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Background: Fms-like tyrosine kinase-3, internal tandem duplication (FLT3-ITD) mutation, is a known predictor for worse outcome in patients with acute myeloblastic leukemia (AML). However, the prognostic significance of FLT3-ITD mutation in adult, non-transplant patients is still unclear therefore we conducted a systematic review and meta-analysis to explain this issue. The main outcome was overall survival (OS), while additional outcomes included event-free survival (EFS). Methods: Seven Databases (ScienceDirect, Scopus, PubMed, Cochrane, SpringerLink, ProQuest, and EBSCOhost) were searched up to August 2020. Studies investigating the prognostic value of AML in adults with FLT3-ITD mutational status were selected. Studies which patients had received transplantation, diagnosed with acute promyelocytic leukemia (APL) or secondary AML were excluded. The selected studies were divided into subgroups based on their cytogenetic profile. Summary hazard ratios (HR) and 95% confidence intervals (CI) were calculated using fixed-effects models. Heterogeneity tests were conducted and presented in I2 value. Forest plot was presented to facilitate understanding of the results. Publication bias was analyzed by Funnel Plot test. Results: A total of ten studies describing research conducted from 1999 to 2020, met the inclusion criteria for this study. Nine studies reported OS and four studies reported EFS in HR. The highest HR for OS is 6.33 (95% CI, 2.61-15.33; p < 0.001), for EFS is 3.58 (95% CI, 1.59 – 8.05); p = 0.002)., while the lowest for OS is 1.33 (95% CI, 0.88-2.01; P = 0.174) and for EFS is 1.29 (95% CI, 0.75-2.23; p = 0.34). Nine studies were included in meta-analysis with HR for OS 1.91 (95% CI, 1.59–2.30, p < 0.00001), whereas 4 studies were included in meta-analysis for EFS with HR 1.64 (95% CI, 1.25–2.14; p = 0.0003). Conclusion: FLT3-ITD mutation is associated with worse prognosis in adult, non-transplant patients with AML, both for OS and EFS.

Background The prevalence of nonalcoholic fatty liver disease (NAFLD) is increasing. In Indonesia Hasan, I et al. (2002) reported the prevalence of 30.6%. This study evaluated the first time the profile of gut microbiota and correlation with severity of NAFLD in Indonesia. Methods We included 37 subjects age 18–60 years. The characteristic data of the patients and the food recalls were recorded. Abdominal ultrasound, liver transient elastography with controlled attenuation parameter (CAP) were performed. Next generation 16S rRNA metagenomic sequencing was conducted using stool samples. The Spearman correlation test was used to examine the correlation between specific microbial taxa with the severity of NAFLD based on fibrosis and steatosis degree. Results The subjects included 62.2% (n=23) females and 37.8% males (n=14), mean age 50 ± 7.93 years old. They were divided based on fibrosis and steatosis degree into non-significant and significant fibrosis using cut off 7 KPa, mild and moderate-severe steatosis based on cut off 270 dB/m. From all subjects, we got 73% vs 27% non-significant and significant fibrosis, 51.4% vs 48.6% mild and moderate-severe steatosis. At the phylum level, the proportion of Bacteriodetes did not change in fibrosis or steatosis group. The proportion of Proteobacteria and Firmicutes was different in fibrosis and steatosis groups. Actinobacteria unknown bifidobacteriales bifidobacteriaceae bifidobacterium Bifidobacterium adolescentis correlate positively with non significant fibrosis (r = 0.532; p=0.004). Firmicutes clostridia clostridiales lachnospiraceae unknown fusicatenibacter saccharivorans and Firmicutes clostridia clostridales ruminococcaceae unknown [clostridium] leptum correlate negatively with significant fibrosis (r = -0.695; p=0.026 vs r = -0.732; p=0.016). In the group of steatosis, we got Bacteroidetes bacteroidia bacteroidales rikenellaceae alistipes alistipes onderdonkii and Firmicutes clostridia clostridales oscillospiracea oscillospiraceao scilibacter ruminantum correlate negatively with moderate-severe steatosis (r = -0.478; p=0.045 vs r = -0.518; p=0.028); Bacteroidetes bacteroidia bacteroidales rikenellaceae alistipes alistipes putredinis correlate positively with mild steatosis (r = 0.503; p=0.028). Conclusions The abundance of microbiota in NAFLD are not significantly different based on the group of fibrosis and steatosis, especially in phylum level. But at the lower level, some specific microbiota may correlate with the degree of fibrosis and steatosis.

Pendahuluan . Respons hematologi lengkap merupakan bagian tak terpisahkan dari pencapaian target respons sitogenetik lengkap dan respons molekular mayor terapi imatinib mesylate meskipun tidak menentukan prognosis. Respons hematologi lengkap pasien LGK fase kronik di Indonesia lebih rendah daripada kasus LGK fase kronik di dunia (74% vs. 95,3%). Perbedaan ini karena 60% pasien di Indonesia mendapat hidroksiurea lebih dulu. Penelitian ini bertujuan untuk mengetahui faktor-faktor prognostik apa saja yang memengaruhi respons hematologi lengkap pasien LGK fase kronik yang mendapat imatinib mesylate di Indonesia. Metode . Penelitian dilakukan dengan desain kohort retrospektif menggunakan rekam medis pasien leukemia granulositik kronik yang datang berobat ke Klinik Teratai RSCM dan Poli Hematologi RSCM lantai 2 yang mendapat terapi imatinib mesylate sejak Januari 2004-Desember 2011. Hasil . Sebagian besar subjek penelitian laki-laki (61,5%), berumur 26-40 tahun (47,4%), lama diagnosis

Breast cancer is the most common cancer in females worldwide and also in Indonesia. Symptomatic bone marrow metastasis is an uncommon presentation of metastatic breast cancer patient. A retrospective study showed that, out of 12970 patients with breast cancer, only 0.17% had symptomatic bone marrow metastasis. Management of patients with bone marrow metastasis also creates dilemma for the clinician. Risk and benefit from treatment should be discussed and carefully considered. We describe here a case report of a 58-year-old female patient with pancytopenia, who had a history of breast cancer four years before. A PET CT Scan showed multiple vertebrae bone metastasis. Bone marrow biopsy revealed marrow infiltration of metastasis breast cancer in bone marrow. This patient received hormonal treatment, which resulted in promising results for four months. Unfortunately, the patient did not come for control regularly and died due to hepatic failure caused by liver metastasis.

Rheumatoid arthritis (RA) is an autoimmune disease which has recently been recognized to manifest as not only intraarticular but also extraarticular symptoms. Cardiovascular events, presented either subclinically or clinically, were discovered more in AR patients. Atherogenic inflammatory mediator in AR including interleukin-6 (IL-6) was thought to be one of nontraditional cardiovascular risk factor contributing to increase the endothelial dysfunction biomarker such as E-Selectin. This study was purposed to determine the correlation between inflammatory mediator and endothelial dysfunction event, especially between IL-6 and E-Selectin, in RA patient without traditional cardiovascular risk factor. A cross-sectional study was performed to 40 RA patients of Rheumatology Clinic of Cipto Mangunkusumo National General Hospital, Indonesia from September to November 2017. Measurement of the level of IL-6 and E-Selectin were performed using enzyme-linked immunosorbent assay (ELISA). Bivariate correlation analysis was performed to determine the correlation between those two biomarkers. The mean age of this study subjects was 44.9 (13.1) years and median of disease duration was 36 months. This study showed weak correlation between IL-6 and E-Selectin level, but not statistically significant.232, p=0.149). There is weak correlation between IL-6 and sE-Selectin in rheumatoid arthritis patient without traditional risk factor cardiovascular Keywords: traditional risk factor cardiovascular, E-Selectin, interleukin-6, pro inflammatory mediator, rheumatoid arthritis

Background:The mortality of Rheumatoid Arthritis (RA) is quite high, which is largely due to cardiovascular complications caused by endothelial dysfunction. One of the important inflammatory mediators that contribute to RA joints arthritis of TNF-α, also proven to play a role in endothelial dysfunction and play a role in increasing intracellular lipolysis, thus increasing circulating FFA levels.Objectives:To determine the correlation between TNF-α levels with VCAM-1 levels, correlation of TNF-α levels with FFA levels, and correlation of FFA levels with VCAM-1 levels.Methods:Cross sectional and retrospective design studies of adult RA patients treated at Cipto Mangunkusumo Hospital (RSCM), without metabolic disturbances, acute infection, cardiovascular disorders, or other autoimmune diseases. The cross-sectional data was collected from October to November 2017, while retrospective samples were collected since August 2016. TNF-α, VCAM-1, and FFA levels were assessed by serum blood test by ELISA method. Correlation analysis is done by Pearson analysis when the data distribution is normal and with Spearman analysis when the data distribution is not normal.Results:A total of 35 subjects were enrolled in the study. Most (97.1%) were women with an average age of 45.29 years, median disease duration of 48 months, and most had moderate disease activity (65.7%). No significant correlation was found between TNF-α levels and VCAM-1 levels (p = 0.677; r = +0.073). as well betwen TNF-α levels and FFA levels (p = 0.227; r = -0.21). The correlation between FFA and VCAM-1 levels showed significant correlation with negative correlation and weak correlation (p = 0.036; r = -0.355).Conclusions:(1) There was no correlation between TNF-α levels and VCAM-1 levels in RA patients; (2) There was no correlation between TNF-α levels and FFA levels in RA patients; (3) There was a negative correlation between FFA levels and VCAM-1 levels in RA patients.

Because the majority of colubrid species are considered harmless to human beings, colubrid snakebites are rarely reported. However, the venom of Rhabdophis, which is part of the Colubridae family, is procoagulant and leads to severe coagulopathy. Here, we present a case of disseminated intravascular coagulation with enhanced fibrinolysis following a Rhabdophis bite. Although coagulopathy can be treated effectively with the specific Rhabdophis antivenom, this antivenom is not widely available in Indonesia. We also found transient hypertension secondary to the colubrid venom, an unusual finding.

Background There are many factors associated with early mortality after CABG, including postoperative thrombocytopenia (Kertai, 2016). Many factors during CABG surgery, such as administration of heparin or cardio pulmonary bypass during surgery are related to thrombocyte count reduction (Hamid, Akhtar, Naqvi, & Ahsan, 2017; Arepally, 2017). However, it is possible for a post-CABG patient to suffer a significant thrombocyte reduction without reaching the thrombocytopenic state (thrombocyte count Method This is a retrospective cohort study using medical record of 263 adult patients who underwent CABG surgery in dr. Ciptomangunkusumo National Hospital on 2012-2015. Thrombocyte reduction was determined by substracting preoperative thrombocyte count from postoperative thrombocyte count. Receiver operating curve (ROC) analysis between percentage of thrombocyte reduction and 30-day mortality after surgery was done to obtain the sensitivity and specificity value of a particular degree of thrombocyte reduction. Cut off point was obtained from intersection between sensitivity and specificity value. Result Thirty-day mortality rate after CABG surgery in this study was 11.9%. Cut off point obtained from ROC analysis was 30% with area under the curve (AUC) 0.671. The sensitivity of this cut off point to predict early mortality after CABG surgery was 64.5%, while the specificity was 64.7% Conclusion Thrombocyte reduction more than or equal to 30% can be used as a predictor of 30-day mortality after CABG surgery. Figure Disclosures No relevant conflicts of interest to declare.

Pendahuluan . Pasien dengan tuberkulosis (TB) paru memiliki peningkatan risiko untuk mengalami depresi sampai 1,53 kali dari sebuah studi kohort besar. Studi – studi menemukan adanya peningkatan rasio neutrofil – limfosit (RNL) pada berbagai gangguan mood termasuk depresi, juga rasio trombosit – limfosit (RTL) terkait dengan depresi berat yang disertai dengan gejala psikotik. Penelitian ini dilakukan untuk mengetahui karakteristik gambaran darah tepi, RNL, dan RTL pada pasien TB paru yang mengalami depresi. Metode. Studi dengan desain potong lintang dilakukan terhadap 106 pasien TB paru tidak resisten obat yang berobat jalan di poliklinik paru RS Cipto Mangunkusumo, Jakarta dari bulan Agustus hingga Oktober 2018. Diagnosis depresi ditegakkan dengan wawancara menurut kriteria diagnosis dari Diagnostic and Statistical Manual of Mental Disorder- V (DSM-V) dan derajat depresi ditentukan menggunakan kuesioner Beck Depression Inventory -II (BDI-II). Pemeriksaan laboratorium dilakukan untuk mendapatkan hasil darah perifer lengkap, RNL, dan RTL. Uji statistik parametrik digunakan untuk variabel-variabel numerik dengan sebaran merata, sementara uji nonparametrik digunakan bila sebaran tidak merata. Hasil. Dari 106 pasien TB paru tidak resisten obat yang menjadi subjek penelitian, didapatkan proporsi depresi sebesar 32%. Didapatkan nilai leukosit lebih rendah pada pasien TB paru dengan depresi (p=0,024), dan juga nilai limfosit absolut yang lebih rendah pada pasien TB paru dengan depresi (p=0,004) bila dibandingkan dengan subjek tanpa depresi. Rasio neutrofil – limfosit (RNL) dan RTL tidak berhubungan signifikan secara statistik (p>0,05) dengan beratnya derajat depresi. Simpulan. Nilai hitung leukosit dan limfosit pada pasien TB paru dengan depresi lebih rendah dibandingkan pasien tanpa depresi. Nilai RNL dan RTL pada pasien depresi dengan TB paru lebih tinggi walaupun tidak signifikan secara statistik. Kata K unci : D epresi, Gambaran darah tepi, Rasio neutrofil – limfosit, Rasio trombosit – limfosit, Tuberkulosis paru Peripheral Blood Count Characteristics, Neutrophil-Lymphocyte Ratio, and Platelet-Lymphocyte Ratio Pulmonary Tuberculosis Patients with Depression Introduction . Patients with pulmonary tuberculosis (TB) had an increased risk for depression up to 1.53 times from a large cohort study. Studies have found an increase in the neutrophil - lymphocyte ratio (NLR) in various mood disorders including depression, also the value of the platelet-lymphocyte ratio (PLR) associated with major depression accompanied by psychotic symptoms. This study aimed to describe the peripheral blood characteristics, NLR, and PLR in pulmonary TB patients with depression. Method s . A cross-sectional study of 1 06 non-multidrug-resistant pulmonary TB patients was done at outpatient department of Cipto Mangunkusumo General Hospital, Jakarta from August to October 2018. The diagnosis of depression was made by interview according to Diagnostic and Statistical Manual of Mental Disorder-V (DSM-V) criteria, and severity of depression is determined using Beck Depression Inventory-II (BDI-II). The laboratory tests were done to obtain complete peripheral blood results, NLR, and TLR. Parametric test was used for numeric variables with even distribution, and nonparametric test for variables with uneven distribution . Results. From 10 6 patients with non-multidrug-resistant pulmonary TB, the proportion of depression was 3 2 %. White blood cell count (p=0.024), and absolute lymphocte count (p=0.004) is lower in depressed TB patients compared to nondepressed TB patients. There were no significant relationship between NL R and TLR and the severity of depression in depressed pulmonary TB patients (p>0.05). Conclusion. White blood cell count and absolute lymphocyte count are lower in depressed pulmonary TB patients. Meanwhile, RNL and PLR are higher in depressed pulmonary TB patients eventhough not statistically significant.

Pendahuluan. Petugas kesehatan memiliki risiko pajanan infeksi yang cukup tinggi. Hepatitis B, hepatitis C, dan human immunodeficiency virus (HIV) adalah beberapa penyakit yang dapat menular melalui pajanan cairan atau jaringan tubuh. Rumah Sakit Umum Cipto Mangunkusumo (RSCM) telah mencanangkan profilaksis pasca pajanan terhadap HIV, hepatitis B, dan hepatitis C. Penelitian ini dilakukan untuk menilai pelaksanaan profilaksis pasca pajanan terhadap HIV, hepatitis B, dan hepatitis C pada petugas kesehatan di RSCM Jakarta. Metode. Studi potong lintang dilakukan pada petugas terpajan yang terdata melalui laporan di RSCM Jakarta pada tahun 2014-2016. Data demografis dikumpulkan melalui rekam medis dan dilanjutkan dengan wawancara untuk data tambahan. Data diolah secara statistik menggunakan SPSS versi 20. Hasil. Dari 196 subjek yang melaporkan pajanan, sebagian besar merupakan perempuan (69,9%), bekerja sebagai perawat (38,3%), dan dokter (49,5%), serta mayoritas terpajan secara per kutan (93,4%). Dari seluruh laporan tersebut didapatkan 183 pajanan berisiko, dengan anti-HIV reaktif pada 19 (10,4%), HBsAg positif pada 11 (6,0%), dan anti-HCV reaktif pada 12 (6,6%) sumber pajanan. Mayoritas petugas terpajan diketahui tidak memiliki HIV, hepatitis B, dan hepatitis C. Hanya 27,5% petugas terpajan memiliki kadar anti-HBs protektif. Dari 183 pajanan berisiko, sebanyak 44,3% mendapatkan rekomendasi antiretroviral (ARV), namun hanya 49,4% petugas yang minum ARV secara lengkap (28 hari). Capaian evaluasi anti-HIV pada bulan ke-3 dan ke-6 hanya dilakukan oleh 21,3% petugas. Rekomendasi profilaksis pasca pajanan hanya diberikan kepada 20,3% laporan, dengan capaian hanya 13,5% dan 13,3% untuk vaksinasi hepatitis B dan immunoglobulin (HBIG). Evaluasi ulangan HBsAg 3 dan 6 bulan secara lengkap hanya dilakukan oleh 13,5% petugas kesehatan, mayoritas petugas (64,9%) tidak melakukan evaluasi ulang HBsAg. Dari seluruh pajanan berisiko hepatitis C, mayoritas tidak melakukan evaluasi ulang terhadap anti-HCV (69,9%). Simpulan. Pelaksanaan profilaksis pasca pajanan terhadap HIV, hepatitis B, dan hepatitis C masih rendah, terutama pada evaluasi status serologis lanjutan. Oleh karena itu, penanganan profilaksis secara komprehensif penting dilakukan termasuk peningkatan pengetahuan dan kesadaran petugas kesehatan, peninjauan kembali standar operasional prosedur, dan komunikasi yang efektif. Kata Kunci: Hepatitis B, Hepatitis C, HIV, Petugas kesehatan, Profilaksis pascapajanan Profil of Implementation of Post Exposure Prophylaxis of Hepatitis B, Hepatitis C and Human Immunodeficiency Virus to Health Care Worker in Cipto Mangunkusomo Hospital 2014-2016 Introduction. Health care workers (HCW) have a high risk of infectious substance exposure. Hepatitis B, hepatitis C, or human immunodeficiency virus (HIV) are some diseases transmitted by body fluid or body tissue. Cipto Mangunkusumo Hospital Jakarta has been implementing post-exposure prophylaxis (PEP)s towards HIV, hepatitis B, and hepatitis C. This study aimed to identify the implementation of post-exposure prophylaxis of HIV, Hepatitis B, and Hepatitis C among HCW in Cipto Mangunkusumo Hospital Jakarta. Methods. A cross-sectional study was conducted to exposed workers in Cipto Mangunkusumo Hospital Jakarta between 2014-2016 who had been recorded by report. Demographic data were collected through medical record and interview was conducted to gather additional data. Statistical analysis was conducted with SPSS 20. Results. Among 196 reports, most HCW were female (69.9%), worked as nurse (38.3%), medical doctor (49.5%), and exposed percutaneously (93.4%). There were 183 risky exposures, with 19 (10.4%) reactive anti-HIV, 11 (6.0%) positive HBsAg, and 12 (6.6%) reactive anti-HCV in source of exposure. Almost all of the HCW has no HIV, hepatitis B, nor hepatitis C at the moment of exposure. Recommendation for antiretroviral (ARV) was given to 81 HCW, but only 49.4% completed the course. Anti-HIV follow up was done only by 21.3% workers. Recommendation of PEP for hepatitis B was given to 37 HCW. But, only 13.5% and 13.3% receive hepatitis B vaccination and hepatitis B immunoglobulin, respectively. Follow-up of HBsAg and anti-HBs on 3rd and 6th months were done by 41 (31.1%), 38 (28.8%), and 2 (1.5%) workers who were recommended to receive prophylaxis. In 182 workers recommended to do the follow-up of anti-HCV, 39 (21.4%), and 37 (20.3%) workers did the follow-up on 3rd and 6th month. Majority of exposed workers were not re-evaluated for HBsAg (64.9%) and anti-HCV (69.9%). Conclusions. The implementation of post-exposure prophylaxis for HIV, Hepatitis B, and Hepatitis C was still low especially in re-evaluation serologic marker. Comprehensive management is recommended including improving knowledge of health care workers, re-evaluation of operational procedure standard, and effective communication.

Pendahuluan. Komplikasi kardiovaskular yang disebabkan oleh disfungsi endotel menjadi salah satu penyebab mortalitas yang cukup tinggi pada pasien Artritis Reumatoid (AR). Faktor Reumatoid (RF) merupakan autoantibodi yang sering dijumpai pada AR dan diduga dapat meningkatkan respon inflamasi dan disfungsi endotel. Sindroma metabolik dapat pula meningkatkan disfungsi endotel. Belum ada studi yang menilai korelasi RF dan disfungsi endotel pada pasien AR tanpa sindroma metabolik. Penelitian ini bertujuan untuk mengetahui korelasi antara kadar RF dengan kadar VCAM-1 pada pasien AR tanpa sindroma metabolik. Metode. Penelitian desain potong lintang terhadap pasien AR dewasa yang berobat di Poliklinik Reumatologi RSUPN Cipto Mangunkusumo tanpa sindroma metabolik. Pengumpulan data dilakukan sejak Februari hingga Maret 2018 dari data penelitian sebelumnya yang diambil periode Februari 2016 hingga September 2017. Kadar RF dan VCAM-1 dinilai melalui pemeriksaan serum darah dengan metode ELISA. Korelasi antarkedua variabel dibuat dengan analisis korelasi Spearman menggunakan SPSS versi 20.0. Hasil. Sebanyak 46 subjek diikutsertakan dalam penelitian ini. Sebagian besar (95,7%) subjek adalah perempuan dengan rerata usia 44,43 tahun, median lama sakit 36 bulan, dan sebagian besar memiliki derajat aktivitas sedang (52,2%). sebagian besar pasien memiliki RF positif (63%). Korelasi antara kadar RF dengan kadar VCAM-1 memiliki kekuatan korelasi yang lemah tetapi tidak bermakna secara statistik (r=0,264; p=0,076). Subjek dengan RF positif memiliki kadar VCAM-1 yang lebih tinggi (626,89 vs. 540,96 ng/mL). Simpulan. Belum didapatkan korelasi antara RF dengan VCAM-1 pada pasien Artritis Reumatoid tanpa sindroma metabolik. Kata Kunci: Artritis reumatoid, Faktor reumatoid, Sindroma metabolik, Vascular Cell Adhesion Molecule-1 Correlation between Rheumatoid Factor and Vascular Cell Adhesion Molecule-1 Levels in Rheumatoid Arthritis Patients without Metabolic Syndrome Introduction. Cardiovascular complications caused by endothelial dysfunction become one of the highest causes of mortality in patients with Rheumatoid Arthritis (RA). Rheumatoid Factor (RF) is an autoantibody that is commonly found in RA and is thought increasing the inflammatory response and endothelial dysfunction. Metabolic syndrome may also increase endothelial dysfunction. There have been no study assessing correlation between RF and endothelial dysfunction in RA patients without metabolic syndrome. Aim of this study was to determine the correlation between RF levels with VCAM-1 levels in RA patients without metabolic syndrome. Methods. Cross sectional design study of adult RA patients treated in Rheumatology Polyclinic of Cipto Mangunkusumo General Hospital without metabolic syndrome. Data collection was conducted from February to March 2018 from the previous research data taken from February 2016 to September 2017. The levels of RF and VCAM-1 were assessed through blood serum testing using the ELISA method. Correlation between the two variables was made using Spearman correlation analysis with SPSS 20.0 Results. A total of 46 subjects were included in the study. Most (95.7%) subjects were women with an average age of 44.43 years, median duration of 36 months, and most had moderate activity (52.2%). Most patients had a positive RF (63%). The correlation between RF levels and VCAM-1 levels had a weak correlation strength but was not statistically significant (r= 0.264; p= 0.076). Subjects with RF positive had higher levels of VCAM-1 (626.89 vs. 540.96 ng / mL). Conclusion. There is no correlation yet between RF and VCAM-1 in RA patient s without metabolic syndrome.

to assess the current use of anticoagulants and implementation of International Guidelines in venous thromboembolism (VTE) prophylaxis in hospitalized patients with acute medical illnesses in Jakarta, Indonesia.a multicenter, prospective, disease registry, recruiting patients diagnosed as acutely ill medical diseases and other medical conditions at risk of VTE, with in-hospital immobilization for at least 3 days.of 401 patients, 46.9% received anticoagulants which included unfractionated heparin (64.4%), fondaparinux (11.7%), enoxaparin (9.6%), warfarin (3.7%), and combination of anticoagulants (10.6%). VTE prophylaxis using physical and mechanical method was used in 81.3% of patients, either as a single modality or in combination with anticoagulants. During hospitalization, VTE were found in 3.2% patients; 10 patients (2.5%) had lower limb events and 3 patients (0.75%) had a suspected pulmonary embolism. The main reference international guidelines used were AHA/ASA 2007 (47.4%), followed by ACCP 2008 (21.7%).the study showed underutilization of prophylaxis anticoagulants in which mechanical thromboprophylaxis either alone or combination with anticoagulants was the most commonly used. Unfractionated heparin was the preferable choice. The most commonly used guideline was AHA/ASA 2007. VTE thromboprophylaxis in medically ill patients needs to be encouraged.

Aim: To assess CML patient’s characteristic including demographic, clinical and hematological characteristic of patients with CML including quantitative BCR-ABL and BCR-ABL gene sequencing. Methods: This study was an open-label, single arm, non-randomized, cross sectional study in patients with CML being treated with imatinib mesylate (IM) from 12 centers. Result: A total of 100 patients were evaluated between January 1, 2009 and December 31, 2011. The median age was 34-35 years old (mean of age is 36 years old), and more patients in the productive age was found. ------- (?) were 80 of the 100 patients who had been examined for the BCR-ABL gene mutation with the sequencing method before consuming IM. Mutation in the P-loop was seen in 2,27% (1 out of 44 patients), this finding was beyond our expectation since 47,69% (31 out of 65 patients) of our patients did not achieved CHR at three months. On the other hand, 15,9% (7 out of 44 patients) of our patients had mutation outside the P-loop. Conclusions: The characteristics of CML patients in Indonesia were not different from CML patients in Asia in general. Our finding concerning the high frequency mutation in the BCR-ABL gene outside the P-loop needs further study.

Pendahuluan. Artritis Reumatoid (AR) merupakan penyakit kronik yang membutuhkan pengobatan jangka panjang dan memengaruhi kualitas hidup penderitanya. Kuesioner SF-12 merupakan kuesioner kualitas hidup generik yang dapat digunakan untuk pasien AR dan telah diuji kesahihan dan keandalannya diInggris. Penelitian ini bertujuan untuk menguji keandalan dan kesahihan kuesioner SF-12 Berbahasa Indonesia Metode. Enam puluh lima orang pasien yang telah didiagnosis AR secara klinis sebelumnya berdasarkan kriteria ACR/EULAR, diwawancarai dengan menggunakan kuesioner SF-36 dan SF-12 versi Indonesia. Kesahihan dinilai menggunakan kesahihan konstruksi dan kesahihan eksternal dan keandalan dinilai melalui metode konsistensi internal dan tes ulang. Hasil. SF-12 berbahasa Indonesian tidak terbukti memiliki kesahihan yang baik dengan korelasi setiap pertanyaan dengan SF-36 terbukti rendah pada domain RE dan MH (P

Acquired hemophilia A merupakan kondisi dimana faktor koagulasi VIII menjadi tidak aktif akibat pembentukan autoantibodi. Kondisi ini dikaitkan dengan kehamilan, keganasan, dan penyakit auitoimun dengan kelainan kulit. Pada kasus ini, seorang wanita berusia 66 tahun, datang dengan keluhan perdarahan paska tindakan yang disertai dengan lesi kulit. Pasien didiagnosis dengan acquired hemophilia A dengan ditemukannya inhibitor faktor VIII terkait dengan pemfigoid bulosa. Kata Kunci: Acquired hemophilia A, diagnosis, pemfigoid bulosa, tata laksana Diagnosis and Treatment of Acquired Hemophilia A (AHA) with Bullous Pemphigoid Acquired hemophilia A is a condition in which coagulation factor VIII become inactive due to autoantibody formation. This condition is related to pregnancy, malignancy, and autoimmune disease with skin disorder. In this case report, a 66 years woman with a post procedural bleeding with skin disorder. Later on, patient diagnosed with acquired hemophilia A with a factor VIII inhibitors related to bullous pemphigoid. Keywords : Acquired hemophilia A, bullous pemphigoid, diagnosis, treatment

To analyze the clinical characteristics of patients with chronic phase CML and evaluate complete hematologic responses (CHR) and overall survival (OS) after treatment with Imatinib.This is a cross sectional study using retrospective medical record of patients with chromosome Philadelphia positive and/or BCR-ABL positive chronic phase CML at the polyclinic of Teratai Department of Internal Medicine Cipto Mangunkusumo National Hospital during 2003-2008. In a period of 6 years, we included 53 patients with chromosome Philadelphia positive and/or BCR-ABL positive chronic phase CML. Patients were administered Imatinib 400 mg daily and then evaluation of clinical characteristics and complete blood count + differential count were performed every 2 weeks until CHR achieved at 3 months as defined by white cells count10,000/mm3, platelet count450,000/mm3, and non palpable spleen.The median age was 37 years (16-67 years). Males were slightly more frequent than females (29 v.s. 24) with ratio of 1.2:1. Thirty three percent of patients had splenomegaly. The vast majority (60%) of patients had previous treatment with Hydroxyurea. The laboratory features were: median of hemoglobin level was 10.0 g/dL (6.3-16.6 g/dL), median of white-cell count was 13,300/uL (1900-621,000/uL), and median of platelet count was 424,000/uL (108,000-4,400,000/uL). Median of basophils was 1.6% (0%-20%) and 88% of patients had5% blasts in bone marrow.A CHR was achieved in 74% of patients and overall survival during the study was 66%. The most common adverse events were: nausea, myalgia, hypopigmentation of the skin, anemia, thrombocytopenia, and neutropenia.

Interleukin-6 (IL-6) is a multifunctional cytokine that plays a central role in host defense due to its wide range of immune and hematopoietic activities and also its potential ability to induce the acute phase response. The high concentration of IL-6 has implication in the pathology of some diseases especially in DHF/DSS patients. This cytokine play a crucial role in the enhanced production of anti-platelet or anti-endothelial cell auto antibodies local or systemic, elevated levels of tPA, as well as a deficiency in coagulation, leading to plasma leakage and bleeding. We describe the pathogenic, characteristic and mechanism of IL-6 during DV infection.