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"Penyakit paru-paru akibat bakteri Nontuberculous Mycobacteria (NTM) semakin banyak terdeteksi pada kelompok rentan. Ketahanan NTM terhadap klorin mencapai 1000 kali lipat dibandingkan E. Coli, memungkinkan NTM bertahan di sistem distribusi air. Penelitian ini bertujuan menganalisis konsentrasi dan spesies NTM pada air bersih di rumah tangga dan Rumah Sakit X, serta mengestimasi dosis paparan NTM pada kelompok rentan menggunakan metode quantitative microbial risk assessment (QMRA). Metode penelitian meliputi enumerasi bakteri dengan media Middlebrook M7H10, elektroforesis, PCR, dan sanger sequencing. Rata-rata konsentrasi total NTM di rumah tangga Kecamatan Beji dan Sukmajaya, dengan sumber PDAM dan air tanah, adalah 14,7 CFU/L dan 11,3 CFU/L. Di Rumah Sakit X, konsentrasi rata-rata adalah 5,3 CFU/L. Ditemukan 2 spesies NTM pada 10 isolat (20%), yaitu Gordonia sp., Mycobacterium wolinskyi, dan Mycolicibacterium mucogenicum di rumah tangga, serta Streptomyces sp. di Rumah Sakit X. Estimasi dosis risiko paparan NTM menggunakan QMRA menunjukkan dosis paparan di rumah tangga sebesar 0,00434 CFU dan di Rumah Sakit X sebesar 0,00197 CFU. Meskipun konsentrasi NTM tergolong rendah, diperlukan langkah-langkah pengurangan paparan NTM seperti penggunaan filter dan UV, mengganti jenis perbandingan, serta mengurangi stagnasi air bersih untuk mengurangi risiko kesehatan.

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The incidence of lung Lung diseases caused by Nontuberculous Mycobacteria (NTM) are increasingly detected in vulnerable groups. NTM's resistance to chlorine is up to 1000 times greater than that of E. Coli, allowing NTM to persist in water distribution systems. This study aims to analyze the concentration and species of NTM in household and Hospital X clean water, and to estimate the NTM exposure dose to vulnerable groups using the quantitative microbial risk assessment (QMRA) method. The research methods included bacterial enumeration using Middlebrook M7H10 media, electrophoresis, PCR, and Sanger sequencing. The average total concentration of NTM in households in Beji and Sukmajaya Districts, with PDAM and groundwater sources, was 14.7 CFU/L and 11.3 CFU/L, respectively. At X Hospital, the average concentration was 5.3 CFU/L. Two NTM species were found in 10 isolates (20%), namely Gordonia sp., Mycobacterium wolinskyi, and Mycolicibacterium mucogenicum in households, as well as Streptomyces sp. in X Hospital. The NTM exposure risk dose estimation using QMRA indicated an exposure dose in households of 0.00434 CFU and 0.00197 CFU in Hospital X. Although the NTM concentration was relatively low, measures to reduce NTM exposure, such as using filters and UV, changing disinfectant types, and reducing clean water stagnation, are necessary to mitigate health risks."

"Bakteri patogen,seperti NTM, dapat ditemukan di limgkungan seperti tanah dan perairan alami. Sumber air baku untuk air bersih dari perairan akan diolah di instalasi pengolahan air minum. Meskipun klorin digunakan untuk disinfeksi dalam pengolahan air minum, NTM yang resistem terhadap klorin tetap dapat tumbuh di sistem distribusi perpipaan. Air dari sistem distribusi ini akan mengalir menuju rumah tangga dan fasilitas umum, seperti rumah sakit, kemudian air digunakan melalui shower yang berpotensi melepaskan NTM dalam biofilm sebagai partikel aerosol. Partikel aerosol ini dapat terhirup oleh manusia dan berpotensi menyebabkan penyakit bagi individu yang memiliki sistem kekebalan tubuh yang lemah. Penelitian ini dilakukan di rumah tangga dan Rumah Sakit X di Kecamatan Beji dan Sukmajaya, Kota Depok. Shower di Rumah Sakit X menunjukkan pertumbuhan NTM dalam biofilm yang lebih tinggi dibandingkan rumah tangga. Rata-rata NTM dalam biofilm di rumah tangga adalah 7,00 × 102 CFU/swab pada sumber air tanah, (7,25 ± 5,30) × 102 CFU/swab pada sumber air PDAM, dan (0,85 ± 1,10) × 103 CFU/swab di Rumah Sakit X dengan sumber air PDAM. Sementara itu, perbedaan permukaan shower juga memengaruhi keberadaan NTM pada biofilm yang tumbuh di shower dengan gagang berbahan krom (25%) dan plastik (12,5%). Hasil penelitian pada isolat bakteri dari rumah tangga dan Rumah Sakit X berdasarkan PCR, elektroforesis, dan sanger sequencing, ditemukan dua spesies NTM, yaitu Mycobacterium intracellulare dan Mycobacterium senegalense.

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Pathogenic bacteria, such as NTM, can be found in environments such as soil and natural waters. Raw water sources for clean water from waters will be treated in drinking water treatment plants. Although chlorine is used for disinfection in drinking water treatment, chlorine-resistant NTM can still grow in the piped distribution system. Water from these distribution systems will flow to households and public facilities, such as hospitals, where it is used in showers, potentially releasing NTM in biofilms as aerosol particles. These aerosol particles can be inhaled by humans and potentially cause illness for individuals with weakened immune systems. This study was conducted in households and Hospital X in Beji and Sukmajaya sub-districts, Depok City. Showers in Hospital X showed higher growth of NTM in biofilm than households. The average NTM in biofilm in households was 7.00 × 102 CFU/swab at groundwater source, (7.25 ± 5.30) × 102 CFU/swab at PDAM water source, and (0.85 ± 1.10) × 103 CFU/swab at Hospital X with PDAM water source. Meanwhile, differences in shower surfaces also affected the presence of NTM in biofilms grown in showers with chrome (25%) and plastic (12,5%) handles. The results of research on bacterial isolates from households and Hospital X based on PCR, electrophoresis, and sanger sequencing, found two NTM species, namely Mycobacterium intracellulare and Mycobacterium senegalense."

"Tuberkulosis (TB) sampai dengan saat ini masih merupakan salah satu masalah kesehatanutama di Indonesia. Sepuluh persen dari TB ekstraparu adalah TB tulang, dan sekitar 50%penderita TB tulang menyerang tulang belakang (Spinal Tuberkulosis). Respon tubuhterhadap Mycobacterium tuberculosis (M.tb) sehingga menimbulkan penyebaranekstraparu, khususnya respon makrofag sebagai pertahanan lini pertama, masih belumsepenuhnya dimengerti. Makrofag menghasilkan molekul reactive oxygen species (ROS)sebagai hasil dari oxygen burst untuk mengeliminasi antigen. Nitrat Oksida (NO) danmieloperoksidase (MPO) berperan pada oxygen burst Selain itu, Pada fagositosisterdapat organel lisosom yang di dalamnya terdapat enzim hidrolase (fosfatase asam danbeta glukuronidase) berguna pada pencernaan intraseluler. Penelitian ini mengujihipotesis bahwa ada gangguan fungsi makrofag pada pasien TB tulang belakang. Monositdiisolasi dari peripheral blood mononuclear cells (PBMC) dari lima pasien TB tulangbelakang dan lima orang sehat sebagai kontrol. Monosit yang terisolasi dikultur denganstimulasi dari macrophage colony-stimulating factor (M-CSF) selama tujuh hari untukpematangan. Kemampuan fagositosis makrofag dinilai aktivitasnya terhadapa sel darahmerah 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 bahwamonosit yang diisolasi dari PBMC pasien TB tulang belakang secara signifikan lebihsedikit dibandingkan dengan kelompok kontrol (2992.103 vs 6474.103 (sel / mL)) danjuga lebih sedikit makrofag yang melekat pada sel darah merah domba (SDMD) (264.103vs 598.103 (sel / mL)). Namun, produksi NO (2346 vs 325,17 (μmol / gram protein)), danMPO (570,7 vs 17,4 (unit / mg), beta-glukuronide (0,149 vs 0,123 (unit / mg)), dan asamfosfatase aktivitas (1776,9 vs 287,9 (unit / mg)) dari makrofag kelompok TB tulangbelakang lebih tinggi daripada kelompok yang sehat serta korelasi negatif kuat danbermakna antara fagositosis makrofag dengan tiap variabel tersebut. Selain itu, Terdapatkorelasi positif lemah dan tidak bermakna antara kejadian fagositosis dan uji WST.Meskipun pengenalan rendah pada benda asing, proses makrofag intraseluler, termasukaktivitas oksidatif dan fungsi lisosom, tinggi secara signifikan. Hasil ini menunjukanpenurunan fungsi makrofag pada pasien TB tulang belakang serta terdapat kemungkinanadanya dominasi imunitas non-spesifik bawaan pada infeksi TB tulang belakangTuberculosis (TB) is still one of the main health problems in Indonesia. Ten percent ofextrapulmonary TB is bone TB and about 50% of people with bone TB affected to thespine. The immune response against Mycobacterium tuberculosis (M.tb), which causesextrapulmonary 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) andmyeloperoxidase (MPO) play a role in oxygen burst. Also, phagocytosis process involvedlysosomal organelles in which there are hydrolase enzymes (acid phosphatase and betaglucuronidase),which have important role in intracellular digestion. This study examinedthe hypothesis about impairment of macrophage function in spondylitis TB patients.Monocytes were isolated from peripheral blood mononuclear cells (PBMC) collectedfrom five spinal TB patients and five healthy people as controls. Isolated monocytes werecultured by stimulation of macrophage colony-stimulating factor (M-CSF) for seven daysfor maturation. The phagocytic ability of macrophages is assessed as to their activity onsheep red blood cells. Whereas nitric oxide (NO), myeloperoxidase (MPO), betaglucuronidase,and acid phosphatase activity were investigated by spectrophotometermethods. Data was analyzed using SPSS version 20. We found that monocytes isolatedfrom 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 bloodcells 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 macrophagesin the spondylitis TB group were higher than in the healthy group. There was a strongand significant negative correlation between phagocytosis of macrophages with each ofthe previous variables. There was no significant difference between phagocytic abilityand the WST test. Although the recognition against foreign bodies was low, intracellularmacrophage processes, including oxidative activity and lysosomal function, weresignificantly higher than control. This result showed a decrease of macrophage functionin spondylitis TB patients as well as a possible dominance of non- specific immunity."

"Paparan biologis akibat resistensi antimikroba (AMR), khususnya ESBL E. coli di peternakan, menjadi ancaman kesehatan kerja dan global. Kesehatan dan Keselamatan Kerja (K3) berperan penting dalam melindungi pekerja dari risiko tersebut. Studi ini bertujuan mengidentifikasi hotspot ESBL E. coli di peternakan terpadu dan merancang intervensi optimal berbasis logika fuzzy untuk meningkatkan K3 dalam kerangka One Health. Studi ini menggunakan metode HAZOP – Delphi untuk menentukan 12 lokasi pengambilan sampel secara sistematis. Sebanyak 134 sampel dari berbagai sumber di peternakan dikumpulkan untuk isolasi dan karakterisasi ESBL E. coli, termasuk analisis genom utuh (WGS) terhadap 18 isolat. Paparan pekerja terhadap feses diukur melalui studi eksperimental, dengan memperkirakan fecal ingestion rate. Risiko paparan E. coli dan ESBL E. coli dianalisis menggunakan pendekatan QMRA dan metode William T. Fine. Skenario intervensi K3 – One Health dirancang dan diprioritaskan menggunakan logika fuzzy dua tahap untuk menentukan strategi perlindungan pekerja yang paling efektif. ESBL E. coli ditemukan pada 34,6 (45/130) contoh uji, konsentrasi tertinggi pada pupuk asal unggas (7,4 log₁₀ CFU/g) dan feses broiler (6,7 log₁₀ CFU/g). Analisis WGS menunjukkan adanya gen pembawa kode resisten dan peluang E. coli patogen ekstraintestinal (ExPEC E. coli). Hotspots utama ditetapkan pupuk asal unggas, feses broiler dan feses itik, seluruhnya berada di peternakan unggas. Rata-rata incidental fecal ingestion rate oleh pekerja bervariasi dari 0,3 – 23,5 mg/hari (unggas) dan 6,8 - 8,6 mg/hari (ruminansia). Setelah paparan ESBL E. coli dihitung dari perkalian antara konsentrasi bakteri dengan fecal ingestion rate, diperoleh nilai tertinggi berasal dari pupuk unggas (median >5.000 log10 CFU/d, skor risiko William T. Fine 80 - 110). Usulan intervensi berupa program kontrol K3 – One Health meliputi: substitusi (alat semi-otomatis, reduksi fecal ingestion rate 50%), kontrol teknik (penyimpanan pakan di silo mereduksi paparan E. coli 81,1 – 87,6%; modifikasi pengomposan mereduksi ESBL E. coli 40 - 63%; barrier rumah kompos mereduksi E. coli hampir 100%), dan pemakaian APD (mengurangi ingesti sekitar 99%). Pekerja di area unggas menjadi prioritas, dan program K3 – One Health yang mengkombinasikan reduksi paparan 60 - 100% dengan pemilihan biaya menengah hingga tinggi dipilih berdasarkan logika fuzzy. Diproyeksikan intervensi terpilih mampu mengurangi paparan E. coli dan ESBL E. coli dengan rata-rata reduksi sebesar 62,6% [60.5 – 64.7% CI]. Keberhasilan program juga ditopang oleh platform logika fuzzy dan strategi adaptif lintas sektor peternakan.

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This comprehensive study aimed to identify hotspots of ESBL E. coli in an integrated farm and develop optimal intervention scenarios using fuzzy logic to enhance occupational health and safety (OHS) within the One Health framework. Biological exposure due to antimicrobial resistance (AMR), particularly ESBL E. coli in farms, poses a threat to occupational and global health. OHS plays a crucial role in protecting workers from these risks. This study employed the HAZOP–Delphi method to systematically determine 12 sampling locations. A total of 134 samples from various farm sources were collected for ESBL E. coli isolation and characterization, including whole genome sequencing (WGS) of 18 isolates. Worker exposure to stool was measured experimentally by estimating fecal ingestion rates. The risk of exposure to E. coli and ESBL E. coli was analyzed using QMRA and the William T. Fine methods. OHS–One Health intervention scenarios were designed and prioritized using a two-stage fuzzy logic approach to determine the most effective worker protection strategies. ESBL E. coli was detected in 34.6% (45/130) of samples, with the highest concentrations found in poultry fertilizer (7.4 log₁₀ CFU/g) and broiler stools (6.7 log₁₀ CFU/g). WGS analysis revealed the presence of resistance genes and the potential presence of extraintestinal pathogenic E. coli (ExPEC). Key hotspots were identified as poultry fertilizer, broiler stools, and duck stools, all located in poultry farms. The average incidental fecal ingestion rates by workers ranged from 0.3–23.5 mg/day (poultry) and 6.8–8.6 mg/day (ruminants). Exposure to ESBL E. coli, calculated by multiplying bacterial concentration with ingestion rate, was highest from poultry manure (median >5,000 log₁₀ CFU/day; William T. Fine risk score: 80–110). Proposed interventions for the OHS–One Health program include substitution (semi-automatic tools reducing ingestion rate by 50%), engineering controls (feed storage in silos reducing E. coli exposure by 81.1–87.6%; composting modifications reducing ESBL E. coli by 40–63%; compost house barriers reducing E. coli by nearly 100%), and use of PPE (reducing ingestion by ~99%). Poultry area workers were prioritized, and the selected OHS–One Health program combined 60–100% exposure reduction with medium-to high-cost options, chosen via fuzzy logic. The projected outcome was an average reduction in E. coli and ESBL E. coli exposure by 62.6% [CI: 60.5–64.7%]. The program will be succeeded by fuzzy logic platform adaptation and dynamic cross-sectoral strategies in livestock farming."