Indonesian Journal of Pharmacy

Educational Curriculum to Improve Clinical Outcomes in Diabetes Mellitus Patients: A Systematic Review

Anita Kumala Hati, Nanang Munif Yasin, Susi Ari Kristina, Lutfan Lazuardi — Mon, 04 Sep 2023 00:00:00 +0700

The success of controlling the current condition of Diabetes Mellitus (DM) is not only determined by the help of medicine. DM therapy management is strongly supported by the success of providing education to DM patients, so that patients comply with treatment, adopt a healthy lifestyle, and can prevent complications that can end in death. This systematic review aims to find out what curriculum or content of educational materials needs to be given to DM patients to improve the achievement of clinical outcomes. Sage, Scient direct, and Pubmed were searched for relevant articles published between 2012 and 2022 using multiple search terms. STROBE tools were used to conduct quality assessments. Following that, a narrative synthesis of the findings was performed yield 1619 citations. After de-duplicating and screening, 18 studies were eligible for inclusion giving results. Educational materials related to diet/nutrition (n=17), physical activity (n=15), DM treatment (n=14), complications and risk factors (n= 13), goal setting or Healthy Living with DM (n=13), monitoring blood glucose levels parameters (n=11), description of DM (n=7), mental health (n=5), and foot care DM (n= 4). The review was hampered by the poor quality of the included studies. However, the evidence presented shows that educational materials provided to DM patients can improve clinical outcomes. Overall, the evidence base for educating DM patients in the community is still limited, and further research is needed.

A Narrative Review of Staphylococcus hominis Resistance Pattern: Multidrug- and Possible Extensively Drug-Resistance

Mon, 04 Sep 2023 00:00:00 +0700

Staphylococcus hominis is the third most frequent opportunistic pathogen in neonates and immunosuppressed patients that cause bacteremia, septicemia, endophthalmitis, and endocarditis. The emergence of methicillin resistant Staphylococcus hominis (MRSHo) has been reported and is a growing concern. This review was intended to determine the susceptibility of Staphylococcus hominis to antibiotic agents with pharmacokinetics/pharmacodynamic approach. In addition, this review was determined the phenotypic criteria and antibiotic choice of Staphylococcus hominis infection. Four databases i.e., PubMed, PlosOne, ScienceDirect and Google Scholar were employed in searching process. Antibiotic resistance was identified using the minimum inhibitory concentration (MIC) and the percentage of resistance. The breakpoint value was based on The European Committee on Antimicrobial Susceptibility Testing (EUCAST) Breakpoint tables for interpretation of MIC and zone diameters Version 11.0. There were 876 articles identified, 35 duplications were removed. These gave a total of 841 articles were screened yet 820 articles were irrelevant. Eventually, 21 articles were reviewed in this report. This review found that Staphylococcus hominis is potentially had MDR activity and a possible XDR bacterium that resistant to some antibacterial agents. The susceptibility of antibiotic to bacteria is not identical, and the regional reported drug resistance varies commonly due to differences in environment and antibiotic use. The resistance profile of Staphylococcus hominis is a complex interaction that affected by multifactorial such as: pharmacokinetics/pharmacodynamics index, mutant prevention concentration (MPC), mutant selection window (MSW), and the capability to produce biofilm.

Vitamin D3 and the Molecular Pathway of Skin Aging

Mon, 04 Sep 2023 00:00:00 +0700

Many women pay attention to skin aging. Signs of aging such as lines, wrinkles, dry skin, hyperpigmentation, and loss of elasticity affect skin appearance and self-confidence. Age, lifestyle, and particularly UV irradiation stimulate reactive oxygen species (ROS) production. ROS induces the breakdown of collagen through matrix metalloproteinases (MMPs). Collagen and elastin play a pivotal role in skin aging. They maintain skin integrity, strength, and resiliency. Antioxidant and keratolytic agents are often used in anti-aging products, including several vitamins such as vitamin A, B, C and E. To date, several studies have been reported in the literature for the effects of vitamin D on collagen synthesis and MMPs inhibition. This review focuses on identifying and assessing the molecular pathways of vitamin D effects related to skin aging. The literature was collected from Google Scholar, Elsevier, Science Direct, PubMed, and Scopus databases and accessed between January 2019 and May 2022. The literature screening was conducted using keywords like “vitamin D3”, “collagen”, “matrix metalloproteinases”, “skin aging” and related to the study topic were included. The effect of vitamin D3 on MMPs inhibition (particularly on MMP-1, MMP-3, and MMP-9) has been widely published. Several studies have reported that vitamin D increases collagen synthesis and clinically improves skin elasticity. However, there have been controversial results regarding how vitamin D3 affects transforming growth factor-β (TGF-β) correlated with skin elasticity by the molecular pathway. Therefore, it can be concluded that vitamin D3 is a potential alternative agent in improving skin aging.

Impact of Gene Polymorphism on Pharmacokinetics and Pharmaco-dynamics of Calcium Channel Blockers: A Narrative Review

Mon, 04 Sep 2023 00:00:00 +0700

A class of drugs known as calcium channel blockers (CCBs) is used to treat hypertension, angina, and arrhythmias. There are two subcategories of this medication class: dihydropyridines and non-dihydropyridines. Studies on CYP3A5*3, AGTR1 rs275653, ABCB1 (MDR1) rs1045642, and POR*28 A503V have all investigated the effects of SNPs on CCBs. This study will carry out more research to ascertain which SNPs have the most influence on the effectiveness of CCBs. The narrative reviews in this article come from a variety of sources. We performed searches in Pubmed, ScienceDirect, and Google Scholar using the terms "calcium channel blocker," "efficacy," "blood pressure response," "pharmacokinetic," and "polymorphism" OR "genetic" OR "genomic" to find pertinent articles. When prescription antihypertensive medications, particularly calcium channel blockers, it is important to take into account certain gene variants for example CYP3A5*3/*3, CYP3A4 *1G/*1G, MDR1 C3435T , RyR3 gene rs877087 because of their considerable effects.

Nano-Perfumes As A Fragrance Carrier: Their Brief History, Essential Aspects, Development, Preparation Methods, Characteristics, And Future Perspectives

Indra Gunawan, Budi Setiadi Daryono, Eka Noviana, T N Saifullah Sulaiman — Mon, 04 Sep 2023 00:00:00 +0700

Nano-perfume is an alcohol-free perfume in the form of oil-in-water nanoemulsions containing fragrance. Due to its favorable properties, nano-perfume may appeal to a broader client base, including children and individuals with sensitive skin. This technology can provide an alternative solution to the low permanence of fragrances by eliminating ethanol and decreasing the amount of surfactant, co-surfactant, and solvents used in the formulation. However, relatively few researchers have studied and developed this technology to date. In this review, we examine several essential elements of nano-perfume, therefore it is hoped that relevant questions will be raised regarding the future of this technology. The discussion is focused on the definition and composition of perfume, the notion of "notes" in fragrances products, nanotechnology in the cosmetics industry, significant characteristics of nano-perfume, as well as problems and prospects.

Efficacy of Different Solvents in the Extraction of Bioactive Compounds and Anticancer Activities of Thyme (Thymus vulgaris L.) Leaves and Twigs

Aify Zulfa Kamalia, Woro Anindito Sri Tunjung — Mon, 04 Sep 2023 00:00:00 +0700

Thyme contains phytochemicals that exhibit cytotoxic and cytogenic activities. Differ solvents have different abilities in dissolving plant bioactive compounds. The objective of this study is to determine the anticancer properties of thyme leaves and twigs including profile of bioactive compounds, cytotoxicity, ability of apoptosis induction and caspase-3 activation of different solvent extracts on T47D breast cancer cell line. An experimental study was conducted in eight groups. T47D breast cancer cell line was treated with thyme extracts as treatment group, doxorubicin as positive control, while untreated T47D cells were used as negative control. Thyme was extracted by maceration using 6 different solvents: methanol, ethanol, chloroform, ethyl acetate, dichloromethane, and n-hexane. Bioactive compounds of all extracts were analyzed by GC-MS. Cytotoxicity was investigated through MTT assay on T47D breast cancer cell line. The percentage of apoptosis and caspase-3 were detected by flow cytometry using Annexin V-PI and BD Cytofix/Cytoperm, respectively. Thymol as the main bioactive compound in thyme was found in all extracts. MTT results revealed that six solvents extracts had moderate to weak cytotoxicity with dichloromethane had the lowest IC₅₀ values at 120.23 µg/ml. All thyme extracts promoted apoptosis in T47D cells with apoptosis percentage of methanol, chloroform, ethyl acetate, ethanol, dichlorometane, n-Hexane and doxorubicin were 82.67; 80.98; 73.13; 72.28; 60.62; 27.74 and 98.43%, respectively. Among all extracts, methanol extract showed the highest apoptosis and caspase-3 activation percentage. We conclude that all thyme extracts had anticancer properties in T47D breast cancer cell line although efficacy of each solvent extract was differed.

Neuroprotective Potential of Vitamin B-12 Against Cadmium–Induced Neuroinflammation Mediated Memory Dysfunctions in Adult Albino Mice

Mon, 04 Sep 2023 00:00:00 +0700

Cadmium induces neurotoxicity in brain and results in increased enzymatic functions, accumulation of Amyloid beta plaque and Neuo Fibrillary Tangles (NFTs) causing neurodegenerative diseases. The purpose of the present work was to investigate the anti-inflammatory or anti-oxidative potential of vitaminB₁₂against Cd -induced memory impairment and mechanism of signaling pathway of vitamin-B12 protection in Cd-induced neuroinflammatory in mice model. Male albino mice of BALB/C trait of age 7 to 8 weeks and weighing about (30-32±3g) were used as model animal in the study. All mice were divided in three groups. Control Group (CG) treated with 0.9% saline (1mL/Kg), Cd Cl₂ administered Group (CD) (1mg/kg) and Cd +Vitamin administered group (CV) B-12 (500µg/kg). CD group was treated with Cd Cl2 for three weeks on alternate days while CV group was treated with Vitamin B₁₂and toxin CdCl2 for the next two weeks intraperitonealy. Behavior tests like Morris Water Maze (MWM) and Y-Maze (YM) tests were conducted on the experimental mice to study the neuro protective potential of Vitamin-B₁₂ against CdCl₂ induced memory dysfunctions. After completing the above procedures, mice were sacrificed and the brains of each group were collected for protein quantification step and western blotting. The Immuno blots of Iba-1, NF-kB, TNF-α, IL-1β, BACE1 and Aβ proteins in the brain homogenates of CD and CV mice confirm the anti-neuroinflammatory potential of vitamin-B12 against Cadmium –induced Neuroinflammation. Escape latency of CV group mice receiving Methylcobalamine was less and showed better performance in MWM test. The results of Y-maze test also showed that the spontaneous percentage alternation of CD group mice was less than CV and CG group of mice. Immuno blot of p-Akt confirm the signaling pathways of vitamin-B12 protection in Cd-induced neuroinflammatory mediated memory-impairment in the model mice. Our findings suggest that Vitamin-B₁₂ could be a potent candidate drug for treating cognitive dysfunctions due to its anti-inflammatory and anti-oxidative potential. Our study also shows that Vitamin-B₁₂ activates p-Akt signaling pathway along with decreasing the NF-Κb, TNF-α and IL-1β to protect the brain of mice against CdCl₂ neurotoxicity.

Co-Milling: A Successful Approach to Enhance Solubility of a Poorly Soluble Antihypertensive Drug

Marwa Malik Kamil, Asmaa Abdelaziz Bayoumi — Tue, 01 Aug 2023 00:00:00 +0700

The aim of the work was to enhance the solubilization of Olmesartan-medoxomil (OM) and formulate stable, rapidly-dissolving-tablet formulations. OM, on the other hand, is classified as Biopharmaceutics Classification System (BCS) Class II drug, which indicates that it is characterized by water-insolubility. Therefore, increasing its solubilization has the potential to boost its bioavailability. For the OM evaluation, a new HPLC technique was invented and then validated in accordance with international standards. The formulation of tablets involved co-milling with certain superdisintegrants, specifically croscarmellose sodium (Ac-Di-Sol) and crospovidone in varying percentages, followed by mixing with pH-adjusting substances such as calcium carbonate to increase solubilization in cases where the drug is soluble in alkaline. Following the evaluation of the created formulations, the optimized formulations were selected for further stability assessment. Co-milling process with crospovidone greatly improved the olmesartan release. The optimized formulations were OD11 and OD12, which exhibited fast disintegration, and the release exceeded 90% within 10 min, while the release for Olmesartan medoxomil pure standard was 9.8% after 10 min. The OD11 and OD12 were chosen for further stability assessment and revealed good stability behavior, as the study on optimized formulations revealed that the degradation was less than 5% after storage for six months at 40 °C and 75% relative humidity. Some formulations exhibited good results in terms of disintegration and release. The results of the formulations (OD11 and OD12) suggested that co-grinding with crospovidone may increase the solubilization of OM to greater than 90% after 10 minutes.

Assessing the Antimetabolite Activity of Anthocyanins in Cantigi Fruits from Two Conservation Sites in Indonesia

Mon, 04 Sep 2023 00:00:00 +0700

The objective of the current study was to evaluate the antimetabolite activity of anthocyanins in Cantigi fruits from two Indonesian conservation areas. Cantigi (Vaccinium varingiaefolium) is a native fruit species known for its rich anthocyanin content associated with various health benefits. However, more research needs to be conducted on the antimetabolite properties of these anthocyanins. This study collected Cantigi fruits from two conservation sites in Indonesia, Tangkuban Perahu (CTP) and Papandayan (CPP) Mountain, and the antimetabolite activity was evaluated using enzymatic assays. The results demonstrated significant antimetabolite activity of CTP, particularly in inhibiting α-Glucosidase (53.72±1,98 µg/ml), pancreatic lipase (110.48±2,13 µg/ml), and angiotensin-converting enzyme (27.32±1,24 µg/ml). Furthermore, our analysis using HRMS revealed the presence of three anthocyanin compounds, delphinidin, malvidin, and peonidin, which are believed to contribute to the observed antimetabolite activities of Cantigi. These findings provide valuable insights into the specific compounds responsible for the bioactivity of Cantigi and further support its potential as a natural source of bioactive substances. Future research should focus on elucidating the molecular mechanisms underlying the effects of these anthocyanins on the targeted enzymes and exploring their potential synergistic interactions.

The Effects of Duration of Fermentation on Total Phenolic Content, Antioxidant Activity, and Isoflavones of The Germinated Jack Bean Tempeh (Canavalia Ensiformis)

Iva Tsalissavrina, Agnes Murdiati, Sri Raharjo, Lily Arsanti Lestari — Mon, 04 Sep 2023 00:00:00 +0700

The daily consumption pattern of people in Indonesia is very close to the consumption of side dishes derived from legumes, especially those consumed in the form of tempeh food products. The purpose of this study was to determine the content of total phenolic compounds, flavonoids, antioxidant activity and isoflavone content of germinated jackbean tempeh with a fermentation duration of 0–5 days. Isoflavone extract was obtained by the extraction method using 70% alcohol. The total content of phenolic compounds was measured by the method of Folin ciocalteau, antioxidant activity was measured with DPPH and isoflavone content was determined using High Performance Liquid Chromatography (HPLC). The total content of phenolic compounds (TPC), antioxidant activity and isoflavone was analyzed using the ANOVA assay and differences between treatments compared to the Smallest Real Difference test with a meaningfulness level of 5%. The total phenolic compound content and the highest antioxidant activity during the tempeh fermentation process were obtained on the 5th day fermentation period of 10.70±0.31 (mg. GAE/g) for total phenolic and 457.04±151.91(%) for IC₅₀ values with intergroup test results showed significant differences. The highest isoflavone deposits were also obtained at day 5 tempeh fermentation duration for all isoflavones i.e. daidzein, glycitein, genistein and factor-2 and there were significant differences between treatment groups. The isoflavone content was 4.6341±1.7431 mg/kg for daidzein, 5.4483±2.2936 mg/kg for glycitein, 0.9236±0.3288 mg/kg for genistein and 0.458±0.209 for factor-2. This study shows that the germination and fermentation process of tempeh causes changes in the content of total phenolic compounds and antioxidant activity as well as increasing and influencing the isoflavone profile.

Alginate-ZnO-Poly(ethylene glycol) dimethacrylate (PEGDMA) via Interpenetrating Polymer Network as a Functional Material for Wound Dressing

Ane Nurjanah, Muhammad Bachri Amran, Rusnadi Rusnadi — Mon, 04 Sep 2023 00:00:00 +0700

Alginate is a biopolymer that has been widely applied as a wound dressing material. To increase the mechanical and antibacterial properties of a wound dressing material, nanoparticles and synthetic polymers are used to modify alginate. One of the materials synthesized into nanoparticles is ZnO, which has potential applications in the medical field because of its good antibacterial properties. On the other hand, PEGDMA has not been widely used in the medical field, opening opportunities to develop research, especially regarding wound dressing materials. However, there has never been a detailed report on the modification of alginate using ZnO and PEGDMA. In this paper, alginate was modified using ZnO and poly(ethylene glycol) dimethacrylate (PEGDMA; alginate–ZnO–PEGDMA, AZP), which was synthesized using the Interpenetrating Polymer Network (IPN) method. AZP can increase a wound dressing material’s mechanical properties by 78% and the antibacterial properties by 94%, which indicates that alginate modification with ZnO and PEGDMA produces high-performance wound dressing materials.

Persistence to Antihypertensive and Clinical Outcomes in Acute Coronary Syndrome Patients after Percutaneous Coronary Intervention

Mon, 04 Sep 2023 00:00:00 +0700

Acute coronary syndrome (ACS) is a life-threatening condition that carries a high risk of recurrent cardiovascular events and death. Persistence to treatment is known to reduce disease morbidity and mortality in patients with ACS. In this study, we focus on ACS patients undergoing their first percutaneous coronary intervention (PCI) to investigate the association between persistence to antihypertensive therapy and clinical outcomes. A retrospective cohort study with two years of follow-up was conducted with 367 patients recruited. Patients were deemed as having the persistence to antihypertensive therapy (C02, C03, C07, C08, C09) if the gap between prescriptions was ≤ 30 days. The clinical outcomes are defined as a composite of major adverse cardiac event (MACE), major adverse cardiovascular and cerebrovascular events (MACCE), myocardial infarction, recurrent PCI, stroke, all-cause death, cardiovascular death, and hospitalization. Cumulative persistence to antihypertensive showed 72.3% of ACS patients still taking antihypertensive one year after PCI. Persistence to treatment with antihypertensive therapy can be used as a predictor of MACE or MACCE because it was associated with recurrent PCI (RR 1.94, 95% CI = 1.02-3.71). Our study indicates that among ACS patients undergoing their first PCI, non-persistence to antihypertensive therapy may lead to worse clinical outcomes. This data will be useful to promote secondary prevention in ACS patients after PCI.

A Retrospective Study of Body Weight Changes in Patients Receiving Cyproheptadine in A Hospital-Based Outpatient Setting in Thailand

Mon, 04 Sep 2023 00:00:00 +0700

Cyproheptadine has been used as an appetite stimulant to increase body weight in various population. This study aimed to determine the effect of cyproheptadine on weight changes in Thai patients. A retrospective longitudinal study was conducted in adult patients who were prescribed with cyproheptadine, having body weight records at 2 times consecutively during 12-month period at the medical outpatient department, the Police General Hospital, Thailand. Of 125 participants, 69.6% were females and the mean age was 78.38 (SD ± 11.68) years. Hypertension, dyslipidemia and diabetes mellitus were the most common underlying conditions. The mean body mass index (BMI) at 1^st visit was 21.16 (SD ± 3.64) kg/m². The mean body weight at 1^st and 2^nd visit were 52.46 (SD ± 11.11) kg, and 52.61 (SD ± 10.98) kg, respectively. Overall, there was no significant change in body weight between two visits. In underweight patients (BMI < 18.5 kg/m²), the mean BMI decreased significantly in the 2^nd visit compared to 1^st visit (p = 0.044). At the 2^nd visit, older age and high-density lipoprotein cholesterol levels were negatively associated with body weight (p < 0.05). The polypharmacy (odds ratio (OR), 0.778; 95% confidence interval (CI), 0.616 – 0.982), the presence of hypertension (OR, 0.022; 95%. CI, 0.001 – 0.390) and low-density lipoprotein cholesterol levels (OR, 0.969; 95% CI, 0.942 – 0.996) were also negatively associated with abnormal BMI. Cyproheptadine might not improve the body weight of patients in this population. The factors associated with lower body weight in this study may be helpful in further research.

The Effects of Zingiber Officinale and Propolis supplementation on Hospitalized Covid-19 Patients' Oxygen Saturation

Mon, 04 Sep 2023 00:00:00 +0700

Antiviral, anti-inflammatory, and supportive therapy are required in the Covid-19 management, whilst there is no available specific antiviral for Covid-19 patients. Zingiber officinale and Propolis were reported to suppress the pro-inflammatory cytokines and their safety profiles were considered in several toxicity studies. However, their efficacy in hospitalized Covid-19 patients has not been clarified yet. This study explored the activity of Z. officinale and Propolis in modulating the clinical signs and hematology parameters in hospitalized Covid-19 patients. A total of 22 subjects were divided into a control group (standard therapy), and a treatment group (standard therapy and supplemented with the combination of Z. officinale 500 mg/day and Propolis 1000 mg/day). We analyzed the differences in demographic characteristics, clinical signs, and hematology parameters at pre and post-treatment in both groups. The increased oxygen saturation in control and treatment groups were 0.45 ± 0.45 and 3.45 ± 1.16, respectively (p = 0.011). Moreover, the high-fluorescent lymphocyte count (HFLC) and mean platelet volume (MPV) in the treatment group tend to be lower compared to the control, although it is not statistically significant. The supplementation of Z. officinale and Propolis has beneficial effects in alleviating clinical signs of Covid-19 disease, especially in the enhancement of oxygen saturation, and tend to restore the hematological parameters.

The Evaluation of Favipiravir Utilization and Clinical Outcome of Inpatients Covid-19 in Secondary Care Hospital, Central Java

Nialiana Endah Endriastuti, Heny Ekowati, Masita Wulandari Suryoputri — Mon, 04 Sep 2023 00:00:00 +0700

Coronavirus Disease 2019 (COVID-19) is a disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The favipiravir is one of the antiviral treatments for COVID-19. There has been limited research done on favipiravir in Indonesia, and there is controversy on the drug's efficacy. This study aims to determine the utilization of favipiravir affected patients with COVID-19. This study was a retrospective data collection method and an observational study. The information was collected from the medical reports of confirmed COVID-19 patients between in March 2020 and June 2021 at the Secondary Care Hospital in Banyumas Regency, Central Java Province, Indonesia. By comparing clinical symptoms before and after using favipiravir, the results of temperature, respiratory rate, and cough symptom parameters were used to evaluate the effects of using favipiravir on clinical symptoms. The total number of 250 patients were qualified the inclusion criteria consisted of 90 patients with severity of illness in mild level, 101 patients had moderate level, and 59 patients with severe level. Most patients reported symptoms of coughing, shortness of breath, weakness, fever, and nausea. The majority of favipiravir patients (n=200; 80%) initiated with a dose of 1600 mg/12 hours, followed by a dose of 600 mg/12 hours, with the longest length of therapy (8-14 days) (n=145; 58%). At all grades of disease severity, statistical analysis of patients showed the significant improvement in cough, fever, and respiratory rate after taking favipiravir (p=0.0001). In conclusion, favipiravir may have beneficial effects on COVID-19 patients in all grade severity of illness.