Robert Sinto

• Academic staff at University of Indonesia

Background/Objective: This study explores the epidemiology and clinical features of re-emerging mpox in Jakarta, Indonesia. Methods: This study used a retrospective study design to describe the epidemiological data, clinical features, and mortality of mpox patients from August 2022 to December 2023. In addition, this study also aims to identify the...

To generate consensus and provide expert clinical practice statements for the management of adult sepsis in resource-limited settings. An international multidisciplinary Steering Committee with expertise in sepsis management and including a Delphi methodologist was convened by the Asia Pacific Sepsis Alliance (APSA). The committee selected an inter...

Background/Objective: This study is to identify the epidemiology and clinical features of Mpox in Jakarta that just reemerged in Indonesia. Methods: This study used a cross-sectional study design to describe the epidemiological data, clinical features, and mortality of Mpox patients from August 2022 to December 2023. In addition, this study also ai...

Background: Since Monkeypox (mpox) had an outbreak on 6th May 2022 in 75 countries, it has been declared by the World Health Organization (WHO) that mpox is a public health of international emergency concern (PHEIC). WHO declared mpox as PHEIC again in August 204. Indonesia was also affected by the mpox outbreak with most of the cases coming from v...

Resistensi antimikroba (antimicrobial resistance, AMR), secara khusus antibiotik, telah menjadi masalah dunia saat ini. Masalah resistensi antibiotik terjadi pada seluruh jenis antibiotik yang ada, dan terjadi di seluruh negara, termasuk Indonesia. Dalam skala global, Perserikatan Bangsa-Bangsa mengeluarkan World Health Assembly Resolution WHA 68.7...

(1) Background: This study aims to assess visceral fat values, waist circumference (WC), body mass index (BMI), and body fat percentage for their ability to predict poor outcomes during COVID-19 patients’ hospitalization; (2) Methods: This study was a prospective cohort of mild–moderate COVID-19 patients hospitalized at Dr. Cipto Mangunkusumo Natio...

Background There are still many patients newly diagnosed with HIV at an advanced stage in Indonesia. We aimed to identify factors associated with 1-year mortality among cytomegalovirus (CMV)-infected people living with HIV (PLHIV). Methods This retrospective cohort study was carried out at a tertiary-care hospital in Jakarta, Indonesia (January 20...

Background Data on the dynamics and persistence of humoral immunity against SARS-CoV-2 after primary vaccination with two-dose inactivated vaccine (CoronaVac) are limited. This study evaluated the sequential effects of prior infection, heterologous boosting with mRNA-1273 (Moderna), and the occurrence of Omicron vaccine-breakthrough infection (VBI)...

Purpose To generate consensus and provide expert clinical practice statements for the management of adult sepsis in resource-limited settings. Methods An international multidisciplinary Steering Committee with expertise in sepsis management and including a Delphi methodologist was convened by the Asia Pacific Sepsis Alliance (APSA). The committee...

Background: Febrile neutropenia (FN) is an oncologic emergency which commonly occurrs in patients who undergo chemotherapy, with a mortality rate of 12.5%. Risk stratification in FN plays an important role in increasing the accuracy of therapy. This study aims to compare the performance between CISNE score and MASCC score in predicting complicatio...

Background The WHO Global Antimicrobial Resistance Surveillance System (GLASS) aims to describe antimicrobial resistance (AMR) patterns and trends in common bacterial pathogens, but data remain limited in many low and middle-income countries including Indonesia. Methods We systematically searched Embase, PubMed and Global Health Database and three...

Antimicrobial Surveillance

Background: Antibiotic resistance is the main problem in infectious disease management. Multidrug-resistant (MDR) bacteria could be carried by admitted patients and become a source of spread in the hospital, causing infections in other patients or the patients themselves. However, the screening of MDR bacteria has not been a standard in developing...

Background: Diagnosis of infection in advanced solid tumor patients can be challenging since signs and symptoms might be overlapping due to paraneoplastic condition. Delay diagnosis of existing infection can lead to more severe conditions and increased mortality. Procalcitonin (PCT) has been used to support the diagnosis of bacterial infection and...

Coronavirus disease 2019 (COVID-19) has been extensively researched, particularly with regard to COVID-19 vaccines. However, issues with logistics and availability might cause delays in vaccination programs. Thus, the efficacy and safety of half-dose heterologous mRNA should be explored. This was an open-label observational study to evaluate the im...

Background Little is known about diagnostic and antibiotic use practices in low and middle-income countries (LMICs) before and during COVID-19 pandemic. This information is crucial for monitoring and evaluation of diagnostic and antimicrobial stewardships in healthcare facilities. Methods We linked and analyzed routine databases of hospital admiss...

Background Limited data exist from southeast Asia on the impact of SARS-CoV-2 variants and inactivated vaccines on disease severity and death among patients hospitalised with COVID-19. Methods A multicentre hospital-based prospective cohort was enrolled from September 2020 through January 2023, spanning pre-delta, delta, and omicron periods. The p...

Introduction Currently, Imatinib (IM) which is a Tyrosine Kinase Inhibitor (TKI), is the main treatment for patients with chronic myeloid leukemia (CML). Major molecular response (MMR) is used as therapeutic response. Resistance to IM may be caused by hypoxia which is regulated by hypoxia inducible factor (HIF) 2-α. The role of HIF2-α is currently...

Background: Sepsis is a major problem that contributes to a high mortality rate. Its mortality is especially high in patients with malignancy. One study reported that sepsis patients with malignancy have a 2.32 times higher risk of mortality compared to patients without malignancy. For this reason, factors that influence mortality in sepsis patien...

Background: One of the efforts in antibiotic stewardship for limiting antibiotic resistance is the assessment of the quality of antibiotic use. To date, the quality and appropriateness of antibiotic use in Indonesia, a low-middle-income non-European country, have not yet been assessed using proven quality indicators (QIs). One recommended tool to m...

The high burden of infection mortality worldwide calls for the need for prompt risk assessment of its outcome. This article studied for accuracy of quick Sequential Organ Failure Assessment (qSOFA) combined with lactate measurement in predicting the mortality of adult patients with infection. Literature searching was performed in PubMed/Medline®, C...

Introduction Typhoid fever diagnosis is challenging for clinicians in areas with limited laboratory facilities. Scoring methods based on signs and symptoms are useful for screening for probable cases of typhoid fever. The Nelwan Score variables are derived from the clinical signs and symptoms of patients with suspected typhoid. We validated the Nel...

To rule out coronavirus disease–2019 (COVID-19) in patients scheduled to undergo emergency medical procedures, SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) must be performed. In developing countries, the use of SARS-CoV-2 RT-PCR has been limited by its unavailability and long processing time. Hence, a quick screening score to...

Background: There is a paucity of data regarding blood culture utilization and antimicrobial-resistant (AMR) infections in low and middle-income countries (LMICs). In addition, there has been a concern for increasing AMR infections among COVID-19 cases in LMICs. Here, we investigated epidemiology of AMR bloodstream infections (BSI) before and duri...

Background A major driver of antimicrobial resistance (AMR) and poor clinical outcomes is suboptimal antibiotic use, although data are lacking in low-resource settings. We reviewed studies on systemic antibiotic use (WHO ATC/DDD category J01) for human health in Indonesia, and synthesized available evidence to identify opportunities for interventio...

BACKGROUND Sepsis is a leading cause of mortality and morbidity globally. Gram-negative bacteremia was reported to have a high risk of septic shock and poor prognosis. This study aimed to evaluate the role of procalcitonin in predicting mortality in patients with sepsis due to Gram-negative bacteria. METHODS This was a retrospective cohort study p...

Background: Data on secondary bacterial infection in patients with COVID-19 in Indonesia are still limited, while the use of empirical antibiotics continues to increase. This study aims to determine the secondary bacterial infection rate in hospitalized COVID-19 patients and factors related to secondary bacterial infection. Methods: This is a re...

Introduction A major driver of antimicrobial resistance (AMR) and poor clinical outcomes is suboptimal antibiotic use, although data are lacking in low-resource settings. We reviewed studies on systemic antibiotic use (WHO ATC/DDD category J01) for human health in Indonesia, and synthesized available evidence to identify opportunities for intervent...

Background: Mesenchymal stem cells (MSCs) are known to have immunomodulatory, anti-inflammatory, anti-apoptotic, and angiogenesis effects that are useful for relieving inflammation, recovery, and protection of lung tissues in COVID-19 patients. Secretome, a secretory product of MSCs, has several advantages over

Background: The inactivated whole-virus vaccine CoronaVac (SinoVac) is the COVID-19 vaccine most administered worldwide. However, data on its immunogenicity and reactogenicity to heterologous boosting with mRNA vaccines are lacking. Methods: In a cohort of hospital staff in Jakarta, Indonesia, who received two-dose CoronaVac six months prior (media...

Background Coagulopathy and inflammation are associated with coronavirus disease 2019 (COVID-19) severity. This study assessed D-dimer concentration and its correlation with inflammatory markers and COVID-19 severity. Methods This was a retrospective cross-sectional study involving 194 COVID-19 cases, with the severity of infection graded in accor...

Introduction COVID-19 is a pandemic with significant mortality and it is important to differentiate severe and non-severe cases. We conducted a study to evaluate hematologic profiles with inflammation markers in COVID-19 patients and to determine the correlation of neutrophil-lymphocyte ratio (NLR) with disease severity. Methods A cross-sectional...

Background: COVID-19 is a disease caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) that has become a pandemic. It became apparent that COVID-19 transmitting from person to person. The clinical manifestations and characteristics of COVID-19 encompassing from asymptomatic infection until severe pneumonia and death. This study ai...

Objective Despite the routine use of MASCC score in febrile neutropenia patients, researches showed that serious complications still occur in 15-42% of low-risk patients; therefore, a new scoring system Clinical Index of Stable Febrile Neutropenia (CISNE) is developed to predict the complication better. This retrospective cohort study aimed to asse...

Introduction. Typhoid fever can be challenging to diagnose since clinicians often depend merely on clinical presentation. Clinical scores are useful to provide more accurate diagnosis. Variables in Nelwan Score are derived from clinical signs and symptoms of suspected cases for typhoid. Diagnostic value of Nelwan Score based on a cut-off value has...

Coronavirus disease 2019 (COVID-19) memiliki spektrum manifestasi klinis yang sangat luas meliputi hampir semua bagian disiplin ilmu kedokteran. Keterbatasan dan ketersediaan uji diagnosis yang ada saat ini menyebabkan hambatan deteksi awal pasien dengan kecurigaan COVID-19. Penulisan artikel ini bertujuan untuk mengenalkan sistem penapisan COVID-1...

Background Routine use of the Sequential Organ Failure Assessment (SOFA) score to prognosticate patients with sepsis is challenged by the requirement to perform numerous laboratory tests. The prognostic accuracy of the quick SOFA (qSOFA) without or with lactate criteria has not been prospectively investigated in low and middle income countries. We...

Pada awal 2020, dunia dikejutkan dengan mewabahnya pneumonia baru yang bermula dari Wuhan, Provinsi Hubei yang kemudian menyebar dengan cepat ke lebih dari 190 negara dan teritori. Wabah ini diberi nama coronavirus disease 2019 (COVID-19) yang disebabkan oleh Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Penyebaran penyakit ini tela...

Sepsis occurs as a result of systemic inflammatory process. The release of bacterial components to the systemic circulation leads to activation of inhibitor kappa B kinase (IKK)-b and nuclear factor kappa B(NF-�B) through phosphorylation and ubiquiti-nation. Excessive inflammatory process with maladaptive host’s immune response leads to organ dysfu...

Objective: Methicillin-resistant Staphylococcus aureus (MRSA) colonization is associated with serious surgical site infection in high-risk patients. High prevalence of MRSA colonization was reported in many settings, nonetheless local data is required. The purpose of this study is to identify the prevalence and risk factor of MRSA nasal carriage i...

Background: lactate clearance and central venous oxygen saturation (ScvO2) are two methods for determining tissue oxygenation adequacy. There is a controversy regarding method better associates with and predicts sepsis and septic shock patients' mortality. This study address the association of achieving one or two targets of microcirculatory resus...

Previous lactate clearance cut off for early mortality prediction in sepsis and septic shock patient was determined by consensus from small sample size-study. We investigated the best lactate clearance cut off and its ability to predict early mortality in sepsis and septic shock patients. This cohort study was conducted in Intensive Care Unit of Ci...

The study on the degree of agreement among three established sepsis diagnosis criteria become the necessity to investigate the best sepsis diagnosis criteria in Indonesia further. A cross-sectional study of adult Emergency Room patients hospitalized with a diagnosis of infection in CiptoMangunkusumo Hospital, Indonesia was conducted during March an...

Background The role of vascular endothelial (VE) components in dengue infection with plasma leakage is unknown. Therefore, we conducted a study to determine the adjusted association of the endothelial glycocalyx layer (EGL) and tight and adherens junction markers with plasma leakage. Methods A prospective observational study was conducted at Cipto...

Sepsis berat dan renjatan septik telah menjadi masalah kesehatan yang utama di seluruh dunia. Untuk menekan angkamortalitas dini, upaya resusitasi yang dilakukan pada keadaan sepsis berat dan renjatan septik harus ditujukan padapencapaian target parameter makrosirkulasi maupun mikrosirkulasi, khususnya yang telah terbukti berhubungan denganmortalit...

Berbagai upaya telah dilakukan oleh berbagai klinisi dan peneliti di seluruh dunia untuk menurunkan mortalitas pasien sepsis, khususnya sepsis yang disertai dengan gangguan fungsi organ atau yang dikenal dengan sepsis berat. Perumusan kriteria diagnosis, upaya stratifikasi derajat berat sepsis, penyusunan protokol resusitasi, penyusunan pedoman tat...

Latar belakang. Beberapa penelitian di Indonesia mendeteksi gangguan perkembangan pada anak usia pra sekolah 12,8%-28,5%. Perkembangan anak berhubungan dengan banyak faktor, satu sama lain saling terkait, sehingga sulit dilihat apakah memang benar ada hubungan antara tiap faktor risiko dengan gangguan perkembangan. Tujuan. Mengetahui hubungan antar...

The body circardian rhythm affects blood pressure variability at day and night, therefore blood pressure at day and night might be different. Nocturnal hypertension is defined as increase of blood pressure >120/70mmHg at night, which is caused by disturbed circadian rhythm, and associated with higher cardiovascular and cerebrovascular events also m...

Background: There are several limitations in diagnosing plasma leakage using the World Health Organization (WHO) guidelines of dengue hemorrhagic fever. We conducted a study to develop a dengue scoring system to predict pleural effusion and/or ascites using routine laboratory parameters. Methods: A prospective observational study was carried out...

ABSTRACT Aim: to evaluate the performance of Vitek2 compact machine (Biomerieux Inc. ver 04.02, France) in reference to manual methods for susceptibility test for Candida resistance among HIV/AIDS patients. Methods: a comparison study to evaluate Vitek2 compact machine (Biomerieux Inc. ver 04.02, France) in reference to manual methods for susceptib...

Sepsis occurs as a result of systemic inflammatory process. The release of bacterial components to the systemic circulation leads to activation of inhibitor kappa B kinase (IKK)-β and nuclear factor kappa B (NF-κB) through phosphorylation and ubiquitination. Excessive inflammatory process with maladaptive host's immune response leads to organ dysfu...

Tetralogy of Fallot (ToF) is the most common form of cyanotic congenital heart disease after 1 year of age, with overall incidence approaching 10% of all congenital heart disease. Natural survival (i.e. without corrective procedure) into the fourth decade is extremely rare (only about 3%), but there is a tendency of increasing number of women with...