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MANIFESTATIONS OF HIV AIDS IN CASE NEUROLOGY: EPIDEMIOLOGY STUDY AT SAIFUL ANWAR HOSPITAL YEAR 2013-2014 Munir, Badrul; Candradikusuma, Didi
Malang Neurology Journal Vol 1, No 1 (2015): January
Publisher : Malang Neurology Journal

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (438.163 KB) | DOI: 10.21776/ub.mnj.2015.001.01.2

Abstract

Background. Complications of HIV-AIDS cases neurological disorders are quite high and also very high mortality, but so far the data on disease epidemiology in Indonesia is still very limited.Objective. To determine the pattern of HIV-AIDS disease involving the nervous system in patients admitted to Saiful Anwar hospital.Methods. This prospective cohort study with a record of all patients with HIV-AIDS didagnosis manifest neurological disorders treated in an isolation room for HIV-AIDS Saiful Anwar Hospital for 1 year (September 2013- August 2014).Results. During 12 months acquired HIV-AIDS with neurological disorders as many as 23 patients (38.3% of all patients with an infection of the nervous system) with an average age of 48 years. Male gender 47.83%) and 52.17% of women. Number of CD4+ average of 24 / microliter, while the average number of leucocytes 9675/uL, while the most common sequence of disease; 39.1% of cerebral toxoplasmosis, tuberculosis meningoencephalitis 21.7%, 17.4% viral encephalitis, bacterial meningoencephalitis 13%, 4.3% dementia, cerebral abscess 4.3%. The mortality rate is still high, ranging from 57.6%.Conclusion. Manifestations of HIV AIDS in the field of neurology are very high, cerebral toxoplasmosis is the most common diagnosis, and correlated with the levels of CD4+. The mortality rate of HIV-AIDS cases manifesting high neurology.
Terapi ARV Meningkatkan Kadar IL-17 Serum pada Pasien HIV Wahyudi, Hendrik; Candradikusuma, Didi; B, Niniek Budiarti; Ismanoe, Gatoet
Jurnal Kedokteran Brawijaya Vol 27, No 4 (2013)
Publisher : Fakultas Kedokteran Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (529.47 KB) | DOI: 10.21776/ub.jkb.2013.027.04.8

Abstract

Penurunan jumlah atau fungsi Th-17 mempengaruhi produksi IL-17 sehingga virus HIV lebih mudah mengalami replikasi. Pemberiaan ARV yang dapat menekan replikasi virus HIV diharapkan dapat memperbaiki produksi IL-17 dan menyebabkan pulihnya fungsi Th-17. Penelitian dilakukan untuk mengetahui rerata kadar IL-17 serum pada pasien HIV sebelum dan setelah 3 bulan mendapat terapi ARV. Survei pre dan post tes dilakukan pada  pasien infeksi HIV yang baru terdiagnosa di RSU Dr. Saiful Anwar-Malang. Diagnosa HIV berdasarkan  kriteria WHO, dan IL-17 serum diukur dengan metode ELISA. Hitung limfosit T-CD4 absolut menggunakan metode flowcytometry. Analisa statistik yang digunakan untuk komparasi numerik  adalah uji t berpasangan dan  analisa korelasi menggunakan uji Spearman. Kadar IL-17 serum penderita HIV sebelum dan sesudah 3 bulan mendapat terapi ARV adalah 44,17±12,56 pg/mL dan 52,91±9,90 pg/mL (p=0,005). Hitung sel limfosit T-CD4 absolut  sebelum dan sesudah 3 bulan mendapat terapi ARV adalah 69,41±95,06 cells/mL dan 180,72±73,15 cells/mL (p=0,000). Kadar IL-17 serum didapatkan tidak berkorelasi dengan hitung sel T-CD4 absolut (p=0,914, r=-0,024). Dapat disimpulkan kadar IL-17 serum dan CD4 penderita HIV setelah 3 bulan mendapat terapi ARV lebih tinggi dibandingkan sebelum mendapat terapi ARV, namun, kadar IL-17 tidak berhubungan dengan hitung sel limfosit T-CD4.Kata Kunci: CD4, infeksi HIV, IL-17 serum, Th-17
Sensitivity and Specificity of Nested PCR for Diagnosing Malaria: Cases in Several Areas of Indonesia Arifin, Samsul; Fitri, Loeki Enggar; Sujuti, Hidayat; Hermansyah, Bagus; Endharti, Agustina Tri; Burhan, Niniek; Candradikusuma, Didi; Sulistyaningsih, Erma; Tuda, Josef Sem Berth; Zein, Umar
Journal of Tropical Life Science Vol 8, No 2 (2018)
Publisher : Journal of Tropical Life Science

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jtls.08.02.11

Abstract

Indonesia is still included in high endemic area of malaria infection. Early detection as well as appropriate and quick treatment is needed to be able to prevent and treat malaria in Indonesia. Laboratory examination using a microscopic method is still used as the gold standard to diagnose malaria cases. However, the morphology similarity of some Plasmodium species and the number of parasites that can be seen under microscopy causes malaria diagnosis become difficult if only relying on microscopy diagnostic method. The purpose of this study is to analyze the sensitivity and specificity of nested PCR compared to microscopic examination in diagnosing malaria cases. A cross-sectional study has been carried out in some areas of Indonesia and the microscopic analysis as well as nest PCR was done in Laboratory of Parasitology and Laboratory of Central Biomedical Faculty of Medicine, Universitas Brawijaya, Malang East Java Indonesia. A total of 149 blood samples from patients with clinical symptoms of malaria had been obtained from Sumatra, Sulawesi and East Java during December 2011 to December 2013. From 149 sample, 81.9% samples were diagnosed malaria positive by microscopy examination, whereas the PCR results showed that 90.6% of samples were positive. Nested PCR sensitivity is 97.5%, and microscopy 88.2%. Nested PCR specificity is 40.7%, whereas microscopy 78.5%. PPV and NPV for nested PCR are 88,2% and 78.5% respectively, and for microscopy are 97.5% and 40.7% respectively. Nested PCR has a higher sensitivity than microscopy in diagnosing malaria and is able to detect mixed infection better than microscopic examination. However, it is statistically less specific than microscopy examination.
DIAGNOSTIC TEST OF POLYNEUROPATHY SCORE, 10-G SEMMES WENSTEIN MONOFILAMENT (SWM) AND VIBRATION PERCEPTION TRESHOLD (VPT)-QUANTITATIVE SENSORY TESTING (QST) IN DISTAL SENSORY POLYNEUROPATHY (DSP)-HUMAN IMMUNODEFICIENCY VIRUS (HIV) Purbasari, Bethasiwi; Kurniawan, Shahdevi Nandar; Husna, Machlusil; Candradikusuma, Didi; Al-Rasyid, Harun
Malang Neurology Journal Vol 5, No 1 (2019): January
Publisher : Malang Neurology Journal

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2019.005.01.4

Abstract

Background: HIV/AIDS is a worldwide pandemic. Peripheral neuropathy is the most common neurologic complication with distal sensory polyneuropathy (HIV-DSP) as the most frequent form of manifestation. HIV-DSP is one of the major causes of global pain morbidity and often undiagnosed earlier, resulting in treatment given when HIV-DSP grade is already severe. Early detection is imperative to prevent the progression of HIV-DSP and improve patient’s quality of life. Polyneuropathy score, 10-g Semmes-Weinstein Monofilament (SWM) and vibration perception threshold (VPT)-quantitative sensory testing (QST) are considered to be potential candidates for HIVDSP screening tool.Objective: To measure the reability of Polyneuropathy Score, SWM and VPT- QST in diagnosing HIV-DSP.Methods: This research is a descriptive study with cross-sectional design. Research was conducted on 77 patients of HIV/AIDS outpatient clinic in RS Saiful Anwar (RSSA) during November 2016 - April 2017 (n = 77). Patients were screened for HIV-DSP by using polyneuropathy score, such as: Michigan Neuropathy Screening Instrument (MNSI), Toronto Clinical Scoring Sysytem (TCSS), Brief Peripheral Neuropathy Score (BPNS), SWM, and VPT-QST. Sensitivity, specificity, positive predictive value and negative predictive value of BPNS, TCSS, MNSI, SWM and VPT-QST are analyzed using cross tabulation. Area under receiver operating characteristic (ROC) curve analysis was used to measure diagnostic accuracy of each tools. SPSS 19.0 was used for statistical analysis.Results: TCSS had a sensitivity, specificity, positive predictive value, negative predictive value positive likelihood ratio, negative likelihood ratio, and accuracy as much as: 70%, 97%, 97%, 74%, 23,33, 0,28 and 83%. The result of TCSS analysis using ROC showed that TCSS had excellent diagnostic value with AUC (Area Under Curve) of 0.89 (95%CI 82%-96,5%). The AUC of BPNS score, monofilamen and VPT-QST respectively: 0,469, 0,194, and 0,189.Conclusion: The result of the HIV-DSP diagnostic test using TCSS score has the best value compared to other tools.
NEUROLOGICAL MANIFESTATION ON HOSPITALIZED PATIENT WITH PROBABLE COVID-19 IN SAIFUL ANWAR HOSPITAL INDONESIA (SERIAL CASES) Munir, Badrul; Rianawati, Sri Budhi; Kurniawan, Shahdevi Nandar; Santoso, Widodo Mardi; Arisetijono, Eko; Candradikusuma, Didi; Heri, Sutanto; Chozin, Iin Noor; Dwi, Pratiwi Suryanti; Astuti, Tri Wahju; Asmiragani, Syaifullah
Malang Neurology Journal Vol 6, No 2 (2020): July
Publisher : Malang Neurology Journal

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2020.006.02.1

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Background: Coronavirus disease 2019 (Covid-19) caused by SARS-Cov-2 had been spreading worldwide including Indonesia, but In Indonesia, it was difficult to diagnose confirmation Covid-19 by Polymerase Change Reaction (PCR). and in clinical practice to treat covid-19,  Indonesia Health Ministry use term probable covid-19 for patients under observation Covid-19, but study for neurological manifestation on  probable Covid-19 is very lacking.Objective: Knowing the neurological manifestation of patient probable Covid-19.Methods: Observational study from Covid-19 medical record and neuro-Covid-19 medical record of all probable Covid-19 hospitalized in the isolation ward of Saiful Anwar Hospital (RSSA) Malang since March-May, 2020 (3 months). Probable Covid-19 criteria were given by Covid-19 task force team based on Health Minister Indonesia criteria. This criterion was based on clinical manifestation (severe upper respiratory symptoms, or mild-severe pneumonia), radiologic examination (lung infiltrate and or chest CT scan), and laboratory examination. Neurological manifestation is based on clinical symptom appeared while patient hospitalized, supported with radiologic and laboratory data which was supervised by neurologist or neurologist resident. All data was inputted to neuro-Covid-19 e-registry on the smartphone application, sent periodically to the data center in Neurology Department RSSA Malang.Results: A hundred and fourteen probable Covid-19 was registered with mean age 34,5 year old and mostly at the young age of 20-50 years (38%). The neurological manifestation was observed in 4 patients (3,4% from all possible Covid-19 patients) with thrombotic stroke as the most common manifestation (50%), followed by myelum tumor (25%) and hypoxia encephalopathy (25%). Stroke patients in probable Covid-19 had old age (72 and 82 years) accompanied by several comorbid such as hypertension, DM and CVA history and Covid symptoms of cough, shortness of breath and fever. Hemiparesis was found improved with aspirin and neurotropic therapy. Patient with myelum tumor had a covid symptom of shortness of breath, cough, and fever with UMN tetraparesis. Previous MRI examination results suspected meningioma. The patient died while hospitalized. Patients with hypoxia encephalopathy admitted with decreased consciousness due to shortness of breath with acidosis respiratory symptoms (pH 7,22 ). This condition improved after oxygenation without focal neurologic deficit.Conclusion: Neurological manifestation in probable Covid-19 was 3,4% of all patients. The most common diagnosis was a thrombotic stroke, followed by myelum tumor, hypoxia encephalopathy, and mortality rate is 25%.
Shorter All-oral Bedaquiline-containing MDR-TB Regimen : The Backgrounds & Implementations Winoto, Eden Suryoiman; Candradikusuma, Didi
Clinical and Research Journal in Internal Medicine Vol 2, No 1 (2021): First Issue of 2021
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.crjim.2021.002.01.6

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The continuing spread of Multidrug-Resistant Tuberculosis (MDR-TB), which is defined as TB that shows resistance to both isoniazid and rifampicin, become one of the most urgent and difficult challenges in TB control. In Indonesia, the estimated total DR-TB case incidence of 24,000 or 8.8/100,000 population (2.4% of total new TB patients). The first-ever MDR-TB treatment guideline published by WHO required a long duration (up to 20–24 months) and contained toxic second-line drugs with less effective & unfavorable outcomes. About ten years ago, a short regimen lasting nine instead of 20 months, called “Bangladesh regimen”, revolutionized MDR-TB treatment. The advent of rapid molecular diagnostic tests, discoveries of new and repurposed drugs, promising results based on trials and meta-analysis had prompted WHO to update its guidelines. Notably, drugs such as bedaquiline and clofazimine are now strongly recommended for the treatment of MDR-TB. At the same time, older injectables drugs have been downgraded due to poor effectiveness and side-effect profiles. In 2019, based on the programmatic data from the shorter all-oral bedaquiline-containing regimen implemented routinely in South Africa, WHO revised its recommendations on the use of a standardized shorter regimen. Based on the analysis, WHO affirmed its conditional recommendation for the shorter all-oral bedaquiline-containing MDR -TB regimen to be offered as a treatment option to MDR -TB patients who satisfy the eligibility criteria. The implementation of this all-oral shorter regimen is expected to improve the programmatic management of the MDR-TB worldwide.