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Introduction: Artificial intelligence (AI) enables machines to perform many complicated human skills which require various levels of human intelligence. In the field of medicine, AI helps physicians in making diagnoses and treatments for patients with more efficiency, accuracy, and precision. In order to prepare medical students who are the future healthcare workforce, it is important to enhance their readiness, knowledge and perception toward AI. This study aims to assess Pelita Harapan University (PHU) medical students' readiness, knowledge, and perception toward AI. Methods: A quantitative cross-sectional study was conducted to assess respondents' readiness, knowledge and perception toward AI. An online questionnaire was distributed via Google Forms to all batch of medical students. Medical Artificial Intelligence Readiness Scale for Medical Students (MAIRS-MS) questionnaire was used to evaluate AI readiness, while an adapted questionnaires was used to evaluate knowledge and perception toward AI. Data were then analyzed using IBM Statistical Package for Social Sciences (SPSS) version 23.0. Results: A total of 650 respondents were included in this study. Most respondents were in pre-clinical phase (88%) while the remaining were in clinical phase (12%). Overall, the total mean score for AI readiness was 73.34 of 100. Respondents had a mean score 24.52 ± 5.26 of 40, 27.78 ± 4.65 of 40, 10.57 ± 2.07 of 15, and 10.47 ± 2.00 of 15 in the cognitive, ability, vision, and ethics domain respectively. Generally, respondents had sufficient knowledge and positive perception toward AI. There were also significant correlation between readiness and knowledge with gender, having studied coding previously in high school, and having family or close friends working in AI field. Social media also had a good influence on enchancing readiness in the domain of ability and ethics, and perception towards AI. Conclusion: Medical students of PHU mostly showed neutral to favorable response on readiness, knowledge, and perception towards AI. Incorporating AI into high school and medical curriculum is an important step to prepare medical students' encounter and partnership with AI as the future workforce in medicine. [ABSTRACT FROM AUTHOR]

Background: Fluvoxamine may be beneficial for the management of coronavirus disease 2019 (Covid-19) because of its effect on the sigma-1 receptor. Available evidence from randomized clinical trials (RCTs) has shown conflicting results. Objective: This study sought to analyze the efficacy and safety of fluvoxamine as an outpatient treatment for Covid-19. Methods: Using specific keywords, we comprehensively go through the potential articles on PubMed, Scopus, Europe PMC, and ClinicalTrials.gov sources until February 1, 2023. We collected all published clinical trials on fluvoxamine and Covid-19. We were using Review Manager 5.4 to conduct statistical analysis. Results: We include a total of 6 trials. Our pooled analysis revealed that fluvoxamine did not offer any significant benefit when compared with placebo in reducing the risk of clinical deterioration (risk ratio [RR] = 0.83; 95% CI: 0.65-1.06, P = 0.14, I 2 = 29%), and hospitalization (RR = 0.80; 95% CI: 0.62-1.04, P = 0.09, I 2 = 0%) of Covid-19 outpatients. The serious adverse events did not differ significantly between the 2 groups. Conclusions and Relevance: This study indicates that although safe, fluvoxamine was not effective for outpatient treatment of Covid-19. Until more evidence can be obtained from larger RCTs, our study did not encourage the use of fluvoxamine as routine management for patients with Covid-19. [ABSTRACT FROM AUTHOR]

Copyright of Indonesian Journal of Gastroenterology, Hepatology & Digestive Endoscopy is the property of Indonesian Society of Gastroenterology/Assoc for the Study of the Liver/Soc. for Digestive Endoscopy and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Some proportions of populations, such as immunocompromised patients and organ transplant recipients might have inadequate immune responses to the vaccine for coronavirus disease 2019 (COVID‐19). For these groups of populations, administering monoclonal antibodies might offer some additional protection. This review sought to analyze the effectiveness and safety of tixagevimab‐cilgavimab (Evusheld) as pre‐exposure prophylaxis against COVID‐19. We used specific keywords to comprehensively search for potential studies on PubMed, Scopus, Europe PMC, and ClinicalTrials.gov sources until 3 September 2022. We collected all published articles that analyzed tixagevimab‐cilgavimab on the course of COVID‐19. Review Manager 5.4 was utilized for statistical analysis. Six studies were included. Our pooled analysis revealed that tixagevimab‐cilgavimab prophylaxis may decrease the rate of SARS‐CoV‐2 infection (OR: 0.24; 95% CI: 0.15–0.40, p < 0.00001, I2 = 75%), lower COVID‐19 hospitalization rate (OR: 0.13; 95% CI: 0.07–0.24, p < 0.00001, I2 = 0%), decrease the severity risk (OR: 0.13; 95% CI: 0.07–0.24, p < 0.00001, I2 = 0%), and lower COVID‐19 deaths (OR: 0.17; 95% CI: 0.03–0.99, p = 0.05, I2 = 72%). In the included studies, no major adverse events were reported. This study proposes that tixagevimab‐cilgavimab was effective and safe for preventing COVID‐19. Tixagevimab‐cilgavimab may be offered to those who cannot be vaccinated or have inadequate immune response from the COVID‐19 vaccine to give additional protection. [ABSTRACT FROM AUTHOR]

Objective: Unknown etiology Background: Many drugs have been reported to cause immune-mediated adverse drug reactions (IM-ADRs) in human immunodeficiency virus (HIV) patients; the most common is cutaneous adverse drug reaction (CADR). Immune thrombocytopenia purpura (ITP) is frequent in HIV patients, and it can be caused HIV, opportunistic infections, or drugs. Although drugs can cause immune thrombocytopenia, termed drug-induced immune thrombocytopenia (DIIT), there has been no study on DIIT in HIV patients. Case Report: A 33-year-old male patient was admitted to our hospital with pruritic skin lesion over the entire body, which started 7 days before. He was diagnosed with HIV infection, brain toxoplasmosis, and pulmonary tuberculosis 2 weeks before admission, and was given trimethoprim sulphamethoxazole, isoniazid, rifampicin, pyrazinamide, and ethambutol. Clindamycin was added 10 days before admission. Skin examination revealed generalized erythematous macules with palpable petechiae and purpura. The platelet count was 141 000/μL when he was diagnosed with HIV, and it was 2000/μL at the time of admission. Clindamycin was discontinued and he was given steroids and platelet transfusion. The skin lesions improved along with an increased platelet count. He was discharged on the 10th day of admission, with platelet count of 42 000/μL. When he returned to the outpatient clinic on the 15th day, his platelet was 54 000/μL. The skin lesions had resolved completely and become hyperpigmented, and no purpura or petechiae were seen. Conclusions: We present a case of an HIV patient with IM-ADR in the form of DIIT in conjunction with CADR that might have been caused by clindamycin. [ABSTRACT FROM AUTHOR]

Objective: Unknown etiology Background: Many drugs have been reported to cause immune-mediated adverse drug reactions (IM-ADRs) in human immunodeficiency virus (HIV) patients; the most common is cutaneous adverse drug reaction (CADR). Immune thrombocytopenia purpura (ITP) is frequent in HIV patients, and it can be caused HIV, opportunistic infections, or drugs. Although drugs can cause immune thrombocytopenia, termed drug-induced immune thrombocytopenia (DIIT), there has been no study on DIIT in HIV patients. Case Report: A 33-year-old male patient was admitted to our hospital with pruritic skin lesion over the entire body, which started 7 days before. He was diagnosed with HIV infection, brain toxoplasmosis, and pulmonary tuberculosis 2 weeks before admission, and was given trimethoprim sulphamethoxazole, isoniazid, rifampicin, pyrazinamide, and ethambutol. Clindamycin was added 10 days before admission. Skin examination revealed generalized erythematous macules with palpable petechiae and purpura. The platelet count was 141 000/μL when he was diagnosed with HIV, and it was 2000/μL at the time of admission. Clindamycin was discontinued and he was given steroids and platelet transfusion. The skin lesions improved along with an increased platelet count. He was discharged on the 10th day of admission, with platelet count of 42 000/μL. When he returned to the outpatient clinic on the 15th day, his platelet was 54 000/μL. The skin lesions had resolved completely and become hyperpigmented, and no purpura or petechiae were seen. Conclusions: We present a case of an HIV patient with IM-ADR in the form of DIIT in conjunction with CADR that might have been caused by clindamycin. [ABSTRACT FROM AUTHOR]

Summary: Vitamin D has many protective properties and potential role against acute lung injury. Low serum vitamin D is associated with high risk of pneumonia and development of acute respiratory distress syndrome. This study sought to analyse the efficacy of vitamin D in improving the outcomes of coronavirus disease 2019 (Covid‐19) patients. Using specific keywords, we comprehensively searched the potential articles on PubMed, Europe PMC and ClinicalTrials.gov database until 8th May 2021. All published studies on Covid‐19 and vitamin D were retrieved. Statistical analysis was conducted using Review Manager 5.4 software. A total of 11 studies with 22,265 Covid‐19 patients were included in the meta‐analysis. Our data suggested that vitamin D supplementation was associated with reduction in intensive care unit admission rate (OR 0.27; 95% CI: 0.09–0.76, p = 0.010, I2 = 70%, random‐effect modelling); reduction of the need for mechanical ventilation (OR 0.34; 95% CI: 0.16–0.72, p = 0.005, I2 = 61%, random‐effect modelling) and reduction of mortality from Covid‐19 (OR 0.37; 95% CI: 0.21–0.66, p < 0.001, I2 = 50%, random‐effect modelling). Further analysis showed that the associations were influenced by age (p = 0.020). Our study suggests that vitamin D supplementation may offer beneficial effects on Covid‐19 outcomes. However, more randomized clinical trials are required to confirm this conclusion. [ABSTRACT FROM AUTHOR]

Summary: Ivermectin is an FDA‐approved drug for a parasitic disease that has broad antiviral activity. This study aims to analyse the efficacy of ivermectin in improving the Covid‐19 outcomes. We systematically searched the PubMed, Europe PMC and ClinicalTrials.gov database using specific keywords related to our aims until 10th May 2021. All published randomized clinical trial studies on Covid‐19 and ivermectin were retrieved. The quality of the study was assessed using Jadad scale assessment tool for clinical trial studies. Statistical analysis was done using Review Manager 5.4 software. A total of 19 studies with 2768 Covid‐19 patients were included in this meta‐analysis. This meta‐analysis showed that ivermectin was associated with reduction in severity of Covid‐19 (RR 0.43 [95% CI 0.23–0.81], p = 0.008), reduction of mortality (RR 0.31 [95% CI 0.15–0.62], p = 0.001), higher negative RT‐PCR test results rate (RR 1.23 [95% CI 1.01–1.51], p = 0.04), shorter time to negative RT‐PCR test results (mean difference [MD] −3.29 [95% CI −5.69, −0.89], p = 0.007), higher symptoms alleviations rate (RR 1.23 [95% CI 1.03−1.46], p = 0.02), shorter time to symptoms alleviations (MD −0.68 [95% CI −1.07, −0.29], p = 0.0007) and shorter time to hospital discharge (MD −2.66 [95% CI −4.49, −0.82], p = 0.004). Our study suggests that ivermectin may offer beneficial effects towards Covid‐19 outcomes. More randomized clinical trial studies are still needed to confirm the results of our study. [ABSTRACT FROM AUTHOR]

In light of the current coronavirus disease 2019 (COVID-19) vaccination programs being implemented worldwide, this study aimed to evaluate the COVID-19 vaccine acceptance survey in Indonesia conducted by the World Health Organization (WHO), the Ministry of Health of the Republic of Indonesia, the National Immunization Technical Advisory Group (NITAG), and the United Nations Children's Fund (UNICEF), published in November 2020. It was found that Sumatra Island having lower COVID-19 vaccine acceptance rates, with Aceh Province displaying the lowest level of vaccine acceptance. Thus, a cross-sectional study was conducted, and a logistic regression analysis was used to identify the factors affecting COVID-19 vaccine acceptance. Out of 368 respondents who participated in the survey, 143 (38.9%) accepted the vaccine, and 225 (61.1%) refused it. Vaccine safety concerns constituted the most reported reason for refusal (43.6%). This study also found that province of residence and basic immunization status were determinants of COVID-19 vaccine acceptance in Sumatra. Concerns regarding vaccine safety might be the reason for the low level of vaccination in Sumatra. Increased education and encouragement from healthcare professionals and regional authority figures can alleviate public concerns and improve vaccine acceptance. [ABSTRACT FROM AUTHOR]

Purpose: As coronavirus disease 2019 (COVID-19) continues to spread rapidly causing approximately 186 million confirmed cases around the world, the urgency to reach herd immunity through vaccination is increasing. However, vaccine safety is a top priority to limit the occurrence of adverse events. Henceforth, this study aims to recognize and perceive COVID-19 vaccine safety in Indonesia during the pandemic. Materials and Methods: This is a cross-sectional study and was conducted in Indonesia during the COVID-19 pandemic using an online survey of demographic information and a qualitative questionnaire. Responses were recorded and the association between demographic characteristics from survey questions was tested using chi-square with a risk estimate and 95% confidence interval. Results: A total of 311 participants from 33 out of 34 provinces in Indonesia participated in this study. Recorded responses showed multiple side effects of the COVID-19 vaccine both shortand long-term experienced by the participants. Significant associations were found between demographic factors and COVID-19 vaccine side effects such as female gender with shortterm puncture site (odds ratio [OR], 0.463; 95% confidence interval [CI], 0.263-0.816) and shortterm other reactions (OR, 0.463; 95% CI, 0.263-0.816), domicile outside Java island with longterm puncture site (OR, 4.219; 95% CI, 1.401-12.701) and immune reactions (OR, 3.375; 95% CI, 1.356-8.398), also between married marital status and long-term vagal reaction (OR, 4.655; 95% CI, 1.321-16.409). Conclusion: Gender, domicile and marital status factors were associated with COVID-19 vaccine side effects in Indonesian people. [ABSTRACT FROM AUTHOR]

Aim: The purpose of the current study is to analyze the potential association between viral hepatitis and the severity of COVID-19. Background: Coronavirus disease 2019 (COVID-19) is a worldwide concern that has created major issues with many aspects. It is important to identify the risk factors for severe outcomes of this disease. To date, no association between viral hepatitis and severe COVID-19 has not been established. Methods: Through November 5th, 2020, the databases of PubMed, Google Scholar, and medRxiv were systematically searched using specific keywords related to the focus of the study. All articles published on COVID-19 and viral hepatitis were retrieved. The Mantel- Haenszel formula with random-effects models was used to obtain the risk ratio (RR) along with its 95% confidence intervals (CIs) for dichotomous variables. The two-tailed p-value was set with a value ≤0.05 considered statistically significant. Restricted-maximum likelihood meta-regression was done for several variables, such as age, gender, hypertension, diabetes, and other liver disease. Results Analysis results included a total of 16 studies with a total of 14,682 patients. Meta-analysis showed that viral hepatitis increases the risk of developing severe COVID-19 (RR 1.68 (95% CI 1.26 -- 2.22), p = 0.0003, I2 = 21%, random-effect modeling). According to the meta-regression analysis, the association between viral hepatitis and severe COVID-19 was not influenced by age (p = 0.067), diabetes (p = 0.057), or other liver disease (p = 0.646). Conclusion: An increase of severe COVID-19 risk is associated with viral hepatitis. To reduce the risk of COVID-19, patients with viral hepatitis should be monitored carefully. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to investigate the effects of natural adjuvants (G2 and PC) to activate natural killer cells in colorectal cancer. Background: Natural killer (NK) cells are an element of the innate immune system that can recognize and kill cancer cells and provide hope for cancer therapy. One of the current methods in cancer immunotherapy is NK cell therapy. Immunotherapy with NK cells has been limited because of the low number and cytotoxicity level of NK cells. Natural adjuvants such as PC and G2 may stimulate the immune system. It seems that these adjuvants could increase cytotoxic NK cells. Methods: Twelve patients with colorectal cancer and six healthy individuals qualified for inclusion in this study. Peripheral blood mononuclear cells (PBMCs) from each patient with two distinctive concentrations (105and 5-104 cells/well) were treated with Interleukin2 (IL2), PC, and G2 adjuvant separately. The NK cell's surface markers, including CD16, CD56, and NKG2D, were evaluated by flow cytometry. The cytotoxicity effect of treated PBMCs as effector cells against NK sensitive cell line (K562) was assessed using the LDH assay method. Results The results revealed a significant increase in the level of CD16+NKG2D+ NK cells in PBMCs treated with the G2 group compared with the control group in CRC PBMC (p<0.001) as well as the normal PBMC group (p < 0.01). In addition, the results indicated a significant increase in the level of CD56+NKG2D+ cells in the PBMC treated with PC (p < 0.05) and G2 (p < 0.001) groups compared with the PBMC group. The cytotoxicity result of PBMC from CRC patients in 10:1 ratio of the effector: target showed that the cells' cytotoxicity in the PBMCs treated with PC (p<0.01) and G2 (p<0.05) was significantly higher than the untreated PBMC. Conclusion: According to the result of this study, it can be stated that the PC and G2 adjuvants could be candidates for inducing cytotoxic natural killer cells. [ABSTRACT FROM AUTHOR]

Currently, there is no widely acceptable and proven effective treatment for coronavirus disease 2019 (COVID‐19). Colchicine has been shown to offer a benefit in reducing the inflammation in several inflammatory diseases. This study aims to analyze the efficacy of colchicine administration and outcomes of COVID‐19. We systematically searched the PubMed and Europe PMC database using specific keywords related to our aims until January 29, 2021. All articles published on COVID‐19 and colchicine treatment were retrieved. The quality of the study was assessed using the Newcastle–Ottawa Scale (NOS) tool for observational studies and Revised Cochrane risk‐of‐bias tool for randomized trials (RoB 2) for clinical trial studies. Statistical analysis was done using Review Manager 5.4 software. A total of eight studies with 5778 COVID‐19 patients were included in this meta‐analysis. This meta‐analysis showed that the administration of colchicine was associated with improvement of outcomes of COVID‐19 [OR 0.43 (95% CI 0.34–0.55), p < 0.00001, I2 = 0%, fixed‐effect modelling] and its subgroup which comprised of reduction from severe COVID‐19 [OR 0.44 (95% CI 0.31–0.63), p < 0.00001, I2 = 0%, fixed‐effect modelling] and reduction of mortality rate from COVID‐19 [OR 0.43 (95% CI 0.32–0.58), p < 0.00001, I2 = 0%, fixed‐effect modelling]. Our study suggests the routine use of colchicine for treatment modalities of COVID‐19 patients. More randomized clinical trial studies are still needed to confirm the results from this study. [ABSTRACT FROM AUTHOR]

Copyright of Indonesian Journal of Gastroenterology, Hepatology & Digestive Endoscopy is the property of Indonesian Society of Gastroenterology/Assoc for the Study of the Liver/Soc. for Digestive Endoscopy and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Coronavirus disease 2019 (COVID‐19) has caused a significant impact on all aspects of life, with the number of death cases still increasing. Therefore, identification of potential treatment for reducing the severity of the disease is important. Currently, the data regarding the effectiveness of tocilizumab as treatment agents for COVID‐19 infection is still conflicting. This study aims to give clear evidence regarding the potential benefit of tocilizumab in reducing the biomarkers of COVID‐19 infection. We systematically searched the PubMed Central database using specific keywords related to our aims until July 24th, 2020. All articles published on COVID‐19 and tocilizumab were retrieved. A total of 9 studies with a total of 577 patients were included in our analysis. Our meta‐analysis showed that tocilizumab treatment is associated with reduction of C‐reactive protein (mean difference [MD]: −106.69 mg/L [95% confidence interval [CI]: −146.90, −66.49 mg/L], p <.00001; I2 = 98%, random‐effect modeling), d‐dimer (MD: −3.06 mg/L [95% CI: −5.81, −0.31 mg/L], p =.03; I2 = 98%, random‐effect modeling), Ferritin (MD: −532.80 ng/ml [95% CI: −810.93, −254.67 ng/ml], p =.0002; I2 = 25%, random‐effect modeling), procalcitonin (MD: −0.67 ng/ml [95% CI: −1.13, −0.22 ng/ml], p =.004; I2 = 92%, random‐effect modeling], and increment in the levels of lymphocyte count (MD: 0.36 × 103/μl [95% CI: 0.18, 0.54 × 103/μl], p <.0001; I2 = 88%, random‐effect modeling). Administration of tocilizumab is effective in reducing the biomarkers of the COVID‐19 infection. Highlights: There are no widely accepted drugs for the management of COVID‐19 patients.The benefit of tocilizumab administration in reducing the biomarkers of COVID‐19, but not on the mortality outcome.Physicians may hence consider adding tocilizumab as a treatment for patients with COVID‐19, especially in patients with severe disease. [ABSTRACT FROM AUTHOR]

The three most common comorbidities that are associated with increased mortality in COVID-19 patients are Hypertension, Diabetes, and Cardiovascular disease, Angiotensin-converting enzyme (ACE) inhibitors and Angiotensin II receptor blockers (ARB) are the drugs most commonly prescribed for the management of these diseases. Recent experimental study in animals and humans have found that SARS-CoV-2 uses ACE2 as the receptors for entry. Moreover, in an animal study, the use of ACE inhibitor/ARB increases the level of ACE2 expression that can lead to increased SARS-CoV-2 infectivity. On the other side, some evidences suggest that the ACE2 receptor is not necessary for SARS-CoV-2 entry into the cell and suggested that there is a cofactor that play part. Experimental studies in humans also showed that there is no association between ACE inhibitor/ARB with SARS-CoV-2 infectivity and mortality. In conclusion, there is still insufficient data to stop the use of inhibitor/ARB in SARS-CoV-2 patients. Therefore, we suggested that in line with the recommendations from ESC and AHA/ACC, the use of these two drugs in SARS-CoV-2 patients with cardiovascular comorbidity should still be continued. [ABSTRACT FROM AUTHOR]

Copyright of Indonesian Journal of Gastroenterology, Hepatology & Digestive Endoscopy is the property of Indonesian Society of Gastroenterology/Assoc for the Study of the Liver/Soc. for Digestive Endoscopy and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The multifactorial mechanisms of immune thrombocytopenia (ITP) in patients with human immunodeficiency virus (HIV) and tuberculosis (TB) could be caused by HIV, TB or anti-TB drugs. No patients with HIV and opportunistic infection of miliary pulmonary TB who developed thrombocytopenia after treatment with anti-TB drugs have been reported. A 47-year-old woman with HIV/acquired immunodeficiency syndrome and miliary TB with normal platelet count (229 000/μL) started anti-TB drugs (rifampicin, isoniazid, pyrazinamide and ethambutol). After 10 days of treatment, her platelet count was low (17 000/μL). As rifampicin and isoniazid were stopped and intravenous methylprednisolone was given, her platelet count began to increase. After more than a month, her platelet count was normal (192 000/μL) and she started antiretrovirals. This improved platelet count after high-dose methylprednisolone is suggestive of ITP; however, the dilemma is whether it was rifampicin alone that caused ITP or did HIV and disseminated TB infection also play a role? [ABSTRACT FROM AUTHOR]

Dear Editor, Coronavirus disease 2019 (COVID-19), a pandemic disease, has caused a significant impact on the economic, health, and social aspect. Older patients with COVID-19 infection may present with atypical symptoms of infections. [Extracted from the article]

To control the spread of COVID-19 transmission, Indonesia government has broadcasted information about the pandemic. The aim of this study is to evaluate the understanding of young people, about COVID-19 during the early outbreak in Indonesia. An online-based cross-sectional data collection was conducted from adolescents aged 10 to 25 years, based on 10 questions regarding general COVID-19 information. There were 355 subjects from 25 out of 34 Indonesian provinces who participated in the study, with mean age of 19.93 ± 2.91 years. Better understanding was found in the female and higher-income population. Largely, the subjects got the information from social media, instead of the official government site for COVID-19. Lack of understanding about crucial preventive measures was found, such as handwashing and physical distancing. In conclusion, the participants have an overall moderate-good initial understanding toward COVID-19 during the early outbreak in Indonesia. These results can be used as baseline data for development of awareness measurement tools. [ABSTRACT FROM AUTHOR]

Sphingomonas paucimobilis is a yellow-pigmented, glucose nonfermenting, aerobic, Gram negative bacillus of low pathogenicity. This organism was found in the implantation of indwelling catheters, sterile intravenous fluid, or contaminated hospital environment such as tap and distilled water, nebulizer, ventilator, and hemodialysis device. A 55-year-old female was hospitalized for diabetic foot ulcer in the presence of multiple comorbidities: diabetes mellitus, colonic tuberculosis, end-stage renal disease, and indwelling catheters for central venous catheter and hemodialysis. The patient passed away on the 44th day of admission due to septic shock. The organism found on blood culture on the 29th day of admission was multidrug resistant S. paucimobilis. Severe infection and septic shock due to S. paucimobilis have been reported particularly in immunocompromised patients, but there has been only one reported case of death in a premature neonate with septic shock. This is the first reported lethal case of S. paucimobilis bacteremia in an adult patient. [ABSTRACT FROM AUTHOR]

Vascular events are the most common clinical complication of essential thrombocythemia, leading to sign and symptoms of this disease. There are various sign and symptoms of essential thrombocythemia, such as thrombosis in artery or vein, and enlarged spleen. Portal hypertension and hepatic cirrhosis could be caused by essential thrombocythemia via intrahepatic thrombus. Anemia in essential thrombocythemia patient treated with hydroxyurea could be the side effect of bone marrow supression and also hydroxyurea induced hemolytic anemia. Association betweeen autoimmune hemolytic anemia and primary biliary cirrhosis or hepatic cirrhosis has been discussed. This case report presented an patient diagnosed with essential thrombocythemia. He later developed hepatic cirrhosis possibly caused by intra hepatic thrombus in the setting of hypercoagulabuility in myeloproliverative disorders. He also sufferred from anemia due to hydroxyurea induced hemolytic anemia. Association between autoimmune hepatic cirrhosis and autoimmune hemolytic anemia should also be considered in this patient. [ABSTRACT FROM AUTHOR]

Background: Dengue virus (DENV) infection is an emerging arboviral infection in tropical and sub-tropical countries in South-East Asia, the Western Pacific and South and Central America. Secondary DENV infection is the most widely accepted risk factor for the development of severe forms. Methods to discriminate primary and secondary DENV infection may be of great prognostic value. ELISA based detection of specific antibodies (IgG and IgM) to the four DENV serotypes is valuable for detemination of primary or secondary infection. Several studies had been performed to discriminate primary and secondary DENV infection using the ratio of IgG and IgM at the various days of symptoms onset. The aim of this study is to determine the best cut-off point of IgG to IgM ratio is able to discriminating secondary from primary DENV infection in adult using samples from early days of symptoms onset. Methods: This prospective cohort study on 48 adult patients with DENV infected patients on the period of August 2011-January 2012 in 5 out-patient settings health facilities in Tangerang district, Banten province, Indonesia with chief complaint of fever less than 3 days. Datas were collected on the day the patients attended health facilities, consisted of demographic, clinical, laboratory, and serological data. Serological data from 48 serum sample from adult patients were evaluated using Focus Diagnostics Dengue Virus IgM and IgG Capture DxSelect™ ELISA Kits to determine IgG, IgM index values and SD Bioline Dengue Duo™ Rapid Tests to determine NS1, IgG, and IgM result. Results: According to NS1, IgG and IgM results, 36 patients were classified as secondary infection, 12 were primary Infection. The mean (SD) of IgG/IgM ratios for secondary and primary infection were 3.28 (0.54) and 0.18 (0.11) consecutively. The IgG/IgM ratio of ≥ 1.14 confirmed secondary infection with sensitivity of 80.56 %, specificity 91.67 %, accuracy level 83.33 %, and likely hood ratio of (LR) 9.67. Conclusion: The IgG/IgM ratio of ≥ 1.14 as the best cut off point to determine secondary DENV infection in early days of symptoms onset. [ABSTRACT FROM AUTHOR]

Background: Dengue virus (DENV) infection is an emerging arboviral infection in tropical and sub-tropical countries in South-East Asia, the Western Pacific and South and Central America. Secondary DENV infection is the most widely accepted risk factor for the development of severe forms. Methods to discriminate primary and secondary DENV infection may be of great prognostic value. ELISA based detection of specific antibodies (IgG and IgM) to the four DENV serotypes is valuable for detemination of primary or secondary infection. Several studies had been performed to discriminate primary and secondary DENV infection using the ratio of IgG and IgM at the various days of symptoms onset. The aim of this study is to determine the best cut-off point of IgG to IgM ratio is able to discriminating secondary from primary DENV infection in adult using samples from early days of symptoms onset. Methods: This prospective cohort study on 48 adult patients with DENV infected patients on the period of August 2011–January 2012 in 5 out-patient settings health facilities in Tangerang district, Banten province, Indonesia with chief complaint of fever less than 3 days. Datas were collected on the day the patients attended health facilities, consisted of demographic, clinical, laboratory, and serological data. Serological data from 48 serum sample from adult patients were evaluated using Focus Diagnostics Dengue Virus IgM and IgG Capture DxSelect™ ELISA Kits to determine IgG, IgM index values and SD Bioline Dengue Duo™ Rapid Tests to determine NS1, IgG, and IgM result. Results: According to NS1, IgG and IgM results, 36 patients were classified as secondary infection, 12 were primary Infection. The mean (SD) of IgG/IgM ratios for secondary and primary infection were 3.28 (0.54) and 0.18 (0.11) consecutively. The IgG/IgM ratio of ≥ 1.14 confirmed secondary infection with sensitivity of 80.56 %, specificity 91.67 %, accuracy level 83.33 %, and likely hood ratio of (LR) 9.67. Conclusion: The IgG/IgM ratio of ≥ 1.14 as the best cut off point to determine secondary DENV infection in early days of symptoms onset. [ABSTRACT FROM AUTHOR]

Copyright of Indonesian Journal of Gastroenterology, Hepatology & Digestive Endoscopy is the property of Indonesian Society of Gastroenterology/Assoc for the Study of the Liver/Soc. for Digestive Endoscopy and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Pseudomonas putida is a rod-shaped, non fermenting Gram-negative organism frequently found in the environment that utilizes aerobic metabolism, previously thought to be of low pathogenicity. It had been reported as cause of skin and soft tissue infection, especially in immunocompromised patients. A female green grocer, 51 year-old came to internal medicine out-patient clinic with gangrene and osteomyelitis on her 1st, 2nd and 3rd digit and wound on the sole of the right foot since 1 month prior. The patient had history of uncontrolled diabetes since a year ago. She was given ceftriaxone 2 grams b.i.d, metronidazole 500 mg t.i.d empirically and then amikacin 250 mg b.i.d, followed by amputation of the digits and wound debridement. The microorganism's culture from pus revealed multi drug resistant Pseudomonas putida. She recovered well after antibiotics and surgery. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about a study which investigates the knowledge of resident medical officers (RMOs) or physicians in a general hospital in Indonesia about sepsis.