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Polifarmasi dan Interaksi Obat Pasien Usia Lanjut Rawat Jalan dengan Penyakit Metabolik Dasopang, Eva S.; Harahap, Urip; Lindarto, Dharma
Indonesian Journal of Clinical Pharmacy Vol 4, No 4 (2015)
Publisher : Indonesian Journal of Clinical Pharmacy

Penyakit metabolik merupakan penyakit yang berkaitan dengan peningkatan usia seperti hipertensi, diabetes melitus, dislipidemia, dan obesitas. Penyakit-penyakit tersebut ditangani dengan terapi obat yang sifatnya polifarmasi sehingga dapat menyebabkan risiko terjadi interaksi obat-obat. Penelitian ini dilakukan secara restropektif dengan menggunakan rekam medis pasien usia lanjut dengan penyakit metabolik yang di rawat jalan di Rumah Sakit Umum Pusat Haji Adam Malik Medan. Sebanyak 328 sampel yang termasuk ke dalam kriteria inklusi diperoleh data bahwa jumlah interaksi obat-obat yang terjadi cukup tinggi sebesar 78,96%. Pola mekanisme yang terbanyak adalah farmakokinetik (63,6%) dengan tingkat keparahan yang terbanyak adalah moderat (69,8%). Penelitian ini menunjukan adanya korelasi antara jumlah interaksi dengan jumlah obat (r= 0,728; p= 0,0001), dan jumlah interaksi dengan jumlah diagnosis (r= 0,264; p= 0,0001).Kata kunci: Interaksi obat, penyakit metabolik, polifarmasiPolipharmacy and Drug Interactions in Elderly Patients with Metabolic DiseasesMetabolic disease is a disease that is associated with increasing age such as hypertension, diabetes mellitus, dyslipidemia and obesity. Such diseases are treated with polypharmacy therapy that can cause increased risk of drug interactions. This study was conducted using a restropective method using the medical records of elderly patients with metabolic diseases in outpatient unit of H. Adam Malik General Hospital Medan. A total of 328 samples were included in the inclusion criteria data showed that the numberof drug-drug interactions that occur quite high at 78.96%. The pattern of drug interaction mechanism that most frequently occur is pharmacokinetic (63.6%) and the highest severity was moderate (69.8%). This study shown a correlation between the number of interactions with a number of drugs (r= 0.728; p=0.0001), and the number of interactions with a number of diagnoses (r= 0.264; p= 0.0001).Keywords: Drug-interactions, metabolic-disease, polypharmacy

Efektifitas Kombinasi Ekstrak Sambiloto (Andrographis paniculata (burm.f.) nees) dan Daun Salam (Syzygium polyanthum (wight) walp) terhadap Kadar hs-CRP pada Pasien Dislipidemia Yulindaa, Wina; Lindarto, Dharma; Syafril, Santi
Majalah Kedokteran Nusantara The Journal Of Medical School Vol 50, No 3 (2017): The Journal of Medical School
Publisher : Fakultas Kedokteran USU

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Introduction Dyslipidemia is risk factor of cardiovascular disease and significantly correlated with increased hs-CRP concentration. Simvastatin, a sintetic antidyslipidemic drug, decreases hs- CRP concentration. But long term use of sintetic drug may cause side effects, so that phytopharmaca is preferably to be consumed. Combination sambiloto extract and salam could decrease proinflammatory cytokines, cholesterol, and triglyceride. Aim of this study was to compare the effect of combination sambiloto extract and salam with simvastatin on hs-CRP concentration in dyslipidemic patientsMethods This clinical trial use prospective design. Treated group (n = 15) and control group (n = 15) were selected by double blind random sampling. Before and after 30 days therapy, blood sample was taken. Data was analysed with SPSS, p < 0.05 was considered significant.Results There was significant decrease of hs-CRP before and after 30 days therapy in treated group ((3.02 Â± 3.13 vs 1.67 + 1.37) mg/dL; p = 0.005); meanwhile insignificant decrease was there in control group ((2.78 Â± 1.97 vs 2.25 Â± 2.32) mg/dL; p = 0.285). hs-CRP decrease of treated group was bigger than in control group, but statistically insignificant ((1.35 Â± 2.37 vs 0.53 Â± 1.96) mg/dL; p = 0.089 mg/dL).Conclusion Combination sambiloto extract (Andrographis paniculata) and salam (Syzygium polyanthum) 2 x 150 mg for 30 days decreased hs-CRP concentration lower than simvastatin 1 x 20 mg, but statistically insignificant.Keywords : hs-CRP, Andrographis paniculata and Syzygium polyanthum, dyslipidemia

Chronic Effect Various Type of Exercises to Fasting Blood Glucose and Insulin Resistance Machrina, Yetty; Purba, Ambrocious; Lindarto, Dharma; Daulay, Milahayati
Sumatera Medical Journal Vol. 2 No. 2 (2019): Sumatera Medical Journal (SUMEJ)
Publisher : Talenta Publisher

Exercise is non-pharmacological management for Diabetes Mellitus (DM) type-2. Previous study found that both eerobic and interval training improved insulin resistance. The aim of this study was to analyze the chronic effect various type of exercises to fasting blood glucose (FBG) and insulin resistance in DM type-2 model rats. It was an experimental study, twenty male Wistar rats, age 8 weeks, weight 150-180 gram as the object. Rats were given high fed diet for 4 weeks then injected streptozocin dose 30 mg/kgBB in citrate buffer pH 4.5 i.p, and 45 mg/kgBB at the following week. Groups were divided into i.e moderate continous training (MCT), severe continous training (SCT), slow interval training (SIT), and fast interval training (FIT). All groups were treated with ran on the treadmill three times a week for 8 weeks. Fasting blood glucose and fasting insulin were checked before and after intervention. Insulin resistance was determined by calculating HOMA-IR. Data analized with paired t-test (p<0,05). The results shown that all group significantly decreased fasting blood glucose and insulin resistance (p <0,05) after eight weeks exercise except insulin resistance in MCT group. Fasting blood glucose and insulin resistence post-test was found lowest in SIT groups in this study. In conclucions chronic effect of aerobic continous and aerobic interval in various intensity can decrease fasting blood glucose and insulin resistance in DM type-2 rat model. Slow interval training was the best exercise model to decrease insulin resistance.

PERBEDAAN STATUS ORAL HIGIENE DAN PERIODONTAL PASIEN KOMPROMIS DAN NON KOMPROMIS MEDIS RAWAT INAP DI RSUP H. ADAM MALIK MEDAN: COMPARATIVE OF ORAL HYGIENE AND PERIODONTAL STATUS OF HOSPITALIZED MEDICALLY COMPROMISED AND NON-COMPROMISED PATIENTS IN CENTRAL GENERAL HOSPITAL H. ADAM MALIK MEDAN Herniza Yusdani; Sondang Pintauli; Dharma Lindarto
Dentika: Dental Journal Vol. 18 No. 2 (2014): Dentika Dental Journal
Publisher : TALENTA

Kondisi kompromis medis, terutama pada pasien rawat inap di rumah sakit, telah lama diketahui sebagai faktor risikoyang berpotensi terhadap terjadinya penyakit periodontal. Banyak penelitian yang telah dilaporkan mengenai hubungankondisi kompromis medis dengan penyakit periodontal. Tujuan penelitian ini adalah untuk menganalisis status oralhigiene dan periodontal pasien kompromis dan non kompromis medis rawat inap di Rumah Sakit Umum Pusat H. AdamMalik Medan. Desain penelitian ini adalah kasus kontrol dengan 60 pasien kompromis medis (penderita penyakit jantungdan Diabetes melitus tipe 2) dan 60 pasien non kompromis medis (penderita penyakit THT dan mata). Digunakan OralHygiene Index Simplified (OHI-S) untuk mengukur status oral higiene dan Periodontal Disease Index (PDI) olehRamfjord. Hasil penelitian menunjukkan bahwa 73,3% pasien kompromis medis mempunyai oral higiene buruk dan64,7% periodontitis. Sebaliknya, 70% pasien non kompromis medis mempunyai oral higiene baik dan 35,3%periodontitis. Odds ratio oral higiene terhadap pasien rawat inap kompromis medis adalah 6,4 dan penyakit periodontalterhadap pasien rawat inap kompromis medis 2,8. Sebagai kesimpulan, pasien kompromis medis terutama penyakitjantung dan DM tipe 2 mempunyai oral higiene 6 kali lebih buruk dan 3 kali lebih berisiko periodontitis dibandingkanpasien non kompromis medis.

Pengaruh Puguntano terhadap HOMA-IR Pada Pasien Diabetes Melitus yang Baru Didiagnosis Siahaan, Billy Stinggo; Lindarto, Dharma
Majalah Kedokteran Bandung Vol 49, No 2 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Resistensi insulin sangat penting pada diabetes melitus sebagai prediktor yang kuat terhadap perkembangan diabetes melitus dan target terapi saat hiperglikemia sudah terjadi. HOMA-IR merupakan suatu metode yang telah tervalidasi dalam menilai resistensi insulin pada pasien diabetes melitus. Puguntano suatu tanaman budidaya yang terdapat di Sumatra Utara diketahui memiliki efek antidiabetes. Sampel diambil dari tahun 2015-2016 di Rumah Sakit Haji Adam Malik Medan. Studi ini mencoba menilai pengaruh puguntano sebagai tanaman budidaya di Sumatera Utara terhadap resistensi insulin pada pasien Diabetes Melitus tipe 2. Untuk mengetahui pengaruh pemberian serbuk puguntano terhadap HOMA-IR pada pasien DM tipe 2 yang baru didiagnosis. Dilakukan uji klinis terbuka dengan desain paralel selama 12 minggu pada 24 pasien (12 pasien dan 12 kontrol) Diabetes Mellitus tipe 2 yang baru terdiagnosaÂ yang dibagi dalam 2 grup masing-masing diberikan puguntano dan metformin selama 12 minggu. HOMA-IR dan HbA1c diperiksa pada awal dan akhir pengobatan (minggu ke 12). Didapatkan penurunan HOMA-IR rata-rata pada grup puguntano 1,71 (Â±2,29) (p=0,034). Tidak didapatkan perbedaan penurunan HOMA-IR rata-rata antara kedua grup puguntano vs metformin 1.71 (Â±2,29) vs 0,80 (Â±1,47) (p=0,402). Didapatkan penurunan nilai HOMA-IR dengan pemberian puguntano pada penderita Diabetes Mellitus tipe 2 yang baru didiagnosis. Simpulan, efek puguntano dalam mengontrol gula darah terutama dalam perannya memperbaiki sensitifitas insulin tidak jauh berbeda dengan metformin yang telah menjadi obat standar dalam pengobatan lini pertama diabetes melitus tipe 2. [MKB. 2017;49(2):67â€“72]Â Kata kunci: Diabetes melitus, HOMA-IR, puguntanoÂ Â Effect of Puguntano on HOMA-IR in Newly Diagnosed Type 2 Diabetes MellitusÂ Insulin resistance is important not only as a powerful predictor of future development of type 2 diabetes mellitus but also as a therapeutic target once hyperglycemia is present. HOMA-IR is a method for assessing insulin resistance that has been validated worldwide. Puguntano is one of the traditional plants found in North Sumatera that has been recognized for its anti-diabetic effect. Samples were taken from 2015â€“2016 at H. Adam Malik General Hospital Medan. This study tried to assess the effect of puguntano as a traditional plant in North Sumatera on insulin resistance in type 2 diabetes melitus patients and aimed to determine the effect of puguntano treatment on HOMA-IR in newly diagnosed type 2 diabetes mellitus patients. This was a randomized open clinical trial on 24 newly diagnosed type 2 diabetes mellitus patients (12 patients and 12 controls) divided into 2 groups who were assigned to receiveÂ puguntano or Metformin for 12 weeks. HOMA-IR and Hba1c were determined at baseline and at the end of 12 weeks. In puguntano group, the mean decrease of HOMA-IR was 1.71 (Â± 2.29) (p=0.034). There was no difference in terms of the mean decrease of HOMA-IR between the puguntano and Metformin group, which was 1.71 (Â±2.29) vs 0.80 (Â±1.47) (p=0.402). There was a decrease mean of HOMA-IR level with puguntano treatment in newly diagnosed type 2 diabetes mellitus patients which was statistically significant. In conclusions, the effect of puguntano in controlling blood sugar especially in its role of improving insulin sensitivity is not much different from metformin which has become a standard drug in the first-line treatment of type 2 diabetes mellitus. [MKB. 2017;49(2):67â€“72]Â Key words: Diabetes mellitus, HOMA-IR, puguntano

HUBUNGAN PEMBENTUKAN BIOFILM OLEH BAKTERI GRAM NEGATIF DENGAN RESISTENSI ANTIBIOTIK PADA WANITA DIABETES MELITUS TIPE 2 Sahputri, Juwita; Lindarto, Dharma; Ganie, Ratna Akbari
AVERROUS: Jurnal Kedokteran dan Kesehatan Malikussaleh Averrous, Vol. 4: No. 1 (Mei, 2018)
Publisher : Fakultas Kedokteran Universitas Malikussaleh

Diabetes melitus (DM) memiliki efek jangka panjang terhadap sistem genitourinari yang menjadi faktor predisposisi terjadinya infeksi saluran kemih (ISK) pada pasien wanita dan umumnya bersifat asimtomatik. Bakteri gram negatif merupakan mikroorganisme penyebab tersering yang dapat membentuk biofilm sehingga sering menyebabkan resistensi antibiotik. Penelitian ini bertujuan untuk membuktikan hubungan antara pembentukan biofilm bakteri gram negatif dengan resistensi antibiotik pada wanita diabetes melitus tipe 2 (DMT2). Menggunakan desain penelitian cross sectional dengan teknik total sampling. Jumlah sampel penelitian adalah 45 orang wanita DMT2 anggota Program Pengendalian Penyakit Kronis (PROLANIS). Pada semua responden dilakukan kultur urin porsi tengah, uji sensitivitas dan pemeriksaan biofilm terhadap isolat bakteri yang teridentifikasi. Hasil kultur urin menunjukkan bakteriuria signifikan 14 (31%) responden. Identifikasi koloni menunjukkan bakteri penyebab ISK antara lain Escherichia coli (35,7%), Klebsiella pneumoniae (35,7%), Enterobacter sp (21,5%) dan Citrobacter sp (7,1%). Uji sensitivitas dijumpai 8 (57%) isolat resisten terhadap antibiotik, yaitu 2 (14,2%) isolat terhadap ciprofloksasin dan 6 (42,8%) isolat terhadap TMP-SMX. Bakteri gram negatif yang diisolasi 100% mampu membentuk biofilm dengan kategori weak. Berdasarkan analisis bivariat dengan uji Rank Spearman correlation dapat disimpulkan bahwa terdapatnya hubungan yang sangat lemah antara pembentukan biofilm oleh bakteri gram negatif dengan resistensi antibiotik ciprofloksasin dan TMP-SMX.

Gambaran Fungsi Hormon Tiroid Pada Penderita DM Tipe 2 Rawat Jalan Mardianto Mardianto; Suherdy Suherdy; Dharma Lindarto
Jurnal Kedokteran Syiah Kuala Vol 10, No 1 (2010): Volume 10 Nomor 1 April 2010
Publisher : Universitas Syiah Kuala

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AbstractBackground: In previous studies reported that impaired of thyroid function in patients with type 2 diabetes showed different results. This study aims to know the description of the thyroid hormone function in type 2 diabetes mellitus outpatient.Methods: A cross sectional study was conducted from ·September 2009 - March 2010 in H. Adam Malik General Hospital. The subjects were all outpatients at the clinic of Endocrine and Metabolic who met the criteria participated in this study. All samples were examined of TSHs, FT4, adrandom blood glucose, Total cholesterol, HDL cholesterol, and LDL cholesterol.Results: There were 40 patients with type 2 diabetes who had participated in study with 19 men(47.5%), and 21 women (52.5%) with mean age of 58.3 years. We found thyroid dysfunction is10% or 4 people and in details, 2 people (5%) of subclinical hypothyroidism and 2 people {5%) ofsubclinical hyperthyroidism. There were significant differences in average concentrations of three TSHs groups (pl = 0.0010, p2 = 0.012, p3 = 0.001), whereas Fr4 significantly different in eutiroid group and subclinical hyperthyroidism (p2 = 0.00 l) and subclinical hypothyroidism ·group and subclinical hyperthyroidism {p3 = 0.001). TSHs levels correlated positively and statisticallysignificant with total cholesterol (r = 0.989, p = 0,011)Conclusions: Overview of thyroid hormone function in 40 patients with type 2 diabetes mellitusindicates 10% of dysfunction with more women than men, and ages who have been affected is over 60 years.(JKS 2010; I: 1-8) Keywords: Dysfunction of Thyroid Hormone, Diabetes Mellitus Type 2

Polifarmasi dan Interaksi Obat Pasien Usia Lanjut Rawat Jalan dengan Penyakit Metabolik Eva S. Dasopang; Urip Harahap; Dharma Lindarto
Indonesian Journal of Clinical Pharmacy Vol 4, No 4 (2015)
Publisher : Universitas Padjadjaran

Penyakit metabolik merupakan penyakit yang berkaitan dengan peningkatan usia seperti hipertensi, diabetes melitus, dislipidemia, dan obesitas. Penyakit-penyakit tersebut ditangani dengan terapi obat yang sifatnya polifarmasi sehingga dapat menyebabkan risiko terjadi interaksi obat-obat. Penelitian ini dilakukan secara restropektif dengan menggunakan rekam medis pasien usia lanjut dengan penyakit metabolik yang di rawat jalan di Rumah Sakit Umum Pusat Haji Adam Malik Medan. Sebanyak 328 sampel yang termasuk ke dalam kriteria inklusi diperoleh data bahwa jumlah interaksi obat-obat yang terjadi cukup tinggi sebesar 78,96%. Pola mekanisme yang terbanyak adalah farmakokinetik (63,6%) dengan tingkat keparahan yang terbanyak adalah moderat (69,8%). Penelitian ini menunjukan adanya korelasi antara jumlah interaksi dengan jumlah obat (r= 0,728; p= 0,0001), dan jumlah interaksi dengan jumlah diagnosis (r= 0,264; p= 0,0001).Kata kunci: Interaksi obat, penyakit metabolik, polifarmasiPolipharmacy and Drug Interactions in Elderly Patients with Metabolic DiseasesMetabolic disease is a disease that is associated with increasing age such as hypertension, diabetes mellitus, dyslipidemia and obesity. Such diseases are treated with polypharmacy therapy that can cause increased risk of drug interactions. This study was conducted using a restropective method using the medical records of elderly patients with metabolic diseases in outpatient unit of H. Adam Malik General Hospital Medan. A total of 328 samples were included in the inclusion criteria data showed that the numberof drug-drug interactions that occur quite high at 78.96%. The pattern of drug interaction mechanism that most frequently occur is pharmacokinetic (63.6%) and the highest severity was moderate (69.8%). This study shown a correlation between the number of interactions with a number of drugs (r= 0.728; p=0.0001), and the number of interactions with a number of diagnoses (r= 0.264; p= 0.0001).Keywords: Drug-interactions, metabolic-disease, polypharmacy

UJI PRA KLINIS TOLERANSI GLUKOSA EKSTRAK ETANOL SERTA PENGUJIAN TOKSISITAS AKUT EKSTRAK ETANOL DARI PUGUN TANA (Picria felterrae Lour.) Imam Bagus Sumantri; Sumadio Hadisahputra; Dharma Lindarto; Awaluddin Saragih
JBIO: jurnal biosains (the journal of biosciences) Vol 3, No 2 (2017): Jurnal Biosains
Publisher : Universitas Negeri Medan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24114/jbio.v3i2.7435

Diabetes mellitus merupakan penyakit degeneratif yang memerlukan pengobatan yang intensif. Tanaman tradisional untuk pengobatan diabetes banyak dijumpai di masyarakat dan telah digunakan secara turun temurun. Pugun Tana (Picria felterrae Lour.) merupakan tumbuhan khas yang digunakan oleh masyarakat Dairi untuk pengobatan diabetes. Data hasil penelitian efektifitas sebagai antidiabetes dari Pugun Tana belum banyak dilakukan. Penelitian ini dilakukan bertujuan untuk menguji keamanan dan efektifitas dari Pugun Tanan sebagai antidiabetes sehingga dapat digunakan sebagai tanaman tradisional yang aman dan berkhasiat.Penelitian ini dilakukan dengan karakteristik simplisia daun (penentuan kadar air, penentuan kadar abu total dan tidak larut dalam asam, penentuan kadar sari larut etanol dan penentuan larutan kadar sari larut air). Ekstrak dibuat dalam crude extract dengan metode maserasi-perkolasi.Uji Toksisitas secara akut crude extract daun pugun tana tidak menunjukkan tanda-tanda keracunan dan kematian yang berarti sampai dosis 10.000 mg/kg bb. Crude extract pugun tana (Picria felterrae Lour.) dikategorikan praktis tidak toksis atau toksisitas ringan. Namun, data indeks organ menunjukkan bahwa ada perbedaan dari organ seperti hati, dan perbedaan ini tidak memberikan perbedaan yang berarti dibandingkan dengan dosis lainnya. Uji Toleransi glukosa dengan pemberian larutan glukosa dosis 5 g/kg bb menunjukkan bahwa pemberian ekstrak etanol pugun tana dosis 50, 100 dan 200 mg/kg BB tersebut menurunkan kadar gula darah tikus yang diberikan glukosa 50%. Suspensi ekstrak pugun tana dosis 100 mg/kg bb memberikan penurunan kadar gula darah hampir sama dengan suspensi glibenklamid dosis 10 mg/kg bb dan kenaikan dosis ekstrak tidak memberikan efek penurunan kadar gula darah yang lebih baik. Kata kunci: tikus obesitas, toleransi glukosa, toksisitas akut, picria felterrae, pugun tana

The Correlation between Glycemic Characteristic and Erythrocyte Indices in Obesity Dharma Lindarto; Santi Syafril; Dairion Gatot
The Indonesian Biomedical Journal Vol 8, No 3 (2016)
Publisher : The Prodia Education and Research Institute (PERI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18585/inabj.v8i3.215

BACKGROUND: Elevated blood glucose level is a major factor in development of diabetic complications due to unfavorable hyperglycemic induced biochemical as well as hematological indices changes. The aim of this study was to evaluate the correlation between glycemic characteristic and erythrocyte indices in obese subjects with different glycemic status.METHODS: Cross cross-sectional study was designed, and 80 obese subjects were enrolled. The correlations between glycemic characteristic (fasting plasma glucose (FPG), postprandial plasma glucose (PPG), hemoglobin A1c (HbA1c) and homeostasis model assessment of insulin resistance (HOMA-IR)) and erythrocyte indices (Hb, red blood count (RBC), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC)) were evaluated.RESULTS: Of 80 obese subjects with different glycemic status, there were 48 patients with only obesity (HbA1c <5.7%), 19 patients with pre-diabetes (HbA1c 5.7-6.4%) and 13 patients with diabetes (HbA1c >6.4%). Glycemic characteristic and profile lipid (high-density lipoprotein cholesterol (HDL-C), triglycerides (TG)) were differ significantly in the different HbA1c level. Erythrocyte indices were not differ significantly in the different HbA1c level. Partial Spearman's correlation analysis showed that only MCV was significantly correlated with glycemic characteristic of FPG, PPG, HbA1c and HOMA-IR (r=-0.36, p=0.001; r=-0.29, p=0.007; r=-0.27, p=0.014 and r=-0.236, p=0.035; respectively).CONCLUSION: MCV was significantly correlated with glycemic characteristic (FPG, PPG, HbA1C and HOMAIR). Further investigations are recommended.KEYWORDS: MCV, glycemic-characteristic, HbA1c, erythrocyte indices

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