Baseline glycated hemoglobin and potassium level correlated with pretreatment QT-corrected interval among patients with diabetic drug-resistant tuberculosis

Background

Bedaquiline is a core drug with an optimized background regimen for treating drug-resistant tuberculosis (DR-TB) patients. One of the adverse effects of bedaquiline is QT-corrected (QTc) interval prolongation. TB patients with diabetes mellitus (DM) are more likely to develop QTc interval prolongation during TB treatment than those without DM. This study aimed to correlate baseline electrolyte levels (potassium, calcium, and magnesium), thyroid-stimulating hormone (TSH), body mass index (BMI), blood glucose, glycated hemoglobin (HbA1c), and pretreatment QTc interval among patients with diabetic DR TB who received regimens containing bedaquiline.

Methods

It was a prospective study with a cross-sectional design. Blood samples, BMI, and electrocardiogram were collected at baseline before starting the regimen for DR-TB. Pearson correlation was used to correlate between baseline electrolyte level, TSH, BMI, complete blood count, blood glucose, HbA1c, and pretreatment QTc interval.

Results

Seventy-two DR-TB patients met the inclusion criteria, half with DM. The blood glucose and HbA1c were significantly higher in patients with DM. Pretreatment QTc interval was similar between the two groups. Levels of calcium, magnesium, TSH, blood glucose, and BMI were not correlated with pretreatment QTc interval. There was a correlation between baseline potassium and HbA1c levels with pretreatment QTc interval (P < 0.05; r = 0.357 and r = -0.376, respectively). Baseline potassium level correlates with the pretreatment QTc interval in those without DM.

Conclusion

Baseline HbA1c and potassium levels correlate with pretreatment QTc interval among DR-TB patients with DM. Our study indicates the importance of monitoring HbA1c and potassium levels during DR-TB therapy containing bedaquiline for early detection of QTc prolongation.

Favorable outcome of individual regimens containing bedaquiline and delamanid in drug-resistant tuberculosis: A systematic review

Background

Drug-resistant tuberculosis (DR-TB) is a public health concern that is difficult to treat, requiring long and complex treatment with highly effective drugs. Bedaquiline and/or delamanid have already shown promising outcomes in patients with DR-TB, increasing the rate of culture conversion and lowering TB-related mortality.

Methods

We comprehensively searched and evaluated the effectiveness of individual regimens containing bedaquiline and delamanid on culture conversion and treatment success. We assessed for quality either observational or experimental studies.

Results

We identified 14 studies that met the inclusion criteria using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart with 12 observational and 2 experimental studies. Of 1691 DR-TB patients enrolled in the included studies, 1407 of them concomitantly received regimens containing bedaquiline and delamanid. Overall multidrug resistant (MDR), preextensively drug resistant (XDR), and XDR-TB were seen in 21.4%, 44.1%, and 34.5%, respectively. Of 14 studies, 8 of them reported favorable outcomes including sputum culture conversion and cure rate at the end of treatment, meanwhile 6 studies only reported sputum culture conversion. Sputum culture conversion at the end of the 6^th month was 63.6%-94.7% for observational studies, and 87.6%-95.0% for experimental studies. The favorable outcome at the end of treatment was 67.5%-91.4%. With high pre-XDR and XDR cases among DR-TB patients with limited treatment options, regimens containing bedaquiline and delamanid provide successful treatment.

Conclusion

In DR-TB patients receiving regimens containing bedaquiline and delamanid, favorable outcomes were high including sputum conversion and cure rate.

Scoping review: QT interval prolongation in regimen containing bedaquiline and delamanid in patients with drug-resistant tuberculosis

Background

A regimen containing bedaquiline-delamanid is recommended in management of drug-resistant tuberculosis (DR TB) to increase a success rate. However, this regimen was rare in a clinical setting due to a potential risk of QT prolongation. Several studies have reported the incidence of QT prolongation after administration of this regimen, but the results are inconsistent due to different sample size, study design, and covariate. The aim of this review is to summarize and analyze the published articles related to QT prolongation of bedaquiline and delamanid in PubMed and ScienceDirect databases using a scoping review.

Methods

This scoping review was conducted under PRISMA for scoping review. The outcomes of this review were incidence of QT prolongation and death. We found 8 articles to be included in this review.

Results

The incidence of QT prolongation was higher for DR TB patients who received a regimen containing bedaquiline and delamanid. However, this review found no clinical symptoms, such as cardiac arrhythmias, torsade de pointes, or even death. DR TB patients, especially the elderly, were at risk for QT prolongation. Special consideration in patients with HIV and low level of potassium should be closely monitored for QT interval.

Conclusion

The regular measurement of electrocardiography was highly recommended to evaluate QT interval. Generally, the use of individualized regimen containing bedaquiline and delamanid is relatively safe in DR TB patients.

Condition Factors and Growth Patterns of Mantis Shrimp (Harpiosquilla raphidea) in the Estuary Waters of Berombang River, Labuhanbatu Regency, North Sumatera

Background: Mantis shrimp is one of the favorite shrimp caught by fishermen around the estuary waters of Berombang River, Labuhanbatu Regency. This study aimed to determine the condition factors and growth patterns of mantis shrimp population. Method: Three station points were determined using a purposive random sampling method. The sampling of Harpiosquilla raphidea was carried out using trawl nets. The data analysis provided information on growth patterns and condition factors. Result: The results showed that the growth patterns of male H. raphidea belonged to the positive b> 3 allometric category, where weight growth was faster than carapace growth. Moreover, the growth patterns of female H. raphidea belonged to the negative b<3 allometric category, where the carapace growth was faster than body weight growth. The value of Fulton (K) condition factors for male H. raphidea ranged from 3.54 to 13.18, and for females, it ranged from 15.28 to 22.09. The value of correlation analysis of Physic-chemical parameters, water temperature (0.935) and DO (0.832) showed the high category correlation test results. Conclusion: This result showed that from November 2021 to January 2022, the condition of H. raphidea population around the estuary waters of Berombang River was known and predicted to be in the adult stage

Andrographolide and epigallocatechin gallate (EGCG) lower the risk of addiction induced by nicotine and cigarette smoke extract (CSE) in mice

Background: Nicotine, a psychoactive compound from the tobacco plant, produces a reward effect that potentially causes addiction. It is postulated that nicotine addiction occurs through increased reactive oxygen species production in nucleus accumbens, which causes damage to the endogenous antioxidant defense system resulting in an increased need for nicotine intake, which leads to addiction. The antioxidants, andrographolide and epigallocatechin gallate (EGCG), are expected as potential substances to decrease the risk of nicotine addiction. This study aimed to analyze the effect of andrographolide and EGCG on the risk of addiction induced by nicotine and cigarette smoke extract (CSE) in mice. Methods: Thirty-five Balb/c male mice, divided into seven groups, were used in this study. The administered drugs were normal saline 1.0 mL/kg BW as control group, nicotine 0.5 mg/kg BW, CSE 1.0 mg/kg BW, andrographolide 50 mg/kg BW, and EGCG 50 mg/kg BW as pre-treatment. Conditioned place preference (CPP) with a biased design method was used to evaluate the reward effects induced by nicotine and CSE. Several stages were carried out, namely pre-conditioning, conditioning, post-conditioning, extinction, and reinstatement tests. Results: Based on the CPP score, both nicotine (p<0.001) and CSE (p<0.001) groups increased the reward effect significantly compared to that of the normal saline group. The andrographolide + nicotine (p<0.001) and EGCG + nicotine (p<0.001) groups decreased the reward effect significantly compared to that of the nicotine group without pharmacological treatment. Similarly, the andrographolide + CSE (p<0.001) and EGCG + CSE (p<0.01) groups decreased the reward effect significantly compared to that of the CSE group without pharmacological treatment. Conclusions: Andrographolide and EGCG lower the risk of addiction induced by nicotine and CSE.

Effectivity of Erythropoietin-Alpha between Fixed- and Adjusted-Dose in Chronic Kidney Disease Patients With Anemia on Hemodialysis

Anemia is a common complication in chronic kidney disease (CKD) patient with hemodialysis. The cause of anemia is mainly due to erythropoetin deficiency because the kidneys as a erythropoetin producer are damaged. The most appropriate management of anemia in CKD with hemodialysis is the administration of Erythropoietin Stimulating Agent (ESA) or erythropoetin (Epo). The effectiveness of Epo therapy is influenced by the type of Epo used, the dose of Epo given, the route and frequency of Epo administration, as well as several conditions that affect it such as infection or inflammation, absolute and functional iron deficiency, and malnutrition. Therapeutic targets can be achieved if the dose given is in accordance with the needs of the patient, based on the patient's weight The purpose of this study was to determine the differences in the achievement of Epo-alpha fixed-dose administration compared with adjustment-dose in patients with CKD anemia with hemodialysis after administration of Epo-alpha for 4 weeks in outpatient poly hemodialysis units at Bhayangkara H.S Hospital. Samsoeri Mertojoso Surabaya. In this study, there were 20 patients who met the inclusion criteria (15 male and 5 female) divided into 2 groups, 10 patients in the fixed-dose group and 10 patients in the adjustment-dose group. In the fixed-dose group with a adequacy level of 132.25 ± 29.17, the average Hb change achievement was 0.68 ± 0.63 g / dL (p=0.008), whereas in the adjustment-dose group the achievement of the average Hb change the mean was 1.09 ± 0.82 g / dL (p=0.002). For the Hct parameter, the average Hct change in the fixed-dose group was 2.77 ± 2.23% (p=0.004), while in the adjustment-dose group the average Hct change achievement was 4.02 ± 2.63 g / dL (p=0.001). There was no difference in the achievement of the effectiveness of Epo on the two parameters Hb (p=0.224) and Hct (p=0.256) in the fixed-dose group compared with adjustment-dose.

Analysis of IFN-gamma and IL-10 Levels as Markers of Inflammation and Response Therapy of Anti-Tuberculosis in MDR Lung TB Patients

Multidrug-Resistant Tuberculosis (MDR TB) is caused by an organism that is resistant to at least isoniazid and rifampisin, the two most potent TB drug. Immune response to against Mycobacterum tuberculosis infection is related to the function of immunity. The function of interferon-γ (pro-inflammatory) is to activate macrophages, to stimulate antimicrobial molecules (to reactive oxygen species and nitric oxide), and to inhibits interleukin-10. Interleukin-10 function is to triggers humoral immunity, to inhibit IFN- γ. This study aimed to analyze level changes and the correlation with clinical data, also months of MDR TB patients who received standard OAT therapy. This was an observational study using cross sectional design. There were 29 patients who received standard MDR TB OAT therapy from 1-24 months, who met the inclusion criteria. Then, the patients were divided based on duration of the therapy, which are the initial/intensive and advanced phase. The initial phase divided into 2: first one is for 1-4 months therapy’s time (5 patients) and the second one is for more than 4-8 months (6 patients). Then, the advanced group divided into two groups again, which are third group with more than 8-16 months (13 patients) and fouth group with more than 16-24 months (5 patients). Then, measured serum concentration IFN-γ, IL-10 at the start of the study and 4 weeks later with the ELISA method. This research during the period July-December (6 months). IFN-γ post concentrations were decreased by 39.14 ± 139.12 pg/mL (p > 0.05). The concentration of IL-10 was decreased by 33.93 ± 109.20pg/mL (p>0.05). Based on the TB score bandim method during pre and posts results were 1 patient experienced severity change from severity class 1 to 2, 1 patient from severity class 2 to 1, 1 patient remained in severity 2 and 26 patient remained in severity 1. The results showed that serum IFN-γ and IL-10 levels in initial/intensive and advanced phase patients who received MDR TB regiment after four weeks did not changed,

Analysis of ANC Levels after Filgrastim Therapy in Acute Leukemia Children with Neutropenia

Cytotoxic chemotherapy suppresses the hematopoietic system, and the most serious hematologic toxicity is neutropenia. This can decrease a risk of infection that causes delays in treatment and reduction of dose intensity, which reduces therapeutic outcome. Filgrastim is used to increase neutrophils level whose therapeutic effect is unknown. The effectiveness of filgrastim is based on the ANC level pre- and post-therapy. This study aimed to analyze the use of filgrastim on ANC level changes in acute leukemia children with neutropenia, and to analyze the patient that achieve ANC level’s targeted therapy = 1000 cell/mm3. A prospective observational study with a longitudinal design was conducted from June to October 2016. The inclusion criteria of the study were patients who diagnosed acute leukemia with neutropenia and received filgrastim 10 µg/kgBW for 3, 4, 5 days. Patients’ ANC levels were measured before and after filgrastim therapy. This study has been approved its ethical clearance by Dr. Saiful Anwar Hospital, Malang. Data were obtained on the basis of neutropenic episodes, followed by 7 episodes of obtaining filgrastim for 3 days, 1 episode of obtaining filgrastim for 4 days, and 7 episodes of obtaining filgrastim for 5 days. Thus, it consists of 15 episodes. In 3 days, ANC levels increased by 9.5 fold from 381.3 ± 91.8 cell/mm3 to 3984.9 ± 426.8 cell/mm3, but in 5 days, ANC levels decreased by 0.9 fold from 200.9 cell/mm3 ± 98.2 to 189.7 ± 14.2 cell/mm3. Filgrastim was able to increased the ANC levels around nine fold for 3 days of theraphy. There were 53% neutropenia patients who achieved the goal of therapy. Filgrastim therapy with dose 10 µg/kgBW for 3 to 5 days has been able to reach the therapeutic target of 53% in acute leukemia children with neutropenia. The increased levels of ANC maximum was reached on the third day with increased levels of 9.5 fold.

Effectivity of Erythropoietin-Alpha between Fixed- and Adjusted-Dose in Chronic Kidney Disease Patients With Anemia on Hemodialysis

Anemia is a common complication in chronic kidney disease (CKD) patient with hemodialysis. The cause of anemia is mainly due to erythropoetin deficiency because the kidneys as a erythropoetin producer are damaged. The most appropriate management of anemia in CKD with hemodialysis is the administration of Erythropoietin Stimulating Agent (ESA) or erythropoetin (Epo). The effectiveness of Epo therapy is influenced by the type of Epo used, the dose of Epo given, the route and frequency of Epo administration, as well as several conditions that affect it such as infection or inflammation, absolute and functional iron deficiency, and malnutrition. Therapeutic targets can be achieved if the dose given is in accordance with the needs of the patient, based on the patient's weight The purpose of this study was to determine the differences in the achievement of Epo-alpha fixed-dose administration compared with adjustment-dose in patients with CKD anemia with hemodialysis after administration of Epo-alpha for 4 weeks in outpatient poly hemodialysis units at Bhayangkara H.S Hospital. Samsoeri Mertojoso Surabaya. In this study, there were 20 patients who met the inclusion criteria (15 male and 5 female) divided into 2 groups, 10 patients in the fixed-dose group and 10 patients in the adjustment-dose group. In the fixed-dose group with a adequacy level of 132.25 ± 29.17, the average Hb change achievement was 0.68 ± 0.63 g / dL (p=0.008), whereas in the adjustment-dose group the achievement of the average Hb change the mean was 1.09 ± 0.82 g / dL (p=0.002). For the Hct parameter, the average Hct change in the fixed-dose group was 2.77 ± 2.23% (p=0.004), while in the adjustment-dose group the average Hct change achievement was 4.02 ± 2.63 g / dL (p=0.001). There was no difference in the achievement of the effectiveness of Epo on the two parameters Hb (p=0.224) and Hct (p=0.256) in the fixed-dose group compared with adjustment-dose.

Analysis of IFN- And IL-10 Levels as Markers of Inflamation and Response Therapy of Anti-Tuberculosis in MDR Lung TB Patients

Multidrug-Resistant Tuberculosis (MDR TB) is caused by an organism that is resistant to at least isoniazid and rifampisin, the two most potent TB drug. Immune response to against Mycobacterum tuberculosis infection is related to the function of immunity. The function of interferon-γ (pro-inflammatory) is to activate macrophages, to stimulate antimicrobial molecules (to reactive oxygen species and nitric oxide), and to inhibits interleukin-10. Interleukin-10 function is to triggers humoral immunity, to inhibit IFN- γ. This study aimed to analyze level changes and the correlation with clinical data, also months of MDR TB patients who received standard OAT therapy. This was an observational study using cross sectional design. There were 29 patients who received standard MDR TB OAT therapy from 1-24 months, who met the inclusion criteria. Then, the patients were divided based on duration of the therapy, which are the initial/intensive and advanced phase. The initial phase divided into 2: first one is for 1-4 months therapy’s time (5 patients) and the second one is for more than 4-8 months (6 patients). Then, the advanced group divided into two groups again, which are third group with more than 8-16 months (13 patients) and fouth group with more than 16-24 months (5 patients). Then, measured serum concentration IFN-γ, IL-10 at the start of the study and 4 weeks later with the ELISA method. This research during the period July-December (6 months). IFN-γ post concentrations were decreased by 39.14 ± 139.12 pg/mL (p > 0.05). The concentration of IL-10 was decreased by 33.93 ± 109.20pg/mL (p>0.05). Based on the TB score bandim method during pre and posts results were 1 patient experienced severity change from severity class 1 to 2, 1 patient from severity class 2 to 1, 1 patient remained in severity 2 and 26 patient remained in severity 1. The results showed that serum IFN-γ and IL-10 levels in initial/intensive and advanced phase patients who received MDR TB regiment after four weeks did not changed.

Analysis of ANC Levels after Filgrastim Therapy in Acute Leukemia Children with Neutropenia

Cytotoxic chemotherapy suppresses the hematopoietic system, and the most serious hematologic toxicity is neutropenia. This can decrease a risk of infection that causes delays in treatment and reduction of dose intensity, which reduces therapeutic outcome. Filgrastim is used to increase neutrophils level whose therapeutic effect is unknown. The effectiveness of filgrastim is based on the ANC level pre- and post-therapy. This study aimed to analyze the use of filgrastim on ANC level changes in acute leukemia children with neutropenia, and to analyze the patient that achieve ANC level’s targeted therapy = 1000 cell/mm3. A prospective observational study with a longitudinal design was conducted from June to October 2016. The inclusion criteria of the study were patients who diagnosed acute leukemia with neutropenia and received filgrastim 10 µg/kgBW for 3, 4, 5 days. Patients’ ANC levels were measured before and after filgrastim therapy. This study has been approved its ethical clearance by Dr. Saiful Anwar Hospital, Malang. Data were obtained on the basis of neutropenic episodes, followed by 7 episodes of obtaining filgrastim for 3 days, 1 episode of obtaining filgrastim for 4 days, and 7 episodes of obtaining filgrastim for 5 days. Thus, it consists of 15 episodes. In 3 days, ANC levels increased by 9.5 fold from 381.3 ± 91.8 cell/mm3 to 3984.9 ± 426.8 cell/mm3, but in 5 days, ANC levels decreased by 0.9 fold from 200.9 cell/mm3 ± 98.2 to 189.7 ± 14.2 cell/mm3. Filgrastim was able to increased the ANC levels around nine fold for 3 days of theraphy. There were 53% neutropenia patients who achieved the goal of therapy. Filgrastim therapy with dose 10 µg/kgBW for 3 to 5 days has been able to reach the therapeutic target of 53% in acute leukemia children with neutropenia. The increased levels of ANC maximum was reached on the third day with increased levels of 9.5 fold.

Analysis of Prophylactic Antibiotics Usage in Caesarean Section Delivery

Caesarean section is the delivery through a surgical incision in the abdomen and uterus with various risks, such as Surgical Site Infection (SSI) which either occurs rapidly (24-48 hours postoperatively) or delayed. To reduce the risk of various post-cesarean section infections, prophylactic antibiotics are given. The administration of prophylactic antibiotics with recommended regimens, such as in developed countries as in the United States and Europe, with first generation of cephalosporins has not been applied in Dr. Iskak Hospital, Tulungagung. This hospital still used other types of antibiotics, such as cefotaxime or ceftriaxone. In addition, for several reasons, prophylactic antibiotics were continued with other antibiotics to reduce the risk of delayed infection. This study was designed to analyze the effectiveness of prophylactic antibiotics as recommended in cesarean section. This was a prospective observational study with consecutive sampling type, examined 41 mothers with cesarean section at the Department of Obstretics and Gynecology, Dr. Iskak Hospital, Tulungagung, Indonesia. This study was conducted from May to July, 2017. The results of the study showed that the effectiveness of prophylactic antibiotic use was 98% based on the clinical parameters and maternal laboratory outcome, which showed that SIRS was in normal category. Whereas, there was one mother (2%) who had SSI on day 10 postoperatively.

Analysis of High Dose and Long-Term Prednisone Therapy on Trap 5B Level Change in Children with Steroid Sensitive Nephrotic Syndrome

Nephrotic syndrome is a condition which is characterized by protein leakage from the blood to the urine through glomeruli. It leads to hypoproteinemia and generalised oedema. Patients with nephrotic syndrome need high dose and long term glucocorticoid such as prednisone. High dose and long term glucocorticoid can increase bone resorption. Biological marker is a valuable tool to evaluate efficacy of therapy. TRAP 5B is a sensitive biological marker for bone resorption because it reflects the number of osteoclasts. TRAP 5B is not affected by renal dysfunction and food. It also has a low diurnal variation than other bone resorption marker. The aim of this study was to analyze the changes of TRAP 5B levels at induction and alternate phase in children with steroid sensitive nephrotic syndrome. This observational prospective study was conducted from May to October 2016. Venous blood samples obtained at 08.00-10.00 am. TRAP5B levels were measured before and after induction phase and after alternate phase using ELISA. Fifteen patients were included in this study (60% boys). Majority of their age was 6 - <12 years and 40% were dependent steroid NS. TRAP 5B serum levels in induction phase increased by 37.41%±56.22%. In alternate phase, TRAP 5B serum levels increased by 28.75%±66.55% compared to the induction phase. However, the level change of both phases were not significant. As a conclusion, TRAP 5B levels increased in induction and alternate phase after high dose and long-term prednisone treatment in nephrotic syndrome.

Children with Standard Risk Acute Lymphoblastic Leukemia in Induction And Consolidation Phase

Prednisone has an important role in the therapy of patient with standard risk ALL. Patients with standard risk ALL receiving high dose prednisone as therapy and supraphysiology dose of prednisone are expected to cause suppression in HPA-axis (Hypothalamic Pituitary Adrenal axis). This suppression could reduce immune system in children with ALL and increase infection risk because reduction of cortisol level. In Indonesia, we did not find study about the incident of adrenal suppression after high dose prednisone therapy, especially in induction to consolidation phase ALL patient. The aim of this study was to analyze adrenal suppression after high dose prednisone therapy on children with standard risk acute lymphoblastic leukemia in induction and consolidation phase. This study has received a certificate of Ethical Clearance No. 588/Panke.KKE/X/2016, a longitudinal observational, prospective, non-randomized trial involving children with ALL who received prednisone for 49 days during the induction phase. We collected and compared laboratory result of cortisol level in children with ALL and received prednisone therapy during induction to consolidation phase. Sample was taken at week 0,4,5,6,7,8,10,12 in the course of ALL chemotheraphy Indonesian protocol year 2013. Serum was examined using methods CLIA ADVIA Centaur® XP. Between June 2016 – January 2017, 13 patients (8 males, 5 females) were included in this study. Decrease of cortisol level after prednisone therapy occured in week-10 as much as 53% compared with week-0  (p=0.027). Cortisol level increased 64% of week-12 compared with week-10 (p=0.003). In conclusion, high dose prednisone is not significant to causing adrenal suppression in induction phase of ALL patients, and the reducing cortisol level is reversible.

Analysis of Methyldopa Therapy on sFlt-1 Antiangiogenic Levels in Patients with Severe Preeclampsia

Methyldopa is the first-line drugs to treat hypertension in pregnancy. It can decrease blood pressure in preeclampsia by affecting a2-adrenoreceptors in central nervous system. However, it could also act by decreasing  production of sFlt-1 antiangiogenic protein levels involved in the pathophysiology of hypertention  in preeclampsia. The purpose of this study was to analyze methyldopa therapy on sFlt-1 antiangiogenic levels in the plasma of pregnant women with severe preeclampsia at the Obstetric Departement, Haji Hospital, Surabaya. This was a prospective study with observational cross-section study design. The sFlt-1 angiogenic levels were observed before and after (48 hours) methyldopa administration in severe preeclampsia patient with or without complications in the period of August to October 2016. Patient received methyldopa 250 mg or 500 mg, three times a day for clinical indications according a standard protocol. The study was approved by the ethical committee of Haji Hospital, Surabaya. There were 19 patients with preeclampsia who met the inclusion criteria, showed a decrease in the levels of sFlt-1 before and 48 hours after methyldopa therapy. Levels of sFlt-1 before methyldopa therapy in a dose of 250 mg was 10.15±10.00 (2.55-34.70) ng/ml and after therapy 8,37±9,20 (0.72-9.20) ng/ml, with a percentage decrease 17.54%. sFlt-1 levels before methyldopa therapy in a dose of 500 mg was 8.05±7.07 (2.55-20.76) ng/ml, after  therapy 4.50±2.90 (2.19-9.95) ng/ml, with a percentage decrease 44.16%. Methyldopa therapy could decrease sFlt-1 levels of antiangiogenic factor in patients with severe preeclampsia.

EFFECTIVENESS AND SAFETY DIFFERENCES OF ISOXSUPRINE AND NIFEDIPINE AS TOCOLYTICS IN THE RISK OF PRETERM LABOR

Premature labor is a cause of high rates of perinatal morbidity and mortality. The use of tocolytics is one of the efforts to handle the risk of preterm labor. Tocolytics which are widely used in Indonesia is isoxsuprine and nifedipine. The purpose of this study was to identify the difference of effectiveness and safety of isoxsuprine as tocolytics in the risk of preterm labor. This was an observational study in the form of a case study that was done in detail and depth to the patients who were diagnosed as imminent preterm labor. In conclusion, there were differences in the effectiveness and safety of isoxsuprine and nifedipine as tocolytics in the risk of preterm labor.

EFFECTS OF METHYLDOPA ON VEGF LEVELS AS PROANGIOGENIC FACTOR IN SEVERE PRE-ECLAMPSIA AT HAJI HOSPITAL, SURABAYA

Methyldopa is the main antihypertensive drug widely used in pregnant women with hypertensive disorder. It lowers blood pressure in pre-eclampsia by affecting a2-adrenoreceptors in central nervous system. However, it also decreases the production of proangio-genic factors that involved in the pathophysiology of hypertension in pre-eclampsia. Vascular Endothelial Growth Factor (VEGF) is one of proangiogenic and mitogenic factor that important for vasodilatation. VEGF is produced by the placenta and affected after treatment with methyldopa. The aim of this study was to analyze the effects of methyldopa on VEGF maternal circulating level as a proangiogenic factor in severe pre-eclampsia patients who were hospitalized at Obstetrics and Gynecology Department, Haji Hospital, Surabaya. This study was performed by cohort prospective observational method on August to October 2016.The data was assessed at before and 48 hours after methyldopa therapy. The study was approved by the ethical committee of Haji Hospital, Surabaya. There were 19 patients with severe pre-eclampsia who met inclusive criteria. The results showed that levels of VEGF before and 48 hours after 250 mg methyldopa therapy were 1178.37(281.97-3567.28) pg/mL and 1055.17 (129.79-4272.66) pg/mL, respectively. VEGF levels in severe pre-eclampsia patients were 1194.29 (175.68-3432.01) pg/mL at before treatment and 510.66 (214.34-1236.16) pg/mL after treatment with methyldopa 500 mg therapy. In conclusion, methyldopa could decrease VEGF level on severe pre-eclampsia patients, with a decrease of 10% at the dose of 250 mg and 57% at the dose of 500 mg.

METHOTREXATE USE IS SAFE IN CHILDREN WITH ACUTE LYMPHOBLASTIC LEUKEMIA

Monitoring level of methotrexate is not only aimed at monitoring effectiveness, but also safety aspects of the administration of high-dose methotrexate because the use of high-dose methotrexate is one of the problems associated with toxicity in various organs.  In the use of high-dose methotrexate, measurement of methotrexate is important to identify patients with a high risk of toxicity, particularly nephrotoxicity as well as for dosing guidelines for leucovorin therapy. The aim of this study was to analyze the safety of high-dose methotrexate on kidney function during chemotherapy consolidation phase in children with acute lymphoblastic leukemia. This was a longitudinal, observational prospective study conducted to determine the safety profile of high-dose methotrexate on kidney function during chemotherapy consolidation phase in children with acute lymphoblastic leukemia. Patients who met the inclusion criteria were given high-dose methotrexate according to the 2013 Indonesian ALL Chemotherapy Protocol. Measurement of methotrexate level and kidney function was done 3 times on each cycle of chemotherapy consolidation phase. Measurements were made on the 0, 24 and 48 hours after the first drop of high-dose methotrexate. This study had been reviewed by Ethics Committee of Dr. Soetomo Hospital Surabaya. There were 12 patients who met inclusion criteria and 6 patients among them had finished their chemotherapy consolidation phase completely. There was no significant change in kidney function after the administration of high-dose methotrexate compared to baseline (p>0.05) and there was no significant correlation between serum level of methotrexate versus creatinine clearance. In conclusion, methotrexate was safe to use in children with acute lymphoblastic leukemia.

ANALYSIS OF NACL-MANNITOL HYDRATION ON RENAL FUNCTION OF HEAD AND NECK CANCER PATIENTS RECEIVING HIGH-DOSE CISPLATIN CHEMOTHERAPY COMBINATION

Cisplatin is one of platinum cytostatic drug for the medication of solid cancers, one of which is head and neck cancer. Adverse event that resulted during drug treatment was acute or chronic nephrotoxicity. Cisplatin concentration in proximal tubular epithelial cells is about 5 times the serum concentration. Platinum exposure on renal tubular cells bonding covalent complex which stimulate production of inflammatory factors that lead to apoptosis and necrosis cell. Cisplatin nephrotoxicity can be prevented by aggressive hydration or alternate method of administration. The aim of this study was to analyze the effectiveness of NaCl-Mannitol hydration on renal function of head and neck cancer patients receiving cisplatin 100 mg/m2 chemotherapy combination with 5FU or paclitaxel. This was a cohort, prospective, and observational study to analyze renal function of head and neck cancer patients receiving cisplatin 100 mg/m2 chemotherapy combination with 5FU or paclitaxel. Inclusion criteria were BUN 7-18 mg/dl and serum creatinine < 2 mg/dl of any cycle. All patients received infuse NaCl-Mannitol hydration with term that provided in Surgeon Departement of Dr. Soetomo General Hospital. Data obtained were BUN, SCr, and eClCr Cockroft-Gault, each was measured pre- and post-hydration. In cisplatin and 5FU chemotherapy combination value BUN pre-hydration (11,99 + 4,62) mg/dl, value BUN post-hydration (12,14 + 4,74) mg/dl and value serum creatinine pre-hydration (0,97 + 0,34) mg/dl, value serum creatinine post-hydration (1,02 + 0,37) mg/dl. Meanwhile to the combination of cisplatin and paclitaxel chemotherapy, value BUN pre-hydration (10,19 + 2,58) mg/dl, value of BUN post-hydration (10,43 + 2,31) mg/dl and value of serum creatinine post- hydration (0,98 + 0,26) mg/dl. In conclusion, NaCl-Mannitol hydration administration is adequate which is shown by BUN and serum creatinine in pre- and post-hydration data within normal limits.

ANALYSIS OF DL--TOCOPHEROL AS ANTIOXIDANT ON MALONDIALDEHYDE LEVEL IN PEDIATRIC PATIENTS WITH -THALASSEMIA MAJOR

Thalassemia is a hereditary form of anemia that affects the synthesis of hemoglobin. The management of therapy in patients with b-thalassemia major which patients should receive continuous blood transfusions and increased iron absorption from the digestive tract causes excess iron in the body. This will lead to an increase of free iron level that triggers Radical Oxygen Species (ROS). Increased level of ROS can initiate lipid peroxidation which used as an indicator of oxidative stress in cells and tissues and produce reactive carbonyl, mainly malondialdehyde (MDA). Thus, MDA measurement is widely used as an indicator of lipid peroxidation. On the other hand, the risk of oxidative damage can be reduced by antioxidant, one of them is Vitamin E that is a fat-soluble vitamin with high potential antioxidant. The objective of this study was to analyze the effect of the dl-a-tocopherol (Vitamin E) administration on decrease of MDA serum level on pediatric patients with b-thalassemia major. This was a longitudinal observational study design for one group without comparison was conducted to examine the use of vitamin E to decreased MDA serum level on children patients with b-thalassemia major. The inclusion criteria were patients who rely on blood transfusions, patients who received only one type of iron chelating agents during the study period, the clinical condition is stable, agrees, and has completed the informed consent. In the course of the study of 21 patients there were variations in patient compliance in taking vitamin E tablet dosage 200 IU once-daily for one month: only 11 out of 21 patients consumed 30 tablets of vitamin E 200 IU (total dose of 6000 IU) in the 1-month study, and only data from those 11 samples will be analysed further. MDA serum level was measured pre- and post-administration of vitamin E and patient’s characteristics of subjects was obtained for additional information. Pre-administration of vitamin E, serum level of MDA was 1239.4 ± 502.55 ng/mL with a range of 216.95 to 2297.3 ng/mL, whereas in the group post administration of vitamin E, MDA serum level was 786.49 ± 704.88 ng/mL with a range of 6.5380 to 1958.6 ng/mL. In conclusion, there was no significant difference in MDA serum level in the group pre- and post- administration of vitamin E (p = 0.15).

PHOSPHATIDYLGLYCEROL STUDY AS FETAL LUNG MATURATION PARAMETER AFTER DEXAMETHASONE ADMINISTRATION FOR WOMEN AT RISK OF PRETERM BIRTH

Phosphatidylglycerol is an important indicator of fetal lung maturation, which plays a role in stabilizing surfactant lipoprotein complex. Corticosteroid antenatal can stimulate the synthesis of pulmonary surfactant in infants with preterm birth. The objective of this study is to examine the phosphatidylglycerol levels as fetal lung maturation parameter after dexamethasone administration in women with preterm birth compared to L/S ratio parameter. This study was prospective longitudinal (cohort). The samples were pregnant women with preterm birth risk at 28-34 weeks gestation getting the therapy of antenatal dexamethasone 6 mg IM every 12 hours given 4 times in 48 hours. The samples were 17 patients. Determination of L/S ratio and PG levels was performed by ELISA. The study was conducted from May - November 2015 and reviewed to obtain ethics eligibility permit by the research ethic committees of Dr. Soetomo General Hospital. The results show that the mean value of L/S ratio is 2.28 with a range of 1.35 to 9.06 and the mean of PG level is 1.17 with a range from 0 to 3.79. L/S ratio and PG show no significant relationship between the two of them. Increased levels of PG on the gestational age of 28-32 weeks have not demonstrated clinically significant changes yet. The highest PG level occurs in the gestational age of 32-34 weeks.

ANALYSIS OF INDUCTION PHASE GLUCOCORTICOID USE ON ADRENAL SUPPRESSION IN PEDIATRIC PATIENTS WITH ACUTE LYMPHOBLASTIC LEUKEMIA

Glucocorticoids play an important role in the treatment of acute lymphoblastic leukemia (ALL). However, supraphysiological doses may cause suppression of the adrenal. Adrenal suppression resulting in reduced cortisol response may cause an inadequate host defence against infections, which remains a cause of morbidity and mortality in children with ALL. The occurrence of adrenal suppression before and after glucocorticoid therapy for childhood ALL is unclear. The aim of this study is to analysis the effect of glucocorticoid on cortisol levels during induction phase chemotherapy in children with acute lymphoblastic leukemia. A cross-sectional, observational prospective study was conducted to determine the effect of glucocorticoid on cortisol levels in children with acute lymphoblastic leukemia. Patients who met inclusion criteria were given dexamethasone or prednisone therapy for 49 days according to the 2013 Indonesian Chemotherapy ALL Protocol. Cortisol levels were measured on days 0, 14, 28, 42 and 56 of induction phase chemotherapy. There were 24 children, among 31 children recruited, who suffered from acute lymphoblastic leukemia. Before treatment, the means of cortisol levels were 228.95 ng/ml in standard risk group (prednisone) and 199.67 ng/ml in high risk group (dexamethasone). In standard risk group, the adrenal suppression occurs at about day 56. There was a significant decrement of cortisol levels in high risk group in days 14, 28, 42 against days 0 of induction phase (p=0.001). Both groups displayed different peak cortisol levels after 6 week of induction phase (p=0.028). Dexamethasone resulted in lower cortisol levels than prednisone during induction phase chemotherapy in children with acute lymphoblastic leukemia.

EFFECTIVITY AND RENAL SAFETY OF CYCLOSPORINE AND METHYLPREDNISOLONE COMBINATION THERAPY IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

Cyclosporine and methylprednisolone combination are second line therapy for moderate to severe systemic lupus erythemathosus. Some study suggest that the combination were effective to decrease of systemic lupus erythematosus disease activity. But record from the study, cyclosporine cause nephrotoxicity side effect. Therefore, this study should be considered to monitore therapy effect on disease activity and renal side effect. The aim of this study is to analyze the effect of cyclosporine and methylprednisolone combination therapy on disease activity in systemic lupus erythematosus (SLE) assessed by MEX-SLEDAI and renal side effect assessed by creatinine, ureum and proteinuria. A cohort, observational prospective study was conducted to determine the effect of cyclosporine and methylprednisolone combination therapy on disease activity of SLE and renal side effect of this combination. Patients who met criteria were given cyclosporine and methylprednisolone combination that normally renal function tests. MEX-SLEDAI score, creatinine, ureum and proteinuria were measured for fourth times (one time in one mounth), before study, 1st mounth, 2nd mounth, and 3rd mounth. The study comprised 9 patients SLE were given cyclosporine and methylprednisolone combination that normally renal function tests. All patients were female and had productive age. At 3rd mounth, there was increase patients who had MEX-SLEDAI score <2 (55,6%) and one patient (11,1%) had increase of creatinine, ureum and proteinuria. In conclusion, cyclosporine and methylprednisolone combination therapy showed the effectiveness and safety in 88,9% patients and renal dysfunction in 11,1% patients.

C-REACTIVE PROTEIN (CRP) AS A SUPPORTING MARKER OF ANTIBIOTIC EFFECTIVENESS ON CENTRAL NERVOUS SYSTEM (CNS) INFECTIONS

Infection of the central nervous system in pediatric patients have a high mortality as well as acute and chronic neurological sequelae. Signs of the disease are unclear, so cerebrospinal fluid (CSF) test is used as a gold standard for diagnosis, but the investigation has faced many obtacles. Empiric antibiotic therapy is the key factor in reducing morbidity and mortality. Microbiological culture result is obtained within 5-7 days. The effectiveness of empirical antibiotic use is questionable. Therefore, other investigations are conducted to determine the effectiveness of antibiotics by using one marker, the CRP. This study was to analyze CRP level in supporting antibiotic therapy effectiveness in pediatric patients with central nervous system (CNS) infections. A prospective cohort study was conducted to determine the relationship of CRP with other parameters, including clinical, microbiological and laboratory, in pediatric patients with central nervous system infections. Patients meeting blood samples criteria were taken before (H0), the third day (H3) and the fifth day (H5) after antibiotics administration. This study involved 10 patients with central nervous system infections (meningoencephalitis, encephalitis and encephalitis with cerebral edema). Six patients were male, with ages less than a year. Antibiotic treatment effectiveness was associated with improved condition of the patients' CRP level. It was 3.558 ±3.196 before (H0), 3.878±2.813 on the third day (H3) and 3.891±2.204 on the fifth day (H5) after antibiotic administration. Leukocyte levels were 13.680±1.660 before (H0), 17.832±7.213 on the third day (H5), and 10.546±3.671 on the fifth day (H5) after antibiotic administration. Pearson's correlation test analysis performed on CRP and WBC parameters showed H0 p=0.981, CRP and WBC H3 p=0.621, while CRP and WBC H5 obtained significance p=0.644. There was no significant correlation observed between CRP and WBC parameters before and after antibiotic administration. In conclusion, there was no correlation of CRP levels with clinical, laboratory and micobiological parameters in patients with central nervous system infections.