ANALYZING PANDEMIC IMPACTS ON RESPIRATORY DISEASE PATTERNS AND FUNCTIONAL OUTCOMES IN GERIATRIC INPATIENTS
Authors: Melinda Harini1, Jenica Xaviera Budiman2, Wanarani Alwin1, Megawati Al’badly Ponco Dewi Poernomo3
Affiliation:
1 Department of Physical Rehabilitation, University of Indonesia, Cipto Mangunkusumo Hospital, Jl. Salemba Raya No. 6, Jakarta Pusat, 10430, Indonesia
2 Medical Doctor Study Program, Faculty of Medicine, University of Indonesia, Jl. Salemba Raya No. 6, Jakarta Pusat, 10430, Indonesia
3Faculty of Medicine, University of Jenderal Soedirman, Jl. Dr. Gumbreg No.1, Purwokerto, 53112, Indonesia
Correspondence to: Melinda Harini, Departement of Physical Rehabilitation, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jl. Salemba Raya No. 6, Jakarta Pusat, 10430, Indonesia
E-mail: melindaharini@gmail.com
Phone number : +628159635765
ABSTRACT
Introduction: In 2020, COVID-19 has forced upon people for a change in their lifestyle to prevent and accommodate it, which may bring about its own set of positive and negative impacts.
Objectives: This research aims to analyze the effects of COVID-19 pandemic on the geriatric population in Jakarta through evaluation of changes in patient characteristics and disease variation of patients hospitalized in a major Indonesian hospital non-COVID geriatric inpatient ward.
Methods: This is a Retrospective study using secondary data of patients that was hospitalized in hospital’s geriatric inpatient ward between May 2019-December 2020. Data was collected from EHR and analyzed using IBM SPSS Statistics 27.0 for a cross-sectional design study.
Results: Changes of patients’ age group and gender is not statistically significant. The notable shifts within medical diagnosis group are the increase of incidence of non-COVID respiratory infections (9.6% to 12.64%), encephalopathy cases (2.7% to 6.7%), and gastrointestinal bleeding (5.7% to 7.1%), and decrease in cardiovascular diseases incidence (20.5% to 13.8%) and neoplasm cases (12.8% to 8.6%). Within functional diagnosis group, there is increase in mobility disorders (24% to 30.1%).
Conclusion: COVID-19 pandemic does not cause significant change in patients’ characteristics (gender and age group), but significantly causes a shift in the variation of diseases recorded as the main reason for patients’ admission into the inpatient ward. Future studies should evaluate strategies to help geriatric patients in cases like COVID pandemic, due to the increased incidence in mobility disorders, non-COVID respiratory infections, gastrointestinal bleeding, and encephalopathy.
Key words: COVID-19, functional diagnosis, geriatric patients, pandemic
EFEKTIVITAS PENAMBAHAN TERAPI BESI INTRAVENA BERSAMA TRANSFUSI DARAH PADA PASIEN ANEMIA AKIBAT DEFISIENSI BESI
Farell Omar Dwipayana, Gurmeet Singh
Program Studi Profesi Dokter, Fakultas Kedokteran Universitas Indonesia
Divisi Respirologi dan Penyakit Kritis, Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo, Fakultas Kedokteran Universitas Indonesia
ABSTRAK
Latar Belakang: Anemia defisiensi besi sering memerlukan stabilisasi cepat dengan transfusi packed red cells (PRC), namun transfusi tidak mengatasi defisit besi. Besi intravena berpotensi mempercepat normalisasi hemoglobin.
Tujuan: Menilai efektivitas dari penambahan besi IV bersamaan dengan transfusi dibandingkan transfusi saja pada pasien dewasa dengan ADB.
Metode: Pencarian literatur dilakukan di 3 database (PubMed, Cochrane, Scopus). Kriteria yang digunakan adalah pasien dewasa, ADB, intervensi kombinasi (PRC+besi IV) vs PRC saja, dengan luaran utama peningkatan kadar Hb. Karena tidak ditemukan uji langsung/tinjauan sistematis mengenai terapi kombinasi vs PRC, sintesis data menggunakan bukti tidak langsung dengan telaah kritis terhadap tinjauan sistematis perbandingan besi IV vs PRC pada populasi ADB.
Hasil: Bukti tidak langsung menunjukkan PRC memberi kenaikan Hb lebih cepat, sedangkan besi IV unggul dalam pemulihan Hb pada 3–12 minggu, dan berpotensi mencegah anemia berulang dan menurunkan kebutuhan transfusi. Namun, heterogenitas populasi (perioperatif, postpartum, fraktur panggul, hamil) tinggi dan meta-analisis gabungan tidak dapat dilakukan.
Kesimpulan: Pada pasien dewasa ADB yang memerlukan stabilisasi cepat, strategi kombinasi PRC+besi IV direkomendasikan untuk mendapatkan stabilisasi segera sekaligus pemulihan Hb berkelanjutan. Namun, rekomendasi ini berbasis bukti tidak langsung, uji acak terkontrol masih diperlukan.
Kata Kunci: anemia defisiensi besi, transfusi PRC, besi intravena
Prevalence and Characteristic of Post-Intensive Care Syndrome Patient in Indonesia: A Multi-Centre Prospective Cohort Study
1,2Peggy Sunarjo, 2Widjajalaksmi Kusumaningsih, 2Luh Karunia Wahyuni, 3Dita Aditianingsih, 4Retno Asti Werdhani, 5Kristiana Siste Kurniasanti, 6Wisnu Ananta Kusuma, 7Siti Chandra Widjanantie, 7Anitta Florence Stans Paulus,8Ernita Akmal,9 Tresia Fransiska Tambunan
1Doctoral Program in Medical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
2Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Indonesia—Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
3Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia—Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
4Department of Community Medicine, Faculty of Medicine, Universitas Indonesia—Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
5Department of Psychiatry, Faculty of Medicine, Universitas Indonesia—Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
6Department of Computer Science, Faculty of Mathematics and Natural Sciences, IPB University, Bogor, Indonesia
7Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Indonesia—Persahabatan General Hospital, Jakarta, Indonesia
8Department of Anesthesiology and Intensive Care, Persahabatan General Hospital, Jakarta, Indonesia
9Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Indonesia—Universitas Indonesia General Hospital, Depok, Indonesia
Corresponding Author: Peggy Sunarjo; Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Indonesia—Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia; Email: roswitapeggy@gmail.com.
ABSTRACT
Background: Advances in critical care management have increased survival rates during intensive care unit (ICU) care. However, many survivors experience Post-Intensive Care Syndrome (PICS), a complex of physical, cognitive, and mental health disorders that progress from the ICU and hospital discharge. Still, data on PICS prevalence in Indonesia remain limited. This study aimed to determine the prevalence and characteristics of PICS among ICU survivors in tertiary hospitals.
Methods: This cohort study from July 2024 – 2025 across three tertiary teaching hospitals in Indonesia. Adult ICU survivors discharged for at least one month were assessed using the validated Indonesian version of the Post-Intensive Care Syndrome Questionnaire (PICSQ). Patient characteristics were categorized into pre-ICU, durante-ICU, and post-ICU variables. PICS diagnosis was established if impairment was present in at least one domain.
Results: A total of 132 subjects (53.8% male; mean age range 18–70 years) were included. The prevalence of PICS was 30.3%. Mental impairment was the most common (28%), followed by cognitive (19.7%) and physical impairments (16.7%). Combined impairments were also observed: cognitive–physical (6.9%), cognitive–mental (7.5%), physical–mental (10.6%), and all three domains (10.6%). Cardiovascular disease (46.2%) was the most frequent primary ICU diagnosis, and comorbidities were present in 67% of subjects. Early rehabilitation was provided to 62.1% of patients, though it did not significantly improve mental health outcomes. At discharge, 47.8% of subjects were independent, while the remainder showed varying levels of dependency.
Conclusion: Approximately one-third of ICU survivors in Indonesia experienced PICS within one month post-discharge, with mental impairment being the most prevalent domain. These findings highlight the urgent need for systematic post-ICU screening, multidisciplinary rehabilitation programs, and long-term follow-up to improve quality of life after discharge.
Keywords: Post-Intensive Care Syndrome, ICU survivors, prevalence, cognitive impairment, mental health, Indonesia
Profil Tuberkulosis Ekstra Paru Di RS Ngoerah
I Gede Ketut Sajinadiyasa1, Gede Dilajaya Robin2, Ni Made Dewi Dian Sukmawati3
1Departemen/KSM Penyakit Dalam, Fakultas Kedokteran Universitas Udayana/ RS Ngoerah, Denpasar, Bali, Indonesia
2Program Studi Pendidikan Dokter Spesialis Penyakit Dalam, Fakultas Kedokteran Universitas Udayana/RS Ngoerah, Denpasar, Bali, Indonesia.
3Departemen/KSM Penyakit Dalam, Fakultas Kedokteran Universitas Udayana/ RS Ngoerah, Denpasar, Bali, Indonesia
Korespondensi: I Gede Ketut Sajinadiyasa/085237068670/ sajinadiyasa@unud.ac.id
ABSTRAK
Latar belakang: Tuberkulosis sangat menular, ditularkan dari manusia ke manusia melalui udara sewaktu berbicara, batuk, bersin, dan lain - lain. Dari WHO secara global pada tahun 2022, 7,5 juta orang ditemukan dengan kasus baru yang didiagnosis tuberkulosis, 83% di antaranya dengan TB paru dan 17% dengan TB paru ekstra. Daerah dengan jumlah kasus TB paru ekstra tertinggi adalah Mediterania Timur (22%) dan Asia Tenggara (21%).
Metode: Desain penelitian yang digunakan adalah studi deskriptif menggunakan pendekatan cross-sectional, untuk menentukan ikhtisar tuberkulosis ekstrapulmonary. Subjek penelitian adalah pasien TB yang tercatat di Poliklinik TB RS Ngoerah Denpasar pada 2023. Metode pengambilan sampel menggunakan pengambilan sampel total.
Hasil: Dari penelitian ini, ditemukan bahwa lebih sedikit orang yang didiagnosis menderita TB paru ekstra daripada TB non-ekstra-paru. Sebanyak 62 orang (43,4%) didiagnosis menderita TB paru ekstra dan 81 orang (56,6%) tidak didiagnosis menderita TB paru ekstra. Jenis TB ekstra paru yang paling umum adalah TB yang disebarkan (32,7%). Angka kematian juga tertinggi dalam penyebaran TB (15,4%).
Kesimpulan: Dari penelitian ini, lebih banyak kasus ditemukan pada pria, usia < 60 tahun, dan dengan TB yang disebarkan. Dari tingkat kematian TB ekstrapulmonary, lebih banyak kasus TB ekstrapulmonary yang meninggal adalah laki-laki, berusia <60 tahun dan dengan penyebaran TB. Berdasarkan hasil penelitian ini, perlu dilakukan penelitian lebih lanjut, karena penelitian ini hanya menjelaskan karakteristik data dalam bentuk deskriptif, tanpa menjelaskan hubungan antara faktor-faktor ini sehubungan dengan risiko kematian akibat TB paru ekstra.
Kata kunci: tuberkulosis paru ekstra, kematian, jenis
Uncovering Hemodynamic Innovation: An Integrated Bibliometric Analysis of the Use of Doppler Technology in the Diagnosis and Management of Obstructive Sleep Apnea
Arman Yurisaldi Saleh1, Dwi Arwandi Yogi Saputra2, Riezky Valentina3, Tirta Darmawan Susanto 4
1Neurology Department Faculty of Medicine UPN Veteran Jakarta, Indonesia
2Department of Public Health Sciences, Faculty of Medicine, UPN Veteran Jakarta, Indonesia
3Neurology Department Faculty of Medicine UPN Veteran Jakarta, Indonesia
4Family Medicine and Primary Care Department, Universitas Pelita Harapan, Indonesia
(*Corresponding author’s e-mail: drarmanyurisaldic@gmail.com)
Abstract
1) Introduction: Obstructive Sleep Apnea (OSA) is a sleep disorder causing hypertension, cardiovascular disease, and metabolic disorders. Doppler technology, a non-invasive imaging method, is used to detect vascular changes in OSA patients. A bibliometric review of literature on Doppler use in OSA cases can help identify trends and areas for further study. This analysis can reveal leading journals, influential authors, and the relationship between diagnostic technology and clinical knowledge. It can also help in setting research priorities and developing innovative solutions for OSA diagnosis and management.; 2) Materials and methods: This research aims to explore the evolution of scientific disciplines by finding and identifying trends, patterns and correlations in scientific texts related to certain topics. The focus of this study was doppler and osa or osbstructive sleep apneu using both quantitative and qualitative analysis. 3) Results and discussion:. Bibliometric analysis reveals increasing publications, global collaboration, significant diagnostic standards are not yet evenly distributed; Doppler technology effectively detects hemodynamic dynamics in OSA. and 4) Conclusions: The review emphasizes the importance of Doppler technology in improving OSA diagnostics and treatments. It highlights the need for collaboration between academic, clinical, and technological domains to improve care standards. The study highlights the transformative potential of hemodynamic understanding and Doppler technology in sleep medicine. This research was conducted in April 2025
Keywords: Obstructive Sleep Apnea (OSA), Doppler Ultrasound, Hemodynamics, Bibliometrics, Diagnostics, Management, Sleep Medicine
Subcutaneus Emphysema– a Very Rare Asthma Complication
Raihan Ar’ Rachman¹, Prayudi Santoso², Yana Akhmad Suryana²
¹Department of Internal Medicine, Hasan Sadikin General Hospital, Faculty of Medicine, Universitas Padjadjaran,
Bandung, Indonesia
²Division of Pulmonology and Critical Care, Department of Internal Medicine, Hasan Sadikin General Hospital, Faculty
of Medicine, Universitas Padjadjaran, Bandung, Indonesia
ABSTRACT
Background:
Asthma is a chronic inflammatory disease that causes partially or completely reversible airway obstruction¹. Common asthma complications include severe asthma and severe hypoxemia. Pneumomediastinum and subcutaneous emphysema represent rare complications of acute asthma exacerbation. The incidence of pneumomediastinum is approximately 1:44,000, with 70% presenting with subcutaneous emphysema. The underlying mechanism is characterized by alveolar rupture due to a sudden increase in intrathoracic pressure Although typically self-limiting, delayed recognition may lead to potentially serious outcomes⁴.
Case Presentation:
We report a female who presented with shortness of breath for two days prior to admission, accompanied by productive cough with yellow sputum and fever. The patient further experienced (don’t repeat “accompanied by”) swelling of the neck extending to the chest, along with pain and wheezing during breathing. The patient had a history of asthma with almost daily exacerbations and chronic electronic cigarette use. Examination showed neck-to-chest swelling with crepitus and bilateral wheezing. Radiography confirmed that she had pneumonia, pneumomediastinum, and subcutaneous emphysema. She was treated with antibiotics, bronchodilators, and supportive therapy, and improved within five days.
Conclusion:
Subcutaneous emphysema is a rare complication of acute asthma exacerbation. Although generally self-limiting, rapid diagnosis through clinical and radiological evaluation can prevent more severe complications. Conservative treatment provides good outcomes when performed promptly and appropriately.
Keywords: asthma, pneumomediastinum, subcutaneous emphysema
Uji Diagnostik Lipoarabinomannan Urin untuk Deteksi Mycobacterium tuberculosis pada Pasien Dengan dan Tanpa Infeksi HIV
Dean Handimulya Djumaryo1, Gurmeet Singh2, I Puta Eka Krisnha Wijaya2, Andriana Kirana Puspa1
1Departemen Patologi Klinik, Fakultas Kedokteran Universitas Indonesia dan Rumah Sakit Cipto Mangunkusumo, Jakarta
2Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia dan Rumah Sakit Cipto Mangunkusumo, Jakarta
ABSTRAK
Latar belakang
Uji diagnostik tuberkulosis (TB) sebagian besar masih bergantung pada sampel sputum yang sulit diperoleh pada anak-anak, pasien dengan TB ekstrapulmoner, serta orang dengan Human Immunodeficiency Virus (ODHA). Komponen utama dinding sel Mycobacterium tuberculosis (Mtb), yaitu lipoarabinomannan (LAM) yang berperan sebagai faktor virulensi dan dapat masuk ke sirkulasi darah. Karena ukuran molekulnya yang kecil, LAM dapat difiltrasi oleh ginjal dan diekskresikan dalam urin. Deteksi LAM urin menawarkan pendekatan non invasif yang mudah dilakukan, sehingga berpotensi menjadi point of care testing (POCT) untuk diagnosis TB, terutama pada populasi dengan kesulitan pengambilan sputum atau status imunokompromais seperti ODHA.
Metode
Penelitian ini merupakan studi potong lintang yang dilakukan di RSUPN Dr. Cipto Mangunkusumo pada 96 subjek dengan dugaan tuberkulosis (TB), baik dengan maupun tanpa infeksi Human Deficiency Virus (HIV). Sampel urin diperiksa menggunakan Abbott Determineä TB LAM Ag, suatu uji imunokromatografi untuk deteksi antigen LAM. Hasil pemeriksaan dibandingkan dengan composite reference standard, yaitu hasil positif dari salah satu pemeriksaan real time polymerase chain reaction (RT-PCR), pulasan batang tahan asam (BTA), atau kultur BTA. Uji normalitas data numerik dianalisis menggunakan uji Kolmogorov-Smirnov dan disajikan dalam bentuk nilai tengah (nilai terendah-tertinggi). Data kategorik disajikan dalam bentuk frekuensi absolut (n) dan persentase (%). Performa diagnostik uji LAM dinilai berdasarkan sensitivitas, spesifitas, nilai prediktif, dan akurasi.
Hasil
Dari 96 subjek penelitian, sensitivitas, spesifisitas, nilai prediktif positif (NPP), dan nilai prediktif negatif (NPN) uji LAM urin terhadap hasil pemeriksaan bakteriologis TB berturut-turut adalah 51%, 68%, 46%, dan 73%. Pada 33 subjek dengan infeksi HIV, nilai sensitivitas, spesisifitas, NPP dan NPN masing-masing adalah 54%, 59%, 40%, dan 72%. Sedangkan pada 63 subjek tanpa infeksi HIV, sensitivitas dan NPP masing-masing sebesar 50%, serta spesifisitas dan NPN sebesar 73%. Uji LAM urin menunjukkan performa diagnostik sedang, dengan sensitivitas sedikit lebih tinggi pada pasien dengan HIV dibandingkan tanpa HIV.
Kesimpulan
Pemeriksaan LAM urin merupakan metode yang cepat dan sederhana untuk membantu diagnosis tuberkulosis. Uji ini menunjukkan performa diagnostik sedang, dengan sensitivitas yang lebih tinggi pada pasien dengan infeksi HIV dibandingkan tanpa HIV, sehingga lebih bermanfaat sebagai alat bantu diagnosis pada populasi tersebut.
Kata kunci: Human Immunodeficiency Virus, Lipoarabinomannan, Tuberkulosis, Point of care testing, Urin
The Unclassical Manifestation of Tuberculosis: Mimicking Lung Metastasis and Cutaneous Lymphoma: Case Report
Shanaz Novriandina [1], Yana Akhmad [2], Risa Miliawati [3], Pramesti Indri [4], Prayudi Santoso [2]
[1] Department of Internal Medicine, Fakultas Kedokteran Universitas Padjadjaran / RSUP Dr. Hasan Sadikin Bandung
[2] Respirology and Critical Disease Division, Department of Internal Medicine, Fakultas Kedokteran Universitas Padjadjaran / RSUP Dr. Hasan Sadikin Bandung
[3] Department of Dermatology and Venereology, Fakultas Kedokteran Universitas Padjadjaran / RSUP Dr. Hasan Sadikin Bandung
[4] Department of Radiology, Fakultas Kedokteran Universitas Padjadjaran / RSUP Dr. Hasan Sadikin Bandung
Abstract
Background: Lung Tuberculosis (TB) may occur with atypical presentations and radiological findings that mimic lung metastasis and cutaneous lymphoma. Diagnostic challenges for atypical TB will increase the risk of delaying proper treatment, irrational use of broad-spectrum antibiotics, and continuing transmission of Mycobacterium tuberculosis (Mtb).
Case: A 57-year-old woman presented with a one-year history of a chronic non-healing ulcer over the axilla and inguinal regions, along with multiple discharging sinuses and surrounding induration. The lesions were initially described as bacterial abscesses or hidradenitis suppurativa. She was repeatedly given a systemic antibiotic and a topical corticosteroid over two months. However, her condition deteriorated and was complicated by secondary infection. Xpert Mtb/RIFon sputum and pus detected rifampicin-sensitive Mtb, and a skin biopsy revealed features consistent with scrofuloderma. A diagnosis of disseminated TB was established, and she started on anti-tuberculosis treatment and showed clinical improvement after four weeks.
Discussion: The delayed diagnosis of disseminated TB mimicking lung metastasis and cutaneous lymphoma resulted in delayed treatment of anti-tuberculosis and progressive worsening of clinical symptoms. The diagnosis was made based on Xpert Mtb/RIFon sputum and pus in the wound base, thoracic CT scan, and skin biopsy. The patient was started on anti-tuberculosis therapy and showed clinical improvement after four weeks of treatment.
Conclusion: Chronic ulcers that have worsened despite systemic broad-spectrum antibiotics should be considered as cutaneous tuberculosis. Scrofuloderma, the most common cutaneous tuberculosis, is one of the markers of disseminated TB. It requires assessment to confirm pulmonary and extrapulmonary TB.
Keywords: Scrofuloderma; lung tuberculosis; disseminated tuberculosis; lung metastasis
DIAGNOSIS DAN TATALAKSANA CHRONIC PULMONARY ASPERGILOSIS
Andhika Pangestu1*, Gurmeet Singh*2
1Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia – RSUPN dr. Cipto Mangunkusumo, Jakarta, Indonesia
2Divisi Respirologi dan Penyakit Kritis, Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia – RSUPN dr. Cipto Mangunkusumo, Jakarta, indonesia.
Korespondensi*:
Divisi Respirologi dan Penyakit Kritis, Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia – RSUPN dr. Cipto Mangunkusumo, Jakarta, indonesia. Jln. Diponegoro No. 70. Jakarta, Indonesia.
Email: gurmeetsingh10@yahoo.com, andhika.pangestu@ui.ac.id
Abstract
Chronic Pulmonary Aspergillosis (CPA) is a spectrum of pulmonary infectious diseases. The incidence of CPA is increasing year by year. CPA is part of pulmonary mycosis, which is also increasing in incidence, as are cases of TB infection, chronic obstructive pulmonary disease (COPD), lung cancer, and other pulmonary diseases. The incidence of CPA is often found in conjunction with other pulmonary infections such as pulmonary TB. CPA is caused by Aspergillosis sp, 90% of which is caused by Aspergillus fumigatus. Clinical manifestations vary with systemic and respiratory symptoms, with a case fatality rate of approximately 20-33% in the short term and more than 50% over a 5-year period. Adequate and holistic diagnostic and management approaches play a crucial role in improving outcomes, quality of life, and survival rates in CPA patients.
Keywords: Chronic Pulmonary Aspergillosis, CPA, Diagnosis, Management
Abstrak
Chronic Pulmonary Aspergillosis (CPA) merupakan spektrum dari penyakit infeksi paru. Insidensi CPA meningkat dari tahun ke tahun. CPA merupakan bagian dari penyakit mikosis paru yang juga kejadiannya meningkat seperti kasus infeksi TB, penyakit paru obstruktif kronik (PPOK), keganasan paru dan penyakit paru lainnya. Insidensi CPA sering dijumpai bersamaan dengan infeksi paru lainnya seperti TB paru. CPA diakibatkan oleh Aspergillosis sp, 90% disebabkan oleh Aspergillus fumigatus. Manifestasi klinis bervariatif dengan gejala sistemik dan gejala respirasi, dengan case fatality rate sekirat 20-33% pada jangka pendek serta lebih dari 50% pada rentang waktu 5 tahun. Pendekatan diagnosis dan tatalaksana adekuat dan holistik berperan penting untuk meningkatkan outcome, quality life dan survival rate pada pasien CPA.
Kata kunci: Chronic Pulmonary Aspergillosis, CPA, Diagnosis, Tatalaksana
Faktor-faktor yang Mempengaruhi Kejadian Depresi pada pasien Obstructive Sleep Apnea (OSA) dan Tatalaksananya
Shatri H1, Pangestu A2, Jeger DP1, Irvianita V1, Faisal E1, Putranto R1
1Divisi Psikosomatik dan Paliatif, Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia, Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo
2Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia, Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo
Correspondence:
Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia –
RSUPN dr. Cipto Mangunkusumo, Jakarta, Indonesia. Jln. Diponegoro No. 70. Jakarta, Indonesia.
Email : andhika.pangestu@ui.ac.id, pangestudhika27@gmail.com
Abstract
Obstructive Sleep Apnea (OSA) is anupper airway obstruction that causes periods of breathing cessation. OSA is a sleep disorder breathing syndrome that can have long-term effects such as metabolic dysfunction, insulin resistance, and, if further progresses, can cause microvascular and macrovascular complications that can increase morbidity and mortality rates. The multifactorial causes of depression in OSA patients are influenced by internal and external factors. The management approach for depressive disorders in OSA patients involves a multidisciplinary team and a combination of pharmacological and non-pharmacological management approaches, as well as the management of comorbid conditions in patients.
Keywords: Obstructive Sleep Apnea, sleep disorder breathing syndrome
Abstrak : Obstructive Sleep Apnea (OSA) merupakan suatu obstruksi jalan nafas atas yang menyebabkan periode nafas berhenti. OSA sebagai sleep disorder breathing syndrome yang dapat memiliki efek jangka panjang seperti disfungsi metabolik, resistensi insulin dan bila lebih lanjut dapat menyebabkan komplikasi mikrovaskular dan makrovaskular yang dapat meningkatkan angka morbiditas dan mortalitas. Multifaktorial penyebab depresi pada pasien OSA dipengaruhi oleh faktor internal dan eksternal. Pendekatan tatalaksana gangguan depresi pada pasien OSA melibatkan tim multidisiplin dan pendekatan tatalaksana medikamentosa dan non-medikamentosa serta tatalaksana komorbid pada pasien.
Kata Kunci : Sindrom Gangguan Pernapasan Saat Tidur; Sindrom Apnea Obstruktif Saat Tidur
Delayed-Onset Linezolid-Induced Severe Anemia in a Young Patient With Spinal Rifampicin-Resistant Tuberculosis
Herikurniawan1*, Aziza Harris
1 Division of Respirology and Critical Care, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo National Hospital.
*Correspondence Author; 085643606817; herikurniawan.md@gmail.com
ABSTRACT
Background: Linezolid is a core drug in regimens for multidrug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB) due to its potent intracellular activity against Mycobacterium tuberculosis. However, prolonged use is associated with cumulative hematologic toxicity, which can develop insidiously during extended treatment.
Case Presentation: We present the case of a 20-year-old female with spinal RR-TB who developed severe anemia after 11 months on a linezolid-containing regimen, following an initially stable hematologic profile. Laboratory monitoring revealed progressive anemia (hemoglobin 5.9 g/dL) and leukopenia (white blood cell count 1,790/mm³). Bone marrow suppression secondary to linezolid toxicity was suspected. Discontinuation of linezolid and transfusion support led to gradual hematologic recovery.
Conclusion: This case highlights the potential for delayed-onset, yet reversible, hematologic toxicity during long-term linezolid therapy, even in young patients without traditional risk factors. Sustained hematologic monitoring throughout the entire treatment course is essential to ensure patient safety and optimize outcomes in RR-TB management.
Keywords: Linezolid, Bicytopenia, Rifampicin-Resistant Tuberculosis, Hematologic Toxicity, Long-Term Monitoring, Case Report
ABSTRAK
Latar Belakang: Linezolid merupakan salah satu obat utama dalam rejimen pengobatan tuberkulosis multidrug resistant dan resisten rifampisin (MDR/RR-TB) karena aktivitas intraselulernya yang kuat terhadap Mycobacterium tuberculosis. Namun, penggunaan jangka panjang linezolid dikaitkan dengan toksisitas hematologis kumulatif yang dapat berkembang secara perlahan selama pengobatan berkepanjangan.
Presentasi Kasus: Kami melaporkan kasus seorang perempuan usia 20 tahun dengan tuberkulosis RR pada tulang belakang yang mengalami anemia berat setelah 11 bulan menjalani pengobatan dengan rejimen yang mengandung linezolid, meskipun sebelumnya profil hematologisnya stabil. Pemantauan laboratorium menunjukkan anemia progresif (hemoglobin 5,9 g/dL) dan leukopenia (jumlah leukosit 1.790/mm³). Supresi sumsum tulang akibat toksisitas linezolid dicurigai sebagai penyebabnya. Penghentian linezolid dan pemberian transfusi mendukung pemulihan hematologis secara bertahap.
Kesimpulan: Kasus ini menyoroti potensi toksisitas hematologis dengan onset tertunda namun reversibel selama terapi linezolid jangka panjang, bahkan pada pasien muda tanpa faktor risiko tradisional. Pemantauan hematologis yang berkelanjutan sepanjang durasi pengobatan sangat penting untuk menjaga keselamatan pasien dan mengoptimalkan hasil terapi pada kasus RR-TB.
Kata Kunci: linezolid, bisitopenia, tuberkulosis resisten rifampisin, toksisitas hematologis, pemantauan jangka panjang, laporan kasus
DOI: 10.2614/ijc.v12i2