Background: Sepsis in children could significantly increase the morbidity and mortality rates particularly in the Pediatric Intensive Care Unit (PICU). Moreover, the prevalence of antibiotic resistance is continuously increasing around the world mainly caused by uncontrolled used of antibiotic. Henceforth, this study aimed to determine the relationship between bacterial type and the resistance with clinical outcome of sepsis patients in PICU.Methods: An observational analytic retrospective cohort study using medical record data from January 2015-April 2017 was conducted. All subjects were sepsis patients with positive blood cultures treated at PICU Sanglah Hospital. Factors related to mortality and relative risk (RR) were analyzed using Chi-Square Test with a significance value of p <0.05 with 95% confidence interval (CI).Results: 75 subjects met the inclusion criteria, but only 63 subjects with complete data were enrolled. The gram-negative and MDR bacteria types were detected in 31 (49%) subjects and 33 (52.4%) subjects respectively. The number of deaths was 29 (46%). The most common types of gram-negative bacteria were Pseudomonas aeruginosa (16%) followed by gram-positive Staphylococcus hominis (25%). The most common multi-drug resistant (MDR) bacteria were Staphylococcus hominis. The presence of MDR bacteria significantly increase the mortality (p = 0.015, RR 2.02, 95% CI: 1.096-3.725), whereas gram-negative had no significant mortality impact (p = 0.891: RR 0.96; 95% CI: 0.564- 1.645). Compared to non-MDR bacteria, most MDR related mortality occurred during the first 10 days.Conclusion: MDR bacteria significantly increased the mortality rates in pediatric patient treated in PICU compared to non-MDR ones.Â

Background: Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disease. Only a few renal cysts are detected in most affected individuals before 30 years of ages and only 2% of patients with ADPKD present with early clinical manifestations before 15 years old. The average age at onset of chronic kidney disease (CKD) was 50 years. ADPKD is caused by mutations in one of two genes, PKD 1 and PKD 2. PKD1 was associated with more severe disease than PKD2, with earlier age at diagnosis, higher number of kidney cysts, the earlier onset of hypertension and faster progression to CKD stage five.  Objective: To describe of the factors that caused early onset of CKD stage five in ADPKD.Case: An 11 years old boy diagnosed with CKD stage 5 caused by ADPKD with urinary tract infection. The patient complaint with fatigue, pale, fever, flank pain and cloudy urine. The grandfather got the renal failure history and aunty got hypertension since she was young. The parents of patient have consanguinous mating. In the physical examination has been found hypertension grade 1. The laboratory test has been shown decrease of glomerular filtration rate, anemia, imbalance electrolite and metabolic acidosis. Urine investigation  with leucosituria and positive E. Colli. Ultrasonography  and CT stonography showed bilateral multiple cysts in the kidneys with left kidney enlargement. His parents also got multiple cysts in both of kidneys with the normal size of kidneys. Gene analysis showed homozygous for missense mutations 11734insC, in exon 43 of the PKD 1 gene. The patient got regular hemodialysis and other supportive therapy.Conclusion: The early onset of CKD stage five in ADPKD is related to PKD 1 homozygous gene mutation, male gender and enlargement of kidney.

Background: Macrophage migration inhibitory factor (MIF) is known had pleiotropic properties particularly participating in inflammatory and immune responses. MIF has initially involved phagocytosis, spreading, and tumoricidal activity in macrophage. Recently, MIF was determined as a proinflammatory cytokine that has a pivotal role in viral infection such as dengue. This study aims to evaluate the role of MIF levels in patients with dengue infection at Sanglah General Hospital, Bali, IndonesiaMethods: A cross-sectional study was conducted among 48 children aged 1 to 12 years who hospitalized in the Children's Ward of Sanglah General Hospital, Bali, Indonesia, from August 2016 to July 2017. The respondents were divided into two groups: 24 children with a diagnosis of Dengue Shock Syndrome (DSS) (Group 1) and 24 non-DSS children. Data regarding age group, gender, obesity status, history of secondary infection, grading for dengue infection, and levels of MIF were assessed in this study. The MIF levels between both groups were evaluated and analyzed using SPSS version 23 for Mac. Results: Most of the patients were age > 5 years old in Non-DSS (87.5%) and DSS (54.2%) groups. However, females were predominant in the Non-DSS group (66.7%), but males in the DSS group (58.3%). The non-obesity history was more frequent in both Non-DSS (87.5%) and DSS (87.5%) groups. But, the history of secondary infection was more common in the DSS (70.8%) compared with a non-DSS group (37.5%). A significant difference in mean MIF levels was found between patients with DSS (102 (42.91-141.12) ng/ml) and non-DSS (24.85 (12.61-50.80) ng/ml) (p <0.001). MIF levels were significantly different between several degrees of dengue infection (P<0.05).Conclusions: Serum MIF levels in non-DSS patients significantly differ from MIF levels in DSS patients. MIF serum levels increase in accordance with the increasing degree of severity of dengue infection. This data shows that MIF has a role in the occurrence of severe dengue infection.

BackgroundIn the past, cardiovascular involvement did not seem to be a common complication of HIV, but in recent years it has been described more frequently. With the advent of highly active antiretroviral therapy (HAART), the symptoms of cardiac disease has changed, as the number of HIV-infected patients with abnormal diastolic parameters has increased significantly, often presenting as symptomatic rather than asymptomatic. Objective To analyze for a possible correlation between HAART duration and left ventricular diastolic function in HIV-infected children.Methods This cross-sectional study was conducted from . Subjects with HAART were collected using a consecutive sampling method. The following data were recorded for each subject: age, sex, current stage of HIV, CD4+ level, as well as HAART regimen and duration of use. Transthoracic echocardiography was performed for tissue doppler imaging (TDI) of diastolic function. Spearman's test was used to analyze the strength of correlation based on normality test results. Results This study involved 53 subjects, 21 of whom had impaired diastolic function. There was no correlation between HAART duration and diastolic function in children with HIV infection (r= -0.03; P=0.82). Conclusion Diastolic dysfunction is found in children under HAART treatment, but there is no correlation between HAART treatment duration and diastolic dysfunction. [Paediatr Indones. 2019;59:139-43; doi: http://dx.doi.