PROFIL TERAPI OBAT ANTI NYERI KANKER DAN EFEK SAMPING PADA PASIEN DENGAN NYERI KANKER YANG MENDAPAT TERAPI OPIOID BARU DI POLI PALIATIF DAN BEBAS NYERI RSUD DR. SOETOMO

Latar belakang: Nyeri kanker merupakan rasa nyeri yang dirasakan seseorang akibat pertumbuhan tumor yang menekan saraf, otot, atau tulang. Setiap tahun diperkirakan 4,5 juta pasien meninggal akibat kanker dan 3,5 juta lainnya menderita nyeri kanker setiap hari. Dalam penanganannya, WHO sejak beberapa dekade lalu sudah mengeluarkan suatu tahapan terapi yaitu, WHO Three Steps Ladder yang bertujuan untuk meningkatkan kualitas hidup pasien dengan nyeri kanker. Pada dasarnya, terapi ini menggunakan obat-obatan yang naik secara bertahap hingga opioid kuat. Opioid sendiri merupakan obat penghilang nyeri yang ampuh namun, terdapat beberapa efek samping yang biasanya dapat muncul seperti, konstipasi, mual, muntah, depresi nafas, dan lain lain. Metode: Metode penelitian ini menggunakan desain retrospektif descriptive. Populasi yang dipakai pada penelitian ini adalah pasien dengan nyeri kanker yang mendapatkan terapi opioid baru di Poli Paliatif dan Bebas Nyeri RSUD Dr. Soetomo pada bulan Januari 2017 sampai dengan Desember 2017. Hal yang akan diamati adalah, obat opioid apa saja yang digunakan, efek samping yang timbul akibat penggunaan obat opioid, dan waktu muncul efek samping pertama. Hasil: Hasil penelitian menunjukkan Jumlah pasien yang datang ke Poli Paliatif dan Bebas Nyeri RSUD Dr. Soetomo selama setahun sebanyak 808 pasien. Obat opioid yang paling banyak digunakan adalah codein (77.67%), lalu efek samping yang paling banyak dirasakan oleh pasien merupakan konstipasi (56.06%), dan waktu muncul efek samping pertama paling banyak adalah dari kelompok 0-2 minggu (64.71%). Kesimpulan: Di Poli Paliatif dan Bebas Nyeri RSUD Dr. Soetomo, obat opioid yang paling banyak digunakan adalah codein dengan efek samping yang paling sering dirasakan konstipasi, dan efek samping dirasakan muncul pertama kali pada kurun waktu 0-2 minggu

The role of oxidative stress markers in Indonesian chronic kidney disease patients: a cross sectional study

Background: Several aspects of chronic kidney disease (CKD) such as the incidence rate and mortality rate are concerning. Oxidative stress contributes to progression and mortality in patients with CKD; however, a specific correlation between several markers of oxidative stress and the estimated glomerular filtration rate (eGFR) and albumin-creatinine ratio (ACR) in the Indonesian population has not been sufficiently described yet. Methods: This study was an analytic observational study with a sample of 56 patients with CKD in Universitas Airlangga Hospital, Surabaya, Indonesia, from December 2019 – March 2020. The markers for oxidative stress investigated were urinary 8-hydroxy-2 deoxyguanosine (8-OHdG), serum symmetric dimethylarginine (SDMA) and asymmetric dimethylarginine (ADMA). The correlations between each variable of oxidative stress and CKD were analyzed using Pearson analysis. Results: There was a positive correlation between 8-OHdG and eGFR (p=0.00, r=0.51); however, there was a negative correlation between 8-OHdG and ACR (p=0.025, r=-0.30). SDMA and eGFR showed a negative correlation (p=0.00, r=-0.648), while SDMA and ACR showed a positive correlation (p=0.03, r=0.349). ADMA showed a negative correlation with eGFR (p=0.00, r=-0.476). There were significantly decreased 8-OHdG but increased ADMA and SDMA as the CKD stage progressed (p=0.001, p=0.00, and p = 0.00, respectively). Higher urine 8-OHdG was detected in patients without history of hemodialysis, whereas ADMA and SDMA showed higher value in patients with hemodialysis (p=0.00, p=0.00, and p=0.004, respectively), patients with history of diabetes mellitus (DM) had higher mean 8-OHdG (p 0.000) yet lower serum ADMA and SDMA (p=0.004 and p=0.003, respectively). Conclusions: In patients with CKD in Indonesia, the markers for oxidative stress 8-OHdG, SDMA, and ADMA are correlated with eGFR and ACR levels. There were also significant difference in 8-OHdG, SDMA, and ADMA levels among CKD stages, between dialysis vs non dialysis, and DM vs non DM patients

National Health Insurance-Based Telemedicine Implementation For Hypertension Management In Primary Centres

Hypertension nowadays still becomes one of the severe problems in Indonesia, with a prevalence of 34% in 2018. The complication of hypertension causes the most deaths and disabilities in Indonesia and cost 75% of The Social Security Organizing Agency (BPJS) budget or IDR 15 trillion in 2019. This problem was probably caused by patients' lack of knowledge and limited personnel at the primary health centre (PHC). Telemedicine is a health care provider without any direct contact, which has various methods. Today, telemedicine in Indonesia is growing rapidly along with technology and legal regulation in its implementation, increasing users by 700% in the first year of 2020. Despite the rise of those numbers, telemedicine in PHC is still limited. Recently, the Ministry of Health and various organizations have issued telemedicine regulations at primary level health facilities in collaboration with The Social Security Organizing Agency. This review aims to discuss the current implementation and the potential future of telemedicine-based hypertension management in collaboration with the Social Security Organizing Agency in PHC