Kinetics of CD69 Expression on Natural Killer Cells During Acute Phase of Dengue Infection`

ABSTRACTIntroduction: Dengue infection is major annual public health problem in Indonesia. NK cells have a role in cellular immunity to viral infection, however only a few studies of NK cells and were conducted in vivo especially in Indonesia.Objectives: To explore the kinetics of CD 69 expression on NK cells during the acute phase of dengue infection.Methods: Observational cohort study in Dr. Sardjito Hospital was conducted. Clinical data and laboratory data was collected to measure the number of activated NK cells (CD69) using flowcytometry. The percentage of CD69 then calculated using non- parametric test (Kuskal-Wallis Test) and Student t-test. The fluorescence intensity of CD69 was also analyzed.Results: The mean of activated NK cells (CD69) percentage was higher during the early days of acute phase (day 2 to day3), and continuously declined until the seventh day but statistically they were not significant. Fluorescence intensity of CD69 showed its peak during the fifth day of fever.Conclusion: CD69 expression on activated NK cells were increased during the early days (day 2-day 3) of acute fever but decreased after that (day 4-day 7). The highest intensity of CD69 expression was on the fifth day of fever. Keywords: Dengue infection, kinetics, NK cell, CD69, cellular immune response, acute phase, adults

The Kinetics of CD8+ T Lymphocytes in Dengue Patients in Yogyakarta

ABSTRACTIntroduction: Dengue    fever can be graded into dengue fever (DF), dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). The CD8+ T lymphocytes mediate antiviral activity by producing cytokines and directly destroyed the dengue virus infected cells. This study focuses in observing the kinetics of CD8+ T lymphocytes absolute and relative count in dengue patients.Objectives: To observe the kinetics of CD8+ T lymphocytes absolute and relative              count in dengue patients.Methods: The research design used is a descriptive study. This research measures and observes the kinetics CD8+ T lymphocytes absolute and relative count from day 2 to day 7. The CD8+ T lymphocytes count was determined using flowcytometry. Data was analyzed using ANOVA and independent t test with p<0.05 considered as significant.Results: The CD8+ T lymphocytes absolute count is low during the beginning of disease course and it gradually increases from day 2 to day 7. The CD8+ T lymphocytes relative count decreases from day 2 to day 3, and start to increase back from day 3 to day 7. There is no difference between the level of CD8+ T lymphocytes absolute count and relative count between DF and DHF patients.Conclusion: There is an increase in CD8+ T lymphocytes absolute count and relative count in dengue patients. There is no difference between DF and DHF patients in CD8+ T lymphocytes absolute and relative count. Keywords: dengue fever; dengue hemorrhagic fever; CD8+ T lymphocytes; absolute count; relative count

Penggunaan Antibiotika Aminoglikosida pada Pasien Anak di RSUP Dr. Sardjito Yogyakarta

Antibiotik merupakan obat yang banyak diresepkan. Penggunaannya yang tidak tepat dapat meningkatkan morbiditas, mortalitas dan toksistas obat serta dapat memperpanjang lama perawatan dan menambah biaya pengobatan. Penggunaan antibiotik pada pasien anak membutuhkan perhatian khusus karena beresiko mengalami Adverse Drug Reactions (ADRs). Antibiotik aminoglikosida merupakan antibiotik spektrum luas yang dapat digunakan untuk mengatasi infeksi saluran kemih, sepsis dan pneumonia. Penelitian ini bertujuan untuk mengetahui gambaran penggunaan antibiotik aminoglikosida pada pasien anak di RSUP Dr. Sardjito Yogyakarta. Penelitian ini merupakan penelitian deskriptif observasional dengan pengambilan data secara retrospektif. Pelaksanaan penelitian dengan ethical approval dari Komisi Etik Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan Universitas Gadjah Mada. Penelitian dilaksanakan di Instalasi Catatan Medik RSUP Dr. Sardjito. Sampel penelitian adalah pasien anak yang mendapatkan terapi antibiotik aminoglikosida amikasin dan gentamisin selama tahun 2020. Berdasarkan penelitian yang telah dilakukan dapat disimpulkan bahwa pasien terbanyak adalah pasien usia 0-12 bulan dengan jenis kelamin laki-laki. Sebanyak 66 % merupakan pasien rujukan, 35,4 % mendapatkan perawatan ≤ 10 hari, 66,2 % luaran terapi membaik dan diizinkan pulang berdasarkan keputusan dokter. Terapi antibiotik yang diperoleh sebanyak 63,1 % adalah terapi empiris, 48,4% mendapatkan antibiotik selama ≥ 6 hari. Jenis antibiotik terbanyak yang digunakan adalah kombinasi antibiotik ampisilin dan gentamisin sesuai dengan pedoman terapi

Determinan sosial kejadian dengue shock syndrome di kota Semarang

Latar belakang: Infeksi virus dengue masih menjadi masalah kesehatan serius di Indonesia, khususnya Kota Semarang sebagai daerah endemis. Pada tahun 2014, insidensi DBD masih tinggi yaitu 92,43 per 100.000 penduduk dengan angka kematian 1,66. Sebagian besar kasus yang meninggal mengalami syok sindrom. Perbedaan tingkat keparahan DBD dan risiko kematian berhubungan dengan ketidakadilan sosial yang terjadi. Penelitian ini bertujuan untuk mengetahui determinan sosial yang berhubungan dengan dengue shock syndrome (DSS).Metode: Studi ­case control dilakukan pada bulan Februari - Maret 2016. Kasus yaitu penderita DBD yang mengalami syok sindrom berdasarkan diagnosis dokter rumah sakit, dan kontrol adalah penderita DBD yang tidak mengalami syok sindrom. Pengambilan sampel dengan purposive sampling, berdasarkan rekam medik rumah sakit dan register kasus DBD tahun 2015 di Dinas Kesehatan Kota Semarang, kemudian subjek diminta persetujuan tertulis untuk diwawancarai. Analisis data dengan uji chi square dan regresi logistik.Hasil: Sebanyak 73 kasus dan 73 kontrol dilibatkan dalam penelitian ini. Determinan sosial yang berhubungan dengan kejadian DSS di Kota Semarang yaitu umur < 5 tahun (balita) dengan aOR sebesar 4,022 (95% CI=1,275-12,680, p=0,018), dan umur 5-18 tahun (anak-anak) dengan aOR sebesar 4,140 (95% CI=1,476-11,606, p=0,007), serta status rujukan dengan aOR sebesar 3,217 (95% CI=1,285-8,053, p=0,013).Kesimpulan: Masyarakat harus mewaspadai risiko terjadinya syok sindrom dengan memeriksakan balita dan anak dengan gejala DBD ke fasilitas kesehatan agar segera mendapatkan pengobatan. Diagnosis yang tepat dan pengambilan keputusan yang cepat oleh tenaga kesehatan untuk merujuk pasien ke rumah sakit perlu dilakukan untuk mengurangi risiko terjadinya penyakit DBD yang lebih parah.Social determinants of dengue shock syndrome in SemarangPurpose This study aimed to know the social determinants related to dengue shock syndrome.Methods This study used a case control design in Semarang. Cases were dengue patients with shock syndrome diagnosed by a clinician in the hospital, and controls were dengue patients without shock syndrome. Participants were recruited using purposive sampling, and completed written informed consent to be interviewed using a questionnaire.ResultsResults showed that children aged <18 years have the highest risk of having DSS compared to other age groups. Referral system was also correlated to dengue shock syndrome.Conclusion This study recommends the clinicians to undertake appropriate diagnosis and prompt decision making to reduce the risk of more severe DHF events. The community should improve the awareness of shock syndrome by taking their children immediately to health services for examination if they have dengue symptoms in order to get the adequate treatment

THE KINETIC OF ACTIVATED MONOCYTES IN ACUTE PHASE DENGUE INFECTION

Introductions: Nowadays dengue infection is at present one of the most common mosquito-borne viral diseases of humans worldwide. Initially, Dengue infections were primarily recorded when they occurred as epidemics in tropical and subtropical countries. Monocyte/macrophage infection is central to the pathogenesis of dengue fever and to the origin of dengue hemorrhagic fever. Increased activation of monocytes and greater numbers of DEN-infected cells were associated with more severe Dengue, implicating a role for monocyte activation in dengue immunopathogenesis. Thus, more knowledge about the relation between numbers of activated monocyte with dengue severities is essential for better understanding regarding this subject.Objectives: Studying the relation between numbers of activated monocyte, marked by HLA-DR marker intensity with Dengue Fever severity throughout the disease course, from day 2 until day 6 of acute dengue fever.Methods: This research is cross sectional observational study. The location in done at Dr. Sardjito Hospital in 6 months time.Results: There is a negative correlation between median number of activated monocyte with dengue severity, on day 3 of acute dengue fever.Conclusion: There was a negative correlation between numbers of activated monocyte marked by HLADR intensity with disease severity on day 3 of acute dengue infection.Keywords: Activated Monocyte; Human Leukocyte Antigen (HLA)-DR intensity; Percentage of Activated Monocyte; Dengue Fever Severity

Status gizi dan gambaran klinis penyakit pada pasien HIV anak awal terdiagnosis

Nutritional status and clinical disease of HIV children patients when diagnosed for the first timeBackground: Human immunodeficiency virus (HIV) infection in children can cause nutritional problems. Currently, HIV-infected children are still diagnosed when the disease stage is advanced. Nutritional status is a marker of advanced stage conditions in HIV infection.Objective: To determine the clinical findings of disease and nutritional status of HIV children patients when diagnosed for the first time.Methods: We conducted a cross-sectional descriptive study. The data were taken from the medical record documents of child patients aged 0-18 years with the ICD 10 code B20, who was treated at the Dr. Sardjito Yogyakarta Hospital from 1 January 2004-31 December 2019. Results: There were 191 children diagnosed with HIV, 56% of them were boys. The median age was 34 months (IQR 25: 13 months, IQR 75: 69 months), and 95.5% among those were infected perinatally. There were 77 (40,3%) children who suffered from severe malnutrition and 55 (28.8%) children were moderate acute malnutrition. At the age of 0-60 months among them, there were 49 children (36.3%) suffered from severely underweight, 35 children (25.9%) underweight, 53 (39.3%) severely stunted, 38 (28.1%) stunted, 28 severely wasted (20.7%), and wasted as many as 24 (17.8%). At the age of 5-18 years old, there were 19 (33.9%) and 5 (8.9%) children who suffered from severely wasted and wasted respectively. World Health Organization (WHO) stages 3 and 4 were experienced by 62 (32.5%) and 68 (35.6%) children. As many as 41.3% of children had enlarged lymph nodes, thrush (40.8%), pneumonia (40.8%), and persistent or chronic diarrhea (21.5%). Conclusions: The nutritional status of HIV-infected children at baseline was dominated by underweight and stunted. The most clinical findings of the disease when the child was diagnosed with HIV infection were lymphadenopathy, oral thrush, pneumonia, and persistent or chronic diarrhea

The Kinetics of White Blood Cells in Acute Dengue Infection

ABSTRACTIntroduction: Dengue is a mosquito borne viral febrile illness with a high incidence rate of approximately 50 million cases of infection world wide every year. Dengue virus can infect many cells, e.g. monocytes, dendritic cells, Kuppfer cells, B cells including bone marrow and lung. Leukocytes plays an important roles in eliminating dengue virus especially monocytes. However, dengue virus sometimes attack the monocytes and uses them for replication causing monocyte to unde go apoptosis in order to prevent spreading by certain mechanisms.Objectives: To explore the difference in white blood cells count in acute dengue patients from day 2 to day 6.Methods: This research is conducted in a cross sectional observational study method by recording the WBC count, Lymphocytes count, Neutrophils Count, Relative Monocytes Count, and Absolute Monocytes Count from NS-1 positive dengue infection patient using the hematology analyzer. The data was taken from day 2 to day 6 of the fever. One-way ANOVA test was used and a p value <0.05 was considered as significant.Results: In this study, there is a significant difference of leukocyte count, relative and absolute lymphocytes count, relative and absolute neutrophils count, and relative and absolute monocytes count from day 2 to day 6 of dengue infection (p value less than 0.05).Conclusion: Dengue patient have leucopenia on day 2 until day 6 of dengue fever. Lymphocytosis occurs on day 6 of dengue fever. Neutrophils decrease in early infection. Monocytes count is normal in dengue fever, but decrease in DHFKeywords: dengue in fection, leukocyte, lymphocytes, neutrophils, monocyte

The HLA-DR Expression on Monocytes in Acute Dengue Infection

Introduction: Dengue is the most common disease of mosquito-borne infection. According to the World Health Organization, it is estimated that 50 million cases ofdengue infection have been reported annually. Macrophages andmonocyte are thought to play an important role in dengue infection both as primary targets of viral infection and as a source of immunomodulatory cytokines.Whenmonocytes are infectedby dengue viruses, it processed the virus by lyses it and expressed the antigen on its surfacemembrane bind together with HLA class II molecules. HLA-DR-expressing monocytes in acute dengue patientsespecially the intensity is still poorly understood.Measurement of at difference days of infectionwill give an evidence about the role ofmonocytes in dengue pathogenesisObjectives: To observe the kinetics on percentage of HLA-DR expressingmonocytes and themedian of HLA-DR expression intensity in acute dengue infection.Methods: This researchwas an observational type study conducted by cross sectionalmethod towards all the dengue patients in Dr. Sardjito’s General Hospital. Blood samples were drawn from 32 acute dengue infected patients from Day 1 to Day 6th. The HLA-DR expression was measured flow cytometrically using FACS Calibur.Results: The data showed that the mean difference in acute dengue infection from Day 1 to Day 6 is not significant with the p-value larger than 0.05, (p>0.05).Conclusion: The peak level of activated HLA-DR monocyte was at day 2 and then decreasing until day 6. There were no significant changes in percentage of HLA-DR-expressing monocytes from the day 1 to the day 6 and the median intensity of HLA-DR expression in acute dengue infection.Keywords HLA-DR-expressing monocytes, Acute Dengue Infectio

Predictors of mortality in immunocompromised children with respiratory infections

Background Respiratory infection is a common morbidity and a major cause of mortality in immunocompromised children. Hence, identification of clinical parameters that predict mortality among immunocompromised children with respiratory infections is of importance to provide timely and appropriate intervention. Objective To determine predictors of mortality in immunocompromised children with respiratory infections. Methods We conducted a prospective cohort study of immunocompromised children aged 18 years or younger with respiratory tract infections who were admitted to Dr. Sardjito Hospital, Yogyakarta, Indonesia. All eligible children were prospectively followed up until hospital discharge. Clinical and laboratory parameters during the first 24 hours of hospitalization were collected. Results Of 79 eligible children, the overall mortality was 11 subjects (13.9). Fever, tachycardia, tachypnea, cyanosis, leukopenia, neutropenia, thrombocytopenia, and pleural effusion were predictive factors of mortality in bivariate analysis (P<0.25). A logistic regression model showed that neutropenia (absolute neutrophil count <125/mm3) and tachycardia were the best independent predictors of mortality in immunocompromised children with respiratory infections. The children with tachycardia had 15.8 times higher probability of mortality (95CI 5.0 to 4.4) and those with neutropenia had 8.24 times higher probability of mortality. Cyanosis and pleural effusion were also independent mortality predictors. Conclusion The risk of mortality is significantly increased in immunocompromised children with respiratory infection when tachycardia and neutropenia are also present. Paediatr Indones. 2022;62:237-42 DOI: 10.14238/pi62.4.2022.237-42. © 2022, Indonesian Pediatric Society Publishing House. All rights reserved

Faktor Risiko Anemia pada Pasien Kusta Anak dalam terapi MDT (Multi Drug Therapy)

Latar belakang. Sepuluh persen kasus kusta baru yang terdeteksi di Indonesia merupakan kusta anak. Pemberian MDT (multi drug therapy) khususnya komponen dapson dapat menimbulkan efek samping anemia hemolitik. Tujuan. Mengetahui prevalensi dan faktor risiko terjadinya anemia pada pasien kusta anak dengan terapi MDT. Metode. Penelitian cross sectional dilakukan di RS Kusta Sitanala Tangerang pada bulan April-Desember 2013. Subyek penelitian adalah pasien kusta anak usia kurang dari 18 tahun yang diambil secara consecutive sampling. Kriteria inklusi adalah semua pasien kusta anak dengan terapi MDT yang setuju dengan informed consent. Terapi kusta selain MDT atau mendapatkan terapi rutin lain, putus obat MDT >6 bulan atau sedang mengalami reaksi kusta tidak diikutsertakan. Kadar hemoglobin diperiksa dengan metode Cyanmethemoglobin. Analisis menggunakan uji chi square dan Fisher’s exact. Hasil. Didapatkan 70 pasien dengan kadar hemoglobin rata-rata 10,8 g/dL pada kelompok anemia, dan 12,5 g/dL tidak anemia. Empat puluh dari pasien tersebut (57,1%) mengalami anemia. Rerata indeks eritrosit menunjukkan anemia normositik normokromik. Pasien yang mendapatkan terapi MDT ≥3 bulan berisiko untuk mengalami anemia (PR: 2,7; IK95%:1,02-7,23). Faktor usia (PR:1,7; IK95%: 0,64-4,35), jenis kelamin (PR:1,3; IK95%: 0,49-3,26), status gizi (PR:1,6; IK95%: 0,57-4,25), dan jenis terapi (PR:0,4; IK95%: 0,04-4,31) bukan merupakan faktor risiko terjadinya anemia. Kesimpulan. Lama terapi ≥3 bulan merupakan faktor risiko anemia pada kusta anak dengan terapi MDT