Bone is an important organ for supports the body that stores reserve of calcium, phosphorus, and other minerals. In fracture conditions where bleeding, soft tissue edema, nerve damage, and blood vessels around the bone damage happen, they can cause the mobilization of these minerals in the surrounding tissue. One of the efforts made in the treatment of these fractures is reconnection, in which it works by filling of bone defect with a matrix and administration of anti-infection. Biomaterial filling in defective bone is thought to accelerate the healing process of bone fracture and prevent osteomyelitis. For this reason, this study evaluates the acceleration of bone fracture healing using natural hydroxyapatite (NHA) bone filler in rabbits with bone defect model. Fracture modeling was performed by surgical technique and drilling of bones with a 4.2 mm diameter to form a defect in the rabbit femur. Bone implant contained bovine hydroxyapatite-gelatin-glutaraldehyde (BHA implant) or bovine hydroxyapatite-gelatin-glutaraldehyde-gentamicin (BHA-GEN implant) that was inserted in bone defects. 27 rabbits were divided into 3 groups: the control group who had bone defect, the bone defect group was given BHA implant and the bone defect group was given BHA-GEN implant. Observation of osteoclast, osteoblast, osteocyte, BALP level, and bone morphological integrity was carried out on the 14th, 28th, and 42nd days after surgery. Histological observation of rabbit femur showed a significant difference on the number of osteoclast, osteoblast and osteocyte in all three groups. The BALP level also showed a significant difference in the group given the natural BHA bone implant compared to the control group on day 14 (p = 0.0361). Based on the result of the X-ray, there was also a better integration of rabbit femur bone in groups with the use of BHA or BHA-GEN bone implant. Thus, it can be concluded that the use of a natural BHA implant can accelerate the process of bone repair in the fracture of rabbit femur. In addition, BHA implants were compatible as a matrix for supporting the bone cell growth.
Background: Bisphosphonates, such as alendronate (ALE), have been known to be effective in the treatment of bone cancer and osteoporosis. However, it has been reported that the systemic administration of ALE causes a considerable side effect. Thus, the formulation injectable bone substitute (IBS) for local administration of ALE, which functions as drug delivery system (DDS) as well as filling agent in osteoporosis-induced bone fracture, is needed. Objective: To establish the biodegradable and biocompatible formulation for ALE in injectable form which supports the drug delivery system and acts as filling agent in bone fracture. Methods: Hydroxyapatite (HA) was added to the mixture of gelatin and hydroxypropyl methyl cellulose (GEL-HPMC). ALE was added to the mixture and semisolid form was prepared for granulation. The dried granule, as injectable matrix, was grinded and mixed with appropriate amount of Na2HPO4. Results: Porosity of injectable form was higher than those of granule form. Injectable semisolid form was produced by adding 0.8 mL Na2HPO4 on each gram of granule with 10-12 min setting time. MTT assay showed that matrix was biocompatible showed by more than 100% viability. In vitro dissolution study showed that ALE was slowly released in more than 20 days. Conclusions: The formula of IBS using HA-GEL-HPMC may act as an effective drug delivery system for local administration of ALE in bone fracture. AbstrakLatar belakang: Golongan bisfosfonat sebagai obat kelainan tulang sudah lama dipergunakan seperti kanker tulang dan osteoporis. Namun karena efek samping dari obat tersebut maka dibuat formula lokal dalam bentuk injektabel yang berfungsi sebagai sistem penghantaran obat dan pengisi celah yang terbentuk dari fraktur akibat osteoporosis. Tujuan: untuk membuat formula dari hidroksiapatit (HA) dan gelatin (GEL) sebagai penghantaran/pembawa obat (SPO) maupun pengisi tulang. Formula injektabel bersifat biodegradable dan biokompatibel dan obat yang digunakan adalah alendronat (ALE). Hidroksi propil Metil Selulosa (HPMC) ditambahkan untuk memudahkan pembawa membentuk bahan setengah padat. Metode: HA ditambahkan ke dalam campuran GEL-HPMC diaduk selajutnya di tambahkan ALE dan diaduk sampai membentuk massa yang tepat untuk dibuat granul. Granul kering digerus sebagai matrik injektabel dan diencerkan dengan Na2HPO4. Hasil: porositas (SEM) bentuk granul < bentuk hasil injeksi, repasta dari matrik bentuk serbuk memerlukan Na2HPO4 0,8 ml/gram dan seting dalam waktu 10-12 menit. Matrik bersifat biokompatibel dengan viabilitas >100% (MTT). Dari hasil uji disolusi in vitro menunjukkan bahwa ALE dapat dilepas secara perlahan dalam waktu > 20 hari. Kesimpulan: Formula injektabel (IBS) HA-GEL-HPMC dapat berfungsi sebagai penghantaran ALE secara lokal. Kata kunci: hidroksi apatit, Gelatin, HPMC, alendronat, Na2HPO4, sistem penghantaran obat
Alendronate is a drug of the bisphosphonate group used for the treatment and prevention of osteoporosis in postmenopausal women. However, when given orally, alendronate can cause indigestion and osteonecrosis of the jaw. It also has a poor bioavailability. Taking these disadvantages into account, an injection formulation of alendronate was created in this study to act on the site locally. Beside alendronate, the injection also contains bovine hydroxyapatite and gelatin as alendronate carriers. Both, besides being able to act as carriers, are also able to reduce bone damage caused by osteoporosis. The aim of this study was to determine the effectiveness of alendronate injection for fractures caused by osteoporosis in mouse models that were ovariectomized. The parameters used in this study were ALP concentration in blood and bone radiology. The results of ALP concentration showed that there were no significant differences in each group. The average ALP concentration of the negative control group was 277.67 ± 46.090, in the positive control group 270.33 ± 189.716, in the BHA-Gel group 406.33 ± 212.547 and in the BHA-Gel Alendronate group 325.00 ± 73.750. Bone radiology results and macroscopic observations still showed bone defects in each group.Yet in the negative control group, the BHAGel-Alendronate group and the BHA-Gel group, bone defects were almost entirely ameliorated. On the contrary, bone defects were still present in the positive control group. Based on the results obtained, it was shown that the injection of alendronate has not been shown to significantly overcome osteoporosis fractures. Keywords: Osteoporosis, Alendronate, Ovariectomy, Bovine hydroxyapatite, Gelatin
Background: Meningitis defined as an inflammation of the meninges, a membrane that surrounds the brain. The inflammation is a result from bacterial infection. Central nervous system infection is a medical emergency because of the progressivity and potentially life-threatening. Antibiotics usage become crucial to reduce morbidity and mortality. Objective: This study was aimed to assess the use of antibiotics, prescribed for patients with bacterial meningitis in Neurology Department of Dr. Soetomo General Hospital Surabaya from January 2010 until June 2015. Methods: Retrospective study using medical record of inpatients obtained from January 1st 2010 until June 30th 2015. The inclusion criteria were inpatients with bacterial meningitis (diagnosed by physician using CT scan data, lumbal puncture and clinical signs and symptoms) and prescribed with antibiotics. Patients with antibiotics therapy less than 3 days and infection other than bacterials were excluded. Results: From 85 patients, male to female ratio was 1.66. Meningitis appear to be mostly occured in productive age, 39 (45.88%) in 15 - 29 years old and 40 (47.06%) in 30 - 60 years old. Number of antibiotics prescribed were 130 prescriptions, as single and combination therapy. The most prescribed antibiotic was cephalosporins (97 prescriptions), dominated by 2 g twice daily ceftriaxone with 86 (66.15%) from overall prescriptions. Followed by metronidazole and fluoroquinolons,11 (8.46%) and 8 (6.15%) respectively. In addition, there were 26 prescriptions of combination therapy, mostly ceftriaxone and metronidazole. Conclusion: Bacterial meningitis are mostly treated using ceftriaxone which is an appropriate drug of choice.
Background: Bronchodilators are used to treat asthma symptoms. The administration of this therapy can be given through monotherapy or in combination to achieve the maximum therapeutic effect. Objective: This study aimed to examine the prescribing pattern of bronchodilators in asthmatic outpatients. Methods: A retrospective study was done by reviewing and analyzing medical records of asthmatic outpatients from January 2019 until December 2020. Data analysis was performed descriptively. Results: In this study, bronchodilators were administered by inhalation 97.4% compared to oral routes 2.6%. Combination bronchodilator therapy showed 54.7% compared to monotherapy by 46.3%. The combination ICS/LABA budesonide/formoterol 160/4.5 mcg was the most widely used 45.7%. Conclusion: The use of a bronchodilator was in accordance with the Global Initiative for Asthma guidelines. The route of drug administration through inhalation is more widely used than oral. Combination bronchodilators were more recommended than bronchodilator monotherapy to control asthma symptoms.
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