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"Latar Belakang. Pneumonia komunitas merupakan masalah kesehatan global dan memiliki morbiditas dan mortalitas yang tinggi. Rasio neutrofil-limfosit merupakan petanda inflamasi yang sederhana, cepat dan murah serta dapat dilakukan di fasilitas terbatas. Penelitian sebelumnya menunjukkan bahwa RNL saat awal perawatan dapat digunakan sebagai prediktor mortalitas, lama rawat inap dan kemungkinan kejadian sepsis, tetapi belum ada studi yang meneliti perannya dalam memprediksi kesembuhan dalam 7 hari pada pasien dengan pneumonia komunitas.Tujuan. Mengetahui peran rasio neutrofil-limfosit dalam memprediksi kesembuhan dalam 7 hari pada pasien dengan pneumonia komunitas.Metode. Penelitian ini menggunakan desain kohort retrospektif terhadap pasien pneumonia komunitas yang dirawat di RSCM dari periode 1 November 2017-31 Desember 2018. Data neutrofil, limfosit dan leukosit serta RNL pada awal perawatan diambil dari rekam medis. Kriteria kesembuhan dalam 7 hari berupa perbaikan keluhan, pemeriksaan fisik, tanda vital yang stabil sesuai panduan IDSA/ATS dan atau perbaikan rontgent toraks. Nilai rasio neutrofil-limfosit yang optimal didapatkan menggunakan kurva ROC. Analisis variabel perancu dilakukan dengan regresi logistik.Hasil. Terdapat 195 subjek penelitian yang dianalisis. Median usia sampel 65 tahun (21-90), dengan penyakit komorbid terbanyak adalah diabetes melitus (49,7%), terdapat 1 pasien yang mendapatkan antibiotik sebelum perawatan, dan 72,1% pasien dengan skor CURB-65 ≥ 2. Dari kurva ROC didapatkan nilai AUC 0,554 (IK95%: 0,473-0,635) dengan p>0,05. Analisa regresi logistik dan analisis subgrup menunjukkan CURB-65 skor 2 merupakan effect modifier.Kesimpulan. Rasio neutrofil-limfosit pada awal perawatan tidak dapat digunakan sebagai prediktor untuk memprediksi kesembuhan dalam 7 hari pada pasien dewasa pneumonia komunitas yang dirawat

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Background. Community acquired pneumonia is a global health problem and has a high morbidity and mortality. The neutrophil to lymphocyte ratio is a simple, rapid, inexpensive marker of systemic inflammation and can be done in a limited facility. Other studies had shown that neutrophil to lymphocyte ratio can be used to predict mortality, length of stay and sepsis, but there are no studies that investigate its role in predicting cure within 7 days in patients with community acquired pneumonia.Aim. To investigate neutrophil to lumphocyte ratio as a predictor of cure within 7 days in patients with community acquired pneumonia.Method. A retrospective cohort study was conducted using medical records in Cipto Mangunkusumo Hospital for community acquired pneumonia patients who were admitted from the period 1st November 2017-31st December 2018. Neutrophil, lymphocytes and neutrophil to lymphocyte ratio was obtained upon admittance. Criteria for cure within 7 days include improvement of clinical symptoms, physical examination, stable vital signs according to IDSA / ATS guidelines and or improvement of chest X-ray. Neutrophil to lymphocyte cut off was determined using the ROC curve. Confounding factors was analysed using logistic regression.Results. There were 195 subjects. Median age was 65 years (21-90). Diabetes mellitus (49.7%) was the most frequent comorbid. There were one patients treated with antibiotics prior to admission and 72.1 % of patients with a CURB-65 score ≥ 2. ROC curve showed that AUC 0.554 (95%CI: 0.473-0.635 ) with p>0.05. Logistic regression analysis and subgroup analysis showed that CURB-65 2 was an effect modifier.Conclusion. Neutrophil to lymphocyte ratio upon admittance cannot be used as a predictor of cure within 7 days in adult patients with community acquired pneumonia."

"Community-Acquired Pneumonia CAP adalah penyakit sistem pernapasan yang menyerang jaringan parenkim paru. Penyakit ini banyak mengancam individu dewasa dengan penurunan sistem imun. Penderita CAP mengalami peningkatan setiap tahunnya akibat peningkatan polusi udara yang berada di wilayah perkotaan, terutama pada kawasan industri. Penderita CAP akan mengalami peningkatan produksi sputum yang berujung pada kesulitan dalam mengeluarkan sputum. Pasien dengan CAP sering mengalami penurunan refleks batuk yang membuat sputum terakumulasi di jalan napas sehingga menyebabkan peningkatan usaha untuk bernapas. Fisioterapi dada merupakan salah satu teknik pembersihan jalan napas pada pasien dengan penurunan refleks batuk. Karya Ilmiah Akhir Ners ini bertujuan untuk menganalisis intervensi fisioterapi dada untuk mengurangi gejala serta mencegah perburukan pada pasien dengan CAP. Metodologi yang digunakan adalah metode studi kasus dan analisa penelitian yang telah ada. Hasil analisa yang didapatkan menunjukkan fisioterapi dada dapat menurunkan usaha napas pasien, pengurangan episode demam, perubahan karakteristik sputum, serta penuruan persentase mortalitas melalui skoring CURB-65.

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Community Acquired Pneumonia CAP is a respiratory disease that attacks the pulmonary parenchymal tissue. This disease threatens many adults with decreased immune system. CAP sufferers are increasing every year due to increasing air pollution in urban areas, especially in industrial areas. CAP sufferers will experience an increase in sputum production that leads to difficulties in removing sputum. Patients with CAP often have decreased cough reflexes that make sputum accumulate in the airway causing increased effort to breathe. Chest physiotherapy is one of the airway cleansing techniques in patients with decreased cough reflexes.

This Final Scientific Work of Ners aims to analyze the interventions of chest physiotherapy to reduce symptoms and prevent worsening of patients with CAP. The methodology used is the case study method and the existing research analysis. The results obtained showed chest physiotherapy can decrease the patient 39 s breathing effort, reduction of febrile episodes, changes in sputum characteristics, as well as the percentage of mortality by scoring CURB 65."

"Latar belakang : Pneumonia komunitas (PK) merupakan penyakit dengan angka kejadian morbiditas dan mortalitas yang tinggi secara global. Sebagai penyakit infeksi maka respons inflamasi bisa diukur melalui beberapa serum biomarker yang bisa digunakan sebagai prediktor untuk lama rawat. Identifikasi pasien risiko tinggi lama rawat yang panjang dengan menggunakan kombinasi beberapa serum biomarker diharapkan bisa menjadi acuan dalam intervensi yang cepat dan tepat termasuk didalamnya penggunaan antibiotik sehingga berpengaruh pada luaran klinis pasien PK.Tujuan : Studi ini bertujuan untuk mendapat sistem skoring dengan menggunakan beberapa serum biomarker seperti prokalsitonin, C-reactive protein (CRP), leukosit, asam laktat, D-dimer dan albumin terhadap lama rawat pasien PK sedang beratMetode : Studi ini menggunakan desain kohort prospektif pasien PK sedang berat yang dirawat di IGD/ICU/HCU RSUPN dr. Cipto Mangunkusumo periode Mei 2022 s/d Juli 2023. Variabel-variabel prediktor lama rawat pasien PK sedang berat didapatkan dari hasil analisis multivariat dengan regresi logistik.Hasil : Dari total 360 subjek yang memiliki lama rawat > 14 hari sebanyak 204 subjek (56,67%) dan ≤ 14 hari sebanyak 156 subjek (44,44%). Variabel prediktor yang secara konsisten mempengaruhi lama rawat adalah asam laktat dengan RR 1,305 (IK 95% 1,097 – 1,551, p=0,003) dan albumin dengan RR 2,234 (IK 95% 1,164– 2,156, p=0,003). Performa determinan dengan analisis kurva ROC menunjukkan kemampuan prediksi lemah (AUC=0,629). Performa kalibrasi dengan uji Hosmer-Lemeshow test menunjukkan validasi baik (0,562). Biomarker lain yang dianggap signifikan dalam analisis bivariat yaitu prokalsitonin dengan RR 1,481 (IK 95% 1,121-1,954, p=0,006) dan C-reactive protein RR 2,465 (IK 95% 1,141-5,326). Leukosit dan D-dimer tidak dinilai signifikan sebagai biomarker PK sedang berat (p = 0,947).Simpulan : Terdapat hubungan antara asam laktat dan albumin dengan lama rawat pasien PK sedang berat. Tidak terdapat model skoring lama rawat pasien PK sedang berat.

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Background: Community-acquired pneumonia (CAP) is a disease with a high global incidence of morbidity and mortality. As an infectious disease, the inflammatory response can be measured through several serum biomarkers that can be used as predictors for the length of hospital stay (LOS). The identification of patients at high risk for prolonged hospitalization using a combination of several serum biomarkers is expected to serve as a reference for prompt and accurate interventions, including the use of antibiotics, thereby influencing the clinical outcomes of CAP patients.

Objective: This study aims to establish a scoring system using several serum biomarkers such as procalcitonin, C-reactive protein (CRP), leukocytes, lactic acid, D-dimer, and albumin for the length of hospital stay in patients with moderate to severe CAP.

Method: This study employs a prospective cohort design involving patients with moderate to severe CAP treated in the Emergency Department (ED), Intensive Care Unit (ICU), and High-Care Unit (HCU) at RSUPN dr. Cipto Mangunkusumo from May 2022 to July 2023. Variables to predict for the length of hospital stay in patients with moderate to severe CAP were obtained from multivariate analysis using logistic regression.

Results: A total of 360 subjects were included in this study, including 204 subjects (56.67%) with LOS more than 14 days, while 156 subjects (44.44%) had LOS of 14 days or less. The consistently influencing predictor variables for the length of hospital stay were lactate with RR 1.305 (95% CI 1.097–1.551, p=0.003) and albumin with RR 2.234 (95% CI 1.164–2.156, p=0.003). Determinant performance with ROC curve analysis showed weak predictive ability (AUC=0.629). Calibration performance with the Hosmer-Lemeshow test indicated good validation (0.562). Other biomarkers considered significant only in bivariate analysis were procalcitonin with RR 1.481 (95% CI 1.121–1.954, p=0.006) and C-reactive protein with RR 2.465 (95% CI 1.141–5.326). Leukocytes an D-dimer were not considered significant as a biomarker for moderate to severe CAP (p=0.947).

Conclusion: There is a relationship between lactate and albumin with the length of hospital stay in patients with moderate to severe CAP. However, there is no scoring model for the length of hospital stay in these patients."

"Latar Belakang. Hipoalbuminemia sudah diketahui merupakan faktor prediktor morbiditas dan mortalitas pada pasien usia lanjut dengan pneumonia dan CRP merupakan petanda klinis yang penting pada pneumonia. Namun hubungan antara kadar CRP dengan penurunan kadar albumin, sebagai protein fase akut negatif, saat infeksi akut belum pernah diteliti sebelumnya.Tujuan. Mendapatkan: (1) perbedaan kadar CRP awal perawatan antara pasien dengan daa tanpa penurunan albumin, (2) perbedaan risiko teradinya penurunan albumin antara pasien dengan kadar CRP awal tinggi dan rendah, dan (3) korelasi antara kadar CRP dan albumin saat awal perawatan pada pasien-pasien usia lanjut dengan pneumonia komunitas yang dirawat di rumah sakit.Metodalogi. Stuart potong-lintang dan kohort-prospektif dilakukan pada pasien-pasien usia lanjut (>60 tahun) dengan diagnosis pneumonia komunitas yang dirawat di RSCM, untuk diamati penurunan kadar albuminnya selama 5 hari perawatan. Pasien-pasien dengan keadaan-keadaan yang dapat mempengaruhi kadar albumin dan CRP, serta infeksi selain pn nimcnia komunitas dieksklusi dari penelitian. Penilaian kadar CRP dilakukan pada hari pertama perawatan (cut-off 20 mg/L), sementara penurunan albumin ditentukan dari perubahan kadar albumin selama 5 hari perawatan (cut-off 10%). Analisis statistik dilakukan dengan uji-t independen, uji chi-square, dan uji korelasi sesuai dengan tujuan penelitian.Hasil Utama. Selama periode April-Juni 2005 terkumpul 26 pasien usia lanjut dengan pneumonia komunitas yang masuk perawatan di RSCM. Hanya 23 pasien yang menyelesaikan penelitian sampai 5 hari dengan 17 pasien memiliki kadar CRP awal tinggi, dan didapatkan penurunan albumin >10% pada 7 pasien setelah 5 hari perawatan. Terdapat perbedaan rerata kadar CRP hari-1 diantara kedua kelompok (175,36 mgfL vs 75,67 mg/L; P = 0,026; 1K95% 13,25-186,13 mgfL). Namun tidak didapatkan perbedaan risiko bermakna antara pasien dengan kadar CRP tinggi dengan pasien dengan kadar CRP rendah scat awal dengan terjadinya penurunan albumin saat awal perawatan (RR = 2,12; P = 0,621; 11(95% 0,256-29,07). Tidak didapatkan pula korelasi antara kadar CRP dan albumin saat awal perawatan (r = 0,205, P = 0,314)Kesimpulan. Tingginya kadar CRP awal perawatan berhubungan dengan terjadinya penurunan kadar albumin selama perawatan, namun tidak ada perbedaan risiko terjadinya penurunan albumin selama perawatan antara pasien dengan CRP awal tinggi dan CRP awal rendah, serta tidak ada korelasi antara kadar CRP dan albumin scat awal perawatan pada pasien-pasien usia lanjut dengan pneumonia komunitas yang dirawat di rumah sakit.

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Backgrounds. Hypoalbuminemia widely known as a predictive factor for increasing morbidity and mortality in elderly patients, including with pneumonia; while CRP has known as a clinical marker for pneumonia. But relationship between CRP level with decrease of serum albumin level, as a negative acute-phase protein, during acute infection has never been studied before.

Objectives. To found: (1) CRP level difference between patient with and without decreased of serum albumin level, (2) risk for developing decreased of serum albumin level in patients with high CRP compared to patients with low CRP level, and (3) correlation between CRP and albumin level on admission in hospitalized elderly patients with community-acquired pneumonia.

Methods. Cross-sectional and prospective-cohort studies was conducted in hospitalized elderly patients with community-acquired pneumonia that admitted to RSCM, to observed the decreased of serum albumin level in five days of hospitalization. Conditions that known could influence CRP and albumin consentration have been excluded, and other infections as well. CRP level was determined on admission (cut-off 20 mgfL), while decreased of serum albumin was observed for 5 days of hospitalization (cu[-off 10%). Statistical analysis was done by using independent t-test, chi-square test, and correlation test appropriately accord-ing to the objectives of the study.

Main Results. During study period (April to June, 2005) 26 hospitalized elderly patients with community-acquired pneumonia had been included into study, but only 23 of them that finished the study for 5 days. There were 17 patients that have high level of CRP on admission, and 7 patiens that developing decreased of serum albumin level more than 10% in fifth day compared to their serum albumin level on admission. There was significant mean CRP difference among 2 groups (175,36 mgfL vs 75,67 mg/L; P = 0,026; 95%CI 13,25-186,13 mgfL), but there was no risk difference between patients with high and low CRP level on admission for developing decreased albumin level on fifth day of hospitalization (RR = 2,12; P = 0,621; 95%CI 0,256-29,07). And there was no correlation between CRP and albumin level on admission (r = 0,205, P = 0,314)

Conclusions. Patients with high CRP level on admission tend to have decreased of serum albumin level during hospitalization, but there was no risk difference for developing decreased of serum albumin level between patients with high and low CRP level, and there was no correlation between CRP and albumin level on admission in hospitalized elderly patients with community-acquired pneumonia."

"Latar Belakang: Community Acquired Pneumonia (CAP) merupakan salah satu penyebab utama morbiditas dan mortalitas di dunia. Bakteri atipikal (Chlamydia pneumoniae, Mycoplasma pneumaniae, Legionella pneumophila) sebagai penyebab penting CAP. Sejauh ini belum ada pemeriksaan mikrobiologi yang rutin dilakukan sehingga perlu pengembangan uji, salah satunya metode molekuler multiplex real time PCR. .Tujuan: Melakukan optimasi uji multiplex real time PCR untuk mendeteksi secara simultan dan cepat C.pneumoniae, L.pneumophila dan M.pneumoniae pada sputum pasien CAP.Metode: Penelitian ini merupakan uji eksperimental laboratorium yang terdiri atas 3 tahap. Tahap 1 meliputi optimasi suhu penempelan, primer, probe, volume elusi akhir dan cetakan DNA. Tahap 2 untuk menentukan batas ambang deteksi DNA dan reaksi silang. Tahap 3 adalah penerapan uji multiplex real time PCR pada spesimen sputum pasien CAP.Hasil: Uji multiplex real time PCR telah berhasil dioptimasi dengan ambang batas minimal deteksi DNA untuk Chlamydia pneumoniae, Legionella pneumophila dan Mycoplasma pneumaniae adalah 1855, 3185 dan 130 kopi DNA. Uji ini tidak bereaksi silang dengan mikroorganisme yang berpotensi menimbulkan reaksi positif palsu. Sebanyak 134 sputum telah diuji dan ditemukan positif M.pneumoniae sebanyak 1 spesimen (0,74 %).Kesimpulan: Uji multiplex real time PCR dapat mendeteksi C.pneumoniae, M.pneumoniae, dan L.pneumophila secara simultan pada sputum pasien CAP.

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Background: Community Acquired Pneumonia (CAP) is one of the leading causes of morbidity and mortality in the world. Atypical bacteria (Chlamydia pneumoniae, Legionella pneumophila, Mycoplasma pneumaniae) are the important causes of CAP. In daily clinical practice, detection of atypical bacteria are sometimes neglected due to the limited standard test available. The real time multiplex PCR methode can be used as an alternative test for the detection of atypical bacteria.Objective: Optimization of the multiplex real time PCR test to simultaneously detect C.pneumoniae, L.pneumophila and M.pneumoniae in CAP patients.Methods: This study is experimental laboratory test that conducted in three phases. The first is optimization of annealing temperature, primers dan probe concentration, final elution of DNA extraction and volume of PCR templete. The second is determination of minimal detection of DNA and cross reaction of optimized real time PCR multiplex. The third is application of real time PCR multiplex in sputum clinical specimen patient with CAP.Results: The multiplex real time PCR test was successfully optimized for annealing temperature, concentration of primer both forward and reverse, probes concentration and inhibitor. Limit detection of the DNA Chlamydia pneumoniae, Legionella pneumophila and Mycoplasma pneumaniae were 1855 copies, 3185 copies and 130 copies DNA. This test also showed no cross reaction to microorganisms that have potential to cause false positives. A total of 134 sputum clinical specimens have been tested with this method and only one sample (0,74%) was positive M.pneumoniae.Conclusion: The multiplex real time PCR assay can detect C. pneumoniae, M. pneumoniae, and L. pneumophila simultanously in sputum of patients with Community Acquired Pneumonia (CAP)"

"Community-acquired pneumonia (CAP) adalah suatu peradangan akut pada parenkim paru yang disebabkan oleh mikroorganisme dan didapat dari masyarakat. Terapi optimal antibiotik extended empiric sering diperdebatkan sehingga penatalaksanaan CAP merupakan tantangan besar bagi para klinisi. Penelitian ini bertujuan menganalisis perbandingan luaran terapi, efektivitas biaya dan pilihan terapi antibiotik yang baik serta hubungan ketepatan penggunaan dengan biaya antibiotik extended empiric monoterapi dan dualterapi CAP. Desain penelitian ini adalah kohort prospektif dengan waktu pengambilan sampel Juni-September 2018 di ruang boarding IGD RSUP Fatmawati Jakarta. Diperoleh hasil dualterapi tertinggi diberikan pada komorbid gangguan kesadaran. Nilai P=0,643 untuk perbaikan klinis setelah hari ke-5 pemberian antibiotik extended empiric monoterapi dengan dualterapi. Nilai ACER monoterapi lebih rendah (Rp.256.896,36) dibandingkan dualterapi (Rp.609.505,56) dengan antibiotik terbaik yaitu seftriakson serta kombinasi siprofloksasin dan seftriakson. Terdapat hubungan antara ketepatan penggunaan dengan biaya antibiotik extended empiric (r=0,282;P=0,005). Dari hasil penelitian tersebut dapat disimpulkan bahwa antara penggunaan antibiotik monoterapi dengan dualterapi tidak berbeda signifikan dalam luaran klinis setelah hari ke-5 pemberian antibiotik extended empiric, efektivitas biaya monoterapi lebih baik dibandingkan dualterapi dengan pilihan monoterapi terbaik adalah seftriakson dan dapat dipertimbangkan pemberian kombinasi siprofloksasin dan seftriakson pada komorbid gangguan kesadaran serta terdapat kekuatan hubungan sedang antara ketepatan penggunaan dengan biaya antibiotik extended empiric.

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Community-acquired pneumonia (CAP) is an acute inflammation of the pulmonary parenchyme caused by microorganisms and obtained from community. Optimal therapy for extended empirical antibiotics is debated so CAP management is still a major challenge. This study aims to analyze the comparison of therapeutic outcomes, cost effectiveness and the best choice of antibiotic therapy also the correlation between the accuracy of use and cost of monotherapy and dualtherapy extended empirical antibiotics in prospective cohort. The sampling time was June-September 2018 in the ED boarding room Fatmawati Hospital, Jakarta. Highest dualtherapy results for unconsciousness comorbid. P value=0,643 for clinical improvement after the 5th day of extended empiric monotherapy and dualtherapy. Monotherapy ACER is lower (Rp 256.896,36) than dualtherapy (Rp.609.505,56), the best antibiotics are ceftriaxone and ciprofloxacin-ceftriaxone. There is a relationship between the accuracy of use and cost of extended empiric antibiotics (r=0,282;P=0,005). It can be concluded that between the use of monotherapy and dualtherapy did not differ significantly in clinical outcomes after the 5th day, cost effectiveness of monotherapy was better than dualtherapy with the best choice was ceftriaxone and consideration of ciprofloxacin-ceftriaxone for unconsciousness comorbid, there is a moderate relationship between the accuracy of use and cost of extended empirical antibiotics."

"ABSTRAKPendahuluan: Pneumonia komunitas CAP salah satu penyebab kematian tertinggi. Tujuan mengetahui respons pengobatan selama perawatan pasien CAP secara empiris serta faktor yang berkaitan dengan pola kuman, respons pengobatan, gejala klinis, laboratorium, foto toraks, lama rawat dan faktor komorbid di RS persahabatan.Metode: Kohort prospektif pasien pneumonia komunitas rawat inap di RS Persahabatan selama 15 bulan terkumpul 47 pasien. Gejala klinis, hasil laboratorium, foto toraks dan hasil mikrobiologi. Sampel mirkobiologi dikumpulkan sebelum dan sesudah pemberian antibiotik.Hasil: Terkumpul 47 pasien. laki-laki 74,5% dan perempuan 25,5%. Rerata umur 61 tahun. Gejala klinis awal paling banyak sesak napas 51% berkurang 27,7% dan batuk 32% berkurang 23,4%. Nilai awal leukosit rerata 15,27. sel/mm3 berkurang 12,0. sel/mm3. Foto toraks awal infiltrat 89,3% menurun 38,3%. Patogen pada sputum sebelum penggobatan Klebseiella pneumonia 34,0%. Hasil sputum pasca terapi empiris eradikasi 91.5%. Pengobatan antibiotik tersering seftriakson. Faktor komorbid tersering keganasan rongga toraks. Lama rawat minimal 4 hari dengan terapi sulih minimal 3 hari.Kesimpulan: Pasien CAP paling dominan menunjukan gejala klinis sesak napas dan batuk, gambaran infiltrat pada foto toraks dan gram-negatif Klebsiella pneumonia pada sputum. Terjadi penurunan leukosit setelah pemberian antibiotik. Terapi empiris dengan antibiotik tunggal masih sensitif.

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ABSTRACTIntroduction : Pneumonia is the first leading disease with the highest mortality in hospitalized patients. The purpose of this study is to determine treatment response for the empirical treatment of CAP patients and factors associated with patterns of bacteria, treatment response, clinical symptoms, laboratory and chest X-ray, length of stay and comorbidities in Persahabatan Hospital, Jakarta. Methods : Prospective cohort study in hospitalized community acquired pneumonia patients at Persahabatan Hospital while 15 month. Clinical symptoms, laboratory findings, chest x-ray and microbiologic. Microbiologic sample is before and after antibiotic administration.Results : There were 47 patients. Male accounted 74,5% and female 25,5%. The average age was 61 years old. Clinical symptoms before treatment were dyspnea 51% decreased to 27,7% and cough 32% decreased to 23,4%. Leukocytes count was 15,27 cell/mm3 decreased to 12,0 cell/mm3. Chest x-ray infiltrates 89,3% decreased to 38,3%. Before-treatment microbiological patterns were K. pneumoniae 34,0%. Result after empirical treatment was eradication 91,5%. The most frequent innitial antibiotic administration was ceftriaxone.The most frequent comorbidity was thoracic malignancy. The patients were hospitalized at least for 4 days with replacement therapy at least for 3 days.Conclusion: Patients with CAP predominantly showed symptoms of dypnea and cough, infiltrates on chest x-ray and gram-negative Klebsiella pneumonia in sputum samples. There were resolution of leucocyte counts after antibiotic administration. Empirical antibiotic treatments with single drug were still sensitive."

"Community acquired pneumonia (CAP) oleh patogen resisten obat (PRO) memiliki tingkat keparahan yang tinggi. CAP akibat PRO memerlukan terapi antibiotik spektrum luas, skor Drugs Resistance in Pneumonia (DRIP) mampu memprediksi kasus tersebut. Penggunaan skor DRIP dapat mencegah kegagalan terapi antibiotik empirik dan mempersingkat lama rawatan, untuk itu diperlukan validasi. Penelitian ini merupakan studi Cohort Retrospektif pada pasien CAP yang dirawat inap selama periode Januari 2019 hingga Juni 2020. Data diambil dari rekam medis, kegagalan antibiotik bila terdapat kematian, pindah rawat ICU dan eskalasi antibiotik. Performa skor DRIP dianalisis dengan menentukan nilai kalibrasi dan diskriminasi, uji Hosmer-Lemeshow dan Area Under Curve (AUC). Diperoleh 480 pasien yang telah memenuhi kriteria. Terdapat 331 pasien (69%) dengan skor DRIP <4 dan 149 pasien (31%) dengan skor DRIP ≥4, dengan jumlah kegagalan antibiotik sebesar 283 pasien (59%), 174 pasien (61,4%) skor DRIP <4 dan 109 pasien (38,5%) skor DRIP ≥4. Kalibrasi DRIP menggunakan uji Hosmer-Lemeshow diperoleh p-value = 0,667 (p>0,05), diskriminasi AUC pada kurva ROC diperoleh 0,651 (IK 95%; 0,601-0,700). Skor DRIP menunjukkan performa yang cukup baik dalam memprediksi kegagalan antibiotic empiric pada pasien CAP yang terinfeksi PRO. Skor DRIP tidak berhubungan dengan lama rawatan di Rumah Sakit.

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Community-acquired pneumonia (CAP) caused by drug resistant pathogens (DRP) has a high level of severity. The incidence of CAP due to DRP requires broad spectrum antibiotic therapy, the Drugs Resistance in Pneumonia (DRIP) score is able to predict these cases. The use of the DRIP score can prevent antibiotic failure and minimize length of hospitalization, but validation is needed . This research is a retrospective cohort study in CAP patients who were hospitalized during the period January 2019 to June 2020. Data were taken from patient medical records, and failure of empiric antibiotics occurs when one of this criteria are found: patient mortality, ICU transfer and escalation of antibiotics as well as length of stay. Furthermore, the performance of the DRIP score was analyzed by determining the calibration and discrimination, using the Hosmer-Lemeshow test and the Area Under Curve (AUC). There were 480 patients who met the criteria. There were 331 patients (69%) with a DRIP score <4 and 149 patients (31%) with a DRIP score ≥4, with a total of 283 patients (59%) of antibiotic failures which were detailed in 174 patients (61.4%) with a DRIP score <4 and 109 patients (38.5%) DRIP score ≥4. DRIP calibration using the Hosmer-Lemeshow test obtained p-value=0.667 (p>0.05), AUC observations on the ROC curve obtained 0.651 (95% CI; 0.601-0.700). The DRIP score showed good performance in predicting failure of empiric antibiotics in infected CAP patients. PRO. The DRIP score is not related to the length of stay in the hospital."

"Pada awalnya imunologi dianggap tidak memiliki peran dalam penyakit kanker, namunberbagai penelitian saat ini telah membuktikan bahwa sel imun tubuh dapat menghambatperkembangan sel kanker. Sel imun yang diketahui berperan dalam mematikan sel tumoradalah sel limfosit T sitotoksik CD4+ dan CD8+.Reseptor PD-1 atau programmed death 1 ligand (CD279) sebagai molekul yang bersifatmensupresi proses imunologi dihasilkan pada membran plasma sel T dan jika berikatandengan PD-L1 akan menekan respon imun, ekspresi berlebihan dari PD-L1 akanmenekan respons dari sel imun terutama sel limfosit T.Saat ini rasio neutrofil-limfosit (NLR) darah dikenal sebagai salah satu petanda untukprognosis maupun prediktor dalam terapi kanker. Peningkatan jumlah neutrofil di darahperifer merupakan petanda dari inflamasi kronik yang menunjukkan gangguan dariimunitas seluler, sedangkan jumlah limfosit darah menunjukkan respons dari sel Tsitotoksik yang baik.Penelitian ini menemukan bahwa terdapat hubungan signifikan antara NLR pra radiasidengan PD-L1 ELISA pasca radiasi (p=0.010) sehingga NLR pra radiasi dapat digunakansebagai prediktor untuk PD-L1 ELISA pasca radiasi. Tidak ditemukan hubungansignifikan antara PD-L1 intratumoral ELISA dengan sebukan limfosit stromal tumor,namun terdapat kecenderungan hubungan negatif antara PD-L1 intratumoral ELISAdengan sebukan limfosit stromal tumor pasca radiasi.

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Decades ago immunology was not considered to have role in cancer, but various studieshave now proven that immune cells can inhibit the development of cancer cells. Immunecells that are known to play a role in killing tumor cells are CD4 + and CD8 + cytotoxicT cells.PD-1 receptor or programmed death 1 ligand (CD279) as a molecule that suppresses theimmunological process produced on the T cell plasma membrane and it binds to PD-L1will suppress the immune response, thus excessive expression of PD-L1 will suppressthe response of immune cells especially T cell lymphocytesRecently the neutrophil-lymphocyte ratio (NLR) is known as one of the markers for theprognosis and predictor of cancer therapy. An increase in the number of neutrophils inperipheral blood is a sign of chronic inflammation which shows a disruption of cellularimmunity, whereas the number of blood lymphocytes shows a response from normalcytotoxic T cells.This study showed that there was a significant correlation between pre-EBRT NLR andpost EBRT PD-L1 ELISA (p = 0.010) so that pre-EBRT NLR could be used as a predictorfor post EBRT PD-L1 ELISA. No significant relationship was found betweenintratumoral PD-L1 ELISA with a tumor stromal lymphocyte, but there was a trend ofnegative relationship between intratumoral PD-L1 ELISA with a post-radiation tumorstromal lymphocyte"

"Studi-studi sebelumnya menunjukkan adanya hubungan antara rasio neutrofil-limfosit(neutrophil-to-lymphocyte ratio, NLR) dan rasio platelet-limfosit (platelet-to-lymphocyteratio, PLR) sebagai penanda respons inflamasi sistemik dalam mendiagnosis kankerprostat. Tujuan studi ini adalah menilai NLR dan PLR prebiopsi prostat untukmenentukan efektivitasnya dalam memprediksi kanker prostat. Studi ini menggunakandesain retrospektif. Penelitian ini mengikutsertakan seluruh pasien hiperplasia prostatbenigna (benign prostatic hyperplasia, BPH) dan kanker prostat yang menjalani biopsi diRumah Sakit Adam Malik antara bulan Agustus 2011 sampai Agustus 2015. Batas PSAyang digunakan adalah 5 ng/dL sebagai kandidat biopsi. Hubungan antara variabelprebiopsi yang mempengaruhi persentase prostat dievaluasi termasuk usia, kadarprostate-specific antigen (PSA), dan estimasi volume prostat (estimated prostate volume,EPV). Nilai PLR dan NLR dihitung dari rasio hitung platelet dengan neutrofil absolutterhadap hitung limfosit absolut. Nilainya kemudian dianalisis dan dilihat apakah terdapathubungan dengan diagnosis BPH dan kanker prostat. Dari 298 pasien yang diikutsertakandalam studi ini, penelitian ini membagi dua grup menjadi 126 (42,3%) pasien BPH dan172 (57,7%) pasien kanker prostat. Terdapat perbedaan yang signifikan pada PSA(19.28±27.11 ng/dL vs 40.19±49.39 ng/dL), EPV (49.39±23.51 cc vs 58.10±30.54 cc),PLR (160.27±98.96 vs 169.55±78.07), dan NLR (3.57±3.23 vs 4.22 ± 2.59) pada keduagrup (p<0,05). Analisis Receiver Operating Characteristics (ROC) dilakukan untuk PLRdan NLR dalam menganalisis nilainya dalam memprediksi kanker prostat. Area UnderCurve (AUC) PLR adalah 57,9% dengan sensitivitas 56,4% dan spesifisitas 55,6% padabatas cut-off 143 (p=0,02). Cut-off NLR 3,08 memberikan AUC 62,8% dengansensitivitas 64,5% dan spesifisitas 63,5%. AUC ini komparabel bila dibandingkan denganAUC PSA sendiri (68,5%). Penelitian ini lalu menjalani regresi logistik antara PSA, PLR,dan NLR dengan hasil eksklusi PLR bila dihitung seara konjungtif. DEngan demikian,NLR memiliki performa menjanjikan dalam memprediksi kanker prostat pada pasiendengan PSA di atas 4 ng/dL (RO=3,2; 95% CI: 1,96-5,11). Kami menemukan bahwasebanyak 80 (63,5%) pasien dengan biopsi jinak memiliki nilai NLR negatif dalam studiini. Dari penelitian ini disimpulkan bahwa NLR memiliki potensi menjanjikan dalammemprediksi kanker prostat. Diperlukan penelitian lebih lanjut untuk memvalidasinyasebagai alat diagnostik.

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Previous studies demonstrated promising value of platelet-to-lymphocyte (PLR) andneutrophil-to-lymphocyte ratio (NLR) as systemic inflammatory response in prostatecancer. This study was conducted to evaluate their pre-biopsy values in predictingprostate cancer. This is a diagnostic study with retrospective design. We included allbenign prostatic hyperplasia (BPH) and prostate cancer (PCa) patients who underwentprostate biopsy in Adam Malik Hospital between August 2011 and August 2015. We usedPSA value above 4 ng/dL as the threshold for the biopsy candidates. The relationshipbetween pre-biopsy variables affecting the percentage of prostate cancer risk wereevaluated, including: age, prostate specific antigen (PSA) level, and estimated prostatevolume (EPV). The PLR and NLR was calculated from the ratio of related platelets orabsolute neutrophil counts with their absolute lymphocyte counts. The values thenanalyzed to evaluate their associations with the diagnosis of BPH and PCa. Out of 298patients included in this study, we defined two groups consist of 126 (42.3%) BPH and172 PCa (57.7%) patients. Mean age for both groups are 66.36±7.53 and 67.99±7.48 yearsold (p=0.64), respectively. There are statistically significant differences noted from PSA(19.28±27.11 ng/dL vs 40.19±49.39 ng/dL), EPV (49.39±23.51 cc vs 58.10±30.54 cc),PLR (160.27±98.96 vs 169.55±78.07), and NLR (3.57±3.23 vs 4.22 ± 2.59) features ofboth groups (p<0.05). A Receiver Operating Characteristics (ROC) analysis wasperformed for PLR and NLR in analyzing their value in predicting prostate cancer. TheArea Under Curve (AUC) of PLR is 57.9% with sensitivity of 56.4% and specificity of55.6% in the cut-off point of 143 (p=0.02). The NLR cut-off point of 3.08 gives 62.8%AUC with 64.5% sensitivity and 63.5% specificity. These AUCs were comparable withthe AUC of PSA alone (68.5%). We performed logistic regression between PSA, PLR,and NLR with result in the exclusion of PLR if calculated conjunctively. Therefore, NLRhas a promising performance in predicting PCa in patients with PSA above 4 ng/dL(OR=3.2; 95% CI: 1.96-5.11). We found as many as 80 (63.5%) patients with benignbiopsy results with negative NLR value in this study."