ANALYZING PANDEMIC IMPACTS ON RESPIRATORY DISEASE PATTERNS AND FUNCTIONAL OUTCOMES IN GERIATRIC INPATIENTS

Authors: Melinda Harini¹, Jenica Xaviera Budiman², Wanarani Alwin¹, Megawati Al’badly Ponco Dewi Poernomo³

Affiliation:

¹ Department of Physical Rehabilitation, University of Indonesia, Cipto Mangunkusumo Hospital, Jl. Salemba Raya No. 6, Jakarta Pusat, 10430, Indonesia

² Medical Doctor Study Program, Faculty of Medicine, University of Indonesia, Jl. Salemba Raya No. 6, Jakarta Pusat, 10430, Indonesia

³Faculty of Medicine, University of Jenderal Soedirman, Jl. Dr. Gumbreg No.1, Purwokerto, 53112, Indonesia

Correspondence to: Melinda Harini, Departement of Physical Rehabilitation, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jl. Salemba Raya No. 6, Jakarta Pusat, 10430, Indonesia

E-mail: melindaharini@gmail.com

Phone number : +628159635765

ABSTRACT

Introduction: In 2020, COVID-19 has forced upon people for a change in their lifestyle to prevent and accommodate it, which may bring about its own set of positive and negative impacts.

Objectives: This research aims to analyze the effects of COVID-19 pandemic on the geriatric population in Jakarta through evaluation of changes in patient characteristics and disease variation of patients hospitalized in a major Indonesian hospital non-COVID geriatric inpatient ward.

Methods: This is a Retrospective study using secondary data of patients that was hospitalized in hospital’s geriatric inpatient ward between May 2019-December 2020. Data was collected from EHR and analyzed using IBM SPSS Statistics 27.0 for a cross-sectional design study.

Results: Changes of patients’ age group and gender is not statistically significant. The notable shifts within medical diagnosis group are the increase of incidence of non-COVID respiratory infections (9.6% to 12.64%), encephalopathy cases (2.7% to 6.7%), and gastrointestinal bleeding (5.7% to 7.1%), and decrease in cardiovascular diseases incidence (20.5% to 13.8%) and neoplasm cases (12.8% to 8.6%). Within functional diagnosis group, there is increase in mobility disorders (24% to 30.1%).

Conclusion: COVID-19 pandemic does not cause significant change in patients’ characteristics (gender and age group), but significantly causes a shift in the variation of diseases recorded as the main reason for patients’ admission into the inpatient ward. Future studies should evaluate strategies to help geriatric patients in cases like COVID pandemic, due to the increased incidence in mobility disorders, non-COVID respiratory infections, gastrointestinal bleeding, and encephalopathy.

Key words: COVID-19, functional diagnosis, geriatric patients, pandemic

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EFEKTIVITAS PENAMBAHAN TERAPI BESI INTRAVENA BERSAMA TRANSFUSI DARAH PADA PASIEN ANEMIA AKIBAT DEFISIENSI BESI

Farell Omar Dwipayana, Gurmeet Singh

Program Studi Profesi Dokter, Fakultas Kedokteran Universitas Indonesia

Divisi Respirologi dan Penyakit Kritis, Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo, Fakultas Kedokteran Universitas Indonesia

 ABSTRAK

Latar Belakang: Anemia defisiensi besi sering memerlukan stabilisasi cepat dengan transfusi packed red cells (PRC), namun transfusi tidak mengatasi defisit besi. Besi intravena berpotensi mempercepat normalisasi hemoglobin.

Tujuan: Menilai efektivitas dari penambahan besi IV bersamaan dengan transfusi dibandingkan transfusi saja pada pasien dewasa dengan ADB.

Metode: Pencarian literatur dilakukan di 3 database (PubMed, Cochrane, Scopus). Kriteria yang digunakan adalah pasien dewasa, ADB, intervensi kombinasi (PRC+besi IV) vs PRC saja, dengan luaran utama peningkatan kadar Hb. Karena tidak ditemukan uji langsung/tinjauan sistematis mengenai terapi kombinasi vs PRC, sintesis data menggunakan bukti tidak langsung dengan telaah kritis terhadap tinjauan sistematis perbandingan besi IV vs PRC pada populasi ADB.

Hasil: Bukti tidak langsung menunjukkan PRC memberi kenaikan Hb lebih cepat, sedangkan besi IV unggul dalam pemulihan Hb pada 3–12 minggu, dan berpotensi mencegah anemia berulang dan menurunkan kebutuhan transfusi. Namun, heterogenitas populasi (perioperatif, postpartum, fraktur panggul, hamil) tinggi dan meta-analisis gabungan tidak dapat dilakukan.

Kesimpulan: Pada pasien dewasa ADB yang memerlukan stabilisasi cepat, strategi kombinasi PRC+besi IV direkomendasikan untuk mendapatkan stabilisasi segera sekaligus pemulihan Hb berkelanjutan. Namun, rekomendasi ini berbasis bukti tidak langsung, uji acak terkontrol masih diperlukan.

Kata Kunci: anemia defisiensi besi, transfusi PRC, besi intravena

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Prevalence and Characteristic of Post-Intensive Care Syndrome Patient in Indonesia: A Multi-Centre Prospective Cohort Study

 ^1,2Peggy Sunarjo, ²Widjajalaksmi Kusumaningsih, ²Luh Karunia Wahyuni, ³Dita Aditianingsih, ⁴Retno Asti Werdhani, ⁵Kristiana Siste Kurniasanti, ⁶Wisnu Ananta Kusuma, ⁷Siti Chandra Widjanantie, ⁷Anitta Florence Stans Paulus,⁸Ernita Akmal,⁹ Tresia Fransiska Tambunan

 ¹Doctoral Program in Medical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

²Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Indonesia—Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia

³Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia—Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia

⁴Department of Community Medicine, Faculty of Medicine, Universitas Indonesia—Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia

⁵Department of Psychiatry, Faculty of Medicine, Universitas Indonesia—Dr.  Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia

⁶Department of Computer Science, Faculty of Mathematics and Natural Sciences, IPB University, Bogor, Indonesia

⁷Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Indonesia—Persahabatan General Hospital, Jakarta, Indonesia

⁸Department of Anesthesiology and Intensive Care, Persahabatan General Hospital, Jakarta, Indonesia

⁹Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Indonesia—Universitas Indonesia General Hospital, Depok, Indonesia

Corresponding Author: Peggy Sunarjo; Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Indonesia—Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia; Email: roswitapeggy@gmail.com.

ABSTRACT

Background: Advances in critical care management have increased survival rates during intensive care unit (ICU) care. However, many survivors experience Post-Intensive Care Syndrome (PICS), a complex of physical, cognitive, and mental health disorders that progress from the ICU and hospital discharge. Still, data on PICS prevalence in Indonesia remain limited. This study aimed to determine the prevalence and characteristics of PICS among ICU survivors in tertiary hospitals.

Methods: This cohort study from July 2024 – 2025 across three tertiary teaching hospitals in Indonesia. Adult ICU survivors discharged for at least one month were assessed using the validated Indonesian version of the Post-Intensive Care Syndrome Questionnaire (PICSQ). Patient characteristics were categorized into pre-ICU, durante-ICU, and post-ICU variables. PICS diagnosis was established if impairment was present in at least one domain.

Results: A total of 132 subjects (53.8% male; mean age range 18–70 years) were included. The prevalence of PICS was 30.3%. Mental impairment was the most common (28%), followed by cognitive (19.7%) and physical impairments (16.7%). Combined impairments were also observed: cognitive–physical (6.9%), cognitive–mental (7.5%), physical–mental (10.6%), and all three domains (10.6%). Cardiovascular disease (46.2%) was the most frequent primary ICU diagnosis, and comorbidities were present in 67% of subjects. Early rehabilitation was provided to 62.1% of patients, though it did not significantly improve mental health outcomes. At discharge, 47.8% of subjects were independent, while the remainder showed varying levels of dependency.

Conclusion: Approximately one-third of ICU survivors in Indonesia experienced PICS within one month post-discharge, with mental impairment being the most prevalent domain. These findings highlight the urgent need for systematic post-ICU screening, multidisciplinary rehabilitation programs, and long-term follow-up to improve quality of life after discharge.

Keywords: Post-Intensive Care Syndrome, ICU survivors, prevalence, cognitive impairment, mental health, Indonesia

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Profil Tuberkulosis Ekstra Paru Di RS Ngoerah

I Gede Ketut Sajinadiyasa¹, Gede Dilajaya Robin², Ni Made Dewi Dian Sukmawati³

¹Departemen/KSM Penyakit Dalam, Fakultas Kedokteran Universitas Udayana/ RS Ngoerah, Denpasar, Bali, Indonesia

²Program Studi Pendidikan Dokter Spesialis Penyakit Dalam, Fakultas Kedokteran Universitas Udayana/RS Ngoerah, Denpasar, Bali, Indonesia.

³Departemen/KSM Penyakit Dalam, Fakultas Kedokteran Universitas Udayana/ RS Ngoerah, Denpasar, Bali, Indonesia

Korespondensi: I Gede Ketut Sajinadiyasa/085237068670/ sajinadiyasa@unud.ac.id

 ABSTRAK

Latar belakang: Tuberkulosis sangat menular, ditularkan dari manusia ke manusia melalui udara sewaktu berbicara, batuk, bersin, dan lain - lain. Dari WHO secara global pada tahun 2022, 7,5 juta orang ditemukan dengan kasus baru yang didiagnosis tuberkulosis, 83% di antaranya dengan TB paru dan 17% dengan TB paru ekstra. Daerah dengan jumlah kasus TB paru ekstra tertinggi adalah Mediterania Timur (22%) dan Asia Tenggara (21%).

Metode: Desain penelitian yang digunakan adalah studi deskriptif menggunakan pendekatan cross-sectional, untuk menentukan ikhtisar tuberkulosis ekstrapulmonary. Subjek penelitian adalah pasien TB yang tercatat di Poliklinik TB RS Ngoerah Denpasar pada 2023. Metode pengambilan sampel menggunakan pengambilan sampel total.

Hasil: Dari penelitian ini, ditemukan bahwa lebih sedikit orang yang didiagnosis menderita TB paru ekstra daripada TB non-ekstra-paru. Sebanyak 62 orang (43,4%) didiagnosis menderita TB paru ekstra dan 81 orang (56,6%) tidak didiagnosis menderita TB paru ekstra. Jenis TB ekstra paru yang paling umum adalah TB yang disebarkan (32,7%). Angka kematian juga tertinggi dalam penyebaran TB (15,4%).

Kesimpulan: Dari penelitian ini, lebih banyak kasus ditemukan pada pria, usia < 60 tahun, dan dengan TB yang disebarkan. Dari tingkat kematian TB ekstrapulmonary, lebih banyak kasus TB ekstrapulmonary yang meninggal adalah laki-laki, berusia <60 tahun dan dengan penyebaran TB. Berdasarkan hasil penelitian ini, perlu dilakukan penelitian lebih lanjut, karena penelitian ini hanya menjelaskan karakteristik data dalam bentuk deskriptif, tanpa menjelaskan hubungan antara faktor-faktor ini sehubungan dengan risiko kematian akibat TB paru ekstra.

Kata kunci: tuberkulosis paru ekstra, kematian, jenis

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Uncovering Hemodynamic Innovation: An Integrated Bibliometric Analysis of the Use of Doppler Technology in the Diagnosis and Management of Obstructive Sleep Apnea

Arman Yurisaldi Saleh¹, Dwi Arwandi Yogi Saputra², Riezky Valentina³, Tirta Darmawan Susanto ⁴

¹Neurology Department Faculty of Medicine UPN Veteran Jakarta, Indonesia

²Department of Public Health Sciences, Faculty of Medicine, UPN Veteran Jakarta, Indonesia

³Neurology Department Faculty of Medicine UPN Veteran Jakarta, Indonesia

⁴Family Medicine and Primary Care Department, Universitas Pelita Harapan, Indonesia

(^*Corresponding author’s e-mail: drarmanyurisaldic@gmail.com)

Abstract

1) Introduction: Obstructive Sleep Apnea (OSA) is a sleep disorder causing hypertension, cardiovascular disease, and metabolic disorders. Doppler technology, a non-invasive imaging method, is used to detect vascular changes in OSA patients. A bibliometric review of literature on Doppler use in OSA cases can help identify trends and areas for further study. This analysis can reveal leading journals, influential authors, and the relationship between diagnostic technology and clinical knowledge. It can also help in setting research priorities and developing innovative solutions for OSA diagnosis and management.; 2) Materials and methods: This research aims to explore the evolution of scientific disciplines by finding and identifying trends, patterns and correlations in scientific texts related to certain topics. The focus of this study was doppler and osa or osbstructive sleep apneu using both quantitative and qualitative analysis. 3) Results and discussion:. Bibliometric analysis reveals increasing publications, global collaboration, significant diagnostic standards are not yet evenly distributed; Doppler technology effectively detects hemodynamic dynamics in OSA. and 4) Conclusions: The review emphasizes the importance of Doppler technology in improving OSA diagnostics and treatments. It highlights the need for collaboration between academic, clinical, and technological domains to improve care standards. The study highlights the transformative potential of hemodynamic understanding and Doppler technology in sleep medicine. This research was conducted in April 2025

Keywords: Obstructive Sleep Apnea (OSA), Doppler Ultrasound, Hemodynamics, Bibliometrics, Diagnostics, Management, Sleep Medicine

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Subcutaneus Emphysema– a Very Rare Asthma Complication

Raihan Ar’ Rachman¹, Prayudi Santoso², Yana Akhmad Suryana²
¹Department of Internal Medicine, Hasan Sadikin General Hospital, Faculty of Medicine, Universitas Padjadjaran,
Bandung, Indonesia
²Division of Pulmonology and Critical Care, Department of Internal Medicine, Hasan Sadikin General Hospital, Faculty
of Medicine, Universitas Padjadjaran, Bandung, Indonesia

ABSTRACT
Background:
Asthma is a chronic inflammatory disease that causes partially or completely reversible airway obstruction¹. Common asthma complications include severe asthma and severe hypoxemia. Pneumomediastinum and subcutaneous emphysema represent rare complications of acute asthma exacerbation. The incidence of pneumomediastinum is approximately 1:44,000, with 70% presenting with subcutaneous emphysema. The underlying mechanism is characterized by alveolar rupture due to a sudden increase in intrathoracic pressure Although typically self-limiting, delayed recognition may lead to potentially serious outcomes⁴.
Case Presentation:
We report a female who presented with shortness of breath for two days prior to admission, accompanied by productive cough with yellow sputum and fever. The patient further experienced (don’t repeat “accompanied by”) swelling of the neck extending to the chest, along with pain and wheezing during breathing. The patient had a history of asthma with almost daily exacerbations and chronic electronic cigarette use. Examination showed neck-to-chest swelling with crepitus and bilateral wheezing. Radiography confirmed that she had pneumonia, pneumomediastinum, and subcutaneous emphysema. She was treated with antibiotics, bronchodilators, and supportive therapy, and improved within five days.
Conclusion:
Subcutaneous emphysema is a rare complication of acute asthma exacerbation. Although generally self-limiting, rapid diagnosis through clinical and radiological evaluation can prevent more severe complications. Conservative treatment provides good outcomes when performed promptly and appropriately.

Keywords: asthma, pneumomediastinum, subcutaneous emphysema

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Uji Diagnostik Lipoarabinomannan Urin untuk Deteksi Mycobacterium tuberculosis pada Pasien Dengan dan Tanpa Infeksi HIV

Dean Handimulya Djumaryo¹, Gurmeet Singh², I Puta Eka Krisnha Wijaya², Andriana Kirana Puspa¹

¹Departemen Patologi Klinik, Fakultas Kedokteran Universitas Indonesia dan Rumah Sakit Cipto Mangunkusumo, Jakarta

²Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia dan Rumah Sakit Cipto Mangunkusumo, Jakarta

ABSTRAK

Latar belakang

Uji diagnostik tuberkulosis (TB) sebagian besar masih bergantung pada sampel sputum yang sulit diperoleh pada anak-anak, pasien dengan TB ekstrapulmoner, serta orang dengan Human Immunodeficiency Virus (ODHA). Komponen utama dinding sel Mycobacterium tuberculosis (Mtb), yaitu lipoarabinomannan (LAM) yang berperan sebagai faktor virulensi dan dapat masuk ke sirkulasi darah. Karena ukuran molekulnya yang kecil, LAM dapat difiltrasi oleh ginjal dan diekskresikan dalam urin. Deteksi LAM urin menawarkan pendekatan non invasif yang mudah dilakukan, sehingga berpotensi menjadi point of care testing (POCT) untuk diagnosis TB, terutama pada populasi dengan kesulitan pengambilan sputum atau status imunokompromais seperti ODHA.

Metode

Penelitian ini merupakan studi potong lintang yang dilakukan di RSUPN Dr. Cipto Mangunkusumo pada 96 subjek dengan dugaan tuberkulosis (TB), baik dengan maupun tanpa infeksi Human Deficiency Virus (HIV). Sampel urin diperiksa menggunakan Abbott Determineä TB LAM Ag, suatu uji imunokromatografi untuk deteksi antigen LAM. Hasil pemeriksaan dibandingkan dengan  composite reference standard, yaitu hasil positif dari salah satu pemeriksaan real time polymerase chain reaction (RT-PCR), pulasan batang tahan asam (BTA), atau kultur BTA. Uji normalitas data numerik dianalisis menggunakan uji Kolmogorov-Smirnov dan disajikan dalam bentuk nilai tengah (nilai terendah-tertinggi). Data kategorik disajikan dalam bentuk frekuensi absolut (n) dan persentase (%). Performa diagnostik uji LAM dinilai berdasarkan sensitivitas, spesifitas, nilai prediktif, dan akurasi.

Hasil

Dari 96 subjek penelitian, sensitivitas, spesifisitas, nilai prediktif positif (NPP), dan nilai prediktif negatif (NPN) uji LAM urin terhadap hasil pemeriksaan bakteriologis TB berturut-turut adalah 51%, 68%, 46%, dan 73%. Pada 33 subjek dengan infeksi HIV, nilai sensitivitas, spesisifitas, NPP dan NPN masing-masing adalah 54%, 59%, 40%, dan 72%. Sedangkan pada 63 subjek tanpa infeksi HIV, sensitivitas dan NPP masing-masing sebesar 50%, serta spesifisitas dan NPN sebesar 73%. Uji LAM urin menunjukkan performa diagnostik sedang, dengan sensitivitas sedikit lebih tinggi pada pasien dengan HIV dibandingkan tanpa HIV.

Kesimpulan

Pemeriksaan LAM urin merupakan metode yang cepat dan sederhana untuk membantu diagnosis tuberkulosis. Uji ini menunjukkan performa diagnostik sedang, dengan sensitivitas yang lebih tinggi pada pasien dengan infeksi HIV dibandingkan tanpa HIV, sehingga lebih bermanfaat sebagai alat bantu diagnosis pada populasi tersebut.

Kata kunci: Human Immunodeficiency Virus, Lipoarabinomannan, Tuberkulosis, Point of care testing, Urin

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The Unclassical Manifestation of Tuberculosis: Mimicking Lung Metastasis and Cutaneous Lymphoma: Case Report

Shanaz Novriandina [1], Yana Akhmad [2],  Risa Miliawati [3], Pramesti Indri [4], Prayudi Santoso [2]

[1] Department of Internal Medicine, Fakultas Kedokteran Universitas Padjadjaran / RSUP Dr. Hasan Sadikin Bandung

[2] Respirology and Critical Disease Division, Department of Internal Medicine, Fakultas Kedokteran Universitas Padjadjaran / RSUP Dr. Hasan Sadikin Bandung

[3] Department of Dermatology and Venereology, Fakultas Kedokteran Universitas Padjadjaran / RSUP Dr. Hasan Sadikin Bandung

[4] Department of Radiology, Fakultas Kedokteran Universitas Padjadjaran / RSUP Dr. Hasan Sadikin Bandung

Abstract

Background: Lung Tuberculosis (TB) may occur with atypical presentations and radiological findings that mimic lung metastasis and cutaneous lymphoma. Diagnostic challenges for atypical TB will increase the risk of delaying proper treatment, irrational use of broad-spectrum antibiotics, and continuing transmission of Mycobacterium tuberculosis (Mtb).

Case: A 57-year-old woman presented with a one-year history of a chronic non-healing ulcer over the axilla and inguinal regions, along with multiple discharging sinuses and surrounding induration. The lesions were initially described as bacterial abscesses or hidradenitis suppurativa. She was repeatedly given a systemic antibiotic and a topical corticosteroid over two months. However, her condition deteriorated and was complicated by secondary infection. Xpert Mtb/RIFon sputum and pus detected rifampicin-sensitive Mtb, and a skin biopsy revealed features consistent with scrofuloderma. A diagnosis of disseminated TB was established, and she started on anti-tuberculosis treatment and showed clinical improvement after four weeks.

Discussion: The delayed diagnosis of disseminated TB mimicking lung metastasis and cutaneous lymphoma resulted in delayed treatment of anti-tuberculosis and progressive worsening of clinical symptoms. The diagnosis was made based on Xpert Mtb/RIFon sputum and pus in the wound base, thoracic CT scan, and skin biopsy. The patient was started on anti-tuberculosis therapy and showed clinical improvement after four weeks of treatment.

Conclusion: Chronic ulcers that have worsened despite systemic broad-spectrum antibiotics should be considered as cutaneous tuberculosis. Scrofuloderma, the most common cutaneous tuberculosis, is one of the markers of disseminated TB. It requires assessment to confirm pulmonary and extrapulmonary TB.

Keywords: Scrofuloderma; lung tuberculosis; disseminated tuberculosis; lung metastasis

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DIAGNOSIS DAN TATALAKSANA CHRONIC PULMONARY ASPERGILOSIS

 Andhika Pangestu^1*, Gurmeet Singh^*2 

¹Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia – RSUPN dr. Cipto Mangunkusumo, Jakarta, Indonesia

²Divisi Respirologi dan Penyakit Kritis, Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia – RSUPN dr. Cipto Mangunkusumo, Jakarta, indonesia.

Korespondensi*:

Divisi Respirologi dan Penyakit Kritis, Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia – RSUPN dr. Cipto Mangunkusumo, Jakarta, indonesia. Jln. Diponegoro No. 70. Jakarta, Indonesia.

Email: gurmeetsingh10@yahoo.com, andhika.pangestu@ui.ac.id

Abstract

Chronic Pulmonary Aspergillosis (CPA) is a spectrum of pulmonary infectious diseases. The incidence of CPA is increasing year by year. CPA is part of pulmonary mycosis, which is also increasing in incidence, as are cases of TB infection, chronic obstructive pulmonary disease (COPD), lung cancer, and other pulmonary diseases. The incidence of CPA is often found in conjunction with other pulmonary infections such as pulmonary TB. CPA is caused by Aspergillosis sp, 90% of which is caused by Aspergillus fumigatus. Clinical manifestations vary with systemic and respiratory symptoms, with a case fatality rate of approximately 20-33% in the short term and more than 50% over a 5-year period. Adequate and holistic diagnostic and management approaches play a crucial role in improving outcomes, quality of life, and survival rates in CPA patients.

Keywords: Chronic Pulmonary Aspergillosis, CPA, Diagnosis, Management

Abstrak

Chronic Pulmonary Aspergillosis (CPA)  merupakan spektrum dari penyakit infeksi paru. Insidensi CPA meningkat dari tahun ke tahun. CPA merupakan bagian dari penyakit mikosis paru yang juga kejadiannya meningkat seperti kasus infeksi TB, penyakit paru obstruktif kronik (PPOK), keganasan paru dan penyakit paru lainnya. Insidensi CPA sering dijumpai bersamaan dengan infeksi paru lainnya seperti TB paru. CPA diakibatkan oleh Aspergillosis sp, 90% disebabkan oleh Aspergillus fumigatus. Manifestasi klinis bervariatif dengan gejala sistemik dan gejala respirasi, dengan case fatality rate sekirat 20-33% pada jangka pendek serta lebih dari 50% pada rentang waktu 5 tahun. Pendekatan diagnosis dan tatalaksana adekuat dan holistik berperan penting untuk meningkatkan outcome, quality life dan survival rate pada pasien CPA.

Kata kunci: Chronic Pulmonary Aspergillosis, CPA, Diagnosis, Tatalaksana

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Faktor-faktor yang Mempengaruhi Kejadian Depresi pada pasien Obstructive Sleep Apnea (OSA) dan Tatalaksananya

Shatri H¹, Pangestu A², Jeger DP¹, Irvianita V¹, Faisal E¹, Putranto R¹

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

²Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia, Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo

Correspondence:

Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia –

RSUPN dr. Cipto Mangunkusumo, Jakarta, Indonesia. Jln. Diponegoro No. 70. Jakarta, Indonesia.

Email : andhika.pangestu@ui.ac.id, pangestudhika27@gmail.com

Abstract

Obstructive Sleep Apnea (OSA) is anupper airway obstruction that causes periods of breathing cessation. OSA is a sleep disorder breathing syndrome that can have long-term effects such as metabolic dysfunction, insulin resistance, and, if further progresses, can cause microvascular and macrovascular complications that can increase morbidity and mortality rates. The multifactorial causes of depression in OSA patients are influenced by internal and external factors. The management approach for depressive disorders in OSA patients involves a multidisciplinary team and a combination of pharmacological and non-pharmacological management approaches, as well as the management of comorbid conditions in patients.

Keywords: Obstructive Sleep Apnea, sleep disorder breathing syndrome

Abstrak : Obstructive Sleep Apnea (OSA) merupakan suatu obstruksi jalan nafas atas yang menyebabkan periode nafas berhenti. OSA sebagai sleep disorder breathing syndrome yang dapat memiliki efek jangka panjang seperti disfungsi metabolik, resistensi insulin dan bila lebih lanjut dapat menyebabkan komplikasi mikrovaskular dan makrovaskular yang dapat meningkatkan angka morbiditas dan mortalitas. Multifaktorial penyebab depresi pada pasien OSA dipengaruhi oleh faktor internal dan eksternal. Pendekatan tatalaksana gangguan depresi pada pasien OSA melibatkan tim multidisiplin dan pendekatan tatalaksana medikamentosa dan non-medikamentosa serta tatalaksana komorbid pada pasien.

Kata Kunci : Sindrom Gangguan Pernapasan Saat Tidur; Sindrom Apnea Obstruktif Saat Tidur

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Delayed-Onset Linezolid-Induced Severe Anemia in a Young Patient With Spinal Rifampicin-Resistant Tuberculosis

Herikurniawan^1*, Aziza Harris

¹ Division of Respirology and Critical Care, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo National Hospital.

*Correspondence Author; 085643606817; herikurniawan.md@gmail.com

ABSTRACT

Background: Linezolid is a core drug in regimens for multidrug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB) due to its potent intracellular activity against Mycobacterium tuberculosis. However, prolonged use is associated with cumulative hematologic toxicity, which can develop insidiously during extended treatment.

Case Presentation: We present the case of a 20-year-old female with spinal RR-TB who developed severe anemia after 11 months on a linezolid-containing regimen, following an initially stable hematologic profile. Laboratory monitoring revealed progressive anemia (hemoglobin 5.9 g/dL) and leukopenia (white blood cell count 1,790/mm³). Bone marrow suppression secondary to linezolid toxicity was suspected. Discontinuation of linezolid and transfusion support led to gradual hematologic recovery.

Conclusion: This case highlights the potential for delayed-onset, yet reversible, hematologic toxicity during long-term linezolid therapy, even in young patients without traditional risk factors. Sustained hematologic monitoring throughout the entire treatment course is essential to ensure patient safety and optimize outcomes in RR-TB management.

Keywords: Linezolid, Bicytopenia, Rifampicin-Resistant Tuberculosis, Hematologic Toxicity, Long-Term Monitoring, Case Report

ABSTRAK
Latar Belakang: Linezolid merupakan salah satu obat utama dalam rejimen pengobatan tuberkulosis multidrug resistant dan resisten rifampisin (MDR/RR-TB) karena aktivitas intraselulernya yang kuat terhadap Mycobacterium tuberculosis. Namun, penggunaan jangka panjang linezolid dikaitkan dengan toksisitas hematologis kumulatif yang dapat berkembang secara perlahan selama pengobatan berkepanjangan.

Presentasi Kasus: Kami melaporkan kasus seorang perempuan usia 20 tahun dengan tuberkulosis RR pada tulang belakang yang mengalami anemia berat setelah 11 bulan menjalani pengobatan dengan rejimen yang mengandung linezolid, meskipun sebelumnya profil hematologisnya stabil. Pemantauan laboratorium menunjukkan anemia progresif (hemoglobin 5,9 g/dL) dan leukopenia (jumlah leukosit 1.790/mm³). Supresi sumsum tulang akibat toksisitas linezolid dicurigai sebagai penyebabnya. Penghentian linezolid dan pemberian transfusi mendukung pemulihan hematologis secara bertahap.

Kesimpulan: Kasus ini menyoroti potensi toksisitas hematologis dengan onset tertunda namun reversibel selama terapi linezolid jangka panjang, bahkan pada pasien muda tanpa faktor risiko tradisional. Pemantauan hematologis yang berkelanjutan sepanjang durasi pengobatan sangat penting untuk menjaga keselamatan pasien dan mengoptimalkan hasil terapi pada kasus RR-TB.

Kata Kunci: linezolid, bisitopenia, tuberkulosis resisten rifampisin, toksisitas hematologis, pemantauan jangka panjang, laporan kasus

 DOI: 10.2614/ijc.v12i2

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Celline Margareth Winarto, Agus Cahyono, Olivia Benedick Sri Panggabean, Agus Suharto

Department of Medicine,University of Surabaya, Surabaya. (031) 2981353. Agus_jsc@yahoo.co.id

Latar Belakang: Asma adalah penyakit saluran napas kronik yang merupakan masalah kesehatan masyarakat yang serius di berbagai negara di seluruh dunia. Asma dapat bersifat ringan dan tidak mengganggu aktivitas, namun dapat bersifat menetap dan mengganggu aktivitas bahkan kegiatan sehari-hari. Seseorang dengan asma menetap mengalami penurunan kondisi fisik sehingga membatasi pasien untuk melakukan kegiatan sehari-hari. Menurut data WHO (World Health Organization) prevalensi asma di dunia mencapai 262 juta pada tahun 2019. Prevalensi asma di Indonesia menurut data Kemenkes RI mencapai 12 juta pada tahun 2020. Pada saat pandemi COVID-19 terjadi, pasien asma tidak melakukan kontrol rutin ke rumah sakit dikarenakan ketakutan akan terpapar COVID-19 sehingga gejala yang diderita oleh pasien menjadi semakin parah dan obat-obatan yang dikonsumsi juga habis. Namun belum banyak penelitian yang secara spesifik membandingkan tingkat perburukan asma bronkial sebelum dan saat pandemi, sehingga diperlukan studi yang mengkaji dampak pandemi terhadap kondisi pasien asma secara lebih mendalam. Penelitian ini menghadirkan kebaruan dengan membandingkan perburukan asma bronkial sebelum dan saat pandemi COVID-19, yang belum banyak diteliti sebelumnya di Indonesia.

Metode Penelitian: Penelitian dilakukan dengan mengambil data rekam medis pasien asma bronkial paru rawat jalan di RSUD Haji Provinsi Surabaya dan RSUD Ibnu Sina Gresik pada bulan Agustus-Oktober 2023 dengan total populasi 325 pasien asma bronkial dan 30 pasien asma bronkial memenuhi kriteria inklusi. Data diuji menggunakan uji komparasi Mc Nemar dengan 16 sampel yang memburuk dari hasil Mc Nemar.

Hasil Penelitian : Hasil penelitian pada uji non parametrik komparasi Mc Nemar menunjukkan nilai signifikansi 0,808 dan 23 sampel yang memburuk dari hasil uji Mc Nemar yang menunjukkan tidak didapatkan adanya perbedaan perburukan asma bronkial sebelum dan saat pandemi COVID-19.

Kesimpulan: Tidak terdapat adanya perbedaan perburukan asma bronkial sebelum dan saat pandemi COVID-19.

Kata kunci: Asma bronkial, Perburukan asma bronkial, Pandemi COVID-19.

DOI: 10.2614/ijc.v12i1

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

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

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

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

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

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