The prevalence of hypokalemia in hospitalized patients with infectious diseases problem at Cipto Mangunkusumo Hospital, Jakarta.

AIM: to know the prevalence of hypokalemia that occurs in hospitalized patients with infectious diseases. METHODS: a cross sectional study was carried out in the internal ward Cipto Mangunkusumo General Hospital in Jakarta from December 2005 until June 2006. All hospitalized patients with infectious diseases receiving "replacement solution" were included in this study. We collected the blood sample to perform the serum potassium level at the time of admission and discharge. RESULTS: one hundred and five patients were enrolled in this study; consisting of 44 males and 61 females. The age ranged from 14 to 70 years old. The most common infectious diseases were dengue fever, while the underlying diseases were hepatobiliary disorders. "Replacement solutions" which were given, were ringer's lactate 91%, normal saline 8%, and ringer's acetate 1%. Prevalence of hypokalemia among the hospitalized patients, on admission was 24 patients (23%) and during hospitalization was 39 patients (37%). The mean level of hypokalemia on admission was 3.11 + SD 0.37 mEq/L (range from 1.7 to 3.4 mEq/L) and during hospitalization was 3.13 + SD 0.25 mEq/L (range from 2.5 to 3.4 mEq/L). On admission, the ratio of mild : moderate : severe hypokalemia is 22 : 2 : 1. And at discharge the ratio of mild to moderate hypokalemia becomes 19 : 6. CONCLUSION: the prevalence of hypokalemia in hospitalized patients with infectious disease in Cipto Mangkunkusumo's Hospital, Jakarta is 23%. Further studies are needed to know the contributing factors including the usage of 'intravenous fluid' in relations to hypokalemic state during hospitalization.

Correlation between CD4 count and intensity of Candida colonization in the oropharynx of HIV-infected/ AIDS patient.

AIM: To know the correlation between CD4 count and intensity of Candida colonizations in the oropharynx of HIV-infected/AIDS patients, to get the prevalence of oropharyngeal candidiasis (OPC), and to know what kind of Candida species that causes oropharynx candidiasis of HIV-infected/AIDS patients. METHODS: A cross-sectional study was conducted in HIV-infected/AIDS patients who came as outpatients and inpatients in Cipto Mangunkusumo Hospital. The patients were interviewed, physically examined, their CD4 counts were checked, and their mouth rinse samples were taken to be cultured. Candida species was identified in CHROMagar media, and data were processed. RESULTS: From September 2004 until January 2005, 60 HIV-infected/AIDS patients were included in this study. There were 86.7% males and 13.3% females. Majority of the patients were from 20-30 years age group (85%). The most frequent transmission was among drug users (75%) followed by sexual contact (18.3%). The median of CD4 counts was 100 cells/il, ranged from 2 to 842 cells/il. Proportion of the OPC was 63.3% (CI 95% = 51.1 - 75.5). From 59 Candida isolates in this study, 74.58% were C. albicans. Candida non C. albicans species that were found in this trial were C. krusei, C. parapsilosis and C. tropicalis. There was significant correlation between low CD4 counts and high intensity of Candida colonization on the oropharynx of the subjects (r = -0.756). CONCLUSION: There was strong negative correlation (r = -0.756) between CD4 count and intensity of Candida colonization in the oropharynx of HIV-infected/AIDS patients. Proportion of OPC in this study was 63.3%. The most frequent species found in the oropharynx of the subjects was C. albicans.

Surveillance of nosocomial infections in Dr. Cipto Mangunkusumo National General Hospital, Jakarta, 1999-2002.

Nosocomial infection are one of the main problem in hospital which are associated with significant morbidity, mortality and increased economic cost. Surveillance should be attempted regularly to obtain local data of incidence of nosocomial infections, types of infection, pathogen and resistance pattern. We reported the results of nosocomial surveillance in Dr. Cipto Mangunkusumo National General Hospital, Jakarta, in year 1999 to 2002. The data were obtained from surveillance, conducted by Nosocomial Infection Control Committee. Surveillance were performed to patient in risk of nosocomial infections such as underwent surgical procedure, urinary catheter, peripheral or central venous catheter, ventilator and other invasive procedure. Criteria for nosocomial infection which were used, based on technical guidelines of nosocomial infection in Dr. Cipto Mangunkusumo National General Hospital, year 1999; which referred to CDC definition of nosocomial infections. Incidence rate of nosocomial infections in year 1999, 2000, 2001 and 2002 were 1.1, 0.9, 0.6 and 0.4 % respectively. Type of nosocomial infection include catheter related, surgical wound, urinary tract and respiratory tract infections, ranged between 0 to 5.6 %. Gram negative bacteria consist of Pseudomonas sp, Enterobacter aerogenes, Escherichia coli, Proteus mirabilis were the most common nosocomial pathogen. Gram positive bacteria consist of Staphylococcus epidermidis, Staphylococcus aureus and Streptococcus anhemolyticus. Trend of increasing incidence of Gram positive nosocomial infection also showed in our surveillance. Mostly Gram negative bacteria had been resistant to penicillin, co amoxicillin-clavulanic acid and 3rd generation cephalosporin, but still sensitive to 4th generation cephalosporin and aminoglycoside. The Gram positive bacteria were still sensitive to penicillin, co amoxicillin-clavulanic acid, 4th generation cephalosporin and aminoglycoside.

The clinical, laboratory, and microbiological profile of patients with sepsis at the Internal Medicine Inpatient Unit of Dr. Cipto Mangunkusumo National General Hospital, Jakarta.

At the moment, the diagnosis of sepesis is established based on the criteria of the presence of a clinical manifestation of systemic inflammatory response syndrome/SIRS, infection, and organ dysfunction. In the last two years, the idea to add several additional parameters to these criteria has developed, with the proposition to use the acronym PIRO (P: predisposition, I: infection, R: response, and O: organ failure). Clinical manifestations of sepsis at each hospital or treatment unit may differ according to the severity of sepsis, the focus of infection, comorbidity, and organ dysfunction or failure. This study evaluated the demographic, comorbidity, source of infection, SIRS manifestation, organ dysfunction, and microbiological profile of sepsis at the Internal Medicine Inpatient Ward of Dr. Cipto Mangunkusumo National General Hospital, Jakarta. A correlative, cross-sectional, descriptive study was performed on 42 subjects with sepsis, severe sepsis, and septic shock. The study was performed at the Inpatient Ward of Dr. Cipto Mangunkusumo NAtional General Hospital, Jakarta, in the year 2002. Clinical and laboratory (hematological, biochemical, and blood gas analysis) data, as well as results of aerobic cultures of the blood and other specimens were recorded. The criteria of sepsis used were based on that of the American College of Chest Physician and the Society of Critical Care Medicine in 1992. The results of the study demonstrated a proportional distribution of sepsis based on age and sex, with comorbidity in 88% of subjects, consisting of diabetes mellitus and other chronic diseases. The most common sources of infection were the lungs, skin-soft tissue, abdomen, and urinary tract, with Gram-negative bacteria more commonly found than Gram-positive bacteria. SIRS manifestation was found among over 70% of subjects, with the most common manifestations being tachycardia and tachypnea. The most common manifestations of organ dysfunction were reduced consciousness, metabolic acidosis, renal dysfunction, and a lower mean arterial pressure. There was a correlation between these parameters and the degree of sepsis.

Beta-hydroxybutirate levels as a determinant for the success of diabetic ketoacidosis management.

AIM: To obtain a greater understanding of the diagnosis and evaluation of success in diabetic ketoacidosis management. METHODS: A prospective observational study was performed on patients with diabetic ketoacidosis at the Emergency Unit of Cipto Mangunkusumo General Hospital. All patients that were admitted were had their blood glucose, beta-hydroxybutirate, acetoacetate, pH, pCO2, HCO3, anion gap and consciousness levels serially monitored on upon admittance (0 hour) and the 2nd, 6th, 12th, 18th and 24(th) hours. The correlation coefficient of each examination was also calculated. The benefit of serial examination of each variable was also determined for each ketoacidosis undergoing the study. RESULTS: Out of the 19 available samples, a strong negative correlation was found between beta-hydroxybutirate and pH with a value of r>0.5 (from -0.524 to -0.833 with p<0.05) for 24 hours, compared to acetoacetate with the lowest r of -0.515 to -0.731 lasting up to 12 hours. Blood glucose and pH is correlated only at 0 hour, the same with the correlation between beta-hydroxybutirate and HCO(3). pCO2 and anion gap is better compared to that of blood glucose and acetoacetate. There is no correlation between the three and the level of consciousness. Significant serial examinations to perform are blood glucose, beta-hydroxybutirate, and HCO(3). CONCLUSION: beta-Hydroxybutirate has a stronger correlation compared to blood glucose and or acetoacetate towards pH, pCO2, HCO(3), and anion gap. Patients with ketoacidosis are recommended to undergo blood beta-hydroxybutirate examination. Serial examination should be performed for blood glucose, beta-hydroxybutirate, and bicarbonate.

The correlation between thrombopoietin and platelet count in adult dengue viral infection patients.

AIM: To investigate alteration in humoral regulation during the course of dengue viral infection. METHODS: A prospective analytic study had been conducted involving 40 subjects with dengue viral infection. Subjects were recruited according to consecutive non-probability sampling. Subjects were categorized according to days of illness, platelet counts and serum thrombopoietin (TPO) levels. The plasma TPO levels examinations were done once daily until the platelet counts reached more than 100,000/mm(3). RESULTS: Statistical analysis showed the mean serum TPO levels were increased during thrombocytopenia phase of the disease, and differ significantly from the convalescent phase (mean value 428 pg/ml vs 220.1 pg/ml, p= 0.00). There was also a statistically significant inverse correlation between serum TPO levels and platelet counts (p= 0.00). CONCLUSION: TPO levels were significantly increased in adult patients with dengue infection in which platelets in circulation were markedly reduced, and the TPO levels were inversely related to the platelet counts.