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Abstrak :
ABSTRAK Latar Belakang : Diagnosis Inflammatory Bowel Disease (IBD) masih didasarkan pada pemeriksaan invasif (endoskopi dan histopatologi). Fecal calprotectin merupakan petanda inflamasi intestinal non invasif yang dapat digunakan untuk membedakan IBD dengan penyakit intestinal non inflamasi, namun studi-studi yang ada masih memberikan perbedaan nilai diagnostik dan hubungannya dengan derajat IBD. Tujuan : Membuktikan bahwa pemeriksaan fecal calprotectin memiliki nilai diagnostik yang tinggi untuk mendiagnosis IBD serta berhubungan dengan derajat IBD. Metode : Penelitian ini adalah studi potong lintang untuk melakukan uji diagnostik. Penelitian dilakukan di beberapa rumah sakit di Jakarta mulai bulan September 2014 sampai Februari 2015. Kurva ROC dibuat untuk mendapatkan nilai diagnostik fecal calprotectin dan uji Krusskal Wallis untuk menilai perbedaan kadar fecal calprotectin menurut derajat IBD. Hasil : Terdapat 71 pasien IBD berdasarkan pemeriksaan kolonoskopi diikutkan dalam penelitian. Dari pasien tersebut didapatkan sebanyak 57 pasien ditetapkan definite IBD berdasarkan pemeriksaan histopatologi. Kadar fecal calprotectin lebih tinggi bermakna pada pasien IBD dibanding yang bukan IBD (553,8 μg/g vs 76,95 μg/g, p < 0,001). Didapatkan nilai titik potong 179,3 μg/g dengan sensitivitas 96% (IK 95% 0,88-0,99), spesifisitas 93% (IK 95% 0,69-0,99) dan Area Under Curve (AUC) 99,5% (IK 95% 0,98-1,00). Didapatkan perbedaan bermakna kadar fecal calprotectin pada masing-masing derajat IBD (p < 0,001). Kesimpulan : Pemeriksaan fecal calprotectin memiliki nilai diagnostik yang tinggi untuk mendiagnosis IBD serta berhubungan dengan derajat IBD.

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ABSTRACT Background : Diagnosis of inflammatory bowel disease (IBD) is still based on invasive examination such as endoscopy and biopsy. Fecal calprotectin as a intestinal inflammation marker can used for diagnosis, but studies still had different diagnostic value and it?s correlation with grading of IBD. Objective : Proving that fecal calprotectin have a high diagnostic value for IBD and correlation with grading of IBD. Methods : A cross sectional study for diagnostic of IBD. This study was conducted at several Hospitals in Jakarta from September 2014 until February 2015. A curve of ROC to determined diagnostic value of fecal calprotectin and Krusskal Wallis analysis to assessed of different value of fecal calprotectin according grade of IBD were made. Results : Based on colonoscopy, 71 patient IBD were participated in this study. There were 57 patient diagnosis as definite IBD based on histopathology examination. Value of fecal calprotectin for IBD patient was higher than non IBD (553.8 μg/g vs 76.95 μg/g, p < 0,001). Value of fecal calprotectin was 179.3 μg/g as a new cutoff value with sensitivity 96% (CI 95% 0.88-0.99), specificity 93% (CI 95% 0.69-0.99) and Area Under Curve (AUC) 99.5% (CI 95% 0.98- 1.00) for diagnostic IBD. There was significant differences value of fecal calprotectin according every grade of IBD ( p < 0.001 ). Conclusion : Fecal calprotectin has a high diagnostic value for IBD and correlated with grading of IBD.

Abstrak :
Latar belakang: Terdapat peningkatan kebutuhan layanan paliatif, namun belum semua terjangkau. RSUPN Dr.Cipto Mangunkusumo mengidentifikasi kebutuhan paliatif dengan menggunakan perangkat penapisan, namun belum dilakukan penelitian untuk menilai performanya. Tujuan penelitian: Mengetahui performa perangkat penapisan paliatif dari RSUPN Dr.Cipto Mangunkusumo serta mengetahui titik potong yang optimal untuk perawatan paliatif. Metode: Desain penelitian ini potong lintang, dilakukan di RSUPN Dr.Cipto Mangunkusumo Juli 2019 - Oktober 2019. Pengambilan sampel dilakukan dengan cara consecutive sampling. Keandalan diukur dengan interclass correlation coefficient (ICC). Konsistensi internal dinilai dengan koefisien Cronbach-Alpha. Uji kesahihan kriteria dievaluasi dengan menggunakan uji Pearson. Hasil: Terkumpul 64 subjek, dan terbanyak kelompok usia 51-70 tahun (50%). Kanker merupakan penyakit dasar terbanyak (87,5%). Penyakit komorbid terbanyak adalah penyakit ginjal (17,1%). Sebaran skor paliatif terbanyak pada skor 6 (23,4%). Rata -rata skor adalah 7,51. Mortalitas pasien di RS sebesar 51,6%. Dari kurva sebaran skor paliatif didapatkan nilai AUC 0,687 dengan IK 95% (0,557-0,818). Titik potong optimal untuk menentukan batas konsultasi pada pasien paliatif didapatkan pada skor 8. Seluruh pasien merupakan pasien paliatif menurut pendapat ahli berdasarkan kriteriaWHO. Kesimpulan: Performa perangkat ini cukup baik untuk menilai pasien dalam kondisi terminal dan kompleks. Titik potong optimal pada penelitian ini adalah 8. Diperlukan penelitian lebih lanjut dengan proporsi data yang merata. ......Background: There was an increasing need for palliative services, but not all are affordable. Cipto Mangunkusumo Hospital identified the need for palliation by using a screening score, but no research has been done to assess the performance of this screening device. Objectives: To determine performance of the palliative patient screening tool questionnaire from Cipto Mangunkusumo Hospital to assess the need of palliative care and to know the optimal cut off point for palliative care. Methods: The study was cross sectional, and was conducted in Cipto Mangunkusumo Central General Hospital from July 2019-October 2019. Sampling was done by consecutive sampling. The reliability test was measured by the interclass correlation coefficient (ICC). Internal consistency was assessed by the Cronbach-Alpha coefficient. The criterion validity test was conducted by evaluated using the Pearson test. Results: The total samples collected were 64 samples. The age group was dominated by 51-70 years (50%). Cancer was the most basic disease found (87.5%). Most comorbid diseases were kidney disease (17.1%). The most palliative score distribution was seen at a score of 6 (23.4%). The mean score was 7.51. Patient mortality in the hospital was 33 patients (51.6%). From the palliative score distribution curve, it was found an AUC value of 0.687 with a CI 95% (0.557-0.818). Optimal cut off point was 8. All of patients were palliative according to expert opinion. Conclusion: This palliative screening tool was quite good for assessing palliative patients in terminal and complex conditions. The optimal cut off point in this study was 8. Further research is needed with an equally proportion samples.

Abstrak :
Hampir 50% kasus infertilitas disebabkan oleh faktor pria. Infertilitas pria dapat tidak terdeteksi dengan analisis sperma dan mempengaruhi keluaran Teknologi Reproduksi Berbantu. Penelitian ini bertujuan untuk mengembangkan metode pemeriksaan untuk meramalkan infertilitas pria. Dengan desain potong lintang dan consecutive sampling didapatkan 2 kelompok subjek, infertil (78 subjek) dan fertil (36 subjek). IFD sperma diperiksa menggunakan metode sperm chromatin dispersion (SCD) dengan kit Halosperm®. Didapatkan nilai median IFD sperma kelompok infertil lebih tinggi secara bermakna dibandingkan kelompok fertil. IFD sperma juga memiliki AUC yang paling tinggi dibandngkan ketiga komponen analisis sperma (konsentrasi, motilitas, dan morfologi). IFD sperma memiliki nilai diagnostik yang lebih tinggi dibandingkan analisis sperma dengan titik potong optimal 26,1% dengan sensitivitas 80,8%, spesifisitas 86,1%, NDP 92,6%, dan NDN 67,4%. ......Almost 50% of infertility are caused by male factors. Male infertility could not be detected by conventional sperm analysis and affect the outcome of Assissted Reproductive Technology. This study aim to develop a method to predict male infertility better. Using cross-sectional design and consecutive sampling, obtained two groups of subjects, infertile (78 subjects) and fertile (36 subjects). Sperm DNA fragmentation index (DFI) was examined using sperm chromatin dispersion (SCD) test by Halosperm® kit. Median value of sperm DFI on infertile group was significantly higher compared to fertile group. Sperm DFI also had the highest AUC compared to the three components of conventional sperm analysis (concentration, motility, and morphology). Sperm DFI had a higher diagnostic value than the sperm analysis with optimal cut-off-point of 26.1% with sensitivity of 80.8%, specificity of 86.1%, PPV of 92.6%, and NPV of 67.4%.

Abstrak :
Latar Belakang : Karsinoma Sel Hati (KSH) merupakan kanker dengan prognosis yang buruk dan Indonesia termasuk negara dengan prevalensi hepatitis B yang tinggi. Performa alfa fetoprotein (AFP) sebagai penanda tumor pada surveilans KSH terutama dipengaruhi oleh etiologi penyakit hati yang mendasari. Titik potong AFP untuk surveilans KSH di Indonesia tidak berdasarkan etiologi penyakit hati yang mendasari. Tujuan : Mengetahui titik potong terbaik pemeriksaan biomarker AFP untuk surveilans KSH dengan etiologi hepatitis B kronik. Metode : Penelitian mengambil data rekam medis Divisi Hepatobilier RSUPN Dr. Cipto Mangunkusumo periode tahun 2017-2023. Sebanyak 506 subjek hepatitis B kronik semua spekturm (hepatitis B tanpa sirosis, sirosis hati, dan KSH stadium awal BCLC 0 dan A) diambil secara total sampling dalam kurun waktu 26 Juli 2023 hingga 31 Agustus 2023. Penentuan nilai titik potong AFP dilakukan dengan metode receiver operating characteristics (ROC). Hasil : Untuk surveilans KSH dengan etiologi hepatitis B, analisis kurva ROC memberikan area under the curve (AUC) didapatkan 0.792 (IK 95%, 0.719-0.866), dan titik potong dengan index Youden tertinggi adalah 8.7 ng/ml, dengan nilai sensitivitas 58%, spesifisitas 94%, nilai duga positif (NDP) 56.14%, nilai duga negatif (NDN) 94.43%. Analisis kurva ROC dilanjutkan berdasarkan status sirosis pasien. Untuk menentukan titik potong yang membedakan KSH dengan sirosis hati dari sirosis hati saja, menghasilkan AUC 0.803 (IK 95%, 0.722-0.884) dengan titik potong yang didapatkan adalah 8.6 ng/ml, dengan sensitivitas, spesifisitas, NDP, NDN, dan RK + adalah 60.5%, 92.4%, 45,10%, 95,24%, dan 7,09 masing-masing. Untuk menentukan titik potong yang membedakan KSH tanpa sirosis hati dari hepatitis B kronik tanpa sirosis hati, menghasilkan AUC 0.777 (IK 95%, 0.631-0.923) dengan titik potong yang didapatkan adalah 6.6 ng/ml yang memberikan hasil sensitivitas, spesifisitas, NDP, NDN, dan RK positif adalah 63.16%, 98.35%, 85.71%, 94.44%, dan 38.21 masing-masing. Kesimpulan : Titik potong surveilans KSH dengan etiologi spesifik hepatitis B lebih rendah dibandingkan dengan nilai titik potong AFP surveilans KSH sebelumnya yang tidak spesifik etiologi. Nilai titik potong 8.7 ng/ml menghasilkan sensitivitas dan spesifisitas terbaik untuk titik potong surveilans KSH dengan etiologi hepatitis B. Pada pasien KSH non sirosis, titik potong surveilans AFP lebih rendah yakni 6.6 ng/ml. Hal ini perlu menjadi perhatian klinisi dalam surveilans kelompok pasien hepatitis B kronik tanpa sirosis. ......Background: Hepatocellular carcinoma (HCC) is a cancer with a poor prognosis. Indonesia is a country with a high prevalence of chronic hepatitis B infection. The performance of alpha fetoprotein (AFP) as a tumor marker in HCC surveillance is primarily influenced by the etiology of the underlying liver disease. The AFP cutoff value for HCC surveillance in Indonesia is not based on the etiology of the underlying liver disease. Objective: To determine the best cut-off value of AFP biomarker examination for HCC surveillance in chronic hepatitis B patients. Methods: The study took medical record data from the Hepatobiliary Division of RSUPN Dr. Cipto Mangunkusumo for the 2017-2023 period. A total of 506 chronic hepatitis B subjects of all spectrums (hepatitis B without cirrhosis, liver cirrhosis, and early stage HCC, BCLC 0 and A) were taken by total sampling in the period 26 July 2023 to 31 August 2023. Determination of the AFP cut-off value was carried out using the receiver operating characteristics (ROC) method. Results: For HCC surveillance caused by hepatitis B virus, ROC curve analysis gave an area under the curve (AUC) of 0.792 (95% CI, 0.719-0.866), and the cut-off value with the highest Youden index was 8.7 ng/ml, with a sensitivity value of 58%, specificity 94%, positive predictive value (PPV) 56.14%, negative predictive value (NPV) 94.43%. ROC curve analysis was then performed based on the patient's cirrhosis status. ROC curve analysis to determine the cut-off point that distinguishes HCC with liver cirrhosis from liver cirrhosis alone, resulted in an AUC of 0.803 (95% IK, 0.722-0.884) with a cut-off point 8.6 ng/ml, with sensitivity, specificity, PPV, NPV, and LR+ of 60.5%, 92.4%, 45.10%, 95.24%, and 7.09 respectively. ROC curve analysis to determine the cut-off point that distinguishes HCC without liver cirrhosis from chronic hepatitis B without liver cirrhosis resulted in an AUC of 0.777 (95% CI, 0.631-0.923) with a cut-off point 6.6 ng/ml which gave sensitivity, specificity, PPV, NPV, and LR positive results of 63.16%, 98.35%, 85.71%, 94.44%, and 38.21 respectively. Conclusion: The cut-off value of AFP in HCC surveillance on hepatitis B specific etiology is lower than the cut-off value of AFP in previous HCC surveillance which was not etiology specific. The cut-off value of 8.7 ng/ml produces the best sensitivity and specificity for the cut-off value for HCC surveillance with hepatitis B etiology. In non- cirrhotic HCC patients, the AFP surveillance cut-off point is lower than cirrhotic HCC patients (6.6 ng/ml). This needs to be of concern to clinicians in surveillance of groups of chronic hepatitis B patients without cirrhosis.

Abstrak :
Latar belakang: Pneumonia menjadi penyebab infeksi tersering yang meningkatkan mortalitas dan morbiditas pasien kanker paru. Serum procalcitonin (PCT) merupakan penanda hayati yang sering digunakan untuk mendiagnosis infeksi terutama pneumonia. Nilai titik potong kadar PCT untuk mendiagnosis pneumonia pada kanker paru sampai saat ini belum diketahui. Tujuan penelitian ini untuk mengetahui peran PCT dalam diagnosis pneumonia pada pasien kanker paru. Metode: Penelitian uji diagnostik dengan desain potong lintang terhadap pasien kanker paru dan terduga pneumonia di Instalasi Gawat Darurat dan ruang perawatan paru RSUP Persahabatan Jakarta bulan Agustus-Oktober 2018. Pneumonia ditegakkan berdasarkan panduan pneumonia yang dikeluarkan oleh Persatuan Dokter Paru Indonesia. Pemeriksaan PCT dilakukan untuk mengetahui perbedaan kadar PCT pada kanker paru dengan dan tanpa pneumonia serta dilakukan analisis untuk menentukan titik potong optimal kadar PCT untuk diagnosis pneumonia pada pasien kanker paru dengan menggunakan ROC. Hasil: Sebanyak 60 pasien kanker paru diikutsertakan. Pasien kanker paru dengan pneumonia sebanyak 31 orang (51,7%) dengan karakteristik laki-laki sebanyak 77,4% dan rerata usia 54,68±10,59 tahun, jenis kanker terbanyak adenokarsinoma (51,6%), stage IV (83,9%), skala tampilan 3 (45,2%), status gizi kurang (45,2%), dan bekas perokok (54,8%). Terdapat perbedaan bermakna median kadar PCT pasien kanker paru dengan pneumonia dibandingkan tanpa pneumonia [1,81 (0,08-200)μg/L berbanding 0,30 (0,05-3,67) μg/L;p<0,001]. Terdapat peningkatan kadar PCT pasien kanker paru dengan metastasis, komponen neuroendokrin, jumlah metastasis ≥ 2, metastasis hepar meskipun hasil ini tidak bermakna secara statistik. Serum PCT berperan lebih baik dibandingkan kadar leukosit dan hitung jenis neutrofil untuk membedakan antara pneumonia dan bukan pneumonia pada pasien kanker paru (p <0,001, p=0,297; p=0,290). Serum PCT memiliki akurasi yang baik dengan AUC 0,829 (IK 95% 0,722-0,935]. Titik potong optimal kadar PCT untuk mendiagnosis pneumonia pada pasien kanker paru adalah 0,65 μg/L dengan sensitivitas 77,4% dan spesifisitas 79,3%. Kesimpulan: Kadar PCT pada pasien kanker paru dengan pneumonia lebih tinggi dibandingkan tanpa pneumonia. Titik potong optimal kadar PCT untuk diagnosis pneumonia pada kanker paru adalah 0,65 μg/L.

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Background: Pneumonia accounts for higher morbidity and mortality than any other infections in lung cancer patients. Procalcitonin (PCT) is a clinical biomarker to diagnose infection including pneumonia. Cut off point to diagnose pneumonia in lung cancer patient still unclear. The study aims to determine the roleof PCT in diagnosing pneumonia in lung cancer patients. Methods: Diagnostic test with cross sectional design was conducted in lung cancer patients with suspected pneumonia admitted to emergency and pulmonary ward of Persahabatan Hospital Jakarta, Indonesia between August – October 2018. A diagnosis of pneumonia was complying to the guideline provided by the Indonesian Society of Respirology. Serum PCT level (sPCT) between lung cancer patients with and without pneumonia was measured followed by statistical analysis. The optimal sPCT cut off point to diagnose pneumonia in lung cancer was determined using ROC curve. Result: From sixty patients, lung cancer patients presented with pneumonia was found in 31 patients (51.7%) with mean age 54.68±10.59 yo, which 77.4% were males, 51.6% were adenocarcinomas, 83.9% were stage IV cases, 45.2% were patients with ECOG performance status of 3, 45.2% were underweight and 54.8% were ex-smokers. The sPCT were significantly higher in lung cancer with pneumonia compared to those without pneumonia [1.81 (0.08-200)μg/L vs 0.30 (0.05-3.67) μg/L; p<0.001]. The sPCT were higher in lung cancer accompanied with metastasis, neuroendocrine component, ≥2 metastatic sites and liver metastatic, although these results were not statistically significant. The sPCT showed a better performance in differentiating pneumonia in lung cancer compared to leucocyte count and absolute neutrophil count (p <0.001, p=0.297; p=0.290, respectively). The sPCT showed a good accuracy to diagnose pneumonia in lung cancer with AUC 0.829 (CI 95% 0.722-0.935). The optimal cut off point of sPCT to diagnose pneumonia in lung cancer was 0.65 μg/L with 77.4% sensitivity and 79,3% specificity. Conclusion: The sPCT was significantly higher in lung cancer with pneumonia than those without pneumonia. The optimal cut off point of sPCT to diagnose pneumonia in lung cancer was 0.65 μg/L.

Abstrak :
ABSTRAK
Latar Belakang: Robekan perineum derajat III dan IV pada persalinan pervaginam telah menarik perhatian yang cukup tinggi di kalangan praktisi medis. Faktor-faktor risiko yang dapat menyebabkan robekan tersebut perlu diketahui karena dapat menyebabkan inkontinensia alvi di kemudian hari dan menimbulkan keluhan-keluhan pada ibu Tujuan: Mengetahui insidensi terjadinya robekan perineum derajat III dan IV tahun 2013 di RSCM, titik potong berat lahir janin yang berisiko menyebabkan terjadinya robekan dan sistem skor untuk memprediksi terjadinya robekan tersebut. Metode: Penelitian observasional dengan menggunakan metode potong lintang dilakukan di IGD Obstetri dan Ginekologi RSUPN Dr.Cipto Mangunkusumo pada Januari–Desember 2013. Semua subyek bersalin per vaginam sesuai dengan kriteria inklusi dan eksklusi dimasukkan dalam penelitian sampai jumlah subyek minimal terpenuhi. Dengan metode ROC AUC ditetapkan titik potong berat lahir janin yang berisiko terjadinya OASIS. Semua faktor risiko dianalisis dengan analisis regresi logistik. Faktor-faktor yang berhubungan terhadap terjadinya OASIS akan dinilai probabilitasnya dengan menggunakan rumus p= 1/(1+e-y). Hasil: Dari 466 sampel penelitian, Subjek yang mengalami OASIS adalah 43 (9.2%) sampel. Dengan metode ROC AUC didapatkan titik potong berat lahir janin yang berisiko yaitu 2910 gram. Setelah analisis regresi logistik didapatkan 4 variabel sebagai faktor risiko robekan perineum derajat III-IV yaitu persalinan forcep (p<0.001;OR 0.043,IK 95% 0.015-0.123), persalinan vakum (p<0.001;OR 0.131, IK 95% 0.054-0.317), berat lahir janin >2910 gram (p=0.014; OR 0.35; IK 95% 0.157 -0.807) dan multiparitas (p<0.001;OR 6.388; IK 95% 2.57-15.84). Dengan menerapkan rumus probabilitas p= 1/(1+e-y) didapatkan persalinan dengan alat dan berat lahir janin >2910 gram meningkatkan probabilitas terjadinya OASIS., sedangkan multiparitas bersifat sebaliknya. Kesimpulan: Insidensi OASIS perlu diketahui tiap tahunnya untuk menjadi tolak ukur tata laksana yang telah dilakukan. Titik potong berat lahir janin >2910 gram dapat menjadi nilai ukur baru pada penelitian-penelitian selanjutnya karena lebih mewakili subjek orang Indonesia. Sistem skor probabilitas yang sederhana ini dapat membantu klinisi dalam memprediksi terjadinya OASIS pada saat proses persalinan sehingga diharapkan dapat mengurangi insidensinya di masa mendatang.

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ABSTRACT
Background: Obstetrical Anal Sphincter Injuries (OASIS) during vaginal deliveries have been highly concerned in daily practices. Risk factors that lead to OASIS must be identified. OASIS may eventually cause faecal incontinence in the future that can cause complaints among patients. Objectives: To identify the incidence of OASIS at Cipto Mangunkusumo Hospital in 2013, to determine cut off point of fetal birth weight that may lead to OASIS and to acquire the probability scoring system for risk factors causing OASIS. Methods: We conducted cross sectional observational research in delivery suite Cipto Mangunkusumo Hospital from Januari to December 2013. After inclusion and exclusion criteria screening, all subjects who underwent deliveries vaginally took part in the research. Receiver Operating Characteristic, Area Under The Curve (ROC) method was performed to determine fetal birth weight cut off point that may cause OASIS. Logistic regresion analysis was performed to analyze all the risk factors. Risk factors that significantly lead to OASIS were calculated and analyzed by equational probability formula p= 1/(1+e-y). Result: Among 466 research samples, we identified there were 43 (9.2%) subjects suffered from OASIS. ROC AUC method were applied to determine fetal birth weight cut off point that may lead to cause OASIS which resulted >2910 gram. As logistic regresion analysis performed, there were four risk factors that may cause OASIS. There were forceps delivery (p<0.001;OR 0.043,CI 95% 0.015-0.123), vacuum delivery (p<0.001;OR 0.131, CI 95% 0.054-0.317), fetal birth weight >2910 gram (p=0.014; OR 0.35; CI 95% 0.157-0.807) and multiparit y (p<0.001;OR 6.388; CI 95% 2.57-15.84). The equation probability formula p= 1/(1+e-y) was conducted. It resulted that assisted vaginal delivery and fetal birth weight >2910 gram increase the probability of OASIS incidence, while multiparity resulted conversely. Conclusion: OASIS incidence is crucial to be identified each year so that we can evaluate the treatment that has been conducted. Fetal birth weight cut off point of >2910 gram can be applied in the next researches in the future because it respresents more proportionally for Indonesian people. This simple probability scoring system can help clinicians to predict OASIS during delivery process so it may reduce the incidence.