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"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.

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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."

"ABSTRAK Latar Belakang: dahak BTA mikroskopik adalah teknik diagnostik cepat yang palingbanyak digunakan untuk mendiagnosis TB paru. Di RSUP Persahabatan, pemeriksaandahak BTA mikroskopik membutuhkan tiga pemeriksaan sampel dahak lebih dari duahari, (sewaktu pertama, pagi, sewaktu kedua). Pengambilan dua sampel dahak akanmengurangi waktu, uang dan beban kerja laboratorium mikrobiologiTujuan: Penelitian ini bertujuan untuk mendapatkan sensitivitas dan spesifisitaspemeriksaan dahak BTA mikroskopik dari tiga bahan pemeriksaan dahak dan duabahan pemeriksaan dahak.Metode: Kami secara acak mengumpulkan data demografi dan hasil laboratorium (hasildahak BTA dan hasil biakan M.tuberculosis) dari pasien terduga TB kasus baru di RSUPPersahabatan dari data bulan Januari 2012 hingga Desember 2013. Subjek harus berusiaminimal 15 tahun dan bukan pasien TB MDR dan bukan pasien HIVHasil: Dari 360 pasien terduga TB paru, sebanyak 210/360 (58,3%) memiliki hasilbiakan M. tuberculosis positif. Sensitivitas 100% dan spesifisitas 69.2% pada hasilpemeriksaan BTA mikroskopik tiga kali (S1, P, S2) dan hasil pemeriksaan BTAmikroskopik dua kali sensitivitasnya 89.8% dan spesifisitas 94.1%. Kesimpulan: Hasil pemeriksaan dahak BTA mikroskopik 2 kali pemeriksaan memberikan spesifisitas yang lebih tinggi bila dibandingkan dengan hasil pemeriksaan3 kali dahak BTA mikroskopik dan memiliki sensitivitas yang masih cukup tinggi.ABSTRACT Background: Sputum smear microscopy is the rapid diagnostic technique that mostwidely used for diagnosing pulmonary tuberculosis. In Persahabatan hospital, sputumsmear microscopy requires three sputum sample examinations over two days, (spot1,morning, spot2). Collection of two sputum samples would reduce time, money andwork load of microbiology laboratory.Objectives: This study aimed to get sensitivity and specificity of sputum smearmicroscopy from three sputum samples collection and two sputum samples collection.Methods: We randomly collected demography and laboratory data (sputum smear andM.tuberculosis culture result) of presumptive TB new cases in Persahabatan hospitalfrom January 2012 to Desember 2013. Subjects must be 15 years old minimum, nonmultidrug-resistant TB presumptive and have non reactive HIV status.Results: Of 360 presumptive TB patients, 58.3% have M.tuberculosis positive cultureresults. Senstivity and specificity of sputum smear microscopy from three sputumsamples collection (S1, M, S2) are 100% and 69.2%. Smear microscopy of two samplescollection Sensitivity and specificity sputum smear microscopy 89.8% and 94.1%. Conclusion: Sputum smear microscopy test result from 2 sputum collections gives increase specificity compared to smear microscopy of 3 samples and have highly sensitivity.;Background: Sputum smear microscopy is the rapid diagnostic technique that mostwidely used for diagnosing pulmonary tuberculosis. In Persahabatan hospital, sputumsmear microscopy requires three sputum sample examinations over two days, (spot1,morning, spot2). Collection of two sputum samples would reduce time, money andwork load of microbiology laboratory.Objectives: This study aimed to get sensitivity and specificity of sputum smearmicroscopy from three sputum samples collection and two sputum samples collection.Methods: We randomly collected demography and laboratory data (sputum smear andM.tuberculosis culture result) of presumptive TB new cases in Persahabatan hospitalfrom January 2012 to Desember 2013. Subjects must be 15 years old minimum, nonmultidrug-resistant TB presumptive and have non reactive HIV status.Results: Of 360 presumptive TB patients, 58.3% have M.tuberculosis positive cultureresults. Senstivity and specificity of sputum smear microscopy from three sputumsamples collection (S1, M, S2) are 100% and 69.2%. Smear microscopy of two samplescollection Sensitivity and specificity sputum smear microscopy 89.8% and 94.1%. Conclusion: Sputum smear microscopy test result from 2 sputum collections gives increase specificity compared to smear microscopy of 3 samples and have highly sensitivity.;Background: Sputum smear microscopy is the rapid diagnostic technique that mostwidely used for diagnosing pulmonary tuberculosis. In Persahabatan hospital, sputumsmear microscopy requires three sputum sample examinations over two days, (spot1,morning, spot2). Collection of two sputum samples would reduce time, money andwork load of microbiology laboratory.Objectives: This study aimed to get sensitivity and specificity of sputum smearmicroscopy from three sputum samples collection and two sputum samples collection.Methods: We randomly collected demography and laboratory data (sputum smear andM.tuberculosis culture result) of presumptive TB new cases in Persahabatan hospitalfrom January 2012 to Desember 2013. Subjects must be 15 years old minimum, nonmultidrug-resistant TB presumptive and have non reactive HIV status.Results: Of 360 presumptive TB patients, 58.3% have M.tuberculosis positive cultureresults. Senstivity and specificity of sputum smear microscopy from three sputumsamples collection (S1, M, S2) are 100% and 69.2%. Smear microscopy of two samplescollection Sensitivity and specificity sputum smear microscopy 89.8% and 94.1%. Conclusion: Sputum smear microscopy test result from 2 sputum collections gives increase specificity compared to smear microscopy of 3 samples and have highly sensitivity."

"Latar belakang: Tuberkulosis merupakan salah satu infeksi oportunistik dan penyebab kematian terbanyak pada pasien HIV. Keterlambatan diagnosis menyebabkan peningkatan kematian karena gejala dan tanda tidak khas. Pemeriksaan awal diagnostik lebih cepat dengan performa diagnosis lebih baik diperlukan untuk meningkatkan keakuratan dan kecepatan diagnosis. Penelitian ini dilakukan dengan menggunakan pemeriksaan molekular yaitu Xpert MTB/RIF® yang dapat mendeteksi DNA Mycobacterium tuberculosis dan data Xpert MTB/RIF® pada pasien HIV masih sangat terbatas. Tujuan: Mengetahui nilai diagnostik Xpert MTB/RIF® dalam mendiagnosis tuberkulosis paru pada pasien HIV. Metode: Penelitian potong lintang terhadap pasien HIV dengan kecurigaan tuberkulosis yang datang ke UPT HIV RSCM dan pasien ruang rawat penyakit dalam Gedung A RSCM dari Oktober 2012 hingga April 2013. Xpert MTB/RIF® dibandingkan dengan kultur media cair BACTEC MGIT 960®. Kemampuan diagnostik Xpert MTB/RIF® dinilai dengan membuat tabel 2x2 dan menghitung nilai sensitivitas, spesifitisitas, nilai duga positif, nilai duga negatif, rasio kemungkinan positif dan rasio kemungkinan negatif serta rentangan nilainya menurut batas 95 % batas kepercayaan. Hasil: Sejumlah 66 subjek menjadi subjek penelitian dengan 43 subjek mendapatkan hasil kultur M. tuberculosis positif. Subjek penelitian umumnya usia 25-35 tahun (58%) dengan jenis kelamin laki-laki (73%), IMT rendah (53%) dan CD4 < 50 sel/mm3 (56%). Faktor risiko terbanyak akibat pemakaian narkoba suntik (62%) Didapatkan hasil sensitivitas Xpert MTB/RIF® adalah 93% (IK 95% 87% - 99%), spesifisitas 91,3% (IK 95% 84,5 - 98,1%), Nilai Duga Positif 95,2% (IK 95% 90,1% - 100%), Nilai Duga Negatif 87,5% (IK 95% 79,5% - 95,5%), Rasio Kemungkinan Positif 10,7 serta Rasio Kemungkinan Negatif 0,08. Simpulan: Kemampuan diagnostik Xpert MTB/RIF® dalam mendiagnosis tuberkulosis paru pada pasien HIV sangat baik.

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Background: Tuberculosis is one of the most common presenting illness and the leading cause of death among people living with HIV. The clinical features of pulmonary tuberculosis in HIV-infected patients are not typical. The accurate diagnosis of pulmonary tuberculosis in HIV-infected patient remains a clinical challenge. Xpert MTB/RIF® is a new molecular modality for rapid diagnostic of tuberculosis. However, performance-related data from HIV-infected patients are still limited.

Objectives: To determine the accuracy of Xpert MTB/RIF® in diagnosing pulmonary tuberculosis in HIV-infected patients.

Methods: This is a cross-sectional study performed in HIV-infected patients who suspected having pulmonary tuberculosis during October 2012 to April 2013 in Cipto Mangunkusumo Hospital. We investigated the diagnostic accuracy of Xpert MTB/RIF® compared liquid media culture.

Results: A total of 66 patients were suspected having pulmonary tuberculosis, and 43 patients were confirmed by culture examinations. Most of the patients were 25 - 35 years olds (58%), male (73%), have a low BMI (53%) and low CD4+ (56%). Most of HIV-infected patients were intravenous drugs user (62%). The sensitivity and specificity of Xpert MTB/RIF® were 93.0% (95% CI, 87.0% to 99.0%) and 91.3% (95% CI, 84.5% to 98.1%). The positive and negative predictive values were 95.2% (95% CI, 90.1% to 100%) and 87.5% (95% CI, 79.5% to 95.5%). Positive and negative likelihood ratios were 10.7 and 0.08.

Conclusion: Xpert MTB/RIF® has a good performance in diagnosing pulmonary tuberculosis in HIV-infected patients."

"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)."

"ABSTRAKLatar Belakang: Diagnosis TBEP memiliki banyak tantangan. Spektrum histopatologi yang bervariasi hingga belum ada standar baku emas untuk penegakan diagnosis. Penegakan diagnosis sering berdasarkan kecurigaan klinis. Sebagian besar TBEP adalah pausibasiler sehingga nilai sensitivitasnya rendah dan sangat bervariasi antar jenis sampel. TCM dilaporkan memiliki sensitivitas dan spesifisitas yang baik dan WHO telah merekomendasikannya.Tujuan: Penelitian ini bertujuan untuk mengetahui performa pemeriksaan TCM jaringan dalam penegakan diagnosis TBEP pada orang dewasa. Standar baku emas yang digunakan pada penelitian ini adalah pemeriksaan histopatologi atau BTA jaringanMetode: Penelitian ini merupakan uji diagnostik dengan rancangan studi potong lintang analitik melibatkan 73 pasien. Pengambilan sampel dilakukan secara konsekutif pada pasien tersangka TBEP usia 18 tahun di RSUPN Dr. Cipto Mangunkusumo. Pemeriksaan TCM dilakukan dengan mesin GeneXpert MTB/Rif dan dilakukan penilaian sensitivitas, spesifisitas, nilai duga positif, nilai duga negatif, dan akurasi.Hasil: Sampel yang terdiagnosis sebagai TBEP didominasi oleh TB osteoartikular (28,6%). Gambaran histopatologi peradangan granulomatosa dan TCM positif sebanyak 19 sampel, peradangan non spesifik dan TCM positif sebanyak 1 sampel, peradangan kronik dengan sel atipik dan TCM positif sebanyak 2 sampel, peradangan granulomatosa dan TCM negatif sebanyak 13 sampel. Sensitivitas dan spesifisitas keseluruhan TCM adalah 59,38% dan 92,6%. Nilai duga positif dan nilai negatif TCM adalah 86% dan 74%. Akurasi TCM adalah 78,1%.Simpulan: Performa pemeriksaan TCM dalam penegakan diagnosis TBEP cukup baik. Sensitivitas dari TCM untuk diagnosis TBEP sangat bervariasi. Hasil TCM negatif tidak menyingkirkan diagnosis TBEP dan integrasi dengan modalitas pemeriksaan lain sangat direkomendasikan. Spesifisitas TCM cukup tinggi sehingga dapat membantu menegakkan diagnosis TBEP.

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ABSTRACTBackground: The diagnosis of EPTB has many challenges. The histopathological spectrum varies, until there is no gold standard for diagnosis. The diagnosis is often based on clinical suspicion. Most of the EPTB are paucibacillary so their sensitivity is low and varies greatly between types of samples. Tissue rapid molecular test is reported to have good sensitivity and specificity and WHO has recommended it.Objective This study aims is to determine the performance of tissue rapid molecular test in the diagnosis of EPTB in adults. The gold standard in this study is histopathology or tissue AFB.Methods: This study is a diagnostic test with analytic cross-sectional study design involving 73 patients. Sampling was carried out consecutively in patients with EPTB suspects aged 18 years at Dr. Cipto Mangunkusumo Hospital. Tissue rapid molecular test examination is carried out with a GeneXpert MTB/Rif machine and sensitivity, specificity, positive predictive value, negative predictive value, and accuracy are assessedResults: The diagnosed sample as EPTB is dominated by osteoarticular TB (28.6%). The overview of histopathological findings are granulomatose's inflammation and tissue rapid molecular test positive:19 samples, non-specific inflammation and positive tissue rapid molecular test: 1 sample, chronic inflammation with the atypical cells and positive tissue rapid molecular test: 2 samples, no granulomatose's inflammation and negative rapid molecular test: 13 samples. The overall sensitivity and specificity of rapid molecular test are 59.38% and 92.6%. The positive predictive values and negative predictive values of rapid molecular test are 86% and 74%. The accuracy of rapid molecular test is 78.1%.Conclusions: The performance of tissue rapid molecular test in diagnosing EPTB is good enough. The sensitivity of rapid molecular test for the diagnosis of EPTB varies widely. Negative rapid molecular test result does not rule out diagnosis of EPTB and integration with other examination modalities is highly recommended. Rapid molecular test specificity is high enough so it can help enforce the diagnosis of EPTB."

"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.

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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."

"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."