Analysis of Clinical Features of Pulmonary TB Patients at Dr. Hospital. P.P. Magretti Saumlaki in 2022

Pulmonary Tuberculosis is the most common disease in 2022 at RSUD dr. P.P. Magretti Saumlaki Tanimbar Islands, Maluku. This study aims to determine the clinical picture of patients according to the characteristics of person, place and time. The retrospective approach is presented in descriptive form. The sampling technique uses purposive sampling. The sample was 51 pulmonary TB patients in the isolation room in 2022 with complete medical record files. The research results showed that the largest age group was 19-44 years, 24 people (47.1%). The male gender was more numerous, numbering 28 people (54.9%). The most common clinical symptoms were shortness of breath, 15 people (29.4%); The highest number of supporting examinations with Ro Thorax was 36 people (70.6%). The most common diagnoses were pulmonary TB on OAT as many as 22 people (43.1%). More patients returned home and recovered, namely 17 people (33.3%). The longest length of stay was 21.6% (3 days). The conclusion of this study is that pulmonary TB patients in the isolation room at RSUD dr. P.P. More Magretti in 2022: male gender, age 19-44 years, clinical symptoms of shortness of breath, AP/PA Thorax X-ray examination, discharged home recovered, and 3 days of


INTRODUCTION
Tuberculosis is an infectious disease caused by germs Mycobacterium tuberculosis.These germs spread through the air.Globally, it is estimated that 9.9 million people suffered from TB in 2020.(WHO, Global Tuberculosis Report, 2021).The number of deaths due to Tuberculosis in 2020 was 1.3 million, this has increased compared to 2019, which was 1.2 million (Ministry of Health of the Republic of Indonesia, 2022).Indonesia has committed to reducing the incidence of tuberculosis cases to 65 per 100,000 population by 2030.Efforts to control tuberculosis in Indonesia in 2020-2024 are directed at accelerating Indonesia's efforts to achieve the elimination of tuberculosis by 2030, as well as ending the tuberculosis epidemic by 2050.(Indonesian Ministry of Health , 2020).The target for finding new cases in the Tanimbar Islands Regency in 2022 and 2023 is 458 cases.The achievement in 2022 is 241 cases (52.62%) and as of June 2023 it reached 117 cases.This certainly needs to be paid attention to and improved in order to meet the target of finding new cases.The number of Tuberculosis deaths in 2022 in Tanimbar Islands Regency is 26 people.Pulmonary TB is a disease that is still dominant at the Regional General Hospital dr.P.P. Magretti.This can be seen from the report on the top 10 inpatient and outpatient diseases in 2022, where pulmonary TB is the number 1 most inpatient disease with 98 patients and the number 3 disease in outpatients with 175 patients.(SIRS RL 5 RSUD dr.P.P. Magretti 2022).The aim of this research is to determine the clinical picture of pulmonary TB patients at RSUD dr.P.P. Magretti Saumlaki in 2022 in an isolation room according to the characteristics of person, time and place.There has never been any research on the analysis of clinical features of pulmonary TB patients at RSUD dr.P.P. Magretti.Similar research was conducted by Rosy Mutiara Tsani and Kasno regarding the Clinical Features of Pulmonary Tuberculosis at RSUP dr.Kariadi Semarang Period January-June 2011.

METHOD
This research is research with a retrospective approach and is presented in descriptive form.This research was carried out in the isolation inpatient room at RSUD dr.P.P. Magretti Saumlaki, Tanimbar Islands Regency from 16-30 June 2023.The population in this study were all pulmonary TB patients in the Isolation inpatient ward at RSUD dr.P.P. Magretti Saumlaki in 2022.Sampling using techniques purposive sampling.Purposive sampling technique according to Sugiyono (2018) is sampling using certain considerations in accordance with the desired criteria to determine the number of samples to be studied.The type of data in this study is secondary data, namely Medical Record Files (BRM) of pulmonary TB patients hospitalized in isolation rooms which are declared complete (inclusion criteria).After the data is collected, descriptive analysis will be carried out for each variable, then the data will be grouped and analyzed using the SPSS application.The results of processing and analysis are presented in tabular form.

RESULT
The total number of pulmonary TB patients recorded in the isolation room inpatient register in 2022 is 71 people.Meanwhile, the medical record files that were declared complete were 51 patients.The data examined in this study include: age, gender, clinical symptoms, type of supporting examination, diagnosis, condition at home, and length of stay.1.2 shows the age group 10-18 years as many as 1 person (2.0%), 19-44 years as many as 24 people (47.1%), ages 45-59 years as many as 15 people (29.4%), and age over 60 years old were 11 people (21.6%).For more clarity, it can be seen in the following diagram: Tuberculosis is a disease that causes morbidity and death at all ages throughout the world, especially in developing countries.The highest incidence of pulmonary tuberculosis usually affects young adults (Mangngi, 2018).The results of the life cycle situation analysis found various health problems at every stage of life starting from neonates and infants (0-1 year); toddlers (1-5 years), pre-school children 5-6 years; children 6-10 years; teenagers 10-19 years; WUS/PUS (15-49 years) or adults 19-44 years to pre-elderly 45-59 years, and elderly 60 years and over.These problems include neonatal disorders, pneumonia, malnutrition, malaria, diarrhea, HIV-AIDS, TB, PTM, and cardio vascular disease, all of which greatly affect the quality of life in old age.(Ministry of Health, 2016).This is the basis behind the researchers dividing the age group into 4 groups, namely: 10-18 years, 19-44 years, 45-59 years and 60 years and above.1.3 shows that there were 28 men (54.9%) while there were 23 women (45.1%).
To make it clearer, it can be depicted in the following diagram: Figure 1.2 Frequency Distribution of Pulmonary TB Patients According to Gender From figure 1.2 it is known that there are more male pulmonary TB patients than female.
Pulmonary TB disease tends to be higher in men than women, because of the habit of smoking and drinking alcohol so that the body's defense system decreases and it is more easily exposed to agents that cause pulmonary TB (Aditama, 2000) (Mangngi, 2018).This is in line with the results of research by Amina  1.4 shows the clinical symptoms of pulmonary TB patients with cough/cough with phlegm in 9 people (17.6%), cough with phlegm accompanied by blood in 6 people (11.8%), chest pain in 1 person (2.0%), fever in 8 people ( 15.7%), malaise/weakness in 11 people (21.5%), decreased weight/appetite in 1 person (2.0%) and shortness of breath in 15 people (29.4%).
For more clarity, see the following diagram: The general signs and symptoms felt by tuberculosis sufferers vary, but there can also be no complaints at all.Some of the most frequently felt symptoms of tuberculosis infection are fever, coughing for more than three weeks, coughing followed by additional symptoms such as phlegm mixed with blood, shortness of breath, decreased appetite and decreased body weight (Radji, 2013) (Mangngi, 2018).1.5 shows that 36 people had pulmonary TB patients with Ro Thorax investigations (70.6%), 11 people had RO and TCM TB (21.6%), and 4 people without supporting examinations (7.8%).For more clarity, you can see the following picture:   1.6 shows that 14 people (27.5%) were diagnosed with active/new pulmonary TB, 22 people were on OAT (43.1%), 12 people had dropped out of OAT (23.5%) and 3 people were MDR pulmonary TB. (5.9%).For more clarity, see the following diagram: New cases are patients who have never received OAT before or have had a history of receiving OAT for less than 1 month (< 28 doses if using program drugs).On OAT is a case with a treatment history of a patient who has received OAT for 1 month or more (>28 doses when using program drugs).OAT withdrawal is a case after loss to follow up or a patient who has taken OAT for 1 month or more and has not continued it for more than 2 consecutive months and is declared loss to follow up as a result of treatment.For OAT withdrawal cases, more supervision needs to be carried out (providing education and PMO).The drug swallowing supervisor (PMO) must observe every drug intake that the OAT swallowed by the patient is the right drug, the right dose and the right interval, besides that the PMO should be someone who has been trained, is well accepted and chosen together with the patient (Ministry of Health of the Republic of Indonesia, 2019b ).This is done to prevent severity/relapse, complications and/or death due to pulmonary TB.  1.8 shows that the length of stay for pulmonary TB patients is 1 to 11 days with the highest percentage being 21.6%, namely 3 days with a total of 11 patients.And the lowest percentage was 2.0%, namely 7 days and 11 days with 1 patient.This can be seen in the following diagram 1.6.The definition of the number of treatment days is the total number of treatment days for all patients treated for a total of one year.Meanwhile, the total length of treatment is the total length of treatment for the patient from admission to discharge, for one year.Example: a patient is admitted to the hospital on the 5th and goes home on the 10th.So days of treatment = 5th, 6th, 7th, 8th, 9th, 10th = 6 days.Meanwhile length of stay = 10th -5th = 5 days.The measure used to determine the length of stay is ALOS (Average Length of Stay).AlOS is the average length of stay (in days) for a patient.The ideal ALOS parameter value is 6-9 days.
The ALOS value of each hospital can be obtained from the SIRS Online reporting R.L. 1.2 and 3.1.(RI Ministry of Health, 2019).ALOS value of RSUD dr.P.P. Magretti Saumlaki in 2022 is 2 days.This needs to be paid attention to because it is not yet in accordance with ideal standards.Length of care for pulmonary TB patients at RSUD dr.P.P. Magretti was influenced by several factors, including:

Cost
The cost factor is also a factor in the length of hospital stay.This can be seen in the condition of patient discharge where there are 12 patients who have been forced to return home or at their own request (APS).

Supporting investigation
Types of supporting examinations that are invalid and/or experiencing stock shortages often lead to extensions of treatment days.Because it is necessary to re-examine or postpone the examination.
In some patients, taking sputum samples during the Genexpert examination experienced problems because the sample given by the patient or family was not phlegm but saliva.Another reason is that the phlegm is mixed with blood, so a repeat sample needs to be taken.

CONCLUSION
The conclusion of this research is that pulmonary TB patients who are hospitalized in the isolation room at RSUD dr.P.P.More Magretti in 2022: male, aged 19-44 years, has clinical symptoms of shortness of breath, examination to support diagnosis using X-ray examination results (Ro) AP/PA Thorax Photo, patient goes home in good condition with 3 days of stay.

Figure 1
Figure 1.1 Frequency Distribution of Pulmonary TB Patients According to Age

Figure 1 . 3
Figure 1.3 Frequency Distribution of Pulmonary TB Patients According to Clinical Symptoms

Figure 1 . 4
Figure 1.4 Frequency Distribution of Pulmonary TB Patients according to Supporting Examinations

Figure 1 . 5
Figure 1.5 Frequency Distribution of Pulmonary TB Patients According to Diagnosis

Figure 1 . 7
Figure 1.7 Frequency Distribution of Pulmonary TB Patients According to Length of Hospitalization

Table 1 .
1 shows that the valid sample size is 51 people.Minimum patient age 17 years, maximum 79 years.Average age 44 years.Minimum length of stay is 1 day, maximum length of stay is 11 days.Average length of stay is 5 days.Standard Deviation is good because it has a value smaller than the mean and there is no data deviation for each variable.Table1.2Frequency Distribution of TB Patients According to Age Groups

Table 1 .
6 Frequency Distribution of Pulmonary TB Patients According to Diagnosis Diagnosis

Table 1 .
7 Frequency Distribution of Pulmonary TB Patients according to Condition of Return

Table 1 .
7 shows that 17 (33.3%) of the pulmonary TB patients who returned home recovered, 16 (31.4%)improved, 12 (23.5%)recovered at their own request/forced return home, and 6 (11.8%) died.).For more clarity, you can see the following image: Figure 1.6 Frequency Distribution of Pulmonary TB Patients according to Discharge Condition Figure 1.6 shows that more pulmonary TB patients who went home recovered and died the least.Recovered are pulmonary TB patients with positive bacteriological confirmation at the start of treatment and negative sputum BTA or negative culture at the end of treatment and have negative test results in one of the previous examinations.Meanwhile, deaths are TB patients who died for any reason before and during TB treatment.Supervised treatment helps patients to take OAT regularly and completely.Directly Observed Treatment Short Course (DOTS) is a monitoring method recommended by WHO and is a supporting package that can answer patient needs.(RI Ministry of Health, 2019b) Table 1.8 Distribution of Pulmonary TB Patients According to Length of Hospitalization