Association of hydrazine and SGPT level two hours after drug administration at the end of intensive phase treatment of pulmonary tuberculosis patients

ABSTRACTIntroduction: Isoniazid in the regiment treatment of pulmonary tuberculosis patients causes side effects. Hepatotoxicity is one of the isoniazid’s side effects that need medical attention. Isoniazid-induced hepatotoxicity has no correlation with high level of isoniazid in plasma. However, several animal studies show it has an association with hydrazine, a metabolite of isoniazid. The role of hydrazine in isoniazid-induced hepatotoxicity among tuberculosis patients is unclear.Objective: The aim of this study was to analyze the correlation of hydrazine and serum glutamic-pyruvic transaminase (SGPT) levels at two hours after drug administration in the end of intensive phase treatment of pulmonary tuberculosis patients.Methods: This was an observational study with cross-sectional design. Fifty eight newly diagnosed pulmonary tuberculosis patients were enrolled in this study. Venous blood sampling was collected at two hours after drug administration in the end of intensive phase treatment. SGPT level was measured by an automatic chemical analyzer. Hydrazine level was measured by using high-performance liquid chromatography (HPLC). Statistical significance was analyzed using correlation test.Results and Discussion: The incidence of hepatotoxicity was 3.4% and about 8.6% patients had elevated SGPT at two hours after drug administration in the end of intensive phase treatment. There was no correlation between hydrazine level and SGPT levels in this study. These results indicated that hepatotoxicity or minimal liver damage in some patients might occur in the administration of standard dose isoniazid. It might be caused by isoniazid’s metabolites itself, or various other factors.Conclusions: There was no correlation between hydrazine level and SGPT levels at 2 hours after drug administration in the end of intensive phase treatment in this study

Prediction score for post-stroke cognitive impairment (PSCI) after acute ischemic stroke

It was estimated that patients with ischemic stroke and post-stroke cognitive impairment (PSCI) have been increasing. In addition, this PSCI is often late diagnosed when it has already developed into post-stroke dementia. Only a few studies have developed a scoring system of predictor factors cognitive impairment (CI) for post-acute ischemic stroke in Indonesia. This study aimed to develop a scoring system of predictor factors of CI for post-stroke ischemic patients. The patients included were >18 years old diagnosed with acute ischemic stroke who underwent mini-mental state examination (MMSE) and clock drawing test (CDT) examination on day-30 at Bethesda Hospital Yogyakarta. It was retrospective cohort study design and samples were obtained from the stroke registry and medical records. Patients who had a history of CI and incomplete medical records were excluded. The results of MSSE and CDT at day-30 were the outcomes of this study. To evaluate the relationship between the independent variable and the dependent variable, chi-squared tests were perforemd followed by multivariate logistic regression analysis with Hosmer-Lemeshow tests with backward likelihood-ratio (LR) method and by assessing the final area under the curve (AUC) model. The final model was transformed into a scoring system to determine the value of probability prediction of PSCI, the optimal cut-off point, the sensitivity value and specificity value of the cognitive impairment scoring system at day-30 after acute ischemic stroke. A total of 140 subjects were included in the study with an average age of 62.8 years, 86 (61.4%) males and 54 (38.6%) females. Ninety-one subjects (65%) experienced post-stroke CI. The multivariate analysis showed age >70 years, education level ≤6 years, modified ranking score (mRS) >3 at diagnosis, Barthel index score ≤4 at diagnosis, the number of multiple lesions and the location of lesion in the cortex were independent predictor factors affecting CI 30 days after acute ischemic stroke. The developed predictor score obtained AUC discrimination value of 82.6% (95%CI:0.757-0.896) and calibration value of p>0.366. The scoring system had a value range of 0-7, and with a cut-off ≥1, it had a sensitivity value of 86.8% and a specificity value of 59.2%. It can be concluded that the predictor score has a good performance in predicting the occurrence of PSCI at day-30 after acute ischemic stroke

Severity and treatment level of acute gastroenteritis with rotavirus in children under 5 years in INDONESIA

Rotavirus diarrhea causing gastroenteritis in children under five years is an importantissue that urgently needs to be addressed globally. Delay in management of rotavirusdiarrhea can be fatal. Diagnostic tool for detecting rotavirus is, therefore, needed.However, until now the gold standard diagnostic tools are expensive, often not availableand affordable in health care settings. The aim of the study was to compare the Vesikariclinical severity score of rotavirus-positive with rotavirus-negative in hospitalized childrenwith acute gastroenteritis. Furthermore, the difference of the level of treatment betweenrotavirus-positive with rotavirus-negative was also evaluated. This was a cross sectionalstudy that using secondary data from medical records of five general teaching hospital inIndonesia. Subjects were children aged <5 years with acute watery diarrhea admitted tothe hospital. Statistical analysis used was chi square test, U-Mann Whitney, and KruskalWallis. The results showed that the patient with rotavirus positive have higher dehydration(80.2%) compared to rotavirus negative (70%). The severity level of clinical feature washigher in diarrhea due to rotavirus positive than non rotavirus (11.47± 2.89 vs 10.41± 2.70; p<0.000). The level of treatment was higher in rotavirus positive. The majorityhad treatment plan C (47.7%) higher than plan B and A (45.6% and 30.9%; p<0.050).This was opposite with patient with rotavirus negative that majority had treatment inplan A (69.1%) higher than plan B and C (54.4% and 52.3%) (p<0.001). In conclusion,the severity of gastroentrities in children under 5 years using vesikari score are higher indiarrhea due to rotavirus positive than non rotavirus. The treatment level plan C is higherthan plan B and A in diarrhea due to rotavirus. This is opposite with non rotavirus majorityhave treatment in plan A higher than plan B and C

PREDICTORS OF THE USE OF GASTROPROTECTIVE AGENTS IN PATIENTS USING NSAID IN YOGYAKARTA INDONESIA

Non Steroid Anti-Inflammatory (NSAID) is one type of Anti- Inflammatory drug that is used to treat pain in patients of osteoarthritis (OA) and rheumatoid arthritis (RA). The use of NSAIDscan cause gastrointestinal side effects. To prevent the side effects, NSAIDs are prescribed in combination with gastroprotective agent (GPA).The aim of the study is to determine factors considered in the GPA prescription by the doctors in patients who have risk factors for gastric disorder due to NSAIDs use. This study was performed using a cross-sectional observational design. The data were collected retrospectively during a period of January to December 2010. The subjects were and RA patients considering the inclusion and exclusion criteria. The data included patient characteristics (gender, age, occupation, payment method, the primary diagnosis), prescription NSAID,prescription \u27OfGPA,history of gastrointestinal disease, NSAID prescription with corticosteroids, prescription with antiplatelet. The data were processed descriptively and quantitatively, and analyzed statistically using chi-square and log. regression with 95% Confidence Interval. The results showed that there were correlation between some predictor factors with prescription of gastroprotective agent. These factors were women patient, patient age of &#880565 years, oxicam prescribing, diclofenac sodium prescribing, prescribing >1 type of NSAIDs,prescription of NSAID concomitant with corticosteroids, prescription, of NSAID concomitant with antiplatelet, patients with history of gastrointestinal, prescribing NSAIDswith duration of &#88053 months. Patient with a history of gastrointestinal disease was the most predictor influential factor, withOR (odds ratio) of 3.6 (95% CI: - 4.66). Predictor factor of patients with a history of dyspepsia possessed the highest OR {OR=4,29 (CI 95%: 3.23- 5.7)}. It means that patients with a history of dyspepsia prescribed NSAIDs would have greater risk of 4.29 times to get prescription than patients without a history of dyspepsia. Prescribing NSAIDs > 1 DDD (defined daily dose) had p value of 0.777, which means there was no relationship between GPA prescription with NSAIDs > 1 DDD prescription

THE BLOOD PRESSURE AND THERAPY EXPENDITURE CHANGE DUE TO HYPERTENSION COMORBIDITY: AN ANALYTICAL PROSPECTIVE STUDY IN SECONDARY CARE HOSPITALS IN JOGJAKARTA INDONESIA

Objective: To measure the comorbid effect on blood pressure and therapy expenditure in 4 secondary care hospitals in Jogjakarta.Methods: We conducted an 8-month prospective pharmacoeconomic study with hospital perspective. All hypertensive outpatients, with Askes-insurance whose beneficiaries were governmental employees, with at least 2 moly visits at the index date were included. The subjects with malignancy, hemodialysis, and less than 4 visits were excluded. The expenditure comprised the cost for cardiovascular medicine, doctor, physical/laboratory test, emergency visit, and physiotherapy. We analyzed the expenditure change and sensitivity analysis with Anova-test, whereas the proportion of subjects with good controlled blood pressure with the chi-square test.Results: The eligible subjects (N=656) consisted of no comorbid (n=105), stroke (n=82), cardiovascular (n=209), diabetes mellitus/chronic kidney disease or DM/CKD (n=149), and combined comorbid (n=111) groups. The baseline blood pressure was similar to no comorbid (p&gt;0.05), except for the diastolic blood pressure in a cardiovascular group. The stroke and cardiovascular groups had more subjects at mean systolic blood pressure lower than 140 mmHg with odds ratio (OR) 2.01 (CI95%:1.12-3.62) and 2.10 (CI95%:1.31-3.39) respectively than no comorbid group; but the mean blood pressure was not clinically different. The total therapy expenditure increased at 6.5% (p&lt;0.61); 22.7% (p&lt;0.03); 78.6% (p&lt;0.01); 78.5% (p&lt;0.01) per subject-visit for stroke, cardiovascular, DM/CKD, and combined-comorbid groups than no comorbid group respectively. Except for stroke group, the incremental expenditure was price-sensitive (p&lt;0.05).Conclusion: The total therapy expenditure but not blood pressure was likely to be influenced by hypertension comorbidity. We suggest that preventing hypertension comorbidity has the benefit to reduce total therapy expenditure

Sedative hypnotics use as the risk factor for fall incidents on geriatric patients

Fall incident is one of geriatric syndromes that cause an increasing public health burden worldwide.The risk factors for falls incidents on geriatric patients have been identified included medicationuse. Benzodiazepine is a sedative hypnotic that found to be associated with an increase fallincidents. The aim of the study was to evaluate the influence of sedative hypnotics on the riskof fall incidents on geriatric patients. This was an observational study using cohort designinvolving 188 eligible geriatric patients comprising 94 patients who take sedative hypnotics and94 patients who not. All pasients then underwent a test for functional mobility and fall riskusing timed “up & go” test (TUG). The subjects who take ≤ 20 seconds to complete the TUG wasconsidered to have low risk for fall incidents, whereas those who take >20 seconds was consideredto have high risk for fall incidents. The results showed that the use of sedative hypnotics, sex,and number of drugs taken were associated with fall incidents on geriatric patients. Geriatricpatients who use sedative hypnotics were 2.41 times higher at risk of fall incidents than thosewho not use sedative hypnotics (95%CI;1.12-5.17; p=0.023). Geriatric patients who takealprazolam were 2.78 times higher at risk of fall incidents compared to those who not take(95% CI: 1.49-5.19; p=0.028). Furthermore, female geriatric patients were 3.29 times higher atrisk of fall incidents compared to male geriatic patients (95%CI: 1.58-6.88; p=0.001) and theuse of ≥ 4 kinds of drugs were 2.76 times higher at risk of fall incidents compared to the use of<4 kinds of drugs (95%CI:1.21-6.29; p=0.015). In conclusion, sedative hypnotics is found tobe a risk factor for fall incidents on geriatric patients

PREDICTORS OF THE USE OF GASTROPROTECTIVE AGENTS IN PATIENTS USING NSAID IN YOGYAKARTA INDONESIA

Non Steroid Anti-Inflammatory (NSAID) is one type of AntiInflammatory  drug  that  is  used  to  treat  pain  in  patients  of osteoarthritis  (OA)  and  rheumatoid  arthritis  (RA).  The  use  of NSAIDs can cause gastrointestinal side effects. To prevent the side effects,  NSAIDs  are  prescribed  in  combination  with gastroprotective  agent  (GPA).  The  aim  of  the  study  is  to determine  the  factors  considered  in  the  GPA  prescription  by  the doctors  in  patients  who  have risk  factors  for  gastric  disorder  due to  NSAIDs  use.  This  study was  performed using  a  cross-sectional observational  design.  The  data  were  collected  retrospectively during  a  period  of  January to December  2010.  The subjects were OA  and  RA  patients  considering  the  inclusion  and  exclusion criteria.  The  data  included  patient  characteristics  (gender,  age, occupation, payment  method, the primary diagnosis),  prescription of NSAID, prescription of GPA, history of gastrointestinal disease, NSAID  prescription  with  corticosteroids,  prescription  with antiplatelet.  The  data  were  processed  descriptively  and quantitatively, and analyzed statistically using chi-square and log. regression with 95% Confidence Interval. The results showed that there  were  correlation  between  some  predictor  factors  with prescription  of  gastroprotective agent.  These  factors  were  women patient,  patient  age of  ≥  65  years,  oxicam  prescribing, diclofenac sodium prescribing, prescribing &gt;1 type of NSAIDs, prescription of NSAID  concomitant  with  corticosteroids,  prescription  of  NSAID concomitant  with  antiplatelet,  patients  with  history  of gastrointestinal, prescribing NSAIDs with duration of ≥ 3 months. Patient  with  a  history  of  gastrointestinal  disease  was  the  most predictor  influential  factor,  with  OR  (odds  ratio)  of  3.6  (95%  CI: 2.79  -  4.66).  Predictor  factor  of  patients  with  a  history  of dyspepsia  possessed  the  highest  OR  {OR=4,29  (CI  95%:  3.23–5.7)}.  It  means  that  patients  with  a  history  of  dyspepsia prescribed  NSAIDs  would  have  greater  risk  of  4.29  times  to  get GPA  prescription  than  patients  without  a  history  of  dyspepsia. Prescribing  NSAIDs  &gt;  1  DDD  (defined  daily  dose)  had  p  value  of 0.777,  which  means  there  was  no  relationship  between  GPA prescription with NSAIDs &gt; 1 DDD prescription.Key  words: Gastroprotective  Agent,  Non-steroid  anti-inflammatory, Osteoarthritis, Rheumatoid Arthriti

Laboratory Testing of Transovarial Transmission in Aedes Aegypti Mosquito

Introduction: Ae. aegypti is one of the vectors causing Dengue Hemorrhagic Fever (DHF) that feeds on human blood suffering from DHF and transmit it to another healthy human. The ability of Dengue Virus (DENV) to survive in nature is due to 2 mechanisms i.e. horizontal transmission among viremic vertebratae infected by Aedes mosquitos and vertical (transovarial) transmission from infected female mosquito to another generation.Objectives: To know the differences between next generation’s viral carriage, percentage ofmosquito descendants carrying DENV, and the distribution of DENV in its infected mosquitos.Methods: Study design was a quasi experimental posttest-only design with control group. The study was conducted on 53 second-generation female Ae. aegypti mosquitos which are grouped into treatment and control groups. Dengue Viral antigen in both groups were detected by immunohistochemistry method using Streptavidin Biotin Peroxidase Complex (SBPC) in paraffin embedding preparation of mosquitos aged 1-7 days. Fisher exact test was used to compare proportion of virus detected in moaquitos between 2 groups.Results: The virus detected in second generation of DEN-infected and uninfected mosquitos were 100% and 85.7%, respectively. The virus was distributed from day 1 to 7 in all organs such as brains, thorax, salivary gland, gastric epithelial cells, and ovarium of the infected mosquitos. Similar distribution was not detected in control mosquitoes.Conclusion: There was no difference in next mosquito generation’s transovarial infection among DENV-infected and uninfected Ae. aegypti mosquitos.Keywords: Ae. aegypti mosquito; Dengue virus (DENV); transovarial transmission; immunohistochemistry method, Streptavidin Biotin Peroxidase Complex (SBPC)

The effect of the implementation of evidence-based drug formulary on antibacterial use in a private hospital at Tanjung Enim, Sumatera Selatan, Indonesia

The increase of drug expenditure in the hospital has facilitated the implementation of an evidence-based drug formulary. The aim of this study was to assess the change in antibacterial use after the implementation of an evidence-based drug formulary in a private hospital at Tanjung Enim, Sumatera Selatan, Indonesia. This study used a pre-posttest design. Drug use data in the period before (2010-2011) and after (2012-2013) the formulary implementation were extracted from the hospital medical records. The drug use in the hospital before and after the implementation was compared using t-test and chi-square test, with the significance level of 0.05. Average number of drugs prescribed per prescription after the implementation was similar with that before the implementation (4.4 vs 4.6; p > 0.05). However, the proportion of generic drugs prescribed increased significantly after the formulary implementation (17.0% vs 52.7%; p < 0.05). Moreover, it was still significantly increased when the analysis was conducted only for antibacterial drugs (25.9% vs 72.0%; p < 0.05). Average drug cost per prescription was 34% lower after the intervention (p < 0.05), and the average cost for antibacterial drug was also decreased (26%). The use of antibacterial drugs was significantly decreased after the intervention (12.5% vs 6.9%; p < 0.05). The most often antibacterial drugs prescribed before the interventions were beta-lactams and macrolides; while quinolones were more increasingly used after the intervention. In conclusion, the implementation of evidence-based hospital drug formulary in a private hospital at Tanjung Enim, Sumatera Selatan significantly increase generic drug use and decreased antibacterial use and average drug cost per prescription.    Key words : drug formulary – prescribing pattern – generic drug – antibacterial – private hospita

The effect of the implementation of evidence-based drug formulary on antibacterial use in a private hospital at Tanjung Enim, Sumatera Selatan, Indonesia

The increase of drug expenditure in the hospital has facilitated the implementation of an evidence-based drug formulary. The aim of this study was to assess the change in antibacterial use after the implementation of an evidence-based drug formulary in a private hospital at Tanjung Enim, Sumatera Selatan, Indonesia. This study used a pre-posttest design. Drug use data in the period before (2010-2011) and after (2012-2013) the formulary implementation were extracted from the hospital medical records. The drug use in the hospital before and after the implementation was compared using t-test and chi-square test, with the significance level of 0.05. Average number of drugs prescribed per prescription after the implementation was similar with that before the implementation (4.4 vs 4.6; p > 0.05). However, the proportion of generic drugs prescribed increased significantly after the formulary implementation (17.0% vs 52.7%; p < 0.05). Moreover, it was still significantly increased when the analysis was conducted only for antibacterial drugs (25.9% vs 72.0%; p < 0.05). Average drug cost per prescription was 34% lower after the intervention (p < 0.05), and the average cost for antibacterial drug was also decreased (26%). The use of antibacterial drugs was significantly decreased after the intervention (12.5% vs 6.9%; p < 0.05). The most often antibacterial drugs prescribed before the interventions were beta-lactams and macrolides; while quinolones were more increasingly used after the intervention. In conclusion, the implementation of evidence-based hospital drug formulary in a private hospital at Tanjung Enim, Sumatera Selatan significantly increase generic drug use and decreased antibacterial use and average drug cost per prescription.       Key words : drug formulary – prescribing pattern – generic drug – antibacterial – private hospita