In addition to health complaints, other factors determined antibiotic consumption. In view of the likely viral origin of respiratory complaints and the resistance of intestinal pathogens, most antibiotic use was probably unnecessary or ineffective. Future interventions should be directed towards healthcare providers.

This article estimates the magnitude and quality of antibiotic prescribing in Indonesian hospitals and aims to identify demographic, socio-economic, disease-related and healthcare-related determinants of use. An audit on antibiotic use of patients hospitalized for 5 days or more was conducted in two teaching hospitals (A and B) in Java. Data were collected by review of records on the day of discharge. The method was validated through concurrent data collection in Hospital A. Multivariate logistic regression analysis was performed to determine variables to explain antibiotic prescribing. Prescriptions were assessed by three reviewers using standardized criteria. A high proportion (84%) of 999 patients (499 in Hospital A and 500 in Hospital B) received an antibiotic. Prescriptions could be categorized as therapeutic (53%) or prophylactic (15%), but for 32% the indication was unclear. Aminopenicillins accounted for 54%, and cephalosporins (mostly third generation) for 17%. The average level of antibiotic use amounted to 39 DDD/100 patient-days. Validation revealed that 30% of the volume could be underestimated due to incompleteness of the records. Predictors of antibiotic use were diagnosis of infection, stay in surgical or paediatric departments, low-cost nursing care, and urban residence. Only 21% of prescriptions were considered to be definitely appropriate; 15% were inappropriate regarding choice, dosage or duration, and 42% of prescriptions, many for surgical prophylaxis and fever without diagnosis of infection, were deemed to be unnecessary. Agreement among assessors was low (kappa coefficients 0.13-0.14). Despite methodological limitations, recommendations could be made to address the need for improving diagnosis, treatment and drug delivery processes in this setting.

In this study, we sought to determine the roles of albumin in wound healing, which is infused both pre- and postoperatively in malnourished patients presenting with hypoalbuminemia. For the purposes of the study, we used 25 male Sprague Dawley rats of predetermined weight and age, which were initially maintained in a standard environment and fed the same diet for 7 days prior to being segregated into one of the following five groups: A, control, normal protein feed (20% casein); B, hypoalbuminemia, 25% rat albumin infusion prior to surgery; C, hypoalbuminemia, normal protein feed (20% casein); D, hypoalbuminemia, 25% rat albumin infusion after surgery; and E, hypoalbuminemia, low-protein feed (casein 2%). The animals in all five groups were subjected to four deep incisions in their dorsal muscle fascia. On days 1, 3, 5, and 7 after surgery, ELISA was used to determine serum levels of TNF-α, IL-1, IL-6, CRP, and MMP-8, whereas immunohistochemistry was used to determine the tissue expression of EGFR, ERK1, ERK2, TGF-β, collagen, and MMP-8. Significant reductions in serum levels of TNF-α, IL-1, and CRP were detected in the groups receiving albumin infusion and the high-casein diet (P<0.05). The administration of albumin and a high-casein diet also increased the tissue expression of EGFR, ERK1, ERK2, TGF-β, and collagen and decreased that of MMP-8 relative to the hypoalbuminemia control (P<0.05). We propose that the administration of albumin promoted NF-κB signaling which, in turn, induced the transduction and transcription of factors involved in wound healing. Albumin infusion and dietary proteins play vital roles in accelerating the wound healing process, as they can contribute to correcting the hypoalbuminemic state. These findings provide insights that will contribute to our understanding of wound healing, particularly in malnourished patients.

Introduction:In the aftermath of the magnitude 9 Sumatra-Andaman earthquake and Indian Ocean tsunami of 2004, a huge number of international responders launched rescue and relief missions in Aceh Province of Indonesia. Thousands of voluntary personnel came to help the wounded, assist with recovery, and rebuild damaged communities. As is often the case with disasters, the necessary disaster management manpower was not immediately athand. Consequently, rescue and relief missions did not coordinate with one another, and chaotic inefficiency prevailed.Just a little over a year after the 2004 earthquake and tsunami, a second disaster occurred in Indonesia following a major earthquake that occurred in May 2006 on Indonesia's most populous island. The May 2006 earthquake killed 5,000 people in Yogyakarta Province, located in the central region of Java Island.

Background: Maternal mortality rate (MMR) of Indonesia is quite high with the ratio of 305 per 100.000 live births in 2015. This rate support the MMR of Indonesia higher than the MMR of other South-East Asia countries. Preeclampsia is the second cause of misscarriage and fetal mortality. Pulmonary edema is severe complication of preeclampsia with 2.9 -5 % incidence rate. Case: There were 3 cases reported. The first case was severe preeclampsia with pulmonary edema, termination of pregnancy, mechanical ventilation and diuretics had done and obtained respon of weaning from mechanical ventilation. The second case was severe preeclampsia with dengue haemoragic fever (DHF) grade II and pulmonary edema. Termination of pregnancy, mechanical ventilation and diuretics had done and the respon of progress was rapid. The third case was eclampsia with impaired renal function and anuria even had given diuretics. Arterial Blood Gas test which severe metabolic acidosis accompanied by the increase of ureum and serum creatinine, and after hemodialysis and ultrafiltration had done, patients can be weined from mechanical ventilation. Discussion: Preeclampsia was the main cause of maternal morbidity and mortality in Indonesia. Pulmonary edema was one of main complication which related with maternal mortality. By knowing the etiology, the pulmonary edema of severe preeclampsia and eclampsia can be properly treated. The use of mechanical ventilation as the component of positive end expiratory pressure (PEEP) oxygenation and ventilation, fluid restriction, diuretics and the balance of fluid which negatively can expedite the healing process of pulmonary edema. Conclusion: One of mortality and mortality cause of severe preeclampsia and eclampsia patients was pulmonary edema. By knowing the etiology of pulmonary edema in preeclampsia patients, hopefully that the therapeutic pattern can be more precisely, so that the maternal morbidity and mortality can be lowered. ABSTRAKLatar Belakang: Angka kematian ibu (AKI) di Indonesia masih cukup tinggi dengan jumlah 305 per 100.000 kelahiran hidup pada tahun 2015. Angka ini menjadikan AKI Indonesia lebih tinggi daripada AKI negara Asia Tenggara lainnya. Preeklampsia merupakan penyumbang terbesar nomer dua pada kasus keguguran atau kematian janin. Edema paru merupakan komplikasi berat dari preeklampsia dengan angka kejadian 2,9-5%. Kasus: Terdapat 3 kasus yang dilaporkan. Kasus pertama adalah PEB dengan edema paru, dilakukan terminasi kehamilan, ventilasi mekanik dan diuretik, didapatkan respon penyapihan ventilasi mekanik. Pada kasus kedua adalah PEB disertai dengan dengue haemorhagic fever (DHF) grade II dan edema paru dilakukan terminasi kehamilan, ventilasi mekanik dan diuretik, respon kemajuan berlangsung cepat. Pada kasus ketiga adalah eklampsia dengan ganguan fungsi ginjal dan anuria walaupun telah diberikan diuretika, analisa gas darah yang asidosis metabolik berat disertai peningkatan ureum dan serum kreatinin, setelah dilakukan hemodialisa dan ultrafiltrasi pasien dapat disapih dari ventila...