Bilateral spontaneous pneumothorax in tuberculosis and HIV patient: A case report

INTRODUCTION

Bilateral secondary spontaneous pneumothorax due to tuberculosis and human immunodeficiency virus (TB-HIV) infection is a rare case which has a poor prognosis and high-risk mortality.

CASE PRESENTATION

An Indonesian male, 31 years old, complained of shortness of breath, chest pain, and weight loss (15 kg for 2 months). He has a history of HIV and has been only on ARVs for 3 months since being diagnosed. He, his sister, and his mother had all experienced tuberculous lymphadenitis. The patient appears weak, dyspnea, visual analogue scale (VAS) of 5, blood pressure (BP) of 92/64 mmHg, heart rate (HR) of 112 ×/min, temperature of 37.7 °C, respiratory rate (RR) of 32 ×/min, oxygen saturation (SpO2) of 98 % (simple mask of 8 L/min). On inspection and fremitus, the development of left lung expansion was delayed. Percussion sound of left lung was hypersonor and decreased lung sounds on auscultation. A chest X-ray revealed pneumothorax sinistra. The patient underwent needle thoracocentesis with chest tube insertion and water seal drainage (WSD). During the continuation phase, the patient also took anti-retroviral (ARV) and anti-tuberculosis drug (ATD). The patient had improved but a few days later developed a pneumothorax dextra and received treatment. The patient only survived for 2 days afterwards and died caused by hypovolemic shock.

DISCUSSION

Management of pneumothorax in TB-HIV patients shows only temporary improvement but poor prognosis. Adherence of HIV patients to ARVs minimizes the risk of infected with Mycobacterium tuberculosis in endemic areas.

CONCLUSION

HIV patients are anticipated to remain committed to their treatment regimens in order to reduce the occurrence of pneumothorax induced by TB-HIV in endemic areas.

Clinical Characteristics of 6102 Asymptomatic and Mild Cases for Patients with COVID-19 in Indonesia

BACKGROUND

The COVID-19 pandemic has led to a rise in confirmed cases, making epidemiological studies crucial for identifying the source of transmission and developing effective treatment methods. We conducted a study on the clinical characteristics of patients with asymptomatic and mild symptoms of COVID-19 at a rescue hospital in Indonesia.

METHODS

This is an epidemiological study involving 6102 patients who were admitted to the Indrapura forefront hospital in Surabaya from May 2020 to February 2021. We described demographic data, clinical signs and symptoms, laboratory data, therapy, and clinical outcomes.

RESULTS

A total of 6102 patients were involved in this study, with 3664 (60.04%) being male and 2438 (39.95%) being female. The age range of 21-30 years was the most prevalent, accounting for 31.1% (1898 patients). The population had 1476 patients (24.2%) with comorbid conditions. The most prevalent comorbidity observed among these patients was hypertension, affecting 1015 individuals (16.6%). Out of the total 6006 patients observed, 40.7% (n = 2486) were asymptomatic, 54.6% (n = 3329) had mild symptoms, and 3.1% (n = 191) had moderate symptoms. All patients were administered supportive therapy without the use of antiviral medication. Out of the 6102 patients included in the study, 5923 patients (97.1%) achieved a cure, 36 patients (0.6%) are currently undergoing treatment, 142 patients (2.3%) were referred for desaturation indications (SpO2 < 94%), and one patient died due to a suspected cardiovascular event. Out of the total number of patients, 74.5% (4529 patients) had an average length of stay (LOS) of less than 10 days, while 25.6% (1563 patients) had an average length of stay of more than 10 days.

CONCLUSION

The clinical presentation of asymptomatic and mild COVID-19 patients at a rescue hospital varies significantly based on the age and sex of patients. Cough and hyposmia are commonly observed symptoms. Supportive therapy is effective, and strict implementation of social distancing is crucial in preventing the spread of this disease from individuals who are asymptomatic or have mild symptoms.

Random Blood Glucose, but Not HbA1c, Was Associated with Mortality in COVID-19 Patients with Type 2 Diabetes Mellitus—A Retrospective Study

Previous studies have yielded inconsistent results on whether glycated hemoglobin (HbA1c) and random blood glucose (RBG) are associated with mortality of coronavirus disease 2019 (COVID-19) patients with type 2 diabetes mellitus (T2DM). This study aimed to assess the association of HbA1c and RBG with mortality among COVID-19 patients with T2DM. A retrospective study was conducted on 237 patients with COVID-19 and T2DM (survival (n = 169) and non-survival groups (n = 68)). Data on socio-demography, comorbidities, clinical symptoms, laboratory examination, and mortality were collected. Patients in the non-survival group had an older age range as compared with those in the survival group (60 (52.3–65.0) vs. 56.0 (48.5–61.5) years, p = 0.009). There was no statistical gender difference between the two groups. After matching was done, chronic kidney disease, NLR, d-dimer, procalcitonin, and random blood glucose were higher in the non-survival group compared to the survival group (p < 0.05). HbA1c levels were similar in survivors and non-survivors (8.7% vs. 8.9%, p=0.549). The level of RBG was independently associated with mortality of COVID-19 patients with T2DM (p = 0.003, adjusted OR per 1-SD increment 2.55, 95% CI: 1.36–4.76). In conclusion, RBG was associated with the mortality of COVID-19 patients with T2DM, but HbA1c was not.

Incidence of SARS-CoV-2 infection in hospital workers before and after vaccination programme in East Java, Indonesia-A retrospective cohort study

Background

The incidence of the Coronavirus Disease 2019 (COVID-19) among healthcare workers (HCWs) is widespread. It is important to understand COVID-19 characteristics among HCWs before and after vaccination. We evaluated the incidence of COVID-19 among HCWs in East Java, Indonesia comparing the characteristics of the disease between the pre- vs post-vaccination periods.

Methods

A retrospective observational study was conducted among HCWs in two major hospitals in East Java, Indonesia, between April 01, 2020, and Oct 31, 2021. All HCWs were offered vaccination with inactivated viral vaccine (CoronaVac) from Jan 15, 2021. Therefore, we divided the time of the study into the pre-vaccination period (between April 01, 2020, and Jan 14, 2021) and post-vaccination period (between Jan 15 and Oct 31, 2021). We then compared the pattern of COVID-19 infections, and hospitalisations between these periods.

Findings

A total of 434 (15.1%) and 649 (22.6%) SARS-CoV-2 infections were reported among study participants (n = 2878) during the pre-vaccination and post-vaccination periods, respectively. The vaccine effectiveness was 73.3% during the first 3-4 months after vaccination but this decreased to 17.6% at 6-7 months after vaccination, which coincided with the emergence of the delta variant. The overall hospitalisation rate was reduced from 23.5% in the pre-vaccination period to 14.3% in the post-vaccination period. Hypertension appeared to be the strongest risk factor affecting hospitalisation in the pre-vaccination period. However, the risk due to hypertension was reduced in the post-vaccination period.

Interpretation

The risk to contract COVID-19 remains high among HCWs in East Java, Indonesia. Vaccination is important to reduce infection and hospitalisation. It is essentially important to evaluate the characteristics of COVID-19 infection, hospitalisation, the impact of co-morbidities and vaccine effectiveness in order to improve the measures applied in protecting HCWs during the pandemic.

Funding

Mandate Research Grant No:1043/UN3.15/PT/2021, Universitas Airlangga, Indonesia.

Clinical characteristics of patients with COVID-19 admitted to the COVID-19 Emergency Field Hospital of Bangkalan, Indonesia

Background: Following the surge of coronavirus disease 2019 (COVID-19) cases in the epicenter of East Java Province, this study aimed to determine the clinical characteristics of patients with COVID-19 at one of the emergency field hospitals in Indonesia.

Methods: This was a single-centered, retrospective descriptive study of 763 patients admitted to the COVID-19 Emergency Field Hospital of Bangkalan from July 5 2021 to September 30 2021. The demographic data, clinical signs and symptoms, pre-existing comorbidities, therapy, and clinical outcomes of the patients were analyzed using SPSS.

Results: The clinical characteristics of patients with COVID-19 at the emergency hospital were varied. A total of 763 patients were included. The most common age was between 40 and 49 years (31.1%), a slight majority were women (51.5%), and most had travelled abroad in the last 14 days (99.1%). Of the 763 patients, 70.9% had no comorbidities. Half of the patients were asymptomatic (49.4%), 46% were mild cases, 4.1% were moderate, and 0.5% severe. The most common symptoms were productive cough (15.7%) and headache (15.3%). Supportive and comorbidity therapy were given which showed excellent clinical outcomes.

Conclusions: This study presents the description of the clinical characteristics of COVID-19 patients during high surge cases of COVID-19 that are mostly dominated by Indonesian migrant workers in a field hospital. majority of COVID-19 patients were asymptomatic and therapy without antibiotics or antivirals showed positive outcomes in COVID-19 patients.

Hypertension is associated with antibody response and breakthrough infection in health care workers following vaccination with inactivated SARS-CoV-2

Several types of vaccines have been developed to prevent the coronavirus disease 2019 (COVID-19). It is important to understand whether demographic and clinical variables affect the effectiveness of various types of vaccines. This study analysed the association between demographic/clinical factors, antibody response and vaccine effectiveness in healthcare workers vaccinated with inactivated virus.

We enrolled 101 healthcare workers who received two doses of inactivated viral vaccine (CoronaVac). Blood samples were analysed at 1, 3, and 5 months after the second dose of vaccination. Data regarding demographic characteristics, medical histories, and clinical parameters were collected by interview and medical examination. In a separate retrospective study, we analysed the incidence of vaccine breakthrough infection on 2714 healthcare workers who received two doses of inactivated viral vaccine. Medical histories and demographic data were collected using a structured self-reported questionnaire.

We found that antibody titres markedly increased at 1 month after vaccination but gradually decreased at 3–5 months post-vaccination. We observed a significant association between age (≥40 years) and antibody level, whereas sex and body mass index (BMI) exhibited no effect on antibody titres. Amongst clinical variables analysed, high blood pressure and history of hypertension were significantly correlated with lower antibody titres. Consistently, we found a significant association in the retrospective study between hypertension and the incidence of breakthrough infection.

In conclusion, our results showed that hypertension is associated with lower antibody titres and breakthrough infection following COVID-19 vaccination. Thus, blood pressure control might be important to improve the efficacy of inactivated virus vaccine.

Clinical characteristics and outcomes of hospitalized COVID-19 patients with diabetes mellitus in East Java, Indonesia: A cross-sectional study

Introduction: Diabetes mellitus has been perceived as the worsening factor for coronavirus disease 2019 (COVID-19), where diabetes mellitus patients with pre-existing inflammatory condition could develop acute respiratory disease syndrome as well as multi-organ dysfunction. Managing diabetes mellitus amidst severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is also a matter of concern as several antidiabetic therapies could affect the progression of COVID-19. This study aimed to provide the clinical characteristics and outcomes of patients with both COVID-19 and diabetes mellitus receiving blood glucose lowering therapies and COVID-19 symptomatic treatments.

Methods: This retrospective study was performed on 260 medical records of patients hospitalized between May 2020 to February 2021 in East Java, Indonesia. Patients were confirmed COVID-19 positive based on the results from real time polymerase chain reaction (RT-PCR) using nasal swab samples collected on hospital admission. Data included were demographic characteristics, COVID-19 symptoms, severity of COVID-19, comorbidities (other than diabetes mellitus), fasting blood glucose (FBG), and 2-hours post-prandial blood glucose (2hPBG), and outcomes.

Results: Most of the patients had age range of 41–60 years old (76.1%) with more than a half of the subjects (60%) were obese. Patients with uncontrolled diabetes were distributed evenly among the COVID-19 severities (74.3% in asymptomatic group, 73.6% in mild group, and 74.1% in moderate group). There were reductions in FBG and 2hPBG levels measured before (210.75±81.38 and 271.19±100.7 mg/dL, respectively) and after the treatment (181.03±68.9 and 222.01±86.96 mg/dL, respectively). All patients received multivitamin and symptomatic treatment for COVID-19. Oral antidiabetic drug (57.6%) and insulin (28.8%) were administered to lower the blood glucose level of the patients. As many as 96.9% patients survived, while 3.1% died.

Conclusion: COVID-19 could affect the blood glucose level, suggesting the importance of antihyperglycemic therapies among patients with both COVID-19 and diabetes mellitus.

The clinical impact of bacterial co-infection among moderate, severe and critically ill COVID-19 patients in the second referral hospital in Surabaya

Background: Data on the prevalence of bacterial co-infections among COVID-19 patients are limited, especially in our country, Indonesia. We aimed to assess the rate of bacterial co-infections in hospitalized COVID-19 patients and report the most common microorganisms involved and the antibiotic use in these patients.

Methods: This study is a retrospective cohort study,among COVID-19 adult patients admitted to Universitas Airlangga Hospital Surabaya from 14 March-30 September 2020. The bacterial infection is defined based on clinical assessment, laboratory parameters, and microbiology results.

Results: A total of 218 patients with moderate to critical illness and confirmed COVID-19 were included in this study. Bacterial infection was confirmed in 43 patients (19.7%). COVID-19 patients with bacterial infections had longer hospital length of stay (17.6 6.62 vs 13.317.12), a higher proportion of respiratory failure, intensive care treatment, and ventilator use. COVID-19 patients with bacterial infection had a worse prognosis than those without bacterial infection (p<0.04). The empirical antibiotic was given to 75.2% of the patients. Gram-negative bacteria were commonly found as causative agents in this study (n = 39; 70.37%).

Conclusion: COVID-19 patients with bacterial infection have a longer length of stay and worse outcomes. Healthcare-associated infections during intensive care treatment for COVID-19 patients must be carefully prevented.

The clinical impact of bacterial co-infection among moderate, severe and critically ill COVID-19 patients in the second referral hospital in Surabaya

Background: Data on the prevalence of bacterial co-infections among COVID-19 patients are limited, especially in our country, Indonesia. We aimed to assess the rate of bacterial co-infections in hospitalized COVID-19 patients and report the most common microorganisms involved and the antibiotic use in these patients. Methods: This study is a retrospective cohort study, among COVID-19 adult patients admitted to Universitas Airlangga Hospital Surabaya from 14 March-30 September 2020. The bacterial infection is defined based on clinical assessment, laboratory parameters, and microbiology results. Results: A total of 218 patients with moderate to critical illness and confirmed COVID-19 were included in this study. Bacterial infection was confirmed in 43 patients (19.7%). COVID-19 patients with bacterial infections had longer hospital length of stay (17.6 ± 6.62 vs 13.31±7.12), a higher proportion of respiratory failure, intensive care treatment, and ventilator use. COVID-19 patients with bacterial infection had a worse prognosis than those without bacterial infection (p<0.04). The empirical antibiotic was given to 75.2% of the patients. Gram-negative bacteria were commonly found as causative agents in this study (n = 39; 70.37%). Conclusion: COVID-19 patients with bacterial infection have a longer length of stay and worse outcomes. Healthcare-associated infections during intensive care treatment for COVID-19 patients must be carefully prevented.

THE RELATIONSHIP OF BASIC CLINICAL STATUS WITH THE QUALITY OF LIFE OF HIV AND AIDS PATIENTS

Background: The success of individual antiretroviral drug (ARV) treatment in patients with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) was determined by conducting a routine evaluation of the patients’ Cluster of Differentiation 4 (CD4) count. The indicators used to measure the success of the HIV and AIDS treatment were mortality, mobility, and quality of life (QoL). Purpose: The purpose of this research was to analyze the relationship between clinical status (smoking status, duration of ARV therapy, the CD4 count, and body mass index [BMI]) and the QoL of patients with HIV and AIDS who were stable during treatment. Methods: This type of research was quantitative analytical research with a cross-sectional design. This research was conducted at Dr. Soetomo Hospital, Surabaya, from September to November 2017. The study population was patients with HIV and AIDS in Dr. Soetomo Hospital, Surabaya. The research sample was taken by purposive sampling with the inclusion criteria being patients with HIV and AIDS who had been treated for ≥6 months with adherence ≥95% and who came directly to the hospital. Results: The majority of respondents were female (53.36%), junior/senior high school graduates (66.67%), married (62.22%), non-smoking (75.56%), had undergone ARV therapy for ±10 years (77.78%), and had a QoL in the adequate category (62.22%). The basic clinical status with a significant relationship with the respondents’ QoL were the CD4 count (p = 0.00) and BMI (p = 0.00). Conclusion: There was a relationship of the CD4 count and BMI with the QoL of the patients with HIV and AIDS.

Knowledge and Attitude on Human Immunodeficiency Virus among Migrant Worker Candidates in East Java, Indonesia

Background: In 2018, East Java province becomes the province with the highest number of Human Immunodeficiency Virus (HIV) cases in Indonesia with an incidence of more than 8,000 cases. This province has various groups of Indonesian Migrant Workers (Tenaga Kerja Indonesia, TKI) working in various sectors in different countries, making them prone to HIV infection. This study aimed to determine the level of knowledge and attitude towards HIV and Acquired Immune Deficiency Syndrome (AIDS) among migrant worker candidates in East Java. Methods: This was a cross-sectional descriptive study conducted in August 2018 in the Provincial Manpower and Transmigration Office of East Java, Indonesia. The knowledge and attitude towards HIV disease were assessed using a self-validated questionnaire distributed to 104 migrant worker candidates as the subjects of this study. Results: Eighty-nine percent of the subjects had good knowledge, while 98% of them had good attitudes towards HIV disease. Furthermore, 86% had good attitudes toward HIV transmission. However, no correlation was observed between the subjects’ level of knowledge and their attitude (p=0.334). Conclusions: In general, the level of knowledge and attitudes of migrant worker candidates in East Java towards HIV disease is good. Nevertheless, more knowledge and education on healthy behavior need to be envisaged for this group.

Comparison between Exposure of Ciprofloxacin and Cefotaxime on Developing of Escherichia coli ESBL

This study aimed to compare ciprofloxacin and cefotaxime exposure to develop ESBL producing Escherichia coli (E. coli). A total of 16 isolates of cefotaxime sensitive E. coli and ciprofloxacin were exposed to ciprofloxacin and cefotaxime for 14 days using the Kirby-Bauer antibiotic disc diffusion method. Colonies that grew on the edge of the inhibiting zone were exposed each day by the same method. Furthermore, we observed the occurrence of resistance to cefotaxime as ESBL screening test. Isolates were resistant, the following day the ESBL was confirmed by the Modified Double Disk Sinergy Test (MDDST) method using Cefotaxime (CTX), Ceftazidime (CAZ), Aztreonam (ATM), and Amoxilin Clavulanate (AMC) antibiotic discs. From 16 isolates of ESBL producing E. coli exposed to ciprofloxacin, it was obtained 4 (25%) to ESBL E. coli. ESBL production occurred after E. coli was exposed to ciprofloxacin on days 5, 6, 7, and 12. While those exposed to cefotaxime none becomes ESBL E. coli. There was no difference between ciprofloxacin and cefotaxime exposure to develop ESBL producing E. coli (p=0.101; Chi-square).

The mechanism of the effects of Monascus jmbA rice on increased platelet count in Wistar rats infected with Dengue virus serotype 3

Background

Several traditional medicines have been developed among communities as part of the efforts to improve thrombocytopenia in patients with Dengue virus infection (DVI). Among those efforts is the administration of Monascus jmbA rice (MJR), which is rice fermented with Monascus purpureus. The administration of MJR is believed to increase the platelet count in patients with DVI.

Aim

The objective of this study is to elucidate the mechanism of the effects of MJR on increased levels of platelets in DVI serotype 3 through changes in IL-3, IL-6, IL-11 and TNF-α.

Methods

It was a true experimental laboratory study using the randomized posttest only control group design. The study compared between groups of wistar rats were being treated only with group IVD wistar rats who experienced treatment followed by administration of MJR as well as groups of wistar rats without any treatment as a control group.

Results

The increase in platelet count in the group treated with DVI + MJR was higher than that treated with only DVI and the difference was a significant (P<0.05). Increased levels of TNF-α in the group treated with DVI + MJR were lower than that treated with only DVI and the difference was significant (P<0.05). The significant levels of the causal relationship of TNF-α with IL-6, TNF-α with IL-11 and IL- 6 with platelets were 0.044 (P<0.05), 0.029 (P<0.05) and 0.041 (P<0.05), respectively.

Conclusion

MJR is capable of increasing platelet count through the role of TNF- α and IL-6 in Wistar rats infected with DVI serotype 3.

Profile of antiretroviral and its outcome on patients with HIV-AIDS in Wamena Public Hospital

In Papua, HIV/AIDS is characterized as a widespread epidemic, with a prevalence of 2.3% and a case rate of 416.91 per 100.000. The low accessibility of healthcare services is a major challenge for health services in Papua. The purpose of this study was to determine the profile of ARV use and therapy outcomes of HIV/AIDS patients at Wamena Public Hospital in Papua. This research is an observational cross-sectional retrospective study. Data was collected from the medical records of 236 patients who met the inclusion criteria. Study showed that FDC (TDF + 3TC + EFV) is the most frequently used ARV. ARV therapy improved the clinical condition of 14 patients, and 9 patients had a worsening of their clinical condition. There was an increase in CD4 cell count after 6, 12, and 24 months of ARV therapy in 76%; 55%; and 72% of patients. There were 55 adverse drug events that required a change of regimen. Based on this study, the use of antiretroviral drugs improved clinical condition, decreasing the number of IO, and increasing the patient's CD4 cell count.

Cutaneous adverse drug reaction in Human Immunodeficiency virus patient associated with antiviral therapy: A retrospective study

Drug hypersensitivity reactions specifically cutaenous adverse drug reaction (CADR) occur at higher rate in human immunodeficiency virus (HIV)- positive patients than general population and cause significant morbidity, in early era of antiretroviral therapy (ART), the incidence of skin rashes can reach 50% in HIV patients taking HIV medications. The purpose of this study is to evaluate the pattern of CADR in HIV patients associated with ART. A retrospective study took data from medical record CADR in HIV patients associated with ART at HIV ward, Dr. Soetomo General Hospital Surabaya, since January 2013 until December 2015. During the period of three years, there were 20 CADR patients in at HIV ward, Dr. Soetomo General Hospital Surabaya. The most common patient was male, with the highest age group of 25-44 years old, and the most clinical feature found were maculopapular rash, and Steven Johnson Syndrome (SJS). The most common antiviral therapy were nevirapine. The number of CADR in HIV patient associated with ART cases increased. The most clinical feature were maculopapular rash followed by SJS, only few cases of toxic epidermal necrolysis.

Hubungan Kepatuhan Minum Obat Anti Diabetik dengan Regulasi Kadar Gula Darah pada Pasien Perempuan Diabetes Mellitus

Background: Blood glucose level controlling is the important thing for diabetes mellitus treatment. Diabetics patients need to understand the factors which influence blood glucose level such as the compliance of anti-diabetic drug.Objective: Determine the relationship and the risk of between oral anti-diabetic drug consumption adherence and blood glucose level regulation for diabetes mellitus female patients.Method: Case control study design with purposive sampling technique, in order to obtain 26 research samples which consist of two groups, they are case group (unregulated blood glucose) which has 13 samples and the control group (regulated blood glucose) whice has 13 samples. The samples are female respondents aged 45-59 years old suffering diabetes mellitus. This research analyzed the relationshipand risk between anti-diabetic consumption adherence and blood glucose level regulation in diabetes mellitus patients using chi-square test.Results: Patients with unregulated blood glucose showed 46.2% people were obedient and 53.8% were not obedient in consuming anti-diabetic drugs. Patients with regulated blood glucose showed 92.3% people were obedient and 7.7% people were not obedient in consuming anti-diabetic drugs. Chi square test showed that there was a relationship between anti-diabetic drugs consumption adherence and blood glucose level regulstion for diabetes mellitus patients with p = 0.015 (p <0.05) and an OR value of 14 with a 95% CI (1.385-141.485), which means that unobedient have 14 times risker suffered terrible blood glucose regulation than obedient patients.Conclusion: There was a relationship between anti-diabetic drug consumption adherence and blood glucose level regulation in female patients aged 45-59 years in Mojo Health Center, Pucang Sawu, and Keputih Surabaya. Patients with uncontrolled blood sugar level are more disobedient in consuming anti-diabetic drugs. Meanwhile, patients with controlled blood glucose were most obedient people in consuming anti-diabetic drugs.ABSTRAKLatar Belakang: Pengendalian kadar gula darah merupakan hal yang penting dalam penanganan diabetes melitus. Pasien diabetes perlu memahami faktor-faktor yang mempengaruhi pengendalian kadar gula darah salah satunya adalah kepatuhan minum obat anti diabetik.Tujuan:  Mengetahui hubungan dan besar risiko kepatuhan minum obat oral anti diabetik dengan regulasi kadar gula darah pada pasien perempuan diabetes mellitus.Metode: Desain penelitian kasus kontrol dengan teknik purposive sampling, sehingga diperoleh 26 sampel penelitian yang terdiri dari dua kelompok yaitu kelompok kasus (gula darah tidak teregulasi) sebanyak 13 dan kelompok kontrol (gula darah teregulasi) sebanyak 13 responden perempuan berusia 45-59 tahun yang menderita diabetes melitus. Hubungan dan besar risiko kepatuhan minum obat anti diabetik dengan regulasi gula darah pasien diabetes mellitus menggunakan uji chi-square. Hasil: Pasien dengan gula darah tidak teregulasi menunjukkan sebanyak 46,2% patuh dan 53,8% tidak patuh dalam minum obat anti diabetik. Pasien dengan gula darah teregulasi menunjukkan sebanyak 92,3% patuh dan 7,7% tidak patuh dalam minum obat anti diabetik. Uji chi square menunjukkan terdapat hubungan antara kepatuhan minum obat anti diabetik dengan regulasi kadar gula darah pada pasien diabetes melitus dengan nilai p=0,015 dan nilai OR sebesar 14 dengan CI 95% (1,385-141,485) yang berarti responden yang tidak patuh minum obat anti diabetik berisiko 14 kali mengalami regulasi gula darah yang buruk dibandingkan dengan pasien yang patuh dalam minum obat anti diabetik.Kesimpulan: Terdapat hubungan antara kepatuhan minum obat anti diabetik dengan regulasi gula darah pada pasien perempuan rawat jalan usia 45-59 tahun di Puskesmas Mojo, Pucang Sawu, dan Keputih Surabaya. Pasien dengan kadar gula darah tidak terkontrol lebih banyak tidak patuh dalam minum obat anti diabetik, sedangkan pada pasien dengan gula darah terkontrol sebagian besar cukup patuh dalam minum obat anti diabetik.

Asupan Vitamin A, C, E, Dan IMT (Indeks Massa Tubuh) Pada Lansia Hipertensi dan Non Hipertensi Di Puskesmas Banyu Urip, Surabaya

Background: Hypertension is a non-comunicable disease that easy found in ederly. Dietary intake had an important role as prevent and manage hypertension.Objectives: The objective of this study was to invistigate correlation of dietary intake of vitamins A, C, E and Body Mass Index (BMI) with hypertension among ederly at Puskesmas Banyu Urip Surabaya.Methods: This study was observational that uses case-control desain. Samples calculated according Lemeshow formula amount of 32 respondent (total case and control). This study was held in July until August 2018. Statistical analysis use Chi Square.Results: The result showed that most of subjects were 66-70 years old, woman (87.5%), who had education history primary school (37.5%), and work as house wife (71.9%). Most of subject had adequate vitamin A (96.9%), inadequate vitamin C (87.5%) and inadequate vitamin E (100%). BMI most subject was normal (59.4%). This study demostrated that there was no significant correlation between vitamin C intake and hypertension (OR=3.462; 95% CI=0.32-37.473; p=0.300), and no significant correlation between BMI and hypertension (OR=0.455; 95% CI=0.18-1.921; p=0.236). Averange intake of vitamin A in respondent hypertension was 1301.02±407.84 ug and 1968.03 ±407.84 ug in respondent with normo tension. Averange intake of vitamin E in respondent hypertension was 3.06 ±1.2 mg and 3.34 ±1.23 mg in respondent with normo tension. Conclusions: There was no significant correlation between dietary intake vitamin C and BMI with hypertension. Averange intake of vitamin A, C, and E was better in respondent with normo tension. ABSTRAKLatar Belakang: Hipertensi merupakan penyakit tidak menular dan mudah ditemui pada usia lansia. Asupan makanan memegang peranan penting dalam mencegah dan penatalaksanaan hipertensi.Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan antara asupan vitamin A, C, E dan IMT dengan hipertensi pada lansia di Puskesmas Banyu Urip Surabaya.Metode: Penelitian ini menggunakan metode observasional dengan desain case control. Sampel penelitian ini dihitung sesuai dengan rumus Lemeshow yakni sebesar 32 responden (total kelompok kasus dan kontrol). Penelitian ini dilakukan pada bulan Juli hingga bulan Agustus 2018. Analisis statistik yang digunakan uji Chi Square.Hasil: Sebagian besar responden berusia 66-70 tahun, berjenis kelamin wanita (87,5%), riwayat pendidikan terakir SD sederajat (37,5%), dan berkerja sebagai ibu rumah tangga (71,9%). Tingkat kecukupan vitamin A sebagian besar baik (96,9%). Tingkat kecukupan vitamin C sebagian besar kurang (87,5%). Tingkat kecukupan vitamin E kurang (100%). IMT sebagian besar responden normal (59,4%). Tidak terdapat hubungan yang signifikan antara asupan vitamin C dengan hipertensi (OR=3,462; 95% CI=0,32-37,473; p=0,300) dan tidak terdapat hubungan yang signifikan IMT dengan hipertensi (OR=0,455; 95% CI=0,18-1,921; p=0,236). Rata-rata asupan vitamin A pada responden hipertensi sebesar 1301,02 ±407,84 ug dan pada tekanan darah normal 1968,03 ±956,67 ug. Rata-rata asupan vitamin E  pada responden hipertensi sebesar 3,06 ±1,2 mg dan pada tekanan darah normal sebesar 3,34 ±1,23 mg.Kesimpulan: Asupan vitamin C dan IMT tidak berhubungan signifikan dengan kejadian hipertensi. Rata-rata asupan vitamin A, C, dan E lebih besar pada responden kelompok tekanan darah normal.

CRYPTOCOCCAL ANTIGENEMIA IN HIV/AIDS PATIENTS USING LATERAL FLOW IMMUNOASSAY DETECTION AT Dr. SOETOMO GENERAL HOSPITAL SURABAYA

Cryptococcus  infection in HIV / AIDS patients results in cryptococcal meningitis, a major cause of subacute meningitis  with 100% mortality if not receiving appropriate antifungal therapy. An examination of cryptococcal antigen will provide risk information for patients who will experience cryptococcal meningitis. Better diagnosis in asymptomatic and symptomatic phases of cryptococcosis are key components to reduce morbidity and mortality. This study aims to determine the proportion of cryptococcal antigenemia in HIV / AIDS patients treated at Intermediate Treatment-Infectious Diseases Unit of Dr. Soetomo General Hospital Surabaya. Cryptococcal antigenemia was examined in HIV / AIDS patients with suspected Cryptococcus infection and CD4+ T cell lymphocyte count <200 cell /μl. The examination used a lateral flow assay diagnostic tool, a simple FDA(Food and Drug Administration)-approved immunochromatographic test system for detection of capsular polysccharide antigens of Cryptococcus species complex (Cryptococcus neoformans and Cryptococcus gattii) in blood. This test meets all of the World Health Organization ASSURED criteria (affordable, sensitive, specific, user friendly, rapid/robust, equipment-free, and delivered). Sensitivity and specifiticy of this method from serum are both 100%. There were 3 positive cryptococcal antigenemia from 41 serum HIV / AIDS patients with suspected cryptococcus infection at Intermediate Treatment- Infectious Diseases Unit of Dr. Soetomo General Hospital Surabaya. All of these patients were male aged over 36 years, had CD4+ T cell lymphocytes <100 cell /μl and had never received antiretroviral therapy before. The proportion of cryptococcal antigenemia in HIV / AIDS patients with suspected Cryptococcus infection at Intermediate Treatment-Infectious Diseases Unit of Dr. Soetomo General Hospital Surabaya was 7.32%.

Medical Audit of the Management of Patients with Sepsis in the Intermediate Care Unit of Department Internal Medicine School of Medicine Airlangga University/Dr. Soetomo Hospital

Sepsis and septic shock is one of the highest causes of death in patients treated in hospitals. Research Objectives: to evaluate the quality of the management of sepsis patients in Intermediate Care Unit, Department of Internal Medicine Dr. Soetomo Hospital Surabaya, Indonesia. This study was a retrospective study to re-evaluate the patient medical record. The number of patients treated: 275 patients, sepsis patients: 80 patients, the number of patients who entered the study 50 patients, 30 (60%) female and 20 (40%) men, most age groups aged 60 -70 years (32%), Mean 54 Median 56. Diagnostic accuracy according to the criteria of sepsis 45 (90%) patients, compliance with taking blood culture 2 (4%) patients, appropriate antibiotic selection 49 (98%) patients, the number of patients who should not be given antibiotics (4 patients), but given the antibiotic is 3 (75%) patients, the number of patients who should be given antibiotics (46 patients) but were not given antibiotics 1 (2%) patient. The reason of patients discharged: 27 had died (54%), 13 cured (26%), not yet recovered 10 (20%). The reason of patients discharged forcibly: to feel recovered 2 (20%), the condition gets worse 3 (30%), no cost 2 (20%), not clear 3 (30%). Patients with sepsis remain a big problem, and it still needs to improve the management of sepsis on existing guidelines.