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Abstrak :
ABSTRAK
Latar belakang : Prevalens diabetes melitus (DM) terus meningkat di negara berkembang yang merupakan negara endemis tuberkulosis (TB). Diabetes melitus meningkatkan risiko infeksi, hambatan konversi sputum dan kegagalan pengobatan TB. Penelitian ini bertujuan menganalisis faktor-faktor yang mempengaruhi konversi sputum Basil Tahan Asam (BTA) mikroskopik pada akhir bulan kedua pengobatan TB pada pasien TB paru kasus baru dengan DM. Metode : Penelitian kohort retrospektif ini dilaksanakan di RSUP Perahabatan terhadap pasien-pasien TB paru BTA positif kasus baru dengan DM yang berobat pada periode Juli 2012 sampai Juni 2015. Hubungan faktor risiko dengan konversi sputum BTA mikroskopik dianalisis dengan analisis bivariat dan multivariat. Hasil penelitian: Proporsi kegagalan konversi sputum BTA mikroskopik pada pasien TB paru kasus baru dengan DM adalah 43,04%, sedangkan pada pasien tanpa DM 22,75% (p<0,001, KI95% 0,11-0,30) dan risiko relatif (RR) kegagalan konversi 1,89 kali lebih tinggi pada kelompok DM. Faktor risiko yang meningkat bermakna pada pasien gagal konversi adalah kadar kepositifan sputum BTA sebelum 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 lebih rendah bermakna (p=0,013). Analisis multivariat mendapatkan faktor risiko terkuat untuk kegagalan konversi sputum adalah kadar albumin serum yang rendah (p=0,046, aOR 0,464, KI95% 0,218-0,986), tingkat kepositifan sputum BTA 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, status kontrol DM yang tidak baik, kavitas pada foto toraks dan kadar albumin serum yang rendah meningkatkan risiko kegagalan konversi sputum BTA pada pasien TB dengan DM.ABSTRACT
Background: The link of DM and TB is more prominent in developing countries where TB is endemic and the burden of DM is increasing. Diabetes mellitus increases the risk of TB infection, delayed sputum smear conversion and TB treatment failure. This study would like to evaluate factors associated with delayed sputum smear conversion in the end of two months of TB treatment in new cases TB with DM patients in Persahabatan Hospital. Methods: This retrospective cohort study was conducted in Persahabatan Hospital, included all new cases TB with DM patients in the period from July 2012 - June 2015. All the risk factors performed bivariate and multivariate analysis in association with sputum smear conversion in the end of two months of TB treatment. Results: The proportion of sputum smear conversion failure is higher in TB-DM than non-DM patients (43,04 vs 22,75%) (p<0,001, CI95% 0,11-0,30) with the relative 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 serum albumin (p=0,013) in non-conversion patients. Multivariate analysis resulted in risk factors strongly associated with sputum conversion failure are low albumin level (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 smear conversion failure in TB-DM patients.;Background: The link of DM and TB is more prominent in developing countries where TB is endemic and the burden of DM is increasing. Diabetes mellitus increases the risk of TB infection, delayed sputum smear conversion and TB treatment failure. This study would like to evaluate factors associated with delayed sputum smear conversion in the end of two months of TB treatment in new cases TB with DM patients in Persahabatan Hospital. Methods: This retrospective cohort study was conducted in Persahabatan Hospital, included all new cases TB with DM patients in the period from July 2012 - June 2015. All the risk factors performed bivariate and multivariate analysis in association with sputum smear conversion in the end of two months of TB treatment. Results: The proportion of sputum smear conversion failure is higher in TB-DM than non-DM patients (43,04 vs 22,75%) (p<0,001, CI95% 0,11-0,30) with the relative 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 serum albumin (p=0,013) in non-conversion patients. Multivariate analysis resulted in risk factors strongly associated with sputum conversion failure are low albumin level (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 smear conversion failure in TB-DM patients.;Background: The link of DM and TB is more prominent in developing countries where TB is endemic and the burden of DM is increasing. Diabetes mellitus increases the risk of TB infection, delayed sputum smear conversion and TB treatment failure. This study would like to evaluate factors associated with delayed sputum smear conversion in the end of two months of TB treatment in new cases TB with DM patients in Persahabatan Hospital. Methods: This retrospective cohort study was conducted in Persahabatan Hospital, included all new cases TB with DM patients in the period from July 2012 - June 2015. All the risk factors performed bivariate and multivariate analysis in association with sputum smear conversion in the end of two months of TB treatment. Results: The proportion of sputum smear conversion failure is higher in TB-DM than non-DM patients (43,04 vs 22,75%) (p<0,001, CI95% 0,11-0,30) with the relative 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 serum albumin (p=0,013) in non-conversion patients. Multivariate analysis resulted in risk factors strongly associated with sputum conversion failure are low albumin level (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 smear conversion failure in TB-DM patients.;Background: The link of DM and TB is more prominent in developing countries where TB is endemic and the burden of DM is increasing. Diabetes mellitus increases the risk of TB infection, delayed sputum smear conversion and TB treatment failure. This study would like to evaluate factors associated with delayed sputum smear conversion in the end of two months of TB treatment in new cases TB with DM patients in Persahabatan Hospital. Methods: This retrospective cohort study was conducted in Persahabatan Hospital, included all new cases TB with DM patients in the period from July 2012 - June 2015. All the risk factors performed bivariate and multivariate analysis in association with sputum smear conversion in the end of two months of TB treatment. Results: The proportion of sputum smear conversion failure is higher in TB-DM than non-DM patients (43,04 vs 22,75%) (p<0,001, CI95% 0,11-0,30) with the relative 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 serum albumin (p=0,013) in non-conversion patients. Multivariate analysis resulted in risk factors strongly associated with sputum conversion failure are low albumin level (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 smear conversion failure in TB-DM patients.

Abstrak :
ABSTRAK Latar belakang: Penyakit paru obstruktif kronik merupakan penyebab utama morbiditas dan mortalitas di dunia. Penyakit komorbid pada PPOK berkontribusi terhadap rendahnya status kesehatan, mempengaruhi lama perawatan bahkan kematian. Osteoporosis merupakan komorbid yang cukup sering ditemukan pada PPOK. Di Indonesia khususnya di RSUP Persahabatan belum ada data prevalens osteoporosis pasien PPOK stabil. Objektif: Tujuan penelitian ini adalah mendapatkan angka prevalens osteoporosis pada pasien PPOK stabil di RSUP Persahabatan Jakarta. Metode: Disain penelitian ini adalah potong lintang. Pasien PPOK stabil yang berkunjung di poliklinik Asma/PPOK RSUP Persahabatan yang memenuhi kriteria inklusi dan eksklusi. Subjek diperiksa densitas mineral tulang menggunakan dual energy x-ray absorptiometry (DXA) dan diperiksa kadar vitamin D darah. Saat pasien berkunjung, dilakukan anamnesis gejala, eksaserbasi, riwayat merokok, penggunaan kortikosteroid (oral atau inhalasi), komorbid, penilaian status gizi. Selanjutnya dilakukan analisis dengan uji statistik. Hasil: Subjek terbanyak adalah laki-laki (90,6%) dengan kelompok usia 65-75 tahun (53,1%), riwayat merokok terbanyak (84,4%). Berdasarkan derajat PPOK terbanyak adalah GOLD II (46,9%) dan grup B (50%) dengan menggunakan kortikosteroid sebanyak (65,7%). Pada penelitian ini didapatkan prevalens osteoporosis sebesar 37,5%, artinya lebih dari sepertiga pasien mengalami osteoporosis. Dalam Penelitian ini tidak terdapat hubungan bermakna secara statistik antara grup PPOK, derajat PPOK, jenis kelamin, riwayat merokok, riwayat kortikosteroid, usia, kadar 25-OHD, faal paru dengan terjadinya osteoporosis pada pasien PPOK stabil (p>0,05). Pada penelitian ini didapatkan hubungan bermakna pada IMT yang rendah sebagai faktor risiko osteoporosis pada PPOK stabil (p<0,001). Kesimpulan: Prevalens osteoporosis pada pasien PPOK stabil di RSUP Persahabatan Jakarta adalah 37,5%. Terdapat hubungan yang bermakna secara statistik antara IMT dengan osteoporosis pada pasien PPOK stabil (p<0,001).

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ABSTRACT Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in the world. Comorbid diseases in COPD contributing to low health status, affecting the duration of treatment and even death. Osteoporosis is a quite often comorbid that found in COPD. In Indonesia, particularly in Persahabatan Hospital there are no data of prevalence on osteoporosis in patient with stable COPD. Objective: The purpose of this research is to get the prevalence?s data of osteoporosis in patients with stable COPD at Persahabatan Hospital-Jakarta. Method: The studie?s design was cross-sectional. Patients with stable COPD who came to the Asthma/COPD policlinic at Persahabatan Hospital-Jakarta who meet the criteria of inclusion and exclusion. Subjects had an examined of bone mineral density using dual energy x-ray absorptiometry (DXA) and had an examined of vitamin D blood level. At the time of visit, conducted anamnesis of symptoms, exacerbations, history of smoking, used of corticosteroid (oral or inhaled), comorbid, assessment of nutritional status. Then we did statistical test for analysis. Results: Subjects were dominated with male (90.6%) in the age group 65-75 years old (53.1%), and smoking history (84.4%). The most degree of COPD of the subject were GOLD II (46.9%) and group B (50%) that using corticosteroid (65.7%). In this study we found prevalence of osteoporosis was 37.5%, meaning that approximately more than one third of the patients have had osteoporosis. There were no statistically significant relationship between COPD group, the degree of COPD, sex, smoking history, history of corticosteroid, age, levels of 25-OHD, pulmonary function with the occurrence of osteoporosis in patients with stable COPD (p>0.05). We found a significant relationship on low BMI as a risk factor for osteoporosis in stable COPD (p<0.001). Conclusion: The prevalence of osteoporosis in patients with stable COPD in Persahabatan Hospital-Jakarta is 37.5%. There are a statistically significant relationship between BMI with osteoporosis in patients with stable COPD (p <0.001).

Abstrak :
Latar Belakang. Mikroangiopati diabetik DM seperti nefropati, retinopati, dan neuropati merupakan komplikasi umum diabetes melitus tipe 2 T2DM . Paru merupakan salah satu organ target dari komplikasi mikrovaskular dan penurunan kapasitas difusi paru pada mikroangiopati DM masih sedikit diketahui. Metode. Penelitian ini bersifat potong lintang pada subjek T2DM yang menjalani pemeriksaan kapasitas difusi paru terhadap karbon monoksida DLCO, albumin urin, funduskopi dan elektromiografi EMG di poliklinik rawat jalan DM terpadu. Kriteria eksklusi yaitu penyakit paru akut atau kronis. Hasil. Sebanyak 52 subjek L/P:20/32 usia 58 10,4 tahun sebagian besar menunjukkan HbA1c>6,5 41/52 78 , tidak pernah merokok 41/52 78,8 . rerata terdiagnosis DM 10,5 6,9 tahun, sebanyak 33 63,5 le;10 tahun dan 19 36,5 subjek >10 tahun. Subjek dengan neuropati lebih banyak ditemukan yaitu sebesar 41/52 26,3 diikuti nefropati 29/52 18,6 dan retinopati 9/52 5,8 dengan rerata DLCO sebesar 16,01 4,12 ml/menit/mmHg . Penurunan kapasitas difusi pada Mikroangiopati DM ditemukan sebanyak 14/52 25 subjek, didapatkan nilai p pada nefropati sebesar p=0,27, retinopati p=0,36 dan neuropati p=0,49. Kesimpulan. Gangguan kapasitas difusi paru pada mikroangiopati DM mengalami penurunan namun tidak mempunyai hubungan yang yang bermkana, hal ini menunjukkan gangguan faal difusi paru pada mikroangiopati DM.

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Background. Diabetic microangiopathy such as nephropathy, retinopathy and neuropathy is a common complications of type 2 diabetes mellitus T2DM . The lung is one of the target organs in the development of vascular complications in diabetic patients and little is known about the impairment of pulmonary diffusing capacity due to the diabetic microangiopathy. Method. The subjects were T2DM patients underwent carbon monoxide lung diffusion capacity DLCO test, urine test, funduscopy and electromyography EMG examination with consecutively from diabetic outpatient clinic. The exclusion criterias were acute or chronic pulmonary diseases. Results. A total of 52 subjects m/f: 20/32 ages 58 10.4 years mostly showed HbA1c> 6.5 41/52 78 , never smoked 41/52 78.8 . diagnosed DM rates of 10.5 6.9 years, 33 63.5 le;10 years and 19 36.5 subjects> 10 years. Subjects with more neuropathy were 41/52 26.3 followed by nephropathy 29/52 18.6 and retinopathy 9/52 5.8 with DLCO average of 16.01 4.12 ml / min / mmHg . The decrease in diffusion capacity in Microangiopathy DM was found in 14/52 25 subjects, obtained p value on nephropathy of p=0.27, retinopathy p=0.36 and neuropathy p=0.49 respectively. Conclusion. This study demonstrated that diffusion capacity is impairment in diabetic microangiopathy patients. Pulmonary diffusion capacity has no association with diabetic microangiopathy but there is a decreased pulmonary diffusion physiology.

Abstrak :
Latar belakang: Diabetes melitus tipe 2 merupakan penyakit komorbid yang sering ditemui pada pasien PPOK. Penyakit paru obstruktif kronik dipertimbangkan sebagai faktor risiko berkembangnya diabetes tipe 2 melalui beberapa mekanisme antara lain inflamasi sitemik, merokok, stres oksidatif, obesitas dan penggunaan kortikosteroid inhalasi. Prevalens DM pada pasien PPOK di Indonesia belum diketahui secara pasti. Diabetes melitus sebagai penyakit komorbid pada pasien PPOK akan mempengaruhi morbiditas dan mortalitas pasien PPOK. Metode: Penelitian ini merupakan penelitian potong lintang dengan analisis deskriptif yang dilakukan di poliklinik asma ndash;PPOK Rumah sakit umum pusat Persahabatan pada bulan Februari ndash; Maret 2017 untuk melihat kejadian diabetes pada pasien PPOK. Enam puluh empat pasien PPOk di ambil untuk ikut dalam penelitian ini secara consecutive sampling. Pada semua pasien dilakukan wawancara, pemeriksaan fisis dan pemeriksaan laboratorium. Hasil: Pada penelitian ini diambil 64 pasien PPOK lakilaki: 60, perempuan : 4 dengan usia rata rata 65 8.7 tahun. Sebanyak 12 subjek 18.8 sudah memiliki riwayat DM sebelumnya dan pasien ini dimasukan kedalam kelompok DM tanpa memandang hasil laboratorium. Dari 52 81.3 subjek yang belum diketahui status DM ditemukan 2 subjek 3,1 dengan diagnosis DM. Prevalens DM pada pasien PPOK pada penelitian ini sebesar 21.9. Ditemukan 16 subjek 25 dengan kadar HbA1c sesuai dengan prediabetes. Tidak ditemukan hubungan bermakna antara usia, jenis kelamin, riwayat merokok, sataus gizi, hambatan aliran udara dan penggunaan kortikosteroid inhalasi dengan kejadian DM pada pasien PPOK. Kesimpulan: Prevalens DM pada pasien PPOK dalam penelitian ini adalah sebesar 21..9 . Penapisan komorbid DM penting dilakukan secara berkala. ...... Background: Type 2 diabetes mellitus DM is a common comorbidity of COPD. COPD may be considered as a risk factor for new onset type 2 DM via multiple pathophysiological alterations such as systemic inflammation, smoking, oxidative stress, obesity and inhaled corticosteroid use. Exact prevalence of DM in COPD patients in Indonesia are still unclear. Co morbid conditions like DM have great impacts on the outcome of COPD in the form of severity, morbidity and mortality Method: A cross sectional study with descriptive analysis was done in Asthma COPD clinic Persahabatan Hospital from February to March 2017 to screen COPD patients for DM. Sixty four subjects were recruited consecutively. Interview, physical examination and laboratory testing were performed in all subjects. Results: A total of 64 patients with COPD Males 60, Female 4 with mean age 65 8.7 were screened for DM. Patients with known history of DM were 12 18.8 and were enrolled as Known DM cases. Remaining 52 81.3 patients whose DM status were unclear and screened by random or fasting blood sugar and HbA1c. Two subjects 3.1 were considered as newly diagnosed DM cases. Prevalence of DM in present study was 21.9. Number of patients with prediabetes were 16 subjects 25. There were no significant relationship among gender, age, smoking, nutritional status, airflow limitation and inhaled corticosteroid use in occurrence of DM among COPD patients. Conclusion: Prevalence of DM in COPD patients in the present study is 21.9. It is important to screen all COPD patients for DM routinely.