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All Journal International Journal of Integrated Health Sciences Althea Medical Journal Folia Medica Indonesiana Sari Pediatri Majalah Kesehatan FKUB Indonesian Journal of Clinical Pathology and Medical Laboratory (IJCPML)
Adhi Kristianto Sugianli
Department Of Clinical Pathology RSHS/Faculty Of Medicine Padjadjaran University
Biochemistry, Genetics & Molecular Biology Health Professions Medicine & Pharmacology Neuroscience Public Health Other

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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

Abstract

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

Abstract

     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 NLCR and Enhances the Sepsis-3 Strategy Emmy Hermiyanti Pranggono; Endah Nurul Aini; Uun Sumardi; Yovita Hartranti; Adhi Kristianto Sugianli
Folia Medica Indonesiana Vol. 58 No. 2 (2022): June
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (751.686 KB) | DOI: 10.20473/fmi.v58i2.31051

Abstract

Highlights: The combination of NLCR and PLR will improve the ability to distinguish infection rather than noninfection in the emergency setting for early antibiotic prescribing as well as the sepsis-3 strategy. The diagnostic value of PLR in adult bacterial sepsis patients has never been studied.   Abstract: According to Sepsis-3, antibiotics should be administered in the first hour of diagnosis of sepsis. Still, there is difficulty in differentiating between bacterial and nonbacterial infections and a lack of a rapid diagnostic tool to distinguish them. This study evaluated the diagnostic value of NLCR and PLR in suspected bacterial sepsis. The diagnostic value of PLR in adult bacterial sepsis patients has never been studied. This study was a retrospective study from the medical record of Dr. Hasan Sadikin Hospital Bandung. All patients at age ≥ 18 years diagnosed with sepsis based on ICD-10 code and qSOFA ≥ 2 were included. We calculated sensitivity, specificity, NPV, PPV, positive LR, and AUC of NLCR and PLR. There were 177 patients included in this study. The sensitivity of NLCR was 69.5%, specificity was 34.7%, NPV was 56.9%, PPV was 47.9%, and LR+ was 1.06, while the sensitivity of PLR was 62.2%, specificity was 38.9%, NPV was 54.4%, PPV was 46.8%, and LR+ was 1.02. We obtained cut-off values for NLCR 11.06, AUC 0.500, PLR 222.41, and AUC 0.497. The low value of AUC NLCR and PLR was due to prior antibiotic use. The combination of NLCR and PLR had higher positive LR (1.16) and specificity (54.7%), and also, according to NLCR, we had the highest sensitivity (69.5%). The combination of NLCR and PLR enhances the sepsis-3 strategy because it can be used as screening tools for bacterial sepsis, and antibiotics can also be administered in the first hour of managing sepsis, particularly in the emergency ward.
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

Abstract

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.
Antibiotic Susceptibility among Infective Endocarditis Population: Syndromic Antibiogram Evaluation at Indonesian National Cardiovascular Center Indrawati, Lilik; Sugianli, Adhi Kristianto; Prakoso, Baskoro Justicia; Gunawan, Adrian; Soerarso, Rarsari; Soesanto, Amiliana M.; Dewi, Andaru Dahesih
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 31 No. 1 (2024)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v31i1.2223

Abstract

Infective Endocarditis (IE) is a life-threatening disease with a high mortality rate (25%). Laboratory approaches to support the diagnosis of IE especially blood and/or cardiac vegetation culture, are crucial for providing definitive therapy. However, negative culture is frequently observed, therefore empirical use of antibiotics seems unavoidable and may lead to increasing antimicrobial resistance. This study aims to observe the prevalence of antibiotic susceptibility among the IE population using the WISCA approach. This retrospective study observed medical record data of all inpatients diagnosed with IE according to ICD-10 at Cardiovascular Center Harapan Kita Hospital (NCCHK) between January 2018 and December 2022. Patient data were combined with bacterial identification and antibiotic susceptibility test data from the laboratory information system, and evaluated based on period (year). A total of 67,858 inpatients and 1.1% (n=772) were diagnosed with IE. Successful culture growth (blood and/or cardiac vegetation specimen) was between 36.8% and 70% annually. Streptococcus viridans group (82/237, 34.6%) and Coagulase-negative Staphylococci (57/237, 24.1%) were dominantly observed among the IE population. Low susceptibility among Penicillin (34.3%) towards Gram-positive bacteria, as first-line treatment option in IE. Meanwhile, high susceptibility range was observed in Ceftriaxone (95.7%), Gentamicin (80.4%), Rifampicin (84.4%), and Vancomycin (98.7%) as second-line treatment in IE. Despite the low prevalence, the occurrence of antimicrobial resistance in IE has become a priority concern. Continuing the syndromic antibiogram is mandatory to assist the trend of empirical antibiotic usage and refine the established local treatment guidelines.
The Utility of Micro-R/Hypo-He Ratio Cut-off for Distinguishing Iron Deficiency Anemia and Minor Thalassemia Audiyananda, Dwika; Prihatni, Delita; Surata, Nida; Sugianli, Adhi Kristianto
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 31 No. 1 (2024)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v31i1.2234

Abstract

     Thalassemia is a genetic disease with impaired synthesis of the globin chain that causes anemia. Thalassemia and Iron Deficiency Anemia (IDA) are both microcytic hypochromic anemia but have different proportions of hypochromic and microcytic erythrocytes due to differences in disease mechanisms. Research parameters of the hematology analyzer: %Micro-R, %Hypo-He, and MH ratio can be used as early screening for thalassemia and IDA. This study aimed to evaluate the cut-off of %Micro-R, %Hypo-He, and MH ratio to differentiate thalassemia from IDA. A cross-sectional study was carried out on 217 subjects. Subjects were divided into two groups, thalassemia and IDA based on hemoglobin electrophoresis, hematology examination, and Mentzer index. Differences and cut-off values of %Micro-R, %Hypo-He, and MH ratio between the two groups were analyzed. The number of collected data was 134, consisting of 89 thalassemia patients and 45 IDA patients. Thalassemia patients had a median %Micro-R value of 51.2 (4.3-79.0), %Hypo-He value of 7.2 (0.2-50.2), and MH ratio of 7.17 (1.10-64.50), higher than IDA patients (p=0.000; p=0.176; p=0.000). The optimal cut-off value for %Micro-R in discriminating thalassemia trait from IDA was >12.7, with the area under the ROC curve (AUC) of 0.945, sensitivity of 92.1%, and specificity of 82.2%. The cut-off value for MH ratio > 3.27 with AUC 0.833, sensitivity of 85.4%, and specificity 77.8% showed lower performance of cut-off value compared to %Micro-R. The algorithm using %Micro-R and MH ratio was proposed for thalassemia trait screening. High %Micro-R and MH are suggestive of thalassemia trait than of IDA.
Crossmatch Results After Repeated Transfusions Horian, Erinca; Lismayanti, Leni; Sugianli, Adhi Kristianto
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 31 No. 3 (2025)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v31i3.2349

Abstract

Patients with thalassemia, chronic kidney disease, hematologic and non-hematologic malignancies may require repeated transfusions. Repeated transfusions can have a detrimental effect, leading to the formation of alloantibodies and/or autoantibodies. These antibodies can cause incompatible crossmatch results. This study aims to identify the clinical characteristics of patients with incompatible crossmatch results after repeated transfusions, to ensure safe transfusions. This study is a cross-sectional, observational descriptive study conducted at Dr. Hasan Sadikin General Hospital from January to December 2022. Patients were included if they had received more than one transfusion within the past year, defined as 'repeated transfusions'. The following data were collected: age, gender, blood type, diagnosis, quantity of blood bags, total number of transfusions, interval between transfusions, history of incompatibility, and Coombs Test. The data were obtained through the laboratory information system and from blood request forms in the Blood Service Unit. Out of 2285 subjects receiving repeated transfusions, 38.1% experienced crossmatch incompatibility. The majority (91.2%) of these cases were minor. Crossmatch incompatibility occurred more frequently in subjects under the age of 15 (22.6-23.3%) and those with diagnosis of thalassemia (25.6-27.3%). Most subjects with minor crossmatch incompatibility had a history of receiving more than four blood bags (51.9-60%), an interval between transfusions of four weeks or less (92.2-92.8%), and a history of previous incompatibility (72.1-80.5%). The important clinical characteristics of patients with incompatible crossmatch results after repeated transfusions were age, underlying diagnosis, quantity of blood bags, interval between transfusions, and history of previous crossmatch incompatibility.
KARAKTERISTIK PASIEN FRAKTUR TERBUKA TERINFEKSI DI RSUP dr. HASAN SADIKIN BANDUNG TAHUN 2018-2020 Fatimah; Rasyid, Hermawan Nagar; Sugianli, Adhi Kristianto
Majalah Kesehatan Vol. 12 No. 3 (2025): Majalah Kesehatan
Publisher : Faculty of Medicine Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/majalahkesehatan.2025.012.03.3

Abstract

Tujuan utama tata laksana fraktur terbuka yang tepat adalah mencegah terjadinya infeksi. Namun, infeksi pada fraktur terbuka dapat dipengaruhi oleh faktor yang berkaitan dengan pasien dan kejadian cedera. Tujuan penelitian ini untuk mengetahui karakteristik kejadian fraktur terbuka terinfeksi di RSUP dr. Hasan Sadikin Bandung (RSHS) pada periode Januari 2018–Desember 2020. Penelitian deskriptif dengan mengevaluasi secara retrospektif terhadap data rekam medis pasien dengan diagnosis fraktur terbuka menurut ICD-10 di RSHS, berdasarkan kriteria inklusi dan eksklusi. Data penelitian dikelompokkan menjadi (1) faktor terkait dengan pasien dan kejadian cedera, serta (2) faktor terkait dengan tata laksana fraktur terbuka. Data penelitian dianalisis dan ditabulasi sebagi tabel distribusi frekuensi menggunakan Microsoft Excel. Sebesar 2,9% kejadian infeksi ditemukan pada subjek terinklusi. Sebesar 70% subjek fraktur terbuka terinfeksi terjadi pada umur 18-50 tahun, dengan lokasi fraktur tersering pada anggota gerak bawah (92,3%), dengan tipe III fraktur terbuka menurut klasifikasi Gustilo-Anderson. Seluruh subjek fraktur terbuka terinfeksi mendapat pemberian antibiotik profilaksis, namun sebesar 53,8% subjek mendapatkan tindakan debridemen dalam waktu >24 jam. Jenis stabilisasi fraktur, fiksasi eksterna diterapkan pada 69,2% subjek dan sebesar 76,9% subjek dilakukan penutupan luka waktu <3 hari. Sebesar 76,9% subjek memiliki hasil biakan bakteri Gram negatif, dengan bakteri dominan adalah Pseudomonas aeruginosa. Faktor yang berkaitan dengan kejadian fraktur terbuka terinfeksi pada penelitian ini menjadi hal yang perlu diperhatikan dalam keberhasilan tata laksana infeksi, meliputi lokasi fraktur, tipe fraktur terbuka menurut klasifikasi Gustilo-Anderson, serta penundaan tata laksana fraktur terbuka.
Co-Authors Adrian Gunawan, Adrian Agus Sunardi Agustinus Wiraatmadja Amalia, Ridha Amiliana M. Soesanto Andaru Dahesihdewi Ariel Bagoes Prakoso Audiyananda, Dwika Benjamin Yong Qing Nan Coriejati Rita Dewi Kartika Turbawaty Eka Surya Nugraha Emmy Hermiyanti Pranggono Endah Nurul Aini Fatimah Grace Amanda Maharani Hasti Savira Yudiana Hermawan Nagar Rasyid, Hermawan Nagar Horian, Erinca Ida Parwati Jennifer Hadiman Leni Lismayanti Lilik Indrawati, Lilik Mia Milanti Dewi Nadjwa Zamalek Dalimoenthe Nita Elvina Wisudawati Nur Suryawan Hidayat Prakoso, Baskoro Justicia Prihatni, Delita Qing Nan, Benjamin Yong Rarsari Soerarso Reni Ghrahani Siti Aminah Surata, Nida Susi Susanah Uun Sumardi, Uun Yovita Hartranti Yoyos Dias Ismiarto