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Abstrak :
Kelainan metabolisme besi dapat terjadi akibat gangguan sintesis heme dan globin. Gangguan sintesis heme dijumpai pada defisiensi besi, anemia penyakit menahun dan anemia sideroblastik. Gangguan sintesis rantai globin dikenal sebagai hemoglobinopati terdiri dari thalassemia dan hemoglobin varian. Defisiensi besi dibedakan menjadi defisiensi besi tahap I, ii, Ilia dan l1ib. Pada defisiensi besi tahap I dan 11 belum dijumpai anemia, sedangkan tahap III a dan b telah dijumpai anemia. Diagnosis kelainan metabolisme besi dilakukan dengan perneriksaan hematologi, status besi tubuh, analisis hemoglobin dan menemukan ringed sideroblast di sum-sum tulang. Pada kasus campuran thalassemia E3 heterozigot dengan anemia defisiensi besi, anaiisis hemoglobin dilakukan setelah perbaikan status besi tubuh untuk mencegah rendah palsu kadar Hb A2 dan F. Besi berperan panting di Susunan Saraf Pusat (SSP) diantaranya untuk mileinisasi saraf, neurotransmiter dan metabolisme katekolamin. Pada penelitian ini dari 150 subyek diperoleh proporsi kelainan metabolisme besi sebesar 94'%. Kelainan metabolisme besi yang diperoleh terdiri dari defisiensi besi tahap I, II, Isla dan IIIb, anemia penyakit menahun, thalassemia 8 heterozigot, kemungkinan thalassemia a 1 atau 2 gen delesi, penyakit Hb H, HPF thalassemia heterozigot ganda serta campuran kelainan tersebut. Kelainan metabolisme besi dibedakan menjadi kelainan metabolisme besi disertai anemia (80.14%) dan tanpa anemia (19.85%). Proporsi hemoglobinopati (39.71%) dan campuran hemoglobinopati dengan defisiensi besi (39%) merupakan kelainan metabolisme besi terbanyak dibandingkan defisiensi besi (19.85%). Pada penelitian ini diperoleh prestasi belajar buruk secara bermakna pada kasus defisiensi besi (p<0.05) dibandingkan dengan kasus bukan defisiensi besi, tErutama pada mata pelajaran matematika dan bahasa Indonesia. Oleh karena proporsi hemoglobinopati yang lebih tinggi dibandingkan defisiensi besi, disarankan untuk diadakan tindak lanjut oleh dinas kesehatan setempat untuk mencegah peningkatan kasus hemoglobinopati homozigot atau heterozigot ganda. Untuk kasus defisiensi besi dilakukan pemeriksaan lanjutan guna mencari penyebab.

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Iron metabolism disorder may caused by defects of heme or globin synthesis. Defect of heme synthesis includes iron deficiency, anemia of chronic disease and siderobistic anemia. Defect of giobin synthesis are called hemoglobinopathies. Hemoglobinopathies may include either thalassemias or hemoglobin variants. Iron deficiency is classified into stage I, stage II, stage ill a and Ilib. Anemia is found in iron deficiency stage llla and 111b_ Diagnosis of iron metabolism disorder were done by hematology examination, iron status, hemoglobin analysis and bone marrow ringed sideroblast. In thalassemia R heterozygote patients with Iron deficiency anemia before hemoglobin analysis, iron status must be corrected to prevent falsey low Hb A2 and F levels. In the central nervous system iron are utilized in myelinisation, neurotransmitter and catecolamine metabolism. In this study on 150 subjects, proportion of iron metabolism disorder was 94%. Iron metabolism disorder were classified into iron deficiency stage I, II, Illa and illb, anemia of chronic disease, thalassemia 13 heterozygote, suspected of thalassemia a 1 or 2 gene deletion and mixed case between iron metabolism disorder. iron metabolism disorder was divided into anemia (80.14%) and non anemia (19.85%). Hemoglobinopathies (39.71%), mixed case between hemoglobinopathies and iron deficiency (39%) comprises biggest proportion compared with iron deficiency (19.85%).This study also found that iron deficiency subjects had significantly worse academic achievement (p<0.05) compared with non iron deficiency subjects especially in math and. bahasa Indonesia. As the proportion of hemoglobinopathies was higher than iron deficiency, we suggest that the district heatlh department to take action to prevent the increase in the prevalence of homozygous or compound heterozygous hemoglobinopathies. For iron deficiency cases, further investigation is needed to find causes of iron deficiency.

Abstrak :
Karsinoma kandung kemih merupakan keganasan nomor empat terbanyak. Dampak beban ekonomi karsinoma kandung kemih cukup nyata, sehingga diperlukan deteksi dini keganasan kandung kemih untuk menurunkan beban ekonomi. Sistoskopi merupakan pemeriksaan baku emas untuk identifikasi karsinoma kandung kemih, tetapi pemeriksaan tersebut invasif dan menyebabkan ketidaknyamanan bagi pasien. Sitologi urin tidak invasif, tetapi hasilnya tidak bisa didapatkan dengan cepat dan terdapat ketergantungan interpretasi pemeriksa.Tujuan penelitian ini adalah untuk membandingkan nilai diagnosis dua penanda tumor, yaitu ELISA NMP-22, ELISA UBC urin, serta kombinasi keduanya pada pasien karsinoma kandung kemih. Penelitian uji diagnostik ini terdiri dari 25 orang pasien dengan indikasi sistoskopi dan trans ureteral resection bladder tumor (TUR-BT)/biopsi tumor. Pasien yang memenuhi kriteria masukan dan tolakan dilakukan pengambilan urin pasien kemudian dilakukan pemeriksaan ELISA NMP-22 dan ELISA UBC urin. Hasil pemeriksaan ELISA NMP-22 dan ELISA UBC urin akan dibandingkan dengan pemeriksaan sistoskopi disertai dengan hasil histopatologi.Permeriksaaan ELISA NMP-22 urin dengan cut-off 10 U/ml mempunyai sensitivitas 62,3% dan spesifisitas 83,3%, nilai prediksi positif 81,8% dan nilai prediksi negatif71,4%,likelihood ratio positif3,73 dan likelihood ratio negatif0,45. Jika kasus sistitis dieksklusi maka didapatkan sensitivitas adalah 69,2%, spesifisitas 75%, nilai prediksi positif 81,8%, nilai prediksi negatif 60%, likelihood ratio positif 2,76 , likelihood ratio negatif0,42. Pemeriksaan ELISA UBC dengan cut-off 12 ug/Lmempunyai sensitivitas 38,5% dan spesifisitas 91,7%, nilai prediksi positif 83,3% dan nilai prediksi negatif57,9%,likelihood ratio positif4,63 dan likelihood ratio negatif0,67. Jika kasus sistitis dieksklusi maka didapatkan sensitivitas adalah 38,5%, spesifisitas 87,5%, nilai prediksi positif 83,3%, nilai prediksi negatif 46,7%, likelihood ratio positif 3,08 , likelihood ratio negatif0,70. Kombinasi pemeriksaan ELISA NMP-22 dengan UBC urin mempunyai sensitivitas 76,9% dan spesifisitas 75%, nilai prediksi positif 76,9% dan nilai prediksi negatif75%,likelihood ratio positif3,08 dan likelihood ratio negatif0,31. Jika kasus sistitis dieksklusi maka didapatkan nilai sensitivitas adalah 78,5%, spesifisitas 71,4 %, nilai prediksi positif 84,6 %, nilai prediksi negatif 62,5%, likelihood ratio positif2,74 , likelihood ratio negatif0,30. Kami menyimpulkan kombinasi pemeriksaan ELISA NMP-22 dengan ELISA UBC urin lebih baik karena mempunyai sensitivitas paling tinggi sehingga adanya tumor di kandung kemih baik primer maupun rekuren tidak akan luput dari diagnosis, meskipun harus dipastikan lagi dengan pemeriksaan sistoskopi.

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Bladder cancer is the forth most common cancer. Bladder cancer posseses a significant economic burden so that early detection of baldder cancer may decrease the economic burden. Cystoscopy is the reference standard for identification of bladder carcinoma, but it is invasive andcauses significant discomfortto the patient. Urinary cytology is noninvasive but time consuming and hampered by inter-observer variations. The aim of this study is to compare the diagnostic value of the urine NMP-22 ELISA test, UBC-ELISA test and combination of both tests on suspect bladder carcinoma patients.This diagnostic study included25 patients who were indicated for cystoscopy and trans uretheral resection bladder tumor / tumor biopsy. From patients who met requirements for the inclusion and exclusion criteria, the urine voided sample was taken and used for NMP-22 ELISA test and UBC ELISA test. The results of NMP-22 ELISA test and UBC ELISA test were evaluated against the cystoscopy and histological findings as the reference standard.The result of diagnostic study of NMP-22 ELISA test with cut-off 10 U/mlshowed that it had a sensitivity of 62,3% and a specificity of 83,3%, a positive predictive value of 81,8% and a negative predicitive value of 71,4%, a positive likelihood ratio of 3,73 and a negative likelihood ratio of 0,45. If the cystitis case was excluded, it had a sensitivity of 69,2%, and a specificity of 75%, a positive predictive value of 81,8%, and a negative predicitive value of 60%, a positive likelihood ratio of 2,76 , and a negative likelihood ratio of0,42. Diagnostic value of UBC ELISA test with cut-off 12 ug/L had a sensitivity of 38,5% and a specificity of 91,7%, a positive predictive value of 83,3% and a negative predicitive value of 57,9%, a positive likelihood ratio of 4,63 and a negative llikelihood ratio of 0,67. If the cystitis case was excluded, it had a sensitivity of 38,5%, and a specificity of 87,5%, a positive predictive value of 83,3%, and a negative predicitive value of 46,7%, a positive likelihood ratio of 3,08 , and a negative likelihood ratio of0,70.Diagnostic value of combined NMP-22 ELISA test with UBC ELISA test had a sensitivity of 76,9% and a specificity of 75%, a positive predictive value of 76,9% and a negative predicitive value of 75%, a positive likelihood ratio of 3,08 and a negative llikelihood ratio of0,31. If the cystitis case was excluded, it had a sensitivity of 78,5%, and a specificity of 71,4%, a positive predictive value of 84,6%, and a negative predicitive value of 62,5%, a positive likelihood ratio of 2,74 , and a negative likelihood ratio of0,30.The conclusion was that the combined NMP-22 ELISA test with UBC test had the highest sensitivity, thus itwould not miss any primary or recurrent tumour in the bladder, although this neededto be confirmed by cystoscopy.

Abstrak :
ABSTRAK
Banyak studiBanyak studi epidemiologi, klinis dan in vitro terakhir menunjukkan hubungan antara vitamin D dengan tuberkulosis (TB) paru. Kadar 25-hidroksivitamin D (25(OH)D) yang rendah berhubungan dengan penyakit TB paru aktif dan laten. Namun, sampai saat ini belum ada data mengenai hubungan kadar 25(OH)D dan status vitamin D dengan derajat lesi TB paru. Tujuan penelitian ini dilakukan untuk mendapatkan hubungan antara proporsi status vitamin D dan kadar 25(OH)D dengan derajat lesi TB paru ringan, sedang dan berat. Desain penelitian potong lintang, terdiri dari 137 pasien TB paru terbagi menjadi kelompok derajat lesi TB paru ringan, sedang dan berat masing-masing 46, 47 dan 44 pasien. Diagnosis TB paru berdasarkan Pedoman Nasional Pengendalian Tuberkulosis, Kementerian Kesehatan Republik Indonesia. Derajat lesi TB paru dinilai secara radiologis berdasarkan klasifikasi dari National Tuberculosis and Respiratory Disease Association, New York. Status vitamin D ditetapkan menurut rekomendasi Holick. Pada ketiga kelompok dicatat data karakteristik subjek dan dilakukan pemeriksaan 25(OH)D. Status vitamin D pada subjek penelitian ini didapatkan sebanyak 122(89,1%) defisiensi dan 15(10,9%) insufiensi vitamin D. Proporsi defisiensi dan insufisiensi vitamin D kelompok TB paru ringan, sedang dan berat tidak didapatkan perbedaan bermakna, masing-masing dengan 84,8% dan 15,2%; 91,5% dan 8,5%; 90,9% dan 9,1%. Kadar 25(OH)D kelompok TB paru ringan, sedang dan berat tidak berbeda bermakna, masing-masing dengan rerata 12,96 (SB±5,83)ng/mL, 12,42 (SB±5,13)ng/mL, dan 11,29 (SB±5,61)ng/mL. Kami menyimpulkan status vitamin D dan kadar 25(OH)D tidak berhubungan dengan derajat lesi TB paru. Proporsi defisiensi dan insufisiensi vitamin D kelompok TB paru ringan, sedang dan berat tidak didapatkan perbedaan bermakna, masingmasing dengan 84,8% dan 15,2%; 91,5% dan 8,5%; 90,9% dan 9,1%.

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ABSTRACT
Most recent epidemiological, clinical and in vitro studies indicate that there is a the relationship between vitamin D and pulmonary tuberculosis (TB). Low concentration of 25- hydroxyvitamin D (25(OH)D) is associated with active and latent pulmonary TB disease. Nevertheless, there is no data about the relationship between vitamin D status and concentrations of 25(OH)D with severity of pulmonary TB. The aim of this study was to obtain the relationship between proportions of vitamin D and concentrations 25(OH)D with mild, moderate and severe degrees of pulmonary TB lesions. This was a cross-sectional study, 137 patients with pulmonary TB and 46, 47 and 44 patients each of mild, moderate and severe degree of pulmonary TB lesions, respectively. Diagnosis of pulmonary TB was based on National Tuberculosis Control Guideline, Ministry of Health of the Republic of Indonesia. The degree of pulmonary TB lesion was radiologically assessed based on classifications of the National Tuberculosis and Respiratory Disease Association, New York. Vitamin D status was defined according to Holick recommendations. Baseline characteristics of subjects were recorded and 25(OH)D concentrations were measured in subjects of each groups. Vitamin D status of the subjects were 122 (89.1%) deficiency and 15 (10.9%) insufficiency of vitamin D. The proportions of vitamin D deficiency and insufficiency at mild, moderate and severe degree of pulmonary TB lesions were also not significantly different, i.e. 84.8% and 15.2%, 91.5% and 8.5%, 90.9% and 9.1%, respectively. Concentrations of 25 (OH) D in each group of mild, moderate and severe pulmonary TB lesions were not significantly different, with a mean (SD) 12.96 (5.83)ng/mL, 12.42 (5.13)ng/mL, and 11.29 (5.61)ng/mL respectively. It is concluded that vitamin D status and serum 25 (OH) D were not related to the degree of pulmonary TB lesion. The proportion of vitamin D deficiency and insufficiency at mild, moderate and severe degree of pulmonary TB lesions were also not significantly different, i.e. 84.8% and 15.2%, 91.5% and 8.5%, 90.9% and 9.1%, respectively.

Abstrak :
ABSTRAK
Artritis rematoid merupakan penyakit otoimun sistemik yang paling sering ditemukan di dunia pada berbagai populasi dan ras, ditandai oleh inflamasi menetap pada jaringan sendi yang meliputi sendi perifer, distribusi simetris, dengan atau tanpa kerusakan rawan sendi dan erosi tulang. Pemantauan aktivitas penyakit diperlukan untuk menentukan keberhasilan terapi. Selama ini, pemantauan aktivitas penyakit menggunakan Disease Activity Score 28 (DAS28), meskipun terdapat kekurangan berupa parameter klinis yang bersifat subjektif, menggunakan perhitungan yang rumit, dan terdapat ketidakseragaman nilai titik potong derajat aktivitas penyakit pada berbagai penelitian.

Penelitian ini merupakan penelitian potong lintang untuk menilai korelasi antara kadar anti-CCP serum dan cairan sendi dengan aktivitas penyakit (DAS28) pada 30 subjek dengan artritis rematoid. Subjek yang memenuhi kriteria masukan dan tidak ada kriteria tolakan dilakukan penentuan skor DAS28 serta pemeriksaan anti-CCP serum dan cairan sendi.

Median (rentang) kadar anti-CCP serum secara keseluruhan, pada tingkat aktivitas penyakit sedang, dan berat adalah 112.23 (1.02-1853.07), 70.98 (1.02-1224.07), dan 157.59 (1.07-1853.07) RU/mL. Median (rentang) kadar anti-CCP cairan sendi secara keseluruhan, pada tingkat aktivitas penyakit sedang dan berat adalah 85.54 (0.90-4150.58), 58.90 (1.03-2477.81), dan 110.23 (0.90-4150.58) RU/mL. Median (rentang) skor DAS28 pada keseluruhan subjek ditemukan 5.04 (4.04-7.10). Uji korelasi Spearman didapatkan korelasi positif lemah namun tidak bermakna secara statistik antara kadar anti-CCP serum dan DAS28 dengan rs = 0.296, p = 0.056, korelasi positif lemah yang bermakna secara statistik antara anti- CCP cairan sendi dan DAS28 dengan rs = 0.331, p = 0.037, sedangkan korelasi antara anti-CCP serum dengan cairan sendi ditemukan kuat yang bermakna secara statistik dengan rs = 0.907, p <0.01.

Kami menyimpulkan kadar anti-CCP cairan sendi berkorelasi lemah dengan aktivitas penyakit (DAS28). Tidak ditemukan korelasi yang bermakna secara statistik antara kadar anti-CCP serum dengan aktivitas penyakit (DAS28). Terdapat korelasi kuat antara kadar anti-CCP serum dengan kadar anti-CCP dalam cairan sendi.

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ABSTRACT
Rheumatoid arhtritis is the most common chronic systemic autoimmune disease worldwide among many populations and races, characterized by persistent joint inflammation affecting peripheral joints, symmetrical distribution, with or without joint damage or bone erosion. Disease activity monitoring is needed to determine treatment response. Nowadays, Disease Activity Score 28 (DAS28) is used to monitor disease activity, although it uses subjective clinical parameter, complicated calculation, and ununiformity cut-off value for disease activity stages on various researches.

This study was a cross sectional study to assess wheter there was any correlation between anti-CCP serum and synovial fluid concentration with disease activity (DAS28) in 30 rheumatoid arhtritis subject. Blood and synovial fluid specimen collection and DAS28 determination was performed on subjects who fulfill inclusion and exclusion criteria, followed by anti-CCP assay on each specimen.

Median (range) anti-CCP serum concentration in overall, moderate, and severe disease activity were 112.23 (1.02-1853.07), 70.98 (1.02-1224.07), and 157.59 (1.07-1853.07) RU/mL, respectively. Median (range) anti-CCP synovial fluid concentration in overall, moderate, and severe disease activity were 85.54 (0.90-4150.58), 58.90 (1.03-2477.81), and 110.23 (0.90-4150.58) RU/mL, respectively. Median (range) of DAS28 were 5.04 (4.04-7.10). A weak but not statistically significant correlation was found between serum anti-CCP concentration and DAS28 with rs = 0.296 (p = 0.056). A weak and significant correlation was found between synovial fluid anti-CCP concentration and DAS28 with rs = 0.331 (p = 0.037). A strong and significant correlation are found between serum and synovial fluid anti-CCP concentration, with rs = 0.907 (p <0.01) using Spearman correlation test.

We concluded that synovial fluid anti-CCP concentration weakly correlated with disease activity. No significant correlation was found between serum anti-CCP concentration with disease activity. Strong correlation was found between serum and synovial fluid anti-CCP concentration.

Abstrak :
ABSTRAK
Berbagai studi terkini menunjukkan hubungan antara vitamin D dan sepsis. Vitamin D berperan sebagai stimulator produksi peptida antimikroba dan mencegah inflamasi yang berlebihan. Insufisiensi dan defisiensi vitamin D berhubungan dengan risiko terjadinya sepsis. Saat ini belum terdapat data mengenai hubungan status vitamin D dengan pasien infeksi tanpa sepsis, sepsis, dan sepsis berat. Tujuan penelitian ini dilakukan untuk mendapatkan hubungan antara proporsi status vitamin D dengan pasien infeksi tanpa sepsis, sepsis, dan sepsis berat. Desain penelitian potong lintang, terdiri dari 60 pasien infeksi terbagi menjadi kelompok infeksi tanpa sepsis, sepsis, dan sepsis berat masing-masing 20 pasien. Diagnosis sepsis berdasarkan modifikasi SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference 2001. Status vitamin D ditetapkan menurut rekomendasi Holick. Pada ketiga kelompok tersebut dicatat data karakteristik subjek dan dilakukan pemeriksaan 25(OH)D. Status vitamin D pada subjek penelitian ini didapatkan sebanyak 5 (8,33%) orang insufisiensi dan 55 (91,67%) orang defisiensi vitamin D Proporsi insufisiensi pada kelompok infeksi tanpa sepsis adalah 5%, sepsis 10%, dan sepsis berat 10%. Proporsi defisiensi pada kelompok infeksi tanpa sepsis adalah 95%, sepsis 90%, dan sepsis berat 90%. Didapatkan perbedaan tidak bermakna proporsi insufisiensi dan defisiensi vitamin D pada kelompok infeksi tanpa sepsis, sepsis, dan sepsis berat. Kami menyimpulkan status vitamin D tidak berhubungan dengan beratnya sepsis. Proporsi insufisiensi dan defisiensi pada pasien infeksi tanpa sepsis, sepsis, dan sepsis berat masing-masing didapatkan 5% dan 95%; 10% dan 90%; 10% dan 90%.

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ABSTRACT
Recent studies have shown that there is a relationship between vitamin D and sepsis. Vitamin D has a a role as a potent stimulator of antimicrobial peptides and prevent an over reaction of the inflammatory response. Insufficiency and deficiency of vitamin D have been associated with sepsis event. Nevertheless, there is no data about the relationship between vitamin D status with infection without sepsis, sepsis, and severe sepsis patient. The aim of this study was to obtain the relationship between proportions of vitamin D with infection without sepsis, sepsis, and severe sepsis patient. This was a cross-sectional study, 60 patients with infection were divided into groups of infection without sepsis, sepsis, and severe sepsis, each consisted of 20 patients. Diagnosis of sepsis was based on modified SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference 2001. Vitamin D status was defined according to Holick recommendations. Baseline characteristics of subjects were recorded and 25(OH)D concentrations were measured in subjects of each groups. According to status of Vitamin D, 5 (8,33%) subjects were insufficiency and 55 (91,67%) were deficiency. The proportions of vitamin D insufficiency at infection without sepsis group were 5%, sepsis 10%, and severe sepsis 10%. The proportions of vitamin D deficiency at infection without sepsis group were 95%, sepsis 90%, and severe sepsis 90%. The proportions of insufficiency and deficiency at infection without sepsis, sepsis, and severe sepsis patient were not significantly different (p > 0.05). It is concluded that vitamin D status were not related to infection severity. The proportions of vitamin D insufficiency and deficiency at infection without sepsis, sepsis, and severe sepsis, i.e. 5% and 95%; 10% and 90%; 10% and 90%, respectively.

Abstrak :
ABSTRAK
Sepsis merupakan penyakit umum di perawatan intensif dan hampir 1/3 pasien yang dirawat di ICU adalah pasien sepsis. Banyak penelitian dilakukan untuk mencari penanda sepsis yang handal dan jumlah apoptosis limfosit mulai banyak diteliti sebagai penanda sepsis. Apoptosis limfosit terjadi mulai 24 jam pertama setelah onset sepsis. Saat ini belum terdapat data yang menunjukkan dapat digunakannya jumlah apoptosis limfosit sebagai penanda prognostik sepsis. Tujuan penelitian ini adalah mengetahui dapat tidaknya jumlah apoptosis limfosit digunakan sebagai penanda prognostik pada pasien sepsis berat

Desain penelitian adalah uji prognosis secara prospektif, terdiri dari 30 pasien sepsis berat dibagi berdasarkan mortalitas 14 hari, yaitu 15 pasien hidup dan 15 pasien meninggal. Diagnosis sepsis berdasarkan modifikasi definisi sepsis oleh International Sepsis Definitions Conference 2001. Jumlah apoptosis limfosit dihitung menggunakan metode flowcytometry dengan reagen antibodi monoklonal CD45 berlabel PerCP, Annexin V berlabel FITC, dan Propidium Iodide. Pada kedua kelompok tersebut dicatat data karakteristik subyek dan dilakukan penghitungan jumlah apoptosis limfosit

Rerata jumlah apoptosis limfosit pada kelompok pasien hidup adalah 0,992% dengan simpang baku 0,44% dan rerata jumlah apoptosis limfosit pada kelompok pasien meninggal adalah 1,5853% dengan simpang baku 0,57%. Jumlah apoptosis limfosit pada kedua kelompok berbeda bermakna dengan nilai p 0,004. Ditentukan nilai cut-off jumlah apoptosis limfosit 0,97%untuk menentukan prognosis pasien sepsis, dengan AUC 0,791 (IK 95% 0,631 ? 0,951), sensitivitas 86,7%, dan spesifisitas 60%. Kurva Kapplan Meier berdasarkan nilai cut-off 0,97% menunjukkan gambar yang memenuhi asumsi proporsional hazard dengan rasio hazard 0,182 (IK 95% 0,041 - 0,814), p = 0,026. Kami menyimpulkan jumlah apoptosis limfosit pasien sepsis berat dapat digunakan untuk memprediksi pasien yang meninggal dilihat dari mortalitas 14 hari, dengan nilai AUC sedang. Cut-off jumlah apoptosis limfosit 0,97% dapat digunakan sebagai cut-off dalam tatalaksana pasien sepsis berat

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ABSTRACT
Sepsis is a common illness in intensive care, almost 1/3 of patients admitted to the ICU were sepsis patients. There are plenty of researches to find a reliable marker of sepsis and the number of apoptotic lymphocytes began widely studied as a marker of sepsis. Apoptosis of lymphocytes occurred from the first 24 hours after the onset sepsis. There are currently no data on whether the number of apoptotic lymphocytes can be used as a prognostic marker of sepsis. The purpose of this study was to determine whether the number of apoptotic lymphocytes can be used as a prognostic marker in patients with severe sepsis

This was a prospective prognosis study, consisting of 30 severe sepsis patients grouped based on 14-day mortality, 15 patients are survivors and 15 patients are nonsurvivors. The diagnosis of sepsis is based on a modified definition of sepsis by the International Sepsis Definitions Conference 2001. The number of apoptotic lymphocytes was calculated using flowcytometry with PerCP-labeled anti-CD45 monoclonal antibody, FITC-labeled Annexin V, and Propidium Iodide. In both groups, characteristics of subjects were recorded and the number of apoptotic lymphocytes was calculated.

The mean of apoptotic lymphocytes in the survivor group is 0.992% with a standard deviation of 0.44%, and the mean of apoptotic lymphocytes in the nonsurvivor group is 1.5853% with a standard deviation of 0.57%. The difference between the two groups is significant with p = 0.004. This study yields an apoptotic lymphocytes cut-off value of 0.97% to determine prognosis of severe sepsis patients, with AUC of 0.791 (CI 95% from 0.631 to 0.951), 86.7% sensitivity and 60% specificity. Kapplan Meier curve based on the 0.97% cut-off demonstrates that hazard proportion is fulfilled with hazard ratio of 0.182 (95% CI 0.041 to 0.814) and p= 0.026. It is concluded that the number of apoptotic lymphocytes in severe sepsis patients can be used to predict nonsurvivors based on 14-day mortality, with moderate AUC. The apoptotic lymphocytes cut-off value of 0.97% can be used as a cut-off for severe sepsis patient management

Abstrak :
ABSTRACT
Kesulitan 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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ABSTRACT
The 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.