Jose M. Mandei

Case Report: Severe Plasmodium vivax Malaria Mimicking Sepsis in a Neonate

Severe congenital malaria associated with Plasmodium vivax is uncommon. In Indonesia, most congenital malaria cases are due to Plasmodium falciparum infections. Most cases of congenital or neonatal malaria in endemic areas are diagnosed from peripheral smear as part of routine sepsis workup. Differentiating congenital and acquired neonatal malaria is very difficult. The case presented in this study describes severe P. vivax malaria with cholestatic jaundice and sepsis-like signs and symptoms in neonates. The mother was asymptomatic and the neonate was successfully treated with intravenous artesunate. Severe P. vivax malaria with cholestatic jaundice in neonates is an uncommon condition that should be included in the differential diagnosis of infants displaying hemolytic anemia, thrombocytopenia, cholestatic jaundice, and hepatosplenomegaly in malaria-endemic zones. Early diagnosis can prevent the use of unnecessary antibiotics and mortality of neonates.

Hubungan antara Kadar Asam Urat, Interleukin-6 dan hs-CRP pada Anak Obes

Latar belakang . Hubungan antara kadar asam urat dengan sindrom metabolik banyak diteliti akhir-akhir ini. Asam urat juga menghambat proliferasi sel endotel dan menstimulasi produksi C-reactive protein (CRP) pada sel endotel. Interleukin-6 (IL-6) berasal dari jaringan adiposa yang menyebabkan peningkatan CRP. Tujuan . Menganalisis hubungan antara kadar asam urat, IL-6, dan hs-CRP pada anak obes. Metode . Kami melakukan penelitian potong lintang pada bulan Oktober 2015 sampai Desember 2015. Subyek anak obes berumur 6-12 tahun. Informed consent diberikan oleh orang tua. Penelitian ini telah disetujui oleh Komite Etik penelitian FK Unsrat. Hubungan antara asam urat, IL-6, dan hs-CRP diuji dengan uji Pearson dan regresi linear. Data dianalisis dengan software SPSS versi 22.0, nilai p<0,05 signifikan. Hasil . Terdapat 43 anak obes, 60.5% laki-laki, dan 39.5% perempuan. Hubungan asam urat dan hs-CRP didapatkan r=0,458 dan p=0,001, sedangkan hubungan IL-6 dan hs-CRP didapatkan hasil r=0,331 dan p=0,015. Kesimpulan . Terdapat hubungan positif antara asam urat dan hs-CRP, hubungan positif lemah antara IL-6 dan hs-CRP pada anak obes.

Hubungan Kadar Serum Metabolit Nitrit Oksida dan Gangguan Fungsi Ginjal pada Sepsis

Latar belakang. Sepsis adalah respons sistemik terhadap infeksi dengan salah satu komplikasinya berupa gagal organ ginjal. Peran nitrit oksida (NO) sebagai mediator yang terlibat dalam mekanisme gagal organ ginjal kasus sepsis masih bersifat kontroversi. Tujuan . Mengevaluasi hubungan antara kadar serum NO dan gangguan fungsi ginjal pada sepsis anak. Metode. Desain penelitian potong lintang secara konsekutif dilaksanakan sejak bulan Juni sampai November 2012 dengan sampel anak usia satu bulan sampai lima tahun yang didiagnosis sepsis. Pemeriksaan kadar serum kreatinin mencerminkan fungsi ginjal dan kadar serum metabolit NO (nitrat dan nitrit) mencerminkan kadar NO endogen. Uji korelasi menggunakan uji korelasi Spearman, dinyatakan bermakna apabila p<0,05. Data diolah menggunakan piranti lunak SPSS 19.00 Hasil . Diperoleh 40 subjek dengan median usia 8,5 bulan (2 sampai 70 bulan) dan 22 di antaranya anak laki-laki. Kadar metabolit NO ditemukan berhubungan dengan kadar serum kreatinin (rs=0,33; p=0,041). Kesimpulan. Terdapat hubungan antara peningkatan kadar serum NO dan terjadinya gangguan fungsi ginjal pada anak dengan sepsis.

Confusions and dilemma around hepatic dysfunction associated falciparum malaria: A case report and brief review of the literature

Malaria remains a big burden in East Indonesia. Severe malaria assaults children in endemic area and leads to enormous morbidities and mortalities. According to the World Health Organizations criteria, recognition of one or more of the following clinical features should raise the suspicion of severe malaria i.e, cerebral malaria (unrousable coma), severe anemia (hemoglobin 3 mg/dl), pulmonary edema or adult respiratory distress syndrome (ARDS), hypoglycemia (glucose 5% of the erythrocytes infested by parasites), or jaundice (bilirubin> 3 mg/dl).l-3 Jaundice in malaria due to hepatic dysfunction is a classical case, nevertheless, there are some confusions and dilemmas in managing it.1 We report a case with jaundice due to hepatic dysfunction and hemolysis associated falciparum malaria that we treated in General Hospital of Fakfak, West Papua, and provide a brief literature review on the matter.

Comparison of blood plasma and gelatin solution in resuscitation of children with dengue shock syndrome

Background Dengue shock syndrome (DSS) is characterized by severe vascular leakage and hemostasis disorder. It is the cause of death in 1 to 5 percent of cases. WH 0 management guidelines for resuscitation remain empirical rather than evidence-based. Objective To find out the alternative fluids to replace plasma leakage in DSS. Methods We performed a prospective study and randomized comparison of plasma and gelatin solution for resuscitation of Indonesian children with DSS. We randomly assigned 25 subjects with DSS to receive plasma and 25 children to receive gelatin fluid. Statistical analyse were performed using chi-square test, Fishers exact test, t test, Mann-Whitney test. Results The increment of pulse pressure width and the decrement of hematocrit in subjects treated with gelatin were higher than that of plasma atfour-hour therapy (P=0.002 and P=0.017). Only one patient died caused by unusually manifestation of DSS. The increment of body temperature in subjects treated with plasma was higher than that of gelatin at four-hour therapy (P=O.Oll). The decrement of platelet count in subjects treated with gelatin were less than that of plasma (P=0.018). The increment of diuresis rate in subjects treated with gelatin was higher than that of plasma at twenty-hour therapy (P 0.05). Conclusions Gelatin solution can be used as volume replacement in resuscitation of DSS if blood plasma is not available especially at four-hour therapy.