Clinical Pathology

Introduction: Since the first human cases of H5N1 avian influenza virus infection were detected in Indonesia in 2005, the Sulianti Saroso Infectious Diseases Hospital in Jakarta has managed 27 confirmed cases from September 2005 to December 2007. Materials and Methods: We reviewed the clinical and epidemiological data of these patients. Results: Clinical and radiological features were not specific. Most patients were young and had indirect contact with infected poultry. The majority of cases presented to the Infectious Diseases hospital late when the patients already had features of the systemic inflammatory response syndrome (SIRS). The mortality was high at 77%. Conclusion: There is clearly an urgent need for better field diagnostics and therapeutics for the management of this emerging pathogen. Ann Acad Med Singapore 2008;37:454-7

INTRODUCTION Since the first human cases of H5N1 avian influenza virus infection were detected in Indonesia in 2005, the Sulianti Saroso Infectious Diseases Hospital in Jakarta has managed 27 confirmed cases from September 2005 to December 2007. MATERIALS AND METHODS We reviewed the clinical and epidemiological data of these patients. RESULTS Clinical and radiological features were not specific. Most patients were young and had indirect contact with infected poultry. The majority of cases presented to the Infectious Diseases hospital late when the patients already had features of the systemic inflammatory response syndrome (SIRS). The mortality was high at 77%. CONCLUSION There is clearly an urgent need for better field diagnostics and therapeutics for the management of this emerging pathogen.

Introduction: Since the first human cases of H5N1 avian influenza virus infection were detected in Indonesia in 2005, the Sulianti Saroso Infectious Diseases Hospital in Jakarta has managed 27 confirmed cases from September 2005 to December 2007. Materials and Methods: We reviewed the clinical and epidemiological data of these patients. Results: Clinical and radiological features were not specific. Most patients were young and had indirect contact with infected poultry. The majority of cases presented to the Infectious Diseases hospital late when the patients already had features of the systemic inflammatory response syndrome (SIRS). The mortality was high at 77%. Conclusion: There is clearly an urgent need for better field diagnostics and therapeutics for the management of this emerging pathogen.

Background There is a paucity of data regarding blood culture utilization and antimicrobial-resistant (AMR) infections in low and middle-income countries (LMICs). In addition, there has been a concern for increasing AMR infections among COVID-19 cases in LMICs. Here, we investigated epidemiology of AMR bloodstream infections (BSI) before and during the COVID-19 pandemic in the Indonesian national referral hospital. Methods We evaluated blood culture utilization rate, and proportion and incidence rate of AMR-BSI caused by WHO-defined priority bacteria using routine hospital databases from 2019 to 2020. A patient was classified as a COVID-19 case if their SARS-CoV-2 RT-PCR result was positive. The proportion of resistance was defined as the ratio of the number of patients having a positive blood culture for a WHO global priority resistant pathogen per the total number of patients having a positive blood culture for the given pathogen. Poisson regression models were used to assess chan...

Background Little is known about diagnostic and antibiotic use practices in low and middle-income countries (LMICs) before and during COVID-19 pandemic. This information is crucial for monitoring and evaluation of diagnostic and antimicrobial stewardships in healthcare facilities. Methods We linked and analyzed routine databases of hospital admission, microbiology laboratory and drug dispensing of Indonesian National Referral Hospital from 2019 to 2020. Patients were classified as COVID-19 cases if their SARS-CoV-2 RT-PCR result were positive. Blood culture (BC) practices and time to discontinuation of parenteral antibiotics among inpatients who received a parenteral antibiotic for at least four consecutive days were used to assess diagnostic and antibiotic use practices, respectively. Fine and Grey subdistribution hazard model was used.

Myeloma IgD κ merupakan kasus keganasan sel plasma yang jarang dijumpai, dan belum pernah dilaporkan di Indonesia. Pada keadaan normal, kadar IgD dalam darah sangat rendah, sehingga peningkatan kadar IgD dalam darah dapat terlewatkan pada pemeriksaan elektroforesis protein serum. Pada makalah ini dilaporkan kasus seorang wanita 59 tahun dengan nyeri tulang hebat. Pemeriksaan radiologi menunjukkan adanya fraktur kompresi torakal dan penyempitan foramen torakal. Diagnosis mieloma pada pasien ini ditegakkan berdasarkan kriteria WHO, stadium berdasarkan kriteria Durie Salmon, dan prognosis buruk berdasarkan International Prognostic Index dari International Myeloma Working Group. Pada elektroforesis protein serum dijumpai spike monoklonal yang kecil dan pada imunofi ksasi didapatkan IgD κ and free light chain κ.

HIV rapid diagnostic tests (RDTs) are now used widely in non-laboratory settings by non-laboratory-trained operators. Quality assurance programmes are essential in ensuring the quality of HIV RDT outcomes. However, there is no cost-effective means of supplying the many operators of RDTs with suitable quality assurance schemes. Therefore, it was examined whether photograph-based RDT results could be used and correctly interpreted

To establish the prevalence of HIV, syphilis, and sexual risk behaviour among three groups of men who have sex with men in Jakarta, Indonesia, and to investigate sexual links between these men and broader heterosexual populations. Methods: Anonymous, cross sectional surveys among community recruited transgender and male sex workers and self recognised men who have sex with men (MSM) were undertaken in mid-2002 in Jakarta, Indonesia. Places where transgender and male sex workers sell sex and where men go to meet noncommercial male sex partners were mapped. Probability samples were selected for the sex worker populations, while a mixed probability and convenience sample was drawn for self recognised MSM. Blood was drawn for HIV and syphilis serology and community interviewers administered a standardised questionnaire. Results: HIV prevalence was 22% among transgender sex workers, 3.6% among male sex workers, and 2.5% among self recognised MSM, and syphilis prevalence was 19.3%, 2.0% and 1.1% respectively. 59.3% of transgender sex workers and 64.8% of male sex workers reported recent unprotected anal intercourse with clients, and 53.1% of other MSM reported unprotected anal sex with male partners. Some 54.4% of male sex workers and 18.3% of other MSM reported female partners in the preceding year. Conclusion: HIV has reached substantial levels among transgender sex workers, and is not negligible in other MSM groups. Risk behaviour is high in all subpopulations, and bisexual behaviour is common, meaning the threat of a wider epidemic is substantial. Prevention programmes targeting male-male sex are needed to reduce this threat.

Introduction: Invasive candidiasis is a severe form of infection. The incidence of invasive fungal infections has increased, due to the increasing number of patients with impaired immunity who are being treated through prolonged stay in hospital facilities. Neurological patient treatment methods such as antimicrobials, corticosteroid, central venous catheter (CVC), total parenteral nutrition, and mechanical ventilation use are associated with common risk factors for invasive candidiasis. Our study demonstrated invasive candidiasis prevalence among neurological patients. Methodology: A cross-sectional study was done with consecutive sampling of neurological patients who were hospitalized from January 2017 to February 2020 at the Mahar Mardjono National Brain Center Hospital East Jakarta Indonesia. Patients with sepsis, septic shock, or fever (> 38.5 °C), and who had not received antifungals before culture were enrolled in the study. Clinical specimens were obtained from blood, liq...

Introduction: Sphingomonas paucimobilis, previously known as Pseudomonas paucimobilis, is a Gram-negative rod. It is emerging as an opportunistic pathogen that can infect individuals in community or hospital settings. It is believed that the natural habitat of this organism is soil and water, including water sources in the hospital environment. Case report: We describe the case of a 46-year-old patient in whom S. paucimobilis was identified in the implanted bone flap after craniotomy. The postoperative bone flap was implanted in the right hypochondria and replaced after 8 weeks. There was a hypochondriac abscess in the area under the bone. Specimens from the thickened fascia and bone flap were cultured. The Gram stain showed Gram-negative rods and these rods were identified as S. paucimobilis. The patient was treated with a combination of Gentamicin 240 mg and Levofloxacin 750 mg once daily because the bacteria were resistant to carbapenem, trimethoprim-sulfamethoxazole, and anti-ps...

proliferative diabetic retinopathy (DR) is an advanced form of DR that eventually could lead to blindness. Levels of vitreous advanced glycation end products (AGEs) and D-dimer may reflect the pathological changes in the retina, but only few studies have assessed their correlation with blood hemoglobin A1C (HbA1c) levels. This study aimed to find the association between blood HbA1c levels with vitreous AGEs and D-dimer levels in patients with proliferative DR. an analytical cross-sectional study was performed in subjects with proliferative DR who underwent vitrectomy. Subjects were divided into 2 subgroups, i.e. uncontrolled (HbA1c >7%) and controlled (HbA1c <7%) groups. Vitreous AGEs and D-dimer levels were assessed; the levels were compared between uncontrolled and controlled hyperglycemic patients. Statistic correlation tests were also performed for evaluating blood HbA1c, vitreous AGEs, and D-dimer levels. a total of 47 patients were enrolled in this study and 32 (68.1%) o...

Antibiotik profilaksis adalah antibiotik yang diberikan pada pasien yang akan menjalani pembedahan untuk mencegah terjadinya infeksi akibat tindakan operasi. Antibiotik profilaksis diberikan secara intravena agar dicapai konsentrasi maksimum di serum/jaringan pada saat operasi. Pemilihan antibiotika profilaksis yang sesuai pada tindakan pembedahan sangat menentukan keberhasilan dalam mencegah terjadinya infeksi luka operasi. Penelitian ini bertujuan untuk mengetahui besarnya angka kejadian infeksi luka operasi dan mengevaluasi penggunaan antibiotika profilaksis dalam pencegahan infeksi luka operasi di rumah sakit Premier Bintaro, Kota Tanggerang. Jenis penelitian ini adalah observasional dengan rancangan studi deskriptif analitik melalui penelusuran data yang dilakukan secara retrospektif pada pasien yang menjalani pembedahan di ruang operasi. Analisa dan evaluasi data berupa deskripsi pola penggunaan antibiotika profilaksis dan angka kejadian infeksi luka operasi serta hubungan ant...

Introduction: COVID19 is a new disease caused by the SARS CoV-2 virus which became pandemic in 2019 In October 2020, COVID 19 cases in Indonesia continued to increase, reaching 304,007 cases The mortality rate of this disease is 3 6% This disease shows many symptoms such as asymptomatic, fever, cough, diarrhoea, severe shortness of breath Case: 53 years-old man with fever for five days with cough, sore throat, and tightness Physical examination revealed a temperature of 38 °C and bilateral lung crackles with ground-glass opacity of the right lung in pulmonary CT scan PCR results obtained positive SARS-CoV 2 Discussion: In the early phase of COVID19 infection, complete peripheral blood tests tended to be normal with a mild increase in CRP When ARDS occurs, there is a significant decrease in absolute lymphocyte, and increased CRP levels The decreased Hb levels accompanied by increased LDH is suspected hemolysis of erythrocyte Other laboratory examination shows an increase of acute pha...

Background: COVID-19 is an infection caused by SARS-CoV 2. RT-PCR test is the gold standard for COVID-19 diagnosis, detecting the virus nucleic acid. However, this test is not yet available in every healthcare center, thus making the diagnostic process lengthy. A prompt diagnosis and immediate management are important to decrease mortality and morbidity rate, as well as to prevent transmission. A simple and practical diagnostic model using determinant factors is needed to guide the physician for a quicker decision-making. Method: This study is a cross sectional study using consecutive sampling method. The study was conducted at RSUPN Cipto Mangunkusumo, Jakarta from March to June 2020. History of contact with COVID-19, clinical symptoms, laboratory examination, and chest radiographs data were taken from medical records. The steps of analysis were univariate, bivariate, and multivariate analyses, followed by ROC curve and Hosmer-Lemeshow calibration. Result: There were 187 patients w...

BACKGROUND The emergence of drug-resistant pathogens (DRP) in recent years possibly contributes to the common problems associated with community-acquired pneumonia. However, to predict the risk of the ailment, the DRIP score is mainly applied, although no validation study has been reported in Indonesia. Therefore, the score prediction accuracy in the population, patient characteristics and germ patterns appears indefinite, particularly for Cipto Mangunkusumo Hospital, Jakarta. The purpose of this study is to determine the DRIP performance as an instrument in predicting infections due to drug-resistant pathogens (DRP) in community-acquired pneumonia at Cipto Mangunkusumo Hospital. METHODS This research employed a cross-sectional design, where the subjects were community-acquired pneumonia patients treated between January 2019 and June 2020. In addition, adequate medical records of the participants were obtained. The condition is defined as DRP when the sputum culture results show res...

Background: Colitis is a gastrointestinal disease that poses a major problem in Indonesia. Zinc (Zn) is an important trace element which plays role as antimicrobial in intestinal mucosa, increases gastrointestinal barrier, and immune function. Colitis can cause histologic changes in gastrointestinal tract epithelial which will disrupt the absorption and excretion of Zn causing zinc deficiency. This study aims to evaluate the difference of Zn level in colitis and healthy subjects, as well as the fecal analysis profile of colitis patients in Cipto Mangunkusumo General Hospital. Method: The design of this study was cross-sectional and was performed in colitis and healthy subjects. Colitis patients were recruited consecutively in patients in Gastroenterology Clinic and Gastrointestinal Endoscopy Centre in Cipto Mangunkusumo General Hospital. Zinc examination from blood sample was performed using spectrophotometry. Fecal analysis was performed manually. The level of zinc from colitis sub...

Chronic kidney disease (CKD) patients have higher risk to develop cardiovascular disease (CVD) than non-CKD patients. Neutrophil lymphocyte ratio (NLR) in CKD patients reflects inflammation status and role as complementary prognostic marker to evaluate cardiovascular risk in stage 3 to 5 CKD. High prevalence of vitamin D deficiency commonly found in CKD patients, leads to endothelial dysfunction and increase inflammation. NGAL is used as renal injury biomarker but nowadays NGAL has been known plays important role in CVD pathophysiology. CVD identification in CKD patients is necessary to obtain CVD risk and to stratify mortality earlier in CKD patients. This study aimed to obtain the differences and continued to obtain cut off of NLR, vitamin D and NGAL in CKD patients undergoing hemodialysis (HD) with and without CVD if the differences was significantly. A cross-sectional study was conducted in dr. Cipto Mangunkusumo National Hospital Jakarta, in December- February 2020. Total subje...

The oligoclonal band indicates presence of antibodies specific to the disease, possibly due to the activation of certain clones of B lymphocytes. This intrathecal immunoglobin synthesis can be persistent for months to years, for example, in respons to paramyxoviruses, herpes virus, coxsackievirus, and Treponema pallidum; or can be synthesized for life, for example in multiple sclerosis and subacute sclerosing panencephalitis (SSPE). We report a case of SSPE in a 15-year-old male patient. The patient had myoclonic jerks that occurred in the thoracal femoral region. Necessary laboratory tests identified reactive anti-measles IgG, which indicates a previous measles infection or exposure to vaccination. This report describes the usefulness of the oligoclonal bands in the diagnosis of the neurodegenerative disease SSPE that is progressive and fatal to the central nervous system due to persistent measles virus infection in the gray and white matter.

TINJAUAN PUSTAKA PENDAHULUAN Psoriasis merupakan penyakit kulit yang ditandai bercak-bercak eritema berbatas tegas dengan skuama kasar berlapis dan transparan, bersifat kronis dan residif, penyebabnya autoimun. Psoriasis kronis tidak hanya menyerang kulit tetapi pada sekitar 10-40% penderita juga menyebabkan komplikasi radang sendi yang disebut artritis psoriatika; insidennya di Eropa 3-7%, USA 1-2% dari seluruh populasi, di Indonesia belum diketahui. 9,11,12 Diperlukan pengetahuan yang lebih dalam tentang artritis psoriatika untuk dapat mencegahnya. ETIOPATOGENESIS Etiologi langsung artritis psoriatika masih belum diketahui; dapat disebabkan oleh ABSTRAK Artritis Psoriatika adalah suatu penyakit kronis yang ditandai oleh lesi kulit psoriasis, dan juga peradangan sendi. Penyakit ini mempunyai turunan genetik yang kuat, gen yang diturunkan antara lain HLA-Cw6, B27, B38, B39, serta CD8 sel T lebih dominan. Beberapa tipe artritis psoriatika yaitu tipe simetris, asimetris, DIP (Distal interphalangeal), spondilitis, artritis mutilans. Artritis psoriatika hampir selalu mendahului artritis (80%) tetapi bisa timbul artritis dulu pada sekitar 15%, sehingga menyulitkan diagnosis. Arthrocentesis selain membantu diagnosis juga dapat sebagai terapi tambahan. Artritis psoriatika mirip artritis rematoid, tetapi tidak menghasilkan antibodi spesifi k, sehingga terapi utama pada artritis psoriatika bukan steroid tetapi NSAIDs, sulfasalazin, dan siklosporin, lefl unomide, methotrexate. Prognosis tergantung onset, stadium penyakit, saat didiagnosis dan terapi, jumlah sendi yang terkena.