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Sensitivity and specificity of serum procalcitonin level compared to leucocyte count for diagnosis surgical site infection on patients undergoing major surgery in Dr. Sardjito General Hospital Yogyakarta Umi Sholekah Intansari, Muhammad Sayuti Supomo
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 45, No 01 (2013)
Publisher : Universitas Gadjah Mada

Surgical site infection (SSI) is one of the most serious complications on sugical procedure. However, its diagnosis is still based on the clinical and laboratory examination that take more time and less sensitive and specific. Therefore, early diagnosis that is more accurate and precise is needed. Some biomarker such as serum procalcitonin (PCT) is promoted for diagnosis SSI. The aim of the study was to evaluate the sensitivity and specificity of serum PCT compared with leucocyte for diagnosis SSI on patients undergoing major surgery. This was a descriptive analytical study with a prospective observational design. Patients who underwent a major surgery between October 30th and December 31rt, 2011 and fulfilled the inclusion and exclusion criteria were recruited. Clinical and laboratory examinations including leucocyte count were conducted presurgery. On 3rd day postsurgery, blood sample was taken for PCT and leucocyte count measurement. A blood bacterial culture was performed on patients suffering from SSI according to Centers for Disease Control (CDC) criteria. Patients were then followed until 30 days postsurgery. A total of 49 patients consisting of 22 men and 27 women were involved in this study. Surgical site infection was found in 16 patients consisting of 8 (50%) patients with clean surgical wound, 3 (19%) patients with clean surgical contamination wound, 4 (25%) patients with surgical contamination wound and 1 (6%) patient with dirty surgical wound. Furthermore, laboratory examination found that 9 patients had abnormal leucocyte with 5 of them suffering from SSI, whereas from 14 patients with serum PCT abnormal, 11 patients suffered from SSI. Diagnostic test showed that the sensitivity and specificity of serum PCT for diagnosis SSI were 68.75 and 90.90%, respectively, whereas the sensitivity and specificity of leucocyte were 31.25 and 87.87%, respectively. In conclusion, serum PCT has better sensitivity and specificity compared with leucocyte for the diagnosisof SSI in patients with major surgery. Â Â Keywords: procalcitoninserum - leucocyte Â - surgical site infection- diagnostic test - sensitivity â specificityÂ Â Â

Natural Killer (NK) cells and severity of dengue infection among children hospitalized in Dr. Sardjito Hospital Ida Savitri Laksanawati, Umi S. Intansari
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 40, No 02 (2008)
Publisher : Universitas Gadjah Mada

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Background: Dengue infection isONE OF the most frequent infectious diseases in Indonesia. The manifestation of dengue infections varies from asymptomatic to live-threatening, dengue shock syndrome. It is hypothesized that immune responses contribute to immunopathogenesis of severe dengue infection. Natural killer INK) cells are innate lymphocytes which play a crucial role in anti-pathogen host defense and are particularly important in mediating resistance to viral infections. However, only a few studies of NK cells have been conducted in vivo, especially in Indonesia.ObJectives: The objectives of this study were to find the correlation between the number of NK cells with severity of the disease, and to find out the profile of NK cells absolute numbers in acute and convalescent dengue infection patients among children hospitalized n Dr. Sardjito hospitalMethods: An observational prospective study was conducted. Clinical and laboratory data were followed from the day of admission until the day of discharge. The severity of the disease was graded according to the WHO criteria for Dengue Hemorrhagic Fever IDHF). The absolute number of NK cells was measured by flow cytometer using monoclonal antibody anti-CD3, anti-CD16 + 56, and anti-CD45, with dual platform method. Student t-test was used to find out the difference of NK cell absolute number between acute and convalescent phases. The correlation between NK cells and the severity of the disease was analyzed using Spearman correlation test.Results: NK cell absolute number tended to be lower in acute compared to convalescent phase, but the difference was not statistically significant. There was an inverse correlation between the NK cell absolute number and the severity of dengue infection Ir=-O.322; p=O.017).Conclusion: Absolute number of NK cells were decreased during acute phase of dengue infection, and the decrease was more pronounced in severe than in mild dengue infection.Key words: NK cells absolute number - mild and severe dengue infection - acute and convalescent phases

Kinetics of CD4+ T-Lymphocyte in Dengue Virus Infection Laksono, Ida Safitri; Intansari, Umi S.
Majalah Kedokteran Bandung Vol 46, No 4 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Cellular immunity plays an important role in viral infection. The activation of effector T-lymphocytes and the release of cytokines define the course of dengue viral infection. CD4âº T-lymphocyte induces the immunopathology via various mechanisms; however, Â its kinetics in different onset of fever and disease severity are not fully understood. This study was conducted to observe the kinetics of CD4+ T-lymphocyte level among dengue infected patients and to obtain the absolute cell count and relative percentage of CD4+ T-lymphocyte. This was a descriptive study on thirty six patients who met the WHO-1997 criteria of dengue infection, hospitalized in Dr. Sardjito Hospital in the period of March to May 2009. The CD4+ T-lymphocytes were examined using the flow cytometer. The significance of median CD4+ T-lymphocytes among days were assessed using Kruskal-Wallis and Mann-Whitney SPSS 11 for Window. The absolute CD4+ T-lymphocyte was significantly different among days (p<0.05) between DF and DHF patients, while the relative CD4+ percentage count was notÂ different (p>0.05).Â The Absolute CD4+ T-lymphocytes count was low in the beginning of the disease course and increased from the 2nd day of fever to the normal level on the 7th day. In conclusion, DF and DHF do not differ in the absolute CD4+ T-lymphocytes count as well as in the relative CD4+ T-lymphocytes percentage.Key words: CD4+ T-lymphocyte, dengue fever, dengue hemorrhagic fever, dengue virusKinetik Limfosit T CD4+ pada infeksi Virus DengueAbstrakImunitas seluler berperan penting dalam infeksi virus. Aktivasi efektor limfosit T dan terlepasnya sitokin merupakan gambaran utama perjalanan klinis infeksi virus dengue. Sel limfosit T CD4+ menginduksi imunopatologi melalui berbagai mekanisme, namun bagaimana kinetikanya pada hari demam yang berbeda dan derajat berat penyakit masih belum sepenuhnya dipahami. Penelitian ini bertujuan untuk mengamati kinetika sel limfosit T CD4+ pada pasien infeksi dengue dan mendapatkan kadar absolut serta persentase relatif limfosit T CD4+. Penelitian deskriptif ini mengikutsertakan tiga puluh enam pasien yang memenuhi kriteria WHO 1997 untuk infeksi dengue, dirawat di RSUP Dr. Sardjito antara Maret sampai Mei 2009. Kadar limfosit T CD4+ diperiksa menggunakan flow cytometer. Perbedaan median limfosit T CD4+ pada berbagai hari demam dianalisis menggunakan Uji Kruskal-Wallis dan Mann-Whitney SPSS 11 untuk Windows. Kadar absolut limfosit T CD4+ berbeda secara bermakna antara hari demam (p<0,05). Persentase relatif limfosit T CD4+ tidak berbeda bermakna antara demam dengue dan demam berdarah dengue (p>0,05). Kadar absolut limfosit T CD4+ rendah pada awal perjalanan penyakit, meningkat pada hari ke-2 demam dan mencapai nilai normal pada hari ke-7 demam. Demam dengue dan demam berdarah dengue tidak menunjukkan kadar absolut maupun persentase relatif limfosit T CD4+ yang berbeda bermakna. Kata kunci: Demam berdarah dengue, demam dengue, limfosit T CD4+, virus dengueÂ DOI: 10.15395/mkb.v46n4.341

Natural Killer (NK) cells and severity of dengue infection among children hospitalized in Dr. Sardjito Hospital Umi S. Intansari Ida Savitri Laksanawati
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 40, No 02 (2008)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Show Abstract | Download Original | Original Source | Check in Google Scholar

Background: Dengue infection isONE OF the most frequent infectious diseases in Indonesia. The manifestation of dengue infections varies from asymptomatic to live-threatening, dengue shock syndrome. It is hypothesized that immune responses contribute to immunopathogenesis of severe dengue infection. Natural killer INK) cells are innate lymphocytes which play a crucial role in anti-pathogen host defense and are particularly important in mediating resistance to viral infections. However, only a few studies of NK cells have been conducted in vivo, especially in Indonesia.ObJectives: The objectives of this study were to find the correlation between the number of NK cells with severity of the disease, and to find out the profile of NK cells absolute numbers in acute and convalescent dengue infection patients among children hospitalized n Dr. Sardjito hospitalMethods: An observational prospective study was conducted. Clinical and laboratory data were followed from the day of admission until the day of discharge. The severity of the disease was graded according to the WHO criteria for Dengue Hemorrhagic Fever IDHF). The absolute number of NK cells was measured by flow cytometer using monoclonal antibody anti-CD3, anti-CD16 + 56, and anti-CD45, with dual platform method. Student t-test was used to find out the difference of NK cell absolute number between acute and convalescent phases. The correlation between NK cells and the severity of the disease was analyzed using Spearman correlation test.Results: NK cell absolute number tended to be lower in acute compared to convalescent phase, but the difference was not statistically significant. There was an inverse correlation between the NK cell absolute number and the severity of dengue infection Ir=-O.322; p=O.017).Conclusion: Absolute number of NK cells were decreased during acute phase of dengue infection, and the decrease was more pronounced in severe than in mild dengue infection.Key words: NK cells absolute number - mild and severe dengue infection - acute and convalescent phases

High-sensitivity C-reactive protein/albumin (hs-CRP/albumin) ratio as a predictor of deterioration of clinical outcome in central nervous system infections Hayati, Hanifah Fajarisna; Satiti, Sekar; Paryono, Paryono; Intansari, Umi; Sutarni, Sri; Subagya, Subagya; Indarwati, Indarwati; Setyopranoto, Ismail
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 55, No 4 (2023)
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19106/JMedSci005504202306

Central nervous system (CNS) infections such as encephalitis, meningitis, or myelitis have high morbidity and mortality in Indonesia. High sensitivity C-reactive protein (hs-CRP) is a sensitive marker of acute inflammation, while albumin is the most abundant protein component in plasma and cerebrospinal fluid (CSS). Infection triggers an inflammatory response so that an increase in the hs-CRP/albumin ratio (CAR) can be a predictor of worsening clinical outcome in patients with CNS infections. However, studies examining the predictor value of serum and CSF CAR on worsening clinical outcomes of patients are limited, particularly in CNS infections. The purpose of this study was to prove the CAR as a predictor of worsening clinical outcome in patients with CNS infections. It was an observational study using a prospective cohort design. Fifty subjects recruited until October 2021 at Dr. Sardjito General Hospital were involved. The multivariate regression analysis showed that serum CAR (OR=3.604; 95%CI=1.487-8.736; p =0.005) could be a single predictor. However, by combining three variables, namely serum CAR, CSF CAR, and decreased consciousness at admission, could be a stronger predictor of worsening clinical outcome in patients with CNS infection (AUC = 97.1%; 95%CI = 0.929-1.00; p <0.001). The optimal cut-off value for serum CAR was 1.35 (Youden index = 0.88, sensitivity = 96%, specificity = 92%) while for CSF CAR was 0.14 (Youden index = 0.60, sensitivity = 76%, specificity = 84%). In conclusion, a combination predictive model of three variables, namely serum CAR, CSF CAR, and awareness at admission can be a stronger predictor of clinical outcome in patients with CNS infection than serum CAR alone.

Number of natural killer cells and cytokine levels in peripheral blood at various degrees of severity Devita, Ninda; Arjana, Adika Zhulhi; Intansari, Umi Solekhah; Susilowati, Rina
Communications in Science and Technology Vol 8 No 1 (2023)
Publisher : Komunitas Ilmuwan dan Profesional Muslim Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21924/cst.8.1.2023.1106

This study aims to investigate NK cell number and cytokines level in various degrees of severity in COVID-19 cases. A total of 63 COVID-19 patient aged >18 y were divided into mild-moderate and severe-critical groups. Patient characteristics and peripheral blood count were obtained from medical records. NK cells number, levels of IFN-?, IL-10, and IL-12 in peripheral blood were examined by means of flow cytometry. The severe-critical group had leukocytosis, neutrophilia, lymphopenia, higher Neutrophil Lymphocyte Ratio, lower NK cell number and higher level of IL-10. In severe-critical group, those aged >60 years had higher IL-10. In both groups, patients with diabetes comorbidities had a higher number of NK cells (p<0.05). NK cell number and IL-10 in peripheral blood have potential as a predictor of severe COVID-19 patients.

Perbandingan Tingkat Deteksi Bakteri Gram Negatif Penghasil Karbapenemase Pada Uji Carba Nordmann Poirel (Carba NP) Dan Modified Hodge Test (MHT) Muliasih, Mulat; Dahesihdewi, Andaru; Intansari, Umi Solekhah
Jurnal Ilmu Kedokteran dan Kesehatan Vol 11, No 12 (2024): Volume 11 Nomor 12
Publisher : Prodi Kedokteran Fakultas Kedokteran Universitas Malahayati

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/jikk.v11i12.17485

Penggunaan karbapenem yang tinggi pada infeksi bakteri Gram negatif menimbulkan resistansi dengan mekanisme terbanyak berupa produksi enzim karbapenemase yang menyebabkan kematian lebih tinggi daripada mekanisme lain. Diperlukan suatu uji fenotip pendeteksi penghasil karbapenemase yang bisa menentukan terapi dengan cepat dan mengontrol penyebaran infeksi. Penelitian ini merupakan penelitian observasional analitik dengan rancangan potong lintang. Sampel berupa isolat klinis pasien bangsal dengan hasil tes kultur berupa patogen Gram negatif resistan karbapenem. Kriteria eksklusi yaitu sampel klinis berasal dari alat, hasil kultur polimikrobia, dan data rekam medis tidak lengkap. Isolat klinis diperiksa uji Carba NP dan MHT untuk dideteksi sebagai penghasil karbapenemase. Kemampuan kedua uji dibandingkan dan dihitung nilai Kappa. Hasil penelitian Carba NP mendeteksi karbapenemase 56 isolat (74,66%), tidak berbeda bermakna dengan uji MHT yang mendeteksi 53 isolat (70,66%), p 0,549. Nilai Kappa kedua metode 0,6.

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