Terapi Tuberkulosis dengan intervensi jalur kematian makrofag

Jumlah kasus tuberkulosis (TB) dan jumlah kematian TB tetap tinggi untuk penyakit yang bisa disembuhkan. Defisiensi vitamin D sering didapatkan pada pasien TB. Hal tersebut dikarenakan stimulasi Toll-like receptor 2/1 oleh antigen Mycobacterium tuberculosis menginduksi enzim CYP27B I untuk mengubah vitamin D menjadi bentuk akhir. Jadi jika asupan vitamin D pada pasien TB tidak terjaga, akan terjadi kekurangan vitamin. Patogenesis tuberkulosis paru berkaitan erat dengan Stres oksidatif. Suplementasi antioksidan akan sangat bermanfaat untuk meningkatkan evektivitas terapi. Astragaloside 4, antioksidan yang poten, berinteraksi dengan NF-KB inhibitor (he8) dan subunit p65 NF-KB. Astragalus membranaceus adalah keluarga Leguminosae (kacang-kacangan). Senyawa aktif Astragalus a.1 astragaloside 4 (Ast4). Mencit yang diinfeksi M. tuberculosis dibagi secara acak menjadi kelompok yang menerima terapi obat anti tuberkulosis (OAT) saja, kelompok yang menerima OAT dan suplementasi astragaloside 4, kelompok yang menerima OAT dan suplementasi vitamin D, serta kelompok yang Imenerima OAT, kombinasi suplementasi astragaloside 4 dan vitamin D. Penelitian tahun pertama menganalisis tentang 2 jalur kematian makrofag terinfeksi TB, didapatkan hasil bahwa suplementasi vitamin D berperan penting pada peningkatan ekspresi CYP27BI dan autofagi. Vitamin D diperlukan untuk menurunkan MMP9. Kombinasi suplementasi astragaloside 4 dan vitamin D diperlukan untuk menurunkan nekrosis makrofag. Nekrosis sel memungkinkan bakteri menyebar dan menginfeksi sel baru. Penelitian tahun ke-2 menganalisis pengaruh suplemenlasi Ast4 dan atau vitamin D terhadap stres retikulum endoplasmik pada TB khususnya jalur PERK-ATF4-CHOP dengan mengukur ekspresi GRP78, PERK, activating transcription factor (ATF4) dan CCAAT/enhancer binding protein (C/EBP) homologous protein (CHOP). Kesimpulan penelitian untuk menurunkan ekspresi GRP78, PERK, ATr4 dan CHOP perlu kombinasi suplementasi vitamin D dan Ast4. Seperti diketahui kolesterol dan asam lemak pada tubuh inang dikatabolisme M. tuberculosis untuk sumber energi dan menyusun vegetatifnya seperti asam mikolat. Peroksidasi lipid mcmperberat kerusakan jaringan paru dengan menambah stres oksidatif. Penelitian tahun ke-3 menganalisis peran sinyal antioksidan dalam hal ini Ast4 dan atau vitamin D terhadap homeostasis redoks pada tuberculosis. Kesimpulan penelitian suplementasi astragalosida 4 pada OAT mcningkalkan ekspresi superoksida dismutase (SOD) endogen, suplementasi vilamin D pada OAT meningkatkan aktivitas glutathione peroxidase (GPx), suplementasi Astragaloside 4 pada OAT dapat menurunkan malondialdehida (MDA), dan suplementasi vitamin D menurunkan ekspresi I-Isp70

Ence Of ESBL Bacteria In Baby Box Handle At Dr. Soetomo Hospital

Health Associated Infection (HAI) in neonates can increase neonatal infection risk, which is a fairly frequent cause of neonatal death. Microorganisms that are quite often found to contaminate include gram-negative bacteria such as Escherichia coli and Klebsiella pneumoniae. Gram-negative bacteria are also quite often found to have resistance to antibiotic therapy that is usually given, especially actlactam, and will increase the degree of disease to mortality, this bacterium is called ESBL. The study was conducted to determine the level of ESBL bacterial contamination in health facilities at Dr. Soetomo general hospital. Swabs are taken and biochemical tests were done to identify pathogen species. These isolates were also tested for ESBL production by the double-disc synergy test (DDST). There were 30 samples that contaminate the handle of the baby box, 2 of which (6.67%) tested positive for ESBL. With good hand hygiene, the use of disinfectants in medical devices, floors, walls, and doors, maintenance and replacement of tap water filters, and regular monitoring can reduce the number of bacterial contamination

The Prevalence of Candidiasis Oris, Tuberculosis, and Anemia in Hospitalized HIV Patients Admitted in Dr. Soetomo General Hospital, Surabaya, Indonesia

Introduction: HIV infection attacks the immune system, thus making a person vulnerable to various secondary diseases. Various secondary infections trigger systemic endothelium activation and lead to sepsis. Comorbid diseases cause high morbidity and mortality rates in HIV patients. This study aims to determine the prevalence of secondary diseases in HIV patients. Methods: Analytic and descriptive study with crossectional study design. Data were obtained from medical records of hospitalized patients at RSUD Dr. Soetomo Surabaya from August 2019 - February 2020. Results: Patients are dominated by the 30-39-year-old age group (48.8%) with male gender (69.4%), high school graduates (69.4%), private employees (44.7%), Muslim (90.3%), married (53.1%), CD4 <100 cells/µL(28.1%). From 392 patients, there were 46 2-time inpatients, seven 3-time inpatients times, and four 4-time inpatients, which brings a total of 320 HIV patients during the inclusion period. The highest prevalence of secondary disease was candidiasis oris (56.3%), tuberculosis (40.9%), and anemia (39.7%). There was association between age to complications (p= 0.042) and CD4 counts to complications (p= 0.022). Conclusion: HIV patients with CD4 counts of less than 200 cells / µL are very susceptible to various secondary diseases

Polymerase Chain Reaction of Mycobacterium tuberculosis GYRB Gene Region for Rapid Screening Tes of Pumonary Tuberculosis

gyrB gene of Mycobacterium tuberculosis have conserved and specific DNA region with high copy number. Primer base in conserved and specific DNA region increases the accuracy of nucleic acid amplification method. Determining of tuberculosis diagnosis accurately and rapidly would be useful to appropriately determine the therapy. The objective of this study was to determine sensitivity and specificity of the PCR of gyrB gene region to detect Mycobacterium tuberculosis compared with gold standard method using Lowenstein Jensen (LJ) medium. Thirty sputum samples from pulmonary Tuberculosis suspects were examined using standard culture method in LJ medium and PCR gyrB gene region. Using PCR we positively found gyrB gene region of Mycobacterium tuberculosis in 21 sputum samples, similar to that if we used the gold standard method, with 100% sensitivity and 100% specificity. In conclusion, PCR of Mycobacterium tuberculosis gyrB gene region has a high accuracy, a rapid screening method for TB laboratory diagnosi

IN VITRO ANTIBACTERIAL ACTIVITY OF EUCALYPTUS (Melaleuca leucadendra) OIL AGAINST METHICILLIN-RESISTANT Staphylococcus aureus (MRSA)

Highlights • The use of eucalyptus oil is natural and risk-free. It has a lengthy history of use as a traditional medicine in Asia, including Indonesia. • It has been demonstrated that eucalyptus oil possesses antibacterial activity against MRSA, and this activity was controlled by the oil's concentration. Abstract Background: Eucalyptus (Melaleuca leucadendra) oil is used by Indonesians as an herbal medicine. Eucalyptus containing 1,8-cineol at 72.30% is expected to be used as an antibacterial.  Objective: The study aimed to assess the antibacterial activity of eucalyptus oil against Methicillin-resistant Staphylococcus aureus (MRSA) bacteria in vitro. Material and Method: The materials used were eucalyptus oil (M. leucadendra) in various concentrations with ethyl acetate as solvent. The research method used was the agar-well diffusion assay. The MRSA was suspended to 0.5 McFarland turbidity. The MRSA suspension was thoroughly swabbed onto the surface of the Mueller-Hinton agar plate. The wells were made with a diameter of 0.6 mm on Muller-Hinton agar aseptically and 100 µl of eucalyptus oil was put into the well using a micropipette and incubated for 24 hours at 37°C. The diameter of the inhibition zone was measured with a caliper. Statistical analysis using the SPSS software edition 23. Result: Eucalyptus oil solution starting from a concentration of 10% to 100% had an antibacterial response, which could be seen by the formation of a bacterial inhibition zone around the eucalyptus oil (M. leucadendra) wells. The inhibition ability of eucalyptus oil against MRSA bacteria was greatest at a concentration of 90% with an inhibition zone of 31.26 mm. It was found that the concentration of eucalyptus oil affected the diameter of the bacterial inhibition area. Conclusion: Eucalyptus oil has been shown to have antibacterial activity against MRSA and was influenced by the concentration of the oil

Profile of Tinea Corporis and Tinea Cruris in Dermatovenereology Clinic of Tertiery Hospital: A Retrospective Study

Background: Tinea corporis and cruris are dermatophytes that infect the skin, and they are caused by Trichophyton sp., Microsporum sp., and Epidermophyton sp. Dermatophyte fungal-infect keratin-containing skin classified by the body’s location, such as tinea corporis (skin besides haired area, body, hands, or feet) and tinea cruris (groin & perineal region). Purpose: To evaluate the clinical profiles and treatments of tinea corporis and cruris at Dermatology and Venereology (DV) outpatient clinic Dr. Soetomo General Academic Hospital in 2018. Methods: A retrospective-descriptive study based on medical records of DV outpatient clinic Dr. Soetomo General Academic Hospital, Surabaya. Data collected from August to December 2019. Tinea corporis and cruris profiles evaluation based on age, sex, occupation, precipitating factors, complaints, illness duration, family history, lesion’s location and description, and therapy. Result: A total of 164 patients (35 tinea corporis, 76 tinea cruris, and 53 tinea corporis and cruris), predominantly female, age 46–55 years, came treatment less-than-a-month cases, excessive sweating, itching, tinea corporis lesion’s location on the face and body, tinea cruris in  groin, tinea corporis and cruris on body and groin, erythematous macules, firm borders, active margins, scales, central healing, positive KOH 10–20% examination, miconazole cream therapy 2%, griseofulvin therapy, griseofulvin oral and ketoconazole cream 2% combination therapy. Discussion: Tinea corporis and cruris are common in females as their history and symptoms supported by the characteristics of laboratory examination, the presence of hyphae in potassium hydroxide (KOH) 10–20%. Most patients were prescribed with oral griseofulvin, especially in large lesions cases

Progress In Knowledge Of Microscopic Tuberculosis Diagnosis Laboratory Training Participants

Indonesia is the second highest tuberculosis (TB)-burden country in the world. TB affects men and women in productive ages. Early and accurate diagnosis of TB is crucial in TB management because it allows prompt treatment with appropriate regimen. Sputum smear microscopy is the most common method used in resource-limited laboratories. The aim of this study is to assess whether adult learning method with student-centered approach can improve knowledge in laboratory techniques in microscopic TB diagnosis. It was a quasi experimental research with one group pretest and posttest design. Pretest was conducted before the training started. During the training, participants attended lectures, discussion sessions, and hands-on laboratory activities. After training, participants were asked to respond to posttest. There were 33 participants of this training (n=33). Paired t-test analysis showed significant difference between pretest and posttest scores (p=6.5x10-9). Variance between pretest scores was 4.00 and variance between posttest scores were 1.34. Pearson correlation coefficient was 0.45. Regardless their level of knowledge before training, participants could achieve relatively equivalent results after training. Significant difference between pre- and post-training test scores indicated that the learning method was effective and the training could improve participants knowledge in laboratory techniques in microscopic TB diagnosis

The prevalence of diabetes mellitus among hospitalized tuberculosis positive case admitted in Hajj Hospital, Surabaya, Indonesia

Introduction: Tuberculosis (TB) is the cause of significant health and death problems worldwide. Indonesia is known as the second highest country with TB burden in the world after India. The incident of TB is further increasing in diabetes mellitus patients. Diabetes mellitus disrupts the body’s immune function; thus, patients are more susceptible to infection, including TB. The purpose of this study was to determine the prevalence of diabetes mellitus history (DM) among newly diagnosed TB patients in Surabaya. Methods: 160 patients were grouped into two groups; the first group (67 patients) was positive for TB and diabetes mellitus, and the second group (93 patients) was positive for TB only. Data were collected from TB patients based on acid-fast bacilli stain (AFB) and positive Xpert MTB/RIFF. Blood glucose level was collected from 2hrPPG, and glycated hemoglobin (HbA1c). Results: The prevalence of TB related with DM history was 42% from 55 ± 9.52 years old. Patients with TB-DM showed poor glucose blood level, their 2hrPPG was 301.43 ± 126.80 mg/dl, and the HbA1c result (> 6.5%) was 82%. The rifampicin resistant level result was not significantly different between TB and TB-DM (4.4% and 3% respectively). Conclusions: Our results highlight the incidence of DM history in TB positive patient that was hospitalized in Hajj Hospital. Therefore, it is important to monitor the prevalence of DM in TB newly diagnosed cases to assist practitioner to choose better treatment while considering the risk of DM interference

prevalence of esbl bacteria in baby box handle at dr. Soetomo hospital

Abstract Health Associated Infection (HAI) in neonates can increase neonatal infection risk, which is a fairly frequent cause of neonatal death. Microorganisms that are quite often found to contaminate include gram-negative bacteria such as Escherichia coli and Klebsiella pneumoniae. Gram-negative bacteria are also quite often found to have resistance to antibiotic therapy that is usually given, especially actlactam, and will increase the degree of disease to mortality, this bacterium is called ESBL. The study was conducted to determine the level of ESBL bacterial contamination in health facilities at Dr. Soetomo general hospital. Swabs are taken and biochemical tests were done to identify pathogen species. These isolates were also tested for ESBL production by the double-disc synergy test (DDST). There were 30 samples that contaminate the handle of the baby box, 2 of which (6.67%) tested positive for ESBL. With good hand hygiene, the use of disinfectants in medical devices, floors, walls, and doors, maintenance and replacement of tap water filters, and regular monitoring can reduce the number of bacterial contamination

Penerapan Higiene dan Sanitasi Lingkungan pada Pasien Diare Balita di Puskesmas Surabaya

Surabaya has the most cases of diarrhea in East Java, with the highest detection targets in Gading Health Center (2346 cases) and Mojo Health Center, with diarrhea cases handled by 1322 cases. This study aimed to describe hygiene and environmental sanitation in under-five diarrhea patients in the working area of Surabaya Health Center. This study used a survey method, descriptive approach, interviews, and questionnaires in October 2019-March 2020. The results showed 62,2% of under-fives ‘drinking water sources were ineligible, 86,5% of mothers’ handwashing behavior were ineligible, 67,6% of the use of serving hoods were ineligible, 100% of food ripeness level were eligible, 59,5% of the distance between well and septic tank were eligible, 100% of latrines were eligible, 89,2% of sewerages were ineligible, and 83,8% of waste disposal facilities were ineligible. This research concluded that drinking water sources, handwashing behavior, serving hoods, sewerages, and waste disposal facilities were ineligible. The problems can be solved by consuming branded gallons of water / well water or refillable water that is boiled before consumption, improving how to wash hands with soap and running water, covering food using a serving hood, use the cover to close the sewerage, and throwing the trash into the temporary shelter (TPS) as much as two times a week or less than 3x24 hours.Kota Surabaya memiliki kasus diare terbanyak di Jawa Timur dengan target penemuan terbanyak di Puskesmas Gading sebanyak 2346 kasus dan Puskesmas Mojo dengan kasus diare ditangani sebanyak 1322 kasus. Tujuan penelitian ini adalah mengetahui gambaran higiene dan sanitasi lingkungan pasien diare balita di wilayah kerja Puskesmas Surabaya. Penelitian ini menggunakan metode survei, pendekatan deskriptif, wawancara dan kuesioner pada bulan Oktober 2019-Maret 2020. Hasil penelitian menunjukkan 62,2% sumber air minum balita tidak memenuhi syarat, 86,5% perilaku cuci tangan ibu tidak memenuhi syarat, 67,6% penggunaan tudung saji tidak memenuhi syarat, 100% kematangan makanan memenuhi syarat, 59,5% jarak sumur dengan septic tank memenuhi syarat, 100% jamban memenuhi syarat, 89,2%, saluran pembuangan air limbah tidak memenuhi syarat, dan 83,8% sarana pembuangan sampah tidak memenuhi syarat. Simpulan penelitian ini adalah sumber air minum, perilaku cuci tangan, penggunaan tudung saji, saluran pembuangan air limbah, dan sarana pembuangan sampah masing- masing tidak memenuhi syarat. Permasalahan tersebut dapat diatasi dengan mengonsumsi air galon bermerk/air sumur atau air isi ulang yang direbus sebelum dikonsumsi, memperbaiki cara mencuci tangan dengan sabun dan air mengalir, menutup makanan dengan tudung saji, memasang penutup untuk saluran pembuangan air limbah, dan membuang sampah ke TPS sebanyak 2 kali dalam seminggu atau kurang dari 3x24 jam. &nbsp