Umi S. Intansari

PERAMALAN SEPSIS AKIBAT PROCALCITONIN TERKAIT KELUARAN HASIL KLINIS

Sepsis is a systemic inflammatory response due to a severe infection. The systemic immune response rises after the local immune response does not successfully eliminate the antigen. Procalcitonin (PCT) has been known as the marker for bacterial infection. The aim of this study was to know whether PCT could be used as a predictor of clinical outcome in sepsis incidence. A prospective cohort design was used in this study. The subjects were patients entering the Internal ward who met the inclusion and exclusion criteria and examined for the basic data collection. For the assessment of SOFA (Sepsis-related Organ Failure Assessment) score, blood specimens were taken for PCT examination, on the first day since the diagnosis of sepsis and on the third day. The patients were observed until the tenth day to determine the assessment of their survival analysis. This study involved 50 subjects who fulfilled the inclusion and exclusion criteria. The mean levels of PCT on day I and III were 5.19±5.83 ng/mL and 6.37±9.85 ng/mL, respectively. The mean levels of PCT on day I and III in the group with increased SOFA score was 5.01±1.17 ng/mL and 3.86±1.46 ng/mL, respectively. The mean levels of PCT on day I and III in the group without increased SOFA was 5.32±1.21 ng/mL and 4.88±2.21 ng/mL, respectively. The relative risk of increased PCT against the poor output expressed by the increased SOFA score was 5.75. In the survival analysis, it was shown that 52% of patients survived at day 10. In the group of non survival patients; the number of patients with increased PCT was more than that without increased PCT. Based on this study, it can be concluded that procalcitonin could be used as a predictor for the clinical outcome in sepsis patients.

FCγII (CD32) MONOSIT DI INFEKSI DENGUE PRIMER DAN SEKUNDER {FcγRII (CD32) Monocytes in Primary and Secondary Dengue Infection}

Dengue infection is a major health problem in the world, including Indonesia. Clinical manifestations of dengue infection vary widely, from asymptomatic until dengue shock syndrome (DSS). Antibody Dependent Enhancement (ADE) hypothesis that states that non-neutralizing antibodies in secondary dengue infection may enhance dengue infection via Fcγ receptors is still controversial. Clinical research shows that not all secondary infections manifest as DHF/DSS, but nearly all DHF/DSS cases are caused by secondary infection. Allegedly, the expression of Fcγ has an effect on this incident. This study is an observational analytical study with a cross sectional design to determine the expression of FcγRII (CD32) monocytes in patients with primary and secondary dengue infection. CD32 of monocytes was measured using FACS Calibur with lyse no wash technique. Primary and secondary dengue infection were determined by IgM/IgG optical density ratio using ELISA capture method. The ratio of IgM/IgG ≥1.2 was considered as primary infection, while the ratio <1.2 was considered as secondary infection. Twenty primary and 32 secondary dengue infection patients in acute phase of dengue infection partisipated in this study. Expressions of Fcγ RII (CD32) monocytes were significantly lower in primary than secondary dengue infection (187.825±31.584 vs 218.598±43.414 MFI; p=0.008). CD32 expressions were higher in day 3 compared to day 4 of fever.

LEUKEMIA MEGAKARIOBLASTIK AKUT PADA SEORANG ANAK

Acute Megakaryoblastic Leukemia (FAB AML M7) occurs in all age groups with two peaks in distribution. The one is in adults and the other in children 1 to 3 years of age especially in those with Down’s syndrome. The diagnosis of AML M7 requires more than 30% of the nucleated bone marrow cells being megakaryoblasts. The AML M7 was under diagnosed before the availability of monoclonal antibodies. The more common types of AML MO-M6 have to be excluded by morphological and cytochemical analysis whereas immunology is needed to exclude ALL. The megakaryocytic nature of the leukemia has to be proven by ultrastructural demonstration of platelet peroxidase or by immunological demonstration of CD61, CD42, CD41 on the surface of the leukemic blasts. Megakaryocytic/megakaryoblastic leukemias show a wide morphologic spectrum. Cytoplasmic blebs and protrusions are the most prominent feature of many cases. The nuclei of these cells are round with more finely reticulated chromatin and with prominent nucleoli. The megakaryoblastic nature of these cells can be suggested by morphology. Cytochemistry is of limited diagnostic value in megakaryoblastic leukemias. Usually it is used to exclude the more common types of leukemia. An eighteen months girl was admitted to hospital with anemia and hepatosplenomegaly. There is dismorphic - hypertelorism face and enlargement of neck lymph nodes. The laboratory examination found anemia, hyperleukocytosis with 75 % blast cells. Morphologically the blast cells show prominent blebs and cytoplasmic budding resemble features of budding platelets. The cytochemistry staining for granulocyte and erythrocyte lineages were negative. The expressions of lymphoid and myeloid lineages markers by immunoflowcytometry method were also negative. Cytogenetic examination was followed. The physical and laboratory examination result conclude a child with Acute Megakaryoblastic Leukemia. Cytogenetic examination was followed

THE AUTOMATIC MICRODILUTION-BROTH IN SENSITIVITY TESTING OF ACINETOBACTER BAUMANNII ISOLATES (Microdilution-Broth Otomatis Dalam Uji Kepekaan Isolat Acinetobacter Baumannii)

Acinetobacter baumannii (A.baumannii) merupakan bakteri Gram negatif, non-fermentatif dan non-motil yang seringkali menjadi penyebab infeksi pada manusia. Infeksi A.baumannii di Indonesia adalah sebanyak 25,8%. Belakangan ini telah dikembangkan metode microdilution-broth untuk uji kepekaan antimikrobia. Penelitian ini bertujuan untuk mengetahui ketidaktepatan metode microdilutionbroth otomatis (Viteks2) dibandingkan dengan metode uji E (M.I.C.E.TM) secara mengukurnya. Penelitian potong lintang ini dilakukan terhadap 76 isolat klinik A.baumannii yang diperoleh dari pasien yang dirawat inap di RSUP Dr Sardjito Yogyakarta. Uji kepekaan meropenem dilakukan terhadap isolat klinik tersebut dengan menggunakan metode microdilution-broth otomatis (Viteks2) dan uji E (M.I.C.ETM). Patokan peka ≤4 ug/mL, intermediet 8 ug/mL dan resisten ≥ 16 ug/mL serta dilakukan perhitungan ketidaktepatan uji kepekaan meropenem metode microdilution-broth otomatis Viteks2. Isolat klinik A.baumannii sebagian besar diperoleh dari pasien rawat bukan gawat darurat 72,4% dan diikuti oleh yang berada di bangsal rawat yang gawat darurat dan poliklinik secara berturutturut 21,1% dan 6,5%. Sumber sampel sebagian besar adalah nanah, darah dan air kemih berturut-turut 44,7%, 19,7% dan 14,5%. Metode microdilution-broth otomatis (Viteks2) menunjukkan 56,6% peka, 42,1% resisten dan 1,3% intermediet, sedangkan M.I.C.ETM menunjukkan 59,2% peka, 38,2% resisten dan 2,6% intermediet. Kesalahan kecil jika hasil M.I.C.ETM adalah Resisten (R)/Peka (P) dan Viteks2 adalah intermediet (I) atau M.I.C.ETM adalah I dan Viteks2 adalah R atau P. Kesalahan utama jika uji E M.I.C.ETM adalah P dan Viteks2 adalah R. Secara berturut-turut kesalahan kecil dan utama adalah 2,63% dan 2,63% (kurang dari 10%). Metode microdilutionbroth otomatis (Viteks2) cukup tepat dalam menentukan uji kepekaan Meropenem terhadap A.baumannii.

, DALAM KEADAAN (STATUS) IMUNOLOGIS DAN KLINIS PENGOBATAN ANTIRETROVIRAL PENDERITA HIV/AIDS CD38 LIMFOSIT CD8 + , TAMPANG (PROFIL) CD4 +

ABSTRACT The relationship between immune activation and pathogenesis of Human Immunodeficiency Virus (HIV) infection is unproven. It has been hypothesized that state that HIV-induced activation enhances the magnitude of HIV replication other study shown that viral replication impaired immune activation. One of the best immune activation marker is CD38 expression on CD8 because it has the strongest significant prognostic markers. It was previously shown that increased CD8 + T-cell activation has predictive value for disease progression but the relation is still controversial. One hypothesis state that HIV-induced activation enhances the magnitude of HIV replication, other said that viral replication impaired immune activation. To know the profile of immunology and clinical state of HIV/ AIDS patients by determining the CD38 molecule expression on CD8 + profiles and clinical state. Crosssectonal, observasional study was done. Twenty nine HIV/AIDS patients who routinely had medical check up and having routine + cells as an activation marker, CD4 + antiretroviral therapy at Sardjito hospital and 8 healthy people as normal controls were involved in this study. The count of CD4 + cells counts had significant negative correlation with WHO stage (p = 0.012). Expression of CD38 molecule on CD8 absolute counts and expression of CD38 molecule on CD8 cells were measured using flowcytometry. The CD4 + cells of HIV/AIDS patients were higher compared to normal controls, 209.29 ± 76.56, 109.61 + 32.29 respectively (p < 0.05). That expression was not correlated with CD4 + + counts and CD4 increment after therapy was statistically significant (p = 0.003). The CD4 + increment. It might be caused by the time of measurement was not at the begining of diseases. The CD4 + count was negatively correlated with the WHO stage. Expression of CD38 molecule on CD8 + cells of HIV/AIDS patients were significantly higher compared to normal controls but it wasn’t correlated with the CD4 + + number and CD4 + increment after therapy.