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Abstract Background Anemia is a common clinical finding in HIV-infected patients and iron deficiency or redistribution may contribute to the development of low hemoglobin levels. Iron overload is associated with a poor prognosis in HIV and Hepatitis C virus infections. Iron redistribution may be caused by inflammation but possibly also by hepatitis C co-infection. We examined the prevalence of anemia and its relation to mortality in a cohort of HIV patients in a setting where injecting drug use (IDU) is a main mode of HIV transmission, and measured serum ferritin and sTfR, in relation to anemia, inflammation, stage of HIV disease, ART and HCV infection. Methods Patient characteristics, ART history and iron parameters were recorded from adult HIV patients presenting between September 2007 and August 2009 in the referral hospital for West Java, Indonesia. Kaplan-Meier estimates and Cox's regression were used to assess factors affecting survival. Logistic regression was used to identity parameters associated with high ferritin concentrations. Results Anemia was found in 49.6% of 611 ART-naïve patients, with mild (Hb 10.5 - 12.99 g/dL for men; and 10.5 - 11.99 g/dL for women) anemia in 62.0%, and moderate to severe anemia (Hb < 10.5 g/dL) in 38.0%. Anemia remained an independent factor associated with death, also after adjustment for CD4 count and ART (p = 0.008). Seroprevalence of HCV did not differ in patients with (56.9%) or without anemia (59.6%). Serum ferritin concentrations were elevated, especially in patients with anemia (p = 0.07) and/or low CD4 counts (p < 0.001), and were not related to hsCRP or HCV infection. Soluble TfR concentrations were low and not related to Hb, CD4, hsCRP or ART. Conclusion HIV-associated anemia is common among HIV-infected patients in Indonesia and strongly related to mortality. High ferritin with low sTfR levels suggest that iron redistribution and low erythropoietic activity, rather than iron deficiency, contribute to anemia. Serum ferritin and sTfR should be used cautiously to assess iron status in patients with advanced HIV infection.

Background: Dengue has emerged as one of the most important infectious diseases in the last five decades. Evidence indicates the expansion of dengue virus endemic areas and consequently the exponential increase of dengue virus infections across the subtropics. The clinical manifestations of dengue virus infection include sudden fever, rash, headache, myalgia and in more serious cases, spontaneous bleeding. These manifestations occur in children as well as in adults. Defining the epidemiology of dengue in a given area is critical to understanding the disease and devising effective public health strategies. Methodology/Principal Findings: Here, we report the results from a prospective cohort study of 4380 adults in West Java, Indonesia, from 2000–2004 and 2006–2009. A total of 2167 febrile episodes were documented and dengue virus infections were confirmed by RT-PCR or serology in 268 cases (12.4%). The proportion ranged from 7.6 to 41.8% each year. The overall incidence rate of symptomatic dengue virus infections was 17.3 cases/1,000 person years and between September 2006 and April 2008 asymptomatic infections were 2.6 times more frequent than symptomatic infections. According to the 1997 WHO classification guidelines, there were 210 dengue fever cases, 53 dengue hemorrhagic fever cases (including one dengue shock syndrome case) and five unclassified cases. Evidence for sequential dengue virus infections was seen in six subjects. All four dengue virus serotypes circulated most years. Inapparent dengue virus infections were predominantly associated with DENV-4 infections. Conclusions/Significance: Dengue virus was responsible for a significant percentage of febrile illnesses in an adult population in West Java, Indonesia, and this percentage varied from year to year. The observed incidence rate during the study period was 43 times higher than the reported national or provincial rates during the same time period. A wide range of clinical severity was observed with most infections resulting in asymptomatic disease. The circulation of all four serotypes of dengue virus was observed in most years of the study. [ABSTRACT FROM AUTHOR]

Objectives: Dengue fever may manifested without or with warning sign (DWOWS or DWS) and severe dengue (SD) (WHO 2009). DWOWS can be distinguished from DWS if there is plasma leakage that can be showed by changes in plasma (increased hematocrite) or detecting ascites or pleural effusion by USG. Standard abdominal ultra-sound examination (USG) could found plasma leakage, but this equipment is costly and impractical in daily use. In this study we examined the role of pocket USG device to detect plasma leakage as alternative to ordinary USG. Methodology: Dengue fever patients are included prospectively in HSH since March 2011 until March 2012, examined appropriately to confi rm and classify dengue disease. Pocket USG (P02742, 3.5 Mhz, Signos, Australia) was used to fi nd ascites, pleural efusion or thickened gallbladder wall (defi ned as wall thickness >0.35 cm). Examined bedside on hospitalized day 1, 3 and 5 for every patients. Analysis was conducted assessing contribution of this USG examination to detect of plasma leakage in comparison with increased hematocrite. Results: Sixty nine dengue patients were enrroled with characteritis as, fever median duration of 6-7 days, 31 male (45%) with a mean±SD age of 33±15 years. Hct increase (as indicator of plasma leakage) has detected in 22 (31.9 %) of the group. Pocket USG detected ascites in 12 (17.4%), pleural efusion 10 (14.5%). GBT in 22 (31.9%), and pericholecystic fl uid in 5 (7.2%) of the patients. Fluid accumulation mostly detect in median day of fever 6 (range 3-8) days. Overall, fl uid accumulation as plasma leakage was detected by USG in 27 (39.1%) where as hematocrite increased were found in 22 (31.9%) (p<0.05). GBT were compared to hematocrite for severe dengue (SD), (p<0.01, OR 64.50, 95% CI 9.54-436.20). In comparison with standard USG accuracy was reasonably well. Based on these, we can clasify dengue patient into 42 (60.9%) DWOWS, 22 (31.9%) DWS and 5 (7.2%) SD. Conclusion: Pocket USG allows detection of plasma leakage including GBT related to severity of dengue infection more sensitive than Hct. Because of its portability, it can be used bedside and in emergency room rapidly. [ABSTRACT FROM AUTHOR]

Aim: To investigate the hematologic manifestation and the relationship of the abnormalities with mortality., Methods: We examined hematologic data from 10 Avian influenza patients in Hasan Sadikin Hospital Bandung between November 2005 and March 2007., Results: The mortality rate was 70%. Anemia was found in 30% (3 of 10 patients). Leukopenia was found in 60% (6 of 10 patients. Lymphopenia and neutropenia were found in 50% (4 of 8 patients) and 62.5% (5 of 8 patients). Sixty percent (6 of 10 patients) had thrombocytopenia. Anemia was not correlated with mortality (OR=0.08). Leukopenia, neutropenia and lymphopenia were correlated with mortality (OR=5, OR=8 and OR=12, respectively). Thrombocytopenia was also correlated with mortality (OR=5)., Conclusion: Leukopenia, neutropenia, lymphopenia and thrombocytopenia were common findings among avian influenza patients in Hasan Sadikin Hospital. Decreased white blood cells and platelets were correlated with mortality.