R. Chauhan et Reumatol Clin.

18 (2022) 15–19
al.

CRITICAL UDARA dr. ESNAWAN ANTARIKSA

APPRAISAL PERIODE 10 APRIL – 17 JUNI 202

Cushing’s disease pathobiology, FAKUL

diagnosis, and management. TAS
KEDOK
TERAN

UNIVER
SITAS
Pembimbing: KRISTE
dr. Mayorita, Sp.PD N
KRIDA
Penguji:
dr.Suryantini Singgih, Sp.PD WACAN
A
Disusun Oleh:
Sapto
112022033

KEPANITERAAN KLINIK ILMU

PENYAKIT DALAM
FAKULTAS KEDOKTERAN
UNIVERSITAS KRISTEN KRIDA
WACANA
RUMAH SAKIT ANGKATAN

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R. Chauhan et Reumatol Clin. 18 (2022) 15–19
al.

LEM
Nama dan Nim Sapto 112022033

Tanggal 24 april 2023

Judul Critical Appraisal Cushing’s disease pathobiology, diagnosis, and
management
Aspek yang Dinilai Skor
1 2 3 4 5
Kemampuan Analisi
Penguasaan Teori
Referensi
Bentuk Referat Tertulis
Cara Penyajian
Total

Nilai% = (Total/25) x 100%

Keterangan : 1 = sangat kurang (20%), 2 = kurang (40%), 3 = sedang (60%), 4 = baik (80%),
dan 5 =sangat baik (100%)
Komentar Penilai

Nama Penilai Paraf

(dr. Suryantini Singgih, Sp.PD)

BAR
PENILAIA
N

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R. Chauhan et Reumatol Clin. 18 (2022) 15–19
al.

Fig. 1. Summary of immunoassays in total patients (n = 1289).

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R. Chauhan et Reumatol Clin. 18 (2022) 15–19
al.

Ethical approval
chest involvement was observed in most of the diseases.
Table 2 indicates the involvement of different organsRes
Patient consent was obtained for diagnosis and treatment Therapy. 2012;14:210.
at the hospital. This was an observational study; no personal
identi- fiers like name, addresses were used and no additional
sample was drawn for this study. All investigation, treatment,
and monitoring were according to the current ‘standard-of-
care’.

Results

The incidence of serum ANCA and specific autoantibodies

Upon IIF investigation, ANCA was detected in 13.0% (168

out of 1289) at 1:20 dilution, of which 23.8% (40/168), 25.0%
(42/168, and 47.6% (80/168) were positive with P-ANCA, C-
ANCA and atypical pattern respectively. Atypical ANCA with
granulocytes specific ANA was observed in 3.6% (6/168) cases
(Fig. 1). On evaluation with a line immunoassay, 6.7%
(86/1289) were positive out of which 52.3% (45/86), 41.9%
(36/86), 8.8% (6/86) were positive for anti-MPO, anti- PR3, and
anti-GBM respectively.

Association of ANCA patterns with specific autoantibodies

The association of a specific autoantibody with specific

immunofluorescence (IIF) pattern was observed. Out of 40 P-
ANCA positive cases, 92.5% (37/40) were positive for anti-
MPO and 5.0% (2/40) were positive for anti-PR3. Among 42 C-
ANCA cases, 76.2% (32/42) and 16.7% (7/42) were positive for
anti-PR3 and anti-MPO respectively (Fig. 1). Images of various
ANCA IIF patterns are shown in Fig. 2.
Incidentally, while studying the association of IIF patterns
and specific autoantibodies, we found the distribution of anti-
MPO and anti-PR3 in AAV (shown in Table 1). Anti-MPO
antibody was predominant in 87.5% (7/8) of EGPA and 91.3%
(21/23) cases of MPA/RLV. The anti-PR3 antibody was
predominant in 87.5% (28/32) cases of GPA.

Clinical features of IIFT positive samples

Out of 168 IIF positive samples 8, 32, and 23 cases were

observed as EGPA, GPA, and MPA/RLV respectively. Six cases of
rapidly pro- gressive glomerulonephritis (RPGN) were identified
as positive for GBM. 105 cases remained unclassifiable. A
comparison of demo- graphics among AAV diseases were
shown in Table 1. Kidney and