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"Penyakit tuberkulosis sampai saat ini masih merupakan masalah kesehatan masyarakat yang penting di Indonesia dengan prevalensi BTA (basil tahan asam) (+) sebesar 0,29 %.1 Menurut Survey Kesehatan Rumah Tangga (SKRT) Departemen Kesehatan Republik Indonesia tahun 1986, penyakit tuberkulosis paru menduduki urutan ke-10 dari pola kesakitan dan penyebab kematian nomor 4 di Indonesia.2 Pada survey yang sama tahun 1995, penyakit ini akan terus meningkat baik pada angka kesakitan maupun kematiannya.Diagnosis penyakit tuberkulosis paru umumnya didasarkan dengan ditemukannya kuman BTA pada sputum penderita. Meskipun demikian pemeriksaan ini mempunyai beberapa kelemahan. Pemeriksaan sputum langsung biasanya sulit didapatkan hasil positif, misal pada penderita dengan lesi yang minimal dan pada anak-anak karena memerlukan jumlah kuman tertentu untuk memberikan hasil positif. Keterlambatan dalam membuat diagnosis dapat mengakibatkan komplikasi yang serius seperti meningitis dan perikarditis, sebaliknya pengobatan yang tidak terarah mengakibatkan pemborosan biaya dan dapat menimbulkan efek samping obat. Pemeriksaan biakan M.tuberculosis membrikan hasil yang lebih baik daripada pemeriksaan mikroskopik langsung, tetapi cara ini memerlukan waktu yang lebih lama, kurang lebih 8 minggu, dan relatif lebih mahal.

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Tuberculosis is still an important public health problem in Indonesia with a prevalence of BTA (acid-fast bacilli) (+) of 0.29%. generally based on the discovery of BTA germs in the patient's sputum. However, this examination has several weaknesses. Direct sputum examination is usually difficult to obtain positive results, for example in patients with minimal lesions and in children because it requires a certain number of germs to give positive results. Delays in making a diagnosis can result in serious complications such as meningitis and pericarditis, on the other hand, undirected treatment results in wasted costs and can cause drug side effects. M. tuberculosis culture examination gives better results than direct microscopic examination, but this method requires a longer time, approximately 8 weeks, and is relatively more expensive. microscopic"

"Pendahuluan : Kerusakan paru yang luas dan riwayat pemakaian antibakteri jangka panjang merupakan faktor risiko yang meningkatkan angka kejadian kolonisasi jamur. Kedua hal ini terjadi pada pasien TB paru MDR. Meningkatnya kasus TB MDR di Indonesia akan meningkatkan risiko terjadinya kolonisasi jamur di paru. Penelitian ini untuk mengetahui profil kolonisasi jamur pada pasien bekas TB paru MDR.Metode : Penelitian potong lintang terhadap pasien yang telah dinyatakan sembuh dari TB paru MDR dari tahun 2009-2015, yang kontrol ke Poli TB MDR RSUP Persahabatan selama bulan November-Desember 2015. Dengan menggunakan teknik consecutive sampling maka ditentukan sebanyak 61 subjek yang kemudian dilakukan induksi sputum. Hasil sputum induksi kemudian dilakukan pemeriksaan sputum jamur langsung dan biakan jamur dalam media Saboraud Dextrose Agar.Hasil : Subjek berusia antara 19-76 tahun. Dari 61 pasien , kelompok usia terbanyak antara usia 35-50 tahun sebnayak 28 orang (45,9%) diikuti usia kurang dari 35 tahun 23 orang (37,7%) dan usia lebih dari 50 tahun sebanyak 10 orang (16,01%). Sebanyak 28 orang (45,95) IMT normal, 17 orang IMT berlebih dan 16 orang (26%) IMT kurang. Sebanyak 28 subjek (45,9%) mempunyai riwayat merokok. Spektrum kolonisasi jamur pada pasien bekas TB paru MDR adalah 42 orang (68,9%) kolonisasi jamur positif dengan 29 orang (47,5) spesies C. albicans, 6 (9,8%) kombinasi C. albicans dan C. tropicalis, 2 orang (3,3%) masing-masing As flavus dan kombinasi C. albicans dan C. krusei serta masing-masing 1 orang (1,6%) spesies C. tropicalis, C. parapsilosis dan kombinasi C. albicans+C. parapsilosis.Kesimpulan: Kolonisasi jamur pada pasien bekas TB paru MDR tinggi dan harus diawasi dan harus dievaluasi untuk membedakan antara kolonisasi atau penyakit serta diobati untuk meningkatkan kualitas hidup pasca pengobatan TB MDR.

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Introduction : Extensive lung damage and long term history of using antibacterial drugs are a risk factor that increase the incidence of fungal colonization. Both of these occurred in patients with pulmonary MDR TB. The increasing cases of MDR TB in Indonesia will increase the risk of fungal colonization in the lung. This study is to determine the profile of fungal colonization in post MDR TB patients.

Methods: This cross sectional study included patients who had been cured by the doctor in 2009-2015 and came to MDR Clinic from November-Desember 2015 in Persahabatan Hospital to check up. Sixty one patients were decided by consecutive sampling. From each patient, sputum induction for sputum fungal smear and fungal culture using Sabaraud Dextrose Agar.

Results: The age range of patients are between 19 to 76 years old. Out of 61 patients, among those group 45,9% are between the age of 35-50 years , 37,7% below the age 35 years old and 16,4% above age 50 years old. Twenty eight patients have normal body mass index, 17 patients are overweight and 16 patients are underweight. Number of patients who have smoking history are 45,9%. The spectrum of positive fungal colonization in post pulmonary MDR TB patients were 42 subjects (68.9%) consist of 29 subjects (47.5%)were Candida albicans, 6 subjects (9.8%) were combination of C. albicans and C. tropicalis, 2 subjects (3.3%) respectively were Aspergillus flavus and combinations of C. albicans and C. krusei. The others were C. tropicalis, C. parapsilosis and C. albicans + C. parapsilosis combination were 1 subject (1.6%) respectively.

Conclusion: Fungal colonization in post pulmonary MDR TB patients is high and should be monitored and must be evaluated to distinguish between colonization and disease and treated to improve quality of life post-treatment of MDR TB."

"Perbedaan antara tes untuk infeksi tuberkulosis (TB) yang resistan terhadap obat menjadi lebih umum karena alat diagnostik menjadi lebih bervariasi. Hal tersebut membingungkan dokter karena belum ada tes TB diagnostik cepat dengan sensitivitas dan spesifisitas yang baik. Kasus suspek-TB di RSUPP, pusat primer dan tersier untuk kasus TB paru Indonesia, disaring dengan GeneXpert MTB / RIF dan dikonfirmasikan dengan uji kepekaan obat anti-tuberkulosis.Discrepancies between tests for drug-resistant tuberculosis (TB) infections are becoming more common as diagnostic tools become more varied. These discrepancies confuse clinicians because there is not yet a rapid diagnostic TB test with good sensitivity and specificity. Suspected-TB cases at Rumah Sakit Umum Pusat Perhasabatan (RSUPP), a primary and tertiary center for Indonesia’s pulmonary TB cases, are screened with GeneXpert MTB/RIF and confirmed with conventional drug- susceptibility testing (DST)."

"Penyakit TB masih merupakan masalah kesehatan kesehatan masyarakat yang penting di Indonesia. Upaya diagnostik TB paru masih terus ditingkatkan. Pemeriksaan penunjang diagnosis TB yang sekarang digunakan masih mempunyai sensitiviti dan spesitiviti yang rendah. Tujuan penelitian mengetahui tingkat akurasi uji tuberkulin dan PCR terhadap penegakkan diagnosis TB serta hubungan uji tuberkulin dan PCR dengan BTA mikroskopis dan biakan M. Tb dalam diagnosis TB paru.Metode penelitian cross-sectional, uji diagnostik dan analisa data menggunakan Chi-Square. Kriteria inklusi penderita terdapat gejala klinik riwayat batuk 3 minggu disertai atau tanpa batuk darah, nyeri dada, sesak napas dan riwayat minum obat TB dalam jangka waktu kurang dari 1 bulan serta bukan TB (kontrol). Seluruh sampel dilakukan anamnesis, pemeriksaan fisik, lekosit, LEDI/II, foto toraks, uji tuberkulin, PCR, BTA mikroskopis 3X dan biakan M. Tb mctode kudoh. Baku emas yang digunakan biakan M. Tb metode kudoh. Data diolah menggunakan SPSS versi 11.00.Berdasar 127 sampel masuk kriteria inklusi 121. Sampel berjumlah 121 terdiri dari 61 sampel tersangka TB dan 60 sampel kontrol Sensitiviti dan spesivisiti uji tuberkulin terhadap biakakn metode Kudah menggunakan cut-off point 15,8 mm 33% dan 93%. Sensitiviti PCR terhadap biakab metode Kudoh 100%, spesitiviti PCR 78%. Didapatkan perbedaan bermakna dan hubungan lemah uji tuberkulin dengan biakan M. Tb dan PCR serta didapatkan perbedaan dan hubungan bermakna PCR dengan BTA mikroskopis biakan M. Tb.Kesimpulan basil keseluruhan penelitian mendapatkan basil 39 sampel biakan positif, 36 sampel BTA mikroskopis positif, 57 sampel PCR positif dan 18 sampel uji tuberkulin positif. Ditemukan sensitiviti basil uji tuberkulin lebih rendah daripada PCR, BTA mikroskopis dan biakan M. Tb mctode Kudoh. Meskipun terdapat perbedaan bermakna basil uji tuberkulin pada biakan positif clan negatif, BTA mikroskopis positif dan negatif, serta PCR positif dan negatif, akan tetapi uji tuberkulin (menggunakan cut-off point 15.8 mm) kurang dapat membantu penegakan diagnosis TB para. Berdasarkan hasil penelitian ditemukan bahwa diantara keempat pemeriksaan penunjang diagnosis TB paru PCR mempunyai nilai sensitivit dan spesitiviti tinggi ( 100% dan 78%). sehingga PCR dapat digunakan sebagai pemeriksaan penunjang diagnosis TB paru apabila didapatkan klinis dan radiology mendukung TB paru. Menggunkan pemeriksaan PCR akan didapatkan metode penegakan diagnosis TB paru yang cepat ( 1 hari ) dibandingkan dengan menunggu hasil biakan M. Tb hingga 8 minggu.

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Objective. In an attempt diagnosis pulmonary tuberculosis still increased continuously. Now additional examination pulmonary tuberculosis have been lack sufficient sensitivity and sensitivities. The aim of this study was to determine the validity of tuberculin skin testing (TST) and PCR toward assessment diagnosis pulmonary of tuberculosis with correlation between tuberculin skin testing to PCR with AFB microscopic and solid media culture of M. tuberculosis for the diagnosis of pulmonary tuberculosis.

Method. A cross-sectional study, diagnostic test and analysis with Chi-Square test. Inclusion criteria patient with pulmonary symptom include chronic cough 3 weeks with or without hemoptysis, chest pain, breathlessness and past history of ATA less than 1 month with non-tuberculosis patient (control). The general samples was examination Ro thorax, tuberculin skin testing, PCR, AFB microscopic and conventional culture. The golden standard is conventional culture test using Kudoh method. Analyze of the data with SPSS version 11.0.

Result. The study material comprised 121 samples from 127 samples. These samples include 61 samples from patient with probably active pulmonary tuberculosis and 60 control comprising healthy individuals. The sensitivity and specificity of tuberculin skin testing with cut-off point 15.8 mm greater was 33% and 93% on conventional culture test using Kudoh method. PCR sensitivity was 100% and spesitivity was 78%. It was showed the positivity correlation between pulmonary tuberculosis and conventional culture as well as PCR and AFB microscopic, the conventional culture test.

Conclusion. The sensitivity of tuberculin skin testing less than PCR, AFB microscopic and conventional culture test. So that not enough to assessment diagnosis pulmonary tuberculosis. The sensitivity and specificity PCR was I00% and 78%. With the use of PCR test, we were able to detect diagnosis pulmonary tuberculosis more rapidly in less than I day, compared to average 8 week required for detection by conventional culture."

"Untuk mengetahui aplikasi klinis pemeriksaan serologi dalam mendeteksi antibodi IgG spesifik terhadap Tuberkulosis ( TB ) dengan kit Pathozyme-TB yang menggunakan antigen 38 kDa, kit Pathozyme-Myco yang menggunakan antigen 38 kDa dan Lipopolisakarida ( LPS ), serta kit MycoDot yang menggunakan antigen Lipoarabinomanan ( LAM ) , dilakukan penelitian pada penderita TB paru di Jakarta. Bahan penelitian berupa 194 serum dari 79 orang penderita TB paru dengan BTA positip, 61 orang penderita TB paru dengan BTA negatip, 31 orang penderita penyakit paru non-TB dan 23 orang sehat yang kontak dengan penderita TB minimal 1 tahun, diperoleh dari Rumah Sakit Persahabatan Jakarta. Pada ke empat kelompok tersebut penelitian dilakukan secara crosssectional. Penelitian longitudinal dilakukan terhadap 39 penderita TB paru dengan BTA dan biakan positip selama terapi dengan Obat Anti Tuberkulosis (OAT) 3 dan 6 bulan. Hasil penelitian didapatkan nilai batas diagnosis yang sebaiknya digunakan untuk kit Pathozyme-Myco adalah serapan kontrol positip rendah ( SKPR ) dibagi dengan 1,5 sedangkan untuk kit Pathozyme-TB adalah SKPR dibagi dengan 3. Menggunakan kit Pathozyme-Myco didapatkan nilai sensitivitas sebesar 78 % dan spesifisitas 78 % pada penderita TB dengan BTA positip dan negatip, sensitivitas 82 % dan spesifisitas 78 /o pada penderita TB paru dengan BTA positip, sensitivitas 72 % dan spesifisitas 78 % pada penderita TB paru dengan BTA negatip. Menggunakan kit Pathozyme-TB didapatkan sensitivitas sebesar 44 % dan spesifisitas 91 % pada pendenta TB paru dengan BTA positip dan negatip, sensitivitas 51 % dan spesifisitas 91 % pada penderita TB paru dengan BTA positip dan sensitivitas 34 % dan spesifisitas 91 % pada penderita TB paru dengan BTA negatip. Menggunakan kit Myco-Dot didapatkan sensitivitas sebesar 67,8 % dan spesifisitas 95,6 % pada penderita TB paru dengan BTA positip dan negatip, sensitivitas 75,9 % dan spesifisitas 95,6 % pada TB paru dengan BTA positip, sensitifitas 57,4 % dan spesifisitas 95,6 % pada penderita TB paru dengan BTA negatip. Sensitivitas kit Pathozyme-Myco dan MycoDot cukup tinggi terutama pada TB paru dengan BTA positip, sedangkan sensitivitas Pathozyme-TB kurang tinggi terutama pada TB paru dengan BTA negatip. Spesifisitas pemeriksaan menggunakan ketiga macam kit yaitu Pathozyme-Myco, Pathozyme-TB dan MycoDot cukup baik.Menggunakan kit Pathozyme-Myco dan Pathozymc-TB didapat nilai diagnosis dan interval kepercayaan cukup baik yaitu berturut-turut 0,847 (0,771-0,923) dan 0,725 (0,629- 0,821). Nilai prediksi positip pada kit Pathozyme-Myco, Pathozyme-TB dan MycoDot baik yaitu berturut-turut 74,6 - 88%, 70,8 - 88,9% dan 94,6 - 97,9%. Nilai prediksi negatip pada kit Pathozyme-Myco dan MycoDot cukup baik yaitu berturut-turut 56,5 - 75,0 % dan 53,6 - 85,2 %. Tetapi nilai prediksi negatip pada kit Pathozyme-TB tidak cukup baik, yaitu 35,9 - 54,0 % . Ketiga macam kit yaitu Pathozyme-Myco, Pathozyme-TB dan MycoDot dapat digunakan untuk serodiagnostik TB. Menggunakan kit Pathozyme-Myco dan Pathozyme-TB, tidak didapatkan perubahan kadar antibodi IgG terhadap TB setelah terapi OAT 3 bulan dan tidak didapatkan kadar antibodi IgG TB di bawah nilai batas diagnosis setelah terapi OAT 6 bulan, sehingga pemeriksaan ini tidak dapat digunakan pada pemantauan terapi dan tidak dapat membedakan penderita TB paru aktif dengan bekas TB paru yang baru sembuh. Pada penelitian ini tidak dijumpai adanya pengaruh status gizi pada hasil pemeriksaan dengan menggunakan kit Pathozyme-Myco, Pathozymc-TB dan MycoDot.

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To determine the clinical application of serologic test by detection of IgG antibodies for tuberculosis (TB), researeh was done on TB patients in Jakarta, using 38 kDa antigen in Pathozyme-TB, 38 kDa and Lipopolysaccharides (LPS) antigens in Pathozyme-Myco and Lipoarabinomannan (LAM) antigen in MycoDot kit. One hundred and ninety four sera were collected from 79 pulmonary TB patients with positive sputum smears, 61 patients with negative sputum smears, 31 patients with pulmonary disease other than TB and 23 healthy persons who had minimal 1 year contact with TB patients. All patients were got from Persahabatan Hospital Jakarta. The study was done cross-sectionally. Longitudinal study was accomplished to 39 TB patients with positive sputum smears and culture, during their 3 months and 6 months oral anti tuberculosis therapy. The detection limit for diagnosis using Pathozymc-Myco and Pathozyme-TB kit are the absorbance oflow positive control devidcd by 1.5 and 3 repectivcly. Pathozyme-Myco kit had sensitivity of 78 % and 78 % specificity in pulmonary TB patients with either positive or negative sputum smears, 82 % sensitivity and 78 % specificity in positive sputum smears pulmonary TB patients, 72 % sensitivity and 78 % specificity in smearnegative pulmonary TB patients. Pathozyme-TB kit had 44 % sensitivity, 91 % specificity in pulmonary TB patients with either positive or negative sputum smears, 51 % sensitivity and 91% specificity in smear-positive pulmonary TB patients, 34 % sensitivity and 91 % specificity in smear-negative pulmonary TB patients. MycoDot kit had 67.8 % sensitivity and 95.6 % in either positive or negative sputum smears pulmonary TB patients, 75.9 % sensitivity and 95.6 % specificity in smear-positive pulmonary TB patients, 57.4 % sensitivity and 95.6 % specificity in smear-negative pulmonary TB patients. Pathozymc-Myco and MycoDot had a high sensitivity especially for pulmonary TB patients with positive sputum smears, while the sensitivity of Pathozyme-TB was lower especially for negative sputum smears pulmonary TB patients. All the kit had a good specificity. Pathozyme-Myco and Pathozyme-TB had a diagnosis value and confidence interval of 0.847(0.771-0.923) and 0.725(0.629-0.821) respcctivcly. Positive predietive value for PathozymeMyco, Pathozyme-TB and MycoDot are 74.6 - 88 %, 70.8-88.9 % and 94.6-97.9 %. Negative predietive value for Pathozyme-Myco and MycoDot (56.5- 75.0 % and 53.6 - 85.2 %) were better than Pathozyme-TB (35.9-54 %). From these results, it was concluded that the detection of IgG antibodies against 38 kDa, LPS and LAM are uscful for serodiagnosis of pulmonary TB. Pathozyme-Myco and Pathozyme-TB kits did not show IgG TB antibodies dccreased lower than detection limit for diagnosis after 3 and 6 months therapy, so it cannot be used for therapy monitoring and for differentiated the active TB from currently recovcrcd TB patients. There is no nutrional status effect to the result ofthe three kits. "

"ABSTRAKLatar belakang : Penyebab kematian pada TB paru seringkali tidaktergambarkan dengan jelas disebabkan sebagian besar studi mengandalkan padaregistrasi TB berdasarkan sertifikat kematian. Hanya sedikit studi penyebabkematian berdasarkan otopsi ataupun audit kematian untuk mengetahui penyebabkematian sebenarnya. Audit kematian diperlukan untuk meningkatkan mutupelayanan Rumah Sakit.Tujuan : Penelitian ini dilakukan untuk mengetahui penyebab kematian pada TBparu bakteriologis terkonfirmasi apakah berkaitan dengan TB secara langsungatau tidak langsung (berkaitan dengan komorbid) berdasarkan audit kematian,guna identifikasi intervensi yang efektif untuk mencegah kematian TB.Metoda : Penelitian potong lintang ini dilakukan di RSUP Persahabatan dengansubjek penelitian adalah semua pasien TB paru bakteriologis terkonfirmasi yangmeninggal di RS Persahabatan tahun 2014 yang memenuhi kriteria inklusi daneksklusi. Data diambil dari rekam medis, dilakukan audit kematian dan dinilaikesesuaian penyebab kematian langsung maupun tidak langsung antara sertifikatkematian dengan audit kematian.Hasil : Terdapat 51 subyek dengan laki-laki sebanyak 35 orang (68,6%) danperempuan 16 orang (31,4%). Penyebab kematian langsung terkait TBberdasarkan audit kematian sebanyak 15 subyek (29,4 %) yaitu disebabkan olehgagal napas (17,6 %) dan meningitis TB (11,8%). Penyebab kematian langsungtidak terkait TB berdasarkan audit kematian adalah 36 subyek (70,6%) yaitusepsis infeksi bakteri (41,2%) menjadi penyebab terbanyak, diikuti AIDS (3,9%),penyakit kardiovaskular (3,9 %), penyebab lain (5,9 %) dan tidak diketahui(15,7%). Diagnosis TB paru bakteriologis terkonfirmasi yang sesuai padasertifikat kematian berdasarkan audit adalah 25 subyek (49%) dan penyebabkematian langsung TB paru bakteriologis terkonfirmasi pada sertifikat kematianyang sesuai berdasarkan audit kematian adalah 27 subyek (52,9%).Kesimpulan : Penyebab kematian langsung pada TB paru bakteriologisterkonfirmasi terkait TB yang terbanyak disebabkan oleh gagal napas sedangkanyang tidak terkait TB yang terbanyak disebabkan oleh sepsis infeksi bakteri.Diperlukan intervensi lebih lanjut untuk mencegah kematian TB.

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ABSTRACTBackground : The causes of death in pulmonary TB are often not representedclearly caused most studies rely on the registration of TB based on deathcertificates. Only a few studies based on autopsy or death audits. Medical audit isnecessary to improve the quality of service in the hospital.Objective : The aim of the study is to know the cause of death in pulmonary TBbacterically proven whether related directly or undirecly with TB (regardingcomorbid) based on audit of death to identify effective intervention to preventmortality in TB.Method : This is cross sectional study in RSUP Persahabatan with subject ofstudy all of pulmonary TB patients bacterically proven died in RSUPPersahabatan in 2014 according to inclution and exclusion criteria. The data weretaken from medical record, with audit of death asses the cause of death direct ornot direct between certificate of death and audit of death.Result : There are 51 subjects. Male are 35 subjects (68,6%) and female are 16subject (31,4%).The causes of death directly related with TB based on audit ofdeath are 15 (29,4%) caused by respiratory failure (17,6 %) and meningitis TB(11,8 %). The causes of death are not directly related with TB based on audit ofdeath are 36 subjects (70,6 %) caused by sepsis with bacterial infection (41,2 %),AIDS are (3,9 %), cardiovascular diseases (3,9 %), other causes are (5,9 %) andunknown are (15,7 %). The diagnosis of pulmonary TB in a death certificate inaccordance with the results of the audit are 25 subjects (49%) and pulmonarytuberculosis cause of death on death certificates in accordance with the results ofthe audit are 27 subjects (52.9%).Conclusion : The causes of death are pulmonary tuberculosis bacteriology mostdirectly caused by respiratory failure while the causes of death are notimmediately TB that most caused by sepsis with bacterial infection as the cause.Required further interventions to reduce mortality of TB."

"Latar belakang: Efusi pleura tuberkulosis (TB) adalah bentuk umum dari TB ekstra paru. Proporsi efusi pleura pada kasus TB adalah terbesar kedua setelah keganasan di RSUP Persahabatan. Diagnosis definitif ditegakan dengan menemukan basil Mycobacterium tuberculosis (M.tb) dari cairan pleura mapun jaringan pleura walaupun kurang sensitif. Analisis cairan pleura dan pemeriksaan kadar adenosine deaminase (ADA) dapat membantu dalam mendiagnosis efusi pleura pada kasus TB terutama pada negara dengan insidens TB menengah hingga tinggi. Tujuan: Tujuan penelitian ini adalah membandingkan profil efusi pleura pada kelompok TB dan non-TB. Metode: Penelitian potong lintang dilakukan terhadap 411 catatan medis subjek dengan efusi pleura yang menjalani prosedur diagnostik di RSUP Persahabatan dari bulan Januari 2013 hingga 31 December 2015 secara retrospektif. Semua jaringan dan cairan diperiksa untuk pemeriksaan mikrobiologi, histopatologi, analisis cairan pleura dan ADA. Total 273 subjek dieksklusikan dan 138 subjek memenuhi kriteria inklusi untuk TB (n=65) dan non-TB (n=73). Hasil: Nilai tengah usia pada kelompok TB adalah 27 (15-69) tahun dengan proporsi 34 (75%) laki-laki berbeda bermakna dengan nilai tengah usia pada kelompok non TB yaitu 51 (16-75) tahun yang terdiri atas 38 (52%) perempuan. Pada kelompok TB rentang nilai ADA adalah 5,9 hingga 437,6 U/L dengan nilai tengah 103 U/L sedangkan pada kelompok non TB rentang 3,4 hingga 155 U/L dengan nilai tengah 19,9 U/L. Protein cairan pleura pada kelompok TB memiliki rerata 5,6 (SD 1,1) mg/dL berbeda bermakna dibandingkan pada rerata kelompok non TB yaitu 4,9 (SD 1,6) mg/dL. Sensitivitas ADA dengan titik potong 60 IU/dL adalah 89% dengan spesifitas 77% untuk kepositifan TB. Protein cairan pleura dengan titik potong 5 g/dL memberikan sensitivitas dan spesifitas sebesar 60% dan 52%. Pada penelitian ini kombinasi titik potong ADA dengan kadar 60 IU/L dan protein dengan kadar 5 g/dL meningkatkan spesifisitas menjadi 78% dan sensitivitas menjadi 66%. Kesimpulan: Hasil ADA dan protein cairan pleura harus diintepretasikan bersama temuan klinis dan hasil uji konfirmasi lain.

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Background: Pleural effusion is a common form of extra pulmonary tuberculosis (TB). Effusion due to pleural TB is second biggest proportion after malignancy in Persahabatan Hospital. The definitive diagnosis was established by determining the basil of Mycobacterium tuberculosis (M.tb) in the pleural fluid or pleural tissue but less sensitive. Pleural fluid analysis and adenosine deaminase (ADA) level can aid in the diagnosis of TB pleural effusions commonly used in the countries with a moderate to high incidence of TB.

Objectives: The aim of the study is comparing the profile of pleural effusion in TB and non-TB group.

Methods: This is retrospective cross sectional study on 411 subjects with pleural effusions who underwent diagnostic procedure at Persahabatan Hospital by January 1st 2013 to December 31th 2015. All data from tissue and fluid sample of microbiological, histopathological, pleural fluid and ADA examinations were taken from medical records. Total 138 patients met our inclusion criteria for TB (n=65) and non-TB (n=73) and 273 patients were excluded.

Results: Median of age in tuberculosis group age median was 27 (15-69) years old and consisted of 34 male (75%). Median of age in non-TB group was 51 (16.75) years old and consisted of 38 female (52%). In TB groups ADA range from 5.9 to 437.6 U/L with median ADA level 103 and in non TB groups ADA level range from 3.4 to 155 U/L with median 19.9 U/L. In TB groups protein level mean 5.6 (SD 1.1) mg/dL non TB 4.9 (SD 1.6) mg/dL. By using cut off the sensitivity of ADA level 60 IU/dL were 89% with specifity 77%. Protein level cutoff at 5 g/dL the sensitivity and specifity were 60% and 52%. This study showed a combination of ADA and protein as a cut off increasing specifity up to 78% and sensitivity 66%.

Conclusion: The results of ADA and protein of pleural fluid should be interpreted in parallel with clinical findings and the results of comfirmation tests."

"[ABSTRAKLatar belakang : Insidens Multi-drug resistant pulmonary tuberculosis (TB-MDR) meningkat hampir 2% tiap tahun sedangkan prevalensinya di dunia 4,3%. WHO melaporkan bahwa kasus TB-MDR tahun 2008 di Indonesia terjadi 6427 kasus.Tujuan : Penelitian ini bertujuan untuk menentukan identifikasi TB-MDR di Rumah sakit Umum Pusat Persahabatan dan Klibur Domin Timur laste dengan melakukan evaluasi selama enam bulan.Metode : Penelitian dilakukan dengan kohor retrospektif November 2014 dari rekam medis pasien TB-MDR di RSUP Persahabatan Jakarta dan Penampungan Klibur Domin Timoe Leste. Pemilihan sampel di RSUP Persahabatan dengan cluster random sampling sedangkan di Klibur Domin dengan total sampling.Hasil : Total sampel 49 yaitu 32 pasien di RSUP Persahabatan Jakarta dan 17 pasien di penampungan Klibur Domin Timor Leste yang memenuhi kriteria inklusi. Jenis kelamin laki-laki paling banyak ditemukan baik di RSUP Persahabatan Jakarta (75%) maupun di Penampungan klibur Domin Timor Leste (94,1%) dengan usia produktif (35-44 tahun). Dari karakteristik dasar pengobatan ditemukan riwayat pengobatan ulang kategori II 37,5% paling banyak di RSUP Persahabatan dan di Klibur Domin 82,3% .Hasil pemeriksaan mikroskopis positif di RSUP Persahabatan 65,6% sedangkan di Klibur Domin 100%. Dari pola diagnostik di RSUP Persahabatan ditemukan pemeriksaan gabungan kultur+GenXpert yang terbanyak yaitu 50% sedangkan di Klibur Domin cenderung hanya mendapat diagnosis TB-MDR dari satu pemeriksaan yaitu kultur 64,7% dan Genxpert 18,8%. diterapi.Berdasarkan pola resistensi masing-masing di RSUP Persahabatan yaitu resisten R,H,E,S (56,2%) dan Klibur Domin resisten R,H (70,5%). Kesimpulan : Penelitian ini menunjukkan bahwa betapa pentingnya mengetahui faktor-faktor yang mempengaruhi terjadinya TB-MDR, perlunya pemantauan yang terus menerus dan pengobatan yang segera dan tepat. Pada penelitian ini dapat diketahui bahwa tidak terdapat perbedaan yang menonjol dalam penegakan diagnosis, pemantauan dan pengobatan pasien TB-MDR di RSUP Persahabatan dan Timur Laste.;

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ABSTRACTIntroduction : Multi-drug resistant with pulmonary tuberculosis (TB-MDR) incidence rise to 2% every year, meanwhile prevalence of TB-MDR in the world is 4.3%. WHO report estimated that at 2008 cases of TB MDR in Indonesia were 6427. Objective : The aim of this study is to determine identification of TB-MDR at Persahabatan hospital and Klibur Domin Timur Leste with six months cohort review approach. Methods : This retrospective cohort study was conducted November 2014 from the medical records of TB-MDR patients at Persahabatan Jakarta hospital and Klibur Domin Care of Timor Leste. The sample selection at Persahabatan hospital was with cluster random sampling and Klibur Domin care was with total sampling. Results. Out of a total of 49 patients, 32 patients at Persahabatan Jakarta hospital and 17 patients at Klibur Domin Care Timor Leste, all include inclusion criteria. Male most commonly found in Persahabatan hospital (75%) and Klibur Domin care of Timor Leste (94.1%) with the productive age (35-44 years). From basic characteristics of the history of anti tuberculosis drugs found, category II was most common at Persahabatan hospital (37.5%) and Klibur Domin care was also found to have category II most common (82,3%). Acid fast bacilli positive in Persahabatan hospital was 65.6% and Klibur Domin Timor Leste 100%. Resistance respectively at Persahabatan hospital was R,H,E,S resistant (56.2%) and Klibur Domin care was R,H resistant (70,5%). Conclusion. This study shows the importance of knowing the factors that influence occurance of TB-MDR, the need of countinues monitoring, immediate and appropiate treatment. In this study can be seen that there is no significant difference at diagnosis, monitoring and treatment of TB-MDR at Persahabatan Hospital and Klibur Domin shelter at East Timor.;Introduction : Multi-drug resistant with pulmonary tuberculosis (TB-MDR) incidence rise to 2% every year, meanwhile prevalence of TB-MDR in the world is 4.3%. WHO report estimated that at 2008 cases of TB MDR in Indonesia were 6427. Objective : The aim of this study is to determine identification of TB-MDR at Persahabatan hospital and Klibur Domin Timur Leste with six months cohort review approach. Methods : This retrospective cohort study was conducted November 2014 from the medical records of TB-MDR patients at Persahabatan Jakarta hospital and Klibur Domin Care of Timor Leste. The sample selection at Persahabatan hospital was with cluster random sampling and Klibur Domin care was with total sampling. Results. Out of a total of 49 patients, 32 patients at Persahabatan Jakarta hospital and 17 patients at Klibur Domin Care Timor Leste, all include inclusion criteria. Male most commonly found in Persahabatan hospital (75%) and Klibur Domin care of Timor Leste (94.1%) with the productive age (35-44 years). From basic characteristics of the history of anti tuberculosis drugs found, category II was most common at Persahabatan hospital (37.5%) and Klibur Domin care was also found to have category II most common (82,3%). Acid fast bacilli positive in Persahabatan hospital was 65.6% and Klibur Domin Timor Leste 100%. Resistance respectively at Persahabatan hospital was R,H,E,S resistant (56.2%) and Klibur Domin care was R,H resistant (70,5%). Conclusion. This study shows the importance of knowing the factors that influence occurance of TB-MDR, the need of countinues monitoring, immediate and appropiate treatment. In this study can be seen that there is no significant difference at diagnosis, monitoring and treatment of TB-MDR at Persahabatan Hospital and Klibur Domin shelter at East Timor., Introduction : Multi-drug resistant with pulmonary tuberculosis (TB-MDR) incidence rise to 2% every year, meanwhile prevalence of TB-MDR in the world is 4.3%. WHO report estimated that at 2008 cases of TB MDR in Indonesia were 6427. Objective : The aim of this study is to determine identification of TB-MDR at Persahabatan hospital and Klibur Domin Timur Leste with six months cohort review approach. Methods : This retrospective cohort study was conducted November 2014 from the medical records of TB-MDR patients at Persahabatan Jakarta hospital and Klibur Domin Care of Timor Leste. The sample selection at Persahabatan hospital was with cluster random sampling and Klibur Domin care was with total sampling. Results. Out of a total of 49 patients, 32 patients at Persahabatan Jakarta hospital and 17 patients at Klibur Domin Care Timor Leste, all include inclusion criteria. Male most commonly found in Persahabatan hospital (75%) and Klibur Domin care of Timor Leste (94.1%) with the productive age (35-44 years). From basic characteristics of the history of anti tuberculosis drugs found, category II was most common at Persahabatan hospital (37.5%) and Klibur Domin care was also found to have category II most common (82,3%). Acid fast bacilli positive in Persahabatan hospital was 65.6% and Klibur Domin Timor Leste 100%. Resistance respectively at Persahabatan hospital was R,H,E,S resistant (56.2%) and Klibur Domin care was R,H resistant (70,5%). Conclusion. This study shows the importance of knowing the factors that influence occurance of TB-MDR, the need of countinues monitoring, immediate and appropiate treatment. In this study can be seen that there is no significant difference at diagnosis, monitoring and treatment of TB-MDR at Persahabatan Hospital and Klibur Domin shelter at East Timor.]"

"Keterlambatan diagnosis dapat memperparah penyakit, meningkatkan risiko kematian dan kemungkinan penularan tuberkulosis di masyarakat. Penelitian ini bertujuan untuk mengetahui berapakah proporsi dan lama waktu keterlambatan diagnosis dan faktor risiko apa saja yang berhubungan dengan keterlambatan diagnosis TB paru di Kabupaten Tebo. Penelitian ini menggunakan desain cross sectional yang dilakukan pada penderita tuberkulosis yang berobat di rumah sakit dan puskesmas dalam Kabupaten Tebo tahun 2018. Sampel dalam penelitian ini berjumlah 366 responden. Anaisis multivariat menggunakan cox regression. Hasil penelitian proporsi keterlambatan diagnosis (>28 hari) sebesar 63,93%. Faktor predisposisi (umur ≥ 45 tahun), faktor pendukung (jenis UPK Non-DOTS dikunjungi pertama kali, stigma tinggi dan jarak tempuh ke UPK ≥ 30 menit) dan faktor kebutuhan (persepsi penyakit tidak serius) merupakan faktor risiko yang berhubungan dengan keterlambatan diagnosis. Perlu dilakukan peningkatan kualitas program pengendalian tuberkulosis, penyuluhan tuberkulosis agar masyarakat mempunyai persepsi yang benar terhadap tuberkulosis dan untuk mengurangi stigma negatif terhadap penyakit tuberkulosis, meningkatkan akses ke unit pelayanan kesehatan DOTS serta penemuan secara aktif untuk mengurangi keterlambtan diagnosis.

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Delay in diagnosis can lead to increased severity of the disease, increased the risk of death and the possibility of transmission of tuberculosis in the community. The objective of this study was to determine proportion and the length of delay in diagnosis and factors associated with the delay in diagnosis among pulmonary tuberculosis patient in Tebo Distric. This study design using cross sectional conducted in patients with tuberculosis who was treated at hospitals and health centers at Tebo District in 2018. The sample in this study amounted to 366 respondents. Multivariat analysis using a multivariate cox regression. The results showed that the proportion of diagnosis delay (> 28 days) was 63.93 %. Predisposing factors (age ≥ 45 years), enabling factors (first consulting Non-DOTS health care unit, high stigma and distance to the health care unit DOTS ≥ 30 minutes) and need factors (perception of the disease is not serious) are risk factors associated with the diagnostic delay. Necessary improving the quality of tuberculosis control programs, counseling tuberculosis so that people have the correct perception against tuberculosis and to reduce the negative stigma against tuberculosis, improving access to health care units DOTS and active case finding are vital to reduce diagnostic delay."

"Pendahuluan: Tuberkulosis (TB) adalah penyebab utama kematian akibat infeksi di dunia. Sejak tahun 2008 - 2017 terdapat penurunan angka keberhasilan pengobatan TB di Indonesia (< 90%). Rekomendasi pengobatan TB di Indonesia adalah paduan obat antituberkulosis (OAT) dosis berselang sebagian (2RHZE/4R3H3) atau harian (2RHZE/4RH). Menurut WHO, paduan OAT RHZE/R3H3 mempunyai angka kegagalan dan kekambuhan yang lebih tinggi. Namun, penelitian meta-analisis RCT menyatakan bahwa kedua paduan OAT mempunyai angka kegagalan dan kekambuhan yang sama. Oleh karena itu, dilakukan penelitian untuk membandingkan hasil pengobatan dan efek samping antara paduan OAT 2RHZE/2RH dengan 2RHZE/4R3H3.Metode: Penelitian ini merupakan studi analitik observasional dengan desain cross sectional yang membandingkan hasil pengobatan dan efek samping antara paduan OAT 2RHZE/4RH dengan 2RHZE/4R3H3 pada pasien TB paru kategori I di RSUP Persahabatan periode Januari 2015 sampai Juni 2018. Data sekunder diambil dari rekam medik. Hasil pengobatan dinilai sesuai definisi dalam pedoman nasional penanggulangan TB di Indonesia dan WHO. Efek samping dinilai dari seluruh efek samping terkait OAT yang tercatat dalam rekam medik.Hasil: Terdapat 175 pasien pada masing-masing kelompok. Pada kelompok paduan OAT 2RHZE/4RH terdapat 89.1% pasien berhasil, 13.1% sembuh,76.0% pengobatan lengkap, 10.6% putus berobat, 0.6% gagal, dan tidak ada yang meninggal. Pada kelompok paduan OAT 2RHZE/4R3H3 terdapat 91.4% pasien berhasil, 39.4% sembuh, 52.0% lengkap, 8% putus berobat, tidak ada yang gagal, dan 0.6% meninggal. Tidak ada perbedaan bermakna untuk keberhasilan pengobatan (p=0.470, OR=1.299, IK95%;0.637-2.648), putus berobat (p=0.659 ,OR=0.758, IK95%;0.365-1.577), gagal (p=1.000), dan meninggal (p=1.000) di antara kedua kelompok. Namun, terdapat perbedaan bermakna untuk kesembuhan (p=0.003, OR=2.358, IK95%;1.375-5.206) dan pengobatan lengkap (p=<0.001, OR=0.342, IK95%;0.217-0.540). Sebagian besar pasien mengalami efek samping pengobatan (51.1%) terutama di tahap intensif (73.2%). Pada tahap lanjutan tidak ada perbedaan bermakna kejadian efek samping antara kedua kelompok (p= 0.324, OR=1.386, IK95%; 0.723-2.657).Kesimpulan: Kesembuhan kelompok paduan OAT 2RHZE/4R3H3 lebih baik daripada 2RHZE/4RH, sedangkan pengobatan lengkap sebaliknya. Tidak ada perbedaan bermakna untuk keberhasilan pengobatan, putus berobat, kegagalan, meninggal, dan kejadian efek samping pada tahap lanjutan di antara kedua kelompok.

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Introduction: Tuberculosis (TB) is the main cause of death for infectious disease in the world. Since 2008 - 2017, there was a decline of TB success rate (< 90%) in Indonesia. Treatment of TB in Indonesia are using antituberculosis drugs with part daily dose combination (2RHZE/4R3H3) or daily dose combination (2RHZE/4RH). WHO concluded that 2RHZE/4R3H3 combination had higher failure and recurrence rate. However, a meta-analysis study showed that both combinations had same failure and recurrence rate. Therefore, this study is conducted to compare treatment outcomes and adverse effects between 2RHZE/4RH combination and 2RHZE/4R3H3 combination.

Method: This was an observational analytic study with cross sectional design which compared treatment outcomes and adverse effects between 2RHZE/4RH combination and 2RHZE/4R3H3 combination in pulmonary tuberculosis patient at RSUP Persahabatan period January 2015 until June 2018. Secondary data was taken from medical record. Treatment outcomes were assessed using definition in Indonesia National Guideline of TB and WHO. Adverse effects were assessed from all adverse effects that written in medical record.

Result: There are 175 patients in each group. In 2RHZE/4RH combination group, there were 89.1% patients succeed, 13.1% cured, 76.0% completed treatment, 10.6% lost to follow up, 0.6% failed and no one died. In 2RHZE/4R3H3 combination group, there were 91.4% patients succeed, 39.4% cured, 52.0% completed treatment, 8% lost to follow up, no one failed, and 0.6% died. There was no significant difference for success (p=0.470, OR=1.299, IK95%;0.637-2.648), loss to follow up (p=0.659, OR=0.758, IK95%;0.365-1.577), failure (p=1.000), and death rate (p=1.000) between two groups. However, there was a significant difference for cure (p=0.003, OR=2.358, IK95%;1.375-5.206) and complete treatment rate (p=<0.001, OR=0.342, IK95%;0.217-0.540) between two groups. Most patients had adverse effects (51,5%), especially in intensive phase (73,2%). In continuation phase, there was no significant difference of adverse effects event between two groups (p = 0.324, OR= 1.386, IK95%; 0.723-2.657).

Conclusion: Cure rate was better in 2RHZE/4R3H3 group than 2RHZE/4RH group, for completed treatment on the contrary. There was no significant difference for success rate, loss to follow up rate, failure rate, death rate, and adverse effects event in continuation phase between two groups."