Hypoglycemia is one of the most important complications of diabetes treatment and it becomes an obstacle in hypoglycemia medication. Besides, hypoglycemia can cause nerve damage and impaired cognitive function so that it influences the patients mortality, morbidity, and quality of life. Recognition of hypoglycemia risk factors, blood glucose monitoring, selection of appropriate regimens and educational programs for healthcare professionals and patients with diabetes are the major issues to maintain good glycemic control, minimize the risk of hypoglycemia, and prevent long-term complications. This research employs retrospective method and the design of the research is case control.  The sample of this research is 72 patients with type 2 diabetes which is divided into two groups.  The first group is case and It consists of 23 patients (31,9%) getting hypoglycemia. Then, the second group is control and it consists of 49 patients (68,1%). In the second group the 49 patients do not get hypoglycemia and they do not receive any hypoglycemia medication in the hospital. The Results of multivariate logistic regression analysis shows that there is a significant different between the variables reduction in food intake (p 0,011) and lower laboratory result of HbA1C (p 0,003) on the incidence of hypoglycemic, where the variable reduction in food intake has the strong relationship with most major hypoglycemic (OR 9,329). On the other hand, other variables such as the use of antidiabetic drugs, diabetes duration, age, comorbidities and polypharmacy showed no significant association with hypoglycemic events. Thus, the hypoglycemic risk factors in patients with type 2 diabetes receiving antidiabetic therapy due to reduction in food intake and lower laboratory results of HbA1C. Patients with reduction in food intake at risk of hypoglycemic events nine times greater than patients with normal food intake. Keywords: type 2 diabetes mellitus, hypoglycemia, food intake, HbA1C

Diabetes mellitus (DM) is a group of common metabolic disorders that share the phenotype of hyperglycemia. India is emerging as the world diabetic capital. Insulin is a therapeutic option to treat either type 1 and type 2 DM. Inadequate awareness about the use of insulin is likely to influence its acceptance and adherence. The present study was done to assess the knowledge, attitude, and practice regarding insulin use among diabetic patients at Victoria Hospital, Bangalore, India. Knowledge, attitude, and practice of sixty diabetic patients (either inpatients or outpatients) were assessed by using a validated questionnaire consisting of 24 items. Scores were allotted to each question and evaluated after applying appropriate statistical tests. The mean age of the patients was 53.51±6.48 years (58.33% males). The mean knowledge score was 9.06±1.88 out of 22, attitude score was 4.78±1.37 out of 12 and practice score was 7.75±1.24 out of 11. The mean score of attitude was better in females compared to male patients (5.32±1.34 vs. 4.4±1.28). Male patients scored 38.57% compared to female patients (41.33%) for the question regarding symptoms of hypoglycemia. 57.14% of male patients and 72% of female patients carried simple carbohydrates when going out. Despite good practice scores, the knowledge and attitude scores regarding insulin use were inadequate. Potential adverse effects of insulin can be avoided and better knowledge, attitude, and practice can be achieved by providing proper education to patients. Keywords: knowledge, attitude, practice, diabetic, insulin

Authors and Keywords Index

The geriatric population in Indonesia is increasing rapidly every year. The large number of drugs consumed by geriatric patients results in potentially inappropriate prescriptions (PIP) in the form of mis-prescribing drugs (potentially inappropriate medicines or PIM) and under-prescribing drugs (potentially prescription omission or PPO). In Indonesia, especially in Bandung, there is limited research on PIP in geriatric patients with cardiovascular disorders (CVDs). This study aims to identify PIP and factors that influence PIM and PPO based on STOPP/START criteria and the relationship between the incidence of PIM and kidney function in geriatric inpatients with CVDs at Hasan Sadikin Hospital, Bandung, West Java, Indonesia. The present retrospective study was cross-sectionally conducted from January to December 2022. The Chi-square tests were carried out to determine factors that were significantly related to PIM and PPO. Of the 192 patients, 33.4% patients experienced PIM with the most being NSAIDs with eGFR <30 mL/min/1.73 m2 (36%). As many as 35% of patients experienced PPO with the most frequent PPO not being given angiotensin-converting enzyme inhibitor (ACEi) in patients with systolic heart failure (41.8%). Factors that were significantly associated with PIM were comorbid kidney dysfunctions (OR 5; 95% CI: 2.367-10.342), and no factors were found that were significantly associated with PPO. Taking everything into consideration, it was found that PIM and PPO were common in hospitalized geriatric patients with CVDs. Kidney dysfunctions are a risk factor for PIM. These findings suggest that it is important to evaluate prescribing for geriatric patients during hospitalization using STOPP/START criteria to reduce the prevalence of PIP

Anredera cordifolia or binahong is one of the Indonesian medicinal plants that is used to treat peptic ulcer. The purpose of this study was to evaluate the effect of the addition of sodium carboxymethylcellulose (CMC) and sorbitol on anti-peptic ulcer activity of A. cordifolia leaves extracts in male Wistar rats. The plants were extracted using decoction method and freeze dried. Three liquid formulas were used i.e., i) a combination of sodium CMC and sorbitol; ii) only sorbitol; iii) extract only. The rats were divided into 6 groups, i.e., positive control (sucralfate 35 mg/kg body weight); negative control (80% ethanol); normal control; and 3 formulas. After the administration of the liquid formula, all groups, except normal control, were given 80% ethanol (l5 ml/kg body weight) to induce peptic ulcer. Antipeptic ulcer activity was evaluated using direct observation on rats gastric mucosa, and histopathology assessment. The result showed that the strongest anti-peptic ulcer  was shown by sorbitol only (96.95% inhibition),  followed by the combination of sodium CMC and sorbitol (92.68% inhibition). The formula which only contained extract showed only  31.70% inhibition.  Statistical analysis showed significant differences between formula 1 and 2 with negative controls. In conclusion, A. cordifolia leaves extract with the addition of sorbitol showed the strongest anti-peptic ulcer activity. Keyword: Anredera cordifolia, peptic ulcer, suspense, Wistar rat.

Antibiotics play a vital role in prevention and treatment of various infections. But inappropriate antibiotic choice could lead to emergence of multi-drug resistance (MDR) among microorganisms. Since, the antibiotic susceptibility pattern of organisms could vary from place to place; forming a local prophylaxis and treatment protocol could hugely reduce this global burden. The primary objectives of the study were to observe the frequency of multi-drug resistant organisms causing Surgical Site Infections (SSIs) and to study the pattern of antibiotic usage for the prophylaxis and treatment of SSIs. A descriptive study was carried out in general surgical wards of KR hospital, Mysore for a period of 18 months (2015-2016). The relevant data was collected from the case sheets of patients who were diagnosed with SSI. Pus samples were collected, and culture-sensitivity was done. Collected data were analyzed using relevant statistical tests. A total of 263 study subjects including both males and females were enrolled in the study. Cefotaxime was the most common antibiotic used for pre-surgical prophylaxis (n=221). Out of 263 pus samples 92% were culture positive. The most common organisms causing SSI were E-coli-ESBL (n=73) and MRSA (n=44). About 95% of organisms showed multi-drug resistance. Imipenem, Gentamicin, Piperacillin-Tazobactum and Linezolid were the most common antibiotics used in the treatment of SSIs. The result of the study is alarming. Overall, there is great rise in the prevalence of MDR organisms causing SSIs. The hospital antibiotic policy should be revised in such a way to decrease the emergence of MDR microbes.

Non-genetic traits as predictors of variation in response to pharmacological interventions in ASD need to be identified for better management. This review aims to identify these non-genetic traits and the role of adjuvant medications in ASD. Electronic database searches in PUBMED and Cochrane libraries were conducted using MeSH search terms "Autism" and "Risperidone." Randomized or cross-over trials comparing the efficacy of ‘risperidone plus placebo’ vs. ‘risperidone plus adjuvant medications’ using Aberrant Behavior Checklist-Community Version (ABC-CV) scores in ASD patients of any age group were included in the analysis. The quantity of reduced irritability (ABC-I) sub-score was the primary outcome measure analyzed.In contrast, the reduction in remaining ABC-CV sub-scores at the end of 10 weeks were the secondary outcome measures analyzed. All the outcome measures were estimated by calculating the Mean Difference (MD) values and their 95% Confidence Intervals (CI) by both fixed and random effect models using Revman 5.4.1 software. A total of 13 trials were found to be eligible and included in the quantitative synthesis of efficacy. A small but significant decrease in the ABC irritability sub-score was evident in the ‘risperidone plus adjuvants’ group (MD: -3.19, 95% CI:-3.82, -2.56, N=658). The meta-analysis results attributed the highest decrease in ABC-irritability sub-scores to adjuvant topiramate. There is a possibility of bias and minimal impact of adjuvants in alleviating irritability symptoms of ASD. Baseline severity of irritability symptoms and the dose/medication regimen appear to be possible non-genetic traits responsible for variation in response to pharmacological intervention.

Many diseases occur due to inflammation that is not handled properly. One of the feature of inflammation is swelling or edema. Inflammation can be handled with traditional medicine, such as Muntingia calabura L. (M. calabura L.) Pharmacologically, this plant extract is reported to have antipyretic, analgesic, anti-inflammatory, antioxidant, and antibacterial. Metabolite compound contained in M. calabura L. has the potential as an anti-inflammatory agent. The objective of this study is to ascertain the secondary metabolites contained in M. calabura L. leaves infusion. This experimental research method includes the simplicia making and infusion of M. calabura L. leaves by cold infusion and phytochemical screening. This study also showed that the infusion of M. calabura L. leaves contained flavonoids, alkaloids, and triterpenoids. Overall, the findings indicate potential as an anti-inflammatory agent that requires further investigation, specifically in preclinical testing.

Differences in drugs consumption time may affect its absorption and metabolism in the bodywhich could lead to differences in its efficacy. For hypertension patients, one of the mostfrequently used drugs for lowering blood is captopril. However, information regarding theinfluence of consumption time on captopril efficacy was limited. Therefore, this study wasconducted to compare the efficacy of captopril in lowering blood pressure when administeredbefore and after meal. This was an experimental study with two treatment groups,conducted at Dr. Soedarso General Hospital, Pontianak, Indonesia, during April-June 2015.Statistical analysis was performed using Mann-Whitney, Exact-Fisher, and T-test. We foundout that the reduction of systolic blood pressure in group who consumed captopril beforeand after meal was 30 mmHg and 25 mmHg, respectively (p<0.05). The similar reduction indiastolic bloos pressure was observed in both groups (10 mmHg, p>0.05). In conclusion, itis recommended to take captopril on an empty stomach since it showed better efficacy whenadministered before meal compared to after meal consumption.Keywords: hypertension, captopril, absorption

Tobacco (Nicotiana tabacum L.) is a commercial plant that often used for making cigarettes. In 2012, the government issued regulations for the diversification of tobacco products besides cigarettes. Some of these diversified tobacco products include organic pesticides, anesthetics, cosmetic ingredients, and biochar as an alternative to coal. Therefore, in order to further to diversification of tobacco product, this study aimed to determine the antioxidant activity from n-hexane extract from leaves using the Soxhlet extraction method. Antioxidant activity was assessed by the DPPH (2,2-diphenyl-1-picrylhydrazyl) method, while the total phenolic content was determined using the Folin-Ciocalteu method that allowed quantification of phenolic compounds in the extract, which possesses the role of antioxidant. The IC50 value obtained from the antioxidant activity assay of the n-hexane extract of tobacco leaves was 426.042 μg/mL, classified as very weak. Meanwhile, the total phenolic content was 51.93 mg GAE/g. These results suggest that the high total phenol content may have other potential activities that can be tested, such as antibacterial activity.

AIDS is the late stage of infection with the Human Immunodeficiency Virus (HIV). Even though the Highly Active Antiretroviral Therapy (HAART) for the management of HIV/ AIDS has been in existence in Ghana since 2003, there is still limited data on their effectiveness. This study therefore sort to ascertain the effectiveness of HAART used at Anti-retroviral therapy (ART) Centres in the Ashanti region of Ghana by assessing its effects on immunological and haematological markers as well as some significant indicators such as body temperature and blood pressure changes. The study was a retrospective cross sectional study which reviewed medical record folders of 156 HIV infected patients who had attended the selected ART centres in the Ashanti region of Ghana between 2010 and 2014. About 49% of the study population had a significant rise in their CD4 counts after six months strict adherence to specific HAART regimen. HAART effectively reduced viral loads and increased CD4 counts in most of the patients whose medical record folders were reviewed. Socioeconomic factors, formal education and lack of health literacy had a significant effect on adherence to the HAART regimen, however; marital status of patients did not have any significant effect on adherence, CD4 counts and the haemoglobin concentration of patients. Based on results obtained from this study, HAART could be considered as effective in the adult population in the Ashanti region of Ghana provided there is a high level of adherence. Immunological and haematological markers for the assessment of effectiveness could also improve with high adherence recommended HAART regimen

Drug-related problems are a common problem among stroke patients due to comorbidities resulting from the complex management of stroke treatment leading to polypharmacy management. Studies show that 90% of stroke patients have drug-related problems (DRPs). However, there is limited information on the impact of comorbidities as risk factors for DRP prevalence and unfavorable prognosis in patients with ischemic stroke. This study aimed to determine the risk factors for DRP and clinical outcomes as modifiable comorbidities in ischemic stroke patients admitted to a tertiary hospital between January 2020 and October 2021 were indeed significant influences. The study was conducted retrospectively using a cross-sectional analysis of patient’s medical records. The study found no significant association between the presence of comorbidities and polypharmacy in patients with the incidence of DRP, although we found that the DRPs occurrence was found more in a patient with comorbidities and polypharmacy. Diabetes mellitus was found to have a significant association with no improvement in NIHSS scores in ischemic stroke patients. We found that diabetes mellitus patient had an increased risk of non-improvement NIHSS score 2,987 times compared to patients without diabetes mellitus. The second increased risk was the presence of comorbid hypertension (OR 1.352), the third was the occurrence of polypharmacy (OR 1,175), and the fourth was dyslipidemia (OR 1.138).

Hypertension is one of the world’s most hazardous diseases since it harms the heart, brain, kidneys, and other organs. Patients’ understanding of hypertension can be the key to successful treatment. Nonadherence with antihypertensive medication is a primary cause of therapeutic failure and is considered a serious issue. The purpose of this study is to examine the association between antihypertensive knowledge and adherence at public healthcare facilities. This study employed a quantitative approach using a cross- sectional design. The purposive sampling technique determined the sample, resulting in 100 hypertensive respondents from Public Healthcare. Knowledge is the independent variable in data collection; adherence to antihypertensive medications is the dependent variable; and demographic variables are the confounding variable. We employed the HFQ (Hypertension Fact Questionnaire) and MMAS-8 (Modified Morisky Adherence Scale-8) questionnaires as data-gathering instruments. We conducted univariate, bivariate, and multivariate analyses on the data using SPSS. Based on the study’s findings, it is possible to conclude that there is a significant association between knowledge level and adherence with antihypertensive medicine use in public healthcare, with a p-value of 0.003. Comorbidities are a risk factor for hypertension that affects adherence, with a p-value of 0.007 and an OR of 0.801, indicating that patients are 0.801 times more likely to take their medicine

Psidium guajava (P. guajava) leaves have been empirically used to stop bleeding. Tannin, one of this plant’s secondary metabolites, may contribute to this activity. However, information regarding its pharmacologicy activity was limited. Therefore, this study was performed to evaluate local hemostatic activity of P. guajava leaves. This study used Duke method with male Swiss Webster mice as test animals. The animals were grouped into three i.e., negative control (distilled water), positive control (epinephrin), and P. guajava group. Its tail was cut (2-3 mm) and the bleeding time was calculated. Statistical analysis was performed using   Kruskal-Wallis test and continued with Least Significant Different (LSD) test. The mean (SD) of bleeding time for those groups were 246.00 (22.95),  72.40 (5.55), and 88.40 (7.03), respectively.  There was a significant difference between the negative control group with the other two groups, but there was not significant difference between the positive control group and the P. guajava group. In conclusion, P. guajava showed promising local hemostatic activity and can be further developed as potential hemostatic agents.  Keywords: Psidium guajava, hemostatic, bleeding time

Authors and Keywords Index of Volume 1 No 3

Analgesic drugs like morphine and other opioids exhibit several harmful effects. Thus, the exploration of a new and safer analgesic drug is necessary. Utilizing Indonesia's biodiversity richness, medicinal plants can serve as an alternative source of novel analgesic drugs. Here, we show the analgesic activity of Kratom (Mitragyna speciosa) leaf ethanol extract (KE) in formaldehyde-induced rat (Rattus norvegicus) models. The effect of KE was examined by observing the duration of spontaneous nociceptive behavior such as paw licking or limp leg. The result showed that rats treated with 70 mg/kg KE demonstrated significantly (p<0.01) decreased nociceptive behavior compared to those receiving vehicles. However, a higher KE dose (210 mg/kg) failed to increase the analgesic effect and showed a slight reduction (not significant) compared to the control group. These findings proved that kratom leaf ethanol extract has the potential to alleviate painful conditions.

Hospital-acquired infection has become serious issue during previous decades. In Indonesia, the prevalence of nosocomial infection reached almost 10% of total patients encounter. The objective of this study was to investigate the sterility status of 160 sets of re-used instruments in three intermediate care rooms, including High Care Cardiac Unit (HCCU), Neosurgical Critical Care Unit (NCCU) and Burn Care Unit (BCU) of Dr. Hasan Sadikin General Hospital and analyzed whether there was association between time and storage condition towards sterility status. All tested instruments were sterilized in Central Sterile Supply Department (CSSD) of the hospital and distributed to those intermediate care rooms. Observations and microbiology assays were carried out for four weeks. We found that the worst contamination was found in BCU room with 2.50% bacterial infection in week I, II and III, and 4.375% of fungal infection in week I, II and IV. The best sterility status of reusable instruments was found in CSSD, followed by NCCU, and HCCU. Time and storage condition influenced fungal contamination, while these factors did not associated with the bacterial contamination. In conclusion, sterility status of reusable medical instruments was relatively satisfactory, but there was still room for improvement, particularly at burn care facilities.Keywords: hospital-acquired infections, hospital, nosocomial, sterility

Routine immunization is a program that must ensure adequate coverage as one preventive measure against the transmission of vaccine-preventable disease (VPD). Vaccines are the most cost-effective healthcare investment as it has been shown to prevent and reduce the incidence of disease, disability, and death from VPD, which is estimated to kill 2 – 3 million people each year. As of July 11, 2020, the COVID-19 pandemic has been deemed the worst public health emergency in the world, with over 12 million positive cases and 556,342 fatalities documented in 213 nations. The impact of the pandemic on routine immunization has resulted in higher morbidity and mortality from this VPD in countries with low coverage. This review article comprehensively describes routine immunization services and case reports of immunization performance during the COVID-19 pandemic.

Treatment for pneumonia has always been a challenge due to the difficulties in diagnosis and the growing incidence of antibiotic resistance. Beta-lactam antibiotics are the first line treatment for pneumonia. The combination of beta-lactam with other antibiotics are preferred than single antibiotic therapy. However, there was limited information regarding the effectiveness of combination between beta-lactam with either macrolides or fluoroquinolone for the treatment of pneumonia.The purpose of this study was to determine the most effective combination of antibiotics for hospitalized adults pneumonia patients. This was a cross-sectional study with prospective data collection. The data source was the medical record of the subjects. We included adult pneumonia patients hospitalized at Dr. Hasan Sadikin General Hospital during June-August 2015. We found that mean reduction of body temperature in group who received combination of a beta-lactam antibiotic and azithromycin was 1.53 0C, while in levofloxacin group, the reduction was 1.22 0C (p=0.210). Reduction in leukocytes and respiratory rate were 7800 and 2.29 times/minute, respectively, in the former group, while in the latter group the reduction of leukocytes and respiratory rate were 2600 and 5 times/minute. The differences were not statistically significant in both parameters (p=0.036 and 0.149, respectively). In conclusion, better clinical outcomes were observed in patients treated with combination of beta-lactam and azithromycin compared to combination of beta-lactam and levofloxacin, although the difference was not statistically significant.Keywords: pneumonia, pneumonia therapy, combination therapy for pneumonia

Head lice (Pediculus humanus capitis), a parasite causing hair problem,  often occurs in society.The study aimed to evaluate in vitroeffectiveness of shampoo formulation containing neem oil as an anti head lice. An experimental method was used to examine the formulation of shampoo, irritation test, testing the effectiveness of shampoo against head lice (Pediculicidal activity), and testing the effectiveness of shampoo against nits (Ovicidal activity). The effectiveness test employed an in vitromethod where neem oil shampoo were tested directly towards head lices and nits isolated from humans, then the mortality was observed. To recognize the safety of the shampoo, skin and eye irritation tests were carried out by applying 0.5 ml on the skin and dripping 0.1 ml shampoo into New Zealand white rabbit’s eyes.Data were analyzed using Kruskal Wallis and Mann Whitney. The study results showed that the primary irritation index for 5%, 10%, 15%, and 20% neem oil shampoo were 0; 0111; 0.222; and 0.222, respectively. All of the shampoos were very mild irritation response category. Eye irritation tests showed that only the 20% neem oil shampoo gave a mild irritation response with degree of corneal opacity ≥ 1 and recovered after 7 days of observation. The 5%, 10%, 15%, and 20% neem oil shampoo were effective as an anti head lice. The 15% and 20% neem oil shampoo had anti head lice effectiveness activity as same as 1% permethrin lotion. In conclusion, the 15% neem oil shampoo was chosen as the best shampoo, its high anti head lice effect and light irritation response. Keywords: Head lice, neem oil (Azadirachta indica A. Juss), shampoo