INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY https://indonesianjournalofclinicalpathology.org/index.php/patologi <p>INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY is the official journal of the Indonesian Association of Clinical Pathology. It is committed to publishing peer-reviewed, original articles related to the science of pathology in its broadest sense, including Anatomical Pathology, Chemical Pathology and Biochemistry, Cytopathology, Experimental Pathology, Genetics, Hematology, Immunology and Immunopathology, Microbiology and Molecular Pathology.</p> Indonesian Association of Clinical Pathologist and Medical laboratory en-US INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY 0854-4263 Author Guidelines https://indonesianjournalofclinicalpathology.org/index.php/patologi/article/view/2316 Author Guidelines Dian Wahyu Utami Copyright (c) 2024 INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY https://creativecommons.org/licenses/by-sa/4.0 2024-02-16 2024-02-16 30 2 Comparison of Two SARS-CoV-2 Rapid Antigen Test https://indonesianjournalofclinicalpathology.org/index.php/patologi/article/view/2098 <p>The Coronavirus Disease 2019 (COVID-19) pandemic continues to spread worldwide. A quick, simple, and accurate test to diagnose COVID-19 is essential for this situation. This study aims to evaluate and compare the rapid antigen examination of SARS-CoV-2 with Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) in detecting SARS-CoV-2. A retrospective study with a cross-sectional approach using medical record data from suspected, controlled, and confirmed COVID-19 patients whose samples were taken simultaneously for rapid antigen examination of SARS-CoV-2 (SD-Biosensor and Lungene) and RT-PCR at Labuang Baji Hospital, Makassar from September 2020-September 2021. Each instrument's sensitivity, specificity, negative predictive value, and positive predictive value were analyzed with the Receiver Operating Characteristics (ROC) curve method. This study obtained data from 312 rapid antigen tests for SARS-CoV-2, divided into two categories, 98 using Lungene and 214 using SD-Biosensor. Rapid antigen Lungene had a sensitivity of 71.4%, specificity of 71.4%, an accuracy of 71.4%, and a 31 reactive result in CT value. The SD-Biosensor Rapid antigen had a sensitivity of 62.6%, a specificity of 99.1%, an accuracy of 82.2%, and a 26 reactive result in CT value. In summary, the sensitivity of rapid antigen Lungene is higher than SD-Biosensor. Specificity and accuracy of rapid antigen SD-Biosensor higher than Lungene. Rapid test antigen SARS-CoV-2 has the potential to be a screening test for COVID-19 as long as the sampling time is right.</p> Stefany Boroh Irda Handayani Nursin Abdul Kadir Uleng Bahrun Copyright (c) 2024 INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY https://creativecommons.org/licenses/by-sa/4.0 2024-02-16 2024-02-16 30 2 107 111 10.24293/ijcpml.v30i2.2098 Procoagulant Phospholipid Activity and MPV Values in Acute Ischemic Stroke https://indonesianjournalofclinicalpathology.org/index.php/patologi/article/view/2103 <p>Ischemic stroke can be caused by atherothrombosis or embolism. Atherothrombosis occurs due to the rupture of an atherosclerotic plaque causing platelet activation. There are several markers of platelet activation, including platelet microparticles. The levels of platelet microparticles can be measured by examining procoagulant phospholipid (PPL) activity. It is not yet known exactly what activates thrombopoiesis, which can be assessed by an increase in Mean Platelet Volume (MPV). This study aimed to know whether there is an increase in PPL activity and MPV values in acute ischemic stroke, whether platelet activation is influenced by differences in ischemic stroke subtypes, and whether there is a relationship between PPL activity and MPV values in acute ischemic stroke. The study design was cross-sectional and involved 60 subjects. PPL activity in acute ischemic stroke (65.14±13.35 seconds) tends to be higher (shorter clotting time) than in healthy individuals (68.59±8.56 seconds), however, this difference was not statistically and clinically significant. The MPV value in acute ischemic stroke (9.83±0.72 fL) compared to healthy individuals (9.65±0.86 fL) however this difference was not statistically significant. PPL activity in the SAO subtype (61.66<strong>±</strong>1.31 seconds) tends to be higher than LAA (68.62<strong>±</strong>14.57 seconds), however, this difference was also not statistically significant. There was a weak correlation between PPL activity (seconds) and MPV value (fL) in acute ischemic stroke (r =0.34, p-value=0.03).</p> <p> </p> <p> </p> <p> </p> <p> </p> Cynthia Cynthia Suzanna Immanuel Rahajuningsih Dharma Setiabudhy Copyright (c) 2024 INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY https://creativecommons.org/licenses/by-sa/4.0 2024-02-16 2024-02-16 30 2 112 116 10.24293/ijcpml.v30i2.2103 Analysis of Blood Group Discrepancy at Dr. Wahidin Sudirohusodo Hospital's Blood Transfusion Unit Makassar https://indonesianjournalofclinicalpathology.org/index.php/patologi/article/view/2117 <p>Discrepancy is a lack of compatibility of blood group tests between forward grouping and reverse grouping. Based on the cause, discrepancies are divided into four groups as follows: group I discrepancies, which occur due to weak or missing antibodies, group II discrepancies, which occur due to weak or missing antigens, group III discrepancies, which result in the formation of rouleaux, and group IV discrepancies, which are caused by other problems. A retrospective study was carried out by using ABO blood group data, which were analyzed by the automatic gel test method with the IH-1000 device. Data from January 2019 to December 2021 was collected at the Blood Transfusion Unit, Dr. Wahidin Sudirohusodo Hospital of Makassar, and the data were grouped using SPSS version 22. A total of 21.742 samples were tested. The number of detected ABO blood group discrepancies was 127 (0.58%). There were 68 (51.3%) males and 59 (46.5%) females with an age range divided into toddler (38.6%), child (2.4%), adolescent (13.4%), adult (8.7%), pre-elderly (17.3%), and elderly (6.3 %). Based on the disease, discrepancies were categorized into samples with infectious disease (33.9%), autoimmune disease (3.9%), malignancy (23.6%), chronic disease (11%), and others (27.6%). The discrepancies consisted of group I (70.9%), group II (0%), group III (0.8%), and group IV (28.3%). There was a significant correlation between age and blood group discrepancy with p &lt; 0.001 and moderate correlation strength (0.54). The prevalence of discrepancy in this study was 0.58%. Discrepancies must be resolved before they are reported to minimize transfusion reactions.</p> Erdayanti Erdayanti Rachmawati Muhiddin Mansyur Arif Copyright (c) 2024 INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY https://creativecommons.org/licenses/by-sa/4.0 2024-02-16 2024-02-16 30 2 117 121 10.24293/ijcpml.v30i2.2117 Detecting Iron Deficiency Anemia in Type C Hospital: Role of RDW and MCV Parameters https://indonesianjournalofclinicalpathology.org/index.php/patologi/article/view/2100 <p>Iron deficiency anemia remains a global health problem, which is also a prominent cause of morbidity and mortality of all range of ages. There are three stages of anemia development, and there are some parameters to detect bodily iron status. Transferrin saturation is one of the reliable parameters. Among all hematology parameters, Red Cell Distribution Width (RDW) and Mean Corpuscular Volume (MCV) are two of the most often studied. MCV and RDW are relatively affordable and accessible, most importantly for rural areas with lower socioeconomic status. This was an analytical observational study with a cross-sectional design aimed to determine the correlation between RDW and MCV values with iron deficiency anemia, which was measured by transferrin saturation. A significant correlation was found between RDW, MCV values, and iron deficiency anemia in patients of Mitra Keluarga Cikarang Hospital and Permata Keluarga Hospital, Jakarta with a p-value of &lt;0.05. Sensitivity and specificity for MCV were 75% and 100%, for RDW were 55.45% and 80%, respectively. In conclusion, RDW and MCV parameters can be used as screening instruments for iron deficiency anemia.</p> Marina Ludong Ninik Sukartini Nuri Dyah Indrasari Dewi Wulandari Copyright (c) 2024 INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY https://creativecommons.org/licenses/by-sa/4.0 2024-02-16 2024-02-16 30 2 122 125 10.24293/ijcpml.v30i2.2100 Comparative Diagnostic Value of Dengue Infection Using ELFA and Two Commercial Immuno-Chromatography Tests https://indonesianjournalofclinicalpathology.org/index.php/patologi/article/view/2246 <p>Dengue Virus (DEN-V) can lead to a broad spectrum of clinical presentations, from mild symptoms to mortality. Based on the presence of antibodies, dengue infection is categorized into primary and secondary dengue. Early diagnosis is crucial for effective treatment of DEN-V infection. Non-Structural Antigen 1 (NS1) and dengue antibodies like immunoglobulin M (IgM) and immunoglobulin G (IgG) anti-dengue are standard assays used for dengue diagnosis. Various immunoassay methods, including Enzyme-Linked Fluorescent Assay (ELFA) and Immuno-Chromatographic Tests (ICT), are employed to detect these antigens and antibodies. This study aimed to compare the diagnostic value between ELFA and two commercial ICTs for detecting NS1 antigen, IgM/IgG anti-dengue. Seventy suspected dengue patients with fever lasting two to seven days at Premier Hospital, Surabaya were enrolled in this study. Blood serum samples from the individuals were tested for NS1 antigen and IgM/IgG anti-dengue using VIDAS<sup>®</sup> and two commercial ICTs (Boson and SD Bioline). The sensitivity of NS1 antigen assays using ELFA and two ICTs was calculated, as well as the agreement rate between ELFA and both ICTs. ELFA demonstrated high sensitivity (77.97%) for NS1 antigen detection in diagnosing dengue infection compared to two ICTs (76.27% and 45.45%). Using an automated system in ELFA can offer more excellent diagnostic value and objective results and determine the cut-off ratio of IgM/IgG antibodies. All of this comes at a cost comparable to ICT.</p> Jusak Nugraha Dian Luminto Agatha Efrad Saputri Copyright (c) 2024 INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY https://creativecommons.org/licenses/by-sa/4.0 2024-02-16 2024-02-16 30 2 126 131 10.24293/ijcpml.v30i2.2246 Humoral and Cellular Immune Response on COVID-19 Patients and Sinovac Vaccine Participants https://indonesianjournalofclinicalpathology.org/index.php/patologi/article/view/2061 <p>Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV)-2 is a new SARS-CoV virus. A person who is infected with this virus will induce both humoral and cellular immune responses. Herd immunity can be achieved through vaccination. The purpose of vaccination is the formation of antibodies capable of neutralizing coronavirus against the receptor binding domain. This study aimed to determine the differences between humoral and cellular immune responses between confirmed COVID-19 patients and Sinovac vaccine participants. This observational analytic study with a prospective cohort approach was conducted between March to October 2021. Fifty subjects (25 officers who had received vaccinations for COVID-19 patients and 25 COVID-19 patients treated at the Dr. Moewardi General Hospital) and met the inclusion and exclusion criteria were enrolled. Different tests were carried out to see the difference between the levels of CD8<sup>+</sup> T cells and anti-SARS-CoV-2 antibodies in the vaccine group and the COVID-19 patient group. There was no significant difference in humoral immune response (anti-SARS-CoV-2) between the vaccine group and COVID-19 patient group [33.93 (0.4–196.6) U/L vs. 101.28±158.59 U/L; p=0.409], but there was a significant difference in cellular immune response (CD8<sup>+</sup>) between the vaccine group and COVID-19 patient group [878.52±47368 cells/µL vs. 270.16±213.64 cells/µL; p=0.001]. CD8 assay can be used as a parameter to differentiate the cellular immune response between COVID-19 patients and COVID-19 vaccine recipients.</p> Brigitte Rina Aninda Sidharta Mas Aditya Senaputra Copyright (c) 2024 INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY https://creativecommons.org/licenses/by-sa/4.0 2024-02-16 2024-02-16 30 2 132 137 10.24293/ijcpml.v30i2.2061 Comparative Analysis of C-Reactive Protein and Procalcitonin Levels in the Severity of COVID-19 Patients https://indonesianjournalofclinicalpathology.org/index.php/patologi/article/view/2156 <p>Coronavirus Disease 2019 (COVID-19) is a systemic disease characterized by mild to critical symptoms with a high risk of mortality. Fast and precise inflammatory markers are needed to predict the severity and prognosis of COVID-19 to decrease the mortality rate. The elevated levels of C-Reactive Protein (CRP) and procalcitonin may predict an increased risk of aggravation in COVID-19 patients. <strong> </strong>This study aimed to analyze the CRP and procalcitonin levels of COVID-19 severity. This was a cross-sectional retrospective study involving 160 COVID-19 patients at Dr. Wahidin Sudirohusodo Hospital. Subjects were grouped based on the severity of COVID-19 (mild, moderate, severe, critical). The difference in CRP and procalcitonin levels based on the severity of COVID-19 was analyzed using the Kruskal-Wallis test and the Spearman correlation test. The age of participants in this study ranged from 19-87 years old. The higher CRP and procalcitonin level shows heavier the severity of COVID-19 (p&lt;0.001). This indicated a significant difference between CRP, procalcitonin levels, and the severity of COVID-19. This study showed that there was a significant correlation between CRP and procalcitonin with the severity of COVID-19, CRP (p&lt;0.001) and procalcitonin (p&lt;0.001).</p> Tuti Alawiyah Asvin Nurulita Uleng Bahrun Copyright (c) 2024 INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY https://creativecommons.org/licenses/by-sa/4.0 2024-02-16 2024-02-16 30 2 138 142 10.24293/ijcpml.v30i2.2156 Analysis of Platelet Counts and Leukocyte Residues at Different Storage Times in Thrombocyte Concentrate https://indonesianjournalofclinicalpathology.org/index.php/patologi/article/view/2147 <p>Thrombocyte Concentrate (TC) is one of the blood components given as therapy to patients. Ensuring the quality of TC products is essential to know if they can be transfused to patients. This study aimed to analyze platelet counts and leukocyte residues in TC products with different storage times. Cross-sectional research with a prospective cohort design was carried out at the Blood Transfusion Unit of Dr. Wahidin Sudirohusodo Hospital, Makassar, in September 2022. The study samples were ten bags of TC products produced from whole blood using the buffy coat method. The average platelet count in TC products on the 1<sup>st</sup>, 3<sup>rd</sup>, and 5<sup>th</sup> day were 50.65x10<sup>9</sup> (± 24.58); 66.24x10<sup>9</sup> (± 34.83); 47.34x10<sup>9</sup> per unit (± 37.75). Statistical tests showed no significant decrease between the 1<sup>st</sup>, 3<sup>rd</sup>, and 5<sup>th</sup> days. A meaningful decrease was obtained on the 3<sup>rd</sup> and 5<sup>th</sup> day (p &lt; 0.05), while on the ratio of the 1<sup>st</sup> and 3<sup>rd</sup> day, there was no meaningful difference (p &gt; 0.05). The average number of leukocytes is 0.0727x10<sup>9</sup> per unit (± 0.0659). The average number of platelets and leukocyte residues in TC products is by PERMENKES No. 91 of 2015 standards. Thrombocyte concentrate products can be used until the 5<sup>th</sup> day of storage.</p> Tania Aryadi Pramudyawardhani Raehana Samad Rachmawati Adiputri Muhiddin Copyright (c) 2024 INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY https://creativecommons.org/licenses/by-sa/4.0 2024-02-16 2024-02-16 30 2 143 146 10.24293/ijcpml.v30i2.2147 The Role of Fibrin Monomer Compared to D-dimer and CRP in Determining COVID-19 Severity https://indonesianjournalofclinicalpathology.org/index.php/patologi/article/view/2110 <p>Fibrin Monomer (FM), as a product of thrombin activity in cleaving fibrinogen, can be used as an early marker of thrombotic events in COVID-19 patients. D-dimer is a commonly used marker of hemostasis as a product of plasmin activity in cleaving polymeric fibrin. D-dimer is often used to help decide whether to initiate anticoagulant administration. This study aims to know whether FM can be used as a marker for thrombotic events such as D-dimer in COVID-19 patients; CRP levels were also examined to determine how inflammation affected the two hemostatic indicators. A total of 93 patients were confirmed with COVID-19 by PCR. The median (min-max) FM in the severe stage was 4.53 (2.26-58.20)ug/mL, whereas, in the mild-moderate stage, it was 4.21 (2.19-32.35 ug/mL. There are significant differences in median D-dimer levels in severe stages to mild-moderate, respectively 0.46 (0.14–7.58) and 0.7890, and ages. The level of FM that can be used to differentiate the severe stage is &gt; 4.46 ug/mL (sensitivity 56.3%, specificity 58.0%) as in the D-dimer level is &gt; 0.58 ug/mL ((sensitivity 75.0%, specificity 65.2%). There is a moderate positive correlation between fibrin monomer and D-dimer, a weak positive correlation between D-dimer and CRP, and no correlation between FM and CRP. This study concludes that the FM median level is higher in severe COVID-19 than in D-dimer. Fibrin monomer levels have a positive correlation with D-dimer. Fibrin Monomer levels are not affected by CRP.</p> <p> </p> Anggraini Iriani Usi Sukorini Marsya Kaila Fatina Naja F Aflah Sarah A Aiman Rizka K Gemilang Telly Kamelia Copyright (c) 2024 INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY https://creativecommons.org/licenses/by-sa/4.0 2024-02-16 2024-02-16 30 2 147 152 10.24293/ijcpml.v30i2.2110 Identification of Community- and Hospital Pulmonary Bacterial Infection Using Culture and PCR Panel in COVID-19 https://indonesianjournalofclinicalpathology.org/index.php/patologi/article/view/2113 <p>Co-infection or secondary infection is associated with a worse outcome in COVID-19. Information concerning the distribution of pathogenic microbes in COVID-19 has yet to be widely studied. This study aims to evaluate the distribution of bacterial infection in COVID-19, detected using conventional culture and molecular methods. This study was conducted in March-May 2021 in Dr. Hasan Sadikin General Hospital, with a study population of moderate, severe, and critical COVID-19 patients. Microorganisms were identified and analyzed from expectorant sputum or Endotracheal tube aspirates using conventional culture methods (VITEK 2 Compact) and multiplex PCR pneumonia panel (Biofire). Data was presented in a table and figures to describe the organism profile among the two methods. From the 450 COVID-19 patients, 59 subjects were included. The positivity rate of microbial identification reached 79.7% in both methods, dominated by Gram-negative bacteria for both community and hospital-acquired infections. The pathogens most frequently detected using conventional methods and multiplex PCR were <em>Acinetobacter baumanii</em> (15.3%; 23.7%) and <em>Klebsiella pneumoniae</em> (23.7%; 28.8%). The multiplex PCR method detected <em>Haemophilus influenzae</em> (15.3%) and respiratory viruses (3.4%), which conventional methods could not detect. Gram-negative bacteria were the most frequent pathogen in COVID-19 in both populations. The multiplex PCR method has the advantage due to its shorter examination time. The application of both methods helps determine antibiotic therapy for COVID-19. Both methods identified <em>Klebsiella pneumoniae</em> and <em>Acinetobacter baumanii</em> as the dominant bacteria in both populations. This study helps establish antibiotic management in COVID-19, thus preventing antibiotic resistance.</p> Ronal Winter Adhi Kristianto Sugianli Ida Parwati Copyright (c) 2024 INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY https://creativecommons.org/licenses/by-sa/4.0 2024-02-16 2024-02-16 30 2 153 158 10.24293/ijcpml.v30i2.2113 Analysis of NLR, PLR, and Carcinoembryonic Antigen in Colorectal Cancer Patients https://indonesianjournalofclinicalpathology.org/index.php/patologi/article/view/2063 <p>Colorectal cancer (CRC) is the second leading cause of cancer death worldwide. The development and prognosis of CRC are affected by the tumor's appearance and the host's inflammatory response. A combination of several parameters, including the Neutrophil-Lymphocyte Ratio (NLR) and Platelet-Lymphocyte Ratio (PLR), has been used as a cancer prognostic marker. Research needs to be performed to analyze its role in CRC. This study aimed to determine the differences in the NLR, PLR, and CEA values with the severity and site of CRC. Medical record data were collected from 246 CRC patients from January 2021 to June 2022 at Dr. Wahidin Sudirohusodo Hospital were used and grouped by severity (metastatic and non-metastatic) and site (left colon, right colon, rectum). This study collected the data on NLR, PLR, and CEA levels. The Mann-Whitney, Spearman Rho, and Kruskal-Wallis tests were used for statistical analysis by the research objectives (significant if p&lt;0.05). There were differences in median PLR (194.47 vs. 201.18; p=0.045) and CEA (3.3 ng/mL vs. 11.95 ng/mL; p&lt;0.001) between the metastatic and non-metastatic groups, whereas there was no significant difference of median NLR between the two groups (2.77 vs. 2.79; p=0.438). No correlation was found between the NLR, PLR, and CEA level values with the location of CRC (p-values 0.978, 0.511, 0.419, respectively). PLR and CEA values were higher in metastatic CRC than in non-metastatic CRC, while NLR value was not significantly different. There was no correlation between the NLR, PLR, and CEA level values with the CRC site.</p> <p> </p> Budi Parabang Tenri Esa Uleng Bahrun Copyright (c) 2024 INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY https://creativecommons.org/licenses/by-sa/4.0 2024-02-16 2024-02-16 30 2 159 162 10.24293/ijcpml.v30i2.2063 Modified HEART Score Analysis in Patients with NSTEMI and STEMI https://indonesianjournalofclinicalpathology.org/index.php/patologi/article/view/2095 <p>Cardiovascular disease is one of the leading causes of death. The utility of the risk score in the emergency department is for the initial examination of patients with chest pain suspected of acute coronary syndrome. HEART score was developed in the Netherlands and utilized to stratify chest pain patients and classify the risk of the patients as well as to identify the possibility of Major Adverse Cardiac Event (MACE) occurrences in 6 weeks. This study aimed to compare STEMI and NSTEMI using the modified HEART score in chest pain patients at the Integrated Heart Center (PJT) Dr. Wahidin Sudirohusodo Government Hospital, Makassar. This study used a cross-sectional approach from January 1 to March 31, 2022. The sample was drawn from patients with chest pain clinically diagnosed NSTEMI or STEMI based on the medical records containing the procedure of initial examination and HEART score risk stratification of each patient. The HEART score was found to be statistically significantly higher in STEMI (7.0 and 7.3) than in NSTEMI (6.0 and 5.6) (p&lt;0,001). AUC 0.809 (p&lt;0.001). The cut-off value of the HEART score can be used as a predictor of STEMI/NSTEMI. A cut-off value of 5.5 and 6.5 (alternative) were obtained from the ROC curve and can provide optimal sensitivity and specificity. The higher the score appeared on the HEART score (high risk), the higher the number of STEMI diagnoses compared to NSTEMI diagnoses. This is characterized by a significant increase of Troponin-I. Hence, the HEART score can be used as a scoring measure to predict whether the patient will be diagnosed with NSTEMI or STEMI.</p> Widya Pratiwi Sulina Yanti Wibawa Amaliyah T. Lopa Darmawati Rauf Copyright (c) 2024 INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY https://creativecommons.org/licenses/by-sa/4.0 2024-02-16 2024-02-16 30 2 163 167 10.24293/ijcpml.v30i2.2095 CD64 and I/T Ratio as a Diagnostic Test on Neonatal Sepsis in Banjarmasin https://indonesianjournalofclinicalpathology.org/index.php/patologi/article/view/2077 <p>Neonatal sepsis remains a major problem in the service and care of neonates. The clinical features of neonatal sepsis are non-specific, which makes it difficult to diagnose. The primary objective of this study was to assess the clinical use of cluster of differentiation 64 as a diagnostic marker of neonatal infection. This research used an analytical observational study. The research subjects consisted of 43 samples of neonates at Ulin Hospital, Banjarmasin who had met the inclusion criteria. The results of the study concluded that there was no significant difference between the I/T ratio and cluster of differentiation 64 values in patients with suspected neonatal sepsis with the gold standard procalcitonin and/or blood culture at Ulin Hospital with p=0.874 for the I/T ratio and p=0.285 for cluster of differentiation 64. The diagnostic test for the I/T ratio with a cut-off of 0.2 showed a sensitivity of 23.8%, specificity of 72.7%, positive predictive value of 45.5%, negative predictive value of 50%, mean of 0.16, and median of 0.11. The results of the cluster of differentiation 64 diagnostic test with a cut-off of 2025 showed a sensitivity of 42.9%, specificity of 72.7%, positive predictive value of 81.8%, negative predictive value of 50%, mean of 2487.93, and median of 1671. There was no significant difference between the I/T ratio and cluster of differentiation 64 values in patients with suspected neonatal sepsis with the gold standard procalcitonin and/or blood culture at Ulin Hospital, Banjarmasin.</p> <p> </p> Dewi Indah Noviana Pratiwi Pandji Winata Nurikhwan Muhammad Naufal Firdaus Copyright (c) 2024 INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY https://creativecommons.org/licenses/by-sa/4.0 2024-02-16 2024-02-16 30 2 168 171 10.24293/ijcpml.v30i2.2077 Prognostic Analysis of NLR, PLR, and, LMR in Osteosarcoma at Dr. Wahidin Sudirohusodo Hospital https://indonesianjournalofclinicalpathology.org/index.php/patologi/article/view/2126 <p>Osteosarcoma is a primary pediatric bone malignancy with an annual incidence of 5.6 cases per million children under the age of 15. The high mortality rate leads to necessary for prognostic biomarkers of the disease. NLR, PLR, and LMR can be considered as prognostic predictors of osteosarcoma patients. This study aimed to determine the difference and correlation between NLR, PLR, and LMR based on grade and outcome in osteosarcoma patients. The study used medical record data from 122 osteosarcoma patients at Dr. Wahidin Sudirohusodo Hospital, Makassar. Samples were grouped by stage according to Enneking criteria (Grade I, II, and III) and by outcome (deceased and not deceased), then analyzed based on NLR, PLR, and LMR values using the Kruskal-Wallis test and the Mann-Whitney test (significant if p&lt;0.05). There was a significant difference in NLR, PLR, and LMR values by grade, (p=0.05). There was a significant difference in the value of NLR, and LMR based on output (p=0.00), but not in PLR (p=0.954). There was a correlation between the values of NLR, PLR, and LMR and the stage of osteosarcoma (p=0.05). Based on the outcome, a correlation with the NLR and LMR values was obtained (p=0.00), but there was no correlation with the PLR value (p=0.955). Cut-off NLR, PLR, and LMR were 4.43; 0.21; and 0.44, respectively, with sensitivity of 76%, 56%, and 76% and a specificity of 76%, 63.9%, and 68%, respectively. There were differences in NLR, PLR, and LMR values based on the stage and outcome of osteosarcoma. Higher NLR, PLR, and LMR values will lead to a higher stage of osteosarcoma and a worse outcome. Cut-off NLR, PLR, and LMR optimal for distinguishing stage of osteosarcoma were 4.43; 0.21, and 0.44, respectively.</p> Febriani Helda Pongbala Uleng Bahrun Mansyur Arif Copyright (c) 2024 INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY https://creativecommons.org/licenses/by-sa/4.0 2024-02-16 2024-02-16 30 2 172 176 10.24293/ijcpml.v30i2.2126 Differences in Hemoglobin Levels 6 Hours and 24 Hours After Packed Red Cells Transfusion https://indonesianjournalofclinicalpathology.org/index.php/patologi/article/view/2093 <p>The hemoglobin examination instructed by Dr. Sardjito General Hospital attending doctors was 6 hours after the PRC transfusion. It is recommended that a hemoglobin examination be carried out 24 hours after transfusion to determine the patient's hemoglobin after complete equilibrium occurs. This study aimed to determine the mean increase in Hb levels 6 hours and 24 hours after PRC transfusion and to examine the difference in Hb levels 6 hours and 24 hours after PRC transfusion, respectively, compared with baseline Hb levels in non-hematological malignancy patients. This prospective analytic observational study examined hemoglobin at 6 hours and 24 hours after PRC transfusion. The differential test between delta Hb levels 6 hours after PRC transfusion compared to baseline Hb levels and delta Hb levels 24 hours after PRC transfusion compared to baseline Hb levels were analyzed using paired T-test. There was a statistically significant difference between baseline Hb levels and Hb levels 6 hours after PRC transfusion (p&lt;0.0001) and a statistically significant difference between baseline Hb levels and Hb levels 24 hours after PRC transfusion (p&lt;0.0001). The differential test between delta Hb levels 6 hours after PRC transfusion compared to baseline Hb levels and delta Hb levels 24 hours after PRC transfusion compared to baseline Hb levels obtained a statistically significant difference (p=0.0024). The mean increase in hemoglobin was 1.76<u>+</u>0.78 g/dL 6 hours after PRC transfusion and 1.9<u>+</u>0.78 g/dL 24 hours after PRC transfusion. There were differences in delta Hb levels 6 hours and 24 hours after PRC transfusion, respectively, compared with baseline Hb levels in non-hematological malignancy patients, which were statistically significant but not clinically significant.</p> Surawijaya Bakhtiar Kaslam Usi Sukorini Teguh Triyono Copyright (c) 2024 INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY https://creativecommons.org/licenses/by-sa/4.0 2024-02-16 2024-02-16 30 2 177 182 10.24293/ijcpml.v30i2.2093 Laboratory Results and Clinical Characteristics of Probable Omicron Patients at Dr. Wahidin Sudirohusodo Hospital https://indonesianjournalofclinicalpathology.org/index.php/patologi/article/view/2108 <p>Since the Omicron variant was first detected on November 24, 2021, in Southern Africa, it has now been detected in more than 110 countries and is estimated to continue to spread. Given the rapid spread and serious dangers of COVID-19, it is urgent to continuously improve and expand research on its clinical diagnosis and treatment. The analysis of this study identifies the laboratory results and clinical characteristics of probable Omicron. This study aimed to determine the laboratory results and clinical characteristics of probable Omicron patients at Dr. Wahidin Sudirohusodo Hospital. This descriptive study used a cross-sectional approach with medical record data of probable Omicron patients at Dr. Wahidin Sudirohusodo Hospital from January to July 2022 with a total of 241 research subjects. The results of the analysis showed that probable Omicron patients at Dr. Wahidin Sudirohusodo Hospital who were hospitalized consisted of 124 (51.5%) males and 117 (48.5%) females, 66 (22.8%) subjects with age range &gt;60 years, 88 (30.4%) subjects with age range of 40-60 years, 45 (15.6%) subjects with age range 19-40 years and 42 (14.5%) subjects with age &lt;18. Most subjects, which consisted of 79 (27.3%) patients reside in Makassar. The mean WBC count, NLR value, LMR value, and CT value found in this study were 10.8; 5.6; 0.5; and 33.94, respectively. The Omicron variant infects more males than females mainly at the age of 40-60 years, with a relatively low average CT value of 33.94 and a slight increase of NLR, MLR, and WBC count.</p> Fadhlan Fadhlan Uleng Bahrun Tenri Esa Copyright (c) 2024 INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY https://creativecommons.org/licenses/by-sa/4.0 2024-02-16 2024-02-16 30 2 183 186 10.24293/ijcpml.v30i2.2108 Analysis of the D-dimer/Platelets Ratio in Sepsis Patients at Dr. Wahidin Sudirohusodo Hospital Makassar https://indonesianjournalofclinicalpathology.org/index.php/patologi/article/view/2149 <p>Sepsis is a condition with a life-threatening organ dysfunction. This condition is caused by a dysregulated host response to infection. This study aimed to determine the ratio and cut-off value of D-dimer/platelets in sepsis patients. This study was a cross-sectional observational study. This study took secondary data from the medical records of 142 patients at Dr. Wahidin Sudirohusodo Hospital (RSWS) from January 2018 to December 2021. The results of this study showed that the D-dimer/platelet ratio was significantly higher in those who died (mean 0.151) compared to those who survived (mean 0.028) (p&lt;0.015) with a cut-off value of 0.020.</p> Yarianti Yarianti Darwati Muhadi Agus Alim Abdullah Copyright (c) 2024 INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY https://creativecommons.org/licenses/by-sa/4.0 2024-02-16 2024-02-16 30 2 187 190 10.24293/ijcpml.v30i2.2149 The Role of Effluent Analysis and Culture in Diagnosis and Monitoring of Peritoneal Dialysis-Related Peritonitis https://indonesianjournalofclinicalpathology.org/index.php/patologi/article/view/1900 <p>Peritoneal Dialysis (PD) is one of the available renal replacement therapy options for End-Stage Renal Disease (ESRD). One of the most common complications of PD is peritonitis. A 13-year-old boy was admitted to the hospital due to cloudy effluent and abdominal pain four days before admission. He was diagnosed with ESRD in 2015 and has undergone Continuous Ambulatory Peritoneal Dialysis (CAPD) since 2017. The physical examination findings were as follows: the temperature was 36.6 C, the conjunctiva was anemic, the abdomen was tender, and both of the lower extremities were edematous. Peritoneal dialysis effluent analysis showed yellow and turbid effluent with a leukocyte count of 13.346 cells/µL and polymorphonuclear (PMN) cells predominance (69.3%), effluent and serum urea of 221 and 243 mg/dL, effluent and serum creatinine of 16.7 and 18.26 mg/dL, respectively. Effluent Gram stain showed increased leukocytes without bacteria, while effluent culture showed the growth of Methicillin-sensitive <em>Staphylococcus aureus</em>. According to the International Society of Peritoneal Dialysis 2022 guidelines, all criteria for infective peritonitis in this patient were met: clinical features (turbid effluent and abdominal pain), increased cell count (&gt;100 cells/µL) with PMN &gt;50%, and positive effluent culture. The patient was administered intravenous Ampicillin-Sulbactam based on the effluent culture and antimicrobial susceptibility testing. Serial effluent analyses suggested a return-to-normal trend in leukocyte and PMN counts. After 18 days of hospitalization, the patient was allowed to discharge based on clinical and laboratory improvements.</p> Nuri Dyah Indrasari Najib Ali Copyright (c) 2024 INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY https://creativecommons.org/licenses/by-sa/4.0 2024-02-16 2024-02-16 30 2 197 201 10.24293/ijcpml.v30i2.1900 Detection of Partial Central Diabetes Insipidus in Limited Resource Setting https://indonesianjournalofclinicalpathology.org/index.php/patologi/article/view/1939 <p>Antidiuretic hormone (ADH) is an endogenous prohormone peptide synthesized in the posterior hypothalamus that regulates water excretion by the kidney. Diabetes insipidus is a disorder characterized by the excretion of large amounts of urine (diabetes) that are hypotonic, watery, and tasteless (insipid). The rarity of this case is one of the causes of missed diagnosis. If not diagnosed properly, patients will receive therapy that exacerbates the disease. The Water Deprivation Test (WDT) is one of the dynamic tests that can be done to narrow the diagnosis. A 44-year-old female was admitted to the hospital with chief complaints of polydipsia and polyuria during the previous 9 months. The patient had a history of irregular menstruation, cesarean delivery due to abdominal mass, and breast lump surgery. Diabetes mellitus and thyroid disease were excluded. Her blood pressure during admission was 150/100 mmHg and her body mass index was 31.1. Fluid balance data obtained before the water deprivation test showed that the urine volume (output) was 7.150 mL per 24 hours, and the total water input was 6.290 mL. Water deprivation test results showed that the kidneys were partially respond to the administration of exogenous ADH, suggestive of partial central diabetes insipidus.</p> Merci M. Pasaribu Dina Nurul Istiqomah Dewi Wulandari Copyright (c) 2024 INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY https://creativecommons.org/licenses/by-sa/4.0 2024-02-16 2024-02-16 30 2 202 205 10.24293/ijcpml.v30i2.1939 HbA1c As Diabetes Mellitus Biomarker and Its Methods Evolution https://indonesianjournalofclinicalpathology.org/index.php/patologi/article/view/2191 <p>This literature aims to review various aspects of HbA1c as a Diabetes Mellitus (DM) biomarker and various HbA1c examination methods and their respective advantages and limitations. Diabetes mellitus is a condition characterized by chronic hyperglycemia and can lead to microvascular and macrovascular complications in the future. HbA1c has been used extensively over the last few decades to monitor glycemic control and assess microvascular and macrovascular risk. It has also been used as one of the diagnostic criteria for DM. HbA1c is hemoglobin A, which is glycated at the N terminal of its valine beta-globin chain and provides an overview of glycemic control over the past three months. HbA1c is often reported using % or mmol/mol units and can be adjusted to assess the average blood glucose level over the past three months. Various methods developed for HbA1c examination include immunoassay, boronate affinity, enzymatic, capillary electrophoresis, and Ion-Exchange High-Performance Liquid Chromatography (IE-HPLC), and each has its advantages and limitations. In addition to their advantages in detecting HbA1c, the capillary electrophoresis and IE-HPLC methods can also detect other types of hemoglobin and the presence of hemoglobin variants.</p> Liong Boy Kurniawan Copyright (c) 2024 INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY https://creativecommons.org/licenses/by-sa/4.0 2024-02-16 2024-02-16 30 2 191 196 10.24293/ijcpml.v30i2.2191 Cover and Contents https://indonesianjournalofclinicalpathology.org/index.php/patologi/article/view/2319 Cover and Contents Dian Wahyu Utami Copyright (c) 2024 INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY https://creativecommons.org/licenses/by-sa/4.0 2024-02-16 2024-02-16 30 2