Alergi obat merupakan salah satu masalah kesehatan yang cukup serius. Alergi obat dapat didefinisikan sebagai reaksi simpang obat yang melibatkan mekanisme imunologis. Meskipun demikian, tidak mudah menentukan apakah suatu reaksi simpang obat merupakan reaksi alergi dan dibutuhkan suatu pendekatan diagnosis yang sistematis. Selain anamnesis, pemeriksaan fisis, pemeriksaan penunjang alergi obat yang terdiri dari pemeriksaan penunjang umum dan khusus yang dapat dilakukan baik in vivo, in vitro, maupun dengan biopsi. Tata laksana alergi obat adalah menghindari faktor yang menimbulkan gejala, mengobati reaksi secara benar dan cara-cara khusus seperti threating through, tes dosing, desensitisasi dan pramedikasi terhadap obat-obat tertentu.Kata Kunci: alergi, diagnosis,obat, tata laksana Approach to Diagnosis and Treatment of Drug AllergyDrug allergy is a serious medical problem. Drug allergy can be defined as an adverse drug reaction involving immunological mechanism. However, it is not easy to decide whether an adverse drug reaction is an allergic reaction, and it requires a systematically diagnostic approach. Beside a thorough history taking and physical examination, there are general and specific laboratory examination to investigate drug allergy which can be done in vivo, in vitro, or biopsy. The management of drug allergy include the avoidance of the precipitating event, and specific methods to reduce the drug reaction which include threating through, dosing test, desensitization, and the administration of premedication for certain drugs.
Introduction. Dysbiosis microbiota is considered as one of the consequences and impacts of high uremic toxins in patients with Chronic Kidney Disease (CKD), which can lead to an increased risk of progression and mortality. The aim of this systematic review and meta-analysis was to perform quantitative effect of microbiota modulation for estimated Glomerular Filtration Rate (eGFR), uremic toxin (total-p cresyl/total pCS), and inflammatory marker (hs-CRP) outcome among CKD patients. Methods. Article searches were conducted from PubMed, ScienceDirect, and Cochrane Library data sources from 2010-2022. Assessment of article quality follows the rules of PRISMA (Preferred Reporting Items in Systematic Review and Meta-Analysis). Only randomized controlled trial (RCT) articles investigating the effect of symbiotic, prebiotic, of probiotic for CKD were included in the analysis. Effect size quantify from Standardized Mean Difference (SMD), using a continuous random effect model and described in the forest plot model. Results. A total of 17 RCT studies with a total 867 CKD stage 1-5 subjects (440 subjects in the intervention group and 427 subjects in the control group). The intervention duration ranging from 1-12 months. The studies included had varied on methodologies, with significant heterogenicity (I296,96%, p Conclusions. The administration of probiotic/prebiotic/symbiotic supplements to CKD patients resulted in significant improvements in e-GFR and reductions in total pCS. These results suggest the potential of symbiotic, prebiotic, and probiotic supplementation to improve CKD outcome.
Background: Liver cirrhosis (LC) is still being important public health concern, due to the rising of global incidence and mortality. There is risk progression in LC patients to acute-on-chronic liver failure (ACLF) patients with high incidence of complication and high short-term mortality rate. It needs rapid and simpler predictor to immediate and accurate triage of the patient. The aim of this study is to review systematically the role of PWR to predict the mortality in ACLF cirrhosis patient.Method: This systematic review study was identified by searching Pub-Med, Cochrane library, and EMBASE database (2016-2022). Only observational studies were included. ACLF patient was selected as the main subject in each study, and PWR was added as short-term mortality predictor. The Cochran seven step model was used to perform the review.Results: Six cohort retrospective studies met inclusion criteria, including total 1,348 patient ACLF. Half of studies included had high level of evidence. The non-survivor ACLF patient had significantly lower PWR values than survivor. The range of HR of PWR to predict mortality in ACLF was 0.665-0.995, with p value 0.0001. Whereas the cutoff range of PWR value to predict non survivor in ACLF patient was 7.83-14.2.Conclusion: PWR had a predictive efficacy, similar to CLIF-SOFA and MELD score in terms of predicting short-term mortality in ACLF patients. PWR showed significantly independent risk factor of short term mortality in ACLF cirrhotic patient.
Hemoroid adalah suatu penyakit tidak menular yang terjadi di daerah anorektal. Hemoroid disebabkan oleh suatu aktivitas yang memicu pelebaran dan inflamasi pembuluh darah vena di plexus haemorrhoidalis yang terdapat di sekitar anus dan rektum. Hemoroid diklasifikasikan dalam 4 tingkatan yaitu hemoroid kelas I, II, III, dan IV. Micronized Purified Flavonoid Fraction (MPFF) adalah suatu obat plebotonik yang kerap digunakan dalam pengobatan konservatif hemoroid kelas I dan II. Tinjauan Pustaka ini bertujuan untuk memahami peran MPFF dalam terapi pengobatan hemoroid kelas I dan II serta mengevaluasi efektivitasnya dalam menangani hemoroid secara menyeluruh. Tinjauan pustaka ini ditulis dengan metode menganalisis dan meninjau secara sistematis hasil kajian dari beberapa penelitian terhadap penggunaan MPFF dalam pengobatan hemoroid. Hasil penelitian yang melibatkan 1.952 pasien hemoroid secara acak menemukan bahwa MPFF efektif dalam meredakan gejala pada 1.489 (76,3%) pasien yang menderita hemoroid. Selain itu, ditemukan juga 68 (3,5%) pasien yang mengikuti pengobatan invasif (pembedahan) untuk menangani hemoroid kelas IV dan sebanyak 395 (20,2%) pasien dengan hemoroid kelas I – III menjalani pengobatan konservatif campuran. Penelitian tersebut menunjukkan bahwa MPFF termasuk pengobatan konservatif yang cukup efektif untuk mengatasi hemoroid kelas I dan II, tetapi kurang berdampak untuk mengatasi tingkatan hemoroid yang lebih tinggi.
Tuberkulosis merupakan penyakit infeksi paru dan diabetes mellitus merupakan gangguan metabolisme karena terdapat kelainan pada insulin. Keduanya memiliki hubungan dua arah yang sudah banyak dibuktikan, risiko terjadinya TB pada penderita DM akibat adanya gangguan sistem imun. Pada diabetes imunitas seluler berkurang yang berdampak pada berkurang nya limfosit dan makrofag yang peranan penting dalam pertahanan terhadap kuman Mycobacterium tuberculosis. Pengobatan pada tuberkulosis paru dengan penyakit penyerta diabetes mellitus berpontesi menyebabkan kegagalan dalam pengobatan, oleh karena itu perlu dilakukannya pemantauan dalam pengobatan untuk mencapai sasaran dalam pengobatan, dan perlu diperhatikan ada nya interaksi antara OAT yang mempengaruhi konsentrasi obat antiadiabetik oral agar mendapatkan dosis yang tepat untuk mencapai keberhasilan pengobatan.
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