BackgroundA practical and simple regimen for all malaria species is needed towards malaria elimination in Indonesia. It is worth to compare the efficacy and safety of a single dose of artemisinin-naphthoquine (AN) with a three-day regimen of dihydroartemisinin-piperaquine (DHP), the existing programme drug, in adults with uncomplicated symptomatic malaria.MethodsThis is a phase III, randomized, open label using sealed envelopes, multi-centre, comparative study between a single dose of AN and a three-day dose of DHP in Jayapura and Maumere. The modified WHO inclusion and exclusion criteria for efficacy study were used in this trial. A total of 401 eligible adult malaria subjects were hospitalized for three days and randomly treated with AN four tablets single dose on day 0 or DHP three to four tablets single daily dose for three days, and followed for 42 days for physical examination, thick and thin smears microscopy, and other necessary tests. The efficacy of drug was assessed by polymerase chain reaction (PCR) uncorrected and corrected.ResultsThere were 153 Plasmodium falciparum, 158 Plasmodium vivax and 90 P. falciparum/P. vivax malaria. Mean of fever clearance times were similar, 13.0 ± 10.3 hours in AN and 11.3 ± 7.3 hours in DHP groups. The mean of parasite clearance times were longer in AN compared with DHP (28.0 ± 11.7 hours vs 25.5 ± 12.2 hours, p = 0.04). There were only 12 PCR-corrected P. falciparum late treatment failures: seven in AN and five in DHP groups. The PCR uncorrected and corrected on day −42 of adequate clinical and parasitological responses for treatment of any malaria were 93.7% (95% Cl: 90.3–97.2) and 96.3% (95% Cl: 93.6–99.0) in AN, 96.3% (95% Cl: 93.5–99.0) and 97.3% (95% Cl: 95.0–99.6) in DHP groups. Few and mild adverse events were reported. All the abnormal haematology and blood chemistry values had no clinical abnormality.ConclusionAN and DHP are confirmed very effective, safe and tolerate for treatment of any malaria. Both drugs are promising for multiple first-line therapy policies in Indonesia.
The prevalence of metabolic syndrome (MS) in the world is between 20-25%, whereas in Indonesia 23.34%, is higher in men (26.2%) than in women (21.4%). SM is predicted to cause a two-fold increase in the risk of heart disease and five-fold in type 2 diabetes mellitus. There are no data on MS incidents in Indonesia. The aim of this study was to determine MS predictor and hazard rate from predictor factors during the six-years follow up in Bogor city. This study is a sub sample of data “Cohort Study of Non Communicable Disease Risk Factors” in Bogor City conducted in 2017. The sample taken is respondents who meet the criteria of MS in accordance with NCEP/ATP III. A total of 4,215 samples that were MS free at baseline were analyzed. Data were collected by interview, physical measurement and laboratory examination every two years during the six year follow-up (2011-2017). Bivariate analysis was performed to obtain a significant p value, followed by multivariate analysis with cox regression to see the hazard rate (HR). The result is the incidence of MS was 56 person years per 10.000 population, during 6 yeras observation. After adjusting for age, the MS were women with predictor or HR 4.78 (95% CI 1.11 – 20.56) and carbohydrate intake with HR 2.99 (95% CI 1.28 – 6.98). Women was main predictors of MS after controlling carbohydrate intake among people aged 25 years and above.To control of carbohydrate intake among women is a priority of MS control programs in community. Predictors for the incidence of SM women at risk were 4.78 times compared to men and carbohydrate consumption was 2.99 times. Abstrak Prevalensi sindrom metabolik (SM) di dunia antara 20-25%, sedangkan di Indonesia 23,34%, lebih tinggi pada laki-laki (26,2%) dibandingkan pada perempuan (21,4%). SM diprediksi menyebabkan kenaikan dua kali lipat risiko terjadinya penyakit jantung dan lima kali lipat pada penyakit diabetes melitus tipe 2. Belum ada data insiden SM di Indonesia. Tujuan penelitian untuk menentukan variabel prediksi responden SM dan mendapatkan hazard rate dari faktor prediktor selama follow up enam tahun di Kota Bogor. Penelitian ini merupakan sub sampel data “Studi Kohor Faktor Risiko Penyakit Tidak Menular” di Kota Bogor yang dilakukan pada tahun 2017. Sampel yang diambil adalah responden yang memenuhi kriteria SM sesuai NCEP/ATP III. Sebanyak 4.215 sampel yang bebas SM saat baseline, dianalisis. Data dikumpulkan dengan metode wawancara, pengukuran fisik dan pemeriksaan laboratorium setiap dua tahun selama follow up enam 6 tahun (2011-2017). Analisis bivariat dilakukan untuk mendapatkan nilai p yang bermakna, dilanjutkan dengan analisis multivariat dengan regresi cox untuk melihat hazard rate (HR). Hasil penelitian menunjukkan insiden SM sebesar 56 per 10.000 penduduk selama enam tahun pengamatan. Setelah di disesuaikan dengan umur maka HR atau prediktor SM adalah perempuan 4,78 (95% CI 1,11 – 20,56) dengan p = 0,03 dan asupan karbohidrat 2,99 (95% CI 1,28 – 6,98) dengan p = 0,01. Wanita dan asupan karbohidrat adalah prediktor untuk SM pada responden berusia 25 tahun ke atas. Kontrol asupan karbohidrat pada wanita merupakan prioritas program pengendalian sindrom metabolik di masyarakat. Prediktor untuk kejadian SM wanita berisiko sebesar 4,78 kali dibanding dengan laki laki dan komsumsi karbohidrat 2,99 kali.
One of the adverse effect of prolonged patients with diabetes mellitus (DM), coronary heart disease (CHD), and stroke was the emerge of chronic kidney disease (CKD) and it would be burden of the economic. The prognosis of CKD in new cases of DM, CHD, and stroke during followed up in Cohort Study Noncommunicable Disease Risk Factor in Bogor was not yet known. Aim to study was to obtain to CKD profile in DM, CHD, stroke, and comorbid incidences during Cohort Study Noncommunicable Disease Risk Factor. This article has been result of cross sectional further analysis of secondary data on 370 new cases of DM, CHD, and stroke that who were examined for blood creatinine levels and calculated eGFR on 2018 and 2019. DM was diagnosed from fasting glucose ≥126 mg/dl or post prandial glucose ≥200mg/dl. CHD was diagnosed by ECG examination and validated by cardiologist and stroke was diagnosed by anamnesis by a neurologist. The main variable is eGFR as an indicator of CKD which is the result of CKP-epi calculation based on creatinine levels in the blood. Other variables are age, sex, type of disease (DM, CHD, and stroke). Data were analyzed using chi-square test. The results showed that average age patients with CKD on new cases of DM, CHD, stroke, and comorbid in Bogor were 48.2 ± 8.6 years old. Proportions CKD on new cases of DM, CHD, strok and comorbid were 59.5%, 56.7%, 66.7% and 50.0%. CKD was higher in older woman than others. The prevalence of CKD was found very high in subjects with stroke, DM, CHD, and comorbid. So, it is necessary to prevent complications by early diagnosis of NCD with regular monitoring of kidney function by creatinine level test and avoid using drugs that caused kidney damage. Abstrak Salah satu komplikasi buruk dari penderita diabetes melitus (DM), penyakit jantung koroner (PJK), dan strok yang berkepanjangan adalah munculnya gangguan fungsi ginjal dan akan membebani ekonomi bagi penderitanya. Gambaran prognosis gangguan fungsi ginjal pada insiden DM, PJK, dan strok selama pemantauan Studi Kohor Faktor Risiko PTM (FRPTM) Bogor belum diketahui. Tujuan penelitian untuk mendapatkan gambaran gangguan fungsi ginjal pada kasus baru DM, PJK, dan strok yang muncul selama pemantauan Studi Kohor FRPTM. Artikel ini merupakan hasil analisis lanjut secara potong lintang dari data sekunder kasus baru (insiden) DM, PJK, dan strok pada Studi Kohor FRPTM sebanyak 370 subjek yang diperiksa kadar kreatinin darah dan dihitung eLFG pada tahun 2018 dan 2019. DM didiagnosis dari kadar gula darah puasa ≥126 mg/dl atau post prandial ≥200mg/dl. PJK dari hasil pemeriksaan EKG dan validasi dokter spesialis jantung dan strok hasil anamnesis oleh spesialis saraf dan sudah mengalami rawat jalan. Variabel utama adalah eLFG merupakan indikator terjadinya gangguan fungsi ginjal yang merupakan hasil hitung kadar kreatinin dalam darah dengan CKD-epi. Variabel lain adalah umur, jenis kelamin, jenis penyakit (DM, PJK, dan strok). Data dianalisis dengan uji chi-square. Hasil menunjukkan temuan gangguan fungsi ginjal pada penderita DM, PJK, strok, dan komorbid di Bogor berumur 48,2 ± 8,6 tahun dan proporsi masing-masing 59,5%, 56,7%, 66,7%, dan 50%. Subjek yang mengalami gangguan fungsi ginjal menunjukkan lebih banyak pada umur lebih tua dan perempuan. Tingginya proporsi gangguan fungsi ginjal pada penderita strok, DM, PJK, dan komorbid diperlukan pencegahan komplikasi sejak awal terdiagnosis PTM dengan memantau fungsi ginjal dengan pemeriksaan kadar kreatinin secara teratur, serta menghindari penggunaan obat yang menimbulkan kerusakan ginjal.
Abstract Blood glucose level could be measured before 2-3 months using glycated haemoglobin (HbA1c). In diabetes mellitus (DM) the size of low-density lipoprotein (LDL-K) often changes to a small size, called small dense LDL-K sdLDL) which is atherogenic and low high-density lipoprotein (HDL) level. High HbA1c indicates uncontrolled glucose levels and often cause complications of coronary heart disease (CHD). This is a further investigation from the previous one about ”The Relationship between HbA1c with LDL and Apo B in DM patients with cardiac complications." This study used analytical, cross-sectional design. Thirty patients DM with CHD complications were examined for HbA1C levels via the Exchange-HPLC ion methods, HDL-K and LDL-K by enzymatic colourimetric methods and apo B by the immunoturbidimetry methods. The relationship between variables was analyzed by the Pearson correlation test.The mean level of HbA1c was 8.72%, male HDL was 35.67 mg / dl, female was 39.57 mg / dl, LDL-K was 110.64 mg / dl, apo B was 111.88 mg / dl and sd-LDL was 1, 02. A strong negative relationship between HbA1c and HDL levels for both men and women with r = - 0.647; r = - 0.675 with significance level p = 0.017; p = 0.008. Whereas HbA1c with sd-LDL has a weak negative relationship, but not significant (r = -0.352; p = 0.057). Hence, lipid profile measurement can be considered to monitor risk of cardiovacular diseases, particularly in those with abnormal blood glucose metabolism. AbstrakPemantauan kadar gula 2-3 bulan sebelumnya dapat diukur menggunakan glycated hemoglobin (HbA1c). Pada diabetes melitus (DM) ukuran low density lipoprotein (LDL-K) sering berubah menjadi kecil, yang dinamakan small dence LDL-K (sd-LDL) yang bersifat aterogenik, dan kadar high density lipoprotein (HDL) sering rendah. HbA1c yang tinggi menandakan kadar glukosa tidak terkontrol dan sering menyebabkan salah satu komplikasi ke penyakit jantung koroner (PJK). Penelitian ini merupakan penelitian lanjutan dari penelitian berjudul “ Hubungan HbA1c dengan trigliserida dan Apo B pada penderita DM dengan komplikasi penyakit jantung” Studi ini menggunakan desain analitik potong lintang. Tiga puluh pasien DM dengan komplikasi PJK diperiksa kadar HbA1c melalui metoda ion-Exchange HPLC, HDL-K dan LDL-K dengan metoda kolometrik enzimatik dan apo B dengan metoda imunoturbidimetri. Hubungan antar variabel dianalisis dengan uji korelasi Pearson.Hasil penelitian didapatkan laki laki 16 dan perempuan 14 pasien. Kadar rerata HbA1c 8,72%, HDL laki laki 35,67 mg/dl, perempuan 39,57 mg/dl, LDL-K 110,64 mg/dl, apo B 111,88 mg/dl dan sd-LDL 1,02. Hubungan negatif kuat antara kadar HbA1c dan HDL baik laki laki maupun perempuan dengan r = - 0,647 ; r = - 0,675 dengan tingkat kemaknaan p = 0,017; p = 0,008. Sedangkan HbA1c dengan sd-LDL terdapat hubungan negatif lemah, tetapi tidak bermakna (r=-0,352 ; p = 0,057). Karena itu, pemeriksaan profil lipid dapat dipertimbangkan untuk memantau risiko penyakit kardiovaskular khususnya bagi mereka dengan gangguan metabolisme gula darah
Diabetes mellitus type 2 (T2DM) is a chronic disease and can cause complications, one of which is decreased kidney function. Anemia is a complication of T2DM, especially if it is accompanied by renal disorders. The aim of this study was to show the relationship between HbA1c and hemoglobin (Hb), hematocrit (HCT), creatinine, and glomerular filtration rate (GFR) in T2DM respondents with and without complications of chronic renal failure (CRF). This study used a subset of the Non-Communicable Diseases cohort data set by the Center for Public Health Efforts in Central Bogor sub-district, Bogor City. The research design was an analytic observational study. Respondents were all T2DM with complete data as much as 303 people. The respondents diagnosed based on the results of previous blood sugar tests. The inclusion criteria were people with T2DM who had complete data (HBA1c, Hb, HCT, and creatinine). Bivariate analysis between the dependent variable (T2DM with or without CRF) and the independent variable (HbA1c, Hb, HCT, creatinine, and LFG) used the Spearman correlation. The results showed a strong positive correlation between HbA1c and Hb (r = 0,66, p<0,05) and HCT (r = 0,67, p<0,05)in T2DM respondents with CRF, but there is no correlation between HbA1c and creatinine and LFG. In T2DM without CRF there is a weak positive correlation between HbA1c and Hb (r = 0,26, p<0,05) and HCT (r = 0,21, p<0,05), a negative correlation between HbA1c and creatinine (r = -0,29, p<0,05), and there is a weak positive correlation between HbA1c and LFG (r = 0,24, p<0,05 ). The conclusion is that controlling blood sugar by examining HbA1c levels shows a strong positive correlation with Hb levels and HCT in T2DM with CRF and a weak negative correlation with LFG in T2DM without CRF. This difference is not in accordance with the existing theory Abstrak Diabetes melitus tipe 2 (DMT2) merupakan penyakit kronik dan dapat menimbulkan komplikasi, salah satunya adalah penurunan fungsi ginjal. Anemia merupakan komplikasi DMT2 khususnya jika disertai gangguan renal. Tujuan penelitian ini menunjukkan hubungan hemoglobin A1c (HbA1c) dengan hemoglobin (Hb), hematokrit (HCT), kreatinin, dan laju filtrasi glomerulus (LFG) pada responden DMT2 dengan dan tanpa komplikasi gagal ginjal kronik (GGK). Penelitian ini menggunakan subset data kohor penyakit tidak menular (PTM) yang dilakukan oleh Puslitbang Upaya Kesehatan Masyarakat di Kecamatan Bogor Tengah, Kota Bogor. Desain penelitian adalah studi observasional analitik. Responden adalah semua penderita DMT2 dengan data lengkap sebanyak 303 orang yang didiagnosis berdasarkan hasil pemeriksaan gula darah sebelumnya. Kriteria inklusi adalah penderita DMT2 yang memiliki data lengkap (HbA1c, Hb, HCT, dan kreatinin). Analisis bivariat antara variabel dependen (DMT2 dengan atau tanpa GGK) dengan variabel independen (HbA1c, Hb, HCT, kreatinin dan LFG) mengunakan korelasi Spearman. Hasil penelitian menunjukkan pada responden DMT2 dengan GGK terdapat korelasi positif yang kuat antara HbA1c dengan Hb (r = 0,66, p<0,05) dan HCT (r = 0,67, p<.0,05). Sedangkan HbA1c dengan kreatin dan LFG tidak terdapat korelasi. Pada DMT2 tanpa GGK terdapat korelasi positif lemah antara HbA1c dengan Hb (r = 0,26, p<0,05 ) dan HCT (r = 0,21, p<0,05), terjadi korelasi negatif antara HbA1c dengan kreatinin sebesar (r = -0,29, p<0,05), dan terdapat korelasi positif lemah antara HbA1c dengan LFG ( r = 0,24, p<0,05 ). Simpulan yang dapat diambil adalah pengontrolan gula darah dengan pemeriksaan kadar HbA1c menunjukkan korelasi positif yang kuat dengan kadar Hb dan HCT pada DMT2 dengan GGK dan korelasi negatif lemah dengan LFG pada DMT2 tanpa GGK. Perbedaan tersebut belum sesuai teori yang ada.
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