Studi Penilaian Klinis Penggunaan Antibiotik pada Pasien Penyakit Ginjal Kronis

A 6-week longitudinal prospective study was conducted to assess the effectiveness and the safety antibiotic used in chronic kidney disease (CKD) patients in internal medicine ward. We compared white blood count and glomerular fi ltration rate before and after antibiotic used. The CKD patients who admitted in the internal medicine ward and age ≥18 years old were included this study. Patients with incomplete laboratory data and renal replacement therapy were excluded in this study. The 25 patients who enrolled in this study were recruited. The majority gender of CKD was male (64%), the mean of age was 61.52±14.17 years old with length of stay (LOS) was 6.92±4.05 days. The highest number of patients was in CKD stage 3 (n=10, 40%) and was followed by CKD stage 2 (n=6, 24%). Most of them were diagnosed community acquired pneumonia. Tablet azithromycin (n=16, 64%) then Cefotaxime intra venous injection (IV) (n= 6, 24%), and Ceftazidime IV (n=5, 20%), Cloxacillin IV (n=4, 16%) were the most antibiotics prescribed. Generally patients had been prescribed appropriate dose of antibiotic and 88% of them showed improved white blood count. In contrast, the glomerular fi ltration rate of 44% CKD patients was getting worse. In conclusion, this study clearly indicate the CKD patients require close monitoring to maintenance of renal function even the antibiotic had been prescribed appropriately.Sebuah studi prospektif longitudinal 6 minggu dilakukan untuk menilai efektivitas dan antibiotik keamanan yang digunakan pada pasien penyakit ginjal kronis (CKD) di bangsal pengobatan internal. Kami membandingkan jumlah darah putih dan tingkat fi ltrasi glomerulus sebelum dan sesudah antibiotik digunakan. Pasien CKD yang dirawat di bangsal penyakit dalam dan usia ≥18 tahun dimasukkan dalam penelitian ini. Pasien dengan data laboratorium yang tidak lengkap dan terapi penggantian ginjal dikeluarkan dalam penelitian ini. 25 pasien yang terdaftar dalam penelitian ini direkrut. Jenis kelamin mayoritas CKD adalah laki-laki (64%), rata-rata usia adalah 61,52 ± 14,17 tahun dengan lamanya tinggal (LOS) adalah 6,92 ± 4,05 hari. Jumlah pasien terbanyak adalah pada CKD stadium 3 (n = 10, 40%) dan diikuti oleh CKD tahap 2 (n = 6, 24%). Sebagian besar dari mereka didiagnosis menderita radang paru-paru. Tablet azitromisin (n = 16, 64%) kemudian Cefotaxime injeksi intra vena (IV) (n = 6, 24%), dan Ceftazidime IV (n = 5, 20%), Cloxacillin IV (n = 4, 16%) adalah antibiotik yang paling diresepkan. Umumnya pasien telah diberi dosis antibiotik yang tepat dan 88% dari mereka menunjukkan peningkatan jumlah darah putih. Sebaliknya, tingkat fi ltrasi glomerulus dari 44% pasien CKD semakin buruk. Kesimpulannya, penelitian ini jelas menunjukkan pasien CKD memerlukan pemantauan ketat terhadap pemeliharaan fungsi ginjal bahkan antibiotik telah diresepkan dengan tepat

Clinical evaluation of Dyslipidemia among type II diabetic patients at Public hospital Penang, Malaysia

<p>Abstract</p> <p>Background</p> <p>Global views emphasize the need for early; effective intervention against the atherogenic dyslipidemia associated with type 2 diabetes and metabolic syndrome to reduce the risk of premature cardiovascular diseases. Our aim was to determine the clinical practices and compliance among dyslipidemia with type II diabetes and hypertension in multiracial society.</p> <p>Method(s)</p> <p>Study was carried out in out-patient department of General hospital Penang over a period of ten months (Jan - Oct 2008). Study reflects the retrospective data collection covering a period of three years from Jan 2005 - Dec 2007. Universal sampling technique was used to select all the patients' undergone treatment for diabetes type II and dyslipidemia. All the concerned approvals were obtained from Clinical research Committee (CRC). Data was analyzed by using SPSS 15^®.</p> <p>Result(s)</p> <p>A total of 501 diabetes type 2 patients with dyslipidemia were identified in this study. The demographic data showed that 55.9% (n = 280) were female patients and 44.1% (n = 221) were males. Patients on combination therapy of metformin with other antidiabetic agent were 79%, while 21% were on monotherapy. Lovastatin was received as monotherapy in 83% of study population, while only 17% were on combination with gemfibrozil. Means of FPG and lipid profile were reduced from the initial (2005) to the latest level (2007) significantly (p < 0.001). Only 0.89% decrease in mean weight with S.D 13.1 as compared to initial S.D 12.8 after three years of Cohort. While in description 35.2% representatives gain weight with majority of males (71.5%), 52.3% with weight loss of 1-3 pounds majority (69.3%) with female respondents and rest 12.4% remains with same weight with mix gender distribution.</p> <p>Conclusion</p> <p>Metformin and lovastatin use among patients of type 2 diabetes and dyslipidemia is significantly improved the clinical outcomes. No significant association of metformin or lovastatin is found against the hypertension. Metformin and calcium channel blocker combination therapy was found to be the best choice in the co-treatment of diabetes and hypertension.</p

Management of Sepsis

This study aims to document the microbial profile and pattern of use of antibiotics in the government hospital of Penang state, Malaysia. A retrospective study was conducted in 2007 in the general medical ward of Hospital Pulau Pinang, Malaysia. The mortality rate was 54.22% with severe sepsis or septicemia. Mithicillin resistant staphylococcus aureus caused 37% of deaths, while 33% of deaths involved Klebsiella Spp. Commonly prescribed antibiotics included; cloxacillin 500mg (qid) 20%, tazocin 2gm (bid) 1.1%, and  vancomycin 1gm (od) 27%. We report the use of high doses of antibiotics in the six months prior to a notable rise in resistant infections

Clinical Modalities And Therapeutic Outcomes; Between Ever-Smokers Versus Never-Smokers Of Tuberculosis Patients In Penang, Malaysia.

Aim: There is consistent evidence that tobacco smoking has been implicated as a risk factor for tuberculosis infection, disease and death. Study was aimed to identify the impact of smoking on Tuberculosis (TB) clinical characteristics and treatment outcome and to emphasize this association thus may be useful in the management of TB cases. Method: The retrospective, observational and cross-sectional cohort survey was done to compare disease characteristic and clinical presentation during treatment of TB. Result: Five hundred twenty four TB patients were consecutively recruited during the period of the study. Of this, 250 [47.7%] were never smokers. Ever smoking TB patients accounted for 274 [52.3%]. There were significant relationships between smoking status of TB patient with race and initial Mantoux test. But there were no significant association between smoking habit and marital status, patients&apos; identities, history of chronic disease, history of contact to pulmonary TB patients and BCG scar. Ever smoker TB patients&apos; were four times more likely to have slower smear conversion at two months compared to non-smoker tuberculosis patients&apos;. Conclusion: We found a high risk of death from smoking induce tuberculosis. Treatment outcomes were not statistically significant with/without smoking. It was seen that smoking is consider as a risk factor for unfavorable outcomes among TB patients registered in DOTS program in term of therapeutic compliance

Technological study of preparing gel from semi-solid extract of Cacalia hastata L.

Most of the drugs which are used for wound healing are imported in Mongolia. It is required to develop drug formulation and increase local productions used for the treatment of wound healing. For the purpose of solving the above problems, we aimed to prepare new drug formulation from Cacalia hastata L. for the treatment of wound healing. Cacalia hastata L. is a medicinal plant, member of the family Asteraceae. Cacalia hastata L. is widely used for the Mongolian traditional medicine to treat wound healing, gastric ulcer, poisoning fever, liver fever, bile fever, oral cavity, and gynecological diseases. We prepared Cacalia gel from semi-solid extract of Cacalia hastata L. using various excipients such as gel former, solvent, neutralizer, antimicrobial preservative, and humectant. Gel formulation was standardized by such criteria, as the amount of biologically active compound, appearance (color, smell), pH, viscosity, and bacterial contamination. Stability testing of gel formulation was studied by long-term method. The quality of the Cacalia gel which was stored in room temperature, its appearance, viscosity, and amount of biological active compound were stable. The stability testing of the gel formulation from Cacalia hastata L. is continued

Perceived Stress Scale Psychometric Validation for Malaysian Diabetic Patients

Aims: The purpose of this study was to provide factorial analytic findings, construct validation and normative data for the Malaysian diabetic patients. Gender difference was also examined with racial response to PSS-10. Study design: Population base cross sectional survey. Place and Duration of Study: Penang between Nov 2009 and March 2010. Methodology: Cluster random sampling technique was employed for the selection participants in the community. A total of 1924 diabetic patients with age ≥ 18 (mean age = 39.51) were approached; 992 of them were female and 932 of them were male. People rated how often they had experienced these feelings in the last week on a five-point Likert scale from 0 = never to 4 = very often. The scale was translated into Malay language independently by two psychological counselors who had at least a master’s degree and bilingual efficiency. The LISREL 8.30 program was used to assenting factor analysis. Chisquare (χ 2)/df (degree of freedom) ratio, GFI (goodness of fit index), AGFI (adjusted goodness of fit index) and root mean square error of approximation (RMSEA) were used to evaluate the fit of the model (two-factor). Results: Barlett’s test of sphericity was 1603.417 (p<0.001) and Kaiser-Meyer-Olkin measure of the sampling adequacy was 0.83. Varimax rotation was conducted with these two identified factors. Factor A integrated items 1, 2, 3, 6, 9 and 10, labeled as ‘Perceived Avoidance’ while Factor B containing items 4, 5, 7, 8 and labeled as ‘Perceived Controllable’. Item variance showed 45.73 per cent of accountability with Factor A and 13.43 per cent with Factor B. Mandatory factor analysis for the two-factor of Malaysian version of PSS yielded: GFIs: χ 2 (39) = 127.846, p<0.001, χ 2/df= 4.1; GFI = 0.97; AGFI = 0.96; RMSEA = 0.06 and CFI = 0.99. Conclusion: PSS-10 is a reliable tool for assessing the stress measures among diabetic living of the society. High stress level is identified among the females as compared to male diabetic patients. Overall the whole cohort has high perceived stress level