Poster Session : PS 0374 ; Infectious Disease ; In Vitro Antiplasmodial Effect of Propolis Water Extract

( Vitanata Muhammad Arfijanto ),( Musofa Rusli ),( Nurul Azizah ),( Akbar Fahmi ),( Usman Hadi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Effi cacy of such antimalarial therapies (e.g ACT, eg. chloroquine, sulphadoxine- pyrimethamine, and quinine) has declined, and there is an urgent need to investigate antiplasmoidal effect of propolis as natural source novel antimalarial substance. Methods: It is a laboratory experimental study. The sample is thin blood smear infected with 3D7-strain intraerythrocytic P. falciparum in vitro. The thin blood smear made from each well in microplate tested with propolis water extract in dose of 100, 10, 1 and 0.1 μg/mL. Observations under microscope (1000-fold optical enlaregement) on sample stained with Giemsa on hour-0 and hour-48 were done, to describe the percentages of parasitemia, growth, and inhibition. Probit analysis was conducted to determine the IC50 of propolis water extract. Results: Inhibition percentages for dose of propolis water extract 100; 10, 1 and 0.1 μg/mL, are 33.33%, 13.70%, 11.76% and 5.88%, respectively. The experimental result show that propolis is related to the antiplasmodial activity. The probit analysis showed propolis IC50 is 2572,65 μg/mL. Conclusions: Propolis water extract had antiplasmodial effect on intraerythrocytic P. falciparum in vitro. Propolis has the potential to be developed as an anti-malarial drug in the future.

Poster Session : PS 0392 ; Infectious Disease ; Profi le of Vcam in Patients with Confi rmed Mild Dengue Infection in Surabaya, Indonesia

( M Vitanata Arfijanto ),( Musofa Rusli ),( Nasronudin Nasronudin ),( Maria I Lusida ),( Muhammad A Isfandiari ),( Evhy Apryani ),( Siswanto Siswanto ),( Mj Reynolds ),( Umar F Achmadi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Dengue infection is still an endemic disease in Indonesia. The hallmark of dengue infection is the posibility to progress to fatal disease. VCAM is known for some role in the pathogenesis of dengue. The aim of the study was To describe VCAM profi le in patients with dengue infection Methods: This study design was cross-sectional study and conducted from January 2012 to November 2013. This study has been approved by Ethical Committee. The subjects were dengue patients with 10 years-old of age or above, with fever on day-1 or day-2, suspected dengue infection according to WHO criteria, showed positive result either by NS-1, and or IgM - IgG. Complete blood count, clinical chemistry, and VCAM were performed on the fi rst day of admission. Correlations were analyzed with Spearman test. Results: We recruited 100 subjects with positive result either by NS-1, and or IgM - IgG, and positive viral load showed. Clinical profi le and laboratory of the subjects were: fever 38±1.03 ℃, hemoglobin 13.57±1.45 g/dL, hematocrite 39.44±4.16 %, leucocyte 3.82x10³ cells/mm3, thrombocyte 98 (min-max 19-312)x10³ cells/mm3, lymphocyte 28.58±12.69%, serum albumin 3.79±0.54 g/dL, VCAM 233 (min-max 60.5-938) ng/ dL. The proportion of thrombocytopenia, hemoconcentration and hypoalbuminemia were 38.6%, 46.5% and 24.8%, respectively. The clinical diagnosis were dengue fever, DHF grade I, and DHF grade grade II; with proportions: 52.5%, 42.6% and 4%, respectively. There were no subject progressing to severe dengue. There were no correlation between VCAM with severity grading, thrombocytopenia, hemoconcentration, hypoalbuminemia, or hemorrhagic events. There were signifi cant weak correlation between VCAM level and body temperature level (r=0.21, p <0.05). Conclusions: We reported VCAM profi le of subjects with mild dengue infection. Signifi cant weak correlation between VCAM level and body temperature level was found in the subjects.

Poster Session : PS 0393 ; Infectious Disease ; Clinical Profi le of Confi rmed Mild Dengue Infection Cases in Surabaya, Indonesia: Case Reports of 100 Patients

( Musofa Rusli ),( M Vitanata Arfijanto ),( Nasronudin Nasronudin ),( Maria I Lusida ),( Muhammad A Isfandiari ),( Evhy Apryani ),( Siswanto Siswanto ),( Mj Reynolds ),( Umar F Achmadi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Dengue infection is an endemic arboviral disease in Indonesia. Dengue infection can lead to fatal disease, including Dengue Shock Syndrome. Clinical recognition of Dengue infection cases in daily practice is important, as well as case recognition by using routine complete blood count and clinical chemistry. There were no such data in Surabaya for dengue infection cases. The aim of the study was to describe clinical profi le patients with dengue infection. Methods: The study design was cross-sectional study and conducted from January 2012 to November 2013. This study has been approved by Ethical Committee. We recruited subjects with 10 years-old of age or above, with fever on day-1 or day-2, suspected dengue infection according to WHO criteria, showed positive result either by NS-1, and or IgM - IgG. Complete blood count, clinical chemistry, liver function, kidney function, and viral load were performed on the fi rst day of admission. Results: The subjects` age were 19 (min-max 10-59) year-old. Of the 100 subjects with positive result either by NS-1, and or IgM - IgG, and positive viral load showed: Fever 38±1.03℃, hemoglobin 13.57±1.45 g/dL, hematocrite 39.44+4.16 %, leucocyte 3.82x10³ cells/mm3, thrombocyte 98 (min-max 19-312)x10³ cells/mm3, lymphocyte 28.58±12.69%, SGPT 48.31 (min-max 6.8-307.9) IU, SGOT 89.77 (min-max 16.5-716) IU, BUN 10.25±4.71 g/dL, serum creatinine 0.75±0.2 g/dL, serum albumin 3.79±0.54 g/ dL. Hematocrite level were slightly lower than reference. The clinical diagnosis were dengue fever, DHF grade I, and DHF grade grade II; with proportions: 52.5%, 42.6% and 4%, respectively. There were no subject progressing to severe dengue. Conclusions: We reported clinical profile of subjects with mild dengue infection. Leucopenia, thrombocytopenia and mild to moderate increase of transaminase were present in the subjects.

Poster Session : PS 0410 ; Infectious Disease ; Melaleuca Alternifolia Concentrate (MAC) as a Causal Therapy of Dengue Infection

( Nasronudin ),( M Inge Lusida ),( Brian Rachman ),( Musofa Rusli ),( Matoillah Isfandiari ),( Evhy Apryani ),( Vitanata Arfijanto ),( Sudibyo ),( Jt Tjahjana ),( Siswanto ),( Mj Reynolds ),( Umar F A 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Dengue infection is distributed throughout the tropical areas around the world, including Indonesia. Dengue fever/ dengue hemorrhagic fever is a mosquito- borne disease caused by dengue virus of any serotype 1 (DEN1) to DEN4. Until now, therapy is based on pathophysiology. Aims: To evaluate the effi cacy and safety of MAC for the treatment of dengue infection. Methods: This clinical trial phase III was designed to study the inhibitory property of MAC against dengue virus (DENV) activity. A double-blind, randomized, controlled trial method was approved by Ethical Committee of Dr. Soetomo Hospital. This study was conducted from January 2012 to November 2013. After a signed informed consent, 530 patients, fever on day-1 or day-2, suspected dengue infection according to WHO criteria, showed positive result either by NS-1, and or IgM - IgG, were recruited. The subjects were divided into 2 groups. Group I received WHO standard treatment and 300 mg - MAC twice daily orally for 7 days. Group II received WHO standard treatment only. History, physical examination and complete blood count were done every day. Laboratory test (liver function, kidney function, CD4, CD8, VCAM, viral load) were performed on the fi rst, fourth and seventh day. Results: The results showed that the quantity of virus signifi cantly decreased in the treatment group (96.67%) compared to the control group (44.79%). Also showed that MAC did improve the immune system by increasing the value of CD8 (6.89%) and CD4 (9.95%). MAC provision does not interfere with the function of liver and kidney, and was well tolerated by the patients. Conclusions: MAC has signifi cant reduction of viral load level, may have immunomodulatory effects, prevent the plasma leakage, no hepatotoxic and nephrotoxic effects. MAC effi cacy as an antiviral agent against DENV infection has been very effectively illustrated.

Poster Session : PS 0421 ; Infectious Disease ; Demographic and Seroepidemiologic Patterns of Dengue Infection in Surabaya, Indonesia

( M Atoillah Isfandiari ),( M Inge Lusida ),( E Bimo Aksono ),( Brian E Rachman ),( Rahayu Anggraini ),( Musofa Rusli ),( M Vitanata Arfijanto ),( Nasronudin ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Dengue infection cases in Surabaya, contributed to more than 25% of cases in the East Java province during 2012-2013. This study was held to determine the patterns of dengue infection in Surabaya based on patient demographic and types of the virus prior to a clinical trial study of herbal medicine for the treatment of dengue infection Methods: A total of 460 patients with dengue infection diagnosed by specific non-structural 1 (NS1) antigen and or IgM/IgG examination, with fi rst or second day of fever, distributed in 10 hospitals and 15 health centers, obtained during January 2012 to November 2013, were included in this cross-sectional study. Strain identifi cation was based on multiplex RT-PCR for DEN1 to DEN4. The level of CD4 molecules on T-Lymphocytes were also quantitatively determined by ELISA Results: Around one third of the patients (34.6%) were aged between 21-60 y.o, with the rests were under 21 y.o. The dengue type was identifi ed in 209 patients. Among them, 77% were single type infection and 19% were double or more type infection, with DEN1 (34,9%) to be the most prevalent. The average level of CD4 molecules among patients was moderate (5.86±9,1 ng/mL), with no signifi cant difference level among each age group. During the two-year of study, the number of incidence per month fi uctuated between 1 to 80 cases, but tended not to follow general seasonal pattern. Conclusions: In Surabaya, Dengue infections are likely to be found widely among adults, with the pattern of incidence per month tend not to follow regular seasonal pattern. Among all strains, DEN 1 was most widely identifi ed, either as single or double infection with other strains during the period of study. Healthcare preparedness to care dengue infection patients should be conducted throughout the year.