Aspartate Aminotransferase to Platelet Ratio Index Score in Correlation with Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio to Predict Hepatic Cirrhosis in Hepatitis C Patients

Background: Tissue biopsy examination which is an invasive procedure has become the mainstay for hepatic cirrhosis identification in patients with hepatitis. Alternatively, noninvasive method using the aspartate aminotransferase (AST) to platelet ratio index (APRI) score has been developed to predict hepatic cirrhosis. Furthermore, the neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) have been used to predict the severity of hepatitis C. This study aimed to analyze the relationship between APRI scores and NLR and PLR in chronic hepatitis C patients.Methods: This correlative cross-sectional observational study used secondary data of complete blood counts such as neutrophil, lymphocyte, and platelet values, as well as AST values of patients with hepatitis C in the outpatient and inpatient installation of Dr. Hasan Sadikin General Hospital during 2019. The inclusion criteria were patients aged ≥18 years, male and female, who were diagnosed as hepatitis C patients, patients who had AST examination data, leukocytes, count type, and platelets. Data were analyzed using the Spearman rank correlation test.Results: The 123 subjects were dominantly male with an age range of 46–55 years. There was no correlation between the APRI and NLR scores (p=0.229). However, there was a moderate and significant negative correlation between APRI and PLR scores with a correlation coefficient of -0.468 (p=0.000).Conclusion: There is a significant negative correlation between APRI and PLR scores to predict the occurrence of hepatic cirrhosis in patients with Hepatitis C

Validity of Immunoglobulin M Anti Salmonella typhi Serologic Test in Childhood Typhoid Fever

Background: Typhoid fever, which mostly affects children, remains a major health problem in developing countries. Early diagnosis will help the management and thus, reduce morbidity and mortality. However, a rapid diagnostic test that detects the presence of immunoglobulin M (IgM) directed towards Salmonella typhi (S. typhi) antigen remains controversial despite its popularity. This study was aimed to assess the validity of IgM anti S. typhi serologic test in childhood typhoid fever. Methods: This retrospective diagnostic test, used blood culture as gold standard. Forty-one typhoid fever children with fever of 1–14 days admitted to Dr. Hasan Sadikin General Hospital Bandung from 2013 to 2015 were recruited. Diagnosis of typhoid fever is made clinically. Data were analyzed by Receiver Operating Characteristic (ROC) curve and diagnostic test.Results: Forty one children diagnosed with typhoid fever, 37 were positive for IgM anti S. typhi, but only 18 were positive for S. typhi in blood culture. IgM anti S. typhi (cut-off ≥4) test had an Area Under the Curve (AUC) of 59%, sensitivity of 100% and specificity of 17.39%. IgM anti S. typhi with cut-off >8 showed the highest AUC with sensitivity of 55.56% and specificity of 73.68%.Conclusions: IgM anti S. typhi test of cut-off >8 performs better than cut-off ≥4 in terms of AUC..[AMJ.2017;4(1):138–42] DOI: 10.15850/amj.v4n1.103

Aspartate Aminotransferase to Platelet Ratio Index Score in Correlation with Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio to Predict Hepatic Cirrhosis in Hepatitis C Patients

Background: Tissue biopsy examination which is an invasive procedure has become the mainstay for hepatic cirrhosis identification in patients with hepatitis. Alternatively, noninvasive method using the aspartate aminotransferase (AST) to platelet ratio index (APRI) score has been developed to predict hepatic cirrhosis. Furthermore, the neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) have been used to predict the severity of hepatitis C. This study aimed to analyze the relationship between APRI scores and NLR and PLR in chronic hepatitis C patients.Methods: This correlative cross-sectional observational study used secondary data of complete blood counts such as neutrophil, lymphocyte, and platelet values, as well as AST values of patients with hepatitis C in the outpatient and inpatient installation of Dr. Hasan Sadikin General Hospital during 2019. The inclusion criteria were patients aged ≥18 years, male and female, who were diagnosed as hepatitis C patients, patients who had AST examination data, leukocytes, count type, and platelets. Data were analyzed using the Spearman rank correlation test.Results: The 123 subjects were dominantly male with an age range of 46–55 years. There was no correlation between the APRI and NLR scores (p=0.229). However, there was a moderate and significant negative correlation between APRI and PLR scores with a correlation coefficient of -0.468 (p=0.000).Conclusion: There is a significant negative correlation between APRI and PLR scores to predict the occurrence of hepatic cirrhosis in patients with Hepatitis C

Validity of Immunoglobulin M Anti Salmonella typhi Serologic Test in Childhood Typhoid Fever

Background: Typhoid fever, which mostly affects children, remains a major health problem in developing countries. Early diagnosis will help the management and thus, reduce morbidity and mortality. However, a rapid diagnostic test that detects the presence of immunoglobulin M (IgM) directed towards Salmonella typhi (S. typhi) antigen remains controversial despite its popularity. This study was aimed to assess the validity of IgM anti S. typhi serologic test in childhood typhoid fever. Methods: This retrospective diagnostic test, used blood culture as gold standard. Forty-one typhoid fever children with fever of 1–14 days admitted to Dr. Hasan Sadikin General Hospital Bandung from 2013 to 2015 were recruited. Diagnosis of typhoid fever is made clinically. Data were analyzed by Receiver Operating Characteristic (ROC) curve and diagnostic test.Results: Forty one children diagnosed with typhoid fever, 37 were positive for IgM anti S. typhi, but only 18 were positive for S. typhi in blood culture. IgM anti S. typhi (cut-off ≥4) test had an Area Under the Curve (AUC) of 59%, sensitivity of 100% and specificity of 17.39%. IgM anti S. typhi with cut-off >8 showed the highest AUC with sensitivity of 55.56% and specificity of 73.68%.Conclusions: IgM anti S. typhi test of cut-off >8 performs better than cut-off ≥4 in terms of AUC..[AMJ.2017;4(1):138–42] DOI: 10.15850/amj.v4n1.103

Distribution of VDR Gene Polymorphisms Bsm-I rs1544410 and Apa-I rs7975232 among HIV/AIDS Patients from West Java

Vitamin D receptor, encoded by VDR gene, mediates vitamin D functions by not only regulating calcium metabolism and homeostasis but also in regulating immune response. Polymorphisms in VDR gene may increase the progression of human immunodeficiency virus (HIV) infection into acquired immunodeficiency syndrome (AIDS). This study aimed to explore the distribution of VDR polymorphisms among HIV sero-positive patients in West Java. A cross-sectional study was performed, recruiting 96 patients infected with HIV and VDR polymorphisms were analyzed. The genotype distributions of Bsm-I among HIV-infected patients were 2.2%, 18.5%, and 79.3% for BB, Bb, and bb, respectively whereas the distributions of Apa-I were 54.4%, 38.9%, and 6.7% for AA, Aa and aa, respectively. The frequency of VDR polymorphisms in Bsm-I among HIV-infected patients in West Java were considered high for b allele (88.6%), and in contrast for A allele in Apa-I that was 73.91%. Further studies involving healthy controls are needed to explore the VDR polymorphisms distribution in general population. Moreover, a cohort study, albeit challenging, is needed to further assess the association between VDR polymorphisms and the progression of HIV infection.Distribusi Polimorfisme gen VDR Bsm-I rs1544410 dan Apa-I rs7975232 pada Pasien HIV/AIDS di Jawa BaratReseptor vitamin D yang dikode oleh gen VDR mempunyai peranan penting terhadap fungsi vitamin D, tidak hanya dalam regulasi metabolisme dan keseimbangan kalsium namun juga berperan dalam meregulasi respon imun. Polimorfisme pada gen VDR ditengarai dapat meningkatkan progresivitas infeksi human immunodeficiency virus (HIV) menjadi acquired immunodeficiency syndrome (AIDS). Penelitian ini bertujuan mengetahui distribusi polimorfisme gen VDR pada pasien HIV di Jawa Barat. Penelitian ini melibatkan 96 pasien HIV dan dilakukan analisis polimorfisme gen VDR. Distribusi genotip Bsm-I pada pasien HIV di Jawa Barat adalah 2,2%, 18,5%, dan 79,3% untuk BB, Bb, dan bb, secara beurutan; sedangkan pada Apa-I adalah 54,4%, 38,9%, dan 6,7% untuk AA, Aa, dan aa. Frekuensi polimorfisme pada Bsm-I pada pasien HIV di Jawa Barat tergolong tinggi pada alel b (88,6%) dan berbanding terbalik pada dan Apa-I dengan alel A yaitu 73,91%. Penelitian lebih lanjut yang melibatkan individu kontrol diperlukan untuk mengetahui distribusi polimorfisme gen VDR pada populasi umum. Selain itu, studi kohort pada pasien HIV/AIDS diperlukan untuk menilai hubungan antara polimorfisme gen VDR terhadap progresivitas infeksi HIV

Urinary Epithelial Sodium Channel (EnaC) Level as A Diabetic Marker of Nephropathy in Type 2 Diabetes Mellitus with Hypertension

Increased prevalence of diabetes mellitus (DM) leads to the increased of various complications including diabetic nephropathy, which can lead to the end stage renal disease (ESRD). The Epithelial sodium channel (ENaC), which is located in distal convoluted tubules, plays an important role in transepithelial sodium reabsorption for electrolyte homeostasis. Diabetes mellitus can cause changes in ENaC function which will interfere with kidney blood pressure control, worsening hypertension, and kidney injury that eventually may trigger diabetic nephropathy. The aim of this study was to determine the validity of urinary ENaC for screening diabetic nephropathy in type 2 diabetes mellitus (T2DM) with uACR as the gold standard. This was a cross-sectional analytical observational study conducted in Dr. Hasan Sadikin General Hospital Bandung, Indonesia, from December 2020 to July 2021. The subjects were 87 patients T2DM with hypertension with the majority of subjects (n=62) had a mean age of 56 years old and were experiencing albuminuria and hyperglycemia with DM for a duration of < 10 years. The poor glycemic control in these patients accelerated the occurrence of kidney damage. Result showed that urine ENaC level had a sensitivity and specificity of 82.3% and 48%, respectively, with 72.4% accuracy. The cut-off point of urine ENaC in this study was 0.98 ng/mL. Hence, urine ENaC level can be used as a test to screen for diabetic nephropathy with 82.3% sensitivity

Correlation Between P-Selectin Level and Platelet Aggregation in Cerebral Venous Sinus Thrombosis Patients

One of the causes of cerebral venous sinus thrombosis (CVST) is platelet hyperactivity. Adhesion and secretion are the beginning of platelet activation, which is indicated by a change in the Platelet-selectin (P-selectin) level. The end result of platelet activation is platelet aggregation. However, it is unknown whether the beginning of platelet activation ends with platelet aggregation. This study aimed to discover the correlation between P-selectin level and platelet aggregation in CVST. This study used a cross-sectional escriptive observational correlative approach. Subjects were the CVST outpatients visiting the Neurology Department of Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, from July to September 2021. A total of 49 subjects met the inclusion and exclusion criteria. This study used citrate plasma samples for platelet aggregation and serum for P-selectin assessment. Platelet aggregation were assessed using the light transmission platelet aggregation method while P-selectin was assessed using Enzyme-linked immunosorbent assay (ELISA). Platelet aggregation median was 10.6% (range 0.2–82.4%), which reflected normoaggregation. Platelet hyperaggregation were seen in 9 samples (8.4%). Median of P-selectin was 2.4 ng/mL (range 0.1–10.1 ng/mL) which were normal. High P-selectin level was observed in 16 (32.7%) with 4/16 (25%) experiencing platelet hyperaggregation. Statistical analysis showed a weak negative correlation between P-selectin and platelet aggregation (r=-0.012; p=0.467). In conclusion, no correlation is seen between P-selectin and platelet aggregation, which may be due to the fact that platelets are influenced by many factors that are not examined in this study

Profil Ekspresi Koreseptor Human Immunodeficiency Virus CCR5 dan CXCR4 pada penderita Infeksi Human Immunodeficiency Virus yang menggunakan Narkoba Suntik

Infeksi human immunodeficiency virus masih merupakan masalah kesehatan global, termasuk di Indonesia dan pemakai narkoba suntik merupakan populasi yang besar di antara orang dengan  infeksi HIV/AIDS (ODHA) yang berperan penting dalam  transmisi infeksi HIV. Opioid banyak digunakan penasun dan memengaruhi ekspresi CCR5 serta CXCR4 yang merupakan  koreseptor yang digunakan oleh HIV untuk menginfeksi sel limfosit T CD4. Penelitian ini bertujuan menganalisisperbedaan  ekspresi koreseptor HIV CCR5 dan CXCR4 antara ODHA penasun dan ODHA bukan pemakai narkoba. Penelitian observasional analitik dengan  rancangan cross sectional ini dilaksanakan pada September 2011−Mei 2013. Subjek penelitian adalah ODHA penasun yang diikutsertakan secara consecutive sampling  di RSUP Dr. Hasan Sadikin Bandung  serta di komunitas di Jawa Barat. Pemeriksaan ekspresi koreseptor CCR5, CXCR4 dan jumlah sel limfosit T CD4 dilakukan dengan metode flowsitometri. Ditemukan 80 orang subjek penelitian dengan 17 orang pengguna narkoba suntik aktif, 16 orang dalam terapi metadon, 15 orang mantan penasun, dan 32 orang bukan pemakai narkoba. Persentase CXCR4 di permukaan sel limfosit T CD4 lebih tinggi bermakna pada ODHA bukan pemakai narkoba dibanding dengan ODHA penasun (86,13; 78,23; p 0,001). Tidak terdapat perbedaan bermakna  ekspresi CCR5 dan MFI CXCR4 di permukaan sel limfosit T CD4 antara ODHA penasun dan ODHA bukan pemakai narkoba (p>0,05).  Dari penelitian ini disimpulkan bahwaekspresi CXCR4  lebih tinggi pada ODHA penasun dibanding dengan ODHA bukan pemakai narkoba pada sel limfosit T CD4. Ekspresi koreseptor CXCR4 yang lebih tinggi dibanding dengan CCR5 baik pada kelompok ODHA penasun dan bukan pemakai narkoba

Characteristics of Anemia in Children with HIV Infection

Anemia is a hematologic complication commonly encountered in HIV patients. Although the severity of anemia is generally mild, anemia has been shown to be a strong risk factor for disease progression, particularly in HIV infected person. With different severity and types of anemia in HIV patients, it is necessary to identify the severity and type of anemia in HIV-infected children, thus helping to determine the prognosis and management of their anemia. The purpose of this study was to describe HIV patient staging infection, co-morbidities, and type of anemia in HIV-infected children based on their therapy. A descriptive quantitative research was conducted in Dr. Hasan Sadikin General Hospital Bandung. Data were collected from patients’ medical records diagnosed with HIV between 2015–2017. The severity of anemia was set according to World Health Organization standards in 2011 and the types of anemia were identified from the erythrocyte index on routine hematologic examination. Forty-seven of 73 children had anemia. Based on the severity of anemia, 26% mild anemia, 60% moderate anemia, and 15% severe anemia were found. Subsequently, hypochromic microcytic (40%), macrocytic (32%), and normocytic normochromic (28%) anemia were identified. Considering the direct and indirect mechanism to yield anemia in HIV-infected patients, this double sword symptom becomes the most common complication burdened the growth and development of HIV-infected children. This study made it even more pronounced. Key words: Anemia, Children, HI

Korelasi Jumlah Folikel Antral dengan Kadar 25(OH)D Serum pada Penderita Sindrom Ovarium Polikistik

Sindrom ovarium polikistik (SOPK) ditandai oleh hiperandrogenisme, oligo atau anovulasi, dan morfologi ovarium polikistik. Penanda ovarium polikistik, yaitu terdapat ≥12 folikel antral dengan diameter 2–9 mm pada pemeriksaan ultrasonografi. Vitamin D (25-hidroksivitamin D; 25(OH)D) berperan pada proses steroidogenesis di sel teka ovarium dan pengaturan ekspresi reseptor follicle stimulating hormone (FSH) di sel granulosa ovarium. Defisiensi 25(OH)D menyebabkan penurunan aktivitas FSH, sehingga folikel antral di ovarium berukuran kecil dan berjumlah banyak. Tujuan penelitian ini mengetahui korelasi jumlah folikel antral dengan kadar 25(OH)D serum pada penderita SOPK. Uji observasional analitik  dengan rancangan potong lintang di Rumah Sakit Umum Pusat Dr. Hasan Sadikin (RSHS) Bandung dilakukan selama bulan September 2017─Juni 2018. Subjek penelitian adalah 52 penderita SOPK yang telah didiagnosis oleh klinisi obstetri dan ginekologi RSHS Bandung. Pengambilan darah vena dilakukan untuk pemeriksaan kadar 25(OH)D serum dengan metode ELISA. Hasil penelitian ini mendapatkan 56% subjek memiliki kadar 25(OH)D serum ≤20 ng/mL. Hasil uji korelasi Spearman didapatkan korelasi negatif kuat yang bermakna (r = -0,867, p<0,001) jumlah folikel antral dengan kadar 25(OH)D serum. Kadar 25(OH)D serum yang rendah pada penderita SOPK berkorelasi dengan jumlah folikel antral yang banyak. Terdapat korelasi negatif antara jumlah folikel antral dan kadar 25(OH)D serum pada penderita SOPK.  Kata kunci: Folikel antral, 25(OH)D serum, sindrom ovarium polikistik   Correlation between Antral Follicles Count and Serum 25(OH)D Levels in Polycystic Ovary Syndrome Patients Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism, oligo- or anovulation, and polycystic ovarian morphology. Vitamin D (25-hydroxyvitamin D; 25(OH)D) plays a role in the steroidogenesis process in the ovarian theca cells and regulates follicle stimulating hormone (FSH) receptor expression in granulosa cells. In 25(OH)D deficiency there is a decrease in FSH activity that the follicles become small and the antral follicles count in the ovary increases. The aim of this study was to determine the relationship between antral follicles count and serum 25(OH)D levels in PCOS patients. A cross-sectional analytical observational study was conducted in Dr. Hasan Sadikin General Hospital Bandung in September 2017─June 2018. Subjects of this study were 52 PCOS patients diagnosed by obstetricians and gynecologists of the hospital. Blood vein samples were collected to examine serum 25(OH)D levels using ELISA method. Serum 25(OH)D level of ≤20 ng/mL was found in 55.8% of the subjects in this study. Analysis using Spearman’s correlation test showed a significant negative correlation (r = -0.867, p <0.001) between antral follicles count and serum 25(OH)D level in patients with PCOS. Lower levels of 25(OH)D serum in PCOS patients correlates with higher number of antral follicles count. There is a negative correlation between antral follicles count and serum 25(OH) D level in PCOS patients. Key words: Antral follicle count, 25(OH)D serum levels, polycystic ovary syndrom