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.
Cyclin D1 is a protein that plays a role in the transition from the G1 to S phase of the cell cycle. Cyclin D1 expression has been found to increase in various malignancies and, in many studies, was associated with tumor growth, stage, lymph node involvement, distant metastases, and poor prognosis. Until now, studies on the association of cyclin D1 expression level with chemotherapy response have shown different results. An in-depth understanding of the cell cycle will allow doctors to develop target therapies that work when specific interventions are carried out at certain stages. Some studies reported that cyclin D1 expression was inversely related to chemotherapy response, while others showed opposite results. A significant number of studies have attempted to elucidate this ambiguous effect of cyclin D1. The suggested mechanism involves the difference of cancer cell types, the effect of chromosome instability in a few malignancies, trigger to an excessive DNA repair protein expression stimulus, and the response to DNA damage severity. The ambiguous effect of cyclin D1 towards chemotherapy was thought to arise from the difference in tumor type, chemotherapy agents used, and cell damage severity caused by cytostatics as per different research works. More in-depth research with parallel evaluation of other possible mechanisms such as DNA repair should elucidate the reason behind the inconsistent findings.
Abstrak AbstractNon-psychogenic polydipsia with hyponatremia is a rare clinical presentation. Primary hyperparathyroidism is a disorder of calcium, phosphate, and bone metabolism caused by increased level of parathyroid hormone (PTH). It is estimated the incidence of primary hyperparathyroidism are 21.6 per 100,000 person a year. This case report describe a 45-yearold man presented with non-psychogenic polydipsia. This patient drank a lot of water out of the fear of recurrent kidney stones. He had history of recurrent nephrolithiasis with hypercalcemia. We investigate further the cause of hypercalcemia and we diagnosed primary hyperparathryoidism as the cause.
Polisitemia atau eritrositosis merupakan peningkatan jumlah sel darah merah dalam sirkulasi. Polisitemia merupakan kasus yang bisa menimbulkan pertanyaan dan dilema bagi dokter. Artikel ini akan membahas tentang pendekatan diagnosis dan tata laksana polisitemia. Keluhan awal yang dirasakan oleh pasien umumnya nonspesifik, seperti lemas, pusing akibat hiperviskositas darah. Selain itu, hal penting yang harus diketahui adalah penyakit penyerta, obat-obat yang rutin digunakan, kebiasaan, riwayat trombosis (stroke, penyakit jantung) dan riwayat keluarga. Secara umum, pasien polisitemia memperlihatkan gejala plethora. Pemeriksaan status generalis kita mencari adanya tanda yang mengarahkan kepada polisitemia sekunder, seperti rendahnya saturasi oksigen yang dapat ditemui pada polisitemia sekunder. Pemeriksaan penunjang awal yang mudah dikerjakan adalah pemeriksaan darah tepi lengkap. Ferritin dan saturasi transferin dilakukan untuk menilai status besi yang dapat menyamarkan kejadian polisitemia, terutama bila gambaran darah tepi menunjukkan mikrositik hipokrom. Pemeriksaan lanjutan yang dapat dilakukan adalah pemeriksaan molekular. Pada kasus polisitemia vera, upaya untuk mencegah terjadinya kejadian trombosis menjadi tujuan utama pengobatan. Pada kasus polisitemia sekunder, tata laksana dilakukan untuk mengidentifikasi penyakit yang mendasari serta mengobatinya, salah satunya dengan phlebotomi.
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