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ABSTRACT
Kesulitan dalam penegakan diagnosis definitif efusi pleura tuberkulosis berdasarkan metode konvensional ataupun biopsi menyebabkan berbagai usaha untuk mencari alternatif strategi diagnostik lainnya. Kriteria diagnostik yang direkomendasikan adalah apabila pasien terdapat gejala klinik tuberkulosis dan pemeriksaan cairan pleura menunjukkan eksudat berdasarkan kriteria Light, aktivitas adenosin deaminase (ADA) > 40 U/l, dan rasio limfosit/neutrofil > 0.75, maka diagnosis efusi pleura tuberkulosis boleh ditegakkan yang dibuktikan dengan respon terapi. Tujuan penelitian ini adalah mendapatkan nilai diagnostik real time polymerase chain reaction (RT PCR) pada efusi pleura tersangka tuberkulosis yang memenuhi kriteria diagnostik. Penelitian uji diagnostik prospektif menggunakan 43 sampel cairan pleura dari tersangka tuberkulosis yang dipilih secara konsekutif. Diagnosis efusi pleura tuberkulosis ditegakkan berdasarkan respon terapi positif atau kultur positif. Kultur cairan pleura menggunakan media Lowenstein-Jensen. RT PCR dikerjakan menggunakan primer yang dapat mengenali gen IS6110 dan gen MPB64.

Dari 43 sampel tersebut, Mycobacterium tuberculosis dapat dideteksi oleh RT PCR pada 7 sampel, 4 diantaranya dengan kultur positif. Dengan demikian, sensitivitas RT PCR adalah 16.3% yang lebih tinggi daripada sensitivitas berdasarkan kultur saja yaitu 9.3%. Nilai duga positif dan nilai duga negatif RT PCR berturut-turut adalah 100% dan 0%. Spesifisitas, rasio kemungkinan positif, dan rasio kemungkinan negatif RT PCR tidak dapat dinilai karena semua subyek penelitian memiliki respon terapi positif atau kultur positif. RT PCR memiliki keunggulan yaitu dapat digunakan untuk menegakkan diagnosis definitif efusi pleura tuberkulosis lebih sensitif dan cepat dibandingkan kultur. Dengan demikian, penelitian ini mendapatkan bahwa pada pasien yang memenuhi kriteria diagnosis efusi pleura TB, maka RT PCR merupakan pilihan metode untuk identifikasi infeksi Mycobacterium tuberculosis secara definitif, karena sensitivitas yang rendah maka tidak dapat digunakan sendiri (tunggal).

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ABSTRACT
The difficulty to confirm the definitive diagnosis of tuberculous pleural effusion (TBPE) based on conventional laboratory methods and pleural biopsy have lead to the searching of alternative diagnostic strategies. The recommended diagnostic criteria approach for TBPE diagnosis are if a patient has clinical feature of tuberculosis (TB) and the pleural fluid analysis showed exudate based on Light criteria, the adenosine deaminase (ADA) activity > 40 U/l, and lymphocyte/neutrophil ratio > 0.75, then the diagnosis of TBPE is actually established. The aim of this study is to investigate the diagnostic value of RT PCR on suspected TBPE that fullfiled the recommended diagnostic criteria. The diagnostic study with prospective design assessed 43 pleural fluid samples of suspected TBPE that were selected consecutively. The diagnosis of TBPE was confirmed based on positive response therapy or positive culture of the pleural fluid. Pleural fluid culture was performed using Lowenstein-Jensen medium. Real time polymerase chain reaction (RT PCR) was carried out using the primer that detect IS6110 and MPB64 gene.

Among 43 samples of suspected TBPE, Mycobacterium tuberculosis could be detected by RT PCR in 7 samples with 4 of them had positive culture. The sensitivity of RT PCR therefore was 16.3%, it was higher than the sensitivity based on culture only which was 9.3%. Positive predictive value and negative predictive value of RT PCR were 100% and 0%, respectively. The specificity, positive likelihood ratio, and negative likelihood ratio of RT PCR could not be defined because all subjects had positive response therapy or positive culture. RT PCR has an advantage that it can be used to establish definitive diagnosis of TB earlier compared to culture. Therefore, when the patient fulfilled the recommended criteria of tuberculous pleural effusion, RT PCR is the method of choice for definitive identification of Mycobacterium tuberculosis infection. However, due to the low sensitivity, it can not be used alone.

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Latar Belakang: Penelitian mengenai petanda inflamasi akut terkait pajanan uap las pada pekerja las sudah banyak dilakukan. Akan tetapi, tidak semua penelitian tersebut sepakat terjadi perbedaan jumlah petanda inflamasi akut sesudah terpajan uap las. Penelitian ini ingin mengetahui apakah terjadi perbedaan jumlah petanda inflamasi akut akibat pajanan uap las dengan sel netrofil mukosa hidung sebagai petanda inflamasinya. Metode:Pada penelitian longitudinal ini, 110 pekerja di sebuah perusahaan pembuat knalpot diperiksa jumlah sel netrofil mukosa hidungnya sebelum dan sesudah terpajan uap las serta diukur kadar logam Kromium, Besi, Mangan, dan Aluminium dalam darah pada 40 pekerja diantaranya. Dilakukan pengukuran kadar logam Cr, Fe, Mn, dan Al di lingkungan kerja untuk menilai kadar pajanan. Hasil:Pengukuran lingkungan menunjukkan kadar Kromium, Besi, Mangan, dan Aluminium udara berada di bawah Nilai Ambang Batas. Sel netrofil sediaan apus sebelum dan sesudah terpajan uap las 8 jam sama – sama berjumlah 2 sel/10 lpk (p = 0,233). Pada penelitian ini juga ditemukan kadar dalam darah logam Cr sebesar 1,03 µg/l; logam Fe sebesar 283.787,73 µg/l; logam Mn sebesar 14,96 µg/l; dan logam Al sebesar 25,68 µg/l. Kesimpulan:Tidak ditemukan perbedaan jumlah sel netrofil mukosa hidung yang bermakna secara statistik akibat pajanan uap las. ......Background and Objective: Many studies about acute inflammation marker regarding metal fume exposure have been conducted but not all agree that metal fume exposure will raise acute inflammation response. One of the acute inflammation markers is nasal mucous neutrophil and this study was conducted to investigate the difference of neutrophil count after being exposed to metal fume as acute inflammation response. Methods: This study used a longitudinal design with 110 welders as subjects. Nasal mucous neutrophil data was collected before and after 8 hours metal fume exposure. Metal fume (i.e. Chromium, Iron, Manganese, and Aluminum) exposure in the work place was measured with AAS while blood metal level in 40 subjects among them was with ICP-MS. Results: Chromium, Iron, Manganese, and Aluminum fume level in the work place was under Threshold Limit Value while Chromium, Iron, Manganese, and Aluminum blood level was 1,03 µg/l; 283.787,73 µg/l; 14,96 µg/l; and 25,68 µg/l respectively.Neutrophil count before and after 8 hours metal fume exposure didn’t show any difference with statistically significance (p = 0,233) Conclusions: There was no statistical significant increase of nasal mucous neutrophil regarding metal fume exposure

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Latar belakang: Sepsis neonatorum awitan lambat SNAL , merupakan penyebab morbiditas dan mortalitas terpenting bayi berat lahir rendah di rumah sakit. Klinisnya tidak spesifik sehingga membutuhkan pemeriksaan penunjang untuk mendiagnosisnya. Baku emas kultur darah memiliki nilai diagnostik yang rendah dan hingga kini belum ada penanda infeksi tunggal yang dapat mendiagnosis sepsis neonatorum. Toll-like receptor TLR berperan dalam mengenali patogen dan memulai respon imun. Ekspresi TLR2 dan TLR4 diharapkan dapat menjadi penanda sepsis neonatorum. Tujuan: Mengetahui ekspresi TLR2 dan TLR4 neutrofil dan monosit serta nilai diagnostiknya pada SNAL. Metode: Studi potong lintang pada Mei-Juni 2017 yang melibatkan 52 neonatus >72 jam dengan klinis sepsis. Pemeriksaan darah perifer lengkap, rasio I/T, CRP, PCT, TLR2 dan TLR4 menggunakan flow cytometry dilakukan dan dibandingkan dengan kultur darah. Hasil: Insidens SNAL penelitian ini sebesar 32,6 . Terdapat penurunan ekspresi TLR2 neutrofil maupun monosit pada kasus SNAL. Peningkatan ekspresi TLR4 neutrofil memiliki sensitivitas 88,2 , spesifisitas 20 , dan AUC 0,541. Ekspresi TLR4 monosit memiliki sensitivitas 92,1 , spesifisitas 11,4 , dan AUC 0,528 jika dibandingkan kultur darah. Nilai AUC CRP meningkat hingga lebih dari 0,75 setelah dikombinasikan dengan TLR4. Simpulan: Pada SNAL, ekspresi TLR4 memiliki sensitivitas yang baik namun kurang spesifik. Pemeriksaan TLR4 dapat menunjang nilai diagnostik CRP. ......Background Late onset neonatal sepsis LONS , is the major morbidity and mortality in low birth weight. Unspecific clinical manifestation make laboratory examination is needed to establish the diagnosis. Unfortunately, blood culture as a gold standard has low diagnostic value. While, there is no single infection marker to diagnose neonatal sepsis. TLRs are a sensor to recognize the pathogens and trigger the immune response. Expression of TLR2 and TLR4 are promising to be a septic marker. Aim To know the expression of TLR2 and TLR4 neutrophil and monocyte and their diagnostic value in LONS. Methods A cross sectional study was conducted from May June 2017 which involved 52 neonates 72 hours with clinically sepsis. Complete blood count, I T ratio, CRP, PCT, TLR2 and TLR4 by flow cytometry already done and compared to blood culture. Result The incidence of LONS is 32.6 . There is TLR2 down expression in LONS. Expression of TLR4 neutrophil has sensitivity 88.2 , specificity 20 , and AUC 0.541. While TLR4 monocyte has sensitivity 92.1 , specificity 11.4 , and AUC 0.528. AUC of CRP is increased over to 0.75 after combined with TLR4. Conclusion Expression of TLR4 have good sensitivity but less specific. TLR4 expression could increase the diagnostic value of CRP.

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Latarbelakang: Demam neutropenia merupakan komplikasi tersering pada terapi anak dengan keganasan. Terapi antibiotik empiris diketahui dapat menurunkan angka morbiditas dan mortalitas. Namun demikian, dilaporkan peningkatan kejadian resistensi terhadap seftazidim.  Sefepim menurunkan demam lebih cepat dan mempersingkat lama perawatan dibandingkan seftazidim sehingga pada beberapa negara dilaporkan sebagai antibiotik monoterapi lini pertama. Penelitian ini bertujuan untuk membandingkan efektivitas pemberian seftazidim dan sefepim dalam hal lama penurunan demam dan kenaikan jumlah neutrofil absolut yang diamati selama 72 jam pertama setelah pemberian terapi empiris pada demam neutropenia anak dengan leukemia akut, serta bertujuan untuk mengetahui pola kuman dan sensitivitas antibiotik.

Metode: Uji acak terkontrol membandingkan efektivitas pemberian sefepim dan seftazidim. Pasien secara acak dibagi ke dalam dua kelompok intervensi, seftazidim dan sefepim, pada setiap kelompok terdiri atas 36 pasien. Dilakukan pemberian terapi dan hasil dicatat setelah pengamatan selama 72 jam.

Hasil: Penurunan demam didapatkan pada 28 anak (77.8%) dengan terapi seftazidim dan 33 anak (91.7%) dengan terapi sefepim. Tidak terdapat perbedaan bermakna antara kedua kelompok dalam hal lama penurunan demam (p=0.101). Pada kelompok seftazidim, median lama penurunan demam adalah 32 jam (8-171 jam), sedangkan pada kelompok sefepim adalah 24 jam (6-75 jam). Kenaikan jumlah neutrofil absolut didapatkan pada 1 anak (2.8%) dengan terapi seftazidim dan 10 anak (27.8%) dengan terapi sefepim dengan jumlah neutrofil absolut ≥ 1000 sel/mm³ setelah 72 jam pertama pemberian terapi. Terdapat perbedaan bermakna antara kedua kelompok (p=0.003). Median kenaikan jumlah neutrofil absolut pada 72 jam pertama kelompok seftazidim adalah 315 (0-1887) sel/mm³, sedangkan pada kelompok sefepim adalah 432 (0-4266) sel/mm³. Tidak terdapat perbedaan bermakna antara kedua kelompok (p=0.235). Pada hasil kultur darah didapatkan biakan terbanyak adalah bakteri Gram negatif, ditemukan pada 8 subyek (72%) dari kedua kelompok yaitu bakteri Escherichia coli, Klebsiella pneumoniae dan Salmonella sp. Hasil uji sensitivitas isolat bakteri Gram negatif dari biakan darah, antibiotik sefepim mempunyai persentase terbesar, yaitu 75% dari bakteri yang tumbuh pada biakan, sedangkan seftazidim 38%.

Kesimpulan: Sefepim lebih baik dibandingkan seftazidim dalam penurunan suhu dan kenaikan jumlah neutrofil absolut lebih pada 72 jam walaupun secara statistika tidak berbeda bermakna

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Introduction: Neutropenic fever is the most frequent complication during cancer therapy in children. Empirical antibiotic therapy has been known to reduce the mortality and morbidity rate. However, resistance against ceftazidime has been reported. Cefepime reduces fever and shorten the length of hospitalization better than ceftazidime that several countries have reported using it as the first-line antibiotic therapy. This study is aimed to compare the effectivity of ceftazidime and cefepime to reduce fever and to increase the absolute neutrophils count in the first 72 hours.

Method: A randomized controlled trial to compare cefepime and ceftazidime. Patients were randomly divided into two intervention groups, ceftazidime and cefepime, each group consist of 36 patients. Patients were treated, the results were noted after 72 hours.

Results: Fever was reduced in 28 children (77.8%) treated with ceftazidime and 33 children (91.7%) treated with cefepime. No significant difference was found between the two groups regarding the amount of time it took for the fever to drop (p=0.101). For ceftazidime, fever was reduced in 32 hours (8-171 hours) on average, while it took cefepime 24 hours (6-75 hours) on average to reduce the fever. The increase of absolute neutrophils in the first 72 hours was found in 1 child (2.8%) treated with ceftazidime, while there were 10 children (27.8%) treated with cefepime whose absolute neutrophils increased ≥ 1000 cells/mm³ in the first 72 hours. A significant difference was found between the two groups (p=0.003). On average, the increase of absolute neutrophils in the first 72 hours for ceftazidime was 315 (0-1887) cells/mm³, while the average number for cefepime was 432 (0-4266) cells/mm³. No significant difference was found between the two groups (p=0.235). Blood culture revealed that the most common pathogen are gram-negative bacterias. Found in 8 subjects (72%) in the two groups were Escherichia coli, Klebsiella pneumoniae, and Salmonella sp. Sensitivity test for isolated gram-negative bacteria from the blood culture revealed that cefepime had the greatest sensitivity of 75% while ceftazidime had only 38%.

Conclusion: It was found that cefepime yielded better results compared to ceftazidime regarding fever reduction and absolute neutrophil increase in the first 72 hours, even if the results were not statistically significant.

 

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Latar Belakang : Non-alcoholic fatty liver disease (NAFLD) adalah penyakit hati kronik yang ditandai dengan akumulasi lemak berlebihan di hati. Elastografi Transien (ET) dan metode Controlled Attenuation Parameter (CAP) merupakan metode pemeriksaan non-invasif untuk menilai derajat fibrosis dan steatosis, namun tidak tersedia di seluruh rumah sakit di Indonesia. Rasio Neutrofil Limfosit (RNL) merupakan penanda peradangan sederhana yang berpotensi memprediksi luaran penyakit. Tujuan : Mengetahui nilai diagnostik RNL sebagai indikator derajat keparahan steatosis dan fibrosis NAFLD. Metode : Penelitian ini adalah studi potong lintang menggunakan data sekunder dari data rekam medis tahun 2016-2018. Analisis statistik deskriptif dan analitik berupa uji korelasi, Receiver Operating Curve (ROC) dan Area Under The Curve (AUC) dipakai untuk mengetahui luaran studi. Hasil : Dari 106 subjek penelitian, kebanyakan pasien adalah perempuan (62,3%) berusia rata-rata 57,29 tahun dan menderita sindrom metabolik (77,4%). Sebagian besar pasien memiliki derajat steatosis sedang-berat (66%) dengan rerata ET 6,14 (2,8-18,2). Terdapat korelasi antara nilai CAP (r=0,648; p<0,001) dan ET (r=0,621; p<0,001) dengan RNL. Penggunaan RNL untuk menilai derajat steatosis sedang-berat memiliki titik potong 1,775 dengan sensitivitas, spesifisitas, NDP dan NDN sebesar 81,5%, 80,6%, 89,1%, dan 69,1%; titik potong 2,150 untuk menilai fibrosis signifikan dengan sensitivitas, spesifisitas, NDP dan NDN berurutan sebesar 92.3 %, 87.5%, 70.6%, dan 97.2%. Simpulan : RNL memiliki korelasi positif terhadap derajat steatosis dan fibrosis dengan sensitivitas dan spesifisitas yang tinggi. ......Introduction : Non-alcoholic fatty liver disease (NAFLD) is a chronic inflammatory disease with excessive fat accumulation in the liver. Transient Elastography (TE) with Controlled Attenuation Parameter (CAP) is a device and method to examine the degree of fibrosis and steatosis. However, this device is not widely available across Indonesia. Neutrophil and Lymphocyte Ratio (NLR) is a simple marker for inflammation which has a potency to predict disease outcome. Objective : To know the diagnostic value of RNL as the indicator of steatosis and fibrosis severity. Methods : This was a cross-sectional study using secondary data from the medical record, starting from 2016-2018 with the respective inclusion and exclusion criteria. A descriptive and analytic statistic, including correlation test, Receiver Operating Curve (ROC) and Area Under The Curve (AUC) were done to know the outcome of the study. Result: Out of 106 subjects, 62.3% patients were women with aged mean 57.29 years old and 77.4% had metabolic syndrome. Most patients had average-severe steatosis degree (66%) with the mean of ET mean 6.14 (2.8-18.2). There was a positive correlation between CAP and TE compared with NLR with r = 0.647 (p<0.001) and r = 0.621 (p<0.001) respectively. The use of NLR to assess moderate-severe steatosis has a cutoff point of 1.775 with sensitivity, specificity, PPV and NPV of 81,5%, 80,6%, 89,1%, and 69,1%; cutoff point 2,150 to assess significant fibrosis with sensitivity, specificity, PPV and NPV of 92.3 %, 87.5%, 70.6%, 97.2% respectively. Conclusion : NLR has a positive correlation with the degree of steatosis and fibrosis with high sensitivity and specificity.

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[ABSTRAK
Latar belakang : Pada masa sekarang, reperfusi miokardium dengan trombolitik atau intervensi koroner perkutan primer ( IKPP) adalah terapi utama pada pasien yang mengalami IMA EST. Tujuan utama IKPP untuk mengembalikan patensi arteri epikardial yang mengalami infark dan mencapai reperfusi mikrovaskular secepat mungkin. Namun keberhasilan mengembalikan patensi dari arteri koroner epikardial setelah oklusi tidak selalu menjamin cukupnya reperfusi ke level mikrovaskular, yang disebut sebagai fenomena no reflow atau microvascular obstruction (MVO). Terdapat dua mekanisme yang berperan pada no reflow yaitu disfungsi mikrovaskular dan kerusakan intergritas mikrostruktur endotel. Kerusakan endotel dapat diakibatkan berbagai hal, diantara nya jejas reperfusi yang akan mengaktivasi netrofil. Netrofil teraktivasi akan mengeluarkan radikal bebas oksigen, enzim proteolitik dan mediator proinflamasi yang secara langsung menyebabkan kerusakan jaringan dan endotel. Trimetazidine adalah obat antiangina yang dapat menurunkan netrofil yang dimediasi oleh trauma jaringan setelah jantung mengalami iskemia. Akan tetapi belum diketahui secara luas pengaruh pemberian trimetazidine terhadap akumulasi netrofil pada kejadian IMA EST yang dilakukan tindakan IKPP. Metode : Sebanyak 68 pasien IMA EST yang menjalani IKPP dipilih secara konsekutif sejak Januari 2015 sampai Juni 2015 diambil saat masuk UGD, dilakukan pengambilan darah vena perifer untuk menghitung jumlah netrofil sebelum IKPP, kemudian pasien menjalani IKPP. Setelah 6 jam paska IKPP dilakukan pengambilan kembali darah vena perifer untuk menghitung kembali jumlah netrofil paska IKPP. Hitung netrofil diperiksa dengan Sysmex 2000i. Perhitungan statistik dinilai dengan SPSS 17. Hasil : Dari 68 subyek, dibagi menjadi 28 subyek pada kelompok yang diberikan trimetazidine dan 40 subyek yang diberikan plasebo. Tidak didapatkan perbedaan jumlah netrofil pada kelompok perlakuan dan kelompok kontrol baik sebelum maupun sesudah IKPP, netrofil pre IKPP pada trimetazidine vs plasebo 10.71 ± 3.263 vs 10.99 ± 3.083,nilai p:0,341. Nilai netrofil post IKPP pada trimetazidine vs plasebo 9.49 ± 3.135 vs 9.92 ± 3.463,nilai p:0,664. Kesimpulan : Tidak terdapat penurunan jumlah netrofil pasca pemberian trimetazidine pada pasien IMA EST yang menjalani IKPP.

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ABSTRACT
Background Nowadays, reperfusion strategy, either with thrombolytic or Primary Percutaneous Coronary Intervention (PPCI), is the core treatment for Acute ST-Segment Elevation Myocardial Infarct (STEMI). The goal of PPCI is to restore the patency of infarcted epicardial artery and establish microvascular reperfusion as soon as possible so that necrotic myocardial area can be reduced. However, successful restoration of infarcted epicardial artery is not always followed by enough reperfusion to the microvascular part. Trimetazidine is an antianginal drug, can reduce neutrophil which was mediated by tissue trauma during ischemic heart condition. Trimetazidine is currently approved and widely known as antianginal drug which affect metabolism. Unfortunately, its influence over neutrophil accumulation in acute STEMI patients which undergo PPCI is not well understood. Method There were 68 consecutive-selected acute STEMI patients which undergo PPCI since January 2015 until Juni 2015. They were admitted in emergency department. Peripheral vein blood sampling was taken to measure neutrophil before PPCI was performed. Six hour after PPCI was conducted, another peripheral vein blood sampling was taken for another neutrophil measurement. Neutrophil measurement was performed with Sysmex 2000i. Statistical analysis was performed by using SPSS 17. Result Among 68 patients, divided in two groups, trimetazidine 28 patients and plasebo 40 patients. There were no differences amount of neutrophils in trimetazidine or plasebo group, before or after PPCI. Neutrophil pre PPCI in trimetazidine vs plasebo group 10.71 ± 3.263 vs 10.99 ± 3.083, p:0,341. Neutrophil post PPCI in trimetazidine vs plasebo group 9.49 ± 3.135 vs 9.92 ± 3.463, p:0,664. Conclusion There were no reducing amount of neutrophils after trimetazidine was given in patients STEMI which underwent PPCI., Background Nowadays, reperfusion strategy, either with thrombolytic or Primary Percutaneous Coronary Intervention (PPCI), is the core treatment for Acute ST-Segment Elevation Myocardial Infarct (STEMI). The goal of PPCI is to restore the patency of infarcted epicardial artery and establish microvascular reperfusion as soon as possible so that necrotic myocardial area can be reduced. However, successful restoration of infarcted epicardial artery is not always followed by enough reperfusion to the microvascular part. Trimetazidine is an antianginal drug, can reduce neutrophil which was mediated by tissue trauma during ischemic heart condition. Trimetazidine is currently approved and widely known as antianginal drug which affect metabolism. Unfortunately, its influence over neutrophil accumulation in acute STEMI patients which undergo PPCI is not well understood. Method There were 68 consecutive-selected acute STEMI patients which undergo PPCI since January 2015 until Juni 2015. They were admitted in emergency department. Peripheral vein blood sampling was taken to measure neutrophil before PPCI was performed. Six hour after PPCI was conducted, another peripheral vein blood sampling was taken for another neutrophil measurement. Neutrophil measurement was performed with Sysmex 2000i. Statistical analysis was performed by using SPSS 17. Result Among 68 patients, divided in two groups, trimetazidine 28 patients and plasebo 40 patients. There were no differences amount of neutrophils in trimetazidine or plasebo group, before or after PPCI. Neutrophil pre PPCI in trimetazidine vs plasebo group 10.71 ± 3.263 vs 10.99 ± 3.083, p:0,341. Neutrophil post PPCI in trimetazidine vs plasebo group 9.49 ± 3.135 vs 9.92 ± 3.463, p:0,664. Conclusion There were no reducing amount of neutrophils after trimetazidine was given in patients STEMI which underwent PPCI.]

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

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

Abstrak :
Obstruksi saluran cerna adalah kondisi yang sering memerlukan operasi dan dapat menyebabkan komplikasi serius. Neutrophil-to-lymphocyte ratio (NLR) telah digunakan sebagai indikator inflamasi pada berbagai kondisi medis, namun penelitian mengenai hubungan antara NLR dan obstruksi saluran cerna masih terbatas. Oleh karena itu, penelitian ini bertujuan untuk mengevaluasi peran NLR sebagai prediktor praoperasi yang hemat biaya dan sederhana terhadap mortalitas dan morbiditas pascaoperasi, khususnya infeksi luka operasi pada pasien dewasa dengan obstruksi saluran cerna. Penelitian ini merupakan penelitian potong lintang yang dilakukan pada pasien dewasa dengan obstruksi saluran cerna di Rumah Sakit Cipto Mangunkusumo Jakarta. Sampel penelitian terdiri dari 150 pasien dengan karakteristik dasar yang meliputi jenis kelamin, usia, jenis obstruksi saluran cerna, dan kadar neutrofil dan limfosit. Pasien yang meninggal pascaoperasi memiliki rata-rata NLR yang lebih tinggi (26,50) dibandingkan dengan pasien yang masih hidup (9,77). Analisis multivariat menunjukkan bahwa NLR merupakan faktor prediktif independen untuk morbiditas (OR = 1,37) dan mortalitas pasien (OR = 1,10). Penelitian ini juga mengidentifikasi cut-off nilai NLR praoperasi terbaik untuk menjadi prediktor morbiditas (9,95) dan mortalitas (12,51) pasien obstruksi saluran cerna pascaoperasi dengan sensitivitas dan spesifisitas yang tinggi. Temuan ini menunjukkan bahwa NLR dapat digunakan sebagai indikator yang dapat diandalkan dalam memprediksi hasil operasi pada pasien obstruksi saluran cerna ......Intestinal obstruction is a condition that often requires surgery and can lead to serious complications. Neutrophil-to-lymphocyte ratio (NLR) has been used as an inflammation indicator in various medical conditions, but research on the relationship between NLR and intestinal obstruction is still limited. Therefore, this study aims to evaluate the role of NLR as a cost-effective and simple preoperative predictor of postoperative mortality and morbidity, particularly surgical site infection, in adult patients with intestinal obstruction. This study is a cross-sectional study conducted at Cipto Mangunkusumo Hospital in Jakarta. The study sample consists of 150 adult patients with intestinal obstruction, with baseline characteristics including gender, age, type of intestinal obstruction, and neutrophil and lymphocyte levels. Patients who died postoperatively had a higher average NLR (26.50) compared to those who survived (9.77). Multivariate analysis showed that NLR was an independent predictive factor for morbidity (OR = 1.37) and patient mortality (OR = 1.10). This study also identified the optimal preoperative NLR cut-off values as predictors of morbidity (9.95) and mortality (12.51) in postoperative intestinal obstruction patients, with high sensitivity and specificity. These findings indicate that NLR can be used as a reliable indicator for predicting surgical outcomes in patients with intestinal obstruction.

Abstrak :
Pada penderita kanker paru terjadi inflamasi sistemik dan dapat dilihat dengan peningkatan rasio netrofil limfosit di mana pemeriksaan ini lazim dilakukan di Rumah Sakit. Inflamasi sitemik dapat menyebabkan anoreksia sehingga asupan pada penderita kanker paru menurun dan memengaruhi status gizinya.  Penelitian ini bertujuan untuk mengetahui hubungan antara status gizi dengan rasio netrofil limfosit pada pasien kanker paru di RSUP Persahabatan. Penelitian ini menggunakan desain cross-sectional. Data diambil dari wawancara, pemeriksaan fisik, pemeriksaan laboratorium, dan dari rekam medis pasien poliklinik onkologi RSUP Persahabatan (n=52). Pada penelitian ini subjek sebagian besar berjenis laki-laki (61,5%), rentang usia terbanyak antara 50-60 tahun (38,5%), memiliki riwayat merokok (55,8%) dengan indeks Brinkman berat (30,8%). Lebih dari 50% subjek dengan asupan energi dan protein dibawah rekomendasi asupan untuk pasien kanker. Sebagian besar subjek penelitian berisiko malnutrisi atau malnutrisi sedang (38,5%) dan sebanyak 67,3% mengalami malnutrisi. Sebagai kesimpulan tidak terdapat hubungan antara status gizi dengan rasio netrofil limfosit pada penelitian ini (p = 0,35). ......Systemic inflammation in patients with lung cancer can be seen by the increase in the neutrophil lymphocyte ratio where these examinations are common in hospitals. Systemic inflammation can cause anorexia, with the result that nutrition intake of patients with lung cancer decreases and affects their nutritional status. This study aims to determine the association between nutritional status and the ratio of lymphocyte neutrophils in patients with lung cancer at Persahabatan Hospital. This is a cross-sectional study. Data were taken from interviews, physical examinations, laboratory analysis, and patients medical records in the oncology clinic of Persahabatan Hospital (n = 52) The subjects of the study were mostly male (61.5%), the largest age range was between 50-60 years (38.5%), had a history of smoking (55.8%) with a severe Brinkman index (30.8%). More than 50% of the subjects with energy and protein intake were below the recommended intake for cancer patients. Most of the study subjects were at risk of malnutrition or moderate malnutrition (38.5%) and 67.3% of them were experiencing malnutrition. In conclusion, there was no relationship between nutritional status with the ratio of neutrophil to lymphocytes in this study (p = 0.35).

Abstrak :
Kasus kekerasan seksual dalam bentuk persetubuhan dapat terjadi pada perempuan usia reproduksi yang sedang mengalami keputihan. Sekitar 75-80% dari semua perempuan setidaknya sekali menderita infeksi kandidiasis vulvovaginal dan infeksi tersebut menyumbang lebih dari 25% vaginitis menular. Kondisi keputihan akibat kandidiasis disebabkan oleh perubahan mikrobioma vagina dapat menimbulkan perubahan pH dan jumlah neutrofil vagina yang memengaruhi motilitas dan persistensi spermatozoa dalam vagina. Lama motilitas dan persistensi spermatozoa dalam vagina baik pada kondisi fisiologis maupun patologis merupakan dasar pertimbangan bagi praktisi forensik dalam penentuan waktu terjadinya persetubuhan. Penelitian ini bertujuan untuk menganalisis pH, jumlah neutrofil, dan profil mikrobioma vagina terhadap motilitas dan persistensi spermatozoa dalam vagina tikus kandidiasis. Penelitian eksperimental ini menggunakan tikus putih (Rattus norvegicus) galur wistar dengan tikus jantan sebanyak 6 ekor untuk sampel spermatozoa dan tikus betina sebanyak 32 ekor untuk perlakuan. Tikus betina dibagi dua kelompok yaitu tikus normal dan tikus kandidiasis. Pada kedua kelompok tikus betina diberikan perlakuan berupa inseminasi semen dalam vagina. Variabel yang diukur adalah pH, jumlah neutrofil, profil mikrobioma, motilitas dan persistensi spermatozoa dalam vagina. Analisis statistik perbedaan pH, jumlah neutrofil vagina, diversitas alfa mikrobioma, motilitas dan persistensi spermatozoa antara tikus kondisi normal dan model kandidiasis dengan uji Mann-Whitney, sedangkan perbedaan diversitas beta mikrobioma dilakukan uji permutational multivariate analysis of variance (Permanova). Estimasi survival motilitas dan persistensi spermatozoa dalam vagina menggunakan kurva kesintasan Kaplan-Meier dengan uji log-rank untuk penilaian signifikansi. Hubungan antara pH, jumlah neutrofil dan profil mikrobioma vagina dengan motilitas dan persistensi spermatozoa, dengan uji korelasi Spearman dilanjutkan uji regresi linear berganda. Hipotesis terbukti apabila pada uji perbedaan, uji log-rank,dan uji korelasi didapatkan nilai signifikansi p<0,05. Hasil penelitian menunjukkan terdapat perbedaan pH, jumlah neutrofil, motilitas dan persistensi spermatozoa antara kelompok tikus normal dengan tikus kandidiasis, namun tidak terdapat perbedaan profil mikrobioma tikus normal dan tikus kandidiasis. Kesintasan motilitas dan persistensi spermatozoa dalam vagina lebih lama pada tikus normal dibandingkan tikus kandidiasis. Terdapat korelasi antara pH dan jumlah neutrofil dengan motilitas dan persistensi spermatozoa dalam vagina tikus, namun tidak terdapat korelasi profil mikrobioma dengan motilitas dan persistensi spermatozoa dalam vagina tikus normal dan tikus kandidiasis. Semakin tinggi pH dan jumlah neutrofil dalam vagina, maka motilitas dan persistensi spermatozoa dalam vagina akan semakin menurun. Prosedur tambahan baru pada pemeriksaan kasus kekerasan seksual yang disarankan untuk dilakukan adalah pemeriksaan pH dan jumlah neutrofil vagina. ......Cases of sexual violence in the form of sexual intercourse can occur in women of reproductive age who are experiencing vaginal discharge. Approximate 75-80% of all women suffer from vulvovaginal candidiasis infection at least once and the infection accounts for more than 25% of infectious vaginitis. The condition of vaginal discharge due to candidiasis is caused by changes in the vaginal microbiome which can cause changes in vaginal pH and neutrophil count which affects the motility and persistence of spermatozoa in the vagina. Duration of motility and persistence of spermatozoa in the vagina, both physiological and pathological conditions is a basic consideration for forensic practitioners in determining time since intercourse. This study aimed to analyze pH, neutrophil count, and vaginal microbiome profile on the motility and persistence of spermatozoa in the vagina of candidiasis rat as a principles for determining the time since intercourse. An experimental study was conducted using white rats (Rattus norvegicus) Wistar strain with 6 male rats for spermatozoa samples and 32 female rats for treatment. Female rat were divided into two groups, namely normal and candidiasis rat. In both groups, female rat were given treatment in the form of vaginal insemination of semen. The variables measured included pH, neutrophil count, microbiome profile, motility and persistence of spermatozoa in the vagina. Statistical analysis of differences in pH, vaginal neutrophil count, microbiome alpha diversity, motility and persistence of spermatozoa between rat in normal conditions and candidiasis models was carried out using the Mann-Whitney test, while differences in microbiome beta diversity were carried out by the permutational multivariate analysis of variance (Permanova) test. Estimation of survival motility and persistence of spermatozoa in the vagina used the Kaplan-Meier survival curve with the log-rank test for significance assessment. The correlation between pH, neutrophil count and vaginal microbiome profile with spermatozoa motility and persistence, with the Spearman correlation test followed by multiple linear regression tests. The hypothesis is proven if the difference test, log-rank test and correlation test show a significance value of p<0.05.The results showed that there were differences in pH, neutrophil count, motility and persistence of spermatozoa between groups of normal and candidiasis rat, but there were no differences in the microbiome profiles of normal and candidiasis rat. The survival of motility and persistence of spermatozoa in the vagina is longer in normal rat than in candidiasis rat. There was a correlation between pH and the neutrophil count with the motility and persistence of spermatozoa in the vagina of rat, but there was no correlation between the microbiome profile and the motility and persistence of spermatozoa in the vagina of normal and candidiasis rat. The higher the pH and neutrophil count in the vagina, the motility and persistence of spermatozoa in the vagina will decrease. A new additional procedure in examining cases of sexual violence that is recommended to be carried out is checking the pH and vaginal neutrophil count.