ObjectiveSeveral studies reported that infection of extended-spectrum β lactamase (ESBL)-producing Escherichia coli (E. coli) or Klebsiella pneumoniae (K. pneumoniae) contributed to higher mortality rates but others found it was not associated with mortality. A prospective cohort study which involved 72 patients was conducted to assess the risk of mortality of bloodstream infection due to ESBL-producing K. pneumoniae or E. coli as compared to those infected by either K. pneumoniae or E. coli which not produce ESBL.ResultMortality in the group of patients infected with ESBL-producing bacteria was 30.6%, whereas in another group which was infected with non ESBL-producing bacteria was 22.2% (p = 0.59). Kaplan–Meier’s analysis showed that the survival rate during 14-days follow-up among these two group was not significantly different (p = 0.45) with hazard ratio 1.41 (95% CI  0.568–3.51). Stratification analysis found that adult and elderly patients, patients with sign of leukocytosis, and patients treated with carbapenem were modifier effect variables.

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.

Background: The highest prevalence of nutrition problem due to nutrition deficiency is iron deficiency. Chronic disease anemia often occurs coincide with iron deficiency and both show of low iron serum appearance. Difficulty occurs when iron deficiency determined in chronic disease anemia by routine parameters. Bone marrow stainning can indicate iron store, but it is invasive. Therefore it needs another more practical parameter that has higher diagnostic value. Objective: To know the more practical parameter that can determine iron deficiency in chronic disease anemia Discussion: Ferritin serum indicates iron store in the body, whereas transferin receptor indicates functional of iron uptake in the erythrocyte. Changes of ferritin level due to inflammation process are varies. Recent evidence shows different changes of transferin receptor between iron deficiency anemia and those in chronic disease anemia. In chronic disease anemia, receptor transferin level increase but not as high as in those who suffer from pure iron deficiency anemia. Studies on groups of iron deficiency anemia, iron deficiency with acute inflammation, chronic disease anemia and healthy control population showed significance differences of receptor transferin among them. sTrF-R index is an index derived from the calculation of transferin receptor level divided by logarithmic of the ferritin level. The usage of sTfR-F index indicates more significance difference as compared to transferin receptor. Its sensitivity and specificity increase when it is applied to diagnose iron deficiency in elderly group. Conclusions: sTfR-F index is more sensitive and specific for the determination of iron deficiency in chronic disease anemia

Background and Aim: The emergence of methicillin-resistant Staphylococcus aureus (MRSA) as a highly pathogenic strain in veterinary and human medicine is a growing global problem. This study aimed to evaluate MRSA isolates of human and animal origin against various antibiotics in Yogyakarta, Indonesia. Materials and Methods: The susceptibility test was carried out by the disk diffusion method using Mueller-Hinton agar against nine antibiotic disks. Methicillin-resistant S. aureus strains were genetically confirmed through mecA gene detection encoding for methicillin resistance by polymerase chain reaction. Results: All 240 S. aureus strains isolated from animals and humans were resistant to penicillin G (P) (100% and 99%, respectively), followed by ampicillin (AMP), amoxicillin (AML), oxacillin (OX), erythromycin (E), clindamycin (DA), tetracycline (TE), gentamicin (GEN), and ciprofloxacin (CIP). Eighty-three MRSA strains were resistant to OX (100%), P (100%), AMP (99.27%), AML (95.52%), E (87.77%), TE (71.33%), DA (63.24%), GEN (38.81%), and CIP (26.87%). Conclusion: The antimicrobial resistance pattern of S. aureus human isolates was similar to their animal counterpart, with 77.20% of MRSA strains classified as multidrug-resistant (MDR) bacteria. These findings indicate an increase in MDR S. aureus strains of animal origin in Yogyakarta, thus raising public health concerns about MRSA zoonotic spread.

Diabetic nephropathy is one of diabetic complications characterized by proteinuria and impaired renal function. Confirmation of diagnosis based either on urine value of albumin excretion rate (AER) 30-300 mg/24 hours or albumin creatinine ratio (ACR) 30-300 mg/g or total protein creatinine ratio (TPCR) 150-500 mg/g. It is reported that TPCR measurement is more acceptable since it is convenient, fast and does not require special preparation. The aim of this study was to investigate the accuracy of TPCR for diagnosis of diabetic nephropathy among patients with type 2 diabetes (type 2 DM). A diagnostic test study was conducted which involved 86 patients with type 2 DM where urine TPCR value equal or more than 150mg/g was independently and blindly compared with AER as a refference standard to diagnose diabetic nephopathy. The inclusion criteria were patients with type 2 DM who suspected suffer from diabetic nephropathy (suffer from DM more than 4 years) and agree to participate in this study. Those whom were suffer from at least on of the following diseases urinary tract infection, congestive heart failure, liver dysfunction, pregnancy, multiple myeloma, microangiopathy hemolytic anemia (MAHA) and incomplete data were excluded from the study. Contingency (2x2) table analysis was used to calculate sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio for positive test result/LR(+), likelihood ratio for negative test result/ LR(-), and accuracy. The average of TPCR among diabetic nephropathy patient was 248.07 mg/g. It was significantly higher than compared to those non diabetic nephropathy patient (103.52 mg/g). It was found 75 true positive, 9 true negative, and 2 false positive. The result showed that TPCR had a sensitivity, specificity, PPV, and NPV of 97.4%, 100%, 100%, and 81,8% respectively to diagnose diabetic nephropathy.The TPCR with value equal or more than 150 mg/g in the morning sample urine can be used to diagnose diabetic nephropathy. 75 positif benar, 9 negatif benar, dan 2 positif palsu. Hasil pemeriksaan menunjukkan bahwa TPCR memiliki sensitifitas 97,4%, spesifisitas 100%, NPP 100%, dan NPN 81,8% untuk diagnosis nefropati diagnostik. TPCR dengan nilai sama atau lebih dari 150 mg/g pada sampel urin pagi dapat digunakan untuk diagnosis nefropati diabetik.