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BLOOD GLUCOSE TARGET ACHIEVEMENT AND ANTIDIABETES REGIMEN IN TYPE-2 DIABETIC GERIATRIC PATIENTS
Get PDFDiabetes mellitus (DM) is a leading caused morbidity in geriatric patients. The prevalence of type-2 DM is more than 90% of DM population and increase with age, and half of those patients were geriatric. Blood glucose (BG) control is important for prevention diabetes complications, but attention must be given in geriatric patients due to the increasing susceptibility to risk of hypoglycemia. The aimed of this study was to identify BG achievement in diabetic geriatric patients and its therapeutic management. This study was done in Outpatient Geriatric Clinic, Dr. Soetomo General Hospital Surabaya Indonesia in the period of March to June, 2012. The inclusion criteria were type-2 diabetic geriatric patients with/without diabetic complication that received antidiabetic therapy and had BG data. The results from 165 patients showed that BG target achieved by 53% patients, 41% patients not achieved the target, while 6% patients in risk ofhypoglycemia. Management therapy for patients with achieved BG target was done by (1) continued therapy as before, (2) increasing dosage regimen for patients with BG already in the target but still within the upper limit target or decrease dosage regimen for patients with BG in lower limit target to avoid hypoglycemia, (3) change type of medication for patients who experienced side effects. Meanwhile, from all patients that failed to achieve BG target there were some patients received additional medications and regimen changes, but the rest of those didn’t receive any additional medication or regimen changes, which were many of them eventually became one of the drug-related problems in this patient group. In conclusion, there were still quite large number patients that did not achieve BG target, therapy management changes were made based on BG profile and there were drug related problems related to dosage regimen that needs pharmaceutical care interventio
INCREASING SENSITIVITY OF MCF-7/DOX CELLS TOWARDS DOXORUBICIN BY HESPERETIN THROUGH SUPPRESSION OF P-GLYCOPROTEIN EXPRESSION
Get PDFLong-term use of doxorubicin causes cancer resistance due to overexpression of P-glycoprotein (P-gp), a protein that plays a role in cell drug efflux. The purpose of this study is to determine the action of hesperetin in increasing the cytotoxicity of doxorubicin on MCF-7 cancer cells resistant to doxorubicin (MCF-7/DOX) through suppression of P-gp expression. Cytotoxic assay of single and combinational treatment of doxorubicin and hesperetin were performed by using MTT assay. Apoptosis evidence was examined by using double staining with acridine orange and ethidium bromide dyes, while Pgp expression was determined by using immunocytochemistry. Hesperetin reduced cell viability in dose dependent manner. Both MCF-7 ori and MCF-7/DOX cells gave different responses to hesperetin with the IC50 values of >500μM and 267μM, respectively. Combining treatment of hesperetin and doxorubicin to MCF-7/DOX cells at the dose of 95μM and 230nM increased apoptosis evidence and suppressed P-gp expression. These results suggest that hesperetin enhances the anticancer effect of doxorubicin to resistance MCF-7 cells through suppression of P-gp expression
COMPARATIVE STUDIES ON SYNTHESIS AND STRUCTURE OF OLD AND NEW POLYMORPHS OF DESVENLAFAXINE - AN ANTIDEPRESSANT DRUG
Get PDFDesvenlafaxine succinate (pristiq) is an important non-hormonal drug used in the treatment of major depressive disorder and problems associated with menopause.This article summarizes the synthesis and investigation of new polymorphic form of Desmethylvenlafaxine. The new polymorph has been compared with the old polymorph using XRD, DSC, FTIR, SEM and HPLC techniques. Three prominent reflections with higher intensities lying at 20.3, 13.1 and 15.8 have been noted in the XRD measurements for the new polymorph. Higher intensity (XRD) peaks for the new polymorph indicates good crystalline quality. FTIR spectra shows close match between the polymorphs. DSC measurements show enhanced thermal stability for the new polymorph. Higher purity is indicated by the HPLC studies.Key words: desvenlafaxine, polymorphism, structure, crystalline, purit
COST EFFECTIVENESS ANALYSIS BETWEEN ASPIRIN AND CITICOLINE IN STROKE PATIENT IN PROF DR MARGONO SOEKARJO HOSPITAL PURWOKERTO
Get PDFStroke is the third highest cause of death after heart disease and cancer. An appropriate therapy decision is important because it related to many factors such as cost and quality of life. Most of Indonesian physicians’ use citicoline and Aspirin for stroke patients. A Cohort Retrospective study was performed to 40 patients with aspirin and 77 patients with citicoline. Secondary data such as cost, length of stay (LoS) was collected from medical records. Furthermore, patient health level was measured by National Institute of Health Stroke Scale (NIHSS) which was collected from patient directly. The average of patients’ age was 60.59±11.31 years old. The NIHSS showed no significant difference between aspirin (2.58±2.93) and citicoline (3.10±2.90) groups. Otherwise, LoS was different between two groups (p value 0.000). The average of total cost in aspirin group (IDR 2,593,250.00) was lower than citicoline groups (IDR 11,384,210.00) and the differences were statistically siginificant. The Incremental Cost Effectiveness Ratio (ICER) between aspirin compared to citicoline was IDR 16,905,692.31 per quality of life. Aspirin was strongly dominated to citicoline in cost, LoS and NIHSS.
EVALUATION OF IMMUNOMODULATORY ACTIVITY OF SESBANIA GRANDIFLORA FLOWERS EXTRACT IN MICE
Get PDFThe aim of the present study was to investigate the immunomodulatory activity of Sesbania grandiflora on cellular and humoral immunity. Oral administration of the methanolic extract (200 and 400mg/kg) of S. grandiflora flowers, in mice, dose-dependently significantly enhanced the production of circulating antibody titre in mice in response to SRBC. It significantly potentiated the delayed-type hypersensitivity reaction induced by sheep red blood cells (SRBC). Good response was also found towards phagocytosis in carbon clearance assay and prevented myelosuppression in cyclophosphamide drug. Aqueous extract at 250mg/kg dose level failed to show immunomodulatory activity but 500mg/kg of aqueous extract potentiated the activity however less significantly compared with both dose of methanolic extract. The results obtained in this study indicate that methanolic extract (400mg/kg) of S. grandiflora possesses potential immunomodulatory activity.
NEW HOPE ON DRUG LEADS DEVELOPMENT FROM DEEP OCEAN: HALOGENATED ALKALOIDS OF AGELAS SPONGES
Get PDFAgelas sponge is found in abundancy from Indonesia’s ocean. This sponge produces an important chemotaxonomic group of compounds, derived from pyrrole-imidazole alkaloids. This group of compounds is one of those exclusively found from marine environment. Marine sponges are reported to be promising drug lead producers having unique chemical structures of which many have no terrestrial counterparts. The objective of this report is to give an overview of the reported attempts from up to down stream to develop pyrrole-imidazole alkaloids as new drug lead. Literatures up to 2013 reporting this group of compounds from Agelas sponges were studied. Discussion on the halogenated alkaloids covers the producers, description of high chemical diversity, identification, biosynthesis and ecological relevance as well as their role as a promising drug candidate. Alternatives to provide continous supplies for drug development are also discussed considering that wild harvesting of the sponge producers can lead to ecological damage in the future . Broad range of interesting pharmacological importance as well as several success in developing synthetic route for production supports its development as drug candidate.
APPLICATION OF MONTMORILLONITE, ZEOLITE AND HYDROTALCITE NANOCOMPOSITE CLAYS-DRUG AS DRUG CARRIER OF SUSTAINED RELEASE TABLET DOSAGE FORM
Get PDFCaptopril is an angiotensin converting enzyme (ACE) inhibitor as antihypertensive treatment with half-life about 2h. Development of sustained-release dosage form can maintenance the drug concentration at therapeutic window in long period of time with constant release. Montmorillonite, zeolite and hydrotalcite nano-composites were used as drug carrier as sustained release dosage form. This study aimed to determine the drug release from nanocomposite of montmorillonite-drug, zeolite-drug and hydro-talcite-drug. Nanocomposite drug and carriers were made with the model drug was dispersed in carrier with matrix system. Matrices used montmorillonite, zeolite and hydrotalcite with concentrations of 20%, 30% and 40%. Characterization of matrices were done by testing the physical properties of the granules and drug release. Dissolution test using apparatus II USP model with speed rotation of 50rpm of, 900mL of HCl 0.1N as medium. The results were compared statistically with one way ANOVA 95% of interval confidence. The results showed that the difference of matrices and concentrations gave the difference effect in flow time, compact-tibility, DE360, initial burst release and maintenance release (p<0.05). Nanocomposites between drug and nanoclays occurred after 60min were shown with decreasing the drug release rate. Nanocomposite was formed with the drug molecules adsorb on nanoporous of carrier material. Increasing of clays concentration improved the fluidity and compactibility, reduced the drug release
ANALYSIS OF COST AND OUTCOME THERAPY OF BLOOD TRANSFUSION ON ANEMIA TREATMENT FOR INPATIENT WITH CHRONIC RENAL FAILURE
Get PDFChronic Renal Failure (CRF) is a slow progressive loss of kidney function over a period of several years. One of its complications that determines the patient’s quality of life is anemia. Blood transfusion can be used to treat anemia in patient with CRF. The purpose of this study are to measure the average costs per patient, assess the therapy outcomes, and determine the factors that influence the cost of blood transfusion in anemia treatment for patients with CRF in A, B, and C hospitals. This study was a descriptive non-experimental research. Cost analysis was based on the perspective of the hospital. Data were obtained retrospectively from medical records and payment details of inpatient with CRF who experienced anemia in A (tertiery hospital in Yogyakarta province), B (tertiary hospital in Central Java province), and C (private hospital in the province of Yogyakarta) hospitals. Data was analysed by calculating the average costs per patient, while therapy outcome was measured by calculating the percentages of patients who achieved the target of hemoglobin level. Furthermore, the factors that influenced the amount of the total cost were analysed using Oneway ANOVA and Independent T-Test for data with normal distribution and the Kruskal-Wallis and Mann-Whitney for data with non-normal distribution. The results showed that the average costs per patient for anemia treatment in patient with CRF who had blood transfusion therapy were Rp 8,873,243.39±4,417,825.83 in A hospital, Rp 5,249,464.97±4,283,655.41 in B hospital; and Rp 7,961,088.00±6,105,501.80 in C hospital. Most of the patients in A, B, and C hospitals had achieved the target of hemoglobin level (>7g/dL) with the percentages of 95.56%, 68.57% and 87.50% respectively. The factors that mainly influenced the cost of anemia treatment in CRF are length of hospitalization for A hospital, age, gender, payment models, and length of hospitalization for B hospital, whereas age and length of hospitalization for C hospital. Key words: cost analysis, outcome therapy, blood transfusion, anemia, chronic renal failu
IMPROVEMENT OF DISSOLUTION RATE OF INDOMETHACIN FROM FAST DISSOLVING TABLETS
Get PDFIn the current study Indomethacin (IM) fast dissolving tablets (FDTs) were prepared by direct compression technique in order to enhance its dissolution rate. The tablets were formulated using two different approaches; super-disintegration and efferves-cence. A combination formulation of above approaches was also developed to further improve its properties. The super-disintegrants used in the formulae were sodium starch glycolate (Primogel), cross-povidone (Kollidon) and cross-carmellose (Ac-di-sol). Sodium bicarbonate and citric acid combination was employed as effervescent ingredients. The prepared powder mixtures of IM were subjected to evaluation of various pre-compression parameters and tablets were evaluated for weight variation, dimension, hardness, friability, drug content, disintegration, wetting time, uniformity of dispersion, in vitro drug release and stability studies. The FT-IR spectra shown there are no interaction between of IM with excipient. The results of pre-compression studies indicate acceptable flow property for all the powder mixtures. The data of weight variation, dimension, hardness, friability, uniformity of dispersion and drug content studies were within the official limits. The wetting time and disintegration time decreases considerably with the increase in super-disintegrants amount. By using the combination approach, the disintegration and wetting time further decreased. In vitro dissolution studies were carried out using phosphate buffer pH 6.8 as dissolution medium for 60min and observed that formulation IF9, among super-disintegration approach, released highest percentage (97.13±2.09) of IM. In vitro drug release was highest (98.54±2.89) at 60 min for formulation IF11, when all the formulations were taken into consideration. The stability study was performed on the promised formulation IF11 at 40±2oC/ 75±5% RH for 3 months and the results indicated that there were no significant changes in aforesaid tablet properties
ANTICANCER ACTIVITY OF MANGOSTEEN PERICARP DRY EXTRACT AGAINST MCF-7 BREAST CANCER CELL LINE THROUGH ESTROGEN RECEPTOR -α
Get PDFBreast cancer has very complex morphological and molecular characteristic. Estrogen receptor is one of biomarker in breast cancer progression, more than 60% breast cancer overexpress estrogen receptor α (ERα). Xanthone in Garcinia mangostana was investigated whether to have anticancer activity on colorectal, prostate, lung, blood and breast cancer. This research was focused on molecular mechanism of anticancer activity of mangosteen pericarp extract (MPE) on ER-α. This study used MCF-7 cells as a model of ER-α overexpressed breast cancer cells. Cytotoxic study towards MCF-7 cells was designed by using MTT test, further apoptotic induction assay was determined by double staining method using acridine orange and ethidium bromide. Extract molecular mechanism against breast cancer was assayed by immunocytochemistry. The MTT data was analyze using probit analysis to get IC50 then apoptosis and immunocytochemistry data were analysis qualitative analysis. MPE had strong cytotoxic activity on MCF-7 cells with IC50 of 45μg/mL and morphological changes passed through apoptosis induction. The expression of ER-α in MPE treated cells was same as untreated cells. MPE did not suppress ER-α in both nucleus and cytoplasm. Anticancer activity of MPE misht be mediated by other gene involved in ER-α signaling pathway in breast cancer cells