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"Latar belakang. Pada tahun 2015, prevalensi perokok di indonesia mencapai 76% pada populasi laki-laki dan 3,6% pada populasi perempuan. Prevalensi merokok yang tinggi dapat berdampak pada penyebaran infeksi. Metode Penelitian. Pengambilan data dilakukan di RSUP Persahabatan menggunakan metode potong-lintang pada populasi pasien TB paru dan memiliki hasil uji BTA positif, yang datang ke poli pada bulan Oktober-November 2018. Hasil. Sebanyak 129 subjek merupakan TB paru dengan hasil BTA positif. Diantaranya, 70 (54,4%) subjek bukan perokok, 29 (22,5%) perokok ringan, 20 (15,5%) perokok sedang, dan 10 (7,8%) perokok berat. Dari 129 subjek, 25 (19,4%) subjek berada pada kategori hasil BTA scanty, 45(34,9%) pada kategori 1+, 28 (21,7%) subjek pada kategori 2+, dan 31 (24,0%) pada kategori 3+. Hasil analisis menunjukan bahwa kebiasan merokok berkorelasi positif lemah (d = 0,214, p = 0,010), berdasarkan jumlah konsumsi rokok per hari dan lama tahun merokok, dengan tingginya hasil uji BTA (jumlah kandungan bakteri tahan asam pada sputum). Kesimpulan. Riwayat kebiasan merokok (jumlah konsumsi rokok per hari x lama merokok dalam tahun) berkorelasi lemah dengan hasil uji BTA sebelum pengobatan.

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Objectives. In the year 2015, a high number of smoking prevelance in Indonesia reached 76% among men above 15 years old and 3,6% among women above 3,6%. This high number of prevalence could be a high risk to infection of tuberculosis.

Methods. Data collection was conducted at RSUP Persahabatan by cross-sectional method. Subjects are lung TB patients who has positive acid-fast bacilli (AFB) smear result and came to the hospital on October-November 2018.

Result. A total of 129 lung TB subjects had a positive AFB smear. Among those, 70 (54,4%) subjects are not a smokers, 29 (22,5%) are mild smokers, 20 (15,5%) are moderate smokers, and 10 (7,8%) are heavy smokers. From 129 subject, 25 (19,4%) subjects are found to be in the AFB criteria of scanty, 45(34,9%) subjects have 1+ result, 28 (21,7%) subjects have 2+ result, dan 31 (24,0%) subjects have 3+ result. A bivariate analysis was then condected and shows that there is a weak positive correlation (d = 0,214, p = 0,010) between smoking and high result of AFB smear.

Conclusion: Smoking (calculated by number of ciggarete smoked everyday x period of time consumed (years)) has a weak positive correlation with the result of acid-fast bacilli smear pre-treatment."

"Di Indonesia, tingkat keberhasilan pengobatan tuberkulosis hanya mencapai 84% dan kemungkinan terjadinya kekambuhan berada pada 2%. Namun demikian, masih sangat sedikit penelitian yang memelajari hubungan antara ketidak teraturan obat anti tuberkulosis dengan hasil uji sputum BTA pada pasien TB kambuh. Pengambilan data dilakukan di Rumah Sakit Umum Persahabatan dengan menggunakan metode cross sectional. Target populasi dari penelitian ini adalah pasien yang terdiagnosis TB kambuh pada tahun 2018. Dari 40 subjek penelitian, didapati subjek laki-laki berjumlah 19 (47,5%) dan perempuan berjumlah 21 (52,5%). Berdasarkan usia, jumlah kasus kambuh terbanyak dapat ditemui di rentang usia 36-55 dan 46-55 dengan jumlah 10 (25%). Didapati 24 (60%) subjek memiliki riwayat pengobatan yang tidak teratur dan hasil BTA tertinggi adalah negatif dengan jumlah subjek 13 (35%). Dari hasil analisis chi square, didapatkan p=0,00883 dengan OR 6,43 (IK95% 1,495-27,646) dan dari hasil analisis Mann Whitney, didapatkan p=0,014 dengan rerata peringkat 15,06 dan 24,13 untuk riwayat pengobatan yang teratur dan tidak teratur. Ada hubungan antara riwayat pengobatan tuberkulosis dengan hasil jumlah BTA dengan nilai OR 6,43 dengan IK95% 1,495-27,646, dan tren hasil jumlah BTA yang cenderung naik lebih tinggi pada riwayat pengobatan yang tidak teratur.

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In Indonesia, the success rate of tuberculosis treatment is only at 84% while the probability of a relapse case to occur is 2%. However, studies regarding the relation of previous tuberculosis regiments with AFB sputum smear are very limited. Datas are collected from RSUP Persahabatan by using cross-sectional method. Subjects of this experiment are patient that has been diagnosed with relapse tuberculosis in the year 2018. From 40 subjects, the ratio between male and female is 47,5% and 52,5% respectively.

Most subjects are on the age range of 36-45 and 46-55 (10 subjects each). Among those 40 subjects, 24 (60%) has been found to have irregular precious TB regiments while 13 has negative results of AFB sputum smear. Upon bivariate analysis with chi square, it is found that patients with irregular previous TB regiments are 6,43 times more likely (p=0,00883 OR 6,43 CI95% 1,495-27,646) to have a positive AFB sputum smear than those with regular previous TB regiments.

Upon using Mann Whitney analysis, it is found that average rank of irregular treatment and regular treatment is 24,13 and 15,06 respectively. There is a relation of previous TB regiments with results of AFB sputum smear with OR 6,43 CI95% 1,495-27,646 and a positive trend of AFB sputum smear on patients with irregular previous TB treatment."

"Latar belakang: Hubungan antara TB dan DM sudah lama diketahui. Sistem imun rendah pada DM sehingga risiko berkembangnya TB laten menjadi TB aktif lebih tinggi. Penderita DM memiliki 2-3 kali risiko untuk menderita TB dibanding tanpa DM. Sekitar 10% kasus TB secara global berhubungan dengan DM. Prevalensi TB DM berdasarkan penelitian potong lintang oleh Wijayanto di Poli Endokrin RSUP Persahabatan pada pasien DM tipe 2 dari Oktober sampai Nopember 2013 adalah 28,2%. Pablos-Mendez dkk. menemukan bahwa hanya DM yang kurang terkontrol atau tidak terkontrol dikaitkan dengan peningkatan risiko TB. Tujuan: Tujuan utama dari penelitian ini adalah untuk menentukan sensitivitas dan spesifisitas mikroskop sputum BTA dan Xpert MTB / RIF untuk diagnosis TB pada pasien dengan DM. Metode: Penelitian ini adalah studi analitik deskriptif potong lintang pada pasien kelompok DM yang masih menjalani pengobatan di RS Persahabatan dari bulan Mei 2014 sampai jumlah sampel tercapai. Penelitian akan dilakukan di poli Paru dan Penyakit Dalam divisi Endokrin dan Metabolik RS Persahabatan. Pasien dengan keluhan tuberklosis baik yang belum pernah minum OAT atau dengan riwayat pengobatan sbelumnya dan didukung dari foto toraks yang menunjukan gambaran kecurigaan TB akan dilakukan pemeriksaan diagnostik mikrobiologis sputum BTA dan Xpert MTB/RIF. Hasil: Tujuh puluh subjek diskrining dan hanya 55 subjek memenuhi kriteria inklusi. Terdapat 32 laki-laki (58,2%) dan 23 perempuan (41,8%). Umur antara 25-72 tahun. Indeks massa tubuh kurang 11 (20%), normal 31(56,4%) dan lebih 13(23,6%). Gula darah antara 110-481 mg/dl. Lama menderita DM <5 tahun adalah 40 (72,7%), 5-10 tahun adalah 7(12,7 %), 10-15 tahun adalah 6(10,9%) dan >15 tahun adalah 2(3,6%). HbA1c terkontrol 11(20%) dan tidak terkontrol 44(80 %). Riwayat tidak pernah TB 41 (74,5%), TB sembuh 9(16,4%) dan gagal atau putus obat 5 (9,1%). Sputum BTA(+) 29 (52,7%) dan Xpert MTB/RIF(+) 36(65,5%). Tingkat HbA1c tidak terkontrol BTA(+)/Xpert MTB/RIF(+) 30 (54,5%). Uji diagnostik kedua alat memiliki sensitivitas 77,8 % dan spesifisitas 94,7%. Kesimpulan: Xpert MTB/RIF memiliki nilai kepositifan yang lebih tinggi daripada sputum BTA dalam mendeteksi M.Tb. Tidak ada perbedaan sensitivitas dan spesifisitas pemeriksaan mikroskopik sputum BTA dan Xpert MTB/RIF dalam upaya penegakan diagnosis TB pada pasien DM.

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Background: The relationship between Tuberculosis (TB) and Diabetes Mellitus (DM) has long been known. People with DM have 2-3 times the risk of developing TB. The prevalence of TB-DM based on cross sectional study by Wijayanto in Endocrine clinic at Persahabatan Hospital in DM type 2 patients in 2013 was 28.2%. Pablos-Mendez et al. found that only DM poorly controlled or uncontrolled associated with the increased risk of TB.

Purpose: The main purpose of this study is to determine the sensitivity and specificity of Acid Fast Bacilli (AFB) smear and Xpert MTB/RIF for diagnosis of TB in DM.

Methods: This study is a cross-sectional descriptive analytic study in patients with DM group who are still undergoing treatment at Persahabatan Hospital from May 2014. The study is conducted in Pulmonary clinic and Internal Medicine clinic. Patients with DM who have TB complaints that have not been taken either TB drug or with a history of treatment and supported from chest X-ray shows the suspicion of TB will require the microbiological diagnosis of AFB smear and Xpert MTB/RIF.

Result: Seventy subjects are screening and only 55 subjects meet the inclusion criteria. There are 32 males (58.2%) and 23 females (41.8%). There are ages between 25-72 years old. Their body mass index are less than 11(20%), normal 31(56.4%) and over 13(23.6%). The blood sugar is between 110-481 g/dl. The length of suffer DM <5 years are 40(72.7%), 5-10 years were 7(12.7%), 10-15 years were 6(10.9%) and >15 years are 2(3.6%). The controlled HbA1c is 11(20%) and uncontrolled is 44(80%). By history of TB which has never been suffered are 41(74.5%), treatment cured are 9(16.4%) and failure or withdrawal are 5(9.1%). Smear of AFB(+)ve are 29(52,7%) and Xpert MTB/RIF(+) are 36(65,5%). Uncontrolled HbA1c levels pulmonary TB with AFB smear/Xpert (+)ve are 30(54.5%). Sensitivity and specificity by using both are 77.8% and 94.7%.

Conclusion: The Xpert MTB/RIF has a higher value of positivity that detect M.Tb than AFB smear.There is no difference in the sensitivity and specificity of AFB smear and Xpert MTB/RIF for TB diagnosis in patients with DM."

"ABSTRAKTuberkulosis Multidrug Resistant (TB MDR) merupakan suatu masalah dan menjadi tantangan yang paling besar terhadap program pencegahan dan pemberantasan TB dunia. Angka kesembuhan pada TB MDR relatif lebih rendah dengan terapi yang lebih sulit, mahal, dan lebih banyak efek samping. Konversi kultur sputum M. tuberculosis dalam 2 bulan pengobatan dapat digunakan sebagai indikator luaran terapi dan target pertama dalam terapi TB MDR. Penelitian ini bertujuan untuk mengetahui hubungan antara gabungan derajat positivita sputum basil tahan asam (BTA), adanya kavitas paru, malnutrisi, diabetes mellitus (DM), dan kebiasaan merokok dengan konversi kultur sputum M. tuberculosis dalam 2 bulan pengobatan. Metode penelitian ini adalah penelitian khusus-kontrol dengan mengambil data sekunder dari penderita yang didiagnosis TB MDR di Klinik TB MDR Rumah Sakit Umum Pusat Dokter Hasan Sadikin pada periode April 2012 sampai dengan desember 2014. Kelompok kontrol adalah data pasien TB MDR yang mengalami konversi dalam 2 bulan pengobatan dan kelompok kasus adalah data pasien yang tidak mengalami konversi dalam 2 bulan pengobatan. Data analis dengan analisis univariat diikuti analisis multivariat regresi logistik. Hasilnya subjek penelitian berjumlah 190 orang, terbagi dalam kelompok kasus dan kontrol masing-masing 95 orang. Variabel bermakna pada analisis univariat adalah derajat positivitas sputum BTA, adanya kavitas paru, DM, dan malnutrisi. Analisis dilanjutkan dengan analisis multivariat regresi logistik dasn diperoleh hasil bahwa variabel yang berhubungan paling kuat dengan konversi kultut sputum BTA dalam 2 bulan pengobatan adalah derajat positivitas sputum BTA (Sputum BTA +1 p = 0,000, OR = 5,46; IK 95%:2,510-11, sputum BTA +2 p = 0,045, OR = 2.253; IK 95%: 1,017 - 4,989) dan adanya kavitas (p = 0,000, OR = 3,22; IK 95%: 1,61 - 6,45). Kesimpulannya derajat positivitas sputum BTA dan adanya kavitas memiliki hubungan yang paling kuat dengan konversi kultur sputum M. tuberculosis dalam 2 bulan pengobatan pada pasien TB MDR. "

"ABSTRAK Latar belakang : Prevalens diabetes melitus (DM) terus meningkat di negaraberkembang yang merupakan negara endemis tuberkulosis (TB). Diabetes melitusmeningkatkan risiko infeksi, hambatan konversi sputum dan kegagalanpengobatan TB. Penelitian ini bertujuan menganalisis faktor-faktor yangmempengaruhi konversi sputum Basil Tahan Asam (BTA) mikroskopik padaakhir bulan kedua pengobatan TB pada pasien TB paru kasus baru dengan DM.Metode : Penelitian kohort retrospektif ini dilaksanakan di RSUP Perahabatanterhadap pasien-pasien TB paru BTA positif kasus baru dengan DM yang berobatpada periode Juli 2012 sampai Juni 2015. Hubungan faktor risiko dengan konversisputum BTA mikroskopik dianalisis dengan analisis bivariat dan multivariat.Hasil penelitian: Proporsi kegagalan konversi sputum BTA mikroskopik padapasien TB paru kasus baru dengan DM adalah 43,04%, sedangkan pada pasientanpa DM 22,75% (p<0,001, KI95% 0,11-0,30) dan risiko relatif (RR) kegagalankonversi 1,89 kali lebih tinggi pada kelompok DM. Faktor risiko yang meningkatbermakna pada pasien gagal konversi adalah kadar kepositifan sputum BTAsebelum terapi (p=0,021), HbA1c (p=0,014), GDP (p=0,047), GD 2jam PP(p=0,030) dan kavitas pada foto toraks (p=0,033) sedangkan albumin serum lebihrendah bermakna (p=0,013). Analisis multivariat mendapatkan faktor risikoterkuat untuk kegagalan konversi sputum adalah kadar albumin serum yangrendah (p=0,046, aOR 0,464, KI95% 0,218-0,986), tingkat kepositifan sputumBTA mikroskopik sebelum terapi yang tinggi (p=0,009, aOR 2,313, KI95%1,230-4,349) dan kadar HbA1c yang tinggi (p=0,018, aOR 1,298, KI 95% 1,047-1,610).Kesimpulan: Tingkat kepositifan sputum BTA sebelum terapi yang tinggi, statuskontrol DM yang tidak baik, kavitas pada foto toraks dan kadar albumin serumyang rendah meningkatkan risiko kegagalan konversi sputum BTA pada pasienTB dengan DM.ABSTRACT Background: The link of DM and TB is more prominent in developing countrieswhere TB is endemic and the burden of DM is increasing. Diabetes mellitusincreases the risk of TB infection, delayed sputum smear conversion and TBtreatment failure. This study would like to evaluate factors associated withdelayed sputum smear conversion in the end of two months of TB treatment innew cases TB with DM patients in Persahabatan Hospital.Methods: This retrospective cohort study was conducted in PersahabatanHospital, included all new cases TB with DM patients in the period from July2012 - June 2015. All the risk factors performed bivariate and multivariateanalysis in association with sputum smear conversion in the end of two months ofTB treatment.Results: The proportion of sputum smear conversion failure is higher in TB-DMthan non-DM patients (43,04 vs 22,75%) (p<0,001, CI95% 0,11-0,30) with therelative risk (RR) for sputum conversion failure 1,89 higher in TB-DM patients.Bivariate analysis resulted in significant higher of initial sputum smear level(p=0,021), HbA1c (p=0,014), FBG (p=0,047), post prandial Blood Glucose(p=0,030) and cavity at chest x-ray (p=0,033) and significant lower of serumalbumin (p=0,013) in non-conversion patients. Multivariate analysis resulted inrisk factors strongly associated with sputum conversion failure are low albuminlevel (p=0,046, CI95% 0,218-0,986), high initial sputum smear level (p=0,009,CI95% 1,230-4,349) and high HbA1c level (p=0,018, CI 95% 1,047-1,610).Conclusions: Higher initial sputum smear level, uncontrolled diabetic status,cavity at chest x-ray and lower albumin level associated with sputum smearconversion failure in TB-DM patients.;Background: The link of DM and TB is more prominent in developing countrieswhere TB is endemic and the burden of DM is increasing. Diabetes mellitusincreases the risk of TB infection, delayed sputum smear conversion and TBtreatment failure. This study would like to evaluate factors associated withdelayed sputum smear conversion in the end of two months of TB treatment innew cases TB with DM patients in Persahabatan Hospital.Methods: This retrospective cohort study was conducted in PersahabatanHospital, included all new cases TB with DM patients in the period from July2012 - June 2015. All the risk factors performed bivariate and multivariateanalysis in association with sputum smear conversion in the end of two months ofTB treatment.Results: The proportion of sputum smear conversion failure is higher in TB-DMthan non-DM patients (43,04 vs 22,75%) (p<0,001, CI95% 0,11-0,30) with therelative risk (RR) for sputum conversion failure 1,89 higher in TB-DM patients.Bivariate analysis resulted in significant higher of initial sputum smear level(p=0,021), HbA1c (p=0,014), FBG (p=0,047), post prandial Blood Glucose(p=0,030) and cavity at chest x-ray (p=0,033) and significant lower of serumalbumin (p=0,013) in non-conversion patients. Multivariate analysis resulted inrisk factors strongly associated with sputum conversion failure are low albuminlevel (p=0,046, CI95% 0,218-0,986), high initial sputum smear level (p=0,009,CI95% 1,230-4,349) and high HbA1c level (p=0,018, CI 95% 1,047-1,610).Conclusions: Higher initial sputum smear level, uncontrolled diabetic status,cavity at chest x-ray and lower albumin level associated with sputum smearconversion failure in TB-DM patients.;Background: The link of DM and TB is more prominent in developing countrieswhere TB is endemic and the burden of DM is increasing. Diabetes mellitusincreases the risk of TB infection, delayed sputum smear conversion and TBtreatment failure. This study would like to evaluate factors associated withdelayed sputum smear conversion in the end of two months of TB treatment innew cases TB with DM patients in Persahabatan Hospital.Methods: This retrospective cohort study was conducted in PersahabatanHospital, included all new cases TB with DM patients in the period from July2012 - June 2015. All the risk factors performed bivariate and multivariateanalysis in association with sputum smear conversion in the end of two months ofTB treatment.Results: The proportion of sputum smear conversion failure is higher in TB-DMthan non-DM patients (43,04 vs 22,75%) (p<0,001, CI95% 0,11-0,30) with therelative risk (RR) for sputum conversion failure 1,89 higher in TB-DM patients.Bivariate analysis resulted in significant higher of initial sputum smear level(p=0,021), HbA1c (p=0,014), FBG (p=0,047), post prandial Blood Glucose(p=0,030) and cavity at chest x-ray (p=0,033) and significant lower of serumalbumin (p=0,013) in non-conversion patients. Multivariate analysis resulted inrisk factors strongly associated with sputum conversion failure are low albuminlevel (p=0,046, CI95% 0,218-0,986), high initial sputum smear level (p=0,009,CI95% 1,230-4,349) and high HbA1c level (p=0,018, CI 95% 1,047-1,610).Conclusions: Higher initial sputum smear level, uncontrolled diabetic status,cavity at chest x-ray and lower albumin level associated with sputum smearconversion failure in TB-DM patients.;Background: The link of DM and TB is more prominent in developing countrieswhere TB is endemic and the burden of DM is increasing. Diabetes mellitusincreases the risk of TB infection, delayed sputum smear conversion and TBtreatment failure. This study would like to evaluate factors associated withdelayed sputum smear conversion in the end of two months of TB treatment innew cases TB with DM patients in Persahabatan Hospital.Methods: This retrospective cohort study was conducted in PersahabatanHospital, included all new cases TB with DM patients in the period from July2012 - June 2015. All the risk factors performed bivariate and multivariateanalysis in association with sputum smear conversion in the end of two months ofTB treatment.Results: The proportion of sputum smear conversion failure is higher in TB-DMthan non-DM patients (43,04 vs 22,75%) (p<0,001, CI95% 0,11-0,30) with therelative risk (RR) for sputum conversion failure 1,89 higher in TB-DM patients.Bivariate analysis resulted in significant higher of initial sputum smear level(p=0,021), HbA1c (p=0,014), FBG (p=0,047), post prandial Blood Glucose(p=0,030) and cavity at chest x-ray (p=0,033) and significant lower of serumalbumin (p=0,013) in non-conversion patients. Multivariate analysis resulted inrisk factors strongly associated with sputum conversion failure are low albuminlevel (p=0,046, CI95% 0,218-0,986), high initial sputum smear level (p=0,009,CI95% 1,230-4,349) and high HbA1c level (p=0,018, CI 95% 1,047-1,610).Conclusions: Higher initial sputum smear level, uncontrolled diabetic status,cavity at chest x-ray and lower albumin level associated with sputum smearconversion failure in TB-DM patients."

"ABSTRAKStudi ini bertujuan untuk mengetahui hubungan indeks massa tubuh (IMT)dengan konversi sputum pada pasien TB paru BTA positif. Studi dilakukan padaDesember 2013 – Januari 2014 di poli paru RSUP Persahabatan. Desain studiyang digunakan adalah desain studi kohort retrospektif. Jumlah sampel pada studiini adalah 120 pasien, 60 pasien dengan IMT < 18,5 kg/m2 dan 60 pasien denganIMT ≥ 18,5 kg/m2. Sampel diambil secara konsekutif. Dari studi ini, diketahuibahwa probabilitas kumulatif gagal konversi pasien TB paru sebesar 17,0% dansebanyak 9,2% pasien TB paru mengalami gagal konversi. Probabilitas kumulatifgagal konversi pada pasien TB paru BTA positif dengan IMT < 18,5 kg/m2(24,4%) lebih besar dibanding pasien dengan IMT ≥ 18,5 kg/m2 (9,3%). Di antarapasien dengan IMT < 18,5 kg/m2, hazard rate konversi sputum akan semakinrendah jika peningkatan berat badan yang dialami pasien di akhir tahap intensif <1 kg dibandingkan dengan pasien yang mengalami peningkatan berat badan ≥ 1kg. Hasil analisis multivariat menunjukkan bahwa indeks massa tubuh < 18,5kg/m2 menurunkan peluang terjadinya konversi sebesar 37,8% (HR 0,622; 95%CI 0,389-0,995) setelah dikontrol oleh kategori pengobatan, peningkatan beratbadan di akhir tahap intensif, dan hasil sputum di awal pengobatan. Status gizipasien selama masa pengobatan perlu ditingkatkan untuk menunjang keberhasilanpengobatan.

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ABSTRACTThe aim of this study was to identify the association of body mass index(BMI) with sputum smear conversion among AFB positive pulmonary tuberculosispatients. This study was conducted from Desember 2013 to Januari 2014 atpulmonary ward RSUP Persahabatan. The design study was retrospective cohort.A total of 120 patients consecutively enrolled in this study, 60 patients havingBMI < 18,5 kg/m2 and 60 patients having BMI ≥ 18,5 kg/m2. The cumulativeprobability of failed conversion among AFB positive pulmonary tuberculosispatients was 17,0% and 9,2% patients failed to have sputum conversion. Thecumulative probability of failed conversion among patients having BMI < 18,5kg/m2 (24,4%) was higher than patients having BMI ≥ 18,5 kg/m2 (9,3%). AmongBMI < 18,5 kg/m2 patients, hazard rate of sputum conversion would be lower iftheir weight gain at the end of intensive phase < 1 kg than having weight gain ≥ 1kg. Multivariat analysis found that BMI < 18,5 kg/m2 reduced the probability ofsputum conversion up to 37,8% (HR 0,622; 95% CI 0,389-0,995) after controlledby treatment category, weight gain at the end of intensive phase, and initialsputum. Nutritional status of TB patients during treatment must be increased tosupport the successful treatment."

"Penyakit kusta masih menjadi masalah kesehatan di dunia terutama di Indonesia sebagai negara dengan prevalensi tertinggi ketiga di dunia. Gejala klinis dan pemeriksaan penunjang yang ada sulit untuk menegakkan diagnosis definitif kusta pausibasilar (PB) dengan basil tahan asam (BTA) negatif. Diperlukan uji alternatif seperti real-time polymerase chain reaction berbasis probe TaqMan yang sensitif dan spesifik untuk mendeteksi Mycobacterium leprae. Tujuan penelitian ini adalah mendeteksi M. leprae pada pasien kusta PB dengan basil tahan asam negatif, dengan menggunakan real-time polymerase chain reaction (PCR) berbasis probe TaqMan pada spesimen kerokan jaringan kulit dan jaringan biopsi kulit. Sebanyak 24 pasien yang menjadi sampel penelitian. Setiap pasien dilakukan pengambilan spesimen kerokan jaringan kulit dari cuping telinga dan lesi kulit dan jaringan biopsi kulit. Uji TaqMan real-time PCR memberikan positivitas sebesar 20,8%, 25% dan 95,8% pada spesimen kerokan jaringan kulit cuping telinga, lesi kulit dan pada jaringan biopsi kulit. Positivitas hasil pemeriksaan patologi anatomi (PA) yang menunjukkan kusta sebesar 79,2%. Hal ini menunjukkan bahwa pemeriksaan TaqMan real-time PCR mampu meningkatkan kemampuan diagnosis pemeriksaan PA sebesar 16,6%. yang selama ini menjadi pemeriksaan baku emas kusta. Spesimen yang dianjurkan untuk digunakan pada pemeriksaan TaqMan real-time PCR adalah jaringan biopsi kulit.

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Leprosy is still considered as a major health problem worldwide especially in Indonesia as the third highest prevalence in the world. The clinical symptoms are often similar with other skin diseases and the current available laboratory methods to establish definitive diagnosis of paucibacillary leprosy with negative acid-fast bacilli is difficult. Therefore, it is important to apply an alternative assay such as real-time polymerase chain reaction-based TaqMan probe for sensitive and specific detection of Mycobacterium leprae. The aim of this study is to detect M. leprae in paucibacillary leprosy with negative acid-fast bacilli using real-time PCR-based TaqMan probe in slit skin and skin biopsy tissue specimens. A total of 24 patients were selected as sample. From each patient it was taken slit skin specimen from the ear lobe and skin lesions and skin biopsy tissue specimen. The TaqMan real-time PCR showed 20,8%, 25% and 95,8% positivity in slit skin of earlobes, slit skin lession and skin biopsy tissue respectively. Histopatology examination result showed 79,2% positivity of leprosy. It showed that TaqMan real-time PCR could improve the diagnosis by 16,6% compared to histopathology which considered as gold standard. Specimen recommended to be used is skin biopsy tissue."

"ABSTRAKPendahuluan : Deteksi Basil Tahan Asam (BTA) Ziehl Neelsen cairan serebrospinal (CSS) di RSUPN dr Cipto Mangunkusumo tahun 2014 tidak pernah positif. Pewarnaan Auramine-O dapat meningkatkan sensitivitas deteksi BTA. Perlu modifikasi sitosentrifugasi pada pulasan BTA, agar dapat deteksi BTA lebih banyak dan cepat.Metode: uji diagnostik pulasan BTA CSS Ziehl Neelsen metode non sitosentrifugasi, Cytospin, Cytopro serta Auramine-O Cytopro dibandingkan dengan baku emas biakan TB MGIT.Hasil: Uji diagnostik BTA Ziehl Neelsen tanpa sitosentrifugasi, tidak dapat dinilai karena BTA tidak terdeteksi di semua sampel. Uji diagnostik Ziehl Neelsen Cytospin dan Cytopro sama yaitu sensitivitas 64%, spesifisitas 85%, NPP 54%, NPN 89 %. Uji diagnostik Auramine-O Cytopro, sensitivitas 91%, spesifisitas 26%, NPP 26%, NPN 91 %.Kesimpulan: Pulasan BTA CSS metode sitosentrifugasi dapat menggantikan metode non sitosentrifugasi. Pulasan BTA CSS Auramine-O dapat me rule out diagnosis meningitis TB.

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ABSTRACT

Introduction: Detection of AFB from CSF with Ziehl Neelsen staining in 2014 at dr Cipto Mangunkusumo general hospital never gives positive result. Staining with Auramine-O smear staining can increase its sensitivity. Acid fast bacilli cytocentrifugation is needed as a modification in AFB slide preparation to gain more bacilli faster.

Methods: Diagnostic perfomance of AFB slide prepared by non cytocentrifugation, Cytospin, Cytopro with Ziehl Neelsen stain, prepared by cytopro with Auramine-O stain are compared to TB MGIT as a gold standard.

Results: Acid fast bacilli slide prepared with non cytocentrifugation method and stained by Ziehl Neelsen cannot be obtained because AFB was not detected in all samples. Acid fast bacilli slide prepared with Cytospin and Cytopro and stained with Ziehl Neelsen has sensitivity (64%), specificity (85%), PPV (54%), 89% NPV. Acid fast bacilli slide prepared with Cytopro and stained with Auramine-O has sensitivity (91%), specificity (26%), PPV (26%), 91 % NPV.

Conclusion: Detection of AFB from CSF with cytocentrifugation method can replace non cytocentrifugation method. Acid fast bacilli slide prepared cytocentrifugation and stained by Auramine-O can rule out Tuberculous meningitis."

"Mayoritas kasus tuberkulosis yang tidak terdiagnosis memiliki hasil sputum basil tahan asam negatif. Pembiakan Mycobacteria Growth Indicator Tube diperhitungkan sebagai penunjang pemeriksaan basil tahan asam dalam konfirmasi diagnosis tuberkulosis. Penelitian ini bertujuan untuk mengetahui sensitivitas dan spesifisitas pewarnaan basil tahan asam terhadap BACTEC Mycobacteria Growth Indicator Tube 960. Penelitian ini menggunakan studi uji diagnosis pada 188 sampel yang memenuhi kriteria penelitian dari Laboratorium Departemen Mikrobiologi Klinik Fakultas Kedokteran Universitas Indonesia-Rumah Sakit Cipto Mangunkusumo FKUI-RSCM. Data dianalisis secara komparatif kategorik berpasangan dengan uji McNemar. Dari 188 sampel 107 laki-laki dan 31 perempuan dengan median usia 35[17-76 tahun , hasil positif basil tahan asam scanty, 1 , 2 , 3 dan BACTEC Mycobacteria Growth Indicator Tube 960 berturut-turut adalah 32,9 62 sampel dan 59,6 112 sampel. Sensitivitas pewarnaan basil tahan asam terhadap BACTEC Mycobacteria Growth Indicator Tube 960 berbeda signifikan p=0,000 [8,1371e-13] . Melalui tabel 2x2 diketahui sensitivitas, spesifisitas, nilai duga positif, dan nilai duga negatif pewarnaan basil tahan asam terhadap BACTEC Mycobacteria Growth Indicator Tube 960 berturut-turut adalah 52,7 ; 96,1 ; 95,1 ; dan 57,9 . Pemeriksaan BACTEC Mycobacteria Growth Indicator Tube 960 memiliki sensitivitas dan spesifisitas yang lebih unggul daripada pemeriksaan BTA dan dapat digunakan untuk menunjang pemeriksaan BTA sebagai uji diagnostik TB.

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The majority of undiagnosed tuberculosis cases have negative acid fast bacilli result. Culture with Mycobacteria Growth Indicator Tube is considered as a support to acid fast bacilli smear in confirmation of tuberculosis diagnosis. This study aims to determine the sensitivity and spesificity of acid fast bacilli smear against BACTEC Mycobacteria Growth Indicator Tube 960. This study used a diagnostic test study in 188 samples that met the study criteria obtained from Clinical Microbiology Laboratory of Faculty of Medicine Universitas Indonesia Cipto Mangunkusumo Hospital FMUI RSCM . Data were analyzed with McNemar test. Out of 188 samples 107 males and 31 females with an average age of 35 17 76 years , positive results for acid fast bacilli scanty, 1 , 2 , 3 and BACTEC Mycobacteria Growth Indicator Tube 960 respectively were 32.9 62 samples and 59.6 112 samples. The sensitivity of acid fast bacilli smear against BACTEC Mycobacteria Growth Indicator Tube 960 is significantly different p 0,000 8,1371e 13 . Through the 2x2 table, the sensitivity, specificity, positive and negative predictive value respectively were 52.7 , 96.1 , 95.1 , and 57.9 . BACTEC Mycobacteria Growth Indicator Tube 960 has superior sensitivity than acid fast bacilli smear and can be used to support acid fast bacilli smear in diagnosing tuberculosis cases."

"Tuberkulosis TB masih menjadi masalah kesehatan utama di Indonesia yang terjadi akibat banyaknya kasus TB yang tidak terdeteksi melalui diagnosis. TB dapat di diagnosis melalui adanya tanda dan gejala, pemeriksaan apusan basil tahan asam BTA dan kultur sputum. Apusan BTA merupakan pemeriksaan yang murah dan sederhana namun sensitivitas dan spesifisitas belum diketahui pada Laboratorium Mikrobiologi Klinik FKUI-RSCM. Penelitian ini bertujuan untuk mengetahui sensitivitas dan spesifisitas pewarnaan BTA terhadap kultur LJ. Sebanyak 188 sampel sputum didapatkan dari Laboratorium Mikrobiologi Klinik FKUI-RSCM periode Januari ndash; Juni 2015 dan telah memenuhi kriteria inklusi. Penelitian ini menggunakan studi uji diagnosis dan data dianalisis secara komparatif kategorik berpasangan dengan uji McNemar. Dari 188 sampel, didapatkan hasil positif basil tahan asam scanty, 1, 2, 3 dan kultur LJ berturut-turut adalah 13 sampel 6,9 dan 18 sampel 9,6. Dari tabel 2x2 didapatkan sensitivitas dan spesifisitas pewarnaan BTA terhadap kultur LJ adalah 72,2 dan 100. Sedangkan nilai duga positif dan nilai duga negatif adalah 100 dan 97,14.

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Tuberculosis TB remains one of the major health problems in Indonesia due to the high number of suspected TB was not detected through diagnosis. TB can be diagnosed by its symptoms, acid fast bacilli AFB smear and by cultivation of sputum. AFB smear microscopy is cheap and simple but its sensitivity and specificity not known in Clinical Microbiology Laboratory FMUI RSCM. The aim of this study was to determine sensitivity and specificity of AFB smear against LJ. There were 188 sputum samples people with suspected TB obtained from Clinical Microbiology Laboratory FMUI RSCM from Januari to Juni 2015 that eligible for inclusion. This study used diagnostic test study and the data was analyzed using McNemar test. Out of 188 sputum samples, positive result for AFB smear and culture LJ were 13 samples 6,9 and 18 samples 9,6 respectively. Based on table 2 x 2, the sensitivity, specificity, positive predictive value and negative predictive value of LJ against AFB smear were 72 100 100 and 97,14 respectively."