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Abstrak :
Tuberculosis is one of 6 fatal infectious diseases in the world, and causes three million deaths annually. Tuberculosis (TB) is a pulmonary and systemic disease caused by My-cobacterium tuberculosis. TB classification consists of pulmonary and extra-pulmonary TB. TB stimulates both the specific and non-specific immune systems. Disseminated tuberculosis is military lung TB with several extra-pulmonary organ manifestations. The main management for multi-organ TB is the administration of anti-tuberculosis drugs. In pleural effusion due to lung TB, corticosteroid may reduce systemic and local reactions to tuberculoprotein, reduce pleural exudate secretion and fibrosis, as well as reduce deformity of the chest wall and scoliosis that can inflict children. We report a case of a 25 year-old woman who came with a chief complaint of progressive breathing difficulty since 2 days prior to admission. Since } year prior to admission, the patient's abdomen became bloated and there was edema in her legs. Her lost her appetite and weight, and suffered from a mild fever. The patient had a cough with thick whitish sputum. The patient had not menstruated for 7 months. She had a history of liver disease. Physical examination results were as follows: the patient was moderately ill, fully conscious, and had malnutrition. She weighed 37 kg and was 149 tall. Her blood pressure was 100/70 mm Hg, her pulse rate 84 times/minute, her body temperature 37" Celsius, and her respiration rate 18 times per minute. Her conjunctiva were pale. Her right supra-clavicular and mandibular lymph nodes had a diameter of 2 cm, were resilient, mobile, not tender, and had smooth surfaces. Her lung sounds demonstrated weakened vesicular sounds in her left lung, with loud rales in both lungs. Her abdomen was enlarged, distended to 92 cm, with venectations. Her liver and spleen could not be assessed. There was undulation and normal bowel sounds. Her extremities were warm and edematous. Her left inguinal lymph node was enlarged to 1 cm, resilient, well-defined, mobile, and not tender. Her left inguinal lymph node was 5 mm in diameter. Her laboratory results were as follows: Hemoglobin level 9.0 g/dl, Hematocryte level 27 vol%, erythrocyte count 3.66 juta/ul, and leukocyte count 14.500/ul. Her chest x-ray demonstrated milliary tuberculosis. Abdominal ultrasound revealed a congestive liver, exudative peritonitis, and a mass in the spleen. Ascites fluid aspiration revealed exudate fluid. Pathological cytology revealed chronic granulomatous inflammation, with the possibility ofTB, and no signs of malignant cells. Ascites fluid microbiological culture turned out negative. During the first echocardiography, no pericardia! effusion was found, and the ejection fraction was 61%. During the second echocardiography, there was thickening of the walls, and pericardial effusion. Catheterization was attempted, but failed due to cyanosis. Electrocardiography demonstrated low voltage at nodes 1, II, aVR, aVL, aVF. The patient was consulted to the retina subdivision, and no tubercle was found. Problem: disseminated TB with pericarditis, ascites due to exudative peritonitis, anemia, malnutrition, and secondary amenorrhea. The patient's condition improved under treatment ofRHZE 300/300/1000/750mg, 3x1 tablet ofB complex vitamins, 3x10 mg ofprednison, 1x100 mg ofaldactone, and 1x1 tablet of provera. Her difficulty breathing alleviated, her waist diameter was reduced to 76 cm.

Abstrak :
Background: The ideal therapy for ascites in liver cirrhosis is a low sodium chat and a combination of furosemide and spironolacton. However; this still sometimes does not produce satisfactory results, even after increasing the dose of the diuretic. Such failure occurs due to the influence ol the Renin Angiotensin Aldosterone (RAA) system. Low doses ol ACE inhibitors (captopril) should improve renal blood llow and increase filtration at the glomeruli, thus increasing natriuresis without causing haemodynamic imbalance. Study aim: To discover the natriuretic and diuretic effects of low dose captopril achuvant in patients with liver cirrhosis who have received furosemide and splronolacton by measuring urinary sodium and 24-hour urine output. Materials and method: This study was conducted on in- and out- patients with liver cirrhosis and Ascites at the Dr. Kariedi Central Public Hospital. Semarang, who met the inclusion and exclusion criteria. The study took place from June 1st, 1997 to March 3st1, 1998, and included 40 cases of liver cirrhosis with ascites. Study design: Open comparative randomized clinical trial with permuted blocks. All of the patients received a low let diet, 40 mg of lurosemide, 3x50 mg of spironolacton for 2 weeks, and patients with a urinary sodium level was below 80 mEq/L were randomized into two groups: group A receiving 3 x 6.25 mg of captopril, and group B receiving standard therapy.

Abstrak :
lnfected ascites is one of the complication happened in liver cirrhotic patient in ascites. There are 5 infected ascites classifications i. e. Spontaneous Ascites Infection Consist of Spontaneous Bacterial Peritonitis, Monomicrobial Non Neurocytic Bacteriascites, Culture Negative Neurovytic Ascites, Secondary Bacterial Peritonitis and Iantrogenic Polimicrobial Bacterascites. Spontaneous Bacterial Peritonitis (SBP) is the infection in ascites without unrecognized intra abdominal infection source. The normal floras in the gastrointestinal, respiratory or urinal tract are the important infection source in SBP. As we know that normal ascites has ability to kill micro organism through phagocitosis function, opsonization, but when infected occurs; phagocitosis function, opsanization, and MPS could be worst so that the possibility of being SBP increased. The commoon frequently sign and symtom of SBP are fever, abdominal pain, consciousness assault,tenderness, diarrhea, paralytic ileus, hypotension and hypothermia. Some of the invasive actions like endoscopy, variceal sclerothrerapy and ligation may cause intestine flora translocation to mesenteric gland bacterimia and infected ascites also made transmural passage intestine micro organism to ascites may cause infected ascites. Cefotaxime is the antibiotic that more frequently studied to SBP patient. The close of cefotaxirne to SBP patient show that 2 grant/6 hours and 2 grain/I2 hours injected produce SBP resolution and the same survival, besides that 2 gram/8 hours injected for 5 and 10 days also show the same effectively. The antibiotic prophylaxis such as quinolon group show the effective result in liver cirrhotic with the gastroentestinal tract bleeding and lout total protein (<1 graim/dl ) or has the SBP experience patients.

Abstrak :
Spontaneous bacterial peritonitis (SBP) is one of serious complication of liver cirrhosis. Most of the patient with SBP have severe reduced liver function that clasified as Child Plugh class C. There are other risk factors for SBP such as poor nutritional status, GI bleeding, intravascular catheter insertion, ascites fluid protein concentration of less than I g/L, large volume paracentesis, urinary tract infection and respiratory tract infection. The management of SBP is mainly the administration of proper antibiotics. The antibiotic of choice for the emperial treatment is cefotaxim.

Abstrak :
Latar Belakang: Pasien sirosis hati berisiko mengalami infeksi bakteri cairan asites melalui jalur translokasi patogen di dalam saluran cerna. Kategori infeksi bakteri cairan asites netrositik meliputi PBS dan ANKN. Baku emas pemeriksaan meliputi jumlah PMN, kultur bakteri dan DNA ribosomal RNA 16S untuk mengkaji adanya patogen bakteri pada cairan asites sirosis hati. Data populasi sel alat analisa hematologi otomatis belum optimal digunakan dan perlu dikaji dalam hal kemampuan mendeteksi infeksi bakteri cairan asites. Tujuan: Mengetahui proporsi, pola patogen, kepekaan terhadap antibiotik pada infeksi bakteri cairan asites sirosis hati dan kemampuan diagnostik 5 parameter hematologi dalam data populasi sel alat analisa hematologi otomatis dengan baku emas jumlah PMN, kultur bakteri dan atau identifikasi adanya materi genetik bakteri dengan DNA ribosomal RNA 16S pada cairan asites. Metode: Penelitian potong lintang pada subjek asites sirosis hati oleh sebab apapun berusia ≥ 18 tahun di 3 rumah sakit rujukan tersier di Jakarta selama 4 Januari - 30 April 2021. Variabel independen terdiri dari HFLC, IG, ANC, NESFL, Delta Ret-Hb, parameter tambahan RNL dengan baku emas jumlah PMN ≥ 250, kultur bakteri positif & atau rt- PCR DNA ribosomal RNA 16S positif dengan nilai CT ≤ 31.1 pada cairan asites netrositik. Hasil: 93% subjek adalah sirosis hati dekompensata CPS ≥ 8. Proporsi infeksi bakteri cairan asites dengan baku emas kultur: PBS 4.1%, ANKN 10.3%, bakterasites 7.1%; kultur dan DNA ribosomal RNA 16S bakteri: PBS 7.1%, ANKN 7.1%, bakterasites 45.9%. Kultur bakteri yang tumbuh 11.2% : gram negatif 54.5%, gram positif 45.4%, tidak ditemukan bakteri anaerob & E. coli. ESBL ditemukan pada E. aerogenes & P. aeruginosa. Nilai diagnostik tunggal diperoleh pada parameter IG (sensitivitas 64.3%, spesifitas 75%), ANC (64.2%, 70.2%) dan RNL (71.4%, 71.4%). Nilai diagnostik gabungan memberikan hasil terbaik pada IG, HFLC, NESFL dengan AUC 0.80 IK 95% 0.68 – 0.92 p <0.001, sensitivitas 66%, spesifitas 84%, yang berasosiasi negatif dengan infeksi bakteri cairan asites netrositik dan menghasilkan sistem skor dengan nilai AUC, sensitivitas dan spesifitas yang sama. Simpulan: Hasil kultur & DNA bakteri memberikan proporsi infeksi bakteri cairan asites (PBS, ANKN, bakterasites) 60.1% dengan bakteri gram positif & negatif yang hampir seimbang. Ditemukan resistensi ESBL. IG, ANC & RNL memiliki nilai diagnostik tunggal. IG, HFLC dan NESFL memiliki nilai diagnostik gabungan serta menghasilkan sistem skor untuk infeksi bakteri cairan asites netrositik (PBS, ANKN). ......ackground: Liver cirrhosis posseses risks to sustain ascitic bacterial infection in peritoneal cavity through GI tract pathogen translocation. Neutrocytic ascites bacterial infection includes SBP & CNNA. Diagnostic gold standards for them are ascitic fluid PMN count, bacterial culture and 16S RNA Ribosomal DNA. Cell population data of automated hematology analyzer is not widely used nor evaluated as part of diagnostic process in ascitic bacterial infection. Objective: To determine proportion, microbial pattern, antibiotic susceptibility, diagnostic values of 5 hematological parameters in cell population data of automated hematology analyzer toward gold standard of ascitic fluid bacterial infection : PMN count, bacterial culture positivity and or positivity identification of 16S RNA ribosomal DNA in liver cirrhosis ascitic fluid . Methods: Cross sectional study of ascitic liver cirrhosis due to any cause in ≥ 18 years old subject conducted in 3 tertiary referral hospitals in Jakarta during 4 January to 30 April 2021. Independent variables consist of HFLC, IG, ANC, NESFL, Delta Ret-Hb with gold standard ascitic fluid of PMN count ≥ 250, bacterial culture positivity and or rt-PCR 16S RNA Ribosomal DNA positivity with CT value ≤ 31.1 in neutrocytic ascitic fluid. Results: There are 93% decompensated liver cirrhosis whose CP ≥ 8. Proportion according to culture: SBP 4.1%, CNNA 10.3%, bacterascites 7.1%, while culture and or 16S ribosomal DNA : SBP 7.1%, CNNA 7.1%, bacterascites 45.9%. Proportion of 11.2% positive bacterial culture consists of gram negative 54.5%, gram positive 45.4% & none of anaerobic bacteria nor E. coli. ESBL is detected in E. aerogenes & P. aeruginosa. Individual diagnostic value includes IG (sensitivity 64.3%, specifity 75%), ANC (64.2%, 70.2%) and additional parameter of LNR (71.4%, 71.4%) . The best combination diagnostic value is found in IG, HFLC, NESFL with AUC 0.80, 95% CI 0.68 – 0.92 p <0.001, sensitivity 66%, spesifity 84% which contains negative association to neutrocytic ascites bacterial infection. It produces a score system with similar AUC, sensitivity and specifity. Conclusions: Culture and bacterial DNA results in ascitic bacterial infection (SBP, CNNA, bacterascites) 60.1% with almost equal proportion of gram positive & negative bacterial culture with ESBL resistance. IG, ANC & LNR have individual diagnostic value in neutrocytic ascitic bacterial infection, otherwise IG, HFLC and NESFL are combined cell population data parameters and yield a score system for neutrocytic ascites bacterial infection (SBP,CNNA).

Abstrak :
The current book focuses on three of these categories, pleuritis, acsites and pericarditis. The presented book reports valuable information about malignant effusions to basic and clinical medical specialists in academia, practice, as well as industry. The main topics considered include contemporary diagnostic approaches and modern therapeutic strategies, including conventional drugs, methods of intracavitary adoptive immunotherapy, chemotherapy and hyperthermia, commercial and experimental drugs being still under study.