First report of amphotericin B resistant Candida haemulonii isolated from the ICU of a referral hospital in Indonesia.

Background and Objectives: Amphotericin B is a broad-spectrum antifungal agent commonly used to treat Candida haemulonii infection. C. haemulonii was isolated from patients reported to be intrinsically resistant to amphotericin B, encoded by the ERG2 and ERG11 genes. However, there have been limited studies concerning amphotericin B-resistant C. haemulonii in Indonesia. The objective of this study is to explore the phenotypic and genotypic characteristics (ERG2 and ERG11) of C. haemulonii isolated from the ICU of a referral hospital in Indonesia. Materials and Methods: Identification and susceptibility tests were conducted using VITEK2. Thereafter, DNA was extracted and amplified using conventional PCR followed by DNA sequencing (Sanger method). Results: The results of the phenotypic susceptibility test showed that all C. haemulonii were resistant to amphotericin B. ERG2 and ERG11 sequences showed the same amino acid sequence and corresponded to references that are resistant to amphotericin B. Conclusion: The resistant properties of C. haemulonii against amphotericin B found in this study require further exploration, including comparing resistant and sensitive C. haemulonii to amphotericin B. In addition, it is necessary to analyze other genes besides ERG2 and ERG11.

Burnout and coping strategies among resident physicians at an Indonesian tertiary referral hospital during COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has increased the burden on resident physicians. They may use different coping strategies to manage those burdens, which partly determine their mental health outcomes, including burnout syndrome. This study explores the relationship between coping strategies and burnout among resident physicians during the COVID-19 pandemic in an Indonesian tertiary referral hospital. METHODS: This online cross-sectional study was conducted from June to August 2020, involving nine residency programs in the Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo Hospital. Burnout syndrome was assessed using Maslach Burnout Inventory, while Brief COPE measured coping strategies. RESULTS: A total of 388 residents participated in this study. High emotional exhaustion (EE), depersonalization (DP), and low personal accomplishment (PA) were found in 15.5%, 5.2%, and 39.2%, respectively. Residents more often use adaptive than maladaptive coping strategies. Higher PA was correlated to residents using problem-focused (r = 0.299; p < 0.001) and emotion-focused (r = 0.397; p < 0.001). Meanwhile, dysfunctional coping strategies are moderately correlated with EE (r = 0,518; p <0,001) and DP (r = 0,507; p<0,001). CONCLUSION: The use of dysfunctional coping strategies is linked to higher emotional exhaustion and depersonalization aspect of burnout. However, a higher sense of personal accomplishment is linked to problem-focused and emotion-focused strategies. Appropriate identification and intervention of residents with dysfunctional coping strategies may be beneficial in reducing burnout risk.

Deconstructing the professional identity formation of basic science teachers in medical education.

PURPOSE: The role of basic science teachers (BSTs) in medical education has been changing dynamically. Less is known, however, about how BSTs perceive their professional identity and what factors influence its formation. This study aims to explore how the professional identity of BSTs is formed and what factors influence this professional identity formation (PIF) using the 4S ("Situation, Self, Support, Strategies") Schlossberg framework. METHOD: A qualitative descriptive study using focus groups (FGs) was conducted. Maximum variation sampling was used to purposively select BSTs. A rigorous thematic analysis was completed, including independent thematic analysis, intermittent checking and iterative discussions among researchers, and member checking. RESULTS: Nine FGs, involving 60 teachers, were conducted. The findings highlighted four major themes reflecting the 4S framework: the self as internal driver, early-career events and opportunities, individual and institutional support, and active participation in continuing professional development. Both the "Self" and the "Situation" components prompted the BSTs to utilize supports and enact strategies to become professional teachers. Although the BSTs in this study were primarily internally driven, they relied more on existing support systems rather than engaging in various strategies to support their growth. CONCLUSION: It is important to address the PIF of BSTs given their dynamic roles. Looking through the lens of the 4S framework, PIF is indeed a transition process. A structured, stepwise faculty development program, including mentorship, reflective practice, and a community of practice designed to foster BSTs' identities, should be created, taking into consideration the diverse factors influencing the PIF of BSTs.

Exploring College Adjustment in First-Year Gen Z Medical Students and Its Contributing Factors.

Background: First-year medical students need to adjust to university life to achieve optimal education. Notably, generation Z (Gen Z) students recently admitted to medical school possess unique characteristics that may affect their adjustment. However, limited studies have evaluated the adjustment of Gen Z medical students. In line with this, the present study explores the adjustment process of Gen Z medical students in their first year of study. Methods: A qualitative phenomenological study was held from January 2020 to October 2020. The respondents comprised first-year students from two medical institutions. Maximum variation sampling was applied to select the respondents. Moreover, 11 focus group discussions (FGDs) with students and 10 in-depth interviews with lecturers were conducted. Curriculum documents were examined, and then the data were analysed thematically. Results: Three themes were identified: i) domain; ii) process and iii) contributing factors to college adjustment. Academic, social and personal-emotional components of adjustment were included in the domain theme. The process theme consisted of transition, transition-transformation and transformation phases. Meanwhile, the contributing factors consisted of existing and supportive factors. Student characteristics, including demographics, mentality, prior educational experiences and social support, were considered the existing factors, while technology, learning system and well-being constituted the supporting factors. Conclusion: College adjustment involves various domains, processes and contributing factors that are unique to Gen Z characteristics, technology dependence and culture. Therefore, well-prepared faculties are needed to support the adjustment of Gen Z students.

Professional identity formation of medical teachers in a non-Western setting.

INTRODUCTION: Understanding and supporting professional identity formation (PIF) among medical teachers has become increasingly important in faculty development programs. In this study, we explored medical teachers' PIF in Indonesia. METHODS: We conducted a qualitative descriptive study using focus group discussions (FGDs) at four medical schools in Indonesia. Basic science and clinical teachers from four different schools were selected to participate. Data were transcribed, coded, and analysed to develop themes and subthemes. RESULTS: Seventeen FGDs were completed, involving 60 basic science and 59 clinical teachers. Four major themes regarding the formation of medical teachers' professional identity emerged: an internal dialogue between intrinsic values and external influences, empowerment through early socialization, experiential workplace learning, and envisioning the future. The PIF process was similar for basic science and clinical teachers. CONCLUSION: Our findings suggested that PIF among medical teachers in a non-Western setting is a continuous and dynamic process that is shaped by key socialization factors (e.g. role models, workplace learning, peer support), with significant influences from religious beliefs, family values, and societal recognition. Faculty development programs should consider the dynamic and continuous nature of PIF among medical teachers and encourage clinicians and basic scientists to explore their values and beliefs, realize their goals, and envision their future.

The Role of TB-LAMP Method in Detecting Mycobacterium tuberculosis from Sputum of Patients Suspected of Having Pulmonary Tuberculosis.

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.

Detecting the Helicobacter pylori 16S rRNA Gene in Dyspepsia Patients Using Real-Time PCR.

BACKGROUND: early detection of H. pylori is essential to prevent the development of infections into gastric malignancies. The coccoid form of H. pylori is difficult to detect either by culture or histopathology; however, it can be detected using molecular methods, such as real-time PCR. The study was expected to provide new information on the development of H. pylori detection. METHODS: a cross-sectional study was conducted at the Gastrointestinal Endoscopy Center of Cipto Mangunkusumo Hospital between October 2016 and August 2017. The sampling method used was consecutive sampling. Biopsy from gastric antrum and corpus were performed in 64 patients. We collected 2 specimens from each site to be examined using real-time PCR and histopathology. Initially, we conducted real-time PCR optimization followed by application of clinical samples from gastric biopsy. Data analysis using McNemar's χ2 and Kappa tests. RESULTS: the real-time PCR showed 25% positivity, while the positive proportion of histopathological examination was 14%. Real-time PCR has a sensitivity and specificity 88.9% dan 85.5%, respectively. The McNemar's χ2 test showed that there is significantly different (p=0.039) between the two tests; kappa value (p=0.561).  Conclusion: the real-time PCR examination is more sensitive than histopathology. This technique can improve diagnosis by 11% compared to histopathological examination.

The Immunogenicity and Safety of CYD-Tetravalent Dengue Vaccine (CYD-TDV) in Children and Adolescents: A Systematic Review.

AIM: to assess the immunogenicity and safety of CYD-tetravalent dengue vaccine (CYD-TDV) in children. METHODS: comprehensive literature searches were conducted on various databases. Randomized-controlled trials on children with CYD-TDV as intervention were selected based on inclusion and exclusion criteria. Data extracted from selected trials included safety of vaccine and immunogenicity in terms of Geometric Mean Titres (GMT) of antibodies. RESULTS:   six clinical trials were selected based on preset criteria. GMT values were obtained using 50% Plaque Reduction Neutralization Test (PRNT) and safety was semi-quantitatively assessed based on adverse effects. Additional data processing was done to obtain a better understanding on the trends among the studies. The results showed that the groups vaccinated with CYD-TDV showed higher immunogenicity against dengue virus antigens than the control groups. Safety results were satisfactory in all trials, and most severe side effects were unrelated to the vaccine. CONCLUSION: CYD-TDV is both effective and safe for patients in endemic regions. This gives promise for further development and large-scale research on this vaccine to assess its efficacy in decreasing dengue prevalence, and its pervasive implementation in endemic countries, such as Indonesia.

Risk Factors and Scoring Systems for Patients with Candidemia at a Tertiary Hospital in Jakarta, Indonesia.

AIM: to identify the risk factors of candidemia and to develop a scoring system that could be implemented in Cipto Mangunkusumo Hospital (RSCM), Jakarta, Indonesia. METHODS: this study was a retrospective study with case control design using the medical records of patients since 2011 to 2014. All sepsis patients hospitalized in the RSCM with a positive blood culture for Candida were included in this study as a case group. The control group was all of the sepsis patients without candidemia. The ratio for case and control groups was equal (1:1). RESULTS: from 234 patients who were analyzed, the risk factors that influenced the study were length of stay of 8-14 days (OR 3.464; 95% CI 1.458-7.800), length of stay of more than 14 days (OR 6.844; 95% CI 3.0-15.330), severe sepsis (OR 16.407; 95% CI 1.458-7.800), and surgery (OR 3.03; 95% CI 1.492-6.152). The predictors for candidemia in RSCM were length of stay in hospital for 8-14 days (score 1), a length of stay ≥14 days (score 2), severe sepsis (score 3), and surgery (score 1), with a cut off score of 3.5. CONCLUSION: the results of this study have indicated that a scoring system in order to guide an empirical treatment for candidemia can be developed by using the risk factors for candidemia from patients who have been identified as patients with risk at Cipto Mangunkusumo Hospital.