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All Journal Majalah Kedokteran Bandung Paediatrica Indonesiana
Reni Ghrahani
Department of Child Health Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital Bandung, Indonesia
Health Professions Medicine & Pharmacology

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Strong Positive Correlation between Neutrophil-to-lymphocyte Ratio and C-reactive Protein in Early Onset Sepsis Ghrahani, Reni; Yuniati, Tetty; Judistiani, Raden Tina Dewi; Setiabudiawan, Budi
Majalah Kedokteran Bandung Vol 51, No 4 (2019)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v51n4.1421

Abstract

Sepsis is a life-threatening disease with a high number of mortality in premature infants. Premature infants have immature immune systems, with less pool neutrophils and imperfect ability to destroy pathogen. Neutrophil function is  supported by lymphocyte’s ability to form antibody or specific cell-surface receptors for particular antigens. This underlies the use of neutrophil-to-lymphocyte ratio (NLR) as an inflammation marker to detect and assess the severity of sepsis. C-reactive protein (CRP) is known as an acute phase reactant. Neutrophil-to-lymphocyte ratio is an easier, fast, and inexpensive method when compared to CRP. The aim of this study was to evaluate the correlation between NLR and CRP in detecting early-onset sepsis (EOS) in premature infants. A cross-sectional study was conducted on 53 premature infants born and hospitalized in a hospital in Indonesia who were recruited during the period of April to October 2018.  Blood was sampled from the umbilical cord at birth for laboratory examination. The NLR was determined as the ratio of neutrophil to lymphocyte count. The Tollner scoring system was used to identify sepsis. Mann Whitney-U test and Spearman Correlation test were computed for the statistical analysis. neutrophil-to-lymphocyte ratio which results showed a strong positive correlation with CRP (r= 0.702, 0=0.001) in premature infants with EOS. Leukocyte count was lower in infants with EOS than those without EOS group (median; IQR, x103: 8.9 (6.3-13.8) vs 12.5 (10.1- 16.1); p=0.016). Neutrophil-to-lymphocyte ratio and CRP tended to be lower in EOS group when compared to  that of the non-EOS group. In conclusion, NLR has a strong positive correlation with CRP in premature infants with EOS. Korelasi Positif Kuat antara Neutrophil-to-lymphocyte dan C-reactive protein pada Sepsis Awitan DiniSepsis pada bayi prematur adalah keadaan mengancam jiwa dengan mortalitas tinggi. Bayi prematur memiliki sistem imun imatur, sedikit persediaan neutrofil serta fungsi  belum sempurna untuk melawan patogen. Fungsi neutrofil didukung limfosit membuat antibodi serta reseptor permukaan spesifik untuk antigen tertentu. Neutrophil-to-lymphocyte ratio (NLR) diajukan untuk petanda inflamasi, mendeteksi dan menentukan derajat sepsis, sedangkan C-reactive protein (CRP) telah diketahui sebagai protein fase akut. Neutrophil-to-lymphocyte ratio adalah pemeriksaan yang lebih mudah, cepat, murah dibandingkan dengan CRP. Penelitian potong lintang ini bertujuan mengevaluasi korelasi NLR dengan CRP untuk mendeteksi sepsis awitan dini pada 53 bayi prematur, yang lahir dan dirawat di rumah sakit kami, selama April-Oktober 2018. Sampel darah dari tali pusat pada saat lahir. Neutrophil-to-lymphocyte ratio adalah rasio jumlah neutrofil terhadap limfosit. Skoring Tollner digunakan untuk mengidentifikasi sepsis. Analisis statistik menggunakan Uji Mann-Whitney dan korelasi Spearman. Korelasi positif antara NLR dengan CRP di antara bayi prematur dengan sepsis awitan dini adalah r=0,702, p=0,001. Bayi dengan sepsis awitan dini memiliki jumlah leukosit lebih rendah dibanding bayi non-sepsis (median; IQR, x103: 8,9 (6,3-13,8) vs 12,5 (10,1- 16,1); p=0,016). Neutrophil-to-lymphocyte ratio dan CRP lebih rendah pada kelompok sepsis dibanding non-sepsis. Simpulan, NLR memiliki korelasi positif kuat dengan CRP pada bayi prematur dengan sepsis awitan dini.
Distribusi Subtipe Juvenile Idiopathic Arthritis di Bandung Ghrahani, Reni; Setiabudiawan, Budi; Sapartini, Gartika; Puspasari, Hesti
Majalah Kedokteran Bandung Vol 44, No 2 (2012)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Juvenile idiopathic arthritis (JIA) merupakan penyakit reumatik kronik tersering pada anak yang terjadi sebelum usia 16 tahun. Penelitian ini bertujuan mengevaluasi profil penderita yang didiagnosis JIA. Dilakukan penelitian deskriptif retrospektif terhadap penderita JIA yang datang ke Divisi Alergi Imunologi Departemen Ilmu Kesehatan Anak Rumah Sakit Dr. Hasan Sadikin Bandung pada periode Januari 2006–Oktober 2011 berdasarkan rekam medis. Didapatkan 28 penderita JIA terdiri atas 10 anak laki-laki dan 18 anak perempuan, dengan rentang usia 2–14 tahun, usia rata-rata 8,25±3,62 tahun. Sebanyak 14 penderita JIA merupakan tipe oligoartritis persisten, 6 tipe sistemik, 5 tipe poliartritis, dan terdapat 1 orang penderita poliartritis tipe dewasa. Pada pemeriksaan laboratorium, didapatkan 2 penderita dengan faktor reumatoid positif dan 14 penderita negatif. Terapi yang diberikan obat antiinflamasi nonsteroid sebagai protokol terapi standar, steroid, dan disease modifying anti-rheumatic drugs (metotreksat). Terdapat 3 penderita meninggal yang semuanya merupakan tipe sistemik. Simpulan, sebagian besar JIA merupakan tipe oligoartritis persisten, lebih banyak ditemukan pada anak perempuan dibandingkan dengan laki-laki. Kasus kematian terjadi pada JIA tipe sistemik. Sebagian besar penderita memberikan respons yang baikterhadap protokol terapi standar. [MKB. 2012;44(2):101–5].Kata kunci: Anak, juvenile idiopathic arthritis, subtipe Distribution of Juvenile Idiophatic Arthritis Subtypes in BandungJuvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children which begin before 16 years of age. The objective of this study was to evaluate the profile of patients who diagnosed as JIA. The descriptive retrospective study was done to patients with JIA who came to Allergy Immunology Division, Department of Child Health Dr. Hasan Sadikin Hospital Bandung during January 2006–October 2011 period, based on the medical records. There were 28 patients with JIA consisted of 10 boys and 18 girls, age ranged 2–14 years, with mean age of onset of 8.25±3.62 years. There were 14 patients with persistent oligoarthritis type, 6 patients with systemic type, 5 patients with polyarthritis type and 1 patient with polyarthritis adult type. The laboratory data showed 2 patients with positive rheumatoid factor and 14 patients were negative. Non-steroidal anti-inflammatory drugs >as standard protocol therapy, steroids and disease modifying anti-rheumatic drugs (methotrexate) were used for treatment. There were 3 patients with systemic type death. In conclusions, most of JIA cases were persistent oligoathritis type, girls more than boys, and all death cases were systemic JIA. Most of cases had satisfactory therapeutic outcomes with standard protocol therapy. [MKB. 2012;44(2):101–5].Key words: Children, juvenile idiopathic arthritis, subtypes DOI: http://dx.doi.org/10.15395/mkb.v44n2.78
Pola Antibodi Antinuklear Sebagai Faktor Risiko Keterlibatan Sistem Hematologi Lupus Eritematosus Sistemik pada Anak Ghrahani, Reni; Setiabudiawan, Budi; Sapartini, Gartika
Majalah Kedokteran Bandung Vol 47, No 2 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Lupus eritematosus sistemik (LES) adalah penyakit autoimun kronik yang melibatkan berbagai sistem organ ditandai dengan produksi berbagai autoantibodi. Penyakit ini memiliki manifestasi klinis yang sangat bervariasi. Antibodi antinuklear diketahui memiliki pola-pola tertentu yang diduga berkorelasi dengan keterlibatan sistem organ tertentu pada LES. Penelitian ini dilakukan untuk melihat hubungan pola antibodi antinuklear (ANA) dengan  keterlibatan berbagai sistem organ pada anak yang menderita LES. Studi potong lintang dilakukan terhadap 93 anak dengan diagnosis LES yang datang ke Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Padjajaran/Rumah Sakit Dr. Hasan Sadikin Bandung, pada periode September 2006–April 2015. Analisis data dilakukan dengan uji chi kuadrat dan uji-t. Subjek terdiri atas 85 (91%) perempuan dan 8 (9%) laki-laki, dengan rasio perempuan:laki-laki adalah 10,6:1. Usia rata-rata adalah 10,5±3 tahun dan rentang usia 2–17 tahun. Pola ANA terbanyak adalah speckled (58%) dan homogen (19%). Subjek dengan pola ANA homogen lebih berisiko mengalami keterlibatan hematologi yaitu anemia (OR 4,8; IK 95%: 1,1–19) dan leukopenia (OR 3,9; IK 95%: 2,0–7,5) dibanding subjek dengan pola ANA bukan homogen. Tidak didapatkan hubungan pola ANA dengan keterlibatan sistem organ lain. Titer antidsDNA pada subjek dengan pola ANA homogen lebih tinggi dibanding subjek dengan pola ANA bukan homogen (p=0,02). Simpulan, subyek dengan pola ANA homogen memiliki risiko lebih besar mengalami keterlibatan hematologi dibanding dengan pola ANA yang lain. [MKB. 2015;47(2):124–28]Kata kunci: Keterlibatan sistem organ, lupus eritematosus sistemik, pola antibodi antinuklear (ANA)Antinuclear Antibody Pattern as a Risk Factor in Hematological System Involvement in Pediatric Systemic Lupus ErythematosusAbstractSystemic lupus erythematosus (SLE) is a chronic autoimmune disease that can involve any organ system with the evidence of autoantibody production. The disease has a wide range of clinical manifestation. Antinuclear antibody is known to have particular staining patterns and suspected have a correlation with multiorgan involvement. The objective of this study was to define  antinuclear antibody (ANA) staining pattern correlation from multiorgan involvement in 93 children with SLE. This was a cross-sectional study conducted at the Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital Bandung during the period of September 2006 to April 2015. Data were analyzed using chi-square test and t-test. This study involved 93 children with SLE, consisted of 85 (91%) females and 8 (9%) males, with a ratio of 10.6:1. Mean age was 10.5±3 years with age range of 2 to 17 years. The most frequent ANA staining patterns were speckled (58%) and homogenous (19%). Subjects with homogenous pattern have a higher hematology involvement risk, which are anemia (OR: 4.8, CI 95%, 1.1–19) and leukocytopenia (OR 3.9, 95% CI 2.0–7.5). Subjects with homogenous ANA pattern had a higher titer of anti-dsDNA than those with other patterns (p=0.02). In conclusion, subjects with homogenous pattern have a higher hematology involvement risk. [MKB. 2015;47(2):124–28]Key words: Antinuclear antibody staining pattern, multisystem organ involvement, systemic lupus erythematosus  DOI: 10.15395/mkb.v47n2.571
Kadar IgE Total pada Anak Obesitas Dengan atau Tanpa Riwayat Penyakit Atopik dalam Keluarga Setiabudiawan, Budi; Ghrahani, Reni; Sapartini, Gartika; Rayani, Putria; Amelinda, Citra
Majalah Kedokteran Bandung Vol 45, No 2 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (721.139 KB)

Abstract

Prevalensi obesitas dan penyakit atopik anak, khususnya usia sekolah meningkat pada dekade terakhir ini. Penyakit atopik diperantarai oleh IgE serta dipengaruhi faktor genetik dan lingkungan. Resistensi leptin pada obesitas berkaitan dengan stimulasi TH2 yang berpengaruh pada produksi IgE. Tujuan penelitian ini yaitu untuk mengetahui hubungan kadar IgE total dengan obesitas pada anak dengan atau tanpa riwayat penyakit atopik dalam keluarga. Penelitian potong lintang ini dilaksanakan pada periode April–September 2010 yang melibatkan 160 anak usia 6–11 tahun pada beberapa sekolah dasar di Bandung. Terdapat 4 kelompok yaitu kelompok 1: obesitas dengan riwayat penyakit atopik dalam keluarga, 2: gizi normal dengan riwayat penyakit atopik dalam keluarga, 3: obesitas tanpa riwayat penyakit atopik dalam keluarga, 4: gizi normal tanpa riwayat penyakit atopik dalam keluarga. Pemeriksaan kadar IgE total dengan metode Electro-chemiluminescene Immunoassay (ECLIA). Kemaknaan data kategorik diuji dengan Uji chi-kuadrat, berdasarkan p<0,05. Kadar IgE total tinggi pada tiap kelompok masing-masing 30 (83%), 24 (60%), 21 (54%), dan 11 (28%) anak (p<0,001). Pada kelompok riwayat penyakit atopik dalam keluarga, kadar IgE total tinggi pada anak obesitas lebih banyak [30 anak (83%)] dibandingkan dengan gizi normal [24 anak (60%)] (p=0,025). Pada kelompok tanpa riwayat penyakit atopik dalam keluarga, kadar IgE total tinggi pada anak obesitas [21 anak (54%)] lebih banyak dibandingkan dengan gizi normal [11 anak (28%)] (p=0,017). Disimpulkan kadar IgE total tinggi lebih banyak pada anak obesitas dibandingkan dengan gizi normal dengan dan tanpa riwayat penyakit atopik dalam keluarga. [MKB. 2013;45(2):130–34]Kata kunci: Anak, IgE total, obesitas, riwayat atopik keluargaTotal IgE Levels in Childhood Obesity With or Without Family Historyof Atopic DiseaseThe prevalence of obesity and atopic disease in children, especially at school age increased in the last decade. Diseases mediated by IgE and atopy were influenced by genetic and environmental factors. Leptin resistance in obesity is associated with stimulation of TH 2 which affects the production of IgE. The purpose of this study was to determine the relationship of total IgE levels with obesity in children with or without family history of atopic disease. A cross-sectional study was conducted in the period April-September 2010, which involved 160 children aged 6–11 years at several elementary schools in Bandung. There are 4 groups: group 1: obese with family history of atopic disease, 2: normal nutrition with family history of atopic disease, 3: obese without family history of atopic disease, 4: normal nutrition without family history of atopic disease. Examination of total IgE levels were done by ECLIA method. Significance categorical data were tested by Chi-Square test, based on p <0.05. High total IgE levels in each group, respectively 30 (83%), 24 (60%), 21 (54%), and 11 (28%) children (p<0.001). In the group with family history of atopic disease, total IgE levels in obese children were higher [30 children (83%)] compared with normal nutrition [24 children (60%)] (p=0.025). In the group without family history of atopic disease, high total IgE levels in obese children [21 children (54%)] were higher than the normal nutrition [11 children (28%)] (p = 0.017). Inferred high total IgE levels more in obese children compared with normal nutrition with and without a history of atopic disease in the family. [MKB. 2013;45(2):130–34]Key words: Atopy, family history, obesity, total IgE level DOI: http://dx.doi.org/10.15395/mkb.v45n2.87
Optic nerve sheath diameter and severity of central nervous infection Dewi, Anggun Puspita; Lukmanul Hakim, Dzulfikar Djalil; Rahayuningsih, Sri Endah; Risan, Nelly Amalia; Ghrahani, Reni; Adrizain, Riyadi
Paediatrica Indonesiana Vol. 63 No. 5 (2023): September 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.5.2023.411-7

Abstract

Background Central nervous system (CNS) infection affects the brain, and can cause cerebral edema, increased intracranial pressure (ICP), cerebral herniation, and death. Measurement of the optic nerve sheath diameter (ONSD) by ultrasound is a new, non–invasive examination to predict ICP, with high sensitivity and specificity.Objective To analyze for a possible association between ONSD measured by ultrasonographic examination and severity of CNS infection. Methods This cross–sectional study was performed in the Pediatric Department of Hasan Sadikin Hospital, Bandung, West Java. Subjects were chosen by consecutive sampling. We measured ONSD, examined clinical manifestations, as well as performed a cerebrospinal fluid (CSF) study and imaging of CNS infection. Data analysis was done by paired T–test and one–way ANOVA, followed by Tukey test on significant variables. Results Subjects consisted of 32 children with CNS infection. The most common clinical symptoms were fever, decreased consciousness, and nuchal rigidity. Bivariate analysis revealed strong positive associations between ONSD and Glasgow Coma Scale (GCS), increased protein levels in CSF, and type of CNS infection. Conclusion Larger ONSD is significantly associated with lower GCS, increases CSF protein, and particular CNS infections. The ONSD is also associated with meningitis tuberculosis grade III, with a higher mean ONSD of both eyes compares to other CNS infections. Hence, the higher the ONSD, the more severe the degree of CNS infection.
Co-Authors Adrizain, Riyadi Budi Setiabudiawan Citra Amelinda Dewi, Anggun Puspita Dzulfikar Djalil Lukmanul Hakim Gartika Sapartini Hesti Puspasari Nelly Amalia Risan, Nelly Amalia Putria Rayani Raden Tina Dewi Judistiani Sri Endah Rahayuningsih Tetty Yuniati