Latar belakang. Dampak curah hujan terhadap prevalensi dengue sangat penting untuk diteliti sebagai alat untuk meramalkan variasi insidens dan risiko yang berhubungan dengan dampak perubahan iklim.Tujuan. Untuk menilai apakah peningkatan curah hujan di Palembang, setelah selang waktu tertentu, berhubungan dengan peningkatan jumlah kasus DBD anak yang dirawat di tiga rumah sakit di Palembang. Kedua, menilai hubungan puncak curah hujan dengan puncak kasus DBD yang dirawat. Jumlah kasus DBD yang dirawat di tiga rumah sakit tersebut diasumsikan mencerminkan tingkat kejadian DBD di Kota Palembang.Metode.Data curah hujan didapat dari Badan Meteorologi Klimatologi dan Geofisika kota Palembang. Prevalensi DBD yang dirawat dikompilasikan dari buku/Data Register. Hubungan peningkatan curah hujan dengan peningkatan jumlah kasus DBD ditelusuri melalui olah statistik. Hubungan puncak curah hujan dengan puncak kasus DBD yang dirawat dinilai berdasarkan selang waktu antara puncak curah hujan dan puncak prevalensi perawatan kasus. Hasil.Terdapat korelasi antara curah hujan dan peningkatan jumlah kasus DBD yang dirawat. Korelasi mulai terjadi satu bulan sebelum puncak curah hujan (r=0,332; p=0,001), meningkat saat puncak curah hujan (r=0,353; p=0,000), dan menurun satu bulan sesudahnya (r=0,262; p=0,008). Bulan serta tanggal curah hujan berhimpitan dengan prevalensi kasus yang DBD yang dirawat. Anomali bulan puncak hujan diikuti perubahan puncak prevalensi DBD. Kesimpulan.1) Curah hujan berkorelasi dengan kejadian DBD, korelasi paling kuat terjadi dengan kasus DBD pada puncak curah hujan; 2) Puncak curah hujan bulanan berhimpitan dengan bulan puncak kasus DBD dan perubahan puncak curah hujan sejalan dengan perubahan puncak kasus DBD

Background The pediatric logistic organ dysfunction-2 (PELOD-2) score is recommended by the Indonesian Pediatric Society Emergency and Intensive Care Working Group as an indicator of life-threatening organ dysfunction for sepsis in children. However, The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) recommended the Sequential (Sepsis-related) Organ Failure Assessment (SOFA) score in determining life-threatening organ dysfunction, which has not been adjusted for pediatric patients. Objective To assess the accuracy of the pediatric SOFA score in diagnosing sepsis in children admitted to the pediatric intensive care unit (PICU) at Mohammad Hoesin Hospital, Palembang, South Sumatera. Methods The study was conducted in children with organ dysfunction caused by infection admitted in PICU, from April to December 2019. Subjects were included by consecutive sampling, according to the following inclusion criteria: all patients aged 1 month to 18 years who met organ dysfunction and two SIRS criteria, with infection according to the 2005 PSCC criteria. Laboratory tests performed included complete blood count (CBC), blood gas analysis, measurement of C-reactive protein (CRP), liver and kidney function tests. In all patients, pSOFA and PELOD-2 scores were calculated within 24 hours of admission. We compared the accuracy of pSOFA score to PELOD-2 score ≥ 11.   Results Of 108 subjects, there were 59 males and 49 females, with median age 11 (range 1-193) months. We compared the accuracy of pSOFA score to PELOD-2 score ≥ 11 and obtained a sensitivity of 93.3% and a specificity of 79.5%, for pSOFA cut-off score ≥ 8. Pediatric SOFA score cutoff ≥ 8 was determined by receiver operating curve (ROC). The area under the curve (AUC) for pediatric SOFA score was 93.9% (95%CI 89.7 to 98.0%). Conclusion Pediatric SOFA score ≥ 8 is the optimal cut-off for predicting life-threatening organ dysfunction in pediatric sepsis. Multicenter revalidation is needed to find the most optimal cut-off point for general use in Indonesia.

Background Sepsis is still the leading cause of death in neonates in developing countries. Proper administration of antibiotics is important for managing neonatal sepsis. The microorganisms that cause neonatal sepsis, as well as their sensitivity patterns, change over time and differ from one place to another. Since 2001, ceftazidime has been used as an empirical antibiotic for managing neonatal sepsis at Dr. Mohammad Hoesin Hospital, Palembang, South Sumatera, but its effectiveness is questionable. Objective To evaluate the effectiveness of ceftazidime as an empiric therapy for neonatal sepsis. Methods This study was pre-experimental, for one group, pre- and post-test, was conducted in 49 neonates with neonatal sepsis in the Neonatal Ward at Dr. Mohammad Hoesin Hospital, Palembang, South Sumatera, from April to September 2019. The effectiveness of ceftazidime was determined based on clinical and laboratory improvements 72 hours after ceftazidime administration. Results Of 49 neonates, 28 experienced clinical and laboratory improvement, while 21  experienced improvement in only one parameter, either clinical or laboratory. Gram positive bacteria were found in 22/49 subjects. Conclusion There is a significant difference on white blood cell count and CRP level between before and after ceftazidime administration but overall ceftazidime is no longer effective as empiric antibiotic therapy in neonatal sepsis.

Background The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) defined sepsis as life-threatening organ dysfunction due to immune dysregulation against infection. It recommends the Sequential (sepsis-related) Organ Failure Assessment (SOFA) score to evaluate life-threatening organ dysfunction. But the SOFA tool has not been adjusted for pediatric patients.  The Indonesian Pediatrics Society (IPS) uses the same sepsis definition and recommends using the PELOD-2 score as an indicator of life-threatening organ dysfunction in children.     Objective To evaluate the validity of the PELOD-2 score for predicting life-threatening organ dysfunction in pediatric sepsis. Methods A prospective cohort study was conducted in children with sepsis who were admitted to the PICU.  Subjects were taken consecutively with inclusion criteria of 1 month-18 years of age, with organ dysfunction, having two or more symptoms of systemic inflammatory response syndrome (SIRS), and suspected or proven infection.  PELOD-2 score, with and without lactate result, of each subject were plotted to receiver operating characteristic (ROC) curve, then we determined the most optimal cut off point to predict the life-threathneing organ dysfunction in pediatric sepsis based on the sensitivity and specificity of each score. Results Sixty-six patients were analyzed, with 40 males and 26 females aged 2 to 183 months (median 11 months).  Twenty patients died while in the PICU. A PELOD-2 score (with lactate) cut-off ≥ 7 was determined by ROC curve, with sensitivity of 80% and specificity of 78%. The area under the curve (AUC) of PELOD-2 score (with lactate) was 84.8% (95%CI 74.7 to 95.9%).  A PELOD-2 score (without lactate) ≥ 7  was the most optimum cut off based on its Youden index, it haD 70% of sensitivity and 80% of specificity. Conclusion PELOD-2 score ≥ 7 , with or without lactate component is the optimal cut-off for predicting life-threatening organ dysfunction in pediatric sepsis.

Latar belakang. Terapi antibiotik empiris spektrum luas merupakan standar pengobatan demam neutropeniapada keganasan karena morbiditas dan mortalitas yang berhubungan dengan sepsis bakterial. Pilihanantibiotik empiris awal, tetapi tetap kontroversial.Tujuan. Membandingkan efektivitas kombinasi ceftazidim + amikasin dan ceftazidime dalam mengatasidemam neutropenia pada keganasan di RSMH Palembang.Metode. Uji klinis acak buta ganda dilakukan sejak Desember 2012 hingga Juli 2013 di Bangsal HematologiAnak RSMH Palembang. Subjek dibagi menjadi dua kelompok, yaitu kelompok yang mendapat ceftazidime+ amikacin dan ceftazidime. Pada anak dengan keganasan yang mengalami suhu aksila >38,00C disertaiabsolute neutrophil count <1000/μL, periode bebas demam dalam 3 x 24 jam setelah pemberian regimenantibiotik awal dievaluasi untuk menilai efektivitas terapi. Data dianalisis dengan uji kai kuadrat dan Fisherexact, serta program SPSS 18.0.Hasil. Tigapuluh satu anak berusia 1-15 tahun dengan keganasan yang mengalami 46 episode demamneutropenia terdistribusi homogen pada setiap kelompok (masing-masing 23 episode). Microbiologicallydocumented infection, clinically documented infection dan unexplained fever ditemukan pada 29, 6, dan 11episode demam neutropenia. Proporsi keberhasilan pemberian ceftazidime + amikacin dalam mengatasidemam hingga hari ketiga pemantauan adalah 82,6%, sedangkan ceftazidime 56,5% (p=0,055; IK 95%:0,975-2,190).Kesimpulan. Pemberian kombinasi ceftazidime + amikacin memiliki angka keberhasilan yang lebih baikdibandingkan ceftazidim dalam menurunkan demam hingga hari ketiga, meskipun secara statistik tidak berbedabermakna.