Risk Factors Analysis of Typhoid Fever Occurence of Inpatient in Kebumen Public Hospital in 2013

ABSTRACTIntroduction: Typhoid fever is a disease caused by infection of Salmonella typhoid and paratyphoid bacteria. There are 350-810 people who get this disease per 100.000 people and the percentage of death is 0.6-5%. Typhoid fever in Kebumen Regency always belongs to the big five diseases. The criteria are the number of in-patient in the hospital and the extraordinary occurrence for 4 years (from 2007 to 2010). This disease is related to unhealthy sanitation and bad individual hygiene practice.Objective: To analyze the risk factors of typhoid fever occurrence of inpatient in Kebumen Public Hospital in 2013.Methods : This research is an analytical observational research with control case study design. The sample subject was taken by using consecutive sampling method and there were 148 respondents, consisting of 74 case respondents and 74 control respondents. The data were analyzed by using McNemar (bivariate) test and conditional logistic regression (multivariate).Results : Most respondents are in the age of 15-20 years old (32.43%), female (70.27%), the graduates of Senior/Vocational High School (29.05%) and student/university student (34.46%). The results of multivariable analysis are the risk factor of eating non-homemade snack habit is high (p=0.000; OR=5.586; CI 95% 2.142-14.571) followed by the habit of washing hands before eating (p=0.003;OR=2.835; CI 95% 1.433-5.609). Water clean sources, facility for defecation,  defecation habit in latrine, and typhoid fever history in family are not the risk factors of typhoid fever occurrence of in-patient in Kebumen Public Hospital.Conclusion : The risk to get typhoid fever in Kebumen Regency is higher on those whose habits of eating non-homemade snacks  and not washing hand by using soap before eating. Therefore, the health officer should improve individual hygiene promotion and give information to society and those who manage food processing public place.Key Words: Risk factors,Typhoid fever, Kebumen

Th e Accuracy of Delta Neutrophil Index as a Marker of Sepsis Severity Level Compare to Serum Amyloid A

Background. Early diagnosis of infection before its progression to become organ dysfunction or circulation failure has an important clinical effect and critical patient outcome. Diagnostic modality used as a gold standard on diagnosing sepsis condition still relies on microbe culture. Microbial culture needed a long duration to grow bacteria in high numbers be identified. The upcoming alternative diagnostic modality used as a marker of sepsis severity level was Delta Neutrophil Index (DNI) and Serum Amyloid A (SAA). There were no references to compare the accuracy of DNI and SAA as a marker of sepsis severity level.Methods. 45 study subjects were patients with sepsis and severe sepsis or septic shock first known when first come to the ER or underwent treatment in the inpatient unit, ICU (Intensive Care Unit) or IMC (Intermediate Care) Sardjito’s Hospital that fulfilled the inclusion and exclusion criteria. The independent variable was DNI and the dependent variable was sepsis severity level. All of blood samples from septic patient undergo DNI and SAA test. Distributed data used the Kolmogorov-Smirnov test. DNI and SAA accuracy used sensitivity, specificity, positive predictive value, negative predictive value, like hood ratio and receiver-operating characteristics (ROC) curve.Results. The study consisted of 45 study subjects. The mean age was 52.98 years. The mean of SAA in this study was 54.39 ± 45.53 mg/L, while the mean of DNI in this study was 12.47 ± 8.79 %. Cut off point DNI 6.85% with value of sensitivity 93%, specificity 70%, positive predictive value (PPV) 79.31%, and negative predictive value (NPV) 87.5%, like hood ratio for a positive test result (LR+) (PLR) 14.28 and like hood ratio for a negative test result (LR-) (NLR) 3.3. Cut off for SAA 54.93 mg/L with value of sensitivity 60%, specificity 56%, positive predictive value (PPV) 52%, negative predictive value (NPV) 64%, like hood ratio for a positive test result (LR+) (PLR) 1.36 and likelihood ratio for a negative test result (LR-) (NLR) 0.71.Conclusions. DNI has better diagnostic accuracy value as a marker of sepsis severity level than SAA.Keywords. Sepsis, sepsis severity level, Delta Neutrophil Index (DNI), Serum Amyloid A (SAA

SISTEM PENDUKUNG PENGAMBILAN KEPUTUSAN KLINIS DALAM PEMBERIAN TERAPI ANTIBIOTIK YANG RASIONAL

Pemilihan terapi antibiotik yang rasional pada penyakit infeksi akan memperbaiki simptom klinis secara lebih cepat, efisien dibandingkan dengan terapi yang tidak tepat atau tidak sesuai. Klinisi harus meningkatkan keahlian dalam penggunaan antibiotik yang rasional pada penyakit infeksi yang ringan atau berat dan pada penyakit yang disebabkan oleh virus. Terapi antibiotik yang rasional mencegah terjadinya resistensi antibiotik. Sistem pendukung pengambilan keputusan klinis (SPKK) akan meningkatkan penggunaan antibiotik yang rasional. Penelitian ini mengembangkan prototipe SPKK untuk mendukung pengambilan keputusan penggunaan antibiotik yang rasional. Desain penelitian ini menggunakan pendekatan action research. Pengembangan sistem dengan prototiping menggunakan rule based dengan format IF (gejala) THEN (terapi). Pengujian system dilakukan dengan membandingkan output dari klinisi dan dari sistem. Hasil evaluasi system terdapat 50 data kuesioner yang diberikan pada klinisi dengan hasil yang sesuai dengan guideline adalah output dari klinisi 35 (70%) dan output system 49 (98%), X2=0,087, p=0,768. Pada hasil atas menunjukkan bahwa sistem memiliki performan yang baik

Changes in Anthropometry Measurement among Human Immunodefi ciency Virus/Acquired Immune Defi ciency Syndrome (HIV/AIDS) Patients Received Antiretroviral Treatment

ABSTRACTBackground: Estimated nearly 38.6 million people infected by HIV and 2.8 million died in 2005. Evidence suggests the existence of a very important relationship between the output and improved nutritional statusin HIV/AIDS patients. Poor nutritional status in HIV/AIDS can be caused by several factors, namely the intake and absorption of inadequate nutrition, metabolic changes, hyper metabolism, or a combination of these, changes in the gastrointestinal tract as well as interactions between drugs and nutrients. Losing weight remains on the HAART (Highly Active Antiretroviral Therapies) era, but the problems are the side effects of HAART and lipodystrophy.Objective: The purpose of this study is to determine the provision of anti- retroviral effect on changes in anthropometric values people with HIV/AIDS. Method: The study is using the one group pre-posttest design (quasi-experimental), by assessing changes in anthropometric values in subjects with HIV before and after the administration of ARVs. Analysis of the data is computerized by a computer program Result: Obtained 30 samples of the study with anthropometric changes pre and post ARVs 6 months. Theweight was 51.4 ± 9.12 to 53.6 ± 8.68 with a p-value 0.001. Body Mass Index (BMI) was 19.98 ± 3.47 into 20.84 ± 3.35 with a p-value 0.001 and upper arm circumference 24.13 ± 3.62 into 24.95±3.48 with a p-value 0.003. The provision of antiretroviral drugs for 6 months infl uences the change in nutritional status of HIV patients are assessed by anthropometric measure. Signifi cant changes in the changes body weight, BMIand upper arm circumference. Changes in anthropometric values ARV Efavirenz group and non-Efavirenz meaningful change signifi cant in skinfold thickness obtained at the value of p 0.010.Conclusion: There were no signifi cant changes in anthropometric values compared to patients with early stage HIV and advanced stage after 6 months of antiretroviral therapy.Keywords: HIV, antiretroviral drugs, anthropometric, nutritional statu

Faktor – Faktor Risiko yang Berpengaruh terhadap Kejadian Demam Tifoid pada Orang Dewasa

Background: In 2000 it was estimated that typhoid fever had caused more than 21.6 million morbidity and 216,510 deaths. In Indonesia typhoid fever is still very endemic. Morbidity in semi rural areas reaches 157/ 100,000 in rural population and increases to 810/100,000 in urban population. At District of Bulungan morbidity caused by typhoid fever is still relatively very high. The major cases of typhoid fever of patients hospitalized at RSUD dr. H. Soemarno Sosroatmodjo happen to age group of > 14 years old (63.84%).Objective: To identify risk factors associated with the incidence of typhoid fever in adults.Method:  The study was observational and used a case control study design. There were 260 samples, comprising 130 cases and 130 control matched based on age and gender. Location of the study was dr. H. Soemarno Sosroatmodjo Hospital at District of Bulungan, Province of Kalimantan Timur. Cases were  hospitalized adult patients diagnosed having typhoid fever based on clinical symptoms and laboratory examination. Control consisted of new patients diagnosed not having typhoid fever. Data analysis used chi square, Odds Ratio (OR) and logistic regression.Result: The result of multivariate analysis showed that only the variable of not washing hands using soap before having meal was associated with the incidence of typhoid fever in adults (p=0.002; OR=1.625; 95%CI=1.497 – 4.602). Whereas the variables of eating out, history of typhoid in the family, availability of clean water and ownership of toilet that did not meet health requirements had no association with the incidence of typhoid fever.Conclusion: The habit of not washing hands using soap before having meal was factor associated with the incidence of typhoid fever in adults at District of Bulungan. Therefore health promotion on clean and healthy lifestyle should be introduced to all community, particularly washing hands using soap before having meal.Keywords: typhoid fever, adults, risk factors, case contro

Persistent lymphopenia in septic patients at Dr. Sardjito General Hospital, Yogyakarta

Sepsis triggers immune responseboth pro-inflammatory and anti-inflammatory. Lymphocytes play an important role in the regulation of the inflammatory response. The decrease in lymphocyte numbers due to continuous apoptosis by sepsiscan suppress the immune system and failure to resolve inflammation. Persistent lymphopenia is also associated with a poor prognosis of sepsis. Currently, there are limited studies about persistent lymphopenia in sepsis patients in low- and middle-income countries, including Indonesia. This study aimed to describe the sociodemographic, clinical, and laboratory patterns of sepsis patients with persistent lymphopenia. This was a descriptive study that analyzed patients’ medical records who were treated at the Department of Internal Medicine, Dr. Sardjito General Hospital, Yogyakarta from January 1st, 2016, to December 31th, 2017. Patients diagnosed with clinical sepsis and persistent lymphopenia were included in the study. The status of persistent lymphopenia was described as lymphocyte counts that remained low or lower (<1.62x103/L) on day 4± 24 h compared to the initial value at the time of sepsis diagnosis (day one). Information of patients’ individual and clinical characteristics, complete blood cell count profiles and culture results were included. The outcomes of interest were the survival status and length of stay of the patients. A total of 101 patients with sepsis and persistent lymphopenia were involved in this study. The average increase in lymphocyte numbers was 73.63 ± 426.86/µL. The main source of infection was pulmonary infection, with a mortality rate of 43.6% and a median survival of 19 days. The average length of stay was 13.1±6.8. Persistent lymphopenia in patients with sepsis has a high mortality. Further research is needed to determine the clinical ramifications of persistent lymphopenia

A fatal acute appendicitis with sepsis and pneumonia was caused by melioidosis: a case report

We report anunderdiagnosed fatal case of melioidosis that involved dygestion system which complicated with pneumonia, and sepsis. The case was initially diagnosed as acute appendicitis, and subsequently the patient underwent an exploratory laparatomy and appendectomy. He was discharged afer 3 days of hospitalization. Thirty days afterward, he was admitted to another private hospital to experience another exploratory laparatomy with indication of pancreatitis, intra-abdominal organs adhesions, and postoperative enterocutaneous fistula (ECF), and hospitalized there for 25 days. He eventually suffered from sepsis, pneumonia, unclosed ECF, anemia, hypoalbuminemia, and electrolyte imbalance. He then referred to a tertiary teaching hospital and hospitalized there for a total 134 days until he passed away. His clinical condition was declining, despite a long course of broad spectrum antibiotics. Treatment delay, prolong hospitalization, and complications were the inevitable, although Burkholderia pseudomallei was finally identified 2 weeks prior to his death. This case highlight that melioidosis canassociate with acute appendicitis, and that the delay on its diagnosis and treatment may trigger complications and death

PENGGUNAAN ANTIBIOTIK TERHADAP LUARAN KLINIK PASIEN INFEKSI SALURAN KEMIH AKIBAT KATETERISASI

Infeksi saluran kemih akibat kateterisasi didefinisikan sebagai infeksi pada pasien yang pernah atau masih menggunakan kateter indwelling (menetap). Penggunaan antibiotik secara tidak rasional dapat menimbulkan pengobatan kurang efektif, resiko efek samping, meningkatnya resistensi antibiotik dan tingginya biaya pengobatan. Penelitian ini bertujuan untuk mengetahui rasionalitas penggunaan antibiotik dan pengaruhnya terhadap luaran klinik pasien infeksi saluran kemih akibat kateterisasi. Penelitian ini merupakan penelitian analitik dengan menggunakan desain cohort retrospektif dengan pengambilan data secara retrospektif berdasarkan data catatan medis pasien infeksi saluran kemih akibat kateterisasi di RSUP Dr. Sardjito Yogyakarta periode Januari 2013-November 2015. Pasien yang memenuhi kriteria inklusi dievaluasi rasionalitas penggunaan antibiotiknya dengan metode Gyssens serta outcome klinik setelah terapi antibiotik empiris diberikan selama tiga hari. Data dianalisis dengan uji statistik Chi-square (variabel kategorik). Jumlah pasien pada penelitian ini sebanyak 63 pasien. Hasil penelitian menunjukkan bahwa penggunaan antobiotik empiris yang diberikan pada pasien CAUTI setelah dievaluasi dengan metode Gyssens, dari 63 pasien diketahui 49 (77,77 %) pasien penggunaannya rasional (kategori 0) dan 14 pasien (22,22 %) tidak rasional. Penggunaan antibiotik rasional pada pasien infeksi saluran kemih akibat kateterisasi memberikan luaran klinik lebih baik dibandingkan dengan pasien yang mendapatkan antibiotik tidak rasional. Kata kunci: Infeksi saluran kemih akibat kateterisasi, antibiotik, rasionalitas, luaran klinik, metode Gyssen

The Use of an Ambroxol Solution to Assess Acute Dermal Irritation on Rabbit Skin

Ambroxol can overcome infections due to the presence of biofilms in the body by interfering with the formation of sticky biofilms and reducing biofilm production, so it has the potential to be used in topical preparations for the treatment of infections. This study aimed to measure the irritating effect on the skin of rabbits resulting from the ambroxol solution to assess the safety of the ambroxol solution. The methods refers to BPOM 2020, namely by dabbing 0.5 ml of ambroxol solution on the back skin of rabbits, then covering it with gauze and non-irritant plasters, after 4 hours of cleaning of residues is then observed at 1 , 24, 48 and 72 hours to see whether or not there was an effect of erythema and edema arising from the influence of the experiment, and at the end of the investigation, a histopathological test was carried out. The results of the research are Macroscopically the ambroxol solution did not show any erythema and edema, so the primary irritation index score was obtained for all test solutions with a score of 0. In contrast, in the microscopic irritation test, the score for erythema was 4 and for edema was 3.&nbsp; . From this research, it can be concluded that the ambroxol solution non-irritating to the skin. &nbsp; KEYWORDS: Biofilm, ambroxol solutions, acute irritation test. &nbsp; &nbsp