High doses of rifampin may help patients with tuberculous meningitis (TBM) to survive. Pharmacokinetic pharmacodynamic evaluations suggested that rifampin doses higher than 13 mg/kg given intravenously or 20 mg/kg given orally (as previously studied) are warranted to maximize treatment response. In a double-blind, randomized, placebo-controlled phase II trial, we assigned 60 adult TBM patients in Bandung, Indonesia, to standard 450 mg, 900 mg, or 1,350 mg (10, 20, and 30 mg/kg) oral rifampin combined with other TB drugs for 30 days. The endpoints included pharmacokinetic measures, adverse events, and survival. A double and triple dose of oral rifampin led to 3- and 5-fold higher geometric mean total exposures in plasma in the critical early days (2 ± 1) of treatment (area under the concentration-time curve from 0 to 24 h [AUC], 53.5 mg · h/liter versus 170.6 mg · h/liter and 293.5 mg · h/liter, respectively; < 0.001), with proportional increases in cerebrospinal fluid (CSF) concentrations and without an increase in the incidence of grade 3 or 4 adverse events. The 6-month mortality was 7/20 (35%), 9/20 (45%), and 3/20 (15%) in the 10-, 20-, and 30-mg/kg groups, respectively ( = 0.12). A tripling of the standard dose caused a large increase in rifampin exposure in plasma and CSF and was safe. The survival benefit with this dose should now be evaluated in a larger phase III clinical trial. (This study has been registered at ClinicalTrials.gov under identifier NCT02169882.).

Interprofessional Collaboration (IPC) yang buruk menjadi faktor penting dalam kesalahan medis. IPC dapat ditingkatkan sejak masa pendidikan melalui Interprofessionalism Education (IPE). Penelitian ini bertujuan untuk mengetahui persepsi mahasiswa program studi rumpun ilmu kesehatan Universitas Padjadjaran (Unpad) terhadap IPE. Metode Penelitian analitik komparatif menggunakan kuesioner Interdisciplinary Education Perception Scale (IEPS) yang diterjemahkan dan divalidasi dibagikan kepada mahasiswa Program Studi Kedokteran, Pendidikan Kedokteran Gigi, Farmasi, Keperawatan, Diploma Kebidanan, serta Profesi Dokter, Dokter Gigi, Apoteker, dan Ners Unpad sejumlah 252 mahasiswa meliputi 28 mahasiswa dari setiap program studi. Persepsi mahasiswa dikategorikan menjadi baik, cukup baik, dan kurang baik. Uji t independen dilakukan untuk membandingkan kelompok sarjana dan diploma dengan profesi, sedangkan One way Anova dan Post Hoc Tukey digunakan untuk membandingkan antar program studi pada kelompok sarjana dan diploma serta profesi. Hasil Persepsi 98% responden masuk ke dalam kategori baik. Uji Anova menunjukkan perbedaan signifikan antar program studi pada kelompok sarjana dan diploma (p = 0,004) serta pada kelompok profesi (p < 0,001). Komponen IPE “Kebutuhan yang dirasakan untuk kerjasama profesional” memiliki persepsi baik yang lebih rendah dibandingkan dengan komponen “Kompetensi dan otonomi” dan “Persepsi kerjasama aktual”. Diskusi Mahasiswa sudah memahami mengenai peran dan kompetensi masing-masing profesi. Namun, pemahaman mengenai profesi tenaga kesehatan lain dan pentingnya kerjasama antar profesi masih kurang, sehingga perlu diadakan IPE di Unpad.Kata Kunci: Interprofessional collaboration, interprofessional education, mahasiswa, persepsi

Background: Steroid-resistant nephrotic syndrome (SRNS) is a leading contributor to chronic kidney disease (CKD), and calcineurin inhibitors (CNIs) or monoclonal antibodies are currently the best identified therapy. Meanwhile, some developing countries still use alkylating agents (AA) such as cyclophosphamide (CPA) to treat SRNS due to economic reasons. Objectives: This study aims to determine the employability of soluble urokinase plasminogen activator receptor (suPAR) as a biomarker for monitoring therapy in SRNS children and compare the clinical improvement with those treated with an AA and CNIs. Methods: This was a retrospective cohort study conducted at Hasan Sadikin Hospital, Indonesia. The data was collected from July 2019 to July 2020 from 70 children with FSGS. Clinical signs were evaluated monthly, and serum suPAR level was measured at the third and sixth months following therapy. Two-way repeated measures ANOVA was carried out to compare the differences in suPAR level at baseline with the third and sixth months in SRNS patients who received AA and CNIs. Results: The mean age was nearly similar between the two groups based on the t-test (P = 0.140). Steroid-resistant nephrotic syndrome was more frequent in boys than in girls (P = 0.020), according to the Chi-square test. Baseline serum suPAR level was not significantly different between the two groups. In the third month, the daily urinary protein level was higher in SRNS patients that received the AA compared to the CNIs group (P < 0.001). There was a significant interaction between time and treatment (F(2,138) = 7.203, P = 0.001), with higher suPAR level in SRNS patients that received the AA compared to those administered with CNIs at the 3rd and 6th months, but this difference was not statistically significant (P > 0.05). Conclusions: As a noninvasive tool, suPAR is a promising modality in monitoring SRNS therapy, and CNIs have a tendency to achieve faster remission than the AA.

Kekurangan air bersih merupakan salah satu faktor munculnya penyakit diare yang menjadi penyebab terbesar kedua terhadap kematian anak di bawah usia lima tahun. Terdapat banyak faktor yang memengaruhi kepemilikan sumber air bersih yang digunakan. Penelitian ini menggunakan data sekunder Survei Demografi dan Kesehatan Indonesia (SDKI) tahun 2012 di wilayah Provinsi Jawa Barat (n= 2.264) yang diperoleh secara umum melalui situs resmi DHS. Data yang digunakan merupakan data nominal dan ordinal, Beberapa variabel dikategorisasi ulang, kemudian seluruh variabel dianalisis menggunakan regresi logistik. Hasil yang didapatkan, variabel yang memiliki hubungan signifikan dengan kepemilikan SAM yang aman adalah jenis permukiman, jenis fasilitas sanitasi, pendidikan terakhir KK dan indeks kekayaan keluarga. Disamping itu, masih ditemukan disparitas antara rumah tangga yang tinggal di perkotaan dan pedesaan, di perkotaan masyarakat lebih mudah mengakses sumber air minum (SAM) yang aman sebesar 2 kali dibandingkan dengan masyarakat yang tinggal di pedesaan [AOR=1,97(IK 95% 1,53;2,53)]. Hasil penelitian ini mendapatkan informasi bahwa Indeks kekayaan keluarga dan pendidikan memiliki hubungan yang positif dengan kepemilikan SAM. Semakin tinggi indeks kekayaan keluarga semakin dapat mengakses SAM yang aman.Kata Kunci : Air Minum, Diare, Sanitasi, SDKI.

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29 30 Running title: high dose rifampicin in tuberculous meningitis 31 Word count: running title: 46 characters; abstract: 199 words; main text: 3487 words 32 2 ABSTRACT 33 34 Background 35High doses of rifampicin may help tuberculous meningitis (TBM) patients to survive. Pharmacokinetic-36 pharmacodynamic evaluations suggested that rifampicin doses higher than 13 mg/kg intravenously or 20 mg/kg 37 orally (as previously studied) are warranted to maximize treatment response. 38 Methods 39In a double-blinded, randomised, placebo-controlled phase II trial, we assigned 60 adult TBM patients in 40 Bandung, Indonesia, to standard 450 mg, 900 mg or 1350 mg (10, 20 and 30 mg/kg) oral rifampicin combined 41 with other TB drugs for 30 days. Endpoints included pharmacokinetic measures, adverse events and survival. 42 Results 43A double and triple dose of oral rifampicin led to three and five-fold higher geometric mean total exposures in 44 plasma in the critical early days (21) of treatment (AUC 0-24h: 53·5 mg.h/L vs 170·6 mg.h/L vs. 293·5 mg.h/L, 45 p<0·001), with proportional increases in CSF concentrations and without an increase in the incidence of grade 46 3/4 adverse events. Six-month mortality was 7/20 (35%), 9/20 (45%) and 3/20 (15%) in the 10, 20 and 30 mg/kg 47 groups, respectively (p=0·12). 48 Conclusions 49Tripling the standard dose caused a large increase in rifampicin exposure in plasma and CSF and was safe. 50Survival benefit with this dose should now be evaluated in a larger phase III clinical trial. 51 52 53 54 55 In 2016, the WHO published data on 10.4 million new tuberculosis (TB) cases and 1·3 million deaths caused by 57 this disease worldwide, making it the leading single infectious disease killer.(1) In turn, tuberculous meningitis 58 (TBM) is the most devastating form of TB. It occurs in 1-6% of patients with TB,(2, 3) leading to death or 59 neurological disability in more than 30% of affected patients.(2, 4, 5) 60 Antimicrobial treatment for TBM follows the model for pulmonary TB, with intensive and continuation phases 61 of treatment. It adheres to the same first-line TB drugs and dosing guidelines,(6) although it is known that some 62 first-line TB drugs, including rifampicin, achieve suboptimal concentrations beyond the blood-brain and blood-63 cerebrospinal fluid (CSF) barriers. Rifampicin is a crucial TB drug, evidenced by the high mortality rate in TBM 64 patients with resistance to rifampicin.(7, 8) As it takes a long time to develop new drugs to treat TB and TBM, it 65is important to make the best possible use of existing drugs. We performed a series of studies to evaluate higher 66 doses of rifampicin in Indonesian patients with TBM. 67A first open-label, randomised phase II clinical trial showed that a 33% higher dose of rifampicin administered 68 intravenously (13 mg/kg iv) for two weeks led to a three-fold higher exposure to rifampicin in plasma and CSF 69 during the first critical days of treatment, and a strong reduction in mortality at six months after the treatment 70 started (adjust...

The prevalence of chronic kidney disease on dialysis or CKD5D is increasing with a significant impact on disease burden in many countries. Patients are usually listed in the national renal registries, which report demographic data, incidence, prevalence, and outcome. The survival rate is an important outcome measure to characterize the impact of treatment in the CKD5 patient population in the national and international renal registries. Indonesian Society of Nephrology (InaSN) has the Indonesian Renal Registry program to collect data that was endorsed to monitor dialysis treatment quality in Indonesia. IRR releases an annual report, but there is no survival analysis yet. This study aimed to discover the five-year survival rate of CKD5D patients in West Java between 2007–2018 and its factor based on the IRR database. A retrospective cohort study was performed by gaining all patients' data from the IRR database, then data on all of the patients from West Java province who completed a 5-year follow-up on December 31, 2018. Kaplan-Meier analysis and Cox proportional hazard's model were used to analyze the risk factors. There were 3,199 data included in this study. In total, the 1, 2, 3, 4, and 5 year survival rates are 82%, 70%, 62%, 58%, and 55 %, respectively. Patients whose age is above 55 years and with unknown underlying kidney disease have a worse survival rate with a hazard ratio of 1.28 and 1.50, respectively. Further exploration of IRR data will provide better information on dialysis treatment in Indonesia.

Introduction Most pediatric cancer patients in developing countries present at an advanced stage due to delayed diagnosis, being an important barrier to effective care. The objective of this study was to evaluate the associated factor of patient delay and explore significant parental practice‐associated risk factor to patient delay. Methods This was a sequential mixed methodology, utilizing data from the Indonesian Pediatric Cancer Registry for clinical variables and completed interviews with parents using structured questionnaires to obtain their sociodemographic data. A binary logistic regression analysis model was fitted to identify factors associated with patient delay. Additional semi‐structured interviews related to parental practice of using complementary and alternative medicine (CAM) were administered to 30 parents. Thematic framework analysis was performed on qualitative data to explore determinant factors of parental practice of using CAM. Results We interviewed 356 parents with children with cancer. The median patient delay was 14 days (interquartile range [IQR]: 6–46.5 days). The most extended delay was in patients with malignant bone tumors (median 66, IQR: 14–126). In multivariable logistic regression analysis, solid cancer (odds ratio [OR] = 5.22, 95% confidence interval [CI]: 2.79–9.77, p < .001) and use of CAM (OR = 1.86, 95% CI: 1.13–3.08, p = .015) were associated with patient delay. Qualitative interviews highlighted key issues relative to determinant parental factors using CAM, including vague initial childhood cancer symptoms, parental health‐seeking behavior, CAM availability and accessibility, also barriers of healthcare facilities. Conclusion Type of cancer and use of CAM are essential factors that cause patient delay. It should be addressed in the future childhood cancer awareness and childhood cancer diagnosis pathway.