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Cut Antara Keumala Muda
Prevalensi antigen Cryptococcus pada serum pasien terinfeksi HIV pra ARV = Prevalence of serum Cryptococcal antigen in PWHIV Pre-ART
"Latar Belakang: Meningitis Cryptococcus merupakan infeksi oportunistik penting pada penderita AIDS dan menduduki urutan ke tiga infeksi otak. Angka kejadian meningitis Cryptococcus secara umum sebesar 957 900 kasus per tahun. Angka kejadian di Indonesia sekitar 5-30%, dan di Jakarta sebesar 21,9%. Angka kejadian tersebut tampaknya belum mencerminkan kondisi sebenarnya, mungkin karena gejala klinis yang tidak khas dan diagnosis pasti memerlukan cairan otak yang sulit didapat. Diperlukan metode lain untuk membantu keputusan klinis saat pungsi lumbal belum dapat dilakukan sehingga prevalensi kriptokokosis yang sesungguhnya diketahui.
Tujuan: Mengetahui prevalensi kriptokokosis pada pasien terinfeksi HIV pra ARV di UPT HIV RSCM.
Metode penelitian: Studi potong lintang dilakukan sejak Mei - Juli 2013. Subjek penelitian adalah pasien terinfeksi HIV pra ARV. Antigen serum Cryptococcus diperiksa dengan metode lateral flow immunoassay (LFA).
Hasil: Dari 78 subjek penelitian, sebanyak 59% adalah laki-laki, berusia 18-68 tahun. Kadar CD4 berkisar antara 2-754 sel/mm3, dan 68% dengan CD4 <200 sel/mm3. Sebanyak lima (6,4%) subjek positif antigen serum Cryptococcus, dua diantaranya dilakukan pungsi lumbal dengan hasil tidak dijumpai Cryptococcus. Kedua subjek ini mendapat terapi flukonazol oral dan hidup sampai saat ini. Tiga subjek lain menolak tatalaksana dan meninggal empat minggu kemudian.
Simpulan: Prevalensi kriptokokosis pada pasien terinfeksi HIV pra ARV di UPT HIV-RSCM sebesar 6,4%.
Background: Cryptococcal meningitis is prominent opportunistic infections occur in PWHIV and seats as the third most frequent brain infection. In general, Meningitis Cryptococcal reach 957 900 cases per year. It is estimated that the prevalence rate is 21.9% and 5 - 30% for Jakarta and Indonesia, respectively. It does not reflect the real number, which might be due to unspecific clinical symptoms. In making diagnosis, it requires cerebrospinal fluid that is challenging to obtain. Other method is needed to feeding clinical decision, when lumbal puncture cannot be performed. Thus, real Cryptococcal prevalence is known.
Aim: To ascertain Cryptococcal prevalence among pre-ART PWHIV at Integrated HIV Clinic, Cipto Mangunkusumo Hospital.
Method: This study using cross-sectional design conducted from May – July 2013 at the HIV clinic. Participants of the study were patients who have not started ART. Cryptococcal serum antigen was tested using LFA.
Results: Of 78 participants, 59% male, age 18 - 68 year old. CD4 countvaried from 2 - 754 cell/mm3, where 68% had CD4 count <200 cell/mm3. Five participants (6.4%) were positive to Cryptococcal serum antigen, whereas two run lumbal puncture which showing negative result for Cryptoccus. They received oral fluconazole treatment and have survived until present. The rest refused thetreatment and passed away four weeks later.
Conclusion: Cryptococcosis prevalence among pre-ART PWHIV at Integrated HIV clinic, Cipto Mangunkusumo Hospital is 6.4%."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2013
SP-Pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Nita Nurhidayati
Optimasi real time polymerase chain reaction untuk deteksi cytomegalovirus pada sampel plasma, urin, dan liquour cerebrospinal pasien Human Immunodeficiency Virus dengan tersangka infeksi otak. = Optimization of real time polymerase chain reaction for detection of cytomegalovirus in plasma, urine, and liquor cerebrospinal samples from Human Immunodeficiency Virus positive patients with suspected central nervous system infections
"ABSTRAK
Latar belakang : Cytomegalovirus (CMV) merupakan salah satu infeksi oportunistik
pada pasien dengan sindrom immunodefisiensi (AIDS). Gejala klinis dan CT scan
tidak dapat menegakkan diagnosa definitif ensefalitis CMV. Oleh karena itu
diperlukan uji alternatif untuk menegakkan diagnosis infeksi CMV pada pasien HIV
dengan infeksi otak. Salah satu uji yang sensitif dan spesifik adalah Real Time
Polymerase Chain Reaction (rPCR).
Tujuan : Mendapatkan uji deteksi molekular CMV pada pasien HIV dengan
tersangka infeksi otak.
Metode : Penelitian dilakukan dalam 3 tahap. Tahap 1 adalah optimasi konsentrasi
primer, probe, suhu annealing, volume elusi ekstraksi DNA, dan volume cetakan.
Tahap 2 adalah uji spesifisitas (reaksi silang) dan uji sensitivitas (ambang batas
deteksi DNA) rPCR dan tahap 3 adalah penerapan uji rPCR yang sudah dioptimasi
terhadap sampel plasma, urin, dan LCS.
Hasil : Kondisi optimal uji rPCR telah diperoleh dengan konsentrasi primer dan
probe 0,1 μM, dengan kondisi suhu reaksi rPCR: aktivasi enzim pada 950C selama 3
menit; 45 siklus pada 950C selama 15 detik (denaturasi) dan 560C selama 1 menit
(annealing dan ekstensi). Volume elusi ekstraksi DNA yang optimal untuk ketiga
jenis sampel (LCS, plasma dan urin) adalah 40 μL, dan volume cetakan rPCR untuk
LCS, plasma, dan urin, masing-masing adalah 5, 4, dan 3 μL. Uji rPCR mampu
mendeteksi DNA pada 50.000 jumlah kopi/mL dan tidak bereaksi silang dengan
Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus,
Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Mycobacterium
tuberculosis, Candida spp, Toxoplasma gondii, EBV,HSV,dan VZV. Penerapan uji
rPCR pada sampel klinis memberikan hasil negatif pada semua sampel LCS, 72,22%
positif pada sampel plasma, dan 72,22% positif pada sampel urin.
Kesimpulan: Telah dilakukan optimasi uji rPCR dengan minimal deteksi DNA
CMV 50.000 jumlah kopi/mL dan tidak bereaksi silang dengan mikroorganisme yang
berpotensi menyebabkan positif palsu (false positive).ABSTRACT
Background: Cytomegalovirus (CMV) is one of opportunistic infections in patients
with Aquired Immunodeficiency Syndrome (AIDS). Clinical manifestations are not
typical, and CT scans can not define encephalitis CMV specifically. Therefore, it is
important to apply an alternative assay for sensitive and specific detection of CMV
infection in HIV patients with suspected central nervous system (CNS) infections.
One of the assays is real time polymerase chain reaction (rPCR).
Objective: To obtain a molecular assay for detection of CMV in HIV patients with
suspect CNS infections.
Methods: This study was conducted in three phases. The first is optimization of
concentrations of primers, probe, annealing temperature, final elution of DNA
extraction, and volume of PCR template. The second is determinations of sensitivity
(minimal detection of DNA) and specificity (cross-reaction) of the optimized rPCR,
and the third is application of the rPCR for clinical samples of plasma, urine, and
liquor cerebrospinal (LCS).
Results: The rPCR reaction showed optimal concentrations of primers and probe at
0.1 μM, with thermal cycler: 950C for 3 min (enzyme activation), followed by 45
cycles of 950C for 15 sec (denaturation) and 560C for 1 min (annealing and
extension). Final elution of DNA extraction was 40 μL and volume of PCR templates
for urine, plasma, and LCS was 3, 4, and 5 μL, respectively. The rPCR had minimal
detection of DNA at 50,000 copies/mL and was not cross-reacted with
Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus,
Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Mycobacterium
tuberculosis, Candida spp, Toxoplasma gondii, Epstein-Bar Virus (EBV), Herpes
Simplex Virus (HSV) and Varicella Zoster Virus (VZV). Application of rPCR for
clinical samples showed that the rPCR yielded 72.22% positive for plasma or urine,
and negative for all LCS samples.
Conclusion: The rPCR has been optimized in this study with minimal DNA detection
at 50,000 copies/mL and was not cross-reacted with other microorganisms that are
potential to cause false positive results.;Background: Cytomegalovirus (CMV) is one of opportunistic infections in patients
with Aquired Immunodeficiency Syndrome (AIDS). Clinical manifestations are not
typical, and CT scans can not define encephalitis CMV specifically. Therefore, it is
important to apply an alternative assay for sensitive and specific detection of CMV
infection in HIV patients with suspected central nervous system (CNS) infections.
One of the assays is real time polymerase chain reaction (rPCR).
Objective: To obtain a molecular assay for detection of CMV in HIV patients with
suspect CNS infections.
Methods: This study was conducted in three phases. The first is optimization of
concentrations of primers, probe, annealing temperature, final elution of DNA
extraction, and volume of PCR template. The second is determinations of sensitivity
(minimal detection of DNA) and specificity (cross-reaction) of the optimized rPCR,
and the third is application of the rPCR for clinical samples of plasma, urine, and
liquor cerebrospinal (LCS).
Results: The rPCR reaction showed optimal concentrations of primers and probe at
0.1 μM, with thermal cycler: 950C for 3 min (enzyme activation), followed by 45
cycles of 950C for 15 sec (denaturation) and 560C for 1 min (annealing and
extension). Final elution of DNA extraction was 40 μL and volume of PCR templates
for urine, plasma, and LCS was 3, 4, and 5 μL, respectively. The rPCR had minimal
detection of DNA at 50,000 copies/mL and was not cross-reacted with
Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus,
Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Mycobacterium
tuberculosis, Candida spp, Toxoplasma gondii, Epstein-Bar Virus (EBV), Herpes
Simplex Virus (HSV) and Varicella Zoster Virus (VZV). Application of rPCR for
clinical samples showed that the rPCR yielded 72.22% positive for plasma or urine,
and negative for all LCS samples.
Conclusion: The rPCR has been optimized in this study with minimal DNA detection
at 50,000 copies/mL and was not cross-reacted with other microorganisms that are
potential to cause false positive results.;Background: Cytomegalovirus (CMV) is one of opportunistic infections in patients
with Aquired Immunodeficiency Syndrome (AIDS). Clinical manifestations are not
typical, and CT scans can not define encephalitis CMV specifically. Therefore, it is
important to apply an alternative assay for sensitive and specific detection of CMV
infection in HIV patients with suspected central nervous system (CNS) infections.
One of the assays is real time polymerase chain reaction (rPCR).
Objective: To obtain a molecular assay for detection of CMV in HIV patients with
suspect CNS infections.
Methods: This study was conducted in three phases. The first is optimization of
concentrations of primers, probe, annealing temperature, final elution of DNA
extraction, and volume of PCR template. The second is determinations of sensitivity
(minimal detection of DNA) and specificity (cross-reaction) of the optimized rPCR,
and the third is application of the rPCR for clinical samples of plasma, urine, and
liquor cerebrospinal (LCS).
Results: The rPCR reaction showed optimal concentrations of primers and probe at
0.1 μM, with thermal cycler: 950C for 3 min (enzyme activation), followed by 45
cycles of 950C for 15 sec (denaturation) and 560C for 1 min (annealing and
extension). Final elution of DNA extraction was 40 μL and volume of PCR templates
for urine, plasma, and LCS was 3, 4, and 5 μL, respectively. The rPCR had minimal
detection of DNA at 50,000 copies/mL and was not cross-reacted with
Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus,
Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Mycobacterium
tuberculosis, Candida spp, Toxoplasma gondii, Epstein-Bar Virus (EBV), Herpes
Simplex Virus (HSV) and Varicella Zoster Virus (VZV). Application of rPCR for
clinical samples showed that the rPCR yielded 72.22% positive for plasma or urine,
and negative for all LCS samples.
Conclusion: The rPCR has been optimized in this study with minimal DNA detection
at 50,000 copies/mL and was not cross-reacted with other microorganisms that are
potential to cause false positive results.;Background: Cytomegalovirus (CMV) is one of opportunistic infections in patients
with Aquired Immunodeficiency Syndrome (AIDS). Clinical manifestations are not
typical, and CT scans can not define encephalitis CMV specifically. Therefore, it is
important to apply an alternative assay for sensitive and specific detection of CMV
infection in HIV patients with suspected central nervous system (CNS) infections.
One of the assays is real time polymerase chain reaction (rPCR).
Objective: To obtain a molecular assay for detection of CMV in HIV patients with
suspect CNS infections.
Methods: This study was conducted in three phases. The first is optimization of
concentrations of primers, probe, annealing temperature, final elution of DNA
extraction, and volume of PCR template. The second is determinations of sensitivity
(minimal detection of DNA) and specificity (cross-reaction) of the optimized rPCR,
and the third is application of the rPCR for clinical samples of plasma, urine, and
liquor cerebrospinal (LCS).
Results: The rPCR reaction showed optimal concentrations of primers and probe at
0.1 μM, with thermal cycler: 950C for 3 min (enzyme activation), followed by 45
cycles of 950C for 15 sec (denaturation) and 560C for 1 min (annealing and
extension). Final elution of DNA extraction was 40 μL and volume of PCR templates
for urine, plasma, and LCS was 3, 4, and 5 μL, respectively. The rPCR had minimal
detection of DNA at 50,000 copies/mL and was not cross-reacted with
Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus,
Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Mycobacterium
tuberculosis, Candida spp, Toxoplasma gondii, Epstein-Bar Virus (EBV), Herpes
Simplex Virus (HSV) and Varicella Zoster Virus (VZV). Application of rPCR for
clinical samples showed that the rPCR yielded 72.22% positive for plasma or urine,
and negative for all LCS samples.
Conclusion: The rPCR has been optimized in this study with minimal DNA detection
at 50,000 copies/mL and was not cross-reacted with other microorganisms that are
potential to cause false positive results."
Fakultas Kedokteran Universitas Indonesia, 2016
Sp-PDF
UI - Tugas Akhir  Universitas Indonesia Library
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Yuni Kirana Wulandari
Deteksi basil tahan asam cairan serebrospinal metode sitosentrifugasi dengan ziehl neelsen dan auramine-o pada tersangka meningitis tuberkulosis = Detection of acid fast bacilli in cerebrospinal fluid by cytocentrifugation method with ziehl neelsen and auramine-o on suspected tuberculous meningitis / Yuni Kirana Wulandari
"ABSTRAK
Pendahuluan : Deteksi Basil Tahan Asam (BTA) Ziehl Neelsen cairan serebrospinal (CSS) di RSUPN dr Cipto Mangunkusumo tahun 2014 tidak pernah positif. Pewarnaan Auramine-O dapat meningkatkan sensitivitas deteksi BTA. Perlu modifikasi sitosentrifugasi pada pulasan BTA, agar dapat deteksi BTA lebih banyak dan cepat.
Metode: uji diagnostik pulasan BTA CSS Ziehl Neelsen metode non sitosentrifugasi, Cytospin, Cytopro serta Auramine-O Cytopro dibandingkan dengan baku emas biakan TB MGIT.
Hasil: Uji diagnostik BTA Ziehl Neelsen tanpa sitosentrifugasi, tidak dapat dinilai karena BTA tidak terdeteksi di semua sampel. Uji diagnostik Ziehl Neelsen Cytospin dan Cytopro sama yaitu sensitivitas 64%, spesifisitas 85%, NPP 54%, NPN 89 %. Uji diagnostik Auramine-O Cytopro, sensitivitas 91%, spesifisitas 26%, NPP 26%, NPN 91 %.
Kesimpulan: Pulasan BTA CSS metode sitosentrifugasi dapat menggantikan metode non sitosentrifugasi. Pulasan BTA CSS Auramine-O dapat me rule out diagnosis meningitis TB.
ABSTRACT
Introduction: Detection of AFB from CSF with Ziehl Neelsen staining in 2014 at dr Cipto Mangunkusumo general hospital never gives positive result. Staining with Auramine-O smear staining can increase its sensitivity. Acid fast bacilli cytocentrifugation is needed as a modification in AFB slide preparation to gain more bacilli faster.
Methods: Diagnostic perfomance of AFB slide prepared by non cytocentrifugation, Cytospin, Cytopro with Ziehl Neelsen stain, prepared by cytopro with Auramine-O stain are compared to TB MGIT as a gold standard.
Results: Acid fast bacilli slide prepared with non cytocentrifugation method and stained by Ziehl Neelsen cannot be obtained because AFB was not detected in all samples. Acid fast bacilli slide prepared with Cytospin and Cytopro and stained with Ziehl Neelsen has sensitivity (64%), specificity (85%), PPV (54%), 89% NPV. Acid fast bacilli slide prepared with Cytopro and stained with Auramine-O has sensitivity (91%), specificity (26%), PPV (26%), 91 % NPV.
Conclusion: Detection of AFB from CSF with cytocentrifugation method can replace non cytocentrifugation method. Acid fast bacilli slide prepared cytocentrifugation and stained by Auramine-O can rule out Tuberculous meningitis."
Depok: Fakultas Kedokteran Universitas Indonesia, 2016
T-Pdf
UI - Tesis Membership  Universitas Indonesia Library
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Endang Rahmawati
Deteksi toxoplasma gondii dan epstein barr virus pada pasien HIV dengan gejala klinis tersangka infeksi otak menggunakan Dupleks Real-time PCR = Detection of toxoplasma gondii and epstein barr virus in HIV patient with clinical symptom suspect central nervous system infection using duplex real-time polymerase chain reactio
"ABSTRAK
Lesi fokal otak merupakan komplikasi neurologi pada pasien HIV yang ditandai oleh lesi desak ruang (Space Occupying Lesion) yang membutuhkan penanganan cepat dan tepat. Di beberapa negara, lesi ini dapat disebabkan oleh toksoplasma ensefalitis dan limfoma otak primer. Lesi yang disebabkan oleh toksoplasmosis dan limfoma otak primer yang disebabkan oleh Epstein Barr virus sulit untuk dibedakan menggunakan CT scan ataupun MRI. Pemeriksaan gold standar untuk membedakan keduanya yaitu dengan biopsi otak, namun hal ini merupakan tindakan invasif dan dapat menimbulkan komplikasi. Penelitian ini bertujuan untuk memperoleh uji deteksi untuk diagnosis cepat infeksi Toxoplasma gondii dan Epstein Barr virus. Desain yang dipakai pada penelitian adalah studi eksperimental laboratorium. Uji deteksi yang dikembangkan adalah dupleks real-time PCR yang dapat mendeteksi T.gondii dan EBV atau kombinasi keduanya dalam satu reaksi pada sampel pasien HIV dengan gejala klinis tersangka infeksi otak. Tahap pertama dilakukan optimasi dupleks real-time PCR meliputi suhu annealing, konsentrasi primer dan probe, uji volume elusi dan volume cetakan. Penentuan ambang batas deteksi dilakukan untuk mengukur minimal T.gondii dan EBV yang dapat dideteksi. Reaksi silang untuk mengetahui spesifisitas teknik dilakukan menggunakan bakteri dan virus sebagai berikut Staphylococcus aureus, Klebsiella pneumonia, Pseudomonas aeruginosa, Mycobacterium tuberculosis H37Rv, Candida spp, Cytomegalo virus, Herpes zoster virus, dan Varicella zoster virus. Dupleks real-time PCR yang telah optimal diaplikasi pada sampel pasien. Sampel yang digunakan adalah darah dan cairan serebrospinal dari pasien HIV dengan gejala klinis infeksi otak yang dirawat di bagian neurologi RSCM. Hasil optimasi dupleks real-time PCR diperoleh suhu annealing untuk T.gondii dan EBV 58°C, konsentrasi primer forward dan reverse untuk T.gondii dan EBV adalah 0,2 µM, konsentrasi probe T.gondii 0,4µM, konsentrasi probe EBV 0,2 µM. Deteksi ambang batas minimal DNA untuk T.gondii 5,68 copy /ml, sedangkan EBV 1,31 copy/ml. Uji yang dikembangkan pada penelitian ini termasuk uji yang sensitif dibandingkan hasil penelitian lain. Uji reaksi silang primer dan probe dupleks real-time PCR terhadap beberapa bakteri dan virus lain, menunjukkan tidak bereaksi silang dengan primer dan probe yang digunakan untuk mendeteksi T.gondii dan EBV. Hasil pemeriksaan dupleks real-time PCR pada sampel darah diperoleh 16% positif T.gondii, 40% positif Epstein Barr virus, sebanyak 16% positif Epstein Barr virus dan T.gondii dan pada sampel cairan serebrospinal diperoleh hasil 20% positif T.gondii, sebanyak 28% positif Epstein Barr virus dan 4% positif terhadap Epstein Barr Virus dan T.gondii. ABSTRACT
Focal brain lesion is neurology complication in HIV that marked with Space Occupying Lesion (SOL), that need rapid and effective handling. In most country, this lesion could be cause by encephalitis toxoplasma and Primary Central Nervous System Lymphoma that related to Epstein Barr virus infection that was difficult to distinguished using CT scan or MRI. Gold standard to distinguished was brain biopsy, but this examination was invasive procedure that cause complication. Therefore, we need a reliable and rapid examination to distinguished it. This study aimed to get detection for rapid diagnosis of T.gondii and EBV infection. This study was an experimental laboratory. First step was optimation of dupleks real-time PCR include annealing temperature, primer andprobe consentration, elution volume and template volume. Minimal detection of DNA to measured minimal T.gondii and EBV that could be detected. Cross reaction to know technique spesivisity using bacterial and virus Staphylococcus aureus, Klebsiella pneumonia, Pseudomonas aeruginosa, Mycobacterium tuberculosis H37Rv, Candida spp, Cytomegalo virus, Herpes zoster virus, and Varicella zoster virus. Dupleks real-time PCR has been optimally applied to patient. The sample from blood and cerebrospinal fluid of HIV patients who admitted in the neurology department of RSCM then examined to duplex real-time PCR to detect T.gondii and EBV. The optimation of duplex real-time PCR, the annealing temperature for T.gondii and EBV were 58°C, consentration of primer forward and reverse for T.gondii and EBV were 0,2 µM, consentration of probe for T.gondii was 0,4µM and EBV was 0,2µM.. Minimal DNA detection for T.gondii was 5,68 copy/ml and EBV was 1,31 copy /ml. This study was sensitive like the others. Spesivisity technique of real-time PCR, there was not cross reaction between another bacteria and virus that used as primer and probe for T.gondii and EBV. From the results of the duplex real-time PCR on blood samples, 16 % was positive T.gondii, 40% Epstein Barr virus, and 16% were positive Epstein Barr virus and T.gondii and from cerebrospinal fluid samples 20% was positive T.gondii, 28% was positive Epstein Barr virus and 4% were positive for Epstein Barr Virus and T.gondii.;Focal brain lesion is neurology complication in HIV that marked with Space Occupying Lesion (SOL), that need rapid and effective handling. In most country, this lesion could be cause by encephalitis toxoplasma and Primary Central Nervous System Lymphoma that related to Epstein Barr virus infection that was difficult to distinguished using CT scan or MRI. Gold standard to distinguished was brain biopsy, but this examination was invasive procedure that cause complication. Therefore, we need a reliable and rapid examination to distinguished it. This study aimed to get detection for rapid diagnosis of T.gondii and EBV infection. This study was an experimental laboratory. First step was optimation of dupleks real-time PCR include annealing temperature, primer andprobe consentration, elution volume and template volume. Minimal detection of DNA to measured minimal T.gondii and EBV that could be detected. Cross reaction to know technique spesivisity using bacterial and virus Staphylococcus aureus, Klebsiella pneumonia, Pseudomonas aeruginosa, Mycobacterium tuberculosis H37Rv, Candida spp, Cytomegalo virus, Herpes zoster virus, and Varicella zoster virus. Dupleks real-time PCR has been optimally applied to patient. The sample from blood and cerebrospinal fluid of HIV patients who admitted in the neurology department of RSCM then examined to duplex real-time PCR to detect T.gondii and EBV. The optimation of duplex real-time PCR, the annealing temperature for T.gondii and EBV were 58°C, consentration of primer forward and reverse for T.gondii and EBV were 0,2 µM, consentration of probe for T.gondii was 0,4µM and EBV was 0,2µM.. Minimal DNA detection for T.gondii was 5,68 copy/ml and EBV was 1,31 copy /ml. This study was sensitive like the others. Spesivisity technique of real-time PCR, there was not cross reaction between another bacteria and virus that used as primer and probe for T.gondii and EBV. From the results of the duplex real-time PCR on blood samples, 16 % was positive T.gondii, 40% Epstein Barr virus, and 16% were positive Epstein Barr virus and T.gondii and from cerebrospinal fluid samples 20% was positive T.gondii, 28% was positive Epstein Barr virus and 4% were positive for Epstein Barr Virus and T.gondii.;Focal brain lesion is neurology complication in HIV that marked with Space Occupying Lesion (SOL), that need rapid and effective handling. In most country, this lesion could be cause by encephalitis toxoplasma and Primary Central Nervous System Lymphoma that related to Epstein Barr virus infection that was difficult to distinguished using CT scan or MRI. Gold standard to distinguished was brain biopsy, but this examination was invasive procedure that cause complication. Therefore, we need a reliable and rapid examination to distinguished it. This study aimed to get detection for rapid diagnosis of T.gondii and EBV infection. This study was an experimental laboratory. First step was optimation of dupleks real-time PCR include annealing temperature, primer andprobe consentration, elution volume and template volume. Minimal detection of DNA to measured minimal T.gondii and EBV that could be detected. Cross reaction to know technique spesivisity using bacterial and virus Staphylococcus aureus, Klebsiella pneumonia, Pseudomonas aeruginosa, Mycobacterium tuberculosis H37Rv, Candida spp, Cytomegalo virus, Herpes zoster virus, and Varicella zoster virus. Dupleks real-time PCR has been optimally applied to patient. The sample from blood and cerebrospinal fluid of HIV patients who admitted in the neurology department of RSCM then examined to duplex real-time PCR to detect T.gondii and EBV. The optimation of duplex real-time PCR, the annealing temperature for T.gondii and EBV were 58°C, consentration of primer forward and reverse for T.gondii and EBV were 0,2 µM, consentration of probe for T.gondii was 0,4µM and EBV was 0,2µM.. Minimal DNA detection for T.gondii was 5,68 copy/ml and EBV was 1,31 copy /ml. This study was sensitive like the others. Spesivisity technique of real-time PCR, there was not cross reaction between another bacteria and virus that used as primer and probe for T.gondii and EBV. From the results of the duplex real-time PCR on blood samples, 16 % was positive T.gondii, 40% Epstein Barr virus, and 16% were positive Epstein Barr virus and T.gondii and from cerebrospinal fluid samples 20% was positive T.gondii, 28% was positive Epstein Barr virus and 4% were positive for Epstein Barr Virus and T.gondii."
Fakultas Kedokteran Universitas Indonesia, 2016
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library
cover
Novi Yanti
Deteksi Serologi Treponema Pallidum pada Cairan Serebrospinal dengan Infeksi Intrakranial = Serology Detection of Treponema Pallidum in Cerebrospinal Fluid with Intracranial Infection
"ABSTRAK
Sifilis adalah penyakit menular seksual kronik yang memiliki manifestasi klinis yang bervariasi dan menetap untuk waktu yang lama. Neurosifilis merupakan salah satu komplikasi sifilis sistemik dengan temuan di cairan serebrospinal dengan atau tanpa gejala yang jelas. Pemeriksaan yang saat ini tersedia dalam mendukung diagnosis hanya tersedia pemeriksaan analisis cairan serebrospinal dan serologi Treponema pallidum. Saat ini belum diketahui prevalensi neurosifilis di rumah sakit peneliti dan profil serologi Treponema pallidum dari bahan cairan serebrospinal.
Penelitian ini merupakan penelitian potong lintang, dilakukan November 2017-Maret 2018 terhadap 50 cairan serebrospinal dan darah yang diperiksakan analisis cairan serebrospinal dengan keterangan klinis terduga infeksi intrakranial. Serum dan cairan serebrospinal diperiksakan RPR, TPHA, anti-Treponema pallidum ELISA IgG dan khusus cairan serebrospinal diperiksa pula rapid test Treponema pallidum. Uji statistik menggunakan chi quare and Fisher exact test.
Dari penelitian terhadap 50 cairan serebrospinal dan serum didapatkan rapid test Treponema pallidum, RPR dan TPHA cairan serebrospinal reaktif 4(8%). Dari bahan serum didapatkan RPR reaktif 8(16%) dan TPHA reaktif 9(18%). Anti-Treponema pallidum ELISA IgG positif 4 sampel (8%). Dari 50 sampel didapatkan 7 (14%) neurosifilis, 4 confirmed neurosyphilis dan 3 probable neurosyphilis sesuai kriteria Center for Disease Control and Prevention. Profil analisis cairan serebrospinalnya tidak berwarna, jernih, tidak ada bekuan, hitung sel 12.71 ±9.20 sel/μl, dominasi mononuklear 11.57±9.47 sel/μl, Pandy positif, protein cairan 42.29±21.49 mg/dl, glukosa cairan 55±5.16 mg/dl, glukosa serum 101.04±20.10 mg/dl, dan klorida 122.14±2.48 mEq/L. Pemeriksaan RPR, TPHA, dan anti-Treponema pallidum ELISA IgG dengan bahan serum dan cairan serebrospinal memiliki hubungan bermakna.
Dari penelitian ini didapatkan 14% sesuai dengan neurosifilis dari populasi penelitian dan didapatkan 85.71% dengan HIV reaktif. Pada pasien HIV disarankan RPR dan TPHA serum untuk pemeriksaan skrining sifilis.
ABSTRACT
Syphilis is a chronic sexually transmitted disease that has varying clinical manifestations and persist for a long time. Neurosyphilis is one of the complications of systemic syphilis with findings in cerebrospinal fluid with or without obvious symptoms. Examinations currently available for diagnostic support were cerebrospinal fluid analysis and serology of Treponema pallidum. There is currently no known prevalence of neurosyphilis in the research hospital and serologic profile of Treponema pallidum from cerebrospinal fluid.
This study was a cross sectional study, conducted November 2017-March 2018 against 50 cerebrospinal fluid and blood samples that examined cerebrospinal fluid analysis with clinical information of suspected intracranial infection. Serum and cerebrospinal fluid examined by RPR, TPHA, anti-Treponema pallidum ELISA IgG and particulary rapid test Treponema pallidum for cerebrospinal fluid. Statistic tests were chi quare and Fisher exact test.
From a total of 50 cerebrospinal fluid and serum, 4(8%) had reactive cerebrospinal fluid T. pallidum rapid tests, RPRs and TPHAs. From serum there were 8(16%) reactive RPRs and 9(18%) reactive TPHAs. Anti-Treponema pallidum ELISA IgG was positif 4 samples (8%). Among the 50 samples, 7 (14%) had neurosyphilis, 4 were confirmed neurosyphilis and 3 were probable neurosyphilis according to Center for Disease Control and Prevention criteria. The cerebrospinal fluid analysis profile is colorless, clear, without clot, cell count 12.71±9.20 cells/μl, mononuclear 11.57±9.47 cells/μl, positive for Pandy, cerebrospinal fluid protein 42.29±21.49 mg/dl, glucose 55±5.16 mg/dl, serum glucose 101.04±20.10 mg/dl, and chloride 122.14±2.48 mEq/L. Rapid Plasma Reagin, TPHA, and anti-Treponema pallidum ELISA IgG were associated between serum specimen and cerebrospinal fuid.
Neurosyphilis was found in 14% of our patient population and 85.71% was reactive for HIV. Rapid Plasma Reagin and TPHA in sera were recommended for syphilis screening for HIV patient."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2018
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Deteksi serologi treponema pallidum pada cairan serebrospinal dengan infeksi intrakranial = Serology detection of treponema pallidum in cerebrospinal fluid with intracranial infection
"ABSTRAK
Sifilis adalah penyakit menular seksual kronik yang memiliki manifestasi klinis yang bervariasi dan menetap untuk waktu yang lama. Neurosifilis merupakan salah satu komplikasi sifilis sistemik dengan temuan di cairan serebrospinal dengan atau tanpa gejala yang jelas. Pemeriksaan yang saat ini tersedia dalam mendukung diagnosis hanya tersedia pemeriksaan analisis cairan serebrospinal dan serologi Treponema pallidum. Saat ini belum diketahui prevalensi neurosifilis di rumah sakit peneliti dan profil serologi Treponema pallidum dari bahan cairan serebrospinal. Penelitian ini merupakan penelitian potong lintang, dilakukan November 2017-Maret 2018 terhadap 50 cairan serebrospinal dan darah yang diperiksakan analisis cairan serebrospinal dengan keterangan klinis terduga infeksi intrakranial. Serum dan cairan serebrospinal diperiksakan RPR, TPHA, anti-Treponema pallidum ELISA IgG dan khusus cairan serebrospinal diperiksa pula rapid test Treponema pallidum. Uji statistik menggunakan chi quare and Fisher exact test. Dari penelitian terhadap 50 cairan serebrospinal dan serum didapatkan rapid test Treponema pallidum, RPR dan TPHA cairan serebrospinal reaktif 4 8 . Dari bahan serum didapatkan RPR reaktif 8 16 dan TPHA reaktif 9 18 . Anti-Treponema pallidum ELISA IgG positif 4 sampel 8 . Dari 50 sampel didapatkan 7 14 neurosifilis, 4 confirmed neurosyphilis dan 3 probable neurosyphilis sesuai kriteria Center for Disease Control and Prevention. Profil analisis cairan serebrospinalnya tidak berwarna, jernih, tidak ada bekuan, hitung sel 12.71 9.20 sel/ l, dominasi mononuklear 11.57 9.47 sel/ l, Pandy positif, protein cairan 42.29 21.49 mg/dl, glukosa cairan 55 5.16 mg/dl, glukosa serum 101.04 20.10 mg/dl, dan klorida 122.14 2.48 mEq/L. Pemeriksaan RPR, TPHA, dan anti-Treponema pallidum ELISA IgG dengan bahan serum dan cairan serebrospinal memiliki hubungan bermakna. Dari penelitian ini didapatkan 14 sesuai dengan neurosifilis dari populasi penelitian dan didapatkan 85.71 dengan HIV reaktif. Pada pasien HIV disarankan RPR dan TPHA serum untuk pemeriksaan skrining sifilis.
ABSTRACT
Syphilis is a chronic sexually transmitted disease that has varying clinical manifestations and persist for a long time. Neurosyphilis is one of the complications of systemic syphilis with findings in cerebrospinal fluid with or without obvious symptoms. Examinations currently available for diagnostic support were cerebrospinal fluid analysis and serology of Treponema pallidum. There is currently no known prevalence of neurosyphilis in the research hospital and serologic profile of Treponema pallidum from cerebrospinal fluid. This study was a cross sectional study, conducted November 2017-March 2018 against 50 cerebrospinal fluid and blood samples that examined cerebrospinal fluid analysis with clinical information of suspected intracranial infection. Serum and cerebrospinal fluid examined by RPR, TPHA, anti-Treponema pallidum ELISA IgG and particulary rapid test Treponema pallidum for cerebrospinal fluid. Statistic tests were chi quare and Fisher exact test. From a total of 50 cerebrospinal fluid and serum, 4 8 had reactive cerebrospinal fluid T. pallidum rapid tests, RPRs and TPHAs. From serum there were 8 16 reactive RPRs and 9 18 reactive TPHAs. Anti-Treponema pallidum ELISA IgG was positif 4 samples 8 . Among the 50 samples, 7 14 had neurosyphilis, 4 were confirmed neurosyphilis and 3 were probable neurosyphilis according to Center for Disease Control and Prevention criteria. The cerebrospinal fluid analysis profile is colorless, clear, without clot, cell count 12.71 9.20 cells/ l, mononuclear 11.57 9.47 cells/ l, positive for Pandy, cerebrospinal fluid protein 42.29 21.49 mg/dl, glucose 55 5.16 mg/dl, serum glucose 101.04 20.10 mg/dl, and chloride 122.14 2.48 mEq/L. Rapid Plasma Reagin, TPHA, and anti-Treponema pallidum ELISA IgG were associated between serum specimen and cerebrospinal fuid. Neurosyphilis was found in 14 of our patient population and 85.71 was reactive for HIV. Rapid Plasma Reagin and TPHA in sera were recommended for syphilis screening for HIV patient. "
2018
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UI - Tugas Akhir  Universitas Indonesia Library
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Hanna Karmila
Kualitas Informed Consent Pungsi Lumbal Di RSUPN Dr. Cipto Mangunkusumo, Indonesia = Informed Consent Quality Of Lumbar Puncture Procedure In RSUPN Dr. Cipto Mangunkusumo
"Latar belakang. Penolakan tindakan pungsi lumbal cukup besar. Salah satu faktor yang berperan adalah pengetahuan, pemahaman serta persepsi pasien dan keluarga yang kurang tepat terhadap tindakan pungsi lumbal. Informed consent yang baik diharapkan dapat memperbaiki hal ini. Penelitian ini dilakukan untuk menilai kualitas informed consent pungsi lumbal.
Metode penelitian. Penelitian ini dilakukan dua tahap. Tahap 1 penyusunan dan analisis kuesioner. Tahap 2 uji coba dan penilaian reliabilitas. Tahap 1 menggunakan desain uji validasi isi. Populasi adalah dokter spesialis neurologi yang memiliki pengetahuan dan pemahaman pungsi lumbal. Sampel diambil dengan cara intentional sampling. Tahap 2 menggunakan desain potong lintang. Populasinya adalah pasien/wali pasien yang telah mendapakan informed consent pungsi lumbal di IGD, bangsal/poli neurologi RSUPN Dr. Cipto Mangunkusumo  bulan Desember 2022-Januari 2023. Sampel diambil dengan cara consecutive sampling.
Hasil. Kuesioner pungsi lumbal 2022 memiliki validitas isi yang baik namun tingkat pemahaman memiliki reliabilitas yang kurang baik. Sebanyak 75% tenaga medis profesional dalam memberikan informed consent pungsi lumbal. Sebanyak 28,12% penerima informasi memahami informasi yang diberikan. Sebanyak 68,8% penerima informasi puas terhadap proses informed consent. Sebanyak 25% proses informed consent pungsi lumbal berkualitas. Kesimpulan. Sebagian besar tenaga medis sudah profesional dalam melakukan informed consent pungsi lumbal meskipun belum seluruhnya penerima informasi memahami informasi yang disampaikan. Sebagian besar penerima informasi puas dengan proses informed consent pungsi lumbal. Kualitas informed consent pungsi lumbal di RSUPN Dr. Cipto Mangunkusumo masih harus ditingkatkan.
Background: There is quite a number of rejection for lumbar puncture procedure. One of its most contributing factor is inadequate understanding of the procedure itself from the patient or family. A well prepared informed consent is aimed to mitigate this issue. This study was conducted in order to evaluate the quality of informed consent for lumbar puncture in our centre.
Methods. This study is done in 2 phases, on the 1st phase we compose and analyze the questionnaire and on the 2nd phase is to test and evaluate its reliability. Content validation test design was used on the 1st phase. Study population are neurologists who possess the understanding and competency of lumbar puncture. Samples are chosen by intentional sampling. For the 2nd phase, we used the cross-sectional design study. And the population are patients or their family who received lumbar puncture informed consent in ER unit, neurology ward or clinic at RSUPN Dr. Cipto Mangunkusumo, starting from December 2022 to January 2023. Sample was chosen by consecutive sampling.
Results. Lumbar puncture questionnaire is pretty well validated for its content, although it’s not that well defined on how much it can be understood by the patient. As much as 75% of neurologists have given professional informed consent for their patient. But only 28.12% of the patients truly understood the information they received. And 25% of all informed consent was done in a good quality.
Conclusion. Most of neurologists have done their informed consent in a professional manner, even though not all patient could understand the information quite fully. Most of the patients are satisfied with how well the informed consent was explained. The conclusion is there are still ways to improve the quality of lumbar puncture informed consent in RSUPN Dr. Cipto Mangunkusumo "
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2023
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UI - Tugas Akhir  Universitas Indonesia Library
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David
Karakteristik Klinis, Penunjang, Dan Luaran Ensefalitis Autoimun Di RSUPN Dr. Cipto Mangunkusumo, Indonesia = Clinical, Ancillary Characteristics, And Prognosis Of Autoimmune Encephalitis In Dr. Cipto Mangunkusumo National Center General Hospital, Indonesia
"Latar Belakang. Sejak laporan pertama ensefalitis antireseptor N-methyl-D-aspartate (NMDA) pada 2007, prevalensi ensefalitis autoimun (EA) serupa dengan ensefalitis infeksi (EI). Sayangnya, heterogenitas klinis EA, serupanya klinis dengan EI, penyakit autoimun seperti neuropsikiatrik lupus eritematosus sistemik, atau penyakit psikiatrik menjadi tantangan deteksi awal dan tatalaksana EA. Keterlambatan berhubungan dengan perburukan luaran, sedangkan kekurang-tepatan menerapi EI sebagai EA dapat mengeksaserbasi infeksi. Studi ini bertujuan mengenali karakteristik EA, khususnya ensefalitis antireseptor NMDA definit sebagai EA tersering, di era keterbatasan ketersediaan penunjang definitif di Indonesia.
Metode. Studi kohort retrospektif dengan rekam medis di RSUPN dr. Cipto Mangunkusumo dilakukan pada curiga EA yang menjalani pemeriksaan antireseptor NMDA cairan otak sejak Januari 2015-November 2022. Karakteristik klinis dan penunjang EA, EA seropositif NMDA, dan luarannya dinilai. Analisis univariat dan bivariat dilakukan sesuai kebutuhan.
Hasil. Dari 102 subjek yang melalui kriteria inklusi dan eksklusi, terdapat 14 EA seropositif dan 32 seronegatif NMDA. Temuan klinis EA terbanyak adalah gangguan psikiatri dan tidur (85,7%), gangguan kesadaran (78,3%), prodromal (76,1%), dan bangkitan (70,6%). Karakteristik penunjang EA adalah inflamasi sistemik (75,0%), inflamasi cairan otak (69,2%), abnormalitas MRI (57,9%) dominan inflamasi (42,2%), dan abnormalitas EEG (89,5%). Karakteristik klinis EA seropositif NMDA adalah psikosis (76,9% vs 24,1%, p=0,002), delirium (71,4% vs 40,6%, p=0,06), bangkitan (71,4% vs 46,7%, p=0,12), takikardia (55,6% vs 17,6%, p=0,08), dan gangguan otonom lainnya (55,6% vs 23,5%, p=0,19), sedangkan klinis EA seronegatif NMDA adalah somnolen (34,4% vs 7,1%, p=0,07) dan defisit neurologis fokal (31,3% vs 7,1%, p=0,13). Leukositosis dan pleositosis cairan otak dengan dominasi mononuklear secara signifikan lebih ditemukan pada EA seropositif NMDA. Sebanyak 10,9% subjek meninggal.
Kesimpulan. Karakteristik klinis EA adalah gangguan psikiatri dan tidur, gangguan kesadaran, prodromal, dan bangkitan. Psikosis, delirium, bangkitan, dan disfungsi otonom cenderung lebih ditemukan pada EA seropositif NMDA. Inflamasi sistemik, cairan otak, MRI, dan abnormalitas EEG sering ditemukan pada EA, terutama seropositif NMDA. 
Background. Since the first report of N-methyl-D-aspartate receptor (NMDAR) encephalitis in 2007, the prevalence of autoimmune encephalitis (AE) was similar to infectious encephalitis (IE). Unfortunately, heterogenities of EA as well as similarities in the manifestation to IE, other autoimmune diseases including neuropsychiatric systemic lupus erythematosus, or psychiatric diseases compromised the early detection and management of EA. This delay correlated with worse outcome whereas the inaccuracy in treting IE as AE may exacerbate infection. This study aimed to describe the characteristics of EA, particularly definitive NMDAR encephalitis as the most common, in the era of limited availability of definitive ancillary test in Indonesia.
Methods. Retrospective study using medical records at Dr. Cipto Mangunkusumo National Center General Hospital was conducted for suspected EA cases tested for cerebrospinal fluid NMDAR autoantibody test from January 2015 to November 2022. Clinical, ancillary characteristics, and concordance between clinical diagnosis and diagnostic criteria were assessed. Univariate, bivariate, and multivariate analysis were perfomed as needed.
Result. Of 102 subjects following inclusion and exclusion criteria, there were 14 seropositive and 32 seronegative NMDA subject. Clinical characterstics of AE were psychiatric and sleep disorder (85,7%), altered consciousness (78.3%), prodromal (76.1%), and seizure (70.6%). Ancillary characteristics of AE were systemic inflammation (75.0%), cerebrospinal fluid inflammation (69.2%), MRI abnormalities (57.9%) with inflammatory predominance (42.2%), and EEG abnormalities (89.5%). Seropositive NMDA characteristics were psychosis (76.9% vs 24.1%, p=0.002), delirium (71.4% vs 40.6%, p=0.06), seizure (71.4% vs 46.7%, p=0.12), tachycardia 955.6% vs 17.6%, p=-0.08), and other autonomic disorder (55.6% vs 23.5% p=0.19) whereas seronegative NMDA characteristics were somnolence (34.4% vs 7.1%, p=0.07) and focal neurologic deficit (31.3% vs 7.1%, p=0.13). Leukocytosis and cerebrospinal fluid pleocytosis with mononuclear predominance were significantly found in seropositive NMDA AE. The mortality rate was 10.9%.
Conclusion. Clinical characteristics of AE were psychiatric and sleep disorder, altered consciousness, prodromal, and seizure. Psychosis, delirium, seizure, and autonomic dysfunction tended to be found in seropositive NMDA AE. Inflammation in systemic, cerebrospinal fluid, and MRI findings as well as EEG abnormalities commonly occurred in AE, especially seropositive NMDA."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022
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UI - Tugas Akhir  Universitas Indonesia Library
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Septiana Andri Wardana
Kualitas Hidup Pasien Meningitis Tuberkulosis Selesai Obat Anti-tuberkulosis = Quality of Life Among Tuberculous Meningitis Patients Upon Completion of Anti-tuberculosis Treatment
"Latar Belakang. Prevalensi disabilitas pada pasien meningitis tuberkulosis (MTB) hampir setara dengan angka mortalitas mencapai 29-50%. Aspek luaran pasien MTB tidak cukup dinilai berdasarkan angka morbiditas dan mortalitasnya, namun mencakup kesehatan fisik, mental, dan sosial seperti yang didefinisikan oleh World Health Organization (WHO). Penelitian ini bertujuan untuk mengetahui kualitas hidup pasien MTB selesai obat anti-tuberkulosis (OAT) dan faktor-faktor yang memengaruhinya. Metode. Studi potong lintang (cross sectional) dilakukan pada pasien MTB, termasuk tuberkuloma selesai OAT di RSUPN dr. Cipto Mangunkusumo periode Mei 2019-Juni 2023. Karakteristik demografis, klinis, diagnosis, tatalaksana pasien dinilai dari data rekam medis dan wawancara. Luaran kualitas hidup pasien dinilai menggunakan kuesioner SF (Short form)-36. Analisis statistik dilakukan dengan SPSS versi 19.0, yaitu Mann-Whitney dan Kruskal-Wallis untuk data kategorik, Spearman untuk data numerik. Hasil. Dari 53 subjek penelitian dengan median usia 30 (IQR 25,5-39) tahun, didapatkan median skor SF-36 yaitu, 86,5 (IQR 74,9-92,8). Median (IQR) skor pada aspek fisik (PCS) dan mental (MCS) kualitas hidup serupa, yaitu 85 (IQR 69,4-94,85) dan 88,1 (IQR 74,1-95,3). Faktor yang berhubungan dengan kualitas hidup pasien MTB selesai OAT antara lain penghasilan (p=0,033), kejang (p=0,028), kelemahan motorik (p=0,023), dan mRS saat pulang perawatan (p=0,007). Faktor yang berhubungan dengan skor PCS adalah pekerjaan (p=0,012), penghasilan (p=0,007), kelemahan motorik (p=0,024), dan mRS saat pulang perawatan (p=0,01). Faktor yang berhubungan dengan skor MCS adalah usia (p=0,006) dan kejang (p=0,025). Kesimpulan. Kualitas hidup pasien MTB selesai OAT berdasarkan skor SF-36, PCS, dan MCS tergolong baik. Faktor yang memengaruhi kualitas hidup lebih tinggi pada pasien MTB selesai OAT adalah berpenghasilan, tanpa klinis kejang atau kelemahan motorik, dan mRS saat pulang perawatan 0-2. Faktor yang memengaruhi aspek fisik lebih tinggi adalah pekerjaan, berpenghasilan, tanpa klinis kelemahan motorik, dan mRS saat pulang perawatan 0-2, sedangkan aspek mental lebih tinggi adalah usia ≥30 tahun dan tanpa klinis kejang. Kata kunci. Kualitas hidup, meningitis tuberkulosis, selesai OAT, SF-36<
The prevalence of disabilities among tuberculous meningitis (TBM) patients almost similar with its mortality rate (29-50%). The comprehensive evaluation of long-term outcomes should encompass not only morbidity and mortality rates but also incorporate the dimensions of physical, mental, and social well-being as outlined by the World Health Organization (WHO). This study aimed to assess the quality of life (QoL) among patients with TBM following the completion of anti-tuberculosis treatment (ATT) and investigating the factors that have impacts on this particular aspect. Methods. Retrospective cross sectional study of TBM patients, including tuberculoma upon completion of ATT at dr. Cipto Mangunkusumo National Center General Hospital during May 2019-June 2023. Demographic, clinical, diagnostic, and treatment characteristics were conducted by medical records and interviews. The assessment of QoL in TBM patients was performed using Short form (SF)-36 questionnaire. Statistical analysis was performed with SPSS version 19.0 (Mann-Whitney and Kruskal-Wallis for categorical data, Spearman for numeric data). Result. The study involved 53 participants, with median of age 30 (IQR 25.5-39) years, demonstrated favorable median SF-36 score of 86.5 (IQR 74.9-92.8). Median of physical score (PCS) and mental score (MCS) almost similar, 85 (IQR 69.4-94.85) and 88.1 (IQR 74.1-95.3), respectively. The impact of various factors on QoL was assessed, revealing significant associations with monthly income (p=0.033), presence of seizure (p=0.028), motoric abnormalities (p=0.023), and mRS at discharge (p=0.007). Employment (p=0.012), monthly income (p=0.007), motoric abnormalities (p=0.024), and mRS at discharge (p=0.01) were identified as factors influencing the PCS score. Age (p=0.006) and presence of seizure (p=0.025) found to impact the MCS score. Conclusion. The evaluation of QoL in TBM patients after completing ATT utilizing SF-36 score, PCS, and MCS revealed favorable outcome. Several factors were found to significantly influence higher SF-36 score, including monthly income, absence of seizure and motoric abnormalities, and mRS at discharge of 0-2. Similarly, factors such as employment, monthly income, absence motoric abnormality, and mRS at discharge of 0-2 were associated with higher PCS scores. Furthermore, a higher MCS score was observed in patients aged 30 years or older and those without seizures. Keywords. Quality of life, QoL, tuberculous meningitis, completion ATT, SF-36"
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2023
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UI - Tugas Akhir  Universitas Indonesia Library
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Lenny Naulita
Insidensi dan faktor risiko hospital readmission pada infeksi intrakranial di Rumah Sakit Cipto Mangunkusumo = Incidence and risk factors hospital readmission of intracranial infection in Cipto Mangunkusumo National Hospital
"Latar Belakang: Meskipun kontroversial, hospital readmission (HR) dapat mencerminkan keadaan pasien saat dipulangkan dan sebagai indikator untuk mengevaluasi mutu perawatan rumah sakit (RS). Penelitian ini bertujuan untuk mengetahui insidensi dan faktor risiko HR pada pasien infeksi intrakranial.
Metode Penelitian: Studi kohort retrospektif pasien infeksi intrakranial periode April 2019-November 2021, menggunakan data Indonesian Brain Infection Study dan telusur rekam medis. Analisis bivariat menggunakan uji Chi Square dan Mann Whitney, dilanjutkan dengan analisis multivariat regresi logistik.
Hasil: Insidensi HR pasien infeksi intrakranial sebesar 28,45%. Mayoritas subjek mengalami HR sebelum 30 hari (64,7%). Penyebab HR terbanyak adalah penyakit lain yang berbeda dengan diagnosis awal (55,9%). Komorbid penyakit ginjal meningkatkan risiko HR (aOR=7,2, IK 95%=2,2-23,8,p=0,000). Gejala klinis saat perawatan awal berupa kelemahan motorik dan kejang juga meningkatkan risiko HR (aOR=2,27,IK 95%=1,28-4,01, p=0,001) dan (aOR=1,93,IK 95%=1,02-3,62, p=0,037). Sedangkan ketersediaan pelaku rawat dapat menurunkan risiko HR (aOR=0,07,IK 95%=0,03-0,45, p=0,002).
Kesimpulan: Insidensi HR pada pasien infeksi intrakranial dalam waktu 6 bulan sebesar 28,45%. Penyakit ginjal, gejala klinis kelemahan motorik dan kejang pada perawatan awal merupakan faktor yang dapat meningkatkan risiko HR, sedangkan ketersediaan pelaku rawat merupakan faktor yang dapat menurunkan risiko HR. 
Background: Although controversial, hospital readmission (HR) can reflect the patient's condition at discharge and as an indicator to evaluate the quality of hospital care. This study aims to determine the incidence and risk factors for HR in intracranial infections.
Method: A retrospective cohort study of intracranial infection patients, in period April 2019-November 2021, using secondary data from the Indonesian Brain Infection Study and tracing medical records. Bivariate analysis using Chi Square and Mann Whitney test, followed by multivariate logistic regression analysis.
Results: The incidence of HR in patients with intracranial infections was 28.45%. The majority of subjects experienced HR before 30 days (64.7%). The most common cause of HR was other diseases that were different from the initial diagnosis (55.9%). Kidney disease comorbidity increased HR risk (aOR=7.2;95%CI=2.2-23.8;p=0.000). Clinical symptoms during initial treatment such as motor weakness and seizures also increased the risk of HR (aOR=2.27;95%CI=1.28-4.01;p=0.001) and (aOR=1.93;95%CI=1.02-3.62;p=0.037). Meanwhile, the availability of caregivers can reduce HR risk (aOR=0.07;CI 95=0.03-0.45;p=0.002).  
Conclusion: The incidence of HR in patients with intracranial infection within 6 months was 28.45%. Kidney disease, motor weakness and seizures are factors that can increase the risk of HR, while the availability of caregivers is a factor that can reduce the risk of HR."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022
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UI - Tugas Akhir  Universitas Indonesia Library
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