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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