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.

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.

The correlation between coagulation test and albumin with antithrombin III in Dengue hemorrhagic fever.

AIM: To analyse the correlation between coagulation tests (PT APTT fibrinogen, D-dimer) and albumin with AT-II in DHF as well to find the formula to calculate AT-III with the parameter of coagulation tests and albumin. METHODS: A descriptive-correlative cross sectional study was conducted to 49 patients with DHF consisted of DHF I(17), DHF (19), DHF III (6) and DHF IV (7). The diagnosis of DHF is based on WHO criteria 1997. The laboratory examinations were coagulation tests (PT, APT, fibrinogen and D-dimer), antithrombin III and albumin, performed when the fever subside and the platelets reached the lowest count(4(th) - 6(th) day). RESULTS: A significant correlation was found between PT and AT-III (r= -0.631; p=0.000), between D-dimer and AT-III (r= -0.337; p=0.021) and between albumin and AT-III (r= 0.291; p-0.045). In multiple linier regression analysis(backward), AT-III can be calculated with the formula, accuracy 68.3%. CONCLUSIONS: PT and D-dimer were correlated negatively with AT-III, however albumin was correlated positively with AT-III. PT, D-dimer and AT-III were correlated with the grading severity of the DHF. In this study, AT-III can be calculated with the formula, accuracy 68.3%.

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.

Diagnosis of disseminated intravascular coagulation in sepsis scoring system of a thrombosis-hemostasis center.

BACKGROUND: Disseminated intravascular coagulation (DIC) is a septic complication that is not easily diagnosed. The purpose of the study is to obtain a scoring system to diagnose DIC in sepsis. SUBJECT AND METHODS: An observational study with a cross-sectional design was performed at the Department of Internal Medicine, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital from February to August 2002. Subjects were septic patients in the emergency unit or inpatient ward of the Department of Internal Medicine, and were taken consecutively. The criteria of sepsis, severe sepsis and septic shock were based on ACCP/SCCM Consensus 1991. The evaluation conformed to the Thrombosis Hemostasis Center (THC) scoring system, compared with modified Bick scoring system as a gold standard. RESULTS: There were 34 subjects ranging from 19 to 78 years old, 32.4% were septic patients, 41.2% with severe sepsis and 26.5% with septic shock. The most common source of infection was pneumonia, where bacterial pathogens were found in 35.2% of blood aerobic culture and 17.7% in pus or urine culture. Gram negative bacteria was the most common pathogen found. According to a modified Bick and THC scoring system, DIC was found in all subjects, consisting of mild and moderate DIC. No severe DIC was found. There was no difference between both scoring systems, with a p value of 0.125 based on the Mc Nemar test. There was no difference found in mild and moderate DIC in sepsis, severe sepsis and septic shock of modified Bick scoring systems (p value of 0.987) and THC scoring system (p value of 1.000). CONCLUSION: No difference was found between THC and modified Bick scoring system in diagnosing DIC in septic patients. In sepsis, severe sepsis and septic shock, mild and moderate DIC complications can be diagnosed with THC scoring system, which are of the same potency with the modified Bick, with the assumption that the modified Bick scoring system was the same as the Bick scoring system.