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"Ketoprofen merupakan obat antiinflamasi yang memiliki kelarutan di dalam air yang rendah. Pada umumnya ketoprofen diberikan secara oral. Namun, memiliki kelemahan yaitu dapat terjadi metabolisme lintas pertama dan pendarahan gastrointestinal. Maka dari itu untuk mengatasi hal tersebut, dapat diberikan secara transdermal yaitu dengan dissolving microneedle. Selain itu, untuk meningkatkan kelarutan dari ketoprofen diperlukan metode yang dapat meningkatkan kelarutan seperti co-grinding. Tujuan penelitian ini adalah untuk memformulasikan dan mengkarakterisasi dissolving microneedle yang mengandung co-grinded ketoprofen. Co-grinded ketoprofen diformulasikan dengan PVA atau PVP dan dilanjutkan karakterisasi yang meliputi spektrofotometri FTIR, analisis difraksi sinar-X, analisis termal, dan uji disolusi. Co-grinded ketoprofen dikombinasikan dengan polimer PVA dan/atau PVA lalu dimasukkan ke dalam dissolving microneedle dan dilakukan evaluasi yang meliputi kekuatan mekanis, kehilangaan massa air selama pengeringan, uji kemampuan insersi, dan uji pelarutan jarum. Berdasarkan hasil uji disolusi co-grinded ketoprofen yang terpilih adalah ketoprofen : PVA = 1 : 2 dengan profil disolusi tertinggi yaitu 99,62 ± 1.56% pada menit ke-60. Dapat disimpulkan bahwa formula dissolving microneedle F8 (5% PVA + 15% PVP) dan F11 (7,5% PVA + 15% PVP) dapat diformulasikan dalam dissolving microneedle yang memberikan kekuatan mekanik yang baik yaitu dengan persentase pengurangan tinggi jarum 0,58 ± 0,21% untuk F8 dan 1,26 ± 0,56 untuk F11, mampu membentuk lubang >25% pada lapisan ketiga parafilm, serta waktu pelarutan jarum pada menit ke-10 untuk F8 dan pada menit ke 22,5 untuk F11.

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Ketoprofen is an anti-inflammatory drug that has low water solubility. In general, ketoprofen is given orally. However, it has disadvantages such as first pass metabolism and gastrointestinal bleeding. Therefore, to overcome this, it can be given transdermally, namely by dissolving microneedle. In addition, to increase the solubility of ketoprofen, co-grinding is a method that can be used. The purpose of this study was to formulate and characterize dissolving microneedles containing co-grinded ketoprofen. Co-grinded ketoprofen is formulated in combination with PVA or PVP and characterization is continued using FTIR spectrophotometry, X-ray diffraction analysis, thermal analysis, and dissolution test. Co-grinded ketoprofen was combined with PVA and/or PVA polymer and then put into a dissolving microneedle. The evaluation that is carried out includes mechanical strength, loss of drying, insertion test, and in skin dissolution. Based on the results of the co-grinded ketoprofen dissolution test, the selected ketoprofen : PVA = 1: 2 with the highest dissolution profile was 99.62 ± 1.56% at 60 minutes. It can be said that the dissolving microneedle formula F8 (5% PVA + 15% PVP) and F11 (7.5% PVA + 15% PVP) can be formulated in dissolving microneedle which provides good mechanical strength by reducing the number of needles by 0.58 ± 0 .21% for F8 and 1.26 ± 0.56 for F11, capable of forming holes >25% in the third layer of parafilm, as well as needle coating time at 10 minutes for F8 and at 22.5 minutes for F11."

"Latar Belakang: Disfungsi saluran cerna berhubungan dengan luaran klinis yang lebih buruk pada pasien sakit kritis. Kadar albumin serum yang rendah merupakan salah satu faktor yang dapat meningkatkan risiko disfungsi saluran cerna. Hubungan kadar albumin dengan disfungsi saluran cerna masih inkonklusif karena pendekatan diagnostik disfungsi saluran cerna yang belum terstandarisasi dengan baik. Gastrointestinal dysfunction score (GIDS) instrumen dengan subjektivitas minimal dan reproduktifitas maksimal, diharapkan dapat menegakkan diagnosis disfungsi saluran cerna dengan objektivitas yang lebih baik. Penelitian ini dilakukan untuk mengetahui hubungan antara kadar albumin saat admisi dengan terjadinya disfungsi saluran cerna yang dinilai menggunakan GIDS. Metode: Penelitian ini merupakan penelitian kohort prospektif pada subjek berusia ≥18 tahun yang dirawat di ruang rawat intensif Rumah Sakit Umum Pusat Nasional (RSUPN) dr. Cipto Mangunkusumo dan Rumah Sakit Universitas Indonesia (RSUI). Karakteristik subjek penelitian berupa usia, jenis kelamin, status gizi, penyakit komorbid, diagnosis admisi intensive care unit (ICU), waktu inisiasi pemberian nutrisi oral atau enteral, kebiasaan mengonsumsi alkohol, dan skor sequential organ failure assessment (SOFA). Dilakukan analisis bivariat untuk menilai hubungan kadar albumin saat admisi dengan disfungsi saluran cerna. Hasil: Diperoleh 64 subjek, kelompok kadar albumin rendah 32 subjek dan kelompok kadar albumin normal 32 subjek. Rerata usia subjek 50,2±15,7, laki-laki 64,1%, 26,6% subjek dengan status gizi berat badan normal berdasarkan indeks massa tubuh (IMT), 50% subjek dengan malnutrisi secara klinis,  21,9% subjek dengan diagnosis komorbid diabetes melitus dan 3,1% subjek dengan parkinson, 34,4 % subjek dengan diagnosis admisi bedah, 95,3% subjek mendapatkan nutrisi oral atau enteral ≤ 48 jam, median skor SOFA 3 (0-12). Rerata kadar albumin  subjek dengan disfungsi saluran cerna 2,7±0,6 g/dL, rerata kadar albumin  subjek tidak disfungsi saluran cerna 3,7±0,7 g/dL. 31,3% subjek mengalami disfungsi saluran cerna. Terdapat hubungan signifikan secara statistik antara kadar albumin saat admisi dengan disfungsi saluran cerna RR 9 (95%CI 2,3-35,6; p <0,001) dan skor GIDS, p<0,001. Kesimpulan: Terdapat hubungan bermakna antara kadar albumin saat admisi dengan disfungsi saluran cerna. Pemeriksaan kadar albumin saat admisi ICU idealnya dilakukan secara rutin dan diikuti dengan koreksi kadar albumin apabila ditemukan kondisi hipoalbuminemia.

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Background: Gastrointestinal dysfunction is associated with worse clinical outcomes in critically ill patients. Low serum albumin levels are one factor that can increase the risk of gastrointestinal dysfunction. The relationship between albumin levels and gastrointestinal dysfunction is still inconclusive because the diagnostic approach to gastrointestinal dysfunction is not yet well standardized. Gastrointestinal dysfunction score (GIDS) is an instrument with minimal subjectivity and maximum reproducibility, which is expected to provide a diagnosis of gastrointestinal dysfunction with better objectivity. This research was conducted to determine the relationship between albumin levels at admission and the occurrence of gastrointestinal dysfunction as assessed using GIDS. Methods: This study is a prospective cohort study of subjects aged ≥18 years who were treated in the intensive care unit at RSUPN dr. Cipto Mangunkusumo and RSUI. Characteristics of research subjects included age, gender, nutritional status, comorbid diseases, ICU admission diagnosis, time of initiation of oral or enteral nutrition, alcohol consumption habits, and SOFA score. Bivariate analysis was carried out to assess the relationship between albumin levels at admission and gastrointestinal dysfunction. Results: There were 64 subjects, 32 subjects in the low albumin level group and 32 subjects in the normal albumin level group. Mean age of subjects 50.2 ± 15.7, 64.1% male, 26.6% subjects with normal weight nutritional status based on BMI, 50% subjects with clinical malnutrition, 21.9% subjects with comorbid diagnosis of diabetes mellitus and 3.1%  subjects with Parkinson's, 34.4%  subjects with surgical admission diagnosis, 95.3% subjects received oral or enteral nutrition ≤ 48 hours, median SOFA score 3 ( 0-12). The mean albumin level of subjects with gastrointestinal dysfunction was 2.7 ± 0.6 g/dL, the mean albumin level of subjects without gastrointestinal dysfunction was 3.7 ± 0.7 g/dL. 31.3% of subjects experienced gastrointestinal dysfunction. There was a statistically significant relationship between albumin levels at admission and gastrointestinal dysfunction RR 9 (95%CI 2.3-35.6; p <0.001) and GIDS score, p<0.001. Conclusion: There is a significant relationship between albumin levels at admission and gastrointestinal dysfunction. Albumin levels examination during ICU admission should ideally be carried out routinely and followed by correction of albumin levels if hypoalbuminemia is found."

"Latar Belakang. Perdarahan saluran cerna bagian atas (SCBA) masih menjadi masalah di Indonesia. Penanganan yang tepat serta identifikasi faktor-faktor yang dapat memengaruhi lamanya perawatan dapat mengurangi pembiayaan. Di Indonesia belum ada studi secara terkait faktor-faktor yang memengaruhi lamanya perawatan pasien dengan perdarahan SCBA.Tujuan.Mengetahui faktor-faktor apa saja yang memengaruhi lamanya perawatan pasien dengan perdarahan SCBA. Metode. Desain penelitian kohort retrospektif dilakukanpada yang datang dengan perdarahan SCBA yang berobat di Rumah Sakit Cipto Mangunkusumo. Pengambilan sampel secara konsekutif dan dilakukan analisis bivariat menggunakan uji Mann Whitney, hasil yang signifikan dilanjutkan analisis multivariat regresi multiple linier.Hasil. Penelitian melibatkan 133 subjek dengan rerata usia subjek 51 tahun (minimal 20 tahun, maksimal 83 tahun), subyek penelitian 57,1% subjek berjenis kelamin laki-laki. Analisis bivariat Endoskopi kurang dari 24 jam, Hemodinamik subyek, infeksi, gagal jantung, dan keganasan didapatkan memengaruhi lamanya perawatan pada pasien perdarahan SCBA. Analisis multivariat mendapatkan keganasan, hemodinamik, infeksi dan lama tunggu endoskopi merupakan variabel yang paling berpengaruh dengan R square: 0,374. Kesimpulan. Endoskopi lebih dari 24 jam, hemodinamik subyek, infeksi selama perawatan, gagal jantung dan keganasan merupakan faktor-faktor yang memengaruhi lamanya perawatan pasien dengan perdarhan SCBA.

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ABSTRACTBackground. Upper Gastrointestinal bleeding are prevalent cause of hospitalization. Risk factor identification of length of stay can minimize the cost. In Indonesia, there is no specific study about risk factor identification that prolong length of stay in upper Gastrointestinal bleeding patient. Objectives. To identification factors that influence length of stay patient with upper gastrointestinal bleedingMethods. This is a retrospective cohort study, analyzing medical record upper gastrointestinal bleeding patient in Cipto Mangunkusumo Hospital. Consecutive sampling was performed with bivariate analysis is performed by using Mann Whitney analysis and Multivariate analysis by Regression linier.Result. A total of 133 subject enrolled in this study, withmedian age of subject was 51 years (minimal 20 years, maximal 83 years), male (57,1%). In bivariate analysis, late endoscopy (>24 hours), hemodynamic instability, nosocomial infection, heart failure, and malignancy in gastrointestinal tract influence the length of stay patient with upper gastrointestinal bleeding. Multivariate analysis found late endoscopy (>24 hours), hemodynamic instability, nosocomial infection and malignancy has major impact.Conclusion. Late endoscopy (>24 hours), hemodynamic instability, nosocomial infection, and malignancy in gastrointestinal tract influence the length of stay patient with upper gastrointestinal bleeding."

"Summary: "Learn all you need to know about gastrointestinal drugs and their clinical use with this one-stop, rapid reference pocket guide. Brought to you by many of the world’s leading GI drug experts, Pocket Guide to Gastrointestinal Drugs provides comprehensive guidance to the pharmacological properties of drugs used to treat gastrointestinal conditions, including mechanisms of action, appropriate administration, and potential adverse effects associated with their use. Organized by class of drug and ranging from PPIs to immunosupressants, each chapter first examines the specific agents within that class and then their appropriate and judicious use across a range of specific GI disorders. Key features include: - Introduction of drug class, - Basic pharmacology, including mechanism of action, bioavailability, metabolism, interactions, adverse effects, toxicity, and special considerations, - Dosing information for each GI condition and on- and off-label use, - Consistent use of both generic and trade names throughout, - Specific reference to drug use in pediatric patients and during pregnancy. Perfect for quick consultation on the wards and in the office, Pocket Guide to Gastrointestinal Drugs is the ideal tool for all those managing patients with GI conditions, including gastroenterologists, GI trainees, emergency physicians, GI specialist nurses, primary care physicians and residents, intensivists and pharmacists"--Provided by publisher.Contents: Machine generated contents note: Section I: Upper GI Tract1 Prokinetic agents and antiemetics / Hemangi Kale and Ronnie Fass -- 2 Proton pump inhibitors / Wanda P. Blanton and M. Michael Wolfe -- 3 Histamine H2-receptor antagonists / Kentaro Sugano -- 4 Prostaglandins and other mucosal protecting agents / Carlos Sostres and Angel LanasSection II: Small and Large Intestine -- 5 5-HT Modulators and other anti-diarrheal agents and cathartics / Albena Halpert and Douglas Drossman -- 6 5-Aminosalicylates / Hannah L. Miller and Francis A. Farraye -- 7 Immunosuppressive agents / Lev Lichtenstein and Gerald M. Fraser -- 8 Biological agents / Gert Van AsscheSection III: Liver and Pancreas -- 9 Interferons / Robert C. Lowe -- 10 Nucleoside analogues / David P. Nunes -- 11 Ursodeoxycholic acid and chelating agents / James Dooley -- 12 Agents for the treatment of portal hypertension / Karen L. Krok and Andres Cardenas -- 13 Pancreatic enzymes / Steven Czinn and Samra S. Blanchard -- Section IV: Antimicrobials and Vaccines -- 14 Antibiotics for the therapy of gastrointestinal diseases / Melissa Osborn -- 15 Antimicrobials for parasitic diseases / Joachim Richter -- 16 Vaccines for Viral Hepatitides / Savio John and Raymond T. Chung -- 17 Rotavirus and Other Enteric Vaccinations / Christopher J. Moran and Esther Israel -- Section V: Nutrition and Probiotics -- 18 Parenteral and enteral nutrition feeding formulas / Dominic N. Reeds and Beth Taylor -- 19 Probiotics / Christina M. Surawicz."