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"Latar belakang: Hemoglobin A1c HbA1c menyebabkan peningkatan kerentanan terhadap tuberkulosis, mulai dari gejala klinis ,derajat keparahan dan respon terhadap terapi. Penelitian ini bertujuan untuk mengetahui pengaruh kadar HbA1c terhadap lama konversi dan perbaikan gejala klinis pada fase intensif pengobatan pasien TB paru kasus baru di Balai Besar Kesehatan Paru Masyarakat BBKPM Bandung pada tahun 2015. Metode: Penelitian ini menggunakan metode kohort prospektif yang dilakukan pada bulan April 2015 hingga September 2015 di BBKPM Bandung. Kriteria inklusi untuk penelitian ini adalah pasien TB paru kasus baru berusia ge; 15 tahun dan bersedia untuk berpartisipasi dalam penelitian ini dengan menandatangani surat persetujuan. Kriteria eksklusi penelitian ini adalah pasien TB paru dengan diabetes mellitus dan kehamilan. Hasil Penelitian: Jumlah subjek yang didiagnosis sebagai kasus baru TB paru bakteriologis dan klinis, kasus baruadalah 123 pasien, terdiri dari 63 51,2 perempuan dan 60 48,8 laki-laki. Pasien dengan nilai HbA1c. 6.5 sebanyak 111 subjek 90,2 dan HbA1c ge; 6,5 sebanyak 12 subjek 9,8. Subjek dengan BTA positif di 69 56,1 dan BTA negatif sebanyak 54 subyek 43,9. Pada subjek TB paru bakteriologis dengan nilai HbA1c ge; 6,5 dan waktu konversi sputum BTA lebih dari. bulan adalah 54,5 sedangkan subjek dengan HbA1c. 6.5 adalah 45,5. Kesimpulan: Penelitian ini menunjukkan bahwa prevalens DM pada pasien TB kasus baru adalah 9,8 dan kejadian waktu konversi lebih dari. bulan pada subjek TB paru kasus baru dengan HbA1c ge; 6,5 adalah 10 kali lebih tinggi dibandingkan pada pasien TB paru kasus baru dengan HbA1c. 6,5. Nilai HbA1c tidak menunjukan hubungan yang bermaknaterhadap perubahan klinis pada pasien TB paru kasus baru setelah pengobatan fase intensif.

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Background: Haemoglobin A1c (HbA1c) causes increased susceptibility to tuberculosis, as well as clinical symptoms, severity, and response to therapy. This study aims to determine the influences of HbA1c levels toward sputum conversion time and clinical symptoms in a new case pulmonary tuberculosis new cases with intensive phase of TB treatment at the Community Center for Lung Health (BBKPM) Bandung in 2015.

Method: A prospective cohort study was conducted in April 2015 until September 2015 at BBKPM Bandung. Inclusion criteria for this study is a new case of pulmonary TB patients aged ≥ 15 years and willing to participate in the study by signing a letter of approval. The exclusion criteria of this study are pulmonary TB patients with diabetes mellitus and pulmonary TB patients with pregnancy. This study used Chi-square test to find relative risk of all variables which evaluated.

Results: The number of subjects who diagnosed as new cases of pulmonary TB were 123 patients, consists of 63 female and 60 male. Patients with HbA1c levels <6.5% at 111 subjects and levels of ≥ 6.5% by 12 subjects. Subjects with smear positive in 69 (56.1%) and negative AFB as many as 54 subjects (43.9%). Duration of sputum smear conversion time for more than 2 months were 11 subjects (8.9%) while the conversion time for 2 months were 112 subjects (91.1%). Subjects with HbA1c levels ≥ 6.5% were longer obtained sputum smear conversion of more than 2 months (54,5%) compared to subjects with HbA1c levels < 6.5% (45.5%). Level of HbA1c did not show significant result in clinical changes after intensive phase treatment either patient with HbA1c ≥ 6,5% or HbA1c < 6,5%.

Conclusion: This study shows that there are significant influences of HbA1c levels towards sputum smear conversion time in patients with new cases of pulmonary TB in BBKPM Bandung, however the level of HbA1c does not show significant difference in clinical changes in patient with tuberculosis after intensive phase treatment."

"Salah satu indikator program pengendalian TB secara Nasional strategi DOTS adalah angka keberhasilan pengobatan TB. Fokus utama pengendalian TB strategi DOTS adalah memutus mata rantai penularan TB oleh penderita TB paru sputum BTA positif. Berdasarkan penelitian penderita TB paru sputum BTA negatif dapat menularkan 13-20% (Tostmann A, et al, 2008). BBKPM Bandung sebagai salah satu UPK strategi DOTS pencapaian angka keberhasilan pengobatan masih dibawah target Nasional. Tujuan: mempelajari faktor yang mempengaruhi keberhasilan pengobatan pasien TB paru sputum BTA negatif dan pasien TB paru sputum BTA positif. Faktor yang mempengaruhi keberhasilan pengobatan TB antara lain faktor individu (umur, jenis kelamin, pekerjaan, kepatuhan berobat) dan obat dan penyakit (rejimen, dosis, lama pengobatan, komorbid HIV dan DM). Indikator keberhasilan pengobatan: pemeriksaan ulang sputum BTA menjadi/tetap negatif dan kenaikan berat badan. Desain penelitian: kohort retrospektif. Sampel: data pasien TB Paru yang tercatat di TB 01 tahun 2009-2011dijadikan 2 sub populasi, Pasien TB paru dengan sputum BTA negatif 292 kasus dan pasien TB paru dengan sputum BTA positif 461 kasus. Analisis: multivariabel regresi logistik. Hasil: OR keberhasilan pengobatan pasien TB paru sputum BTA negatif patuh berobat 1,4 dibandingkan tidak patuh (CI : 0,7-3,0) dan pasien TB paru sputum BTA positif patuh berobat 1,1 di bandingkan tidak patuh (CI : 0,6-2,2) setelah dikontrol umur, jenis kelamin dan pekerjaan. Saran: Meningkatkan peran PMO, dan memperhatikan faktor komorbid dalam tatalaksana pengobatan pasien TB paru.

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Succes rate of TB treatment is an important indicator of the Natinal TB control program.The main focus of TB control program DOTS strategy is to break the chain of TB transmission. Tostmann A, et al (2008) showed that through 13-20% sputum smear negative pulmonary tuberculosis patients can spread TB the bacteria. BBKPM Bandung as one of CGU DOTS strategy has lower treatment succes rate of the national targets.

Purpose: To study factors that influence the treatment succes rate of compare with both smear positve and negative pulmonary tuberculosis patients. Those are age, gender, occupation, treatment compliance (factor individu) and regimen, dose, duration of treatment, comorbid HIV and DM (drug and disease). Indicator of treatment succes are the conversion of sputum result examination and the gain weight.

Study design: a retrospective cohort study.

Samples: the pulmonary TB patient data recorded at TB 01 yeras 2009-2011. The number of TB patients with sputum smear positive are 461 and negative are 292.

Analysis: Multivariable logistic regression.

Result: OR treatment succes among sputum smear-negative pulmonary TB patients 1,4 (CI: 0,7-3,0) and among sputum smear positive pulmonary Tb patients who adhere to treatment is 1,1 (CI:0,6-2,2) after controlling for age, sex, and occupation.

Suggestion: Enhancing the role of the PMO to increase the treatment adherence rate, treat the TB patients with HIV and DM co-infection."

"Pendahuluan: Kadar obat yang rendah dalam darah pasien TB paru diduga berhubungan dengan respon pengobatan yang buruk seperti kegagalan konversi sputum mikroskopis, yang merupakan risiko terjadinya kegagalan pengobatan. Namun berbagai penelitian menunjukan hasil kontroversial, sebagian menunjukan terdapat hubungan antara kadar obat dengan konversi sputum akhir intensif, sebagian lagi menunjukan respon terapi yang sama baiknya untuk kadar normal maupun kadar rendah. Faktor yang diduga menyebabkan perbedaan hasil ini adalah perbedaan MIC rifampisin dan isoniazid terhadap Mycobacterium tuberculosis (MTB) pada pasien-pasien TB di setiap wilayah. Penelitian ini bertujuan mengetahui hubungan kadar rifampisin dan isoniazid darah dengan konversi, serta hubungan rasio kadar puncak rifampisin dan isoniazid darah terhadap MIC (Cmax/MIC) dengan konversi sputum pasien TB paru di akhir fase intensif. Metode: Desain penelitian adalah kasus kontrol dengan jumlah sampel sebanyak 40 orang, yang terbagi dalam kelompok kasus (tidak konversi, n=20) dan kelompok kontrol (konversi, n=20). Kadar rifampisin dan isoniazid darah diukur pada dua jam setelah minum obat yang merupakan perkiraan kadar puncak rifampisin dan isoniazid, menggunakan metode LC/MS-MS. Data MIC diambil dari 20 isolat kultur MTB sputum pasien TB paru kasus baru di RSP dr. H.A Rotinsulu Bandung menggunakan metode MGIT. Hasil: Dari 40 pasien didapatkan rerata kadar rifampisin 5,58±2,41 mg/L dengan 36 pasien (90%) diantaranya memiliki kadar puncak di bawah normal. Untuk isoniazid didapatkan median kadar 1,46 (0,40-6,10) mg/L dengan 32 pasien (80%) diantaranya memiliki kadar puncak isoniazid di bawah normal. Pada penelitian ini didapatkan MIC rifampisin 0,25 mg/L dan MIC isoniazid 0,05 mg/L, lebih rendah dibanding kadar kritis masing-masing obat.

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Introduction: Low plasma drug concentration in pulmonary TB patients are thought to be associated with poor treatment outcomes such as microscopic sputum conversion failure, which is a risk of treatment failure. However, various studies showed controversial results, some showed that there was an association between drug concentration with sputum conversion at the end of intensive phase, while others showed the same good outcome for normal and low concentrations. Factors thought to cause these controversial in results are the differences in the MIC of rifampicin and isoniazid against Mycobacterium tuberculosis in TB patients in each region. This study aims to determine the association between blood rifampicin and isoniazid concentratiom with sputum conversion, as well as the association between the ratio of peak blood concentration of rifampicin and isoniazid to MIC (Cmax/MIC) with sputum conversion of pulmonary TB patients at the end of the intensive phase.

Methods: The study design was a case-control study with a sample size of 40 subjects, which were divided into a case group (non-conversion, n=20) and a control group (conversion, n=20). The blood concentration of rifampicin and isoniazid were measured two hours after taking the drug which is an estimate of the peak concentrations of rifampicin and isoniazid, using the LC/MS-MS method. MIC data were taken from 20 MTB sputum culture isolates from new cases of pulmonary TB patients at RSP dr. H.A Rotinsulu Bandung using the MGIT method.

Results: Of the 40 patients, the mean concentration of rifampicin was 5.58 ± 2.41 mg/L with 36 patients (90%) of whom had peak concentrations below normal. For isoniazid, the median concentration was 1.46 (0.40-6.10) mg/L with 32 patients (80%) of whom had peak concentration of isoniazid below normal. In this study, the MIC of rifampicin 0.25 mg/L and MIC of isoniazid 0.05 mg/L were lower than the critical concentration of each drug. There was no association between blood rifampicin concentration (OR: 11.18; 95% CI: 0.20-223.00, p= 0.106), blood isoniazid concentration (OR: 3.86; 95% CI: 0.67-22 .22, p= 0.235), and the Cmax/MIC ratio of rifampicin (OR: 0.474; 95% CI: 0.039-5.688, p=1.00) with intensive final sputum conversion. However, there was an association between low concentration of both drugs simultaneously (OR: 6.00; 95% CI: 1.08-33.27, p = 0.028), and the Cmax/MIC ratio of isoniazid (OR: 4.333; 95% CI: 1.150). -16,323, p= 0.027) with sputum conversion at the end of the intensive phase.

Conclusion: There was no association between blood rifampicin concentration, blood isoniazid concentration, and the Cmax/MIC ratio of rifampicin with microscopic sputum conversion at the end of the intensive phase. However, there was an association between low concentration of both drugs and the Cmax/MIC ratio of isoniazid and sputum conversion at the end of the intensive phase."

"ABSTRAKStudi ini bertujuan untuk mengetahui hubungan indeks massa tubuh (IMT)dengan konversi sputum pada pasien TB paru BTA positif. Studi dilakukan padaDesember 2013 – Januari 2014 di poli paru RSUP Persahabatan. Desain studiyang digunakan adalah desain studi kohort retrospektif. Jumlah sampel pada studiini adalah 120 pasien, 60 pasien dengan IMT < 18,5 kg/m2 dan 60 pasien denganIMT ≥ 18,5 kg/m2. Sampel diambil secara konsekutif. Dari studi ini, diketahuibahwa probabilitas kumulatif gagal konversi pasien TB paru sebesar 17,0% dansebanyak 9,2% pasien TB paru mengalami gagal konversi. Probabilitas kumulatifgagal konversi pada pasien TB paru BTA positif dengan IMT < 18,5 kg/m2(24,4%) lebih besar dibanding pasien dengan IMT ≥ 18,5 kg/m2 (9,3%). Di antarapasien dengan IMT < 18,5 kg/m2, hazard rate konversi sputum akan semakinrendah jika peningkatan berat badan yang dialami pasien di akhir tahap intensif <1 kg dibandingkan dengan pasien yang mengalami peningkatan berat badan ≥ 1kg. Hasil analisis multivariat menunjukkan bahwa indeks massa tubuh < 18,5kg/m2 menurunkan peluang terjadinya konversi sebesar 37,8% (HR 0,622; 95%CI 0,389-0,995) setelah dikontrol oleh kategori pengobatan, peningkatan beratbadan di akhir tahap intensif, dan hasil sputum di awal pengobatan. Status gizipasien selama masa pengobatan perlu ditingkatkan untuk menunjang keberhasilanpengobatan.

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ABSTRACTThe aim of this study was to identify the association of body mass index(BMI) with sputum smear conversion among AFB positive pulmonary tuberculosispatients. This study was conducted from Desember 2013 to Januari 2014 atpulmonary ward RSUP Persahabatan. The design study was retrospective cohort.A total of 120 patients consecutively enrolled in this study, 60 patients havingBMI < 18,5 kg/m2 and 60 patients having BMI ≥ 18,5 kg/m2. The cumulativeprobability of failed conversion among AFB positive pulmonary tuberculosispatients was 17,0% and 9,2% patients failed to have sputum conversion. Thecumulative probability of failed conversion among patients having BMI < 18,5kg/m2 (24,4%) was higher than patients having BMI ≥ 18,5 kg/m2 (9,3%). AmongBMI < 18,5 kg/m2 patients, hazard rate of sputum conversion would be lower iftheir weight gain at the end of intensive phase < 1 kg than having weight gain ≥ 1kg. Multivariat analysis found that BMI < 18,5 kg/m2 reduced the probability ofsputum conversion up to 37,8% (HR 0,622; 95% CI 0,389-0,995) after controlledby treatment category, weight gain at the end of intensive phase, and initialsputum. Nutritional status of TB patients during treatment must be increased tosupport the successful treatment."

"TB paru merupakan masalah di Indonesia. Data Riskesdas 2010 menunjukkan, prevalensi TB Paru 2009/2010 sebesar 725/100.000 penduduk. Evaluasi hasil dilihat dengan angka konversi pada akhir pengobatan fase intensif sebesar 80%. Masalah utama kegagalan konversi adalah komponen perilaku penderita TB paru yaitu keterlambatan diagnosis dan tidak selesainya pengobatan yang berakibat resistensi ganda OAT. Penelitian ini menggunakan desain kasus kontrol, populasi sebanyak 1.305 adalah penderita TB paru pengobatan fase intensif tahun 2010 yang tercatat di formulir TB 01 puskesmas di Kabupaten Bekasi. Sampel diambil sebanyak 170 penderita, dikelompokkan menjadi gagal konversi sebanyak 200 penderita dan konversi sebanyak 1.105 penderita. Setiap kelompok diambil masing-masing 85 penderita. Data dikumpulkan dengan wawancara menggunakan kuesioner. Metode analisis data dengan uji Chi Square dan regresi logistik. Hasil penelitian menunjukkan responden tidak teratur minum obat lebih besar yang mengalami kegagalan konversi (74,1%) dibandingkan yang konversi (46,4%). Hasil uji Chi square ada hubungan yang bermakna antara keteraturan minum obat, sikap terhadap keteraturan minum obat, pengetahuan tentang TB, penyuluhan kesehatan, efek samping obat, dan status gizi dengan kegagalan konversi. Hasil uji statistik dengan regresi logistik menunjukkan faktor paling berhubungan dengan kegagalan konversi adalah status gizi OR: 4,705: 95% CI: 2,143-10,332. Status gizi penderita TB paru perlu ditingkatkan sebagai upaya bersama dengan pemberian OAT.

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Pulmonary TB is a problem in Indonesia. Riskesdas 2010, the prevalence of pulmonary TB 2009/2010 for 725/100.000 population. Evaluation results conversion rate at the end of the intensive phase of treatment by 80%. The main problem is the conversion of a component failure behavior of patients with pulmonary TB is not the completion of delayed diagnosis and resulting treatment dual resistance OAT. Design study are casecontrol study. Population of 1305 patients with pulmonary TB is an intensive phase of treatment in 2010 are recorded in the TB form 01 health centers in the district of Bekasi. Samples were taken 170 patients, classified as many as 200 patients failed to convert and convert as many as 1.105 people. Each group of 85 patients taken at random. Data were collected by interview using a questionnaire. Methods of data analysis with chi square tests and logistic regression.

The results showed respondents do not regularly drink more drugs that have failed conversion (74.1%) compared to the conversion (46.4%). Chi square test results there was a significant association between the regularity of drug taking, attitudes toward medication order, knowledge of TB, health education, medication side effects, and nutritional status with conversion failure. The results of statistical tests with logistic regression showed factors associated with failure of the conversion is the nutritional status OR: 4,705: 95% CI: 2,143-10,332. Nutritional status of patients with pulmonary TB needs to be improved as a joint effort with the provision of OAT."

"Latar belakang: Pasien tuberkulosis (TB) paru rentan mengalami infeksi oportunistik, termasuk oleh Aspergillus (aspergilosis paru). Keberadaan Aspergillus dikonfirmasi dengan uji kultur. Uji kepekaan Aspergillus terhadap obat anti-jamur (OAJ) dilakukan untuk mengetahui pilihan OAJ yang tepat. Itrakonazol merupakan salah satu OAJ pilihan untuk aspergilosis paru. Resistensi OAJ dapat disertai gejala klinis yang luas. Penelitian ini bertujuan untuk mengetahui karakteristik klinis pasien dikaitkan dengan hasil uji kepekaan Aspergillus terhadap itrakonazol.Metode: Penelitian potong-lintang ini dilakukan pada Juli-November 2021 dan merupakan bagian dari penelitian sebelumnya. Isolasi Aspergillus dari sputum pasien TB paru dilakukan menggunakan medium agar Sabouraud. Karakteristik klinis yang diteliti meliputi usia, jenis kelamin, indeks massa tubuh (IMT), dan gejala. Adapun uji kepekaan jamur dilakukan dengan metode cakram sesuai protokol.Hasil: Penelitian ini menyertakan 28 isolat Aspergillus sp. yang berasal dari sputum 28 pasien TB paru. Jumlah pasien laki-laki lebih dominan (24 orang). Rerata usia 50 ± 15,1 tahun, dengan kelompok usia terbanyak < 60 tahun (21 pasien). Sebanyak 12 pasien (42,9%) memiliki IMT rendah. Gejala klinis yang didapatkan meliputi: batuk (42,9%), batuk darah (35,7%), sesak (39,3%), nyeri dada (14,3%), dan rasa lelah (35,7%). Kultur sputum menunjukkan pertumbuhan 28 isolat Aspergillus, terdiri atas: 14 isolat Aspergillus fumigatus, 6 isolat Aspergillus flavus, dan 8 isolat Aspergillus niger. Uji kepekaan Aspergillus terhadap itrakonazol menunjukkan 23 isolat sensitif, 3 isolat intermediat, dan 2 isolat resisten. Analisis statistik menunjukkan tidak terdapat hubungan bermakna antara karakteristik klinis pasien dengan hasil uji kepekaan jamur.Kesimpulan: Tidak terdapat hubungan bermakna antara karakteristik klinis pasien dengan hasil uji kepekaan Aspergillus terhadap itrakonazol dalam penelitian ini.

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Introduction: Pulmonary tuberculosis (TB) patients are susceptible to opportunistic infections, including Aspergillus infections (aspergillosis). The presence of Aspergillus was confirmed by a culture test, followed by its susceptibility study to antifungal. Antifungal resistance is generally accompanied by serious symptoms, so clinical observations are important for better clinical awareness. This study aims to determine the relationship between clinical characteristics and susceptibility study of Aspergillus to itraconazole.

Method: This cross-sectional study was carried out from July-November 2021, as part of the previous study on aspergillosis in TB patients. Aspergillus was isolated from the sputum of pulmonary TB patients using Saboraud's agar dextrose medium. Clinical characteristics obtained through patient’s history including age, gender, body mass index, and symptoms The fungal susceptibility test was carried out by disc diffusion method according to the protocol after treatment.

Result: This study included 28 isolates of Aspergillus from the sputum of 28 pulmonary TB patients. The number of males were dominant (24 from 28 patients) than females. The mean age was 50 ± 15.1 years, with the commonest age group < 60 years (21 patients). Total of 12 patients (42.9%) had a low body mass index. Clinical symptoms included: cough (42.9%), hemoptysis (35.7%), dyspnea (39.3%), chest pain (14.3%), and fatigue (35.7%). %). The sputum culture showed 14 Aspergillus fumigatus isolates, 6 Aspergillus flavus isolates, and 8 Aspergillus niger. The susceptibility test of Aspergillus to itraconazole revealed 23 sensitive isolates, 3 intermediate isolates, and 2 resistant isolates. Statistical analysis showed that there was no relationship between the patient’s clinical characteristics and the antifungal susceptibility test of itraconazole.

Conclusion: There was no significant correlation between the patient’s clinical characteristics and the antifungal susceptibility test to itraconazole in this study"

"Indonesia menempati urutan kesembilan dari dua puluh tujuh negara yang memiliki beban MDR (Multi Drug Resistan) TB (Tuberkulosis) di dunia. Kegagalan konversi pada pasien TB paru merupakan salah satu penyebab terjadinya resisten OAT (Obat Anti Tuberkulosis). Pasien TB paru BTA (Basil Tahan Asam) positif kategori I yang mengalami kegagalan konversi di puskesmas wilayah Kota Serang tahun 2014 sebanyak 49 pasien dari 602 pasien TB yang diobati. Penelitian ini bertujuan mengetahui faktor-faktor yang berhubungan dengan kegagalan konversi pasien TB paru BTA positif kategori I dengan menggunakan studi cross sectional. Uji statistik yang digunakan adalah regresi logistik terhadap 168 orang pasien TB paru BTA positif kategori I tahun 2014. Hasil penelitian diperoleh bahwa pasien TB paru BTA positif kategori I yang mengalami kegagalan konversi sebanyak 28%. Ada hubungan antara tingkat pendapatan, pengetahuan tentang TB, sikap pasien terhadap pengalaman terkait TB, jarak dan akses ke puskesmas, kondisi lingkungan tempat tinggal, informasi kesehatan dari petugas TB dan efek samping obat terhadap kegagalan konversi pasien TB paru BTA positif kategori I. Faktor yang paling dominan berhubungan adalah informasi kesehatan dari petugas TB (nilai p value = 0,002, OR 33,217, 95% CI 3,600-306,497). Disimpulkan bahwa peran petugas kesehatan sangat berpengaruh terhadap keberhasilan pengobatan pasien TB paru. Diperlukan komitmen petugas dalam menjalankan fungsi kesehatan masyarakat di antaranya meningkatkan kemampuan petugas dalam memberikan informasi kesehatan serta menjalin kerjasama dengan pasien dan keluarganya untuk terus memberikan pendampingan dan pemberian motivasi selama pengobatan sehingga mencegah terjadinya kegagalan konversi yang dapat berpengaruh terhadap keberhasilan pengobatan.

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Indonesia ranks ninth out of twenty-seven countries which has the burden of MDR (Multi Drug Resistance) TB in the world. The failure of conversion in TB (Tuberculosis) patients was one of the contributing factor to ATD (Anti Tuberculosis Drugs) resistance. Smear positive pulmonary TB patients who have failed first category conversion in Serang City area health centers in 2014 in 49 patients out of 602 treated TB patients. The research aimed to search for factors that connect to abortive attempt in conversion of TB patient with positive lung BTA category 1 by cross sectional study. A statistic test which had been used was binominal logistic regression with TB patient with positive lung AFB (Acid-Fast Bacilli) category 1 as research subject in 2014, with sample of 168 TB patients.

The result of the examination showed that TB patients with positive lung BTA category I experienced failure as much as 28%. There were links between level of income, knowledge of TB, and patient?s respond to their experiences, distance and access to local government clinic, condition of residence, health information from TB health workers and side effects of medicine to abortive attempt in conversion of TB patient with positive lung BTA category 1 by cross sectional study. The most dominant factor of all was sanitary information from TB health workesr (p value = 0.002, OR 33.217, 95% CI 3.600-306.497). It was concluded that health workers play an important role to succeed the treatment of TB lung patients. The workers commitment are needed to perform their duty to increase health information and to bond relationship between patients and their family to provide support and motivate during the therapy, thus the failure in conversion could be prevented."

"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."

"Tuberkulosis Paru merupakan penyakit infeksius yang menjadi salah satu penyebab kematian karena infeksi di seluruh dunia. Salah satu indikator yang digunakan untuk memantau dan menilai pengobatan adalah dengan menentukan konversi sputum. Status gizi yang baik akan dapat mempengaruhi perubahan konversi sputum Tuberkulosis Paru dan keberhasilan terapi. Pada penelitian ini dilakukan analisis mengenai hubungan perubahan berat badan dengan konversi sputum pasien Tuberkulosis Paru di RS Persahabatan tahun 2013 - 2015. Desain studi penelitian ini adalah potong lintang dengan sampel penelitian sebanyak 100. Sampel penelitian diambil dari data rekam medis dan dianalisis dengan uji Chi-Square. Hasil penelitian ini adalah secara statistik tidak terdapat hubungan yang signifikan antara perubahan berat badan dengan konversi sputum pasien tuberkulosis paru di RS Persahabatan tahun 2013-2015 p=0,433 Tuberkulosis Paru merupakan penyakit infeksius yang menjadi salah satu penyebab kematian karena infeksi di seluruh dunia. Salah satu indikator yang digunakan untuk memantau dan menilai pengobatan adalah dengan menentukan konversi sputum. Status gizi yang baik akan dapat mempengaruhi perubahan konversi sputum Tuberkulosis Paru dan keberhasilan terapi. Pada penelitian ini dilakukan analisis mengenai hubungan perubahan berat badan dengan konversi sputum pasien Tuberkulosis Paru di RS Persahabatan tahun 2013 - 2015. Desain studi penelitian ini adalah potong lintang dengan sampel penelitian sebanyak 100. Sampel penelitian diambil dari data rekam medis dan dianalisis dengan uji Chi-Square. Hasil penelitian ini adalah secara statistik tidak terdapat hubungan yang signifikan antara perubahan berat badan dengan konversi sputum pasien tuberkulosis paru di RS Persahabatan tahun 2013-2015 p = 0,433 "

"ABSTRAKLatar belakang : Banyak penyakit yang dihubungkan dengan merokok seperti penyakit keganasan, kardiovaskuler, diabetes mellitus DM , penyakit paru obstruktif kronik PPOK , arthritis, impotensi, infertilitas, alzheimer, TB dan lain- lain. Paru merupakan organ yang banyak mengalami kerusakan berat akibat merokok. Merokok terbukti mengganggu bersihan mukosilier dan berhubungan dengan peningkatan risiko terjadinya TB paru. Konversi sputum merupakan indikator penting untuk melihat keberhasilan pengobatan TB. Penelitian ini bertujuan untuk mengetahui bagaimana hubungan riwayat merokok dan keberhasilan pengobatan fase intensif tuberkulosis TB paru di RSUD.Metode : Desain penelitian menggunakan metode kohort prospektif yang dilakukan pada pasien TB paru basil tahan asam BTA positif perokok dan bukan perokok yang berkunjung ke Pelayanan Tuberkulosis Terpadu PTT yaitu poli rawat jalan dan ruang rawat inap infeksi paru RSU Dr. Zainoel Abidin Banda Aceh dari 1 November 2015 hingga Februari 2016. Data yang diperoleh diuji dengan menggunakan statistical package for social sciences SPSS 20.Hasil : Total 38 subjek dibagi kedalam 2 kelompok 19 subjek perokok dan 19 subjek bukan perokok , semua subjek perokok adalah laki-laki sedangkan subjek bukan perokok terdiri dari laki-laki dan perempuan. Dari hasil penelitian bulan pertama p=0,009 didapatkan subjek yang bukan perokok konversi sputum BTA berjumlah 14 orang 73,7 dan 5 orang tidak konversi, sedangkan pada subjek perokok 6 orang 31,6 yang konversi dan 13 orang 68,4 tidak konversi. Pada bulan kedua p=0,202 , lebih dari setengah jumlah subjek yang bukan perokok konversi sputum BTA berjumlah 17 orang 89,5 dan 2 orang 10,5 yang tidak konversi sedangkan pada subjek perokok yang konversi berjumlah 14 orang 73,7 dan 5 orang 26,3 yang tidak konversi.Kesimpulan : Terdapat hubungan bermakna antara kebiasaan merokok terhadap konversi sputum BTA bulan I.Kata kunci : TB paru, merokok, konversi sputum

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ABSTRACTBackground Many diseases are associated with smoking such as malignant disease, cardiovascular, diabetes mellitus DM , chronic obstructive pulmonary disease COPD , arthritis, impotence, infertility, Alzheimer 39 s Disease, tuberculosis and others. Lung is an organ that suffered heavy damage from smoke. Smoking is proven to disrupt the ciliary mucosal clearance and it is associated with an increased risk of pulmonary tuberculosis. Sputum conversion is an important indicator to assess the success of TB treatment. This study aims to determine the relation between smoking history and the success intensive phase treatment of pulmonary tuberculosis TB at Dr Zainoel Abidin Hospital.Method This is a prospective cohort study in patients with pulmonary tuberculosis acid fast bacilli AFB positive smokers and non smokers who visited the Integrated Tuberculosis Care PTT , at outpatient and inpatient pulmonary infection RSU Dr. Zainoel Abidin hospital Banda Aceh from 28 November 2015 until 1 February 2016. The data were tested using statistical package for social sciences SPSS 20.Results A total of 38 subjects were divided into 2 groups 19 subjects with 19 subjects smokers and non smokers . All subjects smokers are male while non smoker subjects consisted of male and female. The results of the first month study p 0.009 , there are 14 non smoker subjects with AFB conversion 73,7 and 5 subjetcs without AFB conversion. Among smoking subjects there are 6 subjets 31.6 with AFB conversion and 13 subjects 68.4 without AFB conversion. In the second month p 0,202 , more than half subjects who are non smokers had AFB conversion, 17 subjects 89.5 and 2 subjects 10.5 had no AFB conversion. In smokers group there are 14 subjects 73.7 had AFB conversion and 5 subject 26.3 had no conversion.Conclusion There was a significant relation between smoking habit and the occurrence of first month AFB sputum"