Vol 4 No 4 (2017)

    Adhella Menur Naysilla
    Dokter Umum RSUD Brigjen H. Hasan Basry, Kandangan,
    Hulu Sungai Selatan, Kalimantan Selatan, Indonesia


    The development of congenital heart disease management (PJB) causes patients to live an adult life now known as Congenital Heart Disease (GUCH) and Adult Congenital Heart Disease (ACHD). Patients with acute ureanotic ACHD with natural survival (no intervention measures in childhood) can suffer from complications of pulmonary hypertension and Eisenmenger syndrome. Complications can increase patient morbidity and
    mortality and worsen the quality of life. The patient may need corrective surgery and even a heart transplant. Some conditions that can not be administered by surgery cause the patient to take medication and in high lifetime medical surveillance. This case report discusses a 26-year-old male Banjar tribe coming with cough and breath with oxygen saturation of four extremities of 80%. Patients have a history of congenital heart disease with no intervention measures in childhood. Patients were diagnosed with sekundum ASD with severe pulmonary hypertension and Eisenmenger syndrome, secondary polycythemia PJB, and pulmonary TB in advanced stage 1 treatment. Diagnosis is obtained from anamnesis, physical examination, and investigation. ECG, radiology, laboratory, spirometry, and echocardiography Doppler. Patients care in ICU and treated with oxygenation, pulmonary vasodilators, diuretics, and iron supplementation and folic acid. Advanced pulmonary TB treatment. The patient underwent flebotomy 3 times. After treating 18 days, the patient showed a clinical improvement and was referred to the Ulin Hospital Banjarmasin for further examination and management.
    Keywords : ACHD asianotik, ASD sekundum, pulmonary hypertension, Eisenmenger syndrome

  • Pulmonary Hypertension in Obesity Hypoventilation Syndrome: A Case Report
    Vol 4 No 4 (2017)

    Davin Takaryanto,1,2, Ade Erna1,2, Hendarsyah Suryadinata1,3
    1 Faculty of Medicine, UniversitasPadjadjaran, Bandung, Indonesia
    2Department of Internal Medicine, Sumedang Regional Public Hospital, Sumedang, Indonesia
    3 Respiratory Critical Disease Division, Department of Internal Medicine, HasanSadikin General Hospital, Bandung, Indonesia


    Introduction:The prevalence of obesity continues to increase every year across the world. Obesity has been a risk factor for developing some chronic and non-communicable diseases. Obesity hypoventilation syndrome (OHS) is one of non-communicable disease that emerges with obesity as its primary risk factor. We presented a case with severe obesity, chronic hypoventilation and multiorgan impairmentscaused by OHS, a disease that is often misdiagnosed and mistreated hence leads to higher mortality rate.
    Case Report: A woman, 54 years old, was brought to hospital emergency ward with decrease of consciousness (hypersomnolent) and breathlessness. The patient had an excessive sleeping amount of time with morning or nocturnal headache, snoring, and sleeping apnea. She had been diagnosed as asthma and pulmonary hypertension and had been given therapy. She was severely obese with BMI of 44.07 kg/m2. The patient suffered multiorgan failures of respiratory failure, hepatic impairment, cardiac failure, and renal disease. She underwent positive pressure ventilatory assistance after being delayed until after fourth day of hospitalization. She suffered from cardiac arrest due to septic shock and respiratory failure. Cardiopulmonary resuscitation was carried out, but eventually the patient died.
    Discussions:OHS is an alveolar hypoventilation or hypercapnia that occurs daily in obese patient without underlying disease that could lead to hypo ventilatory state. Majority of patients with OHS also experience obstructive sleep apnea hypopnea syndrome (OSAHS). Patients who complain respiratory problems are often misdiagnosed as asthma or chronic obstructive pulmonary disease even though theyshowsome obvious OHS clinical features. Chronic hypercapnia could lead to dyspnea worsened by physical activity, sleep problem, excessive daily sleeping time, delirium, myoclonus, and seizures. Along with clinical findings, further confirmatory examinations are needed to support OHS diagnosis. OHS could lead to some complications such as pulmonary hypertension and right heart failure (corpulmonale). Bariatric surgery and positive pressure ventilation with mechanical ventilator are primary therapies for OHS.
    Conclusions: Diagnosis of OHS should be considered when finding obese patients who complain respiratory problems. Missed diagnosis and inadequate therapy in OHS patients could lead to high morbidity and mortality rate. Advance diagnostic tools are needed to accurately diagnose, follow up and treat OHS patients intensively.
    Keywords: hypoventilation, hypercapnia, obesity, Pickwickian syndrome

    Vol 4 No 4 (2017)

    1Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia


    Background:Most clinicians are focusing on artery’s complications that might be happen due to manipulation on artery while the PCI procedure. However, vein’s complication is also happen in rarity.
    Case description: A 69-year-old female patient was undergone an elective-PCI procedure. Patient’s medical history with hypertension and hyperlipidemia; pacemaker implanted; decreased effort tolerance-shortness of breath; significant mid RCA and LAD lesion shown by CT Coronary Angiogram. The PCI procedure was done through access of the right common femoral artery. A 6-FrenchCordisExoseal for vascular closure device was utilized.
    After discharging, the patient complained of a painful swelling of her right leg. Physical examination showed diffuse swelling of the entire right leg and bruising around the puncture site. A vascular Doppler study was performed. It demonstrated thrombus in the right proximal superficial femoral vein.

  • Correlation Between Inhaled Beta 2 Agonist and Corticosteroid with The Degree of Control and Lung Function in Asthma
    Vol 4 No 4 (2017)

    Muhammad Ranushar, Harun Iskandar, Nur Ahmad Tabri, Makbul Aman,Syakib Bakri
    Departement of Internal Medicine Medical Faculty
    Hasanuddin University Makassar


    Background: Asthma is an important chronic airway disease and is still a serious and mass public health problem in many countries. Asthma control has been difficult to achieve using conventional therapies such as short-acting beta 2 agonist (SABAs), oral beta 2 agonists, oral corticosteroids and theophylline, leading to asthma difficult to control. Treatment of asthma based on GINA uses asthma control medications (controller) in the form of inhalation of beta 2 agonist combination with inhaled steroid/Inhaled Corticosteroid (ICS) and can be a combination of both. Classification of degree control based on GINA is considered more practical, easier to adapt, and more clinically valuable.
    Objective: To know the relationship of type therapy with degree of control and lung function of asthma patient.
    Methods: This study was a cross sectional study. The samples used were patients with asthma diagnosis both outpatient and inpatient according to GINA criteria. The subjects of the study were data collection in the form of therapy method. Spirometry measurements determine FEV1% and asthma control degree according to GINA criteria. The study was conducted in February-May 2016 at Pulmonology Polyclinic RS Wahidin Sudirohusodo Makassar and Hasanuddin University hospital in Makassar
    Results: The age of the subjects varied between 19 and 69 years old, the FEV1% score ranged from 18% to 98%, male subjects were 23 (33,8%) and 45 (66,2%). There was no significant association of therapeutic method with lung function (p> 0,05). There is a significant relationship between therapy method and degree of control asthma (p <0,001).
    Conclusions: In patients with asthma who received combination therapy such as combination budesonide and formoterol or salmeterol and fluticasone significantly more achieved a better degree of control than in patients who only received agonist beta 2 inhalation or corticosetoid inhalation only.
    Keywords: Asthma, therapeutic method, lung function, degree of control, Forced Expiration Volume 1, Inhalation of beta 2 agonists, inhaled corticosteroids, inhalation corticosteroid and beta-2 agonist combination.

  • The Impact of Genetic Profile Diversity of Mycobacterium Tuberculosis In Tb-HIV Compared to TB Non HIV Patients
    Vol 4 No 4 (2017)

    KeikoYolanda Gunardi1, Telly Kamelia2
    1Faculty of Medicine, Universitas Indonesia
    2Respirology and Critical Illness Division, Internal Medicine Department
    Cipto Mangunkusumo Hospital/ Faculty of Medicine Universitas Indonesia


    Introduction: Tuberculosis (TB) remains as ignificant global health problem,but it is possibly curable when TB is detected and effectively treated. Drug resistant become the hardest challenge to cure this disease. The Multidrug resistance TB is of ten linked to the diversity of Mycobacterium tuberculosis genotype.This study aimed to investigate whether diversity of genetic profile M.tuberculosis influenced the drug resistance.
    Methods: A literature search was conducted in several electronic databases. PubMed, Proquest, and Scopus were used to find articles which investigate the association between diversity of MTB genotype and drug resistant. After applying the inclusion and exclusion criteria,there were six eligible articles. However, after restricting more thoroughly, there were only one case control study was used for appraisal.
    Results:One case control study identified the impacts of genetic profile diversity and drug resistant was found. It also compared HIV infected and non HIV patients.A total of 158 samples were used. The association between drug resistance mutation and genetic strain background was strongly established (P<0.0001). The most frequent mutations in Switzerland were poB (S531L) resistance to rifampin and katG (S315T) which was resistant to isoniazid. The study found that genetic background, especially lineage 2 (Beijing strain) of the M.TB had a high association with drug resistance.This association was stronger formulation drug resistance and in HIV positive patients. (OR19,70;95%CI,1,30to298,19;P=<0,0001).
    Conclusion: Current evidence showes there was a clear evidence that the diversity of genetic give an impact to resistant of the drug. It is recommended that future studies in Indonesia is needed to demonstrate consistent effects in clinical settings since Indonesia is an endemic area for Tuberculosis
    Keywords: M.Tuberculosis, genome, genotype, genetic Profile, TB-HIV, TB-Natïve, drug resistance

  • Intrapleural Streptokinase for Tuberculosis Loculated Pleural Effusion
    Vol 4 No 3 (2017)

    Ario Perbowo Putra1, Stephanie Dewi Samsuria1, Griskalia Christine 1, Zulkifli Amin2
    1Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Indonesia 2Division of Respirology and Critical Care, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Indonesia


    Summary: Intrapleural streptokinase was performed to a 25-year-old-male with loculated pleural effusion due to tuberculosis infection. The effusion was improved significantly after fibrinolytic and antituberculosis therapy. Before insertion of intrapleural streptokinase, the pleural volume drained twice with in total volume was 1700 ml, but no significant changes were seen on the chest X-ray. After streptokinase use, the volume drained was almost 1800 ml and the chest X-ray showed significant improvement, as well as the patient condition. Intrapleural streptokinase is an effective procedure in improving drainage of loculated pleural effusion due tuberculosis.
    Key words: Pleural effusion,Streptokinase, fibrinolytic

  • Pendekatan Perioperatif Paru Terkini
    Vol 4 No 3 (2017)

    Mohammad Adi Firmansyah1, Gurmeet Singh2, Zulkifli Amin2
    1Departemen Ilmu Penyakit Dalam FKUI/RSCM
    2Divisi Respirologi dan Perawatan Penyakit Kritis, Departemen Ilmu Penyakit Dalam FKUI/RSCM
    Korespondensi : madif12@gmail.com


    Evaluasi perioperatif paru merupakan bagian penting pada tatalaksana pasien dengan penyakit
    paru yang akan menjalani pembedahan kardiak atau non-kardiak elektif. Tujuan dari evaluasi
    perioperatif secara umum adalah (1) identifikasi kondisi komorbids yang dapat meningkatkan
    terjadinya komplikasi perioperatif; (2) optimalisasi kondisi umum jika memungkinkan; (3) memahami,
    mengenali, dan mengobati kejadian yang dapat menyebabkan terjadinya komplikasi pasca operasi;
    (4) menganjurkan pemeriksaan preoperatif yang diduga dapat mempengaruhi stratifikasi risiko dan
    manajemen pasien; dan (5) menganjurkan modalitas pasca operasi yang dapat menurunkan risiko
    terjadinya komplikasi.1 Fleischer (2002) melaporkan dari 485.850 pasien yang menjalani pembedahan, sebanyak 4.038 (0.7%) diantaranya mengalami kematian, dengan penyebab terbanyak akibat adanya kondisi komorbid pasien tersebut (1:95), faktor kesalahan pembedahan (1: 420), dan kesalahan anestesi (1: 2680).1 Insiden komplikasi paru pasca operasi (postoperative pulmonary complications – PPC) cukup tinggi dengan angka bervariasi dari 2 hingga 19%.2 Smetana melaporkan komplikasi paru terjadi sekitar 6.8% dari
    seluruh jenis pembedahan.3 Ateletaksis, pneumonia, gagal napas, dan eksaserbasi dari penyakit paru kronis
    merupakan PPC yang sering dilaporkan. Komplikasi paru dilaporkan lebih banyak terjadi dibandingkan 
    komplikasi kardiak, dan menyebabkan bertambahnya masa perawatan pasien di rumah sakit

  • Faktor-Faktor yang Mempengaruhi Mortalitas Pasien ARDS di Rumah Sakit Cipto Mangunkusumo Jakarta
    Vol 4 No 3 (2017)

    Kripti Hartini1, Zulkifli Amin2, Ceva W. Pitoyo2, Cleopas Martin Rumende2
    1Departemen Ilmu Penyakit Dalam FKUI/RSCM
    2Divisi Respirologi dan Perawatan Penyakit Kritis, Departemen Ilmu Penyakit Dalam FKUI/RSCM


    Background: Acute respiratory distress syndrome (ARDS) is an emergency in respirology field that contributes to high mortality rate. To decrease the mortality rate of ARDS patients, we need to identify factors affecting it. Studies about factors affecting ARDS mortality showed varying results and until now there is still no comprehensive study about it in Indonesia especially at Cipto Mangunkusumo National hospital (RSCM).
    Objective: To analyze factors affecting mortality of ARDS patients at Cipto Mangunkusumo Hospital.
    Methods: This study was a retrospective cohort on ARDS patients who were hospitalized in Cipto Mangunkusumo hospital within 2008 and 2012. Data about clinical condition, laboratory, chest X-ray, and outcome of hospitalization were all collected from medical records. Bivariate analysis were performed on age, ARDS etiology, comorbidity Charlson index, PaO2/FiO2 ratio, APACHE II score, and ventilator use in the first 48 hours since ARDS diagnosed.
    Multivariate with logistic regression would be done to variables that fulfilled the condition.
    Results: A total of 368 patients were included in this study. Inhospital mortality was 75.3%. On bivariate analysis we found that age, ARDS’ etiologies, comorbidity Charlson index, PaO2/FiO2 ratio, APACHE II score, and ventilator use in the first 48 hours since ARDS was diagnosed were variables that had significant associations with inhospital mortality. From multivariate analysis, we found variables that had associations with mortality were sepsis (RR 1.26; 95% CI 1.20-1.32; p < 0.001), the high APACHE II score (RR 1.19; 95% CI 1.04-1.30; p = 0.019) ,and no ventilator use in the first 48 hours since ARDS was diagnosed (RR 1.37; 95% CI 1.25-1.43; p < 0.001).
    Conclusions: Sepsis, high APACHE II score, and no ventilator use in the first 48 hours since ARDS was diagnosed were independent factors affecting ARDS patients mortality.
    Key words: acute respiratory distress syndrome, factors affecting mortality

  • Distribusi Faktor-Faktor yang Mempengaruhi Kelaikan Terbang Pasien PPOK pada Jemaah Haji Indonesia
    Vol 4 No 3 (2017)

    Moh Syahrir Azizi1Anna Uyainah2Zulkifli Amin2Moh Sedijono3Hamzah Satri41Departemen Ilmu Penyakit Dalam FKUI/RSCM2Divisi Respirologi dan Perawatan Penyakit Kritis, Departemen Ilmu Penyakit Dalam FKUI/RSCM3Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Kristen Krida Wacana4Divisi Psikosomatik, Departemen Ilmu Penyakit Dalam FKUI/RSCMKorespondensi

    Background: The decreased pressure in aircraft cabins may cause hypoxia symptoms in patients with Chronic Obstructive Pulmonary Disease (COPD). Currently, no publication is known to have reported the profile in-flight hypoxia symptoms and pre-flight medical screening in COPD pilgrims.
    Objective: To obtain profile of in-flight hypoxia and pre-flight assessment for fitness-to-fly without oxygen
    supplementation based on pulmonary function test, oxygen saturation, and the ability to walk more than 50 meters among pilgrims with COPD.
    Methods: This is a desciptive study which was conducted during the pilgrimage season in 2011.
    Results: Thirty six COPD patients were identified and subsequently recruited to this study. Pre-flight medical
    assesment concluded that 33 subjects were fit to fly without supplemental oxygen. Nevertheless, three subjects developed in-flight hypoxia symptoms i.e. two of them were fit to fly without supplemental oxygen, while another subject was recommended to have supplemental oxygen. Characteristics of subjects with in-flight hypoxia were as follows: current smokers (10.5%), not known to have COPD prior to health examination (8.8%), moderate COPD category (9.5%), above 60 years old (5,3%), and had comorbidities (4,2%).
    Conclusion: Most pilgrims with COPD were fit to fly without oxygen supplementation.
    Key words: Hypoxia symptoms, COPD, Pilgrims.

  • Karakteristik dan Kesintasan 90 Hari Pasien Sindrom Vena Kava Superior di Rumah Sakit Cipto Mangunkusumo dan Rumah Sakit Kanker Dharmais
    Vol 4 No 3 (2017)

    Malikul Chair1, zulkifli Amin, Noorwati, Andika Rachman,Pringgodigdo

    1Departemen Ilmu Penyakit Dalam FKUI/RSCM2Divisi Respirologi dan Perawatan Penyakit Kritis, Departemen Ilmu Penyakit Dalam FKUI/RSCM3Divisi Hematologi dan Onkologi Medis, Departemen Ilmu Penyakit Dalam RS Kanker Dharmais4 Divisi Hematologi dan Onkologi Medis, Departemen Ilmu Penyakit Dalam FKUI/RSCM5Divisi Ginjal Hipertensi, Departemen Ilmu Penyakit Dalam FKUI/RSCMKorespondensi

    Background: Superior vena cava syndrome (SVCS) is a collection of symptoms of superior vena cava due to
    suppression by the masses in the superior mediastinum and is a medical emergency that needs to be managed immediately. Assessment profiles and survival rate is important in determining the treatment of SVCS patients.
    Objective: To obtain the profile and survival rate of SVCS patients in Mangunkusomo Cipto Hospital and Dharmais Cancer Hospital.
    Methods: This is a cohort restrospective design that was conducted on SVCS patients during January 2000 to
    December 2011 at Cipto Mangunkusomo Hospital and Dharmais Cancer Hospital.
    Results: The study population was composed of 151 study subjects. Most of them were male sex (76.2%), 18-60 years old (76.8%), and the economic status was private financing (51.7%). Type of primary tumor was lung tumor (52.3%).
    The most frequent signs and symptoms found were dyspnea (84,1%), cough (68,2%) and face or neck swelling (12%). Many study subjects presented with a moderate SVCS grade (60.3%). Based on survival rate-analysis, there were several factors that showed significant differences in survival rate, the economic status (p=0.021), SVCS grade (p=0.006), pneumonia (p=0.013), and type of primary tumor (p=0.03)
    Conclusions: The most SVCS patients are males, age range 18-60 years old, lung tumor, having dyspnea and
    a moderate SVCS grade. Economic status, SVCS grade, pneumonia, and the type of primary tumor, play a role in survival rate of SVCS patients. Such factors should be considered in decision making for treatment of SVCS patients.
    Key words: Superior vena cava syndrome, survival


  • Spirometri
    Vol 4 No 3 (2017)

    Anna Uyainah, Zulkifli Amin, Feisal 1Departemen Ilmu Penyakit Dalam FKUI/RSCM 2Divisi Respirologi dan Perawatan Penyakit Kritis, Departemen Ilmu Penyakit Dalam FKUI/RSCMKorespondensi : a.uyainah@gmail.com



    Uji fungsi faal paru pada dasarnya dilakukan untuk mengetahui apakah kerja pernapasan
    seseorang mampu mengatasi kedua resistensi yang mempengaruhi kerja pernapasan, yaitu resistensi
    elastik dan resistensi nonelastik, sehingga dapat menghasilkan fungsi ventilasi yang optimal.
    Ventilasi dipengaruhi oleh saluran napas, paru dan dinding dada. Dua bagian terakhir mengatur
    besarnya volume dan aliran udara pada saat istirahat dan ketika beraktivitas, seperti: kegiatan fisik,
    bersuara, batuk, tertawa, perubahan posisi tubuh, dan lain-lain. Pada penyakit kardiopulmoner, volume paru dapat berubah sebagai hasil dari mekanisme dinamis saluran napas dan pola bernapas disertai perubahan statis pada paru dan dinding dada. Resistensi elastik dihasilkan oleh sifat elastis
    paru (tegangan permukaan cairan yang membatasi alveolus dan serabut elastis yang terdapat di seluruh
    paru) dan rongga toraks (kemampuan meregang otot, tendon, dan jaringan ikat). Resistensi nonelastik dihasilkan oleh tahanan gesekan terhadap aliran udara dalam saluran napas, dalam jumlah kecil yang juga disebabkan karena viskositas jaringan paru. Parameter yang digunakan untuk menilai kemampuan kerja pernapasan dalam mengatasi kedua resistensi tersebut adalah volume paru, baik volume statis maupun dinamis. Volume statis menggambarkan kemampuan kerja pernapasan dalam mengatasi resistensi elastik, sedangkan volume dinamik mengukur kecepatan aliran udara dalam saluran pernapasan dibandingkan dengan fungsi waktu yang digunakan untuk menilai kemampuan kerja pernapasan mengatasi resistensi nonelastik.

    Vol 4 No 2 (2017)

    Heri Gunawan, Rahmad Isnanta, Zainal Syafri, Refli Hasan
    Divisi Kardiologi, Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran
    Universitas Sumatera Utara/RSUP H Adam Malik


    Iskemia tungkai akut (Acute Limb Ischemia) adalah terjadinya penurunan mendadak perfusi tungkai yang biasa melibatkan trombus dan emboli. Pada pemeriksaan fisik bisa dijumpai hilangnya denyut nadi bagian distal oklusi, kulit dingin dan pucat, penurunan respons sensorik dan kekuatan otot.Seorang wanita umur 61 tahun datang ke ruang IGD dengan nekrosis setinggi betis kaki kanan dan ujung kaki kiri yang dialami 10 hari ini. Riwayat penyakit terdahulu: DM tipe 2, post stroke, dan post TBC paru. Pemeriksaan penunjang menunjukkan peningkatan fungsi ginjal (ureum 152 mg/dL, kreatinin 2,08 mg/dL),peningkatan D-dimer (1100), hipoalbuminemia (2,4 g/dL), penurunan kadar AT III (49,9), status hiperglikemia (KGDN: 125 mg/dL dan KGD2jPP: 249 mg/dL), dan USG dopler kesan suatu deep vein trombosis femoralis kiri kanan dan poplitea kanan. Pemeriksaan arteriografi menunjukkan hasil stenosis 90% arteri poplitea sinistra sebelum percabangan, dan tampak kolateral mengisi arteri tibialis anterior sinistra namun tidak tampak mengisi arteri metatarsal sinistra; dan oklusi total arteri femoralis superfisial dekstra.Pasien didiagnosis sebagai ALI(Acute Limb Ischemia) o/t cruris dextra et digiti I-III pedis sinistra. Pasien diterapi dengan pemberian heparin, insulin, aspilet, albumin, transfusi FFP dan PRC sertaamputasi setinggi lutut kanan.Kondisi pasien membaik dan dapat dipulangkan untuk berobat jalan.
    keywords : Acute Limb Ischemi, pedis sinistr, thrombus graf, Paresthesia, Pain, Pallor, Pulselessness, Poikilothermia

    Vol 4 No 2 (2017)

    Adhella Menur Naysilla
    Dokter Umum RSUD Brigjen H. Hasan Basry, Kandangan,
    Hulu Sungai Selatan, Kalimantan Selatan, Indonesia


    Perkembangan tata laksana penyakit jantung bawaan (PJB) menyebabkan pasien dapat menjalani kehidupanremaja hingga dewasa yang kini dikenal dengan Grown Up Congenital Heart Disease (GUCH) dan Adult Congenital Heart Disease (ACHD). Pasien ACHD asianotik dengan survivalitas alami (tanpa tindakan intervensi pada masa anak) dapat menderita komplikasi berupa hipertensi pulmonal dan sindroma Eisenmenger. Komplikasi dapat meningkatkan morbiditas dan mortalitas pasien serta memperburuk kualitas hidup. Pasien dapat sajamembutuhkan tindakan pembedahan korektif bahkan transplantasi jantung. Beberapa kondisi yang tidak dapat diperbaiki dengan pembedahan menyebabkan pasien harus mengonsumsi obat dan dalam pengawasan medis ketat seumur hidup.Laporan kasus ini membahas seorang laki-laki suku Banjar 26 tahun datang dengan batuk darah dan sesak napas dengan saturasi oksigen keempat ekstremitas 80%. Pasien memiliki riwayat penyakit jantung bawaan tanpa tindakan intervensi pada masa anak.Pasien didiagnosis dengan ASD sekundum disertai hipertensi pulmonal berat dan sindrom Eisenmenger, polisitemia sekunder PJB, dan TB paru dalam pengobatan kategori 1 fase lanjut. Diagnosis didapatkan dari anamnesis, pemeriksaan fisik, serta pemeriksaan penunjang berupa EKG, radiologi, laboratorium, spirometri, dan ekokardiografi Doppler.Pasien dirawat di ICU dan diterapi dengan oksigenasi, vasodilator pulmonal, diuretik, serta suplementasi besi dan asam folat. Pengobatan TB paru dilanjutkan. Pasien menjalani flebotomi sebanyak 3 kali. Setelah dirawat 18 hari, pasien menunjukkan perbaikan klinis dan dirujuk ke RSUD Ulin Banjarmasin untuk pemeriksaan dan tata laksana lebih lanjut.
    Kata kunci: ACHD asianotik, ASD sekundum, hipertensi pulmonal, sindroma Eisenmenger

    Vol 4 No 2 (2017)

    Sipta Pebrianti1, Ridzqie Dibyantari1, R.A.Linda Andriani2, Diah Syafriani2, Zen Ahmad2
    1Departemen Ilmu Penyakit Dalam FKUNSRI/RSMH Palembang
    2Divisi Pulmonologi Departemen Ilmu Penyakit Dalam FKUNSRI/RSMH Palembang


    Tuberkulosis payudara atau mastitis tuberkulosis merupakan tuberkulosis ekstra paru yang menyerang payudara dan seringkali didiagnosis awal sebagai kanker payudara. Kasus ini sangat jarang dijumpai pada pasien dengan jenis kelamin laki-laki. Infeksi Mycobacterium tuberculosis (M.Tb) ini, secara patologi anatomi (PA) terlihat dari adanya keterlibatan secara ekstensif lobulus mammae dengan granuloma epiteloid dan disertai berbagai derajat kaseasi, yang terdiri dari Langhan’s giant cells, seldatia, sel-sel epiteloid, infiltrasis elmono nuklear dengan fibrosis di sekelilingnya, dan disertai pembentukan mikroabses. Berikut disampaikan kasus, seorang laki-laki berumur 23 tahun datang dengan keluhan benjolan di dada kiri dan telah dilakukan biopsi. Pada pemeriksaan fisik didapatkan skar post biopsi pada payudara kiri. Pemeriksaan foto polos toraks normal dan BTA Sputum negatif, namun pada pemeriksaan histopatologi ditemukan inflamasi granulomatosa kronik spesifik sehingga didiagnosis sebagai mastitis tuberkulosis dan diberikan terapi obat anti tuberkulosis (OAT).
    Kata kunci: tuberkulosis, payudara, laki-laki

    Vol 4 No 2 (2017)

    Angelin Utami Cahyani1, Eko Budiono2
    1Resident ofInternal Medicine Departement of UGM Medical Faculty/Dr. Sardjito Hospital Yogyakarta
    2Pulmonology Division of internal Medicine Departement of UGM Medical Faculty/Dr. Sardjito Hospital Yogyakarta
    1Departemen Ilmu Penyakit Dalam FKUNSRI/RSMH Palembang
    2Divisi Pulmonologi Departemen Ilmu Penyakit Dalam FKUNSRI/RSMH Palembang


    The found of Epidermal Growth Factor Receptor (EGFR)mutation in patient with Non Small Cell Lung Carcinoma (NSCLC) began the personalized therapy in treatment management of NSCLC. Since discovered 10 years ago, EGFR mutation which was response to Tyrosine Kinase Inhibitor (TKI) such asgefitinib, there was also found that the condition in which that therapy was resisted. Mutation in exon 20 insertion that leads to poor signaling of EGFR inhibition is associate with oncogenic trasnformation which is resistance to TKI. This case will be disscused to know if there is any resistance to TKI that need to be treated by other strategy.
    Keywords: Lung Cancer, Non Small Cell Lung Carcinoma, Adenocarcinoma, Epidermal Growth Factor Receptor, Tyrosine Kinase Inhibitor, Gefitinib, Iressa

    Vol 4 No 2 (2017)

    Puji Astuti Tri K1, Anak Agung Arie1, Cleopas Martin Rumende2
    1)Internal Medicine Department, Cipto Mangunkusumo National General Hospital-Faculty of Medicine, Universitas Indonesia
    2)Division of Respirology and Critical Care, Internal Medicine Department, Cipto Mangunkusumo National General Hospital-Faculty of Medicine, Universitas Indonesia


    Systemic Sclerosis (SSc) is achronic tissue disorder characterized by immune dysfunction, microvascular injury, and fibrosis. Organ involvement in patients with SSc is variable; however, pulmonary involvement occurs in up to 90% of patients with SSc. Interstitial lung disease (ILD) is a majorcomplication in SSc and has ahigh mortality rate. The SSc-ILD therapy is basically consistent with the progress of scleroderma pathophysiology. In this case, we examine a case of 59-years-old female patientwith a blackened ulcer on her left hand ring finger with disappearing of her distal finger segment, and also a chronic white phlegm cough followed by dysnea in exertion. Clinical examination and evaluation explored that she had a scleroderm, accompanied with ILD. Her complaint did not improve, so she got an immunosuppresant and supportive therapy to control the worsening of her disease.
    Keywords: systemic sclerosis, interstitial lung disease

  • Efektivitas Kortikosteroid sebagai Terapi Adjuvan pada Pneumonia Komunitas Berat
    Vol 4 No 1 (2017)

    Michelle Audrey Darmadi1, Gurmeet Singh2
    1 Mahasiswa Fakultas Kedokteran Universitas Indonesia
    2 Divisi Respirologi dan Perawatan Penyakit Kritis, Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia /
    Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo



    Background: Community-acquired pneumonia (CAP) is a common, yet serious infection as it is associated with high mortality and morbidity. Rather than microorganism proliferation, inflammatory response of the host itself seems to be the responsible trigger for the clinical manifestations of pneumonia. Corticosteroid or glucocorticoid is the most potent and commonly used anti-inflammatory known to date. However, evidence of the benefit of corticosteroid use remains controversial and there are risk of side effects. It is expected that corticosteroid use as adjuvant therapy can help reduce mortality in patient with severe CAP.
    Methods: Literature search was conducted using 4 databases, namely PubMed, Cochrane, Scopus, and Clinical Key with the keywords corticosteroid, severe pneumonia, and mortality. We obtained 6 articles and critical appraisal were done for each article using the criteria validity, importance, and applicability
    Results: We reviewed 2 randomized clinical trial (RCT) articles and 4 meta-analysis articles. According to the study we gathered, it is suggested that corticosteroid use seem to reduce mortality in severe CAP, but not so in less severe CAP. However, interpretation of each study gathered must be taken with caution. Steroid use is also considered to be an acceptable treatment in Indonesia.
    Conclusion: Studies suggest the use of corticosteroid as an adjuvant therapy might reduce mortality in severe CAP patients, but until recently, there is still no strong evidence to support it. Therefore, a larger study might be needed to obtain stronger evidence.
    Keywords: severe pneumonia, corticosteroid, mortality, adjuvant therapy
    Latar Belakang: Pneumonia komunitas (PK) adalah penyakit infeksi yang umum namun bersifat serius dan diasosiasikan dengan mortalitas dan morbiditas yang tinggi. Dibanding proliferasi mikroorganisme, respon inflamasi dari inanglah yang memicu manifestasi klinis dari pneumonia. Kortikosteroid atau glukokortikoid adalah obat anti-inflamasi yang paling efektif dan paling banyak digunakan. Namun bukti manfaat penggunaan kortikosteroid masih kontroversial dan terdapat risiko efek samping.Diharapkan penggunaan kortikosteroid sebagai terapi adjuvan dapat menurunkan mortalitas pasien dengan pneumonia komunitas berat.
    Metode: Pencarian literatur dilakukan pada 4 database internet yaitu PubMed, Cochrane, Scopus, dan Clinical Key dengan menggunakan kata kunci corticosteroid, severe pneumonia, dan mortality. Hasil pencarian akhir didapatkan 6 artikel dan dilakukan telaah kritis menurut aspek validity, importance, dan applicability.
    Hasil: Didapatkan 2 artikel randomized clnical trial dan 4 artikel meta-analisis. Berdasarkan studi yang terkumpul, secara garis besar, penggunaan kortikosteroid tampak menurunkan mortalitas pada pneumonia komunitas berat, tetapi tidak pada derajat kurang berat.Namun demikian, interpretasi hasil dari setiap studi yang dikumpulkan perlu dilakukan secara hati-hati.Penggunaan steroid juga termasuk sebagai pengobatan yang tergolong aplikabel untuk dilakukan di Indonesia.
    Kesimpulan: Penggunaan kortikosteroid sebagai terapi adjuvan cenderung dapat menurunkan mortalitas pada pasien PK berat, namun hingga kini belum terdapat bukti yang cukup kuat untuk mendukung hal tersebut. Dibutuhkan studi yang lebih besar untuk mendapatkan bukti yang lebih kuat.
    Kata Kunci: pneumonia berat, kortikosteroid, mortalitas, terapi adjuvant

  • Acute Postpapartum Pulmonary Edema in a 34-year-old Preeclampsia Woman
    Vol 4 No 1 (2017)

    Yohanes Susanto1, Patrice Ginting2, Ruddy Hardiansyah3
    1General Practitioner, Metta Medika Hospital, Sibolga, North Sumatera
    2Internist, Metta Medika Hospital, Sibolga, North Sumatera
    3Anesthesiologist-Intensivist, Metta Medika Hospital, Sibolga, North Sumatera



    Acute dyspnea after pregnancy is a rare presentation and a number of important conditions may accompany it. Pulmonary embolism, amniotic fluid embolism, pneumonia, aspiration, and pulmonary edema are some of the potential causes that must considered. Pulmonary edema complicates around 0,05% of low-risk pregnancies but may develop in up to 2,9% of pregnancies complicated by preeclampsia, with 70% of cases occurring after birth. The most common contributing factors include peripartum cardiomyopathy, underlying cardiac disease, preeclampsia, administration of tocolytic agents and iatrogenic fluid overload. Here we report a case of 34-year-old woman of 1st postpartum day following lower uterine cesarean section presented with acute progressive dyspnea from her first pregnancy who was admitted in intensive care unit with history of preeclampsia. Clinical examination and relevant investigations explored that it was a case of acute pulmonary edema. Patient was kept in ventilator and was treated with intravenous diuretic and calcium channel blocker. After diuresis, considerable improvement was observed in her respiratory status. The day after, the patient became hemodynamically stable and was weaned off the ventilator. After seven days, she was discharged in stable condition.
    Keywords: post-partum, pulmonary edema, preeclampsia
    Dispnea akut setelah kehamilan merupakan keadaan yang jarang terjadi serta seringkali disertai kondisi-kondisi penting lainnya. Emboli paru, emboli air ketuban, pneumonia, aspirasi, dan edema paru, adalah penyebab dispnea yang perlu dipikirkan. Edema paru terjadi pada 0,05% pada kehamilan dengan risiko rendah, tetapi dapat meningkat menjadi sebesar 2,9% pada kehamilan dengan preeklampsia, dengan 70% terjadi setelah persalinan. Faktor pendukung lainnya adalah kardiomiopati peripartum, adanya penyakit jantung, preeklampsia, pemberian obat tokolitik, dan kelebihan pemberian cairan. Berikut ini adalah sebuah kasus pada seorang perempuan berusia 34 tahun post partum 1 hari dengan riwayat sectio caesarea dan preeklampsia yang mengalami dispnea akut progresif sehingga dirawat di ICU. Pemeriksaan fisik dan pemeriksaan lainnya menunjukkan bahwa kasus ini merupakan sebuah kasus edema paru akut. Pasien menggunakan ventilator dan mendapat terapi diuretik intravena serta penyekat kanal kalsium. Setelah mendapat terapi diuresis, kondsi pasien membaik. Setelah tujuh hari perawatan, pasien dipulangkan dengan kondisi stabil
    Kata kunci: post-partum, edema paru, eklampsia

  • Pelacakan Pasien TB MDR Terkonfirmasi Yang Belum Memulai Pengobatan Di RSUP Dr. Hasan Sadikin Bandung Periode Apr il 2012 – Februari 2015
    Vol 4 No 1 (2017)

    Dedi Suyanto1, Ii Sariningsih2, Basti Andriyoko3, Prayudi Santoso4
    1Tim Tuberkulosis RSHS
    2Klinik TB MDR Instalasi Rawat Jalan RSHS
    3Divisi Biomolekuler Departemen Patologi Klinik RSHS 4Ketua Tim TB-MDR RSUP dr. Hasan Sadikin


    Abstr act
    Latar Belakang: RSUP Dr. Hasan Sadikin ditunjuk sebagai pusat rujukan penanganan pasien tuberkulosis resisten obat (TB MDR) di Jawa Barat sejak tahun 2012 dan sampai bulan Februari 2015 tercatat sebanyak 1982 suspek TB MDR yang diperiksakan dahaknya. Dari suspek sebanyak itu sebanyak 384 didiagnosis sebagai (TB MDR). Namun ternyata dari 384 pasien yang didiagnosis sebagai TB MDR, hanya sebanyak 338 pasien yang sudah mendapatkan pengobatan. Masih ada sebanyak 47 pasien TB MDR yang belum memulai pengobatan dengan berbagai alasan.
    Tujuan: Penelitian ini bertujuan untuk mengetahui karakteristik pasien serta faktor-faktor yang menghambat pemberian OAT MDR pada pasien yang sudah didiagnosis TB MDR di RSHS.
    Metode: Penelitian ini menggunakan data primer berupa hasil wawancara menggunakan kuesioner yang diisi oleh subjek penelitian (responden), dengan mengunjungi tempat tinggal pasien (home visit). Jika subjek penelitian tidak berhasil ditemukan, atau telah meninggal dunia, maka data kuesioner diisi melalui wawancara dari keluarga atau petugas puskesmas setempat.
    Hasil: Dari hasil pengumpulan data didapatkan bahwa dari 47 subjek penelitian, sebanyak 21 pasien (44%) tidak berhasil dilacak dengan berbagai sebab seperti pindah alamat, pulang kampung, tidak ada di alamat yang tertera, atau alamat tidak ditemukan (fiktif). Hal ini menyebabkan tidak didapatkannya informasi mengenai alasan mereka belum memulai pengobatan. Sisanya sebanyak 26 pasien (55%) berhasil didapatkan informasi mengenai alasan yang membuat mereka belum memulai pengobatan. Dari 26 pasien, 13 (50%) diantaranya menolak diobati, 6 pasien (23%) meninggal, 3 pasien (11%) terkendala administrasi BPJS, 2 pasien (7%) terlambat mendapatkan informasi, 1 pasien (3%) terkendala biaya, serta 1 pasien (3,85%) diobati di tempat lain. Dari 13 pasien yang menolak diobati, 7 pasien (53%) menolak dengan alasan yang tidak jelas, 2 pasien (15%) menolak karena takut efek samping, 2 pasien (15%) lebih memilih pengobatan alternatif, 1 pasien (7%) menolak karena tidak bisa meninggalkan pekerjaan, dan 1 pasien (7%) menolak karena merasa sehat.
    Simpulan: Pasien yang menolak pengobatan antara lain disebabkan karena takut efek samping, tidak bisa meninggalkan pekerjaan, memilih obat alternatif, atau merasa dirinya sehat.
    Kata kunci: TB MDR, belum pengobatan

  • Management of Acute Heart Failure Post ST -Segment Elevation Myocardial Infarction in Non-Revascularization C apable Hospital
    Vol 4 No 1 (2017)

    IvanaPurnama Dewi1,2, Kristin Purnama Dewi1, Rizaldy Pinzon1, BagusAndi Pramono2
    1Faculty of Medicine, Duta Wacana Christian University, Yogyakarta
    2Cardiology and Vascular Division, PanembahanSenopati Hospital, Bantul

    Acute heart failure (AHF) defined as a sudden gradual onset of heart failure symptoms. Acute heart failure commonly occur after acute onset of ST-segment elevation myocardial infarction (STEMI). ST-segment Elevation Myocardial Infarction can lead to a sudden impairment in systolic and diastolic function, resulting in a decreased cardiac output, elevated filling pressures, and the development of cardiogenic pulmonary edema with rapid fluid accumulation in the lungs that potentially fatal cause of acute respiratory distress. ST-segment Elevation Myocardial Infarction-Acute Heart Failure patients require hospitalization and if possible cardiac catheterization and revascularization. The main treatment goals in the hospitalized patient are to restore euvolemia and to minimize adverse events. Here we report the clinical findings of anAHF case in post STEMI with thrombolytic therapy patient. This case has good prognosis after intensive pharmacology combination therapy.
    Keywords: STEMI, Acute Heart Failure, Management

  • Leucocyte, Neutrophils counts and Procalcitonin levels in Salmonella and Gram-negative Bacteremias
    Vol 4 No 1 (2017)

    Suhendro Suwarto1, Zahra Farhanni Suhardi2, Amin Soebandrio3,4
    1Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
    2 Faculty of Medicine Universitas Indonesia.
    3Eijkman Institute for Molecular Biology, Jakarta, Indonesia.
    4Department of Microbiology, Faculty of Medicine Universitas Indonesia.


    Background: The laboratory marker of leucocytes, neutrophils and procalcitonin (PCT) are elevated in Gram-negative-infected patients. Salmonella species, a cause of typhoid fever, are also a type of Gram-negative bacteria. We investigated the laboratory marker of bacterial infection levels in Salmonella and Gram-negative bacteremias.
    Methods: This retrospective study was conducted in Jakarta, Indonesia. Sixty-one patients with positive blood cultures of Salmonellaor Gram-negative bacteria who were admitted to the hospital from April 2014 through May 2017 were included. Twenty-seven patients (44,3%) had Salmonella, and 34 patients (55,7%) had Gram-negative bacteremias. The following laboratory parameters were recorded: leucocyte count, neutrophil count, and PCT levels. Bivariate analysis was used to analyze the differences in the laboratory marker between Salmonella and Gram-negative bacteremias.
    Results: Gram-negative bacteremia was significantly associated with an elevated leucocyte count (p<0.001), neutrophil count (p<0,001) and PCT levels (p<0,001). The leucocyte count cut-off of ≥10.5x103/μL, a neutrophil countcut-off of ≥80,9% and a PCT level cut-off of ≥1,18 ng/ml were significantly higher in the Gram-negative bacteremia group compared with the Salmonella group (p<0,001 for each variable).
    Conclusion: Leucocyte, neutrophil counts, and PCT levels in Gram-negative bacteremia were higher than inSalmonella bacteremia.
    Keywords: Gram negative bacteremia,leucocyte, neutrophils cells counts, procalcitonin, Salmonella bacteremia.

  • Epicardial Adipose Tissue Thickness as A Predictor Of Coronary Lesion Severity In Stable Coronary Artery Disease Patients
    Vol 4 No 1 (2017)

    MirnawatiMappiare, Abdul Hakim Alkatiri, Peter Kabo
    Department of Cardiology, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia

    Background: Epicardial adipose tissue (EAT) is a visceral adipose tissue surrounding the heart. Correlation of EAT with coronary artery disease (CAD) in Indonesia is unknown. To address this issue, we evaluate the capacity of EAT thickness measured by transthoracic echocardiogram (TTE) to predict the severity of coronary lesion.
    Methods: In this cross sectional study conducted in Wahidin Sudirohusodo Hospital, Makassar, Indonesia, 127 stable CAD patients were enrolled. EAT was identified as an echo-lucent area on the free wall of the right ventricle of the two-dimensional TTE at end diastole in the parasternal long-axis view. Coronary angiograms were analyzed for severity of CAD using modified Gensini score. Accordingly, we classified the study population into two angiographic groups: patients with non-severe CAD (score ≤13; n=73) and severe CAD (score >13; n=54).
    Results: There were no significant differences between the groups with respect to body mass index and waist circumference (p=0,562 and 0,659, respectively). There was a positive linear relationship between EAT thickness and modified Gensini score for the entire subjects (R2=21.4%). EAT thickness was significantly greater in patients with severe CAD than in those with non-severe CAD (8,4±2,1 mm vs6,1±2.5 mm, p<0,001). EAT thickness of >7,0 mm had 79,6% sensitivity and 71,2% specificity (ROC area of 0,812, p<0,001)for predicting severe CAD.
    Conclusion: Our results could help identify severe CAD by readily available and relatively inexpensive TTE, thereby indicating whether early invasive coronary angiography and timely interventions should be performed.
    Keywords: epicardial adipose tissue, echocardiography, coronary artery disease, Indonesia.

  • Body Mass Index As A Predictor Of Negative Sputum Conversion In Underweight Patients With Newly Diagnosed Pulmonary Tuberculosis
    Vol 3 No 4 (2016)

    Adrina Vanyadhita1, Dian Kusumadewi2
    1Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
    2Department of Community Medicine, University of Indonesia, Jakarta, Indonesia
    Introduction: Tuberculosis infection remains a global problem especially in developing countries. In 2013, approximately 9 million of people were diagnosed with tuberculosis and 1.5 million died from tuberculosis. The association between tuberculosis and malnutrition is well established that tuberculosis can cause malnutrition and an individual with malnutrition is susceptible to tuberculosis.
    Therefore, low body mass index (BMI) as seen in patients with tuberculosis is often present at the time of diagnosis.
    Aim: to assess the role of body mass index in predicting the negative sputum conversion in patients with tuberculosis
    Methods: Searching was carried out using the database of Pubmed, Cochrane Central Register of Clinical Trials and Science Direct on 20th March 2015. The search strategy included following keywords and combinations “body mass index AND pulmonary tuberculosis AND sputum conversion”. Three articles was included in the critical appraisal.
    Results: A study conducted by Putri FA et al revealed severely low BMI (BMI < 16 kg/m2) is significantly associated with longer negative sputum conversion (HR 0.56, 95%CI 0.38–0.81 and lower probability of conversion before 4 months (aRR 0.67, 95%CI 0.56–0.93). A study by Kenangalem E et al showed that in patients with pulmonary tuberculosis, the time to predict the accomplishment in negative conversion of sputum culture by lower body mass index is not significant with p value of 0.91 and hazard ratio of
    0.99 (95%CI 0.85-1.16). A study by Hesseling AC et al revealed low body mass index (BMI <18 kg/m2) is not significantly associated with sputum culture conversion after 2 months of treatment but it significantly predicted a tuberculosis recurrence within 24 months after the completion of treatment.
    Conclusion:Based on the critical appraisal of three studies, the predictor factor of sputum conversion in patients with pulmonary tuberculosis by body mass index is not significant and needs further study.
    Keywords: tuberculosis, body mass index, sputum conversion

  • Characteristic of Pericardial Effusion Patient based on Age, Gender, Cytological and Clinical Diagnosis at SMF Pathology Anatomy Hasan Sadikin Bandung Hospital in 2009-2013
    Vol 3 No 4 (2016)

    Indah Pratiwi1, Hasrayati Agustina2,Erwan Martanto3 1Faculty of Medicine Universitas Padjadjaran 2Departement of Pathology Anatomy,UniversitasPadjadjaran/Dr. HasanSadikin General Hospital Bandung 3Departement of Cardiology and Internal Medicine, UniversitasPadjadjaran/Dr. HasanSadikin General Hospital Bandung


    Background: Pericardial effusion is a common condition in clinical practice. Manifestation of effusion depends on its causes and the underlying diseases as well as influenced by patient’s characteristics and geographical location. This study was conducted to determine the characteristic of pericardial effusion patient based on age, gender, cytological and clinical diagnosis. Method: The study was conducted using descriptive retrospective method. The data collected was medicalrecord ofpericardial effusion patients for 5 years from 1st January 2009 to 31st December 2013. This study was conducted in SMF Pathology Anatomy Dr. HasanSadikin General Hospital Bandung. Fifty four cases were collected as samples through total sampling technique. The variables were age, gender, cytological diagnosis and clinical diagnosis. Results: Pericardial effusion mostly occurred in 21-30 years old. Pericardial effusion is more common in man than woman. Based on the type of cytology, the most common pericardial effusion was non-specific inflammation. The most common clinical features of patients is tuberculous infection. Conclusions: Pericardial effusion frequently occurred in 21-30 years old. Based on gender, pericardial effusion is not significantly distributed between male and female. Basesd on cytological diagnosis, pericardial effusion is mostly diagnosed as nonspesific inflammation type. The manjority of clinical feature of pericardial effusion is tuberculosis infection.

    Keywords: age, clinical diagnosis, gender, pericardial effusion, type of cytological diagnosis

  • Berhenti Merokok
    Vol 3 No 4 (2016)

    Zulkifli Amin Divisi Respirologi dan Perawatan Penyakit Kritis Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Indonesia/ Rumah Sakit Cipto Mangunkusumo


    The smoking habit give many bad effects, especially in health and economy aspect. In Indonesia, most people still have this habit. Quit smoking is beneficial. Clinicians have an important role in helping patients to quit their smoking habit. Keywords; quit, smoking Kebiasaan merokok memberikan dampak yang buruk, terutama pada hal kesehatan dan ekonomi. Di Indonesia sendiri, masih banyak penduduk yang memiliki kebiasan merokok. Berhenti merokok memberikan keuntungan yang banyak. Dokter memiliki peranan penting dalam membantu pasien mengehentikan kebiasaan merokoknya.

    Kata kunci: berhenti merokok

  • Tes Bronkodilatasi
    Vol 3 No 4 (2016)

    Anna Uyainah ZN,Gurmeet Singh Divisi Respirologi dan Perawatan Penyakit Kritis Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Indonesia/Rumah Sakit Cipto Mangunkusumo


    Tes bronkodilatasi adalah tes untukmelihat responsivitas saluran nafas terhadap bronkodilator.Spirometri merupakan pemeriksaan yang sangat penting dalam menilai derajat obstruksi saluran nafas pasien. Di samping data-data lain seperti riwayat penyakit, rekam medis sebelumnya, riwayat keluarga dan pekerjaan, pemeriksaan fisik, dan kesan klinis, data spirometri juga memiliki andil dalam menentukan diagnosis dan terapi pasien.

    Kata kunci: tes bronkodilatasi

  • Reactivation of Cytomegalovirus Infection in A Non-HIV Immunocompromised Patient
    Vol 3 No 4 (2016)

    Gurmeet Singh, Stephanie Gita Wulansari Respirology and Critical Illness Division, Internal Medicine Department Cipto Mangunkusumo Hospital/ Faculty of Medicine Universitas Indonesia


    Introduction: Cytomegalovirus (CMV) is a double-stranded DNA virus and a member of the Herpesviridae family. Cytomegalo- virus infection is one of the important causes of mortality and morbidity in immunocompromised patients. This is a case report of 72 year-old immunocompromised male patient with worsening cough needing an intubation despite previous adequate antibiotic administration. Further examination showed positive CMV infection. The patient showed improvement after administration of ganciclovir.

    Keywords: cytomegalovirus, immunocompromised, reactivation, pneumonitis

  • A Rare Case of Upper Back Pain as The Presenting Complaint of Acute Myocardial Infarction
    Vol 3 No 4 (2016)

    Ian Huang1, Raymond Pranata2,Novita3 1General Practitioner, Siloam Hospitals Buton, Baubau, Indonesia 2Faculty of Medicine, UniversitasPelitaHarapan, Tangerang, Banten, Indonesia 3Internist, Siloam Hospitals Buton, Baubau, Indonesia


    Introduction: Acute upper back pain as one of the atypical symptoms of acute myocardial infarction (AMI) is more frequently encountered in women, elderly, diabetics, and patients with prior stroke or heart failure.1 Failure to recognize atypical clinical presentation of AMI conveys to delayed diagnosis, which are associated with increased morbidity and mortality.2 Abstract : Acute upper back pain as one of the atypical symptoms of acute myocardial infarction (AMI) is more frequently encountered in women, elderly and diabetics. Failure to recognize atypical clinical presentation of AMI conveys to delayed diagnosis, which are associated with increased morbidity and mortality. Herein we report a case of 46 yearsold male presenting with a sudden onset of severe acute upper back pain 6 hours prior to hospital admission. Diagnosis of AMI was delayed until 12 hours later after typical ischemic chest pain manifested and ECG reading showed evolution of ST-Elevation Myocardial In- farction (STEMI). Due to the atypical clinical presentation, diagnosis of AMI in this patient was delayed. Vigilant observation and low threshold for acute coronary syndrome (ACS) work-up are obligatory to prevent delayed diagnosis and management. Keywords: back pain, STEMI, atypical presentation, ACS, myocardial infarction


    Nyeri punggung atas adalah salah satu gejala atipikal dari infark miokard akut (IMA) yang lebih sering ditemukan pada perempuan, lanjut usia dan penderita diabetes. Kegagalan untuk mengenali presentasi atipik dari IMA menyebabkan telatnya diagnosis yang dihubungkan dengan meningkatnya mortalitas dan morbiditas. Dalam kasus ini kami melaporkan seorang laki-laki berusia 46 tahun datang dengan keluhan nyeri punggung atas yang berat dan mendadak sejak 6 jam sebelum masuk rumah sakit. Diagnosis IMA tertunda hingga 12 jam kemudian ketika nyeri dada tipikal dirasakan dan EKG menunju- kan evolusi dari STEMI. Karena presentasi klinis yang atipikal, diagnosis IMA pada pasien ini tertunda. Pemantauan yang jeli danpemeriksaan lanjutanuntuk sindrom koroner akut (SKA) wajibdilaksanakan untuk mencegah tertundanya diagnosis dan tatalaksana yang sesuai.

    Kata Kunci: nyeri punggung, STEMI, presentasi atipikal, SKA, infark miokard

  • Abses Hepar dan Empiema dengan Fistula Hepatopleura
    Vol 3 No 3 (2016)

    Telly Kamelia
    Divisi Respirologi dan Perawatan Penyakit Kritis, Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia, RSUPN Cipto Mangunkusumo, Jakarta
    Liver abscess is an inflammatory lesions of the liver that can spread into the pleural cavity resulting in empyema and lung abscess. One of the causes of spread to the pleural cavity is due to hepatopleura fistulas. In this case, a man, 43 years old, came with complaints of shortness of breath that became heavier since one week ago, accompanied by upper abdominal pain, bleeding cough one time, stomach felt enlarged, and history of smoking, promiscuity, and drinking alcohol. On physical examination, it was found the right lung left behind during inspiration, vocal fremitus decreased, dull percussion, and vesicular sounds decreased in the right lung field and hepatomegaly. IDT amoeba was 1,92 and pleural fluid examination showed an exudate. Massive pleural effusion was found on chest X-ray. In hepatology ultrasound was found liver abscess, hepatomegaly, and right pleural effusion. In thoracic ultrasound examination obtained the right loculated pleural effusion. Thoracic CT scan with contrast showed cavity with air-fluid level in the right hemithorax and hepatic lesions in 4th,5th segments. The results of the liver abscess fluid analysis obtained microbiological examination did not find germs, acid-fast bacilli (AFB) smear was negative, culture examination is not find microorganisms and anaerobes, pathological examination showed colored brown viscous fluid, and microscopic examination obtained the necrotic mass and fibrous connective tissue.
    Key words : liver abscess, empyema, lung abscess, hepatopleural fistula

  • Karakteristik Sengatan Panas Pada Jemaah Haji Indonesia Tahun 2016
    Vol 3 No 3 (2016)

    Herikurniawan, Anna Uyainah ZN
    Divisi Respirologi dan Perawatan Penyakit Kritis, Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia-RSUPN Dr. Cipto Mangunkusumo
    Background: Heat stroke is an emergency condition that become one of the main cause of morbidity and mortality during pilgrimage in the summer. Old age, comorbid diseases, high temperature (>45oC), and heavy physical activity are the risk factors for heat stroke. Heat stroke can be prevented by awareness of early sign and symptom, people who has susceptibility, and the predisposition situation.
    Method: This study was a cross sectional study with consecutive sampling method among Indonesian hajj pilgrims in 2016 who got heat stroke in Arafah and Mina. Diagnosis of heat stroke and heat exhaustion was made based on: 1. fever/hyperpirexia 2. pale skin/dry skin 3. decrease of consciousness/confusion, and 4. no sign of infection Results: There were 41 Indonesian hajj pilgrims had heat stroke, consists of 16 persons had heat stroke and the rest had heat exhaustion. The majority of subjects were males (63,4%). Most of subjects were > 70 years old (29,3%) There were 14,6% subjcts that had diabetes mellitus and 12,2% had hypertension. There were 78% heat stroke condition occured in Arafah and 22% occured in Mina.There were 68,5% subjects that recovered, and 29,3% got hospitalizad. Conclusion: Most of heat stroke victim was above 70 years old. Major comorbid were diabetes mellitus and hypertension. Most of heat stroke condition occured in Arafah.
    Keywords: heat stroke, heat exhaustion, Indonesian hajj pilgrims

  • MDR TB (Multi Drug Resistant Tuberculosis) Reversi
    Vol 3 No 3 (2016)

    Zen Ahmad1, Diah Syafriani2, Merianson2
    1Sub Bagian Pulmonologi FK UNSRI/RSMH-Palembang
    2 PPDS SP2 IPD Bidang Ilmu Pulmonologi FK UNSRI/RSMH-Palembang
    Multi Drug Resistant Tuberculosis (MDR TB) is tuberculosis caused by Mycobacterium tuberculosis that resistant to rifampicin and isoniazid. The diagnosis of MDR TB is made based on clinical symptoms, physical examination, radiologic finding, acid fast bacilli examination, and TB culture. It is a case about female, 36 years old, diagnosed with MDR TB who underwent intensive phase and had sputum conversion. However, after underwent the continuation phase, the sputum examination showed reversion. The point of this case is the importance to decide whether continue or discontinue the treatment of MDR TB, because the treatment was considered to be failed
    Keywords: Multi Drug Resistant Tuberculosis, conversion, reversion

  • Akurasi Diagnosis Obstructive Sleep Apnea dengan Level 3 Portable Monitor Sleep Test
    Vol 3 No 3 (2016)

    Telly Kamelia
    Divisi Respirologi dan Perawatan Penyakit Kritis, Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia, RSUPN Cipto Mangunkusumo, Jakarta
    Introduction: Obstructive sleep apnea (OSA) is a breathing disorder that commonly occur during sleep. OSA occurs due to upper airway collapse either totally or partially. Polysomnography examination level 3 still often performed by the clinician because the examination is easy and not expensive.
    Objective: Assess the accuracy diagnosis of obstructive sleep apnea with level 3 portable sleep monitor test.
    Method: The literature search conducted using PubMed and the Cochrane database, obtained 37 articles. The selection of articles and critical study of systematic review is based on validity, importance, and applicability standardized by the Centre of Evidence Medicine University of Oxford British and critical analyzes articles diagnosis standardized by the British Medical Journal (BMJ).
    Results: a systematic review and meta-analysis by Shayeb et al. (2014) found that the examination of level 3 portable sleep monitor test has moderate to high heterogeneity (I2 value of 53% -85%), the sensitivity and specificity (0,79-0,97 and 0,60-0,93). A cohort studies by Garg et al. (2014) showed that examination of level 3 at home had a sensitivity of 0,96, specificity of 0,43, 0,79 PPV, and NPV 0,82.
    Conclusion: Examination level 3 with a portable monitor in the house has a good degree of accuracy and is recommended for high-risk OSA patients without comorbid.
    Keywords : obstructive sleep apnea, polysomnography, level 3 portable sleep monitor test, sensitivity, specificity

  • Tuberkulosis Kelenjar Lakrimalis
    Vol 3 No 3 (2016)

    Triyanti Kurniasari Ananta Putri Sudibyo, Eko Budiono
    Bagian Ilmu Penyakit Dalam, Universitas Gajah Mada
    Introduction: Orbital TB is an uncommon condition. Lacrimal gland TB or dacryoadenitis is a type of orbital TB condition that uncommon, even in endemic country.
    Case presentation: A woman, 48 years old, came with diplopia. There was a gradual swelling with no pain at palpebra. There was no history of fever or lung disease. The histopathological examination showed granulomatous inflammation with giant cell of Datia Langhans that came from lacrimal gland. Microbiological study to find acid fast bacilli showed negative result. Patient gave good response after underwent TB treatment. Conclusion: Lacrimal gland TB can not be diagnosed easily because it is commonly not accompanied with TB at other site. However, consideration for this diagnosis is still important, especially in endemic areas such as Indonesia.
    Keywords: tuberculosis, lacrimal gland, histopathology

  • Interaction of Side Effects of Second Line TB Drugs Therapy in MDR-TB: Ethionamide- induced Hypothyroid and Cycloserine-induced Depression Episode
    Vol 3 No 3 (2016)

    Try Nirmala Sari1, Sumardi2, Heni Retnowulan2, Barmawi Hisyam2, Bambang Sigit Riyanto2, Eko Budiono2, Ika Trisnawati2
    1 Resident of Department of Internal Medicine, FK UGM/RSUP Dr. Sardjito Yogyakarta
    2Division of Pulmonology, Department of Internal Medicine, FK UGM/RSUP Dr. Sardjito Yogyakarta
    Background: Second line anti tuberculosis drug in MDR-TB patients is notorious for having several side effects. Ethionamide is anti tuberculosis drug that is used as a second line therapy in MDR-TB patient management. Hypothyroid is an important side effect in ethionamide administration. Cycloserine is in the fourth group of second line therapy that acts as bacteriostatics. Psychiatric side effects such as anxiety, hallucination, depression, euphoria, habit alteration, and suicide are reported in 9,7%-50% of patients in cycloserine therapy. Case Presentation: A 46 year-old lady with MDR-TB started her second line anti TB drugs therapy since January 2016. Her regimen included levofloxacin, cycloserine, ethionamide, pyrazinamide, ethambutol and PAS (Para- Aminosalicylic Acid). Therapy evaluation in the first month control founded fatigueness, reduced communication, self-secluding, and behaviour alteration. Patient often felt sad, desperate, and had a lot of thought on her illness. Patient also had thoughts of suicide. Patient was then hospitalized and was diagnosed by psychiatry department with TB drugs -possibly cycloserine-induced depression episode. Then, cycloserine therapy was stopped. And at the same time, laboratory result showed an increase in TSH without hypothyroid symptoms. Levothyroxin 1x100 mcg was administered. In the third month of therapy, patient returned with a much higher TSH level, then ethionamide was stopped for 3 months. Evaluation was conducted post ethionamide cessation and found well-controlled TSH level. Ethionamide was then continued with titration doses per month.
    Conclusion: In MDR-TB therapy, potential complication of ethionamide administration should be considered carefully. Severe neurotoxicity caused by cycloserine can be managed by delaying the drug use temporarily. It is also worth considered that hypothyroid state can exhibit depression symptoms therefore careful monitoring of the side effects of anti TB drug therapy is needed.
    Keywords: Multi drug resistant, tuberculosis, drug-induced hypothyroid, drug-induced psychosis.

  • The Value of Peripheral Oxygen Saturation as a Prognostic Tool for Critically Ill Medical Emergency Patients
    Vol 3 No 2 (2016)

    Zulkifli Amin1, Martin Winardi2
    1Division of Respirology and Critical Care, Department of Internal Medicine,
    Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Indonesia 2Department of Internal Medicine, Faculty of Medicine,
    Universitas Indonesia, Cipto Mangunkusumo Hospital, Indonesia

    Background: Decreased oxygen supply due to acute physiological deterioration may increase mortality risk, particularly in critically ill patients with inadequacy to compensate such changes. The aim of the study was to evaluate peripheral oxygen saturation (SpO2) at admission in predicting mortality of emergency patients with critical conditions at Cipto Mangunkusumo Hospital (CMH), the national referral hospital in Indonesia. Methods: We performed a retrospective cohort study of emergency patients with critical conditions at Emergency department (ED), CMH from October to November 2012. SpO2 was meassured within 15 minutes after patients’ arrivals. Subjects were divided into two groups: group 1 consisted of subjects with SPO2 more or equal to 95% and subjects with SpO2 less than 95% were in group 2. Primary outcome measured was in-hospital mortality. Log-rank test was used to analyze survival between groups. Risk of in-hospital mortality was analyzed with Cox proportional hazard model.
    Results: In-hospital mortality rate was observed in 69 (40.1%) from 172 patients. Patients with SpO2 less than 95% had a significantly lower survival rate (mean survival 21.3 vs 28.6 days, log-rank p = 0.011). The hazard ratio of mortality was 1.8 (95% CI 1.13 to 2.90) in patients whose SpO2 fell below 95%.
    Conclusions: Peripheral oxygen saturation below 95% at admission was significantly associated with increased risk of in-hospital mortality. Given the ease of its measurement, SpO2 should be considered as a predictor of mortality in emergency patients with critical conditions.
    Keywords: Peripheral oxygen saturation, critical conditions, emergency, mortality

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