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"ABSTRAKPasien rawat inap dengan malnutrisi dapat mengalami kehilangan albumin melalui saluran cerna yang ditandai dengan penurunan albumin serum dan peningkatan kadar AAT tinja. Tujuan penelitian ini untuk menilai kehilangan protein melalui saluran cerna pada pasien di ruang rawat inap RSCM. Penelitian menggunakan rancangan potong lintang dengan uji deskriptif analitik, dengan menilai kadar AAT tinja dan albumin serum penderita rawat inap. Hasil penelitian pada 41 subjek malnutrisi dan 33 subjek tidak malnutrisi mendapatkan nilai median AAT tinja pada kelompok malnutrisi sebesar 86,9 mg/dL dengan rentang 26,3 - 310,3 mg/dL. Pada kelompok tidak malnutrisi didapat median nilai AAT tinja 12,2 mg/dL dengan rentang 1,4 - 25,6 mg/dL. Rerata albumin serum pada kelompok malnutrisi adalah 2,6 ± 0,4 g/dL sedangkan pada kelompok tidak malnutrisi 4,0 ± 0,4 g/dL. Terdapat korelasi kuat yang berlawanan arah antara kadar AAT tinja dan kadar albumin serum yang berarti terjadi kebocoran albumin serum melalui saluran cerna akibat gangguan integritas usus terutama pada pasien yang mengalami malnutrisi.

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ABSTRACTHospitalized patients with malnutrition can have albumin loss through gastrointestinal tract characterized by the decreased of serum albumin and the increased levels of fecal AAT. The purpose of this study was to assess the loss of protein through the gastrointestinal tract in hospitalized patients at RSCM hospital. The study was a cross-sectional study with descriptive analytic approach, assessing the levels of fecal AAT and serum albumin from 41 malnourish and 33 non malnourish subject. Fecal AAT median scores among the malnourished group was 86.9 mg/dL with a range from 26.3 to 310.3 mg/dL. In the non malnourished group fecal AAT median value was 12.2 mg / dL with a range from 1.4 to 25.6 mg/dL. The mean serum albumin in malnourished group was 2.6 ± 0.4 g/dL, while in the non malnourished group was 4.0 ± 0.4 g/dL. There is a strong negative correlation between fecal AAT levels and serum albumin, which indicates that serum albumin leakage through the gastrointestinal tract was due to impaired intestinal integrity especially in malnourished patients."

"ABSTRAKLatar belakang: D-dimer adalah hasil pemecahan cross-linked fibrin, sehingga peningkatan kadar D-dimer dapat dipakai sebagai penanda aktivasi sistem koagulasi dan fibrinolisis. Kadar D-dimer yang normal dapat dipakai untuk menyingkirkan diagnosis trombosis pada pasiendengan dugaan trombosis, tetapi hal ini tidak dapat dipakai pada kehamilan karena kadar D-dimer juga meningkat pada kehamilan. Tujuan: Menentukan kadar D-dimer pada wanita hamil tanpa komplikasi pada tiap trimester. Metode: Penelitian potong lintang dilakukan pada 90 wanita hamil tanpakomplikasi yang terdiri dari 30 orang dari trimester 1, trimester 2 dantrimester 3 dan 30 wanita sehat sebagai kontrol. Penelitian dilakukan daribulan Juli sampai Agustus 2012.Pengukuran kadar D-dimer denganreagen Innovance memakai koagulometer Sysmex CA 1500 diDepartemen Patologi Klinik. Hasil:Semua wanita dalam kelompok control mempunyai kadar D-dimer dalam rentang normal (<0.5mg/L FEU). Kadar D-dimer pada trimester 1 berkisar antara0,1 – 1,07 mg/L FEU dan 8 di antara 30 (27%) menunjukkan peningkatan kadar D-dimer, pada trimester 2 kadar D-dimer berkisarantara 0.6 – 3,34 mg/L FEUdan 26 di antara 30 (87%) menunjukkan peningkatan kadar D-dimer, sedang pada trimester 3 kadar D-dimer berkisar antara 0.69 – 3,75 mg/L FEU dan seluruhnyamenunjukkan peningkatan kadar D-dimer.Kadar D-dimer pada wanita hamil lebih tinggi secara bermakna dibandingkan wanita tidak hamil. Kesimpulan: Peningkatan kadar D-dimer ditemukan pada 27% wanita hamil trimester 1, 86% pada trimester 2 dan 100% pada trimester 3.

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ABSTRACTBackground: D-dimer is degradation product of cross-linked fibrin, therefore increased D-dimer level indicates activation of coagulation and fibrinolysis. Normal D-dimer level can be used to rule out diagnosis of venous thromboembolism in suspected patient, however it cannot apply in pregnancy because D-dimer level also increase during pregnancy. The aim of study is to determine the level of D-dimer on uncomplicated pregnancy in each trimester. Aim: The study is to determine the level of D-dimer on uncomplicated pregnancy in each trimester. Methods: A cross sectional study was done on 90 uncomplicated pregnant women consisted of 30 women of each trimester and 30 healthy, nonpregnant women as control group from July to August 2012. D-dimer level was measured by Innovance D-dimer using Sysmex CA 1500 coagulometer in Department of Clinical Pathology, Dr. Cipto Mangunkusumo Hospital, Jakarta. Result: All women in the control group showed normal D-dimer level (<0,5 mg/L FEU). The range of D-dimer level in the 1st trimester was 0,17 – 1.07 mg/L FEU , 8 out of 30 (27%) pregnant women showed increased D-dimer level, in the 2nd trimester was 0,31 – 3,34 mg/L FEU, 26 out of 30 (87%) indicated increased D-dimer, and in the 3 rd trimester the range of D-dimer level was 0,69 – 3, 75 mg/L FEU, and all of pregnant women 100% showed increased D-dimer level. Conclusion:The levelof D-dimer in the 1st trimester was 0.17- 1.07 mg/L FEU, in the 2ndtrimester was 0,31 – 3,34 mg/L FEU, andin the 3 rd trimesterwas 0.69-3.75% mg/L FEU."

"Infeksi yang disebabkan oleh methicillin-resistant Staphylococcus aureus (MRSA) telah menyebabkan beban mortalitas dan morbiditas yang bermakna. Mengingat hal tersebut, sangat penting untuk dapat mendeteksi MRSA dengan cepat dan akurat. Saat ini deteksi MRSA dapat dilakukan dengan dua cara, yaitu metode fenotipik dan genotipik. Pada penelitian ini, metode fenotipik dilakukan dengan uji kepekaan antibiotik menggunakan oksasilin dan sefoksitin, sementara metode genotipik dilakukan dengan polymerase chain reaction (PCR) gen nuc dan mecA. Gen nuc merupakan penanda genetik S. aureus, sedangkan gen mecA adalah gen yang mengkode penicillin-binding protein 2a (PBP2a). Protein ini memiliki afinitas rendah terhadap antibiotik β-laktam, sehingga menyebabkan resistensi terhadap antibiotik seperti metisilin, oksasilin, dan sefoksitin. Penelitian ini bertujuan untuk membandingkan metode fenotipik terhadap metode genotipik yang merupakan baku emas dalam mendeteksi MRSA. Sebanyak 136 isolat S. aureus diikutsertakan dalam penelitian ini. Dilakukan PCR untuk mengamplifikasi gen nuc dan mecA dengan hasil: 37 sampel terdeteksi sebagai MRSA (nuc+, mecA+), 96 sampel sebagai methicillinsensitive Staphylococcus aureus atau MSSA (nuc+, mecA-), and 3 sampel sebagai bukan S. aureus (nuc-). Persentase MRSA yang dideteksi dengan metode genotipik adalah sebesar 27,8%. Deteksi MRSA dengan metode fenotipik dilakukan dengan uji kepekaan antibiotik menggunakan oksasilin dan sefoksitin. Tidak terdapat perbedaan hasil uji kepekaan antara kedua antibiotik tersebut. Secara keseluruhan, hasil deteksi MRSA dengan metode fenotipik konsisten dengan metode genotipik, dengan dideteksinya MRSA sebesar 27,8%. Hal tersebut mengartikan bahwa sensitivitas dan spesifisitas metode fenotipik terhadap metode genotipik adalah sebesar 100%.

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Methicillin-resistant Staphylococcus aureus (MRSA) infection has caused significant morbidity and mortality burden. Therefore, detecting MRSA accurately as early as possible is very important. There are two methods used in detecting MRSA, which are phenotypic and genotypic methods. In this study, phenotypic method was done by antibiotic susceptibility test using oxacillin and cefoxitin, while genytopic method was carried out by amplifying nuc and mecA gene with polymerase chain reaction (PCR). Nuc gene is a genetic marker for S. aureus, and mecA gene is responsible in the coding of penicillin-binding protein 2a (PBP2a). This protein has a low affinity to β-lactam antibiotics, thus causing antibiotic resistance to the antibiotics, such as methicillin, oxacillin, and cefoxitin.

This study was aimed to compare phenotycipic method to genotypic method as the gold standard, to detect MRSA. There were 136 S. aureus isolates included in this study. PCR to amplify nuc and mecA gene was conducted with the results of the following: 37 samples detected as MRSA (nuc+, mecA+), 96 samples as methicillin-sensitive Staphylococcus aureus or MSSA (nuc+, mecA-), and 3 samples as non-S. aureus (nuc-). The percentage of MRSA detected by genotypic method was 27,8%.

The detection of MRSA through the phenotypic method was done by antibiotic susceptibility test using oxacillin and cefoxitin. Susceptibility test between these antibiotics showed no difference in result. In general, the result of phenotypic method was consistent to the results from the genotypic method, by detecting 27,8% MRSA. Therefore, the sensitivity and specificity of phenotypic method compared to the genotypic method were 100%."

"Infeksi Clostridium difficile toksigenik meningkat tajam pada satu dekade terakhir, menyebabkan pseudo membran colitis (PMC) dan Clostridium difficile associated diarrhea (CDAD). Salah satu faktor risikonya adalah penggunaan antibiotik. Tujuan penelitian adalah mengetahui prevalensi dan gambaran karakteristik subyek dengan Clostridium difficile toksigenik serta menilai kemampuan rapid test toksin terhadap real time PCR. Subyek penelitian prospektif ini adalah 90 subyek dewasa dengan terapi antibiotik lebih dari 2 minggu. Hasil pemeriksaan menggunakan rapid test dan real time PCR disajikan dalam tabel 2x2, dilakukan uji statistik dengan chi square. Hasil penelitian menunjukkan 2 spesimen dieksklusi karena hasil invalid, 24 spesimen positif dan 64 negatif dengan rapid test toksin; 33 spesimen positif dan 55 negatif dengan real time PCR. Prevalensi Clostridium difficile toksigenik berdasar rapid test toksin adalah 27,3% dan real time PCR 37,5%. Terdapat perbedaan bermakna antara konsistensi feses dan jumlah antibiotik dengan terdeteksinya Clostridium difficile toksigenik (p<0,05). Terdapat hubungan antara lama terapi antibiotik dengan terdeteksinya Clostridium difficile toksigenik menggunakan real time PCR (p=0,010, RR=2,116). Sensitivitas, spesifisitas, nilai duga positif, nilai duga negatif, rasio kemungkinan positif dan rasio kemungkinan negatif rapid test toksin terhadap real time PCR berturut-turut adalah 69,7%; 98,2%; 95,8%; 84,4%; 39,2 dan 0,31. Dari hasil penelitian disimpulkan bahwa prevalensi Clostridium difficile di RSCM lebih tinggi dibanding Malaysia, Thailand dan India; subyek dengan terapi antibiotik lebih dari 4 minggu berisiko terdeteksi Clostridium difficile toksigenik 2 kali lebih besar dibanding subyek dengan terapi antibiotik kurang dari 4 minggu; rapid test toksin dapat digunakan sebagai alat deteksi Clostridium difficile toksigenik.

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Toxigenic Clostridium difficile infection have increased sharply in the last decade, causing a pseudo membrane colitis (PMC) and Clostridium difficile associated diarrhea (CDAD). One of the biggest risk factor is the use of antibiotics. The purpose of the study was to determine the prevalence and characteristics of subjects with toxigenic Clostridium difficile and assess the ability of the toxin rapid test compared to real-time PCR. Ninety adult subjects with antibiotic therapy more than 2 weeks were enrolled to this prospective study. The results of toxin rapid test and real-time PCR were presented in 2x2 table, statistical tests was calculated with chi square. Two specimens were excluded due to invalid results. The results showed 24 positive and 64 negative specimens by toxin rapid test; 33 positive and 55 negative specimens by real-time PCR. The prevalence of toxigenic Clostridium difficile based on toxin rapid test were 27.3% and 37.5% by real-time PCR. There were significant differences between stool consistency and number of antibiotics that were used with the detection of toxigenic Clostridium difficile. There was a relationship between duration of antibiotic therapy with detection of toxigenic Clostridium difficile using real-time PCR (p = 0.010, RR = 2.116). Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of toxin rapid test against real-time PCR were 69.7%; 98.2%; 95.8%; 84.4%; 39.2 and 0.31, respectively. The study concluded that the prevalence of Clostridium difficile in RSCM was higher than Malaysia, Thailand and India; subjects with antibiotic therapy for more than 4 weeks had double risk to have toxigenic Clostridium difficile than subjects with antibiotic therapy for less than 4 weeks and toxin rapid test could be used as a tool to detect toxigenic Clostridium difficile."

"Latar Belakang Penelitian Kapasitas kerja fisik (KKF, physical working capacity) yaitu derajat metabolisme (kerja) yang dapat dicapai oleh seseorang. KKF menilai kesanggupan seseorang untuk melakukan kerja fisik dinamis berat yang berlangsung dalam waktu relatif cukup lama (1). WHO (1969) merumuskan bahwa physical performance capacity atau potensi untuk mencapai prestasi dari segi fisik, ditentukan oleh daya aerobik maksimum dan kapasitasnya, daya anaerobik maksimum dan kapasitasnya, kekuatan otot maksimum serta ketahanannya, koordinasi sistem neuromuskuler dan toleansi subjektif terhadap kerja (2). Di laboratorium Ilmu Faal, KKF diukur dari daya tangkap oksigen maksimum atau daya aerobik maksimum yang disingkat sebagai V02 max. Tetapi hingga saat ini belum ada indikator kuantitatif baku yang dapat digunakan secara pasti sebagai prasyarat tercapainya optimasi latihan berupa peningkatan KKF yang nyata (1). Mengingat dalam setiap kerja fisik tubuh memperoleh energi dari hasil metabolisme aerob dan anaerob (3,4), maka selain pengukuran V02 max. yang mengukur sistem kardiorespirasi (aerobik), perlu pula dilakukan pengukuran kadar asam laktat (AL) darah yang menilai kemampuan anaerobik tubuh. Kemampuan anaerobik ini menjadi lebih penting setelah diketahui bahwa endurance performance mempunyai korelasi lebih baik terhadap AL daripada V02 max. (5). "

"Terdapat dua macam perubahan faali yang terjadi dalam tu buh selama gerak badan. Pertama, perubahan faali yang terjadi akibat kerja fisik (exercise) dan kedua, perubahan faali yang terjadi secara bertahap dalam tubuh akibat latihan fisik (training) yang teratur. Beberapa peneliti melaporkan selama kerja fisik terjadi peningkatan kadar elektrolit serum, sedangkan latihan fisik dapat menyebabkan turunnya kadar elektrolit serum.Penelitian ini bertujuan membuktikan adanya pengaruh ker ja fisik dengan beban maksimal dan latihan fisik yang teratur selama 6 minggu terhadap kadar elektrolit serum, sehingga diharapkan dapat memberikan sumbangan data yang bermanfaat dalam menentukan apakah perlu penambahan air atau elektrolit sesudah kerja fisik dan latihan fisik.Telah dilakukan penelitian terhadap 10 atlit balap sepeda dari Pelatda DKI Jaya mengenai kadar elektrolit serum (natrium, kalium, klorida, kalsium dan magnesium) yang dilakukan sebelum dan sesudah menjalani latihan fisik selama 6 minggu. Pemeriksaan kadar elektrolit serum baik sebelum maupun sesudah latihan fisik dilakukan masing-masing 4 kali, yaitu sebelum kerja fisik (menit ke 0), waktu melakukan kerja . fisik menggunakan ergosikel Monark dengan beban maksimal {150 watt) menit ke 5, saat kerja fisik maksimal dan waktu melakukan pemulihan aktif pada menit ke 20 sesudah kerja fisik maksimal.Hasil penelitian menunjukkan bahwa selama kerja fisik dengan beban maksimal kadar natrium, kalium, korida, kalsium total dan magnesium total serum meningkat secara bermakna, se dangkan sesudah pemulihan aktif kadarnya menurun dan tidak berbeda lagi dengan kadar sebelum kerja fisik. Sesudah latihan fisik selama 6 minggu terjadi penurunan kadar semua elektrolit serum yang diperiksa, baik sebelum maupun sesudah latihan fisik menunjukkan pada perubahan kadar elektrolit serum yang hampir sama.Melihat hasil pemeriksaan kadar elektrolit serum sesudah latihan fisik selama 6 minggu dan kurangnya ?intake? natrium, kalium, kalsium dan magnesium, penulis mengusulkan selama latihan fisik perlu penambahan air dan elektrolit terutama kalsium dan magnesium. Sedangkan sesudah kerja fisik dengan beban maksimal, tidak perlu penambahan air dan elektrolit.untuk mengetahui apakah turunnya kadar elektrolit serum sesudah latihan fisik selama 6 minggu mengganggu peningkatan prestasi yang diharapkan, serta membuktikan kebenaran hipotesis turunnya kadar elektrolit serum karena kehilangan lewat keringat atau karena masuknya elektrolit ke dalam eritrosit dan sel otot yang sedang berkontraksi, penulis mengusulkan dilakukan penelitian lanjutan antara PKO Senayan dan Bagian Patologi Klinik FKUI-RSCM mengenal hal-hal tersebut. Di usulkan pula untuk melanjutkan penelitian serupa pada berbagai cabang olahraga yang lain untuk mengetahui apakah ada pola khusus."

"Karsinoma kandung kemih merupakan keganasan nomor empat terbanyak. Dampak beban ekonomi karsinoma kandung kemih cukup nyata, sehingga diperlukan deteksi dini keganasan kandung kemih untuk menurunkan beban ekonomi. Sistoskopi merupakan pemeriksaan baku emas untuk identifikasi karsinoma kandung kemih, tetapi pemeriksaan tersebut invasif dan menyebabkan ketidaknyamanan bagi pasien. Sitologi urin tidak invasif, tetapi hasilnya tidak bisa didapatkan dengan cepat dan terdapat ketergantungan interpretasi pemeriksa.Tujuan penelitian ini adalah untuk membandingkan nilai diagnosis dua penanda tumor, yaitu ELISA NMP-22, ELISA UBC urin, serta kombinasi keduanya pada pasien karsinoma kandung kemih. Penelitian uji diagnostik ini terdiri dari 25 orang pasien dengan indikasi sistoskopi dan trans ureteral resection bladder tumor (TUR-BT)/biopsi tumor. Pasien yang memenuhi kriteria masukan dan tolakan dilakukan pengambilan urin pasien kemudian dilakukan pemeriksaan ELISA NMP-22 dan ELISA UBC urin. Hasil pemeriksaan ELISA NMP-22 dan ELISA UBC urin akan dibandingkan dengan pemeriksaan sistoskopi disertai dengan hasil histopatologi.Permeriksaaan ELISA NMP-22 urin dengan cut-off 10 U/ml mempunyai sensitivitas 62,3% dan spesifisitas 83,3%, nilai prediksi positif 81,8% dan nilai prediksi negatif71,4%,likelihood ratio positif3,73 dan likelihood ratio negatif0,45. Jika kasus sistitis dieksklusi maka didapatkan sensitivitas adalah 69,2%, spesifisitas 75%, nilai prediksi positif 81,8%, nilai prediksi negatif 60%, likelihood ratio positif 2,76 , likelihood ratio negatif0,42. Pemeriksaan ELISA UBC dengan cut-off 12 ug/Lmempunyai sensitivitas 38,5% dan spesifisitas 91,7%, nilai prediksi positif 83,3% dan nilai prediksi negatif57,9%,likelihood ratio positif4,63 dan likelihood ratio negatif0,67. Jika kasus sistitis dieksklusi maka didapatkan sensitivitas adalah 38,5%, spesifisitas 87,5%, nilai prediksi positif 83,3%, nilai prediksi negatif 46,7%, likelihood ratio positif 3,08 , likelihood ratio negatif0,70. Kombinasi pemeriksaan ELISA NMP-22 dengan UBC urin mempunyai sensitivitas 76,9% dan spesifisitas 75%, nilai prediksi positif 76,9% dan nilai prediksi negatif75%,likelihood ratio positif3,08 dan likelihood ratio negatif0,31. Jika kasus sistitis dieksklusi maka didapatkan nilai sensitivitas adalah 78,5%, spesifisitas 71,4 %, nilai prediksi positif 84,6 %, nilai prediksi negatif 62,5%, likelihood ratio positif2,74 , likelihood ratio negatif0,30. Kami menyimpulkan kombinasi pemeriksaan ELISA NMP-22 dengan ELISA UBC urin lebih baik karena mempunyai sensitivitas paling tinggi sehingga adanya tumor di kandung kemih baik primer maupun rekuren tidak akan luput dari diagnosis, meskipun harus dipastikan lagi dengan pemeriksaan sistoskopi.

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Bladder cancer is the forth most common cancer. Bladder cancer posseses a significant economic burden so that early detection of baldder cancer may decrease the economic burden. Cystoscopy is the reference standard for identification of bladder carcinoma, but it is invasive andcauses significant discomfortto the patient. Urinary cytology is noninvasive but time consuming and hampered by inter-observer variations. The aim of this study is to compare the diagnostic value of the urine NMP-22 ELISA test, UBC-ELISA test and combination of both tests on suspect bladder carcinoma patients.This diagnostic study included25 patients who were indicated for cystoscopy and trans uretheral resection bladder tumor / tumor biopsy. From patients who met requirements for the inclusion and exclusion criteria, the urine voided sample was taken and used for NMP-22 ELISA test and UBC ELISA test. The results of NMP-22 ELISA test and UBC ELISA test were evaluated against the cystoscopy and histological findings as the reference standard.The result of diagnostic study of NMP-22 ELISA test with cut-off 10 U/mlshowed that it had a sensitivity of 62,3% and a specificity of 83,3%, a positive predictive value of 81,8% and a negative predicitive value of 71,4%, a positive likelihood ratio of 3,73 and a negative likelihood ratio of 0,45. If the cystitis case was excluded, it had a sensitivity of 69,2%, and a specificity of 75%, a positive predictive value of 81,8%, and a negative predicitive value of 60%, a positive likelihood ratio of 2,76 , and a negative likelihood ratio of0,42. Diagnostic value of UBC ELISA test with cut-off 12 ug/L had a sensitivity of 38,5% and a specificity of 91,7%, a positive predictive value of 83,3% and a negative predicitive value of 57,9%, a positive likelihood ratio of 4,63 and a negative llikelihood ratio of 0,67. If the cystitis case was excluded, it had a sensitivity of 38,5%, and a specificity of 87,5%, a positive predictive value of 83,3%, and a negative predicitive value of 46,7%, a positive likelihood ratio of 3,08 , and a negative likelihood ratio of0,70.Diagnostic value of combined NMP-22 ELISA test with UBC ELISA test had a sensitivity of 76,9% and a specificity of 75%, a positive predictive value of 76,9% and a negative predicitive value of 75%, a positive likelihood ratio of 3,08 and a negative llikelihood ratio of0,31. If the cystitis case was excluded, it had a sensitivity of 78,5%, and a specificity of 71,4%, a positive predictive value of 84,6%, and a negative predicitive value of 62,5%, a positive likelihood ratio of 2,74 , and a negative likelihood ratio of0,30.The conclusion was that the combined NMP-22 ELISA test with UBC test had the highest sensitivity, thus itwould not miss any primary or recurrent tumour in the bladder, although this neededto be confirmed by cystoscopy."

"Diabetes Melitus tipe 2 merupakan sekumpulan gangguan metabolik dengan karakteristik hiperglikemia. Komplikasi klinis akibat DM berkolerasi dengan status glikemik, sehingga diperlukan upaya pengontrolan status glikemik pasien DM, baik jangka pendek, jangka menengah maupun jangka panjang untuk mencegah atau mengurangi komplikasi progresif akibat penyakit tersebut. Parameter laboratorium untuk pemantauan status glikemik meliputi kadar glukosa darah harian, HbA1c, dan albumin glikat (AG). Penelitian ini bertujuan untuk mendapatkan gambaran kadar HbA1c dan kadar AG pada pasien DM tipe 2 tidak terkontrol, mendapatkan korelasi antara kadar HbA1c dan kadar AG, juga melihat penurunan kadar HbA1c dan AG sesudah terapi 1 dan 3 bulan. Penelitian dilakukan dengan desain studi diagnostik, yang melibatkan 32 subyek penelitian yang diikuti selama 3 bulan mulai bulan Februari hingga Mei 2014. Diagnosis DM tipe 2 ditegakkan oleh dokter Spesialis Penyakit Dalam dan diagnosis DM tipe 2 tidak terkontrol didapatkan dari hasil pemeriksaan HbA1c > 7 %. Hasil penelitian mendapatkan rerata (SD) kadar glukosa darah puasa bulan ke-0, ke-1, dan ke-3 berturut-turut sebesar 170,5(51,6) mg/dL; 162,7(54,6) mg/dL, dan 147,3(45,9) mg/dL. Median (rentang) kadar glukosa darah 2 jam postprandial l(G2PP) bulan ke-0 dan ke-1 sebesar 220 mg/dL (90-544) mg/dL dan 191,5 mg/dL (114-468) mg/dL; rerata(SD) kadar G2PP bulan ke-3 sebesar 201(65,98) mg/dL. Korelasi antara kadar HbA1c dan kadar AG adalah : pada bulan ke-0, r=0,79, p<0,001, bulan ke-1 r=0,74, p<0,001 dan bulan ke-3 r=0,78, p<0,001. Penurunan kadar HbA1c dari baseline (delta-1) dan pada bulan ke-3 (delta-3) adalah median (rentang) delta-1 sebesar 0,43% (0,35-0,74)%, p<0,001 dan median (rentang) delta-3 sebesar 0,89% (0,64-2,30)%, p<0,001. Penurunan kadar AG bulan ke-1 dari baseline (delta-1) dan pada bulan ke-3 (delta-3): median (rentang) delta-1 sebesar 0,94% (0,48-1,64)%, p<0,001, dan median (rentang) delta-3 sebesar 1,79% (0,33-1,40)%, p<0,001. Kami menyimpulkan bahwa terdapat korelasi positif bermakna antara kadar HbA1c dan kadar AG pada bulan ke-0, ke-1, dan ke-3, dengan kekuatan korelasi kuat (r = 0.7-0.8), selain itu terdapat penurunan kadar HbA1c dan AG yang bermakna sesudah terapi 1 dan 3 bulan.

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Type 2 diabetes mellitus (T2DM) is a group of metabolic disorders with hyperglycemic characteristic. Clinical complications of DM correlate with glycemic state, therefore it is necessary to make an effort to control DM glycemic state, in short-, medium-, and long-term to prevent or minimize progressive complications due to the disease. Laboratory parameters to monitor glycemic state include daily blood glucose, HbA1c, and glycated albumin (GA).

This study aimed to obtain HbA1c and GA levels in uncontrolled type 2 DM patients, the correlations between HbA1c and GA levels, and also the decrease in HbA1c and GA levels after 1 month and 3 months treatment. This was a diagnostic study involving 32 subjects that were followed for 3 months from February to May 2014. Type 2 DM was diagnosed by the internist in the Department of Internal Medicine and the uncontrolled type 2 DM was confirmed by HbA1c measurement of > 7%.

The results showed that mean (SD) fasting blood glucose levels at baseline, 1 month and 3 months were 170.5 (51.6) mg/dL; 162.7 (54.6) mg/dL, and 147.3(45.9) mg/dL, respectively. Median (range) 2 hours postprandial blood glucose levels at baseline and 1 month respectively, were 220 mg/dL (90-544) mg/dL and 191.5 mg/dL, respectively, and mean (SD) at 3 months was 201,7 (65,98) mg/dL. Correlations between HbA1c and GA levels : at baseline r =0.79, p<0.001, at 1 month r=0.74, p<0.001 and at 3 months r=0.78, p<0.001.

Decreases of HbA1c level from baseline, at 1 month (delta-1) and at 3 months (delta-3) : median (range) delta-1was 0.43% (0.35-0.74)%, p<0.001 and median (range) delta-3 was 0.89% (0.64-2.30)%, p<0.001. Decreases of GA level from baseline, at 1 month (delta-1) and at 3 months (delta-3) : median (range) delta-1 was 0.94%(0.48-1.64)%, p<0.001, and median (range) delta-3 was 1.79%(0.33-1.40)%, p<0.001.

We concluded that there were significant positive correlations between HbA1c and GA levels at baseline,1 month and 3 months, with strong correlations (r=0.7-0.8). In addition, there were also significant decreases in HbA1c and GA levels from baseline at 1 month and 3 months therapy."

"[ABSTRAKLatar Belakang: Infeksi merupakan penyebab kematian yang penting pada thalassemia. Peningkatan risiko infeksi disebabkan oleh banyak faktor antara lain karena kelebihan besi dan splenektomi. Penelitian ini bertujuan mengetahui perbedaan fungsi fagositosis monosit pada pasien thalassemia mayor pasca splenektomi dan non splenektomi serta mengetahui hubungan fungsi fagositosis monosit dengan kadar feritin serum.Metode: Penelitian dilakukan di Departemen Patologi Klinik RSCM, Jakarta pada September 2013 ? Februari 2014. Desain penelitian potong lintang, dengan subjek penelitian pasien thalassemia mayor, terdiri dari 58 subjek pasca splenektomi dan 58 subjek non splenektomi yang telah dilakukan macthing umur dan jenis kelamin. Dilakukan pemeriksaan fagositosis monosit menggunakan E.coli yang telah diopsonisasi dan dilabel FITC sebagai target, (PhagotestTM) dan diperiksa dengan flow cytometry BD FACSCalibur. Kadar feritin serum diperiksa dengan Cobas e 601.Hasil: Median fagositosis monosit pada 58 subjek pasca splenektomi 5,03 (0,17 ? 22,79) %, dan pada 58 subjek non splenektomi 7,09 (0,11 ? 27,24) %, dan nilai p > 0.05. Kadar feritin serum pada subjek pasca splenektomi 6.724 (644,60 ? 21.835) ng/mL dan subjek non splenektomi 4.702,50 (1.381 ? 14.554) ng/mL, dan nilai p < 0.05. Hasil uji korelasi fungsi fagositosis monosit dengan kadar feritin didapatkan r = 0.13 (nilai p = 1.00).Kesimpulan: Tidak terdapat perbedaan bermakna antara fungsi fagositosis monosit pada pasien thalassemia mayor pasca splenektomi dan non splenektomi. Kadar feritin serum pada pasien thalassemia mayor pasca splenektomi lebih tinggi secara bermakna dibandingkan non splenektomi. Tidak didapatkan hubungan antara fagositosis monosit dengan kadar feritin serum.

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ABSTRACTBackground : Infection is an important cause of death in thalassemia. Increase of risk of infection could be due to iron overload and post-splenectomy. The study aimed to determine the difference of phagocytosis function of monocyte between post-splenectomized and non- splenectomized patients with thalassemia major, and the correlation of phagocytosis function of monocyte and serum ferritin level.Methods : The study was conducted in Department of Clinical Pathology Cipto Mangunkusumo hospital, Jakarta, in September 2013 ? Februari 2014. It was a cross sectional study. The study subjects consisted of 58 post-splenectomized patients and 58 non-splenectomized patients with age and sex matching. Phagocytosis function of monocyte was determined using E.coli opsonized and labelled with FITC as target, (Phagotest TM) and was measured by flow cytometry BD FACSCalibur. Serum ferritin level was measured using Cobas e 601.Result : Median phagocytosis of monocyte was 5,03 (0,17 ? 22,79) %, in 58 post- splenectomized subjects and 7,09 (0,11 ? 27,24) % in non-splenectomized subjects; p value > 0.05. Serum ferritin level was 6.274 (644,60 ? 21.835) ng/mL in post-splenectomized subjects and 4.702,50 (1.381 - 14.554) ng/mL in non-splenectomy subjects; p value < 0.05. The correlation between phagocytosis function of monocyte and serum ferritin level was r = 0.13 ( p value = 1.00).Conclusion : There was no statistical difference of phagocytosis function of monocyte between post-splenectomized subjects and non-splenectomized subjects. Serum ferritin level in post- splenectomized was higher than non-splenectomized subjects. There was no correlation between phagocytosis function of monocyte and serum ferritin level.;Background : Infection is an important cause of death in thalassemia. Increase of risk of infection could be due to iron overload and post-splenectomy. The study aimed to determine the difference of phagocytosis function of monocyte between post-splenectomized and non- splenectomized patients with thalassemia major, and the correlation of phagocytosis function of monocyte and serum ferritin level.Methods : The study was conducted in Department of Clinical Pathology Cipto Mangunkusumo hospital, Jakarta, in September 2013 – Februari 2014. It was a cross sectional study. The study subjects consisted of 58 post-splenectomized patients and 58 non-splenectomized patients with age and sex matching. Phagocytosis function of monocyte was determined using E.coli opsonized and labelled with FITC as target, (Phagotest TM) and was measured by flow cytometry BD FACSCalibur. Serum ferritin level was measured using Cobas e 601.Result : Median phagocytosis of monocyte was 5,03 (0,17 – 22,79) %, in 58 post- splenectomized subjects and 7,09 (0,11 – 27,24) % in non-splenectomized subjects; p value > 0.05. Serum ferritin level was 6.274 (644,60 – 21.835) ng/mL in post-splenectomized subjects and 4.702,50 (1.381 - 14.554) ng/mL in non-splenectomy subjects; p value < 0.05. The correlation between phagocytosis function of monocyte and serum ferritin level was r = 0.13 ( p value = 1.00).Conclusion : There was no statistical difference of phagocytosis function of monocyte between post-splenectomized subjects and non-splenectomized subjects. Serum ferritin level in post- splenectomized was higher than non-splenectomized subjects. There was no correlation between phagocytosis function of monocyte and serum ferritin level., Background : Infection is an important cause of death in thalassemia. Increase of risk of infection could be due to iron overload and post-splenectomy. The study aimed to determine the difference of phagocytosis function of monocyte between post-splenectomized and non- splenectomized patients with thalassemia major, and the correlation of phagocytosis function of monocyte and serum ferritin level.Methods : The study was conducted in Department of Clinical Pathology Cipto Mangunkusumo hospital, Jakarta, in September 2013 – Februari 2014. It was a cross sectional study. The study subjects consisted of 58 post-splenectomized patients and 58 non-splenectomized patients with age and sex matching. Phagocytosis function of monocyte was determined using E.coli opsonized and labelled with FITC as target, (Phagotest TM) and was measured by flow cytometry BD FACSCalibur. Serum ferritin level was measured using Cobas e 601.Result : Median phagocytosis of monocyte was 5,03 (0,17 – 22,79) %, in 58 post- splenectomized subjects and 7,09 (0,11 – 27,24) % in non-splenectomized subjects; p value > 0.05. Serum ferritin level was 6.274 (644,60 – 21.835) ng/mL in post-splenectomized subjects and 4.702,50 (1.381 - 14.554) ng/mL in non-splenectomy subjects; p value < 0.05. The correlation between phagocytosis function of monocyte and serum ferritin level was r = 0.13 ( p value = 1.00).Conclusion : There was no statistical difference of phagocytosis function of monocyte between post-splenectomized subjects and non-splenectomized subjects. Serum ferritin level in post- splenectomized was higher than non-splenectomized subjects. There was no correlation between phagocytosis function of monocyte and serum ferritin level.]"

"[ABSTRAKGastro Entero Pancreatic Neuro Endocrine Tumor (GEP-NET) merupakan keganasan yang jarang dijumpai di dunia dibandingkan dengan keganasan gastrointestinal lainnya. Menurut dataGEP-NET kadang sulit dibedakan dengan Irritabel Bowel Syndrome (IBS) dalam mendiagnosisnya. Keluhan GEP-NET antara lain nyeri perut, diare, flushing, sampai penurunan berat badan. Keluhan IBS antara lain nyeri perut, mual, diare atau dengan tanpa konstipasi. Saat ini telah dikembangkan pemeriksaan Chromogranin A (CgA) untuk membantu dalam pemeriksaan penapisan pasien yang menderita IBS maupun pasien yang dicurigai GEP-NET.Penelitian ini merupakan penelitian deskriptif untuk mengetahui kadar CgA pada kelompok normal, mengetahui kadar CgA pada pasien yang didiagnosis IBS, mengetahui kadar CgA pada pasien yang memiliki risiko GEP-NET dan mengetahui perbedaan kadar CgA pada pasien yang didiagnosis IBS dan pasien yang dicurigai menderita GEP-NET yang keduanya memiliki risiko GEP-NET.Pada penelitian ini didapatkan kadar CgA serum pada kelompok kontrol normal dengan nilai mean 50,70 μg/L, median 48,89 μg/L dengan rentang minimum-maksimum antara 42,66-80,62 μg/L. Pada penelitian ini didapatkan kadar CgA serum pada kelompok IBS dengan nilai mean 76,67 μg/L, median 64,82 μg/L dengan rentang minimum-maksimum antara 45,52-243,18 μg/L. Pada penelitian ini didapatkan kadar CgA serum pada kelompok yang dicurigai GEP- NET denga nilai mean median 66,23 μg/L dengan rentang minimum-maksimum antara 49,89-656,41 μg/L.Pada penelitian ini tidak terdapat perbedaan kadar CgA pada populasi pasien yang didiagnosa IBS maupun pada pasien yang dicurigai menderita GEP-NET yang keduanya memiliki risiko menderita GEP-NET dikemudian hari.

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ABSTRACTGastro Entero Pancreatic Neuro Endocrine Tumors (GEP-NET) is a malignancy that is rarely found in the world compared to other gastrointestinal malignancies. According to data registration data The Surveillance, Epidemiology and End Results (SEER) an increase in the incidence of sharp from 1973 (from 0.92 to 1.28 in 100,000 population per year), to 2004 (from 5.09 to 5.42 in 100,000 population per year).GEP-NET is difficult to distinguish from Irritabel Bowel Syndrome (IBS) in diagnose sometimes. GEP-NET complaints include abdominal pain, diarrhea, flushing, until the weight loss. Complaints of IBS include abdominal pain, nausea, diarrhea or with no constipation. We have been developed examination Chromogranin A (CgA) to assist in the screening examination of patients who suffer from IBS and patients who are suspected of suffering from GEP-NET.This study is a descriptive study to determine levels of CgA in the normal group, knowing CgA levels in patients diagnosed IBS, knowing CgA levels in patients who have a risk of GEP-NET and know the difference CgA levels in patients diagnosed with IBS and patients suspected of suffering from GEP- NET who both have risk GEP-NET.In this study, serum levels of CgA in the normal control group with a mean of 50,70 μg/L, median 48,89 μg / L with a minimum-maximum range between 42,66 to 80,62 μg/L. In this study, serum levels of CgA in the IBS group with a mean of 76,67μg /L, median 64,82 μg/L with a minimum-maximum range between 45,52 to 243,18 μg/L. In this study, serum levels of CgA in the group suspected of GEP-NET premises mean median value 66,23 μg/L with a minimum-maximum range between 49.89 to 656.41 g / L. In this study there was no difference in the levels of CgA IBS patients diagnosed population and in patients suspected of suffering from GEP-NET are both at risk of suffering from GEP-NET in the future., Gastro Entero Pancreatic Neuro Endocrine Tumors (GEP-NET) is a malignancy that is rarely found in the world compared to other gastrointestinal malignancies. According to data registration data The Surveillance, Epidemiology and End Results (SEER) an increase in the incidence of sharp from 1973 (from 0.92 to 1.28 in 100,000 population per year), to 2004 (from 5.09 to 5.42 in 100,000 population per year).GEP-NET is difficult to distinguish from Irritabel Bowel Syndrome (IBS) in diagnose sometimes. GEP-NET complaints include abdominal pain, diarrhea, flushing, until the weight loss. Complaints of IBS include abdominal pain, nausea, diarrhea or with no constipation. We have been developed examination Chromogranin A (CgA) to assist in the screening examination of patients who suffer from IBS and patients who are suspected of suffering from GEP-NET.This study is a descriptive study to determine levels of CgA in the normal group, knowing CgA levels in patients diagnosed IBS, knowing CgA levels in patients who have a risk of GEP-NET and know the difference CgA levels in patients diagnosed with IBS and patients suspected of suffering from GEP- NET who both have risk GEP-NET.In this study, serum levels of CgA in the normal control group with a mean of 50,70 μg/L, median 48,89 μg / L with a minimum-maximum range between 42,66 to 80,62 μg/L. In this study, serum levels of CgA in the IBS group with a mean of 76,67μg /L, median 64,82 μg/L with a minimum-maximum range between 45,52 to 243,18 μg/L. In this study, serum levels of CgA in the group suspected of GEP-NET premises mean median value 66,23 μg/L with a minimum-maximum range between 49.89 to 656.41 g / L. In this study there was no difference in the levels of CgA IBS patients diagnosed population and in patients suspected of suffering from GEP-NET are both at risk of suffering from GEP-NET in the future.]"