Pola Perubahan Urutan Asam Amino pada Hemaglutinin Virus H5N1 Indonesia

Wabah virus flu burung tipe A, H5N1 yang memiliki patogenisitas tinggi diketahui telah menginfeksi dan mematikan jutaan unggas di Indonesia sehingga menimbulkan kerugian yang besar secara ekonomi pada peternakan unggas.  Hemaglutinin pada virus ini merupakan salah satu faktor penentu patogenisitas virus. Selain itu, komponen virus ini rentan mengalami mutasi dan dapat menyebabkan pergeseran dan penataan ulang antigen virus sehingga tercipta clade virus yang baru. Kemudian peranan HA dalam penempelan virus ke sel inang menyebabkan HA ini menjadi target untuk pengembangan obat maupun vaksin. Dengan demikian, penelitian ini bertujuan mencari pola urutan asam amino hemaglutinin yang khas pada H5N1 yang memiliki patogenisitas tinggi di Indonesia. Penelitian ini dilakukan dengan cara mengumpulkan urutan asam amino hemaglutinin H5N1 yang menginfeksi unggas di Indonesia mulai 2006 sampai 2016. Kemudian untuk mengetahui pola urutan asam amino hemaglutinin yang khas pada H5N1, dilakukan analisis penjajaran. Berdasarkan analisis tersebut dikethui bahwa urutan asam amino bagian loop hemagglutinin yang berada pada daerah asam amino posisi 341-346 memiliki pola –RRK-

Sintesis Zeolit Silikalit-1 Menggunakan Limbah Tongkol Jagung sebagai Sumber Silika

Tongkol jagung merupakan limbah agrikultural yang banyak mengandung silika yang pemanfaatannya belum maksimal. Silika dai tongkol jagung dapat menjadi solusi alternatif untuk menggantikan sumber silika komersial. Penelitian ini bertujuan untuk mengisolasi, mensintesis, dan mengkarakterisasi zeolit silikalit-1 dari limbah tongkol jagung. Metode sol-gel digunakan untuk mengisolasi silika yang selanjutnya digunakan untuk sintesis zeolit silikalit-1 dengan metode hidrotermal. Komposisi silika ditentukan oleh X-Ray Fluorescence (XRF). Silika yang dihasilkan sebesar 34,55%. Pengotor utama silika yang dihasilkan dari hasil ekstraksi adalah Na2O sebesar 7,48%. X-Ray Diffraction (XRD) menunjukkan bahwa silika hasil isolasi adalah amorf. Data Fourier Transform InfraRed (FTIR) menunjukkan adanya siloksan dan kelompok silanol didalam silika. X-Ray Diffraction (XRD) menunjukan bahwa zeolit silikalit-1 telah berhasil disintesis dengan ukuran kristal sebesar 15,28 nm. Data Fourier Transform InfraRed (FTIR) menunjukkan adanya gugus D5R pentasil pada zeolit yang dihasilkan. Scanning Electron Microscope (SEM) menunjukan morfologi dari zeolit silikalit-1 berbentuk bola-bola kecil yang merupakan benih kristal heksagonal yang sepenuhnya belum terbentuk

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Molnupiravir plus usual care versus usual care alone as early treatment for adults with COVID-19 at increased risk of adverse outcomes (PANORAMIC): an open-label, platform-adaptive randomised controlled trial

Background: The safety, effectiveness, and cost-effectiveness of molnupiravir, an oral antiviral medication for SARS-CoV-2, has not been established in vaccinated patients in the community at increased risk of morbidity and mortality from COVID-19. We aimed to establish whether the addition of molnupiravir to usual care reduced hospital admissions and deaths associated with COVID-19 in this population. Methods: PANORAMIC was a UK-based, national, multicentre, open-label, multigroup, prospective, platform adaptive randomised controlled trial. Eligible participants were aged 50 years or older—or aged 18 years or older with relevant comorbidities—and had been unwell with confirmed COVID-19 for 5 days or fewer in the community. Participants were randomly assigned (1:1) to receive 800 mg molnupiravir twice daily for 5 days plus usual care or usual care only. A secure, web-based system (Spinnaker) was used for randomisation, which was stratified by age (&lt;50 years vs ≥50 years) and vaccination status (yes vs no). COVID-19 outcomes were tracked via a self-completed online daily diary for 28 days after randomisation. The primary outcome was all-cause hospitalisation or death within 28 days of randomisation, which was analysed using Bayesian models in all eligible participants who were randomly assigned. This trial is registered with ISRCTN, number 30448031. Findings: Between Dec 8, 2021, and April 27, 2022, 26 411 participants were randomly assigned, 12 821 to molnupiravir plus usual care, 12 962 to usual care alone, and 628 to other treatment groups (which will be reported separately). 12 529 participants from the molnupiravir plus usual care group, and 12 525 from the usual care group were included in the primary analysis population. The mean age of the population was 56·6 years (SD 12·6), and 24 290 (94%) of 25 708 participants had had at least three doses of a SARS-CoV-2 vaccine. Hospitalisations or deaths were recorded in 105 (1%) of 12 529 participants in the molnupiravir plus usual care group versus 98 (1%) of 12 525 in the usual care group (adjusted odds ratio 1·06 [95% Bayesian credible interval 0·81–1·41]; probability of superiority 0·33). There was no evidence of treatment interaction between subgroups. Serious adverse events were recorded for 50 (0·4%) of 12 774 participants in the molnupiravir plus usual care group and for 45 (0·3%) of 12 934 in the usual care group. None of these events were judged to be related to molnupiravir. Interpretation: Molnupiravir did not reduce the frequency of COVID-19-associated hospitalisations or death among high-risk vaccinated adults in the community

Molnupiravir plus usual care versus usual care alone as early treatment for adults with COVID-19 at increased risk of adverse outcomes (PANORAMIC): an open-label, platform-adaptive randomised controlled trial

BackgroundThe safety, effectiveness, and cost-effectiveness of molnupiravir, an oral antiviral medication for SARS-CoV-2, has not been established in vaccinated patients in the community at increased risk of morbidity and mortality from COVID-19. We aimed to establish whether the addition of molnupiravir to usual care reduced hospital admissions and deaths associated with COVID-19 in this population.MethodsPANORAMIC was a UK-based, national, multicentre, open-label, multigroup, prospective, platform adaptive randomised controlled trial. Eligible participants were aged 50 years or older—or aged 18 years or older with relevant comorbidities—and had been unwell with confirmed COVID-19 for 5 days or fewer in the community. Participants were randomly assigned (1:1) to receive 800 mg molnupiravir twice daily for 5 days plus usual care or usual care only. A secure, web-based system (Spinnaker) was used for randomisation, which was stratified by age (<50 years vs ≥50 years) and vaccination status (yes vs no). COVID-19 outcomes were tracked via a self-completed online daily diary for 28 days after randomisation. The primary outcome was all-cause hospitalisation or death within 28 days of randomisation, which was analysed using Bayesian models in all eligible participants who were randomly assigned. This trial is registered with ISRCTN, number 30448031.FindingsBetween Dec 8, 2021, and April 27, 2022, 26 411 participants were randomly assigned, 12 821 to molnupiravir plus usual care, 12 962 to usual care alone, and 628 to other treatment groups (which will be reported separately). 12 529 participants from the molnupiravir plus usual care group, and 12 525 from the usual care group were included in the primary analysis population. The mean age of the population was 56·6 years (SD 12·6), and 24 290 (94%) of 25 708 participants had had at least three doses of a SARS-CoV-2 vaccine. Hospitalisations or deaths were recorded in 105 (1%) of 12 529 participants in the molnupiravir plus usual care group versus 98 (1%) of 12 525 in the usual care group (adjusted odds ratio 1·06 [95% Bayesian credible interval 0·81–1·41]; probability of superiority 0·33). There was no evidence of treatment interaction between subgroups. Serious adverse events were recorded for 50 (0·4%) of 12 774 participants in the molnupiravir plus usual care group and for 45 (0·3%) of 12 934 in the usual care group. None of these events were judged to be related to molnupiravir.InterpretationMolnupiravir did not reduce the frequency of COVID-19-associated hospitalisations or death among high-risk vaccinated adults in the community

Analisis Portopolio Produk Pada PT. Asuransi Umum Bumiputeramuda 1967 Cabang Lampung Menggunakan Matrik Boston Consulting Group (BCG)

Produk dapat dinilai potensial oleh target pasar karena keunggulannya atau kutilitas yang dapat dihasilkannya demikian juga yang di harapkan PT. Asuransi Umum Bumiputera 1967 Cabang Lampung. Masalah pada penelitian ini tahun 2013 hanya tercapai target se-besar 91% dan pertumbuhan tidak maksimal hanya sebesar 8,10% pada PT. Asuransi Umum Bumiputera Muda 1967 Cabang Lampung. Berdasarkan masalah maka perumusan masalah pada penelitian ini  yaitu: Bagaimana pemetaan  portopolio  produk  dan staretegi yang diterapkan PT. Asuransi Umum Bumiputeramuda 1967 Cabang Lampung meng-gunakan Matrik Boston Consulting Group (BCG)”. Adapun Tujuan penelitian ini yaitu: menganalisis pemetaan portopolio produk dan strategi yang diterapkan pada PT. Asuransi Umum Bumiputeramuda 1967 Cabang Lampung.  Metode analisis menggunakan Matrik Boston Consulting Group (BCG). Berdasarkan hasil pemetaan pada matrik Boston Consulting Group (BCG) dapat dijelaskan bahwa  kesebelas produk PT. Asuransi Umum Bumiputeramuda 1967 Cabang Lampung  menempati kuadran (posisi) yang berbeda-beda yaitu : Pada kuadran I  atau Question Mark terdapat enam produk yang dipetakan dalam posisi ini yaitu produk asuransi kebakaran, asuransi mobil, asuransi motor, asuransi kredit, asuransi uang, dan asuransi kebongkaran. Ini menunjukan 55% produk yang dipasarkan PT.Asuransi Umum Bumiputeramuda 1967 Cabang Lampung pangsa pasarnya masih lebih kecil dibandingkan kompetitor utama, tetapi tingkat pertumbuhan produk 5 tahun terakhir cukup tinggi. Pada Kuadran II atau Star, terdapat empat produk asuransi yaitu asuransi ke-sehatan, asuransi kecelakaan diri, asuransi surety bond, dan asuransi dokter liability. Ini menunjukan 37% produk yang dipasarkan PT. Asuransi Umum Bumiputeramuda 1967 Cabang Lampung dalam posisi yang optimal, di mana posisi yang semua perusahaan menginginkannya, di mana tingkat pertumbuhan dan tingkat pangsa pasar cukup tinggi. Pada Kuadran IV atau Dog terdapat satu produk asuransi yaitu marine cargo. Ini menunjukan hanya ada 0.09% produk yang dipasarkan PT. Asuransi Umum Bumiputeramuda 1967 Cabang Lampung dalam kondisi tidak lagi memiliki daya saing yang unggul dan tingkat pertumbuhan yang lambat.The products can be considered as potential market target because it’s excellence or quality that can be produced, as well as the expected in PT. Bumiputeramuda General Insurance 1967, Lampung Branch. The problem in this research is: by the year of 2013, they only reached the target of 91% and the growth is not maximum, only by 8.10% in PT. Bumiputeramuda General Insurance 1967, Lampung Branch. Based on this  problem formulation in this research is: How is mapping of product portfolios and strategy applied by PT. Bumiputeramuda General Insurance 1967, Lampung Branch using Boston Consulting Group (BCG) Matrix. The purpose of this study are: to analyze mapping product portfolio and strategy applied to the PT. General Insurance 1967 Bumiputeramuda Lampung branch. The method of analysis using  Boston Consulting Group (BCG) Matrix. Based on the mapping results of the matrix of the Boston Consulting Group (BCG) can be explained that the eleven product of PT. Bumiputeramuda 1967 General Insurance Lampung Branch occupies different a quadrant (position) : In the first quadrant or Question Mark there are six products that are mapped in this position. the product are fire insurance, automobile insurance, motorcycle insurance, credit insurance, money insurance, and insurance burglary. It shows 55 % of products marketed by PT .Bumiputeramuda 1967 General Insurance Lampung Branch market share is still smaller than the main competitors , but the rate of growth of the past 5 years the product is high enough. In Quadrant II or Star, there are four insurance products, the product are health insurance, personal accident insurance, surety bond insurance, and physician liability insurance. It shows 37 % of products marketed by PT .  Bumiputeramuda 1967 General Insurance Lampung Branch in the optimal position, in which position all companies want, which pertubuhan level and the level of market share is quite high. In Quadrant IV or the Dog, there is one product that is marine cargo insurance. It shows only 0:09 % of products marketed by PT. Bumiputeramuda 1967 General Insurance Lampung Branch in a state that  no longer has a superior competitiveness and slower growth rates

Production of mycophenolic acid by Penicillium brevicompactum—A comparison of two methods of optimization

Production of mycophenolic acid (MPA) by submerged fermentation using the microfungus Penicillium brevicompactum MTCC 8010 is reported here. Screening experiments were used to identify: the suitable media composition; the optimal initial pH; and the optimal incubation temperature to maximize the production of MPA in batch cultures. The initial concentrations of the selected sources of carbon (glucose), nitrogen (peptone) and the precursors (methionine, glycine) were then optimized by: (1) one-at-a-time variation of factors; and (2) a central composite design (CCD) of experiments, in a 12-day batch culture at an initial pH of 5.0, an incubation temperature of 25 °C, and an agitation speed of 200 rpm. The medium optimized using the one-at-a-time variation yielded a peak MPA titer of 1232 ± 90 mg/L. The medium optimized by the CCD method yielded a 40% higher MPA titer of 1737 ± 55 mg/L. The latter value was nearly 9-fold greater than the titer achieved prior to optimization