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Abstrak :
Pada kejadian luar biasa tahun 2004 dilaporkan bahwa pasien-pasien DBD di Jakarta memenuhi berbagai rumah sakit sampai tak tertampung dan harus dirawat di koridor rumah sakit dengan tempat tidur tambahan. Hal serupa tidak tampak di RS dr Cipto Mangunkusumo (RSCM); meskipun terjadi peningkatan jumlah pasien DBD namun tidak sampai memerlukan penambahan tempat tidur yang berarti. Di seluruh wilayah DKI Jakarta terdapat 70 RS umum yang terdiri dari 8 RS pemerintah dan 62 RS swasta. RSUPN dr. Cipto Mangunkusumo, RSUD Koja, RSAB Harapan Kita, RSUD Pasar Rebo, dan RSUP Fatmawati adalah RS pemerintah yang masing-masing mewakili kelima wilayah di DKI Jakarta. RSU Sumber Wares yang berada di wilayah Jakarta Barat adalah sebuah RS swasta yang telah Iama melakukan penelitian mengenai DBD. Adanya kejadian luar biasa akan menyebabkan jumlah kasus berat bertambah, namun sangat mungkin pula terjadi overdiagnosis. Sorotan media massa yang berlebihan mengenai kejadian luar biasa DBD, di samping kebijakan pemerintah membebaskan biaya pemeriksaan, berperan dalam peningkatan jumlah pasien di berbagai rumah sakit. Untuk menghindari overdiagnosis tersebut dapat digunakan kriteria diagnosis secara klinis dan laboratorium dengan menggunakan kritena WHO tahun 1997. Tujuan penggunaan kriteria WHO adalah untuk mengidentifikasi dengan tepat pasien yang memiliki risiko timbal komplikasi akibat dengue berat (DBD dan DSS), dan juga untuk memfasilitasi triase dan penggunaan swnber daya yang terbatas secara tepat. Kriteria ini juga dapat digunakan sebagai alat epidemiologi untuk mengumpulkan data kesehatan masyarakat mengenai insiders infeksi dengue simtomatik, beratnya penyakit, dan lain-lain, yang dapat dirnanfaatkan untuk mengevaluasi program pemberantasan dan tata laksana kasus dengue. Kriteria WHO digunakan untuk menentukan kasus DBD dan tidak meliputi kasus DD, sehingga kriteria ini dapat membantu dalam menentukan CFR secara tepat dengan hanya meniasukkan kasus DBD dalam perhitungannya. Dikhawatirkan CFR yang dilaporkan saat ini meliputi pula kasus-kasus DD sehingga tampaknya terjadi penurunan dari tahun ke tahun. Dalam menghadapi KLB DBD, diperlukan peningkatan kewaspadaan dari segenap petugas kesehatan balk di tingkat puskesmas, dokter praktek perseorangan sampai rumah sakit. Maka perlu dipahami panduan yang telah ada dalam menghadapi KLB DBD agar penanganan pasien bisa dilakukan secara cepat, tepat dan efisien. Untuk itu perlu diketahui data karakteristik demografi, klinis, laboratoris serta tata laksana KLB DBD untuk dapat menjadi acuan dalam perbaikan perencanaan menghadapi KLB DBD di masa datang. Rumusan masalah Bagaimana karakteristik pasien, tata laksana dan ketepatan diagnosis demam berdarah dengue di Jakarta pada kejadian luar biasa tahun 2004?

Abstrak :
Virus dengue merupakan virus kelas Flaviviridae yang ditularkan melalui gigitan nyamuk Aedes aegypti yang sebelumnya telah terinfeksi oleh virus dengue. Diagnostik dini dilakukan dalam upaya menekan penyebaran virus ini agar pasien yang terinfeksi bisa ditangani lebih cepat. NS1 merupakan protein yang terdapat pada virus dengue dapat ditemukan di darah pasien satu hari setelah gejala infeksi primer maupun sekunder. Hal ini menjadikan NS1 penanda biologis serta target nanobodi yang tepat dalam diagnosis infeksi virus dengue. Nanobodi yang mengenali antigen NS1 pada DENV menjadi potensi alat uji diagnostik dengue karena sifatnya yang lebih unggul daripada antibodi konvensional. Penelitian ini berfokus pada pembuatan prototipe tes diagnostik cepat berbasis uji aliran lateral untuk mendeteksi NS1 pada virus dengue menggunakan nanobodi anti-NS1. Pada penelitian ini, nanobodi anti-NS1 klon DD7 dan DD5 diekspresikan pada E. coli BL21(DE3). Dalam pembuatan prototipe, dilakukan optimasi formulasi konjugasi antara nanopartkel emas dengan nanobodi anti-NS1. Sebanyak tiga optimasi dilakukan dalam mendapatkan konjugasi nanopartikel emas dengan nanobodi yang optimal, yaitu optimasi pH buffer, konsentrasi nanobodi, dan diameter nanopartikel emas. pH buffer optimal untuk klon DD5 dan DD7 adalah buffer borat pH 9, konsentrasi nanobodi optimal untuk klon DD5 dan DD7 adalah 10 ng, dan diameter optimal nanopartikel emas untuk klon DD5 dan DD7 adalah 40 nm. Pada pembuatan prototipe, konjugasi antara nanopartikel emas dan nanobodi klon DD5 belum berhasil mendeteksi antigen yaitu berupa virus dengue pada bagian test line prototipe dan untuk konjugasi antara nanopartikel emas untuk klon DD7 menghasilkan reaksi false positive pada prototipe. ......Dengue virus is a class of Flaviviridae virus transmitted through the bite of Aedes aegypti mosquitoes that have previously been infected by the dengue virus. Early diagnostics are carried out in an effort to suppress the spread of this virus so that infected patients can be treated faster. NS1 is a protein found in the dengue virus that can be found in the patient's blood one day after symptoms of primary or secondary infection.This makes NS1 a biosensor as well as a precise target for nanobodies in the diagnosis of dengue virus infection. Nanobodies that recognize NS1 antigens in DENV are potential dengue diagnostic test kits because they are superior to conventional antibodies. This research focuses on making rapid diagnostic tests based on lateral flow assay to detect NS1 in dengue viruses using anti-NS1 nanobodies as an alternative diagnostic test on dengue virus. In this study, anti-NS1 nanobodies of DD7 and DD5 clones were expressed in E. coli BL21(DE3). In making prototypes, optimization of conjugate formulations between gold nanoparticles and anti-NS1 nanobodies was carried out. A total of three optimizations were carried out in obtaining the conjugation of gold nanoparticles with optimal nanobodies, namely optimization of buffer pH, nanobody concentration, and diameter of gold nanoparticles. The optimal buffer pH for DD5 and DD7 clones is pH 9 borate buffer, the optimal nanobody concentration for DD5 and DD7 clones is 10 ng, and the optimal diameter of gold nanoparticles for DD5 and DD7 clones is 40 nm. In making the prototype, the conjugation between gold nanoparticles and DD5 clone nanobodies has not succeeded in detecting antigens in the form of dengue virus in the prototype test line and for conjugation between gold nanoparticles for DD7 clones resulting in false positive reactions in the prototype.

Abstrak :
Kebocoran plasma pada fase kritis berhubungan dengan morbiditas dan mortalitas infeksi dengue. Hingga saat ini belum diketahui pasti patofisiologinya dan kejadiannya belum dapat diprediksi. Diteliti peran respons imun pejamu dengan kejadian kebocoran plasma pada pasien dengue dengan melihat hubungan antara hitung virus intra-monosit dan hitung monosit absolut pada fase akut dengan kejadian kebocoran plasma pada fase kritis, serta mengetahui adanya antibodi terhadap sel endotel yang kemungkinan berperan pada kebocoran plasma. Penelitian ini merupakan kohort prospektif dengan 127 subjek penelitian yang terinfeksi serotipe DENV tunggal berdasarkan rt-PCR dan dirawat di rumah sakit sebelum hari keempat demam. Spesimen darah diambil pada hari kedua demam, dan perubahan klinis dan laboratoris dipantau hingga hari ketujuh perawatan. Kebocoran plasma ditentukan pada fase kritis hari ke-5 sampai ke-7, berdasarkan kriteria WHO dan dengue score. Pada pasien dengan kebocoran plasma berdasarkan kriteria WHO, tidak terdapat perbedaan hitung virus DENV plasma pada hari kedua demam (p = 0,325) dengan pasien tanpa kebocoran plasma. Hitung virus DEN intra-monosit lebih tinggi secara bermakna (p = 0,031). Jika dikelompokkan berdasarkan dengue score, perbedaan hitung DENV intra-monosit bermakna antara kelompok skor > 3 dan skor < 1 (p = 0,07), namun tidak ditemukan perbedaan antara kelompok skor 2 dan < 1 (p = 0,14) dan antara skor 2 dan skor > 3 (p = 0,23). Demikian pula tidak ada perbedaan bermakna hitung DENV plasma pada ketiga kelompok tersebut (nilai p masing-masing adalah 0,07, 0,14, dan 0,95). Hitung absolut monosit darah tepi mengalami penurunan pada semua pasien, dengan titik terendah pada hari ketiga demam. Penurunan lebih besar secara bermakna (p = 0,015) terjadi pada kelompok dengan kebocoran plasma. Dengan titik potong hitung monosit absolut hari ketiga 250 sel/L, diperoleh AUC 0,742 untuk memprediksi kebocoran plasma dengan kriteria WHO, dan AUC 0,647 untuk memprediksi dengue score > 3 pada fase kritis. Selain itu, ditemukan antibodi terhadap sel endotel pada pasien terinfeksi DENV, dengan 3 target lebih banyak diekspresikan pada pasien dengan kebocoran plasma adalah protein berukuran 37 kDa, 75 kDa, dan 120 kDa. Kebocoran plasma pada fase kritis berhubungan dengan hitung virus DENV intra-monosit yang lebih lebih tinggi dan jumlah absolut monosit darah tepi yang lebih rendah pada fase akut. Dengan titik potong hitung monosit absolut pada hari ketiga 250 sel/L dapat diprediksi kejadian kebocoran plasma pada fase kritis. Ditemukan antibodi terhadap sel endotel yang kemungkinan berhubungan dan berpotensi sebagai penanda prediktor kebocoran plasma. ......Plasma leakage during the critical phase is associated with morbidity and mortality from dengue infection. Until now, the pathophysiology is remains unclear, and the occurrence is unpredictable. We examine the role of host immune response in the pathophysiology of plasma leakage in dengue infected patients by studying the association of intra-monocyte DENV viral load and monocyte absolute count during the acute phase with plasma leakage during critical phase. We also examined the existence of anti-endothelial antibody in dengue infected patients’ plasma that could potentially be involved in the plasma leakage. This prospective cohort study involved 127 subjects with single DENV serotype infected identified by rt-PCR and hospitalized for three days after the fever occurs. Blood samples were taken on the second day, and all the patients were monitored until the 7th day for clinical and laboratory changes. Plasma leakage was determined on fifth to seventh day, according to the WHO criteria and dengue score. In the plasma leakage group, based on WHO criteria, there was no significant difference in plasma DENV viral load (p = 0.325), while the intra-monocyte DENV viral load was significantly higher (p = 0.031). Based on the dengue score grouping, intra-monocyte DENV viral load was significantly higher on score > 3 compared to score < 1 (p = 0.07), but there was no significant difference between scores 2 and < 1 (p = 0.14), and between scores 2 and > 3 (p = 0.23). There were no significant differences in plasma DENV viral load among those groups (respective p values: 0.07, 0.14, and 0.95). The monocyte absolute count decreased in all the patients, with the lowest count was reached on the third day of fever. On day 3, the monocyte absolute counts were significantly lower among plasma leakage patients compared to non-plasma leakage patients (p = 0.015). By using a cut-off point of absolute monocyte count of 250 cells/L, We obtained an AUC of 0.742 which was used to predict the occurrence of plasma leakage in the critical phase based on WHO criteria, and AUC 0.647 to predict dengue score > 3. We also found the anti-endothelial antibodies in the acute plasma of dengue infected patients. The prominent antibodies targeting endothelial proteins of 37 kDa, 75 kDa, and 120 kDa were expressed more among the plasma leakage groups. Plasma leakage during the critical phase is associated with higher intra-monocyte DENV viral loads and lower monocyte absolute count compared to the acute phase. The monocyte absolute count cut-off point of 250 cells/L on the third day may be used as predictor of plasma leakage. Anti- endothelial antibodies were detected in acute plasma and might be associated and used as predictors of plasma leakage.

Abstrak :
[ABSTRAK
Latar Belakang: Insiden dan case fatality rate pasien terinfeksi dengue di Indonesia masih tinggi. Penyebab kematian utama pada infeksi dengue adalah renjatan yang disebabkan oleh kebocoran plasma. Kejadian hiponatremia dan hipokalemia sering ditemukan pada pasien yang mengalami infeksi dengue, namun keduanya tidak termasuk penanda kebocoran plasma dalam kriteria DBD oleh WHO. Penelitian ini bertujuan untuk mengetahui rerata penurunan kadar natrium dan kalium serum pada pasien terinfeksi dengue dengan atau tanpa kebocoran plasma, dan mengonfirmasi penelitian sebelumnya apakah kadar natrium dan kalium bisa dipakai sebagai penanda kebocoran plasma. Metode: Studi kohort prospektif dilaksanakan pada pasien terinfeksi dengue ≥ 16 tahun dengan demam mendadak ≤ 3 hari yang dirawat di ruang rawat inap Penyakit Dalam RS Cipto Mangunkusumo dan RS Persahabatan Jakarta pada pada Agustus 2013-Juni 2014. Dilakukan pemeriksaan natrium serum, kalium serum, albumin, dan ultrasonografi untuk melihat adanya penebalan kandung empedu, asites dan efusi pleura pada pasien terinfeksi dengue pada hari pertama masuk perawatan dan hari kelima demam. Untuk mendapatkan rerata penurunan natrium dan kalium serum antara pasien terinfeksi dengue yang mengalami kebocoran plasma dan yang tidak, digunakan uji komparatif t-test tidak berpasangan. Hasil: Terdapat 35 orang subjek penelitian pasien terinfeksi dengue yang diambil secara konsekutif. Rerata kadar natrium serum pada pasien Demam Dengue (DD) pada saat masuk 134,66 ± 4,00 mEq/L dan pada hari kelima demam 130,95 ± 4,80 mEq/L. Sementara pada pasien Demam Berdarah Dengue (DBD) didapatkan kadar natrium pada saat masuk 132,469 ± 3,45 mEq/L dan pada saat hari kelima 129,35 ± 2,67 mEq/L. Perbedaan rerata penurunan kadar natrium antara pasien DBD dengan DD sebesar 0,43 mEq/L, IK 95% [-2,56; 3,42], p = 0,386. Rerata kadar kalium serum pada pasien DD pada saat masuk 3,48 ± 0,44 mEq/L dan pada hari kelima demam 3,39 ± 0,38 mEq/L. Sementara pada pasien DBD didapatkan rerata kadar kalium pada saat masuk 3,32 ± 0,25 mEq/L dan pada hari kelima demam 3,11 ± 0,30 mEq/L. Perbedaan rerata penurunan kadar kalium pasien DBD dengan DD sebesar 0,12 mEq/L, IK 95% [-0,34; 0,10], p = 0,145. Simpulan: Tidak didapatkan perbedaan rerata penurunan kadar natrium dan kalium serum pada pasien terinfeksi dengue dengan kebocoran plasma dibandingkan dengan tanpa kebocoran plasma.

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ABSTRACT
Background: Incidence and case fatality rate of dengue-infected patients in Indonesia is still high. The main causes of death in dengue infection is shock caused by plasma leakage. The incidence of hyponatremia and hypokalemia often found in patients with dengue infection, but they do not include markers of plasma leakage in DHF criteria by WHO. This study aims to determine the average decrease of serum sodium and potassium levels in patients infected with dengue with or without plasma leakage, and confirm previous studies whether the levels of sodium and potassium can be used as a marker of plasma leakage. Method: A prospective cohort study conducted in patients infected with dengue ≥ 16 years old with sudden fever ≤ 3 days treated in Cipto Mangunkusumo Hospital and Persahabatan Hospital in Jakarta between August 2013 to June 2014. Checking serum sodium, potassium, albumin, and ultrasound to see the thickening of the gall bladder, ascites and pleural effusion in patients infected with dengue on the first day of treatment and the fifth day of fever. We used comparative unpaired t-test to obtain an average decrease in serum levels of sodium and potassium between dengue infected patients who undergo plasma leakage and are not. Results: There were 35 research subjects infected with dengue taken consecutively. The average of serum sodium levels in patients with Dengue Fever (DF) at the time of entry was 134,66 ± 4,00 mEq/L and on the fifth day of fever was 130,95 ± 4,80 mEq/L. While in patients with Dengue Hemorrhagic Fever (DHF) obtained sodium levels at the time of entry was 132,469 ± 3,45 mEq/L and on the fifth day of fever was 129,35 ± 2,67 mEq/L. The difference of the average of decreased level of sodium between DHF and DF patients was 0,43 mEq/L, CI 95% [-2,56; 3,42], p = 0,386. The average of serum potassium levels in patients with DF at the time of entry was 3,48 ± 0,44 mEq/L and on the fifth day of fever was 3,39 ± 0,38 mEq/L. While in patients with DHF, obtained potassium levels at the time of entry was 3,32 ± 0,25 mEq/L and on the fifth day of fever was 3,11 ± 0,30 mEq/L. The difference of the average of decreased level of potassium between DHF and DF patients was 0,12 mEq/L, CI 95% [-0,34; 0,10], p = 0,145. Conclusion: There were no differences in average of decreased level of serum sodium and potassium in dengue-infected patients with plasma leakage compared to without plasma leakage;Background: Incidence and case fatality rate of dengue-infected patients in Indonesia is still high. The main causes of death in dengue infection is shock caused by plasma leakage. The incidence of hyponatremia and hypokalemia often found in patients with dengue infection, but they do not include markers of plasma leakage in DHF criteria by WHO. This study aims to determine the average decrease of serum sodium and potassium levels in patients infected with dengue with or without plasma leakage, and confirm previous studies whether the levels of sodium and potassium can be used as a marker of plasma leakage. Method: A prospective cohort study conducted in patients infected with dengue ≥ 16 years old with sudden fever ≤ 3 days treated in Cipto Mangunkusumo Hospital and Persahabatan Hospital in Jakarta between August 2013 to June 2014. Checking serum sodium, potassium, albumin, and ultrasound to see the thickening of the gall bladder, ascites and pleural effusion in patients infected with dengue on the first day of treatment and the fifth day of fever. We used comparative unpaired t-test to obtain an average decrease in serum levels of sodium and potassium between dengue infected patients who undergo plasma leakage and are not. Results: There were 35 research subjects infected with dengue taken consecutively. The average of serum sodium levels in patients with Dengue Fever (DF) at the time of entry was 134,66 ± 4,00 mEq/L and on the fifth day of fever was 130,95 ± 4,80 mEq/L. While in patients with Dengue Hemorrhagic Fever (DHF) obtained sodium levels at the time of entry was 132,469 ± 3,45 mEq/L and on the fifth day of fever was 129,35 ± 2,67 mEq/L. The difference of the average of decreased level of sodium between DHF and DF patients was 0,43 mEq/L, CI 95% [-2,56; 3,42], p = 0,386. The average of serum potassium levels in patients with DF at the time of entry was 3,48 ± 0,44 mEq/L and on the fifth day of fever was 3,39 ± 0,38 mEq/L. While in patients with DHF, obtained potassium levels at the time of entry was 3,32 ± 0,25 mEq/L and on the fifth day of fever was 3,11 ± 0,30 mEq/L. The difference of the average of decreased level of potassium between DHF and DF patients was 0,12 mEq/L, CI 95% [-0,34; 0,10], p = 0,145. Conclusion: There were no differences in average of decreased level of serum sodium and potassium in dengue-infected patients with plasma leakage compared to without plasma leakage, Background: Incidence and case fatality rate of dengue-infected patients in Indonesia is still high. The main causes of death in dengue infection is shock caused by plasma leakage. The incidence of hyponatremia and hypokalemia often found in patients with dengue infection, but they do not include markers of plasma leakage in DHF criteria by WHO. This study aims to determine the average decrease of serum sodium and potassium levels in patients infected with dengue with or without plasma leakage, and confirm previous studies whether the levels of sodium and potassium can be used as a marker of plasma leakage. Method: A prospective cohort study conducted in patients infected with dengue ≥ 16 years old with sudden fever ≤ 3 days treated in Cipto Mangunkusumo Hospital and Persahabatan Hospital in Jakarta between August 2013 to June 2014. Checking serum sodium, potassium, albumin, and ultrasound to see the thickening of the gall bladder, ascites and pleural effusion in patients infected with dengue on the first day of treatment and the fifth day of fever. We used comparative unpaired t-test to obtain an average decrease in serum levels of sodium and potassium between dengue infected patients who undergo plasma leakage and are not. Results: There were 35 research subjects infected with dengue taken consecutively. The average of serum sodium levels in patients with Dengue Fever (DF) at the time of entry was 134,66 ± 4,00 mEq/L and on the fifth day of fever was 130,95 ± 4,80 mEq/L. While in patients with Dengue Hemorrhagic Fever (DHF) obtained sodium levels at the time of entry was 132,469 ± 3,45 mEq/L and on the fifth day of fever was 129,35 ± 2,67 mEq/L. The difference of the average of decreased level of sodium between DHF and DF patients was 0,43 mEq/L, CI 95% [-2,56; 3,42], p = 0,386. The average of serum potassium levels in patients with DF at the time of entry was 3,48 ± 0,44 mEq/L and on the fifth day of fever was 3,39 ± 0,38 mEq/L. While in patients with DHF, obtained potassium levels at the time of entry was 3,32 ± 0,25 mEq/L and on the fifth day of fever was 3,11 ± 0,30 mEq/L. The difference of the average of decreased level of potassium between DHF and DF patients was 0,12 mEq/L, CI 95% [-0,34; 0,10], p = 0,145. Conclusion: There were no differences in average of decreased level of serum sodium and potassium in dengue-infected patients with plasma leakage compared to without plasma leakage]

Abstrak :
Latar Belakang: Demam berdarah dengue merupakan salah satu penyakit infeksi ditularkan melalui gigitan nyamuk Aedes aegypti. Insiden dan angka kematian Demam Berdarah Dengue (DBD) terus meningkat di Indonesia. Belum penemuan vaksin untuk penyakit ini, menjadikannya satu-satunya cara untuk mencegahnya penyebarannya adalah dengan mengontrol vektor propagasi, yaitu menggunakan insektisida sintetis. Beberapa daerah di Indonesia sudah melaporkan Kasus resistensi terhadap insektisida sintetik, seperti di Jawa Tengah dan Jawa Tengah DI. Yogyakarta, hal ini dikarenakan pemakaian yang berlebihan dan dalam waktu yang lama panjang. Salah satu solusi yang bisa dilakukan adalah dengan menggunakan Insektisida herbal. Selain tidak banyak digunakan, dibuat dari bahan insektisida tanaman juga lebih ramah lingkungan. Salah satu tanaman yang bisa dipilih merupakan tumbuhan manggis (Garcinia mangostana). Kandungan metabolit sekunder Tanaman manggis termasuk alkaloid, flavonoid, terpenoid, tanin dan saponin yang diketahui memiliki efek larvasida yang tinggi terhadap A. aegypti. Tambahan Nanokomposit Ag-TiO2 dapat digunakan untuk mempercepat kematian larva. Tujuan: Penelitian ini dilakukan untuk melihat aktivitas insektisida ekstrak kulit manggis dan nanokomposit AgTiO2 terhadap larva dan nyamuk dewasa A. aegypti. Metode: Penelitian ini menggunakan dua subjek yaitu: 1) larva instar III dan IV dan 2) nyamuk A. aegypti dewasa yang terpapar ekstrak kulit manggis (Konsentrasi 500, 1000, 1500, 2000, dan 2500 ppm), nanokomposit Ag-TiO2 dan campuran ekstrak kult manggis dengan nanocompsite Ag-TiO2 diulang lima kali) Nyamuk dewasa A. Aegypti yang terkena ekstrak kulit manggis (Konsentrasi 2500, 5000, 10000, dan 20000), nanokomposit AgTiO2 (konsentrasi 5, 10, 20, dan 30 ppm), dan campuran Konsentrasi ekstrak kulit manggis dengan konsentrasi 2500, 5000, 10000, dan 20000 ppm nanokomposit (15 ppm) diulang tiga kali. Hasil: Uji Coba Pearson Ditemukan nilai r = +0.843 dan p = 0.001 pada konsentrasi penelitian campuran Ekstrak kulit manggis mengandung nanokomposit. Ini menandakan hubungan kuat dan positif (+) di antara konsentrasi campuran ekstrak kulit manggis mengandung nanokomposit dengan jumlah kematian nyamuk A. aegypti dewasa. Kesimpulan: Ekstrak kulit manggis dikoordinasikan dengan nanokomposit yang telah terbukti efektif dalam meningkatkan aktivitas insektisida terhadap larva dan nyamuk dewasa A. aegypti. ......Background: Dengue hemorrhagic fever is an infectious disease transmitted through the bite of Aedes aegypti mosquitoes. The incidence and mortality rate of Dengue Hemorrhagic Fever (DHF) continues to increase in Indonesia. There has not been a vaccine for this disease yet, making it the only way to prevent its spread is to control the propagation vector, namely using synthetic insecticides. Several regions in Indonesia have reported cases of resistance to synthetic insecticides, such as in Central Java and Central Java, DI. Yogyakarta, this is due to excessive use and for a long time. One solution that can be done is to use herbal insecticides. Besides not being widely used, it is made from plant insecticides which are also more environmentally friendly. One of the plants to choose from is the mangosteen plant (Garcinia mangostana). Secondary metabolite content Mangosteen plants include alkaloids, flavonoids, terpenoids, tannins and saponins which are known to have a high larvicidal effect against A. aegypti. Additional Ag-TiO2 nanocomposites can be used to accelerate larval mortality. Objective: This study was conducted to determine the insecticidal activity of mangosteen peel extract and AgTiO2 nanocomposites against A. aegypti larvae and adult mosquitoes. Method: This study used two subjects, namely: 1) instar larvae III and IV and 2) adult A. aegypti mosquitoes exposed to mangosteen peel extract (concentration 500, 1000, 1500, 2000, and 2500 ppm), Ag-TiO2 nanocomposites and a mixture of mangosteen culture extract and Ag-TiO2 nanocomposites were repeated five times) Adult mosquitoes A. Aegypti were exposed to mangosteen peel extract (Concentrations 2500, 5000, 10000, and 20000), AgTiO2 nanocomposites (concentrations of 5, 10, 20, and 30 ppm), and mixed concentrations of mangosteen peel extract with concentrations of 2500, 5000, 10000, and 20000 ppm nanocomposites (15 ppm) were repeated three times. Results: Pearson Trial It was found that the value of r = +0.843 and p = 0.001 in the research concentration mixture of mangosteen peel extract contained nanocomposites. This signifies relationship strong and positive (+) among the concentrations of the mangosteen peel extract mixture containing nanocomposites with the number of deaths of adult A. aegypti mosquitoes. Conclusion: Mangosteen peel extract coordinated with nanocomposites had been shown to be effective in increasing insecticidal activity against larvae and adult mosquitoes. aegypti.

Abstrak :
[Kasus Demam Berdarah Dengue (DBD) dan demam dengue (DD) dilaporkan meningkat di seluruh dunia setiap tahunnya, terutama di negara Asia Tenggara termasuk Indonesia Gambaran klinis dari DBD/DD adalah demam, sakit kepala, nyeri otot dan sendi, ruam kulit yang mirip dengan campak, dan hasil lab menunjukkan penurunan jumlah trombosit. Hingga saat ini belum ada antiviral khusus untuk DBD. Penelitian ini bertujuan untuk mengevaluasi pengaruh virgin coconut oil (VCO) terhadap replikasi virus dengue (DENV). Penelitian ini merupakan penelitian eksperimental yang dilakukan di Laboratorium Mikrobiologi, Departemen Mikrobiologi, Fakultas Kedokteran Universitas Indonesia. Data yang diperoleh ini berasal dari hasil eksperimen yang dilakukan dengan 6 pengulangan untuk setiap perlakuan yaitu pemberian VCO 5%, 1%, 0,5% dan 0,1%, kontrol negatif dan Dimethyl Sulfoxide (DMSO). Penghambatan replikasi DENV dilihat dengan menghitung titer virus setelah perlakuan VCO. Titer virus dihitung dengan menggunakan metode focus assay. Hasil penelitian menunjukkan bahwa IC50 dari VCO adalah kuat, sementara CC50 VCO adalah moderat. Hal ini menunjukkan bahwa secara signifikan VCO menghambat replikasi DENV dengan kisaran cukup aman untuk digunakan pada sel dalam dosis terbatas. Penelitian lebih lanjut perlu dilakukan untuk mengevaluasi efek VCO pada replikasi DENV in vivo, sehingga dapat ditemukan kandidat anti DENV di masa mendatang.;Cases of the Dengue Hemorrhagic Fever (DHF)/Dengue Fever (DF) were reported increasing worldwide annually, especially in South Asia counties including Indonesia The clinical features of DF/DHF are fever, headache, muscle and joint pains, a characteristic skin rash that is similar to measles, which lead to thrombocytopenia as a lab result. Until now, specific antiviral for dengue virus (DENV) is not available yet. The objective of this research was to evaluate the effect of virgin coconut oil (VCO) to the DENV replication. This research was experimental study and was conducted at Microbiology laboratory, Department of Microbiology, Faculty of Medicine University of Indonesia. The data that was obtained for this study came from the experimental studied with 6 repeated experiments for each treatment of various concentartion of 5%, 1%, 0.5% and 0.1% as well as negative control and Dimethyl Sulfoxide (DMSO). Inhibition of DENV replication was determined by calculating of DENV titer after treated with VCO. The focus assay was used to calculate the DENV titer. The result showed that IC50 and CC50 of VCO was strong and moderate respectively. VCO was significantly inhibited the replication of DENV with adequate safe range to use for cells within limited dosages. Therefore, we concluded that VCO can be a candidate antiviral for DENV. Next study is needed to evaluate the effect of VCO in vivo, therefore we will find an antiviral of DENV virus in future.;Cases of the Dengue Hemorrhagic Fever (DHF)/Dengue Fever (DF) were reported increasing worldwide annually, especially in South Asia counties including Indonesia The clinical features of DF/DHF are fever, headache, muscle and joint pains, a characteristic skin rash that is similar to measles, which lead to thrombocytopenia as a lab result. Until now, specific antiviral for dengue virus (DENV) is not available yet. The objective of this research was to evaluate the effect of virgin coconut oil (VCO) to the DENV replication. This research was experimental study and was conducted at Microbiology laboratory, Department of Microbiology, Faculty of Medicine University of Indonesia. The data that was obtained for this study came from the experimental studied with 6 repeated experiments for each treatment of various concentartion of 5%, 1%, 0.5% and 0.1% as well as negative control and Dimethyl Sulfoxide (DMSO). Inhibition of DENV replication was determined by calculating of DENV titer after treated with VCO. The focus assay was used to calculate the DENV titer. The result showed that IC50 and CC50 of VCO was strong and moderate respectively. VCO was significantly inhibited the replication of DENV with adequate safe range to use for cells within limited dosages. Therefore, we concluded that VCO can be a candidate antiviral for DENV. Next study is needed to evaluate the effect of VCO in vivo, therefore we will find an antiviral of DENV virus in future., Cases of the Dengue Hemorrhagic Fever (DHF)/Dengue Fever (DF) were reported increasing worldwide annually, especially in South Asia counties including Indonesia The clinical features of DF/DHF are fever, headache, muscle and joint pains, a characteristic skin rash that is similar to measles, which lead to thrombocytopenia as a lab result. Until now, specific antiviral for dengue virus (DENV) is not available yet. The objective of this research was to evaluate the effect of virgin coconut oil (VCO) to the DENV replication. This research was experimental study and was conducted at Microbiology laboratory, Department of Microbiology, Faculty of Medicine University of Indonesia. The data that was obtained for this study came from the experimental studied with 6 repeated experiments for each treatment of various concentartion of 5%, 1%, 0.5% and 0.1% as well as negative control and Dimethyl Sulfoxide (DMSO). Inhibition of DENV replication was determined by calculating of DENV titer after treated with VCO. The focus assay was used to calculate the DENV titer. The result showed that IC50 and CC50 of VCO was strong and moderate respectively. VCO was significantly inhibited the replication of DENV with adequate safe range to use for cells within limited dosages. Therefore, we concluded that VCO can be a candidate antiviral for DENV. Next study is needed to evaluate the effect of VCO in vivo, therefore we will find an antiviral of DENV virus in future.]