Ning Rintiswati

Immune modulation properties of herbal plant leaves: Phyllanthus niruri aqueous extract on immune cells of tuberculosis patient - in vitro study

Abstract Disease progression in Tuberculosis (TB) is dependent on host’s immune system. Phyllanthus niruri, a traditional herb, has long been used to boost immune system in Indonesian society. This study aimed to observe the potential role of P. niruri in inducing immune cells activity in TB patients by in vitro approach. Peripheral blood mononuclear cells (PBMCs) and macrophages were collected from active pulmonary TB patients. After stimulation with graded doses of P. niruri aqueous extract, cell proliferation, phagocytic activity and nitric oxide (NO) release were analysed. P. niruri aqueous extract induced proliferation of PBMCs, increased NO release, and improved macrophages phagocytic activity. These effects were observed in a dose-dependent manner. This may lead to further research for the potential role of P. niruri as immunomodulatory adjuvant therapy for TB patients.

Diagnostic work-up and loss of tuberculosis suspects in Jogjakarta, Indonesia

BackgroundEarly and accurate diagnosis of pulmonary tuberculosis (TB) is critical for successful TB control. To assist in the diagnosis of smear-negative pulmonary TB, the World Health Organisation (WHO) recommends the use of a diagnostic algorithm. Our study evaluated the implementation of the national tuberculosis programmes diagnostic algorithm in routine health care settings in Jogjakarta, Indonesia. The diagnostic algorithm is based on the WHO TB diagnostic algorithm, which had already been implemented in the health facilities.MethodsWe prospectively documented the diagnostic work-up of all new tuberculosis suspects until a diagnosis was reached. We used clinical audit forms to record each step chronologically. Data on the patients gender, age, symptoms, examinations (types, dates, and results), and final diagnosis were collected.ResultsInformation was recorded for 754 TB suspects; 43.5% of whom were lost during the diagnostic work-up in health centres, 0% in lung clinics. Among the TB suspects who completed diagnostic work-ups, 51.1% and 100.0% were diagnosed without following the national TB diagnostic algorithm in health centres and lung clinics, respectively. However, the work-up in the health centres and lung clinics generally conformed to international standards for tuberculosis care (ISTC). Diagnostic delays were significantly longer in health centres compared to lung clinics.ConclusionsThe high rate of patients lost in health centres needs to be addressed through the implementation of TB suspect tracing and better programme supervision. The national TB algorithm needs to be revised and differentiated according to the level of care.

Prediktor faktor kekambuhan tuberkulosis di kabupaten Bantul

Latarbelakang: Program DOTS berhasil meningkatkan penemuan kasus TB paru BTA positif, namun tingkat kekambuhan TB paru masih ditemukan sebesar 3-5% hingga tahun 2014. Kekambuhan merupakan indikator penting keberhasilan jangka panjang pengobatan TB paru dan merupakan suspek MDR (multi drug resistence). Tujuan penelitian ini adalah mengetahui faktor yang berhubungan dengan kekambuhan TB. Metode: Desain penelitian adalah kohort retrospektif. Data yang digunakan adalah register TB kabupaten Bantul tahun 2003-2014 terdaftar ada 3418 pasien. Pengambilan sampel dilakukan dengan metode non random dengan purposive sampling berdasarkan kritera inklusi tedapat 904 sampel. Variable yang diukur adalah usia, jenis kelamin, pengawas menelan obat, fasilitas pelayanan kesehatan, social ekonomi dan konversi dahak. Analisis data menggunakan cox proportion hazard model untuk menentukan kejadian serta kapan terjadinya suatu event. Hasil penelitian: Jenis kelamin laki-laki (HR=0,91 p-value= 0,17) usia >40 tahun (HR=1,03 p-value= 0,59), penghasilan rendah (HR=0,89 p-value= 0,11) bukan prediktor kekambuhan TB, sedangkan pengobatan di rumah sakit (HR=0,81 p-value= 0,00), tidak konversi dahak (HR=0,58 p-value= 0,00), kegagalan pengobatan (HR=0,49 95%CI 0,37-0,64), dan pengobatan kurang/lebih dari 6 bulan (HR=0,008 95%CI 0,00-0,07) merupakan prediktor kekambuhan TB. Terdapat 56 (6,18%) dari 904 pasien yang mengalami kekambuhan setelah sembuh atau gagal dalam pengobatan. Rata-rata pasien kambuh setelah 17 bulan selesai pengobatan pertamnaya. Kesimpulan: Fasiltas kesehatan, konversi dahak, status akhir pengobatan dan lama pengobatan merupakan faktor kekambuhan Tb paru, sehingga tepat untuk memprediksi kekambuhan TB di Kabupaten Bantul.

The Susceptibility of katG Ser315Thr Mycobacterium tuberculosis mutant Against Anti Tuberculosis Drugs

Mycobacterium tuberculosis resistant strains is a matter of great concern for TB control Program since no cure for some multi drug resistance TB (MDR-TB) cases. These strains could spread around the world, make a great challenges for control measures. Mycobacterium tuberculosis strains resistance to anti tuberculosis drugs is mainly caused by the alteration in several genes encoding the molecular targets. Mutation of katG at codon 315 especially Ser315Thr are responsible for INH resistance in a large proportion of TB cases. The aim of this study is to know the frequency of of katG Ser315Thr of M. tuberculosis mutant and the pattern of resistance to Anti TB drugs. The study design was observational laboratoric. Eighty fi ve M. tuberculosis INH resistant clinical isolates were screened for mutation of katGSer315Thr by using PCR-RFLP and DNA sequence analysis.The results showed that katG Ser 315Thr were identifi ed in 23 (27,05%) of INH resistance isolates. Frequency of MDR among the katG Ser315Thr mutants almost double than the non mutant. The result suggested that the the katG Ser315Thr mutation may play important role in the development of MDR-TB.

PREVALENSI VIRURIA SITOMEGALOVIRUS PADA POPULASI ORANG DEWASA NORMAL

ABSTRACT The aim of this study was to get cytomegalovirus viruria prevalence data in healthy adult population. Urine samples were obtained from healthy individuals. Preparation of sample and sera (polyclonal antibody) were performed by standard method., and detection of cytomegalovirus antigen in urine sediment were done by Indirect Immunofluorescence Antibodi Technique (IFAT). The results were analyzed with chi square pearson. From 341 healthy individuals (16 ♀ and 125 ♂) age between 18 to 61 years. Cytomegalovirys viruria were found in 5 (3, 55%) of subjects. In group of subjects less than 30 years of age, cytomegalovirus viruria were found in 3,82% subject whereas in group of subjects more than 30 years of age, cytomegalovirus viruria was not found; chi square pearson statistic analysis did not show significant difference between two groups (p = 0,529). In group of women, cytomegalovirus viruria were found in 6,25% subjects whereas in group of men, cytomegalovirus viruria were found in 3,2% subjects; chi square pearson statistic analysis did not show significant difference between two groups (p = 0,535). Cytomegalovirus viruria prevalence among healthy adult population studied was relatively low (3,55%). Key words: Cytomegalovirus, viruria, prevalence, latent infection, Indirect Immunofluorescence Antibodi Technique (IFAT)