Background Dengue hemorrhagic fever (DHF) leads to high morbidity and mortality if not be treated properly and promptly. Obesity may play a role in the progression of DHF to dengue shock syndrome (DSS) and could be a prognostic factor.Objective To evaluate childhood obesity as a prognostic factor for DSS. MethodsWe reviewed medical records of patients with DHF and DSS admitted to Department of Child Health, Dr. Sardjito fever, a milder form of disease, or other viral infections. Risk factors for DSS were analyzed by logistic regression analysis. ResultsConclusion Obesity is not a risk factor for DSS, while plasma [Paediatr Indones. 2013;53:187-92.].
Background Transmission within families and multiple spike protein mutations have been associated with the rapid transmission of SARS-CoV-2. We aimed to: (1) describe full genome characterization of SARS-CoV-2 and correlate the sequences with epidemiological data within family clusters, and (2) conduct phylogenetic analysis of all samples from Yogyakarta and Central Java, Indonesia and other countries. Methods The study involved 17 patients with COVID-19, including two family clusters. We determined the full-genome sequences of SARS-CoV-2 using the Illumina MiSeq next-generation sequencer. Phylogenetic analysis was performed using a dataset of 142 full-genomes of SARS-CoV-2 from different regions. Results Ninety-four SNPs were detected throughout the open reading frame (ORF) of SARS-CoV-2 samples with 58% (54/94) of the nucleic acid changes resulting in amino acid mutations. About 94% (16/17) of the virus samples showed D614G on spike protein and 56% of these (9/16) showed other various amino acid mutations on this protein, including L5F, V83L, V213A, W258R, Q677H, and N811I. The virus samples from family cluster-1 (n = 3) belong to the same clade GH, in which two were collected from deceased patients, and the other from the survived patient. All samples from this family cluster revealed a combination of spike protein mutations of D614G and V213A. Virus samples from family cluster-2 (n = 3) also belonged to the clade GH and showed other spike protein mutations of L5F alongside the D614G mutation. Conclusions Our study is the first comprehensive report associating the full-genome sequences of SARS-CoV-2 with the epidemiological data within family clusters. Phylogenetic analysis revealed that the three viruses from family cluster-1 formed a monophyletic group, whereas viruses from family cluster-2 formed a polyphyletic group indicating there is the possibility of different sources of infection. This study highlights how the same spike protein mutations among members of the same family might show different disease outcomes.
ObjectiveThe study aims to illustrate the acceptability of the dengue vaccine before and after the dengue vaccination suspension in urban poor communities in Quezon City, Philippines.ResultsThere were 12 interviews conducted in November 2017 and 5 focus group discussions in January 2018, a month after vaccine program suspension with 41 participants. All participants were selected through purposive criterion sampling. Thematic analysis showed acceptability of the dengue vaccine was associated with parental experience with vaccination and dengue, trust in public health institutions and communication received by parents. Post-dengue vaccination suspension triangulation indicated that the parents regretted the experience, trust to public institutions was eroded and the communication strategy was deemed inadequate. This led to low vaccine acceptability post-vaccine suspension.
Background Transmission of infection between patients by health workers, and the irrational use of antibiotics are preventable causes for healthcare-associated infections (HAI) and multi-resistant organisms. A previous study implementing a hand hygiene campaign and antibiotic stewardship program significantly reduced these infections. Sustaining such interventions can be challenging. Aims To evaluate whether there was a sustained effect of a multifaceted infection control and antibiotic stewardship program on HAI and antibiotic use 5 years after it began. Methods A prospective evaluation study was conducted over 26 months (from February 2016 to April 2018) in a teaching hospital in Indonesia, 5 years after the implementation of an antibiotic stewardship and infection control program, which was successful when initially evaluated. All children admitted to the pediatric ICU and pediatric wards were observed daily. Assessment of HAI was made based on the criteria from the Centers for Disease Control and Prevention. Assessment of rational antibiotic use was based on the WHO Pocket Book of Hospital Care for Children. Multivariable logistic regression analysis was used to quantify the relationship between the HAI and the multifaceted intervention.
ABSTRAKCommunity Acquired Pneumonia (CAP) merupakan penyakit infeksi yang menjadi salah satu penyebab utama kematian anak di negera berkembang. Pola pemberian antibiotik di rumah sakit biasanya masih berdasarkan empiris. Penggunaan antibiotik yang tidak tepat berisiko menyebabkan kegagalan terapi atau resistensi bakteri. Penelitian ini bertujuan untuk mengetahui rasionalitas pemberian antibiotik empiris dan hubungannya terhadap luaran klinis pasien anak dengan CAP di bangsal rawat inap RSUP Dr. Sardjito Yogyakarta. Penelitian menggunakan rancangan deskriptif analitik dengan desain cohort retrospektif. Subyek penelitian adalah pasien anak didiagnosis CAP yang dirawat di bangsal rawat inap anak RSUP Dr. Sardjito Yogyakarta periode 1 Januari -31 Desember 2018. Rasionalitas antibiotik empiris dievaluasi menggunakan metode Gyssens. Luaran klinis yang diamati berupa parameter kondisi klinis membaik dan belum membaik menurut klinisi yang tercantum pada rekam medis. Analisis data dilakukan secara deskriptif untuk karakteristik pasien, pola penggunaan dan rasionalitas antibiotik empiris,sedangkan uji Chi-square untuk melihat hubungan rasionalitas antibiotik empiris terhadap luaran klinis. Hasil penelitian menunjukkan terdapat 73 pasien yang memenuhi kriteria inklusi dan ekslusi (132 regimen antibiotik empiris). Sebanyak 76,5% regimen terapi antibiotik empiris memenuhi kategori rasional (kategori 0). Jenis ketidakrasionalan yang terjadi yaitu kategori IIIB 5,3% dan kategori IIA 18,2%. Analisis Chi-square menunjukkan rasionalitas antibiotik empiris meningkatkan luaran klinis pasien CAP anak secara bermakna (p = 0,011; OR = 2,957; 95 % CI = 1,263 -6,923). ABSTRACTCommunity Acquired Pneumonia (CAP) is an infectious disease which is one of the main causes of child mortality in developing countries. The pattern of giving antibiotics at the hospital is usually still empirical. Inappropriate use of antibiotics may cause failure of therapy or bacterial resistance. This study aims to determine the empirical antibiotic rationality and the relationship of rationality to the clinical outcome of CAP-pediatric inpatients at RSUP. Dr. Sardjito Yogyakarta. The study conducted using a descriptive analytic method with a retrospective cohort design. The subjects were CAP-pediatric inpatients at RSUP. Dr. Sardjito Yogyakarta period 1 January-31 December 2018. The rationality of empirical antibiotics is evaluated using the Gyssens algorithm. The clinical outcome was either good or bad outcome according to the clinician stating in the medical record. Patient characteristics, empirical antibiotic therapy and rationality patterns were analyzed descriptively. The relationship between empirical antibiotic rationality and clinical outcome were evaluated using Chi square test. There were 73 patients who met the inclusion and exclusion criteria (132 empirical antibiotic regimens). Rational antibiotic therapy accounted 76.5% (category 0). Types of irrationality of antibiotic found were IIIB (5.3%) and IIA categories (18.2%). Chi-square analysis showed ...
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