Perbandingan Efek Terapi Gabapentin dan Amitriptilin pada Pasien Stroke dengan Nyeri Neuropati

Stroke merupakan masalah bagi negara berkembang. Insidensi stroke di Indonesia 234 per 100.000 penduduk dan sekitar 2 - 8 % pasien stroke yang mengalami lesi serebrovaskular akan mengalami nyeri neuropati. Beberapa penelitian sudah membuktikan Gabapentin dan Amitriptilin dapat digunakan sebagai terapi nyeri neuropati namun belum ada yang membandingkan secara langsung pada pasien stroke dari segi efek dan efek samping. Tujuan penelitian ini untuk mengetahui perbandingan penggunaan Gabapentin dan Amitriptilin terhadap efek terapi pada pasien stroke iskemik dengan nyeri neuropati di Rumah Sakit Jogja. Metode yang digunakan pada penelitian ini adalah quasi experimental dengan consequtive sampling dengan sampel 23 pasien pada kelompok Gabapentin dan 18 pasien pada kelompok Amitriptilin serta dievaluasi skor nyeri selama 1 bulan dengan menggunakan Visual Analog Scale (VAS) setiap 2 minggu. Hasil penelitian menunjukkan pemakaian Gabapentin dan Amitriptilin selama 4 minggu menurunkan skor nyeri yang diukur dengan VAS, masing-masing 2,87±1,33 dan 2,44±0,78 dengan nilai p= 0,24 yang artinya tidak berbeda signifikan. Disimpulkan bahwa penggunaan Gabapentin dan Amitriptilin sebagai terapi nyeri neuropati pasien stroke perbedaannya tidak bermakna. Stroke becomes significant problem for developing countries. In Indonesia, data show 234 incidents per 100,000 citizensand around 2 - 8 % stroke patients who suffer from cerebrovascular lesion will also suffer from central neuropathic pain. Some studies have showed  that Gabapentin and Amitritilin can be used as neuropathic pain therapy but so far there has been  no studies  that directly compares the effectiveness and side effects in stroke patients. The objective of the research is to investigate the therapeutic effect comparison of Gabapentin and amitriptylin patients as neuropathic pain relief therapy in outpatient ischemic in Jogja Hospital. The method used in this research is quasi experimental with consequtive sampling with 23 patients in Gabapentin group and 18 patients in Amitriptilin group, and then they were evaluated pain scores in 1 month by Visual Analog Scale (VAS) every two weeks. The results of the research that use of Gabapentin and amitriptyline for 4 weeks showed a decrease in pain scores measured by VAS, respectively 2.87 ± 1.33 and 2.44 ± 0.78 with a p-value 0,24. It can be concluded that effectiveness in Gabapentin and Amitriptilin users as pain relief was not statistically different

ADHERENCE TO SECONDARY STROKE PREVENTION THERAPIES IN ISCHEMIC STROKE PATIENTS AT TEACHING HOSPITAL IN CENTRAL JAVA INDONESIA

Objective: Patients who survive from the first stroke have risk factors to be recurrent. Based on American Heart Association/American Stroke Association and PERDOSSI (Indonesian Neurologist Association), medications which are prescribed to reduce the risk of recurrent stroke as secondary stroke prevention therapies include antiplatelet/anticoagulant as well as antihypertensive and lipid lowering agent. Patients' adherence to the secondary stroke prevention therapies is important to reduce the recurrent stroke. Methods: This is a quantitative research and the data was collected retrospectively. The number of subjects of this study were 165 respondents. The participants were interviewed by researchers about their adherence to secondary stroke prevention by Modified Morisky Adherence Scale 8 (MMAS-8) questionnaire. Patients' adherence was stated as low (MMAS-8 score < 6); moderate (MMAS-8 score = 6-7) and high (MMAS-8 = 8). This research was taken at a teaching hospital in Central Java Indonesia.Results: Of 165 participants, 48 participants (29%) were categorized to have low adherence, 43 participants (26%) had moderate adherence, and 74 participants (45%) had high adherence to secondary stroke prevention therapies. The reasons for not adhering to the medications were felt better (34.1%), forgetfulness (18.7%), boredom (16.5%), lack of family support (8.8%), lack of time (6.6%), felt worse (5.5%), concern about side effects (3.3%), preference to Complementary Alternative Medicines (3.3%), and cost (3.3%).Conclusion: The number of patients who has high adherence to secondary stroke prevention was 45% and the most common reason why participants did not adhere to therapy was because they felt better (34.1%).  Â

A QUALITATIVE STUDY OF PERSPECTIVES, EXPECTATIONS AND NEEDS OF EDUCATION IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

Objective: Education of patients with Chronic Obstructive Pulmonary Disease is proven effective to improve the quality of life of patients. But more information is still required to find COPD patients needs in therapy. The authors set to explore perceptions, expectations, and needs of COPD patients as a part of pharmaceutical services.Methods: This is a study of qualitative phenomenology analysis conducted in four hospitals in Mojokerto, East Java, Indonesia. The study interviews 14 patients diagnosed with COPD for at least three months and aged ³40 y old. Patients are interviewed about their perceptions, expectations, and needs about education experienced by them.Results: All patients consider that education is important. Some of them think this education must be offered by a medical practitioner when they visit the hospital. This matter is less understood by the hospital. This matter results in the poor treatment of COPD patients and failure. Patients only receive education when they are diagnosed by a physician. Further education is not given if patients do not ask. Education material should cover causes of COPD, progression, and subsequent medication.Conclusion: Education for COPD patients support treatment offered by medical practitioners. Education need room reserved for this purpose. Pharmacists also need to support this education by monitoring drug therapy and informs COPD patients about prescribed drugs

Evaluating the impact of AsmaDroid® on knowledge, attitude, and behavior of relapse prevention among asthmatic patients

The success of asthma self-management is determined by three essential factors: healthcare professionals, patients, and drugs. Regarding patient factors, the level of knowledge plays a role and leads to a positive attitude and behavior to prevent future attack relapse. This quasi-experimental study aimed to determine the effectiveness of a mobile phone app-assisted educational intervention in improving the quality of knowledge, attitude, and behavior among patients with asthma. The study included 140 participants who were divided into two groups, i.e., control and treatment. The treatment group received and installed the app into their smartphone and then was asked to study all the educational materials in the app for four weeks. A test was carried out before and after the intervention period to examine the effectiveness of the intervention. This study used the statistical program IBM® SPSS® Version 22.0 to analyze data, and a parametric statistical test was utilized to test the statistical hypothesis in this investigation. The study found improvement, as many as 87.14% for knowledge, 77.14% for attitude, and 67.15% for behavior, with a p-value each of 0.01. It could be concluded that digital-based patient education using a mobile app improves the patients' knowledge, attitude, and behavior

The effectiveness and cost of lansoprazole and pantoprazole for stress ulcer prophylaxis in intensive care unit

The incidence of bleeding is increased in high risk patients with critical conditions in Intensive Care Unit (ICU). Appropriate prophylaxis medicine is necessary to reduce the incidence of stress ulcer bleeding during hospitalization in ICU which further can minimize the cost of patient care in the ICU. Currently, lansoprazole and pantoprazole are used as a stress ulcers prophylaxis. Nevertheless, there has not been sufficient evidence proving their effectiveness. This study was aimed to compare the effectiveness and cost between iv lansoprazole and iv pantoprazole as a stress ulcer prophylaxis in ICU. In this retrospective observational study, the data were obtained from medical records of all patients admitted to ICU in a District Hospital in Yogyakarta from January 2014 until December 2016. Effectiveness of therapy were obtained from objective data in the medical record by looking at the incidence of major (clinically significant) and minor (overt gastrointestinal) bleeding. Chi-square analysis was performed to analyze the difference of bleeding incidence. The average cost was presented as Expected Monetary Value (EMV), which consisted of the cost of prophylaxis and treatment of bleeding. The difference in average cost was analyzed using independent t-test. A total of 119 patients were included in this study. There were 62 patients in the lansoprazole group and 47 patients in the pantoprazole group. Forty eight patients (77,4%) from lansoprazole group and 35 patients (61,4%) from pantoprazole group did not experience any GI bleeding. There was no statistical difference in the incidence of GI bleeding between the two groups (CI 95%, P-value = 0.057). The EMV of lansoprazole group was higher than pantoprazole group IDR 645.122,57 and IDR 511.629,39 respectively. In conclusion, there was no significant difference regarding the effectiveness between iv lansoprazole and iv pantoprazole as stress ulcer prophylaxis. Costs for the prophylaxis of stress ulcers is lower on the use of pantoprazole compared to lansoprazole

THE CORRELATION OF TRANEXAMIC ACID USED AS ANTIFIBRINOLYTIC THERAPY TO GLASGOW COMA SCALE FOR THE FIRST 7 DAYS IN HAEMORRHAGIC STROKE PATIENTS

Objective: Treatment of haemorrhagic stroke using tranexamic acid is still used in some hospitals, to prevent the occurrence of the complication called rebleeding. Rebleeding is an important cause of bad outcomes that result loss of consciousness and even death. The administration of the antifibrinolytic tranexamic acid in patients with haemorrhagic stroke can reduce the occurrence of rebleeding but it also can increase poor outcome caused by cerebral ischemia that can worsen the patient's condition.Methods: This study used observational study design, cohort, prospective, and multicenter. The purpose of this study was to determine the effectiveness of the use of tranexamic acid in patients with haemorrhagic stroke. Statistical testing is done by analyzing the Glasgow Coma Scale (GCS) score on day 1st, day 3rd, and day 7th between the treatment groups haemorrhagic stroke patients who received tranexamic acid therapy as antifibrinolytic therapy in Bethesda Hospital for 23 patients compared with a control group of patients haemorrhagic stroke who did not receive therapy as tranexamic acid antifibrinolytic therapy in the Dr. Sardjito Hospital for 23 patients.Results: The statistical analysis of the independent t-test showed that there was no significant difference between the average GCS score of day 1st (P=262), day 3rd (P=0.293), and day 7th (P=0.648) between treatment group and control group. The statistical analysis of the Mann-Whitney showed that there was not significant difference comparing the difference between the pre and post GCS score at treatment group and control group (P=0.158).Conclusion: Administration of tranexamic acid in patients with haemorrhagic stroke (treatment group) gives the same clinical response compared to the patients who did not receive tranexamic acid therapy (control group) based on assessment of the Glasgow Coma Scale (GCS) score.Â

Effect of ethanol extract of Erythrina fusca Lour (cangkring) leaves on suppression of cyclooxygenase-2 expression in raji cell line

COX-2. COX-2 is expressed highly in inflammation and cancer cells. The effect of ethanol extract of Erythrina fusca Lour (cangkring) toward suppression of COX-2 expression in Raji cells was studied using immunocytochemistry method. This research showed that ethanol extract of E. fusca Lour leaves on concentration of 250,0; 125,0; dan 62,50 μg/mL was able to suppress the COX-2 expression significantly in comparison to control, with the inhibition of 70,19 ± 2,14 %; 44,69 ± 1,62 %; and 23,25 ± 2,21 %.Key words: COX-2 expression, anti-inflammation, anti cancer, Raji cells, ethanol extract of E. fusca leaves, immunocytochemistr

The bioavailability of furosemide-polyethylene glycol (PEG 4000) solid dispersion in male rabbits

Furosemide is a potential diuretic drug usually used for the secondary treatment of hypertension. Unfortunately this agent is very slightly soluble in water, so it has poor bioavailability. The oral administration of drug shows that only 60 % of the dose can be absorbed.The aim of the present study is to increase the bioavailability of furosemide by mixing the furosemide-PEG 4000 solid dispersion (1 : 1) in capsule dosage forms (formula A). The powder of LasixR tablet in capsules was used as a standard reference (formula B), and the original powder of furosemide in capsules was used as control (formula C). All of the formulas contained 40 mg of furosemide.The bioavailability of these formulas was evaluated following oral administration in male rabbits using The Latin Square Cross Over Design, then the plasma furosemide concentrations were analyzed spectrofluorometrically. The results indicated that the bioavailability of furosemide in the formula A was equal to that of the formula B (P > 0,05) or both formulas were bioequivalent. But the Cpmax value of the formula C was significantly lower in comparison with the formulas A and B.Key words: furosemide, solid dispersion, bioavailability

ANTIBIOTICS ADMINISTRATION TO ENHANCE THE SUCCESS OF THERAPY IN SEPSIS PATIENTS

Objective: Sepsis is reported to cause 9.3% death from the total 250,000 patients in the United States. De-escalation of antibiotics is expected to increase the effectiveness of therapy, to decrease in the level of antibiotic resistance and to reduce mortality in sepsis patients. The purpose of this study was to describe the frequency and characteristics of de-escalation of antibiotics in patients with sepsis and its influence on patient.Method: The study was conducted retrospectively with purposive sampling in hospitalized patients in a hospital in Yogyakarta, to the patients whose age are above 15 years, in the month of January to December 2015. Totally 162 patients were included, in demographic, antibiotic regimens, duration of antibiotic treatment, de-escalation of antibiotics treatment, the culture results, mortality, and length of hospital stay (LoS).Result: The result showed that 116 patients were without de-escalation of antibiotics where the majority of cases is the absence of changes in the types of antibiotics that are given from the start of the therapy until the treatment is completed. The age of the most sepsis patients treated is about 46-60 years (36.4%), LOS was 6-10 days highest (27.2%), the number of patient received antibiotics for hospitalized majority 1-2 types of antibiotics (46.9%), originally most of the patients' room are as many as those from emergency unit 63.6%, clinical outcomes patients who were recovered as many as 46.3%, the most co-morbidities that frequently appear in sepsis patients is pneumonia is 616.6% cases. Patients who were examined culture is 29%.Conclusion: Giving antibiotics is appropriate and adequate to prevent the possibility of resistance and death and the de-escalation strategy is a strategy that is safely used to treat patients with sepsis.Â