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INDONESIA
Indonesian Journal of Clinical Pathology and Medical Laboratory (IJCPML)
Published by Perhimpunan Dokter Spesialis Patologi Klinik Indonesia
ISSN : 08544263     EISSN : 24774685     DOI : https://dx.doi.org/10.24293
Core Subject : Health, Science,
Biochemistry, Genetics & Molecular Biology Health Professions Medicine & Pharmacology Neuroscience
Indonesian Journal of Clinical Pathology and Medical Laboratory (IJCPML) is a journal published by “Association of Clinical Pathologist” professional association. This journal displays articles in the Clinical Pathology and Medical Laboratory scope. Clinical Pathology has a couple of subdivisions, namely: Clinical Chemistry, Hematology, Immunology and Serology, Microbiology and Infectious Disease, Hepatology, Cardiovascular, Endocrinology, Blood Transfusion, Nephrology, and Molecular Biology. Scientific articles of these topics, mainly emphasize on the laboratory examinations, pathophysiology, and pathogenesis in a disease.
Arjuna Subject : Kedokteran - Kedokteran (Lain-Lain)
Articles 22 Documents
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Search results for , issue "Vol. 29 No. 2 (2023)" : 22 Documents clear
Severe Falciparum Malaria with Multiple Complications in Sanglah Hospital Denpasar Evelin Vianetha Prima Snak; I Nyoman Wande; Ni Nyoman Mahartini
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 29 No. 2 (2023)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v29i2.1830

Abstract

Malaria is caused by Plasmodium, which is transmitted through the bite of infected female Anopheles mosquitoes. Plasmodium falciparum causes the most severe form of malaria and can be life-threatening. A 63-year-old male with decreased consciousness, fever, chills, vomiting, and joint pain. The patient works in the Ivory Coast, malaria-endemic areas. Physical examination found clouding of consciousness and jaundice. Laboratory examination results are leukocytosis with eosinophilia and thrombocytopenia, increased of Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), total bilirubin, direct and indirect bilirubin, Blood Urea Nitrogen (BUN), creatinine, decreased of estimated Glomerular Filtration Rate (e-GFR), decreased random plasma glucose. Urinalysis showed macroscopic hematuria, positive blood, and protein are found, and erythrocyte sediment is increased. A blood gas analysis examination revealed metabolic acidosis. Rapid Diagnostic Test (RDT) showed positive for Plasmodium falciparum. The blood smear showed leukocytosis with eosinophilia and thrombocytopenia and the ring-form trophozoites stage of Plasmodium falciparum. The definitive diagnosis of falciparum malaria is confirmed by microscopic peripheral blood smear and malaria RDT for antigen detection. An overall investigation concluded the patient diagnosed is severe falciparum malaria with various complications including hypoglycemia, jaundice, and acute kidney failure. The patient died on the first day after being treated in Sanglah Hospital, Denpasar.
Patient with Recurrent Hypoglycemia Caused by Malignant Giant Insulinoma Clareza Arief Wardhana; Anak Agung Wiradewi Lestari; I Nyoman Wande
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 29 No. 2 (2023)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v29i2.1832

Abstract

Insulinoma is a functional endocrine tumor in the pancreas and the most common cause of hypoglycemia due to endogenic hyperinsulinism. Insulinoma is a rare case, with an incidence of 1-4 cases per million people each year. Malignant insulinoma is an insulinoma that is proven to metastasize to other tissues and only happens in 5-10% of insulinoma cases. Insulinoma with a size >9 cm is classified as giant insulinoma. Since 1927, fewer than 40 cases of giant insulinoma have been reported. 56 years old female was referred from a private hospital with the chief complaint of decreased consciousness due to recurrent hypoglycemia. On physical examination, palpable ±12x4 cm solid mass with an uneven surface in the epigastric region. Laboratory tests found an increase in c-peptide, fasting insulin, and liver function tests. A contrast CT scan found a heterogeneous solid mass 7.6x8.6x13.6 cm in cauda of the pancreas and hepatomegaly with multiple metastatic nodules. Results of pancreas and liver biopsy showed poorly differentiated carcinoma that metastasizes to the liver. In this case, based on patient history, physical and other examinations, it can be concluded that the patient was diagnosed with an observation of recurrent hypoglycemia caused by giant insulinoma with liver metastases.
Blood Gas Analysis as A Predictor of Mortality in Critical COVID-19 Patients in Dr. Moewardi Hospital Surakarta Maria Sekar Cahyaningrum; Dian Ariningrum; Widana Primaningtyas; Tonang Dwi Ardyanto
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 29 No. 2 (2023)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v29i2.1970

Abstract

COVID-19 has been declared a global pandemic affecting many countries, including Indonesia. The worsening of COVID-19 patients may go unnoticed because one of the clinical manifestations of COVID-19 is silent hypoxia, where the patients’ blood oxygen saturation drops with no visible symptoms. Blood gas analysis is needed to detect silent hypoxia. This study aims to confirm whether blood gas analysis results correlate with the mortality of critical COVID-19 patients. This was a retrospective cohort study, the samples were taken from the medical records of critical COVID-19 patients from May 2020-July 2021. The variables observed were gender, age, comorbidities, oxygen saturation (SaO2), partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), bicarbonate (HCO3-), and blood pH. Descriptive statistics, bivariate, and multivariate analyses were done. There were 210 samples, where 137 patients survived (65.24%) and 73 patients died (34.76%). The data analysis showed that comorbidities and blood pH significantly correlate with the mortality of critical COVID-19 patients, with p-values < 0.05; indicating that comorbidities and blood pH can be used as mortality predictors in critical COVID-19 patients. The RR for comorbidities and blood pH were 2.194 and 2>294, respectively, with CI 95% 1.202-4.833 for comorbidities and 1.151-5.295 for blood pH. The cut-off value used for blood pH was 7.310.
Analysis of NLR in Type 2 Diabetes Mellitus with and without Diabetic Foot Ulcer Rafika Ulandari; Liong Boy Kurniawan; Nurahmi Nurahmi; Darwati Muhadi
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 29 No. 2 (2023)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v29i2.1971

Abstract

Patients with type 2 diabetes mellitus (T2DM) have increased followed by complications including diabetic foot ulcer. Systemic inflammatory conditions in T2DM with diabetic foot ulcers can be assessed by inflammatory markers. Neutrophil Lymphocyte Ratio (NLR) is a good indicator of systemic inflammatory conditions. A retrospective study of the medical record at Dr. Wahidin Sudirohusodo Hospital, Makassar from September 2019 – September 2021 involved 120 patients consisting of 60 patients for each group of T2DM with and without diabetic foot ulcers. Leukocytes, neutrophils, lymphocytes, and NLR based on routine blood results using the flow cytometry method. Mann-Whitney test was used for comparison between the two groups on NLR and Kruskal-Wallist test was used for the relationship between NLR and Wagner classification. There was a significant difference in leukocytes, neutrophils, lymphocytes, and NLR in T2DM patients with diabetic foot ulcers compared to those without 16.2±8.6 and 9.8±4.2 103/µL (p<0.001); 13.3±8.4 and 5.0±3.8 103/µL(p<0.001); 1.6±1.7 and 2.5±2.5 103/µL(p<0.001); 10.0±10.1 and 3.5±4.5, respectively. The relationship between the NLR and Wagner classification was the highest at Wagner grade 5 (12.87±5.0) and the lowest was at Wagner grade 2 (6.18±7.83) with significant statistical test results (p<0.037). There was increasing NLR in T2DM with diabetic foot ulcers due to systemic inflammation. The NLR integrates different immune pathways, such as neutrophils as an inflammatory response and lymphocytes controlling the inflammatory response. Lymphocytes count and NLR level on T2DM with diabetic foot ulcer were higher than those without diabetic foot ulcer.  
IL-6 Levels Analysis Controlled in Type 2 Diabetes Mellitus Patients and Uncontrolled Moonika Todingan; Rachmawati Muhiddin; Liong Boy Kurniawan
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 29 No. 2 (2023)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v29i2.1972

Abstract

Interleukin   6 (IL-6) is one of the pro-inflammatory cytokines responsible for inducing tissue-specific and/or systemic inflammation, which is a major contributor to the induction of inflammation of pancreatic islet cells.  Inflammation of pancreatic cells causes impaired insulin secretion and Type 2 Diabetes Mellitus (T2DM). This study aims to determine the levels of IL-6 in T2DM patients with different levels of severity. A cross-sectional study of 46 subjects was performed with 21 in the controlled T2DM group and 25 in the uncontrolled T2DM group. Interleukin-6 levels were measured using the ELISA method. The statistical tests used were the Mann-Whitney test and the Spearman test. The test results were significant if the p-value <0.05. The level of IL-6 in uncontrolled T2DM was higher (64.00±77.65 pg/mL) than in controlled T2DM (31.25±11.04 pg/mL).  Although the levels in both groups were different, the value was not statistically significant (p=0.120). There was no significant correlation found between HbA1c and IL-6 (p=0.125, r =0.230). Several experimental studies have shown that IL-6 inhibits glucose-stimulated insulin secretion from pancreatic islets in experimental animals. However, some of them revealed that acute exposure to IL-6 did not appear to affect pancreatic islet cell function, which is still controversial today. This study found a tendency of increased IL-6 in high-severity T2DM compared to low-severity T2DM although not statistically significant. Further studies with more clinically homogeneous samples are still needed.
Analysis of Monocyte/Lymphocyte Ratio and Monocyte/HDL Ratio as A Predictor of Mortality in ACS Nanda Amelia; Tenri Esa; Darmawaty E Rauf
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 29 No. 2 (2023)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v29i2.1978

Abstract

Inflammatory process plays a role in the prognosis and development of Acute Coronary Syndrome (ACS). Inflammation parameters associated with ACS mortality are Monocyte/Lymphocyte ratio (MLR) and Monocyte/High Density Lipoprotein ratio (MHR). This study aimed to analyze MLR and MHR as predictors of ACS mortality based on the GRACE score. A cross-sectional retrospective study on ACS patients at Dr. Wahidin Sudirohusodo Makassar for the period January 2019-December 2020. Acute coronary syndrome patients were grouped into low, medium and high risk based on the GRACE score. Monocyte/lymphocyte ratio and MHR were measured on admission. The Kolmogorov-Smirnov test, Kruskal-Wallis test, Spearman's correlation test and Receiver Operating Characteristics (ROC) statistical tests were used. The statistical test results were significant if the p-value < 0.05. The sample consisted of 422 ACS patients, 70 low risk patients, 156 medium risk and 196 high risk patients. Age range 30–88 years. The mean MLR 0.50±0.37 and MHR 0.19±0.15. The mean MLR was the highest significant at high risk (0.58) and the lowest at low risk (0.37) (p<0.001); while MHR was not significant. Monocyte/lymphocyte ratio was positively correlated with GRACE score (p < 0.001), while MHR was not correlated (p 0.310). From the MLR ROC curve, the cut-off was 0.35 (AUC 0.673; 95% CI 0.695-0.742). MLR values increase in high-risk patients due to the ongoing inflammatory process. The MHR value did not show a positive correlation with mortality. Monocyte/lymphocyte ratio had a predictive value on mortality with a cut-off of 0.35 while the role of MHR still requires further research.
Decreased T530-pSIRT1 Expression in CD45- Cells After Red Grape Administration Agustin Iskandar; Carla Pramudita Susanto; Chilmi S; Wihastuti TA
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 29 No. 2 (2023)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v29i2.1982

Abstract

T530-pSIRT1 is one of the biomarkers that shows senescence activity. CD45- cells are the phenotype for late Endothelial Progenitor Cells (EPCs) expressing endothelial antigens. Resveratrol in red grapes is thought to be able to increase T530-pSIRT1 expression and improve endothelial quality. This study aimed to determine the change in T530-pSIRT1 expression by CD45- cells after the administration of red grapes. This study had a quasi-experimental pre-test-post-test one-group design. Research subjects were taken using consecutive sampling methods in the adult population aged 45-55 years. Expression of T530-pSIRT1 was analyzed from the number of CD45- cells and Mean Fluorescence Index (MFI) of CD45- cells using the immune flow cytometry method. Statistical analysis used GraphPad version 9.2.0. The number of research subjects was 17 people with a mean age of 47.3 years and 52.9% were female. There was a significant decrease in the number of CD45- cells (p=0.02) and a significant decrease in T530-pSIRT1 expression indicated by MFI CD45- cells, which were significant (p = < 0.0001). Decrease in T530-pSIRT1 expression in CD45- cells is thought to be caused by several factors that cannot be controlled during the study subject's consumption of red grapes such as diet, exercise, mental stress, and rest periods. Further research is needed to determine the appropriate dose and timing of red grape consumption to increase SIRT1 levels. Consumption of red grapes decreased expression of T530-pSIRT1, which could be caused by the dose and time of consumption of red grapes and the lifestyle of the research subjects that could not be controlled.
Analysis of Reticulocyte Hemoglobin Equivalent in Routine and Non-Routine Blood Donors in Makassar Andy Inna Agustina; Samad R; Juliyani S; Mansyur Arif
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 29 No. 2 (2023)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v29i2.1984

Abstract

Blood donation often causes the depletion of iron stores in the body resulting in anemia. One of the markers to assess the hemoglobin content in reticulocytes is Ret-He. This study aims to analyze Ret-He in routine and non-routine blood donors. This was a cross-sectional study using primary data from routine and non-routine blood donors at the Blood Transfusion Technical Implementation Unit of South Sulawesi Province from June 2021 to September 2021. The study population was blood donors who met the donor selection requirements. The research samples were blood donors who qualified as routine and non-routine blood donors. For a total of 66 blood donors, namely 33 routine blood donors and 33 non-routine blood donors, the mean Ret-He of routine blood donors (33.6 pg) was lower than that of non-routine blood donors (35 pg). The Mann-Whitney test showed a significant difference between routine and non-routine blood donors (p=0.008). Ret-He levels in routine blood donors were significantly lower than in non-routine blood donors. This is because routine blood donors donate blood more frequently and regularly, affecting the iron reserves in the donor's body. The study showed that the Ret-He level of routine blood donors was lower than that of non-routine blood donors but was still within the normal values of Ret-He (normal value: 30.2 pg - 36.7 pg). Ret-He levels in routine blood donors were lower than non-routine blood donors but were still within the normal range.
Analysis of Kidney Function Tests as Predictor of Mortality in COVID-19 Sitti Rahma; Yuyun Widaningsih; Liong Boy Kurniawan; Fitriani Mangarengi
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 29 No. 2 (2023)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v29i2.1985

Abstract

Cytokine release syndrome and Acute Respiratory Distress Syndrome (ARDS) increase the incidence of Acute Kidney Injury (AKI) in COVID-19 patients, which is associated with a poor prognosis and risk of death. The purpose of this study was to analyze urea, creatinine, and eGFR values as predictors of mortality in COVID-19 patients. A retrospective cohort study was carried out using secondary data from medical records of 311 COVID-19 patients who were treated at the Hasanuddin University State Higher Education Hospital from August 2020 to August 2021. Data were analyzed using the Mann-Whitney test, Chi-Square, and Logistic Regression. The risk of mortality for COVID-19 patients with urea levels > 53 mg/dL was 5.128 times higher than that of urea levels ‰  53 mg/dL (OR=5.128; CI =2.530 – 10.391, p<0.001). The risk of mortality for COVID-19 patients with creatinine levels  > 1.3  mg/dL was 2.696 times higher than that of creatinine levels  ‰  1.3  mg/dL (OR= 2.696; CI = 1.330 – 5.463, p<0.001). The risk of mortality in COVID-19 patients with an eGFR <  90  mL/min/1.73 m2  was  3.692 times higher than that of an eGFR ‰ 90 mL/min/1.73 m2 (OR=3.692; CI = 2.134 – 6.389, p<0.001). Multiple logistic regression analysis showed that urea and eGFR were better predictors of mortality than creatinine (OR= 0.374, p=0.002 vs. OR 0.344, p=0.007 vs. OR 1.192, p=0.694). The COVID-19 patient group with high serum urea and creatinine levels and low eGFR values had a greater risk of mortality compared to the group of patients who had normal results. Urea levels and eGFR values were better predictors of mortality than serum creatinine.
Analysis of Neutrophil/Lymphocyte Ratio and Culture Results on Clinical Severity of Patients with CAP Nurul Afiah; Irda Handayani; Nursin Abd. Kadir
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 29 No. 2 (2023)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v29i2.1987

Abstract

Community-Acquired Pneumonia (CAP) is an acute infection with high morbidity and mortality, especially among toddlers and elders in Indonesia. Culture is the gold standard for infectious diseases, which requires a long time. Therefore, a rapid, inexpensive, easy-to-use marker such as NLR is needed. To analyze the relationship of NLR and culture results with the clinical severity of CAP. A retrospective study with a cross-sectional design was performed using secondary data from CAP patients at Dr. Wahidin Sudirohusodo Hospital from January 1st, 2018 to July 31st, 2021. The study conducted on 113 samples showed no significant differences between NLR and clinical severity of CAP (p-value of 0.071). However, the mean value of NLR in severe CAP was higher (6±4.74) than in moderate CAP (2.58±1.8) with no significant correlation (p-value 0.071). There was a significant difference in culture on the clinical severity of CAP (p-value 0.005). A positive correlation was found between culture and clinical severity of CAP (p-value 0.004) with weak correlation strength (r=0.266). NLR is an early detection marker of infection. Stimulation of growth hormone causes an increase in neutrophil count, apoptosis acceleration, and lymphocyte redistribution; therefore, increased neutrophils are common in severe clinical conditions. The insignificant relationship between NLR and clinical severity might be caused by the therapeutic intervention given. The ATS/IDSA guidelines stated that culture results were positive in 4-15%. The mean NLR value in severe CAP was slightly higher than that of moderate CAP, but no significant difference was found. There was a weak correlation between culture results and the clinical severity of CAP patients.

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