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"Latar Belakang: Infeksi dengue dan demam tifoid merupakan penyakit endemik di Indonesia. Namun pada awal awitan demam terdapat kesulitan dalam membedakan keduanya. Oleh karena itu dibutuhkan modalitas pemeriksaan penunjang yang sederhana untuk membantu diagnosis infeksi dengue dan demam tifoid. C-Reactive Protein (CRP) merupakan alat bantu diagnostik yang terjangkau, cepat dan murah untuk diagnosis penyebab demam akut. Penelitian ini bertujuan mengetahui perbedaan kadar CRP pada demam akut karena infeksi dengue dengan demam tifoid. Metode: Penelitian ini merupakan studi potong lintang pada pasien demam akut dengan diagnosis demam dengue/demam berdarah dengue atau demam tifoid yang dirawat di IGD atau ruang rawat RSCM, RS Pluit dan RS Metropolitan Medical Center Jakarta dalam kurun waktu Januari 2010 sampai dengan Desember 2013. Kadar CRP yg diteliti adalah CRP yang diperiksa 2-5 hari setelah awitan demam. Data penyerta yang dikumpulkan adalah data demografis, data klinis, pemberian antibiotik selama perawatan, leukosit, trombosit, netrofil, LED dan lama perawatan. Hasil: Sebanyak 188 subjek diikutsertakan pada penelitian ini, terdiri dari 102 pasien dengue dan 86 pasien demam tifoid. Didapatkan median (RIK) CRP pada infeksi dengue adalah 11,65 (16) mg/L dan pada demam tifoid adalah 53 (75) mg/L. Terdapat perbedaan median CRP yang bermakna antara infeksi dengue dan demam tifoid (p <0,001). Pada titik potong persentil 99%, didapatkan hasil kadar CRP infeksi dengue sebesar 45,91 mg/L dan kadar CRP demam tifoid pada level persentil 1% sebesar 8 mg/L. Simpulan: Terdapat perbedaan kadar CRP pada demam akut karena infeksi dengue dengan demam tifoid. Pada titik potong persentil 99%, kadar CRP >45,91 mg/L merupakan diagnostik CRP untuk demam tifoid, kadar CRP <8 mg/L merupakan diagnostik CRP untuk infeksi dengue. kadar CRP 8-45,91 mg/L merupakan area abu-abu dalam membedakan diagnosis keduanya.

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Background: Dengue infection and typhoid fever are endemic disease in Indonesia. But in the early days of onset sometimes it is difficult to distinguish them. A simple modality test is needed to support the diagnosis. C-Reactive Protein (CRP) is an affordable, fast and relatively less expensive diagnostic tool to diagnose the causes of acute fever. This study was aimed to determine the differences of CRP level in the acute febrile caused by dengue infection or typhoid fever.

Methods: A cross sectional study has been conducted among acute febrile patients with diagnosis of dengue fever/dengue hemorrhagic fever or typhoid fever who admitted to the emergency room or hospitalized in Cipto Mangunkusumo Hospital, Pluit Hospital, and Metropolitan Medical Center Hospital Jakarta between January 2010 and December 2013. Data obtained from medical records. CRP used in this study was examined at 2-5 days after onset of fever. The other collected data were demographic data, clinical data, use of antibiotics, leukocytes, platelets, neutrophils, ESR, and length of stay in hospital.

Results: 188 subjects met the inclusion criteria; 102 patients with dengue and 86 patients with typhoid fever. Median CRP levels in dengue infection was 11.65 (16) mg/L and in typhoid fever was 53 (75) mg/L. There were significant differences in median CRP levels between dengue infection and typhoid fever (p < 0.001). At the 99% percentile cut-off point, CRP levels for dengue infection was 45.91 mg/L and CRP levels for typhoid fever at 1% percentile was 8 mg / L.

Conclusion: There was significantly different levels of CRP in acute fever due to dengue infection and typhoid fever. At the 99% percentile cut-off point, CRP level >45.91 mg/L was diagnostic for typhoid fever, CRP level <8 mg/L was diagnostic for dengue infection. CRP level between 8 to 45.91 mg/L was a gray area for determinating diagnosis of dengue infection and typhoid fever."

"Latar belakang: Tuberkulosis resistan obat (TB RO) merupakan salah satu tantangan terbesar dalam upaya pemberantasan TB di dunia, termasuk di Indonesia. Pengobatan TB RO menghadapi sejumlah kendala,termasuk hipotiroid, yang sering kali tidak terdiagnosis walau berpotensi memengaruhi kepatuhan dan hasil pengobatan TB RO, dikarenakan gangguan farmakokinetik obat dan penurunan kualitas hidup. Tujuan: Penelitian ini bertujuan untuk mengetahui insiden kejadian hipotiroid dan faktor risikonya (jenis kelamin, indeks massa tubuh, komorbiditas HIV, jenis OAT dan anti-TPO) pada pasien TB RO di Jakarta Metode: Penelitian ini merupakan penelitian kohort ambispektif yang dilakukan di empat rumah sakit rujukan TB RO di Jakarta, Indonesia. Data awal diambil dari sistem informasi tuberkulosis nasional dan subjek yang tidak memiliki data TSH awal atau memiliki masalah tiroid pada awal penelitian akan dieksklusi. Subjek yang telah menjalani pengobatan TB RO selama 3 sampai 6 bulan direkrut dan diambil data berupa kuesioner, pemeriksaan fisik dan pengambilan sampel darah vena (TSH dan anti-TPO). Hasil: Sebanyak 148 subjek TB RO diikutsertakan dalam penelitian ini. Hipotiroid ditemukan pada 8 subjek (5,4%). Walaupun kejadian hipotiroid tampaknya lebih sering terjadi pada subjek dengan jenis kelamin wanita (4/56, 7,1% vs 4/92, 4,3%) HIV (1/5, 20% vs 7/143, 4,9%), mendapat OAT kombinasi etionamid/PAS (3/28, 10,7% vs 5/120, 4,2%%), dan dengan anti-TPO positif (1/9, 11,1% vs 7/139, 5%), sedangkan lebih jarang terjadi pada subjek dengan malnutrisi (4/83, 4,8% vs 4/65,6,1%), namun penelitian ini tidak menemukan hubungan yang signifikan secara statistik antara jenis kelamin (RR = 1,6, IK 95% 0,4-6,3), indeks massa tubuh (RR = 0,7, IK 95% 0,2 - 3,0), komorbiditas HIV (RR = 4,1, IK 95% 0,6-27,2), jenis OAT kombinasi etionamid/PAS (RR = 2,6, IK 95% 0,6-10,1), anti-TPO (RR = 2,2, IK 95% 0,3-16,0) dengan kejadian hipotiroid pada TB RO, yang mungkin terkait dengan angka kejadian hipotiroid yang relatif rendah dalam penelitian ini. Kesimpulan: Insiden hipotiroid pada pasien TB RO di Indonesia relatif rendah dibandingkan dengan negara lain. Penelitian yang lebih besar diperlukan untuk menilai faktor risiko yang berkontribusi terhadap kejadian hipotiroid pada pasien TB RO.

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Background: Drug-resistant tuberculosis (DR-TB) represents one of the most significant challenges to the global effort to eradicate TB, including in Indonesia. The treatment of DR-TB is confronted with a number of significant obstacles, including hypothyroidism, which may frequently unrecognised and underdiagnosed, despite the fact that it may potentially affect DR-TB treatment adherence and outcomes, due to its impaired drug pharmacokinetics and reduced quality of life. Objective: We aim to assess the incidence of hypothyroidism, and its respective risk factors (Sex, body mass index, HIV comorbidity, DR-TB drug regimen, anti-TPO), in DR-TB patients in health services for DR-TB in Jakarta. Methods: This was an ambispective cohort study conducted in four tuberculosis referral hospitals in Jakarta, Indonesia. Baseline data was retrieved from the national tuberculosis information system. Participants who had undergone DR-TB treatment for a period of 3 to 6 months were recruited for questionairre, physical examination and venous blood sampling (TSH and Anti-TPO). Participants with baseline thyroid problems were excluded. Results: A total of 148 DR-TB subjects were included in this study. Hypothyroidism were found in 8 subjects (5.4%). Interestingly, the incidence of hypothyroidism was more frequent among subjects with female gender (4/56, 7.1% vs. 4/92, 4.3%), those with HIV (1/5, 20% vs 7/143, 4.9%), receiving ethionamide/PAS (3/28, 10.7% vs 5/120, 4.2%) and with positive anti-TPO (1/9, 11.1% vs 7/139, 5%), hereas it was less t frequent in subjects with malnutrition (4/83, 4.8% vs 4/65, 6.1%). Our study observed no statistically significant relationship between sex (RR = 1.6, 95% CI 0.4 - 6.3), body mass index (RR = 0.7, 95% CI 0.2 - 3.0), HIV comorbidity (RR = 4.1, 95% CI 0.6 - 27.2), type of antituberculosis drugs (ethionamide/PAS) (RR = 2.6, 95% CI 0.6 - 10.1), anti-TPO (RR= 2.2, 95% CI 0.3 - 16.0) and hypothyroidism, which might be related to the relatively low incidence of hypothyroidism in our study. Conclusions: The incidence of hypothyroidism among DR-TB patients in Indonesia was relatively low in comparison to other countries. Larger study is needed to assess the contributing risk factors for the development of hypothyroidism among DR-TB patients."