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Objectives This study was conducted to assess adverse drug reactions and their management in MDR-TB patients. Indonesia is the fifth highest country with multidrug-resistant tuberculosis (MDR-TB) high burden around the world. The number of MDR-TB patients in Indonesia is increasing every year, but the data regarding ADRs are still limited. Therefore, more data on their characteristics and their management is very valuable for clinicians and pharmacists. Methods The study is a descriptive study, using retrospective data of MDR-TB patients who completed therapy from January 1st, 2015 to December 31st, 2015 at the Tuberculosis Outpatient unit at the Dr. Soetomo Teaching Hospital Indonesia. Each adverse effect was judged with standards of the clinic and was documented in patients’ medical records. Results There were 40 patients included in this study. During therapy, 70% of patients developed at least one adverse drug reaction. The five most prevalent adverse effects found in this study were hyperuricemia (52.5%) followed by gastrointestinal (GI) disturbances (40%), ototoxicity (37.5%), hypokalemia (27.5%), and athralgia (12.5%). Managements that were undertaken to overcome the adverse drug reactions were adding symptomatic drugs and/or modifying the treatment regimen. Conclusions Because of the small samples we cannot attain a general conclusion. However, the result of this study is very imperative as this data gives us insight regarding adverse effects in MDR-TB patients in Indonesia.

Background: Data on the prevalence of bacterial co-infections among COVID-19 patients are limited, especially in our country, Indonesia. We aimed to assess the rate of bacterial co-infections in hospitalized COVID-19 patients and report the most common microorganisms involved and the antibiotic use in these patients. Methods: This study is a cross sectional study with retrospective approach, among COVID-19 adult patients admitted to Universitas Airlangga Hospital Surabaya from 14 March-30 September 2020. The bacterial infection is defined based on clinical assessment, laboratory parameters, and microbiology results. Results: A total of 218 patients with moderate to critical illness and confirmed COVID-19 were included in this study. Bacterial infection was confirmed in 43 patients (19.7%). COVID-19 patients with bacterial infections had longer hospital length of stay (17.6 ± 6.62 vs 13.31±7.12), a higher proportion of respiratory failure, intensive care treatment, and ventilator use. COVID-19 patients with bacterial infection had a worse prognosis than those without bacterial infection (p Conclusion: COVID-19 patients with bacterial infection have a longer length of stay and worse outcomes. Healthcare-associated infections during intensive care treatment for COVID-19 patients must be carefully prevented.

Background: Indonesia started to implement the Shorter Regimen (STR) since 2017, but not all of MDR/RR-TB patients were treated with STR until the end of treatment. The presence of side effects of one orseveral drugs in the STR and the resistance to fluoroquinolone and or 2nd line injection drug after startingtreatment caused a switch in regimen from STR to a longer regimen. This study was conducted to evaluatethe factors that caused switch STR to the longer regimen.Methods: This was a descriptive study in MDR/RR-TB patients who received STR from October 2017to December 2019. Patients who switch their regimen were analyzed and determine the factors cause ofswitching STR to a longer regimen.Conclusion: The major cause of switching was due to the presence of resistance to fluoroquinolone and 2ndline injection drugs and incidence of prolonged QT. A diagnostic rapid test such as the line probe assay 2ndline TB drugs is absolutely a screening tool to determine MDR-TB patients, pre-XDR-TB or XDR TB assoon as the regimen is given. Monitoring and efforts to overcome prolonged QT side effects are also neededto prevent switch regimens that can affect the patient’s psychological condition.

Background: The prevalence of COVID-19 cases in Indonesia until June 9th 2020, Government has confirmed the number of 32.076 positive cases from 34 provinces in Indonesia with 1.923 fatalities. Along with the development of technology, stem cell-based biological medical therapy, and stem cell-based immunotherapy were developed to find out its potential in the case of COVID-19 treatment besides using chemical drugs as a therapy.Methods: In this study, in vitro research will be conducted to determine the potential of hematopoietic stem cells (HSC) against SARS-CoV-2 (COVID-19) viruses with virus isolates from Indonesia. The SARS-CoV-2 virus was planted in rat kidney cells and Vero cells, then cells that had been planted with the virus were given HSC cells and then evaluated at 24, 48, and 72 hours. The evaluation is done by collecting cells and supernatant from the cell plate and then evaluating the viral load using a Polymerase Chain Reaction (PCR) machine.Results: The results showed that the addition of HSC on cells that had been infected by SARS-CoV-2 decrease in viral load within 24 to 72 hours in all variations of Multiples of Infection (MoI) values.Conclusions: The administration of HSC cells has the potential to eliminate SARS-CoV-2 virus. Although this research is an in vitro study, this study could be the basis for the development of alternative stem cell-based therapies to handle COVID-19 cases in Indonesia.

Introduction: Smoking has been reported as one of tuberculosis (TB) risk factor. The association between smoking and TB has been proven in multiple studies, but little known about the association between smoking degree and sputum smear positive. Methods: An analytic observational study using cross-sectional design. Data of patients with pulmonary TB conducted at DOTS (Directly Observed Treatment Short course)/MDR (Multi Drug Resistance) outpatient and inpatient ward in Dr Soetomo General Hospital Surabaya from January to October 2018. The degree of smoking was measured using Brinkman Index (BI). The odds ratio (OR) and 95% confidence intervals (CI) were also estimated.Results: There were 94 patients with pulmonary TB, 56 non-smoker and 38 smoker. Light smoking (P = 0,120, OR = 0.200, 95% CI: 0.022-1.823), moderate smoking (P=0.377, OR = 1.667, 95% CI: 0.533-5.209), heavy smoking (P=0.076, OR= 0.333, 95% CI: 0.96-1.160). Moderate smoking compared to heavy smoking as a control (P=0.33, OR = 5.000, 95% CI=1.096-22.820). Conclusion: There’s no significant correlation between smoking habits and sputum smear positive, but the present study evidenced the patients with smoking habits had greater chance to get sputum smear positive than non-smokers. Patient with moderate smoking compared to heavy smoking had greater chance to get sputum smear positive.

Background: The evaluation of potential drugs is urgently needed against SARS-CoV2 and Lopinavir/ritonavir and Clarythromycin was considered as the drugs. Methods: Cytotoxicity test using MTT assay was done using human mesenchymal stem cells and drugs concentration used: 0.2; 2; 10; 100; 400 ppm for each Lopinavir, Clarithromycin and com­bining Lopinavir+Clarithromycin. We prepared Vero cells in 12-well plate for viral inoculation then given drugs with concentration: 1 ppm, 15 ppm, and 37.5 ppm of Lopinavir/ritonavir (200/50 mg), either 0.5 ppm, 4 ppm and 8 ppm of Chlarithromycin (500 mg) and 0.5 ppm, 5 ppm and 15 ppm of combination Lopinavir+Chlarithromycin. The qRT-PCR was performed to observe viral load. The observation were done in 24, 48, 72 hours after inoculation. Results: There is no cytotoxic effect in human mesenchymal stem cells. Testing with multilevel concentration 50% (CC50) showed cytotoxicity level (ppm) for each Lopinavir, Clarithromycin and Lopinavir+Clarithromycin are 3451.8 ppm, 2285.97 ppm and 12230.6 ppm. The morphology changes in Vero cells showed formation of giant cells, colony of detachment cells and cyto pathic effect. Antiviral activity or inhibition concentration of 50% to virus (IC50) value of each, Lopinavir, Clarithromycin and combination Lopinavir+Clarithromycin are 0.9757; 0.9246; and

Tuberculosis is an acute infectious disease that primarily affects the lungs. Probiotics supplementation can increase the number and activity of NK cell in peripheral blood by modulation of IL-12, thus increasing IFN-γ production by Th1 response. Vitamin B 1 acts on macrophages and affects neutrophil motility. Vitamin B 6 is associated with the release of cytokines and the responsiveness of NK cells, while vitamin B 12 affects to lymphocytes, Tcell proliferation, CD4 + ratios, and NK cell activity. To analyze the effects of probiotics and vitamin B 1 , B 6 , B 12 supplementation on IFN-γ and IL-12 levels during intensive phase of antituberculosis treatment. The study was pre-post test randomised control by time series. The control group was TB patients with standard therapy of antituberculosis and vitamin B6, while the intervention group was TB patients receiving therapy plus once daily probiotics and vitamin B 1 , B 6 , B 12 supplementation during the intensive phase. Blood samples were withdrawn at baseline, one month, and two months after therapy to measure plasma IFN-γ and IL-12 levels using the ELISA method. Twenty two patients were divided equally into two groups. There was a tendency to greater increase of IFN-γ in the first month of the intervention group, followed by a significant decline after two-month therapy ( p 0.05). However, the percentage was higher in the supplementation group. Adding probiotics and vitamins B 1 , B 6 , B 12 could improve immune response through IL-12 and IFN-γ modulation during intensive phase therapy.