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"Leukemia merupakan keganasan utama pada anak dan merupakan penyebab utama kematian karena kanker pada anak. Penelitian yang dilakukan di RSUPNCM melaporkan leukemia merupakan jenis keganasan paling sering yaitu 30-40% dari seluruh keganasan pada anak. Pemeriksaan sitologi cairan otak merupakan baku emas dalam menegakkan diagnosis leukemia meningeal, akan tetapi sensitivitasnya hanya 71%. Oleh sebab itu dicari metode yang lebih baik untuk menilai keterlibatan SSP pada leukemia akut yang tidak mahal dan memiliki sensitivitas baik. Sel blas dijumpai pada 8 (9,6%) dari 83 cairan otak yang berasal dari 58 pasien anak dengan L. CV pemeriksaan protein dengan pyrogallol red berkisar antara 2,5% sampai 7,5%. Difference (%) pemeriksaan protein dengan pyrogallol red adalah (-17,6 - 5,01%). Pemeriksaan protein dengan pyrogallol red dan asam sulfosalisilat 3% memberikan korelasi positif derajat sedang dengan r=0,52. Nilai median protein menggunakan pyrogallol red pada cairan otak dengan sel blas positif dan negatif adalah 23 mg/dL dan 15 mg/dL. Nilai rerata kadar beta 2 mikroglobulin cairan otak dengan sel blas positif dan negatif adalah 1,13 mg/L dan 0,95 mg/L. Jumlah leukosit cairan otak dengan sel blas positif dan negatif adalah 20 dan 10/μL. Pemeriksaan protein dengan pyrogallol red dan asam sulfosalisilat 3% memberikan korelasi positif derajat sedang. Ketelitian dan ketepatan pemeriksaan protein dengan metode ikat zat warna menggunakan reagen pyrogallol red cukup baik. Ketelitian pemeriksaan protein dengan metode turbidimetri dengan asam sulfosalisilat 3% cukup baik, sedangkan ketepatannya kurang baik. Kadar protein, kadar β2 mikroglobulin, dan jumlah leukosit pada cairan otak dengan sel blas mempunyai median atau rerata lebih tinggi dibanding cairan otak tanpa sel blas.

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Leukemia is the major cause of children malignancy and most common cause of death in children cancer. Studies conducted in Ciptomangunkusumo Hospital reported it as the most frequent malignancy in children, contributing 30-40% of all malignancies. Cytology of cerebrospinal fluid (CSF) is the gold standard for meningeal leukemia diagnosis, but its sensitivity was only 71%. Therefore, it is necessary to find a more sensitive and cheaper method to evaluate central nervous system involvement in acute leukemia.

Blasts were found in 8 of 83 CSF from 58 children with acute lymphoblastic leukemia. Protein examination with pyrogallol red had a CV of 2,5-7,5%. Difference (d) was -(17,6)-5,01% for pyrogallol red. Protein examination with 3% sulfosalicylic acid and pyrogallol red showed a positive moderate correlation (r = 0,52). Protein levels determined with pyrogallol red had a median of 23 mg/dL and 15 mg/dL. Mean β2 microglobulin levels in blast positive CSF and blast negative CSF were 1,13 mg/L and 0,95 mg/L respectively. Leukocyte count was 20 cells/μL for blast positive CSF and 10 cells/μL for blast negative CSF.

Protein tests using 3% sulfosalicylic acid and pyrogallol red had a moderate positive correlation. The one using pyrogallol red had good precision and accuracy. Precision of protein test using 3% sulfosalicylic acid was good, but the accuracy was not as good as pyrogallol red. Protein, β2 microglobulin level, and leukocyte count on blast positive CSF had a higher median or mean than blast negative CSF."

"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."

"Cacingan merupakan penyakit menular yang menjadi masalah kesehatan masyarakat di dunia dan paling sering disebabkan oleh spesies Ascaris lumbricoides, Trichuris trichiura, dan cacing tambang (Ancylostoma duodenale dan Necator americanus). Cacingan dapat menyebabkan diare, anemia defisiensi besi (ADB), malnutrisi, dan berbagai gejala usus lainnya. ADB pada infeksi A. lumbricoides dan T. trichiura karena cacing menyerap zat gizi yang berperan pada pembentukan Hb, sedangkan pada infeksi cacing tambang akibat perdarahan kronik di saluran cerna. Defisiensi besi dapat terjadi tanpa adanya anemia. Penelitian ini bertujuan untuk mendapatkan data proporsi cacingan, profil hematologi , dan profil zat besi pada anak yang terinfeksi cacing usus di SD Panimbang Jaya, Pandeglang. Diperoleh 205 subjek penelitian yang memiliki data hematologi, profil besi, dan telur cacing. Proporsi cacingan di Pandeglang adalah 44,4% yang didominasi oleh infeksi cacing intensitas ringan (79,1%). Spesies cacing yang menginfeksi adalah A. lumbricoides, T. trichiura dan campuran keduanya. Didapatkan perbedaan bermakna kadar Hb (p = 0,001), RDW-CV (p = 0,038), retikulosit absolut (p = 0,002), retikulosit relatif (p = 0,007), dan feritin (p= <0,001) antara kelompok subjek yang terinfeksi cacing usus dan tidak terinfeksi. Didapatkan perbedaan bermakna kadar feritin (p = 0,018) dan TIBC (p = 0,001) antara subjek yang terinfeksi cacing intensitas ringan dan sedang. Didapatkan indeks Mentzer >13 pada kelompok subjek yang terinfeksi cacing usus dan tidak terinfeksi

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Soil-Transmitted Helminth (STH) infection is a public health problem in the world and most often caused by species of Ascaris lumbricoides, Trichuris trichiura, and hookworms (Ancylostoma duodenale and Necator americanus). STH infection can cause diarrhea, iron deficiency anemia (IDA), malnutrition, and various intestinal symptoms. IDA in A. lumbricoides and T. trichiura infections caused by absorption of nutrients that play a role in the formation of Hb, while in hookworm infections is due to chronic bleeding in the gastrointestinal tract. Iron deficiency can occur in the absence of anemia. This study aims to obtain the proportion of STH infection, hematological profiles, and iron profiles in children infected by STH at SD Panimbang Jaya, Pandeglang. Two hundred and five research subjects had data on hematology, iron profile and worm eggs. The proportion of STH infection in Pandeglang was 44.4% which was dominated by mild intensity STH infection (79.1%). The species of STH that infect are A. lumbricoides, T. trichiura and a mixture of both. There were significant differences in the levels of Hb (p = 0.001), RDW-CV (p = 0.038), absolute reticulocytes (p = 0.002), relative reticulocytes (p = 0.007), and ferritin (p = <0.001) between STH infected and not infected group. There was a difference in ferritin levels (p = 0.018) and TIBC levels (p = 0,001) between mild and moderate STH-infected subjects. Mentzer index was >13 in both groups of subjects infected with STH and not infected."

"Defisiensi besi merupakan defisiensi nutrisi terbanyak di seluruh dunia, dengan prevalensi tertinggi pada kelompok perempuan usia reproduksi. Di Indonesia prevalensi anemia defisiensi besi pada ibu hamil 50,5%. Penting dilakukan penapisan dini sebelum terjadi anemia defisiensi besi, untuk mencegah komplikasi sistemik yang permanen, pada ibu maupun janin. Saat ini telah dikembangkan parameter ekuivalen hemoglobin retikulosit (RET-He) yang mendeteksi kadar hemoglobin dalam retikulosit. Usia retikulosit di sirkulasi hanya 24-48 jam, maka RET-He lebih menggambarkan keadaan sebenarnya dari status besi pada sumsum tulang. Saat besi di sumsum tulang menurun, RET-He akan mengalami penurunan. Pemeriksaan RET-He dilakukan pada alat hitung sel darah otomatis dan tidak memerlukan tabung darah tambahan karena dilaporkan sebagai bagian dari hitung retikulosit. Penelitian ini bertujuan untuk mendapatkan rentang nilai RET-He pada perempuan usia reproduksi, melakukan penapisan defisiensi besi pada perempuan hamil trimester I dan II menggunakan RET-He dan membandingkannya hemoglobin, feritin, dan saturasi transferin. Juga untuk mendapatkan titik potong RET-He dengan sensitivitas dan spesifisitas yang optimal pada perempuan hamil trimester I dan II. Didapatkan rentang nilai RET-He pada perempuan usia reproduksi 30,69-36,17 pg. Didapatkan 100 perempuan hamil trimester I dan II yang terdiri dari 3 kelompok berdasarkan feritin dan saturasi transferin yaitu 67 (67%) subyek tanpa defisiensi besi, 17 (17%) subyek dengan defisiensi besi tahap I, dan 16 (16%) subyek dengan defisiensi besi tahap II. Rerata ± SD kadar hemoglobin, RET-He, dan saturasi transferin adalah 12,35 ± 1,02 g/dL, 33,60 ± 1,88 pg, dan 28,63 ± 1,07%. Median(min-maks) feritin adalah 40,10 (6,24 ± 191,30) ng/mL. Dari kurva ROC untuk menentukan titik potong nilai RET-He yang memberikan sensitivitas dan spesifisitas terbaik dibandingkan dengan feritin sebagai baku emas, didapatkan RET-He dengan titik potong 33,65 pg pada sensitivitas 67% dan spesifisitas 64,18% dan area under the curve (AUC) 66,4%, serta didapatkan PPV 47,8%, NPV 79,6%, LR positif 1,86 dan LR negatif 0,52. Ditemukan perbedaan bermakna kadar RET-He antara kelompok tanpa defisiensi besi dan kelompok defisiensi besi tahap II dan antara kelompok defisiensi besi tahap I dan tahap II. Tidak terdapat perbedaan bermakna antara kelompok tanpa defisiensi besi dan kelompok defisiensi besi tahap I.

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Iron deficiency is the most common nutrient deficiency in the world, on developing and industrial countries. Population with highest risk of iron deficiencies is women in reproductive ages. In Indonesia the prevalence of iron deficiency anemia in pregnant women is 50,5%. Iron deficiency anemia in pregnancy can affect to both mother and fetus. In order to prevent permanent systemic complications, it is important to do early detection before iron deficiency anemia developed.

On early phase of iron deficiency before anemia developed, we need an additional test of ferritin, serum iron and saturation index aside from complete blood count. Nowadays people developed a parameter named reticulocyte hemoglobin equivalent (RET-He) which detect the hemoglobin in a young erythrocyte. Reticulocyte will be on circulation for only 24-48 hours, so the RET-He will give more appropriate condition of bone marrow iron. In condition where the bone marrow iron is depleted, the RET-He shows a decrease. This parameter can be tested together with CBC, so that it will not need additional blood sample.

This research aim to attain RET-He reference range on reproductive age women, to screen iron deficiency on first and second trimester pregnant women with RET-He and compare it to other parameters that available now : hemoglobin, ferritin, transferrin saturation, and to develope RET-He cut-off with optimal sensitivity and specificity.

RET-He’s reference range on reproductive women is 30,69-36,17 pg. We attained 100 I and II trimester pregnant women which can be divided into 3 groups based on ferritin and transferrin saturation : 67 women (67%) without iron deficiency, 17 women (17%) with iron deficiency stage I, and 16 women (16%) with iron deficiency stage II. Hemoglobin’s, RET-He’s and transferrin saturation’s mean ± SD are 12,35 ± 1,02 g/dL, 33,60 ± 1,88 pg, and 28,63 ± 1,07%. Ferritin’s median(min-max) are 40,10(6,24-191,30) ng/mL. Using ROC curve we found RET-He at 33,65 pg as an optimal cut-off point to differentiate iron deficiency with 67% sensitivity, 64,18% specificity, and 66,4% area under the curve (AUC).

From crosstabs table of RET-He with ferritin as gold standard and 33,65 pg as cut-off point we attained 47,8% PPV, 79,6% NPV, positive LR 1,86 and negative LR 0,52. We found significant differences of RET-He between non-iron deficiency and iron deficiency stage II groups and between iron deficieny stage I and iron deficiency stage II groups. There was no difference between non-iron deficiency and iron deficiency stage I groups."

"Ekuivalen hemoglobin retikulosit menggambarkan banyaknya besi dalam retikulosit yang akan digunakan dalam proses pembentukan hemoglobin. Pada alat Sysmex parameter tersebut dikenal sebagai Ret-He. Namun demikian, saat ini parameter tersebut belum digunakan secara rutin di Indonesia. Tujuan penelitian ini adalah untuk mendapatkan nilai cut off, sensitivitas dan spesifisitas Ret-He untuk penilaian status besi pada pasien penyakit ginjal kronik dengan hemodialisis. Desain penelitian potong lintang, terdiri dari 120 subyek PGK dengan hemodialisis. Dilakukan pemeriksaan hematologi lengkap, Ret-He serta pemeriksaan besi serum dan unsaturated iron binding capacity (UIBC) untuk menghitung nilai saturasi transferin. Penentuan nilai cut off Ret-He berdasarkan kurva receiver operating characteristic (ROC) dengan saturasi transferin sebagai baku emas. Untuk penilaian status besi, didapatkan nilai cut off Ret-He 30,3 pg dengan sensitivitas 81,6% dan spesifisitas 76,8% . Parameter Ret-He dapat digunakan sebagai alternatif untuk penilaian status besi pasien penyakit ginjal kronik dengan hemodialisis.

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Hemoglobin reticulocyte equivalent represent the iron content in the reticulocyte that will be used in hemoglobinization process. In Sysmex hematology analyzer this parameter known as Ret-He. However, this parameter has not been routinely used in Indonesia. The objective of this study is to determine cut-off, sensitivity and specificity of Ret-He to assess iron deficient state in chronic kidney disease patients undergoing hemodialysis. One hundred and twenty patients undergoing hemodialysis were included in the study. Complete blood count, Ret-He and transferin saturation were determined. The receiver operating characteristic curve were demonstrated to obtain the cut off value of Ret-He. In 30.3 pg Ret-He cut off point, the sensitivity and spesificity to assess iron deficient state were 81.6% and 76.8% respectively. Ret-He can be used as an alternative parameter to assess iron deficient state in chronic kidney disease patients undergoing hemodialysis."

"[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]"

"Pasien sirosis hati perlu dievaluasi secara berkala untuk menentukan adanya varises esofagus (VE) dan ukurannya (besar atau kecil), karena VE besar membutuhkan penatalaksanaan yang lebih agresif. Evaluasi ini dilakukan dengan endoskopi yang tidak selalu ada, invasif, dan berbiaya tinggi. Penelitian ini bertujuan untuk mendapatkan pemeriksaan yang non invasif, lebih murah, dan lebih mudah diakses untuk menentukan besarnya VE. Parameter yang diteliti adalah hitung trombosit, prothrombin time (PT), kadar albumin, dan bilirubin. Desain penelitian adalah potong lintang dengan 64 subjek, terdiri atas 24 pasien sirosis hati dengan VE besar dan 40 tanpa VE besar. Pada penelitian ini didapatkan perbedaan bermakna pada hitung trombosit, PT, dan kadar albumin antara kedua kelompok, sedangkan kadar bilirubin tidak memberikan perbedaan yang bermakna. Untuk parameter hitung trombosit didapatkan besar area under the curve untuk memprediksi VE besar sebesar 80,9%, dengan cutoff 89,5 x 103/μL didapatkan sensitivitas 79,2% dan spesifisitas 75,0%; PT 68,4%, dengan cutoff 14,05 detik didapatkan sensitivitas 70,8% dan spesifisitas 67,5%; kadar albumin 76,6%, dengan cutoff 3,275 g/dL didapatkan sensitivitas 70,8% dan spesifisitas 75,0%. Model prediksi sirosis hati dengan VE besar adalah P = 1/(1 + Exp-Logit (y)) dengan Logit (y) = 11,989 – 0,026 x hitung trombosit – 2,243 x kadar albumin – 0,184 x PT.

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Patients with liver cirrhosis require periodic evaluation to determine the presence and size of esophageal varices (EV), because the large ones demand more aggressive management. Evaluation is done using endoscopy, which is not always available, invasive, and costly. This study aims to acquire tests that are noninvasive, cheaper, and more accessible to determine the size of EV. Studied parameters were platelet count, prothrombin time (PT), albumin, and bilirubin level. The study design was cross sectional with 64 subjects, consisted of 24 liver cirrhotic patients with large VE and 40 without.

This study found significant difference in platelet count, PT, and albumin level between both groups, while bilirubin level was not. The size of area under the curve for platelet count to predict large VE was 80.9%, cutoff 89.5 x 103/μL (sensitivity 79.2%, specificity 75.0%), PT 68.4%, cutoff 14.05 seconds (sensitivity 70.8%, specificity 67.5%), and albumin level 76.6%, cutoff 3.275 g/dL (sensitivity 70.8%, specificity 75.0%). Prediction model for liver cirrhosis with large VE was P = 1/(1 + Exp-Logit (y)) with Logit (y) = 11.989 – 0.026 x platelet count – 2.243 x albumin level – 0.184 x PT."

"Pasien sirosis hati perlu dievaluasi secara berkala untuk menentukan adanya varises esofagus (VE) dan ukurannya (besar atau kecil), karena VE besar membutuhkan penatalaksanaan yang lebih agresif. Evaluasi ini dilakukan dengan endoskopi yang tidak selalu ada, invasif, dan berbiaya tinggi. Penelitian ini bertujuan untuk mendapatkan pemeriksaan yang non invasif, lebih murah, dan lebih mudah diakses untuk menentukan besarnya VE. Parameter yang diteliti adalah hitung trombosit, prothrombin time (PT), kadar albumin, dan bilirubin. Desain penelitian adalah potong lintang dengan 64 subjek, terdiri atas 24 pasien sirosis hati dengan VE besar dan 40 tanpa VE besar. Pada penelitian ini didapatkan perbedaan bermakna pada hitung trombosit, PT, dan kadar albumin antara kedua kelompok, sedangkan kadar bilirubin tidak memberikan perbedaan yang bermakna. Untuk parameter hitung trombosit didapatkan besar area under the curve untuk memprediksi VE besar sebesar 80,9%, dengan cutoff 89,5 x 103/μL didapatkan sensitivitas 79,2% dan spesifisitas 75,0%; PT 68,4%, dengan cutoff 14,05 detik didapatkan sensitivitas 70,8% dan spesifisitas 67,5%; kadar albumin 76,6%, dengan cutoff 3,275 g/dL didapatkan sensitivitas 70,8% dan spesifisitas 75,0%. Model prediksi sirosis hati dengan VE besar adalah P = 1/(1 + Exp-Logit (y)) dengan Logit (y) = 11,989 ? 0,026 x hitung trombosit ? 2,243 x kadar albumin - 0,184 x PT.

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Patients with liver cirrhosis require periodic evaluation to determine the presence and size of esophageal varices (EV), because the large ones demand more aggressive management. Evaluation is done using endoscopy, which is not always available, invasive, and costly. This study aims to acquire tests that are noninvasive, cheaper, and more accessible to determine the size of EV. Studied parameters were platelet count, prothrombin time (PT), albumin, and bilirubin level. The study design was cross sectional with 64 subjects, consisted of 24 liver cirrhotic patients with large VE and 40 without.

This study found significant difference in platelet count, PT, and albumin level between both groups, while bilirubin level was not. The size of area under the curve for platelet count to predict large VE was 80.9%, cutoff 89.5 x 103/μL (sensitivity 79.2%, specificity 75.0%), PT 68.4%, cutoff 14.05 seconds (sensitivity 70.8%, specificity 67.5%), and albumin level 76.6%, cutoff 3.275 g/dL (sensitivity 70.8%, specificity 75.0%). Prediction model for liver cirrhosis with large VE was P = 1/(1 + Exp-Logit (y)) with Logit (y) = 11.989 ? 0.026 x platelet count ? 2.243 x albumin level - 0.184 x PT."

"ABSTRAKPemeriksaan thyroid-stimulating hormon TSH) merupakan salah satu pemeriksaan utama dalam mendiagnosis kelainan pada kelenjar tiroid. World Health Organization (WHO) merekomendasikan pemeriksaan kadar TSH menggunakan bahan serum. Penggunaan plasma dapat membantu pencapaian turn around time (TAT) laboratorium namun perbedaan hasil pengukuran antara serum dan plasma belum diketahui. Pada penelitian dibandingkan hasil pengukuran kadar TSH menggunakan tabung penampung serum dengan clot activator tanpa gel pemisah (Tabung I), tabung penampung plasma dengan antikoagulan heparin tanpa gel pemisah (Tabung II), dan tabung penampung plasma dengan antikoagulan heparin dan gel pemisah (Tabung III). Selain itu juga dilihat gambaran kadar TSH berdasarkan jenis kelamin, usia, dan kadar glukosa darah sewaktu. Desain penelitian adalah potong lintang dengan menggunakan 89 subjek penelitian yang dipilih secara censecutive sampling. Didapatkan median kadar TSH pada tabung I, II, dan III secara berturut-turut sebesar 1,380 (0,032-7,420) µIU/mL, 1,380 (0,030-7,480) µIU/mL, dan 1,360 (0,030-7,460) µIU/mL. Tidak didapatkan perbedaan bermakna kadar TSH ketiga tabung secara statistik. Median selisih kadar TSH antara tabung II dan III dengan tabung I secara proporsional didapatkan sebesar -0,9% (-7,2 - 2,2)% dan -1,7% (-8,0 - 1,6)%. Penyimpangan kadar TSH tabung II dan III yang didapatkan telah sesuai dengan nilai ketidaktepatan yang dapat diterima menurut Ricos. Didapatkan gambaran median kadar TSH pada kelompok laki-laki dan perempuan secara berturut-turut sebesar 1,500 (0,032-4,250) µIU/mL dan 1,345 (0,058-7,420) µIU/mL. Median kadar TSH pada kelompok usia 31-40 tahun dan >61 tahun secara berturut-turut sebesar 1,190 (0,609-3,240) µIU/mL dan 1,730 (0,088-5,760) µIU/mL. Pada kelompok glukosa darah sewaktu <200 mg/dL didapatkan nilai median glukosa darah sewaktu pada kelompok kadar TSH di atas nilai rujukan, dalam rentang nilai rujukan dan dibawah nilai rujukan secara berturut-turut sebesar 175 (151-199) mg/dL, 89 (60-190) mg/dL, dan 107 (73-117) mg/dL. Dari hasil yang diperoleh dapat disimpulkan bahwa spesimen dari ketiga tabung penampung dapat digunakan untuk pemeriksaan kadar TSH tanpa memberikan perbedaan hasil yang bermakna baik secara statistik maupun secara klinis. Gambaran kadar TSH yang didapatkan menunjukkan nilai median kadar TSH lebih tinggi pada laki-laki dibandingkan perempuan, terdapat pola peningkatan kadar TSH pada kelompok usia yang lebih tua, dan nilai median glukosa lebih tinggi pada kelompok kadar TSH di atas rentang nilai rujukan.

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ABSTRACTThyroid-stimulating hormone (TSH) is one of the important laboratory parameters in diagnosing the thyroid gland abnormalities. The World Health Organization (WHO) recommends using serum samples to measure TSH levels. The use of plasma samples can help to improve laboratory turn around time (TAT) but the difference of measurements results between serum and plasma samples is unknown. The aims of this atudy were to compare TSH levels using serum tubes with clot activator (Tube I), plasma tubes with heparin anticoagulants (Tube II), and plasma tubes with heparin anticoagulant and gel separator (Tube III), and to show an overview of TSH levels according to gender, age, and random blood glucose levels. A cross sectional study was conducted using 89 blood samples from subjects that were selected by consecutive sampling. The median TSH levels in tubes I, II, and III were 1.380 (0.032-7.420) µIU/mL, 1.380 (0.030-7.480) µIU/mL, and 1.360 (0.030-7.460) µIU/mL respectively. There were no statistically significant differences in TSH levels of the three tubes. The median TSH levels differences of tubes II and III compared to tube I were -0.9% (-7.2 - 2.2) and -1.7% (-8.0 - 1.6) respectively. Biases of the measurement results obtained were in accordance with the spesicified desirable bias according to Ricos. The median TSH levels of the male and female groups was 1.500 (0.032-4.250) µIU/mL and 1.345 (0.058-7.420) µIU/mL respectively. Median TSH levels of 31-40 years old age group and >61 years old age group were 1.190 (0.609-3.240) µIU/mL and 1.730 (0.088-5.760) µIU/mL respectively. In the group of blood glucose level <200 mg/dL, the median of blood glucose level according to above, within, and below reference range of TSH were 175 (151-199) mg/dL, 89 (60-190) mg/dL, and 107 (73-117) mg/dL. In conclusion, specimens from the three tubes could be used to examine TSH levels without giving neither statistically nor clinically significant difference. The measurement of TSH levels obtained in the study showed a higher median TSH levelin the male group compared to the female group, higher TSH levels in the older age group, and a higher median glucose level in the TSH group above the reference range of TSH.

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"Latar belakang: CTC sebagai bagian dari liquid biopsy berperan dalam melakukan monitoring pasien kanker payudara yang menjalani terapi. Adanya CTC menjadi pertanda resistensi terapi dan memengaruhi prognosis pasien. Penelitian ini bertujuan melihat adakah perubahan nilai CTC pada pasien kanker payudara stadium lokal lanjut atau lanjut yang mendapatkan kemoterapi serta melihat perubahan nilai CTC tersebut apakah dipengaruhi oleh usia, status menopause, subtipe, metastasis, dan grade.Metode: Didapatkan 30 sampel pasien kanker payudara stadium lokal lanjut atau lanjut yang akan mendapatkan kemoterapi berbasis Anthracycline dan Taxan. Pre kemoterapi pasien diambil darah perifer dan dilakukan pemeriksaan CTC menggunakan flowcytometry dengan antibodi EpCAM. Pasien lalu menjalani siklus kemoterapi hingga lengkap. Setelah itu pasien kembali diambil darah perifer dan diperiksa nilai CTC post kemoterapi.Hasil: Dari ke 30 sampel, didapatkan mean usia 47,93+7.30. Sebanyak 56,7 (n=17) belum menopause, 43,3% status tumor T3 dan T4, status kelenjar getah bening terbanyak adalah N0 dan N1 (43,3%). Hanya 2 pasien yang ditemukan ada metastasis. 56,7% pasien dengan grade 3, dan subtipe terbanyak adalah luminal B ( 63,4%, n=19). Terdapat 22 pasien (73,3%) dengan ER positif, 14 pasien (46,7%) dengan PR positif. Terdapat 11 pasien (36,7%) dengan Her2 positif dan 21 pasien (70%) dengan Ki67 high proliferation. Hasil CTC pre kemoterapi didapatkan nilai median 1460,50 sedangkan CTC post kemoterapi didapatkan nilai median 415,50 dilakukan uji Wilcoxon dan perbedaan bermakna dengan nilai p=0,002. Analisis multivariat regresi linier dihubungkan antara penurunan nilai CTC terhadap usia, status menopause, subtipe, metastasis, dan grading didapatkan status menopause berhubungan bermakna terhadap perubahan nilai CTC (p<0,05).Kesimpulan: CTC pada pasien kanker payudara stadium lokal lanjut dan lanjut setelah kemoterapi lebih rendah bermakna dibandingkan sebelum kemoterapi. Status menopause memiliki hubungan bermakna terhadap penurunan jumlah CTC setelah kemoterapi pada kanker payudara stadium lokal lanjut dan lanjut

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Background: As part of liquid biopsy, CTCs play a role in monitoring breast cancer patients undergoing therapy. The existence of CTCs is a sign of therapy resistance and affects patient prognosis. This study aims to examine whether there are changes in CTC values in patients with locally advanced or advanced breast cancer, who receive chemotherapy and are influenced by age, menopause status, subtype, metastasis, and grade.

Method: Of the 30 samples of locally advanced or advanced breast cancer patients receiving Anthracycline and Taxan-based chemotherapy were obtained. Pre-chemotherapy, peripheral blood, was drawn and CTCs were examined using flow cytometry with EpCAM antibody. Patients then undergo a complete chemotherapy cycle. After that, the patients were again taken peripheral blood and examined for post-chemotherapy CTC values.

Result: The study was conducted at Cipto Mangunkusumo Hospital, started from December 2022 to December 2023. Of the 30 samples with the mean age was 47,93+7,30. A total of 56,7 (n=17) were not menopause, 43,3% of tumor status with the T3 and T4, and the most common lymph node status with the N0 and N1 (43,3%). Only two patients were found to have metastasis. Then, 56,7% of patients had grade 3, and the most common subtype was luminal B (63,4%, n=19). There were 22 patients (73,3%) with ER positive, 14 patients (46,7%) with PR positive, 11 patients (36,7%) with Her2 positive, and 21 patients (70%) with Ki67 high proliferation. Pre-chemotherapy CTC results obtained a median value of 1460.50, Meanwhile, post-chemotherapy CTC obtained a median value of 415,50. Wilcoxon test was performed and the difference was significant with a value of p = 0,002. Multivariate linear regression analysis was correlated between the decrease in CTC values with age, menopause status, subtype, metastasis, and grading. The menopausal status has a significant association with decrease CTC values (p<0,05).

Conclusion: CTC in locally advanced and advanced breast cancer patients after chemotherapy was significantly lower than before chemotherapy. menopause status has a significant association with decreased CTC values after chemotherapy in locally advanced and advanced breast cancer."