INDONESIA’S DEFENSE HEALTH PERSPECTIVE

The National Defense System is a systematic and planned concept, structure and organization, fostering the spirit of the universe of the people and nation, to strengthen and defend themselves from various threats, challenges, obstacles and disturbances that break the Indonesian building and network. The concept embodies software that contains the philosophy, purpose, theoretical framework and framework of the concept of national defense, as a soul and heart that moves continuously in the spirit of conscience defending the country. The purpose of this study is to develop a study about the strategic role of defense health as a diversified potential for multifunctional health to guide the national level of resilience. The potential of health in the field of defense with its strategic thinking decomposes the breadth of Indonesia's geographic region, which has distinctive characteristics of health problems based on geomedicine maps. The dynamic stratification of health problems makes geomedicine maps as a measure of defense health policy. The concept proposed in this study is expected to be one of the basic references in forming a defense health study program at Indonesia Defense University. The method, that needs to be developed, is the transformation of the health of Indonesian National Armed Forces (TNI). At this time, it has achieved dynamic values in realizing a broader role, not only in the field of health services and support, but it has begun to expand into the field of research and development (R & D). This development also related to global challenges, where the spread/pandemic of illness becomes an extraordinary homework, especially related to defense health. Defense health is a multiparadigmatic concept with multidisciplinary scientific dimensions and parameters, and various multi-approaches (analysis, synthesis, and solution), based on philosophy and history, build a defense health characteristic that has a scientific perspective that has reliability and validity, so th purpose of this study can be obtained

STRATEGI PEMBANGUNAN KESEHATAN DAN KETAHANAN NASIONAL DALAM PERSPEKTIF DAYA JUANG BANGSA

Daya tahan bangsa bermakna konsep dan kekuatan memelihara ketahanan nasional mencakup eksistensi di tengah peradaban dan perubahan lingkungan strategis, menuju kondisi dinamis ketahanan nasional untuk memelihara keteraturan, stabilitas, dan potensi terjadinya perubahan (the stability idea of changes). Tantangan dan problematika ketahanan nasional merupakan varian dinamik yang memerlukan pemikiran komprehensif terhadap sistem, kebijakan dan strategi perilaku kebangsaan (behaviour science) yang didukung patriotisme dan energi keamanan kesehatan bangsa terhadap peran TNI untuk mengisi zona dan akumulasi pembangunan kesehatan yang menggambarkan performance keswadayaan dan ketahanan nasional. Daya juang kesehatan bangsa dalam perspektif kekuatan struktural dan partisipatif bertitik tolak kepada kemampuan menggerakkan leadership, metabolic health community dan agent of change yang memenuhi nilai keandalan High Reliability Organization (HRO). Keandalan yang terbentuk akan memicu spirit inovasi dan out the box merangkai suatu jejaring (networking) untuk perubahan, sehingga termanifestasikan sebagai performance keandalan profesional yang menjunjung tinggi potensi kesehatan bangsa dan ketahanan nasional. Sinergitas Sistem Kesehatan Nasional (SKN) dan Sistem Kesehatan Pertahanan (Siskeshan) merupakan jaring yang saling bertaut untuk mendukung upaya pemberdayaan nilai strategis kesehatan nasional. Strategi ini menguatkan jejaring ketahanan nasional (one health) terhadap kompleksitas ancaman global kesehatan yang mengancam ketahanan nasional. Tantangan global dengan adanya Public Health Emergency berupa wabah yang sedemikian cepat dengan problematika yang sulit diprediksi, memicu setiap negara memperkuat daya juang bangsa untuk mensinergikan pembangunan kesehatan berasaskan sistem ketahanan nasional.Kata Kunci : daya tahan bangsa, leadership, agent of change, sinergitas skn-siskeshan, Unha

Septic Pulmonary Embolism Following Appendectomy Surgery

Septic Pulmonary embolism is a rare condition where there were numerous pulmonary infarcts resulting from blood clot emboli that also contains microorganism. This disorder is insidious onset, Its clinical features usually unspecific and the diagnosis usually difficult to establish. A 43 old woman who underwent an appendicitis surgery, reentered the hospital at the sixth day after surgery presented with fever, pain at the surgical site, progressive severe dyspnea and chest tightness. From the physical examination finding there were tachycardia, tachypneu, wet rough basal rhonki on the right rear and tenderness at right lower region of the abdomen. The thorax-abdomen CT scan result was pleuropneumonial with minimal effusion in the right side. ACT angiography scan of the chest and abdomen showed intralumen emboli in medial lobe segmen of right pulmonary artery, right pleuropneumonia with segmental lession in segmen 10 right lobe and inflammation process along right lateral wall of the abdomen. Laboratory results that also supported diagnosis were D dimer 3442 ng/mL and culture result from surgical site pus showed E. Coli ESBL (+). Base on these findings, this case was established as a septic pulmonary embolism.Key words: septic pulmonary embolism, appendicitis surgery, E. coli ESBL (+)

Plasmodium ovale Infection After One Year Mefloquine Prophylaxis in A Young Indonesian Soldier: A Case Report

Malaria chemoprevention using mefloquine has become the WHO standard regimen for military personnel who stay in the endemic area for an extended period of time. We reported a case of Plasmodium ovale infection in a young Indonesian Soldier following one year mefloquine prophylaxis 250 mg weekly. Typical fever and chills were experienced two weeks after returning from one year duty in Congo, West-Central Africa. The diagnosis of ovale malaria was made by peripheral blood smear, and 35/250 parasites in small microscopic view was found. Then, he recovered after dihydroartemisin and primaquine combination therapy. This was an unusual case of long-term prophylaxis failure since mefloquine has been recognized as the agent for malaria prevention, even multi-drug-resistance Plasmodium. Dormant stage of Plasmodium ovale, quinoline-resistance potential, and the efficacy of mefloquine itself are discussed as the cause of that phenomenon

Cardiac Dysfunction due to Sepsis

Sepsis is a condition where bacteremia persist and precede by SIRS sign, in a severe condition sepsis can manifest as septic shock and refractory septic shock with very high mortality rate, up to 50% during hospitalization, almost equalize death due to myocardial infarction. In a severe sepsis at least one of organ dysfunction is present, cardiovascular is one of the most frequent affected organ system in severe sepsis and almost always affected during septic shock. During sepsis depression of cardiac systolic and diastolic func-tion characterized by bi-ventricular impairment of contractility, decrease in ventriclular compliance which manifest as subsequent reduction in left ventricular ejection fraction and LV stroke work index. The pathophysi-ology of cardiac depression during sepsis remain unclear up to now, but many evidence showed that circulating cardio toxic agent (IL 1, IL 8, C3a), endotoxin (LPS), cytokine (IL 1, IL 6, TNF a), endothelin 1 (ET 1), nitric oxide (NO), prostanoid (Tromboxan & Prostasiklin), and adhesion molecule (intercellular adhesion molecule-1 & vascular cell adhe-sion molecule-1) play important role in depressing cardiac function during sepsis. Definitive therapy regarding cardiac dysfunction during sepsis is still unknown, but adequate supportive management in maintaining adequate preload continued by inotropic and or vasopressor with low dose cor-ticosteroid, low dose nitroglycerine (in selected patients) and statin are prove in clinical trial effective in providing better outcome. Poor cardiac function in sepsis is related to poor outcome during hospitalization. This article discus about cardiac dysfunction, pathophysiology and supportive management in adult with sepsis

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

A Clinical Profile of Hepatitis a Patients in Jakarta, Indonesia

Background: To determine the incidence of hepatitis A infections and the clinical profiles of adult patients admitted to public hospitals in Jakarta, Indonesia. Methods: This was a cross-sectional study that utilised consecutive secondary data from internal medicine wards of seven public hospitals in Jakarta between 2011 and 2013. Eligibility criteria included patients over the age of 18 years and an ICD-10 diagnosis code of B15, acute hepatitis A. Case proportion was reported per 1000 people by dividing incidence per year to total in-ward patients. Clinical profiles were reported descriptively. Laboratory results were compared and categorised into groups of patients aged below and above 25 years old. Results: Data revealed that hospitalisations of patients with hepatitis A had decreased from 2011 to 2013. 289 patients were studied, the majority were young adults (18-25 years old) and their common chief complaints were nausea (36%), fever (24%), and jaundice (21%). Higher bilirubin levels were seen in older patients. There were 13 patients coinfected with hepatitis B, one patient coinfected with hepatitis C, and one patient coinfected with HIV. Conclusions: The proportion of hepatitis A infection amongst adults admitted to public hospitals in Jakarta was low and had decreased during the study period. Most of the patients reported classical clinical manifestations. This study found that the targeted age group may benefit from receiving routine hepatitis A vaccinations

A Randomized, Double-Blind, Multicenter Clinical Study Comparing the Efficacy and Safety of a Drug Combination of Lopinavir/Ritonavir-Azithromycin, Lopinavir/Ritonavir-Doxycycline, and Azithromycin-Hydroxychloroquine for Patients Diagnosed with Mild to Moderate COVID-19 Infections

At the present time, COVID-19 vaccines are at the testing stage, and an effective treatment for COVID-19 incorporating appropriate safety measures remains the most significant obstacle to be overcome. A strategic countermeasure is, therefore, urgently required. Aim. +is study aims to evaluate the efficacy and safety of a combination of lopinavir/ritonavirazithromycin, lopinavir/ritonavir-doxycycline, and azithromycin-hydroxychloroquine used to treat patients with mild to moderate COVID-19 infections. Setting and Design. +is study was conducted at four different clinical study sites in Indonesia. +e subjects gave informed consent for their participation and were confirmed as being COVID-19-positive by means of an RTPCR test. +e present study constituted a randomized, double-blind, and multicenter clinical study of patients diagnosed with mild to moderate COVID-19 infection. Materials and Methods. Six treatment groups participated in this study: a Control group Madministered with a 500 mg dose of azithromycin; Group A which received a 200/50 mg dose of lopinavir/ritonavir and 500 mg of azithromycin; Group B treated with a 200/50 mg dose of lopinavir/ritonavir and 200 mg of doxycycline; Group C administered with 200 mg of hydroxychloroquine and 500 mg of azithromycin; Group D which received a 400/100 mg dose of lopinavir/ritonavir and 500 mg of azithromycin; and Group E treated with a 400/100 mg dose of lopinavir/ritonavir and 200 mg of doxycycline. Results. 754 subjects participated in this study: 694 patients (92.4%) who presented mild symptoms and 57 patients (7.6%) classified as suffering from a moderate case of COVID-19. On the third day after treatment, 91.7%–99.2% of the subjects in Groups A–E were confirmed negative by a PCR swab test compared to 26.9% in the Control group. Observation of all groups which experienced a significant decrease in virus load between day 1 and day 7 was undertaken. Other markers, such as CRP and IL-6, were significantly lower in all treatment groups (p< 0.05 and p< 0.0001) than in the Control group. Furthermore, IL-10 and TNF-α levels were significantly elevated in all treatment groups (p< 0.0001). +e administration of azithromycin to the Control group increased CRP and IL-6 levels, while reduced IL-10 and TNF-α on day 7 (p< 0.0001) compared with day 1. Decreases in ALTand AST levels were observed in all groups (p< 0.0001). +ere was an increase in creatinine in the serum level of the Control, C, D, and E groups (p< 0.05), whereas the BUN level was elevated in all groups (p< 0.0001). Conclusions. +e study findings suggest that the administration of lopinavir/ritonavir-doxycycline, lopinavir/ritonavir-azithromycin, and azithromycinhydroxychloroquine as a dual drug combination produced a significantly rapid PCR conversion rate to negative in three-day treatment of mild to moderate COVID-19 cases. Further studies should involve observation of older patients with severe clinical symptoms in order to collate significant amounts of demographic data