EVALUATION OF COVID-19 VACCINE EFFECTIVENESS AMONG HEALTHCARE WORKERS USING CASCADE ANALYSIS

Background: Healthcare workers in Indonesia have been prioritized for vaccination. Nevertheless, fully vaccinated healthcare workers are still at risk of being infected with COVID-19, but will be less likely to develop severe symptoms, be hospitalized or be at risk for death as compared to those who have not been vaccinated. Objectives: This study aims to analyze the incidence of COVID-19 in fully vaccinated healthcare workers. Methods: This cross-sectional study was conducted in 2021. All healthcare workers who have been fully vaccinated, have recovered from COVID-19 (2-4 weeks after vaccination) and able to complete a questionnaire were the participants. The collected data was then analyzed using the cascade method. Results: Based on the 529 collected questionnaires, by using the cascade analysis conclude that the percentage of healthcare workers who have been fully vaccinated was 99%, healthcare workers who have been fully vaccinated and then infected with COVID-19 was 14%, healthcare workers who have been fully vaccinated, infected with COVID-19 and hospitalized was 4%, healthcare workers who have been fully vaccinated, exposed to COVID-19, hospitalized and experienced the long-haul effect of COVID-19 was 0%. Discussion: Health workers are still at risk of being confirmed by COVID-19, because have high risk of being exposed in the workplace. The risk of being confirmed and severity are also influenced by age, gender and comorbidities. Conclusions: Complete vaccinations of healthcare workers did not reduce their risk of being infected with COVID-19, however, it can reduce the severity and the risk of the long-haul effects.

Sodium Hyaluronate Eye Drops for College Students with Computer Vision Syndrome in Indonesia

Highlight: Computer vision syndrome (CVS) that causes dry eyes becomes a health problem for college students. Sodium hyaluronate eyedrops can be used as one of the CVS therapy strategies for students suffering from CVS.   Abstract: The use of computers and mobile devices is increasing. Computers and mobile devices help our daily work or study. However, prolonged use of them may cause computer vision syndrome (CVS). Nowadays, CVS becomes a health problem for everyone working with computers or mobile devices including college students because it causes dry eyes. It may disrupt reading, doing professional work, or using a computer which is important for college students to complete academic tasks. Sodium hyaluronate can be used to overcome the dry eye problem due to CVS. To assess the effectiveness of sodium hyaluronate eyedrops on students suffering from CVS, pre- and post-administration of sodium hyaluronate was measured for two weeks. Inclusion criteria for this study were college students aged 20-35 years, using a computer for >2 hours a day, not using nonsteroidal anti-inflammatory drugs (NSAIDs), not consuming drugs, or having a disease that affects tear production and bearing no pregnancy. Parameters assessed include tear break-up time using the Tear Break-Up Time (TBUT) test, tear production using the Schirmer I test, the number of clinically subjective symptoms, and Ocular Surface Disease Index (OSDI) scores. Data were analyzed using student paired t-tests or Wilcoxon Rank Test. There were statistically significant differences before and after the TBUT (4.4 vs 6.7 seconds; p<0.0001); the Schirmer I Test (4 vs 6 mm; p<0.05), and the number of clinically subjective symptoms (3 vs 0 clinically subjective symptoms; p<0.0001). The OSDI scores did not show statistical differences before and after administration of sodium hyaluronate (27 vs 21; p>0.05), but there was a positive impact from moderate to mild dry eye. Sodium hyaluronate eyedrops can be used as one of the CVS therapy strategies for students suffering from CVS.

Prevalence and factors associated with potentially inappropriate medication and medication complexity for older adults in the emergency department of a secondary teaching hospital in Indonesia

Background

Older adults experience progressive decline in various organs and changes in pharmacokinetics and pharmacodynamics of the drugs in the body which lead to an increased risk of medication-related problems. Potentially inappropriate medications (PIMs) and medication complexity are key factors contributing to adverse drug events in the emergency department (ED).

Objective

To estimate the prevalence and investigate the risk factors of PIMs and medication complexity among older adults admitted to the ED.

Methods

A retrospective observational study was conducted among patients aged > 60 years admitted to the ED of Universitas Airlangga Teaching Hospital in January - June 2020. PIMs and medication complexity were measured using the 2019 American Geriatrics Society Beers Criteria® and Medication Regimen Complexity Index (MRCI), respectively.

Results

A total of 1005 patients were included and 55.0% (95% confidence interval [CI]: 52 - 58%) of them received at least one PIM. Whereas, the pharmacological therapy prescribed to older adults had a high complexity index (mean MRCI 17.23 + 11.15). Multivariate analysis showed that those with polypharmacy (OR= 6.954; 95% CI: 4.617 - 10.476), diseases of the circulatory system (OR= 2.126; 95% CI: 1.166 - 3.876), endocrine, nutritional, and metabolic diseases (OR= 1.924; 95% CI: 1.087 - 3.405), and diseases of the digestive system (OR= 1.858; 95% CI: 1.214 - 2.842) had an increased risk of receiving PIM prescriptions. Meanwhile, disease of the respiratory system (OR = 7.621; 95% CI: 2.833 - 15.150), endocrine, nutritional and metabolic diseases (OR = 6.601; 95% CI: 2.935 - 14.847), and polypharmacy (OR = 4.373; 95% CI: 3.540 - 5.401) were associated with higher medication complexity.

Conclusion

In our study, over one in every two older adults admitted to the ED had PIMs, and a high medication complexity was observed. Endocrine, nutritional and metabolic disease was the leading risk factors for receiving PIMs and high medication complexity.

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.

Correlation between the exposure time to mobile devices and the prevalence of evaporative dry eyes as one of the symptoms of computer vision syndrome among Senior High School students in East Java, Indonesia

OBJECTIVES

Computer vision syndrome (CVS) is a group of various eye and vision-related problems from prolonged use of mobile devices. Symptoms include dry eyes, blurred vision, eye strain, headache, and also neck and shoulder pain. This study was carried out to analyze the correlation between the exposure time of High Energy Visible (HEV) from mobile devices' use and the prevalence of evaporative dry eyes in young age.

METHODS

An observational cross-sectional study was done using quota sampling method for 100 High School students. Data collection was performed using questionnaire to identify daily use of mobile devices (hours) and duration for using mobile devices (years). A classification was determined as mild, moderate, and heavy HEV exposure. Evaporative dry eyes were diagnosed using tear break-up time test (TBUT) of less than 10 s for both eyes.

RESULTS

Ninety-four students participated in this study. A total of 82 students (87.2%) experienced evaporative dry eyes. There were 11 students (11.7%) who had dry eyes with mild exposure, 18 students (19.1%) had dry eyes with moderate exposure, and 53 students (56.4%) had dry eyes with heavy exposure. A chi square analysis showed all HEV exposures have similar risk to the prevalence of dry eyes among High School students (p<0.05).

CONCLUSIONS

The risk of developing evaporative dry eyes, as one of the symptoms of CVS in young age with normal tear production, could be induced even with minimal exposure to mobile devices.

Effectiveness of citicoline in pediatric patients with refractive amblyopia in Surabaya, East Java, Indonesia

OBJECTIVES

Amblyopia is a decrease of visual acuity that cannot be attributed to any structural abnormality of the eye or visual system, causing a partial or complete loss of vision due to inadequate stimulation in early life. Citicoline has been reported to improve visual acuity in amblyopic eyes as adjuvant treatment. This study was aimed to determine the effectiveness of citicoline in pediatric patients with refractive amblyopia in ophthalmology daily practices.

METHODS

This was a retrospective-descriptive study with a time limited sampling method. This study was conducted at Surabaya Eye Clinic, East Java, Indonesia, by reviewing medical records for the period of January 2018 to December 2019.

RESULTS

A total of 34 eyes were included in the study with the majority aged five years (41.2%) and six years (35.3%). The severity of amblyopia varied among patients, 21 eyes (61.76%) had mild amblyopia, seven eyes (20.59%) had moderate amblyopia, and two eyes (5.88%) had severe amblyopia. The duration of given therapy also varied, 18 eyes (52.94%) were given 3 months therapy, two eyes were given 4 months therapy, 12 eyes were given 6 months therapy, and two eyes were given 8 months therapy. Citicoline was found effective in mild and moderate amblyopia and for the duration of 3 and 6 months (p<0.05). In others group who did not showed statistically significant improvement was due to inadequate samples but clinically significant improvement was noted.

CONCLUSIONS

Citicoline therapy resulted in a clinically and statistically improvement in refractive amblyopia patients.

Providing counseling through home pharmacy care (HPC) for hemodialysis patients with hypertension in lowering blood pressure

OBJECTIVES

Hypertension is one of the main factors in increasing the risk of cardiovascular disease with 51% reported cause of death in chronic kidney disease (CKD) patients with end-stage renal disease (ESRD). It is a comorbid that needs to be managed properly and gets special attention from various health disciplines including a pharmacist.

METHODS

This was a quasi experimental study with pretest-posttest intervention using home pharmacy care (HPC) counseling both on the counseling and the noncounseling group. Initial data collection and informed consent was done at the Hemodialysis Unit Aloei Saboe and Toto Kabila Hospital, Gorontalo. The parameters in the study were patients' compliance to their medication using the Medication Adherence Questionnaire (MAQ) and Pill Count Adherence (PCA) questionnaires and the patient's blood pressure.

RESULTS

Fifty-eight patients met the inclusion criteria and were divided into two groups (the counseling group and the noncounseling group). Based on MAQ and PCA, the level of patient medication adherence increased significantly in the counseling group compared to the noncounseling group with a significance value of p<0.05. Increasing adherence was correlated with patients' outcome of lowering blood pressure. More patients in the counseling group showed decrease in systolic and diastolic blood pressure compared to the noncounseling group (86.2 vs. 17.2% for systolic BP and 69 vs. 10.3% for diastolic blood pressure (BP). Following adjusted confounding variables, counseling through HPC provided a chance of decreasing systolic blood pressure 32 times (95% CI: 7.198-144.550) and diastolic blood pressure 42 times (95% CI: 6.204-286.677).

CONCLUSIONS

HPC affects the improvement of patient medication adherence and reduction of blood pressure in hemodialysis patients with hypertension.

ANALYSIS OF CHANGES IN THE SERUM LEVEL NT-proBNP AFTER ACE INHIBITORS THERAPY IN PATIENTS WITH HEART FAILURE

BNP secreted by left ventricle as response to wall stress in patient with heart failure. Elevated concentration of NT-pro-BNP correlate with severity of heart failure across all stages of the condition and left ventricle ejection fraction in patient. Several clinical trials have demonstrated that neurohormonal modulation on the RAAS decreases NT-proBNP level and results in favorable outcomes. One of the drug used for blocked RAAS system is ACE inhibitor, decrease of NT-proBNP level show response to therapy include therapy with ACE inhibitors. To analize changes in the levels serum NT-proBNP levels after ace inhibitor therapy in patients with heart failure and monitoring creatinine serum. This study was a observational, prospective, non-randomized trial involving patient age 21-75 years, with NYHA class II-III HF, using ACE inhibitor therapy plus other therapy maximum 3 months before study without ARB or beta blocker. We compared serum NT-pro-BNP and creatinin serum parameters before and after two months treatment with ACE inhibitor. This study conducted in cardiovascular ambulatory patient dr. Soetomo hospital Surabaya. Between August-November 2015, 13 patient (38-63 years, 6 woman, 7 men) include in this study. The mean baseline level of NT-proBNP is 2166.92±1236.73 pg/ml, and creatinin serum 1.023±0.601 mg/dL. The NT-pro-BNP were significantly decreased after two months of treatment with ACE inhibitors 1508.23±651 pg/mL (p=0.025), there were no significant differences creatinin serum between two groups 0.951±0.0365 mg/dL (p=0.111). The results demonstrated the benefits of ACE inhibitor on the neurohormonal profile in patients with HF. If necessary we could measure NT-proBNP level to support prognosis data and monitoring effectivity therapy especially ACE inhibitor which had antiremodelling effect towards patients with HF.

ANALYSIS OF CHANGE IN NT-proBNP AFTER ANGIOTENSIN RECEPTOR BLOCKER (ARB) THERAPY IN PATIENT WITH HEART FAILURE

NT-proBNP is an inactive fragment of BNP secreted by stretched ventricle as response to wall stress in patients with heart failure. As a specific cardiac marker, elevated NT-proBNP correlates well with heart failure severity. The principle of heart failure therapy is modulation on neurohormonal activation. ARB can modulate neurohormon on RAA system, that result in decreasing NT-proBNP level and favorable outcomes. Reduction in NT-proBNP more than biologic variability (> 25%) shows a therapy response.This study was to analyze change of NT-proBNP after ARB therapy in ambulatory HF patients. This observational prospective study was carried from September to December 2015. Blood sampling was performed on patients who meet the inclusion criteria of the study at first visit and after 2 months therapy. NT-proBNP was measured by IMMULITE® as primary parameter and creatinin as secondary parameter. There are 14 patients met the inclusion criteria of the study (11 males and 3 females). ARB therapy used in patients were Valsartan (64%), Telmisartan (22%) and Candesartan (14%). After 2 months ARB therapy, a decrease in level of NT-proBNP with initial median 3092.5 (216 – 32112) pg/ml to 2135.5 (350 – 16172) pg/ml respectively were statistically significant (p=0.003). And the secondary parameter creatinin serum convert to eGFR shows a change in eGFR with initial median 73.33 (37.05 – 266.68) ml/minute to 81.04 (39.31 – 167.02) ml/minute respectively were statistically not significant (p=0.657). There were 7 patients (50%) have a decrease > 25%. In this study, we found that ARB therapy can change NT-proBNP level significantly after 2 months therapy.