Swiss-Cheese Model Kausalitas Efek Samping Obat: Laporan Kasus Perdarahan Saluran Cerna Pada Penggunaan Obat Herbal

Abstract—Pharmacovigilance is a process to identify, evaluating, comprehending, and avoiding harmful drug or treatment-related events. Unfortunately, Indonesia still has a relatively low rate of reporting adverse drug reactions (ADR), including those caused by herbal medications. Lack of information is one factor contributing to this, among others being ignorance and lack of awareness. The Swiss-cheese model is a risk analysis approach that can be used to examine variables that could contribute to the occurrence of adverse drug reactions. A woman, 72, was checked into the hospital after complaining of melena. The patient had previously used herbal product that containing of Retrofracti fructus, Languatis rhizoma, Piperis nigri fructus, Blumeae folium, and Orthosiphonis folium, patient also consume herbs that made from lemongrass (Cymbopogon citratus) dan turmeric (Curcuma longa). Some herbs may have an impact on the cyclooxygenase (COX) system, raising the danger of gastrointestinal problems including bleeding. Diverse patient comorbidities may potentiate adverse drug reactions, necessitating careful monitoring of medication side effects, encompassing both pharmaceutical and herbal remedies. Swiss-cheese model is an approach that can be used to analyze factors that can contribute to adverse drug event. Naranjo and WHO-UMC were used in the causality analysis. Keywords: herbs; adverse drug reaction, gastrointestinal bleeding, patient safety, pharmacovigilans   Abstrak—Farmakovigilans merupakan kegiatan ditujukan sebagai upaya mendeteksi, menilai, memahami, dan mencegah kejadian yang merugikan akibat obat ataupun produk pengobatan. Sayangnya pelaporan efek samping obat (ESO) termasuk obat herbal masih sangat rendah di Indonesia. Hal ini dapat diakibatkan oleh kurangnya pengetahuan dan perhatian, salah satunya akibat kurangnya data. Swiss-cheese model adalah pendekatan analisis risiko yang dapat digunakan untuk menganalisis faktor-faktor yang dapat berkontribusi terhadap kejadian ESO. Seorang wanita 72 tahun masuk ke rumah sakit dengan keluhan melena. Pasien memiliki riwayat penggunaan produk herbal yang mengandung Retrofracti fructus, Languatis rhizoma, Piperis nigri fructus, Blumeae folium, Orthosiphonis folium, serta memiliki riwayat mengonsumsi jamu serai (Cymbopogon citratus) dan kunyit (Curcuma longa). Beberapa herbal memiliki potensi mempengaruhi sistem siklooksigenase (COX), sehingga meningkatkan risiko terjadinya gangguan pada saluran cerna seperti perdarahan. Serangkaian kondisi pasien dapat meningkatkan risiko terjadinya efek samping obat, sehingga perlunya perhatian terhadap efek samping obat termasuk obat herbal. Pemodelan Swiss-cheese merupakan suatu pendekatan yang dapat digunakan untuk menganalisis faktor-faktor yang dapat berkontribusi terhadap kejadian ESO. Analisis kausalitas dilakukan dengan menggunakan WHO-UMC dan Naranjo. Hal ini ditujukan sebagai upaya peningkatan pelayanan kesehatan yang aman bagi pasien. Kata kunci: obat herbal, efek samping, perdarahan saluran cerna, keamanan pasien, farmakovigilan

Mapping the Genomic Impact of the COVID-19 Virus

The COVID-19 pandemic caused by the RNA virus SARS-CoV-2, has had a significant impact not only on bodily metabolism but also at the genomic level. This study utilizes a bibliometric approach to map and identify the relationship between COVID-19 and DNA damage, genomic instability, and cell cycle deregulation. The research began with the development of in- depth research questions and conducted two rounds of literature search in the Scopus database with stringent filters to ensure relevance and accuracy. From an initial 1098 documents, 576 relevant documents were selected for further analysis. The collected data was then visualized using bibliometric methods, enabling the identification of important patterns, trends, and relationships among the research variables. Key findings indicate that DNA damage, which can induce apoptosis, is the worst impact of the infection on cells. Term frequency analysis and science mapping revealed a close relationship between "DNA damage" and "apoptosis". Furthermore, discussions on genomic instability highlight telomere regulation issues, while cell cycle deregulation during virus replication in mammalian cells indicates the importance of maintaining cell membrane integrity. This study confirms the importance of bibliometric analysis in detecting and understanding the impact of COVID-19 at the genomic level, proposing several potential research targets and enhancing our understanding of the biological response to viral infection

Unveiling The Critical Role Of CYP2C19 Gene In Precision Medicine Through Bibliometric Analysis

The CYP2C19 gene is pivotal in precision medicine, influencing the efficacy of therapeutic approaches, particularly in pharmacokinetics and pharmacogenomics. This study aims to extensively chart the research landscape of the CYP2C19 gene, delineating crucial interconnections among various research themes, and identifying significant studies and future research directions in precision medicine, with a focus on CYP2C19. An extensive literature review was conducted, adhering to PRISMA guidelines for reference curation and employing bibliometric analysis for research mapping. A total of 2,293 documents were retrieved from the Scopus database using 'precision' as the keyword. After meticulous refinement and data preparation, 1,829 of these publications were deemed suitable for in- depth analysis. The study reveals a notable increase in CYP2C19-related research from 2019 to 2022. The bibliometric analysis identified four primary clusters: Clopidogrel, Pharmacogenomics-Pharmacokinetics, Cytochrome P450, and Voriconazole. The Voriconazole cluster exhibited a unique divergence, indicating opportunities for collaborative research. Key strategic areas identified include valproic acid, antidepressants, and herb-drug interactions. Our findings provide valuable insights into the CYP2C19 gene research, offering a foundation for guiding future research in precision medicine

PATTERNS OF METHAMPHETAMINE USE AND ITS ASSOCIATIONS WITH PSYCHIATRIC SYMPTOMS IN PATIENTS UPON ADMISSION AT THE NATIONAL REHABILITATION CENTER LIDO BOGOR, INDONESIA

Objective: Methamphetamine (MA) is a substance that is heavily abused worldwide. This present study aimed to investigate the association between the patterns of methamphetamine use and psychiatric symptoms in patients upon admission at The National Rehabilitation Center, Lido Bogor. Methods: This was a cross-sectional study of MA abusers during the period of January 2016–December 2018 at The National Rehabilitation Center, Lido, Bogor. This study was done by assessing medical records. The inclusion criteria were MA abusers at the age of 18 y and above. Assessment of psychiatric symptoms was evaluated using Addiction Severity Index (ASI). Microsoft Excel and SPSS version 22.0 were used to process the data. Results: The inclusion criteria were fulfilled by 1842 MA abusers. We found that 770 (41.8%) of MA abusers were assessed with psychiatric symptoms according to ASI. Depression was the most prevalent psychiatric symptom (31.9%), followed by anxiety (24.5%), and psychosis (8.9%). According to the results of multivariate analysis, the demographic profile and the mode of MA administration that are associated with the psychiatric symptoms were: female [odds ratio (OR): 1.95; 95% confidence interval (CI): 1.25–2.96, p<0.001], 5-year duration of use [OR 1.43; 95% CI: 1.43 (1.19–1.73), p<0.001], smoking as the route of administration [OR 1.3; 95% CI: 1.08–1.56, p<0.001, p = 0.006], and concomitant use with other narcotics [OR 1.76; 95% CI: 1.46–2.13, p<0.001]. Conclusion: Among MA abusers admitted to The National Rehabilitation Center, the main factors associated with psychiatric symptoms were: female, long duration of use, smoking as the route of administration, and concomitant use with other narcotics

Farmakogenomik: Pendekatan Farmakologi Menuju Personalised Medicine

Variabilitas respon obat antar pasien merupakan salah satu penyebab morbiditas dan mortalitas pada pasien. Sebagian pasien dapat mengalami adverse drug reaction (ADR) maupun efek subterapeutik pada pemberian obat. Terdapat beberapa faktor yang berkontribusi terhadap hal tersebut, salah satunya adalah variabilitas genetik antar individu. Variabilitas genetik tersebut mendorong perkembangan ilmu farmakogenomik saat ini. Farmakogenomik adalah ilmu yang mempelajari bagaimana gen memengaruhi respon individu terhadap obat. Tujuan dikembangkannya farmakogenomik adalah untuk menghasilkan pengobatan yang lebih optimal. Beberapa gen telah dibuktikan memiliki keterkaitan terhadap respon obat, yang mana dapat mempengaruhi kadar obat di dalam darah (farmakokinetik) maupun efek obat secara langsung (farmakodinamik). Perubahan farmakokinetik dan farmakodinamik obat dapat berpotensi menyebabkan toksisitas maupun penurunan efektivitas suatu obat. Tulisan ini bertujuan untuk memaparkan ketersediaan informasi variasi genetik yang telah diketahui dapat mempengaruhi respon obat, sehingga dapat membantu meningkatkan ketepatan strategi farmakoterapi

FARMAKOGENOMIK: PENDEKATAN FARMAKOLOGI MENUJU PERSONALISED MEDICINE

One of the factors contributing to patient morbidity and death is variable variability in treatment response. Adverse drug responses (ADRs) or subtherapeutic effects are possible in certain patients during medication administration. The genetic variation is one of the many variables that contribute to this condition. Pharmacogenomics is the study of how genes influence an individual's response to drugs. The goal of pharmacogenomics  is to optimise treatment for the patient. It has been established that a number of genes are associated with drug response, which affects both the direct effects of drugs (pharmacodynamics) and their blood levels (pharmacokinetics). Modifications to a medication's pharmacokinetics and pharmacodynamics may result in toxicity or lessen its efficacy. In order to increase the precision of pharmacotherapy techniques, this study aims to elucidate the availability of data on genetic variants that are known to affect medication response.Variabilitas respon obat antar pasien merupakan salah satu penyebab morbiditas dan mortalitas pada pasien. Sebagian pasien dapat mengalami adverse drug reaction (ADR) maupun efek subterapeutik pada pemberian obat. Terdapat beberapa faktor yang berkontribusi terhadap hal tersebut, salah satunya adalah variabilitas genetik antar individu. Variabilitas genetik tersebut mendorong perkembangan ilmu farmakogenomik saat ini. Farmakogenomik adalah ilmu yang mempelajari bagaimana gen memengaruhi respon individu terhadap obat. Tujuan dikembangkannya farmakogenomik adalah untuk menghasilkan pengobatan yang lebih optimal. Beberapa gen telah dibuktikan memiliki keterkaitan terhadap respon obat, yang mana dapat mempengaruhi kadar obat di dalam darah (farmakokinetik) maupun efek obat secara langsung (farmakodinamik). Perubahan farmakokinetik dan farmakodinamik obat dapat berpotensi menyebabkan toksisitas maupun penurunan efektivitas suatu obat. Tulisan ini bertujuan untuk memaparkan ketersediaan informasi variasi genetik yang telah diketahui dapat mempengaruhi respon obat, sehingga dapat membantu meningkatkan ketepatan strategi farmakoterap

Implementation of Interprofessional Education (IPE) in Phytotherapy Class at University of Surabaya

Implementation of Interprofessional Education (IPE) in Phytotherapy Class by Students of University of Surabaya Oeke Yunita1, Risma Ikawaty2, Jefman Efendi Marzuki H.Y. 2 1Faculty of Pharmacy, University of Surabaya 2Faculty of Medicine, University of Surabaya Corresponding author: Oeke Yunita, Raya Kalirungkut Surabaya, +622981112, +622981111, [email protected] ABSTRACT Introduction: Many developed countries have been teaching interprofessional education (IPE) for more than 53 years. Those countries including Canada, UK, US, and Australia. The use of IPE in the healthcare education curriculum has been shown to improve communication and teamwork skills of healthcare professional. Aim of this study is to see how IPE approach can be implemented at the Faculty of Pharmacy and Medicine, particularly in the Phytotherapy class. Method: This was a preliminary study for the development of Model IPE, specifically for Competency Domain Ethics and Shared Values and Interprofessional Communication. The research was carried out at the University of Surabaya and involved two study programs, namely Pharmacy and Medicine. Observational research method applied on 108 students from both faculties who took Phytotherapy class for two weeks. The survey method was used to conduct the assessment, which was based on the Interdisciplinary Education Perception Scale and the Communication Rubric. Results: This study found that the application of IPE at Phytotherapy class could help students to get insight into the characteristics and values of various healthcare professions. This approach also helped student to practice and improve soft-skills on communication and teamwork as a first step toward collaborative practice among healthcare practitioners Conclusions: IPE teaching methods can be used in pharmacy and medicine curriculum and can be developed into another courses and extracurricular activities collaborative learning, health professions education, interprofessional education, phytotherap

Psychotics Effects of Cyclopentolate 1%

Introduction: Cyclopentolate eye drops 1% are frequently used during the cycloplegic refraction test. Cyclopentolate 1% side effects that are neurotoxic have the potential to be fatal but are extremely rare. Case Illustration: Thirty minutes after the first drop of the cycloplegic refraction preparation, a 4-year- old kid had neurotoxic effects in the form of anxiety, disrupted communicative interactions, and hallucinations after receiving 3 drops of 1% cyclopentolate. Drug administration was stopped, and the patient was observed in the ER. After stopping the eye drops and being monitored in the ED for two hours, the condition improved. Discussion: A cycloplegic medication that affects muscarinic receptors is cyclopentolate 1%. Administering eye drops is supposed to have a local effect on the eyes only, but frequently systemic effects can happen if there is absorption via the mucosa of the throat, nose, and stomach due to the eye drops' flow through the nasolacrimal duct when the medicine is instilled. One of Cyclopentolate's 1% uncommon adverse effects is neurotoxic impact, which can be fatal. When cyclopentolate interacts with the central nervous system's muscarinic receptors, this syndrome may result. The severity of the side effects increases with dosage and administration frequency, age and BMI, and dose. Focusing on the Lacrimal Canal during delivery and using the lowest dose of cyclopentolate are recommended to minimize side effects. Conclusion: Cyclopentolate 1% has a rare but potentially catastrophic side effect called neurotoxicity. Reduce the dosage of cyclopentolate, administer it properly and using the combination with other cycloplegic can reduce adverse effects