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"Latar Belakang: Protein S100B merupakan protein yang berikatan dengan kalsium pada sel-sel astroglial jaringan otak. Peningkatan kadar protein S100B dalam serum disebabkan karena aktivasi kerusakan astrosit dan sel glial, dan kerusakan integritas sawar darah otak. Beberapa studi prospektif terakhir, para ahli menghubungkan protein S100B dengan prediksi keluaran pasien cedera kepala. Tujuan: Mengetahui hubungan kadar Protein S100B 6 jam pasca trauma terhadap skala keluaran GOSE 3 bulan pada penderita CKR dan CKS. Metode: Penelitian ini bersifat deskriptif analitik dengan data dikumpulkan secara prospektif pada pasien cedera kepala ringan dan sedang yang dirawat di UGD RSCM. Hasil: Dari 45 sampel, didapatkan kelompok yang paling banyak adalah laki-laki (65.7%), usia 15-20 tahun (45.7%), tingkatp endidikan SMA (48.6%), CT scan normal (54.3%), kadar protein S100B < 0.403 μg/L (54.3%) dan GOSE >= 7 (71.4%). Terdapat hubungan yang bermakna antara derajat cedera kepala dengan GOSE, CT scan dengan GOSE dan kadar protein S100B dengan GOSE. Kesimpulan: Protein S100B merupakan prediktor yang sensitif terhadap keluaran, dimana pasien dengan protein S100B tinggi memperlihatkan keluaran yang buruk dibandingkan pasien dengan kadar protein S100B rendah.

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Backgrounds: S100B protein is a protein that binds with calcium in brainastroglial cell. The increase in S100B serum level can be caused caused byastrocyte and glial cell damage and disturbance of blood brain barrier. Several prospective studies have elooked into the relationship of S100B protein with headinjury patents outcome.

Aim: To investigate the relationship between S100B protein level 6 hours aftertrauma and the outcome of patients with mild and moderate head injury using GOSE 3 months after trauma.

Method: This is an analytic descriptive study using data collected prospectivelyin mild and moderate head injury patients admitted to the emergency departmentof Cipto Mangunkusumo hospital.

Result: The majority of patients were male 65 7 aged between 15 20 yearsold 45 7 senior high school graduates 48 6 with normal CT scan 54 3 with S100B protein level 0 403 g L 54 3 and with GOSE 7 71 4. There was a significant relationship between the severity of head injury and GOSE CT scan finding and GOSE and S100B protein level and GOSE.

Conclusion: S100B protein level is a sensitive predictor for head injury patientoutcome in which patients with higher S100B protein level correlates with pooreroutcome."

"Latar Belakang. Cedera kepala merupakan salah satu masalah kesehatan masyarakat yang serius yang dapat menyebabkan kematian, kecacatan fisik dan kecacatan mental. Cedera kepala dapat menyebabkan sel astrosit rusak sehingga mengeluarkan protein S 100B yang dapat dideteksi didalam darah perifer, sehingga dapat dipakai untuk memprediksi tingkat keparahan cedera kepala yang terjadi. Penelitian ini bertujuan untuk mencari hubungan antara kadar protein S 100B dengan tingkat keparahan cedera kepala. Metode. Desain penelitian adalah potong lintang untuk mengetahui kadar protein S 100B pada pasien cedera kepala akut onset kurang dari 24 jam. Subyek penelitian sejumlah 85 pasien yang datang berobat ke Instalasi Gawat Darurat RSCM sejak bulan maret ? juni 2015. Dilakukan penilaian GCS, lamanya tidak sadarkan diri, lamanya amnesia pasca trauma dengan bantuan alat TOAG, pemeriksaan CT Scan dan pemeriksaan serum protein S 100B. Hasil. Didapatkan kadar rerata protein S 100B serum 0,77 μg/L, rerata durasi amnesia 21,22 jam, rerata nilai GCS 13. Terdapat perbedaan kadar protein S 100B pada CKR (rerata 0,4175) dibandingkan dengan pada CKS dan CKB (1,0722) (p=0,020), nilai titik potong kadar protein S 100B pasien yang meninggal 0,765 μg/L (p= 0,002). Simpulan. Kadar rerata protein S 100B pada cedera kepala ringan lebih rendah dibandingkan dengan kadar protein S 100B pada cedera kepala sedang dan berat, semakin tinggi kadar protein S 100B akan semakin tidak baik keluaran pasien cedera kepala.

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Background. Traumatic brain injury is still a serious community health problem can cause death, physical and mental disability. Protein S 100B release from destructive astrocyte from brain injury and detected in the peripheral blood, so that protein S 100B can serve as predictor of severity traumatic brain injury. This research aimed to find association between protein S 100B with traumatic brain injury severity.

Method. This was a cross sectional study focusing to protein S 100B value from acute traumatic brain injury patients with onset < 24 hours. Eighty five patients were recruited from emergency room RSCM. GCS value, duration of post traumatic amnesia with TOAG tools, duration loss of consciousness, brain CT scan and concentration serum protein S 100B were record.

Results. The mean concentration serum Protein S 100B were 0.77, mean PTA duration were 21,22 hours, and the mean GCS were 13. There is a significant differentiation value of concentration protein S 100B from mild trumatic brain injury compare moderate and severe traumatic brain injury (p=0,020), cut off point for death patients was 0,765 μg/L.

Conclusion. The mean serum Protein S 100 B from mild trumatic brain injury lower than moderate and severe traumatic brain injury higher consentration of protein S 100B have bad outcome."

"Proses inflamasi pada kanker kepala dan leher menyebabkan peningkatan sitokin proinflamasi dan sintesis protein fase akut c-reactive protein, CRP yang kemudian menyebabkan perubahan metabolisme dan anoreksia pada penderitanya. Seng merupakan zat gizi yang memiliki peran penting dalam menekan inflamasi, namun dilaporkan sekitar 65 pasien kanker kepala dan leher mengalami kekurangan seng. Penelitian potong lintang ini bertujuan mengetahui korelasi antara asupan seng dan kadar seng serum dengan kadar c-reactive protein CRP sebagai upaya menekan inflamasi sehingga dapat mengurangi morbiditas dan mortalitas pasien kanker kepala leher. Dari 49 subyek yang dikumpulkan secara konsekutif di Poliklinik Onkologi RS Kanker Dharmais, 67,3 adalah laki-laki, rentang usia subyek 46 ndash;65 tahun. Frekuensi terbanyak 65,3 adalah kanker nasofaring dan 69,4 berada pada stadium IV. Seratus persen subyek memiliki asupan seng dibawah nilai angka kecukupan gizi. Rerata kadar seng serum subyek adalah 9,83 2,62 mol/L. Sebanyak 51 subyek memiliki kadar CRP yang meningkat. Terdapat korelasi negatif yang lemah antara kadar seng dengan kadar CRP subyek r =-0,292, p =0,042, namun tidak terdapat korelasi antara asupan seng dengan kadar CRP subyek p =0,86.

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The inflammatory process of head and neck cancer leads to increase the proinflammatory cytokines and the synthesis of c reactive protein CRP , which then causes metabolic alteration and anorexia in the patients. Zinc is one of nutrient that has an important role in suppressing inflammation. It is reported that about 65 of head and neck cancer patients have zinc deficiency. The aim of this cross sectional study is to determine the correlation between zinc intake and serum zinc levels with CRP level as an effort to reduce inflammation to reduce the morbidity and mortality of head and neck cancer patients. Subjects were collected by consecutive sampling in the Oncology Polyclinic Dharmais Cancer Hospital, from 49 subjects 67,3 were men, most subjects were in the age range between 46 ndash 65 years. The highest frequency 65,3 is nasopharyngeal cancer and 69,4 are already in stage IV. All subjects in this study have a zinc intake below the recommended dietary allowance RDA in Indonesia. The mean serum zinc level of the subjects was 9.83 2.62 mol L. Most subjects have elevated CRP levels. There was a weak significant negative correlation between zinc concentration and CRP levels of subjects r 0.292, p 0.042, but there was no correlation between zinc intake and CRP levels of subjects p 0.86. "

"Latar Belakang: Cedera kepala dikaitkan dengan aktivasi kaskade koagulasi dapat menyebabkan koagulopati. Hal ini berhubungan dengan hasil akhir atau keluaran yang tidak baik pada pasien. Deteksi dini dan evaluasi berkala faktor hemostasis dibutuhkan pada pengelolaan pasien cedera kepala sedang dan berat dalam memperbaiki hasil keluaran perawatan pasien cedera kepala.Tujuan: Diketahuinya angka kejadian prevalensi koagulopati pada pasien cedera kepala sedang berat dan hubungan gangguan hemostasis tersebut dengan hasil keluarannya.Metode Penelitian: Penelitian ini merupakan studi ?nested case control?. Studi ini bersarang pada penelitian awal yang berupa studi komparasi potong lintang. Data hemostasis diperiksa pada hari pertama(<24 jam dari kejadian) saat di Instalasi Gawat Darurat(IGD) RSCM. Pasien cedera kepala sedang dan berat ini nantinya akan diikuti sampai akhir perawatan inap dan dinilai hasil keluaran perawatannya. Koagulopati adalah gangguan status koagulasi, dapat berupa hiperkoagulasi atau hipokoagulasiHasil: Terdapat 76 sampel, 38 sampel memiliki keluaran baik dan 38 sampel memiliki keluaran buruk. Pria(81,6%) lebih banyak dari wanita. Sebagian besar subjek berusia 18-50 tahun(81,6%). Koagulopati terjadi pada 34,2% pasien. Koagulopati merupakan faktor prediksi keluaran buruk pada cedera kepala (OR 4,429; 95%IK 1,569 ? 12,502; p=0,004). Hasil analisis multivariat menunjukkan urutan prioritas kemaknaan faktor yang mempengaruhi keluaran subjek cedera kepala yang terkuat berturut-turut di penelitian ini adalah usia (50,271), derajat cedera kepala (46,522), dan koagulopati (5,409). Terdapat hubungan bermakna antara beratnya derajat cedera kepala dengan terjadinya koagulopati p= 0,009.Kesimpulan: Prevalensi koagulopati pada cedera kepala sedang berat cukup tinggi. Pasien dengan koagulopati memiliki keluaran yang lebih buruk

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Background: Brain injury is associated with activation of the coagulation cascade, contributing to coagulopathy. This condition is correlated with unfavorable outcome. Early detection and evaluation of hemostatic factors are needed in treatment of moderate-severe traumatic brain injury (TBI) to improve patient outcome.

Objectives: To determined the number of prevelence coagulopathy in moderate severe TBI and the relationship of the hemostatic disorder with outcome.

Materials and Method: We did the nested case control study. Hemostatic parameters were recorded from emergency departement (ED) not exceeding 24 hours from onset of accident. Moderate-severe TBI patients were followed until the patients discharged and we assessed the outcome. Coagulopathy was defined as hypocoagulopathy or hypercoagulopathy.

Results: From 76 subjects, 38 subjects were favorable outcome and 38 subjects had unfavorable outcome. Men were higher than women (81,6%), mostly subjects were in range 18-50 years(81,6%). Coagulopathy occured in 36% of all patients. Coagulopathy was the predictor of unfavorable outcome for TBI (OR 4,429; 95%CI 1,569 ? 12,502; p=0,004). From the multivariate analysis, the priority level for TBI outcome, in order of strongest to weakest correlation, were age (50,271), severity of traumatic brain injury(46,522) and coagulopathy(5,409). There was significant correlation between severity of traumatic brain injury and coagulopathy (p= 0,009).

Conclusions: Our study confirmed a quite high prevalence of coagulopathy in patients with moderate-severe TBI. Patients with coagulopathy had poorer outcome compared to non-coagulopathy"

"Latar Belakang. Obesitas merupakan faktor risiko luaran buruk pada pasien COVID-19. Sampai saat ini studi penilaian hubungan parameter obesitas berupa nilai lemak viseral, lingkar pinggang (LP), indeks massa tubuh (IMT), dan persentase lemak tubuh secara bersamaan dengan luaran COVID-19 menggunakan metode sederhana berupa bioimpedance analyzer (BIA) masih terbatas. Keempat variabel tersebut akan dinilai kemampuannya untuk memprediksi luaran buruk selama perawatan pasien COVID-19.Metode. Penelitian ini merupakan kohort prospektif dari 261 pasien COVID-19 ringan-sedang di RSUPN Cipto Mangunkusumo rawat inap sejak Desember 2020 hingga Maret 2021. Pasien dilakukan pemeriksaan BIA, LP, dan IMT saat admisi. Dilakukan analisis multivariat regresi logistik untuk menilai kemampuan nilai lemak viseral, persentase massa tubuh, IMT dan LP untuk memprediksi luaran buruk komposit yang mencakup ARDS dan mortalitas.Hasil. Didapatkan median nilai lemak viseral 10 (setara 100 cm2 ), lingkar pinggang 93 cm, IMT 26,1 kg/m2 , dan persentase lemak tubuh 31,5%. Berdasarkan multivariat regresi logistik, lingkar pinggang secara statistik bermakna sebagai faktor yang berpengaruh terhadap luaran buruk pada pasien COVID-19 [RR 1,04 (IK 95% 1,01-1,08)] bersama dengan derajat COVID-19 [RR 4,3 (IK 95% 1,9- 9,9)], skor NEWS [RR 5,8 (IK 95% 1,1-31)] saat admisi, dan komorbiditas [RR 2,7 (IK 95% 1,1-6,3)].Kesimpulan. Luaran buruk COVID-19 selama perawatan pasien COVID-19 terkonfirmasi dapat dipengaruhi oleh lingkar pinggang.

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Background. Obesity is a risk factor for adverse outcomes in COVID-19 patients. Until now, studies on assessing the relationship between obesity parameters in the form of visceral fat, waist circumference (WC), body mass index (BMI), and body fat percentage simultaneously with COVID-19 outcomes using a simple method such as bioimpedance analyzer (BIA) are still limited. The four variables will be assessed for their ability to predict adverse outcomes during the treatment of COVID-19 patients.

Method. This study is a prospective cohort of 261 mild-moderate COVID-19 subjects at Cipto Mangunkusumo General Hospital who were hospitalized from December 2020 to March 2021. Patients underwent BIA, WC, and BMI examinations upon admission. Multivariate logistic regression analysis was performed to assess the ability of visceral fat, body mass percentage, BMI, and WC to predict poor composite outcomes, including ARDS and mortality.

Results. The median value of visceral fat was 10 (equivalent to 100 cm2 ), WC was 93 cm, BMI was 26.1 kg/m2 , and body fat percentage was 31.5%. Based on multivariate logistic regression, WC was statistically significant as a factor influencing poor outcomes in COVID-19 patients [RR 1.04 (95% CI 1.01-1.08)] along with COVID-19 degree of severity [RR 4.3 (95% CI 1.9-9.9)], NEWS score [RR 5.8 (95% CI 1.1-31)] at admission, and comorbidities [RR 2.7 (95% CI 1.1) - 6.3)].

Conclusion. During the hospitalization of confirmed COVID-19 patients, poor outcomes can be affected by waist circumference."

"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."

"Tujuan penelitian ini adalah untuk mengetahui korelasi antara penilaian risiko malnutrisi menggunakan skor PG-SGA dengan kadar CRP serum sehingga dapat digunakan untuk memprediksi tingkat inflamasi pada pasien kanker kepala dan leher stadium I_IV guna mencegah terjadinya kaheksia. Malnutrisi hingga kaheksia pada kanker terjadi karena interaksi faktor tumor, faktor pejamu dan faktor-faktor lainnya. Faktor tumor berupa sitokin pro-inflamasi akan memicu respons pejamu untuk memproduksi protein fase akut seperti CRP. Protein fase akut memerlukan sejumlah substrat yaitu asam amino yang berasal dari otot rangka. Otot rangka akan mengalami degradasi sehingga menyebabkan wasting otot rangka. Oleh karena itu, CRP selain dapat digunakan sebagai marker inflamasi sistemik juga dapat digunakan sebagai salah satu indikator faktor risiko yang berperan dalam terjadinya malnutrisi dan kaheksia. Efek wasting otot rangka yang ditimbulkan secara tidak langsung oleh CRP dapat dinilai dengan terdapatnya penurunan BB maupun berkurangnya massa otot yang juga merupakan komponen dalam penilaian PG-SGA. Penelitian ini merupakan studi potong lintang dengan menggunakan consecutive sampling yang melibatkan 51 subjek kanker kepala dan leher stadium I_IV yang belum mendapatkan terapi. Hasil penelitian didapatkan rerata usia 46,6 13,9 tahun, sebanyak 76,5 berjenis kelamin laki-laki. Kanker nasofaring merupakan kanker terbanyak 80,4 , dan stadium terbanyak yaitu stadium IVA. Rerata indeks massa tubuh IMT yaitu 20,6 4,0 kg/m2, dan sebanyak 37,3 subjek berada pada IMT normal. Berdasarkan skor PG-SGA sebanyak 64,7 subjek berisiko tinggi malnutrisi dengan rerata skor PG-SGA 11,7 6,2. Nilai median CRP yaitu 6,4 0,4_170,4 . Penelitian ini memperoleh korelasi positif yang signifikan antara skor PG-SGA dengan kadar CRP serum dengan kekuatan korelasi lemah r = 0,372; p = 0,007.

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The purpose of this study was to determine the correlation between the malnutrition risk assessment using PG SGA score with serum CRP levels so that it can be used to predict the levels of inflammation in head and neck cancer patients stage I IV to prevent cachexia. Malnutrition and cancer cachexia occurs due to the interaction of tumor factors, host factors and other factors. Tumor factors such as pro inflammatory cytokines will trigger a response of the host to produce acute phase proteins such as CRP. Acute phase protein which require a number of amino acids derived from skeletal muscle. Skeletal muscles will be degraded, causing skeletal muscle wasting. Therefore, CRP can be used as a marker of systemic inflammation and can be used as one indicator of the risk factors also that contribute to malnutrition and cachexia. Effect of skeletal muscle wasting which caused indirectly by the CRP can be assessed by the weight loss and reduced muscle mass which is a component in the assessment of PG SGA also. This study is a cross sectional study using consecutive sampling, 51 subjects head and neck cancer stage I IV who had not received treatment participated in this study. Data showed the mean age of subjects was 46.6 13,9 years, and 76 were male. Most cancer sites were as nasopharyngeal 80,4, and mostly in stage IVA. The mean body mass index BMI is 20,6 40 kg m2, with most of the BMI is normal 37,3. Based on PG SGA score 64,7 of the subjects at high risk of malnutrition, and the PG SGA mean score is 11,7 6,2. The median value of CRP is 6,4 0,4 170,4. The result of this study showed a significant positive correlation between PG SGA score with serum CRP levels with the strength of correlation is weak r 0,372 p 0,007. "

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

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

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

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

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

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

"Latar Belakang: Acute Kidney Injury pada COVID-19 merupakan komplikasi penting dan dikaitkan dengan peningkatan risiko kematian diduga diperantarai kondisi inflamasi dan disregulasi imun, baik di awal maupun selama perawatan. Tujuan: Untuk mengetahui hubungan antara IL-6, IL-10, TNF-" dengan AKI dan memprediksi perburukan hematuria, dan kejadian AKI Metode: Studi potong lintang dan prospektif kohort melibatkan 43 pasien COVID-19 derajad sedang dan berat yang dirawat di Rumah Sakit Pertamina Pusat di Jakarta, Indonesia dari bulan November 2020 hingga Januari 2021. Selama observasi dilakukan pemeriksaan darah lengkap, serum kreatinin, urinalisis, kadar IL-6, IL-10, TNF-" pada hari pertama dan hari ketujuh pengobatan atau sebelum hari ketujuh jika pasien meninggal atau dipulangkan, dan perubahannya di analisis. Insiden AKI ditentukan ketika perubahan serum kreatinin dan urin output memenuhi kriteria pedoman Kidney Disease Improving Global Outcomes. Uji korelasi dilakukan terhadap peningkatan sitokin dengan perubahan hematuria dan kreatinin. Uji Wilcoxon dilakukan untuk mengetahui perbedaan kadar sitokin diantara status albuminuria. Selanjutnya dilakukan uji Receiver Operator Characteristic untuk melihat kemampuan prediksi IL-6, IL-10, TNF-" terhadap perburukan hematuria dan kejadian AKI, menggunakan AUC minimal 0,7 dengan batas bawah IK 95% lebih dari 0,5 dan nilai p <0,05 Hasil: Terdapat korelasi antara peningkatan kadar serum IL-10 dengan perubahan serum kreatinin (r= -0,343; p 0,024) tetapi tidak pada perubahan IL-6 dan TNF-a. Perubahan hematuria tidak berkorelasi dengan peningkatan ketiga kadar sitokin. Juga tidak ada perbedaan dalam kadar sitokin di antara kelompok albuminuria. Kadar serum TNF-" dihari pertama perawatan dapat memprediksi AKI pada hari ke tujuh, AUC 85%; p=0,045 (IK 0,737-0,963), tetapi tidak dapat memprediksi perburukan hematuria Kesimpulan: Terdapat korelasi antara peningkatan IL-10 dengan perubahan serum kreatinin. TNF-! pada hari pertama perawatan dapat memprediksi kejadian AKI di hari ketujuh perawatan pasien COVID-19 derajat sedang dan berat.

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Background: Acute Kidney Injury is an important complication and is associated with increased risk of death in COVID-19 due to inflammatory conditions and immune dysregulation, both at the beginning and during treatment. Aim: To determine the relationship between IL-6, IL-10, TNF-α with AKI and their ability to predict the worsening of hematuria, and the incidence of AKI. Methods: 43 moderate and severe COVID-19 patients treated from November 2020 to January 2021 at Pertamina Central Hospital in Jakarta, Indonesia were included in this cross-sectional and prospective cohort study. During observation, tests including complete blood count, serum creatinine, urinalysis, levels of IL-6, IL-10 and TNF-α were performed on the first and seventh day of treatment, or before day 7 if the patient died or was discharged, and the changes were analyzed. The incidence of AKI is determined when changes in serum creatinine and urine output meet the criteria in the Kidney Disease Improving Global Outcomes guidelines. Correlation test was performed on increased cytokines with changes in hematuria and creatinine. Wilcoxon test was performed to obtain differences in cytokine levels among albuminuria status. Receiver Operator Characteristic test was then carried out to see the predictive ability of IL-6, IL-10, TNF- α on the worsening of hematuria and the incidence of AKI. Results: There was a correlation between increased serum IL-10 levels with changes in serum creatinine (r= -0.343; p 0.024), but not in IL-6 and TNF-a levels. On the other hand, changes in hematuria did not correlate with an increase in the levels of the three cytokines. There was also no significant difference in the levels of cytokines among albuminuria groups. Serum TNF-! levels on the first day of treatment were able to predict AKI on the seventh day (AUC 85%; p=0.045; 95%CI 0.737-0.963), but did not predict the worsening of hematuria. Conclusion: There was a correlation between increased serum IL-10 with changes in serum creatinine. TNF-! on the first day of treatment can predict the incidence of AKI on the seventh day of treatment for moderate and severe COVID-19 patients."

"ABSTRAKLatar Belakang: Pasien cedera kepala sedang (CKS) dan cedera kepala berat (CKB) memerlukan perawatan di rumah sakit sehingga beresiko terkena infeksi nosokomial seperti pneumonia yang dapat memperburuk keluaran. Karena banyaknya faktor yang dapat mempengaruhi keluaran pasien cedera kepala dengan pneumonia, diperlukan suatu sistem skoring untuk menilai derajat keparahan pneumonia.Tujuan: Untuk mengetahui apakah sistem skoring CURB-65 dapat dipakai untuk memprediksi keluaran pasien CKS dan CKB yang mengalami pneumonia.Metode: Penelitian ini merupakan studi prospektif. Subjek penelitian adalah seluruh pasien CKS dan CKB yang dirawat di Rumah Sakit Cipto Mangunkusumo (RSCM) Jakarta selama periode penelitian. Diagnosis pneumonia ditegakkan sesuai kriteria The Center for Disease Control (CDC). Penilaian derajat keparahan pneumonia dilakukan dengan skoring CURB-65. Keluaran yang dinilai adalah hidup atau meninggal.Hasil: Dari 176 pasien CKS dan CKB, terdapat 26 pasien yang menderita pneumonia. Rentang usia subjek penelitian adalah 15 - 71 tahun. Sebagian besar berjenis kelamin laki-laki dan berusia < 65 tahun. Nilai maksimal dari CURB-65 pada penelitian ini adalah 3. Sedangkan nilai yang terbanyak adalah 2. Nilai CURB-65 ditemukan tidak bermakna sebagai prediktor keluaran pasca cedera kepala. Keluaran pasien cenderung dipengaruhi variabel usia, penurunan kesadaran, peningkatan kadar BUN, dan peningkatan frekuensi napas. Diantara 5 pasien yang meninggal, ada 2 pasien yang memiliki nilai CURB-65 = 3, sehingga tampak adanya kecenderungan peningkatan mortalitas pada pasien-pasien dengan nilai CURB-65 = 3.Kesimpulan: Walaupun skoring CURB-65 tidak bermakna sebagai prediktor keluaran pada pasien CKS dan CKB dengan pneumonia, penelitian pendahuluan ini menemukan adanya kecenderungan pengaruh masing-masing komponen CURB-65 (penurunan kesadaran, frekuensi napas, kadar BUN, serta usia) terhadap resiko kematian pasien

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ABSTRACTBackground: Patients with moderate and severe traumatic brain injury (TBI) require hospitalization, therefore they have higher risk in developing nosocomial infections such as pneumonia which can worsen their outcomes. Since there are many factors that can affect outcome of head-injured patients with pneumonia, a scoring system for evaluating the severity of pneumonia is needed.Objective: To know whether the CURB-65 scoring system can be used to predict the outcome of moderate and severe TBI patients who developed pneumonia during hospitalization.Methods: This was a prospective study. The study subjects were all moderate and severe TBI patients who had been hospitalized in Cipto Mangunkusumo Hospital during the research period. Diagnosis of pneumonia was confirmed if the patient fulfiled the criteria from The Center for Disease Control (CDC). The severity of pneumonia was determined by using CURB-65 scoring system. The outcome would either be dead or alive.Results: Of 176 patients with moderate and severe TBI, there were 26 patients who developed pneumonia. The age of the subjects ranged between 15 to 71 years. Most of them were male and over the age of 65. The maximum score of CURB-65 was 3. The mode of CURB-65 score was 2. CURB-65 was shown to be not useful in predicting outcome of head-injured patients with pneumonia. The outcome was seemingly associated with age, loss of consciousness, BUN, and respiratory rate. Among 5 patients who were dead, there were 2 patients who had a CURB-65 score of 3, thus there was a trend of increasing mortality in patients with a CURB-65 score of 3.Conclusions: Although the CURB-65 scoring system was not found to be useful in predicting outcome of moderate and severe TBI patients, this preliminary study have found that there were a tendency that each component of CURB-65 (loss of consciousness, respiratory rate, BUN, age) have some effects on mortality. "