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"Selama kehamilan terjadi perubahan hormonal dan metabolik yang kompleks pada wanita hamil, yang dapat memperlihatkan gambaran klinik klasik mirip hipertiroid, sehingga diagnosis hipertiroid pada masa kehamilan menjadi lebih sulit. Perubahan hasil tes fungsi tiroid pada masa kehamilan lebih mempersulit lagi diagnosis tersebut, sehingga perlu dicari parameter yang relatif tidak dipengaruhi kehamilan. Diharapkan pemeriksaan kadar TSH dapat menggantikan parameter yang dipakai sekarang.Tujuan penelitian ini adalah mengetahui adakah perbedaan kadar TSH antara wanita hamil dengan wanita tidak hamil dan antara wanita hamil trimester II dengan trimester III. Selain itu untuk mendapatkan nilai rujukan kadar TSH pada wanita hamil.Dari bulan April sampai September 1990 di UPF Bagian Patologi Klinik FKUI- RSCM telah dilakukan pemeriksaan kadar TSH-IRMA terhadap 30 orang wanita usia subur dan 60 orang wanita hamil trimester II, pemeriksaan diulang kembali pada kehamilan trimester III.Kadar TSH-IRMA pada 30 orang wanita usia subur berkisar antara 0,4 - 3,1 mIU/l dengan nilai rata- rata 1,2 mIU/l. Kadar TSH-IRMA 60 orang wanita hamil trimester II berkisar antara 0,2 - 3,1 mIU/1 dengan nilai rata- rata 1,26 mIU/l. Nilai rujukan kadar TSH-IRMA wanita hamil trimester II adalah 0,29-3,73 mIU/1. Dan kadar TSH-IRMA pada 52 orang wanita hamil trimester III berkisar antara 0,2 - 3,3 mIU/1 dengan nilai rata- rata 1,17 mIU/l. Nilai rujukan kadar TSH-IRMA wanita hamil trimester III adalah 0,26-3,59mIU/1.Hasil uji distribusi dari ke 3 kelompok data dengan tes Anderson Darling didapat distribusi log Gaussian.Uji student's t test untuk membandingkan antara wanita usia subur sebagai kontrol dengan wanita hamil trimester II didapat kadar TSH-IRMA ke 2 kelompok tidak berbeda bermakna ( p=O,6955 ). Juga antara kontrol dengan trimester III dan antara trimester II dengan trimester III dengan p=0,7333 dan p=0,297.Uji korelasi antara trimester II dan trimester III dengan Pearson's r product moment correlation didapat adanya korelasi antara ke 2 kelompok dengan r=0,5783 dan persamaan garis regresi y = 0,6251x± O,38O3.Kesimpulan penelitian ini adalah kadar TSH wanita usia subur yang tidak hamil tidak berbeda dengan kadar TSH wanita hamil trimester II dan trimester III. Juga tidak terdapat perbedaan antara kadar TSH wanita hamil trimester II dengan trimester III.Disarankan untuk melakukan penelitian serupa dengan subjek yang lebih banyak termasuk wanita hamil trimester I untuk mendapatkan nilai rujukan yang lebih memenuhi syarat.Juga disarankan melakukan penelitian kadar TSH pada wanita hamil yang menderita hipo/ hipertiroid.

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During pregnancy, there are hormonal and metabolic changes, which can mimic the classical picture of hyperthyroid, so diagnosis of hyperthyroid during pregnancy is difficult. The changes of thyroid function test results make the diagnosis even more difficult. It is necessary to find a parameter which is relatively not influence by pregnancy.

The aims of this study are to evaluate the differences of TSH level between pregnant women with non pregnant women and between pregnant women trimester II with trimester III. Beside these, to get the reference range of TSH level in pregnant women.

From April to September 1990 in Department of Clinical Pathology, Dr Cipto Mangunkusumo Hospital/ University of Indonesia, 30 women in child bearing period and 60 pregnant women trimester II had been evaluated their TSH-IRMA level, this test had been repeated in pregnancy trimester III.

TSH-IRMA level in 30 women was between 0,4-3,1 mIU/1 (mean : 1,2 mIU/1). In 60 pregnant women trimester II TSH level was between 0,2 - 3,1 mIU/l (mean 1,28 mIU/1). The reference range was between 0,29 - 3,73 mIU/1. In 52 women trimester III TSH-IRMA level was between 0,2 - 3,3 mIU/1 (mean : 1,17 mIU/1). The reference range was between 0,28 - 3,59 mIU/l.

The data of these 3 groups with Anderson Darling's test were found to be log Gaussian distribution.

TSH-IRHA level of pregnant women trimester II and trimester Ill were not significantly different from control. (p = 0,6955 and p = 0,7333). Also between trimester II and trimester III with p = 0, 297.

There is a correlation between trimester II and trimester III' with r = 0,5783 and regression line Y = 0,6251X ± 0,3803.

In conclusions, TSH level in non pregnant woman, did not differ to pregnant women trimester II and trimester III. There was no difference between TSH level trimester II; and trimester III.

We suggest to make the same evaluation with more subject included pregnant women in trimester I for getting more acceptable reference range.

Also we suggest to evaluate TSH level in pregnant women who suffer hypo/ hyperthyroidism."

"ABSTRAKKanker kolorektal menempati urutan ketiga terbanyak dari kasus kanker pada laki-lakidan menempati urutan kedua pada wanita di seluruh dunia. Karakteristik enzimatikkanker kolorektal menunjukkan adanya peningkatan enzim M2PK tumor. Penelitian inibertujuan untuk mengevaluasi pemeriksaan M2PK tumor pada feses pasien tersangkakeganasan kolorektal dibandingkan dengan pemeriksaan histopatologi sebagai bakuemas, menggunakan nilai titik potong baru dan nilai titik potong berdasarkan manufaktur.Desain penelitian adalah desain potong lintang dengan penyajian data secara deskriptifanalitik. Subjek penelitian terdiri dari 86 pasien dewasa yang menjalankan kolonoskopi.Pemeriksaan M2PK tumor pada feses dilakukan menggunakan kit ScheBo Tumor M2-PK Stool Test dengan metode ELISA. Proporsi M2PK tumor pada feses pasientersangka kanker kolorektal pada penelitian ini didapatkan sebesar 72,09%. Nilai titikpotong baru untuk pemeriksaan M2PK tumor didapatkan sebesar 14,18 U/ml dengansensitivitas 59,26%, spesifisitas 59,32%, NPP 40,00% dan NPN 76,09%. Hasil ujidiagnostik menggunakan nilai titik potong M2PK berdasarkan manufaktur (≥4 U/ml)didapatkan sensitivitas 92,59%, spesifisitas 37,29%, NPP 40,32%, dan NPN 91,67%.Berdasarkan hasil tersebut, maka pemeriksaan M2PK tumor pada feses dengan nilai titikpotong 4 U/ml dapat digunakan, terutama sebagai uji penapisan (screening) kankerkolorektal, sedangkan pemeriksaan M2PK sebagai uji diagnostik kanker kolorektal masihmembutuhkan penelitian lebih lanjut."

"Latar Belakang: Infeksi Helicobacter pylori merupakan infeksi kronis bakterial yang berhubungan dengan penyakit gastroduodenal. Berdasarkan konsensus Bangkok, pemeriksaan diagnostik infeksi H.pylori hendaknya dilakukan pada semua pasien dispepsia kronis. Urea breath test (UBT) merupakan pemeriksaan referens non-invasif dengan biaya cukup mahal. Rapid test antigen feses merupakan pemeriksaan yang praktis dengan biaya lebih terjangkau. Penelitian ini bertujuan mengevaluasi peran diagnostik rapid test antigen H.pylori dalam feses terhadap UBT pada pasien dispepsia. Metode: Penelitian ini merupakan uji potong lintang terhadap pasien dispepsia di RSUPN Cipto Mangunkusumo selama bulan Agustus-Oktober 2018. Sebanyak 70 subjek diambil secara consecutive sampling dan dilakukan pemeriksaan rapid test SD Bioline H.pylori Ag^® dan Urea [¹³C] Breath Test Kit-Heliforce^®. Hasil: Rerata usia subjek penelitian adalah 46,2 ± 14,23 tahun (18-70 tahun) dan terdapat 17,14% subjek positif terinfeksi H.pylori berdasarkan hasil UBT. Sensitivitas, spesifisitas, nilai prediksi positif, dan nilai prediksi negatif rapid test secara berurutan adalah 41,67%, 100%, 100%, dan 89,23%. Simpulan: Rapid test antigen H.pylori dalam feses memiliki sensitvitas yang kurang baik tetapi memiliki spesifisitas, NPP, dan NPN yang cukup baik; praktis digunakan; dan harganya jauh lebih terjangkau sehingga masih dapat dipertimbangkan untuk digunakan pada daerah dengan keterbatasan ekonomi dan fasilitas.

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Background: Helicobacter pylori infection is a chronic bacterial infection associated with gastroduodenal diseases. Based on the Bangkok consensus, a diagnostic test of H.pylori infection should be carried out in all patients with chronic dyspepsia. Urea breath test (UBT) is a non-invasive reference test with a fairly expensive cost. Stool antigen rapid test is a practical test with a more affordable cost. We aimed to evaluate the diagnostic role of the H.pylori stool antigen rapid test against UBT in dyspeptic patients.

Methods: This was a cross-sectional study of dyspeptic patients at RSUPN Cipto Mangunkusumo during August-October 2018. A total of 70 subjects were taken by consecutive sampling method and tested with rapid test SD Bioline H.pylori Ag^® and Urea [¹³C] Breath Test Kit-Heliforce^®.

Results: The mean age of the subjects was 46.2 ± 14.23 years (18-70 years) and there were 17.14% subjects positively infected with H.pylori based on UBT results. Sensitivity, specificity, positive predictive value, and negative predictive value of the rapid test were 41.67%, 100%, 100%, and 89.23% respectively.

Conclusion: Helicobacter pylori stool antigen rapid test had poor sensitivity but had a good specificity, PPV, and NPV; practical use; and more affordable price so that it could still be considered to be used in areas with economic and facilities limitations."

"ABSTRAKMenurut Jakarta Cancer Registry tahun 2012, kanker kolorektal merupakan kanker terbanyak kedua pada laki-laki dan terbanyak keempat pada perempuan di Indonesia. Pemeriksaan skrining kanker kolorektal yang saat ini tersedia memiliki berbagai keterbatasan. Matrix metalloproteinase-9 (MMP-9) adalah endopeptidase yang berperan dalam degradasi matriks ekstraseluler, dan disekresi oleh berbagai sel seperti sel tumor, sel radang, dan fibroblas. Penelitian ini bertujuan untuk mengetahui peran diagnostik MMP-9 feses dibandingkan dengan gambaran histopatologi sebagai baku emas. Desain penelitian adalah potong lintang. Penelitian dilakukan terhadap 52 subjek terduga kanker kolorektal yang menjalani kolonoskopi. Kadar MMP-9 feses diperiksa menggunakan kit MMP-9 dari R&D Systems dengan metode ELISA. Akurasi diagnostik kadar MMP-9 feses sebesar 0,855. Titik potong kadar MMP-9 feses didapatkan 1,237 ng/ml dengan sensitivitas 88,9%, spesifisitas 76,7%, nilai prediksi positif 44,4%, dan nilai prediksi negatif 97,1%. Pemeriksaan kadar MMP-9 feses dapat dipertimbangkan dalam skrining kanker kolorektal.

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ABSTRACT

According to Jakarta Cancer Registry 2012, colorectal cancer is the second most common cancer in men and fourth in women in Indonesia. Colorectal cancer screening tests currently available, have various limitations. Matrix metalloproteinase-9 (MMP-9) is endopeptidase which plays a role in the degradation of the extracellular matrix, and is secreted by various cells such as tumor cells, inflammatory cells, and fibroblasts. This is a cross sectional study aims to determine the diagnostic role of faecal MMP-9 compared to histopathological features as gold standard. The study was conducted on 52 subjects with suspected colorectal cancers who underwent colonoscopy. The levels of faecal MMP-9 were examined using MMP-9 kit from R&D Systems using ELISA method. Diagnostic accuracy of faecal MMP-9 levels is 0.855. The cutoff point was 1.237 ng/ml with sensitivity of 88.9%, specificity of 76.7%, positive predictive value of 44.4%, and negative predictive value of 97.1%. Faecal MMP-9 can be considered as a screening test in colorectal cancer."

"Rapid swab antigen SARS-CoV-2 merupakan pemeriksaan alternatif dalam mendeteksi SARS-CoV-2. Salah satu faktor yang mempengaruhi pemeriksaan rapid swab antigen SARS-CoV-ialah viral load yang direpresentasikan dengan cycle threshold (CT) pada pemeriksaan rRT-PCR. Hasil CT yang tinggi membuat sensitivitas pemeriksaan rapid swab antigen SARS-CoV-2 rendah. Tujuan utama pada penelitian ialah untuk menentukan nilai CT tertinggi pada pemeriksaan rRT-PCR yang mampu memberikan hasil reaktif pada pemeriksaan COVID-19 Ag (Standard Q SD Biosensor). Penelitian merupakan penelitian observasional dengan metode potong lintang dilakukan pada poliklinik demam RS dr. Cipto Mangunkusumo pada tanggal Juli 2020- Desember 2021. Total subjek dalam penelitian berjumlah 235 terdiri dari 24,7% subjek dengan rRT-PCR SARS-CoV-2 positif dan 75,3% subjek dengan rRT-PCR SARS-CoV-2 negatif. Median CT tertinggi pada pemeriksaan rRT-PCR SARS-CoV-2 yang mampu memberikan hasil reaktif pada pemeriksaan COVID-19 Ag (Standard Q SD Biosensor) ialah 28,22 (13,33- 39,16), sedangkan median CT tertinggi pada COVID-19 Ag (Standard Q SD Biosensor) non-reaktif ialah 34,45 (26,08-39,65). Sensitivitas, spesifisitas, NPV, PPV, dan LR positif dan LR negatif hasil COVID-19 Ag (Standard Q SD Biosensor) pada CT ≤ 40 adalah 63.8%, 99.4%, 89.3%, 97.4%, 112.9, dan 0.4. Pada CT ≤ 33 sensitivitas, spesifisitas, NPV, PPV, dan LR positif dan LR negatif ialah 77.1%, 99.4%, 95.7%, 96.4%, 136.5, dan 0.2 sedangkan pada CT ≤ 25 sensitivitas, spesifisitas, NPV, PPV, dan LR positif dan LR negatif adalah 92.3%, 99.4%, 99.4%, 92.3%, 163.4, dan 0.1. Titik potong CT rRT-PCR SARS-CoV-2 tertinggi ialah 26,06 dengan hasil sensitivitas 100% dan spesifisitas 99,4%. Pemeriksaan COVID-19 Ag (Standard Q SD Biosensor) dapat dipakai untuk keperluan diagnosis, contact tracing atau community surveilance.

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SARS-CoV-2 rapid antigen swab is an alternative test for detecting SARS-CoV-2 infection. One of the factors that influence the examination is viral load, which is represented by the cycle threshold (CT) in the rRT-PCR examination. The higher CT value will result in lower sensitivity of SARS-CoV-2 rapid antigen swab examination. The main objective of the study was to determine the highest CT value in rRT-PCR examination which still able to give reactive results on the COVID-19 Ag test (Standard Q SD Biosensor). The study was a cross-sectional study carried out at the fever polyclinic in dr. Cipto Mangunkusumo Hospital between July 2020 - December 2021. The study consisted of 235 subjects, 24.7% of subjects were SARS-CoV-2 positives and 75.3% of subjects were negative for SARS-CoV-2 infections. Median highest CT value in the SARS-CoV-2 rRT-PCR examination which able to give reactive results on the COVID-19 Ag (Standard Q SD Biosensor) test was 28.22 (13.33-39.16) while the median CT value on the non-reactive COVID-19 Ag (Standard Q SD Biosensor) was 34.45 (26.08-39.65). The sensitivity, specificity, NPV, PPV, and LR positive and LR negative results of COVID-19 Ag (Standard Q SD Biosensor) were 63.8%, 99.4%, 89.3%, 97.4%, 112.9, and 0.4 at CT value ≤ 40. The sensitivity, specificity, NPV, PPV, and LR positive and LR negative at CT value ≤ 33 were 77.1%, 99.4%, 95.7%, 96.4%, 136.5, and 0.2, while at CT ≤ 25 sensitivity, specificity, NPV, PPV, and LR positive and LR negative were 92.3%, 99.4%, 99.4%, 92.3%, 163.4, and 0.1. The cut-off point for the highest CT value was 26.06 with a sensitivity of 100% and a specificity of 99.4%. In conclusion, COVID-19 Ag (Standard Q SD Biosensor) was acceptable for diagnosis, contact tracing or community surveillance."

"Defisiensi besi pada pasien penyakit ginjal kronis dengan hemodialisis (PGK-HD) merupakan penyebab terapi erythropoietin-stimulating agent (ESA) menjadi tidak responsif. Soluble transferrin receptor (sTfR) merupakan marker evaluasi status besi serta respons eritropoiesis yang tidak dipengaruhi inflamasi. Indeks sTfR (rasio sTfR/log feritin) diperkirakan dapat meningkatkan performa sTfR. Tujuan penelitian adalah mengevaluasi performa diagnostik sTfR dan indeks sTfR dalam tatalaksana anemia defisiensi besi pada PGK-HD. Penelitian merupakan studi potong lintang yang melibatkan 127 pasien PGK-HD di Unit Hemodialisis RS Cipto Mangunkusumo pada bulan Agustus-September 2018. Setiap subjek diperiksakan sTfR, indeks sTfR, marker besi, feritin, reticulocyte hemoglobin equivalent (RET-He), serta darah perifer lengkap. Saturasi transferin (TSAT) dan RET-He digunakan sebagai baku emas. Uji diagnostik menggunakan Chi Square dan kurva receiver operating characteristic (ROC). Pada penelitian ini didapatkan titik potong sTfR 2,71 mg/L (sensitivitas 83,3%, spesifisitas 56,5%) dan titik potong indeks sTfR 1,39 (sensitivitas 76,2%, spesifisitas 70,6%). Parameter sTfR dapat bermanfaat sebagai skrining dalam penentuan status besi serta respon eritropoiesis pada pasien PGK-HD. Tata laksana terapi besi yang adekuat akan membuat terapi ESA menjadi efektif, sehingga anemia dapat teratasi, dan kualitas hidup pasien membaik.

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Iron deficiency in patients with chronic kidney disease and hemodialysis (CKD-HD) can cause unresponsiveness to erythropoietin-stimulating agent (ESA). Soluble transferrin receptor (sTfR) is a potential marker to evaluate iron status and erythropoiesis response, that’s not influenced by inflammation. The sTfR index (sTfR/log ferritin ratio) has been proposed could increase the diagnostic efficacy than sTfR alone. We evaluated the diagnostic performance of sTfR and sTfR index for management of iron deficiency in CKD-HD. This cross-sectional study was conducted at Cipto Mangunkusumo Hospital, Indonesia from August-September 2018, involving 127 CKD-HD patients. The sTfR level, sTfR index (sTfR/log ferritin), iron status, ferritin level, reticulocyte hemoglobin equivalent (RET-He), and complete blood count were assessed. Transferrin saturation (TSAT) and RET-He were used as references. Diagnostic tests were analyzed using the chi-square test and receiver operating characteristic curve analysis. We identified sTfR cutoff of 2.71 mg/L (sensitivity 83.3%, specificity 56.5%) and sTfR index cutoff of 1.39 (sensitivity 76.2%, specificity 70.6%). The sTfR might be useful as a screening parameter to evaluate iron status and erythropoietin response in CKD-HD patients. Appropriate iron therapy will make ESA therapy more effective, which will help to overcome anemia, and finally will improve the quality of life of CKD-HD patients.

 

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"ABSTRAKTujuan : Mengetahui hubungan kadar protein S100 pada pasien cedera otak ringan dan sedang yang diukur secara bertahap pada saat pasien tiba di rumah sakit, beberapa jam pasca trauma, dan sekian hari perawatan di rumah sakit, sehingga dapat digunakan sebagai petanda kerusakan otak.Latar belakang : Cedera otak menjadi masalah kesehatan masyarakat di seluruh dunia karena dapat menyebabkan kecacatan dan kematian. Diagnosis cedera otak ditegakkan berdasarkan pemeriksaan klinis neurologi, dan CT scan atau MRI untuk melihat kerusakan anatomi. Pemeriksaan kadar protein S100 pada pasien cedera otak ringan dan sedang dengan menggunakan bahan serum diperlukan untuk mendeteksi dan dapat untuk mengevaluasi adanya kerusakan otak pasca traumatik.Metode : Subyek penelitian adalah orang sehat dan pasien cedera otak ringan dan sedang berdasarkan nilai SKG, pemeriksaan klinis neurologi, dan CT scan, yang diambil darahnya untuk pemeriksaan kadar protein S100 pada saat tiba di rumah sakit, 6 jam pasca trauma, 24 jam pasca trauma, dan hari terakhir perawatan. Pemeriksaan kadar protein S100 dalam serum menggunakan Elecsys S100 dengan prinsip ECLIA.Hasil : Terdapat perbedaan bermakna (p = 0,001) pada semua kadar protein S100 yang diukur saat tiba di rumah sakit, 6 jam pasca trauma, 24 jam pasca trauma, dan hari terakhir perawatan, baik pada pasien cedera ringan maupun sedang. Puncak kadar protein S100 tercapai pada 6 jam pasca trauma pada pasien cedera otak ringan dan sedang. Kadar protein S100 pada pasien cedera otak sedang saat tiba di rumah sakit lebih tinggi secara bermakna dibandingkan pasien cedera otak ringan (median 0,259 μg/L rentang 0,207 – 0,680 μg/L vs median 0,150 μg/L rentang 0,051 – 0,289 μg/L, p = 0,001) dan kadar protein S100 pasien cedera otak ringan saat tiba di rumah sakit lebih tinggi secara bermakna dibandingkan kadar protein S100 orang sehat (median 0,150 μg/L rentang 0,051 – 0,289 μg/L vs rerata 0,065 ± 0,017μg/L, p = 0,001).Kesimpulan : Pada pasien cedera otak ringan dan sedang saat tiba di rumah sakit sudah terdapat peningkatan kadar protein S100 secara bermakna dibandingkan dengan orang sehat. Protein S100 dapat digunakan sebagai petanda untuk deteksi dan evaluasi kerusakan otak pasca traumatik.

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ABSTRACTObjective: To identify the relation of protein S100 level in mild and moderate brain injury patient, which is measured repeatedly at admission, few hours post trauma, and few days of hospitalization, thus it can be used as brain injury biomarker.Background: Brain injury becomes worldwide public health issue since it may cause disability and mortality. The diagnosis of brain injury is made based on clinical neurology examination, and CT scan or MRI, to observe anatomical impairment. Serum S100 protein examination in mild and moderate brain injury patients is needed to detect and evaluate the presence of post traumatic brain injury.Method: This research subject is healthy people and patients with mild and moderate brain injury, based on their GCS grade, clinical neurologic examination, and CT scan. On these patients, the blood for S100 protein examination is taken at admission, 6 hours post trauma, 24 hours post trauma, and last day of hospitalization. Examination of a serum S100 protein is conducted using Elecsys S100 with ECLIA method.Result: There is significant difference (p = 0,001) in mild or moderate brain injury patients in all serum S100 protein which is measured at admission, 6 hours post trauma, 24 hours post trauma, and the last day of hospitalization. The peak level of serum S100 protein reached at 6 hours post trauma. Serum S100 protein in moderate brain injury patients at admission is significantly higher than the mild ones (median 0, 259 μg/L range 0,207 – 0,680 μg/L vs median 0,150 μg/L range 0,051 – 0,289 μg/L, p = 0,001), and serum S100 protein in mild brain injury patients is also significantly higher than healthy people (median 0,150 μg/L range 0,051 – 0,289 μg/L vs mean 0,065 ± 0,017μg/L, p = 0,001).Conclusion: In mild and moderate brain injury patients, serum S100 protein is already significantly increased at admission, compared to healthy people. Serum S100 protein can be used as brain injury biomarker to detect and evaluate the presence of post traumatic brain injury."

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

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

"ABSTRAKPendahuluan : Deteksi Basil Tahan Asam (BTA) Ziehl Neelsen cairan serebrospinal (CSS) di RSUPN dr Cipto Mangunkusumo tahun 2014 tidak pernah positif. Pewarnaan Auramine-O dapat meningkatkan sensitivitas deteksi BTA. Perlu modifikasi sitosentrifugasi pada pulasan BTA, agar dapat deteksi BTA lebih banyak dan cepat.Metode: uji diagnostik pulasan BTA CSS Ziehl Neelsen metode non sitosentrifugasi, Cytospin, Cytopro serta Auramine-O Cytopro dibandingkan dengan baku emas biakan TB MGIT.Hasil: Uji diagnostik BTA Ziehl Neelsen tanpa sitosentrifugasi, tidak dapat dinilai karena BTA tidak terdeteksi di semua sampel. Uji diagnostik Ziehl Neelsen Cytospin dan Cytopro sama yaitu sensitivitas 64%, spesifisitas 85%, NPP 54%, NPN 89 %. Uji diagnostik Auramine-O Cytopro, sensitivitas 91%, spesifisitas 26%, NPP 26%, NPN 91 %.Kesimpulan: Pulasan BTA CSS metode sitosentrifugasi dapat menggantikan metode non sitosentrifugasi. Pulasan BTA CSS Auramine-O dapat me rule out diagnosis meningitis TB.

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ABSTRACT

Introduction: Detection of AFB from CSF with Ziehl Neelsen staining in 2014 at dr Cipto Mangunkusumo general hospital never gives positive result. Staining with Auramine-O smear staining can increase its sensitivity. Acid fast bacilli cytocentrifugation is needed as a modification in AFB slide preparation to gain more bacilli faster.

Methods: Diagnostic perfomance of AFB slide prepared by non cytocentrifugation, Cytospin, Cytopro with Ziehl Neelsen stain, prepared by cytopro with Auramine-O stain are compared to TB MGIT as a gold standard.

Results: Acid fast bacilli slide prepared with non cytocentrifugation method and stained by Ziehl Neelsen cannot be obtained because AFB was not detected in all samples. Acid fast bacilli slide prepared with Cytospin and Cytopro and stained with Ziehl Neelsen has sensitivity (64%), specificity (85%), PPV (54%), 89% NPV. Acid fast bacilli slide prepared with Cytopro and stained with Auramine-O has sensitivity (91%), specificity (26%), PPV (26%), 91 % NPV.

Conclusion: Detection of AFB from CSF with cytocentrifugation method can replace non cytocentrifugation method. Acid fast bacilli slide prepared cytocentrifugation and stained by Auramine-O can rule out Tuberculous meningitis."

"ABSTRAKSecondary iron overload pada thalassemia mayor terjadi karena eritropoiesis inefektif dan tranfusi berkala. Besi melebihi transferin sehingga banyak non transferin bound iron NTBI yang mengkatalisasi terjadinya ion radikal bebas yang merusak jaringan. Pengendapan besi pada saluran cerna mengakibatkan perubahan fungsi, kerusakan organ, gangguan ketersediaan asam amino. Iron overload dikurangi dengan kelasi besi. Transferin merupakan kelator alami tubuh terdiri asam amino dominan alanin, leusin, glisin, asam aspartat. Berdasarkan penelitian, pasien iron overload memiliki transferin lebih rendah dibandingkan non iron overload. Penelitian bertujuan mengetahi perubahan status besi, profil asam amino dan hubungan iron overload dengan profil asam amino. Parameter yang diteliti : besi serum, unsaturated iron binding capacity UIBC , total iron binding capacity TIBC , feritin, saturasi transferin, indeks transferin, alanin, leusin, glisin, asam aspartat. Desain penelitian kohort dengan 21 subjek, yaitu 13 thalassemia beta mayor dan 8 thalassemia beta HbE. Hasil penelitian didapatkan perubahan status besi bermakna yaitu peningkatan feritin pasca transfusi, penurunan feritin pasca kelasi 1 bulan, peningkatan kadar besi pasca kelasi 3 bulan. Perubahan asam amino bermakna yaitu penurunan alanin, leusin, serta peningkatan glisin pasca kelasi 1 bulan Terdapat hubungan kuat, bermakna searah antara indeks transferin dan alanin pre transfusi. Terdapat hubungan kuat, bermakna, searah antara indeks transferin dengan alanin dan glisin pasca transfusi.

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ABSTRACTSecondary iron overload in thalassemia major occurs due to ineffective erythropoiesis and periodic transfusions. The excess of iron exceed transferrin so there are many non transferrin bound iron NTBI that induce tissue damaging free radical ion. Accumulation of iron in intestine can lead to changes in the function, organ damage, lack of amino acid availability. Iron overload can be reduced by iron chelation. Transferrin is the body 39 s natural chelator comprising of dominant amino acid alanine, leucine, glycine, aspartic acid. Research found that transferrin were lower in iron overload patients. This study aims to acquire the changes of iron status, amino acid profile, and correlation between iron overload and amino acid profile. Studied parameter were serum iron, unsaturated iron binding capacity UIBC , total iron binding capacity TIBC , ferritin, transferrin saturation, transferrin index, alanine, leucine, glycine, aspartic acid. The study design were cohort with 21 subjects consisted of 13 beta major thalassemia and 8 beta Hbe thalassemia. The result showed significant iron status changes ferritin increased post transfusion, ferritin decreased after 1 month chelation and serum iron increased after 3 months chelation. Significant amino acid profile changes decreased of alanine and leucine, and glycin increased after 1 month chelation. There rsquo s significant correlation between transferrin index and alanine pre transfusion. There rsquo s significant correlation between transferrin index and alanine, glycine after 3 month chelation. "