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Abstrak :
Demam berdarah dengue (DBD) adalah penyakit yang ditandai dengan demam dan perdarahan. Selain itu terdapat efusi pleura yang diduga karena peningkatan permeabilitas vaskular. Berdasarkan tanda tersebut, diduga disfungsi endotel memegang peranan dalam patogenesis demam berdarah dengue. Tujuan penelitian ini adalah untuk mengetahui apakah pada demam berdarah dengue terjadi disfungsi endotel dengan memeriksa kadar sVCAM-1, von Willebrand factor dan petanda aktivasi koagulasi yaitu D dimer. Di samping itu ingin diketahui apakah ada hubungan antara petanda disfungsi endotel dengan beratnya penyakit. Desain penelitian ini potong lintang, kelompok kasus terdiri atas 31 penderita DBD dan kelompok kontrol terdiri atas 30 penderita demam bukan DBD. Kadar sVCAM-1 diperiksa dengan cara ELISA, vWF dengan cara enzyme linked fluorescent assay (ELFA) dan D-dimer dengan cara sandwich enzyme immunoassay. Hasil penelitian menunjukkan bahwa rerata kadar sVCAM-1 pada kelompok DBD dan kelompok kontrol berturut-turut adalah 1323 ng/mL dan 1003 ng/mL, sedangkan simpang bakunya berturut-turut 545 ng/mL dan 576 ng/mL. Rerata kadar vWF pada kelompok DBD dan kontrol berturut-turut 284% dan 327%, dengan simpang baku berturut-turut 130% dan 141%. Kadar sVCAM-1 tidak berkorelasi dengan jumlah trombosit, kadar albumin, kadar D dimer dan beratnya penyakit. Terdapat korelasi lemah antara kadar vWF dengan D dimer dan beratnya penyakit. ( r = 0,472 dan r = -0,450). Kesimpulan: Hasil pemeriksaan sVCAM-1, vWF dan D dimer menunjukkan bahwa pada DBD terjadi disfungsi endotel. Namun tidak ada hubungan antara sVCAM-1 dengan beratnya penyakit, hanya ada hubungan yang lemah antara vWF dengan D dimer maupun beratnya penyakit.

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Endothelial Dysfunction in Dengue Hemorhagic Fever. Dengue hemorrhagic fever (DHF) is characterized by fever, bleeding, and pleural effusion which may be caused by increased vascular permeability. Based on these findings it is assumed that endothelial dysfunction plays a role in the pathogenesis of DHF. The aims of this study was to know whether endothelial dysfunction occurs in DHF by measuring sVCAM-1, vWF, and D dimer. The relationship between endothelial dysfunction and severity of the disease would also be analyzed. This was a cross sectional study which involved 31 DHF patients and 30 non DHF fever patients as control group. The level of sVCAM-1 was determined by ELISA method, vWF by enzyme linked fluorescent assay , and D dimer by sandwich enzyme immunoassay. The results indicated that mean of sVCAM-1 level in DHF group and control group were 1323 ng/mL and 1003 ng/mL, while standard deviation (SD) were 545 ng/mL and 576 ng/mL respectively. The mean of vWF level in DHF group and control group were 284% and 327%, with SD 130% and 141% respectively. The level of sVCAM-1 did not correlate with platelet count, albumin level, D dimer level and severity of disease. There was a weak correlation between vWF level with D dimer and severity of disease ( r = 0,472 and r = -0,450 ). Conclusion: The results of this study indicate that endothelial dysfunction occurs in DHF, but there is no correlation between sVCAM-1 with severity of disease, only a weak correlation between vWF with D dimer and severity of disease is found.

Abstrak :
ABSTRACT
Background: in recent years, diphtheria has reemerged in several countries including Venezuela, Yemen, Bangladesh, and Haiti. Similarly, Indonesia also showed an increased number of diphtheria cases in 2010-2017 despite the Diphteria, Tetanus, Pertussis (DTP) immunization program applied in Indonesia for children. This study aimed to evaluate the epidemiology of diphtheria cases which occurred in Indonesia during 2010-2017. Methods: this was a retrospective study of diphtheria cases in Indonesia. The following source of data about diphtheria disease burden and vaccine coverage was obtained from Ministry of Health Republic of Indonesia, Indonesian Pediatric Society and World Health Organization South East Asia Regional Office. Results: the number of diphtheria cases in Indonesia were distributed across 30 provinces with a total of 811 cases in 2011; 1,192 cases in 2012; 296 cases in 2014; and 939 cases in 2017. Based on age group, the highest number of case fatality rate were in age group of 5-9 years old. Diphtheria immunization coverage in Indonesia among children was fluctuated, reported as 67.7 % in 2007, 61.9 % in 2010, 75.6% in 2013 and 61.3% in 2018. In addition to that, the organization of internal medicine has recommend booster of DPT immunization every 10 years for those children that had received complete DPT vaccination during childhood, however this was not applied. As the countermeasure towards this trend, the Ministry of Health implemented three rounds of Outbreak Response Immunization (ORI) targeted for the age group of 0-1-6 months old and 1-18 years old in 2017 and tailor approached for adults that had exposed to cases. Banten, DKI Jakarta and West Java were the first three provinces to implement this program considering their condensed population and high risk of disease transmission. Conclusion: in Indonesia, there was dramatic increase of diphtheria case in 2010-2017, where immunization in children should be reinforced by increasing coverage more than 95% and adult boosted vaccination approaches should be initiated to prevent the spread of these fatal diphtheria diseases in Indonesia.