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"Latar Belakang Tuberkulosis resisten obat (TB RO) merupakan fenomena penambah insidensi Tuberkulosis yang sudah menjadi masalah kesehatan kritis secara global. Di dunia, dari 7,5 juta kejadian TB 73% nya merupakan TB RO. Insidensi TB RO di Indonesia sebanyak 24.000 atau 8,8/100.000 penduduk. Salah satu faktor risiko yang penting untuk menjadi perhatian adalah status gizi pasien, dimana didapatkan malnutrisi dapat mempengaruhi prognosis dan keberhasilan pengobatan. Parameter penilaian status gizi secara umum menggunakan Indeks Massa Tubuh (IMT) yang sudah diklasifikasikan oleh WHO untuk penilaian status gizi. Metode Penelitian menggunakan desain kohort retrospektif dengan subjek sebanyak 90 sampel yang diambil menggunakan simple random sampling dengan rekam medis di RSUP Persahabatan tahun 2018-2022. Hasil Karakteristik subjek didapatkan mayoritas laki-laki (56,7%) dan berusia 25-64 tahun (82,2%). Tipe resistensi obat yang paling banyak adalah resistensi rifampisin (71,1%). Sebelum pengobatan, 42,2% pasien berada dalam kategori underweight. Setelah pengobatan, proporsi pasien underweight menurun menjadi 23,3%, sementara pasien normal-overweight dan obesitas masing-masing meningkat menjadi 55,6% dan 21,1%. Peningkatan IMT yang signifikan diamati post-pengobatan (perbedaan rata-rata 1,581, p=0,00). Analisis regresi logistik ordinal menunjukkan bahwa usia (25-64 tahun) secara signifikan berkorelasi dengan peningkatan IMT, sementara pasien dengan TB resisten rifampisin dan pre-XDR menunjukkan kemungkinan lebih besar untuk penurunan IMT. Kesimpulan Terdapat peningkatan signifikan dalam IMT post-pengobatan yang menunjukkan dampak positif dari terapi TB RO terhadap status gizi pasien. Usia dan tipe resistensi obat berperan signifikan dalam mempengaruhi perubahan IMT setelah pengobatan.

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Introduction Drug-resistant tuberculosis (DR-TB) is a phenomenon that increases the incidence of tuberculosis, which has become a critical global health issue. Worldwide, among the 7,5 million TB cases, 73% were diagnosed with DR-TB. The incidence of DR-TB in Indonesia is 24,000 or 8,8/100,000 population. One of the important risk factors to consider is the nutritional status of the patient, where it was found that malnutrition can affect prognosis and treatment success. The general parameter for assessing nutritional status is the Body Mass Index (BMI) which has been classified by the WHO for nutritional assessment of patients. Method This study used a retrospective cohort design with 90 samples taken using simple random sampling of the medical records at Persahabatan Hospital from 2018-2022. Results The characteristics of the subjects found mostly were male (56,7%) and aged 25-64 years (82,2%). The most common type of drug resistance was rifampicin resistance (71,1%). Before treatment, 42,2% of patients were in the underweight category. After treatment, the proportion of underweight patients decreased to 23,3%, while the normal-overweight and obese patients each increased to 55,6% and 21,1%. A significant increase in BMI was observed post-treatment (average difference 1,581, p=0,00). Ordinal logistic regression analysis showed that age (25-64 years) was significantly correlated with an increase in BMI, while patients with rifampicin-resistant and pre-XDR TB were more likely to have a decrease in BMI. Conclusion There was a significant increase in BMI post-treatment, indicating the positive impact of DR-TB therapy on patient nutritional status. Age and type of drug resistance play a significant role in influencing BMI changes after treatment."

"Latar Belakang: Malnutrisi merupakan salah satu predikor luaran pengobatan yang buruk. Indeks masa tubuh (IMT) kurang 18,5 kg/m2 dan ketidakcukupan peningkatan berat badan saat pengobatan berkaitan dengan peningkatan risiko kegagalan pengobatan kematian dan kekambuhan TB. Intervensi gizi tinggi energi dan protein dapat memperbaiki malnutrisi sehingga memperbaiki imunitas, kekuatan otot dan mempercepat konversi.Metode: Penelitian ini merupakan open label non-randomised clinical trial dan merupakan merupakan uji pendahuluan. Penelitian ini dilakukan di poliklinik MDR RSUP Persahabatan periode April-Desember 2022 pada pasien TB resistan obat (RO) yang mengalami malnutrisi. Kelompok intervensi mendapatkan edukasi gizi dan suplementasi nutrisi oral tinggi energi dan protein (705 kkal dan 31 gram per hari) selama 60 hari sedangkan kelompok kontrol hanya mendapat edukasi gizi selanjutnya dievaluasi perubahan berat badan, waktu koversi, perubahan keluhan dan parameter hematologi.Hasil: Didapatkan 36 pasien kelompok intervensi dan 34 pasien kontrol. Pemberian suplementasi nutrisi meningkatkan asupan energi total dan protein harian [2012 vs 1596 kkal, p<0,001; 79 vs 58gram, p<0,001] dan meningkatkan berat badan ≥5% pada kelompok intervensi dibandingkan kontrol [OR:14,518 95%IK (3,778-55,794), p<0,001]. Kelompok intervensi (86,1%) mengalami waktu konversi pada bulan ke-2 dibandingkan kelompok kontrol 70,6% (p<0,114). Perbaikan keluhan batuk dan sesak napas pada kelompok intervensi dibandingkan kontrol [p<0,001 (batuk) dan p<0,001 (sesak)]. Terdapat perbedaan penurunan kadar protein total dan globulin pada kedua kelompok [p:0,038 (protein total) dan p:0,02 (globulin)] pascaintervensi. Protein total dan globulin merupakan reaktan fase akut sebagai petanda inflamasi dan berguna untuk evaluasi respons pengobatan TB dan intervensi nutrisi. Hasil analisis multivariat mendapatkan bahwa pasien dengan penurunan berat badan derajat sedang-berat sebelum pengobatan TB RO akan memiliki kenaikan berat badan ≥5% [aOR: 4,701 95%IK (1,334-16,569), p<0,001], sedangkan pasien yg memiliki keluhan sesak saat aktivitas sebelum pengobatan akan memiliki kesulitan naik berat badan ≥5% setelah dua bulan pengobatan [aOR:0,168 95%IK (0.043-0.797), p:0,074].Kesimpulan: Intervensi gizi pada pasien TB RO dengan malnutrisi merupakan pendekataan terbaru untuk membantu keberhasilan pengobatan.

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Background: Malnutrition is a predictor of poor treatment outcomes. Body mass index (BMI) less than 18.5 kg/m2 and inadequate weight gain during treatment are associated with an increased risk of treatment failure, death and recurrence. Nutritional intervention with high energy and protein can correct malnutrition thereby improving immunity, muscle strength and accelerating conversion.

Methods: This study is an open clinical trial design and is a preliminary test. This research was conducted at the MDR polyclinic at Persahabatan Hospital through the April-December 2022 of malnourished drug resistance (DR)-TB patients. The intervention group received nutriotion education and high energy and protein oral nutritional supplementation (705 kcal and 31gr per day) for 60 days while the control group only received education. This study is to evaluate body weight, conversion time rate, changes in complaints and hematological parameters.

Results: There were 36 patients in the intervention group and 34 control patients. Providing nutritional supplementation increased total energy and daily protein intake [2012 vs 1596 kcal p<0.001; 79 vs 58 gr, p<0.001] and increased body weight ≥5% in the intervention group compared to the control [OR:14.518 95% CI (3.778-55.794), p<0.001]. The intervention group (86.1%) experienced conversion time in the 2nd month compared to the control group 70.6% (p<0.114). Improvements in complaints of cough and shortness of breath in the intervention group compared to controls (p<0.001 and p<0.001). There were differences in the decrease in total protein and globulin levels in the two groups (p:0.038 and p:0.02) after the intervention. Total protein and globulin are acute phase reactants as markers of inflammation and are useful for evaluating response to treatment. The results of the multivariate analysis found that patients with moderate-to-severe weight loss before DR-TB treatment would have a weight gain of ≥5% [aOR: 4.701 95% CI (1.334-16.569), p<0.001], whereas patients who had shortness of breath when active before treatment will have difficulty gaining weight ≥5% after two months of treatment [aOR:0.168 95% CI (0.043-0.797), p:0.074].

Conclusion: Nutritional intervention in malnourished DR-TB RO is the latest approach to assist in successful treatment."

"Latar belakang: Kompleksitas pengobatan TB RO berupa durasi pengobatan yang panjang, penggunaan beberapa obat lini kedua, toksisitas obat, dan interaksi obat akibat multidrug use dapat menyebabkan efek samping pengobatan pada pasien. Hal ini dapat mengurangi efektivitas pengobatan dan memengaruhi luaran pengobatan TB RO. Tujuan: Untuk melihat efek samping obat/kejadian tidak diinginkan terhadap luaran pengobatan TB RO.Metode: Penelitian observasional dengan desain kohort retrospektif ini dilakukan di RSUP Persahabatan, Jakarta. Sumber data adalah data sekunder dari sistem informasi tuberkulosis (SITB) yang melibatkan pasien TB RO yang menjalani pengobatan di tahun 2021 – 2023. Metode sampling berupa total sampling. Analisis data bivariat antara KTD dengan luaran pengobatan TB RO berupa Cox regresi dan uji Log-Rank, yang kemudian dilanjutkan dengan analisis multivariat menggunakan Extended Cox Regresi.Hasil: Dari 583 subjek yang diikutsertakan dalam penelitian ini, insidens luaran pengobatan tidak berhasil sebanyak 40,65%. Sebanyak 12,69% pasien mengalami efek samping berat. Sebagian besar efek samping terjadi pada fase intensif pengobatan TB RO (43,57%). Jenis efek samping yang paling sering dialami pada pasien adalah gangguan gastrointestinal (79,25%), gangguan muskuloskeletal (58,32%), dan gangguan saraf (49,40%). Efek samping berupa KTD berat/serius tidak memiliki asosiasi yang signifikan terhadap terjadinya pengobatan tidak berhasil berdasarkan hasil analisis Cox regresi bivariat (HR=0,823; 95% CI: 0,558-1,216; p=0,329) dan analisis multivariat Extended Cox regresi (setelah dikontrol oleh variabel kovariat). Probabilitas survival antara kelompok dengan KTD berat dan kelompok non-KTD berat tidak berbeda bermakna. Kesimpulan: pemantauan efek samping selama pengobatan TB RO berlangsung merupakan hal yang penting untuk menunjang keberhasilan pengobatan.

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Background: The complexity of treating drug-resistant tuberculosis (DR TB) involves prolonged treatment duration, the use of several second-line drugs, drug toxicity, and drug interactions due to multidrug use, which can lead to adverse drug reactions in patients. These issues can reduce treatment effectiveness and affect treatment outcomes for DR TB.

Objective: To investigate the impact of adverse drug reactions/adverse events on DR TB treatment outcomes.

Methods: This observational study utilized a retrospective cohort design conducted at RSUP Persahabatan, Jakarta. The data source was secondary data from the tuberculosis information system (SITB) involving DR TB patients who underwent treatment between 2021 and 2023. The sampling method was total sampling. Bivariate data analysis between adverse events and TB RO treatment outcomes involved Cox regression and Log Rank tests, followed by multivariate analysis using Extended Cox Regression.

Results: Among the 583 subjects included in this study, the incidence of unsuccessful treatment outcomes was 40.65%. Severe adverse drug reactions were experienced by 12.69% of patients. Most adverse reactions occurred during the intensive phase of TB RO treatment (43.57%). The most common types of adverse reactions experienced by patients were gastrointestinal disorders (79.25%), musculoskeletal disorders (58.32%), and neurological disorders (49.40%). Severe/serious adverse reactions did not have a significant association with unsuccessful treatment outcomes based on the results of the bivariate Cox regression analysis (HR=0.823; 95% CI: 0.558-1.216; p=0.329) and the multivariate Extended Cox regression analysis (after adjusting for covariate variables). The survival probability between the group with severe adverse reactions and the non- severe adverse reactions group did not differ significantly.

Conclusion: Monitoring adverse drug reactions during DR TB treatment is crucial to support the success of the treatment."

"Latar Belakang:Tuberkulosis resisten obat (TB-RO) merupakan ancaman bagi seluruh dunia termasuk Indonesia, karena memerlukan waktu lama dan biaya yang besar dalam mengobati penyakit tersebut meskipun telah ditangani dengan baik. Data penelitian di luar negeri menunjukkan bahwa terdapat kekambuhan TB-RO, tapi datanya sangat terbatas. Di Indonesia belum ada data tentang angka kekambuhan TB-RO.Tujuan: Mengevaluasi pasien TB resisten obat (TB-RO) pasca pengobatan yang datang kontrol pada bulan ke 6, 12, 18, dan 24 di RSUP Persabatan Jakarta.Metode: Penelitian menggunakan desain penelitian potong lintang terhadap pasien TB-RO yang telah dinyatakan sembuh dan pengobatan lengkap yang datang kontrol di poli MDR RSUP Persahatan Jakarta mulai bulan April 2017 sampai Desember 2017. Dilakukan anamnesis, pemeriksaan fisis, pemeriksaan foto toraks dan biakan sputum. Mencatat data pengobatan dan hasil-hasil pemeriksaan terkait data yang diperlukan dalam dalam rekam medis pasien.Hasil: Didapatkan 60 subjek penelitian dengan rerata usia 42,3 + 12,5 tahun, berjenis kelamin laki-laki 31 (51,7%) dan perempuan 29 (48,3%), dengan rerata IMT 21,75+ 4,34. Dari hasil foto toraks didapatkan gambaran dominan lesi luas dan hasil kultur sputum semua pasien yang diteliti tidak ditemukan pertumbuhan Mycobacterium tuberculosis.Kesimpulan: Tidak ditemukan kekambuhan pada pasien TB resisten obat yang yang telah dinyatakan sembuh dan pengobatan lengkap yang datang kontrol pasca pengobatan di RSUP Persahabatan Jakarta.

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Objective: This study aimed to evaluate DR-TB patients which was biannually performed for two-years (e.g. at the 6th, 12th, 18th, and 24th mos) after treatment completion.

Methods: This cross-sectional study involved DR-TB patients completing their treatment at Persahabatan General Hospital Jakarta, Indonesia, between April and December 2017. The post-treatment evaluation during the 6th, 12th, 18th, and 24th mos included clinical, chest x-ray (CXR) and sputum culture examination.

Results: Sixty patients were observed in this study, 31 (51.7%) were males and 29 (48.3%) were females. The mean age was 42.3+12.5 yo and the mean body mass index was 21.75+4.34. Fourty nine (81.7%) patients showed extensive lesions per CXR and none of the patient showed Mycobacterium tuberculosis growth per sputum culture.

Conclusion: There was no recurrence of DR-TB from patients completing their treatment at Persahabatan General Hospital Jakarta, Indonesia during two-years post-treatment evaluation."

"Berdasarkan data SITB per 2 Februari 2022, terdapat 8306 kasus TB-RR/MDR terkonfirmasi melalui pemeriksaan laboratorium. Keberhasilan pengobatan TB MDR di Indonesia tahun 2021 belum mencapai target dan termasuk rendah dibandingkan dengan global yaitu sebesar 45%. Penelitian bertujuan mengidentifikasi faktor-faktor yang berhubungan dengan keberhasilan pengobatan pasien TB MDR di RSUP Persahabatan tahun 2019. Penelitian ini menggunakan desain studi kohort retrospektif. Penelitian menggunakan data sekunder dari rekam medis pasien TB MDR yang berobat di RSUP Persahabatan tahun 2019 yang dilihat sejak awal pengobatan hingga didapatkan hasil akhir pengobatan. Terdapat 273 sampel yang sesuai kriteria inklusi dan eksklusi. Data dianalisis menggunakan IBM SPSS Statistics 25 dengan uji chi-square, dengan RR untuk mengetahui derajat hubungan antar variabel dan dan p < 0,05 sebagai batas kemaknaan. Pada hasil analisis diketahui umur (p=0,000; RR=1,603 95CI% 1,251–2,055), jenis kelamin (p=0,749; RR=1,045 95CI% 0,798–1,369), pendidikan (p=0,165; RR=1,228 95CI% 0,929–1.634), pekerjaan (p=0,298; RR=0,893 95CI% 0,8723–1,103), status pernikahan (p=0,000; RR=1,932 95%CI 1,318–2,833), wilayah tempat tinggal (p=0,092, RR=1,288 95%CI 0,933–1,779), hasil pemeriksaan sputum awal (p=0,272; RR=1,126 95%CI 0,911–1,191), interval inisiasi pengobatan (p=0,021; RR=0,698 95%CI 0,494–0,986). Faktor yang memiliki hubungan signifikan secara statistik dengan keberhasilan pengobatan adalah umur, status pernikahan, dan interval inisiasi pengobatan.Based on SITB data as of February 2, 2022, there were 8306 confirmed cases of RR/MDR TB through laboratory tests. The success of MDR TB treatment in Indonesia in 2021 has not reached the target and is low compared to global, which is 45%. This study aims to identify factors associated with successful treatment of MDR TB patients at Persahabatan Hospital in 2019. This study used a retrospective cohort study design. The study used secondary data from the medical records of MDR TB patients who were treated at the Friendship Hospital in 2019 which were seen from the beginning of treatment until the final results of treatment were obtained. There were 273 samples that met the inclusion and exclusion criteria. Data were analyzed using IBM SPSS Statistics 25 with chi-square test, with RR to determine the degree of relationship between variables and p < 0.05 as the limit of significance. The results of the analysis showed that age (p=0.000; RR=1.603 95CI% 1.251–2.055), gender (p=0.749; RR=1.045 95CI% 0.798–1.369), education (p=0.165; RR=1.228 95CI% 0.929– 1.634), occupation (p=0.298; RR=0.893 95CI% 0.8723–1.103), marital status (p=0.000; RR=1.932 95%CI 1.318–2.833), area of ​​residence (p=0.092, RR=1.288 95%CI 0.933–1.779), results of initial sputum examination (p=0.272; RR=1.126 95%CI 0.911–1.191), treatment initiation interval (p=0.021; RR=0.698 95%CI 0.494–0.986). Factors that had a statistically significant relationship with treatment success were age, marital status, and treatment initiation interval."

"Pada penderita kanker paru terjadi inflamasi sistemik dan dapat dilihat dengan peningkatan rasio netrofil limfosit di mana pemeriksaan ini lazim dilakukan di Rumah Sakit. Inflamasi sitemik dapat menyebabkan anoreksi sehingga asupan pada penderita kanker paru menurun dan memengaruhi status gizinya. Kejadian malnutrisi yang tinggi pada pasien paru dapat berakibat lamanya rawat inap, turunnya kualitas hidup, dan dapat memengaruhi keberhasilan terapi kanker sehingga terapi nutrisi yang cepat dan tepat sangat perlu dilakukan. Salah satu diagnostik status gizi pada penderita kanker yaitu dengan menggunakan kriteria ASPEN yang terdiri dari penurunan asupan, penurunan berat badan, penurunan massa otot dan massa lemak subkutan, akumulasi cairan general atau lokal, dan kapasitas fungsional. Dikatakan malnutrisi jika terdapat dua dari enam kriteria tersebut. Penelitian ini merupakan studi potong lintang yang bertujuan untuk mengetahui hubungan status gizi dengan rasio netrofil limfosit pada pasien kanker paru di RSUP Persahabatan. Data diambil dari wawancara, pemeriksaan fisis, pemeriksaan laboratorium, dan rekam medis pasien poliklinik onkologi RSUP Persahabatan (n =52). Pada penelitian ini subjek sebagian besar berjenis laki-laki (61,5%), rentang usia terbanyak antara 50-60 tahun (38,5%), memiliki riwayat merokok (55,8%) dengan indeks Brinkman berat (30,8%). Lebih dari 50% subjek dengan asupan energi dan protein dibawah rekomendasi asupan untuk pasien kanker. Sebagian besar subjek penelitian berisiko malnutrisi atau malnutrisi sedang (38,5%) dan sebanyak 67,3% mengalami malnutrisi. Pada penelitian ini subjek dengan nilai rasio netrofil limfosit tinggi sebanyak 38,5% dan rendah sebanyak 61,5%. Tidak terdapat hubungan antara status gizi dengan rasio netrofil limfosit pada penelitian ini (p = 0,35).

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Systemic inflammation in patients with lung cancer can be seen by the increase in the neutrophil lymphocyte ratio where these examinations are common in hospitals. Systemic inflammation can cause anorexia, with the result that nutrition intake of lung cancer patients decreases and affects their nutritional status. High incidence of malnutrition in lung cancer patients can result in length of stay, decreased quality of life, and can affect the treatment of cancer therapy, therefore prompt and appropriate nutritional therapy is essential. One of the diagnostics of nutritional status for lung cancer patients is by using the ASPEN criteria which consist of decreased nutritional intake, weight loss, decreased muscle mass and subcutaneous fat mass, general or local fluid accumulation, and functional capacity. Malnutrition can be seen if there are two of the six criteria. This study is a cross-sectional study which aimed to determine the association between nutritional status and the ratio of lymphocyte neutrophils in lung cancer patients at Persahabatan Hospital. Data were taken from interviews, physical examinations, laboratory analysis, and patients medical records in the oncology polyclinic of Persahabatan Hospital (n = 52). The subjects of the study were mostly male (61.5%), the largest age range was between 50-60 years (38.5%), had a history of smoking (55.8%) with a severe Brinkman index (30.8%). More than 50% of the subjects with energy and protein intake were below the recommended intake for cancer patients. Most of the study subjects were at risk of malnutrition or moderate malnutrition (38.5%) and 67.3% of them were experiencing malnutrition. The subjects with the highest neutrophil lymphocyte ratio value were 38.5% and the lowest value were 61.5%. Overall, there was no relationship between nutritional status and the ratio of neutrophil to lymphocytes in this study (p = 0.35)."

"Pada penderita kanker paru terjadi inflamasi sistemik dan dapat dilihat dengan peningkatan rasio netrofil limfosit di mana pemeriksaan ini lazim dilakukan di Rumah Sakit. Inflamasi sitemik dapat menyebabkan anoreksia sehingga asupan pada penderita kanker paru menurun dan memengaruhi status gizinya.  Penelitian ini bertujuan untuk mengetahui hubungan antara status gizi dengan rasio netrofil limfosit pada pasien kanker paru di RSUP Persahabatan. Penelitian ini menggunakan desain cross-sectional. Data diambil dari wawancara, pemeriksaan fisik, pemeriksaan laboratorium, dan dari rekam medis pasien poliklinik onkologi RSUP Persahabatan (n=52). Pada penelitian ini subjek sebagian besar berjenis laki-laki (61,5%), rentang usia terbanyak antara 50-60 tahun (38,5%), memiliki riwayat merokok (55,8%) dengan indeks Brinkman berat (30,8%). Lebih dari 50% subjek dengan asupan energi dan protein dibawah rekomendasi asupan untuk pasien kanker. Sebagian besar subjek penelitian berisiko malnutrisi atau malnutrisi sedang (38,5%) dan sebanyak 67,3% mengalami malnutrisi. Sebagai kesimpulan tidak terdapat hubungan antara status gizi dengan rasio netrofil limfosit pada penelitian ini (p = 0,35).

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Systemic inflammation in patients with lung cancer can be seen by the increase in the neutrophil lymphocyte ratio where these examinations are common in hospitals. Systemic inflammation can cause anorexia, with the result that nutrition intake of patients with lung cancer decreases and affects their nutritional status. This study aims to determine the association between nutritional status and the ratio of lymphocyte neutrophils in patients with lung cancer at Persahabatan Hospital. This is a cross-sectional study. Data were taken from interviews, physical examinations, laboratory analysis, and patients medical records in the oncology clinic of Persahabatan Hospital (n = 52) The subjects of the study were mostly male (61.5%), the largest age range was between 50-60 years (38.5%), had a history of smoking (55.8%) with a severe Brinkman index (30.8%). More than 50% of the subjects with energy and protein intake were below the recommended intake for cancer patients. Most of the study subjects were at risk of malnutrition or moderate malnutrition (38.5%) and 67.3% of them were experiencing malnutrition. In conclusion, there was no relationship between nutritional status with the ratio of neutrophil to lymphocytes in this study (p = 0.35)."

"Tuberkulosis resisten obat (TBRO) merupakan salah satu masalah kesehatan yang sangat serius di dunia. TBRO adalah keadaan dimana bakteri tuberkulosis sudah tidak dapat lagi dibunuh dengan obat anti tuberkulosis (OAT). Untuk memastikan terapi obat yang diberikan aman, efektif, dan rasional diperlukan pemantauan terapi obat (PTO) pada pasien TBRO. Studi retrospektif ini dilakukan pada pasien TBRO yang mendapatkan terapi di Rumah Sakit Universitas Indonesia (RSUI) antara April hingga Agustus 2022. Kriteria inklusi pada PTO ini adalah pasien yang tertulis diagnosis TBRO di rekam medik dengan data riwayat pengobatan lengkap. Dari 26 pasien TBRO, didapatkan 20 pasien dengan paduan terapi jangka panjang dan 6 pasien dengan paduan terapi jangka pendek. Dari 20 pasien yang mendapatkan paduan terapi jangka panjang, 3 pasien diantaranya meninggal dunia. Dari 23 pasien yang dilakukan pemantauan terapi obat di Poli TBRO RSUI, sebanyak 87% pasien sudah tepat dosis, 60,9% pasien sudah mendapatkan terapi efek samping obat yang sesuai, dan 87% pasien mendapatkan paduan pengobatan yang sesuai.

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Drug-resistant tuberculosis (TBRO) is a very serious health problem in the world. TBRO is a condition where the tuberculosis bacteria can no longer be killed with anti-tuberculosis drugs (OAT). To ensure that drug therapy is safe, effective, and rational, it is necessary to monitor drug therapy (PTO) in TBRO patients. This retrospective study was conducted on TBRO patients receiving therapy at the University of Indonesia Hospital (RSUI) between April and August 2022. The inclusion criteria for this PTO were patients who had a TBRO diagnosis written in the medical record with complete medical history data. Of the 26 TBRO patients, 20 patients received long/individual regiment and 6 patients with short treatment regiment (STR). Of the 20 patients who received long-term therapy, 3 of them died. Of the 23 patients who were monitored for drug therapy at the RSUI TBRO Polyclinic, as many as 87% of patients received the right dose, 60.9% of patients received appropriate drug side effect therapy, and 87% of patients received appropriate treatment regimens."

"Latar Belakang: Tuberkulosis resistan obat (TB RO) masih menjadi masalah kesehatan utama di dunia. Tahun 2020 secara global terdapat 157.903 kasus TB Multi Drug Resistant/Rifampicin Resistant (MDR/RR) terdeteksi dan ternotifikasi, 95% dilakukan enrollment, namun angka keberhasilan pengobatan TB RR/MDR sebesar 59% dan TB XDR sebesar 52%, sedangkan di Indonesia terdapat 8.268 kasus TB RR/MDR, 52% dilakukan enrollment namun angka keberhasilan pengobatan TB RR/MDR sebesar 47% dan TB XDR 30%. Tahun 2020, Klofazimin (CFZ) merupakan salah satu bagian grup B pengobatan TB RO tanpa injeksi pada paduan jangka pendek dan jangka panjang. Terdapat beberapa efek samping dalam penggunaan CFZ salah satunya adalah hiperpigmentasi kulit. Penelitian ini bertujuan untuk mengetahui kekerapan, karakteristik subjek, awitan, durasi, dan derajat hiperpigmentasi kulit akibat CFZ serta faktor apa saja yang berhubungan pada pengobatan TB RO di RSUP Persahabatan. Metode: Desain penelitian ini adalah kohort retrospektif menggunakan data rekam medis pasien, dilakukan di Poli TB RO RSUP Persahabatan Juli 2021-Mei 2022, dengan teknik total sampling. Subjek penelitian adalah pasien TB RO yang mendapatkan CFZ di Poli TB RO di RSUP Persahabatan yang memulai enrollment pada tahun 2019-2020 yang memenuhi kriteria penelitian. Hiperpigmentasi kulit dinilai dari anamnesis bulanan setiap pasien kontrol. Hasil: Didapatkan 429 subjek penelitian dengan kekerapan hiperpigmentasi kulit pada 48 subjek (11,18%). Karakteristik subjek usia 41 (18−78) tahun, 58% laki-laki, 48% dengan gizi kurang dan normal, 25,2% komorbid DM tipe 2 dan 2,8% komorbid HIV, durasi pengobatan 285 (1−860) hari, kasus terbanyak TB RR/MDR sebesar 89,3%, dan luaran sembuh sebesar 47%. Efek samping hiperpigmentasi kulit didapatkan dengan median awitan 31 (28−168) hari pengobatan dan hingga pengobatan selesai efek samping hiperpigmentasi kulit masih didapatkan (belum reversibel). Kesimpulan: Terdapat hubungan antara efek samping hiperpigmentasi kulit dengan durasi pengobatan (p=<0,001)m yakni hari ke 344 (70−769) dan paduan jangka pendek oral dan jangka pendek injeksi (p=<0,001)f dengan RR 10,100 (5,059−20,166).

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Background: Drug-resistant tuberculosis (DR TB) is still a major health problem in the world. In 2020 globally there were 157,903 cases of Multi Drug Resistant/Rifampin Resistant (MDR/RR) TB detected and notified, 95% were enrolled, but the treatment success rate for RR/MDR TB was 59% and XDR TB was 52%, while in Indonesia there were Of the 8,268 cases of RR/MDR TB, 52% underwent enrollment but the success rate of RR/MDR TB treatment was 47% and 30% XDR TB. In 2020, Clofazimine (CFZ) is part of group B RO-TB treatment without injection in short-term and long-term combinations. There are several side effects in using CFZ, one of which is skin hyperpigmentation. This study aims to determine the frequency, subject characteristics, onset, duration, and degree of skin hyperpigmentation due to CFZ and what factors are related to the treatment of DR TB at Persahabatan Hospital. Methods: The design of this study was a retrospective cohort using patient medical record data, carried out at the DR TB clinic Persahabatan Hospital from July 2021-May 2022, with a total sampling technique. The research subjects were DR TB patients who received CFZ at the DR TB clinic at the Persahabatan Hospital who started enrollment in 2019-2020 who met the research criteria. Skin hyperpigmentation was assessed from the monthly history of patient. Results: There were 429 subjects who received CFZ with frequent skin hyperpigmentation in 48 subjects (11.18%). Subject’s characteristics are 41 (18−78) years old, 58% male, 48% with malnutrition and normal, 25.2% comorbid type 2 DM and 2.8% comorbid HIV, duration of treatment 285 (1−860) days, the most cases of RR/MDR TB were 89.3%, and the outcome recovered was 47%. The side effect of skin hyperpigmentation was obtained with a median onset of 31 (28−168) days of treatment and until the end of treatment the side effect of skin hyperpigmentation was still found (not reversible). Conclusion: There is a relationship between side effects of skin hyperpigmentation with treatment duration (p=<0.001)m i.e. day 344 (70−769) and short-term oral and short-term injection (p=<0.001)f with RR 10.100 (5.059−20.166)."

"Latar Belakang: Tuberkulosis resistan obat (TB RO) masih menjadi masalah kesehatan utama di dunia. Tahun 2020 secara global terdapat 157.903 kasus TB Multi Drug Resistant/Rifampicin Resistant (MDR/RR) terdeteksi dan ternotifikasi, 95% dilakukan enrollment, namun angka keberhasilan pengobatan TB RR/MDR sebesar 59% dan TB XDR sebesar 52%, sedangkan di Indonesia terdapat 8.268 kasus TB RR/MDR, 52% dilakukan enrollment namun angka keberhasilan pengobatan TB RR/MDR sebesar 47% dan TB XDR 30%. Tahun 2020, Klofazimin (CFZ) merupakan salah satu bagian grup B pengobatan TB RO tanpa injeksi pada paduan jangka pendek dan jangka panjang. Terdapat beberapa efek samping dalam penggunaan CFZ salah satunya adalah hiperpigmentasi kulit. Penelitian ini bertujuan untuk mengetahui kekerapan, karakteristik subjek, awitan, durasi, dan derajat hiperpigmentasi kulit akibat CFZ serta faktor apa saja yang berhubungan pada pengobatan TB RO di RSUP Persahabatan. Metode: Desain penelitian ini adalah kohort retrospektif menggunakan data rekam medis pasien, dilakukan di Poli TB RO RSUP Persahabatan Juli 2021-Mei 2022, dengan teknik total sampling. Subjek penelitian adalah pasien TB RO yang mendapatkan CFZ di Poli TB RO di RSUP Persahabatan yang memulai enrollment pada tahun 2019-2020 yang memenuhi kriteria penelitian. Hiperpigmentasi kulit dinilai dari anamnesis bulanan setiap pasien kontrol. Hasil: Didapatkan 429 subjek penelitian dengan kekerapan hiperpigmentasi kulit pada 48 subjek (11,18%). Karakteristik subjek usia 41 (18−78) tahun, 58% laki-laki, 48% dengan gizi kurang dan normal, 25,2% komorbid DM tipe 2 dan 2,8% komorbid HIV, durasi pengobatan 285 (1−860) hari, kasus terbanyak TB RR/MDR sebesar 89,3%, dan luaran sembuh sebesar 47%. Efek samping hiperpigmentasi kulit didapatkan dengan median awitan 31 (28−168) hari pengobatan dan hingga pengobatan selesai efek samping hiperpigmentasi kulit masih didapatkan (belum reversibel). Kesimpulan: Terdapat hubungan antara efek samping hiperpigmentasi kulit dengan durasi pengobatan (p=<0,001)m yakni hari ke 344 (70−769) dan paduan jangka pendek oral dan jangka pendek injeksi (p=<0,001)f dengan RR 10,100 (5,059−20,166). Kata kunci: efek samping, hiperpigmentasi kulit, klofazimin, tuberkulosis resistan obat.

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Background: Drug-resistant tuberculosis (DR TB) is still a major health problem in the world. In 2020 globally there were 157,903 cases of Multi Drug Resistant/Rifampin Resistant (MDR/RR) TB detected and notified, 95% were enrolled, but the treatment success rate for RR/MDR TB was 59% and XDR TB was 52%, while in Indonesia there were Of the 8,268 cases of RR/MDR TB, 52% underwent enrollment but the success rate of RR/MDR TB treatment was 47% and 30% XDR TB. In 2020, Clofazimine (CFZ) is part of group B RO-TB treatment without injection in short-term and long-term combinations. There are several side effects in using CFZ, one of which is skin hyperpigmentation. This study aims to determine the frequency, subject characteristics, onset, duration, and degree of skin hyperpigmentation due to CFZ and what factors are related to the treatment of DR TB at Persahabatan Hospital. Methods: The design of this study was a retrospective cohort using patient medical record data, carried out at the DR TB clinic Persahabatan Hospital from July 2021-May 2022, with a total sampling technique. The research subjects were DR TB patients who received CFZ at the DR TB clinic at the Persahabatan Hospital who started enrollment in 2019-2020 who met the research criteria. Skin hyperpigmentation was assessed from the monthly history of patient. Results: There were 429 subjects who received CFZ with frequent skin hyperpigmentation in 48 subjects (11.18%). Subject’s characteristics are 41 (18−78) years old, 58% male, 48% with malnutrition and normal, 25.2% comorbid type 2 DM and 2.8% comorbid HIV, duration of treatment 285 (1−860) days, the most cases of RR/MDR TB were 89.3%, and the outcome recovered was 47%. The side effect of skin hyperpigmentation was obtained with a median onset of 31 (28−168) days of treatment and until the end of treatment the side effect of skin hyperpigmentation was still found (not reversible). Conclusion: There is a relationship between side effects of skin hyperpigmentation with treatment duration (p=<0.001)m i.e. day 344 (70−769) and short-term oral and short-term injection (p=<0.001)f with RR 10.100 (5.059−20.166)."