Faktor – Faktor Prediktor Mortalitas Sepsis Dan Syok Sepsis Di Icu Rsup Dr Kariadi

LatarBelakang : Sepsis dan syok sepsis merupakan suatu sindroma kompleks dan multifaktorial, yang insidensi, morbiditas, dan mortalitasnya masih tinggi di dunia. Faktor - faktor yang mempengaruhi dan memperberat perjalanan penyakit sepsis diantaranya usia, jenis kelamin, fokus infeksi, skor APACHE II, skor qSOFA, jumlah leukosit, kadar hemoglobin, kadar hematokrit, jumlah trombosit, kadar glukosa, kadar albumin, kadar kreatinin serum, sistolik, denyut jantung, laju pernafasan, PaO2/FiO2, dan komorbid.Tujuan : Mengetahui faktor – faktor prediktor mortalitas sepsis dan syok sepsisMetode : Penelitian ini merupakan penelitian observasional analitik dengan metode kasus kontrol yang dilakukan mulai April-Mei 2016. Kasus adalah penderita sepsis dan syok sepsis yang meninggal setelah dirawat di ICU RSUP Dr. Kariadi, sedangkan kontrol adalah penderita sepsis dan syok sepsis yang bertahan hidup setelah dirawat di ICU atau bangsal RSUP Dr. Kariadi. Data diambil dari catatan medik pasien dan kemudian dianalisis menggunakan univariat dan bivariat dengan SPSS 21.Hasil : Pada penelitian ini didapatkan 40 pasien sebagai kasus dan 7 pasien sebagai kontrol. Setelah dilakukan uji Fisher's exact diperoleh nilai kemaknaan hubungan antara variabel dengan kematian sebagai berikut : usia (p = 0.553 [OR = 1.346]), jenis kelamin (p = 0.623 [OR = 1.091]), fokus infeksi (p = 0.285 [OR = 2.222]), skor APACHE II (p = 0.488 [OR = 2.056]), skor qSOFA (p = 0.501 [OR = 0.667]), jumlah leukosit (p = 0.291 [OR = 2.250]), kadar hemoglobin dan hematokrit (p = 0.473 [OR = 0.5]), jumlah trombosit (p = 0.574 [OR = 1.206]), kadar glukosa (p = 0.394 [OR = 1.750]), kadar albumin (p = 0.357), kadar kreatinin serum (p = 0.606 [OR = 0.831]), sistolik (p = 0.190 [OR = 3.056]), denyut jantung (p = 0.525 [OR = 0.75]), laju pernafasan (p = 0.499 [OR = 1.393]), PaO2/FiO2 (p = 0.426 [OR = 1.630]), dan komorbid (p = 0.660 [OR = 0.786]).Kesimpulan : Variabel yang diteliti tidak berhubungan bermakna dengan kejadian kematian pada sepsis maupun syok sepsis. Hasil ini memiliki kelemahan berupa jumlah sampel yang sedikit sehingga tidak dapat mewakili populasi. Selain itu ada beberapa variabel lain yang diperkirakan berpotensi menjadi prediktor mortalitas sepsis maupun syok sepsis tetapi tidak diteliti karena keterbatasan data

Perbedaan Profil Laboratorium Penyakit Demam Berdarah Dengue Anak Dan Dewasa Pada Fase Kritis

Background: Dengue Haemorrhagic Fever (DHF) is a tropical infectious disease that often affects children and adults. The prevalence of DHF continues to increase every year. One of the major manifestations of DHF is hypovolemic shock caused by plasma leakage. Children may be less able to compensate the plasma leakage than adults so they have greater risk of shock. Laboratory tests are used to determine the state of hemoconcentration and thrombocytopenia of patients with DHF, especially in the critical phase to monitor and prevent the patient become worse. Objective: To analyze the differences in laboratory profile of hemoconcentration, leukopeny, and hrombocytopenia of children and adults with DHF in the critical phase.Methods: The study was observational analytic with retrospective cross sectional design. It included 70 samples of children and 70 samples of adult with DHF. Data was taken at the Dr. Kariadi Hospital. The research instrument was medical records of children and adults patients with DHF in the critical phase.Results: In children, laboratory profile of hematocrit increased as much as 63.3%, while in adult as much as 36.7%(p=0.006). Laboratory profile of leukocytes in children decreased by 48.5% and 51.5% in adults (p=0.735). Laboratory profile of platelets in children decreased by 56.7% and 43.3% in adults (p=0.007).Conclusions: There are significant differences between hemoconcentration and hrombocytopenia laboratory profiles of children and adults in the critical phase but there is no significant difference between leukopeny laboratory profiles of children and adults in the critical phase

Perbedaan Profil Klinis Penyakit Demam Berdarah Dengue (Dbd) Pada Anak Dan Dewasa

Background : Dengue hemorrhagic fever is a communicable disease commonly found in tropical and subtropical area and a major health problem in Indonesia. This disease can lead to different clinical profiles between children and adults.Aim : To analyze the differences of clinical profile consist of duration of fever, hemorrhagic manifestations, hepatomegaly, plasma leakage, and the degree of dengue hemorrhagic fever (DHF) in children and adults.Methods : This research was an observational study with cross sectional retrospective design. Total of samples were 154 consisting of 79 children and 75 adults who are diagnosed denguehemorrhagic fever. Data was obtained from medical records from January 2013 to March 2015. Statistical test was using Chi square test, Mann Whitney, and two samples Kolmogorov Smirnov with significance limit of p < 0.05 and a confidence interval of 95% . Result : Chi square test found no significant difference in duration of fever (p = 0,304), and found significant differences in spontaneous bleeding (p = 0.001), hepatomegaly (p < 0.001), shock ( p < 0.001) and plasma leakage ( p < 0.001) which is more common in children than in adults . Mann Whitney test found significant differences in the mean time of fever duration (p = 0.017) which longer in adults (6.61 days). Two samples Kolmogorov -Smirnov test found significant differences in the degree of DHF ( p = 0.004 ) .Conclusion : There were significant differences (p>0,05) of clinical profile consist of mean time of fever duration, spontaneous bleeding manifestations (especially petechiae and ecchymosis/ purpura), hepatomegaly, shock, plasma leakage (especially hemoconcentration, pleural effusion, and edema palpebra), and the degree of DHF

Polymorphisms of TLR4 Asp299Gly and TNF-α -308G/A in Leptospirosis

Background : TLR4 Asp299Gly and TNF-α -308G/A polymorphisms have been shown to be associated with increased susceptibility and severity of infection. TLR4 Asp299Gly polymorphism could affect the host's ability to respond to leptospira sp. TNF-α -308G/A polymorphism, is associated with the high producer of TNF-α.Methods : Total of 36 leptospirosis patients (IgM anti leptospira and MAT positive) and healthy individual with the equal number were included. The polymorphisms were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) using site spesific restriction enzyme.Results : Distribution of homozygous wild-type TLR4 Asp299Gly polymorphism was higher in both of groups ( 94.5:97.2%.) and homozygous mutant allele was absent. There was not significantly difference of TLR4 Asp299Gly in leptospirosis patients and healthy group ( ρ=1.00; OR 0.5; 95%CI, 0.04-5.6) and between mild and severe leptospirosis (ρ=0.54; OR 1.54 ; 95% CI, 1.20-1.98). The presence of homozygous wild-type TNF-α -308G/A polymorphism was higher between leptospirosis patients and healthy group (100:94.5%) andhomozygous mutant allele was not found in both of the groups. No significantly different of TNF-α -308G>A polymorphism between leptospirosis patient and healthy group (ρ=0.49).Conclusions : In this study, the polymorphisms of TLR4 Asp299Gly and TNF-α -308G/A were not associated with the susceptibility and severity of leptospirosis

Keterlibatan Organ Pada Pasien Leptospirosis Di Rsup Dr Kariadi Semarang

Background: Leptospirosis is a zoonotic disease that is widespread in the world. The incidence of leptospirosis in Indonesia, especially in Semarang is still quite high and leptospirosis can cause organ involvement that can increase patient morbidity.Purpose: Measuring organ involvement in patients with leptospirosis in the Hospital Dr. Kariadi and analyze differences in organ involvement in icteric leptospirosis and anicteric leptospirosis patients.Methods: This study is a descriptive analytic. Data were taken from the case record form of clinical research data leptospirosis Hospital Dr. Kariadi. Subjects were all patients with confirmed leptospirosis, with a total of 84 patients. Diagnosis is made by MAT. Differences in liver organ involvement, kidney, lung and heart were analyzed by Fisher's Exact test, while the difference in hematologic organ involvement were analyzed by Kolmogorov Smirnof 2 samples.Results: In patients with icteric leptospirosis, organ involvement is the liver appears most 100%. In anikteric leptospirosis patients, organ involvement is the most widely kidney 76.9%. The difference between the kidney and liver organ involvement in patients with icteric leptospirosis and anikteric leptospirosis is significant with p <0.05. The difference between organ involvement lungs, heart, and hematology in patients with icteric leptospirosis and anikteric leptospirosis is not significant with p>0.05.Conclusion: There is a difference between engagement kidney and liver in icteric leptospirosis and anikteric leptospirosis patienrs. There is no difference between organ involvement pulmonary, cardiac and hematological in icteric leptospirosis and anikteric leptospirosis patients

Prevalence and classification of high antimicrobial resistant Staphylococcus aureus in wastewater eluted from poultry slaughterhouse

The continued and increasing development of antimicrobial resistant bacteria among the foodborne pathogens had caused worldwide to be alarmed. Being the earliest to develop antimicrobial resistance, Staphylococcus aureus is constantly monitored for any new resistance development. The resistance development is often linked to wastewater and the treatment plants where the pressure of antibiotic is the highest. Hence, this study investigated on the prevalence of high antimicrobial resistant S. aureus in the wastewater eluted from a poultry slaughterhouse. A total of thirty wastewater samples were collected from a poultry slaughterhouse in Semenyih, Selangor. Most probable number (MPN)-plating method was employed to enumerate the S. aureus count in the wastewater. The results indicated that S. aureus was highly present whereby all samples (100%) were positive and the concentration ranged between 11 – 2.1 x 104 MPN/ml. Isolated S. aureus strains were screened for their antimicrobial susceptibility using the Kirby-Bauer Disk Diffusion Test method to classify their antimicrobial resistance eleven antibiotics. The MAR index measured was between 0.18 and 0.91, inferring that the strains are highly antimicrobial resistance. All S. aureus strains were 100% resistant to ampicillin (25 μg) and cefazolin (30 μg). 94.1% of the strains were resistant to penicillin (10 μg) which phenotypically indicated these strains are Methicillin-resistant S. aureus (MRSA). Notably, 17.6% of the strains developed resistance to vancomycin and was categorized as Vancomycin-resistant S. aureus (VRSA). There is a need to take drastic preventive measures to control the resistance development in S. aureus to conserve public health

Desialylation of platelets induced by Von Willebrand Factor is a novel mechanism of platelet clearance in dengue

Thrombocytopenia and platelet dysfunction are commonly observed in patients with dengue virus (DENV) infection and may contribute to complications such as bleeding and plasma leakage. The etiology of dengue-associated thrombocytopenia is multifactorial and includes increased platelet clearance. The binding of the coagulation protein von Willebrand factor (VWF) to the platelet membrane and removal of sialic acid (desialylation) are two well-known mechanisms of platelet clearance, but whether these conditions also contribute to thrombocytopenia in dengue infection is unknown. In two observational cohort studies in Bandung and Jepara, Indonesia, we show that adult patients with dengue not only had higher plasma concentrations of plasma VWF antigen and active VWF, but that circulating platelets had also bound more VWF to their membrane. The amount of platelet-VWF binding correlated well with platelet count. Furthermore, sialic acid levels in dengue patients were significantly reduced as assessed by the binding of Sambucus nigra lectin (SNA) and Maackia amurensis lectin II (MAL-II) to platelets. Sialic acid on the platelet membrane is neuraminidase-labile, but dengue virus has no known neuraminidase activity. Indeed, no detectable activity of neuraminidase was present in plasma of dengue patients and no desialylation was found of plasma transferrin. Platelet sialylation was also not altered by in vitro exposure of platelets to DENV nonstructural protein 1 or cultured DENV. In contrast, induction of binding of VWF to glycoprotein 1b on platelets using the VWF-activating protein ristocetin resulted in the removal of platelet sialic acid by translocation of platelet neuraminidase to the platelet surface. The neuraminidase inhibitor oseltamivir reduced VWF-induced platelet desialylation. Our data demonstrate that excessive binding of VWF to platelets in dengue results in neuraminidase-mediated platelet desialylation and platelet clearance. Oseltamivir might be a novel treatment option for severe thrombocytopenia in dengue infection