Correlation of Nitrite Oxide with Severity and Survival Rate of Sepsis Patients

The objective of this research was to determine the correlation between Nitric Oxide (NO) levels with the severity ofsepsis, to describe the kinetics of NO levels, and to evaluate it in predicting mortality. This research was a longitudinal cohortobservational analytical study. The variables were serum NO levels and SOFA scores, which were serially evaluated. Thecorrelation test and difference test were used for statistical analysis. The survivor and the non-survivor group consisted of 14(41.18%) and 20 (58.82%) patients, respectively. There was a correlation between serum NO levels and the SOFA score at the24-hour observation (r=0.403; p=0.041). Non-parametric Mann-Whitney test showed that there was no kinetics of NOth levels at 0, 24, 72, and 144-hour observation (p-values =0.897 and 0.703, respectively). NO levels > 111,16 μmol/L at the 24hour could predict the risk of death with hazard ratio 4.7 compared to NO levels < 111,16 μmol/L. The survival rate ofpatients with serum NO levels <111,16 μmol/L and > 111,16 μmol/L was 83.3% and 37.5%, respectively. There was acorrelation between serum NO levels and SOFA scores at the 24-hour observation. However, there was no kinetics of NOlevels at serial evaluations. Nitric oxide levels with a cut-off of 111,16 μmol/L at 24 hours could predict the survival of septicth patients. Utilization of serum NO level at 24 hour can be used to evaluate the severity of septic patients and aggressivemanagement if there is an increase in serum NO levels > 111,16 μmol/L at 24 hours.

Selection of Hormonal Reference Values for Undescended Testicle Case in 8-Year-Old Boy with Abnormal Chromosome

Establishing the diagnosis of undescended testicles requires appropriate hormonal laboratory reference values basedon age and gender. An 8-year-old boy with an undescended testicle, mental retardation, and stunting had a blood test thatwas carried out at the Clinical Pathology Laboratory, dr. Cipto Mangunkusumo (RSCM) Hospital on February 6, 2020, withtestosterone levels of 0.69 nmol/L (N male: 4.94-32.01 nmol/L) indicating decreased testosterone levels. The patient wasconsulted from urological surgery to pediatric endocrinology to determine the presence or rudiment of the patient'stesticles. Using the reference range of testosterone values assists clinicians in determining the diagnosis, monitoringtherapy, and prognosis of a disease. There are some testosterone reference values, which are currently available, includingCanadian Laboratory Initiative on Pediatric Reference Intervals Database (CALIPER) and the Tanner stage reference value.Later is more applicable because it is based on chronological age and secondary sexual development in assessing pubertydevelopment. A case of an 8-year-old boy with a clinical diagnosis of an undescended testicle, the laboratory test resultsshowed normal-low testosterone levels using the CALIPER and Tanner stage ranges according to the patient's age. Noincrease of testosterone levels after the second HCG stimulation test might be due to differences in the HCG administrationprotocol; therefore, the diagnosis of anorchia had not been established, and chromosome abnormalities of 46 XY, +6 Mar,17 dmin on chromosome analysis suggested the suspected syndrome. These findings were consistent with the suspicion ofprimary hypogonadism in children with suspected syndrome caused by bilateral cryptorchidism with a suspectedseminiferous tubular defect.

Comparison of Blood Gas Analysis on Hemodialysis in Patients with Chronic Kidney Diseases

Chronic Kidney Disease (CKD) is defined as a renal failure that has lasted for more than three months. Hemodialysis is thetype of kidney replacement therapy that is mostly used, and blood gas analysis can be used to identify this condition. Thisstudy is to compare the blood gas analysis on pre-and post-dialysis in patients with CKD using pH, PaCO , PaO , HCO , SO , 2 2 3 2and BE as markers of improvement in the patients'condition. The population was all patients diagnosed with CKD andhemodialysis at Wahidin Sudirohusodo Hospital, and eligible according to the criteria in this study. The sample size wasdetermined using Federer's calculation, and the statistical analysis using paired T-test and Wilcoxon signed-rank test withα=0.05. Subjects were 34 patients, consisting of 18 females (52.9%) and 16 males (47.1%). Hemodialysis had the mostsignificant impact on the PaO and SaO variables. Relation between PaO and SaO was illustrated in a sigmoid curve. 2 2 2 2Oxygen-bound hemoglobin increased after the first molecule was bound. An almost full PaO pressure will cause a slight 2increase in SaO . Whereas at <90% saturation, a slight decrease in PaO will cause a large decrease in SaO . PaO and SaO 2 2 2 2 2determine cardiac efficiency and the markers for assessing the metabolic conditions of the lungs and heart that correlatewith oxygen. Chronic kidney disease patients experienced improved conditions after undergoing hemodialysis withincreased blood gas values, especially in PaO and SaO .

D-Dimer Analysis in COVID-19 Patients

The COVID-19 incidence is increasing around the world. Some countries are experiencing worsening conditions, evendeaths. One coagulation marker that noticeably increases in COVID-19 patients is D-dimer. This study aimed to analyzeD-dimer levels of COVID-19 patients. Retrospective study using medical records of 84 COVID-19 patients, conducted fromApril to August 2020 at UNHAS Hospital. Patients were grouped based on the severity of the disease as non-severe andsevere. D-dimer levels were measured using the Alere Triage® D-dimer with the fluorescent immunoassay method. Thestatistical test used was Mann-Whitney, D-dimer prognostic levels were calculated with ROC analysis to get the cut-off.Significant if the p < of 0.05. The sample consisted of 74 non-severe and ten severe COVID-19 patients, mostly in the 30-39age group. D-dimer levels in non-severe (0.31±0.38 μg/L) significantly differ from severe group (3.09±2.56 μg/L) (p<0.001).The Receiver Operating Characteristics (ROC) curve showed D-dimer sensitivity and specificity of 90.0% and 89.2%,respectively at the ≥ 0.80 μg/L cut-off, Negative Predictive Value (NPV) of 98.5%, and Positive Predictive Value (PPV) of52.9%. D-dimer levels increased in severe COVID-19 patients due to an increased inflammatory response resulting inexcessive thrombin. The ROC D-dimer curve indicated a cut-off rate of 0.80 μg/L, providing optimal sensitivity andspecificity. D-dimer has a significant difference in non-severe and severe COVID-19 patients and shows good value todetermine the severity of COVID-19 disease with a cut-off value ≥ 0.80 μg /L.

Correlation between Very Low-Density Lipoprotein and Trygliseride with Glycated Hemoglobin Levels in Type 2 Diabetes Mellitus Patients

Patients with Type 2 Diabetes Mellitus (T2DM) have an increased prevalence of dyslipidemia, which contributes to ahigher risk of dyslipidemia- related complications in T2DM such as cardiovascular disease and stroke. This study aimed todetermine the correlation between TG and VLDL-C towards HbA1c levels in a person with T2DM. A retrospective study of 74outpatients with T2DM at Sanglah General Hospital, Denpasar, who examined serum HbA1c and lipid profiles were tracedfor serum TG. From the obtained TG profile, a secondary calculation of VLDL was carried out using the Friedewald equation(TG/5). A correlation test was used to determine the relationship between TG and VLDL-C towards HbA1c levels. Serum TG(212.95±147.46 mg/dL) and VLDL (36.69±23.54 mg/dL) were found to be higher in the group with poor glycemic control(HbA1c > 7 mg/dL) compared to serum TG (111.00±39.56 mg/dL) and VLDL (21.05±6.13 mg/dL) in the group with goodglycemic control (HbA1c ≤ 7 mg/dL) (p < 0.05). A positive correlation between serum TG (r=0.512; p < 0.001) and VLDL(r=0.18; p <0.001) towards HbA1c levels in T2DM patient was found. Insulin resistance increases the production of VLDL andApoC-III in the liver and increased chylomicron absorption in the gastrointestinal tract, causing prolonged postprandiallipemia and disruption of VLDL and TG clearance, thereby resulting in increased TG and VLDL in circulation. There is asignificant positive correlation between serum TG and VLDL towards HbA1c levels in a patient with T2DM.

Neutrophil-Lymphocyte Ratio and Procalcitonin as Predictors of the Severity of Acute Pancreatitis

The Neutrophil-Lymphocyte Ratio (NLR) and procalcitonin are used to indicate systemic inflammation in variousmedical disorders. Both parameters were determined in this study to predict the severity of acute pancreatitis. This studywas a cross-sectional study using a retrospective approach to patients diagnosed with acute pancreatitis by using medicalrecord data from patients at Dr. Wahidin Sudirohusoso Hospital, Makassar, from January 2014 to May 2019. This studycomprised 35 patients hospitalized with acute pancreatitis, with a similar proportion of males and females. This studydiscovered that the mean age in this study was 44.17±12.9 years. The most prevalent cause was Gallstones (77.1%), themost severe degree was mild (54.2%), and the highest outcome was survival (77.1%). The NLR (9.93±11.19, p=0.011)increased in proportion to severity. However, additional analysis based on classification of disease severity revealed thatonly mild-severe NLR was significant (p=0.005). Procalcitonin (8.13±11.25, p=0.001) increased along with the increaseddisease severity, and the subsequent analysis showed that the distribution of severity was similar. The NLR can predict theseverity of acute pancreatitis but is less effective than procalcitonin. This study required a more proportional subjectpopulation and consideration of other factors.

Determining Acute Leukemia Lineage Using Mie Map Red Blood Cell

The determination of myeloid and lymphoid lineage is essential for the diagnosis and therapy of acute leukemia. Immunophenotyping is the gold standard to determine the lineage of acute leukemia, but it is still constrained and relatively expensive. Mie Map RBC in the ADVIA 2120i is a parameter that can give additional information about myeloid and lymphoid lineage but has never been studied before. It is expected that Mie Map RBC can be used to differentiate the lineage of acute myeloid and lymphoid leukemia if immunophenotyping is not present. This study aimed to analyze the diagnostic value of Mie Map RBC with ADVIA 2120i towards immunophenotyping in determining myeloid and lymphoid lineage in acute leukemia. Child and adult patients diagnosed with acute leukemia (n=30) that had peripheral blood smear and bone marrow aspiration with blasts > 20% were examined using ADVIA 2120i. The Mie Map RBC lineage results were compared to the lineage of immunophenotyping. The sensitivity and specificity of the Mie Map RBC myeloid series are respectively 60.00%, 93.33%. The sensitivity and specificity of the Mie Map RBC lymphoid series are respectively 93.33% and 60.00%. The diagnostic accuracy value of Mie Map RBC is 76.67%. The determination of acute leukemia myeloid series lineage has high specificity. If there is no population outside the matrix of Mie Map RBC, it highly suggests myeloid series. On the other hand, the determination of acute leukemia lymphoid series lineage has a relatively low specificity meaning that the population outside the matrix of Mie Map RBC does not always suggest a lymphoid lineage

Correlation between Platelet to Lymphocyte Ratio with C-Reactive Protein in COVID-19 Patients

Coronavirus 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Inflammation occurs when the body is infected with the virus. Platelets play a role in immune response and immunomodulation by activating P-Selectin Glycoprotein (PSGL) to the site of inflammation. Lymphocytes play a role through CD4 T-cells, B-cells producing specific viral antibodies, and CD8 cytotoxic T-cells by directly killing the virus in infected cells. This study aimed to prove the correlation between PLR and CRP as inflammation markers in COVID-19 patients. This study was a retrospective observational study with the cross-sectional approach at Dr. Kariadi Hospital, Semarang, for the period March-August 2020. Spearman test performed for analyzing data with p<0.05 was significant. Thirty-three confirmed COVID-19 patients with median value of PLR 218 (103-1609) and CRP 15.94 (1.24-200) mg/L were tested for correlation with a value of p=0.013 and r=0.427. The increase of PLR and CRP in COVID-19 patients was caused by an inflammatory process mediated by the immune response. High values in the blood were associated with disease severity and poor prognosis. There was a statistically significant moderate positive correlation between PLR and CRP in COVID-19 patients.

Analysis of Blood Availability During the COVID-19 Pandemic Period in Blood Bank Dr. Wahidin Sudirohusodo Hospital

Blood Bank's challenge during the COVID-19 era is securing and protecting blood supplies even though countries aretaking precautionary measures with social distancing to prevent or reduce the number of infections caused by COVID-19.This study aimed to compare blood availability before and during the COVID-19 pandemic at the blood bank of Dr. WahidinSudirohusodo Hospital. A Descriptive-analytic study with an observational approach using the Shapiro-Wilk test todetermine the normality of the sample and the paired T-test. Sample data was taken between March-August 2019 andMarch-August 2020. A significant difference was found in blood demand (p-value=0.004), amount of blood transfusion(p-value=0.006), stock and reference report (p-value=0.005), blood service report (p-value=0.005), cito waiting time(p-value=0.002) and regular waiting time (p-value=0.016). There was no significant difference in blood indicator Packed RedCell (PRC) (p-value=0.119). The Large-Scale Social Restriction Policy (PSBB) and reduction of elective surgery in hospitalsaffect the fulfillment of Blood Bank and faster attendance time of blood during the pandemic. The decrease in a number ofblood demands during the COVID-19 pandemic affected the number of blood transfusions, blood service reports, stocks,referrals, and cito and regular waiting time services.