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"Latar Belakang: Seiiring dengan bertambahnya jumlah pasien diabetes melitus tipe 2 maka angka kejadian nefropati diabetik juga ikut meningkat. Berbagai faktor telah diidentifikasi turut memperberat kejadian nefropati diabetik salah satunya status vitamin D 25(OH)D. Vitamin D memiliki efek non-kalsemik yang dapat memengaruhi sistem renin-angiotensin sehingga turut berperan dalam kejadian albuminuria. Studi sebelumnya menunjukan tingginya prevalensi defisiensi vitamin D 25(OH)D pada pasien diabetes melitus tipe 2 dan defisiensi vitamin D diduga berhubungan dengan kejadian albuminuria. Tujuan: Mengetahui asosiasi antara status vitamin D 25(OH)D dengan albuminuria pada pasien diabetes melitus tipe 2 di Indonesia. Metodologi: Dilakukan studi potong lintang pada 96 pasien diabetes melitus tipe 2 yang berobat ke poliklinik Metabolik-Endokrin RSUPN-CM. Pemeriksaan kadar vitamin D 25(OH)D menggunakan kit Diasorin dengan metode CLIA dan albuminuria dinilai berdasarkan kadar albumin pada sampel urine sewaktu. Analisis bivariat menggunakan metode chi square dan analisis multivariat menggunakan teknik regresi logistik. Hasil: Prevalensi defisiensi vitamin D 25(OH)D pada pasien diabetes melitus tipe 2 sebesar 49% dengan nilai median kadar vitamin D 25(OH)D pada pasien diabetes melitus tipe 2 adalah 16,35 ng/mL (4,2-41,4 ng/mL). Tidak didapatkan adanya hubungan yang bermakna antara defisiensi vitamin D dengan albuminuria baik pada analisa bivariat maupun multivariat (OR 0,887;IK95% 0,335-2,296). Faktor perancu seperti kontrol gula darah yang buruk dan berat badan lebih sangat mempengaruhi hubungan antara defisiensi vitamin D dengan kejadian albuminuria pada pasien diabetes melitus tipe 2. Simpulan: Studi ini belum dapat menyimpulkan adanya hubungan antara defisiensi vitamin D 25(OH)D dengan albuminuria pada pasien diabetes melitus tipe 2 di Indonesia.

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Background: In line with the increasing number of patients with diabetes mellitus type 2, the incidence of diabetic nephropathy is also increased. Various factors aggravating diabetic nephropathy have been identified, among others vitamin D 25(OH)D level. Vitamin D has a non-calcemic effect on renin-angiotensin system, causing albuminuria. Previous studies showed a high prevalence of vitamin D deficiency in patients with type 2 diabetes mellitus and it was related to the incidence of albuminuria.

Aim: To know the association between vitamin D 25(OH)D level with albuminuria in patients with type 2 diabetes mellitus in Indonesia.

Methods: A cross-sectional study was conducted in 96 patients with type 2 diabetes mellitus at outpatient clinic of Metabolic-Endocrine Cipto Mangunkusumo Hospital. Serum vitamin D level was assessed using Diasorin kit with CLIA method. Albuminuria was assessed using random urine sample. For bivariate analysis using chi square and multivariate analysis using regression logistic method.

Results: The prevalence of vitamin D 25(OH)D deficiency in patients with type 2 diabetes mellitus was 49% with a median value 16,35 ng / mL (4,2 - 41,4 ng /mL). There was no significant correlation between vitamin D deficiency with the severity of albuminuria (OR 0,887; 95% CI 0,335 to 2,296). Confounding factors such as poor blood glucose control and overweight strongly influenced the association between vitamin D deficiency with the incidence of albuminuria in patients with type 2 diabetes mellitus.

Conclusion: The results of this study have not been able to show an association between vitamin D deficiency with the severity of albuminuria in patients with type 2 diabetes mellitus in Indonesia."

"ABSTRAKLatar Belakang:Kandidemia merupakan infeksi aliran darah dengan morbiditas dan mortalitas yang tinggi. Gambaran klinis kandidemia sulit dibedakan dengan pasien sepsis sehingga sering terlambat didiagnosis. Kultur darah sebagai baku emas diagnostik kandidemia memiliki beberapa keterbatasan, sedangkan prediktor yang ada saat ini sulit diaplikasikan dalam praktik klinis sehari-hari. Telah ada penelitian tentang faktor risiko kandidemia di luar negeri dan Indonesia, tetapi belum ada yang membahas khusus pada pasien sepsis dewasa non neutropenia.Tujuan:Mengetahui faktor risiko kandidemia pada pasien sepsis non neutropenia.Metode:Desain kasus kontrol dengan mengambil data rekam medik pasien sepsis sejak Januari 2011 sampai Juli 2015 di Rumah Sakit Cipto Mangunkusumo. Penilaian faktor risiko dilakukan dengan metode Chi-square dan dilanjutkan dengan analisis regresi logistik multivariat dengan mengikutsertakan variabel perancu.Hasil:Dari 51 kasus dan 153 kontrol didapatkan faktor risiko yang berhubungan dengan kejadian kandidemia adalah kateter urin [adjusted OR=5,239 (IK 95% 2,141 ? 12,819), p<0,001], nutrisi parenteral [adjusted OR=2,583 (IK 95% 1,297 ? 5,144), p=0,007], kortikosteroid [adjusted OR=2,183 (IK 95% 1,002 ? 4,755), p=0,049], dan antibiotik spektrum luas [adjusted OR=4,047 (IK 95% 1,178 ? 13,904), p=0,026].Kesimpulan:Kateter urin, nutrisi parenteral, kortikosteroid, dan antibiotik spektrum luas merupakan faktor risiko penting karena dapat meningkatkan risiko kejadian kandidemia pada pasien sepsis non neutropenia.

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ABSTRACT

Background:

Candidemia is a bloodstream infection with high morbidity and mortality. Clinical manifestations of candidemia resemble with sepsis patients so that diagnosis was delayed. Blood culture as a diagnostic gold standard had some limitations, while the current predictors difficult to apply in daily clinical practice. There were studies about risk factors of candidemia in other countries and Indonesia, but no one had studied specifically in adult non-neutropenic sepsis patients.

Objective:

To identify the risk factors for candidemia in non-neutropenic sepsis patients.

Method:

A case-control study from medical records of septic patients was conducted during the period January 2011 ? July 2015 in Cipto Mangunkusumo Hospital. We analyzed risk factors using Chi-square method followed by multivariate logistic regression adjusted with confounding factors.

Results:

A total 51 cases and 153 controls were analyzed to identify the risk factors of candidemia. After adjustment, candidemia was associated with urinary catheter [adjusted OR=5,239 (95% CI 2,141 ? 12,819), p<0,001], parenteral nutrition [adjusted OR=2,583 (95% CI 1,297 ? 5,144), p=0,007], corticosteroids [adjusted OR=2,183 (95% CI 1,002 ? 4,755), p=0,049], and broad spectrum antibiotics [adjusted OR=4,047 (95% CI 1,178 ? 13,904), p=0,026].

Conclusion:

Urinary catheter, parenteral nutrition, corticosteroids, and broad spectrum antibiotics are important risk factors that can increase the risk of candidemia in non-neutropenic sepsis patients."

"Latar belakang. CAPD merupakan modalitas dialisis yang berkembang di Indonesia. Status nutrisi dianggap sebagai salah satu faktor yang mempengaruhi kesintasan pasien CAPD. Indonesia belum memiliki data mengenai status nutrisi pasien CAPD, serta faktor-faktor yang berkorelasi dengan status nutrisi pada kelompok pasien tersebut. Tujuan. Mengetahui faktor-faktor yang berkorelasi dengan status nutrisi pada pasien CAPD. Metode. Penelitian potong lintang dilaksanakan di poliklinik CAPD RSCM dan RS PGI Cikini bulan Desember 2012 sampai Mei 2013. Status nutrisi dinilai dengan Malnutrition Inflammation Score. Inflamasi didapatkan dari pemeriksaan hsCRP. Asidosis metabolik didapatkan dari pemeriksaan HCO3 vena. Asupan energi dan protein harian didapatkan dari analisis food record dengan menggunakan program FP2. Usia dan lama menjalani CAPD didapatkan dari kartu identitas dan rekam medis. Analisis bivariat dilakukan dengan metode Pearson atau Spearman/Kendall. Analisis tidak dilanjutkan ke analisis multivariat karena distribusi status nutrisi sebagai variabel tergantung tidak normal. Hasil. Dari 44 subjek penelitian, didapatkan 75% subjek penelitian memiliki status nutrisi baik. Rerata usia 48,4+12,6 tahun. Median lama menjalani CAPD adalah 20,5 bulan (2-94 bulan) dan median kadar hsCRP sebesar 2,8 mg/L (0,2-204,2 mg/L). Rerata kadar HCO3 sebesar 25,2+2,3 mEq/L. Rerata asupan energi adalah 37,3+ 9,3 kkal/kg/hari dan rerata asupan protein 1,0+ 0,3 gram/kg/hari. Faktor inflamasi berkorelasi dengan status nutrisi pada pasien CAPD (r=0,433; p=0,003). Simpulan. Faktor yang berkorelasi dengan status nutrisi pada pasien CAPD adalah inflamasi. Korelasi antara usia, lama menjalani CAPD, asupan energi dan protein serta asidosis metabolik dengan status nutrisi belum dapat dibuktikan pada penelitian ini.

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Background. CAPD is a developing dialysis modality in Indonesia. Nutritional status is considered as one of determinant factor in CAPD patients survival. There is no data regarding nutrional status and correlated factors with nutritional status in CAPD patients in Indonesia.

Objectives. To know correlated factors with nutritional status in CAPD patients.

Methods. A cross sectional study was conducted in CAPD clinic at Cipto Mangunkusumo and Cikini Hospital during December 2012 until May 2013. Nutritional status was determined by Malnutrition Inflammation Score, inflammation by hsCRP and metabolic acidosis by vein HCO3. DEI and DPI were determined by food record analysis by using FP2 program. Age and dialysis vintage were based on identity card and medical record. Statistical analysis was performed by using Pearson or Spearman/Kendall methods. Multivariat analysis can't be done in this study because of the distribution abnormality of nutritional status as independent variable.

Results. Out of 44 subjects, the nutritional status of 75% subjects was found good. Mean age was 48.4+12.6 years old. Dialysis vintage median was 20.5 (2-94) months and hsCRP level median was 2.8 (0.2-204.2) mg/L. Mean HCO3 level was 25.2+2.3 mEq/L. Mean DEI was 37.3+9.3 kcal/kg/d and mean DPI was 1.0+0.3g/kg/d. Inflammation is correlated with nutritional status in CAPD patients (r=0.433 ; p=0.003).

Conclusion. Factors that correlated with nutritional status in CAPD patients is inflammation. Correlation between age, dialysis vintage, DEI, DPI and metabolic acidosis with nutritional status can not be determined yet in this study."

"Latar Belakang: Penyakit Paru Obstruktif Kronik (PPOK) berkontribusi terhadap masalah kesehatan yang bermakna selama penyelenggaraan haji. Kementerian Kesehatan RI mendokumentasikan PPOK sebagai penyebab ketiga terbesar perawatan jemaah haji yaitu sebesar 7,2% pada tahun 2010. Identifikasi individu yang berisiko lebih tinggi untuk mengalami eksaserbasi akut PPOK selama pelaksanaan haji menjadi penting. Oleh karenanya, penggunaan skor CAT dalam memprediksi risiko eksaserbasi akut pada populasi khusus ini perlu diteliti lebih lanjut. Tujuan: Mengevaluasi skor CAT sebagai prediktor kejadian eksaserbasi akut pada jemaah haji dengan PPOK. Metode: Penelitian kohort prospektif ini dilakukan pada jemaah haji Embarkasi Provinsi DKI Jakarta tahun 2012. Sebelum keberangkatan, subyek diminta mengisi CAT dan diberikan kartu pencatatan harian untuk mencatat gejala eksaserbasi akut selama pelaksanaan haji. Kartu serupa juga diberikan pada dokter kelompok terbang (kloter) mereka. Saat kedatangan di tempat disembarkasi, subyek diwawancarai dan dilakukan pemeriksaan kesehatan serta pengumpulan kartu pencatatan harian dari pasien maupun dokter kloter. Eksaserbasi akut ditentukan dari kartu pencatatan harian dan buku kesehatan haji yang dibawa oleh tiap jemaah. Hasil: Sebanyak 61 pasien PPOK direkrut dengan subyek laki-laki sejumlah 57 orang (93,4%) dan rerata usia 58,8±8,5 tahun. Eksaserbasi akut terjadi pada 35 pasien (57,4%). Skor CAT berkisar antara 0–25 dengan rerata 8,2±5,5. Persentase kelompok kategori CAT rendah (skor<10) sebesar 63,9% sementara 36,1% memiliki kategori CAT sedang-berat (skor CAT 10-30). Didapatkan Risiko Relatif sebesar 1,33 (IK95% 0,875–2,020), Nilai Duga Positif: 0,68 (IK95% 0,47–0,84), dan AUC 0,773 (IK95% 0,647-0,898). Median skor CAT 9 (nilai minimum 1; maksimum 25) untuk kelompok eksaserbasi akut dan median 4 (nilai minimum 0; maksimum 17) untuk kelompok tidak eksaserbasi akut yang bermakna secara statistik (p<0.0001, Uji Mann-Whitney). Simpulan: Terdapat peningkatan kejadian eksaserbasi akut pada jemaah haji dengan CAT kategori sedang-berat dibandingkan kelompok CAT kategori ringan namun belum terlihat perbedaan risiko yang bermakna pada penelitian ini dan skor CAT memiliki kemampuan untuk memprediksi terjadinya eksaserbasi akut.

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Background: COPD contributes to significant health problems during pilgrimage for moslems. Indonesian Ministry of Health COPD as the third leading causes of hospitalization pilgrims with percentage of 7.2% in 2010. Identifying individuals with higher risk to have acute exacerbation during the pilgrimage is essential. Therefore, the use of CAT scores in predicting the risk of acute exacerbation in this special population merits further investigation.

Objective: To evaluate CAT score as predictor of acute exacerbation event in pilgrims with COPD.

Methods: This propective cohort study was conducted to pilgrims from DKI Jakarta Province in 2012. Prior to departure, subjects were asked to complete CAT and given diary card to record any symptoms of exacerbation during pilgrimage. Similar observation card were also given to their pilgrims groups’ doctors. On arrival at disembarkation point, subjects underwent interview and health examination while diary cards were collected from both patients and their doctors. Acute exacerbation were determined from the diary cards and individual health record book carried by every pilgrim.

Results: Sixty one COPD patients were recruited comprising 57 male subjects (93.4%) and mean age for this study is 58.8 ± 8.5 years. Acute exacerbation occurred in 35 patients (57.4%). CAT scores range from 0–25 with a mean of 8.2±5.5. Percentage of low CAT category group (score <10) was 63.9% while the 36.1% of subjects were in medium to high CAT category group (score 10-30). Relative Risk for acute exacerbation was 1.33 (95% CI 0.875 – 2.020), Positive Predivetive Value: 0.68 (95%CI 0.47–0.84), and AUC 0.773 (95% CI 0.647-0.898) and median CAT scores were 9 (minimum value 1; maximum 25) for acute exacerbation group and 4 (minimum value 0; maximum 17) for and non acute exacerbation group which was statistically significant (p<0.0001, Mann-Whitney U test).

Conclusion: An increasead numbers of acute exacerbation was observed in moderate-severe category CAT score compared to those in mild category nevertheless a significant risk difference was not demonstrated in this study and CAT score has the ability to predict acute exacerbation."

"[ABSTRAKLatar Belakang : Pemberian kotrimoksazol diberikan sebagai standar pencegahan primer terhadap infeksi toksoplasmosis dan pneumonia Pneumocystis jirovecii (PCP) pada pasien HIV dengan CD4 kurang dari 200 sel/mm3 dan pasien tuberkulosis. Beberapa penelitian di luar negeri mendapatkan bahwa pemberian profilaksis kotrimoksazol belum sesuai dengan panduan nasional, sehingga perlu dilakukan penelitian untuk menilai kepatuhan dokter dalam meresepkan profilaksis primer kotrimoksazol.Tujuan : mengetahui pola peresepan dokter terutama dalam memulai, menghentikan, dosis obat, efek samping, durasi pemberian dan persentase lama pemberian profilaksis primer kotrimoksazol pada pasien HIVMetode : Studi ini merupakan studi kohort retrospektif dan mengambil data semua pasien HIV usia lebih dari 18 tahun yang berobat ke UPT HIV RSCM tahun 2004-2013 dan memenuhi kriteria pemberian profilaksis primer kotrimoksazol. Variabel yang diteliti adalah pola inisiasi peresepan, penghentian peresepan, dosis, durasi, persentase lama pemberian, serta ada tidaknya efek samping kotrimoksazolHasil : Sejumlah 3818 pasien mempunyai indikasi pemberian kotrimoksazol dengan nilai tengah usia pasien adalah 29 tahun, pria (79,1%), tuberkulosis (58,5%), stadium 3 dan 4 (86%). Nilai tengah CD4 saat awal adalah 51 sel/mm3 (RIK 101). Profilaksis primer kotrimoksazol sudah dimulai pada 83% pasien. Pemberian dosis kotrimoksazol sudah sesuai pedoman pada 99,8% pasien. Efek samping yang dari yang paling sering sampai yang jarang terjadi adalah peningkatan transaminase (38,1%), leukopenia (16,9%), anemia (16,5%), mual (15,4%), muntah (7,8%), trombositopenia (7,4%) dan alergi (5,3%). Efek samping yang menyebabkan penghentian peresepan adalah alergi (100%), anemia (2,4%), peningkatan transaminase (2,1%), muntah (0,8%) dan leukopenia (0,6%). Pola penghentian peresepan tidak sesuai pedoman pada 61,6% dengan nilai tengah persentase lama pemberian 87,5% (RIK 39) dan nilai tengah durasi pemberian profilaksis primer kotrimoksazol adalah 20 bulan (RIK 20). Durasi pada pasien dengan CD4≤100 sel/mm3 dan >100 sel/mm3 adalah 21 bulan (RIK 22) dan 12,5 bulan (RIK 14,75) dengan nilai p=0,000.Kesimpulan : walaupun pada saat awal 83% pasien HIV dewasa dilakukan pemberian profilaksis primer kotrimoksazol dengan pengaturan dosis yang sangat baik, namun 61,6% penghentian peresepan tidak sesuai pedoman.

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ABSTRACTBack Ground : Cotrimoxazole was standard of primary prevention against toxoplasmosis infection and Pneumocystis jirovecii pneumonia (PCP) in patients with CD4 less than 200 cell/mm3 and tuberculosis. Some study found that prophylactic use cotrimoxazole in patients with HIV was inappropriate with national guideline. It was necessary to have research in order to know clinician adherence to prescribe primary cotrimoxazole prophylaxis.Objective : to know initiation, discontinuation, dosage, adverse events, duration and duration percentage of primary cotrimoxazole prophylaxis in HIV patientsMethods : This was cohort retrospective study and was done in UPT HIV RSCM and subject of study were all patients more than 18 years old from 2004 to 2013 and had indication of primary cotrimoxazole prophylaxis. Variable in this study were initiation, discontinuation, dosage, duration, duration percentage and adverse events of primary cotrimoxazole prophylaxis.Result : There were 3818 patients had indication of primary cotrimoxazole prophylaxis with median age of study subjects were 29 years old, 79,1% were male, 58,5% were tuberculosis, WHO clinical stage 3 and 4 were 86%. Median CD4 at beginning was 51 cell/mm3 (IQR 101). Initiation of primary cotrimoxazole prophylaxis was performed in 83% patients who met indication. 99,8% patients used appropriate dose of cotrimoxazole. Frequent adverse events were increasing hepatic transaminase (38,1%), leucopenia (16,9%), anemia (16,5%), nausea (15,4%), vomiting (7,8%), thrombocytopenia (7,4%) and hypersensitivity (5,3%). Adverse event causing discontinuation were hypersensitivity (100%), anemia (2,4%), increasing hepatic transaminase (2,1%), vomiting (0,8%) and leucopenia (0,6%). Inappropriate discontinuation of cotrimoxazole was 61,6% with median duration percentage was 87,5% (IQR 39) and median of duration was 20 month (IQR 20). Duration in patients with CD4≤100 cell/mm3 and >100 cell/mm3 was 21 month (IQR 22) and 12,5 month (IQR 14,75) p=0,000.Conclusion : although initiation of primary cotrimoxazole prophylaxis was done in 83% adult HIV patients with appropriate dosage, but 61,6% discontinuation was inappropriate with guideline;Back Ground : Cotrimoxazole was standard of primary prevention against toxoplasmosis infection and Pneumocystis jirovecii pneumonia (PCP) in patients with CD4 less than 200 cell/mm3 and tuberculosis. Some study found that prophylactic use cotrimoxazole in patients with HIV was inappropriate with national guideline. It was necessary to have research in order to know clinician adherence to prescribe primary cotrimoxazole prophylaxis.Objective : to know initiation, discontinuation, dosage, adverse events, duration and duration percentage of primary cotrimoxazole prophylaxis in HIV patientsMethods : This was cohort retrospective study and was done in UPT HIV RSCM and subject of study were all patients more than 18 years old from 2004 to 2013 and had indication of primary cotrimoxazole prophylaxis. Variable in this study were initiation, discontinuation, dosage, duration, duration percentage and adverse events of primary cotrimoxazole prophylaxis.Result : There were 3818 patients had indication of primary cotrimoxazole prophylaxis with median age of study subjects were 29 years old, 79,1% were male, 58,5% were tuberculosis, WHO clinical stage 3 and 4 were 86%. Median CD4 at beginning was 51 cell/mm3 (IQR 101). Initiation of primary cotrimoxazole prophylaxis was performed in 83% patients who met indication. 99,8% patients used appropriate dose of cotrimoxazole. Frequent adverse events were increasing hepatic transaminase (38,1%), leucopenia (16,9%), anemia (16,5%), nausea (15,4%), vomiting (7,8%), thrombocytopenia (7,4%) and hypersensitivity (5,3%). Adverse event causing discontinuation were hypersensitivity (100%), anemia (2,4%), increasing hepatic transaminase (2,1%), vomiting (0,8%) and leucopenia (0,6%). Inappropriate discontinuation of cotrimoxazole was 61,6% with median duration percentage was 87,5% (IQR 39) and median of duration was 20 month (IQR 20). Duration in patients with CD4≤100 cell/mm3 and >100 cell/mm3 was 21 month (IQR 22) and 12,5 month (IQR 14,75) p=0,000.Conclusion : although initiation of primary cotrimoxazole prophylaxis was done in 83% adult HIV patients with appropriate dosage, but 61,6% discontinuation was inappropriate with guideline;Back Ground : Cotrimoxazole was standard of primary prevention against toxoplasmosis infection and Pneumocystis jirovecii pneumonia (PCP) in patients with CD4 less than 200 cell/mm3 and tuberculosis. Some study found that prophylactic use cotrimoxazole in patients with HIV was inappropriate with national guideline. It was necessary to have research in order to know clinician adherence to prescribe primary cotrimoxazole prophylaxis.Objective : to know initiation, discontinuation, dosage, adverse events, duration and duration percentage of primary cotrimoxazole prophylaxis in HIV patientsMethods : This was cohort retrospective study and was done in UPT HIV RSCM and subject of study were all patients more than 18 years old from 2004 to 2013 and had indication of primary cotrimoxazole prophylaxis. Variable in this study were initiation, discontinuation, dosage, duration, duration percentage and adverse events of primary cotrimoxazole prophylaxis.Result : There were 3818 patients had indication of primary cotrimoxazole prophylaxis with median age of study subjects were 29 years old, 79,1% were male, 58,5% were tuberculosis, WHO clinical stage 3 and 4 were 86%. Median CD4 at beginning was 51 cell/mm3 (IQR 101). Initiation of primary cotrimoxazole prophylaxis was performed in 83% patients who met indication. 99,8% patients used appropriate dose of cotrimoxazole. Frequent adverse events were increasing hepatic transaminase (38,1%), leucopenia (16,9%), anemia (16,5%), nausea (15,4%), vomiting (7,8%), thrombocytopenia (7,4%) and hypersensitivity (5,3%). Adverse event causing discontinuation were hypersensitivity (100%), anemia (2,4%), increasing hepatic transaminase (2,1%), vomiting (0,8%) and leucopenia (0,6%). Inappropriate discontinuation of cotrimoxazole was 61,6% with median duration percentage was 87,5% (IQR 39) and median of duration was 20 month (IQR 20). Duration in patients with CD4≤100 cell/mm3 and >100 cell/mm3 was 21 month (IQR 22) and 12,5 month (IQR 14,75) p=0,000.Conclusion : although initiation of primary cotrimoxazole prophylaxis was done in 83% adult HIV patients with appropriate dosage, but 61,6% discontinuation was inappropriate with guideline, Back Ground : Cotrimoxazole was standard of primary prevention against toxoplasmosis infection and Pneumocystis jirovecii pneumonia (PCP) in patients with CD4 less than 200 cell/mm3 and tuberculosis. Some study found that prophylactic use cotrimoxazole in patients with HIV was inappropriate with national guideline. It was necessary to have research in order to know clinician adherence to prescribe primary cotrimoxazole prophylaxis.Objective : to know initiation, discontinuation, dosage, adverse events, duration and duration percentage of primary cotrimoxazole prophylaxis in HIV patientsMethods : This was cohort retrospective study and was done in UPT HIV RSCM and subject of study were all patients more than 18 years old from 2004 to 2013 and had indication of primary cotrimoxazole prophylaxis. Variable in this study were initiation, discontinuation, dosage, duration, duration percentage and adverse events of primary cotrimoxazole prophylaxis.Result : There were 3818 patients had indication of primary cotrimoxazole prophylaxis with median age of study subjects were 29 years old, 79,1% were male, 58,5% were tuberculosis, WHO clinical stage 3 and 4 were 86%. Median CD4 at beginning was 51 cell/mm3 (IQR 101). Initiation of primary cotrimoxazole prophylaxis was performed in 83% patients who met indication. 99,8% patients used appropriate dose of cotrimoxazole. Frequent adverse events were increasing hepatic transaminase (38,1%), leucopenia (16,9%), anemia (16,5%), nausea (15,4%), vomiting (7,8%), thrombocytopenia (7,4%) and hypersensitivity (5,3%). Adverse event causing discontinuation were hypersensitivity (100%), anemia (2,4%), increasing hepatic transaminase (2,1%), vomiting (0,8%) and leucopenia (0,6%). Inappropriate discontinuation of cotrimoxazole was 61,6% with median duration percentage was 87,5% (IQR 39) and median of duration was 20 month (IQR 20). Duration in patients with CD4≤100 cell/mm3 and >100 cell/mm3 was 21 month (IQR 22) and 12,5 month (IQR 14,75) p=0,000.Conclusion : although initiation of primary cotrimoxazole prophylaxis was done in 83% adult HIV patients with appropriate dosage, but 61,6% discontinuation was inappropriate with guideline]"

"[ABSTRAKPendahuluanHipertensi merupakan masalah kesehatan dunia karena jumlah penderita yangbanyak serta komplikasi yang diakibatkannya. Pengendalian tekanan darah padapada pasien hipertensi masih belum adekuat. Penyebab utama kegagalanpengendalian tekanan darah pada pasien hipertensi adalah ketidak-patuhan berobat,adanya therapeutic inertia dan penyakit yang resisten.TujuanMengetahui proporsi therapeutic inertia pada pasien dengan tekanan darah tidakterkontrol, tingkat medication adherence dan proporsi pengendalian tekanan darahpada pasien hipertensi yang telah berobat lebih dari enam bulan dengan melakukanpengisian kuesioner mengenai kepatuhan berobat dan evaluasi dari rekam medismengenai tatalaksana hipertensi.MetodeTelah dilakukan penelitian potong lintang pada bulan April 2015 sampai Mei 2015terhadap 126 pasien dengan hipertensi dan telah berobat lebih dari enam bulan dipoliklinik Ginjal-Hipertensi RSCM Jakarta-Indonesia. Subjek dilakukanwawancara terstruktur dan pengukuran tekanan darah dan diminta untuk mengisikuesioner 8-item Morisky Medication Adherence Score (MMAS-8) untuk menilaikepatuhan berobat serta evaluasi rekam medis pasien untuk menilai tatalaksanahipertensi yang diterima, serta tekanan darah selama berobat.HasilDidapatkan 113 subjek yang sesuai dengan kriteria penelitian. Dari hasil penelitiandidapatkan pengendalian tekanan darah adalah sebesar 69,3% dari seluruhkunjungan pada pasien dengan tekanan darah tinggi, dari 30,7% pasien dengantekanan darah tidak terkontrol, tingkat therapeutic inertia mencapai 84,1%.Kepatuhan berobat yang baik didapatkan pada 85,8% pasien dengan hipertensiSimpulanTingkat pengendalian tekanan darah pada pasien hipertensi sudah cukup baik.Kepatuhan berobat pasien dengan hipertensi sudah baik. Tingkat therapeuticinertia pada pasien hipertensi dengan tekanan darah tidak terkontrol masih tinggi.

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ABSTRACTBackgroundHypertension is a worldwide medical problem because of huge amount ofhypertensive patient and complication tha follows. The blood pressure control ofhypertensive patients is inadequate. The main reason failure in controlling bloodpressure of hypertensive patient are medication inadherent, therapeutic inertia andresistant disease.ObjectivesTo determine the proportion of therapeutic inertia in hypertensive patient withuncontrolled blood pressure, medication adherence level and blood pressurecontrol rate in hypertensive patient who has been on medication for over than sixmonth by filling questionnaire on medication adherence and evaluation of medicalrecord on hypertension therapy.MethodA cross-sectional study was conducted in April 2015 through May 2015 on 126hypertensive patient and has been on hypertension medication for over than sixmonth at Nephrology-Hypertension clinic Cipto Mangunkusumo Hospital, Jakarta-Indonesia. We conducted structured interview and blood pressure measurement tothe subject, and requested to fill 8-item Morisky Medication Adherence Score(MMAS-8) to evaluate medication adherence and reveiw of medical record toevaluate hypertension therapy and blood pressure during ambulatory visit.ResultsThere were 113 subject that meet the study criteria. The blood pressure control ratewere 69.3% from all visit of hypertensive patient. From 30.7% visit withuncontrolled blood pressure, therapeutic inertia were 84,1%. Good medicationadherence were found in 85.8% hypertensive patient.ConclusionBlood pressure control rate in hypertensive patient is good. Medication adherencein hypertensive patient were also found good. We found that the theraputic inertialevel among hypertensive patient with uncontrolled blood pressure is high., BackgroundHypertension is a worldwide medical problem because of huge amount ofhypertensive patient and complication tha follows. The blood pressure control ofhypertensive patients is inadequate. The main reason failure in controlling bloodpressure of hypertensive patient are medication inadherent, therapeutic inertia andresistant disease.ObjectivesTo determine the proportion of therapeutic inertia in hypertensive patient withuncontrolled blood pressure, medication adherence level and blood pressurecontrol rate in hypertensive patient who has been on medication for over than sixmonth by filling questionnaire on medication adherence and evaluation of medicalrecord on hypertension therapy.MethodA cross-sectional study was conducted in April 2015 through May 2015 on 126hypertensive patient and has been on hypertension medication for over than sixmonth at Nephrology-Hypertension clinic Cipto Mangunkusumo Hospital, Jakarta-Indonesia. We conducted structured interview and blood pressure measurement tothe subject, and requested to fill 8-item Morisky Medication Adherence Score(MMAS-8) to evaluate medication adherence and reveiw of medical record toevaluate hypertension therapy and blood pressure during ambulatory visit.ResultsThere were 113 subject that meet the study criteria. The blood pressure control ratewere 69.3% from all visit of hypertensive patient. From 30.7% visit withuncontrolled blood pressure, therapeutic inertia were 84,1%. Good medicationadherence were found in 85.8% hypertensive patient.ConclusionBlood pressure control rate in hypertensive patient is good. Medication adherencein hypertensive patient were also found good. We found that the theraputic inertialevel among hypertensive patient with uncontrolled blood pressure is high.]"