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Wijaya M, Surja SS, Adawiyah R, Hariadi A, Setianingrum F, Rozaliyani A, Burhan E, Tugiran M, Sjam R, Denning DW, Wahyuningsih R. Histoplasma antigen detection in unconfirmed pulmonary tuberculosis and cross-reactivity with Aspergillus antigen in patients and in food in Jakarta, Indonesia. Mycoses 2024; 67:e13670. [PMID: 37897135 DOI: 10.1111/myc.13670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 10/29/2023]
Abstract
PURPOSE H. capsulatum is endemic in Indonesia, but the value of Histoplasma antigen detection has not been studied. PATIENTS AND METHODS Histoplasma galactomannan (GM) ELISA was applied to sera of patients with unproven pulmonary tuberculosis (TB) and patients with a positive Aspergillus GM. Both Histoplasma and Aspergillus GM tests were performed to determine any possible cross-reaction with certain foods. RESULTS Fourteen of 122 (11.5%) sera of patients with newly diagnosed clinical TB were positive for Histoplasma GM. The positivity rate in the serum of patients 5-6 and 12 months after TB diagnosis was 3.8% and 3.5%, respectively. Of 88 positive Aspergillus GM sera, 63 (71.6%) were also positive for Histoplasma GM. All tested foods were positive for Aspergillus GM, while 65% of foods were positive for Histoplasma GM. CONCLUSION Galactomannan is widespread in sera and food in Jakarta, possibly related to food consumption. Histoplasma and Aspergillus antigen detection for the diagnosis will require additional means of confirming the diagnosis; negative tests may be more helpful for ruling out invasive histoplasmosis and aspergillosis.
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Affiliation(s)
- Meiliyana Wijaya
- Study Program of Clinical Parasitology, Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Parasitology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Sem Samuel Surja
- Department of Parasitology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Robiatul Adawiyah
- Study Program of Clinical Parasitology, Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Indonesia Pulmonary Mycoses Centre (IPMC), Faculty of Medicine Universitas Indonesia and Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia
- Master's Programme in Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Infectious Diseases and Immunology Research Center (IDIRC), Indonesian Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ariananda Hariadi
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Findra Setianingrum
- Study Program of Clinical Parasitology, Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Indonesia Pulmonary Mycoses Centre (IPMC), Faculty of Medicine Universitas Indonesia and Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia
- Master's Programme in Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Anna Rozaliyani
- Study Program of Clinical Parasitology, Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Indonesia Pulmonary Mycoses Centre (IPMC), Faculty of Medicine Universitas Indonesia and Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia
- Master's Programme in Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Erlina Burhan
- Indonesia Pulmonary Mycoses Centre (IPMC), Faculty of Medicine Universitas Indonesia and Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia
| | - Mulyati Tugiran
- Study Program of Clinical Parasitology, Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Indonesia Pulmonary Mycoses Centre (IPMC), Faculty of Medicine Universitas Indonesia and Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia
- Master's Programme in Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ridhawati Sjam
- Study Program of Clinical Parasitology, Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Indonesia Pulmonary Mycoses Centre (IPMC), Faculty of Medicine Universitas Indonesia and Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia
- Master's Programme in Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - David W Denning
- Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Retno Wahyuningsih
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Parasitology, Faculty of Medicine, Universitas Kristen Indonesia, Jakarta, Indonesia
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Donovan J, Bang ND, Imran D, Nghia HDT, Burhan E, Huong DTT, Hiep NTT, Ngoc LHB, Thanh DV, Thanh NT, Wardhani ALS, Maharani K, Gasmara CP, Hanh NHH, Oanh PKN, Estiasari R, Thu DDA, Kusumaningrum A, Dung LT, Giang DC, Ha DTM, Lan NH, Chau NVV, Nguyet NTM, Geskus RB, Thuong NTT, Kestelyn E, Hamers RL, Phu NH, Thwaites GE. Adjunctive Dexamethasone for Tuberculous Meningitis in HIV-Positive Adults. N Engl J Med 2023; 389:1357-1367. [PMID: 37819954 PMCID: PMC7615197 DOI: 10.1056/nejmoa2216218] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Adjunctive glucocorticoids are widely used to treat human immunodeficiency virus (HIV)-associated tuberculous meningitis despite limited data supporting their safety and efficacy. METHODS We conducted a double-blind, randomized, placebo-controlled trial involving HIV-positive adults (≥18 years of age) with tuberculous meningitis in Vietnam and Indonesia. Participants were randomly assigned to receive a 6-to-8-week tapering course of either dexamethasone or placebo in addition to 12 months of antituberculosis chemotherapy. The primary end point was death from any cause during the 12 months after randomization. RESULTS A total of 520 adults were randomly assigned to receive either dexamethasone (263 participants) or placebo (257 participants). The median age was 36 years; 255 of 520 participants (49.0%) had never received antiretroviral therapy, and 251 of 484 participants (51.9%) with available data had a baseline CD4 count of 50 cells per cubic millimeter or less. Six participants withdrew from the trial, and five were lost to follow-up. During the 12 months of follow-up, death occurred in 116 of 263 participants (44.1%) in the dexamethasone group and in 126 of 257 participants (49.0%) in the placebo group (hazard ratio, 0.85; 95% confidence interval, 0.66 to 1.10; P = 0.22). Prespecified analyses did not reveal a subgroup that clearly benefited from dexamethasone. The incidence of secondary end-point events, including cases of immune reconstitution inflammatory syndrome during the first 6 months, was similar in the two trial groups. The numbers of participants with at least one serious adverse event were similar in the dexamethasone group (192 of 263 participants [73.0%]) and the placebo group (194 of 257 participants [75.5%]) (P = 0.52). CONCLUSIONS Among HIV-positive adults with tuberculous meningitis, adjunctive dexamethasone, as compared with placebo, did not confer a benefit with respect to survival or any secondary end point. (Funded by the Wellcome Trust; ACT HIV ClinicalTrials.gov number, NCT03092817.).
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Affiliation(s)
- Joseph Donovan
- From the Oxford University Clinical Research Unit (J.D., D.T.T.H., N.T.T.H., L.H.B.N., D.V.T., N.T.T., D.D.A.T., N.T.M.N., R.B.G., N.T.T.T., E.K., N.H.P., G.E.T.), Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease (N.D.B., L.T.D., D.C.G., D.T.M.H., N.H.L.), the Hospital for Tropical Diseases (H.D.T.N., N.T.T., N.H.H.H., P.K.N.O., N.V.V.C.), Pham Ngoc Thach University of Medicine (H.D.T.N.), and the School of Medicine, Vietnam National University of Ho Chi Minh City (N.H.H.H., N.H.P.) - all in Ho Chi Minh City, Vietnam; the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford (J.D., R.B.G., N.T.T.T., E.K., R.L.H., N.H.P., G.E.T.), and London School of Hygiene and Tropical Medicine, London (J.D.) - both in the United Kingdom; and Dr. Cipto Mangunkusumo National Reference Hospital (D.I., K.M., C.P.G., R.E., A.K.), Persahabatan National Respiratory Referral Hospital (E.B.), and Oxford University Clinical Research Unit Indonesia (A.L.S.W., R.L.H.), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Nguyen D Bang
- From the Oxford University Clinical Research Unit (J.D., D.T.T.H., N.T.T.H., L.H.B.N., D.V.T., N.T.T., D.D.A.T., N.T.M.N., R.B.G., N.T.T.T., E.K., N.H.P., G.E.T.), Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease (N.D.B., L.T.D., D.C.G., D.T.M.H., N.H.L.), the Hospital for Tropical Diseases (H.D.T.N., N.T.T., N.H.H.H., P.K.N.O., N.V.V.C.), Pham Ngoc Thach University of Medicine (H.D.T.N.), and the School of Medicine, Vietnam National University of Ho Chi Minh City (N.H.H.H., N.H.P.) - all in Ho Chi Minh City, Vietnam; the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford (J.D., R.B.G., N.T.T.T., E.K., R.L.H., N.H.P., G.E.T.), and London School of Hygiene and Tropical Medicine, London (J.D.) - both in the United Kingdom; and Dr. Cipto Mangunkusumo National Reference Hospital (D.I., K.M., C.P.G., R.E., A.K.), Persahabatan National Respiratory Referral Hospital (E.B.), and Oxford University Clinical Research Unit Indonesia (A.L.S.W., R.L.H.), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Darma Imran
- From the Oxford University Clinical Research Unit (J.D., D.T.T.H., N.T.T.H., L.H.B.N., D.V.T., N.T.T., D.D.A.T., N.T.M.N., R.B.G., N.T.T.T., E.K., N.H.P., G.E.T.), Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease (N.D.B., L.T.D., D.C.G., D.T.M.H., N.H.L.), the Hospital for Tropical Diseases (H.D.T.N., N.T.T., N.H.H.H., P.K.N.O., N.V.V.C.), Pham Ngoc Thach University of Medicine (H.D.T.N.), and the School of Medicine, Vietnam National University of Ho Chi Minh City (N.H.H.H., N.H.P.) - all in Ho Chi Minh City, Vietnam; the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford (J.D., R.B.G., N.T.T.T., E.K., R.L.H., N.H.P., G.E.T.), and London School of Hygiene and Tropical Medicine, London (J.D.) - both in the United Kingdom; and Dr. Cipto Mangunkusumo National Reference Hospital (D.I., K.M., C.P.G., R.E., A.K.), Persahabatan National Respiratory Referral Hospital (E.B.), and Oxford University Clinical Research Unit Indonesia (A.L.S.W., R.L.H.), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ho D T Nghia
- From the Oxford University Clinical Research Unit (J.D., D.T.T.H., N.T.T.H., L.H.B.N., D.V.T., N.T.T., D.D.A.T., N.T.M.N., R.B.G., N.T.T.T., E.K., N.H.P., G.E.T.), Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease (N.D.B., L.T.D., D.C.G., D.T.M.H., N.H.L.), the Hospital for Tropical Diseases (H.D.T.N., N.T.T., N.H.H.H., P.K.N.O., N.V.V.C.), Pham Ngoc Thach University of Medicine (H.D.T.N.), and the School of Medicine, Vietnam National University of Ho Chi Minh City (N.H.H.H., N.H.P.) - all in Ho Chi Minh City, Vietnam; the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford (J.D., R.B.G., N.T.T.T., E.K., R.L.H., N.H.P., G.E.T.), and London School of Hygiene and Tropical Medicine, London (J.D.) - both in the United Kingdom; and Dr. Cipto Mangunkusumo National Reference Hospital (D.I., K.M., C.P.G., R.E., A.K.), Persahabatan National Respiratory Referral Hospital (E.B.), and Oxford University Clinical Research Unit Indonesia (A.L.S.W., R.L.H.), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Erlina Burhan
- From the Oxford University Clinical Research Unit (J.D., D.T.T.H., N.T.T.H., L.H.B.N., D.V.T., N.T.T., D.D.A.T., N.T.M.N., R.B.G., N.T.T.T., E.K., N.H.P., G.E.T.), Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease (N.D.B., L.T.D., D.C.G., D.T.M.H., N.H.L.), the Hospital for Tropical Diseases (H.D.T.N., N.T.T., N.H.H.H., P.K.N.O., N.V.V.C.), Pham Ngoc Thach University of Medicine (H.D.T.N.), and the School of Medicine, Vietnam National University of Ho Chi Minh City (N.H.H.H., N.H.P.) - all in Ho Chi Minh City, Vietnam; the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford (J.D., R.B.G., N.T.T.T., E.K., R.L.H., N.H.P., G.E.T.), and London School of Hygiene and Tropical Medicine, London (J.D.) - both in the United Kingdom; and Dr. Cipto Mangunkusumo National Reference Hospital (D.I., K.M., C.P.G., R.E., A.K.), Persahabatan National Respiratory Referral Hospital (E.B.), and Oxford University Clinical Research Unit Indonesia (A.L.S.W., R.L.H.), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Dau T T Huong
- From the Oxford University Clinical Research Unit (J.D., D.T.T.H., N.T.T.H., L.H.B.N., D.V.T., N.T.T., D.D.A.T., N.T.M.N., R.B.G., N.T.T.T., E.K., N.H.P., G.E.T.), Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease (N.D.B., L.T.D., D.C.G., D.T.M.H., N.H.L.), the Hospital for Tropical Diseases (H.D.T.N., N.T.T., N.H.H.H., P.K.N.O., N.V.V.C.), Pham Ngoc Thach University of Medicine (H.D.T.N.), and the School of Medicine, Vietnam National University of Ho Chi Minh City (N.H.H.H., N.H.P.) - all in Ho Chi Minh City, Vietnam; the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford (J.D., R.B.G., N.T.T.T., E.K., R.L.H., N.H.P., G.E.T.), and London School of Hygiene and Tropical Medicine, London (J.D.) - both in the United Kingdom; and Dr. Cipto Mangunkusumo National Reference Hospital (D.I., K.M., C.P.G., R.E., A.K.), Persahabatan National Respiratory Referral Hospital (E.B.), and Oxford University Clinical Research Unit Indonesia (A.L.S.W., R.L.H.), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Nguyen T T Hiep
- From the Oxford University Clinical Research Unit (J.D., D.T.T.H., N.T.T.H., L.H.B.N., D.V.T., N.T.T., D.D.A.T., N.T.M.N., R.B.G., N.T.T.T., E.K., N.H.P., G.E.T.), Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease (N.D.B., L.T.D., D.C.G., D.T.M.H., N.H.L.), the Hospital for Tropical Diseases (H.D.T.N., N.T.T., N.H.H.H., P.K.N.O., N.V.V.C.), Pham Ngoc Thach University of Medicine (H.D.T.N.), and the School of Medicine, Vietnam National University of Ho Chi Minh City (N.H.H.H., N.H.P.) - all in Ho Chi Minh City, Vietnam; the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford (J.D., R.B.G., N.T.T.T., E.K., R.L.H., N.H.P., G.E.T.), and London School of Hygiene and Tropical Medicine, London (J.D.) - both in the United Kingdom; and Dr. Cipto Mangunkusumo National Reference Hospital (D.I., K.M., C.P.G., R.E., A.K.), Persahabatan National Respiratory Referral Hospital (E.B.), and Oxford University Clinical Research Unit Indonesia (A.L.S.W., R.L.H.), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Lam H B Ngoc
- From the Oxford University Clinical Research Unit (J.D., D.T.T.H., N.T.T.H., L.H.B.N., D.V.T., N.T.T., D.D.A.T., N.T.M.N., R.B.G., N.T.T.T., E.K., N.H.P., G.E.T.), Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease (N.D.B., L.T.D., D.C.G., D.T.M.H., N.H.L.), the Hospital for Tropical Diseases (H.D.T.N., N.T.T., N.H.H.H., P.K.N.O., N.V.V.C.), Pham Ngoc Thach University of Medicine (H.D.T.N.), and the School of Medicine, Vietnam National University of Ho Chi Minh City (N.H.H.H., N.H.P.) - all in Ho Chi Minh City, Vietnam; the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford (J.D., R.B.G., N.T.T.T., E.K., R.L.H., N.H.P., G.E.T.), and London School of Hygiene and Tropical Medicine, London (J.D.) - both in the United Kingdom; and Dr. Cipto Mangunkusumo National Reference Hospital (D.I., K.M., C.P.G., R.E., A.K.), Persahabatan National Respiratory Referral Hospital (E.B.), and Oxford University Clinical Research Unit Indonesia (A.L.S.W., R.L.H.), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Dang V Thanh
- From the Oxford University Clinical Research Unit (J.D., D.T.T.H., N.T.T.H., L.H.B.N., D.V.T., N.T.T., D.D.A.T., N.T.M.N., R.B.G., N.T.T.T., E.K., N.H.P., G.E.T.), Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease (N.D.B., L.T.D., D.C.G., D.T.M.H., N.H.L.), the Hospital for Tropical Diseases (H.D.T.N., N.T.T., N.H.H.H., P.K.N.O., N.V.V.C.), Pham Ngoc Thach University of Medicine (H.D.T.N.), and the School of Medicine, Vietnam National University of Ho Chi Minh City (N.H.H.H., N.H.P.) - all in Ho Chi Minh City, Vietnam; the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford (J.D., R.B.G., N.T.T.T., E.K., R.L.H., N.H.P., G.E.T.), and London School of Hygiene and Tropical Medicine, London (J.D.) - both in the United Kingdom; and Dr. Cipto Mangunkusumo National Reference Hospital (D.I., K.M., C.P.G., R.E., A.K.), Persahabatan National Respiratory Referral Hospital (E.B.), and Oxford University Clinical Research Unit Indonesia (A.L.S.W., R.L.H.), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Nguyen T Thanh
- From the Oxford University Clinical Research Unit (J.D., D.T.T.H., N.T.T.H., L.H.B.N., D.V.T., N.T.T., D.D.A.T., N.T.M.N., R.B.G., N.T.T.T., E.K., N.H.P., G.E.T.), Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease (N.D.B., L.T.D., D.C.G., D.T.M.H., N.H.L.), the Hospital for Tropical Diseases (H.D.T.N., N.T.T., N.H.H.H., P.K.N.O., N.V.V.C.), Pham Ngoc Thach University of Medicine (H.D.T.N.), and the School of Medicine, Vietnam National University of Ho Chi Minh City (N.H.H.H., N.H.P.) - all in Ho Chi Minh City, Vietnam; the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford (J.D., R.B.G., N.T.T.T., E.K., R.L.H., N.H.P., G.E.T.), and London School of Hygiene and Tropical Medicine, London (J.D.) - both in the United Kingdom; and Dr. Cipto Mangunkusumo National Reference Hospital (D.I., K.M., C.P.G., R.E., A.K.), Persahabatan National Respiratory Referral Hospital (E.B.), and Oxford University Clinical Research Unit Indonesia (A.L.S.W., R.L.H.), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Anna L S Wardhani
- From the Oxford University Clinical Research Unit (J.D., D.T.T.H., N.T.T.H., L.H.B.N., D.V.T., N.T.T., D.D.A.T., N.T.M.N., R.B.G., N.T.T.T., E.K., N.H.P., G.E.T.), Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease (N.D.B., L.T.D., D.C.G., D.T.M.H., N.H.L.), the Hospital for Tropical Diseases (H.D.T.N., N.T.T., N.H.H.H., P.K.N.O., N.V.V.C.), Pham Ngoc Thach University of Medicine (H.D.T.N.), and the School of Medicine, Vietnam National University of Ho Chi Minh City (N.H.H.H., N.H.P.) - all in Ho Chi Minh City, Vietnam; the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford (J.D., R.B.G., N.T.T.T., E.K., R.L.H., N.H.P., G.E.T.), and London School of Hygiene and Tropical Medicine, London (J.D.) - both in the United Kingdom; and Dr. Cipto Mangunkusumo National Reference Hospital (D.I., K.M., C.P.G., R.E., A.K.), Persahabatan National Respiratory Referral Hospital (E.B.), and Oxford University Clinical Research Unit Indonesia (A.L.S.W., R.L.H.), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Kartika Maharani
- From the Oxford University Clinical Research Unit (J.D., D.T.T.H., N.T.T.H., L.H.B.N., D.V.T., N.T.T., D.D.A.T., N.T.M.N., R.B.G., N.T.T.T., E.K., N.H.P., G.E.T.), Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease (N.D.B., L.T.D., D.C.G., D.T.M.H., N.H.L.), the Hospital for Tropical Diseases (H.D.T.N., N.T.T., N.H.H.H., P.K.N.O., N.V.V.C.), Pham Ngoc Thach University of Medicine (H.D.T.N.), and the School of Medicine, Vietnam National University of Ho Chi Minh City (N.H.H.H., N.H.P.) - all in Ho Chi Minh City, Vietnam; the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford (J.D., R.B.G., N.T.T.T., E.K., R.L.H., N.H.P., G.E.T.), and London School of Hygiene and Tropical Medicine, London (J.D.) - both in the United Kingdom; and Dr. Cipto Mangunkusumo National Reference Hospital (D.I., K.M., C.P.G., R.E., A.K.), Persahabatan National Respiratory Referral Hospital (E.B.), and Oxford University Clinical Research Unit Indonesia (A.L.S.W., R.L.H.), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Cakra P Gasmara
- From the Oxford University Clinical Research Unit (J.D., D.T.T.H., N.T.T.H., L.H.B.N., D.V.T., N.T.T., D.D.A.T., N.T.M.N., R.B.G., N.T.T.T., E.K., N.H.P., G.E.T.), Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease (N.D.B., L.T.D., D.C.G., D.T.M.H., N.H.L.), the Hospital for Tropical Diseases (H.D.T.N., N.T.T., N.H.H.H., P.K.N.O., N.V.V.C.), Pham Ngoc Thach University of Medicine (H.D.T.N.), and the School of Medicine, Vietnam National University of Ho Chi Minh City (N.H.H.H., N.H.P.) - all in Ho Chi Minh City, Vietnam; the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford (J.D., R.B.G., N.T.T.T., E.K., R.L.H., N.H.P., G.E.T.), and London School of Hygiene and Tropical Medicine, London (J.D.) - both in the United Kingdom; and Dr. Cipto Mangunkusumo National Reference Hospital (D.I., K.M., C.P.G., R.E., A.K.), Persahabatan National Respiratory Referral Hospital (E.B.), and Oxford University Clinical Research Unit Indonesia (A.L.S.W., R.L.H.), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Nguyen H H Hanh
- From the Oxford University Clinical Research Unit (J.D., D.T.T.H., N.T.T.H., L.H.B.N., D.V.T., N.T.T., D.D.A.T., N.T.M.N., R.B.G., N.T.T.T., E.K., N.H.P., G.E.T.), Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease (N.D.B., L.T.D., D.C.G., D.T.M.H., N.H.L.), the Hospital for Tropical Diseases (H.D.T.N., N.T.T., N.H.H.H., P.K.N.O., N.V.V.C.), Pham Ngoc Thach University of Medicine (H.D.T.N.), and the School of Medicine, Vietnam National University of Ho Chi Minh City (N.H.H.H., N.H.P.) - all in Ho Chi Minh City, Vietnam; the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford (J.D., R.B.G., N.T.T.T., E.K., R.L.H., N.H.P., G.E.T.), and London School of Hygiene and Tropical Medicine, London (J.D.) - both in the United Kingdom; and Dr. Cipto Mangunkusumo National Reference Hospital (D.I., K.M., C.P.G., R.E., A.K.), Persahabatan National Respiratory Referral Hospital (E.B.), and Oxford University Clinical Research Unit Indonesia (A.L.S.W., R.L.H.), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Pham K N Oanh
- From the Oxford University Clinical Research Unit (J.D., D.T.T.H., N.T.T.H., L.H.B.N., D.V.T., N.T.T., D.D.A.T., N.T.M.N., R.B.G., N.T.T.T., E.K., N.H.P., G.E.T.), Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease (N.D.B., L.T.D., D.C.G., D.T.M.H., N.H.L.), the Hospital for Tropical Diseases (H.D.T.N., N.T.T., N.H.H.H., P.K.N.O., N.V.V.C.), Pham Ngoc Thach University of Medicine (H.D.T.N.), and the School of Medicine, Vietnam National University of Ho Chi Minh City (N.H.H.H., N.H.P.) - all in Ho Chi Minh City, Vietnam; the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford (J.D., R.B.G., N.T.T.T., E.K., R.L.H., N.H.P., G.E.T.), and London School of Hygiene and Tropical Medicine, London (J.D.) - both in the United Kingdom; and Dr. Cipto Mangunkusumo National Reference Hospital (D.I., K.M., C.P.G., R.E., A.K.), Persahabatan National Respiratory Referral Hospital (E.B.), and Oxford University Clinical Research Unit Indonesia (A.L.S.W., R.L.H.), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Riwanti Estiasari
- From the Oxford University Clinical Research Unit (J.D., D.T.T.H., N.T.T.H., L.H.B.N., D.V.T., N.T.T., D.D.A.T., N.T.M.N., R.B.G., N.T.T.T., E.K., N.H.P., G.E.T.), Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease (N.D.B., L.T.D., D.C.G., D.T.M.H., N.H.L.), the Hospital for Tropical Diseases (H.D.T.N., N.T.T., N.H.H.H., P.K.N.O., N.V.V.C.), Pham Ngoc Thach University of Medicine (H.D.T.N.), and the School of Medicine, Vietnam National University of Ho Chi Minh City (N.H.H.H., N.H.P.) - all in Ho Chi Minh City, Vietnam; the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford (J.D., R.B.G., N.T.T.T., E.K., R.L.H., N.H.P., G.E.T.), and London School of Hygiene and Tropical Medicine, London (J.D.) - both in the United Kingdom; and Dr. Cipto Mangunkusumo National Reference Hospital (D.I., K.M., C.P.G., R.E., A.K.), Persahabatan National Respiratory Referral Hospital (E.B.), and Oxford University Clinical Research Unit Indonesia (A.L.S.W., R.L.H.), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Do D A Thu
- From the Oxford University Clinical Research Unit (J.D., D.T.T.H., N.T.T.H., L.H.B.N., D.V.T., N.T.T., D.D.A.T., N.T.M.N., R.B.G., N.T.T.T., E.K., N.H.P., G.E.T.), Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease (N.D.B., L.T.D., D.C.G., D.T.M.H., N.H.L.), the Hospital for Tropical Diseases (H.D.T.N., N.T.T., N.H.H.H., P.K.N.O., N.V.V.C.), Pham Ngoc Thach University of Medicine (H.D.T.N.), and the School of Medicine, Vietnam National University of Ho Chi Minh City (N.H.H.H., N.H.P.) - all in Ho Chi Minh City, Vietnam; the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford (J.D., R.B.G., N.T.T.T., E.K., R.L.H., N.H.P., G.E.T.), and London School of Hygiene and Tropical Medicine, London (J.D.) - both in the United Kingdom; and Dr. Cipto Mangunkusumo National Reference Hospital (D.I., K.M., C.P.G., R.E., A.K.), Persahabatan National Respiratory Referral Hospital (E.B.), and Oxford University Clinical Research Unit Indonesia (A.L.S.W., R.L.H.), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ardiana Kusumaningrum
- From the Oxford University Clinical Research Unit (J.D., D.T.T.H., N.T.T.H., L.H.B.N., D.V.T., N.T.T., D.D.A.T., N.T.M.N., R.B.G., N.T.T.T., E.K., N.H.P., G.E.T.), Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease (N.D.B., L.T.D., D.C.G., D.T.M.H., N.H.L.), the Hospital for Tropical Diseases (H.D.T.N., N.T.T., N.H.H.H., P.K.N.O., N.V.V.C.), Pham Ngoc Thach University of Medicine (H.D.T.N.), and the School of Medicine, Vietnam National University of Ho Chi Minh City (N.H.H.H., N.H.P.) - all in Ho Chi Minh City, Vietnam; the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford (J.D., R.B.G., N.T.T.T., E.K., R.L.H., N.H.P., G.E.T.), and London School of Hygiene and Tropical Medicine, London (J.D.) - both in the United Kingdom; and Dr. Cipto Mangunkusumo National Reference Hospital (D.I., K.M., C.P.G., R.E., A.K.), Persahabatan National Respiratory Referral Hospital (E.B.), and Oxford University Clinical Research Unit Indonesia (A.L.S.W., R.L.H.), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Le T Dung
- From the Oxford University Clinical Research Unit (J.D., D.T.T.H., N.T.T.H., L.H.B.N., D.V.T., N.T.T., D.D.A.T., N.T.M.N., R.B.G., N.T.T.T., E.K., N.H.P., G.E.T.), Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease (N.D.B., L.T.D., D.C.G., D.T.M.H., N.H.L.), the Hospital for Tropical Diseases (H.D.T.N., N.T.T., N.H.H.H., P.K.N.O., N.V.V.C.), Pham Ngoc Thach University of Medicine (H.D.T.N.), and the School of Medicine, Vietnam National University of Ho Chi Minh City (N.H.H.H., N.H.P.) - all in Ho Chi Minh City, Vietnam; the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford (J.D., R.B.G., N.T.T.T., E.K., R.L.H., N.H.P., G.E.T.), and London School of Hygiene and Tropical Medicine, London (J.D.) - both in the United Kingdom; and Dr. Cipto Mangunkusumo National Reference Hospital (D.I., K.M., C.P.G., R.E., A.K.), Persahabatan National Respiratory Referral Hospital (E.B.), and Oxford University Clinical Research Unit Indonesia (A.L.S.W., R.L.H.), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Do C Giang
- From the Oxford University Clinical Research Unit (J.D., D.T.T.H., N.T.T.H., L.H.B.N., D.V.T., N.T.T., D.D.A.T., N.T.M.N., R.B.G., N.T.T.T., E.K., N.H.P., G.E.T.), Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease (N.D.B., L.T.D., D.C.G., D.T.M.H., N.H.L.), the Hospital for Tropical Diseases (H.D.T.N., N.T.T., N.H.H.H., P.K.N.O., N.V.V.C.), Pham Ngoc Thach University of Medicine (H.D.T.N.), and the School of Medicine, Vietnam National University of Ho Chi Minh City (N.H.H.H., N.H.P.) - all in Ho Chi Minh City, Vietnam; the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford (J.D., R.B.G., N.T.T.T., E.K., R.L.H., N.H.P., G.E.T.), and London School of Hygiene and Tropical Medicine, London (J.D.) - both in the United Kingdom; and Dr. Cipto Mangunkusumo National Reference Hospital (D.I., K.M., C.P.G., R.E., A.K.), Persahabatan National Respiratory Referral Hospital (E.B.), and Oxford University Clinical Research Unit Indonesia (A.L.S.W., R.L.H.), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Dang T M Ha
- From the Oxford University Clinical Research Unit (J.D., D.T.T.H., N.T.T.H., L.H.B.N., D.V.T., N.T.T., D.D.A.T., N.T.M.N., R.B.G., N.T.T.T., E.K., N.H.P., G.E.T.), Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease (N.D.B., L.T.D., D.C.G., D.T.M.H., N.H.L.), the Hospital for Tropical Diseases (H.D.T.N., N.T.T., N.H.H.H., P.K.N.O., N.V.V.C.), Pham Ngoc Thach University of Medicine (H.D.T.N.), and the School of Medicine, Vietnam National University of Ho Chi Minh City (N.H.H.H., N.H.P.) - all in Ho Chi Minh City, Vietnam; the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford (J.D., R.B.G., N.T.T.T., E.K., R.L.H., N.H.P., G.E.T.), and London School of Hygiene and Tropical Medicine, London (J.D.) - both in the United Kingdom; and Dr. Cipto Mangunkusumo National Reference Hospital (D.I., K.M., C.P.G., R.E., A.K.), Persahabatan National Respiratory Referral Hospital (E.B.), and Oxford University Clinical Research Unit Indonesia (A.L.S.W., R.L.H.), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Nguyen H Lan
- From the Oxford University Clinical Research Unit (J.D., D.T.T.H., N.T.T.H., L.H.B.N., D.V.T., N.T.T., D.D.A.T., N.T.M.N., R.B.G., N.T.T.T., E.K., N.H.P., G.E.T.), Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease (N.D.B., L.T.D., D.C.G., D.T.M.H., N.H.L.), the Hospital for Tropical Diseases (H.D.T.N., N.T.T., N.H.H.H., P.K.N.O., N.V.V.C.), Pham Ngoc Thach University of Medicine (H.D.T.N.), and the School of Medicine, Vietnam National University of Ho Chi Minh City (N.H.H.H., N.H.P.) - all in Ho Chi Minh City, Vietnam; the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford (J.D., R.B.G., N.T.T.T., E.K., R.L.H., N.H.P., G.E.T.), and London School of Hygiene and Tropical Medicine, London (J.D.) - both in the United Kingdom; and Dr. Cipto Mangunkusumo National Reference Hospital (D.I., K.M., C.P.G., R.E., A.K.), Persahabatan National Respiratory Referral Hospital (E.B.), and Oxford University Clinical Research Unit Indonesia (A.L.S.W., R.L.H.), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Nguyen V V Chau
- From the Oxford University Clinical Research Unit (J.D., D.T.T.H., N.T.T.H., L.H.B.N., D.V.T., N.T.T., D.D.A.T., N.T.M.N., R.B.G., N.T.T.T., E.K., N.H.P., G.E.T.), Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease (N.D.B., L.T.D., D.C.G., D.T.M.H., N.H.L.), the Hospital for Tropical Diseases (H.D.T.N., N.T.T., N.H.H.H., P.K.N.O., N.V.V.C.), Pham Ngoc Thach University of Medicine (H.D.T.N.), and the School of Medicine, Vietnam National University of Ho Chi Minh City (N.H.H.H., N.H.P.) - all in Ho Chi Minh City, Vietnam; the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford (J.D., R.B.G., N.T.T.T., E.K., R.L.H., N.H.P., G.E.T.), and London School of Hygiene and Tropical Medicine, London (J.D.) - both in the United Kingdom; and Dr. Cipto Mangunkusumo National Reference Hospital (D.I., K.M., C.P.G., R.E., A.K.), Persahabatan National Respiratory Referral Hospital (E.B.), and Oxford University Clinical Research Unit Indonesia (A.L.S.W., R.L.H.), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Nguyen T M Nguyet
- From the Oxford University Clinical Research Unit (J.D., D.T.T.H., N.T.T.H., L.H.B.N., D.V.T., N.T.T., D.D.A.T., N.T.M.N., R.B.G., N.T.T.T., E.K., N.H.P., G.E.T.), Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease (N.D.B., L.T.D., D.C.G., D.T.M.H., N.H.L.), the Hospital for Tropical Diseases (H.D.T.N., N.T.T., N.H.H.H., P.K.N.O., N.V.V.C.), Pham Ngoc Thach University of Medicine (H.D.T.N.), and the School of Medicine, Vietnam National University of Ho Chi Minh City (N.H.H.H., N.H.P.) - all in Ho Chi Minh City, Vietnam; the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford (J.D., R.B.G., N.T.T.T., E.K., R.L.H., N.H.P., G.E.T.), and London School of Hygiene and Tropical Medicine, London (J.D.) - both in the United Kingdom; and Dr. Cipto Mangunkusumo National Reference Hospital (D.I., K.M., C.P.G., R.E., A.K.), Persahabatan National Respiratory Referral Hospital (E.B.), and Oxford University Clinical Research Unit Indonesia (A.L.S.W., R.L.H.), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ronald B Geskus
- From the Oxford University Clinical Research Unit (J.D., D.T.T.H., N.T.T.H., L.H.B.N., D.V.T., N.T.T., D.D.A.T., N.T.M.N., R.B.G., N.T.T.T., E.K., N.H.P., G.E.T.), Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease (N.D.B., L.T.D., D.C.G., D.T.M.H., N.H.L.), the Hospital for Tropical Diseases (H.D.T.N., N.T.T., N.H.H.H., P.K.N.O., N.V.V.C.), Pham Ngoc Thach University of Medicine (H.D.T.N.), and the School of Medicine, Vietnam National University of Ho Chi Minh City (N.H.H.H., N.H.P.) - all in Ho Chi Minh City, Vietnam; the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford (J.D., R.B.G., N.T.T.T., E.K., R.L.H., N.H.P., G.E.T.), and London School of Hygiene and Tropical Medicine, London (J.D.) - both in the United Kingdom; and Dr. Cipto Mangunkusumo National Reference Hospital (D.I., K.M., C.P.G., R.E., A.K.), Persahabatan National Respiratory Referral Hospital (E.B.), and Oxford University Clinical Research Unit Indonesia (A.L.S.W., R.L.H.), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Nguyen T T Thuong
- From the Oxford University Clinical Research Unit (J.D., D.T.T.H., N.T.T.H., L.H.B.N., D.V.T., N.T.T., D.D.A.T., N.T.M.N., R.B.G., N.T.T.T., E.K., N.H.P., G.E.T.), Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease (N.D.B., L.T.D., D.C.G., D.T.M.H., N.H.L.), the Hospital for Tropical Diseases (H.D.T.N., N.T.T., N.H.H.H., P.K.N.O., N.V.V.C.), Pham Ngoc Thach University of Medicine (H.D.T.N.), and the School of Medicine, Vietnam National University of Ho Chi Minh City (N.H.H.H., N.H.P.) - all in Ho Chi Minh City, Vietnam; the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford (J.D., R.B.G., N.T.T.T., E.K., R.L.H., N.H.P., G.E.T.), and London School of Hygiene and Tropical Medicine, London (J.D.) - both in the United Kingdom; and Dr. Cipto Mangunkusumo National Reference Hospital (D.I., K.M., C.P.G., R.E., A.K.), Persahabatan National Respiratory Referral Hospital (E.B.), and Oxford University Clinical Research Unit Indonesia (A.L.S.W., R.L.H.), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Evelyne Kestelyn
- From the Oxford University Clinical Research Unit (J.D., D.T.T.H., N.T.T.H., L.H.B.N., D.V.T., N.T.T., D.D.A.T., N.T.M.N., R.B.G., N.T.T.T., E.K., N.H.P., G.E.T.), Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease (N.D.B., L.T.D., D.C.G., D.T.M.H., N.H.L.), the Hospital for Tropical Diseases (H.D.T.N., N.T.T., N.H.H.H., P.K.N.O., N.V.V.C.), Pham Ngoc Thach University of Medicine (H.D.T.N.), and the School of Medicine, Vietnam National University of Ho Chi Minh City (N.H.H.H., N.H.P.) - all in Ho Chi Minh City, Vietnam; the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford (J.D., R.B.G., N.T.T.T., E.K., R.L.H., N.H.P., G.E.T.), and London School of Hygiene and Tropical Medicine, London (J.D.) - both in the United Kingdom; and Dr. Cipto Mangunkusumo National Reference Hospital (D.I., K.M., C.P.G., R.E., A.K.), Persahabatan National Respiratory Referral Hospital (E.B.), and Oxford University Clinical Research Unit Indonesia (A.L.S.W., R.L.H.), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Raph L Hamers
- From the Oxford University Clinical Research Unit (J.D., D.T.T.H., N.T.T.H., L.H.B.N., D.V.T., N.T.T., D.D.A.T., N.T.M.N., R.B.G., N.T.T.T., E.K., N.H.P., G.E.T.), Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease (N.D.B., L.T.D., D.C.G., D.T.M.H., N.H.L.), the Hospital for Tropical Diseases (H.D.T.N., N.T.T., N.H.H.H., P.K.N.O., N.V.V.C.), Pham Ngoc Thach University of Medicine (H.D.T.N.), and the School of Medicine, Vietnam National University of Ho Chi Minh City (N.H.H.H., N.H.P.) - all in Ho Chi Minh City, Vietnam; the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford (J.D., R.B.G., N.T.T.T., E.K., R.L.H., N.H.P., G.E.T.), and London School of Hygiene and Tropical Medicine, London (J.D.) - both in the United Kingdom; and Dr. Cipto Mangunkusumo National Reference Hospital (D.I., K.M., C.P.G., R.E., A.K.), Persahabatan National Respiratory Referral Hospital (E.B.), and Oxford University Clinical Research Unit Indonesia (A.L.S.W., R.L.H.), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Nguyen H Phu
- From the Oxford University Clinical Research Unit (J.D., D.T.T.H., N.T.T.H., L.H.B.N., D.V.T., N.T.T., D.D.A.T., N.T.M.N., R.B.G., N.T.T.T., E.K., N.H.P., G.E.T.), Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease (N.D.B., L.T.D., D.C.G., D.T.M.H., N.H.L.), the Hospital for Tropical Diseases (H.D.T.N., N.T.T., N.H.H.H., P.K.N.O., N.V.V.C.), Pham Ngoc Thach University of Medicine (H.D.T.N.), and the School of Medicine, Vietnam National University of Ho Chi Minh City (N.H.H.H., N.H.P.) - all in Ho Chi Minh City, Vietnam; the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford (J.D., R.B.G., N.T.T.T., E.K., R.L.H., N.H.P., G.E.T.), and London School of Hygiene and Tropical Medicine, London (J.D.) - both in the United Kingdom; and Dr. Cipto Mangunkusumo National Reference Hospital (D.I., K.M., C.P.G., R.E., A.K.), Persahabatan National Respiratory Referral Hospital (E.B.), and Oxford University Clinical Research Unit Indonesia (A.L.S.W., R.L.H.), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Guy E Thwaites
- From the Oxford University Clinical Research Unit (J.D., D.T.T.H., N.T.T.H., L.H.B.N., D.V.T., N.T.T., D.D.A.T., N.T.M.N., R.B.G., N.T.T.T., E.K., N.H.P., G.E.T.), Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease (N.D.B., L.T.D., D.C.G., D.T.M.H., N.H.L.), the Hospital for Tropical Diseases (H.D.T.N., N.T.T., N.H.H.H., P.K.N.O., N.V.V.C.), Pham Ngoc Thach University of Medicine (H.D.T.N.), and the School of Medicine, Vietnam National University of Ho Chi Minh City (N.H.H.H., N.H.P.) - all in Ho Chi Minh City, Vietnam; the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford (J.D., R.B.G., N.T.T.T., E.K., R.L.H., N.H.P., G.E.T.), and London School of Hygiene and Tropical Medicine, London (J.D.) - both in the United Kingdom; and Dr. Cipto Mangunkusumo National Reference Hospital (D.I., K.M., C.P.G., R.E., A.K.), Persahabatan National Respiratory Referral Hospital (E.B.), and Oxford University Clinical Research Unit Indonesia (A.L.S.W., R.L.H.), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Burhan E, Liu K, Marwali EM, Huth S, Wulung NGHML, Juzar DA, Taufik MA, Wijaya SO, Wati DK, Kusumastuti NP, Yuliarto S, Pratomo BY, Pradian E, Somasetia DH, Rusmawatiningtyas D, Fatoni AZ, Mandei JM, Lantang EY, Perdhana F, Semedi BP, Rayhan M, Tarigan TRS, White N, Bassi GL, Suen JY, Fraser JF. Characteristics and outcomes of patients with severe COVID-19 in Indonesia: Lessons from the first wave. PLoS One 2023; 18:e0290964. [PMID: 37747884 PMCID: PMC10519602 DOI: 10.1371/journal.pone.0290964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 08/18/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Indonesia's national response to COVID-19 evolved rapidly throughout 2020. Understanding pandemic response and outcomes is crucial for better mitigation strategies ahead. This study describes the characteristics and outcomes of patients admitted to ICU during the early stages of the pandemic. METHODS This is a multi-centre prospective observational study including patients from twelve collaborating hospitals in Indonesia. All patients were clinically suspected or laboratory-confirmed COVID-19 cases admitted to ICU between January 2020 and March 2021. The primary outcome was monthly ICU mortality. Descriptive statistics of patient characteristics and treatment were generated as secondary outcomes. RESULTS From 559 subjects, the overall mortality was 68% and decreased over the study period, while the mortality of patients that received mechanical ventilation was 92%, consistently high over the study period. Fatal cases showed 2- and 4-day delays from symptoms onset to hospital admissions and ICU admissions, respectively. Evidence-backed approaches which could influence patient outcome, such as extracorporeal membrane oxygenation, prone positioning, renal replacement therapy, and neuromuscular blockade were scarcely administered. CONCLUSIONS The mortality rate of COVID-19 patients in Indonesia was extremely high during the first major outbreak of disease, particularly in those mechanically ventilated. Delayed admission and unavailability of evidence-based approaches due to high burden on health facility during COVID-19 crisis could be addressed by efficient public health measures and enhancing health infrastructure to improve the future pandemic response.
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Affiliation(s)
- Erlina Burhan
- Faculty of Medicine, Department of Pulmonology and Respiratory Medicine, Universitas Indonesia and Persahabatan Hospital, Jakarta, Indonesia
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Eva M. Marwali
- Pediatric Cardiac Intensive Care Unit, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Samuel Huth
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | | | - Dafsah A. Juzar
- Departement of Cardiology and Vascular Medicine, Intensive Cardiovascular Care Unit, National Cardiovascular Center Harapan Kita and Universitas Indonesia, Jakarta, Indonesia
| | - Muhammad A. Taufik
- Anesthesiology and Critical Care Department, Fatmawati General Hospital, Jakarta, Indonesia
| | - Surya O. Wijaya
- Intensive Care Unit, Sulianti Saroso Hospital, Jakarta, Indonesia
| | - Dyah K. Wati
- Pediatric Intensive Care Unit, Sanglah Hospital, Denpasar, Bali, Indonesia
| | - Neurinda P. Kusumastuti
- Pediatric Intensive Care Unit, Universitas Airlangga Hospital, Surabaya, East Java, Indonesia
| | - Saptadi Yuliarto
- Pediatric Intensive Care Unit, Saiful Anwar Hospital, Malang, East Java, Indonesia
| | | | - Erwin Pradian
- Intensive Care Unit, Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Dadang H. Somasetia
- Pediatric Intensive Care Unit, Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | | | - Arie Z. Fatoni
- Intensive Care Unit, Saiful Anwar Hospital, Malang, East Java, Indonesia
| | - Jose M. Mandei
- Pediatric Intensive Care Unit, RSUP Prof Dr R. D. Kandou Manado, Indonesia
| | - Eka Y. Lantang
- Intensive Care Unit, RSUP Prof Dr R. D. Kandou Manado, Indonesia
| | - Fajar Perdhana
- Intensive Care Unit, Universitas Airlangga Hospital, Surabaya, East Java, Indonesia
| | | | - Muhammad Rayhan
- Pediatric Cardiac Intensive Care Unit, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Tiffany R. S. Tarigan
- Pediatric Cardiac Intensive Care Unit, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | | | - Gianluigi L. Bassi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Jacky Y. Suen
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - John F. Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Kusmiati T, Burhan E, Sugiyono RI, Arlinda D, Naysilla AM, Wibisono BH, El Khair R, Candrawati NW, Sinaga BYM, Djaharrudin I, Lokida D, Kosasih H, Susanto NH, Butar Butar DP, Adawiyah R, Fatril AE, Karyana M, Denning DW, Wahyuningsih R. The seroprevalence of anti-Histoplasma capsulatum IgG antibody among pulmonary tuberculosis patients in seven referral tuberculosis hospitals in Indonesia. PLoS Negl Trop Dis 2023; 17:e0011575. [PMID: 37729126 PMCID: PMC10511117 DOI: 10.1371/journal.pntd.0011575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/06/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Histoplasma capsulatum exposure is rarely suspected in Indonesia. Pulmonary histoplasmosis can occur simultaneously with pulmonary tuberculosis (TB) or as an alternative diagnosis in clinically-diagnosed TB patients with no microbiological evidence of TB. This study aimed to determine the seroprevalence of anti-H. capsulatum IgG antibody among pulmonary TB patients. METHODOLOGY This was a sub-study of 306 participants from a prospective cohort pulmonary TB study conducted at seven TB referral hospitals in Indonesia. The study population was presumptive pulmonary TB adult patients who underwent microbiological TB examinations and were categorized as drug-sensitive (DS), drug-resistant (DR), and clinically-diagnosed TB. Anti-H. capsulatum IgG antibody levels at baseline were measured using MVista Histoplasma Ab enzyme immunoassays. Data were summarized using descriptive statistics. Bivariate and multivariate logistic regression analysis were performed to assess factors associated with anti-H. capsulatum IgG antibody positive result. RESULTS 12.7% (39/306) of pulmonary TB patients were positive for anti-H. capsulatum IgG antibodies (DR-TB patients (15.9%, 18/114), DS-TB (13.0%, 15/115), and clinically-diagnosed TB (7.8%, 6/77)). The median unit value of anti-H. capsulatum IgG antibody for all positive samples was 15.7 (IQR 10.2-28.9) EU. This median unit value was higher in clinically-diagnosed TB patients compared to DS-TB or DR-TB patients (38.1 (IQR 25.6-46.6) EU, 19.7 (IQR 12.3-28.9) EU, and 10.9 (IQR 9.2-15.4), respectively). There were 10 patients (3.3%) with anti-H. capsulatum IgG antibody levels above 30 EU. Factors associated with the anti-H. capsulatum IgG antibody positive result were malignancies (OR 4.88, 95% CI 1.09-21.69, p = 0.037) and cavitary lesions (OR 2.27, 95% CI 1.09-4.70, p = 0.028). CONCLUSIONS Our results provide evidence of exposure to H. capsulatum among pulmonary TB patients in Indonesia. Further studies are needed to provide a comprehensive picture of this fungal disease in other populations and regions to enhance awareness among clinicians and public health officials.
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Affiliation(s)
- Tutik Kusmiati
- Department of Pulmonology, Soetomo Hospital, Surabaya, Indonesia
| | - Erlina Burhan
- Department of Pulmonology, Persahabatan Hospital, Jakarta, Indonesia
| | - Retna Indah Sugiyono
- Indonesia Clinical Research Center (INA-CRC), Health Policy Agency, Ministry of Health, Jakarta, Indonesia
| | - Dona Arlinda
- Indonesia Clinical Research Center (INA-CRC), Health Policy Agency, Ministry of Health, Jakarta, Indonesia
| | - Adhella Menur Naysilla
- Indonesia Clinical Research Center (INA-CRC), Health Policy Agency, Ministry of Health, Jakarta, Indonesia
| | | | - Riat El Khair
- Department of Clinical Pathology and Laboratory Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Sardjito Hospital, Yogyakarta, Indonesia
| | - Ni Wayan Candrawati
- Department of Pulmonology, Faculty of Medicine, Universitas Udayana, Prof. IGNG. Ngoerah General Hospital, Bali, Indonesia
| | | | - Irawaty Djaharrudin
- Department of Pulmonology, Faculty of Medicine, Universitas Hasanuddin, Wahidin Sudirohussodo Hospital, Makassar, Indonesia
| | - Dewi Lokida
- Department of Clinical Pathology, Tangerang District Hospital, Banten, Indonesia
| | - Herman Kosasih
- Indonesia Clinical Research Center (INA-CRC), Health Policy Agency, Ministry of Health, Jakarta, Indonesia
| | - Nugroho Harry Susanto
- Indonesia Clinical Research Center (INA-CRC), Health Policy Agency, Ministry of Health, Jakarta, Indonesia
| | - Deni Pepy Butar Butar
- Indonesia Clinical Research Center (INA-CRC), Health Policy Agency, Ministry of Health, Jakarta, Indonesia
| | - Robiatul Adawiyah
- Department of Parasitology, Universitas Indonesia, Jakarta, Indonesia
| | - Ayu Eka Fatril
- Department of Parasitology, Universitas Indonesia, Jakarta, Indonesia
| | - Muhammad Karyana
- Indonesia Clinical Research Center (INA-CRC), Health Policy Agency, Ministry of Health, Jakarta, Indonesia
| | - David W. Denning
- Manchester Fungal Infection Group, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Retno Wahyuningsih
- Department of Parasitology, Universitas Indonesia, Jakarta, Indonesia
- Department of Parasitology, Faculty of Medicine, Universitas Kristen Indonesia, Jakarta, Indonesia
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5
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Wiyarta E, Nugraha DA, Ramadani MI, Gustya GF, Ammar MF, Edwar HD, Kheirizzad N, Mukhlisah MN, Burhan E, Syahruddin E. Clinical utility and diagnostic value of tumor-educated platelets in lung cancer: a systematic review and meta-analysis. Front Oncol 2023; 13:1201713. [PMID: 37564936 PMCID: PMC10410284 DOI: 10.3389/fonc.2023.1201713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/12/2023] [Indexed: 08/12/2023] Open
Abstract
Background The review addresses the knowledge gap concerning the diagnostic value and clinical utility of tumor-educated platelets (TEPs) in adult patients with lung cancer. Methods We searched twelve databases: PubMed, CENTRAL, EMBASE, CINAHL, MEDLINE, Scopus, ProQuest, MedRxiv, BioRxiv, SSRN, Clinicaltrials.gov, and CNKI up to 24 March 2023, to include any diagnostic study regarding TEPs and LC. TEPs diagnostic value was evaluated from pooled sensitivity and specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and the area under the curve (AUC). QUADAS 2 was used to assess the risk of bias. Heterogeneity analysis was assessed using the receiver operating characteristic (ROC) plane, Galbraith plot, bivariate boxplot, sensitivity analysis, and meta-regression. TEPs clinical utility was evaluated from Fagan's nomogram. Results 44 reports from 10 studies, including 7,858 events and 6,632 controls, were analyzed. The pooled sensitivity, specificity, PLR, NLR, and DOR were 0.80 (95% CI 0.79-0.80), 0.69 (95% CI 0.69-0.70), 2.92 (95% CI 2.50-3.41), 0.26 (95% CI 0.21-0.32), and 12.1 (95% CI 8.61-16.76), respectively. In addition, the AUC of the Summary ROC curve was 0.85 (95% CI: 0.81-0.88). The overall risk of bias was low. Heterogeneity may result from cancer stage, cancer control, measuring equipment, and RNA types across studies. There was no apparent publication bias (p=0.29) with significant positive (79%) and negative (22%) post-test probability, according to Deeks funnel plot asymmetry test and Fagan's nomogram. Conclusion TEPs could be a moderately effective candidate biomarker for LC diagnosis.
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Affiliation(s)
- Elvan Wiyarta
- Respiratory and Tuberculosis Research and Training Center (SATURATE), Faculty of Medicine, Persahabatan National Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Darrin Ananda Nugraha
- Respiratory and Tuberculosis Research and Training Center (SATURATE), Faculty of Medicine, Persahabatan National Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Muhammad Indera Ramadani
- Respiratory and Tuberculosis Research and Training Center (SATURATE), Faculty of Medicine, Persahabatan National Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Gita Fajri Gustya
- Respiratory and Tuberculosis Research and Training Center (SATURATE), Faculty of Medicine, Persahabatan National Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Muhammad Farrasy Ammar
- Respiratory and Tuberculosis Research and Training Center (SATURATE), Faculty of Medicine, Persahabatan National Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Hana Dzakira Edwar
- Respiratory and Tuberculosis Research and Training Center (SATURATE), Faculty of Medicine, Persahabatan National Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Nildza Kheirizzad
- Respiratory and Tuberculosis Research and Training Center (SATURATE), Faculty of Medicine, Persahabatan National Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Mutiah Nurul Mukhlisah
- Respiratory and Tuberculosis Research and Training Center (SATURATE), Faculty of Medicine, Persahabatan National Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Erlina Burhan
- Infection Division, Department of Pulmonology, Faculty of Medicine, Universitas Indonesia, Persahabatan National Hospital, Jakarta, Indonesia
| | - Elisna Syahruddin
- Oncology Division, Department of Pulmonology, Faculty of Medicine, Universitas Indonesia, Persahabatan National Hospital, Jakarta, Indonesia
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6
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Burhan E, Syahruddin E, Isbaniah F, Desianti GA, Fachrucha F, Sari CYI, Ismail E, Astuti P, Maruli MF, Mubarak F, Rengganis AT, Bilqis HH, Taslim I, Sastria E, Wiyarta E. Evaluation of safety and effectiveness of remdesivir in treating COVID-19 patients after emergency use authorization study. Front Pharmacol 2023; 14:1205238. [PMID: 37456740 PMCID: PMC10347402 DOI: 10.3389/fphar.2023.1205238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023] Open
Abstract
Background: This study aimed to determine the real-world safety and effectiveness of remdesivir in hospitalized adult COVID-19 patients with moderate-to-critical disease in Indonesia. Methods: A multicenter, retrospective cohort study was conducted at four COVID-19 referral hospitals in Jakarta. A total of 587 patients were included, of whom 243 received remdesivir within 72 h of admission. The safety endpoints were the proportions of patients with any adverse event (AE), any grade 3 AE, and AE of each system organ class. The effectiveness endpoints were ICU admission >24 h from baseline, live discharge and mortality at day 14, live discharge and mortality at day 28, and virologic conversion. Patients who received remdesivir within 72 h of admission were considered the treatment group, and those who did not were the control group. Multivariate adjustments were performed using a modified Poisson regression. Results: The study found no significant differences in safety endpoints between the two groups. However, the effectiveness endpoints showed that remdesivir was associated with a decreased risk of ICU admission >24 h from baseline (RR 0.71, 95% CI 0.52-0.96), an increased probability of live discharge at day 14 (RR 1.37, 95% CI 1.08-1.74), and an increased probability of live discharge at day 28 (RR 1.28, 95% CI 1.05-1.57). The rate of virologic conversion was not significantly different between the two groups. Conclusion: The study concludes that remdesivir is safe and effective in the treatment of moderate-to-critical COVID-19 in a real-world setting in Indonesia.
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Affiliation(s)
- Erlina Burhan
- Department of Pulmonology and Respiratory Medicine, Persahabatan Central General Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Elisna Syahruddin
- Department of Pulmonology and Respiratory Medicine, Persahabatan Central General Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Fathiyah Isbaniah
- Department of Pulmonology and Respiratory Medicine, Persahabatan Central General Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Ginanjar Arum Desianti
- Department of Pulmonology and Respiratory Medicine, Persahabatan Central General Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Fanny Fachrucha
- Department of Pulmonology and Respiratory Medicine, Persahabatan Central General Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Cut Yulia Indah Sari
- Department of Pulmonology, Jakarta Islam Hospital Cempaka Putih, Jakarta, Indonesia
| | - Efriadi Ismail
- Department of Pulmonology and Respiratory Medicine, Persahabatan Central General Hospital, Universitas Indonesia, Jakarta, Indonesia
- Department of Pulmonology, Yarsi Hospital, Jakarta, Indonesia
| | - Puji Astuti
- Department of Pulmonology, Cengkareng District General Hospital, Jakarta, Indonesia
| | - Muhammad Farhan Maruli
- Department of Pulmonology and Respiratory Medicine, Persahabatan Central General Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Farhan Mubarak
- Department of Pulmonology and Respiratory Medicine, Persahabatan Central General Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Anggit Tresna Rengganis
- Department of Pulmonology and Respiratory Medicine, Persahabatan Central General Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Hazia Hanifa Bilqis
- Department of Pulmonology and Respiratory Medicine, Persahabatan Central General Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Imammurahman Taslim
- Department of Pulmonology and Respiratory Medicine, Persahabatan Central General Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Evan Sastria
- General Practitioner, Yarsi Hospital, Jakarta, Indonesia
| | - Elvan Wiyarta
- Department of Medical Science, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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7
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Burhan E, Mubarak F, Adilah SASU, Sari CYI, Ismail E, Astuti P, Hanifah Y, Wiyarta E, Suryana NM. Association between cardiovascular diseases and COVID-19 pneumonia outcome in Indonesia: a multi-center cohort study. Front Med (Lausanne) 2023; 10:1190148. [PMID: 37457562 PMCID: PMC10339801 DOI: 10.3389/fmed.2023.1190148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
Background COVID-19 is a pandemic affecting 185 countries, including Indonesia. Cardiovascular diseases (CVD) in COVID-19 patients were linked to worse clinical outcomes. However, the association remained inconclusive due to limited data in Indonesia. This study aimed to determine the association between CVD in COVID-19 pneumonia patients with its clinical outcomes. Methods This retrospective cohort study was conducted in four Indonesian hospitals, enrolling 584 adult COVID-19 pneumonia patients from September 2020 to July 2021. Patients were categorized into two groups: non-CVD and CVD [hypertension, coronary artery disease (CAD), chronic heart failure (CHF), hypertensive heart disease (HHD), arrhythmia, cardiomegaly, left ventricular hypertrophy (LVH), mitral regurgitation (MR), and myocardial injury (MI)]. Clinical outcomes include in-hospital mortality, intensive care unit admission, ventilator use, earlier death, and prolonged hospital stay. Mann-Whitney test was used for analysis. Results The most common CVD was hypertension (48.1%), followed by MI (10.6%), CAD (9.2%), CHF (6.8%), HHD (3.1%), arrhythmia (1.7%), and others (0.7%). The in-hospital mortality rate was 24%, and patients were hospitalized for a median of 12 days. MI was the only CVD that increased in-hospital mortality (RR 2.105). It was also significantly increased in patients with diabetes mellitus (RR 1.475) and chronic kidney disease (RR 2.079). Meanwhile, prolonged hospital stay was associated with any CVD (RR 1.553), hypertension (RR 1.511), MI (RR 1.969), CHF (RR 1.595), diabetes mellitus (RR 1.359), and cerebrovascular disease (RR 2.203). Conclusion COVID-19 pneumonia in patients with CVD, specifically MI and hypertension, worsens the COVID-19 clinical outcomes.
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Affiliation(s)
- Erlina Burhan
- Department of Pulmonology and Respiratory Medicine, Persahabatan Central General Hospital, Universitas Indonesia, Jakarta, Indonesia
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Farhan Mubarak
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | | | - Cut Yulia Indah Sari
- Department of Pulmonology, Jakarta Islam Hospital Cempaka Putih, Jakarta, Indonesia
| | - Efriadi Ismail
- Department of Pulmonology, Yarsi Hospital, Jakarta, Indonesia
| | - Puji Astuti
- Department of Pulmonology, Cengkareng District General Hospital, Jakarta, Indonesia
| | - Yasmina Hanifah
- Department of Cardiology and Vascular Medicine, Persahabatan Central General Hospital, Jakarta, Indonesia
| | - Elvan Wiyarta
- Department of Medical Science, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Nana Maya Suryana
- Department of Cardiology and Vascular Medicine, Persahabatan Central General Hospital, Jakarta, Indonesia
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8
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Rich ML, Khan U, Zeng C, LaHood A, Franke MF, Atwood S, Bastard M, Burhan E, Danielyan N, Dzhazibekova PM, Gadissa D, Ghafoor A, Hewison C, Islam MS, Kazmi E, Khan PY, Lecca L, Maama LB, Melikyan N, Naing YY, Philippe K, Saki NA, Seung KJ, Skrahina A, Tefera GB, Varaine F, Vilbrun SC, Võ L, Mitnick CD, Huerga H. Outcomes of WHO-conforming, longer, all-oral multidrug-resistant TB regimens and analysis implications. Int J Tuberc Lung Dis 2023; 27:451-457. [PMID: 37231598 PMCID: PMC10237267 DOI: 10.5588/ijtld.22.0613] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/02/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND: Evidence of the effectiveness of the WHO-recommended design of longer individualized regimens for multidrug- or rifampicin-resistant TB (MDR/RR-TB) is limited.OBJECTIVES: To report end-of-treatment outcomes for MDR/RR-TB patients from a 2015-2018 multi-country cohort that received a regimen consistent with current 2022 WHO updated recommendations and describe the complexities of comparing regimens.METHODS: We analyzed a subset of participants from the endTB Observational Study who initiated a longer MDR/RR-TB regimen that was consistent with subsequent 2022 WHO guidance on regimen design for longer treatments. We excluded individuals who received an injectable agent or who received fewer than four likely effective drugs.RESULTS: Of the 759 participants analyzed, 607 (80.0%, 95% CI 77.0-82.7) experienced successful end-of-treatment outcomes. The frequency of success was high across groups, whether stratified on number of Group A drugs or fluoroquinolone resistance, and ranged from 72.1% to 90.0%. Regimens were highly variable regarding composition and the duration of individual drugs.CONCLUSIONS: Longer, all-oral, individualized regimens that were consistent with 2022 WHO guidance on regimen design had high frequencies of treatment success. Heterogeneous regimen compositions and drug durations precluded meaningful comparisons. Future research should examine which combinations of drugs maximize safety/tolerability and effectiveness.
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Affiliation(s)
- M L Rich
- Division of Global Health Equity, Brigham and Women´s Hospital, Boston, MA, Partners In Health, Boston, MA, USA
| | - U Khan
- Interactive Research & Development Global, Singapore, Singapore
| | - C Zeng
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - A LaHood
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - M F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - S Atwood
- Division of Global Health Equity, Brigham and Women´s Hospital, Boston, MA
| | | | - E Burhan
- Persahabatan General Hospital, Jakarta, Indonesia
| | - N Danielyan
- Médecins Sans Frontières (MSF), Tbilisi, Georgia
| | | | - D Gadissa
- Partners In Health (PIH), Addis Ababa, Ethiopia
| | - A Ghafoor
- National Tuberculosis Programme (NTP), Ministry of National Health, Islamabad, Pakistan
| | | | - M S Islam
- Interactive Research & Development, Dhaka, Bangladesh
| | - E Kazmi
- Directorate General Health Services, Centers for Disease Control and Prevention, Sindh, Pakistan
| | - P Y Khan
- Partners In Health, Boston, MA, USA, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - L Lecca
- Socios En Salud Sucursal, Lima, Peru
| | - L B Maama
- PIH, Maseru, Lesotho, NTP, Maseru, Lesotho
| | - N Melikyan
- Epicentre, Paris, France, MSF, Yerevan, Armenia
| | | | | | - N A Saki
- World Health Organization, Country Office, Dhaka, Bangladesh
| | - K J Seung
- Division of Global Health Equity, Brigham and Women´s Hospital, Boston, MA, Partners In Health, Boston, MA, USA
| | | | - G B Tefera
- Partners In Health (PIH), Addis Ababa, Ethiopia
| | | | - S C Vilbrun
- GHESKIO Institute of Infectious Diseases and Reproductive Health, NTP, Port-au-Prince, Haiti
| | - L Võ
- Friends for International TB Relief, Ho Chi Minh City, Vietnam
| | - C D Mitnick
- Division of Global Health Equity, Brigham and Women´s Hospital, Boston, MA, Partners In Health, Boston, MA, USA, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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9
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Paton NI, Cousins C, Suresh C, Burhan E, Chew KL, Dalay VB, Lu Q, Kusmiati T, Balanag VM, Lee SL, Ruslami R, Pokharkar Y, Djaharuddin I, Sugiri JJR, Veto RS, Sekaggya-Wiltshire C, Avihingsanon A, Sarin R, Papineni P, Nunn AJ, Crook AM. Treatment Strategy for Rifampin-Susceptible Tuberculosis. N Engl J Med 2023; 388:873-887. [PMID: 36808186 DOI: 10.1056/nejmoa2212537] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND Tuberculosis is usually treated with a 6-month rifampin-based regimen. Whether a strategy involving shorter initial treatment may lead to similar outcomes is unclear. METHODS In this adaptive, open-label, noninferiority trial, we randomly assigned participants with rifampin-susceptible pulmonary tuberculosis to undergo either standard treatment (rifampin and isoniazid for 24 weeks with pyrazinamide and ethambutol for the first 8 weeks) or a strategy involving initial treatment with an 8-week regimen, extended treatment for persistent clinical disease, monitoring after treatment, and retreatment for relapse. There were four strategy groups with different initial regimens; noninferiority was assessed in the two strategy groups with complete enrollment, which had initial regimens of high-dose rifampin-linezolid and bedaquiline-linezolid (each with isoniazid, pyrazinamide, and ethambutol). The primary outcome was a composite of death, ongoing treatment, or active disease at week 96. The noninferiority margin was 12 percentage points. RESULTS Of the 674 participants in the intention-to-treat population, 4 (0.6%) withdrew consent or were lost to follow-up. A primary-outcome event occurred in 7 of the 181 participants (3.9%) in the standard-treatment group, as compared with 21 of the 184 participants (11.4%) in the strategy group with an initial rifampin-linezolid regimen (adjusted difference, 7.4 percentage points; 97.5% confidence interval [CI], 1.7 to 13.2; noninferiority not met) and 11 of the 189 participants (5.8%) in the strategy group with an initial bedaquiline-linezolid regimen (adjusted difference, 0.8 percentage points; 97.5% CI, -3.4 to 5.1; noninferiority met). The mean total duration of treatment was 180 days in the standard-treatment group, 106 days in the rifampin-linezolid strategy group, and 85 days in the bedaquiline-linezolid strategy group. The incidences of grade 3 or 4 adverse events and serious adverse events were similar in the three groups. CONCLUSIONS A strategy involving initial treatment with an 8-week bedaquiline-linezolid regimen was noninferior to standard treatment for tuberculosis with respect to clinical outcomes. The strategy was associated with a shorter total duration of treatment and with no evident safety concerns. (Funded by the Singapore National Medical Research Council and others; TRUNCATE-TB ClinicalTrials.gov number, NCT03474198.).
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Affiliation(s)
- Nicholas I Paton
- From the Infectious Diseases Translational Research Programme and Yong Loo Lin School of Medicine, National University of Singapore (N.I.P., C.C., C.S., P.P.), National University Hospital (K.L.C.), and Singapore Clinical Research Institute (Q.L., S.L.L., Y.P.) - all in Singapore; the Faculty of Medicine, Universitas Indonesia, and Persahabatan General Hospital, Jakarta (E.B.), Dr. Soetomo Hospital, Surabaya (T.K.), Universitas Padjadjaran, Bandung (R.R.), Dr. Wahidin Sudirohusodo Hospital, Makassar (I.D.), and Saiful Anwar Hospital, Malang (J.J.R.S.) - all in Indonesia; De La Salle Medical and Health Sciences Institute, Cavite (V.B.D.), the Lung Centre of the Philippines, Quezon City (V.M.B.), and the Tropical Disease Foundation, Makati (R.S.V.) - all in the Philippines; the Infectious Diseases Institute, Makerere University, Kampala, Uganda (C.S.-W.); HIV-NAT, Thai Red Cross AIDS Research Center and Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (A.A.); the National Institute of TB and Respiratory Diseases, New Delhi, India (R.S.); and the London School of Hygiene and Tropical Medicine (N.I.P.) and the Medical Research Council Clinical Trials Unit at University College London (N.I.P., A.J.N., A.M.C.) - both in London
| | - Christopher Cousins
- From the Infectious Diseases Translational Research Programme and Yong Loo Lin School of Medicine, National University of Singapore (N.I.P., C.C., C.S., P.P.), National University Hospital (K.L.C.), and Singapore Clinical Research Institute (Q.L., S.L.L., Y.P.) - all in Singapore; the Faculty of Medicine, Universitas Indonesia, and Persahabatan General Hospital, Jakarta (E.B.), Dr. Soetomo Hospital, Surabaya (T.K.), Universitas Padjadjaran, Bandung (R.R.), Dr. Wahidin Sudirohusodo Hospital, Makassar (I.D.), and Saiful Anwar Hospital, Malang (J.J.R.S.) - all in Indonesia; De La Salle Medical and Health Sciences Institute, Cavite (V.B.D.), the Lung Centre of the Philippines, Quezon City (V.M.B.), and the Tropical Disease Foundation, Makati (R.S.V.) - all in the Philippines; the Infectious Diseases Institute, Makerere University, Kampala, Uganda (C.S.-W.); HIV-NAT, Thai Red Cross AIDS Research Center and Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (A.A.); the National Institute of TB and Respiratory Diseases, New Delhi, India (R.S.); and the London School of Hygiene and Tropical Medicine (N.I.P.) and the Medical Research Council Clinical Trials Unit at University College London (N.I.P., A.J.N., A.M.C.) - both in London
| | - Celina Suresh
- From the Infectious Diseases Translational Research Programme and Yong Loo Lin School of Medicine, National University of Singapore (N.I.P., C.C., C.S., P.P.), National University Hospital (K.L.C.), and Singapore Clinical Research Institute (Q.L., S.L.L., Y.P.) - all in Singapore; the Faculty of Medicine, Universitas Indonesia, and Persahabatan General Hospital, Jakarta (E.B.), Dr. Soetomo Hospital, Surabaya (T.K.), Universitas Padjadjaran, Bandung (R.R.), Dr. Wahidin Sudirohusodo Hospital, Makassar (I.D.), and Saiful Anwar Hospital, Malang (J.J.R.S.) - all in Indonesia; De La Salle Medical and Health Sciences Institute, Cavite (V.B.D.), the Lung Centre of the Philippines, Quezon City (V.M.B.), and the Tropical Disease Foundation, Makati (R.S.V.) - all in the Philippines; the Infectious Diseases Institute, Makerere University, Kampala, Uganda (C.S.-W.); HIV-NAT, Thai Red Cross AIDS Research Center and Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (A.A.); the National Institute of TB and Respiratory Diseases, New Delhi, India (R.S.); and the London School of Hygiene and Tropical Medicine (N.I.P.) and the Medical Research Council Clinical Trials Unit at University College London (N.I.P., A.J.N., A.M.C.) - both in London
| | - Erlina Burhan
- From the Infectious Diseases Translational Research Programme and Yong Loo Lin School of Medicine, National University of Singapore (N.I.P., C.C., C.S., P.P.), National University Hospital (K.L.C.), and Singapore Clinical Research Institute (Q.L., S.L.L., Y.P.) - all in Singapore; the Faculty of Medicine, Universitas Indonesia, and Persahabatan General Hospital, Jakarta (E.B.), Dr. Soetomo Hospital, Surabaya (T.K.), Universitas Padjadjaran, Bandung (R.R.), Dr. Wahidin Sudirohusodo Hospital, Makassar (I.D.), and Saiful Anwar Hospital, Malang (J.J.R.S.) - all in Indonesia; De La Salle Medical and Health Sciences Institute, Cavite (V.B.D.), the Lung Centre of the Philippines, Quezon City (V.M.B.), and the Tropical Disease Foundation, Makati (R.S.V.) - all in the Philippines; the Infectious Diseases Institute, Makerere University, Kampala, Uganda (C.S.-W.); HIV-NAT, Thai Red Cross AIDS Research Center and Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (A.A.); the National Institute of TB and Respiratory Diseases, New Delhi, India (R.S.); and the London School of Hygiene and Tropical Medicine (N.I.P.) and the Medical Research Council Clinical Trials Unit at University College London (N.I.P., A.J.N., A.M.C.) - both in London
| | - Ka Lip Chew
- From the Infectious Diseases Translational Research Programme and Yong Loo Lin School of Medicine, National University of Singapore (N.I.P., C.C., C.S., P.P.), National University Hospital (K.L.C.), and Singapore Clinical Research Institute (Q.L., S.L.L., Y.P.) - all in Singapore; the Faculty of Medicine, Universitas Indonesia, and Persahabatan General Hospital, Jakarta (E.B.), Dr. Soetomo Hospital, Surabaya (T.K.), Universitas Padjadjaran, Bandung (R.R.), Dr. Wahidin Sudirohusodo Hospital, Makassar (I.D.), and Saiful Anwar Hospital, Malang (J.J.R.S.) - all in Indonesia; De La Salle Medical and Health Sciences Institute, Cavite (V.B.D.), the Lung Centre of the Philippines, Quezon City (V.M.B.), and the Tropical Disease Foundation, Makati (R.S.V.) - all in the Philippines; the Infectious Diseases Institute, Makerere University, Kampala, Uganda (C.S.-W.); HIV-NAT, Thai Red Cross AIDS Research Center and Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (A.A.); the National Institute of TB and Respiratory Diseases, New Delhi, India (R.S.); and the London School of Hygiene and Tropical Medicine (N.I.P.) and the Medical Research Council Clinical Trials Unit at University College London (N.I.P., A.J.N., A.M.C.) - both in London
| | - Victoria B Dalay
- From the Infectious Diseases Translational Research Programme and Yong Loo Lin School of Medicine, National University of Singapore (N.I.P., C.C., C.S., P.P.), National University Hospital (K.L.C.), and Singapore Clinical Research Institute (Q.L., S.L.L., Y.P.) - all in Singapore; the Faculty of Medicine, Universitas Indonesia, and Persahabatan General Hospital, Jakarta (E.B.), Dr. Soetomo Hospital, Surabaya (T.K.), Universitas Padjadjaran, Bandung (R.R.), Dr. Wahidin Sudirohusodo Hospital, Makassar (I.D.), and Saiful Anwar Hospital, Malang (J.J.R.S.) - all in Indonesia; De La Salle Medical and Health Sciences Institute, Cavite (V.B.D.), the Lung Centre of the Philippines, Quezon City (V.M.B.), and the Tropical Disease Foundation, Makati (R.S.V.) - all in the Philippines; the Infectious Diseases Institute, Makerere University, Kampala, Uganda (C.S.-W.); HIV-NAT, Thai Red Cross AIDS Research Center and Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (A.A.); the National Institute of TB and Respiratory Diseases, New Delhi, India (R.S.); and the London School of Hygiene and Tropical Medicine (N.I.P.) and the Medical Research Council Clinical Trials Unit at University College London (N.I.P., A.J.N., A.M.C.) - both in London
| | - Qingshu Lu
- From the Infectious Diseases Translational Research Programme and Yong Loo Lin School of Medicine, National University of Singapore (N.I.P., C.C., C.S., P.P.), National University Hospital (K.L.C.), and Singapore Clinical Research Institute (Q.L., S.L.L., Y.P.) - all in Singapore; the Faculty of Medicine, Universitas Indonesia, and Persahabatan General Hospital, Jakarta (E.B.), Dr. Soetomo Hospital, Surabaya (T.K.), Universitas Padjadjaran, Bandung (R.R.), Dr. Wahidin Sudirohusodo Hospital, Makassar (I.D.), and Saiful Anwar Hospital, Malang (J.J.R.S.) - all in Indonesia; De La Salle Medical and Health Sciences Institute, Cavite (V.B.D.), the Lung Centre of the Philippines, Quezon City (V.M.B.), and the Tropical Disease Foundation, Makati (R.S.V.) - all in the Philippines; the Infectious Diseases Institute, Makerere University, Kampala, Uganda (C.S.-W.); HIV-NAT, Thai Red Cross AIDS Research Center and Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (A.A.); the National Institute of TB and Respiratory Diseases, New Delhi, India (R.S.); and the London School of Hygiene and Tropical Medicine (N.I.P.) and the Medical Research Council Clinical Trials Unit at University College London (N.I.P., A.J.N., A.M.C.) - both in London
| | - Tutik Kusmiati
- From the Infectious Diseases Translational Research Programme and Yong Loo Lin School of Medicine, National University of Singapore (N.I.P., C.C., C.S., P.P.), National University Hospital (K.L.C.), and Singapore Clinical Research Institute (Q.L., S.L.L., Y.P.) - all in Singapore; the Faculty of Medicine, Universitas Indonesia, and Persahabatan General Hospital, Jakarta (E.B.), Dr. Soetomo Hospital, Surabaya (T.K.), Universitas Padjadjaran, Bandung (R.R.), Dr. Wahidin Sudirohusodo Hospital, Makassar (I.D.), and Saiful Anwar Hospital, Malang (J.J.R.S.) - all in Indonesia; De La Salle Medical and Health Sciences Institute, Cavite (V.B.D.), the Lung Centre of the Philippines, Quezon City (V.M.B.), and the Tropical Disease Foundation, Makati (R.S.V.) - all in the Philippines; the Infectious Diseases Institute, Makerere University, Kampala, Uganda (C.S.-W.); HIV-NAT, Thai Red Cross AIDS Research Center and Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (A.A.); the National Institute of TB and Respiratory Diseases, New Delhi, India (R.S.); and the London School of Hygiene and Tropical Medicine (N.I.P.) and the Medical Research Council Clinical Trials Unit at University College London (N.I.P., A.J.N., A.M.C.) - both in London
| | - Vincent M Balanag
- From the Infectious Diseases Translational Research Programme and Yong Loo Lin School of Medicine, National University of Singapore (N.I.P., C.C., C.S., P.P.), National University Hospital (K.L.C.), and Singapore Clinical Research Institute (Q.L., S.L.L., Y.P.) - all in Singapore; the Faculty of Medicine, Universitas Indonesia, and Persahabatan General Hospital, Jakarta (E.B.), Dr. Soetomo Hospital, Surabaya (T.K.), Universitas Padjadjaran, Bandung (R.R.), Dr. Wahidin Sudirohusodo Hospital, Makassar (I.D.), and Saiful Anwar Hospital, Malang (J.J.R.S.) - all in Indonesia; De La Salle Medical and Health Sciences Institute, Cavite (V.B.D.), the Lung Centre of the Philippines, Quezon City (V.M.B.), and the Tropical Disease Foundation, Makati (R.S.V.) - all in the Philippines; the Infectious Diseases Institute, Makerere University, Kampala, Uganda (C.S.-W.); HIV-NAT, Thai Red Cross AIDS Research Center and Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (A.A.); the National Institute of TB and Respiratory Diseases, New Delhi, India (R.S.); and the London School of Hygiene and Tropical Medicine (N.I.P.) and the Medical Research Council Clinical Trials Unit at University College London (N.I.P., A.J.N., A.M.C.) - both in London
| | - Shu Ling Lee
- From the Infectious Diseases Translational Research Programme and Yong Loo Lin School of Medicine, National University of Singapore (N.I.P., C.C., C.S., P.P.), National University Hospital (K.L.C.), and Singapore Clinical Research Institute (Q.L., S.L.L., Y.P.) - all in Singapore; the Faculty of Medicine, Universitas Indonesia, and Persahabatan General Hospital, Jakarta (E.B.), Dr. Soetomo Hospital, Surabaya (T.K.), Universitas Padjadjaran, Bandung (R.R.), Dr. Wahidin Sudirohusodo Hospital, Makassar (I.D.), and Saiful Anwar Hospital, Malang (J.J.R.S.) - all in Indonesia; De La Salle Medical and Health Sciences Institute, Cavite (V.B.D.), the Lung Centre of the Philippines, Quezon City (V.M.B.), and the Tropical Disease Foundation, Makati (R.S.V.) - all in the Philippines; the Infectious Diseases Institute, Makerere University, Kampala, Uganda (C.S.-W.); HIV-NAT, Thai Red Cross AIDS Research Center and Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (A.A.); the National Institute of TB and Respiratory Diseases, New Delhi, India (R.S.); and the London School of Hygiene and Tropical Medicine (N.I.P.) and the Medical Research Council Clinical Trials Unit at University College London (N.I.P., A.J.N., A.M.C.) - both in London
| | - Rovina Ruslami
- From the Infectious Diseases Translational Research Programme and Yong Loo Lin School of Medicine, National University of Singapore (N.I.P., C.C., C.S., P.P.), National University Hospital (K.L.C.), and Singapore Clinical Research Institute (Q.L., S.L.L., Y.P.) - all in Singapore; the Faculty of Medicine, Universitas Indonesia, and Persahabatan General Hospital, Jakarta (E.B.), Dr. Soetomo Hospital, Surabaya (T.K.), Universitas Padjadjaran, Bandung (R.R.), Dr. Wahidin Sudirohusodo Hospital, Makassar (I.D.), and Saiful Anwar Hospital, Malang (J.J.R.S.) - all in Indonesia; De La Salle Medical and Health Sciences Institute, Cavite (V.B.D.), the Lung Centre of the Philippines, Quezon City (V.M.B.), and the Tropical Disease Foundation, Makati (R.S.V.) - all in the Philippines; the Infectious Diseases Institute, Makerere University, Kampala, Uganda (C.S.-W.); HIV-NAT, Thai Red Cross AIDS Research Center and Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (A.A.); the National Institute of TB and Respiratory Diseases, New Delhi, India (R.S.); and the London School of Hygiene and Tropical Medicine (N.I.P.) and the Medical Research Council Clinical Trials Unit at University College London (N.I.P., A.J.N., A.M.C.) - both in London
| | - Yogesh Pokharkar
- From the Infectious Diseases Translational Research Programme and Yong Loo Lin School of Medicine, National University of Singapore (N.I.P., C.C., C.S., P.P.), National University Hospital (K.L.C.), and Singapore Clinical Research Institute (Q.L., S.L.L., Y.P.) - all in Singapore; the Faculty of Medicine, Universitas Indonesia, and Persahabatan General Hospital, Jakarta (E.B.), Dr. Soetomo Hospital, Surabaya (T.K.), Universitas Padjadjaran, Bandung (R.R.), Dr. Wahidin Sudirohusodo Hospital, Makassar (I.D.), and Saiful Anwar Hospital, Malang (J.J.R.S.) - all in Indonesia; De La Salle Medical and Health Sciences Institute, Cavite (V.B.D.), the Lung Centre of the Philippines, Quezon City (V.M.B.), and the Tropical Disease Foundation, Makati (R.S.V.) - all in the Philippines; the Infectious Diseases Institute, Makerere University, Kampala, Uganda (C.S.-W.); HIV-NAT, Thai Red Cross AIDS Research Center and Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (A.A.); the National Institute of TB and Respiratory Diseases, New Delhi, India (R.S.); and the London School of Hygiene and Tropical Medicine (N.I.P.) and the Medical Research Council Clinical Trials Unit at University College London (N.I.P., A.J.N., A.M.C.) - both in London
| | - Irawaty Djaharuddin
- From the Infectious Diseases Translational Research Programme and Yong Loo Lin School of Medicine, National University of Singapore (N.I.P., C.C., C.S., P.P.), National University Hospital (K.L.C.), and Singapore Clinical Research Institute (Q.L., S.L.L., Y.P.) - all in Singapore; the Faculty of Medicine, Universitas Indonesia, and Persahabatan General Hospital, Jakarta (E.B.), Dr. Soetomo Hospital, Surabaya (T.K.), Universitas Padjadjaran, Bandung (R.R.), Dr. Wahidin Sudirohusodo Hospital, Makassar (I.D.), and Saiful Anwar Hospital, Malang (J.J.R.S.) - all in Indonesia; De La Salle Medical and Health Sciences Institute, Cavite (V.B.D.), the Lung Centre of the Philippines, Quezon City (V.M.B.), and the Tropical Disease Foundation, Makati (R.S.V.) - all in the Philippines; the Infectious Diseases Institute, Makerere University, Kampala, Uganda (C.S.-W.); HIV-NAT, Thai Red Cross AIDS Research Center and Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (A.A.); the National Institute of TB and Respiratory Diseases, New Delhi, India (R.S.); and the London School of Hygiene and Tropical Medicine (N.I.P.) and the Medical Research Council Clinical Trials Unit at University College London (N.I.P., A.J.N., A.M.C.) - both in London
| | - Jani J R Sugiri
- From the Infectious Diseases Translational Research Programme and Yong Loo Lin School of Medicine, National University of Singapore (N.I.P., C.C., C.S., P.P.), National University Hospital (K.L.C.), and Singapore Clinical Research Institute (Q.L., S.L.L., Y.P.) - all in Singapore; the Faculty of Medicine, Universitas Indonesia, and Persahabatan General Hospital, Jakarta (E.B.), Dr. Soetomo Hospital, Surabaya (T.K.), Universitas Padjadjaran, Bandung (R.R.), Dr. Wahidin Sudirohusodo Hospital, Makassar (I.D.), and Saiful Anwar Hospital, Malang (J.J.R.S.) - all in Indonesia; De La Salle Medical and Health Sciences Institute, Cavite (V.B.D.), the Lung Centre of the Philippines, Quezon City (V.M.B.), and the Tropical Disease Foundation, Makati (R.S.V.) - all in the Philippines; the Infectious Diseases Institute, Makerere University, Kampala, Uganda (C.S.-W.); HIV-NAT, Thai Red Cross AIDS Research Center and Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (A.A.); the National Institute of TB and Respiratory Diseases, New Delhi, India (R.S.); and the London School of Hygiene and Tropical Medicine (N.I.P.) and the Medical Research Council Clinical Trials Unit at University College London (N.I.P., A.J.N., A.M.C.) - both in London
| | - Rholine S Veto
- From the Infectious Diseases Translational Research Programme and Yong Loo Lin School of Medicine, National University of Singapore (N.I.P., C.C., C.S., P.P.), National University Hospital (K.L.C.), and Singapore Clinical Research Institute (Q.L., S.L.L., Y.P.) - all in Singapore; the Faculty of Medicine, Universitas Indonesia, and Persahabatan General Hospital, Jakarta (E.B.), Dr. Soetomo Hospital, Surabaya (T.K.), Universitas Padjadjaran, Bandung (R.R.), Dr. Wahidin Sudirohusodo Hospital, Makassar (I.D.), and Saiful Anwar Hospital, Malang (J.J.R.S.) - all in Indonesia; De La Salle Medical and Health Sciences Institute, Cavite (V.B.D.), the Lung Centre of the Philippines, Quezon City (V.M.B.), and the Tropical Disease Foundation, Makati (R.S.V.) - all in the Philippines; the Infectious Diseases Institute, Makerere University, Kampala, Uganda (C.S.-W.); HIV-NAT, Thai Red Cross AIDS Research Center and Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (A.A.); the National Institute of TB and Respiratory Diseases, New Delhi, India (R.S.); and the London School of Hygiene and Tropical Medicine (N.I.P.) and the Medical Research Council Clinical Trials Unit at University College London (N.I.P., A.J.N., A.M.C.) - both in London
| | - Christine Sekaggya-Wiltshire
- From the Infectious Diseases Translational Research Programme and Yong Loo Lin School of Medicine, National University of Singapore (N.I.P., C.C., C.S., P.P.), National University Hospital (K.L.C.), and Singapore Clinical Research Institute (Q.L., S.L.L., Y.P.) - all in Singapore; the Faculty of Medicine, Universitas Indonesia, and Persahabatan General Hospital, Jakarta (E.B.), Dr. Soetomo Hospital, Surabaya (T.K.), Universitas Padjadjaran, Bandung (R.R.), Dr. Wahidin Sudirohusodo Hospital, Makassar (I.D.), and Saiful Anwar Hospital, Malang (J.J.R.S.) - all in Indonesia; De La Salle Medical and Health Sciences Institute, Cavite (V.B.D.), the Lung Centre of the Philippines, Quezon City (V.M.B.), and the Tropical Disease Foundation, Makati (R.S.V.) - all in the Philippines; the Infectious Diseases Institute, Makerere University, Kampala, Uganda (C.S.-W.); HIV-NAT, Thai Red Cross AIDS Research Center and Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (A.A.); the National Institute of TB and Respiratory Diseases, New Delhi, India (R.S.); and the London School of Hygiene and Tropical Medicine (N.I.P.) and the Medical Research Council Clinical Trials Unit at University College London (N.I.P., A.J.N., A.M.C.) - both in London
| | - Anchalee Avihingsanon
- From the Infectious Diseases Translational Research Programme and Yong Loo Lin School of Medicine, National University of Singapore (N.I.P., C.C., C.S., P.P.), National University Hospital (K.L.C.), and Singapore Clinical Research Institute (Q.L., S.L.L., Y.P.) - all in Singapore; the Faculty of Medicine, Universitas Indonesia, and Persahabatan General Hospital, Jakarta (E.B.), Dr. Soetomo Hospital, Surabaya (T.K.), Universitas Padjadjaran, Bandung (R.R.), Dr. Wahidin Sudirohusodo Hospital, Makassar (I.D.), and Saiful Anwar Hospital, Malang (J.J.R.S.) - all in Indonesia; De La Salle Medical and Health Sciences Institute, Cavite (V.B.D.), the Lung Centre of the Philippines, Quezon City (V.M.B.), and the Tropical Disease Foundation, Makati (R.S.V.) - all in the Philippines; the Infectious Diseases Institute, Makerere University, Kampala, Uganda (C.S.-W.); HIV-NAT, Thai Red Cross AIDS Research Center and Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (A.A.); the National Institute of TB and Respiratory Diseases, New Delhi, India (R.S.); and the London School of Hygiene and Tropical Medicine (N.I.P.) and the Medical Research Council Clinical Trials Unit at University College London (N.I.P., A.J.N., A.M.C.) - both in London
| | - Rohit Sarin
- From the Infectious Diseases Translational Research Programme and Yong Loo Lin School of Medicine, National University of Singapore (N.I.P., C.C., C.S., P.P.), National University Hospital (K.L.C.), and Singapore Clinical Research Institute (Q.L., S.L.L., Y.P.) - all in Singapore; the Faculty of Medicine, Universitas Indonesia, and Persahabatan General Hospital, Jakarta (E.B.), Dr. Soetomo Hospital, Surabaya (T.K.), Universitas Padjadjaran, Bandung (R.R.), Dr. Wahidin Sudirohusodo Hospital, Makassar (I.D.), and Saiful Anwar Hospital, Malang (J.J.R.S.) - all in Indonesia; De La Salle Medical and Health Sciences Institute, Cavite (V.B.D.), the Lung Centre of the Philippines, Quezon City (V.M.B.), and the Tropical Disease Foundation, Makati (R.S.V.) - all in the Philippines; the Infectious Diseases Institute, Makerere University, Kampala, Uganda (C.S.-W.); HIV-NAT, Thai Red Cross AIDS Research Center and Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (A.A.); the National Institute of TB and Respiratory Diseases, New Delhi, India (R.S.); and the London School of Hygiene and Tropical Medicine (N.I.P.) and the Medical Research Council Clinical Trials Unit at University College London (N.I.P., A.J.N., A.M.C.) - both in London
| | - Padmasayee Papineni
- From the Infectious Diseases Translational Research Programme and Yong Loo Lin School of Medicine, National University of Singapore (N.I.P., C.C., C.S., P.P.), National University Hospital (K.L.C.), and Singapore Clinical Research Institute (Q.L., S.L.L., Y.P.) - all in Singapore; the Faculty of Medicine, Universitas Indonesia, and Persahabatan General Hospital, Jakarta (E.B.), Dr. Soetomo Hospital, Surabaya (T.K.), Universitas Padjadjaran, Bandung (R.R.), Dr. Wahidin Sudirohusodo Hospital, Makassar (I.D.), and Saiful Anwar Hospital, Malang (J.J.R.S.) - all in Indonesia; De La Salle Medical and Health Sciences Institute, Cavite (V.B.D.), the Lung Centre of the Philippines, Quezon City (V.M.B.), and the Tropical Disease Foundation, Makati (R.S.V.) - all in the Philippines; the Infectious Diseases Institute, Makerere University, Kampala, Uganda (C.S.-W.); HIV-NAT, Thai Red Cross AIDS Research Center and Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (A.A.); the National Institute of TB and Respiratory Diseases, New Delhi, India (R.S.); and the London School of Hygiene and Tropical Medicine (N.I.P.) and the Medical Research Council Clinical Trials Unit at University College London (N.I.P., A.J.N., A.M.C.) - both in London
| | - Andrew J Nunn
- From the Infectious Diseases Translational Research Programme and Yong Loo Lin School of Medicine, National University of Singapore (N.I.P., C.C., C.S., P.P.), National University Hospital (K.L.C.), and Singapore Clinical Research Institute (Q.L., S.L.L., Y.P.) - all in Singapore; the Faculty of Medicine, Universitas Indonesia, and Persahabatan General Hospital, Jakarta (E.B.), Dr. Soetomo Hospital, Surabaya (T.K.), Universitas Padjadjaran, Bandung (R.R.), Dr. Wahidin Sudirohusodo Hospital, Makassar (I.D.), and Saiful Anwar Hospital, Malang (J.J.R.S.) - all in Indonesia; De La Salle Medical and Health Sciences Institute, Cavite (V.B.D.), the Lung Centre of the Philippines, Quezon City (V.M.B.), and the Tropical Disease Foundation, Makati (R.S.V.) - all in the Philippines; the Infectious Diseases Institute, Makerere University, Kampala, Uganda (C.S.-W.); HIV-NAT, Thai Red Cross AIDS Research Center and Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (A.A.); the National Institute of TB and Respiratory Diseases, New Delhi, India (R.S.); and the London School of Hygiene and Tropical Medicine (N.I.P.) and the Medical Research Council Clinical Trials Unit at University College London (N.I.P., A.J.N., A.M.C.) - both in London
| | - Angela M Crook
- From the Infectious Diseases Translational Research Programme and Yong Loo Lin School of Medicine, National University of Singapore (N.I.P., C.C., C.S., P.P.), National University Hospital (K.L.C.), and Singapore Clinical Research Institute (Q.L., S.L.L., Y.P.) - all in Singapore; the Faculty of Medicine, Universitas Indonesia, and Persahabatan General Hospital, Jakarta (E.B.), Dr. Soetomo Hospital, Surabaya (T.K.), Universitas Padjadjaran, Bandung (R.R.), Dr. Wahidin Sudirohusodo Hospital, Makassar (I.D.), and Saiful Anwar Hospital, Malang (J.J.R.S.) - all in Indonesia; De La Salle Medical and Health Sciences Institute, Cavite (V.B.D.), the Lung Centre of the Philippines, Quezon City (V.M.B.), and the Tropical Disease Foundation, Makati (R.S.V.) - all in the Philippines; the Infectious Diseases Institute, Makerere University, Kampala, Uganda (C.S.-W.); HIV-NAT, Thai Red Cross AIDS Research Center and Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (A.A.); the National Institute of TB and Respiratory Diseases, New Delhi, India (R.S.); and the London School of Hygiene and Tropical Medicine (N.I.P.) and the Medical Research Council Clinical Trials Unit at University College London (N.I.P., A.J.N., A.M.C.) - both in London
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10
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Burhan E, Wijaya I. The role of high dose vitamin d and glutathione supplementation in COVID-19 treatment: A case series. J Infect Dev Ctries 2023; 17:188-193. [PMID: 36897901 DOI: 10.3855/jidc.17109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/16/2022] [Indexed: 03/11/2023] Open
Abstract
COVID-19 has been affecting millions of people worldwide and becoming a global public health burden. Therefore, exploring treatment options is essential to help flatten the curve and reduce hospitalization time. This is a case series of ten COVID-19 patients in Jakarta and Tangerang, Indonesia, who received a high dose of vitamin D and glutathione supplementation daily. Within 5-7 days of treatment, all patients were confirmed COVID-19 negative. To date, this is the first report from Indonesia describing the potential benefit of supplementing vitamin D and glutathione concurrently in improving clinical conditions and expediting the recovery time of COVID-19 patients.
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Affiliation(s)
- Erlina Burhan
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia - Persahabatan General Hospital, Jakarta, Indonesia
| | - Indra Wijaya
- Diabetes Connection Care, Eka Hospital BSD, Bumi Serpong Damai, Tangerang, Indonesia
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11
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Karuniawati A, Burhan E, Koendhori EB, Sari D, Haryanto B, Nuryastuti T, Gayatri AAAY, Bahrun U, Kusumawati RL, Sugiyono RI, Susanto NH, Diana A, Kosasih H, Naysilla AM, Lokida D, Neal A, Siddiqui S, Lau CY, Karyana M. Performance of Xpert MTB/RIF and sputum microscopy compared to sputum culture for diagnosis of tuberculosis in seven hospitals in Indonesia. Front Med (Lausanne) 2023; 9:909198. [PMID: 36743681 PMCID: PMC9896521 DOI: 10.3389/fmed.2022.909198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 12/07/2022] [Indexed: 01/21/2023] Open
Abstract
Introduction Tuberculosis (TB) is a major public health concern in Indonesia, where the incidence was 301 cases per 100,000 inhabitants in 2020 and the prevalence of multi-drug resistant (MDR) TB is increasing. Diagnostic testing approaches vary across Indonesia due to resource limitations. Acid-fast bacilli (AFB) smear is widely used, though Xpert MTB/RIF has been the preferred assay for detecting TB and rifampicin resistance since 2012 due to higher sensitivity and ability to rapidly identify rifampicin resistance. However, <1,000 Xpert instruments were available in Indonesia as of 2020 and the Xpert supply chain has suffered interruptions. Methods We compared the performance of Xpert MTB/RIF and AFB smear to facilitate optimization of TB case identification. We analyzed baseline data from a cohort study of adults with pulmonary TB conducted at seven hospitals across Indonesia. We evaluated sensitivity and specificity of AFB smear and Xpert MTB/RIF using Mycobacterium tuberculosis (Mtb) culture as the gold standard, factors associated with assay results, and consistency of Xpert MTB/RIF with drug susceptibility test (DST) in detecting rifampicin resistance. Results Sensitivity of AFB smear was significantly lower than Xpert MTB/RIF (86.2 vs. 97.4%, p-value <0.001), but specificity was significantly better (86.7 vs. 73.3%, p-value <0.001). Performance varied by hospital. Positivity rate for AFB smear and Mtb culture was higher in subjects with pulmonary cavities and in morning sputum samples. Consistency of Xpert MTB/RIF with DST was lower in those with rifampicin- sensitive TB by DST. Discussion Additional evaluation using sputa from primary and secondary Indonesian health centers will increase the generalizability of the assessment of AFB smear and Xpert MTB/RIF performance, and better inform health policy. Clinical trial registration [https://clinicaltrials.gov/], identifier [NCT027 58236].
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Affiliation(s)
- Anis Karuniawati
- Department of Microbiology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Erlina Burhan
- Department of Pulmonary and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Persahabatan Hospital, Jakarta, Indonesia
| | - Eko Budi Koendhori
- Department of Medical Microbiology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Hospital, Surabaya, Indonesia
| | - Desvita Sari
- Department of Microbiology, Faculty of Medicine, Universitas Diponegoro, Dr. Kariadi Hospital, Semarang, Indonesia
| | - Budi Haryanto
- Microbiology Unit, Persahabatan Hospital, Jakarta, Indonesia
| | - Titik Nuryastuti
- Department of Microbiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - A. A. A. Yuli Gayatri
- Department of Internal Medicine, Faculty of Medicine, Universitas Udayana, Prof. IGNG. Ngoerah General Hospital, Bali, Indonesia
| | - Uleng Bahrun
- Department of Clinical Pathology, Faculty of Medicine, University of Hasanuddin, Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
| | - R. Lia Kusumawati
- Department of Microbiology, Faculty of Medicine, Universitas Sumatera Utara, H. Adam Malik General Hospital, Medan, Indonesia
| | - Retna Indah Sugiyono
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
| | - Nugroho Harry Susanto
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
| | - Aly Diana
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia,Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Sumedang, Indonesia
| | - Herman Kosasih
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia,*Correspondence: Herman Kosasih,
| | | | - Dewi Lokida
- Department of Clinical Pathology, Tangerang District Hospital, Tangerang, Indonesia
| | - Aaron Neal
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Sophia Siddiqui
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Chuen-Yen Lau
- HIV Dynamics and Replication Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Muhammad Karyana
- National Institute of Health Research and Development, Ministry of Health, Republic of Indonesia, Jakarta, Indonesia
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12
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Silitonga P, Jiang W, Wyatt S, Burhan E, Kes EFM, Long Q, Long Q. Factors affecting time to treatment initiation after diagnosis for multidrug-resistant/rifampicin-resistant tuberculosis patients: A mixed-methods study in Jakarta, Indonesia. Trop Med Int Health 2023; 28:43-52. [PMID: 36477995 DOI: 10.1111/tmi.13838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate the time to treatment initiation (TTI) for multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) patients after diagnosis in Indonesia and biological, psychological and social factors associated with the time interval. METHODS This study was conducted in Persahabatan Hospital, Jakarta using a mixed-methods approach. Registry data and medical records of MDR/RR-TB patients were collected and matched (hospital dataset), and linked with psychosocial assessment results (linked dataset). Descriptive analysis was conducted to understand patient characteristics and the distribution of TTI after RR-TB diagnosis by GeneXpert. Generalised linear regression was used to analyse factors associated with delay duration, and logistic regression to explore factors associated with the delay longer than the median duration for both datasets (basic vs. extended model). In-depth interviews were conducted with patients and healthcare workers to understand the procedure of treatment initiation and how different factors led to delay. RESULTS The hospital dataset included 275 patient-matched cases, and 188 were further linked with psychosocial assessment results. The median time interval was 24 days [interquartile range (IQR) 23.5] and 26 days (IQR 21.25), respectively. Regression analysis showed that in the extended model, comorbidities (exp [coefficient]= 1.93), unemployment (exp [coefficient] = 1.80) and poor knowledge of MDR/RR-TB (exp (coefficient) = 1.67) seemed to have the strongest effects on prolonging the time interval (p < 0.05). Unsuccessful TB treatment history was the only factor that significantly increased the risk of delay longer than the median duration (p < 0.05) in the basic model, while none of the factors were significant in the extended model. The qualitative study identified provider-side factors (centralised service provision and insufficient human resources) and patient-side factors (physical weakness, psychological stress and financial concern) associated with treatment delay. CONCLUSION MDR/RR-TB patients in Persahabatan Hospital, Jakarta, Indonesia waited around 25 days for treatment initiation after RR-TB diagnosis. Health system solutions are needed to address challenges facing both MDR/RR-TB patients and healthcare providers to reduce delay in treatment initiation.
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Affiliation(s)
- Permata Silitonga
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Weixi Jiang
- School of Public Health, Fudan University, Shanghai, China
| | - Sage Wyatt
- Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Erlina Burhan
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia-Persahabatan Hospital, Jakarta, Indonesia
| | | | - Qian Long
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Qian Long
- Global Health Research Center Duke Kunshan University Kunshan Jiangsu China
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13
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Agustin H, Massi MN, Djaharuddin I, Patellongi I, Susanto AD, Islam AA, Hatta M, Bukhari A, Tabri NA, Santoso A, Burhan E, Isbaniyah F, Farsida, Effendy Z. Correlation expression Toll-like receptor 4 with multidrugs resistant tuberculosis in diabetes mellitus condition. Indian J Tuberc 2023; 70:59-64. [PMID: 36740319 DOI: 10.1016/j.ijtb.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/09/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Toll-like receptor (TLR) are ligand homologous protein in the APC cell membrane that has functions as a receptor to triger leukocytes and innate immune responses. When there is a Microbacterium tuberculosis (MTB) infection enters from droplets to the lungs, the alveolar macrophages perform a phagocytic function. The interaction between M. tuberculosis and the TLR macrophage receptors produces chemokines which induce migration of monocytes and dendrite cells for destruction. Diabetes militus (DM) has become risk factor for developing tuberculosis. DM condition will reduce immunity and the ability of immune cell phagocytes bactery and triger severe infections. The consequences of more severe infection and metabolic disorders that occur make a person more likely to experience Multidrugs resistant MTB. Not much data that reports on the expression of TLR4 as a ligand that triggers an immune response in conditions of MDR and DM. We try to find out correlation between TLR-4 in MDR MTB, diabetes and level of MTB bacteria in experimental animals. METHODS We conducted an experimental study on 30 experimental mice weighing 25 grams consisting of negative control grub, infected with MTB, infected with MDR MTB, negative control diabetes, MTB DM, MDR MTB DM. DM animals were induced by streptozosin to experience DM, then in the treatment of infection, intraperitoneal MTB and MDR MTB bacterial injections were given. Termination was carried out on day 14. We count number of bacteria level in the lungs and perform evaluation TLR4 from blood sampel. RESULTS The negative control group had mean TLR value of 1.47 (± 0.46) while the MTB group showed an increase in TLR 9.22 (± 0.39) followed by MDR MTB 9.50 (± 0.29), DM negative control 9, 21 (± 0.24) and more increasing in conditions of DM MTB 13.36 (± 0.32) and DM MDR MTB 13.35 (± 0.34). ANOVA analysis showed a significant difference (P = 0.00). pearson correlation analysis find strong correlation TLR4 in MTB and MDR MTB with diabetes. CONCLUSION there were a significant difference level TLR4 between MTB and MDR TB infection with diabetes. higher TLR4 level higher in DM MTB, DM MDR MTB. TLR 4 strong correlates with an increase in the number of MTB bacteria.
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Affiliation(s)
- Heidy Agustin
- Faculty of Medicine, Hasanuddin University, Indonesia.
| | | | | | | | - Agus Dwi Susanto
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Indonesia University, Indonesia.
| | | | | | | | | | - Arif Santoso
- Faculty of Medicine, Hasanuddin University, Indonesia
| | - Erlina Burhan
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Indonesia University, Indonesia.
| | - Fathiyah Isbaniyah
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Indonesia University, Indonesia
| | - Farsida
- Faculty of Medicine and Health, University of Muhammadiyah Jakarta, Indonesia
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Solante R, Alvarez-Moreno C, Burhan E, Chariyalertsak S, Chiu NC, Chuenkitmongkol S, Dung DV, Hwang KP, Ortiz Ibarra J, Kiertiburanakul S, Kulkarni PS, Lee C, Lee PI, Lobo RC, Macias A, Nghia CH, Ong-Lim AL, Rodriguez-Morales AJ, Richtmann R, Safadi MAP, Satari HI, Thwaites G. Expert review of global real-world data on COVID-19 vaccine booster effectiveness and safety during the omicron-dominant phase of the pandemic. Expert Rev Vaccines 2023; 22:1-16. [PMID: 36330971 DOI: 10.1080/14760584.2023.2143347] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION COVID-19 vaccines have been highly effective in reducing morbidity and mortality during the pandemic. However, the emergence of the Omicron variant and subvariants as the globally dominant strains have raised doubts about the effectiveness of currently available vaccines and prompted debate about potential future vaccination strategies. AREAS COVERED Using the publicly available IVAC VIEW-hub platform, we reviewed 52 studies on vaccine effectiveness (VE) after booster vaccinations. VE were reported for SARS-CoV-2 symptomatic infection, severe disease and death and stratified by vaccine schedule and age. In addition, a non-systematic literature review of safety was performed to identify single or multi-country studies investigating adverse event rates for at least two of the currently available COVID-19 vaccines. EXPERT OPINION Booster shots of the current COVID-19 vaccines provide consistently high protection against Omicron-related severe disease and death. Additionally, this protection appears to be conserved for at least 3 months, with a small but significant waning after that. The positive risk-benefit ratio of these vaccines is well established, giving us confidence to administer additional doses as required. Future vaccination strategies will likely include a combination of schedules based on risk profile, as overly frequent boosting may be neither beneficial nor sustainable for the general population.
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Affiliation(s)
| | - Carlos Alvarez-Moreno
- Infectious Diseases Unit, Facultad de Medicina. Universidad Nacional de Colombia. Clinica Universitaria Colombia, Clínica Colsanitas, Colombia
| | - Erlina Burhan
- Faculty of Medicine Universitas Indonesia, RSUP Persahabatan, Jakarta, Indonesia
| | | | | | | | - D V Dung
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Kao-Pin Hwang
- China Medical University Children's Hospital, Taichung, Taiwan
| | - Javier Ortiz Ibarra
- Médico Hospital Materno Perinatal Monica Pretelini Sáez, Toluca de Lerdo, México
| | | | | | | | - Ping-Ing Lee
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | | | | | | | - Anna Lisa Ong-Lim
- College of Medicine - Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Alfonso J Rodriguez-Morales
- Faculty of Medicine, Fundacion Universitaria Autónoma de las Americas, Pereira, Risaralda, Colombia & Master of Clinical Epidemiology and Biostatistics, Universidad Cientifica del Sur, Lima, Peru
| | - Rosana Richtmann
- Santa Joana Hospital and Maternity, the Institute of Infectious Diseases Emílio Ribas in Sao Paulo, Brazil
| | | | - Hindra Irawan Satari
- Division of Infectious Diseases and Tropical Pediatrics, Department of Child Health Medical Faculty, Universitas Indonesia, Cipto Mangunkusumo Hospital, Indonesia
| | - Guy Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam, and The Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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15
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Burhan E, Karyana M, Karuniawati A, Kusmiati T, Wibisono BH, Handayani D, Riyanto BS, Sajinadiyasa IGK, Sinaga BYM, Djaharuddin I, Indah Sugiyono R, Susanto NH, Diana A, Kosasih H, Lokida D, Siswanto, Neal A, Lau CY, Siddiqui S. Characteristics of Drug-sensitive and Drug-resistant Tuberculosis Cases among Adults at Tuberculosis Referral Hospitals in Indonesia. Am J Trop Med Hyg 2022; 107:984-991. [PMID: 36252800 PMCID: PMC9709011 DOI: 10.4269/ajtmh.22-0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 08/18/2022] [Indexed: 11/07/2022] Open
Abstract
As Indonesia's rifampin resistance testing rates are lower than global testing rates per the 2020 WHO global tuberculosis (TB) report, prevalence of multidrug-resistant TB may be underestimated. Our study aimed to evaluate prevalence and patterns of TB drug resistance (DR) within Indonesia. We conducted a cross-sectional analysis of baseline data collected from 2017-2018 as part of a cohort study of adults with presumed pulmonary TB at 7 DR-TB referral hospitals in Indonesia. Bacteriological examinations (acid-fast bacilli, GeneXpert, sputum culture) and drug-susceptibility testing were performed following the guidelines of the National TB Program. Of 447 participants with complete bacteriological examinations, 312 (69.8%) had positive sputum cultures for Mycobacterium tuberculosis. The proportion of MDR and pre-extensively drug-resistant was higher in previously treated compared with newly diagnosed participants (52.5% [73/139] versus 15% [26/173]). Compared with drug-sensitive case, drug-resistant TB was associated with cavities. Given the difference between rates of DR in TB referral hospitals from our study compared with the WHO survey in 2019 that showed 17.7% and 3.3% DR among previously treated and newly diagnosed participants globally, further characterization of Indonesia's TB epidemiology in the general population is needed. Strategies, including public policies to optimize case finding, strengthen capacity for resistance testing, and prevent loss to follow-up will be critical to reduce the burden of TB in Indonesia.
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Affiliation(s)
- Erlina Burhan
- Persahabatan Hospital/Department of Pulmonary and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Muhammad Karyana
- National Institute of Health Research and Development, Ministry of Health, Republic of Indonesia, Jakarta, Indonesia
| | - Anis Karuniawati
- Department of Microbiology, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Tutik Kusmiati
- Dr. Soetomo Hospital/Universitas Airlangga, Surabaya, Indonesia
| | | | - Diah Handayani
- Persahabatan Hospital/Department of Pulmonary and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | | | | | - Bintang Yinke Magdalena Sinaga
- H. Adam Malik General Hospital, Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Irawaty Djaharuddin
- Dr. Wahidin Sudirohusodo Hospital/Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Retna Indah Sugiyono
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
| | - Nugroho Harry Susanto
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
| | - Aly Diana
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Sumedang, Indonesia
| | - Herman Kosasih
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
| | - Dewi Lokida
- Department of Clinical Pathology, Tangerang District Hospital, Tangerang, Indonesia
| | - Siswanto
- National Institute of Health Research and Development, Ministry of Health, Republic of Indonesia, Jakarta, Indonesia
| | - Aaron Neal
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Chuen-Yen Lau
- HIV Dynamics and Replication Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Sophia Siddiqui
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
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16
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Reyes LF, Murthy S, Garcia-Gallo E, Merson L, Ibáñez-Prada ED, Rello J, Fuentes YV, Martin-Loeches I, Bozza F, Duque S, Taccone FS, Fowler RA, Kartsonaki C, Gonçalves BP, Citarella BW, Aryal D, Burhan E, Cummings MJ, Delmas C, Diaz R, Figueiredo-Mello C, Hashmi M, Panda PK, Jiménez MP, Rincon DFB, Thomson D, Nichol A, Marshall JC, Olliaro PL. Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study. Crit Care 2022; 26:276. [PMID: 36100904 PMCID: PMC9469080 DOI: 10.1186/s13054-022-04155-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/30/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). METHODS This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. RESULTS A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]). CONCLUSIONS In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable.
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Affiliation(s)
- Luis Felipe Reyes
- Pandemic Sciences Institute, University of Oxford, Oxford, UK.
- Infectious Diseases Department, Universidad de La Sabana, Chía, Colombia.
- Critical Care Department, Clínica Universidad de La Sabana, Chía, Colombia.
| | - Srinivas Murthy
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | | | - Laura Merson
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Elsa D Ibáñez-Prada
- Infectious Diseases Department, Universidad de La Sabana, Chía, Colombia
- Critical Care Department, Clínica Universidad de La Sabana, Chía, Colombia
| | - Jordi Rello
- Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
- Centro de Investigación Biomédica En Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Yuli V Fuentes
- Infectious Diseases Department, Universidad de La Sabana, Chía, Colombia
- Critical Care Department, Clínica Universidad de La Sabana, Chía, Colombia
| | - Ignacio Martin-Loeches
- Department of Clinical Medicine, St James's Hospital, Multidisciplinary Intensive Care Research Organization (MICRO), Dublin, Ireland
| | - Fernando Bozza
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil
- Brazilian Research in Intensive Care Network (BRICNet), Rio de Janeiro, Brazil
- Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Sara Duque
- Infectious Diseases Department, Universidad de La Sabana, Chía, Colombia
| | - Fabio S Taccone
- Department of Intensive Care, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Laboratoire de Recherche Experimentale, Department of Intensive Care, Hôpital Erasme, Brussels, Belgium
| | - Robert A Fowler
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | | | | | | | | | - Erlina Burhan
- Infection Division, Department of Pulmonology and Respiratory Medicine, Universitas Indonesia, Depok, Indonesia
| | - Matthew J Cummings
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | - Rodrigo Diaz
- Intensive Care Unit, Clinica Las Condes, Santiago, Chile
| | | | - Madiha Hashmi
- Critical Care Asia and Ziauddin University, Karachi, Pakistan
| | | | | | | | - David Thomson
- Division of Critical Care, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Alistair Nichol
- University College Dublin Clinical Research Centre at St Vincent's University Hospital, Dublin, Ireland
| | - John C Marshall
- Li Ka Shing Knowledge Institute, Unity Health Toronto, St Michael's Hospital, Toronto, ON, Canada
| | - Piero L Olliaro
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
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17
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Solante R, Alvarez-Moreno C, Burhan E, Chariyalertsak S, Chiu NC, Chuenkitmongkol S, Do-Van D, Hwang KP, Kiertiburanakul S, Lee PI, Lobo RC, Macias A, Nghia CH, Ong-Lim A, Ortiz Ibarra J, Richtmann R, Rodriguez-Morales AJ, Safadi MAP, Satari HI. Further implications on the global real-world vaccine effectiveness against SARS-CoV-2. Expert Rev Vaccines 2022; 21:1355-1357. [PMID: 35968671 DOI: 10.1080/14760584.2022.2110073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Carlos Alvarez-Moreno
- Infectious Diseases Unit, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Erlina Burhan
- Faculty of Medicine Universitas Indonesia, RSUP Persahabatan, Jakarta, Indonesia
| | | | | | | | - Dung Do-Van
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Kao-Pin Hwang
- China Medical University Children's Hospital, Taichung, Taiwan
| | | | - Ping-Ing Lee
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | | | | | | | - Anna Ong-Lim
- College of Medicine - Philippine General Hospital, University of the Philippines, Manila, Philippines
| | | | - Rosana Richtmann
- Santa Joana Hospital and Maternity, the Institute of Infectious Diseases Emílio Ribas in Sao Paulo, Sao Paulo, Brazil
| | - Alfonso J Rodriguez-Morales
- Grupo de Investigacion Biomedicina, Faculty of Medicine, Fundacion Universitaria Autónoma de las Americas, Pereira, Colombia.,Master of Clinical Epidemiology and Biostatistics, Universidad Cientifica del Sur, Lima, Peru
| | | | - Hindra Irawan Satari
- Division of Infectious Diseases and Tropical Pediatrics, Department of Child Health Medical Faculty, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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18
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Chuenkitmongkol S, Solante R, Burhan E, Chariyalertsak S, Chiu NC, Do-Van D, Husin M, Hwang KP, Kiertiburanakul S, Kulkarni PS, Lee PI, Lobo RC, Nghia CH, Ong-Lim A, Sivasampu S, Suah JL, Tok PSK, Thwaites G. Expert Review on global real-world vaccine effectiveness against SARS-CoV-2. Expert Rev Vaccines 2022; 21:1255-1268. [PMID: 35748494 DOI: 10.1080/14760584.2022.2092472] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION COVID-19 vaccines have been highly effective in reducing morbidity and mortality during the pandemic. While primary series vaccination rates are generally high in Southeast Asian (SEA) countries, various factors have limited the rollout and impact of booster doses. AREAS COVERED We reviewed 79 studies in the publicly available International Vaccine Access Center (IVAC) VIEW-hub platform on vaccine effectiveness (VE) after primary immunizations with two-dose schedules. VE data were reported for SARS-CoV-2 infection, COVID-19-related hospitalizations and deaths, and stratified across variants of concern (VOC), age, study design and prior SARS-CoV-2 infection for mRNA vaccines (BNT162b2, mRNA-1273 and combinations of both), vector vaccines (AstraZeneca, AZD1222 "Vaxzevria") and inactivated virus vaccines (CoronaVac). EXPERT OPINION The most-studied COVID-19 vaccines provide consistently high (>90%) protection against serious clinical outcomes like hospitalizations and deaths, regardless of variant. Additionally, this protection appears equivalent for mRNA vaccines and vector vaccines like AZD1222, as supported by our analysis of local Asian and relevant international data, and by insights from SEA experts. Given the continued impact of COVID-19 hospitalizations and deaths on healthcare systems worldwide, encouraging vaccination strategies that can reduce this burden is more relevant than attempting to prevent broader but milder infections with specific variants, including Omicron.
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Affiliation(s)
| | | | - Erlina Burhan
- Faculty of Medicine Universitas Indonesia, RSUP Persahabatan, Jakarta, Indonesia
| | | | | | - Dung Do-Van
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Masliyana Husin
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
| | - Kao-Pin Hwang
- China Medical University Children's Hospital, Taichung, Taiwan
| | | | | | - Ping-Ing Lee
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | | | | | - Anna Ong-Lim
- College of Medicine - Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
| | - Jing Lian Suah
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
| | - Peter Seah Keng Tok
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
| | - Guy Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam, and The Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, UK
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19
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Prasenohadi P, Burhan E, Dhunny S, Suharno W, Wabnitz P, Kim YW, Petrosillo N. Double-Blind, Randomized, Placebo-Controlled Study on hzVSF-v13, a Novel Anti-Vimentin Monoclonal Antibody Drug as Add-on Standard of Care in the Management of Patients with Moderate to Severe COVID-19. J Clin Med 2022; 11:jcm11112961. [PMID: 35683351 PMCID: PMC9181020 DOI: 10.3390/jcm11112961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/16/2022] [Accepted: 05/20/2022] [Indexed: 02/04/2023] Open
Abstract
Humanized Virus Suppressing Factor-variant 13 (hzVSF-v13), a monoclonal IgG4 antibody against vimentin, was investigated in moderate to severe COVID-19 pneumonia through a Phase II study. Patients were randomized to two different IV doses of the test drug or saline with standard of care. Overall, 64 patients were recruited, and 62 entered the efficacy assessment in the full analysis set. Primary endpoint: The clinical failure rate at day 28 was 15.8% for placebo, 9.1% for low-dose hzVSF-v13 and 9.5% for high-dose hzVSF-v13 (not significant). A trend toward better efficacy was shown in several secondary endpoints, with statistical significance between low-dose hzVSF-v13 and placebo in terms of the rate of improved patients on the ordinal scale for clinical improvement (OSCI): 90.0% vs. 52.63% (p = 0.0116). In the severe stratum, the results of low-dose hzVSF-v13 vs. placebo were 90.0% and 22.2% for OSCI (p = 0.0092), 9 days and 14 days for time to discontinuation of oxygen therapy (p = 0.0308), 10 days and 15 days for both time to clinical improvement (TTCI) and time to recovery (TTR) and p = 0.0446 for both TTCI and TTR. Change from baseline of NEWS2 score at day 28 was -3.4 vs. + 0.4 (p = 0.0441). The results propose hzVSF-v13 as a candidate in the treatment of severe COVID-19.
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Affiliation(s)
- Prasenohadi Prasenohadi
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Persahabatan Hospital, Universitas Indonesia, Jakarta 13230, Indonesia; (P.P.); (E.B.)
| | - Erlina Burhan
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Persahabatan Hospital, Universitas Indonesia, Jakarta 13230, Indonesia; (P.P.); (E.B.)
| | - Sri Dhunny
- Department of Pulmonology, Pasar Minggu General Hospital, South Jakarta 12550, Indonesia;
| | | | - Paul Wabnitz
- clinPHARMA, Precision Medicine & Clinical Trials, Adelaide, SA 5061, Australia;
| | - Yoon-Won Kim
- ImmuneMed, Chuncheon 24232, Korea; or
- Department of Microbiology, Faculty of Medicine, Hallym University, Chuncheon 24252, Korea
| | - Nicola Petrosillo
- Head, Infection Prevention & Control—Infectious Disease Service, Foundation University Hospital, Campus Bio-Medico UniCampus University, 00128 Rome, Italy
- Correspondence:
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20
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Burhan E, Rachmadi RA. Omicron surge and the future of COVID-19 vaccinations. Med J Indones 2022. [DOI: 10.13181/mji.bc.226066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The global surge of Omicron has caused significant concern. Omicron has caused new wave of infections in nations with adequate vaccine coverage. Omicron has around 30 mutations that are similar to the previous variant of concerns, possibly decreasing vaccine effectiveness (VE). Hence, the emergence of Omicron is predicted to be a significant public health challenge and may alter the future of COVID-19 vaccinations. Furthermore, other issues may affect vaccine policy in the future such as the never-ending vaccine inequity, waning immunity of current COVID-19 vaccines, decreasing VE against new emerging strains, and new findings regarding hybrid immunity. This literature review aimed to explore the possible steps forward using the most updated knowledge on COVID-19 vaccines and Omicron.
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21
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Burhan E, Soepandi PZ, Isbaniah F, Damayanti K, Edwar SQ, Maruli MF, Ralena NA, Susanto AD. Determinants of treatment outcomes in patients with multidrug-resistant TB. Int J Tuberc Lung Dis 2022; 26:126-132. [PMID: 35086624 DOI: 10.5588/ijtld.21.0351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Treating multidrug-resistant TB (MDR-TB) remains challenging. However, the determinants and timing of poor outcomes during MDR-TB treatment are still poorly understood.METHODS: We conducted a retrospective cohort study on all adult MDR-TB patients treated at Persahabatan Hospital, Jakarta, Indonesia, between January 2013 and December 2016. Risk factors for poor outcomes were analysed using Cox regression.RESULTS: Death occurred at a median time of 6 months (IQR 4-14) and loss to follow-up (LTFU) at 7 months (IQR 3-11). In multivariate analysis, advanced age (aHR 2.91, 95% CI 1.21-6.96; P = 0.017 for age >60 years), having diabetes mellitus (aHR 2.18, 95% CI 1.25-3.82; P = 0.006) and HIV co-infection (aHR 3.73, 95% CI 1.14-12.23; P = 0.030) were predictive of poor outcome in the first 7 months of treatment, whereas history of LTFU (patients who were LTFU once: aHR 2.14, 95% CI 1.33-3.47; P = 0.002; patients who were LTFU more than once: aHR 3.61, 95% CI 1.68-7.77; P = 0.001) and baseline body mass index <18.5 kg/m² (aHR 1.98, 95% CI 1.10-3.56; P = 0.022) predicted poor outcome after 7 months of treatment.CONCLUSION: Different subsets of patients with MDR-TB are at risk of poor outcome at different times during treatment.
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Affiliation(s)
- E Burhan
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia, Lung Clinic, Persahabatan Hospital, Jakarta, Indonesia
| | - P Z Soepandi
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia, Lung Clinic, Persahabatan Hospital, Jakarta, Indonesia
| | - F Isbaniah
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia, Lung Clinic, Persahabatan Hospital, Jakarta, Indonesia
| | - K Damayanti
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia, Lung Clinic, Persahabatan Hospital, Jakarta, Indonesia
| | - S Q Edwar
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia, Lung Clinic, Persahabatan Hospital, Jakarta, Indonesia
| | - M F Maruli
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia, Lung Clinic, Persahabatan Hospital, Jakarta, Indonesia
| | - N A Ralena
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - A D Susanto
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia, Lung Clinic, Persahabatan Hospital, Jakarta, Indonesia
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Abbas A, Abdukahil SA, Abdulkadir NN, Abe R, Abel L, Absil L, Acharya S, Acker A, Adachi S, Adam E, Adrião D, Ageel SA, Ahmed S, Ain Q, Ainscough K, Aisa T, Ait Hssain A, Ait Tamlihat Y, Akimoto T, Akmal E, Al Qasim E, Alalqam R, Alam T, Al-dabbous T, Alegesan S, Alegre C, Alessi M, Alex B, Alexandre K, Al-Fares A, Alfoudri H, Ali I, Ali Shah N, Alidjnou KE, Aliudin J, Alkhafajee Q, Allavena C, Allou N, Altaf A, Alves J, Alves JM, Alves R, Amaral M, Amira N, Ammerlaan H, Ampaw P, Andini R, Andrejak C, Angheben A, Angoulvant F, Ansart S, Anthonidass S, Antonelli M, Antunes de Brito CA, Anwar KR, Apriyana A, Arabi Y, Aragao I, Arali R, Arancibia F, Araujo C, Arcadipane A, Archambault P, Arenz L, Arlet JB, Arnold-Day C, Aroca A, Arora L, Arora R, Artaud-Macari E, Aryal D, Asaki M, Asensio A, Ashley E, Ashraf M, Ashraf S, Asim M, Assie JB, Asyraf A, Atique A, Attanyake AMUL, Auchabie J, Aumaitre H, Auvet A, Azemar L, Azoulay C, Bach B, Bachelet D, Badr C, Baig N, Baillie JK, Baird JK, Bak E, Bakakos A, Bakar NA, Bal A, Balakrishnan M, Balan V, Bani-Sadr F, Barbalho R, Barbosa NY, Barclay WS, Barnett SU, Barnikel M, Barrasa H, Barrelet A, Barrigoto C, Bartoli M, Bartone C, Baruch J, Bashir M, Basmaci R, Basri MFH, Bastos D, Battaglini D, Bauer J, Bautista Rincon DF, Bazan Dow D, Bedossa A, Bee KH, Behilill S, Beishuizen A, Beljantsev A, Bellemare D, Beltrame A, Beltrão BA, Beluze M, Benech N, Benjiman LE, Benkerrou D, Bennett S, Bento L, Berdal JE, Bergeaud D, Bergin H, Bernal Sobrino JL, Bertoli G, Bertolino L, Bessis S, Betz A, Bevilcaqua S, Bezulier K, Bhatt A, Bhavsar K, Bianchi I, Bianco C, Bidin FN, Bikram Singh M, Bin Humaid F, Bin Kamarudin MN, Bissuel F, Biston P, Bitker L, Blanco-Schweizer P, Blier C, Bloos F, Blot M, Blumberg L, Boccia F, Bodenes L, Bogaarts A, Bogaert D, Boivin AH, Bolze PA, Bompart F, Bonfasius A, Borges D, Borie R, Bosse HM, Botelho-Nevers E, Bouadma L, Bouchaud O, Bouchez S, Bouhmani D, Bouhour D, Bouiller K, Bouillet L, Bouisse C, Boureau AS, Bourke J, Bouscambert M, Bousquet A, Bouziotis J, Boxma B, Boyer-Besseyre M, Boylan M, Bozza FA, Brack M, Braconnier A, Braga C, Brandenburger T, Brás Monteiro F, Brazzi L, Breen D, Breen P, Breen P, Brett S, Brickell K, Broadley T, Browne A, Browne S, Brozzi N, Brusse-Keizer M, Buchtele N, Buesaquillo C, Bugaeva P, Buisson M, Burhan E, Burrell A, Bustos IG, Butnaru D, Cabie A, Cabral S, Caceres E, Cadoz C, Callahan M, Calligy K, Calvache JA, Cam J, Campana V, Campbell P, Campisi J, Canepa C, Cantero M, Caraux-Paz P, Cárcel S, Cardellino CS, Cardoso F, Cardoso F, Cardoso N, Cardoso S, Carelli S, Carlier N, Carmoi T, Carney G, Carpenter C, Carqueja I, Carret MC, Carrier FM, Carroll I, Carson G, Carton E, Casanova ML, Cascão M, Casey S, Casimiro J, Cassandra B, Castañeda S, Castanheira N, Castor-Alexandre G, Castrillón H, Castro I, Catarino A, Catherine FX, Cattaneo P, Cavalin R, Cavalli GG, Cavayas A, Ceccato A, Cervantes-Gonzalez M, Chair A, Chakveatze C, Chan A, Chand M, Chantalat Auger C, Chapplain JM, Chas J, Chaudary M, Chávez Iñiguez JS, Chen A, Chen YS, Cheng MP, Cheret A, Chiarabini T, Chica J, Chidambaram SK, Chin-Tho L, Chirouze C, Chiumello D, Cho HJ, Cho SM, Cholley B, Chopin MC, Chow TS, Chow YP, Chua HJ, Chua J, Cidade JP, Cisneros Herreros JM, Citarella BW, Ciullo A, Clarke E, Clarke J, Claure Del Granado R, Clohisey S, Cobb JP, Coca N, Codan C, Cody C, Coelho A, Coles M, Colin G, Collins M, Colombo SM, Combs P, Connolly J, Connor M, Conrad A, Contreras S, Conway E, Cooke GS, Copland M, Cordel H, Corley A, Cormican S, Cornelis S, Cornet AD, Corpuz AJ, Cortegiani A, Corvaisier G, Costigan E, Couffignal C, Couffin-Cadiergues S, Courtois R, Cousse S, Cregan R, Crepy D'Orleans C, Croonen S, Crowl G, Crump J, Cruz C, Cruz Berm JL, Cruz Rojo J, Csete M, Cucino A, Cullen A, Cullen C, Cummings M, Curley G, Curlier E, Curran C, Custodio P, da Silva Filipe A, Da Silveira C, Dabaliz AA, Dagens A, Dahly D, Dalton H, Dalton J, Daly S, D'Amico F, Daneman N, Daniel C, Dankwa EA, Dantas J, D’Aragon F, de Boer M, de Loughry G, de Mendoza D, De Montmollin E, de Oliveira França RF, de Pinho Oliveira AI, De Rosa R, de Silva T, de Vries P, Deacon J, Dean D, Debard A, DeBenedictis B, Debray MP, DeCastro N, Dechert W, Deconninck L, Decours R, Defous E, Delacroix I, Delaveuve E, Delavigne K, Delfos NM, Deligiannis I, Dell'Amore A, Delmas C, Delobel P, Delsing C, Demonchy E, Denis E, Deplanque D, Depuydt P, Desai M, Descamps D, Desvallée M, Dewayanti S, Diallo A, Diamantis S, Dias A, Diaz P, Diaz R, Diaz Diaz JJ, Didier K, Diehl JL, Dieperink W, Dimet J, Dinot V, Diop F, Diouf A, Dishon Y, Dixit D, Djossou F, Docherty AB, Doherty H, Dondorp AM, Dong A, Donnelly CA, Donnelly M, Donohue C, Donohue S, Donohue Y, Doran C, Doran P, Dorival C, D'Ortenzio E, Douglas JJ, Douma R, Dournon N, Downer T, Downey J, Downing M, Drake T, Driscoll A, Dryden M, Duarte Fonseca C, Dubee V, Dubos F, Ducancelle A, Duculan T, Dudman S, Duggal A, Dunand P, Dunning J, Duplaix M, Durante-Mangoni E, Durham III L, Dussol B, Duthoit J, Duval X, Dyrhol-Riise AM, Ean SC, Echeverria-Villalobos M, Egan S, Eira C, El Sanharawi M, Elapavaluru S, Elharrar B, Ellerbroek J, Eloy P, Elshazly T, Elyazar I, Enderle I, Endo T, Eng CC, Engelmann I, Enouf V, Epaulard O, Escher M, Esperatti M, Esperou H, Esposito-Farese M, Estevão J, Etienne M, Ettalhaoui N, Everding AG, Evers M, Fabre I, Fabre M, Faheem A, Fahy A, Fairfield CJ, Fakar Z, Faria P, Farooq A, Farrar JJ, Farshait N, Fateena H, Fatoni AZ, Faure K, Favory R, Fayed M, Feely N, Feeney L, Fernandes J, Fernandes M, Fernandes S, Ferrand FX, Ferrand Devouge E, Ferrão J, Ferraz M, Ferreira B, Ferreira S, Ferrer-Roca R, Ferriere N, Ficko C, Figueiredo-Mello C, Fiorda J, Flament T, Flateau C, Fletcher T, Florio LL, Flynn B, Flynn D, Foley C, Foley J, Fomin V, Fonseca T, Fontela P, Forsyth S, Foster D, Foti G, Fourn E, Fowler RA, Fraher DM, Franch-Llasat D, Fraser C, Fraser JF, Freire MV, Freitas Ribeiro A, Friedrich C, Fritz R, Fry S, Fuentes N, Fukuda M, Gaborieau V, Gaci R, Gagliardi M, Gagnard JC, Gagné N, Gagneux-Brunon A, Gaião S, Gail Skeie L, Gallagher P, Gallego Curto E, Gamble C, Gani Y, Garan A, Garcia R, García Barrio N, Garcia-Diaz J, Garcia-Gallo E, Garimella N, Garot D, Garrait V, Gauli B, Gault N, Gavin A, Gavrylov A, Gaymard A, Gebauer J, Geraud E, Gerbaud Morlaes L, Germano N, ghisulal PK, Ghosn J, Giani M, Giaquinto C, Gibson J, Gigante T, Gilg M, Gilroy E, Giordano G, Girvan M, Gissot V, Gitahi J, Giwangkancana G, Glikman D, Glybochko P, Gnall E, Goco G, Goehringer F, Goepel S, Goffard JC, Goh JY, Golob J, Gomes R, Gomez K, Gómez-Junyent J, Gominet M, Gonzalez A, Gordon P, Gordon A, Gorenne I, Goubert L, Goujard C, Goulenok T, Grable M, Graf J, Grandin EW, Granier P, Grasselli G, Grazioli L, Green CA, Greene C, Greenhalf W, Greffe S, Grieco DL, Griffee M, Griffiths F, Grigoras I, Groenendijk A, Grosse Lordemann A, Gruner H, Gu Y, Guarracino F, Guedj J, Guego M, Guellec D, Guerguerian AM, Guerreiro D, Guery R, Guillaumot A, Guilleminault L, Guimarães de Castro M, Guimard T, Haalboom M, Haber D, Habraken H, Hachemi A, Hadri N, Haidash O, Haider S, Haidri F, Hakak S, Hall A, Hall M, Halpin S, Hamer A, Hamers R, Hamidfar R, Hammond T, Han LY, Haniffa R, Hao KW, Hardwick H, Harrison EM, Harrison J, Harrison SBE, Hartman A, Hashmi J, Hashmi M, Hayat M, Hayes A, Hays L, Heerman J, Heggelund L, Hendry R, Hennessy M, Henriquez A, Hentzien M, Herekar F, Hernandez-Montfort J, Herr D, Hershey A, Hesstvedt L, Hidayah A, Higgins D, Higgins E, HigginsOKeeffe G, Hinchion R, Hinton S, Hiraiwa H, Hitoto H, Ho A, Ho YB, Hoctin A, Hoffmann I, Hoh WH, Hoiting O, Holt R, Holter JC, Horby P, Horcajada JP, Hoshino K, Hoshino K, Houas I, Hough CL, Houltham S, Hsu JMY, Hulot JS, Hussain I, Ijaz S, Illes HG, Imbert P, Imran M, Imran Sikander R, Inácio H, Infante Dominguez C, Ing YS, Iosifidis E, Ippolito M, Isgett S, Ishani PGPI, Isidoro T, Ismail N, Isnard M, Itai J, Ito A, Ivulich D, Jaafar D, Jaafoura S, Jabot J, Jackson C, Jamieson N, Jaquet P, Jassat W, Jaud-Fischer C, Jaureguiberry S, Javidfar J, Jawad I, Jaworsky D, Jayakumar D, Jego F, Jelani AM, Jenum S, Jimbo-Sotomayor R, Job VDP, Joe OY, Jorge García RN, Joseph C, Joseph M, Joshi S, Jourdain M, Jouvet P, June J, Jung A, Jung H, Juzar D, Kafif O, Kaguelidou F, Kaisbain N, Kaleesvran T, Kali S, Kalicinska A, Kalomoiri S, Kamal S, Kamaluddin MAA, Kamaruddin ZAC, Kamarudin N, Kandamby DH, Kandel C, Kang KY, Kant R, Kanwal D, Kanyawati D, Karki B, Karpayah P, Karsies T, Kartsonaki C, Kasugai D, Kataria A, Katz K, Kaur A, Kaur Johal S, Kawasaki T, Kay C, Keane H, Keating S, Kellam P, Kelly A, Kelly A, Kelly C, Kelly N, Kelly S, Kelly Y, Kelsey M, Kennedy R, Kennon K, Kernan M, Kerroumi Y, Keshav S, Kestelyn E, Khalid I, Khalid O, Khalil A, Khan C, Khan I, Khanal S, Kho ME, Khoo D, Khoo R, Khoo S, Khoso N, Kiat KH, Kida Y, Kiiza P, Kildal AB, Kim JB, Kimmoun A, Kindgen-Milles D, King A, Kitamura N, Klenerman P, Klont R, Kloumann Bekken G, Knight S, Kobbe R, Kodippily C, Kohns Vasconcelos M, Koirala S, Komatsu M, Korten V, Kosgei C, Kpangon A, Krawczyk K, Krishnan S, Krishnan V, Kruglova O, Kumar A, Kumar D, Kumar G, Kumar M, Kumar Vecham P, Kuriakose D, Kurtzman E, Kusumastuti NP, Kutsogiannis D, Kutsyna G, Kyriakoulis K, Lachatre M, Lacoste M, Laffey JG, Lagrange M, Laine F, Lairez O, Lakhey S, Lalueza A, Lambert M, Lamontagne F, Langelot-Richard M, Langlois V, Lantang EY, Lanza M, Laouénan C, Laribi S, Lariviere D, Lasry S, Latif N, Launay O, Laureillard D, Lavie-Badie Y, Law A, Lawrence C, Lawrence T, Le M, Le Bihan C, Le Bris C, Le Falher G, Le Fevre L, Le Hingrat Q, Le Maréchal M, Le Mestre S, Le Moal G, Le Moing V, Le Nagard H, Le Turnier P, Leal E, Leal Santos M, Lee BH, Lee HG, Lee J, Lee SH, Lee TC, Lee YL, Leeming G, Lefebvre B, Lefebvre L, Lefevre B, LeGac S, Lelievre JD, Lellouche F, Lemaignen A, Lemee V, Lemeur A, Lemmink G, Lene HS, Lennon J, León R, Leone M, Leone M, Lepiller Q, Lescure FX, Lesens O, Lesouhaitier M, Lester-Grant A, Levy B, Levy Y, Levy-Marchal C, Lewandowska K, L'Her E, Li Bassi G, Liang J, Liaquat A, Liegeon G, Lim KC, Lim WS, Lima C, Lina B, Lina L, Lind A, Lingas G, Lion-Daolio S, Lissauer S, Liu K, Livrozet M, Lizotte P, Loforte A, Lolong N, Loon LC, Lopes D, Lopez-Colon D, Loschner AL, Loubet P, Loufti B, Louis G, Lourenco S, Lovelace-Macon L, Low LL, Lowik M, Loy JS, Lucet JC, Lumbreras Bermejo C, Luna CM, Lungu O, Luong L, Luque N, Luton D, Lwin N, Lyons R, Maasikas O, Mabiala O, MacDonald S, MacDonald S, Machado M, Macheda G, Macias Sanchez J, Madhok J, Maestro de la Calle G, Mahieu R, Mahy S, Maia AR, Maier LS, Maillet M, Maitre T, Malfertheiner M, Malik N, Mallon P, Maltez F, Malvy D, Manda V, Mandei JM, Mandelbrot L, Manetta F, Mangal K, Mankikian J, Manning E, Manuel A, Maria Sant`Ana Malaque C, Marino D, Marino F, Markowicz S, Maroun Eid C, Marques A, Marquis C, Marsh B, Marsh L, Marshal M, Marshall J, Martelli CT, Martin DA, Martin E, Martin-Blondel G, Martinelli A, Martin-Loeches I, Martinot M, Martin-Quiros A, Martins A, Martins J, Martins N, Martins Rego C, Martucci G, Martynenko O, Marwali EM, Marzukie M, Masa Jimenez JF, Maslove D, Maslove D, Mason P, Mason S, Masood S, Masood S, Mat Nor B, Matan M, Mateus Fernandes H, Mathew M, Mathieu D, Mattei M, Matulevics R, Maulin L, Maxwell M, Maynar J, Mazzoni T, Mc Sweeney L, McAndrew L, McArthur C, McCarthy A, McCarthy A, McCloskey C, McConnochie R, McDermott S, McDonald SE, McElroy A, McElwee S, McEneany V, McEvoy N, McGeer A, McKay C, McKeown J, McLean KA, McNally P, McNicholas B, McPartlan E, Meaney E, Mear-Passard C, Mechlin M, Meher M, Mehkri O, Mele F, Melo L, Memon K, Mendes JJ, Menkiti O, Menon K, Mentré F, Mentzer AJ, Mercier E, Mercier N, Merckx A, Mergeay-Fabre M, Mergler B, Merson L, Mesquita A, Metwally O, Meybeck A, Meyer D, Meynert AM, Meysonnier V, Meziane A, Mezidi M, Michelagnoli G, Michelanglei C, Michelet I, Mihelis E, Mihnovit V, Miranda-Maldonado H, Misnan NA, Mohamed NNE, Mohamed TJ, Moin A, Molina D, Molinos E, Molloy B, Mone M, Monteiro A, Montes C, Montrucchio G, Moore S, Moore SC, Morales Cely L, Moro L, Morocho Tutillo DR, Morton B, Motherway C, Motos A, Mouquet H, Mouton Perrot C, Moyet J, Mudara C, Mufti AK, Muh NY, Muhamad D, Mullaert J, Muller F, Müller KE, Munblit D, Muneeb S, Munir N, Munshi L, Murphy A, Murphy A, Murphy L, Murris M, Murthy S, Musaab H, Muyandy G, Myrodia DM, N N, Nagpal D, Nagrebetsky A, Narasimhan M, Narayanan N, Nasim Khan R, Nazerali-Maitland A, Neant N, Neb H, Nekliudov NA, Nelwan E, Neto R, Neumann E, Neves B, Ng PY, Nghi A, Nguyen D, Ni Choileain O, Ni Leathlobhair N, Nichol A, Nitayavardhana P, Nonas S, Noordin NAM, Noret M, Norharizam NFI, Norman L, Notari A, Noursadeghi M, Nowicka K, Nowinski A, Nseir S, Nunez JI, Nurnaningsih N, Nyamankolly E, O Brien F, O'Callaghan A, Occhipinti G, OConnor D, O'Donnell M, Ogston T, Ogura T, Oh TH, O'Halloran S, O'Hearn K, Ohshimo S, Oldakowska A, Oliveira J, Oliveira L, Olliaro PL, O'Neil C, Ong DS, Ong JY, Oosthuyzen W, Opavsky A, Openshaw P, Orakzai S, Orozco-Chamorro CM, Orquera A, Ortoleva J, Osatnik J, O'Shea L, O'Sullivan M, Othman SZ, Ouamara N, Ouissa R, Owyang C, Oziol E, Pabasara HMU, Pagadoy M, Pages J, Palacios A, Palacios M, Palmarini M, Panarello G, Panda PK, Paneru H, Pang LH, Panigada M, Pansu N, Papadopoulos A, Parke R, Parker M, Parra B, Parrini V, Pasha T, Pasquier J, Pastene B, Patauner F, Patel J, Pathmanathan MD, Patrão L, Patricio P, Patrier J, Patterson L, Pattnaik R, Paul C, Paul M, Paulos J, Paxton WA, Payen JF, Peariasamy K, Pedrera Jiménez M, Peek GJ, Peelman F, Peiffer-Smadja N, Peigne V, Pejkovska M, Pelosi P, Peltan ID, Pereira R, Perez D, Periel L, Perpoint T, Pesenti A, Pestre V, Petrou L, Petrov-Sanchez V, Pettersen FO, Peytavin G, Pharand S, Piagnerelli M, Picard W, Picone O, Piero MD, Pierobon C, Piersma D, Pimentel C, Pinto R, Pires C, Pironneau I, Piroth L, Pius R, Piva S, Plantier L, Plotkin D, Png HS, Poissy J, Pokeerbux R, Pokorska-Spiewak M, Poli S, Pollakis G, Ponscarme D, Popielska J, Post AM, Postma DF, Povoa P, Póvoas D, Powis J, Prapa S, Preau S, Prebensen C, Preiser JC, Prinssen A, Pritchard MG, Priyadarshani GDD, Proença L, Pudota S, Puéchal O, Pujo Semedi B, Pulicken M, Puntoni M, Purcell G, Quesada L, Quinones-Cardona V, Quirós González V, Quist-Paulsen E, Quraishi M, Rabaa M, Rabaud C, Rabindrarajan E, Rafael A, Rafiq M, Ragazzo G, Rahman AKHA, Rahman RA, Rahutullah A, Rainieri F, Rajahram GS, Rajapakse N, Ralib A, Ramakrishnan N, Ramanathan K, Ramli AA, Rammaert B, Ramos GV, Rana A, Rangappa R, Ranjan R, Rapp C, Rashan A, Rashan T, Rasheed G, Rasmin M, Rätsep I, Rau C, Ravi T, Raza A, Real A, Rebaudet S, Redl S, Reeve B, Rehan A, Rehman A, Reid L, Reid L, Reikvam DH, Reis R, Rello J, Remppis J, Remy M, Ren H, Renk H, Resende L, Resseguier AS, Revest M, Rewa O, Reyes LF, Reyes T, Ribeiro MI, Richardson D, Richardson D, Richier L, Ridzuan SNAA, Riera J, Rios AL, Rishu A, Rispal P, Risso K, Rivera Nuñez MA, Rizer N, Robb D, Robba C, Roberto A, Roberts S, Robertson DL, Robineau O, Roche-Campo F, Rodari P, Rodeia S, Rodriguez Abreu J, Roessler B, Roger C, Roger PM, Roilides E, Rojek A, Romaru J, Roncon-Albuquerque Jr R, Roriz M, Rosa-Calatrava M, Rose M, Rosenberger D, Rossanese A, Rossetti M, Rossignol B, Rossignol P, Rousset S, Roy C, Roze B, Rusmawatiningtyas D, Russell CD, Ryan M, Ryan M, Ryckaert S, Rygh Holten A, Saba I, Sadaf S, Sadat M, Sahraei V, Saint-Gilles M, Sakiyalak P, Salahuddin N, Salazar L, Saleem J, Saleem J, Sales G, Sallaberry S, Salmon Gandonniere C, Salvator H, Sanchez O, Sánchez Choez X, Sanchez de Oliveira K, Sanchez-Miralles A, Sancho-Shimizu V, Sandhu G, Sandhu Z, Sandrine PF, Sandulescu O, Santos M, Sarfo-Mensah S, Sarmento Banheiro B, Sarmiento ICE, Sarton B, Satyapriya S, Satyawati R, Saviciute E, Savio R, Savvidou P, Saw YT, Schaffer J, Schermer T, Scherpereel A, Schneider M, Schroll S, Schwameis M, Schwartz G, Scott JT, Scott-Brown J, Sedillot N, Seitz T, Selvanayagam J, Selvarajoo M, Semaille C, Semple MG, Senian RB, Senneville E, Sepulveda C, Sequeira F, Sequeira T, Serpa Neto A, Serrano Balazote P, Shadowitz E, Shahidan SA, Shahnaz Hasan M, Shamsah M, Shankar A, Sharjeel S, Sharma P, Shaw CA, Shaw V, Shi H, Shiban N, Shiekh M, Shiga T, Shime N, Shimizu H, Shimizu K, Shimizu N, Shindo N, Shrapnel S, Shum HP, Si Mohammed N, Siang NY, Sibiude J, Siddiqui A, Sigfrid L, Sillaots P, Silva C, Silva MJ, Silva R, Sim Lim Heng B, Sin WC, Singh BC, Singh P, Sitompul PA, Sivam K, Skogen V, Smith S, Smood B, Smyth C, Smyth M, Smyth M, Snacken M, So D, Soh TV, Solis M, Solomon J, Solomon T, Somers E, Sommet A, Song MJ, Song R, Song T, Song Chia J, Sonntagbauer M, Soom AM, Sotto A, Soum E, Sousa AC, Sousa M, Sousa Uva M, Souza-Dantas V, Sperry A, Spinuzza E, Sri Darshana BPSR, Sriskandan S, Stabler S, Staudinger T, Stecher SS, Steinsvik T, Stienstra Y, Stiksrud B, Stolz E, Stone A, Streinu-Cercel A, Streinu-Cercel A, Strudwick S, Stuart A, Stuart D, Subekti D, Suen G, Suen JY, Sukumar P, Sultana A, Summers C, Supic D, Suppiah D, Surovcová M, Suwarti S, Svistunov AA, Syahrin S, Syrigos K, Sztajnbok J, Szuldrzynski K, Tabrizi S, Taccone FS, Tagherset L, Taib SM, Talarek E, Taleb S, Talsma J, Tampubolon ML, Tan KK, Tan LV, Tan YC, Tanaka C, Tanaka H, Tanaka T, Taniguchi H, Tanveer H, Taqdees H, Taqi A, Tardivon C, Tattevin P, Taufik MA, Tawfik H, Tedder RS, Tee TY, Teixeira J, Tejada S, Tellier MC, Teoh SK, Teotonio V, Téoulé F, Terpstra P, Terrier O, Terzi N, Tessier-Grenier H, Tey A, Thabit AAM, Tham ZD, Thangavelu S, Thibault V, Thiberville SD, Thill B, Thirumanickam J, Thompson S, Thomson D, Thomson EC, Thurai SRT, Thuy DB, Thwaites RS, Tierney P, Tieroshyn V, Timashev PS, Timsit JF, Tirupakuzhi Vijayaraghavan BK, Tissot N, Toh JZY, Toki M, Tolppa T, Tonby K, Tonnii SL, Torres A, Torres M, Torres Santos-Olmo RM, Torres-Zevallos H, Towers M, Trapani T, Traynor D, Treoux T, Trieu HT, Tripathy S, Tromeur C, Trontzas I, Trouillon T, Truong J, Tual C, Tubiana S, Tuite H, Turmel JM, Turtle LC, Tveita A, Twardowski P, Uchiyama M, Udayanga PGI, Udy A, Ullrich R, Umer Z, Uribe A, Usman A, Vajdovics C, Val-Flores L, Valle AL, Valran A, Van de Velde S, van den Berge M, van der Feltz M, van der Valk P, Van Der Vekens N, Van der Voort P, Van Der Werf S, van Dyk M, van Gulik L, Van Hattem J, van Lelyveld S, van Netten C, Van Twillert G, van Veen I, Vanel N, Vanoverschelde H, Varghese P, Varrone M, Vasudayan SR, Vauchy C, Vaughan H, Veeran S, Veislinger A, Vencken S, Ventura S, Verbon A, Vidal JE, Vieira C, Vijayan D, Villanueva JA, Villar J, Villeneuve PM, Villoldo A, Vinh Chau NV, Visseaux B, Visser H, Vitiello C, Vonkeman H, Vuotto F, Wahab NH, Wahab SA, Wahid NA, Wainstein M, Wan Muhd Shukeri WF, Wang CH, Webb SA, Wei J, Weil K, Wen TP, Wesselius S, West TE, Wham M, Whelan B, White N, Wicky PH, Wiedemann A, Wijaya SO, Wille K, Willems S, Williams V, Wils EJ, Wing Yiu N, Wong C, Wong TF, Wong XC, Wong YS, Xian GE, Xian LS, Xuan KP, Xynogalas I, Yacoub S, Yakop SRBM, Yamazaki M, Yazdanpanah Y, Yee Liang Hing N, Yelnik C, Yeoh CH, Yerkovich S, Yokoyama T, Yonis H, Yousif O, Yuliarto S, Zaaqoq A, Zabbe M, Zacharowski K, Zahid M, Zahran M, Zaidan NZB, Zambon M, Zambrano M, Zanella A, Zawadka K, Zaynah N, Zayyad H, Zoufaly A, Zucman D. The value of open-source clinical science in pandemic response: lessons from ISARIC. Lancet Infect Dis 2021; 21:1623-1624. [PMID: 34619109 PMCID: PMC8489876 DOI: 10.1016/s1473-3099(21)00565-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/16/2021] [Indexed: 12/31/2022]
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Setianingrum F, Rozaliyani A, Adawiyah R, Syam R, Tugiran M, Sari CYI, Nandipinto F, Ramnath J, Arifin AR, Handayani D, Burhan E, Rumende M, Wahyuningsih R, Rautemaa-Richardson R, Denning DW. A prospective longitudinal study of chronic pulmonary aspergillosis in pulmonary tuberculosis in Indonesia (APICAL). Thorax 2021; 77:821-828. [PMID: 34848556 PMCID: PMC9340040 DOI: 10.1136/thoraxjnl-2020-216464] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 07/23/2021] [Indexed: 11/30/2022]
Abstract
Objectives Chronic pulmonary aspergillosis (CPA) can complicate recovery from pulmonary TB. CPA may also be misdiagnosed as bacteriologically negative TB. This study aimed to determine the incidence of CPA in patients treated for TB in Indonesia, a country with a high incidence of TB. Methods In this prospective, longitudinal cohort study in patients treated for pulmonary TB, clinical, radiological and laboratory findings were analysed. Sputum was collected for fungal culture and TB PCR. Patients were assessed at baseline (0–8 weeks) and at the end (5–6 months) of TB therapy. CPA diagnosis was based on symptoms (≥3 months), characteristic radiological features and positive Aspergillus serology, and categorised as proven, probable and possible. Results Of the 216 patients recruited, 128 (59%) were followed up until end of TB therapy. At baseline, 91 (42%) had microbiological evidence for TB. Aspergillus-specific IgG was positive in 64 (30%) patients and went from negative to positive in 16 (13%) patients during TB therapy. The incidence rates of proven and probable CPA at baseline were 6% (n=12) and 2% (n=5) and end of TB therapy 8% (n=10) and 5% (n=7), respectively. Six patients (two with confirmed TB) developed an aspergilloma. Diabetes mellitus was a significant risk factor for CPA (p=0.040). Persistent cough (n=5, 50%; p=0.005) and fatigue (n=6, 60%; p=0.001) were the most common symptoms in CPA. Conclusion CPA should be considered a relatively frequent differential diagnosis in patients with possible or proven TB in Indonesia. Lack of awareness and limited access to Aspergillus-specific IgG tests and CT imaging are obstacles in establishing a CPA diagnosis.
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Affiliation(s)
- Findra Setianingrum
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Pulmonary Mycosis Centre, Jakarta, Indonesia
| | - Anna Rozaliyani
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Pulmonary Mycosis Centre, Jakarta, Indonesia.,Grha Permata Ibu Hospital, Jakarta, Indonesia.,MH Thamrin Hospital, Jakarta, Indonesia
| | - Robiatul Adawiyah
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Pulmonary Mycosis Centre, Jakarta, Indonesia
| | - Ridhawati Syam
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Pulmonary Mycosis Centre, Jakarta, Indonesia
| | - Mulyati Tugiran
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Pulmonary Mycosis Centre, Jakarta, Indonesia
| | | | | | - Johannes Ramnath
- Department of Internal Medicine, Faculty of Medicine, Universitas Kristen Indonesia, Jakarta, Indonesia.,Universitas Kristen Indonesia Hospital, Jakarta, Indonesia
| | - Arief Riadi Arifin
- Pulmonary Mycosis Centre, Jakarta, Indonesia.,MH Thamrin Hospital, Jakarta, Indonesia
| | - Diah Handayani
- Pulmonary Mycosis Centre, Jakarta, Indonesia.,Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia
| | - Erlina Burhan
- Pulmonary Mycosis Centre, Jakarta, Indonesia.,Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia
| | - Martin Rumende
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Dr Ciptomangunkusumo Hospital, Jakarta, Indonesia
| | - Retno Wahyuningsih
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Pulmonary Mycosis Centre, Jakarta, Indonesia.,Department of Parasitology, Faculty of Medicine, Universitas Kristen Indonesia, Jakarta, Indonesia
| | - Riina Rautemaa-Richardson
- Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,National Aspergillosis Centre and the Department of Infectious Diseases, Manchester University NHS Foundation Trust, Manchester, UK
| | - David W Denning
- Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK .,Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Agustina R, Syam AF, Wirawan F, Widyahening IS, Rahyussalim AJ, Yusra Y, Rianda D, Burhan E, Salama N, Daulay R, Halim ARV, Shankar AH. Integration of symptomatic, demographical and diet-related comorbidities data with SARS-CoV-2 antibody rapid diagnostic tests during epidemiological surveillance: a cross-sectional study in Jakarta, Indonesia. BMJ Open 2021; 11:e047763. [PMID: 34376448 PMCID: PMC8359859 DOI: 10.1136/bmjopen-2020-047763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/25/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Affordable options for COVID-19 epidemiological surveillance are needed. Virus detection by reverse transcription-PCR (RT-PCR) is sensitive but costly, and antigen-based rapid diagnostic tests (RDTs) are cheap but with reduced sensitivity; both detect current infection but not exposure. RDT-IgM/IgG antibodies to SARS-CoV-2 detect exposure but have poor sensitivity for current infection. We investigated if the integration of symptomatic, demographical and diet-related comorbidities data with antibody RDTs improves their potential to assess infection rates in addition to exposure, thereby broadening their utility for surveillance. DESIGN We conducted a cross-sectional study using data from community surveillance for SARS-CoV-2. Health workers collected nasopharyngeal swabs for RT-PCR and RDT antigen assessments and venous blood for RDT-IgM/IgG from symptomatic and asymptomatic persons. Data on age, gender, contact history, symptoms (ie, fever, cough, runny nose, sore throat, headache, dyspnoea and diarrhoea), diet-related comorbidities (ie, diabetes and hypertension) and chest radiology were collected. SETTING High-risk communities in Jakarta, Indonesia, in May 2020. PARTICIPANTS 343 community members' data were included. OUTCOME MEASURES RDT-IgM/IgG sensitivity, specificity and predictive values and area under receiver operating characteristic curve for RT-PCR positivity using RDT results alone and in combination with other predictors, including symptom components derived from principal component analysis. RESULTS There were 24 PCR-confirmed infections. RDT-IgM/IgG-positive tests were associated with infection (OR 10.8, 95% CI 4.43 to 26.4, p<0.001) with an area under the curve (AUC) of 0.708% and 50% sensitivity, 91.5% specificity, 30.8% positive predictive value (PPV) and 96.1% negative predictive value (NPV). RDT results combined with age, gender, contact history, symptoms and comorbidities increased the AUC to 0.787 and yielded 62.5% sensitivity, 87.0% specificity, 26.6% PPV and 96.9% NPV. CONCLUSIONS SARS-CoV-2 RDT-IgM/IgG results integrated with other predictors may be an affordable tool for epidemiological surveillance for population-based COVID-19 exposure and current infection, especially in groups with outbreaks or high transmission.
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Affiliation(s)
- Rina Agustina
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
- Human Nutrition Research Center - Indonesian Medical Education and Research Institute (HNRC-IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ari Fahrial Syam
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Fadila Wirawan
- Human Nutrition Research Center - Indonesian Medical Education and Research Institute (HNRC-IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Indah S Widyahening
- Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Clinical Epidemiology and Evidence-Based Medicine Unit, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Ahmad Jabir Rahyussalim
- Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Yusra Yusra
- Department of Clinical Pathology, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Davrina Rianda
- Human Nutrition Research Center - Indonesian Medical Education and Research Institute (HNRC-IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Erlina Burhan
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Ngabila Salama
- Health Office, Government of DKI Jakarta Province, Jakarta, Indonesia
| | - Rebekka Daulay
- Health Office, Government of DKI Jakarta Province, Jakarta, Indonesia
| | | | - Anuraj H Shankar
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Eijkman-Oxford Clinical Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
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Dilogo IH, Aditianingsih D, Sugiarto A, Burhan E, Damayanti T, Sitompul PA, Mariana N, Antarianto RD, Liem IK, Kispa T, Mujadid F, Novialdi N, Luviah E, Kurniawati T, Lubis AMT, Rahmatika D. Umbilical cord mesenchymal stromal cells as critical COVID-19 adjuvant therapy: A randomized controlled trial. Stem Cells Transl Med 2021; 10:1279-1287. [PMID: 34102020 PMCID: PMC8242692 DOI: 10.1002/sctm.21-0046] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/20/2021] [Indexed: 12/11/2022] Open
Abstract
One of the main causes of acute respiratory distress syndrome in coronavirus disease 2019 (COVID-19) is cytokine storm, although the exact cause is still unknown. Umbilical cord mesenchymal stromal cells (UC-MSCs) influence proinflammatory T-helper 2 (Th2 ) cells to shift to an anti-inflammatory agent. To investigate efficacy of UC-MSC administration as adjuvant therapy in critically ill patients with COVID-19, we conducted a double-blind, multicentered, randomized controlled trial at four COVID-19 referral hospitals in Jakarta, Indonesia. This study included 40 randomly allocated critically ill patients with COVID-19; 20 patients received an intravenous infusion of 1 × 106 /kg body weight UC-MSCs in 100 ml saline (0.9%) solution (SS) and 20 patients received 100 ml 0.9% SS as the control group. All patients received standard therapy. The primary outcome was measured by survival rate and/or length of ventilator usage. The secondary outcome was measured by clinical and laboratory improvement, with serious adverse events. Our study showed the survival rate in the UC-MSCs group was 2.5 times higher than that in the control group (P = .047), which is 10 patients and 4 patients in the UC-MSCs and control groups, respectively. In patients with comorbidities, UC-MSC administration increased the survival rate by 4.5 times compared with controls. The length of stay in the intensive care unit and ventilator usage were not statistically significant, and no adverse events were reported. The application of infusion UC-MSCs significantly decreased interleukin 6 in the recovered patients (P = .023). Therefore, application of intravenous UC-MSCs as adjuvant treatment for critically ill patients with COVID-19 increases the survival rate by modulating the immune system toward an anti-inflammatory state.
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Affiliation(s)
- Ismail Hadisoebroto Dilogo
- Stem Cell Medical Technology Integrated Service Unit, Cipto Mangunkusumo Central Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.,Stem Cell and Tissue Engineering Research Cluster Indonesian Medical Education and Research Institute (IMERI) Universitas Indonesia, Jakarta, Indonesia.,Department of Orthopaedic and Traumatology, Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Dita Aditianingsih
- Department of Anesthesiology and Intensive Care Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.,Intensive Care Division, Universitas Indonesia Hospital, Depok, Indonesia
| | - Adhrie Sugiarto
- Department of Anesthesiology and Intensive Care Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Erlina Burhan
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine Universitas Indonesia, Persahabatan General Hospital, Jakarta, Indonesia
| | - Triya Damayanti
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine Universitas Indonesia, Persahabatan General Hospital, Jakarta, Indonesia
| | - Pompini Agustina Sitompul
- Directorate of Medical Services, Nursing and Supporting, Sulianti Saroso Infection Disease Hospital, Jakarta, Indonesia
| | - Nina Mariana
- Directorate of Human Resources Development, Education and Operational Sulianti Saroso Infection Disease Hospital, Jakarta, Indonesia
| | - Radiana D Antarianto
- Stem Cell and Tissue Engineering Research Cluster Indonesian Medical Education and Research Institute (IMERI) Universitas Indonesia, Jakarta, Indonesia.,Department of Histology, Universitas Indonesia Fakultas Kedokteran, Jakarta, Indonesia
| | - Isabella Kurnia Liem
- Stem Cell Medical Technology Integrated Service Unit, Cipto Mangunkusumo Central Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.,Stem Cell and Tissue Engineering Research Cluster Indonesian Medical Education and Research Institute (IMERI) Universitas Indonesia, Jakarta, Indonesia.,Department of Anatomy, Universitas Indonesia Fakultas Kedokteran, Jakarta, Indonesia
| | - Tera Kispa
- Stem Cell Medical Technology Integrated Service Unit, Cipto Mangunkusumo Central Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Fajar Mujadid
- Stem Cell Medical Technology Integrated Service Unit, Cipto Mangunkusumo Central Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Novialdi Novialdi
- Stem Cell Medical Technology Integrated Service Unit, Cipto Mangunkusumo Central Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Evah Luviah
- Stem Cell and Tissue Engineering Research Cluster Indonesian Medical Education and Research Institute (IMERI) Universitas Indonesia, Jakarta, Indonesia
| | - Tri Kurniawati
- Stem Cell Medical Technology Integrated Service Unit, Cipto Mangunkusumo Central Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Andri M T Lubis
- Department of Orthopaedic and Traumatology, Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.,Installation of Innovation Management and Intellectual Property, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Dina Rahmatika
- Stem Cell Medical Technology Integrated Service Unit, Cipto Mangunkusumo Central Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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Rozaliyani A, Setianingrum F, Azahra S, Abdullah A, Fatril AE, Rosianawati H, Burhan E, Handayani D, Arifin AR, Zaini J, Tugiran M, Adawiyah R, Syam R, Wibowo H, Wahyuningsih R, Kosmidis C, Denning DW. Performance of LDBio Aspergillus WB and ICT Antibody Detection in Chronic Pulmonary Aspergillosis. J Fungi (Basel) 2021; 7:311. [PMID: 33919511 PMCID: PMC8073219 DOI: 10.3390/jof7040311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 12/30/2022] Open
Abstract
The detection of Aspergillus antibody has a key role in the diagnosis of chronic pulmonary aspergillosis. Western blot (WB) and immunochromatography (ICT) lateral flow detection of Aspergillus antibody can be used as confirmatory and screening assays but their comparative performance in TB patients is not known. This study investigated the performance of these assays among 88 post-tuberculosis patients with suspected CPA. Sensitivity, specificity, receiver operating curve (ROC), area under-curve (AUC) and the agreement between two assays were evaluated. Both WB and ICT showed good sensitivity (80% and 85%, respectively) for detection of Aspergillus antibodies. Substantial agreement (0.716) between these assays was also obtained. The highest AUC result (0.804) was achieved with the combination of WB and ICT. The global intensity of WB correlated with the severity of symptoms in CPA group (p = 0.001). The combination of WB and ICT may increase specificity in CPA diagnosis.
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Affiliation(s)
- Anna Rozaliyani
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (F.S.); (A.A.); (A.E.F.); (M.T.); (R.A.); (R.S.); (H.W.); (R.W.)
- Pulmonary Mycosis Centre, Jakarta 10430, Indonesia; (E.B.); (D.H.); (A.R.A.); (J.Z.)
| | - Findra Setianingrum
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (F.S.); (A.A.); (A.E.F.); (M.T.); (R.A.); (R.S.); (H.W.); (R.W.)
- Pulmonary Mycosis Centre, Jakarta 10430, Indonesia; (E.B.); (D.H.); (A.R.A.); (J.Z.)
| | - Sresta Azahra
- Magister Program of Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia;
| | - Asriyani Abdullah
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (F.S.); (A.A.); (A.E.F.); (M.T.); (R.A.); (R.S.); (H.W.); (R.W.)
| | - Ayu Eka Fatril
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (F.S.); (A.A.); (A.E.F.); (M.T.); (R.A.); (R.S.); (H.W.); (R.W.)
| | - Harmi Rosianawati
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Persahabatan National Respiratory Referral Hospital, Jakarta 13230, Indonesia;
| | - Erlina Burhan
- Pulmonary Mycosis Centre, Jakarta 10430, Indonesia; (E.B.); (D.H.); (A.R.A.); (J.Z.)
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Persahabatan National Respiratory Referral Hospital, Jakarta 13230, Indonesia;
| | - Diah Handayani
- Pulmonary Mycosis Centre, Jakarta 10430, Indonesia; (E.B.); (D.H.); (A.R.A.); (J.Z.)
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Persahabatan National Respiratory Referral Hospital, Jakarta 13230, Indonesia;
| | - Arief Riadi Arifin
- Pulmonary Mycosis Centre, Jakarta 10430, Indonesia; (E.B.); (D.H.); (A.R.A.); (J.Z.)
- MH Thamrin Hospital, Jakarta 10440, Indonesia
| | - Jamal Zaini
- Pulmonary Mycosis Centre, Jakarta 10430, Indonesia; (E.B.); (D.H.); (A.R.A.); (J.Z.)
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Persahabatan National Respiratory Referral Hospital, Jakarta 13230, Indonesia;
| | - Mulyati Tugiran
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (F.S.); (A.A.); (A.E.F.); (M.T.); (R.A.); (R.S.); (H.W.); (R.W.)
- Pulmonary Mycosis Centre, Jakarta 10430, Indonesia; (E.B.); (D.H.); (A.R.A.); (J.Z.)
| | - Robiatul Adawiyah
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (F.S.); (A.A.); (A.E.F.); (M.T.); (R.A.); (R.S.); (H.W.); (R.W.)
- Pulmonary Mycosis Centre, Jakarta 10430, Indonesia; (E.B.); (D.H.); (A.R.A.); (J.Z.)
| | - Ridhawati Syam
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (F.S.); (A.A.); (A.E.F.); (M.T.); (R.A.); (R.S.); (H.W.); (R.W.)
- Pulmonary Mycosis Centre, Jakarta 10430, Indonesia; (E.B.); (D.H.); (A.R.A.); (J.Z.)
| | - Heri Wibowo
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (F.S.); (A.A.); (A.E.F.); (M.T.); (R.A.); (R.S.); (H.W.); (R.W.)
- Pulmonary Mycosis Centre, Jakarta 10430, Indonesia; (E.B.); (D.H.); (A.R.A.); (J.Z.)
| | - Retno Wahyuningsih
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (F.S.); (A.A.); (A.E.F.); (M.T.); (R.A.); (R.S.); (H.W.); (R.W.)
- Pulmonary Mycosis Centre, Jakarta 10430, Indonesia; (E.B.); (D.H.); (A.R.A.); (J.Z.)
- Department of Parasitology, Faculty of Medicine, Universitas Kristen, Jakarta 13530, Indonesia
| | - Chris Kosmidis
- Manchester Academic Health Science Centre, Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, School of Biological Sciences, Medicine and Health, University of Manchester, Manchester M23 9LT, UK; (C.K.); (D.W.D.)
| | - David W Denning
- Manchester Academic Health Science Centre, Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, School of Biological Sciences, Medicine and Health, University of Manchester, Manchester M23 9LT, UK; (C.K.); (D.W.D.)
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27
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Surendra H, Elyazar IR, Djaafara BA, Ekawati LL, Saraswati K, Adrian V, Widyastuti, Oktavia D, Salama N, Lina RN, Andrianto A, Lestari KD, Burhan E, Shankar AH, Thwaites G, Baird JK, Hamers RL. Clinical characteristics and mortality associated with COVID-19 in Jakarta, Indonesia: A hospital-based retrospective cohort study. Lancet Reg Health West Pac 2021; 9:100108. [PMID: 33681830 PMCID: PMC7924904 DOI: 10.1016/j.lanwpc.2021.100108] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 01/08/2023]
Abstract
Background Data on COVID-19-related mortality and associated factors from low-resource settings are scarce. This study examined clinical characteristics and factors associated with in-hospital mortality of COVID-19 patients in Jakarta, Indonesia, from March 2 to July 31, 2020. Methods This retrospective cohort included all hospitalised patients with PCR-confirmed COVID-19 in 55 hospitals. We extracted demographic and clinical data, including hospital outcomes (discharge or death). We used logistic regression to examine factors associated with mortality. Findings Of 4265 patients with a definitive outcome by July 31, 3768 (88%) were discharged and 497 (12%) died. The median age was 46 years (IQR 32-57), 5% were children, and 31% had >1 comorbidity. Age-specific mortalities were 11% (7/61) for <5 years; 4% (1/23) for 5-9; 2% (3/133) for 10-19; 2% (8/638) for 20-29; 3% (26/755) for 30-39; 7% (61/819) for 40-49; 17% (155/941) for 50-59; 22% (132/611) for 60-69; and 34% (96/284) for ≥70. Risk of death was associated with higher age, male sex; pre-existing hypertension, diabetes, or chronic kidney disease; clinical diagnosis of pneumonia; multiple (>3) symptoms; immediate ICU admission, or intubation. Across all ages, risk of death was higher for patients with >1 comorbidity compared to those without; notably the risk was six-fold increased among patients <50 years (adjusted odds ratio 5.87, 95%CI 3.28-10.52; 27% vs 3% mortality). Interpretation Overall in-hospital mortality was lower than reported in high-income countries, probably due to younger age distribution and fewer comorbidities. Deaths occurred across all ages, with >10% mortality among children <5 years and adults >50 years.
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Affiliation(s)
- Henry Surendra
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia.,Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Akademi Ilmuwan Muda Indonesia, Jakarta, Indonesia
| | - Iqbal Rf Elyazar
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia.,Akademi Ilmuwan Muda Indonesia, Jakarta, Indonesia
| | - Bimandra A Djaafara
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia.,MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Lenny L Ekawati
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Kartika Saraswati
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Verry Adrian
- Jakarta Provincial Health Office, Jakarta, Indonesia
| | - Widyastuti
- Jakarta Provincial Health Office, Jakarta, Indonesia
| | - Dwi Oktavia
- Jakarta Provincial Health Office, Jakarta, Indonesia
| | | | - Rosa N Lina
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| | - Adhi Andrianto
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| | | | - Erlina Burhan
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Anuraj H Shankar
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Guy Thwaites
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - J Kevin Baird
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Raph L Hamers
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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28
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Lamontagne F, Stegemann M, Agarwal A, Agoritsas T, Siemieniuk R, Rochwerg B, Bartoszko J, Askie L, Macdonald H, Al-Maslamani M, Amin W, Da Silva ARA, Barragan FAJ, Bausch FJ, Burhan E, Cecconi M, Chacko B, Chanda D, Dat VQ, Du B, Geduld H, Gee P, Haider M, Nerina H, Hashimi M, Jehan F, Hui D, Hunt BJ, Ismail M, Kabra S, Kanda S, Kawano-Dourado L, Kim YJ, Kissoon N, Krishna S, Kwizera A, Lisboa T, Leo YS, Mahaka I, Hela M, Migliori GB, Mino G, Nsutebu E, Pshenichnaya N, Qadir N, Ranganathan SS, Sabzwari S, Sarin R, Shankar-Hari M, Sharland M, Shen Y, Souza JP, Tshokey T, Ugarte S, Uyeki T, Venkatapuram S, Wachinou AP, Wijewickrama A, Vuyiseka D, Preller J, Brignardello-Petersen R, Kum E, Qasim A, Zeraatkar D, Owen A, Guyatt G, Lytvyn L, Jacobs M, Vandvik PO, Diaz J. A living WHO guideline on drugs to prevent covid-19. BMJ 2021; 372:n526. [PMID: 33649077 DOI: 10.1136/bmj.n526] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
CLINICAL QUESTION What is the role of drugs in preventing covid-19? WHY DOES THIS MATTER?: There is widespread interest in whether drug interventions can be used for the prevention of covid-19, but there is uncertainty about which drugs, if any, are effective. The first version of this living guideline focuses on the evidence for hydroxychloroquine. Subsequent updates will cover other drugs being investigated for their role in the prevention of covid-19. RECOMMENDATION The guideline development panel made a strong recommendation against the use of hydroxychloroquine for individuals who do not have covid-19 (high certainty). HOW THIS GUIDELINE WAS CREATED This living guideline is from the World Health Organization (WHO) and provides up to date covid-19 guidance to inform policy and practice worldwide. Magic Evidence Ecosystem Foundation (MAGIC) provided methodological support. A living systematic review with network analysis informed the recommendations. An international guideline development panel of content experts, clinicians, patients, an ethicist and methodologists produced recommendations following standards for trustworthy guideline development using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. UNDERSTANDING THE NEW RECOMMENDATION The linked systematic review and network meta-analysis (6 trials and 6059 participants) found that hydroxychloroquine had a small or no effect on mortality and admission to hospital (high certainty evidence). There was a small or no effect on laboratory confirmed SARS-CoV-2 infection (moderate certainty evidence) but probably increased adverse events leading to discontinuation (moderate certainty evidence). The panel judged that almost all people would not consider this drug worthwhile. In addition, the panel decided that contextual factors such as resources, feasibility, acceptability, and equity for countries and healthcare systems were unlikely to alter the recommendation. The panel considers that this drug is no longer a research priority and that resources should rather be oriented to evaluate other more promising drugs to prevent covid-19. UPDATES This is a living guideline. New recommendations will be published in this article and signposted by update notices to this guideline. READERS NOTE This is the first version of the living guideline for drugs to prevent covid-19. It complements the WHO living guideline on drugs to treat covid-19. When citing this article, please consider adding the update number and date of access for clarity.
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Affiliation(s)
- François Lamontagne
- Université de Sherbrooke, Centre de recherche due CHU de Sherbrooke, Sherbrooke, Quebec, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Miriam Stegemann
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases, Respiratory Medicine and Critical Care, Berlin, Germany
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Arnav Agarwal
- Division of General Internal Medicine, McMaster University, Hamilton, Ontario, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Thomas Agoritsas
- Division of General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- MAGIC Evidence Ecosystem Foundation, Oslo, Norway
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Reed Siemieniuk
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Jessica Bartoszko
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Lisa Askie
- World Health Organization, Geneva, Switzerland
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Helen Macdonald
- The BMJ, London, UK
- Not guideline development group member; resource for methodology, systematic review, and content support
| | | | - Wagdy Amin
- Ministry of Health and Population, Cairo, Egypt
| | | | | | | | - Erlina Burhan
- Infection Division, Department of Pulmonology and Respiratory Medicine, Faculty of Medicine Universitas Indonesia
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Binila Chacko
- Division of Critical Care Medicine at Christian Medical College, Vellore, India
| | - Duncan Chanda
- Adult Infectious Disease Centre, University Teaching Hospital, Lusaka, Zambia
| | - Vu Quoc Dat
- Department of Infectious Diseases, Hanoi Medical University, Hanoi, Vietnam
| | - Bin Du
- Peking Union Medical College Hospital, Beijing, China
| | - Heike Geduld
- Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | | | | | | | | | - David Hui
- Stanley Ho Centre for Emerging Infectious Diseases, Chinese University of Hong Kong, Hong Kong SAR, China
| | | | | | - Sushil Kabra
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Leticia Kawano-Dourado
- Pulmonary Division, Heart Institute (InCor)- HCFMUSP, Medical School, University of Sao Paulo, São Paulo, Brazil and Research Institute, Hospital do Coração (HCor), São Paulo, Brazil
| | - Yae-Jean Kim
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Niranjan Kissoon
- Department of Paediatrics and Emergency Medicine, University of British Columbia, Vancouver, Canada
| | | | - Arthur Kwizera
- Department of Anaesthesia and Critical Care, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Yee-Sin Leo
- National Center for Infectious Diseases, Singapore
| | | | - Manai Hela
- Emergency Medical Services, Faculty of Medicine, Tunis, Tunisia
| | | | | | | | | | - Nida Qadir
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | | | | | - Rohit Sarin
- National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | | | | | - Yinzhong Shen
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | | | | | - Sebastian Ugarte
- Faculty of Medicine Andres Bello University, Indisa Clinic, Santiago, Chile
| | - Tim Uyeki
- Influenza Division, Centers for Disease Control and Prevention, USA
| | | | | | | | | | - Jacobus Preller
- World Health Organization, Geneva, Switzerland
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Romina Brignardello-Petersen
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Elena Kum
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Anila Qasim
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Andrew Owen
- University of Liverpool, Liverpool, UK
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Lyubov Lytvyn
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Michael Jacobs
- Royal Free London NHS Foundation Trust, London, UK
- Not guideline development group member; resource for methodology, systematic review, and content support
- co-senior author
| | - Per Olav Vandvik
- MAGIC Evidence Ecosystem Foundation, Oslo, Norway
- Department of Health Economics and Health Management, Institute for Health and Society, University of Oslo, Oslo, Norway
- Not guideline development group member; resource for methodology, systematic review, and content support
- co-senior author
| | - Janet Diaz
- World Health Organization, Geneva, Switzerland
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Not guideline development group member; resource for methodology, systematic review, and content support
- co-senior author
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29
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Aniwidyaningsih W, Elhidsi M, Sari A, Burhan E. Characteristics and outcomes of endobronchial tuberculosis therapy. Lung India 2021; 38:101-103. [PMID: 33402653 PMCID: PMC8066932 DOI: 10.4103/lungindia.lungindia_132_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Wahju Aniwidyaningsih
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia - Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia
| | - Mia Elhidsi
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia - Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia
| | - Adistya Sari
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia - Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia
| | - Erlina Burhan
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia - Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia
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Nurwidya F, Arliny Y, Yunus F, Burhan E, Andarini S, A Jusman S, Yunir E, Kekalih A, Soeroton A. Diagnostic Predictors of Active Tuberculosis Infection in Diabetic Patients with Latent Tuberculosis: A Review on Cathelicidin and 1,25-dihydroxyvitamin D3. J Nat Sci Biol Med 2021. [DOI: 10.4103/jnsbm.jnsbm_26_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Rozaliyani A, Rosianawati H, Handayani D, Agustin H, Zaini J, Syam R, Adawiyah R, Tugiran M, Setianingrum F, Burhan E, Kosmidis C, Wahyuningsih R. Chronic Pulmonary Aspergillosis in Post Tuberculosis Patients in Indonesia and the Role of LDBio Aspergillus ICT as Part of the Diagnosis Scheme. J Fungi (Basel) 2020; 6:jof6040318. [PMID: 33260909 PMCID: PMC7712371 DOI: 10.3390/jof6040318] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/27/2020] [Accepted: 11/18/2020] [Indexed: 12/24/2022] Open
Abstract
Chronic pulmonary aspergillosis (CPA) is a common sequela of pulmonary tuberculosis (TB). The diagnosis of CPA is difficult and often misdiagnosed as smear-negative TB in endemic settings. Aspergillus IgG detection is the cornerstone of CPA diagnosis. There are a lack of studies on the prevalence of CPA in GeneXpert/smear-negative TB patients in Indonesia, despite a high number of TB cases. This study aims to determine the CPA rate in HIV-negative, GeneXpert-negative patients presenting with symptoms following completion of TB therapy and to evaluate the performance of LDBio Aspergillus immunochromatographic technology (ICT) lateral flow assay in the diagnosis of CPA. CPA was diagnosed on the basis of symptoms for ≥3 months, characteristic chest imaging and positive Aspergillus culture. Twenty (22%) out of 90 patients met the criteria for CPA. The LDBio test was positive in 16 (80%) CPA patients and in 21 (30%) non-CPA patients (p < 0.001) with 80% sensitivity and 70% specificity. Logistic regression revealed a positive LDBio Aspergillus ICT result, smoking history and diabetes to be important predictors of CPA diagnosis. Although CPA is an unrecognised disease in Indonesia, this study suggests that more than one in five GeneXpert negative patients with persistent symptoms following completion of TB therapy may have CPA.
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Affiliation(s)
- Anna Rozaliyani
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (R.S.); (R.A.); (M.T.); (F.S.); (R.W.)
- Pulmonary Mycosis Centre, Jakarta 10430, Indonesia; (H.R.); (D.H.); (H.A.); (J.Z.); (E.B.)
- Grha Permata Ibu Hospital, Depok 16425, Indonesia
- Correspondence: ; Tel.: +62-213-102-135; Fax: +62-21-3983-2018
| | - Harmi Rosianawati
- Pulmonary Mycosis Centre, Jakarta 10430, Indonesia; (H.R.); (D.H.); (H.A.); (J.Z.); (E.B.)
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Persahabatan National Respiratory Referral Hospital, Jakarta 13230, Indonesia
| | - Diah Handayani
- Pulmonary Mycosis Centre, Jakarta 10430, Indonesia; (H.R.); (D.H.); (H.A.); (J.Z.); (E.B.)
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Persahabatan National Respiratory Referral Hospital, Jakarta 13230, Indonesia
| | - Heidy Agustin
- Pulmonary Mycosis Centre, Jakarta 10430, Indonesia; (H.R.); (D.H.); (H.A.); (J.Z.); (E.B.)
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Persahabatan National Respiratory Referral Hospital, Jakarta 13230, Indonesia
| | - Jamal Zaini
- Pulmonary Mycosis Centre, Jakarta 10430, Indonesia; (H.R.); (D.H.); (H.A.); (J.Z.); (E.B.)
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Persahabatan National Respiratory Referral Hospital, Jakarta 13230, Indonesia
| | - Ridhawati Syam
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (R.S.); (R.A.); (M.T.); (F.S.); (R.W.)
- Pulmonary Mycosis Centre, Jakarta 10430, Indonesia; (H.R.); (D.H.); (H.A.); (J.Z.); (E.B.)
| | - Robiatul Adawiyah
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (R.S.); (R.A.); (M.T.); (F.S.); (R.W.)
- Pulmonary Mycosis Centre, Jakarta 10430, Indonesia; (H.R.); (D.H.); (H.A.); (J.Z.); (E.B.)
| | - Mulyati Tugiran
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (R.S.); (R.A.); (M.T.); (F.S.); (R.W.)
- Pulmonary Mycosis Centre, Jakarta 10430, Indonesia; (H.R.); (D.H.); (H.A.); (J.Z.); (E.B.)
| | - Findra Setianingrum
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (R.S.); (R.A.); (M.T.); (F.S.); (R.W.)
- Pulmonary Mycosis Centre, Jakarta 10430, Indonesia; (H.R.); (D.H.); (H.A.); (J.Z.); (E.B.)
| | - Erlina Burhan
- Pulmonary Mycosis Centre, Jakarta 10430, Indonesia; (H.R.); (D.H.); (H.A.); (J.Z.); (E.B.)
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Persahabatan National Respiratory Referral Hospital, Jakarta 13230, Indonesia
| | - Chris Kosmidis
- Manchester Academic Health Science Centre, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M23 9LT, UK;
| | - Retno Wahyuningsih
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (R.S.); (R.A.); (M.T.); (F.S.); (R.W.)
- Pulmonary Mycosis Centre, Jakarta 10430, Indonesia; (H.R.); (D.H.); (H.A.); (J.Z.); (E.B.)
- Department of Parasitology, Faculty of Medicine, Universitas Kristen, Jakarta 13530, Indonesia
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Amanda G, Tafroji W, Sutoyo DK, Burhan E, Haryanto B, Safari D. Serotype distribution and antimicrobial profile of Streptococcus pneumoniae isolated from adult patients with community-acquired pneumonia in Jakarta, Indonesia. Journal of Microbiology, Immunology and Infection 2020; 54:1175-1178. [DOI: 10.1016/j.jmii.2020.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 11/30/2022]
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Wahid MH, Sjahrurachman A, Sitorus AH, Burhan E. The Role of TB-LAMP Method in Detecting Mycobacterium tuberculosis from Sputum of Patients Suspected of Having Pulmonary Tuberculosis. Acta Med Indones 2020; 52:352-359. [PMID: 33377880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Indonesia is one of the countries with the highest incidence of tuberculosis (TB) in the world. Appropriate diagnosis is an effort to control TB. The World Health Organization has recommended loop-mediated isothermal amplification (LAMP). In order to be applied routinely, it is necessary to do research to evaluate the LAMP method. METHODS the research was a cross-sectional study and was carried out at the Clinical Microbiology Laboratory of the Faculty of Medicine, Universitas Indonesia, for 100 patients suspected of having pulmonary TB. Each patient handed over two direct sputum specimens. For each direct sputum specimen, an acid-fast bacilli (AFB) smear was carried out. Two direct sputum specimens from each patient were combined to produce mixed sputum. For each mixed sputum specimen, an AFB smear, Lowenstein-Jensen culture, and TB-LAMP were carried out. RESULTS the percentage of LAMP (+) cells in mixed sputum that was AFB (-) was 32.78%. The TB-LAMP showed a sensitivity of 100% (95% CI 89.56-100%), a specificity of 69.64% (95% CI 55.74-80.84%), positive predictive value of 71.19% (95% CI 57.73-81.86%), and negative predictive value of 100% (95% CI 88.83-100%). CONCLUSION TB-LAMP has both high sensitivity and negative predictive value.
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Affiliation(s)
- Mardiastuti H Wahid
- Department of Clinical Microbiology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta.
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Agarwal A, Hunt B, Stegemann M, Rochwerg B, Lamontagne F, Siemieniuk RA, Agoritsas T, Askie L, Lytvyn L, Leo YS, Macdonald H, Zeng L, Alhadyan A, Muna AM, Amin W, da Silva ARA, Aryal D, Barragan FAJ, Bausch FJ, Burhan E, Calfee CS, Cecconi M, Chacko B, Chanda D, Dat VQ, De Sutter A, Du B, Freedman S, Geduld H, Gee P, Haider M, Gotte M, Harley N, Hashimi M, Hui D, Ismail M, Jehan F, Kabra SK, Kanda S, Kim YJ, Kissoon N, Krishna S, Kuppalli K, Kwizera A, Lado Castro-Rial M, Lisboa T, Lodha R, Mahaka I, Manai H, Mendelson M, Migliori GB, Mino G, Nsutebu E, Peter J, Preller J, Pshenichnaya N, Qadir N, Ranganathan SS, Relan P, Rylance J, Sabzwari S, Sarin R, Shankar-Hari M, Sharland M, Shen Y, Souza JP, Swanstrom R, Tshokey T, Ugarte S, Uyeki T, Evangelina VC, Venkatapuram S, Vuyiseka D, Wijewickrama A, Tran L, Zeraatkar D, Bartoszko JJ, Ge L, Brignardello-Petersen R, Owen A, Guyatt G, Diaz J, Kawano-Dourado L, Jacobs M, Vandvik PO. A living WHO guideline on drugs for covid-19. BMJ 2020; 370:m3379. [PMID: 32887691 DOI: 10.1136/bmj.m3379] [Citation(s) in RCA: 475] [Impact Index Per Article: 118.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Updates This is the fourteenth version (thirteenth update) of the living guideline, replacing earlier versions (available as data supplements). New recommendations will be published as updates to this guideline. Clinical question What is the role of drugs in the treatment of patients with covid-19? Context The evidence base for therapeutics for covid-19 is evolving with numerous randomised controlled trials (RCTs) recently completed and underway. Emerging SARS-CoV-2 variants and subvariants are changing the role of therapeutics. What is new? The guideline development group (GDG) defined 1.5% as a new threshold for an important reduction in risk of hospitalisation in patients with non-severe covid-19. Combined with updated baseline risk estimates, this resulted in stratification into patients at low, moderate, and high risk for hospitalisation. New recommendations were added for moderate risk of hospitalisation for nirmatrelvir/ritonavir, and for moderate and low risk of hospitalisation for molnupiravir and remdesivir. New pharmacokinetic evidence was included for nirmatrelvir/ritonavir and molnupiravir, supporting existing recommendations for patients at high risk of hospitalisation. The recommendation for ivermectin in patients with non-severe illness was updated in light of additional trial evidence which reduced the high degree of uncertainty informing previous guidance. A new recommendation was made against the antiviral agent VV116 for patients with non-severe and with severe or critical illness outside of randomised clinical trials based on one RCT comparing the drug with nirmatrelvir/ritonavir. The structure of the guideline publication has also been changed; recommendations are now ordered by severity of covid-19. About this guideline This living guideline from the World Health Organization (WHO) incorporates new evidence to dynamically update recommendations for covid-19 therapeutics. The GDG typically evaluates a therapy when the WHO judges sufficient evidence is available to make a recommendation. While the GDG takes an individual patient perspective in making recommendations, it also considers resource implications, acceptability, feasibility, equity, and human rights. This guideline was developed according to standards and methods for trustworthy guidelines, making use of an innovative process to achieve efficiency in dynamic updating of recommendations. The methods are aligned with the WHO Handbook for Guideline Development and according to a pre-approved protocol (planning proposal) by the Guideline Review Committee (GRC). A box at the end of the article outlines key methodological aspects of the guideline process. MAGIC Evidence Ecosystem Foundation provides methodological support, including the coordination of living systematic reviews with network meta-analyses to inform the recommendations. The full version of the guideline is available online in MAGICapp and in PDF on the WHO website, with a summary version here in The BMJ. These formats should facilitate adaptation, which is strongly encouraged by WHO to contextualise recommendations in a healthcare system to maximise impact. Future recommendations Recommendations on anticoagulation are planned for the next update to this guideline. Updated data regarding systemic corticosteroids, azithromycin, favipiravir and umefenovir for non-severe illness, and convalescent plasma and statin therapy for severe or critical illness, are planned for review in upcoming guideline iterations.
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Affiliation(s)
- Arnav Agarwal
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Not panel member; resource for methodology, systematic review, and content support
| | - Beverly Hunt
- St Thomas’ Hospital, London, UK
- ivermectin and IL-6 receptor blocker panel member
| | - Miriam Stegemann
- Charité - Universitätsmedizin Berlin, Germany
- ivermectin and IL-6 receptor blocker panel member
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - François Lamontagne
- Université de Sherbrooke, Centre de recherche due CHU de Sherbrooke, Quebec, Canada
- Not panel member; resource for methodology, systematic review, and content support
- Corticosteroid panel member
| | - Reed Ac Siemieniuk
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Not panel member; resource for methodology, systematic review, and content support
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Division of General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
- MAGIC Evidence Ecosystem Foundation, Oslo, Norway
- Not panel member; resource for methodology, systematic review, and content support
- Corticosteroid panel member
| | - Lisa Askie
- World Health Organization, Geneva, Switzerland
| | - Lyubov Lytvyn
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not panel member; resource for methodology, systematic review, and content support
| | - Yee-Sin Leo
- National Center for Infectious Diseases, Singapore
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Helen Macdonald
- The BMJ, London, UK
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano (MI), Italy
- Not panel member; resource for methodology, systematic review, and content support
| | - Linan Zeng
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not panel member; resource for methodology, systematic review, and content support
| | | | | | - Wagdy Amin
- Ministry of Health and Population, Cairo, Egypt
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | | | | | | | - Frederique Jacquerioz Bausch
- Geneva University Hospital, Switzerland
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Erlina Burhan
- Infection Division, Department of Pulmonology and Respiratory Medicine, Faculty of Medicine Universitas Indonesia
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Carolyn S Calfee
- University of California, San Francisco, USA
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano (MI), Italy
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
| | | | - Duncan Chanda
- Adult Infectious Disease Centre, University Teaching Hospital, Lusaka, Zambia
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Vu Quoc Dat
- Department of Infectious Diseases, Hanoi Medical University, Hanoi, Vietnam
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - An De Sutter
- University of Gent, Belgium
- ivermectin and IL-6 receptor blocker panel member
| | - Bin Du
- Peking Union Medical College Hospital, Beijing, China
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Stephen Freedman
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Canada
| | - Heike Geduld
- Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Patrick Gee
- USA
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | | | | | - Nerina Harley
- Royal Melbourne Hospital and Epworth Healthcare, Melbourne, Australia
- ivermectin and IL-6 receptor blocker panel member
| | - Madiha Hashimi
- Ziauddin University, Karachi, Pakistan
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - David Hui
- Stanley Ho Centre for Emerging Infectious Diseases, Chinese University of Hong Kong, China
| | | | | | - Sushil K Kabra
- All India Institute of Medical Sciences, New Delhi, India
- Department of Anaesthesia and Critical Care, College of Health Sciences, Makerere University, Kampala, Uganda
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Seema Kanda
- McMaster University (alumnus)
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Yae-Jean Kim
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Niranjan Kissoon
- Department of Paediatrics and Emergency Medicine, University of British Columbia, Vancouver, Canada
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | | | | | - Arthur Kwizera
- Department of Anaesthesia and Critical Care, College of Health Sciences, Makerere University, Kampala, Uganda
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | | | | | - Rakesh Lodha
- All India Institute of Medical Sciences, New Delhi, India
| | - Imelda Mahaka
- Zimbabwe
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Hela Manai
- Emergency Medical Services, Faculty of Medicine, Tunis, Tunisia
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Marc Mendelson
- Groote Schuur Hospital, University of Cape Town, South Africa
| | | | - Greta Mino
- Alcivar Hospital in Guayaquil, Ecuador
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Emmanuel Nsutebu
- Sheikh Shakhbout Medical City, Abu Dhabi
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | | | | | - Natalia Pshenichnaya
- Central Research Institute of Epidemiology of Rospotrebnadzor, Moscow, Russia
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Nida Qadir
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Shalini Sri Ranganathan
- University of Colombo, Sri Lanka
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | | | | | - Saniya Sabzwari
- Aga Khan University, Karachi, Pakistan
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Rohit Sarin
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- MAGIC Evidence Ecosystem Foundation, Oslo, Norway
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Manu Shankar-Hari
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- ivermectin and IL-6 receptor blocker panel member
| | - Michael Sharland
- St. George’s University Hospital, UK
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Yinzhong Shen
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Joao P Souza
- University of Sao Paulo, Brazil
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | | | | | - Sebastian Ugarte
- Faculty of Medicine Andres Bello University, Indisa Clinic, Santiago, Chile)
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Timothy Uyeki
- Influenza Division, U.S. Centers for Disease Control and Prevention, United States
| | | | - Sridhar Venkatapuram
- King’s College, London, UK
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Dubula Vuyiseka
- University of Stellenbosch, South Africa
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Ananda Wijewickrama
- Ministry of Health, Sri Lanka
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Lien Tran
- Infectious Diseases Data Observatory (IDDO), Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not panel member; resource for methodology, systematic review, and content support
| | - Jessica J Bartoszko
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not panel member; resource for methodology, systematic review, and content support
| | - Long Ge
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Division of General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
- The BMJ, London, UK
- Not panel member; resource for methodology, systematic review, and content support
| | - Romina Brignardello-Petersen
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not panel member; resource for methodology, systematic review, and content support
| | - Andrew Owen
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, England
- Not panel member; resource for methodology, systematic review, and content support
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Not panel member; resource for methodology, systematic review, and content support
| | - Janet Diaz
- World Health Organization, Geneva, Switzerland
- Not panel member; resource for methodology, systematic review, and content support
- co-senior author
| | - Leticia Kawano-Dourado
- Pulmonary Division, Heart Institute (InCor)- HCFMUSP, Medical School, University of Sao Paulo, São Paulo, Brazil and Research Institute, Hospital do Coração (HCor), São Paulo, Brazil
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Michael Jacobs
- Royal Free London NHS Foundation Trust
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
- co-senior author
| | - Per Olav Vandvik
- MAGIC Evidence Ecosystem Foundation, Oslo, Norway
- Department of Health Economics and Health Management, Institute for Health and Society, University of Oslo, Oslo, Norway
- Not panel member; resource for methodology, systematic review, and content support
- co-senior author
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35
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Fuady A, Houweling TAJ, Mansyur M, Burhan E, Richardus JH. Catastrophic costs due to tuberculosis worsen treatment outcomes: a prospective cohort study in Indonesia. Trans R Soc Trop Med Hyg 2020; 114:666-673. [PMID: 32511712 PMCID: PMC7456597 DOI: 10.1093/trstmh/traa038] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/21/2020] [Accepted: 05/12/2020] [Indexed: 11/21/2022] Open
Abstract
Background While the incidence of catastrophic costs due to tuberculosis (TB) remains high, there is little evidence about their impact on TB treatment outcomes and adherence. We assessed their effect on treatment outcomes and adherence in Indonesia. Methods We interviewed 282 adult TB patients who underwent TB treatment in urban, suburban and rural districts of Indonesia. One year after the interview, we followed up treatment adherence and outcomes. We applied multivariable analysis using generalized linear mixed models. Results Follow-up was complete for 252/282 patients. Eighteen (7%) patients had unsuccessful treatment and 40 (16%) had poor adherence. At a threshold of 30% of annual household income, catastrophic costs negatively impacted treatment outcomes (adjusted odds ratio [aOR] 4.15 [95% confidence interval {CI} 1.15 to 15.01]). At other thresholds, the associations showed a similar pattern but were not statistically significant. The association between catastrophic costs and treatment adherence is complex because of reverse causation. After adjustment, catastrophic costs negatively affected treatment adherence at the 10% and 15% thresholds (aOR 2.11 [95% CI 0.97 to 4.59], p = 0.059 and aOR 2.06 [95% CI 0.95 to 4.46], p = 0.07). There was no evidence of such an effect at other thresholds. Conclusions Catastrophic costs negatively affect TB treatment outcomes and treatment adherence. To eliminate TB, it is essential to mitigate catastrophic costs.
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Affiliation(s)
- Ahmad Fuady
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000CA Rotterdam, The Netherlands.,Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jl Pegangsaan Timur No. 16 Jakarta 10310, Indonesia
| | - Tanja A J Houweling
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000CA Rotterdam, The Netherlands
| | - Muchtaruddin Mansyur
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jl Pegangsaan Timur No. 16 Jakarta 10310, Indonesia
| | - Erlina Burhan
- Department of Respiratory and Pulmonology, Persahabatan Hospital - Faculty of Medicine, Universitas Indonesia, Jl Persahabatan No. 1 Jakarta 13230, Indonesia
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000CA Rotterdam, The Netherlands
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Setianingrum F, Rozaliyani A, Syam R, Adawiyah R, Tugiran M, Sari CYI, Burhan E, Wahyuningsih R, Rautemaa-Richardson R, Denning DW. Evaluation and comparison of automated and manual ELISA for diagnosis of chronic pulmonary aspergillosis (CPA) in Indonesia. Diagn Microbiol Infect Dis 2020; 98:115124. [PMID: 32736160 DOI: 10.1016/j.diagmicrobio.2020.115124] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/22/2020] [Accepted: 06/28/2020] [Indexed: 12/16/2022]
Abstract
Pulmonary tuberculosis (TB) is one of the common risk factors for chronic pulmonary aspergillosis (CPA). A positive Aspergillus IgG is a key element of the diagnosis of CPA but this has not been studied in Indonesia. We conducted studies with patients at the end of TB therapy in Indonesia. We performed receiver operating curve (ROC) analysis to determine the optimum cutoff of the Aspergillus-specific IgG level (Immulite and Dynamiker ELISA) in those patients who met criteria of CPA in relation to control groups. In 203 TB patients, 26 (13%) patients had clinical and radiological features of CPA. We derived optimum cutoffs for Immulite Aspergillus-specific IgG of 11.5 mg/L and Dynamiker anti-galactomannan IgG of 106.8 AU/mL (sensitivity 89% and 83%, specificity 78% and 51%, respectively). The currently accepted Aspergillus-specific IgG cutoff of Immulite and Dynamiker assays for CPA diagnosis may require slight adjustment for the Indonesian population.
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Affiliation(s)
- Findra Setianingrum
- Department of Parasitology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; Faculty Biology, Medicine and Health, The University of Manchester and Manchester Academic Health Science Centre, Manchester, United Kingdom; Pulmonary Mycosis Centre, Jakarta, Indonesia.
| | - Anna Rozaliyani
- Department of Parasitology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; Pulmonary Mycosis Centre, Jakarta, Indonesia; Grha Permata Ibu Hospital, Jakarta, Indonesia; Department of Pulmonology and Respiratory Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Ridhawati Syam
- Department of Parasitology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; Pulmonary Mycosis Centre, Jakarta, Indonesia
| | - Robiatul Adawiyah
- Department of Parasitology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; Pulmonary Mycosis Centre, Jakarta, Indonesia
| | - Mulyati Tugiran
- Department of Parasitology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; Pulmonary Mycosis Centre, Jakarta, Indonesia
| | | | - Erlina Burhan
- Pulmonary Mycosis Centre, Jakarta, Indonesia; Department of Pulmonology and Respiratory Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; Persahabatan Hospital, Jakarta, Indonesia
| | - Retno Wahyuningsih
- Department of Parasitology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; Pulmonary Mycosis Centre, Jakarta, Indonesia; Department of Parasitology, Faculty of Medicine, Universitas Kristen Indonesia, Jakarta, Indonesia
| | - Riina Rautemaa-Richardson
- Faculty Biology, Medicine and Health, The University of Manchester and Manchester Academic Health Science Centre, Manchester, United Kingdom; National Aspergillosis Centre, Wythenshawe Hospital, Manchester, United Kingdom
| | - David W Denning
- Faculty Biology, Medicine and Health, The University of Manchester and Manchester Academic Health Science Centre, Manchester, United Kingdom; National Aspergillosis Centre, Wythenshawe Hospital, Manchester, United Kingdom
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Burhan E, Agustin H, Susanto AD, Dharmawan INIP, Meyer M, Rogayah R. Discordance Between Clinical Status and Chest X-Ray (CXR) in COVID-19 Patient with Asymptomatic Transmission in Jakarta. Acta Med Indones 2020; 52:297-298. [PMID: 33020341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Coronavirus Disease 2019 (COVID-19) symptoms are highly various in each patient. CXR are routinely used to monitor the disease progression. However, it is not known whether chest X-Ray (CXR) is a good modality to assess COVID-19 pneumonia.Male, 55 years-old, with pneumonia caused by COVID-19. Discordance was found between patient's clinical status and CXR lesion. On the 7th day of symptoms, patient was clinically well despite severe lesion shown on CXR. On the following day, patient clinically deteriorated despite the improvement on CXR lesion.Improvement of CXR does not always correlate well with patient's clinical status. Clinician have to be careful when using CXR to monitor patient with COVID-19 pneumonia.
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Affiliation(s)
- Erlina Burhan
- Department of Pulmonology, Faculty of Medicine Universitas Indonesia - Persahabatan Hospital, Jakarta, Indonesia.
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Fuady A, Houweling TAJ, Mansyur M, Burhan E, Richardus JH. Cost of seeking care for tuberculosis since the implementation of universal health coverage in Indonesia. BMC Health Serv Res 2020; 20:502. [PMID: 32493313 PMCID: PMC7271484 DOI: 10.1186/s12913-020-05350-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/21/2020] [Indexed: 11/16/2022] Open
Abstract
Background Although tuberculosis (TB) patients often incur high costs to access TB-related services, it was unclear beforehand whether the implementation of universal health coverage (UHC) in Indonesia in 2014 would reduce direct costs and change the pattern of care-seeking behaviour. After its introduction, we therefore assessed TB patients’ care-seeking behaviour and the costs they incurred for diagnosis, and the determinants of both. Methods In this cross sectional study, we interviewed adult TB patients in urban, suburban, and rural districts of Indonesia in July–September 2016. We selected consecutively patients who had been treated for TB in primary health centers for at least 1 month until we reached at least 90 patients in each district. After establishing which direct and indirect costs they had incurred during the pre-diagnostic phase, we calculated the total costs (in US Dollars). To identify the determinants of these costs, we applied a general linear mixed model to adjust for our cluster-sampling design. Results Ninety-three patients of the 282 included in our analysis (33%) first sought care at a private clinic. The preference for such clinics was higher among those living in the rural district (aOR 1.88, 95% CI 0.85–4.15, P = 0.119) and among those with a low educational level (aOR 1.69, 95% CI 0.92–3.10, P = 0.090). Visiting a private clinic as the first contact also led to more visits (β 0.90, 95% CI 0.57–1.24, P < 0.001) and higher costs than first visiting a Primary Health Centre, both in terms of direct costs (β = 16.87, 95%CI 10.54–23.20, P < 0.001) and total costs (β = 18.41, 95%CI 10.35–26.47, P < 0.001). Conclusion Despite UHC, high costs of TB seeking care remain, with direct medical costs contributing most to the total costs. First seeking care from private providers tends to lead to more pre-diagnostic visits and higher costs. To reduce diagnostic delays and minimize patients’ costs, it is essential to strengthen the public-private mix and reduce the fragmented system between the national health insurance scheme and the National TB Programme.
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Affiliation(s)
- Ahmad Fuady
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. .,Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
| | - Tanja A J Houweling
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Muchtaruddin Mansyur
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Erlina Burhan
- Department of Respiratory and Pulmonology, Persahabatan Hospital - Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Abstract
BACKGROUND Wildfire and volcano eruption occurred in Indonesia due to its geographical location, climate change, global warming, and human behavior. Various substances produced an increased risk of experiencing health problems, including respiratory infection. Evidence about the effect of pulmonary infection during natural disasters is still limited. This study was aimed to review and elaborate on previous studies to determine the effect of air pollution exposure during natural disasters and respiratory infection.
METHODS Literature searches were conducted on PubMed, EBSCOhost, and Google Scholar, and was limited to the 10 last years, human studies, and the English language. Inclusion criteria were articles with representation for clinical questions, review articles, population studies, and the full-text article was available. Exclusion criteria were articles that only discussed the exposure to and not the association with the effect of the respiratory infection. The Oxford Center for Evidence-Based Medicine tools appraised six relevant articles.
RESULTS Air pollution during a natural disaster enhances particulate matter to 10–70 μg/m3 and more than 5 times the aerosol optical depth measurement compared with the tolerated air concentration. The air level was consistently related to acute respiratory infection, pneumonia, bronchitis, and bronchiolitis admissions in wildfire smoke and volcanic eruption in this review. Nevertheless, there was a diverse result for upper respiratory infection cases.
CONCLUSIONS Natural disasters increased the level of ambient air pollution that exceeded the levels recommended by the World Health Organization air quality guideline. Air pollution may play an important role in respiratory tract infection, especially among population with high exposure.
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Burhan E, Prasenohadi P, Rogayah R, Isbaniyah F, Reisa T, Dharmawan I. Clinical Progression of COVID-19 Patient with Extended Incubation Period, Delayed RT-PCR Time-to-positivity, and Potential Role of Chest CT-scan. Acta Med Indones 2020; 52:80-83. [PMID: 32291376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Coronavirus Disease 2019 (COVID-19), previously called 2019-nCoV, is a novel disease caused by SARS- CoV-2 which was first identified as outbreak of unknown respiratory illness in Wuhan, China. COVID- 19 was declared as global health emergency by WHO on March 11, 2020 and quickly elevated to global pandemic on 11 March 2020. COVID-19 symptom is highly various in each patient, with fever, fatigue, shortness of breath, and cough as the main presenting symptoms. Patient with COVID-19 may shows severe symptom with severe pneumonia and ARDS, mild symptom resembling simple upper respiration tract infection, or even completely asymptomatic. Approximately 80% of cases is mild. However the number may changes as more people are getting tested. Some experts are estimating that up to 50% of all cases may be asymptomatic carrier.
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Affiliation(s)
- Erlina Burhan
- Department of Pulmonology, Faculty of Medicine Universitas Indonesia - Persahabatan Hospital, Jakarta, Indonesia.
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Dewi A, Putra A, Burhan E. P1.03-44 Role of Serum Procalcitonin as Diagnostic Biomarker of Pneumonia in Lung Cancer Patient. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Handayani D, Fajarwati I, Priyonugroho G, Burhan E, Kusmiati T, Muzakkir I, Siagian P, Riyanto BS, Wibisono BH, Sajinadiyasa IGK, Susanto NH. Radiologic pattern as a predictor of multi-drug resistant tuberculosis; a multicenter study. Tuberculosis (Edinb) 2019. [DOI: 10.1183/13993003.congress-2019.pa2956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Fuady A, Houweling TAJ, Mansyur M, Burhan E, Richardus JH. Effect of financial support on reducing the incidence of catastrophic costs among tuberculosis-affected households in Indonesia: eight simulated scenarios. Infect Dis Poverty 2019; 8:10. [PMID: 30709415 PMCID: PMC6359783 DOI: 10.1186/s40249-019-0519-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/13/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The World Health Organization's End Tuberculosis Strategy states that no tuberculosis (TB)-affected households should endure catastrophic costs due to TB. To achieve this target, it is essential to provide adequate social protection. As only a few studies in many countries have evaluated social-protection programs to determine whether the target is being reached, we assessed the effect of financial support on reducing the incidence of catastrophic costs due to TB in Indonesia. METHODS From July to September 2016, we interviewed adult patients receiving treatment for TB in 19 primary health centres in urban, sub-urban and rural area of Indonesia, and those receiving multidrug-resistant (MDR) TB treatment in an Indonesian national referral hospital. Based on the needs assessment, we developed eight scenarios for financial support. We assessed the effect of each simulated scenario by measuring reductions in the incidence of catastrophic costs. RESULTS We analysed data of 282 TB and 64 MDR-TB patients. The incidences of catastrophic costs in affected households were 36 and 83%, respectively. Patients' primary needs for social protection were financial support to cover costs related to income loss, transportation, and food supplements. The optimum scenario, in which financial support would be provided for these three items, would reduce the respective incidences of catastrophic costs in TB and MDR-TB-affected households to 11 and 23%. The patients experiencing catastrophic costs in this scenario would, however, have to pay high remaining costs (median of USD 910; [interquartile range (IQR) 662] in the TB group, and USD 2613; [IQR 3442] in the MDR-TB group). CONCLUSIONS Indonesia's current level of social protection is not sufficient to mitigate the socioeconomic impact of TB. Financial support for income loss, transportation costs, and food-supplement costs will substantially reduce the incidence of catastrophic costs, but financial support alone will not be sufficient to achieve the target of 0% TB-affected households facing catastrophic costs. This would require innovative social-protection policies and higher levels of domestic and external funding.
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Affiliation(s)
- Ahmad Fuady
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000CA, Rotterdam, the Netherlands. .,Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
| | - Tanja A J Houweling
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000CA, Rotterdam, the Netherlands
| | - Muchtaruddin Mansyur
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Erlina Burhan
- Department of Respiratory and Pulmonology, Persahabatan Hospital - Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000CA, Rotterdam, the Netherlands
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Nurwidya F, Ratnawati, Burhan E, Intani C, Handayani H. Comparison of tuberculin skin test and interferon-gamma release assay in the diagnosis of latent tuberculosis infection among indonesian health-care workers. J Nat Sci Biol Med 2019. [DOI: 10.4103/jnsbm.jnsbm_67_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Burhan E, Wibisono B, Indah R, Sajinadiyasa GK, Riyanto B, Kusmiati T, Susanto N. 771. Drug Resistance Tuberculosis (DR-TB), Comorbidities and Risk Factors Identified in a Prospective Multicenter Cohort Study in Indonesia. Open Forum Infect Dis 2018. [PMCID: PMC6254384 DOI: 10.1093/ofid/ofy210.778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background The numbers of patients with drug resistance TB (DR-TB) increased annually by over 20% globally in the last decade. However, data on the prevalence of DR-TB in Indonesia are limited. The objective of this study to estimate the proportion of DR-TB in new and previously treated TB cases, and to identify comorbidities and risk factors. Methods This study has been conducted at seven hospitals throughout Indonesia since March 2017. Clinically TB patients ≥18-year-old were enrolled and followed until 6 months after treatment completed. Demography and clinical data were recorded; sputum, blood, urine, and PBMC were collected at several time points. AFB smear, sputum culture, Xpert MTB/RIF, and drug sensitivity tests were performed. Drug resistance TB is determined by Xpert MTB/RIF. Results Of 151 enrolled patients, 103 (68%) were confirmed M. tuberculosis by Xpert MTB/RIF, and 47 (46%) were confirmed rifampicin resistance. The distribution of DR-TB in each study site is shown in Figure 1. Among those with comorbidities (38%), comorbidity with diabetes (based on HbA1c level and diabetes history), HIV, and cancer was 9%, 26%, and 7%. Demography, nutrition status, contact and treatment history, and comorbidities are shown in Table 1. DR-TB primary infection contributes to 23% of DR-TB cases. Biomarkers that may predict treatment failure and TB-genotyping are underway. Conclusion The proportion of DR-TB in both new and previously treated patients in our cohort was significantly higher than the estimated number from the WHO and Ministry of Health. TB is a serious threat for public health and mitigation plan must be implemented at all levels. ![]()
Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | | | - Retna Indah
- INA-RESPOND, National Institute of Health Resources and Development, Ministry of Health Indonesia, Jakarta Pusat, Indonesia
| | | | | | | | - Nugroho Susanto
- INA-RESPOND, National Institute of Health Resources and Development, Ministry of Health Indonesia, Jakarta Pusat, Indonesia
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Donovan J, Phu NH, Mai NTH, Dung LT, Imran D, Burhan E, Ngoc LHB, Bang ND, Giang DC, Ha DTM, Day J, Thao LTP, Thuong NTT, Vien NN, Geskus RB, Wolbers M, Hamers RL, van Crevel R, Nursaya M, Maharani K, Hien TT, Baird K, Lan NH, Kestelyn E, Chau NVV, Thwaites GE. Adjunctive dexamethasone for the treatment of HIV-infected adults with tuberculous meningitis (ACT HIV): Study protocol for a randomised controlled trial. Wellcome Open Res 2018; 3:31. [PMID: 30320225 PMCID: PMC6143919 DOI: 10.12688/wellcomeopenres.14006.2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2018] [Indexed: 12/02/2022] Open
Abstract
Background: Tuberculous meningitis (TBM) is the most severe form of tuberculosis. Co-infection with HIV increases the risk of developing TBM, complicates treatment, and substantially worsens outcome. Whether corticosteroids confer a survival benefit in HIV-infected patients with TBM remains uncertain. Hepatitis is the most common drug-induced serious adverse event associated with anti-tuberculosis treatment, occurring in 20% of HIV-infected patients. The suggested concentration thresholds for stopping anti-tuberculosis drugs are not evidence-based. This study aims to determine whether dexamethasone is a safe and effective addition to the first 6-8 weeks of anti-tuberculosis treatment of TBM in patients with HIV, and investigate alternative management strategies in a subset of patients who develop drug induced liver injury (DILI) that will enable the safe continuation of rifampicin and isoniazid therapy. Methods: We will perform a parallel group, randomised (1:1), double blind, placebo-controlled multi-centre Phase III trial, comparing the effect of dexamethasone versus placebo on overall survival in HIV-infected patients with TBM, in addition to standard anti-tuberculosis and antiretroviral treatment. The trial will be set in two hospitals in Ho Chi Minh City, Vietnam, and two hospitals in Jakarta, Indonesia. The trial will enrol 520 HIV-infected adults. An ancillary study will perform a randomised comparison of three DILI management strategies with the aim of demonstrating which strategy results in the least interruption in rifampicin and isoniazid treatment. An identical ancillary study will also be performed in the linked randomised controlled trial of dexamethasone in HIV-uninfected adults with TBM stratified by LTA4H genotype (LAST ACT). Discussion: Whether corticosteroids confer a survival benefit in HIV-infected patients remains uncertain, and the current evidence base for using corticosteroids in this context is limited. Interruptions in anti-tuberculosis chemotherapy is a risk factor for death from TBM. Alternative management strategies in DILI may allow the safe continuation of rifampicin and isoniazid therapy.
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Affiliation(s)
- Joseph Donovan
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | | | - Le Tien Dung
- Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam
| | - Darma Imran
- Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Erlina Burhan
- Persahabatan Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | | | | | | | | | - Jeremy Day
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Nguyen TT Thuong
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Ronald B. Geskus
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Marcel Wolbers
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Raph L Hamers
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Eijkman Oxford Clinical Research Unit, Eijkman Institute of Molecular Biology, Jakarta, Indonesia
| | - Reinout van Crevel
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, Netherlands
| | - Mugi Nursaya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Eijkman Oxford Clinical Research Unit, Eijkman Institute of Molecular Biology, Jakarta, Indonesia
| | - Kartika Maharani
- Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Tran Tinh Hien
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Kevin Baird
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Eijkman Oxford Clinical Research Unit, Eijkman Institute of Molecular Biology, Jakarta, Indonesia
| | | | - Evelyne Kestelyn
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Guy E. Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Donovan J, Phu NH, Mai NTH, Dung LT, Imran D, Burhan E, Ngoc LHB, Bang ND, Giang DC, Ha DTM, Day J, Thao LTP, Thuong NTT, Vien NN, Geskus RB, Wolbers M, Hamers RL, van Crevel R, Nursaya M, Maharani K, Hien TT, Baird K, Lan NH, Kestelyn E, Chau NVV, Thwaites GE. Adjunctive dexamethasone for the treatment of HIV-infected adults with tuberculous meningitis (ACT HIV): Study protocol for a randomised controlled trial. Wellcome Open Res 2018; 3:31. [PMID: 30320225 PMCID: PMC6143919 DOI: 10.12688/wellcomeopenres.14006.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2018] [Indexed: 12/27/2022] Open
Abstract
Background: Tuberculous meningitis (TBM) is the most severe form of tuberculosis. Co-infection with HIV increases the risk of developing TBM, complicates treatment, and substantially worsens outcome. Whether corticosteroids confer a survival benefit in HIV-infected patients with TBM remains uncertain. Hepatitis is the most common drug-induced serious adverse event associated with anti-tuberculosis treatment, occurring in 20% of HIV-infected patients. The suggested concentration thresholds for stopping anti-tuberculosis drugs are not evidence-based. This study aims to determine whether dexamethasone is a safe and effective addition to the first 6-8 weeks of anti-tuberculosis treatment of TBM in patients with HIV, and investigate alternative management strategies in a subset of patients who develop drug induced liver injury (DILI) that will enable the safe continuation of rifampicin and isoniazid therapy. Methods: We will perform a parallel group, randomised (1:1), double blind, placebo-controlled multi-centre Phase III trial, comparing the effect of dexamethasone versus placebo on overall survival in HIV-infected patients with TBM, in addition to standard anti-tuberculosis and antiretroviral treatment. The trial will be set in two hospitals in Ho Chi Minh City, Vietnam, and two hospitals in Jakarta, Indonesia. The trial will enrol 520 HIV-infected adults. An ancillary study will perform a randomised comparison of three DILI management strategies with the aim of demonstrating which strategy results in the least interruption in rifampicin and isoniazid treatment. An identical ancillary study will also be performed in the linked randomised controlled trial of dexamethasone in HIV-uninfected adults with TBM stratified by LTA4H genotype (LAST ACT). Discussion: Whether corticosteroids confer a survival benefit in HIV-infected patients remains uncertain, and the current evidence base for using corticosteroids in this context is limited. Interruptions in anti-tuberculosis chemotherapy is a risk factor for death from TBM. Alternative management strategies in DILI may allow the safe continuation of rifampicin and isoniazid therapy.
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Affiliation(s)
- Joseph Donovan
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | | | - Le Tien Dung
- Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam
| | - Darma Imran
- Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Erlina Burhan
- Persahabatan Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | | | | | | | | | - Jeremy Day
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Nguyen TT Thuong
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Ronald B. Geskus
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Marcel Wolbers
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Raph L Hamers
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Eijkman Oxford Clinical Research Unit, Eijkman Institute of Molecular Biology, Jakarta, Indonesia
| | - Reinout van Crevel
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, Netherlands
| | - Mugi Nursaya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Eijkman Oxford Clinical Research Unit, Eijkman Institute of Molecular Biology, Jakarta, Indonesia
| | - Kartika Maharani
- Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Tran Tinh Hien
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Kevin Baird
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Eijkman Oxford Clinical Research Unit, Eijkman Institute of Molecular Biology, Jakarta, Indonesia
| | | | - Evelyne Kestelyn
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Guy E. Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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48
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Abstract
Tuberculosis (TB) is one of the leading causes of adult death in the Asia-Pacific Region, including Indonesia. As an infectious disease caused by Mycobacterium tuberculosis (MTB), TB remains a major public health issue especially in developing nations due to the lack of adequate diagnostic testing facilities. Diagnosis of TB has entered an era of molecular detection that provides faster and more cost-effective methods to diagnose and confirm drug resistance in TB cases, meanwhile, diagnosis by conventional culture systems requires several weeks. New advances in the molecular detection of TB, including the faster and simpler nucleic acid amplification test (NAAT) and whole-genome sequencing (WGS), have resulted in a shorter time for diagnosis and, therefore, faster TB treatments. In this review, we explored the current findings on molecular diagnosis of TB and drug-resistant TB to see how this advancement could be integrated into public health systems in order to control TB.
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Affiliation(s)
- Fariz Nurwidya
- Department of Pulmonology and Respiratory Medicine, Universitas Indonesia Faculty of Medicine, Persahabatan Hospital, Jakarta, Indonesia
| | - Diah Handayani
- Department of Pulmonology and Respiratory Medicine, Universitas Indonesia Faculty of Medicine, Persahabatan Hospital, Jakarta, Indonesia
| | - Erlina Burhan
- Department of Pulmonology and Respiratory Medicine, Universitas Indonesia Faculty of Medicine, Persahabatan Hospital, Jakarta, Indonesia
| | - Faisal Yunus
- Department of Pulmonology and Respiratory Medicine, Universitas Indonesia Faculty of Medicine, Persahabatan Hospital, Jakarta, Indonesia
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49
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Nurwidya F, Ratnawati, Wijaya D, Nazaruddin A, Burhan E. The relationship between hemoglobin A1C levels and sputum conversion time in indonesian patients with new cases of pulmonary tuberculosis. J Nat Sci Biol Med 2018. [DOI: 10.4103/jnsbm.jnsbm_24_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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50
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Probandari A, Widjanarko B, Mahendradhata Y, Sanjoto H, Cerisha A, Nungky S, Riono P, Simon S, Farid MN, Giriputra S, Putra AE, Burhan E, Wahyuni CU, Mustikawati D, Widianingrum C, Tiemersma EW, Alisjahbana B. The path to impact of operational research on tuberculosis control policies and practices in Indonesia. Glob Health Action 2016; 9:29866. [PMID: 26928217 PMCID: PMC4770863 DOI: 10.3402/gha.v9.29866] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 01/03/2016] [Accepted: 01/27/2016] [Indexed: 11/14/2022] Open
Abstract
Background Operational research is currently one of the pillars of the global strategy to control tuberculosis. Indonesia initiated capacity building for operational research on tuberculosis over the last decade. Although publication of the research in peer-reviewed journals is an important indicator for measuring the success of this endeavor, the influence of operational research on policy and practices is considered even more important. However, little is known about the process by which operational research influences tuberculosis control policy and practices. Objective We aimed to investigate the influence of operational research on tuberculosis control policy and practice in Indonesia between 2004 and 2014. Design Using a qualitative study design, we conducted in-depth interviews of 50 researchers and 30 policy makers/program managers and performed document reviews. Transcripts of these interviews were evaluated while applying content analysis. Results Operational research contributed to tuberculosis control policy and practice improvements, including development of new policies, introduction of new practices, and reinforcement of current program policies and practices. However, most of these developments had limited sustainability. The path from the dissemination of research results and recommendations to policy and practice changes was long and complex. The skills, interests, and political power of researchers and policy makers, as well as health system response, could influence the process. Conclusions Operational research contributed to improving tuberculosis control policy and practices. A systematic approach to improve the sustainability of the impact of operational research should be explored.
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Affiliation(s)
- Ari Probandari
- Department of Public Health, Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia;
| | - Bagoes Widjanarko
- Department of Health Promotion, Faculty of Public Health, Universitas Diponegoro, Semarang, Indonesia
| | - Yodi Mahendradhata
- Centre for Health Policy and Management, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Hary Sanjoto
- Department of Public Health, Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia
| | - Ancila Cerisha
- Department of Public Health, Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia
| | - Saverina Nungky
- Department of Public Health, Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia
| | - Pandu Riono
- Department of Biostatistics, Faculty of Public Health, Universitas Indonesia, Jakarta, Indonesia
| | - Sumanto Simon
- Department of Clinical Pathology, Faculty of Medicine, Universitas Atmajaya, Jakarta, Indonesia
| | - Muhammad Noor Farid
- Department of Biostatistics, Faculty of Public Health, Universitas Indonesia, Jakarta, Indonesia
| | - Sardikin Giriputra
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Artawan Eka Putra
- Department of Public Health, Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia
| | - Erlina Burhan
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Chatarina U Wahyuni
- Department of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Dyah Mustikawati
- Sub-directorate of Tuberculosis, Ministry of Health, Jakarta, Indonesia
| | | | | | - Bachti Alisjahbana
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia
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