Vitamin D level has a significant inverse correlation with depressive symptoms. The associa- tion of vitamin D level with unipolar or bipolar disorders are inconclusive among Indians. This study was aimed to find the severity of major depressive disorders and their correlation with vitamin D status. A cross-sectional study was conducted among patients (15-65 years old) diagnosed clinically with a major depressive disorder with a known serum 25 (OH) D levels. Mild, moderate, and severe depressive disorders were categorized into groups like vitamin D sufficient (≥75 nmol/L), insufficient (51-74 nmol/L), and deficient (<50 nmol/L). The data were analyzed for correlation. A total of 83 patients (33 males and 50 females) were included. Among the total, only four patients (4.8%) had bipolar disorder, while 79 patients (95.1%) had the unipolar disorder. Three bipolar patients and 68 unipolar patients had 25(OH)D levels below normal. Correlation analysis between the severity of disease and 25(OH)D level found a non-linear negative correlation in males (r= -0.07595, p= 0.7123) and positive correlation in females (r= 0.04234, p= 0.7823). However, correlation of age with 25(OH)D level was positive in males (r= 0.4151, p= 0.035) and negative in females (r= -0.1553, p= 0.3085). A negative correlation was found between the severity of the unipolar disorder and serum 25(OH)D levels in males. Therefore, male patients presented with the unipolar depressive disorder may consider vitamin D supplementation

COVID-19 is a contagious ailment primarily attributed to the severe acute respiratory syndrome coronavirus. Indonesia persists in confronting the COVID-19 pandemic, and South Tangerang City has emerged as one of the municipalities in Indonesia that has been significantly affected. There are two categories of medications employed for COVID-19 treatment according to government policies, namely favipiravir and remdesivir. This study aims to as- sess the cost-effectiveness of favipiravir and remdesivir medications at the South Tangerang General Hospital, Indonesia. The present study employs a retrospective research design characterized by a quantitative approach, utilizing cross-sectional methodologies. The analy- sis mostly consists of descriptive techniques. The sample consisted of 479 individuals, with 246 individuals receiving outpatient treatment and 233 undergoing inpatient treatment. The inclusion criteria for this study consisted of individuals diagnosed with COVID-19 who had tested positive for the antiviral medications favipiravir and remdesivir. The findings indicated that the Average Cost-Effectivenss Ratio (ACER) for inpatients treated with fa- vipiravir was IDR 2,354,319,859, but for those treated with remdesivir, it amounted to IDR 3,501,513,488. Regarding the outpatient population utilizing favipiravir, the total expendi- ture amounts to IDR 420,083,118. Similarly, patients utilizing remdesivir incur a total ex- penditure of IDR 797,282,432. It is worth noting that the Cost-Effectivenss Ratio (CER) for patients using favipiravir is IDR 1,545,621, whereas patients using remdesivir have a CER of IDR 2,309,705. This study makes a valuable contribution to the existing body of research by demonstrating the cost-effectiveness of favipiravir. Consequently, future studies inves- tigating the overall effectiveness of favipiravir in COVID-19 patients must employ more comprehensive criteria.

Medicinal plants are widely used for the treatment of different infectious diseases. This study was aimed to investigate antibacterial activity of Pluchea indica (P. indica) and Piper betle (P.betle) ethanol extract on Staphylococcus epidermidis (S. epidermidis) and Pseudomonasaeruginosa (P. aeruginosa) using agar disk diffusion method. Ethanol extract of Piper betle showed more potent antibacterial activity than P. indica against S. Epidermidis with the highest inhibiton zone at 30.71 mm and 21.73 mm from 1 mg/ml concentration, respectively. In contrast, against P. aeruginosa, the ethanol extract of P. indica was more potent than P. betle with 21.44 mm and 20.12 mm of inhibition zone on 1 mg/ml concentration, respectively. There was no increased effect from the combination of these two extracts against these bacteria. When comparing the antibacterial activity of these extract with tetracycline asthe standard, we found that antibacterial activity of P. indica at the concentration of 0.9 mg/ ml was comparable with that of tetracycline at concentration of 12.52 μg/ml, while P. betle needed 0.3 mg/ml concentration to had similar activity with 10.51 μg/ml of tetracycline. In conlusion, the antibacterial activity of ethanol extracts of P. indica and P. betle indicated that these extract had sufficient potential to warrant further examination and development as a new antibacterial agent.Keywords: Pluchea indica, Piper betle, antibacterial, agar disk diffusion

Inflammation is a local reaction in vascular tissue characterized by several symptoms, e.g.,  swelling, redness, and pain. Indonesia is one of the countries with high biodiversity, including traditional medicinal plants. Artocarpus altilis is one the plants that is widely used to treat inflammation. There is limited information on biological activity of A. altilis.This study was performed to evaluate anti-inflammatory properties  of A. altilis detached and attached leaves in Wistar male rats. A. altilis was extracted using soxhlet method at 67.4 0C with methanol solvent. Inflammation was induced by the administration of carrageenan to the rats paw. Subsequently, the extract of A. altilis were orally administered. The edema were measured using plethysmometer for 6 hours. We found that there were differences in anti-inflammatory activity between detached and attached leaves. The inhibition of edema in attached leaves were 50% and 53.33% for the concentration of 50 mg and 100 mg, respectively. The greater inhibiton was observed in the detached leaves, with 73.33% and 76.67% inhibition, for the concentration of 50 mg and 100 mg, respectively. Nevertheless, the inhibition percentage was still below diclofenac sodium as a positive control (83.33%).  In conclusion, A. altilis leaves extracts showed good anti-inflammatory properties and has the potential for development of anti-inflammatory drug.  Keywords: Artocarpus altilis, carageenan, inflammation, edema

Tuberculosis/Human Immunodeficiency Virus (TB/HIV) co-infection has poorer treatment outcome compared to non-co-infected patients. To benefit from therapy and to avoid contracting treatment-resistant strains, the individuals must adherent to medications. There is limited information regarding successful TB treatment outcomes and their associated factors. Thus, the study was designed to identify medication adherence associated with treatment outcomes among TB/HIV Patients at Prof. Dr. Sulianti Saroso Infectious Disease Hospital. This research was an observational study with retrospective approach from January 2015 to December 2017 by taking data from medical records and TB-01 form of TB/HIV patients in the outpatient clinic of the disease which would be used as a sample. Regarding compliance in treatment with first visit for 2-4 months, an approach using secondary data which were TB-01 Form, as well as HIV Care and Antiretroviral Therapy summary forms was used. The statistical analysis used was the bivariate analysis with the chi-square test as the statistical test. A total of 114 patients were included in the study. The outcome of treatment success obtained from this study had a patient cure rate of 91.30%. There is a significant relationship between medication adherence to successful tuberculosis treatment outcome with p-value= 0.012; OR= 5.684. There is a meaningful relation between medication compliance with treatment outcome. It is when on medication adherence, the treatment results can be declared cured in accordance with predetermined criteria, while when not on medication adherence, the treatment results are not declared cured.

Chemotherapy-induced nausea and vomiting (CINV) is a complication of highly emetogenic chemotherapy (HEC) agents. The present meta-analysis was conducted to quantify and analyze the efficacy and safety of adding olanzapine to a Neurokinin Receptor Antagonist (NKRA) based triple-drug regimen in preventing HEC-induced CINV. Electronic database searches in PUBMED and Cochrane library was conducted using MeSH search terms “olanzapine” and “chemotherapy-induced nausea and vomiting.” Randomized or cross-over trials comparing the efficacy of “olanzapine + NKRA based triple-drug regimen” vs. “placebo + NKRA based triple-drug regimen” in patients of age > 18 years with any malignancy receiving HEC were considered under inclusion criteria. Complete Response (CR) for the delayed (25–120 h) phase of CINV in patients receiving HEC agents was the primary outcome measure analyzed. Outcome measures were estimated by calculating the Risk Difference (RD) values and their 95% Confidence Intervals (CI). The Mantel-Haenszel method and both fixed and random effect models were used in the analysis by Revman 5.4.1 soft- ware. An additional 14% (RD: 0.14, 95% CI: 0.09 to 0.19) of patients treated with olanzapine + triple-drug regimen had a statistically significant higher CR in the delayed phase when compared to placebo + NKRA-based triple-drug regimen. Adding olanzapine at 10mg to the triple-drug regimen significantly improves delayed phase CR rates by 16% and delayed phase ‘no significant nausea’ rates by 30%. Results need to be interpreted cautiously in the background of response variations and limited trials included in our analysis

Infectious diseases are a major concern in the field of health, especially in developing countries like Indonesia. Children are vulnerable to infections because their immune systems are not fully developed. Proper management is necessary for the prevention and treatment of infectious diseases in pediatric patients. Antibiotics are the primary choice for addressing bacterial infections. However, the increased use of antibiotic can contribute to high levels of antimicrobial resistance (AMR), rendering infection treatment ineffective. The evaluation of antibiotic use can be conducted through the ATC/DDD method, which focuses on the quantity and types of antibiotics used. Although this method provides a quantitative overview, a qualitative approach using the Gyssens method and interviews with relevant parties is necessary for a more in-depth understanding of the rationality of antibiotic use. This study aims to comprehend the patterns of antibiotic use in pediatric inpatients at one of Bandung Regional Hospitals during August 2023. Using a retrospective observational approach, data were collected and processed using the ATC/DDD method. The evaluation results show that cephalosporins is the most commonly used antibiotic group, with cefotaxime being the dominant antibiotic administered intravenously. Quantitative evaluation indicates variations in DDD/100 patient days among different antibiotics, with ciprofloxacin having the highest value and amikacin the lowest. For a comprehensive understanding, qualitative research using the Gyssens method and interviews is necessary to strengthen the evaluation results of antibiotic use. Ultimately, this study provides a thorough perspective on antibiotic use in pediatric inpatients, supporting efforts to control antimicrobial resistance and promote more judicious antibiotic selection.

The prevalence of pneumonia is particularly high among pediatric patients. Appropriate antibioticsselection is required to reduce mortality and morbidity rates associated with thesediseases. However, information on cost-effectiveness of empirical antibiotics treatment forpneumonia was limited. This study was aimed to evaluate cost-effectiveness of cefotaximeand ceftazidime for pneumonia in pediatric patients. This study was a retrospective crosssectional study conducted at a hospital in Bandung during January-December 2012. Datawere derived from medical records of pediatric pneumonia inpatients during study period.Cost was calculated based on direct medical cost, i.e., inpatient care, medical support, andmedicines that were used from admission until hospital discharge. The results showed thatthere was no statistical difference in the average medical cost of the treatment using cefotaxime(1,197,017 IDR) and ceftazidime (2,245,748 IDR). Incremental cost effectivenessratio (ICER) showed that cefotaxime is more cost effective than ceftazidime with greaterreduction of leukocytes level (576 IDR/mm3 ). The use of cefotaxime is recommended forthe treatment of pnuemonia in pediatric patients.Keywords: cost minimization, cost effectiveness, cefotaxime, ceftazidime, pneumonia

This study aimed to evaluate the potential of bioactive compounds from Pyrrosia piloselloides leaves as xanthine oxidase (XO) inhibitors through an in silico approach. Methods included molecular docking and molecular dynamics simulations to identify the binding affinity of test compounds to XO. Among 59 screened compounds, 3 compounds (2,6,10,14,18,22-Tetracosahexaene, 6-Hydroxymethaqualone, and β-Sitosterol acetate) exhibited the lowest binding energy in comparison to the control, Allopurinol, with key residue contributions from GLU 802, ARG 880, and THR 1010. Molecular dynamics simulations confirmed the interaction stability, with β-Sitosterol acetate showing the lowest total binding free energy (-46.23 ± 0.66 kcal/mol). ADMET predictions revealed promising pharmacokinetic profiles for these compounds. This study highlights Pyrrosia piloselloides as a promising source of novel XO inhibitors, with further validation required through in vitro and in vivo experiments.

Sungkai (Peronema canescens Jack) is an alternative natural ingredient that can be used as an antidiabetic containing several secondary metabolites which are thought to reduce blood glucose levels by inhibiting the action of the α-glucokinase enzyme and increasing the activity of antioxidant enzymes and being able to regenerate β-cells, damaged pancreas so that insulin deficiency can be overcome. The aim of this study was to determine the effect of P. canescens leaves ethanol extract on antidiabetic activity and to determine the effect of various doses of sungkai leaf ethanol extract as antidiabetic. The scientific research method used in this study was a completely randomized design (CRD) and data analysis used in this study is the one way ANOVA, following by the Duncan test. Blood glucose measurement in treated mice was carried out 3 times. Mice were devided into five groups, three mice in each group, and each group was administered different dosages of sungkai extract (T1 = extract 175 mg/kg body weight; T2 = extract 350 mg/kg body weight; T3 = extract 700 mg/ kg body weight). First, the mice were acclimatized for six days and the injection of treatment was started at day 7. Blood glucose levels, urine volume, body weight and daily drinking of mice was carried out before induction (day 0), after induction (day 8) and after the end of treatment for 10 days (day 18), was carried out using the Point of Care Test (POCT) method using the Easy Touch GCU. The results showed that the ethanol extract of sungkai leaves had the potential to reduce blood glucose levels in mice. The ethanol extract of sungkai leaves at a dose of 350 mg/kg body weight has the most optimal potential to reduce blood glucose levels, urine volume, daily drinking, and body weight.

Maternal mortality is one of the significant burdens requiring appropriate measures including family planning methods to control post-partum morbidity and mortality. The early age of marriage among women is accompanied by early pregnancies also contributes to maternal mortality. Knowledge about contraceptive usage could prevent such incidences.  This study aimed to evaluate the knowledge, attitude, and perception regarding contraceptives among medical interns in our college. This cross-sectional questionnaire study was done on 60 house surgeons (interns), at MVJ Medical College and Research Hospital, Hoskote, using a validated questionnaire that consisted of 22 questions including MCQs and case scenarios to assess their knowledge, perception, and attitude about contraceptive methods. Data were analyzed in the form of percentages. Among 60 interns, 36 were females and the majority of students were from urban backgrounds. About 73.3% of interns had adequate knowledge about various contraceptive methods and their usage. The interns have a perception that illiteracy, lack of awareness and social, and religious values are major hurdles for contraceptive usage and have an attitude that doctors are most suitable to give information regarding contraceptive methods. Considering medical interns as future physicians and their responsible role in counseling about contraceptive usage in effective family planning, they need to have a positive attitude with fair knowledge and perception about the contraceptive methods which can be achieved by educating them early in their academic carrier.

Chronic renal disease is a substantial health challenge in numerous countries worldwide, including Indonesia. Chronic renal disease patients frequently experience comorbidities and require multiple medications (polypharmacy). In patients receiving polypharmacy, it is necessary to monitor the occurrence of drug interactions. The current study analyzed the most probable of drug-drug interactions based on severity and management. Furthermore, to analyzed the most probable drug-food interactions based on severity and management in patients hospitalized with chronic renal disease. From September to October 2023, a cross-sectional study was carried out using retrospective data gathering. The population that attains the study criteria is referred to as the present research sample. The sampling methodology utilizes the saturated sample method. The tools utilized encompassed the Lexicomp® drug interaction checking application. The severity and management categories for probable drug-drug interactions and drug-food interactions are defined within the Lexicomp® application. The study analyzed medical data from 51 patients in total. The results of the current study showed that there were probable drug-drug interactions in 68.62% and drug-food interactions in 47.06% of patients hospitalized with chronic kidney disease. Based on severity, the most probable drug-drug interaction and drug-food interaction is in the moderate category. Based on the management, the most probable drug-drug interaction needs to be monitored, and the most probable drug-food interaction needs to be avoided concurrent administration with food. In patients with chronic renal disease, it is crucial to minimize and handle probable drug-drug and drug-food interactions.

Rational use of drugs plays an important role in efficacy and safety. World Health Organization(WHO) developed a set of indicators to assess medicines precribing pattern. The aim ofthis study was to evaluate the rational use of drugs among internal medicines outpatients ata hospital in Papua, Indonesia, using WHO prescribing indicators. This study was a retrospectiveobservational study conducted during January-March 2014. The data were obtainedfrom patients medical prescriptions. From each prescriptions, data regarding the the totalnumber of drugs, generic, antibiotics, parenteral, and essential drugs were extracted. A totalof 2025 medical precriptions were included in this study. We found out that the averagenumber of drugs per prescription was 2.3. Majority of the prescribed drugs were generic(84.14%). The use of antibiotics, parenteral drugs, and essential drugs were 33.43%, 3.40%,and 60.13%, respectively. Polypharmacy was relatively low among the subjects. The medicinesprescribing patterns among internal medicines outpatients were in accordance withWHO recommendation.Keywords: prescribing indicator, polypharmacy, essential drugs

Authors and Keywords Index of Volume 2 No. 1

Pharmaceutical services recently require new ideas and innovation to provide maximum benefit concerning the pharmacological treatments of patients and taking responsibility for the process of monitoring their therapy. One of the efforts proposed to be implemented by pharmacists is the pharmaceutical care program which is designed to ensure pharmacists are able to monitor safe and effective medication use and also to provide timely access to medicines for the population. Moreover, the application of eHealth in terms of technology is expected to be effective, networked, patient-centered, and accessible for patients. Therefore, Pharm-Care Tadulako® which is a personalized eHealth application designed with key features of pharmaceutical care to enhance communication between pharmacists and patients is presented in this study. Some of the services designed to be provided by this application include electronic medical records, drug reminders, pharmaceutical messenger, clinical data monitoring, and medication analysis. The application was designed using Software Development Life Cycle (SDLC) Waterfall, after which a pilot study was conducted at four pharmacies in Palu City, Centre of Sulawesi, Indonesia, using 30 patients who volunteered willingly to participate in the experiment. It was discovered that 65% out of the 30 patients were aged 26-45 years old out of which 36% were observed to be suffering from hypertension. The Pharm-Care Tadulako® application was found to have a good impact on pharmacists during the process of providing pharmaceutical care services to patients while they were able to monitor their treatment through the five main features of the application.

Indonesia is one of the country with the highest prevalence of malaria infections. In order to achieve malaria control as an act to support Millenium Development Goals, complete eradication of Plasmodium parasites needs to be conducted. Drugs resistance has been a hindrance in this act. This study aimed to assess Plasmodium parasite resistance towards chloroquine (CQ) and artemisinin combined therapy (ACT) through the determination of polymorphism on pfcrt K76T and pfatpase6 S769N genes, respectively. Subjects of this study were 16 adult patients positively diagnosed with malaria infection caused by P. falciparum or cross infection. DNA obtained from patient blood samples were amplified using polymerase chain reaction (PCR) and then the fragment of pfcrt and pfatpase6 were then digested using ApoI and DdeI, respectively. The results showed that 81% of the pfcrt K76T polymorphism was occured on the samples, which indicated the resistance of CQ. Meanwhile, 87% of the patient samples did not showed any polymorphism of pfatpase6 S769N gene, which indicated no resistance of ACT. This study showed that CQ was no longer effective as the first line therapy of antimalarial drugs due to the resistance of P. falciparum to CQ. However, the used of ACT still can be maintained in the antimalarial drug therapy regimen. In conclusion, the polymorphism of both genes negatively influenced the effectivity of antimalarial therapy using artemisinin.Keywords: antimalarial drugs, resistance, polymorphism, endemic area

Bedaquiline have been included in the shorter treatment regimen (STR) to treat patients with multidrug-resistant tuberculosis (MDR-TB). The aim of this study is to evaluate the effectiveness and safety of STR containing bedaquiline. Data were collected retrospectively from medical records of MDR-TB patients receiving STR between January 2020 and December 2021. Sputum culture was evaluated at six months (24 weeks) and the end of treatment. Measurement of renal and liver function test, serum electrolytes, and uric acid were evaluated to assess safety during six months of treatment. Treatment failure, death, and loss to follow-up were also recorded during the study period. Thirty eligible MDR-TB met the inclusion criteria. Twenty-five of them had a positive culture at baseline. After treatment completion, 96.0% patients experienced sputum culture conversion. A significant decrease in potassium and calcium serum levels was observed at three months of treatment. Cases of treatment failure and loss to follow-up were 3.3% and 6.6%, respectively. MDR-TB patients receiving STR containing bedaquiline demonstrated favorable sputum conversion with tolerable safety profile

Patients with hyperlipidaemia is at increased risk of developing atherosclerotic cardiovascular disease (ASCVD). The use of appropriate statin therapy is important to obtain optimal health outcomes. However, there was limited information regarding the risk of ASCVD among Indonesian hyperlipidaemia population and the appropriateness of statin therapy given to these patients. This study aimed to assess the ASCVD risks among the patients and evaluate the use of statin therapy at hospitalized hyperlidaemia patients. This cross sectional study used medical records as data source. This study was conducted at one hospital in Pontianak, Indonesia during Januari-June 2017. We included 50 subjects. The 10-year risk of ASCVD was assessed using ASCVD pooled cohort risk assessment equation (PCRAE). The results showed that 66% of the included subjects had a relatively high risk of developing ASCVD. Subjects with high risk of ASCVD received inappropriate statin therapy. High intensity statin should be given to these patients. In conclusion, large proportion of the subjects were at high risk of developing ASCVD. Nevertheless, inappropriate statin therapy were given to these patients. Improvement in medication practice should be done to prevent complication and increase quality of health outcomes.Keywords: ASCVD, dyslipidemia, statin

Authors and Keywords Index of Volume 4 No. 3

Hyperlipidemia is a major cause of atherosclerotic coronary and cerebrovascular disorders affecting a large Indian population. The cost of various hypolipidemic drugs that are used for the prevention and treatment of these afflictions largely varies in the Indian pharmaceutical market. Our study aimed to evaluate the cost variation of different brands of hypolipidemic drugs and to compare the branded prices with their corresponding generic and ceiling prices. The costs of various drugs were procured from the latest issue of the “Drug Today” from October to November 2020 edition which is a directory of all the drugs available in India published quarterly every year by Lorina Publications (India) Inc. Cost ratio, percent cost variation, and daily defined dose (DDD) were calculated. We also compared the branded prices of drugs with their generic and ceiling prices available on the official website.A total of 9 single hypolipidemic drugs and 9 fixed-dose combinations (FDC) showed a wide per cent cost variation. The highest percentage of cost variation was atorvastatin 80 mg (3284%) whereas fenofibrate showed the lowest percent cost variation (0.91%). The cost ratio was also found higher in 2 from 6 drugs. Among FDCs, atorvastatin 10mg + ezetimibe 10 mg (484%) showed a higher cost variation and rosuvastatin 20 mg + fenofibrate 160mg (0.6%) showed a minimum variation. The maximum cost variation from branded prices compared to generic prices was found in simvastatin 20 mg (544%) and atorvastatin 10 mg (155%). In summary, our study showed a wide variation in the cost of hypolipidemic drugs available in the Indian market which provides an insight to the prescriber, gives drug price control authorities to minimize the financial burden on the patient, and improves their compliance