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"The immune response of dengue fever/dengue hemorrhagic fever is a series of immunopathogenesis processes starting from viral infection to the target on monocytes and macrophages. It may consequently cause a cascade of viremia in the circulation that stimulates the afferent, efferent, and effector mechanism by the interaction of the humoral and complement system. The cascade results in inflammatory substance that will affect capillary permeability and activate coagulation factors leading to further effects on endothelial level. The mechanism involving pathogenesis of DHF/DSS is still vague. So far, a theory of heterologous infection has been developed, which explains that on second infection, there is subneutralization that induce viral replication. The autoimmune mechanism development leads to the better understanding of DHF. It also explains the autoimmune response of the viral infection, which consists of molecular mimicry, bystander activation and viral persistence. The development of the autoimmune pathomechanism is related to the role of autoantibody and endothelial dysfunction that may have role in worsening DHF.

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Respons imun pada demam dengue/demam berdarah dengue merupakan suatu rangkaian imunopatogenesis yang dimulai sejak target infeksi virus terhadap monosit dan makrofag. Selanjutnya akan menimbulkan suatu kaskade dari viremia di sirkulasi yang menstimulasi mekanisme aferen, mekanisme eferen dan mekanisme efektor melalui interaksi dengan berbagai sistem humoral dan komplemen. Substansi inflamasi yang dihasilkan akan mempengaruhi permeabilitas kapiler dan mengaktivasi faktor koagulasi serta berpengaruh terhadap kerja tingkat endotel. Mekanisme yang melibatkan patogenesis DBD/DSS masih belum jelas. Selama ini berkembang teori infeksi heterologus infection, dimana pada infeksi kedua kalinya terjadi sub netralisasi yang memicu replikasi virus. Mekanisme autoimun merupakan suatu proses autoimun yang dapat memperkaya kazanah pemahaman DBD. Mekanisme autoimun tersebut, menjelaskan respons autoimun oleh infeksi virus yang terdiri dari molecular mimicry, bystander activation dan viral persistence. Patomekanisme auto imun ini berkembang terkait peranan autoantibodi dan tingkat endotel proses disfungsi yang dimungkinkan berperan terhadap memberatnya DBD"

"Continued geographic expansion of dengue viruses and their mosquito vectors has seen the magnitude and frequency of epidemic dengue/​dengue hemorrhagic fever (DF/​DHF) increase dramatically. Recent exciting research on dengue has resulted in major advances in our understanding of all aspects of the biology of these viruses, and this updated second edition brings together leading research and clinical scientists to review dengue virus biology, epidemiology, entomology, therapeutics, vaccinology and clinical management."

"Interleukin (IL)-18 (interferon-g inducing factor) merupakan salah satu sitokin yang diproduksi makrofag, berperan dalam diferensiasi sel T-helper menjadi T-helper-1, dan produksi interferon g. T-helper-1 berperan dalam imunitas seluler khususnya pada infeksi virus termasuk infeksi dengue. Dilakukan studi deskriptif korelatif mengenai hubungan kadar IL-18 dengan derajat penyakit pada penderita demam dengue (DD) dan demam berdarah dengue (DBD) yang dirawat. Pada 42 subyek yang terdiri dari 20 (47,6%) penderita demam dengue dan 22 (52,3%) demam berdarah dengue (derajat I sampai IV menurut kriteria WHO tahun 1999). Didapatkan kadar IL-18 secara bermakna lebih tinggi pada DHF dibandingkan DF. Didapatkan korelasi kadar IL-18 dengan nilai hematokrit dan hitung trombosit. Studi ini menunjang kemungkinan keterlibatan IL-18 dalam patogenesis DBD pada pasien dewasa. (Med J Indones 2004; 13: 86-9)

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Interleukin (IL)-18 ( interferon-g inducing factor) is one of cytokines, produced by macrophage, take part in differentiation T-helper (Th) to Th1 and interferon g producing. T-helper1 play role in cellular immunity especially in viral infection include dengue. A descriptive correlative study has done to know the correlation between IL-18 levels and disease severity in admitted dengue fever (DF) and dengue hemorrhagic fever (DHF) patients. In 42 subjects consist of 20 (47.6%) DF and 22 (53.3%) DHF (grade I to IV WHO criteria, 1999) showed that IL-18 levels significantly higher in DHF than DF patients. There are significant correlation between IL-18 levels and hematocrit and low platelet value. This study supports the possible role of IL-18 in pathogenesis DHF in adults. (Med J Indones 2004; 13: 86-9)"

"scleroderma is an autoimmune disease characterized by organ fibrosis, resistant to standard treatment. It is suspected the addition of Physalis angulata Linn. (Ciplukan) extract as adjuvant therapy can improve the scleroderma skin fibrosis. The aim at this study is to evaluate the effect of ciplukan extract as adjuvant on scleroderma skin fibrosis in standard therapy, based on modified Rodnan skin scale (MRSS), inflammatory biomarkers, immunology and serum fibrosis. Methods: double-blind, randomized clinical trial was performed in scleroderma patients with stable disease at Cipto Mangunkusumo hospital and Hasan Sadikin hospital during November 2015−March 2017 who met the selection criteria and continued to receive standard therapy. The subjects were randomly allocated into two groups: the study group received the ciplukan extract 3 x 250 mg / day for 12 weeks and the placebo group. Examination of MRSS, ESR, P1NP, BAFF and sCD40L was performed every 4 weeks until the end of the study. Results: fifty-nine subjects completed the study. They consisted of 29 subjects of the treatment group and 30 of the placebo group, with an average age of 41 (SD 9) years, the proportion of women: male = 9 : 1. There was a significant improvement of skin fibrosis in the study group with a highly significant decrease in MRSS (35.9% VS 6.3%, p <0.001) and a relative decrease in P1NP levels (17.8% VS 0.7%, p = 0.002). No decrease in ESR, BAFF and sCD40L levels in both groups. There was a weak but significant positive correlation between MRSS with P1NP levels (r = 0.236, p = 0.036). Conclusion: Ciplukan extract with dose 3 x 250 mg for 12 weeks as adjuvant on scleroderma standard therapy alleviates skin fibrosis significantly based on MRSS and P1NP levels.

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Latar belakang: skleroderma merupakan penyakit autoimun yang resisten terhadap pengobatan standar, penambahan ekstrak herba ciplukan (Physalis angulata Linn) diduga dapat memperbaiki fibrosis kulit skleroderma. Penelitian ini bertujuan mengkaji peran ekstrak herba Ciplukan sebagai terapi ajuvan untuk fibrosis kulit skleroderma yang mendapat terapi standar, berdasarkan MRSS, biomarker inflamasi, imunologi dan fibrosis serum.

Metode: uji klinis acak tersamar ganda pada pasien skleroderma stabil yang berobat jalan di RSCM dan RSHS sejak November 2015−Maret 2017 yang memenuhi kriteria inklusi dan menerima terapi standar. Subjek secara random terbagi dua: kelompok uji yang mendapat ekstrak herba C iplukan 3x 250 mg/hari selama 12 minggu dan kelompok plasebo. Pemeriksaan MRSS, LED, P1NP, BAFF dan sCD40L dilakukan setiap 4 minggu hingga akhir penelitian.

Hasil: lima puluh sembilan subjek menyelesaikan penelitian, 29 subjek kelompok uji dan 30 subjek kelompok plasebo, rerata usia 41 (SB 9) tahun, proporsi wanita : pria = 9 : 1. Ditemukan perbaikan fibrosis kulit bermakna pada kelompok uji dengan penurunan relatif MRSS sebesar 35,9% dibandingkan plasebo 6,3% dengan p < 0,001 dan penurunan relatif bermakna kadar P1NP sebesar 17,8% dibandingkan plasebo 0,7% dengan p = 0,002. Tidak ditemukan penurunan kadar LED, BAFF dan sCD40L pada kedua kelompok. Terdapat korelasi positif bermakna antara MRSS dengan kadar P1NP (r = 0,236, p = 0,036).

Kesimpulan: pemberian ekstrak etanol herba ciplukan dosis 3 x 250 mg selama 12 minggu sebagai terapi ajuvan pada skleroderma dalam terapi standar, secara klinis dan statistik menunjukkan perbaikan kelainan fibrosis kulit berdasarkan MRSS dan biomarker fibrosis P1NP serum secara bermakna dibandingkan kontrol."

"Graves’ ophthalmopathy is the most common extra-thyroid manifestation in patients with Graves’ disease, based on inflammatory and autoimmune conditions in orbital tissue. This practical guideline was formed by a multidiciplinary team, and is intended to provide guidance for diagnosis and management of Graves’ ophthalmopathy in daily clinical practice to improve quality of care and treatment outcome.

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Oftalmopati Graves merupakan manifestasi ekstra-tiroid yang paling sering dijumpai pada pasien dengan penyakit Graves, yang didasari oleh kondisi inflamasi dan autoimun pada jaringan orbital. Panduan praktis ini dibuat oleh tim dengan anggota yang terdiri dari berbagai disiplin ilmu, dan diharapkan dapat memberikan panduan untuk pendekatan diagnosis dan tatalaksana oftalmopati Graves dalam praktek klinik sehari-hari untuk meningkatkan mutu pelayanan dan hasil pengobatan pada pasien."

"Background: The recent development in technology and industry has increased the incidence of occupational disorders of which eventually affect the productivity and cost of related industries. Whether the products or the waste-materials are harmful to airway function, it needs to be investigated. Purpose: To study the incidence of occupational \rhinitis (OR) caused by exposure of sodium lauryl sulfate dust and irritant gases in the workplace. Methods: In this prospective study, 115 industrial workers who were exposed daily to multi–irritant material were investigated with questionnaire, anterior rhinoscopy, nasal endoscopy, peak nasal inspiratory flow (PNIF) meter, skin prick test, and nasal mucous scrapping before (V1) and after 8 hours (V2) work. The diagnosis of OR was made when symptoms of rhinitis worsened on workdays and a decrease of PNIF (≥20%) at V2. In addition, hours of daily exposure to irritant, years of working, improper usage of personal protection device (nasal and oral mask), and smoking were assessed by bivariate and multivariate analysis. Result: 32 workers of 115 (27.8%) were diagnosed as OR based on increased rhinitis symptoms during workdays and decreased PNIF after work. Incidence of OR increased in workers who had worked >10 years=2.15 (IC 95%:1.19-3.87, p=0.009) and who did not use personal protective equipment properly (p=0.04, RR:2.3, IC 95%:1.29-4.28). Conclusion: Exposure to occupational reagent such as sodium lauryl sulfate dust and multi-irritant gasses was a causal factor of OR. A proper perusal of personal protection equipment (PPE) is mandatory in workplace to minimize the risk of developing OR. "

"Penelitian ini membahas tentang evaluasi implementasi clinical pathway pada penyakit Dengue Hemorrhagic Fever anak di RSUP Fatmawati tahun 2016. Tujuan dari penelitian ini adalah untuk mendapatkan evaluasi input, proses, dan outcome implementasi clinical pathway pada kasus Dengue Hemorrhagic Fever anak serta mengetahui hambatannya. Jenis penelitian ini adalah kuantitatif dan kualitat if dengan menggunakan operational research dengan metode observasi, wawancara mendalam dan terstruktur. Hasil penelitian didapatkan pengisian clinical pathway pada pasien DHF anak bulan Januari-Juni 2016 sebesar 55,15%. Format clinical pathway DHF anak sudah ringkas dan jelas namun belum lengkap dengan kriteria hasil. Belum optimalnya sosialisasi SPO, edukasi clinical pathway, serta imbalan dan sanksi. Formulir clinical pathway selalu tersedia di ruang rawat inap. Terdapat beberapa masalah dalam proses implementasi clinical pathway yaitu tidak adanya pengisian clinical pathway di IGD atau ruang lain, belum optimalnya kolaborasi antar tenaga kesehatan, belum adanya monitoring dan evaluasi untuk meningkatkan kepatuhan dan kelengkapan pengisian clinical pathway. Evaluasi outcome dari implementasi clinical pathway DHF anak yaitu terdapat variasi pada lama hari rawat 12%, pemeriksaan penunjang DTL, Urine, Feses 99 %, Anti Degue, IgG/IgM 6%, pemeriksaan CXR RLD 55%, gizi 35%, pengobatan parasetamol 40% dan IVFD 2%.

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This research discusses the evaluation of clinical pathways implementation in children's Dengue Hemorrhagic Fever (DHF) disease at RSUP Fatmawati in 2016. This research aims to get input evaluation, process, and outcomes clinical pathways implementation in children's DHF disease and the obstacle. This is a quantitat ive and qualitative research that usen operational research with observation methodology, in-depth and structured interviews. The result shows that clinical pathways admission filling with patient in children?s DHF disease 55.15% in January-June 2016. Clinical pathway's form in children?s DHF disease are concise and clear but no outcome criteria. SPO?s socialization, clinical pathways educating, reward, and punishment are not optimum. Clinical pathway's form are always available at inpatient unit. There are some problems in the process of clinical pathways implemention, there is no filling clinical pathways in the ER (Emergency Room) or the other room, the lack of collaboration among health proffesional, no monitoring and evaluation to improve compliance and completeness of clinical pathways. Outcome evaluation of clinical pathways implementation in children's DHF are variations of length of stay 12%, DTL, Urine, Feses investigation 99 %, Anti Degue, IgG/IgM 6%, CXR RLD 55%, nutrition 35%, parasetamol treatment 40% and IVFD 2%."

"Dengue Hemorrhagic Fever (DHF) merupakan masalah kesehatan yang umum terjadi di Indonesia, terlebih lagi saat memasuki musim penghujan. Anak-anak menyumbang kasus terbanyak pada kasus DHF di Indonesia. Efek dari virus penyebab DHF salah satunya adalah kebocoran plasma akibat penurunan kadar trombosit dalam tubuh penderita. Salah satu masalah keperawatan yang berkaitan erat dengan kebocoran plasma pada DHF adalah risiko hipovolemia. Karya ilmiah ini ditulis bertujuan untuk menganalisis asuhan keperawatan masalah risiko hipovolemia pada anak dengan DHF. An. M (10 tahun) dengan dengan DHF mengalami demam tinggi dengan suhu 38,5oC, kondisi membran mukosa yang pucat serta kondisi bibir yang kering, tekanan darah 102/60 mmHg, frekuensi nadi 97 kali per menit, dan kekuatan nadi yang teraba agak lemah. Kadar trombosit saat dilakukan pemeriksaan pertama kali sebesar 81000/µl. Intervensi manajemen cairan diberikan selama 5 hari, pasien mengalami perbaikan status hidrasi yang terlihat dari kondisi membrane mukosa dan bibir menjadi lembab, tanda vital stabil, terjadi kenaikan trombosit dan peningkatan intake per oral pasien. Hasil penelitian ini diharapkan dapat menjadi landasan untuk peningkatan kesadaran dalam melakukan pemantauan cairan yang akurat serta memahami kondisi klinis pasien dengan kekurangan cairan atau kelebihan cairan.

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Dengue Hemorrhagic Fever (DHF) is the one of most common health problem in Indonesia, especially during the rainy season. Children are the largest contributor for dengue cases in Indonesia. One of the effects of the virus that causes DHF is plasma leakage due to the thrombocytopenia. Risk of hypovolemia is the one of common nursing problem that occur in patient with DHF. This scientific paper is written to analyzing nursing care for the risk of hypovolemia in children with DHF. Patient M (10 years old) has a high fever with a temperature of 38,5oC, has pale mucous membranes and dry lips, the blood pressure 102/60 mmHg, pulse rate 97 beats per minute with the poor beats of pulses. The platelet level was 81000/µl. The fluid management intervention was given for 5 days, the patient shows an improvement in hydration status as seen from the condition of mucous membranes and lips becoming moist, stable vital signs, an increase in platelets level and patient’s oral intake. The results that expected from this study are for to be a baseline for increasing awareness of conducting accurate fluid monitoring and understanding the clinical condition of patient with fluid deficiency or fluid overload"

"Demam berdarah dengue menyerang anak-anak daripada orang dewasa. Sistem kekebalan tubuh yang rentan beresiko terpapar suatu penyakit. Demam berdarah dengue menyebabkan peningkatan kapiler plasma sehingga seseorang mengalami hipovolemia. Asuhan keperawatan diperlukan dalam mengatasi hipovolemia dengan memberikan intervensi keperawatan manajemen hipovolemia dan pemantauan cairan menggunakan fluid chart. Fluid chart digunakan untuk memantau dan mencatat secara akurat intake dan output guna mencapai keseimbangan cairan tubuh. Klien usia 10 tahun mengalami kondisi demam tinggi 3 hari, keadaan lemas, mukosa kering, serta pemeriksaan laboratorium menunjukkan hematokrit menurun (39,2%) dan trombosit menurun (157 10 3 /μL). Pemeriksaan hemodinamik serta pemeriksaan darah perifer lengkap rutin setiap 24 jam untuk mengevaluasi kondisi pasien selama dilakukan perawatan. Kesimpulannya, penerapan fluid chart efektif membantu memonitor cairan masuk dan keluar pasien ditandai dengan balans cairan membaik, pemeriksaan darah perifer lengkap menunjukkan proses perbaikan, serta kondisi vital yang stabil.

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Dengue hemorrhagic fever attacks children more than adults. A vulnerable immune system is at risk of exposure to disease. Dengue hemorrhagic fever causes an increase in plasma capillaries so that a person experiences hypovolemia. Nursing care is needed to treat hypovolemia by providing nursing interventions to manage hypovolemia and monitor fluids using a fluid chart. Fluid charts are used to accurately monitor and record intake and output to achieve body fluid balance. A 10 year old client experienced a high fever for 3 days, weakness, dry mucosa, and laboratory examination showed decreased hematocrit (39.2%) and decreased platelets (157 103/μL). Hemodynamic examination and routine complete peripheral blood examination every 24 hours to evaluate the patient's condition during treatment. In conclusion, the application of a fluid chart is ef ective in helping monitor the patient's incoming and outgoing fluids as indicated by improved fluid balance, complete peripheral blood examination showing the improvement process, and stable vital conditions."

"Demam Berdarah Dengue (DBD) adalah penyakit yang disebabkan oleh virus dengue yang termasuk anggota genus Flavivirus dan keluarga Flaviviridae yang menyebar melalui nyamuk Aedes (Stegomyia). Jumlah kasus DBD di seluruh dunia dilaporkan meningkat lebih dari 8 kali lipat selama dua dekade terakhir, dari 505.430 kasus pada tahun 2000, menjadi lebih dari 2,4 juta pada tahun 2010, dan 5,2 juta pada tahun 2019. Peningkatan insiden DBD dipengaruhi oleh berbagai faktor, baik itu faktor alam, kebiasaan manusia, hingga jenis virus penyebab DBD itu sendiri. Faktor alam yang dimaksud disini antara lain faktor iklim, seperti curah hujan (mm), temperatur rata-rata (℃), dan kelembapan rata-rata (%). Peningkatan insiden DBD dapat dicegah dengan upaya pencegahan yang dilakukan sedini mungkin oleh pemerintah dan masyarakat. Informasi prediksi tren insiden DBD dapat menjadi masukan bagi masyarakat dan pemerintah untuk meningkatkan kewaspadaan terhadap peningkatan insiden DBD di DKI Jakarta. Dalam melakukan prediksi tren insiden DBD, dapat dilakukan dengan berbagai pendekatan, salah satu diantaranya adalah machine learning. Pada tugas akhir ini, implementasi machine learning menggunakan model The Attention Mechanism-Enhanced LSTM (LSTM-ATT) dan Poisson Regression, akan digunakan untuk memprediksi tren insiden DBD dari waktu ke waktu. LSTM-ATT adalah sebuah model machine learning yang digunakan untuk memproses data sequence. Poisson Regression adalah model regresi yang dapat digunakan pada data yang variabel responnya berdistribusi Poisson dan bertipe diskrit. Prediksi yang akan dilakukan didasarkan pada jumlah insiden DBD sebagai variabel respon, serta faktor iklim seperti curah hujan, suhu, dan kelembapan sebagai variabel prediktor. Untuk proporsi data, kedua model tersebut menggunakan proporsi data training sebesar 80% dan data testing sebesar 20%. Model yang dibentuk ini dievaluasi dengan nilai dari Root Mean Square Error (RMSE) dan Mean Absolute Error (MAE). Hasil implementasi terbaik pada skrips ini dihasilkan oleh model LSTM-ATT dengan evaluasi di setiap wilayah DKI Jakarta: Jakarta Pusat RMSE: 9,5727, MAE: 6,6946; Jakarta Timur RMSE: 21,5288, MAE: 15,6365; Jakarta Barat RMSE: 16,3683, MAE: 12,4908; Jakarta Utara RMSE: 23,5911, MAE: 15,2969; Jakarta Selatan RMSE: 18,3811, MAE: 14,0262.

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Dengue Hemorrhagic Fever (DHF) is a disease caused by the dengue virus, which belongs to the Flavivirus genus and Flaviviridae family, transmitted through Aedes mosquitoes (Stegomyia). The number of DHF cases worldwide has reported an increase of more than 8 times over the past two decades, from 505,430 cases in 2000 to over 2.4 million in 2010 and 5.2 million in 2019. The increase in DHF incidence is influenced by various factors, including natural factors, human behavior, and the type of dengue virus itself. Natural factors include climate factors such as rainfall (mm), average temperature (℃), and average humidity (%). The increase in DHF incidence can be prevented through early prevention efforts by the government and the community. Predicting the trend of DHF incidence can provide input for the community and the government to increase vigilance against the increasing incidence of DHF in Jakarta. Various approaches can be used for predicting the trend of DHF incidence, one of which is machine learning. In this final project, the implementation of machine learning using the LSTM-ATT and Poisson Regression models will be used to predict the trend of DHF incidence over time. LSTM-ATT is a machine learning model used to process sequential data, such as time series data. On the other hand, Poisson Regression is a regression model that can be used for data with Poisson-distributed response variables and discrete types. The prediction will be based on the number of DHF incidents as the dependent variable, and climate factors such as rainfall, temperature, and humidity as independent variables. The performance of the models will be evaluated using the Root Mean Square Error (RMSE) and Mean Absolute Error (MAE). The best implementation results in this thesis were produced by the LSTM-ATT model with evaluation in each area of DKI Jakarta: Central Jakarta RMSE: 9.5727, MAE: 6.6946; East Jakarta RMSE: 21.5288, MAE: 15.6365; West Jakarta RMSE: 16.3683, MAE: 12.4908; North Jakarta RMSE: 23.5911, MAE: 15.2969; South Jakarta RMSE: 18.3811, MAE: 14.0262."