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Grasp of dihydroartemisinin resistance in Indonesia: Focused on genetic polymorphisms and new antimalarial
Get PDFThe eastern region of Indonesia is endemic to malaria, a tropical parasitic infection that causes significant mortality. The Sustainable Development Goals (SDGs) encompass the global commitment to prevent and eliminate malaria by the end of 2030. Nevertheless, the biggest issue lies in the antimalarial drug resistance in Indonesia. Genetic polymorphism has been a considerable factor in the mechanism of antimalarial drug resistance of which could lead to inadequate activity of antimalarial drugs to undertake Plasmodium infection by several molecular mechanisms. Hence, first-line therapy for malaria in Indonesia such as dihydroartemisinin, piperaquine, and primaquine, becomes ineffective. However, the resistance is unavoidable. This review aims to summarize the genetic polymorphism possible mechanisms contributing to antimalarial resistance in the Indonesian population and to discuss the potential new antimalarial drug candidates
Quantity of antibiotic use and its association with clinical outcomes in COVID-19 patients: A snapshot from a provincial referral hospital in Indonesia
Get PDFIrrational antibiotic use in Indonesia is considered high, yet there are still lacks reliable information regarding the issue. The quantity of antibiotic use studies, in particular during coronavirus disease 2019 (COVID-19) pandemic, was not well reported. The aim of this study was to evaluate antibiotic use in COVID-19 patients at a province referral hospital in Aceh, Indonesia, Dr Zainoel Abidin Hospital, and to assess the association between antibiotic use and COVID-19 clinical outcomes. The defined daily dose (DDD) method was used and expressed in DDDs per 100 patient-days as in hospital setting. The data were obtained from inpatient confirmed COVID-19 patients between March 2020 and December 2021. A logistic regression was used to determine the association between patients’ characteristics and antibiotic usage with clinical outcomes. A total of 361 treated COVID-19 patients were included using a random sampling technique and analyzed. Out of 361 patients, 89.2% of them were treated with antibiotic(s). All the antibiotics were given empirically except for cefazoline (5.5%) that was used as prophylaxis to obstetric patients who underwent the c-section. Azithromycin was the most prescribed antibiotic and levofloxacin had the highest DDD. Our data suggested that there was no association between antibiotic use and clinical outcomes of COVID-19 patients (p=0.128). Having sepsis and another pulmonary disease however were associated with mortality of COVID-19 patients with adjusted odds ratio (aOR) 14.14; 95%CI 2.94–67.90, p=0.001 and aOR 8.64; 95%CI 3.30–22.63, p<0.001, respectively. In addition, patients older than 60-year-old had a higher chance to an unfavorable outcome compared to those younger than 30-year-old, aOR: 7.61; 95%CI: 1.07–53.94. In conclusion, the use of antibiotics is prevalent among COVID-19 and it is not directly associated with clinical outcomes
Evaluating the impact of triple elimination program for mother-to-child transmission of HIV, syphilis, and hepatitis B in Indonesia
Get PDFIndonesian government launched a triple elimination program to eliminate mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV), syphilis, and hepatitis B in 2018, aiming to increase screening uptake among pregnant women during antenatal visits and to reduce the rates of these infections in children less than 50 per 100,000 live births. Despite this initiative, a thorough assessment of its effectiveness, particularly in Bandung, the capital city of West Java, as one of the most densely populated cities in Indonesia with a high HIV incidence, has yet to be conducted. The aim of this study was to analyze the impact of this triple elimination program in Bandung by assessing the data between 2017 and 2020. Monthly data was obtained from the Health Office of Bandung for four years, including number of screenings done for HIV, syphilis, and hepatitis B, number of confirmed cases and number of pregnant women treated for those infections. Additionally, data on children under 24 months old afflicted by these infections were also collected. Our data indicated an increase in screening coverage for HIV, syphilis, and HBV among pregnant women; however, it remained below the national set benchmarks for screening coverage. Only 59.5% of HIV-positive pregnant women received anti-retroviral therapy in 2020, while merely 25% of syphilis-positive cases were administered benzathine penicillin G. Syphilis screening was correlated with an increase in positive cases among children, suggesting missed opportunities in managing syphilis-positive pregnant women. Furthermore, management of HIV- and syphilis-positive cases had suboptimal outcomes. Data on hepatitis B was not evaluated since it was not available. To achieve the triple elimination program goals, comprehensive coordination among all relevant stakeholders is required, as is continuous monitoring and evaluation
Celiac disease: Pathogenesis, disease management and new insights into the herbal-based treatments
Get PDFCeliac disease (CD) is a gluten intolerance autoimmune disorder which its symptoms involve the gastrointestinal tract and sometimes the other organs. It is one of the most prevalent health problems rising in many populations as statistics show that in every 100 people about one person is suffering from CD. It has been observed that the persons who genetically contain the human leukocyte antigen (HLA) DQ2 and HLA DQ8 genes involved in the immune system haplotypes are more prone to develop an allergy to gluten. The only treatment currently available for CD is a strict gluten-free diet. However, recent research has shown promising new insights into the herbal-based treatments of CD. New insight on CD is now offering various prospects to manage its treatment, diagnosis, and serving in the development of advanced therapies. Several herbs and botanical extracts have demonstrated anti-inflammatory, immunomodulatory, and gut-healing properties that make them potential candidates for the management of CD. Here, we provide an updated review on pathogeneses and managements of CD. In particular, we summarize the current understandings of herbal-based treatments for CD and highlights their potential benefits
Clinical and oral microbiome pattern of halitosis patients with periodontitis and gingivitis
Get PDFHalitosis is caused by a bacterial proteolytic process that induces the production of volatile sulfur compounds, odor-causing gases. The aim of this study was to determine the clinical oral hygiene state and oral microbiome pattern of halitosis patients with periodontitis and gingivitis. The oral hygiene state of halitosis patients with periodontitis and gingivitis was assessed using the oral hygiene index simplified (OHI-S), decay missing filled teeth (DMFT), and tongue biofilm. The dorsum of the tongue and subgingival swabs were cultured for bacteria, and bacterial morphology was evaluated using Gram staining. Evaluation of the bacterial genus using the Bergey's systematic bacteriology diagram as a guide. A total of ten patients with periodontitis and gingivitis were included. Our data indicated that the scores of OHI-S and DMFT were different significantly between halitosis patients with periodontitis and gingivitis (both had p<0.001) while tongue biofilm score was not different between groups. On the dorsum of the tongue, periodontitis patients had a significant higher oral microbiome population (85.65x106 CFU/mL) compared to those with gingivitis (0.047x106 CFU/mL) with p=0.002. In contrast, the number of microbiomes in the subgingival had no significant different between periodontitis and gingivitis. On the dorsum of the tongue, six bacterial genera were isolated from periodontitis cases and seven genera were detected from gingivitis patients. On subgingival, 10 and 15 genera were identified from periodontitis and gingivitis, respectively. Fusobacterium, Propionibacterium, Eubacterium and Lactobacillus were the most prevalent among periodontitis cases while Porphyromonas was the most prevalent in gingivitis patients. In conclusion, although OHI-S and DMFT are different between periodontitis and gingivitis, overlapping of bacterial genera was detected between periodontitis and gingivitis cases
Antioxidant and antiaging activity of Cinnamomum burmannii and Michelia champaca extract and combinations
No full textAging is a natural skin process that occurs due to intrinsic and extrinsic factors, such as excessive exposure to ultraviolet light (photoaging). The mechanism of damage involves the production of excess free radicals that trigger oxidative stress in the skin. Determining the natural products that have high antioxidant activities as antiaging is up most important. Cinnamomum burmannii and Michelia champaca are typical Aceh plants that are believed to have high antioxidant effects. The aim of this study was to determining the contents of C. burmannii and M. champaca as well as to determine the antioxidant and antiaging activities of either individually or combinations. The qualitative phytochemical and semi-quantitative analysis of the extracts were conducted using gas chromatography and mass spectroscopy (GC-MS). The antioxidant activity was examined by radical scavenging using the DPPH radical while the antiaging activity was tested the tyrosinase enzyme inhibition test. The phenolic and flavonoid contents of C. burmannii were higher than M. champaca (66.34 vs 24.71 mg gallic acid equivalent/gr) and (80.52 vs 60.20 mg quercetin equivalent/gr). The inhibitory concentration (IC₅₀) of M. champaca extract in inhibiting DPPH indicated that M. champaca had a better antioxidant activity than C. burmannii. The combination of C. burmannii and M. champaca extracts had a lower IC₅₀ compared to M. champaca alone. C. burmannii and M. champaca extract had a weak potential to inhibit tyrosinase activity (IC₅₀ value ≥1000 µg/mL). In conclusion, this study indicates that M. champaca and C. burmannii have strong antioxidant activities and these might associate with polyphenol contents
Coexistence of pulmonary tuberculosis and small cell lung carcinoma: A significant problem in tuberculosis-endemic country?
Get PDFPulmonary tuberculosis and lung cancer are public health problems, causing significant morbidity and mortality worldwide. The coexistence of the two diseases has rarely been reported while their causative association has been noticed leading to diagnosis delayed and prognosis worsening. In this case report, we present the case of a patient with coexistence of pulmonary tuberculosis and small cell lung carcinoma. A 54-year-old male was presented with the complained of lower left chest pain for six months, which was getting worse four days before admission to the hospital. The patient also complained of cough and decreased appetite and weight loss. Initial chest X-ray revealed an infiltrate and cavity in the upper right lung and inhomogeneous consolidation in the left paracardial. After the patient was diagnosed with pulmonary tuberculosis and was given anti-tuberculosis drugs for two months, the cavity and consolidation decreased with no clinically significant improvement. We performed a bronchoscopy with suspicion of lung cancer and a forceps biopsy in which small cell carcinoma was confirmed. The patient received two cycles of chemotherapy and anti-tuberculosis was continued for four months. During the observation in the fourth month, there was a reduction in the tumor size. This case highlights that similarity of clinical symptoms between pulmonary tuberculosis and lung cancer often lead to misdiagnosis of both. Therefore, in the absence of complete clinical and radiological improvement in pulmonary tuberculosis patients, the coexistence of lung cancer should be considered. This also highlights that early diagnosis is critical for the favorable outcome
Distribution and antibacterial susceptibility pattern of isolated bacteria from endotracheal aspirates among ventilator-assisted pneumonia patients in Indonesia
Get PDFAn accurate and timely identification of causative microorganisms as well as determination of their antibiotic susceptibility patterns will help in the selection of proper antibiotics and prevention of their misuse in pneumonia patients. The aim of this study was to determine the distribution and antibiotic susceptibility pattern of bacteria isolated from endotracheal aspirates of ventilator-assisted pneumonia patients in Indonesia. A retrospective cross-sectional study was conducted at Dr. Zainoel Abidin Hospital, a provincial reference hospital in Banda Aceh, Indonesia, from January to December 2021. Ventilator-assisted pneumonia patients aged ≥17 years treated in the hospital were considered eligible. Antibiotic susceptibility was valuated using Kirby-Bauer disc-diffusion followed with VITEK 2 Compact. We included 57 patients of which 73.7% males and 26.3% aged 56–65 years (represent the majority group of the patients). Each patient reported at least one comorbidity and the average duration of receiving mechanical ventilation was 8.68 days, and more than half (59.7%) of the patients had a poor clinical outcome (died). A total 57 bacteria isolates (consisting nine species) were recovered; 68.5% Gram-negative and 31.5% Gram-positive bacteria. Among 57 patients, Acinetobacter baumannii was the most frequent isolated Gram-negative bacteria (19.3%), followed by Klebsiella pneumoniae (17.5%), Pseudomonas aeruginosa (15.8%), and Achromobacter denitrificans (12.3%). A. baumannii exhibited <70% sensitivity to aminoglycoside and carbapenem antibiotics and 100% resistance to third-generation cephalosporins. The most abundant Gram-positive bacteria was Staphylococcus aureus (17.5%), followed by S. haemolyticus (10.5%) and S. epidermidis (3.5%). All S. aureus were sensitive to linezolid, tigecycline, vancomycin, and macrolide antibiotics (azithromycin, clarithromycin, clindamycin, and erythromycin), whereas 50% were sensitive to some beta-lactams. However, 50% of S. aureus were methicillin resistant S. aureus (MRSA). Given the magnitude of multi-drug resistance, an empiric antimicrobial therapy in particular to specific settings and implementation of antibiotic stewardship programs are crucial
One Health approach and zoonotic diseases in Indonesia: Urgency of implementation and challenges
Get PDFThe urgency of implementing the One Health approach to overcome zoonotic diseases cannot be overstated. By recognizing the interconnectedness of human health, animal health, and the environment, we can effectively prevent and respond to emerging infectious disease threats. This correspondence provides information on the importance of generating research on zoonotic diseases, especially in Indonesia, where research is still relatively scarce. The Indonesian government has taken steps to implement the One Health by establishing the One Health Coordinating Unit and the National Zoonosis Committee; however, implementation has not been optimal. The urgency and challenges are focused on critical implementation aspects in the community. The urgency of implementing One Health includes that Indonesia has experienced several outbreaks of zoonotic diseases, high environmental degradation, and the antimicrobial resistance (AMR) issue in Indonesia has increased. The challenges faced in implementing One Health are overcoming fragmentation due to incohesive communication between important sectors, securing funding and resource investment, aligning policies to eliminate regulation barriers, capacity building to increase awareness and professionals, and addressing critical socioeconomic factors. By prioritizing implementing the One Health approach and addressing existing challenges, Indonesia can build a more resilient and integrated system to protect the well-being of all species, protect ecosystems, and prevent the devastating effects of zoonotic diseases on global health. In this review, we present the urgency of One Health implementation and its challenges comprehensively
Risk factors of early mortality in COVID-19 patients in Indonesia: A retrospective cohort study in a provincial referral hospital of Aceh
Get PDFSome of coronavirus disease 2019 (COVID-19) patients died after being hospitalized and early mortality is a matter of concern during the pandemic; therefore, it is critical to determine which patients are the most vulnerable of having early mortality. The aim of this study was to determine the risk factors for early mortality among hospitalized COVID-19 patients in Indonesia. A retrospective cohort study was conducted on hospitalized COVID-19 patients from July 2020 to September 2021 at Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia. Demographic data, clinical characteristics, laboratory findings, and mortality were collected. Early mortality was defined as a death before seven days of the hospitalization. Multivariate regression analysis was employed to determine the risk factors associated with early mortality. We included the data of 624 COVID-19 patients who died during the study period. More than half of the patients were male and aged over 50 years old. The average hospitalization period was 10 days and most patients had more than two comorbidities. Chronic lung disease was the most common comorbidity (46.0%) followed by respiratory disease (26.8%) and heart disease (14.3%). Multiple comorbidities and elevated D-dimers exceeding 3376.92 ng/mL were associated with early mortality with OR: 7.029; 95%CI: 2.02–24.43 and OR: 1.000085, 95%CI: 1.000028–1.000142, respectively. In conclusion, early mortality in COVID-19 patients was associated with having multiple comorbidities and elevated D-dimer level. Therefore, it is crucial to assess the presence of comorbidities and routine laboratory test while managing COVID-19 patients in order to prevent the early mortality