Name : Angeline Tancherla dr.

Andree Kurniawan, SpPD

NIM : 01071170034

EBM - Diagnostic Study

1. Opinion on Medical Journal

Immunoglobulin G (IgG) to IgM ratio in secondary adult dengue infection

using samples from early days of symptoms onset
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4509644/)

Dengue, which is caused by DENV (Dengue Virus) transmitted through

mosquitoe bites, has affected many countries, especially countries with tropical or
sub-tropical climate. Indonesia has been one of the countries that has a high risk
of DENV infection. According to WHO, Indonesian ranked as the 2nd highest
country where dengue is endemic. Dengue has brought many death cases to the
Indonesian people. And so, preventive measures are important. Other than to
prevent, we should also know how to diagnose in order to treat. The medical
journal of the above is really remarkable, because with the study done, people can
determine specifically if the DENV infection is primary or secondary through the
use of IgG and IgM. The result of the study is that IgG/IgM ratio of ≥1.14 is the
best cut off point to determine secondary DENV infection. The result has a
sensitivity of 80.56 % and specificity of 91.67 %, which makes it valid. And to
test the IgG and IgM ratio, ELISA (Enzyme-Linked Immunosorbent Assay) kits
would be needed. And from the study above, we know that ELISA kits are
commercially available at an affordable price. Therefore, people can distinguish
between primary and secondary DENV infections even in remote, impoverished
and endemic areas where re-infections with different serotypes are frequent. But
the IgM antibodies may only be detected on the third to seventh day after
symptoms appear. So, it is better to check the IgM when or after a person has a
constant fever for 3 days or more. Lastly, I also hope that there will be more
medical journals published, like the above, in order to help improve the health of
mankind.
2. • Diagnosis pasti keganasan tumor tiroid selama ini adalah dengan biopsi.
Namun biopsi sakit, invasif, mahal, hasilnya lama dan perlu ahli PA.
• Pertanyaan : Apakah USG dapat membedakan tumor tiroid jinak atau ganas?
• Kumpulkan 100 pasien dengan tumor tiroid
• Lakukan USG pada ke-100 pasien, hasilnya : positif (ganas) atau negatif
(jinak)
• Lakukan biopsi/PA pada ke-100 pasien, hasilnya juga positif (ganas) atau
negatif (jinak)

Baku Emas (Biopsi-PA)

GANAS JINAK TOTAL

GANAS 40 10 50

USG JINAK 5 45 50

TOTAL 45 55 100

Ø Sensitivity : 40/45 x 100% = 88.89%

Ø Specificity : 45/55 x 100% = 81.82%

Ø Positive predictive value : 40/50 x 100% = 80%

Ø Negative predictive value : 45/50 x 100% = 90%

Ø Conclusion : The sensitivity and specificity are all above 80%, and that makes
the result valid. So, USG can be used as a valid alternative to determine if the
tumor is malignant or not.