Introduction: Patients with deep vein thrombosis (DVT) pose high morbidity and mortality risk thus needing fast and accurate diagnosis. Wells clinical prediction scores with D-dimer testing are traditionally used to rule out patients with low probability of DVT. However, D-dimer testing has a few limitations regarding its relatively low specificity. Neutrophillymphocyte ratio (NLR), a marker of inflammation, was found to increase in DVT. Hence, we aimed to evaluate the role of NLR for DVT diagnosis. Methods: Data were collected from medical records of patients with suspected DVT at Cipto Mangunkusumo National General Hospital during January-December 2014. Diagnosis of DVT was conducted using lower limb ultrasonography. Diagnostic values for NLR, D-dimer, and NLR + D-dimer were determined by receiver operating characteristic (ROC) analysis to obtain area under the curve (AUC), sensitivity, specificity, negative predictive value, and positive predictive values. Sensitivity and specificity analyses of NLR and D-dimer were also conducted based on Wells score and divided into groups of low and high probability of DVT. Results:The AUC values for NLR, D-dimer, and NLR + D-dimer were 72.6%, 70.4%, and 76.1%, respectively. The optimal cut-off value determined for NLR was 5.12 with sensitivity of 67.7%, specificity of 67.9%, PPV of 68.85%, and NPV of 64.91% in differentiating subjects with and without DVT. This study also found that D-dimer had sensitivity of 69.4%, specificity of 71.4%, PPV of 72.88%, and NPV of 67.8%. Meanwhile, the NLR + D-dimer combination had sensitivity of 66.1% and specificity of 72.6%. Multivariate analysis showed that NLR (OR: 2.636; 95% CI: 1.144-6.076; p: 0.023) and D-dimer (OR: 4.175; 95% CI: 1.810-9.633; p: 0.001) were associated with DVT. Conclusion: NLR value has wider AUC than D-Dimer and is relatively easier to obtain and does not require specific assay, thus enabling rapid evaluation of symptomatic patients suspected of having DVT. Adding NLR to D-dimer increased AUC to detect DVT. Therefore, NLR could serve as a complementary diagnostic tool for D-dimer to exclude DVT, especially in low clinical probability patients.
Aim: To compare between entecavir and lamivudine as hepatitis B reactivation prophylaxis in cancer patient with chemotherapyMethod could evoke its resistance lead to a question about how effective entecavir as a drug of choice in Indonesia for HBV reactivation prophylaxis in chemotherapy patients. This is the reason why this topic were discussed in this evidence-based case report.
Pendahuluan. Hipotensi postprandial sebenarnya sering terjadi dan saat ini dikenal sebagai masalah klinis yang penting.Studi-studi yang ada menunjukkan bahwa prevalensi hipotensi postprandial pada usia lanjut cukup tinggi. Hipotensi postprandial merupakan prediktor mortalitas pada orang usia lanjut dan menyebabkan banyak sekuele yang signifikan pada subyek yang terkena. Hingga saat ini, penelitian-penelitian yang berkaitan dengan hipotensi postprandial lebih banyak dilakukan pada kelompok usia lanjut di negara-negara maju yang definisi usia lanjut, proporsi penyakit, proporsi obat-obatan yang digunakan serta proporsi asupan yang berbeda dengan kelompok usia lanjut di negara berkembang khususnya Indonesia. Tujuan. Mengetahui proporsi dan faktor-faktor yang berhubungan dengan kejadian hipotensi postprandial pada kelompok usia lanjut.Metode. Penelitian studi potong-lintang dilakukan pada subjek usia lanjut di RSCM. Dilakukan pengisian kuesioner dan pengukuran tekanan darah sebelum makan dan setiap 15 menit sampai 2 jam setelah makan. Makanan yang dimakan dicatat untuk dianalisis.Hasil. Selama periode Januari – Maret 2010 terkumpul 119 subjek usia lanjut dengan rerata umur 67,50 ± 5,92 tahun. Sebanyak 53,8% memiliki hipertensi dan menggunakan obat anti hipertensi, 36.1% memiliki riwayat diabetes mellitus dan menggunakan obat pengontrol gula darah, 9,2% pernah mengalami stroke, 7.6% menggunakan terapi digoksin, 29.4% menggunakan terapi nitrat dan 3.4% menjalani hemodialisis rutin. Hipotensi postprandial didapatkan pada 55% subjek. Penggunaan obat diuretik loop dan insulin berhubungan dengan kejadian hipotensi postprandial. Selain itu diketahui pula bahwa penurunan tekanan darah postprandial lebih besar pada subjek dengan hipertensi, menggunakan obat ACE inhibitor, menggunakan obat diuretik loop/furosemid, menggunakan diuretik HCT, menggunakan insulin dan menggunakan obat nitrat.Simpulan. Penelitian ini menyimpulkan bahwa proporsi hipotensi postprandial pada subjek usia lanjut adalah 55%. Penggunaan obat diuretik loop dan insulin berhubungan dengan kejadian hipotensi postprandial. Penurunan tekanan darah postprandial lebih besar pada subjek dengan hipertensi, menggunakan obat ACE inhibitor, menggunakan obat diuretik loop/furosemid, menggunakan diuretik HCT, menggunakan insulin dan menggunakan obat nitrat.
Basement is a hard layer which has a high-density contrast compare to the above it layer. In geotechnics, this layer is useful for the basement installation of high-rise buildings and other heavy buildings. Rock density contrast is sensitive physical parameter to be detected using gravity data. The study conducted in Depok City is aimed to identify the presence and the depth of the basement. Gravity data has been collected from 87 stations throughout the city of Depok. The average density value of rocks in the study area is 1.73 g/cc which was obtained by using the Parasnis method. The shallow basement layer is mapped using the Energy Spectrum Analysis - Multi Window Test (ESA-MWT) method. This method works by windowing test points from Complete Bouger Anomaly (CBA) values to get the interface depth for each test point. The fault structure can be identified through a residual anomaly map and by the Multi Scale - Second Vertical Derivative (MS-SVD) method whose results correlate with each other. The basement layer was successfully identified among the 3 other horizon layers and was at a depth of 0 - 68 m below the subsurface. Fault structures were also identified in the study area in the North and South part of the study area, where its fault identified as a normal fault.
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