Suction Pump Assist Device in Cardiogenic Shock
Lukman H. Makmun, Telly Kamelia, Ryan Ranitya, Zuswayudha Samsu
- Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
- Respirology and Critical Illness Divison, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
ABSTRACT
Background: Cardiogenic shock is a critical condition where the heart fails to pump blood effectively, lead- ing to high mortality rates. Mechanical circulatory support can temporarily reduce the heart’s workload while maintaining systemic perfusion. This paper in- troduces the Suction Pump Assist Device, an early mechanical support system patented in 1979.
Aim: To present the design, working principle, and clinical relevance of the Suction Pump Assist Device and compare it to the modern standard, Extracorpo- real Membrane Oxygenation (ECMO).
Method: The working principle of the suction pump assist device was analyzed and compared to ECMO, which has been the standard of care for cardiogenic shock since 2016.
Results: The Suction Pump Assist Device operates on a principle similar to VA-ECMO, where venous blood is oxygenated externally and returned to the arterial system, thereby reducing cardiac workload and ensur- ing systemic oxygenation. While ECMO has evolved significantly with technological advancements, the fundamental concept remains consistent.
Conclusion: The Suction Pump Assist Device repre- sents an early innovation in mechanical circulatory support for cardiogenic shock, sharing key principles with modern ECMO systems.
Keywords: Cardiogenic shock, Mechanical circula- tory support, ECMO, Suction pump assist device
Validation of Clinical PROMISE Score in Predicting 3-Month Mortality in Malignant Pleural Effusion Patients
Validation of Clinical PROMISE Score in Predicting 3-Month Mortality in Malignant Pleural Effusion Patients
Dita Gemiana1, Cleopas Martin Rumende2, Ikhwan Rinaldi3, Robert Sinto4 , Aida Lydia5, Rudy Hidayat6, Noto Dwimartutie7, Nadia Ayu Mulansari3
1 Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
2 Respirology and Critical Illness Divison, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
3 Hematology and Medical Oncology Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
4 Tropical and Infectious Diseases Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
5 Nephrology Divison, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
6 Rheumatology Divison, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
7 Geriatric Divison, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
Corresponding Author: Dita Gemiana
Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
Email: dita.gemiana91@ui.ac.id, Phone 081319100857
Abstract
Background: Pleural effusion is a frequent complication of malignancy. Malignant pleural effusion accounts for 15% to 35% of all pleural effusion cases and the incidence rate reaches 660 people per 1 million population globally. Several prediction models have been evaluated to predict mortality in malignant pleural effusion patients. The PROMISE score is a prediction model for 3-month mortality in patients with malignant pleural effusion.
Methods: A retrospective cohort study was conducted on patients with malignant pleural effusion registered in 2015-2022 at Cipto Mangunkusumo National Central General Hospital. A three-month mortality assessment was carried out. The collected data was analyzed using the Hosmer-Lemeshow goodness-of-fit test to determine the calibration performance and creation of a Receiver Operating Curve (ROC) curve to determine the discrimination performance of the Clinical PROMISE score on three-month mortality outcomes.
Results: A total 120 subject were included in the study. The majority of subjects were women (73.3%), mean age 55 years and other types of cancer (78.3%). The Clinical PROMISE score had good calibration performance (p = 0.230, coefficient of correlation r = 0.945). The discrimination performance of the Clinical PROMISE score was good with an AUC of 0.849 (95% CI 0.776 –0.922).
Conclusion: The calibration and discrimination performance of Clinical PROMISE score to predict 3-month mortality of malignant pleural effusion is good.
Keywords: Malignant pleural effusion, mortality, Clinical PROMISE score.
Unexpected Tension Pneumothorax Complicated by Double-Lumen Catheter Insertion in Patient with Mechanical Ventilator
Unexpected Tension Pneumothorax Complicated by Double-Lumen Catheter Insertion in Patient with Mechanical Ventilator: A Case Report
Arif Himmawan, Rullyano Hardian, Fitriah Sherly Marleen
Khidmat Sehat Afiat General Hospital of Depok
Koresponden: himmawan89@gmail.com
Abstract
Introduction: Tension pneumothorax is an emergency situation with a high mortality rate which can be caused by trauma/iatrogenic. We report a case of tension pneumothorax observed after insertion of a double-lumen cetheter in a patient on a mechanical ventilator.
Case: A 70 year old man with a mechanical ventilator was designed to install a double-lumen catheter in preparation for hemodialysis. After insertion of a double-lumen catheter, the patient’s saturation decreased, breath sounds from the right hemithorax decreased. A chest X-ray shows a collapsed right lung and flattened diaphragm. A needle thoracocentesis was performed at the 2nd ICS, the right mid-clavicular line, and continued with the installation of a WSD at the 5th ICS, the right anterior axilla line. The result is a clinical improvement.
Discussion: Tension pneumothorax is not an uncommon complication in mechanical ventilated patient, but its occurance immediately after insertion of a double-lumen cetheter is extremely rare. Subsequent decline in respiratory and cardiovascular function can be life-threatening if not detected early enough and managed properly. With the needle thoracocentesis and insertion of a WSD tube, the patient’s clinically condition significantly improved.
Conclusion: Tension pneumothorax is an emergency situation with a high mortality rate which can be caused by trauma/iatrogenic. With the needle thoracocentesis and insertion of WSD tube, a clinical improvement in the patient’s condition was evident.
Keywords: tension pneumothorax, double-lumen catheter, mechanical ventilator
ANALYSIS OF DEMOGRAPHIC PROFILE AND CHARACTERISTICS OF ACUTE CORONARY SYNDROME PATIENTS
ANALYSIS OF DEMOGRAPHIC PROFILE AND CHARACTERISTICS OF ACUTE CORONARY SYNDROME PATIENTS: AN OBSERVATIONAL STUDY
Muhammad Perdana Airlangga1*, Irma Kartikasari2, Juliana Juliana3, Saski Yasmin Alfina4, Frida Nur Rohmatin5,
1,2 Faculty of Medicine, Muhammadiyah Surabaya University, Indonesia
3 General Practitioner, Siti Khodijah Muhammadiyah Sepanjang Hospital, Indonesia
4,5 Internship doctor, Siti Khodijah Muhammadiyah Sepanjang Hospital, Indonesia
* Correspondence Author: angga.cardio@gmail.com
ABSTRACT
Cardiovascular disease (CVD) is the leading cause of death globally. Based on the 2018 Indonesia Basic Health Research data, the prevalence of heart disease in Indonesia reached 1.5% including Acute Myocardial Infarction (AMI). Blockage or total occlusion of the coronary arteries in ST-Elevation Myocardial Infarction (STEMI) patients requires immediate reperfusion (Percutaneous Coronary Intervention (PCI) or fibrinolytic therapy). Based on data from the Sidoarjo Health Office in 2023, there was 3968 cases of AMI. This study aims to identify the profile of Acute Coronary Syndrome (ACS) patients in Sidoarjo, This is a descriptive observational study with a retrospective cohort study design. This study used secondary data from the medical records with an inclusion and exclusion criteria. There were 150 samples which predominantly males (85%) with aged 50-60 years (47%). The most systolic blood pressure was ≤120 mmHg (55%). The result of PCI in patients showed that the most was Coronary Artery Disease (CAD) triple vessel disease (44%). A total of 67 of 150 patients experienced occlusion, 36 were chronic total occlusion (CTO) and 31 others were acute total occlusion. The location of the most common cause of blockage was in the Left Anterior Descendens (LAD) artery, which was 121 patients. This study showed that the most PCI patients were male, aged 51-60 years, systolic blood pressure <120 mmHg, multi vessel disease, chronic total occlusion, the most arterial blockage was located in the LAD artery, and had normal creatinine serum.
Keywords: Acute coronary syndrome, cardiovascular diasease, chronic total occusion
Latent Tuberculosis Treatment in HIV-Positive Patients
Latent Tuberculosis Treatment in HIV-Positive Patients: What’s New? Is It Overtreatment? Which One Is Preferred?
Arya Marganda Simanjuntak1, Ellya Catharine Lumbantoruan2, Merlinda Veronica3, Heri Ginting4, Anwar Sholeh4, Dani Rosidana4
1 Research Intern, Department of Internal Medicine, Faculty of Medicine, Universitas Riau, Arifin Achmad General Hospital
2 Faculty of Medicine, Universitas Tanjungpura, Pontianak, Indonesia
3 Tropical Infection Division, Department of Internal Medicine, Faculty of Medicine, Universitas Riau, Arifin Achmad General Hospital, Pekanbaru, Riau, Indonesia
4 Pulmonary and Critical Medicine Division, Department of Internal Medicine, Faculty of Medicine, Universitas Riau, Arifin Achmad General Hospital, Pekanbaru, Riau, Indonesia
Corresponding Author : Arya Marganda Simanjuntak, Dept of Internal Medicine, Faculty of Medicine, Universitas Riau, Arifin Achmad General hospital. arya.marganda@gmail.com
ABSTRACT
Latent Tuberculosis Infection (LTBI) is a focus especially in HIV-seropositive patients because immunocompromise increases the risk of reactivation of LTBI into active TB. Therefore, LTBI therapy was developed to prevent the TB from becoming active. However, several issues have been questioned regarding LTBI therapy in HIV patients as an overtreatment and potentially dangerous because both drugs in TB and HIV have the same profile of hepatotoxicity. This review comprehensively discusses existing regimens and current evidence on the management of LTBI in HIV patients. This should be taken into consideration, but we also see from recent studies that if a patient has TB activation in HIV, it will decrease treatment success and also increase morbidity and mortality. Therefore, LTBI therapy has been developed up to the latest prevention guideline in 2024 with fewer treatment regimens than Active TB with 3HP or 3 HR. While it can be argued that LTBI therapy in HIV patients is necessary and not overtreatment, measures have also been developed to reduce the rate of hepatotoxicity that may occur.
Keywords : HIV, Latent Tuberculosis, Pharmacotherapy, Tuberculosis, Treatment
Glucocorticoid-Induced Immunosuppression and Immunocompromised Host Pneumonia
Glucocorticoid-Induced Immunosuppression and Immunocompromised Host Pneumonia
Mira Yulianti, Department of Internal Medicine, Division of Respirology and Critical Illness, Faculty of Medicine Universitas Indonesia – Dr. Cipto Mangunkusumo General Hospital
Dwitya Wilasarti, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia – Dr. Cipto Mangunkusumo General Hospital
Corresponding author: Dwitya Wilasarti, Dr Cipto Mangunkusumo Hospital, Jl Pangeran Diponegoro no 71, Central Jakarta, dwitya.w@gmail.com
Abstract:
Glucocorticoid is still a mainstay therapy in numerous diseases despite advances in novel chemotherapy and biologic immunomodulators. Estimated prevalence of glucocorticoid exposure is 1% in the general population. Glucocorticoid affect the immune system through various pathways, rendering those exposed to glucocorticoid immunocompromised. Studies have found that even at lower doses and short-term prescription, infection risk is increased in this population. Pneumonia is one of the leading causes of infection in the immunocompromised population, and based on the latest ATS/IDSA workshop report regarding immunocompromised-host pneumonia (ICHP), diagnosis and the etiologic workup differs compared to the community acquired pneumonia in immunocompetent patients. Approach to admission to inpatient care also differs due to the higher possibility of rapid deterioration of initially stable patients. Empirical treatment targets core respiratory pathogens but must be followed up to an attempt to determine causative pathogen according to clinical predisposition and imaging findings.
Abstrak:
Glukokortikoid tetap menjadi opsi pengobatan penting untuk berbagai penyakit, meskipun telah ada kemajuan dalam kemoterapi dan terapi biologis. Sekitar 1% dari populasi umum diperkirakan terpapar glukokortikoid, yang mempengaruhi sistem kekebalan tubuh melalui berbagai jalur, sehingga meningkatkan risiko infeksi. Secara khusus, penelitian menunjukkan bahwa bahkan dosis rendah dan penggunaan jangka pendek dapat meningkatkan risiko infeksi. Pneumonia menjadi salah satu infeksi utama pada individu dengan imunitas menurun. Pedoman terbaru dari ATS/IDSA menekankan bahwa diagnosis dan pemeriksaan etiologis pneumonia pada pasien dengan imunitas menurun (ICHP) berbeda dari pneumonia yang didapat di masyarakat pada pasien yang imunokompeten. Keputusan untuk merawat inap pasien pada populasi tersebut juga sangat bergantung pada keputusan klinis karena memiliki risiko lebih tinggi untuk mengalami perburukan kondisi dengan cepat walau datang dengan klinis stabil. Pengobatan empiris biasanya menargetkan patogen pernapasan umum, tetapi penting untuk memperbaiki pendekatan ini berdasarkan temuan klinis dan pencitraan untuk secara efektif mengidentifikasi organisme penyebabnya.
Keywords: immunocompromised host pneumonia, glucocorticoid
Factors Influencing the Survival of Patients with Pleural Effusion Without Clear Etiology
Factors Influencing the Survival of Patients with Pleural Effusion Without Clear Etiology
Bellinda Magdalena1, Gurmeet Singh2, Lisnawati3, Dicky L. Tahapary4
1Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
2Div of Respirology and Critical Care, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
3Departmen of Anatomic Pathology, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
4Division of Endocrinology and Metabolism, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
*Corresponding author: Bellinda Magdalena
Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
E-mail: bellindamagdalena@gmail.com
Abstract
BACKGROUND: Undiagnosed pleural effusion is a common cause of respiratory distress worldwide and contribute to morbidity and mortality. OBJECTIVE: The aim of this study is to evaluate factors affecting mortality and determine the 30 day and 90 day survival of patients with pleural effusion undergoing medical thoracoscopy. METHODS: This prospective study was conducted on patients with pleural effusion of unknown etiology who were over 18 years old and underwent medical thoracoscopy in Dr. Cipto Mangunkusumo National General Hospital, a tertiary care hospital in Jakarta, Indonesia. The study included 57 patients with pleural effusion who underwent medical thoracoscopy from January 2023 to May 2024. Patients were monitored up to 90 days after medical thoracoscopy. Kaplan-Meier and Cox proportional hazard analysis was used to analyze the data. RESULTS: The 90-day survival rate was 74.63% (CI 66.36-82.88). Analysis using the cox proportional hazard showed male gender [HR 2.108 (CI 0.732-6.076), p=0.167)] and poor ECOG PS [HR 3.822 (CI 0.863-16.928), p=0.077] were factors directly influencing the 90-day mortality of patients with pleural effusion of unknown etiology undergoing medical thoracoscopy. CONCLUSION: The 90-day survival rate of patients with pleural effusion with unknown etiology undergoing medical thoracoscopy is 74.63% (CI 66.36-82.88). Patients with pleural effusion of unknown etiology undergoing medical thoracoscopy who were male and with worse ECOG PS were associated with a higher risk of mortality within 90 days post procedure.
Keywords: Pleural effusion, medical thoracoscopy, survival, mortality
Efek Samping Pemanjangan Masa QT Interval dalam Pengobatan Tuberkulosis Resisten Obat
Pendekatan Tatalaksana dan Pengawasan Efek Samping Pemanjangan Masa QT Interval dalam Pengobatan Tuberkulosis Resisten Obat
Raden Fidiaji Hiltono Santoso*, Herikurniawan**, Mira Yulianti**
*Divisi Kardiologi, Departemen Ilmu Penyakit Dalam RS Cipto Mangunkusumo
**Divisi Pulmonologi, Departemen Ilmu Penyakit Dalam RS Cipto Mangunkusumo
ABSTRACT
Tuberculosis (TB) is one of the deadliest infectious diseases in the world. A major challenge in its treatment is the long duration of therapy, which often leads to low patient adherence to medication. This can result in incomplete treatment, therapy failure, and the development of drug resistance.
Drug-resistant tuberculosis (DR-TB) occurs when TB bacteria no longer respond to first-line anti-TB drugs such as rifampicin and/or isoniazid. In the treatment of DR-TB, the use of combination therapy that includes bedaquiline has been shown to yield better outcomes. However, it is also associated with an increased risk of cardiac side effects, particularly arrhythmias caused by QT interval prolongation.
QT interval prolongation can trigger dangerous arrhythmias and increase the risk of sudden death. Therefore, it is crucial to conduct thorough risk assessments and monitor the side effects of DR-TB treatment, especially for drugs that carry a risk of QT prolongation. Additionally, a good understanding of emergency management for arrhythmias is essential to ensure patient safety and treatment success.
Keywords: Tuberculosis, DR-TB, MDR-TB, QT Interval Prolongation, Arrhythmia.
EFEKTIVITAS TINDAKAN BRONHOALVEOLAR LAVAGE DALAM PENEGAKAN DIAGNOSIS TUBERKULOSIS PARU PADA PASIEN YANG KESULITAN MENGELUARKAN SPUTUM
EFEKTIVITAS TINDAKAN BRONHOALVEOLAR LAVAGE DALAM PENEGAKAN DIAGNOSIS TUBERKULOSIS PARU PADA PASIEN YANG KESULITAN MENGELUARKAN SPUTUM
Ade Yudisman1, Prayudi Santoso2, Arto Yuwono Soeroto2
1Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Padjadjaran/ RSUP Dr Hasan Sadikin Bandung
2Divisi Respirologi dan Penyakit Kritis Respirasi, Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Padjadjaran/ RSUP Dr Hasan Sadikin Bandung
Corresponding Author:
Ade Yudisman. 1Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Padjadjaran/ RSUP Dr Hasan Sadikin Bandung Jl Pasteur No. 38, Bandung, 10430, Indonesia. E-mail: yudismanade@yahoo.com
Abstrak
Latar belakang: Pemeriksaan Bakteri Tahan Asam (BTA) dan Test Cepat Molekular (TCM) pada penegakkan diagnosis TB Paru memerlukan specimen sputum. Penegakkan diagnosis menjadi sulit, bila sputum tidak didapatkan. Hal ini dapat menimbulkan overdiagnosis atau overtreatment serta undertreatment, terutama pada kasus terduga TBC resisten obat atau TB paru kasus kambuh dengan gejala klinis dan hasil interpretasi foto toraks yang menggambarkan TB namun tidak berhasil mendapatkan hasil bakteriologis. Pada kasus pasien tersebut, maka sputum untuk pemeriksaan bakteriologis bisa didapat melalui prosedur Bronhoalveolar Lavage (BAL) dengan menggunakan bronkoskopi. Hasilnya dapat membantu klinisi untuk tidak ragu-ragu memberikan terapi TB paru sensitif atau resisten obat, bahkan mungkin pasien tidak diberikan Obat anti Tuberkulosa (OAT) sama sekali. Metode: Penelitian kohort-retrospektif data primer yang diperoleh dari rekam medis dalam rentang januari 2023 sampai november 2024 di RSUD Cibabat. Subjek penelitian adalah pasien presumptive TB kasus baru dan kambuh dengan gejala klinis dan interpretasi gambaran toraks TB paru. Spesimen yang digunakan adalah hasil BAL menggunakan bronkoskopi fleksibel sebanyak > 5 cc. Spesimen dilakukan pemeriksaan BTA dengan pewarnaan Ziehl Neelsen (ZN), dan pemeriksaan TCM Ultra. Hasil: Dari 122 pasien presumptive TB baru, hasil dengan TCM positif 115 (94,3%), dan 7 (5,7%) yang negatif. Pada 34 pasien presumptive TB kambuh, subjek dengan hasil BTA positif adalah 4 (11,7%), sekaligus kesemuanya mendapatkan hasil TCM positif pula. Kesimpulan: BAL efektif untuk mendapatkan sputum bagi pasien yang tidak dapat mengeluarkan sputum spontan atau dengan kualitas buruk, sehingga menghindari keterlambatan diagnosis, mencegah overdiagnosis dan undertreatment. TCM sangat sensitif untuk kasus baru namun butuh hasil BTA positif pada diagnosis TB paru kasus kambuh.
Kata kunci: tuberkulosis paru, bronchoalveolar lavage, TCM, BTA, Brokoskopi
Abstract
Background: Bacteriological examinations of Acid-Fast Bacilli (AFB) and the Molecular Rapid Test (Xpert MTB/RIF test) for diagnosing pulmonary tuberculosis (TB) require sputum specimens. Diagnosis becomes challenging when sputum is unavailable, potentially leading to overdiagnosis, overtreatment, or undertreatment, particularly in cases of drug-resistant TB or recurrent pulmonary TB with clinical symptoms and chest radiographs suggestive of pulmonary TB but without bacteriological confirmation. In patients who have difficulty expectorating sputum, a specimen for bacteriological examination can be obtained through Bronchoalveolar Lavage (BAL) using bronchoscopy. The results can assist clinicians in making precise decisions, such as initiating therapy for drug-sensitive or drug-resistant pulmonary TB, or even refraining from administering Anti-Tuberculosis Drugs (ATDs) altogether. Methods: This retrospective cohort study utilized primary data collected from medical records between January 2023 and November 2024 at Cibabat General Hospital. The study subjects were presumptive new and recurrent pulmonary TB cases with clinical symptoms and chest X-ray interpretations suggestive of pulmonary TB, as reported in the Tuberculosis Information System of the Ministry of Health of the Republic of Indonesia. Specimens were obtained through BAL using flexible bronchoscopy, collecting >5 mL into sputum containers. The specimens were examined for AFB using Ziehl-Neelsen (ZN) staining and Xpert MTB/RIF test Ultra testing, including rifampicin resistance detection. Results: Among the group of presumptive new pulmonary TB cases, 115 (94.3%) of 122 subjects tested positive by Xpert MTB/RIF test, while only 7 (5.7%) were negative. In the group of presumptive recurrent pulmonary TB cases, 4 (11.7%) of 34 subjects tested positive for AFB, and all of these also tested positive by Xpert MTB/RIF test. Conclusion: BAL is a viable solution for obtaining sputum samples for bacteriological examination in patients unable to produce spontaneous or high-quality sputum. This approach can prevent delays in tuberculosis diagnosis, avoid overdiagnosis, and reduce undertreatment. Furthermore, MTB detection through BAL can identify drug resistance and assess the high risk of transmission. This facilitates timely diagnosis, appropriate therapy, and rapid contact investigation measures. While Xpert MTB/RIF test is highly sensitive for diagnosing new cases, positive AFB results remain critical for diagnosing recurrent pulmonary TB cases.
Keywords: pulmonary tuberculosis, bronchoalveolar lavage, AFB, bronchoscopy
INTERACTION OF TUBERCULOSIS IN DIABETES MELLITUS AS A RISK POPULATION- HOW TO PREVENT IT
Elcia Melisa Dwisari Simatupang1*, Fransiscus Ginting2,
Elvando Tunggul Mauliate Simatupang3
1Public Health Center of Uluan Sub-District, Government of Toba District, Province of North Sumatera
2Department of Internal Medicine, Haji Adam Malik Central General Hospital, Medan,
Province of North Sumatera
3Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Riau University, Pekanbaru, Province of Riau
ABSTRACT
Diabetes mellitus (DM) is a challenge in controlling Pulmonary Tuberculosis (PTB) cases. The increase in DM cases is one of the reasons that Indonesia is the second highest contributor of PTB cases in the world. The relationship between these two diseases impacts morbidity and mortality globally. This condition is based on the role of each individual’s immune system against Mycobacterium tuberculosis (Mtb) infection. Impairment of the innate and adaptive immune system in eliminating Mtb infection influences the increase of PTB cases with DM. Early prevention is important in the interaction of DM and PTB.
Keywords: Diabetes Mellitus, Tuberculosis,
Interaction, Risk Population
KILOTORAKS PADA PENDERITA ADENOKARSINOMA PARU
Katrin Wilentina Siahaan1, I Gede Ketut Sajinadiyasa2
1Program Studi Pendidikan Dokter Spesialis Penyakit Dalam, Fakultas Kedokteran Universitas Udayana/ RSUP. Prof. I.G.N.G. Ngoerah Denpasar,
Bali, Indonesia.
2Departemen/KSM Penyakit Dalam, Fakultas Kedokteran Universitas Udayana/
RSUP. Prof. Prof. I.G.N.G. Ngoerah Denpasar, Bali, Indonesia
ABSTRACT
Chylothorax is a rare cause of pleural effusion, secondary to accumulation of lymph in the pleural space. Diagnosis is based on the triglyceride and cholesterol content of pleural fluid obtained with thoracentesis. Chylothorax is usually described as traumatic or nontraumatic. Causes of nontraumatic chylothorax include a wide range of differential diagnoses. Thoracic malignancies and lymphoma are the most common causes and are responsible for chylothorax by extrinsic compression or invasion of the thoracic duct. One of the causes of nontraumatic chylothorax is lung cancer. The main cause of chylothorax is traumatic, typically postsurgical, secondary to iatrogenic direct puncture of the thoracic duct during thoracic surgery. Chylothorax is associated with significant morbidity and mortality if left untreated. The etiology, clinical presentation, and diagnosis and the management of chylothorax must be well understood to diagnose and provide appropriate therapy to patients.
Keyword: Chylothorax, Nontraumatic Chylothorax, Lung cancer