36 research outputs found
Suggested Rational Considerations for ANA-IF and ENA-Profile Test Requisition: Clinical Manifestation, Gender, Pattern, and Titer of ANA-IF
No full textBACKGROUND: 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, autoantibod
Ekspresi Reseptor FcγII (CD32)Monosit pada Pasien Infeksi Dengue dan Subyek Sehat
No full textDengue infection is a global threat and an endemic or epidemic disease in
almost countries especially in tropical and subtropical regions, including
Indonesia. Since it was first discovered in 1968 until 2009, the World Health
Organization (WHO) noted Indonesia as a country with the highest cases of
dengue hemorrhagic fever (DHF) in Southeast Asia. Manifestations of dengue
infection vary widely, and it can be asymptomatic or symptomatic, such as the
undifferentiated fever, dengue fever (DF), DHF or dengue shock syndrome (DSS).
Antibody-dependent enhancement (ADE) is one of the central hypotheses
for the pathogenesis of DHF/DSS that hadbeen proposed 3 decades ago.
Preexisting antibodies to one serotype form infectious immune complexes
withheterotypic serotypes and bind to FcγII receptor such as
monocytes/macrophages. This facilitates the entry of dengue virus / DENV,
replication, and spread which willincreasing the degree of the disease severity.
This study is an observational analytic study with a cross-sectional design
to determine expression of FcγIIR (CD32) monocytes in patient with dengue
infection and healthy subject. The study subjects were patients with DENV
infection based on WHO 2011 criteria, hospitalized in RSUPDR. Sardjito
Yogyakarta andRSUD Panembahan Senopati Bantul, and resident/relatives with
consecutive selected and meet the criteria for inclusion or exclusion. Examination
expression of FcγIIR (CD32) monocytes in whole boodwith lyse no wash
principle using flowcytometry. The results shown in the descriptive analysis and
analysis of differences expression of FcγIIR (CD32) monocytes in patients with
dengue infection and healthy subjects.Expressionof FcγIIR (CD32) monocytes in
patients with dengue infection higher than healthy subjects
Natural Killer (NK) cells and severity of dengue infection among children hospitalized in Dr. Sardjito Hospital
No full textBackground: 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 hospital
Methods: 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.322p=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 phase
Perbandingan Tingkat Deteksi Bakteri Gram Negatif Penghasil Karbapenemase Pada Uji Carba Nordmann Poirel (Carba NP) Dan Modified Hodge Test (MHT)
No full textPenggunaan 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
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
No full textSurgical 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.
Factors influencing plateletpheresis donations in Yogyakarta, Indonesia
No full textDespite its life saving potential, regrettably, blood transfusion has yet to be optimally applied in Indonesia. Funding difficulties and both public and professional lack of knowledge hinders its progress. More lives can be saved by using a safer, more proper, and specialized blood transfusion procedure. Plateletpheresis, one method to obtain platelet products, requires a different donation procedure than that of whole blood-derived platelet. High quality plateletpheresis product donation will positively impact the transfusion efficacy and platelet recovery of the recipient, improving patient’s clinical state. This study analyzes factors from both the donor and donation procedure that influence the quality of plateletpheresis product. The study analyzes data of plateletpheresis donations from blood transfusion service and plateletpheresis transfusions from medical records at Dr. Sardjito General Hospital, Yogyakarta, Indonesia, within the period of August 2012 to January 2013 using cross sectional design. Forty-four plateletpheresis donations were obtained during the study. All donors were male with the following mean values; age 31.9 ± 9.9 years, weight 70.2 ± 10.2 kg, body mass index (BMI) 24.7 ± 3.2 kg/m2, hematocrit 44 ± 3.2 %, and procedure time 84.2 ± 19.2 min. The median value of platelet yield was 3.2x1011 (2.1x1011 – 4x1011). The median value of pre-donation platelet count was 248.5x103/μL (204x103/μL – 391x103/μL) and the mean value of product volume was 275 ± 22.9 mL. The results showed that pre-donation platelet count (r = 0.329; p 0.05). In conclusion, pre-donation platelet count and product volume of plateletpheresis influence the yield of plateletpheresis. However, the yield is not correlated to the post-donation platelet count. Thus, other clinical factors should be considere
Kinetics of CD4+ T-Lymphocyte in Dengue Virus Infection
No full textCellular 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. CD4⁺ T-lymphocyte induces the immunopathology via various mechanisms; however, 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 (p0.05). 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
Natural Killer (NK) cells and severity of dengue infection among children hospitalized in Dr. Sardjito Hospital
No full textBackground: 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 phase
Peranan Laboratorium dalam Prevention of Mother to Child Transmission (PMTCT) HIV
No full textHuman Immunodeficiency Virus (HIV) adalah retrovirus RNA yang dapat menyebabkan penyakit klinis, yaitu Acquired Immunodeficiency Syndrome (AIDS). Transmisi virus dari ibu ke anak (mother to child transmission/MTCT) dapat terjadi melalui darah maternal, sekresi saluran genital, dan ASI. Risiko penularan HIV dari ibu ke bayi dapat ditekan hingga 2% dengan program PMTCT. Tulisan ini bertujuan untuk memaparkan tentang peran laboratorium dalam mendukung program PMTCT HIV. Dalam hal ini laboratorium memegang peranan yang penting dalam mendeteksi HIV secara dini dan diikuti dengan evaluasi. Untuk menentukan bayi tidak mengidap HIV, diperlukan minimal dua kali pemeriksaan polymerase chain reaction (PCR) RNA HIV dengan hasil negatif, yaitu pada usia 4-6 minggu dan pada usia 4-6 bulan. Pada saat bayi berusia 18 bulan dilakukan pemeriksaan antibodi terhadap HIV dengan cara Enzyme-linked Immunosorbent Assay (ELISA) untuk konfirmasi. Laboratorium memegang peranan penting dalam melakukan deteksi dini HIV serta membantu dalam proses follow up sehingga dapat mendukung program PMTCT.                                                                        Kata kunci: PMTCT, HIV, PCR, ELISA   [Laboratory Role In The Prevention of Mother to Child Transmission (PMTCT) of HIV]The Human Immunodeficiency Virus (HIV) is a RNA retrovirus which causes the clinical disease termed the acquired immunodeficiency syndrome (AIDS). Mother-to-child transmission (MTCT) may occurred because of the intrapartum maternal blood exposure, infected genital tract secretions and during breastfeeding. The aim of this paper is to explain the role of laboratory to support PMTCT program. Laboratory plays an important role in PMTCT, that given the starting point of PMTCT is early detection of HIV and followed by evaluation. To determine the baby does not have HIV, it takes at least two times the HIV RNA PCR with negative results, (at 4-6 weeks of age and at the age of 4-6 months). And then infants examined for HIV antibodies by Enzyme-linked Immunosorbent Assay (ELISA) for confirmation at 18-month-old. Laboratory has an important role to support diagnose of HIV and their follow up, so it can be support PMTCT program.Keywords: PMTCT, HIV, PCR, ELIS
