Studi Beban Pencemaran Logam Berat Kadmium (Cd) pada Ballast Water Kapal Barang dan Kapal Penumpang di Pelabuhan Tanjung Emas Semarang

Ballast water exchange is one of the operations of the ship. The more number of vessels that lean to make the amount of ballast water that is dumped in the waters of the port of Tanjung Emas the more higher. Ballast water pollution due to the cargo and passenger ships at the Port of Tanjung Emas cause pollution load which impact indirectly on the quality of water.The purpose of this study was to determine the burden of the heavy metal cadmium pollution of water ballast cargo and passenger ships in the Port of Tanjung Emas in Semarang.This type of research is descriptive survey with cross sectional approach. The variables in this research include the number of vessels, the type of ship, age of ship, cadmium levels ship ballast water, sewage discharge ballast water of ships and ship ballast water pollutant load. Population and sample in this research were 30 cargo and passenger ships with criteria that ship rely at the port of Tanjung Emas in Semarang and have a ballast water tank. The results showed cadmium levels of 30 samples ship ballast water (100%) is above the threshold value with the highest level of 2,457 mg/l and the lowest level of 1,076 mg/l. Waste discharge ballast water ships at the Port of Tanjung Emas highest level of 350 m3/hour and the lowest level of 1.00 m3/hour. The results of pollutant load calculations ship ballast water of 30 samples cargo and passenger ships at the Port of Tanjung Emas shows that the highest pollutant load of 0,782 kg/day and most lower pollutant load 0,002 kg/day. The conclusion of this study is the pollutant load of cadmium from the cargo and passenger ships at the Port of Tanjung Emas has a varies value depending on the type of ship and vessel age

Analisis Kaitan Riwayat Merokok Terhadap Pasien Tuberkulosis Paru (TB Paru) Di Puskesmas Srondol

TB Paru atau Tuberkulosis Paru merupakan penyakit menular dan dapat menyebabkan kematian. Temuan kasus Tuberkulosis Paru di Jawa Tengah pada tahun 2011 mencapai 20.623 kasus. Puskesmas Srondol termasuk sepuluh besar puskesmas dengan angka kejadian tuberkulosis yang tinggi di Kota Semarang. Bahkan, Puskesmas Srondol juga menjadi Puskesmas dengan peningkatan kasus TB paru tertinggi. Sementara, merokok merupakan perilaku yang membahayakan kesehatan paru-paru. Di Kota Semarang sendiri, angka perokok cukup tinggi dan perilaku merokok masih dianggap sebagai gaya hidup. Penelitian ini bertujuan untuk menemukan hubungan antara riwayat merokok dengan kejadian TB Paru. Metode penelitian adalah survei dengan pendekatan case series dan cohort dan jenis penelitiannya merupakan penelitian analitik

Neuropsychiatric manifestations and sleep disturbances with dolutegravir-based antiretroviral therapy versus standard of care in children and adolescents: a secondary analysis of the ODYSSEY trial

BACKGROUND: Cohort studies in adults with HIV showed that dolutegravir was associated with neuropsychiatric adverse events and sleep problems, yet data are scarce in children and adolescents. We aimed to evaluate neuropsychiatric manifestations in children and adolescents treated with dolutegravir-based treatment versus alternative antiretroviral therapy. METHODS: This is a secondary analysis of ODYSSEY, an open-label, multicentre, randomised, non-inferiority trial, in which adolescents and children initiating first-line or second-line antiretroviral therapy were randomly assigned 1:1 to dolutegravir-based treatment or standard-of-care treatment. We assessed neuropsychiatric adverse events (reported by clinicians) and responses to the mood and sleep questionnaires (reported by the participant or their carer) in both groups. We compared the proportions of patients with neuropsychiatric adverse events (neurological, psychiatric, and total), time to first neuropsychiatric adverse event, and participant-reported responses to questionnaires capturing issues with mood, suicidal thoughts, and sleep problems. FINDINGS: Between Sept 20, 2016, and June 22, 2018, 707 participants were enrolled, of whom 345 (49%) were female and 362 (51%) were male, and 623 (88%) were Black-African. Of 707 participants, 350 (50%) were randomly assigned to dolutegravir-based antiretroviral therapy and 357 (50%) to non-dolutegravir-based standard-of-care. 311 (44%) of 707 participants started first-line antiretroviral therapy (ODYSSEY-A; 145 [92%] of 157 participants had efavirenz-based therapy in the standard-of-care group), and 396 (56%) of 707 started second-line therapy (ODYSSEY-B; 195 [98%] of 200 had protease inhibitor-based therapy in the standard-of-care group). During follow-up (median 142 weeks, IQR 124–159), 23 participants had 31 neuropsychiatric adverse events (15 in the dolutegravir group and eight in the standard-of-care group; difference in proportion of participants with ≥1 event p=0·13). 11 participants had one or more neurological events (six and five; p=0·74) and 14 participants had one or more psychiatric events (ten and four; p=0·097). Among 14 participants with psychiatric events, eight participants in the dolutegravir group and four in standard-of-care group had suicidal ideation or behaviour. More participants in the dolutegravir group than the standard-of-care group reported symptoms of self-harm (eight vs one; p=0·025), life not worth living (17 vs five; p=0·0091), or suicidal thoughts (13 vs none; p=0·0006) at one or more follow-up visits. Most reports were transient. There were no differences by treatment group in low mood or feeling sad, problems concentrating, feeling worried or feeling angry or aggressive, sleep problems, or sleep quality. INTERPRETATION: The numbers of neuropsychiatric adverse events and reported neuropsychiatric symptoms were low. However, numerically more participants had psychiatric events and reported suicidality ideation in the dolutegravir group than the standard-of-care group. These differences should be interpreted with caution in an open-label trial. Clinicians and policy makers should consider including suicidality screening of children or adolescents receiving dolutegravir

Dolutegravir twice-daily dosing in children with HIV-associated tuberculosis: a pharmacokinetic and safety study within the open-label, multicentre, randomised, non-inferiority ODYSSEY trial

Background: Children with HIV-associated tuberculosis (TB) have few antiretroviral therapy (ART) options. We aimed to evaluate the safety and pharmacokinetics of dolutegravir twice-daily dosing in children receiving rifampicin for HIV-associated TB. Methods: We nested a two-period, fixed-order pharmacokinetic substudy within the open-label, multicentre, randomised, controlled, non-inferiority ODYSSEY trial at research centres in South Africa, Uganda, and Zimbabwe. Children (aged 4 weeks to <18 years) with HIV-associated TB who were receiving rifampicin and twice-daily dolutegravir were eligible for inclusion. We did a 12-h pharmacokinetic profile on rifampicin and twice-daily dolutegravir and a 24-h profile on once-daily dolutegravir. Geometric mean ratios for trough plasma concentration (Ctrough), area under the plasma concentration time curve from 0 h to 24 h after dosing (AUC0–24 h), and maximum plasma concentration (Cmax) were used to compare dolutegravir concentrations between substudy days. We assessed rifampicin Cmax on the first substudy day. All children within ODYSSEY with HIV-associated TB who received rifampicin and twice-daily dolutegravir were included in the safety analysis. We described adverse events reported from starting twice-daily dolutegravir to 30 days after returning to once-daily dolutegravir. This trial is registered with ClinicalTrials.gov (NCT02259127), EudraCT (2014–002632-14), and the ISRCTN registry (ISRCTN91737921). Findings: Between Sept 20, 2016, and June 28, 2021, 37 children with HIV-associated TB (median age 11·9 years [range 0·4–17·6], 19 [51%] were female and 18 [49%] were male, 36 [97%] in Africa and one [3%] in Thailand) received rifampicin with twice-daily dolutegravir and were included in the safety analysis. 20 (54%) of 37 children enrolled in the pharmacokinetic substudy, 14 of whom contributed at least one evaluable pharmacokinetic curve for dolutegravir, including 12 who had within-participant comparisons. Geometric mean ratios for rifampicin and twice-daily dolutegravir versus once-daily dolutegravir were 1·51 (90% CI 1·08–2·11) for Ctrough, 1·23 (0·99–1·53) for AUC0–24 h, and 0·94 (0·76–1·16) for Cmax. Individual dolutegravir Ctrough concentrations were higher than the 90% effective concentration (ie, 0·32 mg/L) in all children receiving rifampicin and twice-daily dolutegravir. Of 18 children with evaluable rifampicin concentrations, 15 (83%) had a Cmax of less than the optimal target concentration of 8 mg/L. Rifampicin geometric mean Cmax was 5·1 mg/L (coefficient of variation 71%). During a median follow-up of 31 weeks (IQR 30–40), 15 grade 3 or higher adverse events occurred among 11 (30%) of 37 children, ten serious adverse events occurred among eight (22%) children, including two deaths (one tuberculosis-related death, one death due to traumatic injury); no adverse events, including deaths, were considered related to dolutegravir. Interpretation: Twice-daily dolutegravir was shown to be safe and sufficient to overcome the rifampicin enzyme-inducing effect in children, and could provide a practical ART option for children with HIV-associated TB