Hasil Pencarian  ::  Simpan CSV :: Kembali

"Tujuan: Untuk memahami mekanisme terjadinya resistensi terhadap obat antituberkulosis dengan mempergunakan pendekatan epidemiologik genetik. Bahan dan metode penelitian:Disain penelitian : kasus - kontrol.Tempat: Rumah Sakit Persahabatan, Jakarta, Rumah Sakit Umum dr. M. Jamil, Sumatera Barat dan Rumah Sakit Umum dr. Wahidin Sudirohusodo, Makasar. Laboratorium Mikrobiologi FKUI, Jakarta, Lembaga Biologi Molekuler Eijkman, Jakarta dan Laboratorium Bioteknologi Universitas Padjajaran, Bandung. Lama penelitian: 8 bulan ( Januari 2002 - Agustus 2002 ). Subjek penelitian: Masing-masing 279 sampel dahak yang sensitif dan resisten INH serta 36 sampel dahak yang sensitif dan resisten rifampisin. Bahan: sampel dahak yang dikirim dari ketiga rumah sakit tersebut, diperiksa silang di laboratorium mikrobiologi FKUI, Jakarta, lalu diadakan pemeriksaan PCR dan sequencing di Lembaga Eijkman dan laboratorium BioteknoIogi Universitas Padjajaran, Bandung. Disamping itu dilakukan wawancara untuk mendapatkan keterangan mengenai kepatuhan berobat dan pengobatan yang tidak optimal. Data yang terkumpul dianalisis dengan menggunakan analisis uji statistik. Hasil: Prevalensi resistensi terhadap INH dari ketiga propinsi berkisar dari 11,9 % sampai 15,6 %, prevalensi resistensi terhadap rifampisin berkisar dari 1,3 % sampai 1,6 % dan prevalensi resistensi ganda berkisar dari 0,6 % sampai 1,3 %, M. tuberculosis yang mengalami mutasi padagen katG dari ketiga propinsi didapatkan sebesar 60,2 % dan mempunyai kemungkinan risiko resisten terhadap INH sebesar 32,6 kali bila dibandingkan dengan M. tuberculosis yang tidak mengalami mutasi pada gen katG. M. tuberculosis yang resisten terhadap rifampisin dari ketiga propinsi menunjukkan bahwa semua M tuberculosis tersebut mengalami mutasi padagen rpoB, dimana mutasi gen rpoB pada kodon 516 (16,6 %), kodon 526 (63,8 %), kodon 529 dan kodon 531 masing-masing sebesar 5,5 %. Hal ini dapat dikatakan bahwa M. tuberculosis dari ketiga propinsi yang resisten terhadap INH dan rifampisin mengalami beraneka ragam jenis mutasi (diversity). Di ketiga propinsi, ketidakpatuhan penderita tuberkulosis berobat didapatkan sebesar 56,3 % pada M. tuberculosis resisten terhadap INH dan 75 % M. tuberculosis yang resisten terhadap rifampisin. 65,9 % penderita tuberkulosis yang mendapatkan pengobatan monotherapy mengalami resisten terhadap INH dan 75 % penderita tuberkulosis yang mendapatkan pengobatan tidak optimal mengalami resisten terhadap rifampisin. Mutasi baru gen rpoB pada kodon 529 ditemukan 2 buah yang berasal dari propinsi Jakarta dan propinsi Sumatera Barat. Mutasi baru ini tidak mempunyai dampak klinik dan biologis karena kedua kodon tersebut menyandi asam amino yang lama yaitu arginin.

---

Genetic Epidemiological and Risk Factor Of M. Tuberculosis For Being Resistant To INH And Or RifampicinObjective of the Study: To understand the mechanisms of resistance to antituberculosis drugs by genetic epidemiological study.

Methods and materials of the study:

Study design: Case - control study.

Location: Persahabatan Hospital (Jakarta), M. Jamil General Hospital (West Sumatra), Wahidin Sudirohusodo General Hospital (South Sulawesi), Microbiology Laboratory FKUI (Jakarta), Eijkman Institute for biology molekuler (Jakarta) and Padjadjaran University Biotechnology Laboratory (West Java).

Duration of study: 8 months ( January 2002 - August 2002 ).

Subject: 279 samples sputum each that were sensitive and resistant to NH, 36 sample sputum each that were sensitive and resistant to rifampiscin.

Material of study: - Sputum sample from three hospitals were sent to Microbiology Laboratory FKUI for crosschecking. Subsequently PCR examination and sequencing were performed in Eijkman Institute and Padjadjaran University Biotechnology Laboratory. In addition interviews were conducted to obtain information about patient compliance and optimal treatment. All data were subjected to statistical analysis.

Results: Resistance prevalence to INH from three provinces range from 11.9 % to 15.6 %; resistance prevalence to rifampicin 1.3 % to 1.6 % and multidrug resistant prevalence: 0.6 % to 1.3 %. Mutation on gene katG M. tuberculosis from three provinces were 60.2 % and have a probability resistance risk to INH 32.6 times compared to M. tuberculosis that didn't have mutation on gene katG. All M. tuberculosis resistant to rifampicin isolated from three provinces have a mutation on gene rpoB, on codon 516 (16.66 %), codon 526 (63.8%), codon 529 and codon 531 respectively 5.5 %. This situation showed that M. tuberculosis from three provinces resistant to INH and rifampicin have a diversity mutant, In the three provinces, non compliance from tuberculosis patient - were 56.3 % of M. tuberculosis resistant to INH and 75 % of M. tuberculosis resistant to rifampicin. INH monotherapy result in 65.9 % resistance and sub optimal treatment result in 75 % resistance to rifampicin. Two new mutations have been found in gene rpoB codon 529 from Jakarta and West Sumatra. And this new mutant has no clinical and biology impact because the two codons encode amino acid was same, is arginine.

Conclusions: Resistance prevalence to NH and or rifampicin in three provinces is significantly high despite a good health infrastructure. If this problem occurs in other provinces with difference geographic characteristic, demographic, socioeconomic and health infrastructure, most probably the resistance prevalence to INH and or rifampicin will be much be more pronounced. The development of resistance of M. tuberculosis to INH and or rifampicin is influenced by mutation on gene encoding enzyme catalase peroxidase (katG) and RNA Polymerise ( rpoB ). Non-compliance and sub optimal treatment are selection factors for katG and rpoB mutant.

Recommendations: It is recommended to continue a similar study in the other provinces with difference geographic, demographic, socio economic, health infrastructure and also other study with mutant. For the Department of Health it is recommended to accelerate methods of early detection of tuberculosis cases that are sensitive or resistant to antituberculosis drugs and monitoring system to record and to report tuberculosis cases from other public health services e.g. Private practices, non government clinics, hospitals and institution to ensure continuous availability and quality of controlled drugs."

"Epidemiologi malaria di desa Salubarana dan Kadaila, Kabupaten Mamuju, Provinsi Sulawesi Selatan, Indonesia telah diteliti selama bulan Juli sampai December 2002 untuk mendapatkan data dasar yang berkaitan dengan faktor parasit, vektor, inang, dan lingkungan. Survei malariometrik bulanan selama kurun waktu 6 bulan menemukan suatu prevalensi malaria yang relatif tinggi di Kadaila dibandingkan dengan Salubarana. Kadaila terutama dihuni oleh transmigran dari Jawa, Bali, Lombok dan dari kabupaten lain di Sulawesi Selatan, sedangkan Salubarana dihuni oleh penduduk asli suku Mandar. Pada analisis 1.113 apusan darah yang diperoleh dari individu-individu yang dilibatkan secara acak pada survei ini ditemukan 59 positif malaria, terdiri dari Plasmodium falciparum dan P. vivax. Kedua spesies tersebut mendominasi apusan darah yang diperiksa dan kadang-kadang ditemukan sebagai infeksi campuran. Anopheles barbirostris dikonfirmasi sebagai vektor malaria pada kedua desa, sedangkan 7 spesies lainnya An. barbumbrosus, An. parangensis, An. vagus, An. crawfordi, An. pseudobarbirostris, An. tessellatus dan An. subpictus harus pula dipertimbangkan sebagai vektor. Di kedua desa, An. barbirostris mendominasi dan pada umumnya vektor ini menggunakan genangan air di sungai dan tanah sebagai tempat perindukan serta memiliki kebiasaan istirahat di dalam dan di luar rumah. Temuan-temuan ini dapat digunakan untuk penyusunan suatu program penanggulangan malaria yang berbasis bukti di daerah tersebut. (Med J Indones 2003; 12: 252-8)

---

Malaria epidemiology in Salubarana and Kadaila villages, Mamuju District, South Sulawesi Province, Indonesia was studied from July-December 2002 to obtain baseline data related to the parasite, mosquito vector, human host, and environmental factors. Monthly malariometric surveys conducted during the six- month period revealed a relatively high prevalence of malaria in Kadaila in comparison to Salubarana. Kadaila was mainly inhabited by migrants from Java, Bali, Lombok, and from other districts of South Sulawesi. Salubarana, on the other hand, was inhabited mainly by indigenous Mandarese. Analysis of 1,113 blood smears taken from individuals randomly involved in the survey revealed 59 positive samples, consisting of Plasmodium falciparum or P. vivax. These two species predominated the samples examined and were occasionally found as mixed infection. Anopheles barbirostris was confirmed as a vector for malaria in this area whereas 7 other species An. barbumbrosus, An. parangensis, An. vagus, An. crawfordi, An. pseudobarbirostris, An. Tessellatus, and An. subpictus should be considered as potential vectors. The first mentioned species predominated, using mainly riverbeds and ground pools as breeding places with a habit of indoor or outdoor resting. These findings could be useful for establishing evidence-based malaria control program in the area. (Med J Indones 2003; 12: 252-8)"

"The environment at risk -- Environmental epidemiology -- Environmental toxicology -- Environmental policy and regulation -- Zoonotic and vector-borne diseases -- Toxic metals and elements -- Pesticides and other organic chemicals -- Ionizing and nonionizing radiation -- Water quality -- Air quality -- Food safety -- Solid and liquid wastes -- Occupational health -- Injuries with a focus on unintentional injuries and death"

"Drawing on a wide range of sciences in addition to demography, gerontology, and epidemiology, including medical sociology, biostatistics, public policy, bioethics, and molecular biology. The author treats theoretical and applied issues, links methods and findings, covers the material internationally, nationally, and locally, and while focusing on the elderly, treats the entire life course. The methods, materials, and pespectives of demography and epidemiology are brought to bear on such topics as the prospects for future increases in human longevity, the relative contribution of life style, environment, genetics, and chance in human longevity, the measurement of the share of healthy years in total life expectancy, the role of population growth in the rising costs of health care, and the applications of health demography in serving the health needs of local communities. "

"This book is designed to summarize unique methodological issues relevant to the study of aging, biomarkers of aging and the biology/physiology of aging and in-depth discussions of the etiology and epidemiology of common geriatric syndromes and diseases. Contributing authors in the book represent many disciplines, not only epidemiology and clinical geriatrics, but also demography, health services, research, cardiovascular disease, diabetes, psychiatry, neurology, social services, musculoskeletal diseases and cancer. "

"This book covers the basic concepts of epigenetic epidemiology, discusses challenges in study design, analysis, and interpretation, epigenetic laboratory techniques, the influence of of age and environmental factors on shaping the epigenome, the role of epigenetics in the developmental origins hypothesis, and provides the state of the art on the epigenetic epidemiology of various health conditions including childhood syndromes, cancer, infectious diseases, inflammation and rheumatoid arthritis, asthma, autism and other neurodevelopmental disorders, psychiatric disorders, diabetes, obesity and metabolic disorders, and atherosclerosis."

"Modern methods for epidemiology provides a concise introduction to recent development in statistical methodologies for epidemiological and biomedical researchers."

"This book presents the recent progress in basic and clinical research in Primary Liver Cancer (PLC) in China and around the world. PLC patients in China make up more than 50% of the total patients worldwide. By contributing to the book, the leading experts in the field of liver cancer in China as well as in the US share with readers their new concepts, practices, and experiences from bench to bed, from population study to individual survey, from molecular search to clinical practice, and from early diagnosis to treatment. "

"Mathematical models can be very helpful to understand the transmission dynamics of infectious diseases. This book presents examples of epidemiological models and modeling tools that can assist policymakers to assess and evaluate disease control strategies. Contents: Development and Analysis of Models for Infectious Diseases; Application of Models to Real Disease Data; User-Friendly Modeling Tools for Public Health Policymakers. Readership: Researchers in mathematical biology, mathematical modeling, infectious diseases and complex systems."