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"Latar Belakang. Komplikasi pascabedah elektif meningkat sejalan dengan peningkatan usia. Status frailty pada pasien usia lanjut dikaitkan dengan peningkatan kejadian komplikasi pascabedah. Pengaruh status frailty terhadap komplikasi 30 hari pascabedah perlu diteliti lebih lanjut pada pasien usia lanjut di Indonesia.Tujuan. Mengetahui pengaruh status  frailty terhadap komplikasi 30 hari pascabedah elektif pada pasien usia lanjut.Metode. Studi dengan desain kohort prospektif untuk meneliti pengaruh status frailty terhadap kejadian komplikasi 30 hari pascabedah elektif pada pasien usia lanjut, dengan menggunakan pengambilan data pada pasien yang menjalani pembedahan elektif di RS Cipto Mangunkusumo pada tanggal 20 April sampai dengan 13 Juli 2018. Penilaian frailty dengan menggunakan FI 40 items. Analisis bivariat dan multivariat dengan logistik regresi dilakukan untuk menghitung crude risk ratio (RR) dan adjusted RR terjadinya komplikasi 30 hari pascabedah elektif antara kelompok frail terhadap kelompok fit, dan antara kelompok pre-frail terhadap kelompok fit dengan menggunakan SPSS.Hasil. Sebanyak 21,1% dari total 180 subjek pasien usia lanjut yang menjalani pembedahan elektif mengalami komplikasi 30 hari pascabedah. Proporsi kejadian komplikasi 30 hari pada kelompok frail lebih tinggi dibandingkan dengan kelompok pre-frail dan fit (41,7% vs 15% vs 9,4%). Pada analisis multivariat, didapatkan adjusted RR pada kelompok frail sebesar 4,579 (IK 95% 1,799-8,118), setelah memperhitungkan faktor perancu, yakni jenis pembedahan. Pada kelompok pre-frail, tidak ditemukan komplikasi yang berbeda bermakna walaupun terdapat kecenderungan komplikasi lebih tinggi dibandingkan kelompok fit.Kesimpulan. Kondisi frail meningkatkan risiko komplikasi 30 hari pascabedah elektif pada pasien usia lanjut. Sedangkan pre-frail dibandingkan fit walaupun tidak menunjukkan perbedaan yang signifikan, namun terdapat kecenderungan peningkatan komplikasi.

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Background. Postoperative complication is increased in the elderly patients. Frailty in the elderly is associated with postoperative complication. The impact of frailty on 30- day complications after elevtive surgery needs to be evaluated in the elderly patients in Indonesia.

Objectives. To identify the impact of frailty on 30-day complications after elective surgery in the elderly patients.

Methods. A prospective cohort study was conducted to determine the impact of frailty on 30-day complications after elective surgery in the elderly patient in Cipto Mangunkusumo hospital from 20 April to 13 Juli 2018. Frailty was asessed using Frailty Index  40 items. Analysis was done using SPSS statistic for univariate, bivariate and multivariate logistic regression to obtain crude risk ratio and adjusted risk ratio of probability of 30-day complications after elective surgery in the elderly patients.

Result. Out of the total 180 eldery patients who underwent elective surgery, 21,1% of those had 30-day complications. Postoperative complications were higher in those with frail than pre-frail and fit subjects(41,7% vs 15% vs 9,4%). Multivariate analysis using logistic regression analysis with type of surgery as counfounder, revelead that adjusted RR in frail group was 4.579 (95% CI 1.799-8.118). Although pre-frail subjects showed higher postoperative complications than fit subjects, but there were no differences significantly.

Conclusion. Elderly patients with frail condition had higher 30-day complications after elective surgery. There were no significant differences between pre-frail compared to fit subject on 30-day complications after elective surgery, although pre-frail subject tends to showed higher complication."

"Penelitian ini bertujuan mengetahui pengaruh lama pemberian antiretroviral (ARV) setelah Obat Anti Tuberkulosis (OAT) dimulai terhadap kegagalan perbaikan CD4 pasien ko-infeksi TB-HIV. Penelitian dilakukan pada mei-juni 2016 di Rumah Sakit Penyakit Infeksi (RSPI) Prof. Dr. Sulianti Saroso. Design penelitian yang digunakan adalah kohort restrospektif dengan follow-up selama satu setengah tahun. Populasi studi adalah pasien Ko-infeksi TB-HIV yang naive ART dan tercatat pada rekam medis periode Januari 2010 - November 2014. Kriteria inklusi sampel adalah pasien usia ≥15 tahun, mendapat OAT minimal 2 minggu sebelum ART dimulai, dan memiliki data hasil pemeriksaan CD4 sebanyak dua kali dengan total sampel adalah 164 orang. Probabilias kumulatif kegagalan perbaikan CD4 pasien ko-infeksi TB-HIV sebesar 14,43%. Hazard rate kegagalan perbaikan CD4 pada pasien yang memulai terapi ARV 2-8 minggu setelah OAT dibandingkan dengan yang menunda terapi ARV 8 minggu setelah OAT masing-masing 767 per 10.000 orang tahun dan 447 per 10.000 orang tahun (p=0,266). Analisis multivariat dengan menggunakan uji cox regresi time independen menunujukkan rate kegagalan perbaikan CD4 pada pasien yang memulai ART >8 minggu setelah OAT lebih rendah dibandingkan pasien yang memulai ART pada 2-8 minggu setelah OAT (Adjusted HR=0,502 ; 0,196-1,287 ; p value=0,151) setelah dikontrol oleh jenis regimen ARV dan klasifikasi pengobatan TB.

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This study was aim to assess the effect of time to Antiretroviral Treatment (ART) on CD4 response failure in TB-HIV coinfection patients. This study was conducted from May to June 2016 at Infectious Disease Hospital Sulianti Saroso. This study used cohort restrospective design with one and half year time to follow up. Study population were TB-HIV coinfected patients, noted as a naive ART patient in medical records from january 2010-november 2014. A total 164 patients ≥ 15 years old, had Anti Tuberculosis Treatment (ATT) 2 weeks before ART and had minimum 2 CD4 sell count laboratorium test results. The cumulative probability of CD4 response failure among TB-HIV co-infected patients was 14,43%. Hazard rate of CD4 response failure was 767 per 10.000 person year in early ART (2-8 weeks after ATT) versus 474 per 10.000 person year in delayed ART (8 weeks after ATT) arm (p=0,266). In multivariate analysis using time independent cox regression test, rate of CD4 responses failure was lower in patients with delayed ART until 8 weeks after ATT than early ART 2-8 weeks after ATT. (Adjusted HR=0,502 ; 0,196-1,287 ; P value=0,151) controlled by types of ARV regiments and classification of TB cure."

"[LATAR BELAKANG : Tuberkulosis (TB) hingga saat ini masih menjadi masalah kesehatan di dunia. Berdasarkan tuberculosis global report 2013 insidens TB pada tahun 2012 di seluruh dunia tidak jauh berbeda dibandingkan tahun sebelumnya, yaitu sekitar 8,6 juta. Berbagai penelitian menunjukan bahwa TB mempunyai kaitan erat terhadap gangguan hematologi seperti anemia, lekositosis, netrofilia, peningkatan laju endap darah (LED), trombositosis atau trombositopenia. Menurut WHO anemia merupakan indikator yang buruk terhadap status nutrisi dan tingkat kesehatan pasien dengan TB paru. Status nutrisi sendiri mempunyai peran terhadap seluruh fungsi sistem tubuh termasuk sistem imunitas terhadap berbagai penyakit infeksi dan status nutrisi pada pasien TB paru ditemukan secara bermakna lebih rendah dibandingkan orang sehat. Kedua keadaan ini saling berkaitan satu dengan lainnya, malnutrisi dapat menjadi predisposisi terjadinya penyakit TB dan TB itu sendiri dapat menyebabkan malnutrisi.TUJUAN : Penelitian ini untuk mengetahui hubungan antara perubahan nilai pemeriksaan hematologi (DHb, DLekosit, DLED) dan status gizi (DAlbumin, DIMT) pasien TB paru BTA (+) kasus baru sebelum dan sesudah pemberian OAT kategori 1 fase intensif dengan usia, jenis kelamin, konversi sputum dan perubahan gambaran foto toraks.METODE : Penelitian dengan desain uji klinik pre dan post study sejak bulan Januari-Juni 2014. Sebanyak 114 subjek penelitian terpilih sesuai kriteria inklusi dan bersedia mengikuti penelitian hingga akhir fase intensif.HASIL : Dari 114 orang subjek penelitian, 13 orang subjek dikeluarkan karena tidak dapat menyelesaikan penelitian. Terdapat 101 orang subjek penelitian yang bisa menyelesaikan penelitian dengan kelompok usia yang terkecil antara 23-46 tahun. Subjek penelitian terbanyak laki-laki (67,3%) dengan pendidikan terbanyak menengah (40,6%) dan bekerja sebagai pegawai swasta (41,5%). Sebagian besar subjek mengalami konversi sputum (81,2 %) dan perbaikan foto toraks (63,4%). Parameter hematologi mean ΔHb (0,78±1,08), median ΔLeukosit [1.760 (-8.948,93 – 17.738,96)], median ΔLED [-24,00 (-85 – 83)]. Parameter status gizi median ΔAlbumin [0,50 (0 – 2)] dan median ΔIMT [0,93 (-2,34 – 3,51)].KESIMPULAN : Terdapat hubungan yang bermakna antara parameter hematologi (Δleukosit) terhadap konversi sputum (p=0,038) dan parameter status gizi (ΔIMT) terhadap konversi sputum (p=0,004), BACKGROUND: Up to now, tuberculosis is still becoming a world health problem. Based on tuberculosis global report 2013, the incidence of TB in 2012 was not far different from the previous years that was about 8,6 millions. Various studies have showed that TB is closely related to the disturbance of hematology such as anemia, leucocytosis, neutrophylia, increasing of blood sedimentation rate, thrombocytosis or thrombocytopenic. According to WHO, anemia becomes bad indicator to nutritional and health status in patient with TB. While the nutrition status it self has an important role to the whole function of the body system including immune system to avoid various infectious diseases. The nutritional status in patients with TB significantly found lower compared to the healthy persons. These two factors are closely related to each other. Malnutrition cause predisposition of TB whereas TB it self can cause.PURPOSE: This study is aimed to know the relationship between hematology parameter changes (∆Hb, ∆Leucocyte, and ∆erythrocyte sedimentation rate/ESR) and the nutritional status (∆Albumin, ∆BMI) in patients with TB, AFB (+) new case before and after treatment with antituberculosis drugs category I during intensive phase based on age, sex, sputum conversion, and thorax radiology changes.METHOD: This method uses clinically design for Pre and post study from January up to June 2014. Around 114 persons have been selected according to inclusion criteria and agree to join this study until the end of intensive phase.RESULT: From 114 persons used as subjects, 13 are excluded due to the unfinished study. There are 101 subjects who are able to complete this study with the lowest age are 23 to 46. The largest subjects are male (67.3%) with their education are senior high school (40.6%) and working as private employees (41.5%). Most subjects have sputum conversion (81,2%) and radiological improvement (63.4%). In hematology parameter, the mean ∆Hb is (0.78±1.08), the ΔLeucocyte median is [1,760 (-8,948.93 – 17,738.96)], the ΔESR median is [-24.00 (-85 – 83). In nutritional status parameter, the median for ∆Albumin is [0.50 (0–2)] and ∆BMI is [0.93(-2.34 – 3.51)].CONCLUSION: Statistically, there are significant relationship between hematology parameter (∆Leucocyte) to sputum conversion (p=0.038) and nutritional status (∆BMI) to sputum conversion (p=0.004).]"

"HIV/AIDS merupakan penyakit menular yang menyerang sistem immun. Penelitian ini bertujuan untuk menggali dan memahami berbagai pengalaman pasien HIV/AIDS dengan TB dalam mengkonsumsi obat antiretroviral dan anti tuberculosis. Metode penelitian kualitatif dengan pendekatan fenomenologi digunakan dalam penelitian ini. Wawancara mendalam dilakukan kepada enam orang partisipan. Analisis data dengan menggunakan metode Colaizzi. Penelitian ini menghasilkan tujuh tema, yaitu pengalaman minum obat, perubahan fisiologi, perubahan psikologi, perubahan sosiologi, permasalahan ekonomi, pengalaman di pelayanan kesehatan serta spirit dan spiritualitas. Berdasarkan tema yang dihasilkan, disarankan agar perawat dapat memberikan asuhan keperawatan yang komprehensif dan holistik mencakup biopsikososial spiritual pada pasien karena mereka mengalami perubahan-perubahan besar dengan HIV/AIDS.

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HIV / AIDS is an infectious disease that attacks the immune system. This study aims to explore and understand the various experiences of HIV / AIDS with TB patients in consuming antiretroviral and anti-tuberculosis drugs. Qualitative research method with phenomenological approach used in this study. In-depth interviews carried out to six participants. Analysis of the data by using Colaizzi method. This research identify seven themes, namely experience taking medication, changes in physiology, psychology changes, changes in sociology, economic problems, experience in health car and spirit & spiritualit. Based on the theme generated, it is recommended that nurses can provide a comprehensive and holistic biopsychosocial spiritual nursing care cover to patients as they undergo major changes with HIV / AIDS."

"[ABSTRAKSerial kasus ini bertujuan untuk mempelajari dan menerapkan terapi nutrisi sebagai bagian dari terapi tuberkulosis (TB) paru. Komplikasi yang menyertai TB paru dapat meningkatkan morbiditas dan mortalitas. Seluruh pasien serial kasus ini dalam kondisi malnutrisi dan terdapat komplikasi yang menyertai masingmasing kasus berupa drug-induced hepatotoxicity, peritonitis TB, diabetes melitus tipe 2, dan pneumotoraks dengan dispepsia. 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% kebutuhan energi (1,2?1,5 g/kg BB). Saran pemberian mikronutrien minimal mencapai angka kecukupan gizi. Pasien yang mendapat obat antituberkulosis berupa isoniazid disarankan mendapat suplementasi vitamin B6 dengan dosis tertentu untuk mencegah neuritis perifer. Outcome yang dinilai meliputi kondisi klinis, asupan, dan toleransi asupan. Pemberian terapi nutrisi sebagian besar pasien dimulai dari kebutuhan energi basal yang pada akhir masa perawatan dapat mencapai target kebutuhan energi total. Pemantauan jangka panjang pasca rawat inap, disarankan tidak hanya menilai outcome berdasarkan perubahan berat badan, namun dilakukan penilaian komposisi tubuh, terutama massa lemak, karena pada kasus TB terjadi abnormalitas metabolisme yang disebut anabolic block.

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ABSTRACTThe aim of this case series was to study and apply nutrition therapy as integral part of pulmonary tuberculosis (TB) therapy. Pulmonary TB with complications was associated with increased of morbidity and mortality. Malnutrition was coexisted with several complications such as drug-induced hepatotoxicity, peritoneal TB, type 2 diabetes mellitus, and pneumothorax with dyspepsia. HarrisBenedict 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% energy requirement (1,2?1,5 g/body weight). Micronutrient recommendation was given to fulfill one fold recommended daily allowance. Patients with isoniazid therapy needed to get pyridoxine supplementation to prevent peripheral neuritis. Outcome measurements included clinical condition, amount of intake, and intake tolerance. Most patients were given initial nutrition therapy from basal energy requirement and has shown increment. At the end of hospitalization, all of patients could achieve total energy requirement. Due to abnormality of metabolism, usually termed as anabolic block, it was recommended not only to measure body weight as primary outcome, but also body composition., The aim of this case series was to study and apply nutrition therapy as integral part of pulmonary tuberculosis (TB) therapy. Pulmonary TB with complications was associated with increased of morbidity and mortality. Malnutrition was coexisted with several complications such as drug-induced hepatotoxicity, peritoneal TB, type 2 diabetes mellitus, and pneumothorax with dyspepsia. HarrisBenedict 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% energy requirement (1,2–1,5 g/body weight). Micronutrient recommendation was given to fulfill one fold recommended daily allowance. Patients with isoniazid therapy needed to get pyridoxine supplementation to prevent peripheral neuritis. Outcome measurements included clinical condition, amount of intake, and intake tolerance. Most patients were given initial nutrition therapy from basal energy requirement and has shown increment. At the end of hospitalization, all of patients could achieve total energy requirement. Due to abnormality of metabolism, usually termed as anabolic block, it was recommended not only to measure body weight as primary outcome, but also body composition.]"

"Kemunculan MDR-TB menghambat program pemberantasan TB dan berakibat pada meningkatnya angka kematian dan beban control TB. Tempat pengobatan TB, termasuk riwayat pengobatan, sangat mungkin merupakan predictor MDR-TB yang kuat. Tujuan dari studi ini ada untuk mengidentifikasi dan menganalisis tempat pengobatan TB primer sebagai salah satu factor yang mungkin berkontribusi dalam perkembangan TB menjadi MDR-TB. Pengumpulan data dilaksanakan pada bulan Desember 2009 hingga Agustus 2010. Mengguanakan metode cross-sectional, data didapatkan melaui wawancara mendalam dengan 50 pasien MDR-TB yang sedang mendapatkan pengobatan di klinik MDR-TB RS Persahabatan. Dalam jumlah besar pasien MDR-TB mendapatkan pengobatan di puskesmas (38%) dan dokter praktik pribadi (28%). Tidak ditemukan adanya assosiasi antara tempat pengobatan TB pertama dan kepatuhan pasien sedangkan assosiasi terlihat antara tempat pengobatan TB pertama dan peresepan obat gratis.

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The emergence of MDR-TB hampers TB eradication program which resulted in high fatality rate and increase burden of TB control. TB treatment place, including history of treatment, might be a strong predictor of MDR-TB. The purpose of this study is to identify and analyze primary TB treatment place as the contributing factor that may lead to the development of TB towards MDR-TB. The data collection was done from December 2009 to August 2010 at Persahabatan Hospital. Using cross-sectional method, data is obtained through thorough interview of 50 MDR-TB patients undergoing treatment in MDR-TB Clinic in Persahabatan Hospital. Large proportion of MDR-TB patient received their primary TB treatment at puskesmas (38%) and private Practice (28%). It is found that there is no association between primary TB treatment place and patient compliance while association appears between primary TB treatment place and free drug prescription."

"Tuberkulosis TB merupakan salah satu penyakit pembunuh yang kerap menjadi masalah besar di dunia dan diperburuk oleh masalah efek samping obat yang berdampak pada terhentinya pengobatan pasien TB. Penelitian ini dilaksanakan untuk mengkaji hubungan antara efek samping OAT dengan keberlanjutan pengobatan TB. Studi ini dilakukan dengan desain penelitian analitik menggunakan studi cross-sectional dengan melibatkan 172 data rekam medis penderita TB paru dewasa yang diobati dan mendapatkan efek samping di RSCM selama tahun 2014. Pada penelitian ini didapatkan 73,8 pasien mendapatkan efek samping minor dan 26,2 mengalami efek samping minor. Jenis efek samping minor yang muncul didominasi oleh gangguan gastrointestinal 34 dan jenis efek samping mayor didominasi hepatitis yang diinduksi oleh obat 60 . Penelitian ini menunjukkan terdapatnya hubungan yang bermakna antara variabel jenis efek samping dengan keberlanjutan terapi OR, 9,33; 95 CI, 4,20-20,72.

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Tuberculosis TB is one of top infectious diseases killer and remains as a major health problem worldwide. Moreover, the TB treatment adverse effects are able to escalate the treatment default. This study aimed to evaluate the correlation between anti TB drug adverse reactions and treatment default. A cross sectional study was performed with a total of 172 medical record data of adult pulmonary TB patients who were treated with first line anti TB drugs in Dr. Cipto Mangunkusumo National General Hospital during 2014 and experienced adverse reaction.

127 patients 73.8 were experiencing minor adverse reaction and 45 patients 26.2 were experiencing mayor adverse reaction. The adverse reaction was dominated by gastrointestinal disorders 34 and drug induced hepatitis 60. There was a significant correlation between adverse reactions of anti TB drug and the treatment default cases OR, 9.33 95 CI, 4.20 20.72 p."