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A CASE REPORT OF MODERATE COVID-19 AND MALARIA FALCIPARUM CO-INFECTION WITH THROMBOCYTOPENIA Nelda Aprilia Salim; Harun Hudari; Mega Permata; Yenny Dian Andayani; Zen Ahmad; Verdiansah Verdiansah
JURNAL KEDOKTERAN DAN KESEHATAN Vol 8, No 3 (2021)
Publisher : Fakultas Kedokteran Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/JKK.V8I3.13814

The COVID-19 pandemic that attacks the world has made the attention of all medical personnel focused on this disease. The clinical picture is similar to other infectious diseases such as malaria, dengue, influenza, etc., which often leads to misdiagnosis. We report the case of a man, 31 years old, with a history of travel and complaints of high fever persisting for more than 7 days. On physical examination, the temperature was 39-40 C, others were within normal limits. Initial platelet count was 69 x 103/µL, leukocytes was 15.52 x 109/L, CRP was 96 mg/L. The blood smear found Plasmodium falciparum, and PCR SARS-CoV-2 was positive. Chest X-ray showed pneumonia. Dihydroartemisinin-piperaquine and primaquine therapies were administered for malaria, as well as favipiravir, azithromycin, and other symptomatic therapy for COVID-19. Platelets decreased to 38 x 103/µL while D-dimer level increased (> 20 mg/L). Anticoagulant was delayed. On monitoring after therapy, the platelets returned to normal, the D-dimer level decreased, and there was no bleeding. The co-infectious conditions of malaria and COVID-19 should be suspected in patients with suggestive symptoms and travel history from endemic areas, therefore both examinations should be performed. This co-infection has the potential to cause hyper inflammation and hypercoagulation and this is associated with a poor prognosis. Appropriate treatment is needed.

The Effect of KatG S315t M. Tuberculosis Gene Mutation on Conversion Rate of MDR-TB Patients with Shorter-Course Treatment Raden Ayu Linda Andriani; Zen Ahmad
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 4 No. 4 (2020): Bioscientia Medicina: Journal of Biomedicine and Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/bsm.v4i4.158

Background. Resistance to the INH drug is most often caused by a mutation of the KatG S315T M.Tb gene. MDR TB treatment with short-term WHO mixes using high-dose INH drugs is considered less effective in this mutation condition because it causes high resistance to INH. The effectiveness of MDR TB treatment can be seen from the sputum smear conversion rate. This study was aimed to determine the effect of the S315T katG gene mutation on the treatment response of patients with MDR TB who received WHO short-term alloys at Dr Moh Hoesin general hospital, Palembang, Indonesia. Method. This study uses observational analytic with a prospective cohort approach. The study subjects were MDR TB patients at Dr Moh Hoesin general hospital, Palembang, Indonesia, and a PCR-RFLP examination was performed to see the katG gene, followed by sputum smear evaluation at the end of the first and second months of treatment to assess the speed of conversion. Data analysis using SPSS 25 with the chi-square statistical test. Results. The frequency of katG S315T M.Tb gene mutations was 51.85%. The majority of MDR TB sufferers experience rapid conversion (92.59%). 64.29% of the katG S315T gene mutation group experienced sputum smear conversion after one month, 28.57% after two months, and 7.14% after three months of treatment. There was no significant difference in conversion speed in the two groups (p = 0.741). Conclusion. There was no effect of the S315T M.Tb katG gene mutation on the speed of sputum smear conversion of MDR TB patients who received short-term alloy treatment.

Comparison of Chest X-Ray Assessment in Multi-Drug Resistance to Drug- Sensitive Tuberculosis Patients Sari Afiah Miyuki Rifani; Zen Ahmad; M. Yusri; Erial Bahar
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 5 No. 1 (2021): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/bsm.v5i1.185

Introduction. Indonesia ranks third in tuberculosis cases, with 23,000 new dualdrug-resistant tuberculosis patients. The delay in predicting tuberculosis resistanceoccurs because sputum tools are not yet available. This study aimed to determinethe differences in chest x-rays for drug-sensitive multiple drug-resistanttuberculosis in Palembang. Method. A case-control design to compare theradiological characteristics of multiple drug resistance with drug-sensitive atPalembang during January-July 2020. One hundred thirty-eight patients consistedof cases of drug-sensitive tuberculosis and multidrug-resistant tuberculosis basedon the rapid molecular test that met the inclusion criteria, analyzed forposteroanterior chest X-rays by a radiologist without knowing the diagnosis—comparative chi-square using SPSS 22. Result. Multidrug resistance tuberculosishad more extensive or moderate lesions than drug-sensitive tuberculosis 89.8% vs72.4%. The multidrug-resistant group has more infiltrate detected, namely 84.1% vs69.6% and cavity 37.6% vs 30.4%. Atelectasis and pleural effusion are common indrug-resistant tuberculosis. Bivariate analysis showed that multidrug-resistanttuberculosis lesion infiltrates compared to drug-sensitive tuberculosis with p =0.025; OR 2,6 (CI 95% 1,1-6,0) sensitivity 85.5%, specificity 30.4%. Multivariateanalysis showed the presence of infiltrates p = 0.028; OR 2.58 (CI 95% 1.1-6.003).Consolidation, nodules, cavities, fibrosis, atelectasis, pleural effusion were notsignificant differences in the two groups. Conclusion. Multidrug-resistanttuberculosis has a more expansive lesion, the presence of infiltrates and cavities thatis more dominant than drug-sensitive tuberculosis.

Relationship between Interleukin 6 Serum Levels and Degree of Depression in Systemic Lupus Erythematosus Patients Internal Disease in Dr. Moh Hoesin Palembang Shinta Suharno; Eddy Mart Salim; Ali Apriansyah; Taufik Indrajaya; Zen Ahmad; Erial Bahar
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 5 No. 3 (2021): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/bsm.v5i3.224

Introduction. Systemic Lupus Erythematosus (LES) is a chronic autoimmune inflammatory disease affecting many organ systems with varied clinical manifestations, disease course and prognosis. One of the clinical manifestations that can occur is depression as much as 25%. In LES patients, there is an increase in proinflammatory cytokines, one of which is IL-6, which is often associated with contributing to the pathophysiology of depression. The purpose of this study was to determine the relationship between serum IL-6 levels and the degree of depression in LES patients at RSUP DR. Mohammad Hoesin Palembang. Methods. Analytic observational study in the form of correlation test with cross sectional design which was conducted in the Internal Medicine room RSUP DR. Mohammad Hoesin Palembang from May 2019 to March 2020. The number of study subjects was 40 samples who were LES patients with depression who had been calculated using the BDI (Beck's Depression Inventory). All subjects were examined for serum IL-6 levels and evaluated for factors that influence it. Results. There were 40 study subjects aged 18-56 years. The median degree of depression was 16 with a range of values from 10 to 40. There were 17 people (42.5%) with mild depression degree, 14 people (35%) moderate depression, and 9 people (22.5%) major depression. In LES activities, there were 5 people (12.5%) with light LES activities, 20 people (50%) with moderate LES activities, and 15 people (37.5%) with heavy LES activities. The mean serum IL-6 level was 11.57 pg / mL with a value range of 1.1-50pg / mL. There was a significant correlation between the degree of depression and LES activity (p = 0.004; r = 0.444) and between serum IL-6 levels and the degree of depression (p = 0.025; r = 0.169). However, there was no significant correlation between serum IL-6 levels and LES activity (p = 0.057; r = 0.304). Conclusion. There is a relationship between serum IL-6 levels and the degree of depression in LES patients at Dr. Moh. Hoesin Palembang with a very weak correlation.

The Role of Extracorporeal Membrane Oxygenation on Acute Respiratory Distress Syndrome Dini Ardiyani; Zen Ahmad
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 5 No. 10 (2021): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/bsm.v5i10.362

Acute lung injury and acute respiratory distress syndrome are characterized by rapid-onset respiratory failure following a variety of direct and indirect insults to the parenchyma or vasculature of the lungs. Extracorporeal membrane oxygenation is a form of extracorporeal life support where an external artificial circulator carries venous blood from the patient to a gas exchange device (oxygenator) where blood becomes enriched with oxygen and has carbon dioxide removed. This blood then re-enters the patients circulation. The potential advantages of ECMO over conventional manajement may extend beyond its role in supporting patients with ARDS. ECMO may facilitate and enhance the application of lung-protective ventilation by minimizing ventilator-induced lung injury.

Hiv Stage 4 With Pulmonary Tuberculosis, Collitis Tuberculosis, Oral Candidiasis, Wasting Syndrome, And Sensorineural Deafness: A Case Report Fadel Fikri Suharto; Edwin Nugraha Fetriawan; Muhamad Satria Yudha Pratama; R. Yudistira Dwi Ananda; Zen Ahmad; Raden Ayu Linda Andriani; Harun Hudari
Jurnal RSMH Palembang Vol. 2 No. 2 (2021): Jurnal RSMH Palembang
Publisher : RSUP Dr Moh Hoesin Palembang

Human immunodeficiency virus (HIV) is a retrovirus type virus that infects cells of the human immune system (especially CD4 positive T-cells and major components of the cellular immune system) and interferes with their function. This viral infection results in a continuous decline in the immune system, which will result in immune deficiency. People who are immune deficient/immunodeficiency become more susceptible to various types of infections. A 23 year male, a cafe employee, was admitted to hospital with complaints of weakness since 2 weeks before. He has productive cough for 3 weeks. He had decrease of food appetite, nauseas and vomiting. He had weight loss about 10 kg in the last 4 months. Patient had history of free sex, LGBT, since 2016 and history of hearing loss for 3 months. Laboratory finding showed rhonchi were found at the apex of the right and left lungs, Anti-HIV reactive and Absolute CD-4 count was 53 cell/uL, Gene Xpert MTB was detected, and Acid fast bacilli in stool is positive. Audiometry showed bilateral sensorineural deafness. Patient was diagnosed with HIV stage 4 with pulmonary tuberculosis, tuberculosis collitis, oral candidiasis, wasting syndrome, and sensorineural deafness.

The Effect of KatG S315t M. Tuberculosis Gene Mutation on Conversion Rate of MDR-TB Patients with Shorter-Course Treatment Raden Ayu Linda Andriani; Zen Ahmad
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 4 No. 4 (2020): Bioscientia Medicina: Journal of Biomedicine and Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/bsm.v4i4.158

Background. Resistance to the INH drug is most often caused by a mutation of the KatG S315T M.Tb gene. MDR TB treatment with short-term WHO mixes using high-dose INH drugs is considered less effective in this mutation condition because it causes high resistance to INH. The effectiveness of MDR TB treatment can be seen from the sputum smear conversion rate. This study was aimed to determine the effect of the S315T katG gene mutation on the treatment response of patients with MDR TB who received WHO short-term alloys at Dr Moh Hoesin general hospital, Palembang, Indonesia. Method. This study uses observational analytic with a prospective cohort approach. The study subjects were MDR TB patients at Dr Moh Hoesin general hospital, Palembang, Indonesia, and a PCR-RFLP examination was performed to see the katG gene, followed by sputum smear evaluation at the end of the first and second months of treatment to assess the speed of conversion. Data analysis using SPSS 25 with the chi-square statistical test. Results. The frequency of katG S315T M.Tb gene mutations was 51.85%. The majority of MDR TB sufferers experience rapid conversion (92.59%). 64.29% of the katG S315T gene mutation group experienced sputum smear conversion after one month, 28.57% after two months, and 7.14% after three months of treatment. There was no significant difference in conversion speed in the two groups (p = 0.741). Conclusion. There was no effect of the S315T M.Tb katG gene mutation on the speed of sputum smear conversion of MDR TB patients who received short-term alloy treatment.

Comparison of Chest X-Ray Assessment in Multi-Drug Resistance to Drug- Sensitive Tuberculosis Patients Sari Afiah Miyuki Rifani; Zen Ahmad; M. Yusri; Erial Bahar
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 5 No. 1 (2021): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/bsm.v5i1.185

Introduction. Indonesia ranks third in tuberculosis cases, with 23,000 new dualdrug-resistant tuberculosis patients. The delay in predicting tuberculosis resistanceoccurs because sputum tools are not yet available. This study aimed to determinethe differences in chest x-rays for drug-sensitive multiple drug-resistanttuberculosis in Palembang. Method. A case-control design to compare theradiological characteristics of multiple drug resistance with drug-sensitive atPalembang during January-July 2020. One hundred thirty-eight patients consistedof cases of drug-sensitive tuberculosis and multidrug-resistant tuberculosis basedon the rapid molecular test that met the inclusion criteria, analyzed forposteroanterior chest X-rays by a radiologist without knowing the diagnosis—comparative chi-square using SPSS 22. Result. Multidrug resistance tuberculosishad more extensive or moderate lesions than drug-sensitive tuberculosis 89.8% vs72.4%. The multidrug-resistant group has more infiltrate detected, namely 84.1% vs69.6% and cavity 37.6% vs 30.4%. Atelectasis and pleural effusion are common indrug-resistant tuberculosis. Bivariate analysis showed that multidrug-resistanttuberculosis lesion infiltrates compared to drug-sensitive tuberculosis with p =0.025; OR 2,6 (CI 95% 1,1-6,0) sensitivity 85.5%, specificity 30.4%. Multivariateanalysis showed the presence of infiltrates p = 0.028; OR 2.58 (CI 95% 1.1-6.003).Consolidation, nodules, cavities, fibrosis, atelectasis, pleural effusion were notsignificant differences in the two groups. Conclusion. Multidrug-resistanttuberculosis has a more expansive lesion, the presence of infiltrates and cavities thatis more dominant than drug-sensitive tuberculosis.

Relationship between Interleukin 6 Serum Levels and Degree of Depression in Systemic Lupus Erythematosus Patients Internal Disease in Dr. Moh Hoesin Palembang Shinta Suharno; Eddy Mart Salim; Ali Apriansyah; Taufik Indrajaya; Zen Ahmad; Erial Bahar
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 5 No. 3 (2021): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/bsm.v5i3.224

Introduction. Systemic Lupus Erythematosus (LES) is a chronic autoimmune inflammatory disease affecting many organ systems with varied clinical manifestations, disease course and prognosis. One of the clinical manifestations that can occur is depression as much as 25%. In LES patients, there is an increase in proinflammatory cytokines, one of which is IL-6, which is often associated with contributing to the pathophysiology of depression. The purpose of this study was to determine the relationship between serum IL-6 levels and the degree of depression in LES patients at RSUP DR. Mohammad Hoesin Palembang. Methods. Analytic observational study in the form of correlation test with cross sectional design which was conducted in the Internal Medicine room RSUP DR. Mohammad Hoesin Palembang from May 2019 to March 2020. The number of study subjects was 40 samples who were LES patients with depression who had been calculated using the BDI (Beck's Depression Inventory). All subjects were examined for serum IL-6 levels and evaluated for factors that influence it. Results. There were 40 study subjects aged 18-56 years. The median degree of depression was 16 with a range of values from 10 to 40. There were 17 people (42.5%) with mild depression degree, 14 people (35%) moderate depression, and 9 people (22.5%) major depression. In LES activities, there were 5 people (12.5%) with light LES activities, 20 people (50%) with moderate LES activities, and 15 people (37.5%) with heavy LES activities. The mean serum IL-6 level was 11.57 pg / mL with a value range of 1.1-50pg / mL. There was a significant correlation between the degree of depression and LES activity (p = 0.004; r = 0.444) and between serum IL-6 levels and the degree of depression (p = 0.025; r = 0.169). However, there was no significant correlation between serum IL-6 levels and LES activity (p = 0.057; r = 0.304). Conclusion. There is a relationship between serum IL-6 levels and the degree of depression in LES patients at Dr. Moh. Hoesin Palembang with a very weak correlation.

The Role of Extracorporeal Membrane Oxygenation on Acute Respiratory Distress Syndrome Dini Ardiyani; Zen Ahmad
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 5 No. 10 (2021): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/bsm.v5i10.362

Acute lung injury and acute respiratory distress syndrome are characterized by rapid-onset respiratory failure following a variety of direct and indirect insults to the parenchyma or vasculature of the lungs. Extracorporeal membrane oxygenation is a form of extracorporeal life support where an external artificial circulator carries venous blood from the patient to a gas exchange device (oxygenator) where blood becomes enriched with oxygen and has carbon dioxide removed. This blood then re-enters the patients circulation. The potential advantages of ECMO over conventional manajement may extend beyond its role in supporting patients with ARDS. ECMO may facilitate and enhance the application of lung-protective ventilation by minimizing ventilator-induced lung injury.

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