Role of Risk Factors in the Incidence of Multidrug-Resistant Tuberculosis

Objective: To determine the risk factors that played roles in the incidence of multidrug-resistant tuberculosis (MDR-TB) in such patients. Multidrug-Resistant Tuberculosis is a form of tuberculosis caused by Mycobacterium tuberculosis that is resistant to at least isoniazid and rifampicin.Methods: This was a case control study to compare MDR-TB to non-MDR-TB pulmonary tuberculosis outpatients in Dr. Hasan Sadikin General Hospital, Bandung on August–September 2014. Fifty MDR-TB outpatients were included as the cases and 50 non-MDR-TB outpatients as controls. Data was collected by questionnaires and patient’s registration forms. Bivariate and multivariate analyses were performed using chi-square test and multiple logistic regression test, with p<0.05 considered significant. Results: From bivariate analysis, number of previous tuberculosis treatments, regularity of previous treatment, and burden of cost were significant risk factors for developing MDR-TB (p<0.05); while from multivariate analysis, number of previous TB treatments was the only risk factor that played a significant role in the incidence of MDR-TB (OR 24.128 95% CI 6.771-85,976). Conclusions: Patients and medication factors are risk factors that play roles in the incidence of MDR-TB. The significant risk factor is the number of previous TB treatment. Keywords: Multidrug-resistant tuberculosis, resistance, risk factors, tuberculosis DOI: 10.15850/ijihs.v5n2.99

Comorbidities of Chronic Obstructive Pulmonary Disease Patients at Respirology and Critical Care Outpatient Clinic Dr. Hasan Sadikin General Hospital, Bandung, Indonesia

Background: Chronic obstructive pulmonary disease (COPD) is a chronic disease that becomes one of the leading causes of death in the world. The COPD is usually accompanied by comorbidities that impact prognosis and increase patients’ expenses. However, the comorbidities of COPD patients have not yet to be known in Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. This study was aimed to determine the frequency, type and number of comorbidities accompanying COPD.Methods: This study was a retrospective, cross-sectional study at the respirology and critical care outpatient clinic of Dr. Hasan Sadikin General Hospital, Bandung, Indonesia in 2012. Data were obtained from medical records of patients diagnosed with COPD and had an obstructive pulmonary function test result. Sampling technique in this study was total sampling. Data were classified by age, gender, smoking history and severity of disease and were analyzed to determine the frequency, type and number of comorbidities accompanying COPD. Results: Thirty eight COPD patients with obstructive pulmonary function test results were analyzed. It consists of 31 males and 7 females with age ranged between 43–82 years and median age of 64 years. Severe obstruction was found in 15 of 38 patients. Comorbidities were found in 26 patients, and 2 patients had up to four comorbidities. The most common comorbidity was hypertension (9 of 38).Conclusions: The majority of COPD patients had comorbidities and the most frequent comorbidity was hypertension. [AMJ. 2017;4(1):30–5]DOI: 10.15850/amj.v4n1.101

Thoracic Radiography Findings of Multi Drug Resistant Tuberculosis at Dr. Hasan Sadikin General Hospital Bandung

Background: The prevalence of multidrug-resistant pulmonary tuberculosis (MDR-TB) continues to increase, especially in Indonesia. Thoracic radiography examination plays a role in the TB diagnosis by providing findings of typical lesions in patients. The aim of the study was to determine the thoracic radiography findings in MDR-TB patients.Methods: This was a cross-sectional retrospective descriptive study. This study had explored secondary data from medical records of patients who previously had a clinical diagnosis of MDR-TB and underwent thoracic radiography examinations at the Department of Radiology, Dr. Hasan Sadikin General Hospital, Bandung on July - August 2020 Result: Of 110 data collected, the average age was 37±12.6 years with male patients were predominantly prevalent and 65.5% had large lesions. The most frequent findings of lesions were calcification (94.5%) and fibrosis (90.9%). Other major findings were infiltration (88.2%), consolidation (55.5%), cavity (65.5%), ground-glass opacity (60.9%) while other were found in less than half of the cases such as bronchiectasis (23%), nodule (34.5%), atelectasis (36.4%), lymphadenopathy (34.5%), and others. Interestingly, the miliary pattern was not found.Conclusion: Large lesions, calcification, fibrosis, infiltration, consolidation, cavities, and ground-glass opacities are the main features of the radiographic findings in the majority of MDR-TB patients

Association between Malnutrition Inflammation Score and Latent Tuberculosis among Chronic Hemodialysis Patients

Objective: To investigate the association of malnutrition with latent tuberculosis (TB) among chronic kidney disease (CKD) patients on hemodialysis (HD).Methods: This was a cross-sectional study conducted at the Hemodiaylisis Unit of Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. Subjects were patients aged >18 years who had undergone HD twice a week for at least three months. Patients suspected of active tuberculosis (TB), malignancy, or immunocompromised were excluded. Latent TB was diagnosed using the interferon-gamma release assays (IGRA). Malnutrition was defined by a malnutrition inflammation score (MIS) of less than 5. All data including age, sex, CKD etiologies, and laboratory findings were obtained and recorded in a case report form.Results: A total of 120 subjects were involved in this study. Subjects with positive, negative, and indeterminate IGRA results were 39.2%, 56.7%, and 4.2%, respectively. There was no significant differences in subjects characteristics between positive and negative IGRA subjects.  The MIS>5 was shown to have no statistically significant association with positive IGRA subjects (OR=3.47, 95%CI 0.93–12.93).Conclusion: Malnutrition based on an MIS score of less than 5 is not statically associated, but clinically associated, with latent TB. Further causal inference study to investigate these associations is needed

Role of Risk Factors in the Incidence of Multidrug-Resistant Tuberculosis

Objective: To determine the risk factors that played roles in the incidence of multidrug-resistant tuberculosis (MDR-TB) in such patients. Multidrug-Resistant Tuberculosis is a form of tuberculosis caused by Mycobacterium tuberculosis that is resistant to at least isoniazid and rifampicin.Methods: This was a case control study to compare MDR-TB to non-MDR-TB pulmonary tuberculosis outpatients in Dr. Hasan Sadikin General Hospital, Bandung on August–September 2014. Fifty MDR-TB outpatients were included as the cases and 50 non-MDR-TB outpatients as controls. Data was collected by questionnaires and patient’s registration forms. Bivariate and multivariate analyses were performed using chi-square test and multiple logistic regression test, with p<0.05 considered significant. Results: From bivariate analysis, number of previous tuberculosis treatments, regularity of previous treatment, and burden of cost were significant risk factors for developing MDR-TB (p<0.05); while from multivariate analysis, number of previous TB treatments was the only risk factor that played a significant role in the incidence of MDR-TB (OR 24.128 95% CI 6.771-85,976). Conclusions: Patients and medication factors are risk factors that play roles in the incidence of MDR-TB. The significant risk factor is the number of previous TB treatment. Keywords: Multidrug-resistant tuberculosis, resistance, risk factors, tuberculosis DOI: 10.15850/ijihs.v5n2.99

Comorbidities of Chronic Obstructive Pulmonary Disease Patients at Respirology and Critical Care Outpatient Clinic Dr. Hasan Sadikin General Hospital, Bandung, Indonesia

Background: Chronic obstructive pulmonary disease (COPD) is a chronic disease that becomes one of the leading causes of death in the world. The COPD is usually accompanied by comorbidities that impact prognosis and increase patients’ expenses. However, the comorbidities of COPD patients have not yet to be known in Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. This study was aimed to determine the frequency, type and number of comorbidities accompanying COPD.Methods: This study was a retrospective, cross-sectional study at the respirology and critical care outpatient clinic of Dr. Hasan Sadikin General Hospital, Bandung, Indonesia in 2012. Data were obtained from medical records of patients diagnosed with COPD and had an obstructive pulmonary function test result. Sampling technique in this study was total sampling. Data were classified by age, gender, smoking history and severity of disease and were analyzed to determine the frequency, type and number of comorbidities accompanying COPD. Results: Thirty eight COPD patients with obstructive pulmonary function test results were analyzed. It consists of 31 males and 7 females with age ranged between 43–82 years and median age of 64 years. Severe obstruction was found in 15 of 38 patients. Comorbidities were found in 26 patients, and 2 patients had up to four comorbidities. The most common comorbidity was hypertension (9 of 38).Conclusions: The majority of COPD patients had comorbidities and the most frequent comorbidity was hypertension. [AMJ. 2017;4(1):30–5]DOI: 10.15850/amj.v4n1.101

Effective Visual Media to Increase Knowledge and Comprehension of Multidrug Resistant Tuberculosis Among Patients and Their Caregivers

Indonesia ranks thirdamong countries with the largest number of TB cases after India and China. Globally, more than 3-4% of all TB cases are Multidrug-Resistant Tuberculosis (MDR TB). MDR TB is a more complicated TB that needs extra treatments, which extend treatment time and increase adverse effects. Thus, MDR TB patients and their families often feel demotivated about completing treatment, leading to loss to follow up, which contributes to the never-ending transmission and greatly affects the success rate of the national TB control program. Thus, better knowledge and perception on MDR treatment for patients and families plays a crucial role in dealing with this issue. A cross-sectional study was performed from April to June 2019 to evaluate the effectiveness of visual educational media for TB patients and their caregivers. Participants consisted of 144 patients diagnosed with MDR TB and their caregivers or family members (n=22). A pre-test was administered before an education session by a nurse and visual media were used as the educational material. At the end of the session, a post-test was performed. The post-test score was then compared to the pre-test score to evaluate the session’s effectiveness using the paired t-test. Result showed significant increase in the post-test score (t= 3.249, df=3, p=0.04), with the caregivers attained a higher score, showing better improvement in knowledge after the session compared to the patient group. Hence, the MDR TB educational intervention using visual media is considered effective to increase participants ‘understanding of MDR TB. It is expected that with increased knowledge on MDR TB, the treatment success rate will increase and becomes the catalyst for the nationwide TB control strategy

Improving Diagnostic of Pulmonary Tuberculosis in HIV Patients by Bronchoscopy: A Cross Sectional Study

Background: diagnostic of pulmonary TB in HIV patients is a problem due to non specific clinical features, or radiological appearance. HIV patients with CD4≤200 cells/mL infected with M. tuberculosis have less capacity in containing M. tuberculosis, developing granulomas, casseous necrosis, or cavities. This condition is caused by weakend inflammatory which later reduced sputum production and may cause false negative result. This study aimed to assess differences in the positivity level of acid fast bacilli (AFB) and cultures of M. tuberculosis from non-bronchoscopic sputum (spontaneous and induced sputum) compared to bronchoscopic sputum (bronchoalveolar lavage) in HIV positive patients suspected pulmonary tuberculosis with CD4<200 cells/μL.Methods: this cross sectional study was conducted in adult HIV patients treated in Hasan Sadikin Hospital with CD4≤200 cells/μL suspected with pulmonary tuberculosis by using paired comparative analytic test. All patients expelled sputum spontaneously or with sputum induction on the first day. On the next day, bronchoalveolar lavage (BAL) was performed. The two samples obtained from two methods were examined by AFB examination with staining Ziehl Neelsen (ZN) and cultured of M. tuberculosis on solid media Ogawa on all patients. Positivity, sensitivity and increased sensitivity of AFB and culture of M. tuberculosis in the non bronchoscopic and bronchoscopic groups were compared.Results: there were differences in the positivity level of AFB with ZN staining between non-bronchoscopic and bronchoscopic groups which were 7/40 (17.5%) vs 20/40 (50.0%) (p<0.001). The differences between the cultures of non-bronchoscopic and bronchoscopic groups were 16/40 (40.0%) vs 23/40 (57.5%) (p=0.039). Bronchoscopic sputum increased the positivity level of the ZN AFB examination by 32.5% (from 17.5% to 50.0%) as well as on culture examination by 17.5% (from 40.0% to 57.5%).Conclusion: Bronchoalveolar lavage can improve the positivity level of smears and cultures in patients suspected of pulmonary TB in HIV patients with CD4<200 cells/μL

Effect of Treadmill Exercise Using 80% Intensity of Six Minute Walk Test on Walking Distance and Quality of Life in Moderate Stage Chronic Obstructive Pulmonary Disease Patients

Skeletal muscle dysfunction poses as one of the systemic manifestation of chronic obstructive pulmonary disease (COPD) in the impact of inactivity and deconditioning from early fatigue to the end of declining quality of life (QoL). Giving pulmonary rehabilitation program of treadmill exercise will overcome the problem, but standard method for moderate stage of COPD is not yet available. This study aimed to evaluate the effect of treadmill exercise using 80% intensity of six minute walk test on walking distance and QoL in moderate stage COPD in order to overcome muscle dysfunction. Samples were taken from Physical Medicine and Rehabilitation and Respirology subdivision of Internal Medicine outpatient clinic of Dr. Hasan Sadikin General Hospital Bandung, from March 2012–April 2013. Data analysis was tested using t-test for comparison of two independent mean data. Otherwise, non parametric test of Mann Whitney and Wilcoxon Match Pair test. Thirty three subjects of moderate stage COPD were divided into 2 groups (intervention and control). Intervention group received treadmill exercise with 80% intensity from preliminary 6MWT for 30–60 minutes/session, 3 session/week for 6 weeks. Significant increase on walking distance was found in intervention group (70.66 m) compared to control group (7.43 m) after 6 weeks (p≤0.05). QoL using St. George Respiratory Questionnaire (SGRQ) showed significant decrease in intervention group for all components in the end of 6 weeks (total p=0.0038, symptoms p=0.0162, activities p=0.0043 and impact p=0.0057, p≤0.05). Eighty percent intensity of 6MWT in treadmill exercise for 6 weeks was well tolerated and could overcome skeletal muscle dysfunction in moderate stage COPD. It also revealed higher values in aerobic capacity and QoL compared to previous studies. In conclusion, treadmill exercise using 80% intensity of 6MWT provides further walking distance and higher QoL compared to control in moderate stage COPD

Clinical overview, laboratory findings, and radiological outcomes of COVID-19 Patients in the city of Bandung, Indonesia

This study analyzed the chest CT of COVID-19 patients with clinical and laboratory features. A retrospective study of chest CT, laboratory analysis, and clinical features of patients with COVID-19 was conducted from March to September 2020. Sixty-nine symptomatic patients agreed to join the study. The scoring for chest CT was based on the proportion of lobar involvement with visual assessment. Chest CT scores were paired with clinical and laboratory findings. The relation of all these findings with the patients’ outcomes was statistically assessed with univariate and multivariate analyses. Ground glass opacity was the most common finding in the early course of the disease (≤ 7 days), while crazy-paving, consolidation, and fibrosis were dominantly observed in the late phase (&gt;7 days). The CT score was significantly higher in severe patients (p &lt; 0.0001) and late-phase than that in early-phase patients (p &lt; 0.0001). CT score was significantly correlated with CRP (p&lt;0.001), ALC (p=0.002) and NLR (p&lt;0.001). Chest CT score correlates significantly with laboratory findings and disease severity in COVID-19 patients. Therefore, chest CT score has a potential role in estimating the outcomes of these patients. In addition, a Faster diagnostic workup in symptomatic cases would be beneficial to the patients.Este estudio analizó la TC de tórax de pacientes con COVID-19 con características clínicas y de laboratorio. Se realizó un estudio retrospectivo de TC de tórax, análisis de laboratorio y características clínicas de pacientes con COVID-19 de marzo a septiembre de 2020. Sesenta y nueve pacientes sintomáticos aceptaron unirse al estudio. La puntuación de la TC de tórax se basó en la proporción de afectación lobular con evaluación visual. Las puntuaciones de la TC de tórax se emparejaron con los hallazgos clínicos y de laboratorio. La relación de todos estos hallazgos con los resultados de los pacientes se evaluó estadísticamente con análisis univariados y multivariados. La opacidad en vidrio esmerilado fue el hallazgo más común en el curso temprano de la enfermedad (≤ 7 días), mientras que el empedrado, la consolidación y la fibrosis se observaron predominantemente en la fase tardía (&gt; 7 días). La puntuación de CT fue significativamente mayor en pacientes graves (p &lt;0,0001) y de fase tardía que en pacientes de fase temprana (p &lt;0,0001). La puntuación de CT se correlacionó significativamente con CRP (p &lt;0,001), ALC (p = 0,002) y NLR (p &lt;0,001). La puntuación de la TC de tórax se correlaciona significativamente con los hallazgos de laboratorio y la gravedad de la enfermedad en pacientes con COVID-19. Por lo tanto, la puntuación de la TC de tórax tiene un papel potencial en la estimación de los resultados de estos pacientes. Además, un estudio de diagnóstico más rápido en casos sintomáticos sería beneficioso para los pacientes