Category IIA Research Articles

KAJIAN RASIONALITAS PENGGUNAAN ANTIBIOTIK PADA ANAK DENGAN INFEKSI SALURAN KEMIH DI RSUD Dr. MOEWARDI SURAKARTA

Urinary tract infection (UTI) is the second highest infectious disease among children in Indonesia. Management of UTI requires antibiotic therapy, but the irrational use of antibiotics makes this disease one of the contributors to the high rate of antibiotic resistance. Therefore, there is a need for a study to measure the rationality of antibiotic use in children with UTI. This study is a descriptive observational study with a cross sectional design. Data were collected retrospectively using a purposive sampling technique based on medical record data of pediatric patients at Dr. Moewardi Surakarta Hospital in 2021-2023. The results showed that out of 100 medical records of pediatric patients with UTI, 68.00% were women and 32.00% were men. Based on age, the highest incidence of UTI occurred in the age range of 10-18 years as much as 52.00%. The most common antibiotic use was ampicillin 68.00%. The results of the rationality study showed 69.00% in category 0 (rational use of antibiotics). Irrationality occurred in category IIA (antibiotic use is not the right dose) 17.00%, IIIA (antibiotic use with too long duration) 1.00%, IIIB (antibiotic use with too short duration) 4.00%, IIA & IIIB (antibiotic use is not the right dose & duration is too short) 2.00%, IVA (there are other more effective antibiotic options) 4.00%, IIIB & IVA (antibiotic use is too short duration & there are other more effective antibiotic options) 3.00%. It can be concluded that the rational use of antibiotics needs to be improved.

Evaluation of antimicrobial stewardship implementation in elective surgery in dr Cipto Mangunkusumo General Hospital using Gyssens Method

Introduction. Nowadays, surgical site infections (SSI) remain the most common complication of surgical procedures. In prevention, prophylactic antibiotics are the first option, which leads to the high use of antibiotics. However, antibiotic administration should be based on strategies such as stewardship. Thus, the study aimed to assess the situation using Gyssens' method. Method. A retrospective cohort study analyzed the antibiotic administration of most major elective surgeries, including thyroidectomy, mastectomy, and cholecystectomy, proceeded in Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia, from January to July 2023. Indication, type, dosage, timing, interval, duration, and route of administration were the variables of interest. Results. Of 191 subjects who underwent the most common elective surgery procedures, 30 used combination antibiotics. Gyssens category 0 consists of 165 subjects (86.5%), and 11 subjects (5.8%) were classified as category IIA, indicating inappropriate dose (inadequate, insufficient). Inaccuracies were identified as mistimed administration (5.8%), less effective antibiotic selection (3.1%), incorrect dosage (2.6%), and inappropriate timing (2.1%). The association of Gyssens categories with SSIs showed a p-value of > 0.05 with an odds ratio of 1, indicating that both appropriate and inappropriate antibiotics of the Gyssens category showed no impact on SSIs or non–SSIs. Conclusion. The adherence to antimicrobial stewardship in the most common elective surgery in the Department of Surgery, dr. Cipto Mangunkusumo General Hospital was 86.4 and subjected to improvement.

QUALITATIVE EVALUATION OF ANTIBIOTIC USE IN THE NICU ROOM (NEONATE INTENSIVE CARE UNIT) IN HOSPITAL X CITY OF PADANG YEAR 2022

Neonates are very vulnerable to infection due to exposure to microorganisms during labor and sometime after birth. Some neonates need special care in the Neonatal Intensive Care Unit (NICU) room because of infection cases that require antibiotic therapy. This study aims to evaluate the use of antibiotics qualitatively. This study is an analytic descriptive study with cross sectional design, using retrospective data. Evaluation of antibiotic use qualitatively with the Gyssens method. While the relationship between the rationality of antibiotic use with the description of demographic and clinical characteristics of patients was analyzed by chi square. The source of data was the medical records of patients admitted to the NICU room of Hospital X in Padang City who were admitted from January 1, 2022 to December 31, 2022. Descriptive analysis was performed to determine the description of demographic and clinical characteristics of patients and evaluation of antibiotic use. From this study, the results of qualitative evaluation obtained category 0 (rational) 180 (71.14%), category IIa as many as 14 (5.53%), category IIb as many as 9 (3.56%), category IIIa as many as 21 (8.30%) and category IIIb as many as 28 (11.07%).The relationship between the accuracy of antibiotic use with the description of demographic characteristics and NICU discharge conditions obtained the results there is a difference in the level of accuracy of antibiotic use with the birth process (p=0.000) and there is a difference in the level of accuracy of antibiotic use with NICU discharge conditions (p=0.000).

EVALUASI PENGGUNAAN ANTIBIOTIK PASIEN PNEUMONIA DENGAN METODE GYSSENS

The purpose of this study is to determine the rationality of using antibiotics in pneumonia patients with the gyssens method in the inpatient installation of Nene Mallomo Hospital, Sidrap Regency for the 2021 period. This type of research is descriptive research with a quantitative approach conducted retrospectively. The results of the evaluation of the use of antibiotics based on the gyssens method were obtained the use of appropriate / rational antibiotics (category 0) by 14% and irrational use of antibiotics by 86% which were divided into other antibiotics that were more effective (category IVa) by 67%, the use of antibiotics too long (category IIIa) by 5%, the use of antibiotics too short (category IIIb) by 13% and the use of antibiotics not right dose (category IIa) by 1%. In this study, it can be concluded from the category assessed that the use of antibiotics in pneumonia patients at Nene Mallomo Hospital, Sidrap Regency is irrational.

EVALUASI PENGGUNAAN ANTIBIOTIK DENGAN METODE GYSSENS PADA PASIEN DEMAM TIFOID ANAK DI INSTALASI RAWAT INAP RSUP Dr. SITANALA TAHUN 2019-2021

Typhoid fever is a disease caused by bacteria and its treatment requires antibiotics. Antibiotic-resistant bacteria can grow as a result of improper use of antibiotics. The purpose of this study was to determine the rational usage pattern and percentage of antibiotic drug use according to the Gyssens method. This non-experimental study employed retrospective data collecting from the medical records of children treated for typhoid fever at the Dr. Sitanala in 2019–2021 and used the Gyssens technique for analysis. According to the study's findings, 28 patients (46.67%) were classified as irrational, whereas 32 patients (53.33%) were considered rational (category 0). In this study, it can be concluded that the use of antibiotics used in typhoid fever patients, namely ceftriaxone (82,54%), cefotaxime (14.29%), and cefixime (3.17%) with the intravenous route of administration (96.83%) and orally (3.17%). Irrational use of antibiotics included Gyssens category V (antibiotics are not needed) (1.67%), category IVC (there are cheaper antibiotics) (11,86%), category IIIB (the duration of giving antibiotics are too short) (30,51%), category IIA (not the right doses) (20,34%), and category I (not on time to give antibiotics) (18.64%).

PP121 Assessment Of Heart Rate Characteristics Analysis

IntroductionThe heart rate characteristics (HRC) analysis is a technique for predicting and monitoring neonatal infectious diseases in infants with a risk for infectious disease, such as sepsis, using the HRC index based on the electrocardiogram (ECG) data transmitted from a HeRO® device connected to an ECG monitor.MethodsThe assessments were performed via a systematic review. Searching five databases (KoreaMed, Ovid-MEDLINE, Ovid-EMBASE, and Cochrane) yielded 284 related studies. Two reviewers independently assessed the quality of these studies, using the Scottish Intercollegiate Guidelines Network checklist and the assessment results were described based on the results of the quality appraisal and level of evidence.ResultsThe safety and effectiveness of the technique were assessed based on eight non-Korean studies (one randomized controlled trial (RCT), five cohort studies, one case-control study, one case series). The four studies that reported area under the curve (AUC) values, the timing of the analysis and AUC values (0.67– 0.75) were inconsistent among the studies. The elevation of the HRC index prior to the diagnosis of an infectious disease was not observed for meningitis or for multiple infectious diseases. In addition, although the group with additional monitoring using the technique had a significantly lower mortality rate, whether the HRC index had a direct impact on the infection prevention activities and the possibility of bias arising from the researchers’ precautionary treatment based on the clinical symptoms and other test results as well as the actual time of disease onset are unknown.ConclusionsTherefore, the committee presented the following recommendations based on the available evidence and expert opinion. HRC analysis is a safe technique for predicting and monitoring neonatal infectious diseases in infants with a risk for infectious disease, such as sepsis, using the HRC index based on the ECG data transmitted from a HeRO® device connected to an ECG monitor; however, further research is needed to determine its effectiveness (Level of evidence C, Technology category II-a).

The potential role of miRNAs and regulation of their expression in the development of mare endometrial fibrosis

Mare endometrial fibrosis (endometrosis), is one of the main causes of equine infertility. Despite the high prevalence, both ethology, pathogenesis and the nature of its progression remain poorly understood. Recent studies have shown that microRNAs (miRNAs) are important regulators in multiple cellular processes and functions under physiological and pathological circumstances. In this article, we reported changes in miRNA expression at different stages of endometrosis and the effect of transforming growth factor (TGF)-β1 on the expression of the most dysregulated miRNAs. We identified 1, 26, and 5 differentially expressed miRNAs (DEmiRs), in categories IIA (mild fibrosis), IIB (moderate fibrosis), and III (severe fibrosis) groups compared to category I (no fibrosis) endometria group, respectively (Padjusted < 0.05, log2FC ≥ 1.0/log2FC ≤ − 1.0). This study indicated the potential involvement of miRNAs in the regulation of the process associated to the development and progression of endometrosis. The functional enrichment analysis revealed, that DEmiRs target genes involved in the mitogen-activated protein kinases, Hippo, and phosphoinositide-3-kinase (PI3K)-Akt signalling pathways, focal adhesion, and extracellular matrix-receptor interaction. Moreover, we demonstrated that the most potent profibrotic cytokine—TGF-β1—downregulated novel-eca-miR-42 (P < 0.05) expression in fibroblasts derived from endometria at early-stage endometrosis (category IIA).

Measurement Does Not Take Place in a Legal Vacuum

Measurement Does Not Take Place in a Legal Vacuum

Evaluasi Pola dan Rasionalitas Penggunaan Antibiotik pada Pasien Neonatus di Ruang NICU dan Perinatal RSUD Banjarnegara

Neonates are particularly susceptible to infections caused by exposure to microorganisms during labor or shortly after birth. Some neonates require treatment in the NICU and perinatal rooms because of cases of infection that require antibiotics as therapy. This study aimed to determine the pattern of antimicrobial administration, antimicrobial rationality, and its relationship to clinical outcomes. This study used a cross-sectional design with prospective data collection using the medical record of neonates in the NICU and Perinatal rooms at RSUD Banjarnegara during November 2020-January 2021. The samples in this study were all neonatal patients who received antibiotics. Evaluation of antibiotics use was carried out using the Gyssens method. Descriptive analysis was conducted to determine the description of the research sample and the antibiotics used. A total of 131 samples had normal birth weight characteristics of 71%. The single antibiotic most frequently used as amoxicillin (21 patients), and the combination antibiotic was ampicillin+gentamicin (106 patients). The results of the evaluation using the Gyssens method showed that patients received 265 antibiotics, 85.55% were in category 0, 8.75% in category IIa, 3.8% in category IIIb, and 1.9% in category IIb. Of the 131 neonates treated, 124 patients were declared improved and 7 others died. The correlation between antibiotic rationality and clinical outcomes was analyzed by Chi-square, the result of the Asymp value. Sig (2-sided) 0.138 which means there is no relationship between the two. The rationality and effectiveness of clinical outcomes of antibiotics used during the study were considered good because the number of patients who were discharged with improved conditions was much greater than those who died.

Metallopeptidades 2 and 9 genes epigenetically modulate equine endometrial fibrosis.

Endometrium type I (COL1) and III (COL3) collagen accumulation, periglandular fibrosis and mare infertility characterize endometrosis. Metalloproteinase-2 (MMP-2), MMP-9 and tissue inhibitors of metalloproteinases (TIMP-1 and TIMP-2) are involved in collagen turnover. Since epigenetic changes may control fibroproliferative diseases, we hypothesized that epigenetic mechanisms could modulate equine endometrosis. Epigenetic changes can be reversed and therefore extremely promising for therapeutic use. Methylation pattern analysis of a particular gene zone is used to detect epigenetic changes. DNA methylation commonly mediates gene repression. Thus, this study aimed to evaluate if the transcription of some genes involved in equine endometrosis was altered with endometrial fibrosis, and if the observed changes were epigenetically modulated, through DNA methylation analysis. Endometrial biopsies collected from cyclic mares were histologically classified (Kenney and Doig category I, n = 6; category IIA, n = 6; category IIB, n = 6 and category III, n = 6). Transcription of COL1A1, COL1A2, COL3A1, MMP2, MMP9, TIMP1, and TIMP2 genes and DNA methylation pattern by pyrosequencing of COL1A1, MMP2, MMP9, TIMP1 genes were evaluated. Both MMP2 and MMP9 transcripts decreased with fibrosis, when compared with healthy endometrium (category I) (P < 0.05). TIMP1 transcripts were higher in category III, when compared to category I endometrium (P < 0.05). No differences were found for COL1A1, COL1A2, COL3A1 and TIMP2 transcripts between endometrial categories. There were higher methylation levels of (i) COL1A1 in category IIB (P < 0.05) and III (P < 0.01), when compared to category I; (ii) MMP2 in category III, when compared to category I (P < 0.001) and IIA (P < 0.05); and (iii) MMP9 in category III, when compared to category I and IIA (P < 0.05). No differences in TIMP1 methylation levels were observed between endometrial categories. The hypermethylation of MMP2 and MMP9, but not of COL1A1 genes, occurred simultaneously with a decrease in their mRNA levels, with endometrial fibrosis, suggesting that this hypermethylation is responsible for repressing their transcription. Our results show that endometrosis is epigenetically modulated by anti-fibrotic genes (MMP2 and MMP9) inhibition, rather than fibrotic genes activation and therefore, might be promising targets for therapeutic use.

Qualitative Evaluation of Antibiotics Use with Gyssens Method in Sepsis Patients at Fatmawati Central General Hospital Jakarta

Sepsis still becomes a major health problem worldwide, with a fairly high mortality rate ranging from 20 to 50%. Antibiotic therapy with rational use can reduce the mortality rate. In contrast, the irrational use of antibiotic therapy will increase the occurrence of resistance, which impacts the increase of morbidity, mortality, and health costs. The objective of this study was to evaluate the quality in the use of antibiotics using the Gyssens method in patients with sepsis. This study was an observational study with a cross-sectional method conducted at Fatmawati Central General Hospital Jakarta from January to December 2020. The research subjects were 110 patients with sepsis who met the inclusion criteria. In this study, 49.09% of patients used rational antibiotics and 50.91% of patients used irrational antibiotics that were found in category VI (0.91%), V (17.28%), IVa (3.63%), IVb (0.91%), IVc (0.91%), IIIa (3.63%), IIIb (20%), IIa (0.91%), and IIb (2.73%). The duration of antibiotic therapy was the only factor that affected the quality of antibiotic use (p = 0.012). There was no difference in mortality between patients with rational and irrational use of antibiotics (p = 0.333, OR = 1.654, 95% CI 0.714-3.829). However, after adjusting for the duration of therapy, irrational use of antibiotics significantly affected mortality (p = 0.017, OR = 3.5, 95% CI 1.255-9.761). In conclusion, the antibiotic use in half of the sepsis patients were irrational. Since irrational use was associated with mortality, efforts need to be taken to improve the quality of antibiotic use.

Collagen Type III as a Possible Blood Biomarker of Fibrosis in Equine Endometrium.

Simple SummaryIn the mare, endometrosis is a disease characterized by excessive collagen fibers deposition in the endometrium (uterus inner layer), which is responsible for infertility. The gold standard method for endometrosis evaluation has been endometrial biopsy histopathological classification. The use of blood biomarkers for endometrosis identification would be less invasive, and could provide additional information regarding endometrosis diagnosis and fertility prognosis. Therefore, this study aimed to identify possible blood biomarkers for endometrosis diagnosis and fertility assessment on mares. Reproductive examination, endometrial biopsy histopathological classification, and blood collection were performed. Endometrium and serum collagen type I (COL1) and type III (COL3), and hydroxyproline concentrations were determined. In conclusion, serum COL3 concentration might be considered as a potential aid for the diagnosis of endometrosis and fertility prognosis in the mare. In contrast, COL1 and hydroxyproline did not prove to be effective as biomarkers of endometrial fibrosis in this species. Although it is very unlikely that a single blood biomarker could replace a histopathological evaluation, serum COL3 may have clinical applications. Thus, it may be useful to evaluate a group of mares as possible recipients in embryo transfer programs, where performing endometrial biopsies of several mares is not feasible.Collagen pathological deposition in equine endometrium (endometrosis) is responsible for infertility. Kenney and Doig’s endometrial biopsy histopathological classification is the gold standard method for endometrosis evaluation, whereby blood biomarkers identification would be less invasive and could provide additional information regarding endometrosis diagnosis and fertility prognosis. This study aimed to identify blood biomarkers for endometrosis diagnosis (42 mares were used in experiment 1), and fertility assessment (50 mares were used in experiment 2). Reproductive examination, endometrial biopsy histopathological classification (Kenney and Doig) and blood collection were performed. Endometrium and serum collagen type I (COL1) and type III (COL3), and hydroxyproline concentrations were measured (ELISA). Serum COL3 cut-off value of 60.9 ng/mL allowed healthy endometria (category I) differentiation from endometria with degenerative/fibrotic lesions (categories IIA, IIB or III) with 100% specificity and 75.9% sensitivity. This cut-off value enabled category I + IIA differentiation from IIB + III (76% specificity, 81% sensitivity), and category III differentiation from others (65% specificity, 92.3% sensitivity). COL1 and hydroxyproline were not valid as blood biomarkers. Serum COL3 cut-off value of 146 ng/mL differentiated fertile from infertile mares (82.4% specificity, 55.6% sensitivity), and was not correlated with mares’ age. Only COL3 may prove useful as a diagnostic aid in mares with endometrial fibrosis and as a fertility indicator.

Intravenous human immunoglobulin utilization patterns and cost analysis in a Malaysian tertiary referral hospital

IntroductionWhile intravenous human immunoglobulin therapy is potentially lifesaving for rare diseases, the significant costs associated with its usage warrant due attention. This study evaluated the costs and prescribing patterns of IVIg.MethodsThis was a retrospective analysis of medical records in a tertiary hospital. The evidence category IIA and below, as well as strength of recommendations level B and below were classified as lower evidence category and lower strength of recommendation, respectively. Patients’ demographic data, indications, dosing regimen, physician specialty were retrieved from medical records, while the cost was derived based on total prescribed doses.ResultsOut of 78 patients, more than half of the patients were prescribed with off-label IVIg based on MOHM Formulary (52, 66.7%), FDA indications (52, 66.7%) and EMA indications (46, 59.0%). 37 (47.4%) cases used IVIg for indications with lower evidence category and 52 (66.7%) cases with lower strength of recommendation. The total cost of IVIg use within the 2-year period was RM 695,426.36, with RM267,993.40 (38.5%) spent for indications with lower evidence category. Immunoglobulin use in rheumatology and neurology cases were associated with lower evidence category (p < 0.001).ConclusionsA high proportion of off-label immunoglobulin use was observed. A timely update of prescribing policy, standardization of prescribing guidelines may promote appropriate immunoglobulin prescribing and justify expenses.

RATIONALITY OF ANTIBIOTICS USE WITH QUANTITATIVE AND QUALITATIVE METHODS AT HOSPITAL IN INDONESIA

&#x0D; Infection is one of the biggest causes of death in Indonesia which can be influenced by the appropriate use of antibiotics. Irrational use of antibiotics can cause bacteria to become resistant to antibiotics so that the effectiveness of the drug decreases or even disappears. This study aims to evaluate the use of antibiotics given to inpatients at a private hospital in Indonesia both quantitatively and qualitatively in the period July to December 2021. This study is an observational study with retrospective data collection where qualitative analysis using the Gyssens Method and quantitative analysis uses the DDD method. The results of the qualitative analysis showed that from 30 cases observed, there were 9 cases (30%) irrational prescriptions, namely 1 case in category V, 4 cases in category IVA, 2 cases in category IIIB and 2 cases in category IIA. The results of the quantitative analysis showed that the antibiotics with the highest DDD/100 patient days in the period July to December 2021 were Ceftriaxone with a successive value of 39.15; 39.81; 36.22; 55.65; 41,48 and 49, 42 while antibiotics with the lowest DDD/100 patient-days values in the period July to December obtained different results. Based on research results, there are irrational antibiotic prescriptions and Ceftriaxone became the most commonly prescribed antibiotic.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Combination of XGBoost Analysis and Rule-Based Method for Intrapartum Cardiotocograph Classification

PurposeThe two major components of a cardiotocograph (CTG) are uterine contraction (UC) and fetal heart rate (FHR) signals. CTG has been widely used to monitor fetal well-being in the past 50 years. The guideline provided by the National Institute of Child Health and Human Development (NICHD) classifies CTG patterns into three categories (I, II, and III) in evaluating the status of a fetus. However, manual interpretation of CTG is time-consuming and is subjected to inter-personal bias.MethodsIn this study, we combined the rule-based method and eXtreme Gradient Boosting (XGBoost) analysis in classifying CTG patterns. Because of the persistent controversies about the Category II of NICHD, XGBoost analysis was used to classify it into IIa and IIb. A total of 68 pregnant women were enrolled in this study.ResultsThree categories (I, II, and III) were consistent in both manual interpretation by clinicians and our algorithm across all categories, and the average Kappa was about 0.72. The probability of fetal distress (FD) was 28.8% and 71.2% in the categories IIa and IIb, respectively.ConclusionThese findings show the proposed method has the potential to provide a clinical assistant tool to monitor fetal well-being and has high potential to be an assistive and warning system to reduce the burden of medical staff.

Predictability of Elimination and Excretion of Small Molecules in Animals and Humans, and its Impact on Dosimetry for human ADME Studies with Radiolabeled Drugs.

We assessed the extent to which urinary and fecal excretion of 14C-labeled drug material in animal ADME studies was predictive of human ADME studies. We compared observed plasma elimination half-lives for total drug-related radioactivity in humans to pre-study predictions, and we estimated the impact of any major differences on human dosimetry calculations. We included 34 human ADME studies with doses of 14C above 0.1 MBq. We calculated ratios of dosimetry input parameters (percentage fecal excretion in humans versus animals; observed half-life in humans versus predicted pre-study) and output parameters (effective dose post-study versus pre-study) and assessed their relationship. A quantitative correlation assessment did not show a statistically significant correlation between the ratios of percentages of 14C excreted in feces and the ratios of dosimetry outcomes in the entire dataset, but a statistically significant correlation was found when assessing the studies that were based on ICRP 60/62 (n=19 studies; P=0.0028). There also appeared to be a correlation between the plasma half-life ratios and the ratios of dosimetry results. A quantitative correlation assessment showed that there was a statistically significant correlation between these ratios (P<0.0001). In all cases where the plasma elimination half-life for 14C in humans was found to be longer than the predicted value, the radiation burden was still within ICRP Category IIa. Containment of the actual radiation burden below the limit of 1.00 mSv appeared to be determined partly also by our choice to limit 14C doses to 3.7 MBq.

EVALUASI PENGGUNAAN ANTIBIOTIKA PADA PASIEN LEUKEMIA LIMFOBLASTIK AKUT DENGAN DEMAM NEUTROPENIA DI RUMAH SAKIT UMUM DAERAH ABDUL WAHAB SJAHRANIE SAMARINDA

ABSTRACT&#x0D; &#x0D; The use of antibiotics is one of the management of neutropenic fever in patients with acute&#x0D; lymphoblastic leukemia (ALL). Irrational and excessive antibiotics can promote resistance to&#x0D; certain bacteria. The aim of this study was to evaluate the use of antibiotics given to ALL patients&#x0D; with neutropenic fever qualitatively and quantitatively. This type of observational research was&#x0D; conducted with a descriptive method using a cross-sectional design. Retrospective data collection&#x0D; from medical records of ALL patients who received antibiotics during 2017-2018. The quality of&#x0D; antibiotic use was analyzed using the Gyssens method, while the quantity of antibiotic use was&#x0D; analyzed using the DDD method per 100 bed days. Based on the results of the study of 7 ALL&#x0D; patients with neutropenic fever, the rational (category 0) use of antibiotics was 50% and the&#x0D; irrational (category I-IV) use of antibiotics was 50%. The use of inappropriate antibiotic dose (category IIA) was 25%, the use of the antibiotic inaccurate interval of use (category IIB) was&#x0D; 10%, and there was no indication that antibiotic use (category V) was 15%. Quantitative&#x0D; evaluation of the use of antibiotics using the DDD method per 100 bed days showed that the total&#x0D; use of antibiotics was 7 types with a DDD value of 100 patient days of 19.15. The most widely used&#x0D; antibiotic is the cephalosporin class, namely cefotaxime with a DDD value of 6.51.&#x0D; &#x0D; Keywords: antibiotics, leukemia, quality, quantity

A Gyssens Evaluation On Antibiotics Usage On Inpatients With Urinary Tract Infection In Hospital X, Central Jakarta, on January 2017 – June 2019

Urinary tract infections are infections from the bladder to the renal parenchyma, and can affect all ages. Empirical therapy can reduce morbidity, but due to the use of antibiotics that are not appropriate will have an impact on resistance that will cause increase morbidity, mortality, and health costs. In the Southeast Asian region, high use of antibiotics were found almost more than 80% in various provinces in Indonesia. This study aims to assess the appropriatness use of antibiotics in hospitalized patients with UTIs in the District Hospital X in the period January 2017 - June 2019 using gyssens criteria. This is retrospective study. Research data sourced from medical records. Data was collected and assessed with Gyssens flow, then processed using Microsoft Excel. The results found 15 cases (46.88%) with the appropriate use (category 0), 3 cases (9.37%) incorrect interval (category IIB), 1 case (3.33%) incorrect dosage (category IIA ), 10 cases (31.25%) too short given (category IIIB), 3 cases (9.37%) too long given (category IIIA). Empirical therapy inpatients with diagnosis urinary tract infections atvDistrict Hospital X, 46.8% of antibiotics were used appropriately.

Level of Scientific Evidence Underlying Recommendations from the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for Hematologic Malignancies: Are We Moving Forward?

Background: National Comprehensive Cancer Network (NCCN) guidelines are the most comprehensive and widely used standard for clinical care in malignant hematology by clinicians and payers in the US. The level of scientific evidence in NCCN guidelines for malignant hematological conditions has not been recently investigated. We describe the distribution of categories of evidence and consensus (EC) among the 10 most common hematologic malignancies with regard to recommendations for staging, initial and salvage therapy, and surveillance. Methods: NCCN uses a system of guideline development distinct from other major professional organizations. The NCCN definitions for EC are: category I, high level of evidence such as randomized controlled trials with uniform consensus; category IIA, lower level of evidence with uniform consensus; category IIB, lower level of evidence without a uniform consensus but with no major disagreement; and category III, any level of evidence but with major disagreement. We compared our results with previously published results from 2011 guidelines. Results: Total recommendations increased by 16.6% from 1160 (2011) to 1353 (2020). Of the 1353 recommendations, Category 1, 2A, 2B and 3 EC were 5%, 91%, 4%, 1% while in 2011 they were 3%, 93%, 4% and 0% respectively. Recommendations with category 1 EC were found in all guidelines, except for Burkitt's Lymphoma. 6.3% of therapeutic recommendations were category 1 EC with the majority (56.4%) pertaining to initial therapy. Guidelines with highest proportions of therapeutic recommendations with category 1 EC were Multiple Myeloma (12.4%), CLL/SLL (6.9%) and AML (5.6%). Between 2011 and 2020, the proportion of category I recommendations increased significantly only in Follicular lymphoma and CLL/SLL. No category 1 EC recommendations existed in staging or surveillance. Conclusion: Recommendations issued in the 2020 NCCN guidelines are largely developed from lower levels of evidence but with uniform expert opinion. Despite the major advances in hematology in the past decade, this is largely unchanged. Our study underscores the urgent need and available opportunities to expand the current evidence base in malignant hematological disorders which forms the platform for clinical practice guidelines. Figure Disclosures No relevant conflicts of interest to declare.

Collagen and Eosinophils in Jenny's Endometrium: Do They Differ With Endometrial Classification?

Collagen fibers and inflammatory cells are the basis for jenny endometrium Kenney and Doig's classification developed for the mare. The infiltration of a large number of eosinophils in the jenny endometrium is intriguing. Eosinophil and fibroblast produced IL33, which has been related to fibrosis development and chronicity. This work on the endometrium consisted of (i) quantification of collagen type I (COL1A2), type III (COL3A1), and IL33 transcripts; (ii) histological localization and quantification of COL1 and COL3 proteins; and (iii) eosinophil and neutrophil count and correlation with collagen area and IL33 transcripts. Localization of COL protein in the jenny endometrium was also compared to the mare endometrium. As fibrosis increased, eosinophil and neutrophil count decreased (P < 0.05). A 5-fold increase in IL33 transcripts was noted from categories IIA to III. There was a tendency toward a positive correlation between eosinophil count and IL33 transcripts in category IIA endometrium (P = 0.055). Neither transcripts of COL1A2 nor COL3A1 nor the areas of COL1 or COL3 differed with endometrial categories. Unlike for the mare, and regardless of the jenny endometrium classification, COL3 was always found to different extents in the stratum compactum, while COL1 was mainly present in deep stroma. As fibrosis progressed in the mare, an extensive increase in COL1 fibers was notorious under the surface epithelium. Correlations between neutrophil count and COL1 and COL3 areas were observed in the jenny endometrium, although no correlation was found for eosinophil count. Neutrophil count positive correlation with the COL1 area and negative correlation with the COL3 area in endometria with mild lesions suggest that neutrophils in the jenny endometrium may be involved in fibrogenesis. In addition, when eosinophilia subsides, the endometrium reacts with fibrosis establishment, which could be stimulated by the pro-fibrotic cytokine IL33, whose release might then be ascribed to fibroblasts. Further studies are needed to analyze the effect of the presence of COL3 next to the surface epithelium in the stratum compactum, or around the endometrial glands on jenny's endometrial function and fertility.