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"Pendahuluan. Penglepasan interferon-gamma oleh limfosit T yang antigenspecific akan meningkat setelah sel tersebut dipaparkan kembali dengan antigen tuberkulosis (TB) secara in vitro, khususnya apabila sel tersebut berasal dari lokasi infeksi TB aktif. Penelitian ini merupakan uji diagnostik pemeriksaan interferon-gamma release assay (IGRA) metode enzyme-linked immunospot (ELISPOT), yaitu T-SPOT.TB®, untuk deteksi TB pleura menggunakan spesimen sel mononuklear (MN) cairan pleura. Metode. Sebanyak 48 pasien efusi pleura terduga TB dengan karakteristik cairan pleura eksudatif berdasarkan kriteria Light dan dominasi sel MN lebih dari 50% dilakukan pemeriksaan T-SPOT.TB, biakan TB media cair Mycobacterial Growth Indicator Tube (MGIT), dan aktivitas adenosine deaminase (ADA) cairan pleura. Hasil. Dengan baku emas biakan TB MGIT didapatkan nilai sensitivitas 100%, spesifisitas 20%, nilai prediksi positif (NPP) 20%, dan nilai prediksi negatif (NPN) 100%. Dengan baku emas kombinasi biakan TB MGIT dan aktivitas ADA didapatkan nilai sensitivitas 100%, spesifisitas 88,89%, NPP 97,5%, dan NPN 100%. Kesimpulan. IGRA metode ELISPOT menggunakan spesimen cairan pleura merupakan pemeriksaan yang cepat dan bermanfaat sehingga dapat dipertimbangkan sebagai pemeriksaan tambahan pada pasien efusi pleura terduga TB.

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Introduction. The release of interferon-gamma by antigen-specific T lymphocytes increases after rechallenge with tuberculosis (TB) antigen in vitro, especially at a localized site of TB infection. This study aimed to evaluate the diagnostic value of a commercial enzyme-linked immunospot (ELISPOT) assay for interferon-gamma, T-SPOT.TB®, in the diagnosis of TB pleurisy using pleural fluid mononuclear cells.

Methods. 48 subjects, presumed to have pleural TB with exudative pleural effusion by Light's criteria, dominated by mononuclear cells, had their pleural fluid specimen tested with T-SPOT.TB, TB Mycobacterial Growth Indicator Tube (MGIT) culture, and pleural fluid adenosine deaminase (ADA) activity.

Results. The sensitivity, specificity, positive and negative predictive values of the assay were 100%, 20%, 20%, 100%, respectively, if TB MGIT culture was used as the gold standard, and 100%, 88,89%, 97,5%, 100%, respectively, if TB MGIT culture and ADA activity of pleural fluid were used as the gold standard.

Conclusion. The ELISPOT assay for interferon-gamma is useful and rapid so it can be considered as a supplementary test to explore TB pleurisy."

"BACKGROUND: there are many researches about IGRA in extrapulmonary Tuberculosis (TB), but there only few data from developing countries. This was the first research about the utility of IGRA in extrapulmonary TB performed in Indonesia as developing country with the 2nd most frequent of TB cases in the world. This study aimed to identify the advantage of IGRA examination in diagnosing extrapulmonary TB.METHODS:eighty-four patients, presumed to have extrapulmonary TB were examined with IGRA and gold standard examination. The gold standard examination was performed by histopathologic examination, and tissue smear for acid-fast bacilli.RESULTS:among 84 patients included in the study, 57 patients were tested positive with gold standard, where 50 patients among them were also tested positive with IGRA. Among 27 patients tested negative with gold standard, IGRA positive was found in 10 patients. Lymphadenitis was the most common manifestation of the extrapulmonary TB. Diagnostic test from IGRA for extrapulmonary TB found as follows: sensitivity 87,71%, specificity 63%, positive predictive value 83,33%, and negative predictive value 70,83%.CONCLUSION:IGRA could be used as supporting tool in the diagnosis of extrapulmonary TB. The negative result, however, does not indicate absence of TB infection"

"Penyakit gastroenterologi masih merupakan masalah kesehatan utama di Indonesia, dengan kolitis menempati urutan kelima dari sepuluh penyakit terbanyak pada pelayanan rawat jalan. Kesamaan gambaran klinis dan hasil pemeriksaan diagnostik kolitis TB dan Inflammatory Bowel Disease (IBD) menyebabkan kesulitan diagnosis. Studi ini bertujuan untuk mengetahui peran diagnostik Interferon-Gamma Release Assay (IGRA) metode Elispot pada pasien terduga kolitis tuberkulosis di Indonesia. Dilakukan studi potong lintang dan acak dengan penyajian data deskriptif analitik. Subjek penelitian merupakan 60 pasien terduga kolitis tuberkulosis yang mengunjungi poliklinik gastroenterologi di RSUPNCM bulan April-Oktober 2018. Sampel yang digunakan adalah darah vena. Hasil uji diagnostik IGRA metode Elispot dengan baku emas pemeriksaan histopatologi adalah sensitivitas 83,3%, spesifisitas 57,4%, NPP 17,3%, dan NPN 96,9%. Hasil uji diagnostik IGRA metode Elispot dengan baku emas pemeriksaan kolonoskopi adalah sensitivitas 53,9%, spesifisitas 55,3%, NPP 25%, dan NPN 81,3%. Hasil uji diagnostik IGRA metode Elispot dengan baku emas pemeriksaan kolonoskopi dan histopatologi adalah sensitivitas 57,1%, spesifisitas 60,5%, NPP 28,6%, dan NPN 81,3%. Hasil uji diagnostik IGRA metode Elispot dengan baku emas pemeriksaan histopatologi, kolonoskopi, dan evaluasi klinis akhir adalah sensitivitas 100%, spesifisitas 59,3%, NPP 21,3%, dan NPN 100%. Tes IGRA Metode Elispot dapat digunakan sebagai pemeriksaan penapisan.

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Gastroenterology diseases are still a major health problem in Indonesia, with colitis ranks fifth among the top ten diseases in outpatient care. The similarity of clinical features and diagnostic results of TB and Inflammatory Bowel Disease causes difficulties in diagnosis. This study is aimed to determine the diagnostic value of Interferon-Gamma Release Assay (IGRA) with Elispot Method in patients with suspected tuberculous colitis in Indonesia. It is a cross sectional and randomized study, shown as an analytic descriptive report. There were 60 patients with suspected tuberculosis colitis, visiting gastroenterology polyclinic at RSCM from April-October 2018. The sample was venous blood.  Diagnostic results of IGRA with Elispot Method with histopathology test as the gold standard are sensitivity 83,3%, specificity 57,4%, PPV 17,3%, and NPV 96,9%. As with colonoscopy as the gold standard are sensitivity 53,9%, specificity 55,3%, PPV 25%, dan NPV 81,3%. Meanwhile, with colonoscopy and histopathology test as the gold standard are sensitivity 57,1%, specificity 60,5%, PPV 28,6%, dan NPV 81,3%. And, diagnostic results  of IGRA with Elispot Method with colonoscopy, histopathology test, and final clinical judgement as the gold standard are sensitivity 100%, specificity 59,3%, PPV 21,3%, dan NPV 100%. IGRA with Elispot Method can be used as screening test."

"ABSTRAKPendahuluan: Pasien HIV/Aquired immunedeficiency syndrome (AIDS) lebih berisiko untuk terinfeksi tuberkulosis (TB) dan mengalami progresifitas menjadi TB aktif lebih besar dibandingkan dengan orang yang tidak terinfeksi HIV. Pasien HIV tanpa bukti adanya TB aktif dianggap sebagai TB laten dan dilakukan pemberian isoniazid preventive therapy (IPT). Salah satunya cara diagnosis TB laten adalah dengan pemeriksaan IGRA. TSPOT®.TB adalah IGRA metode ELISPOT, mengukur jumlah limfosit T yang memproduksi interferon gamma (IFN-γ) setelah stimulasi oleh antigen spesifik Mycobacterium tuberculosis compex (MTB) yaitu ESAT-6 (panel A) dan CFP-10 (panel B). Penelitian ini bertujuan untuk melihat bagaimana hasil IGRA metoda ELISPOT pada pasien HIV-TB aktif dan pasien HIV-TB laten di Pokdisus RSCM.Metode: Rancangan penelitian ini adalah potong lintang. Subjek penelitian terdiri dari 3 pasien HIV-TB aktif dan 31 pasien HIV-TB laten yang dilakukan pemeriksaan IGRA metode ELISPOT.Hasil: Gejala klinis terdapat pada semua subyek HIV-TB aktif yaitu batuk ≥ 2 minggu, demam, dan penurunan berat badan, sedangkan pada HIV-TB laten gejala klinis terjadi pada 3/31 subyek (9.7%). Pemeriksaan yang medukung diagnosis TB aktif yaitu tuberculin skin test (TST), foto paru, GeneXpert MTB/RIF, dan hasil Patologi Anatomi (PA). Pemeriksaan sputum basil tahan asam (BTA) tidak ditemukan pada semua subyek TB aktif. Hasil IGRA positif pada 10/31 subyek (32.3%) di kelompok HIV-TB laten dan 2/4 subyek pada kelompok HIV-TB aktif. Rerata spot panel A (ESAT-6) pada kelompok HIV-TB aktif adalah 37.75 (SD 46.0) spot, dan panel B (CFP-10) rerata 10.7 (SD15.3) spot. Kelompok HIV-TB laten memiliki median 1.5 (rentang 0-92 spot) untuk panel A, dan panel B median 3.0 ( rentang 0-479 spot).Kesimpulan: Pasien HIV-TB aktif lebih banyak mengalami gejala klinis dari pada pasien HIV-TB laten. Diagnosis TB aktif pada pasien HIV lebih banyak ditegakan berdasarkan klinis karena konfirmasi bakteriologis sulit ditemukan. Hasil IGRA positif ditemukan pada 2/4 subyek HIV-TB aktif, 32,3% pada subyek HIV-TB laten, dan jumlah spot belum dapat digunakan untuk menentukan HIVTB aktif dengan HIV-TB laten.

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ABSTRACT

Introduction. HIV/ Aquired immunedeficiency syndrome (AIDS) patients has a bigger risk to get infected by tuberculosis (TB) and progressed to active TB infection more than a people who without HIV infected. HIV patients without vidence of active TB infection are presumed as latent TB infection and need to be given isoniazid preventive theraphy (IPT). Interferon-gamma release assay which is available for identification latent TB infection, are in vitro blood test of cellmediated immune response; measuring T-cell release of IFN- γ following stimulation by antigents specific to the M. tuberculosis complex i.e ESAT-6 and CFP-10. The objective of this study is to investigate IGRA ELISPOT method in HIV-active TB infection and HIV-latent TB infection in Pokdisus RSCM

Methods. This study was cross-sectional study. Interferon-gamma release assay ELISPOT method was performed on 4 HIV-active TB infection and 31 HIVlatent infection.

Results. All subjects with HIV-active TB had clinical manifestations such as cough more than 2 weeks, fever and weight loss, but only 3/31 (9,7%) HIV-latent TB subjects had clinical manifestation. Other assay supporting active TB diagnosis such as tuberculin skin test (TST), chest X-ray, GeneXpert MTB/RIF and biopsies were not found in all active TB subjects. Interferon-gamma release assay was positive in 10/31 subjects (32.2%) in the HIV-active TB group and 2/4 subjects in the HIV-latent TB group. Mean spot panel A(ESAT-6) and panel B (CFP-10 in HIV-active TB are 37.75 (SD 46.0) spot and 10,7 (SD 15.3) spot. Median spot panel A and panel B in HIV-latent TB are 1.5 (range 0-92) spot and 3.0 (range 0-479) spot.

Conclusion. patients with HIV-active TB has more clinical manifestation compared to HIV-latent TB patients. Active TB status more often diagnosed from clinical manifestation, because bacteriological confirmation were hard to find on patiens with HIV. IGRA positive result were found 2/4 subject with active TB patients, 32.3% in subject with latent TB, and spot count cannot yet be used for differentiating HIV-active TB from HIV-latent TB status."

"Latar Belakang: Infeksi tuberkulosis laten ITBL merupakan ancaman bagi para petugas kesehatan terutama yang sehari-harinya kontak dengan penderita Tuberkulosis TB. Infeksi TB telah dapat dideteksi sejak lebih dari 100 tahun yang lalu dengan uji tuberkulin tuberculin skin test, TST. Sebagai alternatif terhadap uji tuberkulin saat ini telah tersedia pemeriksaan in vitro berupa pemeriksaan interferon gamma release assay IGRA. Tujuan: Penelitian ini bertujuan untuk membandingkan TST dan IGRA dalam mendiagnosis TB laten pada petugas kesehatan di Rumah Sakit Umum Pusat Persahabatan Jakarta. Metode: Penelitian dilakukan dengan disain potong lintang. Hasil: Prevalens ITBL pada petugas kesehatan di RSUP Persahabatan adalah 66. Sejumlah 67 subjek dilakukan pemeriksaan IGRA dan TST dengan hasil 27 40 subjek dengan hasil pemeriksaan IGRA positif, 42 63 subjek dengan hasil pemeriksaan TST positif dan 44 66 subjek dengan hasil pemeriksaan IGRA dan atau TST positif, dengan kesesuaian sedang ?=0,459. Tidak ada hubungan antara usia dan parut BCG dengan hasil pemeriksaan TST maupun IGRA. Kesimpulan: proporsi ITBL berdasarkan TST lebih besar dibadingkan IGRA dengan kesesuaian sedang

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Introduction: Latent tuberculosis infection LTBI is a threat to the healthcare workers, especially who close contact with tuberculosis TB patients. Tuberculosis infection has been detected since more than 100 years ago with the tuberculin test TST. As an alternative to the tuberculin test now is currently available in vitro examination of interferon gamma release assay IGRA.

Objective: to compare TST and IGRA in the diagnosis of LTBI among healthcare workers in Persahabatan HospitalJakarta.

Method: The study is conducted with a cross sectional design.

Results: The prevalence of latent TB among health care workers in Persahabatan general Hospital was 66 .Of the 67 subjects examined, there were 27 40 subjects with IGRA positive, 42 63 subjects with TST positive and 44 66 subjects with IGRA and or TST positive, with moderate agreement 0,459 . There was no correlation between age and BCG scar with the results of the TST or IGRA.

Conclusion: High proportion of LTBI more positive with TST compare to IGRA, with moderate agreement"

"ABSTRAK Pendahuluan: Biopsi jarum inti dianggap memiliki hasil akurasi yang samadengan biopsi terbuka dan telah menjadi prosedur rutin untuk menegakkandiagnosis lesi muskuloskeletal. Namun demikian uji diagnostik biopsi jarum intidi Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo (RSUPN CM)belum dilaporkan. Tujuan dari analisis retrospektif ini adalah untuk mendapatkannilai ketepatan diagnosis biopsi jarum inti pada lesi muskuloskeletal.Metode: Dari Januari 2011 hingga Agustus 2015, semua pasien dengan lesi muskuloskeletal di RSUPN CM yang menjalani biopsi jarum inti dan eksisi tumor diidentifikasi dan diambil datanya. Ketepatan diagnosis dianalisis baik untukkesimpulan histopatologi maupun kesimpulan clinical pathology conference(CPC).Hasil: Sebanyak 86 sampel dikumpulkan dalam penelitian ini. Ketepatandiagnosis biopsi jarum inti dibandingkan dengan spesimen pasca eksisi adalah74,4%. Setelah dilakukan CPC, nilai ketepatan menjadi 83,7% dengan sensitivitas98%, spesifisitas 59%, NDP 87%, NDN 93% (p = 0.00). Ketepatan biopsi jaruminti setelah pulasan imunohistokimia naik menjadi 84,9% (p = 0,438). Ketepatanuntuk membedakan lesi jinak dan ganas adalah 97,1% (jinak) dan 82,7% (ganas)(p = 0.00). Ketepatan untuk membedakan lesi primer dan metastasis adalah 97,2%(primer) dan 85,7% (metastasis) (p = 0.00).Diskusi: Kami mendapatkan nilai ketepatan biopsi jarum inti yang sedikit lebihrendah karena dalam penelitian ini dituntut untuk membuat diagnosis sampaitingkat morfologi (ICD O dan ICD X). Namun demikian, dengan modalitas lainseperti imunohistokimia dan kesimpulan CPC, ketepatan menjadi meningkat.Ketepatan diagnosis untuk membedakan lesi jinak-ganas dan primer-metastasis tinggi. Biopsi jarum inti direkomendasikan untuk penegakkan diagnosis lesi muskuloskeletal.ABSTRACT Introduction: Core needle biopsy is considered to have similar results with openbiopsy in accuracy and already become a routine procedure to establish thediagnosis of musculoskeletal lesion. However, diagnostic test of core needlebiopsy application in Cipto Mangunkusumo Hospital has not been reported.Therefore, the aim of this retrospective analysis was to attain the accuracy ofmusculoskeletal lesion diagnosis using core needle biopsy. Methods: From January 2011 to August 2015, all patients with musculoskeletal lesion in Cipto Mangunkusumo Hospital underwent core needle biopsy andsubsequent tumour excision were indentified and enrolled. Diagnostic accuracywere calculated for both histopathology and clinical pathology conference (CPC)conclusion.Results: A total of 86 samples were indentified and enrolled in this study. Theaccuracy of core needle biopsy compared to subsequent excision is 74.4%. WithCPC conclusion, the accuracy is 83.7% with sensitivity 98%, specificity 59%,PPV 87%, NPV 93% (p=0.00). The accuracy with immunohistochemistry is84.9% (p=0.438). The accuracy to distinguish benign and malignant lesion is 97.1% (benign) and 82.7% (malignant) (p= 0.00). The accuracy to distinguishprimary and metastatic lesion is 97,2% (primary) and 85,7% (metastatic) (p=0.00). Discussion: We found slightly inferior results for core needle biopsy accuracycompared to literature due to high specificity diagnosis obligatory (ICD O andICD X morphology) in our study. However, with other modalities such asimmunohistochemistry and CPC, the accuracy is increased. The accuracy todistinguish between benign vs malignant and primary vs metastatic lesion is high.Core needle biopsy is recommended to establish diagnosis for selected musculoskeletal lesions.;Introduction: Core needle biopsy is considered to have similar results with openbiopsy in accuracy and already become a routine procedure to establish thediagnosis of musculoskeletal lesion. However, diagnostic test of core needlebiopsy application in Cipto Mangunkusumo Hospital has not been reported.Therefore, the aim of this retrospective analysis was to attain the accuracy ofmusculoskeletal lesion diagnosis using core needle biopsy. Methods: From January 2011 to August 2015, all patients with musculoskeletal lesion in Cipto Mangunkusumo Hospital underwent core needle biopsy andsubsequent tumour excision were indentified and enrolled. Diagnostic accuracywere calculated for both histopathology and clinical pathology conference (CPC)conclusion.Results: A total of 86 samples were indentified and enrolled in this study. Theaccuracy of core needle biopsy compared to subsequent excision is 74.4%. WithCPC conclusion, the accuracy is 83.7% with sensitivity 98%, specificity 59%,PPV 87%, NPV 93% (p=0.00). The accuracy with immunohistochemistry is84.9% (p=0.438). The accuracy to distinguish benign and malignant lesion is 97.1% (benign) and 82.7% (malignant) (p= 0.00). The accuracy to distinguishprimary and metastatic lesion is 97,2% (primary) and 85,7% (metastatic) (p=0.00). Discussion: We found slightly inferior results for core needle biopsy accuracycompared to literature due to high specificity diagnosis obligatory (ICD O andICD X morphology) in our study. However, with other modalities such asimmunohistochemistry and CPC, the accuracy is increased. The accuracy todistinguish between benign vs malignant and primary vs metastatic lesion is high.Core needle biopsy is recommended to establish diagnosis for selected musculoskeletal lesions.;Introduction: Core needle biopsy is considered to have similar results with openbiopsy in accuracy and already become a routine procedure to establish thediagnosis of musculoskeletal lesion. However, diagnostic test of core needlebiopsy application in Cipto Mangunkusumo Hospital has not been reported.Therefore, the aim of this retrospective analysis was to attain the accuracy ofmusculoskeletal lesion diagnosis using core needle biopsy. Methods: From January 2011 to August 2015, all patients with musculoskeletal lesion in Cipto Mangunkusumo Hospital underwent core needle biopsy andsubsequent tumour excision were indentified and enrolled. Diagnostic accuracywere calculated for both histopathology and clinical pathology conference (CPC)conclusion.Results: A total of 86 samples were indentified and enrolled in this study. Theaccuracy of core needle biopsy compared to subsequent excision is 74.4%. WithCPC conclusion, the accuracy is 83.7% with sensitivity 98%, specificity 59%,PPV 87%, NPV 93% (p=0.00). The accuracy with immunohistochemistry is84.9% (p=0.438). The accuracy to distinguish benign and malignant lesion is 97.1% (benign) and 82.7% (malignant) (p= 0.00). The accuracy to distinguishprimary and metastatic lesion is 97,2% (primary) and 85,7% (metastatic) (p=0.00). Discussion: We found slightly inferior results for core needle biopsy accuracycompared to literature due to high specificity diagnosis obligatory (ICD O andICD X morphology) in our study. However, with other modalities such asimmunohistochemistry and CPC, the accuracy is increased. The accuracy todistinguish between benign vs malignant and primary vs metastatic lesion is high.Core needle biopsy is recommended to establish diagnosis for selected musculoskeletal lesions."

"Pendahuluan: Imunoregulasi yang terjadi pada kehamilan menyebabkan ibu hamil lebih rentan terhadap infeksi, termasuk infeksi parasit. Salah satu parasit intestinal yang paling sering ditemukan di negara berkembang adalah Blastocystis-terutama banyak dijumpai pada populasi imunosupresi. Belum diketahui apakah infeksi Blastocystis dapat memengaruhi respon imun seluler terhadap infeksi patogen lain. Penelitian ini bertujuan untuk mengetahui hubungan infeksi Blastocystis pada kehamilan dengan respon imun seluler terhadap infeksi tuberkulosis, yang dimodelkan dengan stimulasi purified protein derivative (PPD). Metode: Penelitian ini menggunakan desain studi potong lintang dengan data yang bersumber dari penelitian utama yang telah dilakukan di daerah endemik Blastocystis. Sebanyak 98 ibu hamil trimester ketiga menjadi sampel dalam penelitian ini. Status infeksi Blastocystis ditetapkan berdasarkan pemeriksaan mikroskopis sampel feses. Respon imun seluler yang dinilai adalah kadar sitokin proinflamasi IFN-γ dan sitokin antiinflamasi IL-10 yang diambil dari kultur darah subjek dan diukur dengan Luminex assay.Hasil: Kadar IFN-γ dan IL-10 setelah stimulasi PPD lebih tinggi pada kelompok ibu hamil sehat dibandingkan ibu hamil terinfeksi Blastocystis, tetapi perbedaan kadar ini tidak signifikan untuk IFN-γ (p=0,356) dan signifikan untuk IL-10 (p=0,001). Perbandingan kadar sitokin setelah stimulasi PPD dengan basal yang dihitung dalam bentuk rasio menunjukkan hasil yang lebih tinggi pada kelompok ibu hamil sehat baik untuk IFN-γ dan IL-10, tetapi keduanya tidak bermakna secara statistik (p=0,428 untuk rasio IFN-γ dan p=0,564 untuk rasio IL-10). Rasio keseimbangan sitokin proinflamasi-antiinflamasi (rasio IFN-γ/rasio IL-10) pascastimulasi PPD lebih tinggi pada kelompok terinfeksi Blastocystis, meskipun tidak signifikan secara statistik (p=0,741). Kesimpulan: Infeksi Blastocystis pada ibu hamil tidak menunjukkan perbedaan respons imun terhadap stimulasi PPD dibandingkan dengan ibu hamil sehat.

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Introduction: Predominant immunoregulatory state in pregnancy is associated with higher risk of infection, including parasitic infection. One of the most common intestinal parasites found in developing country is Blastocystis-which mainly found in immunocompromised population. It is not yet known whether Blastocystis infection could influence cellular immune response to other pathogens. Therefore, this research aims to discover the association between Blastocystis infection in pregnancy with cellular immune response to tuberculosis infection, which is modelled by purified protein derivative (PPD) stimulation. Method: This is a cross-sectional study which uses data from primary research that has been done in a Blastocystis-endemic area. Study samples consist of 98 pregnant women in their third trimester. Blastocystis infection was determined from microscopic examination of stool specimen. The cellular immune response is assessed by measuring serum level of IFN-γ and IL-10 as pro- and anti-inflammatory cytokine, respectively. The serum is obtained from a whole blood culture, and its cytokine level will further be measured with Luminex assay.Result: IFN-γ and IL-10 level with PPD-stimulation is higher in healthy pregnant women compared to Blastocystis-infected subjects, but this difference is not statistically significant for IFN-γ (p=0.356) and significant for IL-10 (p=0.001). The PPD-stimulated/basal ratio of both IFN-γ and IL-10 is also higher in healthy pregnant women, but it is not statistically significant (p=0.428 for IFN-γ ratio and p=0.564 for IL-10 ratio). Although not statistically significant, the pro- and anti-inflammatory cytokine balance (IFN-γ ratio/IL-10 ratio) after PPD stimulation is higher in pregnant women infected with Blastocystis (p=0.741). Conclusion: There is no difference in the cellular immune response to PPD stimulation in pregnant women infected with Blastocystis compared to healthy pregnant women."

"Latar Belakang: Petugas kesehatan adalah kelompok yang kontak dekat dengan pasien tuberkulosis TB . Infeksi tuberkulosis telah terdeteksi sejak lebih dari 100 tahun yang lalu dengan uji tuberkulin.Sebagai alternatif terhadap uji tuberkulin saat ini telah tersedia pemeriksaan in vitro berupa pemeriksaan interferon gamma release assay IGRA. Tujuan: Penelitian ini bertujuan untuk membandingkan uji tuberkulin dan IGRA dalam mendiagnosis dan uji tapis TB laten pada petugas kesehatan di Balai Besar Kesehatan Paru Masyarakat BBKPM Bandung. Metode: Penelitian dilakukan dengan disain potong lintang. Hasil uji tuberkulin ditetapkan untuk menunjukkan ITBL baru jika terdapat indurasi ge; 10 mm atau jika hasil uji tuberkulin ge; 15 mm bagi petugas kesehatan yang pernah menjalani uji tuberkulin sebelumnya.Seluruh subjek penelitian telah dilakukan anamnesis, pemeriksaan fisis, foto toraks dan cek sputum BTA untuk menyingkirkan diagnosis infeksi tuberkulosis aktif. Hasil: Penelitian ini dilakukan dari bulan Januari sampai April 2015 di 84 petugas kesehatan. Prevalens TB laten adalah sebesar 51,2 dengan IGRA dan 29,8 denganuji tuberkulin dengan kesesuaian yang cukup ? = 0,34 . Terdapat hubungan yang signifikan antara usia dan pendidikan yang rendah dengan hasil IGRA dan status merokok dengan uji tuberkulin. Kesimpulan: Proporsi ITBL lebih tinggi dengan IGRA dibandingkan dengan uji tuberkulin dengan kesesuaian yang cukup dan terdapat hubungan yang signifikan antara usia dan pendidikan rendah dengan hasil IGRA serta status merokok dengan TST.

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Introduction Haealthcare workers are groups that are close contact with tuberculosis TB patients. Tuberculosis infection had been detected since more than 100 years ago with the tuberculin test TST. As an alternative to the tuberculin test now is currently available in vitro examination of interferon gamma release assay IGRA.

Objectives: to compare TST and IGRA in the diagnosing and screening of LTBI among healthcare workers in Balai Besar Kesehatan Paru Masyarakat BBKPM Bandung.

Methods: This study is a cross sectional design. Tuberculin test results were set to show new LTBI if there was induration ge 10 mm or ge 15 mm in healthcare workers who had had a previous TST. The subjects have been done anamnesis, physical examination, chest X ray and sputum smear checks for excluding the diagnosis of active tuberculosis infection. The relationship with the characteristics of the subjects was calculated with p le 0.05.

Results: This research was conducted from January to April 2015 in 84 healthcare workers. The prevalence of latent TB was 51,2 in IGRA and 29,8 in TST with sufficient agreement 0,34. There were significant correlation between age and low education with the results of IGRA and in smoking status with TST.

Conclusion: Proportion of LTBI is higher with IGRA compared with TST, with sufficient agreement and there are significant correlation between age and low education with the results of IGRA and in smoking status with TST.Keywords Latent tuberculosis infection, tuberculin skin test, interferon gamma release assay "

"Pemeriksaan laboratorium di RS merupakan Salah satu pemeriksaan penunjang medis yang membutuhkan biaya besar dalam rangka menegakkan diagnosa dan monitoring suatu penyakit. Terbatasnya kemampuan pemeriksaan laboratoriurn yang dimiliki RS dibandingkan dengan banyaknya parameter pemintaan pemeriksaan laboratorium yang diminta oleh klinisi, mengakibatkan teqiadinya rujukan pemeriksaan.Evaluasi rujukan pemeriksaan laboratoriurn ini dilakukan di Instalasi Patologi Klinik RSU Tangerang untuk mendapatkan gambaran rujukan pemeriksaan sebagai salah satu alat untuk mengetahui kemampuan pemeriksaan dan pencapaian terhadap standar kemampuan minimal yang harus dlmiliki, serta mengetahui ada tidaknya rujukan tidak tepat dibandingkan dengan kemampuan pemeriksaan yang dimiliki. Kemarnpuan pemeriksaan dilihat dari aspek kemampuan SDM yang tersedia, tersedianya peralatan laboratorium yang dibutuhkan, dan tersedianya reagensia untuk pemeriksaan.Dari hasil evaluasi terhadap rujukan pemeriksaan didapatkan adanya 11 parameter rujukan pemeriksaan tidak tepat, 4 parameter pemeriksaan merupakan tes konfirmasi, dan terjadinya peningkatan kemampuan 15 parameter pemeriksaan sesuai standar dan 1 parameter pemeriksaan diluar standar. Disamping itu didapatkannya potensi untuk meningkatkan kemampuan 5 parameter pemeriksaan hormon.Hasil penelitian ini memberikan gambaran bahwa Instalasi Patologi Klinik RSU Tangerang sebagai unit teknis terkait dalam rujukan pemeriksaan kurang dilibatkan dalam proses klarifikasi pembayaran kepada laboratorium rujukan, dan terjadinya tumpang tindih parameter pemeriksaan ke dalam 2 bidang/kegiatan pada standar kemampuan pemerikaan.

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Laboratory examination in hospital is one among other costly supporting examination needed in order to establish diagnosis and illness and monitoring as well. Limitation of hospital?s capacity to conduct several laboratory examination to meet the demand of clinician will result the increase of speciment referrals. This evaluation of speciment referral is conducted in Clinical Pathology Departement, Tangerang Hospital, aimed to get overall review of laboratory examination referrals (speciment referrals), as a tool to measure laboratory capacity and target result compare to minimal standard, required as well as' unappropriate referral in relation with capacity. Hospital's capacity is measured through human resoureesl, equipment and reagent availability.Evaluation result ll unapropriate paramaters of referral, 4 parameters are conirrnation test ; increase of 15 parameters compare to standard ; 1 parameter outside standard ; 5 parameters of hormon examination and potential to be improved.This research show that Clinical Patology Departement of Tangerang hospital as related technical unit is not enough involved in billing system and duplication of parameters in 2 fields of activities of examination capacity standard."

"ABSTRAK Soluble CD14-ST presepsin merupakan penanda sepsis baru untuk diagnosis dan prognosis sepsis neonatorum. Kadar presepsin meningkat pada keadaan sepsis disebabkan oleh aktivitas protease di fagolisosom. Penelitian ini bertujuan untuk mengetahui manfaat pemeriksaan serial kadar presepsin sebagai penanda pemantauan respons terapi dan prognosis pada pasien SNAL secara bedside dengan menggunakan sampel darah kapiler. Desain penelitian kohort prospektif. Subjek penelitian terdiri dari 20 neonatus sehat dan 42 pasien SNAL. Pemeriksaan kadar presepsin dengan alat Pathfast pada hari ke-1, ke-3, dan ke-6 setelah diterapi. Kadar presepsin pada pasien SNAL 1104 pg/mL (608 ? 6225 pg/mL) lebih tinggi dibandingkan pada neonatus sehat 448 pg/mL (191 ? 513 pg/mL), nilai p 0,000. Pada pasien SNAL kelompok respons terapi kadar presepsin lebih rendah dibandingkan dengan kelompok non respons pada hari ke-3 dan ke-6 (p<0,05). Pada pasien SNAL kelompok non survivor kadar presepsin lebih tinggi dibandingkan dengan kelompok survivor hari ke-6 (p<0,05). Kadar presepsin berkorelasi positif dengan kadar CRP (r=0,488) dan jumlah leukosit (r=0,321). Nilai cut-off kadar presepsin hari ke-6 untuk penentuan prognosis 1365 pg/mL mempunyai AUC 0,789 (IK 95% 0,652 ? 0.926), sensitivitas 90.9%, dan spesifisitas 67,7%. Pemeriksaan presepsin hari ke-3 atau ke-6 secara bedside dengan darah kapiler bermanfaat untuk pemantauan terapi dan prognostik pasien SNAL.ABSTRACT Soluble CD14-ST presepsin as a new septic marker for diagnostic and prognostic of neonatal sepsis. Concentration of presepsin significantly increases in bacterial sepsis induced by phagolysosome protease activity. The objective of this study is to investigate the prognostic and monitoring value of presepsin in late onset neonatal sepsis (LOS) with serial capillary whole blood assay. This was prosphective cohort, from 20 healthy neonates and 42 LOS patient. The concentration of presepsin was analysed using Pathfast analyzer at 1st, 3rd & 6th day after therapy. Median of presepsin in LOS patient is 1104 pg/mL (608 ? 6225 pg/mL) significantly higher than healty neonates 448 pg/mL (191 ? 513 pg/mL), p value 0.000. Median of presepsin at 3rd & 6th day after therapy in LOS with therapeutic respons is significantly lower than LOS with no respons (p<0.05). Median of presepsin at 6th day after therapy in nonsurvivor is significantly higher than in survivor (p<0.05). There are positive correlation between presepsin and CRP (r=0.488) or leucocyte count (r=0.321). Cut-off presepsin at 6th day after therapy 1365 pg/mL is found with AUC 0.789 (CI 95% 0.652 ? 0.926), sensitivity 90.9%, dan spesificity 67.7%. Presepsin assay at 3rd or 6th day after therapy with capillary whole blood can be used to predict the prognostic and therapeutic respons in LOS patient.;Soluble CD14-ST presepsin as a new septic marker for diagnostic and prognostic of neonatal sepsis. Concentration of presepsin significantly increases in bacterial sepsis induced by phagolysosome protease activity. The objective of this study is to investigate the prognostic and monitoring value of presepsin in late onset neonatal sepsis (LOS) with serial capillary whole blood assay. This was prosphective cohort, from 20 healthy neonates and 42 LOS patient. The concentration of presepsin was analysed using Pathfast analyzer at 1st, 3rd & 6th day after therapy. Median of presepsin in LOS patient is 1104 pg/mL (608 ? 6225 pg/mL) significantly higher than healty neonates 448 pg/mL (191 ? 513 pg/mL), p value 0.000. Median of presepsin at 3rd & 6th day after therapy in LOS with therapeutic respons is significantly lower than LOS with no respons (p<0.05). Median of presepsin at 6th day after therapy in nonsurvivor is significantly higher than in survivor (p<0.05). There are positive correlation between presepsin and CRP (r=0.488) or leucocyte count (r=0.321). Cut-off presepsin at 6th day after therapy 1365 pg/mL is found with AUC 0.789 (CI 95% 0.652 ? 0.926), sensitivity 90.9%, dan spesificity 67.7%. Presepsin assay at 3rd or 6th day after therapy with capillary whole blood can be used to predict the prognostic and therapeutic respons in LOS patient.;Soluble CD14-ST presepsin as a new septic marker for diagnostic and prognostic of neonatal sepsis. Concentration of presepsin significantly increases in bacterial sepsis induced by phagolysosome protease activity. The objective of this study is to investigate the prognostic and monitoring value of presepsin in late onset neonatal sepsis (LOS) with serial capillary whole blood assay. This was prosphective cohort, from 20 healthy neonates and 42 LOS patient. The concentration of presepsin was analysed using Pathfast analyzer at 1st, 3rd & 6th day after therapy. Median of presepsin in LOS patient is 1104 pg/mL (608 ? 6225 pg/mL) significantly higher than healty neonates 448 pg/mL (191 ? 513 pg/mL), p value 0.000. Median of presepsin at 3rd & 6th day after therapy in LOS with therapeutic respons is significantly lower than LOS with no respons (p<0.05). Median of presepsin at 6th day after therapy in nonsurvivor is significantly higher than in survivor (p<0.05). There are positive correlation between presepsin and CRP (r=0.488) or leucocyte count (r=0.321). Cut-off presepsin at 6th day after therapy 1365 pg/mL is found with AUC 0.789 (CI 95% 0.652 ? 0.926), sensitivity 90.9%, dan spesificity 67.7%. Presepsin assay at 3rd or 6th day after therapy with capillary whole blood can be used to predict the prognostic and therapeutic respons in LOS patient.;Soluble CD14-ST presepsin as a new septic marker for diagnostic and prognostic of neonatal sepsis. Concentration of presepsin significantly increases in bacterial sepsis induced by phagolysosome protease activity. The objective of this study is to investigate the prognostic and monitoring value of presepsin in late onset neonatal sepsis (LOS) with serial capillary whole blood assay. This was prosphective cohort, from 20 healthy neonates and 42 LOS patient. The concentration of presepsin was analysed using Pathfast analyzer at 1st, 3rd & 6th day after therapy. Median of presepsin in LOS patient is 1104 pg/mL (608 ? 6225 pg/mL) significantly higher than healty neonates 448 pg/mL (191 ? 513 pg/mL), p value 0.000. Median of presepsin at 3rd & 6th day after therapy in LOS with therapeutic respons is significantly lower than LOS with no respons (p<0.05). Median of presepsin at 6th day after therapy in nonsurvivor is significantly higher than in survivor (p<0.05). There are positive correlation between presepsin and CRP (r=0.488) or leucocyte count (r=0.321). Cut-off presepsin at 6th day after therapy 1365 pg/mL is found with AUC 0.789 (CI 95% 0.652 ? 0.926), sensitivity 90.9%, dan spesificity 67.7%. Presepsin assay at 3rd or 6th day after therapy with capillary whole blood can be used to predict the prognostic and therapeutic respons in LOS patient."