Category: Nevin Manimala

J Basic Clin Physiol Pharmacol. 2021 Jun 25;32(4):453-458. doi: 10.1515/jbcpp-2020-0434.

ABSTRACT

OBJECTIVES: Medication non-adherence mostly occurs in patients with a wide range of disease severity, including asthma. The aim of the study was to assess the self reported adherence to asthma therapy and investigate the relationship between adherence, asthma control and asthma-related quality of life.

METHODS: The study was a cross-sectional study in which participants were recruited from an outpatient department, in one hospital in Surabaya. Patients (aged≥18 years) with asthma who had used any regular asthma medications were included. Standardised questionnaires, including Juniper’s Asthma Control Questionnaire (ACQ), Adherence to Refills and Medications Scales (ARMS) and Juniper’s Asthma Quality of Life Questionnaire (AQLQ) were used.

RESULTS: A total of 82 adults with asthma were recruited in the study. Male participants’ mean age was 49.13 ± 14.10 years (n = 23). Approximately 59 participants (72.0%) were females, 30 participants (36.5%) were using Budesonide inhaler, and 73 participants (89.0%) never smoked. The mean of ACQ, AQLQ, and ARMS scores were 1.62 ± 1.19, 4.96 ± 1.24, and 16.98 ± 4.12, respectively. Of 82 patients studied 53 (64.6 %) had “uncontrolled asthma” and more than 85% participants both showed “non adherence” to asthma therapy and nearly 46% of them indicated that their quality of life was affected by asthma. There was a significant association between ACQ and AQLQ (p<0.05), whereas no statistically significant association was found between ACQ and ARMS.

CONCLUSIONS: The majority of patients reported non-adherence to asthma medications. Poor controlled asthma has been associated with lower asthma-related quality of life.

PMID:34214370 | DOI:10.1515/jbcpp-2020-0434

Diagnosis (Berl). 2021 Jul 1. doi: 10.1515/dx-2021-0016. Online ahead of print.

ABSTRACT

OBJECTIVES: Clinical reasoning skills are essential for sound medical decision-making. Though many have suggested that clinical reasoning instruction should begin in pre-clerkship curricula, neither pre-clerkship clinical skills director perspectives nor extent of instruction is known. This survey study serves as part of a needs assessment for United States medical school pre-clerkship clinical reasoning curricula.

METHODS: United States medical school pre-clerkship clinical skills course directors were surveyed about perceived importance of formal instruction on clinical reasoning concepts, inclusion of these concepts in the curricula, barriers to instruction, and familiarity with clerkship curricula. Results were analyzed using descriptive and analytic statistics. Narrative comments were analyzed qualitatively for themes.

RESULTS: Of 148 directors surveyed, 102 (69%) participated and 89 (60%) completed all closed-ended items. Each clinical reasoning concept was identified as somewhat to extremely important to include in pre-clerkship curricula by 90-99% of respondents. Pre-clerkship curricula included variable degrees of formal instruction for concepts, though most respondents rated their inclusion as moderate or extensive. Perceived importance of teaching most concepts moderately correlated with the degree of inclusion in the curriculum (Spearman’s rho 0.39-0.44). Curricular time constraints and lack of faculty with skills to teach these concepts were the most frequently cited barriers to instruction. Respondents indicated being somewhat 57% (n=54) to extremely 29% (n=27) familiar with clerkship curricula at their institutions.

CONCLUSIONS: This study is the first to examine pre-clerkship clinical skills course director perspectives about clinical reasoning instruction and extent of its inclusion in their curricula.

PMID:34214385 | DOI:10.1515/dx-2021-0016

J Basic Clin Physiol Pharmacol. 2021 Jun 25;32(4):675-680. doi: 10.1515/jbcpp-2021-0074.

ABSTRACT

OBJECTIVES: One of the treatments for rheumatoid arthritis (RA) was methotrexate which a disease modifying antirheumatic drug therapy. The use of methotrexate required the right dose and length of therapy to achieve remission. The effectivity of methotrexate could be accounted by disease activity score 28 (DAS28) as a tool has been used clinically with a combination number of tender joints, swollen joints, erythrocyte sedimentation rate, and global clinical assessment by the patient. The aim of this study was to determine the effective dose and length of therapy methotrexate was measured by DAS28 score.

METHODS: This research was a cross-sectional study and data was collected from patient medical records in Saiful Anwar Hospital, Malang, from February to July 2018. The research has been given ethical clearance. The inclusion criteria for the 88 subjects were men and women, over 20 years of age, usage of only methotrexate for at least three months, an erythrocyte sedimentation rate score, uncomplicated inflammatory bowel disease, cancer, and systemic lupus erythematosus. All data obtained was entered in formula DAS28. The Statistic analysis used both Pearson and Spearman’s rank correlation.

RESULTS: Only 16 patients achieved remission. There were not significant correlation in statistical analysis between DAS score and cumulative dose (r=-0.091; p=0.400), average dose (r=0.043; p = 0.692), maximum dose (r=0.074; p=0.492), and length of therapy (r=-0.075; p = 0.489). The initial dose of therapy methotrexate was different and the length of therapy was adjusted to the patient’s health condition.

CONCLUSIONS: The maximum dose and length of therapy methotrexate was required to achieve remission in RA.

PMID:34214354 | DOI:10.1515/jbcpp-2021-0074

J Basic Clin Physiol Pharmacol. 2021 Jun 25;32(4):777-781. doi: 10.1515/jbcpp-2020-0468.

ABSTRACT

OBJECTIVES: This study aimed to estimate the prevalence and analyze the risk factors for linezolid-induced hematological side effects in multidrug-resistant tuberculosis (MDR-TB) patients.

METHODS: Data were collected from medical records of MDR-TB patients who received linezolid between January 2018 and May 2020. Statistical significance analysis and multivariate analysis were performed with SPSS version 24 software.

RESULTS: Hematological side effects were identified in 27 out of 93 patients (29.0%). The most prevalent effect was anemia (29.0%), while the less prevalent effects were thrombocytopenia (3.2%) and leukopenia (2.2%). These side effects were reported after 2 weeks of linezolid treatment. The drug dose was more than 11 mg/kgBW/day or patient weighing less than 54 kg was identified as an independent risk factor for anemia in multivariate analysis.

CONCLUSIONS: Anemia was the most prevalent of linezolid-induced hematological side effects in MDR-TB patients. Therefore, hemoglobin monitoring might be recommended in patients weighing less than 54 kg and after receiving linezolid therapy for at least 2 weeks.

PMID:34214355 | DOI:10.1515/jbcpp-2020-0468

J Basic Clin Physiol Pharmacol. 2021 Jun 25;32(4):595-601. doi: 10.1515/jbcpp-2020-0469.

ABSTRACT

OBJECTIVES: Fever is a condition when the body experiences an increase in average body temperature above normal level. Maja fruit (Crescentia cujete L.) contains chemical compounds including alkaloid, flavonoid, saponin, and terpenoid, suspected as potential antipyretics.

METHODS: The study aimed to determine the antipyretic activity of ethanol extract of Maja fruit. A total of 25 male white mice of the DDY strain (20-30 g). These treatments divided into three groups with a dose extract of 125, 250, 500 mg/kg BW, standard groups of ibuprofen 400 mg/kg BW, and control groups of CMC-Na 1%. Mice were injected intraperitoneally with 0.1 cc of DPT vaccine-induced. Observations were made by measuring the rectal temperatures of mice using a digital thermometer before DPT vaccine injected or average temperatures, at 0 min (after DPT vaccine injected), 60, 120, 180, and 240 min after administering the test material. The differences between the positive control group, test group, and the negative control group were compared using statistical analysis using one-way variance analysis (ANOVA). The results were considered statistically when the value is (p<0.05).

RESULTS: The above phytochemical screening results showed that alkaloids, flavonoids, and saponins were present in the Maja fruit powder and extract (C. cujete L.). Based on the results of the statistical analysis obtained, i.e., Group II was not significantly different from Group III and Group IV (p≤0.05) and was significantly different from Group I and Group V. Group I was significantly different from Group II, Group III and Group IV and was not significantly different from Group V (p≥0.05).

CONCLUSIONS: The study showed that Maja fruit mice’s antipyretic behavior at doses of 125, 250, and 500 mg/kg BW was confirmed as a result in reducing the body temperature of male mice. The 500 mg/kg BW dosage of Maja fruit extract (C. cujete L) effectively reduced fever.

PMID:34214325 | DOI:10.1515/jbcpp-2020-0469

J Basic Clin Physiol Pharmacol. 2021 Jun 25;32(4):583-587. doi: 10.1515/jbcpp-2020-0402.

ABSTRACT

OBJECTIVES: This study aimed to evaluate the variation concentration effect of propyleneglycol, glycerin, and polyethyleneglycol 400 as a nonvolatile solvent on the physical properties and dissolution rate of the loratadine liquisolid tablet.

METHODS: The tablet was formulated into 10 formulas, where nine were liquisolid and one was conventional (CT). The concentration of propyleneglycol, glycerin, and polyethyleneglycol used in liquisolid tablets were 14, 15, and 16%. Furthermore, the mixture was evaluated based on flow properties and compressibility index. The tablet was evaluated based on hardness, friability, disintegration time, and dissolution, and the data obtained was evaluated with ANOVA or Kruskal-Wallis statistic program.

RESULTS: The result showed that flow properties, disintegration time, and dissolution have a significant value less than 0.05. The tablet friability for all concentration solvents, hardness at 14 and 15% solvent concentration, and compressibility index at 15 and 16% have significant value more than 0.05. The 16% propyleneglycol type solvent concentration tablet has the physical properties and contains the best solution.

CONCLUSIONS: From the result, it is reasonable to conclude that F7 is the tablet with all the physical properties and the best dissolution.

PMID:34214337 | DOI:10.1515/jbcpp-2020-0402

J Basic Clin Physiol Pharmacol. 2021 Jun 25;32(4):693-700. doi: 10.1515/jbcpp-2020-0453.

ABSTRACT

OBJECTIVES: The incision method operation with a high risk of infection in a clean and clean-contaminated operation requires the use of prophylactic antibiotics to minimize the risk of infection. This study was designed to analyze the effectiveness of prophylactic antibiotics in patients with digestive and oncology surgeries.

METHODS: The statistical method used was chi-square to determine the risk factors for infection at surgical site infections (SSI) in patients with digestive and oncology surgeries. This study had received ethical approval from the Ethics Committee of Dr. H. Slamet Martodirdjo Hospital, Pamekasan.

RESULTS: There were 67 patients consisted of 48 digestive surgeries (71.6%) and 19 oncology surgeries (28.4%). The criteria of observation on day 30 showed that as 1 (1.5%) SSI patient experienced purulence, inflammation, and erythema around the surgical wound so an analysis of p>0.05 was carried out so that there was no association with the incidence of SSI during hospitalization, but other factors originating from the patient, such as a lack of personal hygiene at home and lack of nutritious food intake was measured in temperature, pulse, respiration, and white blood cells examination before surgery and 24 h after surgery, all within normal ranges. The qualitative analysis of prophylactic antibiotics using the Gyssen method showed that 31 (46.3%) rationales needed an improvement process.

CONCLUSIONS: The widely used prophylactic antibiotics, namely cefazolin and cefuroxime are recommended antibiotics used in incision surgery and rationale used.

PMID:34214340 | DOI:10.1515/jbcpp-2020-0453

J Basic Clin Physiol Pharmacol. 2021 Jun 25;32(4):421-427. doi: 10.1515/jbcpp-2020-0415.

ABSTRACT

OBJECTIVES: Indonesia is one of the top 20 countries with the highest prevalence of drug resistant tuberculosis (DR-TB) worldwide with a percentage of new cases of 2.4% and retreatment of 13%. Bedaquiline (BDQ) is one of the drugs that used in the individual long regimen treating DR-TB. BDQ is also combined with levofloxacin (LFX) and/or clofazimine (CFZ) that can cause QTc interval prolongation. The aim was to study the differences in the use of BDQ regimens to the lengthening of the QTc interval and to study risk factors (diabetes, hypokalemia, sex, BMI, and age) in BDQ regimen.

METHODS: This study was an observational retrospective study with a total sampling method, which was conducted at Dr. Soetomo General Hospital Surabaya. Samples from this study were patients diagnosed with DR-TB at Dr. Soetomo General Hospital Surabaya in the period of January 2015-December 2019 who used BDQ regimen and met the inclusion criteria. The ECG data were analyzed from the mean of each group (BDQ regimen and risk factors), also analyzed using statistical analysis.

RESULTS: Data obtained from total sample in this study were 73 patients. The most widely used different regimens in this study were the combination of BDQ + LFX by 36 patients (49.3%), BDQ + LFX + CFZ by 16 patients (21.9%), BDQ by 11 patients (15.1%) and BDQ + CFZ 10 patients (13.7%). Out of 73 patients, 52 patients (71.2%) experienced lengthening of the QT interval and grade 1 of QTc interval prolongation occurred in most patients and also the onset was mostly one month after using BDQ regimen. The side effects of QTc interval prolongation from groups of combination and risk factors were no difference in each month (p>0.05).

CONCLUSIONS: This study can be concluded that there were no differences in the QTc prolongation between the groups of BDQ regimen (BDQ, BDQ + LFX, BDQ + CFZ and BDQ + LFX + CFZ) and the groups of risk factors.

PMID:34214323 | DOI:10.1515/jbcpp-2020-0415

J Basic Clin Physiol Pharmacol. 2021 Jun 25;32(4):403-413. doi: 10.1515/jbcpp-2020-0485.

ABSTRACT

OBJECTIVES: The aim of this study was to identify the patterns of medication load, its medication burden, coordination of healthcare and patient’s understanding of their conventional cardiac medications and related herbal-derived preparations.

METHODS: The study is a mixed-method both, quantitative and qualitative approach, which involved Filipino elderly patients (n=69) enrolled in the outpatient service of the National Center for Geriatric Health, Manila. Data were gathered through face-to-face surveys and interviews using a semi-structured questionnaire. Descriptive statistics were used during data analysis. Thematic analysis was also used to emphasize patterns in the responses of the participants.

RESULTS: Respondents were knowledgeable on the name (86.9%), visual characteristics (78.3%), and indication and administration of their medicine (88.4%). The frequency of their doctor’s information on the possible side effects of the medicines was noted. The almost negligible difference in the proportions of those who asserted during the information dissemination on the medication side effect by their doctors was observed (<10.5%). Association on the age and awareness of any interaction on the drugs they are taking (p=0.032) and an association between the gender and awareness of the doctor/pharmacists about other drugs the patient is taking (p=0.033) were observed. During thematic analysis, elderly respondents were keen on the physician’s advice than that of the pharmacist. This is due to the limited knowledge of elderly patients on the role of pharmacists to conduct medication counseling.

CONCLUSIONS: The majority of the elderly patients recognized the purpose and extent of medication. It was noted that pharmacists play a limited role in understanding selected Filipino elderly patients on their medication. Lack of communication between the patient and the pharmacist was noted as preliminary findings in the study. Respondents were not yet informed of the responsibility of the pharmacist to provide information regarding their medication. Integration of pharmacists’ care for geriatric health must be strengthened and highly recommended. Supervision by the healthcare professionals, particularly by the pharmacists, must be fully established.

PMID:34214303 | DOI:10.1515/jbcpp-2020-0485

J Basic Clin Physiol Pharmacol. 2021 Jun 25;32(4):447-451. doi: 10.1515/jbcpp-2020-0465.

ABSTRACT

OBJECTIVES: Heart disease is a clinical condition characterized by specific signs such as joint inflammation, weakness, and shortness of breath. Left ventricular remodeling can be experienced by patients with heart failure wherein a change in myocyte and nonmyocyte components occurs. One of the biomarkers in heart disease with myocardial fibrosis is matrix metalloproteinase-9 (MMP-9). Common therapy that is often given to patients with heart failure is ACE inhibitors. This main objective of this research is to investigate the effect of ACE inhibitor therapy on the degrees of MMP-9 as a biomarker among patients with heart disease.

METHODS: This research applied one group pretest-posttest design to analyze the variation in the levels of MMP-9 as a biomarker for heart function. Twenty-three subjects with acute heart disease met that inclusion also exclusion criteria, who were selected using nonrandom sampling. Statistical analysis was conducted to specify the levels of MMP-9 before, after the administration of therapy.

RESULTS: The most widely used ACE inhibitor drug was ramipril for 15 patients (65%), and the least used ACE Inhibitor drug was captopril for two patients (9%). Meanwhile, the mean MMP-9 levels before therapy was (1,915.26 pg/mL ± 260.84), and the mean MMP-9 levels after therapy was (1,916.93 pg/mL ± 383.12). The statistical analysis result revealed no significant difference in the degrees of Matrix Metalloproteinase-9 accumulation (p=0.378).

CONCLUSIONS: There was no significant reduction in the levels of Matrix Metalloproteinase-9 after pretest and posttest.

PMID:34214315 | DOI:10.1515/jbcpp-2020-0465