In Indonesia, the prevalence of Acute Coronary Syndrome (ACS) continues to rise annually and remains high. Aspirin and adenosine diphosphate receptor inhibitors are recommended as part of the dual antiplatelet therapy that is recommended by the standard guidelines for managing ACS. Ticagrelor, a new treatment option for ACS, has been made available during the current period of Indonesia's National Health Insurance. Ticagrelor is more effective, but it costs more. Objective: In patients with ST-Elevation Myocardial Infarction (STEMI), the goal of this study was to compare how much ticagrelor and clopidogrel cost when compared to one another with relative ratio (RR) analysis and 95% confidence interval (CI) with p<0.05 considered significant. This study was a decision tree-based retrospective cohort study with a one-year follow-up following the STEMI event. In 2017-2018, 496 patients, 92 of whom had taken ticagrelor and 404 of whom had taken clopidogrel, participated in the study at Dr. Sardjito General Hospital Yogyakarta. An incremental cost-effectiveness ratio (ICER) was used to present a cost-effectiveness analysis. In comparison to clopidogrel, the ticagrelor group's annual average total cost is higher. In the ticagrelor group, cardiovascular disease (CVD) event rates were 7.6%, while in the clopidogrel group, they were 21% (RR: 0.362, CI 95%: 0.173–0.755, p=0.005. Ticagrelor's ICER was IDR885.584 per CVD prevented compared to clopidogrel's. The yield of ticagrelor was lower (ICER <3 Gross Domestic Product/GDP) when compared to the WHO threshold ratio of willingness to pay (GDP per capita Indonesian = USD3.927, based on 2018). Ticagrelor is an antithrombotic that prevents CVD events in STEMI patients at the lowest cost.

Uncontrolled hypertension will increase mortality and morbidity rates. The adherence is an important factor in controlling blood pressure. Uncontrolled blood pressure will affect cardiovascular risk. Therefore, hypertensive patients must comply with taking medication to control blood pressure and cardiovascular risk. This study was an analytical observational study with a cross-sectional design. A total of 85 respondents who met the inclusion criteria were measured for adherence using the MPR (Medication Possession Ratio) method and the MARS-5 (Medication Adherence Report Scale-5) questionnaire. A patient who had blood pressure <140/90 mmHg was categorized as controlled hypertension. The cardiovascular risk was measured using the ACC/AHA criteria method. Data were analyzed using chi-square tests and odds ratio (OR) with 95% confidence interval (CI) and p<0.05 considered significant. This study showed that there was a significant association between adherence to antihypertensive therapy to controlled blood pressure, either according to MPR (OR=18.262; 95%CI=5.259-63.412; p=0.000) and MARS-5 (OR=31.607; 95%CI=8.170-122.277; p=0.000). A significant association was found between antihypertensive adherence and cardiovascular risk, either according to MPR (OR=3.733; 95%CI=1.269-10.983; p=0.020) and MARS-5 (OR=9.000; 95%CI=2.702-29.983; p=0.000). Therefore, this study concludes a significant relationship between antihypertensive adherence to controlled blood pressure and cardiovascular risk in Purworejo Regency.

Immunomodulators are substances or compounds that can modulate or help increase the activity and function of the immune system. The medicinal use of herbal plants is now increasing again among Indonesian people. Noni (Morinda citrifolia) is a plant commonly found in Indonesia that has long been known to have many benefits for treating and preventing various diseases and the secondary metabolites have potential as immunomodulators. This study aimed to determine the protein network associated with the body's immune system, which was activated by the administration of noni. The explorative descriptive research was conducted with in silico analysis using a computational model with software, including KNApSAck, Dr. Duke, Pubchem, Swiss ADME, Swiss Target Prediction, Gene Cards, Venny, STRING, and KEGG. Based on the results of pharmacological network analysis, noni contains 128 secondary metabolites, and 83 of them have high bioavailability. Based on pharmacological network analysis, (z,z,z)-8,11,14-eicosatrienoic-acid and 1-5-6-trihydroxy-anthraquinone are important compounds that play a role in the immune system because they are expected to interact with five crucial pathways related to immunomodulators.

Class 1 and 2 histone deacetylase inhibitors (HDACI) have been reported as novel therapeutic approaches to treat neurodegenerative disorders, depression, anxiety, and cognitive deficits. HDACI ameliorated deficits in cognition and stress-related behaviors in a wide range of neurologic and psychiatric disorders. Preclinically, behavioral bioassay can be used to predict the influence of new compounds for treatment of these illnesses. Curcumin and its new analogues PGV-0 and PGV-1 have been reported to inhibit HDAC2. However, reports regarding the effect of curcumin and its analogues on memory and cognitive function, anxiety, and social interaction behavior are as yet to be examined. Mice were divided into control and treated groups. Brain disorder was induced by oral administration of 10% ethanol in sodium-CMC for 7 days. Curcumin, PGV-0, PGV-1, and sodium butyrate (as positive control) were then given orally once a day for 21 days. The behavior tests of social interaction, open field, radial 8-arm-maze, and passive avoidance were performed on day 29. To increase dissolution and bioavailability of the compounds, they were formulated in a self-nano emulsifying drug delivery system (SNEDDS). Brains were isolated and analyzed using PCR to investigate the expression of genes related to neurobehavioral disorders hdac2, trkB, and bdnf. In different doses, curcumin, PGV-0, and PGV-1 increased social interaction capability, declined anxiety level, and improved long-term memory and cognitive function. The mechanism proposed is: HDACI curcumin and its analogues (PGV-0 and PGV-1) that keep the histone protein in acetylation state increase bdnf expression. The increased trkB expression is increasing the activation of the bdnf gene because trkB is the primary receptor of bdnf that supports the survival of existing neurons and encourages the growth and differentiation of new neurons and synapses. Thus, those mechanisms could improve long-term memory and cognitive function, increase social interaction, and reduce anxiety in ethanol-induced mice with brain disorders.

The administration of COVID-19 vaccine in children aims to control the spread of this disease in Indonesia. Parents make the decision whether to vaccinate their children against COVID-19 or not. This study was conducted to analyze parents’ acceptance of the COVID-19 vaccination for children in Indonesia based on the Theory Planned Behavior (TPB). The research design used a cross-sectional survey involving 400 parents of children aged 6-11 years in Indonesia in 34 provinces. Samples were purposively selected based on inclusion criteria: parents are older than 18 years, parents of children aged 6-11 years and live in Indonesia. The exclusion criteria were parents of children who recovered from COVID-19 less than 3 months and children with COVID-19 contraindications. The chi-squared test was conducted to determine the correlation between parents’ acceptance and TPB constructs that include attitudes, subjective norms and behavioral control. A multivariate logistic regression analysis was employed to analyze the TPB construct with the largest contribution on parents’ acceptance of the COVID-19 vaccination. The results showed high acceptance toward COVID-19 vaccination for children aged 6-11 years (98.5%). Positive subjective norms and positive behavioral control also contributed to the parental acceptance of the COVID-19 vaccine for children in Indonesia (p-value = 0.000), in which subjective norms had the largest influence (sig. 0.096 value with Exp B value of 6.203). TPB is a useful framework in developing proper interventions to raise the vaccination acceptance of parents in Indonesia.

tomach ulcer is a prevalent digestive problem that can lead to serious complications such as bleeding in the digestive tract, perforation, recurrence, cancer, and even death. One of its potential remedies lies in the antioxidant compounds contained in hantap leaves. Accordingly, this study aimed to investigate the anti-gastric ulcer effects of hantap leaf extract in white male rats induced by water immersion and cold-resistant stress methods. Hantap leaf extract (EEDH) was obtained by maceration using 96% ethanol, resulting in a yield of 7.8%. The results of gastric macroscopic observations based on percentage of ulcer inhibition showed that EEDH doses of 50, 100, and 200 mg/kg BW did not have a significant difference (p<0.05) with ranitidine, exhibiting the same gastroprotective effects. An increase in the dose does not lead to a corresponding rise in the gastroprotective effect. Therefore, 50 mg/kg BW of EEDH was considered to be the optimum dose.