Kematian Maternal Di Nusa Tenggara Timur

A prospective study was carried out in villages around health centers, which were distributed over 10 regencies in Timor island of East Nusa Tenggara province. All deaths occurring in 1986 were recorded and reported to the health centers. Each case was investigated by the health center doctor to identify the multiple causes of death as well as its related factors. Pregnancy and delivery histories of maternal deaths were analysed. In the study area, the maternal mortality ratio was found to be 1346 per 100,000 live births, and the maternal mortality rate was 101 per 100,000 women aged 15-49 years. The maternal mortality ratio, among women under 20 years of age, was 3390 per 100,000 live births; and 4545 per 100,000 live births among women aged 40 years and over. The predominant factor as a risk of maternal deaths was attributable to delivery assistance by non medical personnel, which was 71%. Maternal deaths attributable to the first parities was 40%, and to pregnancies without antenatal care was 20.1%}. The most prevalent disease causing maternal deaths were haemorrhage 46.2%}, postpartum infections 30.8% and retained placenta 30.8%. To reduce maternal mortality, the most important intervention is to provide qualified delivery assistants especially for the first parities, and the provision of accessible delivery centers for emergency cases in addition to provision of appropriate antenatal care for early detection of high risk pregnancies. Family planning programs will have to be more specified towards high risk groups, i.e women aged under 20 years or 35 years and over, as well as women of high parity. A similar study is recommended to be conducted throughout the other parts of East Nusa Tenggara islands in order to evaluate the general maternal health status of the province

Artesunat-amodiakuin dan Klorokuin untuk Pengobatan Malaria Vivaks di Puskesmas Kopeta, Maumere, Nusa Tenggara Timur, 2007

Indonesia merupakan negara endemis malaria yang merekomendasi Artemisinin-based Combination Therapy (ACT) untuk malaria Plasmodium vivax. Konfirmasi resistensi P.vivax terhadap kloroquin dan efikasi ACT perlu diteliti untuk mendukung kebijakan pengobatan malaria. Provinsi Papua bersama Nusa Tenggara Timur (NTT) penyumbang utama kasus malaria di Indonesia. Tujuan penelitian untuk mengevaluasi efikasi dan keamanan ACT program artesunat-amodiakuin (AsAq) dibandingkan obat konvensional klorokuin (Cq) pada malaria vivaks di Puskesmas, Provinsi NTT. Penelitian ini merupakan penelitian klinis, prospektif, evaluasi efikasi dan keamanan AsAq dibandingkan Cq pada subyek P.vivax malaria dan diamati selama 28 hari, sesuai protokol WHO tahun 2003. Efikasi AsAq dan Cq dianalisis dan dibandingkan secara intention to treat (ITT) dan per protocol (PP). Keamanan obat dievaluasi berdasarkan timbulnya atau memberatnya gejala klinis dalam kurun waktu 28 hari. Total 100 subjek monoinfeksi P. Vivax yang memenuhi criteria diobati secara acak dengan AsAq atau Cq. Efikasi hari-28 AsAq dibandingkan Cq secara Intention to Treat (ITT) adalah 93,7% (95%CI: 83,8 97,9) versus 56,4% (95%CI: 50,1 75,9) dengan Log Rank (Mantel Cox)<0.001 dan Hazard Ratio 8,3 (95%CI: 2,4 28,2). Efikasi hari-28 AsAq per protocol (PP) adalah 93,6% (95%CI: 82,8 97,8) dibandingkan Cq51,4% (95%CI: 35,9 66,6) dengan Log Rank (Mantel Cox)<0,001 dan HR 9,3 (95%CI: 2,7 31,7). Dua (4%) kasus dengan Cq mengalami kegagalan pengobatan dini (Early Treatment Failure) di hari-3. Kejadian sampingan terbanyak AsAq dan Cq adalah muntah (26% vs 20,4%)dan dua kasus pengobatan Cq merupakan kasus kejadian sampingan serius karena muntah berulang yang memerlukan rawat inap. Efikasi AsAq lebih baik secara signifikan dibandingkan Cq untuk pengobatan P. Vivax di Maumere. Muntah merupakan kejadian sampingan AsAq dan Cq yang paling sering terjadi dan memerlukan pengobatan. ACT alternatif yang efektif dan aman dibutuhkan untuk pengobatan infeksi P. vivax.Kata kunci : artesunat, amodiakuin, klorokuin, P. vivax.AbstractIndonesia as a malaria endemic country is recommended to use Artemisinin-based Combination Therapy (ACT) for P. vivax malaria. Confirmation of Chloroquine resistant and ACT efficacy for P. vivax need to be investigated for supporting malaria treatment policy. Papua and East Nusa Tenggara (NTT) contribute the main malaria cases in Indonesia. To evaluate efficacy and safety of ArtesunateAmodiaquine (AsAq) as an ACT programme compared to drug Klorokuin (Cq) as a conventional for vivax malaria at Public Health Care in NTT. This was a clinical study, prospective, efficacy and safety evaluation of AsAq compared to Cq for malaria P.vivax subject and followed by 28 days, based on WHO protocol 2003. Intention to treat (ITT) and per protocol (PP) was performed to compare AsAq and Cq efficacy. Safety was evaluated based on the incidance or severity of clinical symptoms by 28 days of follow up. Total of 100 P. vivax monoinfection suitable with the inclusion/exclusion criteria was randomized treated with AsAq or Cq. The 28 days efficacy of AsAq and Cq was 93.7% (95%CI: 83.8 97.9) versus 56.4% (95%CI: 50.1 75.9) with Log Rank (Mantel Cox)<0.001 and Hazard Ratio (HR) 8,3 (95%CI: 2,4 28,2) by intention to treat (ITT). Per protocol (PP) efficacy was 93.6% (95%CI: 82.8 97.8) compared toCq51.4% (95%CI: 35.9 66.6), Log Rank (Mantel Cox) <0,001 and HR 9,3 (95%CI: 2,7 31,7). Two (4%) cases with Cq had early treatment failure (ETF) at day 3. The major adverse event was vomiting for both AsAq and Cq (26% vs 20,4%) and two cases with severe vomiting were hospitalized. The efficacy of AsAq was better significantly than Cq for P. vivax treatment in Maumere. Vomiting was the major adverse event for both drugs and needed a treatment. The alternative of effective and safety ACT is needed for P. vivax infection.Key word : artesunate, amodiaquine, choloquine, P. vivax

Keragaman Genetik Petanda P. Falciparum dari Specimen Subyek Penelitian Monitoring Dihidroartemisinin-piperakuin di Kalimantan dan Sulawesi

Treatment failure in falciparum malaria may be caused by parasite resistant to antimalarial drug or new infection. Polymorphism genetic marker of P. falciparum namely MSP1, MSP2 and GLURP locus genes in the population should be identified as a baseline to distinguish the cause of treatment failure. A nested Polymerase Chain Reaction (PCR) method was applied to each locus gene separately. A total 121 dried blood spot specimens from subjects infected with P. falciparum in monitoring Dihydroartemisinin-Piperaquine treatment in Kalimantan and Sulawesi Islands were analyzed. Locus genes of MSP1, MSP2 and GLURP were successful identified 82.6%, 96.7% and 81.0% respectively. However, the three (MSP1, MSP2 and GLURP) locus genes were only found in 71.9% (87 of 121) samples. All of MSP1 locus gene had just one allele, two alleles on most of MSP2 (67.5%) and few of GLURP (14.3%). Multi genotype infection was likely dominant than a single genotype infection (65.5% vs. 34.5%). Based on allele length classification, MSP2 locus gene shows more variety of allele class (12 alleles) than GLURP (9 alleles) and MSP1 (7 alleles), with an allele length mostly for MSP1: 440 - 479 bp, MSP2: 480–519 bp and GLURP: 580–639 bp. In this study, falciparum malaria cases were commonly as multi-genotype infection, and MSP2 was a dominant and polymorphic genetic marker of P.falciparum. Keywords: P. falciparum, PCR, MSP1, MSP2, GLURP, allele Abstrak Gagal pengobatan pada malaria falsiparum dapat disebabkan oleh parasit yang resisten terhadap obat antimalaria atau oleh infeksi baru. Keragaman genetik petanda Plasmodium falciparum yaitu lokus gen MSP1, MSP2 dan GLURP dalam suatu populasi perlu diidentifikasi sebagai dasar untuk membedakan penyebab gagal pengobatan. Metode pemeriksaan yang digunakan adalah nested Polymerase Chain Reaction (PCR) terhadap masing-masing lokus gen secara terpisah. Telah dianalisis 121 spesimen resapan darah kering pada kertas filter dari subyek terinfeksi P.falciparum pada studi monitoring pengobatan dengan Dihidroartemisinin-Piperakuin di Kalimantan dan Sulawesi. Masing-masing lokus gen MSP1, MSP2 dan GLURP yang dapat diidentifikasi sebanyak 82,6%, 96,7% and 81,0%. Sedangkan ketiga lokus gen tersebut ditemukan hanya pada 71,9% (87/121) sampel. Lokus gen MSP1 semuanya mempunyai 1 alel, sedangkan dua alel ditemukan pada sebagian besar MSP2 (67,5%) dan sebagian kecil GLURP (14,3%). Infeksi multi-genotip oleh dua atau lebih genotip P.falciparum ditemukan pada 65,5% sampel dan infeksi tunggal hanya 34,5% sampel. Keragaman klas alel paling banyak ditemukan pada lokus gen MSP2 sebanyak 12 klas alel, GLURP sebanyak 9 klas alel, dan MSP1 sebanyak 7 klas alel. Alel pada lokus gen MSP1 sebagian besar pada kisaran 440 - 479 bp, MSP2: 480 – 519 bp, dan GLURP: 580–639 bp. Pada penelitian ini kasus malaria falsiparum umumnya merupakan infeksi multi-geotip, dan MSP2 merupakan petanda gen P.falciparum yang dominan dan beragam. Kata kunci : P. falciparum, PCR, MSP1, MSP2, GLURP, ale

Faktor Risiko Penyakit Ginjal Kronik : Studi Kasus Kontrol Di Empat Rumah Sakit Di Jakarta Tahun 2014

A case control study was conducted in four government hospitals in Jakarta according to KidneyDisease Improving Global Outcome (KDIGO) 2012 criteria, in the last 10 years. Control subjectswere diagnosed as not CKD based on estimating glomerulus filtration rate (e-GFR) of ≥60ml /minute/1.73m2 and normal urinalysis test. Data were collected by interviewing with subjects usingstructured questionnaires. Laboratory test results were extracted from the medical records orretested laboratory results of serum creatinine, HbA1c, and urinalysis at screening and enrollmenttime. A total of 429 eligible subjects in each group were analysed by logistic regression. Age, familyhistory of CKD, plain water consumption ≤2000ml/day, carbonated drink consumption, energy drinkconsumption, history of kidney diseases, kidney stone, hypertension, and diabetes mellitus increasedrisk of CKD with adjusted odds ratio range from 1.8 to 25.8. Consumption of coffee, tea, chocolate,alcohol drinks, non-steroid anti-inflammatory drug (NSAID), traditional herbal for musculoskeletaldisorder or obesity, smoking, and less quality of drinking water were not significantly associatedwith CKD. It concluded that risk factors of CKD were everyday consumption of carbonated drinkand energy drink

Leukopenia Sebagai Prediktor Terjadinya Sindrom Syok Dengue Pada Anak Dengan Demam Berdarah Dengue Di Rspi. Prof. Dr. Sulianti Saroso

The development of DHF patient usually assessed base on clinical condition, platelet count and haematocrit value as the DSS indicators. While leukocyte count is irrespective though leucopenia is common in viral infection. Therefore, further analysis was run to determine whether leucopenia could be as a predictor of DSS This study was a retrospective study with a case control (1:2) design using hospitalized children medical records from January 2006 to April 2008 at Prof. Dr. Sulianti Saroso Infectious Diseases Hospital. DSS cases were purposive sampling, and DHF controls were selected using simple random sampling. There were 43 children diagnosed as DSS, and 86 diagnosed as DHF. By multivariate analysis, DHF subjects with leucopenia showed 2.9 times higher risk to develop DSS than DHF subjects without leucopenia. ( 95% CI: 1.2-6.6). Increasing hematocrite was found as a confounding variable with (ORa: 4.0 ; 95% CI: 1.7-9.5). As conclusion, leucopenia could be a predictor of progression DHF to DSS

Deteksi P.vivax Single Nucleotide Polymorphism (Snp) Y976f dari Sampel Monitoring Pengobatan Dihidroartemisinin-piperakuin di Kalimantan dan Sulawesi

This study was a part of the activity of monitoring Dihydroartemisinin-Piperaquine (DHP) treatment in subjects infected with P.falciparum and P.vivax in Kalimantan and Sulawesi. SNP Y976F had been proved as the mutation in pvmdr1 gene which was related to P. vivax resistance chloroquine in Papua. Data of spreading pvmdr1 SNP Y976F outside Papua is needed for using Dihidroartemisinin-Piperakuin policy in the treatment of vivax malaria in Indonesia. Detection of SNP Y976F was done against 95 day0-samples of subjects confirmed infected with P.vivax or mixed infection of P.vivax and P.falciparum by PCR. The results showed that 88 (93%) of a total 95 samples were positive detected 976F mutant which were distributed in all sentinel sites of West Kalimantan (2of 3), Central Kalimantan (6 of 8), North Sulawesi (63 of 65), and Central Sulawesi (17 of 19). In conclusion, pvmdr1 SNP Y976F has been spreaded in all sentinel sites. Key words: P.vivax, pvmdr1, Single Nucleotide Polymorphism Abstrak Penelitian ini merupakan bagian kegiatan dari monitoring pengobatan Dihidroartemisinin-Piperakuin (DHP) pada subyek yang terinfeksi dengan P.vivax atau infeksi campuran P.falciparum dan P. vivax di Kalimantan dan Sulawesi. SNP Y976F merupakan mutasi pada gen pvmdr1 yang terbukti berhubungan dengan P. vivax resisten klorokuin di Papua. Dalam rangka kebijakan penggunaan Dihidroartemisinin-Piperakuin untuk pengobatan malaria vivaks di seluruh Indonesia, perlu data penyebaran parasit SNP Y976F pada gen pvmdr1 di luar Papua. Deteksi SNP Y976F dilakukan terhadap 95 sampel H0 subyek terinfeksi P. vivax atau infeksi campuran P.vivax dan P.falciparum yang telah dikonfirmasi dengan PCR. Hasil menunjukkan bahwa 88 dari 95 sampel (93%) terdeteksi positif galur mutan 976F yang tersebar di Kalimantan Barat (2 dari 3), Kalimantan Tengah (6 dari 8), Sulawesi Utara (63 dari 65) dan Sulawesi Tengah (17 dari 19). Kesimpulannya bahwa P.vivax galur Y976F sudah tersebar di setiap sentinel penelitian. Kata kunci: P.vivax, pvmdr1, Single Nucleotide Polymorphis