Faktor Prognosis Sindrom Syok Dengue pada Anak

Latar belakang. Manifestasi klinis yang bervariasi, patogenesis yang kompleks, dan perbedaan serotipe virus membuat sulit memprediksi perjalanan penyakit dengue. Banyak penelitian yang telah dilakukan tentang faktor prognosis terjadinya sindrom syok dengue (SSD), tetapi semuanya menggunakan pedoman World Health Organization (WHO) tahun 1997. Tujuan. Penelitian ini bertujuan mengetahui faktor-faktor prognosis terjadinya SSD berdasarkan pedoman WHO tahun 2011. Metode. Studi retrospektif menggunakan data rekam medik pasien anak usia 0 sampai <18 tahun dengan diagnosis demam berdarah dengue (DBD), SSD dan expanded dengue syndrome (EDS) yang memenuhi kriteria WHO tahun 2011 di RSCM dari Januari 2013 sampai Desember 2016. Variabel independen, yaitu jenis kelamin, usia, status gizi, infeksi dengue sekunder, leukopenia, nyeri abdomen, perdarahan gastrointestinal, hepatomegali dan kebocoran plasma. Syok merupakan variabel dependen. Analisis multivariat menggunakan analisis regresi logistik. Hasil. Subyek yang memenuhi kriteria penelitian 145 pasien, 52 (35,8%) di antaranya mengalami SSD. Lima dari 52 pasien SSD mengalami syok selama perawatan di rumah sakit. Analisis bivariat yang menghasilkan faktor-faktor signifikan di antaranya, malnutrisi, gizi lebih dan obesitas, perdarahan gastrointestinal, hemokonsentrasi, asites, leukosit ≥5.000 mm3, ensefalopati, peningkatan enzim hati dan overload. Hasil analisis multivariat menunjukkan variabel hemokonsentrasi dan peningkatan enzim hati merupakan faktor prognosis SSD. Kesimpulan. Hemokonsentrasi dan peningkatan enzim hati merupakan faktor prognosis terjadinya SSD

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

Spatiotemporal variability in dengue transmission intensity in Jakarta, Indonesia.

BACKGROUND: Approximately 70% of the global burden of dengue disease occurs on the Asian continent, where many large urban centres provide optimal environments for sustained endemic transmission and periodic epidemic cycles. Jakarta, the capital of Indonesia, is a densely populated megacity with hyperendemic dengue transmission. Characterization of the spatiotemporal distribution of dengue transmission intensity is of key importance for optimal implementation of novel control and prevention programmes, including vaccination. In this paper we use mathematical models to provide the first detailed description of spatial and temporal variability in dengue transmission intensity in Jakarta. METHODOLOGY/PRINCIPAL FINDINGS: We applied catalytic models in a Bayesian framework to age-stratified dengue case notification data to estimate dengue force of infection and reporting probabilities in 42 subdistricts of Jakarta. The model was fitted to yearly and average annual data covering a 10-year period between 2008 and 2017. We estimated a long-term average annual transmission intensity of 0.130 (95%CrI: 0.129-0.131) per year in Jakarta province, ranging from 0.090 (95%CrI: 0.077-0.103) to 0.164 (95%CrI: 0.153-0.174) across subdistricts. Annual average transmission intensity in Jakarta province during the 10-year period ranged from 0.012 (95%CrI: 0.011-0.013) in 2017 to 0.124 (95%CrI: 0.121-0.128) in 2016. CONCLUSIONS/SIGNIFICANCE: While the absolute number of dengue case notifications cannot be relied upon as a measure of endemicity, the age-distribution of reported dengue cases provides valuable insights into the underlying nature of transmission. Our estimates from yearly and average annual case notification data represent the first detailed estimates of dengue transmission intensity in Jakarta's subdistricts. These will be important to consider when assessing the population-level impact and cost-effectiveness of potential control and prevention programmes in Jakarta province, such as the controlled release of Wolbachia-carrying mosquitoes and vaccination

Expert review of global real-world data on COVID-19 vaccine booster effectiveness and safety during the omicron-dominant phase of the pandemic

Introduction COVID-19 vaccines have been highly effective in reducing morbidity and mortality during the pandemic. However, the emergence of the Omicron variant and subvariants as the globally dominant strains have raised doubts about the effectiveness of currently available vaccines and prompted debate about potential future vaccination strategies. Areas covered Using the publicly available IVAC VIEW-hub platform, we reviewed 52 studies on vaccine effectiveness (VE) after booster vaccinations. VE were reported for SARS-CoV-2 symptomatic infection, severe disease and death and stratified by vaccine schedule and age. In addition, a non-systematic literature review of safety was performed to identify single or multi-country studies investigating adverse event rates for at least two of the currently available COVID-19 vaccines. Expert opinion Booster shots of the current COVID-19 vaccines provide consistently high protection against Omicron-related severe disease and death. Additionally, this protection appears to be conserved for at least 3 months, with a small but significant waning after that. The positive risk-benefit ratio of these vaccines is well established, giving us confidence to administer additional doses as required. Future vaccination strategies will likely include a combination of schedules based on risk profile, as overly frequent boosting may be neither beneficial nor sustainable for the general population

International Nosocomial Infection Control Consortium report, datasummary of 50 countries for 2010-2015 : Device-associated module

Q3Artículo original1495-1504Background: We report the results of International Nosocomial Infection Control Consortium (INICC) sur-veillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America,Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.Methods:During the 6-year study period, using Centers for Disease Control and Prevention National Health-care Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregateof 3,506,562 days.Results:Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAIrates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associatedpneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples,frequencies of resistance ofPseudomonasisolates to amikacin (29.87% vs 10%) and to imipenem (44.3%vs 26.1%), and ofKlebsiella pneumoniaeisolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27%vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs.Conclusions:Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported inCDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the re-duction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC’s main goal tocontinue facilitating education, training, and basic and cost-effective tools and resources, such as stan-dardized forms and an online platform, to tackle this problem effectively and systematically

Pola Penyakit Malaria pada Anak Di RSU Manna, Bengkulu Selatan

Penyakit malaria sampai saat ini masih merupakan masalah kesehatan yang perlu diperhatikan di negara kita, karena penyakit ini masih termasuk dalam kelompok lima besar pola penyakit anak di Puskesmas, demikian pula di Rumah Sakit Umum Manna Bengkulu Selatan. Untuk mengetahui pola penyakit malaria pada anak yang di rawat RSU Manna, dilakukan penelitian retrospektif dari dokumen medik pasien yang dirawat dari tanggal 1 Januari 1990 sampai dengan 31 Desember 1992. Dalam kurun waktu tersebut telah dirawat 122 anak pasien malaria, tetapi dari jumlah tersebut hanya 68 pasien (55,7%) yang memenuhi syarat penelitian yang terdiri atas 41 pasien anak laki-laki (60,3%) dan 27 pasien anak perempuan (39,7%). Semua pasien diobati sesuai dengan pedoman pengobatan yang dikeluarkan oleh Departemen Kesehatan R.I. Empat pasien di antaranya meninggal dunia (5,9%). Kelompok umur yang terbanyak adalah kelompok umur 1-4 tahun (38,2%), sedangkan parasit penyebab terbanyak adalah Plasmodium vivax (58,8%). Manifestasi klinis adalah demam (100%), diikuti oleh muntah (39,7%), sedangkan menggigil bukan merupakan gejala yang terbanyak (32,3%). Hepatomegali dan mencret ditemukan pada 33,9% pasien, sedangkan splenomegali didapatkan pada 8,7% pasien. Pada penelitian ini tampak pedoman pengobatan dari Departemen Kesehatan R.I. masih menunjukkan hasil yang baik

Pilihan Terapi Empiris Demam Tifoid pada Anak: Kloramfenikol atau Seftriakson?

Demam tifoid pada anak besar (lebih dari usia sepuluh tahun) pada umumnya mempunyai gambaran klinis demam tifoid menyerupai dewasa. Demikian juga derajat berat penyakit akan lebih parah dibandingkan pasien anak yang lebih muda. Oleh karena itu, pengamatan keadaan klinis pasien selama mendapat pengobatan harus dievaluasi dengan cermat terutama mengenai parameter keberhasilan pengobatan seperti keadaan umum, suhu, gejala intestinal, komplikasi baik intra maupun ekstra intestinal, hitung leukosit, fungsi hati, dan asupan cairan serta nutrisi. Pemeriksaan biakan darah terhadap Salmonella typhi merupakan baku emas untuk diagnosis demam tifoid. Walaupun pada saat ini telah terdapat berbagai uji diagnostik cepat (rapid diagnostic test) yang dapat dipergunakan untuk pasien rawat jalan, untuk pasien rawat inap harus dilakukan pemeriksaan biakan Salmonella typhi. Selain untuk menegakkan diagnosis, adanya biakan positif sangat berguna untuk menilai apakah pengobatan empiris yang diberikan saat pertama kali pasien datang ke rumah sakit sudah tepat. Perlu diperhatikan bahwa uji resistensi bakteri harus disertakan pada hasil biakan. Hasil uji resistensi diperlukan dalam menilai antibiotik pilihan alternatif apabila pengobatan empiris tidak seperti yang kita harapkan. Kloramfenikol sampai saat ini masih merupakan pengobatan lini pertama untuk demam tifoid pada anak yang dirawat di Departemen Ilmu Kesehatan RS Cipto Mangunkusumo Jakarta. Namun saat ini banyak dilaporkan adanya keadaan multidrug resistance Salmonella typhi (MDSRT), seperti dilaporkan di Pakistan, Mesir, dan Thailand. Maka untuk kasus MDRST diberikan pilihan pengobatan lini kedua yaitu seftriakson atau kuinolon. Namun karena penggunaan kuinolon masih kontroversi untuk anak mengingat dapat menyebabkan artropati, maka seftriakson menjadi pilihan kedua untuk demam tifoid pada anak

Steatocrit: A Simple Method for Detection Fat Malabsorption

Steatocrlt was determined through microcentrifugation of fecal hemogenate from 45 patients with chronic diarrhoea. In the same patients urine materials were collected to determine fat malabsorption using Lipiodol absorption test. There were 28 male and 17 female patients. Severe malabsorption using steatocrit was detected tn 31 patients (68;9%), while LAT determined severe malabsorption in 34 patients (75.5%). The overall sensitivity was 88.2%, and spesificity was 90.9%. Nutritional status did not influence the sensitivity and spesificity of steatocrit. We propose that this simple semiquantitative test can be used as an alternative method for detecting fat malabsorption particularly in laboratories with limited technical expertise