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"ABSTRACTKesulitan dalam penegakan diagnosis definitif efusi pleura tuberkulosis berdasarkan metode konvensional ataupun biopsi menyebabkan berbagai usaha untuk mencari alternatif strategi diagnostik lainnya. Kriteria diagnostik yang direkomendasikan adalah apabila pasien terdapat gejala klinik tuberkulosis dan pemeriksaan cairan pleura menunjukkan eksudat berdasarkan kriteria Light, aktivitas adenosin deaminase (ADA) > 40 U/l, dan rasio limfosit/neutrofil > 0.75, maka diagnosis efusi pleura tuberkulosis boleh ditegakkan yang dibuktikan dengan respon terapi. Tujuan penelitian ini adalah mendapatkan nilai diagnostik real time polymerase chain reaction (RT PCR) pada efusi pleura tersangka tuberkulosis yang memenuhi kriteria diagnostik. Penelitian uji diagnostik prospektif menggunakan 43 sampel cairan pleura dari tersangka tuberkulosis yang dipilih secara konsekutif. Diagnosis efusi pleura tuberkulosis ditegakkan berdasarkan respon terapi positif atau kultur positif. Kultur cairan pleura menggunakan media Lowenstein-Jensen. RT PCR dikerjakan menggunakan primer yang dapat mengenali gen IS6110 dan gen MPB64.Dari 43 sampel tersebut, Mycobacterium tuberculosis dapat dideteksi oleh RT PCR pada 7 sampel, 4 diantaranya dengan kultur positif. Dengan demikian, sensitivitas RT PCR adalah 16.3% yang lebih tinggi daripada sensitivitas berdasarkan kultur saja yaitu 9.3%. Nilai duga positif dan nilai duga negatif RT PCR berturut-turut adalah 100% dan 0%. Spesifisitas, rasio kemungkinan positif, dan rasio kemungkinan negatif RT PCR tidak dapat dinilai karena semua subyek penelitian memiliki respon terapi positif atau kultur positif. RT PCR memiliki keunggulan yaitu dapat digunakan untuk menegakkan diagnosis definitif efusi pleura tuberkulosis lebih sensitif dan cepat dibandingkan kultur. Dengan demikian, penelitian ini mendapatkan bahwa pada pasien yang memenuhi kriteria diagnosis efusi pleura TB, maka RT PCR merupakan pilihan metode untuk identifikasi infeksi Mycobacterium tuberculosis secara definitif, karena sensitivitas yang rendah maka tidak dapat digunakan sendiri (tunggal).

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ABSTRACTThe difficulty to confirm the definitive diagnosis of tuberculous pleural effusion (TBPE) based on conventional laboratory methods and pleural biopsy have lead to the searching of alternative diagnostic strategies. The recommended diagnostic criteria approach for TBPE diagnosis are if a patient has clinical feature of tuberculosis (TB) and the pleural fluid analysis showed exudate based on Light criteria, the adenosine deaminase (ADA) activity > 40 U/l, and lymphocyte/neutrophil ratio > 0.75, then the diagnosis of TBPE is actually established. The aim of this study is to investigate the diagnostic value of RT PCR on suspected TBPE that fullfiled the recommended diagnostic criteria. The diagnostic study with prospective design assessed 43 pleural fluid samples of suspected TBPE that were selected consecutively. The diagnosis of TBPE was confirmed based on positive response therapy or positive culture of the pleural fluid. Pleural fluid culture was performed using Lowenstein-Jensen medium. Real time polymerase chain reaction (RT PCR) was carried out using the primer that detect IS6110 and MPB64 gene.Among 43 samples of suspected TBPE, Mycobacterium tuberculosis could be detected by RT PCR in 7 samples with 4 of them had positive culture. The sensitivity of RT PCR therefore was 16.3%, it was higher than the sensitivity based on culture only which was 9.3%. Positive predictive value and negative predictive value of RT PCR were 100% and 0%, respectively. The specificity, positive likelihood ratio, and negative likelihood ratio of RT PCR could not be defined because all subjects had positive response therapy or positive culture. RT PCR has an advantage that it can be used to establish definitive diagnosis of TB earlier compared to culture. Therefore, when the patient fulfilled the recommended criteria of tuberculous pleural effusion, RT PCR is the method of choice for definitive identification of Mycobacterium tuberculosis infection. However, due to the low sensitivity, it can not be used alone."

"Latar belakang: Sepsis neonatorum awitan lambat SNAL , merupakan penyebab morbiditas dan mortalitas terpenting bayi berat lahir rendah di rumah sakit. Klinisnya tidak spesifik sehingga membutuhkan pemeriksaan penunjang untuk mendiagnosisnya. Baku emas kultur darah memiliki nilai diagnostik yang rendah dan hingga kini belum ada penanda infeksi tunggal yang dapat mendiagnosis sepsis neonatorum. Toll-like receptor TLR berperan dalam mengenali patogen dan memulai respon imun. Ekspresi TLR2 dan TLR4 diharapkan dapat menjadi penanda sepsis neonatorum. Tujuan: Mengetahui ekspresi TLR2 dan TLR4 neutrofil dan monosit serta nilai diagnostiknya pada SNAL. Metode: Studi potong lintang pada Mei-Juni 2017 yang melibatkan 52 neonatus >72 jam dengan klinis sepsis. Pemeriksaan darah perifer lengkap, rasio I/T, CRP, PCT, TLR2 dan TLR4 menggunakan flow cytometry dilakukan dan dibandingkan dengan kultur darah. Hasil: Insidens SNAL penelitian ini sebesar 32,6 . Terdapat penurunan ekspresi TLR2 neutrofil maupun monosit pada kasus SNAL. Peningkatan ekspresi TLR4 neutrofil memiliki sensitivitas 88,2 , spesifisitas 20 , dan AUC 0,541. Ekspresi TLR4 monosit memiliki sensitivitas 92,1 , spesifisitas 11,4 , dan AUC 0,528 jika dibandingkan kultur darah. Nilai AUC CRP meningkat hingga lebih dari 0,75 setelah dikombinasikan dengan TLR4. Simpulan: Pada SNAL, ekspresi TLR4 memiliki sensitivitas yang baik namun kurang spesifik. Pemeriksaan TLR4 dapat menunjang nilai diagnostik CRP.

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Background Late onset neonatal sepsis LONS , is the major morbidity and mortality in low birth weight. Unspecific clinical manifestation make laboratory examination is needed to establish the diagnosis. Unfortunately, blood culture as a gold standard has low diagnostic value. While, there is no single infection marker to diagnose neonatal sepsis. TLRs are a sensor to recognize the pathogens and trigger the immune response. Expression of TLR2 and TLR4 are promising to be a septic marker. Aim To know the expression of TLR2 and TLR4 neutrophil and monocyte and their diagnostic value in LONS. Methods A cross sectional study was conducted from May June 2017 which involved 52 neonates 72 hours with clinically sepsis. Complete blood count, I T ratio, CRP, PCT, TLR2 and TLR4 by flow cytometry already done and compared to blood culture. Result The incidence of LONS is 32.6 . There is TLR2 down expression in LONS. Expression of TLR4 neutrophil has sensitivity 88.2 , specificity 20 , and AUC 0.541. While TLR4 monocyte has sensitivity 92.1 , specificity 11.4 , and AUC 0.528. AUC of CRP is increased over to 0.75 after combined with TLR4. Conclusion Expression of TLR4 have good sensitivity but less specific. TLR4 expression could increase the diagnostic value of CRP."

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Latarbelakang: Demam neutropenia merupakan komplikasi tersering pada terapi anak dengan keganasan. Terapi antibiotik empiris diketahui dapat menurunkan angka morbiditas dan mortalitas. Namun demikian, dilaporkan peningkatan kejadian resistensi terhadap seftazidim.  Sefepim menurunkan demam lebih cepat dan mempersingkat lama perawatan dibandingkan seftazidim sehingga pada beberapa negara dilaporkan sebagai antibiotik monoterapi lini pertama. Penelitian ini bertujuan untuk membandingkan efektivitas pemberian seftazidim dan sefepim dalam hal lama penurunan demam dan kenaikan jumlah neutrofil absolut yang diamati selama 72 jam pertama setelah pemberian terapi empiris pada demam neutropenia anak dengan leukemia akut, serta bertujuan untuk mengetahui pola kuman dan sensitivitas antibiotik.

Metode: Uji acak terkontrol membandingkan efektivitas pemberian sefepim dan seftazidim. Pasien secara acak dibagi ke dalam dua kelompok intervensi, seftazidim dan sefepim, pada setiap kelompok terdiri atas 36 pasien. Dilakukan pemberian terapi dan hasil dicatat setelah pengamatan selama 72 jam.

Hasil: Penurunan demam didapatkan pada 28 anak (77.8%) dengan terapi seftazidim dan 33 anak (91.7%) dengan terapi sefepim. Tidak terdapat perbedaan bermakna antara kedua kelompok dalam hal lama penurunan demam (p=0.101). Pada kelompok seftazidim, median lama penurunan demam adalah 32 jam (8-171 jam), sedangkan pada kelompok sefepim adalah 24 jam (6-75 jam). Kenaikan jumlah neutrofil absolut didapatkan pada 1 anak (2.8%) dengan terapi seftazidim dan 10 anak (27.8%) dengan terapi sefepim dengan jumlah neutrofil absolut ≥ 1000 sel/mm³ setelah 72 jam pertama pemberian terapi. Terdapat perbedaan bermakna antara kedua kelompok (p=0.003). Median kenaikan jumlah neutrofil absolut pada 72 jam pertama kelompok seftazidim adalah 315 (0-1887) sel/mm³, sedangkan pada kelompok sefepim adalah 432 (0-4266) sel/mm³. Tidak terdapat perbedaan bermakna antara kedua kelompok (p=0.235). Pada hasil kultur darah didapatkan biakan terbanyak adalah bakteri Gram negatif, ditemukan pada 8 subyek (72%) dari kedua kelompok yaitu bakteri Escherichia coli, Klebsiella pneumoniae dan Salmonella sp. Hasil uji sensitivitas isolat bakteri Gram negatif dari biakan darah, antibiotik sefepim mempunyai persentase terbesar, yaitu 75% dari bakteri yang tumbuh pada biakan, sedangkan seftazidim 38%.

Kesimpulan: Sefepim lebih baik dibandingkan seftazidim dalam penurunan suhu dan kenaikan jumlah neutrofil absolut lebih pada 72 jam walaupun secara statistika tidak berbeda bermakna

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Introduction: Neutropenic fever is the most frequent complication during cancer therapy in children. Empirical antibiotic therapy has been known to reduce the mortality and morbidity rate. However, resistance against ceftazidime has been reported. Cefepime reduces fever and shorten the length of hospitalization better than ceftazidime that several countries have reported using it as the first-line antibiotic therapy. This study is aimed to compare the effectivity of ceftazidime and cefepime to reduce fever and to increase the absolute neutrophils count in the first 72 hours.

Method: A randomized controlled trial to compare cefepime and ceftazidime. Patients were randomly divided into two intervention groups, ceftazidime and cefepime, each group consist of 36 patients. Patients were treated, the results were noted after 72 hours.

Results: Fever was reduced in 28 children (77.8%) treated with ceftazidime and 33 children (91.7%) treated with cefepime. No significant difference was found between the two groups regarding the amount of time it took for the fever to drop (p=0.101). For ceftazidime, fever was reduced in 32 hours (8-171 hours) on average, while it took cefepime 24 hours (6-75 hours) on average to reduce the fever. The increase of absolute neutrophils in the first 72 hours was found in 1 child (2.8%) treated with ceftazidime, while there were 10 children (27.8%) treated with cefepime whose absolute neutrophils increased ≥ 1000 cells/mm³ in the first 72 hours. A significant difference was found between the two groups (p=0.003). On average, the increase of absolute neutrophils in the first 72 hours for ceftazidime was 315 (0-1887) cells/mm³, while the average number for cefepime was 432 (0-4266) cells/mm³. No significant difference was found between the two groups (p=0.235). Blood culture revealed that the most common pathogen are gram-negative bacterias. Found in 8 subjects (72%) in the two groups were Escherichia coli, Klebsiella pneumoniae, and Salmonella sp. Sensitivity test for isolated gram-negative bacteria from the blood culture revealed that cefepime had the greatest sensitivity of 75% while ceftazidime had only 38%.

Conclusion: It was found that cefepime yielded better results compared to ceftazidime regarding fever reduction and absolute neutrophil increase in the first 72 hours, even if the results were not statistically significant.

 

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"Latar Belakang: Penelitian mengenai petanda inflamasi akut terkait pajanan uap las pada pekerja las sudah banyak dilakukan. Akan tetapi, tidak semua penelitian tersebut sepakat terjadi perbedaan jumlah petanda inflamasi akut sesudah terpajan uap las. Penelitian ini ingin mengetahui apakah terjadi perbedaan jumlah petanda inflamasi akut akibat pajanan uap las dengan sel netrofil mukosa hidung sebagai petanda inflamasinya.Metode:Pada penelitian longitudinal ini, 110 pekerja di sebuah perusahaan pembuat knalpot diperiksa jumlah sel netrofil mukosa hidungnya sebelum dan sesudah terpajan uap las serta diukur kadar logam Kromium, Besi, Mangan, dan Aluminium dalam darah pada 40 pekerja diantaranya. Dilakukan pengukuran kadar logam Cr, Fe, Mn, dan Al di lingkungan kerja untuk menilai kadar pajanan.Hasil:Pengukuran lingkungan menunjukkan kadar Kromium, Besi, Mangan, dan Aluminium udara berada di bawah Nilai Ambang Batas. Sel netrofil sediaan apus sebelum dan sesudah terpajan uap las 8 jam sama – sama berjumlah 2 sel/10 lpk (p = 0,233). Pada penelitian ini juga ditemukan kadar dalam darah logam Cr sebesar 1,03 µg/l; logam Fe sebesar 283.787,73 µg/l; logam Mn sebesar 14,96 µg/l; dan logam Al sebesar 25,68 µg/l.Kesimpulan:Tidak ditemukan perbedaan jumlah sel netrofil mukosa hidung yang bermakna secara statistik akibat pajanan uap las.

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Background and Objective: Many studies about acute inflammation marker regarding metal fume exposure have been conducted but not all agree that metal fume exposure will raise acute inflammation response. One of the acute inflammation markers is nasal mucous neutrophil and this study was conducted to investigate the difference of neutrophil count after being exposed to metal fume as acute inflammation response.

Methods: This study used a longitudinal design with 110 welders as subjects. Nasal mucous neutrophil data was collected before and after 8 hours metal fume exposure. Metal fume (i.e. Chromium, Iron, Manganese, and Aluminum) exposure in the work place was measured with AAS while blood metal level in 40 subjects among them was with ICP-MS.

Results: Chromium, Iron, Manganese, and Aluminum fume level in the work place was under Threshold Limit Value while Chromium, Iron, Manganese, and Aluminum blood level was 1,03 µg/l; 283.787,73 µg/l; 14,96 µg/l; and 25,68 µg/l respectively.Neutrophil count before and after 8 hours metal fume exposure didn’t show any difference with statistically significance (p = 0,233)

Conclusions: There was no statistical significant increase of nasal mucous neutrophil regarding metal fume exposure"

"Latar Belakang : Non-alcoholic fatty liver disease (NAFLD) adalah penyakit hati kronik yang ditandai dengan akumulasi lemak berlebihan di hati. Elastografi Transien (ET) dan metode Controlled Attenuation Parameter (CAP) merupakan metode pemeriksaan non-invasif untuk menilai derajat fibrosis dan steatosis, namun tidak tersedia di seluruh rumah sakit di Indonesia. Rasio Neutrofil Limfosit (RNL) merupakan penanda peradangan sederhana yang berpotensi memprediksi luaran penyakit. Tujuan : Mengetahui nilai diagnostik RNL sebagai indikator derajat keparahan steatosis dan fibrosis NAFLD. Metode : Penelitian ini adalah studi potong lintang menggunakan data sekunder dari data rekam medis tahun 2016-2018. Analisis statistik deskriptif dan analitik berupa uji korelasi, Receiver Operating Curve (ROC) dan Area Under The Curve (AUC) dipakai untuk mengetahui luaran studi. Hasil : Dari 106 subjek penelitian, kebanyakan pasien adalah perempuan (62,3%) berusia rata-rata 57,29 tahun dan menderita sindrom metabolik (77,4%). Sebagian besar pasien memiliki derajat steatosis sedang-berat (66%) dengan rerata ET 6,14 (2,8-18,2). Terdapat korelasi antara nilai CAP (r=0,648; p<0,001) dan ET (r=0,621; p<0,001) dengan RNL. Penggunaan RNL untuk menilai derajat steatosis sedang-berat memiliki titik potong 1,775 dengan sensitivitas, spesifisitas, NDP dan NDN sebesar 81,5%, 80,6%, 89,1%, dan 69,1%; titik potong 2,150 untuk menilai fibrosis signifikan dengan sensitivitas, spesifisitas, NDP dan NDN berurutan sebesar 92.3 %, 87.5%, 70.6%, dan 97.2%. Simpulan : RNL memiliki korelasi positif terhadap derajat steatosis dan fibrosis dengan sensitivitas dan spesifisitas yang tinggi.

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Introduction : Non-alcoholic fatty liver disease (NAFLD) is a chronic inflammatory disease with excessive fat accumulation in the liver. Transient Elastography (TE) with Controlled Attenuation Parameter (CAP) is a device and method to examine the degree of fibrosis and steatosis. However, this device is not widely available across Indonesia. Neutrophil and Lymphocyte Ratio (NLR) is a simple marker for inflammation which has a potency to predict disease outcome.

Objective : To know the diagnostic value of RNL as the indicator of steatosis and fibrosis severity.

Methods : This was a cross-sectional study using secondary data from the medical record, starting from 2016-2018 with the respective inclusion and exclusion criteria. A descriptive and analytic statistic, including correlation test, Receiver Operating Curve (ROC) and Area Under The Curve (AUC) were done to know the outcome of the study.

Result: Out of 106 subjects, 62.3% patients were women with aged mean 57.29 years old and 77.4% had metabolic syndrome. Most patients had average-severe steatosis degree (66%) with the mean of ET mean 6.14 (2.8-18.2). There was a positive correlation between CAP and TE compared with NLR with r = 0.647 (p<0.001) and r = 0.621 (p<0.001) respectively. The use of NLR to assess moderate-severe steatosis has a cutoff point of 1.775 with sensitivity, specificity, PPV and NPV of 81,5%, 80,6%, 89,1%, and 69,1%; cutoff point 2,150 to assess significant fibrosis with sensitivity, specificity, PPV and NPV of 92.3 %, 87.5%, 70.6%, 97.2% respectively.

Conclusion : NLR has a positive correlation with the degree of steatosis and fibrosis with high sensitivity and specificity."

"[ABSTRAKLatar belakang : Pada masa sekarang, reperfusi miokardium dengan trombolitikatau intervensi koroner perkutan primer ( IKPP) adalah terapi utama pada pasienyang mengalami IMA EST. Tujuan utama IKPP untuk mengembalikan patensiarteri epikardial yang mengalami infark dan mencapai reperfusi mikrovaskularsecepat mungkin. Namun keberhasilan mengembalikan patensi dari arteri koronerepikardial setelah oklusi tidak selalu menjamin cukupnya reperfusi ke levelmikrovaskular, yang disebut sebagai fenomena no reflow atau microvascularobstruction (MVO). Terdapat dua mekanisme yang berperan pada no reflowyaitu disfungsi mikrovaskular dan kerusakan intergritas mikrostruktur endotel.Kerusakan endotel dapat diakibatkan berbagai hal, diantara nya jejas reperfusiyang akan mengaktivasi netrofil. Netrofil teraktivasi akan mengeluarkan radikalbebas oksigen, enzim proteolitik dan mediator proinflamasi yang secara langsungmenyebabkan kerusakan jaringan dan endotel. Trimetazidine adalah obatantiangina yang dapat menurunkan netrofil yang dimediasi oleh trauma jaringansetelah jantung mengalami iskemia. Akan tetapi belum diketahui secara luaspengaruh pemberian trimetazidine terhadap akumulasi netrofil pada kejadian IMAEST yang dilakukan tindakan IKPP.Metode : Sebanyak 68 pasien IMA EST yang menjalani IKPP dipilih secarakonsekutif sejak Januari 2015 sampai Juni 2015 diambil saat masuk UGD,dilakukan pengambilan darah vena perifer untuk menghitung jumlah netrofilsebelum IKPP, kemudian pasien menjalani IKPP. Setelah 6 jam paska IKPPdilakukan pengambilan kembali darah vena perifer untuk menghitung kembalijumlah netrofil paska IKPP. Hitung netrofil diperiksa dengan Sysmex 2000i.Perhitungan statistik dinilai dengan SPSS 17.Hasil : Dari 68 subyek, dibagi menjadi 28 subyek pada kelompok yang diberikantrimetazidine dan 40 subyek yang diberikan plasebo. Tidak didapatkan perbedaanjumlah netrofil pada kelompok perlakuan dan kelompok kontrol baik sebelummaupun sesudah IKPP, netrofil pre IKPP pada trimetazidine vs plasebo 10.71 ±3.263 vs 10.99 ± 3.083,nilai p:0,341. Nilai netrofil post IKPP pada trimetazidinevs plasebo 9.49 ± 3.135 vs 9.92 ± 3.463,nilai p:0,664.Kesimpulan : Tidak terdapat penurunan jumlah netrofil pasca pemberiantrimetazidine pada pasien IMA EST yang menjalani IKPP.

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ABSTRACTBackgroundNowadays, reperfusion strategy, either with thrombolytic or Primary PercutaneousCoronary Intervention (PPCI), is the core treatment for Acute ST-SegmentElevation Myocardial Infarct (STEMI). The goal of PPCI is to restore the patencyof infarcted epicardial artery and establish microvascular reperfusion as soon aspossible so that necrotic myocardial area can be reduced. However, successfulrestoration of infarcted epicardial artery is not always followed by enoughreperfusion to the microvascular part. Trimetazidine is an antianginal drug, canreduce neutrophil which was mediated by tissue trauma during ischemic heartcondition. Trimetazidine is currently approved and widely known as antianginaldrug which affect metabolism. Unfortunately, its influence over neutrophilaccumulation in acute STEMI patients which undergo PPCI is not wellunderstood.MethodThere were 68 consecutive-selected acute STEMI patients which undergo PPCIsince January 2015 until Juni 2015. They were admitted in emergency department.Peripheral vein blood sampling was taken to measure neutrophil before PPCI wasperformed. Six hour after PPCI was conducted, another peripheral vein bloodsampling was taken for another neutrophil measurement. Neutrophil measurementwas performed with Sysmex 2000i. Statistical analysis was performed by usingSPSS 17.ResultAmong 68 patients, divided in two groups, trimetazidine 28 patients and plasebo40 patients. There were no differences amount of neutrophils in trimetazidine orplasebo group, before or after PPCI. Neutrophil pre PPCI in trimetazidine vsplasebo group 10.71 ± 3.263 vs 10.99 ± 3.083, p:0,341. Neutrophil post PPCI intrimetazidine vs plasebo group 9.49 ± 3.135 vs 9.92 ± 3.463, p:0,664.ConclusionThere were no reducing amount of neutrophils after trimetazidine was given inpatients STEMI which underwent PPCI., BackgroundNowadays, reperfusion strategy, either with thrombolytic or Primary PercutaneousCoronary Intervention (PPCI), is the core treatment for Acute ST-SegmentElevation Myocardial Infarct (STEMI). The goal of PPCI is to restore the patencyof infarcted epicardial artery and establish microvascular reperfusion as soon aspossible so that necrotic myocardial area can be reduced. However, successfulrestoration of infarcted epicardial artery is not always followed by enoughreperfusion to the microvascular part. Trimetazidine is an antianginal drug, canreduce neutrophil which was mediated by tissue trauma during ischemic heartcondition. Trimetazidine is currently approved and widely known as antianginaldrug which affect metabolism. Unfortunately, its influence over neutrophilaccumulation in acute STEMI patients which undergo PPCI is not wellunderstood.MethodThere were 68 consecutive-selected acute STEMI patients which undergo PPCIsince January 2015 until Juni 2015. They were admitted in emergency department.Peripheral vein blood sampling was taken to measure neutrophil before PPCI wasperformed. Six hour after PPCI was conducted, another peripheral vein bloodsampling was taken for another neutrophil measurement. Neutrophil measurementwas performed with Sysmex 2000i. Statistical analysis was performed by usingSPSS 17.ResultAmong 68 patients, divided in two groups, trimetazidine 28 patients and plasebo40 patients. There were no differences amount of neutrophils in trimetazidine orplasebo group, before or after PPCI. Neutrophil pre PPCI in trimetazidine vsplasebo group 10.71 ± 3.263 vs 10.99 ± 3.083, p:0,341. Neutrophil post PPCI intrimetazidine vs plasebo group 9.49 ± 3.135 vs 9.92 ± 3.463, p:0,664.ConclusionThere were no reducing amount of neutrophils after trimetazidine was given inpatients STEMI which underwent PPCI.]"

"Objective: The aim of this study was to evaluate chemotactic activity of neutrophil to S. mutans. Chemotaxix assay was performed in blind well chambers. Materials & methods: Hanks balanced salt solution (HBSS) containing 106 S. mutants, 108 S. mutans, 10-8 M fMLP, or HBSS alone were placed in the lower wells of the chamber and covered with polycarbonate membrane filter. Neutrophils suspension (2X105 cells) was then placed in the upper compartment. After incubation for 60 mins at 37°C in a humidified atmosphere with 5% CO2, the filters were removed and stained with Giemsa. Result: ANOVA revealed statistically significant differences among groups (p<0.05), indicating that S. mutans induced neutrophils chemotaxis. The number of neutrophils migration in response to 108 S. mutans and 106 S. mutans were significantly greater compared to fMLP (p<0.05). Conclusion: S. mutans may active human neutrophils, resulting in the chemotaxis of the neutrophils."

"Latar Belakang : Penyakit arteri perifer PAP ekstremitas bawah merupakan salah satu komplikasi makrovaskular DM tipe 2 yang memiliki angka morbiditas dan mortalitas yang tinggi. Proses inflamasi telah diketahui berperan dalam terjadinya PAP pada penyandang DM tipe 2. Rasio neutrofil limfosit atau neutrophil lymphocyte ratio NLR telah digunakan sebagai penanda inflamasi kronik. Sejauh penelusuran kepustakaan yang dilakukan, belum didapatkan studi yang meneliti hubungan antara NLR dengan kejadian PAP ekstremitas bawah pada penyandang DM tipe 2. Tujuan : Mengetahui hubungan antara NLR dengan kejadian PAP ekstremitas bawah pada penyandang DM tipe 2. Metodologi : Penelitian ini menggunakan desain potong lintang dengan subjek penyandang DM tipe 2 yang menjalani pemeriksaan ankle brachial index ABI di poliklinik divisi Metabolik Endokrin RSCM periode Oktober 2015 ndash; September 2016. Didapatkan 249 subjek penelitian yang memenuhi kriteria inklusi dan eksklusi. Dilakukan pengambilan data sekunder dari rekam medis mengenai data ABI, NLR, data demografik serta faktor perancu. Subjek dinyatakan menderita PAP ekstremitas bawah jika memiliki nilai ABI le; 0,9 dengan pemeriksaan probe Doppler. Data NLR kemudian dikategorikan berdasarkan median nilai NLR dan dicari hubungan nilai NLR dengan kejadian PAP ekstremitas bawah. Uji chi square digunakan untuk analisis bivariat dan regresi logistik digunakan untuk analisis multivariat. Hasil : Penyakit arteri perifer ekstremitas bawah ditemukan pada 36 subjek 14,5. Didapatkan nilai median NLR total sebesar 2,11. Nilai median NLR didapatkan lebih tinggi pada kelompok PAP daripada tanpa PAP 2,46 vs 2,04. Terdapat hubungan yang bermakna antara nilai NLR ge; 2,11 dengan kejadian PAP ekstremitas bawah pada penyandang DM tipe 2 PR 2,46, 95 IK 1,23 ndash; 4,87; p=0,007. Dengan menggunakan uji regresi logistik, diketahui bahwa hipertensi merupakan variabel perancu. Simpulan : Terdapat hubungan antara rasio neutrofil limfosit dengan kejadian penyakit arteri perifer ekstremitas bawah pada penyandang DM tipe 2.

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Background : Lower extremity peripheral artery disease PAD is one of diabetic macrovascular complication which has high rate of morbidity and mortality. Chronic inflammation has been known to have a role in the pathogenesis of PAD in diabetic patient. Recently, neutrophil lymphocyte ratio NLR has been used as a marker of chronic inflammation. To the best of our knowledge, there are no prior studies about the relationship between NLR and PAD in type 2 diabetic patients.

Aim : To determine the relationship between neutrophil lymphocyte ratio and lower extremity peripheral artery disease in type 2 diabetic patient.

Methods : This was a cross sectional study on 249 patients with type 2 diabetes mellitus who underwent ankle brachial index ABI examination at Metabolic and Endocrinology Divison in Cipto Mangunkusumo Hospital between October 2015 ndash September 2016. The data were retrospectively collected from medical record. Lower extremity peripheral artery disease was defined as having ABI value le 0,9 by probe Doppler. Neutrophil lymphocyte ratio were categorized based on the median value and the relationship with lower extremity PAD were determined. Chi square test was used for bivariate analysis and logistic regression was used for multivariate analysis against confounding variables.

Result : Lower extremity peripheral artery disease was found in 36 subject 14,5. Median of NLR was 2,11. The median value of NLR was found higher in subjects with lower extremity PAD than without PAD 2,46 vs 2,04. There was an association between NLR value ge 2,11 and lower extremity PAD in type 2 diabetic patient p 0,007 PR 2,46 and 95 CI 1,23 ndash 4,87. By using logistic regression, it was known that hypertension was the confounding variable.

Conclusion : There is a relationship between neutrophil lymphocyte ratio and lower extremity peripheral artery disease in type 2 diabetic patients."

"Demam neutropenia pasca kemoterapi adalah morbiditas yang masih tinggi pada anak dengan keganasan. Sejumlah faktor prognostik, pola kuman, penggunaan antibiotik dan antijamur dapat memengaruhi luaran namun penelitian di Indonesia masih terbatas. Penelitian ini bertujuan mengetahui pola kuman, sensitvitas antibiotik serta faktor yang berpengaruh terhadap mortalitas infeksi anak DN. Penelitian ini dilakukan secara kohort retrospektif serta studi desktriptif terhadap 180 pasien (252 episode demam) di RSCM periode 2015-2017. Riwayat medis, pola kuman, sensitivitas antibiotik didata serta faktor prognostik dianalisis menggunakan uji multivariat regresi logistik. Bakteri terbanyak adalah gram negatif 51,5% diikuti gram positif 47,1%%. Golongan jamur terbanyak adalah Candida sp.(82,5%) Sensitivitas antibiotik Klebsiella sp. terutama amikasin (85,71%), Pseudomonas aeruginosa terhadap seftazidim (75%), amikasin dan gentamisin (100%). Staphylococcus sp. terutama amoksiklav dan ampicsulbactam (76.92%). Hampir semua golongan jamur sensitif flukonoazole, ketokonazole, vorikonazole (80-100%). Faktir prognostik yang meningkatkan mortalitas adalah pemasangan vena sentral (RR 1,947; IK95% 1,114-3,402), gizi kurang (RR 1,176;IK95% 1,044-1,325), gizi buruk (RR 1,241;IK95% 0,975-1,579), serta keganasan hematologi (RR 0,87;IK95% 0,788-0,976).

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Fever post-chemotherapy neutropenia is still a high morbidity in children with malignancy. A number of prognostic factors, microorganisms, antibiotic and antifungal use can affect outcomes but research in Indonesia is still limited. This study aims to determine the pattern of germs, antibiotic sensitivity and factors that influence the mortality of FN child infections. This study was a retrospective cohort as well as a descriptive study of 180 patients (252 episodes of fever) in RSCM 2015-2017 period. Medical history, microorganisms, antibiotic sensitivity was recorded as well as prognostic factors were analyzed using multivariate logistic regression tests. The most common bacteria was gram negative 51.5% and gram positive 47.1 %%. In the fungus group, Candida sp. was most common (82.5%). Antibiotic sensitivity of Klebsiella sp. mainly amikasin (85.71%), Pseudomonas aeruginosa against seftazidim (75%), amikasin and gentamisin (100%). Staphylococcus sp. mainly amoksiklav and ampicsulbactam (76.92%). Almost all fungi groups was sensitive flukonoazole, ketoconazole, voriconazole (80-100%). Prognostic factors that increase mortality was central venous insertion (RR 1,947; 95%CI 1,114-3,402), wasted (RR 1,176; 95%CI 1,044-1,325), severe malnutrition (RR 1,241; 95%CI 0.975-1,579), and hematological malignancies (RR 0.87; 95%CI 0.788-0.976)."