KONTROL MUTU PEWARNAAN HISTOKIMIA DAN IMUNOHISTOKIMIA

Pewarnaan sediaan histologi dibagi menjadi pewarnaan umum atau rutin menggunakan hematoksilin eosin dan pewarnaan khusus yaitu histokimia dan imunohistokimia. Kontrol diperlukan untuk mengkonfirmasi bahwa hasil pewarnaan benar, akurat, dan bisa dipercaya. Pewarnaan rutin biasanya tidak memerlukan kontrol. Pewarnaan khusus memerlukan kontrol baik kontrol jaringan maupun kontrol reagen. Pewarnaan histokimia membutuhkan kontrol positif saja, sedangkan pewarnaan imunohistokimia minimal dua kontrol yaitu kontrol positif dan kontrol negatif.

THE RELATIONSHIP OF CERVICAL VERTEBRAL MATURATION (CVM) STAGE AND ANTEROPOSTERIOR FACIAL DIMENSIONS IN INDONESIAN POPULATION

Background: Growth and development are two different but interrelated and difficult to separate factors. The growth spurt in boys is different from girls. Facial growth is closely related to overall body growth, one of which is the growth of the cervical vertebrae. Objective: The objective of this study was to determine the anteroposterior dimensions of the face based on the maturation levels of cervical vertebrae in 12-14 years old children. Method: Quantitative research using an analytic observational method with a cross-sectional approach was conducted on 21 boys and 21 girls. Measurement of anteroposterior facial length (S-A' and PTM-A) and assessment of cervical vertebral bone maturation level using the Hassel and Farman method. Results: Independent t-test results showed that there was a significant difference (p <0.05) in facial length (S-A') between male and female subjects at all maturation levels of cervical vertebrae. There was a significant difference (p <0.05) in facial length (S-A') based on the maturation level of the cervical vertebrae (CVMS) in male subjects. Independent t-test results showed that there was a significant difference in facial length (PTM-A) based on the maturation level of cervical vertebrae in female subjects (p <0.05). Conclusion: There was a difference in facial length (S-A ') between male and female subjects at all maturation levels of the cervical vertebrae. There is a difference in facial length (S-A') based on the maturation level of the cervical vertebrae (CVMS) in male subjects. There are differences in anteroposterior facial length (PTM-A) based on the maturation level of the cervical vertebrae in female subjects. There is a relationship between the maturation level of the cervical vertebrae with the anteroposterior dimensions of the face S-A' and PTM-A in male subjects.

CIPLUKAN (PHYSALIS ANGULATA LINN.) EXTRACT AS A NATURAL ADJUVANT REMEDIES FOR SCLERODERMA

Scleroderma or systemic sclerosis is a rare connective tissue autoimmune disorder.1 Its prevalence in Indonesia is not well recorded but scleroderma is listed as the third most common disease in rheumatology outpatient clinic in Hasan Sadikin Hospital, Bandung, West Java, Indonesia.2,3 Scleroderma is characterized by skin fibrosis, small vessel vasculopathy, and immune system abnormality. The cutaneous lesion of scleroderma is presenting with excessive collagen type-1 production and deposition, as well as exaggerated inflammatory process. There is no specific diagnosis test is available, but in most cases, there are some laboratory findings which support the diagnosis of scleroderma, such as elevated erythrocyte sedimentation rate (ESR), B lymphocyte stimulator (BAFF), C-Reactive Protein (CRP), Soluble Cd40 Ligand (sCD40L), and Procollagen Type-1 N-Terminal Propeptide (P1NP).3-6 The treatment of this autoimmune disease remains a challenge for clinicians. The current treatment for scleroderma is expensive and some side effects as well as drug resistance are reported. Some new medicines are still under research, not accessible, and too expensive for most Indonesian communities. Hence, new therapeutic options are constantly sought.7 Ciplukan herb (Physalis angulate Linn) is a medicinal plant which grows in Indonesia. It has been known for its efficacy and safety as long-term anti-inflammatory, anti-proliferative, and anti-angiogenesis agent.7 Dewi et al conducted a double –blind, randomized clinical trial using ciplukan herb extract as an adjuvant treatment for scleroderma. The clinical trial was performed in Jakarta and Bandung, Indonesia for 2 years. There are 59 scleroderma patients, age 15-60 years old, had stable treatment for at least 3 months, who randomly divided into treatment group (29 people) and control group (30 people). The treatment group received 250 mg ciplukan herb extract three times a day and the control group received 250 mg amylum three times a day for 12 weeks. A 35,9% skin thickness reduction was found in treatment group. It is greater than control group which only gained 6,3% reduction (p<0,001). Skin thickness was rated using Modified Rodnan Skin Score (MRSS) and there was 6 points MRSS reduction in the first three months. P1NP level also diminished 17,8% in treatment group compare with 0,7% in control group (p=0,002).7 Ciplukan herb extract shows synergic effect as anti-fibrotic in the skin of scleroderma patients through its efficacy as antioxidant, anti-inflammatory, anti-proliferative agent. Ciplukan herb contains phenolic compound such as flavonoid, tannin, phenylpropane, and other phenols which has immunomodulator activity. The phenol derivates can inhibit oxidative stress and reduce inflammation which take a major role in the pathogenesis of scleroderma. The antioxidant property of phenols protects lymphocytes from reactive oxygen molecule. Sitosterol contained ciplukan herbs also shows strong anti-inflammatory property.7 The research was the first clinical trial in the world which investigate the effect of ciplukan herb extract as the adjuvant treatment for scleroderma. There is not any correlation between MRSS and ESR, BAFF, CD40L serum level in both group despite their role as inflammatory markers. Further research is needed using other inflammatory markers to prove the anti-inflammation effect of ciplukan herbs.

CHEST IMAGING FOR EARLY DIAGNOSIS OF COVID-19 ON A PATIENT WITHOUT RESPIRATORY SYMPTOMS: A CASE REPORT

Background: The Coronavirus 2019 disease (COVID-19) is transmitted through droplet and aerosol from the respiratory tract of an infected person; and fomites from infected linen and surface. On August 1, 2020, in Yogyakarta, there were 741 confirmed positive cases of COVID-19, and it is still possible to increase. In the time of understanding COVID-19, there are many cases with atypical presentation, including gastrointestinal symptoms. Objective: To describe a COVID-19 case without respiratory symptoms and the role of radiology in detecting COVID-19. Case Description: A 55-year-old male patient came to the hospital complaining of nausea and loss of appetite. Based on the results of the physical examination, there was flatulence. Initial investigations revealed a non-reactive SARS CoV 2 IgG and IgM result. Further non-contrast MSCT Thorax showed infiltrates with bilateral sub-pleural posterolateral consolidation, particularly the left, showing typical pneumonia. Multiple blebs were also found, denoting bronchiectasis. Confirmatory RT-PCR result was positive for SARS CoV 2. Conclusion: COVID-19 usually presents with common respiratory symptoms. However, some patients also experience gastrointestinal symptoms that initially were not detected as COVID-19. In time of COVID-19 pandemic, persistent gastrointestinal symptoms in a high-risk patients warrant further chest imaging and RT-PCR of SARS CoV-2 to detect or exclude the possibility of COVID-19 diagnosis.

EATING HABITS OF OVERWEIGHT CHILDREN AT SEKOLAH DASAR BUDYA WACANA, YOGYAKARTA

Background: Childhood obesity is related to chronic diseases in the future, which could be prevented through changes in eating habit. Strategy in eating behaviour needs an in-depth understanding on contributing factors to unhealthy eating habits in school-age children. Meanwhile, evidence on those factors, especially related increased calorie intake, is still scarce in Indonesia. Objective: This study is aimed to explore the eating habit of primary school students with obesity in a private school in Yogyakarta. Method: A qualitative interview involving parents of obese children was performed at Sekolah Dasar Budya Wacana in January 2020. The transcripts were analysed using a thematic approach to acquire major themes related to the cause of unhealthy eating habits. Results: From 11 parents, there are two major themes developed, which are unhealthy eating habits and parental influences. There are two unhealthy eating habits discovered in this study, which are irregular mealtime and unhealthy food choices. Parental influence which commonly found in children with obesity is permissive parenting style. Conclusion: This study found similar result with previous studies on unhealthy food choices. However, irregular mealtime in this study is not consistent with other literatures which shows a lack of association with childhood obesity, hence need further research to explore the relationship. Permissive parenting style, which commonly found in younger population also play an important role in children unhealthy food choice. This study revealed that health behaviour change strategy in obese children should consider focussing on healthy food preferences with support from parents and family.

APPROPRIATE LABORATORY AND IMAGING APPROACH FOR EARLY DIAGNOSIS IN HOSPITAL SETTING

The main objective of global health is to reduce preventable death equally throughout the world. One important strategy is primary prevention through health promotion and early detection. Early diagnosis is defined as several methods to determine in patients the nature of a disease or disorder at its early stage of progression. In a referral health system, such as Indonesia, early diagnosis could be implemented both in primary care and secondary or tertiary referral hospital. Primary care centres screens fatal diseases, such as cancer and cardiovascular risk factors, mostly in asymptomatic patients with identified risk of having the diseases. Accordingly, the early detection programme has been designed for large population in a community setting. It is uncommon for hospitals in Indonesia applying primary prevention where most of the patients are referred with at least a couple of differential diagnoses. Subsequently, early diagnosis in hospital setting would be defined either as accelerating the diagnosis confirmation or detecting any uncommon findings on patients with atypical presentation. In some situation, early detection of life-threatening condition at hospital would prolong or even prevent death. Aside from accurate history taking and comprehensive physical examination, advance laboratory procedure and imaging might assist in early detection at hospital setting. This time, our issue presents case reports on the benefit of early detection in the management of rare disease, anaemia, and COVID-19 pandemic among patients without symptoms or with atypical presentation. In developed countries, most of known congenital diseases were screened prenatally or immediately after delivery. The most common practice in Indonesia is a regular prenatal ultrasound and through physical examination of the baby in their first week. However, this approach would still miss many rare diseases with delayed presentation such as Legg-Calve-Perthes Diseases (LCPD). Pradyana and Astuti1 discussed a paediatric case of LCPD highlighting the difficulty in diagnosis confirmation on a limp gait symptom. Serial imaging not only important in case follow-up, but also to detect newly existing abnormalities which verify the presence of LCPD. Iron deficiency anaemia (IDA) primarily affects women and children in Indonesia. Currently, school-based screening of haemoglobin in teenage girls could prevent the sequalae of IDA through iron supplementation. Early detection in anaemia would determine the presence of IDA before the declined haemoglobin. Recently, international investigators discovered novel biomarker to detect the presence of IDA in asymptomatic patients. Fenty described the potential of using reticulocyte haemoglobin equivalent (Ret-He) to characterize IDA amongst asymptomatic patients in hospital settings.2 This approach would be beneficial for screening purpose in high-risk population, both in community and hospital setting. During COVID-19 pandemic, early diagnosis is a necessity to reduce the infection rate with early quarantine. However, challenging situation might come in patients with atypical presentation, such as gastritis. Widiastana et al describe the later COVID positive result on patients with gastritis which nonresponsive to general treatment.2 The patients did not have any classical signs and symptoms of COVID-19, hence in the community, misdiagnosis of similar condition might exacerbate the rising infection cases.

THE POTENTIAL OF RETICULOCYTE HAEMOGLOBIN EQUIVALENT (RET-HE) IN IRON DEFICIENCY ANAEMIA SCREENING AT BETHESDA HOSPITAL, YOGYAKARTA

Background: Traditionally, iron deficiency anaemia (IDA) is diagnosed with iron and ferritin status. Ret-He measurement is a promising parameter to detect iron depletion in earlier stages. Previous studies recommended Ret-He examination as IDA screening. Objective: Compare the Ret-He level and iron status of patients with and without IDA at Bethesda Hospital, Yogyakarta. Method: This is a cross-sectional study using laboratory record of haematological examination at Bethesda Hospital from march to August 2019. Erythrocyte indices, iron status and Ret-He measurement was further examined between IDA and non-IDA group by ANOVA, t-test or non-parametric tests. Results: There were 105 samples, where 22 (20.95%) had complete result of Ret-He and iron status, and 10 (45.45%) diagnosed with IDA. The Ret-He level in IDA group is significantly lower than non-IDA group (17.53 ± 2.43 vs 31.50 ± 4.03, p < 0.001). Conclusion: Ret-He level is lower in IDA group, consistent with other biochemical parameters (Serum iron, Serum ferritin, TIBC, and TSAT). This finding might lead to future research on the potential of Ret-He for early detection of IDA in high-risk populations.

SERIAL IMAGING OF A CHILD WITH LEGG-CALVE-PERTHES DISEASE AT BETHESDA HOSPITAL, YOGYAKARTA: A CASE REPORT

Background: Legg-Calve-Perthes disease (LCPD) is a rare condition of idiopathic avascular necrosis of the femoral head, mostly affects children under fifteen old. Most cases only affect one femoral head; bilateral involvement only occurs in about 15% of cases. Early diagnosis and prompt intervention play an important role in the prognosis to prevent degenerative damage on the bones and joints. Objective: To describe a case of Legg-Calve-Perthes disease in a 9-year-old boy in Bethesda Hospital, Yogyakarta. Case Description: A 9-year-old boy came with one month history of worsening pelvic pain to Bethesda Hospital, Yogyakarta. He also showed limping and limited mobility. Initial imaging studies did not find any abnormalities. Further follow-up with MSCT scan related to the complaint of persistent pain showed defects of left hip joint indicating Legg-Calve-Perthes disease. The patient undergone skin traction treatment which shows modest improvement on serial radiographic examinations during hospital admission. Conclusion: The rarity of LCPD warrant thorough imaging studies on children with unexplainable severe hip joint pain. Treatment should be initiated as early as possible after diagnosis to prevent further bone damage and worsening prognosis. Conservative management with skin traction would benefit the patient in restoring normal anatomy and optimal joint congruence to prevent degenerative damage to the joints.

THE EFFECT OF A TRIPOD CANE ON THE FUNCTIONAL MOBILITY OF PATIENTS WITH KNEE OSTEOARTHRITIS

Background: Canes have been recommended as walking aids for knee osteoarthritis to reduce the loading on the affected knee. Patients are usually recommended to hold the cane in the contralateral hand to the affected knee. Nevertheless, some patients prefer to hold the cane ipsilateral to the affected knee. However, the effect of using ipsilateral or contralateral tripod cane on functional mobility in patients with knee osteoarthritis is still unknown Objective: To compare the immediate effect of ipsilateral and contralateral tripod cane usage on functional mobility in patients with symptomatic knee osteoarthritis Method: This cross-sectional study involved 30 overweight or obese patients with symptomatic unilateral or bilateral knee osteoarthritis (Kellgren Lawrence grade 2 and 3) who never use a cane. Functional mobility was evaluated with Time Up and Go test in three conditions; without walking aid, with tripod cane contralateral and ipsilateral to the more painful knee. Results: The TUG time of aid-free walking is 4.75 (p < 0.001, 95% CI 3.79 - 5.71) seconds faster than ipsilateral cane use and 6.69 (p < 0.001, 95%CI 5.35 - 8.03) seconds faster than contralateral cane use. The TUG time of ipsilateral cane use is 1,94 (95% CI, 1.13 - 2.79) seconds faster than contralateral. Conclusion: Patients with symptomatic knee OA who use tripod cane ipsilateral to the more painful knee have higher functional mobility than the contralateral.

OPTIMAL CONDITION FOR MULTIPLEX POLYMERASE CHAIN REACTION (PCR) IN DETECTING ASCARIS LUMBRICOIDES, TRICHURIS TRICHIURA, AND NECATOR AMERICANUS IN PRESERVED STOOL

Background: Multiplex PCR examination is one of the molecular examination methodologies applied to detect soil-transmitted helminth (STH) infection. Optimization of the multiplex PCR method is a complex process, but it is necessary to obtain both a correct detection process and a satisfactory DNA product. Objective: To determine whether multiplex PCR can be optimized to diagnose STH from Indonesian isolates, and to find the optimal method for detection of A. lumbricoides, T. trichiura, and N. americanus infections in stool that have been stored for 3 years. Methods: A total of 15 samples were examined, and these samples were previously examined by using a microscopic method, then continued with optimization steps. Result: The optimal PCR mixture used primers targeting COI gene for A. lumbricoides, 18S rDNA for T. trichiura and ITS1 for N. americanus, 15 µl of Go Taq Green Master Mix, 5 µl of the 3 pairs of primers, 5 µl of DNA template and 4 µl of DdH2O, and the condition was 30 minutes of 950C denaturation, 30 second of 530C annealing and 1 minute of 720C extension, repeated for 35 cycles. Conclusion: Multiplex PCR can be optimized for STH detection from Indonesian isolates. The successful detection using the multiplex PCR method was influenced by sample preparation prior to DNA isolation, which includes several steps i.e. homogenization of samples using bead beaters and passing samples on liquid nitrogen rapidly.