Introduction: Diagnosis of Tuberculosis (TB) in children is difficult because the clinical presentation is not specific, the chest X-ray interpretation has low accuracy and sputum sample is difficult to obtain. Antigen detection test such as rapid urine LAM is a non-invasive alternative for diagnosing TB . Lipoarabinomannan (LAM) is the main component of M.tuberculosis cell wall. Aim:To determine the diagnostic value of urinary LAM antigen for diagnosis of childhood TB. Materials and Methods:In the present cross-sectional study, subjects were included using consecutive sampling method. All the children aged 0-14 years Suspected of pulmonary or extra pulmonary TB suffering from cough more than two weeks, fever without clear aetiology, loss of body weight or poor weight gain, fatigue, malaise, chronic lymph node enlargement, spine angulation, joint swelling and had history of contact with positive sputum smear adult TB patient were enrolled in the study. Pulmonary and extra pulmonary diagnosis was based on clinical presentation, Tuberculin Skin Test (TST), chest X-ray, Acid Fast Bacillus (AFB) staining and or sputum culture. Urinary LAM level was measured by using Enzyme-Linked Immunosorbent Assay (ELISA). Cut off value and Area Under the Curve (AUC) were determined using ROC statistical analysis (SPSS 21.0). Sensitivity and specificity was measured from 2x2 cross table.Results: Out of 61 subjects suspected as TB, 49 (80.3%) were eventually diagnosed with TB. Of those diagnosed with TB, 21 (42.9%) were microbiologically confirmed cases either by sputum microscopy (34.7%) or culture (8.2%), whereas 28 subjects were unconfirmed cases (57.1%). The urinary LAM level was higher in subjects with TB (1.80+1.02) mg/l compared to non-TB group (0.46+0.3) mg/l; p<0.001(independent t-test). Urine LAM had 83% sensitivity and 85% specificity with cut off value 0.98 mg/l using microbiological and clinical confirmation as standard reference and 33% sensitivity and 60% specificity with cut off value 1.69 mg/l using microbiological confirmation only. Conclusion:Urinary LAM has good diagnostic value for childhood TB diagnosis.
ABSTRAK PendahuluanDiabetes mellitus (DM) merupakan penyakit metabolik ditandai oleh hiperglikemia yang disebabkan berkurangnya produksi atau kerja insulin. DM dapat menyerang anak-anak. Kami melaporkan kasus hiperglikemia pada anak berusia 9 tahun dengan kadar C-peptida dalam batas normal. KasusAnak perempuanberusia 9 tahun, dibawa ke rumah sakit dikeluhkan lemah badan selama satu minggu. Pasien juga dikeluhkan sering kencing terutama di malam hari selama sebulan dan bekas kencing dirubung oleh semut. Pemeriksaan fisik dalam batas normal. Pemeriksaan laboratorium hari pertama : hemoglobin 14,8 g/dl, leukosit 9.860 sel/ul, trombosit 297.000 sel/ul, gula darah acak 328 mg/dl. Pemeriksaan hari kedua : gula darah puasa 274 mg/dl, gula darah 2 jam post prandial 370 mg/dl, dan glukosuria. Pemeriksaan C-Peptida 2,74 ng/ml (normal 1,1 -4,4 ng/ml) PembahasanPada pasien anak ini ditemukan gejala khas diabetes yaitu fatigue dan poliuri. Pada pemeriksaan laboratorium didapatkan hiperglikemia. Sesuai dengan pedoman dari PERKENI pasien ini didiagnosis sebagai DM, yaitu tipe-1, dengan diferential diagnosis Maturity onset diabetes of the young (MODY) mengingat kadar C-peptida dalam batas normal. DM tipe 1 disebabkan oleh karena kerusakan sel beta pankreas akibat adanya autoantibodi terhadap pankreas. Sedangkan MODY disebabkan oleh mutasi genetik pada sel â pankreas sehingga terjadi inefektifitas produksi atau gangguan pelepasan insulin. Pemeriksaan tambahan seperti deteksi antibodi sel islet disarankan untuk menetapkan diagnosis DM tipe 1, dan pemeriksaan genetik untuk mendeteksi terjadinya mutasi sel â pankreas. Simpulan Diagnosis Type-1 Diabetes mellitu, dengan diagnosis banding Maturity onset diabetes of the young(MODY)Kata Kunci: hiperglikemia anak, C-peptida, Diabetes mellitus tipe-1, MODY 26 VOLUME 13 NOMOR 1 JUNI 2017
ABSTRAKDiabetes mellitus (DM) merupakan penyakit metabolik ditandai oleh hiperglikemia yang disebabkan berkurangnya produksi atau kerja insulin. DM dapat menyerang anak-anak. Kami melaporkan kasus hiperglikemia pada anak berusia 9 tahun dengan kadar C-peptida dalam batas normal.Anak perempuanberusia 9 tahun, dibawa ke rumah sakit dikeluhkan lemah badan selama satu minggu. Pasien juga dikeluhkan sering kencing terutama di malam hari selama sebulan dan bekas kencing dirubung oleh semut. Pemeriksaan fisik dalam batas normal. Pemeriksaan laboratorium hari pertama : hemoglobin 14,8 g/dl, leukosit 9.860 sel/ul, trombosit 297.000 sel/ul, gula darah acak 328 mg/dl. Pemeriksaan hari kedua : gula darah puasa 274 mg/dl, gula darah 2 jam post prandial 370 mg/dl, dan glukosuria. Pemeriksaan C-Peptida 2,74 ng/ml (normal 1,1 -4,4 ng/ml) Pada pasien anak ini ditemukan gejala khas diabetes yaitu fatigue dan poliuri. Pada pemeriksaan laboratorium didapatkan hiperglikemia. Sesuai dengan pedoman dari PERKENI pasien ini didiagnosis sebagai DM, yaitu tipe-1, dengan diferential diagnosis Maturity onset diabetes of the young (MODY) mengingat kadar C-peptida dalam batas normal. DM tipe 1 disebabkan oleh karena kerusakan sel beta pankreas akibat adanya autoantibodi terhadap pankreas. Sedangkan MODY disebabkan oleh mutasi genetik pada sel â pankreas sehingga terjadi inefektifitas produksi atau gangguan pelepasan insulin. Pemeriksaan tambahan seperti deteksi antibodi sel islet disarankan untuk menetapkan diagnosis DM tipe 1, dan pemeriksaan genetik untuk mendeteksi terjadinya mutasi sel â pankreas. Diagnosis Type-1 Diabetes mellitus, dengan diagnosis banding Maturity onset diabetes of the young(MODY)Kata Kunci: hiperglikemia anak, C-peptida, Diabetes mellitus tipe-1, MODY ABSTRACT Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia resulting from reduced insulin production, insulin action, or both. DM can attack children. This case reports a nine years old girlwith hyperglycemia and normal levels of C-peptide.A 9-year-old girl presented to the hospital with fatigue for one week. She also complained of frequent urination, especially at night for a month and the former urine were meshed by ants. Physical examination were within normal limits. First day laboratory examination data: haemoglobin 14,8 g/dl, leukocytes 9.860 cells/ul, platelets 297.000 cells/ul, random blood glucose 328 mg/dl. Second day examination: fasting blood glucose 274 mg/dl, blood glucose 2 hours post prandial 370 mg/dl,74 ng/ ml (normal 1,[1][2][3][4]4 ng/ml) We found typical symptoms of diabetes in this patient which are fatigue and polyuria. Laboratory examination found hyperglycemia. In accordance with the guidelines of PERKENI, she can be diagnosed as a type-1 DMwith differential diagnostic was Maturity onset diabetes of the young (MODY), considering the levels of C-peptide within normal limits.The pathophysiology in diabetes type 1 is a destruction of beta cells in the pancreas by autoantibodies. MODY is caused by a genetic mutation in p...
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