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   Table of Contents - Current issue
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December 2019
Volume 11 | Issue 8 (Supplement)
Page Nos. 547-649

Online since Monday, December 30, 2019

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ORIGINAL ARTICLES  

Physical study of Chloramphenicol In Situ Gel with Base Hydroxypropyl Methylcellulose and Poloxamer 188 Highly accessed article p. 547
Insan S Kurniawansyah, Dolih Gozali, Iyan Sopyan, Muhammad Iqbal, Anas Subarnas
DOI:10.4103/jpbs.JPBS_201_19  
Objective: The aim of this study was to determine the best formulation of ophthalmic in situ gel preparation by two different bases, Poloxamer 188 and HPMC (hydroxypropyl methylcellulose), with physical evaluation, such as organoleptic, pH, viscosity, and gel capacity during 28 days of storage time. Materials and Methods: The two different concentrations of the gel made by using Poloxamer 188 were F1 (5%) and F2 (10%), and those made by using HPMC were F3 (0.45%) and F4 (1%). Results: The results of this study showed that formulation 1 (F1) was the optimum formulation, having pH 6.45, viscosity of 5.47 cP, and a better gel capacity than other formulas. Conclusion: In situ gel for ophthalmic preparations is developed to mask the limitation of conventional forms of ophthalmic preparation. In situ gel technology significantly increase the effectivity of drugs in the raw material and drug bioavailability in new drug delivery systems based on in situ gel concept.
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Antioxidant activity of crude bromelain of pineapple (Ananas comosus (L.) Merr) crown from Subang district, Indonesia Highly accessed article p. 551
Nyi M Saptarini, Driyanti Rahayu, Irma E Herawati
DOI:10.4103/jpbs.JPBS_200_19  
Background: Antioxidants are chemical compounds that can donate one or more electrons to free radicals to prevent degenerative diseases. The crown of pineapple (Ananas comosus (L.) Merr.) contains bromelain, that is, a proteolytic enzyme, which can act as an antioxidant. Aims and Objectives: The aim of this study was to determine the antioxidant activity of crude bromelain from pineapple crowns that were collected from Subang district, West Java, Indonesia. Materials and Methods: Antioxidant activity was determined by the method of 2,2-diphenyl-1-picrylhydrazyl (DPPH) with vitamin C as a standard and measured with visible spectrophotometer. Results: The pineapple crown was produced 0.26% of dried crude bromelain with total protein content 44.10% and IC50 value 3624 μg/mL of crude bromelain, which was equivalent to 1590.18 μg/mL of total protein. Conclusion: Crude bromelain has medium antioxidant activity.
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Anticalculi activity of apigenin and celery (Apium graveolens L.) extract in rats induced by ethylene glycol–ammonium chloride p. 556
Sofi N Stiani, Fillah M Syahidah, Hanindhiya Fikriani, Anas Subarnas, Taofik Rusdiana
DOI:10.4103/jpbs.JPBS_202_19  
Objective: Kidney stones (nephrolithiasis) is one of the kidney diseases in the form of stones that contain crystal and organic matrix components. It is one of the most common diseases of the urinary tract. Calcium stone is the most important type of stone (80%) found in the case of kidney stones. Celery (Apium graveolens L.) is a plant rich in flavonoids, which can break down calcium crystals. Apigenin is considered to be one of the main flavonoids because of its presence and abundance in celery. This research aimed to compare the anticalculi effect of apigenin with that of celery extract. Materials and Methods: Wistar albino rats were given ethylene glycol 0.75% (vol/vol) and ammonium chloride 2% (wt/vol) orally for 7 days in all groups to induce hyperoxaluria and Rats treated by Apigenin at doses 1.2, 2.4, and 4.8 mg/kg of rat body weight and celery extract at doses of 200, 400, and 600 mg/kg of rat body weight as anticalculi. Measurements of calcium levels in the kidneys and urine of rats was obtained using atomic absorption spectroscopy. Data obtained were statistically analyzed with the IBM SPSS by ANOVA Method version 21.0 probability value < 0.05 was considered significant. Result: The results showed that both apigenin and celery extracts caused kidney stone to decay. From the data Apigenin and celery showed that calcium level in urine there were significant differences (p value < 0.05) in treated group from negative control group but calcium level in kidney there were not significant differences (p value > 0.05). Conclusion: Celery extract has better ability to break down kidney stones than apigenin.
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Optimization of secreted recombinant human epidermal growth factor production using pectate lyase B from Escherichia coli BL21(DE3) by central composite design and its production in high cell density culture p. 562
Sriwidodo Sriwidodo, Toto Subroto, Iman P Maksum, Nasrul Wathoni, Tina Rostinawati, Himmatul Ulya, Indah U Putri
DOI:10.4103/jpbs.JPBS_207_19  
Context: Human Epidermal Growth Factor (hEGF) is a potential therapeutic protein that has been widely used as a healing agent for various chronic wounds. It induces the proliferation and metabolism of epithelial cells, regenerates skin cells, and validates skin elasticity. In the previous study, recombinant hEGF (rhEGF) had been successfully expressed extracellularly in Escherichia coli (E. coli) BL21 (DE3) using pectate lyase B (PelB) signal peptide. The previous study has shown that the medium concentration and the induction time influenced the production of rhEGF. Aims: Therefore, this study was conducted to optimize the induction time and medium concentration for rhEGF extracellular secretion then followed by scale-up production. Settings and Design: This experiment was carried out using E. coli BL21 (DE3) which contains pD881 plasmid that carries hEGF and PelB gene. Optimization design of induction time and medium concentration were obtained using Central Composite Design (CCD). Methods and Material: The method of study started by the rejuvenation of E. coli culture, extracellular secretion, and optimization in the flask scale then followed by scaled-up production with high-cell density culture in the fermenter. Statistical analysis used: The optimization was carried out using Response Surface Methodology (RSM) and multi regression analysis. Results: This work showed that the multiplication of 1.5-fold medium concentration with induction time 3h after the culture started gave the best result among another condition in this study. Additionally, the rhEGF production in the fermenter scale was identified by SDS-PAGE Tricine and quantified by ELISA, which showed 122.40 μg of the rhEGF per milliliter medium. Conclusions: In respect of the result, we conclude that the optimized condition of extracellular secretion was successfully obtained, and gives higher result before the previous study.
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Comparative effect of curcumin and nanocurcumin on nephroprotection at cisplatin-induced rats p. 567
Ni Made D Sandhiutami, Wawaimuli Arozal, Melva Louisa, Deni Rahmat, Tjoeng Mandy
DOI:10.4103/jpbs.JPBS_208_19  
Background: Cisplatin is a first-line chemotherapeutic agent for various solid tumors including ovarian and breast cancer. Thereby, it has been proven effective as an antineoplastic agent, but its clinically use is limited because of its nephrotoxicity side effect. Aims and Objectives: This study aimed to investigate curcumin as a renoprotector agent against cisplatin nephrotoxicity. Materials and Methods: The samples used were curcumin and its nanoparticles formulated using ionic gelation method. The nephrotoxicity was investigated through several parameters such as serum creatinine, blood urea nitrogen, serum albumin, kidney weight ratio, and histopathology. These parameters were tested on rats and divided into the following four groups: normal group, negative control group that administered cisplatin with doses amount of 7 mg/kg body weight (BW) intraperitoneally, nanocurcumin group (cisplatin + nanocurcumin) and curcumin group (cisplatin + curcumin). The agents were administered at a dose of 100 mg/kg BW every day in 9 days before cisplatin administration. The sample of blood serum and kidneys organ were taken 48h after cisplatin administration. Results: The negative control group showed a significant increase in serum creatinine, blood urea nitrogen, and kidney weight ratio, whereas it showed a significant decrease in serum albumin. The administration of sample agents showed a significant decrease in serum creatinine, blood urea nitrogen, and kidney weight ratio and an increase in the albumin level as compared to negative control group. Conclusion: Nanocurcumin showed significant improvement in kidneys more than curcumin. In contrast, histopathological examination verified the necrosis in negative control group, suggesting the renoprotection effect of nanocurcumin against nephrotoxicity on cisplatin-induced rats.
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Knowledge, attitudes, and practices of lung cancer risk factors in West Bandung Society p. 574
Mally G Sholih, Dyah A Perwitasari, Rini Hendriani, Hadyana Sukandar, Melisa I Barliana, Auliya A Suwantika, Rizky Abdulah, Maya Febriyanti, Eky Septian, Ajeng Diantini
DOI:10.4103/jpbs.JPBS_213_19  
Background: Lung cancer is one of the leading causes of morbidity and mortality worldwide, so prevention of lung cancer is necessary. The aim of this study was to measure level of knowledge, attitude, and actions concerning risk factors of lung cancer in West Bandung. Materials and Methods: The research was conducted by quantitative study design with a quasi-experimental approach. Measurement of respondents’ knowledge, attitudes, and actions was carried out by giving questionnaires of knowledge, attitudes, and actions. Questionnaires were given to respondents before and after providing education about risk factors of lung cancer. Respondents were from 42 societies in Bandung. The data obtained were tested by using comparison and correlation test. Results: The results showed a significant difference between knowledge and attitudes (P = 0.001). Meanwhile, the action did not change significantly (P > 0.05). Correlation test showed that knowledge and attitude had a correlation of P = 0.001 in the pretest and P = 0.23 (P < 0.05) in the posttest. Conclusion: This research concludes that the level of knowledge and attitudes toward risk factors of lung cancer has increased.
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Effect of atypical antipsychotic on blood pressure in inpatients with schizophrenia of Prof. Dr. Soerojo Mental Health Hospital Magelang p. 580
Haafizah Dania, Melisa I Barliana, Dyah A Perwitasari, Rizky Abdulah
DOI:10.4103/jpbs.JPBS_211_19  
Context: Schizophrenia ranks the top of all mental disorders with poor prognosis. Central Java Province is in the top five of schizophrenia incidents in Indonesia. Antipsychotic is the main therapy for schizophrenia, which is divided into 2, atypical and typical. The atypical antipsychotic is more preferable because of the minimal effect of the extrapyramidal syndrome but affects the blood pressure. Aims: To analyze the blood pressure of schizophrenia inpatients during the pre and post-use of atypical antipsychotics in RSJ Prof. Dr. Soerojo Magelang. Settings and Design: This study was an observational study with cohort retrospective methods. Methods and Material: The research was approved and reviewed by the committee of ethics and law of Prof. Dr. Soerojo Mental Hospital. The inclusion criteria are those diagnosed with schizophrenia based on Diagnostic and Statistical Manual of Mental Disorders-IV (DSM IV), aged about 17-55 years old, receiving antipsychotic atypical therapy for at least 3 months.The exclusion criteria are inpatients who also receive antidepressants and antihypertension, have a history of cardiovascular disease and hypertension, and incomplete medical records. Statistical analysis used: Wilcoxon, Mann-Whitney, and Kruskal-Wallis test. Results: The result of this study most of them were treated using combination risperidone and clozapine (82.1%). In this study, 43 inpatients experienced a decrease in systolic blood pressure, 57 in systolic blood pressure, 6 with no change in systolic blood pressure, 47 a decrease in diastolic blood pressure, 50 an increase in diastolic blood pressure, and 9 with no change in diastolic blood pressure. Conclusions: There was no significant difference in the blood pressure before and after the treatment.
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Cost of Illness Study of Patients with Dengue Hemorrhagic Fever at One of the Private Hospitals in Yogyakarta p. 587
Woro Supadmi, Qorni N Izzah, Auliya A Suwantika, Dyah A Perwitasari, Rizky Abdulah
DOI:10.4103/jpbs.JPBS_214_19  
Dengue hemorrhagic fever (DHF) caused by the dengue virus is one of the high-prevalence diseases in tropical countries, such as Indonesia. It has been highlighted that high-prevalence diseases are strongly correlated with high-treatment costs. In particular, Yogyakarta has been reported as one of the provinces with a high prevalence of DHF. This study aimed to estimate the cost of illness because of DHF and to analyze the correlation between the use of drugs with its cost and length of stay, with total hospital administrative cost at one of the private hospitals in Yogyakarta. A cross-sectional study was applied in this study by collecting patients’ medical record and financial data, such as demographic characteristic, medication, length of stay, and direct medical cost health-care perspective. The numbers of dengue patients were applied in this study by considering 87 patients and 143 patients with DHF in 2015 and 2016, respectively. Indirect medical costs were collected from a questionnaire by 20 respondents. Spearman’s statistical test was used in this study to conduct the bivariate test. The average direct medical cost from the perspective of health care in 2015 and 2016 in DHF patients with Badan Penyelenggara Jaminan Sosial (BPJS) insurance and non-BPJS insurance was US$243.6; US$363.41 and US$368.13; US$427.03. The indirect medical costs showed that the highest percentage productivity loss was US$70.98–212.95. Correlation between the numbers of drug with drug cost was significant (P < 0.05) with correlation coefficient (value ρ) of 0.527 and 0.603. Correlation between lengths of stay with the cost of hospitalization was significant (P < 0.05) with correlation coefficient (value ρ) of 0.375 and 0.562. It can be concluded that DHF has a relatively high cost of illness both in direct and indirect costs.
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Analysis of lard in sausage using Fourier transform infrared spectrophotometer combined with chemometrics p. 594
Any Guntarti, Mustafa Ahda, Aprilia Kusbandari, Satriyo W Prihandoko
DOI:10.4103/jpbs.JPBS_209_19  
Sausage is one of foods which must be confirmed halal to consumers. Meat is commonly used in producing sausages, especially beef. However, due to high cost of meat producer usually mixes the ingredients with other cheaper meats, such as pork. This study aimed to analyze the differences in the spectral profile of lard and beef in the sausages using Fourier transform infrared (FTIR). Lard and beef tallow was extracted using Soxhlet apparatus at ±70°C for 6 h with n-hexane. After extraction, lard and beef tallow was evaporated. Then obtained fats were stored in eppendorf and analyzed using FTIR spectrophotometer. The results were then combined with chemometrics such as Partial least squares (PLS) for the quantitative analysis and principal component analysis (PCA) for classification. PLS and PCA analysis was performed on 1200–1000 cm–1. The results of the analyzed PLS provided the linear regression equation y = 0.921x + 4.623 with R2 = 0.985 and root-mean-square error of calibration (RMSEC) = 2.094%. External validation root-mean-square error of prediction (RMSEP) was 4.77% and internal validation root-mean-square-error cross-validation (RMSECV) was 5.12%. The results of the PCA analysis showed the classification of different quadrants between 100% pork sausage and 100% beef sausage. Thus, it can be concluded that FTIR spectroscopy method combined with chemometrics can be applied to identify the presence of pork in the sausage.
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Polymorphism of TPH2 gene rs120074175 is not associated with risk factors of schizophrenia p. 601
James P Laksono, Riyadi Sumirtanurdin, Haafizah Dania, Fitri N Ramadhani, Dyah A Perwitasari, Rizky Abdulah, Melisa I Barliana
DOI:10.4103/jpbs.JPBS_216_19  
Context: Polymorphism on tryptophan hydroxylase 2 (TPH2) gene rs120074175 can cause the synthesis of neurotransmitter serotonin in the brain to reduce up to 80%. Reduced serotonin in the brain can cause dopamine release to occur continuously. Excess dopamine in the brain may cause positive symptom of schizophrenia. Aim: The aim of this study was to investigate the genotype distribution of TPH2 rs120074175 gene on patients with schizophrenia at Prof. Dr. Soerojo Magelang Psychiatric Hospital, Indonesia, and the relationship between the genetic polymorphism of the TPH2 rs120074175 gene against risk factors of schizophrenia. Settings and Design: This was a cross-sectional study. Materials and Methods: The method used was amplification refractory mutation system–polymerase chain reaction (ARMS-PCR). Whole blood from healthy subjects and patients with schizophrenia, Wizard genomic deoxyribonucleic acid (DNA) purification kit (Promega, Fitchburg, Wisconsin), PCR master mix (Promega), ARMS-PCR primers, ddH2O, agarose (Thermo Scientific, Seoul, South Korea), Tris, Acetic Acid, EDTA (TAE) 1X, ethidium bromide, loading dye 6×, and DNA ladder (Thermo Scientific) were the materials used. Statistical Analysis: Hardy–Weinberg equilibrium and chi-square (χ2) tests were used. Results: The results showed that both groups (healthy subjects and patients with schizophrenia) at the Prof. Dr. Soerojo Magelang Psychiatric Hospital have a wild-type GG genotype (100%) without anyone having a mutant A allele. Conclusion: TPH2 rs120074175 gene polymorphism was not associated with risk factors for schizophrenia.
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Single-nucleotide polymorphism of CTLA-4 (rs5742909) in correlation with schizophrenia risk factor p. 605
Riyadi Sumirtanurdin, James P Laksono, Haafizah Dania, Fitri N Ramadhani, Dyah A Perwitasari, Rizky Abdulah, Melisa I Barliana
DOI:10.4103/jpbs.JPBS_215_19  
Background: Cytotoxic T protein lymphocyte antigen-4 (CTLA-4) plays a key role in regulating the T-cell system, where occurrence of disturbances in the system seen by imbalances in Th1 and Th2 levels is believed to be one of the etiologies of schizophrenia. Single-nucleotide polymorphisms (SNPs) at rs5742909 in the CTLA-4 gene (C→T) might affect the expression level of CTLA-4 protein. Aims and Objectives: The aim of this study was to determine the genotype distribution of the CTLA-4 gene (rs5742909) in patients with schizophrenia at Rumah Sakit Jiwa Prof. Dr. Soerojo Magelang and identify the correlation of these genetic polymorphisms as the risk factors of schizophrenia. Materials and Methods: This research was conducted through the stage of submitting ethical approval, primer design, chromosomal DNA isolation, optimization of polymerase chain reaction conditions, and data analysis. Results: Based on the results of the study, the CC genotype was shown in 36 patients (78.26%), TT genotype in 10 patients (21.73%), and no TT genotypes. However, statistical analysis using Fisher’s exact and binary logistic regression statistical test showed no significant relationship between genetic polymorphism of the CTLA-4 rs5742909 against risk factors for schizophrenia (P = 0.05; α = 5%). Conclusion: SNP at rs5742909, C-to-T-allele transition, was not significant associated with the risk of schizophrenia.
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Determination of the major component of water fraction of katuk (Sauropus androgynous (L.) Merr.) leaves by liquid chromatography–mass spectrometry p. 611
Resmi Mustarichie, Tiara Salsabila, Yoppi Iskandar
DOI:10.4103/jpbs.JPBS_205_19  
Background: The katuk leaf (Sauropus androgynous (L.) Merr.) is one of the plants that are used to overcome baldness by the people of Kampung Mak Kemas, Malaysia. It is suspected that secondary metabolites contained in katuk leaves play a key role in stimulating hair growth. Aims and Objectives: The aim of this study was to identify the optimum method to obtain one of the chemical compounds in the water fraction and to identify the hypothesized chemical isolates in the water fraction katuk leave’s ethanol extract. Materials and Methods: The methods used in this study included the collection and determination of the katuk plant, the processing of the katuk, phytochemical filtrating, extracting with ethanol 96%, and fractionation using the liquid-liquid extraction method with n-hexane, ethyl acetate, and water solvents The water fraction of katuk leaves was analyzed by its components by thin-layer chromatography using the stationary phase of silica gel 60 F254, developer of n-butanol:acetic acid:water (4:1:5), and detection under ultraviolet (UV) light at a wavelength of 366 and 254nm, as well as with vanillin-sulfuric acid reagent. To isolate the compounds from water fraction of katuk leaves, it was then eluted with a vacuum column chromatography by eluent with a level polarity that would get 11 subfractions. Each subfraction was checked by two-dimensional thin-layer chromatography to see subfraction purity characterized by the appearance of a spot on the chromatogram plate. The isolate was analyzed using spot test, ultraviolet–visible spectrophotometer, infrared spectrophotometer, and liquid chromatography–mass spectrometry. Results: The isolate was an alkaloid compound with a molecular mass of 406.3131 m/z with the molecular formula C21H39N6O2 as S, S-5, 5′-amino-4,4′-dihexyl-propyldihydropyrazol-3, 3-one. Conclusion: One of the chemical compounds contained in the water fraction of the ethanol extract of the katuk leaf was an alkaloid group.
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Formulation and characterization of α-mangostin in chitosan nanoparticles coated by sodium alginate, sodium silicate, and polyethylene glycol p. 619
Nasrul Wathoni, Agus Rusdin, Erma Febriani, Destiana Purnama, Wahnidar Daulay, Sundoro Y Azhary, Camellia Panatarani, I Made Joni, Ronny Lesmana, Keiichi Motoyama, Muchtaridi Muchtaridi
DOI:10.4103/jpbs.JPBS_206_19  
Context: α-mangostin, one of the xanthone derivative compounds isolated from Garcinia mangostana L. peel extract, has an excellent anticancer efficacy. However, α-mangostin has a lack of site specificity, poor cells selectivity, and low aqueous solubility. Polymeric nanoparticles formulation can be used to solve these problems. Aim: Therefore, the main aim of this study was to develop polymeric nanoparticles of α-mangostin-based chitosan (αM-Ch) coated by sodium alginate (αM-Ch/Al), sodium silicate (αM-Ch/Si), and polyethylene glycol 6000 (αM-Ch/PEG). Materials and Methods: Polymeric nanoparticles were prepared by ionic gelation method with the spray pyrolysis technique. Optimized formula was characterized by scanning electron microscopy, particle size, entrapment efficiency, drug loading, Fourier transform infrared, X-ray diffraction (XRD), and differential scanning calorimetry (DSC). Results: αM-Ch/Al, αM-Ch/Si, and αM-Ch/PEG Nanoparticles were successfully prepared with the range of particle size approximately 200–400nm. The XRD patterns and DSC thermograms of αM-Ch/Al showed an amorphous state, whereas αM-Ch/Si and αM-Ch/PEG indicated low crystalline forms. In addition, αM-Ch/Al had the highest entrapment efficiency (98.33% ± 0.06%) compared to αM-Ch/Si (70.46% ± 8.93%), and αM-Ch/PEG (92.24% ± 10.98%). Conclusion: These results suggest that αM-Ch/Al has the potential to enhance the physicochemical properties of α-mangostin for further formulation as an anticancer agent.
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Dosage and Duration of Methylprednisolone Therapy Affect the Occurrence of Cushing Habitus in Patients with Systemic Lupus Erythematosus p. 628
Didi Permana, Melisa I Barliana, Laniyati Hamijoyo
DOI:10.4103/jpbs.JPBS_212_19  
Context: Systemic lupus erythematosus (SLE) is a multisystem disease with very diverse developments. Corticosteroid is mostly used for the treatment of SLE as antiinflammatory and immunosuppressant, but its long-term use and high dose can cause the side effects such as Cushing habitus. Aim: Analyze the risk factors of Cushing habitus occurrence in patients with SLE comprising pulse dose, duration of therapy, daily dose, and total dose of methylprednisolone. Settings and Design: Case Control study. Materials and Methods: 40 patients with SLE treated at Rheumatology outpatient clinic at Hasan Sadikin Hospital in Bandung was conducted. Each of these patients were divided into case and control groups. The design of this study was a case control study, the data was retrieved from medical record of patients with and without cushing habitus. Statistical Analysis: Chi-squared test was used to test the relationship between independent variables followed by linear logistic regression analysis to determine the influence of the most influential variable in causing Cushing habitus. Results: The results of this study showed that the use of total dose of methylprednisolon (> 8040 mg) has a significant effect on the incidence of Cushing habitus p = 0.029; odds ratio [OR] = 3.55). In addition, daily dose of methylprednisolone >9.4 mg has a significant effect on Cushing habitus (p = 0.012; OR = 2.98). Conclusion: Significant relationship between daily dose and total dose of methylprednisolone on the occurrence of Cushing.
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Kahar method: A novel calculation method of tonicity adjustment p. 635
Abd. K Umar, Nasrul Wathoni, Aliya N Hasanah, Insan S Kurniawansyah, Marline Abdassah
DOI:10.4103/jpbs.JPBS_210_19  
Background: Hypertonic and hypotonic conditions in pharmaceutical preparations decrease the drug’s absorption and bioavailability. In addition, it can cause tissue damage. There are several calculation methods to regulate hypotonic preparations. However, there are no methods that can be used to regulate hypertonic preparations without causing dose-dividing problem. Objective: This study aimed to develop a new calculation using basic principle of freezing point depression method (cryoscopic) that can solve hypotonic and hypertonic problems, especially for hypertonic preparations through reducing the levels of additional ingredients. Methods: The calculation of Kahar method was successfully obtained by substitution and simplification in the basic principle equation of cryoscopic method, and then evaluated by resolving the problems in 42 sterile formula preparations and compared with White–Vincent method, cryoscopic method, equivalent NaCl method, and milliequivalent method through the analysis of its similarity and reliability. Results: The results of similarity analysis between Kahar method and other methods showed good similarity values with more than 0.880. Kahar method and cryoscopic method have the highest similarity of the calculation result with a similarity value of 1. The reliability analysis obtained very good result with Cronbach α = 0.990. Conclusions: These results suggest that Kahar method provides reliable equation with complete and efficient solution to hypotonic and hypertonic problems.
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