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Abstrak :
Pendahuluan Berbagai studi menunjukkan obat off-label banyak diberikan pada pasien anak. Pemberian obat off-label dapat menimngkatkan risiko efek samping obat. Penelitian ini bertujuan mengevaluasi peresepan obat off-label pada pasien anak di Instalasi Gawat Darurat RSUPN dr. Cipto Mangunkusumo (IGD-RSCM) yang selama ini belum pernah diteliti. Metode Desain penelitian ini potong lintnag. Sampel peresepan, diambil dari rekam medis pasien anak di IGD-RSCM secara consecutive sampling. Kriteria inklusi adalah peresepan untuk pasien anak usia 0-18 tahun di IGD RSCM pada periode Januari- Desember 2018. Kriteria eksklusi berupa data tidak terbaca atau tidak lengkap, peresepan elektrolit, suplemen, vitamin, dan obat luar. Data jenis kelamin, usia, dan jenis kelompok obat berdasarkan klasifikasi The Anatomical Therapeutic Chemical (ATC) dicatat. Status peresepan off-label ditentukan berdasarkan usia pasien saat obat diresepkan. Proporsi peresepan off-label pada kelompok gender dan usia anak dianalisis dengan uji Chi-Square. Hasil Dari 446 sampel peresepan yang diuji, 24,7% sampel merupakan peresepan off- label berdasarkan kategori usia.Berdasarkan kelompok ATC, kelompok obat yang paling sering diresepkan adalah obat sistem saraf dengan proposi off-label paling tinggi ditemukan pada kelompok agen antineoplastik dan imunomodulasi (88,2%). Tidak ada perbedaan proporsi peroff-label yang signifikan antara pasien anak laki- laki (21,9%) dan perempuan (27,4%) (p = 0,169, PR= 0,662 IK= 0,593 – 1,005). Tidak ada hubungan signfikan antara kelompok usia (bayi, anak, dan remaja) terhadap proporsi peresepan off-label (p = 0,086). Kesimpulan Proporsi peresepan obat off-label pasien anak di Instalasi Gawat Darurat RSCM adalah 24,7%. Jenis kelamin dan perbedaan kelompok usia antara bayi, anak, dan remaja tidak berhubungan dengan besar proporsi peresepan off-label. ......Introduction Various studies showed that pediatric patients often received off-label drugs. Off- label drug administration can increase the risk of adverse drug reactions. This study aims to evaluate the off-label prescriptions in pediatric patients at the Emergency Department of dr. Cipto Mangunkusumo Hospital (IGD-RSCM) which has never been studied. Methods This is a cross sectional study. Prescription samples were taken from the medical records at IGD-RSCM by consecutive sampling. The inclusion criteria were prescriptions for children aged 0-18 years treated at IGD-RSCM during January- December 2018. The exclusion criteria were unreadable, incomplete prescribing data, electrolytes, supplements, vitamins, and external medications. Data of gender, age, and drug class based on The Anatomical Therapeutic Chemical (ATC) classification were recorded. Off-label prescribing status was determined based on the patient's age at the time of prescription. Proportions of Off-label prescriptions in each gender and pediatric age groups were analyzed using the Chi-Square test. Results Of the 446 prescriptions analyzed , 24.7% were prescribed off-labelly by age category. Based on the ATC, nervous system drugs was the most frequently prescribed medication. The highest proportion of off-label drugs prescription was the antineoplastic and immunomodulating agent (88.2%). There was no significant difference in the off-label prescription proportion between boys (21.9%) and girls (27.4%) (p=0.169, PR=0.662 CI=0.593-1.005). There was no significant association between age groups (infants, children and adolescents) and the proportion of off-label prescriptions (p= 0.086). Conclusion The proportion of pediatric off-label prescription at the IGD-RSCM was 24.7%. Gender and pediatric age group differences were not associated with the level of off-label prescriptions proportions.

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Pendahuluan Pasien anak, termasuk di Pediatric Intensive Care Unit (PICU), tergolong rentan menerima peresepan obat off-label, yang berpotensi menimbulkan kejadian efek samping obat. Penelitian ini bertujuan mengevaluasi penggunaan obat off-label pada pasien anak di PICU RSCM, yang belum pernah diteliti. Metode Sampel merupakan peresepan yang diambil dari rekam medis secara consecutive sampling. Perhitungan jumlah sampel menggunakan proporsi tunggal dan beda dua proporsi. Kriteria inklusi adalah pasien anak <18 tahun yang dirawat di PICU RSCM tahun 2018. Kriteria eksklusi adalah pasien dengan data pengobatan yang sulit dibaca atau tidak lengkap, obat luar, elektrolit, dan suplemen. Data ditabulasi berdasarkan nama obat, jenis kelamin, usia, status off-label obat berdasarkan usia pasien, dan klasifikasi Anatomical Therapeutic Chemical (ATC). Uji Chi-Square dipakai untuk mengetahui beda proporsi penggunaan obat off-label antar kelompok. Hasil Dari 400 peresepan yang dievaluasi, 23,8% tergolong off-label kategori usia. Berdasarkan klasifikasi ATC, peresepan di PICU didominasi oleh obat kardiovaskular (25,25%). Obat muskuloskeletal paling sering diresepkan secara off-label (84,6%). Tidak ada perbedaan signifikan proporsi penggunaan obat off-label pada kelompok laki-laki (21%) dan perempuan (26,5%) (p = 0,196,). Proporsi off-label pada kelompok usia bayi (0-2 tahun) 33,8%, anak (2-12 tahun) 18,6%, dan remaja (12-18 tahun) 14,3%. Peresepan off-label pada bayi lebih tinggi secara signifikan dibandingkan anak (p = 0,002) dan remaja (p = 0,001) Kesimpulan Sebanyak 23,8% peresepan pada pasien PICU diberikan secara off-label berdasarkan usia, dan yang tersering adalah obat muskuloskeletal. Perbedaan proporsi obat off-label antar jenis kelamin tidak signifikan, sedangkan antar kelompok usia signifikan. ......Introduction Pediatric patients, including Pediatric Intensive Care Unit (PICU) patients, are prone to off-label drug prescriptions, which potentially lead to adverse drug reactions. This study aimed to assess the use of off-label drugs on PICU patients at RSCM, which has never been studied before. Methods Samples were prescriptions taken from medical records connsecutively. Sample size were calculated using single proportion and difference between two proportions. The inclusion criteria were <18 years old PICU patients at RSCM admitted in 2018. The exclusion criteria were patients with unclear or incomplete data, external drugs, electrolytes, and supplements. Data were tabulated by drug name, sex, age, off-label drug status based on patient age, and Anatomical Therapeutic Chemical (ATC) classification. Difference in proportions between groups were tested using Chi-Square. Results Of the 400 prescriptions evaluated, 23.8% were off-label by age. Based on the ATC classification, PICU prescription was dominated by cardiovascular drugs (25.25%). Musculoskeletal drugs were most often prescribed off-label (84.6%). There was no significant difference in off-label prescription between males (21%) and females (26.5%) (p = 0.196). The proportion of off-label in the infant age group (0-2 years) was 33.8%, in children (2-12 years) 18.6%, and in adolescents (12-18 years) 14.3%. Infants were given off-label drugs significantly higher than children (p = 0.002) and adolescents (p = 0.001) Conclusion Off-label prescription in PICU patients is 23.8%. Musculoskeletal drugs are most often prescribed off-label. The difference in the proportion of off-label drugs between sexes was not significant, whereas between age groups was significant

Abstrak :
Salah satu strategi eliminasi infeksi Soil transmitted Helminth (STH) adalah pemberian antelmintik seperti albendazol secara massal. Tetapi penggunaan antelmintik secara luas dalam jangka waktu lama dikhawatirkan dapat menyebabkan terjadinya terjadi penurunan efikasi obat. Salah satu faktor yang bisa menyebabkan penurunan efikasinya adalah single nucleotide polymorphism (SNP) kodon 200 gen beta tubulin cacing. Penelitian ini bertujuan untuk mengetahui susunan basa kodon 200 pada A. lumbricoides dan T. trichiura yang bisa menyebabkan adanya perbedaan efikasi albendazol. DNA dari telur dan jaringan cacing diisolasi, diamplifikasi dengan PCR kemudian dilakukan proses sekuensing. Setelah itu pada hasil sekuensing dilakukan alignment dengan sekuens referensi untuk mengetahui susunan basa pada kodon 200 gen beta tubulin. Hasilnya pada dua cacing A. lumbricoides dan satu cacing T. trichiura didapatkan susunan basa TTC pada kodon 200.

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One of the Soil transmitted Helminth (STH) infection elimination strategy is mass administration of anthelmintic such as albendazol. But the anthelmintic widespread use in a long term can cause decrease in efficacy. One of the factor that can cause decrease in efficacy is single nucleotide polymorphism (SNP) codon 200 beta tubulin gene of the worm. This study aimed to determine codon 200 in A. lumbricoides and T. trichiura that can cause a difference in albendazol efficacy. DNA from worm eggs and tissue were isolated, amplificated by PCR and sequenced. Sequencing result were also aligned with the reference sequence to get the bases in codon 200 beta tubulin gene. The bases on codon 200 beta tubulin gene from two A. lumbricoides and one T. trichiura is TTC.

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ABSTRAK
Inflammatory bowel disease IBD merupakan kondisi yang menggambarkan peradangan saluran cerna kronik. Peradangan kronis yang terjadi di kolon dapat berkembang menjadi kanker kolon. Lunasin telah diketahui dapat menekan reaksi inflamasi yang diinduksi lipopolisakarida secara in vitro. Peran lunasin sebagai antiinflamasi secara in vivo masih belum banyak diketahui. Pada penelitian ini dianalisis efek lunasin kedelai dalam menghambat inflamasi dengan melihat ekspresi COX-2, iNOS, dan ?-katenin. Mencit sebanyak 30 ekor dibagi dalam 6 kelompok. Kelompok normal adalah mencit yang tidak diinduksi DSS. Kelompok lain diinduksi dengan DSS 2 melalui air minum selama 9 hari. Hari berikutnya mencit kelompok kontrol negatif tidak menerima perlakuan sedangkan kelompok yang menerima perlakuan diberikan lunasin dosis 20mg/kgBB, dosis 40mg/kgBB dan lunasin komersil serta kontrol positif diberikan aspirin. Perlakuan dilakukan selama 5 minggu. Pemeriksaan histopatologi kolon yang mengalami inflamasi dan skor hasil pewarnaan imunohistokimia protein COX-2, iNOs dan ?-katenin dianalisis menggunakan uji statistik. Lunasin dosis 20mg/kgBB dan dosis 40mg/kgBB mampu menurunkan inflamasi secara signifikan p

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ABSTRACT
Inflammatory bowel disease IBD is a condition describing chronic gastrointestinal inflammation. Chronic inflammation that occurs in the colon can develop into colon cancer. Lunasin has been known to resist inflammatory reactions induced by lipopolysaccharide in vitro. The role of lunasin as antiinflammatory in in vivo is not widely known. In this study we analyzed the effect of lunasin from soybean to decrease the risk of inflammation by analyzing the expression of COX 2, iNOS, and catenin. 30 mice are divided into 6 groups. Normal group was not induced by DSS. The other groups were induced by 2 DSS through drinking water for 9 days. After 9 days, negative control group did not receive any treatment, beside the other groups received treatment given lunasin dose 20mg kgBB and 40mg kgBB, commercial lunasin and positive control given aspirin. Treatment was performed for 5 weeks. Inflammatory colon histopathologic examination and immunohistochemical score of COX 2, iNOs and catenin proteins were analyzed using statistical tests. Lunasin dose 20mg kgBW and 40mg kgBB were able to significantly reduce inflammation p

Abstrak :
Latar Belakang: Prevalensi penyakit ginjal kronik (PGK) stadium akhir di Indonesia mengalami kenaikan setiap tahunnya dan biasanya mempunyai banyak komorbid seperti hipertensi, diabetes mellitus (DM) dan penyakit kardiovaskular. Selain itu pasien PGK juga berisiko mengalami komplikasi jangka panjang seperti anemia, gangguan mineral dan tulang, sehingga memerlukan pengobatan dengan beberapa jenis obat (polifarmasi). Obat-obatan pada pasien PGK digunakan dalam waktu jangka panjang sehingga berpotensi terjadi interaksi antar obat. Semakin banyaknya interaksi obat maka akan meningkatkan risiko efek samping obat (ESO). Pasien PGK juga sangat rentan mengalami peningkatan risiko akumulasi obat dan efek samping karena adanya perubahan parameter farmakokinetik dan farmakodinamik. Selain itu pada pasien PGK stadium 5 dengan hemodialisis (HD) terdapat beberapa obat yang terdialisis dalam proses HD sehingga dapat mengurangi efektivitas pengobatan. Tujuan dari penelitian ini adalah untuk mengetahui pola peresepan pada pasien PGK stadium 5 yang menjalani HD rutin serta kaitannya dengan potensi interaksi obat (PIO) dan kemungkinan ESO yang dapat diakibatkan oleh interaksi antar obat tersebut. Metode: Penelitian ini merupakan penelitian observasional dengan desain potong lintang pada pasien PGK stadium 5 dengan HD rutin di Rumah Sakit Cipto Mangunkusumo dalam periode Januari 2020 sampai dengan Juli 2021. Data diambil dari rekam medis unit HD, rekam medis pusat, electronic health record (EHR) dan hospital information system (HIS). Untuk mengetahui PIO dilakukan penilaian berdasarkan perangkat lunak Lexicomp dan penilaian kausalitas ESO dengan menggunakan algoritma Naranjo. Hasil: Didapatkan 147 pasien yang memenuhi kriteria inklusi dan terdapat 101 jenis obat dengan 2767 kali peresepan dalam waktu 3 bulan. Proporsi pasien yang mengalami potensi interaksi antar obat sebanyak 89% pasien. Proporsi pasien yang mengalami potensi interaksi kategori mayor sebanyak 14% pasien, kategori moderat sebanyak 88% pasien, dan kategori minor sebanyak 37% pasien. Proporsi pasien yang dicurigai mengalami ESO akibat interaksi obat sebanyak 50% (66 pasien) dari 131 pasien yang mengalami PIO. Pada hasil multivariat, hanya komorbid DM yang memiliki hubungan yang bermakna secara statistik dengan ESO yang dicurigai akibat interaksi obat. Kesimpulan: Sebanyak 89% pasien PGK stadium 5 dengan HD mengalami potensi interaksi obat dan hipertensi merupakan efek samping terbanyak yang dicurigai akibat interaksi obat. Komorbid DM mempunyai peran yang cukup penting untuk terjadinya efek samping yang dicurigai akibat interaksi obat pada pasien PGK stadium 5 dengan HD ......Background: The prevalence of end-stage renal disease in Indonesia has increased every year and usually has many comorbidities such as hypertension, diabetes mellitus (DM) and cardiovascular disease. In addition, there is also a risk of long-term complications, thus requiring treatment with several types of drugs (polypharmacy). The higher the frequency of drug interactions, the higher the risk of adverse drug reaction (ADR). Chronic kidney disease (CKD) patients are also very susceptible to an increased risk of drug accumulation and ADR due to changes in pharmacokinetic and pharmacodynamic parameters. In addition, CKD stage 5 patients with hemodialysis (HD) have several drugs that are dialyzed in the HD process so that it can reduce the effectiveness of treatment. The purpose of this study was to determine the prescribing pattern in stage 5 CKD patients on routine HD and its relationship to DDI and the possibility of ADR that could be caused by interactions between these drugs. Methods: This was an observational study with a cross-sectional design in CKD stage 5 patients on routine HD at Cipto Mangunkusumo Hospital in the period January 2020 to July 2021. Data were taken from HD unit medical records. To determine the DDI, an assessment was carried out based on the Lexicomp software and ADR causality assessment using the Naranjo algorithm. Results: A total of 147 patients met the inclusion criteria and there were 101 types of drugs with 2767 prescriptions within 3 months. The proportion of patients who received treatment with potential DDI is 89% of patients. The proportion of patients who received DDI in the major category was 14%, the moderate category was 88%, and the minor category was 37%. From 131 patients with DDI, the proportion of patients suspected having ADR cause by DDI is 50% (66 patients). Multivariate analysis found that only DM had statistically significant relationship with ADR that are suspected due to DDI. Conclusion: In this study, 89% of patients received treatment with potential DDI and hypertension is the most suspected ADR due to drug interactions. Comorbid DM has an important role in the occurrence of ADR due to DDI in stage 5 CKD patients on HD.

Abstrak :
Tuberkulosis (TBC) masih menjadi penyebab utama kematian akibat penyakit menular oleh adanya infeksi. Rifampisin dan isoniazid adalah obat lini pertama yang paling efektif melawan infeksi Mycobacterium tuberculosis. Deteksi resistansi OAT yang tepat, akurat, dan komprehensif, serta pemilihan sampel diperlukan untuk memastikan diagnosis penyakit tuberkulosis pasien. Penelitian ini bertujuan untuk menganalisis perbandingan hasil targeted drug sequencing dari hasil dekontaminasi sputum dengan isolat Mycobacterium tuberculosis dan mengetahui kesesuaian DST fenotipik MGIT, genotipik GeneXpert dalam mendeteksi resistansi rifampisin dan isoniazid. Sampel penelitian ini adalah sampel sputum yang sudah ada hasil GeneXpert positif dan isolate kultur dengan hasil DST MGIT. Hasil dekontaminasi sputum langsung dan kultur positif dari sampel yang sama dilakukan targeted drug sequencing dengan Oxford Nanopore technology menggunakan flowcell MinION Mk1B. Hasil penelitian menunjukkan bahwa pada target gen rpoB pada 5 dari 6 sampel isolat kultur memberikan hasil gen resistan rpoB dan 1 undetermined. Pada sebagian besar dekontaminasi sputum yaitu 5 dari 6 sampel juga memberikan hasil resistan terhadap rpoB dan 1 dekontaminasi sputum yang undetermined. Hasil resistansi obat isoniazid didapatkan pada target gen inhA sebanyak 5 dari 6 isolat kultur memberikan hasil sensitif pada inhA dan 1 isolat undetermined. Sedangkan pada dekontaminasi sputum 4 dari 6 sampel memberikan hasil sensitif pada inhA dan 2 undetermined. Lalu, pada target gen katG terdapat 3 dari 6 isolat kultur memberikan hasil sensitif, 2 isolat resistan, dan 1 undetermined. Sedangkan pada dekontaminasi sputum memberikan 2 hasil sensitif, 2 hasil resistan, dan 2 hasil undetermined. Metode targeted drug sequencing dapat dilakukan dari sampel hasil dekontaminasi sputum dan isolat. Keberhasilan banyak didapatkan dari hasil kultur dibandingkan dekontaminasi sputum. Pemeriksaan dengan targeted drug sequencing memberikan hasil yang sesuai dengan hasil DST MGIT dan GeneXpert untuk deteksi gen resisten Rifampisin (rpoB) dan Isoniazid (inhA dan katG). ......Tuberculosis (TBC) is still the main cause of death due to infectious diseases. Rifampicin and isoniazid are the most effective first-line drugs against Mycobacterium tuberculosis infection. Precise, accurate and comprehensive detection of OAT resistance, as well as sample selection are needed to confirm the patient's diagnosis of tuberculosis. This study aims to compare the results of targeted drug sequencing from sputum decontamination results with Mycobacterium tuberculosis isolates and determine the suitability of MGIT phenotypic and GeneXpert genotypic DST in detecting rifampicin and isoniazid resistance. The samples for this study were sputum samples that had positive GeneXpert results and culture isolates with DST MGIT results. The results of direct sputum decontamination and positive culture from the same sample were subjected to targeted drug sequencing with Oxford Nanopore technology using a MinION Mk1B flowcell. The results showed that for the rpoB gene target, the majority of culture isolates from 5 of the 6 culture isolate samples gave rpoB resistance gene results and 1 was undetermined. In the majority of sputum decontamination, 5 out of 6 samples also gave resistance to rpoB and 1 sputum decontamination was undetermined. Isoniazid drug resistance results were obtained for the inhA gene target, 5 of the 6 culture isolates gave sensitive results for inhA and 1 isolate was undetermined. Meanwhile, in sputum decontamination, 4 of the 6 samples gave sensitive results for inhA and 2 were undetermined. Then, for the katG gene target, 3 of the 6 culture isolates gave sensitive results, 2 isolates were resistant, and 1 was undetermined. Meanwhile, sputum decontamination gave 2 sensitive results, 2 resistant results, and 2 undetermined results. The targeted drug sequencing method can be carried out from samples resulting from decontamination of sputum and isolates. Much success comes from culture results rather than sputum decontamination. Examination with targeted drug sequencing provided results that were in accordance with the results of DST MGIT and GeneXpert for the detection of Rifampicin (rpoB) and Isoniazid (inhA, and katG) resistance genes.

Abstrak :
Pendahuluan: Insulin merupakan obat diabetes melitus tipe-2 yang banyak digunakan terutama untuk diabetes melitus tipe-2 lanjut yang sudah tidak responsif dengan obat oral. Dikenal 2 kelompok insulin yaitu insulin analog dan insulin human. Tujuan penelitian ini adalah membandingkan biaya pengobatan menggunakan obat insulin analog dan insulin human di RS. Islam Sukapura dalam periode Januari 2018-Desember 2018. Metode: Menggunakan metode analitik observasional dengan desain kohort retrospektif dari rekam medis pasien Diabetes melitus tipe-2 yang berobat di poliklinik penyakit dalam RS.Islam Sukapura Jakarta periode Januari 2018-Desember 2018. Hasil: Pada penelitian ini dari 200 pasien terdapat 82 orang yang mendapatkan insulin human dan rata-rata selisih HbA1c awal dan akhir sebesar 1,40 %. Pada 118 pasien yang mendapatkan insulin analog, rata-rata selisih HbA1c awal dan akhir sebesar 1,34 %. Secara statistik tidak terdapat perbedaan manfaat yang bermakna antara insulin human dan insulin analog (P=0,785). Efek samping obat hipoglikemia tdak berbeda bermakna antara insulin human dan insulin analog yaitu 4 orang yang diberikan Insulin analog dan 3 orang yang diberikan insulin human. Biaya untuk insulin analog sebesar Rp. 2.042.100/3 bulan/orang dibandingkan biaya insulin human sebesar Rp. 1.803.375/3 bulan/orang. Dari perbandingan harga tersebut terdapat selisih biaya pengobatan sebesar Rp.238.725/3 bulan/orang, atau sebesar Rp.180.000.000/tahun untuk 200 pasien diabetes melitus tipe-2 di rumah sakit tersebut. Kesimpulan: Untuk membuat pasien diabetes melitus tipe-2 terkontrol dengan biaya lebih murah dapat digunakan insulin human, karena memakai insulin analog akan menggunakan biaya BPJS lebih banyak.

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Introduction: Insulin is a type-2 diabetes mellitus drug that is widely used especially for advanced type-2 diabetes mellitus that is already unresponsive to oral medications. There are 2 kind of insulin, namely analog insulin and human insulin. The purpose of this study was to compare the cost of treatment using insulin analog and insulin human at RS. Islam Sukapura in the period January 2018-December 2018. Method: Using an observational analytic method with a cohort retrospective design based on the medical record of type 2 diabetes mellitus patients who treated at the internal medicine clinic of RS. Islam Sukapura Jakarta period January 2018-December 2018. Results: A total of 200 patients were treated in the clinic. 82 patients who received insulin human and the average difference of initial and final HbA1c was 1.40%. For the 118 patients who received analog insulin, the average difference initial and final HbA1c difference was 1.34%. Statistically there was no significant difference of efficacy of insulin human and insulin analogues (P = 0.785). The side effects of insulin, hipoglikemia, was similar between the two type of insulin, which was 3 patients in the human in group & 4 patients in the analog insulin group. The cost of getting analog insulin was Rp. 2,042,100/3 months/patient compared to the cost of insulin human Rp. 1,803,375/3 months/patient. From the price comparison there is a difference in the cost of treatment of type 2 Diabetes mellitus amounting to Rp.238,725/3 months/person, or for the whole 200 patients would be Rp.180,000,000/year. Conclusion: In order to make lower-cost of insulin use for type 2 diabetes mellitus patients, insulin human should be used. Drug costs for type 2 diabetes mellitus using analog insulin is more expensive than using insulin human.

Abstrak :
Pendahuluan: Saat ini, rejimen kemoterapi berbasis platinum dengan dua jenis obat seperti paklitaksel-karboplatin dan pemetreksat-karboplatin merupakan terapi lini pertama pasien adenokarsinoma paru dengan mutasi epidermal growth factor receptor (EGFR) negatif. Di rumah sakit Persahabatan, kedua rejimen tersebut banyak digunakan dan dijamin pembiayaannya oleh Badan Penyelenggara Jaminan Sosial Kesehatan (BPJS). Dengan harga pemetreksat yang lebih mahal dan efektivitas yang belum diketahui, perlu dilakukan suatu kajian farmakoekonomi. Studi ini bertujuan untuk mengetahui profil efikasi, toksisitas, dan biaya paklitaksel-karboplatin dibandingkan pemetreksat-karboplatin. Metode: penelitian ini merupakan studi potong lintang, menggunakan data rekam medis. Pasien adenokarsinoma paru mutasi EGFR negatif yang pertama kali didiagnosa dan diterapi dengan paklitaksel-karboplatin atau pemetreksat-karboplatin dimasukkan ke dalam kriteria inklusi. Analisis farmakoekonomi dilakukan berdasarkan keluaran klinis yang terdiri dari efektivitas dan biaya medis langsung. Efektivitas dinilai berdasarkan overall response rate (ORR). Hasil: Rekam medis dari 21 pasien paklitaksel-karboplatin dan 21 pasien pemetreksat-karboplatin berhasil dievaluasi. Efektivitas kedua rejimen kemoterapi secara statistik tidak berbeda bermakna yang dilihat dari ORR (P=0,739). Toksisitas hematologi yang sering dialami oleh kedua kelompok adalah anemia, neutropenia, leukopenia derajat 1-2. Anemia, leukopenia, dan neutropenia derajat 3 lebih sering terjadi pada kelompok paklitaksel-karboplatin. Toksisitas nonhematologi kedua kelompok adalah mual muntah, rambut rontok, dengan neuropati perifer lebih banyak dialami kelompok paklitaksel-karboplatin. Melihat hal tersebut, pasien pada kelompok pemetreksat-karboplatin mengalami toksisitas lebih sedikit dibandingkan kelompok paklitaksel-karboplatin. Dari perhitungan analisis minimalisasi biaya diperoleh hasil bahwa biaya rerata per pasien dengan rejimen paklitaksel-karboplatin lebih murah Rp. 10.986.257,55 atau 50,25%, dibandingkan pemetreksat-karboplatin. Kesimpulan: tidak ada perbedaan efektivitas antara kedua rejimen. Biaya rerata per pasien dengan rejimen paklitaksel-karboplatin lebih murah dibandingkan pemetreksat-karboplatin. Diperlukan penelitian prospektif dengan jumlah subjek yang lebih besar dan melibatkan banyak rumah sakit. ......Background: At present, platinum-based chemotherapy regimens with two types of drugs such as paclitaxel-carboplatin and pemetrexed-carboplatin are first-line therapy for pulmonary adenocarcinoma patients with negative epidermal growth factor receptor (EGFR) mutations. At Persahabatan Hospital, the two regimens are widely used and guaranteed by National Health Insurance. With the price of pemetrexed which is more expensive and the effectiveness is unknown, it is necessary to do a pharmacoeconomic study. This study aimed to determine the efficacy, toxicity, and cost profile of paclitaxel-carboplatin compared to pemetrexed-carboplatin. Methods: This s is a cross-sectional study, using medical record data. Patients with pulmonary adenocarcinoma negative EGFR mutations first diagnosed and treated with paclitaxel-carboplatin or pemetrexed-carboplatin were included. A pharmacoeconomic analysis is performed on the basis of clinical outcomes consisting of effectiveness and direct medical costs. Effectiveness was assessed based on the overall response rate (ORR). Results: Medical records from 21 patients with paclitaxel-carboplatin and 21 patients with pemetrexed-carboplatin were successfully evaluated. The effectiveness of the two chemotherapy regimens was not significantly different, which was seen from the ORR (P = 0.739). The most common hematologic toxicity experienced of the two groups are anemia, neutropenia, leukopenia grade 1-2. Anemia, leukopenia and neutropenia grade 3 are more common in paclitaxel-carboplatin group. The nonhematological toxicity of the two groups was nausea vomitus, hair loss, with peripheral neuropathy more experienced by paclitaxel-carboplatin group. Seeing this, patients in pemetreksat-carboplatin group experienced less toxicity compared to paclitaxel-carboplatin group. From the calculation of cost minimization analysis the results showed that the average cost per patient with pulmonary adenocarcinoma negative EGFR mutation with paclitaxel-carboplatin regimen was cheaper Rp. 10.986.257,55 or 50,25%, compared to pemetrexed-carboplatin. Conclusion: there was no difference in effectiveness between the two regimens. The average cost per patient with paclitaxel-carboplatin regimen was cheaper compared to pemetrexed-carboplatin. A prospective study is required with a larger number of study subjects and involves many hospitals.

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[ABSTRAK
Latar belakang: Hipertensi dan aterosklerosis berkaitan dengan disfungsi endotel yang ditandai oleh pengurangan produksi nitric oxide (NO) dan penurunan NO bioavailability. Disfungsi endotel dapat terjadi sejak usia anak-anak dan inaktivitas fisik menjadi faktor risiko penyakit kardiovaskular. Namun belum banyak penelitian mengenai perbedaan pengaruh latihan fisik aerobik pada juvenil dibandingkan dengan dewasa terhadap fungsi vaskular. Penelitian ini bertujuan untuk mengetahui pengaruh usia latihan fisik terhadap kadar NO, MDA dan aktivitas spesifik enzim SOD pada aorta abdominal dengan lama latihan yang sama. Metode: Subjek penelitian adalah tikus usia juvenil dan dewasa muda yang dibagi dalam kelompok latihan dan kontrol. Latihan aerobik selama 8 minggu menggunakan treadmill dengan kecepatan disesuaikan dengan usia tikus selama 20 menit intermitten, 5x seminggu. Analisis kadar NO, MDA dan aktivitas SOD aorta abdominal menggunakan uji t-test independen (data berdistribusi normal dan homogen) atau uji U-Mann Whitney (data tidak normal). Hasil: Kadar NO dan aktivitas spesisfik SOD lebih tinggi pada kelompok latihan dibandingkan kontrol, baik pada kelompok juvenil maupun dewasa muda. Namun hanya pada kelompok dewasa muda yang perbedaannya bermakna. Tidak terdapat perbedaan bermakna kadar MDA antara kelompok latihan dan kontrol pada kedua usia. Kadar MDA pada kelompok juvenil meningkat dan menurun pada kelompok dewasa muda akibat latihan aerobik selama 8 minggu. Kesimpulan: Latihan aerobik dapat meningkatkan produksi NO dan NO bioavailability pada kelompok juvenil maupun dewasa muda. Peningkatan NO bioavailability terjadi melalui aktivitas spesifik enzim SOD. Diduga tingginya kadar MDA pada kelompok latihan dan kontrol juvenil terkait dengan usia dan stres fisik. Belum diketahui apakah peningkatan kadar MDA pada kelompok juvenil masih dalam kisaran normal atau tidak. Oleh karena itu, masih terdapat beberapa pertanyaan terkait manfaat latihan pada juvenil.

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ABSTRACT
Background: Hypertension and atherosclerosis are related to endothelial dysfunction, that characterized with decrease of NO production and bioavailability. Physical inactivity has contribute to endothelial dysfunction that can occur since childhood. However, until now, there were only few studies about the difference effect of aerobic training to vascular function in juvenile and young-adult rats. Therefore, this study aimed to know the effect of age related- exercise training to level of NO, MDA and specific SOD activity in abdominal aorta. Methode: Subjects were juvenile and young adult male wistar rats divided into 2 group: control and aerobic training. Aerobic training performed in 8 weeks with animal treadmill with age-dependent speed for 20 minutes intermittent exercise, 5x per week. Analysis of NO, MDA level, and SOD activity of abdominal aorta used t-test independent (normal distribution and homogen) or U-Mann Whitney (not normal distribution) Results: NO level and SOD specific activity in training group were higher than control group, in both juvenile and young adult group. But, only in young adult group that had significant result. There was no significant different of MDA level in training group compared to control group in both juvenile and young-adult group, but MDA level increased in juvenile group and decreased in young-adult group because of aerobic training for 8 weeks. Conclussion: Aerobic training can increase NO production and bioavaibility both in juvenile and young adult group. Increase of NO bioavailability was considered to the increase of SOD specific activity. We considered that the increase of MDA level in training and control juvenile group were related to age and physical stress. We didn?t know yet the increased level of MDA in juvenile group was still in normal range level or not. Therefore is still any question if training in juvenile rat was benefit or not.;Background: Hypertension and atherosclerosis are related to endothelial dysfunction, that characterized with decrease of NO production and bioavailability. Physical inactivity has contribute to endothelial dysfunction that can occur since childhood. However, until now, there were only few studies about the difference effect of aerobic training to vascular function in juvenile and young-adult rats. Therefore, this study aimed to know the effect of age related- exercise training to level of NO, MDA and specific SOD activity in abdominal aorta. Methode: Subjects were juvenile and young adult male wistar rats divided into 2 group: control and aerobic training. Aerobic training performed in 8 weeks with animal treadmill with age-dependent speed for 20 minutes intermittent exercise, 5x per week. Analysis of NO, MDA level, and SOD activity of abdominal aorta used t-test independent (normal distribution and homogen) or U-Mann Whitney (not normal distribution) Results: NO level and SOD specific activity in training group were higher than control group, in both juvenile and young adult group. But, only in young adult group that had significant result. There was no significant different of MDA level in training group compared to control group in both juvenile and young-adult group, but MDA level increased in juvenile group and decreased in young-adult group because of aerobic training for 8 weeks. Conclussion: Aerobic training can increase NO production and bioavaibility both in juvenile and young adult group. Increase of NO bioavailability was considered to the increase of SOD specific activity. We considered that the increase of MDA level in training and control juvenile group were related to age and physical stress. We didn’t know yet the increased level of MDA in juvenile group was still in normal range level or not. Therefore is still any question if training in juvenile rat was benefit or not., Background: Hypertension and atherosclerosis are related to endothelial dysfunction, that characterized with decrease of NO production and bioavailability. Physical inactivity has contribute to endothelial dysfunction that can occur since childhood. However, until now, there were only few studies about the difference effect of aerobic training to vascular function in juvenile and young-adult rats. Therefore, this study aimed to know the effect of age related- exercise training to level of NO, MDA and specific SOD activity in abdominal aorta. Methode: Subjects were juvenile and young adult male wistar rats divided into 2 group: control and aerobic training. Aerobic training performed in 8 weeks with animal treadmill with age-dependent speed for 20 minutes intermittent exercise, 5x per week. Analysis of NO, MDA level, and SOD activity of abdominal aorta used t-test independent (normal distribution and homogen) or U-Mann Whitney (not normal distribution) Results: NO level and SOD specific activity in training group were higher than control group, in both juvenile and young adult group. But, only in young adult group that had significant result. There was no significant different of MDA level in training group compared to control group in both juvenile and young-adult group, but MDA level increased in juvenile group and decreased in young-adult group because of aerobic training for 8 weeks. Conclussion: Aerobic training can increase NO production and bioavaibility both in juvenile and young adult group. Increase of NO bioavailability was considered to the increase of SOD specific activity. We considered that the increase of MDA level in training and control juvenile group were related to age and physical stress. We didn’t know yet the increased level of MDA in juvenile group was still in normal range level or not. Therefore is still any question if training in juvenile rat was benefit or not.]