A high number of dengue cases are reported annually in Bali. Despite the endemicity, limited data on dengue is available for Bali localities. Molecular surveillance study was conducted to explore the clinical and virological characteristics of dengue patients in urban Denpasar and rural Gianyar areas in Bali during the peak season in 2015. A total of 205 adult dengue-suspected patients were recruited in a prospective cross-sectional study. Demographic and clinical information were obtained, and dengue screening was performed using NS1 and IgM/IgG ELISAs. Viral RNA was subsequently extracted from patients’ sera for serotyping using conventional RT-PCR and Simplexa Dengue real-time RT-PCR, followed by genotyping with sequencing method. We confirmed 161 patients as having dengue by NS1 and RT-PCR. Among 154 samples successfully serotyped, the DENV-3 was predominant, followed by DENV-1, DENV-2, and DENV-4. Serotype predominance was different between Denpasar and Gianyar. Genotyping results classify DENV-1 isolates into Genotype I and DENV-2 as Cosmopolitan Genotype. The classification grouped isolates into Genotype I and II for DENV-3 and DENV-4, respectively. Clinical parameters showed no relationship between infecting serotypes and severity. We observed the genetic diversity of circulating DENV isolates and their relatedness with historical data and importation to other countries. Our data highlights the role of this tourist destination as a potential source of dengue transmission in the region.

Background: Oral candidiasis (OC) is the most frequent opportunistic infection of the oral cavity caused by Candida species overgrowth. A wide variety of risk factor that contributes to yeast infection especially candidiasis. It might be acting as an early marker for people living with HIV/AIDS (PLWHA). There are some risk factors for PLWHA associated OC at

BackgroundAcquired Immunodeficiency Syndrome (AIDS) is a major public health problem. Recently AIDS was considered as a manageable chronic disease. High adherence to Anti-Retroviral Therapy (ART) is necessary to achieve undetectable viral load, reduce morbidity, mortality and to improve the quality of life. It is also preventing the drug resistance, reducing the transmission and finally leading to live longer and healthier.ObjectivesTo assess the factor associated with ART adherence among people living with HIV/AIDS (PLWHA) at Wangaya Hospital, in Denpasar, Bali, Indonesia.MethodologyA cross-sectional study was carried out during January 2015–December 2017 among 202 PLWHA taking ART for at least 6 months. The participants were interviewed using a semi-structured questionnaire to obtain data on socio-demographic characteristics. The data were analyzed using SPSS software for windows version 24.0. Chi-square test was done, the precision value of 95% (p<0.05) was considered statistically to be significant.ResultsA total of 202 PLWHA taking ART, 170 (84.16%) were reported with high adherence (≥95%), 32 (15.84%) were low adherence (<95%). Factors found to be independently associated with high adherence to ART were employment status/occupation (p = 0.011), type of ARV (due to adverse effect of ART) (p = 0.002) and family support (p < 0.001).ConclusionThis study found that the factor associated with ART adherence among PLWHA who visited Wangaya Hospital, in Denpasar, Bali, Indonesia, was employment status, type of ARV and family support.

Lichenoid reaction (LR) is clinically and histopathologically similar to lichen planus (LP), which involves the skin and mucous membrane. LR has identifiable etiology and can be triggered by systemic drug exposure or any other agents. LR occurs in all racial groups and is predominantly observed in young adults aged 20-40 years, but can occur in any age group. Typically, the clinical manifestation of LR is an itchy rash of small (±3-5 mm) shiny, raised, reddish-purple papules. The rash appears suddenly and commonly affects the anterior surface of the arm and hand and the back part of the body. We report a rare case of LR to antihistamines (cetirizine, loratadine) and corticosteroid (methylprednisolone): an adult female 32-year-old patient, with a chief complaint of burning sensation, a few small rashes and itching on the anterior surface of the arm after eating seafood and eggs 7 days prior to admission. From the detailed and chronologic anamnesis of her dietary habits, routine use of drugs and oral hygiene, and from the histopathological results, we concluded the patient has lichenoid reaction caused by drugs (antihistamines and corticosteroids).

Background: The main purpose of treatment in patients with advanced lung cancer is more emphasizing on prolonging survival and improving the patient's quality of life (QOL). Micronutrient deficiency has an impact on the patient's QOL. The purpose of this study was to analyse the relationship between biochemical parameters of nutrient deficiency with QOL in patients with advanced non-small cell carcinoma (NSCLC) at Sanglah hospital.Methods: A cross sectional study was conducted in Sanglah general hospital on March-June 2021. Hemoglobin, albumin, and 2.5 (OH) D levels were obtained from patient's serum. The participant’s QOL was measured with EQ-5D-3L questionnaire. Bivariate analysis using chi-square test or Fisher's exact test, and multivariate analysis using logistic regression.Results: A total of 80 participants were included in this study, and 55% had poor QOL. Seventy percent participants had anemia, 36.3% had hypoalbuminemia, and 26.3% had vitamin D deficiency. The QOL of patients with advanced stage NSCLC was significantly associated with hypoalbuminemia (p=0.000) and vitamin D deficiency (p=0.044). Multivariate analysis showed that the most influential factor on the QOL of patients with advanced stage NSCLC was hypoalbuminemia (AOR 9.158; 95% CI 2.150-30.001; p=0.003).Conclusions: Hypoalbuminemia and vitamin D deficiency were significantly related with QOL of advance NSCLC patients. No relationship was found between anemia and the QOL of advance NSCLC patients. Hypoalbuminemia was the most influential factors related to the QOL of advance NSCLC patients.

Although Japanese encephalitis virus (JEV) is considered endemic in Indonesia, there are only limited reports of JEV infection from a small number of geographic areas within the country with the majority of these being neuroinvasive disease cases. Here, we report cases of JEV infection in non-encephalitic acute febrile illness patients from Bali, Indonesia. Paired admission (S1) and discharge (S2) serum specimens from 144 acute febrile illness patients (without evidence of acute dengue virus infection) were retrospectively tested for anti-JEV IgM antibody and confirmed by plaque reduction neutralization test (PRNT) for JEV infection. Twenty-six (18.1%) patients were anti-JEV IgM-positive or equivocal in their S2 specimens, of which 5 (3.5%) and 8 (5.6%) patients met the criteria for confirmed and probable JEV infection, respectively, based on PRNT results. Notably, these non-encephalitic JE cases were less likely to have thrombocytopenia, leukopenia, and lower hematocrit compared with confirmed dengue cases of the same cohort. These findings highlight the need to consider JEV in the diagnostic algorithm for acute febrile illnesses in endemic areas and suggest that JEV as a cause of non-encephalitic disease has likely been underestimated in Indonesia.

Purpose: This study aimed to determine whether high levels of serum IL-6 and serum hepcidin and CD4<350 cells/ul were risk factors for the anemia of chronic disease (ACD) in HIV-infected patients on the combination of antiretroviral (cARV) therapy with successful clinically and immunological responses. Patients and Methods: A matched case–control study was conducted in the VCT clinic of Sanglah General Hospital, Indonesia, between January 1 and September 1, 2016. The case group was HIV patients with ACD, while the control group was HIV patients without ACD. Purposive consecutive sampling was employed in HIV patients aged 15–65 years who have received cARV therapy for >6 months, had >95% adherence of cARV within 6 months, did not have any clinical failure, did not have any immunological failure and did not receive switch therapy within 6 months. Chi-square test and logistic regression analysis were performed. Results: A total of 42 cases and 42 controls were included in this study. Significant differences were found between case and control, which included serum IL-6, serum hepcidin, smoking, creatinine clearance, anemia at the initiation of cARV, CD4 at the initiation of cARV and actual CD4 (cell/µL). High levels of serum IL-6, high levels of serum hepcidin and CD4< 350 cells/µl were risk factors for ACD. After adjusted with anemia at cARV initiation and BMI, we found that high levels of serum IL-6 (adjusted OR: 17.682; 95% CI: 3.442–90.826), high levels of serum hepcidin (adjusted OR: 10.562; 95% CI: 2.531–44.076) and CD4 <350 cells/µl (adjusted OR: 4.181; 95% CI: 5.6–12.381) remain as risk factors for ACD. Conclusion: High levels of serum IL-6, high levels of serum hepcidin and CD4 count <350 cells/µL were risk factors for ACD in HIV patients with cARV therapy.

Objective: The objective of this study was to determine the correlation between cluster of differentiation 4 (CD4) counts, human immunodeficiency virus (HIV) clinical stages, and hemoglobin (Hb) level among HIV-infected patients with anemia. Methods: A cross-sectional study was conducted in November 2017 at Merpati Clinic of Wangaya Hospital, Denpasar, Bali, Indonesia. We selected 79 HIV patients with anemia to participate in our study. We grouped CD4 counts into two categories: <200 cells/μL and ≥200 cells/μL, and we classified the HIV clinical stages into HIV and acquired immunodeficiency syndrome (AIDS). Results: About 55.7% (44) of men and 44.3% (35) of women were participated in this study. As many as, 91.1% (72) of participants were AIDS patients. The mean Hb was 8.77 g/dl with SD 1.79 g/dl. 81% (64) of study participants were suffered from anemia on chronic disease or inflammatory anemia, and 19% (15) of study participants were suffered from iron deficiency anemia. The median for CD4 counts was 94 cells/μL (3–309 cells/μL) with as many as 78.5% (62) of participants were found to have low CD4 counts (<200 cells/μL). Spearman analysis revealed a positive correlation between CD4 counts and Hb level (r=0.427, p<0.001). Independent sample t-test analysis found a correlation between the HIV clinical stages and Hb level. There was a difference between the mean of Hb level in each stage with the average difference of 0.8 g/dl (95% confidence interval 0.04–1.6; p<0.04). Conclusions: There is a correlation between CD4 counts, HIV clinical stages, and Hb level among HIV patients with anemia.