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High glycosylated hemoglobin level as a risk factor of latent tuberculosis infection in patients with uncomplicated type 2 diabetes mellitus Arliny, Yunita; Yanifitri, Dewi Behtri; Mursalin, Diennisa
Universa Medicina Vol. 41 No. 1 (2022)
Publisher : Faculty of Medicine, Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2022.v41.47-55

Background Diabetes mellitus (DM) is known to increase the risk of infection including tuberculosis (TB). Some studies also showed that 2-15% of latent TB infection (LTBI) will progress to active TB. This study aimed to obtain the prevalence of LTBI and to determine the risk factors of LTBI in patients with type 2 diabetes mellitus (T2DM). Methods This was a cross-sectional study on 242 adult T2DM patients. For LTBI screening we performed the interferon gamma release assay (IGRA) (Quantiferon TB Gold Plus test) and for confirmation of active TB (pulmonary TB) we performed GeneXpert MTB/Rif sputum examination and chest X-ray. Glycosylated hemoglobin (HbA1c) levels, smoking history and BCG scar were collected. Multivariate logistic regression was used to analyze the data. Results Positive IGRA results were found in 99 of 242 uncomplicated T2DM patients while LTBI was found in 82 patients (33.8%). There were significant differences between T2DM patients with latent TB and T2DM patients without infection in HbA1c and specific IFN-Ã£ levels (TB1 minus nil and TB2 minus nil), i.e. 8.5% and 7.6%, 2.5 IU/mL and 0.06 IU/mL, and 2.6 IU/mL and 0.08 IU/mL, respectively. Multivariate analysis showed that the risk factors for LTBI in T2DM patients were smoking history, HbA1c >7%, and no BCG scar. Conclusions Because LTBI is prevalent in T2DM, it is important to screen for it in T2DM patients due to the risk of developing severe active TB. Absence of a BCG scar and high HbA1c levels are strong predictors of LTBI in T2DM patients.

Analysis of Clinical Manifestation at Admission and Comorbidity on Clinical Outcome of COVID-19 Patients in RSUDZA Banda Aceh Isma, Heliyana; Arliny, Yunita; Yanifitri, Dewi Behtri; Budiyanti, Budiyanti; Zulfikar, Teuku
Jurnal Respirologi Indonesia Vol 42, No 4 (2022)
Publisher : Perhimpunan Dokter Paru Indonesia (PDPI)/The Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/jri.v42i4.288

Background: Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV- 2 virus and has become a pandemic until now. Clinical outcomes in patients vary depending on many factors, such as demographics, vital signs, laboratory results, and comorbidities.Methods: This study aims to analyze clinical outcomes in COVID-19 patients associated with the patient's general information (age, sex), demographic factors, admission vital signs, degree of symptoms at admission, blood laboratory results at admission, and comorbidities. This study is an analytic observational study with a cross-sectional design. All variables were examined based on medical records at the time of admission to the hospital. A multivariate analysis was conducted to determine what factors most influence clinical outcomes in treated COVID-19 patients.Results: There were 183 COVID-19 patients included in this study with moderate to critical degrees. Factors that influence the clinical outcome of COVID-19 patients are the presence of comorbidities, old age, high blood pressure and heart rate, anemia, leukocytosis, and increased blood sugar and creatinine at admission. Multivariate analysis showed that clinical symptoms of severe COVID-19 were a factor that influenced poor clinical outcomes in COVID-19 patients, with OR=5.6 (95% CI=2.223-13.90).Conclusion: Age, comorbidity, blood pressure, heart rate, hemoglobin, random blood glucose, and creatinine at admission influence the clinical outcome of admitted COVID-19 patients.

Analysis of Risk Factors for Loculated Pleural Effusion in Patients with Tuberculous Pleural Effusion at dr. Zainoel Abidin Hospital Purqan, Muhammad; Arliny, Yunita; Priyanto, Herry; Yanifitri, Dewi Behtri; Yanti, Budi
Jurnal Respirologi Indonesia Vol 45 No 4 (2025)
Publisher : Perhimpunan Dokter Paru Indonesia (PDPI)/The Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/jri.v45i4.822

Background: Loculated pleural effusion is an effusion that has a lenticular configuration with smooth borders and is relatively homogeneous and can cause atelectasis in the surrounding lung tissue and is a result of excessive inflammation. Tuberculous pleural effusion is characterized by chronic accumulation of fluid and inflammatory cells in the pleural cavity. If not treated appropriately, a loculated pleural effusion can be life-threatening. This study aims to assess risk factors for loculated pleural effusion in TB pleural effusion patients. Method: This is an observational, analytical research with a cross-sectional design. The research sample was taken based on a consecutive sampling technique from TB pleural effusion patients treated at dr. Zainoel Abidin Hospital, Banda Aceh, from January 2024 to April 2024. Results: This study shows a relationship between age, kidney failure and diabetes mellitus on the incidence of loculated pleural effusion in TB pleural effusion patients (P<0.05). Age ≥46 years old has a 12.57 times risk, kidney failure 5.50 times and DM 14.5 times against the incidence of loculated pleural effusion. Gender, anemia, human immunodeficiency virus (HIV), pleural fluid analysis results and positive culture did not correlate with loculated pleural effusion (P>0.05). Conclusion: Age, kidney failure and diabetes mellitus are risk factors for loculated pleural effusion. The increase in age-related risk is associated with chronic inflammation, called inflammaging. Increasing age is also associated with changes in the composition and function of lung cells, making the clearance of pathogens difficult. Intense inflammation and difficulty in clearing pathogens also contribute to the association of kidney failure and diabetes mellitus with loculated pleural effusion.

Cycloserine- and Fluoroquinolone-Induced Seizure in Multidrug-Resistance Tuberculosis (MDR-TB) Patient: A Case Report Yanifitri, Dewi Behtri; Arliny, Yunita; Utami, Wilia Aprilisa; Winardi, Wira
Jurnal Respirasi Vol. 10 No. 1 (2024): January 2024
Publisher : Faculty of Medicine Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jr.v10-I.1.2024.61-68

Introduction: Multidrug-resistant tuberculosis (MDR-TB) is a type of tuberculosis (TB) that is resistant to at least two of the most effective first-line anti-TB drugs, isoniazid (H) and rifampicin (R). Cycloserine (Cs) and levofloxacin (Lfx) are second-line anti-TB drugs used in MDR-TB therapy. Even though they are considered to have high effectiveness, both drugs have the potential to cause side effects. One important side effect is neurotoxicity. Seizures have been reported as a common complication of some drugs. Case: A 39-year-old man was diagnosed with MDR-TB and was treated with individual regimens consisting of Lfx, bedaquiline (Bdq), linezolid (Lzd), clofazimine (Cfz), and Cs. After consuming anti-TB drugs for 27 days, the patient had seizures several times. The patient experienced full-body seizures and loss of consciousness during the seizures. Cs and Lfx were discontinued and replaced by other regimens. Serial electroencephalogram (EEG) showed normal results. After Cs and Lfx were discontinued, the patient never had another seizure. Conclusion: Management of MDR-TB is sometimes complicated because of severe drug side effects. Patients taking Cs and fluoroquinolones (FQs) should be advised to report any sign of seizure or changes in mental status to their healthcare provider.

Analysis of Clinical Manifestation at Admission and Comorbidity on Clinical Outcome of COVID-19 Patients in RSUDZA Banda Aceh Isma, Heliyana; Arliny, Yunita; Yanifitri, Dewi Behtri; Budiyanti, Budiyanti; Zulfikar, Teuku
Jurnal Respirologi Indonesia Vol 42 No 4 (2022)
Publisher : Perhimpunan Dokter Paru Indonesia (PDPI)/The Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/jri.v42i4.288

Background: Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV- 2 virus and has become a pandemic until now. Clinical outcomes in patients vary depending on many factors, such as demographics, vital signs, laboratory results, and comorbidities.Methods: This study aims to analyze clinical outcomes in COVID-19 patients associated with the patient's general information (age, sex), demographic factors, admission vital signs, degree of symptoms at admission, blood laboratory results at admission, and comorbidities. This study is an analytic observational study with a cross-sectional design. All variables were examined based on medical records at the time of admission to the hospital. A multivariate analysis was conducted to determine what factors most influence clinical outcomes in treated COVID-19 patients.Results: There were 183 COVID-19 patients included in this study with moderate to critical degrees. Factors that influence the clinical outcome of COVID-19 patients are the presence of comorbidities, old age, high blood pressure and heart rate, anemia, leukocytosis, and increased blood sugar and creatinine at admission. Multivariate analysis showed that clinical symptoms of severe COVID-19 were a factor that influenced poor clinical outcomes in COVID-19 patients, with OR=5.6 (95% CI=2.223-13.90).Conclusion: Age, comorbidity, blood pressure, heart rate, hemoglobin, random blood glucose, and creatinine at admission influence the clinical outcome of admitted COVID-19 patients.

Anti-TB Drug Side-Effects on the Treatment of Drug-Resistant Tuberculosis (DR-TB) in dr. Zainoel Abidin Hospital Banda Aceh Arliny, Yunita; Muarif, Muhammad Fadjar; Mahdani, Wilda; Yanifitri, Dewi Behtri
Jurnal Respirologi Indonesia Vol 45 No 1 (2025)
Publisher : Perhimpunan Dokter Paru Indonesia (PDPI)/The Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/jri.45i1.507

Background: Drug-resistant tuberculosis (DR-TB) is treated with second-line anti-tuberculosis (anti-TB) drugs which are comparatively less effective and more toxic. The increased toxicity of the drugs may lead to the occurrence of side effects throughout the treatment. The study aims to assess DR-TB patients' side effects and clinical profile at the dr. Zainoel Abidin Hospital, Banda Aceh. Methods: Observational descriptive study of DR-TB patients who underwent treatment from 2020 to 2022 at dr. Zainoel Abidin Hospital, Banda Aceh. The data was taken from medical records of patients which are then analysed using univariate analysis. Results: Out of 49 patients, most of them were male with 23 people (65,3%), belonging to the age group of 46-55 with 11 people (22,4%), worked as entrepreneurs with 11 people (22,4%), and most came from Banda Aceh and Aceh Besar with 14 people each (28,6%). Twenty-seven patients (65,1%) were suspected of secondary infection, most of which were cases of relapse from 10 people (20,4%). 39 of the patients (79,6%) had rifampicin-resistant tuberculosis. 36 patients (73,4%) were given individualized treatment with Lfx – Bdq – Lzd – Cfz – Cs being the most common drug combination given to 16 people (32.7%). All patients experienced side effects from the treatment, with the most common being nausea from 28 people (57,1%) followed by peripheral neuropathy from 19 people (38,8%). Conclusion: Side effects are commonly found in the treatment of DR-TB and may become more prevalent as the treatment continues. Educating the patient and treating side effects is important to maintain patient compliance.

Analysis of Monocyte to Lymphocyte Ratio and Clinical Symptoms of Clinically Confirmed Pulmonary Tuberculosis New Case Patients Before Treatment and After Intensive Phase Handoko, Basti; Arliny, Yunita; Priyanto, Herry; Andayani, Novita; Yanifitri, Dewi Behtri
Jurnal Respirologi Indonesia Vol 45 No 1 (2025)
Publisher : Perhimpunan Dokter Paru Indonesia (PDPI)/The Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/jri.v45i1.533

Background: Treatment evaluation of clinically confirmed pulmonary tuberculosis (TB) is limited to clinical symptoms and chest X-rays that tend to be subjective and no better than bacteriological examination. Monocytes and lymphocytes mediate the immunopathology of TB infection as a form of host defense that affects the systemic concentration of the body’s defense cells. The study assesses the monocyte-to-lymphocyte ratio (MLR) to evaluate TB treatment. Methods: Longitudinal prospective paired t-test with characteristics of clinically confirmed pulmonary TB new cases then compared to monocytes, lymphocytes, and monocyte-lymphocyte ratio (MLR) before administration of anti-tuberculosis drugs (ATD) and the end of the intensive phase. Results: In thirty clinically confirmed pulmonary TB patients before and after the anti-tuberculosis drug (ATD) there was no difference in monocytes pre 8.3 - post 8.5 (P=0.82), there was a difference in lymphocytes pre 17.8 - post 25.6 (P<0.05) that affected the MLR ratio value pre 0.57 - post 0.39 (P<0.05). Conclusion: This study identifies there is a significant difference in MLR before treatment and after the intensive phase of clinically confirmed pulmonary TB.

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