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" ABSTRAKLatar Belakang: Thalassemia merupakan hemoglobinopati herediter yang menyebabkan anemia kronis, sehingga pasien membutuhkan transfusi darah secara rutin yang dapat menyebabkan kelebihan besi. Kelebihan besi dapat memicu beberapa komplikasi, salah satunya adalah gangguan pertumbuhan. Tujuan: Mengetahui hubungan antara kadar hemoglobin dan profil besi dengan gangguan pertumbuhan pada pasien thalassemia. Metode: Studi cross-sectional pada 102 pasien thalassemia di Pusat Thalassemia RSCM Jakarta. Hasil: Empat puluh lima 44,1 subjek adalah perempuan dan 57 55,9 subjek adalah lelaki dengan rentang usia 9-14 tahun. Tiga puluh sembilan 38,2 subjek memiliki perawakan pendek dan 63 61,8 subjek memiliki perawakan normal. Nilai median kadar feritin serum pada pasien perawakan pendek adalah 2062 318-8963 ng/mL dan pada pasien perawakan normal adalah 3315 422,9-12269 ng/mL p.

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ABSTRACTBackground Thalassemia is a hereditary hemoglobinopathy which causes chronic anemia, thus the patients need regular blood transfusion which can cause iron overload. It leads to some complications, one of them is growth retardation. Aim To determine the association between hemoglobin level and iron profile with growth retardation on thalassemia patients. Methods cross sectional study on 102 patients in Thalassemia Center of RSCM Jakarta. Results Forty five 44.1 subjects are girls and 57 55.9 subjects are boys. Their age range was 9 14 years old. Thirty nine 38.2 subjects had short stature and 63 61.8 subjects had normal stature. Median of serum ferritin level in the short stature patients was 2062 318 8963 ng mL and normal stature was 3315 422.9 12269 ng mL p 0.001 . Median of transferrin saturation in the short stature patients was 88 19 100 and normal stature was 83 35 100 p 0.94 . Mean of pra transfusion hemoglobin level in the short stature patients was 8.14 SD 0.93 g dL and normal stature was 8.07 SD 0.86 g dL p 0.68 . Conclusion there is a significant association between serum ferritin level and growth retardation, but there is no significant association between transferrin saturation and pra transfusion hemoglobin level with growth retardation."

"ABSTRAKPubertas terlambat merupakan salah satu komplikasi utama pada pasien thalassemia mayor. Penyebab utama pubertas terlambat pada pasien thalassemia mayor adalah penumpukan besi pada kelenjar hipofisis. Selain itu, anemia kronis pada pasien thalassemia mayor juga dapat menyebabkan pubertas terlambat. Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan antara profil besi dan kadar hemoglobin pra-transfusi dengan status pubertas pasien thalassemia mayor remaja di Pusat Thalassemia RSCM. Metode: Penelitian ini merupakan studi cross-sectional yang melibatkan 47 pasien thalassemia mayor dengan rentang usia 13-18 tahun untuk pasien perempuan dan 14-18 tahun untuk pasien lelaki di Pusat Thalassemia RSCM. Profil besi subjek ditentukan dari kadar feritin serum dan saturasi transferin subjek. Status pubertas subjek ditentukan berdasarkan Tanner Staging. Hasil & Diksusi: Berdasarkan kadar feritin serum, terdapat 47 (100%) subjek yang mengalami kelebihan besi, dengan 35 (75%) diantaranya mengalami kelebihan besi berat. Nilai median feritin serum subjek adalah 3645 (1415-12636) ng/mL. Berdasarkan saturasi transferin, sebesar 36 (77%) subjek mengalami kelebihan besi, dengan nilai median saturasi transferin sebesar 85 (28-100)%. Terdapat 42 (89%) subjek yang mengalami anemia, dengan nilai median kadar hemoglobin pra-transfusi sebesar 8,0 (4,8-9,5) g/dL. Pubertas terlambat ditemukan pada delapan (17%) subjek. Secara statistik, tidak terdapat hubungan yang bermakna antara feritin serum dengan status pubertas (p = 0,183), saturasi transferin dengan status pubertas (p = 0,650), dan kadar hemoglobin pra-transfusi dengan status pubertas (p = 0,932). Berdasarkan hasil tersebut, profil besi dan kadar hemoglobin pra-transfusi tidak berhubungan dengan status pubertas pasien thalassemia mayor remaja di Pusat Thalassemia RSCM.

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ABSTRAKIntroduction Delayed puberty is a major complication in thalassemia major patients. Delayed puberty occurs due to accumulation of iron in the pituitary gland. In addition, chronic anemia in thalassemia major patients can cause delayed puberty.Objectives This study aims to find the association between iron profile and pre transfusion hemoglobin level with pubertal status in adolescent thalassemia major patients in Thalassemia Centre RSCM.Methods This was a cross sectional study that involved 47 thalassemia major patients aged 13 to 18 years for female patients and 14 to 18 years for male patients in Thalassemia Centre RSCM. Iron profile was determined from serum ferritin level and transferrin saturation. Pubertal status was determined by Tanner Staging.Results Discussion Based on serum ferritin level, 47 100 subjects had iron overload, in which 35 75 subjects had severe iron overload. The median of serum ferritin level was 3645 1415 12636 ng mL. Based on transferrin saturation, 36 77 subjects had iron overload. The median of transferrin saturation was 85 28 100 . Forty two 89 subjects were found anemic. The median of pre transfusion hemoglobin level was 8,0 4,8 9,5 g dL. Delayed puberty occurred in eight 17 subjects. Statistically, no significant associations were found between serum ferritin level and pubertal status p 0.183 , transferrin saturation and pubertal status p 0.650 and pre transfusion hemoglobin level and pubertal status p 0,932 . Based on the results, iron profile and pre transfusion hemoglobin level are not associated with pubertal status in adolescent thalassemia major patients in Thalassemia Centre RSCM."

"Anemia didefinisikan sebagai rendahnya kadar hemoglobin di dalam darah. Anemia merupakan masalah kesehatan masyarakat yang cukup besar di Indonesia. Dari berbagai etiologi anemia, thalassemia merupakan hemoglobinopati kuantitatif yang diturunkan yang memiliki prevalensi tinggi di negara-negara Asia Tenggara seperti Indonesia. Penelitian ini bertujuan untuk mengetahui status hemoglobin pada pasien thalassemia di RSUPN dr. Cipto Mangunkusumo, Jakarta dan hubungannya dengan usia dan jenis kelamin. Sebanyak 640 hasil pemeriksaan darah lengkap diperoleh dari pasien rawat jalan yang menderita thalassemia dari Pusat thalassemia di RSUPNCM pada bulan Mei 2012. Berdasarkan analisis statistik, ditemukan bahwa hampir seluruh pasien thalassemia yang datang mengalami anemia (638 pasien), dan mayoritas menderita anemia derajat sedang. Ditemukan pula asosiasi antara usia dan derajat anemia ketika membandingkan antara anemia sedang dengan anemia berat. (p = 0.000). Ditemukan pula korelasi negatif (Spearman rho -0.212) antara usia dan kadar hemoglobin (p = 0.000). Namun demikian, tidak ditemukan asosiasi antara jenis kelamin dengan derajat anemia maupun kadar hemoglobin (masing-masing p = 0.196; 0.557). Hasil studi ini memberikan gambaran terkini mengenai status anemia pasien thalassemia dan dapat digunakan dalam memberikan pelayanan terbaik kepada passion thalassemia.

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Anemia, defined as a low level of hemoglobin concentration in the blood, is a major public health problem. Among the many causes of anemia, thalassemia, an inherited quantitative hemoglobinopathy, is one that is highly prevalent in south-east Asian countries such as Indonesia. This study aimed to find out the hemoglobin status of thalassemia patients in RSUPN dr. Cipto Mangunkusumo, Jakarta and its relationship with age and gender. As many as 640 complete blood count results from outpatients previously diagnosed with thalassemia from the hospital?s Thalassemia Center during May 2012 were obtained for analysis. From statistical analyses, we concluded almost all thalassemia patients were anemic (638 patients), most of which experience moderate anemia.

From statistical testing, there proved to be an association between age and severity of anemia when compared between moderate and severe anemia (p = 0.000). A negative correlation (Spearman?s rho -0.212) was seen between age and hemoglobin level (p = 0.000). Meanwhile, no association was found between gender and severity of anemia or hemoglobin level (p = 0.196; 0.557, respectively). The results of this study provide the most recent information on the current status of anemia among thalassemia patients and can be used in the approach towards thalassemia patients."

"Pendahuluan : Muatan besi berlebih merupakan masalah utama pada pasien thalassemia beta bergantung transfusi karena menyebabkan toksisitas pada jaringan atau organ. Laporan mengenai korelasi antara muatan besi berlebih dengan fungsi endokrin pada pasien dewasa TDT beta yang mengalami retardasi pertumbuhan di Indonesia belum pernah dilaporkan.Tujuan: Mendapatkan profil muatan besi dengan fungsi endokrin pada pasien dewasa TDT beta yang mengalami retardasi pertumbuhan.Metode: Dilakukan studi potong lintang pada pasien thalassemia beta mayor homozigot dan beta HbE usia dewasa yang mendapat transfusi darah di Poliklinik Thalassemia RSCM Jakarta pada Desember 2017. Muatan besi berlebih diwakili oleh feritin serum FS dan saturasi transferin ST, fungsi endokrin yang diperiksa adalah TSHs, fT4, dan IGF-1. FS, fT4 dan TSHs diperiksa dengan metode ELISA. IGF-1 diperiksa berdasarkan metode Solid-Phase ECLIA.Hasil: Proporsi hipotiroid subklinis sebesar 32,7 , kadar IGF-1 rendah pada 79,3 subjek penelitian. Terdapat korelasi negatif lemah FS dengan fT4 r = -0,361; p=0,003 , dan IGF-1 r=-0,313; p=0,008 , tidak terdapat korelasi FS dengan kadar TSHs r=0,074; p=0,29 . Tidak terdapat korelasi ST dengan TSHs r =0,003; p=0,492 , fT4 r=0,018; p=0,448 , dan IGF-1 r=-0,142; p=0,143.Simpulan: Terdapat korelasi negatif antara muatan besi berlebih yang dinilai dari feritin serum dengan fungsi endokrin yang dinilai dengan fT4 dan IGF-1.

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Introduction. Iron overload is a major problem in patients with transfusion dependent beta thalassemia, because it causes toxicity to tissues or organs. The correlation between iron overload and endocrine function in adult TDT beta patients in Indonesia have not been reported.This study aims to obtain a profile of iron load and endocrine function of adult TDT beta patients with growth retardation.Methods Cross sectional study was performed on beta homozygous beta and adult HbE beta patients receiving blood transfusions at the Thalassemia Kiara RSCM Jakarta Clinic, December 2017. Iron overload was represented by serum ferritin FS and transferrin saturation ST, and the endocrine functions are TSHs, fT4 by ELISA method and IGF 1 by the Solid Phase ECLIA method.Results Subclinical hypothyroid proportion was 32,7 and low IGF 1 level was found in 79.3 of subjects. There is a weak negative correlation between FS and fT4 r 0.361 p 0.003, and IGF 1 r 0.313 p 0.008 . No correlation was found between ST with TSHs r 0,003 p 0,492, fT4 r 0,018 p 0,448, and IGF 1 r 0,142 p 0,143.Conclusion There was negative correlation between iron overload based on serum ferritin with endocrine function based on fT4 and IGF 1."

"Latar belakang: Transfusi rutin merupakan terapi utama bagi pasien thalassemia mayor, namun transfusi berulang diikuti masalah baru yaitu beban kelebihan besi yang terakumulasi dalam jaringan. Pemberian terapi kelasi besi adalah satu-satunya cara untuk mempertahankan keseimbangan besi dalam tubuh.Tujuan: Studi ini bertujuan untuka mengetahui hubungan efektivitas terapi, efek samping obat dan biaya antara kelasi besi regimen kombinasi (DFO+DFP dan DFP+DFX) dengan monoterapi DFP dosis ≥ 90 mg/kgbb/hari. Metode: Penelitian ini merupakan penelitian retrospektif observasional dengan desain potong lintang, untuk menganalisis hubungan efektivitas terapi, efek samping obat dan biaya antara kelasi besi regimen kombinasi (DFO+DFP dan DFP+DFX) dengan monoterapi DFP dosis ≥ 90 mg/kgbb/hari. Luaran efektivitas dinilai dengan penurunan serum feritin ≥ 500 ng/mL.Hasil: Setelah 6 atau 12 bulan terjadi penurunan serum feritin pada 16 (34,7%) subyek kelompok kombinasi, dan 22 (27,5%) subyek kelompok monoterapi (p = 0,391). Sembilan (19,5%) subyek kombinasi mengalami efek samping obat, dan 17 (21,2%) subjek pada kelompok monoterapi (p = 0,822). Analisis minimalisisasi biaya menunjukkan bahwa rerata biaya per pasien thalassemia-β mayor anak yang menggunakan rejimen monoterapi selama 6 dan 12 bulan lebih murah Rp 13.556.592,64 (30,46%) dan Rp 20.162.836,10 (25,56%) dari rejimen kombinasi.Kesimpulan: Rejimen kombinasi sama efektifnya dengan rejimen monoterapi dalam menurunkan serum feritin. Tidak ada perbedaan efek samping obat yang bermakna diantara keduanya.

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Background: Blood transfusion is the main therapy for thalassemia major patients, but repeated transfusions are followed by new problems namely the excess iron load accumulated in the body tissue. Iron chelation therapy is the only way to maintain iron balance in the body.

Aim: This study aimed to determine the efficacy, safety , and cost analysis of of combination iron chelation regimen with mono-therapy.

Method:This study was designed as a retrospective observational study with a cross-sectional design, to analyze the relationship between therapeutic effectiveness, drug side effects and the cost of combination iron chelation regimen (DFO+DFP and DFP+DFX) and DFP mono-therapy dose ≥ 90 mg/kg/day. Outcome effectiveness was assessed by decreasing serum ferritin ≥ 500 ng/mL.

Result: After 6 or 12 months there was serum ferritin decreased in 16 (34,7%) subjects in combination group and 22 (27,5%) subjects in mono-therapy group (p = 0,391). Nine (19,5%) subjects in combination group experienced adverse effect, and 17 (21,2%) subjects in the mono-therapy group (p = 0,822). Analysis cost of minimization shows that the average cost per major thalassemia-β patient for children using a mono-therapy regimen for 6 and 12 months is cheaper Rp 13.556.592,64 (30,46%) and Rp 20.162.836,10 (25,56%) compared to combination regimen.

Conclusion: Combination regimens are as effective as a mono therapy regimens in decreasing serum ferritin. There were no significant differences in adverse effect between the two."

"Latar belakang. Kadar hemoglobin pre-transfusi dan feritin serum mempengaruhi pertumbuhan anak dengan thalassemia B-mayor. Penelitian tentang thalassemia sudah dilakukan di Indonesia, namun penelitian tentang hubungan thalassemia dengan pertumbuhan fisik masih terbatas. Tujuan. Mengetahui pengaruh kadar Hb pre-transfusi dan feritin serum berpengaruh terhadap pertumbuhan fisik pasien thalassemia ?-mayor. Metode. Dilakukan bulan Agustus-Oktober 2017 pada pasien anak dengan thalassemia B-mayor yang berobat ke Thalassemia-Centre RSUD Pekanbaru. Penelitian berupa analitik observasional potong lintang, menganalisis pengaruh kadar Hb pre-transfusi dan feritin serum terhadap parameter perawakan pendek dan sangat pendek, gizi kurang dan buruk, usia tulang yang terlambat. Hasil. Subjek 41 orang, rentang usia 18-204 bulan. Jenis kelamin laki-laki lebih banyak daripada perempuan 53,7 vs 46,3. 40 subjek mengalami retardasi pertumbuhan. Terdapat korelasi bermakna antara kadar Hb pre-transfusi dengan Z-score TB/U r=0,507, p=0,001 dan LILA/U r=0,467, p=0,02. Hb pre-transfusi berpengaruh terhadap interpretasi duduk/umur p=0,007, IK95 -1,5 - -0,3, subischial leg length/umur p=0,002, namun tidak pada interpretasi rasio segmen atas/bawah dan usia tulang. Hasil berbeda pada kadar feritin yang tidak memiliki korelasi terhadap semua variabel. Simpulan. Terdapat pengaruh yang bermakna secara statistik antara kadar Hb pre-transfusi dengan parameter penelitian serta tidak terdapat pengaruh yang bermakna secara statistik antara kadar feritin serum dengan parameter tersebut.

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Background. The level of pre transfusion hemoglobin and ferritin serum affect physical growth on patient with thalassemic mayor. Study about thalassemia is mainly reported but its relationship with physical growth is limited.

Objective. The main objective of the present study was to evaluate the relationship of pre transfusion Hb and serum ferritin level in patient with thalassemic mayor.

Material and method. In this analytical cross sectional study, the growth parameters weight, standing height, sitting height, subischial leg length, nutritional status, bone age were measured in 41 patients attending Thalassemia Centre at RSUD in Pekanbaru from August October 2017.

Results. 41 patients with mean age 18 204 months. The results are boys dominated girls in sex criteria 53,7 vs 46,3. As much as 40 subjects have growth retardation. There rsquo s correlation in pre transfusion hemoglobin with Z score height for age r 0,507, p 0,001 and subischial length r 0,467, p 0,02. This study shows relationship in pre transfusion hemoglobin with sitting height p 0,007, IK95 1,5 0,3, subischial leg length p 0,002, but not in segment length and bone age. Serum ferritin level has no correlation to one of those parameters.

Conclusion. There is a significant relationship in physical growth based on parameters mentioned above with pre transfusion Hemoglobin, but not with serum ferritin level. "

"Gangguan Pemusatan Perhatian dan Hiperaktivitas (GPPH) adalah gangguan neuropsikiatri yang dapat terjadi pada anak-anak serta dapat memberikan beban dan hambatan dalam menjalankan fungsi sehari-hari. Komorbiditas psikiatrik pada GPPH dapat menambah morbiditas dan memperburuk prognosis dari GPPH. Perbaikan klinis GPPH berhubungan dengan kualitas hidup yang lebih baik, namun belum ada penelitian mengenai hubungan komorbiditas terhadap lama perbaikan klinis GPPH yang menggunakan alat ukur Abbreviated Conners Parent/Teacher Rating Scale (ACP/TRS), alat ukur yang digunakan di Indonesia. Penelitian ini bertujuan untuk mengetahui hubungan komorbiditas gangguan jiwa terhadap lama perbaikan klinis GPPH dengan menggunakan ACP/TRS. Dengan menggunakaan metode cross-sectional, penelitian ini menggunakan rekam medis pasien GPPH yang datang ke RSUPN Cipto Mangunkusumo (RSCM) dalam periode 1 Januari 2014-1 Januari 2018 sehingga didapatkan 94 sampel. Angka perbaikan klinis pasien GPPH dalam 7 minggu secara keseluruhan adalah 56,4% (n = 53), dengan komorbiditas yang paling sering adalah retardasi mental (40%, n = 16). Penelitian ini tidak menemukan hubungan komorbiditas gangguan jiwa terhadap perbaikan klinis GPPH (P = 0,85), kemungkinan karena variabel lain yang memengaruhi perbaikan klinis pasien tidak dieksklusi. Penelitian lebih lanjut perlu mempertimbangkan kepatuhan pasien dalam berobat dan kecukupan dosis obat yang diberikan.

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Attention-Deficit/Hyperactivity Disorder (ADHD) is a neuropsychiatric disorder that can occur in children, which could add burden to their daily functions. Psychiatric comorbidities in ADHD may increase morbidity and worsen the prognosis of ADHD. Clinical improvement of ADHD is associated with better quality of life. However, there has not been a study of ADHD using Abbreviated Conners Parent/Teacher Rating Scale (ACP/TRS), the instrument used in Indonesia. This cross-sectional study used the medical record of ADHD patients in RSUPN Cipto Mangunkusumo (RSCM) that were in the Medical Records Unit within the period of 1 January 2014-1 January 2018. A total of 94 medical records were obtained. Within 7 weeks, 56,4% of all ADHD patients (n = 53) has improved, with the most prevalent comorbidity being mental retardation (40%, n = 16). This study found no significant relationship between psychiatric comorbidity and the clinical improvement of ADHD (P = 0,85), probably because some variables that affect clinical improvement are not excluded. Further studies that consider patients adherence to medication dan adequacy of the dosage of the drug administered are required."

"[ABSTRAKAnemia defisiensi besi dan thalassemia β trait merupakan penyebabtersering anemia mikrositik hipokrom di Indonesia. Kedua penyakit tersebut sulitdibedakan hanya dengan pemeriksaan hematologi, oleh karena itu diperlukanpemeriksaan tambahan seperti feritin dan analisis hemoglobin. Namun tidak semualaboratorium dapat melakukan pemeriksaan ini. Banyak penelitian yangmembedakan kedua penyakit tersebut dengan indeks eritrosit. Namun indekseritrosit memiliki nilai diagnostik yang berbeda di setiap negara dan belum ada datadi Indonesia. Penelitian ini melakukan uji diagnostik Indeks Mentzer, RDW, Green-King, Sirdah, dan mencari nilai cut-off baru yang memberikan nilai diagnostik lebihbaik.Penelitian terdiri dari 98 subyek definitif anemia defisiensi besi dan 80subyek thalassemia β trait. Nilai diagnostik Indeks Mentzer untuk anemia defisiensibesi adalah sensitivitas 83.6%, spesifisitas 66.2%, NPP 75.2%, NPN 76.8%, RKP2.4, RKN 0.2. Nilai diagnostik Indeks Mentzer untuk thalassemia β trait adalahsensitivitas 66.2%, spesifisitas 83.6%, NPP 76.8%, NPN 75.2%, RKP 4.0, RKN0.4. Nilai diagnostik Indeks RDW untuk anemia defisiensi besi adalah sensitivitas91.8%, spesifisitas 75%, NPP 81.8%, NPN 88.2%, RKP 3.6, RKN 0.1. Nilaidiagnostik Indeks RDW untuk thalassemia β trait adalah sensitivitas 75%,spesifisitas 91.8%, NPP 88.2%, NPN 81.8%, RKP 9.1, RKN 0.2. Nilai diagnostikIndeks Green-King untuk anemia defisiensi besi adalah sensitivitas 96.9%,spesifisitas 67.5%, NPP 78.5%, NPN 94.7%, RKP 2.9, RKN 0.04. Nilai diagnostikIndeks Green-King untuk thalassemia β trait adalah sensitivitas 67.5%, spesifisitas96.9%, NPP 94.7%, NPN 78.5%, RKP 22.0, RKN 0.3. Nilai diagnostik IndeksSirdah untuk anemia defisiensi besi adalah sensitivitas 92.8%, spesifisitas 58.7%,NPP 73.3%, NPN 87.0%, RKP 2.2, RKN 0.1.Nilai diagnostik Indeks Sirdah untukthalassemia β trait adalah sensitivitas 58.7%, spesifisitas 92.8%, NPP 87.0%, NPN73.3%, RKP 8.2, RKN 0.4. Nilai cut-off baru Indeks Mentzer adalah 13.44, RDWI233.4, Green-King 75.06, dan Sirdah 32.52.Keempat indeks eritrosit dapat diaplikasikan untuk orang Indonesia denganIndeks Green-King sebagai indeks yang terbaik.

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ABSTRACTIron deficiency anemia and β trait thalassemia are the most common causesof microcytic hypochromic anemia in Indonesia. Differentiation between them isdifficult when solely based on a hematology examination, so additional laboratorytests are required such as ferritin and hemoglobin analysis. However, not alllaboratories can perform these tests. Many erythrocytes indices have been proposedto determine whether a blood sample is more suggestive for iron deficiency anemiaor β trait thalassemia. Unfortunately these indices have different diagnostic valuein many countries and there is no data about diagnostic value in Indonesia. Thisstudy performs diagnostic test Mentzer, RDW, Green-King, and Sirdah Index anddevelops a new cut-off point that could make a better diagnostic value.This study consists of 98 subjects of iron deficiency anemia and 80 subjectsof β trait thalassemia. Diagnostic values of Mentzer Index for iron deficiencyanemia were sensitivity 83.6%, specificity 66.2%, PPV 75.2%, NPV 76.8%, LR+2.4, LR- 0.2. Diagnostic values of Mentzer Index for β trait thalassemia weresensitivity 66.2%, specificity 83.6%, PPV 76.8%, NPV 75.2%, LR+ 4.0, LR- 0.4.Diagnostic values of RDW Index for iron deficiency anemia were sensitivity91.8%, specificity 75%, PPV 81.8%, NPV 88.2%, LR+ 3.6, LR- 0.1. Diagnosticvalues of RDW Index for β trait thalassemia were sensitivity 75%, specificity91.8%, PPV 88.2%, NPV 81.8%, LR+ 9.1, LR- 0.2. Diagnostic values of Green-King Index for iron deficiency anemia were sensitivity 96.9%, specificity 67.5%,PPV 78.5%, NPV 94.7%, LR+ 2.9, LR- 0.04. Diagnostic values of Green-KingIndex for β trait thalassemia were sensitivity 67.5%, specificity 96.9%, PPV 94.7%,NPV 78.5%, LR+ 22.0, LR- 0.3. Diagnostic values of Sirdah Index for irondeficiency anemia were sensitivity 92.8%, specificity 58.7%, PPV 73.3%, NPV87.0%, LR+ 2.2, LR- 0.1. Diagnostic values Sirdah Index for β trait thalassemiawere sensitivity 58.7%, specificity 92.8%, PPV 87.0%, NPV 73.3%, LR+ 8.2, LR-0.4. The new cut-off point of Mentzer, RDW, Green-King, and Sirdah Index was13.44, 233.4, 75.06, and 32.52 respectively.All indices can be applied for Indonesian people, among which Green-KingIndex had the best diagnostic value, Iron deficiency anemia and β trait thalassemia are the most common causesof microcytic hypochromic anemia in Indonesia. Differentiation between them isdifficult when solely based on a hematology examination, so additional laboratorytests are required such as ferritin and hemoglobin analysis. However, not alllaboratories can perform these tests. Many erythrocytes indices have been proposedto determine whether a blood sample is more suggestive for iron deficiency anemiaor β trait thalassemia. Unfortunately these indices have different diagnostic valuein many countries and there is no data about diagnostic value in Indonesia. Thisstudy performs diagnostic test Mentzer, RDW, Green-King, and Sirdah Index anddevelops a new cut-off point that could make a better diagnostic value.This study consists of 98 subjects of iron deficiency anemia and 80 subjectsof β trait thalassemia. Diagnostic values of Mentzer Index for iron deficiencyanemia were sensitivity 83.6%, specificity 66.2%, PPV 75.2%, NPV 76.8%, LR+2.4, LR- 0.2. Diagnostic values of Mentzer Index for β trait thalassemia weresensitivity 66.2%, specificity 83.6%, PPV 76.8%, NPV 75.2%, LR+ 4.0, LR- 0.4.Diagnostic values of RDW Index for iron deficiency anemia were sensitivity91.8%, specificity 75%, PPV 81.8%, NPV 88.2%, LR+ 3.6, LR- 0.1. Diagnosticvalues of RDW Index for β trait thalassemia were sensitivity 75%, specificity91.8%, PPV 88.2%, NPV 81.8%, LR+ 9.1, LR- 0.2. Diagnostic values of Green-King Index for iron deficiency anemia were sensitivity 96.9%, specificity 67.5%,PPV 78.5%, NPV 94.7%, LR+ 2.9, LR- 0.04. Diagnostic values of Green-KingIndex for β trait thalassemia were sensitivity 67.5%, specificity 96.9%, PPV 94.7%,NPV 78.5%, LR+ 22.0, LR- 0.3. Diagnostic values of Sirdah Index for irondeficiency anemia were sensitivity 92.8%, specificity 58.7%, PPV 73.3%, NPV87.0%, LR+ 2.2, LR- 0.1. Diagnostic values Sirdah Index for β trait thalassemiawere sensitivity 58.7%, specificity 92.8%, PPV 87.0%, NPV 73.3%, LR+ 8.2, LR-0.4. The new cut-off point of Mentzer, RDW, Green-King, and Sirdah Index was13.44, 233.4, 75.06, and 32.52 respectively.All indices can be applied for Indonesian people, among which Green-KingIndex had the best diagnostic value]"

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Kriptokokosis adalah infeki jamur yang disebabkan olehCryptococcus. Manifestasi klinis utama pada pasien terinfeksi HIV adalah kriptokokosis meningeal.  Angka kematian masih tinggi, walaupun pasien telah mendapatkan obat anti-retroviral (ARV). Tujuan penelitian ini adalah untuk mengetahui prevalensi, profil klinis-mikologis dan prediktor yang mempengaruhi luaran klinis. Penelitian ini bersifat retrospektif dengan menelusuri rekam medik pasien RSCM yang bahan kliniknya diperiksa di Departemen Parasitologi FKUI pada Januari 2013 – Oktober  2018. Prevalensi kriptokokosis meningeal pada 161 pasien HIV yang diteliti adalah 24,2% (39 pasien). Pemeriksaan cairan otak  dengan tinta india menunjukan hasil positif pada 47 dari 50 pasien (94%). Pemeriksaan lateral flow assay(LFA) menunjukkan hasil positif pada 27 dari 28 pasien (96,4%) dan biakan pada 29 dari 30 pasien (96,7%). Profil klinis pada 46 pasien yang diteliti menunjukkan gejala klinis terbanyak  sakit kepala (93,5%), diikuti demam (65,2%), muntah (65,2%) dan penurunan berat badan (47,8%). Pencitraan otak pada 38 pasien, menunjukkan hasil normal pada 20 pasien (52,6%), lesi fokal pada 5 pasien dan penyangatan meningen pada 5 pasien (13,1%). Analisis statistik menunjukkan  pemeriksaaan fisis tekanan darah >130/90 mmHg, kaku kuduk dan papiledema didapatkan berhubungan dengan kematian (p<0,05). Dari 46 pasien setelah keluar dari RSCM, luaran hidup ditemukan sebanyak 21 orang (45,7%). Pada tindak lanjut 20 pasien setelah enam bulan keluar RSCM, luaran hidup ditemukan pada 13 orang (65%). Prediktor yang berhubungan dengan luaran klinis mati pada penelitian ini adalah penurunan berat badan, status HIV baru dan papiledema (p<0,05). 

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Cryptococcosis is a fungal infection caused by Cryptococcus. The main clinical manifestation in HIV-infected patients is meningeal cryptococcosis. The mortality rate is still high, despite the use of anti-retroviral drugs (ARVs). The purpose of this study was to determine the prevalence, clinical-mycological profile and predictors for clinical outcomes. This study was retrospective, the data was retrieved  from medical records at Cipto Mangunkusumo hospitalwhose clinical materials were examined in the Parasitology Department faculty of medicine University of Indonesia in January 2013 - October 2018. The prevalence of meningeal cryptococcosis in 161 HIV patients studied was 24.2% (39 patients). Examination of brain fluids with Indian ink showed positive results in 47 of  50 patients (94%). Lateral flow assay (LFA) positive in 27 of 28 patients (96.4%) and from culture the result was positive in 29 out of 30 (96,7%). The clinical profile in 46 patients studied showed the most clinical symptoms is headache (93.5%), followed by fever (65.2%), vomiting (65.2%) and weight loss (47.8%). Brain imaging in 38 patients showed normal results in 20 patients (52.6%), focal lesions in 5 patients and meningeal enhancement in 5 patients (13.1%). Physical examination of blood pressure >130/90 mmHg, neck stiffness and papilledema was found to be associated with death (p<0.05). Of the 46 patients after leaving the Cipto Mangunkusumo hospital, live outcomes were found in 21 patients (45.7%). Live outcomes at follow-up of 20 patients after six months out of the Cipto Mangunkusumo hospitalwere found in 13 patients (65%). Predictors related to dead clinical outcomes in this study were weight loss, new HIV status and papilledema (p <0.05).

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"Latar belakang. Penelitian ini bertujuan menilai gambaran struktur dan fungsi retina serta menilai hubungan antara durasi terapi kelasi besi dan kadar feritin serum dengan abnormalitas struktur retina pada penyandang thalasemia-β mayor yang memperoleh terapi kelasi besi di RSCM. Metode. Penelitian potong lintang ini dilakukan pada penyandang thalasemia-β mayor berusia di atas 10 tahun yang memperoleh terapi kelasi besi dan menjalani kontrol di Pusat Thalasemia RSCM. Subjek dilakukan pemeriksaan oftalmologis, foto fundus, dan fundus autofluorescence. Selanjutnya dilakukan pengambilan subsampel dari subjek awal berdasarkan hasil fundus autofluorescence dan dilakukan pemeriksaan elektroretinografi multifokal dan elektrookulografi. Hasil. Abnormalitas struktur retina didapatkan pada 46,2% subjek sedangkan abnormalitas pemeriksaan fundus autofluorescence didapatkan pada 41,9% subjek. Sebagian besar subjek memiliki tajam penglihatan dan sensitivitas kontras yang normal. Nilai tengah seluruh parameter elektroretinografi multifokal dan rasio amplitudo light peak terhadap dark trough elektrookulografi kedua kelompok subjek berada dalam rentang normal. Didapatkan penurunan sensitivitas kontras yang signifikan pada subjek dengan abnormalitas struktur retina dan makula, namun tidak untuk tajam penglihatan. Kadar feritin serum yang lebih tinggi berhubungan dengan abnormalitas struktur retina. Kesimpulan. Rerata kadar feritin serum dalam periode satu tahun dengan titik potong ≥6.000 ng/ml dapat digunakan sebagai panduan untuk memulai pemeriksaan struktur dan fungsi retina.

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Introduction. This study aims to evaluate retinal structure and function and association between iron chelation treatment duration and serum ferritin level with retinal structure abnormality in β-thalassemia major patients treated with iron-chelating agent in Cipto Mangunkusumo Hospital. Methods. This cross-sectional study was performed on β-thalassemia major patients aged more than 10 years old in Thalassemia Center, Cipto Mangunkusumo Hospital, who received iron-chelating agent for at least one year. Patients underwent ophthalmologic examination, fundus photography, and fundus autofluorescence imaging. Afterwards subsample was chosen based on fundus autofluorescence imaging result, and underwent multifocal electroretinography and electrooculography examination. Results. Retinal structure abnormality was found in 46.2% patients and fundus autofluorescence abnormality in 41.9% patients. The majority of patients had normal visual acuity and contrast sensitivity. Each multifocal electroretinography parameters and light peak to dark trough amplitude ratio in electrooculography had normal median values. Significant contrast sensitivity reduction was found on patients with retinal and macular structure abnormality, but not for visual acuity. Significant association between higher ferritin serum level and retinal structure abnormality was found. Conclusion. Mean ferritin serum level within one year with cutoff point of ≥6.000 ng/ml can be used as a guide to start retinal structure and function evaluation."