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"ABSTRAKPeranan farmasi klinik di era JKN telah berkembang yaitu melakukan evaluasifarmakoekonomi terutama pada penggunaan antibiotik pasien anak di PICU yangberisiko tinggi akan resistensi. Tujuan penelitian adalah untuk mengevaluasi peranserta farmasi klinik pada terapi antibiotik secara ekonomi di PICU RSCM periodeMei-Oktober 2014. Metode yang digunakan adalah analisis efektivitas biaya.terhadap lama rawat pasien pada kelompok pasien yang tidak mendapatkanrekomendasi periode Mei-Juli 2014 (NR) dibandingkan dengan kelompok pasienyang mendapat rekomendasi dari farmasi klinik periode Agustus-Oktober 2014(R). Hasil yang diperoleh dari 42 pasien kelompok NR dan 51 pasien kelompok Radalah total biaya pada kelompok NR sebesar Rp 427.805.134, sedangkankelompok R sebesar Rp 349.302.060. Total lama rawat pasien pada kelompok NRadalah 268 hari, sedangkan kelompok R adalah 228 hari. Rata-rata lama rawat perpasien kelompok NR yaitu 6,4 hari sedangkan kelompok R yaitu 4,5 hari.Persentase efektivitas pada kelompok NR adalah 15,36%, sedangkan kelompok R22,22%. Hasil ACER kelompok NR adalah Rp 1.591.537/hari, sedangkan ACERkelompok NR adalah Rp 1.522.013/hari. Hasil analisa sensitivitasnya adalahdominan karena biaya lebih kecil sedangkan efektivitasnya lebih besar. Olehkarena itu, dapat disimpulkan bahwa peran serta farmasi klinik dalam terapi dapatmenurunkan biaya dan lama rawat pasien di PICU RSCM.

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ABSTRACTThe role of clinical pharmacy in National Health Insurance era to evaluate the useof antibiotics has been evolved, especially for children in PICU which at high riskfor resistance. The research objective was to evaluate the role of clinical pharmacyon antibiotic therapy in the PICU RSCM period from May to October 2014. Themethod used is cost-effectiveness analysis to length of stay between the group ofpatients who did not received recommendation of clinical pharmacy in the periodMay - July 2014 (NR) compared with the group of patients who received therecommendation of clinical pharmacy period from August to October 2014 (R).The results were obtained from 42 patients NR group and 51 patients in the Rgroup. The total direct medical costs in the NR group Rp 427.805.134 , while theR group Rp 349.302.060. Total length of hospital patients in the NR group was268 days, while the R group was 228 days. Average length of stay per patient inthe NR group was 6.4 days, while R group was 4.5 days. Percentage of effectivityfrom the NR group was 15,36%, while the group R was 22,22 %. ACER in NRgroup is Rp 1.591.537 per length of stay, whereas the R group is Rp 1.522.013per length of stay. The results of the sensitivity analysis is dominant because thecosts was less , while its effectiveness is greater. Thus, it can be concluded thatparticipation in the clinical pharm"

"ABSTRAKLatar belakangRestricted antibiotics adalah golongan antibiotik spektrum luas yang termasuk dalam kategori lini 3 kebijakan dan pedoman penggunaan antibiotik PPRA. Restricted antibiotics digunakan secara global terkait dengan banyaknya kejadian resistensi bakteri. Penggunaan restricted antibiotic yang tidak tepat dapat menimbulkan masalah resistensi hingga superinfeksi yang lebih besar, peningkatan mortalitas dan biaya pengobatan. Restriksi pemberian antibiotik ini didasarkan pada risiko resistensi yang lebih besar yang dapat ditimbulkannya, toksisitas dan pertimbangan farmakoekonomik.TujuanUntuk mengevaluasi penggunaan restricted antibiotic di IGD RSCM.MetodePenelitian dilakukan secara kohort prospektif, deskriptif dengan mengambil data pasien usia > 18 tahun yang mendapatkan restricted antibiotic di IGD RSCM selama periode 29 Juli-31 September 2015. Kuantitas penggunaan restricted antibiotic dievaluasi dengan metode ATC/DDD WHO (DDD/100 bed-days) dan kualitas penggunaan restricted antibiotic dievaluasi dengan metode Gyssen. Biaya penggunaan restricted antibiotic dihitung berdasarkan ketetapan biaya oleh RSCM. Penelitian ini juga melihat gambaran dan kesesuaian hasil kultur kuman dengan terapi yang diberikan serta menilai outcome klinik pasien yang mendapatkan restricted antibiotic di IGD RSCM.Hasil penelitianHasil penelitian menunjukkan kuantitas penggunaan restricted antibiotic mencapai 78,3 DDD/100 bed-days dengan penggunaan terbanyak adalah meropenem dan sefepim. Sebanyak 86,7% restricted antibiotic diberikan secara empirik. Hasil pemeriksaan kultur kuman dan uji kepekaan kuman menunjukkan Acinetobacter baumannii dan Pseudomonas aeruginosa merupakan isolat kuman yang menunjukkan resistensi terhadap beberapa restricted antibiotic. Berdasarkan kriteria Gyssen, penggunaan restricted antibiotic termasuk kategori tepat sebesar 45,7%. Biaya terbesar penggunaan restricted antibiotic terdapat pada meropenem dan sefepim. Sebanyak 34 pasien meninggal selama perawatan dengan hasil kultur yang tidak sesuai dengan restricted antibiotic yang digunakan.KesimpulanKuantitas penggunaan dan prevalensi ketidaktepatan penggunaan restricted antibiotic secara umum cukup tinggi di IGD RSCM. Beberapa bakteri menunjukkan resistensi terhadap beberapa restricted antibiotic.

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ABSTRACT

Background

Restricted antibiotics have been used globally due to high prevalence of bacterial resistance. The inappropriate use of restricted antibiotic contributes significantly to the increase of antimicrobial resistance with many consequence such as risk of toxicity, increase of mortality and cost of treatment. Restriction of these antibiotics based on risk of resistance, toxicity and pharmacoeconomics considerations.

Objective

To evaluate the use of restricted antibiotic in adult patients in emergency unit of Cipto Mangunkusumo hospital.

Methods

We performed descriptive, cohort prospective study of adult patients those admitted to the emergency unit of Cipto Mangunkusumo hospital. We reviewed the medical record and electronic health record every day. Subject were patients aged more than 18 years old who received restricted antibiotic from July 29 to September 31, 2015 and all patients were followed up every day until they discharged from hospital. The use of restricted antibiotics were quantitavely evaluated using the ATC/DDD system (DDD/100 bed-days) and qualitatively analyzed using the Gyssen method. All the cost of restricted antibiotic use were calculated using standard price in Cipto Mangunkusumo hospital. This study also assess the clinical outcome and the pattern of sensitivity test of patient those received restricted antibiotic in emergency unit of Cipto Mangunkusumo hospital.

Results

The study results showed that the quantity of restricted antibiotic were 78,3 DDD/100 bed-days during July 29 to September 31, 2015 in the emergency unit of Cipto Mangunkusumo hospital. The most frequently used restricted antibiotic were meropenem dan sefepim. Restricted antibiotic used as empiric therapy was 86.7%. The culture and sensitivity test results showed that Acinetobacter baumannii and Pseudomonas aeruginosa were isolate that have resistance to several restricted antibiotics. Only 45.7% restricted antibiotic use were considered to be definitely appropriate based on Gyssen method. Meropenem and cefepim contribute to the higher cost during hospitalization and 34 patients used restricted antibiotic died during treatment have non concurrent of sensitivity to restricted antibiotic used.

Conclusion

The quantity of restricted antibiotic and prevalence of inappropriate restricted antibiotic use in this emergency department of Cipto Mangunkusumo hospital was generally high. Some bacterias have been resistance to several restricted antibiotic."

"Latar belakang : Skor PELOD-2 digunakan untuk mengetahui prognosis disfungsi organ pada anak sakit kritis. Hasil skor PELOD-2 terkadang tidak berbanding lurus dengan luaran perawatan sehingga tidak selalu dapat digunakan sebagai prediktor luaran pasien yang dirawat di PICU. Tujuan : Mengetahui profil dan luaran pasien sakit kritis yang dirawat di PICU RSCM berdasar skor PELOD-2. Metode : Penelitian retrospektif dengan mengambil data rekam medis pasien rawat di PICU RSCM, periode Januari-Desember 2018 secara total sampling. Penilaian skor PELOD-2 pada 24 jam pertama perawatan, komorbid dan luaran subjek dicatat dalam rekam medis. Hasil : Diperoleh 477 subjek yang memenuhi kriteria. Pasien sakit kritis yang dirawat di PICU RSCM sebagian besar berjenis kelamin laki (56,4%) dan berusia <1 tahun (27,9%), dengan bedah sebagai diagnosis terbanyak (65%). Sebagian besar pasien memiliki penyakit kronik (70,4%). Nilai median skor PELOD-2 2 untuk pasien hidup dan median skor 8 untuk pasien meninggal. Angka mortalitas adalah 10,7%. Sebagian besar subjek memiliki lama rawat <7 hari (75,5%). Subjek dengan lama rawat >14 hari memiliki median skor PELOD-2 tiga kali lipat dari subjek dengan lama rawat <7 hari. Subjek meninggal memiliki median skor PELOD-2 empat kali lipat lebih tinggi dari subjek hidup. Adanya luaran mortalitas dan lama rawat subjek yang tidak sesuai dengan skor PELOD-2 kemungkinan dipengaruhi oleh status nutrisi dan status imun. Titik potong mortalitas skor PELOD-2 pada penelitian ini adalah >5, dan titik potong mortalitas skor PELOD-2 pasien sepsis >7. Simpulan : Skor PELOD-2 dapat digunakan untuk memprediksi prognosis disfungsi organ yang mengancam kehidupan pada anak tanpa imunosupresi, semakin tinggi skor PELOD-2 akan diikuti peningkatan lama rawat dan mortalitas.

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Background: PELOD-2 score is stated can be used to discover prognosis of organ dysfunction in critically ill child. Sometimes PELOD-2 score does not always directly proportional to critically ill child s outcome, therefore sometimes can not be used as outcome and mortality predictor. Objective: To describe critically ill patient s profile and outcome of based on PELOD-2 score. Methods: This descriptive study was retrospective, conducted from January to December 2018 in PICU RSCM by total sampling. Evaluation of PELOD-2 score were performed in the first 24 hours. Subjects comorbid and outcome were stated in medical record. Results: There were 477 subjects that fulfilled the criteria. Most of the subjects were boys (56,4%) and under 1 year of age (27,9%) with surgical were the most common diagnosis (65%). Most of the subject have chronic illness as comorbid (70,4%). Median of PELOD-2 score were 2 for subjects that lived and 8 for subjects that died. Mortality rate is 10,7%. Most of the subjects were stayed in PICU for < 7 days (75,5%). Subjects with length of stay >14 days had median PELOD-2 score 3 times higher than the subjects with length of stay <7 days. Died subjects had median PELOD-2 score 4 times higher than the subjects that lived. The subjects mortality and length of stay that not in accordance with the PELOD-2 score may be influenced by subjects nutritional and immunity status. Mortality cut off point for PELOD-2 score in this study is >5. Mortality cut off point for PELOD-2 for subjects with sepsis is >7 Conclusion: PELOD-2 score is feasible to be used to predict life threatening organ dysfunction in critically ill children without immunosuppression, the higher the PELOD-2 score is equal to higher mortality and longer length of stay."

"Biaya pelayanan kesehatan khususnya rumah sakit sekitar 70% sampai 75 % terdiri dari biaya obat, pesonil dan biaya investasi alat kedokteran canggih. Penggunaan alat kedokteran canggih dalam pelayanan kesebatan akan membawa konsekuensi pada peningkatan biaya pelayanan kesehatan sehingga akan meningkatkan tarif pelayanan kesehatan. Cholecystolithiasis adalah penyakit batu kandung empedu yang banyak menyerang orang yang berumur di ataS 40 tahun. Di RSUPN dr. Cipto Mangunkusumo ada dua metode yang dilakukan pada penata laksanaan Cholecystolithiasis yaitu dengan open cholecystectomy (konvensional) dan dengan laparasacopic cholecystectomy (minimal invasif) menggunakan alat kedokteran canggih, dimana tarif tindakan open cholecystectomy lebih murah di bandingkan dengan tindakan loparascopic cholecystectomy. Penelitian ini merupakan evaluasi ekonomi yang bertujuan untuk memperoleh informasi tentang metode mana yang paling cost effective dan efisien dalam penata laksanaan cholecystolithiasis antara metode open cholecystectomy (open chole) dengan metode loparascopic cholecystectomy (lap chole) dengan menggunakan biaya per DRG's. Jenis penelitian ini adalah descriptive-comparative menggunakan metode studi kasus dengan pendekatan kombinasi kuantitatif dan kualitatif yang dilaksanakan di RSUPN dr. Cipto Mangunkusumo (RSCM) dan dari bulan April sampai JUni 2008, menggunakan data sekunder dan Unit Rekam medik pasien rawat inap dengan diagnosa utama cholecystolithiasis dari bulan Januari-Desembec 2007, keuangan, asset untuk mendapatkan data biaya, serta data primer dari wawancara dengan dokter, paramedis dan petugas yang terlibat da1am penata laksanaan cholecystolithiasis. Unit cost dihitung berdasarkan direct cost dengan activity Based Costing (ABC) dan indirect cost dengan simple distribution. Pengelompokan penata laksanaan cholecystolithiasis dengan open chole di RSCM, yaitu 1) Open choIe murni, 2) Open chole dengan penyulit, 3) Open chole dengan penyerta dan penyulit. Pengelompokan penata laksanaan cholecystolilhiasis dengan lap coole di RSCM, yaitu: 1) Lap coole murni, 2) Lap coole dengan penyerta, 3) Lap chole dengan penyulit, 4) Lap chole dengan penyerta dan penyulit.Clinical pathwary penata laksanaan chOlecystolithiasis dengan open chole dan lap chole yang di dapatkan terdiri ataS tujuh (7) tahap, yaitu: pendaftaran, penetapan diagnosa, admission rawat inap (P3RN), pra operasi, operas, post operasi, dan pulang. Cost of treatment penata laksana Cholecystolithiasis dengan open chole di RSCM tahun 2007, yaitu : Open chole murni dengan rata-rata lama hari rawat 8 hari, biaya Rp.6.454.003, open chole dengan penyulit rata-rata lama hari rawat 11 hari, biaya Rp.8.863.527, open chole dengan penyerta dan penyulit rata-rata lama hari rawat 23 hari, biaya Rp.17.060.543. Cost of treatment penata laksanaan cholecystolithiasis dengan lap chole di RSCM tahun 2007, yaitu; lap chole murni dengan lama hari rawat 6 bali, biaya Rp.7.278.891, lap chole dengan penyerta rata-rata lama hari rawat 13 bali, biaya Rp. 13.004.740, lap chole dengan penyulit rata-rata lama hari rawat 10 hari, biaya Rp.9.246.148, lap chole dengan penyerta dan penyulit rata-rata lama hari rawat 19 hari, biaya Rp.l5.9S0.l93. Effektifitas output cakupan untUk open chole murni 1 orang, open choIe dengan penyulit 2 orang, open chole dengan penyerta dan penyulit 1 orang. Untuk lap chole murni 28 orang, lap ckole dengan penyerta 13 orang, lap chole dengan penyulit 6 orang dan lap choIe dengan penyerta dan penyulit 4 orang. Rata-rata waktu operasi dan rata-rata hari kesembuhan untuk open chole murni 100 menit dan 3 hari, open chole dengan penyulit 110 menit dan 6 hari, open chole dengan penyerta dan penyulit 135 menit dan 7 hari. Rata-rata waktu operasi dan rata-rata hari kesembuhan untuk lap chole murni 92,86 menit dan 2 hari, lap chole dengan penyulit 105 menit dan 5 hari, lap chole dengan penyerta dan penyulit 118,75 menit dan 5 hari. Cost effectiveness analysis dan kedua metode secara keseluruhan didapatkan biaya per pasien dalam setiap episode perawatan lebih mahal pada metode lap chole dibandingkan dengan open chole, dari effektivitas/output didapatkan rata-rata waktu operasi dan rata-rata hari kesembuhan lebih cepat pada metode lap chole dibandingkan dengan metode open chole, sehingga dapat disimpulkan bahwa metode lap chole lebih cost effective dibandingkan dengan metode open chle pada penata laksanaan Cholecystolithiasis. Perlu dibuat clinical pathway dan perhitungan biaya perawatan pasien di rumah sakit secara nasional berdasarkan DRG"s untuk setiap penyakit, dan perlu dilakukan penelitian evaluasi ekonomi leblh lanjut terhadap alat kedokteran canggih lainnya.

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Health care cost, specially in hospital is about 70 to 75 percent consisted of medicines. staff and modern medical equipment investation costs. Utilization of modern medical equipment in health care will take a consequence to increased health care cost, thus will result in increased health care charge. Cholecystholithiasis is a disease of gallstones formation, commonly occure over 40 ages. There are two types of Cholcystolithiasis management at dr. Cipto Mangunkusumo Hospital, open cholecystectomy (conventional) and laparoscopic cholecystectomy (minimal invasive) using modern medical equipment, and open cholecystectomy cost is lower compared to laparoscopic cholecystectomy.

This research was economic evaluation aimed to examine the most cost effective and efficient in cholcystolithiasis management between open cholecystectomy method (open chole) and laparoscopic cholecystectomy method (lap chole) using per DRG's cost.

The research design was descriptive-comparative using case study method with quantitative and qualitative combination approach, conducted at dr. Cipto Mangukusumo Hospital from April to June 2008. Data used were secondary data obtained from Inpatient Medical Record Unit from January to December 2007 with primary diagnosis of Cholecystolithiasis, financial, asset to obtain cost data, and primary data from interview with medical, paramedic and staff related to Cholcystolithiasis management. Unit cost was calculated by direct cost with Activity Base Costing (ABC) and indirect cost by simple distribution.

Grouping of cholcystolithiasis management with open chole at dr. Cipto Mangukusumo Hospital are 1) Pure open chole, 2) Open chole with complication, 3) Open chole with commorbidity and complication. Grouping of cholcystolithiasis management with lap chole are 1) Pure lap chole, 2) Lap cho1e with commorbidity, 3) Lap chofe with complication, 4) Lap chofe with commorbidity and complication.

Clinical Pathway of Cholcystolithiasis management with open chole and lap chole consisted of 7 steps, registration, diagnosis, admission (P3RN), pre operative, operative, post operative and discharge.

Cost of treatment of chofcystolithiasis management with open chofe at dr. Cipto Mangukusumo Hospital in 2007 were pure open chole with length of stay 8 day, the cost was Rp. 6.454.003, open chole with complication with length of stay 11 days, the cost was Rp. 8.863.527, Open chole with commorbidity and complication with length of stay 23 days, the cost was Rp. 17.060.543.

Cost of treatment of cholcystolithiasis management with lap chole at dr. Cipto Mangukusumo Hospital in 2001 were for pure lap chole with length of stay 6 days, the cost was Rp. 7.278.891, lap chole with commorbidity with length of stay 13 days, the cost was Rp. 13.004.740, lap chole with complication with length of stay 10 days, the cost was Rp. 9.245.148, lap chale with commorbidity and complication with length of stay 19 days, the cost was Rp. 15.950.193.

Coverage effectiveness or output for pure open chole was 1 patient, open chole with complication 2 patients, open chole with commorbidity and complication 1 patient. For pure lap chole was 28 patients, lap chole with cemmorbidity 13 patients, lap chole with complication 6 patients and lap chole with commotbidity and compacation 4 patients. Operation prosedure time mean and recovery day mean for pure open chole were 100 minutes and 3 days respectively. Open chole with complication were 110 minutes 6 days respectively, open chole with commorbidity and complication were 135 minutes and 7 days respectively. Opetation procedure time mean and recovery day mean for pure lap chole were 92,86 minutes and 2 day respectively, lap chole with complication were 1O5 minutes 5 days respectively, lap chole with commorbidity and complication were 118,7 minutes and 5 days respectively.

Total cost effectiveness analysis from both methods showed that cost per patient in evety management episode for lap chole was higher compared to open chole, and from effectiveness or output, it is showed that operation prosedur time and recovery day mean of lap chole was shorter compared to open chole. It is concluded that lap chole was more cost effective than open chole method in cholcystolithiasis management. It is suggested to built national clinical pathway and patient charge calculation in hospital based on DRG's for every disease, and it is neaded to conduct future economic evaluation study in other modern medical equipments."

"Introduction : the practice of clinical pharmacy -- Communication skills for the pharmacist -- Taking medication histories -- Physical assessment skills -- Review of laboratory and diagnostic tests -- The patient case presentation -- Therapeutics planning -- Monitoring drug therapies -- Researching and providing drug information -- Ethics in pharmacy and health care."

"Latar Belakang. Sejak laporan pertama ensefalitis antireseptor N-methyl-D-aspartate (NMDA) pada 2007, prevalensi ensefalitis autoimun (EA) serupa dengan ensefalitis infeksi (EI). Sayangnya, heterogenitas klinis EA, serupanya klinis dengan EI, penyakit autoimun seperti neuropsikiatrik lupus eritematosus sistemik, atau penyakit psikiatrik menjadi tantangan deteksi awal dan tatalaksana EA. Keterlambatan berhubungan dengan perburukan luaran, sedangkan kekurang-tepatan menerapi EI sebagai EA dapat mengeksaserbasi infeksi. Studi ini bertujuan mengenali karakteristik EA, khususnya ensefalitis antireseptor NMDA definit sebagai EA tersering, di era keterbatasan ketersediaan penunjang definitif di Indonesia.Metode. Studi kohort retrospektif dengan rekam medis di RSUPN dr. Cipto Mangunkusumo dilakukan pada curiga EA yang menjalani pemeriksaan antireseptor NMDA cairan otak sejak Januari 2015-November 2022. Karakteristik klinis dan penunjang EA, EA seropositif NMDA, dan luarannya dinilai. Analisis univariat dan bivariat dilakukan sesuai kebutuhan.Hasil. Dari 102 subjek yang melalui kriteria inklusi dan eksklusi, terdapat 14 EA seropositif dan 32 seronegatif NMDA. Temuan klinis EA terbanyak adalah gangguan psikiatri dan tidur (85,7%), gangguan kesadaran (78,3%), prodromal (76,1%), dan bangkitan (70,6%). Karakteristik penunjang EA adalah inflamasi sistemik (75,0%), inflamasi cairan otak (69,2%), abnormalitas MRI (57,9%) dominan inflamasi (42,2%), dan abnormalitas EEG (89,5%). Karakteristik klinis EA seropositif NMDA adalah psikosis (76,9% vs 24,1%, p=0,002), delirium (71,4% vs 40,6%, p=0,06), bangkitan (71,4% vs 46,7%, p=0,12), takikardia (55,6% vs 17,6%, p=0,08), dan gangguan otonom lainnya (55,6% vs 23,5%, p=0,19), sedangkan klinis EA seronegatif NMDA adalah somnolen (34,4% vs 7,1%, p=0,07) dan defisit neurologis fokal (31,3% vs 7,1%, p=0,13). Leukositosis dan pleositosis cairan otak dengan dominasi mononuklear secara signifikan lebih ditemukan pada EA seropositif NMDA. Sebanyak 10,9% subjek meninggal.Kesimpulan. Karakteristik klinis EA adalah gangguan psikiatri dan tidur, gangguan kesadaran, prodromal, dan bangkitan. Psikosis, delirium, bangkitan, dan disfungsi otonom cenderung lebih ditemukan pada EA seropositif NMDA. Inflamasi sistemik, cairan otak, MRI, dan abnormalitas EEG sering ditemukan pada EA, terutama seropositif NMDA. 

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Background. Since the first report of N-methyl-D-aspartate receptor (NMDAR) encephalitis in 2007, the prevalence of autoimmune encephalitis (AE) was similar to infectious encephalitis (IE). Unfortunately, heterogenities of EA as well as similarities in the manifestation to IE, other autoimmune diseases including neuropsychiatric systemic lupus erythematosus, or psychiatric diseases compromised the early detection and management of EA. This delay correlated with worse outcome whereas the inaccuracy in treting IE as AE may exacerbate infection. This study aimed to describe the characteristics of EA, particularly definitive NMDAR encephalitis as the most common, in the era of limited availability of definitive ancillary test in Indonesia.

Methods. Retrospective study using medical records at Dr. Cipto Mangunkusumo National Center General Hospital was conducted for suspected EA cases tested for cerebrospinal fluid NMDAR autoantibody test from January 2015 to November 2022. Clinical, ancillary characteristics, and concordance between clinical diagnosis and diagnostic criteria were assessed. Univariate, bivariate, and multivariate analysis were perfomed as needed.

Result. Of 102 subjects following inclusion and exclusion criteria, there were 14 seropositive and 32 seronegative NMDA subject. Clinical characterstics of AE were psychiatric and sleep disorder (85,7%), altered consciousness (78.3%), prodromal (76.1%), and seizure (70.6%). Ancillary characteristics of AE were systemic inflammation (75.0%), cerebrospinal fluid inflammation (69.2%), MRI abnormalities (57.9%) with inflammatory predominance (42.2%), and EEG abnormalities (89.5%). Seropositive NMDA characteristics were psychosis (76.9% vs 24.1%, p=0.002), delirium (71.4% vs 40.6%, p=0.06), seizure (71.4% vs 46.7%, p=0.12), tachycardia 955.6% vs 17.6%, p=-0.08), and other autonomic disorder (55.6% vs 23.5% p=0.19) whereas seronegative NMDA characteristics were somnolence (34.4% vs 7.1%, p=0.07) and focal neurologic deficit (31.3% vs 7.1%, p=0.13). Leukocytosis and cerebrospinal fluid pleocytosis with mononuclear predominance were significantly found in seropositive NMDA AE. The mortality rate was 10.9%.

Conclusion. Clinical characteristics of AE were psychiatric and sleep disorder, altered consciousness, prodromal, and seizure. Psychosis, delirium, seizure, and autonomic dysfunction tended to be found in seropositive NMDA AE. Inflammation in systemic, cerebrospinal fluid, and MRI findings as well as EEG abnormalities commonly occurred in AE, especially seropositive NMDA."

"Latar belakang: Transfusi rutin merupakan terapi utama bagi pasien thalassemia mayor, namun transfusi berulang diikuti masalah baru yaitu beban kelebihan besi yang terakumulasi dalam jaringan. Pemberian terapi kelasi besi adalah satu-satunya cara untuk mempertahankan keseimbangan besi dalam tubuh.Tujuan: Studi ini bertujuan untuka mengetahui hubungan efektivitas terapi, efek samping obat dan biaya antara kelasi besi regimen kombinasi (DFO+DFP dan DFP+DFX) dengan monoterapi DFP dosis ≥ 90 mg/kgbb/hari. Metode: Penelitian ini merupakan penelitian retrospektif observasional dengan desain potong lintang, untuk menganalisis hubungan efektivitas terapi, efek samping obat dan biaya antara kelasi besi regimen kombinasi (DFO+DFP dan DFP+DFX) dengan monoterapi DFP dosis ≥ 90 mg/kgbb/hari. Luaran efektivitas dinilai dengan penurunan serum feritin ≥ 500 ng/mL.Hasil: Setelah 6 atau 12 bulan terjadi penurunan serum feritin pada 16 (34,7%) subyek kelompok kombinasi, dan 22 (27,5%) subyek kelompok monoterapi (p = 0,391). Sembilan (19,5%) subyek kombinasi mengalami efek samping obat, dan 17 (21,2%) subjek pada kelompok monoterapi (p = 0,822). Analisis minimalisisasi biaya menunjukkan bahwa rerata biaya per pasien thalassemia-β mayor anak yang menggunakan rejimen monoterapi selama 6 dan 12 bulan lebih murah Rp 13.556.592,64 (30,46%) dan Rp 20.162.836,10 (25,56%) dari rejimen kombinasi.Kesimpulan: Rejimen kombinasi sama efektifnya dengan rejimen monoterapi dalam menurunkan serum feritin. Tidak ada perbedaan efek samping obat yang bermakna diantara keduanya.

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Background: Blood transfusion is the main therapy for thalassemia major patients, but repeated transfusions are followed by new problems namely the excess iron load accumulated in the body tissue. Iron chelation therapy is the only way to maintain iron balance in the body.

Aim: This study aimed to determine the efficacy, safety , and cost analysis of of combination iron chelation regimen with mono-therapy.

Method:This study was designed as a retrospective observational study with a cross-sectional design, to analyze the relationship between therapeutic effectiveness, drug side effects and the cost of combination iron chelation regimen (DFO+DFP and DFP+DFX) and DFP mono-therapy dose ≥ 90 mg/kg/day. Outcome effectiveness was assessed by decreasing serum ferritin ≥ 500 ng/mL.

Result: After 6 or 12 months there was serum ferritin decreased in 16 (34,7%) subjects in combination group and 22 (27,5%) subjects in mono-therapy group (p = 0,391). Nine (19,5%) subjects in combination group experienced adverse effect, and 17 (21,2%) subjects in the mono-therapy group (p = 0,822). Analysis cost of minimization shows that the average cost per major thalassemia-β patient for children using a mono-therapy regimen for 6 and 12 months is cheaper Rp 13.556.592,64 (30,46%) and Rp 20.162.836,10 (25,56%) compared to combination regimen.

Conclusion: Combination regimens are as effective as a mono therapy regimens in decreasing serum ferritin. There were no significant differences in adverse effect between the two."