Challenges in Providing Treatment of Severe Malaria Case in a District Hospital of Remote Area in Indonesia

Severe Malaria is commonly found due to Plasmodium falciparum infection, which is causing high mortality in patient. A Severe case might be difficult to treat optimally in the remote settings area that could be due to lack in awareness of disease manifestation and inadequate diagnostic facilities. We report a case of Severe Malaria Falciparum infection, confirmed by blood smear eamination of Plasmodium falciparum (Pf) parasites. Patient had received Artemicinin Based Combination Therapy (ACT), which consisted of dihydroartemisinin (DHA)-piperaquine and primaquine (PQ) with no clear clinical and microscopy improvement. The second line anti malaria consisted of quinine, doxycycline, and PQ was then initiated, showing clinical and microscopy responses

Diphtheria Epidemiology in Indonesia during 2010-2017

Background: in recent years, diphtheria has reemerged in several countries including Venezuela, Yemen, Bangladesh, and Haiti. Similarly, Indonesia also showed an increased number of diphtheria cases in 2010-2017 despite the Diphteria, Tetanus, Pertussis (DTP) immunization program applied in Indonesia for children. This study aimed to evaluate the epidemiology of diphtheria cases which occurred in Indonesia during 2010-2017. Methods: this was a retrospective study of diphtheria cases in Indonesia. The following source of data about diphtheria disease burden and vaccine coverage was obtained from Ministry of Health Republic of Indonesia, Indonesian Pediatric Society and World Health Organization South East Asia Regional Office. Results: the number of diphtheria cases in Indonesia were distributed across 30 provinces with a total of 811 cases in 2011; 1,192 cases in 2012; 296 cases in 2014; and 939 cases in 2017. Based on age group, the highest number of case fatality rate were in age group of 5-9 years old. Diphtheria immunization coverage in Indonesia among children was fluctuated, reported as 67.7 % in 2007, 61.9 % in 2010, 75.6% in 2013 and 61.3% in 2018. In addition to that, the organization of internal medicine has recommend booster of DPT immunization every 10 years for those children that had received complete DPT vaccination during childhood, however this was not applied. As the countermeasure towards this trend, the Ministry of Health implemented three rounds of Outbreak Response Immunization (ORI) targeted for the age group of 0-1-6 months old and 1-18 years old in 2017 and tailor approached for adults that had exposed to cases. Banten, DKI Jakarta and West Java were the first three provinces to implement this program considering their condensed population and high risk of disease transmission. Conclusion: in Indonesia, there was dramatic increase of diphtheria case in 2010-2017, where immunization in children should be reinforced by increasing coverage more than 95% and adult boosted vaccination approaches should be initiated to prevent the spread of these fatal diphtheria diseases in Indonesia

Rino-orbital-cerebral Mucormicosys in A Patient Type 1 Diabetic: A Case Report

Mucormycosis is an opportunistic andfrequently fulminating fungal infection causedby members of the family Mucoraceae, orderMucorales and class Zygomycetes which highly invasive and high mortality. Mucormycosis occurs in diabetic patients with poor blood glucose control. We reported a case of rhinocerebral mucormycosis in 20-year-old female patient with type 1 diabetes. The patient was treated for diabetic ketoacidosis and swollen symptoms in the left eye and out secretions from the left nose containing blackish spots. The probable diagnosis of rhinocerebral mucormycosis is made based on the results of direct examination and culture of nasal and palate tissue biopcywhich result suitable for Mucor sp. She was given systemic antifungal therapy with amphotericin B and symptoms of swelling of the left eye and secretions of the left nose with patches of blackness improved

The Vascular Access Related Infections: Have We Anticipated Them Adequately?

The number of patients in need of haemodialysis (HD) is increasing from time to time. In 2018, the Indonesian Renal Registry documented more than 130,000 active patients from 651 registered HD centres. Twenty percent are diabetic patients with end-stage renal disease (ESDR) equal to 8,633 patients. Diabetes Mellitus accounts for 2% of all diabetes cases in the age of 15 year-old and above. Hence, the increasing need for HD is inevitable and is parallel with the need for vascular access procedures.One of the major problems that occurs with vascular access is the risk of infection. Among HD patients, mortality and morbidity are predominantly associated with infection; about one-fifth as a cause of hospital admissions, one-fourth of the infection-related admissions are due to infection of vascular access. Susilo et.al, reported around 40% of patients with temporary vascular access had an infection. Data is limited and might be also underestimated.Unfortunately, the available studies examining risk factors for vascular access-associated infection are scarce and mostly collected with substandard methodology. It is to be highlighted that the study of Susilo et al. may represent the population of a  referral hospital for HD, yet as a reader it is worth noting that heterogeneity among centres and populations should be acknowledged. A comprehensive in-depth review and further research of these studies are crucial for a greater level of understanding for the cause of infection and therefore inform effective early detection and prevention strategies to reduce morbidity and mortality among haemodialysis patients, especially at-risk patients

Effectiveness of Influenza Vaccination in Preventing Acute Asthma Exacerbations in Adult Patient

Acute respiratory tract infection is a major cause of acute exacerbations in asthma. One example of viral respiratory tract infection is influenza caused by influenza virus. Administering influenza vaccine to asthmatic patients is expected to protect them from acute asthma exacerbations caused by influenza virus.The purpose of this case study is to determine the effectiveness of influenza vaccines in protecting the patients from acute exacerbations of asthma in adults. Literature search was conducted in the Pubmed database, EBSCO, Clinical Key, Google Scholar, and Science Direct to identify relevant articles. Literature search was done on March 30th, 2015. There were two selected articles that met the criterias and fully accessible for further review. Both articles had good validity and showed that there was no significant effect of influenza vaccination against acute asthma exacerbations. Number Needed to Treat (NNT) value from one of the articles showed no significancy. Influenza vaccination does not have significant protective effect against acute asthma exacerbations in adults

Efficacy of Tenofovir Disoproxil Fumarate in Preventing Vertical Transmission of Hepatitis B in Mothers with Chronic Hepatitis B: An Evidence-Based Case Report

Background: Hepatitis B virus infection is the most common cause of chronic hepatitis. Vertical transmission is the main transmission route of this virus. Current prevention involves giving newborns immune prophylaxis within 12 hours of birth. However, there is still a failure of immunoprophylaxis, especially in cases of mothers who have a high viral load or are HBeAg positive. Tenofovir disoproxil fumarate (TDF) is the first-line treatment for chronic hepatitis B and is known to reduce perinatal HBV transmission. This study aims to determine the efficacy of TDF in preventing vertical transmission in pregnant women with chronic hepatitis B. Methods: A literature search was performed on the online databases of PubMed/MEDLINE, Embase, Scopus, Cochrane, and ScienceDirect. The inclusion criteria used were pregnant women with chronic hepatitis B and using TDF antiviral as a transmission prevention therapy with the study design used in the form of a meta-analysis, systematic review, randomized or nonrandomized controlled trial. The outcome of interest was the vertical transmission rate of hepatitis B. Results: There are two studies used with a meta-analysis study design and a nonrandomized controlled trial with a good critical review result of Validity, Importance, and Applicability. TDF significantly prevented vertical transmission of hepatitis B compared to placebo. In addition, TDF was not associated with the incidence of maternal and fetal complications. Conclusion: TDF has high effectiveness in preventing vertical transmission of hepatitis B and is safe to give to pregnant women