The Effects of CYP2A6 Gene Polymorphism on Cardiovascular Diseases

The CYP2A6 gene encodes its enzymes and is highly polymorphic, leading to variations in allele forms, both in the active and inactive states. These changes result in a decrease, increase or deletion of enzyme activities. One of the specific substrates is nicotine, an active compound in cigarettes. Nicotine is a major risk factor for cardiovascular diseases, and the inactive alleles tends to decrease its metabolism and expands the threat to infections. Therefore, this study aims to evaluate the effects of CYP2A6gene polymorphism on cardiovascular diseases. Relevant literatures were obtained using PubMed and Google Scholar, while the eventual selection followed the inclusion and exclusion criteria. Based on this review, the CYP2A6 gene polymorphism, both in increased, decreased or deleted alleles, was known to significantly influence nicotine metabolism and its blood levels. Species categorized as slow or poor metabolizers, tend to decrease the nicotine metabolism, but result in greater nicotine blood levels. This outcome subsequently accelerated the activation of the sympathetic nervous system, lipolysis, and insulin resistance, to trigger atherosclerosis. In summary, CYP2A6 gene polymorphism is known to increase cardiovascular diseases, particularly among active or passive smokers.

The Roles of TNFRSF11B Genes as a Trigger for Secondary Osteoporosis in Rheumatoid Arthritis Cases

Rheumatoid arthritis (RA) is an autoimmune disorder responsible for widespread and persistent inflammation of the synovial joint lining. Hence, victims are prone to greater risk of developing secondary osteoporosis (OP), a common complication of arthritis. The global prevalence of secondary OP among RA patients is estimated between 22-36%, although certain genetic polymorphisms pose a possible influence. Also, bone remodeling is closely related to the receptor activator nuclear factor-κB ligand (RANKL)/RANK and osteoprotegerin (OPG). The variables play a significant role in osteoclastogenesis, due to the ability of OPG to inhibit osteoclast differentiation and activation. This literature review discusses the relationship of TNFRSF11B gene polymorphisms that encode OPG protein with the risk of developing secondary osteoporosis in RA patients. The research method encompassed exploring similar articles from Pubmed, Cochrane Library, and Medline, using particular keywords, such as “TNFRSF11B polymorphism”, “osteoprotegerin polymorphism”, “rheumatoid arthritis” and “secondary osteoporosis”. Several distinct conclusions were obtained after analyzing the effects of TNFRSF11B gene polymorphisms on secondary OP in RA cases. Furthermore, the TNFRSF11B gene showed various polymorphisms closely related to bone remodeling, including C950T, G1181C, A163G, T245G and rs4876869.

Workload Analysis of Pharmacy Technicians at Pharmacy Department of Universitas Padjadjaran Dental and Oral Hospital Using Workload Indicators of Staffing Needs

Job responsibilities are significantly accomplished with sufficient and appropriate labor, although it differs in various fields. A major challenge in health facilities involves the ability to balance the number of staff and workloads to ensure quality, effective and efficient performance. Developing countries continue to struggle, in terms of fulfilling these objectives, mainly due to limited resources and budget. Therefore, this study aimed to analyze the workload at the Pharmacy of Universitas Padjadjaran Dental and Oral Hospital (RSGM Unpad) using WHO’s workload indicators of staffing needs (WISN) technique. This study also applied a descriptive cross-sectional design and conducted the WISN methodology between May-September 2020. Subsequently, observations, discussions and interviews were used to generate relevant information from the hospital’s workforce and its 2019 records. The results showed the availability of 7 employees and an annual estimate of 97,440 minutes in work duration. As a consequence, the manpower demands for inpatient-outpatient and logistic-purchasing departments were 4 and 2 persons, respectively. The resulting WISN ratio was 1.17 (> 1), indicating an inadequate workload and staff number. Based on the WISN analysis, it is concluded that the pharmacy is overstaffed under the existing workload conditions. Therefore, employee redistribution and the development of pharmaceutical satellites towards enhancing effectiveness and efficiency are significantly recommended.

Adverse Events of Risperidone and Clozapine Combination Therapy on Schizophrenic Patients at Magelang Mental Hospital

The adverse drug effect of risperidone and clozapine combination therapy possibly increases the BMI, systolic and diastolic blood pressures of mental victims. This study aimed at determining the relationship between the duration of risperidone and clozapine combination therapy and increase in body mass index (BMI), systolic and diastolic blood pressures of schizophrenic patients. The correlation was obtained using the cohort retrospective method on 59 schizophrenic inpatients at Magelang Mental Hospital from February–May 2019. Participants were grouped into 2 categories, termed <8 and ≥8 weeks with 48 and 11 persons, respectively. Subsequently, patients’ BMI, systolic and diastolic blood pressures were measured during the first day of hospitalization and outpatient consultations, based on NCEP-ATP III cut off-point with the modification of Southeast Asian population’s BMI. Structured questionnaires were used to evaluate calory intake and physical activity as well as generate respondents’ medical records. The bivariate analysis results showed a significant relationship between BMI increase at initial hospitalization and during outpatient consultation on group ≥8 weeks therapy, 22.41±2.98 kg/m2 vs 25.2±6.80 kg/m2 (p=0.023, –2.75 (–5.12–(–0.39)). However, there is no major correlation occurred in systolic 117±11.73 mmHg vs 118±15.42 mmHg (p=0.797, 95%CI –1.07 (–9.41–7.26)) and diastolic blood pressures 76±7.86 mmHg vs 73±8.48 mmHg (p=0.192, 95% CI 3.52 (–1.81–8.86)) for both groups. Furthermore, age, gender, smoking status, dosage, co-medication, calory intake and physical activity indicated no substantial variations, in terms of the increase in BMI, systolic and diastolic blood pressures among two categories.

Therapeutic Response of Community Acquired Pneumonia in Geriatrics: A Case Series from Intensive Care Unit

Community acquired pneumonia (CAP) is a common major growing challenge to elderly populations. Several aging factors, including comorbidities, nutritional status and digestive dysfunctions have been associated with increasing CAP among older persons. Furthermore, Streptococcus pneumoniae remains the most predominant pathogen in geriatrics, although multiple drug resistance (MDR) species regularly occur, particularly in severe pneumonia. Broad-spectrum antibiotics or a combination of β-lactam and fluorokuinolones, or β-lactams and macrolides serve as a promising therapy mainly in critical CAP patients. This study describes two geriatric CAP cases representing two separate treatments with widely varied results. The combination of cefoperazone sulbactam-azithromycin did not generate suitable clinical response until 7 days. As a consequence, the macrolides were replaced with amikacin and continued for 3 days. Meanwhile, the cefoperazone sulbactam-levofloxacin samples significantly improved the clinical conditions under 9 days. The selection of antibiotics with sufficient lung penetration is important in providing the effective therapy. Conversely, azithromycin resistance potentially instigates ineffectiveness, but is also recommended due to its pleiotropic effects. The benefit of this case study shows that CAP treatment among older population requires a blend of antibiotics with either a fluorokuinolone or an aminoglycoside. In both instances, azitromisin is believed to demonstrate high resistance, therefore, it is incapable in functioning as a second antibiotic component.

The Beyond-Use Date Perception of Drugs in North Jakarta, Indonesia

Beyond-Use Date (BUD) refers to the unsafe period of drug consumption and is calculated from the moment of opening the primary package. Meanwhile, Indonesia has no current related data, in terms of public awareness. Therefore, this research aims to assess the BUD perception of North Jakarta communities and pharmacists’ roles in providing the relevant information. The data collection process employed a semi-structural interview across 6 districts in the research location between September-November 2019, followed by data transcription and thematic development. Based on 60 informants recruited by purposive sampling, three themes were obtained, including residual drug storage, pharmacists’ contributions, and BUD awareness. Furthermore, about 97% of the respondents were completely unaware of the subject matter, while 100% denied having any form of sensitization from pharmacists. The perception of 50% were based on the expiration date labelled on the medications. In summary, North Jakarta community’s views were possibly influenced by very poor BUD knowledge. Therefore, the role of pharmacists in educating patients and communities appears very essential.

Antibiotic Use and Resistance at Intensive Care Unit of a Regional Public Hospital in Bali: A 3-Year Ecological Study

Antibiotic resistance at Intensive Care Unit (ICU) has been impacted by several factors, including high utilization and selectivity. The consumption rate and its selective pressure appear very extensive, with regular opportunities for cross-transmissions. In addition, ICU patients are susceptible to carriage acquisition and subsequent infections with high resistant bacteria. Therefore, this study investigates the relationship between the use and resistance of antibiotics in the ICU of a regional public hospital. The results potentially serve as confirmations for planning programs necessary to control ICU-related antibiotic consumption levels. This ecological analysis was also based on inpatient retrospective data from a regional public hospital in Bali from 2017–2019. Subsequently, the amount of intake expressed as daily doses (DDDs) per 100 patient days, and percentage of resistant bacterial isolates were examined using Spearman rank correlation. The largest segment of the antibiotics was determined by drug utilization 90% (DU90%) and the phenotypic class was defined by Centers for Disease Control and Prevention (CDC). Similarly, the most predominantly applied antibiotics were levofloxcacin, ceftriaxone, ampicillin, cefotaxime, ciprofloxacin, ampicillin-sulbactam and gentamycin. Meanwhile, the major gram-negative bacteria were Acinetobacter baumannii, Enterobacter cloacae, Enterococcus faecalis, Escherichia coli, Klebsiella pneumonia and Pseudomonas aeruginosa. Furthermore, 5 multi drug resistant (MDR) bacteria were observed, including A. baumannii, E. cloacae, E. coli, K. pneumonia and P. aeruginosa, while A. baumannii and E. cloacae occurred as carbapenem resistant (CR) and extended-spectrum cephalosporin-resistant (ESCR), respectively. However, only E. coli showed a negative significant correlation between antibiotic utilization and the percentage of ICU bacterial sensitivity (r=–0,543; p=0,024). Therefore, higher consumption of antibiotics decreases its percentage susceptibility.