THE SENSITIVITY TEST OF MYCOBACTERIUM TUBERCULOSIS ISOLATES FROM SUSPECT TUBERCULOSIS PATIENTS TO THE SEROMUCOUS OF SNAIL AND CHITOSAN AS AN ALTERNATIVE ANTI-TUBERCULOSIS DRUGS

Objective: The purpose of this research is to study the sensitivity of Mycobacterium tuberculosis (MTB) isolates from suspect TB patients to seromucous of snail and chitosan as an alternative to anti-TB drugs. Methods: The research methods include management specimen, freeze-drying of snail seromucous; formulation of dosage preparation; identification of MTB isolates; and sensitivity testing of MTB isolates to snail seromucous, chitosan, and streptomycin, isoniazid, rifampicin, and ethambutol (SIRE). Results: The characteristics of respondents by sex and age are the majority of male respondents and productive adult age that is 26 years–52 years. MTB isolates used in the study were obtained from the results of the screening of sputum samples of suspect TB patients through microscopic smear examination and molecular rapid test using GeneXpert tools. MTB isolates in patients suspect TB are resistant against seromucous of snails and chitosan that it is compared with SIRE. The dosage of snail seromucous is 8000 mg/l, chitosan 2% is 800 mg/l, and SIRE, respectively (rifampicin 8000 mg/l, isoniazid 20 mg/l, ethambutol 200 mg/l, streptomycin 800 mg/l). Conclusion: MTB isolates from patients suspect who TB is resistant to seromucous of snail (8000 mg/l) and chitosan (800 mg/l)

The Potential and Effectiveness of Snail Seromucoid and Chitosan as Bioimmunostimulators

The host's cellular immune response plays an important role in the process of eliminating microorganisms that cause infection. Substances that can stimulate an increase in the immune response are called immunostimulators. Snail seromucoid contains bioactive compounds such as glycans, peptides, glycopeptides and chondroitin sulfate. Chitosan as an antimicrobial agent can be used in the biomedical field because chitosan has a number of hydroxyl groups (OH) and amine groups (NH2). The research objective was to determine the potency and effectiveness of snail seromucoid and chitosan as bioimmunostimulators. The research method is based on laboratory experimental results with the research stages, namely the analysis of the effectiveness of seromucoid and chitosan on lymphocyte proliferation. The results of the one way ANOVA analysis showed a p value of 0.000 so that there was a significant effect between the treatment groups, namely the effect of giving chitosan 65 ug/ml; snail mucus 65 ug/mL and a combination of chitosan (65 ug/mL) and snail mucus (65 ug/mL) ratio of 1:1, can increase lymphocyte proliferation optimally. This shows that snail mucus, chitosan and their combination in a 1:1 ratio are effective as BRM (Biological Response Modifier). It is hoped that the contribution of the results of this study can be further developed in the bioformulation of snail seromucoid preparations and chitosan as therapeutic agents for infectious diseases, including Acute Respiratory Distress Syndrome (ARDS), Tuberculosis and other diseases.The host's cellular immune response plays an important role in the process of eliminating microorganisms that cause infection. Substances that can stimulate an increase in the immune response are called immunostimulators. Snail seromucoid contains bioactive compounds such as glycans, peptides, glycopeptides and chondroitin sulfate. Chitosan as an antimicrobial agent can be used in the biomedical field because chitosan has a number of hydroxyl groups (OH) and amine groups (NH2). The research objective was to determine the potency and effectiveness of snail seromucoid and chitosan as bioimmunostimulators. The research method is based on laboratory experimental results with the research stages, namely the analysis of the effectiveness of seromucoid and chitosan on lymphocyte proliferation. The results of the one way ANOVA analysis showed a p value of 0.000 so that there was a significant effect between the treatment groups, namely the effect of giving chitosan 65 ug/ml; snail mucus 65 ug/mL and a combination of chitosan (65 ug/mL) and snail mucus (65 ug/mL) ratio of 1:1, can increase lymphocyte proliferation optimally. This shows that snail mucus, chitosan and their combination in a 1:1 ratio are effective as BRM (Biological Response Modifier). It is hoped that the contribution of the results of this study can be further developed in the bioformulation of snail seromucoid preparations and chitosan as therapeutic agents for infectious diseases, including Acute Respiratory Distress Syndrome (ARDS), Tuberculosis and other diseases

The potential of snail seromucous and chitosan as bioimunomodulator for tuberculosis therapy

Tuberculosis (TB) as a global emergency is a chronic disease caused by Mycobacterium tuberculosis (Mtb). Mtb plays an important role in inducing or suppressing the production of Interferon Gamma (IFNG) and IL-4 in the regulation of TB homeostasis and pathogenesis. The bioactive compounds of the snail seromucous (Achatina fulica Ferussac) and chitosan function as biological response modifiers. The study aimed to determine the potential effectiveness of snail seromucous and chitosan as bio-immunomodulator for TB therapy. The research method was based on the results of laboratory experiments with the physic-chemical, biochemical, microbiological examination, snail seromucous protein profile, lymphocyte proliferation, measurement of IFNG, and IL-4 levels. The results of the physic-chemical examination of the snail seromucous showed a specific gravity of 1.010; pH 8, glucose 16 mg/dL; cholesterol 9 mg/dL; protein 2.8 mg/dL and heavy metals (Pb, Cu, Hg, Al) negative. The results of microbiological tests showed that a 100% concentration of snail seromucous was antimicrobial against Staphylococcus aureus, Candida albicans, and Pseudomonas aeruginosa. The protein profile of snail seromucous shows that there are 3 protein subunits, namely the range 55 - 72 kDa and 1 specific protein sub-unit 43 kDa as a bioactive compound achasin sulfate. Addition of chitosan dose of 65 μg/mL; snail seromucous dose of 65 μg/mL and a mixture of chitosan (65 μg/mL): snail seromucous (65 μg/mL) ratio 1: 1, can increase lymphocyte proliferation; optimum levels of IFN-γ and IL-4. Snail seromucous and chitosan are effective immunomodulators and potential candidates for TB therapy

Videogame assisted exercise training in patients with chronic obstructive pulmonary disease: A preliminary study

Background: Exercise training is key to the comprehensive management of patients with chronic obstructive pulmonary disease (COPD). Interactive game-based systems have been proposed to improve effectiveness and compliance with exercise training. Aim: To evaluate the effectiveness of Wii Fit balance board as an additional tool for exercise training in patients with COPD. As a secondary aim we will evaluate the costs. Methods: In a randomized controlled trial, patients were divided into experimental (EG) and control (CG) groups. The CG performed exercise training on a cycle ergometer three times a week for 6 weeks. The EG also followed a program (yoga, strength training, aerobic exercise) using the Wii Fit system. Pre and post treatment six-minute walking distance (6MWD) test, transitional dyspnea index (TDI), the Medical Research Council (MRC) score the Saint George's Respiratory Questionnaire (SGRQ), the body max index, airflow obstruction, dyspnea, and exercise capacity index (BODE) were assessed. Results: The 6MWD increased from 410.7 (105.3) to 477.5 (122.4) and from 376.6 (81.0) to 420 (77.6) meters, in CG and EG respectively, p = 0.0001 without any difference between groups. Both groups experienced significant improvements in TDI and SGRQ, but not in MRC and BODE, without any significant difference between groups. Conclusion: A Wii Fit balance board based video game program was feasible but did not add any benefit to a well conducted standard exercise training program in patients with COPD. Keywords: Pulmonary rehabilitation, Interactive videogame, Health related quality of life, Dyspnea, Exercise trainin

Is Docetaxel the Main Therapy for Lung Metastasis in Granular Cell Tumors?

Introduction: A granular cell tumor is a rare neoplasm originating from mesenchymal tissue. Malignant granular cell tumors have a poor prognosis. The lung is one of the target organs for metastatic malignant granular cell tumors. The number of rare cases makes managing metastatic malignant granular cell tumors unknown. Case: A 19-year-old male complained of shortness of breath for two months. A liver nodule biopsy revealed poorly differentiated carcinoma metastases. Histopathology of the left manus and frontal masses found granular cell tumors—negative immunohistochemistry on S-100 and myogenin. Ki-67 obtained a value of 5%. An X-ray and contrast multislice computerized tomography (MSCT) scan showed multiple metastatic nodules. Right bronchial biopsy forceps revealed a metastatic granular cell tumor. The patient was given docetaxel for six cycles. During the post-administration of docetaxel, the patient experienced clinical and radiological improvement. Conclusion: Until 2016, only three case reports of S-100 negative granular cell tumors existed. A negative S-100 test does not rule out the diagnosis of granular cell tumors. Malignant lesions are more common in males, as in this case. The number of rare cases means that management cannot be determined. Reports of similar cases show patients surviving up to 11 years with docetaxel administration. The patient in this study has survived for one year and is complaint-free

Pengaruh Faktor Risiko terhadap Waktu Timbulnya Efek Samping Kanamisin pada Tuberkulosis Resistan Obat

Kanamisin adalah obat untuk terapi tuberkulosis resistan obat (TB RO) yang menimbulkan efek samping gangguan pendengaran, gangguan fungsi ginjal, dan gangguan elektrolit terutama hipokalemia. Penelitian bertujuan menilai kesintasan waktu timbulnya efek samping dan pengaruh faktor risiko usia, riwayat terapi streptomisin serta berat badan terhadap efek samping akibat pemberian kanamisin pasien TB RO. Penelitian kohort retrospektif dari data rekam medis pasien TB RO dari Januari 2011 sampai April 2017 di RSUD Dr. Moewardi Surakarta. Analisis pengaruh faktor risiko terhadap efek samping menggunakan uji cox regression. Dari 238 pasien didapatkan gangguan pendengaran 143 pasien, gangguan fungsi ginjal 147 pasien, dan hipokalemia 169 pasien. Usia lebih dari 40 tahun hazard ratio (HR) 2,419 (IK: 95%; 1,716–3,409; p= 0,000) dan jenis kelamin perempuan HR: 1,549 (IK: 95%; 1,089–2,202; p= 0,015) berisiko terjadi gangguan pendengaran. Usia lebih dari 40 tahun HR: 1,892 (IK: 95%; 1,353–2,646; p= 0,000) dan jenis kelamin perempuan HR: 1,667 (IK: 95%; 1,179–2,357; p= 0,004) berisiko terjadi gangguan fungsi ginjal. Riwayat streptomisin sebelumnya dan indeks massa tubuh (IMT) tidak berisiko timbul efek samping akibat pemberian kanamisin. Pengawasan ketat timbulnya efek samping gangguan pendengaran dan gangguan fungsi ginjal pasien usia lebih dari 40 tahun dan perempuan pada pengobatan TB RO. Kata kunci: Efek samping, gangguan fungsi ginjal, gangguan pendengaran, kanamisin, TB resistan oba

Para-aortic and Meningitis Tuberculosis: A Case Report

Background: In 2018, Indonesia was in third place as the country with the highest incidence of tuberculosis (TB) in the world. In addition to pulmonary TB, extrapulmonary TB cases are also quite large. Lymphadenitis of the aortic TB can cause a fatal risk if not treated immediately. This study aimed to explore the para-aortic and meningitis tuberculosis case in Klaten Hospital, Central Java.Case presentation: There was a 24-year-old woman with complaints of missing chest pain for 2 months, fear of seeing light (photophobia), and decreased consciousness. The patient was a referral from Klaten Hospital with a diagnosis of a mediastinal tumor. The chest radiograph shows a picture of homogeneous opacity in the anterior mediastinum. Bronchoscopy results show compression stenosis in 1/3 distal and blunt carina. After a sternotomy, it was obtained pus (pus) and tissue granuloma in the area of the aorta. After the rapid molecular test was carried out, the results showed that M tuberculosis detected. The results of histopathology of anatomical pathology show epitheloid tubercle and Datia Langhans cells that suggest an infection with M. tuberculosis. Therapy was done by giving a standard anti-tuberculosis drug, namely Rifampicin 450 mg, INH 300 mg, Ethambutol 1000 mg, and Pyrazinamide 1000 mg. The patient's condition improved marked by weight gain in 2 months.Conclusion: In the case of pulmonary masses (mediastinal tumors), we need to be aware of the possibility of cases of TB lymphadenitis because Indonesia is a country with a high prevalence of TB. This is because a slow diagnosis can lead to life-threatening conditions Keywords: Tuberculosis, para aorta lymphadenitis, meningitis TB, tumor mediastinum, sternotomyCorrespondence: Reviono. Department of Pulmonology and Medical Respiration, Universitas Sebelas Maret Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: [email protected]. Mobile: +6281­8474671.Indonesian Journal of Medicine (2019), 4(3): 201-210https://doi.org/10.26911/theijmed.2019.04.03.0

THORACIC CT-SCAN WITH EGFR MUTATIONS IN PULMONARY ADENOCARCINOMA PATIENTS WITH PULMONARY METASTASES AT DR. MOEWARDI HOSPITAL, SURAKARTA, INDONESIA

Highlights • The thoracic CT scan can be an alternative evaluation before administering EGFR-targeting medicine to patients. • EGFR is now a therapeutic target for lung cancer.   Abstract Background: EGFR mutation is one of the molecular markers associated with prognosis and therapy in lung adenocarcinoma patients, including with lung metastases. The predominant imaging modality for assessing lung cancer is a chest CT scan, which correlates with prognosis. Objective: This study aimed to explore the association between characteristics of lung adenocarcinoma based on chest CT-Scan and EGFR mutation in lung adenocarcinoma with lung metastases. Material and Method: This study involved 65 lung adenocarcinoma patients in Dr. Moewardi Hospital, Surakarta, Indonesia, from January 2018-December 2020. Result: Chest CT-Scan and EGFR mutation were assessed in all subjects. EGFR mutation was found in 32 (49.8%) subjects. The risk of EGFR mutation was found to be higher in patients with lung adenocarcinoma who had lung metastases in a peripheral location (OR=11.56; 95%CI 3.57-37.33; p<0.001), tumor size <4 cm (OR=8.00; 95%CI 2.64-24.22; p<0.001), and semi-solid density (OR=5.21; 95%CI 1.79-15.19; p=0.002). Conclusion: EGFR mutation is associated with tumor location, size, and thickness based on chest CT-Scan in lung adenocarcinoma with lung metastases patients

The Impact of the COVID-19 Pandemic on the Resistance Level of Mycobacterium Tuberculosis in Suspected Tuberculosis Patients at the Surakarta Central General Hospital

Background: Analysis of the impact of the Covid-19 pandemic on the resistance level of Mycobacterium tuberculosis (MTb) isolates to Anti Tuberculosis Drugs (ATD) needs to be carried out considering the level of MTB resistance is an important factor in the occurrence of Multidrug-Resistant TB (MDR-TB) in Indonesia. The purpose of the study was to analyze the impact of the Covid-19 pandemic on the level of resistance of MTb isolates of patients with suspected TB in Surakarta.Subjects and Method: This research is a quantitative descriptive study with a retrospective Cohort based on the medical record data of suspected TB patients  at Surakarta Central General Hospital in 2020 – 2021. The sampling technique was random sampling with a total of 200 samples each year. Data analysis used the SPSS 21 program.Results: Characteristics of respondents with suspected TB patients who visited the Surakarta Central General Hospital in 2020 and 2021, mostly in men and occurring in productive ages 36-55 years. The most effective type of ATD against MTb isolates is Rifampicin with a mean rank of 6.00 and a p=0.035. While Ethambutol is ineffective as an ATD with a mean rank of 58.00 and a p<0.001. The results of the Wilcoxon test analysis showed  there was a significant difference in the level of resistance or sensitivity of MTb isolates in 2020 and 2021 with a p-value=0.000.Conclusion: There is a significant effect of the impact of the Covid-19 pandemic on the level of resistance or sensitivity of MTb isolates of patients with suspected TB in the Surakarta area in 2020 and 2021.Keywords: pandemic, Covid-19, resistance, MTb isolates, ATDCorrespondence: Yusup Subagio Sutanto. Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: [email protected]. Mobile: +62811284165.Indonesian Journal of Medicine (2022), 07(01): 28-38https://doi.org/10.26911/theijmed.2022.07.01.0