INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY

Published by PDS Patklin
Print ISSN: 0854-4263
Publications
ROC curve
Characteristics of research variable: (1,3) β-D glucan and fungal culture
Chemotherapy is a predisposing factor for infection in patients with malignancy, while culture, as the gold standard,limits the diagnosis of fungal infections. (1,3) β-D glucans, the most abundant polysaccharide component of the fungal wall,are increased in patients with Invasive Fungal Infections (IFI). This research was an analytical observational study with across-sectional approach involving 60 acute leukemia patients who received chemotherapy with suspicion of fungalinfection at the General Hospital of Dr. Moewardi, Surakarta, from September to October 2019. Fungal blood cultures andserum (1,3) β-D glucan levels by the enzyme-linked immunoassay method were examined. Diagnostic tests were performedto determine sensitivity, specificity, Positive Predict Value (PPV), Negative Predict Value (NPV), Positive Likehood Ratio (PLR),Negative Likehood Ratio (NLR), and the serum's accuracy value (1,3) β-D glucan levels to fungal culture. Most (88.3%) ofpatients were diagnosed with Acute Lymphocytic Leukemia (ALL), maintenance chemotherapy phase (51.3%), risk factorsfor neutropenia (50%), and intravenous (IV) line use (56.7%). Serum (1,3) β-D glucan levels in patients with positive fungalcultures (4) in blood samples had a median of 482.87 (476.13-640.56) pg/mL, while patients with negative fungal cultures(56) had a mean±SD 298,68±114,39 pg/mL. Diagnostic test with a cut-off of 471,717 pg/mL showed sensitivity of 100.0%,specificity of 96.4%, NPV of 100%, PLR of 28.00, and NLR of 0.00 with an Area Under Curve (AUC) value of 0.982 andCoefficient Interval (CI) 95% (0.950-1.014). The measurement of serum (1,3) β-D glucan at a cut-off value of 471,717 pg/mLshowed good performance as a biomarker for diagnosing and screening IFIs.
 
Plasmodium ring, trophozoite, schizont, and gametocyte stages shown by the arrowhead. (1.1a) Pv Ring; (1.1b) Pf Ring; (1.1c) Pv Trophozoite; (1.1d) Pf Mature Schizont; (1.1e) Pf male gametocyte; (1.1f) Pf female gametocyte
Percentage of abnormalities in WDF and WNR channels of Plasmodium-infected blood
The percentage of abnormalities in WDF and WNR channel of Plasmodium-infected blood
ROC curve analysis (AUC .739) for parasitemia index with a scattergram abnormality
Demographic characteristics of malaria
Malaria remains a health problem in Indonesia. Microscopic examination with Giemsa staining is the gold standard for diagnosing malaria. The density of parasites correlates with the degree of severity and response to therapy of malaria. Malaria-causing plasmodium can be detected by Sysmex XN-1000 which is marked by abnormalities in the WDF, WNR and RET scattergram. This research aimed to determine the correlation of WDF, WNR and RET abnormal scattergram detected by Sysmex XN-1000 and the parasitemia index of malaria at the Merauke General Hospital. This was a cross-sectional study with observational approach conducted between November 2017 – February 2018 at the Merauke General Hospital. Positive malaria samples were stained with Giemsa, their parasitemia index was calculated, routine complete blood count using Sysmex XN-1000 was performed, and the scattergram abnormalities were then analyzed. There were 65 positive malaria samples as follows: P.falciparum (35%), P.vivax (60%), P.ovale (3.1%), and P.malariae (1.5%), but the species did not correlate with parasitemic index (p=0.691). Abnormalities of WDF and WNR scattergram were predominantly found than RET scattergram (80% vs. 27.7%). P.vivax predominantly caused abnormalities of the WDF and WNR scattergram in 36 of 39 samples (92.3%), whereas P.falciparum predominantly caused abnomalities of the RET scattergram in 14 of 23 samples (60.9%). There was 95% positivity of an abnormality in WDF/WNR/RET scattergram with a cut-off of > 5,0165.5/µL. There was correlation between WDF, WNR, RET scattergram detected by Sysmex XN-1000 and the parasitemia index.
 
Sysmex XN-1000 hematology analyzer is an automated 5-part diff analyzer (eosinophils, basophils, neutrophils, lymphocytes, and monocytes). In the calculated area, the type of difference between the Sysmex hematology device and other hematology devices is Immature Granulocyte (IG), Nucleated Red Blood Cell (NRBC), and High Fluorescent Lymphocytes Count (HFLC). The cells calculated in the HFLC area are atypical lymphocytes. In patients with dengue hemorrhagic fever, it is often found atypical lymphocytes called blue plasma lymphocytes. The purpose of this study was to determine the description of HFLC in patients with dengue fever using the hematology analyzer Sysmex XN-1000. A descriptive retrospective study was conducted during April-May 2017. The subjects of the study were adult patients diagnosed with dengue hemorrhagic fever with WHO criteria. Of the 47 samples of Dengue Hemorrhagic Fever (DHF) patients, the average HFLC results were between 2.0-32.3%, which was 11.5%, while the average range of normal HFLC values was between 0.0-1.4% and was 0.3%. In cases of DHF, there is an increase in HFLC. This is likely to be attributed to atypical lymphocyte increase in dengue hemorrhagic fever. Further research with more varied samples still needs to be done.
 
Ovarian cancer is the fourth cancer with most incidence in Indonesian female with 10.238 cases in 20141. Tumor marker CA-125 is assosciated with ovarian cancer, importantly epithelial ovarian cancer. This study aims to find out diagnostic value (sensitivity, specificity, positive predictive value, negative predictive value) of CA-125 among patients with epithelial ovarian cancer in Dr. Soetomo General Hospital Surabaya in 2016. This study used analytic cross sectional method and was performed by evaluating medical records of patients suspected for ovarian malignancy in Dr. Soetomo General Hospital Surabaya in 2016. There were total 97 patients found fit for criteria of inclusion in this study. Tissue histopathological examination confirmed 66 patients have epithelial ovarian malignancy and 31 patients do not. Samples distributed using 35 U/ml as CA-125 upper limit, TP: 54.64%, FP: 19.59%, FN: 13.40%, dan TN: 12.37%. Diagnostic value obtained as follows: sensitivity 80.30%, spesificity 38.71%, positive predictive value 73.61%, negative predictive value 48%, and accuracy 67.01%. Tumor marker associated with ovarian cancer CA-125 has found high in sensitivity but low in specificity among patients with epithelial ovarian cancer in Dr. Soetomo General Hospital Surabaya in 2016.
 
Restriction of the codon 12 PCR product with MvaI enzyme, producing 162 bp at the mutant type (D,E) and 133 bp, 29 bp at wild type (A,B,C,F,G) KRAS gene, H=marker.
Restriction of the codon 13 PCR product with BsuRI enzyme, producing 85 bp, 48 bp and 26 bp at the wild type, 85 bp and 74 bp at the mutant type of KRAS gene.
Restriction with Mva at the codon 12 PCR product and BsuRI at the codon 13 PCR product. B, F=marker, A,C,D,E= the codon 12 PCR product, 162 bp (C), wildtype (A) and mutant type heterozygote (D,E) (mutant type produced band 162 bp, wild type produced band 133 bp and 29 bp, band 29 bp invisible). G,H,I = the codon 13 PCR product, 159bp (G), wildtype (H,I) (wild type produced band 85 bp, 48 bp and 26 bp, mutan type produced band 85 bp and 74 bp).
Kanker kolorektum merupakan salah satu kanker yang tersering di dunia. Target molekuler untuk pengobatan kanker kolorektumyaitu Epidermal Growth Factor Receptor (EGFR) dengan pemberian antibodi monoklonal anti-EGFR. Pemberian pengobatan ini tidakdapat memberikan efek dampak di pasien dengan status gen KRAS bentuk mutan, sehingga perlu dilakukan pemeriksaan status mutasigen KRAS. Telitian berupa deskriptif dengan pendekatan potong lintang yang bertujuan untuk mendapatkan data status mutasi genKRAS kodon 12 dan 13 di pasien adenocarcinoma colorectal. Deteksi mutasi KRAS dilakukan dengan teknik Polymerase Chain ReactionRestriction Fragment Length Polymorphism (PCR RFLP) yang dikonfirmasi dengan sekuensing. Sampel telitian adalah 30 blok parafinyang diperoleh dari Rumah Sakit Dr.Soetomo Surabaya masa waktu Januari-Desember 2013. Setelah dilakukan ekstraksi DNA terdapat21 sampel yang dapat digunakan untuk pemeriksaan lanjutan. Hasil PCR RFLP menunjukkan terdapat 7/21 mutasi pada kodon12 dan tidak terdapat mutasi gen KRAS pada kodon 13. Mutasi pada kodon 12 yaitu GGT>GCT, GGT>GGA dan GGT>GAT yangmenyebabkan perubahan asam amino Gly12Ala, Gly12Gly dan Gly12Asp. Simpulan telitian ini adalah mutasi gen KRAS kodon 12 padaadenocarcinoma colorectal di Rumah Sakit Dr. Soetomo Surabaya sebanyak 33%.
 
Distribution of blood
Each year more than 41,000 blood donations are needed every day and 30 million blood components are transfused. Blood products that can be transfused include Packed Red Cells (PRC), Whole Blood (WB), Thrombocyte Concentrate (TC), Fresh Frozen Plasma (FFP). Monitoring Hemoglobin (Hb) after transfusion is essential for assessing the success of a transfusion. The time factor after transfusion for Hemoglobin (Hb) examination needs to be established, analyze to judge the success of a blood transfusion which is performed. The aim of this study was to analyze the differences in changes of hemoglobin between 6-12 hours, and 12-24 hours after-transfusion. This study was retrospective observational using secondary data. The subjects were patients who received PRC, and WBC transfusion. At 6-12, and 12-24 hours after-transfusion, hemoglobin, RBC, and hematocrit were measured. Then the data were analyzed by unpaired t-test. The collected data included the results of the Hb pre-transfusion, 6-12, and 12-24 hours after-transfusion. The subjects of this study were 98 people. The administration of transfusion increased by 10-30% in hemoglobin concentration at 6-12 hours after-transfusion. While at 12-24 hours after-transfusion, hemoglobin after-transfusion increased 15-37% from the baseline. Hemoglobin values were not different at any of the defined after-transfusion times (p = 0.76 (p>0.05)). Hemoglobin values were not different at 6-12 hours, and 12-24 hours after-transfusion. Keywords: Hemoglobin, measurement, after-transfusion
 
Characteristics of research subjects
Acute Mieloid Leukemia (AML) is a hematologic cause of cancer deaths of 1.2% including a relatively rare disease but by the end of the decade there is an increase in the number of new cases. The immune system in AML is caused by gene mutations giving immunosuppressive effects so that the immune system will be inhibited in eliminating leukemia cells. The immune response of tumors is important to determine the prognosis, development of new cancer immunotherapy as well. One of the subset of lymphocytes T is gdT lymphocyte cell with innate nature, but until now no information is required about gdT cell profile in AML patients. gdT cells have properties as antitumors played by Interferon production g (INF g), and the nature of protumor by interleukin 17 (IL-17). The percentage of lymphocyte T (CD3 +) of AML patients and healthy people did not differ (p = 0.528), indicating, not being activated for proliferation. gdT Lymphocyte cells percentage in healthy people by race, genetic and exposure to the surrounding environment such as infection. Percentage of gdT lymphocyte of AML patients and healthy people was not different from (p = 0.694), showed an immune response by gdT cells Unefected to proliferate. The percentage of gdT llimfocytes expressing the interleukin 17 (gdT17 cells)in patients AML and healthy people did not differ significantly (p = 0.436), this indicates inhibited proliferation.
 
Tuberculosis is an infectious disease which is the second cause of death in the world. Indonesia belongs to the third ranks as themost prevalent tuberculosis country. However the eradication is programmed only to focus on finding the case and treatment of theactive tuberculosis patients. Health care workers are at risk to tuberculosis infection, but there is no examination yet for early detectionactivity of tuberculosis. In order to know the activity of tuberculosis, other examinations are needed such as IL-18 examination. Today, no research about IL-18 is performed yet in Indonesia; therefore this study is performed in order to know the difference of IL-18level in active tuberculosis patients and nurses at risk. This study is to know the difference between IL-18 plasma of active tuberculosispatients and nurses at risk by analysis. A cross sectional, observational analytical study of 8 nurses at risk of tuberculosis and 8 activetuberculosis patients, has been conducted from February up to April 2007, at the Dr. Soetomo General Hospital and Karang TembokHospital in Surabaya. The diagnosis of active tuberculosis patients was based on positive sputum bacteriological examination, positiveradiology examination and who never had received anti-tuberculosis drugs. Nurses at risk of tuberculosis consisted of those who had beenworking more than 2 years, and was examined by negative bacteriological and radiology examination, TB-dot and positive tuberculinskin test with a diameter – 10 mm. IL-18 examination was done by double antibody sandwich ELISA method (MBL/Medical & BiologicalLaboratories Co.Ltd). IL-18 level in active tuberculosis patients was 491.4–1215.3 pg/ml (mean 794.6 pg/ml, SD 222.6), in nursesat risk of tuberculosis was 88.9–429.0 pg/ml (mean 256.2 pg/ml, SD 137.6). There was a significant difference of IL-18 level amongactive tuberculosis patients and nurses at risk of tuberculosis (p < 0.001); the IL-18 level in active tuberculosis patients was significantlyhigher than in nurses at risk of tuberculosis.
 
It is important to predict the severity of COVID-19 during the pandemic. Both Neutrophil Lymphocyte Ratio (NLR) andAbsolute Lymphocyte Count (ALC) are two easy, low-cost, and fast inflammatory markers, which positively correlate with theseverity of COVID-19. The purpose of this research was to analyze the value of NLR and ALC as predictors of COVID-19severity. This research was a retrospective study using medical record data of 376 COVID-19 patients duringApril-September 2020 at the Hasanuddin University Hospital and Makassar City Regional Hospital. Patients were classifiedinto non-severe and severe COVID-19. Neutrophil lymphocyte ratio and ALC values were determined based on routineblood test (Sysmex XS-800i) results, statistical analysis using Independent T-test, while NLR and ALC diagnostic values wereanalyzed with Receiver Operating Characteristics (ROC) curve to obtain the cut-off value, p < 0.05 was significant. Thesamples consisted of 372 non-severe and 49 severe COVID-19 patients. Neutrophil lymphocyte ratio value in non-severe(4.02±5.22) was significantly different from severe COVID-19 (9.81±7.06) (p < 0.001), similar to ALC in non-severe(2.00±0.83x103/μL) and severe COVID-19 (1.22±0.78x103/μL) (p < 0.001). Receiver operating characteristics curve showedthat NLR had a sensitivity of 91.8% and specificity of 66.4% with a cut-off ≥ 3.17 with Negative Predict Value (NPV) of 98.2%and Positive Predict Value (PPV) of 29.0%; while ALC had a sensitivity of 81.6% and specificity of 64.8% at cut-off≤ 1.74x103/μL with NPV of 95.9% and PPV of 25.8%. Increased NLR and decreased ALC in severe COVID-19 patientsoccurred due to an increased inflammatory response resulting in a decreased cellular immunity. Receiver operatingcharacteristics curve showed a cut-off for NLR of 3.17 and ALC of 1.74x103/μL, indicating an optimum sensitivity andspecificity. It was concluded that NLR and ALC can be used as predictors of COVID-19 severity with a cut-off ≥ 3.17 and≤ 1.74x103/μL, respectively.
 
Characteristics of research subjects
Difference test of research variables between subjects with positive and negative PCR test results
Bivariate Analysis of COVID-19
Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Respiratory disorders were the most common sign and symptom of COVID-19. Inflammation on SARS-CoV-2 infection is presumed to play a role in the pathogenesis of COVID-19. The Neutrophil Lymphocyte Ratio (NLR) is one of many biomarkers that has been widely used to assess the risk factors of COVID-19. The derived Neutrophil Lymphocyte Ratio (d-NLR) is a simple, inexpensive, and widely available inflammation biomarker. However, its usage for COVID-19 remains to be further studied. This study aimed to determine the NLR and d-NLR ratio as a risk factor of COVID-19. This study was a retrospective study with a study population of 84 subjects, consisting of 33 patients with positive COVID-19 and 51 patients with negative COVID-19. The result showed that the odds ratio of NLR to COVID-19 was 2.665 with the p-value of 0.047 and confidence interval of 95% 0.998-7.038 at cut-off ≥ 3.1. The odd ratio of d-NLR to COVID-19 was 2.808 with the p-value of 0.026 and confidence interval of 95% 1.129-7.038 at cut-off ≥ 2.0. In conclusion, despite a higher odd ratio of d-NLR compared to NLR, both NLR and d-NLR can be used as a biomarker for the risk factor of COVID-19.
 
Blood Bank's challenge during the COVID-19 era is securing and protecting blood supplies even though countries aretaking precautionary measures with social distancing to prevent or reduce the number of infections caused by COVID-19.This study aimed to compare blood availability before and during the COVID-19 pandemic at the blood bank of Dr. WahidinSudirohusodo Hospital. A Descriptive-analytic study with an observational approach using the Shapiro-Wilk test todetermine the normality of the sample and the paired T-test. Sample data was taken between March-August 2019 andMarch-August 2020. A significant difference was found in blood demand (p-value=0.004), amount of blood transfusion(p-value=0.006), stock and reference report (p-value=0.005), blood service report (p-value=0.005), cito waiting time(p-value=0.002) and regular waiting time (p-value=0.016). There was no significant difference in blood indicator Packed RedCell (PRC) (p-value=0.119). The Large-Scale Social Restriction Policy (PSBB) and reduction of elective surgery in hospitalsaffect the fulfillment of Blood Bank and faster attendance time of blood during the pandemic. The decrease in a number ofblood demands during the COVID-19 pandemic affected the number of blood transfusions, blood service reports, stocks,referrals, and cito and regular waiting time services.
 
The COVID-19 incidence is increasing around the world. Some countries are experiencing worsening conditions, evendeaths. One coagulation marker that noticeably increases in COVID-19 patients is D-dimer. This study aimed to analyzeD-dimer levels of COVID-19 patients. Retrospective study using medical records of 84 COVID-19 patients, conducted fromApril to August 2020 at UNHAS Hospital. Patients were grouped based on the severity of the disease as non-severe andsevere. D-dimer levels were measured using the Alere Triage® D-dimer with the fluorescent immunoassay method. Thestatistical test used was Mann-Whitney, D-dimer prognostic levels were calculated with ROC analysis to get the cut-off.Significant if the p < of 0.05. The sample consisted of 74 non-severe and ten severe COVID-19 patients, mostly in the 30-39age group. D-dimer levels in non-severe (0.31±0.38 μg/L) significantly differ from severe group (3.09±2.56 μg/L) (p<0.001).The Receiver Operating Characteristics (ROC) curve showed D-dimer sensitivity and specificity of 90.0% and 89.2%,respectively at the ≥ 0.80 μg/L cut-off, Negative Predictive Value (NPV) of 98.5%, and Positive Predictive Value (PPV) of52.9%. D-dimer levels increased in severe COVID-19 patients due to an increased inflammatory response resulting inexcessive thrombin. The ROC D-dimer curve indicated a cut-off rate of 0.80 μg/L, providing optimal sensitivity andspecificity. D-dimer has a significant difference in non-severe and severe COVID-19 patients and shows good value todetermine the severity of COVID-19 disease with a cut-off value ≥ 0.80 μg /L.
 
Coronavirus Disease 2019 (COVID-19) is caused by Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2).C-Reactive Protein (CRP) is an inflammation marker that increases significantly in COVID-19 patients. SARS-CoV-2 can affectkidney function and increase the Blood Urea Nitrogen (BUN)-creatinine ratio. The previous study showed that CRP andBUN-creatinine ratios could be used as predictors of the severity and survival of COVID-19 patients. This study aimed todetermine the correlation between CRP levels and the BUN-creatinine ratio in COVID-19 patients. A retrospectivecross-sectional study was conducted on 34 COVID-19 patients who were diagnosed by PCR test at Dr. Kariadi Hospital,Semarang from March to September 2020. The Spearman correlation test was used for statistical analysis. The median CRPvalue was 4.59 (0.36-27.48) mg/L and BUN-creatinine ratio was 15.06 (5.79-37.04), while the correlation between CRP andBUN-creatinine ratio showed p=0.003 and r=0.502. There was a moderate positive correlation between CRP level andBUN-creatinine ratio. C-reactive protein plays a role in the infiltration process of inflammatory cells and increases adhesionmolecules, which can directly or indirectly damage kidney function. SARS-CoV-2 can enter the kidney directly through theACE-2 receptor and activate the renin-angiotensin-aldosterone system, which will increase water and sodium absorption inthe renal tubules, passive reabsorption of BUN, and creatinine filtration in the glomerulus resulting in increasedBUN-creatinine ratio.
 
Coronavirus 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Inflammation occurs when the body is infected with the virus. Platelets play a role in immune response and immunomodulation by activating P-Selectin Glycoprotein (PSGL) to the site of inflammation. Lymphocytes play a role through CD4 T-cells, B-cells producing specific viral antibodies, and CD8 cytotoxic T-cells by directly killing the virus in infected cells. This study aimed to prove the correlation between PLR and CRP as inflammation markers in COVID-19 patients. This study was a retrospective observational study with the cross-sectional approach at Dr. Kariadi Hospital, Semarang, for the period March-August 2020. Spearman test performed for analyzing data with p<0.05 was significant. Thirty-three confirmed COVID-19 patients with median value of PLR 218 (103-1609) and CRP 15.94 (1.24-200) mg/L were tested for correlation with a value of p=0.013 and r=0.427. The increase of PLR and CRP in COVID-19 patients was caused by an inflammatory process mediated by the immune response. High values in the blood were associated with disease severity and poor prognosis. There was a statistically significant moderate positive correlation between PLR and CRP in COVID-19 patients.
 
Mikroorganisme patogen dari hasil pemeriksaan swab
Upper respiratory tract infection usually has been presence on hajj pilgrims after they spent at the holy Mecca. They are known by long duration cough until they were come home. The pilgrims have been given health education how to live in Mecca and Medina before they go to Saudi Arabia and had meningitis vaccination as well. The purpose of this study is to know what the cause of the upper respiratory tract infection. If the pathogens have been found, before departure the infected pilgrims have been given antibiotics to prevent the pilgrimage ceremony to be disturbed.. Regarding the infection problems this study will be done, to give information whether the pathogenic that cause URI is from Indonesia or Saudi Arabia. About 118 people partially from Surabaya’s pilgrims were divided into 1st and 2nd groups (53 and 65 persons). Each group have been examined their pharyngeal swab before the departure to Mecca and after arrival in Surabaya. The samples were kept in transport media, than sent to the Clinical Pathologic Laboratory at Dr Soetomo Hospital. The swab samples were isolated and identificated after the cultivation in the incubator at the laboratory. From the118 pilgrims, only 95 persons completed the laboratory examination before the departure to Mekah and after they arrived in Surabaya. It is found before departure 5 person (5%) contaminated by pathogenic microorganism, four from K. pneumoniae and one A betahemolytic Streptococcus group. After their arrival about 97% have normal flora, but two of them contaminated by Gamma Streptococcus regarding to these results it is concluded that URI may cause by the environment, difference of weather or viral infection origin Because in the town at Saudi Arabia the pilgrim lived together with other peoples which came from various countries of the world.
 
The characteristics of epidemic dengue often presented as periods of hyperendemicity or as the co-circulation of multiple dengue serotypes. Surabaya is an endemic city for Dengue virus (DENV) transmission. Previous study of DENV distribution in 2008-2009 revealed the predominance of DENV-2. DENV serotypes distribution is known to be dynamic and serotype predominance may change through time. This study aims to determine and follow the circulation of DENV serotype in Surabaya in 2012. We recruited 154 denguesuspected patients attending Dr. Soetomo Hospital during February until August 2012. Dengue cases were confirmed by IgG and IgM serology tests and NS1 antigen detection. Serologically-positive samples were further analyzed using two-steps reverse transcriptasepolymerase chain reaction (RT-PCR) and viruses were isolated by propagation in C6/36 mosquito cell line. Seventy one cases (46.1%) were detected as DENV positive infection. Serotyping revealed that 61 samples have monotypic infection with one of all four of DENV serotypes and 10 samples have mix-infections. Overall serotyping result observed the predominance of DENV-1 (60.56%). Our result revealed the circulation of all four serotypes of DENV and the presence of serotype exchange in Surabaya in 2012. Annual change of predominant serotype and the presence of multiple infections may play an important role in the transmission of dengue infection. This information is valuable to dengue surveillance in the region. Therefore, the laboratory diagnosis of DENV serotype should be routinely performed to follow the dynamic of dengue disease
 
Laboratory test results
Laboratory test results
Myeloma is a cytogenetically heterogenous clonal plasma cells proliferative disorder and is almost always preceded by an asymptomatic premalignant stage termed monoclonal Gammopathy of Undetermined Significance (MGUS). Diagnosis of myeloma is based on International Myeloma Working Group (IMWG) 2003 which requires one or more CRAB features including hypercalcemia, renal insufficiency, anemia and lytic bone lesions. The IMWG 2014 updated criteria for the diagnosis of myeloma allows the use of early indicators for therapy before CRAB features happen. This is a case of a 53-year-old male, based on complete blood count and peripheral blood smear having normochromic normocytic anemia, NRBC 7/100 leucocytes, thrombocytopenia, 1% plasmoblasts, 11% plasmocytes and Erythrocyte Sedimentation Rate (ESR) 40 mm. The bone marrow evaluation showed plasmocytes 22.5% ANC with abnormal morphology. The diagnosis myeloma was made based on IMWG 2014 by the presence of plasmocytes 22.5% ANC the bone marrow and having one of Myeloma Defining Events (MDEs) in the form of anemia with hemoglobin level 8.5 g/dL. In addition, patient did examinations of protein electrophoresis, immunofixation and ratio involved/uninvolved Free Light Chain (FLC) serum. The results of those examination confirmed the diagnosis that has been made based on IMWG 2014. Prognosis of the patient is poor by the presence of 11% plasmocytes on blood peripheral and ratio FLC kappa/lambda 0.0010.
 
The percentage of positive NS1 in each dengue virus serot The percentage of positive NS1 in each dengue virus serotype.
The characteristics of subjects
The prevalence of dengue virus serotypes in Surabaya according to several studies
The difference of NS1 detection according to serotypes in primary DVI
The difference of NS1 detection according to serotypes in secondary DVI
Serotipe virus dengue yang beredar terus mengalami perubahan dan berbeda di setiap daerah. Pergeseran serotipe maupun genotipedi dalamnya, mempengaruhi terjadinya wabah dengue di berbagai negara. Perbedaan serotipe diduga bernasab dengan deteksi antigen(Ag) non-structural 1 (NS1), namun belum banyak penelitian yang mendukung hal tersebut. Penelitian potong lintang dikerjakan sejakFebruari-Agustus 2016 dan didapatkan 60 subjek infeksi virus dengue (IVD) dan 25 non-IVD. Ribonucleic acid (RNA) virus denguediperiksa di semua subjek menggunakan Simplexa Dengue Real-Time Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR)termasuk identifikasi serotipe virus dengue dan pemeriksaan NS1 menggunakan uji cepat NS1 Panbio. Perbedaan perbandingan variabelkategorikal dianalisis dengan uji Fisher Exact. Kenasaban antara serotipe dengan deteksi Ag NS1 dianalisis dengan Chi-Kuadrat. RNAvirus dengue terdeteksi di 43 dari 60 subjek IVD (71,7%). Serotipe terbanyak adalah DENV-3 (62,8%). Pergeseran dominasi serotipetelah terjadi di Surabaya, sebelumnya dari DENV-2 ke DENV-1 dan sekarang DENV-3, kemungkinan akibat mobilitas pejamu, transporvirus dan faktor geografis. Kepekaan uji cepat NS1 75% dan kekhasan 100%. Persentase deteksi NS1 antar serotipe berbeda bermakna(p=0,002). Deteksi NS1 lebih rendah pada DENV-1 dibandingkan DENV-2 (p=0,007) ataupun DENV-3 (p=0,003). Serotipe virusdengue bernasab dengan deteksi NS1 (p=0,005). Ciri serotipe maupun genotipe virus dengue kemungkinan mempengaruhi sekresiNS1. Telah terjadi pergeseran serotipe virus dengue di pasien IVD di Surabaya sehingga diperlukan surveillance berkesinambunganuntuk memperkirakan terjadinya wabah. Serotipe bernasab dengan deteksi NS1. Salah satu penyebab hasil negatif palsu NS1 adalahperbedaan serotipe.
 
Diagnosis distribution of patients with DVI who admitted to Dr. Soetomo Hospital Surabaya in 2017-2018
Laboratory findings of patients with EDS when admitted to Dr. Soetomo Hospital in 2017-2018
Anti-dengue IgM-IgG test on patients with EDS when admitted to Dr. Soetomo Hospital in 2017-2018
Dengue Fever (DF) or Dengue Hemorrhagic Fever (DHF) is one of the infectious diseases that attracts much global attention, especially Indonesia because it impacts the mortality rate of the people in the world if adequate treatment is not given. Expanded Dengue Syndrome (EDS) is a clinical manifestation involving several organs such as lungs, liver, kidney, heart, and brain-related to dengue infections, with or without plasma leakage. This study aimed to determine the prevalence of expanded dengue syndrome in patients with dengue virus infection at the Dr. Soetomo Hospital in 2017–2018. Based on its purpose, the sampling technique used in this study was the total sampling of patients with DVI who admitted to Dr. Soetomo Hospital Surabaya. Every pediatric and adult patient who met the criteria were included in this study until a certain period in 2017–2018. After the data collection, only thirty samples of EDS from the 196 sample data were collected. Thirty patients with expanded dengue syndrome had a manifestation of different organs. Such as: neurological, cardiac, respiratory system, gastro-hepatic, and kidneys. The laboratory test results showed that most platelet counts of 51,000 – 100,000 were found in seventeen patients, while the range of hemoglobin and hematocrit was normal. From a total of thirty samples of dengue virus infection patients with EDS, there were only eighteen patients who did a serological test. The most found serological results were (+/-) anti-dengue IgM and (+) anti-dengue IgG (40%).
 
The characteristics of samples before and after sperm cells purification
The aim of this study is to learn about the choice of storage temperature for human sperm cells after sperm purification using somatic cell lysis buffer (SCLB) before sperm small ribonucleic acid (RNA) isolation and analysis. This study was true laboratory experiment using the post-test only control group design. The samples were 13 fresh human semen that has been purified using SCLB. The sperm cells then diluted and divided into four aliquots with different treatment. First aliquot that served as a control group was immediately purified while the last three aliquots were stored for 7 days at different temperature: 4oC, -20o, and -80oC. The small RNA yields between each group then compared after the small RNA isolation and measured using microvolume spectrophotometer. The small RNA yields of control group was 49.8 (5.33-522.46) ng/106 sperm cells. It wasn’t show any significant difference with the other groups of storage temperature: 4oC, -20o, and -80oC [41.09 (7.03-1448.31); 65.95 (7.99-301.16); 76.42 (10.45-434.25); p value 0.314] with p value > α (α = 5%). This condition shows that human sperm cells after sperm purification using SCLB can be stored at 4oC, -20o, or -80oC temperatures depends on each laboratory facilities.
 
Family tree
Radiology Imaging (A) (B) Anteroposterior Thoracolumbar (AP) / Lateral (C) Right Shoulder (D) Coxae AP
Diagnostic algorithm for acromegaly
Preeliminary : Pituitary gigantism is a condition caused by the excessive secretion of growth hormone (GH). Growth Hormone is also the most common pituitary hormone deficient in pituitary disease. Chordoma is a bone primary tumor that grows slowly and rarely found. Hypothyroidism is a pathological condition due to thyroid hormone deficiency. Symptoms of hypogonadism is non-specific including libido disorders, erectile dysfunction and decreased muscle mass and no hair growth in the head or body. Case : A 24-year-old man came with a knee-jerk complaint. Physical examination obtained increased growth of statural and body parts as well as loss of body hair. Laboratory investigation revealed pancytopenia, increased prolactin; decreased GH, IGF-1 and testosterone; increased TSH, decreased FT3 and FT4. Head MRI demonstrated the presence of mass in the clivus.Discussion : In this case, the patient presents with clinical gigantism. However, laboratory examination shows decreased GH and IGF-1 which may be due to the suppressive effect of mass on the clivus bone to the pituitary. The suspicion of hypothyroid found alone or due to mass in the clivus bone still requires further examination. Hypogonadism can result from supression on the pituitary. Pancytopenia can be caused by deficiency of GH or from hypothyroidism.Conclusion : Gigantism may occurred with deficiency GH and IGF-1 due to suppressed pituitary caused by chordoma.
 
Creatinine and uric acid is a product that excreted in the urine by normal kidney functions. The examination of creatinine and uricacid in urine is done on 24-hour urine collection. During the storage of the urine, it is recommended to be stored in a refrigerator withthe grade temperatures ranging from 2–8°C and is not recommended to use any preservative for the examination of creatinine anduric acid in urine. To know the comparation of creatinine and uric acid concentrations in urine between the urine tested immediatelyafter the collection with urine that was stored at a temperature 2–8°C and those at room temperature for 24 hours. A total of 45 urinesamples from outpatient clinic that came to the laboratory, were collected in particular urine vacutainer. Each urine sample is divided intothree tubes. The first tube (P1) examined concentrations of creatinine and uric acid immediately after collection, was considered as thebaseline value. The second tube (P2) stored at 2–8°C and the third tube (P3) is stored at room temperature for 24 hours, then followedby the examination of creatinine and uric acid concentrations. The examination of creatinine in urine was using reagent CREP2 RocheDiagnostic and uric acid in urine was using reagent UA2 Roche diagnostics by Cobas Integra ® 400 plus ® instrument. The mean ofcreatinine in urine concentrations which immediately examined (P1) is (125.10±74.85 mg/dL), concentrations after storage at 2−8°C(P2) and at room temperature (P3) were (123.42±73.80 mg/dL) and (124.09±73.95 mg/dL) respectively. Based on the analysis ofone-way ANOVA, there were no significant differences between the concentrations of creatinine in urine immediately checked which werestored at 2–8°C and at room temperature (P>0.05). The mean of uric acid in urine concentrations which immediately examined (P1) is(52.61±35.48 mg/dL), where as after storage at 2–8°C (P2) and room temperature (P3) were (45.11±31.62 mg/dL) and (46.38±28.91mg/dL) respectively. Based on the analysis of one-way ANOVA, there were no significant differences between the concentrations of uricacid in urine immediately checked by those stored at 2–8°C and at room temperature (P>0.05). Based on this study, it can be concludedthat there were no effect of storage temperature on the concentrations of creatinine and uric acid in urine within 24 hours.
 
Measuring HIV p24 protein is a test which is more practical than determination of CD4+ T-lymphocyte counts and viral load, asit does not require a very sophisticated instrument and requires a lower cost. Independent predictive value of p24 to the decline ofCD4+ T-lymphocytes, clinical progression and survival in HIV-infected patients have been reported. In this study, HIV-infected patientswere found to have HIV p24 protein levels inversely proportional to CD4+ T-lymphocyte counts by using Spearman test (R2=0.225;p=0.0331). Studies on the correlation between HIV p24 protein levels and CD4+ T-lymphocyte counts in stage I HIV infection have notyet been reported. The aim of this study was to prove the correlation between HIV p24 protein levels and CD4+ T-lymphocytes in stageI HIV infection. Research issue was whether a correlation between HIV p24 protein levels and CD4+ T-lymphocyte counts in stage I HIVinfection existed ? The hypothesis was that a correlation between HIV p24 protein levels and CD4+ T-lymphocyte counts in stage I HIVinfection existed. The study design was cross sectional observational. Subjects consisted of 30 stage I HIV-infected patients treated at theInfectious Disease Intermediate Care Unit, Dr. Soetomo Hospital and VCT Clinic of the Dr. Ramelan Naval Hospital, Surabaya from Mayto July 2014. Stage I HIV infection is an asymptomatic HIV infection or with persistent generalized lymphadenopathy and the patientis able to perform normal activities. Levels of p24 were measured by ELISA method and CD4+ T-lymphocyte counts using flowcytometry(BD FACSCaliburTM). The results were statistically analyzed using Pearson’s correlation test. HIV p24 protein levels in stage I of HIVinfection ranged from 1.8 to 10.8 pg/mL, mean of 5.14 pg/mL and a standard deviation of 2.08 pg/mL. CD4+ T-lymphocyte countsdecreased with a range of 49-559 cells /uL for absolute values and 4.42–26.02% for percentage values Correlations between blood p24levels and CD4+ T-lymphocyte counts either absolute (r=–0.392, p=0.032) or percentage (r=–0.363, p=0.049) were found. In stageI HIV-infected patients, a negative correlation was found between p24 levels and CD4+ T-lymphocyte counts, in both CD4+T-lymphocytecounts as absolute and as well as percentage values. This negative correlation showed that the p24 HIV levels were inversely proportionalto the CD4+ T-lymphocyte counts. HIV p24 protein levels have a possibility to be used predicting CD4+ T-lymphocyte counts.
 
KDIGO guideline
Creatinine clearance test
Subjects characteristics
Result of differential analysis
Kidney disease is a global public health problem, affecting over 750 million people worldwide. Glomerular Filtration Rate(GFR), which is calculated by measuring the creatinine clearance with 24-hour urine collection (CC) can be inaccurate due toimproper urine collection, causing the need for an easier and accurate method of calculation. This study was anobservational analytical cross-sectional research using consecutive retrospective sampling. Samples were data of patientswith Chronic Kidney Disease (CKD) who underwent CC test at the Clinical Pathology Laboratory of the Dr. Soetomo HospitalSurabaya during September-October 2018. Data were compared with the results of Cockcroft-Gault (CG), MDRD, andCKD-Epi formula, and were analyzed using the one-sample Kolmogorov-Smirnov test, paired T-test, and Wilcoxon SignedRank test. Correlation of CC results with CG, MDRD, and CKD-Epi results was tested with Spearman's rho and Bland Altmantest. The difference test of CC with CG, MDRD, and CKD-Epi showed results of (p=0.000), (p=0.194), and (p=0.468),respectively. There were significant differences between CC compared to CG, but not MDRD and CKD-Epi. There was amoderate correlation between CG, MDRD, CKD-Epi, and CC with r=0.529; 0.448, and 0.463, respectively. The mostcompatible formula was CKD-Epi. The measurement of GFR with CC correlated with CG, MDRD, and CKD-Epi; therefore, theycould be used as an alternative method to calculate GFR. Further experiments using an exogenous marker should beperformed to determine a suitable eGFR formula according to the degree of damage to the kidney.
 
Measuring HIV p24 protein is a test which is more practical than determination of CD4+ T-lymphocyte counts and viral load, as it does not require a very sophisticated instrument and requires a lower cost. Independent predictive value of p24 to the decline of CD4+ T-lymphocytes, clinical progression and survival in HIV-infected patients have been reported. In this study, HIV-infected patients were found to have HIV p24 protein levels inversely proportional to CD4+ T-lymphocyte counts by using Spearman test (R2=0.225; p=0.0331). Studies on the correlation between HIV p24 protein levels and CD4+ T-lymphocyte counts in stage I HIV infection have not yet been reported. The aim of this study was to prove the correlation between HIV p24 protein levels and CD4+ T-lymphocytes in stage I HIV infection. Research issue was whether a correlation between HIV p24 protein levels and CD4+ T-lymphocyte counts in stage I HIVinfection existed ? The hypothesis was that a correlation between HIV p24 protein levels and CD4+ T-lymphocyte counts in stage I HIV infection existed. The study design was cross sectional observational. Subjects consisted of 30 stage I HIV-infected patients treated at the Infectious Disease Intermediate Care Unit, Dr. Soetomo Hospital and VCT Clinic of the Dr. Ramelan Naval Hospital, Surabaya from May to July 2014. Stage I HIV infection is an asymptomatic HIV infection or with persistent generalized lymphadenopathy and the patient is able to perform normal activities. Levels of p24 were measured by ELISA method and CD4+ T-lymphocyte counts using flowcytometry(BD FACSCaliburTM). The results were statistically analyzed using Pearson’s correlation test. HIV p24 protein levels in stage I of HIV infection ranged from 1.8 to 10.8 pg/mL, mean of 5.14 pg/mL and a standard deviation of 2.08 pg/mL. CD4+ T-lymphocyte counts decreased with a range of 49-559 cells /uL for absolute values and 4.42–26.02% for percentage values Correlations between blood p24 levels and CD4+ T-lymphocyte counts either absolute (r=–0.392, p=0.032) or percentage (r=–0.363, p=0.049) were found. In stage I HIV-infected patients, a negative correlation was found between p24 levels and CD4+ T-lymphocyte counts, in both CD4+T-lymphocyte counts as absolute and as well as percentage values. This negative correlation showed that the p24 HIV levels were inversely proportional to the CD4+ T-lymphocyte counts. HIV p24 protein levels have a possibility to be used predicting CD4+ T-lymphocyte counts
 
A lineage switch from Acute Lymphoblastic Leukemia (ALL) to Acute Myeloid Leukemia (AML) is very rare. It was estimated between6− 9% of cases that occurred, especially lineage switch from ALL to Acute Myelomonoblastic Leukemia (AMMOL). The reviewers reporta case of a 26 years old women with the first clinical presentation were fever and double visions and diagnosed as B-Acute lymphoblasticleukemia ALL with CD13 and CD33 expression aberrations, based on Bone Marrow Aspiration (BMA) and immunoprephenotyping inHongkong Hospital. After induction therapy, in the second month, BMA was done and found 10% blast, so it couldn’t be assessed ascomplete remission. After two (2) months, she comes back to Indonesia to follow continuing the treatment. She was suffered from severeheadache and blurred vision. The blast cell morphology of BMA showed myeloblast 25% and monoblast 60%, consistent with the diagnosisof AMMOL. Moreover, both findings were quite specific for each common cell ALL and acute myelomonocytic leukemia. These findingssupport that this case is completely different leukemic clones occurred at each leukemic expression. Exogenic factor such as chemotherapyand endogenic factor due to chromosomal abnormalities is supposed to be the cause of this lineage switch during the treatment.
 
Comparison of API and TDR-300B identification method to VITEK 2 method
Comparison of API manual identification to TDR-300B method
Statistical test for bacterial identification compatibility by Kappa coefficient
Comparison of manual antimicrobial sensitivity test of Kirby Bauer method to TDR-300B and VITEK 2
Angka kematian infeksi aliran darah cukup tinggi, berkisar 20–50%. Patogen penyebab dapat dibuktikan dengan pemeriksaan kulturdarah yang dilanjutkan dengan uji kepekaan antibiotika. Metode pemeriksaan dapat dilakukan secara manual atau automatis baiksemiautomatis ataupun automatis penuh. Metode manual relatif tidak memerlukan biaya yang besar dibandingkan metode automatisasi.Penelitian ini merupakan analisis observasional dengan desain potong lintang. Metode identifikasi manual memakai metode API danuji kepekaan antibiotika metode difusi cakram antibiotika Kirby Bauer. Kedua metode ini dibandingkan dengan metode semiautomatisTDR-300B. Metode automatis penuh VITEK 2 digunakan sebagai metode rujukan untuk menilai kinerja metode konvensional dansemiautomatis. Bakteri penyebab infeksi aliran darah didominasi Gram negatif kebanyakan Eschericia coli dan Klebsiella pneumonia.Ketepatan metode identifikasi API terhadap VITEK 2 sebesar 87,87%, ketepatan identifikasi metode TDR-300B terhadap metode VITEK2 adalah 90,9%. Hasil ketepatan uji kepekaan antibiotika metode konvensional difusi cakram antibiotika Kirby Bauer terhadap metodeVITEK 2 adalah 84,64%. Ketepatan uji kepekaan antibiotika metode TDR-300B terhadap metode VITEK 2 sebesar 82,5%. Ketepatanmetode API terhadap metode TDR-300B sebesar 84,84%. Ketepatan uji kepekaan antibiotika metode konvensional terhadap metodeTDR-300B sebesar 78,21%. Hasil metode identifikasi dan uji kepekaan antibiotika konvensional tidak berbeda bermakna secara statistikdengan metode semiautomatis TDR-300B. Metode identifikasi dan uji kepekaan antibiotika konvensional masih dapat dipercaya terutamauntuk daerah dengan keterbatasan biaya atau pemeriksaan masih sedikit.
 
Systemic Lupus Erythematosus (SLE) adalah penyakit rematik autoimun yang ditandai adanya inflamasi luas, yang mempengaruhisetiap organ atau sistem dalam tubuh. Sklerosis sistemik (skleroderma) adalah penyakit multisistem kronis yang tidak diketahuipenyebabnya, ditandai dengan penebalan kulit akibat penumpukan jaringan ikat disertai kelainan fungsi dan bentuk organ visceral.Seorang perempuan 31 tahun mengalami nyeri jari-jari dan sendi. Lima tahun lalu didiagnosis kusta serta diobati selama satu tahun.Pemeriksaan fisik didapatkan mouse face appearance, teleangiektasis, salt and pepper appearance, sclerodactili, artritis, serta calcinosis.Peregangan dan pengerasan kulit simetris. Hemoglobin menurun, sediaan darah tepi terdapat sebaran roleaux, neutrofilia dan limfositteraktivasi. Indirect Coomb Test (ICT) inkompatibel. SGOT, total protein, globulin meningkat. Anti Ds-DNA meningkat lima kali dan ANAmeningkat dua puluh kali lipat dari batas normal. Diagnosis SLE didasarkan pada peningkatan kadar ANA dan Ds-DNA. Sklerodermadidasarkan pada pemeriksaan fisik, pemeriksaan hematologi dan anti Scl-70 (anti tropoisomerase I)
 
Kanker pankreas adalah keganasan sel di jaringan pankreas. kejadiannya meningkat pada usia di atas 60 tahun. Namun, sekitar20% dapat terjadi di usia muda. Patogenesis terjadinya masih belum jelas, dikemukakan bahwa mutasi genetik dan faktor eksogen sepertimerokok berhubungan dengan terjadinya keganasan sel pankreas. Kasus adalah seorang laki-laki perokok berusia 31 tahun dengankeluhan utama nyeri ulu hati menjalar ke punggung, disertai mual, muntah, nafsu makan turun. Pada pemeriksaan fisik didapatkansklera ikterik, perkusi redup dan ronkhi di paru, distensi abdomen dan asites. Pada pemeriksaan laboratorik didapatkan leukositosis,trombositopenia, peningkatan aspartate aminotransaminase (AST) lebih dari 10 kali Upper Range Limit (URL), hiperbilirubinemiadirek, peningkatan alkaline phosphatase (ALP), Gamma Glutamyl Transferase (GGT) dan lipase serum, sedangkan amilase serumnormal. Terdapat juga peningkatan kadar CA19-9. Pada computed tomography scan (CT scan) dan Magnetic Resonance Imaging (MRI)didapatkan gambaran kanker pankreas primer yang telah bermetastasis ke pleura dan hati. Kadar amilase normal di pasien dapatdisebabkan karena awal peningkatan dan penurunan kadar amilase terjadi lebih cepat dan pada saat diperiksa telah turun mencapaikadar normal. Simpulan, kanker pankreas dapat terjadi di usia muda. Amilase yang normal dapat terjadi di kanker pankreas.
 
Malaria is a parasitic disease worldwide with a high morbidity and mortality. A rapid and accurate methods is needed to detectthe presence of malaria parasites in blood. A flagging system atypical depolarization (atypdep) on CBC result from Cell-Dyn 3200instrument has been related with malaria infection. An observational cross sectional approach with a total of 48 samples were obtainedfrom inpatients in the Dr. Soetomo Hospital Surabaya. Samples were screened with Cell-Dyn 3200 analyzer for CBC found atypdepflagging. The positive samples were later confirmed by microscopic to detect malaria parasites. From 48 samples with atypdep flagging,seven samples were positive of malaria in peripheral blood smear (13.1%). Most frequent atypdep flagging was seen in malignant disease(18.7), an approximately 54.6% of the sample is not accompanied by symptoms of fever. Lekositosis and anemia were found in each of20 samples (41.6%) and thrombocytopenia in 33.3% of the samples. The presence of atypdep flagging does not necessarily indicate theexistence of malaria infection or it could be said that atypdep flagging is not always associated with the presence of malaria infection.The usage of an atypdep flagging on Cell-Dyn instrument in non-endemic areas such as Surabaya is just an alert sign to evaluate themalaria infection rather than a screening method to detect malaria.
 
Scatterplot graph of the correlation between IL-34 level and Mex-SLEDAI
Disease activity in SLE patients based on Mex-SLEDAI score
Correlation between IL-34 Level and Mex-SLEDAI score
Comparison of IL-34 level according to the disease activity in SLE patients based on Mex-SLEDAI score
Systemic Lupus Erythematosus (SLE) is characterized by exacerbation and remission, which needs close monitoring ofthe disease activity. Systemic lupus erythematosus disease activity can be determined by the SLE Disease Activity Index(SLEDAI) score. Evaluation of the disease activity is essential to be a guidance for treatment. Interleukin-34 (IL-34) is relatedto the pathogenesis of SLE. Serum IL-34 can be a candidate marker to evaluate SLE disease activity, and it is correlated withthe SLEDAI score. This study aimed to determine the correlation between IL-34 level and disease activity in SLE patientsbased on the SLEDAI (Mex-SLEDAI) score. An observational analytical study with a cross-sectional design was carried out insix months (June-November 2019) in 27 SLE patients in the Department of Internal Medicine, Faculty of Medicine, SumateraUtara University/Adam Malik General Hospital, Medan. Systemic lupus erythematosus disease activity was measured basedon the Mex-SLEDAI score. Serum and urine were collected to obtain the Mex-SLEDAI score and IL-34 level. IL-34 level wasmeasured in all subjects by using Enzyme-Linked Immunosorbent Assay (ELISA). Spearman correlation test was used todetermine the correlation between IL-34 level and disease activity in SLE patients based on the SLEDAI (Mex-SLEDAI) score.There was a significant correlation between IL-34 level and disease activity in SLE patients based on SLEDAI (Mex-SLEDAI)score (r=0.965, p < 0.001). Further studies were needed with a sample of SLE patients in a balanced proportion based ontheir disease activity to obtain representative IL-34 levels in SLE patients based on their disease activity.
 
The efficacy of Bacillus Calmette-Guerin (BCG), vaccine against tuberculosis (TB), varies widely, from 0 to 90%; and BCG mainly activates CD4+ T cells, but it fails to activate CD8+ T cells. From the previous study, 38-kDa protein is an adhesin protein. CD8+ T cells play the role in controlling Mycobacterium tuberculosis (M.tb) infection and contribute to the memory immunity. The objective of this study was to determine effect of oral immunization by 38-kDa adhesin protein of M.tb to increase the level of CD8+ T cells in the lung of BALB/c mice. This study used an experimental with post test control group design. The mice were divided into six groups (each group consist of 4 samples), where Group 1: were immunization orally with 100 μg 38-kDa adhesin protein of M.tb and 12 μg ISCOMs. Followed by group 2: 100 μg 38-kDa adhesin protein of M.tb, group 3: 50 μg 38-kDa adhesin protein of M.tb and 12 μg ISCOMs, and group 4: 50 μg 38-kDa adhesin protein of M.tb. Group 5: 12 μg ISCOMs. Group 6: Control. In this study was found increased level of CD8+ T cells in the lung of BALB/c mice after orally immunization with 38-kDa adhesin protein of M.tb. The highest level of CD8+ T cells was on group 1, p=0.000. Also there were found significant differences among the immunized groups, except group 2 and 3, as well as group 5 and 6 also. It can be concluded in this study that oral immunization with 38-kDa adhesin protein of M.tuberculosis could increase the level of CD8+ T cells in the lung of BALB/c mice.
 
Tuberculosis (TB), caused by Mycobacterium tuberculosis (M.tb), is one of the world health problems. Oral vaccination of M.tb hasa potential to reduce the risk and complication of TB. The 38-kDa adhesin protein as one of oral TB vaccine candidates has not beenproven. This study is aimed to determine M.tb 38-kDa adhesin protein effect on macrophage and lymphocyte numbers in mice intestineafter an oral administration. BALB/c mice (n=20), age 6–8 weeks, and were divided into 4 groups: control (K), adjuvant (A), 38-kDa100μg adhesin protein (P), and combination of 100μg 38-kDa adhesin protein with adjuvant (PA). An oral administration was givenat the beginning with 2 boosters every 4 weeks. After 3 days of the second booster, the mice were killed and the intestine was taken andstained with haematoxylin eosin (HE) to measure its macrophages and lymphocytes number. The mean ±2SD were 18.4 (3.71) and6.09 (0.34), 23.0 (7.78) and 8.86 (1.19), 42.2 (13.63) and 23.49 (3.91), 95.4 (30.11), and 53.57 (13.79) respectively for K, A, Pand PA group. The statistical test showed a significant difference among each group revealing the role of M.tb 38-kDa adhesin proteinas immunogenic inducing cellular immunity in intestine. In this study, so far it was found that the oral administration of M. tb 38-kDaadhesin protein has an ability to increase macrophage and lymphocyte numbers in the mice intestinal BALB/c.
 
Tuberculosis remains a serious global health problem despite the widespread use of the vaccine against tuberculosis (TB). Up tonow, the only available TB vaccine, Mycobacterium bovis BCG has a very wide efficacy range from 0 until 80 percent protection sothe development of a new vaccine is needed. The new protein as a candidate vaccine should be assessed for their immunogenicity. Thepurpose of this study was to examine whether Mycobacterium tuberculosis 38 kDa recombinant protein could stimulate a cellularimmune response especially CD3+T lymphocytes to express IL-2 and IL-4 in PBMC cultures. An experimental laboratory research oncultured PBMC of 3 groups consisting of TB patients, contacts of TB positive and healthy subjects, each group consisted of 8 subjects. AllPBMC cultures were induced by Mycobacterium tuberculosis 38 kDa recombinant protein, Purified Protein Derivative (PPD) and withoutantigen as a control. Expression of IL-2 and IL-4 CD3+ T lymphocytes was measured with flowcytometry. In healthy volunteers and TBcontacts there was a significant difference in the expression of IL-2 and IL-4 CD3+ T lymphocytes compared with no any treatment. Thehighest IL-2 expression was in healthy subjects [8.13 (0.622)] while the highest expression of IL-4 was in TB patients [6.436 (4.586)].Mycobacterium tuberculosis 38 kDa recombinant protein could induce the expression of IL-2 and IL-4 of CD3+ T lymphocytes in healthysubjects, TB contacts and TB patients and there were a significance differences in the expression of all groups.
 
Tuberculosis (TB) in Indonesia is at the third level in the world. The effectiveness of TB vaccine in lung TB. prevention varies, thus,this has motivated the researcher to explore based material of vaccine with a higher effectivity. One of the alternate vaccines that hasdeveloped, is the sub unit one made from adhesin protein. The aim of this study was to know the kind of oral administration of 38 kDaadhesin protein of M. tuberculosis in determining so that it can increase the level of macrophage in lungs of BALB/c mice. This study wasan experimental work using BALB/c male mice that were immunized with 38 kDa adhesin protein of Mycobacterium tuberculosis orally.The samples were chosen at random and divided into six (6) groups that consisted of: “100 μg protein +adjuvant ImmunostimulatingComplex (ISCOM)” group (n=5), “50 μg + adjuvant ISCOM” group (n=5), “100 μg” group (n=5), “50 μg” group (n=5), “ISCOM” group(n=5) and “negative control” group (n=5). The measurement of the variable in this study was the number of macrophages . The resultsshowed that the increasing number of macrophage had significant differences between each group. ANOVA test showed a significant levelat p<0.05. The conclusion of this study was that 38 kDa adhesin protein of M. tuberculosis peroral could increase the level of macrophagein the lung of BALB/c mice. The highest level of macrophages was the group induced by 100 μg 38 kDa adhesin protein of M. tuberculosisand adjuvant ISCOM.
 
Tuberculosis remains a serious global health problem despite the widespread use of the vaccine against tuberculosis (TB). Up to now, the only available TB vaccine, Mycobacterium bovis BCG has a very wide efficacy range from 0 until 80 percent protection so the development of a new vaccine is needed. The new protein as a candidate vaccine should be assessed for their immunogenicity. The purpose of this study was to examine whether Mycobacterium tuberculosis 38 kDa recombinant protein could stimulate a cellular immune response especially CD3+T lymphocytes to express IL-2 and IL-4 in PBMC cultures. An experimental laboratory research on cultured PBMC of 3 groups consisting of TB patients, contacts of TB positive and healthy subjects, each group consisted of 8 subjects. All PBMC cultures were induced by Mycobacterium tuberculosis 38 kDa recombinant protein, Purified Protein Derivative (PPD) and without antigen as a control. Expression of IL-2 and IL-4 CD3+ T lymphocytes was measured with flowcytometry. In healthy volunteers and TB contacts there was a significant difference in the expression of IL-2 and IL-4 CD3+ T lymphocytes compared with no any treatment. The highest IL-2 expression was in healthy subjects [8.13 (0.622)] while the highest expression of IL-4 was in TB patients [6.436 (4.586)]. Mycobacterium tuberculosis 38 kDa recombinant protein could induce the expression of IL-2 and IL-4 of CD3+ T lymphocytes in healthy subjects, TB contacts and TB patients and there were a significance differences in the expression of all groups
 
Tuberculosis (TB) is caused by Mycobacterium tuberculosis (M.tb) and is one of the significant mortality causes WHO (2012). Theprimary immune response in TB pathogenesis is Cell Mediated Immunity (CMI), roled by T lymphocytes. Interleukin-2 (IL-2) is a growthfactor for T lymphocytes. Gamma Interferon is the key cytokine in M.tb infection control, synthezised by T lymphocytes. An effectivevaccination strategy is achieved by giving vaccine which is able to stimulate T lymphocytes in synthezising cytokines. The 38 kDa M.tbprotein is potential in the vaccine development program, because it has specific epitopes for T lymphocytes. The aim of this study was toknow how to determine that the 38 kDa recombinant protein of M.tb Malang strain could induce cellular immune response by IL-2 andIFN-γ synthezised by T lymphocytes. The study was carried out by an experimental in vitro study on PBMC from healthy endemic subjects,those having TB contact, and the TB patients themselves. PBMC from subjects was cultured with 38 kDa recombinant protein of M.tbMalang strain, with PPD and without any protein. The analysis of IL-2 and IFN-γ used flowcytometry. The result showed that the highestpercentage of IL-2 was found in the culture with 38 kDa recombinant protein of M.tb Malang strain, in healthy endemic (p=0.000)and in those who had TB contact (p=0.000). the highest percentage of IFN-γ was found in the culture with 38 kDa recombinant proteinof M.tb Malang strain, in healthy endemic (p=0.007) and those who had TB contact (p = 0.105). The 38 kDa recombinant proteinof M.tb Malang strain was able to induce IL-2 and IFN-γ synthezised by TCD3+ lymphocytes from healthy endemic subjects and thosewho had TB contact.
 
Characteristics of the research subjects
Mean of 38 kDa antigen level in urine and serum
Diagnosis TB anak sangat sukar karena gambaran klinis tidak khas, foto paru juga sulit diinterpretasi. Di anak sulit mendapatkandahak, jarang batuk dan jumlah kumannya sedikit. Deteksi antigen Mycobacterium tuberculosis merupakan sebuah pilihan yang tersediauntuk mendiagnosis TB. Teknik diagnosis TB secara serologis dan air kemih memberi banyak keuntungan karena mudah dikerjakan,biaya murah, cepat memberikan hasil dan mudah didapatkan, tidak menyakitkan serta tidak memerlukan spesimen dari jaringan yangsakit. Antigen 38 kDa merupakan antigen lipoprotein ekstraselular Mycobacterium sp memiliki potensi imunogen. Tujuan penelitian iniadalah membandingkan nilai diagnostik antigen 38 kDa Mycobacterium tuberculosis air kemih dan serum di tuberkulosis anak. Metodepenelitian merupakan kajian potong lintang dengan pengambilan sampel secara berurutan (Juni 2013-Juni 2014). Subjek penelitiansebanyak 54 anak yang terduga TB. Dilakukan pemeriksaan kadar antigen 38 kDa Mtb air kemih dan serum dengan metode ELISA.Hasil telitian ini didapatkan rerata kadar antigen 38 kDa air kemih dan serum subjek dengan TB lebih tinggi dibandingkan kelompokbukan TB, rerata/Simpang Baku (SD) antigen 38 kDa Mtb air kemih [0,25(0,388)] vs [0,03(0,011)] p=0,002, AUC (84,3%), Cut-offpoint: 0,04 ng/mL (kepekaan 83% dan kekhasan 71,43%) dan antigen 38 kDa Mtb serum [14,21(13,335)] vs [4,189(0,386)] p=0,263,AUC (63,5%), Cut-off point: 4,25 ng/mL (kepekaan 53,2% dan kekahasan 57,1%). Antigen 38 kDa Mtb air kemih lebih baik daripadaantigen 38 kDa Mtb serum untuk mendiagnostik tuberkulosis anak.
 
Retinol is one of the active forms of vitamin A. In the previous study, it was known that retinol level in serum of DM patient waslower than in healthy people, which correlated with an increase of the glucose levels in these patients. The importance of retinol in insulinsignaling mechanisms that play a role in the pathogenesis of DM is still unknown. One of the components that play a role in insulinsignaling on adipocytes is phosphatidylinositol-3 kinase (PI3K), which encourages the translocation of glucose transporter-4 (GLUT4) tothe cell surface. The aim of this study was to know the importance of retinol therapy in the levels of PI3K enzyme on visceral adipocyteculture with high glucose exposure (25 mM) as a model of DM in vitro by determination method. Retinol therapy was given at a doseof 0.1 μM, 1 μM , and 10 μM. Measurement of PI3K level was done by ELISA method. The mean (SD) levels of PI3K enzyme were 1.91(0.27), 0.94 (0.15), 1.98 (0.22), 1.69 (0.81), 2.04 (0.16) ng/mL respectively, for adipocyte cultures exposed to 5mM glucose (as aphysiological condition), 25mM glucose, and 25mM glucose concentration with doses of retinol therapy 0.1 μM, 1 μM and10 μM. Theresults of this study indicated that high glucose exposure (25 mM) decreased the level of PI3K compared with adipocyte’s culture on5 mM glucose exposure. Retinol therapy with a dose of 0.1μM, 1μM and10 μM on adipocyte culture exposed with high glucose couldincrease the levels of PI3K.
 
Prothrombin Time (PT) and an activated Partial Thromboplastin Time (aPTT) are routine coagulation tests used for pre-operative screening. The analytical step as one of the laboratory test’s stage that plays the role in the determination of the test is influenced by several factors, one of them is choosing its proper devices. The aim of this study was to know the correlation of the PT and aPTT test’s result using Humaclot VA and Sysmex CA 500 devices. A cross sectional study has been done at the Clinical Pathology Laboratory of Wahidin Sudirohusodo Hospital Makassar started from May 2009 until June 2009. The data were analyzed with T and Pearson’s Correlation test. From the 50 samples were obtained the percentage of the corresponding frequency of the PT results between Humaclot VA and Sysmex CA 500 about 84%, whereas the frequency of the corresponding results aPPT between Humaclot VA and Sysmex CA 500 is 76%, the Pearson correlation test for PT=0.58, and aPTT=0.38. There were found the suitability of PT, aPTT of Humaclot VA with CA 500 and both tools have a positive correlation.
 
Gambar 1. Bagan hasil meneliti
The early diagnosis of definite tuberculous meningitis (TBM) is very important in reducing its mortality. The current gold standard ofTBM relies on the isolation of M. tuberculosis from cerebrospinal fluid (CSF) either with direct staining or M. tuberculosis culture, but theseexamination have a low sensitivity due to the pausibasilary condition. Recently there is an assay using rapid Immunochromatography(ICT) cocktail antigen TB in CSF to diagnose TBM. This method can detect ESAT-6, CFP-10 and MPT-64 antigen as an important virulencefactor for the spreading of bacteria to extra pulmonary which is secreted by M. tuberculosis in CSF from TBM patient. The aim of thisstudy was to know the validity of rapid ICT cocktail antigen TB using CSF against MODS culture and acid-fast bacili as a gold standardto diagnose TBM by analyzing. This study iscarried out by a descriptive observational study using cross sectional study design. Thesubjects are patients who were diagnosed as suspected TBM based on Marais criteria and were obtained from the Department of NeurologyHospital Dr. Hasan Sadikin. The examination was done at the Clinical Microbiology Department of Clinical Pathology Dr. Hasan Sadikinhospital since January 2014 until May 2014. A total of 41 subjects which consisted of six (6) subjects with a definite diagnosis of TBM,26 with probable TBM and nine (9) with possible TBM were enrolled in this study. The result of this assay againts acid-fast bacili has the100% sensitivity, 64.1% specificity, 12.5% PPV, 100% NPV, LR(+) 2.78, LR(–)0 and 65.8% accuracy. The result of this assay againtsM. tuberculosis culture has the 83.3% sensitivity, 68.5% specificity, PPV 31.2%, NPV 96%, LR(+) 2.65, LR(–)0.24, accuracy 70.7% andprevalence ratio 7.8. Based on this study, it can be concluded that the validity of this assay againts acid-fast bacili has a high sensitivity,moderate specificity, low PPV, high NPV and moderate accuracy. The result of this assay againts M. tuberculosis culture has a moderatesensitivity and specificity, low PPV, high NPV and moderate accuracy.
 
Penyakit kardiovaskular adalah salah satu penyebab terbesar kematian di dunia, termasuk di Indonesia. Salah satunya adalahpenyakit jantung koroner yang disebabkan adanya aterosklerosis. Perlu adanya petanda pengganti proses aterosklerosis sebagai faktorkebahayaan dan sebagai peramal aterosklerosis dan PJK. Apo B dan rasio Apo B/Apo A-I dianggap sebagai petanda yang terbaik. Tujuanpenelitian untuk mengetahui rasio Apo B/Apo A-I di pasien PJK dengan stenosis lebih besar atau sama dengan 70% dan lebih kecil 70%.Metode penelitian dengan potong lintang di 69 pasien PJK, yaitu 46 pasien PJK dengan stenosis lebih besar atau sama dengan 70% dan23 pasien PJK dengan stenosis lebih kecil 70% di Departemen Kardiologi FK. USU/RSUP H. Adam Malik Medan bekerja sama denganDepartemen Patologi Klinik FK. USU/RSUP. H Adam Malik Medan masa waktu Juli 2015 sampai dengan November 2015. Hasil telitiandidapatkan kadar Apo B di pasien PJK dengan stenosis lebih besar atau sama dengan 70% adalah 115,63±30,96 dan pasien PJK denganstenosis lebih kecil 70% adalah 96,43±25,62 dengan nilai p=0,013. Kadar Apo A-I di pasien PJK dengan stenosis lebih besar atau samadengan 70% adalah 148,30±26,80 dan pasien PJK dengan stenosis lebih kecil 70% adalah 173,74±32,33 dengan nilai p=0,001. RasioApo B/Apo A-I di pasien PJK dengan stenosis lebih besar atau sama dengan 70% adalah 0,79±0,20, rasio Apo B/Apo A-I di pasienPJK dengan stenosis lebih kecil 70% adalah 0,55±0,14 dengan nilai p=0,0001. Dari hasil telitian dapat disimpulkan, bahwa terdapatperbedaan bermakna kadar Apo B, Apo A-I serta rasio Apo B/Apo A-I di pasien PJK dengan stenosis lebih besar atau sama dengan 70%dan pasien PJK dengan stenosis lebih kecil 70%.
 
Reagent selection is one of the factors that could influence the quality of laboratory results. The use of open system tools gives thepossibility to choose the best reagents, including the reagent for high density lipoprotein (HDL) determination. The aim of this studywas to compare HDL level determination using two different reagents measured by Hitachi 902. A cross sectional study was done fromJanuary to February 2007 in Ratulangi Medical Centre Laboratory, Makassar. From 47 samples we found that the mean HDL levelusing Daichi reagent was 50.47 mg/dl ranging from 45.99 mg/dl to 54.94 mg/dl and the mean using Roche reagent was 56.23 mg/dlranging from 50.93 mg/dl to 61.53 mg/dl with p = 0.098, and Pearson Correlation was 0.900 with p = 0.000. There was no significantdifference between HDL level measured by Hitachi 902 using Daichi and Roche reagents.
 
Hemoglobin glikasi (HbA1c) telah diakui secara luas sebagai petanda biologis peramal untuk keparahan Diabetes Melitus (DM).Hemoglobin glikosilasi (HbA1c) adalah petanda biologis penting yang mencerminkan kepekatan glukosa plasma puasa dan postprandialselama 120 hari sebelumnya. Telah dianggap sebagai alat penting dalam diagnosis dan manajemen diabetes. Peningkatan kadar HbA1cberarti resistensi insulin jangka panjang dan konsekuensi berat adanya hiperglikemia, dislipidemia, hiperkoagulabilitas dan responsinflamasi. Terdapat hubungan positif antara HbA1c tinggi dan hasil yang buruk pada DM, penyakit kardiovaskular (CVD) dan inflamasi.HbA1c adalah petanda biologis peramal tidak hanya di DM, tetapi juga untuk CVD dan inflamasi.
 
Pasien diabetes melitus tipe 2 berkebahayaan mengalami komplikasi makro dan mikrovaskuler, yang dipengaruhi oleh kendaliglikemik. Reaktivitas trombosit berperan pada timbulnya komplikasi ini, terutama komplikasi kardiovaskuler. Tujuan penelitian iniadalah membandingkan MPV dan IPF di kendali glikemik baik dan buruk dan menentukan adanya kenasaban MPV dan IPF terhadapHbA1c. Penelitian bersifat analitik observasional dengan rancang bangun potong lintang. Sampel darah EDTA dari 43 orang pasienDM tipe 2, dikumpulkan selama Januari-Februari 2016. HbA1c diperiksa dengan Dimension RxL, sedangkan MPV dan IPF diperiksadengan Sysmex XN-1000. Rerata nilai MPV 10,36±0,84 fL, rerata nilai IPF 4,22±2,29%. Uji perbedaan nilai MPV menurut kendaliglikemik didapatkan p=0,494, uji perbedaan IPF didapatkan p=0,462. Uji kenasaban Pearson antara IPF dan MPV didapatkanr=0,877 (p<0,0001), MPV dan HbA1c didapatkan r=0,018 (p=0,907), IPF dan HbA1c didapatkan r=0,128 (p=0,414). Penelitian inimenunjukkan rerata MPV berada dalam rentang normal, sedangkan rerata IPF meningkat, namun tak terdapat perbedaan bermaknanilai MPV dan IPF di kendali glikemik baik dan buruk. MPV dan IPF pada penelitian ini tak bernasab dengan HbA1c.
 
Top-cited authors
Aryati Aryati
Uleng Bahrun
  • Universitas Hasanuddin
Osman Sianipar
  • Universitas Gadjah Mada
Ida Parwati
  • Faculty of Medicine Universitas Padjadjaran
Jusak Nugraha