Asosiasi Positivitas Nontuberculous Mycobacteria Dengan Derajat Keparahan Pasien Tuberkulosis Paru

Purpose:The research aims to detect a positive association between Non tuberculous Mycobacteria and the severity of pulmonary Tuberculosis patients and to find out what spesies of NTM is detected in patients with pulmonary TB. Method: This study was conducted 40 isolat Mycobacteria at laboratory Clinical Microbiology Soetomo Hospital from patient TB .Colonies were then examined using immunochromatographic antigen MPT 64, then a molecular test was performed using PCR and sequencing. Result: The result showed from 40 samples were used, 20 isolatwere NTM and 20 M.tuberculosis complex. Sequencing of 20 samples were positive by PCR 116SrRNA, and detected Mycobacterium kansasii (30%), Mycobacterium gordonae (5%), Mycobacterium parascrofulaceum (2,5%), Mycobacterium simiae (2,5%) Mycobacterium avium (2,5%), Mycobacterium terrae(2,5%). Clinical severity by Bandim TB score from patients medical record showed asignificant assosiation between positivity of NTM detection and the severity among Tuberculosis patients , with p value =0,03. Conclusion:This finding suggest that NTM infection detection is associated with disease severity of pulmonary TB.. Key word: Nontuberculous Mycobacteria, Severity Class, Tuberculosi

Profile of Mycolic Acid Cleavage Products of Isoniazid Resistant Mycobacterium tuberculosis Isolate By Gas Chromatography-Mass Spectrometry

Mycolic acid cleavage products (MACPs) profile of Mycobacterium tuberculosis (MTB) which is resistant to isoniazid (INH) has been studied. This study describes the profile of MAs based on their cleavage products (MACPs) after esterification process, using BF3 in methanol as a catalyst, by gas chromatography-mass spectrometry detector (GC-MSD). The MACPs profile of INH resistant MTB was compared to MACPs of H37Rv strain and MACPs of INH sensitive MTB isolate. Objective of this study was to obtain the characteristic profile of cellular fatty acid and MACPs of INH-resistant MTB isolate using GC-MS. Samples were cultured in Middlebrook 7H10 medium for more than 21 days. MAs and cellular fatty acids were extracted with chloroform prior to esterification for 1 hour at (90-95)o C using methanolic-BF3 as a catalyst. MACPs were extracted with heptane before injected into GC-MSD. This study obtained that the profile of six characteristic peaks of cellular fatty acids and MACPs of samples of INH-resistant MTB isolate was not significantly different to the INH-sensitive MTB isolate. But, the profile of H37Rv strain was significantly different compared to both INH-resistant MTB and INH-sensitive MTB isolate

PERAN REKAM MEDIS SEBAGAI ALAT BUKTI DALAM PENYELESAIAN SENGKETA MEDIS ANTARA DOKTER DAN PASIEN

Masih banyaknya ditemukan dokter yang tidak menulis rekam medis dengan lengkap. Padahal, apabila terjadi sengketa yang akan dijadikan alat bukti utama dalam persidangan adalah rekam medis. Berdasarkan kondisi tersebut di atas, penulis tertarik untuk melakukan penelitian dengan judul peran rekam medis sebagai alat bukti dalam penyelesaian sengketa medis antara dokter dan pasien. Permasalahan yang di kemukakan adalah sebagai berikut: Bagaimana rekam medis sebagai alat bukti dalam penyelesaian sengketa medis antara dokter dan pasien? Apa saja kendala dan solusi yang timbul saat rekam medis dijadikan alat bukti dalam penyelesaian sengketa medis antara dokter dan pasien di RSUD Djojonegoro Temanggung? Bagaimana akibat hukumnya bila seorang dokter atau RS tidak mempunyai rekam medis yang baik? Metoda yang di gunakan dalam penelitian ini adalah yuridis normatif. Spesifikasi yang digunakan dalam penelitian ini bersifat deskriptif analitis. Sumber data yang di pergunakan dalam penelitian ini adalah data sekunder sebagai data utama dan data primer sebagai data pendukung. Hasil penelitian dan pembahasan tentang peran rekam medis dapat dijadikan sebagai alat bukti surat maupun keterangan ahli. Kendala yang timbul adalah belum pernah dilakukannya sosialisasi oleh pihak RS, sanksi yang diberikan kurang tegas serta tidak dilakukan pembinaan dan pengawasan tentang rekam medis secara rutin. Adapun solusi untuk mengatasi hal tersebut adalah dilakukan sosialisasi kepada seluruh pegawai RS, pemberian sanksi yang tegas serta diberikan pembinaan dan pengawaan secara rutin. Akibat hukum kepada dokter yang tidak membuat rekam medis adalah mendapatkan sanksi  baik sanksi pidana, perdata atau administrasi

In Vitro Test: Antimicrobial Activity Potential From Ciplukan Fruit (Physalis minima L.) Extract in Methicillin-resistant Staphylococcus aureus (MRSA)

In Indonesia, in 2006 the prevalence of infections due to MRSA was 23.5%. Physalis minima L. plants are known to have antimicrobial activity because they contain compounds withaferin A which can induce programmed cell death. This research was to determine the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of Ciplukan (Physalis minima L.) extract in Methicillin-resistant Staphylococcus aureus (MRSA) bacteria. Dilution test with Mueller-Hinton broth medium used for measuring the minimum inhibitory concentration (MIC). Ciplukan  fruit extract was dissolved in distilled water, and poured into a test tube with a certain concentration (0.9 g/mL (90%); 0.3 g/mL (45%); 0.15 g/mL (22.5%); 0.075 g/mL (11.25%) and 0.0375 g/mL (5.625%). After being incubated for 24 hours, the bacteria in the test tube were plated on nutrient agar plates, to determine the MBC. The MIC cannot be determined, because the solution in the dilution test tube is disturbed by the color of the extract so that turbidity cannot be observed. From the observations of the minimum bactericidal concentration MBC of the Ciplukan (Physalis minima  L.) fruit extract against MRSA was in the P1 tube or equivalent to 0.9 g / ml (90%).Abstract  In Indonesia, in 2006, the prevalence of infections due to MRSA was 23.5%. Physalis minima L. plants are known to have antimicrobial activity because they contain compounds withaferin A, which can induce programmed cell death. This research was to determine the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of Ciplukan (Physalis minima L.) extract in Methicillin-resistant Staphylococcus aureus (MRSA) bacteria. Dilution test with Mueller-Hinton broth medium used for measuring the minimum inhibitory concentration (MIC). Ciplukan  fruit extract was dissolved in distilled water, and poured into a test tube with a certain concentration (0.9 g/mL (90%); 0.3 g/mL (45%); 0.15 g/mL (22.5%); 0.075 g/mL (11.25%) and 0.0375 g/mL (5.625%). After being incubated for 24 hours, the bacteria in the test tube were plated on nutrient agar plates to determine the MBC. The MIC cannot be determined, because the medium in the dilution test tube is disturbed by the color of the extract so that turbidity cannot be observed. From the observations of the minimum bactericidal concentration, MBC of the Ciplukan (Physalis minima  L.) fruit extract against MRSA was in the P1 tube or equivalent to 0.9 g / ml (90%).Keywords             : Physalis minima L., Antimicrobial, Ciplukan, Methicillin-resistant Staphylococcus aureus, Withaferin ACorrespondence   : [email protected]

Ko-infeksi asimptomatik helminthiasis pada pasien tuberkulosis paru di Surabaya kota: studi pendahuluan

BACKGROUNDPulmonary tuberculosis (TB) is a leading cause of morbidity and mortality, and East Java province is the second largest contributor of co-infection in Indonesia. Asymptomatic helminth infection among pulmonary tuberculosis patients causes another public health problem. Few data relate to helminth infection based on clinical and immunological outcomes of pulmonary TB in highly endemic areas. METHODSThis study was designed as a preliminary study and aimed to determine helminth co-infection among TB patients with a macroscopic assessment. This cross-sectional study was conducted in June-August 2017. RESULTSAmong 16 treated active TB patients from TB cohort data of Tanakali Kedinding health center found that 56% were stool smear-positive for Trichuris trichiura eggs, but had no clinical symptoms. CONCLUSIONWhether or not the helminth infection may have an impact on the diagnosis and treatment of active TB remains to be further investigated. Co-infection could be inhibited by the host immune response and improve the prognosis of TB treatment.LATAR BELAKANGPenyakit tuberculosis paru (TB) hingga saat ini masih menjadi penyebab utama tingginya angka morbiditas dan mortalitas, dan propinsi Jawa Timur termasuk penyumbang penderita kedua terbanyak di Indonesia. Hanya sedikit data informasi diketahui terkait infeksi kecacingan yang terjadi pada penderita TB baik secara klinis dan imunologi pada daerah endemis. METODEStudi ini di desain sebagai studi awal dan bertujuan untuk menilai ko-infeksi kecacingan diantara penderita TB. Studi potong-lintang ini dilakukan pada bulan Juni-Agustus 2017.HASILEnam belas penderita aktif TB berdasarkan data kohort tuberkulosis Puskesmas Tanakali Kedinding, didapatkan 56%-nya positif kecacingan dengan ditemukannya telur Trichuris trichiura.KESIMPULANWalaupun efek dari infeksi kecacingan tidak berdampak terhadap diagnosis dan pengobatan tuberkulosis, akan tetapi sebaiknya penderita yang terdeteksi sebagai tuberkulosis aktif, dilakukan skrining kecacingan terlebih dahulu. Ko-infeksi dapat dihampat oleh respon imun penderita dan meningkatkan prognosis pengobatan tuberkulosis.&nbsp

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

PREVALENCE OF DIABETES MELLITUS WITH PULMONARY TUBERCULOSIS IN DR. SOETOMO GENERAL ACADEMIC HOSPITAL, SURABAYA, INDONESIA 2016

Highlight: 1. The signs and symptoms of patients with pulmonary tuberculosis and those of diabetes mellitus were similar. 2. Male, aged 51-75 years old, and working in private sector are characteristics of most of the diabetic patients with pulmonary tuberculosis. Abstract: Background: Diabetes Mellitus is a type of disorder where the patients’ blood sugar is above average. Diabetes Mellitus can cause an abundance of comorbidities, from viral infection until metabolic abnormalities. The increased risk of infections is mostly because diabetes mellitus changes how the body works. The changes range from changes in mechanical barriers (humoral immunity) and cellular changes (cellular immunity), the changes of the humoral immunity that can increase the chance of protracting pulmonary tuberculosis. Objective: The purpose of this study was to describe the characteristics of diabetes mellitus in pulmonary tuberculosis in Dr. Soetomo General Academic Hospital, Surabaya, Indonesia from January to December 2016. Materials and Methods: The research method used was an observational study using a cross-sectional design conducted in Central Medical Record for hospitalized patients, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. The diabetes mellitus patients’ data collected from the medical records of Dr. Soetomo General Academic Hospital, Surabaya, Indonesia in 2016 were 1,410 and 11 of them were also diagnosed with pulmonary tuberculosis. The final data taken were from 67 out of 115 patients due to the incomplete medical record. Results: According to the data, the most of the diabetic patients with pulmonary tuberculosis were male, age of 51-75 years old, and worked in private sector. Conclusion: There was a significantly higher number of diabetes mellitus with pulmonary tuberculosis patients in older age, males, and private-sector workers. Diabetic patients with pulmonary

Specific Gyrb Sequence of Mycobacterium Tuberculosis Clinical Isolated From Sputum of Pulmonary Tuberculosis Patients in Indonesia

Background: Indonesia have many different geographic areas which could be various on the variant strains of Mycobacterium tuberculosis. The gyrB gene codes GyrB protein as sub unit compound of Gyrase enzyme that functioning in multiplication of bacteria. Detection of gyrB gene could be a marker of active multiplication of viable bacteria in the specimen from patients; and some of the DNA sequence regions were conserved and specific in the strain of Mycobacterium tuberculosis that would be a marker for identification. This research aims to analyze the sequence of gyrB gene of Mycobacterium tuberculosis clinical isolates from sputum of pulmonary TB patients in Indonesia, and determine the specific region. Method: Mycobacterium tuberculosis clinical isolates have been collected from sputum of the patients with pulmonary TB that live in some area in Indonesia. Isolation and identification of Mycobacterium tuberculosis clinical isolates using standard culture method; sequence analysis using PCR-direct sequencing of the part bases region of gyrB. Results: this study revealed that nucleotide sequence on a fragment 764 bases of gyrB gene Mycobacterium tuberculosis strains among clinical isolates almost identically to a wild type strain Mycobacterium tuberculosis H37Rv and subspecies member of Mycobacterium tuberculosis complex (MTBC), with a little difference of SNPs; there are many difference nucleotide sequence with MOTT and Gram positive or negative bacteria, except Corynebacterium diphtheriae identically with MTBC. Conclusion: the gyrB sequence in Mycobacterium tuberculosis strains among these clinical isolates from sputum of pulmonary TB patients in Indonesia have the conserved specific DNA region that almost identically with wild type strain H37Rv and MTBC

Tuberculous Meningitis: The Microbiological Laboratory Diagnosis and Its Drug Sensitivity Patterns

Background: Tuberculosis continues one of the major challenges to global health. Mycobacterium tuberculosis complex can affect any organ other than the lung parenchyma, include central nervous system. The mortality rate of tuberculous meningitis (TBM) are high worldwide with up to half of survivors suffering irreversible sequelae. Diagnosis of TBM is difficult due to paucibacillary, various clinical manifestation, and invasive procedure to appropriate specimens. Objective: The objectiveis to study the positivity rate of microbiological laboratory diagnosis and its drug sensitivity patterns of TBM patients in Dr. Soetomo Hospital Surabaya during October 2015 until September 2016. Methods: Specimens were cerebrospinal fluids. Identification and drug anti TB sensitivity test were done by BACTEC MGIT 960 system in Clinical Microbiology Laboratory Dr. Soetomo Hospital Surabaya. Result: Most patients with TBM were women (54.29%). Based on age groups, most dominant was adult population (65.71%). Proportion percentage of positive M. tuberculosis complex among 180 specimens were 19.44%. First line anti TB drug sensitivity pattern of 35 isolates were 1 monoresistant, 1 poly-resistant, no multiple drug resistant (MDR), and 33 pan-susceptible. Conclusion: Positivity rate of Mycobacterium tuberculosis complex laboratory diagnosis from TBM suspect patients were low. There was no MDR TB in this study, but mono-resistant and poly-resistant. Microbiological diagnosis was important to give information of active disease and drug sensitivity pattern. Resistance to first line anti TB drugs is alarming to properly manage TBM patients