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Abstrak :
Latar Belakang : Meropenem, salah satu antibiotik yang paling efektif terhadap bakteri gram negatif dan bakteri gram positif, dianggap sebagai pengobatan terakhir yang paling dapat diandalkan untuk infeksi bakteri. Penyebaran yang cepat dari resistensi meropenem, terutama diantara bakteri gram negatif, merupakan masalah kesehatan yang sangat penting. Berbagai faktor diketahui berhubungan dengan kejadian resistensi meropenem terhadap bakteri gram negatif, namun penelitian yang dilakukan pada pasien infeksi intra abdomen masih terbatas. Tujuan : Mengetahui faktor-faktor yang berhubungan dengan resistensi antibiotik meropenem terhadap bakteri gram negatif pada pasien infeksi intra-abdomen di RSCM tahun 2013-2017. Metode : Penelitian desain cross sectional dengan mengambil data dari rekam medis pasien infeksi intra abdomen pada rentang waktu tahun 2013-2017 sebanyak keseluruhan populasi terjangkau. Hasil : Tidak terdapat perbedaan bermakna secara statistik dari faktor-faktor yaitu, usia, jenis kelamin, penyakit yang menyertai, riwayat antibiotik, jumlah leukosit dan jumlah albumin yang berhubungan dengan resistensi meropenem terhadap bakteri gram negatif. Kesimpulan : Usia, jenis kelamin, penyakit yang menyertai, riwayat antibiotik, jumlah leukosit dan jumlah albumin bukan merupakan faktor yang berhubungan dengan resistensi meropenem terhadap bakteri gram negatif pada pasien infeksi intra abdomen. Penelitian lebih lanjut dibutuhkan untuk mengetahui pengaruh faktor-faktor lain yang berhubungan dengan resistensi meropenem terhadap bakteri gram negatif pada pasien infeksi intra abdomen. ......Background : Meropenem, one of the most effective antibiotics against gram-negative bacteria and gram-positive bacteria, is considered to be the most reliable last treatment for bacterial infections. The rapid spread of meropenem resistance, especially among gram negative bacteria, is a very important health problem. Various factors are known to be associated with the incidence of meropenem resistance to gram-negative bacteria, but studies conducted on patients with intra-abdominal infections are still limited. Objectives : To determine the factors associated with meropenem resistance against gram-negative bacteria in patients with intra-abdominal infections at Cipto Mangunkusumo Hospital in the year of 2013-2017. Methods : A cross sectional design study by taking data from medical records of intra-abdominal infection patients in the period of 2013-2017 as much as the entire affordable population. Results : There were no statistically significant differences in factors, namely age, sex, accompanying disease, history of antibiotics, number of leucocyte and amount of albumin associated with meropenem resistance against gram-negative bacteria. Conclusion : Age, sex, accompanying disease, history of antibiotics, number of leucocytes and amount of albumin are not factors associated with meropenem resistance against gram-negative bacteria in patients with intra-abdominal infections. Further research is needed to determine the effect of other factors related to meropenem resistance against gram-negative bacteria in patients with intra-abdominal infections.

Abstrak :
ABSTRAK Dalam upaya penatalaksanaan penderita penyakit kelenjar tiroid, harus dibuat diagnosis anatomik atau etiologik untuk mengetahui penyebab yang mendasari penyakit dan diagnosis fungsional untuk mengetahui status produksi hormon tiroid. Pemeriksaan laboratorium sangat berguna dalam membedakan fungsi kelenjar tiroid tersebut termasuk hipotiroid, eutiroid atau hipertiroid. Penelitian ini bertujuan untuk mengetahui apakah pemeriksaan TSH-sensitif metode IRMA dan ICMA dapat membedakan dengan jelas penderita hipertiroidisme dan kontrol eutiroid, dengan kata lain apakah pemeriksaan tersebut dapat dipakai sebagai uji saring untuk hipertiroidisme. Disamping itu ingin mendapatkan nilai rujukan TSH-IRMA dan ICMA yang dapat dipakai di UPF Patologi Klinik FKUI/RSCM. Subyek penelitian adalah 35 penderita hipertiroidisme, terdiri atas 25 orang wanita dan 10 orang laki-laki, berusia 21-59 {30,2) tahun. Sebagai kontrol adalah 70 orang yang mempunyai fungsi kelenjar tiroid eutiroid, terdiri atas 40 laki-laki dan 29 perempuan, berusia 15-73 (37) tahun. Kriteria diagnostik didasarkan pada temuan klinik dan hasil pemeriksaan laboratorium FT4I. Terhadap subyek penelitian dan kontrol dilakukan pemeriksaan T4 total, T3U, TSH-IRMA (DPC) dan TSH-ICMA (Amerlite). Hasil pemeriksaan kontrol: T4=4,1-15,1 (9,28) ug/dL; T3U = 19,3-33,0 (27,3)%; FT4I=0,81-3,59 (2,53); TSH-IRMA=O,25-3,60 (1,38) mIU/L dan TSH-ICMA=0,54-3,12 (1,34) mIU/L. Terdapat korelasi terbalik antara nilai T4 total, T3U dan FT4I dengan TSH-IRMA maupun TSH-ICMA. Tidak terdapat perbedaan nilai TSH kontrol laki-laki dan perempuan. Tidak terdapat hubungan antara umur dan nilai TSH. Nilai rujukan TSH-IRMA = 0,39-3,63 mIU/L, dan TSH-ICMA = 0,49-2,97 mIU/L.Hasil pemeriksaan penderita hipertiroid: T4 = 16,0->24 ng/dL; T3U=30,3-43,7 (38,3)7.; FT4I = 5,36->10,49; 31 (88,51.) orang mempunyai nilai TSH-IRMA dan ICMA tidak terukur dan, 4 Orang mempunyai nilai TSH-IRMA 0,09; 0,12; 0,16; 0,18 dan TSH-ICMA 0,06; 0,12; 0,13; 0,14. Nilai TSH-IRMA dan TSH-ICMA penderita hipertiroid berbeda bermakna dengan kontrol eutiroid. Terdapat korelasi antara nilai TSH-IRMA dengan TSH-ICMA (r = 0,9922). Nilai TSH-ICMA lebih rendah 6,6% dibanding TSH-IRMA. Nilai batas deteksi TSH-IRMA = 0,09 mIU/L dan TSH-ICMA = 0,04 mIU/L. Biaya per tes TSH-IRMA lebih mahal dibanding TSH-ICMA, karena pemeriksaan TSH-IRMA harus dilakukan in duplo. Pemeriksaan TSH-IRMA dan TSH-ICMA sensitif secara analitik dan klinik untuk diagnosis hipertiroidisme. Kesimpulan penelitian ialah pemeriksaan TSH-IRMA dan TSH﷓ICMA mampu membedakan dengan jelas penderita hipertiroidisme dan kontrol eutiroid, dan dapat dipakai sebagai uji saring hipertiroidisme. Batas deteksi pemeriksaan TSH-ICMA lebih rendah dari pada TSH-IRMA. Nilai rujukan TSH-IRMA berbeda dengan TSH-ICMA. Disarankan untuk melakukan penelitian serupa dengan subyek penelitian dan kontrol (penderita rawat tinggal dan rawat jalan) yang lebih banyak agar dapat ditentukan nilai batas TSH untuk diagnosis hipertiroidisme, dan mendapatkan nilai rujukan yang lebih memenuhi syarat. Disarankan pula untuk menilai kemampuan pemeriksaan TSH untuk memantau pengobatan hipertiroidisme dan pengobatan hormon tiroid.

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In managing patients with thyroid diseases, an anatomical or etiological diagnosis should be made for knowing the basic causes, and functional diagnosis for knowing the thyroid hormone production. Laboratory tests are necessary to differentiate whether the condition is hypothyroid, euthyroid or hyperthyroid. The goal of this study was to know whether TSH-IRMA and ICMA tests can clearly differentiate hyperthyroid patients from euthyroid, and whether this test can be used as the first test for hyperthyroidism. More over, to determine the reference range of TSH-IRMA and ICMA which can be used in the Departement of Clinical Pathology, Dr Cipto Mangunkusumo hospital / Faculty of Medicine University of Indonesia. The subjects of this study were 35 patients with hyperthyroidism. They consist of 25 women and 10 men, who were 21-59 (30,2) years old. We took 70 people who were in euthyroid condition, about 15-73 (37) years old as controls. The criteria of diagnosis were based on clinical finding and FT4I test. Subjects and controls were examined for total T4, T3U, TSH-IRMA (DPC) and TSH-ICMA (Amerlite) levels. Values of the controls were T4 = 4,1-15,1 (9,28) ug/dL; T3U = 19,3-33,0 (27,3)%; FT4I = 0,81-3,59 (2,53); TSH-IRMA = 0,25-3,60 (1,3B) mIU/L and TSH-ICMA = 0,54-3,12 (1,34) mIU/L. There was negative correlation between total T4, T3U or FT4I level and TSH-IRMA or TSH-ICMA. There was no difference between TSH level in male and female controls. No correlation was found between age and TSH level. The reference value of TSH-IRMA was 0,39-3,63 mIU/L and TSH-ICMA was 0,49-2,97 mIU/L. The level of total T4, T3U and FT4I in hyperthyroid were 16,0->24 ng/dL, 30,3-43,7 (38,3)7 and 5,36-7.10,49 respectively. TSH-IRMA and TSH-ICMA value were undetectable in 31(88,5%) persons, and 4 persons have TSH-IRMA level of 0,09; 0,12; 0,16; 0,1B and TSH-ICMA level of 0,06; 0,12; 0,13; 0,14. TSH﷓IRMA and TSH-ICMA level in hyperthyroid were significantly lower than in euthyroid. There was a good correlation between TSH-IRMA and TSH-ICMA (r = 0,9922). T5H-ICMA was 6,6% lower than TSH-IRMA. The detection limit of TSH-IRMA was 0,09 mIU/L and TSH-ICMA was 0,04 mIU/L. One TSH-IRMA test was more expensive than one TSH-ICMA test, because TSH-IRMA test must be performed in duplicate. TSH-IRMA and TSH-ICMA assays were analytically and clinically sensitive and specific for diagnosing hyperthyroidism. In conclusion, TSH-IRMA and TSH-ICMA assays could clearly differentiate hyperthyroid from euthyroid patients, and suitable as screening tests for hyperthyroidism. The detection limit of TSH-ICMA was lower than T5H-IRMA. The reference range of TSH-IRMA was different from TSH-ICMA. Further study with more subjects is still needed to determine TSH lower limit value for diagnosing hyperthyroidism and a more acceptable reference value. We suggest another study to evaluate TSH values in controlling treatment of hyperthyroidism and thyroid hormones supplementation.

Abstrak :
Ekuivalen hemoglobin retikulosit menggambarkan banyaknya besi dalam retikulosit yang akan digunakan dalam proses pembentukan hemoglobin. Pada alat Sysmex parameter tersebut dikenal sebagai Ret-He. Namun demikian, saat ini parameter tersebut belum digunakan secara rutin di Indonesia. Tujuan penelitian ini adalah untuk mendapatkan nilai cut off, sensitivitas dan spesifisitas Ret-He untuk penilaian status besi pada pasien penyakit ginjal kronik dengan hemodialisis. Desain penelitian potong lintang, terdiri dari 120 subyek PGK dengan hemodialisis. Dilakukan pemeriksaan hematologi lengkap, Ret-He serta pemeriksaan besi serum dan unsaturated iron binding capacity (UIBC) untuk menghitung nilai saturasi transferin. Penentuan nilai cut off Ret-He berdasarkan kurva receiver operating characteristic (ROC) dengan saturasi transferin sebagai baku emas. Untuk penilaian status besi, didapatkan nilai cut off Ret-He 30,3 pg dengan sensitivitas 81,6% dan spesifisitas 76,8% . Parameter Ret-He dapat digunakan sebagai alternatif untuk penilaian status besi pasien penyakit ginjal kronik dengan hemodialisis. ......Hemoglobin reticulocyte equivalent represent the iron content in the reticulocyte that will be used in hemoglobinization process. In Sysmex hematology analyzer this parameter known as Ret-He. However, this parameter has not been routinely used in Indonesia. The objective of this study is to determine cut-off, sensitivity and specificity of Ret-He to assess iron deficient state in chronic kidney disease patients undergoing hemodialysis. One hundred and twenty patients undergoing hemodialysis were included in the study. Complete blood count, Ret-He and transferin saturation were determined. The receiver operating characteristic curve were demonstrated to obtain the cut off value of Ret-He. In 30.3 pg Ret-He cut off point, the sensitivity and spesificity to assess iron deficient state were 81.6% and 76.8% respectively. Ret-He can be used as an alternative parameter to assess iron deficient state in chronic kidney disease patients undergoing hemodialysis.

Abstrak :
Diabetes melitus merupakan suatu kelompok penyakit metabolik dengan hiperglikemia sebagai karakteristik utama. Hiperglikemia terjadi karena kelainan sekresi insulin, kerja insulin, dan atau keduanya. Sekitar 50% penyandang diabetes di Indonesia belum terdiagnosis sehingga komplikasi akibat DM tidak dapat dihindari. Pengendalian terjadinya komplikasi dilakukan dengan kontrol glikemik secara teratur. Pemeriksaan kontrol glikemik antara lain dengan glukosa darah puasa, HbA1c, dan fruktosamin. Penelitian ini bertujuan untuk melihat gambaran kadar fruktosamin dan HbA1c pada diabetes melitus tipe 2 tidak terkontrol, mengetahui perubahan kadar fruktosamin dan HbA1c setelah terapi 2 minggu dan 8 minggu, serta hubungan antara keduanya. Penelitian ini menggunakan desain kohort prospektif pada 33 subyek yang terdiri dari 24 orang perempuan dan 9 orang laki-laki. Subyek penelitian diikuti selama 2 minggu dan 8 minggu sejak dilakukan perubahan terapi. Penelitian dimulai pada bulan Februari sampai April 2015. Subyek yang termasuk dalam penelitian adalah diabetes mellitus tipe 2 yang tidak terkontrol dengan HbA1c>7%. Hasil penelitian diperoleh nilai median dan rentang fruktosamin pada minggu ke-0, minggu ke-2, dan minggu ke-8 berturut-turut 362 μmol/L (257-711), 327 μmol/L (234-616), dan 350 μmol/L (245-660). Kadar HbA1c memiliki nilai median dan rentang pada minggu ke-0, minggu ke-2, dan minggu ke-8 yaitu 9.3% (7.1-14.8), 8.8% (6.9-12.7), dan 8.4% (5.9-14.2). Terdapat penurunan bermakna kadar fruktosamin dan HbA1c dengan p<0.001. Adanya korelasi yang kuat dan arah korelasi yang positif antara fruktosamin dan HbA1c (minggu ke-0, r=0.86; minggu ke-2, r=0.82; minggu ke-8, r= 0.84). Pada penelitian ini diperoleh penurunan yang bermakna kadar fruktosamin dan HbA1c pada 2 minggu dan 8 minggu setelah terapi dengan korelasi yang kuat ( r > 0.8) dan arah korelasi positif. Fruktosamin lebih baik digunakan untuk kontrol glikemik jangka menengah (2 minggu) sedangkan HbA1c lebih baik dipakai untuk kontrol glikemik jangka panjang (8 minggu).

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Diabetes mellitus is a group of metabolic diseases with hyperglycemia as the main characteristics. Hyperglycemia occurs due to abnormalities in insulin secretion, insulin action, or both. Approximately 50% of people with diabetes in Indonesia have not been diagnosed, thus complications due to diabetes cannot be avoided. Taking control of diabetes mellitus can be done through glycemic control measurements on a regular basis. Fasting blood glucose, HbA1c, and fructosamine tests are lists of key features for glycemic control measurements. The aims of this study was to overview the levels of fructosamine and HbA1c in uncontrolled type-2 diabetes mellitus, determine changes in fructosamine and HbA1c levels after two weeks and eight weeks of treatment, and analyze the relationship between the two. This study used a prospective cohort design with 33 subjects consisted of 24 women and 9 men. Subjects were followed for two weeks and eight weeks after the initial therapy amendment. The study began in February and April 2015. The subjects included in the study were uncontrolled type-2 diabetes mellitus with HbA1c> 7%. Fructosamine concentration, given as median and range values, at weeks 0, 2, and 8 were 362 μmol/L (257-711), 347 μmol/L (234-660), and 333 μmol/L (235-676), respectively. HbA1c levels (median and range) at weeks 0, 2, and 8 were 9.3% (7.1-14.8), 8.8% (6.9-12.7) and 8.4% (5.9-14.2). There was a significant reduction of fructosamine and HbA1c levels (p <0.001). A strong and positive correlation were found between fructosamine and HbA1c (week 0, r = 0.86; week 2, r = 0.82; week 8, r = 0.84). From this study, it can be concluded that fructosamine and HbA1c levels were significantly reduced at weeks 2 and 8 after treatment, with a positive strong correlation (r> 0.8). Thus, fructosamine is preferable for medium-term (two weeks) glycemic control while the HbA1c is preferred for long-term (eight weeks) glycemic control.

Abstrak :
[ABSTRAK
Anemia defisiensi besi dan thalassemia β trait merupakan penyebab tersering anemia mikrositik hipokrom di Indonesia. Kedua penyakit tersebut sulit dibedakan hanya dengan pemeriksaan hematologi, oleh karena itu diperlukan pemeriksaan tambahan seperti feritin dan analisis hemoglobin. Namun tidak semua laboratorium dapat melakukan pemeriksaan ini. Banyak penelitian yang membedakan kedua penyakit tersebut dengan indeks eritrosit. Namun indeks eritrosit memiliki nilai diagnostik yang berbeda di setiap negara dan belum ada data di Indonesia. Penelitian ini melakukan uji diagnostik Indeks Mentzer, RDW, Green- King, Sirdah, dan mencari nilai cut-off baru yang memberikan nilai diagnostik lebih baik. Penelitian terdiri dari 98 subyek definitif anemia defisiensi besi dan 80 subyek thalassemia β trait. Nilai diagnostik Indeks Mentzer untuk anemia defisiensi besi adalah sensitivitas 83.6%, spesifisitas 66.2%, NPP 75.2%, NPN 76.8%, RKP 2.4, RKN 0.2. Nilai diagnostik Indeks Mentzer untuk thalassemia β trait adalah sensitivitas 66.2%, spesifisitas 83.6%, NPP 76.8%, NPN 75.2%, RKP 4.0, RKN 0.4. Nilai diagnostik Indeks RDW untuk anemia defisiensi besi adalah sensitivitas 91.8%, spesifisitas 75%, NPP 81.8%, NPN 88.2%, RKP 3.6, RKN 0.1. Nilai diagnostik Indeks RDW untuk thalassemia β trait adalah sensitivitas 75%, spesifisitas 91.8%, NPP 88.2%, NPN 81.8%, RKP 9.1, RKN 0.2. Nilai diagnostik Indeks Green-King untuk anemia defisiensi besi adalah sensitivitas 96.9%, spesifisitas 67.5%, NPP 78.5%, NPN 94.7%, RKP 2.9, RKN 0.04. Nilai diagnostik Indeks Green-King untuk thalassemia β trait adalah sensitivitas 67.5%, spesifisitas 96.9%, NPP 94.7%, NPN 78.5%, RKP 22.0, RKN 0.3. Nilai diagnostik Indeks Sirdah untuk anemia defisiensi besi adalah sensitivitas 92.8%, spesifisitas 58.7%, NPP 73.3%, NPN 87.0%, RKP 2.2, RKN 0.1.Nilai diagnostik Indeks Sirdah untuk thalassemia β trait adalah sensitivitas 58.7%, spesifisitas 92.8%, NPP 87.0%, NPN 73.3%, RKP 8.2, RKN 0.4. Nilai cut-off baru Indeks Mentzer adalah 13.44, RDWI 233.4, Green-King 75.06, dan Sirdah 32.52. Keempat indeks eritrosit dapat diaplikasikan untuk orang Indonesia dengan Indeks Green-King sebagai indeks yang terbaik.

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ABSTRACT
Iron deficiency anemia and β trait thalassemia are the most common causes of microcytic hypochromic anemia in Indonesia. Differentiation between them is difficult when solely based on a hematology examination, so additional laboratory tests are required such as ferritin and hemoglobin analysis. However, not all laboratories can perform these tests. Many erythrocytes indices have been proposed to determine whether a blood sample is more suggestive for iron deficiency anemia or β trait thalassemia. Unfortunately these indices have different diagnostic value in many countries and there is no data about diagnostic value in Indonesia. This study performs diagnostic test Mentzer, RDW, Green-King, and Sirdah Index and develops a new cut-off point that could make a better diagnostic value. This study consists of 98 subjects of iron deficiency anemia and 80 subjects of β trait thalassemia. Diagnostic values of Mentzer Index for iron deficiency anemia were sensitivity 83.6%, specificity 66.2%, PPV 75.2%, NPV 76.8%, LR+ 2.4, LR- 0.2. Diagnostic values of Mentzer Index for β trait thalassemia were sensitivity 66.2%, specificity 83.6%, PPV 76.8%, NPV 75.2%, LR+ 4.0, LR- 0.4. Diagnostic values of RDW Index for iron deficiency anemia were sensitivity 91.8%, specificity 75%, PPV 81.8%, NPV 88.2%, LR+ 3.6, LR- 0.1. Diagnostic values of RDW Index for β trait thalassemia were sensitivity 75%, specificity 91.8%, PPV 88.2%, NPV 81.8%, LR+ 9.1, LR- 0.2. Diagnostic values of Green- King Index for iron deficiency anemia were sensitivity 96.9%, specificity 67.5%, PPV 78.5%, NPV 94.7%, LR+ 2.9, LR- 0.04. Diagnostic values of Green-King Index for β trait thalassemia were sensitivity 67.5%, specificity 96.9%, PPV 94.7%, NPV 78.5%, LR+ 22.0, LR- 0.3. Diagnostic values of Sirdah Index for iron deficiency anemia were sensitivity 92.8%, specificity 58.7%, PPV 73.3%, NPV 87.0%, LR+ 2.2, LR- 0.1. Diagnostic values Sirdah Index for β trait thalassemia were sensitivity 58.7%, specificity 92.8%, PPV 87.0%, NPV 73.3%, LR+ 8.2, LR- 0.4. The new cut-off point of Mentzer, RDW, Green-King, and Sirdah Index was 13.44, 233.4, 75.06, and 32.52 respectively. All indices can be applied for Indonesian people, among which Green-King Index had the best diagnostic value, Iron deficiency anemia and β trait thalassemia are the most common causes of microcytic hypochromic anemia in Indonesia. Differentiation between them is difficult when solely based on a hematology examination, so additional laboratory tests are required such as ferritin and hemoglobin analysis. However, not all laboratories can perform these tests. Many erythrocytes indices have been proposed to determine whether a blood sample is more suggestive for iron deficiency anemia or β trait thalassemia. Unfortunately these indices have different diagnostic value in many countries and there is no data about diagnostic value in Indonesia. This study performs diagnostic test Mentzer, RDW, Green-King, and Sirdah Index and develops a new cut-off point that could make a better diagnostic value. This study consists of 98 subjects of iron deficiency anemia and 80 subjects of β trait thalassemia. Diagnostic values of Mentzer Index for iron deficiency anemia were sensitivity 83.6%, specificity 66.2%, PPV 75.2%, NPV 76.8%, LR+ 2.4, LR- 0.2. Diagnostic values of Mentzer Index for β trait thalassemia were sensitivity 66.2%, specificity 83.6%, PPV 76.8%, NPV 75.2%, LR+ 4.0, LR- 0.4. Diagnostic values of RDW Index for iron deficiency anemia were sensitivity 91.8%, specificity 75%, PPV 81.8%, NPV 88.2%, LR+ 3.6, LR- 0.1. Diagnostic values of RDW Index for β trait thalassemia were sensitivity 75%, specificity 91.8%, PPV 88.2%, NPV 81.8%, LR+ 9.1, LR- 0.2. Diagnostic values of Green- King Index for iron deficiency anemia were sensitivity 96.9%, specificity 67.5%, PPV 78.5%, NPV 94.7%, LR+ 2.9, LR- 0.04. Diagnostic values of Green-King Index for β trait thalassemia were sensitivity 67.5%, specificity 96.9%, PPV 94.7%, NPV 78.5%, LR+ 22.0, LR- 0.3. Diagnostic values of Sirdah Index for iron deficiency anemia were sensitivity 92.8%, specificity 58.7%, PPV 73.3%, NPV 87.0%, LR+ 2.2, LR- 0.1. Diagnostic values Sirdah Index for β trait thalassemia were sensitivity 58.7%, specificity 92.8%, PPV 87.0%, NPV 73.3%, LR+ 8.2, LR- 0.4. The new cut-off point of Mentzer, RDW, Green-King, and Sirdah Index was 13.44, 233.4, 75.06, and 32.52 respectively. All indices can be applied for Indonesian people, among which Green-King Index had the best diagnostic value]

Abstrak :
ABSTRAK
Sepsis didefinisikan sebagai suatu systemic inflammatory response syndrome SIRS disertai infeksi, terbukti ataupun tidak, dengan perkembangan penyakit hingga sepsis berat dan syok sepsis. Sepsis merupakan masalah kesehatan yang penting dengan angka mortalitas yang tinggi, mencapai 50 pada sepsis berat. Penelitian ini bertujuan untuk mengetahui peran saturasi oksigen vena sentral ScvO2 , perbedaan tekanan parsial karbondioksida vena sentral dan arteri pCO2 gap , dan kadar laktat saat baseline dan pasca resusitasi, serta bersihan laktat sebagai penanda prognostik pada pasien sepsis berat. Desain penelitian adalah kohort retrospektif dengan 54 pasien sepsis berat, terdiri dari 27 pasien meninggal dalam 14 hari perawatan dan 27 pasien hidup. Pada penelitian ini didapatkan perbedaan bermakna pada kadar laktat pasca resusitasi dan bersihan laktat antara kedua kelompok, sedangkan pada ScvO2 baseline, ScvO2 pasca resusitasi, dan kadar laktat baseline tidak didapatkan perbedaan bermakna. Pada kadar laktat pasca resusitasi didapatkan besar area under the curve AUC untuk memprediksi mortalitas sebesar 84,4 , dengan cutoff 1,45 mmol/L, sensitivitas 74,1 dan spesifisitas 85,2 . Pada bersihan laktat didapatkan besar AUC untuk memprediksi pasien sepsis berat yang hidup sebesar 99,5 , dengan cutoff 1,5 , sensitivitas 100 dan spesifisitas 92,6 . Angka mortalitas pada kelompok pCO2 gap baseline < 6 mmHg sebesar 59,5 dan ge; 6 mmHg sebesar 29,4 , serta pada kelompok pCO2 gap pasca resusitasi < 6 mmHg sebesar 50,0 dan ge; 6 mmHg sebesar 50,0 . Parameter kadar laktat pasca resusitasi dapat digunakan untuk memprediksi mortalitas dengan cutoff 1,45 mmol/L, dan bersihan laktat untuk memprediksi pasien yang hidup dengan cutoff 1,5.

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ABSTRACT
Sepsis is defined as systemic inflammatory response syndrome SIRS accompanied with infection, proven or not, that can progress to severe sepsis or septic shock. Sepsis is an important health problem with high mortality rate, reaching 50 in severe sepsis. This study aims to find out the role of central venous oxygen saturation ScvO2 , carbondioxide partial pressure gap of central venous and arterial pCO2 gap , and lactate at baseline and post resuscitation, and lactate clearance as prognostic markers in severe sepsis. The study design is retrospective cohort with 54 severe sepsis patients, consists of 27 patients that died within 14 days of stay and 27 patients that survived. This study found significant difference in post resuscitation lactate and lactate clearance between both groups, while baseline ScvO2, post resuscitation ScvO2, and baseline lactate was not significantly different. The size of area under the curve AUC for post resuscitation lactate to predict mortality is 84,4 , with cutoff 1,45 mmol L, sensitivity 74,1 and specificity 85,2 . The size of AUC for lactate clearance to predict severe sepsis patients that survived is 99,5 , with cutoff 1,5 , sensitivity 100 and specificity 92,6 . Mortality rate in baseline pCO2 gap group 6 mmHg is 59,5 and ge 6 mmHg is 29,4 , and in post resuscitation pCO2 gap group 6 mmHg is 50,0 and ge 6 mmHg is 50,0 . Post resuscitation lactate can be used to predict mortality with cutoff 1,45 mmol L, and lactate clearance to predict survivor with cutoff 1,5.

Abstrak :
Pada sepsis terjadi inflamasi sistemik yang menyebabkan ketidakseimbangan mekanisme hemostasis, yaitu, peningkatan aktivasi koagulasi, penurunan antikoagulan alamiah, dan penurunan aktivitas fibrinolisis. Ketidakseimbangan ini bermanifestasi pada pembentukan trombus mikrovaskular yang menyebabkan perfusi jaringan menurun, terjadi disfungsi organ dan kematian. Tujuan penelitian ini mengetahui peranan kadar D-dimer, kadar FDP dan rasio FDP/D-dimer dalam memprediksi mortalitas 14 hari pada pasien sepsis. Penilaian skor Acute physiology and Chronic Health Evaluation II (APACHE II) digunakan untuk memprediksi morbiditas dan mortalitas. Desain penelitian potong lintang, penyajian data secara deskriptif. Subjek penelitian berjumlah 55 orang yang terdiri dari 32 laki-laki dan 23 perempuan dengan rerata usia 51,62 tahun. Pada subjek penelitian, dinilai korelasi kadar FDP, kadar D-dimer, dan rasio FDP/D-dimer dengan skor APACHE II. Pada hasil penelitian, didapatkan 20 pasien hidup dan 35 pasien meninggal. Median kadar FDP (12,9μg/mL) dan kadar D-dimer (7μg/mL) subjek meninggal lebih tinggi dibandingkan median kadar FDP (10,9μg/mL) dan kadar D-dimer (5,2 μg/mL) subjek hidup. Median rasio FDP/D-dimer subjek meninggal (1,9) lebih rendah dibandingkan subjek hidup (2,1). Koefisien korelasi Spearman antara kadar FDP, kadar D-dimer, dan rasio FDP/D-dimer dengan skor APACHE II berturut-turut 0,176, 0,187, dan -0,182. Ketiga korelasi itu secara statistik tidak bermakna (p ≥ 0,05). Pada penelitian ini disimpulkan bahwa kadar FDP, kadar D-dimer, dan rasio FDP/D-dimer tidak dapat digunakan sebagai prognosis keluaran sepsis pada mortalitas 14 hari. ......Systemic inflamation in sepsis could leads to an imbalance homeostatic mechanisms including elevated coagulation activity, decreasing level of natural anticoagulant, and decreased fibrinolysis activity. This could leads to formation of microvascular thrombus which eventually will cause tissue hypoperfusion, organ dysfunction and death. The aim of this research is to understand the role of d-dimer and fibrin degradation products (FDP) and FDP/d-dimer ratio in predicting 14-days mortality rate on sepsis patient. The morbidity and mortality rate on this research were based on APACHE II scoring system. This is a cross sectional research and all data are presented in a descriptive report. Participant of this research was 55 people (32 male and 23 female), average age was 51,62 years old. This research evaluate the correlation between FDP level, d-dimer level and FDP/d-dimer ratio with APACHE II scoring system. From all the participant we had 20 subject alive and 35 died during this research. The median level of FDP (12,9μg/mL) and d-dimer (7μg/mL) in those who die were higher than those who live (10,9μg/mL and 5,2 μg/mL). The median FDP/d-dimer ratio in those who die (1,9) was lower comparing to those who live (2,1). Spearman coefficient of correlation between FDP level, d-dimer level and FDP/d-dimer ratio with APACHE II scoring system were 0.176; 0.187; and – 0.182 repectively. This was not significant statistically (p ≥ 0,05). This research has come to a conclusion that FDP and d-dimer level, and FDP/d-dimer ratio cant be used as a prognostic outcome in sepsis on 14 days mortality.

Abstrak :
Latar belakang: Malaria merupakan salah satu masalah kesehatan masyarakat, dapat menyebabkan kematian dan secara langsung menyebabkan anemia. Berdasarkan hasil Riskesdas 2013, insiden malaria di Indonesia1,9 . Upaya menekan angka kesakitan dan kematian dilakukan antara lain melalui penegakan diagnosis dini. Plasmodium falciparum dan Plasmodium vivax adalah 2 spesies penyebab utama penyakit malaria yang ditemukan di Indonesia. Malaria PF/PV Ag Cassette Test Star Diagnostic Plus dengan metode imunokromatografi mendeteksi antigen kedua spesies Plasmodium, sehingga dapat dipertimbangkan sebagai sarana diagnostik alternatif untuk mendiagnosis malaria. Penelitian ini bertujuan melakukan uji diagnostik Malaria PF/PV Ag Cassette Test Star Diagnostic Plus dan mencari korelasi hemolisis dengan derajat parasitemia.Metode: Desain penelitian adalah uji diagnostik menggunakan baku emas pemeriksaan mikroskopik pada 79 orang. Uji korelasi dilakukan pada 32 orang yang memenuhi kriteria inklusi dan eksklusi.Hasil: Pada penelitian ini, didapatkan nilai sensitivitas, spesifisitas, NPP, NPN Malaria PF/PV Ag Cassette Test Star Diagnostic Plus masing-masing sebagai berikut 69 /75 , 100 /100 , 100 /100 , dan 92 /97 . Uji korelasi tidak dapat dilakukan karena hanya 1 pasien yang mengalami hemolisis intravaskuler dan ekstravaskuler dengan derajat parasitemia sedang dan 2 pasien hemolisis ekstravaskuler dengan derajat parasitemia ringan.Kesimpulan:Malaria PF/PV Ag Cassette Test Star Diagnostic Plus dapat digunakan untuk membantu diagnosis malaria pada daerah yang tidak memiliki teknisi laboratorium yang trampil. Secara deskriptif terlihat bahwa hemolisis intravaskuler dan ekstravaskuler mulai terjadi pada derajat parasitemia sedang. Kata kunci: Malaria PF/PV Ag Cassette Test Star Diagnostic Plus ; hemolisis intravaskuler; hemolisis ekstravaskuler; derajat parasitemia. ......Background. Malaria is one of the public health problems that can cause death and directly cause anemia. Based on the results of Riskesdas 2013, the incidence of malaria in Indonesia is 1.9 . Attempts to reduce morbidity and mortality are among others through early diagnosis. Plasmodium falciparum and Plasmodium vivax are the two main causes of malarial disease found in Indonesia. Malaria PF PV Ag Cassette Test Star Diagnostic Plus with imunochromatography method detects both antigen of Plasmodium species so that it can be considered as an alternative diagnostic tool for diagnosing malaria. This study aims to perform diagnostic test Malaria PF PV Ag Cassette Test Star Diagnostic Plus and lookes for correlation between the degree of parasitemia and hemolysis.Methods. The study design was a diagnostic test using a gold standard microscopic examination in 79 people. Correlation test done on 32 people who meet the inclusion and exclusion criteria. Results. In this study, the values of the sensitivity, specificity, NPP, NPN Malaria PF PV Ag Cassette Test Star Diagnostic Plus were 69 75 , 100 100 , 100 100 , and 92 97 respectively. Correlation test can not be done because only one patient undergo intravascular and extravascular hemolysis with moderate degree of parasitemia and 2 patients have extravascular hemolysis with mild degree of parasitemia.Conclusion. Malaria PF PV Ag Cassette Test Star Diagnostic Plus can be used to support the diagnosis of malaria in areas that do not have a skilled laboratory technicians. Descriptively seen that intravascular and extravascular hemolysis begin to occur in the degree of moderate parasitemia. Keywords Malaria PF PV Ag Cassette Test Star Diagnostic Plus , intravascular hemolysis, extravascular hemolysis, degree of parasitemia.

Abstrak :
Hiperglikemia merupakan salah satu faktor risiko terjadinya nefropati diabetik pada pasien diabetes melitus tipe 2. American Diabetes Association (ADA) merekomendasikan pemeriksaan albumin-to-creatinine ratio (ACR) setiap tahun untuk mendeteksi adanya nefropati diabetik. Pemeriksaan 1,5-anhydroglucitol (1,5-AG) merupakan salah satu pemeriksaan untuk monitoring kontrol glikemik. 1,5-AG merupakan penanda yang lebih sensitif untuk mengetahui adanya fluktuasi glukosa dan hiperglikemia postprandial. Beberapa penelitian menunjukkan bahwa hiperglikemia yang terjadi secara intermiten lebih merusak endotel dibandingkan hiperglikemia yang stabil. Desain studi pada penelitian ini adalah potong lintang. Pada penelitian ini dilakukan analisis statistik untuk mendapatkan hubungan 1,5-AG dan HbA1c, 1,5-AG dan glukosa darah 2 jam PP, area under curve dan titik potong 1,5-AG sebagai indikator kontrol glikemik, dan perbedaan median kadar 1,5-AG serta HbA1c pada pasien dengan ACR < 30 mg/g dan ≥ 30 mg/g. Hasil penelitian ini didapatkan koefisien korelasi Spearman antara kadar 1,5-AG dan HbA1c pada pasien DMT2 adalah -0,74 (p<0,001), sedangkan nilai koefisien korelasi antara kadar 1,5-AG dan glukosa darah 2 jam PP pada pasien diabetes melitus tipe adalah -0,45 (p<0,001). Luas area under curve 1,5-AG sebagai indikator kontrol glikemik sebesar 87,1%. Titik potong 1,5-AG untuk indikator kontrol glikemik adalah 10,7 μg/mL. Pasien DMT2 dengan kadar ACR ≥ 30 mg/g memiliki median kadar 1,5-AG yang lebih rendah (6,4 μg/mL) dibandingkan pasien DMT2 dengan ACR < 30 mg/g (median kadar 1,5-AG 12,4 μg/mL), p = 0,007. Terdapat perbedaan median kadar HbA1c yang bermakna (p<0,001) pada pasien DMT2 dengan ACR < 30 mg/g dan ACR ≥ 30 mg/g. Pasien DMT2 dengan kadar ACR ≥ 30 mg/g memiliki median kadar HbA1c yang lebih tinggi (7,9%) dibandingkan kadar HbA1c pasien DMT2 dengan ACR < 30 mg/g (6,9%). Berdasarkan hasil penelitian ini, dapat disimpulkan terdapat korelasi negatif kuat bermakna antara 1,5-AG dan HbA1c; dan korelasi negatif sedang bermakna antara 1,5-AG dan glukosa darah 2 jam PP. Terdapat perbedaan rerata kadar 1,5-AG dan HbA1c yang bermakna antara pasien diabetes melitus dengan ACR < 30 mg/g dan ≥ 30 mg/g. Titik potong 1,5-AG yang direkomendasikan sebagai indikator kontrol glikemik adalah 10,7 μg/mL.

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Hyperglycemia is one of the risk factors for diabetic nephropathy in type 2 diabetes mellitus patients. American Diabetes Association (ADA) recommended annual albumin-tocreatinine ratio (ACR) screening to detect the presence of diabetic nephropathy. 1,5-anhydroglucitol (1,5-AG) is one of the parameters for monitoring glycemic control. 1,5-AG is a more sensitive marker to detect glucose fluctuations and postprandial hyperglycemia. Previous studies showed that intermittent hyperglycemia is more damaging to endothelials than stable hyperglycemia. The study design was cross sectional. In this study, the statistical analysis was performed to obtain the association between 1,5-AG and HbA1c, 1,5-AG and 2-hour postprandial blood glucose; the area under curve and the cutoff of 1,5-AG as an indicator of glycemic control; and the median difference of 1,5-AG and HbA1c value from patients with ACR <30 mg/g and ≥ 30 mg/g. In this study, the coefficient of correlation between the value of 1,5-AG and HbA1c in patients with T2DM is -0,74 (p<0,001), while the coefficient of correlation between 1,5-AG and 2-hour postprandial blood glucose in patients with diabetes mellitus type is -0,45 (p<0,001). The area under curve of 1,5-AG as a glycemic control indicator is 87,1%. The 1,5-AG cutoff point for the glycemic control indicator is 10,7 μg/mL. Patients with T2DM with ACR levels ≥30 mg/g had significantly lower median value of 1,5-AG (6,4 μg/mL) than patients with T2DM with ACR <30 mg/g (12,4 μg/mL). There was significant difference in median HbA1c value from patients with T2DM with ACR <30 mg/g and ≥ 30 mg/g. Patients with T2DM with ACR levels ≥30 mg/g had higher median HbA1c value (7,9%) than HbA1c patients with T2DM with ACR <30 mg/g (6,9%). In this study concluded that the there was a strong and significant negative correlation between 1.5-AG and HbA1c and a moderate and significant negative correlation between 1.5-AG and 2-hour postprandial blood glucose. There was a significant difference of median value of 1,5-AG and HbA1c between patients with diabetes mellitus and ACR <30 mg/g and ACR ≥ 30 mg/g. The cutoff of 1,5-AG which was recommended as a glycemic control indicator was 10,7 μg/mL.

Abstrak :
Sifilis adalah penyakit menular seksual kronik yang memiliki manifestasi klinis yang bervariasi dan menetap untuk waktu yang lama. Neurosifilis merupakan salah satu komplikasi sifilis sistemik dengan temuan di cairan serebrospinal dengan atau tanpa gejala yang jelas. Pemeriksaan yang saat ini tersedia dalam mendukung diagnosis hanya tersedia pemeriksaan analisis cairan serebrospinal dan serologi Treponema pallidum. Saat ini belum diketahui prevalensi neurosifilis di rumah sakit peneliti dan profil serologi Treponema pallidum dari bahan cairan serebrospinal. Penelitian ini merupakan penelitian potong lintang, dilakukan November 2017-Maret 2018 terhadap 50 cairan serebrospinal dan darah yang diperiksakan analisis cairan serebrospinal dengan keterangan klinis terduga infeksi intrakranial. Serum dan cairan serebrospinal diperiksakan RPR, TPHA, anti-Treponema pallidum ELISA IgG dan khusus cairan serebrospinal diperiksa pula rapid test Treponema pallidum. Uji statistik menggunakan chi quare and Fisher exact test. Dari penelitian terhadap 50 cairan serebrospinal dan serum didapatkan rapid test Treponema pallidum, RPR dan TPHA cairan serebrospinal reaktif 4(8%). Dari bahan serum didapatkan RPR reaktif 8(16%) dan TPHA reaktif 9(18%). Anti-Treponema pallidum ELISA IgG positif 4 sampel (8%). Dari 50 sampel didapatkan 7 (14%) neurosifilis, 4 confirmed neurosyphilis dan 3 probable neurosyphilis sesuai kriteria Center for Disease Control and Prevention. Profil analisis cairan serebrospinalnya tidak berwarna, jernih, tidak ada bekuan, hitung sel 12.71 ±9.20 sel/μl, dominasi mononuklear 11.57±9.47 sel/μl, Pandy positif, protein cairan 42.29±21.49 mg/dl, glukosa cairan 55±5.16 mg/dl, glukosa serum 101.04±20.10 mg/dl, dan klorida 122.14±2.48 mEq/L. Pemeriksaan RPR, TPHA, dan anti-Treponema pallidum ELISA IgG dengan bahan serum dan cairan serebrospinal memiliki hubungan bermakna. Dari penelitian ini didapatkan 14% sesuai dengan neurosifilis dari populasi penelitian dan didapatkan 85.71% dengan HIV reaktif. Pada pasien HIV disarankan RPR dan TPHA serum untuk pemeriksaan skrining sifilis.

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Syphilis is a chronic sexually transmitted disease that has varying clinical manifestations and persist for a long time. Neurosyphilis is one of the complications of systemic syphilis with findings in cerebrospinal fluid with or without obvious symptoms. Examinations currently available for diagnostic support were cerebrospinal fluid analysis and serology of Treponema pallidum. There is currently no known prevalence of neurosyphilis in the research hospital and serologic profile of Treponema pallidum from cerebrospinal fluid. This study was a cross sectional study, conducted November 2017-March 2018 against 50 cerebrospinal fluid and blood samples that examined cerebrospinal fluid analysis with clinical information of suspected intracranial infection. Serum and cerebrospinal fluid examined by RPR, TPHA, anti-Treponema pallidum ELISA IgG and particulary rapid test Treponema pallidum for cerebrospinal fluid. Statistic tests were chi quare and Fisher exact test. From a total of 50 cerebrospinal fluid and serum, 4(8%) had reactive cerebrospinal fluid T. pallidum rapid tests, RPRs and TPHAs. From serum there were 8(16%) reactive RPRs and 9(18%) reactive TPHAs. Anti-Treponema pallidum ELISA IgG was positif 4 samples (8%). Among the 50 samples, 7 (14%) had neurosyphilis, 4 were confirmed neurosyphilis and 3 were probable neurosyphilis according to Center for Disease Control and Prevention criteria. The cerebrospinal fluid analysis profile is colorless, clear, without clot, cell count 12.71±9.20 cells/μl, mononuclear 11.57±9.47 cells/μl, positive for Pandy, cerebrospinal fluid protein 42.29±21.49 mg/dl, glucose 55±5.16 mg/dl, serum glucose 101.04±20.10 mg/dl, and chloride 122.14±2.48 mEq/L. Rapid Plasma Reagin, TPHA, and anti-Treponema pallidum ELISA IgG were associated between serum specimen and cerebrospinal fuid. Neurosyphilis was found in 14% of our patient population and 85.71% was reactive for HIV. Rapid Plasma Reagin and TPHA in sera were recommended for syphilis screening for HIV patient.