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Vol 11 No 1 (2024)

Physical Medicine and Rehabilitation Management of Patient With Bilateral Lung Bullar: a Case Report

Tresia Fransiska Uliana Tambunan1, Dinna Yulistya Ningrum2, Dave Nicander Kurnain3

1Cardiorespiration Division, Physical Medicine and Rehabilitation Department, University of Indonesia, Jakarta

2Physical Medicine and Rehabilitation Resident University of Indonesia, Jakarta

3Faculty of Medicine, Tarumanagara University, Jakarta

Correspondent:

Tresia Fransiska UT, Cardiorespiratory division, Physical Medicine and Rehabilitation department, University of Indonesia, Jakarta.

Email: fransiska_ut@yahoo.com.au   

Phone: +62 816-1976-762

Abstract

Lung bullae are defined as air spaces in the lungs, measuring more than 1 cm in diameter when distended, while giant bullae occupy at least 30% of the hemithorax. Bullae are thought to be in contact with the bronchial tree; they are preferentially filled during inspiration, causing collapse of the adjacent normal lung parenchyma. Clinical manifestations of giant bullae include cough, dyspnea, and chest pain, but in some cases, the condition may be asymptomatic. Although the diagnosis of infected bullae has been reported, tuberculosis as a causative pathogen is rare. This case Present a 27 year old male patient came to the medical rehabilitation department of feeling easily tired when walked more than 8 meters. The patient was initially diagnosed with pulmonary tuberculosis 14 months ago, and completed 12 months of antituberculosis treatment. He underwent a thoracotomy decortication wedge resection of the right superior lobe of lung and another thoracotomy to evacuate the haematoma and control the bleeding two weeks before admision. From the physical examination, he had forward head posture, rounded shoulders, and slight hyperkyphotic posture. Respiromotor status showed decreased chest expansion and asymmetrical movement during respiration. Two weeks after rehabilitation program consist of breathing control, chest expansion exercise, airway clearance technique, and aerobic exercises, the patient shows improvement.

Key words: Lung Bullae, Rehabilitation, Thoracotomy, Tuberculosis.

Abstrak

Bula paru didefinisikan sebagai ruang udara di paru-paru, berukuran diameter lebih dari 1 cm saat menggembung, sedangkan bula besar menempati setidaknya 30% hemithorax. Bula diperkirakan bersentuhan dengan cabang bronkial; yang terisi selama selama inspirasi, menyebabkan kolapsnya parenkim paru normal. Manifestasi klinis dari bula besar meliputi batuk, dispnea, dan nyeri dada, namun pada beberapa kasus, kondisi ini mungkin tidak menunjukkan gejala. Meskipun diagnosis bula yang terinfeksi telah dilaporkan, tuberkulosis sebagai patogen penyebab jarang terjadi. Laporan kasus ini melaporkan seorang laki-laki berusia 27 tahun datang ke bagian rehabilitasi medis dengan perasaan mudah lelah jika berjalan lebih dari 8 meter. Pasien awalnya terdiagnosis tuberkulosis paru 14 bulan yang lalu, dan menyelesaikan pengobatan antituberkulosis selama 12 bulan. Dia menjalani reseksi dekortikasi torakotomi pada lobus paru superior kanan dan torakotomi lainnya untuk mengevakuasi hematoma dan mengontrol pendarahan dua minggu sebelum datang ke rumah sakit. Dari pemeriksaan fisik didapatkan postur kepala ke depan, bahu membulat, dan postur sedikit hiperkimfosis. Status respiromotor menunjukkan penurunan ekspansi dada dan gerakan asimetris saat respirasi. Dua minggu setelah program rehabilitasi yang terdiri dari kontrol pernapasan, latihan ekspansi dada, teknik pembersihan jalan napas, dan latihan aerobik, pasien menunjukkan perbaikan.

Kata kunci: Bula paru, Rehabilitasi, Torakotomi, Tuberkulosis.

Vol 11 No 1 (2024)

A Rare Extrapulmonary Tuberculosis, Hepatic Tuberculosis: A Case Report

Ghea Arifah Shabrina1, Telly Kamelia2

1Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

2Pulmonary and Respiratory Medicine Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

 

 

 

ABSTRACT

Introduction:

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis, a disease that attacks the lung parenchyma and can infect other organs. Tuberculosis is a significant health problem and is highly prevalent in developing countries. Abdominal Tuberculosis (TB) is a rare variant of TB, and hepatic tuberculosis is the most infrequent manifestation of tuberculosis infections.

 

Case Illustration:

A 44-year-old female patient complained of abdominal pain since one year ago. Abdominal pain felt in the lower right abdomen, sometimes spreading to the back side. Abdominal pain felt intermittent, not affected by eating or defecation. There were no complaints of fever, cough, shortness of breath, chest pain, and palpitations. The patient denied weight loss, loss of appetite, night sweats, or fluctuating fever. There was no prior history of tuberculosis. These patients have normal liver function and elevated alkaline phosphatase. Multiple calcified hypodense lesions appear in segments VII-VIII of the liver in a Computed Tomography (CT) Scan. A liver biopsy showed clusters of epithelioid cells accompanied by multinucleated giant cells. There was also necrosis resembling caseous necrosis with negative Acid-Fast Bacteria staining. The histological conclusion was following granulomatous inflammation, the possibility of tuberculosis infection could not be ruled out, and no malignant tumor cells were found in the preparations. The stage of fibrosis is around F2-F3. The patient was then diagnosed with hepatic tuberculosis and received anti-tuberculosis therapy. Obtained resolution of abdominal pain improvement and assessment of liver function remained normal after this 2-week treatment.

 

Conclusion:

Hepatic TB is a manifestation of extrapulmonary TB, which is rarely found. Anamnesis, physical examination, and supporting examinations are carried out to diagnose hepatic TB. Investigations such as imaging and liver biopsy can help diagnose this type of TB. The treatment given for hepatic TB is given according to the same regimen as other extrapulmonary TB.

 

Keywords: Hepatic Tuberculosis, Extrapulmonary Tuberculosis, Diagnosis, Management

Vol 11 No 1 (2024)

Bronchial Thermoplasty in Severe Asthma Patients: A Literature Review

Yosua Kevin Hermawan1, Ida Ayu Ika Wari Utami2

1 Department of Pulmonology and Respiratory Medicine, Wangaya General Hospital, Denpasar, Indonesia
2 Department of Pulmonology and Respiratory Medicine, Wangaya General Hospital, Denpasar, Indonesia

Abstract

Severe asthma is caused by chronic inflammation in the airway. Several treatments have been proposed to treat severe asthma. Bronchial thermoplasty is part of management that has been proposed to treat severe asthma. The treatment has been mentioned in asthma guidelines released by Global Initiative for Asthma (GINA) as an interventional management option in uncontrolled severe asthma. Bronchial thermoplasty is approved for patients with the age of at least 18 years old. The treatment is focus on airway smooth muscle by delivering radiofrequency ablation using bronchoscopy. Airway remodeling is an important feature in the disease course of asthma. There are three large randomized trial that has been done for bronchial thermoplasty. The trials recorded an increase in quality of life from asthma patients that have been treated and reduce in exacerbation frequency in long term follow up. The trials also show increased in emergency departments visit and asthma exacerbation for within a certain period after the procedure. Long term follows up of the patients that has undergone the procedure show no deterioration in terms of lung function, indicating a persistent effect of the bronchial thermoplasty. Better understanding in mechanisms of the procedure in the airway and more trials about safety and efficacy is still needed.

Keywords: Bronchial Thermoplasty, Airway smooth muscle, Interventional

Vol 11 No 1 (2024)

Terapi Inhalasi Konvensional Pada Pasien Dewasa

 

Fatih Anfasa1, Gurmeet Singh2

 

 

1 Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia, Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo

2 Divisi Respirologi dan Penyakit Medis Kritis, Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia, Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo

Alamat korespondensi: Dr. dr. Gurmeet Singh, SpPD, K-P. Departemen Ilmu Penyakit Dalam FKUI-RSCM. Jl Diponegoro No. 71, Jakarta Pusat.

Alamat email: gurmeetsingh10@yahoo,com

 

Abstrak

Terapi inhalasi konvensional merupakan salah satu terapi penting pada berbagai penyakit saluran nafas, terutama asma dan penyakit paru obstruktif kronik (PPOK). Pemberian obat melalui inhalasi memberikan berbagai keuntungan dibandingkan pemberian obat melalui jalur lainnya terutama untuk penyakit yang melibatkan organ pernapasan. Meskipun demikian, keefektifan terapi akan berkurang jika pasien tidak dapat menggunakan alat inhalasi dengan tepat. Kesalahan pemakaian alat inhalasi berhubungan dengan menurunnya kontrol penyakit asma, prognosis PPOK yang buruk, serta meningkatkan morbiditas dan mortalitas. Sari pustaka ini bertujuan untuk menjabarkan mekanisme terapi inhalasi konvensional dan berbagai modalitas terapi yang ada untuk pasien dewasa.   

Kata Kunci: terapi inhalasi, pasien dewasa

 

 

Abstract

Conventional inhalation therapy is an important therapy for various respiratory diseases, especially asthma and chronic obstructive pulmonary disease (COPD). Administering drugs via inhalation provides various advantages compared to other routes, especially for diseases involving the respiratory organs. However, the effectiveness of therapy will be reduced if the patient cannot use the inhalation devices correctly. Incorrect use of inhalation devices is associated with decreased asthma control, poor COPD prognosis, as well as increased morbidity and mortality. This article aims to describe the mechanism of conventional inhalation therapy and various therapeutic modalities available for adult patients.

Keywords: inhalation therapy, adult patients

Vol 11 No 1 (2024)

Faktor Risiko Kejadian Tuberkulosis Paru di Berbagai Wilayah Indonesia

Alya Humaida Avy1, Balqis Permata Hutami2, M. Zhafran Alfalah3, Syeri Febriyanti4

 

Fakultas Kedokteran dan Ilmu Kesehatan Universitas Bengkulu

 

Abstract

Background: Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis that attacks the lung organs. This disease can lead to many complications and deaths if not treated properly. Tuberculosis in Indonesia remains a major challenge and requires the attention of all parties. Moreover, Indonesia is currently in the second place with the largest number of cases of pulmonary tuberculosis in the world. The aim of this study is to evaluate the risk factors of lung tuberculosis in various regions of Indonesia.

Method: The method used is the study of literature by searching for scientific articles from online databases.

Results: The results of the study show that there are several risk factors that influence the incidence of pulmonary tuberculosis in Indonesia. The risk factors obtained have much in common in different regions of Indonesia. Each of these risk factors exacerbates and increases the potential for pulmonary TB by generating OR values for each variable. According to the research journal, the six most important risk factors in the incidence of pulmonary tuberculosis in various regions of Indonesia are smoking habits, poor nutritional status, contact with the patient, knowledge level, population density, and poor ventilation of the house.

Conclusion: In this study we highlighted six risk factors for lung tuberculosis in various regions of Indonesia, namely smoking habits, poor nutritional status, contact with the affected, knowledge level, population density, and poor ventilation of the home.

 

Keywords: Pulmonary Tuberculosis, Risk Factor, regions of Indonesia

Abstrak

Latar belakang: Tuberkulosis (TB) adalah suatu penyakit infeksi menular yang disebabkan oleh Mycobacterium tuberkulosis  yang menyerang organ paru. Penyakit ini bisa mengakibatkan banyak komplikasi dan berujung kematian apabila tidak tepat penanganannya. Penyakit Tuberkulosis di Indonesia masih menjadi tantangan besar yang dihadapi dan memerlukan perhatian semua pihak. Terlebih, Indonesia saat ini berada di urutan kedua dengan kasus TB paru terbanyak di dunia. Tujuan dari kajian ini adalah untuk mengevaluasi faktor risiko dari Tuberkulosis paru di berbagai wilayah Indonesia.

Metode: Metode yang digunakan adalah studi literatur dengan mencari artikel ilmiah dari database online.

Hasil: Hasil kajian menunjukkan bahwa ada beberapa faktor risiko yang berpengaruh terhadap kejadian Tuberkulosis paru di Indonesia. Faktor – faktor risiko yang didapat memiliki banyak kesamaan di berbagai wilayah Indonesia. Masing – masing dari faktor risiko tersebut memperberat dan meningkatkan potensi kejadian TB paru dilihat dari nilai OR untuk setiap variabel. Berdasarkan jurnal penelitian, didapatkan 6 faktor risiko yang paling berperan dalam angka kejadian TB paru di berbagai wilayah Indonesia, yaitu  kebiasaan merokok, status gizi buruk, kontak dengan penderita, tingkat pengetahuan, kepadatan hunian, dan ventilasi rumah yang kurang baik.

Kesimpulan: Pada kajian ini, kami menyoroti terdapat 6 faktor risiko kejadian Tuberkulosis paru di berbagai wilayah Indonesia, yaitu kebiasaan merokok, status gizi buruk, kontak dengan penderita, tingkat pengetahuan, kepadatan hunian, dan ventilasi rumah yang kurang baik.

 

Keyword : Tuberkulosis Paru , Faktor Risiko, Wilayah Indonesia

Vol 11 No 1 (2024)

KORELASI NYERI DENGAN AGITASI PADA PASIEN YANG TERINTUBASI DI ICU RUMAH SAKIT UMUM PUSAT HAJI ADAM MALIK MEDAN

 

 

Muhammad Syakur1 ,  Tasrif Hamdi 2  , Andriamuri Primaputra Lubis2

 1Program Studi Magister Kedokteran Klinik / Program Studi Anestesiologi dan Perawatan Intensif, Fakultas Kedokteran, Universitas Sumatera Utara-Rumah Sakit Umum H. Adam Malik Medan, Indonesia

2Program Studi / Departemen Anestesiologi dan Perawatan Intensif, Fakultas Kedokteran, Universitas Sumatera Utara-Rumah Sakit Umum H. Adam Malik Medan, Indonesia

 

ABSTRAK

Latar Belakang: Agitasi umum terjadi pada pasien ICU dan dapat disebabkan oleh faktor-faktor seperti lingkungan baru, paparan obat, kondisi medis, dan kondisi kesehatan mental. Nyeri juga banyak dialami oleh pasien yang diintubasi di ICU yang menerima perawatan medis seperti suctioning ETT, pemasangan kateter urin, nasogastrik, dan tindakan perawatan pasien rutin sehari-hari dapat memperburuk agitasi. Dalam perawatan ICU, penting untuk mempertimbangkan hubungan antara agitasi, nyeri, delirium, dan faktor-faktor lain untuk mengelola dan mengatasi kondisi pasien secara efektif.

Tujuan: Untuk menganalisis korelasi antara nyeri menggunakan CPOT dan agitasi menggunakan RASS pada pasien intubasi di ICU Rumah Sakit Umum Haji Adam Malik.

Metode: Desain penelitian adalah analitik observasional dengan studi cross sectional menggunakan skala CPOT dan RASS sebagai alat ukur selama periode Oktober 2023.

Hasil: Semua data karakteristik (usia, jenis kelamin, BMI, durasi perawatan ICU, dan durasi penggunaan ventilator) tidak menemukan perbedaan dan korelasi (p>0,05) antara kelompok non-bedah dan bedah. Ada perbedaan yang signifikan secara statistik (p<0,001) antara pengukuran pagi dan sore di semua penilaian hemodinamik. Diketahui ada korelasi positif yang signifikan (p<0,001) antara CPOT dan RASS pada pagi hari dengan tingkat korelasi sedang (r = 0,516) dan arah korelasi positif. Tidak ada korelasi yang signifikan secara statistik yang ditemukan antara CPOT malam dan RASS malam. Diketahui bahwa perbedaan nilai CPOT pagi dan RASS pagi dan sore hari signifikan secara statistik (p<0,05), tetapi pada CPOT malam hari tidak ada perbedaan yang signifikan antara kelompok dosis. Diketahui ditemukan perbedaan nilai CPOT pagi pada Golongan 2 dengan 3 (p<0,001) dan Golongan 1 dengan Golongan 3 (p<0,001). Pada pagi hari ditemukan nilai RASS pada Kelompok 2 dengan 3 (<0,001) dan Kelompok 1 dengan Kelompok 3 (<0,001). Pada malam hari RASS, perbedaan signifikan ditemukan pada Kelompok 2 dan Kelompok 3 (p = 0,037).

Kesimpulan: Terdapat korelasi yang signifikan (p<0,001) antara nyeri dan agitasi pada pasien yang diintubasi di ICU Rumah Sakit Umum Adam Malik dengan tingkat korelasi sedang. CPOT dianggap memiliki manfaat untuk digunakan di ICU.

Kata kunci: agitasi, nyeri, ICU, RASS, dan CPOT

Vol 11 No 1 (2024)

Biomarker of Post-COVID-19 Lung Fibrosis: A Systematic Review and Meta-Analysis of Cohort Studies

Gede Ari Mahendra Mardaningrat1*, Putu Andrika2, Isabella Soerjanto Putri1, I Putu Hendri Aryadi1

1 Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia

2 Division of Pulmonary and Critical Care, Department of Internal Medicine, Udayana University/Prof. dr. I.G.N.G Ngoerah Hospital, Denpasar, Bali, Indonesia

 

Abstract

Introduction: The World Health Organization (WHO) labeled COVID-19 as a pandemic. On January 7, 2024, an estimated 774,075,242 confirmed cases of COVID-19 had occurred, resulting in 7,012,986 deaths. Pulmonary fibrosis is commonly observed as a consequence of COVID-19 infection, with a reported prevalence of up to 83.3% in individuals who have recovered from the disease. Pulmonary fibrosis that develops after a COVID-19 infection arises from the immune system's reaction to the virus, resulting in inflammation and lung damage.

Objective: This systematic review and meta-analysis were conducted to determine the laboratory biomarker findings in patients with post-COVID-19 lung fibrosis.

Methods: Systematic review and meta-analysis adhering to the PRISMA and MOOSE guidelines. We conducted a literature search on PubMed, EMBASE, and Web of Science from January 1, 2020, to January 31, 2024.

Results: Nine eligible studies, including 1,406 patients, were identified. The research results showed that several biomarkers had statistically significant values such as lymphocytes (MD: -0.35; 95% CI: -0.49; -0.21), CRP (MD: 40.73; 95% CI: 27.78; 53.69), D-dimer (MD: 0.76; 95% CI: 0.18; 1.34), lactate (MD: 38.43; 95% CI: 19.73; 57.13), and interleukin-6 (MD: 16.97; 95% CI: 2.57; 31.37). Meanwhile, for biomarkers such as white blood cells (MD: 0.14; 95% CI: -0.54; 0.81) and neutrophils (MD: 3.71; 95% CI: -3.80; 11.23), the values were not statistically significant for the occurrence of lung fibrosis.

Conclusion: The diagnosis of pulmonary fibrosis is generally established using biopsy or CT scans. However, in some hospitals with limitations on healthcare resources and equipment such as CT scans, these biomarkers can be used in diagnosing pulmonary fibrosis, especially in patients after experiencing COVID-19 infection.

 

Keywords: Biomarker, COVID-19, Lung Fibrosis, Sars-Cov2

Vol 11 No 1 (2024)

FACTORS CORRELATED WITH INCREMENTAL SHUTTLE WALK TEST DISTANCE IN SEDENTARY HEALTHY ADULTS

Astrid Priscilla Amanda1, Nury Nusdwinuringtyas1, Tresia Fransiska Ulianna Tambunan1, Dewi Friska2

1Physical Medicine and Rehabilitation Department, Cipto Mangunkusumo Hospital,

Faculty of Medicine, Universitas Indonesia

2Community Medicine Department, Faculty of Medicine, Universitas Indonesia

Abstract

Background: In carrying out daily activities, it is influenced by a person’s physical fitness. A person’s functional capacity can be assessed by exercise testing distance. One of the exercise tests that currently being applicated nowadays is incremental shuttle walk test (ISWT). There are various factors that affect cardiorespiratory fitness, as well as demographic and anthropometric characteristics such as age, gender, body height, and body weight. This study focused on demographic and anthropometric factors.

Objective: The aim of this study was to determine the factors that correlate with ISWT distance in sedentary healthy adults

Material and Methods: This study was a cross-sectional study conducted on 85 subjects. Subjects performed ISWT twice, with the greatest distance was included in analysis. The independent variables (age, gender, body height, body weight) were analyzed using bivariate analysis to see the correlation with ISWT distance. Furthermore, multivariate analysis was done to see the most influential variable.

Results: Sixty women were participated in this study. Among four variables, multivariate analysis showed gender, body height, and body weight correlated with ISWT distance (p<0,05)

Conclusion: Gender, body height, and body weight correlated with ISWT distance in sedentary healthy adults.

Keywords: Incremental shuttle walk test, distance, sedentary, healthy, field test

Vol 11 No 1 (2024)

Low Alveolar Macrophages Function, Low BALF IL-6 Level and High BALF CD4 Cell Count is Associated with Successful Extubation and Survival in Severe Pneumonia Patients: Prospective Cohort Study

Gurmeet Singh1,2, Cleopas Martin Rumende1, Iris Rengganis3, Zulkifli Amin1, Tonny Loho4, Emmy Hermiyanti Pranggono5, Kuntjoro Harimurti6, Heri Wibowo7, Nova Bornida Fauzi1, Sudirman Fakhruddin Masse1, Laila Fakhriyatuz Zakiyah1

 

1Division Respirology and Critical Illness, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.

2Doctorate Program Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.

3Division of Allergy and Clinical Immunology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.

4Department of Clinical Pathology, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.

5Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Dr Hasan Sadikin Hospital Bandung, Bandung, Indonesia.

6Department of Internal Medicine, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.

7Head of Integrated Laboratory, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.