In-hospital mortality of patients with acute coronary syndrome (ACS) after implementation of national health insurance (NHI) in Indonesia.

BACKGROUND: The National Health Insurance (NHI) was implemented in Indonesia in 2014, and cardiovascular diseases are one of the diseases that have overburdened the healthcare system. However, data concerning the relationship between NHI and cardiovascular healthcare in Indonesia are scarce. We aimed to describe changes in cardiovascular healthcare after the implementation of the NHI while determining whether the implementation of the NHI is related to the in-hospital mortality of patients with acute coronary syndrome (ACS). METHODS: This is a retrospective comparative study of two cohorts in which we compared the data of 364 patients with ACS from 2013 to 2014 (Cohort 1), before and early after NHI implementation, with those of 1142 patients with ACS from 2018 to 2020 (Cohort 2), four years after NHI initiation, at a tertiary cardiac center in Makassar, Indonesia. We analyzed the differences between both cohorts using chi-square test and Mann-Whitney U test. To determine the association between NHI and in-hospital mortality, we conducted multivariable logistic regression analysis. RESULTS: We observed an increase in NHI users (20.1% to 95.6%, p < 0.001) accompanied by a more than threefold increase in patients with ACS admitted to the hospital in Cohort 2 (from 364 to 1142, p < 0.001). More patients with ACS received invasive treatment in Cohort 2, with both thrombolysis and percutaneous coronary intervention (PCI) rates increasing more than twofold (9.2% to 19.2%; p < 0.001). There was a 50.8% decrease in overall in-hospital mortality between Cohort 1 and Cohort 2 (p < 0.001). CONCLUSIONS: This study indicated the potential beneficial effect of universal health coverage (UHC) in improving cardiovascular healthcare by providing more accessible treatment. It can provide evidence to urge the Indonesian government and other low- and middle-income nations dealing with cardiovascular health challenges to adopt and prioritize UHC.

Room temperature esterification of high-free fatty acid feedstock into biodiesel.

The esterification of a high-free fatty acid feedstock to biodiesel is often performed in high-temperature conditions using either homogeneous or heterogeneous acid catalysts. Thus, this study attempts to esterify oleic acid to biodiesel in room temperature conditions using sulphuric acid as a catalyst and a homogenizer device. The influences of process parameters including the molar ratio of oleic acid to methanol, catalyst concentration and rotational speed on biodiesel conversion were determined in different reaction times. The maximum conversion of 96.1 ± 0.4% was obtained in the presence of a molar ratio of 1 : 12, catalyst concentration of 0.7 mol L-1, a rotational speed of 4000 rpm and a reaction time of 30 minutes. The catalytic reusability test showed that the addition of fresh methanol is required to maintain the catalytic activity. However, the homogenizer-intensify esterification of oleic acid to biodiesel showed better performance than other methods as the reaction could conducted at room temperature and at a short reaction time. The predicted biodiesel properties meet the international standard except for oxidative stability. However, the flow properties revealed that the biodiesel can be used in winter season.

Pharmacokinetics of pyrazinamide during the initial phase of tuberculous meningitis treatment.

Tuberculous meningitis (TBM) is the most severe manifestation of tuberculosis. Pyrazinamide (PZA) is a pivotal antituberculous drug, but its dose has not been optimised for TBM. The aims of this study were to describe the pharmacokinetics of PZA during TBM treatment, to identify predictors of PZA exposure and to assess relationships between PZA dose and exposures in plasma and CSF. Plasma PZA pharmacokinetic data were assessed on Days 2 and 10 of treatment in 52 adult TBM patients. A CSF-to-plasma concentration ratio was determined on Day 2. Predictors of plasma PZA exposure, correlation between plasma and CSF exposures, and prediction of CSF concentrations based on dose and plasma exposure were evaluated. The geometric mean plasma PZA exposure (AUC0-24) and peak concentration (Cmax) on Day 2 were 709 h·mg/L and 59 mg/L following a median dose of 33.3 mg/kg/day; AUC0-24 on Day 10 (523 h·mg/L) was lower (P < 0.001). Dose and BMI correlated with AUC0-24 and Cmax. The CSF concentration at 3-6 h was 42 mg/L and the CSF-to-plasma ratio was 90%. AUC0-24, Cmax and CSF concentration were highly correlated. CSF concentration could be predicted based on dose and various plasma exposure measures with <5% bias and <21% imprecision. Exposure to PZA decreases during the first days of TBM treatment, possibly due to the evolving inductive effect of rifampicin. PZA penetrates well in CSF. The association between PZA dose and exposures in plasma and CSF provides a rationale to study higher PZA doses for TBM.

Double-Blind, Randomized, Placebo-Controlled Phase II Dose-Finding Study To Evaluate High-Dose Rifampin for Tuberculous Meningitis.

High doses of rifampin may help patients with tuberculous meningitis (TBM) to survive. Pharmacokinetic pharmacodynamic evaluations suggested that rifampin doses higher than 13 mg/kg given intravenously or 20 mg/kg given orally (as previously studied) are warranted to maximize treatment response. In a double-blind, randomized, placebo-controlled phase II trial, we assigned 60 adult TBM patients in Bandung, Indonesia, to standard 450 mg, 900 mg, or 1,350 mg (10, 20, and 30 mg/kg) oral rifampin combined with other TB drugs for 30 days. The endpoints included pharmacokinetic measures, adverse events, and survival. A double and triple dose of oral rifampin led to 3- and 5-fold higher geometric mean total exposures in plasma in the critical early days (2 ± 1) of treatment (area under the concentration-time curve from 0 to 24 h [AUC0-24], 53.5 mg · h/liter versus 170.6 mg · h/liter and 293.5 mg · h/liter, respectively; P < 0.001), with proportional increases in cerebrospinal fluid (CSF) concentrations and without an increase in the incidence of grade 3 or 4 adverse events. The 6-month mortality was 7/20 (35%), 9/20 (45%), and 3/20 (15%) in the 10-, 20-, and 30-mg/kg groups, respectively (P = 0.12). A tripling of the standard dose caused a large increase in rifampin exposure in plasma and CSF and was safe. The survival benefit with this dose should now be evaluated in a larger phase III clinical trial. (This study has been registered at ClinicalTrials.gov under identifier NCT02169882.).

Proactive Alleviation Procedure to Handle Black Hole Attack and Its Version.

The world is moving towards a new realm of computing such as Internet of Things. The Internet of Things, however, envisions connecting almost all objects within the world to the Internet by recognizing them as smart objects. In doing so, the existing networks which include wired, wireless, and ad hoc networks should be utilized. Moreover, apart from other networks, the ad hoc network is full of security challenges. For instance, the MANET (mobile ad hoc network) is susceptible to various attacks in which the black hole attacks and its versions do serious damage to the entire MANET infrastructure. The severity of this attack increases, when the compromised MANET nodes work in cooperation with each other to make a cooperative black hole attack. Therefore this paper proposes an alleviation procedure which consists of timely mandate procedure, hole detection algorithm, and sensitive guard procedure to detect the maliciously behaving nodes. It has been observed that the proposed procedure is cost-effective and ensures QoS guarantee by assuring resource availability thus making the MANET appropriate for Internet of Things.

Existence of the rdl mutant alleles among the anopheles malaria vector in Indonesia.

BACKGROUND: The gamma-aminobutyric acid (GABA) receptor-chloride channel complex is known to be the target site of dieldrin, a cyclodiene insecticide. GABA-receptors, with a naturally occurring amino acid substitution, A302S/G in the putative ion-channel lining region, confer resistance to cyclodiene insecticides that includes aldrin, chlordane, dieldrin, heptachlor, endrin and endosulphan. METHODS: A total of 154 mosquito samples from 10 provinces of malaria-endemic areas across Indonesia (Aceh, North Sumatra, Bangka Belitung, Lampung, Central Java, East Nusa Tenggara, West Nusa Tenggara, West Sulawesi, Molucca and North Molucca) were obtained and identified by species, using morphological characteristic. The DNA was individually extracted using chelex-ion exchanger and the DNA obtained was used for analyses using sequencing method. RESULTS: Molecular analysis indicated 11% of the total 154 Anopheles samples examined, carried Rdl mutant alleles. All of the alleles were found in homozygous form. Rdl 302S allele was observed in Anopheles vagus (from Central Java, Lampung, and West Nusa Tenggara), Anopheles aconitus (from Central Java), Anopheles barbirostris (from Central Java and Lampung), Anopheles sundaicus (from North Sumatra and Lampung), Anopheles nigerrimus (from North Sumatra), whereas the 302 G allele was only found in Anopheles farauti from Molucca. CONCLUSION: The existence of the Rdl mutant allele indicates that, either insecticide pressure on the Anopheles population in these areas might still be ongoing (though not directly associated with the malaria control programme) or that the mutant form of the Rdl allele is relatively stable in the absence of insecticide. Nonetheless, the finding suggests that integrated pest management is warranted in malaria-endemic areas where insecticides are widely used for other purposes.

[Nervous system involvement in hemorrhagic fever with renal syndrome].

The authors of the article describe two cases of hemorrhagic fever with renal syndrome (HFRS) with prevalence of signs of nervous system involvement. The first case was a 40-year-old woman with moderate HFRS, who developed Guillain-Barre syndrome of axonal-demyelinating polyneuropathy. An important observation was the absence of hemorrhagic or renal syndrome; combined therapy including plasmapheresis was successful. The second case demonstrated polymorphism of HFRS clinical manifestations with prevalence of neurological symptoms, which consisted in encephalopathy and no renal failure signs; hemorrhagic syndrome was moderate. In both cases the diagnosis was confirmed by elevated titer of antibodies to HFRS virus, belonging to the group of hantaviruses.