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Abstrak :
Penegakkan diagnosis sepsis lebih dini perlu dilakukan agar tepat dalam inisiasi penatalaksanaan sepsis, terutama saat di instalasi gawat darurat. Insidens sepsis cenderung meningkat, di Indonesia mortalitas pada tahun 2000 mencapai 84,5%. Penyebab dari sepsis bersifat multifaktorial. Tujuan penelitian untuk mengetahui faktor yang memengaruhi peningkatan risiko mortalitas berdasarkan jumlah sumber infeksi, asal infeksi (komunitas atau nosokomial), jumlah komorbid, sistem skor, albumin, kalium, dan kreatinin darah pada pasien terdiagnosis sepsis. Desain studi adalah kohort retrospektif dengan data rekam medis RSCM dan penelitian sepsis Divisi Penyakit Tropik dan Infeksi Departemen Ilmu Penyakit Dalam FKUI/RSCM. Kriteria inklusi meliputi pasien dewasa berusia > 18 tahun terdiagnosis sepsis sesuai kriteria Surviving Sepsis Campaign 2012 (SCCM/ESICM/ACCP/ATS/SIS) tahun 2012 dan dirawat inap di RSCM dari Januari 2014?Desember 2015. Studi dianalisis dengan SPSS ver 12.0. Dari 286 pasien, 75,9% memiliki jumlah sumber infeksi tunggal dan 53,5% berasal dari infeksi nosokomial. Selain itu, 80,8% dilaporkan dengan jumlah komorbid multipel. Dari pemantauan selama 28 hari, peningkatan kalium, skor qSOFA > 2, dan skor MSOFA > 11 meningkatkan risiko terjadinya mortalitas akibat sepsis dengan HR kalium > 5,0 mEq/l 1,91 (IK 95% 1,32?1,78, p 0,001) ; HR qSOFA > 2 1,19 (IK 95% 0,92-1,54, p 0,17) dan HR MSOFA > 11 1,38 (IK 95% 0,96?1,98, p 0,07). Median lama rawat inap dari pasien dengan sepsis hari ke-3 (IK 95% 2,53?3,47). Semakin lama pemantauan, maka probabilitas kesintasan akan semakin menurun. Kalium darah, skor qSOFA, dan skor MSOFA merupakan faktor yang memengaruhi mortalitas pasien sepsis di IGD dan dirawat di RSCM selama pemantauan 28 hari. ......Early diagnosis of sepsis is essential to initiate sepsis management especially in emergency room. Sepsis incidence rate tends to increase, in Indonesia the mortality rate year 2000 reached 84.5%. The cause of sepsis is multifactorial. The objectives are to determine factors associated with increased mortality risk based on single/multiple infection sources and comorbidity, community/nosocomial infection, scoring system, albumin/potassium/creatinine concentration in patients with sepsis. This is a cohort retrospective study based on medical records and research tree of sepsis from Division of Tropic and Infection, Internal Medicine Department, FMUI-RSCM. Inclusion criteria includes patients aged > 18 years diagnosed with sepsis based on Surviving Sepsis Campaign 2012 (SCCM/ESICM/ACCP/ATS/SIS), hospitalized in RSCM within January 2014- December 2015. Analysis is based on SPSS ver 12.0. From 286 patients, there were 75.9% suffered from single source of infection and 53.5% due to nosocomial infection. There were 80.8% of septic patients had > 1 comorbidities. Within 28 days, increased potassium, qSOFA score > 2, and MSOFA score > 11 tended to increase mortality risk due to sepsis with HR of potassium > 5,0 mEq/l 1.91 (95% CI 1.32?1.78, p .001) ; HR qSOFA > 2 1.19 (95% CI 0.92?1.54, p .17) dan HR MSOFA > 11 1.38 (95% CI 0.96?1.98, p .07). Median lifetime within 28 days was 3 days (95% CI 2.53?3.47). The longer the duration of survival analysis, the lower the probability of survival. Potassium, qSOFA and MSOFA scoring system were factors associated with increased risk of mortality in patients with sepsis admitted in emergency room and hospitalized in RSCM within 28 days of survival analysis.

Abstrak :
[ABSTRAK
Latar Belakang: Pasien DM dengan ulkus kaki lebih banyak yang mengalamidepresi dan memiliki kualitas hidup yang buruk. Dalam tatalaksana ulkus kaki diabetic perlu diperhatikan faktor psikososial karena diperkirakan dapat mempengaruhi penyembuhan luka melalui induksi gangguan keseimbangan neuroendokrin-imun. Beberapa penelitian mengenai pengaruh depresi pada proses penyembuhan ulkus diabetik telah dilakukan dengan hasil yang masih kontroversial.

Tujuan: Mengetahui pengaruh depresi terhadap proses perbaikan infeksi ulkus kaki diabetik, serta tingkat depresi pada pasien ulkus kaki diabetik rawat inap.

Metode: Observasional, kohort prospektif, terhadap 95 pasien ulkus kaki diabetic terinfeksi yang dirawat di RSCM dan RS jejaring dalam kurun waktu penelitian, terbagi 2 kelompok yaitu kelompok depresi dan kelompok tidak depresi. Data klinis, penilaian depresi, dan data laboratorium diambil saat pasien masuk rumah sakit kemudian dinilai perbaikan infeksi ulkus kaki diabetik dalam 21 hari masa perawatan. Dilakukan analisis bivariat dengan uji Chi-square berdasarkan batas kemaknaan (α) sebesar 5% dan analisis multivariat.

Hasil: Dari 95 subyek penelitian, 38 orang (40%) masuk dalam kelompok tidak depresi, sedangkan kelompok depresi terdiri atas 57 orang (60%). Subyek perempuan jumlahnya dominan pada kelompok depresi (70%). Komorbid terbanyak adalah hipertensi, dengan angka komorbiditas dan penyakit kardivaskular lebih tinggi pada kelompok depresi. Malnutrisi dan obesitas juga lebih banyak pada kelompok depresi (64,9% dan 31,6%), demikian pula dengan kontrol glikemik yang buruk (73,7%). Sebagian besar pasien (73,7%) yang masuk dalam kelompok depresi memiliki depresi ringan. Pada kelompok depresi 40,4% mengalami perbaikan infeksi dalam 21 hari masa perawatan, sedangkan pada kelompok tidak depresi 68,4%.

Simpulan: Depresi cenderung meningkatkan risiko atau kemungkinan tidak terjadinya perbaikan infeksi ulkus kaki diabetik, walaupun setelah dilakukan penyesuaian terhadap variabel perancu, hasil tersebut tidak bermakna secara statistik (adjusted OR 2,429 dengan IK 95% 0,890-6,632). Lebih banyak subjek dengan depresi sedang yang tidak mengalami perbaikan infeksi ulkus kaki diabetik dibandingkan dengan subjek dengan depresi ringan (93,3% dan 47,6%).

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ABSTRACT
Background: Patients with diabetic foot ulcers are more depressed and have a poor quality of life. In the management of diabetic foot ulcers, psychosocial factors need to be considered because it can influence wound healing through induction of neuroendocrine-immune balance disorders. Several studies on the effect of depression in diabetic ulcer healing process has been carried out with results that are still controversial.

Objective: To investigate the effect of depression on diabetic foot ulcer infection healing process, as well as the level of depression in patients with diabetic foot ulcers.

Methods: Observational, prospective cohort, of the 95 patients with infected diabetic foot ulcers treated at Cipto Mangunkusumo hospital and networking hospitals within the study, divided into 2 groups: group of depressed and non-depressed group. Clinical data, assessment of depression, and laboratory data were taken on admission to hospital then we assessed improvements infection of diabetic foot ulcers in 21 days of treatment. Bivariate analysis performed using Chi-square test based on the limit of significance (α) of 5%, also does multivariate analysis.

Results: Of the 95 subjects, 40%was not depressed, while the depressed group consisted of 60%. Female subjects was dominant in the depressed group (66,7%). Most comorbid was hypertension, with a number of comorbidities and disease cardivascular higher in depressed group. Malnutrition and obesity are also higher in the depression group (64,9% and 31,6%), as well as poor glycemic control (73,7%). Most patients (73,7%) included in the depressed group had mild depression. In the depressed group, 40,4% experienced improvement in 21-day period of treatment, whereas in the non-depressed group 68,4%.

Conclusion: Depression tends to increse diabetic foot ulcer infection risk to not improved, although after adjusment of confounding variables the result was not statistically significant (adjusted OR 2,429 with CI95% 0,890-6,632). More subjects with moderate depression who did not exeperience improvement when compared to subjects with mild depression did not exeperience improvement (93,3% and 47,6%). ;Background: Patients with diabetic foot ulcers are more depressed and have a poor quality of life. In the management of diabetic foot ulcers, psychosocial factors need to be considered because it can influence wound healing through induction of neuroendocrine-immune balance disorders. Several studies on the effect of depression in diabetic ulcer healing process has been carried out with results that are still controversial. Objective: To investigate the effect of depression on diabetic foot ulcer infection healing process, as well as the level of depression in patients with diabetic foot ulcers. Methods: Observational, prospective cohort, of the 95 patients with infected diabetic foot ulcers treated at Cipto Mangunkusumo hospital and networking hospitals within the study, divided into 2 groups: group of depressed and non-depressed group. Clinical data, assessment of depression, and laboratory data were taken on admission to hospital then we assessed improvements infection of diabetic foot ulcers in 21 days of treatment. Bivariate analysis performed using Chi-square test based on the limit of significance (α) of 5%, also does multivariate analysis. Results: Of the 95 subjects, 40%was not depressed, while the depressed group consisted of 60%. Female subjects was dominant in the depressed group (66,7%). Most comorbid was hypertension, with a number of comorbidities and disease cardivascular higher in depressed group. Malnutrition and obesity are also higher in the depression group (64,9% and 31,6%), as well as poor glycemic control (73,7%). Most patients (73,7%) included in the depressed group had mild depression. In the depressed group, 40,4% experienced improvement in 21-day period of treatment, whereas in the non-depressed group 68,4%. Conclusion: Depression tends to increse diabetic foot ulcer infection risk to not improved, although after adjusment of confounding variables the result was not statistically significant (adjusted OR 2,429 with CI95% 0,890-6,632). More subjects with moderate depression who did not exeperience improvement when compared to subjects with mild depression did not exeperience improvement (93,3% and 47,6%). ;Background: Patients with diabetic foot ulcers are more depressed and have a poor quality of life. In the management of diabetic foot ulcers, psychosocial factors need to be considered because it can influence wound healing through induction of neuroendocrine-immune balance disorders. Several studies on the effect of depression in diabetic ulcer healing process has been carried out with results that are still controversial. Objective: To investigate the effect of depression on diabetic foot ulcer infection healing process, as well as the level of depression in patients with diabetic foot ulcers. Methods: Observational, prospective cohort, of the 95 patients with infected diabetic foot ulcers treated at Cipto Mangunkusumo hospital and networking hospitals within the study, divided into 2 groups: group of depressed and non-depressed group. Clinical data, assessment of depression, and laboratory data were taken on admission to hospital then we assessed improvements infection of diabetic foot ulcers in 21 days of treatment. Bivariate analysis performed using Chi-square test based on the limit of significance (α) of 5%, also does multivariate analysis. Results: Of the 95 subjects, 40%was not depressed, while the depressed group consisted of 60%. Female subjects was dominant in the depressed group (66,7%). Most comorbid was hypertension, with a number of comorbidities and disease cardivascular higher in depressed group. Malnutrition and obesity are also higher in the depression group (64,9% and 31,6%), as well as poor glycemic control (73,7%). Most patients (73,7%) included in the depressed group had mild depression. In the depressed group, 40,4% experienced improvement in 21-day period of treatment, whereas in the non-depressed group 68,4%. Conclusion: Depression tends to increse diabetic foot ulcer infection risk to not improved, although after adjusment of confounding variables the result was not statistically significant (adjusted OR 2,429 with CI95% 0,890-6,632). More subjects with moderate depression who did not exeperience improvement when compared to subjects with mild depression did not exeperience improvement (93,3% and 47,6%). , Background: Patients with diabetic foot ulcers are more depressed and have a poor quality of life. In the management of diabetic foot ulcers, psychosocial factors need to be considered because it can influence wound healing through induction of neuroendocrine-immune balance disorders. Several studies on the effect of depression in diabetic ulcer healing process has been carried out with results that are still controversial. Objective: To investigate the effect of depression on diabetic foot ulcer infection healing process, as well as the level of depression in patients with diabetic foot ulcers. Methods: Observational, prospective cohort, of the 95 patients with infected diabetic foot ulcers treated at Cipto Mangunkusumo hospital and networking hospitals within the study, divided into 2 groups: group of depressed and non-depressed group. Clinical data, assessment of depression, and laboratory data were taken on admission to hospital then we assessed improvements infection of diabetic foot ulcers in 21 days of treatment. Bivariate analysis performed using Chi-square test based on the limit of significance (α) of 5%, also does multivariate analysis. Results: Of the 95 subjects, 40%was not depressed, while the depressed group consisted of 60%. Female subjects was dominant in the depressed group (66,7%). Most comorbid was hypertension, with a number of comorbidities and disease cardivascular higher in depressed group. Malnutrition and obesity are also higher in the depression group (64,9% and 31,6%), as well as poor glycemic control (73,7%). Most patients (73,7%) included in the depressed group had mild depression. In the depressed group, 40,4% experienced improvement in 21-day period of treatment, whereas in the non-depressed group 68,4%. Conclusion: Depression tends to increse diabetic foot ulcer infection risk to not improved, although after adjusment of confounding variables the result was not statistically significant (adjusted OR 2,429 with CI95% 0,890-6,632). More subjects with moderate depression who did not exeperience improvement when compared to subjects with mild depression did not exeperience improvement (93,3% and 47,6%). ]

Abstrak :
Latar Belakang: Prevalensi infeksi Helicobacter pylori yang masih tinggi di beberapa negara. Penelitian di Guang Zhou terjadi penurunan seroprevalensi infeksi Helicobacter pylori antara tahun 1993 2003 dari 62 5 menjadi 47. Studi prevalensi di salah satu RS swasta Jakarta menunjukkan penurunan prevalensi infeksi Helicobacter pylori dari 12 5 di tahun 1998 menjadi 2 9 di tahun 2005 Perlunya diketahui seroprevalensi dikomunitas saat ini apakah sesuai dengan penurunan yang terjadi pada penelitian berbasis rumah sakit dan faktor faktor yang mempengaruhi infeksi Helicobacter pylori di masyarakat. Tujuan: Mengetahui seroprevalensi dan faktor faktor sosiodemografis yang berhubungan dengan infeksi Helicobacter pylori. Metode: Studi potong lintang terhadap 111 pasien dispepsia yang berobat di Puskesmas Kelurahan Kalibaru Jakarta Utara Januari-Februari 2015. Dilakukan analisa bivariat untuk mengetahui hubungan faktor faktor dengan infeksi Helicobacter pylori menggunakan uji chi square dan uji T tidak berpasangan serta alternatifnya. Analisa multivariat menggunakan uji regresi logistik. Hasil dan Pembahasan: Pada 111 pasien dewasa dengan keluhan dispepsia yang berobat ke Puskesmas Kelurahan Kalibaru didapatkan seroprevalensi Helicobacter pylori sebesar 22 5 95 IK 14 8 30 2. Usia tidak berhubungan dengan infeksi Helicobacter pylori p 0 270. Semakin tinggi tingkat sosial ekonomi semakin rendah rasio odds infeksi Helicobacter pylori OR 0 2 95 IK 0 02-1 71. Semakin tinggi indeks kepadatan penduduk semakin tinggi rasio odds infeksi Helicobacter pylori OR 1 2 95 IK 0 37-4 49. Semakin rendah clean water index semakin tinggi rasio odds infeksi Helicobacter pylori OR 1 5 95 IK 0 57-4 04. Semakin rendah status sanitasi semakin tinggi rasio odds infeksi Helicobacter pylori OR 2 5 95 IK 1 01-6 19. Kesimpulan: Seroprevalensi Helicobacter pylori pada pasien dispepsia kelurahan Kalibaru sebesr 22 5 95 IK 14 8 30 2. Didapatkan hubungan antara sanitasi lingkungan dengan Helicobacter pylori. ......Background: The prevalence of Helicobacter pylori infection in some countries remains high. Study in Guang Zhou showed a decrease in seroprevalence of Helicobacter pylori from 62 5 in 1993 to 47 in 2003. Prevalence studies in one of the private hospitals in Jakarta showed a decrease in the prevalence of Helicobacter pylori infection from 12 5 in 1998 to 2 9 in 2005. It is important to know the seroprevalence in community nowadays and its related factors in society. Objective: To identify seroprevalence of Helicobacter pylori infection and its socio demogrphic related factors. Method: A cross sectional study in 111 patients with dyspepsia who got treatment in Kalibaru Primary Health Care in North Jakarta from January to February 2015. A bivariate analysis was done to know relationship between Helicobacter pylori infection and its related factors using chi square unpaired t test and their alternatives. Multivariate analysis was done using logistic regression test. Result: Seroprevalence of Helicobacter pylori of 111 dyspepsia patients who get treatment in Kalibaru Primary Helath Care in this study was 22 5 95 CI 14 8 30 2. There is no relationship between age and Helicobacter pylori infection p 0 270 Higher socio economic class was related to lower risk Helicobacter pylori infection OR 0 2 95 IK 0 02-1 71. Higher crowding index was related to higher risk Helicobacter pylori infection OR 1 2 95 IK 0 37-4 49. Lower clean water index was related to higher risk Helicobacter pylori infection OR 1 5 95 IK 0 57-4 04. Lower sanitation status was related to higher risk Helicobacter pylori infection OR 2 5 95 IK 1 01-6 19. Conclusion: Seroprevalence of Helicobacter pylori infection in patient with dyspepsia in Kalibaru village was 22 5 95 CI 14 8 30 2. There is a relation between sanitation and Helicobacter pylori infection.

Abstrak :
Latar belakang. Salah satu penentu manifestasi klinis dengue berat adalah kebocoran plasma. Limfosit dan monosit berperan dalam patogenesis kebocoran plasma infeksi dengue sehingga berpotensi sebagai prediktor kebocoran plasma. Tujuan. Menentukan kemampuan hitung jenis limfosit dan monosit demam hari kedua sebagai prediktor kebocoran plasma pada fase kritis infeksi dengue. Metode. Desain kohort retrospektif pasien rawat inap di RSUPN Cipto Mangunkusumo, RSUP Persahabatan dan RSPAD Gatot Soebroto dari tahun 2010 ̶ 2015, memenuhi kriteria inklusi: berusia > 15 tahun; didiagnosis dengue menurut WHO 1997; dikonfirmasi pemeriksaan NS-1/pemeriksaan serologis anti dengue; memiliki data darah perifer lengkap dan hitung jenis mulai demam hari ke-2; USG abdomen, dan/atau albumin pada fase kritis. Dilakukan analisis Reciever Operating Characteristic Curves (ROC curve) dengan interval kepercayaan (IK) 95% dan multivariat regresi logistik untuk memperoleh model prognostik. Hasil. Terdapat 63 subjek dianalisis. Insidens kebocoran plasma 49%. Nilai absolut limfosit dan nilai absolut monosit demam hari ke-2 berpotensi menjadi prediktor kebocoran plasma pada fase kritis dengan AUC 0,65 dan 0,64. Titik potong optimal nilai absolut limfosit dan nilai absolut monosit yang berpotensi sebagai prediktor kebocoran plasma sebesar 1323 dan 770. Nilai absolut limfosit memiliki sensitivitas 90%, spesifisitas 16%. Nilai absolut monosit memiliki sensitivitas 94%, spesifisitas 34%. Model prognostik nilai absolut monosit dan persentase limfosit meningkatkan AUC menjadi 0,723. Simpulan. Kemampuan prediksi kebocoran plasma nilai absolut limfosit dan nilai absolut monosit demam hari kedua lemah. Namun kemampuan tersebut ditingkatkan menjadi sedang oleh model prognostik yang melibatkan persentase limfosit dan nilai absolut monosit. ......Background. The severity of dengue infection was determined by plasma leakage. Lymphocytes and monocytes played an important role in the pathogenesis of plasma leakage in dengue infection so they potentially used as predictors for plasma leakage in a critical phase of dengue infection. Aim. Determined the percentage and absolute number of lymphocytes and monocytes measured on the second day of fever as a predictors for plasma leakage in a critical phase of dengue infection. Method. The research was retrospective cohort study of inpatients at Cipto Mangunkusumo Hospital, Persahabatan General Hospital and Gatot Subroto Military Hospital Jakarta from 2010 ̶ 2015. The inclusion criteria: age > 15 years, suffering from dengue infection according to the diagnostic criteria of WHO in 1997, confirmed by examination of NS-1 or serological anti-dengue, peripheral blood count and differential leucocyte count during treatment from second day of fever, abdominal ultrasound, and / or albumin in the critical phase. Analyses were performed using ROC curve. Multivariate analysis was performed to elicit prognostic models. Results. We determined 63 subjects. The incidence of plasma leakage was 49%. Absolute number of lymphocytes and monocytes on second day of fever were potentially useful as predictors for plasma leakage. The AUC was 0.65 and 0.644. The optimal cut-off point for absolute number of lymphocytes were 1323, the sensitivity was 90% and the specificity 16%. The cut-off for absolute number of monocytes was 770, the sensitivity was 94%, specificity 34%. We found optimal prognostic model which include percentage of lymphocytes and absolute number of monocytes. It could increase the AUC until 0,723. Conclusion. The absolute number of lymphocytes and monocytes on second day of fever in dengue infections were potentially useful as predictors for plasma leakage in a critical phase of dengue infection. Predictive capability could be increased by prognostic model which include percentage of lymphocytes and absolute number of monocytes as predictors.

Abstrak :
Kejadian infeksi dengue dewasa di Indonesia tergolong tinggi. Komplikasinya adalah sindrom renjatan dengue (SRD) akibat kebocoran plasma. Untuk mengatasi kebocoran plasma, WHO menganjurkan pemberian cairan kristaloid isotonik atau koloid seperti albumin 5%. Penelitian in vitro memperlihatkan ikatan albumin dengan reseptor glikoprotein 60 (gp60) di sel endotel menstimulasi ekspresi caveolin-1 dan Src protein tyrosine kinase (PTK) yang meningkatkan perpindahan albumin ke ekstravaskular, namun secara in vivo belum diketahui pengaruh cairan albumin terhadap proses transitosis dan caveolin-1 urin. Penelitian ini merupakan open label randomized controlled trial sejak bulan November 2018 sampai dengan Januari 2020, di beberapa rumah sakit di Jakarta dan Banten. Dari 90 pasien, sebanyak 30 pasien memenuhi kriteria DD, dan 60 pasien memenuhi kriteria DBD. Alokasi secara acak dilakukan pada 60 pasien DBD, yang terdiri atas kelompok demam berdarah dengue yang diberikan ringer laktat (n = 30) dan kelompok demam berdarah dengue yang diberikan albumin (n = 30). Pasien DBD yang diberikan albumin 5%, caveolin-1 plasma menurun pada jam ke-12 (p = 0,016); Src PTK lebih rendah pada jam ke-12 (p = 0,048); hemokonsentrasi lebih ringan pada jam ke-12 (p = 0,022) dan ke-24 (p = 0,001); kadar albumin serum lebih tinggi pada jam ke-12 (p = 0,037) dan ke-24 (p = 0,001); albumin urin lebih ringan pada jam ke-24 (p = 0,006) dan ke-48 (p = 0,005); dan lama rawat lebih pendek (p < 0,001) dibandingkan dengan ringer laktat. Kesimpulan: pemberian cairan albumin 5% memperbaiki kebocoran plasma transitosis dan memperpendek lama rawat pasien DBD. ......The incidence of adult dengue infection in Indonesia is quite high. The complication is dengue shock syndrome (DSS) due to plasma leakage. To overcome plasma leakage, WHO recommends giving isotonic crystalloid solutions or colloids such as albumin 5%. In vitro studies have shown that albumin binding to the glycoprotein receptor 60 (gp60) in endothelial cells stimulates the expression of caveolin-1 and Src protein tyrosine kinase (PTK) which increases albumin transfer to the extravascular space, but in vivo the effect of albumin fluid on the process of transitosis and urine caveolin-1 is not known. This study is an open label randomized controlled trial from November 2018 to January 2020, in several hospitals in Jakarta and Banten. From 90 patients, 30 patients met the criteria for DD, and 60 patients met the criteria for DHF. Random allocation was made to 60 DHF patients, consisting of the dengue hemorrhagic fever group given Ringer's lactate (n = 30) and the dengue hemorrhagic fever group given albumin (n = 30). Patients who were given albumin 5%, caveolin-1 plasma decreased at 12th hours (p = 0.016); Src PTK was lower at 12 hours (p = 0.048); milder hemoconcentration at 12th (p = 0.022) and 24th (p = 0.001) hour; serum albumin levels were higher at 12th (p = 0.037) and 24 hours (p = 0.001); urinary albumin was milder at 24th (p = 0.006) and 48th (p = 0.005); and shorter length of stay (p < 0.001) compared to ringer lactate. Conclusion: administration of albumin 5% fluid improves transcytosis plasma leakage and shortens the length of stay of dengue infection patients.

Abstrak :
Kebocoran plasma pada fase kritis berhubungan dengan morbiditas dan mortalitas infeksi dengue. Hingga saat ini belum diketahui pasti patofisiologinya dan kejadiannya belum dapat diprediksi. Diteliti peran respons imun pejamu dengan kejadian kebocoran plasma pada pasien dengue dengan melihat hubungan antara hitung virus intra-monosit dan hitung monosit absolut pada fase akut dengan kejadian kebocoran plasma pada fase kritis, serta mengetahui adanya antibodi terhadap sel endotel yang kemungkinan berperan pada kebocoran plasma. Penelitian ini merupakan kohort prospektif dengan 127 subjek penelitian yang terinfeksi serotipe DENV tunggal berdasarkan rt-PCR dan dirawat di rumah sakit sebelum hari keempat demam. Spesimen darah diambil pada hari kedua demam, dan perubahan klinis dan laboratoris dipantau hingga hari ketujuh perawatan. Kebocoran plasma ditentukan pada fase kritis hari ke-5 sampai ke-7, berdasarkan kriteria WHO dan dengue score. Pada pasien dengan kebocoran plasma berdasarkan kriteria WHO, tidak terdapat perbedaan hitung virus DENV plasma pada hari kedua demam (p = 0,325) dengan pasien tanpa kebocoran plasma. Hitung virus DEN intra-monosit lebih tinggi secara bermakna (p = 0,031). Jika dikelompokkan berdasarkan dengue score, perbedaan hitung DENV intra-monosit bermakna antara kelompok skor > 3 dan skor < 1 (p = 0,07), namun tidak ditemukan perbedaan antara kelompok skor 2 dan < 1 (p = 0,14) dan antara skor 2 dan skor > 3 (p = 0,23). Demikian pula tidak ada perbedaan bermakna hitung DENV plasma pada ketiga kelompok tersebut (nilai p masing-masing adalah 0,07, 0,14, dan 0,95). Hitung absolut monosit darah tepi mengalami penurunan pada semua pasien, dengan titik terendah pada hari ketiga demam. Penurunan lebih besar secara bermakna (p = 0,015) terjadi pada kelompok dengan kebocoran plasma. Dengan titik potong hitung monosit absolut hari ketiga 250 sel/L, diperoleh AUC 0,742 untuk memprediksi kebocoran plasma dengan kriteria WHO, dan AUC 0,647 untuk memprediksi dengue score > 3 pada fase kritis. Selain itu, ditemukan antibodi terhadap sel endotel pada pasien terinfeksi DENV, dengan 3 target lebih banyak diekspresikan pada pasien dengan kebocoran plasma adalah protein berukuran 37 kDa, 75 kDa, dan 120 kDa. Kebocoran plasma pada fase kritis berhubungan dengan hitung virus DENV intra-monosit yang lebih lebih tinggi dan jumlah absolut monosit darah tepi yang lebih rendah pada fase akut. Dengan titik potong hitung monosit absolut pada hari ketiga 250 sel/L dapat diprediksi kejadian kebocoran plasma pada fase kritis. Ditemukan antibodi terhadap sel endotel yang kemungkinan berhubungan dan berpotensi sebagai penanda prediktor kebocoran plasma. ......Plasma leakage during the critical phase is associated with morbidity and mortality from dengue infection. Until now, the pathophysiology is remains unclear, and the occurrence is unpredictable. We examine the role of host immune response in the pathophysiology of plasma leakage in dengue infected patients by studying the association of intra-monocyte DENV viral load and monocyte absolute count during the acute phase with plasma leakage during critical phase. We also examined the existence of anti-endothelial antibody in dengue infected patients’ plasma that could potentially be involved in the plasma leakage. This prospective cohort study involved 127 subjects with single DENV serotype infected identified by rt-PCR and hospitalized for three days after the fever occurs. Blood samples were taken on the second day, and all the patients were monitored until the 7th day for clinical and laboratory changes. Plasma leakage was determined on fifth to seventh day, according to the WHO criteria and dengue score. In the plasma leakage group, based on WHO criteria, there was no significant difference in plasma DENV viral load (p = 0.325), while the intra-monocyte DENV viral load was significantly higher (p = 0.031). Based on the dengue score grouping, intra-monocyte DENV viral load was significantly higher on score > 3 compared to score < 1 (p = 0.07), but there was no significant difference between scores 2 and < 1 (p = 0.14), and between scores 2 and > 3 (p = 0.23). There were no significant differences in plasma DENV viral load among those groups (respective p values: 0.07, 0.14, and 0.95). The monocyte absolute count decreased in all the patients, with the lowest count was reached on the third day of fever. On day 3, the monocyte absolute counts were significantly lower among plasma leakage patients compared to non-plasma leakage patients (p = 0.015). By using a cut-off point of absolute monocyte count of 250 cells/L, We obtained an AUC of 0.742 which was used to predict the occurrence of plasma leakage in the critical phase based on WHO criteria, and AUC 0.647 to predict dengue score > 3. We also found the anti-endothelial antibodies in the acute plasma of dengue infected patients. The prominent antibodies targeting endothelial proteins of 37 kDa, 75 kDa, and 120 kDa were expressed more among the plasma leakage groups. Plasma leakage during the critical phase is associated with higher intra-monocyte DENV viral loads and lower monocyte absolute count compared to the acute phase. The monocyte absolute count cut-off point of 250 cells/L on the third day may be used as predictor of plasma leakage. Anti- endothelial antibodies were detected in acute plasma and might be associated and used as predictors of plasma leakage.

Abstrak :
ABSTRAK
Latar Belakang: Penilaian status gizi pada lanjut usia saat ini menggunakan Mini Nutritional Assessment MNA , namun memakan waktu yang cukup lama, dilakukan oleh tenaga kesehatan, dan tidak praktis bila digunakan di komunitas. Pemeriksaan kekuatan genggam tangan dapat dijadikan instrumen penapisan status gizi pada lanjut usia. Keuntungan dari pemeriksaan kekuatan genggam tangan antara lain sederhana, alatnya mudah dibawa, tidak membutuhkan waktu yang lama, praktis dan mudah digunakan oleh bukan tenaga kesehatan, tetapi belum ada data titik potong dan akurasi diagnosis kekuatan genggam tangan pada lanjut usia di komunitas.Tujuan: Mendapatkan titik potong dan akurasi diagnosis kekuatan genggam tangan sebagai penapis status gizi pada lanjut usia di komunitas.Metode: Penelitian potong lintang pada subjek berusia ge; 60 tahun di Posbindu di kecamatan Pulogadung, Jakarta Timur selama Januari-Februari 2017. Titik potong kekuatan genggam tangan dianalisis menggunakan kurva Receiver Operating Characteristics ROC . Akurasi diagnosis kekuatan genggam tangan dibandingkan dengan Mini Nutritional Assessment, dinilai dengan menghitung sensitivitas, spesifisitas, nilai duga positif NDP , nilai duga negatif NDN , rasio kemungkinan positif RKP , dan rasio kemungkinan negatif RKN .Hasil: Nilai Area Under the Curve AUC pada lanjut usia laki-laki dan perempuan adalah 90,5 IK95 82,0 ndash;99,0 dan 79,6 IK95 71,7 ndash;87,6 . Titik potong kekuatan genggam tangan lanjut usia laki-laki dan perempuan untuk mendeteksi kondisi malnutrisi berturut-turut adalah le; 25 kg dan le; 18 kg dengan sensitivitas 87,5 dan 77,8 , spesifisitas 80,0 dan 65,0 , NDP 66,7 dan 55,6 , NDN 93,3 dan 83,9 , RKP 4,4 dan 2,2, RKN 0,1 dan 0,3.Simpulan: Titik potong kekuatan genggam tangan lanjut usia laki-laki dan perempuan untuk mendeteksi malnutrisi berturut-turut adalah le; 25 kg dan le; 18 kg. Akurasi diagnosis kekuatan genggam tangan lanjut usia laki-laki dan perempuan dalam mendeteksi malnutrisi berturut-turut dinilai baik dan sedang.Kata Kunci: malnutrisi, lanjut usia, kekuatan genggam tangan, MNA ABSTRACT Backgound Assessment of elderly nutritional status using Mini Nutritional Assessment MNA may take longer time, should be performed by healthcare professional and not simple when using in community. Handgrip strength assessment could be a nutritional screening method for elderly. The benefits of using handgrip strength are simple, reliable, and easy performance method, but there is no sufficient information regarding its cutoffpoint and diagnostic accuracy for community living elderly.Objective To verify the cutoff point and accuracy of handgrip strength for nutritional assessment of community living elderly.Method A crossectional study was conducted at Posbindu in Pulogadung, Jakarta Timur in January February 2017. Subjects were men and women ge 60 years old. Cutoff point of malnutrition was analyzed by the ROC curve. Diagnostic accuracy of handgrip strength was calculated.Results The area under the curve AUC value of hand grip strength in elderly men and women were 90.5 CI 95 82.0 99.0 and 79.6 CI95 71.7 87.6 . Cutoff point of handgrip strength for diagnosis of malnutrition according to the reference standard were le 25 kg for men and le 18 kg for women, with the sensitivity, specificity, PPV, NPV, LR , and LR were 87.5 and 77.8 , 80.0 and 65.0 , 66.7 and 55.6 , 93.3 and 83.9 , 4,4 and 2,2, 0,1 and 0,3 for men and women, respectively.Conclusions Cutoff point of handgrip strength for diagnosis of malnutrition were le 25 kg for men and le 18 kg for women. Diagnostic accuracy of handgrip strength for diagnosis malnutrition in elderly men and women were good and moderate.