Determinan Ketidakpatuhan Terapi Antiretroviral pada ODHA Dewasa

Determinants of non-adherence to antiretroviral therapy in adults with HIV/AIDSPurposeThis study aimed to determine the factors of non-adherence ARV therapy in adult PLWHA.MethodsA case-control study was conducted using secondary data of the Cilacap VCT clinic with consecutive sampling technique. The total sample was 204, consisting of 102 cases and 102 controls (1:1). The cases were adult PLWHA who did not adhere to ARV therapy and the controls were adult PLWHA who adhere to ARV therapy. The bivariate analysis used Chi-square and Fisher's exact tests and multivariate analysis used logistic regression tests. ResultsThe variables that were shown to jointly affect non-adherence to ARV therapy in adult PLWHA were the level of education, CD4 count, PMO and opportunistic infections.ConclusionsThe risk factors of non-adherence to ARV therapy in adult PLWHA were the level of education, PMO, CD4 count and opportunistic infections. There needs to be a special assistance and counseling program on a regular basis to PLWHA adults with low education, obligating all PLWHA adults that start ARV therapy to have a PMO, continue HIV screening programs to entire population at risk and advocate the local governments to facilitate PLWHA who can not afford to obtain CD4 test

An increase in mean platelet volume (MPV) as a predictor of mortality in children with sepsis

Sepsis is associated with increased morbidity and mortality in children worldwide, mainly in developing countries. This fatal risk emphasizes the importance of finding accessible and inexpensive parameters to be used as predictors for mortality in children with sepsis. The aim of this study was to determine the role of increased mean platelet volume (MPV) as a predictor for mortality in children with sepsis.  A case control study was applied using medical records of all in-patients aged 1 mo -18 y diagnosed with sepsis at Dr. Sardjito General Hospital, Yogyakarta from January 2015-December 2016. Bivariate and multivariate analyses by Chi-square and logistic regression to evaluate the correlations between increased MPV within the first 24-72 h (ΔMPV>0) and mortality were applied. Eighty-one eligible subjects met the inclusion/exclusion criteria with the mortality was 52%. Chi-square analysis showed significant correlations between increased MPV and mortality (p=0.005). Multivariate analysis showed increased MPV within the first 24-72 h after sepsis diagnosis as a predictor for mortality after controlling for sex and AKI (adjusted OR 3.851; 95% CI:1.354-10.948; p= 0.011). In conclusion, an increase in MPV within the first 24-72 h after diagnosed is an independent predictor for mortality in children with sepsis

The potential of meropenem and piperacillin-tazobactam combination to Acinetobacter spp clinical isolates in vitro

Acinetobacter spp is one of the most common causes of nosocomial infection, especiallysepsis. A lot of antibiotics resistance happen related to Acinetobacter-related sepsis treatment. This study aimed to evaluate the potential of meropenem and piperacillin-tazobactam combination against Acinetobacter spp in in vitro by using paper strip test. This was experimental study conducted in September to December 2015 at Departement of Microbiology, Faculty of Medicine, Public health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia. Clinical isolates of Acinetobacter samples were obtained from collections of the Department of Microbiology. The data were analyzed using post-test analysis which was conducted by observation over 24 h after the paper strip test was applied in bacterial culture. The MIC value of the antibiotic combination was recorded based on observation. The result showed 12 of 17 clinical isolates were synergistic potential (70.59%) and 5 others were indifferent potential (29.41%). Two of five clinical isolates that show indifferent potential were A. baumannii and all of the clinical isolates that show synergistic potential were Acinetobacter spp. It can be concluded that the combination of meropenem and piperacillin-tazobactam showed more synergistic dominantly than the single use of each of them

Faktor Risiko Kematian Akibat Dengue di Rumah Sakit Sardjito YOGYAKARTA

Risk factors of death due to dengue hemorrhagic fever in a tertiary public teaching hospital of YogyakartaPurposeWe examined risk factors of dengue hemorrhagic fever death in Dr. Sardjito Hospital.MethodWe conducted a case control study from patient medical records and interviews with parents.ResultsWe found 29 deaths and 58 patients who survived. The probability of death among obese children was 6 times higher than non obese children and the probability of death in children with prolonged shock was 12 times higher than children without prolonged shock. Other variables were family occupation, family income, residential zones, transportation, treatment financing, accuracy of diagnosis in previous health facilities, and fluid resuscitation before being referred had no significant relationship with dengue mortality.ConclusionObesity and prolonged shock were risk factors of dengue hemorrhagic fever death in children. Improved education to parents about high risk of shock syndrome among patients is needed especially for obese children. Further studies related to social determinants in dengue hemorrhagic fever death are also necessary

Faktor risiko kematian akibat dengue di rumah sakit Sardjito Yogyakarta

Latar Belakang: Dengue Shock Syndrome (DSS) merupakan penyakit yang terjadi karena infeksi virus dengue dan sangat berhubungan dengan kematian DBD. Di RSUP Dr. Sardjito, kematian DBD meningkat dari 11 orang tahun 2014 menjadi 35 orang pada tahun 2015. Tujuan dari penelitian ini yaitu untuk mengetahui faktor risiko kematian akibat dengue di RSUP Dr. Sardjito Yogyakarta.Metode: Desain studi yang digunakan matched case control dengan perbandingan kasus dan kontrol 1:2.  Kasus adalah pasien DSS rujukan meninggal dunia yang berusia ≤18 tahun. Kontrol adalah pasien DSS rujukan sembuh yang berusia ≤18 tahun. Data diambil dari rekam medis pasien di RSUP dr. Sardjito Yogyakarta tahun 2015-2016 dan wawancara dengan kuesioner kepada orangtua pasien. Tehnik pengambilan sampel dengan metode totality sampling dengan kriteria inklusi dan eksklusi. Data dianalisis dengan menggunakan uji simple dan multiple conditional logistic regression dengan α 5%.Hasil: Dilaporkan 87 anak terdiri dari 29 meninggal dan 58 sembuh. Probabilitas terjadinya kematian pada anak dengan obesitas 6,29 kali lebih besar dibandingkan dengan anak yang tidak obesitas (OR = 6,29; 95% CI  = 1,14 - 34,57; p-value = 0,03) dan probabilitas kematian pada anak yang mengalami prolonged shock 12,14 kali lebih besar dibandingkan dengan anak yang tidak mengalami prolomged shock (OR = 12,14; 95% CI  = 3,22 - 45,82; p-value = 0,00). Variabel lain seperti pekerjaan keluarga, pendapatan keluarga, zona tempat tinggal, transportasi, pembiayaan pengobatan, ketepatan diagonosis di fasilitas kesehatan sebelumnya, dan resusitasi cairan sebelum rujukan tidak memiliki hubungan yang bermakna terhadap kematian akibat dengue.Kesimpulan: Status gizi dan prolonged shock merupakan faktor risiko terjadinya kematian akibat dengue pada anak. Meningkatkan edukasi kepada orangtua terkait bahaya syok sindrom pada penderita DBD khusunya pada anak obesitas. Penelitian lebih lanjut terkait determinan sosial pada kasus kematian akibat dengue juga perlu dilakukan.Risk factors of death due to dengue hemorrhagic fever in a tertiary public teaching hospital of YogyakartaPurposeWe examined risk factors of dengue hemorrhagic fever death in Dr. Sardjito Hospital.MethodWe conducted a case control study from patient medical records and interviews with parents.ResultsWe found 29 deaths and 58 patients who survived. The probability of death among obese children was 6 times higher than non obese children and the probability of death in children with prolonged shock was 12 times higher than children without prolonged shock. Other variables were family occupation, family income, residential zones, transportation, treatment financing, accuracy of diagnosis in previous health facilities, and fluid resuscitation before being referred had no significant relationship with dengue mortality.ConclusionObesity and prolonged shock were risk factors of dengue hemorrhagic fever death in children. Improved education to parents about high risk of shock syndrome among patients is needed especially for obese children. Further studies related to social determinants in dengue hemorrhagic fever death are also necessary

Status gizi dan gambaran klinis penyakit pada pasien HIV anak awal terdiagnosis

Nutritional status and clinical disease of HIV children patients when diagnosed for the first timeBackground: Human immunodeficiency virus (HIV) infection in children can cause nutritional problems. Currently, HIV-infected children are still diagnosed when the disease stage is advanced. Nutritional status is a marker of advanced stage conditions in HIV infection.Objective: To determine the clinical findings of disease and nutritional status of HIV children patients when diagnosed for the first time.Methods: We conducted a cross-sectional descriptive study. The data were taken from the medical record documents of child patients aged 0-18 years with the ICD 10 code B20, who was treated at the Dr. Sardjito Yogyakarta Hospital from 1 January 2004-31 December 2019. Results: There were 191 children diagnosed with HIV, 56% of them were boys. The median age was 34 months (IQR 25: 13 months, IQR 75: 69 months), and 95.5% among those were infected perinatally. There were 77 (40,3%) children who suffered from severe malnutrition and 55 (28.8%) children were moderate acute malnutrition. At the age of 0-60 months among them, there were 49 children (36.3%) suffered from severely underweight, 35 children (25.9%) underweight, 53 (39.3%) severely stunted, 38 (28.1%) stunted, 28 severely wasted (20.7%), and wasted as many as 24 (17.8%). At the age of 5-18 years old, there were 19 (33.9%) and 5 (8.9%) children who suffered from severely wasted and wasted respectively. World Health Organization (WHO) stages 3 and 4 were experienced by 62 (32.5%) and 68 (35.6%) children. As many as 41.3% of children had enlarged lymph nodes, thrush (40.8%), pneumonia (40.8%), and persistent or chronic diarrhea (21.5%). Conclusions: The nutritional status of HIV-infected children at baseline was dominated by underweight and stunted. The most clinical findings of the disease when the child was diagnosed with HIV infection were lymphadenopathy, oral thrush, pneumonia, and persistent or chronic diarrhea

Prevalensi Gangguan Elektrolit Serum pada Pasien Diare dengan Dehidrasi Usia Kurang dari 5 Tahun di RSUP Dr. Sardjito Tahun 2013-2016

Latar belakang. Hingga saat ini, diare masih menjadi salah satu masalah kesehatan dunia, terutama di negara berkembang, termasuk di Indonesia. Salah satu komplikasi lanjutan dari dehidrasi pada diare adalah gangguan elektrolit serum. Tujuan. Untuk mengetahui prevalensi gangguan elektrolit serum pada pasien diare dengan dehidrasi serta karakteristik klinis pasien dan hubungan antara derajat dehidrasi terhadap gangguan elektrolit serum. Metode. Penelitian retrospektif dengan rancangan cross sectional menggunakan data rekam medis. Perbedaan dianalisis menggunakan uji Chi-square. Hasil. Jumlah pasien yang memenuhi kriteria adalah 173 pasien, 115 pasien yang memiliki data rekam medis lengkap. Tujuh puluh di antaranya mengalami gangguan elektrolit serum. Jenis gangguan elektrolit serum terbanyak dialami adalah hipokalsemia (17,34%). Dari 173 pasien diare dengan dehidrasi, 64,74% berjenis kelamin laki-laki, 43,35% berusia 12-35 bulan, 83,24% mengalami muntah, 52,6% mengalami demam, 4,62% mengalami dehidrasi berat. Penelitian ini tidak membuktikan adanya hubungan signifikan antara derajat dehidrasi terhadap gangguan elektrolit (p=0,243). Kesimpulan. Prevalensi gangguan elektrolit serum pada pasien diare dengan dehidrasi pada anak adalah 40,46%

Pola sebaran tingkat infeksi bersama serotipe virus dengue di wilayah kajian RT-PCR Balai Besar Teknik Kesehatan Lingkungan dan Pengendalian Penyakit Yogyakarta: analisis data 2013-2015

Tujuan: Kajian ini bertujuan untuk mengetahui pola sebaran tingkat infeksi bersama serotipe virus dengue di wilayah kajian RT-PCR BBTKLPP Yogyakarta tahun 2013-2015.Metode: Jenis penelitian deskriptif dengan metode spasial. Pengumpulan data 132 responden bersumber pada hasil RT-PCR BBTKLPP Yogyakarta tahun 2013-2015.  Alamat lengkap penderita level desa dari data surveilans arbovirosis dengue BBTKLPP Yogyakarta, digunakan untuk menggambarkan titik koordinat dengan pemanfatan peta RBI dan google Earth dalam mencari alamat/desa serta penentuan sebaran titik koordinat kasus. Analisis ini dilakukan untuk melihat tingkat dan pola infeksi berdasarkan wilayah kajian BBTKLPP Yogyakarta.  Hasil: Terdapat kemiripan tingkat infeksi bersama yang paling kompleks quadruple DEN pada kota Semarang dan kota Jogjakarta, pada kabupaten Kebumen didapatkan tingkat double DEN. Tiga pola infeksi bersama DEN-1 dan DEN-3 dengan p-value < 0,05 di kabupaten Semarang tahun 2014, Sragen tahun 2015 dan kota Semarang tahun 2013 serta 2 pola p-value < 0,1 di Gunung Kidul tahun 2014 dan Kulon Progo tahun 2015. Polainfeksi bersama DEN-1, DEN-2 dan DEN-3 tahun 2015 dengan p-value <0,05 mencakup kabupaten Sragen dan Semarang serta pola p-value < 0,1 di kota Semarang tahun 2013. Kesimpulan: Wilayah tingkat infeksi bersama paling kompleks adalah kota Semarang dan kota Jogjakarta. Pola most likely cluster infeksi bersama DEN-1 dan DEN-3 serta DEN-1, DEN-2 dan DEN-3, diduga akibat penderita terinfeksi dua serotipe berbeda dari nyamuk berbeda atau adanya infeksi lebih dari satu serotipe pada Ae. aegypti atau Ae. albopictus sebagai vektor utama. Perlu penelitian lebih lanjut untuk dapat membuktikan adanya infeksi oleh beberapa serotipe berbeda pada Ae. aegypti atau Ae. albopictus sebagai vektor utama.Pattern of concurrent infection of dengue virus serotype in the regional study areas of Yogyakarta Center for Environmental Health and Diseases Control: an analysis of  2013-2015 dataPurposeThis study aimed to determine the pattern in the spread of infection rates with dengue viral serotypes.MethodsThe study was a descriptive research with spatial mapping methods. Data of 132 respondents were collected based on RT-PCR in 2013-2015. The complete address of the village-level patient from the dengue arbovirosis surveillance data of the Center for Environmental Health and Diseases Control Yogyakarta were used to determine the coordinate points with utilization of RBI and Google Earth maps in searching addresses for distribution of case coordinate points. ResultsThere were similarities with the most complex quadruple joint infection rates of DEN in Semarang and Yogjakarta, while Kebumen obtained double DEN level. Three patterns of infection with DEN-1 and DEN-3 have p-value < 0.05 in Semarang in 2014, Sragen in 2015 and Semarang 2013 and 2 patterns in Gunung Kidul 2014 and Kulon Progo 2015. The patterns of infection with DEN-1, DEN-2 and DEN-3 in 2015 were covering Sragen and Semarang in 2013.ConclusionThe most complex areas of infection were Semarang and Yogyakarta. The pattern of most likely cluster infection with DEN-1 and DEN-3 and DEN-1, DEN-2 and DEN-3 allegedly was a result of two infected patients, different serotypes of different mosquitoes or infection of more than one serotype of Ae. aegypti or Ae. albopictus as the main vector

Current understanding of the origin, molecular biology and continuing evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Recent outbreaks of human coronaviruses, officially named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have put health authorities worldwide on a high alert. Firstly emerged in the city of Wuhan, China, SARS-CoV-2 infection is rapidly escalating into a global pandemic. It is first thought as the result of a zoonotic transmission event, similar to the previous epidemic of coronaviruses. However, a continuously increasing number of confirmed cases indicates that the virus gains capacity of efficient human-to-human transmission. Soon after the pandemic is arising, many efforts are focused on identifying the origin of SARS-CoV-2 infection in the human population. Current evidence suggests that the virus is probably derived from bat or pangolin coronaviruses as the natural host. Whether intermediate host(s) exist in the transmission cascade from bat or pangolin to humans is, to a great extent, elusive. This information is essential as the basis for infection prevention and control measures. In this review, we discuss our recent understanding of SARS-CoV-2 biology, highlighting its origin and molecular evolution

Comparison of cardiac marker profiles in dengue myocarditis

Dengue patients may experience some grade of severity. Cardiac involvement is common in severe dengue, therefore cardiac markers could be used to ensure the diagnosis of dengue myocarditis. However, information of the cardiac marker profiles in patients with milder severity of dengue infection is limited. The study aimed to evaluate creatinine kinase (CK), creatinine kinase-MB (CK-MB) and troponin I (TnI) in dengue myocarditis against the spectrum severity of dengue infection in children. This cross-sectional study was conducted using secondary data from medical records of dengue myocarditis patients aged 1-18 yr in Dr. Sardjito General Hospital, Yogyakarta. Fisher’s Exact tests were performed to compare the increase in cardiac markers to the dengue severity. The increase of CK was observed in dengue fever/DF (6 or 75% of patients), dengue hemorrhagic fever/DHF (6 or 67%) and dengue shock syndrome/DSS (16 or 73%). Furthermore, the increase of CK-MB was also observed in DF (6 or 75%), DHF (8 or 87%), and DSS (21 or 95%). No significant difference in the increase of CK and CK-MB proportions was observed in DF compared to DHF groups and in DF compared to DSS (p>0.05). The increase of Tn I was observed in DHF (2 or 22%) and DSS (10 or 45%) groups but not observed in DF group. Significant difference in the increase of Tn I proportion was observed in DF compared to DSS groups (p=0.022). In conclusion, cardiac involvement is common in all dengue severity level. The increment of Tn I corresponds to an increase in the dengue severity level. Further research by observing cardiac markers sequentially is needed