The concomitant measurements in cardiac index changes after the passive leg raising maneuver can be helpful in predicting who might have an increase in cardiac index with subsequent fluid resuscitation.

Background The incidence of COVID-19 is still rapidly increasing, but little is known about the prevalence and characteristics of fatal cases in children in Indonesia. This study aims to describe the characteristics of pediatric COVID-19 cases with fatal outcomes in Indonesia's tertiary referral hospital. Methods This is a cross-sectional study with data collected from the medical records of COVID-19 patients admitted to Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia, from March to October 2020. Results During the study period, 490 patients were admitted and diagnosed with suspected and probable COVID-19. Of these patients, 50 (10.2%) were confirmed to have COVID-19, of which 20 (40%) patients with positive tests for SARS-CoV-2 had a fatal outcome. The fatality was higher in patients ≥10 years old, categorized with severe disease upon admission, with PaO 2 /FiO 2 ratios of ≤300 mmHg and chronic underlying diseases. The most common clinical manifestations were generalized symptoms, while acute respiratory distress syndrome (8/20) and septic shock (7/20) were the two most common causes of death. Increased procalcitonin, D-dimer, lactate dehydrogenase, and presepsin levels were found in all fatal COVID-19 cases. One patient met the criteria of multisystem inflammatory syndrome in children (MIS-C). Conclusion Our work highlights the high mortality rate in pediatric patients positive for the COVID-19 test. Further studies are needed to understand better the role of SARS-CoV-2 in elaborating the mechanisms leading to death in children with comorbidities.

Background: Indonesia has a high number of COVID-19 cases and mortalities relative to not only among the Asia Pacific region but the world. Children were thought to be less affected by the virus compared to adults. Most of the public data reported combined data between adults and children. The Indonesian Pediatric Society (IPS) was involved in the COVID-19 response, especially in the area of child health. One of IPS's activities is collecting data registries from each of their chapters to provide a better understanding of COVID-19 in children.Objective: The objective of this study was to share the data of suspected and confirmed COVID-19 cases in children from IPS's COVID-19 data registry.Method: This is a retrospective study from the IPS's COVID-19 registry data. We collected the data of COVID-19 in children during March to December 2020 from each of the IPS chapters. We analyzed the prevalence, case fatality rate (CFR), age groups, diagnosis, and comorbidities of the children diagnosed with COVID-19.Result: As of December 21, 2020, there were 35,506 suspected cases of children with COVID-19. In total, there were 522 deaths, with a case fatality ratio (CFR) of 1.4. There were 37,706 confirmed cases with 175 fatalities (CFR 0.46). The highest mortality in confirmed COVID-19 cases was from children ages 10–18 years (42 out of 159 cases: 26%). The most common comorbidity and diagnosis found were malignancy (17.3%) and respiratory failure (54.5%).Conclusion: The CFR of confirmed COVID-19 cases in children in Indonesia is high and should be a major public concern.

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Background While the number of cases of multisystem inflammatory syndrome in children (MIS-C) is increasing, reported cases in Asian countries are still low, particularly in Indonesia. This study aimed to describe the characteristics of patients with MIS-C in a tertiary referral hospital in Indonesia. Methods This is a cross-sectional study with collected data of patients with MIS-C admitted to Dr. Cipto Mangunkusumo from March 2020 to April 2021. Results The first case of MIS-C was detected 5 months after the first reported coronavirus disease 2019 case in Indonesia. Thirteen patients out of 158 positive admitted patients for COVID-19 were diagnosed with MIS-C during the study period. Of these 13 patients, 2 patients (15%) had a fatal outcome. Subjects were predominantly male, and the median age was 7.58 years (IQR 12.3) years. Most patients required mechanical ventilation (7 out of 13 patients) and intubation (8 out of 13 patients). Patients who needed intubation usually needed mechanical ventilation. All inflammatory markers, white blood cells, neutrophil counts, and all coagulation factor parameters (except for normal prothrombin time and activated partial prothrombin time) were elevated. The median time to MIS-C diagnosis was 2 days in the survivor group (n = 11) compared to 8.5 days in the non-survivor group (n = 2). Compared to the non-survivor group, those who survived spent more days in the hospital, received vasopressors earlier, and did not require mechanical ventilation as early as the non-survivors. Conclusions Our work highlights the differences in MIS-C clinical course, treatment, and clinical outcomes between the two groups.

Infeksi luka operasi (ILO) merupakan salah satu komplikasi pascabedah abdomen dan infeksi nosokomial yang sering terjadi pada pasien be dah. Survei oleh WHO menunjukkan 5%34% dari total infeksi nosokomial adalah ILO. Kata kunci: infeksi luka operasi, pascabedah abdomen, faktor risiko

Latar belakang. Sepsis merupakan penyebab utama kematian bayi dan anak. Status imun pejamu dan malnutrisi merupakan faktor penting yang menentukan luaran pada sepsis. Skor pediatric logistic organ dysfunction (PELOD) adalah sistem skoring disfungsi organ pada sakit kritis, untuk memprediksi mortalitas pasien sepsis.Tujuan. Mengetahui faktor risiko usia, status gizi, dan skor PELOD terhadap mortalitas sepsis.Metode. Retrospektif analitik berupa data rekam medis pasien berusia 1 bulan – 18 tahun di PICU RSCM bulan Apri1- Agustus 2011 dengan diagnosis sepsis menurut kriteria konsensus sepsis internasional.Hasil. Sembilanpuluh dua dari 209 pasien mengalami sepsis, 22 (23,9%) di antaranya meninggal. Median usia subjek 15 (rentang 2-192) bulan dengan sebaran terbanyak pada kelompok usia 1 bulan – 1 tahun (62%). Sebagian besar subjek (57,61%) memiliki status gizi kurang. Fokus infeksi tersering adalah infeksi saraf pusat dan gastrointestinal, masing-masing 32 (34,77%) subjek. Gizi buruk (p<0,001; OR 26,88;IK95% 4,74-152,61) dan skor PELOD ≥20 (p<0,001; OR 78,8;IK95%14,23-436,36) merupakan faktor risiko yang secara independen berperan terhadap mortalitas sepsis pada anak.Kesimpulan. Gizi buruk dan skor PELOD ≥20 berperan terhadap mortalitas sepsis pada anak. Usia <5 tahun tidak terbukti sebagai faktor risiko mortalitas sepsis pada anak.

Purpose Peroxisome proliferator-activated receptor gamma (PPAR-γ) has a key role in hepatic fibrogenesis by virtue of its effect on the hepatic stellate cells (HSCs). Although many studies have shown that PPAR-γ agonists inhibit liver fibrosis, the mechanism remains largely unclear, especially regarding the cross-talk between PPAR-γ and other potent fibrogenic factors. Methods This experimental study involved 25 male Wistar rats. Twenty rats were subjected to bile duct ligation (BDL) to induce liver fibrosis, further divided into an untreated group (BDL; n=10) and a group treated with the PPAR-γ agonist thiazolidinedione (TZD), at 14 days post-operation (BDL+TZD; n=10). The remaining 5 rats had a sham operation (sham; n=5). The effect of PPAR-γ agonist on liver fibrosis was evaluated by histopathology, protein immunohistochemistry, and mRNA expression quantitative polymerase chain reaction. Results Histology and immunostaining showed markedly reduced collagen deposition, bile duct proliferation, and HSCs in the BDL+TZD group compared to those in the BDL group ( p <0.001). Similarly, significantly lower mRNA expression of collagen α-1(I), matrix metalloproteinase-2, platelet-derived growth factor (PDGF)-B chain, and connective tissue growth factor (CTGF) were evident in the BDL+TZD group compared to those in the BDL group ( p =0.0002, p <0.035, p <0.0001, and p =0.0123 respectively). Moreover, expression of the transforming growth factor beta1 (TGF-β1) was also downregulated in the BDL+TZD group ( p =0.0087). Conclusion The PPAR-γ agonist inhibits HSC activation in vivo and attenuates liver fibrosis through several fibrogenic pathways. Potent fibrogenic factors such as PDGF, CTGF, and TGF-β1 were downregulated by the PPAR-γ agonist. Targeting PPAR-γ activity may be a potential strategy to control liver fibrosis.