Hasil Pencarian  ::  Simpan CSV :: Kembali

"Kasus chronic pulmonary aspergillosis (CPA) di Indonesia memiliki prevalensi ±83.000 penderita dengan penambahan kasus baru sebanyak 17.561 pasien dengan riwayat tuberkulosis paru-paru setiap tahunnya, disebabkan oleh kapang Aspergillus spp. Gen calmodulin (CaM) merupakan markah genetik Aspergillus yang memiliki spesifikasi sekuens tinggi untuk membedakan tiap spesies Aspergillus, namun studi mengenai profil sekuensnya pada isolat penderita CPA pasca tuberkulosis di Indonesia belum ditemukan laporannya. Penelitian ini menggunakan gen CaM untuk dianalisis sekuens DNA-nya sekaligus mengidentifikasi dan memantau spesies Aspergillus dari 31 isolat spesimen klinis pasien CPA beriwayat tuberkulosis paru-paru dari 6 rumah sakit umum di Jakarta. Ekstraksi DNA dilakukan menggunakan metode PCI lalu gen CaM diamplifikasi dengan primer Cmd5 dan Cmd6, selanjutnya dilakukan sekuensing DNA. Hasil menunjukkan sekuens gen CaM Aspergillus spp. memiliki wilayah lestari dan polimorfik khas antar spesies intraseksi maupun interseksi (Nigri, Fumigati, dan Flavi). Hasil identifikasi molekuler menunjukkan spesies terdiri dari A. niger (n = 3), A. fumigatus (n = 17), A. flavus (n = 4), A. tubingensis (n = 2), A. welwitschiae (n = 2), A. tamarii (n = 2), dan A. brunneoviolaceus (n = 1). Spesies A. welwitschiae dan A. tamarii dikonfirmasi menjadi salah satu spesies kriptik penyebab CPA pada pasien beriwayat tuberkulosis paru-paru di Jakarta, Indonesia.

---

The number of chronic pulmonary aspergillosis (CPA) cases in Indonesia reached a prevalence number ±83.000 patients with increasing rate of 17.561 patients with lung tuberculosis medical history each year, caused by Aspergillus fungi. Calmodulin (CaM) gene is a biomarker for Aspergillus which has high sequence specifity to distinguish among species within the group, however a report to characterize its sequence profile on post-tuberculosis CPA isolates in Indonesia has not yet been found. The aims of this research are to conduct sequence analysis on Aspergillus CaM genes, also to identify and monitor the species from 31 isolates of post-tuberculosis CPA patient’s clinical specimens obtained from 6 public hospital in Jakarta. The results showed that CaM gene from Aspergillus spp. have unique conserved and polymorphic regions both intra/intersectionally (among Nigri, Fumigati, and Flavi) within the genus. The molecular identification results revealed a species consisiting A. niger (n = 3), A. fumigatus (n = 17), A. flavus (n = 4), A. tubingensis (n = 2), A. welwitschiae (n = 2), A. tamarii (n = 2), and A. brunneoviolaceus (n = 1). A. welwitschiae and A. tamarii are confirmed to be one of cryptic species responsible for causing human post-tuberculosis CPA in Jakarta, Indonesia.

"

"Spondilitas tuberkulosa atau Pott’s Disease merupakan infeksi tuberculosis extrapulmonal yang mengenai satu atau lebih tulang belakang. Spondilitas tuberkulosa memiliki 50% kasus yang terjadi dari kasus TB tulang. Penanganan penyakit ini dilakukan dengan terapi medikamentosa dan pembedahan. Namun, saat ini terapi medikamentosa lebih diutamakan. Terapi medikamentosa merupakan metode penanganan TB dengan menggunakan Obat Anti Tuberkulosis (OAT) lini pertama yaitu rifampisin (RIF), isoniazid (INH), pirazinamid (PZA), dan etambutol (ETH). Terapi menggunakan obat ini dilakukan dengan oral selama kurang lebih 6 bulan. Hal ini menyebabkan ketidaknyamanan penderita dan menyebabkan terjadinya resistensi OAT akibat konsumsi obat yang tidak teratur. Pada penelitian ini dilakukan enkapsulasi terhadap OAT ke dalam mikropartikel PLGA untk mengetahui pengaruhnya terhadap profil rilis. Enkapsulasi dilakukan dengan metode emulsifikasi dan penguapan pelarut, kemudian dikeringkan dengan freeze dry sehingga menghasilkan butiran-butiran mikropartikel. Kemudian ditambahkan pula asam askorbat untuk mengetahui pula pengaruhnya terhadap profil rilis OAT. Pada penelitian ini dilakukan uji SEM untuk mengetahui karakteristik dari mikropartikel dan uji HPLC untuk mengetahui profil rilis OAT dalam satu bulan.

---

Tuberculosis Spondility or Pott's Disease is an extrapulmonal tuberculosis infection that hits one or more of the spine. Tuberculosis spondilitas has 50% of cases occurring from bone TB cases. Treatment of this disease is carried out with medical therapy and surgery. However, nowadays medikamentosa therapy takes precedence. Medikamentosa therapy is a method of handling TB using first-line Anti Tuberculosis Drug (ATD), namely rifampicin (RIF), isoniazid (INH), pyrazinamide (PZA), and ethambutol (ETH). Therapy using this drug is done orally for approximately 6 months. This causes discomfort of the sufferer and causes the occurrence of ATD resistance due to irregular consumption of the drug. In this study, encapsulation of ATD into PLGA microparticles to determine its effect on release profile. Encapsulation is done by emulsification and evaporation methods of solvent, then dried with freeze dry resulting in microparticle granules. Then added ascorbic acid to know also the effect on the profile of ATD release. In this study, SEM test was conducted to find out the characteristics of microparticles and HPLC test to find out ATD release profile in one month."

"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.

---

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."

"Penyakit tuberkulosis (TB) paru sering mendasari aspergilosis paru kronis (APK). Diagnosis APK masih menjadi tantangan karena gejala klinis dan hasil pemeriksaan yang tidak khas serta data penelitian yang terbatas. Pemeriksaan immunochromatography test (ICT) Aspergillus dilaporkan bermanfaat dalam diagnosis cepat APK. Tujuan penelitian ini adalah mengetahui kaitan hasil ICT Aspergillus dengan karakteristik klinis pasien TB paru. Penelitian dengan desain potong lintang ini merupakan bagian penelitian sebelumnya tentang diagnosis APK di Indonesia dan berlangsung pada Februari–November 2021. Pemeriksaan ICT Aspergillus dilakukan di laboratorium Departemen Parasitologi FKUI sesuai protokol (LD Bio Diagnostics, Lyon, France). Dari 89 pasien TB paru yang memenuhi kriteria inklusi, terdapat 50 pasien (56,2%) laki-laki. Sebanyak 42,6% pasien dalam rentang usia 45-64 tahun, 56,2% berpendidikan akhir SMP/SMA, dan 53,9% merupakan pekerja. Karakteristik klinis pasien TB paru dalam penelitian ini menunjukkan indeks massa tubuh (IMT) normal pada 36 pasien (40,4%). Penyakit asma didapatkan pada 3,4% pasien, penyakit paru obstruktif kronis (PPOK) 4,5%, diabetes mellitus (DM) 16,9%, hipertensi 6,7%, dan kanker paru 1,1%. Hasil pemeriksaan ICT Aspergillusmenunjukkan hasil positif pada 11 pasien (12,4%). Pada penelitian ini, didapatkan hubungan bermakna antara hasil pemeriksaan ICT Aspergillus dengan penyakit penyerta pada pasien TB paru, yaitu asma (p = 0,039).

---

Pulmonary tuberculosis (TB) is the most common underlying disease of chronic pulmonary aspergillosis (CPA). Diagnosing CPA is still a challenge because of no typical pathognomonic clinical symptoms and examination result. Aspergillus Immunochromatography Test (ICT) is reported to be useful for rapid diagnosis of CPA. This study was used to determine relation between the results of Aspergillus ICT and the clinical characteristics of pulmonary TB patients. This cross-sectional study was part of the previous research on CPA diagnosis in Indonesia. Aspergillus ICT examination was carried out in FKUI Department of Parasitology laboratory according to the protocol (LD Bio Diagnostics, Lyon, France).

From the 89 pulmonary TB patients who met the inclusion criteria, there were 56,2% male patients, 42,6% of patients are within 45-64 years old age range, 56,2% have a final education of middle/high school, and 53,9% are workers, and normal body mass index (BMI) in 36 patients (40,4%). Asthma was found in 3,4% of patients, 4.5% of chronic obstructive pulmonary disease (COPD), 16.9% of diabetes mellitus (DM), 6.7% of hypertension, and 1.1% of lung cancer. Aspergillus ICT showed positive results in 11 patients (12,4%) and were related to the asthma variable (p = 0,039) in statistical analysis."

"TBC masih merupakan masalah kesehatan dunia, bahkan Indonesia. Pemerintah telah menerapkan program DOTS untuk menurunkan angka kesakitan dan kematian akibat TBC, namun angka tersebut masih belum mencapai target. Selama pandemi Covid-19, program DOTS tetap diselenggarakan dengan adanya penyesuaian pengelolaan input dan process. Tujuan dari penelitian ini yakni mengetahui gambaran pelaksanaan program DOTS selama pandemi Covid-19 di wilayah kerja Puskesmas Depok Jaya. Penelitian ini menggunakan pendekatan kualitatif dengan desain studi kasus. Teknik pengumpulan data wawancara mendalam kepada informan utama, yakni Penanggung Jawab Program DOTS, Dokter Penanggung Jawab Program DOTS, Ketua Kader dan PMO, sedangkan informan pendukung, yakni Pasien TBC. Peneliti mengambil data secara daring melalui Zoom Meeting. Hasil penelitian bahwa pelaksanaan program DOTS di tengah pandemi Covid-19 dilaksanakan dengan menerapkan protokol kesehatan, diantaranya wajib memakai masker dua rangkap dan mencuci tangan pakai sabun. Sumber daya PMO dan petugas puskesmas yang berdedikasi memiliki peran penting dalam upaya penyembuhan pasien TBC. Selain itu, ketersediaan anggaran, sarana, dan prasarana yang cukup dapat menunjang keberlangsungan program agar efektif. Kegiatan utama yang masih rutin diadakan yakni pengobatan TBC melalui pemberian Obat Anti Tuberkulosis yang tidak pernah kurang. Terdapat beberapa kendala dalam program DOTS, antara lain jumlah sumber daya kader kesehatan yang sedikit, kurang tersedianya Tes Cepat Molekuler, dan kurang mendukungnya ruangan pasien TBC. Beberapa kegiatan utama di Puskesmas selama pandemi mengalami penurunan jumlah kegiatan, diantaranya investigasi kontak, skrining, penyuluhan, serta pelatihan. Selain itu terdapat beberapa masalah di pelaksanaan program DOTS yang terjadi selama pandemi Covid-19, yaitu masyarakat yang cenderung individualis, kurang terbuka, dan memiliki mobilitas yang tinggi, sehingga petugas puskesmas dan kader kesehatan seringkali kesulitan dalam melakukan pemantauan terkait dengan investigasi kontak dan pengobatan pasien TBC. Dampaknya, cakupan pengobatan TBC tidak mencapai target, yakni sebesar 71,87% berdasarkan Renstra Puskesmas Depok Jaya Tahun 2021—2026. Hasil penelitian menyarankan untuk Puskesmas dapat memberikan pelatihan kepada kader kesehatan terkait dengan penyikapan investigasi kontak dan edukasi penyakit TBC yang baik kepada masyarakat disesuaikan dengan kondisi pandemi Covid-19, memberikan pelatihan kepada PMO terkait memotivasi pasien TBC dalam minum obat secara teratur dan pemeriksaan cek dahak secara rutin, serta perlu melengkapi sarana dan prasarana yang mendukung terkait kebutuhan program DOTS.

---

TB is still a global health problem, even in Indonesia. The government has implemented the DOTS program to reduce morbidity and mortality due to tuberculosis, but this figure has not yet reached the target. During the Covid-19 pandemic, the DOTS program will continue to be held with adjustments to input and process management. The purpose of this study is to describe the implementation of the DOTS program during the Covid-19 pandemic in the Depok Jaya Health Center work area. This research uses a qualitative approach with a case study design. Data collection technique is in-depth interview with the main informants are the person in charge of the DOTS Program, the doctor in charge of the DOTS Program, the head of the cadre, and the medical supervisors, while the supporting informants are the TB patients. Researchers took data online through Zoom Meeting. The results showed that the DOTS program in the mindst of the Covid-19 pandemic was carried out by implementing health protocols, including the obligation to wear two masks and wash hands with soap. Medication supervisor and health center officer resources have an important role in efforts to cure TB patients. In addition, the availability of sufficient budget, facilities, and infrastructure can support the sustainability of the program to be effective. The main activity that is still routinely held is TB treatment through the provision of Anti Tuberculosis Drugs which is never lacking. There are several obstacles in the DOTS program, including the small number of health cadre resources, the lack of availability of Molecular Rapid Tests, and the lack of support for TBC patient rooms. Several main activities at the Health Center during the pandemic experienced a decrease in the number of activities, including contact investigation, screening, counselling, and training. In addition, there are several problems in the implementation of the DOTS program that occurred during the Covid-19 pandemic. People who tend to be individualistic, less open, and have high mobility, so that health center officers and health cadres often find it difficult to carry out monitoring related to contact investigations and patient treatment. As a result, TB treatment coverage did not reach the target, which is 71,87% based on the Depok Jaya Health Center Strategic Plan 2021—2026. The results of the study suggest that the Puskesmas can provide training to health cadres related to the attitude of contact investigations and TB education to the communities adapted to the Covid-19 pandemic conditions, provide training to medication supervisors related to motivating TB patients to take medication regularly and check sputum regularly, and complete supporting facilities and infrastructure related to the needs of the DOTS program."