Analysis of matrix metalloproteinase-9 levels among acute heart failure patients with ACE inhibitor therapy (Dr. Soetomo Regional General Hospital, Surabaya).

OBJECTIVES: Heart disease is a clinical condition characterized by specific signs such as joint inflammation, weakness, and shortness of breath. Left ventricular remodeling can be experienced by patients with heart failure wherein a change in myocyte and nonmyocyte components occurs. One of the biomarkers in heart disease with myocardial fibrosis is matrix metalloproteinase-9 (MMP-9). Common therapy that is often given to patients with heart failure is ACE inhibitors. This main objective of this research is to investigate the effect of ACE inhibitor therapy on the degrees of MMP-9 as a biomarker among patients with heart disease. METHODS: This research applied one group pretest-posttest design to analyze the variation in the levels of MMP-9 as a biomarker for heart function. Twenty-three subjects with acute heart disease met that inclusion also exclusion criteria, who were selected using nonrandom sampling. Statistical analysis was conducted to specify the levels of MMP-9 before, after the administration of therapy. RESULTS: The most widely used ACE inhibitor drug was ramipril for 15 patients (65%), and the least used ACE Inhibitor drug was captopril for two patients (9%). Meanwhile, the mean MMP-9 levels before therapy was (1,915.26 pg/mL ± 260.84), and the mean MMP-9 levels after therapy was (1,916.93 pg/mL ± 383.12). The statistical analysis result revealed no significant difference in the degrees of Matrix Metalloproteinase-9 accumulation (p=0.378). CONCLUSIONS: There was no significant reduction in the levels of Matrix Metalloproteinase-9 after pretest and posttest.

Analysis of the side effect of QTc interval prolongation in the bedaquiline regimen in drug resistant tuberculosis patients.

OBJECTIVES: Indonesia is one of the top 20 countries with the highest prevalence of drug resistant tuberculosis (DR-TB) worldwide with a percentage of new cases of 2.4% and retreatment of 13%. Bedaquiline (BDQ) is one of the drugs that used in the individual long regimen treating DR-TB. BDQ is also combined with levofloxacin (LFX) and/or clofazimine (CFZ) that can cause QTc interval prolongation. The aim was to study the differences in the use of BDQ regimens to the lengthening of the QTc interval and to study risk factors (diabetes, hypokalemia, sex, BMI, and age) in BDQ regimen. METHODS: This study was an observational retrospective study with a total sampling method, which was conducted at Dr. Soetomo General Hospital Surabaya. Samples from this study were patients diagnosed with DR-TB at Dr. Soetomo General Hospital Surabaya in the period of January 2015-December 2019 who used BDQ regimen and met the inclusion criteria. The ECG data were analyzed from the mean of each group (BDQ regimen and risk factors), also analyzed using statistical analysis. RESULTS: Data obtained from total sample in this study were 73 patients. The most widely used different regimens in this study were the combination of BDQ + LFX by 36 patients (49.3%), BDQ + LFX + CFZ by 16 patients (21.9%), BDQ by 11 patients (15.1%) and BDQ + CFZ 10 patients (13.7%). Out of 73 patients, 52 patients (71.2%) experienced lengthening of the QT interval and grade 1 of QTc interval prolongation occurred in most patients and also the onset was mostly one month after using BDQ regimen. The side effects of QTc interval prolongation from groups of combination and risk factors were no difference in each month (p>0.05). CONCLUSIONS: This study can be concluded that there were no differences in the QTc prolongation between the groups of BDQ regimen (BDQ, BDQ + LFX, BDQ + CFZ and BDQ + LFX + CFZ) and the groups of risk factors.

Hematological side effect analysis of linezolid in MDR-TB patients with individual therapy.

OBJECTIVES: This study aimed to estimate the prevalence and analyze the risk factors for linezolid-induced hematological side effects in multidrug-resistant tuberculosis (MDR-TB) patients. METHODS: Data were collected from medical records of MDR-TB patients who received linezolid between January 2018 and May 2020. Statistical significance analysis and multivariate analysis were performed with SPSS version 24 software. RESULTS: Hematological side effects were identified in 27 out of 93 patients (29.0%). The most prevalent effect was anemia (29.0%), while the less prevalent effects were thrombocytopenia (3.2%) and leukopenia (2.2%). These side effects were reported after 2 weeks of linezolid treatment. The drug dose was more than 11 mg/kgBW/day or patient weighing less than 54 kg was identified as an independent risk factor for anemia in multivariate analysis. CONCLUSIONS: Anemia was the most prevalent of linezolid-induced hematological side effects in MDR-TB patients. Therefore, hemoglobin monitoring might be recommended in patients weighing less than 54 kg and after receiving linezolid therapy for at least 2 weeks.

Adverse drug reaction and its management in tuberculosis patients with multidrug resistance: a retrospective study.

OBJECTIVES: This study was conducted to assess adverse drug reactions and their management in MDR-TB patients. Indonesia is the fifth highest country with multidrug-resistant tuberculosis (MDR-TB) high burden around the world. The number of MDR-TB patients in Indonesia is increasing every year, but the data regarding ADRs are still limited. Therefore, more data on their characteristics and their management is very valuable for clinicians and pharmacists. METHODS: The study is a descriptive study, using retrospective data of MDR-TB patients who completed therapy from January 1st, 2015 to December 31st, 2015 at the Tuberculosis Outpatient unit at the Dr. Soetomo Teaching Hospital Indonesia. Each adverse effect was judged with standards of the clinic and was documented in patients' medical records. RESULTS: There were 40 patients included in this study. During therapy, 70% of patients developed at least one adverse drug reaction. The five most prevalent adverse effects found in this study were hyperuricemia (52.5%) followed by gastrointestinal (GI) disturbances (40%), ototoxicity (37.5%), hypokalemia (27.5%), and athralgia (12.5%). Managements that were undertaken to overcome the adverse drug reactions were adding symptomatic drugs and/or modifying the treatment regimen. CONCLUSIONS: Because of the small samples we cannot attain a general conclusion. However, the result of this study is very imperative as this data gives us insight regarding adverse effects in MDR-TB patients in Indonesia.