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TINJAUAN PUSTAKA: PATOGENESIS DAN DIAGNOSIS SISTEMIK LUPUS ERITEMATOSUS May Fanny Tanzilia; Betty Agustina Tambunan; Desak Nyoman Surya Suaemitria Dewi
Syifa'Medika Vol 11, No 2 (2021): Syifa' MEDIKA: Jurnal Kedokteran dan Kesehatan
Publisher : Faculty of Medicine

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32502/sm.v11i2.2788

Abstract

Sistemik Lupus Eritematosus (SLE) adalah penyakit inflamasi autoimun kronis dengan manifestasi klinis yang luas. Perjalanan penyakit dan prognosis dari SLE pun juga beragam. Faktor lingkungan, imunologi, hormonal, dan genetik diketahui memegang peranan dalam perkembangan SLE. Penyakit SLE lebih banyak menyerang wanita terutama usia produktif. Patogenesis SLE mengikutsertakan berbagai sel dan molekul yang berperan pada proses apoptosis, respons imun innate dan adaptif. Diagnosis SLE ditegakkan berdasarkan manifestasi klinis, yang harus memenuhi 4 dari 11 kriteria American Rheumatology Association (ARA) (1997), dan pemeriksaan laboratorium. Terapi SLE bersifat individual berdasarkan manifestasi klinis yang dialami pasien, aktivitas penyakit dan derajat keparahan penyakit serta komorbiditas. Prognosis SLE bervariasi mulai dari ringan hingga berkembang cepat menjadi berat disertai kegagalan multiorgan bahkan kematian. Studi pustaka ini diharapkan dapat memberikan informasi lebih mendalam mengenai patogenesis dan cara menegakkan diagnosis SLE sehingga dapat menjadi dasar dalam pengembangan penelitian mengenai SLE di masa yang akan datang.
The Effect of Polyunsaturated Fatty Acids Omega-3 Supplementation on the Components of Rheumatoid Arthritis Disease Activity: A Systematic Literature Review Nadia Hidayat; Awalia Awalia; Betty Agustina Tambunan; Hermina Novida
Indonesian Journal of Rheumatology Vol. 14 No. 2 (2022): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/ijr.v14i2.191

Abstract

Background: Rheumatoid arthritis (AR) is a chronic disease that causes deformity in most productive age and can lead to death as disease activity increases. Omega-3 polyunsaturated fatty acids (PUFAs) have the potential to complement available therapies in reducing disease activity. Currently, the effect of omega-3 PUFAs on disease activity components is still unclear. This study aimed to determine the effect of omega-3 PUFAs’ supplementation on the components of RA disease activity. Methods: This research is a systematic study with PRISMA guidelines. Literature identification using Pubmed, MDPI, and clinicaltrials.gov. The inclusion criteria used were: giving omega-3 PUFAs, free full-text, RCT, in English or Indonesian, and assessing disease activity and its components; while the exclusion criteria were: unpublished, comparisons were inappropriate. Assessment of literature quality with the Cochrane Collaboration tool. Results: The study included six studies from 1994 to 2017. The effect of omega-3 PUFAs is diversity in changes of disease activity in 4 of 5 studies. Another effect is a significant reduction in the number of joint pains in the literature by daily doses above 2.9 grams or at lower doses taking longer, and swollen joints in 2 studies that were only affected in doses above 2.9 grams. Another change is a significant reduction in pain severity in the studies. Change increases with higher doses. There are variable LED and CRP changes with minimal study resources. Conclusion: Omega-3 PUFAs depend on their dose and administration duration and can, directly and indirectly, affect disease activity through the influence of most of its components, namely: the number of joints affected, the degree of pain, but the results of the ESR and CRP examinations are not sufficient.
Gestational Trophoblastic Neoplasia with Hyperthyroidism Devi Rahmadhona; Betty Agustina Tambunan
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 26 No. 2 (2020)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v26i2.1428

Abstract

Gestational Trophoblastic Neoplasia (GTN) is a malignant lesion arising from placental villous and extra-villoustrophoblastand occurs in 1:40,000 pregnancies. Invasive mole and choriocarcinoma are the vast majority of GTN whichproduce substantial amounts of Human Chorionic Gonadotropin (hCG). Hyperthyroidism in GTN is due to the stimulation ofthe thyroid gland by hCG which has a similar structure with Thyroid-Stimulating Hormone (TSH). A 28-year-old female,suspected with choriocarcinoma and anemia, had a history of recurrent vaginal bleeding for eight months, accompaniedwith loss of appetite, weight loss, palpitation, and tremor. Physical examination such as pulse rate of 114x/minutes, the0 respiration rate of 26x/minutes, temperature 38 C, conjunctival anemia, and dyspnea were reported. In addition, laboratoryfindings such as anemia, leukocytosis, hypoalbuminemia, hypokalemia, increase of LDH, increase of hCG >1,500,000mIU/mL, T4 levels of 14.1 ug/dL (4.40-10.90 ug/dL), FT4 levels of 1.95 ng/dL (0.89-1.76 ng/dL), and decrease of TSH were alsoreported. Abdominal CT Scan suggested uterine mass suspected as malignancy infiltrating to the rectum with metastaticfeatures in the liver, base of left lung, spleen and left kidney. Increased CA-125, and metastatic features of lung rightparacardial and left suprahilar from Chest X-ray were found. Diagnostic criteria for gestational trophoblastic neoplasia are asfollows: increased hCG 4 x tests; increased hCG three weekly tests; histology diagnosis of choriocarcinoma; increased hCG> 20,000 more than four weeks post evacuation and the presence of metastasis. Hyperthyroidism in GTN is potentiallylife-threatening because of heart failure and thyroid storm. Hyperthyroidism increases morbidity and mortality in GTNpatient; therefore, periodic thyroid tests is essential to prevent further complication of hyperthyroidism.
THE CORRELATION OF PROCALCITONIN AND MYELOPEROXIDASE INDEX LEVELS IN SEPSIS PATIENTS Sri Rejeki Wulandari; Betty Agustina Tambunan; Paulus Budiono Notopuro; Hardiono Hardiono
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 25 No. 3 (2019)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v25i3.1451

Abstract

Sepsis masih menjadi masalah utama di dunia. Europan Society of Intensive Care Medicine (ESICM) dan Society of Critical Care Medicine (SCCM) mengikutsertakan quick Sequential Organ Failure Asssessment  (qSOFA) untuk mendiagnosis sepsis. Diperlukan pemeriksaan laboratorium akurat dan cepat selain kultur. Prokalsitonin sebagai penanda spesifik infeksi bakteri. Myeloperoxidase index (MPXI) parameter baru untuk membantu diagnosis sepsis. Penelitian ini bertujuan menganalisis korelasi kadar prokalsitonin dengan MPXI pada pasien sepsis.  Jenis penelitian cross sectional observasional. Pengambilan sampel Desember 2017  – Februari 2018. Subjek penelitian terdiri dari 71 pasien sepsis yang dirawat di Ruang Resusitasi, Ruang Observasi Intensif, dan ruang Intensive Care Unit (ICU) RSUD Dr. Soetomo Surabaya berdasarkan kriteria qSOFA dan SIRS. Pemeriksaan prokalsitonin dengan metode CLIA (ADVIA Centaur XP), MPXI dengan  metode  flowcytometry (ADVIA 2120i) dan kultur menggunakan alat PhoenixTM 100. Kadar prokalsitonin 0,01 ng/mL – 265,16 ng/mL (rerata 16,13 ± 40,91 ng/mL). Nilai MPXI -25,5 – 4,6 (rerata -7,939 ± 4,903). Tidak terdapat korelasi antara kadar prokalsitonin dengan MPXI ( p = 0,604 dan r = - 0,063). Tidak terdapat  korelasi kadar prokalsitonin dengan MPXI pada hasil  kultur positif (p = 0,675, r = 0,072) dan negatif (p = 0,401, r = - 0,147). Kadar prokalsitonin tidak berkolerasi dengan MPXI pada pasien sepsis
ANALYTICAL PERFORMANCE OF PROCALCITONIN LEVEL BETWEEN CHEMILUMINESCENCE AND QUANTITATIVE IMMUNOCHROMATOGRAPHY METHODS IN SEPSIS PATIENTS Mario Mario; Betty Agustina Tambunan; Hardiono Hardiono
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 25 No. 3 (2019)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v25i3.1454

Abstract

Sepsis is a public health problem in many countries. The latest diagnosis criteria are quick Sequential Organ Failure Assessment  (qSOFA). Procalcitonin (PCT) could be used to aid the diagnosis of sepsis. The aim of this study was to determine the diagnostic value of PCT between CLIA and quantitative immunochromatography tests in sepsis patients. Samples were obtained from the resuscitation room, intensive observation room, and Intensive Care Unit (ICU) Dr. Soetomo General Hospital between December 2017-February 2018. One hundred and one subjects were examined and classified into sepsis group (n=71) and healthy group (n=30), based on qSOFA and SIRS criteria. Procalcitonin test with CLIA and quantitative immunochromatography method were performed in all subjects, followed by culture examination in sepsis group using PhoenixTM 100. The diagnostic value of the two methods was analyzed by 2x2 table with a Confidence Interval (CI) of 95%. There were significant differences of procalcitonin level between CLIA and quantitative immunochromatography method in the sepsis group (p=0.009) and in the healthy group (p=0.002). The diagnostic value of procalcitonin level by CLIA method with a cut-off value ≥ 0.27 ng/mL (AUC=0.839, sensitivity (Sn)=74.6%, specificity (Sp)=86.7%, Positive Predictive Value (PPV)=93%, Negative Predictive Value (NPV)=59.1%) had the same sensitivity but higher specificity, PPV, and NPV rather than by quantitative immunochromatography method (AUC=0.786, Sn=74.6%, Sp=66.7%, PPV=84.1%, NPV=52.6%). Procalcitonin examination with CLIA had a better diagnostic value than quantitative immuno-chromatography method.
CORRELATION OF PROCALSITONIN LEVEL WITH SEPSIS DEGREES BASED ON SOFA SCORE Citra Novita; Soeprapto Maat; Betty Agustina Tambunan
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 25 No. 3 (2019)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v25i3.1497

Abstract

Sepsis is defined as a life-threatening organ dysfunction condition caused by dysregulation of host response towards infection. Sepsis is one of the leading causes of death in medical emergency. A recent study revealed 18 millions of sepsis occur annually with a mortality rate of 30%, so early diagnosis in assessing sepsis severity is necessary as a guide for early and specific therapy. Organ dysfunction in sepsis patients is associated with high mortality, assessed by Sequential Organ Failure Assessment (SOFA) criteria. Procalcitonin is widely used for diagnosing, monitoring, and prognosis sepsis. This study aimed to analyze the correlation of procalcitonin level with sepsis severity based on SOFA score.  This was an observational cross-sectional study. Samples were collected from December 2017-February 2018 of 72 patients. Each patient was calculated by SOFA score and underwent procalcitonin examination using an immunochromatography method by RAMP. Results. Samples from 72 patients who met the criteria, were analyzed consisting of 37 mailes(51.4%) and 35 females(48.6%), aged 23-77 years, with mean±SD 47.4±14.02 years. The range of SOFA score was 0-16 with mean±SD 6.47±3.61, while procalcitonin levels 0.20-200 ng/mL mean±SD 21.03±14.63 ng/mL. There was a significant correlation between procalcitonin level and SOFA score (r=0.752;p<0.0001). This suggests that procalcitonin may illustrate the severity of sepsis patients. The higher the procalcitonin, the more severe the sepsis. SOFA score and procalcitonin examinations should be performed routinely in patients with sepsis to assess prognosis (severity) for earlier pretreatment so that the mortality rate can be lowered.  
Diagnostic Value of Myeloperoxidase Index in Bacterial Infections Mirna Rahmafindari; Paulus Budiono Notopuro; Betty Agustina Tambunan
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 27 No. 2 (2021)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v27i2.1557

Abstract

Infectious diseases remain a serious problem in Indonesia. Myeloperoxidase (MPO) is a substance released by neutrophils, which activates the synthesis of hypochlorous acid (HOCL) from hydrogen peroxide (H2O2) and chloride ion (Cl-). Hypochlorous acid plays a vital role in the body's defense against infection. Myeloperoxidase Index (MPXI) is a parameter in the hematology analyzer Advia 2120i based on the principle of flow cytometry. This study aimed to determine the diagnostic value of MPXI in patients with bacterial infections. The study was a cross-sectional observational analysis. The samples consisted of a group of patients with bacterial infection and a group of healthy subjects. The specimens used in this study were whole blood + anticoagulant (EDTA) in a purple tube with a volume of 3 mL to determine the MPXI value in both groups using ADVIA 2120i hematology analyzer. The study subjects consisted of a group of patients with bacterial infections (69 patients) and a group of healthy subjects (33 people). Analysis of the MPXI ROC curve with a cut-off ≥ -5.8 and < -5.8, showed AUC of 0.323 (CI=95%, p=0.004), sensitivity of 34.8%, specificity of 39.4%, Positive Predictive Value (PPV) of 54.5%, and Negative Predictive Value (NPV) of 22.4%. Due to its low diagnostic value, the MPXI value was not recommended to be used as a diagnostic instrument for bacterial infections. Also, further research was highly needed.
The Differences Levels of RANTES and PF4 Based on the Storage of Platelet Concentrate Ni Made Rindra Hermawathi; Betty Agustina Tambunan; Arifoel Hajat
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 27 No. 3 (2021)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v27i3.1577

Abstract

Blood component transfusion is often used as the primary therapy as it is still considered safe. Platelet Concentrate (PC) transfusion plays a critical role in preventing bleeding in patients with severe thrombocytopenia. Allergic reactions are the most frequent transfusion reactions after PC administration. Regulated on Activation Normal T-Cell Expressed and Secreted (RANTES) and Platelet Factor 4 (PF4) cytokines released by platelets during PC storage are responsible for allergic reactions after transfusion. The purpose of this study was to analyze changes in RANTES and PF4 levels during PC storage. This study was an observational analytical research with a time series design carried out at the Clinical Pathology Laboratory and Blood Bank of the Dr. Soetomo Hospital, Surabaya, from June to July 2019. RANTES and PF4 levels in 27 bags derived from Platelet Rich Plasma (PRP) on storage for day 1, day 3, and day five were measured using the ELISA sandwich method. Subject same variant test or Friedman test was used for statistical analysis. The results showed no significant differences in RANTES and PF4 levels based on the storage duration of PCs on days 1, 3, and 5, with p=0.717, and p=0.614, respectively. There was no difference in the storage of PCs from day 1 to day five, and there was no effect on allergic reactions after PC transfusion.
The Suitability of Compatibility Test Results with Gel Method between Diagnostic Grifols Gel Coombs and Diamed-Identification Tigor Pandapotan Sianturi; Betty Agustina Tambunan
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 27 No. 1 (2020)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v27i1.1605

Abstract

A compatibility test as part of a pre-transfusion test is mandatory to ensure blood compatibility between patients and donors. Diamed-ID as the first gel-based product is commonly used as a reference for the compatibility test. The presence of new products such as DG Gel Coombs encourages research to compare them with reference methods. This study aimed to analyze the suitability of DG Gel Coombs to Diamed-ID in the compatibility test with the same sample. This cross-sectional analytic observational study was conducted during November 2017-February 2018 at the Blood Transfusion Unit Dr. Soetomo Hospital, Surabaya using blood samples (n=40), which met the inclusion and exclusion criteria. Simultaneous testing of the two products was according to the manufacturing requirements of each product (using different LISS reagents for red blood cell suspensions and centrifugation arrangements). The suitability of results was tested with Cohen's kappa and significant differences with McNemar. There was a minimum suitability of DG Gel Coombs to Diamed-ID for major compatibility tests, κ 0.307 (95% CI: -0.029-0.643), significance 0.007 (p < 0.05) and moderate for minor, κ 0,678 (95% CI: 0.454-0.903), significance <0.0001 (p < 0.05). McNemar's significance was 0.016 (p < 0.05) for major compatibility test and 0.031 (p < 0.05) for minor. Referring to Diamed-ID's results, false negatives were found on DG Gel Coombs for major compatibility tests (n=7) and minor (n=6). The suitability of results from DG Gel Coombs and Diamed-ID is not strong for compatibility testing.
TUBERCULIN SKIN TEST AND INTERFERON-γ RELEASE ASSAY ON THE DIAGNOSIS OF TUBERCULOUS SPONDYLITIS Hadid, Tsabita; Faris, Muhammad; Betty Agustina Tambunan; Caesaroy Afif Wibowo
Majalah Biomorfologi Vol. 33 No. 2 (2023): MAJALAH BIOMORFOLOGI
Publisher : Universitas Airlangga, Surabaya, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/mbiom.v33i2.2023.92-99

Abstract

Highlights                                                                                                                                      TST and IGRA have a significant correlation with the diagnosis of patients with Tuberculous Spondylitis. Various factors may affect the results of TST and IGRA. Thus, the use of TST and IGRA can be adjusted according to the condition of the hospital, the availability of diagnostic tools, the health worker's physical examination results, and the patient's medical history. Abstract Background: Tuberculous spondylitis or Pott's disease is extrapulmonary tuberculosis that is still a concern to health workers because of the broad spectrum of its clinical symptoms. Delay in diagnosis is very common in this disease. Therefore, its diagnostic tool needs to be thoroughly reviewed to determine its effectiveness. The diagnostic tools studied in this study were Tuberculin Skin Test (TST) and Interferon-γ Release Assay (IGRA). Objective:  To analyze the role of TST and IGRA as diagnostic tools for the diagnosis of tuberculous spondylitis. Material and Method: This study used a systematic review method to analyze topic-related kinds of literature written in English and Indonesian found on PubMed, Scopus, ProQuest, and Web of Science databases. The literature screening process was carried out based on the PRISMA 2020 Guidelines. Result:  Sixteen types of literature were included for a total of 116 patients. TST was detected positive in 45 (63%) and negative in 21 (30%) of a total of 66 patients with Pott's disease. IGRA was detected positive in 51 (77%), negative in 8 (12%), and indeterminate in 2 (3%) of a total of 61 patients with Pott's disease. Conclusion:  TST and IGRA results significantly correlate with the diagnosis of tuberculous spondylitis. Both tests are still relevant for use in the diagnosis of the disease. IGRA and TST are used according to the needs of health workers and patients' health backgrounds.