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"Latar belakang: Pengukuran proteinuria kuantitatif sewaktu (rasio protein/kreatinin urin sewaktu) merupakan metode terbaik untuk evaluasi proteinuria sebagai penanda remisi komplit dan nephrotic-range proteinuria pada pasien anak sindrom nefrotik (SN), karena dianggap lebih praktis dibandingkan baku emas (protein urin tampung 24 jam). Tujuan: Mencari cut-off optimal rasio protein/kreatinin urin sewaktu untuk evaluasi nephrotic-range proteinuria dan remisi komplit dalam penelitian kami serta membandingkan sensitivitas, spesifisitas, nilai duga positif, dan nilai duga negatif antara cut-off yang ditemukan dalam penelitian versus KDIGO (Kidney Disease: Improving Global Outcomes) untuk evaluasi nephrotic-range proteinuria dan remisi komplit. Metode: Penelitian ini merupakan studi potong lintang dengan uji diagnostik yang melibatkan 96 sampel urin 24 jam dan urin sewaktu yang diambil dari anak dengan sindrom nefrotik berusia 3−18 tahun. Subjek penelitian selain diambil sampel urin untuk pemeriksaan protein urin tampung 24 jam dan rasio protein/kreatinin urin sewaktu, juga dilakukan pemeriksaan antropometri untuk menentukan status nutrisi. Analisis menggunakan kurva ROC untuk menentukan cut-off optimal rasio protein/kreatinin urin sewaktu untuk evaluasi nephrotic-range proteinuria dan remisi komplit dalam penelitian kami, kemudian dihitung nilai sensitivitas, spesifisitas, nilai duga positif, dan nilai duga negatif serta dibandingkan nilainya dengan cut-off yang telah ditetapkan oleh KDIGO. Hasil: Cut-off optimal rasio protein/kreatinin urin sewaktu dalam peneltian kami untuk evalusi proteinuria yang menandai remisi komplit adalah <0,4 g/g dan yang menandai nephrotic-range proteinuria (tidak remisi/relaps) adalah >1,5 g/g. Perbandingan nilai sensitivitas, spesifisitas, PPV, dan NPV antara cut-off rasio protein/kreatinin urin sewaktu <0,4 g/g (temuan penelitian) berturut-turut 80,1%, 82,3%, 89,1%, dan 68,3% versus cut-off rasio protein/kreatinin urin sewaktu <0,2 g/g (KDIGO) berturut-turut 95,2%, 44, 1%, 75,6 %, dan 83,3%. Perbandingan nilai sensitivitas, spesifisitas, PPV, dan NPV antara cut-off rasio protein/kreatinin urin sewaktu >1,5 g/g (temuan penelitian) untuk evaluasi nephrotic-range proteinuria berturut-turut 88,5%, 84,3%, 67,7%, dan 95,2% versus cut-off rasio protein/kreatinin urin sewaktu >2 g/g (KDIGO) berturut-turut 84,6%, 91,4%, 78,6%, dan 94,1%. Kesimpulan: Cut-off rasio protein/kreatinin urin sewaktu untuk evaluasi proteinuria nephrotic-range proteinuria (tidak remisi/relaps) pada penelitian kami memperkuat cut-off yang telah dikeluarkan oleh KDIGO sebesar >2 g/g, sementara cut-off untuk evaluasi remisi komplit lebih tinggi nilainya dibandingkan KDIGO sebesar <0,4 g/g.

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Background: Quantitative measurement of proteinuria while (urinary protein/creatinine ratio) is the best method for evaluating proteinuria as a marker of complete remission and nephrotic-range proteinuria in nephrotic syndrome (NS) pediatric patients, because it is considered more practical than the gold standard (24 hours urine protein collection). Objective: Finding the optimal cut-off of urinary protein/creatinine ratio while evaluating nephrotic-range proteinuria and complete remission in our study and comparing sensitivity, specificity, positive predictive value, and negative predictive value between the cut-off found in the study versus KDIGO (Kidney Disease : Improving Global Outcomes) for evaluation of nephrotic-range proteinuria and complete remission.

Method: This study is a cross-sectional study with diagnostic tests involving 96 24-hour urine samples and urine samples taken from children with nephrotic syndrome aged 3−18 years. The subjects of the study were not only taking urine samples for 24-hour storage of urine protein and urine protein/creatinine ratio, as well as anthropometric examination to determine nutritional status. Analysis used the ROC curve to determine the optimal cut-off of urinary protein/creatinine ratio while evaluating nephrotic-range proteinuria and complete remission in our study, then calculated the values of sensitivity, specificity, positive predictive value, and negative predictive value and compared their values with the cut-off values set by KDIGO.

Result: The optimal cut-off of the urinary protein/creatinine ratio during our study for the evaluation of proteinuria that characterized complete remission was <0,4 g/g and that of nephrotic-range proteinuria (no remission/relapse) was >1,5 g/g. Comparison of the values of sensitivity, specificity, PPV, and NPV between the cut-off ratio of urine protein/creatinine when <0,4 g/g (study finding) were 80,1%, 82,3%, 89,1%, and 68,3% versus cut-off urinary protein/creatinine ratio at <0,2 g/g (KDIGO) 95,2%, 44,1%, 75,6%, and 83,3%. Comparison of the values of sensitivity, specificity, PPV, and NPV between the cut-off ratio of urine protein/creatinine when >1,5 g/g (study finding) for evaluation of nephrotic-range proteinuria 88,5%, 84,3%, 67,7%, and 95,2% versus cut-off urinary protein/creatinine ratio at >2 g/g (KDIGO) 84,6%, 91,4%, 78,6%, and 94,1%.

Conclusion: The cut-off of the urine protein/creatinine ratio during the evaluation of nephrotic-range proteinuria (non-remitting/relapsed) in our study reinforces the cut-off that has been issued by KDIGO of >2 g/g, while the cut-off for evaluation of complete remission is more higher value compared to KDIGO of <0,4 g/g."

"ABSTRAKTujuan : Untuk mengetahui nilai pembatas indikator kelebihan lemak tubuh pada lansia.Tempat : Puskesmas Kecamatan Kotamadya Semarang yang mempunyai program lansia binaan.Bahan dan cara : Studi cross-sectional pada lansia 60 tahun ke atas(69 pria dan 173 wanita), subyek penelitian dipilih secara acak sederhana pada tingkat Puskesmas. Data yang dikumpulkan meliputi : data non nutrisi, data nutrisi, antropometri, kadar lipid serum data gula darah puasa .Penetapan nilai pembatas indikator kelebihan lemak tubuh (IMT, Lpe, rasioLPe/Lpa ,ML) ditetapkan pada nilai median. Sedangkan nilai indikator metabolik sebagai faktor risiko PJK ditetapkan pada batas diwaspadai (berdasarkan Konsensus Nasional Dislipidemia Indonesia, 1993).Hasil : Profil kol. total dan kol. HDL serum subyek wanita lebih tinggi daripada subyek pria (p = 0,001). Prevalensi faktor risiko PJK seperti dislipidemia pada subyek wanita lebih tinggi dibandingkan subyek pria (p < 0.05). Nilai-nilai pembatas indikator kelebihan lemak tubuh yang diperoleh pada penelitian ini yaitu IMT (pria 21 kg/m2; wanita 23 kg/m2 ), LPe (pria 79 cm; wanita> 80 cm), rasio LPe-LPa (pria) 0,91; wanita > 0,85), massa lemak tubuh (pria > 22 %; wanita > 35 %). Sensitifitasnya dikaitkan dengan profit lipid sebagai faktor risiko PJK yaitu 40 - 60 %, sedangkan spesifisitasnya 70 - 80 %. Terdapat perbedaan determinan komposisi tubuh terhadap gangguan metabolik pada subyek pria dan wanita. Pada subyek pria nilai pembatas indikator kelebihan lemak tubuh berkorelasi dengan TG dan GDP, sedangkan pada subyek wanita berkorelasi dengan kol. HDL, kol. total, kol. LDL dan TO.Kesimpulan : Nilai-nilai pembatas indikator kelebihan lemak tubuh yang didapat pada penelitian ini cenderung memberi spesifisitas yang lebih tinggi dibanding dengan sensitifitasnya (dikaitkan dengan dislipidemia). Pada subyek pria indikator kelebihan lemak tubuh lebih terkait pada TG den GDP. Sedangkan pada subyek wanita indikator kelebihan lemak tubuh lebih terkait pada dislipidemia.

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ABSTRACT

The Cut Off Point Determination Of Overfatness In Relation to Selected CHD Risks In Elderly In Semarang

Objective :

To determine cut off points of overfatness in the elderly using CHD risks factors as the end points.

Place :

Seven public health centers with elderly clubs in Semarang municipal.

Materials and Methods :

This cross-sectional study involved 242 elderly individuals (69 males & 173 females), aged 60 years and over. Simple random sampling was applied at the PHC level. Structured questionnaires were used to collect information on sosiodemography, life styles, food habits and practices Anthropometric assessments were done to estimate body compositional status. Serum lipids and fasting blood glucose were measured to identify metabolic disorders. High body mass index, high abdominal circumference, high abdominal hip ratio and high fat mass values were used as overfatness indicators. The Indonesian National Consensus on Dyslipidemia was used to identify dyslipidemic cut off values.

Results :

Mean serum total cholesterol and high density lipoprotein (HDL) cholesterol in females were higher than those in males (220.99 ± 46.66 vs 199.31 ± 35.71, p = 0.001 and 51.17 ± 11.58 vs 45.22 ± 12.52, p = 0.001, respectively). The prevalence of CHD risks (dyslipidemic profiles) in females were also higher than that in males (p < 0.05). With respect to CHD risks, cut-off points for overfatness using BM1 values were > 21 kglr2 and ) 23 kglm2 for males and females respectively. Cut off points for other overfatness indicators were AC) 79 cm and ) 80 cm; AHR > 0.91 and ) 0.85 and percent body fat 3 22% and ) 35% for males and females, respectively. Using these cut off values, the sensitivity ranged from 40 -- 60% and the specificity ranged from 70 -- 80%. There were gender differences in the determinants of metabolic disorders. In males, overfatness was more related to TG and fasting blood glucose values. On the other hand, in females, overfatness was more related to total cholesterol, HDL cholesterol, LDL cholesterol and TG.

Conclusion :

This study supports the findings reported by other investigators that cut off values for overfatness, in relation to metabolic disorders, are more specific than sensitive. Gender differences in the determinants of metabolic disorders indicate that interpretation on body compositional disorders in the elderly should be taken cautiously."

"Follicle-stimulating hormone (FSH) dan Testosteron merupakan hormon penting untuk spermatogenesis. Peningkatan FSH serum dan penurunan testosteron berhubungan dengan spermatogenesis abnormal. Azoospermia dapat diklasifikasikan sebagai azoospermia obstruktif dan nonobstruktif. Penelitian ini bertujuan untuk mengetahui nilai batas untuk pemeriksaan testosteron dan FSH dalam memprediksi azoospermia obstruktif dan non-obstruktif. Dari 1.064 pasien, 120 pasien memenuhi kriteria inklusi dan eksklusi. Terdapat 66,7% pada kelompok obstruktif dengan 33,3% pada kelompok non-obstruktif. Tidak ada perbedaan dalam hal usia (36,83 vs 36,62 tahun). Testosteron adalah 405.54 ± 186.14 ng/dL vs 298.84 ± 161.45 ng/dL (p = 0.002) sedangkan FSH adalah 8,53 ± 8,43 mIU/mL vs 20,12 ± 11,89 mIU / mL (p <0,001) untuk azoospermia obstruktif dan non-obstruktif masing-masing. Rata-rata testis 17,74 ± 4,03 cc dan 17,50 ± 4,23 cc sedangkan pada kelompok non obstruktif masing-masing 12,97 ± 5,18 cc dan 13,37 ± 5,31 cc untuk testis kiri dan kanan. Nilai FSH diatas 10,36 mIU/mL mempunyai sensitivitas 82,1% dan spesifisitas 79,5% untuk memprediksi azoospermia non obstruktif. Sayangnya, Testosteron tidak dapat digunakan untuk memprediksi klasifikasi azoospermia. Azoospermia obstruktif dan non-obstruktif dapat diprediksi menggunakan FSH tetapi tidak dengan kadar serum testosteron. Populasi testosteron yang lebih tinggi harus digunakan untuk studi lebih lanjut.

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Follicle-stimulating hormone (FSH) and Testosterone are important for spermatogenesis. Increased serum FSH and decreased testosterone are related to abnormal spermatogenesis. Azoospermia can be classified as obstructive and nonobstructive azoospermia. This study aims to discover cut-off value of Testosterone and FSH in predicting obstructive and non-obstructive azoospermia. From 1064 patients, 120 fulfilled inclusion and exclusion criteria. There were 66.7% in obstructive with 33.3% in non-obstructive group. No difference in terms of age (36,83 vs 36,62 y.o). Testosterone were 405.54 ± 186.14 ng/dL vs 298.84 ± 161.45 ng/dL (p = 0.002) while FSH was 8,53 ± 8,43 mIU/mL vs 20,12 ± 11,89 mIU/mL (p < 0.001) for obstructive and non-obstructive azoospermia respectively. Average testicular were 17.74 ± 4.03 cc and 17.50 ± 4.23 cc while in non-obstructive group are 12.97 ± 5.18 cc and 13.37 ± 5.31 cc for right and left testis respectively. FSH value above 10.36 mIU/mL has sensitivity 82.1% and specificity 79.5% for predicting non-obstructive azoospermia. Unfortunately, Testosterone could not be used in predicting azoospermia classification. Obstructive and non-obstructive azoospermia could be predicted using FSH but not testosterone serum level. Higher testosterone population should be used for further study."

"ABSTRAK Latar Belakang: Sindrom Ovarium Polikistik (SOPK) merupakan penyebab 40%infertilitas pada wanita usia reproduksi. Resistensi insulin sebagai salah satupatofisiolofi yang mendasari SOPK, berkaitan erat dengan jaringan adiposaviseral dan ditemukan pada 30-50% pasien SOPK dengan indeks masa tubuhnormal serta lingkar pinggang kurang dari 80 cm. Retinol Binding Protein-4(RBP-4) yang disekresi oleh jaringan adiposa viseral diketahui sebagai salah satuadipokin yang menyebabkan resistensi insulin. Pengukuran IMT dan lingkarpinggang tidak dapat mewakili akumulasi jaringan adiposa viseral pada SOPKdengan IMT normal serta lingkar pinggang kurang dari 80 cm. Dengandiketahuinya titik potong optimal kadar serum RBP-4 sebagai penanda jaringanadiposa viseral, diharapkan dapat memprediksi risiko kejadian resistensi insulinyang bermanfaat dalam menentukan penatalaksanaan kasus SOPK dengan IMTnormal terkait strategi pengurangan akumulasi jaringan adiposa viseral. Tujuan: Diketahuinya titik potong optimal kadar serum RBP-4 sebagai penandajaringan adiposa viseral untuk memprediksi risiko kejadian resistensi insulin padapenderita SOPK dengan IMT normal. Metode: Studi observasional dengan desain potong lintang selama periode Juli2014 hingga Maret 2015 di Poliklinik Yasmin, RSCM, Jakarta. Hasil: Sejumlah 40 subjek SOPK dengan IMT normal yang memenuhi kriteriainklusi didapatkan 16 subjek (40%) yang mengalami resistensi insulin dan 24subjek (60%) nir resistensi insulin. Sejumlah 23 subjek (57.5%) memiliki lingkarpinggang kurang dari 80 cm, dimana 6 subjek (26%) diantaranya mengalami resistensi insulin. Kadar serum RBP-4 pada kelompok resistensi insulin bermakna lebih tinggi dibandingkan nir resistensi insulin (p 0.008). Dengan analisis ROCdidapatkan AUC kadar serum RBP-4 78.8% (IK 95% -8445.59 ? -1447.98)dengan nilai p 0.002. Titik potong optimal kadar serum RBP-4 adalah 24133ng/mL dengan sensitivitas sebesar 75% dan spesifisitas sebesar 75%. Dengananalisis regresi logistik biner didapatkan pemeriksaan serum RBP-4 menambahnilai diagnostik dari parameter demografis dan klinis AUC 85.7% menjadi 91.1%. Kesimpulan: Kadar serum RBP-4 sebagai penanda jaringan adiposa viseral dapat digunakan untuk memprediksi risiko kejadian resistensi insulin pada penderita SOPK dengan IMT normal. ABSTRACT Background: Polycystic ovarian syndrome (PCOS) contributes to fourty percent

of infertility?s issues on reproductive women. Insulin resistance as one of

important pathophysiology in PCOS, correlates with visceral adipose tissue and is

found on 30-50% PCOS patients with normal body mass index and waist

circumference less than 80 cm. Retinol Binding Protein-4 (RBP-4), which is

secreted by visceral adipose tissue, known as one of adipokines that cause insulin

resistance. The measurement of body mass index and waist circumference could

not represent visceral adiposity on PCOS with normal body mass index and waist

circumference less than 80 cm. Determination of serum RBP-4 cut off level as

visceral adipose tissue marker hopefully could predict the risk of insulin

resistance on polycystic ovarian syndrome with normal body mass index,

therefore it will be useful on its management related to reduction of visceral

adiposity.

Objective: To obtain serum RBP-4 cut off level as visceral adipose tissue marker

to predict the risk of insulin resistance on PCOS with normal body mass index.

Method: This was an observational study with cross sectional design conducted at

Yasmin Clinic, RSCM, Jakarta during a period of July 2014 until March 2015.

Result: Fourty PCOS patients with normal body mass index were participated on

this study. There were 16 subjects (40%) who were insulin resistance and 24

subjects (60%) who were not insulin resistance. There were 23 subjects (57.5%)

who had waist circumference less than 80 cm, where 6 of them (26%) were

insulim resistance. Serum RBP-4 level was significantly higher on insulin

resistance group (p 0.008). After ROC analysis was performed, AUC of serum

RBP-4 was 78.8% (CI 95% -8445.59 ? -1447.98, p 0.002). The cut off level of

serum RBP-4 was 24133 ng/mL with sensitivity 75% and specificity 75%. After

logistic regression analysis was performed, it was found that serum RBP-4 increase diagnostic value of demographic and clinical parameter with AUC 85.7% to 91.1%. ;Background: Polycystic ovarian syndrome (PCOS) contributes to fourty percent

of infertility?s issues on reproductive women. Insulin resistance as one of

important pathophysiology in PCOS, correlates with visceral adipose tissue and is

found on 30-50% PCOS patients with normal body mass index and waist

circumference less than 80 cm. Retinol Binding Protein-4 (RBP-4), which is

secreted by visceral adipose tissue, known as one of adipokines that cause insulin

resistance. The measurement of body mass index and waist circumference could

not represent visceral adiposity on PCOS with normal body mass index and waist

circumference less than 80 cm. Determination of serum RBP-4 cut off level as

visceral adipose tissue marker hopefully could predict the risk of insulin

resistance on polycystic ovarian syndrome with normal body mass index,

therefore it will be useful on its management related to reduction of visceral

adiposity.

Objective: To obtain serum RBP-4 cut off level as visceral adipose tissue marker

to predict the risk of insulin resistance on PCOS with normal body mass index.

Method: This was an observational study with cross sectional design conducted at

Yasmin Clinic, RSCM, Jakarta during a period of July 2014 until March 2015.

Result: Fourty PCOS patients with normal body mass index were participated on

this study. There were 16 subjects (40%) who were insulin resistance and 24

subjects (60%) who were not insulin resistance. There were 23 subjects (57.5%)

who had waist circumference less than 80 cm, where 6 of them (26%) were

insulim resistance. Serum RBP-4 level was significantly higher on insulin

resistance group (p 0.008). After ROC analysis was performed, AUC of serum

RBP-4 was 78.8% (CI 95% -8445.59 ? -1447.98, p 0.002). The cut off level of

serum RBP-4 was 24133 ng/mL with sensitivity 75% and specificity 75%. After

logistic regression analysis was performed, it was found that serum RBP-4 increase diagnostic value of demographic and clinical parameter with AUC 85.7% to 91.1%. "

"Latar Belakang: Diagnosis sepsis pada pasien tumor padat metastasis sulit karena adanya gejala, seperti demam dan leukositosis, dapat timbul tanpa adanya infeksi. Procalcitonin (PCT) merupakan salah satu parameter untuk mendiagnosis sepsis. Titik potong PCT untuk diagnosis sepsis pada pasien tumor padat metastasis dengan demam dan leukositosis masih belum diketahui. Studi sebelumnya belum ada yang menilai titik potong PCT pada pasien tumor padat metastasis dengan demam dan leukositosis.

Tujuan: Mengetahui titik potong PCT dalam diagnosis sepsis pada pasien tumor padat metastasis dengan demam dan leukositosis.

Metode: Studi potong lintang terhadap pasien tumor padat metastasis dengan demam dan leukositosis yang berobat di RSCM Juni 2016 - April 2018. Pada pasien ditentukan ada tidaknya sepsis menggunakan kriteria sepsis sesuai The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), yaitu menggunakan mSOFA. Dilakukan pemeriksaan darah perifer dan PCT. Dilakukan pencarian nilai titik potong PCT untuk diagnosis sepsis pada pasien tumor padat metastasis dengan demam dan leukositosios menggunakan ROC.

Hasil: Didapatkan 86 pasien tumor padat metastasis dengan demam dan lekositosis, dengan wanita sebanyak 61,6%, rerata usia 49,48 ±11,44 tahun. Sebanyak  43 pasien (50%) mengalami sepsis. Dari kurva ROC kadar PCT pada tumor padat metastasis dengan demam dan leukositosis yang mengalami sepsis, didapatkan AUC [0,873 ,IK 0,799 - 0,946, p <0,001]. Nilai titik potong PCT untuk diagnosis sepsis pada pasien tumor padat metastasis dengan demam dan leukositosis adalah 1,755 ng/mL dengan sensitivitas 76,7% dan spesifisitas 81,4%, NDP 80,5%, NDN 77,8%.

Kesimpulan: Nilai titik potong PCT untuk diagnosis sepsis pada tumor padat metastasis dengan demam dan leukositosis adalah 1,755 ng/mL.

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Background: Diagnosis of infection in advanced solid tumor patients can be difficult since fever and leucocytosis is a non-specific clinical marker and can occur without infections. Untreated infections can lead to sepsis, increasing mortality in those patients. Procalcitonin has been used to support the diagnosis of sepsis. Procalcitonin cut off in advanced stage solid tumor patients with fever as a sepsis biomarker is still unclear. No study has seen procalcitonin cut-off in advanced solid tumor patients with fever.

Objective: To discover the cut-off point for sepsis in advanced solid tumor patients with fever.

Method: A cross-sectional study was conducted in the advanced solid tumor patients with fever patients who were admitted to Cipto Mangunkusumo Hospitals, Indonesia during June 2016 to April 2018. Demographic characteristics, physical examinations, laboratory examinations were recorded. Sepsis was defined using 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference criteria.

Results: A total of 86 subjects were enrolled in this study, 61,6% were female with mean age 49,5 years old. Among them, 43 patients (50%) were diagnosed with sepsis. The ROC curve showed that the levels of procalcitonin for sepsis in advanced solid tumor patients with fever was in the area under curve (AUC) 0,891 (CI 826 - 956). Cut-off procalcitonin for diagnosing sepsis in advanced solid tumor patients with fever was 1,755 ng/mL, sensitivity 76,7%, specificity 81,4%, PPV 80,5%, NPV 77,8%.

Conclusions: The cut-off point of procalcitonin level to support sepsis diagnosis in advanced solid tumor patients with fever was higher than normal populations."