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Abstrak :
Latar Belakang: N-asetilsistein (NAS) memiliki banyak manfaat, salah satunya sebagai antikoksidan dan antiinflamasi. Belum banyak penelitian pemberian NAS pada pasien COVID-19. Pemberian NAS pada pasien COVID-19 derajat berat memiliki hasil luaran yang bervariasi, salah satunya diduga disebabkan lama terapi yang hanya beberapa jamhari. Tujuan: Rancangan penelitian ini adalah kohort retrospektif di ICU RS PELNI, Jakarta. Penelitian ini dimulai setelah mendapat sertifikat etik dan ijin lokasi yang dimulai pada bulan Februari-April 2023. Pengambilan sampel secara consecutive sampling. Kriteria penerimaan meliputi pasien COVID-19 derajat berat dengan usia ≥18 tahun. Kriteria penolakan meliputi pasien sedang hamil/menyusui. Kriteria pengeluaran meliputi pasien meninggal sebelum pemberian NAS mencapai 14 hari. Luaran yang diamati adalah kejadian intubasi, mortalitas, nilai rasio netrofil limfosit, kadar D-dimer, dan CRP. Data penelitian merupakan data sekunder dari rekam medis. Data dianalisis dengan uji statistik yang sesuai menggunakan program SPSS versi 27. Hasil: Didapatkan total 112 pasien dengan 55 pasien tidak mendapatkan terapi NAS dan 57 pasien mendapatkan terapi NAS. Dari hasil analisis bivariat didapatkan pasien dengan terapi NAS memiliki kemungkinan untuk diintubasi sebesar 2,7 kali dan tidak berhubugan dengan mortalitas. Dari hasil analisis multivariat, didapatkan hanya variabel kejadian intubasi yang bermakna terhadap mortalitas. Simpulan: Terapi ajuvan NAS tidak menurunkan kejadian intubasi dan mortalitas. ......Background: N-acetylcysteine (NAS) has many benefits, one of which is as an antioxidant and anti-inflammatory. There have not been many studies of giving NAS to COVID-19 patients. Giving NAS to patients with severe degrees of COVID-19 has varied outcomes, one of which is thought to be caused by the duration of therapy which is only a few hours-days. Purpose: This retrospective cohort study was conducted in the ICU of PELNI Hospital, Jakarta. This research was started after obtaining an ethical certificate and location permit which began in February-April 2023. The samples were taken using consecutive sampling. Inclusion criteria was patients with severe degree of COVID-19 aged ≥18 years. Exclusion criteria was patients who are pregnant/breastfeeding. Drop out criteria was patients who died before 14 days of NAS administration. The observed outcomes were intubation events, mortality, neutrophil lymphocyte ratio D-dimer and CRP levels. The research data is secondary data from medical records. Data were analyzed with appropriate statistical tests using the SPSS version 27 program. Results: There were a total of 112 patients with 55 patients not receiving NAS therapy and 57 patients receiving NAS therapy. From the results of bivariate analysis, it was found that patients with NAS therapy had a 2.7 times the likelihood of being intubated and had no association with mortality. From the results of the multivariate analysis, it was found that only the intubation event variable had a significant effect on mortality. Conclusion: Adjuvant therapy for NAS does not reduce the incidence of intubation and mortality.

Abstrak :
ABSTRACT
inflammation, oxidative stress, and fibrosis play important roles after an acute myocardial infarction (AMI) event. The most studied inflammatory biomarker in cardiovascular disease is C-reactive protein (CRP). It has been demonstrated that myeloperoxidase (MPO) and Galectin-3 (Gal-3) have some essential roles on immune system when an AMI event occurs. We aimed to determine the effect of oral N-acetylcysteine (NAC) supplementation at the dose of 600 mg 3 times daily for 3 consecutive days on the immune system of AMI patients. Methods: our randomized single-blinded experimental study using pre- and post-treatment evaluations was performed at Dr. Moewardi Hospital, Indonesia, from May to August 2018. Thirty-two patients with AMI and ST segment elevation (STEMI) who received fibrinolytic therapy were included. There were 17 patients received standard therapy plus 600 mg oral NAC supplementation every 8 h for 3 days and 15 patients received standard therapy, which served as the control group. High-sensitivity C-reactive protein (HsCRP), MPO, and Gal-3 levels of both groups were evaluated at admission and after 72 h receiving treatment. Results: HsCRP, MPO, and Gal-3 levels between NAC and control groups at admission were not significantly different; while intergroup differences after 72 h of NAC supplementation were significant (p values of HsCRP, MPO, and Gal-3 levels were 0.0001, 0.001, and 0.017, respectively). Furthermore, in the NAC group, HsCRP, MPO, and Gal-3 levels at 72 h after treatment were significantly different from the corresponding levels at admission (p values: 0.0001, 0.0001, and 0.0001, respectively); the control group did not show these differences. There were also significant intergroup differences between the NAC and control groups regarding HsCRP, MPO, and Gal-3 levels (p values: 0.011, 0.022, and 0.014, respectively).Conclusion: oral supplementation of 600 mg NAC every 8 h for 72 h can reduce HsCRP, MPO, and Gal-3 levels in AMI patients receiving fibrinolytic therapy. Results of our study will provide more options for supplementation therapy to improve management of IMA patients.

Abstrak :
Latar belakang: Penggunaan tembakau menimbulkan ketergantungan nikotin sehingga proses berhenti merokok menjadi sulit dan membutuhkan bantuan khusus. Keterbatasan terapi berhenti merokok di Indonesia mendorong lahirnya terapi farmakologi alternatif. Hasil penelitian preklinik menunjukkan terdapat peluang efektivitas N-acetylcistein (NAC) terhadap berhenti merokok. Metode: Penelitian ini menggunakan uji acak plasebo terkontrol pada perokok yang dilakukan selama Januari-Desember 2018. Sebanyak 90 perokok mendapatkan perlakuan yang dibedakan menjadi dua kelompok yaitu NAC 2x1200 mg dan plasebo selama 4 minggu. Pengamatan dilakukan pada minggu ke 1,2,3 dan 4. Pada akhir perlakuan dilakukan penilaian abstinence rate (AR), nilai withdrawal dan craving. Hasil: Nilai AR pada kelompok NAC sebesar 37,7% sementara kelompok plasebo 6,7%. Pada variabel demografi yang bermakna terhadap abstinence adalah skor Fagestorm, motivasi dan nilai CO ekshalasi dasar dan percobaan berhenti merokok sebelumnya. Pada variabel akhir penelitian yaitu nilai CO ekshalasi akhir, jumlah rokok akhir, nilai withdrawal akhir dan nilai craving akhir bermakna secara statistik ( nilai p <0,001) Kesimpulan: Abstinence rate pada kelompok NAC lebih superior dibandingkan kelompok plasebo. Penelitian lebih lanjut perlu dilakukan dengan durasi pemberian lebih panjang dan pengamatan terhadap continues abstinance rate (CAR). ......Background: Tobacco cigarette smoking often resulted in nicotine dependence which caused difficulties in smoking cessation program which in turn requiring smokers to seek professional help. However, pharmacotherapy for smoking cessation was limited in Indonesia. Preclinical studies suggested n-acetylcysteine (NAC) might able to reduce withdrawal and craving symptoms for substance dependence particularly nicotine addiction among smokers. Methods : This placebo controlled clinical trial was conducted between January to December 2018. This study randomly grouped 90 cigarette smokers into NAC-treated (NAC 1200 mg bid) and placebo group whose four weeks of treatment was observed. The study objective was to compare abstinence rate (AR), withdrawal, and craving symptoms using scoring system at the end of the study. Results : The AR in NAC-treated group was 37.7% and in placebo group was 6.7%. Fagerstrom score of nicotine dependence, motivation, and base exhaled CO concentration were related to abstinence. Decrease of daily cigarette consumption and exhaled CO concentration, and changes in withdrawal and craving score, were observed among the smokers by the end of the study. Conclusion : This preliminary study suggested feasibility and efficacy of NAC for smoking cessation. Follow-up study of NAC on AR should be carried out.