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Nama : Rulifa SyahroelProgram Studi : Program Pendidikan Dokter Spesialis-II Ilmu Kesehatan AnakJudul : Hipokalsemia sebagai Penanda Derajat Keparahan Infeksi Virus Dengue pada AnakLatar belakang. Kalsium plasma memegang peran vital pada berbagai proses fisiologis tubuh. Hipokalsemia telah didokumentasikan pada infeksi virus dengue terutama pada kasus berat. Masih sedikit data tentang kalsium ion serum pada infeksi virus dengue anak.Tujuan. Menilai kadar kalsium ion serum pada DD, DBD dan SSD serta membuktikan hipokasemia dapat menjadi penanda derajat keparahan infeksi .Metode. Studi potong lintang dilakukan di tujuh RS rujukan Provinsi DKI Jakarta, Sumatera Barat dan Kepulauan Riau selama November 2017 - Februari 2018 pada anak usia 1 - 45vol , nilai hemokonsentrasi >20 dan kadar albumin

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Name Rulifa Syahroel Specialty Pediatric Consultant Program majoring in Infection and Tropical Diseases Title Hypocalcemia as A Marker of Dengue Severity in Children Background. The plasma calcium plays a vital role for physiological process of body. Hypocalcemia has been documented in dengue infection and seen more frequently in severe cases. There is still lack of data about serum ionized calcium in pediatric dengue.Objective. To asses the serum ionized calcium level in DF, DHF, DSS and evaluate hypocalcemia as a marker of dengue severity.Methods. A cross sectional study was done in seven top referral hospitals in Jakarta, West Sumatera and Riau Islands Province from November 2017 Februari 2018. Children aged 1 45vol , hemoconcentration level 20 and albumin serum level

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Latar Belakang : Perbedaan antara demam dengue ( DD ) dan demam berdarah dengue ( DBD ) adalah terjadinya kebocoran plasma pada DBD. Kebocoran plasma pada ruang interstitial ditandai dengan adanya efusi cairan di pleura dan peritoneal, hemokonsentrasi, serta hipovolemia intravaskular. Keadaan ini menyebabkan gangguan perfusi ke jaringan, sehingga menyebabkan metabolism anaerob. yang menimbulkan peningkatan kadar laktat dalam darah. Tujuan Penelitian: Mengetahui peran laktat sebagai prediktor prognosis dan diagnosis kebocoran plasma pada infeksi dengue pasien dewasa. Metode: Studi potong lintang, pada infeksi virus dengue pasien dewasa yang dirawat di bangsal penyakit dalam RS Cipto Mangunkusumo dan RS Persahabatan Jakarta. Jumlah subjek sebanyak 57 orang. Dilakukan pemeriksaan kadar laktat untuk melihat perbedaan rerata kadar laktat antara DD dan DBD dengan uji t-tes tidak berpasangan, dan nilai titik potong kadar laktat pada keadaan tanpa atau dengan kebocoran plasma dilakukan dengan menentukan sensitifitas dan spesifisitas terbaik dari kurva ROC yang sudah dibuat. Hasil: Rerata kadar laktat pada DBD secara bermakna lebih tinggi daripada DD. Nilai titik potong untuk prediktor prognostik pada hari ke-3 yang ditentukan dengan kurva ROC mendapatkan nilai kadar laktat ≥ 2,65 mmol/ L dengan AUC 0,626 ; IK 95% 0,480-0,772. Dan nilai titik potong untuk diagnostik pada hari ke- 5 mendapatkan nilai kadar laktat ≥ 2,55 mmol/L memberikan sensitivitas 66,6%% dan spesifisitas 54,2%. Kesimpulan: Terdapat perbedaan bermakna kadar laktat antara DD dan DBD. Nilai kadar laktat ≥ 2,65 mmol/L belum dapat digunakan sebagai prediktor prognostik adanya kebocoran plasma pada fase kritis. Nilai kadar laktat ≥ 2,55 mmol/L pada saat fase kritis dipakai sebagai petanda adanya kebocoran plasma dengan akurasi yang rendah.

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Background : The difference between dengue fever (DF) and dengue hemorrhagic fever (DHF) is plasma leakage which occurs in DHF. The leakage of plasma into interstitial space is shown by pleura and peritoneal effusion, hemoconcentration, and intravascular hypovolemia. Anaerob metabolism will occur due to perfusion dysfunction which will cause increased serum lactate. Objectives : To determine the role of lactate as a prognostic predictor and diagnostic in plasma leakage which occurs in adult dengue-infected patients. Methods : This is cross-sectional study which is conducted in adult dengueinfected patients hospitalized in internal medicine ward of Cipto Mangunkusumo Hospital and Persahabatan Hospital in Jakarta. There are 57 adult dengue-infected patients recruited. Serum lactate is examined to determine the mean difference between DF and DHF. The data is analyzed by t-test independent and cut-off point is identified in presence as well as absence of plasma leakage which is to determine the sensitivity and specificity based on ROC curve. Results : The mean of serum lactate in DHF is significantly higher compared to DF. The cut-off point of prognostic predictor in day three of fever which is determined based on ROC curve shows lactate serum ≥ 2.65 mmol/L with AUC 0.626; 95% CI 0.480-0.772. Moreover, the cut-off point of diagnostic factor in day five of fever is shown by serum lactate ≥ 2.55 mmol/L with sensitivity 66.6% and specificity 54.2%. Conclusion : There is difference of serum lactate in DF and DHF. Serum lactate ≥ 2.65 mmol/L could not be used as a prognostic predictor of plasma leakage in critical phase. Serum lactate ≥ 2.55 mmol/L during critical phase could be used as a marker of plasma leakage but low of accuracy, Background : The difference between dengue fever (DF) and dengue hemorrhagic fever (DHF) is plasma leakage which occurs in DHF. The leakage of plasma into interstitial space is shown by pleura and peritoneal effusion, hemoconcentration, and intravascular hypovolemia. Anaerob metabolism will occur due to perfusion dysfunction which will cause increased serum lactate. Objectives : To determine the role of lactate as a prognostic predictor and diagnostic in plasma leakage which occurs in adult dengue-infected patients. Methods : This is cross-sectional study which is conducted in adult dengueinfected patients hospitalized in internal medicine ward of Cipto Mangunkusumo Hospital and Persahabatan Hospital in Jakarta. There are 57 adult dengue-infected patients recruited. Serum lactate is examined to determine the mean difference between DF and DHF. The data is analyzed by t-test independent and cut-off point is identified in presence as well as absence of plasma leakage which is to determine the sensitivity and specificity based on ROC curve. Results : The mean of serum lactate in DHF is significantly higher compared to DF. The cut-off point of prognostic predictor in day three of fever which is determined based on ROC curve shows lactate serum ≥ 2.65 mmol/L with AUC 0.626; 95% CI 0.480-0.772. Moreover, the cut-off point of diagnostic factor in day five of fever is shown by serum lactate ≥ 2.55 mmol/L with sensitivity 66.6% and specificity 54.2%. Conclusion : There is difference of serum lactate in DF and DHF. Serum lactate ≥ 2.65 mmol/L could not be used as a prognostic predictor of plasma leakage in critical phase. Serum lactate ≥ 2.55 mmol/L during critical phase could be used as a marker of plasma leakage but low of accuracy]

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Latar Belakang: Kebocoran plasma merupakan salah satu penanda dari derajat keparahan penyakit infeksi virus dengue (DENV). Kadar fibrinogen mengalami perubahan seiring dengan terjadinya kebocoran plasma. Tujuan: Mengetahui hubungan kadar fibrinogen pada pasien infeksi DENV dengan derajat keparahan penyakit. Metode: Peneliti menggunakan desain studi kohort dari data sekunder komunitas di Jakarta pada tahun 2010. Jumlah sampel penelitian adalah 43 orang dengan total 38 orang yang memenuhi kriteria inklusi. Kadar fibrinogen yang digunakan yaitu data pada demam hari ketiga dan keempat dari total tujuh hari ke tiga pemeriksaan, karena merupakan perkiraan hari terjadinya kebocoran plasma. Derajat keparahan penyakit infeksi DENV ditentukan berdasarkan klasifikasi WHO 1997 dan dibagi menjadi dua kelompok yaitu Demam Dengue (DD) dan Demam Berdarah Dengue (DBD). Hasil pemeriksaan kadar fibrinogen pada demam hari ketiga dan keempat dianalisis menggunakan Uji T Independen. Hasil: Hasil pemeriksaan demam hari ketiga menunjukkan tidak ada perbedaan bermakna pada kelompok DD dan DBD (p=0,993), namun rata-rata kadar fibrinogen kelompok DBD (253,8 mg/dL) lebih rendah dibandingkan kelompok DD (253,9 mg/dL). Hasil pemeriksaan kadar fibrinogen demam hari keempat juga menunjukkan tidak ada perbedaan bermakna pada kelompok DD dan DBD (p=0,437), namun rata-rata kadar fibrinogen DBD (218,7 mg/dL) lebih rendah dibandingkan DD (235,4 mg/dL). Kesimpulan: Kadar fibrinogen DBD lebih rendah dibandingkan DD namun tidak menunjukkan perbedaan yang bermakna sehingga tidak terdapat hubungan antara kadar fibrinogen dengan derajat keparahan penyakit pada pasien infeksi DENV. ......Background: Plasma leakage is one of the degree of severity disease determinants in patients with dengue virus (DENV) infection. Fibrinogen levels changes due to plasma leakage in DENV infection. Objective: Investigate the association of fibrinogen level and the degree of severity disease in patients with DENV infection in Jakarta, Indonesia. Methods: Author used a cohort study from secondary data on community in Jakarta at the year of 2010. The total sample is 43 persons, of whom 38 persons met the inclusion criteria. Next, author chose the third and fourth days of a total of seven days fever examination of fibrinogen levels because these days are the estimated days of plasma leakage. The severity of DENV infection is determined based on the 1997 WHO Classification which is divided into two group namely Dengue Fever (DF) and Dengue Haemorrhagic Fever (DHF). The results of examination of fibrinogen levels on the third and fourth day of fever were analyzed using the Independent T Test Results: The results in the third day of fever were no significant difference in the DD and DHF groups (p = 0.993), but the fibrinogen levels in the DHF group (253.8 mg/dL) were lower than those in the DF group (253.9 mg/dL). The results of the examination of fibrinogen levels on the fourth day of fever were also analyzed using the Independent T Test, the results were no significant difference in the DF and DHF groups (p = 0.437), but DHF fibrinogen levels (218.7 mg / dL) were lower than DF (235.4 mg / dL). Conclusion: Fibrinogen levels in DHF were lower than DF but did not show a significant difference so there was no association between fibrinogen levels with the severity of the disease in patients with DENV infection.

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Latar Belakang: Kebocoran plasma merupakan penanda derajat keparahan penyakit infeksi virus dengue. Kadar natrium menurun seiring dengan terjadinya kebocoran plasma. Tujuan: Mengetahui hubungan natrium pada pasien infeksi DENV dengan derajat keparahan penyakit. Metode: Jumlah sampel pada penelitian ini sebesar 43 pasien. Sebanyak lima pasien di eksklusi sehingga 38 sampel yang dapat digunakan pada penelitian ini. Sampel berasal dari data sekunder pasien infeksi DENV pada komunitas di Jakarta. Kadar natrium diambil pada hari ketiga dan keempat demam pada pasien, karena kebocoran plasma yang signifikan terjadi pada hari tersebut sebagai awal fase kritis pasien. Penegakan derajat infeksi DENV menggunakan klasifikasi WHO tahun 1997 yang terbagi atas Undifferentiated fever, DD, dan DBD. Namun, pada penelitian ini kelompok infeksi DENV yang diteliti terbagi atas DD dan DBD. Kadar natrium dan derajat keparahan penyakit akan dianalisis menggunakan uji nonparametrik yaitu Uji Mann-Whitney. Hasil: Nilai median kadar natrium hari ketiga demam pada kelompok pasien DBD (132 mEq/L) lebih rendah dibandingkan kelompok pasien DD (135 mEq/L). Secara statistik tidak ada perbedaan bermakna kadar natrium pada pasien DD dan DBD di hari ketiga demam (p=0,057). Hasil yang sama didapatkan pada hari keempat demam yaitu nilai median kadar natrium kelompok pasien DBD (133 mEq/L) lebih kecil dibandingkan kelompok pasien DD (136 mEq/L). Namun, secara statistik terdapat perbedaan bermakna pada kelompok DD dan DBD (p 0,011). Kesimpulan: Kadar natrium mengalami penurunan pada kelompok pasien DBD dibandingkan dengan DD yaang signifikan pada hari keempat demam tetapi tidak bermakna pada hari ketiga. Sehingga terdapat hubungan antara kadar natrium dengan derajat keparahan penyakit pasien infeksi virus dengue. ......Background: Plasma leakage is used to determine the severity of dengue virus infection. Natrium level decreases along with plasma leakage. Objective: To understand the association of Natrium level in patients with DENV infection to the degree of disease severity. Methods This study used 43 samples. Five patients excluded, there are 38 samples remained in this study. Samples derived from secondary data of patients with DENV infection in the community in Jakarta. Natrium level had taken at the third and fourth days of fever, due to a significant plasma leakage that occurred as the beginning of a critical phase of the patient. Enforcement degree of DENV infection using the 1997 WHO classification, divided into an undifferentiated fever, Dengue Fever (DF), and Dengue Haemmorrhagic Fever (DHF). However, this study examined groups of DENV infection that divided into DF and DHF. Natrium Level and the degree of disease severity will be analyzed using a nonparametric test, the Mann-Whitney test. Results: The median value of the natrium level on the third day of fever in the DHF patient group is (132 mEq/L) lower than the DF patient group (135 mEq/L). There is no statistically significant difference in natrium levels in DF and DHF patients on the third day of fever (p = 0,057). The same results obtained on the fourth day of fever is the median value of the natrium DHF group (133 mEq/L) is smaller than the group of DF (136 mEq/L). However, there is a significant difference between the DF and DHF group (p 0,011). Conclusion: Natrium levels decreased in the DHF patient group compared to the DF group which indicate significance on the fourth day of the Fever, but not on the third day. So, there is a association between Natrium Level and the degree of Disease Severity in Patients with Dengue Virus Infection in Jakarta, Indonesia.