POTENTIAL DRUG INTERACTIONS IN HYPERTENSIVE PATIENTS IN LIWA DISTRICT HOSPITAL, LAMPUNG BARAT, INDONESIA

Objective: Patients with hypertension often suffer from other comorbidities, resulting in prescriptions of multiple drugs to treat the conditions. Multiple drug treatment is potentially associated with drug interactions. This aim of the study was to assess potential drug interactions in hypertensive patients in Liwa District Hospital.Methods: The design of the study was cross-sectional. The prescriptions for in-patients with essential hypertension in the Internal Medicine Unit in Liwa District Hospital during April-December 2012 were collected. Potential drug interactions were analyzed with the Drug Interaction Facts version 4.0, and classified into minor, significant, and serious.Results: A total of 60 hypertensive patients were included. They were prescribed 265 prescriptions, with a median total of 6 (range 1-21) drugs prescribed per prescription. There were 1616 potential drug interactions, with 6 (1-31) potential interactions per prescription. Most interactions (75.6%) were classified as significant. Serious potential interactions were most common in the combinations of diltiazem-amlodipine and spironolactone-potassium chloride, while significant potential interaction may occur most often with the combinations of calcium chloride-amlodipine and bisoprolol-amlodipine.Conclusion: Numerous potential drug interactions might occur in hypertensive patients, and most interactions were significant in severity. The largest proportion of the interactions occurred between antihypertensive agents and other drugs.Â

Kumarin 8-Hidroksiisokapnolakton-2\u27,3\u27- Diol dari Daun Micromelum minutum: Aktivitas Sitotoksik dan Efeknya Terhadap Ekspresi Bcl-2 Sel Mieloma= Coumarin 8-Hydroxyisocapnolactone-2\u27.3\u27-Diol from Micromelum minutum Leaves

Abstract Multiple myeloma shows resistance to chemotherapy after being treated for some time, and one of the causes is overexpression of Bcl-2. Several coumarins had been shown to have cytotoxic activity, and one of them, i.e. imperatorin, caused apoptosis on cancer cells by suppressing the expression of Bcl-2. Coumarin 8-hydroxyisocapnolactone-2\u27,3\u27-diol, isolated from Micromelum minutum leaves, has showed cytotoxic activity on several cancer cell lines. The aims of this study were to find out whether coumarin 8-hydroxyisocapnolactone-2\u273\u27-diol has cytotoxic activity on myeloma cell line and whether the effect was caused through apoptotic process by suppressing the expression of Bcl-2. Cytotoxicity assay was performed on myeloma cell line NS-1, using trypan blue exclusion assay (doxorubicine was used as positive control). Expression of Bcl-2 was examined with immunohistochem-istry method. The result showed that coumarin 8-hydroxyisocapnolactone-2\u27,3\u27-diol has cytotoxic activity on myeloma cell line NS-1, and the ICj,, were 4.16 ug/ ml (24 hours), 4.22 ug/ml (48 hours), and 2.78 ug/ml (72 hours). The coumarin also suppressed the expression of Bcl-2 with IC~ of 17.88 mg/ml. In conclusion, coumarin 8-hydroxyisocapnolactone-2^3\u27-diol showed cytotoxic activity on myeloma cell line, and it was achieved by suppressing the expression of Bcl-2. Keywords: Coumarin - 8-hydroxyisocapnolactone-23\u27-diol - M. minutum -cytotoxic - expression of Bcl-2 - myeloma cell lin

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

Patterns of antiplatelet use in patients with myocardial infarction and subsequent acute coronary syndrome events

Background: Antiplatelet drugs are important for secondary prevention of cardiovascular events after myocardial infarction (MI). Objectives: The objectives of this study were to assess the patterns of antiplatelet drug use in patients who had a MI and to evaluate the impact of subsequent acute coronary syndrome (ACS) events on antiplatelet drug use in the Netherlands. Methods: A descriptive retrospective cohort study was conducted on 4719 patients in Utrecht Cardiovascular Pharmacogenetics studies, who had their first MI during 1986-2009. Medication use was assessed through the Dutch PHARMO Record Linkage System (dispensing database linked to the hospital admission registry). Antiplatelet users were classified as continuous users (gap between consecutive prescriptions ≤90 days), discontinued users (gap of >90days or no refills), and restarters (with a new antiplatelet drug episode after earlier discontinuation) and were followed for a maximum of 10years. Antiplatelet drug use in 90days before and after recurrent consecutive ACS events (MI and unstable angina) following the first MI was also compared. Results: At 1 year of follow-up, 83.7% patients continued using antiplatelets, 76.9% were still on aspirin, and only 36.4% patients were continuing clopidogrel. Most of the discontinuers restarted antiplatelet drugs later, leading to 74.7% antiplatelet users, 62.1% aspirin users and 35.2% clopidogrel users in 10 years after the index MI. For a subgroup of MI patients who started dual antiplatelet therapy with aspirin and clopidogrel (DAPT) after hospital discharge in 2002-2009, a total of 28.9% remained continuous users in 1 year, whereas 24% of the subjects switched to aspirin or clopidogrel monotherapy. When a recurrent ACS event occurred, antiplatelet use increased by 3.6% (

EDUKASI HIDUP SEHAT PADA ANAK DENGAN BERKEBUN SAWI HIJAU DI SDIT INSANURRAHMAN KELURAHAN LOKTABAT UTARA KOTA BANJARBARU

In social life, we can observe that children are less fond of foods made from vegetables. The Proportion of Consumption of Fruits/Vegetables Per Day of the Week in Population Age 5 Years According to the Characteristics of South Kalimantan Province, Riskesdas 2018, 34.56% of children aged 5-9 years do not consume vegetables and fruit. Also, for children aged 10-14 years, as much as 27.68% do not consume fruits and vegetables. This figure is high compared to other age groups. When the service was carried out, the average Pretest score was 8.21, which means that the students had a fairly good knowledge of healthy living education, and the average Post-Test was 8.5. Based on this value, there is an increase in the average knowledge of students after being given counselling. It is known that respondents' pre-test and post-test scores are generally not distributed because the significant value is less than 0.05 (Pre-test Sig Value = 0.001 &lt;0.05 and Post-test Sig Value = 0.001 &lt;0.05). So that the test is carried out with the Wilcoxon test. Based on the results of the Wilcoxon test, it is known that the value of Sig (0.001) &lt;0.05, namely Ho, is rejected, which means that there is a significant difference between the knowledge of the respondents before and after being given educational materials about the benefits of green mustard in preventing non-communicable diseases.  ---  Dalam kehidupan bermasyarakat dapat kita mengamati, bahwa anak-anak kurang menggemari makanan yang berbahan sayur. Proporsi Konsumsi Buah/Sayur Per Hari Dalam Seminggu Pada Penduduk Umur ≥ 5 Tahun menurut Karakteristik Provinsi Kalimantan Selatan, Riskesdas 2018, terdapat 34,56% anak usia 5-9 tahun yang tidak mengkomsumsi sayur dan buah. Dan juga anak usia 10-14 tahun sebanyak 27,68% tidak mengkomsumsi buah dan sayur. Angka yang tinggi disbanding kelompok umur lainnya. Saat dilaksanakan pengabdian didapatkan nilai rata-rata Pretest sebesar 8,21 yang artinya siswa siswa memiliki pengetahuan yang cukup baik mengenai edukasi hidup sehat, kemudian rata-rata Pos-ttest adalah sebesar 8,5. Berdasarkan nilai tersebut terdapat peningkatan rata-rata pengetahuan siswa setelah diberikan penyuluhan. Diketahui bahwa baik nilai pre-test maupun post-test responden tidak berdistribusi normal karena nilai signifikan yang kurang dari 0,05 (Nilai Sig Pre test = 0,001 &lt; 0,05 dan Nilai Sig Post test = 0,001 &lt; 0,05). Sehingga pengujian dilakukan dengan Uji Wilcoxon. Berdasarkan hasil dari Uji Wilcoxon diketahui bahwa nilai Sig (0,001) &lt; 0,05 yaitu Ho ditolak yang artinya ada perbedaan yang signifikan antara pengetahuan responden pada saat sebelum dan sesudah diberikan materi edukasi mengenai manfaat sawi hijau dalam mencegah penyakit tidak menular

Cost Effectiveness Analysis of Rivaroxaban Compared to Warfarin and Aspirin for Stroke Prevention Atrial Fibrillation (SPAF) in the Indonesian healthcare setting

Main drugs used in the prevention of stroke among atrial fibrillation (AF) patients are antiplatelets (aspirin) and oral anticoagulants (OAC). OAC therapy can be difficult to administer due to drug and food interactions, adds the burden of required blood monitoring, narrow therapeutic window, and requirements for dose titration. Rivaroxaban is a single-dose oral anticoagulant which does not require blood monitoring, dose titration or has dietary interactions. Phase III clinical data from the ROCKET trial have recently been reported the non-inferiority of rivaroxaban over warfarin for the prevention of strokes in AF patients. To develop an economic model evaluating the clinical and cost-effectiveness of rivaroxaban for the prevention of stroke in non-valvular AF patients in the Indonesian health care settings. We conducted cost effectiveness analysis from the perspective of payer (national health insurance). Effectiveness data used the international data from previous RCT and network metaanalysis studies. Costs data used local data of Indonesia from national health insurance’s reimbursement tariffs. Markov model was used, comprised of health and treatment states describing the management and consequences of AF. The main analysis was based on data from the phase III trials. Three months was used as cycle length. The time horizon was set at patients’ lifetime (20 years). Costs and outcomes were discounted at a 3% annual rate. Subgroup analysis and extensive sensitivity analysis was conducted. Willingness to pay (WTP) threshold in Indonesia was set as 3 times GDP of Indonesia in 2015, equal about IDR 133,375,000 per quality-adjusted life year (QALY). Base case rivaroxaban vs warfarin has ICER of IDR 141,835,063per QALY at the current cost of rivaroxaban IDR 23,500 and ICER of 130,214,687 per QALY at the proposed cost of rivaroxaban IDR 22,000. One-way sensitivity analysis showed that the key drivers of cost-effectiveness were the utility decrement applied to stable warfarin patients, discontinuation/subsequent discontinuation rates for rivaroxaban, and discontinuation/subsequent discontinuation rates for warfarin. The probabilistic sensitivity analysis suggested that rivaroxaban was cost-effective compared to warfarin in about 45% of cases at the WTP per QALY. Rivaroxaban with the proposed price of IDR 22,000 was considered to be more cost-effective when compared to warfarin

BMI and TLC Influences Doxorubicin/Epirubicin Neoadjuvant Chemotherapy Response in Patients with Locally Advanced Breast Cancer

Anthracycline-based neoadjuvant chemotherapy is the recommended therapy for locally advanced breast cancer (LABC) patients. Unfortunately, no study has reported the relationship between body mass index (BMI), total lymphocyte count (TLC), and responses to this type of chemotherapy. This study aimed to determine the relationship between BMI, TLC, and response to doxorubicin/epirubicin neoadjuvant chemotherapy in LABC patients. A retrospective cohort design was applied to medical records of LABC patients undergoing neoadjuvant chemotherapy at Ulin General Hospital Banjarmasin, Indonesia, from July to December 2021. BMI and TLC data were assessed based on the values before chemotherapy, while the chemotherapy response was measured using the RECIST 1.1 criteria after 3 cycles. Multinomial logistic regression test with 95% confidence level was used to analyze these data. The results showed that as many as 71% of patients experienced a Partial Response (PR), while 5% and 23% of the patients demonstrated Stable Disease (SD) and Progressive Disease (PD), respectively. Each increase in BMI of 1 kg/m2 was significantly associated with an increase in the occurrence of PR and PD by 1.26 times and 1.29 times, respectively, when compared to the occurrence of PD. Meanwhile, an increase in TLC of 100 cells/mm3 was associated with an increase in the occurrence of PR by 6.83 times and an increase in the occurrence of SD. of 6.94 when compared to the occurrence of PD. Therefore, there is a significant relationship between BMI, TLC, and response to anthracycline-based neoadjuvant chemotherapy in LABC patient

Patterns of antiplatelet therapy in patients with ischaemic stroke or transient ischaemic attack

Background: Antiplatelet drugs are indicated for the secondary prevention in ischaemic stroke or transient ischemic attack (TIA) patients. Objectives: This study aimed to assess the trend in antiplatelet drugs utilisation within 90 days after a first ischaemic stroke/TIA and to identify factors associated with the non-use of antiplatelet therapy. Methods: A cohort study was conducted using data from the UK Clinical Practice Research Datalink. A total of 21,064 patients aged 18 years or older diagnosed with a first ischaemic stroke/TIA between 1999 and 2013 were identified. Antiplatelet drug utilisation was evaluated based on the prescription in 90 days after ischaemic stroke/TIA. Age-adjusted prevalence rates of antiplatelet drug use were calculated. Trends over time were assessed using joinpoint regression. Multivariate logistic regression was used to estimate factors associated with non-use of antiplatelet therapy. Results: The age-adjusted prevalence rate of antiplatelet therapy were 77.5% (ischaemic stroke) and 78.2% (TIA). In the period 1999-2013, the average annual increase in antiplatelet prevalence rates were 2.0% (p <0.01) and 1.8% (p <0.01) in patients with ischaemic stroke and TIA, respectively. Aspirin monotherapy was most commonly used in 1999-2009, but the use declined with an increase in the use of aspirindipyridamole. From 2011, the clopidogrel monotherapy prevalence rates were the highest. Among patients with ischaemic stroke, factors significantly associated with non-use of antiplatelet therapy included female sex (OR 1.1), history of heart failure (OR 1.6), diabetes mellitus (OR 0.8), no prior use of antiplatelet (OR 2.3), previous use of oral anticoagulant (OR 9.2), and year of diagnosis (OR 0.95). As for patients with TIA, significant factors included increasing age (OR 0.91), history of heart failure (OR 1.38), hypertension (OR 0.80), no prior use of antiplatelet (OR 3.2), previous use of oral anticoagulant (OR 16.4), and year of diagnosis (OR 0.93). Conclusions: Antiplatelet drugs utilisation in 90 days after ischaemic stroke/TIA increased over time and the pattern of use were in accordance with the current recommendations. Sex, age, diagnosis year, comorbidity, and prior medications use were independently associated with non-use of antiplatelet therapy following ischaemic stroke/TIA