Retnosari Andrajati

Incidence of cisplatin-induced nephrotoxicity and associated factors among cancer patients in Indonesia.

BACKGROUND Cisplatin is still used as a first-line medication for solid tumors. Nephrotoxicity is a serious side effect that can decrease renal function and restrict applicable doses. This research aimed to obtain the profile of cisplatin-induced nephrotoxicity and its associated factors in adult cancer patients at Dharmais National Cancer Hospital (DNCH). MATERIALS AND METHODS The design was cross-sectional with data obtained from patient medical records. We retrospectively reviewed adult cancer patients treated with cisplatin ≥60mg/m2 for at least four consecutive chemotherapy cycles from August 2011 to November 2013. The nephrotoxicity criterion was renal function decline characterized by creatinine clearance <60 ml/min using the Cockroft-Gault (CG) equation. RESULTS Eighty-eight subjects received at least four chemotherapy cycles of cisplatin. The prevalence of cisplatin nephrotoxicity was 34.1%. Symptoms could be observed after the first cycle of chemotherapy, and the degree of renal impairment was higher with increased numbers of cycles (r=-0.946, r2=89.5%). Factors that affected the decline of renal function were patient age (p=0.008, OR=3.433, 95%CI= 1.363-8.645) and hypertension (p=0.026, OR=2.931, 95%CI=1.120-7.670). CONCLUSIONS Cisplatin nephrotoxicity occurred in more than one-third of patients after the fourth cycle of chemotherapy and worsened after each cycle despite preventive strategies such as hydration. The decline of renal function induced by cisplatin ≥60 mg/m2 was affected by age and hypertension.

Factors related to rational antibiotic prescriptions in community health centers in Depok City, Indonesia.

Irrational antibiotic prescription is common in developing countries, including in Indonesia. The aims of this study were to evaluate antibiotic prescription patterns and the factors related to the rationale for antibiotic prescriptions in community health centers in Depok City, Indonesia. The study employed a cross-sectional design in eleven primary health centers in Depok City, Indonesia. The sample consisted of 28 physicians and 788 oral antibiotic prescriptions, 392 of which were evaluated for rationality according to local guidelines issued by the Ministry of Health Republic of Indonesia from October to December 2012. Data were analyzed with chi-square tests and logistic regression analysis. The most widely prescribed antibiotics were amoxicillin (73.5%) and co-trimoxazole (17.4%). The most frequent diseases were acute pharyngitis (40.2%) and non-specific respiratory infection (25.4%). Approximately 220 of the 392 prescriptions did not meet the criteria for rational antibiotic prescriptions with regard to antibiotic selection (22.7%), duration of administration (72.3%), frequency of administration (3.2%), or duration and frequency of administration (1.8%). Physicians who had attended training for rational drug use were 2.01 times more rational than physicians who had never attended training. Physicians with a short working period (i.e., <7 years) were 3.95 times more rational in prescribing antibiotics than physicians who had been working for longer periods (i.e., >7 years). Most antibiotics were prescribed irrationally. Training for rational drug use and length of practice were factors related to the rationality of antibiotic prescriptions. Suitable interventions are urgently required to encourage the rational prescription of antibiotics in the PHCs.

Evaluation of a Clinical Pharmacist Intervention on Clinical and Drug-Related Problems Among Coronary Heart Disease Inpatients: A pre-experimental prospective study at a general hospital in Indonesia

Objectives This study aimed to evaluate the role of a clinical pharmacist intervention in decreasing subsequent clinical and drug-related problems (DRPs) among coronary heart disease (CHD) inpatients with at least one previous DRP. Methods This pre-experimental study with a pre-post design was carried out from January to April 2017 among inpatients with at least one previous DRP at a general hospital in Tangerang District, Banten, Indonesia. Clinical and DRPs were documented prospectively by a clinical pharmacist, with DRPs classified using Version 6.2 of the DRP classification scheme of the Pharmaceutical Care Network Europe Foundation. The intervention consisted of a discussion of identified DRPs with physicians, patients, pharmaceutical logistics clerks, nurses and nutritionists. Following this, any subsequent clinical and DRPs were re-identified and further interventions were conducted as necessary. Results A total of 75 inpatients were included in the study. Pre-intervention, there were 443 DRPs and 202 clinical problems. The most frequent DRPs were adverse drug reactions (52.6%), followed by drug effects (41.8%). Most DRPs were of moderate severity and would have resulted in moderate consequences had the pharmacist not intervened. The interventions resulted in a significant reduction in the number of DRPs, type of DRPs and number of clinical problems (P <0.05 each). Patients with complications were 26.047 times more likely to have no reduction or an increased number of clinical problems compared to patients without complications (P <0.05). Conclusion Clinical pharmacist interventions were found to reduce subsequent DRPs and clinical problems among CHD patients with at least one previous DRP.

The Impact of National Formulary on Cough Medicine Prescribing in Three Primary Health Care in Depok

Objective: To evaluate the use of cough medicine in Acute Respiratory Infections (ARI) patients in three primary health care in Depok in 2015 and suitability with the National Formulary. Method: The study design was descriptive analytic with retrospectively data collection from patient’s prescription, Primary Health Care Management Information System (SIMPUS), and Medicine Management Information System (SIPO). Samples are taken from ARI’s patients prescription from January until December 2015. The analysis was conducted on the prescription that meets the inclusion criteria quantitatively and qualitatively. Quantitative analysis is expressed in DDD and DDD/1000 patients/day. Results: The primary health care that has the biggest quantity of Medicines usage for DDD was in Cipayung (59136, 33g). Then, DDD/1000 patients/day for glyceryl guaiacolate, ambroxol, and dextromethorphan respectively was in Cipayung (14.971g), Limo (1.129 g), and Limo (0,0006g). The primary health care that most suitable with the National Formulary was Conclusion: In conclusion, all the cough medicine use in ARI patients in the three primary health care facilities in Depok in 2015 was unsuitable according to the National Formulary recommendations. Therefore, cough medicine use is needed to be evaluated further. Key words: ATC/DDD, Cough, Cough medicine, Depok Primary Health Care, National Fomulary.

COMPARISON OF ADVERSE DRUG REACTIONS OF SECOND- AND THIRD-GENERATION ORAL CONTRACEPTIVES

Objective: Oral contraceptives are the second-most widely used contraceptives in Indonesia; however, a high percentage rate of withdrawal is seen owing to adverse drug reactions (ADRs). Only a small proportion of users have been provided information about other oral contraceptives such as newer generation progestin as an alternative option to minimize ADR. This study aimed to compare the prevalence of ADR between combined oral contraceptives containing levonorgestrel (LNG) (second generation) and desogestrel (DSG) (third generation), which was expected to have less side effects. Methods: The study has a cross-sectional comparative design with random sampling from users in six villages in Depok City, Indonesia. Data were collected through interviews. The sample includes 60 users of LNG and 40 users of DSG. Results: ADR complaints include intermenstrual bleeding (16.7% vs. 5%), headache (16.7% vs. 5%), nausea/vomiting (25% vs. 0%), breast tenderness (13.3% vs. 0%), impaired sexual intercourse (23.3% vs. 7.5%), weight gain (35% vs. 22.5%), acne (3.3% vs. 7.5%), and face spots/chloasma (28.3% vs. 5%). The LNG group showed significantly higher impaired sexual intercourse (odds ratio (OR): 3.75, 95% confidence interval (CI): 1.003-14.050, p=0.039) and chloasma (OR 7.51, 95% CI: 1.629-34.647, p=0.004). Conclusion: Users’ low knowledge of ADR and how to treat it could be a reason for drug withdrawal. Pharmacies must make efforts to provide counseling in this regard.

related Factors of complete basic Immunization on children and Vaccine Management at Primary Health care and Health Post in X Subdistrict Depok city

background:Poverty in urban area triggered new problem related with their access to health care services. Heavy burden of life in urban makes health, especially reproductive health, never become first priority for urban poor community. This study is aimed to analyzed equity of urban poor community when accessing the reproductive health care. Methods:This is descriptive study with cross sectional design applied. There were 78 women residents of Penjaringansari II Flats in Surabaya selected by simple random sampling (α=10%) as respondents. Penjaringansari II Flats was choosen because it is a slum area that residence by unskilled labours and odd employees. The need fulfillment of respondents in reproductive health care was analyzed by spider web analysis. result: Most of respondents (55.1%) were first married before 20 years old. There were 60.5% of them gave birth before 20 years old also, so it belongs to high risk pregnant women. Spider web area for health care of under age married was less than ideal age married which means that under age married urban poor experienced inequity for ANC health services. Approximately 10.3% of respondents had never use contraceptives because they fear of side effects and inhibiton of their husband. conclutions:Better equity shown in the prevention of cervical cancer. Being perceived as the poor who need assistance, free pap smear was often held by Penjaringansari II residents. Poor conditions experienced by a group not only can promote health care inequity, but also promote health care equity. recomendation:Health care equity for urban poor can be pursued through both aid schemes provided by the community or the government.background: Attractive adses of traditional health services often promises such as certainty of healing, treatment without side effect, experience personnel, exclusive recipes, and testimony of patients who recovered. Ads that this unsubstantiated allegedly played a role in the tendency of people turn to traditional medicine. The aim of the study is to describe the perception of patients about the correspondence between the advertisement and the services provided qualitatively. Methods: The study was conducted in Surabaya for 5 months in 2012. Informants were selected purposively. results: The result shows that most of the information about traditional health services obtained from either advertisement local and national television. Health complaints predominanly degenerative diseases, and most have been treated to modern medicine but because they do not heal, switch to traditional medicine. conclusion: Informants judge ad featuring attractive because advanced equipment, herbal remedies as well as testimonials of patients who have recovered. Much of the promise of the ads is not evident when patients seek treatment, so they seek other traditional treatments. Most of them are less satisfied, but there is a fraction that satisfied because being cured. Traditional health services responsiveness associated with the non-medical aspects assessed either by informants. recomendation:Competent authorities should enforce and socialize media literacy to encourage community.

PENGETAHUAN, SIKAP DAN KEBUTUHAN PENGUNJUNG APOTEK TERHADAP INFORMASI OBAT DI KOTA DEPOK

Background: The implementation analysis of Pap Smears result to the integrated Surveillance development of sexual infection in order to respond the IMS and HIV/AIDS cases which increased especially among the housewife and its aim to the implementation Pap Smears result. Results: The Analysis result: 1. Based on the Pap Smears analysis result when its managed properly might be benefited the information not merely detected service cancer which is tend to increase but its also detected fungal infection and 5 types of IMS data: Haemavilus Vaginalis (HV), Gonococoes (Cocen), Trichomonas Vaginalis (TV), Herpes and Virus Papiloma Humanus (HPV) which is Cocen and TV tend to increase every years. This data might be used for Surveillance Respond of Pap Smears intended to the productive housewife who is representing susceptible age group against sexual infection and HIV/AIDS. 2. The integrated Surveillance activity of HIV and sexual infection along with eight steps of respond Pap Smears, the structure is matching up with Surveillance of WHO respond and the system and mechanism base on decision of Minister of Health number 1116/2003 to instruct the formation of Surveillance technical implementation and the formation Surveillance technical implementation and the formation Surveillance networking among those units. 3. Developing the integrated Surveillance of sexual infection and HIV/AIDS through the uphold unit Pap Smears is required the determination of basis function, the Surveillance uphold unit, the Respond Surveillance uphold and function, formulation of Protap and Instruction, Training, Monitoring and Evaluation Surveillance System, Communication, Procurement of Coordination and Resources. Exceptional the above mentioned it is necessary pay attention as well as Surveillance structure and quality. Suggestion: 1. Improving the Surveillance Respond System by improving the users of culture information and data for making a decision the unit of Pap Smears entirely levels of administrative at Central or Regional. 2. Developing the production of Health Information System that is able to convert data into information Pap Smears to facilitate analysis and interpretation of data. 3. Developing Data Centers, Surveillance and Health Information in accordance with decision of Minister of Health number 116/2003 and filling those units with functional staff epidemiologists and health information experts. Key words: Pap Smears, Surveillance Respond, Sexual Infection-housewifeBackground: Skin cancer is a disease characterized by the growth of skin cells that are not controlled, can damage surrounding tissue and can spread to other of the body. The objective of this analysis is to assess the relationship between various characteristics (gender, age, education, occupation), smoking behavior, and socioeconomic status on the risk of tumors of skin cancer consist of province of Banten, DKI Jakarta, West Java, Central Java, DI Yogyakarta and East Java. Methods: The research design was control case, the case is the respondents who have a history of skin cancer, while controls were respondents who had no history of skin cancer based on data Riskesdas 2007. Controls randomly drawn as many as 4 times the number of cases and were matched by district that is in the 6 (six) province. In this study the number of cases is obtained as many as 266 people and 1064 the number of controls. Results: The results of multivariate analysis showed that there are 2 variables have a statistically significantly associated with tumor/skin cancer,and the type of male sex (OR, 1.37; 95% CI 1,03–1,82), aged 40–49 years (OR 2, 43; 95% CI 1,59–3,73). While the variables education, occupation, smoking behavior, and socioeconomic status were not statistically significant. Key word: determinant factor, skin cancer, Java Island