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Comparation of Bevacizumab Intravitreal Injection Effects with and without Yellow Subthreshold Micropulse Laser (577-nm) Combination on Central Macular Thickness and Best Corrected Visual Acuity of Mild-Moderate Diabetic Macular Edema Patients UTAMI, ALIA NESSA; Djatikusumo, Ari; Khoe, Levina Chandra
Majalah Oftalmologi Indonesia Vol 49 No S2 (2023): Supplement Edition
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/ff95wf62

Abstract

Introduction & ObjectivesThe management of macular edema is constantly evaluated, with anti-VEGF therapy being the firstline. Subthreshold micropulse laser (SML) has been proposed as alternative adjuvant. Previousretrospective studies demonstrated the effectiveness of 577-nm SML as monotherapy in macularedema with CMT below 400 ?m. However, prospective data on the effectiveness of SML as adjuvantis lacking. The aim is to assess the effect of the combination of bevacizumab and 577-nm SML lasercompared to bevacizumab monotherapy on central macular thickness and visual acuity in mildmoderatediabetic macular edema patients. MethodsA prospective randomized clinical trial was performed on diabetic macular edema patients withmacular thickness range of 300-600 ?m. Subjects are divided into two groups. The control groupreceived a standard protocol and the study group received a yellow SML laser adjuvant one weekafter injection. Patients underwent follow-up assessment of visual acuity and central macularthickness at 28 and 35 days post-injection. Results26 subjects were equally divided into study and control groups. Significant decrease in CMT werefound in study group (p=0.011 and 0.014) and the control group (p=0.006 and p=0.001). However,there was no significant difference in ?CMT values between the two groups in the 28-day (p=0.317)and 35-day controls (p=0.84). There was no difference in ?BCVA ETDRS between the study andcontrol groups at 28 days (p=0.568) and 35 days (p=0.128) after injection. ConclusionThe combination of SML and intravitreal bevacizumab can reduce central macular thickness andimprove visual acuity but there was no significant difference with standard monotherapy.
Examining The Relationship between Shift Work and Diabetes Mellitus among Nurses: An Evidence-based Case Report Arifianto, Angga; Widyahening, Indah Suci; Khoe, Levina Chandra; Mokoagow, M. Ikhsan
Occupational and Environmental Medicine Journal of Indonesia Vol. 2, No. 2
Publisher : UI Scholars Hub

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Abstract

Background : Work shifts could cause numerous health problems, such as sleep disorders, weight gain disorders, and unhealthy food intake consumption, leading to obesity and changes in blood glucose levels, that eventually lead to diabetes mellitus. This evidence-based case report aims to provide an evidence of association between shift work and the risk of diabetes mellitus among nurses. Methods : We performed a literature searching from Pubmed, Embase, Cochrane, Scopus, and Google Scholar in September 2023 using keywords ‘shift work’ AND ‘diabetes’ AND ‘nurse’. We included studies that assessed the association between shift work and diabetes among nurses using observational studies, meta-analysis, and systemic review as their study design. The outcome variable was the odd ratio or the relative risk of developing diabetes. We excluded cross-over studies, clinical trials, and cross-sectional studies. In addition, quality assessment was conducted according to The Oxford Center for Evidence-Based Medicine (OCEBM). Results : After title and abstract screening, we found seven out of twenty articles with a total of 689,273 participants. Among these articles, there were three cohort studies which found an increased relative risk (1.08 to 2.60) of diabetes among nurses who worked night and rotating shifts compared to those who did not. Another evidence from two cohort studies and one meta-analysis identified that nurses who worked in full shifts had an increased risk of diabetes (1.05 to 3.60) than those who worked non-shifts. Factors affecting the risk of diabetes were gender, unhealthy lifestyle, sleep disorders, and shift work duration (≥10 years). Conclusions : Shift work in nurses has a significant association with the risk of diabetes mellitus. Nurses had been working shift work for more than 10 years, particularly on night shift, had a higher risk compared to those who had been working for less than 10 years without night shift. Additional factors such as obesity, smoking, lack of physical activity, unhealthy diet, and sleep disorders would increase the risk of diabetes mellitus.
Low-Dose Prophylaxis Versus On-Demand Treatment for Children with Severe Hemophilia A in Indonesia: A Conceptual Model Khoe, Levina Chandra; Atika, Nur; Pertiwi, Dhia Ticha; Putri, Septiara
Kesmas Vol. 21, No. 1
Publisher : UI Scholars Hub

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Abstract

Hemophilia A is a rare bleeding disorder caused by a deficiency of clotting factor VIII, leading to recurrent bleeds, joint damage, and disability. Low-dose prophylaxis has been shown to achieve better clinical outcomes than on-demand treatment in reducing bleeding frequency. However, in Indonesia, access and affordability remain key challenges. This study aimed to develop a conceptual model for conducting a health economic evaluation of low-dose prophylaxis treatment for children with severe hemophilia A in Indonesia. This study followed the ISPOR-SMDM Modeling guidelines, outlining two-stage processes: conceptualization of the clinical problem and model development. A systematic literature review was conducted to identify relevant clinical and economic evidence on low-dose prophylaxis and on-demand treatment in pediatric hemophilia A. Indonesian clinical guidelines and expert input from two hematologists were incorporated to contextualize the model. Thirteen studies (three clinical and ten economic evaluations) consistently reported improved outcomes with low-dose prophylaxis. Most models applied health state transitions involving bleeding episodes, joint damage, complications, and death. Based on this review and discussion, the conceptual model was established to support the cost-effectiveness analysis of low-dose prophylaxis. A rigorous conceptual model serves as the key foundational step in developing a valid, health economic model for the Indonesian setting.