LITERATUR REVIEW: TERAPI NON FARMAKOLOGIS UNTUK MENINGKATKAN KUALITAS TIDUR PASIEN DI ICU ATAU CCU

Sleep is one of the basic human needs. Good quality sleep can increase the improvement of the disease. Sleep disturbances are common among hospitalized patients in CCU and ICU. The purpose of this literature review is to compare several research results on non-pharmacological therapies (eye masks, earplugs, music therapy, turning off lights, environmental modifications) in improving sleep quality to determine the best nursing action and safe for treating sleep disorders patients. Search articles using the PICO framework in the database; Google Scholar, Ebscho, Science direct, Elseiver, MedLine, CINAHL, PubMed, and ProQuest, limited to the last 10 years; 2011 to 2021, 10 International Journals were obtained. Improved sleep quality can be done in several ways; the use of eye masks, earplugs, music therapy, light and sound reduction, switching treatment schedules outside of bedtime, and combinations. The results of the review show schedules outside of bedtime, and combinations. The results of the review show that the most effective actions applied locally to improve sleep quality are reducing lighting and noise and diverting treatment schedules outside of bedtime because it is easy, safe, and does not cost money. If the intervention has not helped, eye masks, earplugs, and/or music can be offered according to the patient's choice, local culture, and facilities available at the hospital. Further research is needed on patients outside the ICU/CCU with a larger number of samples, different age and condition characteristics, longer treatment duration, and using objective sleep quality measurement tools such as polysomnography.

Biosimilar Use in Breast Cancer Treatment: A National Survey of Brazilian Oncologists' Opinions, Practices, and Concerns

PURPOSE Breast cancer is the most common malignancy in Brazilian women, with 66,280 new cases in 2020 (with 20% overexpressing human epidermal growth factor receptor 2 [HER2]). The trastuzumab biosimilar was the first oncology biosimilar approved in Brazil for HER2-positive breast cancer treatment. This study aimed to assess the current level of knowledge of biosimilars, comfort of use, extrapolation indications, and switching of practices among oncologists in Brazil. METHODS A 24-question survey was developed using an online platform that sought information regarding responders' characteristics and use of biosimilars. The survey analyzed the basic knowledge of biosimilars, trastuzumab biosimilars, level of comfort with extrapolation, switching treatment regimens, and opinions concerning the cost of HER2-positive breast cancer therapy. Data were collected between July and September 2019 and included 144 oncologists from five Brazilian regions. RESULTS In total, 95% of respondents could identify the most appropriate definition of biosimilars and 96% felt comfortable prescribing trastuzumab biosimilars. Although 63% of respondents would use the biosimilar in all settings wherein the reference biologic was approved, 35% would use the biosimilar for cases involving metastatic disease. Although 82% of oncologists were in favor of switching from a reference biologic to a biosimilar, 18% would avoid switching regimens. The lack of studies detailing switching to other regimens and the correct timing to switch was the major concern. The cost of HER2 therapy was a significant concern for most oncologists. CONCLUSION Oncologists demonstrated a high level of knowledge of biosimilars and encouraging levels of prescriber use; however, extrapolation and switching treatment regimens are barriers to the effective use of biosimilars in cancer treatment. Efforts should be concentrated on strategies involving medical education programs on biosimilars.

Localized cutaneous argyria: a new observation

A 27-year-old female, a radiotherapy technician, was referred to our consultation with a localized gray pigmentation of the perinasal area. The condition had been asymptomatic for its entire duration of 2 years. A dermatological examination found a localized bluish-gray pigmentation in the perinasal area. Dermoscopy revealed an annular bluish-gray patch. Her occupation involved the manufacture and micromanipulation of machines, which required handling pure iron, nickel, copper, and silver with bare hands. She also reported a tic of flaring the nose. A skin biopsy was performed and histology revealed deposits of fine granules in the basal cell layer of eccrine sweat glands and along the elastic fibers of the superficial dermis, conforming with the diagnosis of argyria. The patient was given laser Q-switching treatment and showed a measurable improvement. This case studies a currently rare dermatological curiosity. Argyria is a disease caused by chronic absorption of silver-rich materials. This is the first description of argyria following the manipulation of radiopaque caches with a tic of flaring the nose.

Differential response to biologics in a patient with severe asthma and ABPA: a role for dupilumab?

Background Allergic bronchopulmonary aspergillosis (ABPA) is a severe hypersensitivity reaction to aspergillus species colonizing the airways of patients with asthma or cystic fibrosis. Biologics including anti-IgE and anti-IL5 antibodies have strongly changed the treatment of severe asthmatics and have partly been reported to be effective in the treatment of ABPA. Recently, dupilumab, an anti-IL4-Rα antibody which inhibits signaling by the Th2-cytokines IL4 and IL13, has been approved for the treatment of severe asthma. Case presentation Here, we report the case of a 49-year-old woman with severe asthma and ABPA, who was uncontrolled despite maximum inhalative therapy, anti-IL5-Rα antibody and continuous oral steroid therapy. Moreover, trials of itraconazole as well as omalizumab showed insufficient efficacy. Lung function revealed peripheral obstruction. FeNO and IgE were increased, eosinophils were suppressed under treatment while marked increases had been documented previously. Switching to dupilumab led to a complete resolution of pulmonary symptoms, resolution of exacerbations and complete withdrawal of oral steroids. A drastic improvement in lung function was noted, with an increase in FEV1 of almost 1 l. FeNO was normalized and IgE strongly reduced. Conclusion Our case highlights that a patient may exhibit differential treatment responses to the currently available asthma biologics and suggests switching treatment if outcome is insufficient. A potential role for dupilumab in the treatment of ABPA warrants future studies.

Long-term safety, immunogenicity and efficacy comparing FKB327 with the adalimumab reference product in patients with active rheumatoid arthritis: data from randomised double-blind and open-label extension studies

Background/ObjectiveFKB327 is a biosimilar of the antitumour necrosis factor adalimumab reference product (RP). A randomised, double-blind (DB) phase 3 study compared the efficacy of FKB327 with the RP in patients with active rheumatoid arthritis (RA) inadequately controlled with methotrexate (MTX). A subsequent randomised open-label extension (OLE) study with treatment switching assessed long-term safety, efficacy, pharmacokinetics and immunogenicity of FKB327 compared with the RP.MethodsPatients with moderate-to-severe, active RA on a stable dose of MTX were randomised 1:1 to receive FKB327 or the RP (40 mg subcutaneously every other week) for 24 weeks. Patients who completed the DB study were enrolled in the OLE and rerandomised 2:1 to receive FKB327 or the RP; two-thirds continued on the same treatment and one-third switched for 30 weeks. All patients received FKB327 through Week 76. Long-term efficacy, safety and immunogenicity were assessed.ResultsOf 728 patients in the DB study, 645 were enrolled in the FKB327-OLE study. The American College of Rheumatology (ACR)20 response rates for all treatment groups at Week 30 in the OLE ranged from 83.2% to 85.9%. ACR20 response rates remained stable for all patients regardless of single- or double-switching treatment and were similar for all treatment sequences through Week 76. The safety profile and incidence of antidrug antibodies were comparable across sequences.ConclusionEfficacy, safety and immunogenicity were similar among patients with RA treated with FKB327 or the RP for up to 2 years, and were not affected by single- or double-switching treatment.

Gender differences in agricultural productivity: evidence from maize farm households in southern Ethiopia

This study examines the impact of gender differences on maize productivity in Dawuro Zone, southern Ethiopia. Our study addressed the limitations of the previous studies in two ways. First, the study separately assessed gender differences in productivity between de facto female-headed households and de jure female-headed households and revealed that female-headed households are not homogenous. Second, the study separately examined the impacts of the covariates on male-headed households and female-headed households using an exogenous switching treatment effect model. We find the existence of gender differences in maize productivity between male-headed households and female-headed households. The maize productivity of male-headed households was overall 44.3% higher than that of female-headed households. However, if female-headed households received the same return on their resources as male-headed households, their productivity would increase by 42.3%. This suggests agricultural policy should target female-headed households to help reduce the productivity gap between male-headed households and female-headed households. Finally, the distributions of the gender differentials between male-headed households and female-headed households are more pronounced at mid-levels of productivity.