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All Journal Indonesian Journal of Tropical and Infectious Disease Molecular and Cellular Biomedical Sciences (MCBS) Indonesian Journal of Biomedicine and Clinical Sciences
Aryana, I Gusti Putu Suka
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Biochemistry, Genetics & Molecular Biology Dentistry Earth & Planetary Sciences Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Clostridium difficile Infection (CDI) by Hypervirulent BI/NAP1/027 Strain: a Comprehensive Review of Toxigenicity, Pathogenesis, Risk Factors, and Preventative Measures Budayanti, Ni Nyoman Sri; Aryana, I Gusti Putu Suka; Wedari, Ni Luh Putu Harta
Indonesian Journal of Tropical and Infectious Disease Vol. 10 No. 1 (2022)
Publisher : Institute of Topical Disease Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijtid.v10i1.31030

Abstract

Clostridium difficile is an anaerobic bacil gram-positive bacteria, able to form spores and toxin, that is transmitted among humans through the fecal–oral route. Clostridium difficile infection (CDI), a typical nosocomial infection has been contributed to a signifi cant proportion of morbidity and mortality among in-patients with a case-fatality rate of 14% within 30 days after diagnosis. Profound culture and toxin examination for C. difficile are still minimal in many hospitals in various Asian countries. Consequently, C. difficile reports in Asia remain rare. Highly virulent form of C. difficile caused greater fatality and epidemics severity. Elderly age, hospitalization, exposure to antibiotics e.g., cephalosporins, fluoroquinolones, clindamycin, and penicillin contributed as main risk factors. Hypervirulent strain BI/NAP1/027 demonstrated to carry CdtLoc gene locus encodes CD196 ADP-ribosyltransferase (CDT) or known as binary toxin. Virulence factors are TcdA, TcdB, CDTa CDTb in which hypersporulation and mutation of TcD gene by hypervirulent strain led to toxin hyperexpression. Early cases detection, building management team to evaluate patient positive with all C. difficile toxins, hand hygiene improvement, continuation of contact precautions after diarrhea resolution, audit of infection control, and restriction of antimicrobials should be implemented as preventative measures. Focus measures also should emphasize on development of vaccine of C. difficile to boost immune state of elderly people. This review aims to describe severity of disease caused by hypervirulent BI/NAP1/027 C. difficile strain, its mechanism or pathogenesis, risk factors, current treatment options available, along with proposed preventative measures and infection control.
Risk Factors Associated with Suspected Clostridium difficile Infection (CDI) in Elderly Diarrhea Patients at Prof. Dr. I.G.N.G. Ngoerah Hospital Aryana, I Gusti Putu Suka; Budayanti, Ni Nyoman Sri; Wedari, Ni Luh Putu Harta
Indonesian Journal of Tropical and Infectious Disease Vol. 11 No. 3 (2023)
Publisher : Institute of Topical Disease Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijtid.v11i3.47664

Abstract

Clostridium difficile infection (CDI) is a typical healthcare-associated infection that contributes to a significant proportion of morbidity and mortality among hospitalized patients. Anaerobe microbiological laboratory examinations cannot be performed at Prof. Dr. I.G.N.G. Ngoerah Hospital, leading to many undetected cases; therefore, it is crucial to determine the risk factors. Identification  of cases may help to prevent, recognize, and  appropriately treat CDI, reducing morbidity and mortality. This study aimed to determine the risk factors associated with suspected CDI in elderly patients with diarrhea due to their vulnerability to immunosenescence. This research used medical records as secondary data to determine the risk factors associated with suspected CDI in elderly diarrhea patients at Prof. Dr. I.G.N.G. Ngoerah Hospital during the year period of 2017 to 2021 with total of 70 samples who met inclusion criteria by purposive sampling technique. One hundred percent of all samples had a history of hospitalization for ³ 48 h. There were 53 patients (77.1%) had a history of antibiotic use, 26 (37.1%) proton pump inhibitors (PPIs), 66 (94.3%) chemotherapy, 66 (94.3%) urinary tract infections, 6 (8.6%) kidney disease, and 7 (10%) myocardial infarction. Seven (10%) patients had vascular disease, and 11 (15.7%) had diabetes mellitus. Risk factors associated with suspected CDI in elderly patients with diarrhea at Prof. Dr. I.G.N.G. Ngoerah Hospital include hospitalization ³ for 48 hours, use of antibiotics in the last few months, proton pump inhibitors, decreased immune system, urinary tract infection, kidney disease, myocardial infarction, vascular disease, and diabetes mellitus.
Decreased Follistatin Levels as a Risk of Acute Sarcopenia Marker in Elderly Aryana, I Gusti Putu Suka; Winangun, I Made Arya
Molecular and Cellular Biomedical Sciences Vol 7, No 3 (2023)
Publisher : Cell and BioPharmaceutical Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21705/mcbs.v7i3.359

Abstract

Background: Acute sarcopenia is an acute muscle loss that has been associated to the frailty and vulnerability of the elderly. Follistatin has been known as a significant marker for sarcopenia, however, studies of follistatin in humans have shown varying results and there have been no studies to date regarding the relationship between follistatin and acute sarcopenia. The aim of this study was to determine changes in follistatin levels as a risk of acute sarcopenia in elderly.Materials and methods: This study was a prospective observational study involving hospitalized elderly. The follistatin level was examined with enzyme-linked immunosorbent assay (ELISA). Meanwhile the determination of acute sarcopenia was done through the measurement of changes in hand grip strength and calf circumference parameters. The data obtained was descriptively analyzed, followed by bivariate and multivariate analysis. A p<0.05 was considered significant.Results: There were 66 subjects in this study. A total of 10 subjects (15.2%) had acute sarcopenia on the 7th day of hospitalization. The cut-off point of decreased follistatin levels was 4.870 with a sensitivity of 82.1% and a specificity of 60%. There was an association between decreased follistatin levels and acute sarcopenia (p=0.01; RR: 6.90; 95% CI: 1.638-29.069). Multivariate analysis results showed that decreased follistatin levels was a significant factor that might influence the occurrence of acute sarcopenia.Conclusion: Since this study showed that decreased follistatin levels might be a risk of acute sarcopenia in the elderly, thus it could be used as a marker of acute sarcopenia, which should be further investigated.Keywords: decreased follistatin levels, acute sarcopenia, elderly
The relationship between frailty incidence and polypharmacy in the elderly age group in Melinggih Village, Gianyar Regency, Bali Pemayun, Tjokorda Istri Ratih Pradnyandari; Aryana, I Gusti Putu Suka
Indonesian Journal of Biomedicine and Clinical Sciences Vol 57 No 1 (2025)
Publisher : Published by Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/inajbcs.v57i1.16258

Abstract

The risk of the elderly population experiencing frailty is more significant in women than man. Several factors are associated with the frailty include the pattern of women’s daily activities being more than men’s, unbalanced nutrition needs, and women suffering more from comorbid diseases, such as osteoporosis,fractures of bone hip, and other degenerative diseases. This study aimed to investigate the relationship between frailty incidence and polypharmacy in the elderly group in Melinggih Village, Gianyar, Bali. This cross-sectional study used secondary data from interviews and questionnaires conducted in December 2022. Samples were collected using a total sampling method. The analysis was conducted using univariate and bivariate analysis, with Chi square tests applied using SPSS 25.0 for Windows. Ninety-five of the 97 patients involving thisstudy had a history of treatment with < 2 types of drugs (non-polypharmacy), while 2 patients with more >2 types of drugs (polypharmacy). No significantly relationship between the number of drugs consumed and frailty status (p= 0.303). In conclusion, no relationship between frailty and polypharmacy is reported in Melinggih Village, Gianyar, Bali.
Co-Authors I Made Arya Winangun Ni Luh Putu Harta Wedari, Ni Luh Putu Harta Ni Nyoman Sri Budayanti Pemayun, Tjokorda Istri Ratih Pradnyandari