Mansyur Arif

Emergence of Melioidosis in Indonesia

Melioidosis is known to be highly endemic in parts of southeast Asia and northern Australia; however, cases are rarely reported in Indonesia. Here we report three cases of melioidosis in Makassar, South Sulawesi, Indonesia occurring between 2013 and 2014. Two patients died and the other was lost to follow-up. Burkholderia pseudomallei isolates from all three cases were identified by the VITEK2 Compact installed in the hospital in 2012. None of the three patients reported received antimicrobials recommended for melioidosis because of the delayed recognition of the organism. We reviewed the literature and found only seven reports of melioidosis in Indonesia. Five were reported before 1960. We suggest that melioidosis is endemic throughout Indonesia but currently under-recognized. Training on how to identify B. pseudomallei accurately and safely in all available microbiological facilities should be provided, and consideration should be given to making melioidosis a notifiable disease in Indonesia.

Capacity and Utilization of Blood Culture in Two Referral Hospitals in Indonesia and Thailand

Abstract. It is generally recommended that sepsis patients should have at least two blood cultures obtained before antimicrobial therapy. From 1995 to 2015, the number of blood cultures taken each year in a 1,100-bed public referral hospital in Ubon Ratchathani northeast Thailand rose from 5,235 to 56,719, whereas the number received in an 840-bed referral public hospital in South Sulawesi, Indonesia, in 2015 was 2,779. The proportion of patients sampled for blood cultures out of all inpatients in South Sulawesi in 2015 (9%; 2,779/30,593) was lower than that in Ubon Ratchathani in 2003 (13%; 8,707/66,515), at a time when health expenditure per capita in the two countries was comparable. Under-use of bacterial cultures may lead to an underestimate and underreporting of the incidence of antimicrobial-resistant infections. Raising capacity and utilization of clinical microbiology laboratories in developing countries, at least at sentinel hospitals, to monitor the antimicrobial resistance situation should be prioritized.

Emergence of Melioidosis in Indonesia and Today’s Challenges

A recent modeling study estimated that there could be as many as 20,000 human melioidosis cases per year in Indonesia, with around 10,000 potential deaths annually. Nonetheless, the true burden of melioidosis in Indonesia is still unknown. The Indonesia Melioidosis Network was formed during the first melioidosis workshop in 2017. Here, we reviewed 101 melioidosis cases (99 human and two animal cases) previously reported and described an additional 45 human melioidosis cases. All 146 culture-confirmed cases were found in Sumatra (n = 15), Java (n = 104), Kalimantan (n = 15), Sulawesi (n = 11) and Nusa Tenggara (n = 1). Misidentification of Burkholderia pseudomallei was not uncommon, and most cases were only recently identified. We also evaluated clinical manifestations and outcome of recent culture-confirmed cases between 2012 and 2017 (n = 42). Overall, 15 (36%) cases were children (age <15 years) and 27 (64%) were adults (age ≥15 years). The overall mortality was 43% (18/42). We conducted a survey and found that 57% (327/548) of healthcare workers had never heard of melioidosis. In conclusion, melioidosis is endemic throughout Indonesia and associated with high mortality. We propose that top priorities are increasing awareness of melioidosis amongst all healthcare workers, increasing the use of bacterial culture, and ensuring accurate identification of B. pseudomalleiand diagnosis of melioidosis.

BMI and Waist Circumference Have Positive Correlation With Mitochondrial DNA Copy Number in Young Adult Male

Received: February 28, 2018 Revised: April 19, 2018 Accepted: May 10, 2018 Abstract: Background: Abdominal obesity is associated with metabolic and cardiovascular diseases. Mitochondrial dysfunction is often related to metabolic disorder commonly found in abdominal obesity. Mitochondrial DNA (mtDNA) copy number is a biomarker which can be used to reflect the activity of mitochondria. Abdominal obesity is more commonly found in males compared to females and the incidence is growing in young adult male, therefore we investigated the relationship of mtDNA copy number and anthropometric and metabolic biomarkers in young adult male.

Body Mass, Total Body Fat Percentage, and Visceral Fat Level Predict Insulin Resistance Better Than Waist Circumference and Body Mass Index in Healthy Young Male Adults in Indonesia

The incidence of obesity which leads to insulin resistance (IR) and metabolic disorder is increasing in developing countries, including Indonesia. Male adults have a higher risk of abdominal obesity than females. This is associated with cardiometabolic disorders. Several anthropometric measurements have been proposed to predict IR. The aim of this study was to investigate whether body mass, body mass index (BMI), waist circumference (WC), body fat percentage (BF) or visceral fat level (VF) could become a better predictor of IR in healthy young male adults. A total of 140 healthy young male adults ranging from 18–25 years were recruited in the study. Insulin resistance was measured by calculating their Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Subjects with a HOMA-IR value ≥75th percentile, with cut off 3.75, were defined as IR. Anthropometric measurements including body weight, BMI, and WC were performed, whereas BF and VC were measured using bioelectrical impedance analysis (BIA). IR had a strong correlation with body weight, BMI, WC, BF, and VF. In the area under the curve of body mass, BF and VF were slightly greater than WC and BMI. Anthropometric measurements correlated strongly with IR but body weight, BF, VF had a stronger correlation than WC and BMI in healthy young male adults.

DIAGNOSIS TIROID (Diagnosis of Thyroid)

Thyroid disease often causes unspecific or mild symptoms, so laboratory tests are needed to confirm the functional diagnosis of the thyroid disorder. The laboratory tests which are important to establish the diagnosis of thyroid disorder include: total and free thyroid hormones, its related (thyroid) hormone binding proteins and auto antibodies. The thyroid hormone tests are mostly measured with competitive or sandwich immunoassays and each method can be interfered by several factors. Some drugs may increase or decrease the thyroid functional tests and several factors such as: underlying diseases, age, pregnancy, occurrence of heterophil antibody and auto antibodies may also interfere the thyroid tests results. The interpretation of an unusual combination from thyroid stimulating hormone such as free thyroxin and tri-iodothyronine results needs confirmation of underlying condition for establishing the right diagnosis. This review is aimed to evaluate several factors which may influence the thyroid tests and interpretation.

ESTIMATED BLOOD LOSS IN OPEN HEART SURGERY (Taksiran Kehilangan Darah di Bedah Jantung Terbuka)

Taksiran kehilangan darah merupakan perkiraan kehilangan darah di setiap tindakan pembedahan. Permintaan darah untuk persiapan pembedahan elektif sering tidak sesuai dengan jumlah darah yang ditransfusikan selama tindakan tersebut karena belum ada panduan mengenai jumlah permintaan darah untuk tata langkah bedah. Penelitian ini bertujuan untuk mengetahui taksiran kehilangan darah pada pembedahan jantung terbuka dan kesesuaian dengan permintaan darah dalam kegiatan tersebut. Penelitian dilakukan secara observasional retrospektif seraya mengambil data rekam medis di Instalasi Rekam Medik RSUP dr. Wahidin Sudirohusodo Makassar antara bulan Januari 2009−Desember 2012. Sebanyak 32 pasien yang menjalani bedah jantung terbuka didapatkan dengan presentasi laki-laki sebanyak 22 pasien (68,75%) dan perempuan sebanyak 10 orang (31,25%). Jumlah taksiran kehilangan darah bedah jantung terbuka rerata 2,80 kantong darah lengkap (980 mL) dan permintaan darah untuk kegiatan tersebut rerata sebanyak 4,00 kantong (1400 mL). Antara jumlah permintaan darah persiapan bedah dan taksiran kehilangan darah (p=0,149) terdapat ketidaksesuaian. Taksiran kehilangan darah di bedah jantung terbuka di RSUP dr. Wahidin Sudirohusodo Makassar di RSUP dr. Wahidin Sudirohusodo Makassar adalah 2,80 kantong darah lengkap (980 mL), yang tidak sesuai dengan jumlah permintaan darah persiapan bedah.

ANGKA BANDING NETROFIL/LIMFOSIT DI POPULASI DEWASA MUDA

Previous studies have shown that neutrophil/lymphocyte ratio in bacteremia is higher than nonbacteremia, therefore it could be used as a marker to distinguish both conditions in patients with sepsis .Another study on oncology patients in ICU showed a correlation between the severity of clinical course and the increase of neutrophil/lymphocyte ratio. In physiological condition, neutrophil/lymphocyte ratio 6. Neutrophil/lymphocyte ratio is a sensitive, fast, cost effective and applicable laboratory test for routine use, therefore this test result can be used as the parameter to assess clinical condition of patients. However, a reference value of neutrophil/lymphocyte ratio has never been defined, especially in Makassar City, South Sulawesi Province. The aim of this study was to know the neutrophil/lymphocyte ratio in a healthy young adult population. A cross sectional study was conducted from March to April 2014, involving residents (specialistic candidates in Medical Faculty, Hasanuddin University, who underwwent medical checkup and voluntarily joined this study. Samples consisted of 198 persons who fulfilled the inclusion criteria with an age range between 24-40 years old, comprising 84 males (42.42%) and 114 females (57.58%). The neutrophil/lymphocyte ratio for all samples was 1.95 (1.15-4.74). Mann Whitney test showed that there was no significant difference of neutrophil/lymphocyte ratio between males and females, 1.88 (1.25-4.74) vs 1.95 (1.15-4.12), p=0.65 and neither between the age group 21-30 years old and 31-40 years old, 1.95 (1.21-4.74) vs 1.94 (1.15-4.09), p=0.82.

CHARACTERISTICS OF CROSSMATCH TYPES IN COMPATIBILITY TESTING ON DIAGNOSIS AND BLOOD TYPES USING GEL METHOD (Ciri Inkompatibilitas Uji Cocok Serasi Metode Gel terhadap Diagnosis dan Golongan Darah)

Pemeriksaan uji cocok serasi adalah pemeriksaan kesesuaian darah pasien dan donor. Pemeriksaan ini untuk mengetahui apakah antigen eritrosit donor sesuai dengan antibodi di serum pasien (uji mayor) dan antigen eritrosit pasien terhadap antibodi di serum donor (uji minor). Pemeriksaan uji cocok serasi dapat dilakukan dengan metode tabung (metode konvensional) dan Gel. Penelitian ini bertujuan untuk mengetahui ciri golongan darah dan diagnosis di inkompatibilitas uji cocok serasi dengan menggunakan metode Gel. Rancangan penelitian berupa observasional retrospektif di Bank Darah Rumah Sakit (BDRS) RSUP Dr.Wahidin Sudirohusodo Makassar dengan mengambil data Sistem Informasi Rumah Sakit (SIRS) dan data rekam medis masa waktu Juni 2013-Juni 2014. Jumlah keseluruhan 213 sampel dengan jumlah laki-laki 105 orang (49,3%) dan perempuan 108 orang (50,7%). Rentang umur terbanyak >17 tahun (83,6%). Kelompok di inkompatibilitas terbanyak di penyakit infeksi (36,2%) dengan golongan darah B (32,9%), rhesus positif (100%) dan tipe inkompatibilitas minor (81,2%). Pasien tanpa riwayat transfusi lebih banyak (97,7%) dibandingkan dengan riwayat transfusi (2,3%). Perlu diteliti lebih lanjut dengan anamnesis langsung di pasien untuk menghindari bias sehingga diperoleh hasil yang lebih sahih. Selain itu diperlukan penelitian lebih lanjut pemeriksaan penyaringan dan identifikasi antibodi di setiap ketidaksesuaian uji cocok serasi.

DAN MYELOPEROxIDASE) DAN DISFUNGSI ENDOTEL (ASIMETRIK DIMETILARGININ) DI KEGEMUKAN (OBESITAS)

Obesity is a pathological condition in which there is an excess body fat due to imbalance energy expenditure. Its association with oxidative stress could cause other metabolic disorders such as endothelial dysfunction, atherosclerosis, and cardiovascular disease. The aim of this study was to assess the correlation of oxidative stress (F2-Isoprostane, Superoxide dismutase and Myeloperoxidase) and endothelial dysfunction (Asymmetric dimethylarginine) which happened in central obese men. A cross sectional study was carried out in 62 central obesity male subjects with ages range between 30−60 years. The researcher determined SOD activity, concentration of MPO as well as ADMA. In this study was found a significant correlation of F2-Isoprostan (r = 0.333, p = 0.008), MPO (r = 0.386; p = 0.008) and ADMA but not with SOD. The elevated concentration of F2-Isoprostane occur 3.5 times (p = 0.02; 95%; CI = 1.19– 10.19), elevated MPO occur 3.7 times (p = 0.023; 95%; CI = 1.16–11.56) while combination of elevated F2-Isoprostane-MPO occur 6.7 times (p = 0.011; 95%; CI = 1.33-33.24) will increase the risk of endothelial dysfunction. There was a significant correlation of oxidative stress with endothelial dysfunction, and the increase concentration of F2-Isoprostane and MPO indicates the occurrence of endothelial dysfunction in central obesity.