Dengue fever is currently the most important mosquito-borne viral disease in Indonesia. In South Sulawesi province, most regions report dengue cases including the capital city, Makassar. Currently, no information is available on the serotypes and genotypes of the viruses circulating in the area. To understand the dynamic of dengue disease in Makassar, we carried out dengue fever surveillance study during 2007-2010. A total of 455 patients were recruited, in which antigen and serological detection revealed the confirmed dengue cases in 43.3% of patients. Molecular detection confirmed the dengue cases in 27.7% of patients, demonstrating that dengue places a significant disease burden on the community. Serotyping revealed that dengue virus serotype 1 (DENV-1) was the most predominant serotype, followed by DENV-2, -3, and -4. To determine the molecular evolution of the viruses, we conducted whole-genome sequencing of 80 isolates. Phylogenetic analysis grouped DENV-2, -3 and -4 to the Cosmopolitan genotype, Genotype I and Genotype II, respectively. Intriguingly, each serotype paints a different picture of evolution and transmission. DENV-1 appears to be undergoing a clade replacement with Genotype IV being supplanted by Genotype I. The Cosmopolitan DENV-2 isolates were found to be regionally endemic and is frequently being exchanged between countries in the region. By contrast, DENV-3 and DENV-4 isolates were related to strains with a long history in Indonesia although the DENV-3 strains appear to have been following a distinct evolutionary path since approximately 1998. To assess whether the various DENV serotypes/genotypes possess different growth characteristics, we performed growth kinetic assays on selected viruses. We observed the relatively higher rate of replication for DENV-1 and -2 compared to DENV-3 and -4. Within the DENV-1, viruses from Genotype I grow faster than that of Genotype IV. This higher replication rate may underlie their ability to replace the circulation of Genotype IV in the community.

Purpose: To analyze risk factors and various nutrients associated with stunting among children aged 6-60 months. Methods: This is a case-control and cross-sectional study between 40 stunting cases and 40 controls. Data on possible risk factors associated with stunting were obtained through direct interviews and using a questionnaire. Examination of vitamin D, zinc, albumin, and ferritin levels was performed on both groups. Data were analyzed using IBM SPSS Statistics for Windows, Version 23.0 (IBM Co., Armonk, NY, USA) to determine risk factors for stunting and to assess the relationship between nutritional levels and stunting. Results: The incidence of stunting was highest in children aged 12-36 months. Children with low weight and very low weight for age comprised of 55% and 22.5%, respectively, of the study participants. The highest mother's educational level was junior high school (40%). History of low birth weight (LBW) was more commonly observed in the stunting group than that in the control group (25.0% and 7.5%, respectively; p=0.034, odds ratio, 0.310 [95% confidence interval, 0.122-0.789]). Approximately 7.5% of cases had premature birth. Exclusive breast feeding was found to be not correlated with stunting. The mean zinc level in the stunting group was 34.17 ng/mL, which was different from that in the control group (50.83 ng/mL) (p=0.023). Blood ferritin, vitamin D, albumin, and calcium levels were not strongly correlated with stunting. Conclusion: LBW is the main risk factor contributing to stunting and is strongly associated with low zinc level.

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Background. The immunopathology of DHF/DSS is yet completely understood. Angiopoietin-2 (Ang-2) produced by endothelial cell could promote vascular leakage by disrupting endothelial junction. Few studies reported the role of Ang-2 in dengue viral infection. Objective. To study the role of Ang-2 in promoting vascular leakage in dengue viral infection. Methods. Prospective cohort study conducted at Prof. Dr. R.D. Kandou, Pancaran Kasih and R.W. Mongonsidi General Hospitals in Manado, from March 2013 to October 2014. Children, aged 1-15 years old, with the diagnosis of dengue viral infection according to 1997 World Health Organization (WHO) criteria [Dengue Fever (DF), Dengue Hemorrhagic Fever (DHF), Dengue Shock Syndrome (DSS)],were recruited consecutively. Written informed consent was obtained from parents or legal guardian. Blood samples were obtained at the time of diagnosis and 48 hours after, evaluated for complete blood counts, albumin, NS-1, Ig M, Ig G anti-dengue, and Ang-2. Results. During the study period, there were 119 children with dengue viral infections (39 DF, 39 DHF, 41 DSS). Patient's characteristics: female predominance, age between 1.5-8.5 years old, well nourished, and mean albumin level were less than ≤3.5 gr% in the DHF and DSS group. Ang-2 level at admission were 2,486.21 pg/dl, 3,194.95 pg/dl and 4,005.32 pg/dl in DF, DHF and DSS group, respectively. Anova test analyses shows significant differences in serum Ang-2 level at admission between DF, DHF and DSS group (p<0.0001). Between those groups, DSS group had the highest level of Ang-2, followed with DHF and DF. Discussion. Mean albumin level were 3.88 gr%, 3.39 gr% and 2.63gr% in DF, DHF and DSS group, respectively. This results shows increasing plasma leakage with increasing severity of dengue viral infection. Increasing level of Ang-2 can promote blood vessels instability therefore causing increased vascular permeability and subsequent plasma leakage. In this study, we found significant elevation of serum Ang-2 in patiens with DSS compared to DHF and DF but the difference was not significant between DF and DHF group. Conclusions. Angiopoietin-2 contributes in transient systemic vascular leak in dengue viral infection.

Ultraviolet (UV) radiation has dangerous effects on the skin that may cause multiple clinical and cellular effects, which will produce DNA damage characterized by formation of photoproducts such as cyclobutane pyrimidine dimer (CPD), and acute inflammation characterized by neutrophil infiltration in the skin tissues. Cocoa flavanols are natural anti inflammatory molecules that has a role in preventing cutaneous UV damage. The aims of this study are to assess protection effects of topical cocoa extract against formation of CPD and tissue neutrophils caused by ultraviolet B radiation. This study is a true experimental study using mice as animal model, conducted at animal laboratory of Hasanuddin University and Sentra Diagnostic Patologia Laboratory from April to Mei 2016. Total of samples were 30. Protection effects of CPD formation occur with application of 200 ppm cocoa extract, with frequency of negative and weak CPD expression were 60% and 40%, respectively. There was an increased in protection with application of 400 ppm cocoa extract, with frequency of negative and weak CPD expression were 80% and 20%, respectively, and there was decrease of protection with application of 800 ppm cocoa extract, with frequency of negative and weak CPD expression were 40% and 60% respectively. The group which only exposed with UVB has higher mean of tissue neutrophils (mean=10,4), and groups with application of 400 ppm and 800 ppm cocoa extract have lowest mean of tissue neutrophils (mean=1,4). There was no significant differences between groups with application of 400 ppm and 800 ppm cocoa extract. The best protection effects on CPD formation and tissue neutrophil achieved with application 400 ppm of cocoa extract.

Recurrent abdominal pain is the most common symptom experienced by children around the world and causes high rates of children absent from school. Gastroduodenitis is a disease with abdominal pain symptoms. The initial clinical symptom was dyspepsia. In most pediatric cases the etiology is unknown (idiopathic). This study presented a case of gastroduodenitis in a 10-year-old boy hospitalized with the chief complaints of heartburn, accompanied by vomiting. The patient has a history of the same complaint in the last 3 months ago, causing the patient to be admitted to the hospital repeatedly. Pain is not relieved by defecation or flatus. On physical examination, tenderness was found in the epigastric and umbilical regions. Chronic gastroduodenitis was confirmed after endoscopic examination and tissue biopsy. Therapy including proton pump inhibitors and lifestyle modifications can improve the child's condition. In the case of gastroduodenitis, it is important to prevent complications, so proper examination and prompt treatment are needed for the sufferer.

Background Nitric oxide (NO) play a key role in the pathogenesis of septic shock. Nitrit oxide metabolite is reported as a good predictor for shock although its role as mortality predictor in sepsis still controversial.Objective To assess the serum nitric oxide (NO) levels and outcomes in pediatric patients with septic shock.Methods We conducted a prospective cohort study from January 2013 to April 2014 in Pediatric Intensive Care Unit (PICU) Prof. Dr. R. D. Kandou Hospital, Manado. Subjects were patients aged 1 month-12 years diagnosed with septic shock. We measured initial serum NO and observed its outcomes in all subjects.Results A total of 37 patients with septic shock met the study criteria. Nineteen children were male (51.4%). Seventeen subjects died and 20 subjects survived. The mean age of subjects with septic shock was 37.3 (SD 14.2) months. The mean serum NO level was significantly higher in the group who died [33.2 μM; 95% CI 23.6 to 42.7] than in the group who survived [13.8 μM; 95%CI 11.6 to 15.9] (P<0.01). The serum NO cut-off point for predicting mortality was 16.15 µM. For NO levels of more than 16.15 µM, the positive predictive value was 72.2% and negative predictive value was 78.9% (OR 9.750; 95%CI 2.154 to 44.138).Conclusion In pediatric patients with septic shock, serum NO levels are significantly higher in those who died than in those who survived. Serum nitric oxide level can be used to predict outcomes of patients with septic shock.

Dengue fever is a major global public health challenge in tropical and subtropical countries. The clinical spectrum of dengue infection ranges from mild illness to the life-threatening severe forms of the disease with plasma leakage, severe bleeding, or multi-organ failure, which may be fatal. The term expanded dengue syndrome is used for atypical manifestations of dengue fever. This study presented a case of expanded dengue syndrome with status epilepticus in a 9-month-old boy hospitalized with the chief complaint decreased of consciousness with fever and seizures. From the physical examination, there was a decrease in consciousness with GCS 9 accompanied by fever, ascites, and gastrointestinal bleeding. On laboratory examination, hyponatremia, increased transaminase enzymes, and hypoalbuminemia with positive dengue IgM were found. The patient had specific clinical features of expanded dengue syndrome with status epilepticus the appropriate anti-convulsion, vasopressor, and fluid management was given to the patient. In cases of dengue virus infection, it is important to prevent other potential complications such as expanded dengue syndrome with status epilepticus.  Early diagnosis of expanded dengue syndrome simultaneously with adequate treatment will prevent the complications of the disease.