Muhammad Fachri

Background: Tuberculosis (TB) is a bacterial infection caused by Mycobacterium TB. According to the International Standard for TB Care (ISTC), Human Immunodeficiency Virus (HIV) is one of the main comorbidities in TB. Purposes: To compare the positivity rate of GeneXpert in diagnosing TB to suspected TB adult patients with and without HIV infection at three private hospitals in Jakarta. Methods: This study uses a cross-sectional approach; the data comes from medical records. The sampling technique in this research uses the cluster sampling formula. The inclusion criteria in this study were adult pulmonary TB patients more than 18 years of age, patients with pulmonary TB, and patients who had complete medical record data, and the exclusion criteria were patients who did not have GeneXpert examination results and adult pulmonary TB patients who did not have laboratory results of HIV Rapid test results. Statistical analysis using the Chi-Square statistical test. Results: A total of 24 adult pulmonary TB patients with HIV and positive GeneXpert were identified, whereas 13 adult TB patients with HIV and positive GeneXpert were identified, and pulmonary TB patients without HIV and positive GeneXpert numbered 59, while those with positive GeneXpert numbered 15. There is a tendency for fewer positive GeneXpert values in Adult Pulmonary TB patients with HIV compared to those without HIV Infection. Statistically not significant (p >0.05) Conclusion: Adult pulmonary TB patients without HIV tend to have higher positive GeneXpert test results than adult pulmonary TB patients with HIV, and there is no statistically significant relationship.

Background: Pulmonary TB and type 2 DM are interdependent medical-epidemiological challenges with high global impact. Pulmonary TB cannot improve in patients with uncontrolled diabetes. Pulmonary TB in patients with type 2 DM presents distinct characteristics, making it crucial to diagnose and treat to understand the effects of TB and oral antidiabetic drugs. The purpose of this study was to compare the duration of treatment for drug-resistant pulmonary TB in the presence and absence of type 2 DM. Methods: This study used a cross-sectional design and single-population proportion method. The participants were enrolled using a consecutive sampling technique. The comparison focused on patients with drug-resistant TB with and without type 2 DM. Initially, 80 patients were recruited; however, after applying the inclusion and exclusion criteria, 22 patients remained. Results: Among the 80 patients, 44 had drug-resistant pulmonary TB with type 2 DM, and 36 patients did not have type 2 DM. The male-to-female ratios ranged from 53 (66.3%) to 27 (33.8%). GeneXpert results in both groups indicated rifampicin resistance. Regarding treatment duration, 13 patients with drug-resistant pulmonary TB and type 2 DM who completed treatment mostly recovered between the 18th and 24th months, whereas nine patients with drug-resistant pulmonary TB without type 2 DM who completed treatment recovered between the 6th to 24th month (Mann‒Whitney test, P = 0.000). Conclusion: The treatment period for patients with drug-resistant pulmonary tuberculosis with type 2 DM was much longer than that for patients with drug-resistant pulmonary tuberculosis without type 2 DM.

Background: Chronic obstructive pulmonary disease (COPD) is characterised by persistent and progressive airflow limitations. The study aimed to determine the relationship between eosinophil values in patients with stable and exacerbated COPD, and the relationship of eosinophil values with two drug regimens used as maintenance therapy in stable COPD. Materials and methods: This cross-sectional study and the variables used in this study were eosinophil counts in stable and exacerbated COPD patients. Results: Eighty-three patients with stable and exacerbated COPD were included. Stable COPD (63.9%) was predominant, with the highest degree of symptoms in group A 18 patients (34%) and Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2; 35 patients (66%). The degree of COPD exacerbation was dominated by Type II COPD 15 patients (50%). Eosinophil counts in patients with stable COPD were less than 100 cells/mm³ 37 patients (44.6%), while in patients with COPD exacerbation, it was greater than 100 cells/mm³ with a total of 30 patients (36.1%). Long acting muscarinic antagonist class of drugs was the most used treatment as maintenance therapy in stable COPD 34 patients (64.2%). Conclusion: The eosinophil counts in patients with COPD exacerbation were significantly higher than those in patients with stable COPD. The provision of maintenance therapy in the long acting β-2 agonist + inhaled glucocorticosteroid group of stable COPD patients was generally provided to COPD patients with eosinophil values greater than 100 cells/mm³, and the provision of long-term maintenance therapy in stable COPD patients was generally given to COPD patients with eosinophil values less than 100 cells/mm³.

Background The impact of the coronavirus disease 2019 (COVID-19) pandemic on tuberculosis (TB) was great enough for COVID-19 to replace TB as the leading cause of death worldwide. The WHO Global Tuberculosis Report 2020 stated that the number of TB cases reported was 845,000. The pandemic caused a decline in the detection of tuberculosis cases, and the attention of the Indonesian government became more focused on making COVID-19 a top priority in prevention and control measures so that tuberculosis cases were neglected. Methods This study used a cross-sectional. The research subjects were recruited using the consecutive sampling technique. The variable of this study was a comparison between pulmonary TB with confirmed COVID-19 and pulmonary TB without COVID-19 using the research subjects for total sampling. Bivariate analysis was used, which was carried out on two compared variables. Results Based on the results of this study, of the 127 samples studied, 101 pulmonary TB patients without COVID-19 and 26 pulmonary TB patients with confirmed COVID-19 were declared cured. This was observed more often among male patients than among female patients. Among TB patients with confirmed COVID-19, two age groups dominated, namely, the 17–25 (23.1%) and > 64 (23.1%) age groups. Moreover, most TB patients without COVID-19 were in the 26–35 age group (23.8%). The results of the length of treatment analysis among pulmonary TB patients without COVID-19 showed ≥ 6 months (82.2%) until these patients were cured. Moreover, the length of treatment for pulmonary TB patients with confirmed COVID-19 until they were declared cured was 7–9 months (61.5%). In this study, the number of pulmonary tuberculosis patients without COVID-19 who had type 2 DM (Diabetes Mellitus) was 77.1%. Conclusions The treatment period for pulmonary tuberculosis patients with confirmed COVID-19 was significantly longer than that for pulmonary tuberculosis patients without COVID-19.

Background: Pneumonia is one of the most common infections caused by the bacterium Klebsiella pneumoniae. During the initiation of an infection, the immune system recognizes the pathogen through the release of high mobility group box 1 (HMGB1), thereby triggering the inflammation process. Miana has demonstrated potent inhibitory effects on the inflammatory process during infection in animal models. The aim of this study was to determine the effect of Miana leaf extract on mRNA HMGB1 expression in Balb/c mice infected with K. pneumoniae. Methods: This study comprised a cohort experiment using 20 Balb/c mice divided into four groups. Balb/c mice in each group were intraperitoneally injected with K. pneumoniae. Group 1 was given a placebo; Group 2 was given Miana; Group 3 was given levofloxacin; and Group 4 was given both levofloxacin and Miana. The levels of mRNA HMGB1 expression were measured using real-time PCR before, during, and after the infection as well as after the treatments. Results: The initial examination results showed that the average level of mRNA HMGB1 expression was 5.51 fc. The mRNA HMGB1 expression in mice after being challenged with K. pneumoniae was 9.64 fc. Group 1 that was given a placebo had a mean mRNA HMGB1 expression level of 14.99 fc. Group 2 that was given Miana had a mean mRNA HMGB1 expression level of 13.95 fc. Group 3 that was given levofloxacin had an average mRNA HMGB1 expression level of 6.45 fc, and Group 4 that was given levofloxacin and Miana together had an average mRNA HMGB1 expression level of 5.59 fc. Conclusion: Miana (Coleus scutellarioides (L.) Benth) increased mRNA HMGB1 expression at the initial administration via regulation of the immune system. Administration of Miana following K. pneumoniae infection inhibited the increase in mRNA HMGB1 expression. Treatment with levofloxacin reduced the level of mRNA HMGB1 expression, and the effect was optimized by the administration of Miana leaf extract as a supplement.

Background: An accurate diagnosis of COVID-19 is essential for pandemic control and for establishing adequate therapeutic strategies to reduce morbidity and mortality. COVID-19 infection replicates in macrophage cells and affects the immune system. Natural resistance-associated macrophage protein-1 (NRAMP-1) carries cation ions, such as Fe2+, Zn2+ and Mn2+, and plays an essential role in the immune system to infection with micro-organisms. In addition, the function of NRAMP-1 is to limit the replication of pathogens by changing the phagosomal environment. Levels of NRAMP-1 protein are based on death, comorbidities and clinical symptoms of COVID-19 patients and it is possible for the soluble protein NRAMP-1 level to be used as an additional biomarker for forensic and medicolegal related COVID-19 cases and prosecutions from patients and families. Methods: Determination of NRAMP-1 protein levels using the enzyme link-immunosorbent assay technique in death, had comorbidities and severity of clinical symptoms of COVID-19 patients. Results: Of the 62 patients who received treatment, 10 patients died with an average NRAMP-1 level of 650 ng/ml and 52 patients who survive with an average NRAMP-1 level of 1065.26 ng/ml. The results of the study also found that 34 patients had comorbidities with an average NRAMP-1 level of 838.82 ng/ml and 28 patients without comorbidities with an average NRAMP-1 level of 1191.92 ng/ml. Based on the severity of clinical symptoms in survive patients, 10 patients with mild were found with an average NRAMP-1 level of 984.31 ng/ml, with moderate in 31 patients with an average NRAMP-1 level of 1104.71 ng/ml and severe in 11 patients with an average NRAMP-1 level of 1027.71 ng/ml. Conclusions: NRAMP-1 protein levels were significantly lower in COVID-19 patients who died and had comorbidities.

Introduction: The clinical manifestations of COVID-19 vary from asymptomatic to symptomatic. COVID-19 patients with severe symptoms often have coagulation disorders similar to systemic coagulopathy. This is associated with a significant increase in mortality. The purpose of this study was to determine the relationship between hypercoagulation and death in hospitalized patients with confirmed COVID-19. Method: This research is an analytic observational, quantitative approach with a cross sectional research design. The method of collecting secondary data comes from medical record data on inpatients who have confirmed COVID-19 at the Islamic Hospital in Jakarta Sukapura, by total sampling. Result: There are 625 research subjects. Most of the subjects were women (52.3%) at the age of 50-59 years (26.6%). The status of living patients was (98.9 %). The value of D dimer tends to increase, the value of PT is normal, and the value of APTT is normal. The Case Fatality Rate (CFR) in the subject was 0.0112% (CFR < 4.35% = low CFR). Conclusion: There is a low CFR in hospitalized patients with confirmed COVID-19 at RSIJ Sukapura. The results of the examination on the parameters of coagulant agents based on patient status in hospitalized patients who were confirmed to be COVID-19 at RSIJ Sukapura, on the D-dimer and APTT parameters there was no significant relationship, while on the PT parameter there was a significant relationship.

Background: Thrombotic complications of coronavirus disease 2019 (COVID-19) are a worrisome aspect of the disease due to their high incidence in critically ill patients and their poor clinical outcomes. The aim of this study was to compare the effectiveness of unfractionated heparin (UFH) and low molecular weight heparin (LMWH) (fondaparinux) in hospitalized COVID-19 patients with hypercoagulable complications. Material and methods: The study design used a retrospective cohort approach incorporating pre- and post-tests via secondary data extracted from the medical records of inpatients with confirmed COVID-19. Results: Among the 98 individuals studied (52% women; 30.6% at >60 years of age), 35 patients received UFH, while the remaining 63 patients received LMWH (fondaparinux). The greatest decrease in the D-dimer value (0.01 +/- 0.5 g fibrinogen equivalent units/mL) was observed in 12 (34.3%) and 15 (23.8%) patients in the UFH and LMWH (fondaparinux) groups, respectively. Most inpatients with confirmed COVID-19 were aged 50-59 years and were women. Conclusion: There was a tendency toward increased D-dimer, normal prothrombin time, normal activated partial thromboplastin clotting time, and increased fibrinogen values in each COVID-19 patient. The results demonstrated a significant relationship between the D-dimer and prothrombin time parameter in confirmed COVID-19 inpatients.

Background: Patients with comorbidities have an increased risk for severe coronavirus disease (COVID-19) symptoms, including abnormal inflammation. Chest X-rays and C-reactive protein (CRP) level are frequently used to evaluate the severity of inflammation. The aim of this study was to investigate the correlation between comorbidities, chest X-ray findings, and CRP level in patients with COVID-19. Materials and methods: This was a cross-sectional, analytic, observational study performed using a quantitative approach. The study population included in patients with confirmed COVID-19. Secondary data from the medical records of the patients were analysed to determine the correlations between comorbidities, chest X-rays, and CRP level. Results: The data of 167 patients (87 [52.1%] females and 80 [47.9%] males) were evaluated. Regarding comorbidities, 86 (51.5%) patients had hypertension, 66 (39.5%) had diabetes mellitus, and 17 (10.2%) had dyspepsia. Chest X-rays showed that 144 (86.2%) patients had pneumonia, whereas 23 (13.8%) did not. A total of 143 (85.6%) patients showed increased CRP levels, whereas 24 (14.4%) did not show any increase. Patients who showed pneumonia on chest X-rays tended to have increased CRP levels. The results also showed that chest X-ray findings were correlated with CRP level. Diabetes mellitus and hypertension were significantly correlated with CRP level (p = 0.05), whereas dyspepsia did not show a significant relationship with CRP level (p > 0.05). Patients with hypertension had a 2.709-fold risk of having increased CRP level compared with patients without hypertension. Patients with pneumonia had a 2.953-fold increased risk for increased CRP level compared to those without pneumonia. Conclusion: Hypertension and diabetes mellitus are significantly correlated with CRP level. Chest X-ray finding is also significantly correlated with CRP level.

Diabetes Mellitus (DM) merupakan faktor risiko perkembangan TB aktif. DM adalah penyakit tidak menular yang bersifat kronis dan akan melemahkan sistem kekebalan tubuh, penderitanya memiliki kemungkinan 3 kali lebih tinggi untuk menderita TB aktif. Tujuan penelitian ini adalah mengkaji gambaran radiologi foto toraks pasien TB paru resistan obat disertai DM tipe 2 dibandingkan dengan pasien TB paru resisten obat tanpa DM tipe 2 di RSIJ Sukapura periode September 2018 – September 2019. Penelitian ini adalah penelitian deskriptif komparatif dengan rancangan penelitian cross sectional (potong lintang). Teknik pengambilan sampel adalah total sampling serta menggunakan data sekunder. Jumlah sampel sebanyak 9 pasien, 5 pasien perempuan dan 4 pasien laki-laki. 4 pasien dengan DM dan 5 pasien bukan DM. Infiltrat adalah gambaran yang banyak ditemukan pada pasien DM dan bukan DM. Pada pasien DM kavitas dan fibrosis merupakan gambaran yang sering ditemukan setelah infiltrat. Pada pasien bukan DM nodul merupakan gambaran yang sering ditemukan setelah infiltrat. Pada penelitian ini menunjukkan hasil tidak terdapat perbedaan yang signifikan antara pasien DM maupun bukan DM.