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

lUniversity of Sultan Ageng Tirtayasa Serang Banten Indonesia

²University of Pembangunan Nasional Veteran

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

 ABSTRACT

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

Keywords: Bronchiectasis, HRCT, Hypercapnea, Tuberculosis,

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

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

Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia

ABSTRAK

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

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

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

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

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

anterior; revaskularisasi, perubahan Elektrokardiografi

Herikurniawan

Respirology and Critical Illness Division, Internal Medicine Department

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

 ABSTRACT

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

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

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

Jefman Efendi Marzuki HY^1,2, Nafrialdi³, Purwantyastuti Ascobat^{3 1}Program Pendidikan Dokter Spesialis Farmakologi Klinik, FK UI, Jakarta ²Departemen Farmakologi, Fakultas Kedokteran Universitas Surabaya, Surabaya ³Departemen Farmakologi dan Terapeutik, FK UI, Jakarta

 ABSTRAK

Delamanid adalah antituberkulosis baru yang dikembangkan untuk mengobati (Tuberkulosis resisten obat)TB-RO. Dalam proses pengembangan delamanid, selain aspek efikasi, aspek keamanan menjadi perhatian khusus terkait potensi efeknya terhadap jantung berupa pemanjangan interval QT. Namun, data pendukung yang diperoleh masih dalam skala kecil dan belum lengkap. Data keamanan lainnya dibutuhkan dalam rangka pengobatan TB-RO. Sehingga, monitoring aktif dibutuhkan untuk meningkatkan pelayanan dan keamanan pasien.

Kata Kunci: Delamanid, monitoring keamanan, jantung, interval QT, patient safety

I Wayan Hero Wantara¹, Ceva Wicaksono Pitoyo¹, Andhika Rachman², Cleopas Martin Rumende¹

¹Respirology and Critcal Illness Division, Internal Medicine Departement, Faculty of Medicine Indonesia University, Cipto Mangunkusumo National General Hospital, Indonesia.

²Medical Hematology-Onkology Division, Internal Medicine Departement, Faculty of Medicine Indonesia University, Cipto Mangunkusumo National General Hospital, Indonesia.

 Introduction: Lung cancer patients often experience pneumonia. This is due to the decrease in body endurance of the patients. Pneumonia complicates treatment, worsens the quality of life, reduces survival, and is often a direct cause of death for lung cancer patients. Dealing with pneumonia in non- small cell lung cancer (NSCLC) patients with continuous antimicrobials treatment without regard to culture sensitivity will cause resistance of germs that cause pneumonia.

Objectives: This study aims to study the characteristics of NSCLC patients, the pattern of germs that cause pneumonia in NSCLC patients, and to compare the survival of NSCLC patients suffering from pneumonia caused by MDR (multidrug resistance) bacteria with those caused by non-MDR bacteria.

Methods: This study was a retrospective cohort with research subjects was NSCLC patients with pneumonia caused by MDR and non-MDR bacteria who were treated at Dr. Cipto Mangunkusumo Hospital from January 2013 to December 2017. Analysis was performed with multivariate cox regression analysis.

Results: The results 32 subjects were infected only from MDR bacteria, 14 subjects infected by both MDR and non MDR bacteria, and 23 subjects were infected by only non-MDR bacteria. The most non-MDR bacteria that cause pneumonia in NSCLC patients was Klebsiella pneumoniae       as much as 37,3%, while the most MDR bacteria that cause pneumonia in NSCLC patients was Acinetobacter baumannii as much as 23,2%. Median survival of NSCLC patients with pneumonia caused by MDR bacteria was 57 days (43,707-70,293) while those by non-MDR bacteria was 92 days (58,772-125,228).

Conclusions: The survival of NSCLC patients with pneumonia caused by MDR bacteria is shorter than that caused by non-MDR bacteria.

Key words: MDR, NSCLC, Pneumonia, Survival

Herikurniawan

Respirology and Critical Illness Division, Internal Medicine Department

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

 ABSTRACT

Central venous catheters (CVCs) are essential for the management of some critically ill patients  and those with limited vascular access to provide interventions and monitoring. The procedure        is catheher was inserted into a venous great vessel that traditionally located in the subclavian     vein, internal jugular vein, or femoral vein. Central venous access has several clinical indications, contraindications and complications that must be considered. Most central lines are placed today  via the Seldinger technique, in which the chosen vein is cannulated with a needle, a guide wire       is inserted to maintain a tract through the skin into the vein, and the catheter is then inserted over  the wire into the vein before the wire is removed. This procedure is generally performed with ultrasound guidance to improve the safety of this procedure. Full sterile technique must be used to decrease catheter-related infections.

Keywords: central venous catheter, criticall ill patients, vascular access, venous great vessel

Arif Mansjoer^1,2, Bambang Sutrisna³

¹Divisi Kardiologi, Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia/RSUPN Dr. Cipto Mangunkusumo, Jakarta

²Unit Pelayanan Jantung Terpadu RSUPN Dr. Cipto Mangunkusumo, Jakarta

³Departemen Epidemiologi Fakultas Kesehatan Masyarakat Universitas Indonesia

Latar Belakang: Lama rawat intensif pasien pascabedah jantung yang memanjang mempengaruhi alur pasien bedah jantung berikutnya. Pengaturan pasien berdasarkan prediksi lama rawat diperlukan agar alur pasien menjadi lancar.

Tujuan: Membuat prediksi lama rawat intensif 48 jam berdasarkan nilai skor dari model yang

dimodifikasi dari faktor-faktor EuroSCORE.

Metode: Penelitian restrospektif dilakukan pada Januari 2012 – Desember 2013 pada 249 pasien yang menjalani bedah jantung di Unit Pelayanan Jantung RSUPN Dr Cipto Mangunkusumo Jakarta. Analisis survival dan regresi Cox dilakukan untuk membuat prediksi lama rawat intensif 48 jam.

Hasil: Pada subjek didapatkan median kesintasan lama rawat intensif adalah 43 jam. Model dari 7 variabel EuroSCORE dapat memprediksi lama rawat intensif 48 jam (AUC 0,67).

Kesimpulan: Model baru dari faktor EuroSCORE dapat memprediksi lama rawat intensif 48 jam.

Kata Kunci: lama rawat intensif, pascabedah jantung

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.

Arto Y. Soeroto¹, Prayudi Santoso¹, Emmy H Pranggono¹, Iceu D Kulsum¹,
Hendarsyah Suryadinata¹, Ferdy Ferdian¹, Ade Yudisman¹, Martina²,Rechta Antartika², Zulkifli Amin³, C. Martin Rumende³, Ceva W. Pitoyo³, Eric D. Tenda³, Zen Akhmad⁴, Thomas Handoyo⁵, M. Ilyas⁶, Fauzar⁷, Bambang S. Riyanto⁸, Samsirun Halim⁹, Efata B. I. Polii¹⁰, Ananda W. Ginting¹¹, Putu Andrika¹², Price Maya¹³, Fajar Raditya¹⁴

¹Divisi Respirologi dan Penyakit Kritis Respirasi Departemen Ilmu Penyakit Dalam FK Unpad/RS Dr. Hasan Sadikin

Perhimpunan Respirologi Indonesia (PERPARI) cabang Bandung

²Departemen Ilmu Penyakit Dalam FK Unpad/RS Dr. Hasan Sadikin

³Divisi Pulmonologi dan Penyakit Kritis, Departemen Penyakit Dalam FKUI/RSCM

Perhimpunan Respirologi Indonesia (PERPARI) Cabang Jakarta

⁴Divisi Pulmonologi Departemen Ilmu Penyakit Dalam FK UNSRI/RS Moh. Husein

Perhimpunan Respirologi Indonesia (PERPARI) Cabang Palembang

⁵Divisi Pulmonologi Departemen Ilmu Penyakit Dalam FK UNDIP/RS Kariadi

Perhimpunan Respirologi Indonesia (PERPARI) Cabang Semarang

⁶Divisi Pulmonologi Departemen Ilmu Penyakit Dalam FK UNHAS/RS Wahidin Sudirohusodo

Perhimpunan Respirologi Indonesia (PERPARI) Cabang Makassar

⁷Divisi Pulmonologi Departemen Ilmu Penyakit Dalam FK UNAND/RSUP Dr. Moh. Djamil

Perhimpunan Respirologi Indonesia (PERPARI) Cabang Padang

⁸Divisi Pulmonologi Departemen Ilmu Penyakit Dalam FK UGM/RSUP Dr. Sardjito

Perhimpunan Respirologi Indonesia (PERPARI) Cabang Yogyakarta

⁹FKIK Univ Jambi /RSUD Raden Mattaher

Perhimpunan Respirologi Indonesia (PERPARI) Cabang Jambi

¹⁰Divisi Pulmonologi Departemen Ilmu Penyakit Dalam FK UNSRAT/RSU Prof Dr Kandou

Perhimpunan Respirologi Indonesia (PERPARI) Cabang Manado

¹¹Divisi Pulmonologi dan Alergi Imunologi Departemen Ilmu Penyakit Dalam FK USU/RS H. Adam Malik/Pirngadi

Perhimpunan Respirologi Indonesia (PERPARI) Cabang Medan

¹²Divisi Pulmonologi Departemen Ilmu Penyakit Dalam FK UNUD/RS Sanglah

Perhimpunan Respirologi Indonesia (PERPARI) Cabang Denpasar

¹³Departemen Ilmu Penyakit Dalam FK Unsyiah/RSUD Dr. Zainoel Abidin

Perhimpunan Respirologi Indonesia (PERPARI) Cabang Aceh

¹⁴Departemen Penyakit Dalam RS Imanuel Way Halim Bandar Lampung

Perhimpunan Respirologi Indonesia (PERPARI) Cabang Lampung

PENDAHULUAN
Virus corona adalah keluarga besar virus yang umum pada manusia dan hewan seperti unta, sapi, kucing, dan kelelawar. Terdapat 7 strain dari virus corona, yaitu 229E (alpha coronavirus), NL63 (alpha coronavirus), OC43 (beta coronavirus), HKU1 (beta coronavirus), MERS-CoV (beta coronavirus yang menyebabkan Middle East Respiratory Syndrome, atau MERS), SARS-CoV (beta coronavirus yang menyebabkan Severe Acute Respiratory Syndrome atau SARS) dan SARS-CoV-2 (COVID-19).^1,2

Virus corona dari binatang dapat menginfeksi manusia dan menyebar diantara manusia melalui transmisi manusia ke manusia seperti MERS-CoV, SARS-CoV, dan terkini adalah COVID-19 (Coronavirus disease 2019). Virus penyebab COVID-19 dinamakan Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2).²

Kasus pneumonia yang tidak diketahui penyebabnya teridentifikasi pertama kali di Wuhan ibukota provinsi Hubei pada awal bulan Desember tahun 2019.³ Pada tanggal 7 Januari 2020, Chinese Center for Disease Control and Prevention (CDC) mengidentifikasi suatu coronavirus baru yang diambil dari swab tenggorokan dari pasien dan kemudian dinamai 2019-nCov atau severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) oleh World Health Organization (WHO).^3-5

Berdasarkan data dari WHO sampai tanggal 25 Mei 2020, kasus Covid-19 yang positif ada 5.304.772 kasus, dengan total kematian 342.029 pasien. Di Indonesia terdapat 22.271 kasus positif, dengan jumlah kematian 1.372 orang.⁶

Muhammad Fachrurozi Sidiq¹, Hasrayati Agustina², Iceu Dimas Kulsum³

¹Program Studi Sarjana Kedokteran, Fakultas Kedokteran Universitas Padjadjaran

²Departemen/KSM Patologi Anatomi, Fakultas Kedokteran Universitas Padjadjaran, RSUP Dr. Hasan Sadikin Bandung 

³Divisi Respirologi dan Respirasi Kritis Departemen/KSM Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Padjadjaran, RSUP Dr. Hasan Sadikin Bandung

ABSTRAK

Latar Belakang: Efusi pleura adalah akumulasi abnormal cairan dalam rongga pleura yang disebabkan oleh adanya peningkatan laju pembentukan cairan pleura, penurunan drainase cairan oleh sistem limfatik, dan/atau keduanya. Efusi pleura dilaporkan menjadi masalah umum pada pasien yang terdapat di departemen ilmu penyakit dalam.

Tujuan: Penelitian ini bertujuan untuk mengetahui profil klinis, gambaran makroskopis dan mikroskopis cairan efusi pleura pada pasien rawat inap di RSUP Dr. Hasan Sadikin Bandung periode Januari 2016 hingga Desember 2018.

Metode: Penelitian ini menggunakan metode deskriptif dan rancangan penelitian potong lintang (cross-sectional) dengan menggunakan data sekunder berupa rekam medik. Sampel yang digunakan pada panelitian ini sebanyak 273 sampel rekam medis pasien yang dirawat inap di Departemen  Ilmu Penyakit Dalam RSUP Dr. Hasan Sadikin Bandung periode Januari 2016 – Desember 2018.

Hasil: Efusi pleura sebagian besar terjadi pada usia <60 tahun (78,39%), lebih sering terjadi pada perempuan dibanding laki-laki. Keluhan utama tersering adalah sesak napas (81,68%) dan lokasi efusi pleura tersering di hemitoraks dekstra (55,68%). Diagnosis klinis terbanyak adalah keganasan (71,43%) terutama kanker paru pada laki-laki dan kanker ovarium pada perempuan. Warna cairan pleura terbanyak ditemukan adalah kuning kemerahan (34,43%) dan pada keganasan cenderung lebih banyak berwarna merah 71,79%. Sebagian besar (58,97%) efusi pleura merupakan eksudat. Hanya 25,64% pasien dengan diagnosis klinis keganasan yang ditemukan sel tumor ganas pada cairan pleuranya.

Simpulan: Efusi pleura paling banyak terjadi pada usia tua dan perempuan lebih banyak dibanding laki-laki dengan keluhan utama terbanyak adalah sesak napas. Cairan efusi eksudat berupa gambaran makroskopis warna merah pada cairan pleura lebih cenderung ditemukan pada keganasan. Profil klinis dan gambaran mikroskopis dapat menggambarkan kemungkinan adanya keganasan pada  efusi pleura.

Kata kunci: Efusi pleura, makroskopis, mikroskopic, profil klinis

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.

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

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

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