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Given the high prevalence in patients with type 2 diabetes where the incidence of 650.000 new cases each year. In type-2, the pancreas does not make enough insulin to keep blood sugar levels remain normal, often because the body does not respond well to insulin. Most people do not realize had been suffering from type 2 diabetes, although the situation has become very serious. Type 2 diabetes has become a commonly experienced in the world and in Indonesia, and the numbers continue to grow due to unhealthy lifestyles, obesity and lazy to exercise. Purpose: To determine how the image of risk factors in patients with type 2 diabetes in the clinic Endocrine and Metabolic Section / SMF FK-UNSRAT BLU RSU Prof. Dr. R.D. Manado Kandou the period of May-October2011. Methods: This type of research is a descriptive study using secondary data. Population of type 2 DM patients who come for treatment at the Polyclinic Endocrine and Metabolic Section / SMF FK-UNSRAT BLU RSU Prof.Dr. R.D. Kandou Manado the period of May - October 2011. The number of samples of 138 patients comprising 60 men and 78 women. Result: The case of DM Tiipe 2 in Endocrine and Metabolic Clinic ever found in women than in men. Acquired risk factors for type 2 diabetes mellitus is a BMI> 23 ever found in an obese BMI groups 1 (25-29,9) of 37 patients, patients with stage 1 hypertension (130-159/80-99 mmHg) obtained by 80 patients , patients with dyslipidaemia as many as 22 patients, patients with a family history of as many as 45 patients, patients with age> 40 years as many as 130 patients, and patients who have risk factors for most of the patients with 3 risk factors as many as 74 patients. Conclusion: Risk factors affecting the incidence of type 2 diabetes mellitus in Endocrine and Metabolic Clinic is a BMI> 23, hypertension> 140/90 mmHg, family history,age> 40 years, dyslipidemia. Key words : Risk factors, Diabetes mellitus type 2, Endocrine and Metabolic Clinic.     Abstrak: Mengingat tingginya prevalensi untuk pasien dengan DM tipe 2 dimana insidennya sebesar 650.000 kasus baru tiap tahunnya. Pada tipe-2, pankreas tidak cukup membuat insulin untuk menjaga level gula darah tetap normal, seringkali disebabkan tubuh tidak merespon dengan baik terhadap insulin tersebut. Kebanyakan orang tidak menyadari telah menderita dibetes tipe 2, walaupun keadaannya sudah menjadi sangat serius. Diabetes tipe 2 sudah menjadi umum dialami didunia maupun di Indonesia, dan angkanya terus bertambah akibat gaya hidup yang tidak sehat, kegemukan dan malas berolahraga. Tujuan: Untuk mengetahui bagaimana gambaran faktor risiko pada pasien DM tipe 2 di Poliklinik Endokrin dan Metabolik Bagian/SMF FK-UNSRAT BLU RSU Prof. Dr. R.D. Kandou Manado periode Mei - Oktober 2011. Metode: Jenis penelitian merupakan penelitian deskriptif dengan menggunakan data sekunder. Populasi pasien DM tipe 2 yang datang berobat di Poliklinik Endokrin dan Metabolik Bagian/SMF FK-UNSRAT BLU RSU Prof.Dr. R.D. Kandou Manado periode Mei-Oktober 2011. Jumlah sampel 138 pasien yang terdiri dari 60 laki-laki dan 78 perempuan. Hasil: Kasus DM Tiipe 2 di Poliklinik Endokrin dan Metabolik terbanyak didapatkan pada perempuan dibandingkan pada laki-laki. Faktor risiko yang didapatkan untuk terjadinya DM tipe 2 adalah IMT >23 terbanyak didapatkan pada IMT golongan obes 1 (25-29,9) sebanyak 37 pasien, pasien dengan hipertensi stage 1 (130-159/80-99 mmHg) didapatkan sebanyak 80 pasien, pasien dengan dislipidemia sebanyak 22 pasien, pasien dengan riwayat keluarga sebanyak 45 pasien, pasien dengan umur >40 tahun sebanyak 130 pasien, dan pasien yang memiliki faktor risiko paling banyak adalah pasien dengan tiga faktor risiko yaitu sebanyak 74 pasien. Simpulan: Faktor risiko yang berpengaruh terhadap kejadian DM tipe 2 di Poliklinik Endokrin dan Metabolik adalah IMT >23, hipertensi >140/90 mmHg, riwayat keluarga, umur > 40 tahun, dislipidemia. Kata kunci : Faktor risiko, diabetes melitus tipe 2, Poliklinik Endokrin dan Metabolik.

To evaluate the effect of Oral-Anticoagulants in Non-Valvular Atrial Fibrillation(NVAF) to control the occurrence of stroke and to assess the mortalityrate, hospital-readmissions, duration of hospital-stay associated with its use in South-Indian population. Methods: This retrospective, comparative hospital-based study conducted in a tertiary-care hospital, Kerala. In this study, NVAF patients with more than eighteen years who were initiated with Newer-Oral-Anticoagulants(NOACs) or Warfarin during the period from January-2016 to January-2018 were selected. Patients with Valvular-Heart-Disease, Transient-Ischemic-Attack, Deep-Vein-Thrombosis, Pulmonary-Embolism, End-Stage-Renal-Disease and those who contraindicated to these drugs were excluded. The patients were followed-up for a period of 1year. The effect of drugs in controlling the occurrence of stroke, stroke-free period, hospital-readmissions, length of hospital-stay and allcause mortality were compared and analyzed among the groups. Analysis of Variance test(ANOVA) were used to compare the baseline parameters and Student's t test, used to compare categorical variables. Results: A total of 133 patients (51warfarin and 82NOAC-group) were enrolled. The number of patients on NOACs had a clinical benefit over warfarin in controlling stroke (78.04% vs 70.58%),(P=0.22). Stroke was not reported in 7.47% of NOAC users during the entire study-period. They were associated with lesser cardiac complications(36.5%), readmissions(15.85%; P=0.07); and had higher risk-reduction in readmissions (41.7%; Relative-Risk-Reduction=0.417) and mortality (12.91%; RRR=0.1291). Mean duration of hospital stay was equally-likely in both groups (Warfarin7;NOACs6). Warfarin-users experienced higher incidence of mortality within first six-months of initiation though mortalityrate similar in both groups during entire study-period (19.6% vs 17.1% for warfarin vs NOAC),[P=0.71]. Hazard ratio were assessed in terms of stroke [0.49 (CI:0.15-1.57);P=0.24), mortality [0.28(CI:0.06-1.19); P=0.71] and major-bleeding [0.844(CI:0.34-2.07);P=0.08] between both drugs, indicating NOACs were associated with lower-risk and had higher safety profile. Conclusions: NOACs were found to be a better alternative for NVAF patients, due to its higher risk-reduction, improved health outcomes and clinical benefits over warfarin under routine clinical settings in South-India.

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Objectives: To assess the cost-per-responder of biologic therapies available in Brazil to treat moderate-to-severe plaque psoriasis (PsO) using as outcomes a reduction of 75%, 90%, and 100% in Psoriasis Area and Severity Index (PASI 75/90/ 100). Methods: Comparative cost-effectiveness of risankizumab, adalimumab, etanercept, guselkumab, infliximab, ixekizumab, secukinumab, and ustekinumab was evaluated for the Brazilian private healthcare system using a cost-perresponder analysis based on PASI score reduction. Efficacy data was extracted from a previously published network meta-analysis (NMA). Cost-per-responder included cost of drug acquisition (ex-factory price) in 3 time horizons (primary response period [12-16 weeks], 1-year and 2-years) multiplied by the number needed to treat (NNT) for each PASI endpoint. Results: Considering NMA base case, the lowest cost-per-responder considering primary response period was observed for risankizumab for PASI 75, 90, and 100 (BRL40,106; 47,729; 83,496, respectively), followed by guselkumab (BRL41,338, 50,906; 94,520, respectively). Overall, the differences in the mean cost-per-responder between risankizumab and other biologic drugs increased with higher PASI reduction. Highest cost-perresponder was observed for infliximab for PASI 75 (BRL64,096) and etanercept for