Hasil Pencarian  ::  Simpan CSV :: Kembali

"Latar Belakang: Meningitis tuberkulosis (TBM) memiliki angka kematian yang tinggi khususnya pada kelompok HIV positif. Penelitian ini bertujuan untuk mengetahui karakteristik klinis dan prediktor kesintasan TBM dalam masa perawatan dan 6 bulan berdasarkan status infeksi HIV.Metode: Studi kohort retrospektif menggunakan data Indonesian Brain Infection Study bulan April 2019-September 2021 dengan diagnosis akhir TBM. Analisis faktor yang berhubungan dengan kesintasan masa perawatan dilakukan dengan regresi logistik. Estimasi probabilitas kesintasan 6 bulan dan prediktor yang berperan dinilai menggunakan kurva Kaplan-Meier dan uji regresi Cox.Hasil: Sebanyak 133 subjek TBM dimasukkan ke dalam studi (HIV positif 39,8%, TBM definite 31,6%). HIV positif memiliki temuan TBM definite yang lebih rendah, peningkatan sel dan protein cairan serebrospinal (CSS) yang lebih rendah, penurunan rasio glukosa CSS:serum yang lebih rendah, dan temuan TB milier yang lebih tinggi. Kesintasan dalam masa perawatan secara umum adalah 73,7% (HIV positif 67,9% vs. HIV negatif 77,5%, p=0,2), dipengaruhi oleh TBM probable dan TBM derajat 3. Estimasi probabilitas kesintasan 6 bulan adalah 57,9% (HIV positif 54,7% vs. HIV negatif 60%, p=0,4), dipengaruhi oleh waktu inisiasi obat antituberkulosis (OAT) dan TBM derajat 3. Tidak didapatkan perbedaan prediktor kesintasan masa perawatan dan 6 bulan berdasarkan status HIV.Kesimpulan: Kelompok HIV positif memiliki gambaran inflamasi CSS yang lebih rendah namun cenderung memiliki kesintasan rawat inap dan 6 bulan yang lebih rendah. TBM stadium lanjut berperan pada kesintasan jangka pendek dan panjang, sementara penundaan inisiasi OAT sejak admisi berhubungan dengan kesintasan jangka panjang.

---

Background: Tuberculous meningitis (TBM) has a high mortality rate, especially in the HIV positive group. This study aims to define the clinical characteristics, as well as to analyze the inhospital and 6 month-survival and the following predictors of TBM patients with and without HIV infection.

Methods: Cohort retrospective study using Indonesian Brain Infection Study data with final diagnosis of TBM, between April 2019 and September 2021. Logistic regression was used to determine the predictors of inhospital survival. Meanwhile, 6-months probability survival was estimated using Kaplan-Meier curves and Cox regression analysis.

Results: A total of 133 subjects were included in the study (HIV positive 39.8%, definite TBM 31.6%). HIV positive group had less TBM definite, lower cerebrospinal fluids (CSF) cells and protein increases, smaller decrease in CSF:serum glucose ratio, and more miliary TB cases. Overall inhospital survival was 73.7% (HIV positive 67.9% vs. HIV negative 77.5%, p=0.2), with predictors of TBM probable and TBM grade 3. Six-month probability survival estimates was 57.9% (HIV positive 54.7% vs. HIV negative 60%, p-=0,4), with predictors of initiation of TB drug timing and TBM grade 3. We found no significant differences of inhospital and 6-month predictors according to HIV status.

Conclusions: Despite less inflammatory profile, HIV positive group had lower inhospital and 6-month survival. Advanced stage TBM had lower inhospital and 6-month survival, while delayed TB drug initiation was more related to the 6-month survival."

"Latar Belakang: Mycobacterium tuberculosis merupakan penyebab tuberkulosis pada paru dan organ lain, seperti meningen meningitis tuberkulosis . Meningitis tuberkulosis dapat merupakan komplikasi tuberkulosis primer, yang bersifat laten/asimptomatik, namun risiko reaktivasi meningkat pada penurunan sistem imun/malnutrisi. Disfagia, defisit kognitif, hemiparese, dan ketidakmampuan makan mandiri juga dapat menyebabkan malnutrisi, sehingga akan meningkatkan lama rawat dan mengganggu perbaikan kapasitas fungsional. Tatalaksana nutrisi diperlukan untuk meminimalisasi kehilangan berat badan, mendapatkan imbang nitrogen positif, dan menyediakan nutrisi untuk membangun system imun. Pada pelaksanaannya, pemberian nutrisi harus memperhatikan kondisi klinis serta komplikasi berupa peningkatan tekanan intrakranial dan defisit neurologi yang terjadi. Metode: Laporan serial kasus ini menguraikan empat kasus meningitis tuberkulosis dengan tuberkulosis paru. Semua pasien datang dengan penurunan kesadaran dan telah terdiagnosis tuberkulosis paru sebelumnya, namun pasien minum obat tidak sesuai dengan anjuran dokter. Status gizi keempat pasien adalah malnutrisi ringan dan berat, obes 1 dan normal. Selama dirawat, tatalaksana nutrisi diberikan sesuai pedoman terapi nutrisi untuk penderita tuberkulosis. Asupan makronutrien diberikan meningkat bertahap sesuai kondisi klinis dan toleransi pasien. Suplementasi mikronutrien juga diberikan. Pemantauan meliputi keluhan subjektif, hemodinamik, analisis dan toleransi asupan, pemeriksaan laboratorium, antropometri, keseimbangan cairan, dan kapasitas fungsional. Hasil: Dua orang pasien menunjukkan perbaikan klinis, kapasitas fungsional, hasil laboratorium, toleransi asupan, dan outcome, sedangkan dua orang lainnya mengalami perburukan dan meninggal pada hari perawatan ke-44 dan ke-24. Kesimpulan: Dukungan nutrisi infeksi tuberkulosis pada paru dan susunan saraf, dapat memberikan manfaat untuk pemulihan pasien.

---

Objective: Mycobacterium tuberculosis is the cause of tuberculous in the lung and other organs, such as the meninges tuberculous meningitis . Tuberculous meningitis can be a complication of primary tuberculous, latent asymptomatic, but the risk of reactivation increases to a decrease in the immune system malnutrition. Dysphagia, defisit kognitif, hemiparese, and inability to eat independently can also cause malnutrition, thereby increasing the length of stay and interfere with the functional capacity improvement. Management of nutrients needed to minimize the lose weight, get a positive nitrogen balance, and provide nutrients for building the immune system. In practice, the nutrition must consider the clinical condition and the complications in the form of increased intracranial pressure and neurological deficits that occur.

Methods: This case series report outlines four cases of tuberculous meningitis with pulmonary tuberculous. All patients present with loss of consciousness and have been diagnosed with pulmonary tuberculous before, but patients taking the medicine does not comply with doctor's advice. Nutritional status of the four patients was mild and severe malnutrition, obese and normal one. During the treatment, management of nutrition was given according to the guidelines of nutrition therapy for patients with tuberculosis. Macronutrient intake increased gradually given appropriate clinical condition and patient tolerance. Micronutrient supplementation are also given. Monitoring included subjective complaints, hemodynamic, analysis and tolerance intake, laboratory tests, anthropometric, fluid balance, and functional capacity.

Results: Two patients showed clinical improvement, functional capacity, laboratory results, tolerance intake, and outcome, while two other people suffered deterioration and died on the 44th and 24th day of treatment.

Conclusion: Nutritional support tuberkulosis infection in the lungs and nervous system, can provide benefit to the patient's recovery."

"Latar Belakang: Meningitis tuberkulosis (TBM) merupakan manifestasi terberat infeksi TB dan prognosisnya bergantung pada kecepatan memulai terapi. Studi ini bertujuan mengetahui alur perjalanan pasien TBM serta faktor-faktor yang memengaruhi keterlambatan dalam mendapatkan pengobatan.Metode Penelitian: Penelitian ini merupakan studi potong lintang dari pasien TBM yang sudah mendapatkan terapi OAT dan dirawat di RSCM pada bulan Januari 2020 – April 2022. Data diperoleh melalui wawancara terhadap pasien atau pendamping dan telusur rekam medis.Hasil: Sebanyak 99 orang subjek yang memenuhi kriteria. Terdapat 6 pola alur perjalanan pasien dengan yang terbanyak adalah mengalami gejala umum diikuti gejala neurologis, mencari pertolongan kesehatan, terdiagnosis, dan mendapatkan pengobatan (52,5%). Fasilitas kesehatan pertama terbanyak dikunjungi pasien adalah praktek dokter swasta (L1b) (35,4%). Median jumlah kunjungan yang dibutuhkan pasien untuk mendapatkan pengobatan adalah 6 (4-9) kunjungan dengan durasi keterlambatan sebagai berikut: keterlambatan pasien 17 (3-33) hari, keterlambatan diagnosis 44 (16-101) hari, keterlambatan pengobatan 1 (0-1) hari, dan keterlambatan total adalah 78 (33-170) hari. Faktor yang secara signifikan berhubungan dengan keterlambatan yang lebih panjang (>78 hari) adalah jumlah kunjungan ke fasilitas kesehatan aOR=3,51 (CI95=1,36-9,10; p=0,01) dan pendidikan rendah aOR=0,30 (CI95=0,01-0,89; p=0,03).Kesimpulan: Pasien TBM di RSCM menjalani kunjungan multipel dan membutuhkan waktu 2,5 bulan sejak mengalami gejala hingga mendapatkan pengobatan dengan keterlambatan terbesar berasal dari sistem kesehatan.

---

Background: Tuberculous meningitis (TBM) is the worst manifestation of TB infection. Its prognosis is depend on timely treatment initiation. This study intend to know TBM patient pathway and factors that affect treatment delay.

Methods: This was a crossectional study of TBM patients who have received antituberculous medication and were admitted at the RSCM January 2020-April 2022. Data were obtained from interview to either patient or caregiver and medical reccord.

Results: A total of 99 subjects met the criteria. There were 6 patterns of patient pathway with the most prevalent is having general symptoms followed by neurological symptoms, first healthcare visit, diagnosed, and treated (52.5%). The first healthcare visited by most patients was private doctor's practice (L1b) (35.4%). Median number of visits before recieving treatment was 6 (4-9) visits. Delay duration are as follow: patient delay 17 (3-33) days, diagnosis delay 44 (16-101) days, treatment delay 1 (0-1) day, and total delay 78 (33-170) days. Factors that significantly associated with longer delays were number of visits to healthcare facilities aOR=3.51 (CI95=1.36-9.10; p=0.01) and lower education aOR=0.30 (CI95=0 .01-0.89; p=0.03).

Conclusions: TBM patients experienced multiple visit and had 2.5 months delay from first symptoms to treatment with the longest delay coming from the healthcare system."

"Latar Belakang : Gangguan fungsi hati pada meningitis tuberkulosis (MTB) dilaporkan sebesar 9,5- 43,3%. Gangguan hati dapat mempengaruhi tata laksana berupa interupsi pemberian obat anti tuberkulosis (OAT) yang dapat menyebabkan perburukan klinis dan meningkatkan risiko kematian terutama pada fase intensif. Metode : Studi kohort retrospektif pada pasien MTB untuk mengetahui karakteristik demografi, laboratorium gangguan fungsi hati dan mortalitas baik pada kelompok dengan dan tanpa interupsi OAT fase intensif. Penelurusan rekam medis pada pasien MTB yang dirawat di RSUPN Cipto Mangunkusumo pada Januari 2019 – April 2023. Hasil : Dari 200 subjek yang memenuhi kriteria, sebanyak 145 subjek (72,5%) mengalami gangguan fungsi hati, terdiri dari 88 subjek (60,7%) derajat ringan, 25 subjek (17,2%) derajat sedang, dan 32 subjek (22,1%) derajat berat. Gangguan fungsi hati banyak terjadi pada lak-laki (59,3%), median usia 37 tahun. Interupsi OAT dilakukan pada 43 subjek (29,7%). Perbedaan karakteristik yang bermakna adalah laki-laki (72,1% vs 53,9%, p=0,04), kadar tertinggi serum glutamic ocaloacetic transaminase (SGOT) (195 (10-2.945) vs 53,5 (14-464), p=<0,001) serum glutamic pyruvic transaminase (SGPT) (128 (10-1.268) vs 50 (10-294), p=<0,001), bilirubin total (1,57 (0,34-8,98) vs 1,08 (0,25-2,43), p=<0,001) dan direk (1,11 (0,19-8,05) vs 0,56 (0,12-2,01), p=<0,001). Gangguan fungsi hati derajat berat lebih banyak pada kelompok dengan interupsi (62,8% vs 4,9%, p=<0,001). Mortalitas lebih banyak pada kelompok dengan gangguan fungsi hati (34,5% vs 16,4%, p=0,012) dan pada kelompok dengan interupsi (55,8% vs 44,2%, p=<0,001). Kesimpulan : Gangguan fungsi hati pada MTB lebih banyak ditemukan pada laki-laki dengan usia dekade ketiga. Perbedaan karakteristik bermakna pada kelompok dengan interupsi OAT adalah kadar fungsi hati dan derajat gangguan fungsi hati yang lebih buruk. Mortalitas lebih banyak pada kelompok dengan gangguan fungsi hati dan kelompok dengan interupsi OAT.

---

Background : Liver dysfunction in tuberculosis meningitis (TBM) has been reported 9,5 – 43,3%. Liver dysfunction could impact to the therapy with interuption of antituberculosis therapy (ATT). That interruption can caused clinical deterioration and increase risk of death, especially in the intensive phase. Methods : Retrospective study on TBM patients to determine the demographic and laboratory characteristics of liver dysfunction and mortality in both groups with and without interruption of intensive phase ATT. Using medical records of TBM patients who admitted at Dr. Cipto Mangunkusumo National General Hospital from January 2019 to April 2023. Results : Total 200 subjects met the criteria, there were 145 subjects (72.5%) had liver dysfunction, the degree were consist of 88 subjects (60.7%) mild, 25 subjects (17.2%) moderate, and 32 subjects (22.1%) severe. Interruption ATT were in 43 subjects (29.7%). Liver dysfunction was common in male and median age were 37 years. Significant characteristics difference were male (72.1% vs 53.9%, p=0.04), peak level of aspartate transaminase (AST) (195 (10-2945) vs 53.5 (14-464), p=<0.001), alanine aminotransferase (ALT) (128 (10-1268) vs 50 (10-294), p=<0.001), total bilirubin (1.57 (0.34-8.98) vs 1.08 (0.25-2.43), p=<0.001) and direct bilirubin (1.11 (0.19-8.05) vs 0.56 (0.12-2.01), p=<0.001). Severe liver dysfunction more common in group with interruption (62.8% vs 4.9%, p=<0.001). Mortality was higher in liver dysfunction group (34.5% vs 16.4%, p=0.012), and in group with interruption (55.8% vs 44.2%, p=<0.001). Conclusion : Liver dysfunction in TBM more common in male in third decade. Significant characteristics difference were male, higher level of liver function test and degree of liver dysfunction. Mortality was higher in liver dysfunction group and group with interruption"

"Latar Belakang. Neurosifilis merupakan infeksi susunan saraf akibat invasi bakteri Treponema Pallidum yang dapat menyebabkan kecacatan. Selain itu gejala klinis neurosifilis beragam, tidak khas, bahkan asimtomatik sehingga dapat menyebabkan kesalahan diagnosis yang cukup tinggi. Angka kejadian sifilis di Indonesia masih tinggi bahkan masih terus meningkat. Akan tetapi hingga saat ini belum diketahui prevalensi dan deskripsi neurosifilis di Indonesia. Studi ini bertujuan untuk mendapatkan prevalensi neurosifilis dan perbandingan karakteristik klinis dan penunjang antara neurosifilis dan non-neurosifilis di RSUPN dr. Cipto Mangunkusumo.Metode. Studi potong lintang dengan data rekam medis di RSUPN dr. Cipto Mangunkusumo pada pasien dengan kecurigaan neurosifilis yang dikonsulkan ke neurologi sejak Januari 2019-Januari 2024. Dilakukan evaluasi karakteristik klinis dan penunjang baik profil darah berupa serum maupun cairan serebrospinal (CSS) serta pencitraan otak.Hasil. Dari 100 subjek dengan kecurigaan neurosifilis yang dikonsulkan ke neurologi, terdapat 72 kasus neurosifilis dan 28 kasus non neurosifilis. Pada kelompok neurosifilis keluhan tersering saat dikonsulkan ke neurologi adalah gangguan penglihatan (OR 7,46 [2,83-19,64], p<0,001) dan nyeri kepala (OR 4,43 [1,22-16.14], p= 0,031). Titer RPR serum (median 1:128) dan TPHA serum kelompok neurosifilis (median 1:10240) lebih tinggi dibandingkan non neurosifilis. Kelompok neurosifilis cenderung memiliki jumlah leukosit CSS lebih tinggi (median 7 [1,00-155,0], p<0,001) dan jumlah protein lebih tinggi (median 47 [5,00-612,00], p<0,001) dibandingkan non-neurosifilis. Pada 10 subjek neurosifilis dengan gambaran pencitraan otak abnormal terdapat 3 subjek dengan gambaran space occupying lesion.Kesimpulan. Prevalensi neurosifilis pada pasien sifilis yang dikonsulkan ke neurologi di RSUPN dr. Cipto Mangunkusumo sangat tinggi (72%). Kecurigaan neurosifilis lebih tinggi pada pasien sifilis dengan keluhan gangguan penglihatan atau nyeri kepala dan memiliki kadar limfosit darah yang rendah, dengan titer RPR serum ≥1:128 dan titer TPHA serum ≥1:10.240. Selain itu studi ini juga mendapatkan 10 subjek dengan abnormalitas pencitraan otak, sehingga pada pasien sifilis terutama dengan gejala dan tanda neurologi perlu dipertimbangkan untuk dilakukan pemeriksaan pencitraan otak MRI Kepala.

---

Background. Neurosyphilis is an infection of the nervous system caused by the invasion of the bacterium Treponema pallidum, which can lead to disability. Additionally, the clinical symptoms of neurosyphilis are varied, non-specific, and can even be asymptomatic, leading to a high rate of misdiagnosis. The incidence of syphilis in Indonesia remains high and continues to increase. However, to date, the prevalence and description of neurosyphilis in Indonesia are still unknown. This study aims to determine the prevalence of neurosyphilis and to compare the clinical and supporting characteristics between neurosyphilis and non-neurosyphilis patients at the National Central General Hospital Dr. Cipto Mangunkusumo.

Methods. A cross-sectional study utilizing medical records at RSUPN Dr. Cipto Mangunkusumo will be conducted on patients suspected of having neurosyphilis who were referred to neurology from January 2019 to January 2024. The study will evaluate clinical characteristics and supportive data, including blood profiles (serum), cerebrospinal fluid (CSF) analysis, and brain imaging.

Result. From 100 subjects with suspected neurosyphilis referred to neurology, there were 72 cases of neurosyphilis and 28 cases of non-neurosyphilis. In the neurosyphilis group, the most common complaints at the time of consultation were visual disturbances (OR 7.46 [2.83-19.64], p<0.001) and headaches (OR 4.43 [1.22-16.14], p=0.031). Serum RPR titers (median 1:128) and TPHA titers (median 1:10240) were higher in the neurosyphilis group compared to the non-neurosyphilis group. The neurosyphilis group tended to have higher CSF leukocyte counts (median 7 [1.00-155.0], p<0.001) and higher protein levels (median 47 [5.00-612.00], p<0.001) compared to the non-neurosyphilis group. Among 10 neurosyphilis subjects with abnormal brain imaging, 3 subjects had findings suggestive of a space-occupying lesion

Conclusion. The prevalence of neurosyphilis among syphilis patients referred to neurology at RSUPN dr. Cipto Mangunkusumo is very high (72%). Suspicion of neurosyphilis is higher in syphilis patients presenting with visual disturbances or headaches and having low blood lymphocyte levels, with serum RPR titers ≥1:128 and serum TPHA titers ≥1:10,240. Additionally, this study also identified 10 subjects with abnormalities in brain imaging. Therefore, in syphilis patients, especially those with neurological symptoms and signs, consideration should be given to performing brain MRI imaging."

"Peran perawat spesialis diperlukan untuk peningkatan kualitas pelayanan asuhan keperawatan yang kompleks dan akurat sebagai pemberi asuhan keperawatan tingkat lanjut kasus neurosain, pendidik, advokat, serta agen pembaharu melalui penerapan evidence based nursing (EBN) dan proyek inovasi. Asuhan keperawatan tingkat lanjut menggunakan teori Adaptasi Roy yaitu pengelolaan pasien meningitis tuberkulosis sebagai kasus utama dan 30 resume gangguan sistem neurologi. Teori Roy banyak bertujuan meningkatkan perilaku adaptif dan mengubah perilaku inefektif. Diagnosis keperawatan yang paling banyak ditemukan pada pasien gangguan sistem neurologi adalah ketidakefektifan perfusi jaringan serebral dan hambatan mobilitas fisik. Penerapan EBN dilakukan pada pasien stroke yang mengalami disfagia. Pasien diberikan latihan menelan shaker exercise hasilnya menunjukkan peningkatan kemampuan menelan dan tidak terjadi aspirasi. Proyek inovasi kelompok menerapkan Pengembangan Media Edukasi Perawatan Pasien Brain Tumor Craniotomy. Penerapan proyek inovasi meningkatkan pengetahuan pasien, keterampilan pasien latihan napas dalam dan mobilisasi setelah operasi, dan menambah kepercayaan diri perawat saat memberikan edukasi. Pengalaman praktik residensi diharapkan menambah kompetensi dan peran perawat spesialis di lahan klinik.

---

The role of nurse specialists is needed to improve the quality of complex and accurate nursing care services as providers of advanced nursing care in cases of neuroscience, educators, advocates, and agents of reform through the application of evidence based nursing (EBN) and innovation projects. Advanced nursing care uses Roy's Adaptation theory, which is the management of meningitis tuberculosis patients as the main case and 30 resumes of neurological system disorders. Roys theory aims to improve adaptive behavior and change ineffective behavior. The most common nursing diagnoses found in patients with neurological system disorders are ineffective perfusion of cerebral tissue and barriers to physical mobility.

EBN application is performed on stroke patients who have dysphagia. The patient is given training to swallow the exercise shaker, which results in increased swallowing ability and no aspiration. The group innovation project applies Development of Educational Media for Nursing Brain Tumor Craniotomy Patients. The application of innovation projects increases patient knowledge, the skills of patients in deep breathing exercises and mobilization after surgery, and increases nurse confidence when providing education. The residency practice experience is expected to increase the competency and role of specialist nurses on the clinic grounds."

"Latar belakang : penegakkan diagnosis TB paru pada pasien HIV dapat dilakukan berdasarkan pemeriksaan mikrobiologis dan klinis. Rekomendasi WHO 2007, memperbolehkan penegakan diagnosis berdasarkan hasil pemeriksaan klinis dengan dan tanpa melalui pemeriksaan mikrobiologis. Penelitian ini bertujuan mendapatkan perbedaan karakteristik gambaran radiografi toraks pasien HIV dengan TB paru yang didiagnosis berdasarkan pemeriksaan mikrobiologis dan klinis. Metode : Penelitian ini adalah comparative cross sectional study. Subyek penelitian diambil secara consecutive dan dipilih berdasarkan catatan hasil pemeriksaan BTA sputum, kultur, Genexpert®, CD4+, dan radiografi toraks. Subyek penelitian dikelompokkan menjadi mikrobiologis dan klinis. Dilakukan pembacaan ulang radiografi toraks. Hasil : gambaran radiografi toraks dengan frekuensi terbanyak pada kelompok diagnosis mikrobiologis adalah infiltrat/konsolidasi, fibroinfiltrat, limfadenopati, kavitas dan kalsifikasi. Sisanya efusi pleura, milier, fibrosis, bronkiektasis, pneumotoraks dan normal. Pada kelompok diagnosis klinis, gambaran radiografi toraks dengan frekuensi terbanyak adalah infiltrat/konsolidasi, kavitas, limfadenopati, fibroinfiltrat dan sisanya kalsifikasi, efusi pleura, milier, fibrosis, bronkiektasis, dan normal. Terdapat perbedaan bermakna karakteristik gambaran radiografi toraks fibroinfiltrat pada kelompok diagnosis mikrobiologis dan klinis. Frekuensi fibroinfiltrat terbanyak adalah di kelompok mikrobiologis dengan sebaran lokasi tersering di lapangan atas paru. Kesimpulan : Terdapat perbedaan bermakna karakteristik gambaran radiografi toraks fibroinfiltrat pada kelompok diagnosis mikrobiologis dan klinis dengan lokasi tersering di lapangan atas paru.

---

Background : To diagnose Pulmonary Tuberculosis in HIV patient can be done based on microbiology examination and clinically. WHO 2007 recommendation, allowing diagnosis based on clinical examination with and without microbiological examination. This study aims to obtain the different characteristics of chest radiographs of HIV patients with pulmonary TB were diagnosed based on clinical and microbiological examination.

Methods : This study is a comparative cross-sectional study. Subjects were taken consecutively and selected based on the results of sputum smear examination, culture, Genexpert®, CD4+, and chest x-ray. The study subjects were grouped into microbiological and clinical. Then we do expertise review.

Results : The most chest x-ray finding in the microbiological group is infiltrates/ consolidation. Following by fibroinfiltrat, lymphadenopathy, cavities and calcification. The rest are pleural effusion, miliary, fibrosis, bronchiectasis, pneumothorax and normal . In the group of clinical diagnosis, the highest frequency chest x-ray finding is infiltrates/ consolidation. Following by cavities, lymphadenopathy, fibroinfiltrat and the rest are calcification, pleural effusion, miliary, fibrosis, bronchiectasis and normal. There is significant differences of fibroinfiltrat on microbiological and clinical diagnosis groups. The highest frequency of fibroinfiltrat is in the microbiological group with the most common sites in the upper of the lung field.

Conclusions : There is significant differences of fibroinfiltrat on microbiological and clinical diagnosis groups with the most common sites in the upper lung field."

"Latar Belakang. Sejak laporan pertama ensefalitis antireseptor N-methyl-D-aspartate (NMDA) pada 2007, prevalensi ensefalitis autoimun (EA) serupa dengan ensefalitis infeksi (EI). Sayangnya, heterogenitas klinis EA, serupanya klinis dengan EI, penyakit autoimun seperti neuropsikiatrik lupus eritematosus sistemik, atau penyakit psikiatrik menjadi tantangan deteksi awal dan tatalaksana EA. Keterlambatan berhubungan dengan perburukan luaran, sedangkan kekurang-tepatan menerapi EI sebagai EA dapat mengeksaserbasi infeksi. Studi ini bertujuan mengenali karakteristik EA, khususnya ensefalitis antireseptor NMDA definit sebagai EA tersering, di era keterbatasan ketersediaan penunjang definitif di Indonesia.Metode. Studi kohort retrospektif dengan rekam medis di RSUPN dr. Cipto Mangunkusumo dilakukan pada curiga EA yang menjalani pemeriksaan antireseptor NMDA cairan otak sejak Januari 2015-November 2022. Karakteristik klinis dan penunjang EA, EA seropositif NMDA, dan luarannya dinilai. Analisis univariat dan bivariat dilakukan sesuai kebutuhan.Hasil. Dari 102 subjek yang melalui kriteria inklusi dan eksklusi, terdapat 14 EA seropositif dan 32 seronegatif NMDA. Temuan klinis EA terbanyak adalah gangguan psikiatri dan tidur (85,7%), gangguan kesadaran (78,3%), prodromal (76,1%), dan bangkitan (70,6%). Karakteristik penunjang EA adalah inflamasi sistemik (75,0%), inflamasi cairan otak (69,2%), abnormalitas MRI (57,9%) dominan inflamasi (42,2%), dan abnormalitas EEG (89,5%). Karakteristik klinis EA seropositif NMDA adalah psikosis (76,9% vs 24,1%, p=0,002), delirium (71,4% vs 40,6%, p=0,06), bangkitan (71,4% vs 46,7%, p=0,12), takikardia (55,6% vs 17,6%, p=0,08), dan gangguan otonom lainnya (55,6% vs 23,5%, p=0,19), sedangkan klinis EA seronegatif NMDA adalah somnolen (34,4% vs 7,1%, p=0,07) dan defisit neurologis fokal (31,3% vs 7,1%, p=0,13). Leukositosis dan pleositosis cairan otak dengan dominasi mononuklear secara signifikan lebih ditemukan pada EA seropositif NMDA. Sebanyak 10,9% subjek meninggal.Kesimpulan. Karakteristik klinis EA adalah gangguan psikiatri dan tidur, gangguan kesadaran, prodromal, dan bangkitan. Psikosis, delirium, bangkitan, dan disfungsi otonom cenderung lebih ditemukan pada EA seropositif NMDA. Inflamasi sistemik, cairan otak, MRI, dan abnormalitas EEG sering ditemukan pada EA, terutama seropositif NMDA. 

---

Background. Since the first report of N-methyl-D-aspartate receptor (NMDAR) encephalitis in 2007, the prevalence of autoimmune encephalitis (AE) was similar to infectious encephalitis (IE). Unfortunately, heterogenities of EA as well as similarities in the manifestation to IE, other autoimmune diseases including neuropsychiatric systemic lupus erythematosus, or psychiatric diseases compromised the early detection and management of EA. This delay correlated with worse outcome whereas the inaccuracy in treting IE as AE may exacerbate infection. This study aimed to describe the characteristics of EA, particularly definitive NMDAR encephalitis as the most common, in the era of limited availability of definitive ancillary test in Indonesia.

Methods. Retrospective study using medical records at Dr. Cipto Mangunkusumo National Center General Hospital was conducted for suspected EA cases tested for cerebrospinal fluid NMDAR autoantibody test from January 2015 to November 2022. Clinical, ancillary characteristics, and concordance between clinical diagnosis and diagnostic criteria were assessed. Univariate, bivariate, and multivariate analysis were perfomed as needed.

Result. Of 102 subjects following inclusion and exclusion criteria, there were 14 seropositive and 32 seronegative NMDA subject. Clinical characterstics of AE were psychiatric and sleep disorder (85,7%), altered consciousness (78.3%), prodromal (76.1%), and seizure (70.6%). Ancillary characteristics of AE were systemic inflammation (75.0%), cerebrospinal fluid inflammation (69.2%), MRI abnormalities (57.9%) with inflammatory predominance (42.2%), and EEG abnormalities (89.5%). Seropositive NMDA characteristics were psychosis (76.9% vs 24.1%, p=0.002), delirium (71.4% vs 40.6%, p=0.06), seizure (71.4% vs 46.7%, p=0.12), tachycardia 955.6% vs 17.6%, p=-0.08), and other autonomic disorder (55.6% vs 23.5% p=0.19) whereas seronegative NMDA characteristics were somnolence (34.4% vs 7.1%, p=0.07) and focal neurologic deficit (31.3% vs 7.1%, p=0.13). Leukocytosis and cerebrospinal fluid pleocytosis with mononuclear predominance were significantly found in seropositive NMDA AE. The mortality rate was 10.9%.

Conclusion. Clinical characteristics of AE were psychiatric and sleep disorder, altered consciousness, prodromal, and seizure. Psychosis, delirium, seizure, and autonomic dysfunction tended to be found in seropositive NMDA AE. Inflammation in systemic, cerebrospinal fluid, and MRI findings as well as EEG abnormalities commonly occurred in AE, especially seropositive NMDA."

"Latar Belakang: Angka kejadian Tuberkulosis Ekstra Paru (TBEP) lebih tinggi pada pasien dengan infeksi HIV. Pasien TBEP dengan infeksi HIV berisiko mengalami perburukan yang cepat dan angka kematian yang tinggi. Oleh karena nya perlu diketahui karakterisitik klinis setiap jenis TBEP agar dapat mendeteksi HIV dan memulai tatalaksana TBEP lebih dini. Tujuan: Mengetahui pola demografi pasien TBEP dan mengetahui karakteristik klinis TBEP pada pasien HIV positif dan HIV negatif. Metode: Penelitian ini dilakukan dengan desain potong lintang dengan menggunakan data sekunder dari rekam medis pasien TBEP di seluruh RSCM baik rawat jalan maupun rawat inap selama tahun 2008-2012. Semua data dikumpulkan dan diseleksi. Kriteria inklusi penelitian ini adalah pasien TBEP dewasa dan memiliki data rekam medis yang lengkap serta dilakukan pemeriksaan Elisa anti HIV. Data yang terkumpul diolah secara deskriptif dengan menggunakan piranti lunak SPSS. Hasil: Penelitian ini mendapatkan 620 pasien TBEP yang terdiri dari 75,97% dengan HIV positif dan 24,03% dengan HIV negatif. Kelompok usia terbanyak 18-40 tahun. Jenis kelamin pria didapat sebesar 76,6%. Sebagian besar (57,7%) berpendidikan SMA dan sederajatnya dan 46,13% tidak bekerja. Distribusi organ terbanyak pada kelompok HIV positif adalah limfadenitis TB ( 42,59%) dan pada kelompok HIV negatif adalah meningitis TB (36,18%). Gambaran klinis sistemik terbanyak adalah penurunan berat badan, demam lama, dan lemah/lemas. Karakteristik klinis tiap jenis TBEP pada kelompok HIV positif dan HIV negatif pada umumnya serupa dan keluhan terbanyak adalah nyeri. Simpulan : Proporsi TBEP pada pasien HIV positif lebih banyak dari pada HIV negatif. Pola demografi TBEP adalah sebagian besar pria, kelompok usia 18-40 tahun, berpendidikan SMA dan sederajatnya, sudah menikah, dan tidak bekerja. Karakteristik klinis setiap jenis TBEP pada pasien HIV positif dan HIV negatif serupa.

---

Background: Prevalence of Extrapulmonary TB (EPTB) increases along with an escalated number of HIV infection. Patients with EPTB with HIV infection are at risk of having rapid deterioration and higher death rate. Therefore, it is important to identify clinical characteristics of each EPTB in both HIV positive and negative patients allowing early EPTB management and thus decreasing its mortality rate.

Objectives: To recognize the demographic pattern of EPTB patients and identify clinical characteristics of EPTB in HIV positive and negative patients.

Methods: This was a cross sectional study that utilized secondary data from medical records of EPTB patients from all units in RSCM, both outpatient and inpatient during a period from 2008 - 2012. Data were gathered and selected. All EPTB patients who had complete medical record and had anti HIV ELISA examined were included in this study. Gathered data were processed descriptively by using SPSS software to be presented.

Result: This study obtained data from 620 EPTB patients consisted of 75,97% with HIV positive and 24,03% with HIV negative. Most patients were in 18 - 40 year-old age group, 70% were male, 57,7% had education at senior high school or equivalent level while 46,13% were unemployed. Distribution of organ involvement in HIV positive were lymphadenitis ( 42,59%) and in HIV negetive were meningitis (36,18%). Systemic clinical presentation were mostly weight loss, prolonged fever, and weakness/fatigue. Clinical characteristics in each EPTB both in HIV positive and negative were generally similar. The most common symptoms were pain.

Conclusion: EPTB proportion in HIV positive patients were higher than in HIV negative. Demographic pattern of EPTB were mostly male, age group 18 - 40 year-old, senior high school or equivalent level and unemployed. Clinical characteristics from each type of EPTB in HIV positive and negative were similar."

"Latar Belakang: Insidensi hiponatremia pada infeksi intrakranial sebesar 30-66%. Hiponatremia dapat memperburuk manifestasi neurologis infeksi intrakranial itu sendiri serta dikaitkan dengan peningkatan morbiditas dan mortalitas.Metode: Penelitian dengan studi potong lintang retrospektif untuk mengetahui karakteristik hiponatremia dan hubungannya dengan keluaran klinis pasien infeksi intrakranial di RSUPN Dr. Cipto Mangunkusumo (RSCM) pada April 2019 s/d Oktober 2021. Data dasar diambil dari Indonesian Brain Infection Study (IBIS) kemudian dilengkapi dari rekam medis. Subjek ≥18 tahun dengan diagnosis akhir infeksi intrakranial masuk kriteria inklusi, sedangkan data tidak lengkap dan tidak rawat inap masuk kriteria eksklusi.Hasil: Terdapat 296 subjek dengan mayoritas meningoensefalitis tuberkulosis (51,4%). Hiponatremia pada 66,6% subjek, terbagi menjadi derajat ringan (54%), sedang (24%) dan berat (22%). Hiponatremia banyak terjadi pada HIV positif (59,1%), komorbid penyakit paru (44,9%) dengan keluhan terbanyak sakit kepala (58,1%). Kematian terjadi pada (24,2%) subjek hiponatremia, dimana usia >60 tahun, komorbid, penyakit paru atau ginjal, hiponatremia berat dan status hiponatremia tidak terkoreksi berhubungan dengan kematian (p<0,05).Kesimpulan: Pada infeksi intrakranial, koinfeksi HIV berhubungan dengan kejadian hiponatremia. Tidak ditemukan perbedaan bermakna karakteristik hiponatremia terhadap mortalitas, status fungsional maupun durasi perawatan. Faktor yang berhubungan dengan mortalitas adalah usia, derajat hiponatremia, komorbiditas, dan status koreksi hiponatremia.

---

ackground: The incidence of hyponatremia in intracranial infection is 30-66%. Hyponatremia can exacerbate the neurological manifestations of the intracranial infection itself and is associated with increased morbidity and mortality.

Methods: This study was a retrospective cross-sectional study to determine the characteristics of hyponatremia and its relationship to the clinical outcome of patients with intracranial infections in Dr. Cipto Mangunkusumo (RSCM) from April 2019 to October 2021. Base data were taken from the Indonesian Brain Infection Study (IBIS) and completed from medical records. Subjects 18 years with a final diagnosis of intracranial infection were included in the inclusion criteria, while incomplete data and no hospitalization were included in the exclusion criteria.

Results: There were 296 subjects with the majority of meningoencephalitis tuberculosis (51.4%). Hyponatremia in 66.6% of subjects was divided into mild (54%), moderate (24%), and severe (22%). Hyponatremia was common in HIV positive (59.1%), comorbid lung disease (44.9%) with headache as a common complaint (58.1%). Mortality occurred in (24.2%) hyponatremic subjects, where age >60 years, comorbidities, pulmonary or renal disease, severe hyponatremia, and uncorrected hyponatremic status were associated with mortality (p<0.05).

Conclusion: In intracranial infection, HIV coinfection is associated with the incidence of hyponatremia. There were no significant differences in the characteristics of hyponatremia on mortality, functional status, and duration of treatment. Factors associated with mortality were age, degree of hyponatremia, comorbidities, and hyponatremia correction status."