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INDONESIA
Indonesian Journal of Medicine
Published by Universitas Sebelas Maret
ISSN : -     EISSN : 25490265     DOI : -
Core Subject : Health,
Medicine & Pharmacology Public Health
Indonesian Journal of Medicine (IJM) is an international, open-access, and double-blind peer-reviewed journal, focusing on the intersection of biomedical science, clinical medicine, and community medicine. The journal began its publication on August 20, 2015, and is published online three times yearly. It is academically designed for all physicians, health researchers, and health care professionals, regardless of their medical specialties, or type of employment.
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Articles 407 Documents
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Meta-Analysis of the Role of Varenicline in Smoking Cessation Lafif, Muhammad Zainul; Murti, Bhisma; Prasetya, Hanung
Indonesian Journal of Medicine Vol. 6 No. 4 (2021)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Smoking is the leading cause of premature death in both developed and developing countries. Smoking cessation efforts can be classified into pharmacological and therapeutic strategies. Varencline is the latest discovery for pharmacological therapy for smoking cessation programs. This study aims to determine the role of varenicline on smoking cessation efforts.Subjects and Method: This was a systematic review and meta-analysis conducted using PRISMA flow diagrams. Search articles through journal databases including: Google Scholar, MEDLINE/ PubMed, Science Direct, Scopus, and Spinger Link by selecting articles published in 2011-2021. The keywords used are “varenicline” OR “pharmacotherapy” AND tobacco OR smoke OR smoked OR smoker AND “smoking cessation”. The research instrument used to assess smoking cessation efforts was the Fagerstrom Test for Nicotine Dependence (FTND). The inclusion criteria were full paper articles with Randomized Controlled Trial (RCT) research methods, the relationship measure used was Mean SD, the intervention given was varenicline, the research subjects were adult smokers who wanted to quit smoking. Eligible articles were analyzed using the Revman 5.3 application.Results: Meta-analysis of 9 articles showed results (SMD -0.11; 95% CI = -0.17 to -0.05; p<0.001).Conclusion: Varenicline has a statistically significant effect in reducing the frequency of smoking per day.Keywords: Varenicline, smoking cessation, quitting smokingCorrespondence: Muhamad Zainul Lafif. Masters Program in Public Health. Universitas Sebelas Maret, Jl.Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: zainullafif@gmail.com. Mobile: 0821­37179433.Indonesian Journal of Medicine (2021), 06(04): 354-363https://doi.org/10.26911/theijmed.2021.06.04.01 
Proximal Tibial Osteosarcoma in Pediatric Patient: A Case Report Sandiwidayat, Komang Septian; Febyan, Febyan
Indonesian Journal of Medicine Vol. 7 No. 3 (2022)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: The most frequent primary malignant bone tumor in children is osteosarcoma. Patients with osteosarcoma are currently treated with a combination of neoadjuvant and adjuvant chemotherapy as well as surgery, either limb-sparing surgery or limb-ablation surgery. How to manage the remaining bone growth during the limb-sparing procedure in youngsters is one of the challenges. Unfortunately, amputation is still many perform for OS patients. The purpose of this study was to inform and educate doctors about the value of early OS diagnosis and treatment in pediatric patients.Case Presentation: We presented case from a male 16 years old Balinese complaint of pain on her left knee 12 months ago. The pain was continuous and got worse at night. The patient went to a traditional masseuse and was given topical herbal ointment. Three months later, a lump appeared on her knee at the size of a small ball and getting bigger. We did a review slide of the previous biopsy sample by the pathology of anatomy in our hospital. The result came out as osteosarcoma with osteoblastic cells. We performed to amputated the limb-affected tumor following wound care routinely controlled.Results: Intraoperatively, we performed wide excision, without patellar tendon, medial collateral ligament, and cruciate ligament preserve. We amputated the limb-affected tumor. The patient routinely controlled to our outpatient clinic every week. Unfortunately, the patient was died after 3 weeks of admission.Conclusion: To reduce the risk of misdiagnosis or delayed diagnosis of osteosarcoma, every source of knee pain with a mass in pediatric age groups should be thoroughly explored with a high index of suspicion for malignant lesions. Therefore, amputation is a cutting-edge osteosarcoma treatment that can be avoided if the patient can be identified early and treated quickly in pediatric oncology malignant instances.Keywords: osteosarcoma, long bone, diagnosis, tibia, pediatricCorrespondence: Komang Septian Sandiwidayat. Oncology Division, Department of Orthopaedic & Traumatology, Sanglah General Hospital, Faculty of Medicine, Udayana University, Bali, Indonesia. Email: drseptianortho@gmail.com. Mobile: 62-821-4725-2042.Indonesian Journal of Medicine (2022), 07(03): 298-305https://doi.org/10.26911/theijmed.2022.07.03.06  
Alcoholic/Narcotic Anonymous Program Outcome: A Systematic Review Adriana, Nadya Puspita; Wicaksono, Dipo
Indonesian Journal of Medicine Vol. 8 No. 3 (2023)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/theijmed.2023.8.3.650

Abstract

Background: Recovery and long-term remission are the goals of treatment for substance use disorders. Though there are many pathways to recovery, the alcoholic/narcotic anonymous program is widely recommended for people with addiction as an adjunct to professional treatment services. However, not many studies reviewed the outcome resulting from alcoholic/ narcotic anonymous programs. This study aimed to systematically review the outcome of alcoholic/ narcotic anonymous programs. Subjects and Method: This article was a systematic review study conducted by searching for articles from online databases such as EBSCO, Google Scholar, PubMed, and Science Direct. PICO: 1) Populations: alcohol addict or illegal drug abuser who is a member or ever joined the alcohol or narcotic anonymous program; 2) Intervention: alcohol or narcotic anonymous program; 3) Comparison: alcohol or narcotic addict or illegal drug abuser who is not the member or never join the alcohol or narcotic anonymous program or etc; 4) Outcome: a variety of outcomes such as reduce of drinking. The dependent variable is the outcome of AA programs. The inclusion criteria for this study were full articles using an observational or experimental study, with the publication year from 2000 until 31st May 2023. The data extraction was focused on the relationship between AA/NA program with the outcome resulting and reported following the Preferred Reporting Items for Systematic Reviews. Results: A total of 9 articles reviewed in this study were from USA and UK. Six studies reported there is a significant relationship between attendance at the AA/ NA program with the increase in days of abstinence. Two studies explained that attending the AA/ NA program could lower the amount and frequency of illegal drug use. Only one study discussed that the AA/NA program could also lessen the depression that addiction causes. Conclusion: Our review suggested that attending the AA/ NA program has benefits such as abstinence, reduced frequency or amount of substance intake, and a reduction in depression or problems brought on by using illegal substances. Keywords: abstinence, alcoholic anonymous, alcoholism, narcotic anonymous, outcome. Correspondence: Nadya Puspita Adriana. Universitas Kusuma Husada. Jaya Wijaya No.11, Banjarsari, Central Java, Surakarta, Indonesia. Email: nadyadriana91@gmail.com. Mobile: 0821-3800-7567
The Correlation between Allergic Diseases and Systemic Lupus Erythematosus Pratiwi, Dewi; Wediningsih, Yulyani; Matea, Ari; Nareswari, Kirana Pawitra; Aryani, Niken Dyah
Indonesian Journal of Medicine Vol. 7 No. 1 (2022)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: The prevalence of autoimmune diseases and major chronic allergic diseases such as allergic rhinitis, asthma, and atopic dermatitis are increasing in line with the occurrence of climate change. Allergy and systemic lupus erythematosus (SLE) are sometimes being linked since both are immune diseases involving gene-environment interactions. The purpose of this research is to investigate the correlation between allergic diseases and SLE.Method: This case-control study was performed on 39 SLE subjects from the Tittari Community and 39 non-SLE subjects aged 15-49 years old, from September until October 2021. All of them were females. The independent variable was allergic disease and the dependent variable was SLE. Partici­pants' characteristics and allergy data were collected through answering the online Score for Allergic Rhinitis (SFAR) questionnaire, then the results were processed with bivariate and multivariate analyses.Results: The correlation between allergic diseases and SLE was significant for atopic dermatitis but not for allergic rhinitis and asthma (p=0.018; p=0.352; p=0.151 respectively). The bivariate analysis revealed that the risk of SLE was 3.17 times higher in atopic dermatitis patients (OR=3.17; 95% CI=1.20-8.39; p=0.018). Furthermore, the multivariate analysis found that subjects with atopic dermatitis had the highest risk of SLE (OR= 3.18; 95% CI= 1.07-9.51; p=0.031).Conclusion: Among allergic diseases, atopic dermatitis was found to be significantly correlated with SLE, where the risk of SLE was raised as the number of atopic dermatitis increased.Keywords: systemic lupus erythematosus, allergic diseases, allergic rhinitis, asthma, atopic dermatitisCorrespondence: Dewi Pratiwi. Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universitas Sebelas Maret – Moewardi Hospital, Indonesia. Email: pratiwidewi81@staff.uns.ac.id. Phone: (0271) 664569.Indonesian Journal of Medicine (2022), 07(01): 19-27https://doi.org/10.26911/theijmed.2022.07.01.03
Effectiveness of Cognitive Behavioral Therapy for Insomnia on Sleep Quality in Patients with Insomnia: A Meta-Analysis Octaviani, Cynthia; Prasetya, Hanung; Murti, Bhisma
Indonesian Journal of Medicine Vol. 8 No. 3 (2023)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/theijmed.2023.8.3.652

Abstract

Background: The relationship between sleep quality and sleep quantity is very close and has a significant impact on a person's sleep needs. If someone does not get enough sleep, then this will have an impact on the quality of their sleep, and vice versa. Therefore, maintaining a good quality of sleep is very important to maintain a healthy body and improve quality of life. The aim of the study was to analyze the effect of cognitive behavior therapy for insomnia (CBT-I) on sleep quality in insomnia patients. Subjects and Method: This study is a meta-analysis with PICO. Population: insomnia patients. Intervention: given cognitive behavior therapy for insomnia (CBT-I). Comparison: not given cognitive behavior therapy for insomnia (CBT-I). Outcome: sleep quality. The articles used in this study were obtained from five databases, namely PubMed, Embase, Web of Science, ScienceDirect, and Google Scholar. The keywords used to search for articles use the medical subject heading (MeSH) term and the emtree of the keywords "Insomnia" AND "Cognitive Behavior Therapy for Insomnia" AND "Sleep Quality". The articles used were full text in English from 2013 to 2023. Articles were selected using the 2021 PRISMA flowchart and analyzed using the RevMan 5.3 application. Results: A total of 10 randomized controlled trial study articles came from Iran, Canada, Spain, Texas, Korea, Kansas and the United States. The total sample size is 473 research subjects. Based on the analysis, insomnia patients who were given CBT-I therapy showed an average PSQI score of 1.88 units lower than those not given CBT-I (placebo), and the difference was statistically significant (SMD = -1.88; 95% CI = -2.55 to -1.22; p<0.001). Then insomnia patients who were given CBT-I showed an average PSQI score of 0.52 units lower than those given other insomnia therapies, and the difference was statistically significant (SMD= -0.52; 95% CI= -0.77 to -0.28; p <0.001) . Then when viewed as a whole, it shows that insomnia patients who are given CBT-I therapy on average have or show a PSQI score of 0.78 units lower than other therapies and without CBT-I therapy (placebo), and this difference is statistically significant (SMD= -0.78; 95% CI= -1.13 to -0.42; p < 0.001). Conclusion:  Cognitive behavior therapy for insomnia (CBT-I) can improve sleep quality in insomnia patients (decrease the PSQI score). Keywords:  insomnia, cognitive behavior therapy for insomnia, sleep quality. Correspondence:  Cynthia Octaviani. Master's Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Jawa Tengah, Indonesia. Email: Cynthia.octaviani14@gmail.com. Mobile: +6287812315855.  
Meta-Analysis the Effect of Hydrotherapy on the Elevation of Motoric Functional Ability in Post Stroke Patients Wibisono, Lilik Sigit; Prasetya, Hanung; Murti, Bhisma
Indonesian Journal of Medicine Vol. 7 No. 1 (2022)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Stroke is the third leading cause of death in the world after heart and cancer and the disease that causes serious and permanent disability is the first in the world. Hydrotherapy in stroke plays a role in developing, maintaining, and restoring movement and function with motor training based on an understanding of the pathophysiology, neurophysiology, kinematics and kinetics of normal motion. The purpose of this study was to analyze the effect of hydrotherapy on improving motor functional ability in post-stroke patients.Subjects and Method: This study was a meta-analysis with the following PICO, population: stroke patients. Intervention: administration of hydrotherapy. Comparison: Standard therapy. Result: motor functional improvement. The articles used in this study were obtained from three databases, namely Google Scholar, Pubmed, and Science Direct. Keywords to search for articles “hydrotherapy” OR “Aquatic therapy” AND “functional enhancement” AND “post stroke”. The articles included are full-text English with a randomized control trial study design from 2002 to 2022. Article selection was carried out using PRISMA flow diagrams. Articles were analyzed using the Review Manager 5.3 application.Results: A meta-analysis of 9 studies from China, Korea, Italy, Spain and Brazil concluded that hydrotherapy has an effect on post-stroke functional improvement. Post-stroke patients who received hydrotherapy intervention had motor functional ability 0.68 units higher than those who did not receive hydrotherapy. The difference was significant (SMD= 0.68; 95% CI = 0.44 to 0.91; p=0.001).Conclusion: Hydrotherapy improves motor functional ability of post-stroke patients.Keywords: Hydrotherapy, functional enhancement, post strokeCorrespondence: Lilik Sigit Wibisono. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Mobile: 087779982774. Email: lilik21_1990@­student.uns.ac.id.Indonesian Journal of Medicine (2022), 07(01): 73-81https://doi.org/10.26911/theijmed.2022.07.01.08
Effect of Gluten Free Casein Free Diet on Maladaptive Behavior in Autistic Children: Meta-Analysis Nurul Hakim, Ruliany Yuni; Tamtomo, Didik; Murti, Bhisma
Indonesian Journal of Medicine Vol. 8 No. 3 (2023)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/theijmed.2023.8.3.647

Abstract

Background: Children with Autism tend to experience gastrointestinal disorders more often. Interactions between the gut and brain microbiome influence mood and behavior in health and disease. Diet therapy, specifically the gluten and case-free diet (GFCF) is an elimination diet that involves removing certain proteins from the normal diet, such as gluten and casein. The right intervention can change behavior for the better and through the right handling. This study aims to estimate the effect of a case-free gluten-free diet on maladaptive behavior in autistic children, through a meta-analysis of primary studies conducted by previous authors. Subjects and Method:  This study is a systematic review and meta-analysis with the following PICO, population: Autism children, intervention: gluten-free case-free diet, comparison: no case-free gluten-free diet, outcome: maladaptive behavior. The articles used in this study were obtained from three databases, namely PubMed, Google Scholar, and Science Direct, using the search key “Diet Gluten Free Casein Free” OR “NonDiet Gluten Free Casein Free” OR “GFCF” AND “Autism” OR “Autism” AND “Maladaptive” AND “Randomize Controlled Trial” OR “RCT”. The included article is a full-text Randomized Controlled Trial study designed from 2002 to 2022 and reports the mean and SD in multivariate analysis. The selection of articles is done using PRISMA flow diagrams. Articles were analyzed using the Review Manager 5.4 application. Results:  A total of 7 randomized controlled trial studies conducted in the Americas, Europe, and Asia were selected for meta-analysis. Autistic children who received casein-free gluten-free had an average score of 0.11 units of maladaptive behavior lower than those who were not given a diet (SMD= 0.11 95% CI= .035 to 0.13; p= 0.360). Conclusion:  The casein-free gluten-free diet has an effect on reducing the risk of maladaptive behavior in children with autism. Keywords:  casein free gluten-free diet, gfcf, maladaptive behavior, autism Correspondence: Ruliany Yuni Nurul Hakim. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A Surakarta 57126, Central Java, Indonesia. Email: Ruliany27@gmail.com. Ponsel +6282124886320. Indonesian Journal of Medicine (2023), 08(03): 286294
Functional Outcome Evaluation of Grade III Open Tibial Fracture Treated by External Fixation as Definitive Treatment Soetjahjo, Bintang; Ermawan, Rieva; Saputra, Rhyan Darma; Hancoro, Udi Herunefi; Nugroho, Bagus Jati; Anugra, Jiva Yori
Indonesian Journal of Medicine Vol. 6 No. 4 (2021)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Tibial shaft fractures including open tibial fractures grade III are one of the most common fractures of long bones. There are many methods of conservative and operative treatment, one of them is external fixation. External fixation is more common used temporary in polytraumatized patients with tibial shaft fractures. The study was undertaken to see if the patient can be treated with external fixation as the definitive treatment and evaluate the functional outcome after the treatment.Subjects and Method: A retrospective review of a prospectively-collected database was performed. Data was taken from the Orthopaedic Department of RSUD Dr. Moewardi Hospital patients’ database. The study included all patients who underwent grade III open tibial fracture treatment from May 2018 to May 2019. A total of 8 patients who were included in our study were a patient with open tibial fractures grade III planned for external fixaton as definitive treatment. They were evaluated radiographically and clinically to determine the union rate. The data were reported descriptively.Results: External fixator time ranged in this study around 240 days. In this study, there were a few patients whose progress were remain unknown due to loss of contact. Fractures studied 5 out of 8, no patient were union after 8 months of external fixator used. 4 out of 8 patients were reported non-union after 8 months based on their radiological examination (50%) and 1 out of 8 patients were reported has been performed Removal of External Fixation (ROEF) after 5 months of treatment. The rest of the 3 patients’ results were remain unknown.Conclusion: Open tibial fractures grade III  of the leg can be managed with use of external fixator as a definitive treatment. However, the use of external fixation does not provide maximum results in grade III A tibial fractures.Keywords: open tibial fractures, external fixation, union, malunionCorrespondence: Bintang Soetjahjo. Dr. Moewardi General Hospital. Jl. Kolonel Sutarto 132, Jebres, Surakarta, Central Java, Indonesia. 57126. Email: bjortho@yahoo.com. Indonesian Journal of Medicine (2021), 06(04): 452-459https://doi.org/10.26911/­theijmed.2021.06.04.11
Effect of "TRISNA" Cultural Approach on Anxiety Reduction and Coping Increase in Drug Patients Adriani, Rita Benya; Sulistyowati, Endang Caturini
Indonesian Journal of Medicine Vol. 8 No. 3 (2023)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/theijmed.2023.8.3.660

Abstract

Latar Belakang: Prevalensi penyalahgunaan narkoba di Provinsi Jawa Tengah relatif tinggi setelah Jawa Barat dan Jawa Timur yaitu 450.000 kasus dengan prevalensi 2,5%. Dukungan psikososial diperlukan untuk mengurangi kasus penyalahgunaan narkoba. Penelitian ini bertujuan untuk mengetahui pengaruh pendekatan budaya “Trisna” terhadap penurunan kecemasan dan peningkatan coping pada pasien program terapi rumatan metadon. Subyek dan Metode: Penelitian ini menggunakan Quasi-Experimental Design yang dilakukan di RSUD Moewardi Surakarta pada bulan Juli sampai Oktober 2017. Populasi penelitian adalah 12 pasien Program Terapi Rumatan Metadon di RSUD Moewardi Surakarta. Penelitian menggunakan teknik total sampling. Variabel independen dalam penelitian ini adalah dukungan psikososial dengan pendekatan budaya “Trisna”, sedangkan variabel dependennya adalah kecemasan dan coping. Instrumen penelitian yang digunakan dalam penelitian ini adalah kuesioner kecemasan dengan menggunakan Hamilton Anxiety Rating Scale (HARS). Analisis data dilakukan untuk mendeskripsikan karakteristik sampel. Analisis bivariat diukur dengan Independent T-Test dengan Aplikasi SPSS. Hasil: Dukungan psikososial yang cukup besar dapat menurunkan kecemasan sebelum intervensi (Mean = 24.50; SD= 20.66) dan setelah intervensi (Mean= 21.33; SD= 18.10) dan secara statistik tidak signifikan p = 0.693. Terdapat peningkatan coping pada pasien kecanduan narkoba, sebelum intervensi (Mean = 24.50; SD= 8.70) dan setelah intervensi (Mean= 25.92; SD= 8.14) dan secara statistik tidak signifikan p = 0.683. Kesimpulan: Terdapat perubahan berupa penurunan kecemasan dan peningkatan coping pada pasien program terapi rumatan metadon yang mendapatkan intervensi dukungan psikososial dengan pendekatan budaya “Trisna”. Kata Kunci: dukungan psikososial, kecemasan, coping. Korespondensi: Rita Benya Adriani, Kementerian Kesehatan Surakarta, Politeknik Kesehatan Surakarta, Jalan Letjend Sutoyo, Mojosongo, Surakarta 57127, Jawa Tengah, Indonesia. Email: benyaadriani@gmail.com. Ponsel +628122617033.
The Impact of the COVID-19 Pandemic on the Resistance Level of Mycobacterium Tuberculosis in Suspected Tuberculosis Patients at the Surakarta Central General Hospital Sutanto, Yusup Subagio; Sutanto, Magdalena; Harti, Agnes Sri
Indonesian Journal of Medicine Vol. 7 No. 1 (2022)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Analysis of the impact of the Covid-19 pandemic on the resistance level of Mycobacterium tuberculosis (MTb) isolates to Anti Tuberculosis Drugs (ATD) needs to be carried out considering the level of MTB resistance is an important factor in the occurrence of Multidrug-Resistant TB (MDR-TB) in Indonesia. The purpose of the study was to analyze the impact of the Covid-19 pandemic on the level of resistance of MTb isolates of patients with suspected TB in Surakarta.Subjects and Method: This research is a quantitative descriptive study with a retrospective Cohort based on the medical record data of suspected TB patients  at Surakarta Central General Hospital in 2020 – 2021. The sampling technique was random sampling with a total of 200 samples each year. Data analysis used the SPSS 21 program.Results: Characteristics of respondents with suspected TB patients who visited the Surakarta Central General Hospital in 2020 and 2021, mostly in men and occurring in productive ages 36-55 years. The most effective type of ATD against MTb isolates is Rifampicin with a mean rank of 6.00 and a p=0.035. While Ethambutol is ineffective as an ATD with a mean rank of 58.00 and a p<0.001. The results of the Wilcoxon test analysis showed  there was a significant difference in the level of resistance or sensitivity of MTb isolates in 2020 and 2021 with a p-value=0.000.Conclusion: There is a significant effect of the impact of the Covid-19 pandemic on the level of resistance or sensitivity of MTb isolates of patients with suspected TB in the Surakarta area in 2020 and 2021.Keywords: pandemic, Covid-19, resistance, MTb isolates, ATDCorrespondence: Yusup Subagio Sutanto. Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: yusupsubagiosutanto@gmail.com. Mobile: +62811284165.Indonesian Journal of Medicine (2022), 07(01): 28-38https://doi.org/10.26911/theijmed.2022.07.01.04

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