Diagnostic Overview and Management of Adult Pulmonary Tuberculosis Patients Inpatient at RSU Royal Prima Medan in 2020

Tuberculosis is an inflammatory disease of the lung parenchyma caused by infection with Mycobacterium tuberculosis. This research aims to find out the description of the diagnosis and management of adult pulmonary TB patients hospitalized at RSU Royal Prima Medan in 2020. This study is a descriptive study. This study is based on medical record data on inpatients with a diagnosis of pulmonary TB at the Royal Prima General Hospital Medan in 2020. The youngest patient was 18 years old and the oldest was 82 years old. The main complaint was shortness of breath (53%), additional complaints were cough (48%), symmetrical physical examination of the thorax (91%), positive sputum smear examination (72%), combined medical management of pulmicort + fumadryl + paracetamol + levofloxacin + OAT category I (72%), the longest length of stay was 7-8 days (38%), the shortest was 11-12 days (1%). In conclusion, pulmonary TB occurs more in men in the 37- 45 year age group (22%), the most complaints are shortness of breath (53%), and the most widely used combination treatment is pulmicort + fumadryl + paracetamol + levofloxacin + drugs anti tuberculosis category I (72%).

Diagnostic and management problems of chylous effusion in a patient with newly-diagnosed tuberculosis

Tuberculosis (TB) remains a major cause of morbidity and mortality globally. Although TB most commonly affects the lungs, any organ or tissue can be involved. Extra-pulmonary forms of TB are commonly unrecognized or late diagnosed. Chylous effusion, i.e. chylothorax and chylous ascites, which is characterized by the presence of chyle in the pleural and peritoneal cavities, is an uncommon manifestation of extra-pulmonary TB. A 22-year-old male, referred to Dr. Soetomo Hospital with complaints of dyspnea, fever, and abdominal distension. Chest X-ray showed pleural effusion. Analysis of fluid obtained from thoracentesis and paracentesis showed chylothorax and chylous ascites. M. tuberculosis had been found in sputum smear examination. ADA (adenosine deaminase) test was performed on ascites fluid and a positive result was obtained. Chylous effusion in this patient were concluded to be related to TB. Patient was then treated with anti-TB drugs and somatostatin. Chylothorax and chylous ascites improved after treatment with somatostatin for 1 week. Administration of anti-TB drugs was planned to be continued for 9 months. The most common causes of non-traumatic chylous effusion in developing countries are infection of TB and filariasis. Chylous effusion is caused by obstruction or disruption of the lymphatic system. ADA test is a new biomedical method that begins to expand its use in body fluids to diagnose extra-pulmonary TB. Fasting, together with total parenteral nutrition, can decrease the lymph flow and balance metabolic impairment. Somatostatin has been used in the treatment of chylous effusion as it diminishes peristalsis and intestinal absorption of fats as well as decreases portal pressure.

GAMBARAN BASIL TAHAN ASAM PADA PENDERITA TUBERKULOSIS PARU

ABCTRACT Tuberculosis is an acute and chronic infections disease that mainly attacks the lungs caused by acid-resistant bacteria (BTA) which are gram positive rods (Mycobacterium tuberculose). Tuberculosis can attack various organs, especially the lungs. This disease if not treated or treatment is incomplete can cause complications until death. The purpose of this study was to determine the description of Acid Resistant Basil in lung TB patients who have been diagnosed by Doctors at Puskesmas Pancurbatu Deli Serdang Regency. This research is descriptive with total population. The sample size in this study was 28 samples. Sputum speech from the study sample was examined by the Zhiel Neelsen staining method. The study was conducted at the Puskesmas Laboratory, Puskesmas Pancur Batu, Deli Serdang Regency. Data were analyzed descriptively. Based on the results of research conducted on Overview of acid-resistant bacilli (BTA) in Patients With Clinical Diagnosis OF Pulmonary Tuberculosis In Pancur Batu Public Health Center Deli Serdang District., apparently 20 samples (71%) were negative and 8 samples (29%) were positive. With the most positive results seen from the age of 17-48 years as many as 5 samples (62%) and those seen from the male Gender as many as 5 samples (62 %). Therefore it is suggested further research is needed by conducting sputum culture in patients with suspected pulmonary tuberculosis but the results of sputum smear examination are negative. Keywords : Tuberculosis, Acid Resistant Bacilli (BTA) ABSTRAK Tuberkulosis adalah penyakit menular akut maupun kronis yang terutama menyerang paru yang disebabkan oleh bakteri tahan asam (BTA) yang bersifat batang gram positif (Mycobacterium tuberculose). Tuberkulosis dapat menyerang berbagai organ terutama paru-paru. Penyakit ini jika tidak diobati atau pengobatannya tidak tuntas dapat menimbulkan komplikasi hingga kematian. Tujuan penelitian ini adalah untuk mengetahui gambaran Basil Tahan Asam Pada Penderita TB Paru yang telah di Diagnosa Dokter di Puskesmas Pancur Batu Kabupaten Deli Serdang. Penelitian ini merupakan deskriptif dengan total populasi. Besar sampel pada penelitian ini adalah 28 sampel. SpeSimen sputum dari sampel penelitian diperiksa dengan metode Pewarnaan Zhiel Neelsen. Penelitian di lakukan di Laboratorium Puskesmas Puskesmas Pancur Batu Kabupaten Deli Serdang.data hasil penelitian dianalisis secara deskriptif. Berdasrkan hasil penelitian yang telah dilaksanakan tentang Gambaran Basil Tahan Asam (BTA) Pada Penderita Diagnosa Klinis Tuberkulosis Paru Di Puskesmas Pancur Batu Kabupaten Deli Serdang, ternyata 20 sampel (71%) negatif dan 8 sampel (29%) positif. Dengan hasil positif terbanyak dilihat dari umur 17-48 tahun sebanyak 5 sampel (62%) dan yang dilihat dari Jenis Kelamin laki-laki sebanyak 5 sampel (62%). Denga demikian disarankan Perlu dilakukan penelitian lanjut dengan melakukan kultur sputum pada penderita terduga tuberkulosis paru namun hasil pemeriksaan sputum BTA negatif. Kata Kunci : Tuberkulosis, Bakteri Tahan Asam (BTA)

Chest Radiography and Xpert MTB/RIF® Testing in Persons with Presumptive Pulmonary TB: Gaps and Challenges from a District in Karnataka, India

Background. In India, as per the latest diagnostic algorithm, all persons with presumptive pulmonary TB (PPTB) are required to undergo sputum smear examination and chest radiography (CXR) upfront. Those with sputum smear positive, sputum smear negative, but CXR lesions suggestive of TB or those with strong clinical suspicion of TB are expected to undergo Xpert MTB/RIF® assay test (also known as CB-NAAT (cartridge-based nucleic acid amplification test)). Objective. To assess what proportion of PPTB who are undergoing sputum smear examination at microscopy centers of public health facilities have undergone CXR and CB-NAAT. To explore the barriers for uptake of CXR and CB-NAAT from the public health care provider’s perspective. Methods. We conducted a sequential explanatory mixed-methods study in Chikkaballapur district of Karnataka State, South India. The quantitative component involved a review of records of PPTB who had undergone sputum smear examination in a representative sample of seven microscopy centers. The qualitative component involved key informant interviews with four medical officers and group interviews with 9 paramedical staff. Results. In February and March 2019, about 732 PPTB had undergone smear examination. Of these, 301 (41%) had undergone CXR and 49 (7%) had undergone CB-NAAT. The proportion of PPTB who had undergone CXR varied across the seven microscopy centers (0% to 89%). CB-NAAT was higher in PPTB from urban areas when compared to rural areas (8% vs. 3%) and in those who were smear positive when compared to smear negative (65% vs. 2%). The major barriers for CXR and CB-NAAT were nonavailability of these tests at all microscopy centers and patients’ reluctance to travel to the facilities where CXR and CB-NAAT services are available. Conclusions. CXR and CB-NAAT of PPTB are suboptimal. RNTCP should undertake measures to address these gaps in implementing its latest diagnostic algorithm.

Karakteristik Penderita Tuberculosis Multidrug Resistant (TB MDR) di Sulawesi Tenggara Tahun 2014-2017

ABSTRACTBackground:MDR TB is one type of bacterial tuberculosis resistance to first-line anti-TB drugs, Isoniazid and Rifampicin. Data from the Provincial Health Office of Southeast Sulawesi cases of MDR TB increase every year that is in 2014 there are 7 patients with MDR TB, 2015 there are 8 patients with MDR TB, 2016 there are 23 patients with MDR TB, and in 2017 there are 28 patients with MDR TB. The purpose of this study is to explain the characteristics of patients with MDR TB in Southeast Sulawesi in 2014-2017. Research Purpose: This study is to explain the characteristics of patients with MDR TB in Southeast Sulawesi in 2014-2017. Research Method: The location of this study was in the Provincial Health Office of Southeast Sulawesi and Bahteramas General Hospital of Southeast Sulawesi Province with study population included all patients diagnosed with MDR TB in Southeast Sulawesi Province 2014-2017. The research data is processed to know the number and percentage of each characteristic of MDR TB patients in Southeast Sulawesi 2014-2017. Research result: The conclusion of the result of the study is characteristic of MDR TB patient in Southeast Sulawesi 2014-2017 dominated by age 15-55 years old, male gender, entrepreneur job, case of drop out treatment, examination of chest X-ray in the form of infiltrate and cavity, sputum smear examination (+1), the type of Rifampicin resistance, and is still temporarily treated.Keyword: MDR TB, age, sex, occupation, medical history, investigation, type of resistance and treatment outcome.

HUBUNGAN TINGKAT MOTIVASI PENGAWAS MINUM OBAT DENGAN PENCAPAIAN ANGKA KONVERSI BTA PADA PASIEN TB PARU

Tubercle Bacillus disease in Indonesia is ranked number 5 in the world. One of the factors that affect the achievement of the conversion rate is PMO motivation in monitoring TB patients during TB medication ingestion. The purpose of this study was to determine the relationship between the level of supervisors’ motivation to take medication with achieving a conversion rate of sputum smear examination of TB patients in the Sukamerindu community health center of Bengkulu Year 2014 This research was a descriptive cross using sectional analytic sample approach that obtained through purposive sampling amounted 37 patients with pulmonary TB and type of data that collected was primary data. Analysis technique that used in this study was the chi-square statistical test, presented in table form and narrative. The results showed that the majority of respondents have low motivation (75.7%) more than the majority achieving of conversion rate (56.8%). Chi Square Test results showed that there was relationship between supervisory level of motivation to take medication and conversion rate achievement of sputum smear examination of pulmonary TB patients (p = 0.024 (<α = 0.05). It is Expected that health workers (nurses and doctors) to be more discipline in monitoring eradication program of infectious diseases, especially pulmonary TB and Drug Supervisory