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Introduction: Psoriasis is a chronic inflammatory disease of the skin that requires comprehensive treatment. Combination therapy can be a good option in optimizing psoriasis treatment outcomes. However, the effectiveness and safety of combination therapy are still not fully understood. This study reviewed the literature examining the effectiveness and safety of the combination treatment of secukinumab and methotrexate in patients with severe Psoriasis vulgaris.Methods: A literature search was performed on PubMed and Google Scholar databases, with several inclusion criteria. The research method used is a case report and controlled trial, with the critical appraisal method using the JBI Critical Appraisal.Result: There were 6 pieces of literature that met the inclusion criteria. All literature describes in detail the clinical condition, course of the disease, management and side effects of treatment, but supporting examinations are not specifically described. In general, all literature shows a clinical improvement in severe psoriasis patients who are given combination treatment, and some literature also explains systemic side effects and residual plaque. The combination of biological agents with conventional systemic treatment has been proposed to optimize the results of psoriasis treatment. One study reported lightweight gastrointestinal disorders related to the use of a combination of secukinumab and methotrexate administration along with biological agents that could prevent or reduce the development of anti-drug antibodies and increase response levels to treatment. Advanced research is still needed in assessing this specific mechanism for this combination therapyConclusion: Combination therapy of secukinumab and methotrexate is effective in treating psoriasis skin manifestations without significant side effects. This drug combination is useful in overcoming the limitations of monotherapy drugs, such as decreasing effectiveness due to prolonged use. Pendahuluan: Psoriasis merupakan penyakit inflamasi kronik pada kulit yang membutuhkan penanganan yang baik. Terapi kombinasi dapat menjadi pilihan yang baik dalam mengoptimalkan luaran pengobatan psoriasis. Namun, efektifitas dan keamanan terapi kombinasi masih belum dipahami sepenuhnya dan masih harus di pertimbangkan. Studi ini menilai beberapa literatur yang menguji efektifitas dan keamanan dari pengobatan kombinasi secukinumab dan methotrexate pada pasien dengan Psoriasis vulgaris berat. Metode: Pencarian literatur dilakukan pada database PubMed dan Google Scholar, dengan beberapa kriteria inklusi. Metode penelitian yang digunakan adalah case report dan controlled trial, dengan metode critical appraisal menggunakan JBI Critical Appraisal.Hasil: Didapatkan sebanyak 6 literatur yang memenuhi kriteria inklusi. Semua literatur menjelaskan secara detail terkait kondisi klinis, perjalanan penyakit, tatalaksana dan efek samping pengobatan, namun pemeriksaaan penunjang tidak dijelaskan secara spesifik. Secara umum, semua literatur menunjukan adanya perbaikan klinis pada pasien psoriasis berat yang diberikan pengobatan kombinasi, beberapa literatur juga menjelaskan efek samping sistemik dan plak residu. Terapi kombinasi agen biologis dengan pengobatan sistemik konvensional telah diusulkan untuk mengoptimalkan hasil pengobatan psoriasis. Satu studi melaporkan adanya gangguan gastrointestinal ringan terkait penggunaan kombinasi secukinumab dan methotrexate. Pemberian methotrexate bersamaan dengan agen biologis dapat mencegah atau mengurangi pengembangan antibodi anti-drug dan meningkatkan tingkat respon terhadap pengobatan. Penelitian lanjutan tetap diperlukan dalam menilai mekanisme spesifik terapi kombinasi ini.Kesimpulan: Terapi kombinasi secukinumab dan methotrexate efektif dalam mengobati manifestasi kulit psoriasis tanpa adanya efek samping bermakna. Kombinasi obat ini berguna dalam mengatasi keterbatasan obat monoterapi, seperti efektifitas yang menurun akibat penggunaan yang berkepanjangan.

The quality of financial reports can be said to be good, if they provide financial statement information that is easy to understand, and can meet the needs required by the user in making a decision, free from misleading meanings, errors in material and can be relied on. The purpose of this study was to determine the effect of the application of government accounting standards (SAP) and financial supervision on the quality of the regional government financial reports of Denpasar city. The data used in this study are primary data using a questionnaire as a method of collecting data obtained from respondents. The population in this study were all employees in OPD in Denpasar City. The method of determining the sample in this study used a purposive sampling method, with the criteria for the sample who held positions as Head of the Finance Subdivision, Expenditure Treasurer and employees who directly carry out accounting functions in OPDs throughout Denpasar City. The sample used in this study were 43 OPDs in Denpasar with 129 respondents. The analysis technique used in this research is Multiple Linear Regression Analysis. The results of this study indicate that the effect of government accounting standards (SAP) and financial supervision has a positive and significant effect on the quality of financial reports for the local government of Denpasar city.

Objective To investigate pregnancy-related disease activity in a contemporary multiple sclerosis (MS) cohort. Methods Data were obtained from the MSBase Registry. Term/preterm pregnancies conceived from 2011-2019 were included (modern cohort). Annualised relapse rates (ARR) were calculated before, during and after pregnancy. Predictors of intrapartum and early postpartum (1st3 months) relapse were determined by clustered logistic and Cox regression analyses, respectively. Results We included 1640 pregnancies from 1452 women. Disease-modifying therapy (DMT) used in the one-year preconception included natalizumab (n=219), fingolimod (n=147), dimethyl fumarate (DMF; n=57) and low-efficacy therapies (n=845). Preconception ARR by DMT class used before conception were: natalizumab, 0.29 (95% CI 0.22-0.37); fingolimod, 0.37 (0.28-0.49); DMF, 0.24 (0.13-0.41); low-efficacy, 0.29 (0.25-0.33); and none, 0.24 (0.19-0.31). Among women who used fingolimod or natalizumab, ARR increased during pregnancy. Intrapartum ARR decreased in preconception DMF, low-efficacy or no DMT groups. ARR spiked after delivery across all DMT groups. Natalizumab continuation into pregnancy reduced the odds of relapse during pregnancy (OR 0.76 per month [0.60-0.95], p=0.017). DMT re-initiation with natalizumab protected against postpartum relapse (HR 0.11 [0.04-0.32], p Conclusion Women with MS prescribed natalizumab or fingolimod preconception had higher rates of intrapartum and postpartum relapse. In women considered to be at high relapse risk, use of natalizumab before pregnancy and continued up to 32-34 weeks gestation, with early re-initiation after delivery is an effective option to minimise relapse risks. Strategies of DMT use have to be balanced against potential foetal/neonatal complications.

The purpose of this study to analyze the influence of empowerment and compensation on employee performance is mediated by organizational commitment. The study was conducted by distributing questionnaires to a sample of 100 honorary employees in regional organizations in Denpasar using the proportionate random sampling method. The analytical method used is Partial Least Square (PLS) analysis. The results of PLS ​​analysis show that empowerment, compensation, and organizational commitment have a positive and significant direct effect on employee performance. Finally, organizational commitment has a positive and significant effect on mediating empowerment and compensation for employee performance. The results of this study imply that empowerment and compensation are important factors in improving employee performance. In addition, the mediating role of organizational commitment can also contribute to improving performance. The management of each regional apparatus organization in Denpasar City needs to pay attention to these matters so that organizational goals can be achieved.

ObjectiveTo investigate pregnancy-related disease activity in a contemporary multiple sclerosis (MS) cohort.MethodsUsing data from the MSBase Registry, we included pregnancies conceived after December 31, 2010, in women with relapsing-remitting MS or clinically isolated syndrome. Predictors of intrapartum relapse and postpartum relapse and disability progression were determined by clustered logistic regression or Cox regression analyses.ResultsWe included 1,998 pregnancies from 1,619 women with MS. Preconception annualized relapse rate (ARR) was 0.29 (95% confidence interval 0.27–0.32), fell to 0.19 (0.14–0.24) in the third trimester, and increased to 0.59 (0.51–0.67) in early postpartum. Among women who used fingolimod or natalizumab, ARR before pregnancy was 0.37 (0.28–0.49) and 0.29 (0.22–0.37), respectively, and increased during pregnancy. Intrapartum ARR decreased with preconception dimethyl fumarate use. ARR spiked after delivery across all DMT groups. Natalizumab continuation into pregnancy reduced the odds of relapse during pregnancy (odds ratio 0.76 per month [0.60–0.95], p = 0.017). DMT reinitiation with natalizumab protected against postpartum relapse (hazard ratio [HR] 0.11 [0.04–0.32], p < 0.0001). Breastfeeding women were less likely to relapse (HR 0.61 [0.41–0.91], p = 0.016). We found that 5.6% of pregnancies were followed by confirmed disability progression, predicted by higher relapse activity in pregnancy and postpartum.ConclusionIntrapartum and postpartum relapse probabilities increased among women with MS after natalizumab or fingolimod cessation. In women considered to be at high relapse risk, use of natalizumab before pregnancy and continued up to 34 weeks gestation with early reinitiation after delivery is an effective option to minimize relapse risks. Strategies of disease-modifying therapy use have to be balanced against potential fetal/neonatal complications.