Performance of Xpert MTB/RIF and sputum microscopy compared to sputum culture for diagnosis of tuberculosis in seven hospitals in Indonesia

IntroductionTuberculosis (TB) is a major public health concern in Indonesia, where the incidence was 301 cases per 100,000 inhabitants in 2020 and the prevalence of multi-drug resistant (MDR) TB is increasing. Diagnostic testing approaches vary across Indonesia due to resource limitations. Acid-fast bacilli (AFB) smear is widely used, though Xpert MTB/RIF has been the preferred assay for detecting TB and rifampicin resistance since 2012 due to higher sensitivity and ability to rapidly identify rifampicin resistance. However, <1,000 Xpert instruments were available in Indonesia as of 2020 and the Xpert supply chain has suffered interruptions.MethodsWe compared the performance of Xpert MTB/RIF and AFB smear to facilitate optimization of TB case identification. We analyzed baseline data from a cohort study of adults with pulmonary TB conducted at seven hospitals across Indonesia. We evaluated sensitivity and specificity of AFB smear and Xpert MTB/RIF using Mycobacterium tuberculosis (Mtb) culture as the gold standard, factors associated with assay results, and consistency of Xpert MTB/RIF with drug susceptibility test (DST) in detecting rifampicin resistance.ResultsSensitivity of AFB smear was significantly lower than Xpert MTB/RIF (86.2 vs. 97.4%, p-value <0.001), but specificity was significantly better (86.7 vs. 73.3%, p-value <0.001). Performance varied by hospital. Positivity rate for AFB smear and Mtb culture was higher in subjects with pulmonary cavities and in morning sputum samples. Consistency of Xpert MTB/RIF with DST was lower in those with rifampicin- sensitive TB by DST.DiscussionAdditional evaluation using sputa from primary and secondary Indonesian health centers will increase the generalizability of the assessment of AFB smear and Xpert MTB/RIF performance, and better inform health policy.Clinical trial registration[https://clinicaltrials.gov/], identifier [NCT027 58236]

STUDI TENTANG PEMBELAJARAN MELUKIS DENGAN MEMANFAATKAN MODEL WAYANG KLASIK MENJADI WAYANG KREASI MATA PELAJARAN SENI BUDAYA KELAS IX SMP NEGERI 2 SUTOJAYAN DI KABUPATEN BLITAR

ABSTRAK   Aswindra Kosasih, Herman. 2011. Pembelajaran Melukis dengan Memanfaatkan Model Wayang Klasik Menjadi Wayang Kreasi Mata Pelajaran Seni Budaya Kelas IX SMP Negeri 2 Sutojayan di Kabupaten Blitar. Skripsi, Program Studi S-1 Pendidikan Seni Rupa, Jurusan Seni dan Desain, Fakultas Sastra Universitas Negeri Malang. Pembimbing: (I) Drs. Iriaji. M.Pd (II) Drs. Andi Harisman.   Kata kunci: pembelajaran, wayang klasik, wayang kreasi Budaya dimiliki oleh sebuah kelompok orang yang diwariskan dari generasi ke generasi dan selalu mengalami perkembangan. Pembelajaran merupakan suatu upaya untuk mencapai tujuan dari belajar yaitu berupa perubahan pengetahuan, tingkah laku, dan sikap siswa baik sebagian maupun seluruhnya melalui serangkaian pengalaman belajar. Proses pembelajaran meliputi tiga tahapan, yaitu: tahap perencanaan, tahap pelaksanaan, dan tahap penilaian. Penelitian ini bertujuan untuk mendeskripsikan persiapan, penyampaian, pelaksanaan hasil karya faktor pendukung dan kendala pembelajaran melukis dengan memanfaatkan model wayang klasik menjadi wayang kreasi mata pelajaran seni budaya. Penelitian ini beerkaitan dengan standar kompetensi mengapresiasi karya seni terapan dan mengekspresikan diri melalui karya seni terapan. Penelitian ini adalah penelitian kualitatif yang bersifat deskriptif dengan menggunakan analisa induktif. Dilakukan di kelas IX SMP Negeri 2 Sutojayan, pada bulan Januari dan Februari 2011. Teknik yang dilakukan peneliti dalam mengumpulkan data dilakukan dengan wawancara dengan guru seni budaya dan observasi lapangan.Wayang merupakan salah satu wujud kebudayaan yang bersifat fisik (material). Dalam pembelajaran melukis yang diteliti adalah aktivitas guru dalam mengajar, meliputi: pencapaian kompetensi, penerapan metode, penggunaan media, dan pengelolaan kelas, sedangkan untuk aktifitas siswa dalam belajar, sebagai hasil pengajaran guru meliputi: perhatian dan kinerja siswa. Hasil penelitian ini menunjukkan bahwa: 1) Persiapan pembelajaran materi melukis dengan memanfaatkan model wayang klasik menjadi wayang kreasi sesuai dengan standart kompetensi ekspresi dan apresiasi karya seni terapan dalam kurikulum KTSP; 2) Guru dalam melaksanakan pembelajaran telah menciptakan suasana yang menggairahkan dan rancangan yang dinamis untuk menata pembelajaran; 3) Media pembelajaran yang digunakan dapat memperjelas penyajian pesan, dan mengirim pesan dari guru ke siswa serta sesuai dengan koridor kompetansi dasar yang ingin dicapai.; 4) Faktor pendukung pembelajaran ini adalah keluarga karena siswa bisa menghargai karya budaya bangsa dirinya, sekolah karena sesuai dengan visi sekolah materi wayang kreasi juga selalu dimasukan dalam kalender sekolah dan masyarakat karena dengan pembelajaran tersebut diharapkan siswa semakin mencintai budaya bangsanya ;5) Adapun yang menjadi faktor kendala adalah permainan game playstation yang dimainkan oleh siswa secara berlebihan sehingga mengganggu rutinitas waktu belajar

A Review of Hantavirus Research in Indonesia: Prevalence in Humans and Rodents, and the Discovery of Serang Virus

Dengue and other common tropical infectious diseases of similar clinical presentation are endemic in Indonesia, which may lead to an underestimation of the prevalence of hantavirus (HTV) infection in the country. To better understand the current burden of HTV infection, this study aimed to both identify acute HTV infection among hospitalized patients with fever and to determine the overall seroprevalence of HTV. These results were further considered within the context of previously reported HTV infection in humans and animals in Indonesia by conducting a review of published literature. As part of an observational cohort study of acute febrile illness, this sub-study retrospectively analyzed blood specimens obtained during admission, during the 2–4-week convalescent period, and three months after admission. Convalescent specimens from patients with clinical signs and symptoms of HTV infection were first screened for HTV IgG. When positive, convalescent specimens and paired acute specimens were screened for HTV IgM, and paired acute specimens were tested for HTV by Reverse Transcription Polymerase Chain Reaction (RT-PCR). A literature review of HTV in Indonesia was conducted on manuscripts manually reviewed for relevance after identification from a search using the terms “hantavirus/Seoul virus” and “Indonesia”. From patients at eight hospitals in seven provincial capitals, HTV IgG seroprevalence was 11.6% (38/327), with the highest being in Denpasar (16.3%, 7/43) and the lowest being in Yogyakarta (3.4%, 1/31). Anti-HTV IgG was most prevalent in adults (13.5%, 33/244) and males (15.6%, 29/186). Acute HTV infections were identified in two subjects, both of whom had Seoul virus. In Indonesia, HTVs have been studied in humans and animals since 1984. Over the past 35 years, the reported seroprevalences in rodents ranged from 0% to 34%, and in humans from 0% to 13%. Fourteen acute infections have been reported, including one in a tourist returning to Germany, but only two have been confirmed by RT-PCR. Almost all rodent and human surveillance results demonstrated serological and molecular evidence of Seoul virus infection. However, in Semarang, anti-Puumala virus IgM has been detected in humans and Puumala RNA in one rodent. In Serang, a new virus named Serang virus was identified due to its differences from Seoul virus. In Maumere, HTV and Leptospira spp. were identified simultaneously in rodents. The burden of HTV infection in Indonesia is underestimated, and additional studies are needed to understand the true prevalence. Seroprevalence data reported here, previous observations of HTV co-infections in rodents, and the prevalence of rodent-borne bacterial infections in Indonesia suggest that the population may be routinely encountering HTVs. While Seoul virus appears to be the most prevalent HTV in the country, further studies are needed to understand which HTVs are circulating

Comparison of the Hemagglutination Inhibition Test and IgG ELISA in Categorizing Primary and Secondary Dengue Infections Based on the Plaque Reduction Neutralization Test

Secondary dengue infection by heterotypic serotypes is associated with severe manifestations of disease, that is, dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). The World Health Organization (WHO) has recommended criteria based on the hemagglutination inhibition (HI) test to distinguish between primary and secondary dengue infections. Since the HI test has practical limitations and disadvantages, we evaluated the accuracy of WHO HI criteria and compared it with criteria based on an IgG enzyme-linked immunosorbent assay (ELISA) using a plaque reduction neutralization test (PRNT) as the gold standard. Both WHO HI criteria and IgG ELISA criteria performed strongly (16/16) in determining primary infection. However, to determine secondary infection, the IgG ELISA criteria performed better (72/73) compared to the WHO HI criteria (23/73)

Case report: two confirmed cases of human Seoul virus infections in Indonesia

Abstract Background Seoul virus (SEOV) is a member of hantavirus family, which is transmitted to humans by Rattus rattus and Rattus norvegicus. Diagnosing SEOV infection is difficult because the clinical presentations are often undifferentiated with other viral or bacterial infections and assays to test antibodies seroconversion and RNA detection are not available in resource-limited setting like Indonesia. Case presentation We report two confirmed cases of SEOV infection from Indonesia. Here, we illustrate the clinical presentations, hematology and biochemistry profiles, and outcomes of the two cases. Phylogenetic analysis revealed that SEOV sequences have highest homology to isolates obtained from rodents in Indonesia. Conclusions This report highlights the importance of considering SEOV infection in febrile patients with lymphopenia, thrombocytopenia, and elevation of liver enzyme despite the absence of hemorrhagic manifestations and renal syndromes. The public health importance of rodent-borne diseases such as SEOV infection urges an integrated epidemiological surveillance both in humans and rodents in Indonesia

MOESM1 of Case report: Weil’s disease with multiple organ failure in a child living in dengue endemic area

Additional file 1. Dataset for the case report

Correction: An observational prospective cohort study of the epidemiology of hospitalized patients with acute febrile illness in Indonesia.

[This corrects the article DOI: 10.1371/journal.pntd.0007927.]