Mutiara Medika: Jurnal Kedokteran dan Kesehatan

Cost-Effectiveness of Ceftriaxone and Levofloxacin Use in Pneumonia Patients at Army Hospital Indonesia

Muhamad Iqbal Husaini — 2025-07-31

Pneumonia is a common respiratory tract infection worldwide and a serious issue in Indonesia, especially in Jakarta. Given the significant burden of pneumonia in Jakarta, periodic pharmacoeconomic evaluations of inpatient treatment are essential to support evidence-based policymaking. This study aims to compare the cost-effectiveness of levofloxacin and ceftriaxone, commonly used for pneumonia treatment. This study is an observational analysis using a cross-sectional method on 58 samples selected by a purposive sampling technique. The results indicate that levofloxacin provides more leukocyte reduction than ceftriaxone, and there were significant differences (p = 0.033). Although ceftriaxone therapy has a lower average direct medical cost than levofloxacin, there is no significant difference in the average direct medical cost of both therapies (p = 0.944). However, levofloxacin therapy has a lower Average Cost-Effectiveness Ratio (ACER) value of IDR 1,410.58 compared to ceftriaxone, making it more cost-effective. Switching from ceftriaxone to levofloxacin requires an additional IDR 64.00 to reduce 1 μL of leukocyte cells. Therefore, levofloxacin is concluded to be more cost-effective for treating pneumonia patients in inpatient care at Gatot Soebroto Army Hospital, Indonesia.

Angiotensin-Converting Enzyme Gene Polymorphism in Obesity and Its Interaction with Blood Pressure in Academicians

Isra Thristy — 2025-07-31

Obesity is one of the risk factors for hypertension. Obesity in hypertensive patients determines the severity of hypertension. Angiotensin-converting enzyme (ACE) is an enzyme that triggers vasoconstriction. ACE gene insertion/deletion polymorphisms may be associated with hypertension. This study aims to determine an association between ACE gene polymorphisms and blood pressure in obese patients. This research used an analytic observational study with a cross-sectional design. The research sample consisted of 36 obese academicians. Blood samples were taken from the patients to examine the ACE gene polymorphism. The correlative hypothesis used the Kruskal-Wallis test. The results showed that the most common types of ACE gene polymorphisms were type II (55.6%), type ID (33.3%), and type DD (11.1%)—the mean value of systolic blood pressure type II 123.29mmHg, type ID 125.82mmHg, DD 134.5mmHg. The mean value of diastolic pressure in ACE gene polymorphism type II was 81.57mmHg, type ID was 79.73mmHg, and type DD was 82.5mmHg. The Kruskal-Wallis test showed a relationship between ACE polymorphism and systolic pressure at p=0.705 (p>0.05) and the relationship between ACE polymorphism and diastolic pressure at p=0.980 (p>0.05). It concluded that there is no relationship between the ACE gene polymorphism and blood pressure in obese academicians.

Analysis of Fungal Causes Onychomycosis and Its Risk Factors in Farmers at South Sulawesi, Indonesia

Bramantyas Kusuma Hapsari — 2025-07-31

Onychomycosis is a fungal infection of the nail caused by dermatophytes, non-dermatophyte, mould (NDM), and yeast. The purpose of the research is to determine the cause of onychomycosis and its risk factors in farmers' nails in Pacciro Village, South Sulawesi, Indonesia. This is an observational research, where macroscopically and microscopically examination used to determine the type of fungus, and questionnaire used to determine the risk factors. By using purposive sampling, there were 47 subjects of farmer with suspected of nails onychomycosis. Most of participants were middle aged and elderly (75%), and had medical history of both or one of hypertension and diabetes mellitus (72%). The result show that 31.08% have poor hygiene, and 27.03% have fairly good hygiene. There were only 14.86 % samples succesfully cultured and determined caused by non-dermatophyte fungi (Aspergillus sp). The Chi-Square test shows a correlation between extrinsic factors (environmental condition and personal hygiene) and Onychomycosis (p = 0.001). There were no correlation between type of fungi (p = 0.21), age (p = 0.30) and medical history (p = 0.44) with Onychomycosis. It concluded that Onychomycosis in study area is caused by Aspergillus sp, with the risk factors of environmental condition and personal hygiene.

In Silico Modeling of Glucokinase Mutation Effect on Thermodynamics and Enzymatic Kinetics in Diabetes Mechanism

Eko Suhartono — 2025-07-31

Mutations in the glucokinase (GCK) enzyme can disrupt the glucose metabolism pathway, potentially increasing the risk of diabetes mellitus. This study attempts to examine the impact of GCK mutations in silico, focusing on thermodynamic and kinetic aspects. Four specific GCK mutations (43 R→H, 131 S→P, 160 D→N, 182 V→L) were analyzed at physiologically temperatures (298-313K) and pH 7.4. Computational analysis revealed that all mutations significantly altered Gibbs free energy (ΔG) values, with the wild-type enzyme showing -14.39J compared to substantially reduced negative values (-1.23J to -2.94J) in mutant forms. Enthalpy changes (ΔH) demonstrated significant linear regression relationships (p<0.05) for most mutations, indicating thermodynamic destabilization of the enzyme structure. Reaction rate constants showed decreased catalytic efficiency across all mutations (wild-type: 1.614×1027 s-1 vs. mutants: 1.606 - 1.607×1027 s-1). Three-dimensional visualizations confirmed structural perturbations at mutation sites. These findings suggest that GCK mutations impair glucose-sensing capabilities through dual mechanisms: reduced catalytic efficiency and thermodynamic instability, potentially the altered insulin secretion thresholds observed in Maturity-Onset Diabetes of the Young type 2 (MODY2) and other diabetes subtypes. Integrating kinetic and thermodynamic parameters provides valuable insights for developing targeted therapeutics such as glucokinase activators (GKAs), offering a ray of hope for diabetes treatment.