Noormartany Noormartany
Departemen Patologi Klinik Fakultas Kedokteran Universitas Padjadjaran-Rumah Sakit Dr. Hasan Sadikin Bandung

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Prothrombin Time, Activated Partial Thromboplastin Time, Fibrinogen, dan D-dimer Sebagai Prediktor Decompensated Disseminated Intravascular Coagulation Sisseminated pada Sepsis

Majalah Kedokteran Bandung Vol 43, No 1 (2011)
Publisher : Fakultas Kedokteran, Universitas Padjadjaran

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AbstrakSepsis adalah respons sistemik terhadap infeksi dan terutama terjadi pada pneumonia. Sepsis dapat menyebabkan komplikasi disseminated intravascular coagulation (DIC) yang dibedakan menjadi compensated dan decompensated DIC. Tujuan penelitian ini adalah untuk menentukan apakah nilai prothrombin time (PT), activated partial thromboplastin time (aPTT), kadar fibrinogen, dan D-dimer dapat digunakan sebagai prediktor decompensated DIC pada penderita sepsis. Penelitian dilakukan di Laboratorium Patologi Klinik Rumah Sakit Hasan Sadikin Bandung mulai September 2008 sampai Juni 2010. Subjek penelitian adalah penderita sepsis yang disebabkan pneumonia. Nilai PT, aPTT, kadar fibrinogen, dan D-dimer semua subjek sepsis dicatat kemudian dilakukan pengamatan sampai subjek dinyatakan mengalami decompensated atau non-decompensated DIC; selanjutnya dilakukan analisis nilai PT, aPTT, kadar fibrinogen, dan D-dimer pada kelompok decompensated dan non-decompensated DIC. Penelitian menggunakan rancangan cohort. Subjek berjumlah 39 orang (58%) penderita sepsis dengan luaran decompensated DIC dan 28 orang (42%) penderita sepsis dengan luaran non-decompensated DIC. Dari parameter hemostasis yang diperiksa, didapatkan bahwa nilai PT, aPTT, dan fibrinogen merupakan prediktor decompensated DIC pada penderita sepsis dengan risiko relatif (RR) masing-masing 240,500; 7,157; dan 6,421. Simpulan, prothrombin time, aPTT, dan fibrinogen merupakan pemeriksaan untuk mengetahui aktivasi koagulasi. Parameter hemostasis yang merupakan prediktor decompensated DIC pada penderita sepsis adalah nilai PT dan aPTT yang memendek serta kadar fibrinogen yang meningkat. [MKB. 2011;43(1):49–54].Kata kunci: Activated partial thromboplastin time, D-dimer, disseminated intravascular coagulation, fibrinogen, prothrombin time, sepsisProthrombin Time, Activated Partial Thromboplastin Time, Fibrinogen,and D-dimer as a Predictor of Decompensated Disseminated Intravascular Coagulation in SepsisAbstractSepsis is a systemic response to infection especially in pneumonia case. Sepsis can cause complications such as disseminated intravascular coagulation (DIC) which can be divided into compensated and decompensated DIC. The purpose of this study was to assess whether the value of prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, and D-dimer levels can be used as predictors of decompensated DIC in sepsis patients. This study was conducted at the Laboratory of Clinical Pathology Rumah Sakit Hasan Sadikin Bandung since September 2008 to June 2010. Subjects were patients with sepsis caused by pneumonia. PT and aPTT values, fibrinogen, and D-dimer levels was recorded from all sepsis patients then patients were observed until diagnosed decompensated or non-decompensated DIC, then the value of PT, aPTT, fibrinogen and D-dimer levels in the group of decompensated DIC and non-decompensated DIC were analysed. This study used cohort design. Subjects were 39 sepsis patients (58%) with outcome decompensated DIC and 28 sepsis patients (42%) with outcome non-decompensated DIC. From the hemostasis parameter test out, it was found that PT, aPTT, and fibrinogen were the predictor of decompensated DIC in patients with sepsis with relative risk 240.500, 7.157, and 6.421; respectively. Conclusions, prothrombin time, aPTT, fibrinogen are the test to know coagulation activation. Hemostasis parameter to predict decompensated DIC in sepsis patients are the shorten PT, aPTT, and the increased fibrinogen. [MKB. 2011;43(1):49–54].Key words: Activated partial thromboplastin time, D-dimer, disseminated intravascular coagulation, fibrinogen,prothrombin time, sepsi

Kadar N-Terminal Pro-Brain Natriuretic Peptide sebagai Prediktor Luaran Klinis Sindrom Koroner Akut

Majalah Kedokteran Bandung Vol 44, No 2 (2012)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Kadar N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma dapat menggambarkan tingkat keparahan iskemia walaupun tidak terjadi nekrosis, iskemia yang transien dapat meningkatkan peregangan dinding jantung yang akan menginduksi sintesis dan pelepasan brain natriuretic peptide (BNP) yang sebanding dengan tingkat keparahan iskemia. Tujuan penelitian untuk mengetahui apakah kadar NT-proBNP pada penderita sindrom koroner akut (SKA) dapat digunakan sebagai parameter prediktor luaran klinis. Penelitian dilakukan sejak bulan Januari hingga Maret 2010. Subjek penelitian penderita SKA yang datang ke Unit Gawat Darurat Rumah Sakit Dr. Hasan Sadikin Bandung dan telah didiagnosis klinis sesuai kriteria World Health Organization. Pada subjek yang memenuhi kriteria inklusi dilakukan pemeriksaan kadar NT-pro BNP dengan metode electrochemiluminescence immunoassay, cardiac troponin T (kuantitatif), dan creatine kinase muscle brain (enzimatik). Analisis data uji normalitas menggunakan one-sample Kolmogorov-Smirnov test, analisis regresi logistik multipel untuk mengetahui parameter prediktor luaran klinis penderita SKA. Dari 83 subjek yang ikut dalam penelitian, didapatkan nilai prediksi kadar NT-proBNP sebesar 1,00 sehingga bukan merupakan prediktor utama luaran klinis, koefisien β NTproBNP sebesar 0,001 menyatakan bahwa setiap penambahan 1.000 pg/mL variabel NT-proBNP akan menambah lama perawatan 1 hari. Pada subjek SKA dengan luaran (outcome) sembuh nilai prediksi cTnT lebih baik sebagai faktor prediktor dibandingkan dengan konsentrasi NT-proBNP (OR=32,53; 95%IK; 0,58–1.819,26). Simpulan, NT-proBNP bukan merupakan prediktor utama luaran klinis pada SKA. Kadar NT-proBNP lebih dari 826,7 pg/mLterdapat kemungkinan prognosis yang buruk sampai dengan kematian. [MKB. 2012;44(2):106–13].The Role of NT-proBNP as Clinical Outcome Predictor for Acute Coronary SyndromesPlasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels may reflect the severity of ischemia, although there is no necrosis. A transient ischemia which can increase the heart wall stretch would induces BNP synthesis and release. Synthesis and release of BNP are comparable with the severity of ischemia. The aim of this study was to analyze whether NT-proBNP levels in patients with acute coronary syndrome (ACS) can be used as a predictor for clinical outcome. Studies was held since January to March 2010. Subject were patients with ACS who came to emergency room Dr. Hasan Sadikin Hospital Bandung and were clinically diagnosed according to World Health Organization criteria. Subjects which were suited with the inclusion criteria, stored until assayed. NT-pro BNP concentration was examined by electrochemiluminescence immunoassay method along with creatine kinase muscle brain (enzymatic method) and cardiac troponin T (quantitative method). Statistical analysis was performed using the one-sample Kolmogorov-Smirnov test for verifying normality, normally distributed data were analyzed using parametric analysis and abnormal distributed data was assayed using multiple logistic regression analysis to determine the parameters which can be used as predictor for clinical outcome in patients with ACS. Multiple logistic regression analysis on 83 subjects showed predictive value of NT-proBNP levels with OR=1.00, which mean there was no different likelihood in patients with high and low concentration of NT-proBNP to have longer hospitality duration. NT-proBNP β coefficient of 0.001 states that every addition of 1,000 pg/mL of NT-proBNP concentration will increase the length of hospitality duration for one day. On convalesce subjects, the most significant predictive value for predicting clinical outcome cTnT was more better than NT-proBNP concentration in patients with ACS (OR=32.53, 95%CI; 0.58–1,819.26). In conclusions, NT-proBNP is not a major predictor of clinical outome in ACS. NT-proBNP levels of >826.7 pg/mL implies a poor prognosis to death. [MKB. 2012;44(2):106–13]. DOI: http://dx.doi.org/10.15395/mkb.v44n2.132 

Kesesuaian Hasil Pemeriksaan Antibodi Virus Herpes Simpleks Metode Enzyme-Linked Immunofiltration Assay dengan Enzyme-Linked Immunosorbent Assay

Majalah Kedokteran Bandung Vol 44, No 3 (2012)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Infeksi virus herpes simpleks (HSV) merupakan infeksi yang disebabkan oleh HSV tipe 1 (HSV-1) dan HSV tipe 2 (HSV-2). HSV-1 biasanya menyebabkan penyakit orofasial, sedangkan HSV-2 biasanya menyebabkan infeksi perigenital. Diagnosis infeksi HSV ditegakkan berdasarkan anamnesis, pemeriksaan fisis, dan laboratorium. Metode deteksi anti-HSV metode enzyme-linked immunosorbent assay (ELISA) memiliki sensitivitas 93–100% dan spesifisitas 95–100%, sedangkan metode enzyme-linked immunofiltration assay (ELIFA) memiliki sensitivitas 83,36–97% dan spesifisitas 83,93–98%. Tujuan penelitian adalah menilai kesesuaian hasil pemeriksaan anti-HSV antara metode ELIFA dan ELISA. Bila terdapat kesesuaian yang baik maka metode ELIFA dapat menggantikan metode ELISA. Penelitian dilakukan di laboratorium klinik RSUP Dr. Hasan Sadikin Bandung sejak bulan Januari–Mei 2011. Rancangan penelitian adalah potong lintang. Subjek penelitian adalah serum penderita tersangka infeksi HSV. Dilakukan analisis statistik untuk menilai agreement Kappa. Sebanyak 66 sampel diperiksa anti-HSV metode ELIFA dan ELISA. Hasil pemeriksaan IgM anti-HSV antara metode ELIFA dan ELISA memiliki kesesuaian baik (p<0,001; K=0,621), hasil pemeriksaan IgG anti-HSV-1 antara metode ELIFA dan ELISA memiliki kesesuaian sedang (p<0,001; K=0,533), dan hasil pemeriksaan IgG anti-HSV-2 antara metode ELIFA dan ELISA memiliki kesesuaian kurang (p=0,006; K=0,260). Simpulan, hanya pemeriksaan IgM anti-HSV metode ELIFA yang memiliki hasil kesesuaian baik dengan metode ELISA, sedangkan pemeriksaan IgG anti-HSV metode ELIFA memiliki kesesuaian sedang atau kurang. [MKB. 2012;44(3):152–8].Kata kunci: IgM anti-HSV, IgG anti-HSV, kesesuaian, metode ELIFA, metode ELISA Agreement of Herpes Simplex Virus Antibody Test Result between Enzymelinked Immunofiltration and Enzyme-linked Immunosorbent Assay MethodsHerpes simplex virus (HSV) infections are very common and are caused by HSV type 1 (HSV-1) and HSV type 2 (HSV-2). HSV-1 being mostly associated with orofacial disease, whereas HSV-2 is usually associated with perigenital infection. Diagnosis of HSV infection is established based on history, physical and laboratory examination. Enzyme-linked immunosorbent assay (ELISA) method to detect anti-HSV has a sensitivity 93–100% and specificity 95–100%, whereas enzyme-linked immunofiltration assay (ELIFA) has a sensitivity 83.36–97% and specificity 83.93–98%. The aim of this study was to assess the agreement of anti-HSV between ELIFA and ELISA methods. This study was conducted in the clinical laboratory RSUP Dr. Hasan Sadikin Bandung since January to May 2011. The study design was cross sectional. Subjects of this study were serum of patients suspected HSV infection. Statistical analysis was performed to assess Kappa agreement. A total of 66 samples were examined anti-HSV using ELIFA and ELISA method. There was good agreement between test results of anti-HSV IgM ELIFA and ELISA method (p<0.001, κ=0.621), moderate agreement between test results of anti- HSV-1 IgG ELIFA and ELISA method (p<0.001, κ=0.533), and fair agreement between test results of anti-HSV-2 IgG ELIFA and ELISA method (p=0.006, κ= 0.260). In conclusions, only the anti-HSV IgM ELIFA method has good agreement with ELISA. DOI: http://dx.doi.org/10.15395/mkb.v44n3.86 

Korelasi Jumlah CD4 Dan Total Lymphocyte Count (Tlc) pada Penderita HIV/AIDS dengan dan tanpa Terapi Antiretroviral

Global Medical & Health Communication (GMHC) Vol 1, No 1 (2013)
Publisher : Fakultas Kedokteran Universitas Islam Bandung

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ABSTRAK Jumlah CD4 merupakan parameter laboratorium yang digunakan untuk memulai dan memantau terapi antiretroviral (ART) pada penderita HIV/AIDS. Namun pemeriksaan jumlah CD4 membutuhkan peralatan laboratorium yang mahal dan tenaga terlatih. World Health Organization (WHO) merekomendasikan total lymphocyte count (TLC) sebagai pengganti CD4 dalam memulai terapi. Penelitian ini bertujuan untuk melihat korelasi antara jumlah CD4 dan TLC pada data dasar, pemantauan pertama dan kedua penderita HIV/AIDS sebagai dasar digunakannya TLC untuk pemantauan terapi. Penelitian ini merupakan penelitian observasional analitik dan bagian dari penelitian kohort IMPACT (Integrated Management for Prevention And Care and Treatment of  HIV/AIDS) pada pasien HIV/AIDS di RS. Dr. Hasan Sadikin Bandung. Data tersebut dibagi menjadi kelompok tanpa ART dan dengan ART, masing-masing kelompok dibagi berdasarkan jenis kelamin. Analisis korelasi dilakukan pada data CD4 dan TLC dari tiap kelompok.Penelitian ini menggunakan 2239 data. Korelasi antara CD4 dan TLC pada data dasar pria tanpa ART adalah 0.644 (p=0.01), wanita tanpa ART adalah 0.74 (p=0.01), pria dengan ART 0.67 adalah (p=0.01), wanita dengan ART adalah adalah 0.601 (p=0.01). Korelasi antara CD4 dan TLC pemantauan pertama pria tanpa ART 0.56 (p=0.01), wanita tanpa ART adalah 0.606 (p=0.01), pria dengan ART adalah 0.569 (p=0.01), wanita dengan ART adalah 0.466 (p=0.01). Korelasi antara CD4 dan TLC pemantauan kedua pria tanpa ART adalah 0.697 (p=0.01), wanita tanpa ART adalah 0.306 (p=0.01), pria dengan ART adalah 0.556 (p=0.01), wanita dengan ART adalah 0.561 (p=0.01).  Kesimpulan :  terdapat korelasi yang baik antara jumlah CD4 dan TLC, sehingga TLC dapat digunakan sebagai alternatif pemantauan terapi sebelum penderita melakukan pemeriksaan CD4.   Kata kunci: CD4, HIV/AIDS, terapi antiretroviral, total lymphocyte count

Validitas Kidney Injury Molecule-1 Urin Metode Mikro Enzyme-Linked Immunosorbent Assay Sebagai Penanda Dini Gangguan Ginjal Akut pada Sepsis

Majalah Kedokteran Bandung Vol 48, No 1 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Gangguan ginjal akut (GgGA) adalah penurunan fungsi ginjal ditandai peningkatan kreatinin serum ≥0,3 mg/dL atau >1,5 kali dibanding dengan kadar sebelumnya atau penurunan urine output <0,5 mL/jam lebih dari 6 jam. Sepsis merupakan penyebab tersering GgGA (20–50%). Kidney injury molecule-1 (KIM-1) adalah glikoprotein transmembran tipe-1. Kadar KIM-1 urin penderita GgGA akibat sepsis meningkat lebih awal dibanding dengan kreatinin serum. Penelitian bertujuan mengetahui validitas KIM-1 urin sebagai penanda dini GgGA pada sepsis, dilakukan di Rumah Sakit Dr. Hasan Sadikin Bandung periode Februari–Mei 2013. Bentuk penelitian observasional analitik khusus dengan rancangan potong lintang. Subjek penelitian adalah penderita sepsis yang didiagnosis klinisi sesuai kriteria The American College of Chest Physician/The Society of Critical Care Medicine 2001, berdasarkan consecutive admission sampling. Metode yang digunakan mikro enzyme-linked immunosorbent assay. Analisis dengan chi-kuadrat, Mann-Whitney, tabel 2x2, dan kurva receiver operating curve untuk menghitung validitas. Subjek terdiri atas 25 penderita sepsis dengan GgGA dan 25 penderita sepsis tanpa GgGA. Kadar KIM-1 urin penderita sepsis dengan GgGA meningkat dibanding dengan tanpa GgGA. Kadar KIM-1 urine cut-off >0,8 ng/mL memiliki sensitivitas 96%, spesifisitas 60%, nilai duga positif 70,6%, nilai duga negatif 93,8%, dan akurasi 78%. Simpulan, sensitivitas KIM-1 urin tinggi, spesifisitas sedang sehingga dapat digunakan sebagai skrining GgGA pada penderita sepsis. [MKB. 2016;48(1):19–25]Kata kunci: GgGA, KIM-1, sepsis, validitas Validity of Urinary Kidney Injury Molecule-1 Using Micro Enzyme-Linked Immunosorbent Assay Method as an Early Marker of Acute Kidney Injury in Sepsis PatientsAAcute kidney injury (AKI) is a rapid decline in renal function marked by increased serum creatinine of ≥0.3 mg/dL or >1.5 times higher than the previous levels or decreased urine output of <0.5 mL/hour for more than 6 hours. Sepsis is the most common cause of AKI (20–50%). Kidney injury molecule-1 (KIM-1) is a type-1 transmembrane glycoprotein. Urinary KIM-1 levels of sepsis patients due to AKI increases earlier than the serum creatinine levels; thus KIM-1 may serve as an AKI marker. This study aimed to determine the validity of urinary KIM-1 as the early marker in sepsis patients with AKI. The study was a specific observational analytical study with cross-sectional design, conducted in Dr. Hasan Sadikin General Hospital Bandung in February–May 2013. Subjects were patients diagnosed with sepsis by clinicians according to the criteria of the The American College of Chest Physician/The Society of Critical Care Medicine 2001 and were selected by consecutive sampling admissions. Urinary KIM-1 levels were measured by micro enzyme-linked immunosorbent assay. The data were analyzed by chi-square, Mann-Whitney, 2x2 tables, and receiver operating curve to measure validity. Subjects consisted of 25 sepsis patients with AKI and 25 sepsis patients without AKI. Urinary KIM-1 level of sepsis patient with AKI increased compared to patients without AKI. Level of urinary KIM-1 with a cut-off of >0.8 ng/mL presented 96% sensitivity, 60% specificity, 70.6% positive predictive value, 93.8% negative predictive value and 78% accuracy. In conclusion, the level of urinary KIM-1 has high sensitivity and moderate specificity thus can be used for AKI screening in sepsis patients. [MKB. 2016;48(1):19–25]Key words: AKI, KIM-1, sepsis, validity

Deteksi Natrium/Iodide Symporter (NIS) pada Galur Sel Kanker Payudara SKBR3 dengan Imunositofluoresens

Majalah Kedokteran Bandung Vol 48, No 1 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Galur sel SKBR3 adalah model kanker payudara positif human epidermal growth factor receptor2 (HER2). Pemberian kemoterapi memperlihatkan respons lengkap hanya pada 50% pasien kanker payudara dengan tipe positif HER2. Kemampuan jaringan tumor menangkap dan mengakumulasi iodium radioaktif dihubungkan dengan ekspresi natrium/iodide symporter (NIS). Tujuan penelitian ini adalah menilai ekspresi dan distribusi NIS pada galur sel SKBR3 serta menilai efek induksi epidermal growth factor (EGF) pada ekspresi NIS menggunakan imunositofluoresens-ISF. Penelitian ini dilakukan di Laboratorium Kultur Sel, Fakultas Kedokteran Universitas Padjadjaran (FKUP) mulai bulan September 2013 sampai dengan April 2014. Sel SKBR3 ditumbuhkan pada plat kultur dan ditunggu hingga konfluen 70%. Sel dibagi atas dua kelompok, yaitu kelompok yang diberi induksi dan kontrol. Induksi EGF diberikan dengan dosis 50 ng/mL. Pemeriksaan ISF menggunakan antibodi primer rabbit polyclonal antibody anti NIS dan antibodi sekunder goat anti rabbit IgG polyclonal antibody. Data hasil pengamatan dinilai secara semikuantitatif. Natrium/iodide symporter tampak terekspresi dan terdistribusi di sitoplasma. Sel yang diinduksi dengan EGF memperlihatkan peningkatan ekspresi NIS di sitoplasma dan distribusinya di membran sel secara bermakna. Sel SKBR3 mengekspresikan NIS yang terdapat di sitoplasma. Induksi EGF meningkatkan ekspresi NIS dan distribusinya di membran sel. Temuan ini dapat mengarah potensi kemampuan sel kanker payudara menangkap dan mengakumulasikan iodium radioaktif. [MKB. 2016;48(1):15–8] Kata kunci: Ekspresi NIS , galur sel SKBR3, kanker payudara, imunositofluoresensDetection of Natrium/Iodide Symporter (NIS) in SKBR-3 Breast Cancer Cell Line Using ImmunocytofluoresenceAbstractSKBR-3 cell line is a breast cancer model for human epidermal growth factor receptor2 (HER2) positive. Only 50% of patients of this type have fully responded to chemotherapy. Natrium iodide symporter expression correlates with the uptake and ability of cells to accumulate radioiodine. The aim of this study was to examine natrium/iodide symporter (NIS) expression and its distribution with and without epidermal growth factor (EGF) treatment using immunocytofluoresence (ICF). This study was conducted at the Cell Culture Laboratory, Faculty of Medicine, Universitas Padjadjaran from September 2013 to April 2014. SKBR3 cells were cultured until 70% confluent. Cells were then divided into two groups: treatment group and control group. The treatment group was treated with EGF 50 ng/mL. Cells were incubated with primary antibody rabbit polyclonal antibody anti-NIS, and then were followed with secondary-antibody goat polyclonal antibody to rabbit. Data from the observation were then assessed semi-quantitatively. Natrium/iodide symporter was seen to be expressed and distributed in the cytoplasm. Cells induced by EGF showed significant increase in NIS expression in cytoplasm and its distribution in cell membrane. It is concluded that the SKBR3 cells express NIS in cytoplasm and that EGF induction increases NIS expression and distribution in cell membrane. This finding leads to a potential ability of breast cancer cells to uptake and accumulate radioiodine. [MKB. 2016;48(1):15–8]Key words: Breast cancer, cell line SKBR-3, immunocytofluoresence, NIS expression DOI: 10.15395/mkb.v48n1.728

Kadar N-Terminal Pro-Brain Natriuretic Peptide sebagai Prediktor Luaran Klinis Sindrom Koroner Akut

Majalah Kedokteran Bandung Vol 44, No 2 (2012)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Kadar N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma dapat menggambarkan tingkat keparahan iskemia walaupun tidak terjadi nekrosis, iskemia yang transien dapat meningkatkan peregangan dinding jantung yang akan menginduksi sintesis dan pelepasan brain natriuretic peptide (BNP) yang sebanding dengan tingkat keparahan iskemia. Tujuan penelitian untuk mengetahui apakah kadar NT-proBNP pada penderita sindrom koroner akut (SKA) dapat digunakan sebagai parameter prediktor luaran klinis. Penelitian dilakukan sejak bulan Januari hingga Maret 2010. Subjek penelitian penderita SKA yang datang ke Unit Gawat Darurat Rumah Sakit Dr. Hasan Sadikin Bandung dan telah didiagnosis klinis sesuai kriteria World Health Organization. Pada subjek yang memenuhi kriteria inklusi dilakukan pemeriksaan kadar NT-pro BNP dengan metode electrochemiluminescence immunoassay, cardiac troponin T (kuantitatif), dan creatine kinase muscle brain (enzimatik). Analisis data uji normalitas menggunakan one-sample Kolmogorov-Smirnov test, analisis regresi logistik multipel untuk mengetahui parameter prediktor luaran klinis penderita SKA. Dari 83 subjek yang ikut dalam penelitian, didapatkan nilai prediksi kadar NT-proBNP sebesar 1,00 sehingga bukan merupakan prediktor utama luaran klinis, koefisien β NTproBNP sebesar 0,001 menyatakan bahwa setiap penambahan 1.000 pg/mL variabel NT-proBNP akan menambah lama perawatan 1 hari. Pada subjek SKA dengan luaran (outcome) sembuh nilai prediksi cTnT lebih baik sebagai faktor prediktor dibandingkan dengan konsentrasi NT-proBNP (OR=32,53; 95%IK; 0,58–1.819,26). Simpulan, NT-proBNP bukan merupakan prediktor utama luaran klinis pada SKA. Kadar NT-proBNP lebih dari 826,7 pg/mLterdapat kemungkinan prognosis yang buruk sampai dengan kematian. [MKB. 2012;44(2):106–13].The Role of NT-proBNP as Clinical Outcome Predictor for Acute Coronary SyndromesPlasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels may reflect the severity of ischemia, although there is no necrosis. A transient ischemia which can increase the heart wall stretch would induces BNP synthesis and release. Synthesis and release of BNP are comparable with the severity of ischemia. The aim of this study was to analyze whether NT-proBNP levels in patients with acute coronary syndrome (ACS) can be used as a predictor for clinical outcome. Studies was held since January to March 2010. Subject were patients with ACS who came to emergency room Dr. Hasan Sadikin Hospital Bandung and were clinically diagnosed according to World Health Organization criteria. Subjects which were suited with the inclusion criteria, stored until assayed. NT-pro BNP concentration was examined by electrochemiluminescence immunoassay method along with creatine kinase muscle brain (enzymatic method) and cardiac troponin T (quantitative method). Statistical analysis was performed using the one-sample Kolmogorov-Smirnov test for verifying normality, normally distributed data were analyzed using parametric analysis and abnormal distributed data was assayed using multiple logistic regression analysis to determine the parameters which can be used as predictor for clinical outcome in patients with ACS. Multiple logistic regression analysis on 83 subjects showed predictive value of NT-proBNP levels with OR=1.00, which mean there was no different likelihood in patients with high and low concentration of NT-proBNP to have longer hospitality duration. NT-proBNP β coefficient of 0.001 states that every addition of 1,000 pg/mL of NT-proBNP concentration will increase the length of hospitality duration for one day. On convalesce subjects, the most significant predictive value for predicting clinical outcome cTnT was more better than NT-proBNP concentration in patients with ACS (OR=32.53, 95%CI; 0.58–1,819.26). In conclusions, NT-proBNP is not a major predictor of clinical outome in ACS. NT-proBNP levels of >826.7 pg/mL implies a poor prognosis to death. [MKB. 2012;44(2):106–13]. DOI: http://dx.doi.org/10.15395/mkb.v44n2.132 

Kesesuaian Hasil Pemeriksaan Antibodi Virus Herpes Simpleks Metode Enzyme-Linked Immunofiltration Assay dengan Enzyme-Linked Immunosorbent Assay

Majalah Kedokteran Bandung Vol 44, No 3 (2012)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Infeksi virus herpes simpleks (HSV) merupakan infeksi yang disebabkan oleh HSV tipe 1 (HSV-1) dan HSV tipe 2 (HSV-2). HSV-1 biasanya menyebabkan penyakit orofasial, sedangkan HSV-2 biasanya menyebabkan infeksi perigenital. Diagnosis infeksi HSV ditegakkan berdasarkan anamnesis, pemeriksaan fisis, dan laboratorium. Metode deteksi anti-HSV metode enzyme-linked immunosorbent assay (ELISA) memiliki sensitivitas 93–100% dan spesifisitas 95–100%, sedangkan metode enzyme-linked immunofiltration assay (ELIFA) memiliki sensitivitas 83,36–97% dan spesifisitas 83,93–98%. Tujuan penelitian adalah menilai kesesuaian hasil pemeriksaan anti-HSV antara metode ELIFA dan ELISA. Bila terdapat kesesuaian yang baik maka metode ELIFA dapat menggantikan metode ELISA. Penelitian dilakukan di laboratorium klinik RSUP Dr. Hasan Sadikin Bandung sejak bulan Januari–Mei 2011. Rancangan penelitian adalah potong lintang. Subjek penelitian adalah serum penderita tersangka infeksi HSV. Dilakukan analisis statistik untuk menilai agreement Kappa. Sebanyak 66 sampel diperiksa anti-HSV metode ELIFA dan ELISA. Hasil pemeriksaan IgM anti-HSV antara metode ELIFA dan ELISA memiliki kesesuaian baik (p<0,001; K=0,621), hasil pemeriksaan IgG anti-HSV-1 antara metode ELIFA dan ELISA memiliki kesesuaian sedang (p<0,001; K=0,533), dan hasil pemeriksaan IgG anti-HSV-2 antara metode ELIFA dan ELISA memiliki kesesuaian kurang (p=0,006; K=0,260). Simpulan, hanya pemeriksaan IgM anti-HSV metode ELIFA yang memiliki hasil kesesuaian baik dengan metode ELISA, sedangkan pemeriksaan IgG anti-HSV metode ELIFA memiliki kesesuaian sedang atau kurang. [MKB. 2012;44(3):152–8].Kata kunci: IgM anti-HSV, IgG anti-HSV, kesesuaian, metode ELIFA, metode ELISA Agreement of Herpes Simplex Virus Antibody Test Result between Enzymelinked Immunofiltration and Enzyme-linked Immunosorbent Assay MethodsHerpes simplex virus (HSV) infections are very common and are caused by HSV type 1 (HSV-1) and HSV type 2 (HSV-2). HSV-1 being mostly associated with orofacial disease, whereas HSV-2 is usually associated with perigenital infection. Diagnosis of HSV infection is established based on history, physical and laboratory examination. Enzyme-linked immunosorbent assay (ELISA) method to detect anti-HSV has a sensitivity 93–100% and specificity 95–100%, whereas enzyme-linked immunofiltration assay (ELIFA) has a sensitivity 83.36–97% and specificity 83.93–98%. The aim of this study was to assess the agreement of anti-HSV between ELIFA and ELISA methods. This study was conducted in the clinical laboratory RSUP Dr. Hasan Sadikin Bandung since January to May 2011. The study design was cross sectional. Subjects of this study were serum of patients suspected HSV infection. Statistical analysis was performed to assess Kappa agreement. A total of 66 samples were examined anti-HSV using ELIFA and ELISA method. There was good agreement between test results of anti-HSV IgM ELIFA and ELISA method (p<0.001, κ=0.621), moderate agreement between test results of anti- HSV-1 IgG ELIFA and ELISA method (p<0.001, κ=0.533), and fair agreement between test results of anti-HSV-2 IgG ELIFA and ELISA method (p=0.006, κ= 0.260). In conclusions, only the anti-HSV IgM ELIFA method has good agreement with ELISA. DOI: http://dx.doi.org/10.15395/mkb.v44n3.86 

Deteksi Natrium/Iodide Symporter (NIS) pada Galur Sel Kanker Payudara SKBR3 dengan Imunositofluoresens

Majalah Kedokteran Bandung Vol 48, No 1 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Galur sel SKBR3 adalah model kanker payudara positif human epidermal growth factor receptor2 (HER2). Pemberian kemoterapi memperlihatkan respons lengkap hanya pada 50% pasien kanker payudara dengan tipe positif HER2. Kemampuan jaringan tumor menangkap dan mengakumulasi iodium radioaktif dihubungkan dengan ekspresi natrium/iodide symporter (NIS). Tujuan penelitian ini adalah menilai ekspresi dan distribusi NIS pada galur sel SKBR3 serta menilai efek induksi epidermal growth factor (EGF) pada ekspresi NIS menggunakan imunositofluoresens-ISF. Penelitian ini dilakukan di Laboratorium Kultur Sel, Fakultas Kedokteran Universitas Padjadjaran (FKUP) mulai bulan September 2013 sampai dengan April 2014. Sel SKBR3 ditumbuhkan pada plat kultur dan ditunggu hingga konfluen 70%. Sel dibagi atas dua kelompok, yaitu kelompok yang diberi induksi dan kontrol. Induksi EGF diberikan dengan dosis 50 ng/mL. Pemeriksaan ISF menggunakan antibodi primer rabbit polyclonal antibody anti NIS dan antibodi sekunder goat anti rabbit IgG polyclonal antibody. Data hasil pengamatan dinilai secara semikuantitatif. Natrium/iodide symporter tampak terekspresi dan terdistribusi di sitoplasma. Sel yang diinduksi dengan EGF memperlihatkan peningkatan ekspresi NIS di sitoplasma dan distribusinya di membran sel secara bermakna. Sel SKBR3 mengekspresikan NIS yang terdapat di sitoplasma. Induksi EGF meningkatkan ekspresi NIS dan distribusinya di membran sel. Temuan ini dapat mengarah potensi kemampuan sel kanker payudara menangkap dan mengakumulasikan iodium radioaktif. [MKB. 2016;48(1):15–8] Kata kunci: Ekspresi NIS , galur sel SKBR3, kanker payudara, imunositofluoresensDetection of Natrium/Iodide Symporter (NIS) in SKBR-3 Breast Cancer Cell Line Using ImmunocytofluoresenceAbstractSKBR-3 cell line is a breast cancer model for human epidermal growth factor receptor2 (HER2) positive. Only 50% of patients of this type have fully responded to chemotherapy. Natrium iodide symporter expression correlates with the uptake and ability of cells to accumulate radioiodine. The aim of this study was to examine natrium/iodide symporter (NIS) expression and its distribution with and without epidermal growth factor (EGF) treatment using immunocytofluoresence (ICF). This study was conducted at the Cell Culture Laboratory, Faculty of Medicine, Universitas Padjadjaran from September 2013 to April 2014. SKBR3 cells were cultured until 70% confluent. Cells were then divided into two groups: treatment group and control group. The treatment group was treated with EGF 50 ng/mL. Cells were incubated with primary antibody rabbit polyclonal antibody anti-NIS, and then were followed with secondary-antibody goat polyclonal antibody to rabbit. Data from the observation were then assessed semi-quantitatively. Natrium/iodide symporter was seen to be expressed and distributed in the cytoplasm. Cells induced by EGF showed significant increase in NIS expression in cytoplasm and its distribution in cell membrane. It is concluded that the SKBR3 cells express NIS in cytoplasm and that EGF induction increases NIS expression and distribution in cell membrane. This finding leads to a potential ability of breast cancer cells to uptake and accumulate radioiodine. [MKB. 2016;48(1):15–8]Key words: Breast cancer, cell line SKBR-3, immunocytofluoresence, NIS expression DOI: 10.15395/mkb.v48n1.728

Validitas Kidney Injury Molecule-1 Urin Metode Mikro Enzyme-Linked Immunosorbent Assay Sebagai Penanda Dini Gangguan Ginjal Akut pada Sepsis

Majalah Kedokteran Bandung Vol 48, No 1 (2016)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Gangguan ginjal akut (GgGA) adalah penurunan fungsi ginjal ditandai peningkatan kreatinin serum ≥0,3 mg/dL atau >1,5 kali dibanding dengan kadar sebelumnya atau penurunan urine output <0,5 mL/jam lebih dari 6 jam. Sepsis merupakan penyebab tersering GgGA (20–50%). Kidney injury molecule-1 (KIM-1) adalah glikoprotein transmembran tipe-1. Kadar KIM-1 urin penderita GgGA akibat sepsis meningkat lebih awal dibanding dengan kreatinin serum. Penelitian bertujuan mengetahui validitas KIM-1 urin sebagai penanda dini GgGA pada sepsis, dilakukan di Rumah Sakit Dr. Hasan Sadikin Bandung periode Februari–Mei 2013. Bentuk penelitian observasional analitik khusus dengan rancangan potong lintang. Subjek penelitian adalah penderita sepsis yang didiagnosis klinisi sesuai kriteria The American College of Chest Physician/The Society of Critical Care Medicine 2001, berdasarkan consecutive admission sampling. Metode yang digunakan mikro enzyme-linked immunosorbent assay. Analisis dengan chi-kuadrat, Mann-Whitney, tabel 2x2, dan kurva receiver operating curve untuk menghitung validitas. Subjek terdiri atas 25 penderita sepsis dengan GgGA dan 25 penderita sepsis tanpa GgGA. Kadar KIM-1 urin penderita sepsis dengan GgGA meningkat dibanding dengan tanpa GgGA. Kadar KIM-1 urine cut-off >0,8 ng/mL memiliki sensitivitas 96%, spesifisitas 60%, nilai duga positif 70,6%, nilai duga negatif 93,8%, dan akurasi 78%. Simpulan, sensitivitas KIM-1 urin tinggi, spesifisitas sedang sehingga dapat digunakan sebagai skrining GgGA pada penderita sepsis. [MKB. 2016;48(1):19–25]Kata kunci: GgGA, KIM-1, sepsis, validitas Validity of Urinary Kidney Injury Molecule-1 Using Micro Enzyme-Linked Immunosorbent Assay Method as an Early Marker of Acute Kidney Injury in Sepsis PatientsAAcute kidney injury (AKI) is a rapid decline in renal function marked by increased serum creatinine of ≥0.3 mg/dL or >1.5 times higher than the previous levels or decreased urine output of <0.5 mL/hour for more than 6 hours. Sepsis is the most common cause of AKI (20–50%). Kidney injury molecule-1 (KIM-1) is a type-1 transmembrane glycoprotein. Urinary KIM-1 levels of sepsis patients due to AKI increases earlier than the serum creatinine levels; thus KIM-1 may serve as an AKI marker. This study aimed to determine the validity of urinary KIM-1 as the early marker in sepsis patients with AKI. The study was a specific observational analytical study with cross-sectional design, conducted in Dr. Hasan Sadikin General Hospital Bandung in February–May 2013. Subjects were patients diagnosed with sepsis by clinicians according to the criteria of the The American College of Chest Physician/The Society of Critical Care Medicine 2001 and were selected by consecutive sampling admissions. Urinary KIM-1 levels were measured by micro enzyme-linked immunosorbent assay. The data were analyzed by chi-square, Mann-Whitney, 2x2 tables, and receiver operating curve to measure validity. Subjects consisted of 25 sepsis patients with AKI and 25 sepsis patients without AKI. Urinary KIM-1 level of sepsis patient with AKI increased compared to patients without AKI. Level of urinary KIM-1 with a cut-off of >0.8 ng/mL presented 96% sensitivity, 60% specificity, 70.6% positive predictive value, 93.8% negative predictive value and 78% accuracy. In conclusion, the level of urinary KIM-1 has high sensitivity and moderate specificity thus can be used for AKI screening in sepsis patients. [MKB. 2016;48(1):19–25]Key words: AKI, KIM-1, sepsis, validity