Antimicrobial Resistance Profile of MDR & Non-MDR Meropenem-Resistant Pseudomonas aeruginosa Isolates of Patients in Intensive Care Unit of Tertiary Hospital

Pseudomonas aeruginosa is one of the gram-negative bacteria that causes infection in the Intensive Care Unit (ICU) which is easily resistant. Patients infected with carbapenem-resistant P. aeruginosa are predicted to have a poor prognosis. This study aims to know the resistance profile of meropenem-resistant P. aeruginosa in the ICU. The results of this study can be used as a measure on the success of antimicrobial resistance control, infection control programs and become a reference for empirical therapy in the ICU. This study used a cross-sectional retrospective descriptive research method and was carried out at the Clinical Microbiology Laboratory of Sanglah Hospital Denpasar for three years, from 2018 to 2020. The results showed 38 of the 93 isolates of P. aeruginosa in the ICU were resistant to meropenem and were derived from sputum and urine. The percentage of meropenem-resistant P. aeruginosa isolates was higher in the multi-drug-resistant group and mostly came from sputum specimens. In 2018, Non-MDR meropenem-resistant P. aeruginosa isolates was that 100% sensitive to all other antibiotics used to treat P. aeruginosa infections, including; ceftazidime, cefepime, ciprofloxacin, gentamicin, amikacin, and piperacillin-tazobactam. In 2019 no meropenem-resistant P. aeruginosa isolates were found. In 2020, its sensitivity to antibiotics ceftazidime and piperacillin-tazobactam was 20.0%, ciprofloxacin 60.0% and to antibiotics gentamicin and amikacin 100%. MDR meropenem-resistant P. aeruginosa isolates in 2018 were still sensitive to ceftazidime (15.4%) and amikacin (69.2%) antibiotics, while in 2019 they were only sensitive to amikacin (37.5%). In 2020, P. aeruginosa isolates were sensitive to the antibiotics ceftazidime and cefepime (11.1%), piperacillin-tazobactam (22.2%), and amikacin (88.9%). Amikacin may be the choice of treatment for MDR meropenem-resistant P. aeruginosa.

Description of Extraordinary Events of Dengue Hemorrhagic Fever In Belu Regency, East Nusa Tenggara Province 2020

Belu Regency is located in the province of East Nusa Tenggara (NTT), Indonesia and is an endemic area for dengue fever. Nationally, until June 2020, there were 16,320 cases of dengue fever with a CFR of 0.009%, while in Belu Regency there were 820 cases recorded until June 2020 with a CFR of 0.97%. This study aims to describe the outbreak of DHF by person, place and time as well as the distribution of cases in Belu Regency. this research is descriptive observational with case series design. The source of research data is secondary data on dengue cases obtained from the 2016-2019 Dengue Hemorrhagic Fever (DHF) Report and the DHF outbreak report in January-June 2020, the Belu District Health O ce. DHF cases in Belu Regency until June 2020 were 820 cases with symptoms of fever 2-7 days by 100% and supported by laboratory platelet examinations of 73%. The highest IR rate until June 2020 is 367 per 100. 000 residents with a CFR of 0.97% spread over 12 sub-districts of Belu Regency. The highest IRs (>20 per 10,000 population) are Atambua city, South Atambua, East Tasifeto, West Atambua, Kakuluk Mesak and West Tasifeto subdistricts. The majority of DHF in the age group 5-14 years 521 cases (27.1%) with female sex as many as 495 cases (51.51%). DHF cases were found since the first epidemiological week at the beginning of the year with peak cases at the 13th week. Belu Regency Is a dengue endemic area with an IR of 367/100,000 population with a CFR of 0.97%. The highest cases were in the 5-14 year age group and spread across 12 sub-districts of Belu Regency.

Characteristics Environmental and Anopheles Larva Species In High And Low Clinical Malaria Cases In The Landak District of West Kalimantan Province

Malaria remains a health problem in Indonesia. West Kalimantan is a malaria endemic area with high and lowincidence. Landak District is one of the malaria endemic area. Malaria cases were found in the areas around illegalgold mining and oil palm plantations. The aims of this study were to describe the characteristics of the breeding sitesand species of Anopheles larvae found in high malaria cases area, namely Amboyo Utara Village and low clinicalmalaria cases, area namely Mandor Village. This research is a descriptive research with cross sectional design. Thesamples were Anopheles larvae collected with Accidental sampling technique in the breeding sites. Environmentalcharacterization of breeding sites were physical characteristic including water temperature and sun exposure,chemical characteristic including water pH and salinity, and biological characteristics including water biota. Theresults of this study ware environmental characteristics that have the potential to breed Anopheles mosquitoes inAmboyo Utara Village, including water temperature 26-30C, shandy, water pH 5.0-7.6, salinity 0.2-1.0 ppt, biotaswater hyacinth, grass and tadpole. The Mandor village, water temperature 29-30 ºC, shandy, pH of 6.9-8.0, salinity of0.5 ppt, water biota grass. Anopheles species found in Amboyo Utara village were larvae of An. vagus (94.30%), An.tessellatus (3.42%), An. subpictus (1.62%), An. indefinitus (0.81%) and An. maculatus (0.81%). Characteristics ofbreeding sites in Mandor village were larvae of An. maculatus (11.11%), An. subpictus (3.70%), and An. vagus(85.18%). The conclusion of this study was that di erent species found at breeding sites with di erent environmentalcharacteristics in both high and low malaria areas in Landak District, West Kalimantan Province.

Correlation Analysis between Ratio of C-Reactive Protein/Albumin and Severity of Dengue Hemorrhagic Fever in Children

Dengue Hemorrhagic Fever (DHF) is a dengue infection which can cause shock and leads to mortality. Hypoalbuminemia is a marker of plasma leakage in DHF and correlated with severity of in fl ammatory response triggered by infection, including DHF. C-Reactive Protein (CRP) is a proin fl ammatory marker that also increases in DHF. This study aims to determine a correlation of CRP/albumin ratio with severity of DHF. Cross sectional study on pediatric patients diagnosed as DHF at Saiful Anwar Malang Hospital was done in July-December 2016. CRP levels were examined using immunoturbidimetry method, while albumin was examined by using Bromocresol Green (BCG) method. Correlation of CRP/albumin ratio with DHF severity was analyzed by using Pearson correlation test.The result showed that there were signi fi cant diff erences in CRP levels and CRP/albumin ratios in the Dengue Shock Syndrome (DSS) and non-DSS group (p = 0.002, p = 0.001, α<0.05). There was no signi fi cant diff erence in albumin level in the same group (p = 0.207, α <0.05). Positive correlation found in CRP and CRP/albumin ratio (r = 0.46, r = 0.49, α <0.01). On the contrary the negative correlation was found in albumin (r = -0.21, α <0.01). This is presumably because albumin is an acute phase protein which will decrease along with the severity of infection. In contrast, CRP will increase during the critical phase of infection. It can be concluded that the CRP/albumin ratio was positively correlated with DHF severity, as well as CRP levels, but not positively correlatedwith albumin.

Convalescent Plasma Therapy: The Early Use in Moderate to Severe COVID-19 Patients in Hospitals with Limited Resources

COVID-19 cases in Indonesia in the period of June-July 2021 showed a catastrophic spike. During this period, a recently discovered variant, the delta variant, appeared to be one of the sources of COVID-19 infection. Treatment modalities are limited due to reduced stock of drugs. A case of a 63-year-old man has been reported, with a history of having been vaccinated with two doses of Sinovac, experiencing moderate-to-severe symptoms of COVID-19 infection then given convalescent plasma therapy since his initial admission to the hospital. Three days after being given convalescent plasma therapy, the improvement was noticeable. Shortness of breath, cough, fever, and weakness were less complained. On the seventh day the patient fully recovered and got discharged. Convalescent plasma therapy was e ective in early stage and was able to improve outcomes. Indonesia needs sucient stocks of convalescent plasma as a therapy to overcome the limitations of medicines.

Evaluation of Epidemiological Investigation 1 -2-5 Implementation Program in Sukabumi

Epidemiological investigations as part of the malaria surveillance system in Indonesia are carried out through the 1-2-5 method. Assessing the 1-2-5 strategy compliance level at the district level is the first step towards determining whether the surveillance and response strategy is working as planned or not. This study was conducted in order to determine whether PE 1-2-5 had been implemented in health centers (puskesmas) in malaria receptive areas according to the technical guidelines issued by the Indonesian Ministry of Health. Health centers were determined through purposive sampling technique. The sampling is determined by selecting health centers that have been doing malaria vector control service in 2018 and 2019. Ten Puskesmas in malaria receptive areas in Sukabumi District were selected. The informants in this study were the key players in the malaria program at the health centers: the head of the health centers, the manager of the malaria program, and the village malaria officer (JMD) who were involved in the vector control process in 2018 and 2019 at the selected health centers. Data collection was conducted through in-depth interviews done by researcher with informants. The interview showed that the malaria program personnel in Sukabumi are doing the strategy as best as possible in order to achieve malaria elimination. 1-2-5 surveillance program in Sukabumi district has been implemented even though the implementation is not as ideal as the technical guidelines suggested by the Indonesian Ministry of Health, Sukabumi district still applied the strategy based on it by adjusting various aspects (resource situation and the availability of facilities) to the suitable condition in Sukabumi.

The Effects of N-Acetylcysteine as Adjuvant Therapy To Reduce TNF-Α Level And Increase SPO2/FIO2 Ratio In Improving Hypoxemia In COVID-19 Patients

Tumor Necrosis Factor Alpha (TNF-α) is a pro-inflammatory cytokine that plays a crucial role in COVID-19 disease progression. N-acetylcysteine (NAC) works throughout several GSH-mediated mechanisms and is known to eliminate oxidative stress in acute respiratory distress syndrome (ARDS) in COVID-19. This study aims to analyze the effect of the N-Acetylcysteine as Adjuvant Therapy to reduce TNF-α levels and Increase SpO2/FiO2 ratio in Improving hypoxemia in COVID-19 Patients. This is a quasi-experimental, non-equivalent control group design study. There were 91 subjects selected using non-random sampling, which consisted of 75 patients in the NAC group and 16 patients in the control group. The TNF-α level was measured using the ELISA method, and SpO2/FiO2 ratio was calculated on day 1 (on admission) and day eight after NAC 5000mg/ 72 hours was given. Statistical analysis was conducted using Wilcoxon and Mann-Whitney U Test. There is a significant decrease in TNF-α level in the treatment group (median 1.49±5.22) (p=0.016) compared with the control group (median 1.64±1.99) (p=0.005). The Median SpO2/FiO2 ratio on day 1 is 163.70±69.64 in the control group and 121.49±40.41 in the treatment group (p=0.005). The Median SpO2/FiO2 ratio on day 8 is 249.69±132.26 in the control group and 151.29±59.18 in the treatment group (p=0.001). There is a positive correlation between serum TNF-α level and SpO2/FiO2 ratio after administration of adjuvant therapy NAC (r=0.240, p=0.038). There is a positive correlation and significant decrease of serum TNF-α and SpO2/FiO2 ratio after adjuvant NAC therapy, which improves hypoxemia in COVID-19 patients.

Analysis of HIV/AIDS Health Problems in Pacitan District East Java 2020

The implementation of health problem analysis is carried out to increase the eff ectiveness and effi ciency of solving health problems through the selection of health problems that become priority problems in a region. The purpose of this study was to analyze the problem and determine the priority of health problems in the work area of the Pacitan District Health Office, East Java Province. This research is a descriptive observational study conducted at the Pacitan District Health Office in January 2020. The type of data used is secondary data obtained from the 2016-2019 Pacitan District Health Profile and primary data obtained through interviews with related parties, namely the head of the fi eld. , section head and program holder. Prioritization of health problems is carried out using the USG method based on the criteria of Urgency, Seriousness, Growth and fi nding the root of the problem using the fi shbone diagram method. The increase in HIV/AIDS cases with an USG score of 128 has become a top priority health problem in Pacitan District. An increase over the last 4 years with the highest number of cases in 2019, which was 39 cases. The fishbine diagram shows the root of the HIV/AIDS problem, namely the lack of public knowledge about HIV/AIDS, the lack of public knowledge about HIV/AIDS, the lack of awareness of people at risk for conducting an HIV test, this makes the community less aware of information about HIV/AIDS, causing public stigma. which results in people being closed / unwilling to check themselves at the puskesmas orhospital. The increase in HIV/AIDS cases is one of the problems in Pacitan district. To reduce the incidence, health workers need to optimize the dissemination of information about HIV/AIDS, especially risk factors, causes, prevention, symptoms and treatment. Increase the understanding of health workers and public awareness in conducting early detection.

Increased Interleukin-6 as Infl ammatory Response and Magnesium Defi ciency in Pre-dialysis Chronic Kidney Disease of Indonesian Children

Chronic kidney disease (CKD) is a serious health problem in children, with increasing morbidity and mortality rates throughout the world. Children with CKD tend to experience magnesium (Mg) defi ciency that can stimulate an infl ammatory response in the body. One of the infl ammatory responses is an increase of Interleukin-6 (IL-6). Study to analyze the correlation between Mg and IL-6 in pre-dialysis CKD children. The methods a cross sectional study was conducted in Dr Soetomo General Academic Hospital from November 2018 to April 2019. Children with pre-dialyis CKD were included in this study. Variables of serum Mg level (mg/dL) and infl ammatory marker (IL-6) were measured from the blood and analyzed by ELISA method. The correlation between Mg and IL-6 was analyzed with Spearman’s correlation test with p <0.05. Result a total of 47 children (27 boys vs 20 girls) between 3 months to 18 years old, with pre-dialysis CKD and no history of magnesium supplementation were included. The primary disease that causes of CKD were lupus nephritis (38.3%), nephrotic syndrome (23.4%), urologic disorder (23.4%), tubulopathy (10.6%) and others (4.3%). The average IL-6 level was 55.42±43.04 pg/dL and Mg level was 2.06±1.54 mg/dL. There were no signifi cant correlation between IL-6 level and Mg level with staging of CKD and duration of illness (p>0.05), but there was a signifi cant correlation between serum Mg level and IL-6 level (r=-0.748; p<0.001). Magnesium levels have a signifi cant inverse correlation with IL-6 levels in pre-dialysis CKD children. The lower the Mg levels in the blood, the higher IL-6 levels and vice versa.

COVID-19 and Endothelial Dysfunction: Biomarkers and Potential Drug Mechanisms

Since the fi rst report of pneumonia outbreak in Wuhan by the end of 2019, Coronavirus Disease 2019 (COVID-19) has become a global pandemic; causing millions of deaths globally and aff ecting the rest of worldwide population. The disease is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which enters hosts by inhabiting Angiotensin-Converting Enzyme-2 (ACE-2) receptors expressed in the endothelium layer of not only the respiratory tracts, but also various organs in the body. COVID-19 has been reported to trigger multiple cardiovascular manifestations. Since endothelial dysfunction plays an important role in cardiovascular events and the endothelium is heavily involved in COVID-19 pathophysiology, it is important to investigate their associations and previously established drug potencies to improve endothelial functions as possible treatment options for COVID-19. In this review, we summarize endothelial dysfunction biomarkers involved in COVID-19 and drugs that have shown potential endothelial protective properties to better understand the incidence of endothelial dysfunction in COVID-19 and its future treatment. We searched in PubMed, Wiley Online Library, EBSCO, ScienceDirect databases for literatures containing following keywords: “Endothelial dysfunction”, “COVID-19”, and “biomarkers”. Eligible publications were then assessed and studied to comprise our literature review. A total of 96 studies matched our criteria and provided scientifi c evidences for our review. Materials were then compiled into a review summarizing endothelial biomarkers involved in COVID-19 and potentially repurposed drugs targeting endothelium for COVID-19.Various endothelial dysfunction biomarkers were found to be elevated in COVID19 and is found to be related to its severity, such as adhesion molecules, selectins, PAI-1, and von Willebrand Factors. Multiple drugs targeting the endothelium are also potential and some are under investigation for COVID-19.