Hasil Pencarian  ::  Simpan CSV :: Kembali

Abstrak :
Tuberculosis is one of 6 fatal infectious diseases in the world, and causes three million deaths annually. Tuberculosis (TB) is a pulmonary and systemic disease caused by My-cobacterium tuberculosis. TB classification consists of pulmonary and extra-pulmonary TB. TB stimulates both the specific and non-specific immune systems. Disseminated tuberculosis is military lung TB with several extra-pulmonary organ manifestations. The main management for multi-organ TB is the administration of anti-tuberculosis drugs. In pleural effusion due to lung TB, corticosteroid may reduce systemic and local reactions to tuberculoprotein, reduce pleural exudate secretion and fibrosis, as well as reduce deformity of the chest wall and scoliosis that can inflict children. We report a case of a 25 year-old woman who came with a chief complaint of progressive breathing difficulty since 2 days prior to admission. Since } year prior to admission, the patient's abdomen became bloated and there was edema in her legs. Her lost her appetite and weight, and suffered from a mild fever. The patient had a cough with thick whitish sputum. The patient had not menstruated for 7 months. She had a history of liver disease. Physical examination results were as follows: the patient was moderately ill, fully conscious, and had malnutrition. She weighed 37 kg and was 149 tall. Her blood pressure was 100/70 mm Hg, her pulse rate 84 times/minute, her body temperature 37" Celsius, and her respiration rate 18 times per minute. Her conjunctiva were pale. Her right supra-clavicular and mandibular lymph nodes had a diameter of 2 cm, were resilient, mobile, not tender, and had smooth surfaces. Her lung sounds demonstrated weakened vesicular sounds in her left lung, with loud rales in both lungs. Her abdomen was enlarged, distended to 92 cm, with venectations. Her liver and spleen could not be assessed. There was undulation and normal bowel sounds. Her extremities were warm and edematous. Her left inguinal lymph node was enlarged to 1 cm, resilient, well-defined, mobile, and not tender. Her left inguinal lymph node was 5 mm in diameter. Her laboratory results were as follows: Hemoglobin level 9.0 g/dl, Hematocryte level 27 vol%, erythrocyte count 3.66 juta/ul, and leukocyte count 14.500/ul. Her chest x-ray demonstrated milliary tuberculosis. Abdominal ultrasound revealed a congestive liver, exudative peritonitis, and a mass in the spleen. Ascites fluid aspiration revealed exudate fluid. Pathological cytology revealed chronic granulomatous inflammation, with the possibility ofTB, and no signs of malignant cells. Ascites fluid microbiological culture turned out negative. During the first echocardiography, no pericardia! effusion was found, and the ejection fraction was 61%. During the second echocardiography, there was thickening of the walls, and pericardial effusion. Catheterization was attempted, but failed due to cyanosis. Electrocardiography demonstrated low voltage at nodes 1, II, aVR, aVL, aVF. The patient was consulted to the retina subdivision, and no tubercle was found. Problem: disseminated TB with pericarditis, ascites due to exudative peritonitis, anemia, malnutrition, and secondary amenorrhea. The patient's condition improved under treatment ofRHZE 300/300/1000/750mg, 3x1 tablet ofB complex vitamins, 3x10 mg ofprednison, 1x100 mg ofaldactone, and 1x1 tablet of provera. Her difficulty breathing alleviated, her waist diameter was reduced to 76 cm.

Abstrak :
A reduction in lung capacity to oxygenize blood as well as in cardiovascular capacity to distribute blood may cause hypoxemia, which could then lead to tissue hypoxia and cellular death. The aim of oxygen treatment is to supply the minimum oxygen concentration needed to achieve adequate tissue oxygenation. There are various methods that can be used to supply oxygen, and the amount of oxygen requirement could also be calculated. Treatment methods are classified into STOT and LTOT. The benefit of oxygen treatment is increased survival, influence on the blood vessels, improved exercise capacity, and positive influence on the respiratory and neuropsychological systems. As with the case with pharmacological treatment, oxygen should be administered at certain doses to achieve greatest efficacy with the least toxicity.

Abstrak :
Background: a patient with a history of tuberculosis (TB) has a risk up to 27% to develop recurrence within 2 years after being cured. Indonesia itself has more than 7,500 recurrent cases annually, regardless of reinfection or relapse. This is an important problem, as recurrent TB is associated with lower cure rates with the anti-TB therapy and higher risk of developing drug resistance. Some risk factors for this recurrence are smoking, poor treatment adherence, low economic status, and weak immune status. This study is aimed to identify whether the use of fixed-dose combination (FDC) anti-tuberculosis therapy increases the risk for tuberculosis recurrence compared with using separate drug formulation. Methods: the search was conducted on MEDLINE, ProQuest, EBSCO, ScienceDirect, and Cochrane according to clinical question. The studies were selected based on inclusion and exclusion criteria and led to five useful articles. The selected studies were critically appraised for their validity, importance, and applicability. Results: five cohort studies were found with comparable validity. Only 1 study has accurate relative risk (RR) with 3.97 (1.14-13.80) and number needed to harm of 18. Other four studies fulfilled the applicability criteria for our case. Conclusion: the use of FDC anti-tuberculosis therapy increases the risk for tuberculosis recurrence compared with using separate drug formulation.

Abstrak :
Background: nowadays, specific IgE measurement has been conducted in Indonesia, however there is still lack of data regarding diagnostic test to detect inhalant allergen in patients with respiratory allergies.This study aimed to determine the accuracy of specific IgE test in diagnosing specific sensitization of inhalant allergen in patients with respiratory allergies. Methods: this was a cross sectional study in patients with respiratory allergies and part of epidemiology study regarding to specific IgE sensitization in Allergy-Immunollogy Division, Cipto Mangunkusumo Hospital, Jakarta within November-December 2016. Measurement of specific IgE sensitization using Immunoblot method (Euroline, Euroimmun AG, Germany). The tested allergen is house dust mites Dermatophagoides pteronyssinus (Der p), Dermatophagoides farinae (Der f), Blomia tropicalis (Blo t) and cockroach Blatella germanica (Bla g). The result is compared with gold standard, skin prick test. The diagnostic result includes sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-). Results: a total of 101 patients were enrolled; 77 (76.2%) were women. Patients mean age was 38.8 years old. Based on SPT, sensitization was highest for Blo t (76.2%), followed by Der p (70.3%), Der f (69.3%), and Bla g (41.6%). Specific IgE-sensitization was highest for Der f (52.9%), followed by Der p (38.2%), Blo t (33.3%) and Bla g (10.8%). Der p allergen had 50.7% sentivity, 90% specificity, 92.3% PPV, 43.5% NPV, 5.1 LR+ and 0.1LR-. Der f showed 71.4% sensitivity, 87.1% specificity, 82.6% PPV, 57.4% NPV, 5.5 LR+ and 0.3 LR-. Blo t allergen had 41.6% sensitivity, 91.7% specificity, 94.1% PPV, 32.8% NPV, 5.0 LR+, and 0.6 LR-. Bla g allergen had 23.8% sensitivity, 98.3% specificity, 90.9% PPV, 64.4% NPV, 14.5 LR+ and 0.8 LR-. Conclusion: serum specific IgE testing to common inhalant allergen in patients with respiratory allergy showed only low-to-moderate sensitivity, but high specificity and PPV. This new assay can be used to diagnose allergen sensitization in the population with high prevalence of TDR and cockroach.

Abstrak :
House dust mites (HDM) are an important inhalant allergen in allergic asthma. However, molecular diagnostic study of specific IgE to HDM allergens has not been done in Indonesia. in addition, the association of quantitative specific IgE measurement with asthma severity has not been investigated. This study aimed to investigate difference of serum quantitative specific IgE levels induced by Dermatophagoides (D).

Abstrak :
Background: the risk of Non Alcoholic Fatty Liver Disease (NAFLD) is increasing in patients with type 2 diabetes. Prevalence and factors related to the increased risk of NAFLD in diabetic patients in Indonesia has never been studied before. Data regarding the profile of fibrosis in the population has also been unknown. This study aimed to identify the difference on the profile of diabetic patients with and without NAFLD as well as the degree of fibrosis. Methods: the study was conducted using a cross sectional method in type 2 diabetic patients who were treated at the outpatient clinic of endocrinology and metabolic division in Cipto Mangunkusumo Hospital. Sampling was done consecutively. Collected data comprised of age, duration of diabetes, body mass index (BMI), waist circumference, HDL, triglyceride, and HbA1C levels. Abdominal ultrasonography was conducted for all patients to determine the presence of NAFLD. Patients with NAFLD were subsequently underwent transient elastography in order to assess their degree of liver fibrosis. Chi-square or Fishers Exact tests were used for bivariate analysis and logistic regression was used for multivariate analysis. Results: as many as 186 patients were analyzed in the study and 84 patients (45.2%) were demonstrated to have NAFLD. Transient elastography examinations were carried out in 68 patients and 17 patients (25.0%) were found with severe fibrosis. Univariate analysis showed significant differences on BMI (PR=1.878; 95%CI= 1.296 2.721; p<0.001) and waist circumference (PR=2.368; 95%CI= 1.117 5.017; p=0.018) between patients with and without NAFLD. However, the multivariate test showed that BMI was the only factor that had a significance difference between both groups (OR=2.989; 95%CI=1.625-5.499; p<0.001). Conclusion: prevalence of NAFLD among type 2 diabetic patients in Cipto Mangunkusumo Hospital has reached 45.2% and 25.0% among them had severe fibrosis. BMI is the only factor found to be associated with the occurrence of NAFLD.

Abstrak :
ABSTRAK
Latar Belakang: Angka mortalitas ARDS khususnya di RSCM masih tinggi, sebesar 75,3%. Prokalsitonin (PCT) dan C-reactive protein (CRP) bisa dipakai sebagai prediktor mortalitas pada ARDS. Saat ini belum didapatkan penelitian yang fokus pada peran PCT dan CRP sebagai prediktor mortalitas tujuh hari pada pasien ARDS di Indonesia. Tujuan: Mengetahui peran PCT dan CRP sebagai prediktor mortalitas tujuh hari pada pasien ARDS di RSCM. Metode: Penelitian ini menggunakan disain kohort prospektif yang dilakukan secara konsekutif pada pasien ARDS di RSCM pada November 2015-Januari 2016. Hasil: Dari 66 pasien ARDS, 40 (60,61%) meninggal dan 26 (39,39%) hidup. Uji normalitas PCT dan CRP didapatkan distribusi dari data-data tersebut tidak normal. Dengan uji Kolmogorov-Smirnov didapatkan p<0,05. Median PCT pada yang meninggal sebesar 4,18 (0,08-343,0) dibandingkan yang hidup sebesar 3,01 (0,11-252,30) p=0,390, AUC 0,563 (IK 95% 0,423-0,703). Median CRP pada yang meninggal sebesar 130,85 (9,20-627,78) dibandingkan yang hidup sebesar 111,60 (0,10-623,77) p=0,408, AUC 0,561 (IK 95% 0,415-0,706). Simpulan: Pemeriksaan PCT dan CRP hari pertama pada penelitian ini belum dapat digunakan sebagai prediktor mortalitas tujuh hari pada pasien ARDS.

Abstrak :
Insidens penyakit jamur invasif semakin meningkat di seluruh dunia dalam 2-3 dekade terakhir. Penyakit ini perlu mendapat perhatian, khususnya pada pasien yang dirawat di Intensive Care Unit (ICU) karena kelompok tersebut lebih rentan. Diagnosis dan terapi dini sangat penting untuk mendapatkan hasil akhir yang lebih baik, ditandai dengan penurunan angka morbiditas dan mortalitas. Tujuan: Mengetahui profil pasien sakit kritis akibat penyakit jamur invasif yang didiagnosis secara dini, Metode: Penelitian ini merupakan studi kohort prospektif pada pasien sakit kritis yang dirawat di RSCM selama periode Maret 2015-September 2015. Jumlah subjek pada penelitian ini diambil berdasarkan jumlah subjek terbanyak dari salah satu faktor (HIV), yaitu 74 subjek. Pada perawatan hari ke-5 hingga 7, dilakukan pengambilan spesimen sesuai dengan standar operasional Pengendalian dan Pencegahan Infeksi Rumah Sakit (PPIRS). Hasil: Sejumlah 206 pasien diikutsertakan pada penelitian ini. Pada 74 subjek dengan penyakit jamur invasif, mayoritas subjek adalah laki-laki (52,7%), usia rerata 58 tahun (rentang 18-79), rerata skor Leon 3 (rentang skor 2-5), subjek terbanyak pada kelompok non-bedah atau non-trauma (72,9&), dengan rerata isolasi jamur positif pada hari ke-5. Spesies jamur yang paling banyak menyebabkan infeksi adalah spesies Kandida (92,2%). Kultur urin merupakan spesimen dengan isolat jamur terbanyak (70,1%) dengan angka mortalitas sebesar 50%. Kesimpulan: Kejadian penyakit jamur invasif yang didiagnosis secara dini banyak didapatkan pada pasien sakit kritis dengan angka mortalitas yang tinggi.

Abstrak :
Pasien HIV berisiko 20-37 kali lipat terinfeksi TB dan TB merupakan penyebab kematian tertinggi pada HIV. Resistensi OAT menjadi masalah utama pengobatan TB pada pasien HIV yang menyebabkan peningkatan mortalitas dan biaya. Rifampisin merupakan OAT utama sehingga perlu diketahui prevalensi resistensi rifampisin dan faktor-faktor yang mempengaruhinya pada pasien TB-HIV. Tujuan: Mengetahui prevalensi resistensi rifampisin pada pasien TB-HIV dan faktor-faktor yang mempengaruhi. Metode: Studi potong lintang terhadap 196 pasien TB-HIV yang menjalani pemeriksaan Xpert MTB-RIF di poli pelayanan terpadu HIV RSUPN-CM selama tahun 2012-2015. Analisa bivariat untuk mengetahui hubungan faktor-faktor terkait dengan kejadian resistensi rifampisin. Analisa multivariat menggunakan uji regresi logistik. Hasil: Didapatkan prevalensi resistensi rifampisin sebesar 13,8%. Usia, jenis kelamin, riwayat penggunaan ARV, dan TB ekstraparu tidak berhubungan dengan kejadian resistensi rifampisin pada pasien TB-HIV. Jumlah CD4<100 memiliki hubungan dengan kejadian resistensi rifampisin (OR 2,57; 95% IK 0,99-6,69), namun secara statistik tidak bermakna. Riwayat pengobatan TB memiliki hubungan signifikan dengan kejadian resistensi rifampisin (OR 3,98; 95% IK 1,68-9,44). Simpulan: Prevalensi resistensi rifampisin TB-HIV di RSUPN-CM sebesar 13,8%. Riwayat TB memiliki hubungan signifikan dengan kejadian resistensi rifampisin pada pasien TB-HIV.