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"Latar Belakang COVID-19 ditetapkan sebagai pandemi sejak tahun 2020. Berbagai terapi telah dikembangkan akan tetapi terdapat laporan kejadian trombosis pasca COVID-19. Diduga salah satu mekanisme yang berperan adalah aktivasi trombosit oleh antibodi.Hal tersebut dikemukakan akibat adanya temuan manifestasi mirip Heparin-Inducued Thrombocytopenia (HIT) pada COVID-19. HIT terjadi akibat adanya antibodi antiPF4/heparin yang berikatan dengan reseptor FcIIR di trombosit. Terdapat banyak penanda aktivasi trombosit, salah satunya P-selektin.Tujuan. Mengetahui perbedaan rerata kadar antiPF4, P-selektin serum, serta agregasi trombosit antar derajat COVID-19.Metode. Penelitian ini menggunakan sampel penelitian sebelumnya Hubungan Kadar 25-Hydroxy Vitamin D dengan Luaran Pasien Terkonfirmasi COVID-19 di Rumah Sakit Cipto Mangunkusumo (RSCM) dan Rumah Sakit Wisma Atlit pada Oktober 2021 sampai Januari 2022. Sampel serum tersebut disimpan di lab RSCM Kencana dan dilakukan simple random sampling. Pemeriksaan kadar P-selektin dan antiPF4 dilakukan dengan metode ELISA di Lab Diagnos, sedangkan agregasi trombosit pasca paparan serum di Lab RSCM.Hasil. Dilakukan analisis pada 160 sampel. Berdasarkan severitas terdapat 21 orang termasuk COVID-19 berat/kritis dan sisanya ringan/sedang. Komorbiditas, penyakit jantung, ginjal kronik, DM tipe 2, dan serebrovaskular secara bermakna lebih banyak pada kelompok berat kritis. Kadar P-selektin secara bermakna lebih tinggi pada kelompok berat kritis (median 43791,79 vs. 39112,3 pg/ml). Selain itu juga didapatkan agregasi yang lebih tinggi pada kelompok berat-kritis dengan agonis ADP 10 dan 5 uM (median masing-masing 32,8 vs 13,8 dan 28,5 vs 11,1 persen). Tidak terdapat perbedaan bermakna antiPF4 antar derajat COVID-19.Kesimpulan. Terdapat perbedaan bermakna kadar P-selektin dan agregasi trombosit antar derajat COVID-19.

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Background. COVID-19 became pandemic since 2020. While its treatment was being developed there were reports of thromboses event after COVID-19. One mechanism suggested was platelet activation due to antibody because of observation similar manifestation with heparin-induced thrombocytopenia in COVID-19. Main culprit of HIT is antibody to PF4/heparin. Which bind FcIIR receptor in thrombocyte, leading to its activation. There are many markers of thrombocyte activation, one of them is P-selectin.

Objectives. Determine the mean difference of P selectin and antiPF4 levels in serum and thrombocyte aggregation between COVID-19 severity.

Methods. This study uses samples already taken before, in Association of 25-Hydroxy-Vitamin D Levels with Outcome of COVID-19 Patients research from October 2021 to January 2022. Serum was stored in -20 C degrees in RSCM Laboratory. We planned to

do a simple random sampling. P-selectin and antiPF4 measured with ELISA in Diagnos Laboratory. Thrombocyte aggregation was measured by Light Transmission Aggregometry in RSCM.

Results. A total of 160 subjects analyzed 21 of them had severe/critical COVID-19. Comorbidities, heart disease, diabetes type 2, cerebrovascular disease were significantly higher in severe/critical disease. The median of P-selectin is significantly higher in severe covid (43791,79 vs. 39112,3 pg/ml). As aggregometry we find significantly higher

aggregation in severe disease with 10 and 5 uM ADP agonist. There is no difference of antiPF4 levels between groups.

Conclusion. There is a significant difference in P-selectin level and maximal aggregation between severe and non-severe COVID-19."

"Latar Belakang : Neuropati perifer merupakan manifestasi ekstraartikular pada Artritis Reumatoid AR yang sudah lama diketahui dan ditemukan pada sekitar 50-57,4 pasien AR dengan patogenesis yang belum jelas hingga saat ini. Nerve Growth Factor NGF, yang dilaporkan berhubungan dengan kejadian neuropati perifer pada pasien Diabetes Mellitus ditemukan dengan kadar yang lebih tinggi pada pasien AR dibandingkan orang normal. Berdasarkan hal tersebut, diperlukan penelitian yang bertujuan mengetahui hubungan antara kadar NGF dengan kejadian neuropati perifer pada pasien AR. Tujuan : Untuk mengetahui rata-rata kadar NGF darah dan ada tidaknya hubungan antara kadar NGF dengan kejadian Neuropati Perifer pada pasien AR. Metode : Penelitian potong lintang dengan metode consecutive sampling pada pasien AR rawat jalan di poli reumatologi Rumah Sakit Cipto Mangunkusumo dilakukan dalam kurun waktu Juli 2015-Maret 2016. Pemeriksaan laboratorium dan fisiologi yang dilakukan adalah NGF dan Elektromiografi-Kecepatan Hantar Saraf EMG-KHS. Subjek kemudian dikelompokkan menjadi 2 kelompok berdasarkan ada atau tidaknya neuropati perifer. Analisis bivariat kemudian dilakukan untuk melihat hubungan antara NGF dengan neuropati perifer diantara 2 kelompok. Data sekunder berupa usia, jenis kelamin, Laju Endap darah LED, C-Reactive Protein CRP, Disease Activity Score DAS 28 LED dan DAS 28 CRP didapat dari rekam medis sebagai data karakteristik dasar pasien. Hasil : Sebanyak 132 pasien diikutsertakan dalam penelitian ini dan didapatkan neuropati perifer sebanyak 45,5 60 orang selama Juli 2015-Maret 2016. Median kadar NGF pada pasien AR adalah 4,11 pg/mL 0,0-24,5 pg/mL. Median NGF pasien AR dengan neuropati perifer adalah 4,11 pg/mL 1,1-20,83 pg/mL, sementara median NGF pada pasien AR tanpa neuropati adalah 3,89 pg/mL 0,0-24,5 pg/mL. Jenis neuropati yang ditemukan pada pasien AR adalah polineuropati 29 subyek/21,97, mononeuropati multipleks 20 subyek/15,15 dan Carpal Tunnel Syndrome 15 subyek/11,36. Pada penelitian ini tidak didapatkan hubungan antara kadar NGF serum dengan kejadian neuropati perifer pada pasien AR p=0,716. Simpulan : Kadar NGF serum pasien AR didapatkan median sebesar 4 pg/mL dengan median NGF serum pada kelompok neuropati perifer 4,11 pg/mL dan kelompok tanpa neuropati 3,89 pg/mL. Tidak terdapat hubungan antara NGF serum dengan kejadian neuropati perifer pasien AR.

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Background : Peripheral neuropathy is an extra articular manifestations in Rheumatoid Arthritis RA, which has been known and is found in approximately 50 to 57.4 of patients with RA with an unclear pathogenesis until now. In DM type 2 patients, Nerve Growth Factor NGF is associated with peripheral neuropathy. NGF level is also reported to be higher among RA patients than that of among healthy subjects. The correlation between NGF level and peripheral neuropathy among RA has not been concluded yet.

Aim : To find out the mean levels of NGF blood serum and the relationship between the NGF serum levels and Peripheral Neuropathy among patients with RA.

Methods : A cross sectional study using consecutive sampling method including patient of rheumatology clinic at Cipto Mangunkusumo hospital was performed between July 2015 to March 2016. The laboratory and physiology measurement incude NGF level and Electromyography Nerve Conduction Velocities EMG NCV were examined to the subjects. Patients were classified into 2 groups based on the diagnosis of Peripheral Neuropathy PN PN positive and PN negative. Bivariate analysis were done to investigate the relationship between NGF and PN among groups. Secondary data such as age, sex, Erythrocyte Sedimentation Rate ESR, CRP, Disease Activity Score DAS 28 ESR and CRP obtained from their medical record as a basic characteristic data of patients.

Results : Among 132 subjects, PN was found in 60 subjects 45,5. The median level of NGF in RA patients was 4.11 pg mL 0.0 to 24.5 pg mL. The median NGF level of RA patients with peripheral neuropathy was 4.11 pg mL 1.1 to 20.83 pg mL, while the median of NGF level in RA patients without neuropathy was 3.89 pg mL 0.0 to 24.5 pg mL. Types of neuropathy among patients with AR were polyneuropathy 29 subjects 21.97, mononeuropathy multiplex 20 subjects 15.15 and Carpal Tunnel Syndrome 15 subjects 11.36. In this study we found no association between NGF serum level and peripheral neuropathy among patients with RA p 0.716.

Conclusion : The median of NGF serum level among RA patients was 4 pg mL. The median of NGF serum level among peripheral neuropathy group was 4.11 pg mL while the median of NGF level in RA patients without neuropathy was 3.89 pg mL. There was no relationship between NGF serum level and peripheral neuropathy among patients with RA."

"Penelitian ini dilakukan dengan tujuan untuk mengetahui apakah ekstrak kering P. niruri mempunyai efek menghambat agregasi trombosit secara in vitro dan in vivo pada orang sehat. Parameter penilaian adalah adanya perubahan nilai agregasi trombosit (% maksimal) dan besar hambatan (%). Sebelum penelitian dilakukan uji validasi yang meliputi uji ketelitian (within-run), penentuan bahan pelarut, uji validasi metoda in vitro, penetapan kadar P. niruri, penentuan waktu inkubasi, dan variasi pemeriksaan agregasi trombosit hari ke hari (intra individu). Pemeriksaan agregasi trombosit dilakukan dengan menggunakan agregator Adenosin difosfat (ADP) dengan kadar akhir Id Kmolll dan alat Platelet Aggregation Chromogenic Kinetic System-4 (PACKS-4). Prinsip pemeriksaan menggunakan alat tersebut yaitu mengukur persentase perubahan intensitas transmisi cahaya yang dapat melewati plasma (PRP) setelah terjadinya agregasi trombosit. Pada penelitian in vitro, dilakukan inkubasi platelets-rich plasma (PRP) dengan larutan ekstrak kering P. niruri dalam 3 kadar selama 5 menit. Air suling ditentukan sebagai pelarut dan kadar ekstrak keying P. niruri ditetapkan 1.5, 3, dan 6 mg/mi. Pada studi in vivo digunakan desain penelitian paralel menyilang, tersamar ganda, acak dengan pembanding plasebo. Pada minggu pertama diberikan ekstrak kering P. niruri dengan dosis 300 mg atau piasebo, diminum sekali sehari selama 7 hari berturut-turut. Setelah periode bebas obat 14 hari, diberikan perlakuan sebaliknya dari perlakuan pertama. Pengukuran agregasi trambosit dilakukan pada awal dan akhir masa minum obat, kemudian ditentukan perubahannya. Penelitian ini mengikutsertakan 5 sukarelawan sehat untuk penelitian in vitro dan 16 orang sukarefawan sehat untuk in vivo. Subyek penelitian tidak minum obat selama 2 minggu terakhir. Analisis statistik penelitian in vitro dilakukan dengan menggunakan ANOVA satu arah, dan untuk in vivo digunakan paired Nest. Perbedaan dianggap bermakna bila diperoleh nilai p c 0,05.Dari hasil uji ketelitian didapatkan nilai koefisien variasi 1,35 %. Dari penelitian in vitro didapatkan besar hambatan (%) agregasi trombosit oleh P. niruri pada kadar larutan P. niruri 0, 1.5, 3, dan 6 mg/ml berturut-turut adalah 0, 0, 3 dan 14% (p = 0.33). Dari penelitian in vivo didapatkan rerata nilai agregasi maksimal sebelum pemberian P. niruri 89.9% dan sesudah pemberian P. niruri adalah 86.9%, dengan nilai hambatan oleh P. niruri sebesar 3%. Rerata (Li- SD) perbedaan nilai agregasi maksimal sebelum dan sesudah pemberian plasebo serta sebelum dan sesudah pemberian P. niruri masing-masing adalah 4.6 (± 17.3)% dan 2.9 (±7.5)% (p= 0.194). Selama penelitian in vivo dicatat adanya keluhan : pusing 4 orang, mengantuk 1 orang dan sering buang air kecil 1 orang pada subyek yang mendapat ekstrak kering P. niruri, serta 1 orang pusing dan 1 orang mengantuk pada subyek yang mendapat piasebo. Dari penelitian ini disimpulkan bahwa pada penelitian in vivo, larutan ekstrak kering P. niruri dalam air sampai dengan kadar 6 mg/ml tidak mempunyai efek menghambat terhadap agregasi trombosit PRP orang sehat, dan pada penelitian in vivo ekstrak kering P. niruri 300 mg, sekali sehari, yang diberikan selama 7 hari berturut-turut juga tidak mempunyai efek hambatan terhadap agregasi trombosit orang sehat.

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This research was conducted to find out whether dry extract of P. Niruri was effective to inhibit platelet aggregation, in vitro and in viva, on healthy human subjects. Parameter of examination was a change in value (% maximal) of platelet aggregation and extends of inhibition (%). For preliminary study, several validation tests were conducted which included precision test (within-run), determining the solvent material, validation test of in vitro method, determining the concentration of P. niruri, determining the incubation time and daily variation of examination of the platelet aggregation (intra-individual). Examination of the platelet aggregation was conducted by using Adenosin Diphosphate (ADP) as aggregating agent with final concentration 10 pmol/l and equipment Platelet Aggregation Chromogenic Kinetic System-4 (PACKS-4). The principle of the test is to measure the percentage of change of the intensity of the light that is able to pass through the platelets-rich plasma (PRP) after the occurrence of the platelet aggregation. On in vitro research PRP was conducted using the solution of dry extract P. niruri in 3 different concentrations for 5 minutes. Distilled water was chosen as the solvent for P. niruri extract and the concentrations prepared were 1.5, 3, and 6 mg/ml. On in vivo study, a randomized, crossover, parallel, double-blind, and placebo-controlled design was applied. in first week, 300 mg of P. niruri extract or placebo was given daily to the subjects for 7 days. After 14 days of wash out period, the procedure was repeated by giving alternative agent to the subjects. Measurement of platelet aggregation was done at the beginning and at the end of the each treatment period. This research involved 5 and 16 normal human subjects, for in vitro and in vivo studies, respectively and not on any drugs therapy for the last two weeks. Statistical test for in vitro study was ANOVA one way, and paired t-test was used for in vivo study. A difference was considered significant if p value < 0.05.

The coefficient of variation for the recovery test was 1.35%. In in vitro study, inhibition of platelet aggregation (%) by P. niruri of 0, 1.5, 3, and 6 mglml were 0, 0, 3 and 14%, respectively (p = 0.33). From in vivo study, mean maximum aggregation value before and after giving P. niruri were 89.9% and 86.9%, respectively, therefore the inhibition by P. niruri was 3%. Mean (SD) change of maximum aggregation value before and after giving placebo and before and after giving P. niruri were 4.6(±17.3%) and 2.9(t7.5%) (p = 0.194). During in vivo study, several adverse events in subjects given dry extract P. niruri were recorded: 4 persons had headache, 1 had drowsiness and 1 had frequent urination, while in subjects given placebo: 2 persons had headache and ; had drowsiness. From this in vitro study, it is concluded that up to the concentration of 6 mg/ml, dry % tract P. niruri solvent in water does not inhibit platelet aggregation activity and in in vivo study, dry extract P. niruri 300 mg, once a day for 7 days continuously, also does not affect platelet aggregation activity in healthy human subjects."

"[ABSTRAKLatar Belakang: Penyakit Demam Berdarah Dengue (DBD) masih endemis dan merupakan masalah yang besar dan serius di Indonesia. Peningkatan kadar laktat dalam darah merupakan petanda hipoksia jaringan pada penyakit DBD, bila hipoksia jaringan tidak terdeteksi lebih awal/dini, dan tidak diberikan cairan lebih agresif dan sesuai, maka akan meningkatkan angka komplikasi dan kematian. Tujuan: Mengetahui perbedaan rerata kadar hematokrit dan albumin serum serta beda proporsi efusi pleura dan atau asites, pasien infeksi dengue dewasa pada berbagai derajat hiperlaktatemia untuk mengetahui secara dini adanya hipoksia jaringan Metode: Penelitian ini adalah Studi uji Potong Lintang. Penelitian dilakukan di RSUPN Cipto Mangunkusumo dan RSUP Persahabatan Jakarta, pada pasien yang dirawat periode waktu April 2014 sampai dengan Mei 2015. Menilai beda rerata kadar hematokrit darah dan albumin serum menggunakan uji statistik Uji T, sedangkan beda proporsi efusi pleura dan atau asites dengan Uji Kai Kuadrat. Hasil: Sebanyak 62 pasien infeksi demam dengue, dibagi kedalam 2 kelompok masing-masing 31 pasien berdasarkan kadar laktat darah. Kelompok I dengan kadar laktat darah > 2 sampai ≤ 2,4 mmol/L dan kelompok II > 2,4 mmol/L. Rerata kadar hematokrit darah pada kelompok I dan II masing-masing 40,06 (SB 4,54) dan 41,03 (SB 4,77). Tidak ada perbedaan rerata kadar hematokrit darah pada kedua kelompok dengan nilai p = 0,42. Rerata kadar albumin serum pada kelompok I dan II masing-masing 3,94 (SB 0,29) dan 3,89 (SB 0,30). Tidak ada perbedaan rerata kadar albumin serum pada kedua kelompok dengan nilai p = 0,49. Proporsi efusi pleura dan atau asites pada kelompok I dan II masing-masing 54,8% dan 58,1%. Tidak ada perbedaan proporsi adanya efusi pleura dan atau asites pada kedua kelompok dengan p = 1. Kesimpulan: Tidak ada perbedaan rerata kadar hematokrit darah dan albumin serum, serta beda proporsi efusi pleura dan atau asites pada kelompok kadar laktat darah > 2 sampai ≤ 2,4 mmol/L dibandingkan > 2,4 mmol/L.

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ABSTRACTBackground: Dengue Haemorrhagic Fever (DHF) is still endemic and is a big and serious problem in Indonesia. Increased levels of lactate in the blood is a marker for tissue hypoxia in DHF , when tissue hypoxia is not detected early and not given the more aggressive fluids and appropriate, it will increase the rate of complications and mortality. Objective: To determine differences in average levels of hematocrit and serum albumin as well as different proportions pleural effusion and/or ascites, adult patients with dengue infection in various degrees hyperlactatemia to know at an early stage for tissue hypoxia. Methods: This study is a test study Cross Sectional. The study was conducted at Cipto Mangunkusumo and at Persahabatan Hospital, Jakarta, in-patients admitted to the time period April 2014 through May 2015. Assessing the mean difference of blood hematocrit levels and serum albumin using statistical test T test, while the different proportion of pleural effusion and/or ascites with test Chi Square. Results: A total of 62 patients of dengue fever infections, distributed into 2 groups of each 31 patients based on blood lactate levels. Group I with a blood lactate levels > 2 to ≤ 2,4 mmol/L and Group II > 2.4 mmol/L. The mean blood hematocrit levels in group I and II, respectively 40.06 (SD 4.54) and 41.03 (SD 4.77). There is no difference in mean blood hematocrit levels in both groups with p = 0.42. The mean levels of serum albumin in group I and II respectively 3.94 (SD 0.29) and 3.89 (SD 0.30). There is no difference in the mean serum albumin levels in both groups with p = 0.49. The proportion of pleural effusion and/or ascites in groups I and II respectively 54.8% and 58.1%. There is no difference in the proportion of the pleural effusion and/or ascites in both groups with p = 1. Conclusion: There is no difference in mean blood hematocrit levels and serum albumin, as well as the different proportions of pleural effusion and/or ascites founds in the group of blood lactate levels > 2 to ≤ 2,4 mmol/L compared to > 2.4 mmol/L.;Background: Dengue Haemorrhagic Fever (DHF) is still endemic and is a big and serious problem in Indonesia. Increased levels of lactate in the blood is a marker for tissue hypoxia in DHF , when tissue hypoxia is not detected early and not given the more aggressive fluids and appropriate, it will increase the rate of complications and mortality. Objective: To determine differences in average levels of hematocrit and serum albumin as well as different proportions pleural effusion and/or ascites, adult patients with dengue infection in various degrees hyperlactatemia to know at an early stage for tissue hypoxia. Methods: This study is a test study Cross Sectional. The study was conducted at Cipto Mangunkusumo and at Persahabatan Hospital, Jakarta, in-patients admitted to the time period April 2014 through May 2015. Assessing the mean difference of blood hematocrit levels and serum albumin using statistical test T test, while the different proportion of pleural effusion and/or ascites with test Chi Square. Results: A total of 62 patients of dengue fever infections, distributed into 2 groups of each 31 patients based on blood lactate levels. Group I with a blood lactate levels > 2 to ≤ 2,4 mmol/L and Group II > 2.4 mmol/L. The mean blood hematocrit levels in group I and II, respectively 40.06 (SD 4.54) and 41.03 (SD 4.77). There is no difference in mean blood hematocrit levels in both groups with p = 0.42. The mean levels of serum albumin in group I and II respectively 3.94 (SD 0.29) and 3.89 (SD 0.30). There is no difference in the mean serum albumin levels in both groups with p = 0.49. The proportion of pleural effusion and/or ascites in groups I and II respectively 54.8% and 58.1%. There is no difference in the proportion of the pleural effusion and/or ascites in both groups with p = 1. Conclusion: There is no difference in mean blood hematocrit levels and serum albumin, as well as the different proportions of pleural effusion and/or ascites founds in the group of blood lactate levels > 2 to ≤ 2,4 mmol/L compared to > 2.4 mmol/L.;Background: Dengue Haemorrhagic Fever (DHF) is still endemic and is a big and serious problem in Indonesia. Increased levels of lactate in the blood is a marker for tissue hypoxia in DHF , when tissue hypoxia is not detected early and not given the more aggressive fluids and appropriate, it will increase the rate of complications and mortality. Objective: To determine differences in average levels of hematocrit and serum albumin as well as different proportions pleural effusion and/or ascites, adult patients with dengue infection in various degrees hyperlactatemia to know at an early stage for tissue hypoxia. Methods: This study is a test study Cross Sectional. The study was conducted at Cipto Mangunkusumo and at Persahabatan Hospital, Jakarta, in-patients admitted to the time period April 2014 through May 2015. Assessing the mean difference of blood hematocrit levels and serum albumin using statistical test T test, while the different proportion of pleural effusion and/or ascites with test Chi Square. Results: A total of 62 patients of dengue fever infections, distributed into 2 groups of each 31 patients based on blood lactate levels. Group I with a blood lactate levels > 2 to ≤ 2,4 mmol/L and Group II > 2.4 mmol/L. The mean blood hematocrit levels in group I and II, respectively 40.06 (SD 4.54) and 41.03 (SD 4.77). There is no difference in mean blood hematocrit levels in both groups with p = 0.42. The mean levels of serum albumin in group I and II respectively 3.94 (SD 0.29) and 3.89 (SD 0.30). There is no difference in the mean serum albumin levels in both groups with p = 0.49. The proportion of pleural effusion and/or ascites in groups I and II respectively 54.8% and 58.1%. There is no difference in the proportion of the pleural effusion and/or ascites in both groups with p = 1. Conclusion: There is no difference in mean blood hematocrit levels and serum albumin, as well as the different proportions of pleural effusion and/or ascites founds in the group of blood lactate levels > 2 to ≤ 2,4 mmol/L compared to > 2.4 mmol/L., Background: Dengue Haemorrhagic Fever (DHF) is still endemic and is a big and serious problem in Indonesia. Increased levels of lactate in the blood is a marker for tissue hypoxia in DHF , when tissue hypoxia is not detected early and not given the more aggressive fluids and appropriate, it will increase the rate of complications and mortality. Objective: To determine differences in average levels of hematocrit and serum albumin as well as different proportions pleural effusion and/or ascites, adult patients with dengue infection in various degrees hyperlactatemia to know at an early stage for tissue hypoxia. Methods: This study is a test study Cross Sectional. The study was conducted at Cipto Mangunkusumo and at Persahabatan Hospital, Jakarta, in-patients admitted to the time period April 2014 through May 2015. Assessing the mean difference of blood hematocrit levels and serum albumin using statistical test T test, while the different proportion of pleural effusion and/or ascites with test Chi Square. Results: A total of 62 patients of dengue fever infections, distributed into 2 groups of each 31 patients based on blood lactate levels. Group I with a blood lactate levels > 2 to ≤ 2,4 mmol/L and Group II > 2.4 mmol/L. The mean blood hematocrit levels in group I and II, respectively 40.06 (SD 4.54) and 41.03 (SD 4.77). There is no difference in mean blood hematocrit levels in both groups with p = 0.42. The mean levels of serum albumin in group I and II respectively 3.94 (SD 0.29) and 3.89 (SD 0.30). There is no difference in the mean serum albumin levels in both groups with p = 0.49. The proportion of pleural effusion and/or ascites in groups I and II respectively 54.8% and 58.1%. There is no difference in the proportion of the pleural effusion and/or ascites in both groups with p = 1. Conclusion: There is no difference in mean blood hematocrit levels and serum albumin, as well as the different proportions of pleural effusion and/or ascites founds in the group of blood lactate levels > 2 to ≤ 2,4 mmol/L compared to > 2.4 mmol/L.]"

"Latar Belakang: Rambut memiliki berbagai fungsi, salah satunya sebagai perkiraan usia individu. Kanitis, atau uban, merupakan tanda penuaan yang muncul pada rambut yang umumnya terjadi pada dekade ke-4 kehidupan. Kanitis prematur (KP) merupakan istilah munculnya kanitis sebanyak 5 helai rambut sebelum usia 25 tahun pada ras Asia. Etiologi penyakit KP belum sepenuhnya dipahami dan dianggap sebagai kelainan multifaktorial. Defisiensi mikronutrien tertentu, meliputi besi dan seng, diperkirakan berperan dalam munculnya KP. Oleh karena itu, diperkirakan kadar besi dan seng dalam serum dan rambut dapat mencerminkan risiko terjadinya KP pada seseorang.Tujuan: Menganalisis perbedaan rerata kadar besi dan seng rambut dan serum KP dibandingkan populasi sehat dan menganalisis korelasi antara kadar besi dan seng rambut dan serum pasien KP dengan derajat keparahan KP.Metode: Penelitian ini merupakan studi observasional analitik dengan desain kasus kontrol dan dilakukan matching jenis kelamin dan usia. Populasi target penelitian adalah pasien KP dan individu sehat yang diambil dengan metode consecutive sampling berdasarkan kriteria penerimaan dan penolakan. Analisis statistik yang sesuai dilakukan untuk membuktikan hipotesis penelitian. Nilai p<0,05 dianggap signifikan secara statistik.Hasil: Diantara 32 sampel kelompok KP, 7 orang mengalami KP ringan, 14 orang mengalami KP sedang, dan 11 orang mengalami KP berat. Diperoleh perbedaan kadar seng rambut yang bermakna secara statistik antara kelompok KP dengan kelompok sehat (184,03 vs. 231,83; p=0,01). Perbedaan parameter lainnya ditemukan tidak bermakna secara statistik. Tidak ditemukan adanya korelasi yang bermakna secara statistik antara kadar besi dan seng serum maupun rambut terhadap kejadian atau derajat keparahan KP. Data tambahan, ditemukan korelasi positif lemah antara indeks massa tubuh (IMT) dengan derajat keparahan KP (rρ= 0,392; p=0,026). Riwayat KP keluarga merupakan faktor risiko KP (aOR 14,829; 95% IK 3,073–71,566, p=0,001). Setiap penurunan 1 unit (µg/g) kadar seng rambut, kemungkinan mengalami KP meningkat (aOR 1,007; 95% IK 1,001–1,013, p=0,022).Kesimpulan: Kadar seng rambut pada kelompok KP lebih rendah dan berbeda bermakna secara statistik dibandingkan dengan kelompok kontrol sehat, namun tidak ditemukan perbedaan rerata yang bermakna pada parameter lainnya. Tidak ditemukan korelasi antara kadar besi dan seng rambut dengan serum, maupun dengan derajat keparahan KP.

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Background: Hair has various functions, one of which is an estimate of an individual's age. Canities, or gray hair, is a sign of aging that appears on the hair and generally begins to occur in the 4th decade of life. Premature canities (PC) is a term for the appearance of gray hair as much as 5 strands of hair before the age of 25 years in Asian ethnicity. The etiology of PC is not fully understood and is considered a multifactorial disorder. Certain micronutrient deficiencies, including iron and zinc, are thought to play a role in the development of PC. Therefore, it is predicted that iron and zinc levels in serum and hair can reflect a person's risk of developing PC.

Aim: To analyze the difference in mean serum and hair levels of iron and zinc between subjects with PC and healthy controls and to assess their correlation with the severity of PC.

Method: This study is an analytic observational study with a case-control design and matched according to age and gender. The target population of the study was patients with PC and healthy individuals who were recruited by consecutive sampling based on inclusion and exclusion criteria. Appropriate statistical analysis was performed to prove the research hypothesis. A p-value of <0.05 is considered statistically significant.

Results: Among the 32 subjects of the PC group, 7 subjects had mild PC, 14 subjects had moderate PC, and 11 subjects had severe PC. There was a statistically significant difference in hair zinc levels between the PC group and the healthy controls (184.03 vs. 231.83; p=0.01). Differences in other parameters were found to be not statistically significant. There was no statistically significant correlation between serum and hair iron and zinc levels on either the incidence or the severity of PC. A weak positive correlation between body mass index (BMI) and the severity of PC (rρ= 0.392; p= 0.026) was obtained. Family history of PC is a risk factor for PC with an aOR 14,829; 95% CI 3.073–71,566, p=0.001. In addition, for every 1 µg/g decrease in hair zinc levels, the probability of experiencing PC increased (aOR 1.007; 95% CI 1.001–1.013, p=0.022).

Conclusion: Hair zinc levels in the PC group were lower and statistically significant compared to the healthy controls but no significant difference was found in other parameters. There was no correlation between hair iron and zinc levels with serum, nor with the severity of PC.

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"Latar Belakang : Gangguan Pemusatan Perhatian/ Hiperaktivitas (GPPH) merupakan gangguan psikiatrik yang sering dijumpai dan diduga terkait dengan gangguan fungsi eksekutif serta defisiensi mikronutrien salah satunya zat besi (feritin). Feritin diperkirakan terkait dengan fungsi eksekutif pada GPPH dalam aktivitasnya pada sistem dopaminergik. Tujuan : Mengetahui hubungan antara kadar feritin dalam serum dan fungsi eksekutif pada anak dengan GPPH. Metode : Desain penelitian ini adalah potong lintang memakai data sekunder, membandingkan rerata kadar feritin dalam serum 22 anak GPPH dengan gangguan fungsi eksekutif , 22 anak GPPH tanpa fungsi eksekutif, dan 22 anak Sehat yang berusia 6-12 tahun. Uji Kruskal Wallis digunakan untuk mengetahui perbedaan yang bermakna diantara ketiga kelompok tersebut dan uji analisis Mann-Whitney digunakan untuk mengetahui perbedaan bermakna pada kelompok anak GPPH. Penegakkan diagnosis GPPH memakai Mini-International Neuropsychiatric Interview-kid (MINI KID), Gangguan Fungsi Eksekutif ditentukan dengan Behavior Rating Inventory of Executive Function versi Bahasa Indonesia (BRIEF-BI). Hasil : Nilai rerata feritin dalam serum sebesar 48,4 ng/mL pada kelompok anak GPPH tanpa gangguan fungsi eksekutif, sebesar 43,5 ng/mL pada kelompok anak GPPH dengan gangguan fungsi eksekutif, serta sebesar 44,0 ng/mL pada kelompok anak sehat. Dari uji Kruskal Wallis Tidak didapatkan perbedaan bermakna antara rerata kadar feritin pada kelompok anak GPPH tanpa gangguan fungsi eksekutif, kelompok anak GPPH dengan gangguan fungsi eksekutif, dan kelompok anak sehat (p > 0,05). Tidak didapatkan perbedaan yang signifikan juga antar kelompok GPPH dengan uji Mann-Whitney (p >0,05). Kesimpulan : Pada penelitian ini tidak didapatkan adanya perbedaan rerata kadar feritin dalam serum antara GPPH dengan gangguan fungsi eksekutif, GPPH tanpa gangguan fungsi eksekutif, dan anak Sehat yang secara statistik signifikan. Diperlukan studi lebih lanjut untuk melihat peran feritin pada aktivitas dopaminergik otak pada anak GPPH.

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Background : Attention Deficit/ Hiperactivity Disorders (ADHD) is a common psychiatric disorder and associated with impaired executive function as well as one of micronutrient deficiencies such iron (ferritin). It has been suggested that ferritin was associated with executive function in ADHD trough activity on the dopaminergic system.

Objectives : To find the relationship between ferritin serum levels and executive function in children with ADHD.

Methods : This study is cross-sectional using secondary data, comparing the mean levels of ferritin serum in 22 ADHD children with impaired executive function, 22 ADHD children with normal executive functions, and 22 healthy children aged 6-12 years. Kruskal Wallis test was performed to determine significant differences among the three groups and Mann-Whitney test analysis test was performed to determine significant differences between ADHD group. The diagnosis of ADHD was diagnosed by MINI KID, while executive function were assessed with BRIEF-Indonesian version.

Results : Mean values obtained in ferritin serum was 48.4 ng / mL in ADHD children with normal executive function, 43.5 ng / mL in ADHD children with impaired executive function, and 44.0 ng / mL in healthy children . With Kruskal Wallis test analysis, there were no significant differences between ferritin serum levels in the group of ADHD children with normal executive function, ADHD children with impaired executive function, and a group of healthy children (p > 0.05). There were also no significant differences between ADHD group with mann-Whitney test analysis (p >0.05).

Conclusions : In this study, there has been found no statistical significant differences in ferritin serum levels between ADHD with impaired executive function, ADHD with normal executive function, and healthy children. Further study is needed to look at the role of ferritin in dopaminergic activity within the brain of ADHD children."

"Latar belakang. Coronavirus disease-2019 (COVID-19) memiliki spektrum penyakit yang sangat luas dari gejala ringan sampai berat, hingga kematian. Reaksi inflamasi berat akibat dari COVID-19 ini menimbulkan gangguan hemostasis yang disebut dengan COVID-19 associated coagulopathy. Penelitian ini bertujuan untuk menilai profil koagulasi pada pasien dalam pemantauan (PDP) ataupun terkonfirmasi COVID-19 serta hubungannya terhadap mortalitas 30-hari pasien.Metode. Studi ini merupakan studi kohort retrospektif di RS Cipto Mangunkusumo (RSCM) selama Maret 2020 hingga Juni 2020. Sebanyak 106 subjek yang sesuai kriteria inklusi dianalisis dari data rekam medis. Dilakukan pengambilan data berupa data demografik, klinis atau hemodinamik pasien, profil koagulasi saat subjek ditentukan sebagai PDP atau terkonfirmasi COVID-19, pemberian terapi tromboprofilaksis heparin, dan status mortalitas 30 hari setelah admisi. Perhitungan statistik dilakukan dengan menggunakan Statistical Package of Social Science (SPSS) versi 24.0. Profil koagulasi subjek penyintas 30 hari dibandingkan dengan subjek yang mengalami mortalitas. Variabel profil koagulasi yang bermakna kemudian dianalisis dengan analisis bivariat dan regresi logistik multivariat.Hasil. Pada kelompok yang mengalami mortalitas 30-hari ditemukan adanya peningkatan jumlah leukosit (p: 0,022), penurunan kadar trombosit (p: 0,016), dan waktu protrombin (PT) dan waktu activated partial thromboplastin time (APTT) yang lebih panjang (p: 0,002 dan p: 0,018) dibandingkan pada kelompok penyintas 30-hari. Tidak ditemukan perbedaan fibrinogen dan d-Dimer yang bermakna secara statistik. PT merupakan suatu profil koagulasi tunggal yang dapat digunakan sebagai prediktor mortalitas 30-hari dengan odds ratio (95% CI) sebesar 1,407 (1,072 – 1,846), nilai p: 0,014.Simpulan. Terdapat hubungan antara faktor koagulasi pasien COVID-19 dengan mortalitas 30 hari di RSCM, khususnya PT yang dapat digunakan sebagai prediktor mortalitas 30-hari.

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.Background. Coronavirus disease-2019 (COVID-19) has a very broad spectrum of disease from mild to severe symptoms, to death. The severe inflammatory reaction as a result of COVID-19 infection causes a hemostasis disorder called COVID-19 associated coagulopathy. This study aims to assess the coagulation profile of patients under monitoring (PDP) or confirmed COVID-19 and its relationship with 30-day mortality.

Method. This retrospective cohort study was conducted at RS Cipto Mangunkusumo (RSCM) from March 2020 to June 2020. A total of 106 subjects who met the inclusion criteria were analyzed from medical record data. Data were collected in the form of patient demographic, clinical or hemodynamic data, coagulation profile when the subject was determined as PDP or confirmed as COVID-19, administration of heparin thromboprophylaxis therapy, and mortality status 30 days after admission. Statistical calculations were performed using the Statistical Package of Social Science (SPSS) version 24.0. We compared the coagulation profiles of the survivor group in contrast to the non-survivor group. Significant coagulation profile variables were analyzed using bivariate analysis and multivariate logistic regression.

Results. There was elevated number of leukocytes (p: 0.022), reduced platelet levels (p: 0.016), and longer prothrombin time (PT) as well as activated partial thromboplastin time (APTT) (p: 0.002 and p: 0.018, consecutively) in non-survivor group. There were no statistical differences in fibrinogen and d-Dimer levels in both groups. Additionally, PT is a single coagulation profile which predicted 30-day mortality with an odds ratio (95% CI) of 1.407 (1.072 - 1.846), and p value: 0.014.

Conclusion. This present study shows abnormal coagulation results are associated with 30-day mortality in COVID-19 patients at RSCM. Prolonged PT was an independent predictor for 30-day mortality in COVID-19 patients"

"Latar Belakang Pneumonia adalah suatu penyakit akibat infeksi pada paru yang menjadi masalah serius, dengan tingkat mortalitas yang mencapai 42,4% di Indonesia sendiri. Pneumonia dikaitkan dengan mortalitas tinggi, salah satunya pada kondisi kegagalan ekstubasi yang terjadi pada pasien yang memerlukan intubasi. Proses patologis ini dikaitkan dengan peningkatan sitokin proinflamasi seperti IL-6 yang dapat ditemukan pada serum ataupun bilasan bronkoalveolar. Penelitian-penelitin terdahulu belum menentukan kaitan sitokin IL-6 dengan prognosis pasien terkait mortalitas dan kegagalan ekstubasi, serta belum menentukan korelasi kadar IL-6 serum dan bilasan bronkoalveolar pada pasien meninggal dan pasien gagal ekstubasi.Tujuan Mengetahui perbandingan kadar IL-6 pada serum dan bilasan bronkoalveolar pada pasien sesuai dengan status mortalitas dan ekstubasi pada pasien pneumonia berat, serta korelasi kadar IL-6 sersum dan bilasan bronkoalveolar pada pasien meninggal dan gagal ekstubasi.Metode Penelitian dengan desain kohort prospektif dilakukan pada 40 pasien pneumonia berat yang terintubasi dan menjalani tindakan bronkoskopi di IGD dan ruang intensif RSCM sejak November 2020 hingga Januari 2021. Kadar IL-6 pada pemeriksaan serum dan pemeriksaan bilasan bronkoalveolar kemudian dianalisis dengan observasi keberhasilan ekstubasi selama 20 hari dan status mortalitas selama 28 hari. Analisis univariat pada karakteristik pasien dilanjutkan dengan analisis bivariat dengan uji perbedaan dua rerata tidak berpasangan dengan data skala numerik dilakukan pada data sebaran normal dan uji Mann-Whitney dilakukan pada data sebaran tidak normal.Hasil Dalam penelitian, didapatkan rasio gagal ekstubasi dan mortalitas sebesar 80% dan 75% secara berurutan. Tidak ditemukan perbedaan bermakna antara kadar IL-6 serum ataupun bilasan bronkoalveolar pada status mortalitas dan ekstubasi pasien. Namun, ditemukan korelasi positif antara kadar IL-6 serum dan kadar IL-6 bilasan bronkoalveolar pada pasien meninggal (r=0,551) dan gagal ekstubasi (r=0,567).Kesimpulan Tidak terdapat perbedaan bermakna pada kadar IL-6 serum dan bilasan bronkoalveolar antara pasien meninggal dan hidup, serta pasien berhasil atau gagal ekstubasi. Namun, terdapat hubungan positif antara kadar IL-6 serum dan bilasan bronkoalveolar pada pasien meninggal dan gagal ekstubasi.

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Background. Pneumonia is a disease caused by infection in the lungs which has become a serious health issue, with a mortality rate of 42.4% in Indonesia itself. Pneumonia is associated with high mortality, one of which is in conditions of extubation failure that occurs in patients who require intubation. This pathological process is associated with an increase in pro-inflammatory cytokines such as IL-6 that can be found in serum or bronchoalveolar lavage. Previous studies have not determined the association of the IL6 cytokine with the prognosis of patients related to mortality and extubation failure, nor have they determined the correlation of serum IL-6 levels and bronchoalveolar lavage in patients dying and patients failing to extubate.

Purpose. To analyze the comparison of IL-6 levels in serum and bronchoalveolar lavage in patients based on their mortality and extubation status in severe pneumonia patients, as well as the correlation of IL-6 levels in serum and bronchoalveolar lavage in patients who died and failed extubation.

Method. The study with a prospective cohort design was conducted on 40 severe pneumonia patients who were intubated and underwent bronchoscopic procedures in the emergency room and intensive room of RSCM from November 2020 to January 2021. IL6 levels were examined on serum and bronchoalveolar lavage sample, which then analyzed with the observation for extubation status for 20 days and mortality status for 28 days. Univariate analysis on patient characteristics was followed by bivariate analysis with unpaired two-mean difference tests with numerical scale data performed on normal distribution data and Mann-Whitney test performed on abnormal distribution data

Result. In the study, the ratio of extubation failure and mortality was 80% and 75% respectively. No significant difference was found between serum IL-6 levels or bronchoalveolar lavage IL-6 levels based on the mortality and extubation status of patients. However, a positive correlation was found between serum IL-6 levels and IL-6 levels of bronchoalveolar lavage in patients who died (r=0.551) and failed extubation (r=0.567).

Conclusion. There were no significant differences in serum IL-6 levels and bronchoalveolar lavage between deceased and living patients, as well as patients succeeded or failed to be extubated. However, there was a positive correlation between serum IL-6 levels and bronchoalveolar lavage IL-6 levels in patients who died and failed extubation."

"[Konsumsi obat-obatan anti agregasi platelet (antiplatelet) seperti clopidogrel yang digunakan untuk menurunkan agregasi platelet dapat mencegah terjadinya trombosis. Namun, konsumsi obat-obatan antiplatelet sintetik seringkali memberikan efek samping bagi tubuh. Daun Tanjung (Mimusops elengi L.) dapat dimanfaatkan sebagai sumber antiplatelet alami dan murah karena mengandung senyawa katekin. Ekstraksi senyawa katekin dari daun Tanjung menggunakan metode refluks dengan pelarut air pada lima variasi waktu (15 menit, 30 menit, 45 menit, 60 menit, 75 menit) menunjukkan bahwa waktu ekstraksi 75 menit menghasilkan kandungan katekin tertinggi, yakni sebesar 452,39 ppm. Hasil analisis ekstrak menggunakan FTIR didapatkan gugus-gugus senyawa yang umumnya terkandung dalam senyawa katekin yaitu fenol, aromatik, serta eter. Efek agregasi antiplatelet dari ekstrak daun Tanjung kemudian diukur menggunakan waktu pendarahan pada mencit galur Deutsche Democratic Yokohama. Ekstrak diberikan secara oral selama 8 hari, dengan pengukuran waktu pendarahan dilakukan pada hari pertama dan hari kesembilan. Kelompok pengujian bioaktivitas antiplatelet adalah kelompok kontrol negatif, kelompok kontrol positif (clopidogrel 0,033 mg/30 gram berat mencit), serta tiga kelompok dosis; TE1 (0,0198 mg/30 gram berat mencit), TE2 (0,0396 mg/30 gram berat mencit), dan TE3 (0,0793 mg/30 gram berat mencit). Pengujian dilakukan dengan cara melukai ekor mencit untuk melihat waktu pendarahan yang dialami mencit sebelum dan sesudah pemberian ekstrak. Setelah mendapatkan peningkatan waktu pendarahan, data dianalisis menggunakan analisis uji varian (Anova) yang dilanjutkan dengan pengujian LSD menggunakan aplikasi SPPS V.16. Hasil dari peningkatan waktu pendarahan menunjukkan bahwa kelompok dosis TE3 dengan dosis 0,0793 mg/30 gram berat mencit memberikan waktu pendarahan sebesar 132.77 + 32.52% yang sebanding dengan kelompok kontrol positif sebesar 110.45 + 13.66%.

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Consumption of anti platelet aggregation (antiplatelet) drugs such as clopidogrel which is used to lower platelet aggregation can be used to prevent thrombosis. However, the consumption of synthetic antiplatelet drugs frequently give side effects to the body. Tanjung (Mimusops elengi L.) leaves can be used as a natural and inexpensive source of antiplatelet compounds that contain catechins. Extraction of catechin compounds from Tanjung?s leaves using reflux system and water as its solvent with five variations of the time (15 minutes, 30 minutes, 45 minutes, 60 minutes, 75 minutes) showed that the extraction time of 75 minutes produces the highest catechin content, which amounted to 452.39 ppm. FTIR analysis results obtained extracts using groups of compounds that are generally contained in catechin compounds of phenols, aromatic, and ether. Antiplatelet aggregation effect of Tanjung leaves extract then measured using bleeding time on DDY strain mice. Extracts is administered orally for 8 days, with bleeding time measurements made on the first day and the ninth day. The antiplatelet activity groups test was negative control group, positive control group (0.033 mg clopidogrel/30 gram weight of mice), and three dose groups; TE1 (0.0198 mg/30 g mouse weight), TE2 (0.0396 mg/30 gram weight of mice), and TE3 (0.0793 mg/30 g mouse weight). Tests conducted by wounding mice to see that the bleeding time of mice before and after administration of the extract. After getting an increase in bleeding time, data were analyzed with SPP V.16 application for analysis of variance test (ANOVA) followed by LSD test. The result of the increase in bleeding time suggests that TE3 dose group with a dose of 0.0793 mg/30 gram weight of the mice gave bleeding time of 132.77 + 32.52% which is comparable to the positive control group amounted to 110.45 + 13.66%., Consumption of anti platelet aggregation (antiplatelet) drugs such as clopidogrel which is used to lower platelet aggregation can be used to prevent thrombosis. However, the consumption of synthetic antiplatelet drugs frequently give side effects to the body. Tanjung (Mimusops elengi L.) leaves can be used as a natural and inexpensive source of antiplatelet compounds that contain catechins. Extraction of catechin compounds from Tanjung’s leaves using reflux system and water as its solvent with five variations of the time (15 minutes, 30 minutes, 45 minutes, 60 minutes, 75 minutes) showed that the extraction time of 75 minutes produces the highest catechin content, which amounted to 452.39 ppm. FTIR analysis results obtained extracts using groups of compounds that are generally contained in catechin compounds of phenols, aromatic, and ether. Antiplatelet aggregation effect of Tanjung leaves extract then measured using bleeding time on DDY strain mice. Extracts is administered orally for 8 days, with bleeding time measurements made on the first day and the ninth day. The antiplatelet activity groups test was negative control group, positive control group (0.033 mg clopidogrel/30 gram weight of mice), and three dose groups; TE1 (0.0198 mg/30 g mouse weight), TE2 (0.0396 mg/30 gram weight of mice), and TE3 (0.0793 mg/30 g mouse weight). Tests conducted by wounding mice to see that the bleeding time of mice before and after administration of the extract. After getting an increase in bleeding time, data were analyzed with SPP V.16 application for analysis of variance test (ANOVA) followed by LSD test. The result of the increase in bleeding time suggests that TE3 dose group with a dose of 0.0793 mg/30 gram weight of the mice gave bleeding time of 132.77 + 32.52% which is comparable to the positive control group amounted to 110.45 + 13.66%.]"