Background: Hemoglobin H (HbH) disease is alpha thalassemia characterized by inactivation of three of four α-globin genes due to deletions with or without non-deletional α-thalassemia. Hb Quong Sze (Hb QS) is a very rare non-deletional α-thalassemia in Indonesia caused by a CTGLeu>CCGPronucleotide substitution at codon 125 of α2 globin gene generating highly unstable hemoglobin. Compound heterozygosity for Hb QS and Southeast Asian double α-globin gene deletion (--SEA) result in accumulation of b-globin tetramers, causing hemolytic anemia.Case Report: A 49 years old Chinese Indonesian female was assessed for thalassemia screening. The phenotype of the proband was normal and only mild anemia was noticeable. She experienced blood transfusion five years ago due to a sudden fall of hemoglobin level after malarial infection. Complete blood count found hemoglobin 8.3 g/dL, Mean Corpuscular Volume (MCV) 65.7 fl and Mean Corpuscular Hemoglobin (MCH) 17.1 pg. HbH disease suggested by abundant Hb H inclusion bodies in the red blood cells. Microcapillary hemoglobin electrophoresis result showed HbH 31.8 %, Hb Bart 0.4%, HbA 67.3% and HbA2 0.5%. Molecular studies were carried out using multiplex polymerase chain reaction (PCR) method, and the common a0-thalassemia(--SEA) was detected in one allele. Direct sequencing analysis of the α1 and α2 globin genes revealed Hb QS in the other allele.Conclusion: Non-deletional Hb H disease due to compound heterozygous of Hb QS with Southeast Asian double α-globin gene deletion (--SEA) has a very low incidence in Indonesia. An advanced molecular analysis should be performed to determine this rare mutation.
Infection in ICU patients can lead to a septic condition with clinical signs similar to Systemic Inflammatory Response Syndrome (SIRS). The high risk of death and high cost of sepsis is the reason to find an early marker in diagnosing sepsis. Blood culture can givea result in 1-3 days, so C reactive protein, procalcitonin and presepsin which are fast and accurate are needed to find a septic condition in SIRS patients. The aim of this study is to determine the diagnostic value of CRP, PCT and presepsin of sepsis with blood culture as the gold standard., The samples were collected from 32 clinically SIRS patients in the Dr. Kariadi Hosiptal, Semarang. The PCT level was measured using ELFA method, CRP level by PET IA method, while presepsin level by CLEA method. The determined area was under curve (AUC) and the cut off level was determined by 2×2 table to find out the sensitivity, spesificity, positive predictive value, negative predictive value and likelihood ratio of CRP, PCT and presepsin as well. The AUC of PCT, CRP and presepsin was 0.78 (cut off 4.314 ng/mL); 0.673 (cut off 10.245 mg/L) and 0.814 (cut off 1134.5 pg/mL). The presepsin level had a higher sensitivity (90%) than PCT (80%) and CRP (70%). PCT specificity was 72.73%, presepsin and CRP specificity each was 68.18%. Based on this study, AUC and sensitivity of presepsin level were found higher than the PCT and CRP level.
Background: Prolonged hyperglycemia cause further complications in patients with Type 2 Diabetes Mellitus (T2DM). Examination of HbA1c as a glycemic control can determine the risk of complications. N-Mid osteocalcin (N-Mid Oc) is used as a marker for early detection of osteoporosis. Increased neutrophil lymphocyte ratio (NLR) is a sign of simple inflammation that contributes to the progression and chronic complications in T2DM. The aim of the study is to analyze the differences between osteoporosis and inflammation markers in controlled and uncontrolled T2DM.Methods: Analityc observational study with cross sectional approach was conducted in June – July 2019 involving 58 DMT2 patients at Diponegoro National Hospital Semarang. The level of N-Mid Oc level were measured by ELISA method and NLR was measured by hematology analyzer, NLR values were obtained after manually calculated. Different test between research variables were using Mann-Whitney U testResults: The median (min - max) N-Mid Oc levels of controlled and uncontrolled T2DM patients were 16.17 (4.98 – 37.28) ng / ml and 12.29 (3.54 – 37.28) ng/ml with a value of p = 0.004. Median (min - max) NLR of DMT2 patients controlled and uncontrolled were 1.82 (0.64 – 3.94) and 2.41 (1.08 – 6.46) with p = 0.007.Conclusion: There is a significant differences between N-Mid O level and NLR in controlled and uncontrolled T2DM patients. Latar belakang: Hiperglikemia berkepanjangan dapat menimbulkan komplikasi lebih lanjut pada pasien Diabetes Melitus Tipe 2 (DMT2). Pemeriksaan HbA1c sebagai kontrol glikemik dapat mengetahui risiko komplikasi. N-Mid osteocalcin (N-Mid Oc) dipakai sebagai salah satu petanda deteksi dini osteoporosis. Peningkatan neutrophil lymphocyte ratio (NLR) merupakan petanda inflamasi sederhana untuk memantau progresivitas dan komplikasi kronik pada DMT2. Tujuan dari penelitian ini adalah untuk membuktikan adanya perbedaan petanda osteoporosis dan inflamasi antara DMT2 terkontrol dan tidak terkontrol.Metode: Penelitian observasional analitik dengan pendekatan belah lintang dilakukan pada bulan Juni - Juli 2019 melibatkan 58 pasien DMT2 di Rumah Sakit Nasional Diponegoro Semarang yang memenuhi kriteria inklusi dan eksklusi. Pemeriksaan N-Mid Oc diperiksa dengan metode ELISA dan Pemerikasaan NLR menggunakan hematology analyser, nilai NLR didapatkan setelah dihitung secara manual. Uji beda antar variabel penelitian mengunakan Mann-Whitney U test’s. Hasil: Median (min – maks) kadar N-Mid Oc pasien DMT2 terkontrol dan tidak terkontrol berturut-turut adalah 16,17 (4,98 – 37,28) ng/ml dan 12,29 (3,54 – 37,28) ng/ml dengan nilai p=0,004. Median (min – maks) NLR pasien DMT2 terkontrol dan tidak terkontrol berturut-turut adalah 1,82 (0,64 – 3,94) dan 2,41 (1,08 – 6,46) dengan nilai p=0,007.Simpulan: terdapat perbedaan bermakna dari N-Mid Oc dan NLR antara pasien DMT2 terkontrol dan tidak terkontrol.
<p><strong>Background</strong></p><p>Chronic hepatitis and hepatic cirrhosis are chronic liver diseases that cause disorders of liver function, such as the formation of platelets and coagulation factors (prothrombin time/PT and activated partial thromboplastin time/APTT). Chronic hepatitis in the long term can develop into hepatic cirrhosis. The aim of this study was to determine platelet count, PT, and APTT as indicators in the progression of chronic hepatitis towards hepatic cirrhosis.</p><p><strong> </strong></p><p><strong>Metho</strong><strong>d</strong><strong>s</strong></p><p>A cross-sectional study was conducted on 50 patients with chronic hepatitis and hepatic cirrhosis in Semarang City Regional General Hospital, Telogorejo Hospital and Kariadi General Hospital. The platelet count was measured with a Sysmex XP-100, while PT and APTT was measured with a Sysmex CA-1500 coagulometer. The Mann Whitney test was applied to analyze the difference in platelet count, PT, and APTT between chronic hepatitis and hepatic cirrhosis.</p><p> </p><p><strong>Results </strong><strong></strong></p><p>Median, minimum, and maximum values of platelet count, PT and APTT in chronic hepatitis were 284.000/µl, 210.000/µl, 390.000/µl; 10.6 sec, 9.5 sec, 13.6 sec; and 30.5 sec, 24.2 sec, 46.4 sec, respectively, and in hepatic cirrhosis they were 96.300/µl, 48.200/µl, 133.800/µl; 27.5 sec, 11.9 sec, 44.7 sec; and 55.6 sec, 31.3 sec, 72.0 sec, respectively. There was a significant difference the reduction of platelet count, and the prolongation of PT and APTT in chronic hepatitis compared to hepatic cirrhosis (p=0.000).</p><p> </p><p><strong>Conclusion</strong><strong>s</strong></p>Prothrombine time and APTT were prolonged and platelet count was decreased in hepatic cirrhosis subjects. The three parameters may be used to evaluate the progression of chronic hepatitis towards hepatic cirrhosis.
Diabetic Nephropathy is one of several chronic complication of type 2 DM that could lead to end stage renal disease (ESRD). In type2 DM patients, about 85% of ESRD caused by diabetic nephropathy. Persistent microalbuminuria can be predictor for nephropathy. Earlydetection of microalbuminuria could be useful in improving an aggressive treatment to avoid ESRD and other macrovasculer disorder intype 2 DM patients. The purpose of this study was to describe the microalbuminuria profile in type 2 DM patients. A cross sectional studywas taken on 21 type 2 DM patients. Data were analyzed by descriptive analyzed (distribution, frequency, mean, standard deviation, ttest). P value < 0.05 was considered significant. This study reveals that frequency microalbuminuria was 78.9%. There was no differentage between microalbuminuria and normoalbuminuria. Duration of diabetes in microalbuminuria patients were more longer. Themean time is 45.3 (41) months and normoalbuminuria 36(16) months. The systolic and diastolic pressure in microlabuminuria washigher than normoalbuminuria. The body mass index between microalbuminurian and normoalbuminuria (P < 0.05) was significantlydifferent. In patient with microalbuminuria the mean of HbA1c value was 7.9(2.5) and in normoalbuminuria patient it was 9(1.8).There were no significant different of lipid profile between both samples. In this study was only found significantly different of body massindex between microalbuminuria and normoalbuminuria patients.
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