Using Web Search Query Data to Monitor Dengue Epidemics: A New Model for Neglected Tropical Disease Surveillance

A variety of obstacles, including bureaucracy and lack of resources, delay detection and reporting of dengue and exist in many countries where the disease is a major public health threat. Surveillance efforts have turned to modern data sources such as Internet usage data. People often seek health-related information online and it has been found that the frequency of, for example, influenza-related web searches as a whole rises as the number of people sick with influenza rises. Tools have been developed to help track influenza epidemics by finding patterns in certain web search activity. However, few have evaluated whether this approach would also be effective for other diseases, especially those that affect many people, that have severe consequences, or for which there is no vaccine. In this study, we found that aggregated, anonymized Google search query data were also capable of tracking dengue activity in Bolivia, Brazil, India, Indonesia and Singapore. Whereas traditional dengue data from official sources are often not available until after a long delay, web search query data is available for analysis within a day. Therefore, because it could potentially provide earlier warnings, these data represent a valuable complement to traditional dengue surveillance

Utility of the Tourniquet Test and the White Blood Cell Count to Differentiate Dengue among Acute Febrile Illnesses in the Emergency Room

Dengue often presents with non-specific clinical signs, and given the current paucity of accurate, rapid diagnostic laboratory tests, identifying easily obtainable bedside markers of dengue remains a priority. Previous studies in febrile Asian children have suggested that the combination of a positive tourniquet test (TT) and leucopenia can distinguish dengue from other febrile illnesses, but little data exists on the usefulness of these tests in adults or in the Americas. We evaluated the diagnostic accuracy of the TT and leucopenia (white blood cell count <5000/mm3) in identifying dengue as part of an acute febrile illness (AFI) surveillance study conducted in the Emergency Department of Saint Luke's Hospital in Ponce, Puerto Rico. From September to December 2009, 284 patients presenting to the ED with fever for 2–7 days and no identified source were enrolled. Participants were tested for influenza, dengue, leptospirosis and enteroviruses. Thirty-three (12%) patients were confirmed as having dengue; 2 had dengue co-infection with influenza and leptospirosis, respectively. An infectious etiology was determined for 141 others (136 influenza, 3 enterovirus, 2 urinary tract infections), and 110 patients had no infectious etiology identified. Fifty-two percent of laboratory-positive dengue cases had a positive TT versus 18% of patients without dengue (P<0.001), 87% of dengue cases compared to 28% of non-dengue cases had leucopenia (P<0.001). The presence of either a positive TT or leucopenia correctly identified 94% of dengue patients. The specificity and positive predictive values of these tests was significantly higher in the subset of patients without pandemic influenza A H1N1, suggesting improved discriminatory performance of these tests in the absence of concurrent dengue and influenza outbreaks. However, even during simultaneous AFI outbreaks, the absence of leucopenia combined with a negative tourniquet test may be useful to rule out dengue

Effect of calcium and vitamin D supplementation on serum calcium level in children with idiopathic nephrotic syndrome

Background Patients with idiopathic nephrotic syndrome (NS) may develop hypocalcemia caused by low levels of albumin and vitamin D -binding protein, which subsequently decreases calcium absorption in the intestine. Hypocalcemia may result in neuromuscular manifestations, such as Chvostek's and Trosseau's signs. Objectives To evaluate the effect of calcium and vitamin D supplementation on hypocalcemia and its clinical manifestations in idiopathic NS children. Methods A randomized, single-blind, controlled trial was performed in idiopathic NS patients aged 1-14 years. Subjects were divided into treatment and placebo groups. Subjects in the treatment group received 800 mg elemental calcium and 400 IU vitamin D supplementation, while they in control group received placebo syrup, both for 8 weeks. Serum calcium and manifestations of hypocalcemia were examined before and after supplementation. Results Thirty subjects completed the study (15 in each group). Seventeen subjects experienced hypocalcemia. Chvostek's and Trosseau's signs were observed in 6 subjects in the treatment group and 2 subjects in the placebo group (P= 0.427). After 8 weeks of intervention, Chvostek's and Trosseau's signs disappeared in both groups, and calcium levels were significantly increased in both groups compared to the levels before intervention. However, there was no significant difference in serum calcium levels after 8 weeks between the treatment and placebo groups (P =0.707). Conclusion Normalization of serum calcium levels and improved clinical manifestations ofhypocalcemia occur both in NS patients who receive calcium and vitamin D supplementation and those who do not

Perbandingan Kadar Vitamin D [25 Hidroksivitamin D] Pada Anak Sakit Kritis dan Nonkritis

Latar belakang. Vitamin D berperan dalam fungsi pertahanan tubuh sehingga defisiensi vitamin D berhubungan dengan derajat keparahan penyakit. Tujuan. Membandingkan kadar vitamin D pada anak sakit kritis dan nonkritis. Metode. Penelitian potong-lintang dengan subjek terdiri atas 25 anak sakit kritis dan 25 anak sakit nonkritis. Kadar vitamin D dianalisis dengan Uji Mann Whitney, Uji Kolmogorov-Smirnov, dan Uji Korelasi Spearman. Kemaknaan dinyatakan pada p <0,05. Hasil. Kadar vitamin D serum rerata pada kelompok kritis dan non kritis masing-masing 11,46 ng/mL dan 25,98 ng/mL (p<0,001). Pada kelompok kritis ditemukan 22/25 subjek mengalami defisiensi dan 3/25 insufisiensi. Pada kelompok nonkritis ditemukan 6/25 subjek mengalami defisiensi, 7/25 insufisiensi, dan 12/25 pasien dengan kadar normal (p<0,001). Pada uji korelasi didapatkan koefisien korelasi (r) = -0,624 (p<0,001). Kesimpulan. Kadar vitamin D serum rerata pada sakit kritis lebih rendah daripada nonkritis dan terdapat korelasi kuat antara sakit kritis dan vitamin D renda

Pedoman diagnosis dan tata laksana infeksi virus dengue pada anak

xx, 76 hal; 25 c

Serum ferritin, serum nitric oxide, and cognitive function in pediatric thalassemia major

Background Hemolysis and repeated blood transfusions in children with thalassemia major cause iron overload in various organs, including the brain, and may lead to neurodegeneration. Hemolysis also causes decreased levels of nitric oxide, which serves as a volume transmitter and slow dynamic modulation, leading to cognitive impairment. Objective To assess for correlations between serum ferritin as well as nitric oxide levels and cognitive function in children with thalassemia major.  Methods This analytical study with cross-sectional design on 40 hemosiderotic thalassemia major patients aged 6−14 years, was done at the Thalassemia Clinic in Dr. Hasan Sadikin Hospital, Bandung, West Java, from May to June 2015. Serum ferritin measurements were performed by an electrochemiluminescence immunoassay; serum nitric oxide was assayed by a colorimetric procedure based on Griess reaction; and cognitive function was assessed by the Wechsler Intelligence Scale for Children test. Statistical analysis was done using Spearman’s Rank correlation, with a significance value of 0.05. Results Abnormal values in verbal, performance, and full scale IQ were found in 35%, 57.5% and 57.5%, respectively. Serum nitric oxide level was significantly correlated with performance IQ (P=0.022), but not with verbal IQ (P=0.359) or full scale IQ (P=0.164). There were also no significant correlations between serum ferritin level and full scale, verbal, or performance IQ (P=0.377, 0.460, and 0.822, respectively). Conclusion Lower serum nitric oxide level is significantly correlated to lower cognitive function, specifically in the performance IQ category. However, serum ferritin level has no clear correlation with cognitive function

Hubungan Spektrum Klinis Infeksi Dengue dengan Kadar Seng dan Feritin Serum

Latar belakang. Sindrom syok dengue (SSD) merupakan masalah kesehatan dengan morbiditas dan mortalitas tinggi. Infeksi dengue dapat menyebabkan badai sitokin dan produksi berlebih MMP-2 dan MMP-9, yaitu suatu enzim yang tergantung seng. Sitokin ini akan menyebabkan peningkatan feritin sebagai reaktan fase akut, sedangkan produksi berlebih MMP-2 dan MMP-9 menjadi salah satu penyebab kebocoran plasma. Tujuan. Menganalisis hubungan spektrum klinis infeksi dengue dengan kadar seng dan feritin serum pada anak. Metode. Penelitian cross-sectional dilaksanakan dari Januari 2012 sampai Mei 2012 melibatkan 39 anak laki-laki dan 42 anak perempuan. Dilakukan pemeriksaan kadar seng serum dengan metode atomic absorption spectroscopy (AAS) dan feritin serum dengan metode electrochemiluminescense immunoasssay (ECLIA). Uji statistik dengan ANOVA dan uji korelasi Spearman. Kemaknaan ditentukan berdasarkan nilai p<0,05. Hasil. Kadar seng serum rendah pada 53 (65%) anak. Rerata kadar seng serum pada demam dengue (DD), demam berdarah dengue (DBD) dan SSD adalah 68,2 μg/dL (SB 15,3), 64,8 μg/dL (SB 15,6) dan 59,2 μg/dL (SB 15,0) (p=0,09), sedangkan kadar feritin tinggi pada 79 (98%) anak dengan rerata 1158,9 ng/mL (SB 1766,8), 3048,2 ng/mL (SB 2566,2), 6891 ng/mL (SB 9822) (p<0,001). Terdapat hubungan kuat dan bermakna antara derajat berat penyakit dengan kadar feritin (p<0,001; r=0,635), tetapi tidak terdapat hubungan dengan kadar seng serum (p=0,043; r=-0,225). Kesimpulan. Spektrum klinis infeksi dengue berhubungan kuat dengan kadar feritin yang tinggi dan memiliki hubungan dengan kadar seng serum rendah

Kejadian Demam dan Kadar IL-10 Serum Pasca Imunisasi DTwP/HepB Ketiga pada Bayi yang Mendapat dan Tidak Mendapat ASI Eksklusif

Latar belakang. Dilaporkan bayi yang mendapat ASI eksklusif lebih jarang mengalami demam pasca imunisasi. Berbagai faktor yang berperan diantaranya adalah IL-10 yang banyak ditemukan dalam ASI. Tujuan. Membandingkan kejadian demam dan kadar IL-10 serum pasca imunisasi DTwP/HepB ketiga antara bayi yang mendapat dan tidak mendapat ASI eksklusif. Metode. Penelitian potong lintang dilaksanakan dari September–Desember 2012 melibatkan 70 bayi usia 4–6 bulan yang menerima imunisasi DTwP/HepB ketiga. Pengukuran suhu tubuh dilakukan sebelum, 30 menit, 6 jam, 12 jam, dan 24 jam pasca imunisasi atau saat demam dilakukan oleh ibu yang telah dilatih. Kadar IL-10 serum diperiksa dengan metode enzyme-linked immunosorbent assay (ELISA). Analisis statistik dilakukan dengan uji chi-kuadrat Pearson dan Mann-Whitney. Hasil. Delapan dari 35 bayi yang mendapat ASI eksklusif (23%) dan 32 dari 35 bayi yang tidak mendapat ASI eksklusif (91%) mengalami demam pasca imunisasi (p<0,001; RP 0,25). Demam pasca imunisasi timbul lebih cepat pada bayi yang tidak mendapat ASI eksklusif. Dari 24 bayi yang mengalami demam dalam 3 jam pasca imunisasi , 22 bayi (92%) tidak mendapat ASI eksklusif dan 2 bayi (8%) mendapat ASI eksklusif (p<0,001). Rata-rata suhu pada bayi yang mendapat ASI eksklusif 37,8 oC, sedangkan yang tidak mendapat ASI eksklusif 38,1 oC (p=0,033). Kadar IL-10 serum rata-rata bayi yang tidak mengalami demam pasca imunisasi 3,25 pg/mL, sedangkan yang mengalami demam 1,71 pg/mL (p<0,001). Kadar IL-10 serum rata-rata bayi yang mendapat ASI eksklusif 3,6 pg/mL, sedangkan yang tidak mendapat ASI eksklusif 1,1 pg/mL (p<0,001). Kesimpulan. Kemungkinan kejadian demam pasca imunisasi pada bayi yang tidak mendapat ASI eksklusif adalah 4 kali lebih tinggi dibandingkan bayi yang mendapat ASI eksklusif. Bayi yang tidak mendapat ASI eksklusif lebih cepat mengalami demam dengan suhu yang lebih tinggi. Bayi yang tidak mendapat ASI eksklusif mempunyai kadar IL-10 serum yang rendah daripada bayi yang mendapat ASI eksklusif