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

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

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

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.

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

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

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

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

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

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.

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

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

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

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.

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

 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

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

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

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

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

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.

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

Zulkifli Amin1, Intan Pratiwi2
1 Divisi Respirologi dan perawatan kritis, Departemen Ilmu Penyakit Dalam, Rumah Sakit Umum Nasional Cipto Mangunkusumo Indonesia 2 Asisten Penelitian di Departemen Penyakit Dalam, Rumah Sakit Umum Nasional Cipto Mangunkusumo, Indonesia

ABSTRAK
Tuberkulosis (TB) dan HIV/AIDS masih menjadi masalah kesehatan di dunia. Tuberkulosis adalah penyakit yang paling umum di antara orang yang hidup dengan HIV. Pasien koinfeksi TB/HIV adalah masalah yang kompleks. Oleh karena itu, perawatan seringkali dapat menjadi rumit disebabkan kondisi medis dan adanya kesulitan kondisi sosial. Kondisi ini dapat membuat pasien tidak patuh dalam menjalani pengobatan. Tenaga kesehatan masyarakat memiliki peran penting dalam menyelesaikan masalah ini.
Kata kunci: ketidakpatuhan, pengobatan, koinfeksi, TB/HIV

Dewi Resnawita, Marlina Rays, Harun Iskandar, Eliana Muis, Muhammad Ilyas,
Nur Ahmad Tabri, Irawati Djaharuddin, Erwin Arief, A. Makbul Aman, Syakib Bakri
Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Hasanuddin

ABSTRAK
Tuberkulosis (TB) merupakan penyakit infeksius yang dapat mengancam nyawa dengan angka
insidensi yang tinggi di dunia, terutama di negara-negara berkembang seperti Indonesia. Meskipun
sebagian besar kasus TB ditemukan pada paru-paru, proporsi pasien yang mengalami infeksi TB
ekstra paru juga menunjukkan angka yang signifikan. Berikut dilaporkan tiga kasus TB ekstra paru.
Kasus pertama, wanita 63 tahun dengan gambaran klinis benjolan pada daerah mulut yang awalnya
diperkirakan menderita tumor kemudian dilakukan pemeriksaan histopatologis diperoleh hasil
peradangan kronik granulomatous. Kasus kedua, wanita 32 tahun dengan gambaran klinis berupa
plak hiperkeratosis, eritema dan skuama regio interphalang digiti dua dextra kemudian dilakukan
pemeriksaan histopatologis diperoleh hasil Tuberkulosis kutis verukosa. Kasus ketiga, laki-laki 32
tahun, dengan nyeri dan bengkak pada lutut kanan kemudian dilakukan pemeriksaan histopatologis
diperoleh hasil radang kronik granulomatosa supuratif. Terhadap ketiga pasien ini diberikan obat
anti tuberkulosis (OAT) kategori I 2(HRZE)/4(HR)3 dan terjadi perbaikan klinis.
Kata kunci: TB ekstra paru, obat anti tuberkulosis

Randy Adiwinata1, Josephine Rasidi1,
Muhammad Reza Arifianto2,
Mohammad Darwis Dahlan3,
Sarmauli Sitorus4,
Benny Indrajaya5,
Restu Ratnaningsih6, Erni Juwita Nelwan7
1Faculty of Medicine, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
2Faculty of Medicine, Hang Tuah University, Surabaya, East Java, Indonesia
3Department of Surgery, Kanujoso Djatiwibowo Hospital, Balikpapan, East Kalimantan, Indonesia
4Department of Neurology, Kanujoso Djatiwibowo Hospital, Balikpapan, East Kalimantan, Indonesia
5Department of Anesthesiology, Kanujoso Djatiwibowo Hospital, Balikpapan, East Kalimantan, Indonesia
6Department of Internal Medicine, Kanujoso Djatiwibowo Hospital, Balikpapan, East Kalimantan, Indonesia
7Division of Tropical and Infectious Disease, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.

ABSTRACT
Introduction: Neurotoxicity manifestations following venomous snakebite may lead to lifethreatening
conditions such as respiratory muscle paralysis leading to respiratory failure and loss
of consciousness. Prompt treatments are required.
Case illustration: A-90-year-old woman presented with loss of consciousness and respiratory
failure following snakebite. On general examination, a patient was unconscious (Glasgow Coma
Score [GCS] 3) with respiratory rate 4-6 rates per minute and frequent apnea period. Her blood
pressure was 267/155 mmHg with sinus tachycardia (150 bpm) and low oxygen saturation (50-
65%). Early intubation was performed due to respiratory failure. Rapid neurological improvement
was seen after snake antivenom and anticholinesterase administration. She was discharged on the
fifth day without any neurotoxic sign.
Discussion: The respiratory failure and loss of consciousness were regarded as acute and severe
neurotoxic envenoming. Geriatric patient may have reduced respiratory capacity which may further
accelerate the respiratory failure. Neurotoxin acted at the pre- and post-synapse neuromuscular
junction. Antivenom is the only definitive therapy in envenoming. Trial of anticholinesterase should
always be conducted in neurotoxic envenoming. Early mechanical ventilation support should be
given in respiratory failure cases.
Conclusion: Antivenom administration and trial of anticholinesterase should be performed in
neurotoxicity envenoming. Mechanical ventilation should not be delayed in present of respiratory
failure.
Keywords: venomous snakebite, respiratory failure, neurotoxin, snake antivenom