As Indonesia’s rifampin resistance testing rates are lower than global testing rates per the 2020 WHO global tuberculosis (TB) report, prevalence of multidrug-resistant TB may be underestimated. Our study aimed to evaluate prevalence and patterns of TB drug resistance (DR) within Indonesia. We conducted a cross-sectional analysis of baseline data collected from 2017–2018 as part of a cohort study of adults with presumed pulmonary TB at 7 DR-TB referral hospitals in Indonesia. Bacteriological examinations (acid-fast bacilli, GeneXpert, sputum culture) and drug-susceptibility testing were performed following the guidelines of the National TB Program. Of 447 participants with complete bacteriological examinations, 312 (69.8%) had positive sputum cultures for Mycobacterium tuberculosis. The proportion of MDR and pre-extensively drug-resistant was higher in previously treated compared with newly diagnosed participants (52.5% [73/139] versus 15% [26/173]). Compared with drug-sensitive case, drug-resistant TB was associated with cavities. Given the difference between rates of DR in TB referral hospitals from our study compared with the WHO survey in 2019 that showed 17.7% and 3.3% DR among previously treated and newly diagnosed participants globally, further characterization of Indonesia’s TB epidemiology in the general population is needed. Strategies, including public policies to optimize case finding, strengthen capacity for resistance testing, and prevent loss to follow-up will be critical to reduce the burden of TB in Indonesia.
Background: The main purpose of treatment in patients with advanced lung cancer is more emphasizing on prolonging survival and improving the patient's quality of life (QOL). Micronutrient deficiency has an impact on the patient's QOL. The purpose of this study was to analyse the relationship between biochemical parameters of nutrient deficiency with QOL in patients with advanced non-small cell carcinoma (NSCLC) at Sanglah hospital.Methods: A cross sectional study was conducted in Sanglah general hospital on March-June 2021. Hemoglobin, albumin, and 2.5 (OH) D levels were obtained from patient's serum. The participant’s QOL was measured with EQ-5D-3L questionnaire. Bivariate analysis using chi-square test or Fisher's exact test, and multivariate analysis using logistic regression.Results: A total of 80 participants were included in this study, and 55% had poor QOL. Seventy percent participants had anemia, 36.3% had hypoalbuminemia, and 26.3% had vitamin D deficiency. The QOL of patients with advanced stage NSCLC was significantly associated with hypoalbuminemia (p=0.000) and vitamin D deficiency (p=0.044). Multivariate analysis showed that the most influential factor on the QOL of patients with advanced stage NSCLC was hypoalbuminemia (AOR 9.158; 95% CI 2.150-30.001; p=0.003).Conclusions: Hypoalbuminemia and vitamin D deficiency were significantly related with QOL of advance NSCLC patients. No relationship was found between anemia and the QOL of advance NSCLC patients. Hypoalbuminemia was the most influential factors related to the QOL of advance NSCLC patients.
COVID-19 is a major public health problem, with still questionable specific cure. Favipiravir is a COVID-19 antiviral that is included in several drugs, potentially a therapy for COVID-19. This study aimed to analyze its efficacy and safety in moderate to critical hospitalized patients. This study was a retrospective cohort in Denpasar City, Bali Province, Indonesia, from August 2020 to January 2021. There was a total of 192 patients; 96 patients in the favipiravir group and 96 patients in the non-favipiravir group (remdesivir/oseltamivir). Effectivity was measured by assessing the clinical condition at the end of the isolation period of 14 days. The favipiravir group showed better clinical conditions than the non-favipiravir group (79.2% vs. 56.3%; aRR 2.196; 95% CI = 1.084 – 4.451, p=0.029), seen from being free of fever and respiratory problems. Stratification analysis demonstrated that the clinical improvement was significantly different in the severe/critical group in favor of favipiravir (RR 1,573; 95% CI = 1.139-2.172). The most common non-serious adverse events (AE) found in the use of favipiravir were gastrointestinal disturbances (12.5%). In conclusion, favipiravir is effective in severe/critical cases, and no serious adverse events were found in its use. Appropriate treatment is expected to help in reducing the public health burden.
Background: Analyses of correlates of SARS-CoV-2 infection or mortality have usually assessed individual predictors. This study aimed to determine if patterns of combined predictors may better identify risk of infection and mortality. Methods: For the period of March 2nd to 10th 2020, the first 9 days of the COVID-19 pandemic in Indonesia, we selected all 18 confirmed cases, of which 6 died, and all 60 suspected cases, of which 1 died; and 28 putatively negative patients with pneumonia and no travel history. We recorded data for travel, contact history, symptoms, haematology, comorbidities, and chest x-ray. Hierarchical cluster analyses (HCA) and principal component analyses (PCA) identified cluster and covariance patterns for symptoms or haematology which were analysed with other predictors of infection or mortality using logistic regression. Results: For univariate analyses, no significant association with infection was seen for fever, cough, dyspnoea, headache, runny nose, sore throat, gastrointestinal complaints (GIC), or haematology. A PCA symptom component for fever, cough, and GIC tended to increase risk of infection (OR 3.41; 95% CI 1.06 - 14; p=0.06), and a haematology component with elevated monocytes decreased risk (OR 0.26; 0.07 - 0.79; 0.027). Multivariate analysis revealed that an HCA cluster of 3-5 symptoms, typically fever, cough, headache, runny nose, sore throat but little dyspnoea and no GIC tended to reduce risk (aOR 0.048; <0.001 - 0.52; 0.056). In univariate analyses for death, an HCA cluster of cough, fever and dyspnoea had increased risk (OR 5.75; 1.06 - 31.3, 0.043), but no other individual predictor, cluster or component was associated. Other significant predictors of infection were age >= 45, international travel, contact with COVID-19 patient, and pneumonia. Diabetes and history of contact were associated with higher mortality. Conclusions: Cluster groups and co-variance patterns may be stronger correlates of SARS-CoV-2 infection than individual predictors. Comorbidities may warrant careful attention as would COVID-19 exposure levels.
Background: Pleural effusion is caused by various disease, including tuberculosis infection and malignancy. To determine the etiology, immunologic parameters are needed to distinguish tuberculous and malignant pleural effusions, including pleural fluid interleukin-6 (IL-6), neutrophil-lymphocyte ratio (NLR), and monocyte-lymphocyte ratio (MLR).Methods: This was a cross-sectional study, conducted at Sanglah General Hospital in Denpasar from March 2020 to September 2020. Pleural fluid IL-6 and leucocyte differential count were measured from subjects with tuberculous and malignant pleural effusions.Results: There were 22 tuberculous pleural effusion subjects with mean pleural fluid IL-6 9269.017±902.211 pg/ml, median (range) pleural fluid NLR 0.123 (0.044-9.449), and MLR 0.065 (0.044-0.355). There were 31 subjects with malignant pleural effusions, with mean pleural fluid IL-6 8212.146±2022.350 pg/ml, median pleural fluid NLR 0.189 (0.015-2.599), and MLR 0.065 (0.010-0.254). Pleural fluid IL-6 in tuberculous pleural effusions were significantly higher (p=0.014). With a pleural fluid IL-6 cut-off ≥9147.959 pg/ml, sensitivity of 63.6% and specificity of 64.5% were obtained. Pleural fluid NLR and MLR of the two groups were not significantly different (p=0.807 and p=0.116).Conclusions: Pleural fluid IL-6 in tuberculous pleural effusions is higher than malignant pleural effusions, with a cut-off of ≥9147.959 pg/ml, tuberculous pleural effusions can be diagnosed with sensitivity of 63.6% and specificity of 64.5%. There is no difference in pleural fluid NLR and MLR in tuberculous and malignant pleural effusions.
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