Claim Missing Document
Check
Articles

Found 12 Documents
Search
Journal : Universa Medicina

Resistensi dari bakteri enterik: aspek global terhadap antimikroba Yenny, Yenny; Herwana, Elly
Universa Medicina Vol 26, No 1 (2007)
Publisher : Faculty of Medicine, Trisakti University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2007.v26.46-56

Abstract

Resistensi antimikroba dari bakteri merupakan suatu masalah kesehatan masyarakat yang sifatnya global. Masalah ini menjadi bertambah penting dalam hal pengobatan infeksi enterik. Di negara-negara berkembang resistensi terhadap obat-obat lapis pertama (first-line drugs) telah dijumpai di antara luman-kuman patogen enterik, yang disebabkan oleh penggunaan antimikroba yang semena-mena. Pada beberapa kasus, derajat resistensi memaksa digunakannya obat-obat lapis kedua dan ketiga, yang harganya lebih mahal. Situasi ini juga mengancam timbulnya resistensi terhadap golongan obat-obat antimikroba golongan ini yang pada akhirnya menyebabkan beban ekonomi yang besar dan resistensi multipel. Di banyak negara berkembang, data mengenai prevalensi resistensi antimikroba sedikit sekali ditemukan. Kurangnya fasilitas laboratorium merupakan kendala besar dalam mengembangkan surveilans yang efektif. Untuk mempertahankan jangka efektivitas suatu antimikroba, khususnya di negara berkembang, perlu dilakukan perbaikan sistem surveilans untuk memantau timbulnya resistensi antimikroba, perbaikan akses laboratorium, peraturan penggunaan antimikroba yang lebih baik, dan pendidikan masyarakat.
The benefits and risks of Echinacea in treatment of common cold and influenza Yenny, Yenny; Djanun, Zunilda
Universa Medicina Vol 27, No 3 (2008)
Publisher : Faculty of Medicine, Trisakti University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2008.v27.132-142

Abstract

The common cold is one of the world’s most prevalent illnesses in adults and children. This upper respiratory tract infection is caused by different kinds of agents. Effects on health, well-being, and productivity are significant. Preparations made from plants of the genus Echinacea are widely used for the prevention and treatment of colds. Three species of Echinacea used for medicinal purposes are Echinacea purpurea, Echinacea angustifolia, and Echinacea pallida. The beneficial effects of Echinacea are thought to be due to its immunomodulatory activity, most notably activation of macrophages, polymorphonuclear leukocytes and natural killer cells. Many clinical trials, including a number of blind randomized trials, have reported health benefits. Although these studies show beneficial effects, recommendations on Echinacea use cannot be made due to lack of product standardization and variability in dosage, sample size and methodological quality used in the trials. Therefore, well-designed studies with consistent standardized measures are required for assessment of the efficacy of Echinacea in treatment of common cold and influenza.
Pleiotropic effects of statins in stroke prevention Yenny, Yenny
Universa Medicina Vol 28, No 2 (2009)
Publisher : Faculty of Medicine, Trisakti University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2009.v28.117-126

Abstract

Cardiovascular disease is the leading cause of death and disability, and  contributes substantially to healthcare budgets. The lipid-lowering drugs, 3-hydroxy-3-methylgulutaryl-coenzyme A (HMG-CoA) reductase inhibitor or statins, reducing mortality and cardiovascular morbidity in patients with established cardiovascular disease. Statins therefore have a place in the secondary prevention of cardiovascular disease. Recent experimental and clinical studies suggest that statins may exert vascular protective effect beyond cholesterol reduction. The cholesterol-independet or “pleiotropic” effects of statin include the upregulation and activation of endothelial nitric acid synthase (eNOS) that can increase nitric oxide (NO) production. Augmentation of NO production increases cerebral blood flow, which can lead to neuroprotection during brain ischaemia. By inhibiting mevalonate synthesis, statins prevent the formation of several isoprenoids (including farnesylpyrophosphate and geranylgeranylpyrophosphate). Inhibiting geranylgeranylation of RhoA small G proteins increases the stability of eNOS mRNA through the remodeling of endothelial actin microfilamens. Moreover, statins directly increase eNOS activity within minutes by activating the pathway involving phosphoinositide 3-kinase and protein kinase B. In the secondary prevention of stroke, the use of statins reduces the incidence of either recurrent stroke or other major vascular events and treatment should be initiated soon after the event. The use of statins does not increase hemorrhagic stroke or cancer and may also favor atherosclerotic plaque regression.
Prevalence of extended spectrum beta-lactamase in Klebsiella pneumoniae Herwana, Elly; Yenny, Yenny; Pudjiadi, Laurentia; Surjawidjaja, Juius E; Lesmana, Murad
Universa Medicina Vol 27, No 3 (2008)
Publisher : Faculty of Medicine, Trisakti University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2008.v27.98-105

Abstract

Increased irrational use of antibiotics promotes bacterial resistance to these drugs. Among the resistance mechanisms developed by bacteria is the production of â-lactamase which can destroy the â-lactam ring and cause resistance to the other â-lactam antibiotics, such as amoxycillin. Extended spectrum â-lactamase (ESBL), an enzyme found in bacterial plasmids, is capable of hydrolyzing third-generation cephalosporins, namely cefotaxime, ceftazidime, ceftriaxone, and the monobactams. ESBL is predominantly found in Klebsiellas spp., Escherichia coli and other bacteria of the Enterobacteriaceae family. This study was conducted to determine the prevalence of Klebsiella resistant to cephalosporins and the prevalence of those producing ESBL. A total of 65 clinical isolates of Klebsiella were tested by the disk diffusion method according to Kirby-Bauer to determine their antibiotic susceptiblity and by the double-disk synergy method to detect the presence of ESBL. The results show that 18.5% of Klebsiella isolates tested were resistant to ceftazidime and cefixime, 13.9% to ceftriaxone, and 23.1% to aztreonam. Testing for ESBL revealed that the prevalence of ESBL producers in clinical Klebsiella isolates ranged from 10.8% to 12.3%. The presence of ESBL, plus the potential for plasmid-mediated quinolone and carbapenem resistance, undoubtedly will create significant therapeutic problems in the future.
Warfarin: do we need genotype-based dose prediction? Yenny, Yenny
Universa Medicina Vol 29, No 3 (2010)
Publisher : Faculty of Medicine, Trisakti University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2010.v29.i-iii

Abstract

For the treatment and prevention of thrombo-embolic disease, the most frequently used anticoagulant drug worldwide is warfarin, an oral coumarin derivative, with more than 30 million prescriptions written for this drug in the United States in 2004.(1) The drug has a narrow therapeutic index and its metabolism varies by as much as a factor of 10 among individual patients, making warfarin therapy difficult to manage. Hemorrhagic complication rates of warfarin are estimated to be 5-7.9% for major (life threatening) hemorrhage and 14-36% for minor hemorrhage (e.g. nosebleeds, microscopic hematuria).(2) This condition makes it difficult to establish the appropriate dose of warfarin.
Pharmacokinetic interactions between rifampicin and efavirenz in HIV-TB coinfections Yenny, Yenny
Universa Medicina Vol 28, No 3 (2009)
Publisher : Faculty of Medicine, Trisakti University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2009.v28.188-201

Abstract

The increased percentage of patients with HIV-TB coinfection leads to inevitable interactions between rifampicin and efavirenz. Efavirenz is a potent non-nucleoside reverse transcriptase inhibitor (NNRTI) for the treatment of HIV infection. The use of this drug combination with rifampicin causes problems in determination of the optimal dosage of efavirenz when administered concomitantly with rifampicin. Efavirenz is metabolized by the enzyme cytochrome P-450 (CYP), i.e. the CYP2B6 and CYP3A4 isozymes, of which rifampicin is an inducer. The induction of cytochrome P-450 by rifampicin is mediated by pregnane X (PXR) and constitutive androstane receptors (CAR) in the cell nucleus, resulting in a wide variation in the plasma efavirenz concentrations, such that a therapeutic failure or the occurrence of toxic effects are to be expected. The optimal dosage of efavirenz is commonly determined through pharmacokinetic studies, but this  is problematic in the combined use of the drug with rifampicin, due to the wide variation in study design, method, and sample size of each study. Ethnic factors and genetic polymorphism of the enzymes that metabolize efavirenz contribute to the problem of determining the optimal dose of this drug. Pharmacokinetic studies with good measurement parameters and methods are still necessary as the basis for determining the optimal dose of efavirenz in the Indonesian population.
High dose simvastatin and adverse muscle effects Yenny, Yenny
Universa Medicina Vol 30, No 3 (2011)
Publisher : Faculty of Medicine, Trisakti University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2011.v30.135-137

Abstract

High blood cholesterol, or hyperlipidemia, is a cardiovascular risk factor. Surveys have demonstrated that 35.6% of adults in the United States suffer from hyperlipidemia.(1) Currently there are various therapeutic regimens available for hyperlipidemia. The use of lipid-lowering drugs, patient education, dietary modification, and exercise have all been recommended for the management of hyperlipidemia.
Thiazolidinedione and cardiovascular risk in type 2 diabetes mellitus Yenny, Yenny
Universa Medicina Vol 27, No 4 (2008)
Publisher : Faculty of Medicine, Trisakti University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2008.v27.183-193

Abstract

Cardiovascular disorders are the most common complications encountered in patients with type 2 diabetes mellitus (DM). The relationship is likely to be multifactorial and may also involve a specific, though ill-defined, diabetic cardiomyopathy. Patients with heart failure accompanied by DM have a reduced cardiac output compared with patients without DM. Thiazolidinediones (TZDs) are agonists of peroxisome proliferator-activated receptor gamma (PPARã) and have beneficial effects in the control of blood glucose and cardiovascular parameters, but the ability of these drugs to induce retention of plasma has to be taken into consideration in prescribing them for patients with DM at high risk of cardiovascular disease. The molecular mechanism of fluid retention by TZDs has not been fully elucidated. Available evidence indicate a possible role of epithelial sodium channels (ENaC) in causing the side effects of TZDs. This paper will discuss the mechanism of ENaC in inducing fluid retention and the management to be applied for anticipating these side effects.
Multimicronutrient supplementation in older persons decreased zinc deficiency but not serum TNF- Herwana, Elly; Yenny, Yenny
Universa Medicina Vol 30, No 2 (2011)
Publisher : Faculty of Medicine, Trisakti University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2011.v30.102-110

Abstract

The increase in the population of older persons needs to be accompanied by increased quality of healthcare in older persons, particularly a decrease in the incidence of infections. Impaired immune responses are common in older adults, and immune senescence likely contributes to the increased incidence of infectious diseases in the older persons. The aging process decreases the immune response and many studies have been conducted to explain the role of supplementation with various micronutrients, such as vitamin C, vitamin E, â-carotene and zinc, on the immune response. The aim of the present study was to assess the influence of 6 months of multi-micronutrient (MMN) supplementation on zinc and tumor necrosis factor (TNF-á) levels in older persons. A randomized controlled trial was conducted on 78 older persons, who were divided into two groups. The treatment group received MMN supplementation containing 40 mg elemental zinc, 120 mg ascorbic acid, 6 mg â-carotene, 15 mg á-tocopherol  and 400 ìg folic acid and the control group 400 mg calcium carbonate. The study did not demonstrate that 6 months of MMN supplementation resulted in significant differences between both groups, with respect to total protein, albumin, globulin, and TNF-á levels. In contrast, MMN supplementation significantly decreased the proportion of older persons with zinc deficiency in the treatment group, in comparison with the control group. The present data suggest that in older persons with relatively good immune and protein status, improvement of the immune status by MMN supplementation may be difficult and at best limited.
The role of polyphenols in causing cardiovascular disease Yenny, Yenny; Herwana, Elly
Universa Medicina Vol 27, No 1 (2008)
Publisher : Faculty of Medicine, Trisakti University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2008.v27.29-38

Abstract

Research on flavonoids has increased since the discovery of the French Paradox, the low cardiovascular mortality rate observed in Mediterranean population in association with red wine consumption and a high saturated fat intake. Plant polyphenol (flavonoid) occurs naturally in fruits, vegetables, and beverages such as tea and wine. Epidemiologic studies suggest that higher polyphenol intake from fruits and vegetables is associated with decreased risk for cardiovascular disease. The mechanisms explaining this observation remain unclear. The vascular endothelium is a critical regulator of vascular homeostasis, and endothelial dysfunction contributes to the pathogenesis and clinical expression of coronary artery disease. Platelet aggregation is a central mechanism in the pathogenesis of acute coronary syndromes, including myocardial infarction and unstable angina. There are numerous reports suggesting that plant polyphenols improve endothelial function and inhibit platelet aggregation in humans.