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DIFFERENCES OF ASYMMETRIC DIMETHYL ARGININE LEVEL IN PATIENTS WITH DIABETIC NEPHROPATHY AND NON-DIABETIC NEPHROPATHY Nita Elvina Wisudawati; Coriejati Rita; Leni Lismayanti; Adhi Kristianto Sugianli
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 24, No 3 (2018)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v24i3.1420

Endothelial dysfunction occurs early in Diabetic Nephropathy (DN), characterized by elevated Asymmetric Dimethylarginine (ADMA) levels. Increased ADMA levels may inhibit endothelial Nitric Oxide Synthase (eNOS) production which are required for Nitric Oxide (NO) formation. Decreased NO levels can increase peripheral resistance and exacerbate the endothelial dysfunction. By knowing the difference of ADMA levels in DN and non-DN patients can help the follow-up and management for the progression of endothelial dysfunction. The purpose of this research was to know the difference of ADMA levels in DN and non-DN by a cross-sectional observational analytical method in 53 diabetes mellitus patients at the Dr. Hasan Sadikin Hospital Bandung (December 2016-July 2017). Urine samples were examined to calculate urinary creatinine albumin ratio (uACR) and serum for ADMA levels. Asymetric dimethylarginin was examined by micro ELISA. Most of the subjects were males (60.38%) with the highest age in the range of 55-64 years (45.28%). Increased ADMA levels were found in 100% of DN and 18.5% of non-DN. Median ADMA levels were found in DN 1.01(0.73-2.25) µmol/L and non-DN 0.57(0.27-1.17) µmol/L, showing a significant difference of ADMA levels (p<0.001). High ADMA levels showed endothelial dysfunction in DN. Serum ADMA levels in DN patients were higher than in non-DN.

THE CORRELATION BETWEEN THE MEAN PLATELET VOLUME VALUES WITH THROMBOCYTE AGGREGATION IN NEPHROPATHY DIABETIC PATIENTS Agus Sunardi; Nadjwa Zamalek Dalimoenthe; Coriejati Rita; Adhi Kristianto Sugianli
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 25, No 1 (2018)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v25i1.1510

Diabetic nephropathy is the most important cause of end-stage renal failure. Chronic hyperglycemia will cause glomerular endothelial damage, and this damage will stimulate hemostasis activation including platelets so that platelet aggregation will increase. The increase of platelet aggregation will increase platelet consumption, which further stimulates thrombopoiesis which will lead to immature platelets of large size to be released into the circulation. This research aimed to determine the positive correlation between MPV with platelet aggregation in patients with diabetic nephropathy. This study was an analytic observational study with a cross-sectional study design. The research was conducted in the Dr. Hasan Sadikin Hospital Bandung from July 2016 to October 2017. A total of 52 subjects who met the inclusion criteria were included in the study. Mean platelet volume and platelet aggregation were performed with venous examination with EDTA and sodium citrate 3.2% anticoagulants. The result of platelet aggregation examination showing platelet hyper-aggregation was found in 44.2% of subjects, 50% normal-aggregation, 5.8% hypo-aggregation. While the median value of MPV in this study was 9.2 fL with the range of 8.00 – 11.80 fL. A positive correlation was found between MPV value with platelet aggregation with r= 0.067, p= 0.634. The conclusion was that there was no correlation between MPV values with platelet aggregation in diabetic nephropathy patients. This small and insignificant r-value might be due to several factors that also affect platelet aggregation in diabetic nephropathy patients, requiring further investigation.

The Combination of NLR and D-dimer as Predictor Instrument for the Severity of COVID-19 Shofia Widya Murti; Delita Prihatni; Adhi Kristianto Sugianli
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.v28i3.1998

Coronavirus Disease-19 (COVID-19) is caused by Severe Acute Respiratory Syndrome-Corona Virus-2 (SARS-CoV-2). In severe cases, the immune response may cause a cytokine storm. Neutrophil Lymphocyte Ratio (NLR) and D-dimer are parameters that may be used to predict the severity of COVID-19. This study aims to determine the diagnostic validity of the combination of NLR and D-dimer on the severity of COVID-19 patients. The study population was hospitalized COVID-19 patients whose diagnosis were confirmed by real time-PCR. This was a retrospective cross-sectional study. The cut-off value was based on the Area Under Curve (AUC) of the Receiver Operator Characteristic Curve (ROC) analysis and the combination of NLR and D-Dimer validity was tested against the severe and non-severe COVID-19 groups by assessing sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), positive Likelihood Ratio (LR+) and negative Likelihood Ratio (LR-). There were 1,314 subjects. Seven hundred and forty-four were in the severe group, 570 in the non-severe group. The combination of NLR > 4.02 and D-dimer > 1.12 mg/L on the severity of COVID-19 showed a sensitivity value of 70.8%, specificity 98.3%, PPV 98.1%, NPV 72.1%, LR+ 40.38 and LR- 0.30. The combination of NLR >4.02 and D-dimer >1.12 mg/L for the severity of COVID-19 showed high specificity and PPV (98.3% and 98.1%). This was also supported by the LR+ value, which indicates that if NLR > 4.02 and D-dimer > 1.12 mg/L, it may cause severe COVID-19 by 40.38 times compared to NLR ≤4.02, and D-dimer ≤1.12 mg/L. The combination of NLR and D-Dimer can be used to predict the severity of COVID-19.

Analysis of C-Peptide Levels Among Gynaecological Malignancies Patients Underwent Chemotherapy with Carboplatin Regiment Nina Tristina; Juandika Juandika; Leni Lismayanti; Adhi Kristianto Sugianli; Raja Iqbal Mulya Harahap
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 29, No 1 (2022)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v29i1.1967

C-peptide is part of the, which its amounts were equal to endogenous insulin secreted by pancreatic β cells. Carboplatin is one of the chemotherapy regimens that are widely used to treat gynecological malignancies. Carboplatin may cause the damage of β-islets of Langerhans, which may cause defects in insulin synthesis leading to secondary diabetes mellitus or other types of diabetes mellitus. The purpose of this study was to determine the differences in C-peptide, (which reflects endogenous insulin levels) levels in patients with gynecologic malignancy who underwent carboplatin chemotherapy. This study was a comparative observational study with a cross-sectional design. There was a total of 42 subjects who met the inclusion criteria. Subjects with gynecological malignancy post-carboplatin chemotherapy regimens had lower serum C-peptide levels in group II compared to group I. Serum C-peptide levels can further be used to monitor side effects of carboplatin and can be used as a test to diagnose the other types of diabetes mellitus especially before starting the fourth cycle

Laboratory Diagnostic and Monitoring at Early Stages of SARS-CoV-2 Infection: Case Report and Literature Review Adhi Kristianto Sugianli; Dewi Kartika Turbawaty; Ida Parwati
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 29, No 1 (2022)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v29i1.1952

COVID-19 is a new respiratory disease caused by severe acute respiratory syndrome Coronavirus type 2 (SARS-CoV-2) and became a pandemic in early 2020. Since the clinical presentation of this viral infection can mimic other types of viral infection (e.g., dengue, influenza, and another respiratory disease), the laboratory approach becomes essential, particularly at the early stages of infection. This case-literature review approach described an outpatient case of a 39-year-old male patient with mild-to-moderate COVID-19 who recovered after 49 days of self-quarantine. Lymphopenia and mild thrombocytopenia can be used as early screening for COVID-19 at the early stages of infection and mainly occur in outpatient settings. Meanwhile, Neutrophil-to-Lymphocyte Count Ratio (NLCR), C-Reactive Protein (CRP), and Liver Function Test (LFT) can be used for severity prediction and/or follow-up the outcome of the infected patient. Therefore, the integrated clinical-laboratory finding at the early stages of infection is vital to provide better and effective patient management.

Laboratory Diagnostic Approach and Interpretation in Gram-Negative Bacterial Infection: A-Case Report of Sepsis in Secondary Hospital Settings Adhi Kristianto Sugianli; Ida Parwati
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 26 No. 3 (2020)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v26i3.1563

Gram-Negative Bacteria (GNB) have been widely reported to cause worldwide infections and life-threatening. The high prevalence of drug-resistant GNB causes the treatment of GNB to become difficult. This case report describes a stepwise laboratory approach and interpretation for Gram-negative bacteria infection in sepsis patients. An 84-year-old female patient with a history of congestive heart failure, after three weeks of hospitalization, GNB was proven as the cause of sepsis. Laboratory approach for inflammation (C-reactive protein, procalcitonin) was made and confirmed with a positive culture of several specimens (sputum, urine, and blood). The identification of bacterial-culture revealed as Carbapenem-resistance Klebsiella pneumoniae and Extended-spectrum Beta-lactamases Escherichia coli. This case highlights GNB as a potential agent to worsen the infection (sepsis) and also a useful approach for the detection of multidrug-resistant bacteria, particularly in secondary hospital settings. The application and interpretation of integrated clinical and laboratory criteria may bring out better and effective patient management.

Laboratory Diagnostic and Monitoring at Early Stages of SARS-CoV-2 Infection: Case Report and Literature Review Adhi Kristianto Sugianli; Dewi Kartika Turbawaty; Ida Parwati
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 29 No. 1 (2022)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v29i1.1952

COVID-19 is a new respiratory disease caused by severe acute respiratory syndrome Coronavirus type 2 (SARS-CoV-2) and became a pandemic in early 2020. Since the clinical presentation of this viral infection can mimic other types of viral infection (e.g., dengue, influenza, and another respiratory disease), the laboratory approach becomes essential, particularly at the early stages of infection. This case-literature review approach described an outpatient case of a 39-year-old male patient with mild-to-moderate COVID-19 who recovered after 49 days of self-quarantine. Lymphopenia and mild thrombocytopenia can be used as early screening for COVID-19 at the early stages of infection and mainly occur in outpatient settings. Meanwhile, Neutrophil-to-Lymphocyte Count Ratio (NLCR), C-Reactive Protein (CRP), and Liver Function Test (LFT) can be used for severity prediction and/or follow-up the outcome of the infected patient. Therefore, the integrated clinical-laboratory finding at the early stages of infection is vital to provide better and effective patient management.

Analysis of C-Peptide Levels Among Gynaecological Malignancies Patients Underwent Chemotherapy with Carboplatin Regiment Nina Tristina; Juandika Juandika; Leni Lismayanti; Adhi Kristianto Sugianli; Raja Iqbal Mulya Harahap
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 29 No. 1 (2022)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v29i1.1967

C-peptide is part of the, which its amounts were equal to endogenous insulin secreted by pancreatic Î² cells. Carboplatin is one of the chemotherapy regimens that are widely used to treat gynecological malignancies. Carboplatin may cause the damage of Î²-islets of Langerhans, which may cause defects in insulin synthesis leading to secondary diabetes mellitus or other types of diabetes mellitus. The purpose of this study was to determine the differences in C-peptide, (which reflects endogenous insulin levels) levels in patients with gynecologic malignancy who underwent carboplatin chemotherapy. This study was a comparative observational study with a cross-sectional design. There was a total of 42 subjects who met the inclusion criteria. Subjects with gynecological malignancy post-carboplatin chemotherapy regimens had lower serum C-peptide levels in group II compared to group I. Serum C-peptide levels can further be used to monitor side effects of carboplatin and can be used as a test to diagnose the other types of diabetes mellitus especially before starting the fourth cycle

The Combination of NLR and D-dimer as Predictor Instrument for the Severity of COVID-19 Shofia Widya Murti; Delita Prihatni; Adhi Kristianto Sugianli
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.v28i3.1998

Coronavirus Disease-19 (COVID-19) is caused by Severe Acute Respiratory Syndrome-Corona Virus-2 (SARS-CoV-2). In severe cases, the immune response may cause a cytokine storm. Neutrophil Lymphocyte Ratio (NLR) and D-dimer are parameters that may be used to predict the severity of COVID-19. This study aims to determine the diagnostic validity of the combination of NLR and D-dimer on the severity of COVID-19 patients. The study population was hospitalized COVID-19 patients whose diagnosis were confirmed by real time-PCR. This was a retrospective cross-sectional study. The cut-off value was based on the Area Under Curve (AUC) of the Receiver Operator Characteristic Curve (ROC) analysis and the combination of NLR and D-Dimer validity was tested against the severe and non-severe COVID-19 groups by assessing sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), positive Likelihood Ratio (LR+) and negative Likelihood Ratio (LR-). There were 1,314 subjects. Seven hundred and forty-four were in the severe group, 570 in the non-severe group. The combination of NLR > 4.02 and D-dimer > 1.12 mg/L on the severity of COVID-19 showed a sensitivity value of 70.8%, specificity 98.3%, PPV 98.1%, NPV 72.1%, LR+ 40.38 and LR- 0.30. The combination of NLR >4.02 and D-dimer >1.12 mg/L for the severity of COVID-19 showed high specificity and PPV (98.3% and 98.1%). This was also supported by the LR+ value, which indicates that if NLR > 4.02 and D-dimer > 1.12 mg/L, it may cause severe COVID-19 by 40.38 times compared to NLR â‰¤4.02, and D-dimer â‰¤1.12 mg/L. The combination of NLR and D-Dimer can be used to predict the severity of COVID-19.

Identification of Community- and Hospital Pulmonary Bacterial Infection Using Culture and PCR Panel in COVID-19 Ronal Winter; Adhi Kristianto Sugianli; Ida Parwati
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 30 No. 2 (2024)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v30i2.2113

Co-infection or secondary infection is associated with a worse outcome in COVID-19. Information concerning the distribution of pathogenic microbes in COVID-19 has yet to be widely studied. This study aims to evaluate the distribution of bacterial infection in COVID-19, detected using conventional culture and molecular methods. This study was conducted in March-May 2021 in Dr. Hasan Sadikin General Hospital, with a study population of moderate, severe, and critical COVID-19 patients. Microorganisms were identified and analyzed from expectorant sputum or Endotracheal tube aspirates using conventional culture methods (VITEK 2 Compact) and multiplex PCR pneumonia panel (Biofire). Data was presented in a table and figures to describe the organism profile among the two methods. From the 450 COVID-19 patients, 59 subjects were included. The positivity rate of microbial identification reached 79.7% in both methods, dominated by Gram-negative bacteria for both community and hospital-acquired infections. The pathogens most frequently detected using conventional methods and multiplex PCR were Acinetobacter baumanii (15.3%; 23.7%) and Klebsiella pneumoniae (23.7%; 28.8%). The multiplex PCR method detected Haemophilus influenzae (15.3%) and respiratory viruses (3.4%), which conventional methods could not detect. Gram-negative bacteria were the most frequent pathogen in COVID-19 in both populations. The multiplex PCR method has the advantage due to its shorter examination time. The application of both methods helps determine antibiotic therapy for COVID-19. Both methods identified Klebsiella pneumoniae and Acinetobacter baumanii as the dominant bacteria in both populations. This study helps establish antibiotic management in COVID-19, thus preventing antibiotic resistance.

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