scholarly journals The Efficacy of 0.03% Dermatological Tacrolimus Ointment for Refractory Vernal Keratoconjunctivitis.

2020 ◽  
Vol 35 (4) ◽  
pp. 229-234
Author(s):  
Hafiza Sadia Imtiaz
Keyword(s):  
Clinical Symptoms ◽  
Clinical Signs ◽  
Vernal Keratoconjunctivitis ◽  
P Value ◽  
Baseline Score ◽  
Assessment Data ◽  
Tacrolimus Ointment ◽  
Topical Tacrolimus ◽  
Quasi Experimental ◽  
Written Informed Consent

  Purpose: To determine the efficacy of 0.03% dermatological tacrolimus ointment in patients with refractory vernal keratoconjunctivitis Study Design: Quasi-experimental study Study Place and Duration: Eye Department, DHQ-Teaching Hospital, Gujranwala, Pakistan from April 2018 to March 2019 Material and Methods: After approval from hospital ethical committee and obtaining written informed consent from each patient/guardian, patients of either gender between 4-16 years of age with VKC not responding to conventional treatment for more than 8 weeks or having steroid-induced complications were included in this study. Dermatological tacrolimus ointment 0.03% started to be placed in inferior fornix in BD frequency along with topical lubricants. Patients were followed up on a regular schedule. Individual symptoms score was assessed from the questionnaire and signs score from observer’s clinical assessment. Data were analyzed using SPSS v23.0. P-value <0.05 was considered as statistically significant. Results: 40 eyes of 20 patients were included in this study. Out of which 4(20%) were female and 16 were male (80%). Mean baseline score for clinical symptoms was 6.65±1.81 that reduced to 1.65±0.81 after 12 weeks treatment course of tacrolimus with a significant p-value of 0.006 (p<0.05). Mean baseline score for clinical signs was 5.9±1.59 that improved to 1.80±0.83 after 12 weeks treatment course with a statistically significant p-value of 0.003 (p<0.05). Conclusions: In conclusion, topical tacrolimus dermatological ointment 0.03% is highly effective in refractory VKC and can be safely used as an alternative in VKC patients who are steroid-responders.

scholarly journals Comparison of two ophthalmic solutions of olopatadine hydrochloride (0.1%) and epinastine hydrochloride (0.05%) on clinical signs of vernal keratoconjunctivitis and side effects of the two drugs

2020 ◽  
Vol 8 (10) ◽  
pp. 3565
Author(s):  
Tahir Husain Ansari ◽  
Yusuf Rizvi
Keyword(s):  
Side Effects ◽  
Clinical Signs ◽  
Treated Group ◽  
Vernal Keratoconjunctivitis ◽  
P Value ◽  
Medical College ◽  
Ocular Itching ◽  
Dry Climates ◽  
Ophthalmic Solutions ◽  
Olopatadine Hydrochloride

Background: Vernal keratoconjunctivitis (VKC) is a recurrent, bilateral, external, ocular inflammation primarily affecting young adults living in warm dry climates. The objectives of the research was to compare the two ophthalmic solutions of olopatadine hydrochloride (0.1%) and epinastine hydrochloride (0.05%) on clinical signs of vernal keratoconjuntivitis and to determine side effects of both the drugs.Methods: The study was carried out in 40 patients who attended the out-patient department (OPD) Ophthalmology, Darbhanga Medical College and Hospital, Laheriasarai from July 2007 to December 2008.  Forty patients with symptoms of VKC (ocular itching, ropy discharge, papillary hypertrophy, gelatinous thickening and horner-trantas spots were selected and included in our study.Results: Mean score of palpebral hyperemia at 0, 14, 28 and 42 days in olopatadine treated eye were 2.1, 1.4, 0.8 and 0.4 respectively having p value <0.01, and <0.01 and <0.05 respectively, while mean score at same stages in placebo eye were 2.1, 2, 1.9, and 1.5 having value >0.05. Epinastine treated group mean score of palpebral hyperemia were <0.01 and <0.01 respectively in epinastine treated eye whereas in placebo treated eye, mean score were 2.1, 2.0, 1.8 and 1.6 respectively having p value >0.05 in all stages. Statistically insignificant reduction at day 14 while very significant reduction at day 28 and 42 was observed in epinastine treated eye as compared to placebo.Conclusions: The present study had shown that both olopatadine and epinastine were effective in treating clinical signs of VKC as compared to placebo.

scholarly journals Long-term use of topical tacrolimus ointment: a safe and effective option for the treatment of vernal keratoconjunctivitis

2019 ◽  
Vol 82 (2) ◽  
Author(s):  
Guilherme Gubert Müller ◽  
Newton Kara José ◽  
Rosane Silvestre de Castro ◽  
Erick Carneiro de Holanda
Keyword(s):  
Vernal Keratoconjunctivitis ◽  
Tacrolimus Ointment ◽  
Topical Tacrolimus ◽  
Effective Option

scholarly journals Long-term results of topical 0.02% tacrolimus ointment for refractory ocular surface inflammation in pediatric patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kyungmin Koh ◽  
Ikhyun Jun ◽  
Tae-im Kim ◽  
Eung Kweon Kim ◽  
Kyoung Yul Seo
Keyword(s):  
Ocular Surface ◽  
Pediatric Patients ◽  
Clinical Signs ◽  
Long Term Results ◽  
Tacrolimus Ointment ◽  
Topical Tacrolimus ◽  
Surface Inflammation ◽  
Ocular Surface Inflammation

Abstract Background No studies have been reported on the efficacy and safety of long-term (≥12 months) use of topical tacrolimus for refractory ocular surface inflammation in pediatric patients. Methods Medical records of pediatric patients who were prescribed topical 0.02% tacrolimus ointment for refractory ocular surface inflammation between January of 2010 and March of 2018 were reviewed retrospectively. Changes in ocular surface signs during slit-lamp examination, clinical symptoms and concurrent steroid use were graded with a scoring system. The presence of side effects was also assessed. The changes in disease severity and patient symptoms were compared between baseline and after the treatment. Results Among 72 patients (55% males, mean age 10.8 ± 3.9 years, range 3 to 17 years), 25 patients (48% males, mean age 11.4 ± 3.9 years) fully recovered, resulting in discontinuance of the ointment treatment before 12 months. Six patients experienced intolerable burning sensation, which required treatment cessation. Cessation days of those who quit were 1,5,14,20,26, and 35 days. Seven patients were lost during follow-up. Thirty-four patients (56% males, mean age 11.2 ± 4.2 years, range 3 to 17 years) were treated with tacrolimus ointment for over 12 months (average 23.1 ± 19.1 months, range 12 to 98 months). During the follow-up period, all patients showed improved clinical signs and symptoms, and no adverse reaction was noted. Conclusions Long-term maintenance of topical tacrolimus 0.02% ointment is safe and effective in improving refractory ocular surface inflammation in pediatric patients.

scholarly journals Effectiveness of Chest Physiotherapy in Cerebrovascular Accident Patients With Aspiration Pneumonia

2020 ◽  
Vol 15 (1) ◽  
pp. 47-52
Author(s):  
Muhammad Hassan Waseem ◽  
Fahad Farooq Lasi ◽  
Jitendar Valecha ◽  
Bakhtawar Samejo ◽  
Sikandar Ali Sangrasi ◽  
...  
Keyword(s):  
Aspiration Pneumonia ◽  
Cerebrovascular Accident ◽  
Clinical Signs ◽  
Female Gender ◽  
Chest Physiotherapy ◽  
P Value ◽  
Breathing Exercises ◽  
Postural Drainage ◽  
Quasi Experimental ◽  
Pre Treatment

Introduction: According to WHO, a stroke refers to rapidly developing clinical signs of focal (or global) disturbance of cerebral functions, with symptoms lasting 24 hours or longer or leading to death. The damage caused by a stroke can interrupt your normal swallowing and food or fluid is entered into your airways and lungs. Dysphagia can damage the lungs, which can trigger a lung infection (pneumonia). To assess the efficacy of chest physiotherapy in the prevention of aspiration pneumonia in stroke patients.Materials and Methods: A quasi-experimental study was conducted with a sample size of 35 participants from C1 ward Agha Khan Hospital in Karachi City, Pakistan. The participants were selected via random sampling method. The inclusion criteria include patients of the C1 ward with a cerebrovascular accident, both male and female gender, with the age ranges from 45 to 63 years. All statistical analysis was done by using SPSS v. 19. The paired t test was used to evaluate the effectiveness of chest physiotherapy in a patient with aspiration pneumonia. The chest physiotherapy includes turning, postural drainage, percussion, vibration, deep breathing exercises, coughing, and suctioning were performed on a patient with aspiration pneumonia.Results: The results of this study show pre-treatment and post-treatment chest congestion, heart rate, and respiratory rate show that the P value is highly significant.Conclusion: This study concludes that chest physiotherapy seems to be effective in treating aspiration pneumonia in cerebrovascular accident patients.

scholarly journals AB0578 SUBCLINICAL ENTHESITIS IN PSORIASIS patiEntS AS prediCtor OF ARTHRITIS (EPESCA STUDY): PRELIMINARY RESULTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1326.2-1326
Author(s):  
E. Di Donato ◽  
A. Becciolini ◽  
S. DI Nuzzo ◽  
N. Chernyschova ◽  
C. Commisso ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Structural Damage ◽  
Clinical Symptoms ◽  
Broad Band ◽  
Power Doppler ◽  
Diagnostic Delay ◽  
Clinical Signs ◽  
Plantar Fascia ◽  
Doppler Signal ◽  
P Value

Background:Enthesitis is one of the typical pathological signs of spondyloarthritis such as psoriatic arthritis (PsA) and it seems to be the Primum movens of the disease. Clinical assessment of enthesitis showed to be less sensitive, compared to ultrasound (US) evaluation, in identifying enthesitis in patients with PsA [1].OMERACT defined US enthesitis as: “hypoechoic and/or thickened insertion of the tendon close to the bone (within 2 mm from the bony cortex), which exhibits Doppler signal if active and that may show erosions, enthesophytes/calcifications as a sign of structural damage” [3]The reported prevalence of subclinical enthesitis in psoriasis (PsO) patients in different countries ranges between 7% and 20% [2].Objectives:The main objective of this study was to estimate, by US evaluation, the prevalence of subclinical enthesitis in PsO patients without any clinical signs of enthesitis. Secondary objectives were to analyze differences, in terms of age, sex, BMI, PsO onset and diagnosis, among patients with enthesitis (active or not active), enthesopathy and without any alteration of enthesis.According to the OMERACT definition of ultrasound enthesitis, patients were divided into 4 groups: patients with active enthesitis (AE) defined as the presence of power-Doppler signal in a hypoechoic and/or thickened insertion of the tendon close to the bone; patient with enthesitis (En) defined as hypoechoic and/or thickened insertion of the tendon close to the bone without PD signal; patients with enthesopathy (Ep) defined as the presence of structural damage (erosions, enthesophytes/calcifications); patients without any alteration of enthesis (WE).Methods:Patients with at least 18 years and a diagnosis of PsO made by a Dermatologist were included. Exclusion criteria were the presence of clinical symptoms or signs of articular or entheseal involvement, diagnosis of arthritis and therapy with bDMARDs or tsDMARDs.All patients underwent US examination on grey scale and Power Doppler (PD) ultrasonography of 6 sites (Achilles, quadriceps, distal and proximal patellar, plantar fascia and triceps enthesis) bilaterally. Ultrasound was performed by an experienced sonographer, using a Logiq P9 equipped with 6-12 MHz broad band linear transducer. Data were reported as frequencies and median with interquartile range. To check differences among these four groups, we used chi-square test or Kruskall-Wallis test. P-value ≤ 0.05 is considered statistically significant.Results:We enrolled 124 consecutive psoriasis patients (47 [37.9%] female) with median age 57.7 (45.3-66.5) years, median disease duration 20.4 (10.1-30.8) years, median BMI 27 [24-29]. Patients with AE, En, Ep were 20.2% (25/124), 49.2% (61/124) and 18.5% (23/124), respectively.Patients WE (12.1%, 15/124) showed significantly lower BMI, younger age and shorter diagnostic delay compared to the other patients.All signs of enthesopathy/enthesitis were more frequently observed at Achilles (33.1%, 41/124), triceps (23.4%, 29/124), quadriceps (20.2%, 25/124), distal patellar (18.5%, 23/124) and proximal patellar (4.8%, 6/124) enthesis.Conclusion:Subclinical enthesitis is quite common in PsO patients, and about 20% showed active enthesitis. The enthesopathy seems to be more frequent in patients with increased delay in PsO diagnosis, older age and higher BMI.References:[1]Bandinelli F. et al. Ultrasound detects occult entheseal involvement in early psoriatic arthritis independently of clinical features and psoriasis severity. Clin Exp Rheumatology. Mar-Apr 2013;31(2):219-24.[2]Zuliani F. et al. Ultrasonographic detection of subclinical enthesitis and synovitis: a possible stratification of psoriatic patients without clinical musculoskeletal involvement. Clin Exp Rheumatol Jul-Aug 2019;37(4):593-599.[3]Balint P. V. et al. Reliability of a consensus-based ultrasound definition and scoring for enthesitis in spondyloarthritis and psoriatic arthritis: an OMERACT US initiative. Ann Rheum Dis 2018 Dec;77(12):1730-1735.Disclosure of Interests:None declared.

scholarly journals Effect of topical tacrolimus ointment on SCORAD index in pediatric atopic dermatitis.

2020 ◽  
Vol 27 (11) ◽  
pp. 2414-2418
Author(s):  
Shazia Bano ◽  
Munazzah Meraj ◽  
Rao Irfan
Keyword(s):  
Atopic Dermatitis ◽  
Clinical Signs ◽  
Case Series ◽  
Systemic Review ◽  
Female Ratio ◽  
Tacrolimus Ointment ◽  
Topical Tacrolimus ◽  
Case Series Study ◽  
Co Morbidity ◽  
Morbidity Data

Objectives: To determine topical tacrolimus ointment’s efficacy in atopic dermatitis. Study Design: Descriptive case series study. Setting: Outpatient Department of Dermatology, Liaquat University of Medical and Health Sciences (LUMHS), Civil Hospital, Hyderabad. Period: 12 October 2017 to 12 April 2018. Material & Methods: Consisted of 106 patients. Detailed History was taken from patients and systemic review was also done to assessed any co-morbidity. Data was analyzed through SPSS version 23.0. Results: In this study 71 (66.98%) patients were men and 35 (33.01%) were female; with male to female ratio 2:1. The mean age was 6.1+1.8 years. Clinical signs of patients were erythema 88(83.01%), edema 76(71.69%), Oozing/ crusting 45(42.45%), excoriation 59(55.66%) and lichenification 64(60.37%). Before treatment start the SCORAD index (SCORAD I) mean was 61.8 ± 11.12 (range 7–103): moderate cases were observed in 87(82.07%) patients (SCORAD I 30 – 49) and 19(17.92%) patients had severe AD (SCORAD I ≥50). After treatment, the SCORAD index mean was 35.8 ± 13.15 (range 7–103): 57(53.77%) patients had SCORAD index values ≤30; moderate cases (SCORAD I 30-49) were observed in 42(39.62%) patients and 7(6.60%) patients had severe AD (SCORAD I >50). In 57(53.77%) cases topical tacrolimus ointment (0.1%) showed positive efficacy in atopic dermatitis, while in 49(46.22%) cases observed negative. Conclusion: The application of topical tacrolimus ointment (0.1%) is effective in the treatment of atopic dermatitis in children.

scholarly journals COMPARING THE EFFECTS OF INTRANASAL BETAMETHASONE SODIUM SULPHATE AND BECLOMETHASONE DIPROPIONATE IN PATIENTS WITH ALLERGIC RHINITIS

2021 ◽  
Vol 71 (3) ◽  
pp. 787-90
Author(s):  
Amir Ali Khan ◽  
Tehmina Rehman Syed ◽  
Attique Ahmed ◽  
Usman Rafique
Keyword(s):  
Allergic Rhinitis ◽  
Beclomethasone Dipropionate ◽  
Clinical Symptoms ◽  
Clinical Success ◽  
Sodium Sulphate ◽  
Military Hospital ◽  
P Value ◽  
Chi Square ◽  
Quasi Experimental ◽  
Chi Square Test

Objective: To compare the effects of Intranasal Betamethasone and Beclomethasone in patients with Allergic Rhinitis. Study Design: Quasi experimental study. Place and Duration of Study: Combined Military Hospital Bahawalpur and Shahida Islam Medical and Dental College Lodhran, from Mar 2018 to Feb 2019. Methodology: A total of 200 patients who were between 22-55 years of age were included in this study. Half of them received Intranasal Betamethasone were compared with the other half who received Intranasal Beclomethasone. Clinical success was compared in both groups in terms of patients becoming a symptomatic. Results: Clinical symptoms were markedly reduced in both groups at the end of the study as 94 (94%) and 78 (78%) of patients who were on Intranasal Betamethasone and Intranasal Beclomethasone respectively showing that Intranasal Betamethasone is superior to Intranasal Beclomethasone in controlling Allergic Rhinitis symptoms. Chi square test is applied and p-value calculated (p=0.045) significant. Conclusion: Intranasal Betamethasone is far more effective drug as compare to Intranasal Beclomethasone in controlling allergic symptoms.

Efektivitas Aroma Terapi Lemon untuk Menangani Emesis Gravidarum

2019 ◽  
Vol 11 (4) ◽  
pp. 277-284
Author(s):  
Vitrianingsih Vitrianingsih ◽  
Sitti Khadijah
Keyword(s):  
Pregnant Women ◽  
Sampling Technique ◽  
T Test ◽  
The Body ◽  
Nausea And Vomiting ◽  
P Value ◽  
Purposive Sampling ◽  
Body Tissues ◽  
Quasi Experimental ◽  
Paired T Test

Studi memperkirakan emesis gravidarum terjadi pada 50-90% kehamilan. Mual muntah pada kehamilan memberikan dampak yang signifikan bagi tubuh dimana ibu menjadi lemah, pucat dan cairan tubuh berkurang sehingga darah menjadi kental (hemokonsentrasi). Keadaan ini dapat memperlambat peredaran darah dan berakibat pada kurangnya suplay oksigen serta makanan ke jaringan sehingga dapat membahayakan kesehatan ibu dan janin. Salah satu terapi yang aman dan dapat dilakukan untuk mengurangi keluahan mual muntah pada ibu hamil adalah pemberian aromaterapi lemon. Penelitian bertujuan untuk mengetahui efektifitas aroma terapi lemon untuk menangani emesis gravidarum. Penelitian ini menggunakan rancangan Quasi experiment  dengan  one group pre-post test design. Populasi penelitian adalah ibu hamil yang mengalami emesis gravidarum di Kecamatan Berbah, Sleman. Jumlah sampel 20 ibu hamil trimester pertama yang diambil dengan teknik purposive sampling. Pengukuran mual muntah dilakukan debelum dan setelah  pemberian aromaterapi lemon menggunakan Indeks Rhodes. Analisa data menggunakan uji Paired t-test. Hasil penelitian didapatkan rata-rata skor mual muntah sebelum pemberian aromaterapi lemon berdasarkan Indeks Rhodes pada Ibu Hamil dengan emesis gravidarum yaitu 22,1 dan terjadi penurunan skor setelah pemberian aromaterapi lemon menjadi 19,8. Ada pengaruh pemberian aromaterapi lemon dengan pengurangan mual muntah pada ibu hamil (p-value = 0.017). Berdasarkan hasil penelitian dapat disimpulkan pemberian aromaterapi lemon efektif untuk mengurangi emesis gravidarum pada ibu hamil trimester pertama.  Kata kunci: aromaterapi lemon, emesis gravidarum THE EFFECTIVENESS OF LEMON AROMATHERAPY FOR HANDLING EMESIS GRAVIDARUM   ABSTRACT Studies estimate that nausea and vomiting (emesis gravidarum) occur in 50 – 90% of pregnancies. Nausea and vomiting of pregnancy have a significant impact on the body in which it makes a mother becomes weak, pale, and decreasing body fluid so that the blood becomes thick (hemoconcentration). This situation can slow down blood circulation and inflict the lack of oxygen and food supplies to the body tissues so that it can endanger the health of the mother and fetus. One of the therapies that is safe and can be conducted to reduce nausea and vomiting of pregnancy is by giving the lemon aromatherapy treatment. The research aims to determine the effectiveness of the aroma of lemon therapy to deal with emesis gravidarum. This study applied quasi-experimental research with one group pretest-posttest design. The population of this study was pregnant women who experienced emesis gravidarum. Furthermore, samples were 20 mothers from Berbah, Sleman taken by using a purposive sampling technique. Nausea and vomiting were assessed between before and after giving lemon aromatherapy using the Rhodes Index. The data were analyzed using the paired t-test. The mean score of nausea and vomiting before giving lemon aromatherapy on mother with emesis gravidarum based on the Rhodes Index was 22.1. However, it decreased after given lemon aromatherapy treatment to 19.8. Therefore, there was an effect on giving lemon aromatherapy treatment toward the decrease of nausea and vomiting for pregnant women (p-value = 0.017). Lemon aromatherapy is effective to reduce emesis gravidarum.  Keywords: lemon aromatherapy, emesis gravidarum

Change in Visual Acuity in Relation to Central Macular Thickness after Intravitreal Bevacizumab in Diabetic Macular Edema

2020 ◽  
Vol 36 (3) ◽  
Author(s):  
Muhammad Ali Haider ◽  
Uzma Sattar ◽  
Syeda Rushda Zaidi
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Intravitreal Bevacizumab ◽  
Macular Thickness ◽  
Rank Test ◽  
P Value ◽  
Central Macular Thickness ◽  
Anti Vegf ◽  
Quasi Experimental

Purpose: To evaluate the change in visual acuity in relation to decrease in central macular thickness,after a single dose of intravitreal Bevacizumab injection.Study Design: Quasi experimental study.Place and Duration of Study: Punjab Rangers Teaching Hospital, Lahore, from January 2019 to June 2019.Material and Methods: 70 eyes with diabetic macular edema were included in the study. Patients having high refractive errors (spherical equivalent of > ± 7.5D) and visual acuity worse than +1.2 or better than +0.2 on log MAR were excluded. Central macular edema was measured in μm on OCT and visual acuity was documentedusing Log MAR chart. These values were documented before and at 01 month after injection with intravitrealBevacizumab. Wilcoxon Signed rank test was used to evaluate the difference in VA beforeand after the anti-VEGF injection. Difference in visual acuity and macular edema (central) was observed,analyzed and represented in p value. P value was considered statistically significant if it was less than 0.01%.Results: Mean age of patients was 52.61 ± 1.3. Vision improved from 0.90 ± 0.02 to 0.84 ± 0.02 on log MARchart. The change was statistically significant with p value < 0.001. Central macular thickness reduced from 328 ±14 to 283 ± 10.6 μm on OCT after intravitreal anti-VEGF, with significant p value < 0.001.Conclusion: A 45 μm reduction in central macular thickness was associated with 0.1 Log MAR unit improvementin visual acuity after intravitreal Bevacizumab in diabetic macular edema.

PENGARUH PEMBERIAN PELAYANAN INFORMASI OBAT DAN KONSELING TERHADAP TINGKAT KEPATUHAN MINUM OBAT PADA PASIEN DIABETES MELITUS DENGAN HIPERTENSI DI RUMAH SAKIT DAERAH IDAMAN BANJARBARU

2020 ◽  
Vol 5 (2) ◽  
pp. 240-249
Author(s):  
Satrio Wibowo Rahmatullah ◽  
◽  
Ika Maulida Nurrahma ◽  
Adnan Syahrizal
Keyword(s):  
Drug Information ◽  
Treatment Success ◽  
Information Service ◽  
Regional Hospital ◽  
P Value ◽  
Chi Square ◽  
Cross Sectional ◽  
Quasi Experimental ◽  
High Level ◽  
Chi Square Analysis

Compliance to achieve treatment success can be improved by providing drug information services (PIO) and counseling to improve understanding of treatment instructions. The general objective of this study was to determine the effect of drug information service and counseling on the level of medication adherence in patients with diabetes mellitus (DM) with hypertension in the Banjarbaru Regional Hospital. This study uses a quasi experimental method with a cross sectional approach and takes patient data prospectively. The results of this study indicate that the group given PIO and counseling showed a high level of adherence as many as 20 respondents (100%). Whereas in the group that was not given PIO and the counseling level of adherence was low, there were 4 respondents (20%). Based on the mann-whitney analysis p-value = 0,000 (<α = 0.05) so that there are differences in the group with PIO and counseling with groups without PIO and counseling, while the chi square analysis p-value = 0.004 (<α = 0 , 05) so that PIO and counseling have a significant effect on the level of adherence to taking medication in patients with DM with hypertension at the Banjarbaru Regional Hospital.

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