@article {2224, title = {Concordance of Sputum and Feces Samples for Detecting Mycobacterium Tuberculosis using Xpert{\textregistered} MTB/RIF Ultra}, journal = {Pharmacognosy Journal}, volume = {16}, year = {2024}, month = {February 2024}, pages = {167-173}, type = {Research Article}, chapter = {167}, abstract = {

Introduction: Tuberculosis (TB) remains a disease with high morbidity and mortality worldwide, and Indonesia ranks among the countries with the highest TB prevalence. There is a need to develop improved detection tools and explore alternative sample sources beyond sputum. Feces samples are one such nonsputum alternative. Xpert{\textregistered} MTB/RIF Ultra is a novel diagnostic tool used in Indonesia. This study aims to assess the concordance of both sputum and feces samples in detecting Mycobacterium tuberculosis (MTB) using Xpert{\textregistered} MTB/RIF Ultra. Methods: An analytical observational study with a cross-sectional design was conducted on TB subjects at Dr. Soetomo Regional Public Hospital (RSUD Dr. Soetomo), Surabaya, and several community health centers (puskesmas) in Surabaya. Sputum and feces samples were collected from the same subjects. These subjects underwent Feces acid-fast bacilli (AFB) tests, sputum and Feces Xpert{\textregistered} MTB/RIF Ultra tests, and sputum culture tests (considered the gold standard), as well as rifampicin resistance tests for positive cultures. Sensitivity and positive predictive value (PPV) tests were conducted using Medcalc software, and the concordance test employed the Kappa value. Results: The study involved 71 research subjects. The sensitivity of Feces AFB tests, sputum, and Feces Xpert{\textregistered} MTB/RIF Ultra tests was 7.3\%, 97.6\%, and 97.6\%, respectively. The Cohen{\textquoteright}s Kappa consistency test for Feces AFB tests and sputum culture produced a Kappa value of 0.063 (p \> 0.05). The Cohen{\textquoteright}s Kappa consistency test on sputum and Feces Xpert{\textregistered} MTB/RIF Ultra tests yielded a Kappa value of 0.409 (p \< 0.05). The Cohen{\textquoteright}s Kappa consistency test on sputum and Feces Xpert{\textregistered} MTB/RIF Ultra tests compared with the rifampicin resistance tests resulted in Kappa values of 0.902 and 0.951 (p \< 0.05). The CT value of Feces Xpert{\textregistered} MTB/RIF Ultra tests was higher than that of sputum Xpert{\textregistered} MTB/RIF Ultra tests. Conclusion: A concordance exists between the results of sputum and Feces Xpert{\textregistered} MTB/RIF Ultra tests, but no concordance is observed between the results of Feces AFB tests and sputum culture tests. The higher CT value of Feces Xpert{\textregistered} MTB/RIF Ultra tests compared to sputum Xpert{\textregistered} MTB/RIF Ultra tests indicates a lower bacterial load in feces. Feces can be considered a viable alternative sample to sputum for MTB detection using Xpert{\textregistered} MTB/RIF Ultra.

}, keywords = {Feces AFB test, Feces Xpert{\textregistered} MTB/RIF Ultra test, Mycobacterium tuberculosis (MTB), rifampicin resistance test, Xpert{\textregistered} MTB/RIF Ultra}, doi = {10.5530/pj.2024.16.23}, author = {Dewi Rochmawati and Puspa Wardhani and Yessy Puspitasari and Tutik Kusmiati and Atika and Hartono Kahar} } @article {1959, title = {Correlation of TB LAM Ag (Tuberculosis Lipoarabinomannan Antigen) Results from Urine with Adenosine Deaminase Levels from Pleural Fluid Patients with Pulmonary TB Accompanied by Pleural Effusion}, journal = {Pharmacognosy Journal}, volume = {15}, year = {2023}, month = {March 2023}, pages = {47-51}, type = {Original Article }, chapter = {47}, abstract = {

Background: One of the newest testing methods for active TB uses TB LAM Antigen, in which lipoarabinomannan (LAM) as the examined substance serves as the main component of the cell wall of M. tuberculosis (MTB) and the degradation product of MTB by macrophages in the human body. Patients with active TB with or without HIV infection may experience a decreased antibody response, which causes LAM not to bind to antibodies so that it can pass through the normal glomerular basement membrane and can be detected in the urine. Lateral flow urine lipoarabinomannan assay (LF-LAM) can detect this material with urine samples from active TB patients. Another TB screening method uses the measurement of adenosine deaminase (ADA) activity. ADA has a very important function for the proliferation and differentiation of lymphoid cells, especially T cells, and assists in the maturation of monocytes into macrophages. Objective: This study aims to qualitatively prove the correlation between the pleural fluid ADA levels of pulmonary TB patients with pleural effusion using the LF-LAM test results and examine the potential of TB LAM Ag, which correlates with increased pleural fluid ADA levels, as a diagnostic tool for diagnosing pulmonary TB. Method: It is an observational analytic study with a crosssectional design. Materials for this study included temporary urine from active TB patients at Dr. Soetomo Regional Public Hospital collected in May-August 2022. The descriptive analysis was conducted using SPSS 25.0. The data were tested for normal distribution and with the homogeneity test of Shapiro-Wilk{\textquoteright}s data. The statistical analysis was performed using the Mann-Whitney test, while the kappa suitability test was carried out to determine the correlation and level of concordance between the ADA cut-off value of pleural fluid and the TB LAM Ag test results. Results: This study involved 50 subjects consisting of 22 (44\%) subjects with ADA test results between 40-100 IU/L compared to 28 subjects (56\%) with ADA test results below 40 IU/L. There were 14 (28\%) subjects with positive TB LAM Ag test results, consisting of 10 (45\%) active TB subjects with a high ADA test cut-off of 40-100 IU/L and 4 (14\%) active TB subjects with a low ADA test cut-off below 40 IU/L, with a p-value = 0.012. Conclusions: There is a correlation between TB Lipoarabinomannan antigen test results of TB patients with pleural effusion. TB LAM Ag can be detected positive on ADA test results of \< 40 IU/L and more positive in active TB patients with high ADA test results of \> 40-100 IU/L. Therefore, the TB LAM Ag test is more sensitive than the ADA test. The cut-off value of the ADA test reached 76.4 U/L, and a positive TB LAM was found.

}, keywords = {Active TB with pleural effusion., Adenosine deaminase (ADA) test, TB Lipoarabinomannan (LAM) Antigen}, doi = {10.5530/pj.2023.15.7}, author = {Sari Prabandari Prasetyaningrum and Arief Bakhtiar and Yessy Puspitasari} } @article {2184, title = {Performance Comparison of Urine Sediment Analytical Tool by Flowcytometry and Digital Imaging with Standardized Manual Microscopic Testing}, journal = {Pharmacognosy Journal}, volume = {15}, year = {2023}, month = {December 2023}, pages = {1189-1196}, type = {Research Article}, chapter = {1189}, abstract = {

Background: Urine sediment examination provides numerous information about patient{\textquoteright}s kidney condition. Flowcytometry and digital imaging system could conduct automatic urine sediment analysis. Therefore, determining the diagnostic performance of the examination is very important in the management carried out by the clinician. This study aims to determine the diagnostic performance of urine flowcytometry and digital imaging sediment examination tools compared to manual microscopes that are standardized as gold standards. Methods: This study is an analytical observational study with a cross-sectional approach on 92 urine samples of patients who attended the Internal Medicine Nephrology Polyclinic of Dr. Soetomo Academic Hospital Surabaya. The performance of flowcytometry and digital imaging methods is assessed by calculating sensitivity and specificity. Analysis of the suitability of each urine sediment parameter used Cohen{\textquoteright}s kappa. Urine sediment analysis with a light microscope was conducted with the Shih-Yung method as a gold standard. Results: The erythrocyte parameters revealed a very favorable result with the concordance of the flowcytometry with the Shih-Yung method (κ=0.82) and fair results for WBC (κ=0.25), Epithelium (κ=0.57) and Cast (κ=0.27). At the same time, yeast had substantial conformity (κ=0.63). The digital imaging method showed substantive fit for WBC (κ=0.676), RBC (κ=0.621), fair for SEC (κ=0.42) and NSE (κ=0.24), moderate for Yeast (κ=0.45), and slight for Hyaline Cast (κ=0.074) and Path Cast (κ= 0.134) Conclusion: The urine flowcytometry demonstrates better performance compatibility with a standardized manual microscope compared to urine digital imaging. However, pathological samples should still be verified with a manual microscope

}, keywords = {Digital imaging, Flowcytometry, Microscopic, Urine sediment}, doi = {10.5530/pj.2023.15.216}, author = {Nur Fitri Hayati Melida Ritonga and Ferdy R. Marpaung and Hartono Kahar and Nunuk Mardiana and Yessy Puspitasari} }