Abstract Background: The incidence of healthy individuals carrying Extended-Spectrum Beta-Lactamase producing Enterobacteriaceae (ESBL-E), especially E. coli (ESBL-EC) and Klebsiella pneumoniae (ESBL-KP), is increasing worldwide. ESBL-E causes early or late onset of neonatal sepsis, resulting in increased morbidity and mortality rates. Although maternal-neonatal transmissions of ESBL-E have been reported in several countries, the prevalence of ESBL-E carriage among pregnant women in Indonesia is not clear. In the present study, we compared the prevalence of carriage of ESBL-E among pregnant women in a primary health care center (PHC) versus two hospitals in Indonesia and identified the phenotypic and genotypic characteristics of the isolated ESBL-E strains. Methods: We collected rectal swab samples from 200 pregnant women who visited a PHC (101 women) or were admitted to Dr. Soetomo Referral Hospital or Airlangga University Hospital (99 women) in Surabaya, Indonesia from July to October 2018. The samples were cultivated on MacConkey Agar plates supplemented with cefotaxime 2 mg/L, at 37oC overnight. The isolated strains were identified by Bruker MALDI BiotyperÒ System, phenotypic detection of ESBL was performed by the combination disk method, and antibiotic susceptibility was tested by the disk diffusion method. In addition, ESBL gene was identified by PCR and DNA sequencing and molecular epidemiological studies were performed by PFGE. Results: ESBL-E strains were isolated from 25 (rate of fecal carriage; 24.8%) pregnant women who visited the PHC and 49 (49.5%) pregnant women who were admitted to the hospitals. The rate of ESBL-E carriage of pregnant women in the hospitals was significantly higher than that in the PHC. Among the 74 isolated ESBL-E strains, ESBL-EC was most frequently isolated (62 strains), followed by ESBL-KP (12 strains). In addition, blaCTX-M15 was the most frequent ESBL gene type of the isolated ESBL-E strains. Conclusion: Our results revealed the high prevalence of ESBL-E carriage in pregnant women, especially those who were admitted to the hospitals. CTX-M15 ESBL-EC was the most frequent type of ESBL-E in the pregnant women in our study. Continuous surveillance for ESBL-E carriage in pregnant women is strongly recommended to reduce the incidence of neonatal sepsis in Indonesia.

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Background: Urinary retention is a condition commonly seen after vaginal delivery, especially in the highrisk cases, such as assisted vaginal delivery, grade 3-4 th perineal rupture, or another high risk. Urinary retention caused by unsynchronized between the contraction of the bladder detrusor. Urinary catheterization is one of the preventions of urinary retention. It gives a time for perineal trauma to relieve and no longer edema, so that urethra can be fully relaxed. Therefore, 24-hour catheterization expected to prevent bladder overdistention. It also prevents the bladder from becoming atonia.Objective: This research aims to study the incidence of urinary retention in assisted vaginal delivery with and without 24-hour catheterization.Method: This study used randomized control trials that compared two groups with 24-hour catheterization and without 24-hour catheterization. This study was conducted on 40 women in each group who experienced assisted vaginal birth at Dr Soetomo Hospital, Indonesia.Result: Six women (15%) experienced urinary retention with 24-hour catheterization and six women (15%) had urinary retention without catheterization. There was no significant difference in the incidence of urinary retention with 24-hour catheterization and without 24-hour catheterization (p-value = 1.00). Also, there was no significant interference of urinary retention in the normal and prolonged second stage of labor (p-value = 0.736), and there was no significant risk factor contributing to urinary retention. Conclusion:No significant difference in urinary retention occurred in assisted vaginal delivery with and without 24-hour catheterization.

Traumatic severe brain injury is a fatal injury, with a mortality rate of up to 50%. About 1.5 million people experience severe brain injury in the United States. There are more than 50,000 deaths and 500,000 incidents of permanent neurological sequelae. About 85% of mortality occurs in the first 2 weeks after the injury. One complication of a severe brain injury is diabetes insipidus. There are no definitive data on the incidence of diabetes insipidus in patients with traumatic severe brain injury of Indonesia so far. In this case report, a male, 45 years old, was taken to the Emergency Installation (IRD) after experiencing a traffic accident 12 hours before being hospitalized. After surgery, the signs of diabetes insipidus was presented by polyuria of 300cc / hour urine production and 149mmol / L hypernatremia, although the immediate administration of desmopressin, the patients clinical and hemodynamic was not shown any improvements. The patient passed away in the days five of treatment in the Intensive Care Unit (ICU). The main treatments for diabetes insipidus in traumatic severe brain injury are adequate rehydration and administration of desmopressin. Adequate hypovolemic, polyuric and hypernatremia corrections are the keys to the successful treatment of diabetes insipidus. Diabetes insipidus in cases of brain injury requires complicated treatment. Therefore, in the case of being handled improperly, it can bring death. ABSTRAKCedera otak berat traumatis adalah cedera fatal, dengan tingkat kematian hingga 50%. Sekitar 1,5 juta orang mengalami cedera otak berat di Amerika Serikat. Terdapat lebih dari 50.000 kematian dan 500.000 insiden gangguan neurologis permanen. Sekitar 85% kematian terjadi dalam 2 minggu pertama setelah cedera. Salah satu komplikasi dari cedera otak yang parah adalah diabetes insipidus. Tidak ada data pasti tentang kejadian diabetes insipidus pada pasien dengan cedera otak traumatis

Objectives: The incidence of healthy individuals carrying multidrug resistant Enterobacteriaceae, including extended-spectrum b-lactamase producing Enterobacteriaceae (ESBL-E), especially extended-spectrum b-lactamase producing Escherichia coli (ESBL-EC) and extended-spectrum b-lactamase producing Klebsiella pneumoniae (ESBL-KP), is increasing worldwide. Although ESBL-E causes early or late onset of neonatal sepsis, the prevalence of ESBL-E carriage among pregnant women in Indonesia is not clear. In the present study, we compared the occurrence of carriage of ESBL-E among pregnant women in a primary health center (PHC) versus two hospitals. Materials and Methods: We collected rectal swab samples from 200 pregnant women who visited a PHC or were admitted to two hospitals in Surabaya, Indonesia from July to October 2018. The ESBL-E strains were isolated from the samples and phenotypically and genotypically analyzed. Results: ESBL-E strains were isolated from 25 (24.8%) pregnant women who visited the PHC and 49 (49.5%) pregnant women who were admitted to the hospitals. The rate of ESBL-E carriage of pregnant women in the hospitals was significantly higher than that in the PHC. Among the 74 isolated ESBL-E strains, ESBL-EC was most frequently isolated (62 strains), followed by ESBL-KP (12 strains). In addition, bla CTX-M-15 was the most frequent ESBL gene type of the isolated ESBL-E strains. Conclusions: Our results revealed the high occurrence of ESBL-E carriage in pregnant women, especially those who were admitted to the hospitals.