Treatment patterns of antipsychotics and clinical features for treating patients with schizophrenia at the teaching hospital in Jakarta, Indonesia

Antipsychotics are a group of psychotropic drugs used as the mainstay treatment for schizophrenia. In Indonesia,studies on the pattern of drug use are still limited, particularly about the rational use of antipsychotics for schizophrenicpatients. This study was aimed to discuss the treatment patterns of antipsychotics and clinical features of inpatientswith schizophrenia. This retrospective study was conducted at the psychiatric ward of a tertiary hospital in Jakarta,Indonesia. The medical records of the inpatients in a year period were recorded. The evaluation of rational useof antipsychotics was assessed using clinical pathway in the hospital and some international guidelines. The datawere documented by using specific forms for the sake of this study. In this study, of the 113 analyzed patients, themost common type of schizophrenia was paranoid, while the common antipsychotics were risperidone (63.7%),haloperidol (20.4%), and quetiapine (19.5%). Surprisingly, we found that 73.4% of patients met one or more criteriaof inappropriateness treatment and majority cause of inappropriateness were inappropriate indication (41.6%). Inthis study, we find out that schizophrenia inpatients were administered to a large number of inappropriate treatments.Knowledge regarding the implementation of clinical pharmacology contributions to the psychiatrists might improvethe prescription’s pattern

Primaquine decreased plasma concentration of ritonavir: single- and repeated-dose study in Sprague Dawley rats.

Background: The present study was aimed to explore the effects of ritonavir and primaquine combination given as a singledose or repeated-dose compared to ritonavir alone on ritonavir plasma concentration in the rats. Methods: In single-dose study, 30 male Spraque Dawley rats were randomly allocated to receive ritonavir 20 mg/kg BW or ritonavir 20 mg/kg BW + primaquine 1.2 mg/kg BW or ritonavir 20 mg/kg BW + ketokonazole 10 mg/kg BW. Ketokonazole was used as positive control of ritonavir metabolism inhibitor. In the repeated-dose study, thirty Spraque Dawley male rats were randomly allocated to receive ritonavir 20 mg/kg BW/day or ritonavir 20 mg/kg BW/day + primaquine 1.2 mg/kg BW/day or ritonavir 20 mg/kg BW/day + rifampicin 100 mg/kg BW/day. Rifampicin was used as a positive control of ritonavir metabolism inducer. Results: In the single-dose study, ketokonazole increased the area under the plasma concentration (AUC) of ritonavir (↑114.8%, p< 0.05), while primaquine tended to decrease the AUC of ritonavir (↓ 32.6%, p> 0.05). Repeated-dose study showed that rifampicin decreases the AUC of ritonavir (↓ 42.8%, p< 0.001), and primaquine decreased the AUC of ritonavir plasma concentration (↓ 46.6%, p< 0.001). Conclusion: Concomitant administration of primaquine and ritonavir decreases the AUC of ritonavir. This effect may result in the insufficient concentration of ritonavir as anti-HIV, which may lead to treatment failure with ritonavir.

Incretin-based therapies for type 2 diabetes mellitus in Asian patients: Analysis of clinical trials.

Aim To review the effi cacy and safety data on incretin-based therapies currently available (exenatide, liraglutide, sitagliptin, vildagliptin) for the treatment of type 2 diabetes mellitus in Asian population. Methods We conducted Medline search of all relevant randomized clinical trials of incretin-based therapies for type 2 diabetes mellitus in Asian populations. Data pertinent to the effi cacy and safety of GLP-1 mimetics and DPP-4 inhibitors were extracted and used. Results We found 14 randomized controlled trials of incretin based-therapy which included 3567 type 2 diabetes mellitus in Asian population (Japanese, Chinese, Korean, Indian). It was shown that incretin-based therapies improved HbA1c at higher extent (up to -1.42% in exenatide 10 mcg bid, -1.85% for liraglutide 0.9 mg qd, -1.4% for sitagliptin 100 mg and -1.4% for vildagliptin 50 mg bid) compared to the effects observed in studies with Caucasian population, with comparable safety profi le. Conclusion The effi cacy of incretin-based therapies in Asian patients improved glycemic parameters in a higher magnitude on some glycemic parameters compared with those in Caucasian population. These results indicate that incretin-based therapies may be more effective in Asian population than in Caucasian.

CYP2A6 gene polymorphisms impact to nicotine metabolism.

Nicotine is a major addictive compound in tobacco cigarette smoke. After being absorbed by the lung nicotine is rapidly metabolized and mainly inactivated to cotinine by hepatic cytochrome P450 2A6 (CYP2A6) enzyme. Genetic polymorphisms in CYP2A6 may play a role in smoking behavior and nicotine dependence. CYP2A6*1A is the wild type of the CYP2A6 gene which is associated with normal or extensive nicotine metabolism. In the CYP2A6 gene, several polymorphic alleles have been reported such as CYP2A6*4, CYP2A6*7, CYP2A6*9, and CYP2A6*10 which are related to decreasing nicotine metabolism activity. The variation of nicotine metabolism activity could alter nicotine plasma levels. Smokers need a certain level of nicotine in their brain and must smoke regularly because of nicotine’s short half-life; this increases the number of smoked cigarettes in extensive metabolizers. Meanwhile, in slow metabolizers, nicotine plasma level may increase and results in nicotine toxicity. This will eventually lower the risk of dependence.

A survey on the appropriateness of drug therapy in patients with renal dysfunction at the Internal Medicine Ward FMUI/Dr. Cipto Mangunkusumo Hospital.

Aim Dose adjusment and drug selection is important in patient with renal dysfuction.This study was aimed to assess the accuracy of dose adjustment and drug selection for renal dysfunction patient at the Internal Medicine Ward FMUI/Dr. Cipto Mangunkusumo Hospital, Jakarta Methods Patients ≥ 18 years old with estimated creatinine clearance < 60 mL/minute based on Cockroft-Gault formula were included in this study. The drugs assessed were those excreted by the kidney or having nephrotoxic effect. The appropriateness of drug selection is assessed based on the preserce or not contraindication or potential of drug-drug interaction. The accuracy of dose adjustment were assessed based on information available in various textbooks, literatures, and drug brochures. Data were collected between May to July 2007. Results Data obtained from 43 patients met the inclusion criterias demonstrated that 164 out of 385 drug prescriptions were mainly eliminated by the kidney or have nephrotoxic characteristic. Out of 164 drug prescriptions, 142 (86.5%) were appropriately adjusted, while the other 22 (13.5%) were inappropriately adjusted for the dose. There was only one contraindication for the usage of the drug and 15.1% potentially drug interaction. Conclusion Dose adjustment and drug selections in patients with renal dysfunction at the Internal Medicine Ward FMUI/Dr. Cipto Mangunkusumo Hospital are conducted appropriately.

Effect of a combination of Phaseolus vulgaris L. extract and acarbose on postprandial glucose level after cooked rice intake in healthy volunteers.

Aim This study was aimed to measure the effects of combination Phaseolus vulgaris extract and acarbose compared to acarbose alone on postprandial glucose concentration in healthy volunteers after cooked rice intake. Methods Blood sample were obtained at several time points up to three hours after cooked rice intake. The parameter for postprandial glucose concentration is the area under the curve (AUC) of glucose concentration vs.time for three hours after cooked rice intake. Results After taking this combination, postprandial glucose concentration was reduced by 21.6%, while the reduction by acarbose alone was 22.9%. Conclusions The reduction of postprandial glucose concentration after administration of this combination was not significantly different compared to that after administration of acarbose alone.

The safety and efficacy of feracrylum as compared to silver sulfadiazine in the management of deep partial thickness burn: A clinical study report.

Instead of haemostatic effect, feracrylum provides antibacterial activity; wound improvement has been clinically proven. Feracrylum is a water soluble mixture of incomplete ferrous salt of polyacrylic acid containing 0.05 to 0.5% of iron in physiologic solution (0.85% solution of sodium chloride). A clinical study on safety and efficacy of feracrylum compared to silver sulfadiazine (SSD) was conducted in burn management, since with the widely use of SSD, the sulfadiazine’s disadvantages lead to wound healing impairment. In this open, randomized, controlled study, feracrylum and SSD were topically applied, each on different side of the burnt areas in parts of body for a treatment period of eleven days. Of eight enrolled patients, seven patients completed the study; one patient withdrew due to acute burn complication. On day 7th and 11th, the re-epithelialization in group receiving feracrylum increased as the raw surface area reduced. Mean percentages of epithelialization on both evaluation days in Feracrylum group were 70.53±24.298 and 81.71±28.922, respectively, which were higher than SSD group (66.15±25.080 and 64.64±74.684 respectively). Feracrylum was found to be safe and well tolerated. This study showed a clinical difference although it was not significant statistically.

Does hyperbaric oxygen administration decrease side effect and improve quality of life after pelvic radiation?

AIM: to evaluate the influence of HBOT to the side effect and quality of life after pelvic radiation. METHODS: this is an open randomized, parallel, prospective study conducted in Department of Obstetrics and Gynecology, Oncology Division and Department of Radiotherapy. Endoscopy procedure was performed in Department of Internal Medicine and tissue biopsy in Department of Pathology Anatomy. The hyperbaric oxygen therapy (HBOT) was done in Dr. Mintohardjo, Navy Seal Hospital Jakarta. The side effect was measured using LENT SOMA scale ratio, the quality of life used the Karnofsky score. The difference of two mean was analyzed using student t test. RESULTS: of 32 patients undergoing HBOT and 33 patients as control, the ratio of ASE of control group was 44.1+/-28.2%, HBOT group was 0.7+/-30.1%; p<0.001; the LSE of control group was 33.6+/-57.6%, HBOT group was -19.6+/-69.4%; p=0.008. Quality of life of control group after intervention was 4.5+/-10.7%; HBOT group was 19.7+/-9.6%; p <0.001. After 6 months of intervention the quality of life was 2.5+/-16.1% in the control group, and HBOT group was 15.2+/-14.7%; p =0.007. CONCLUSION: the study showed that HBOT decreased acute and late side effect, also improved the quality of life of patients with proctitis radiation.

Combination of interferon alfa-2b and ribavirin in relapsed or nonresponding chronic hepatitis C patients following interferon therapy.

Twenty six patients (pts) with chronic hepatitis C (CHC) who reLapsed or non-responded following.interferon (IFN) therapy were given lFN alfa-2b 3 MIU three times a week for 48 weeks in combination with Ribavirin 800-1000 mg daily 2I (80,8%) of the 26.pts completed the study consisted of 12 relapsers and 9 non-responders. Five pts dropped out due to drug adverse events in three pts and non-drug related reason in the other two. In the relapsed group complete response, relapse and sustained response rates were obtained in 9/12(75%), 2/2 (16,5%) and 7/12(58,3%) pts respectively. In the non- responding group, these figures were 3/9 (33,3%), 1/9(I1,1%), and 2/9(22,2%) pts, respectively. The most frequent adverse event was flu-like syndrome, which was found in 18 pts (85,7%). Combination therapy of IFN alfa-2b and ribavirin may induce sustained virological response in relapsed and non-responding CHC patients. This combination therapy is more effective for relapsers compared to for non-responders.

Comparison of the effïcacy and safety of isepamicin plus metronidazole and amikacin plus metronidazole in intra-abdominal infections.

Intra-abdominal infections due to penetrating wound through the abdominal wall or rupture of the gastrointestinal tract are acute conditions requiring prompt surgical intervention and the use of appropriate antimicrobial agents. Isepamicin is an effective aminoglycoside against various Gram-negative pathogens causing intra-abdominal infections. The objective of the present study is to compare the efficacy and safety of isepamicin (15 mg/kgBW IV o.d.) with amikacin (7.5 mg/kgBB b.i.d.), in conjunction with metronidazole for both drugs. An open, randomized, parallel design was applied in this trial. The subject allocation ratio for isepamicin: amikacin is 2:1. Out of 50 patients enrolled in this study, 27 fuffilled the criteria for safety and efficacy population, and 46 for intent-to-treat population. In the safety and efficacy population, the clinical success rare for isepamicin and amikacin group did not differ significantly (i.e., 95% and 100%, respectively). In the intent-to-treat population, the clinical success rates for isepamicin and amikacin group were also insignifficantly different (i.e., 97% and 100%, respectively). The rates of bacteriological elimination for isepamicin and amikacin, were 95% and 100%, respectively in the efficacy and safety population, and 90% and 93%, respectively in the intent-to-treat population. Streptococci and staphylococci were the most frequent (40%) pathogens isolated from pus, and Acinetobacter anitratus (55%) was the most common one isolated from blood. In the efficacy and safety population, the mean (± SD) length of hospital stay in the isepamicin and amikacin groups was 10.7 ± 3.9 and 11.1 ± 3.8 days, respectively, while in the intent-to-treat population, the mean (± SD) length of hospital stay in the isepamicin and amikacin groups was 10.1 ± 3.4 and 10.5 ± 3 days, respectively. In the present study, both aminoglycosides were well tolerated and there was no patient withdrawal associated with side effect. It is concluded that for intra-abdominal infections, intravenous isepamicin given once daily is as effective as intravenous amikacin given twice daily in combination with metronidazole.