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William
Perbandingan Hasil Pengobatan dan Efek Samping Obat Antituberkulosis Kategori I antara Paduan menggunakan Dosis Harian dengan Paduan menggunakan Dosis Berselang Sebagian pada Tuberkulosis Paru = Comparison of Treatment Outcomes and Adverse Effects of Antituberculosis Drugs Category I between Daily Dose Combination and Part Daily Dose Combination in Pulmonary Tuberculosis
"Pendahuluan: Tuberkulosis (TB) adalah penyebab utama kematian akibat infeksi di dunia. Sejak tahun 2008 - 2017 terdapat penurunan angka keberhasilan pengobatan TB di Indonesia (< 90%). Rekomendasi pengobatan TB di Indonesia adalah paduan obat antituberkulosis (OAT) dosis berselang sebagian (2RHZE/4R3H3) atau harian (2RHZE/4RH). Menurut WHO, paduan OAT RHZE/R3H3 mempunyai angka kegagalan dan kekambuhan yang lebih tinggi. Namun, penelitian meta-analisis RCT menyatakan bahwa kedua paduan OAT mempunyai angka kegagalan dan kekambuhan yang sama. Oleh karena itu, dilakukan penelitian untuk membandingkan hasil pengobatan dan efek samping antara paduan OAT 2RHZE/2RH dengan 2RHZE/4R3H3.
Metode: Penelitian ini merupakan studi analitik observasional dengan desain cross sectional yang membandingkan hasil pengobatan dan efek samping antara paduan OAT 2RHZE/4RH dengan 2RHZE/4R3H3 pada pasien TB paru kategori I di RSUP Persahabatan periode Januari 2015 sampai Juni 2018. Data sekunder diambil dari rekam medik. Hasil pengobatan dinilai sesuai definisi dalam pedoman nasional penanggulangan TB di Indonesia dan WHO. Efek samping dinilai dari seluruh efek samping terkait OAT yang tercatat dalam rekam medik.
Hasil: Terdapat 175 pasien pada masing-masing kelompok. Pada kelompok paduan OAT 2RHZE/4RH terdapat 89.1% pasien berhasil, 13.1% sembuh,76.0% pengobatan lengkap, 10.6% putus berobat, 0.6% gagal, dan tidak ada yang meninggal. Pada kelompok paduan OAT 2RHZE/4R3H3 terdapat 91.4% pasien berhasil, 39.4% sembuh, 52.0% lengkap, 8% putus berobat, tidak ada yang gagal, dan 0.6% meninggal. Tidak ada perbedaan bermakna untuk keberhasilan pengobatan (p=0.470, OR=1.299, IK95%;0.637-2.648), putus berobat (p=0.659 ,OR=0.758, IK95%;0.365-1.577), gagal (p=1.000), dan meninggal (p=1.000) di antara kedua kelompok. Namun, terdapat perbedaan bermakna untuk kesembuhan (p=0.003, OR=2.358, IK95%;1.375-5.206) dan pengobatan lengkap (p=<0.001, OR=0.342, IK95%;0.217-0.540). Sebagian besar pasien mengalami efek samping pengobatan (51.1%) terutama di tahap intensif (73.2%). Pada tahap lanjutan tidak ada perbedaan bermakna kejadian efek samping antara kedua kelompok (p= 0.324, OR=1.386, IK95%; 0.723-2.657).
Kesimpulan: Kesembuhan kelompok paduan OAT 2RHZE/4R3H3 lebih baik daripada 2RHZE/4RH, sedangkan pengobatan lengkap sebaliknya. Tidak ada perbedaan bermakna untuk keberhasilan pengobatan, putus berobat, kegagalan, meninggal, dan kejadian efek samping pada tahap lanjutan di antara kedua kelompok.
Introduction: Tuberculosis (TB) is the main cause of death for infectious disease in the world. Since 2008 - 2017, there was a decline of TB success rate (< 90%) in Indonesia. Treatment of TB in Indonesia are using antituberculosis drugs with part daily dose combination (2RHZE/4R3H3) or daily dose combination (2RHZE/4RH). WHO concluded that 2RHZE/4R3H3 combination had higher failure and recurrence rate. However, a meta-analysis study showed that both combinations had same failure and recurrence rate. Therefore, this study is conducted to compare treatment outcomes and adverse effects between 2RHZE/4RH combination and 2RHZE/4R3H3 combination.
Method: This was an observational analytic study with cross sectional design which compared treatment outcomes and adverse effects between 2RHZE/4RH combination and 2RHZE/4R3H3 combination in pulmonary tuberculosis patient at RSUP Persahabatan period January 2015 until June 2018. Secondary data was taken from medical record. Treatment outcomes were assessed using definition in Indonesia National Guideline of TB and WHO. Adverse effects were assessed from all adverse effects that written in medical record.
Result: There are 175 patients in each group. In 2RHZE/4RH combination group, there were 89.1% patients succeed, 13.1% cured, 76.0% completed treatment, 10.6% lost to follow up, 0.6% failed and no one died. In 2RHZE/4R3H3 combination group, there were 91.4% patients succeed, 39.4% cured, 52.0% completed treatment, 8% lost to follow up, no one failed, and 0.6% died. There was no significant difference for success (p=0.470, OR=1.299, IK95%;0.637-2.648), loss to follow up (p=0.659, OR=0.758, IK95%;0.365-1.577), failure (p=1.000), and death rate (p=1.000) between two groups. However, there was a significant difference for cure (p=0.003, OR=2.358, IK95%;1.375-5.206) and complete treatment rate (p=<0.001, OR=0.342, IK95%;0.217-0.540) between two groups. Most patients had adverse effects (51,5%), especially in intensive phase (73,2%). In continuation phase, there was no significant difference of adverse effects event between two groups (p = 0.324, OR= 1.386, IK95%; 0.723-2.657).
Conclusion: Cure rate was better in 2RHZE/4R3H3 group than 2RHZE/4RH group, for completed treatment on the contrary. There was no significant difference for success rate, loss to follow up rate, failure rate, death rate, and adverse effects event in continuation phase between two groups."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
T59177
UI - Tesis Membership  Universitas Indonesia Library
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Albertina Hermina Sesa
Perbandingan hasil pemeriksaan tes cepat molekuler (TCM) dengan penggunaan kertas saring sebagai media transpor dan tanpa kertas saring sebagai media transpor pada pengiriman spesimen dahak pada pasien terduga tuberkulosis paru = Comparison of molecular rapid test (MRT) results using filter paper as transport media and without filter paper as transport media in sending sputum specimens to patients suspected of pulmonary tuberculosis
"Latar Belakang: Tuberkulosis merupakan penyakit menular yang disebabkan oleh mycobacterium tuberculosis (Mtb). Saat ini WHO telah merekomendasikan TCM MTB/RIF Ultra sebagai pemerikaan tuberculos yang cepat tuberculo untuk medeteksi TB. Kesulitan akses layanan tuberculos pemeriksaan TB pada daerah terpencil menjadi salah satu kendala dalan penatalaksaan TB. Kertas saring Whatman yang mengandung alfa selulosa dapat menjadi mendia tuberculo dahak pada pemeriksaan TB. Penelitian ini membandingkan pemeriksaan hasil TCM pada kertas saring sebagai media tuberculo dan tanpa kertas saring sebagai media tuberculo pada pasien terduga TB.
Metode: Desain penelitian adalah potong lintang, pada Poli Paru dan Ruang Rawat Inap di RSUP Persahabatan pada pertengahan Juni hingga Agustus 2024. Subjek penelitian adalah pasien terduga TB paru yang dilakukan pemeriksaan TCM MTB RIF Ultra yang memenuhi kriteria penelitian. Sampel dahak dari subjek kemudian dibagi menjadi dua, dengan penggunaan media kertas saring, di tetes 1cc dahak, keringkan kemudian dimasukan dalam tubercu ukuran 6x8 mm dan didiamkan selama selama 5 hari. Sedangkan pada pot yang lain langsung di periksakan TCM MTB/RIF Ultra.
Hasil: Didapatkan dari 53 subjek dengan karakteristik usia produktif terutama pada laki- laki. Dilakukan uji kepositifan akurasi hasil metode kertas saring yang disimpan selama 5 hari terhadap pot dahak yang diperiksakan secara langsung didapatkan pemeriksaan dengan kertas saring memiliki sensitivitas 84,6% (IK95% 55-98,1) dan spesifisitas92,5%(IK79,6-98,4).DilakukanjugaujikepositifanTCM terhadapvolume dahak, didapatkan dahak 3- 5 cc memiliki hasil akhir positif yang paling tinggi (33,3%) dengan nilai p=0,976. Dilakukan juga uji kepositifan TCM terhadap konsistensi dahak didapatkan dahak yang kental memberikan angka kepositifan yang tinggi (66,7%) dengan nilai p=0,001. Ketika dilakukan uji kepositifan hasil TCM terhadap jenis dahak didapatkan dahak mukopurulen memerikan hasil positif yang tinggi (94,1%) dengan nilai p<0,001. Ketika dilakukan uji kepositifan hasil TCM dengan foto toraks didapatkan gambatan kavitas yang memiliki angka kepositifan tinggi (71,4%) dengan nilai p=0,021.
Kesimpulan: Pemeriksaan TCM yang dilakukan dengan kertas saring memiliki sensitivitas dan spesifisitas yang tinggi menunjukan bahwa metode ini efektif dalam mendeteksi kuman Mtb dengan memiliki kemaknaan secara tuberculo.
Background: Tuberculosis is an infectious disease caused by mycobacterium tuberculosis (MTB). Currently, WHO has recommended TCM MTB rif ultra as a rapid andsensitivediagnosticexaminationtodetectTB.DifficultyinaccessingTB diagnostic services in peripheral areas is one of the obstacles in TB management. Whatman filter paper containing alpha cellulose can be a sputum transport medium in TB examination. This study compares the results of TCM examination on filter paper as a transport medium and without filter paper as a transport medium in suspected TB patients..
Methods: The study design was cross-sectional, at the Pulmonary Polyclinic and Inpatient Room at Persahabatan Hospital in mid-June to August 2024. The subjects were suspected pulmonary TB patients who underwent TCM MTB RIF Ultra examinationwhomettheresearchcriteria.Sputumsamplesfromthesubjectswere then divided into two, using filter paper media, 1cc of sputum was dripped, dried, then put in a 6x8 mm plastic and left for 5 days. While the other pot was immediately examined with TCM MTB/RIF Ultra.
Results: Obtained from 53 subjects with characteristics of productive age, especially in men. A positivity test of the accuracy of the results of the filter paper method stored for 5 days was carried out on the sputum pot that was examined directly, it was found that the examination with filter paper had a sensitivity of 84.6% (95% CI 55- 98.1) and a specificity of 92.5% (CI 79.6-98.4). A TCM
positivity test was also carried out on sputum volume, it was found that 3-5 cc of sputum had the highest positive final result (33.3%) with a p value = 0.976. A TCM positivity test was also carried out on sputum consistency, it was found that thick sputum gave a high positivity rate (66.7%) with a p value = 0.001. When the TCM positivity test was performed on the type of sputum, mucopurulent sputum showed a high positive result (94.1%) with a p value <0.001. When the TCM positivity test was performed with a chest X-ray, a cavity image was obtained which had a high positivity rate (71.4%) with a p value = 0.021.
Conclusion: TCM examination carried out with filter paper has high sensitivity and specificity which are also quite good, indicating that this method is effective in detecting Mtb germs with statistical significance."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2024
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UI - Tugas Akhir  Universitas Indonesia Library
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Darayu Calvert Wilson
Evaluation of the discrepancies between the results of GeneXpert (MTB / RIF) assay and drug-susceptibility tests among drug-resistant pulmonary tuberculosis patients at Jakarta Friendship Center General Hospital = Evaluasi perbedaan antara hasil uji GeneXpert (MTB / RIF) dan tes sesitivitas obat di antara pasien tuberkulosis paru yang resistan di Rumah Sakit Umum Pusat Persahabatan Jakarta
"Perbedaan antara tes untuk infeksi tuberkulosis (TB) yang resistan terhadap obat menjadi lebih umum karena alat diagnostik menjadi lebih bervariasi. Hal tersebut membingungkan dokter karena belum ada tes TB diagnostik cepat dengan sensitivitas dan spesifisitas yang baik. Kasus suspek-TB di RSUPP, pusat primer dan tersier untuk kasus TB paru Indonesia, disaring dengan GeneXpert MTB / RIF dan dikonfirmasikan dengan uji kepekaan obat anti-tuberkulosis.
Discrepancies between tests for drug-resistant tuberculosis (TB) infections are becoming more common as diagnostic tools become more varied. These discrepancies confuse clinicians because there is not yet a rapid diagnostic TB test with good sensitivity and specificity. Suspected-TB cases at Rumah Sakit Umum Pusat Perhasabatan (RSUPP), a primary and tertiary center for Indonesia’s pulmonary TB cases, are screened with GeneXpert MTB/RIF and confirmed with conventional drug- susceptibility testing (DST)."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2018
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UI - Skripsi Membership  Universitas Indonesia Library
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Maria Marchella Purwaningtyas
Studi Ekologi: Hubungan Cakupan Pengobatan, Success Rate, Jenis Kelamin, dan Kepadatan Penduduk terhadap Incidence Rate Tuberkulosis Paru di Jakarta Selatan pada tahun 2022 = Ecological Study: The Correlation between Case Detection Rate, Treatment Success Rate, Gender, and Population Density with Incidence Rate of Pulmonary Tuberculosis in South Jakarta in 2022
"Latar Belakang: Tuberkulosis paru merupakan salah satu jenis penyakit menular yang disebabkan oleh bakteri Mycobacterium tuberculosis. Penyakit ini ditularkan melalui media udara. Tuberkulosis menempati urutan kedua sebagai penyebab utama kematian. Indonesia saat ini berada di peringkat kedua sebagai negara dengan penderita tuberkulosis tertinggi di dunia. Kota Jakarta Selatan berada di urutan ke-3 dengan kasus tuberkulosis terbanyak di Provinsi DKI Jakarta pada tahun 2022.
Tujuan: Mengetahui hubungan antara cakupan pengobatan, success rate, jenis kelamin, dan kepadatan penduduk terhadap incidence rate tuberkulosis paru di 10 kecamatan di Jakarta Selatan pada tahun 2022.
Metode: Menggunakan desain studi berupa studi ekologi dengan uji korelasi untuk menganalisis hubungan antara cakupan pengobatan, success rate, jenis kelamin, dan kepadatan penduduk terhadap incidence rate tuberkulosis paru di 10 kecamatan di Jakarta Selatan dengan menggunakan data dari bulan Januari-Desember pada tahun 2022.
Hasil: Hasil penelitian ini menunjukkan bahwa cakupan pengobatan memiliki hubungan yang signifikan terhadap incidence rate tuberkulosis paru di 10 kecamatan (p = 0,000 –1,000), success rate memiliki hubungan yang signifikan terhadap incidence rate tuberkulosis paru di Kecamatan Jagakarsa (p = 0,047, r = 0,582), proporsi jenis kelamin laki-laki penderita tuberkulosis paru tidak memiliki hubungan yang signifikan terhadap incidence rate tuberkulosis paru di seluruh kecamatan (p = > 0,05), proporsi jenis kelamin perempuan penderita tuberkulosis paru tidak memiliki hubungan yang signifikan terhadap incidence rate tuberkulosis paru di seluruh kecamatan (p = > 0,05), dan kepadatan penduduk memiliki memiliki hubungan yang signifikan terhadap incidence rate tuberkulosis paru di Kecamatan Jagakarsa (p = 0,020, r = -0,659).
Kesimpulan: Hasil studi ini menyarankan Suku Dinas Kesehatan Kabupaten Jakarta Selatan dengan Pemerintah Kota Jakarta Selatan untuk melakukan advokasi dan pemberdayaan masyarakat setempat, memanfaatkan peran dan pelayanan fasilitas kesehatan dalam promosi Kesehatan, serta pelaporan kasus tuberkulosis guna memaksimalkan pengendalian dan pencegahan penyakit tuberkulosis paru.
Background: Pulmonary tuberculosis is one of contagious diseases caused by Mycobacterium tuberculosis. Tuberculosis is transmitted through the air. Tuberculosis ranks as the second main cause of death in the world. Indonesia is currently ranked second as country with the highest number of tuberculosis cases. In 2022, South Jakarta City is ranked 3rd with the most tuberculosis cases in DKI Jakarta Province.
Objective: This study aims to determine the relationship between treatment coverage, success rate, gender, and population density on the incidence rate of pulmonary tuberculosis in 10 sub-districts in South Jakarta in 2022.
Method: The research method being used in this study is an ecological study with a correlation test to analyze the relationship between treatment coverage, success rate, gender, and population density on the incidence rate of pulmonary tuberculosis in 10 sub-districts in South Jakarta using data from January to December in 2022.
Result: This study shows that treatment coverage has a significant relationship with the incidence rate of pulmonary tuberculosis in 10 sub-districts (p = 0,000–1,000), success rate has a significant relationship with the incidence rate of pulmonary tuberculosis in Jagakarsa District (p = 0,047, r = 0,582), the proportion of men with pulmonary tuberculosis does not have a significant relationship with the incidence rate of pulmonary tuberculosis in all sub-districts (p = > 0,05), the proportion of women with pulmonary tuberculosis does not have a significant relationship with the incidence rate of pulmonary tuberculosis in all sub-districts (p = > 0.05), and population density has a significant relationship with the incidence rate of pulmonary tuberculosis in Jagakarsa District (p = 0.020, r = -0.659).
Conclusion: It is advisable for the and health department of South Jakarta district along with South Jakarta government to advocate and empower the local communities, utilize the role and service of health facilities in health promotion and tuberculosis cases reporting in order to maximize the control and prevention of pulmonary tuberculosis."
Depok: Fakultas Kesehatan Masyarakat Universitas Indonesia, 2024
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UI - Skripsi Membership  Universitas Indonesia Library
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Dian Permatasari
Tatalaksana nutrisi pada Tuberkulosis paru dengan infeksi Human Immunodeficiency Virus (HIV) dan Kaheksia = Nutrition management in pulmonary tuberculosis with HIV infection and cachexia
"ABSTRAK
Tuberkulosis (TB) merupakan penyebab utama penyakit dan kematian di dunia. Hubungan antara TB dan malnutrisi telah lama diketahui. Berkembangnya TB secara progresif menyebabkan wasting dan hilangnya massa otot, serta hipoalbuminemia yang juga terlihat pada infeksi human immunodeficiency virus (HIV). Koinfeksi TB/HIV menyebabkan peningkatan metabolisme, gangguan fisik, dan masalah nutrisi. Selain itu, adanya penyakit infeksi kronik seperti halnya TB paru dan HIV/AIDS disertai dengan penurunan BB dapat menyebabkan kaheksia. Serial kasus ini bertujuan untuk mempelajari dan menerapkan terapi nutrisi sebagai bagian dari tatalaksana TB paru, infeksi HIV, dan kaheksia. Seluruh pasien dalam serial kasus ini adalah pasien TB paru dengan malnutrisi berat dan kaheksia. Dua dari empat pasien disertai infeksi HIV. Pemberian nutrisi disesuaikan dengan kondisi, penyakit penyerta, dan kebutuhan yang bersifat individual. Kebutuhan energi basal dihitung dengan persamaan Harris-Benedict dengan kebutuhan energi total setara dengan 35?40 kkal/kg BB. Makronutrien diberikan dalam komposisi seimbang dengan protein 15?20% total kalori (1,5-2 g/kg BB). Suplementasi mikronutrien diberikan sesuai dengan angka kecukupan gizi. Nutrien spesifik berupa omega-3 dan asam amino rantai cabang (AARC) diberikan untuk memperbaiki kaheksia. Keluaran yang dinilai meliputi kondisi klinis, asupan, dan toleransi asupan. Dua dari empat pasien memberikan keluaran klinis lebih baik, namun peningkatan BB tidak signifikan.ABSTRACT Tuberculosis (TB) is a leading cause of illness and death of people globally. The association between TB and malnutrition has long been known. Progressive tuberculous disease results in wasting and loss of muscle mass and hypoalbuminaemia, which are also seen in HIV infection. Co-infection with HIV and TB poses an additional metabolic, physical, and nutritional burden. In addition, chronic infecton disease such as pulmonary TB and HIV/AIDS accompanied with weight loss leads to cachexia. The aim of this case series was to study and apply nutrition therapy as integral part of pulmonary TB, HIV infection and cachexia treatment. All patients in this reports with diagnosis of pulmonary TB with severe malnutrition and cachexia. Two of four patients diagnosed with HIV infection. Nutrition therapy was given individually according to the clinical condition and underlying disease. Harris-Benedict equation was used to calculate basal energy requirement with total energy requirement equivalent to 35?40 kcal/body weight. Balanced macronutrient composition was given with protein 15?20% of total requirement (1,5-2 g/body weight). Micronutrient recommendation was given to fulfill one fold recommended daily allowance. Omega-3 and branched-chain amino acid (BCAA) was given as specific nutrients to improved cachexia. Outcome measurements included clinical condition, intake analysis, and intake tolerance. Two of four patient had improved in clinical outcome but there was no significant difference in weight gain."
Fakultas Kedokteran Universitas Indonesia, 2016
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UI - Tugas Akhir  Universitas Indonesia Library
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Nancy Sovira
Hubungan antara kadar 1,25-Dihydroxyvitamin D dengan Interferon Gamma, Cathelicidin dan Bacterial Load pada penderita Tuberkulosis Paru = The relation of 1,25 Dihydroxyvitamin D levels to Interferon Gamma, Cathelicidin and Bacterial Load in Pulmonary Tuberculosis patients / Nancy Sovira
"ABSTRAK
Tujuan penelitian ini adalah mengetahui kadar 1,25-dihydroxyvitamin D serum
dan hubungannya dengan interferon gamma, cathelicidin dan bacterial load pada
penderita TB paru BTA positif serta hubungan cathelicidin dengan bacterial load.
Rerata kadar IFN-γ adalah 10,8 ± 6,5 pg/mL, rerata kadar 1,25(OH)2D serum
adalah 121,5 ± 38,6 pmol/L dan rerata kada cathelicidin plasma adalan 90,4 ±
21,5 ng/mL. Pada penelitian ini tidak didapatkan hubungan kadar 1,25(OH)2D
serum dengan IFN-γ serum begitu juga dengan cathelicidin plasma. Kadar
cathelicidin plasma tidak berhubungan bermakna dengan bacterial load. Rerata
kadar IFN-γ serum dan cathelicidin plasma pada lesi kavitas lebih rendah daripada
lesi tanpa kavitas (masing-masing p = 0,031 dan p = 0,025). Rerata kadar
cathelicidin plasma subjek dengan riwayat pengobatan TB sebelumnya lebih
rendah daripada subjek kelompok kasus baru (p = 0,004). Pada penelitian ini
didapatkan juga hubungan bermakna kekuatan sedang antara kadar IFN-γ serum
dengan cathelicidin plasma (r = 0,540; p < 0,05).
ABSTRACT
The aim of study was to investigate levels of 1,25-dihydroxyvitamin D and its
relationshio with IFN-γ or cathelicidin in active pulmonary tuberculosis patients
and relation of cathelicidin with bacterial load. The mean of serum 1,25(OH)2D,
IFN-γ, and cathelicidin were 121,5 ± 38,6 pmol/L, 10,8 ± 6,5 pg/mL, 90,4 ± 21,5
ng/mL, respectively. The was no relation 1,25(OH)2D to IFN-γ and cathelicidin
either. The mean of serum IFN-γ and plasma cathelicidin in cavitary lession was
less than non cavitary lession. We also found that plasma cathelicidin level in
subject with prior treatment was less than new cases. There was relation of serum
IFN-γ to plasma cathelicidin (r = 0,540; p < 0,05)."
Fakultas Kedokteran Universitas Indonesia, 2013
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UI - Tesis Membership  Universitas Indonesia Library
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William
Outcomes of daily dose versus party-daily dose treatment for lung tuberculosis: A real-world database study in an Indonesian hospital
"Background a meta-analysis of randomized control trials (RCTs) on category I pulmonary tuberculosis (PTB) treatments showed that either part-daily (2RHZE/4R3H3) or daily dose (2RHZE/4RH) had the same failure and recurrence rates. However, the World Health Organization (WHO) concluded that the part-daily dose had higher failure and recurrence rates. Therefore, this study was conducted to compare the treatment outcomes between both regimens, whether daily dose regimen has a better treatment outcome than part-daily dose regimen, and the adverse effects between both regimens. Methods this was an analytic cross-sectional study of patients at the Persahabatan General Hospital, over the period of January 2015-June 2018. Data were taken from medical records and supported by telephone interviews, each regimen group had 175 patients.
Results there were no significant differences for success rates (p=0.470), lost to follow up rates (p=0.659), failure rates (p=1.000), death rates (p=1.000), and adverse effects in the continuation phase (p=0.324) between the groups. There were, however, significant differences in cure rates (p < 0.001) and complete treatment rates (p<0.001) between the groups. Conclusion the cure rate and complete treatment rate were found to be better for the part-daily than the daily doses. The success rate of both regimens were the same as Indonesia's target (90%). In the continuation phase, there were no significant difference of adverse effects between both regimens."
Jakarta: University of Indonesia. Faculty of Medicine, 2021
610 UI-IJIM 53:1 (2021)
Artikel Jurnal  Universitas Indonesia Library
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Fullarini Stopiati Kukuh Lakutami
Profil kolonisasi jamur pada pasien bekas tuberkulosis paru multidrug resistance di rsup persahabatan = Fungal colonization profile of post pulmonary multidrug resistance tuberculosis mdr tb treatment patients in persahabatan hospital
"Pendahuluan : Kerusakan paru yang luas dan riwayat pemakaian antibakteri jangka panjang merupakan faktor risiko yang meningkatkan angka kejadian kolonisasi jamur. Kedua hal ini terjadi pada pasien TB paru MDR. Meningkatnya kasus TB MDR di Indonesia akan meningkatkan risiko terjadinya kolonisasi jamur di paru. Penelitian ini untuk mengetahui profil kolonisasi jamur pada pasien bekas TB paru MDR.
Metode : Penelitian potong lintang terhadap pasien yang telah dinyatakan sembuh dari TB paru MDR dari tahun 2009-2015, yang kontrol ke Poli TB MDR RSUP Persahabatan selama bulan November-Desember 2015. Dengan menggunakan teknik consecutive sampling maka ditentukan sebanyak 61 subjek yang kemudian dilakukan induksi sputum. Hasil sputum induksi kemudian dilakukan pemeriksaan sputum jamur langsung dan biakan jamur dalam media Saboraud Dextrose Agar.
Hasil : Subjek berusia antara 19-76 tahun. Dari 61 pasien , kelompok usia terbanyak antara usia 35-50 tahun sebnayak 28 orang (45,9%) diikuti usia kurang dari 35 tahun 23 orang (37,7%) dan usia lebih dari 50 tahun sebanyak 10 orang (16,01%). Sebanyak 28 orang (45,95) IMT normal, 17 orang IMT berlebih dan 16 orang (26%) IMT kurang. Sebanyak 28 subjek (45,9%) mempunyai riwayat merokok. Spektrum kolonisasi jamur pada pasien bekas TB paru MDR adalah 42 orang (68,9%) kolonisasi jamur positif dengan 29 orang (47,5) spesies C. albicans, 6 (9,8%) kombinasi C. albicans dan C. tropicalis, 2 orang (3,3%) masing-masing As flavus dan kombinasi C. albicans dan C. krusei serta masing-masing 1 orang (1,6%) spesies C. tropicalis, C. parapsilosis dan kombinasi C. albicans+C. parapsilosis.
Kesimpulan: Kolonisasi jamur pada pasien bekas TB paru MDR tinggi dan harus diawasi dan harus dievaluasi untuk membedakan antara kolonisasi atau penyakit serta diobati untuk meningkatkan kualitas hidup pasca pengobatan TB MDR.
Introduction : Extensive lung damage and long term history of using antibacterial drugs are a risk factor that increase the incidence of fungal colonization. Both of these occurred in patients with pulmonary MDR TB. The increasing cases of MDR TB in Indonesia will increase the risk of fungal colonization in the lung. This study is to determine the profile of fungal colonization in post MDR TB patients.
Methods: This cross sectional study included patients who had been cured by the doctor in 2009-2015 and came to MDR Clinic from November-Desember 2015 in Persahabatan Hospital to check up. Sixty one patients were decided by consecutive sampling. From each patient, sputum induction for sputum fungal smear and fungal culture using Sabaraud Dextrose Agar.
Results: The age range of patients are between 19 to 76 years old. Out of 61 patients, among those group 45,9% are between the age of 35-50 years , 37,7% below the age 35 years old and 16,4% above age 50 years old. Twenty eight patients have normal body mass index, 17 patients are overweight and 16 patients are underweight. Number of patients who have smoking history are 45,9%. The spectrum of positive fungal colonization in post pulmonary MDR TB patients were 42 subjects (68.9%) consist of 29 subjects (47.5%)were Candida albicans, 6 subjects (9.8%) were combination of C. albicans and C. tropicalis, 2 subjects (3.3%) respectively were Aspergillus flavus and combinations of C. albicans and C. krusei. The others were C. tropicalis, C. parapsilosis and C. albicans + C. parapsilosis combination were 1 subject (1.6%) respectively.
Conclusion: Fungal colonization in post pulmonary MDR TB patients is high and should be monitored and must be evaluated to distinguish between colonization and disease and treated to improve quality of life post-treatment of MDR TB."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2016
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UI - Tugas Akhir  Universitas Indonesia Library
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Kenyorini
Hubungan uji tuberkulin dan polymerase chain reaction dengan BTA mikroskopis dan biakan mycrobacterium tuberculosis dalam diagnosis tuberkulosis paru = Correlation of tuberculosis skin testing and PCR with AFB microscopic and conventional culture for the diagnosis pulmonary tuberculosis
"Penyakit TB masih merupakan masalah kesehatan kesehatan masyarakat yang penting di Indonesia. Upaya diagnostik TB paru masih terus ditingkatkan. Pemeriksaan penunjang diagnosis TB yang sekarang digunakan masih mempunyai sensitiviti dan spesitiviti yang rendah. Tujuan penelitian mengetahui tingkat akurasi uji tuberkulin dan PCR terhadap penegakkan diagnosis TB serta hubungan uji tuberkulin dan PCR dengan BTA mikroskopis dan biakan M. Tb dalam diagnosis TB paru.
Metode penelitian cross-sectional, uji diagnostik dan analisa data menggunakan Chi-Square. Kriteria inklusi penderita terdapat gejala klinik riwayat batuk 3 minggu disertai atau tanpa batuk darah, nyeri dada, sesak napas dan riwayat minum obat TB dalam jangka waktu kurang dari 1 bulan serta bukan TB (kontrol). Seluruh sampel dilakukan anamnesis, pemeriksaan fisik, lekosit, LEDI/II, foto toraks, uji tuberkulin, PCR, BTA mikroskopis 3X dan biakan M. Tb mctode kudoh. Baku emas yang digunakan biakan M. Tb metode kudoh. Data diolah menggunakan SPSS versi 11.00.
Berdasar 127 sampel masuk kriteria inklusi 121. Sampel berjumlah 121 terdiri dari 61 sampel tersangka TB dan 60 sampel kontrol Sensitiviti dan spesivisiti uji tuberkulin terhadap biakakn metode Kudah menggunakan cut-off point 15,8 mm 33% dan 93%. Sensitiviti PCR terhadap biakab metode Kudoh 100%, spesitiviti PCR 78%. Didapatkan perbedaan bermakna dan hubungan lemah uji tuberkulin dengan biakan M. Tb dan PCR serta didapatkan perbedaan dan hubungan bermakna PCR dengan BTA mikroskopis biakan M. Tb.
Kesimpulan basil keseluruhan penelitian mendapatkan basil 39 sampel biakan positif, 36 sampel BTA mikroskopis positif, 57 sampel PCR positif dan 18 sampel uji tuberkulin positif. Ditemukan sensitiviti basil uji tuberkulin lebih rendah daripada PCR, BTA mikroskopis dan biakan M. Tb mctode Kudoh. Meskipun terdapat perbedaan bermakna basil uji tuberkulin pada biakan positif clan negatif, BTA mikroskopis positif dan negatif, serta PCR positif dan negatif, akan tetapi uji tuberkulin (menggunakan cut-off point 15.8 mm) kurang dapat membantu penegakan diagnosis TB para. Berdasarkan hasil penelitian ditemukan bahwa diantara keempat pemeriksaan penunjang diagnosis TB paru PCR mempunyai nilai sensitivit dan spesitiviti tinggi ( 100% dan 78%). sehingga PCR dapat digunakan sebagai pemeriksaan penunjang diagnosis TB paru apabila didapatkan klinis dan radiology mendukung TB paru. Menggunkan pemeriksaan PCR akan didapatkan metode penegakan diagnosis TB paru yang cepat ( 1 hari ) dibandingkan dengan menunggu hasil biakan M. Tb hingga 8 minggu.
Objective. In an attempt diagnosis pulmonary tuberculosis still increased continuously. Now additional examination pulmonary tuberculosis have been lack sufficient sensitivity and sensitivities. The aim of this study was to determine the validity of tuberculin skin testing (TST) and PCR toward assessment diagnosis pulmonary of tuberculosis with correlation between tuberculin skin testing to PCR with AFB microscopic and solid media culture of M. tuberculosis for the diagnosis of pulmonary tuberculosis.
Method. A cross-sectional study, diagnostic test and analysis with Chi-Square test. Inclusion criteria patient with pulmonary symptom include chronic cough 3 weeks with or without hemoptysis, chest pain, breathlessness and past history of ATA less than 1 month with non-tuberculosis patient (control). The general samples was examination Ro thorax, tuberculin skin testing, PCR, AFB microscopic and conventional culture. The golden standard is conventional culture test using Kudoh method. Analyze of the data with SPSS version 11.0.
Result. The study material comprised 121 samples from 127 samples. These samples include 61 samples from patient with probably active pulmonary tuberculosis and 60 control comprising healthy individuals. The sensitivity and specificity of tuberculin skin testing with cut-off point 15.8 mm greater was 33% and 93% on conventional culture test using Kudoh method. PCR sensitivity was 100% and spesitivity was 78%. It was showed the positivity correlation between pulmonary tuberculosis and conventional culture as well as PCR and AFB microscopic, the conventional culture test.
Conclusion. The sensitivity of tuberculin skin testing less than PCR, AFB microscopic and conventional culture test. So that not enough to assessment diagnosis pulmonary tuberculosis. The sensitivity and specificity PCR was I00% and 78%. With the use of PCR test, we were able to detect diagnosis pulmonary tuberculosis more rapidly in less than I day, compared to average 8 week required for detection by conventional culture."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2006
T18028
UI - Tesis Membership  Universitas Indonesia Library
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Angelina Siane
Perbandingan efektivitas dan keamanan obat fase lanjutan yang diberikan setiap hari atau intermiten pada tuberkulosis paru dengan diabetes melitus = Safety and efficacy of advance phase daily compared to intermittent treatment of diabetic pulmonary tuberculosis patients
"Latar belakang dan tujuan: diabetes termasuk dalam 8 faktor risiko tertinggi berkembangnya tuberkulosis (TB). Diabetes melitus (DM) meningkatkan risiko TB 3 kali, sedangkan infeksi TB memperburuk kontrol glikemik pasien DM dengan risiko kegagalan terapi TB 69% dan relaps 4 kali. Strategi pengobatan optimal untuk pasien TB-DM belum ditemukan, pengelolaan TB-DM sama dengan pasien TB non-DM. Sejak 2017, WHO tidak lagi merekomendasikan pemberian obat intermiten pada fase lanjutan karena risiko kegagalan terapi, kekambuhan, dan resistensi obat yang lebih tinggi dibandingkan pemberian harian. Penelitian ini bertujuan untuk membandingkan hasil pengobatan dan efek samping pengobatan TB-DM fase lanjutan antara pemberian setiap hari dengan intermiten tiga kali seminggu.
Metode: penelitian retrospektif menggunakan rekam medik pasien TB-DM dengan desain potong lintang. Sampel penelitian adalah seluruh pasien TB-DM yang sudah memasuki fase lanjutan dan memenuhi kriteria inklusi, yaitu pasien TB-DM tanpa HIV, tanpa gangguan fungsi ginjal atau hati, berusia ≥18 tahun yang mendapat pengobatan TB yang diberikan setiap hari dan tiga kali seminggu di RSUP Persahabatan periode 1 januari 2015-31 desember 2018.
Hasil: 64 subyek pada kelompok pengobatan setiap hari dan 69 subyek pada kelompok pengobatan intermiten tiga kali seminggu memenuhi kriteria inklusi. Tidak didapatkan perbedaan antara kelompok pengobatan setiap hari dengan intermiten tiga kali seminggu dalam hal kesembuhan (41,4% vs 44,2%, p=0,814, IP=1,122; IK95%:0,432-2,909), pengobatan lengkap (45,7% vs 50%, p=1,0, IP=1,188; IK95%: 0,430-3,282), gagal (3,4% vs 2,3%, p=0,888, IP=0,667; IK95%: 0,040-11,104), dan putus obat (54,7% vs 49,3%, p=0,533, IP=0,805; IK95%:0,407-1,592). Hanya 1 subyek (3,1%) yang mengalami kekambuhan pada kelompok pengobatan intermiten (p=1,0, IP=0,910; IK95%: 0,910-1,031). Satu subyek (1,6%) pada kelompok pengobatan setiap hari dan 9 subyek (13%) pada kelompok intermiten mengeluhkan efek samping ringan (p=0,018, IP=0,106, IK95%: 0,013-0,861). Sebagian besar pasien pada kedua kelompok menjalani pengobatan selama lebih dari 6 bulan hingga 9 bulan.
Kesimpulan: tidak terdapat perbedaan hasil pengobatan antara pemberian obat setiap hari dengan intermiten tiga kali seminggu pada pasien tuberkulosis dengan diabetes melitus. Terdapat perbedaan dalam hal efek samping, yang sifatnya ringan, antara kedua kelompok pengobatan. Sebagian besar pasien pada kedua kelompok menjalani pengobatan selama lebih dari 6 bulan hingga 9 bulan.
Background and aim: diabetes is the 8th highest risk factor for tuberculosis. Patients with diabetes mellitus (DM) have three times higher risk of active TB. Tuberculosis disturbs glycemic control in DM patients and 69% TB-DM patients would have failed and the risk for relapse is 4 times higher. The optimal treatments strategy for TB-DM patients is not found yet. Management of TB-DM patients is similar with TB without DM. Since 2017, WHO no longer recommends intermittent drug regiment in advanced phase therapy due to the higher risk of treatment failure, TB recurrence, and drug resistance. This study aims to compare treatment outcomes and safety of advanced phase treatment between daily and intermittent treatment in TB-DM patients.
Methods: this is a retrospective study with cross sectional design using medical record at Persahabatan Hospital from 1 January 2015 to 31 December 2018. The study sample are all TB-DM patient who have entered the advanced phase that met inclusion criteria, which are TB-DM patients without HIV/ impaired kidney or liver function, aged ≥18 years who had tuberculosis treatment.
Results: 64 subjects in daily treatment group and 69 subjects in intermittent group met the inclusion criteria. There are no difference between daily and intermittent group in term of cured (41,4% vs 44,2%, p=0,814, IP=1,122; IK95%:0,432-2,909), completed treatment (45,7% vs 50%, p=1,0, IP=1,188; IK95%: 0,430-3,282), failed (3,4% vs 2,3%, p=0,888, IP=0,667; IK95%: 0,040-11,104), and dropouts (54,7% vs 49,3%, p=0,533, IP=0,805; IK95%:0,407-1,592). Only 1 subject (3,1%) in intermittent group had recurrence (p=1,0, IP=0,910; IK95%: 0,910-1,031). One subject (1,6%) in daily treatment group and 9 subjects (13%) in intermittent group had minor side effects (p=0,018, IP=0,106, IK95%: 0,013-0,861). Most subjects in both groups underwent treatment for more than 6 months up to 9 months.
Conclusion: there were no differences in cure rate, complete treatment, failure and dropouts between daily and intermittent treatment in diabetic pulmonary tuberculosis patient. There is difference in side effects, which mostly are mild, between the two group. Most patients in both groups underwent treatment for more than 6 months up to 9 months."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
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UI - Tugas Akhir  Universitas Indonesia Library
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