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"ABSTRAKPendahuluan: Jumlah pasien HIV/AIDS berkembang khususnya di Indonesia, salah satu faktor yang menghambat penanganan pasien adalah diagnosis yang kurang baik. Pemerintah telah memfasilitasi tes diagnostik di setiap puskesmas dengan kombinasi tes cepat anti-HIV menggunakan strategi tiga World Health Organization WHO . Penggunaan kombinasi reagen yang baik diharapkan dapat meningkatkan akurasi dari tes tersebut dalam mendiagnosis HIV/AIDS.Data diperoleh dari bank sampel Rumah Sakit dr. Cipto Mangunkusumo Departemen Patologi Klinik.Metode: Kombinasi dari tiga reagen dipilih berdasarkan persyaratan WHO. Hasil kombinasi reagen dibandingkan dengan status sampel yang dikonfirmasi dengan Western Blot, sehingga dapat dilakukan perhitungan sensitivitas, spesifisitas, dan diskordansi setiap kombinasi.Hasil: Dari sensitivitas, spesifisitas serta diskordansi berbagai kombinasi diperoleh dua kombinasi terbaik dengan hasil yang sama, yaitu SD Bioline HIV -1/2 3.0 Alere -HIV 1 2 Antibody Rapid Oncoprobe Utama - Vikia HIV 1/2 BioMerieux dan Advance Quality Rapid Anti-HIV 1 2 Test Intec - Abon HIV 1/2/O Abon - Vikia HIV 1/2 BioMerieux dengan sensitivitas dan spesifisitas 100 dan nilai diskordansi rendah yaitu 1,53 . Berdasarkan WHO diskordansi masih dianggap baik bila di bawah 5 .Diskusi: Dari kombinasi reagen yang tidak mengikuti persyaratan strategi tiga WHO, ternyata sensitivitas dan spesifisitas dapat mencapai 100 , namun angka diskordansi menunjukkan angka yang sangat tinggi, yaitu 4,3 . Dapat disimpulkan bahwa penerapan persyaratan WHO pada kombinasi reagen meningkatkan sensitivitas, spesifisitas, dan mengurangi diskordansi, sehingga akurasi diagnosis dapat ditingkatkan.

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ABSTRACT

Introduction The number of patients with HIV AIDS develops, especially in Indonesia, One of the factors is unfavorable diagnosis. Government facilitated the diagnostic tests in every health center with a combination of anti HIV rapid test using strategy III of World Health Organization WHO . The use of a good combination of reagents is expected to improve the accuracy in the diagnosis of HIV AIDS. Data is obtained from the sample bank rsquo s in Department of Clinical Pathology Rumah Sakit dr. Cipto Mangunkusumo.Method The combination of three reagents has been selected based on the requirements of WHO. The result is compared to the sample status confirmed by Western Blot, which can be calculated the sensitivity, specificity, and discordant of any combination.Results Based on sensitivity, specificity and discordant from various combinations, it is obtained two best combinations with the same result, namely SD Bioline HIV 1 2 3.0 Alere HIV 1 2 Rapid Antibody Main Oncoprobe Vikia HIV 1 2 bioMerieux and Advance Quality Rapid Anti HIV 1 2 Test Intec ndash Abon HIV 1 2 O Shredded Vikia HIV 1 2 bioMerieux with a sensitivity and specificity of 100 and the discordant value at 1.53 . Based on the WHO the discordant value is still considered as good as long as it is below 5 . Discussion If the combination do not follow the requirements of WHO using strategy III, the sensitivity and specificity can reach 100 , but the discordant value indicate high number, whichis 4.3 . As conclusion, application of the requirements of the WHO on a combination of reagents can increased sensitivity, specificity, and reduce the discordant, so the accuracy of diagnosis can be improved. "

"Defisiensi besi pada pasien penyakit ginjal kronis dengan hemodialisis (PGK-HD) merupakan penyebab terapi erythropoietin-stimulating agent (ESA) menjadi tidak responsif. Soluble transferrin receptor (sTfR) merupakan marker evaluasi status besi serta respons eritropoiesis yang tidak dipengaruhi inflamasi. Indeks sTfR (rasio sTfR/log feritin) diperkirakan dapat meningkatkan performa sTfR. Tujuan penelitian adalah mengevaluasi performa diagnostik sTfR dan indeks sTfR dalam tatalaksana anemia defisiensi besi pada PGK-HD. Penelitian merupakan studi potong lintang yang melibatkan 127 pasien PGK-HD di Unit Hemodialisis RS Cipto Mangunkusumo pada bulan Agustus-September 2018. Setiap subjek diperiksakan sTfR, indeks sTfR, marker besi, feritin, reticulocyte hemoglobin equivalent (RET-He), serta darah perifer lengkap. Saturasi transferin (TSAT) dan RET-He digunakan sebagai baku emas. Uji diagnostik menggunakan Chi Square dan kurva receiver operating characteristic (ROC). Pada penelitian ini didapatkan titik potong sTfR 2,71 mg/L (sensitivitas 83,3%, spesifisitas 56,5%) dan titik potong indeks sTfR 1,39 (sensitivitas 76,2%, spesifisitas 70,6%). Parameter sTfR dapat bermanfaat sebagai skrining dalam penentuan status besi serta respon eritropoiesis pada pasien PGK-HD. Tata laksana terapi besi yang adekuat akan membuat terapi ESA menjadi efektif, sehingga anemia dapat teratasi, dan kualitas hidup pasien membaik.

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Iron deficiency in patients with chronic kidney disease and hemodialysis (CKD-HD) can cause unresponsiveness to erythropoietin-stimulating agent (ESA). Soluble transferrin receptor (sTfR) is a potential marker to evaluate iron status and erythropoiesis response, that’s not influenced by inflammation. The sTfR index (sTfR/log ferritin ratio) has been proposed could increase the diagnostic efficacy than sTfR alone. We evaluated the diagnostic performance of sTfR and sTfR index for management of iron deficiency in CKD-HD. This cross-sectional study was conducted at Cipto Mangunkusumo Hospital, Indonesia from August-September 2018, involving 127 CKD-HD patients. The sTfR level, sTfR index (sTfR/log ferritin), iron status, ferritin level, reticulocyte hemoglobin equivalent (RET-He), and complete blood count were assessed. Transferrin saturation (TSAT) and RET-He were used as references. Diagnostic tests were analyzed using the chi-square test and receiver operating characteristic curve analysis. We identified sTfR cutoff of 2.71 mg/L (sensitivity 83.3%, specificity 56.5%) and sTfR index cutoff of 1.39 (sensitivity 76.2%, specificity 70.6%). The sTfR might be useful as a screening parameter to evaluate iron status and erythropoietin response in CKD-HD patients. Appropriate iron therapy will make ESA therapy more effective, which will help to overcome anemia, and finally will improve the quality of life of CKD-HD patients.

 

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Latar belakang: Kanul dalam trakea yang dibersihkan secara rutin sangat penting untuk pencegahan infeksi. Belum diketahui cara pencucian kanul trakea yang baik untuk mengurangi kemungkinan terjadinya koloni bakteri pembentuk biofilm dan pertumbuhan kuman serta pola kuman pada kanul trakea.

Tujuan penelitian: Memperbaiki tatalaksana perawatan kanul trakea terkait dengan penghambatan koloni bakteri pembentuk biofilm, resistensi kuman terhadap antibiotika dengan kombinasi pencucian kanul trakea menggunakan klorheksidin dan NaCl 0,9% pada pasien yang menggunakan kanul trakea. Metode: Terdapat 40 subjek yang dikelompokkan menjadi 20 subjek kelompok kontrol (dilakukan pencucian kanul menggunakan NaCl 0,9 % dicuci 100 ml selama 10 menit) sedangkan kelompok studi (pencucian kanul menggunakan NaCl 0,9 % sebanyak 100 ml lalu dicuci dengan cairan klorheksidin 2,5 % minimal 20 ml secara merata selama 10 menit). Penelitian ini menggunakan uji klinis acak terkontrol paralel 2 kelompok dengan penyamaran tunggal. Hasil: Dari 40 subjek yang diteliti, didapatkan 17 subjek (85 %) masing-masing kelompok yang menghasilkan bakteri pembentuk biofilm sebelum dilakukan intervensi. Setelah dilakukan intervensi pada kelompok studi didapatkan, 15 subjek negatif biofilm dan 5 subjek positif biofilm p=0,001. Bakteri paling banyak ditemukan pada kelompok kontrol adalah Pseudomonas aeruginosa sedangkan pada kelompok studi masih didapatkan bebrapa bakteri seperti Acinetobacter sp. dan Proteus mirabilis. Amoxicilin-Clavulanat memiliki resisten yang paling tinggi terhadap bakteri pembentuk biofilm pada kedua kelompok. Piperacilin, ceftazidime, ciprofloxacin dan meropenem memiliki sensitifitas yang paling tinggi terhadap bakteri pembentuk biofilm. Kesimpulan: Terdapat penurunan yang bermakna jumlah koloni yang menghasilkan biofilm pada kanul trakea pada kelompok studi dibandingkan kelompok kontrol dalam pencucian kanul trakea (p=0,001).

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Background: Regular cleaning of the cannula in the trachea is very important for infection prevention. How to wash the tracheal cannula which is good to reduce the possibility of colonies of biofilm-forming bacteria and the growth of germs and the pattern of germs on the tracheal cannula is still unknown.

Aim : To improve the treatment of tracheal cannula related to inhibition of biofilm-forming bacterial colonies, resistance to antibiotics with a combination of washing the tracheal cannula using chlorhexidine and NaCl 0.9% in patients using tracheal cannula.

Methods: There were 40 subjects who were grouped into 20 subjects in the control group (washing the cannula using 0.9% NaCl washed 100 ml for 10 minutes) while the study group (washing cannula using 0.9% NaCl as much as 100 ml then washed with 2.5% chlorhexidine solution at least 20 ml evenly for 10 minutes). This study used a parallel randomized controlled trial of 2 groups with a single blinded.

Results: Of the 40 subjects studied, 17 subjects (85%) each group produced biofilm-forming bacteria prior to intervention. After intervention in the study group, 15 subjects were biofilm negative and 5 biofilm positive subjects p = 0.001. The most common bacteria found in the control group is Pseudomonas aeruginosa, while in the study group some bacteria such as Acinetobacter sp. and Proteus mirabilis. Amoxicilin-Clavulanate had the highest resistance to biofilm forming bacteria in both groups. Piperacillin, ceftazidime, ciprofloxacin and meropenem have the highest sensitivity to biofilm-forming bacteria.

Conclusion: There was a significant decrease in the number of colonies that produced biofilm in the tracheal cannula in the study group compared to the control group in tracheal cannula washing (p = 0.001)."

"ABSTRAKPendahuluan : Deteksi Basil Tahan Asam (BTA) Ziehl Neelsen cairan serebrospinal (CSS) di RSUPN dr Cipto Mangunkusumo tahun 2014 tidak pernah positif. Pewarnaan Auramine-O dapat meningkatkan sensitivitas deteksi BTA. Perlu modifikasi sitosentrifugasi pada pulasan BTA, agar dapat deteksi BTA lebih banyak dan cepat.Metode: uji diagnostik pulasan BTA CSS Ziehl Neelsen metode non sitosentrifugasi, Cytospin, Cytopro serta Auramine-O Cytopro dibandingkan dengan baku emas biakan TB MGIT.Hasil: Uji diagnostik BTA Ziehl Neelsen tanpa sitosentrifugasi, tidak dapat dinilai karena BTA tidak terdeteksi di semua sampel. Uji diagnostik Ziehl Neelsen Cytospin dan Cytopro sama yaitu sensitivitas 64%, spesifisitas 85%, NPP 54%, NPN 89 %. Uji diagnostik Auramine-O Cytopro, sensitivitas 91%, spesifisitas 26%, NPP 26%, NPN 91 %.Kesimpulan: Pulasan BTA CSS metode sitosentrifugasi dapat menggantikan metode non sitosentrifugasi. Pulasan BTA CSS Auramine-O dapat me rule out diagnosis meningitis TB.

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ABSTRACT

Introduction: Detection of AFB from CSF with Ziehl Neelsen staining in 2014 at dr Cipto Mangunkusumo general hospital never gives positive result. Staining with Auramine-O smear staining can increase its sensitivity. Acid fast bacilli cytocentrifugation is needed as a modification in AFB slide preparation to gain more bacilli faster.

Methods: Diagnostic perfomance of AFB slide prepared by non cytocentrifugation, Cytospin, Cytopro with Ziehl Neelsen stain, prepared by cytopro with Auramine-O stain are compared to TB MGIT as a gold standard.

Results: Acid fast bacilli slide prepared with non cytocentrifugation method and stained by Ziehl Neelsen cannot be obtained because AFB was not detected in all samples. Acid fast bacilli slide prepared with Cytospin and Cytopro and stained with Ziehl Neelsen has sensitivity (64%), specificity (85%), PPV (54%), 89% NPV. Acid fast bacilli slide prepared with Cytopro and stained with Auramine-O has sensitivity (91%), specificity (26%), PPV (26%), 91 % NPV.

Conclusion: Detection of AFB from CSF with cytocentrifugation method can replace non cytocentrifugation method. Acid fast bacilli slide prepared cytocentrifugation and stained by Auramine-O can rule out Tuberculous meningitis."

"Protein energy wasting (PEW) merupakan sindrom gangguan nutrisi yang sering terjadipada pasien penyakit ginjal kronik (PGK) dengan hemodialisis rutin sekitar 28-80%.Proses hemodialisis dapat meyebabkan hilangnya nutrien seperti asama amino,meningkatkan proses inflamasi yang kemudian dapat meningkatkan katabolisme protein,dan dapat menghambat utilisasi asam amino dalam sintesis protein. Jika tidak ditangani,PEW dapat meningkatkan morbiditas dan mortalitas pasien PGK. Tujuan utamapenelitian adalah untuk mengetahui profil asam amino pasien PGK dengan hemodialisisrutin. Desain penelitian adalah potong lintang dengan 60 subjek pasien PGK usia >18tahun dengan hemodialisis rutin di RS. Umum Pusat Nasional Dr. Cipto Mangukusumo.Sampel berupa dried blood spot (DBS) dan pemeriksaan asam amino menggunakanmetode Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS). Asam aminoyang diperiksa adalah asam amino nonesensial (alanin, arginin, asam aspartat, asamglutamat, asparagin, glisin, glutamin, prolin, serin, tirosin), esensial (histidin, fenilalanin,isoleusin, leusin, lisin, metionin, treonin, triptofan, valin), dan khusus (ornitin, sitrulin).Hasil penelitian didapatkan hampir semua kadar asam amino pada subjek lebih rendahterutama alanin, tirosin, histidin, dan valin; sebaliknya asam aspartat dan serin ditemukanlebih tinggi kadarnya dibandingkan nilai rujukan Mayo dan data internal dewasa sehat.Didapatkan adanya hubungan bermakna antara jenis kelamin dengan fenilalanin,isoleusin, leusin; hipoalbuminemia (albumin <4 g/dL) dengan glisin; hipoalbuminemia(<3,5 g/dL) dengan arginin, asam aspartat, asparagin, histidin, lisin, metionin, danornitin. Didapatkan korelasi yang bermakna antara usia dengan BCAA (isoleusin, leusin,valin), dan metionin; dan hemoglobin dengan isoleusin. Penelitian ini merupakanpenilitian pertama tentang profil asam amino pada pasien PGK dengan hemodialisis diIndonesia dan penelitian pertama kali yang menggunakan sampel DBS pada orangdewasa. Dengan diketahuinya profil asam amino pada PGK dapat dimanfaatkan sebagaidasar pemberian jenis suplementasi asam amino yang sesuai dengan populasi pasien PGKdengan hemodialisis di Indonesia.

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Protein energy wasting (PEW) is a nutritional disorder syndrome that often occurs in

patients with chronic kidney disease (CKD) on routine hemodialysis around 28-80%. The

process of hemodialysis can cause the loss of nutrients such as amino acids, increase the

inflammatory process which can increase protein catabolism, and be able to inhibit the

utilization of amino acids in protein synthesis. If untreated, PEW can increase the

morbidity and mortality of CKD patients. The main objective of the study was to

determine the amino acid profile of CKD patients on routine hemodialysis. The study

design was cross sectional with 60 subjects of CKD patients aged >18 years on routine

hemodialysis at Dr. Cipto Mangunkusumo National Public Hospital. Samples in the form

of dried blood spot (DBS) and amino acid examination using the Liquid Chromatography

Tandem Mass Spectrometry (LC-MS/MS) method. Amino acids examined were

nonessential amino acids (alanine, arginine, aspartic acid, glutamic acid, asparagine,

glycine, glutamine, proline, serine, tyrosine), essential (histidine, phenylalanine,

isoleucine, leucine, lysine, methionine, glycine, glutamine, proline, serine, tyrosine),

special (ornithine, citrulline). The results showed that almost all amino acid levels in the

subjects were lower especially alanine, tyrosine, histidine, and valine; in contrast, aspartic

acid and serine were found to be higher than Mayo reference value and internal data of

healthy adults. A significant relationship was found between gender and phenylalanine,

isoleucine, leucine; hypoalbuminemia (albumin <4g/dL) with glycine; hypoalbuminemia

(<3.5 g/dL) with arginine, aspartate acid, asparagine, histidine, lysine, methionine, and

ornithine. Significant correlation was obtained between age with BCAA (isoleucine,

leucine, valine), and methionine; and hemoglobin with isoleucine. This study is the first

study of the amino acid profile in CKD patients with hemodialysis in Indonesia and the

first study using DBS samples in adults. Knowing the amino acid profile in CKD can be

used as a basis for the of amino acid supplementation that is suitable for the population

of CKD patients with hemodialysis in Indonesia."

"Coronavirus Disease 2019 (COVID-19) merupakan kondisi darurat global dengan angka morbiditas dan mortalitas tinggi. Penyebab terbanyak luaran buruk adalah komorbid yaitu diabetes melitus (DM). Prevalensi dan dampak sesehatan DM di Indonesia tinggi sehingga perlu dilakukan penelitian tentang pengaruh DM terhadap luaran buruk pasien dengan COVID-19. Luaran buruk pada penelitian ini adalah jika selama perawatan pernah terdapat perawatan di ruang intensif, penggunaan ventilator mekanik dan atau kematian. Penelitian ini mencoba menganalisis apakah parameter metabolik yaitu HbA1c, glukosa darah sewaktu (GDS) dan profil lipid pada 48 jam awal perawatan dapat digunakan untuk memprediksi luaran buruk pasien dengan COVID-19 . Sejumlah 66 data pasien yang terdiri dari 33 data luaran buruk dan 33 luaran tidak buruk diikutsertakan pada penelitian. Ditemukan hubungan bermakna secara statistik pada rerata HbA1c, GDS, dan trigliserida sedangkan HDL, LDL dan kolesterol total tidak ditemukan perbedaan bermakna. Parameter HbA1c, GDS, dan trigliserida berturut-turut mempunyai luas Area Under the Curve (AUC) 71,1% ;71,9 dan 66,7%. Analisis regresi logistik didapatkan model prediksi luaran buruk menggunakan trigliserida >155,4 mg/dL, GDS >122,5 mg/dL, serta ada tidaknya komorbid hipertensi, penyakit ginjal dan komorbid lain.

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Coronavirus Disease 2019 (COVID-19) is global emergency with high morbidity and mortality. Bad outcome mostly caused by any comorbidity such as diabetic mellitus. Prevalens and impact of diabetes in Indoensia was high so there was high corncern of diabetic effect on COVID-19 bad outcome. Bad outcome in this study refers to intensive care hospitalization, mechanichal ventilation support and death. This study try to analyze whether metabolic parameter HbA1c, random blood glucose (RBG) and lipid profile at 48 hours admission can be used for predicting COVID-19 bad outcome. Sixty six data from patient consist of each 33 bad and good outcome was collected in this study. There is significant association between bad outcome to mean difference HbA1c, RBG and lipid profile but there is no significant association in HDL, LDL and total cholesterol. HbA1c, RBG, and triglyserida have Area Under the Curve (AUC) 71,1% ;71,9 and 66,7%. Regression logistic analysis generate bad outcome prediction model using triglyseride >155,4 mg/dL, RBG >122,5 mg/dL, and whether or not hypertension, renal disease and other comorbidity."

"Anemia defisiensi besi merupakan salah satu komplikasi penyakit ginjal kronis (PGK) yang sering dijumpai terutama pada pasien yang menjalani hemodialisis rutin. Inflamasi merupakan kondisi yang selalu ada pada pasien PGK yang menjalani hemodialisis, dengan salah satu markernya yaitu C-reactive protein (CRP). Marker besi yang rutin digunakan seperti feritin dan saturasi transferin dipengaruhi oleh inflamasi sehingga status besi pada pasien PGK menjadi sulit dinilai. Marker lain seperti persentase eritrosit hipokrom (%Hypo-He), reticulocyte haemoglobin content (Ret-He), soluble transferrin receptor (sTfR), indeks sTfR, dan persentase eritrosit mikrositik (%MicroR) dapat digunakan untuk menilai status besi, namun belum rutin digunakan. Tujuan penelitian ini adalah untuk mengetahui pengaruh inflamasi terhadap %Hypo-He, Ret-He, sTfR, indeks sTfR, dan %MicroR pada pasien PGK dengan hemodialisis rutin dalam menentukan status besi. Penelitian ini merupakan studi potong lintang yang melibatkan 123 pasien hemodialisis rutin berusia lebih dari 18 tahun di Unit Hemodialisis RS Cipto Mangunkusumo yang berlangsung pada bulan Agustus sampai September 2018. Setiap subjek diperiksakan parameter %Hypo-He, Ret-He, dan %MicroR menggunakan alat automated hematology analyzer Sysmex XN 3000, sedangkan sTfR, indeks sTfR, dan CRP diperiksa menggunakan alat Cobas c311. Didapatkan median CRP sebesar 3,99 (0,2- 129,97) mg/L dengan proporsi pasien PGK dengan hemodialisis rutin yang mengalami inflamasi sebanyak 45,5%. Pada penelitian ini tidak didapatkan perbedaan %Hypo-He, Ret-He, sTfR, indeks sTfR, dan %MicroR pada pasien yang menjalani hemodialisis rutin yang mengalami inflamasi dan noninflamasi sehingga marker-marker tersebut dapat digunakan untuk menentukan status besi pada pasien PGK dengan hemodialisis rutin.

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Iron deficiency anemia is one of the complications seen in chronic kidney disease especially in routine hemodialysis patients. Inflammation, marked by C-reactive protein (CRP), is often found in chronic kidney disease (CKD) patients with hemodialysis. Routine iron markers, such as ferritin and transferrin saturation, are influenced by inflammation. Hence the iron status in CKD patients is difficult to interpret. Other markers like hypochromic erythrocytes percentage (%Hypo-He), reticulocyte haemoglobin content (Ret-He), soluble transferrin receptor (sTfR), sTfR index, and microcytic erythrocytes percentage (%MicroR) can be used to evaluate iron status, but these markers are not commonly used. This study aims to evaluate the influence of inflammation in %Hypo-He, Ret-He, sTfR, sTfR index, and %MicroR in routine hemodialysis patients to determine the iron status. This study was a cross sectional study comprised of 123 routine hemodialysis patients, aged over 18 years old, in Hemodialysis Unit Cipto Mangunkusumo Hospital during August to September 2018. Blood samples from all subjects were evaluated using automated hematology analyzer Sysmex XN 3000 for %Hypo-He, Ret-He, and %MicroR, and Cobas c311 for sTfR, sTfR index, and CRP. Median CRP in all patients was 3,99 (0,2-129,97) mg/L with inflammation occurred in 45,5% patients. There were no differences found in %Hypo-He, Ret-He, sTfR, sTfR index, and %MicroR in routine hemodialysis patients with inflammation and noninflammation so these markers could be used to evaluate iron status in hemodialysis patients."

"Defisiensi besi merupakan defisiensi nutrisi terbanyak di seluruh dunia, dengan prevalensi tertinggi pada kelompok perempuan usia reproduksi. Di Indonesia prevalensi anemia defisiensi besi pada ibu hamil 50,5%. Penting dilakukan penapisan dini sebelum terjadi anemia defisiensi besi, untuk mencegah komplikasi sistemik yang permanen, pada ibu maupun janin. Saat ini telah dikembangkan parameter ekuivalen hemoglobin retikulosit (RET-He) yang mendeteksi kadar hemoglobin dalam retikulosit. Usia retikulosit di sirkulasi hanya 24-48 jam, maka RET-He lebih menggambarkan keadaan sebenarnya dari status besi pada sumsum tulang. Saat besi di sumsum tulang menurun, RET-He akan mengalami penurunan. Pemeriksaan RET-He dilakukan pada alat hitung sel darah otomatis dan tidak memerlukan tabung darah tambahan karena dilaporkan sebagai bagian dari hitung retikulosit. Penelitian ini bertujuan untuk mendapatkan rentang nilai RET-He pada perempuan usia reproduksi, melakukan penapisan defisiensi besi pada perempuan hamil trimester I dan II menggunakan RET-He dan membandingkannya hemoglobin, feritin, dan saturasi transferin. Juga untuk mendapatkan titik potong RET-He dengan sensitivitas dan spesifisitas yang optimal pada perempuan hamil trimester I dan II. Didapatkan rentang nilai RET-He pada perempuan usia reproduksi 30,69-36,17 pg. Didapatkan 100 perempuan hamil trimester I dan II yang terdiri dari 3 kelompok berdasarkan feritin dan saturasi transferin yaitu 67 (67%) subyek tanpa defisiensi besi, 17 (17%) subyek dengan defisiensi besi tahap I, dan 16 (16%) subyek dengan defisiensi besi tahap II. Rerata ± SD kadar hemoglobin, RET-He, dan saturasi transferin adalah 12,35 ± 1,02 g/dL, 33,60 ± 1,88 pg, dan 28,63 ± 1,07%. Median(min-maks) feritin adalah 40,10 (6,24 ± 191,30) ng/mL. Dari kurva ROC untuk menentukan titik potong nilai RET-He yang memberikan sensitivitas dan spesifisitas terbaik dibandingkan dengan feritin sebagai baku emas, didapatkan RET-He dengan titik potong 33,65 pg pada sensitivitas 67% dan spesifisitas 64,18% dan area under the curve (AUC) 66,4%, serta didapatkan PPV 47,8%, NPV 79,6%, LR positif 1,86 dan LR negatif 0,52. Ditemukan perbedaan bermakna kadar RET-He antara kelompok tanpa defisiensi besi dan kelompok defisiensi besi tahap II dan antara kelompok defisiensi besi tahap I dan tahap II. Tidak terdapat perbedaan bermakna antara kelompok tanpa defisiensi besi dan kelompok defisiensi besi tahap I.

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Iron deficiency is the most common nutrient deficiency in the world, on developing and industrial countries. Population with highest risk of iron deficiencies is women in reproductive ages. In Indonesia the prevalence of iron deficiency anemia in pregnant women is 50,5%. Iron deficiency anemia in pregnancy can affect to both mother and fetus. In order to prevent permanent systemic complications, it is important to do early detection before iron deficiency anemia developed.

On early phase of iron deficiency before anemia developed, we need an additional test of ferritin, serum iron and saturation index aside from complete blood count. Nowadays people developed a parameter named reticulocyte hemoglobin equivalent (RET-He) which detect the hemoglobin in a young erythrocyte. Reticulocyte will be on circulation for only 24-48 hours, so the RET-He will give more appropriate condition of bone marrow iron. In condition where the bone marrow iron is depleted, the RET-He shows a decrease. This parameter can be tested together with CBC, so that it will not need additional blood sample.

This research aim to attain RET-He reference range on reproductive age women, to screen iron deficiency on first and second trimester pregnant women with RET-He and compare it to other parameters that available now : hemoglobin, ferritin, transferrin saturation, and to develope RET-He cut-off with optimal sensitivity and specificity.

RET-He’s reference range on reproductive women is 30,69-36,17 pg. We attained 100 I and II trimester pregnant women which can be divided into 3 groups based on ferritin and transferrin saturation : 67 women (67%) without iron deficiency, 17 women (17%) with iron deficiency stage I, and 16 women (16%) with iron deficiency stage II. Hemoglobin’s, RET-He’s and transferrin saturation’s mean ± SD are 12,35 ± 1,02 g/dL, 33,60 ± 1,88 pg, and 28,63 ± 1,07%. Ferritin’s median(min-max) are 40,10(6,24-191,30) ng/mL. Using ROC curve we found RET-He at 33,65 pg as an optimal cut-off point to differentiate iron deficiency with 67% sensitivity, 64,18% specificity, and 66,4% area under the curve (AUC).

From crosstabs table of RET-He with ferritin as gold standard and 33,65 pg as cut-off point we attained 47,8% PPV, 79,6% NPV, positive LR 1,86 and negative LR 0,52. We found significant differences of RET-He between non-iron deficiency and iron deficiency stage II groups and between iron deficieny stage I and iron deficiency stage II groups. There was no difference between non-iron deficiency and iron deficiency stage I groups."

"Latar belakang: Hemoglobin A1c HbA1c adalah pemeriksaan kontrol glikemik jangka panjang yang banyak digunakan. HbA1c berhubungan dengan risiko komplikasi diabetes. Akurasi pemeriksaan HbA1c dapat dipengaruhi kondisi hemoglobin varian. Hemoglobin varian adalah kelainan struktur hemoglobin. Di Indonesia, Hb. paling sering dijumpai. Sehingga peneliti ingin mengetahui prevalensi penderita hemoglobin varian pada pasien pemeriksaan HbA1c di RSUPNCM dan pengaruh hemoglobin varian terhadap pemeriksaan HbA1c metode afinitas boronat POCT dan ion-exchange HPLC dan gambaran mutasi gen hemoglobin varian heterozigot. Metode: Dilakukan uji ketelitian between day serta uji ketepatan within run menggunakan kontrol normal dan patologis. Subjek uji prevalensi adalah seluruh pasien yang melakukan pemeriksaan HbA1c di RSUPNCM. Terhadap subjek tersebut dilakukan pemeriksaan HbA1c metode ion-exchange HPLC dan pada subjek yang didapatkan variant window dilakukan analisa hemoglobin metode ion-exchange HPLC. Dilakukan uji perbedaan dua rerata antar kelompok pemeriksaan, subjek didapatkan secara konsekutif yang memenuhi krteria inklusi dan eksklusi. Terhadap subjek dilakukan pemeriksaan HbA1c metode ion-exchange HPLC, HbA1c metode afinitas boronat POCT Nycocard, dan HbA1c ion exchange extended HPLC dan dilakukan analisa hemoglobin metode ion-exchange HPLC. Analisa hemoglobin metode ion-exchange HPLC dilakukan terhadap seluruh subjek pada kedua kelompok. Dilakukan analisa DNA dengan metode PCR-RFLP dan metode DNA sequence untuk mengetahui gambaran mutasi hemoglobin varian heterozigot pada penelitian ini. Hasil: Didapatkan proporsi penderita hemoglobin varian sebesar 17 per 994 pasien 1.8 pada pasien yang melakukan pemeriksaan HbA1c di RSUPNCM. Pada uji perbedaan rerata HbA1c, metode afinitas boronat POCT dibandingkan ion-exchange extended HPLC didapatkan nilai HbA1c lebih rendah bermakna secara statistik pada kelompok hemoglobin varian p=0.006. Uji perbedaan rerata HbA1c metode ion-exchange HPLC dibandingkan dengan metode ion-exchange extended HPLC tidak didapatkan perbedaan bermakna pada kelompok subjek hemoglobin normal p= 0.534 dan hemoglobin varian p=0.781. Uji perbedaan median HbA1c metode afinitas boronat dan ion exchange extended HPLC tidak bermakna pada kelompok hemoglobin normal p=0.006. dan terdapat perbedaan bermakna pada kelompok hemoglobin varian p=0.006. Hemoglobin varian heterozigot pada penelitian ini terdiri dari. subjek HbG Makassar dan 19 subjek Hb. heterozigot. Hasil DNA sequence dideteksi HbE homozigot dan Hb. Makassar. Hasil PCR-RFLP didapatkan HbE heterozigot. Kesimpulan: Proporsi hemoglobin varian pada pasien pemeriksaan HbA1c di RSUPNCM adalah 17 per 994 pasien 1.8. Hemoglobin varian menyebabkan nilai HbA1c lebih rendah bermakna secara statistik dan klinis pada pemeriksaan metode afinitas boronat POCT dibandingkan metode ion-exchange extended HPLC. Hasil pemeriksaan HbA1c metode ion-exchange HPLC dibandingkan ion-exchange extended HPLC metode rujukan pada kedua kelompok tidak terdapat perbedaan bermakna. Hasil DNA sequence dideteksi HbE homozigot dan Hb. Makassar. Hasil PCR-RFLP didapatkan HbE heterozigotKata Kunci. Hb. Makassar, Hb E, pemeriksaan HbA1c, ion-exchange extended HPLC.

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Background: Hemoglobin A1c HbA1c is. widely used long term glycemic control check. HbA1c is associated with the risk of diabetes complications. Accuracy of HbA1c examination can be influenced by hemoglobin variant condition. Hemoglobin variant is hemoglobin structure disorder. In Indonesia, Hb. is most commonly found. Researcher wanted to know the prevalence of hemoglobin variant patient in HbA1c examination patient at RSUPNCM and the influence of hemoglobin variant on HbA1c examination of POCT boronate affinity method and HPLC ion exchange and gene mutation heterogeneous hemoglobin variant.

Method: Performed between day precision test and accuracy test within run using normal and pathological control. The subjects of prevalence test were all patients performing HbA1c examination at RSUPNCM. Against this subject, HbA1c examination of the HPLC ion exchange method and in the subjects obtained by the variant window was analyzed by the HPLC ion exchange method hemoglobin. The difference test was performed between the two groups, the subjects were obtained in. consecutive manner which fulfilled the inclusion and exclusion krteria. Subjects were subjected to HbA1c examination of the HPLC ion exchange method, HbA1c POCT Nycocard boronate affinity method, and HbA1c ion exchange extended HPLC and HPLC ion exchange hemoglobin analysis performed. The HPLC ion exchange method hemoglobin analysis was performed on all subjects in both groups. DNA analysis was performed using PCR RFLP method and DNA sequence method to find out the heterozygot hemoglobin mutations in this study.

Result: The proportion of variant hemoglobin patients was 17 per 994 patients 1.8 in patients who performed HbA1c examination at RSUPNCM. In the HbA1c mean difference test, the POCT boronate affinity method versus the HPLC extended exchange ion obtained significantly lower HbA1c values in the variant hemoglobin group. 0.006. HbA1c difference test of the HPLC ion exchange method compared with the HPLC extended ion exchange method found no significant difference in the normal hemoglobin group. 0.534 and the variant hemoglobin group. 0.781. The median HbA1c difference test of the boronate affinity method and the extended exchange ion HPLC was not significant in the normal hemoglobin group. 0.006. and there was. significant difference in the variant hemoglobin group. 0.006. Variant hemoglobin heterozygous in this study consisted of. subjects of HbG Makassar and 19 Hb. heterozygous subjects. The DNA sequence result was detected by HbE homozygot and Hb. Makassar. Results of PCR RFLP obtained HbE heterozygotes.

Conclusion: The proportion of variant hemoglobin in HbA1c examination patients at RSUPNCM was 17 per 994 patients 1.8. Variant hemoglobin causes significantly lower HbA1c values statistically and clinically on examination of the POCT boronate affinity method than the HPLC extended exchange ion method. HbA1c examination of ion exchange HPLC method compared to HPLC extended exchange ion reference method in both groups was not significantly different. The DNA sequence result was detected by HbE homozygot and Hb. Makassar. Results of PCR RFLP obtained HbE heterozygotesKey Words Hb. Makassar, Hb E, HbA1c examination, ion exchange extended HPLC."

"ABSTRAKLatar belakang : Penyakit jantung koroner (PJK) dan stroke merupakan penyebabkematian utama baik di negara Barat maupun di Indonesia terutama di daerahperkotaan. Setiap tahun lebih banyak orang meninggal karena penyakitkardiovaskular dibandingkan penyakit lain. Diabetes melitus merupakan faktorrisiko independen untuk penyakit kardiovaskular. Gangguan aliran darah yangmengakibatkan PJK maupun stroke disebabkan oleh trombosis arteri. Aktivasitrombosit diduga terjadi pada pasien diabetes melitus. Ketika trombosit teraktivasiakanterjadi beberapa perubahan diantaranya pelepasan kandungan granula danpembentukan tromboksan A2. Pengukuran tromboksan A2 sulit dilakukan karenasifatnya yang tidak stabil, maka dilakukan pengukuran terhadap metabolitnya 11-dehidro tromboksan B2. tujuan penelitian ini adalah menukur kadar 11 dehidroTxB2 di urin pada pasien diabetes melitus sebagai suatu petanda dini aktivasitrombosit dan mengkorelasikannya dengan hemoglobin A1c (HbA1c).Metoda : Empat puluh lima pasien diabetes melitus tipe 2 dan 30 non diabetessebagai kontrol diambil pada penelitian ini. Pengukuran kadar 11 dehidro TxB2 diurin dengan tehnik competitive EIA menggunakan reagen dari Cayman Chemical.Kadar 11-dehidro tromboksan B2 urin disajikan dalam bentuk rasio dengankreatinin urin. Pengukuran HbA1c dilakukan dengan metode akfinitas boronikmenggunakan NycocardR.Hasil : Pada kelompok diabetes melitus median kadar 11 dehidro TxB2 di urin1216,56 pg/mg kreatinin (70,53 – 12167,72 pg/mg kreatinin). Terdapat perbedaanbermakna dibanding kelompok non diabetes dengan median 200,55pg/mg kreatinin(57,19-602,46 pg/mg kreatinin). Terdapat korelasi yang kuat antara kadar 11dehidro TxB2 pada kelompok diabetik dengan indeks glikemik (HbA1c).Kesimpulan : 11 dehidro TxB2 di urin dapat dipakai sebagai petanda dini aktivasitrombosit pada pasien diabetes melitus dan mempunyai korelasi yang kuat denganHbA1c.

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ABSTRACTBackground: It is widely known that heart disease and stroke are the main cause ofdeath in Western countries. This issue found in Indosesia especially in the urbam ares.Diabetes mellitus is one of the independentbrisk faktor for cardiovaskular. Cirulatorydisorder that result in coronary heart disease and stroke is arterial thrombosis. Plateletplay an important role in the pathogenesis of arterial thrombosis. Some report statedthat platelet activation occurred in diabetes mellitus. When platelet are activated, somechange happened, i.e : released of granule content and thromboxane A2 (TxA2)formation. Measurement of TxA2 as a marker for platelet activation was hampered bythe instability of this substance. Therefore it is preferred to measure their stablemetabolite 11-dehydro thromboxane B2 in urine. The aim of this study is to measureurine 11-dehydro thromboxane B2 in diabetes mellitus as an early of platelet activationand to correlate this value with hemoglobin A1c.Methode: Forty five patients with type 2 diabetes mellitus and 30 non diabetic ascontrol group were enrolled in this study. Measurement of urine 11 dehidro TxB2 wasdone by competitive EIA using reagent from Cayman Chemical. The level of urine 11-dehydro TxB2 was expressed as ratio with urine creatinine. Measurement of HbA1cwas performed by boronic affinity method using NycocardR.Result : In diabetics group the median rate for urine 11 dehydro TxB2 was 1216,56pg/mg creatinine ( 70,53 - 12167,72 pg/mg creatinine). It was significantly higher thanthat of non diabetic group, which median was 200,55 pg/mg creatinine ( 57,19 -602,46 pg/ mg creatinine). the level of urine 11-dehydro TxB2 in diabetics groupshowed a strong correlation with HbA1c as glycemic index.Conclusion: Urine 11-dehydro TxB2 can be used as an early marker of plateletactivation in diabetes mellitus patients and there was a strong correlation with HbA1c."