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"ABSTRAKatar Belakang. Kanker kepala dan leher (KKL) merupakan kanker peringkat ke 6 di Dunia. Mayoritas pasien KKL datang ke Rumah Sakit pada stadium lokal lanjut. Progression Free Survival (PFS) merupakan luaran yang baik untuk mengevaluasi keberhasilan suatu terapi pada kasus tumor padat. Peneliti memilih PFS 2 tahun pada kanker kepala dan leher untuk diteliti karena kurun waktu 2 tahun merupakan waktu biologis untuk suatu tumor padat dapat berkembang kembali. Penelitian dilakukan karena perbedaan jenis kanker kepala leher di Indonesia dibandingkan dengan negara Eropa dan Amerika.Tujuan. Mengetahui mortalitas 2 tahun pasien KKL serta PFS 2 tahun pasien KKL serta faktor-faktor yang Memengaruhi.Metode Studi dengan desain kohort retrospektif yang meneliti 216 pasien KKL stadium lokal lanjut yang menjalani kemoradiasi di Rumah Sakit Cipto Mangunkusumo dalam rentang waktu Januari 2015 sampai Desember 2017. Data diambil melalui rekam medis. Data laboratorium yang diambil memiliki rentang waktu 2-4 minggu sebelum dan 2-4 minggu setelah kemoradiasi. Jika ada data yang kurang seperti durasi ikan asin dan riwayat merokok dikonfirmasi melalui media telepon. Pada penelitian ini tidak melihat proses pembuatan ikan asin dan jumlah ikan asin yang dikonsumsi. Penelitian ini tidak meneliti HPV maupun EBV. Pengamatan PFS dimulai dari hari pertama kemoradiasi sampai terjadinya event berupa progresi atau kematian dalam kurun waktu 2 tahun. Data PFS dicatat dalam 2 kelompok PFS ≤ 2 tahun dan >2 tahun. Analisis bivariat menggunakan uji Kai Kuadrat, variabel-variabel yang bermakna akan diuji lebih lanjut dengan menggunakan uji regresi logistik.Hasil. Penelitian ini mendapatkan 216 pasien yang menjalani kemoradiasi pertama kali di RSCM. Terdapat 103 (47,69%) pasien yang meninggal dalam 2 tahun pasca pengobatan. Sedangkan terdapat 108 (50%) pasien yang mengalami PFS 2 tahun. Berdasarkan hasil analisis multivariat didapatkan bahwa merokok (p=0,024), kadar hemoglobin < 12 g/dl (p=0,008), ECOG (p=0,017), serta respons terapi (p=0,006) memengaruhi PFS 2 tahun pasien KKL.Kesimpulan. Proporsi kematian dalam 2 tahun di RSCM masih cukup tinggi (47,69%), dengan PFS 2 tahun mencapai 50%. Kebiasaan merokok, kadar hemoglobin, ECOG serta respons terapi memengaruhi PFS 2 tahun pasien KKL.

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ABSTRACTBackground. Head and neck cancer (HNC) is the 6th cancer in the world. The majority of HNC patients come to the hospital at the locally advanced stage. Progression Free Survival (PFS) is a good outcome for evaluating the success of therapy in solid tumor cases. Researchers chose a 2-year PFS in head and neck cancer to study because within 2-year period is the biological time for a solid tumor to progress again. The study was conducted because of differences in the types of head and neck cancer in Indonesia compared to European and American countries.Aim. Knowing the mortality of HNC patients and 2 years PFS of HNC patients as well as the factors that influenced.Method. A retrospective cohort study design that examined 216 locally advanced HNC patients who underwent chemoradiation at Cipto Mangunkusumo Hospital in the period of January 2015 to December 2017. Data retrieved through medical records. Laboratory data taken 2-4 weeks prior and 2-4 weeks after chemoradiation. If there is insufficient data such as the duration of salted fish and smoking history it is confirmed through telephone. this study did not see the process of making salted fish and the amount of salted fish consumed. This study did not examine HPV or EBV. PFS observation starts from the first day of chemoradiation until the event occurs in the form of a progression or death within 2 years. PFS data are recorded in 2 PFS groups ≤ 2 years and> 2 years. Bivariate analysis using the Chi Square test, if these requirements are not met, the researcher uses the Fischer-exact test. Variables will be further tested using multivariat logistic regression tests.Results. This study found 216 patients who underwent chemoradiation for the first time at RSCM. There were 103 (47.69%) patients who died within 2 years after treatment. Whereas there were 108 (50%) patients who had PFS 2 years. Based on the results of multivariate analysis, it was found that smoking (p = 0.024), hemoglobin level <12 g / dl (p = 0.008), ECOG (p = 0.017), and therapeutic response (p = 0.006) affected PFS 2 years.Conclusion. The proportion of mortality within 2 years in RSCM is still quite high (47.69%), with a 2-years PFS reaching 50%. Smoking, hemoglobin levels, ECOG and therapeutic response affect the 2-year PFS of patients."

"ABSTRAKEksaserbasi asma masih menjadi masalah pada jamaah selama periode ibadah haji. Terdapat banyak faktor yang berkontribusi terhadap eksaserbasi asma selama ibadah haji. Asma yang terkontrol penuh dan pencegahan sebelum keberangkatan haji menjadi penting untuk menurunkan risiko eksaserbasi.MetodeMetode penelitian berupa cross sectional analitik yang dilakukan pada jamaah haji DKI Jakarta tahun 2018. Jamaah haji dengan asma diseleksi dari Sistem Informasi dan Komputerisasi Haji Terpadu Kesehatan (Siskohatkes). Subjek dievaluasi lebih lanjut di Puskesmas melalui anamnesis, pemeriksaan fisik dan spirometri dan diikuti selama ibadah haji. Terdapat tujuh faktor yang diteliti, yaitu riwayat eksaserbasi asma, obesitas, komorbid, fungsi faal paru, tingkat kebugaran, merokok dan vaksinasi influenza. Kriteria eksklusi dalam pengambilan sampel yaitu memiliki kontraindikasi melakukan spirometri, menderita penyakit paru bukan asma bronkial (TB paru, kanker paru), kesulitan untuk berkomunikasi (penurunan kognitif), tidak bersedia ikut dalam penelitian dan gangguan jantung yang membuat pasien harus membatasi aktivitas fisikHasil68 jamaah haji dengan asma didapatkan untuk penelitian ini yang terdiri atas 46 subjek perempuan (67,6%) dan usia median sebesar 56 tahun. Eksaserbasi akut terjadi pada 27 subjek (39,7%). Pada analisis multivariat dengan uji regresi logistik, didapatkan bahwa riwayat eksaserbasi asma dan obesitas grade II menjadi faktor yang berperan signifikan terhadap eksaserbasi dengan odd ratio (OR) 4,27 (95%IK: 1,156-15,829,p=0,029) dan 4,02 (95%IK: 1,151-14,097, p=0,029).KesimpulanProporsi eksaserbasi sebesar 39,7%. Dari tujuh faktor yang diteliti pada studi ini, riwayat eksaserbasi asma sejak satu tahun sebelum keberangkatan haji dan obesitas grade II menjadi faktor paling penting yang berperan terhadap eksaserbasi asma pada jamaah haji.

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ABSTRACTBackgroundAsthma exacerbation still become problem in pilgrims during hajj period. There are many factors that contribute in asthma exacerbation. Well controlled asthma and prevention before hajj was important to reduce risk of exacerbation.MethodThis is a cross sectional study among asthma hajj pilgrims year 2018 from Jakarta. Hajj pilgrims with asthma were selected from Sistem Informasi dan Komputerisasi Haji Terpadu Kesehatan (Siskohatkes). Subjects were evaluated in primary facility (Puskesmas) through anamnesis, physical examination and spirometry and followed during pilgrimage. There were seven factors that examined in this research, including history of exacerbation, obesity, comorbid, lung physiology function, smoking, fitness level, and influenza vaccination. Exclution criteria includes contraindicated in spirometry test, had lung disease except asthma (tuberculosis, lung cancer), hard to communicate, refused to enter the study and cardiac problems that made patients restricted their activity.ResultSixty eight asthma patients were recruited comprising 46 female subjects (67,6%) and median age for this study is 56 years. Acute exacerbation occurred in 27 subjects (39,7%). In multivariate analysis with logistic regression test, history of exacerbation and grade II obesity were factors that have significant effect on asthma exacerbation with odd ratio 4,27 (95% CI: 1,156-15,829, p=0,029) and 4,02 (95%CI: 1,151-14,097, p=0,029) respectively.ConclusionProportion of exacerbation is 39,7%. From seven factors researched in this study, obesity grade II and history of asthma exacerbation one year before hajj period were the most important factors that contribute on asthma exacerbation among hajj pilgrims."

"Latar Belakang: Peningkatan serotonin plasma dan kortisol saliva yang terjadi pada sindrom koroner akut juga terjadi pada gejala ansietas. Dan kedua penanda biologis tersebut digunakan untuk mengetahui adanya gejala ansietas. Tujuan: Mengetahui perbedaan rerata serotonin plasma dan kortisol saliva pada sindrom koroner akut dengan gejala ansietas di RSUPN dr. Cipto Mangunkusumo. Metode: Dilakukan penelitian klinis poong lintang. Hasil: Kadar serotonin plasma dengan gejala ansietas dan tanpa gejala ansietas dibandingkan nilai normal yaitu 194,83 (142,00-892,04) ng/mL dan 167,16 (150,40-225,96) ng/ml. Kadar kortisol saliva pada subjek dengan gejala ansietas dan tanpa gejala ansietas adalah 2,75 (1,28-4,91) µg/dL dan 2,69 (0,91-7,09) µg/dL. Simpulan: Ada peningkatan kadar serotonin plasma dan kortisol saliva pada gejala ansietas walaupun tidak terdapat hubungan antara serotonin plasma dan kortisol saliva dengan gejala ansietas pada pasien SKA.

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Background: Increases in plasma serotonin and salivary cortisol that occur in acute coronary syndrome also occur in symptoms of anxiety. And the two biological markers are used to determine the presence of anxiety symptoms.

Objective: To determine the difference in mean plasma serotonin and salivary cortisol in acute coronary syndrome with anxiety symptoms at RSUPN dr. Cipto Mangunkusumo.

Methods: Poong Lintang clinical research was conducted.

Results: Compared to normal values, plasma serotonin levels with anxiety symptoms and without anxiety symptoms ​​were 194.83 (142.00-892.04) ng/mL and 167.16 (150.40-225.96) ng/ml. Salivary cortisol levels in subjects with anxiety symptoms and without anxiety symptoms were 2.75 (1.28-4.91) µg/dL and 2.69 (0.91-7.09) µg/dL.

Conclusion: There is an increase in plasma serotonin and salivary cortisol levels in anxiety symptoms although there is no relationship between plasma serotonin and salivary cortisol with anxiety symptoms in ACS patients."

"[ABSTRAKLatar Belakang: Major adverse cardiac events (MACE) merupakan komplikasi serius pada pasien pasca sindrom koroner akut (SKA) sehingga perlu suatu metode yang andal dalam memprediksi kejadiannya. Heart rate variability (HRV) yang menggambarkan ketidakseimbangan sistem otonom pasca SKA dan dapat dilakukan dengan cara yang lebih cepat, mudah, dan praktis berpotensi dapat digunakan sebagai alat stratifikasi risiko MACE.Tujuan: Mengetahui kemampuan HRV awal perawatan yang diukur melalui metode pulse photoplethysmograph (PPG) dalam memprediksi MACE pada pasien pasca SKA yang dirawat di intensive cardiac care unit (ICCU).Metode: Studi ini adalah studi kohort prospektif dengan subjek pasien SKA yang menjalani perawatan di ICCU. Pemeriksaan HRV dilakukan dengan metode PPG dalam 48 jam pasca diagnosis SKA dan adanya MACE dideteksi selama perawatan di ICCU. Komplikasi yang digolongkan sebagai MACE adalah kematian, aritmia fatal, gagal jantung, syok kardiogenik, re-infark, dan komplikasi mekanik. Kemampuan HRV dalam memprediksi MACE dinyatakan melalui AUC (+IK95%) dan untuk parameter yang memiliki kemampuan prediksi baik akan dihitung nilai prediksi positif (PPV) dan nilai prediksi negatif (NPV) beserta IK95% parameter tersebut.Hasil: Sebanyak 75 subjek SKA menjalani pengukuran HRV < 48 jam pasca diagnosis dan sebanyak 18,7% di antaranya mengalami MACE. Parameter LF dengan AUC 0,697 (0,543-0,850) dan rasio LF/HF dengan AUC 0,851 (0,741-0,962) memiliki kemampuan diskriminasi MACE yang paling baik. Parameter LF pada titik potong 89,673 memiliki PPV dan NPV sebesar 13% dan 71%, sedangkan rasio LF/HF pada titik potong 1,718 sebesar 6% dan 50%.Kesimpulan: Variabel LF dan rasio LF/HF merupakan parameter HRV yang dinilai memiliki kemampuan diskriminasi cukup baik terhadap MACE. Kedua variabel tersebut memiliki nilai prediksi negatif sehingga dapat digunakan untuk menyingkirkan kemungkinan terjadinya MACE pada mereka dengan nilai LF > 89,673 dan rasio LF/HR > 1,718.

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ABSTRACTIntroduction: Major adverse cardiac events (MACE) are serious complications needed to be predicted rapidly and accurately in acute coronary syndrome (ACS) patients. Heart rate variability (HRV), reflecting autonomic system imbalance post ACS, is currently available in quick, easy, and practical method. This parameter has potential to be used in MACE risk stratification.Aim: To find the ability of HRV measurement with pulse photoplethysmograph (PPG) method in predicting MACE in post ACS patients hospitalized in intensive cardiac care unit (ICCU).Method: This study is a prospective study using ACS patients in ICCU as its subjects. Measurement of HRV by means of PPG is conducted within 48 hours post diagnosis and the incidence of MACE is identified during ICCU stay. Events classified as MACE are including death, lethal arrhytmia, heart failure, cardiogenic shock, re-infarction, and other mechanical complications. The ability of HRV in predicting MACE was listed as AUC (+95%CI) and for specific HRV parameters which had adequate capability, positive predictive value (PPV) and negative predictive value (NPV) would be calculated.Result: HRV measurements were done in 75 ACS subjects < 48 h post-diagnosis. Among the subjects, 18,7% suffered from MACE. Measurement of LF with AUC 0,697 (0,543-0,850) and LF/HF ratio with AUC 0,851 (0,741-0,962) had the best discrimination values. The former variable had PPV and NPV of 13% and 71% in the cutoff point of 89,673, while the latter had the number of 6% and 50% in the cutoff point of 1,718, respectively.Conclusion: LF and LF/HF ratio are the only HRV variables having adequate MACE discrimination. Both variables have better NPV so that they can be applied in reducing MACE risk in patients with LF > 89,673 and LF/HF ratio > 1,718.;Introduction: Major adverse cardiac events (MACE) are serious complications needed to be predicted rapidly and accurately in acute coronary syndrome (ACS) patients. Heart rate variability (HRV), reflecting autonomic system imbalance post ACS, is currently available in quick, easy, and practical method. This parameter has potential to be used in MACE risk stratification.Aim: To find the ability of HRV measurement with pulse photoplethysmograph (PPG) method in predicting MACE in post ACS patients hospitalized in intensive cardiac care unit (ICCU).Method: This study is a prospective study using ACS patients in ICCU as its subjects. Measurement of HRV by means of PPG is conducted within 48 hours post diagnosis and the incidence of MACE is identified during ICCU stay. Events classified as MACE are including death, lethal arrhytmia, heart failure, cardiogenic shock, re-infarction, and other mechanical complications. The ability of HRV in predicting MACE was listed as AUC (+95%CI) and for specific HRV parameters which had adequate capability, positive predictive value (PPV) and negative predictive value (NPV) would be calculated.Result: HRV measurements were done in 75 ACS subjects < 48 h post-diagnosis. Among the subjects, 18,7% suffered from MACE. Measurement of LF with AUC 0,697 (0,543-0,850) and LF/HF ratio with AUC 0,851 (0,741-0,962) had the best discrimination values. The former variable had PPV and NPV of 13% and 71% in the cutoff point of 89,673, while the latter had the number of 6% and 50% in the cutoff point of 1,718, respectively.Conclusion: LF and LF/HF ratio are the only HRV variables having adequate MACE discrimination. Both variables have better NPV so that they can be applied in reducing MACE risk in patients with LF > 89,673 and LF/HF ratio > 1,718., Introduction: Major adverse cardiac events (MACE) are serious complications needed to be predicted rapidly and accurately in acute coronary syndrome (ACS) patients. Heart rate variability (HRV), reflecting autonomic system imbalance post ACS, is currently available in quick, easy, and practical method. This parameter has potential to be used in MACE risk stratification.Aim: To find the ability of HRV measurement with pulse photoplethysmograph (PPG) method in predicting MACE in post ACS patients hospitalized in intensive cardiac care unit (ICCU).Method: This study is a prospective study using ACS patients in ICCU as its subjects. Measurement of HRV by means of PPG is conducted within 48 hours post diagnosis and the incidence of MACE is identified during ICCU stay. Events classified as MACE are including death, lethal arrhytmia, heart failure, cardiogenic shock, re-infarction, and other mechanical complications. The ability of HRV in predicting MACE was listed as AUC (+95%CI) and for specific HRV parameters which had adequate capability, positive predictive value (PPV) and negative predictive value (NPV) would be calculated.Result: HRV measurements were done in 75 ACS subjects < 48 h post-diagnosis. Among the subjects, 18,7% suffered from MACE. Measurement of LF with AUC 0,697 (0,543-0,850) and LF/HF ratio with AUC 0,851 (0,741-0,962) had the best discrimination values. The former variable had PPV and NPV of 13% and 71% in the cutoff point of 89,673, while the latter had the number of 6% and 50% in the cutoff point of 1,718, respectively.Conclusion: LF and LF/HF ratio are the only HRV variables having adequate MACE discrimination. Both variables have better NPV so that they can be applied in reducing MACE risk in patients with LF > 89,673 and LF/HF ratio > 1,718.]"

"ABSTRAKLatar Belakang: Hipertensi pulmonal merupakan komplikasi tersering padaPenyakit Paru Obstruksi Kronis (PPOK). Angka kematian akan meningkat tajambila pasien PPOK sudah mengalami komplikasi ini. Selama ini pengukuran tekananarteri pulmonalis hanya diukur pada saat pasien PPOK eksaserbasi dirawat diruangintesif dengan cara invasif mengunakan alat Right heart catherization (RHC). Datakelompok PPOK stabil yang mengalami hipertensi pulmonal yang diukur dengancara non invasif masih relatif sedikit yang di publikasi. Saat ini sudah adaEchocardiography Doppler yang dapat digunakan sebagai pengganti RHC padakelompok PPOK stabil.Tujuan: Untuk mengetahui apakah ada hubungan antara Penurunan FEV1 %prediksi dengan Peningkatan Rerata Tekanan Arteri Pulmonalis dan mencari titikpotong terbaik secara klinis antara FEV1 % prediksi dan mPAPMetode: Studi potong lintang pada lima puluh delapan subjek PPOK stabil yangdilakukan spirometri dan pengukuran mPAP dengan menggunakan Ekhokardiografidoppler pada potongan short axis setinggi aorta.Hasil: Nilai rerata FEV1 % prediksi 26,6 (SB 4,7) dan rerata mPAP 37,61 (18,1-59)mmHg. 74 % subjek mengalami hipertensi pulmonal, dengan karakteristik 24 %ringan, 31 % sedang dan 19 % berat. Terdapat korelasi negatif kuat antarapenurunan FEV1 % prediksi dengan peningkatan mPAP. Semakin turun FEV1%prediksi semakin meningkat mPAP. Nilai titik potong terbaik secara klinis 55,3 %dengan sensitivitas 93%Kesimpulan: FEV1 % prediksi berkorelasi negatif yang sangat kuat dengantekanan rerata arteri pulmonalis. FEV1 % prediksi 55,3 % memiliki kemampuanyang cukup baik membedakan PPOK stabil yang sudah mengalami hipertensipulmonal

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ABSTRACTBackground: Pulmonary hypertension is the most common complication of chronicobstructive pulmonary disease (COPD). Mortality rate will increase when COPDcomplication with Pulmonary Hypertension. Right Heart Catheterization (RHC) isthe most common tool to measure Mean Pulmonary Arterial Pressure either in COPDpatients with exacerbations treated in intensive care unit. Data of pulmonaryhypertension in stable COPD group is still relatively rare published. Alternatively toRHC, nowadays echocardiography is used to measure Mean Pulmonary ArterialPressure in stable COPD group.Objective: To determine the correlation between forced expiratory volume in onesecond (FEV1 %) prediction and mean pulmonary arterial pressure. To determine thebest clinically cut-off point between FEV1% prediction with mean pulmonaryarterial pressureMethods: A cross-sectional study was conducted on fifty-eight stable male COPDpatients (mean age : 67,6) under went spirometry. Mean pulmonary arterial pressurewas measured using transthoracic echocardiography at short axis view in aortic level.Results: Mean value of FEV1% was 26,6 % (SD 4,7) with median value of meanpulmonary arterial pressure was 37,61 mmHg (range 18,3-59). 74% subjects werepulmonary hypertension; 24 % mild, 31 % moderate and 19% severe respectively.The correlation test showed a significant strong-negative correlation(r = - 0,948, p < 0,001). The best cut-off point of FEV1% prediction, which has aclinical value correlating to mean pulmonary arterial pressure, was 55,3% with thesensitivity 93 %.Conclusions: Forced expiratory volume in one second (FEV1 %) prediction has asignificant correlation with mean pulmonary arterial pressure in stable chronicobstructive disease patients. The cut-off point FEV1 % prediction was 55,3% has agood capability to discriminate pulmonary hypertension in stable PPOK patient."

"Latar belakang. Penegakan diagnosis demam tifoid masih sulit dilakukan jika hanya menggunakan gejala klinis. Dibutuhkan skor klinis untuk dapat menegakkan diagnosis di awal dengan tepat. Variabel pada skor Nelwan merupakan data yang dapat diperoleh melalui anamnesis dan pemeriksaan fisik sehingga dapat membantu penegakan diagnosis secara dini. Penelitian nilai dignostik skor Nelwan untuk mendiagnosis demam tifoid belum pernah dilakukan sebelumnyaTujuan. Mendapatkan nilai titik potong dan nilai diagnostik skor Nelwan dalam penegakkan diagnosis demam tifoid dewasaMetode. Penelitian ini menggunakan desain potong lintang dengan pendekatan uji diagnosis. Penelitian dilakukan dengan cara mengumpulkan data primer dari pasien poliklinik, IGD, dan rawat inap RSUP Persahabatan, RSUD Budhi Asih, RSUD Tanggerang Selatan, RS Hermina Ciputat, RS Metropolitan Medical Center dan Puskesmas di daerah Jakarta. Kriteria inklusi adalah pasien dengan keluhan demam selama 3-14 hari, mempunyai keluhan saluran cerna, dan bersedia mengikuti penelitian. Diagnosis demam tifoid didapatkan melalui kultur darah, kultur swab rektal dan PCR. Nilai titik potong skor Nelwan ditentukan berdasarkan kurva Receiver Operating Characteristic ROC . Titik potong tersebut kemudian dianalisis dan didapatkan sensitivitas, spesifisitas, nilai duga positif NDP , nilai duga negatif NDN , rasio kemungkinan positif RKP dan rasio kemungkinan negatif RKN .Hasil. Selama penelitian didapatkan 233 sampel dengan proporsi demam tifoid 4,72 . Titik potong skor Nelwan yang optimal adalah 10 dengan AUC 71,3 95 IK 65,9 - 88,7 . Skor Nelwan dengan nilai cut off 10 memiliki sensitivitas 81,8 , spesifisitas 60,8 , nilai duga positif 9,3 , nilai duga negatif 98,5 , rasio kemungkinan positif 2,086, rasio kemungkinan negatif 0,299.Kesimpulan. Skor Nelwan dengan titik potong 10 dapat digunakan sebagai screening pasien dengan klinis demam tifoid.Kata kunci : skor Nelwan, demam tifoid.

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Background. Typhoid fever can be complicated to diagnose if only clinical signs and symptoms are used. By using clinical scores, we can provide an early diagnosis precisel. Variables in Nelwan Scores are derived from history taking and physical examination. Evaluation of diagnostic value of Nelwan score has never been done before.Objectives. To get the cut off point and the diagnostic value of Nelwan score in diagnosing typhoid fever in adult patients.Methods. This study is a diagnostic test with a cross sectional method, involving subjects with fever 3-14 days and gastrointestinal complaints from policlinic, emergency department and hospital ward in Persahabatan Hospital, Budhhi Asih Hospital, South Tanggerang Hospital, HerminaCiputat Hospital, MMC Hospital, Jatinegara and Gambir Primary Health Centre. Diagnosis are confirmed by blood culture, rectal swab culture, and PCR. Cut off analysis was performed using Receiver Operating Characteristic ROC curve and diagnostic value was then analyzed to generate sensitivity, specificity, predictive value and a likelihood ratio.Result. This study involving 233 subjects with a proportion of typhoid fever is 4,72 . The optimal cut off point of Nelwan score is 10 with AUC 71,3 95 IK 65,9 - 88,7 . This cut off point has sensitivity 81,8 , specificity 60,8 , PPV 9,3 , NPV 98,5 , LR 2,086, and LR - 0,299.Conclusion. Nelwan score with cut off point 10 has a good diagnostic value as a screening tool for patients with typhoid fever clinical presentationKeywords :Nelwan score, typhoid fever "