Perburukan Asma Bronkial Sebelum clan Saat Pandemi COVID-19 pads Periode Januari 2019-April 2023

Celline Margareth Winarto, Agus Cahyono, Olivia Benedick Sri Panggabean, Agus Suharto
Bukit Palma A2 24 Citraland Utara, Surabaya

Abstract

Background: Asthma is a chronic respiratory disease that poses a serious public health problem in various countries around the world. Asthma can be mild and not interfere with activities, but it can also be persistent and disrupt daily activities. Individuals with persistent asthma experience a decline in physical condition, limiting their ability to carry out daily activities. According to WHO (World Health Organization) data, the global prevalence of asthma reached 262 million in 2019. The prevalence of asthma in Indonesia, according to data from the Indonesian Ministry of Health, reached 12 million in 2020. During the COVID-19 pandemic, asthma patients did not attend routine hospital check-ups due to fear of exposure to COVID-19, resulting in worsening symptoms and depletion of their medications.
Research Methods : This study is a quantitative observational analytic research with a retrospective approach. The research was conducted by collecting medical record data from 30 outpatients with bronchial asthma in the pulmonary outpatient clinic of Haji Surabaya Provincial Hospital and Ibnu Sina Gresik Hospital in August-October 2023. Data were tested using the Mc Nemar comparison test, revealing 16 samples that showed deterioration according to the Mc Nemar test results.
Results: The research findings from the non-parametric Mc Nemar comparison test indicate a significance value of 0.808, and 23 samples deteriorated based on the Mc Nemar test results, suggesting no significant difference in the exacerbation of bronchial asthma before and during the COVID-19 pandemic.
Conclusion: There is no difference in exacerbation of bronchial asthma before and during the COVID-19 pandemic.
Keyword: Bronchial asthma, Exacerbation of bronchial asthma, COVID-19 pandemic.

Obesitas dalam Kehamilan Tinjauan Literatur 

Rizkiyah Novianti1, Putri Azzahra2, Yara Anesia3, Aldina Ayunda Insani4*
1,2,3,4 Program Studi Kebidanan Program Magister, Fakultas Kedokteran
1,2,3,4 Universitas Andalas

Abstract

Obesity in pregnancy is a health problem that affects both mother and fetus, and increases the complications such as hypertension, gestational diabetes and preeclampsia. This study aims to summarize the literature related to the impact of obesity on pregnant women and fetuses and treatment methods to manage this risk. Based on a literature review of various observational, experimental, and literature studies, it was found that obesity in pregnant women correlates with a high risk of complications, including macrosomia and congenital defects in the fetus. Prevention and management efforts according to the Ministry of Health (MOH) and WHO guidelines, such as nutrition education, family support, dietary regulation, physical activity, and health programs such as GERMAS, have proven effective in reducing the risk of complications. This review is expected to provide comprehensive recommendations to improve the health of pregnant women and fetuses.
Keywords: Obesity, Pregnancy, Pregnancy Complications

Glucocorticoid-Induced Immunosuppression and Immunocompromised Host Pneumonia

Mira Yulianti,
Department of Internal Medicine, Division of Respirology and Critical Illness, Faculty of Medicine Universitas Indonesia – Dr. Cipto Mangunkusumo General Hospital
Dwitya Wilasarti, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia – Dr. Cipto Mangunkusumo General Hospital

Abstract

Glucocorticoid is still a mainstay therapy in numerous diseases despite advances in novel chemotherapy and biologic immunomodulators. Estimated prevalence of glucocorticoid exposure is 1% in the general population. Glucocorticoid affect the immune system through various pathways, rendering those exposed to glucocorticoid immunocompromised. Studies have found that even at lower doses and short-term prescription, infection risk is increased in this population. Pneumonia is one of the leading causes of infection in the immunocompromised population, and based on the latest ATS/IDSA workshop report regarding immunocompromised-host pneumonia (ICHP), diagnosis and the etiologic workup differs compared to the community acquired pneumonia in immunocompetent patients. Approach to admission to inpatient care also differs due to the higher possibility of rapid deterioration of initially stable patients. Empirical treatment targets core respiratory pathogens but must be followed up to an attempt to determine causative pathogen according to clinical predisposition and imaging findings.
Keywords: immunocompromised host pneumonia, glucocorticoid

Transkriptomik pada Tuberkulosis 

Chrispian Oktafbipian Mamudi1
1Doctoral Study Program, Faculty of Medicine, UniversitasPadjadjaran, Bandung 45363, Indonesia
2Lecturer in Internal Medicine, Division of Respirology and Critical Illness, Department of Internal Medicine, Faculty of Medicine, Krida Wacana Christian University, Jakarta, Indonesia

Abstract

Transcriptomics is the study of RNA expression that allows the identification of molecular pathways, biomarkers, and mechanisms of pathogenicity associated with infection. In the context of tuberculosis (TB), this approach provides important insights into pathogenesis, immune response, and therapeutic development. This paper reviews studies that use transcriptomics to support diagnosis, monitor treatment, and discover new therapeutic targets.
Keywords: RNA, TB, Transcriptomics

Diagnostic Prediction Model of Tuberculous Pleural Effusion 

Pradipto Utomo1, Telly Kamelia2, Ceva Wicaksono Pitoyo2, Ina Susianti Timan3, C. Martin Rumende2
1 Internal Medicine Department, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
2 Respirology and Critical Care Division, Internal Medicine Department, Faculty of Medicine, Universitas Indonesia,
Jakarta, Indonesia
3Clinical Pathology Department, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

Abstract

Background: Percentage of TPE reach 20% of total EPTB cases. The diagnosis of TPE is difficult due to pleural biopsy procedure invasiveness and acid fast stain low sensitivity. Adenosine deaminase (ADA) can become reference test with high sensitivity and specificity but availability in primary health care is limited.
Objective: Analyze prediction model in diagnosis of tuberculous pleural effusion.
Methods: This study uses a cross-sectional method. The study was conducted at Cipto mangunkusumo Hospital. Independent variables consist of age, pleuritic chest pain, unilateral pleural effusion, glucose pleural fluid ≤70 mg/dL, exudative mononuclear pleural effusion, negative cytology malignancy, ultrasound characteristic and blood neutrophil-lymphocyte ratio. ADA ≥35 suggests TPE. The variaables analyzed bivariately, multivariately, ROC curve and Hosmer-Lemeshow.
Results: There were 91 subjects with characteristic of male 41 subjects (45,1%) and female 50 subjects (54,9%). Malignancy was the most frequent comorbid with 52 subjects (57,1%). Factors associated with TPE diagnosis are complex ultrasound characteristic OR 5,655 (CI 95% 1,700-18,812), pleural fluid glucose ≤70 mg/dL OR 11,262 (CI 95% 2,931-43,276) and exudative mononuclear dominant pleural effusion OR 8,567 (CI 95% 2,114-34,715). In ROC curve conclude AUC 0,841 with p<0,001 CI 95% (0,762-0,926). The result is a scoring system cut-off value ≥2 with probability 92,8%.
Conclusion: Predicted factors of TPE diagnosis are complex ultrasound characteristic, low pleural fluid glucose and exudative mononuclear dominant pleural effusion. The result is scoring system with cut-off value ≥2 with probability 92,8%.
Keywords: Tuberculous pleural effusion, ADA, complex ultrasound characteristic, exudative mononuclear dominant pleural fluid, pleural fluid glucose

Predictor Factors for 30-Day Mortality in Adult Hospitalized CAP with Immunosuppressive-Dose Glucocorticoid Use

Dwitya Wilasarti1, Mira Yulianti2, Suzy Maria3, Robert Sinto4, Adityo Susilo4, Dicky L. Tahapary5, Dono Antono6, Pringgodigdo Nugroho7
1. Department of Internal Medicine, Faculty of Medicine Universitas Indonesia – Dr. Cipto Mangunkusumo General Hospital
2. Division of Respirology and Medical Critical Illness, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia –
Dr. Cipto Mangunkusumo General Hospital
3. Division of Allergy and Immunology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia –
Dr. Cipto Mangunkusumo General Hospital
4. Division of Infectious and Tropical Diseases, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia –
Dr. Cipto Mangunkusumo General Hospital
5. Division of Endocrinology, Metabolic, and Diabetes, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia –
Dr. Cipto Mangunkusumo General Hospital
6. Division of Cardiology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia –
Dr. Cipto Mangunkusumo General Hospital
7. Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia –
Dr. Cipto Mangunkusumo General Hospital

Abstract

Background: Glucocorticoids are still frequently used for various conditions such as autoimmune diseases and malignancies, leading to immunosuppression and risk of pneumonia. Pneumonia in the immunocompromised host have a higher mortality rate compared to the immunocompetent population. The clinical manifestations of pneumonia in this population are often atypical, and clinical conditions can deteriorate rapidly compared to the time of admission, making predictors at admission necessary to assess risk mortality.
Objective: To evaluate the PSI score, lymphocyte count, increase in procalcitonin levels, history of chemotherapy, history of other immunosuppressant use, and the presence of comorbid lung disease as predictors of 30-day mortality in hospital-acquired community pneumonia patients using immunosuppressive doses of glucocorticoids.
Method: This study is a retrospective cohort study of subjects diagnosed with community-acquired pneumonia who were treated at RSUPN Dr. Cipto Mangunkusumo with a history of immunosuppressive dose glucocorticoid use. Bivariate analysis was conducted, followed by multivariate analysis of the predictor factors for 30-day mortality.
Results: Among the 267 study subjects, significant predictor factors were found, including a PSI score > 91 (RR 1.873; 95% CI 1.383 – 2.535) with a p-value < 0.001, and increased procalcitonin levels (RR 1.386; 95% CI 1.080 – 1.780) with a p-value of 0.01.
Conclusion: A PSI score > 91 and procalcitonin > 0.76 ng/dl are predictors of 30-day mortality in community-acquired pneumonia patients with a history of immunosuppressive doses of glucocorticoids treated at RSUPN Dr. Cipto Mangunkusumo.
Keywords: immunocompromised host pneumonia, glucocorticoids, 30-day mortality

Relationship between Pulse Transit Time, Oxygen Desaturation Index clan Blood Pressure with Apnoea-Hypopnea Index in Obese Patients 

Rattu R1, Kamelia T2
1Divisi Respirologi dan Penyakit Kritis RSUPN Ciptomangunkusumo/FKUI

Abstract

Background Obesity is a complex chronic disease that can impact sleep quality. In assessing sleep physiology, polysomnography is one of the methods used to record physiological parameters related to sleep, such as Apnea-Hypopnea Index (AHI), Pulse Transit Time (PTT), and Oxygen Desaturation Index (ODI). These parameters can be used to establish a diagnosis of sleep disordered breathing. Objective to know the relationship between AHI with Pulse Transit Time (PTT), Blood Presure and Oxygen Desaturation Index (ODI) in patient with obesity. Methods This study is a cross-sectional analytical study conducted at RSUPN Cipto Mangunkusumo assessing the relationship between polysomnography examination parameters, namely AHI, ODI and PTT, in obese patients (BMI ≥25 kg/m2). Results Obese patients with increasingly severe AHI were found to have significantly higher ODI (p<0.001), with a median ODI in the mild AHI group of 11.00, moderate 32.50, and severe 68.00. PTT between AHI groups were not significantly different (p=0.907). No significant relationship was found between ODI and PTT (r=-0.010, p=0.952). A positive correlation was found between systolic blood pressure and AHI score (r = 0.221, p = 0.030).
Discussion The positive correlation between AHI and ODI in this study is in accordance with the results of previous studies. ODI has the potential to be a screening parameter for sleep disordered breathing and a predictor of AHI in obese populations. PTT in previous studies was found to be ineffective in assessing sleep quality because it was influenced by age and other factors. Increased systolic blood pressure in previous studies has also been associated with increased AHI scores.
Conclusion ODI in obese patients correlates well with AHI. PTT was not found to be associated to either ODI or AHI. High systolic blood pressure is correlated with higher AHI.
Keywords: polysomnography, apnea-hypopnea index, pulse transit time, oxygen desaturation index, sleep disordered breathing, obesity

COVID-19 Pulmonary Fibrosis From Acute Infection to Chronic Complications

Gede Ari Mahendra Mardaningrat1*, Putu Andrika2, Isabella Soerjanto Putri1, I Putu Hendri Aryadi1
1 Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
2 Division of Pulmonary and Critical Care, Department of Internal Medicine, Udayana University/Prof. dr. I.G.N.G Ngoerah Hospital, Denpasar, Bali, Indonesia

Abstract

Background: SARS-CoV-2 is a virus that appeared in 2019 and led to the illness known as COVID-19. In the post-COVID-19 infection stage, a lot of patients suffer from fibrosis sequelae and alterations in pulmonary function. This systematic review and meta-analysis aimed to establish the frequency of pulmonary fibrosis after COVID-19 infection, identify risk factors, and recognize biomarkers linked to pulmonary fibrosis development post-COVID-19 infection.
Methods: Following PRISMA and MOOSE guidelines, studies published between January 1, 2020, and June 31, 2024, were analyzed.
Results: Fifteen studies (2,240 patients) revealed a 42.7% prevalence of post-COVID-19 pulmonary fibrosis. Patients with fibrosis were older (mean age 60 years vs. 49.5 years). Heart disease was a significant comorbidity. Symptoms included shortness of breath, chest pain, and muscle pain (p<0.05). Severe COVID-19 (ICU admission, mechanical ventilation, steroid/immunoglobulin therapy) increased fibrosis risk (p<0.05). Radiological findings included consolidation, ground-glass opacity, parenchymal bands, and interlobular thickening. Elevated IL-6, TNF-α, LDH, CRP, and D-dimer levels correlated with fibrosis (p<0.05).
Conclusion: Post-COVID-19 pulmonary fibrosis affected 42.7% of patients, strongly linked to severe COVID-19 and associated treatments. Common lung abnormalities included consolidation and parenchymal bands. Biomarkers IL-6, TNF-α, LDH, CRP, and D-dimer were significant contributors to fibrosis development.
Keywords: Acute infection, Chronic complications, COVID-19, Pulmonary fibrosis, SARS-CoV-2

Jasmine Asy Syauqi Ramadhani¹, Yasmin Nurfitriyanti², Maedia Salsabilla³, Naurah Bagia Aryani⁴, Rifqi Muhammad Hajid⁵
Prodi Farmasi Fakultas Kedokteran Universitas Negeri Semarang Semarang, Jawa Tengah

 

Abstract

Secondary metabolites are compounds that are the result of biosynthesis derived from primary metabolites, and are generally produced by organisms to protect themselves from the environment and from attacks by other organisms. Vis spectrophotometry (vis spectrophotometry) is an analytical technique used to measure the absorbance of light by a sample at a certain wavelength in the visible light range (vis). This study aims to analyze various secondary metabolites in natural materials using Vis spectrophotometry. Secondary metabolites such as flavonoids, terpenoids, and alkaloids have an important role in plant defense and provide various health benefits for humans. Vis spectrophotometry is used to identify and measure the concentration of these metabolites based on their absorbance characteristics at certain wavelengths. The results of the study showed that the Vis spectrophotometry method is able to provide accurate identification and efficient quantification of secondary metabolites in various natural material samples. Flavonoids, terpenoids, and alkaloids were successfully identified and quantified using this technique. This study also confirms that Vis spectrophotometry is a very useful tool in chemical analysis and has wide applications in the pharmaceutical, nutritional, and cosmetic industries. Overall, this study provides a deep insight into the use of Vis spectrophotometry in secondary metabolite analysis and shows the potential of this method for further research and practical applications in various fields.
Keywords: Secondary Metabolites, Natural Products, Vis Spectrophotometry

SUCTION PUMP ASSIST DEVICE IN CARDIOGENIC SHOCK

Lukman H. Makmun, Telly Kamelia, Ryan Ranitya, Zuswayudha Samsu

• Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
• Respirology and Critical Illness Divison, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia

ABSTRACT

 

 

Background: Cardiogenic shock is a critical condition where the heart fails to pump blood effectively, lead- ing to high mortality rates. Mechanical circulatory support can temporarily reduce the heart’s workload while maintaining systemic perfusion. This paper in- troduces the Suction Pump Assist Device, an early mechanical support system patented in 1979.

Aim: To present the design, working principle, and clinical relevance of the Suction Pump Assist Device and compare it to the modern standard, Extracorpo- real Membrane Oxygenation (ECMO).

Method: The working principle of the suction pump assist device was analyzed and compared to ECMO, which has been the standard of care for cardiogenic shock since 2016.

 

Results: The Suction Pump Assist Device operates on a principle similar to VA-ECMO, where venous blood is oxygenated externally and returned to the arterial system, thereby reducing cardiac workload and ensur- ing systemic oxygenation. While ECMO has evolved significantly with technological advancements, the fundamental concept remains consistent.

Conclusion: The Suction Pump Assist Device repre- sents an early innovation in mechanical circulatory support for cardiogenic shock, sharing key principles with modern ECMO systems.

Keywords: Cardiogenic shock, Mechanical circula- tory support, ECMO, Suction pump assist device

Validation of Clinical PROMISE Score in Predicting 3-Month Mortality in Malignant Pleural Effusion Patients

 

Dita Gemiana¹, Cleopas Martin Rumende², Ikhwan Rinaldi³, Robert Sinto⁴ , Aida Lydia⁵, Rudy Hidayat⁶, Noto Dwimartutie⁷, Nadia Ayu Mulansari³

¹ Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia

² Respirology and Critical Illness Divison, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia

³ Hematology and Medical Oncology Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia

⁴ Tropical and Infectious Diseases Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia

⁵ Nephrology Divison, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia

⁶ Rheumatology Divison, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia

⁷ Geriatric Divison, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia

 

Corresponding Author: Dita Gemiana

Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia

Email: dita.gemiana91@ui.ac.id, Phone 081319100857

 

Abstract

Background: Pleural effusion is a frequent complication of malignancy. Malignant pleural effusion accounts for 15% to 35% of all pleural effusion cases and the incidence rate reaches 660 people per 1 million population globally. Several prediction models have been evaluated to predict mortality in malignant pleural effusion patients. The PROMISE score is a prediction model for 3-month mortality in patients with malignant pleural effusion.

Methods: A retrospective cohort study was conducted on patients with malignant pleural effusion registered in 2015-2022 at Cipto Mangunkusumo National Central General Hospital. A three-month mortality assessment was carried out. The collected data was analyzed using the Hosmer-Lemeshow goodness-of-fit test to determine the calibration performance and creation of a Receiver Operating Curve (ROC) curve to determine the discrimination performance of the Clinical PROMISE score on three-month mortality outcomes.

Results: A total 120 subject were included in the study. The majority of subjects were women (73.3%), mean age 55 years and other types of cancer (78.3%). The Clinical PROMISE score had good calibration performance (p = 0.230, coefficient of correlation r = 0.945). The discrimination performance of the Clinical PROMISE score was good with an AUC of 0.849 (95% CI 0.776 –0.922).

Conclusion: The calibration and discrimination performance of Clinical PROMISE score to predict 3-month mortality of malignant pleural effusion is good.

Keywords: Malignant pleural effusion, mortality, Clinical PROMISE score.

Unexpected Tension Pneumothorax Complicated by Double-Lumen Catheter Insertion in Patient with Mechanical Ventilator: A Case Report

 

Arif Himmawan, Rullyano Hardian, Fitriah Sherly Marleen

Khidmat Sehat Afiat General Hospital of Depok

Koresponden: himmawan89@gmail.com

 

 

Abstract

 

Introduction: Tension pneumothorax is an emergency situation with a high mortality rate which can be caused by trauma/iatrogenic. We report a case of tension pneumothorax observed after insertion of a double-lumen cetheter in a patient on a mechanical ventilator.

Case: A 70 year old man with a mechanical ventilator was designed to install a double-lumen catheter in preparation for hemodialysis. After insertion of a double-lumen catheter, the patient’s saturation decreased, breath sounds from the right hemithorax decreased. A chest X-ray shows a collapsed right lung and flattened diaphragm. A needle thoracocentesis was performed at the 2nd ICS, the right mid-clavicular line, and continued with the installation of a WSD at the 5th ICS, the right anterior axilla line. The result is a clinical improvement.

Discussion: Tension pneumothorax is not an uncommon complication in mechanical ventilated patient, but its occurance immediately after insertion of a double-lumen cetheter is extremely rare. Subsequent decline in respiratory and cardiovascular function can be life-threatening if not detected early enough and managed properly. With the needle thoracocentesis and insertion of a WSD tube, the patient’s clinically condition significantly improved.

Conclusion: Tension pneumothorax is an emergency situation with a high mortality rate which can be caused by trauma/iatrogenic. With the needle thoracocentesis and insertion of WSD tube, a clinical improvement in the patient’s condition was evident.

 

Keywords: tension pneumothorax, double-lumen catheter, mechanical ventilator

 

 

ANALYSIS OF DEMOGRAPHIC PROFILE AND CHARACTERISTICS OF ACUTE CORONARY SYNDROME PATIENTS: AN OBSERVATIONAL STUDY

 

Muhammad Perdana Airlangga^1*, Irma Kartikasari², Juliana Juliana³, Saski Yasmin Alfina⁴, Frida Nur Rohmatin⁵,

^1,2 Faculty of Medicine, Muhammadiyah Surabaya University, Indonesia

³ General Practitioner, Siti Khodijah Muhammadiyah Sepanjang Hospital, Indonesia

^4,5 Internship doctor, Siti Khodijah Muhammadiyah Sepanjang Hospital, Indonesia

                                                  * Correspondence Author: angga.cardio@gmail.com                

 

ABSTRACT

Cardiovascular disease (CVD) is the leading cause of death globally. Based on the 2018 Indonesia Basic Health Research data, the prevalence of heart disease in Indonesia reached 1.5% including Acute Myocardial Infarction (AMI). Blockage or total occlusion of the coronary arteries in ST-Elevation Myocardial Infarction (STEMI) patients requires immediate reperfusion (Percutaneous Coronary Intervention (PCI) or fibrinolytic therapy). Based on data from the Sidoarjo Health Office in 2023, there was 3968 cases of AMI. This study aims to identify the profile of Acute Coronary Syndrome (ACS) patients in Sidoarjo, This is a descriptive observational study with a retrospective cohort study design. This study used secondary data from the medical records with an inclusion and exclusion criteria. There were 150 samples which predominantly males (85%) with aged 50-60 years (47%).  The most  systolic blood pressure was  ≤120 mmHg (55%). The result of PCI in patients showed that the most was Coronary Artery Disease (CAD) triple vessel disease (44%). A total of 67 of 150 patients experienced occlusion, 36 were chronic total occlusion (CTO) and 31 others were acute total occlusion. The location of the most common cause of blockage was in the Left Anterior Descendens (LAD) artery, which was 121 patients. This study showed that the most PCI patients were male, aged 51-60 years, systolic blood pressure <120 mmHg, multi vessel disease, chronic total occlusion, the most arterial blockage was located in the LAD artery, and had normal creatinine serum.

Keywords: Acute coronary syndrome, cardiovascular diasease, chronic total occusion

Latent Tuberculosis Treatment in HIV-Positive Patients: What’s New? Is It Overtreatment? Which One Is Preferred?

Arya Marganda Simanjuntak¹, Ellya Catharine Lumbantoruan², Merlinda Veronica³, Heri Ginting⁴, Anwar Sholeh⁴, Dani Rosidana⁴

¹ Research Intern, Department of Internal Medicine, Faculty of Medicine, Universitas Riau, Arifin Achmad General Hospital

² Faculty of Medicine, Universitas Tanjungpura, Pontianak, Indonesia

³ Tropical Infection Division, Department of Internal Medicine, Faculty of Medicine, Universitas Riau, Arifin Achmad General Hospital, Pekanbaru, Riau, Indonesia

⁴ Pulmonary and Critical Medicine Division, Department of Internal Medicine, Faculty of Medicine, Universitas Riau, Arifin Achmad General Hospital, Pekanbaru, Riau, Indonesia

 

Corresponding Author : Arya Marganda Simanjuntak, Dept of Internal Medicine, Faculty of Medicine, Universitas Riau, Arifin Achmad General hospital. arya.marganda@gmail.com

 

ABSTRACT

Latent Tuberculosis Infection (LTBI) is a focus especially in HIV-seropositive patients because immunocompromise increases the risk of reactivation of LTBI into active TB. Therefore, LTBI therapy was developed to prevent the TB from becoming active. However, several issues have been questioned regarding LTBI therapy in HIV patients as an overtreatment and potentially dangerous because both drugs in TB and HIV have the same profile of hepatotoxicity. This review comprehensively discusses existing regimens and current evidence on the management of LTBI in HIV patients.  This should be taken into consideration, but we also see from recent studies that if a patient has TB activation in HIV, it will decrease treatment success and also increase morbidity and mortality. Therefore, LTBI therapy has been developed up to the latest prevention guideline in 2024 with fewer treatment regimens than Active TB with 3HP or 3 HR. While it can be argued that LTBI therapy in HIV patients is necessary and not overtreatment, measures have also been developed to reduce the rate of hepatotoxicity that may occur.

 

Keywords : HIV, Latent Tuberculosis, Pharmacotherapy,  Tuberculosis, Treatment

Glucocorticoid-Induced Immunosuppression and Immunocompromised Host Pneumonia

Mira Yulianti, Department of Internal Medicine, Division of Respirology and Critical Illness, Faculty of Medicine Universitas Indonesia – Dr. Cipto Mangunkusumo General Hospital

Dwitya Wilasarti, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia – Dr. Cipto Mangunkusumo General Hospital

 

Corresponding author: Dwitya Wilasarti, Dr Cipto Mangunkusumo Hospital, Jl Pangeran Diponegoro no 71, Central Jakarta, dwitya.w@gmail.com

Abstract:

Glucocorticoid is still a mainstay therapy in numerous diseases despite advances in novel chemotherapy and biologic immunomodulators. Estimated prevalence of glucocorticoid exposure is 1% in the general population. Glucocorticoid affect the immune system through various pathways, rendering those exposed to glucocorticoid immunocompromised. Studies have found that even at lower doses and short-term prescription, infection risk is increased in this population. Pneumonia is one of the leading causes of infection in the immunocompromised population, and based on the latest ATS/IDSA workshop report regarding immunocompromised-host pneumonia (ICHP), diagnosis and the etiologic workup differs compared to the community acquired pneumonia in immunocompetent patients. Approach to admission to inpatient care also differs due to the higher possibility of rapid deterioration of initially stable patients. Empirical treatment targets core respiratory pathogens but must be followed up to an attempt to determine causative pathogen according to clinical predisposition and imaging findings.

Abstrak:

Glukokortikoid tetap menjadi opsi pengobatan penting untuk berbagai penyakit, meskipun telah ada kemajuan dalam kemoterapi dan terapi biologis. Sekitar 1% dari populasi umum diperkirakan terpapar glukokortikoid, yang mempengaruhi sistem kekebalan tubuh melalui berbagai jalur, sehingga meningkatkan risiko infeksi. Secara khusus, penelitian menunjukkan bahwa bahkan dosis rendah dan penggunaan jangka pendek dapat meningkatkan risiko infeksi. Pneumonia menjadi salah satu infeksi utama pada individu dengan imunitas menurun. Pedoman terbaru dari ATS/IDSA menekankan bahwa diagnosis dan pemeriksaan etiologis pneumonia pada pasien dengan imunitas menurun (ICHP) berbeda dari pneumonia yang didapat di masyarakat pada pasien yang imunokompeten. Keputusan untuk merawat inap pasien pada populasi tersebut juga sangat bergantung pada keputusan klinis karena memiliki risiko lebih tinggi untuk mengalami perburukan kondisi dengan cepat walau datang dengan klinis stabil. Pengobatan empiris biasanya menargetkan patogen pernapasan umum, tetapi penting untuk memperbaiki pendekatan ini berdasarkan temuan klinis dan pencitraan untuk secara efektif mengidentifikasi organisme penyebabnya.

Keywords: immunocompromised host pneumonia, glucocorticoid

Factors Influencing the Survival of Patients with Pleural Effusion Without Clear Etiology

Bellinda Magdalena¹, Gurmeet Singh², Lisnawati³, Dicky L. Tahapary⁴

¹Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia

²Div of Respirology and Critical Care, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia

³Departmen of Anatomic Pathology, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia

⁴Division of Endocrinology and Metabolism, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia

 

*Corresponding author: Bellinda Magdalena

Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia

E-mail: bellindamagdalena@gmail.com

Abstract

BACKGROUND: Undiagnosed pleural effusion is a common cause of respiratory distress worldwide and contribute to morbidity and mortality. OBJECTIVE: The aim of this study is to evaluate factors affecting mortality and determine the 30 day and 90 day survival of patients with pleural effusion undergoing medical thoracoscopy. METHODS: This prospective study was conducted on patients with pleural effusion of unknown etiology who were over 18 years old and underwent medical thoracoscopy in Dr. Cipto Mangunkusumo National General Hospital, a tertiary care hospital in Jakarta, Indonesia. The study included 57 patients with pleural effusion who underwent medical thoracoscopy from January 2023 to May 2024. Patients were monitored up to 90 days after medical thoracoscopy. Kaplan-Meier and Cox proportional hazard analysis was used to analyze the data. RESULTS: The 90-day survival rate was 74.63% (CI 66.36-82.88). Analysis using the cox proportional hazard showed male gender [HR 2.108 (CI 0.732-6.076), p=0.167)] and poor ECOG PS [HR 3.822 (CI 0.863-16.928), p=0.077] were factors directly influencing the 90-day mortality of patients with pleural effusion of unknown etiology undergoing medical thoracoscopy. CONCLUSION: The 90-day survival rate of patients with pleural effusion with unknown etiology undergoing medical thoracoscopy is 74.63% (CI 66.36-82.88). Patients with pleural effusion of unknown etiology undergoing medical thoracoscopy who were male and with worse ECOG PS were associated with a higher risk of mortality within 90 days post procedure. 

Keywords:  Pleural effusion, medical thoracoscopy, survival, mortality

Pendekatan Tatalaksana dan Pengawasan Efek Samping Pemanjangan Masa QT Interval dalam Pengobatan Tuberkulosis Resisten Obat

 

Raden Fidiaji Hiltono Santoso*, Herikurniawan**, Mira Yulianti**

*Divisi Kardiologi, Departemen Ilmu Penyakit Dalam RS Cipto Mangunkusumo

**Divisi Pulmonologi, Departemen Ilmu Penyakit Dalam RS Cipto Mangunkusumo

 

ABSTRACT

Tuberculosis (TB) is one of the deadliest infectious diseases in the world. A major challenge in its treatment is the long duration of therapy, which often leads to low patient adherence to medication. This can result in incomplete treatment, therapy failure, and the development of drug resistance.

Drug-resistant tuberculosis (DR-TB) occurs when TB bacteria no longer respond to first-line anti-TB drugs such as rifampicin and/or isoniazid. In the treatment of DR-TB, the use of combination therapy that includes bedaquiline has been shown to yield better outcomes. However, it is also associated with an increased risk of cardiac side effects, particularly arrhythmias caused by QT interval prolongation.

QT interval prolongation can trigger dangerous arrhythmias and increase the risk of sudden death. Therefore, it is crucial to conduct thorough risk assessments and monitor the side effects of DR-TB treatment, especially for drugs that carry a risk of QT prolongation. Additionally, a good understanding of emergency management for arrhythmias is essential to ensure patient safety and treatment success.

Keywords: Tuberculosis, DR-TB, MDR-TB, QT Interval Prolongation, Arrhythmia.

EFEKTIVITAS TINDAKAN BRONHOALVEOLAR LAVAGE DALAM PENEGAKAN DIAGNOSIS TUBERKULOSIS PARU PADA PASIEN YANG KESULITAN MENGELUARKAN SPUTUM

Ade Yudisman¹, Prayudi Santoso², Arto Yuwono Soeroto²

¹Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Padjadjaran/ RSUP Dr Hasan Sadikin Bandung

²Divisi Respirologi dan Penyakit Kritis Respirasi, Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Padjadjaran/ RSUP Dr Hasan Sadikin Bandung

 

 Corresponding Author:

Ade Yudisman. 1Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Padjadjaran/ RSUP Dr Hasan Sadikin Bandung Jl Pasteur No. 38, Bandung, 10430, Indonesia. E-mail: yudismanade@yahoo.com

Abstrak

Latar belakang: Pemeriksaan Bakteri Tahan Asam (BTA) dan Test Cepat Molekular (TCM) pada penegakkan diagnosis TB Paru memerlukan specimen sputum. Penegakkan diagnosis menjadi sulit, bila sputum tidak didapatkan. Hal ini dapat menimbulkan overdiagnosis atau overtreatment serta undertreatment, terutama pada kasus terduga TBC resisten obat atau TB paru kasus kambuh dengan gejala klinis dan hasil interpretasi foto toraks yang menggambarkan TB namun tidak berhasil mendapatkan hasil bakteriologis. Pada kasus pasien tersebut, maka sputum untuk pemeriksaan bakteriologis bisa didapat melalui prosedur Bronhoalveolar Lavage (BAL) dengan menggunakan bronkoskopi.  Hasilnya dapat membantu klinisi untuk tidak ragu-ragu memberikan terapi TB paru sensitif atau resisten obat, bahkan mungkin pasien tidak diberikan Obat anti Tuberkulosa (OAT) sama sekali. Metode: Penelitian kohort-retrospektif data primer yang diperoleh dari rekam medis dalam rentang januari 2023 sampai november 2024 di RSUD Cibabat. Subjek penelitian adalah pasien presumptive TB kasus baru dan kambuh dengan gejala klinis dan interpretasi gambaran toraks TB paru. Spesimen yang digunakan adalah hasil BAL menggunakan bronkoskopi fleksibel sebanyak > 5 cc. Spesimen dilakukan pemeriksaan BTA dengan pewarnaan Ziehl Neelsen (ZN), dan pemeriksaan TCM Ultra. Hasil: Dari 122 pasien presumptive TB baru, hasil dengan TCM positif 115 (94,3%), dan 7 (5,7%) yang negatif. Pada 34 pasien presumptive TB kambuh, subjek dengan hasil BTA positif adalah 4 (11,7%), sekaligus kesemuanya mendapatkan hasil TCM positif pula. Kesimpulan: BAL efektif untuk mendapatkan sputum bagi pasien yang tidak dapat mengeluarkan sputum spontan atau dengan kualitas buruk, sehingga menghindari keterlambatan diagnosis, mencegah overdiagnosis dan undertreatment. TCM sangat sensitif untuk kasus baru namun butuh hasil BTA positif pada diagnosis TB paru kasus kambuh.

Kata kunci: tuberkulosis paru, bronchoalveolar lavage, TCM, BTA, Brokoskopi

Abstract

Background: Bacteriological examinations of Acid-Fast Bacilli (AFB) and the Molecular Rapid Test (Xpert MTB/RIF test) for diagnosing pulmonary tuberculosis (TB) require sputum specimens. Diagnosis becomes challenging when sputum is unavailable, potentially leading to overdiagnosis, overtreatment, or undertreatment, particularly in cases of drug-resistant TB or recurrent pulmonary TB with clinical symptoms and chest radiographs suggestive of pulmonary TB but without bacteriological confirmation. In patients who have difficulty expectorating sputum, a specimen for bacteriological examination can be obtained through Bronchoalveolar Lavage (BAL) using bronchoscopy. The results can assist clinicians in making precise decisions, such as initiating therapy for drug-sensitive or drug-resistant pulmonary TB, or even refraining from administering Anti-Tuberculosis Drugs (ATDs) altogether. Methods: This retrospective cohort study utilized primary data collected from medical records between January 2023 and November 2024 at Cibabat General Hospital. The study subjects were presumptive new and recurrent pulmonary TB cases with clinical symptoms and chest X-ray interpretations suggestive of pulmonary TB, as reported in the Tuberculosis Information System of the Ministry of Health of the Republic of Indonesia. Specimens were obtained through BAL using flexible bronchoscopy, collecting >5 mL into sputum containers. The specimens were examined for AFB using Ziehl-Neelsen (ZN) staining and Xpert MTB/RIF test Ultra testing, including rifampicin resistance detection. Results: Among the group of presumptive new pulmonary TB cases, 115 (94.3%) of 122 subjects tested positive by Xpert MTB/RIF test, while only 7 (5.7%) were negative. In the group of presumptive recurrent pulmonary TB cases, 4 (11.7%) of 34 subjects tested positive for AFB, and all of these also tested positive by Xpert MTB/RIF test. Conclusion: BAL is a viable solution for obtaining sputum samples for bacteriological examination in patients unable to produce spontaneous or high-quality sputum. This approach can prevent delays in tuberculosis diagnosis, avoid overdiagnosis, and reduce undertreatment. Furthermore, MTB detection through BAL can identify drug resistance and assess the high risk of transmission. This facilitates timely diagnosis, appropriate therapy, and rapid contact investigation measures. While Xpert MTB/RIF test is highly sensitive for diagnosing new cases, positive AFB results remain critical for diagnosing recurrent pulmonary TB cases.

Keywords: pulmonary tuberculosis, bronchoalveolar lavage, AFB, bronchoscopy

Katrin Wilentina Siahaan1, I Gede Ketut Sajinadiyasa2
1Program Studi Pendidikan Dokter Spesialis Penyakit Dalam, Fakultas Kedokteran Universitas Udayana/ RSUP. Prof. I.G.N.G. Ngoerah Denpasar,
Bali, Indonesia.
2Departemen/KSM Penyakit Dalam, Fakultas Kedokteran Universitas Udayana/
RSUP. Prof. Prof. I.G.N.G. Ngoerah Denpasar, Bali, Indonesia

ABSTRACT
Chylothorax is a rare cause of pleural effusion, secondary to accumulation of lymph in the pleural space. Diagnosis is based on the triglyceride and cholesterol content of pleural fluid obtained with thoracentesis. Chylothorax is usually described as traumatic or nontraumatic. Causes of nontraumatic chylothorax include a wide range of differential diagnoses. Thoracic malignancies and lymphoma are the most common causes and are responsible for chylothorax by extrinsic compression or invasion of the thoracic duct. One of the causes of nontraumatic chylothorax is lung cancer. The main cause of chylothorax is traumatic, typically postsurgical, secondary to iatrogenic direct puncture of the thoracic duct during thoracic surgery. Chylothorax is associated with significant morbidity and mortality if left untreated. The etiology, clinical presentation, and diagnosis and the management of chylothorax must be well understood to diagnose and provide appropriate therapy to patients.
Keyword: Chylothorax, Nontraumatic Chylothorax, Lung cancer

 

Elcia Melisa Dwisari Simatupang1*, Fransiscus Ginting2,
Elvando Tunggul Mauliate Simatupang3
1Public Health Center of Uluan Sub-District, Government of Toba District, Province of North Sumatera
2Department of Internal Medicine, Haji Adam Malik Central General Hospital, Medan,
Province of North Sumatera
3Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Riau University, Pekanbaru, Province of Riau

ABSTRACT
Diabetes mellitus (DM) is a challenge in controlling Pulmonary Tuberculosis (PTB) cases. The increase in DM cases is one of the reasons that Indonesia is the second highest contributor of PTB cases in the world. The relationship between these two diseases impacts morbidity and mortality globally. This condition is based on the role of each individual’s immune system against Mycobacterium tuberculosis (Mtb) infection. Impairment of the innate and adaptive immune system in eliminating Mtb infection influences the increase of PTB cases with DM. Early prevention is important in the interaction of DM and PTB.
Keywords: Diabetes Mellitus, Tuberculosis,
Interaction, Risk Population

Physical Medicine and Rehabilitation Management of Patient With Bilateral Lung Bullar: a Case Report

 

Tresia Fransiska Uliana Tambunan¹, Dinna Yulistya Ningrum², Dave Nicander Kurnain³

¹Cardiorespiration Division, Physical Medicine and Rehabilitation Department, University of Indonesia, Jakarta

²Physical Medicine and Rehabilitation Resident University of Indonesia, Jakarta

³Faculty of Medicine, Tarumanagara University, Jakarta

 

Correspondent:

Tresia Fransiska UT, Cardiorespiratory division, Physical Medicine and Rehabilitation department, University of Indonesia, Jakarta.

Email: fransiska_ut@yahoo.com.au   

Phone: +62 816-1976-762

Abstract

Lung bullae are defined as air spaces in the lungs, measuring more than 1 cm in diameter when distended, while giant bullae occupy at least 30% of the hemithorax. Bullae are thought to be in contact with the bronchial tree; they are preferentially filled during inspiration, causing collapse of the adjacent normal lung parenchyma. Clinical manifestations of giant bullae include cough, dyspnea, and chest pain, but in some cases, the condition may be asymptomatic. Although the diagnosis of infected bullae has been reported, tuberculosis as a causative pathogen is rare. This case Present a 27 year old male patient came to the medical rehabilitation department of feeling easily tired when walked more than 8 meters. The patient was initially diagnosed with pulmonary tuberculosis 14 months ago, and completed 12 months of antituberculosis treatment. He underwent a thoracotomy decortication wedge resection of the right superior lobe of lung and another thoracotomy to evacuate the haematoma and control the bleeding two weeks before admision. From the physical examination, he had forward head posture, rounded shoulders, and slight hyperkyphotic posture. Respiromotor status showed decreased chest expansion and asymmetrical movement during respiration. Two weeks after rehabilitation program consist of breathing control, chest expansion exercise, airway clearance technique, and aerobic exercises, the patient shows improvement.

Key words: Lung Bullae, Rehabilitation, Thoracotomy, Tuberculosis.

Abstrak

Bula paru didefinisikan sebagai ruang udara di paru-paru, berukuran diameter lebih dari 1 cm saat menggembung, sedangkan bula besar menempati setidaknya 30% hemithorax. Bula diperkirakan bersentuhan dengan cabang bronkial; yang terisi selama selama inspirasi, menyebabkan kolapsnya parenkim paru normal. Manifestasi klinis dari bula besar meliputi batuk, dispnea, dan nyeri dada, namun pada beberapa kasus, kondisi ini mungkin tidak menunjukkan gejala. Meskipun diagnosis bula yang terinfeksi telah dilaporkan, tuberkulosis sebagai patogen penyebab jarang terjadi. Laporan kasus ini melaporkan seorang laki-laki berusia 27 tahun datang ke bagian rehabilitasi medis dengan perasaan mudah lelah jika berjalan lebih dari 8 meter. Pasien awalnya terdiagnosis tuberkulosis paru 14 bulan yang lalu, dan menyelesaikan pengobatan antituberkulosis selama 12 bulan. Dia menjalani reseksi dekortikasi torakotomi pada lobus paru superior kanan dan torakotomi lainnya untuk mengevakuasi hematoma dan mengontrol pendarahan dua minggu sebelum datang ke rumah sakit. Dari pemeriksaan fisik didapatkan postur kepala ke depan, bahu membulat, dan postur sedikit hiperkimfosis. Status respiromotor menunjukkan penurunan ekspansi dada dan gerakan asimetris saat respirasi. Dua minggu setelah program rehabilitasi yang terdiri dari kontrol pernapasan, latihan ekspansi dada, teknik pembersihan jalan napas, dan latihan aerobik, pasien menunjukkan perbaikan.

Kata kunci: Bula paru, Rehabilitasi, Torakotomi, Tuberkulosis.

 

 

A Rare Extrapulmonary Tuberculosis, Hepatic Tuberculosis: A Case Report

Ghea Arifah Shabrina¹, Telly Kamelia²

1Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

2Pulmonary and Respiratory Medicine Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

 

 

 

ABSTRACT

Introduction:

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis, a disease that attacks the lung parenchyma and can infect other organs. Tuberculosis is a significant health problem and is highly prevalent in developing countries. Abdominal Tuberculosis (TB) is a rare variant of TB, and hepatic tuberculosis is the most infrequent manifestation of tuberculosis infections.

 

Case Illustration:

A 44-year-old female patient complained of abdominal pain since one year ago. Abdominal pain felt in the lower right abdomen, sometimes spreading to the back side. Abdominal pain felt intermittent, not affected by eating or defecation. There were no complaints of fever, cough, shortness of breath, chest pain, and palpitations. The patient denied weight loss, loss of appetite, night sweats, or fluctuating fever. There was no prior history of tuberculosis. These patients have normal liver function and elevated alkaline phosphatase. Multiple calcified hypodense lesions appear in segments VII-VIII of the liver in a Computed Tomography (CT) Scan. A liver biopsy showed clusters of epithelioid cells accompanied by multinucleated giant cells. There was also necrosis resembling caseous necrosis with negative Acid-Fast Bacteria staining. The histological conclusion was following granulomatous inflammation, the possibility of tuberculosis infection could not be ruled out, and no malignant tumor cells were found in the preparations. The stage of fibrosis is around F2-F3. The patient was then diagnosed with hepatic tuberculosis and received anti-tuberculosis therapy. Obtained resolution of abdominal pain improvement and assessment of liver function remained normal after this 2-week treatment.

 

Conclusion:

Hepatic TB is a manifestation of extrapulmonary TB, which is rarely found. Anamnesis, physical examination, and supporting examinations are carried out to diagnose hepatic TB. Investigations such as imaging and liver biopsy can help diagnose this type of TB. The treatment given for hepatic TB is given according to the same regimen as other extrapulmonary TB.

 

Keywords: Hepatic Tuberculosis, Extrapulmonary Tuberculosis, Diagnosis, Management

Bronchial Thermoplasty in Severe Asthma Patients: A Literature Review

Yosua Kevin Hermawan¹, Ida Ayu Ika Wari Utami²

¹ Department of Pulmonology and Respiratory Medicine, Wangaya General Hospital, Denpasar, Indonesia
² Department of Pulmonology and Respiratory Medicine, Wangaya General Hospital, Denpasar, Indonesia

 

Abstract

Severe asthma is caused by chronic inflammation in the airway. Several treatments have been proposed to treat severe asthma. Bronchial thermoplasty is part of management that has been proposed to treat severe asthma. The treatment has been mentioned in asthma guidelines released by Global Initiative for Asthma (GINA) as an interventional management option in uncontrolled severe asthma. Bronchial thermoplasty is approved for patients with the age of at least 18 years old. The treatment is focus on airway smooth muscle by delivering radiofrequency ablation using bronchoscopy. Airway remodeling is an important feature in the disease course of asthma. There are three large randomized trial that has been done for bronchial thermoplasty. The trials recorded an increase in quality of life from asthma patients that have been treated and reduce in exacerbation frequency in long term follow up. The trials also show increased in emergency departments visit and asthma exacerbation for within a certain period after the procedure. Long term follows up of the patients that has undergone the procedure show no deterioration in terms of lung function, indicating a persistent effect of the bronchial thermoplasty. Better understanding in mechanisms of the procedure in the airway and more trials about safety and efficacy is still needed.

Keywords: Bronchial Thermoplasty, Airway smooth muscle, Interventional

Faktor Risiko Kejadian Tuberkulosis Paru di Berbagai Wilayah Indonesia

 

Alya Humaida Avy¹, Balqis Permata Hutami², M. Zhafran Alfalah³, Syeri Febriyanti⁴

 

Fakultas Kedokteran dan Ilmu Kesehatan Universitas Bengkulu

 

 

Abstract

Background: Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis that attacks the lung organs. This disease can lead to many complications and deaths if not treated properly. Tuberculosis in Indonesia remains a major challenge and requires the attention of all parties. Moreover, Indonesia is currently in the second place with the largest number of cases of pulmonary tuberculosis in the world. The aim of this study is to evaluate the risk factors of lung tuberculosis in various regions of Indonesia.

Method: The method used is the study of literature by searching for scientific articles from online databases.

Results: The results of the study show that there are several risk factors that influence the incidence of pulmonary tuberculosis in Indonesia. The risk factors obtained have much in common in different regions of Indonesia. Each of these risk factors exacerbates and increases the potential for pulmonary TB by generating OR values for each variable. According to the research journal, the six most important risk factors in the incidence of pulmonary tuberculosis in various regions of Indonesia are smoking habits, poor nutritional status, contact with the patient, knowledge level, population density, and poor ventilation of the house.

Conclusion: In this study we highlighted six risk factors for lung tuberculosis in various regions of Indonesia, namely smoking habits, poor nutritional status, contact with the affected, knowledge level, population density, and poor ventilation of the home.

 

Keywords: Pulmonary Tuberculosis, Risk Factor, regions of Indonesia

Abstrak

Latar belakang: Tuberkulosis (TB) adalah suatu penyakit infeksi menular yang disebabkan oleh Mycobacterium tuberkulosis  yang menyerang organ paru. Penyakit ini bisa mengakibatkan banyak komplikasi dan berujung kematian apabila tidak tepat penanganannya. Penyakit Tuberkulosis di Indonesia masih menjadi tantangan besar yang dihadapi dan memerlukan perhatian semua pihak. Terlebih, Indonesia saat ini berada di urutan kedua dengan kasus TB paru terbanyak di dunia. Tujuan dari kajian ini adalah untuk mengevaluasi faktor risiko dari Tuberkulosis paru di berbagai wilayah Indonesia.

Metode: Metode yang digunakan adalah studi literatur dengan mencari artikel ilmiah dari database online.

Hasil: Hasil kajian menunjukkan bahwa ada beberapa faktor risiko yang berpengaruh terhadap kejadian Tuberkulosis paru di Indonesia. Faktor – faktor risiko yang didapat memiliki banyak kesamaan di berbagai wilayah Indonesia. Masing – masing dari faktor risiko tersebut memperberat dan meningkatkan potensi kejadian TB paru dilihat dari nilai OR untuk setiap variabel. Berdasarkan jurnal penelitian, didapatkan 6 faktor risiko yang paling berperan dalam angka kejadian TB paru di berbagai wilayah Indonesia, yaitu  kebiasaan merokok, status gizi buruk, kontak dengan penderita, tingkat pengetahuan, kepadatan hunian, dan ventilasi rumah yang kurang baik.

Kesimpulan: Pada kajian ini, kami menyoroti terdapat 6 faktor risiko kejadian Tuberkulosis paru di berbagai wilayah Indonesia, yaitu kebiasaan merokok, status gizi buruk, kontak dengan penderita, tingkat pengetahuan, kepadatan hunian, dan ventilasi rumah yang kurang baik.

 

Keyword : Tuberkulosis Paru , Faktor Risiko, Wilayah Indonesia

Terapi Inhalasi Konvensional Pada Pasien Dewasa

 

Fatih Anfasa¹, Gurmeet Singh²

 

 

1 Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia, Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo

2 Divisi Respirologi dan Penyakit Medis Kritis, Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia, Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo

Alamat korespondensi: Dr. dr. Gurmeet Singh, SpPD, K-P. Departemen Ilmu Penyakit Dalam FKUI-RSCM. Jl Diponegoro No. 71, Jakarta Pusat.

Alamat email: gurmeetsingh10@yahoo,com

 

Abstrak

Terapi inhalasi konvensional merupakan salah satu terapi penting pada berbagai penyakit saluran nafas, terutama asma dan penyakit paru obstruktif kronik (PPOK). Pemberian obat melalui inhalasi memberikan berbagai keuntungan dibandingkan pemberian obat melalui jalur lainnya terutama untuk penyakit yang melibatkan organ pernapasan. Meskipun demikian, keefektifan terapi akan berkurang jika pasien tidak dapat menggunakan alat inhalasi dengan tepat. Kesalahan pemakaian alat inhalasi berhubungan dengan menurunnya kontrol penyakit asma, prognosis PPOK yang buruk, serta meningkatkan morbiditas dan mortalitas. Sari pustaka ini bertujuan untuk menjabarkan mekanisme terapi inhalasi konvensional dan berbagai modalitas terapi yang ada untuk pasien dewasa.   

Kata Kunci: terapi inhalasi, pasien dewasa

 

 

Abstract

Conventional inhalation therapy is an important therapy for various respiratory diseases, especially asthma and chronic obstructive pulmonary disease (COPD). Administering drugs via inhalation provides various advantages compared to other routes, especially for diseases involving the respiratory organs. However, the effectiveness of therapy will be reduced if the patient cannot use the inhalation devices correctly. Incorrect use of inhalation devices is associated with decreased asthma control, poor COPD prognosis, as well as increased morbidity and mortality. This article aims to describe the mechanism of conventional inhalation therapy and various therapeutic modalities available for adult patients.

Keywords: inhalation therapy, adult patients