Snakebite in Indonesia

Indonesia as one of the largest tropical and agricultural countries in the world shared the particularly high burden cases of snakebite. In the last decade, World Health Organization (WHO) has listed snakebite as one of the neglected tropical disease. The clinical manifestations of snakebite could vary according to the type of venoms ranging from mild to life threatening condition. Appropriate first aid treatment and comprehensive management of snakebite cases are warranted to reduce mortality and morbidity rates.Key words: snakebite, neglected tropical disease, Indonesia, treatment, antiveno

Effectiveness of Influenza Vaccination in Preventing Acute Asthma Exacerbations in Adult Patient

Acute respiratory tract infection is a major cause of acute exacerbations in asthma. One example of viral respiratory tract infection is influenza caused by influenza virus. Administering influenza vaccine to asthmatic patients is expected to protect them from acute asthma exacerbations caused by influenza virus.The purpose of this case study is to determine the effectiveness of influenza vaccines in protecting the patients from acute exacerbations of asthma in adults. Literature search was conducted in the Pubmed database, EBSCO, Clinical Key, Google Scholar, and Science Direct to identify relevant articles. Literature search was done on March 30th, 2015. There were two selected articles that met the criterias and fully accessible for further review. Both articles had good validity and showed that there was no significant effect of influenza vaccination against acute asthma exacerbations. Number Needed to Treat (NNT) value from one of the articles showed no significancy. Influenza vaccination does not have significant protective effect against acute asthma exacerbations in adults

Antifungal Susceptibility Testing in HIV/AIDS Patients: a Comparison Between Automated Machine and Manual Method

Aim: to evaluate the performance of Vitek2 compact machine (Biomerieux Inc. ver 04.02, France) in reference to manual methods for susceptibility test for Candida resistance among HIV/AIDS patients. Methods: a comparison study to evaluate Vitek2 compact machine (Biomerieux Inc. ver 04.02, France) in reference to manual methods for susceptibility test for Candida resistance among HIV/AIDS patient was done. Categorical agreement between manual disc diffusion and Vitek2 machine was calculated using predefined criteria. Time to susceptibility result for automated and manual methods were measured. Results: there were 137 Candida isolates comprising eight Candida species with C.albicans and C. glabrata as the first (56.2%) and second (15.3%) most common species, respectively. For fluconazole drug, among the C. albicans, 2.6% was found resistant on manual disc diffusion methods and no resistant was determined by Vitek2 machine; whereas 100% C. krusei was identified as resistant on both methods. Resistant patterns for C. glabrata to fluconazole, voriconazole and amphotericin B were 52.4%, 23.8%, 23.8% vs. 9.5%, 9.5%, 4.8% respectively between manual diffusion disc methods and Vitek2 machine. Time to susceptibility result for automated methods compared to Vitex2 machine was shorter for all Candida species. Conclusion: there is a good categorical agreement between manual disc diffusion and Vitek2 machine, except for C. glabrata for measuring the antifungal resistant. Time to susceptibility result for automated methods is shorter for all Candida species

Antifungal Susceptibility Testing in HIV/AIDS Patients: a Comparison Between Automated Machine and Manual Method

Aim: to evaluate the performance of Vitek2 compact machine (Biomerieux Inc. ver 04.02, France) in reference to manual methods for susceptibility test for Candida resistance among HIV/AIDS patients. Methods: a comparison study to evaluate Vitek2 compact machine (Biomerieux Inc. ver 04.02, France) in reference to manual methods for susceptibility test for Candida resistance among HIV/AIDS patient was done. Categorical agreement between manual disc diffusion and Vitek2 machine was calculated using predefined criteria. Time to susceptibility result for automated and manual methods were measured. Results: there were 137 Candida isolates comprising eight Candida species with C.albicans and C. glabrata as the first (56.2%) and second (15.3%) most common species, respectively. For fluconazole drug, among the C. albicans, 2.6% was found resistant on manual disc diffusion methods and no resistant was determined by Vitek2 machine; whereas 100% C. krusei was identified as resistant on both methods. Resistant patterns for C. glabrata to fluconazole, voriconazole and amphotericin B were 52.4%, 23.8%, 23.8% vs. 9.5%, 9.5%, 4.8% respectively between manual diffusion disc methods and Vitek2 machine. Time to susceptibility result for automated methods compared to Vitex2 machine was shorter for all Candida species. Conclusion: there is a good categorical agreement between manual disc diffusion and Vitek2 machine, except for C. glabrata for measuring the antifungal resistant. Time to susceptibility result for automated methods is shorter for all Candida species

Factors Related to Delayed Antiretroviral Therapy Initiation in HIV Patients

Introduction. Increase access towards antiretroviral therapy (ART) contribute to global decrease of HIV-associated morbidity and mortality. Time to initiation of ART in eligible HIV-infected patients is associated with reduction in mortality and morbidity. Delayed initiation of antiretroviral therapy can lead to increased of mortality rate more than 10% compare to early initiation. Methods. This study was a cross sectional study among adult HIV patients in Out-patient Clinic of HIV Integrated Clinic Cipto Mangunkusumo General Hospital who started ARV therapy for the first time (ART-naïve patients) enrolled from January 2013 to December 2014. The data were extracted from medical records to identify factors associated with delayed initiation ART among HIV patient. Delayed initiation ART was defined as eligible patients didn’t initiate ART within 10 weeks after the diagnosis of HIV infection. Factors identified were gender, education level, employment, marital status, WHO clinical stage, BMI, functional status, and the presence of opportunistic infection. Logistic regression test was used to find factors associated with delayed initiation of ART. Results. There were 444 subjects in this study, which consisted of 107 patients (24.1%) who delayed initiation of ART and 337 patients (75.9%) who didn’t delayed initiation of ART. Based on the bivariate analysis, there were three variables statistically significance, which were advanced WHO clinical stage (p<0.001), lower functional status (p<0.001) and the presence of opportunistic infection (p<0.001). Further multivariate analysis showed that there were two variables associated with delayed initiation of ART, which were advanced WHO clinical stage (OR: 2.92, 95%CI 1.53-7.40, p=0.02) and the presence of opportunistic infection (OR 1.99, 95%CI 1.21-3.29, p=0.01). Conclusions. Advanced WHO clinical stage and the presence of opportunistic infections are factors associated with delayed initiation of ART among HIV patients

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