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The HLA-DR Expression on Monocytes in Acute Dengue Infection Umi Solekhah Intansari; Muhammad Ilham Bin Azib; Mohd Nazirul Shareef bin Mohd Ridhwan; Ida Safitri Laksanawati
Tropical Medicine Journal Vol 2, No 1 (2012): Tropical Medicine Journal
Publisher : Pusat Kedokteran Tropis

Introduction: Dengue is the most common disease of mosquito-borne infection. According to the World Health Organization, it is estimated that 50 million cases ofdengue infection have been reported annually. Macrophages andmonocyte are thought to play an important role in dengue infection both as primary targets of viral infection and as a source of immunomodulatory cytokines.Whenmonocytes are infectedby dengue viruses, it processed the virus by lyses it and expressed the antigen on its surfacemembrane bind together with HLA class II molecules. HLA-DR-expressing monocytes in acute dengue patientsespecially the intensity is still poorly understood.Measurement of at difference days of infectionwill give an evidence about the role ofmonocytes in dengue pathogenesisObjectives: To observe the kinetics on percentage of HLA-DR expressingmonocytes and themedian of HLA-DR expression intensity in acute dengue infection.Methods: This researchwas an observational type study conducted by cross sectionalmethod towards all the dengue patients in Dr. Sardjito’s General Hospital. Blood samples were drawn from 32 acute dengue infected patients from Day 1 to Day 6th. The HLA-DR expression was measured flow cytometrically using FACS Calibur.Results: The data showed that the mean difference in acute dengue infection from Day 1 to Day 6 is not significant with the p-value larger than 0.05, (p>0.05).Conclusion: The peak level of activated HLA-DR monocyte was at day 2 and then decreasing until day 6. There were no significant changes in percentage of HLA-DR-expressing monocytes from the day 1 to the day 6 and the median intensity of HLA-DR expression in acute dengue infection.Keywords HLA-DR-expressing monocytes, Acute Dengue Infection

THE KINETIC OF ACTIVATED MONOCYTES IN ACUTE PHASE DENGUE INFECTION Umi Solekhah Intansari; Arif Bahiyuddin bin Badaruddin; Ida Safitri Laksanawati
Tropical Medicine Journal Vol 1, No 2 (2011): Tropical Medicine Journal
Publisher : Pusat Kedokteran Tropis

Introductions: Nowadays dengue infection is at present one of the most common mosquito-borne viral diseases of humans worldwide. Initially, Dengue infections were primarily recorded when they occurred as epidemics in tropical and subtropical countries. Monocyte/macrophage infection is central to the pathogenesis of dengue fever and to the origin of dengue hemorrhagic fever. Increased activation of monocytes and greater numbers of DEN-infected cells were associated with more severe Dengue, implicating a role for monocyte activation in dengue immunopathogenesis. Thus, more knowledge about the relation between numbers of activated monocyte with dengue severities is essential for better understanding regarding this subject.Objectives: Studying the relation between numbers of activated monocyte, marked by HLA-DR marker intensity with Dengue Fever severity throughout the disease course, from day 2 until day 6 of acute dengue fever.Methods: This research is cross sectional observational study. The location in done at Dr. Sardjito Hospital in 6 months time.Results: There is a negative correlation between median number of activated monocyte with dengue severity, on day 3 of acute dengue fever.Conclusion: There was a negative correlation between numbers of activated monocyte marked by HLADR intensity with disease severity on day 3 of acute dengue infection.Keywords: Activated Monocyte; Human Leukocyte Antigen (HLA)-DR intensity; Percentage of Activated Monocyte; Dengue Fever Severity.

The Kinetics of CD8+ T Lymphocytes in Dengue Patients in Yogyakarta Loo Huai Na; Umi Solekhah Intansari; Ida Safitri Laksanawati
Tropical Medicine Journal Vol 2, No 2 (2012): Tropical Medicine Journal
Publisher : Pusat Kedokteran Tropis

ABSTRACTIntroduction: Dengue fever can be graded into dengue fever (DF), dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). The CD8+ T lymphocytes mediate antiviral activity by producing cytokines and directly destroyed the dengue virus infected cells. This study focuses in observing the kinetics of CD8+ T lymphocytes absolute and relative count in dengue patients.Objectives: To observe the kinetics of CD8+ T lymphocytes absolute and relative count in dengue patients.Methods: The research design used is a descriptive study. This research measures and observes the kinetics CD8+ T lymphocytes absolute and relative count from day 2 to day 7. The CD8+ T lymphocytes count was determined using flowcytometry. Data was analyzed using ANOVA and independent t test with p<0.05 considered as significant.Results: The CD8+ T lymphocytes absolute count is low during the beginning of disease course and it gradually increases from day 2 to day 7. The CD8+ T lymphocytes relative count decreases from day 2 to day 3, and start to increase back from day 3 to day 7. There is no difference between the level of CD8+ T lymphocytes absolute count and relative count between DF and DHF patients.Conclusion: There is an increase in CD8+ T lymphocytes absolute count and relative count in dengue patients. There is no difference between DF and DHF patients in CD8+ T lymphocytes absolute and relative count. Keywords: dengue fever; dengue hemorrhagic fever; CD8+ T lymphocytes; absolute count; relative count.

LACTATE DEHYDROGENASE (LDH) SELAMA PENYIMPANAN Teguh Triyono; Umi Solekhah Intansari; Caesar Haryo Bimoseno
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 19, No 3 (2013)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v19i3.416

During storage, erythrocytes suffered from biomechanical alterations called the “storage lesion”, which may caused hemolysis. The hemolysis released LDH into the plasma. The LDH that was released during hemolysis made it an adequate instrument to assess the quality of in vitro blood products. The aims of this study were to analyse the alteration of LDH level at day 1, 3, 7, 14, and 28 in the WB and PRC, to analyse the correlation between LDH level with storage duration, and also to analyse enhancement differences of LDH level between WB and PRC.This research was an observational study with a cross-sectional design. As the samples there were 11 bags of WB and 10 bags of PRC. Blood products were kept in bloodbank with the temperature range of 2–6° C. The LDH level was measured with the Beckman Chemistry Analyzer. There were statistically significant alterations of LDH level started from day 7 of storage in both blood products (p<0.05). The significant strong correlation between LDH level with the storage duration were found r=0.772; r=0.835 (p<0.05) in WB and PRC respectively. The enhancement differences were found to be higher and significant in the PRC than in the WB started from day 7 of storage (p<0.05). As conclusion, LDH in WB and PRC were signifantly increased during storage, and correlate with storage duration.

The Relationship between Platelet to Lymphocyte Ratio and Platelet Indices with Disease Severity Level of Systemic Lupus Erythematosus Purbosari Lisnaedy; Umi Solekhah Intansari
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.v27i3.1763

Systemic Lupus Erythematosus (SLE) is an episodic, chronic autoimmune inflammatory disease characterized by remission and flare phases. Laboratory parameters required to assess the severity of disease activity in SLE include platelet count and platelet indices. Several studies regarding the Platelet to Lymphocyte Ratio (PLR) and platelet indices on the severity of SLE patients remain inconsistent. This study aimed to evaluate the relationship between PLR value and platelet index with the degree of disease severity in SLE patients. This study used a retrospective analytic observational design in SLE patients from January 2016 to December 2019 at Dr. Sardjito Central Hospital. Disease severity was assessed using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score. Platelet to Lymphocyte Ratio (PLR) values and platelet indices were measured with a hematology analyzer. The data were analyzed using correlation, bivariate, multiple regression tests, and the ROC curve to determine the PLR cut-off. There were 55 SLE patients with high activity (SLEDAI 11-19; n=30(54,54%)) and very high activity (SLEDAI 20; n=25(45.45%)). There was a significant correlation (p <0.05) between the PLR value, platelet count, plateletcrit, and Mean Platelet Volume (MPV) with SLEDAI scores (p <0.05), but only the MPV variable was significant as an independent variable (p=0.0357). In the ROC curve, a cut-off PLR value of 124 was obtained with a sensitivity of 68.0%, specificity of 66.7%, likelihood ratio=2.04 (AUC=0.659 with p-value=0.035) to detect very high disease activity. Based on the PLR value, platelet count and plateletcrit negatively correlated with SLEDAI score but were related to the very high degree of thrombocytopenia in disease activity. The MPV value reflected the high platelet turnover, which had a positive correlation with the SLEDAI score. Patients with a PLR value ≤124 were 2.04 times more likely to have a SLEDAI score of 20, indicating potential use as a predictor of disease activity. The PLR value and platelet indices were significantly related to the degree of SLE activity.

Risks of Hemorrhage and Poor Clinical Outcome in SLE with Thrombocytopenia at Dr. Sardjito Hospital Surawijaya Bakhtiar Kaslam; Umi Solekhah Intansari
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 28, No 3 (2022)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v28i3.1866

Systemic Lupus Erythematosus (SLE) is an autoimmune disease that affects various body organs and causes chronic inflammation. Thrombocytopenia is common in SLE, and there is a risk of causing bleeding, which can result in death. This study aimed to analyze the relationship of thrombocytopenia with bleeding and poor clinical outcomes in SLE patients at Dr. Sardjito Hospital. The design of this study was retrospective observational analytic. The research subjects were patients diagnosed with SLE at Dr. Sardjito Hospital from January 2016-December 2019 who conducted ANA and anti-dsDNA examinations. Statistical analysis using MedCalc version 13.0. Receiver operating characteristic curve analysis to determine the cut-off value of the platelet count for the occurrence of bleeding. Chi-Square for trend test to determine the relationship between the degree of thrombocytopenia and the degree of bleeding. Kaplan-Meier test to determine the six months survival analysis for SLE patients. There were 61 SLE patients at Dr. Sardjito Hospital. Thirty-two patients (52.5%) had thrombocytopenia. The AUC of the platelet count for the occurrence of hemorrhage was 0.988 (95% CI=0.918-1, p < 0.0001), the cut-off value was 146x103/L, sensitivity 100%, specificity 90.6%, and LR+ 10.33. The AUC of the platelet count for grade 3 hemorrhage was 0.929 (95% CI=0.833-0.979, p < 0.0001), cut-off value 91x103/L, sensitivity 100%, specificity 89.3%, and LR+ 9.33. Hemorrhage was seen in 29 subjects with thrombocytopenia. Five subjects (8.2%) died, with a significant difference in the mortality of SLE patients with and without thrombocytopenia in the six months survival analysis (p=0.028). The risk of hemorrhage and poor clinical outcome (death) were significantly higher in SLE patients with thrombocytopenia and increased with the thrombocytopenia grade.

The Relationship between Platelet to Lymphocyte Ratio and Platelet Indices with Disease Severity Level of Systemic Lupus Erythematosus Purbosari Purbosari; Umi Solekhah Intansari
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.v27i3.1763

Systemic Lupus Erythematosus (SLE) is an episodic, chronic autoimmune inflammatory disease characterized by remission and flare phases. Laboratory parameters required to assess the severity of disease activity in SLE include platelet count and platelet indices. Several studies regarding the Platelet to Lymphocyte Ratio (PLR) and platelet indices on the severity of SLE patients remain inconsistent. This study aimed to evaluate the relationship between PLR value and platelet index with the degree of disease severity in SLE patients. This study used a retrospective analytic observational design in SLE patients from January 2016 to December 2019 at Dr. Sardjito Central Hospital. Disease severity was assessed using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score. Platelet to Lymphocyte Ratio (PLR) values and platelet indices were measured with a hematology analyzer. The data were analyzed using correlation, bivariate, multiple regression tests, and the ROC curve to determine the PLR cut-off. There were 55 SLE patients with high activity (SLEDAI 11-19; n=30(54,54%)) and very high activity (SLEDAI 20; n=25(45.45%)). There was a significant correlation (p <0.05) between the PLR value, platelet count, plateletcrit, and Mean Platelet Volume (MPV) with SLEDAI scores (p <0.05), but only the MPV variable was significant as an independent variable (p=0.0357). In the ROC curve, a cut-off PLR value of 124 was obtained with a sensitivity of 68.0%, specificity of 66.7%, likelihood ratio=2.04 (AUC=0.659 with p-value=0.035) to detect very high disease activity. Based on the PLR value, platelet count and plateletcrit negatively correlated with SLEDAI score but were related to the very high degree of thrombocytopenia in disease activity. The MPV value reflected the high platelet turnover, which had a positive correlation with the SLEDAI score. Patients with a PLR value â‰¤124 were 2.04 times more likely to have a SLEDAI score of 20, indicating potential use as a predictor of disease activity. The PLR value and platelet indices were significantly related to the degree of SLE activity.

Risks of Hemorrhage and Poor Clinical Outcome in SLE with Thrombocytopenia at Dr. Sardjito Hospital Surawijaya Bakhtiar Kaslam; Umi Solekhah Intansari
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 28 No. 3 (2022)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v28i3.1866

Systemic Lupus Erythematosus (SLE) is an autoimmune disease that affects various body organs and causes chronic inflammation. Thrombocytopenia is common in SLE, and there is a risk of causing bleeding, which can result in death. This study aimed to analyze the relationship of thrombocytopenia with bleeding and poor clinical outcomes in SLE patients at Dr. Sardjito Hospital. The design of this study was retrospective observational analytic. The research subjects were patients diagnosed with SLE at Dr. Sardjito Hospital from January 2016-December 2019 who conducted ANA and anti-dsDNA examinations. Statistical analysis using MedCalc version 13.0. Receiver operating characteristic curve analysis to determine the cut-off value of the platelet count for the occurrence of bleeding. Chi-Square for trend test to determine the relationship between the degree of thrombocytopenia and the degree of bleeding. Kaplan-Meier test to determine the six months survival analysis for SLE patients. There were 61 SLE patients at Dr. Sardjito Hospital. Thirty-two patients (52.5%) had thrombocytopenia. The AUC of the platelet count for the occurrence of hemorrhage was 0.988 (95% CI=0.918-1, p < 0.0001), the cut-off value was 146x103/L, sensitivity 100%, specificity 90.6%, and LR+ 10.33. The AUC of the platelet count for grade 3 hemorrhage was 0.929 (95% CI=0.833-0.979, p < 0.0001), cut-off value 91x103/L, sensitivity 100%, specificity 89.3%, and LR+ 9.33. Hemorrhage was seen in 29 subjects with thrombocytopenia. Five subjects (8.2%) died, with a significant difference in the mortality of SLE patients with and without thrombocytopenia in the six months survival analysis (p=0.028). The risk of hemorrhage and poor clinical outcome (death) were significantly higher in SLE patients with thrombocytopenia and increased with the thrombocytopenia grade.

Suggested Rational Considerations for ANA-IF and ENA-Profile Test Requisition: Clinical Manifestation, Gender, Pattern, and Titer of ANA-IF Yenny Surjawan; Umi Solekhah Intansari
The Indonesian Biomedical Journal Vol 15, No 3 (2023)
Publisher : The Prodia Education and Research Institute (PERI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18585/inabj.v15i3.2346

BACKGROUND: The anti-nuclear antibody immunofluorescence (ANA-IF) test is used for screening of autoantibody presence in patients with suspected autoimmune disease. Positive ANA-IF should be followed-up with extractable nuclear antigens profile (ENA-profile). High ANA-IF sensitivity combined with low ENA-profile sensitivity, and the evolution of ANA-IF requests may result in a higher number of positive ANA-IF but negative ENA-profile. It is necessary to make an objective assessment in determining the conditions in which rational ANA-IF and ENA-profile should be suggested.METHODS: Data were retrieved retrospectively from the medical records of subjects who performed both ANA-IF and ENA-profile. ANA-IF were examined using immunofluorescence principle with cut-off 1:100. ENA-profile which contained sixteen purified antigens was performed using line-immunoblot principle. Data was analyzed descriptively and analytically using SPSS, and significant result was indicated if p<0.05.RESULTS: The ANA-IF result was dominated by negative (44.9%) and positive-speckled, titer 1:100 (32.9%). Of 923 subjects with positive ANA-IF, 45.4% had a negative ENA-profile. Of 751 subjects with negative ANA-IF, 10.2% had positive ENA-profile. In subjects whose specific clinical entity, the ANA-IF sensitivity and negative predictive value (NPV) in detecting ENA-profile were 93.8% and 93.3%, respectively, but the positive predictive value (PPV) was 63.2%. Women with specific autoimmune manifestation accompanied by ANA-IF homogeneous ≥1:100, or centromeres ≥1:100, or speckled ≥1:320 might have been predicted as subsequent positive ENA-profile with area under curve (AUC) of 77.2%, 76.9%, 79.2%, respectively.CONCLUSION: ANA-IF should only be indicated for those with specific clinical symptoms. For woman with typical symptoms, the presence of positive ANA-IF with homogeneous ≥1:100, or centromeres ≥1:100, or speckled ≥1:320 should be further followed-up by ENA-profile.KEYWORDS: ANA-IF, ENA-profile, autoimmune, autoantibody

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