• ASAP KEBAKARAN HUTAN DAMPAK KESEHATAN DAN PENANGANANNYA
    Vol 6 No 2 (2019)

    EDITORIAL

    Kebakaran hutan masih terjadi di beberapa daerah Indonesia setiap tahunnya, khususnya di Sumatera dan Kalimantan. Apapun penyebabnya, kebakaran hutan akan menghasilkan asap yang berdampak pada berbagai sektor kehidupan seperti terganggunya aktivitas sehari hari, gangguan transportasi, kerusakan lingkungan, turunnya kunjungan wisatawan, ekonomi dan kesehatan. Asap kebakaran hutan terdiri atas campuran gas, uap air, partikel, bahan kimia organik dan trace mineral. Komposisi asap kebakaran hutan tergantung pada beberapa faktor seperti jenis hutan yang terbakar (lahan gambut atau kayu), suhu api, kadar air diudara ataupun kondisi angin.

  • Evaluasi Akupunktur Tanam Benang Pada Asma Bronkial Persisten Derajat Berat Selama 24 Bulan
    Vol 6 No 2 (2019)

    Andry Hartanto1, Hasan Mihardja1
    1Departemen Akupunktur Medik Fakultas Kedokteran Universitas Indonesia – Rumah Sakit Umum Pusat Nasional Dokter Cipto Mangunkusumo, Jakarta, Indonesia

     

    ABSTRAK
    Asma adalah gangguan inflamasi kronis pada saluran pernapasan di mana banyak sel dan elemen seluler yang berperan, khususnya sel mast, eosinofil, limfosit T, makrofag, neutrofil dan sel epitel. Asma yang tidak terkontrol menyebabkan kualitas hidup penderita menurun, bahkan sampai kematian karena limitasi udara pernapasan yang terjadi. Disamping itu, penggunaan obat-obatan asma jangka panjang dapat memberikan efek samping yang besar. Akupunktur terbukti dapat membantu penyembuhan asma dari banyak penelitian yang telah dilakukan melalui proses anti inflamasi. Berikut adalah laporan kasus mengenai akupuntur tanam benang pada pasien asma. Pasien dilakukan akupunktur tanam benang secara penetrasi dari titik EX-B1 Dingchuan ke BL13 Feishu pada kedua sisi dengan polydioxanone. Terapi akupunktur tanam benang dilakukan 1 kali saja saat pasien datang pertama kali. Hasil observasi selama 24 bulan menunjukkan bahwa pasien mengalami perbaikan gejala dari waktu ke waktu, frekuensi kekambuhan yang menurun, penggunaan obat-obatan yang menurun hingga tidak mengkonsumsi obat lagi dan peningkatan nilai Asthma Control Test (ACT) yang menunjukkan pasien terkontrol sepenuhnya pada bulan ke-10 hingga akhir evaluasi. Pada pemeriksaan spirometri pada bulan ke-8, hasil pemeriksaan menunjukkan fungsi paru pasien dalam batas normal.
    Kesimpulan: Akupunktur tanam benang pada pasien dengan asma bronkial persisten derajat berat dapat memperbaiki gejala, mengurangi jumlah penggunaan obat dan meningkatkan nilai Asthma Control Test melalui aksi jaringan neuro-endokrin-imunologi kompleks sebagai anti inflamasi yang merangsang aksis hipotalamus-hipofisa-adrenal, jalur simpatis, jalur parasimpatis kolinergi, aksi antihistamin, sitokin, neuropeptida baik opioid maupun nonopioid dan transient receptor potential cation channel subfamily V member 1 (TRPV1).
    Kata Kunci : asma bronkial, akupunktur tanam benang.

  • Post-Cardiac Injury Syndrome Do We Overlook Its Presence A Case Of Post-Pericardiotomy Syndrome And Current Update Of Its Management Strategy
    Vol 6 No 2 (2019)

    Ian Huang, Prayudi Santoso, Arto Yuwono Soeroto.
    Division of Respirology and Critical Care Medicine, Department of Internal Medicine, Hasan Sadikin Hospital, Padjadjaran University, Bandung, Indonesia

     

    ABSTRACT
    Introduction: Postcardiac injury syndrome (PCIS) is the term that encompasses of postpericardiotomy syndrome, postmyocardial infarction syndrome, and post-traumatic pericarditis. The patient typically presents with fever, pericardial friction rub, and pericardial effusion with or without pleural effusion. The latency period between surgery and clinical manifestation greatly varied which not seldomly causing a delayed diagnosis of the disease.
    Case Report: Herein we report a 30-year-old woman with 1-year history of constrictive pericarditis who was scheduled for a pericardiectomy. She had a history a liver tuberculosis of which she was treated with oral antituberculous drug for 18 months. Her physical examination showed an increased jugular venous pressure with a positive Kussmaul’s Sign, cardiomegaly, and minimal bipedal pitting edema, with otherwise normal examination. Her transesophageal echocardiography (TEE) and MSCT cardiac were positive for constrictive pericarditis. The surgery was uneventful with 200 mL of serous pericardial fluid was removed. Ten days after the surgery, the patient complained fever with increased production of the drainage. She was then assessed as post pericardiotomy syndrome and was given high dose steroid. The drainage was gradually decreased and she was discharged after ten days with anti-inflammatory
    Conclusion: While PCIS is not uncommon, physicians practicing in the field of pulmonary and critical care medicine, and cardiac surgery should be aware not only the presence of this disease, but also to master its prevention and treatment.
    Keywords: Postpericardiotomy syndrome, postpericardiac injury syndrome, pleural effusion, cardiac surgery, prevention

  • Acute Respiratory Distress Syndrome
    Vol 6 No 2 (2019)

    Cleopas Martin Rumende1, I Putu Eka Krisnha Wijaya2
    1Division of Respirology and Critical Care Medicine, Departement of Internal Medicine,
    Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital Indonesia
    2Departement of Internal Medicine, Faculty of Medicine Universitas Indonesia,
    Cipto Mangunkusumo National General Hospital Indonesia

     

    ABSTRAK

    Acute Respiratory Distress Syndrome merupakan akumulasi cairan di alveoli yang menyebabkan terganggunya pertukaran gas di alveoli dan berkurangnya perfusi di jaringan. Kondisi ini dapat disebabkan berbagai etiologi. Tatalaksana ARDS meliputi terapi umum, terapi ventilasi, terapi penyakit yang mendasari, dan terapi target.
    Kata kunci: acute respiratory distress syndrome

  • Pembrolizumab Sebagai Imunoterapi Pada Nonsmall Cell Lung Carcinoma
    Vol 6 No 2 (2019)

    Ardeno Kristianto1, Andhika Rahman2
    1,2Departemen Ilmu Penyakit Dalam, FKUI, Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo

     

    ABSTRAK
    Kanker paru merupakan penyebab kematian nomor satu di antara keganasan lainnya. Sebagian besar kanker paru termasuk dalam jenis kanker paru non-small-cell (nonsmall cell lung carcinoma/NSCLC). Salah satu terapi untuk NSCLC adalah imunoterapi. Pembrolizumab merupakan salah satu imunoterapi yang sudah digunakan di Indonesia yang memberikan hasil yang menjanjikan pada NSCLC.
    Kata kunci: Pembrolizumab, imunoterapi, nonsmall cell lung carcinoma

  • Profil Keamanan Obat Bedaquiline Terhadap Jantung
    Vol 6 No 2 (2019)

    I Gusti Agung Ayu Putu Sri Darmayani1, Purwantyastuti Ascobat2
    1Program Pendidikan Dokter Spesialis Farmakologi Klinik, FKUI
    2Departemen Farmakologi dan Terapeutik, FKUI

     

    ABSTRACT
    Bedaquiline is a new antibiotic particularly developed for the treatment of drug-resistant tuberculosis. Based on the results of studies during drug development, the safety aspect of bedaquiline to the heart was a major concern, since it caused prolongation of QT interval. However, this safety concerns were obtained by observing only small number of patients with incomplete cardiac safety monitoring data. Additional safety data of the heart needs to be systematically collected after the drug is widely used as a programmatic drug. Services and patient safety will be enhanced by implementing active drug safety monitoring (aDSM) from WHO.
    Keywords: Bedaquiline, prolongation QT interval, safety profile

  • The Role Of Opioid in Relieving Breathlessness in Advanced Disease
    Vol 6 No 2 (2019)

    Teddy Septianto
    Division of Anesthesiology, Department of Surgery, Cipto Mangunkusumo National General Hospital Indonesia (RSCM)

     

    ABSTRACT
    Introduction: More than half of patients with advanced disease have difficulty breathing, and this chronic breathlessness can be highly debilitating and challenging to manage. Opioids are the pharmacological drug that usually used for the palliation treatment of breathlessness, although their mechanism of action is still not completely known. This evidence based case report was written to prove that opioids has efficacy and safety to relieving breathlessness in patient with advanced disease.
    Methods: We searched for literatures from several databases, which were: Pubmed, Cochrane Review, and Scopus with keywords: (opioid OR morphin) AND (breathlessness OR dyspnea) AND (advanced disease). The search was conducted on September, 27st 2018. The inclusion criteria were: human study, publication within the last 5 years, English language, randomized controlled trial, meta-analysis, and systematic review. The recruited literatures were appraised using clinical epidemiology and evidence based medicine (CEEBM) worksheet.
    Results: Literature searching from three previously stated databases revealed only one article which were found to fulfill the inclusion criteria. From the review, for the primary outcome of breathlessness, the mean post-treatment dyspnoea score was 0.28 points better in the opioids group. The mean change from baseline dyspnoea score was 0.09 points better in the opioids group, but both of them have low quality evidence. From subgroup analysis, there is a strong treatment effect for morphine, with the mean post-treatment dyspnoea score was 0.32 points better in the opioid group compared to the placebo group. The mean change from baseline dyspnoea score was 0.18 points better in the opioids.
    Conclusion: There is some low quality evidence that shows benefit for the use of oral or parenteral opioids to reliev breathlessness in advanced disease, although the number of included participants was small. In the sub group analysis, there is a strong treatment effect for morphine to reliev breathlessness. We found no evidence to support the use of nebulised opioids. Further research with larger numbers of participants, using standardised protocols and with quality of life measures included, is needed.

  • Proportion of Depression in Non-Multidrug-Resistant Pulmonary Tuberculosis Patients at Cipto Mangunkusumo General Hospital and Its Related Factors
    Vol 6 No 2 (2019)

    Reinaldo Alexander1, Rudi Putranto2, Cleopas Martin Rumende3, Ikhwan Rinaldi4, Hamzah Shatri2
    1Internal Medicine Department, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital
    2Psychosomatic Division of Internal Medicine Department, Faculty of Medicine
    Universitas Indonesia, Cipto Mangunkusumo Hospital
    3 Respirology and Critical Care Division of Internal Medicine Departement,
    Cipto Mangunkusumo National General Hospital Indonesia
    4Medical Hematology-Oncology Division of Internal Medicine Department, Faculty of Medicine
    Universitas Indonesia, Cipto Mangunkusumo Hospital


    Aim: To determine the proportion of depression in non-multidrug-resistant pulmonary TB patients at Cipto Mangunkusumo General Hospital and also its related factors. Method: A cross-sectional study of 122 non-multidrug-resistant pulmonary TB patients was done at outpatient department of Cipto Mangunkusumo General Hospital from August to October 2018. The diagnosis of depression was made by interview according to Diagnostic and Statistical Manual of Mental Disorder-V (DSM-V) criteria, and severity of depression is determined using Beck Depression Inventory-II (BDI-II). Bivariate and multivariate analysis using the logistic regression test was done using SPSS.
    Results: From 122 patients with non-multidrug-resistant pulmonary TB, the proportion of depression is 48,4%. There are 2 factors related to depression in non-multi-drug resistant pulmonary TB patients, which are the occurrence of side effects from TB treatment (p < 0,001; OR 7,13; 95% CI 2,67 - 19,03), and the presence of other chronic disease (p < 0,001; OR 12,90; 95% CI 3,87 - 4,01 - 41,50).
    Conclusion: The proportion of depression in non-multidrug-resistant pulmonary TB patients at Cipto Mangunkusumo General Hospital is 48,4%. The occurrence of TB treatment side effects, and the presence of chronic disease comorbidities are related to depression in non-multidrug-resistant pulmonary TB patients.
    Keywords: depression, non-multi-drug resistant pulmonary Tuberculosis

  • TERAPI REHABILITASI PULMONAL PADA PENYAKIT PARU OBSTRUKTIF KRONIK
    Vol 6 No 2 (2019)

    ABSTRAK

    Penyakit Paru Obstruktif Kronik (PPOK) merupakan salah satu masalah utama kesehatan di seluruh dunia karena insiden yang semakin meningkat. Bahkan pada tahun 2020, diperkirakan PPOK menjadi penyebab kematian ketiga di seluruh dunia. Menurut National Population Health Study (NPHS), 51% pasien PPOK mengeluh bahwa sesak napas menyebabkan keterbatasan aktivitas di rumah, kantor, dan lingkungan sosial meskipun dengan terapi farmakologi yang optimal. Penyakit Paru Obstruktif Kronik menimbulkan gangguan kualitas hidup, penurunan kapasitas fungsional penderita, bahkan sampai menyebabkan kematian. Untuk itu, salah satu strategi penatalaksanaan PPOK adalah dengan rehabilitasi pulmonal, yaitu suatu intervensi yang komprehensif, multidisiplin, dan berdasarkan bukti ilmiah serta bersifat individual yang dirancang untuk mengurangi gejala, meningkatkan kapasitas fungsional, meningkatkan aktivitas dan partisipasi di masyarakat, serta mengurangi biaya kesehatan melalui pengendalian dan penghambatan  manifestasi sistemik dari PPOK .

    Kata Kunci : PPOK, Rehabilitasi Pulmonal

  • PENGARUH PEMBERIAN SUPLEMEN OMEGA 3 TERHADAP KADAR TNF-α SERUM, MASSA OTOT, KEKUATAN OTOT, DAN PERFORMA FISIK PADA PASIEN PPOK DENGAN SARKOPENIA
    Vol 6 No 2 (2019)

    ABSTRACT

    Background: The inflammatory response to COPD does not only occur in the lungs but also occurs systemically. Systemic inflammation causes muscle protein catabolism through various cytokine pathways, especially TNF (tumor necrosis factor)-α. The breakdown of muscle protein that occurs in COPD patients causes loss of muscle mass, decreased muscle strength, and decreased physical performance called sarcopenia. In COPD patients over 50 years, there was a reduction in muscle mass of 1-2% per year and decrease in muscle strength of 1.5-3% per year. Omega-3 polyunsaturated fatty acids (PUFAs) is a supplement that can modulate the inflammatory processes that occur in COPD and increase muscle mass. At present the omega-3 PUFAs supplement has not been widely used as an additional nutrient in COPD patients with sarcopenia.

    Objective: To determine the effect of omega-3 supplementation on serum TNF-α levels, muscle mass, muscle strength, and physical performance in COPD patients with sarcopenia.

    Methods: This research is a double-blind randomized clinical controlled trial. The samples was 40 people consisting of  20 the treatment group and 20 the control group. The subjects were followed for 12 weeks, then the treatment effect consisting of TNF-α, muscle mass, muscle strength, and physical performance were measured, analyzed, and compared between pre and post treatment in the treatment group and the control group.

    Results: In the treatment group the mean difference of serum TNF-α levels was -45,22 pg/ml while in the control group was 31,92 pg/ml (p <0,001). In the treatment group, the mean difference in muscle mass was 8,1 kg while in the control group was -1,06 kg (p <0,001). In the treatment group, the mean difference of muscle strength was 15,07 while in the control group was -0,57 kg (p <0,001). In the treatment group the median difference of 6MWT was 27 meters while in the control group was 1 meter (p <0.001).

    Conclusion: Providing omega-3 supplements can reduce serum TNF-α levels, increase muscle mass, muscle strength, and physical performance in COPD patients with sarcopenia after using for 12 weeks.

    Keywords : COPD, sarcopenia, omega 3 supplementation, serum TNF-α, muscle mass, muscle strength, and six minute walking test

  • Peran Prokalsitonin dan C Reaktif Protein sebagai Prediktor Mortalitas Tujuh Hari pada Pasien Acute Respiratory Distress Syndrome di RSCM
    Vol 6 No 1 (2019)

    Chrispian Oktafbipian Mamudi,1 Zulkifli Amin,1 Rudyanto Sedono,2 Cleopas Martin Rumende1

     

    1. Departemen Ilmu Penyakit Dalam Divisi Resiprologi dan Penyakit Kritis, Fakultas Kedokteran, Rumah Sakit Cipto Mangunkusumo, Jl. Diponegoro no. 71, Jakarta, 10430, Indonesia
    2. Departemen Anestesiologi dan Intensive Care, Fakultas Kedokteran, Rumah Sakit Cipto Mangunkusumo, Jl. Diponegoro no. 71, Jakarta, 10430, Indonesia

     

    Korespondensi:

    Email:chrispianomamudi@yahoo.com

     

    ABSTRAK

    Latar Belakang: Angka mortalitas ARDS khususnya di RSCM masih tinggi, sebesar 75,3%. Prokalsitonin (PCT) dan C-reactive protein (CRP) bisa dipakai sebagai prediktor mortalitas pada ARDS. Saat ini belum didapatkan penelitian yang fokus pada peran PCT dan CRP sebagai prediktor mortalitas tujuh hari pada pasien ARDS di Indonesia.

    Tujuan: Mengetahui peran PCT dan CRP sebagai prediktor mortalitas tujuh hari pada pasien ARDS di RSCM.

    Metode: Penelitian ini menggunakan disain kohort prospektif yang dilakukan secara konsekutif pada pasien ARDS di RSCM pada November 2015-Januari 2016.

    Hasil: Dari 66 pasien ARDS, 40 (60,61%) meninggal dan 26 (39,39%) hidup. Uji normalitas PCT dan CRP didapatkan distribusi dari data-data tersebut tidak normal. Dengan uji Kolmogorov-Smirnov didapatkan p<0,05. Median PCT pada yang meninggal sebesar 4,18 (0,08-343,0) dibandingkan yang hidup sebesar 3,01 (0,11-252,30) p=0,390, AUC 0,563 (IK  95% 0,423-0,703). Median CRP pada yang meninggal sebesar 130,85 (9,20-627,78) dibandingkan yang hidup sebesar 111,60 (0,10-623,77) p=0,408, AUC 0,561 (IK  95% 0,415-0,706).

    Simpulan: Pemeriksaan PCT dan CRP hari pertama pada penelitian ini belum dapat digunakan sebagai prediktor mortalitas tujuh hari pada pasien ARDS.

     

    Kata kunci: ARDS, CRP, mortalitas, PCT

     

  • Pengaruh Ukuran Jarum dalam Tindakan Percutaneus Transthoracic Needle Aspiration Biopsy terhadap Keberhasilan Biopsi dan Kejadian Pneumotoraks pada Penderita Tumor Intratorakal di RSUP Dr Hasan Sadikin Bandung
    Vol 6 No 1 (2019)

    Hendarsyah Suryadinata1, Arto Yuwono Soeroto1, Prayudi Santoso1

     

    1Divisi Respirologi dan Respirasi Kritis Departemen/KSM Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Padjadjaran,RSUP Dr hasan Sadikin Bandung

     

    Korespondensi:

     

    Tim Publikasi Ilmiah Departemen Ilmu Penyakit Dalam,

    Fakultas Kedokteran Universitas Padjadjaran

    Telp. 022-2038986

    email: internershs@gmail.com

    atau : hendarsyahsuryadinata@gmail.com

     

    ABSTRACT

    BACKGROUND: The incidence lung tumors and mediastinum tumors are the main causes of death due to malignancies with 12,9% of all malignancy cases. Lung tumors are more common in developing countries. Biopsy of lung tumors and mediastinal tumors is a frequent and multidisciplinary action. The minimally invasive technique that is mostly done is percutaneus transthoracic needle aspiration biopsy (PTNAB). Research states that PTNAB is a safe, effective, and accurate procedure.

    OBJECTIVE: This study aimed to assess the effect of needle biopsy size on the success of biopsy and the incidence of pneumothorax in intrathoracal tumor patients in Hasan Sadikin General Hospital for the period 2014-2016.

    METHODS: This study is a clinical epidemiological study and observational analytic with a cross sectional study design involving 232 data of patients who met the inclusion criteria and did not meet the exclusion criteria. Matching is done because there are differences in the number of research subjects in each group. The total number of research subjects is 158 patient data. The test used is chi square.

    RESULTS: The results showed that PTNAB's actions using large and small needles had a success rate of 73,4% and 49,4%, respectively, and were significantly different (p <0,05). The success rate of PTNAB's actions is not significantly different from lung tumors and mediastinum. The success rate of PTNAB's actions in mediastinal tumors using large and small needles was 92,3% and 50%, respectively,  and was significantly different (p <0,05). The incidence of pneumothorax after PTNAB's action is zero in both groups so analysis cannot be performed.

    CONCLUSION: This study concluded that the success of PTNAB's actions using large-sized needles on small-sized needles differed significantly.

     

    Keywords: Intrathoracal tumor, PTNAB, Needle size

  • RECURRENT PLEURAL EFFUSION IN A PATIENT WITH SYSTEMIC LUPUS ERYTHEMATOSUS
    Vol 6 No 1 (2019)

    I Putu Eka Krisnha Wijaya1, Zulkifli Amin2
    1Department of Internal Medicine, Cipto Mangunkusumo National General Hospital Indonesia
    2Division of Respirology and Critical Care Medicine, Department of Internal Medicine,
    Cipto Mangunkusumo National General Hospital Indonesia

     

    ABSTRACT 
    Background: Systemic lupus erythematosus (SLE) is an autoimmune disease that more commonly affects women of childbearing age. It is a multi-organ disease and can involve virtually any organ in the body. Pleural effusion can occurred in 30% of patients with SLE, which may be a result of SLE itself, pulmonary emboli, or end-organ damage such as heart or renal failure. The management of pleural effusions in SLE patient can be challenging because the numerous of potential underlying cause and sometimes effusion recur despite appropriate treatment of primary process. Case Report: We reported 33 years old woman patient admitted to our ED with chief complaint of shortness of breath for last 1 week. Chest X-ray result showed bilateral pleural effusion. Serial pleural fluid analysis consistent with conclusion of transudate fluid. Echochardiograpy showed dilatation of left atrium and ventricle and reduced LVEF 34%. These data suggest congestive heart failure as the cause of pleura effusion. A few days after initial thoracocentesis, the patient become dyspnea again because of reccurent pleural effusion. To relieve the symptom, we did insertion of pigtail catheter connected with mini WSD (Water seal drainage). Conclusion: Pleural effusion is a relatively common clinical presentation of a patient with SLE. Pleural effusions may be a result of SLE itself, pulmonary emboli, or end-organ damage such as heart or renal failure. The management of pleural effusions are mainly to relieve the symptoms and treatment of underlying cause. Keywords: SLE, recurrent pleural effusion, congestive heart failure, thoracocentesis

  • The Unfavourable Outcome of Lung Tuberculosis Patient with Diabetes Mellitus Comorbidity
    Vol 6 No 1 (2019)

    Tri Hapsoro Guno1, Telly Kamelia 2, Suharko Soebardi3, Arif Mansjoer4
    1. Department of Internal Medicine, Faculty of Medicine, University of Indonesia-RSUPN CiptoMangunkusumo
    2. Division of Respirology and Critical Illness, Department of Internal Medicine, Faculty of Medicine,
    University of Indonesia-RSUPN CiptoMangunkusumo
    3. Division of Metabolic Endocrinology, Department of Internal Medicine, Faculty of Medicine,
    University of Indonesia-RSUPN CiptoMangunkusumo
    4. Clinical Epidemiology Unit, Department of Internal Medicine, Faculty of Medicine,
    University of Indonesia-RSUPN CiptoMangunkusumo

    ABSTRACT 

    Background : The treatment of lung tuberculosis in patient with diabetes mellitus comorbidity is still a major problem because of high incidence rate, unfavourable outcome and failure. In indonesia, there is no specific study about outcome, characteristics and profile patient with this unfavourable outcome.
    Objectives : To identify the treatment outcome, patient characteristic and patient profile for unfavourable outcome.
    Methods : This is a retrospective cohort study, analyzing medical record of lung tuberculosis patient with diabetes mellitus comorbidity that treated in Cipto Mangunkusumo Hospital from January 2013 to December 2018. Unfavourable outcome as defined by Tb-DOTS national program consist of subject with failure to treat, death, loss to follow up and transferred out without known of final results. Result : A total of 141 subject enrolled in this study, with median age of subject was 57 years (range 28 to 79 years) and majority subject is male (56.03%), Tb relapse found in 24.11% subject. Outcome of Tb treatment based on National Program was treatment complete in 51.77%, Cure in 1.42%, loss to follow up in 31.91%, transferred out in 14%, and died in 7% subjects. Unfavourable outcome found in 46.81% subject, with majority found in male subject, married, working subject, actively smoking, subject with previous Tb treatment, non-adherence, previously known diabetes, underweight or normoweight subject, reduce eGFR below 60 ml/min/1.73m2, subject with insulin therapy on intensive phase, and poorly controlled diabetes.
    Conclusion : Unfavourable outcome found in 46,81% subject, will loss to follow up was the highest composition (31.91%)
    Keywords: Tuberculosis, diabetes mellitus, tuberculosis-diabetes mellitus comorbidity, unfavourable outcomes.

  • TUBERKULOSIS PADA KEHAMILAN
    Vol 6 No 1 (2019)

    Cleopas Martin Rumende1
    1 Divisi Respirologi dan perawatan kritis, Departemen Ilmu Penyakit Dalam,
    Rumah Sakit Umum Nasional Cipto Mangunkusumo Indonesia

    ABSTRAK
    Tuberkulosis (TB) merupakan salah satu permasalahan kesehatan terbesar di dunia. Tuberkulosis pada kehamilan juga menjadi permasalahan yang serius karena dapat berakibat buruk bagi ibu dan janin. Intervensi untuk pencegahan, diagnosis, dan pengobatan TB dapat menurunkan angka morbiditas dan mortalitas baik pada ibu dan anak.
    Kata kunci: tuberkulosis, kehamilan


    ABSTRACT
    Tuberculosis is one of the major health problems in the world. Tuberculosis in pregnancy is also a serious health problem due to the harmful effect for the mother and the child. Intervention in prevention, diagnosis, and medication can decrease the morbidity and mortality for the mother and the child.
    Keywords: tuberculosis, pregnancy

  • Prealbumin as predictor of mortality in CAP
    Vol 6 No 1 (2019)

    Anastasia Asmoro1, Gurmeet Singh2
    1 Student, Fakultas Kedokteran Universitas Indonesia
    2 Pulmonology Division, Internal Medicine Department, Fakultas Kedokteran Universitas Indonesia
    /Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo

    ABSTRACT

    Background: Community-acquired pneumonia is an acute infection of the lung parenchyma transmitted from the community with a high mortality rate. Predictors of mortality include the Pneumonia Severity Index (PSI) and CURB-65, and the biomarkers procalcitonin and D-dimers. Prealbumin (also known as transthyretin) is a biomarker for protein calorie malnutrition and has shown a positive correlation to negative patient outcomes in several different conditions. This study aims to study how prealbumin can be used as a predictor of mortality in CAP. Method: Articles were identified by searching 4 databases and screened for eligibility; 2 articles were eligible for this study. Assessment was done using the Quality in Prognosis Studies (QUIPS) tools and the Prognosis Critical Appraisal form. Result: The two articles assessed in this study have found that prealbumin is correlated with negative outcomes, particularly mortality. The studies have found that the patients who died had low serum prealbumin levels at admission.
    Conclusion: Serum prealbumin concentration is the preferred biomarker for protein calorie malnutrition as it is more sensitive compared to other biomarkers. There is a strong correlation between low serum prealbumin concentration upon admission with negative patient outcomes for patients with CAP. Further studies should include a wider range of subjects, specifically in age, and investigate the role of prealbumin as a predictor of malnutrition or inflammation and how it correlates to negative patient outcomes. Keywords: prealbumin, transthyretin, community-acquired pneumonia, mortality

     

  • DIAGNOSIS DAN TATALAKSANA KARDIOMIOPATI HIPERTROFIK
    Vol 6 No 1 (2019)

    Farissa Luthfia 1, Birry Karim 1
    1 Divisi Kardiologi, Departemen Ilmu Penyakit Dalam FKUI-RSCM

    ABSTRAK

    Kardiomiopati hipertrofik merupakan kelainan genetik jantung yang cukup sering terjadi di populasi pasien usia dewasa. Diagnosis dan tatalaksana dari kardiomiopati hingga saat ini menjadi dilema bagi sebagian dokter. Target penatalaksanaan kardiomiopati hipertrofi adalah menatalaksana gejala dan tanda yang pasien alami, mencegah kematian mendadak, serta pemberian edukasi.
    Kata kunci: diagnosis, tata laksana, kardiomiopati hipertrofik

  • Multidrug_Resistant_Tuberculosis
    Vol 6 No 1 (2019)

    Multidrug Resistant Tuberculosis

    Tuberkulosis (TB) adalah penyakit infeksi menular yang disebabkan oleh Mycobacterium tuberculosis (Mtb). Penularan TB pada umumnya melalui udara (airborne) yang mengandung droplet yang berasal dari penderita dengan TB paru aktif, menginfeksi paru-paru, serta dapat menyebar ke organ tubuh lain. World Health Organization (WHO) menggolongkan negara dengan beban tinggi untuk TB berdasarkan 3 indikator yaitu TB, TB/HIV, dan TB-MDR. Terdapat 30 negara yang masuk dalam daftar tersebut dan satu negara dapat dikelompokkan dalam salah satu daftar tersebut, atau keduanya, bahkan bisa masuk dalam ketiganya. Indonesia termasuk dalam daftar negara dengan beban tinggi untuk ketiga golongan TB tersebut. Berdasarkan angka terbaru WHO (2017), insidensi TB di Indonesia berada dalam urutan ke-3 di dunia dengan jumlah penderita TB sebanyak 842.000.

  • Patogenesis Ventilator Associated Pneumonia Terkini di Intensive Care Unit
    Vol 5 No 4 (2018)

     Febyan1, Soroy Lardo2

    1 Fakultas Kedokteran, Universitas Kristen Krida Wacana,  2 Divisi Penyakit Tropik dan Infeksi, Departemen Penyakit Dalam, RSPAD Gatot Soebroto, Jakarta, Indonesia

    ABSTRACT

    Ventilator Associated Pneumonia (VAP) is part of hospital-acquired pneumonia (HAP) and predominantly caused by Pseudomonas aeruginosa. Several important factors in the pathogenesis of VAP are barrier to Na+-K+-Cl transporter-1 (NKCC1) and endotracheal tube device without antibiofilm. VAP can be prevented by oral hygiene, endotracheal tube device made from antibiofilm, head up 30 degrees, and evaluation of cough ability and also swallowing function.

    Keywords: ventilator associated pneumonia, intensive care unit

    Abstrak
    Ventilator Associated Pneumonia (VAP) merupakan bagian dari hospital-acquired pneumonia (HAP), terutama disebabkan oleh Pseudomonas aeruginosa. Beberapa faktor penting pada patogenesis VAP, antara lain sistem barier Na+-K+-Cl transporter-1 (NKCC1) dan ETT (Endotracheal Tube) tanpa antibiofilm. Upaya pencegahan VAP berupa oral higiene, alat ETT berbahan antibiofilm, elevasi kepala 30 derajat, serta evaluasi kemampuan batuk dan fungsi menelan.

    Kata kunci: ventilator associated pneumonia, instalasi perawatan intensif

  • Korelasi Nilai Cluster of Differentiation 4 (CD4) Dengan Kuantifikasi Deoxyrybonuclead (DNA) Pneumocystic Jiroveci Pada Penderita Human Immunodeficiency Virus (HIV) Dengan Pneumonia
    Vol 5 No 4 (2018)

    Dional Setiawan
    PPDS Ilmu Penyakit Dalam
    Bagian Ilmu Penyakit Dalam, Fakultas Kedokteran, Universitas Andalas/RSUP Dr M Djamil Padang

     

    ABSTRAK

    Latar belakang: Human immunodeficiency virus (HIV) adalah virus yang menyebabkan berkurangnya CD4, ditandai dengan sistem kekebalan yang berkurang sehingga memudahkan infeksi oportunistik, salah satunya adalah infeksi Pneumocystic jiroveci. Meningkatnya insiden kolonisasi dan infeksi pneumocystic jiroveci seiring dengan penurunan CD4, sehingga perlu dilakukan penelitian untuk melihat korelasi nilai CD4 dengan kuantifikasi DNA P. Jiroveci pada pasien HIV dengan pneumonia.
    Metode: Penelitian observasional dengan metode potong lintang dilakukan pada 30 kasus baru pasien HIV dengan pneumonia yang belum mendapat terapi profilaksis PCP (Pneumocystic jiroveci pneumonia) pada pasien Instalasi Penyakit Dalam RSUP Dr. M. Djamil Padang pada bulan Februari sampai Mei 2018. Pasien dengan tes HIV positif cepat diikuti oleh pengukuran kadar CD4 dengan menggunakan flow cytometry. Pemeriksaan kuantifikasi DNA P.jiroveci menggunakan alat quantitative realtime PCR/qRT-PCR
    Hasil: Penelitian ini memperoleh nilai CD4 rata-rata rendah pada pasien HIV dengan pneumonia, 21,37 sel/mm3. Sedangkan rerata kuantifikasi DNA P.jiroveci pada pasien HIV dengan pneumonia, 6238,77 kopi/ml, dengan lebih banyak kejadian kolonisasi P.jiroveci.
    Kesimpulan: Terdapat korelasi negatif dengan adanya korelasi kuat antara nilai CD4 dan kuantifikasi DNA P.jiroveci pada pasien HIV dengan pneumonia. Disarankan bahwa pada pasien HIV dengan pneumonia dengan nilai CD4 rendah perlu diwaspadai adanya risiko infeksi PCP.
    Kata Kunci: HIV, CD4, kuantifikasi DNA P.Jiroveci

  • Profil Pasien Lost to Follow-up dan Faktor-Faktor yang Mempengaruhi pada pasien TB-HIV di RSCM
    Vol 5 No 4 (2018)

    Reagan Paulus Rintar Aruan1, Teguh Harjono Karyadi2, Gurmeet Singh3, Cleopas Martin Rumende3
    1Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia –RSUPN Cipto Mangunkusumo
    2Divisi Alergi Imunologi Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia-RSUPN Cipto Mangunkusumo
    3Divisi Respirologi dan Penyakit Kritis, Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia –RSUPN Cipto Mangunkusumo

    ABSTRAK

    Latar Belakang: Koinfeksi TB-HIV (Tuberkulosis-Human Immunodeficiency Virus) menunjukkan morbiditas dan mortalitas yang tinggi. Pasien TB-HIV yang mengalami lost to follow up dapat menjadi sumber penularan dan resistensi obat. Dibutuhkan data tentang proporsi lost to follow up pasien TB-HIV, serta faktor-faktor yang mempengaruhi.
    Tujuan: Mengetahui proporsi lost to follow up pada pasien TB-HIV serta mengetahui besarnya pengaruh dari masing-masing faktor yaitu: jenis kelamin, usia, jumlah penghasilan, status fungsional, frekuensi transportasi, lama menunggu pengobatan, jumlah obat, tempat tinggal, efek samping, dan status imunodefisiensi.
    Metodologi: Studi kohort retrospektif terhadap 100 pasien TB-HIV rawat jalan di POKDISUS RSCM tahun 2015-2017. Metode pengambilan sampel menggunakan non probability consecutive sampling. Dilakukan analisis bivariat untuk mengetahui hubungan faktor-faktor yang mempengaruhi lost to follow up pasien TB-HIV menggunakan uji chi square serta alternatifnya. Analisa multivariat menggunakan uji regresi logistik untuk mendapatkan Odds Ratio (OR) dari setiap faktor.
    Hasil: Dari 100 pasien dengan TB-HIV rawat jalan POKDISUS RSCM didapatkan proporsi pasien lost to follow up sebesar 39% dan jumlah penghasilan <Rp 3,6 juta (OR 7,04; IK 95% 2,409-20,591)
    Kesimpulan: Jumlah penghasilan merupakan faktor yang bermakna mempengaruhi lost to follow up pasien TB-HIV.

    Kata Kunci: Lost to follow-up, TB-HIV

  • PENDEKATAN DIAGNOSIS DAN TATA LAKSANA MIOPATI TERINDUKSI STEROID
    Vol 5 No 4 (2018)

    Niken Wahyuningsih1, Bambang Setyohadi2
    1 Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia –
    RSUPN Cipto Mangunkusumo
    2 Divisi Rematologi, Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia –
    RSUPN Cipto Mangunkusumo

    Miopati terinduksi steroid memiliki karakteristik adanya kelemahan otot dalam satu atau beberapa bulan setelah pemberian atau peningkatan terapi steroid. Gejalanya yang umum terjadi adalah adanya kelemahan otot proksimal secara bertahap selama periode beberapa minggu yang diikuti dengan perusakan otot. Tes untuk membuktikan hal tersebut adalah dengan mengurangi dosis steroid. Kelemahan yang diakibatkan oleh miopati terinduksi steroid akan mulai membaik dalam tiga atau empat minggu setelah pengurangan dosis yang memadai. Elektromiografi dan biopsi otot dapat membantu untuk menegakkan diagnosis. Penatalaksanaan pada keadaan yang mendasari kelebihan steroid sangat bermanfaat.

    Kata Kunci: Diagnosis, tata laksana, miopati terinduksi steroid


    PENDAHULUAN
    Miopati telah dikenal sebagai efek samping dari terapi kortikosteroid (glukokortikoid) sejak pertama kali diperkenalkan sebagai agen terapeutik pada tahun 1950-an.1 Miopati dapat timbul pada setiap jenis sediaan kortikosteroid. Risikonya dapat meningkat pada pasien dengan usia lanjut dan pasien dengan kanker atau pasien dengan balans nitrogen yang negatif sebelum terapi dilaksanakan.2

  • TUBERKULOSIS PADA TRANSPLANTASI ORGAN
    Vol 5 No 4 (2018)

    Melsa Aprima1, Fauzar2
    1 Program Studi Pendidikan Dokter Spesialis Ilmu Penyakit Dalam, FK UNAND/RS M Djamil, Padang
    2 Divisi Pulmonologi dan Kedokteran Respirasi, Departemen Ilmu Penyakit Dalam
    FK UNAND/RS M Djamil, Padang

     

    ABSTRAK

    Tuberkulosis (TB) hingga saat ini masih menjadi masalah kesehatan masyarakat. Pasien transplantasi organ
    memiliki risiko tinggi untuk terinfeksi Mycobacterium tuberculosis. Frekuensi dan angka mortalitas TB pada
    pasien transplantasi organ lebih tinggi dibandingkan populasi umum. Diagnosis dan penatalaksanaan TB
    aktif maupun TB laten harus dilakukan pada seluruh pasien transplantasi organ.
    Kata kunci: Tuberkulosis, Transplantasi organ

    ABSTRACT
    Tuberculosis is still a public health problem. Organ transplant patients have a high risk of being infected
    with mycobacterium tuberculosis. The frequency and mortality rate of TB in organ transplant patients is
    higher than the general population. Screening, diagnosis, and management of active or latent TB should be
    performed on all organ transplant patients.
    Keywords: Tuberculosis, Organ Transplantation

  • CORELATION BETWEEN INHALED BETA 2 AGONIST AND CORTICOSTEROID WITH THE DEGREE OF CONTROL AND LUNG FUNCTION IN ASTHMA
    Vol 5 No 3 (2018)

    Muhammad Ranushar, Harun Iskandar, Nur Ahmad Tabri, Makbul Aman, Syakib Bakri
    Departement of Internal Medicine Medical Faculty
    Hasanuddin University Makassar
    ABSTRACT
    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 corticosteroid
    inhalation only.
    Keywords: Asthma, therapeutic method, lung function, a degree of control, Forced Expiration
    Volume 1, Inhalation of beta 2 agonists, inhaled corticosteroids, inhalation corticosteroid and beta-
    2 agonist combination.

  • SUPRAVENTRICULAR TACHYCARDIA COMPLICATING DIFFUSE ST DEPRESSION WITH ST ELEVATION IN AVR
    Vol 5 No 3 (2018)

    Raymond Pranata1, Emir Yonas2, Veresa Chintya3 Vito Anggarino Damay1,4
    1Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Banten, Indonesia
    2Faculty of Medicine, YARSI University, Jakarta, Indonesia
    3Sanjiwani General Hospital, Gianyar, Bali, Indonesia
    4Department of Cardiology and Vascular Medicine, Siloam Hospital Lippo Village, Tangerang, Banten, Indonesia
    ABSTRACT
    Background: Lead aVR is frequently neglected in routine clinical practice. Usually, basal septum
    receives blood supply from very proximal septal branches of the left anterior descending artery.
    Transmural infarction of this area usually causes lead ST segment elevation in lead aVR signaling
    proximal left coronary artery (proximal LAD or left main) occlusion. Ischemia and infarction
    leads to metabolic and electrophysiological changes that may cause silent and symptomatic lifethreatening
    arrhythmia.
    Case Report: We reported 50 years old male patient presented to the ED 15 minutes since the
    onset of severe pain in the abdomen accompanied by nausea and sweating. With ECG of diffuse
    ST-segment depression with STE-aVR. The patient was then diagnosed with NSTE-ACS with
    probable left main coronary artery (LMCA) obstruction with differential diagnosis of cholecystitis/
    cholelithiasis with accompanying stable coronary artery disease. Patient felt better and rejected
    hospitalization. The patient then came 7 hours later with dyspnea and worsening abdominal pain.
    ECG of PSVT 189x/minute. Troponin was >10 ng/mL. Patient refused cardioversion and adenosine/
    ATP was unavailable. Amiodarone 150 mg over 10 minutes was administered. After consideration,
    patient was then referred to coronary angiography capable center for immediate invasive strategy.
    Conclusion: ST elevation in lead aVR may signal a severe proximal left coronary artery disease
    (LMCA or proximal LAD). Regardless whether it is caused by proximal left coronary artery disease
    or not, it is also an independent predictor of mortality.
    Keywords: supraventricular tachycardia, ST elevation aVR, left main coronary obstruction

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