RED GINGER (Zingiber officinale var. rubrum): ITS CHEMICAL CONSTITUENTS, PHARMACOLOGICAL ACTIVITIES AND SAFETY

Ginger (Zingiber officinale) which belongs to the Zingiberaceae family, was first cultivated in Asia (Indonesia and Malaysia). This plant is one of the most commonly used herbal supplements taken by many patients to treat various conditions. Z.officinale has three varieties based on its size, colors of rhizome and chemical constituents i.e. .Z. officinale var. officinale (big white ginger or giant ginger, badak or gajah), Z. officinale var. amarum (small white ginger, emprit), and Z. officinale var. rubrum (small red ginger, merah or beureum). These three varieties may partly be deferred from their essential oil contents and are used for different purposes. The essential oils contained in Z. officinale var. rubrum are higher than the other types of ginger, which makes stronger in its pungency smell and taste. There are many studies that confirm beneficial effects of red ginger against the symptoms of diseases, i.e. anti-inflammation, antioxidant, antiemetic, antibacterial and antidiabetics. Z.officinale var. rubrum is considered to be a safe herbal medicine with only few and insignificant adverse/side effects. Although the medicinal properties of red ginger have been known, further trials in humans are required to determine the efficacy of red ginger (or one or more of its constituents) and to establish what, if any, adverse effects are observed

A Review: Is Ginger (Zingiber officinale var. Roscoe) Potential for Future Phytomedicine?

AbstractZingiber officinale Roscoe (red:ginger), is one of the most widely consumed medicinal herbs in the world has been widely used to treat various disorders in Indonesia. There are three known types of ginger: giant ginger or white ginger (Zingiber officinale var. Roscoe), small white ginger or ginger emprit (Zingiber officinale var. Amarum), and red ginger (Zingiber officinale var. Rubrum). The main components of ginger rhizome are carbohydrates, lipids, essential oils, terpenes, and phenol compounds such as gingerol (23-25%) and shogaol (18-25%). Many studies had confirmed benefical effects of ginger against inflammation, free radicals, diabetes melitus, bacterial infection, cancer, nausea, etc. Z. officinale var. rubrum is considered a safe herbal remedy with only slight and not significant adverse effects. This plant is potential fur future phytomedicine, however it needs further explorations on its clinical studies in humans is expected, especially the efficacy and safety of the risk of side effects

SATISFACTION LEVEL OF PATIENTS, PHYSICIANS, AND PRIVATE PRIMARY HEALTHCARE CENTER MANAGERS WITH CHRONIC DISEASE MANAGEMENT PROGRAM IN INDONESIA

Objective:Program PengelolaanPenyakitKronis (PROLANIS) or Chronic Disease Management Program (CDMP) is a healthcare system that was conducted by Healthcare and Social Security Agency in Indonesia to improve patients' quality of life. The objective of this study was to analyze level satisfaction of patients, physicians, and private Primary Healthcare Centers (PHCs) with this program, focusing on hypertension care.Methods:This study was conducted in 7 private PHCs in Bandung City, Indonesia. A cross sectional study was performed to measure patient satisfaction with PSQ-18 on 143 PROLANIS patients with hypertension. A total number of 8 physicians and 7 private PHC managers were involved in this study. Level satisfaction of physicians and private PHC managers were observed by using in-depth interviews.Results:The results showed that patient satisfaction was estimated to be 68.52±8.54, which could be interpreted that patient satisfy with PROLANIS. In-depth interviews showed that physicians did not satisfy with PROLANIS due to several factors (e.g., unintegrated prescription systems, lack of medicines, uncompleted laboratory facilities, lack of physicians, unintegrated referral services, and lack of collaboration between primary and secondary healthcare system). On the other hand, private PHC managers were quite satisfied with PROLANIS due to its linearity with other activities in private PHCs.Conclusion:Level satisfaction of patients with PROLANIS is quite good, while physicians might not satisfy with this program. In particular, private PHC managers confirmed that they are satisfied with this progra

The Role of Administrative and Secondary Data in Estimating the Costs and Effects of School and Workplace Closures due to the COVID-19 Pandemic

As a part of mitigation strategies during a COVID-19 pandemic, the WHO currently recommends social distancing measures through school closures (SC) and work closures (WC) to control the infection spread and reduce the illness attack rate. Focusing on the use of administrative and secondary data, this study aimed to estimate the costs and effects of alternative strategies for mitigating the COVID-19 pandemic in Jakarta, Indonesia, by comparing the baseline (no intervention) with SC + WC for 2, 4, and 8 weeks as respective scenarios. A modified Susceptible-Exposed-Infected-Recovered (SEIR) compartmental model accounting for the spread of infection during the latent period was applied by taking into account a 1-year time horizon. To estimate the total pandemic cost of all scenarios, we took into account the cost of healthcare, SC, and productivity loss due to WC and illness. Next to costs, averted deaths were considered as the effect measure. In comparison with the baseline, the result showed that total savings in scenarios of SC + WC for 2, 4, and 8 weeks would be approximately $24 billion,$25 billion, and $34 billion, respectively. In addition, increasing the duration of SC and WC would increase the number of averted deaths. Scenarios of SC + WC for 2, 4, and 8 weeks would result in approximately 159,075, 173,963, and 250,842 averted deaths, respectively. A sensitivity analysis showed that the wage per day, infectious period, basic reproduction number, incubation period, and case fatality rate were found to be the most influential parameters affecting the savings and number of averted deaths. It can be concluded that all the mitigation scenarios were considered to be cost-saving, and increasing the duration of SC and WC would increase both the savings and the number of averted deaths

Efficacy and Side Effects of Deferasirox and Deferiprone for Thalasemia Major in Children

Thalassemia major (TM) is an inherited disease caused by defective or absent of hemoglobin chain synthesis. Regular chelation therapy is necessary to reduce excess iron in several organs of TM patients. The most commonly used chelating agents are deferasirox and deferiprone. However, information regarding their effectiveness and side effects in Indonesian children population with TM were limited. This study was conducted to assess the effectiveness and side effects of deferasirox and deferiprone in pediatric patients with TM. This was an observational study with prospective analysis which was conducted during April-August 2015. We included pediatric patients with TM who visited a hospital in Bandung, Indonesia, using consecutive sampling method. Thirty two subjects were divided into two groups, i.e., deferasirox and deferiprone group. Review of medical records and interview were performed for each participants. Effectiveness was defined as reduction in ferritin level. Side effects were assessed using Naranjo scale. Data were analyzed using Mann-Whitney test, Wiloxon test and Chi square test. P value < 0.05 defined statistical significance. We found that deferasirox was more effective than deferiprone for the treatment of TM in pediatric patiens, with less side effects. The use of deferasirox as iron chelating agent is recommended for patients with TM. Keywords: deferasirox, deferiprone, ferritin, thalassemia majo

Aktivitas Antioksidan Dan Sitotoksik Serta Penetapan Kadar Senyawa Fenol Total Ekstrak Daun, Bunga, Dan Rimpang Kecombrang (Etlingera elatior)

Kecombrang (Etlingera elatior) merupakan tanaman suku Zingiberaceae yang memiliki potensi sebagai antioksidan. Penelitian ini bertujuan untuk mengetahui aktivitas antioksidan dan sitotoksik terhadap larva udang dari ekstrak daun, bunga, dan rimpang kecombrang, serta menetapkan kadar senyawa fenol totalnya. Sampel daun, bunga, dan rimpang kecombrang dimaserasi dengan pelarut etanol 70% selama 3x24 jam dalam suhu ruangan. Ekstrak yang didapat selanjutnya dievaporasi pada suhu 50 0C sehingga menghasilkan ekstrak kental. Uji aktivitas antioksidan dilakukan menggunakan metode peredaman radikal bebas 1,1-difenil-2-pikrihidrazil (DPPH), dan uji sitotoksik menggunakan metode BSLT (Brine Scrimp Lethality Test). Penetapan kadar fenol total dengan standar asam galat menggunakan reagen Folin Ciocalteu yang diukur dengan spektrofotometer pada panjang gelombang 765 nm. Aktivitas antioksidan dari ekstrak daun, bunga, dan rimpang kecombrang ditunjukkan oleh nilai IC50 masing-masing 52,05; 457,54; dan 310,69 ppm. Aktivitas sitotosik yang dinyatakan dalam nilai LC50 dari ketiga bahan tersebut berturut-turut adalah 859,039; 418,022; dan 1261,202 ppm. Kadar senyawa fenol total ekstrak daun, bunga, dan rimpang kecombrang dihitung sebagai asam galat ekuivalen berturut-turut sebesar 0,339% ± 0,006; 0,144% ± 0,024; dan 0,074% ± 0,018. Ekstrak daun kecombrang menunjukkan aktivitas antioksidan yang paling baik dan kadar fenol total paling tinggi dibandingkan ekstrak bunga dan rimpang kecombrang. Ekstrak daun dan bunga kecombrang menunjukkan potensi sebagai agen antikanker karena menunjukkan nilai LC50 1000 ppm

Sustainable financing for new vaccines in Indonesia: challenges and strategies

Immunization is one of the most cost-effective interventions in global health and has a crucial role in achieving 14 of the 17 sustainable development goals (SDGs). The issue of sustainable financing for new vaccines is particularly pertinent as Indonesia transitions away from extensive Gavi support towards a self-financing immunization system. As the current immunization system transitions, practical solutions must be found and applied to provide more flexibility in the budget for financing immunizations without sacrificing the current healthcare system’s needs. Despite the fact that economic evaluation studies are essential as an initial step to ensure financial readiness, the lack of reliable data is the first barrier to Indonesia’s journey toward a self-financing immunization system. To overcome this problem, standardization of data collection strategies and methodologies are required. In particular, Indonesia may have to explore other options to increase revenue for its immunization system, such as through general revenue from the central government, a sector-wide approach to financing, and a national trust fund. To deal with the tight immunization budget and its consequences, Indonesia also has to restructure its immunization system, which can be implemented through province block grants, insurance mandate and subsidy. Taking the potential of a COVID-19 vaccine into account, the Indonesian government should consider a number of costs and issues beyond the development and procurement of vaccines. The costs of delivering vaccines to the remote parts of Indonesia, implementing the necessary infrastructure, and modifying vaccine delivery are also important in this time of transition. These constraints must be addressed in the new self-financing system and other public health efforts must be increased to decrease the burden of infectious disease as Indonesia develops a stronger immunization system

Barriers and strategies to successful tuberculosis treatment in a high-burden tuberculosis setting:A qualitative study from the patient's perspective

Abstract Background Previously treated tuberculosis (TB) patients are a widely reported risk factor for multidrug-resistant tuberculosis. Identifying patients’ problems during treatment is necessary to control TB, especially in a high-burden setting. We therefore explored barriers to successful TB treatment from the patients’ perspective, aiming to identify potential patient-centred care strategies to improve TB treatment outcome in Indonesia. Methods A qualitative study was conducted in a province of Indonesia with high TB prevalence. Participants from various backgrounds (i.e., TB patients, physicians, nurses, pharmacists, TB activist, TB programmers at the district and primary care levels) were subject to in-depth interviews and focus group discussions (FGDs). All interviews and FGDs were transcribed verbatim from audio and visual recordings and the respective transcriptions were used for data analysis. Barriers were constructed by interpreting the codes’ pattern and co-occurrence. The information’s trustworthiness and credibility were established using information saturation, participant validation and triangulation approaches. Data were inductively analysed using the Atlas.ti 8.4 software and reported following the COREQ 32-items. Results We interviewed 63 of the 66 pre-defined participants and identified 15 barriers. The barriers were classified into three themes, i.e., socio-demography and economy; knowledge and perception and TB treatment. Since the barriers can be interrelated, we determined five main barriers across all barrier themes, i.e., lack of TB knowledge, stigmatisation, long distance to the health facility, adverse drug reaction and loss of household income. Conclusion The main treatment barriers can be considered to strengthen patient-centred care for TB patients in Indonesia. A multi-component approach including TB patients, healthcare providers, broad community and policy makers is required to improve TB treatment success

Aktivitas Antioksidan dan Sitotoksik Serta Penetapan Kadar Senyawa Fenol Total Ekstrak Daun, Bunga, dan Rimpang Kecombrang (Etlingera Elatior)

Kecombrang (Etlingera elatior) merupakan tanaman suku Zingiberaceae yang memiliki potensi sebagai antioksidan. Penelitian ini bertujuan untuk mengetahui aktivitas antioksidan dan sitotoksik terhadap larva udang dari ekstrak daun, bunga, dan rimpang kecombrang, serta menetapkan kadar senyawa fenol totalnya. Sampel daun, bunga, dan rimpang kecombrang dimaserasi dengan pelarut etanol 70% selama 3x24 jam dalam suhu ruangan. Ekstrak yang didapat selanjutnya dievaporasi pada suhu 50 0C sehingga menghasilkan ekstrak kental. Uji aktivitas antioksidan dilakukan menggunakan metode peredaman radikal bebas 1,1-difenil-2-pikrihidrazil (DPPH), dan uji sitotoksik menggunakan metode BSLT (Brine Scrimp Lethality Test). Penetapan kadar fenol total dengan standar asam galat menggunakan reagen Folin Ciocalteu yang diukur dengan spektrofotometer pada panjang gelombang 765 nm. Aktivitas antioksidan dari ekstrak daun, bunga, dan rimpang kecombrang ditunjukkan oleh nilai IC50 masing-masing 52,05; 457,54; dan 310,69 ppm. Aktivitas sitotosik yang dinyatakan dalam nilai LC50 dari ketiga bahan tersebut berturut-turut adalah 859,039; 418,022; dan 1261,202 ppm. Kadar senyawa fenol total ekstrak daun, bunga, dan rimpang kecombrang dihitung sebagai asam galat ekuivalen berturut-turut sebesar 0,339% ± 0,006; 0,144% ± 0,024; dan 0,074% ± 0,018. Ekstrak daun kecombrang menunjukkan aktivitas antioksidan yang paling baik dan kadar fenol total paling tinggi dibandingkan ekstrak bunga dan rimpang kecombrang. Ekstrak daun dan bunga kecombrang menunjukkan potensi sebagai agen antikanker karena menunjukkan nilai LC50 1000 ppm