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"Asfiksia merupakan salah satu penyebab utama morbiditas dan mortalitas neonatus. Deteksi dini asfiksia penting untuk mencegah keluaran buruk jangka pendek. Analisis gas darah tali pusat merupakan metode objektif untuk menilai hipoksia-asidosis janin yang merupakan dasar patologi asfiksia. Penelitian ini terdiri atas dua tahap. Tahap pertama merupakan penelitian comparative cross-sectional untuk menilai hubungan pO2 vena, pCO2 arteri, ΔpO2 vena-arteri, ΔpCO2 arteri-vena tali pusat, dan fractional tissue oxygen extraction dengan keluaran sekunder, yaitu dengan skor Apgar <7 pada menit ke-5. Tahap kedua menggunakan desain nested case-control untuk menilai keluaran primer, yaitu keluaran buruk jangka pendek, meliputi perdarahan intraventrikular, ensefalopati hipoksik-iskemik, perawatan neonatal intensive care unit, serta kematian neonatal dini. Total subjek adalah 47 subjek. Tahap pertama penelitian hanya mendapatkan empat kasus sehingga tidak dapat dinilai hubungan dengan skor Apgar rendah menit ke-5. Tahap kedua penelitian mendapatkan 10 kasus dan 37 kontrol. Delta pO2 vena-arteri tali pusat lebih rendah bermakna (p=0,041), sedangkan fractional tissue oxygen extraction lebih rendah namun tidak bermakna (p=0,059) pada neonatus yang mengalami keluaran buruk jangka pendek dibanding tanpa keluaran buruk. Ketiga parameter lain tidak berhubungan dengan keluaran buruk jangka pendek. Titik potong optimal untuk memprediksi keluaran buruk jangka pendek neonatus adalah ≤3,35 mmHg (Sn=83,8%; Sp=60,0%) untuk ΔpO2 vena-arteri tali pusat dan ≤16,2% (Sn=81,1%; Sp=60,0%) untuk FTOE. Delta pO2 vena-arteri tali pusat (OR=7,75 (p=0,010; IK95% 1,66 – 36,01) maupun FTOE (OR=6,43; p=0,017; IK95% 1,42 – 29,08) prediktif terhadap keluaran buruk jangka pendek neonatus. Model prediksi dibuat menggunakan parameter FTOE.

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Asphyxia remains one of the most common cause of morbidity and mortality in neonates. Early detection is crucial to prevent asphyxia-related short-term adverse outcomes. Umbilical cord blood gas analysis provides objective measurement of fetal hypoxia and acidosis which define asphyxia. This study aimed to evaluate association of umbilical cord venous pO2, arterial pCO2, arterio-venous ΔpCO2, veno-arterial ΔpO2, and fetal fractional tissue oxygen extraction (FTOE) ratio with neonatal short-term adverse events, including intracranial hemorrhage, hypoxic-ischemic encephalopaty, admission to neonatal intensive care unit, and early neonatal death, as primary outcomes, and low 5-minute Apgar score as secondary outcomes. We used nested case-control design to evaluate primary outcomes and comparative cross-sectional design for the latter. A total of 47 subjects were recruited. Low 5-minute Apgar scores were found in four subjects, which did not fulfill the minimum sample size requirement for analysis. Short-term adverse outcomes were found in 10 cases. Delta pO2 was significantly lower (p=0,041), while FTOE was lower albeit not statistically significant (p=0,059) in case compared to control group. The other three parameters failed to show any significant associations. Optimal cutoff value for pO2 was ≤3,35 mmHg with 83,8% sensitivity dan 60,0% specificity, and ≤16,2% for FTOE (Sn=81,1%; Sp=60,0%). Either umbilical veno-arterial ΔpO2 (OR=7,75; p=0,010; 95%CI 1,66 – 36,01) or FTOE (OR=6,43; p=0,017; IK95% 1,42 – 29,08) was predictive for neonatal short-term adverse outcomes. A prediction model was developed for FTOE."

"Infeksi Clostridium difficile toksigenik meningkat tajam pada satu dekade terakhir, menyebabkan pseudo membran colitis (PMC) dan Clostridium difficile associated diarrhea (CDAD). Salah satu faktor risikonya adalah penggunaan antibiotik. Tujuan penelitian adalah mengetahui prevalensi dan gambaran karakteristik subyek dengan Clostridium difficile toksigenik serta menilai kemampuan rapid test toksin terhadap real time PCR. Subyek penelitian prospektif ini adalah 90 subyek dewasa dengan terapi antibiotik lebih dari 2 minggu. Hasil pemeriksaan menggunakan rapid test dan real time PCR disajikan dalam tabel 2x2, dilakukan uji statistik dengan chi square. Hasil penelitian menunjukkan 2 spesimen dieksklusi karena hasil invalid, 24 spesimen positif dan 64 negatif dengan rapid test toksin; 33 spesimen positif dan 55 negatif dengan real time PCR. Prevalensi Clostridium difficile toksigenik berdasar rapid test toksin adalah 27,3% dan real time PCR 37,5%. Terdapat perbedaan bermakna antara konsistensi feses dan jumlah antibiotik dengan terdeteksinya Clostridium difficile toksigenik (p<0,05). Terdapat hubungan antara lama terapi antibiotik dengan terdeteksinya Clostridium difficile toksigenik menggunakan real time PCR (p=0,010, RR=2,116). Sensitivitas, spesifisitas, nilai duga positif, nilai duga negatif, rasio kemungkinan positif dan rasio kemungkinan negatif rapid test toksin terhadap real time PCR berturut-turut adalah 69,7%; 98,2%; 95,8%; 84,4%; 39,2 dan 0,31. Dari hasil penelitian disimpulkan bahwa prevalensi Clostridium difficile di RSCM lebih tinggi dibanding Malaysia, Thailand dan India; subyek dengan terapi antibiotik lebih dari 4 minggu berisiko terdeteksi Clostridium difficile toksigenik 2 kali lebih besar dibanding subyek dengan terapi antibiotik kurang dari 4 minggu; rapid test toksin dapat digunakan sebagai alat deteksi Clostridium difficile toksigenik.

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Toxigenic Clostridium difficile infection have increased sharply in the last decade, causing a pseudo membrane colitis (PMC) and Clostridium difficile associated diarrhea (CDAD). One of the biggest risk factor is the use of antibiotics. The purpose of the study was to determine the prevalence and characteristics of subjects with toxigenic Clostridium difficile and assess the ability of the toxin rapid test compared to real-time PCR. Ninety adult subjects with antibiotic therapy more than 2 weeks were enrolled to this prospective study. The results of toxin rapid test and real-time PCR were presented in 2x2 table, statistical tests was calculated with chi square. Two specimens were excluded due to invalid results. The results showed 24 positive and 64 negative specimens by toxin rapid test; 33 positive and 55 negative specimens by real-time PCR. The prevalence of toxigenic Clostridium difficile based on toxin rapid test were 27.3% and 37.5% by real-time PCR. There were significant differences between stool consistency and number of antibiotics that were used with the detection of toxigenic Clostridium difficile. There was a relationship between duration of antibiotic therapy with detection of toxigenic Clostridium difficile using real-time PCR (p = 0.010, RR = 2.116). Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of toxin rapid test against real-time PCR were 69.7%; 98.2%; 95.8%; 84.4%; 39.2 and 0.31, respectively. The study concluded that the prevalence of Clostridium difficile in RSCM was higher than Malaysia, Thailand and India; subjects with antibiotic therapy for more than 4 weeks had double risk to have toxigenic Clostridium difficile than subjects with antibiotic therapy for less than 4 weeks and toxin rapid test could be used as a tool to detect toxigenic Clostridium difficile."

"ABSTRAKSifilis adalah penyakit menular seksual kronik yang memiliki manifestasi klinis yang bervariasi dan menetap untuk waktu yang lama. Neurosifilis merupakan salah satu komplikasi sifilis sistemik dengan temuan di cairan serebrospinal dengan atau tanpa gejala yang jelas. Pemeriksaan yang saat ini tersedia dalam mendukung diagnosis hanya tersedia pemeriksaan analisis cairan serebrospinal dan serologi Treponema pallidum. Saat ini belum diketahui prevalensi neurosifilis di rumah sakit peneliti dan profil serologi Treponema pallidum dari bahan cairan serebrospinal. Penelitian ini merupakan penelitian potong lintang, dilakukan November 2017-Maret 2018 terhadap 50 cairan serebrospinal dan darah yang diperiksakan analisis cairan serebrospinal dengan keterangan klinis terduga infeksi intrakranial. Serum dan cairan serebrospinal diperiksakan RPR, TPHA, anti-Treponema pallidum ELISA IgG dan khusus cairan serebrospinal diperiksa pula rapid test Treponema pallidum. Uji statistik menggunakan chi quare and Fisher exact test.Dari penelitian terhadap 50 cairan serebrospinal dan serum didapatkan rapid test Treponema pallidum, RPR dan TPHA cairan serebrospinal reaktif 4(8%). Dari bahan serum didapatkan RPR reaktif 8(16%) dan TPHA reaktif 9(18%). Anti-Treponema pallidum ELISA IgG positif 4 sampel (8%). Dari 50 sampel didapatkan 7 (14%) neurosifilis, 4 confirmed neurosyphilis dan 3 probable neurosyphilis sesuai kriteria Center for Disease Control and Prevention. Profil analisis cairan serebrospinalnya tidak berwarna, jernih, tidak ada bekuan, hitung sel 12.71 ±9.20 sel/μl, dominasi mononuklear 11.57±9.47 sel/μl, Pandy positif, protein cairan 42.29±21.49 mg/dl, glukosa cairan 55±5.16 mg/dl, glukosa serum 101.04±20.10 mg/dl, dan klorida 122.14±2.48 mEq/L. Pemeriksaan RPR, TPHA, dan anti-Treponema pallidum ELISA IgG dengan bahan serum dan cairan serebrospinal memiliki hubungan bermakna. Dari penelitian ini didapatkan 14% sesuai dengan neurosifilis dari populasi penelitian dan didapatkan 85.71% dengan HIV reaktif. Pada pasien HIV disarankan RPR dan TPHA serum untuk pemeriksaan skrining sifilis.

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ABSTRACTSyphilis is a chronic sexually transmitted disease that has varying clinical manifestations and persist for a long time. Neurosyphilis is one of the complications of systemic syphilis with findings in cerebrospinal fluid with or without obvious symptoms. Examinations currently available for diagnostic support were cerebrospinal fluid analysis and serology of Treponema pallidum. There is currently no known prevalence of neurosyphilis in the research hospital and serologic profile of Treponema pallidum from cerebrospinal fluid. This study was a cross sectional study, conducted November 2017-March 2018 against 50 cerebrospinal fluid and blood samples that examined cerebrospinal fluid analysis with clinical information of suspected intracranial infection. Serum and cerebrospinal fluid examined by RPR, TPHA, anti-Treponema pallidum ELISA IgG and particulary rapid test Treponema pallidum for cerebrospinal fluid. Statistic tests were chi quare and Fisher exact test.From a total of 50 cerebrospinal fluid and serum, 4(8%) had reactive cerebrospinal fluid T. pallidum rapid tests, RPRs and TPHAs. From serum there were 8(16%) reactive RPRs and 9(18%) reactive TPHAs. Anti-Treponema pallidum ELISA IgG was positif 4 samples (8%). Among the 50 samples, 7 (14%) had neurosyphilis, 4 were confirmed neurosyphilis and 3 were probable neurosyphilis according to Center for Disease Control and Prevention criteria. The cerebrospinal fluid analysis profile is colorless, clear, without clot, cell count 12.71±9.20 cells/μl, mononuclear 11.57±9.47 cells/μl, positive for Pandy, cerebrospinal fluid protein 42.29±21.49 mg/dl, glucose 55±5.16 mg/dl, serum glucose 101.04±20.10 mg/dl, and chloride 122.14±2.48 mEq/L. Rapid Plasma Reagin, TPHA, and anti-Treponema pallidum ELISA IgG were associated between serum specimen and cerebrospinal fuid. Neurosyphilis was found in 14% of our patient population and 85.71% was reactive for HIV. Rapid Plasma Reagin and TPHA in sera were recommended for syphilis screening for HIV patient."

"Penyakit autoimun adalah sindroma ldinik yang disebabkan oleh respon autoimun akibat aktivasi dari sel T maupun sel B atau keduanya terhadap antigen selfl). Penyakit ini merupakan kelainan yang cukup sering ditemukan di ldinik, dapat bersifat ringan maupun berat, terjadi akibat gangguan keseimbangan kerja sistem imun. 1 Penyebab penyakit dan patogenesisnya belum jelas. Gejala dan keparahan dari penyakit autoimun berbeda beda pad a tiap p~ien. Pemeriksaan laboratorium ANA mempunyai tingkat sensitivitas ' dan spesifisitas yang berbeda beda pada tiap penyakit autoimun; pada penyakit LES yang paling sensitif (:::; 95%). Pol a ANA yang ditemukan pada pasien penyakit autoimun dapat berupa speckled, homogen, nuldeoli, perifer, sentromer dan sitoplasma. ' Tujuan penelitian ini adalah mendapatkan data tentang profil ANA pada pasien autoimun yang berobat ke polildinik Alergi dan Imunologi, departemen Ilmu Penyakit Dalam, Rumah Sakit Cipto Mangunkusumo. Penelitian ini berguna untuk memberikan informasi kepada ldinisi tentang pola dominan yang ditemukan pada penyakit autoimun tertentu dan membantu memperkirakan penyakitnya. Subjek diambil dari pasien dewasa (usia> 15 tahun) rawat jalan yang berobat di polildinik Alergi Imunologi (Juni 2010-Agustus 2010) dan menggunakan penelitian deskriptif. Pasien dengan stadium pengobatan stadium pengobatan : maintenance 21(52,5%), tappering offl2 (30%), dan induk~i 7 pasien (17,5%). Pemeriksaan ANA dilakukan pada 40 sampel dan 10 subjek sehat. Subjek penelitian terdiri dari 38 wanita (95%) dan 2 pria (5%) sedangkan subjek sehat terdiri dari 8 wanita (80%) dim 2 pria (20%). Usia median untuk subjek adalah 20-29 tahun sedangkan subjek sehat median umur 30-39 tahun. Kami mendapatkan 6 kontrol denga.'1 hasil negatif dan 4 hasil positif pola speckled halus dengan titer rendah 11100. Pada subjek penelitian didapatkan diagnosis LES 38 pasien (95%) dan 2 slderoderma (5%). Pada pasein LES, didapatkan hasil ANA positif 33 (87%) dan negatif 5 (13%). Pada kedua pasien slderoderma, pemeriksaan ANA nya positif. Pada pasien LES 'dengan ANA positif, karni menemukan pola speckled 26 (65%), terdiri dari speckled kasar 23 (57,5%) dan speckled halus 3 (7,5%), nuldeolar 4 (10%), homogen 2 (5%), dan anti sitoplasma antibodi 1 (2,5%). Modus titer ANA sebelum pengobatan 1110.000 dan setelah pengobatan 11100.

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Autoimmune disease is an inflammatory ,disorder charactherized by autoantibodies among others to nuclear antigen.Severity and symptoms of autoimmune disease differ in each' patient. 'A laboratory test of antinuclear antibo4y (ANA) is different in every autoimmune dis~e; but in SLE, is the most sensitivetest,(:::: 95%). Patterris of ANA were' found in ~utoimmune disease , patients 'are speckled, homogen, nucleoli, peripheral, centrQmere and cytoplasmic pattern. The aim of this study was to found the pattern of ANA iIi patients that 'di~gno~d as 'autoimmune disease in Allergy and Immunology clinic, department" of internal medicine, Cipto Mangunkusumo Hospital. The value of this study was to give infonnation to clinician the most frequent pattern of ANA founded in autoimmune patient and to estimate type of autoimmune disease. ' Subjects were taken in out patient in' Allergy Immunology clinic (June 2010 - Augustus 201 0) in adult autoimmune pa~ents (age:> 15 years). , ' ANA test was applied to 40 autoiininune subjects, and 10 healthy subjects. Thirty eight of subjects were wom~ (95%) and 2 of them were men (5%). The median age is 20-29 years old. (45%). Healthy 'subjects are 8 women and 2 men and median age is 30-40 years old. We found 6 healthy subjects were negative ANA test and 4 were positive fine speckled pattern and titer were low 11100. We found SLE 38 patient (95%) 'and 2 Schlerodenna (5%). From 38 SLE patient ,positive of ANA test '33 (87%) and 5 negative of ANA test (13%), and from 2 schlerodenna 100%' ANA test positive. From positive ANA test of SLE we found 26 speckled pattern (65%), devide in coarse speckled 23 (57,5%) and fine speckled 3 (7,5%),4 nucleolar (10%), 2 homogen pattern (5%), and antlcytoplasmic antib<;>dy pattern 1 (2,5%). In this study founded that the most ANA pattern and spesific for SLE patients in department internal medicine, Cipto Manglmkusumumo Hospital was speckled pattern. The stage of therapy are maintenance ' 21 ' (52,5.%), "tapering off stag~12(30%)and induction stage 7 (17,'5%) is maintenance stage and 7 patient (17,5%) in tapering off stage. , " ' Modus titer ANA Defore therapy ,1/1 0.000 and after therapy 11100."