High ESAT-6 Expression in Granuloma Necrosis Type of Tuberculous Lymphadenitis

A granuloma is one of host cellular immune response form to intracellular and persistent pathogens, and result in the aggregation of several activated immune cells. Intracellular pathogens manipulate host immune responses to avoid immune reactions. M. tuberculosis is the intracellular and persister pathogen, which can stimulate granuloma formation. The formation this granulomas still have different opinions, whether it is the host's way to isolate M. tuberculosis, or how these pathogens are to escape immune responses. Early secretory antigenic target (ESAT)-6 is a typical secretory protein produced by the locus of the gene region of difference (RD)-1 M. tuberculosis. ESAT-6 plays a role in the immunopathogenesis of tuberculosis. This study aims to compare ESAT-6 antigen expression from M. tuberculosis between granulomas with necrosis and granulomas without necrosis. This study was an analytic observation study with a cross-sectional design. Forty-six lymph node paraffin blocks from tuberculous lymphadenitis patients in Department of Anatomical Pathology, Dr. Hasan Sadikin General Hospital, Bandung in 2017 were made in preparations and stained by hematoxylin eosin to assess the presence of necrosis in granulomas, immunohistochemical using ESAT-6 antibodies, then it was quantified using histoscore. Histoscore for ESAT-6 not normally distributed, so it uses Mann-Whitney test used. The results showed that there were 31 granulomas with necrosis (histoscore mean=27.6%) and 15 granulomas without necrosis (histoscore mean=15.1%), there was a significant difference with p<0.05 (p=0.03). The conclusion of this study there is a high histoscore ESAT-6 expression in granuloma type of necrosis tuberculous lymphadenitis.   EKPRESI ESAT-6 TINGGI PADA GRANULOMA LIMFADENITIS TUBERKULOSIS TIPE NEKROSIS Granuloma merupakan salah satu bentuk respons imun seluler pejamu terhadap patogen intraseluler. Patogen intraseluler memanipulasi respons imun pejamu untuk menghindari reaksi imun. M. tuberculosis adalah patogen intraseluler dan persister yang dapat menstimulasi pembentukan granuloma. Terbentuknya granuloma masih memberikan pendapat yang berbeda, apakah merupakan cara tubuh untuk mengisolasi M. tuberculosis atau cara patogen ini untuk menghindari respons imun. Early secretory antigenic target (ESAT)-6 adalah protein sekretori khas yang dihasilkan oleh lokus gen region of difference (RD)-1 M. tuberculosis. ESAT-6 berperan dalam imunopatogenesis tuberkulosis. Penelitian ini bertujuan menganalisis perbedaan ekspresi antigen ESAT-6 M. tuberculosis antara granuloma dengan nekrosis dan granuloma tanpa nekrosis. Penelitian ini merupakan penelitian observasi analitik dengan desain cross sectional. Blok parafin kelenjar getah bening didapat dari pasien yang didiagnosis limfadenitis tuberkulosis di Departemen Patologi Anatomi, RSUP Dr. Hasan Sadikin Bandung pada tahun 2017. Blok parafin tersebut dibuat blangko preparat dan diwarnai dengan hematoksilin eosin untuk menilai nekrosis pada granuloma serta imunohistokimia menggunakan antibodi ESAT-6. Kemudian, sediaan preparat imunohistokimia tersebut dikuantifikasi menggunakan metode histoscore sehingga didapatkan data berupa nilai skor dari pewarnaan ESAT-6. Selanjutnya, dilakukan uji beda antara histoscore granuloma dengan nekrosis dan granuloma tanpa nekrosis tersebut dianalisis karena nilai skor ESAT-6 berdistribusi tidak normal sehingga menggunakan uji Mann-Whitney. Hasil penelitian menunjukkan terdapat 31 granuloma dengan nekrosis (histoscore rerata=27,6%) dan 15 granuloma tanpa nekrosis (histoscore rerata=15,1%), serta terdapat perbedaan signifikan dengan p<0,05 (p=0,03). Simpulan, ekspresi ESAT-6 tinggi pada granuloma limfadenitis tuberkulosis dengan nekrosis

Histopathological Review of Granuloma in Diagnosis of Tuberculosis Lymphadenitis (TBL)

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis and is the second leading cause of death from an infectious disease. Indonesia has the highest TB cases in West Java, East Java, and Central Java. Tuberculosis lymphadenitis (TBL) represents about 30–40% of cases of extrapulmonary tuberculosis. The study aimed to study the clinical and histopathological characteristics of TBL patients. The research design in this study used an exploratory, descriptive method. Data was taken from Al Islam Hospital Bandung as medical records from January 2019 to December 2020. The result showed that TBL primarily affects patients aged 6–11 years (28%), male gender (57%), patients not working (25%), and those residing in the East Bandung area (34%). Histopathological appearance showed granulomas of caseous necrosis, epithelioid cells, and Langhan's cells, indicated by types 1, 2, and 3. The most common type was type 1 (47%), which was more widely distributed in the right neck (46%) with size 1–3 cm. In conclusion, the frequency of TBL is higher in boys aged 6–11 years, residents of the East Bandung area, and patients who did not work. Well-formed granuloma of enlarged lymph nodes in the right neck with size 1–3 cm is most commonly found in TBL

The Relation of Acid Fast Bacilli with Ziehl Neelsen Staining and Histopathologic Examination of Biopsy Specimens in Extrapulmonary TB Suspected Patients

Case finding and diagnosis of extrapulmonary tuberculosis (EPTB) infection are difficult to enforce in the field because not all primary services can do it. The 2016 TB Health Guidelines, the diagnosis of EPTB, is made by clinical, bacteriological, and or histopathological examination from the biopsy. This study analyzed tissue biopsy histopathologically and bacterial of acid-fast bacilli (AFB) slide stained (by Ziehl Neelsen method) associated with histopathological features in patients diagnosed with EPTB. The study conducted in the laboratory of Al Islam Hospital Bandung from November to December 2017. Histopathological diagnosis collected from 1,304 patients, with 760 noninfectious disease patients (58%), 461 infectious disease patients (35%), and 83 (7%) infectious and non-infectious patients. EPTB found in 10% of infectious disease patients. EPTB was mostly originating in neck lymph nodes (18 of 37 patients). The histopathological diagnosis of EPTB infection found that 36 of 37 patients showed granulomas (+), but AFB stained (+) found only in 6 of 37 slides. It is possible because of granulomas is a collection of several inflammatory cells. The lesions develop granulomatous defined by necrosis. There are fewer organisms that usually exist on the periphery both inside and outside the site of infection. This important immune reaction provides the body with protection from antigen recognition, very important in the case of mycobacterial infections. In conclusion, there is no relation between AFB and histopathological examination in patients with EPTB.   HUBUNGAN ANTARA BASIL TAHAN ASAM PEWARNAAN ZIEHL NEELSEN DAN HASIL PEMERIKSAAN HISTOPATOLOGI PADA PREPARAT JARINGAN BIOPSI PASIEN TUBERKULOSIS EKSTRAPARU Penemuan kasus dan diagnosis infeksi tuberkulosis ekstraparu (TBEP) sulit ditegakkan di lapangan karena tidak semua layanan primer dapat melakukannya. Berdasar atas Pedoman Kesehatan TB 2016 untuk Pengendalian TB, diagnosis TBEP dapat dilakukan dengan pemeriksaan klinis, bakteriologis, dan atau histopatologis dari biopsi. Penelitian ini menganalisis semua sediaan histopatologis dari biopsi jaringan dan menganalisis pemeriksaan bakteriologis pewarnaan basil tahan asam (BTA) (dengan metode Ziehl Neelsen) terkait dengan gambaran histopatologis pada pasien yang didiagnosis TBEP. Penelitian dilaksanakan di Laboratorium RS Al Islam Bandung dari November hingga Desember 2017. Diperoleh 1.304 pasien dengan sediaan histopatologis, diagnosis penyakit noninfeksi 760 pasien (58%), penyakit infeksi 461 pasien (35%), penyakit gabungan (infeksi dan noninfeksi) 83 pasien (7%), serta TBEP 10% dari seluruh penyakit infeksi. Sebagian besar TBEP berasal dari kelenjar getah bening leher (18 dari 37 pasien). Hasil diagnosis infeksi TBEP 36 dari 37 pasien ditemukan gambaran histopatologisnya dengan granuloma (+), tetapi dengan pewarnaan BTA (+) hanya 6 dari 37 sediaan. Hal ini mungkin karena granuloma adalah kumpulan beberapa sel inflamasi yang berkembang menjadi nekrosis sehingga lebih sedikit organisme yang biasanya terdapat di dalam maupun di luar lesi. Pembentukan granuloma merupakan reaksi kekebalan yang memberi perlindungan tubuh dari serangan antigen dalam kasus infeksi mikobakterium. Simpulan, tidak terdapat hubungan hasil pewarnaan BTA dengan pemeriksaan histopatologis pada pasien TBEP

Characteristics of Patients with Type 2 Diabetes Mellitus in Al-Ihsan Regional General Hospital

The prevalence of type 2 diabetes mellitus (T2DM) in Indonesia is high, contributing to the fourth mortality rate for non-communicable diseases in Indonesia. The population of T2DM patients spread across all provinces, including West Java, which is the most populous province in Indonesia. One of the referral hospitals in West Java is Al-Ihsan Regional General Hospital in Bandung regency. The purpose of this study was to describe the characteristics of T2DM patients who came to Al-Ihsan Regional General Hospital according to age, gender, and comorbidities parameters. It was a descriptive cross-sectional study using secondary data from medical records of T2DM patients between January 2017 and November 2020. The results were the highest prevalence and incidence of T2DM were in 2017 with as many as 5,051 and 653 respectively; the highest gender each year was female, range between 584–3,333, with the highest male: female ratio of 1:2 in 2017; the age group with the highest prevalence was 55–65 years which was 3,468 (39.53%); and top five comorbidities were hypertension (35.68%), cataracts (6.01%), osteoarthritis (3.58%), pulmonary tuberculosis (2.92%) and dyspepsia (2.91%). This study concluded that the prevalence and incidence of T2DM in Al-Ihsan Regional General Hospital were high, with the predominant female patients, elderly, and comorbid hypertension.   KARAKTERISTIK PASIEN DIABETES MELITUS TIPE 2 DI RSUD AL-IHSAN Angka kejadian diabetes melitus tipe 2 (DMT2) di Indonesia cukup tinggi, menyumbangkan angka kematian keempat penyakit tidak menular di Indonesia. Penderita DMT2 tersebar di seluruh provinsi, termasuk Jawa Barat yang merupakan provinsi terpadat di Indonesia. Salah satu rumah sakit rujukan di Jawa Barat adalah RSUD Al-Ihsan di Kabupaten Bandung. Tujuan penelitian ini adalah menggambarkan karakteristik pasien DMT2 yang datang ke RSUD Al-Ihsan dilihat dari usia, jenis kelamin, dan komorbid. Penelitian ini merupakan penelitian deskriptif cross-sectional menggunakan data sekunder berupa rekam medis pasien DMT2 periode Januari 2017 hingga November 2020. Didapatkan bahwa prevalensi dan insidensi DMT2 tertinggi pada tahun 2017 sebesar 5.051 dan 653 masing-masing; jenis kelamin terbanyak pada setiap tahun adalah wanita sebesar 584–3.333 dengan rasio pria:wanita tertinggi 1:2 pada tahun 2017; kelompok usia dengan prevalensi tertinggi adalah 55–65 tahun sebesar 3.468 (39,53%); dan lima komorbid tertinggi adalah hipertensi (35,68%), katarak (6,01%), osteoartritis (3,58%), tuberkulosis paru (2,92%), dan dispepsia (2,91%). Simpulan penelitian ini adalah prevalensi dan insidensi DMT2 di RSUD Al-Ihsan tinggi dengan pasien terbanyak wanita, lanjut usia, dan komorbid hipertensi

Impact on Medical Education and the Medical Student’s Attitude, Practice, Mental Health, After One Year of the Covid-19 Pandemic in Indonesia

Introduction: The COVID-19 pandemic has caused disruptions in educational institutions across the country, prompting medical schools to adopt online learning systems. This study aims to determine impact on medical education and the medical student’s attitude, practice, mental health after 1 year of the Covid-19 pandemic in Indonesia. Methods: This study utilized a cross-sectional design. An online questionnaire was distributed digitally to 49 medical schools in Indonesia from February–May 2021. A total of 7,949 medical students participated in this study. Sampling was carried out based on a purposive technique whose inclusion criteria were active college students. This research used questionnaires distributed in online version among 49 medical faculties that belong to The Association of Indonesian Private Medical Faculty. Instruments included demographic database, medical education status, experience with medical tele-education, ownership types of electronic devices, availability of technologies, programs of education methods, career plans, attitudes toward pandemic, and the mental health of respondents. Univariate and bivariate statistical analysis was conducted to determine the association of variables. All statistical analyses using (IBM) SPSS version 22.0. Results: Most of the respondents were female (69.4%), the mean age was 20.9 � 2.1 years. More than half of the respondents (58.7%) reported that they have adequate skills in using digital devices. Most of them (74%) agreed that e-learning can be implemented in Indonesia. The infrastructure aspects that require attention are Internet access and the type of supporting devices. The pandemic also has an impact on the sustainability of the education program. It was found that 28.1% were experiencing financial problems, 2.1% postponed their education due to this problems. The delay of the education process was 32.6% and 47.5% delays in the clinical education phase. Around 4% student being sick, self-isolation and taking care sick family. the pandemic was found to affect students’ interests and future career plans (34%). The majority of students (52.2%) are concerned that the pandemic will limit their opportunities to become specialists. Nearly 40% of respondents expressed anxiety symptoms about a variety of issues for several days. About a third of respondents feel sad, depressed, and hopeless for a few days. Results: Most of the respondents were female (69.4%), the mean age was 20.9 � 2.1 years. More than half of the respondents (58.7%) reported that they have adequate skills in using digital devices. Most of them (74%) agreed that e-learning can be implemented in Indonesia. The infrastructure aspects that require attention are Internet access and the type of supporting devices. The pandemic also has an impact on the sustainability of the education program. It was found that 28.1% were experiencing financial problems, 2.1% postponed their education due to this problems. The delay of the education process was 32.6% and 47.5% delays in the clinical education phase. Around 4% student being sick, self-isolation and taking care sick family. the pandemic was found to affect students’ interests and future career plans (34%). The majority of students (52.2%) are concerned that the pandemic will limit their opportunities to become specialists. Nearly 40% of respondents expressed anxiety symptoms about a variety of issues for several days. About a third of respondents feel sad, depressed, and hopeless for a few days. Conclusion: The infrastructure and competency of its users are required for E-learning to be successful. The majority of medical students believe that e-learning can be adopted in Indonesia and that their capacity to use electronic devices is good. However, access to the internet remains a problem. On the other side, the pandemic has disrupted the education process and mental health, with fears of being infected with SARSCoV- 2, the loss of opportunities to apply for specialty training, and the potential for increased financial difficulties among medical students. Our findings can be used to assess the current educational process in medical schools and maximize e-learning as an alternative means of preparing doctors for the future. Keywords: COVID-19, e-learning, Indonesia, medical education, student