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"Latar Belakang. Leptospirosis merupakan penyakit infeksi di daerah tropis yang terabaikan (neglected infectious diseases) akibat vektor hewan dan kondisi lingkungan. Prevalensi di negara beriklim tropis, khususnya Indonesia cukup tinggi namun tidak terdiagnosis dengan baik. Diagnostik pasti sulit didapat karena uji baku emas leptospirosis, MAT (microscopic agglutination test), di Indonesia masih terbatas aksesnya dan uji alternatif belum banyak diteliti efektifitasnya.Metode. Penelitian ini menguji kinerja dua jenis alat diagnostik terbaru yaitu tes cepat berbasis IgM (Leptodipstick), dan PCR (polymerase chain reaction) terhadap gen lipl32 dan secY Leptospira dibandingkan uji baku emas MAT pada populasi Indonesia. Subjek penelitian adalah pasien dewasa rawat inap di RSCM pada tahun 2016-2018 yang memenuhi kriteria klinis leptospirosis WHO dan diujikan dengan MAT, tes cepat Leptospira, dan PCR Leptospira. Penelitian ini bersifat potong lintang, dengan variable yang diteliti meliputi data demografi, manifestasi klinis, paparan pekerjaan, paparan vektor ataupun lingkungan, serta hasil pemeriksaan MAT, tes cepat, dan PCR terhadap Leptospira. Hasil: Terdapat total 30 subjek yang ikut dalam penelitian dengan 11 (36,7%) meninggal dunia. Berdasarkan uji baku emas MAT, 14 (46,67%) dinyatakan reaktif terhadap antibodi Leptospira. Tes cepat Leptospira mendapat nilai sensitivitas 85,71% (95%IK: 57,19-98,22%), serta spesifisitas 62,50% (95%IK: 35,43%-84,80%), dan area di bawah kurva ROC 0,741 (95%IK: 0,549-0,883). Pemeriksaan PCR terhadap gen lipl32, sensitivitas 85,71% (95%IK: 57,19-98,22%), spesifisitas 18,75% (95%IK: 4,05-45,65%), dan area di bawah kurva ROC 0,522 (95%IK: 0,333 – 0,707). Pemeriksaan PCR gen secY, sensitivitas 71,43% (95%IK: 41,90-91,61%), spesifisitas 12,50% (95%IK: 1,55-38,35%), dan area di bawah kurva ROC 0,580 (95%IK: 0,371-0,789). Secara umum, semua uji memiliki sensitivitas yang memuaskan, namun spesifisitas yang buruk dibandingkan dengan MAT. Spesifisitas yang rendah dapat dikaitkan dengan onset penyakit yang sebagian besar berada pada fase akut sehingga belum dapat terdeteksi dengan alat uji yang berbasis antibodi.Kesimpulan. Spesifisitas tes cepat Leptospira dengan IgM maupun PCR terhadap gen lipl32 dan secY Leptospira sebagai alat penapisan cukup baik. Perlu dilakukan penelitian kinerja diagnostik lanjutan berdasarkan onset penyakit.

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Background. Leptospirosis is a neglected infectious disease transmitted by animal vectors and environment. The prevalency in  tropical Asia-Pacific country, including Indonesia was high. The gold standard test for leptospirosis was microscopic agglutination test (MAT), very limited distribution in Indonesia.

Methods. This study compares the diagnostic profiles of two new diagnostic tools, an IgM-based rapid test (Leptodipstick) and polymerase chain reaction (PCR) of the genes lipl32 and secY of the Leptospira genome, to MAT as the gold standard, in the Indonesian population. Adult inpatients of RSCM in the years 2016-2018 with conformity to the WHO clinical criteria for leptospirosis and undergo MAT test, Leptospira rapid test, and Leptospira PCR were enrolled in the study. The study was cross-sectional with the examined variable were demographic data, clinical manifestation, occupational exposure, exposure towards animal vectors or environmental conditions, and results of the MAT, Leptospira rapid test, and Leptospira PCR.

Results. The study enrolled 30 participants, with 11 (36,7%) deceased in the study period. Based on MAT, 14 participants (46,67%) were considered reactive for Leptospira antibodies. The Leptospira rapid test has a sensitivity of 85.71% (95%CI: 57.19-98.22%), and specificity of 62.50% (95%CI: 35.43%-84.80%), and the area under the ROC curve of 0.741 (95%CI: 0.549-0.883). PCR for the gene lipl32 showed a sensitivity of 85.71% (95%CI: 57.19-98.22%), specificity of 18.75% (95%CI: 4.05-45.65%), and area under the ROC curve of 0.522 (95%CI: 0.333-0.707). PCR for the gene secY showed a sensitivity of 71.43% (95%CI: 41.90-91.61%), specificity of 12.50% (95%CI: 1.55-38.35%), and area under the ROC curve of 0.580 (95%CI: 0.371-0.789). Generally, all tests showed a satisfactory sensitivity, yet very low specificity compared to MAT. Area under the curve showed a low (PCR) to moderate (rapid test) diagnostic value for each test. Low specificity may be tied to the onset of the disease of the study sample that most of them are on acute phase which cannot detected by the alternative test with antibody basis.

Conclusion. The diagnostic parameters of the Leptospira IgM rapid test, and Leptospira PCR with the genes lipl32 and secY are still satisfactory to be used as early diagnostic tools in cases of leptospirosis."

"Latar belakang: Saat ini, pasien Coronavirus Disease-19 (COVID-19) derajat sedang dan berat umumnya menerima antibiotik secara dini (<24 jam) dengan pertimbangan kemungkinan infeksi sekunder atau ko infeksi bakteri yang merupakan faktor risiko kematian. Hal ini mengakibatkan pengunaan antibiotik yang berlebihan karena proporsi rendah infeksi sekunder dan ko-infeksi bakteri pada pasien COVID-19 yang meninkatkan risiko resistensi antibiotik. Pemeriksaan penunjang untuk membuktikan keberadaan infeksi sekunder dan ko-infeksi bakteri dapat mengarahkan pemberian antibiotik pada pasien yang tepat. Pada studi ini, pengaruh pemberian antibiotik dini terhadap mortalitas pasien COVID-19 derajat sedang dan berat akan diteliti. Metode: Penelitian ini merupakan jenis penelitian analitik observasional dengan desain retrospektif kohort. Data penelitian diperoleh melalui rekam medis elektronik pasien COVID-19 yang diadmisi mulai Desember 2020 sampai Maret 2021. Pasien yang menerima antibiotik dini adalah pasien yang menerima antibiotik >24 jam setelah admisi. Analisis data dilakukan dengan program SPSS versi 20. Hasil: Dari 180 pasien rawat inap dengan COVID-19, 72 pasien dieksklusi karena tidak memenuhi kriteria eligibilitas sampel. Dari 108 pasien yang terinklusi, 74 (68.5%) pasien memiliki COVID-19 derajat sedang dan 34 pasien (31.5%) memiliki COVID-19 derajat berat. Antibiotik dini diberikan pada 79 (73.1%) pasien dengan median waktu mulai antibiotik 2 hari pada pasien yang tidak menerima antibiotik dini. Hasil analisis univariat tidak menemukan pengaruh signifikan pemberian antibiotik dini pada pasien COVID-19 sedang dan berat (p=0.42). Analisis sub-group berdasarkan derajat penyakit juga tidak menemukan hasil yang signifikan. Kesimpulan: Tidak terdapat hubungan pemberian antibiotik dini terhadap mortalitas pasien COVID-19 derajat sedang dan berat.

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Introduction: Currently, moderate and severe Coronavirus Disease-19 (COVID-19) patients receive early antibiotic (<24 hours) considering the possibility of bacterial secondary infection or co-infection which is a risk factor for mortality. This practice results in overuse of antibiotic because of low proportion of  bacterial secondary infection or co-infection in COVID-19 patients. Evaluation of patients to establish the bacterial infection before antibiotic administration could reduce the use of antibiotic in COVID-19 patients. However, there is no evidence that has proven the safety of delaying the antibiotic administration in moderate and severe COVID-19 patients. Method: This study is an observational study with retrospective cohort design. The study data came from electronic health record of Ciptomangunkusumo hospital from December 2020 to March 2021. Patients that receive antibiotic at the day of admission is categorized as early antibiotic and those who don’t is categorized as not early antibiotic. Data analysis is done by using SPSS ver.20. Result: Out of 180 inpatients with COVID-19, 72 patients were excluded because of ineligibility. From 108 included patients, 75 (68.5%) had moderate COVID-19 and 34 (31.5) had severe COVID-19. Early antibiotic was administered in 79 (73.1%) patients with 2 days median time of antibiotic administration in patients who did not receive early antibiotic. Univariate analysis did not find significant association between early antibiotic administration with mortality (p=0.42). Subgroup analysis of COVID-19 severity also did not show any significant association. Conclusion : Early antibiotic administration does not impact mortality of moderate and severe COVID-19 patients."

"Latar Belakang. Banyak faktor yang memengaruhi derajat berat infeksi dan mortalitas dari infeksi Corona Virus Disease 2019 (COVID-19). COVID-19 menyebabkan kerusakan sel beta pankreas, namun sampai saat ini mekanisme kerusakan ini belum banyak diketahui. Metode untuk menilai fungsi sekresi dari sel beta pankreas adalah Homeostatic Model Assessment- β (HOMA-β) dan C-peptide. Tujuan. Mengetahui hubungan antara HOMA-β dan C-peptide saat admisi dengan luaran buruk pada pasien terkonfirmasi COVID-19 yang dirawat inap. Metode. Penelitian ini merupakan studi kohort retrospektif yang dilakukan di Rumah Sakit Cipto Mangunkusumo (RSCM). Pasien terkonfirmasi COVID-19 (derajat ringan/sedang) berusia > 18 tahun, yang dirawat inap di RSCM Kiara dalam periode waktu September 2020 – Maret 2021, dengan HbA1c <6,5% serta tanpa riwayat diabetes sebelumnya, menjalani pemeriksaan HOMA-β dan C-Peptide. Ditentukan nilai titik potong keduanya untuk kemudian dilihat hubungannya dengan luaran buruk selama perawatan tersebut. Hasil. Dari 232 subyek yang memenuhi kriteria, terdapat 10(4,3%) subyek dengan luaran buruk. Median HOMA-β pada luaran buruk adalah 70,28% (RIK 32,25 – 132,11), sementara itu pada luaran baik adalah 121,6% (RIK 82,39 – 174,23). Median C-peptide pada luaran buruk dan baik berturut-turut adalah 2059 (RIK 1508 – 2762) dan 1647 (RIK 1107 – 2461). Nilai titik potong HOMA-β 80%, dengan AUC 0,702 (IK 95% 0,526-0,879) menunjukkan sensitifitas 60% dan spesifisitas 71,4%. Nilai Hazard Ratio (HR) dari HOMA-β <80 adalah 4,660 (p=0,017). Nilai titik potong C-peptide tidak dapat ditentukan karena AUC 0,555. Kesimpulan. Terdapat hubungan antara nilai HOMA-β saat admisi dengan luaran buruk selama perawatan pada pasien terkonfirmasi COVID-19, namun hubungan C-Peptide tidak didapatkan kemaknaannya dengan luaran buruk selama perawatan. Kata Kunci. COVID-19, C-Peptide, HOMA-β, Luaran buruk.

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Background. Many factors affect the severity of infection and mortality of Corona Virus Disease 2019 (COVID-19) infection. COVID-19 virus linked to pancreatic beta cells damage, yet the mechanism is still unclear. A method to assess the secretory function of pancreatic beta cells is based on Homeostatic Model Assessment- (HOMA-β) and C-peptide. Aim. Determine the relationship between HOMA-β and C-peptide values during admission in hospitalized confirmed COVID-19 patients with poor outcomes. Method. This is a retrospective cohort study conducted at Cipto Mangunkusumo Hospital (RSCM). Patients with confirmed COVID-19 (mild/moderate) who were hospitalized at the RSCM Kiara Hospital during the period September 2020 – March 2021, with HbA1c <6.5%, and without history of diabetes underwent HOMA-β and C-Peptide examination. The cut-off point for both was evaluated, furthermore the relationship with poor outcomes during hospitalization was assessed. Result. From 232 subjects met the inclusion and exclusion criteria, there were 10 (4.3%) subjects with poor outcomes. Median of HOMA-β in poor outcome group was 70.28% (IQR 32.25 – 132.11) while in good outcome group was 121.6% (IQR 82.39 – 174.23). The median of C-peptide on poor and good outcome were 2059 (IQR 1508 – 2762) vs. 1647 (IQR 1107 – 2461), respectively. The HOMA-β cut- off point was 80% showed AUC 0.702 (95% CI 0.526-0.879), with sensitivity 60% and specificity 71.4%. The Hazard Ratio (HR) of HOMA-β value <80% was 4.660 (p=0.017). The C-peptide cut-off point could not be determined because the AUC was 0.555. Conclusion. There is a significant relationship between the HOMA-β during admission and the poor outcome of hospitalized patients with confirmed COVID- 19 yet there is no significant relationship between C-Peptide and poor outcome."

"Latar Belakang : Major Adverse Cardiac Events (MACE) adalah penyebab penting morbiditas dan mortalitas perioperatif pasien usia lanjut yang menjalani operasi non kardiak. Geriatric Sensitive Cardiac Risk Index diketahui memiliki akurasi yang baik dalam memprediksi kejadian henti jantung dan infark miokardium pada usia lanjut yang menjalani operasi non kardiak. Namun, belum pernah dilakukan uji performa index tersebut di Indonesia dengan perbedaan karakteristik usia dan komorbiditas yang berbeda.Tujuan: Mengetahui performa index GSCRI dalam memprediksi kejadian MACE (Major Adverse Cardiac Event) pada pasien usia lanjut yang menjalani operasi non kardiak dengan karakteristik usia lanjut pada populasi geriatri Indonesia.Metode : Studi retrospektif berbasis uji prognostik dengan data rekam medis pasien usia > 60 tahun yang menjalani operasi non kardiak di poliklinik perioperatif dan rawat Inap Gedung A yang menjalani operasi pada tahun 2021-2022 di RSCM dengan memasukkan data-data determinan sesuai kalkulator GSCRI dengan luaran berupa persentase kejadian dan dilihat luaran berupa henti jantung dan infark miokardium pasca operasi. Studi ini dianalisa dengan uji diskriminasi dengan Area Under the Curve (AUC).Hasil : Analisa dilakukan pada 225 subjek dengan median usia 65 tahun dengan proporsi MACE sebesar 3.1% (7 subjek) yang mengalami kejadian MACE pasca pembedahan non kardiak. Performa diskriminasi yang baik (AUC 0.888, IK95% 0.831-0.944).Kesimpulan : Index GSCRI memiliki performa diskriminasi baik dalam memprediksi kejadian MACE pasien usia lanjut yang menjalani pembedahan non kardiak.

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Background : Major Adverse Cardiac Events (MACEs) is an important cause of perioperative morbidity and mortality in elderly patients undergoing non-cardiac surgery. The Geriatric Sensitive Cardiac Risk Index is known to have good accuracy in predicting cardiac arrest and myocardial infarction in the elderly undergoing non-cardiac surgery. However, this performance index has never been tested in Indonesia with different age characteristics and different comorbidities.

Objective: We aimed to determine the performance of the GSCRI index predicting the incidence of MACE (Major Adverse Cardiac Event) in elderly patients undergoing non-cardiac surgery with elderly characteristics in the Indonesian geriatric population.

Methods : Retrospective study based on prognostic test with medical record data of patients aged > 60 years who underwent non-cardiac surgery at the perioperative outpatient and inpatient who underwent surgery in 2021-2022 at RSCM by entering determinant data according to the GSCRI calculator with outcomes form of cardiac arrest and myocardial infarction postoperative. This study was analyzed by discrimination test with Area Under the Curve (AUC).

Results : The analysis was carried out on 225 subjects with an median age of 65 years with a proportion of MACE of 3.1% (7 subjects) who experienced MACE events after non-cardiac surgery. GSCRI had good discrimination performance (AUC 0.888, CI95% 0.831-0.944).

Conclusion: GSCRI index has good discriminatory performance in predicting the incidence of MACE in elderly patients undergoing non-cardiac surgery."

"Latar Belakang: Ansietas dan depresi merupakan gangguan psikosomatis yang paling banyak ditemukan. Pada pasien Lupus Eritematosus, ansietas merupakan gangguan mood paling banyak ditemukan dibandingkan depresi. Selain bagian dari manifestasi NPSLE, ansietas dan depresi dapat memicu terjadinya inflamasi yang akan memengaruhi aktivitas lupus. Hospital Anxiety dan Depresi Scale (HADS) merupakan salah satu skala pengukuran ansietas dan depresi yang berbentuk kuesioner yang mudah digunakan dansudah tervalidasi. Mexican Systemic Lupus Erythemathosus Sistemic Disease Activity (Mex SLEDAI) merupakan sistem skoring untuk pasien LES yang mudah dan lebih murah serta memiliki reliabilitas dan validitas yang baik. Saat ini belum ada yang meneliti perihal hubungan ansietas dan depresi yang menggunakan HADS dengan kadar C3 danC4 pada pasien LES.Tujuan: Mengetahui korelasi antara ansietas dan depresi dengan kedua kadar C3 dan C4 pada pasien LES di RSCM.Metode: Penelitian ini menggunakan desain potong lintang, dilakukan analisis data primer pasien LES usia 18-60 tahun. Dilakukan wawancara dan pemeriksaan fisik serta pengisian kuesioner HADS diikuti dengan pengambilan sampel darah untuk menilai kadar C3 dan C4. Korelasi antara skor HADS ansietas dan depresi dengan kadar C3 dan C4, dan serta Mex-SLEDAI didapat dengan uji korelasi Spearman menggunakan SPSS.Hasil: Dari 120 sampel dengan median usia 31 tahun (24-37), penggunaan steroid dengan median 16 mg/minggu (0-28), dan aktivitas lupus dengan median 6 (0-11). Didapatkan korelasi antara ansietas dengan kadar C3 dan C4 yang signifikan dengan nilai r = -0,189 dan r = -0,206. Tidak didapatkan korelasi depresi dengan kadar C3 dan C4 ataupun korelasi ansietas dan depresi dengan aktivitas lupus.Kesimpulan: Terdapat korelasi negatif antara HADS ansietas dengan kadar C3 ataupun C4.

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Background: Anxiety and depression are the most common psychosomatic disorders. Both of them have the highest prevalence of chronic diseases. In Lupus Erythematosus patients, anxiety is more common compared to depression. They have been widely penelitianed and found to have a clinical relationship. Not only they are one of the manifestations of NPSLE, they can also trigger inflammation that will affect lupus activity. On the other hand, many patients with anxiety and depression are undiagnosed and treated inappropriately. There is a screening tool that can measure both disorders quantitatively, namely the Hospital Anxiety and Depression Scale (HADS). Mexican Systemic Lupus Erythematosus Systemic Disease Activity (Mex-SLEDAI) can also be used to measure lupus activity. The advantage of this scoring is that it can be tested without measuring complement or anti-dsDNA levels, which is not necessarily available in every hospital. One of the factors that affects the activity of lupus is complement activity. Currently, no one has investigated the relationship between anxiety and

depression using HADS with levels of C3 and C4 in SLE patients.

Objective: To determine the correlation between anxiety and depression with levels of C3 and C4 in SLE patients in RSCM.

Methods: This study used a cross-sectional design, analyzed the primary data of SLE patients aged 18-60 years. Interviews and physical examinations were carried out as well as filling out the HADS questionnaire followed by taking blood samples to assess C3 and C4 levels. The correlation between HADS scores of anxiety and depression with levels

of C3 and C4, and Mex-SLEDAI was obtained using the Spearman correlation test using SPSS.

Results: 120 samples with a median age of 31 years (24-37), with the use of steroid doses with a median of 16 mg/week (0-28) and lupus activity with a median of 6 (0-11), there was a correlation between anxiety HADS and C3 levels and C4 which is significant with a value of r = -0.189 and r = -0.206. However, for HADS Depression with levels of C3 or C4 no correlation was found. In addition, in this study, there was no correlation between HADS Anxiety and Depression with Lupus Mex Sledai activity

Conclusion: There was a negative correlation between HADS Anxiety and levels of C3 or C4."

"Latar Belakang: Limfoma Hodgkin merupakan keganasan yang mencakup 1% kasus kanker keseluruhan. Adapun overall survival (OS) pasien limfoma Hodgkin dalam lima tahun mencapai 90%. Namun, progression-free survival (PFS) limfoma Hodgkin hanya mencapai 70-90% dalam kurun waktu 25 bulan. Setelah mengalami progresivitas, pasien mengalami penurunan PFS setelah mendapat terapi lini kedua. Sehingga, perlu diketahui faktor-faktor prediktor yang mempengaruhi PFS pasien limfoma Hodgkin.Tujuan: Mengetahui faktor-faktor prognostik PFS dua tahun pasien limfoma Hodgkin. Metode: Penelitian ini menggunakan desain kohort retrospektif yang melibatkan pasien limfoma Hodgkin yang teregistrasi dari tahun 2011-2021 di Rumah Sakit Umum Pusat Nasional Dokter Cipto Mangunkusumo. Faktor-faktor prognostik yang diteliti adalah stratifikasi risiko, skor prognosis internasional, kadar trombosit, laktat dehidrogenase, indeks komorbiditas Charlson, dan waktu sejak diagnosis hingga terapi. Analisis multivariat terhadap PFS dua tahun dilakukan menggunakan model regresi Cox.Hasil: Terdapat 115 subjek yang disertakan dalam penelitian dengan median usia 29 tahun, kadar trombosit 393.000 sel/L, LDH 340 IU/L, dan waktu sejak diagnosis hingga terapi enam minggu. Sebagian besar subjek penelitian adalah kelompok stadium lanjut (53,91%), total skor prognosis internasional 0-3 (69,57%), dan total skor indeks komorbiditas Charlson 0-1 (75,65%). Angka PFS dua tahun pasien limfoma Hodgkin di RSCM sebesar 59,13%. Hasil analisis bivariat menunjukkan waktu sejak diagnosis hingga terapi yang tidak memiliki kemaknaan secara statistik dengan HR 0,83 (IK 95% 0,42-1,59, p=0,57). Analisis multivariat menghasilkan tiga faktor prognostik independen, yakni stadium lanjut (HR 7,85 IK 95% 3,01-20,47, p<0,01), trombosit >450.000 sel/L (HR 2,77 IK 95% 1,49-5,16, p<0,01), dan LDH baik 250-500 IU/L (HR 2,57 IK 95% 1,01-3,63, p=0,04) maupun >500 IU/L (HR 3,06 IK 95% 1,20-7,82, p=0,02). Sistem skor berdasarkan ketiga variabel tersebut memiliki diskriminasi yang baik (AUROC 0,879, IK 95% 0,816-0,942, p <0,01).Kesimpulan: Stadium lanjut, trombosit >450.000 sel/L, dan LDH 250 IU/L merupakan faktor-faktor prognostik PFS dua tahun pada pasien limfoma Hodgkin.

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Background: Hodgkin's lymphoma is a malignancy that accounts for 1% of all cancer cases. The overall survival (OS) of Hodgkin's lymphoma patients in five years reaches 90%. However, progression-free survival (PFS) for Hodgkin's lymphoma only reaches 70-90% within 25 months. After experiencing progression, patients experienced a decrease in PFS after receiving second-line therapy. So, it is necessary to know the predictor factors that influence the PFS of Hodgkin's lymphoma patients.

Aim: To determine prognostic factors for two-year PFS in Hodgkin's lymphoma patients. Methods: This study used a retrospective cohort design involving Hodgkin's lymphoma patients registered from 2011-2021 at Dokter Cipto Mangunkusumo National General Hospital. The prognostic factors studied were risk stratification, international prognosis score, platelet levels, lactate dehydrogenase, Charlson comorbidity index, and time from diagnosis to therapy. Multivariate analysis of two-year PFS was performed using Cox regression models.

Results: There were 115 subjects included in the study with a median age of 29 years, platelet levels of 393,000 cells/L, LDH 340 IU/L, and time from diagnosis to therapy of six weeks. Most of the research subjects were in the advanced stage group (53.91%), the total international prognosis score was 0-3 (69.57%), and the total Charlson comorbidity index score was 0-1 (75.65%). The two-year PFS rate for Hodgkin's lymphoma patients at RSCM was 59.13%. The results of bivariate analysis showed that the time from diagnosis to therapy was not statistically significant with HR 0.83 (95% CI 0.42-1.59, p=0.57). Multivariate analysis yielded three independent prognostic factors, namely advanced stage (HR 7.85, 95% CI 3.01-20.47, p<0.01), platelets >450,000 cells/L (HR 2.77, 95% CI 1.49-5.16, p<0.01), and LDH either 250-500 IU/L (HR 2.57, 95% CI 1.01- 3.63, p=0.04) or >500 IU/L (HR 3.06 95% CI 1.20-7.82, p=0.02). The scoring system based on these three variables had good discrimination (AUROC 0.879, 95% CI 0.816- 0.942, p <0.01).

Conclusion: Advanced stage, platelets >450,000 cells/L, and LDH >250 IU/L are prognostic factors for two-year PFS in Hodgkin's lymphoma patients."

"atar Belakang: Balans energi positif pada obesitas ditandai dengan hiperadipositosis dan merangsang proses inflamasi kronik yang berdampak pada komplikasi penyakit pasien obesitas. Salah satu penatalaksaan obesitas adalah pemberian diet restriksi kalori. Diet restriksi kalori diduga menyebabkan penurunan kondisi inflamasi kronik yang salah satunya ditandai dengan kadar c-reactive protein (CRP). Namun demikian, berbagai studi memberikan hasil yang inkonsisten.Tujuan: Menilai efek diet restriksi kalori terhadap perubahan kadar CRP dan menilai pengaruh durasi diet tertentu terhadap perubahan kadar CRP pasien obesitas.Sumber Data: Pencarian utama dilakukan pada basis data PubMed, ProQuest, EBSCOhost, Embase dan Scopus hingga 30 Oktober 2020. Pencarian sekunder juga dilakukan secara snowballing, Google Scholar, Global Index Medicus, portal basis data nasional, dan perpustakaan digital 40 universitas di Indonesia.Seleksi Studi: Studi uji klinis acak melibatkan pasien dewasa obes yang menilai efek diet restriksi kalori (tanpa mengkombinasikan dengan terapi nondiet lain) terhadap kadar CRP. Tidak ada batasan tahun publikasi dan bahasa. Penilaian terhadap judul, abstrak dan studi dilakukan oleh dua peninjau independen. Dari 2087 artikel, 11 studi diantaranya memenuhi kriteria eligibilitas.Ekstraksi Data: Ekstraksi data dilakukan oleh kedua peninjau. Korespondensi dilakukan dengan menghubungi peneliti dan tidak didapatkan adanya data tambahan.Hasil: Diet restriksi kalori memiliki efek terhadap penurunan kadar CRP pada pasien obesitas dengan nilai Mean Difference -0.22 (IK 95% -0.40 - -0.04, p 0.006). Intervensi restriksi diet ≤ 12 minggu tidak menunjukkan penurunan bermakna pada kadar CRP, sedangkan intervensi restriksi diet > 12 minggu menunjukkan penurunan bermakna pada kadar CRP.KesimpulanDiet restriksi kalori memiliki efek menurunkan kadar CRP pada pasien obesitas.

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Background: Positive energy balance in obesity is characterized by hyperadipocytosis, which stimulates chronic inflammatory processes in obese patients. Management of obesity includes a calorie restriction diet thought to improve chronic inflammatory conditions, characterized by reduced c-reactive protein (CRP). However, studies have yielded inconsistent results.

Objective: To assess the effect of a calorie-restricted diet on changes in CRP levels and the duration of a particular diet that is significant for its effect on changes in CRP levels in obese patients

Data Source: We searched PubMed, ProQuest, EBSCOhost, Embase and Scopus through October 30,2020. Secondary searching was done by snowballing method including references of qualifying articles and manual searching through google scholar, global index medicus, national databases, and digital library of 40 universities in Indonesia

Study Selection: A randomized controlled trial involving obese adult patients assessed the effect of a calorie-restricted diet (without combination with other nondiet therapy) on CRP levels. No restriction regarding year of publication and language. Titles, abstracts, and articles were reviewed by two independent reviewer. Of the 2087 studies identified in our original search, 11 of them met the eligibility criteria.

Data Extraction: Data extraction was done by two reviewers. Correspondence was done by contacting the authors to confirm additional data. No additional data was obtained

Result: The calorie restriction diet has an effect on reducing CRP levels in obese patients with a Mean Difference value of -0.22 (95% CI -0.40 - -0.04, p 0.006). Dietary restriction interventions ≤ 12 weeks did not show a significant decrease in CRP levels, while dietary restriction interventions > 12 weeks showed a significant decrease in CRP levels

Conclusion: A calorie restriction diet has the effect of lowering CRP levels in obese patients"

"Latar Belakang: Individu dengan diabetes melitus tipe 2 (DMT2) dilaporkan mengalami peningkatan risiko terjadinya sarkopenia dan juga sebaliknya. Penelitian mengenai DMT2 dengan sarkopenia mayoritas berasal dari populasi geriatri. Sampai saat ini belum ada studi yang membandingkan profil metabolik dan parameter inflamasi di kelompok DMT2 dengan dan tanpa sarkopenia pada usia yang lebih muda.Tujuan: Penelitian ini bertujuan untuk mengetahui adanya perbedaan rerata profil metabolik dan parameter inflamasi pada penyandang DMT2 nongeriatri dengan dan tanpa sarkopenia.Metode: Penelitian potong lintang ini melibatkan individu dengan DMT2 nongeriatri berusia  18-59 tahun yang berobat di Rumah Sakit Cipto Mangunkusumo (RSCM), Jakarta, Indonesia pada bulan Januari 2021- Januari 2022. Dilakukan pengambilan data sekunder berupa antropometri dan laboratorium yang mencakup Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), HbA1c dan profil lipid. Kadar interleukin (IL)-6 dan IL-10 serum diukur menggunakan teknik ELISA. Kelompok sarkopenia terdiri atas possible dan true sarcopenia berdasarkan kriteria Asian Working Group for Sarcopenia (AWGS) 2019.Hasil: Dari 100 subjek, 35 subjek dikategorikan ke dalam possible sarkopenia dan 4 subjek true sarkopenia. Subjek DMT2 nongeriatri dengan sarkopenia memiliki median (RIK) nilai HOMA-IR dan kadar HbA1c yang lebih tinggi dibanding subjek tanpa sarkopenia yaitu berturut-turut [6,52 (4,05-17,26) vs. 4,66 (2,61-10,14); p=0,025] dan [9,0% (7,3-10,3)% vs. 7,4% (6,6-8,45)%; p=0,002]. Tidak terdapat perbedaan kadar profil metabolik lain dan IL-6 antara kedua kelompok, sementara kadar IL-10 hanya terdeteksi pada 33 sampel sehingga tidak dapat dianalisis lebih lanjut.Kesimpulan: Median nilai HOMA-IR dan kadar HbA1c kelompok DMT2 nongeriatri dengan sarkopenia lebih tinggi dibanding kelompok tanpa sarkopenia. Tidak ditemukan perbedaan kadar profil metabolik lain dan IL-6 sebagai parameter inflamasi antara kedua kelompok tersebut. Tidak dilakukan analisis beda rerata kadar IL-10 karena sedikitnya sampel yang terdeteksi.

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Background: Individuals with type 2 diabetes mellitus (T2DM) are at increased risk for sarcopenia and vice versa. Studies in T2DM with sarcopenia mostly came from the geriatric population. To date, no study has compared the metabolic profile and inflammatory parameters in younger T2DM subjects with and without sarcopenia.

Aim: This study aimed to assess the mean differences in the metabolic profile and inflammatory parameters of nongeriatric T2DM individuals with vs. without sarcopenia.

Method: This cross-sectional study involved nongeriatric T2DM individuals aged 18-59 years old visiting Cipto Mangunkusumo Hospital, Jakarta, Indonesia between January 2021 and January 2022. Secondary data was obtained, namely anthropometric and laboratory data including Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), HbA1c and lipid profile. Serum levels of interleukin (IL)-6 and IL-10 were measured using the ELISA technique. The sarcopenia group consists of individuals with possible and true sarcopenia based on the Asian Working Group for Sarcopenia (AWGS) 2019 criteria.

Results: From 100 subjects, 35 was categorized as possible sarcopenia and 4 as true sarcopenia. Nongeriatric T2DM subjects with sarcopenia had significantly higher median (interquartile range) HOMA-IR and HbA1c compared to nonsarcopenic subjects [6.52 (4.05-17.26) vs. 4.66 (2.61-10.14); p=0.025] and [9.0% (7.3-10.3)% vs. 7.4% (6.6-8.45)%; p=0.002]. There were no differences in other levels of metabolic profile and IL-6 between the two groups, while IL-10 levels were only detected in 33 samples and could not be analyzed further.

Conclusion: Median HOMA-IR and HbA1c nongeriatric T2DM subjects with sarcopenia was higher than those without sarcopenia. There was no difference in other metabolic profile and IL-6 level as inflammation parameter between the two groups. IL-10 was not analysed further due to the small sample number that were detected."

"Latar belakang: Pandemi COVID-19, selanjutnya disebut pandemi, menyebabkan keterbatasan akses ke fasilitas pelayanan kesehatan yang dapat menyebabkan hiperglikemia tidak terkontrol dan Ketoasidosis Diabetikum (KAD). Studi ini bertujuan untuk mengetahui perbedaan angka kejadian, karakteristik dan luaran pasien KAD sebelum dan selama pandemi. Metode: Penelitian ini merupakan studi analitik kohort retrospektif dengan subjek pasien KAD di RSCM yang datang pada bulan bulan April 2018 – April 2020 (kelompok sebelum pandemi) dan April 2020 – April 2022 (kelompok selama pandemi). Angka kejadian, karakteristik dan luaran pasien diambil dari rekam medis. Studi analitik akan dilakukan menggunakan uji Chi square dan Mann Whitney. Hasil: Sebanyak 354 pasien diikutsertakan dalam penelitian. Angka kejadian KAD meningkat sebelum dan selama pandemi (IRR: 2v13; p: 0,027). Sebagian besar pasien merupakan laki-laki (57,06%) berusia <65 tahun (76,27%) dengan riwayat Diabetes Melitus/ DM (91,81%). Selama masa pandemi, jumlah pasien yang baru terdiagnosis DM dan mengalami KAD lebih tinggi dibandingkan sebelum pandemi (10,98% vs 1,01%). Pasien dengan DM yang telah terdiagnosis (RR: 1,38 95% CI: 1,251-1,526; p <0,001) memiliki risiko yang secara signifikan lebih tinggi mengalami KAD selama pandemi dengan pencetus berupa pneumonia (RR: 1,25 95% CI: 1,08-2,11; p: 0,002). Selama pandemi, mortalitas (RR: 1,23 95% CI: 1,087-1,389; p: 0,001) dan tingkat keparahan KAD secara signifikan meningkat menjadi sedang-berat (RR: 1,3 95% CI: 1,021-1,353; p:0,014). Kesimpulan: Selama masa pandemi COVID-19, terdapat peningkatan jumlah pasien dan angka mortalitas KAD. Terdapat perbedaan karakteristik dan perburukan gambaran KAD selama pandemi COVID-19. Gambaran klinis harus diutamakan dalam tatalaksana pasien.

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Background: The COVID-19 pandemic, hereinafter referred to as a pandemic, causes limited access to health care facilities which leads to uncontrolled hyperglycemia and diabetic ketoacidosis (DKA). This study aims to determine the differences in the incidence, characteristics and outcomes of DKA patients before and during the pandemic.

Methods: This study was a retrospective analytic cohort study comparing the DKA patients presented in April 2018 – April 2020 (as pre-pandemic group) and April 2020 – April 2022 (as during the pandemic group). Incidence rates, characteristics and outcomes were taken from medical records. An analytical study will be carried out using the Chi square and Mann Whitney tests.

Results: A total of 354 patients were included in the study. The incidence of DKA increased during the pandemic (IRR: 2.13; p: 0.027). Most of the patients were male (57.06%) aged <65 years (76.27%) with pre-existing Diabetes Mellitus/DM (91.81%). Newly diagnosed DM proportion was higher in the during pandemic group (10.98% vs 1.01%). Based on the analysis, patients with pre-existing DM (RR: 1.38 95% CI: 1.251-1.526; p <0.001) had a significantly higher risk of experiencing DKA during a pandemic with pneumonia as a precipitating factor (RR: 1.25 95% CI: 1.08-2.11;p: 0.002). During the pandemic, mortality significantly increased (RR: 1.23 95% CI: 1.087-1.389; p: 0.001). DKA severity significantly worsened to moderate-severe (RR: 1.3 95% CI: 1.021-1.353; p:0.014).

Conclusion: During the COVID-19 pandemic, there was an increase of DKA incidence and mortality rate. Different characteristics and worsening features of DKA were found during the pandemic. Clinical features should be prioritized in patient management."