New Evidence of Spondylitis Tuberculosis: Pyogenic Microorganism Contamination or Mixed Infection ?

Introduction. Type of bacteria causing spondylitis is necessary to be specificly recognized. It influences the therapy approach. Mixed bacterial infections found is nowsaday being an important issue. This paper revealed evidence of other bacteria in spondylitis tuberculosis as if they are in the condition of mixed infection or contamination. Materials and methods. Examining the morphology of bacteria was investigated using stain and culture techniques on selective and differential medium to Spondylitis material. All tissue lesions, solid, semisolid and liquid including bone sequester, granulation tissue, pus, and necrotic tissue were used to inspect the raw materials. Results. It has been successfully identified and isolated. The identification revealed three bacteria, namely Staphylococcus epidermidis, Staphylococcus aureus and Mycobacterium tuberculosis which was derived from solid lesions (sequester and necrotic tissue), semisolid (granulation tissue) and liquid (pus). All of the bacteria were taken from four patients with spondylitis. The result shows that from overall four, there is one case of spinal infection by three bacteria that cause infection. Conclusions. Culture examination should be using solid, semisolid and liquid material in order to obtain the whole profile of bacteria which play role in the process of spinal infection

Translation, Validity, and Reliability of the Indonesian Version of the Anterior Cruciate Ligament-Return to Sport After Injury Scale

BACKGROUND: The Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI) scale measures athletes' emotion, confidence, and risk appraisal when returning to sports after an anterior cruciate ligament (ACL) injury and/or ACL reconstruction (ACLR).PURPOSE: To translate the ACL-RSI into the Indonesian language and to assess its validity and reliability in Indonesian-speaking patients after ACLR.STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2.METHODS: After a forward-and-backward translation procedure, the validity and reliability of the Indonesian version of the ACL-RSI (I-ACL-RSI) were investigated. Patients who had undergone ACLR at a single hospital were asked to complete 4 questionnaires: I-ACL-RSI, Injury-Psychological Readiness to Return to Sport, Tampa Scale of Kinesiophobia, and International Knee Documentation Committee. After a 2-week interval, patients were asked to complete the I-ACL-RSI a second time. Following the COSMIN reporting guidelines (Consensus-Based Standards for the Selection of Health Measurement Instruments), we determined construct validity using hypothesis testing, as well as test-retest reliability, internal consistency, floor and ceiling effects, and measurement error.RESULTS: Of 200 eligible patients, 102 (51%) were included in the analysis. All predefined hypotheses on correlations between the I-ACL-RSI and the other questionnaires were confirmed, indicating good construct validity. An intraclass correlation coefficient of 0.90 (2-way random, type agreement) was found for the first and second I-ACL-RSI scores, indicating good test-retest reliability. A Cronbach α of 0.95 indicated good internal consistency, and no floor or ceiling effects were found. The standard error of measurement was 3.9, with the minimal detectable change calculated as 10.9 points at the individual level and 1.1 points at the group level.CONCLUSION: Based on the study findings, the I-ACL-RSI can be considered a valid and reliable questionnaire for Indonesian-speaking patients after ACL injury and/or ACLR.</p

Translation and Psychometric Analysis of the Indonesian Versions of the Lysholm and Tegner Scores for Patients With Anterior Cruciate Ligament Injuries

BACKGROUND: The Lysholm knee score and Tegner activity scale are frequently used patient-reported outcome measures in patients with anterior cruciate ligament (ACL) injuries because of their excellent psychometric properties. These questionnaires were originally developed in the English language. PURPOSE: To translate and cross-culturally adapt these measures into the Indonesian language and study their validity and reliability so that they can be used in the Indonesian-speaking population with ACL injuries. STUDY DESIGN: Cohort study (diagnosis/symptom prevalence); Level of evidence, 2. METHODS: After a forward-backward translation procedure and cross-cultural adaptation, validity and reliability were investigated. A total of 253 patients with an ACL injury were sent 4 questionnaires (36-Item Short Form Health Survey, Kujala anterior knee pain scale, Indonesian Lysholm knee score [I-LK], and Indonesian Tegner activity scale [I-TS]). The responses of those patients were analyzed. Following COSMIN guidelines, construct validity, test-retest reliability, internal consistency, floor and ceiling effects, and measurement errors were determined. The Bland-Altman method was used to explore absolute agreement. RESULTS: A total of 106 patients (42% response rate) were included in this study. Construct validity was considered to be good, as more than 75% of the predefined hypotheses on correlations between the I-LK, I-TS, and other measures were confirmed. Reliability proved excellent, with a high test-retest correlation for both questionnaires (intraclass correlation coefficient = 0.99). Bland-Altman analysis showed no systematic bias between testing and retesting. The internal consistency of the I-LK was good (Cronbach alpha = 0.73). For the I-LK and I-TS, floor and ceiling effects were less than 15% (floor: 0% and 4.7%, respectively; ceiling: 12.3% and 3.8%, respectively); the standard error of measurement was 1.8 and 0.9, respectively; the minimal detectable change at the individual level was 5.1 and 0.6, respectively; and the minimal detectable change at the group level was 2.4 and 0.5, respectively. CONCLUSION: Both the I-LK and I-TS appear to be good evaluation tools for Indonesian-speaking patients with an ACL injury

Translation, Cross-Cultural Adaptation, Validity, and Reliability of the Indonesian Version of the IKDC Subjective Knee Form

Background: No questionnaire is currently available for use in patients with anterior cruciate ligament (ACL) injuries in an Indonesian population. The most-used questionnaire in clinical research for these patients is the International Knee Documentation Committee (IKDC) Subjective Knee Form, as its psychometric properties are considered to be excellent. Purpose: To translate the IKDC into Indonesian and assess its validity for use in Indonesian-speaking patients with ACL injuries. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: After a forward-and-backward translation procedure and cross-cultural adaptation, the validity and reliability of the questionnaire were investigated. The responses of ACL injury patients on 3 questionnaires, the Indonesian-IKDC (I-IKDC), 36-Item Short Form Health Survey, and Kujala Anterior Knee Pain Scale, were compared. Following consensus-based standards for the selection of health measurement instruments guidelines, construct validity, test-retest reliability, internal consistency, floor and ceiling effects, and measurement error were determined. The Bland-Altman method was used to explore absolute agreement. Results: Of 253 ACL injury patients, 106 (42%) responded to the invitation. Construct validity was considered good, as all predefined hypotheses on correlations between the I-IKDC and other scores were confirmed. Reliability proved excellent, with a high test-retest correlation (intraclass correlation coefficient = 0.99). Bland-Altman analyses showed no systematic bias between test and retest. Internal consistency was good (Cronbach α = .90). There were no floor or ceiling effects. Standard error of measurement was 2.1, and the minimal detectable change was 5.8 at the individual level and 0.7 at the group level. Conclusion: The I-IKDC, as developed, appeared to be a good evaluation instrument for Indonesian patients with ACL injuries

Burden and Cost of Anterior Cruciate Ligament Reconstruction and Reimbursement of Its Treatment in a Developing Country:An Observational Study in Indonesia

Objective: The number of anterior cruciate ligament reconstruction (ACLR) procedures is increasing. However, ACLR procedures are likely to be underbudgeted in a developing country like Indonesia. This study aimed to analyze costs for ACLR procedures in Indonesia's resource-limited context, determine the burden of ACLR, and suggest national prices for ACLR reimbursement. Methods: A retrospective observational study was conducted between 1 January and 31 December 2019 on the cost of ACLR from a payer perspective using inpatient billing records in four hospitals. The national burden of ACLR was calculated, and projected national prices for reimbursement were determined. Results: Of 80 ACLRs, 53 (66%) were isolated ACLRs and 27 (34%) ACLRs were combined with meniscus treatment. Mean hospital costs incurred per ACLR procedure were US$2853, with the dominant cost relating to orthopedic implant prices (US$ 1,387.80). The costs of ACLR with combined meniscus treatment were estimated as being 35% higher than isolated ACLR. The national burden of ACLR showed a total budget of US$367.4 million per 100,000 patients (0.03$ 271.3 million per 100,000 patients (0.02% of GDP) for isolated ACLR. Conclusion: ACLR procedures in Indonesia are likely underbudgeted. Adjustments of reimbursement prices for ACLR are needed to facilitate adequate access of Indonesians to the procedures. This study demonstrated varying costs determined for ACLR in Indonesia, which entails that a new reimbursement system with improvement of national prices should become the core of transformation