Tren Penggunaan Antikoagulan Oral Direk dan Warfarin pada Pasien Fibrilasi Atrium

Treatments used in atrial fibrillation therapy, such as those of anticoagulants, consist of vitamin K antagonists (warfarin) and direct oral anticoagulants (dabigatran, apixaban, rivaroxaban, and edoxaban). The use of warfarin requires regular monitoring of prothrombin time (PT) and international normalised ratio (INR). The therapeutic dose range is narrow, but the price is cheaper. Oral anticoagulants are directed, the incidence of major bleeding is lower, ease of use, food and drug interactions are minor, the half-life is shorter, and there is a lack of laboratory monitoring needs. Based on this problem, researchers conducted a study to determine the trend of using warfarin and oral anticoagulants in patients with atrial fibrillation at a public hospital in Jakarta. This study uses a qualitative approach, with longitudinal methods and retrospective data using outpatient medical records for the period 2014 to 2018. The trend of using warfarin anticoagulants decreased from 82.3% in 2014 to 62% in 2016, while oral anticoagulants were reduced. Direct oral anticoagulants are rivaroxaban and dabigatran, which are more widely used than apixaban, and edoxaban; no data on their use has been obtained. The opposite was true from 2017 to 2018, when the use of warfarin increased and caused a decrease in the use of direct oral anticoagulants. This research is expected to contribute to various parties, both health practitioners and academics, in terms of selecting therapies for atrial fibrillation.Pengobatan yang digunakan dalam terapi fibrilasi atrium, seperti yaitu antikoagulan, yang terdiri dari antagonis vitamin K (warfarin) dan antikoagulan oral direk (dabigatran, apiksaban, rivaroksaban, dan edoksaban). Penggunaan warfarin membutuhkan pemantauan rutin protrombin time (PT) dan international normalised ratio (INR), rentang dosis terapi sempit, namun harganya lebih murah. Antikoagulan oral direk, insiden perdarahan mayor lebih rendah, kemudahan penggunaan, interaksi makanan dan obat minor, waktu paruh lebih pendek, dan kurangnya kebutuhan pemantauan laboratorium. Berdasarkan masalah tersebut, peneliti melakukan kajian untuk mengetahui tren penggunaan warfarin dan antikoagulan oral direk pada pasien fibrilasi atrium pada salah satu rumah sakit di Jakarta. Penelitian ini menggunakan pendekatan kualitatif, dengan metode longitudinal dan data bersifat retrospektif menggunakan rekam medis pasien rawat jalan periode tahun 2014 sampai tahun 2018. Tren penggunaan antikoagulan warfarin mengalamipenurunan dari 82,3% tahun 2014 menjadi 62% tahun 2016, sedangkan antikoagulan oral direk mengalamipeningkatan. Antikoagulan oral direk rivaroksaban dan dabigatran lebih banyak digunakan dibandingkanapiksaban, dan edoksaban tidak diperoleh data penggunaannya. Hal sebaliknya pada tahun 2017 sampai2018, dimana penggunaan warfarin mengalami peningkatan dan menyebabkan penurunan penggunaanantikoagulan oral direk. Penelitian ini diharapkan dapat memberikan kontribusi kepada berbagai pihakbaik praktisi kesehatan maupun akademisi dalam hal pemilihan terapi untuk fibrilasi atrium

Analyzing surface EMG signals to determine relationship between jaw imbalance and arm strength loss

BACKGROUND: This study investigated the relationship between dental occlusion and arm strength; in particular, the imbalance in the jaw can cause loss in arm strength phenomenon. One of the goals of this study was to record the maximum forces that the subjects can resist against the pull-down force on their hands while biting a spacer of adjustable height on the right or left side of the jaw. Then EMG measurement was used to determine the EMG-Force relationship of the jaw, neck and arms muscles. This gave us useful insights on the arms strength loss due to the biomechanical effects of the imbalance in the jaw mechanism. METHODS: In this study to determine the effects of the imbalance in the jaw to the strength of the arms, we conducted experiments with a pool of 20 healthy subjects of both genders. The subjects were asked to resist a pull down force applied on the contralateral arm while biting on a firm spacer using one side of the jaw. Four different muscles – masseter muscles, deltoid muscles, bicep muscles and trapezoid muscles – were involved. Integrated EMG (iEMG) and Higuchi fractal dimension (HFD) were used to analyze the EMG signals. RESULTS: The results showed that (1) Imbalance in the jaw causes loss of arm strength contra-laterally; (2) The loss is approximately a linear function of the height of the spacers. Moreover, the iEMG showed the intensity of muscle activities decreased when the degrees of jaw imbalance increased (spacer thickness increased). In addition, the tendency of Higuchi fractal dimension decreased for all muscles. CONCLUSIONS: This finding indicates that muscle fatigue and the decrease in muscle contraction level leads to the loss of arm strength

CAUSE-EFFECT RELATIONS AND OPTIMIZATION OF TABLET CONTAINING EUCOMMIA ULMOIDES AND GARDENIA JASMINOIDES SPRAY-DRIED EXTRACTS

Objective: The E. ulmoides and G. jasminoides (EG) tablets containing 67 mg E. ulmoides spray-dried extract (ESE) and 173 mg G. jasminoides spray-dried extract (GSE) were prepared by employing the direct compression method. Due to the poor flowability and compressibility of the two spray-dried extracts, various excipients were added at different ratios so that the blends can be compressed into tablets with the required standards. This study aimed at the cause-effect relations and optimization of the EG tablet formulation.Methods: Different diluents including dibasic calcium phosphate anhydrous (DCPA), silicified microcrystalline cellulose (SMCC), spray-dried lactose (SDL) and the active ingredients (blend of ESE and GSE at the ratio of 67:173, w/w) were separately investigated their own physical properties. The binary mixtures of the active ingredients with different ratios of DCPA, SMCC, and SDL were evaluated their flowability. D-optimal design based on three independent variables (% DCPA, % croscarmellose sodium (CCS) and % SMCC) was applied to evaluate the cause-effect relations and optimize the EG tablet formulation. The weight variation, disintegration time, hardness and friability were investigated as four dependent variables.Results: The flowability of the powders was found to be affected by the particle size distribution, particle shape and density. The three diluents could significantly improve the flowability of the active ingredients. All independent variables had significant effects on the dependent variables. An increase in % SMCC reduced the weight variation, hardness and increased the friability of tablets. Disintegration time was found to be in the negative relations with % CCS. The tablet hardness was in positive relations with % DCPA. The optimized EG tablet formulation composed of 9 % DCPA (w/w), 35 % SMCC (w/w), and 14 % CCS (w/w) of the excipient blend. The weight variation, disintegration time, hardness and friability of the optimized EG tablets were found to be 1.8 %, 11.7 min, 61.4 N, and 0.5 %, respectively.Conclusion: The ESE and GSE could be formulated into tablet by using direct compression method. The cause-effect relations and optimization of EG tablet formulation were studied and reported for the first time

Effects of combined rice flour and molasses use on the growth performance of Pacific white shrimp (<em>Litopenaeus vannamei</em> Boone, 1931) applied biofloc technology

A 63-day completely random experiment with three replications was carried out to compare the effects of five different combination ratios of rice flour (R) and molasses (M) on the growth and survival rates of Pacific white shrimp (Litopenaeus vannamei Boone, 1931) postlarvae applied biofloc technology. Five biofloc (BF) treatments, including R90-M10, R70-M30, R50-M50, R30-M70, and R10-M90, formed with the addition of different combination ratios of rice flour and molasses, i.e., 90% R+10% M, 70% R+30% M, 50% R+50% M, 30% R+70% M, and 10% R+90% M, respectively, with C/N ratios of 15:1, and a control (neither rice flour nor molasses applied) was randomly arranged into the 18 plastic tanks of 1.0 m3 volume (with 0.5 m3 of water) each tank and salinity of 15‰. The postlarvae (0.095 g) were stocked into the tanks at a 150 ind. m−3 density and fed pelleted feed (40% protein). There was an improvement in growth (FMW, WG, DWG, and SGR) for all treatments. Besides, treatments with more than or equal to 30% molasses have improved SR, FCR, and FB. Especially the highest SR (94.2%) was obtained at the R70-M30, which perhaps created the highest FB (1.435 kg m−3) in this treatment. The lowest FCR (1.28) was also observed in the R70-M30 and significantly differed from the control and other treatments. Besides, water quality parameters were within the ranges recommended for Pacific white shrimp health during the experimental period. Our findings indicated the benefits of shrimp culture using the BF system when different combined ratios of rice flour and molasses were applied, of which a ratio of 70% rice flour and 30% molasses was considered as the best

Autologous Transplantation of Adipose-Derived Stem Cells to Treat Acute Spinal Cord Injury: Evaluation of Clinical Signs, Mental Signs, and Quality of Life

BACKGROUD: Spinal cord injury (SCI) is damage that can cause a temporary or permanent change in spinal cord functions AIM: This work evaluates clinical signs, mental signs, and quality of life (QoL) after autologous adipose-derived stem cells (ADSCs) transplantation to treat acute spinal cord injury (SCI). MATERIAL AND METHODS: In this study, 47 SCI patients were recruited and divided into two groups: intervention and control. ADSCs were isolated and cultured under the cell culture quality control procedure. All patients in both groups underwent neurosurgery with or without ADSC transplantation. The recovery regarding neurological muscle, QoL, neurogenic bladder, and mental improvement was assessed after transplantation. RESULTS: All patients had improved in terms of motor function, bladder function, and daily living. No patients reported any side effect. MRI imaging showed significant changes in the lesion length of the spinal canal and the thickening of the spinal cord. Mental improvement was highest at six months after transplantation and lowest at one month after transplantation. The proportion of patients whose quality of life improved after treatment was 100%, while 80% of patients were satisfied with treatment outcomes. CONCLUSIONS: Thus, our data suggested that ADSCs transplantation was safe and effective for the treatment of SCI patients. Neurological muscle and neurogenic bladder were improved significantly after transplantation

Classification Methods for Mapping Mangrove Extents and Drivers of Change in Thanh Hoa Province, Vietnam during 2005-2018

Mangrove forests have been globally recognised as their vital functions in preventing coastal erosion, mitigating effects of wave actions and protecting coastal habitats and adjacent shoreline land-uses from extreme coastal events. However, these functions are under severe threats due to the rapid growth of population, intensive shrimp farming and the increased intensity of severe storms in Hau Loc and Nga Son districts, Thanh Hoa province. This research was conducted to monitor spatial-temporal changes in mangrove extents using Landsat and Sentinel imageries from 2005 to 2018. Unsupervised and supervised classification methods and vegetation indices were tested to select the most suitable classification method for study sites, then to quantify mangrove extents and their changes in selected years. The findings show that supervised classification was the most suitable in study sites compared to vegetation indices and unsupervised classification. Mangrove forest extents increased by 7.5 %, 38.6 %, and 47.8 % during periods of 2005 - 2010, 2010 - 2015 and 2015 - 2018, respectively. An increase of mangrove extents resulted from national programs of mangrove rehabilitation and restoration during 2005- 2018, increased by 278.0 ha (123.0 %)

Monitoring Changes in Coastal Mangrove Extents Using Multi-Temporal Satellite Data in Selected Communes, Hai Phong City, Vietnam

Mangrove forests are important and known as one of the most productive ecosystems in the tropics. They reduce the impacts of extreme events, provide important breeding grounds for aquatic species and build the resilience of ecosystem-dependent coastal communities. On the contrary, they are also known as one of the most threatened and vulnerable ecosystems worldwide, which have experienced a dramatic decline due to extensive coastal development during the last half-century. Remote sensing techniques have demonstrated a high potential to detect, identify, map, and monitor mangrove conditions and its changes, which is reflected by a large number of scientific papers published on this topic. The aim of this study was to investigate the multi-decadal changes of mangrove forests selected communes in Hai Phong city, North Vietnam, based on using Landsat and Sentinel 2 data from 2000 to 2018. The study used these continuous steps: 1) data pre-processing; 2) image classification using Normalized Difference Vegetation Index; 3) accuracy assessments; and 4) multi-temporal change detection and spatial analysis of mangrove forests. The classification maps in comparison with the ground reference data showed the satisfactory agreement with the overall accuracy was higher than 80.0%. From 2000 to 2018, the areas of mangrove forests in the study regions  increased by 584.2 ha in Dai Hop and Bang La communes (Region 1) and by 124.2 ha in Tan Thanh, Ngoc Xuyen and Ngoc Hai communes (Region 2), mainly due to the boom of mangrove planting projects and good mangrove management at the local community level

Tuberculosis among economic migrants: a cross-sectional study of the risk of poor treatment outcomes and impact of a treatment adherence intervention among temporary residents in an urban district in Ho Chi Minh City, Viet Nam.

BACKGROUND Tuberculosis (TB) remains a major cause of avoidable deaths. Economic migrants represent a vulnerable population due to their exposure to medical and social risk factors. These factors expose them to higher risks for TB incidence and poor treatment outcomes. METHODS This cross-sectional study evaluated WHO-defined TB treatment outcomes among economic migrants in an urban district of Ho Chi Minh City, Viet Nam. We measured the association of a patient's government-defined residency status with treatment success and loss to follow-up categories at baseline and performed a comparative interrupted time series (ITS) analysis to assess the impact of community-based adherence support on treatment outcomes. Key measures of interest of the ITS were the differences in step change (β) and post-intervention trend (β). RESULTS Short-term, inter-province migrants experienced lower treatment success (aRR = 0.95 [95% CI: 0.92-0.99], p = 0.010) and higher loss to follow-up (aOR = 1.98 [95% CI: 1.44-2.72], p  55 years of age (aRR = 0.93 [95% CI: 0.89-0.96], p < 0.001), relapse patients (aRR = 0.89 [95% CI: 0.84-0.94], p < 0.001), and retreatment patients (aRR = 0.62 [95% CI: 0.52-0.75], p < 0.001) had lower treatment success rates. TB/HIV co-infection was also associated with lower treatment success (aRR = 0.77 [95% CI: 0.73-0.82], p < 0.001) and higher loss to follow-up (aOR = 2.18 [95% CI: 1.55-3.06], p < 0.001). The provision of treatment adherence support increased treatment success (IRR(β) = 1.07 [95% CI: 1.00, 1.15], p = 0.041) and reduced loss to follow-up (IRR(β) = 0.17 [95% CI: 0.04, 0.69], p = 0.013) in the intervention districts. Loss to follow-up continued to decline throughout the post-implementation period (IRR(β) = 0.90 [95% CI: 0.83, 0.98], p = 0.019). CONCLUSIONS Economic migrants, particularly those crossing provincial borders, have higher risk of poor treatment outcomes and should be prioritized for tailored adherence support. In light of accelerating urbanization in many regions of Asia, implementation trials are needed to inform evidence-based design of strategies for this vulnerable population

A comparative impact evaluation of two human resource models for community-based active tuberculosis case finding in Ho Chi Minh City, Viet Nam

Background: To achieve the WHO End TB Strategy targets, it is necessary to detect and treat more people with active TB early. Scale–up of active case finding (ACF) may be one strategy to achieve that goal. Given human resource constraints in the health systems of most high TB burden countries, volunteer community health workers (CHW) have been widely used to economically scale up TB ACF. However, more evidence is needed on the most cost-effective compensation models for these CHWs and their potential impact on case finding to inform optimal scale-up policies. Methods: We conducted a two-year, controlled intervention study in 12 districts of Ho Chi Minh City, Viet Nam. We engaged CHWs as salaried employees (3 districts) or incentivized volunteers (3 districts) to conduct ACF among contacts of people with TB and urban priority groups. Eligible persons were asked to attend health services for radiographic screening and rapid molecular diagnosis or smear microscopy. Individuals diagnosed with TB were linked to appropriate care. Six districts providing routine NTP care served as control area. We evaluated additional cases notified and conducted comparative interrupted time series (ITS) analyses to assess the impact of ACF by human resource model on TB case notifications. Results: We verbally screened 321,020 persons in the community, of whom 70,439 were eligible for testing and 1138 of them started TB treatment. ACF activities resulted in a + 15.9% [95% CI: + 15.0%, + 16.7%] rise in All Forms TB notifications in the intervention areas compared to control areas. The ITS analyses detected significant positive post-intervention trend differences in All Forms TB notification rates between the intervention and control areas (p = 0.001), as well as between the employee and volunteer human resource models (p = 0.021). Conclusions: Both salaried and volunteer CHW human resource models demonstrated additionality in case notifications compared to routine case finding by the government TB program. The salaried employee CHW model achieved a greater impact on notifications and should be prioritized for scale-up, given sufficient resources

Microscopic Observation Drug Susceptibility Assay (MODS) for Early Diagnosis of Tuberculosis in Children

MODS is a novel liquid culture based technique that has been shown to be effective and rapid for early diagnosis of tuberculosis (TB). We evaluated the MODS assay for diagnosis of TB in children in Viet Nam. 217 consecutive samples including sputum (n = 132), gastric fluid (n = 50), CSF (n = 32) and pleural fluid (n = 3) collected from 96 children with suspected TB, were tested by smear, MODS and MGIT. When test results were aggregated by patient, the sensitivity and specificity of smear, MGIT and MODS against “clinical diagnosis” (confirmed and probable groups) as the gold standard were 28.2% and 100%, 42.3% and 100%, 39.7% and 94.4%, respectively. The sensitivity of MGIT and MODS was not significantly different in this analysis (P = 0.5), but MGIT was more sensitive than MODS when analysed on the sample level using a marginal model (P = 0.03). The median time to detection of MODS and MGIT were 8 days and 13 days, respectively, and the time to detection was significantly shorter for MODS in samples where both tests were positive (P<0.001). An analysis of time-dependent sensitivity showed that the detection rates were significantly higher for MODS than for MGIT by day 7 or day 14 (P<0.001 and P = 0.04), respectively. MODS is a rapid and sensitive alternative method for the isolation of M.tuberculosis from children