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Tiara Saraswati
Tatalaksana nutrisi pada tuberkulosis paru dengan komplikasi = Medical nutrition therapy in pulmonary tuberculosis with complications
"[ABSTRAK
Serial kasus ini bertujuan untuk mempelajari dan menerapkan terapi nutrisi sebagai bagian dari terapi tuberkulosis (TB) paru. Komplikasi yang menyertai TB paru dapat meningkatkan morbiditas dan mortalitas. Seluruh pasien serial kasus ini dalam kondisi malnutrisi dan terdapat komplikasi yang menyertai masingmasing kasus berupa drug-induced hepatotoxicity, peritonitis TB, diabetes melitus tipe 2, dan pneumotoraks dengan dispepsia. Pemberian nutrisi disesuaikan dengan kondisi, penyakit penyerta, dan kebutuhan yang bersifat individual. Kebutuhan energi basal dihitung dengan persamaan Harris-Benedict dengan kebutuhan energi total setara dengan 35?40 kkal/kg BB. Makronutrien diberikan dalam komposisi seimbang dengan protein 15?20% kebutuhan energi (1,2?1,5 g/kg BB). Saran pemberian mikronutrien minimal mencapai angka kecukupan gizi. Pasien yang mendapat obat antituberkulosis berupa isoniazid disarankan mendapat suplementasi vitamin B6 dengan dosis tertentu untuk mencegah neuritis perifer. Outcome yang dinilai meliputi kondisi klinis, asupan, dan toleransi asupan. Pemberian terapi nutrisi sebagian besar pasien dimulai dari kebutuhan energi basal yang pada akhir masa perawatan dapat mencapai target kebutuhan energi total. Pemantauan jangka panjang pasca rawat inap, disarankan tidak hanya menilai outcome berdasarkan perubahan berat badan, namun dilakukan penilaian komposisi tubuh, terutama massa lemak, karena pada kasus TB terjadi abnormalitas metabolisme yang disebut anabolic block.
ABSTRACT
The aim of this case series was to study and apply nutrition therapy as integral part of pulmonary tuberculosis (TB) therapy. Pulmonary TB with complications was associated with increased of morbidity and mortality. Malnutrition was coexisted with several complications such as drug-induced hepatotoxicity, peritoneal TB, type 2 diabetes mellitus, and pneumothorax with dyspepsia. HarrisBenedict equation was used to calculate basal energy requirement with total energy requirement equivalent to 35?40 kcal/body weight. Balanced macronutrient composition was given with protein 15?20% energy requirement (1,2?1,5 g/body weight). Micronutrient recommendation was given to fulfill one fold recommended daily allowance. Patients with isoniazid therapy needed to get pyridoxine supplementation to prevent peripheral neuritis. Outcome measurements included clinical condition, amount of intake, and intake tolerance. Most patients were given initial nutrition therapy from basal energy requirement and has shown increment. At the end of hospitalization, all of patients could achieve total energy requirement. Due to abnormality of metabolism, usually termed as anabolic block, it was recommended not only to measure body weight as primary outcome, but also body composition., The aim of this case series was to study and apply nutrition therapy as integral part of pulmonary tuberculosis (TB) therapy. Pulmonary TB with complications was associated with increased of morbidity and mortality. Malnutrition was coexisted with several complications such as drug-induced hepatotoxicity, peritoneal TB, type 2 diabetes mellitus, and pneumothorax with dyspepsia. HarrisBenedict equation was used to calculate basal energy requirement with total energy requirement equivalent to 35–40 kcal/body weight. Balanced macronutrient composition was given with protein 15–20% energy requirement (1,2–1,5 g/body weight). Micronutrient recommendation was given to fulfill one fold recommended daily allowance. Patients with isoniazid therapy needed to get pyridoxine supplementation to prevent peripheral neuritis. Outcome measurements included clinical condition, amount of intake, and intake tolerance. Most patients were given initial nutrition therapy from basal energy requirement and has shown increment. At the end of hospitalization, all of patients could achieve total energy requirement. Due to abnormality of metabolism, usually termed as anabolic block, it was recommended not only to measure body weight as primary outcome, but also body composition.]"
Fakultas Kedokteran Universitas Indonesia, 2015
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UI - Tugas Akhir  Universitas Indonesia Library
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Dian Permatasari
Tatalaksana nutrisi pada Tuberkulosis paru dengan infeksi Human Immunodeficiency Virus (HIV) dan Kaheksia = Nutrition management in pulmonary tuberculosis with HIV infection and cachexia
"ABSTRAK
Tuberkulosis (TB) merupakan penyebab utama penyakit dan kematian di dunia. Hubungan antara TB dan malnutrisi telah lama diketahui. Berkembangnya TB secara progresif menyebabkan wasting dan hilangnya massa otot, serta hipoalbuminemia yang juga terlihat pada infeksi human immunodeficiency virus (HIV). Koinfeksi TB/HIV menyebabkan peningkatan metabolisme, gangguan fisik, dan masalah nutrisi. Selain itu, adanya penyakit infeksi kronik seperti halnya TB paru dan HIV/AIDS disertai dengan penurunan BB dapat menyebabkan kaheksia. Serial kasus ini bertujuan untuk mempelajari dan menerapkan terapi nutrisi sebagai bagian dari tatalaksana TB paru, infeksi HIV, dan kaheksia. Seluruh pasien dalam serial kasus ini adalah pasien TB paru dengan malnutrisi berat dan kaheksia. Dua dari empat pasien disertai infeksi HIV. Pemberian nutrisi disesuaikan dengan kondisi, penyakit penyerta, dan kebutuhan yang bersifat individual. Kebutuhan energi basal dihitung dengan persamaan Harris-Benedict dengan kebutuhan energi total setara dengan 35?40 kkal/kg BB. Makronutrien diberikan dalam komposisi seimbang dengan protein 15?20% total kalori (1,5-2 g/kg BB). Suplementasi mikronutrien diberikan sesuai dengan angka kecukupan gizi. Nutrien spesifik berupa omega-3 dan asam amino rantai cabang (AARC) diberikan untuk memperbaiki kaheksia. Keluaran yang dinilai meliputi kondisi klinis, asupan, dan toleransi asupan. Dua dari empat pasien memberikan keluaran klinis lebih baik, namun peningkatan BB tidak signifikan.ABSTRACT Tuberculosis (TB) is a leading cause of illness and death of people globally. The association between TB and malnutrition has long been known. Progressive tuberculous disease results in wasting and loss of muscle mass and hypoalbuminaemia, which are also seen in HIV infection. Co-infection with HIV and TB poses an additional metabolic, physical, and nutritional burden. In addition, chronic infecton disease such as pulmonary TB and HIV/AIDS accompanied with weight loss leads to cachexia. The aim of this case series was to study and apply nutrition therapy as integral part of pulmonary TB, HIV infection and cachexia treatment. All patients in this reports with diagnosis of pulmonary TB with severe malnutrition and cachexia. Two of four patients diagnosed with HIV infection. Nutrition therapy was given individually according to the clinical condition and underlying disease. Harris-Benedict equation was used to calculate basal energy requirement with total energy requirement equivalent to 35?40 kcal/body weight. Balanced macronutrient composition was given with protein 15?20% of total requirement (1,5-2 g/body weight). Micronutrient recommendation was given to fulfill one fold recommended daily allowance. Omega-3 and branched-chain amino acid (BCAA) was given as specific nutrients to improved cachexia. Outcome measurements included clinical condition, intake analysis, and intake tolerance. Two of four patient had improved in clinical outcome but there was no significant difference in weight gain."
Fakultas Kedokteran Universitas Indonesia, 2016
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UI - Tugas Akhir  Universitas Indonesia Library
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Ety Mariatul Qiptiah
Terapi nutrisi pada pasien meningitis tuberkulosis dengan tuberkulosis paru = Nutritional therapy in patients tuberculous meningitis with pulmonary tuberculous
"Latar Belakang: Mycobacterium tuberculosis merupakan penyebab tuberkulosis pada paru dan organ lain, seperti meningen meningitis tuberkulosis . Meningitis tuberkulosis dapat merupakan komplikasi tuberkulosis primer, yang bersifat laten/asimptomatik, namun risiko reaktivasi meningkat pada penurunan sistem imun/malnutrisi. Disfagia, defisit kognitif, hemiparese, dan ketidakmampuan makan mandiri juga dapat menyebabkan malnutrisi, sehingga akan meningkatkan lama rawat dan mengganggu perbaikan kapasitas fungsional. Tatalaksana nutrisi diperlukan untuk meminimalisasi kehilangan berat badan, mendapatkan imbang nitrogen positif, dan menyediakan nutrisi untuk membangun system imun. Pada pelaksanaannya, pemberian nutrisi harus memperhatikan kondisi klinis serta komplikasi berupa peningkatan tekanan intrakranial dan defisit neurologi yang terjadi.
Metode: Laporan serial kasus ini menguraikan empat kasus meningitis tuberkulosis dengan tuberkulosis paru. Semua pasien datang dengan penurunan kesadaran dan telah terdiagnosis tuberkulosis paru sebelumnya, namun pasien minum obat tidak sesuai dengan anjuran dokter. Status gizi keempat pasien adalah malnutrisi ringan dan berat, obes 1 dan normal. Selama dirawat, tatalaksana nutrisi diberikan sesuai pedoman terapi nutrisi untuk penderita tuberkulosis. Asupan makronutrien diberikan meningkat bertahap sesuai kondisi klinis dan toleransi pasien. Suplementasi mikronutrien juga diberikan. Pemantauan meliputi keluhan subjektif, hemodinamik, analisis dan toleransi asupan, pemeriksaan laboratorium, antropometri, keseimbangan cairan, dan kapasitas fungsional.
Hasil: Dua orang pasien menunjukkan perbaikan klinis, kapasitas fungsional, hasil laboratorium, toleransi asupan, dan outcome, sedangkan dua orang lainnya mengalami perburukan dan meninggal pada hari perawatan ke-44 dan ke-24.
Kesimpulan: Dukungan nutrisi infeksi tuberkulosis pada paru dan susunan saraf, dapat memberikan manfaat untuk pemulihan pasien.
Objective: Mycobacterium tuberculosis is the cause of tuberculous in the lung and other organs, such as the meninges tuberculous meningitis . Tuberculous meningitis can be a complication of primary tuberculous, latent asymptomatic, but the risk of reactivation increases to a decrease in the immune system malnutrition. Dysphagia, defisit kognitif, hemiparese, and inability to eat independently can also cause malnutrition, thereby increasing the length of stay and interfere with the functional capacity improvement. Management of nutrients needed to minimize the lose weight, get a positive nitrogen balance, and provide nutrients for building the immune system. In practice, the nutrition must consider the clinical condition and the complications in the form of increased intracranial pressure and neurological deficits that occur.
Methods: This case series report outlines four cases of tuberculous meningitis with pulmonary tuberculous. All patients present with loss of consciousness and have been diagnosed with pulmonary tuberculous before, but patients taking the medicine does not comply with doctor's advice. Nutritional status of the four patients was mild and severe malnutrition, obese and normal one. During the treatment, management of nutrition was given according to the guidelines of nutrition therapy for patients with tuberculosis. Macronutrient intake increased gradually given appropriate clinical condition and patient tolerance. Micronutrient supplementation are also given. Monitoring included subjective complaints, hemodynamic, analysis and tolerance intake, laboratory tests, anthropometric, fluid balance, and functional capacity.
Results: Two patients showed clinical improvement, functional capacity, laboratory results, tolerance intake, and outcome, while two other people suffered deterioration and died on the 44th and 24th day of treatment.
Conclusion: Nutritional support tuberkulosis infection in the lungs and nervous system, can provide benefit to the patient's recovery."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2016
T55631
UI - Tugas Akhir  Universitas Indonesia Library
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Diah Prasmapti Yunianingtias
Terapi Nutrisi pada Pasien Tuberkulosis Paru dengan Malnutrisi = Nutritional Therapy in Pulmonary TB Patient with Malnutrition
"Malnutrisi dan tuberkulosis seringkali ditemukan secara bersamaan, Adanya malnutrisi pada tuberkulosis meningkatkan morbiditas dan mortalitas. Serial kasus ini bertujuan mempelajari efek terapi nutrisi pada pasien TB paru dengan malnutrisi. Pada serial kasus ini tiga orang pasien mengalami malnutrisi berat dan satu pasien mengalami malnutrisi ringan. Nutrisi tahap awal diberikan ≤ 50% kebutuhan energi total (KET) dan ditingkatkan bertahap. Pada akhir masa perawatan, nutrisi dapat mencapai 90% KET. Protein diberikan sebesar 15-20% total kalori. Konseling gizi diberikan pada akhir masa rawat pada pasien dan keluarga. Terapi nutrisi sebaiknya harus menjadi bagian integral dari terapi tuberkulosis.
Malnutrition has been found to coexist with tuberculosis (TB). Malnutrition is associated with increased morbidity and mortality in those with TB. Objective of this case serial is to review the impact of nutritional therapy in pulmonary TB patient with malnutrition. All of four patients were malnourished and had pulmonary TB, of which 3 were severely malnourished. Initially, nutrition therapy commenced with ≤ 50% estimated energy requirement (EER) and incrementally increased to 90% EER at the end of hospitalization. Protein was given 15–20% of total calories. Bedside counseling was provided prior to discharge. Nutrition therapy should be considered as integral part of TB treatment."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014
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UI - Tugas Akhir  Universitas Indonesia Library
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Christofan Lantu
Proporsi tuberkulosis paru pada pasien penyakit paru obstruktif kronik di Rumah Sakit Umum Pusat Persahabatan Jakarta = Proportion of pulmonary tuberculosis in chronic obstructive pulmonary disease patients at Persahabatan Hospital
"[ABSTRAK
Penyakit paru obstruktif kronik (PPOK) merupakan penyebab utama morbiditas dan mortalitas di dunia.Beberapa faktor risiko PPOK juga merupakan faktor risiko terjadinya tuberkulosis (TB).Beberapa penelitian di luar ditemukan prevalens TB paru pada pasien PPOK sekitar 2,6% - 10%.Indonesia khususnya di RSUP Persahabatan belum ada data proporsi TB paru pada pasien PPOK.Objektif: tujuan penelitian ini adalah mendapatkan angka proporsi TB paru pada pasien PPOK di RSUP Persahabatan Jakarta.Metode: desain penelitian ini adalah potong lintang. Pasien PPOK (belum diobati dengan obat anti tuberkulosis) yang berkunjung di poliklinik Asma/PPOK RSUP Persahabatan yang memenuhi kriteria inklusi dan eksklusi.Subjek diperiksa dahak BTA dan pemeriksaan Xpert MTB/RIF. Saat pasien berkunjung, dilakukan anamnesis gejala, eksaserbasi, riwayat merokok, penggunaan kortikosteroid (oral atau inhalasi), komorbid, skor CAT, penilaian status gizi, spirometri dan foto toraks. Semua data dilakukan analisis dengan uji chisquare.Hasil: subjek terbanyak adalah laki-laki (97,3%) dengan kelompok usia 60-79 tahun (74,3%), dengan komorbid terbanyak penyakit jantung (41,9%), gejala klinis terbanyak batuk berdahak (81,1%). Berdasarkan derajat PPOK terbanyak adalah GOLD 3 (44,6%) dan frekuensi eksaserbasi tersering 0-1 (78,4%) dengan menggunakan steroid sebanyak 59,5%. Pada penelitian ini didapatkan pemeriksaan dahak BTA positif 1,4% dan Xpert MTB/RIF positif 2,7%, artinya pemeriksaan Xpert MTB/RIF mempunyai angka kepositifan lebih tinggi dibanding dahak BTA. Dalam penelitian ini didapatkan proporsi TB paru pada pasien PPOK sebanyak 2,7%.Dalam Penelitian ini tidak terdapat hubungan bermakna secara statistik antara derajat PPOK, status gizi, penggunaan kortikosteroid, status merokok dengan prevalens TB paru pada pasien PPOK (p > 0,05).Pada penelitian ini didapatkan hubungan bermakna pada frekuensi eksaserbasi PPOK, hasil pemeriksaan dahak BTA dan hasil pemeriksaan Xpert MTB/RIF dengan proporsi TB paru (p < 0,05).Kesimpulan: proporsi TB pada pasien PPOK di RSUP Persahabatan Jakarta adalah 2,7%. Terdapat hubungan yang bermakna secara statistik antara frekuensi eksaserbasi PPOK dengan proporsi TB paru pada pasien PPOK (p = 0,0006). Terdapat hubungan yang bermakna secara statistik antara hasil pemeriksaan dahak BTA dan hasil pemeriksaan Xpert MTB/RIF dengan proporsi TB paru pada pasien PPOK dengan nilai p < 0,05 (p = 0,000).
ABSTRACT
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in the world. Some of the risk factors for COPD are also risk factors for tuberculosis (TB). Some studies abroad have found the prevalence of pulmonary tuberculosis in COPD patients were 2.6 - 10%. There are no data on the prevalence of pulmonary tuberculosis patients with COPD in Indonesia, particularly in The Department of Pulmonology PersahabatanHospital, Jakarta. Objective: the purpose of this study is to obtain proportion of pulmonary TB in COPD patients in The Department of Pulmonology Persahabatan Hospital, Jakarta. Methods: this is a cross-sectional study. COPD patients (anti-tuberculosis drugs naive) who visit the Asthma/COPD clinic PersahabatanHospital which meet the inclusion and exclusion criteria. Subjects went through acid-fast bacilli sputum smear and Xpert MTB/RIF examination. On patients visit, symptoms, exacerbations history, history of smoking, use of corticosteroids (oral or inhaled), comorbidities, CAT scores, assessment of nutritional status, spirometry and chest X-ray data had been obtained. All data were analyzed with chi-square test. Results: most subjects were male (97.3%) in the age group 60-79 years (74.3%), with mostly found comorbid was heart disease (41.9%), and mostly found clinical symptoms was productive cough (81.1%). Based on classification of COPD is GOLD 3 (44.6%) and the most exacerbation frequency was 0-1 (78.4%) with 59.5% history of steroid usage. In this study, examination of AFB sputum smear positive 1.4% and the Xpert MTB/RIF positive 2.7%, It shows Xpert MTB/RIF examination has a higher positivity rate than AFB sputum smear. The proportion of pulmonary tuberculosis in patients with COPD was 2.7%. We also found no statistically significant relationship between classification of COPD, nutritional status, use of corticosteroids, smoking status with the proportion of pulmonary tuberculosis in COPD patients (p> 0.05) but we found a significant difference in the exacerbations frequency of COPD, the results of sputum smear examination and the results of Xpert MTB/RIF with proportion of pulmonary TB (p <0.05).Conclusion: the proportion of tuberculosis in patients with COPD in The Department of PulmonologyPersahabatan Hospital Jakarta is 2.7%. There is astatistically significant difference between the frequency of exacerbations of COPD with proportion of pulmonary TB in patients with COPD (p = 0.0006). An association is statistically significant different between the results of sputum smear examination and the results of Xpert MTB/RIF with the proportion of pulmonary tuberculosis in patients with COPD with a value of p <0.05 (p = 0.000)., Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and
mortality in the world. Some of the risk factors for COPD are also risk factors for
tuberculosis (TB). Some studies abroad have found the prevalence of pulmonary
tuberculosis in COPD patients were 2.6 - 10%. There are no data on the prevalence of
pulmonary tuberculosis patients with COPD in Indonesia, particularly in The Department
of Pulmonology Persahabatan Hospital, Jakarta. Objective: the purpose of this study is to
obtain proportion of pulmonary TB in COPD patients in The Department of Pulmonology
Persahabatan Hospital, Jakarta. Methods: this is a cross-sectional study. COPD patients
(anti-tuberculosis drugs naive) who visit the Asthma/COPD clinic Persahabatan Hospital
which meet the inclusion and exclusion criteria. Subjects went through acid-fast bacilli
sputum smear and Xpert MTB/RIF examination. On patients visit, symptoms,
exacerbations history, history of smoking, use of corticosteroids (oral or inhaled),
comorbidities, CAT scores, assessment of nutritional status, spirometry and chest X-ray
data had been obtained. All data were analyzed with chi-square test. Results: most
subjects were male (97.3%) in the age group 60-79 years (74.3%), with mostly found
comorbid was heart disease (41.9%), and mostly found clinical symptoms was productive
cough (81.1%). Based on classification of COPD is GOLD 3 (44.6%) and the most
exacerbation frequency was 0-1 (78.4%) with 59.5% history of steroid usage. In this
study, examination of AFB sputum smear positive 1.4% and the Xpert MTB/RIF positive
2.7%, It shows Xpert MTB/RIF examination has a higher positivity rate than AFB
sputum smear. The proportion of pulmonary tuberculosis in patients with COPD was
2.7%. We also found no statistically significant relationship between classification of
COPD, nutritional status, use of corticosteroids, smoking status with the proportion of
pulmonary tuberculosis in COPD patients (p> 0.05) but we found a significant difference
in the exacerbations frequency of COPD, the results of sputum smear examination and
the results of Xpert MTB/RIF with proportion of pulmonary TB (p <0.05). Conclusion:
the proportion of tuberculosis in patients with COPD in The Department of Pulmonology
Persahabatan Hospital Jakarta is 2.7%. There is a statistically significant difference
between the frequency of exacerbations of COPD with proportion of pulmonary TB in
patients with COPD (p = 0.0006). An association is statistically significant different
between the results of sputum smear examination and the results of Xpert MTB/RIF with the proportion of pulmonary tuberculosis in patients with COPD with a value of p <0.05 (p = 0.000).]"
Fakultas Kedokteran Universitas Indonesia, 2015
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library
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Titi Sekarindah
Pengaruh pemberian Vitamin A terhadap profil imun pasien Tuberkulosis Paru dengan terapi obat anti Tuberkulosis = The effect of vitamin A supplementation on the immune profile of pulmonary Tb patient during oral anti tuberculosis treatment
"ABSTRAK
Ruang Lingkup dan Cara Penelitian : Penyakit tuberkulosis paru masih merupakan masalah di negara berkembang termasuk Indonesia. Tuberkulosis menduduki urutan ke 2 sebagai penyebab kematian menurut hasil survey nasional 1992. Dari kepustakaan diketahui bahwa pada penderita tuberkulosis didapati kelainan imunitas seluler, sehingga untuk penyembuhan penyakit tuberkulosis diperlukan pengaktifan sistem imun testa imunitas seluler. Vitamin A sudah lama dikenal sebagai imunomodulator. Dari penelitian terdahulu pemberian retinoid dapat meningkatkan respon imun seluler antara lain kenaikan sel T penolong dan T penolong/supresor. Pada penelitian ini diharapkan pemberian vitamin A sejumlah 2x 200000IU pada penderita TB paru dengan OAT dapat meningkatkan imunitas seluler. Tujuan penelitian ini adalah menilai pengaruh pemberian vitamin A pada penderita tuberkulosis paru yang sedang mendapat OAT terhadap jumlah limfosit total, limfosit T total, sub populasi limfosit T, kadar retinol plasma, dan keadaan klink penderita. Vitamin A 200.000 IU diberikan pada awal penelitian dan setelah 4 minggu. Penelitan dilakukan secara uji klinik tersamar ganda pada 40 penderita TB paru. Penderita dibagi dalam 2 kelompok masing-masing 20 orang yang diberi vitamin A dan placebo. Pada akhir penelitian yaitu setelah 8 minggu, ada 5 orang drop out.
Hasil dan kesimpulan : Dari 40 orang peserta penelitian 10% kadar retinol plasma rendah (<20pg/dl), 30%normal, rendah(20-30pg/d.l), 60% normal. Pada pemeriksaan imunitas seluler 53,85% ada gangguan dan 46,15% normal. Nilai rata rata hitung (X) retinal plasma kelompok placebo dan perlakuan sebelum pemberian vit. .A/placebo berturut-turut adalah 30,24 ± 7,51 µg/dl dan 30,82 ±7,31 µg/dl. Setelah pemberian adalah 36,85 ± 9,74 µg/dl dan 38,02 ± 8,29 µg/dl. Pada uji t berpasangan dari kelompok perbkkan kenaikannya bermakna (p
ABSTRACT
Scope and Method of Study : Pulmonary tuberculosis is still a major health problem in the developing countries including Indonesia. Tuberculosis is number 2 as cause of death (National Survey's data, 1992). According to literature study tuberculosis patients are suffering from an immune defect. To recover from the disease the immune response especially the cellular immune response needs to be activated, because mycobacterium TB are living intracellular. Vitamin A is known as an immunomodulator. From earlier research it is known that retinoid could enhance cellular immune response, ie. increasing T helper cells and the ratio Thelperffsupresor. The hypothesis is that supplementation of vitamin A 2x2000001U to pulmonary TB patients could increase the cellular immunity. The aim of this study was to asses the vitamin A supplementation on the immune?s profile of pulmonary TB patient who are on oral anti tuberculosis treatment. Plasma retinot, nutrients intake, BMI, clinical findings were examined. Vitamin A 200.000M was given twice, in the beginning of the study and after 4 weeks. The design of the study was a randomized double blind clinical trial. Forty patients were selected and divided into 2 groups, a placebo and treatment (vitamin A) group. At the end of the study (after the 8th week), 5 patients dropped out.
Findings and Conclusions : Among 40 patients 10% showed plasma ret noK20 p g/dl), 30% normal low (20-30pgldl) and 60% normal. (03011g041). The cellular immunity was 53,85% abnormal and 46,15% normal The means (X) of plasma retinol of the placebo and study group before supplementation were 30.24 ± 7,51 µg/dl and 30.82 ± 7.31µg/dl respectively; after supplementation 36.85±9.74µg/dl and 38.02 ± 8.29µgldl respectively. Statistical analysis using paired t test showed that the study group was increasing s' 0,05), however there was no Significant difference between the 2 groups. The mean (X) of total lymphocyte before supplementation of the placebo and study group were 22.61 ± 6.51% and 22.63 ± 8,62%; after supplementation 38.09 ± 19.91% and 35.20 + 10.71%. Both were increasing significant; however there was no significant difference between the 2 groups. The T lymphocyte, T helper and ratio Thelper CT supresor were decreasing. T helper more in the placebo group 5.75% 2.29% but there was no significant difference. This study concluded that although vitamin A supplementation 2 X 200.000 IU could increase the plasma retinol but could not yet improve the immune response and clinical status significantly."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 1996
T-Pdf
UI - Tesis Membership  Universitas Indonesia Library
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Cut Yulia Indah Sari
Proporsi penderita kanker paru dengan riwayat keterlambatan diagnosis akibat didiagnosis sebagai tuberkulosis paru = The diagnosis delay of lung cancer patient who were initially diagnosed as pulmonary tuberculosis
"Latar belakang: Di negara endemik TB, kanker paru seringkali terlambat didiagnosis akibat sebelumnya didiagnosis sebagai TB paru. Hal ini menjadi perhatian besar karena diagnosis dini kanker paru dapat meningkatkan ketahanan hidup dan kualitas hidup pasien dengan peluang pembedahan yang lebih besar atau pun modalitas kemo-radioterapi yang dapat dipilih. Penelitian inibertujuan untuk mengetahui proporsi pasien kanker paru yang mengalami keterlambatan diagnosis karena sebelumnya didiagnosis sebagai tuberkulosis paru.
Metode: Penelitian potong lintang ini dilakukan di RS Persahabatan dengan subjek penelitian adalah semua pasien kanker paru yang telah tegak didiagnosis secara histopatologi dari bulan September 2012 hingga Februari 2013 dengan jumlah total 100 pasien. Keterlambatan diagnosis ditetapkan apabila pasien didiagnosis sebagai TB paru dan mendapat Obat Anti Tuberkulosis (OAT) lebih dari 1 bulan sejak awal gejala ditemukan. Dilakukan anamnesis pada semua pasien dengan foto toraks yang didokumentasikan serta pengambilan data-data dari status pasien.
Hasil: Sebanyak 41 dari 100 pasien kanker paru didiagnosis sebagai TB paru dan riwayat mendapat OAT. Dua puluh sembilan dari 41 subjek mendapat OAT lebih dari 1 bulan. Dua puluh sembilan kasus yang terlambat diagnosis tersebut tersebut terdiri dari 21 laki-laki dan 8 perempuan dengan rerata usia 51,5 tahun dan dengan hasil PA yaitu Kanker Paru Karsinoma Bukan Sel Kecil (KPKBSK) sebanyak 28 kasus dan Kanker Paru Karsinoma Sel Kecil (KPKSK) sebanyak 1 kasus serta dengan stage III sebanyak 6 kasus, stage IV sebanyak 22 kasus. Pemeriksaan sputum BTA hanya dilakukan pada 9 kasus. Rerata lama pemberian OAT adalah 4,5±0,4 bulan. Tenaga kesehatan yang memberikan OAT adalah dokter umum sebanyak 12 orang, dokter spesialis paru sebanyak 12 orang dan dokter spesialis penyakit dalam sebanyak 4 orang.
Diskusi : Hasil temuan gambaran foto toraks yang menyerupai TB paru di negara endemik TB dapat menyebabkan keterlambatan diagnosis kanker paru karena awalnya didiagnosis sebagai TB paru. Pemberian OAT tanpa evaluasi yang adekuat terlebih lagi tidak mengacu pada International Standard of TB Care (ISTC) akan memicu keterlambatan diagnosis serta progresivitas penyakit pada pasien kanker paru.
Introduction: In endemic countries, the diagnosis delay of lung cancer is due to initially misdiagnosed as pulmonary tuberculosis. The major concern rise since early diagnosis of lung cancer could improve survival and quality of life by tumor resectability chance and chemo-radiotherapy modality options. This study objective is to find out the proportion of lung cancer diagnosis delay due to misdiagnosed as pulmonary TB initially.
Method: The cross sectional study held in Persahabatan Hospital with the subjects were histopatologically proven lung cancer patients between September 2012 to February 2013 involving totally 100 patients. The diagnosis delay were determined whether the patients had diagnosed as pulmonary tuberculosis and received anti tuberculosis treatment (ATT) more than 1 month since current symptoms onset. All patients were interviewed, all chest X-rays were documented and data from medical records were collected.
Results: Fourty one of 100 patients were diagnosed as pulmonary TB and 29 of 41 patients received ATT more than 1 months. It consist of 21 men and 8 women with mean age 51.5 years old and the histopatological biopsy are 28 Non Small Cell Lung Cancer (NSCLC) cases, and 1 Small Cell Lung Cancer (SCLC) case with mostly end stage such as 6 cases are stage III and 22 cases are stage IV. Pre-referral sputum Acid Fast Bacilli (AFB) was conducted in only 9 cases with the results were negative. Mean duration of ATT taken was 4.5±0.4 months. The ATT were given by 13 general practitioners, 12 pulmonologists and 4 internists.
Discussion: Since similar radiological findings in highly incidence of pulmonary TB, a large number of lung cancer have diagnosis delay due to initially diagnosed as pulmonary tuberculosis. Without proper investigation based on International Standard of TB Care, starting ATT with inadequate evaluation leads to diagnosis delay and lung cancer progression."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2013
T-Pdf
UI - Tesis Membership  Universitas Indonesia Library
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Andi Amalia Wildani
Asuhan keperawatan keluarga dengan ketidakefektifan bersihan jalan napas pada tuberkulosis paru lansia di RT 06/ RW 01 Kelurahan Cisalak Pasar, Kecamatan Cimanggis, Kota Depok = Family Nursing Care with the ineffective airway clearance in elderly pulmonary tuberculosis at RT 06/ RW 01 Kelurahan Cisalak Pasar, Kecamatan Cimanggis, Kota Depok
"Tuberkulosis (TB) merupakan suatu penyakit infeksius yang terutama menyerang parenkim paru, disebabkan oleh mycobacterium tuberculosis. TB merupakan masalah global dan salah satu dampak dari urbanisasi terhadap kesehatan masyarakat. faktor kependudukan dan faktor lingkungan merupakan penyebab terjadinya tuberkulosis di perkotaan. Manifestasi klinis TB pada lansia salah satunya adalah sesak nafas. Karya ilmiah akhir ini bertujuan untuk memberikan gambaran penatalaksanaan asuhan keperawatan keluarga dengan ketidakefektifan bersihan jalan napas pada tuberkulosis paru lansia di RT 06/ RW 01 Kelurahan Cisalak Pasar, Kecamatan Cimanggis, Kota Depok. Intervensi keperawatan yang diberikan adalah inhalasi sederhana dan batuk efektif. Pemberian inhalasi sederhana dan batuk efektif bermanfaat dan dapat diterapkan untuk mengeluarkan dahak, menurunkan frekuensi napas, dan mengurangi sesak napas pada lansia. Pemecahan masalah yang dilakukan ketika inhalasi sederhana dan batuk efektif tidak efektif yaitu pemberian posisi semi fowler untuk meningkatkan ekspansi paru dan mencukupi kebutuhan oksigen sehingga memberikan kenyamanan dan mengurangi sesak.
Tuberculosis (TB) is an infectious disease that primarily affects the lung parenchyma, caused by mycobacterium tuberculosis. TB is a global problem and one of the impacts of urbanization on public health. Demographic factors and enviromental factors are the cause of TB in urban areas. One of clinical manifestations of elderly TB is shortness of breath.The aim of this final assignment is provide descriptive management of family nursing care with the ineffective airway clearance in elderly pulmonary tuberculosis at RT 06/ RW 01 Kelurahan Cisalak Pasar, Kecamatan Cimanggis, Kota Depok. Nursing interventions provided are simple inhalation and effective cough. The simple inhalation and effective cough is still useful and can be applied to remove sputum, lower respiratory rate, and reduce shortness of breath in elderly. The problem solving when simple inhalation and effective cough does not effectively address the problem ineffective airway clearance in elderly pulmonary is the provision of semi fowler position to improve lung expansion and sufficient of oxygen so as to provide comfort and reduce shortness of breath."
Depok: Fakultas Ilmu Keperawatan Universitas Indonesia, 2013
PR-Pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Diantika Prameswara
Manajemen kesehatan diri pada masalah kesehatan tuberkulosis paru di RW 01 Kelurahan Cisalak Pasar, Cimanggis, Depok = Family nursing care with ineffectiveness of self-healthy management on pulmonary tuberculosis problem in RW 01 Kelurahan Cisalak Pasar, Cimanggis, Depok
"Tuberkulosis merupakan penyakit menular yang disebabkan oleh kuman Mycobacterium tuberculosis yang telah menginfeksi sepertiga penduduk dunia. Jawa Barat merupakan salah satu daerah yang memiliki jumlah penderita TB cukup banyak, salah satunya adalah kota Depok. Di Kelurahan Cisalak Pasar ditemukan keluarga dengan dewasa yang menderita penyakit ini dua kali. Saat ini keluarga sedang menjalankan pengobatan anti-tuberkulosis. Selama ini, keluarga tidak melakukan tindakan peningkatan aktivitas untuk mengatasi masalah kesehatan tersebut, padahal keluarga merupakan bagian terdekat yang memiliki peranan penting. Diagnosa keperawatan pada keluarga ini adalah ketidakefektifan manajemen kesehatan diri. Asuhan keperawatan yang dilakukan menitikberatkan pada kelima tugas utama kesehatan keluarga. Perawatan yang dilakukan pada keluarga yaitu untuk mengatasi tanda dan gejala tersebut. Senam pernapasan telah mampu mengurangi sesak dan meningkatkan fungsi paru. Perawatan tersebut diharapkan dikenalkan oleh pemberi pelayanan kesehatan, masyarakat dan bagian ilmu keperawatan agar dapat membantu keluarga dalam melakukan perawatan mandiri.
Tuberculosis is an infection desease caused by Mycobacterium Tuberculosis that infected one-third of human in the world. West Java included an area that the number of people affected by this disease quite a lot, one of those area in West Java is Depok. In Kelurahan Cisalak Pasar, found a fimily with adult who infected by tuberculosis about twice. This time, that family is having treatment anti-tuberculosis. During the time, That family had never took increasing activity to solve the problem. Even though, Family is the nearest part of life that had important role. The diagnose of this family’s problem was ineffectiveness of self-healthy management. Nursing care focused on five main roles of family health care. The traetment was to solve the symptom that may occurs. Resporatory excercise could decrease shorthness breathing and increase lungs function. Those treatments were expected to be introduced by health care provider, community, and part of nursing science to help family in performing self-care."
Depok: Fakultas Ilmu Keperawatan Universitas Indonesia, 2013
PR-Pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Siregar, Nina Aspasia Harli
Hubungan kadar retinol serumdengan derajat bacterial load pada pasien tuberkulosis paru kasus baru di puskesmas = Correlationbetween serum retinol level and semi-quantitative bacterial load in new case of pulmonary tuberculosis at a community health center
"Latar belakang dan tujuan: Tuberkulosis (TB) sampai saat ini merupakan tantangan dan ancaman besar bagi kesehatan masyarakat di dunia. Insidens TB paru di kota Bekasi tahun 2014 adalah 1359/2.510.951 penduduk dan 3099 total kasus selama tahun 2014. Defisiensi mikronutrien seperti retinol dapat terjadi akibat hilangnya nafsu makan, gangguan absorbsi usus halus yang menyebabkan keadaan imununosupresi sehingga meningkatkan risiko infeksi TB. Penelitian ini bertujuan untuk mengetahui hubungan antara kadar retinol serum dengan derajat bacterial TB paru kasus baru di tingkat pelayanan primer.
Metode: Penelitian mempergunakan desain potong lintang dengan 135 sampel yang diambil dengan cara cluster consecutive sampling di puskesmas wilayah kota Bekasi pada penderita TB paru kasus baru yang belum mendapatkan terapi obat anti tuberkulosis (OAT).
Hasil: Karakteristik subjek TB paru kasus baru di puskesmas menurut usia dengan nilai tengah 35,5 tahun (IQR 18-65), laki-laki 62,3%, perokok 44,9%, IMT gizi kurang 56,5%, hipoalbumin 17,4%, kadar retinol serum defisien 40,6%. Lesi kavitas 30,4?% dan derajat bacterial load mayoritas scanty dan +1 dengan persentase berturut-turut 10,1% dan 39,1%. Terdapat perbedaan bermakna kadar albumin, IMT, lesi kavitas dengan bacterial load dengan nilai p=0,003, p=0,014, p=0,011 namun tidak terdapat hubungan bermakna antara kadar retinol serum dengan bacterial load.
Kesimpulan: Kadar retinol serum tidak berhubungan dengan derajat bacterial load pasien TB paru kasus baru di wilayah kerja kota Bekasi serta terdapat hubungan bermakna antara IMT, kadar albumin dan lesi radiologis dengan bacterial load.
Background: Tuberculosis (TB) remains a threat for community health across the globe including Indonesia. The incidence of pulmonary TB in Bekasi, Indonesia in 2014 is 1,395/2,510,951 people and there were 3.099 cases in 2014. Micronutrient deficiency such as retinol can be caused by loss of appetite and disorder in intestinal absorption which could lead to immunosuppressive condition that increased the risk of TB. This study aims to find the correlation between serum retinol level and semi-quantitative bacterial load in new case of pulmonary TB at a community health center.
Methods: This cross-sectional study involved 135 subjects collected through cluster consecutive sampling in a primary health care in Bekasi, Indonesia. The study included new pulmonary TB cases which had no history of taking any anti-TB drugs.
Results: The median age of the subjects was 35.5 years old (IQR 18-65) and most of subjects were males (62.3%), smokers (44.9%), had low body mass index (BMI) (56.5%), had hypoalbuminemia (17.4%), serum retinol deficient (40.6%), presented with cavity lesion (30.4%) and presented with scanty and +1 semi-quantitative bacterial load (10.1% and 39.1%, respectively). There was no significant correlation between serum retinol level and semi-quantitative bacterial load. However, there were significant correlations between serum albumin level, BMI and presence of cavity lesion and semi-quantitative bacterial load (p=0.003, p=0.014, and p=0.011, respectively).
Conclusion: There was no correlation between serum retinol level and semi-quantitative bacterial load in new cases of pulmonary TB patients. There were significant correlations between serum albumin level, BMI and presence of cavity lesion and semi-quantitative bacterial load."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2018
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UI - Tugas Akhir  Universitas Indonesia Library
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