An open pilot study of the efficacy and safety of polygeline in adult subjects with dengue haemorrhagic Fever.

Aim: to observe the efficacy and safety of Polygeline colloid (Haemaccel) in adults with stage I - II of dengue haemorrhagic fever (DHF). Methods: an open, non-comparative clinical trial. The subjects were male or female between 17 - 55 years old, who fulfilled the criteria of stage I or II of DHF according to WHO and selected with consecutive sampling. Fluid treatments were given following this protocol: polygeline i.v. infusion: 500 ml over first 6 hours and continued with 500 ml for the next 18 hours, and maintained to 1000 mL/24 hours from day-2 until maximum day-5. Ringer's lactate infusion: 1000 mL/18 hours from the first day to maximum day-5, as maintenance. Efficacy and safety of polygeline colloid were evaluated using initial stabilization of haematocrite level, measured as percentage of clinical trial subject who has stabilization of haemodynamic status based on serial haematocrite levels examinations, total parenteral fluid required and length of hospitalization. Statisticial analysis was done using ANOVA test and post hoc analysis using Turkey test. Results: there were 43 subjects who completely participated in this study and included in analysis. From baseline levels, haematocrite decreased in first 6 hours during fluid treatment. This decrement persisted in 48 hours of observation. Statistical analysis with ANOVA test showed the significant differences of haematocrite level during observation (Sum of square between groups 495 and within group 4845, p= 0.000). Post hoc analysis with Turkey test showed significant differences of haematocrite level from baseline level to 48, 72 and 96 hours during observation periods. Conclusion: this pilot study showed that polygeline colloid was a safe initial fluid treatment and can be used for maintaining fluid adequacy in adults with stage I-II of DHF.

Open study on efficacy and tolerability of ciprofloxacin XR compared with ciprofloxacin BID in the treatment of typhoid fever.

AIM: To compare the efficacy and tolerability of ciproflaxin extended-release and ciproflaxin intermediate release in the treatment of typhoid fever. METHODS: A prospective, open labelled, clinical trial, comparing the safety and efficacy of extended-release ciprofloxacin 1000 mg once daily (Ciprofloxacin XR) and ciprofloxacin intermediate release 500 mg two times daily (Ciprofloxacin bid) was performed in adult with typhoid fever. Diagnosis for typhoid fever was based on Widal serology test, blood culture and Polymerase Chain Reaction (PCR) for Salmonella typhi. A two-sided student t-test and chi-square or Fisher's exact test were used for the analysis of clinical responses. RESULTS: Good clinical responses were obtained in 32 subjects (14 with Intermediate release ciprofloxacin and 18 with Extended-release ciprofloxacin) and there were no failure case (0%). Day to reach defervescence in Ciprofloxacin BID (mean 3.28 days) was similar to Ciprofloxacin XR group (mean 3.72 days) with p=0.43. Mild side effects were noted in 7.1% of subjects who received Ciprofloxacin BID compared by 22.2% in subjects who received Ciprofloxacin XR, with p=0.29. There were no moderate or severe side effects on both drugs. CONCLUSION: Clinical outcomes were similar for the two treatments and both treatments were well tolerated. Once daily ciprofloxacin XR was safe, effective, and non-inferior to twice-daily ciprofloxacin IR in the treatment of typhoid fever.

Opportunistic infection of HIV-infected/AIDS patients in Indonesia: problems and challenge.

Infectious diseases are one of the biggest health-problem in the world, while HIV/AIDS itself ranks second in mortality. The latest situation shows a remarkable increase of HIV/AIDS cases in Indonesia. About 90.000 to 130.000 people in Indonesia are predicted of being infected with HIV nowadays. HIV may progress to AIDS as patient's immune status decreases. As well to the condition, opportunistic infections will occur and eventually it may lead to death. An efficient and effective approach in early detection and proper management of opportunistic infections, followed with sufficient anti retroviral administration, may reduce mortality. Other approaches in managing HIV/AIDS and opportunistic infections are needed to support a complete and holistic management for patients with HIV. Full participation from family, medical experts, government and public is strictly a must to overcome this problem.

The correlation between total lymphocyte count and the number of candida colony from the oral cavity in HIV/AIDS patients.

HIV infection causes qualitative and quantitative reduction of the T helper (Th) subset of T lymphocytes, facilitating opportunistic infection. One of the common opportunistic infections among HIV/AIDS patients is Candida infection in the oropharynx and esophagus. Detection of increased Candida colonialization is not always easy, CD4 count is a parameter that could be used as reference. The fact is there’s only few laboratory can provide CD4 count. This study is a cross-sectional correlative study to determine the relation between total lymphocyte count as a much more applicable laboratory parameter and the intensity of Candida colonization in the oropharyngeal cavity of patients with HIV infection/AIDS. It was performed in the outpatient ward and inpatient ward of Dr. Cipto Mangunkusumo Hospital, from August 2004 to January 2005. The selected study subjects underwent interview, physical examination and had their blood samples and gargle samples taken. 60 study subjects were recruited, consisting of 52 males (86.7%) and 8 females (13.3%). The mean total lymphocyte count was 1194.53 cells/μL. Oropharyngeal candidiasis was found in 44 subjects (73.3%). There is a trend of higher Candida colonies number with lower total lymphocyte count despite no significant correlation between total lymphocyte count and the number of Candida colonies in the oral cavity of patients with HIV infection/AIDS. There is significant different between total lymphocyte count in positive and negative Candida colonies.

Secondary pneumonia in tetanus patients: a review of six selected cases (Case report).

Tetanus, an infection by C.tetani continues to be a major health problem in the developing world. The course of the disease is typically prolonged, requiring weeks to months of supportive management to resolve. Several studies have been conducted to determine which factor/s really influenced the outcome of tetanus. Factors such as severity of spasms, age, sedation and tachycardia were found to significantly influence mortality. Patients now surviving the initial acute phase of their illness, but new problems have emerged autonomic dysfunction and hospital acquired pneumonia (often with multiresistant organisms) are now the commonest causes of death. This serial cases report presents six selected cases of tetanus, three patients acquired secondary pneumonia during treatment, among the three, two patients are elderly age 70 and 72 years old. Both of the presented patients died during treatment in the hospital.

Assessment of clinical and laboratory parameters that reflect inflammatory response and organ function in sepsis.

Sepsis is a spectrum of clinical conditions caused by the host immune response to infection or other inflammatory stimuli characterized by systemic inflammation. Clinical response to sepsis could be varies according to compensate or decompensate state, inflammatory process and host condition. Aims of this study is to assess the role of some parameters (clinical and biochemical, hematology, arterial blood gas analysis and coagulation) in supporting the diagnosis of sepsis. A cross-sectional study was performed in the Internal Medicine Inpatient Unit of Dr. Cipto Mangunkusumo National General Hospital, Jakarta, from February to July 2002. Forty-two patients who fulfilled the criteria of sepsis, severe sepsis, and septic shock were enrolled in this study. Clinical details and blood specimens for hematological, biochemical, arterial blood gas analysis and coagulation were collected. There were 42 subjects who participated in the study, aged from 19 to 78 years old. Eleven subjects fulfilled the criteria for early sepsis, 20 severe sepsis and 11 septic shock. Clinical examination showed that the Glasgow coma scale (GCS) was significantly reduced in severe sepsis and septic shock. Heart rate, respiration rate and body temperature were increased in all groups. Hemoglobin levels mostly below 10 g/dl and hematocrite levels below 30 %. The leucocyte counts were increased in more than 80%, mostly above 15.000/mm3. The platelet count were low (below 50.000/mm3) especially in septic shock. The serum creatinine were significantly increased (>2 mg/dl) in severe sepsis and septic shock. Albumin was decreased, lactate dehydrogenase/LDH and procalcitonin were increased. The arterial blood gas analysis showed that: pH and HCO3 were decreased especially in septic shock; the PO2 was lower in severe sepsis and septic shock; and PCO2 was below 32 mmHg in all groups. Coagulation examinations showed that fibrinogen was significantly decreased in septic shock; PT and APTT were prolong in severe sepsis and septic shock more than 18.8 and 48 seconds respectively. The d-dimer was also increased mostly in all groups. In conclusions that clinical examinations include level of consciousness, heart rate, mean arterial pressure, temperature and respiration rate and additional laboratory examinations include hamatological, biochemical, blood gas analysis and coagulation examinations can be used as parameters in diagnosis of sepsis. Some parameters include level of consciousness (Glasgow coma scale), serum creatinine, hemoglobin, platelet count and fibrinogen can differ sepsis according to severity.

Clinical manifestation of HIV/AIDS patients: differences between public and private hospitals in Jakarta.

The aims of this study is to determine the demographic data, risk factors, clinical presentations, opportunistic/co-infections and its difference between public and private hospitals. A retrospective -descriptive study was conducted in Dr. Cipto Mangunkusumo National General Hospital (public hospital) and Medistra Hospital (private hospital), Jakarta. The inclusion criteria were new HIV/AIDS cases admitted in year 2002-2003 and positive HIV serology (Elisa method). Secondary data were collected form medical record. Sixty-six subjects were enrolled in this study (public hospital 30 subjects and private hospital 36 subjects), consist of 59 male (89.4%) and 7 female (10.6%). Thirty-seven percent subjects were defined as HIV and 62% AIDS. Risk factors obtained include drug user (59.1%), homosexual (13.6%), heterosexual (21.1%), transfusion (1.5%) and maternal-child (perinatal) (1.5%). The clinical symptoms mainly present as acute fever (56.2%), weight loss (39.4%), cough (38.8%), shortness of breath (27.2%), chronic diarrhea (22.8%), prolong fever (19.7%), loss of conciousness (15.3%), anorexia (15.3%). Significant differences between public and private hospitals were seen in fever and cough symptoms. Clinical presentation of HIV/AIDS patients during admission were : pneumonia (56%), oral trush (22.6%), anemia (56.5%), leucopenia (32.3%), lymphopenia (55.9%), elevated AST/ALT (66.1%), hypoalbuminemia (46.9%), limphadenopathy (10.6%), brain space occuping lesion (7.6%), encephalopathy (6.0%), pulmonary tb and pleural effusion (10.6%). The opportunistic and co-infections present were candidiasis (25.8%), chronic hepatitis C (24.2%), chronic hepatitis B and C (4.5%), pulmonary tb, lymphadenitis and miliary tb. Candidiasis and pulmonary tb were frequently found in public hospital. In conclusion from this study that clinical manifestation of HIV/AIDS were young man or woman, with one or more possible risk factor, had fever, respiratory complain, loss of body weight, chronic diarrhea, fatique, oral trush, anemia, leucopenia, lymphopenia. Patients admitted in private hospital had varied complain; and patients that admitted in public hospital had more severe and advance condition.

Interleukin-18 levels in adult dengue fever and dengue hemorrhagic fever.

Interleukin (IL)-18 ( interferon-γ inducing factor) is one of cytokines, produced by macrophage, take part in differentiation T-helper (Th) to Th1 and interferon γ 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.

Clinical and laboratory manifestations of typhoid fever at Persahabatan Hospital, Jakarta.

AIM: To determine clinical, and therapeutic characteristics, and antibiotic susceptibility test results for typhoid fever. METHODS: A retrospective study using data from medical records of all typhoid fever subjects which is confirmed by blood culture positive for S. typhi or S. paratyphi. This study was performed to determine clinical, laboratory, and therapeutic characteristics. Statistical analysis was performed using unpaired student t-test. RESULTS: Out of 119 subjects, 58.8% were male and 41.2% were female. The average age was 24.98 years (SD 11.11). Predominant symptoms were headache, epigastric pain, nausea, anorexia, together with fever from the afternoon to night. Predominant laboratory abnormalities were decreased or normal leukocyte count, increased of SGOT/SGPT, increased erythrocyte sedimentation rate, thrombocytopenia, and proteinuria. Predominant widal test results for antigen O and H were 1/320. Four time elevations of widal titer were rare in this study. Typhoid hepatitis, typhoid pneumonia, typhoid encephalopathy, intestinal haemorrhage are the most frequent complications in this study. Chloramphenicol is still effective for typhoid fever. CONCLUSION: From this study, it can be concluded that headache, epigastric pain, nausea, decreased appetite together with fever in the evening/at night with normal/decreased leukocyte count and abnormal liver function are the most common clinical symptoms found in typhoid subjects.

Endotoxin in patients with terminal renal failure undergoing dialysis with re-processing dialyser.

AIM: to determine the level of endotoxin in the blood of patients with renal failure prior to and following hemodialysis using re-processing dialyser to know possibility of pyrogenic reactions in hemodialysis patients. METHODS: this study subjects consisted of 10 patients with terminal renal failure undergoing regular hemodialysis. The collected samples were then sent in frozen condition for endotoxin examination in Japan. The normal level of endotoxin in the blood was < 9.8 pg/ml based on standard E.Coli E.0111 endotoxin quantitatively measured using Limulus Amoebocyte lysate test (the endospecy test). Statistical analysis was performed using paired student test. RESULTS: Ten patients with terminal renal failure who were undergoing hemodialysis were obtained, consisting of 1 female and 9 males. The mean age was 55.5 years (SD 6.74), the mean hemoglobin level 7.26 g/dl (SD 2.19), mean white blood cell (WBC) count 8660/mm(3) (SD 3064.2), and mean albumin level 3.59 g/l (SD 247). The etiologies of renal failure were as follows: glomerulonephritis (GN) 30%, Diabetic nephropathy (DN) 20%, hypertension (HT) 10%, interstitial nephritis (IN) 10%, obstruction/infection (01) 10%, unknown (U) 10%. The mean duration of hemodialysis was 97.9 month (SD 54.86). The mean endotoxin level prior to hemodialysis (ET pre-hemodialysis) was 5.4 pg/dl (SD 8). CONCLUSION: we conclude that terminal renal patients who undergoing re-processing hemodialysis did not have endotoxemia both prior to and following hemodialysis unless if they associated with infection, or other complications.