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Abstrak :
Pendahuluan : Walaupun pemerintah Indonesia sudah menetapkan programDirect Observed Treatment Short course DOTS dengan ObatAntituberkulosis OAT kombinasi dosis tetap KDT , masih ditemukan kasustuberkulosis TB baru di Indonesia. Informasi tentang perbedaan efektivitasdan efek samping OAT KDT dan OAT dosis lepasan pada fase intensif danfase lanjutan masih merupakan suatu perdebatan. Penelitian ini bertujuan untukmembandingkan efektivitas dan efek samping OAT KDT dengan OAT dosislepasan pada pasien TB paru kasus baru konfirmasi bakteriologis danmengevaluasi penggunaan fase sisipan pada kedua kelompok OAT. Metode : Penelitian retrospektif observasional ini menggunakan datasekunder dari rekam medis pasien TB paru kasus baru konfirmasibakteriologis yang mendapat pengobatan OAT kategori 1 KDT atau OAT dosislepasan dalam periode 1 Januari 2014 sampai dengan 31 Januari 2017.Efektivitas dinilai dari konversi basil tahan asam BTA pada akhir bulan ke 2dan akhir bulan ke 6, serta evaluasi penggunaan fase sisipan pada akhir bulanke 3. Efek samping dinilai dari efek samping obat ESO mayor dan minoryang timbul selama pemakaian OAT KDT atau dosis lepasan. Perbedaanefektivitas dinilai dengan Chi square. Hasil : Data pasien yang mendapat OAT KDT 33 orang dan OAT dosislepasan 30 orang selama periode 1 Januari 2014 ndash; 31 Januari 2017 di RS drEsnawan Antariksa Halim Perdanakusuma Jakarta di evaluasi. Pada akhir faseintensif, proporsi pasien pada kelompok OAT KDT dan lepasan yangmengalami konversi BTA tidak berbeda bermakna 78,8 vs 83,3 , p=0,693 .Pada akhir fase sisipan, 100 pasien kelompok OAT lepasan mengalamikonversi, satu pasien 14,3 pada kelompok KDT gagal konversi dandikeluarkan dari penelitian ini. Semua pasien yang menyelesaikan fase lanjutanpada kedua kelompok mengalami konversi BTA. ESO mayor berupa hepatitisdan reaksi sensitivitas ditemukan lebih banyak pada kelompok KDTdibandingkan lepasan 6.1 vs 0 . ESO minor juga lebih banyakditemukan pada kelompok KDT dibandingkan lepasan 30.3 vs 23.3 . Efeksamping minor yang paling banyak dialami adalah nyeri perut dan mual.Proporsi subjek yang mengalami ESO lebih banyak pada kelompok KDTdibandingkan kelompok lepasan 33,3 vs 23,3. Kesimpulan : Tidak terdapat perbedaan efektivitas dan efek samping OATkategori 1 KDT dibanding dosis lepasan pada fase intensif dan lanjutan. Terdapat keberhasilan konversi pada akhir fase sisipan pada kedua kelompokOAT.

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Introduction : Eventhough Indonesian Government has established DirectObserved Treatment Short Course DOTS program with fixed dosecombination FDC Antituberculosis, new tuberculosis cases continue to occur.Information on differences in effectiveness and adverse drug reactions ADRs of FDC and separate formulations persists. This study aimed to evaluate theeffectiveness and adverse drug reactions of FDC versus separateantituberculosis formulations in new onset bacteriological confirmedpulmonary TB patients and to evaluate the effect of one month extension ofintensive phase in both groups. Methods : A retrospective observational study was conducted using patientdata records. All new onset pulmonary TB patients with recordedbacteriological confirmation and received first category FDC or separate antituberculosis formulations during January 1st 2014 until January 31st 2017 period were included. Efectiveness outcome were determined by Acid fastbacilli sputum smear conversion at the end of intensive phase month 2 andmonth 6 of therapy, and evaluation of extended phase at the end of month 3.Major and minor ADRs occured during antituberculosis treatment wereconsidered as ADRs outcome. The difference on acid bacilli sputum conversions between two groups were analyzed using Chi Square test. Results : Patients treated with FDC n 33 and with separate formulations n 30 during January 1st 2014 to Januari 31st 2017 at dr. Esnawan AntariksaHospital, Halim perdanakusuma Jakarta were evaluated. The rate of sputumsmear conversions at the end of intensive phase was not significantly higher inseparate formulations group as compared with FDC group 83,3 vs 78,7 ,p 0,693 . The intensive phase was extended one more month for patients withconversion failure at month 2, at the end of extended intensive phase, 100 of separate formulation were convertion. One patient 14,3 in FDC group didnot gain sputum conversion during the extended phase and was considered asmedication failure and being excluded from the study. At the end ofcontinuation phase, sputum smear conversions were achieved by all patients inboth groups. Major ADRs hepatitis and hypersensitivity reactions were foundhigher in FDC group as compared with separate formulations group 6.1 vs0 . Minor ADRs also were found higher in FDC group 30.3 vs 23.3 .The most frequently occurred ADRs were abdominal discomfort and nausea. The proportion of subjects with ADRs were higher in FDC than separateformulation group 33,3 vs 23,3. Conclusion : There were no differences in the effectiveness and safety profile of the first category FDC and separate antituberculosis formulations.Successfulconversions occured at the end of the extended intensive phase in both groups.

Abstrak :
Tuberkulosis adalah penyakit infeksius yang menyebabkan kerusakan pada parenkim paru. Pasien dengan tuberkulosis paru akan terjadi peurunan kapasitas vital paru yang akan menimbulkan compliance paru berkurangnya yang berakibat pada penurunan fungsi paru dan juga kualitas hidup pasien. Masalah diatas perlu dilakukannya tindakan dengan melakukan intervensi yoga pranayama dalam upaya meningkatkan kapasitas vital paru dan kualitas hidup pasien post tuberculosis paru. Tujuan penelitian ini untuk mengetahui Pengaruh latihan yoga pranayama dalam meningkatkan kapasitas vital paru dan kualitas hidup pasien post tuberkulosis Paru. Metode yang digunakan dengan jenis penelitian kuantitatif dengan desain penelitan quasi ekspenmen dengan Pre Test and Post Test With Control Group Design. Jumlah responden yang akan digunakan yaitu sebanyak 60 yang terdiri dari 30 responden kelompok intervensi dan 30 responden kelompok kontrol. Hasil penelitian menunjukan latihan yoga pranayama sebelum dan sesudah intervensi. Selisih perbedaan perubahan nilai kapasitas vital paru setelah intervensi antara kelompok intervensi dan kontrol menunjukan tidak adanya perbedaan yang bermakna (p value 0,236) dan (p value 0,912). Hasil ini menunjukkan bahwa Yoga pranayama efektif dalam meningkatkan kapasitas vital paru. Oleh karena itu, yoga pranayama direkomendasikan dapat menjadi terapi komplementer untuk meningkatkan kapasias vital paru pada pasien post tuberkulosis Paru. ...... Tuberculosis is an infectious disease that caused damage of lung parenchyma. Patients with pulmonary tuberculosis experienced of decreasing the lung’s vital capacity which lead to reduce of lung compliance, decreased lung function, and furthermore affecting patient’s quality of life. The problems can be solved by conducting yoga pranayama intervention as an effort to increase the lung vital capacity and also quality of life patient post pulmonary tuberculosis infection. The purpose of this study was to determine the effect of yoga pranayama practice in increasing lung vital capacity and quality of life patient post-pulmonary tuberculosis infection. The method was used a quantitative research with a quasi-experimental research design using pre and post test with a control group. This study was used 60 respondent consist of 30 respondent as intervention group and 30 respondent as control group. This study found that before and after yoga pranayama intervention gave a significant effect on value of the lung vital capacity (p value 0.000). The difference changes value of lung vital capacity after intervention among the intervention and control groups showed that no significant difference (p value 0.236) and (p value 0.912). These results indicated yoga pranayama was effective to increase the vital capacity of lungs. Therefore, yoga pranayama is recommended as a complementary therapy to increase lung vital capacity on post-pulmonary tuberculosis patients.

Abstrak :
Tuberkulosis (TB) sampai dengan saat ini masih merupakan salah satu masalah kesehatan utama di Indonesia. Sepuluh persen dari TB ekstraparu adalah TB tulang, dan sekitar 50% penderita TB tulang menyerang tulang belakang (Spinal Tuberkulosis). Respon tubuh terhadap Mycobacterium tuberculosis (M.tb) sehingga menimbulkan penyebaran ekstraparu, khususnya respon makrofag sebagai pertahanan lini pertama, masih belum sepenuhnya dimengerti. Makrofag menghasilkan molekul reactive oxygen species (ROS) sebagai hasil dari oxygen burst untuk mengeliminasi antigen. Nitrat Oksida (NO) dan mieloperoksidase (MPO) berperan pada oxygen burst Selain itu, Pada fagositosis terdapat organel lisosom yang di dalamnya terdapat enzim hidrolase (fosfatase asam dan beta glukuronidase) berguna pada pencernaan intraseluler. Penelitian ini menguji hipotesis bahwa ada gangguan fungsi makrofag pada pasien TB tulang belakang. Monosit diisolasi dari peripheral blood mononuclear cells (PBMC) dari lima pasien TB tulang belakang dan lima orang sehat sebagai kontrol. Monosit yang terisolasi dikultur dengan stimulasi dari macrophage colony-stimulating factor (M-CSF) selama tujuh hari untuk pematangan. Kemampuan fagositosis makrofag dinilai aktivitasnya terhadapa sel darah merah domba (SDMD). Sedangkan nitrat oksida (NO), mieloperoksidase (MPO), betaglukuronidase, dan aktivitas fosfatase asam diselidiki dengan metode spektrofotometer. Analisis data dengan menggunakan aplikasi SPSS versi 20. Kami menemukan bahwa monosit yang diisolasi dari PBMC pasien TB tulang belakang secara signifikan lebih sedikit dibandingkan dengan kelompok kontrol (2992.103 vs 6474.103 (sel / mL)) dan juga lebih sedikit makrofag yang melekat pada sel darah merah domba (SDMD) (264.103 vs 598.103 (sel / mL)). Namun, produksi NO (2346 vs 325,17 (μmol / gram protein)), dan MPO (570,7 vs 17,4 (unit / mg), beta-glukuronide (0,149 vs 0,123 (unit / mg)), dan asam fosfatase aktivitas (1776,9 vs 287,9 (unit / mg)) dari makrofag kelompok TB tulang belakang lebih tinggi daripada kelompok yang sehat serta korelasi negatif kuat dan bermakna antara fagositosis makrofag dengan tiap variabel tersebut. Selain itu, Terdapat korelasi positif lemah dan tidak bermakna antara kejadian fagositosis dan uji WST. Meskipun pengenalan rendah pada benda asing, proses makrofag intraseluler, termasuk aktivitas oksidatif dan fungsi lisosom, tinggi secara signifikan. Hasil ini menunjukan penurunan fungsi makrofag pada pasien TB tulang belakang serta terdapat kemungkinan adanya dominasi imunitas non-spesifik bawaan pada infeksi TB tulang belakang Tuberculosis (TB) is still one of the main health problems in Indonesia. Ten percent of extrapulmonary TB is bone TB and about 50% of people with bone TB affected to the spine. The immune response against Mycobacterium tuberculosis (M.tb), which causes extrapulmonary spread, particularly the response of macrophages as a first-line defense, is still not fully understood. Macrophages produce reactive oxygen species (ROS) molecules as a result of oxygen bursts to eliminate antigens. Nitric Oxide (NO) and myeloperoxidase (MPO) play a role in oxygen burst. Also, phagocytosis process involved lysosomal organelles in which there are hydrolase enzymes (acid phosphatase and betaglucuronidase), which have important role in intracellular digestion. This study examined the hypothesis about impairment of macrophage function in spondylitis TB patients. Monocytes were isolated from peripheral blood mononuclear cells (PBMC) collected from five spinal TB patients and five healthy people as controls. Isolated monocytes were cultured by stimulation of macrophage colony-stimulating factor (M-CSF) for seven days for maturation. The phagocytic ability of macrophages is assessed as to their activity on sheep red blood cells. Whereas nitric oxide (NO), myeloperoxidase (MPO), betaglucuronidase, and acid phosphatase activity were investigated by spectrophotometer methods. Data was analyzed using SPSS version 20. We found that monocytes isolated from PBMC of spondylitis TB patients were significantly less than in the control group (2992,103 vs 6474,103 (cells / mL)) and also fewer macrophages attached to red blood cells sheep (264,103 vs 598,103 (cells / mL)). However, NO production (2346 vs 325.17 (μmol / gram protein)), MPO (570.7 vs. 17.4 (units/mg), beta-glucuronide (0.149 vs 0.123 (units/mg)), and acids phosphatase activity (1776.9 vs 287.9 (units/mg)) of macrophages in the spondylitis TB group were higher than in the healthy group. There was a strong and significant negative correlation between phagocytosis of macrophages with each of the previous variables. There was no significant difference between phagocytic ability and the WST test. Although the recognition against foreign bodies was low, intracellular macrophage processes, including oxidative activity and lysosomal function, were significantly higher than control. This result showed a decrease of macrophage function in spondylitis TB patients as well as a possible dominance of non- specific immunity.

Abstrak :
Disertasi ini membahas hubungan varian genotip alel G gen CD209 titik promoter -336 terhadap kejadian Infeksi oportunistik TB Paru Pada ODHA, dengan rancangan potong lintang. Data infeksi oportunistik TB Paru  diperoleh dari catatan rekam medik RSPI Sulianti Saroso, sedangkan adanya penentuan varian genotip alel A/G gen CD209 titik promoter-336 dari pemeriksaan PCR dan analisis sekuensing. Analisis data menggunakan regresi cox. Hasil penelitian menunjukkan ada hubungan alel G gen CD209 titik promoter-336 terhadap kejadian infeksi oportunistik TB Paru (PR 1,57 p=0,235, CI: 0,74-3,32). Alel G gen CD209 titik promoter -336 merupakan faktor risiko pada perempuan terhadap kejadian infeksi oportunistik TB Paru (PR 1,75 p=0,11, CI;0,97-3,14). Alel G gen CD209 titik promoter-336 pada malnutrisi terdapat hubungan terhadap kejadian infeksi oportunistik TB Paru (PR 2,1 p=0,22, Cl; 0,68-6,39). Alel G gen CD209 titik promoter-336 pada kelompok umur diatas 50 tahun  berisiko 3,5 kali mengalami kejadian infeksi oportunistik TB Paru (PR 3,5 p=0,07, Cl;1,09-11,3). Adanya riwayat kontak TB Paru serumah dengan alel G gen CD209 titik promoter-336 juga berisiko 1,5 kali dapat mencetuskan kejadian infeksi oportunistik TB Paru, walaupun tidak signifikan (PR 1,5 p=0,36, Cl 0,85-2,73).

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This dissertation discusses the association effect of genotype variant G allele promoter-336 CD209 gene in evidence pulmonary tuberculosa opportunistic infection in HIV/AIDS with cross sectional study. Pulmonary tuberculosa opportunistic infection data were obtained from the medical records of Sulianti Saroso hospital, while genotype variant G allele promoter-336 CD209 gene data were isolated from peripheral blood mononuclear cells and granulocytes obtained from the blood patients using salting out procedure-336 A/G (rs4804803). Genotyping of CD209 gene variants were studied using  PCR. The sequences of primers, restriction digestion enzymes used and restriction digestion pattern for different alleles. Data were analyzed using cox regression. The result of study showed association of G allele CD209 gene in evidence pulmonary tuberculosa opportunistic infection in HIV/AIDS (PR 1,57 p=0,235, CI: 0,74-3,32) G allele CD209 gene as risk factor for women in evidence pulmonary tuberculosa opportunistic infection in HIV/AIDS (PR 1,75 p=0,11, CI;0,97-3,14). Allele G in CD209 gene has also a strong association for malnutrition in evidence pulmonary tuberculosa opportunistic infection in HIV/AIDS (PR 2,1 p=0,22, Cl; 0,68-6,39). Risk factor of pulmonary tuberculosa opportunistic infection in HIV/AIDS has effects of G allele CD209 gene on ages group over 50 y about 3,5 (PR 3,5 p=0,07, Cl;1,09-11,3). and household pulmonary tuberculosa contact, about 1,5 (PR 1,5  p=0,36, Cl 0,85-2,73).

Abstrak :
Indonesia termasuk ke dalam kriteria negara 'high-burden' dengan insidensi TB yang masih tinggi. Indonesia masuk kedalam kriteria ini karena tingginya data epidemiologis kasus TB-HIV dan TB-MDR. Spesimen klinis terbanyak yang diolah untuk kultur TB adalah sputum, yang mengandung banyak kontaminan dari flora normal tenggorok. Salah satu metode kultur TB yang ideal adalah dengan mengembangkan larutan yang mudah didapat serta efektif tanpa banyak membunuh basil TB. Bleach adalah larutan yang murah dan diketahui secara luas sebagai disinfektan yang baik sehingga dapat dijadikan alternatif. Penelitian dilaksanakan di laboratorium TB LMK FK UI RSCM menggunakan 35 sampel dengan BTA positif. Setiap sampel dibagi dalam 4 kelompok dengan metode dekontaminasi yang berbeda. Keempat metode tersebut menggunakan 4 NaOH, 2 NALC-NaOH, 5 asam oksalat dan 1 bleach. Larutan 1 bleach disiapkan dari larutan pemutih komersial yang ada di pasaran. Setiap kelompok perlakuan dihitung proprsi kontaminasi dan kultur positif. Kultur positif divalidasi menggunakan MPT 64. Hasil penelitian menunjukkan subyek dengan BTA 1 sebanyak 46, BTA 2 37 dan BTA 3 sebanyak 17. Bleach merupakan kelompok dengan proporsi kontaminasi terbaik sebesar 2.8 dibanding 4 NaOH sebesar 5.7, dengan perbedaan proporsi kontaminasi yang signifikan p=0.000. Terdapat perbedaan signifikan antar kelompok dalam proporsi kultur positif p=0.006, tetapi pada uji post hoc tidak ada perbedaan bermakna antara 1 bleach, 4 NaOH dan 2 NALC-NaOH. Kesimpulan penelitian ini, 1 bleach dapat digunakan untuk dekontaminan pada kultur TB dengan harga yang lebih murah, terutama pada sampel BTA 2 keatas serta terkontaminasi berat. ...... Indonesia remains one of 22 high burden countries with highly tuberculosis TB incidence according to WHO. There are a lot of numbers of TB HIV and TB ndash MDR in Indonesia. As most processed clinical specimen for TB culture, sputum is contaminated by normal flora from oropharyngeal tract. The best method to establish appropriate culture from sputum is establishing a safe solution for the laboratory worker without kills numerous TB bacilli, preferred economic and easy prepared solution. Bleach is well known as cheap and good disinfectant that could use as an alternative. The research was aimed to compare the capability as bleach as decontaminat solution to other solution. The study was conducted at TB laboratory of FMUI, by using 35 samples sputum with positive AFS, 3 5 ml. Each sample was divided into 4 groups which was decontaminated by different methods. The methods are 4 NaOH, 2 NALC NaOH, 5 oxalic acid and 1 bleach. 1 Bleach was prepared from commercially bleach. Each group was assessed for contamination and culture positive rate. The positive culture was validated using MPT 64. The number of positive AFS were 1 46, 2 37 and 3 17. Bleach had the best contamination rate which was 2.8 compared to 4 NaOH 5.7, and significant difference among 4 groups p 0.000. There was also significant difference among 4 groups in positive culture proportion p 0.006, but there wasn rsquo t signficant different between 1 bleach, 4 NaOH and 2 NALC NaOH. Conclusion of this study is, 1 bleach can be used as an alternative solution for decontamination of TB culture from highly contaminated sputum with AFB higher than 2.

Abstrak :
Summary: The authors discuss fundamental questions about the biology, genetics, mechanisms of pathogenicity, mechanisms of resistance, and drug development strategies that are likely to provide important new knowledge about TB and new interventions to prevent and treat this disease