Teguh Triyono

Protective effects of HLA-DPA1/DPB1 variants against Hepatitis B virus infection in an Indonesian population.

Human leukocyte antigen (HLA) DPA1/DPB1 variants have been reported to influence Hepatitis B virus (HBV) infection. HLA-DPA1/DPB1 plays a pivotal role in antigen presentation to CD4(+) helper T cells and influences the outcome of HBV infection. To investigate the influence of HLA-DP variants on the outcome of HBV infection in an Indonesian population where it has the third-highest prevalence of HBV infection worldwide, we performed a case-control study of 686 participants, including patients with HBV-related advanced or nonadvanced liver disease, patients with spontaneously resolved HBV, and healthy controls. Single-nucleotide polymorphisms in HLA-DPA1 (rs3077) and HLA-DPB1 (rs3135021, rs9277535, and rs228388) were genotyped using real-time TaqMan® genotyping assays. Because rs2281388 deviated from Hardy-Weinberg equilibrium, it was excluded from subsequent analyses. The results of logistic regression analyses showed that the HLA-DPB1 rs9277535 variants were associated with a reduced risk of persistent HBV infection (odds ratio [OR] 0.70, 95% confidence interval [95% CI] 0.52-0.96, P=0.026, additive genetic model; OR 0.60, 95% CI 0.38-0.96, P=0.033, dominant genetic model). The HLA-DPA1 rs3077 variant was associated with a protective effect increasing the spontaneously resolved HBV infection (OR 0.64, 95% CI 0.41-0.98, P=0.039, dominant genetic model). By contrast, the HLA-DPB1 rs3135021 variant was not associated with the outcome of HBV infection, including susceptibility, spontaneously resolved, or disease progression. Combinations of haplotype markers were also associated with HBV susceptibility (CA for rs3077-rs9277535, OR 0.57, 95% CI 0.36-0.92, P=0.021; GA for rs3135021-rs9277535, OR 0.56, 95% CI 0.36-0.86, P=0.0087). In conclusion, these findings confirm that HLA-DPA1/DPB1 variants were associated with the outcomes of HBV infection in an Indonesian population.

Therapeutic apheresis in Asia: An Indonesia single center experience

In developing countries, like Indonesia, apheresis is still a relative new procedure. Nowadays, therapeutic apheresis procedures are performed in the field of hematology and neurology, especially in the teaching hospitals in Indonesia. Therapeutic apheresis procedure, that is, leukocytapheresis, therapeutic plasma exchange (TPE), and thrombocytapheresis are already performed. In the period 2009–2013, 204 apheresis procedures in 137 patients to reduce the leukocytes, 72 TPE procedures in 17 patients, and 14 thrombocyte reductions were performed in the Sardjito hospital, Yogyakarta, Indonesia. In the future, to improve the therapeutic apheresis implementation, it is important to increase the insurance coverage and also should be considered to introduce the apheresis medicine into the curriculum of appropriate physician programs in Indonesia. Especially in Indonesia, a lot of efforts are still being needed to improve implementation of therapeutic apheresis. J. Clin. Apheresis 30:139–140, 2015.

Rare Helicobacter pylori Infection May Explain Low Stomach Cancer Incidence: Ecological Observations in Bali, Indonesia

The incidence rate of stomach cancer in Bali, Indonesia, is estimated to be strikingly lower than that in Japan. We conducted an on-site ecological study to investigate the association between the stomach cancer incidence and Helicobacter pylori (H. pylori) infection. Recruiting 291 healthy persons (136 men and 155 women) from the general population in Bali, Indonesia, we conducted a urea breath test (UBT) to examine H. pylori infection, along with a pepsinogen test to detect chronic atrophic gastritis and urine analysis to estimate sodium and potassium excretion. UBT positivities were 9% (2-15, 95% confidence interval) for men and 7% (1-12) for women, and positive cases for H. pylori IgG antibodies were 1% (0-3) for men and 3% (0-5) for women, significantly lower than the respective values in Japan. Positive pepsinogen tests in Bali were 0% (0-0) for men and 1% (0-4) for women, also significantly lower than the Japanese figures. Computed values for daily salt excretion were 13.3±4.1 g (mean ± SD) for men and 11.1±3.1 g for women, as high as corresponding Japanese consumption values. Moreover, the estimated potassium excretion was 3.2±0.7 g for men and 2.8±0.6 g for women in Bali, significantly higher than the figures in Japan. There were no associations across genetic polymorphisms of IL-beta, TNF-alpha, and PTPN11 with UBT positivity. The low incidence of stomach cancer in Bali may thus mainly be due to the rare H. pylori infection. Namely, the bacterium infection seems to be a critical factor for gastric cancer rather than host or other environmental factors.

THE RISK FACTOR OF ALLOANTIBODY FORMATION IN THALASSEMIA PATIENTS RECEIVING MULTIPLE TRANSFUSION (Faktor Kebahayaan Terbentuknya Aloantibodi pada Pasien Talasemia yang Menerima Transfusi Darah Berulang)

Untuk kelangsungan hidup pasien talasemia intermediet dan mayor, memerlukan transfusi darah secara teratur. Transfusi berulang ini berpeluang membentuk aloantibodi yang dapat menyebabkan kebahayaan hemolitik. Maka transfusi berulang akan memperberat hemolitik karena pada pasien talasemia sudah ada proses tersebut. Tujuan penelitian ini adalah untuk mengetahui berbagai faktor kebahayaan untuk terbentuknya aloantibodi pada pasien talasemia yang mendapat transfusi darah berulang khusus di RSUP Fatmawati, Jakarta. Cara meneliti ini menggunakan rancangan potong lintang. Subjek penelitian adalah semua pasien talasemia yang mendapat transfusi darah berulang di RSUP Fatmawati Jakarta yang memenuhi patokan kesertaan. Sebanyak 81 subjek diikutkan dalam penelitian ini. Data pada penelitian ini di analisis secara statistik dengan uji Chi Kuadrat. Hasil menguji secara Chi Kuadrat menunjukkan: kelamin, suku, diagnosis, selang transfusi darah, jenis darah, reaksi yang terkait, riwayat keluarga, kadar Hb. Kadar feritin dan golongan darah bukan merupakan faktor kebahayaan untuk terbentuknya aloantibodi, sedang faktor usia, jumlah kantong darah yang ditransfusikan, keberadaan komplikasi akibat transfusi darah dan lama masa waktu menerima darah transfusi, merupakan faktor kebahayaan untuk terbentuknya aloantibodi pada pasien talasemia yang mendapat transfusi berulang di RSUP Fatmawati.

DARAH AMAN DAN PENDONOR DARAH SUKARELA

Safe blood was collected from safe, low risk donors with a related absence of infectious disease screening as well. WHO has stated that to guarantee its safety, blood should only be collected from voluntary non-remunerated blood donors (VNBD) coming from a lowrisk population. The aim of this study was to know the blood donors’ profile in Fatmawati Hospital (FH), Jakarta and Dr. Sardjito Hospital (SH), Yogyakarta by comparison The research was carried out by cross sectional study and data were obtained from the donor’s information records 2011-2013. The data were further descriptively analyzed and presented in tables and graphs. The Student’s t-test was used to analyze the difference of percentage mean for VNBD per-month between two hospitals with p<0.05. Based on the blood donor types, it was shown that most of the blood donors consisted of replacement persons. The mean of monthly VNBD percentage was significantly higher in FH than in SH. There was an increased VNBD percentage i.e. 32, 35, 54 (FH) and 12, 18, 22 (SH) respectively, within the year 2011, 2012 and 2013.

Safe Blood and Voluntary Non-Remunerated Blood Donors

Safe blood was collected from safe, low risk donors with a related absence of infectious disease screening as well. WHO has stated that to guarantee its safety, blood should only be collected from voluntary non-remunerated blood donors (VNBD) coming from a lowrisk population. The aim of this study was to know the blood donors’ profile in Fatmawati Hospital (FH), Jakarta and Dr. Sardjito Hospital (SH), Yogyakarta by comparison The research was carried out by cross sectional study and data were obtained from the donor’s information records 2011-2013. The data were further descriptively analyzed and presented in tables and graphs. The Student’s t-test was used to analyze the difference of percentage mean for VNBD per-month between two hospitals with p<0.05. Based on the blood donor types, it was shown that most of the blood donors consisted of replacement persons. The mean of monthly VNBD percentage was significantly higher in FH than in SH. There was an increased VNBD percentage i.e. 32, 35, 54 (FH) and 12, 18, 22 (SH) respectively, within the year 2011, 2012 and 2013.