The Autoimmune Mechanism in Dengue Hemorrhagic Fever

The immune response of dengue fever/dengue hemorrhagic fever is a series of immunopathogenesis processes starting from viral infection to the target on monocytes and macrophages. It may consequently cause a cascade of viremia in the circulation that stimulates the afferent, efferent, and effector mechanism by the interaction of the humoral and complement system. The cascade results in inflammatory substance that will affect capillary permeability and activate coagulation factors leading to further effects on endothelial level. The mechanism involving pathogenesis of DHF/DSS is still vague. So far, a theory of heterologous infection has been developed, which explains that on second infection, there is subneutralization that induce viral replication. The  autoimmune mechanism development leads to the better understanding of DHF. It also  explains the autoimmune response of the viral infection, which consists of molecular mimicry, bystander activation and viral persistence. The development of the autoimmune pathomechanism is related to the role of  autoantibody and endothelial dysfunction that may have role in worsening DHF

Caesarean section and gut microbiota in children

Over the last two decades, the C-section rate has increased worldwide. It is understood that colonization patterns of intestinal microbiota in infant delivery in C-section vary from those that were delivered vaginally. These different microbial pattern and diversity will impact and respond to immune and dysbiosis-related diseases. This article examined the effect of C-section on gut microbiota in children.Recent Findings: Newborns are influenced by various factors, including mode of delivery, feeding, nutrition, hospitalization, antibiotic and host gene. Several studies have shown that infants with C-section have lower Bifidobacterium while others have shown lower abundance of Enterobactericeae and Bacteroides in infants with C-section compared to infants born vaginally. Although the mode of delivery is only one factor that influences infant microbiota composition, studies conclude that reduced microbial exposure during the C-section is important because it can affect dysbiosis several years after birth. Good microbiota is a key source of microbial-driven immune regulation, changes in normal patterns of bacterial colonization can alter the immune development outcome and may predispose to certain immune-related disorders later in life.Summary: The composition and concentrations of intestinal microbiota between vaginally and C-section born infants are significantly different. Among C-section infants, gut microbiota is associated with lower diversity and therefore induces dysbiosis, which can affect immune development and may predispose to some immune disorders, i.e. allergies in particular. Nutritional approach with pre-, probiotics, and/or synbiotics can have a promising effect early in life in preventing gut dysbiosis

IRON-FORTIFIED SYNBIOTIC FERMENTED MILK WITH TEMPEH EXTRACT TO ENHANCES PROPIONIC ACID, BUTYRIC ACID, AND NON-PATHOGEN MICROBIOME IN ANEMIC WISTAR RAT

Background. Anemia, as a global public health problem, needs to be solved. The previous study by the researcher found the potency of iron-fortified synbiotic fermented milk with tempeh extract as an alternative to overcome anemia. Objective. This study aims to determine the effects of iron-fortified synbiotic fermented milk with tempeh extract towards short-chain fecal fatty acids (SCFAs) and fecal microbiota. Method. The study was a randomized controlled trial with three groups, consisting of 8 anemic Wistar rats. The groups made into anemia within 17 days.The groups treated as follows: group NA: fermented milk with tempeh extract fortified by NaFeEDTA, group FE: fermented milk with tempeh extract fortified by FeSO4 , and group KO: fermented milk with tempeh extract without fortification. SCFAs and microbiota of the rat’s feces determined using the Total Plate Count method. SCFAs were measured after the intervention, while fecal microbiota was measured before and after the intervention. One-way ANOVA was used to measure the difference between NA, FE, and KO groups with post hoc test Bonferroni. Results. There was a significant mean difference between propionic and butyric acid between NA and FE groups and the KO group. The highest Lactobacilli number was in the FE group, while Bifidobacteria and Enterobacteriaceae were highest in the KO group. Meanwhile, the NA group had the highest Escherichia coli number. Conclusion. Iron fortification has positive effects on increasing the production of SCFAs in the gut. Prebiotics and probiotics have positive effects on pathogenic bacteria. Further study is needed to determine the effects of iron-fortified synbiotic fermented milk with tempeh extract in human. &nbsp

Hubungan Tanda dan Gejala Klinis terhadap Kejadian Syok pada Pasien Demam Berdarah Dengue (DBD) di RS PKU Muhammadiyah Gamping Daerah Istimewa Yogyakarta

Infeksi dengue merupakan penyakit endemis di negara-negara beriklim tropis dan subtropis dengan angka morbiditas dan mortalitas tinggi. Sindrom syok dengue merupakan manifestasi klinis infeksi dengue yang paling membahayakan, bila tidak mendapat penanganan secara tepat akan menyebabkan kematian. Penilaian akurat terhadap risiko syok merupakan kunci penting menuju tatalaksana yang adekuat, mencegah syok, dan perdarahan. Tujuan penelitian ini adalah untuk mengetahui tanda dan gejala yang berhubungan terhadap kejadian syok pada pasien DBD. Penelitian ini merupakan jenis penelitian analytic observational dengan desain cross sectional dengan memilih pasien dewasa yang terdiagnosis demam berdarah dengue menurut kriteria WHO 1997 dan dikonfirmasi dengan pemeriksaan serologi di RS PKU Muhammadiyah Gamping dari Januari-April 2015. Analisis bivariat menggunakan uji Chi-square. Hasil penelitian didapatkan 154 pasien DBD yang memenuhi kriteria dan 17 (11%) diantaranya mengalami kejadian syok. Analisis bivariat diperoleh variabel yang mempunyai hubungan signifikan dengan kejadian syok adalah letargi (p=0,001), ascites (p=0,001), efusi pleura (p=0,001), dan hepatomegali (p=0,001). Disimpulkan bahwa letargi, ascites, efusi pleura, dan hepatomegali adalah variabel yang berhubungan terhadap kejadian syok.Dengue infection is an endemic disease in countries with tropical and subtropical with high morbidity and mortality. Dengue shock syndrome is the most dangerous clinical manifestation of dengue infections, if the patient not receive proper treatment will cause mortality. An accurate assessment of the clinical signs dan symptoms as risk factors of shock is an important key to prevent shock, bleeding, and adequate management. The research to determine clinical signs and symptoms related to shock in patients with DHF. The research methods is analytic observational study with cross sectional design by selecting adult patients diagnosed with dengue hemorrhagic fever, according to WHO criteria in 1997 and confirmed by serology test at RS PKU Muhammadiyah Gamping from January to April 2015. The bivariate analysis using Chi-square test. Research showed 154 dengue patients who matched with the criteria and 17 of patients (11%) experiencing shock dengue. From the results of bivariate analysis showed that variables lethargy (p=0,001), ascites (p=0,001), pleural effusion (p=0,001), and hepatomegaly (p=0,001) have a significant relationship with the occurrence of shock. It can be concluded that lethargy, ascites, pleural effusion, and hepatomegaly are variables related to the occurrence of shock

The Analysis of Nutrient, and Acute Toxicity Test Extracts of Billih Fish (Mystacoleucus-padangensis) as Local Food Quality for Zinc Supplementation

Zinc deficiency is caused by low diet consumption of zinc and the rise up of zinc body requitment. Zinc supplementation becomes a key to prevent zinc deficiency in infancies. The supplement of zinc with dose 10 mg/day within 24 weeks is that significant positive effect for the linier development. As resourses of zinc has been known like meat, liver, and seafood tend to be expensive. Therefore it needs a new innovation by using local foods containing big amount of zinc to fulfill the zinc need for children. A good alternative for this is the use of Bilih fish as source of zinc organic. The aims of this reseacrh are to analyzing the substance of nutrient and acute toxicity test of billih fish extract. he main material used is bilih fish extract in the extraction of the fish meal bilih using 96% ethanol solvent, 1 N NaOH, and 0.1 N HCl by the method established by some of the literature. The results of the analysis of zinc levels with Atomic Absorbant Spectrofotometry method (AAS) obtained zinc content of 28.2 mg / 100 mg flour, increased to 161.97 mg / 100 g after becoming extract. Toxicity test was not found dead mice and other toxic symptoms. The extract of billih fish (Mystacoleucus padangensis) contains zinc in that is very high and not toxic. Therefore it will safe as alternative of organic zinc supplementation to decrease the zinc deficiency for stunted children. Keywords: fish extracts bilih - zinc levels - toxicity - organic zinc supplementatio

Effect of self surrender practice on insulin resistance in individuals withtype 2 diabetes mellitus without depression: asingle-blinded randomized controlled trial

Self surrender practice (latihanpasrahdiri/LPD) is a form of relaxation therapy that has been increasingly used, not only in the treatment of psychosomatic diseases, but also of other non-psychosomatic diseases. Previous studies reported thatSSP shows modest improvement on clinical parameters of type 2diabetes mellitus(T2DM) patients,not onlydepression symptoms improvement, but also glycemic control.However, the effect of LPD on insulin resistance has not been investigated. The study aimed to investigate the effect of LPD on insulin resistance in T2DM patients without depression. This was a single-blinded, randomized, controlledtrial conducted in outpatient unit of the Department of Internal Medicine, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Central Java.The subjects of the study were T2DM patients aged over 30 yearsand had no depression.Fourthy-four T2DM patients were randomized into two groups as the controlgroup and the treatment group who underwent SSP group for eight weeks. The data of insulin resistancemeasured by HOMA-IR, perceived stress scale (PSS), fasting plasma glucose (FBG), HbA1c, and two hour plasma glucose (PPG)levels of both groups werecollected and statistically analysed.No significantly different in the patient’scharacteristics of both groups was observed.At the end of the study period, the LPD group showed reduction of HOMA-IR and HbA1c but not statistically significant, (ΔHOMA-IR = -0.39±1.52; p = 0.976; HbA1c=-0.55±0.85%; p = 0.189). The FBG and PPGincreased in the LPD group compared to control but also not statistically significant (ΔFBG=10.16±50.33; p=0.294; PPG=40.74±69.35; p=0.062). We also observed the decrease of stress level in LPD group compared to control groupbut it was no statistical significance (ΔPSS=-5.09±6.47; p=0.655).Self surrender practice (LPD) decreasesHOMA-IR, improves glycemic control (HbA1c) and reduces stress levels in T2DM patients without depressionAlthough the theyarenot statisticallysignificant, however they may be clinically significant

Chronic constipation as a risk factor of urinary tract infection in children

The prevalence of urinary tract infection (UTI) in children is still quite high. In Dr. SardjitoGeneral Hospital, Yogyakarta the incidence of UTI is reported about 3.5%. One of the riskfactors of the incidence of UTI is chronic constipation. However, it is often not a concern in themanagement of UTI pediatric patients. The aim of the study was to evaluate the influence ofchronic constipation in increasing the risk of UTI in children. This was an observational studywith case-control design. Children with symptoms of UTI who visited at the Installation of ChildHealth, Dr. Sardjito General Hospital, Yogyakarta underwent dipstick urinalysis test and urineculture examination. Patients who showed positive urine culture was included in the case group,meanwhile patients who showed negative urine culture was included in the control group. Allpatients were then asked the history of the chronic constipation. The association between theconstipation and the incident of UTI was evaluated using bivariate analysis continued bymultivariate analysis. One hundred and twenty eight eligible subjects consisting 64 subjects ineach group were involved in this study. Statistical analysis showed that children with chronicconstipation have a 3.77 times higher risk of UTI (OR=3.77; 95%CI=3.21-4.32) compare tothose without constipation. Furthermore, the chronic constipation remained to be independentrisk factor of UTI. The incidence of UTI increased 3.99 times higher in children with constipationcompare to those without constipation (aOR=3.99; 95% CI=1.028-15.48). In conclusion, chronicconstipation has been proven to be a risk factor of UTI in childre

Modified Sensory Stimulation Using Breastmilk for Reducing Pain Intensity in Neonates in Indonesia: A Randomized Controlled Trial.

Abstract Purpose Several studies have shown that oral sucrose reduces pain in newborns. However, sucrose has no efficacy in eliminating pain and long-term effects remain unclear. Breast milk may be useful as an alternative, safe sweet solution. Sensorial saturation (SS) is a multisensory analgesic non-pharmacological treatment, which includes touch and sounds as distractors. This study aimed to compare the analgesic effects of SS with sucrose (SSS), SS with breast milk (SSB), and oral sucrose alone (S24%) in neonates undergoing venipuncture. Design and methods This was a randomized controlled trial conducted on 108 neonates who underwent venipuncture at neonatology wards. All babies were randomly assigned to one of three groups: two intervention groups and one control group. Pain response was assessed using the premature infant pain profile—revised (PIPP-R). Data analysis was conducted using the Kruskal–Wallis test and Mann–Whitney U test. Results SSB and SSS were more effective than S24% (p = 0.001). No difference was observed between SSB and SSS (p = 0.669). Conclusion Multisensory stimulation is more effective in reducing pain than unimodal (oral sucrose) analgesia. Breast milk can be used as a sensory gustatory stimulus in multisensory stimulation to reduce pain intensity in neonates, and demonstrates a similar analgesic effect to sucrose. Practice implications The study findings suggest that neonatal nurses could use SSB for management of pain. This intervention could serve as an effective, inexpensive, and safe non-pharmacological analgesic. Additional testing of this intervention is warranted to support its use as an evidence-based pain reduction approach

Faktor risiko konstipasi pada anak

ABSTRACT Dyah Kurniati, M. Juffrie\u27 - Risk factors of constipation in children Background: Despite it is not considered as a dangerous situation in children older than 2 years old, but attention is important in young infant. Improper treatment in constipation may contributed to the raise of anxiety, emotionally disorder either for the children or its relatives. Objective: To determine risk factors related to constipation in children. Design and Methods: A case control study was conducted for all of children who were admitted to ambulatory polyclinic and inpatient clinic of Sardjito Hospital during January 2001 - December 2001. A questionnaire was obtained by the researcher or assistant by direct interview to parent or guardian. Results: We enrolled 86 children, consisted of 43 children in constipation group and the 43 children as control. There was significant difference (p < 0.01) between two groups in the presence of the symptoms (abdominal pain, pain during defecation, vomit, decrease of appetite and encopresis). More children in constipation group and significant difference (