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"Identifikasi IL-6, PCT, dan CRP dalam mendiagnosis awal bakteremia pada pasien leukemia akut dengan demam neutropenia banyak dilakukan. Tujuan studi ini mengetahui performa diagnostik delta IL-6, delta PCT, dan delta CRP sebagai penanda awal kejadian bakteremia pada pasien leukemia akut dewasa dengan neutropenia berat selama menjalani kemoterapi standar (agresif). Desain studi ini potong lintang dengan mengambil semua pasien leukemia akut dewasa yang mengalami neutropenia berat selama menjalani kemoterapi agresif di RS Cipto Mangunkusumo dan RS Kanker Dharmais sejak 9 Agt – 9 Nov 2023. Sampel darah IL-6, PCT dan CRP diambil sebelum mulai kemoterapi dan dalam 24 jam saat mulai mengalami neutropenia berat serta kultur darah aerob volume 40cc dalam 24 jam sejak neutropenia berat. Performa diagnostik delta IL-6, delta PCT, dan delta CRP lemah dan tidak berbeda bermakna sebagai penanda bakteremia dengan AUC 0,6703 (IK95% 0,507-0,833); 0,6821 (IK 95% 0,521-0,844); dan 0,694 (IK 95% 0,532-0,856) serta nilai p=0,9681. Prevalensi bakteremia pada studi ini 64,44% (29/45) dengan bakteri gram positif 77,42% (24/31) dan yang terbanyak ialah Staphylococcus Epidermidis 41,67% (10/24). Walaupun performa diagnostik ketiganya lemah, delta CRP dapat dipertimbangkan digunakan dengan mempertimbangkan biaya dan ketersediaan reagen.

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IL-6, PCT, and CRP test were often performed in acute leukemia patients with febrile neutropenia as early markers of bacteremia. Our objective was to determine the diagnostic performance of delta IL-6, delta PCT, and delta CRP as early markers of bacteremia in adult acute leukemia patients with severe neutropenia during standard/aggressive chemotherapy. This research was conducted using cross-sectional design by taking all of adult acute leukemia patients with severe neutropenia during aggressive chemotherapy at Cipto Mangunkusumo Hospital and Dharmais Hospital from 9 Aug – 9 Nov 2023. IL-6, PCT and CRP blood samples were taken before starting chemotherapy and within 24 hours of starting to experience severe neutropenia as well as blood cultures aerobic volume 40cc. The diagnostic performance of delta IL-6, delta PCT, and delta CRP were weak and didn’t differ significantly as early markers of bacteremia (p = 0.968) with an AUC of 0.6703 (95% CI 0.507-0.833); 0.6821 (95% CI 0.521-0.844); and 0.694 (95% CI 0.532-0.856). Bacteremia was found in 64.44% (29/45), mostly gram-positive bacteria (77.42%) and Staphylococcus epidermidis 41.67%. Although the diagnostic performance of all three markers were weak, delta CRP can be considered as an early marker regarding the cost and availability of reagents."

"Hubungan antara peningkatan kadar interleukin-6 dan protein C reaktif dengan kebocoran plasma pada penderita infeksi dengue dewasa masih belum jelas. Penelitian ini dilakukan untuk mengetahui perbedaan kadar IL-6 dan protein C reaktif antara kelompok infeksi dengue dengan dan tanpa kebocoran plasma. Penelitian dilakukan secara potong lintang terhadap data sekunder dari penderita infeksi dengue dewasa yang dirawat di RSCM dan RSUP Persahabatan antara 1 Maret 2014 - 1 April 2015. Jumlah total sampel adalah 44 orang, terdiri dari 24 orang dengan kebocoran plasma dan 20 orang tanpa kebocoran plasma. Kadar IL-6 pada kelompok dengan dan tanpa kebocoran plasma masing-masing pada hari ke-3 dan ke-5 demam adalah 8,56 vs 3,80 (p = 0,069) pg/mL dan 4,30 vs 2,76 pg/mL (p = 0,025), sedangkan untuk protein C reaktif adalah 10,1 vs 6,8 mg/L (p = 0,014) dan 5,0 vs 2,9 mg/L (p = 0,048). Kadar IL-6 hari ke-3 dan ke-5 demam pada kelompok dengan kebocoran plasma adalah 8,56 vs 4,30 pg/mL (p = 0,037) dan pada kelompok tanpa kebocoran plasma adalah 3,80 vs 2,76 pg/mL (p = 0,005). Kadar protein C reaktif hari ke-3 dan ke-5 demam pada kelompok dengan kebocoran plasma adalah 10,1 vs 5,0 mg/L (p = 0,0001) dan pada kelompok tanpa kebocoran plasma adalah 6,8 vs 2,9 mg/L (p = 0,0001). Tidak ada perbedaan kadar IL-6 pada hari ke-3 demam di antara kedua kelom-pok, sedangkan pada hari ke-5 demam kadarnya lebih tinggi pada kelompok dengan kebocoran plasma. Kadar protein C reaktif hari ke-3 dan ke-5 demam lebih tinggi pada kelompok dengan kebocoran plasma. Kadar IL-6 dan protein C reaktif hari ke-3 lebih tinggi dibandingkan hari ke-5 demam pada kedua kelompok.

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There is stiil unclear association between the elevation of interleukin-6 and C-reactive protein levels with plasma leakage in adult dengue infection patients. The study aims to determine differences in the levels of interleukin-6 and C-reactive protein among groups of dengue infection with and without plasma leakage. This is a cross-sectional study of secondary data from adult patients with dengue infection were treated at Cipto Mangunkusumo and Persahabatan Hospital between March 1, 2014 until April 1, 2015. The total number of samples were 44 people, consisting of 24 people with plasma leakage and 20 people without plasma leakage. Median levels of interleukin-6 for groups with and without plasma leakage each for the 3rd and the 5th day of fever were 8.56 vs 3.80 pg/mL(p = 0.069) and 4.30 vs 2.76 pg/mL (p = 0.025), whereas for C-reactive protein were 10.1 vs 6.8 mg/L ( p = 0.014) and 5.0 vs 2.9 mg/L (p = 0.048).

Median levels of interleukin-6 on the 3rd and the 5th day of fever in the group with plasma leakage were 8.56 vs 4.30 pg/mL (p = 0.037) and in the group without plasma leakage were 3.80 vs 2.76 pg/mL (p = 0.005). Median level of C-reactive protein on the 3rd and 5th day of fever in the group with plasma leakage were 10.1 vs 5.0 mg/L (p = 0.0001) and in the group without plasma leakage were 6.8 vs 2.9 mg/L (p = 0.0001). There was no differences in levels of interleukin-6 on the 3rd day of fever between the two groups, while on the 5th day of fever interleukin-6 levels was higher in the group with plasma leakage. The levels of C-reactive protein on the 3rd and the 5th day of fever were higher in the group with plasma leakage. The level of Interleukin-6 and C-reactive protein on the 3rd day of fever were higher than the 5th day of fever in both groups."

"Latar Belakang. Pasien yang mengalami sepsis dan syok sepsis akan mengalami disfungsi organ akibat reaksi radikal bebas dengan sel endotel mikrovaskular sehingga menyebabkan tingkat morbiditas dan mortalitas yang cukup tinggi. Kondisi difungsi organ dapat diukur melalui perubahan kadar Interleukin-6 (IL-6), C-Reactive Protein (CRP), dan skor Sequential Organ Failure Assessment (SOFA) yang terjadi pada pasien-pasien tersebut. Pemberian asam askorbat yang memiliki kemampuan sebagai free radical scavenging, diharapkan dapat menurunkan proses peradangan atau inflamasi sehingga terjadi perbaikan fungsi organ. Penelitian ini bertujuan untuk mengetahui peran pemberian asam askorbat 6 gram secara intravena terhadap perubahan kadar IL-6, CRP, dan skor SOFA pada pasien sepsis dan syok sepsis di ruang perawatan intensif.Metodologi. Penelitian ini merupakan uji klinis dengan desain uji acak terkontrol, tersamar tunggal yang dilakukan terhadap pasien usia 18-65 tahun dengan diagnosis sepsis atau syok sepsis dalam perawatan 24 jam pertama masuk intensive care unit (ICU) RSUPN Dr. Cipto Mangunkusumo-Jakarta dan ICU RSUP H. Adam Malik-Medan sejak bulan Juli sampai dengan Desember 2019. Sebanyak 49 subyek dirandomisasi menjadi dua kelompok. Kelompok perlakuan (n=23), yang menerima vitamin C 1,5 gram per 6 jam selama 3 hari, dan kelompok kontrol (n=26), yang tidak menerima vitamin C tersebut. Pemeriksaan kadar IL-6, kadar CRP, dan skor SOFA dilakukan pada jam ke-24, 48, dan 72.Hasil. Tidak terdapat perubahan bermakna pada kadar IL-6 (P=0,423), CRP (P=0,080), dan skor SOFA (P=0,809) antara kelompok kontrol dan kelompok perlakuan.Kesimpulan. Pemberian asam askorbat 6 gram secara intravena tidak memberikan perubahan bermakna terhadap kadar IL-6, CRP, dan skor SOFA pada pasien sepsis dan syok sepsis di ruang perawatan intensif.

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Background. Septic and septic shock patients will have organ dysfunctions due to free radical reaction with microvacular endothelial cells, thus morbidity and mortality rate will increase in these conditions. Those organ dysfunctions can be measured through the changes of Interleukin-6 (IL-6) levels, C-Reactive Protein (CRP) levels, and Sequential Organ Failure Assessment (SOFA) scores. The administration of ascorbic acid has a feature known as free radical scavenging. The feature is expected to reduce the inflammatory rate in the organs and to improve the functions. This study was aimed to analyze the intravenous administration effect of 6 grams of ascorbic acid towards the changes of Interleukin-6 levels, C-Reactive Protein levels, and SOFA scores in septic and septic shock patients in intensive care unit

Methods. This was a single blind randomized controlled clinical trial study on patients aged 18-65 years old with septic and septic shock conditions in the first 24 hour care in intensive care unit (ICU) Dr. Cipto Mangunkusumo Hospital-Jakarta and H. Adam Malik Hospital-Medan from July to December 2019. In total, 49 subjects were included in the study and randomized into two groups. Intervetion group (n=23) received 1.5 gram/6 hours of vitamin C in three days consecutively, whereas the control group (n=26) did not receive the vitamin C. Measurements of IL-6 levels, CRP levels, and SOFA scores were performed in the 24th, 48th, and 72th hour.

Results. There were no significant changes of IL-6 levels (p=0.423), CRP levels (p=0.080), and SOFA scores (p=0.809) between the two groups.

Conclusion. The intravenous administration of 6 grams of ascorbic acid did not significantly affect the changes of Interleukin-6 levels, C-Reactive Protein levels, and SOFA scores in septic and septic shock patients in intensive care unit."

"Latar Belakang: Pada tanggal 12 Maret 2020, World Health Organization (WHO) mengumumkan penyakit Coronavirus Disease 2019 (COVID-19) sebagai pandemi yang disebabkan oleh virus Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Infeksi virus dapat menyebabkan kolonisasi organ yang terinfeksi akibat penurunan respon imun oleh patogen akibat penurunan respons imun serta masuknya bakteri patogen melalui akses yang diperantarai oleh mikroorganisme oportunis. Hingga saat ini telah banyak studi yang membahas COVID-19 dari aspek epidemiologi dan karakteristik klinis namun informasi terkait infeksi sekunder akibat bakteri pada COVID-19 masih terbatas.Metode Penelitian: Penelitian ini menggunakan desain studi potong lintang dengan dengan menelusuri data rekam medis pasien yang memiliki riwayat perawatan pneumonia COVID-19 di ruang isolasi Pinere RSUP Persahabatan sejak 1 Januari 2021 - 31 Desember 2021. Total sampel pada penelitian ini adalah sebanyak 111 pasien.Hasil Penelitian: Total pasien pneumonia COVID-19 yang dirawat di ruang isolasi Pinere selama tahun 2021 yaitu sebanyak 718 pasien. Pasien yang memenuhi kriteria inklusi dan eksklusi adalah sebanyak 111 pasien. Karakteristik pasien pneumonia COVID-19 didominasi oleh jenis kelamin laki-laki, median usia 53 tahun, lama rawat 11 hari, status gizi obesitas, belum divaksin, derajat keparahan sedang, penggunaan antivirus remdesivir, antibiotik levofloksasin, azitromisin dan kortikosteroid. Terdapat pertumbuhan bakteri pada 41,5% hasil biakan yang terdiri dari gram negatif (38,8%) dan gram positif (2,7%). Klebsiella pneumoniae merupakan bakteri gram positif terbanyak yang tumbuh, sedangkan Enterococcus faecalis merupakan satu-satunya gram positif yang tumbuh. Tidak terdapat hubungan antara hasil biakan patogen saluran napas terhadap luaran pasien pneumonia COVID-19 (nilai p=0,738). Derajat keparahan tidak berhubungan dengan hasil biakan, tetapi berhubungan dengan luaran pasien pneumonia COVID-19.Kesimpulan: Tidak terdapat hubungan antara hasil biakan patogen saluran napas terhadap luaran pasien pneumonia COVID-19.

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Background: World Health Organization (WHO) declared Coronavirus Disease 2019 (COVID-19) as a pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) virus on March 12, 2020. Viral infections can cause colonization of infected organs due to decreased immune response and entry of pathogenic bacteria through access mediated by opportunistic microorganism. Until now, there have been many studies discussing COVID-19 from the aspect of epidemiology and clinical characteristics, but information regarding secondary infections caused by bacteria in COVID-19 is still limited.

Methods: The design of this study is cross-sectional by tracing the medical record data of patients who had a history of treatment for COVID-19 pneumonia in the Pinere isolation ward of Persahabatan General Hospital from January 1st 2021 to December 31st 2021. The total sample in this study was 111 patients.

Result: The total number of COVID-19 patients treated in the Pinere isolation room during 2021 is 718 patients. Patients who met the inclusion and exclusion criteria were 111 patients. The characteristics of COVID-19 patients were dominated by male, median age 53 years, length of stay 11 days obesity, not yet vaccinated, moderate severity, use of antiviral remdesivir, antibiotics levofloxacin, azithromycin and corticosteroid. There was bacterial growth in 41,5% of culture results consisting of gram negative (38,8%) and gram positive (2,7%). Klebsiella pneumoniae is the most gram positive bacteria that grows, while Enterococcus faecalis is the only gram positive that grows. There was no relationship between the results of respiratory tract cultures and the outcomes of COVID-19 patients (p value = 0.738). The severity of COVID-19 is not associated to culture results, but is associated to the patient’s outcome.

Conclusion: There was no relationship between the results of respiratory tract cultures and the outcomes of COVID-19 patients."

"[ABSTRAKLatar belakang. Kolitis infeksi adalah proses inflamasi pada usus besar yang disebabkan oleh infeksi bakteri patogen, seperti Shigella, Salmonella, E.coli, dan Campylobacter. Dibuktikan dengan pemeriksaan kultur tinja, tetapi biayanya cukup mahal, perlu waktu dan tidak selalu tersedia di semua fasilitas kesehatan. Rekomendasi WHO jumlah lekosit lebih dari 10 per LPB untuk Shigella disentriae dengan klinis disentri dan merupakan indikasi pemberian antibiotika. Sering ditemukan anak diare dengan lekosit kurang dari 10/LPB tetapi hasil kultur positif bakteri patogen. Mencari hubungan jumlah lekosit tinja dengan kejadian diare yang disebabkan infeksi bakteri patogen yang memerlukan terapi antibiotika.Tujuan. Mengetahui prevalensi, sebaran bakteri patogen, nilai leukosit mikroskopik tinja pada anak dengan kolitis infeksi bakteri. Mengetahui hubungan leukosit tinja dengan kultur tinja dan pola sensitivitas antibiotika pada kolitis infeksi bakteri.Metode. Penelitian deskriptif dengan metode potong lintang dan uji diagnostik untuk menilai sensitivitas hitung leukosit tinja untuk mendiagnosis kolitis infeksi bakteri. Penelitian dilakukan di Rumah Sakit Umum Pusat Rujukan Nasional Cipto Mangunkusumo, Jakarta, dari bulan Januari- Juni 2015.Hasil. Dari 45 subjek penelitian ditemukan kultur positif pada 19 subjek (42,2%). Bakteri terbanyak yang ditemukan adalah E.coli (79%), Salmonella sp. (10,5%), dan C.difficille (10,5%). Pada titik potong ROC ditemukan nilai lekosit >8 per LPB dengan sensitivitas 0,654 dan spesifisitas 0.632. E.coli masih memperlihatkan sensitivitas cukup tinggi terhadap kloramfenikol dan siprofloksasin tetapi tidak terhadap sefiksim. Salmonella sp. sensitif terhadap kloramfenikol, sefiksim, dan seftriakson, sedangkan C. difficile sensitif terhadap Seftriakson.Simpulan. Pada penelitian ini ditemukan sebanyak 19 (42,2%) subyek penderita diare hasil kultur tinja positif bakteri patogen dan pada titik potong ROC ditemukan nilai lekosit > 8 per LPB dengan sensitivitas 65.4% dan spesifisitas 63.2%. Pada pola sensitivitas antibiotika, E.coli sensitif terhadap kloramfenikol dan siprofloksasin dan Salmonella dan C.difficile sensitif terhadap seftriakson.

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ABSTRACTBackground. Infective colitis is an inflammatory process in the colon caused by pathogenic bacterial infection, such as Shigella, Salmonella, E.coli, and Campylobacter. Diagnosis is made by fecal culture, but the cost is relatively expensive, time-consuming, and not readily available in every health facility. WHO recommends that fecal leukocyte more than 10 per HPF for the diagnosis of Shigella disentriae with clinical symptom of dysentriae and indicated for antibiotic treatment. Often there are diarrheic children with leukocyte less than 10/HPF but the culture is positive for pathogenic bacteria. This study would like to look for the relationship between fecal leukocyte and incidence of diarrhea caused by pathogenic bacteria infection that requires antibiotic therapy.Objective. To study the prevalence, distribution of pathogenic bacteria, leukocyte count in fecal microscopic test in children with bacterial infective colitis. To study the relationship between fecal leukocyte and fecal culture with sensitivity pattern of antibiotics in bacterial infective colitis.Methods. Descriptive, cross-sectional study and diagnostic test to study the sensitivity of fecal leukocyte count in diagnosing bacterial infective colitis. Study was performed in the Cipto Mangunkusumo Hospital, Jakarta, from January to June 2015.Results. From 45 study subjects, positive culture was found in 19 subjects (42.2%), and the most common bacteria were E.coli (79%), Salmonella sp. (10.5%), and C. difficille (10,5%). At the ROC we found leukocyte count >8 per HPF as cutoff point with 0.654 sensitivity and 0.632 specificity. E. coli still showed relatively high sensitivity to chloramphenicol and ciprofloxacin, but not to cefixime. Salmonella sp. were sensitive to chloramphenicol, cefixime, and ceftriaxone, while C. difficile were sensitive to ceftriaxone.Conclusion. In this study there were 19 (42.2%) subjects with diarrhea, with positive fecal culture for pathogenic bacteria. At the ROC cutoff point we found leukocyte count > 8 per HPF with 65.4% sensitivity and 63.2% specificity. On the antibiotic sensitivity pattern, E. coli was sensitive to chloramphenicol and ciprofloxacin, while Salmonella dan C.difficile were sensitive to ceftriaxone, Background. Infective colitis is an inflammatory process in the colon caused by pathogenic bacterial infection, such as Shigella, Salmonella, E.coli, and Campylobacter. Diagnosis is made by fecal culture, but the cost is relatively expensive, time-consuming, and not readily available in every health facility. WHO recommends that fecal leukocyte more than 10 per HPF for the diagnosis of Shigella disentriae with clinical symptom of dysentriae and indicated for antibiotic treatment. Often there are diarrheic children with leukocyte less than 10/HPF but the culture is positive for pathogenic bacteria. This study would like to look for the relationship between fecal leukocyte and incidence of diarrhea caused by pathogenic bacteria infection that requires antibiotic therapy.Objective. To study the prevalence, distribution of pathogenic bacteria, leukocyte count in fecal microscopic test in children with bacterial infective colitis. To study the relationship between fecal leukocyte and fecal culture with sensitivity pattern of antibiotics in bacterial infective colitis.Methods. Descriptive, cross-sectional study and diagnostic test to study the sensitivity of fecal leukocyte count in diagnosing bacterial infective colitis. Study was performed in the Cipto Mangunkusumo Hospital, Jakarta, from January to June 2015.Results. From 45 study subjects, positive culture was found in 19 subjects (42.2%), and the most common bacteria were E.coli (79%), Salmonella sp. (10.5%), and C. difficille (10,5%). At the ROC we found leukocyte count >8 per HPF as cutoff point with 0.654 sensitivity and 0.632 specificity. E. coli still showed relatively high sensitivity to chloramphenicol and ciprofloxacin, but not to cefixime. Salmonella sp. were sensitive to chloramphenicol, cefixime, and ceftriaxone, while C. difficile were sensitive to ceftriaxone.Conclusion. In this study there were 19 (42.2%) subjects with diarrhea, with positive fecal culture for pathogenic bacteria. At the ROC cutoff point we found leukocyte count > 8 per HPF with 65.4% sensitivity and 63.2% specificity. On the antibiotic sensitivity pattern, E. coli was sensitive to chloramphenicol and ciprofloxacin, while Salmonella dan C.difficile were sensitive to ceftriaxone]"

"Latar Belakang: Patogenitas Corynebacterium pada infeksi difteri, sangat terkait dengan toksin yang dihasilkannya. Indonesia merupakan negara ke dua di dunia yang memiliki kasus difteri terbanyak dengan 1.665 kasus dan 29 kasus kematian di tahun 2018. Toksin difteri dapat dihasilkan oleh 3 spesies penyebab, yaitu C. diphtheriae, C. ulcerans, dan C. pseudotuberculosis yang sulit dibedakan secara mikroskopik dan kultur, sehingga diperlukan deteksi molekuler untuk membedakanya. Karakterisasi C. diphtheriae sebagai spesies penyebab utama, diperlukan untuk mengetahui hubungan kekerabatanya dengan spesies negara lain untuk mencari kemungkinan sumber infeksi. Metode: Sebanyak 108 sampel klinis digunakan dalam penenlitian ini. Teknik kultur dilakukan untuk mendeteksi 3 Corynebacterium patogenik, sedangkan realtime PCR hanya dirancang untuk mendeteksi C. ulcerans dan C. pseudotuberculosis. Pengujian inhibitor, sensitifitas, dan spesifisitas dilakukan pada tahap optimasi. Karakterisasi C. diphtheriae dilakukan dengan metode sekuensing menggunakan gen rpoB parsial pada kultur sampel klinis. Hasil: Limit deteksi real-time PCR untuk C. ulcerans dan C. pseudotuberculosis secara berurutan sebanyak 4,49 dan 1,06 DNA copy number. Uji spesifisitas terhadap 18 mikrorganisme menunjukkan tidak terdapat reaksi silang. Pengujian terhadap 108 sampel klinis memberikan hasil yang sama dengan kultur, tidak ditemukan C. ulcerans dan C. pseudotuberculosis. Pada kultur sampel klinis ditemukan C. diphtheriae sebanyak 10 sampel (9,26%), yang dapat dikelompokkan menjadi 4 clade yaitu clade I, III, IV dan V dengan similaritas 99,2 % sampai 99,7%. Kesimpulan: Kasus suspek difteri dalam studi ini tidak berkaitan dengan infeksi C. ulcerans dan C. pseudotuberculosis, dan hanya positif C. diphtheriae . Hasil karakterisasi gen rpoB pada C. diphtheriae, memperlihatkan hubungan kekerabatan dengan beberapa negara.

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Background: Pathogenicity of Corynebacterium in diphtheria infection is closely related to toxin production. Indonesia is the second highest country in the world that has the most diphtheria cases with 1,665 cases and 29 deaths in 2018. Diphtheria toxin can be produced by 3 species, such as C. diphtheriae, C. ulcerans and C. pseudotuberculosis which are difficult to distinguish microscopically and culture, therefor molecular detection is needed to differentiate them. Characterization of C. diphtheriae as the main causative species, is needed to determine its relationship with other countries to find possible source of infection.

Method: A total of 108 clinical samples were used in this study. Culture techniques were performed to detect 3 pathogenic Corynebacterium and real-time PCR was only designed to detect C. ulcerans and C. pseudotuberculosis. Inhibitor, sensitivity and specificity testing were carried out at the optimization stage. Characterization of C. diphtheriae from culture of clinical samples, was carried out by sequencing method using partial rpoB genes.

Result: The real-time PCR detection limits for C. ulcerans and C. pseudotuberculosis were 4.49 and 1.06 DNA copy number, respectively. Specificity test for 18 microorganism showed no cross reaction. Tested on 108 clinical samples gave the same results as culture, there were not found C. ulcerans and C. pseudotuberculosis. In clinical culture samples found 10 (9.26%) C. diphtheriae, which can be grouped into 4 clades namely clades I, III, IV and V with similarities of 99.2% to 99.7%.

Conclusion: Suspected diphtheria cases in this study were not related to C. ulcerans and C. pseudotuberculosis infections, and were only positive for C. diphtheriae. The results of the rpoB gene characterization test on C. diphtheriae showed a close relationship with several countries.

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"ABSTRAKInfeksi saluran pernafasan akut ISPA merupakan infeksi yang paling sering terjadi pada manusia dengan angka morbiditas dan mortalitas yang tinggi, terutama di negara-negara Asia Tenggara dan Afrika. Sudah diketahui bahwa sebagian besar ISPA disebabkan oleh virus, namun data mengenai etiologi virus di negara berkembang, terutama Indonesia masih terbatas. Studi ini menggunakan metode molekuler berupa PCR dan sekuensing untuk deteksi serta karakterisasi virus saluran nafas umum, termasuk virus zoonosis pada sampel swab orofaring. Subjek studi sebanyak 100 pasien anak dan dewasa dengan gejala infeksi saluran nafas yang datang ke RSU Tabanan. Dari 100 pasien didapatkan angka deteksi virus positif sebesar 40 dan angka ko-deteksi 7 . Pada anak-anak angka deteksi positif mencapai 46 28/61 , sedangkan pada dewasa sebesar 31 12/39 . Virus utama yang terdeteksi adalah influenza 15 , enterovirus 14 dan herpesvirus 11 . Subtipe virus yang mendominasi hasil deteksi yaitu H3N2, human rhinovirus A dan human betaherpesvirus 5. Sebagai kesimpulan, diantara pasien-pasien dengan ISPA di Tabanan, sebagian besar virus yang terdeteksi adalah virus influenza dengan subtipe H3N2.

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ABSTRACT

Acute respiratory tract infection ARTI is the most common infection in human being. The morbidity and mortality rate is high, especially in Southeast Asia and Africa. While it is known that ARTIs are most commonly caused by virus, there are limited data about viral etiology of ARTI in developing countries, especially Indonesia. This study used molecular method to detect 10 common respiratory viral pathogens and zoonotic respiratory viruses. We collected oropharyngeal swabs from 100 patients in Tabanan Regency Hospital suspected with respiratory illness from all age groups. Among 100 patients tested, 40 tested positive for virus, with co detection rate 7 . In addition, positive detection rate in children was 46 28 61 and in adult 31 12 39 . Viruses that were most commonly detected include influenza 15 , enterovirus 14 and herpesvirus 11 . Among them, influenza virus subtype H3N2, human rhinovirus A and human betaherpesvirus 5 was the most frequently detected. In conclusion, among patients with ARTI in Tabanan Regency Hospital, influenza virus subtype H3N2 was the most predominant virus detected. "

"Latar Belakang COVID-19 berdampak secara signifikan bagi dunia. Tingginya prevalensi dan insidensi, serta banyaknya kasus berderajat keparahan sedang-berat, mendorong dunia dan Indonesia untuk mencari terapi yang tepat. Salah satunya adalah anti-interleukin-6 untuk mengatasi badai sitokin yang kerap terjadi pada pasien COVID-19. Anti-interleukin-6 berupa Tocilizumab yang digunakan untuk mengatasi COVID-19 derajat sedang-berat hingga saat ini masih minim diteliti di dunia maupun di Indonesia. Maka, Peneliti berharap penelitian ini dapat berkontribusi pada perkembangan dunia medis di Indonesia. Metode Penelitian ini dilakukan dengan desain kohort retrospektif yang dilakukan di Rumah Sakit Universitas Indonesia. Penelitian ini menggunakan rekam medis pasien COVID-19 berderajat sedang-berat guna menilai hubungan antara pemberian Tocilizumab dengan tingkat mortalitas, lama rawat, dan kadar biomarker inflamasi yaitu C-reactive protein dan D-dimer. Hasil Diperoleh 52 pasien yang diberikan obat Tocilizumab dan 52 pasien kontrol. Pada kelompok pasien yang diberikan Tocilizumab, 48 pasien dirawat pada bulan Januari-Juni dan 4 pasien dirawat pada bulan Juli-Desember. Pada kelompok kontrol, 32 pasien dirawat pada bulan Januari-Juni dan 20 pasien dirawat pada bulan Juli-Desember. Ditemukan sebanyak 40,4% pasien yang memperoleh Tocilizumab hidup dan sembuh, sedangkan pada kelompok kontrol hanya 16,4% pasien yang sembuh (p=0,014). Rata-rata lama rawat pasien kelompok uji mencapai 20,9±11,5 hari, lebih lama dibandingkan kelompok kontrol yaitu 16,5±12,4 hari (p=0,007). Rata-rata penurunan kadar CRP pada kelompok uji adalah -74,65±72,59 mg/L, sedangkan pada kelompok kontrol meningkat (p=0,001). Kadar D-dimer pasien yang diberikan Tocilizumab mengalami penurunan namun tidak signifikan. Kesimpulan Tocilizumab terbukti menurunkan angka mortalitas, menurunkan kadar CRP, dan cenderung menurunkan kadar D-dimer pada pasien COVID-19 derajat sedang-berat.

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Introduction COVID-19 has a significant impact globally. The high prevalence and incidence, also the large number of moderate-severe cases, encouraged the world and Indonesia to look a better therapy. One of them is anti-interleukin-6 to overcome cytokine storm that occurs in COVID-19 patients. Today, there is minimal research that learn about anti-interleukin-6, Tocilizumab. This research hope could contribute to the development of the medical sector in Indonesia. Method This research conducted with a retrospective cohort design at Universitas Indonesia Hospital. This study used medical records of COVID-19 moderate-severe patients to assess the relation between Tocilizumab administration and mortality, length of stay, and levels of C-reactive protein and D-dimer. Result There were 52 moderate-severe COVID-19 patients receiving Tocilizumab and 52 control patients. In the test group, 48 patients treated in January-June and 4 patients treated in July-December. In the control group, 32 patients treated in January-June and 20 patients treated in July-December. It was found that 40,4% of patients who were given Tocilizumab survived, while in the control group only 16,4% of patients survived (p=0,014). The average length of stay for test group reached 20,9±11,5 days, longer than the control group, which was 16,5±12,4 days (p=0,007). The average CRP levels decrease in test group was -74.,65±72,59 mg/L, while it increased in the control group (p=0,001). The D-dimer levels of patients given Tocilizumab decreased but not significant. Conclusion Tocilizumab has been proven to reduce mortality rates, lower CRP levels, and tends to reduce D-dimer levels in moderate-severe COVID-19 patients."

"Latar Belakang: Terdapat peningkatan angka kejadian sepsis pada populasi pediatrik. Bakteri batang Gram negatif merupakan mikroorganisme penyebab terbanyak sepsis pada pediatrik. Studi dari berbagai negara melaporkan terdapat peningkatan angka resistansi bakteri batang Gram negatif namun laporan dari negara berpenghasilan rendah seperti Indonesia masih kurang. Penelitian ini melakukan pemeriksaan fenotipik dan genotipik untuk mengetahui prevalensi bakteri batang Gram negatif resistan multiobat pada pasien pediatrik dengan diagnosis sepsis di RSUPN dr. Cipto Mangunkusumo pada tahun 2020.Metode: Studi cross-sectional ini dilakukan Februari hingga Oktober 2020 dengan subjek penelitian pasien pediatrik dengan diagnosis kerja sepsis yang dirawat di RSUPN dr. Cipto Mangunkusumo tahun 2020 yang memenuhi kriteria inklusi dan eksklusi. Masing-masing subjek dilakukan pengambilan spesimen darah 2 lokasi. Organisme diidentifikasi dan uji kepekaan dengan mesin VITEK-2 dan pemeriksaan molekular dengan Hybridspot-12. Data rekam medis pasien dikumpulkan untuk mencari faktor yang memengaruhi sepsis akibat bakteri batang Gram negatif resistan multiobat.Hasil Penelitian: Didapatkan 94 spesimen darah dari 47 subjek penelitian dengan prevalensi bakteri batang Gram negatif resistan multiobat sebesar 14,9% (7/47). Patogen Gram negatif yang ditemukan adalah Klebsiella pneumonia sebesar 12,8% (6/47) dan Enterobacter cloaceae 2,13% (1/47). Studi ini mendeteksi gen ESBL yang terdiri dari 13 CTX-M dan 8 SHV serta gen karbapenemase yang terdiri dari 12 NDM dan 1 GES. Dari delapan faktor yang dianalisis bivariat didapatkan lama hari rawat sebelum pengambilan spesimen (p= 0,02) dan asal ruang perawatan pasien (p= 0,04) sebagai faktor yang berhubungan dengan infeksi bakteri batang Gram negatif resistan multiobat.Kesimpulan: Pada studi ini, bakteri batang Gram negatif resistan multiobat merupakan patogen penyebab sepsis terbanyak pada pediatrik. Program pengendalian infeksi dan pengendalian resistansi antibiotik perlu digalakkan untuk membatasi transmisi dan kejadian mikroba resistan multiobat.

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Background: There is an increasing incidence of sepsis in the pediatric population. Gram-negative rods are the most common cause of pediatric sepsis. Studies from various countries report an increase in the resistance rate of Gram-negative rods but reports from low-income countries such as Indonesia are still lacking. This study carried out phenotypic and genotypic examinations to determine the prevalence of multidrug-resistant Gram-negative bacteria in pediatric patients with a diagnosis of sepsis at RSUPN dr. Cipto Mangunkusumo in 2020.

Method: This cross-sectional study was conducted from February to October 2020. Each subject took blood specimens at 2 locations. Organisms were identified and susceptibility assayed with the VITEK-2 machine and molecular assay with Hybridspot-12. Data from pediatric patients with a working diagnosis of sepsis who met the inclusion and exclusion criteria were assessed for factors that influence sepsis due to multidrug-resistant Gram-negative bacteria.

Results: Among 47 patients, 94 blood specimens were obtained. Prevalence of multidrug-resistant Gram-negative bacteria was 14.9% (7/47). The pathogen found were Klebsiella pneumonia by 12.8% (6/47) and Enterobacter cloacae 2,13% (1/47). This study detected an ESBL genes consisting of 13 CTX-M and 8 SHV and carbapenemase genes consisting of 12 NDM and 1 GES. Of the eight factors analyzed, the length of hospitalization before specimen collection (p = 0.02) and the patient’s ward (p = 0.04) were factors associated with multidrug-resistant Gram-negative bacterial infection.

Conclusion: In this study, multidrug-resistant Gram-negative rods were the most common pathogen causing sepsis in pediatrics. Infection control and antibiotic resistance control programs need to be promoted to limit the transmission and development of multidrug-resistant organisms."

"ABSTRAKKeamanan pangan saat ini telah menjadi isu penting dalam kesehatan masyarakat.Sekitar 10-20 kejadian luar biasa pada penyakit akibat makanan disebabkan oleh terkontaminasinya makanan dan minuman oleh mikroorganisme pathogen melalui penjamah makanan.Sampai saat ini belum ada penelitian mengenai bakteri patogen pada penjamah makanan di kantin ini.Tujuan penelitian ini adalah mengetahui kejadian infeksi bakteri patogen pada penjamah makanan di kantin sebuah kampus di Depok. Disain penelitian yang digunakan adalah cross sectional. Penelitian dilakukan bulan Mei-Juni 2017 di kantin sebuah kampus di Depok.Populasi penelitian ini seluruh penjamah makanan yang berada di kantin sebuah kampus di Depok.Jumlah sampel 60 orang penjamah makanan.Data yang dikumpulkan merupakan data primer yaitu hasil wawancara dan observasi data karakteristik dan perilaku penjamah, serta data infeksi bakteri patogen melalui pemeriksaan feses di laboratorium.Hasil penelitian diketahui bahwa 60 penjamah makanan termasuk dalam kelompok umur tidak berisiko 30-50 tahun , proporsi penjamah makanan berjenis kelamin laki-laki sedikit lebih banyak dari perempuan 53,3 , mayoritas berpendidikan rendah 58,3 , setengahnya pernah mengikuti pelatihan kesehatan 50 , dan seluruhnya belum pernah melakukan imunisasi tifoid. Hasil pemeriksaan feses diketahui bahwa ada 3 penjamah makanan yang teridentifikasi mengandung bakteri E.coli O157 dalam fesesnya. Selain itu perilaku dan personal hygiene sebagian besar penjamah termasuk dalam kategori kurang baik, faktor lingkungan seperti fasilitas sanitasi kantin sebagian besar sudah memenuhi syarat, dan 83,3 penjamah tidak ada riwayat kontak dengan binatang. Secara statistik tidak ada hubungan yang bermakna antara karakteristik, perilaku, personal hygiene, fasilitas sanitasi dan riwayat kontak dengan binatang terhadap infeksi bakteri patogen.Dengan melihat hasil penelitian ini, disarankan agar pihak kampus terus melakukan edukasi terhadap penjamah makanan terkait perilaku dalam pengelolaan makanan dan pengawasan secara rutin terhadap kualitas kesehatan penjamah, kualitas makanan dan kondisi sanitasi agar kantin dan penjamah tidak menjadi sarana penyebaran penyakit.

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ABSTRACTCurrent food security has become an important issue in public health. Approximately 10 20 of the extraordinary incidence of foodborne illness is caused by food and drink contamination by pathogenic microorganisms through food handlers. Until now there has been no research on pathogenic bacteria at food handlers in this canteen.The purpose of this study is to know the incidence of pathogenic bacterial infections in food handlers in the cafeteria of a campus in Depok. The research design used was cross sectional. The study was conducted in May June 2017 in the canteen of a campus in Depok. The population of this study is all food handlers located in the cafeteria of a campus in Depok. The sample size is 60 food handlers. The data collected are primary data that is the result of interview and observation of characteristic and behavioral data of the handler, and data of bacterial pathogen infection through stool examination in the laboratory.The results of the study revealed that 60 of food handlers were included in the non risk age group 30 50 years , the proportion of male sex food handlers was slightly higher than women 53.3 , the majority of them were low educated 58.3 , Half have attended health training 50 , and all have never done tifoid immunization. The results of faecal examination revealed that there are 3 food handlers identified contain bacteria E. coli O157 in fesesnya. In addition, the behavior and personal hygiene of most of the handlers are in poor category, environmental factors such as canteen sanitation facilities are largely eligible, and 83.3 of the handlers have no history of contact with animals. There was no statistically significant relationship between characteristics, behavior, personal hygiene, sanitation facilities and contact history with animals against pathogenic bacterial infections.By looking at the results of this study, it is suggested that the campus continue to educate food handlers related to behavior in food management and regular supervision on the quality of health of the handlers, food quality and sanitary conditions for canteen and handlers not be a means of spreading the disease."