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"ABSTRAK Latar belakang : Prevalens diabetes melitus (DM) terus meningkat di negaraberkembang yang merupakan negara endemis tuberkulosis (TB). Diabetes melitusmeningkatkan risiko infeksi, hambatan konversi sputum dan kegagalanpengobatan TB. Penelitian ini bertujuan menganalisis faktor-faktor yangmempengaruhi konversi sputum Basil Tahan Asam (BTA) mikroskopik padaakhir bulan kedua pengobatan TB pada pasien TB paru kasus baru dengan DM.Metode : Penelitian kohort retrospektif ini dilaksanakan di RSUP Perahabatanterhadap pasien-pasien TB paru BTA positif kasus baru dengan DM yang berobatpada periode Juli 2012 sampai Juni 2015. Hubungan faktor risiko dengan konversisputum BTA mikroskopik dianalisis dengan analisis bivariat dan multivariat.Hasil penelitian: Proporsi kegagalan konversi sputum BTA mikroskopik padapasien TB paru kasus baru dengan DM adalah 43,04%, sedangkan pada pasientanpa DM 22,75% (p<0,001, KI95% 0,11-0,30) dan risiko relatif (RR) kegagalankonversi 1,89 kali lebih tinggi pada kelompok DM. Faktor risiko yang meningkatbermakna pada pasien gagal konversi adalah kadar kepositifan sputum BTAsebelum terapi (p=0,021), HbA1c (p=0,014), GDP (p=0,047), GD 2jam PP(p=0,030) dan kavitas pada foto toraks (p=0,033) sedangkan albumin serum lebihrendah bermakna (p=0,013). Analisis multivariat mendapatkan faktor risikoterkuat untuk kegagalan konversi sputum adalah kadar albumin serum yangrendah (p=0,046, aOR 0,464, KI95% 0,218-0,986), tingkat kepositifan sputumBTA mikroskopik sebelum terapi yang tinggi (p=0,009, aOR 2,313, KI95%1,230-4,349) dan kadar HbA1c yang tinggi (p=0,018, aOR 1,298, KI 95% 1,047-1,610).Kesimpulan: Tingkat kepositifan sputum BTA sebelum terapi yang tinggi, statuskontrol DM yang tidak baik, kavitas pada foto toraks dan kadar albumin serumyang rendah meningkatkan risiko kegagalan konversi sputum BTA pada pasienTB dengan DM.ABSTRACT Background: The link of DM and TB is more prominent in developing countrieswhere TB is endemic and the burden of DM is increasing. Diabetes mellitusincreases the risk of TB infection, delayed sputum smear conversion and TBtreatment failure. This study would like to evaluate factors associated withdelayed sputum smear conversion in the end of two months of TB treatment innew cases TB with DM patients in Persahabatan Hospital.Methods: This retrospective cohort study was conducted in PersahabatanHospital, included all new cases TB with DM patients in the period from July2012 - June 2015. All the risk factors performed bivariate and multivariateanalysis in association with sputum smear conversion in the end of two months ofTB treatment.Results: The proportion of sputum smear conversion failure is higher in TB-DMthan non-DM patients (43,04 vs 22,75%) (p<0,001, CI95% 0,11-0,30) with therelative risk (RR) for sputum conversion failure 1,89 higher in TB-DM patients.Bivariate analysis resulted in significant higher of initial sputum smear level(p=0,021), HbA1c (p=0,014), FBG (p=0,047), post prandial Blood Glucose(p=0,030) and cavity at chest x-ray (p=0,033) and significant lower of serumalbumin (p=0,013) in non-conversion patients. Multivariate analysis resulted inrisk factors strongly associated with sputum conversion failure are low albuminlevel (p=0,046, CI95% 0,218-0,986), high initial sputum smear level (p=0,009,CI95% 1,230-4,349) and high HbA1c level (p=0,018, CI 95% 1,047-1,610).Conclusions: Higher initial sputum smear level, uncontrolled diabetic status,cavity at chest x-ray and lower albumin level associated with sputum smearconversion failure in TB-DM patients.;Background: The link of DM and TB is more prominent in developing countrieswhere TB is endemic and the burden of DM is increasing. Diabetes mellitusincreases the risk of TB infection, delayed sputum smear conversion and TBtreatment failure. This study would like to evaluate factors associated withdelayed sputum smear conversion in the end of two months of TB treatment innew cases TB with DM patients in Persahabatan Hospital.Methods: This retrospective cohort study was conducted in PersahabatanHospital, included all new cases TB with DM patients in the period from July2012 - June 2015. All the risk factors performed bivariate and multivariateanalysis in association with sputum smear conversion in the end of two months ofTB treatment.Results: The proportion of sputum smear conversion failure is higher in TB-DMthan non-DM patients (43,04 vs 22,75%) (p<0,001, CI95% 0,11-0,30) with therelative risk (RR) for sputum conversion failure 1,89 higher in TB-DM patients.Bivariate analysis resulted in significant higher of initial sputum smear level(p=0,021), HbA1c (p=0,014), FBG (p=0,047), post prandial Blood Glucose(p=0,030) and cavity at chest x-ray (p=0,033) and significant lower of serumalbumin (p=0,013) in non-conversion patients. Multivariate analysis resulted inrisk factors strongly associated with sputum conversion failure are low albuminlevel (p=0,046, CI95% 0,218-0,986), high initial sputum smear level (p=0,009,CI95% 1,230-4,349) and high HbA1c level (p=0,018, CI 95% 1,047-1,610).Conclusions: Higher initial sputum smear level, uncontrolled diabetic status,cavity at chest x-ray and lower albumin level associated with sputum smearconversion failure in TB-DM patients.;Background: The link of DM and TB is more prominent in developing countrieswhere TB is endemic and the burden of DM is increasing. Diabetes mellitusincreases the risk of TB infection, delayed sputum smear conversion and TBtreatment failure. This study would like to evaluate factors associated withdelayed sputum smear conversion in the end of two months of TB treatment innew cases TB with DM patients in Persahabatan Hospital.Methods: This retrospective cohort study was conducted in PersahabatanHospital, included all new cases TB with DM patients in the period from July2012 - June 2015. All the risk factors performed bivariate and multivariateanalysis in association with sputum smear conversion in the end of two months ofTB treatment.Results: The proportion of sputum smear conversion failure is higher in TB-DMthan non-DM patients (43,04 vs 22,75%) (p<0,001, CI95% 0,11-0,30) with therelative risk (RR) for sputum conversion failure 1,89 higher in TB-DM patients.Bivariate analysis resulted in significant higher of initial sputum smear level(p=0,021), HbA1c (p=0,014), FBG (p=0,047), post prandial Blood Glucose(p=0,030) and cavity at chest x-ray (p=0,033) and significant lower of serumalbumin (p=0,013) in non-conversion patients. Multivariate analysis resulted inrisk factors strongly associated with sputum conversion failure are low albuminlevel (p=0,046, CI95% 0,218-0,986), high initial sputum smear level (p=0,009,CI95% 1,230-4,349) and high HbA1c level (p=0,018, CI 95% 1,047-1,610).Conclusions: Higher initial sputum smear level, uncontrolled diabetic status,cavity at chest x-ray and lower albumin level associated with sputum smearconversion failure in TB-DM patients.;Background: The link of DM and TB is more prominent in developing countrieswhere TB is endemic and the burden of DM is increasing. Diabetes mellitusincreases the risk of TB infection, delayed sputum smear conversion and TBtreatment failure. This study would like to evaluate factors associated withdelayed sputum smear conversion in the end of two months of TB treatment innew cases TB with DM patients in Persahabatan Hospital.Methods: This retrospective cohort study was conducted in PersahabatanHospital, included all new cases TB with DM patients in the period from July2012 - June 2015. All the risk factors performed bivariate and multivariateanalysis in association with sputum smear conversion in the end of two months ofTB treatment.Results: The proportion of sputum smear conversion failure is higher in TB-DMthan non-DM patients (43,04 vs 22,75%) (p<0,001, CI95% 0,11-0,30) with therelative risk (RR) for sputum conversion failure 1,89 higher in TB-DM patients.Bivariate analysis resulted in significant higher of initial sputum smear level(p=0,021), HbA1c (p=0,014), FBG (p=0,047), post prandial Blood Glucose(p=0,030) and cavity at chest x-ray (p=0,033) and significant lower of serumalbumin (p=0,013) in non-conversion patients. Multivariate analysis resulted inrisk factors strongly associated with sputum conversion failure are low albuminlevel (p=0,046, CI95% 0,218-0,986), high initial sputum smear level (p=0,009,CI95% 1,230-4,349) and high HbA1c level (p=0,018, CI 95% 1,047-1,610).Conclusions: Higher initial sputum smear level, uncontrolled diabetic status,cavity at chest x-ray and lower albumin level associated with sputum smearconversion failure in TB-DM patients."

"Latar Belakang dan Tujuan: Prevalensi tuberkulosis di Indonesia menduduki peringkat kedua terbanyak setelah India dan peran diagnosis cepat serta akurat sangatlah penting. Sejak tahun 2014 pemeriksaan laboratorium berbasis amplifikasi asam nukleat GenXpert MTB/RIF telah diadopsi dalam pedoman nasional penanggulangan TB paru BTA negatif karena dalam 2 jam dapat lebih akurat mendeteksi basil tahan asam dibandingkan dengan apusan sputum BTA konvensional. Harga yang mahal dan ketersediaan yang terbatas membuat perlunya alternatif lain untuk pemeriksaan ini. Penelitian ini bertujuan untuk membandingkan gambaran radiografi toraks GenXpert MTB/RIF pada pasien tersangka TB paru BTA negatif. Metode: Uji komparasi dengan pendekatan potong lintang membandingkan gambaran radiografi toraks tipikal, atipikal dan bukan TB pada 44 subyek dengan hasil GenXpert MTB/RIF positif dan negatif 22 subyek per kelompok. Analisis berdasarkan adanya komorbiditas HIV, DM, terapi imunosupresan jangka panjang juga dilakukan. Hasil: Terdapat kesesuaian antara gambaran radiografi toraks dengan hasil pemeriksaan genXpert MTB/RIF pada subyek dengan BTA sputum negatif, dengan nilai kappa 0,59 moderate, sensitivitas 81,8 dan spesifisitas 77,3, yang menguat pada kelompok tanpa komorbiditas kappa 0,71l; sensitivitas 87,5, spesifisitas 83,3, serta berkurang pada kelompok dengan komorbiditas kappa 0,464; sensitivitas 81,8 ; spesifisitas 71,4. Lesi radiografi toraks pada kelompok subyek dengan genXpert positif terbanyak adalah infiltrat lapangan atas paru 77,3, nodul 40,9, kavitas 36,4, secara statistik signifikan dengan p<0,05. Kesimpulan: Jika dibandingkan dengan GenXpert MTB/RIF, radiografi toraks memberikan sensitivitas dan spesifisitas yang baik, sehingga dapat dijadikan alternatif modalitas diagnosis yang lebih murah, terutama di daerah perifer Indonesia.......Background and Purpose: Indonesia rsquo s tuberculosis prevalence is currently ranked second highest in the world after India. Therefore, the role of fast and accurate diagnosis is very important. After 2014, a nucleic acid amplification test GenXpert MTB RIF is implemented for negative sputum smear tuberculosis, due to its ability to diagnose tuberculosis within 2 hours with higher accuracy compared to conventional smear. Due to its high cost and lack of availability, an alternative for diagnostic tools should be sought. This study objective is to compare chest radiography using WHO ISTC criteria based on typical and atypical lesion, with GenXpert MTB RIF on subjects who are suspected tuberculosis, with negative sputum smear. Methods: Comparative cross sectional study to compare chest radiography using WHO ISTC criteria based on typical and non typical TB among 44 subjects suspected tuberculosis infection with negative sputum smear, among groups with positive and negative GenXpert each 22 subjects. Analysis is also performed on subjects with and without comorbidities HIV, DM, long term immunosuppressive therapy. Results: We found moderate agreement with kappa value 0,59 moderate, sensitivity 81,8 and specificity 77,3, and showing increased value in group without comorbidities kappa 0,71l sensitivity 87,5, specificity 83,3, and decreased value in group with comorbidities kappa 0,464 sensitivity 71,4 specificity 75. Radiographic lesions most frequently found in positive GenXpert group are upper field infiltrate 77,3, nodules 40,9, and cavities 36,4, with greater proportion compared with negative group, and statistically significant p<0,05. Conclusion: Compared with GenXpert MTB RIF, chest radiography shows good sensitivity and specificity, so it is still potential as cost effective diagnostic modality especially in peripheral areas in Indonesia. "

"Penyakit Tuberkulosis Paru BTA (+) di DKI Jakarta masih merupakan masalah kesehatan, prevalensi penderita TB. Paru BTA (+) tahun 1580 sebesar 2,6%o (dua koma enam perseribu atau permil), tahun 1993-1994 dengan pemeriksaan mikroskop flouresence sebesar $,25%o, sedangkan prevalensi untuk kelompok umur ≥ 15 tahun 4,9%o. Sebagian besar (91,7%) penderita TB. Paru BTA (+) berpenghasilan rendah dan tidak mampu membeli paket obat, sementara paket Obat Anti Tuberkulosisi yang tersedia di Puskesmas belum dimanfaatkan sepenuhnya (79,4%). Oleh karena itu timbul pertanyaan faktor-faktor apakah yang mempengaruhi pemanfaatan pengobatan TB. Paru BTA (+) di Puskesmas ?Penelitian ini menggunakan pendekatan disain kasus kontrol dengan tujuan untuk menjawab pertanyaan diatas. Variabel utama yang dipelajari adalah pengetahuan penderita tentang penyakit TB. Paru BTA (+) dan pengcbatannya, lama sakit serta tingkat keparahan terhadap pemanfaatan pengobatan TB. Paru BTA (+) di Puskesmas.Kasus adalah penderita TB.Paru BTA (+) yang ditemukan melalui Survei Prevalensi tahun 1993-1994 sebanyak 40 penderita, kontrol sebanyak 92 penderita adalah penderita TB. Paru BTA (+) yang mendapat pengobatan paket jangka pendek dari Puskesmas dan bertempat tinggal di wilayah kelurahan yang lama dengan kasus. Analisis bivariat menunjukan bahwa variabel yang berpengaruh terhadap pemanfaatan pengobatan TB. Paru BTA (+) di Puskesmas adalah pengetahuan dengan Odds Rasio (OR) 3,80 (95% CI ; 1,59-9,21 p < 0,001), lama sakit dengan OR 2,52 (95% CI ; 1,02-6,32 p = 0,026), biaya berobat dengan OR 15,83 (957 CI ; 3,44 - 95,85 p < 0,001), biaya transportasi dengan OR 3,43 (95% CI ; 1,48 - 8,07 p < 0,001), kelengkapan pelayanan dengan OR 12,62 (95% CI ;4,76 - 34,31 p<0,001) dan pekerjaan penderita dengan OR 2,23 (95% CI ; 0,94 - 5,36 p = 0,044).Analisis multivariat dengan regresi logistik menunjukkan bahwa variabel yang berpengaruh terhadap pemanfaatan pengobatan TB.Paru BTA (+) di Puskesmas berdasarkan kontribusinya secara berurutan adalah variabel biaya berobat, kelengkapan pelayanan, pengetahuan dan lama sakit dengan nilai likelihood rasio = 112,7062 dan nilai p<0,001.Penelitian ini menyimpulkan bahwa penderita dengan pengetahuan yang baik, biaya berobat yang murah dan pelayanan yang lengkap akan meningkatkan jumlah penderita yang memanfaatkan pengobatan TB Paru BTA (+) di Puskesmas.

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Cases Control Study The Utilization Treatment Of Lung Tuberculosis Sputum Smear Positive Mycobacterium Tuberculosis (Tb. Positive) At Public Health Centres Jakarta Province In 1995Lung Tuberculosis of sputum smear TS (+) at Jakarta Province is still made up of health problem, the prevalence of Lung Tuberculosis in 1980 was 2,C %o (two point six per mill), in 1993-1994 it was 3,25%o of examine by fluorescence microscope, mean while the prevalence for age group 3 15 years was 4,9 %o. Most of sufferers (91,7%) of Lung tuberculosis patients were coming from low-income family and could not afford the package of chemotherapy drugs regimen, while existing package of drugs regimen Anti Tuberculosis at Public Health Centers are unused yet at a whole (79,4%). Therefore, a question comes out, what is the inhibited factors the utilization treatment of Lung Tuberculosis sputum smear (+) at Public Health Centers ?This research used a kind of "cases control design" approach on the purpose to answer the above question. The primary variables to be learned was knowledge patients on Lung Tuberculosis sputum smear (+) and treatment programme, the length of suffering the desease and degree of seriousness of condition against to the utilization of Lung Tuberculosis sputum smear (+) at Public Health Centers.A cases is patient of Lung Tuberculosis sputum smear (+) founded of 40 patients trough Prevalence Survey con-ducted in 1993-1994, control of $2 patients were the sufferers of this desease who had short-term package drugs regimen at Public Health Centers which is located at the same sub-district as the case.Bivariate analysis indicated that affecting variables to the utilization treatment of Lung Tuberculosis sputum smear (+) at Public Health Centers is the knowledge of Odds Ratio (OR) is 3,80 (95% CI ; 1,59-9,21 p < 0,001), the OR of length of suffering is 2,52 (95% CI ; 1,02 - 6,32 p = 0,062), The OR treatment cost is 15,83 (95% CI; 3,44-95,85 p < 0,001 ), the OR of transportation cost is 3,44 (95% CI; 1,48 - 8,07 p t 0,001 ), the OR of services completeness is 12,62 (95% CI ;4,76-34,31 p 0,001) and the OR of patients occupations is 2,23 (95% CI ; 0,94 - 5,36 p = 0,044).Multivariate analysis by logistic regression indicated that affecting variables to the utilization treatment of Lung Tuberculosis sputum smear (+) at Public Health Centers in accordance with the respective contribution are cost treatment, services completeness, knowledge and length of suffering the desease with likelihood ratio = 112,7062 and p value < 0,001.This research concluded that good knowledge of the patient, low-cost of medicinal treatment and completed services will increase the number of patients to the utilization treatment of Lung Tuberculosis sputum smear (+) at Public Health Centers."

"ABSTRACTTuberkulosis adalah penyakit infeksi yang diderita oleh banyak orang di dunia termasuk Indonesia. Konversi sputum adalah salah satu cara untuk mengevaluasi respon pasien tuberkulosis, namun konversi sputum dipengaruhi oleh banyak faktor salah satunya adalah grading sputum yang tinggi. Pada penelitian ini dilakukan penelitian mengenai keberhasilan konversi sputum dihubungkan dengan sputum smear grading. Studi ini dilakukan di tiga puskesmas di Depok dan menggunakan 293 formulir TB.01. Terdapat 25 kejadian gagal konversi dimana 16 dari kejadian itu didapatkan pada kelompok dengan sputum smear grading yang tinggi. Analisis statistik dari data yang didapat menunjukkan bahwa ada hubungan antara sputum smear grading yang tinggi dengan kegagalan konversi dengan RR 3.380 yang memiliki indeks kepercayaan 95 1.549 hingga 7.375. Kesimpulan dari hasil penelitian ini adalah sputum smear grading merupakan salah satu faktor penting yang memengaruhi keberhasilan konversi pada pasien TB.

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ABSTRACTTuberculosis is an infectious disease suffered by many people in the world including Indonesia. Sputum conversion is an indicator to evaluate patient rsquo s response against Tuberculosis drug, but sputum conversion is influenced by many factors and high sputum grading is one of them. In this research, we seek the relation between sputum smear grading and the success of sputum conversion. This study is done in three public health center in Depok and using 293 TB.01 formulir. There are 25 incidence of failure in sputum conversion and 16 of it is from the group whose sputum smear grading is high. Statistical analysis from the data showed that there is a relation between high sputum smear grading and sputum conversion. The RR is 3.380 with 95 confidence interval 1.549 to 7.375. The conclusion from this study is that sputum smear grading is an important factor that influence success rate of conversion of sputum in tuberculosis patient."