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Background: Human immunodeficiency virus (HIV)-associated nephropathy refers to developing kidney disease associated with HIV infection. Tenofovir is associated with an increased risk of acute kidney injury (AKI). Kidney injury molecule-1 (KIM-1) in urine is very specific for kidney injury. This study aimed to determine the changes in the ratio between the levels of KIM-1/urine creatinine and the increase in serum creatinine levels with the incidence of decreased kidney function in people with HIV. Method: This was an observational-analytic study. Subjects were taken using consecutive sampling at Sanglah Hospital Denpasar in 2018. KIM-1 levels were measured by the ELISA method. Results: This study involved 35 patients (21 males and 14 females) with a mean age of 34.89 ± 10.05 years old. The average levels of KIM-1/urine creatinine at 0 hours was 11.039 ± 12.175 ng/ml), KIM-1/urine creatinine at 12 was 12.382 ± 14.671 ng/ml), KIM-1/urine creatinine at 72 was 10.272 ± 11.843 ng/ml). There were no statistically significant differences in the ratio of hours 0 to 12 hours (p = 0.295), and between hours 0-72 (p = 0.413). But there was a significant difference in creatinine levels for 3 months with the initial mean serum (0.848 ± 0.201) and 3 months of evaluation (1.002 ± 0.198) (p =

Background: Malnutrition, systemic inflammation, and atherosclerosis known as MIA syndrome occurs in patients who have undergone regular hemodialysis (HD) and can lower their quality of life (QoL). Current study aimed to determine the interrelation of malnutrition and inflammation to QoL. Methods: A cross-sectional analytic study was conducted in our hemodialysis installation. We performed Malnutrition Inflammation Score (MIS) and measure serum IL-6 to determine malnutrition and inflammation conditions in regular HD patients and utilized ‘Kidney Disease Quality of Life-Short Form (KDQOL-SF) to assess QoL MIS. IL-6 cut-off point were determined by the Receiver Operating Curves (ROC) then we performed linear regression to analyze the relationship level of MIS and IL-6 with level of QoL. We also used path analysis to prove the mechanism model of MIS and IL-6 to QoL on regular HD patients. Results: This study consisted of 60 regular HD patients, 40 (66.7%) of men with mean age of 51.8 years and 78 months average of dialysis vintage. Good QoL was obtained ≥60 overall health (above the median value) and high level of MIS was obtained ≥5 with 75% sensitivity and 21.8% specificity, while high IL-6 level were ≥47.21 pg/mL, with 62.2% sensitivity and specificity of 78.3%. This study found the prevalence of protein-energy wasting (PEW) in regular HD patients was 81.7% by using high level of MIS. MIS were significantly correlated to IL-6 (r = 0.376, p = 0.003) however high level of MIS were uncorrelated to poor QoL. The mechanism of the interrelation of MIS, IL-6, and QoL showed on path analysis that MIS was 15% directly correlated to QoL, however, IL-6 indirectly correlated to QoL on regular hemodialysis patients. Conclusion: MIS and IL-6 were correlated to QoL and MIS also correlated to IL-6. Malnutrition inflammatory score directly affected QoL but IL-6 indirectly affected QoL in regular HD patients.

Introduction: Decreased renal function is associated with a poor prognosis in acute heart failure (AHF). The current standard for assessing the decline in kidney function, creatinine, has several limitations. Serum Neutrophil gelatinase-associated lipocalin (NGAL) is one of the predictive biomarkers that was shown better at indicating an early AKI. Although several studies have examining the role of NGAL as a predictor for poor prognosis in various medical conditions, the result in AHF condition is still inconsistent. This study aimed to determine the role of serum NGAL and decreased renal function (estimated using serum creatinine) in predicting the mortality and major adverse cardiovascular (MACE) events during hospitalization in acute heart failure patientsMethods: Prospective cohort study with consecutive sampling was conducted in AHF patients who were treated at Sanglah General Hospital from July to September 2017. Serum NGAL and creatinine levels were measured at the onset of hospital admission and observed for mortality and MACE during hospitalization.Results: Seventy-seven patients were involved in this study. We found hazard ratio (HR) serum NGAL to mortality was 7.8 (p = 0.009) and increased to 18,9 in multivariate analysis with cox proportional hazards regression model (p = 0.002). There were significant differences in survival (p = 0.002) between patients with high serum NGAL (424 hours survival rate, 95% CI 296-552) than low serum NGAL (baseline survival 680 hours; 95% CI 584-775) after log rank test. Meanwhile, the effect of serum NGAL on MACE and decreased of kidney function on mortality or MACE did not yield significant result.Conclusion: High serum NGAL is an independent predictor of in-hospital mortality among AHF patients.

Background: Delirium is common and serious problem with high morbidity and mortality, especially in geriatric patients. Decrease in the number of neuroprotective factors (IGF-I and IL-1RA) and increase in IFN-γ had been correlated with the incidence of delirium. This study aims to understand whether these markers can be used as predictors for mortality in geriatric patients with delirium in an effort to prevent the adverse events of delirium.Methods: In this observational analytic study with prospective cohort design carried out in the Geriatric Installation care room at Sanglah General Hospital in Denpasar in 2018, 76 samples were examined for their IGF-1, IL-1RA, IFN-γ plasma levels. Patients were then followed during their hospital stay until they were declared cured or died due to delirium or its complications. The relationship between each group and mortality rate were then analyzed using univariate, bivariate and multivariate analysis.Results: In this study, median was used as the cutoff point for IGF-1 levels [21.38 (0.00-91.07)], IL-1RA levels [2,491.48 (193,44-6720,13)] and IFN-γ [194.29 (0.00-2200.96)]. In multivariate analysis, low plasma levels of IGF-1 (HR= 4.12 [95% CI: 1,458 - 11,642, p=0.008]) and IL-1RA (HR=2.91 [95 % CI: 1.037 - 8.154, p= 0.043]) proved to be an independent factor in the occurrence of death in geriatric patients with delirium. However, IFN- γ failed to show any correlations.Conclusion: Both low plasma levels of IGF-1 and IL-1RA can be used as predictors for mortality in geriatric patients with delirium.

Background: The diagnosis of bacterial meningitis is very difficult because of the vague clinical presentation primarily in infants and children. The S100B protein is a brain neurochemistry that may a biomarkers of inflammatory process in the brain and it is thought to have relationship with neuron damage and oxidative stress in bacterial meningitis.Methods: In this study, we measured the levels of S100B protein in CSF and serum by using ELISA method, in children with suspected bacterial meningitis. The diagnosis of proven bacterial meningitis based on positive culture that confirmed the causing bacteria. We analyzed the data by using MedCalc-version 17.6 programe.Results: Eighty patients suspected bacterial meningitis included in this study, 47 (58.8%) male, and mean of age was 29.8 months (SD+32.1). Prevalence of proven bacterial meningitis were 21/80 (26.25%). The main clinical symptoms were seizures, decreased of consciousness, clinically sepsis, positive meningeal sign, vomiting and focal neurologic deficits. The comparison of S100BCSF levels between positive culture and negative culture were 31.4 (SD+32.81) and 29.2 (SD+27.13). A comparison of S100Bserum levels between positive culture and negative culture 114.1 (SD+95.67) dan 74.9 (SD+75.84). Area under curve (AUC) of S100BCSF dan S100Bserum were 0.523 and 0.655, respectively. Levels of S100BCSF protein >54 ng/L and S100Bserum >177 ng/L were optimal criteria for diagnosis bacterial meningitis with sensitivity 29% and 19%, specificity 98% and 98%, respectively.Conclusion: Levels of S100BCSF and S100Bserum protein have prospective value with high specificity to confirm the diagnosis of bacterial meningitis in children. We can use S100Bserum as addition test for the diagnosis of bacterial meningitis in children if there is contraindication for lumbal puncture.

Introduction: Organ involvement may influence the severity of systemic lupus erythematosus (SLE). Ultrasound (US) can detect organs morphological changes in SLE patients. Lack of data about US-detected lupus organs involvement triggered a research that explored the US findings of nephritis, hepatic steatosis, and knee joint effusion in Balinese women with SLE. Method: This was an analytical cross sectional study to discover the prevalence of US-detected nephritis, hepatic steatosis, and knee joint effusion in Balinese women with SLE, and determined their association with clinical and laboratory findings. Anamnesis, physical, laboratory and US examination were performed. Correlations between clinical and laboratory results with US findings were tested using Spearman’s correlation, linear regression and binary logistic regression tests (α = 0.05). Result: From 57 subjects, US nephritis was determined in 19 (33%) subjects, hepatic steatosis in 31 (54.5%) subjects, right knee joint effusion in 12 (21.1%) subjects, and left knee joint effusion in 14 (24.6%) subjects. No significant correlation between dyslipidemia and hepatic steatosis (p>0.05), but significant correlations between knee pain and knee joint effusion (pConclusion: Nephritis, hepatic steatosis, and knee joint effusion were identified in Balinese women SLE patients using US. Some clinical and laboratory indicators had a significant correlation with knee joint effusion and nephritis, but most of the laboratory parameters demonstrated no significant association with hepatic steatosis.