium dalam berkegiatan dan harus memenuhi kriteria Good Laboratory Practice (GLP) serta peraturan perundang-undangan yang berlaku. SOP berkaitan dengan penilaian risiko keselamatan biologik (biosafety), terutama terkait tindakan pencegahan (safety precaution) di laboratorium. Tulisan ini bertujuan untuk mengidentifikasi kepemilikan/ada tidaknya SOP dan evaluasi terhadap SOP yang dimiliki di Laboratorium Klinik Mandiri (LKM) di Indonesia dikaitkan dengan implementasi keselamatan biologik (biosafety), yang dalam tulisan ini dihubungkan dengan kejadian dan komplikasi saat pengambilan darah. Desain penelitian mengikuti Riset Fasilitas Kesehatan (Rifaskes) 2011 yaitu potong lintang. Metodologi dengan cara mendatangi secara langsung setiap LKM sesuai kriteria inklusi, melakukan wawancara menggunakan kuisioner terstruktur, observasi dan pencatatan data sekunder yang diperlukan. Variabel SOP yang dianalisis berjumlah 15 buah sesuai pertanyaan pada Rifaskes 2011. Total 782 LKM direkrut pada Rifaskes 2011. Sejumlah 695 LKM dianalisis untuk kepemilikan/ada tidaknya SOP dan 504 LKM untuk evaluasi SOP. Hasil menunjukkan hanya 49,3% LKM memiliki SOP dan 51,8%-nya yang melakukan evaluasi SOP. LKM yang memiliki dan mengevaluasi ≥ 75% SOP lebih banyak ditemukan di Pulau Jawa dan Sumatera. Kejadian tertusuk benda tajam, terkena limbah infeksius, dan tertumpah limbah lebih sering terjadi pada kelompok kepemilikan/ada tidaknya SOP dan evaluasi SOP < 75%. Komplikasi hematoma, pingsan dan perdarahan lebih banyak dilaporkan oleh kelompok kepemilikan/ada tidaknya SOP dan evaluasi SOP ≥ 75%. Analisis multivariat menunjukkan kepemilikan/ada tidaknya SOP dan evaluasi SOP ≥ 75% berhubungan dengan perlindungan dari komplikasi perdarahan di laboratorium. Kesimpulan dari studi ini bahwa < 75% LKM di Indonesia yang memiliki SOP dan evaluasi SOP, sehingga perlu ditingkatkan untuk dapat menerapkan prinsip keselamatan biologik secara luas

ARTESUNAT-AMODIAKUIN DAN KLOROKUIN UNTUK PENGOBATAN MALARIA VIVAKS DI PUSKESMAS KOPETA, MAUMERE, NUSA TENGGARA TIMUR, 2007

AbstrakIndonesia merupakan negara endemis malaria yang merekomendasi Artemisinin-based Combination Therapy (ACT) untuk malaria Plasmodium vivax. Konfirmasi resistensi P.vivax terhadap kloroquin dan efikasi ACT  perlu  diteliti  untuk  mendukung  kebijakan  pengobatan  malaria.  Provinsi  Papua  bersama Nusa Tenggara Timur (NTT) penyumbang utama kasus malaria di Indonesia. Tujuan penelitian untuk mengevaluasi  efikasi  dan  keamanan ACT  program  artesunat-amodiakuin  (AsAq)  dibandingkan  obat konvensional klorokuin (Cq) pada malaria vivaks di Puskesmas, Provinsi NTT. Penelitian ini merupakan penelitian klinis, prospektif, evaluasi efikasi dan keamanan AsAq dibandingkan Cq pada subyek P.vivax malaria dan diamati selama 28 hari, sesuai protokol WHO tahun 2003. Efikasi AsAq dan Cq dianalisis dan dibandingkan secara intention to treat (ITT) dan per protocol (PP). Keamanan obat dievaluasi berdasarkan timbulnya atau memberatnya gejala klinis dalam kurun waktu 28 hari. Total 100 subjek monoinfeksi P. Vivax yang memenuhi criteria diobati secara acak dengan AsAq atau Cq. Efikasi hari-28 AsAq dibandingkan Cq secara Intention to Treat (ITT) adalah 93,7% (95%CI: 83,8 – 97,9) versus 56,4% (95%CI: 50,1 – 75,9) dengan Log Rank (Mantel Cox)<0.001 dan Hazard Ratio 8,3 (95%CI: 2,4 – 28,2). Efikasi hari-28 AsAq per protocol (PP) adalah 93,6% (95%CI: 82,8 – 97,8) dibandingkan Cq51,4% (95%CI: 35,9– 66,6) dengan Log Rank (Mantel Cox)<0,001 dan HR 9,3 (95%CI: 2,7 – 31,7). Dua (4%) kasus dengan Cq mengalami kegagalan pengobatan dini (Early Treatment Failure) di hari-3. Kejadian sampingan  terbanyak AsAq  dan  Cq  adalah  muntah  (26%  vs 20,4%)dan  dua  kasus  pengobatan  Cq merupakan kasus kejadian sampingan serius karena muntah berulang yang memerlukan rawat inap. Efikasi AsAq  lebih  baik  secara  signifikan  dibandingkan  Cq  untuk  pengobatan  P.  Vivax  di  Maumere. Muntah  merupakan  kejadian  sampingan  AsAq  dan  Cq  yang  paling  sering  terjadi  dan  memerlukan pengobatan. ACT alternatif yang efektif dan aman dibutuhkan untuk pengobatan infeksi P. vivax.Kata kunci : artesunat, amodiakuin, klorokuin, P. vivax.AbstractIndonesia as a malaria endemic country is recommended to use Artemisinin-based Combination Therapy  (ACT)  for  P.  vivax  malaria.   Confirmation  of  Chloroquine  resistant  and ACT  efficacy  for  P. vivax need to be investigated for supporting malaria treatment policy. Papua and East Nusa Tenggara (NTT) contribute the main malaria cases in Indonesia. To evaluate efficacy and safety of ArtesunateAmodiaquine (AsAq) as an ACT programme compared to drug Klorokuin (Cq) as a conventional for vivax malaria at Public Health Care in NTT. This was a clinical study, prospective, efficacy and safety evaluation of AsAq compared to Cq for malaria P.vivax subject and followed by 28 days, based on WHO protocol 2003. Intention to treat (ITT) and per protocol (PP) was performed to compare AsAq and Cq efficacy. Safety was evaluated based on the incidance or severity of clinical symptoms by 28 days of follow up. Total of 100 P. vivax monoinfection suitable with the inclusion/exclusion criteria was randomized treated with AsAq or Cq. The 28 days efficacy of AsAq and Cq was 93.7% (95%CI: 83.8 – 97.9) versus 56.4% (95%CI: 50.1 – 75.9) with Log Rank (Mantel Cox)<0.001 and Hazard Ratio (HR) 8,3 (95%CI: 2,4 – 28,2) by intention to treat (ITT). Per protocol (PP) efficacy was 93.6% (95%CI: 82.8 – 97.8) compared toCq51.4% (95%CI: 35.9– 66.6), Log Rank (Mantel Cox) <0,001 and HR 9,3 (95%CI: 2,7 – 31,7). Two (4%) cases with Cq had early treatment failure (ETF) at day 3. The major adverse event was vomiting for both AsAq and Cq (26% vs 20,4%) and two cases with severe vomiting were hospitalized. The efficacy of AsAq was better significantly than Cq for P. vivax treatment in Maumere. Vomiting was the major adverse event for both drugs and needed a treatment. The alternative of effective and safety ACT is needed for P. vivax infection.Key word : artesunate, amodiaquine, choloquine, P. vivax

Efficacy of Artemisinin-Naphtoquine and Dihydroartemisinin-Piperaquine for uncomplicated malaria patient at primary health care

AbstrakLatar belakang: Hasil uji klinik terdahulu terhadap artemisinin-naftokuin (ANT) dosis sekali minum pada pengobatan pasien dewasa dengan malaria tanpa komplikasi menunjukkan aman, dapat ditoleransi, dan sangat efektif. Data tambahan dibutuhkan untuk verifikasi keamanan dan efikasi dari kelompok umur lainnya sebelum obat baru ini dapat digunakan secara luas di Puskesmas di Indonesia. Metode: Pada penelitian ini, kami menggunakan modifikasi pedoman uji klinis WHO 2009. Studi kuasi- eksperimental ini membandingkan dua paralel grup, subjek dengan ANT di 5 puskesmas rawat inap, dan subjek dengan obat kontrol dihidroartemisinin-piperakuin (DHP) minum obatnya di 5 puskesmas rawat jalan. Hasil: Dari total 182 subjek yang direkrut, 168 kasus malaria yang dianalisis dalam uji klinik ini. Mereka adalah 71 kasus dalam ANT grup dan 97 kasus dalam DHP grup. Karakteristik subjek yang mendapat ANT dan DHP saat rekrutmen adalah Sama kecuali proporsi subjek dengan suhu aksila ≥37.50C, dan proporsi subjek dengan anemia (Hb &lt;11 g/dl) di ANT grup lebih tinggi dibanding DHP grup (61.8% vs23.8%, and 83.1% vs 48.5%). Subjek ANT grup juga lebih rendah proporsi parasite asexualnya pada hari ke-3 dibanding DHP grup (1.4% vs 10.3%). Efikasi terapetik ANT dan DHP adalah 95.1% (95% CI: 88.8-99.1) dan 91.9% (95% CI:84.3-96.0) pada hari 42. Kedua obat memiliki kejadian sampingan ringan.Kesimpulan: Penggunaan ANT adalah aman dan memiliki efikasi yang sama dengan DHP untuk pengobatan pasien dewasa dan anak dengan malaria tanpa komplikasi di Puskesmas. (Health Science Indones 2014;2:100-5).Kata kunci: semua umur, malaria, artemisinin-naftokuin, dihidroartemisinin-piperakuin, puskesmas.AbstractBackground: Our previous study of single dose artemisinin-naphthoquine (ANT) in adult majority male patients showed it as a safe, tolerable, and very effective treatment for uncomplicated malaria. More data is required to verify safety and efficacy from other age groups before this new drug could be widely used in Primary Health Care (PHC)s in Indonesia.Methods: For this study, we modified the 2009 WHO guidelines for clinical trials. This quasi-experimental study compared two parallel groups, subjects given ANT at 5 PHCs with inpatient facilities, and subjects given the control drug dihydroartemisinin-piperaquine (DHP) administered to subjects at 5 PHCs without inpatient facilities. Results: Of a total 182 recruited subjects, 168 malaria cases could be analyzed. There were 71 cases in the ANT group and 97 cases in the DHP group. The characteristics of subjects receiving ANT and DHP at baseline were similar except the proportion of axillary temperature ≥37.50C, and proportion of anaemic subjects (Hb &lt;11 g/dl) in the ANT group were higher than DHP group (61.8% vs 23.8%, and 83.1% vs 48.5%). Subjects in ANT group also had a lower proportion of asexual parasitemia on day-3 than DHP group (1.4% vs 10.3%). The therapeutic efficacy of ANT and DHP, were 95.1% [95% confidence interval (CI) = 88.8-99.1] and 91.9%  (95% CI = 84.3-96.0) by day 42. Both drugs had mild adverse events. Conclusion: The use of ANT is safe and has similar efficacy to DHP for treatment of adults and children patient with uncomplicated malaria at Primary Health Care. (Health Science Indones 2014;2:100-5).Key words: malaria, artemisinin-naphthoquine, dihydroartemisinin-piperaquine, primary health care.</p

Efficacy of Artemisinin-Naphtoquine and Dihydroartemisinin-Piperaquine for uncomplicated malaria patient at primary health care

AbstrakLatar belakang: Hasil uji klinik terdahulu terhadap artemisinin-naftokuin (ANT) dosis sekali minum pada pengobatan pasien dewasa dengan malaria tanpa komplikasi menunjukkan aman, dapat ditoleransi, dan sangat efektif. Data tambahan dibutuhkan untuk verifikasi keamanan dan efikasi dari kelompok umur lainnya sebelum obat baru ini dapat digunakan secara luas di Puskesmas di Indonesia. Metode: Pada penelitian ini, kami menggunakan modifikasi pedoman uji klinis WHO 2009. Studi kuasi- eksperimental ini membandingkan dua paralel grup, subjek dengan ANT di 5 puskesmas rawat inap, dan subjek dengan obat kontrol dihidroartemisinin-piperakuin (DHP) minum obatnya di 5 puskesmas rawat jalan. Hasil: Dari total 182 subjek yang direkrut, 168 kasus malaria yang dianalisis dalam uji klinik ini. Mereka adalah 71 kasus dalam ANT grup dan 97 kasus dalam DHP grup. Karakteristik subjek yang mendapat ANT dan DHP saat rekrutmen adalah Sama kecuali proporsi subjek dengan suhu aksila ≥37.50C, dan proporsi subjek dengan anemia (Hb &lt;11 g/dl) di ANT grup lebih tinggi dibanding DHP grup (61.8% vs23.8%, and 83.1% vs 48.5%). Subjek ANT grup juga lebih rendah proporsi parasite asexualnya pada hari ke-3 dibanding DHP grup (1.4% vs 10.3%). Efikasi terapetik ANT dan DHP adalah 95.1% (95% CI: 88.8-99.1) dan 91.9% (95% CI:84.3-96.0) pada hari 42. Kedua obat memiliki kejadian sampingan ringan.Kesimpulan: Penggunaan ANT adalah aman dan memiliki efikasi yang sama dengan DHP untuk pengobatan pasien dewasa dan anak dengan malaria tanpa komplikasi di Puskesmas. (Health Science Indones 2014;2:100-5).Kata kunci: semua umur, malaria, artemisinin-naftokuin, dihidroartemisinin-piperakuin, puskesmas.AbstractBackground: Our previous study of single dose artemisinin-naphthoquine (ANT) in adult majority male patients showed it as a safe, tolerable, and very effective treatment for uncomplicated malaria. More data is required to verify safety and efficacy from other age groups before this new drug could be widely used in Primary Health Care (PHC)s in Indonesia.Methods: For this study, we modified the 2009 WHO guidelines for clinical trials. This quasi-experimental study compared two parallel groups, subjects given ANT at 5 PHCs with inpatient facilities, and subjects given the control drug dihydroartemisinin-piperaquine (DHP) administered to subjects at 5 PHCs without inpatient facilities. Results: Of a total 182 recruited subjects, 168 malaria cases could be analyzed. There were 71 cases in the ANT group and 97 cases in the DHP group. The characteristics of subjects receiving ANT and DHP at baseline were similar except the proportion of axillary temperature ≥37.50C, and proportion of anaemic subjects (Hb &lt;11 g/dl) in the ANT group were higher than DHP group (61.8% vs 23.8%, and 83.1% vs 48.5%). Subjects in ANT group also had a lower proportion of asexual parasitemia on day-3 than DHP group (1.4% vs 10.3%). The therapeutic efficacy of ANT and DHP, were 95.1% [95% confidence interval (CI) = 88.8-99.1] and 91.9%  (95% CI = 84.3-96.0) by day 42. Both drugs had mild adverse events. Conclusion: The use of ANT is safe and has similar efficacy to DHP for treatment of adults and children patient with uncomplicated malaria at Primary Health Care. (Health Science Indones 2014;2:100-5).Key words: malaria, artemisinin-naphthoquine, dihydroartemisinin-piperaquine, primary health care

MASALAH FILARIASIS DI KABUPATEN SIKKA, PROVINSI NUSA TENGGARA TIMUR (NTT)

MASALAH FILARIASIS DI KABUPATEN SIKKA, PROVINSI NUSA TENGGARA TIMUR (NTT