Zen Ahmad1, Alwi Shahab1, Mohamad Zacky Amirullah1, Erial Bahar1
1Departemen Ilmu Kesehatan Penyakit Dalam, Fakultas Kedokteran, Universitas Sriwijaya, Palembang

Abstract

Background: Multidrug-resistant tuberculosis (MDR TB) is a form of tuberculosis infection caused by mycobacterium strains that are resistant to at least two of the main first-line drugs, i.e. isoniazid and rifampicin. In general, MDR TB treatment success rate in Indonesia is only 47%. One of the factors that may influence the treatment outcomes is Diabetes Mellitus (DM). Early sputum culture conversion was associated with better treatment outcomes compared to late sputum culture conversion. Late sputum culture conversion is associated with poor outcomes and increased mortality rate (50%-80%).
Objective: This study aimed to assess the effects of DM on early sputum culture conversion among MDR TB patient who received short-term regimen therapy.
Methods: This was a retrospective cohort observational analytical study conducted at Borang MDR TB of Mohammad Hoesin General Hospital Palembang from April 2019 to January 2020.
Results: A total of 91 participants were included in the study with DM prevalence of 27%. Early sputum culture conversion was found in 11 subjects with DM (44%) and in 45 non-DM subjects (68%). Analysis results showed that MDR TB patient with DM has 2,7 times of having late sputum culture conversion (RR 2,7; 95% CI, 1,061 – 7,013, p= 0.037) compared to non-DM counterpart. Conclusion: Diabetes Mellitus affects sputum culture conversion among MDR TB patients receiving short-term regimen therapy at Mohammad Hoesin General Hospital Palembang.
Keywords: multidrug-resistant tuberculosis, diabetes mellitus, sputum culture conversion.

Anita Nur Charisma1,2*, Kristin Purnama Dewi1,2, Erika Marfiani1,3
1Fakultas Kedokteran, Universitas Airlangga, Surabaya
2Departemen Pulmonologi dan Ilmu Kedokteran Respirasi, Rumah Sakit Dr. Soetomo, Surabaya
3Departemen Ilmu Penyakit Dalam, Rumah Sakit Dr. Soetomo, Surabaya

Abstract
Pneumocystis jirovecii pneumonia (PCP) is an opportunistic fungal infection in respiratory system caused by fungal organisms that cause pneumonia. The incidence of PCP is relatively low. Appropriate investigations are needed to establish diagnostics for suspected PCP infection in HIV / AIDS patients. Detection of PCP cases should be done as early as possible, so that prophylaxis and PCP treatment are not delayed and can reduce mortality.
Keywords: Investigation diagnostics, pneumocystis pneumonia, HIV/AIDS

Arfian Muzaki1, Gurmeet Singh2
1Program Studi Profesi Dokter, Fakultas Kedokteran Universitas Indonesia
2Divisi Respirologi dan Penyakit Kritis, Dept. Ilmu Penyakit Dalam,RSUPN Cipto Mangunkusumo,
Fakultas Kedokteran Universitas Indonesia

Abstract

Background: Corona virus disease 2019 (COVID-19) is a new disease caused by the SARS-CoV2 virus and announced to be a global pandemic. Symptoms can vary in different people and are divided into asymptomatic, mild, moderate, and severe. Vitamin D is said to have an effect on lowering the risk of microbial infection and death. Therefore, vitamin D is given to COVID-19 patients with the hope of reducing clinical deterioration and mortality.
Objective: To assess the effect of vitamin D on clinical deterioration and mortality in COVID-19 patients based on studies that have been conducted.
Methods: Searching randomized controlled trials and cohorts in three databases, namely PubMed, Scopus, and Cochrane. Articles will be selected and then subjected to a critical review using guidelines from the University of Oxford’s Center for Evidence-based Medicine (CEBM).
Results: A total of three studies were selected with one randomized controlled trial and two cohort studies. All studies claim that offering vitamin D therapy decreased the incidence of admission of patients to the ICU (invasive mechanical ventilation) and mortality. Study drawbacks may bias and influence the significance of the association between vitamin D administration and clinical deterioration.
Conclusion: Administration of vitamin D in hospitalized COVID-19 patients to reduce clinical worsening of patients.
Keywords: Adult, COVID-19, Vitamin D, cholecalciferol, calcifediol

I Putu Eka Krisnha Wijaya, Ceva Wicaksono Pitoyo, Anindita Kartika Wiraputri,
Michael Aaron Romulo Division of Respirology and Critical Care Internal Medicine, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital - Faculty of Medicine University of Indonesia
ABSTRACT
Coronavirus disease 2019 (COVID-19) is a novel acute respiratory disease that has been declared as a pandemic by World Health Organization (WHO) since March 11th 2020. General clinical manifestations of COVID-19 are fever, dry cough, and fatigue. Nonetheless, the majority of COVID-19 cases are asymptomatic. In Indonesia, COVID-19 was reported for the first time on March 2nd 2020. However, in the mid of March 2020 our hospital discovered 2 patients with COVID-19 sign and symptoms that were presented after being cared for several days, even though at that time our hospital hadn’t had any cases yet. Those patients were checked and all of them were positive for COVID-19. The objective of this case report is to raise the awareness of hospital-acquired COVID-19 infection possibility especially in the region with minimal cases so that healthcare staffs always be vigilant and don’t let their guard down towards COVID-19 dissemination threat which is still going on.
Keywords: respiratory medicine, internal medicine
ABSTRAK
Coronavirus disease 2019 (COVID-19) merupakan sebuah penyakit pernapasan akut baru yang dinyatakan sebagai sebuah pandemi oleh World Health Organization (WHO) pada tanggal 11 Maret 2020. COVID-19 memiliki manifestasi klinis umum berupa demam, batuk kering, dan lemas, namun sebagian besar kasus COVID-19 bersifat asimptomatik. COVID-19 pertama kali dilaporkan di Indonesia pada tanggal 2 Maret 2020. Akan tetapi, pada pertengahan bulan Maret 2020 di rumah sakit kami terdapat 2 pasien dengan tanda dan gejala COVID-19 yang muncul setelah beberapa hari dirawat di rumah sakit, meskipun pada saat itu rumah sakit kami belum memiliki kasus. Kedua pasien akhirnya diperiksa dan keduanya didapatkan positif COVID-19. Tujuan laporan kasus ini adalah untuk meningkatkan kewaspadaan terhadap kemungkinan terjadinya infeksi nosokomial terutama pada daerah dengan jumlah kasus yang masih minimal agar tenaga medis tidak lengah dalam menghadapi ancaman penyebaran COVID-19 yang masih akan terus berlanjut.
Kata kunci: respiratory medicine, ilmu penyakit dalam.

Telly Kamelia
Division of Respirology and Critical Care Internal Medicine, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital - Faculty of Medicine University of Indonesia

Abstract
Nowadays, pandemic of COVID-19 impacts worldwide. Coronavirus Disease 2019 affect respiratory system dominantly. However, this virus can also affect other organ systems besides lungs, such as skin, eyes, and heart. This review article was aimed to describe the manifestation of Coronavirus Disease in another organ besides lungs.
Key words: manifestation, extra pulmonary, Coronavirus Disease 2019

ABSTRAK

Ground glass opacities (GGO) merupakan suatu gambaran radiologis  non spesifik pada CT-scan toraks dengan berbagai macam etiologi, mulai dari inflamasi, infeksi, edema paru, perdarahan, penyakit interstisial paru hingga keganasan. Saat ini diketahui bahwa GGO juga dapat terdeteksi pada CT-scan toraks pasien-pasien dengan COVID 19. Temuan CT-scan toraks tipikal infeksi pneumonia COVID-19 berupa GGO yang dominan bilateral, lobus bawah dan perifer. Seringkali kemunculan gambaran GGO pada CT-scan toraks dikorelasikan dengan adanya infeksi COVID-19, padahal GGO bisa disebabkan oleh berbagai macam penyakit. Selain itu, probabilitas bahwa gambaran CT-scan toraks menunjukkan COVID-19, sangat tergantung pada probabilitas  pra-tes infeksi, yang akhirnya ditentukan oleh prevalensi infeksi komunitas. Oleh, karena beragamnya diagnosis banding GGO, perlu pemahaman mengenai etiopatogenesis, penilaian morfologi dan, distribusi GGO. Meskipun diagnosis pasti tidak bisa dibuat hanya berdasarkan pencitraan saja (CT-scan toraks), kombinasi klinis dan pencitraan secara substansial meningkatkan akurasi diagnosis.

Kata kunci: Ground glass opacities, CT-scan toraks, COVID-19

ABSTRACT

Ground glass opacities (GGO) are non-specific radiological features in the lung parenchyma on chest CT with various etiologies, ranging from inflammation, infection, pulmonary edema, pulmonary hemorrhage, interstitial lung diseases to malignancy. It is currently known that GGO can also be detected on chest CT of patients with COVID 19. Imaging finding in COVID-19 pneumonia are predominantly bilateral, basal and peripheral GGO. Ground glass opacities on chest CT are correlated with the presence of COVID-19 infection, even though GGO can be caused by various diseases. In addition, the probability that the chest CT shows COVID-19, highly depends on the pre-test probability of infection, which is ultimately determined by the prevalence of community infection. Because GGO have wide and varied differential diagnoses, it is necessary to understand the etiopathogenesis, morphological criteria, and distribution of GGO. Although a definite diagnosis cannot be determined by imaging alone (chest CT), the combination of clinical and imaging substantially increases the accurate diagnosis.

Key words: Ground glass opacities, chest CT, COVID-19

Amila Hanifan1, Prayudi Santoso2, ArtoYuwono Soeroto2, Miranti Pangastuti3
1Departement of Internal Medicine
2Divison of Pulmonology and Critical Respiration, Department of Internal Medicine
3Dvision of Dermato-Immunoallergology, Department of Dermatovenerology
Faculty of Medicine Universitas Padjadjaran, Dr. Hasan Sadikin Hospital

ABSTRACT
Introduction
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a type of life-threatening drug reaction. Clinical manifestations are morbilli form skin lesions, accompanied by fever, eosifnophilia and systemic involvement which can cause multi-organ failure. The incidence of DRESS syndrome is among 1: 1000 to 1: 10,000 patients, with 10% of mortality rate. Current literature shows that DRESS syndrome can be caused by anti-tuberculosis drugs, including ethambutol (53.5%), rifampicin (26.7%), pyrazinamide (20%), streptomycin (13.3%), and isoniazid (6.7%).
Case Report
A 42-year- old man has been known to suffer from pulmonary TB and undergo anti-tuberculosis drug therapy category I for 3 weeks. The patient has been known to have a history of allergy to ceftriaxone and ibuprofen drugs in previous treatments. The patient underwent a second treatment in the hospital with generalized erythema and scaly itchy skin. The physical examination showed that the patient had 39.1OC of body temperature with icteric sclera. The laboratory examination showed that the eosinophil was increased from 13% to 27%, accompanied by leukocyte 14,400 / UL, haemoglobin10 g / dL, and platelets 86,000 / UL. The examination on kidney and liver function resulted 57.0 mg / dl ureum and creatinine 2.39 mg / dl, and AST 458 IU / l, ALT 155 IU / l, total bilirubin 2,281 mg.dl, γ-glutamyltransferase 134 IU / l, ALP 357 IU / l, INR 1.79. At the beginning of the treatment, the scaly skin of the patient resembled the appearance of xerosis cutis. The development of the treatment showed that the patient fulfilled the DRESS syndrome diagnosis criteria based on RegiSCAR. The patient was treated in an intensive isolation room, and the anti-tuberculosis drugs discontinued.
Conclusion
DRESS syndrome is a drug reaction that can cause death. Diverse skin lesions and hypersensitivity reaction at slow onset make diagnosis difficult to establish. Therefore, diagnosing with RegiSCAR in the beginning and stopping the drug are important in the management of DRESS syndrome.
Keywords: drug eruption, DRESS syndrome, anti-tuberculosis drugs, RegiSCAR, pulmonary TB

Fifi Yuniarti, Linda Andriani, Zen Ahmad
Pulmonology Subdivision, Internal Medicine Departement, Medical Faculty SriwijayaUnversity/
Mohammad Hoesin General Hospital, Palembang, Indonesia

ABSTRACT
Introduction
Chylothoraksand chyloperitoneum are rare condition characterized by milky appearing fluid with elevated trigliseride. Lymphoma is found in 70%as etiology.
Case Ilustration
A women came to emergency room with chief complain shortness of breath since 4 days before admission. In physical examination found tachypnoe, tachycardia, decreased of vesicular in left side hemithorax, with wheezing in the hemithoraxdextra, dull in abdominal percussion and swelling in bilateral lower extremity. Chest radiology found a pleural effusion in bilateral thorax cavity. From CT abdominal and abdominal ultrasonography we found enlargement of paaraortalympnode, intraabdminalextraluminal mass.
Discussion
Chylothorax and chyloperitoneum diagnosed based onpleural trigliserid levels1100 mg/dL, 1290 mg/dL and 1030 in the peritoneal fluid.From sitology and immunohistochemistry showed a follicular lymphoma.We have done chest tube, pleurodesis with bleomycin, inhalation therapy and chemotherapy. Now she have finished the sixth series of chemetherapy and she have partial response.
Conclusion
We thought chylothorax in this patient caused by follicular lymphoma. Chemotherapy was given as underlying treatment.
Keywords: chylothorax, chyloperitoneum, follicular lymphoma
ABSTRACT
Introduksi
Chylothoraks dan chyloperitoneum merupakan kondisi yang jarang ditemukan yang ditandai dengan adanya cairan putih seperti susu dengan peningkatan kadar trigliserida. Lymphoma ditemkan sebagai etiologi sekitar 70%.
IlustrasiKasus
Seroang perempuan datang keruang emergensi RS Muhammad Hoesin Palembang dengan keluhan utama sesak sejak 4 hari sebelum masuk rumah sakit. Dari pemeriksaan fisikditemukan takipnoe, takikardia, penurunan vesikuler pada hemithoraks kiri disertai wheezing, redup pada saat perkusi abdomen dan edema pada bilateral ektremitas inferior. Dari foto thoraks didapatkan efusi pleura kiri. Dari pemeriksaan CT Scan dan USG abdomen didapatkan adanya pembesaran kelerjar getah bening paraaorta dan massa intraabdomen extraluminal.
Diskusi
Chylothorax dan chyloperitoneumdidiagnosis berdasarkankan dengan trigliserida pada cairan pleura kiri 1100 mg/dL, cairan pleura kanan 1290 mg/dL dan cairan ascites 1030 mg/dL. Dari pemeriksaan sitology serta imunohistokimia dengan kesan limfoma folikuler. Kami lakukan pemsangan chest tube, pleurodesis dengan bleomisin, terapi inhalasi dan kemoterapi. Pasien sudah menyelesaikan 6 seri kemoterapi dan memiliki respon remisi parsial untuk penyakitnya ini.
Kesimpulan
Kami berpikir penyebab chylothoraks pada pasien ini adalah follicular lymphoma. Kemoterapi diberikan sebagai terapi definitive.
Kata kunci: chylothorax, chyloperitoneum, follicular lymphoma

Ceva Wicaksono Pitoyo, Ardeno Kristianto
Divisi Respirologi dan Penyakit Kritis Departemen Ilmu Penyakit Dalam
FKUI RSCM
ABSTRAK
Hipoalbuminemia pada keadaan sakit kritis merupakan penanda mortalitas yang penting. Patofisiologi terjadinya hipoalbuminemia pada pasien sakit kritis memiliki beberapa penyebab, meliputi penurunan produksi, adanya mediator peradangan, kebocoran vascular, serta malnutrisi. Pemberian albumin manusia intravena perlu dipertimbangkan diberikan untuk hypoalbuminemia pada sakit kritis
Kata kunci: Hipoalbuminemia, sakit kritis
ABSTRACT
Hypoalbuminemia in critical illness is an important marker of mortality. The pathophysiology of hypoalbuminemia in critical illness including decrease of production, inflammation marker, vascular leakage, and malnutrition. Administration of intravenous human albumin is needed to be considered for treatment of hypoalbuminemia in critical illness.
Keywords: hypoalbuminemia, critical illness

Ivan Banjuradja*, Gurmeet Singh**

Abstrak Abnormalitas fungsi hati merupakan efek samping tersering pemberian regimen obat anti tuberkulosis (OAT) standar dimana menyebabkan 11% penghentian pemberian OAT pada pasien tuberkulosis (TB). Hepatotoksisitas terutama berhubungan dengan pemberian isoniazid (INH), rifampisin (RIF) dan pirazinamid (PZA) pada golongan OAT lini pertama. Manifestasi hepatotoksisitas bervariasi antara hanya berupa abnormalitas fungsi hati sampai kejadian gagal hati akut. Adapun pedoman tatalaksana TB dengan cedera hati akibat OAT sebagian besar masih didasarkan pada opini ahli. Dalam tinjauan pustaka ini akan dibahas mengenai mekanisme kelainan hati akibat OAT, tatalaksana penghentian, mekanisme reintroduksi OAT pada pasien-pasien yang mengalami kelainan fungsi hati, dan tatalaksana pengobatan pada pasien TB dengan riwayat gangguan fungsi hati sebelumnya.
Kata kunci: obat anti tuberkulosis, hepatotoksisitas
Abstract The abnormalities of liver function are the most common antitubercular side effect, which resulted in 11% drug discontinuation. Hepatotoxicity was mainly associated with the isoniazid (INH), rifampicin (RIF), and pyrazinamide (PZA) administration. The manifestation of hepatotoxicity was greatly varies, from asymptomatic abnormal liver function test to disastrous acute liver failure. Most of the recommendation for the management of liver injury related to antitubercular are based on expert opinion. This literature review will discuss the mechanism of antitubercular inducing liver injury, diagnostic work up, reintroduction of antitubercular, and management of tuberculosis in patients with previous liver dysfunction history.
Keywords: antitubercular, hepatotoxicity

Nur Chandra Bunawan1, Robert Sinto2,3, Annisa Dian Harlivasari1, Hardijatmo Muljo Nugroho1, Natalia Wistriany1, Setioningsih Diponegoro1, Debby Permatasari4, Friana Asmely4, Gurmeet Singh2,3, Evy Yunihastuti3
1 Tim Penanganan Kasus pasien dengan Penyakit Infeksi New Emerging dan Re-Emerging Disease (PINERE), Rumah Sakit Umum Daerah (RSUD) Kramat Jati, Jakarta
2 Tim Penanganan Kasus pasien dengan Penyakit Infeksi New Emerging dan Re-Emerging Disease (PINERE), RSUPN Dr Cipto Mangunkusumo, Jakarta
3 Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Indonesia- RSUPN Dr Cipto Mangunkusumo, Jakarta
4 Rumah Sakit Umum Daerah (RSUD) Kramat Jati, Jakarta
Alamat korespondensi: Nur Chandra Bunawan RSUD Kramat Jati Jl. Raya Inpres No. 48 RT 9/RW 9 Kampung Tengah, Kecamatan Kramat Jati, Jakarta Timur 13540 email: nur.chandra86@gmail.com
ABSTRAK
Coronavirus Disease 2019 (COVID-19) memiliki spektrum manifestasi klinis yang sangat luas meliputi hampir semua bagian disiplin ilmu kedokteran. Keterbatasan dan ketersediaan uji diagnosis yang ada saat ini menyebabkan hambatan deteksi awal pasien dengan kecurigaan COVID-19. Penulisan artikel ini bertujuan untuk mengenalkan sistem penapisan COVID-19 yang digunakan di Rumah Sakit Umum Daerah (RSUD) Kramat Jati, Jakarta Timur
Kata kunci: COVID-19, Rumah Sakit Umum Daerah, Kramat Jati, Penapisan
ABSTRACT
Coronavirus Disease 2019 (COVID-19) has a broad spectrum of clinical manifestations encompassing almost all of medical disciplines. Limitation and availability of current diagnostic tests hinder early detection of suspected COVID-19 patients. This article aims to introduce the COVID-19 screening system used in Kramat Jati Regional Public Hospital, East Jakarta
Keywords: COVID-19, Regional Public Hospital, Kramat Jati, Screening

Amelia Lorensia1, Mariana Wahyudi2, Nadia Aisah Mayzika 3
1 Department of Clinical-Community Pharmacy, Faculty of Pharmacy, Universitas Surabaya (UBAYA)
2 Department of Purification and Molecular Biology, Faculty of Biotechnology, Universitas Surabaya (UBAYA)
3 Postgraduate Student of Master of Pharmacy Science, Faculty of Pharmacy, Universitas Surabaya (UBAYA)

Abstract
Background: Omega-3 as a local source plays a role in the arachidonic pathway in asthma therapy, related to an improvement of lung function. The anti-inflammatory effects of omega-3 are known to be related to genetic factors, one of which is on ALOX5 gene polymorphism
Objective: This study aims to determine the profile of ALOX5 polymorphism and the effects of omega-3 fish oil on lung function in asthma in Surabaya
Methods: The method was pre-experimental design, using a purposive sampling technique for data collection from June 2017 to January 2018 in Surabaya. The intervention provided was fish oil which contains 1000 mg of omega-3 for 1 month. The different test using paired t-test to compare before and after getting the intervention. The research subjects were 27 adult outpatient asthmatics and 23 non-asthma patients (as the comparison on genetic testing.
Results: The results of improvement in lung function showed a significant difference (p=0.00) in PEF0 values (average: 217,96L/sec) and PEF4 (average: 325,00L/sec). Of the 27 study subjects, only 23 people could have genetic testing by a buccal swab. Asthma patients had more mutant II genotypes (39,13%) than wild types (30,43%). In this study, the relationship between ALOX5 gene polymorphism and lung function improvement cannot be tested because the number of samples is relatively limited. There was one subject who had constant PEF value (mutant II) and decreased PEF value (mutant III)
Conclusion: Fish oil is effective in improving lung function, especially in asthma patients with wild genotype type.
Keywords: ALOX5, asthma, PEF, fish oil, omega-3
Abstrak
Pendahuluan: Omega-3 sebagai sumber lokal berperan dalam jalur arakidonik dalam terapi asma, terkait dengan peningkatan fungsi paru. Efek antiinflamasi omega-3 diketahui berkaitan dengan faktor genetik, salah satunya pada polimorfisme gen ALOX5
Tujuan: Penelitian ini bertujuan untuk mengetahui profil polimorfisme ALOX5 dan efek minyak ikan omega-3 terhadap fungsi paru-paru penderita asma di Surabaya.
Metode: Metode yang digunakan adalah studi pre-eksperimental dengan teknik pengambilan sampel purposive sampling untuk pengumpulan data dari bulan Juni 2017 sampai Januari 2018 di Surabaya. Intervensi yang diberikan adalah minyak ikan yang mengandung 1000 mg omega-3 selama 1 bulan. Uji beda menggunakan paired t-test untuk membandingkan sebelum dan sesudah mendapat intervensi. Subjek penelitian adalah 27 pasien penderita asma dewasa rawat jalan dan 23 pasien non asma (sebagai pembanding pada pengujian genetik). Hasil peningkatan fungsi paru menunjukkan perbedaan yang signifikan (p = 0,00) pada nilai PEF0 (rata-rata: 217,96L / detik) dan PEF4 (rata-rata: 325,00L / detik). Dari 27 subjek penelitian, hanya 23 orang yang dapat menjalani pengujian genetik dengan swab bukal. Pasien asma memiliki lebih banyak genotipe mutan II (39,13%) dibandingkan tipe liar (30,43%). Dalam penelitian ini, hubungan antara polimorfisme gen ALOX5 dengan peningkatan fungsi paru tidak dapat diuji karena jumlah sampel yang relatif terbatas. Ada satu subjek yang memiliki nilai PEF konstan (mutan II) dan mengalami penurunan nilai PEF (mutan III).
Kesimpulan: Minyak ikan efektif meningkatkan fungsi paru-paru, terutama pada penderita asma tipe wild genotype.
Kata kunci: ALOX5, asma, PEF, minyak ikan, omega-3

Hendarsyah Suryadinata
Respirology and Critical Respiratory Division, Internal Medicine Department
Medical Faculty of Padjadjaran University/ Dr Hasan Sadikin General Hospital

Abstract : Exacerbations characterized by an increase in patients' symptoms above baseline, represent an important feature of the clinical manifestation and natural history of asthma and chronic obstructive pulmonary disease (COPD). Acute asthma and COPD exacerbations are the most common respiratory diseases requiring emergent medical evaluation and treatment. Asthma and COPD exacerbations impose an enormous economic burden on health care budget. In daily clinical practice, a distinction between bronchial asthma and exacerbated COPD is difficult because symptoms are similar. Exacerbations represent a change in symptoms and lung function from the patient usual status. The decrease in expiratory airflow can be quantified by lung function measurements such as peak expiratory flow (PEF) or forced expiratory volume in 1 second (FEV1), compared with the patient’s previous lung function or predicted values. Medications most commonly used for exacerbations are oxygen supplementation, bronchodilators inhalation, corticosteroids, and antibiotics. For severe asthma attacks the administration of magnesium is a possible additional option. Invasive ventilation remains a last resort to ensure respiratory function and indications for this are given in patients with clinical signs of impending exhaustion of breathing. Keyword : exacerbation, asthma, COPD, lung function, medications
Abstrak :
Eksaserbasi yang ditandai oleh adanya perburukan gejala pasien, merupakan salah satu bagian penting dari manifestasi klinis dan perjalanan penyakit pasien dengan asma dan penyakit paru obstuktif kronis (PPOK). Eksaserbasi asma akut dan PPOK merupakan penyakit respirasi yang paling umum ditemukan yang membutuhkan evaluasi dan pengobatan medis segera. Eksaserbasi asma dan PPOK memiliki dampak ekonomi yang besar pada pembiayaan kesehatan. Dalam praktik klinis sehari-hari, perbedaan antara eksaserbasi asma dan PPOK kadang disulitkan oleh gejalanya yang serupa. Eksaserbasi menunjukkan adanya perubahan pada gejala dan fungsi paru dari status pasien biasanya, Penurunan pada aliran eksiprasi dapat dinilai oleh pengukuran fungsi paru seperti alur puncak ekspirasi (APE) atau volume paksa eksiprasi 1 detik (VEP1), dibandingkan dengan nilai fungsi paru sebelumnya atau nilai prediksi. Medikasi yang biasanya digunakan untuk eksaserbasi adalah suplementasi oksigen, inhalasi bronkodilator, kortikosteroid dan antibiotik. Pada pasien serangan asma berat, pemberian magnesium dapat menjadi opsi tambahan. Ventilasi invasif merupakan pilihan terakhir bantuan fungsi respirasi pada pasien dengan tanda ancaman gagal nafas. Kata kunci : eksaserbasi, asma, PPOK, fungsi paru, medikasi

1Program Sarjana Kedokteran, Universitas Padjadjaran, Bandung, Indonesia
2Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran, Universitas Padjadjaran / Rumah Sakit Umum Hasan Sadikin, Bandung, Indonesia
3Departemen Ilmu Kesehatan Masyarakat, Fakultas Kedokteran, Universitas Padjadjaran, Bandung, Indonesia

Abstrak
Latar Belakang: Pneumonia komunitas merupakan masalah kesehatan serius karena penyakit ini termasuk dari sepuluh penyakit yang paling banyak ditemukan di rumah sakit dengan angka kematian tertinggi ketiga di dunia. Kegagalan terapi yang diakibatkan karena resistansi kuman terhadap regimen yang diberikan dapat menyebabkan bertambahnya beban klinis untuk rumah sakit.
Tujuan: Penelitian ini bertujuan untuk mengetahui pola bakteriologi dan data resistansi yang berguna sebagai salah satu pertimbangan untuk terapi empiris pneumonia. Metode: Penelitian ini dilakukan menggunakan desain deskriptif kuantitatif. Data diambil secara retrospektif dari semua hasil uji kepekaan kuman pasien rawat inap di Bangsal Ilmu Penyakit Dalam RSUP Dr. Hasan Sadikin periode 1 Januari – 31 Desember 2018 yang memenuhi kriteria inklusi dan eksklusi. Data yang dicari adalah bakteri penyebab pneumonia dan hasil uji kepekaan yang dihitung berdasarkan resistansi. Hasil: Sebanyak 189 dari 307 data pasien peumonia merupakan infeksi bakteri tunggal dengan 116 diantaranya disebabkan oleh bakteri gram negatif sementara 76 sisanya merupakan infeksi bakteri gram positif. Bakteri gram positif yang paling banyak ditemukan adalah Staphylococcus aureus pada 11 pasien. Bakteri gram negatif yang paling banyak ditemukan adalah Klebsiella pneumoniae pada 26 pasien. Resistansi paling tinggi pada bakteri gram negatif ditemukan pada 17 dari 25 pasien infeksi Pseudomonas aeruginosa terhadap tigecycline. Resistansi terendah pada bakteri gram negatif ditemukan pada 1 dari 26 pasien Klebsiella pneumoniae untuk tigecycline. Resistansi paling tinggi untuk bakteri gram positif paling banyak ditemukan berbagai antibiotik yang diujikan kepada Staphylococcus haemolyticus sementara tidak ditemukan resistansi bakteri gram positif terhadap linezolid. Kesimpulan: Bakteri yang paling banyak ditemukan adalah bakteri gram negatif Klebsiella pneumoniae. Angka resistansi bakteri gram negatif paling banyak ditemukan pada Pseudomonas aeruginosa terhadap tigecycline sementara angka resistansi bakteri gram negatif ditemukan paling tinggi pada Staphylococcus haemolyticus terhadap berbagai antibiotik. Kata Kunci: pneumonia komunitas, pola bakteri, resistansi.
Abstract
Background: Community-Acquired Pneumonia (CAP) is a serious health problem due to its high hospital incidence and mortality rate. Failure to properly treat the infection, mainly caused by the antimicrobial resistance, may increase clinical burden.
Objective: This study aims to observe bacterial pattern and resistance in hospitalized pneumonia patients which may be included in future treatment consideration.
Method: This research was conducted using descriptive quantitative design. Retrospective data of Department of Internal Medicine inpatients with susceptibility test results available from January 1st – December 31st 2018 which fulfilled the inclusion and exclusion criteria was collected through total sampling method. Patients’ data were analyzed and reported by etiological agent and susceptibility test results. Result: Approximately 189 out of 307 available pneoumonia cases were single infections with 116 caused by gram-negative bacteria while 76 were caused by gram-positive bacteria. Staphylococcus dan Klebsiella were the most common gram-positive and negative bacteria found with 11 cases and 26 cases. Highest antibiotic resistance on gram-negative and gram positive bacteria was observed in 17 out of 25 Pseudomonas aeruginosa patients to tigecycline and Staphylococcus haemolyticus on various antibiotics respectively, while the lowest was observed on Amikacin on 4 cases and no resistance found on any patients for linezolid.
Conclusion: The most encountered single CAP etiological agents in Hasan Sadikin Hospital Bandung came from gram-negative bacteria group, which are Klebsiella pneumoniae and Pseudomonas aeruginosa. Tigecycline was the most resisted antibiotic by gram-negative bacteria, while tetracycline was resisted the most by gram-positive bacteria.
Keywords: bacterial pattern, community-acquired pneumonia, resistance.

Gurmeet Singh¹, Nova Bornida Fauzi¹

¹Department of Internal Medicine, Respirology and Critical Illness, Universitas Indonesia, Rumah sakit Cipto Mangunkusumo, Jakarta, Indonesia

ABSTRACT 

COVID-19 is an ongoing pandemic with similar clinical manifestations to other infectious diseases. Until this day there is no exact guideline for the diagnosis and treatment of COVID-19. This case report describes a dengue fever case in a patient with high risk of COVID-19 infection. Rapid detection of this disease helps patients to receive early treatment and also contain the spread of the disease. Due to similar initial symptoms and lab results, a nasopharyngeal swab is recommended on the fifth day of fever, due to high viral load on said days. Clear anamnesis and accurate interpretation of lab and radiologic modalities helps avoidance of unnecessary early medications for COVID-19

Keywords: COVID-19, dengue fever, viral infections

RA Linda Andriani, Zen Ahmad
Divisi Pulmonologi Departemen Penyakit Dalam
Fakultas Kedokteran Universitas Sriwijaya/ RSUP Dr. Moh. Hoesin Palembang Indonesia

Pendahuluan
Indonesia menempati peringkat kelima kasus MDR TB tertinggi di dunia. MDR TB terjadi karena resistensi terhadap obat Rifampisin dan INH yang disebabkan oleh mutasi pada gen M.Tb. Resistensi terhadap obat INH dapat disebabkan oleh beberapa gen tetapi paling sering terjadi karena mutasi gen katG S315TM.Tb. Angka kejadian mutasi gen katG ini bervariasi ditiap daerah. Mutasi gen katG S315TM.Tb dapat menimbulkan resistensi tingkat tinggi terhadap INH.
Tujuan
Mengetahui frekuensi mutasi gen katG S315TM.Tb diantara semua pasien MDR TB di Sumatera Selatan.
Metode
Sebanyak 118 pasien MDR TB yang menjalani pengobatan di RSMH Palembang dari februari 2019 hingga mei 2020 dilakukan pemeriksaan PCR-RFLP laboratorium mikrobiologi FK UNSRI untuk melihat alel kodon 315 gen katG M.Tb.
Hasil
Frekuensi mutasi gen katG S315T M.Tb diantara pasien MDR TB di Sumatera Selatan adalah 48,33%. Pada kelompok mutasi gen katG S315T M.Tb didapatkan indeks massa tubuh yang lebih rendah, jumlah M.Tb yang lebih tinggi dan lesi radiologis yang lebih luas pada saat diagnosis.
Simpulan
Resistensi obat isoniazid pada pasien MDR TB mayoritas disebabkan oleh mutasi gen katG S315T M.Tb. Mutasi ini akan menyebabkan resistensi INH tingkat tinggi. Tingginya angka resistensi INH akan mempengaruhi pengobatan MDR TB.
Kata kunci : MDR TB, mutasi gen katG S315T M.Tb, INH, PCR-RFLP

Nury Nusdwinuringtyas1, Tresia Fransiska Uliana Tambunan2, Faisal Yunus3, Telly Kamelia4
Affiliation(s) of each author :
1. Cardiorespiratory Division, Department of Physical Medicine and Rehabilitation, Dr. Cipto Mangunkusumo National General Hospital, Universitas Indonesia, Jakarta, Indonesia.
2. Cardiorespiratory Division, Department of of Physical Medicine and Rehabilitation, Dr. Cipto Mangunkusumo National General Hospital, Universitas Indonesia, Jakarta, Indonesia.
3. Department of Pulmonology and Respiratory Medicine, Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia.
4. Respirology and Critical Illness Division, Internal Medicine Department, Universitas Indonesia, Faculty of Medicine. Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
Abstract:
This study compared prediction of O2 max from total distance of six minute walk test (6MWT) based on Mongoloid’s formula to Caucasian’s formula in Indonesia (Mongoloid) adults with chronic obstructive pulmonary disease (COPD). It involved 44 COPD subjects (38 males) and used total distance from 6MWT to predict O2max with Nury’s formula (Indonesia-Mongoloid) [(0,053 total distancemeter)+ (0,22 ageyears)+ (0,032 heightcentimeter) – (0,164 weightkilogram)– (2,228 gendermale=0, female=1) - 2,287] and Cahalin formula (American-Caucasian) [(0,006 x total distancefeet) + 3,38].The Prediction of O2max with Nury’s formula was 9,35 (1.98-15.89) ml/ kg/min and Cahalin formula is 3.73 (2.21-4.57) ml/kg/min. We found significant different statistically (p<0,05) in the O2max. We concluded that O2max prediction with Cahalin formula showed that the functional capacity was underestimated. This study showed maximum capacity(O2 max) prediction in Mongoloid adults with COPD could not be predicted by Caucasian’s formula.
Keywords : six minute walk test, COPD, Nury’s formula, Mongoloid
Abstrak
Penelitian ini membandingkan nilai prediksi O2 maksimum dari jarak tempuh yang diperoleh pada uji jalan enam menit (6MWT) pada subjek PPOK dewasa Indonesia (Mongoloid) yang dihitung dengan rumus prediksi O2 max berbasis Mongoloid terhadap rumus berbasis Kaukasoid. Penelitian ini melibatkan 44 subjek penelitian (38 laki-laki). Menggunakan jarak tempuh yang diperoleh dari 6MWT, dihitung prediksi O2 max dengan rumus Nury (Indonesia- Mongoloid) = (0,053 jarak totalmeter)+ (0,22 umurtahun)+ (0,032 tinggi badancentimeter) – (0,164 berat badankilogram) – (2,228 Jenis kelaminlaki-laki=0, perempuan =1) - 2,287 dan Rumus Cahalin (Amerika-Kausasoid) = (0,006 x Jarak totalkaki) + 3,38.Prediksi O2 maksimum dengan rumus Nury sebesar 9.35 (1.98-15.89) ml/kg/min, sedangkan dengan rumus cahalin 3.73 (2.21-4.57) ml/kg/min). Terdapat perbedaan bermakna (p<0.05).
Disimpulkan: menggunakan O2 max prediksi dengan rumus Cahalin menampilkan kapasitas fungsional dibawah nilai sesungguhnya (underestimate), dengan demikian prediksi kapasitas maksimum pada PPOK mongoloid tidak bias diprediksi menggunakan rumus Kaukasoid.
Kata kunci: uji jalan enam menit, PPOK, rumus Nury, Mongoloid

Desdiani Desdiani¹, Asysyukriati R. Prawiro², Dian Handayani³, Bachtiar Husain⁴, Chairul Nurdin Azali⁵, Siti Amanda⁶

lUniversity of Sultan Ageng Tirtayasa Serang Banten Indonesia

²University of Pembangunan Nasional Veteran

³University of North Sumatra ⁴Firdaus Hospital ⁵University of North Sumatra ⁶University of Trisakti

 ABSTRACT

 Bronchiectasis is an abnormal, chronic enlargement of the bronchi and associated with a clinical syndrome of cough, sputum production and respiratory infections. Bronchiectasis may appear in association with pulmonary tuberculosis. A 69 years old woman who had recurrent cough since       3 years ago and treated with the diagnosis of allergic bronchitis. Since 5 months ago she had complained cough and shortness of breath. She was admitted to Intensive Care Unit with reduced consciousness and used ventilator for almost a month, had chronic hypercapnea and no response with antibiotic therapy and inhalation. After two weeks, she had improved by tuberculosis treatment and macrolid antibiotics even though pCO2 levels were difficult to decreased.

Keywords: Bronchiectasis, HRCT, Hypercapnea, Tuberculosis,

Muhammad Hafiizh Alfarrisi¹, Michael², Emir Yonas³, Raymond Pranata⁴ Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia; Faculty of Medicine Universitas Indonesia

Faculty of Medicine, Universitas Kristen Krida Wacana Faculty of Medicine, Universitas YARSI, Jakarta, Indonesia

Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia

ABSTRAK

Latar belakang: Di era pentingnya tindakan reperfusi, ada beberapa pola EKG atipikal yang dapat mengancam jiwa sindrom koroner akut risiko tinggi yang perlu diperhatikan. Salah satunya adalah sindrom Wellens dengan karakteristik adanya abnormalitas gelombang T (gelombang T biphasic atau T dalam terbalik) pada hasil elektrokardiogram (EKG) pasien dalam episode tanpa nyeri dada. Hal ini menunjukkan stenosis pada arteri koroner proksimal anterior descending kiri (LAD) derajat tinggi yang dapat mengakibatkan infark akut pada dinding anterior miokard (AMI) jika tidak dilakukan pengobatan maupun reperfusi.

Tujuan: Untuk menyajikan kasus Wellens sindrom yang mengancam jiwa, sindrom koroner akut risiko tinggi.

Ilustrasi kasus: Seorang pria berusia 48 tahun, perokok berat, datang ke ruang gawat darurat rumah sakit National Cardiac Center Harapan Kita (NCCHK) dengan nyeri dada berulang dalam waktu 18 jam sebelum datang ke rumah sakit. Pemeriksaan EKG menunjukkan irama sinus dengan T negatif yang dalam di V2-V4, tanpa gelombang Q patologis. Pasien diduga sebagai Wellens Sindrom, sindrom koroner akut dengan risiko tinggi. Pasien kemudian dilakukan intervensi koroner perkutan dini (PCI). Ditemukan 90% sumbatan pada LAD proksimal dan berhasil di lakukan pemasangan satu stent.

Kesimpulan: Semua pasien dengan/ tanpa riwayat angina dengan EKG yang dicurigai sebagai sindrom Wellens harus menjalani terapi invasive reperfusi sesegera mungkin. Setiap pasien dengan temuan EKG khas Sindrom Wellens tidak boleh menjalani segala bentuk tes jantung lainnya untuk menegakan diagnostik lebih lanjut karena risiko terjadinya kematian jantung mendadak.

Kata kunci: Sindrom koroner akut risiko tinggi, sindrom Wellens, obstruksi arteri descending kiri

anterior; revaskularisasi, perubahan Elektrokardiografi

Herikurniawan

Respirology and Critical Illness Division, Internal Medicine Department

Faculty of Medicine Indonesia University, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia

 ABSTRACT

Patient safety is an effort conducted to prevent and overcome unexpected problems occurring in   the hospital. Patient safety in health care organization is the most important goal that needs to        be achieved and monitored in regular basis. The International Patient Safety Goals (IPSG) are important guidelines at the international level to promote specific improvements in the process of providing safe and high quality patient care. The patient safety standard which is stated in IPSG is consist of 6 elements: (1) patient identification correctly; (2) increasing communication effectively;

(3) increasing the safety of the high-alert medication; (4) certainty of accurate location, procedure accuracy, and patient-surgery accuracy; (5) reducing the risk of infection related to health service, and (6) reducing the risk of patient harm resulting from falls.

Keywords patient safety, international patient safety goals, patient safety standard