Vol 10 No 2 (2023)

Comparison of Enteral and Parenteral Nutrition in Cancer Patients with Dyspnea: Evidence-Based Case Report

Ni Putu Menganti Harum Putrinata1 Gurmeet Singh2
1Faculty of Medicine, Universitas Indonesia
2Pulmonology Division, Internal Medicine Department, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia

Abstract

Background: The role of nutritional support for cancer patients in palliative care still become a controversial topic, because an ambiguity in choosing between enteral and parenteral treatment were still found in clinical practice, yet a comparison of effectiveness between enteral and parenteral nutrition in cancer patients with dyspnea still remain scarce.

Objective: The purpose of this evidence-based case report is to identify the effectiveness of enteral nutrition compared to parenteral nutrition in adult patients with cancer and dyspnea.

Methods: Literature searching were performed on Pubmed, Cochrane, and Google Scholar database to obtain RCT studies. Searches were made with keyword “enteral nutrition”, “parenteral nutrition”, “dyspnea” “cancer” and “dyspnea score”. Selecting the studies were further based on exclusion and inclusion criteria by results, title, abstract, and full-text screening.

Result: Two studies were found to be relevant according to the criteria. These studies showed that enteral nutrition showed more effectiveness compared to parenteral nutrition in reducing dyspnea score.  Study by Cotogni P et al showed enteral nutrition was more significant in giving lower Modified Borg Dyspnea Score [p =0.01], similarly to the results of study by Kao et al [p=0.05]. However, included study patients is different than patients in clinical practice settings. Therefore, there is a consideration regarding the applicability.

Conclusion: Based on two articles that have been reviewed, enteral nutrition has a positive effect on reducing Modified Borg Dyspnea Score in patients with cancer compared to parenteral nutrition.

 

Keywords: enteral nutrition, parenteral nutrition, dyspnea score, cancer

Vol 10 No 2 (2023)

COMPARING THE EFFECTIVENESS OF FIXED-DOSE COMBINATIONS AND SEPARATE-TABLET REGIMENS ON 2-MONTH PULMONARY TUBERCULOSIS SPUTUM CONVERSION
Ichsan Fauzi Triyoga1, Mira Yuliarti2
1Program Studi Profesi Dokter, Fakultas Kedokteran Universitas Indonesia
2Divisi Pulmonologi, Departemen Gastroenterohepatobilier, Rumah Sakit Umum Pusat Nasional Cipto
Mangunkusumo, Fakultas Kedokteran Universitas Indonesia

ABSTRACT

Background: Tuberculosis (TB) is one of the leading causes of death amongst other non-communicable diseases, accounting for up to 845 thousand cases in 2020 in Indonesia alone. Currently, the WHO recommends the use of anti-tuberculosis fixed dose combinations (FDCs) for treating lung TB. However, before the existence of FDCs, patients rely on the use of anti-TB separate tablets (STs). Both forms offer excellent effectiveness and could be measured objectively through bacterial smear conversion, but different dosages and compliance in each individual may alter the outcomes they offer.
Methods: 5 online databases (Cochrane Central Registers of Trials, Cochrane Database of Systematic Review, Embase Classics, MEDLINE(R) ALL, and Pubmed) were used in finding potential studies. Studies were appraised using the Oxford Center for Evidence-Based Medicine (CEBM) Tool, specifically in the validity, importance, and applicability of the studies.
Result: 24 articles were acquired from literature search, and 3 randomized controlled trials (RCTs) were reviewed. All studies found statistically insignificant results between FDCs and STs in 2-month sputum smear conversion. The negative percentage of patients with a negative 2-month sputum conversion result using FDCs ranges from 88% - 96% and those using STs ranges from 89% - 96%. Relative risk results for all studies are within the 95% CI range, hence precision of results are more certain.
Conclusion: In conclusion, all studies reported FDCs nor STs to have significant effectiveness difference in 2-month sputum smear conversion rate. Future studies should consider doing individual analysis of these forms of anti-TB treatment on bacterial smear conversion with factors that could influence conversion time.
Keywords: fixed dose combinations, separate tablets, 2-month sputum smear conversion, lung tuberculosis

Vol 10 No 2 (2023)

Frailty As A Predictor of Mortality Among Elderly Patients With Pneumonia: A Systematic Review and Meta-Analysis

RA Tuty Kuswardhani1, I Desak Putu Agung Krisdanti2, Christina Permata Shalim3

 

1Division  of  Geriatric  Medicine,  Department  of  Internal  Medicine,  Faculty  of  Medicine,  Udayana University/Prof Dr. I.G.N.G. Ngoerah Hospital, Bali, Indonesia

2Department of Pulmonology and Respiratory, Faculty of Medicine, Udayana University/Udayana University Hospital, Bali, Indonesia

3Siloam Hospitals Kebon Jeruk, Jakarta, Indonesia

ABSTRACT

Introduction: Pneumonia is a significant cause of morbidity and mortality among elderly patients.
Assessing the prognostic factors associated with pneumonia outcomes is crucial for clinical decision-making. This systematic review and meta-analysis aimed to evaluate the impact of frailty on mortality in elderly patients with pneumonia.
Methods: We performed a systematic search on the electronic databases PubMed, Cochrane Library, and Science Direct up to June 12th, 2023. Studies reporting the association between frailty and mortality in elderly patients with pneumonia were included. Quality assessment of the included studies was appraised using a Newcastle-Ottawa Scale. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using random-effects models.
Results: Seven studies involving a total of 376,170 elderly pneumonia patients were included in the meta-analysis. The pooled results demonstrated a significant association between frailty and mortality in this population (pooled OR = 2.76, 95% CI: 2.22-3.44; p<0.00001). Frailty was also significantly associated with prolonged hospitalization (pooled OR = 2.74, 95% CI: 1.90-3.96; p<0.00001).
Conclusion: Frailty is significantly associated with increased mortality and prolonged
hospitalization in elderly patients with pneumonia.
Keywords: elderly, frailty, mortality, pneumonia

Vol 10 No 2 (2023)

SUSPECT HEPATOPLEURAL FISTEL INITIATED BY LUNG ABCESS BECOMES
HYDROPNEUMOTHORAX WITH THE COMPLICATION OF LIVER ABCESS
Sri Indah Indriani1*, Indra Yovi1, Aulia Rezha Yomitra1, Elvando Tunggul Maulite Simatupang1, Heri Krisnata Ginting2, Hariadi Hatta3
1Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Riau University - Arifin Achmad General Hospital Pekanbaru
2Department of Internal Medicine, Faculty of Medicine, Riau University - Arifin Achmad General Hospital Pekanbaru 3Department of Thoracic Cardiovascular Surgery, Faculty of Medicine, Riau University - Arifin Achmad General Hospital Pekanbaru

ABSTRACT
Background: A liver abscess is an inflamed liver lesion that can migrate into the pleural cavity and cause lung abscess and empyema. Hepatopleura fistulas are one of the reasons why cancer might spread to the pleural cavity.
Case: A 25-year-old man complains of sudden shortness of breath, exacerbated by strenuous activity. An x-ray was performed showing a lung abscess. after 6 days, a repeat x-ray showed a hydropneumothorax, and a Water Sealed Drainage was performed. An abdomen ultrasound was carried out and found a picture of a liver abscess. In the patient’s condition, repeated abdominal ultrasounds were done to determine the size of the liver abscess and repeated chest X-rays were done to examine the WSD. No hepatopleural fistula was discovered in this patient, and the liver abscess was less than 5 cm, therefore drainage was not necessary. Antibiotics were administered to the patient. The patient was treated for 40 days and it was found that the lungs had not expanded an open pleural window was performed.
Conclusion: This patient was then consulted for thoracic and cardiovascular surgery for further management of the lungs that had not yet expanded and fluid production was still ongoing, a decision was made with further intervention.
Keywords: Hydropneumothorax, Lung Abscess, Liver Abscess

Vol 10 No 2 (2023)

THE USE OF INDWELLING PLEURAL CATHETER
FOR MALIGNANT PLEURAL EFFUSION
Sri Indah Indriani*, Indra Yovi, Elvando Tunggul Mauliate Simatupang
Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Riau University, Pekanbaru, Riau

ABSTRACT

Malignant Pleural Effusion (MPE) is one of the metastatic processes that occur due to lung cancer. MPE condition can be used as one of the parameters to assess the degree of disease and prognosis of lung cancer patients. Shortness of breath is the most common symptom experienced by lung cancer patients. Indwelling Pleural Catheter (IPC) are recommended as effective management for shortness of breath in patients. The use of IPC also has a pleurodesis effect on problems in the pleura. Palliative therapy with the use of IPC can reduce the length of hospitalization and drainage treatment can be done on an outpatient basis. The development of IPC selection as the first line in MPE cases is also supported by several recent studies so its use is more recommended to be applied to MPE. Some other studies mentioned that IPC is rarely used due to limitations for installation techniques and long-term care is needed after IPC installation.
Keywords: Procedure, Indwelling Pleural Catheter, Malignant Pleural Effusion

Vol 10 No 2 (2023)

HYPOXEMIA DURING BRONCHOSCOPY PROCEDURE:
WHAT WE NEED TO UNDERSTAND AND HOW TO ANTICIPATE IT
Sri Indah Indriani*, Chyntia Triana Putri, Elvando Tunggul Mauliate Simatupang,
Arya Marganda Simanjuntak, Adelia Pratiwi
Department of Pulmonology and Respiratory Medicine, Faculty of Medicine,
Riau University, Pekanbaru, Riau

ABSTRACT

By inserting a Diagnostic Sign (bronchoscope) into the airway, bronchoscopy is an invasive medical treatment that allows tracheobronchial viewing in order to evaluate pathological abnormalities that develop in the lung. The importance of bronchoscopy is growing as lung disease cases become more complex and the demand for minimally invasive diagnostic methods rises. Use of bronchoscopy as a diagnostic and therapeutic tool are its two primary indications. With a low morbidity rate (0.1–2.5%) and a very low fatality rate (0.05%), bronchoscopy is a surgery that is generally considered to be safe. The risk of consequences from bronchoscopy still exists, one of which being hypoxemia. One of the most frequent side effects brought on by several variables is hypoxemia. Due to the use of sedation during bronchoscopy, hypoxemia frequently happens. This situation is often transient and is reversible. The operator must take into account the possibility of hypoxemia while doing the process in order to know when to stop. Hypoxemia should be anticipated, therefore monitoring and oxygen supplementation should be priorities during the process.
Keywords: Hypoxemia, Complications, Bronchoscopy

Vol 10 No 2 (2023)

A case of concurrent tuberculous pleural effusion and peritonitis

Vanya Utami Tedhy1 , Nurhidayat Mohammad1, Lie Khie Chen2, Mira Yulianti3
1Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia
2Division of Tropical Disease and Infection, Department of Internal Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
3Division of Respirology and Critical Illness, Department of Internal Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
Introduction: Extrapulmonary tuberculosis accounted for about 16% of 7.5 million tuberculosis cases worldwide in 2019 with lymph nodes, pleura, and gastrointestinal system as its most common sites of infection.
Case description: A 36 year-old female patient presented with dyspnea and abdominal distention due to unilateral pleural effusion and ascites. She had accompanying symptoms of weight loss and night sweat since 6 months prior to her presentation. The patient’s medical history was unremarkable, but she had positive contact with tuberculosis patients. Diagnostic approach was taken. Both pleural fluid and ascitic fluid were analysed, revealing exudative fluid with lymphocyte predominance. ADA for both pleural and ascitic fluid was elevated. Abdominal CT scan showed para-aortic lymphadenopathy, omental thickening, and complex ascites. Pleural fluid culture for Mycobacterium was positive for M. tuberculosis. Diagnosis of tuberculous pleural effusion and peritonitis was made and anti-tuberculous treatment was initiated.
Conclusion: The variable manifestation of extrapulmonary TB can make diagnosis difficult, but this diagnosis should always be considered especially in the setting of high TB prevalence. Confirmatory diagnosis with microbiological examination should always be attempted, but clinical feature highly suspicious of TB supported with biological marker can aid in the diagnosis of extrapulmonary TB.
Keywords: tuberculous pleural effusion, tuberculous peritonitis, extrapulmonary tuberculosis

ABSTRA CT
Introduction: Extrapulmonary tuberculosis accounted for about 16% of 7.5 million tuberculosis cases worldwide in 2019 with lymph nodes, pleura, and gastrointestinal system as its most common sites of infection.
Case description: A 36 year-old female patient presented with dyspnea and abdominal distention due to unilateral pleural effusion and ascites. She had accompanying symptoms of weight loss and night sweat since 6 months prior to her presentation. The patient’s medical history was unremarkable, but she had positive contact with tuberculosis patients. Diagnostic approach was taken. Both pleural fluid and ascitic fluid were analysed, revealing exudative fluid with lymphocyte predominance. ADA for both pleural and ascitic fluid was elevated. Abdominal CT scan showed para-aortic lymphadenopathy, omental thickening, and complex ascites. Pleural fluid culture for Mycobacterium was positive for M. tuberculosis. Diagnosis of tuberculous pleural effusion and peritonitis was made and anti-tuberculous treatment was initiated.
Conclusion: The variable manifestation of extrapulmonary TB can make diagnosis difficult, but this diagnosis should always be considered especially in the setting of high TB prevalence. Confirmatory diagnosis with microbiological examination should always be attempted, but clinical feature highly suspicious of TB supported with biological marker can aid in the diagnosis of extrapulmonary TB.
Keywords: tuberculous pleural effusion, tuberculous peritonitis, extrapulmonary tuberculosis

Vol 10 No 2 (2023)

Seorang Laki-Laki 49 Tahun Dengan Tuberkulos Monoresisten Isoniazid (Hr-TB) : Kasus Pertama  Hr-TB di RSUP dr.Kariadi Semarang

Arif Wicaksana1, Fathur Nur Kholis2, Banteng Hanang Wibisono2
1Resident of Internal Medicine, Department of Internal Medicine, Faculty of Medicine, Diponegoro University
2 Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine,
Diponegoro University
Introduction : Drug Resistance Tuberculosis still become one of biggest burden on Global TB Control. Isoniazid Resistance Tuberculosis (Hr-TB) is one form of Drug Resistance TB. Although Hr-TB cases is commonly found worldwide, yet this case is the first case to be reported in Kariadi Hospital Semarang.
Case Illustration : A 49-year-old male come with productive cough, sub-febris fever and weight loss within 1 month with history of Complete Drug Sensitive TB treatment 10 years ago. Patient had decreasing of vesicular sound and crackles in lower part of right lung. On chest radiographic evaluation found consolidation on lower base of right lung and image of tuberculosis. Sputum evaluation found Acid-fast Bacteria with Nucleic acid amplification tests (NAAT) detected M. Tuberculosis with rifampicin sensitive, Line Probe Assay (LPA) stated resistance of Low Dose and High Dose Isoniazid. Patient was given treatment regimen of 6RHZE-Lfx. Evaluation was done in second month of treatment that given no identification of Acid-fast bacteria, improvement on chest radiographic, and bodyweight.
Discussion : Hr-TB was found in 156 countries from 2003 until 2017, prevalence of Hr-TB is 7.6% of Newly Diagnosed TB and 11.4% of patient TB on treatment. Mechanism of resistance in Hr-TB are identified the mutation of katG ang inhA that decrease the antimicrobial function of Isoniazid. Diagnostic of Hr-TB based on WHO guideline is using NAAT and LPA to rule out resistance of INH and other line of regimen. WHO 2017 recommendation for Hr-TB treatment is RHZE-Lfx for 6 months. Addition of Fluoroquinolone to the regimen for Hr-TB strengthen treatment regimens since bactericidal effect of Isoniazid replaced by Lfx and became core drug for Drug Resistance TB. Adding Lfx shows improvement on results, and there is no evidence of including Isoniazid on regimen giving poor outcome on therapy.
Conclusion : Hr-Tb need to be identified on high-risk group to have proper diagnosis and therapy and give better prognosis and improve TB elimination.
Keyword : Tuberculosis, Isoniazid, Resistance
ABSTRAK
Pendahuluan : Tuberkulosis resisten obat masih menjadi salah satu permasalahn pada ELiminasi TB secara global. Tuberkulosis mnoresisten isoniazid (Hr-TB) adalah salah satu bentuk TB Resisten Obat. Walaupun kasus Hr-TB banyak ditemukan secara global, tetapu kasus ini adalah kasus pertama yang dilaporkan di RSUP dr. Kariadi Semarang
Ilustrasi Kasus : Seorang laki-laki 49 tahun dating dengan batuk produktif, demam sub febris dan penurnan berat badan dalam 1 bulan dengan Riwayat pengobatan TB Sesitif Obat lengkap 10 tahun yang lalu. Pada pasien ditemukan penurunan suara vesikuler pada dan ronki kasar pada basal paru kanan. Pada pemeriksaan ronsen thoraks didapatkan konsolidasi pada basal paru kanan dan gambaran yang mendukun tuberculosis. Pada pemeriksaan dahak ditemukan BTA dan TCM mendeteksi M. Tuberkulosis dengan sensitive rifampisin. PEmeriksaan Line Probe Assay (LPA) menyatakan resisten dari Isoniazid dosis rendah dan dosis tinggi. Pasien diberikan regimen pengobatan ^RHZE-Lfx. Evaluasi dilakukan pada bulan kedua dari pengobatan dan didapatkan BTA negative dan perbaikan pada ronsen thorakas dan berat badan.
Diskusi : Hr-TB ditemukan pada 156 negara dari 2003 hingga 2017, prevalensi dari Hr-TB adalah 7.6% dari TB kasus baru dan 11.4% pada pasien yang sedang pengobatan TB. MEkanisme reistensi dari Hr-TB diidentifikasi pada mutasi gen katG dan inhA yang menurunkan fungsi antimicrobial dari Isoniazid. Diagnosis dari Hr-TB berdasarkan Guideline WHO menggunakan TCM dan LPAuntuk menemukan adanya resistensi Isoniazid dan regimen lain. Rekomendasi WHO 2017 untuk pengobatan Hr-TB adalah RHZE-Lfx untuk 6 bulan. Penambahan FLuoroquinolon pada regimen untuk Hr-TB memperkuat efek bakterisidal dan menggantikan efek bakterisidal dari Isoniazid dan menjadi core drug untuk TB Resisten Obat. PEnambahan Lfx menunjukan perbaikan pada hasil dan melibatkan Isoniazid pada terapi tidak membuktikan perburukan luaran dari terapi.
Kesimpulan : Hr-TB perlu diidentifikasi pada kelompok resiko tinggi dan mendapatkan diagnosis dan tatalaksana yang tetap untuk mendapatkan prognosis yang lebih baik dan meningkatkan angka eliminasi TB.
Kata Kunci : Tuberkulosis, Isoniazid, Resitensi

Vol 10 No 2 (2023)

Hubungan Penyakit Komorbid dan Faktor Prognostik dengan Mortalitas pada Pasien COVID-19 Critical ill Bulan Juni - Desember 2021 di Ruang Intensive Care RSUP Prof. DR. I.G.N.G Ngoerah Denpasar

Ni Wayan Eka Satyawati1, Putu Andrika2
1Program Studi Spesialis Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Udayana/RSUP Prof. Dr. I.G.N.G. Ngoerah Denpasar, Bali, Indonesia
2Staf Divisi Pulmonologi dan Penyakit Kritis, Departemen/KSM Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Udayana/ RSUP Prof. Dr. I.G.N.G. Ngoerah Denpasar, Bali, Indonesia

Background : Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV2). The spread of COVID-19 occurs globally and designated as a pandemic with clinical manifestations of COVID-19 mainly affect the respiratory system. COVID-19 there is often an increase in inflammatory response, thrombosis, coagulopathy, and the presence of comorbid chronic diseases which is associated with increased degree of disease severity, morbidity and mortality. In this study, aimed that there will be a relationship between the presence of comorbid diseases (Diabetes Mellitus, hypertension, and chronic kidney disease) as well as prognostic factors (platelet levels, neutrophil lymphocyte ratio (NLR), procalcitonin and D-dimer) with mortality in critically ill COVID-19 patients in the Intensive Care Unit (ICU) Prof. Dr. I.G.N.G. Ngoerah Hospital Denpasar.
Methods : This research is an analytical study with a retrospective approach using secondary data from medical records with a purposive sampling method. The population was all medical record data for critically ill COVID-19 patients in the ICU Prof. Dr. I.G.N.G. Ngoerah Hospital Denpasar period June - December 2021 as many as 397 patients. The analysis performed was univariate and bivariate analysis with the Chi-Square statistical test using the SPSS 26.0 application for windows.
Results : In this study, based on data from patients critical ill period June - December 2021 were treated in the ICU Prof. Dr. I.G.N.G Ngoerah Hospital Denpasar obtained that the predominant age was 45-59 years for 214 patients (53.9%), with a mortality rate of 133 patients (50.6%). The gender factor was more in males, 229 patients (57.7%) with a mortality rate of 154 patients (58.6%) The bivariate test results found no significant relationship between age and mortality and between gender and mortality in critically ill COVID-19 patients, with a p-value of 0.148 and 0.62. In the comorbid factor data, more patients with hypertension were found, namely 154 patients (38.8%), while type II DM was 141 patients (35.5%) and chronic kidney disease 84 patients (21.2%). Based on the results of the bivariate test, there was no significant association with mortality in critically ill COVID-19 patients with comorbid factors, with p-values of 0.31 and 0.67, respectively. Whereas in the comorbid factors of chronic kidney disease, the results of bivariate tests found a significant relationship with mortality in critically ill COVID-19 patients, p-value 0.03. In terms of platelet levels, there were more platelets with normal platelet levels, namely 308 patients (77.6%) with bivariate test results, there was no significant relationship with mortality in critically ill COVID-19 patients, p-value 0.23. The factor of NLR levels was higher with an increase in NLR in 365 patients (91.9%), procalcitonin levels was higher with increased procalcitonin in 283 patients (71.3%), D-dimer levels with increased D-dimer levels in 370 patients (93.2%), with the results of bivariate tests there is a significant relationship with mortality in critically ill COVID-19 patients, p-value 0.001 for NLR, p-value 0.000 for procalsitonin and p-value 0.013 for D-dimer.
Conclusion : In this study it was found that the age and gender factors did not have a significant relationship with mortality in critically ill COVID-19 patients who were treated in the June-December 2021 period at Prof. Dr. IGNG Ngoerah Denpasar. While the comorbid factors studied were mostly hypertension, followed by type II DM and chronic kidney disease. However, comorbid chronic kidney disease has a significant relationship with mortality in critically ill COVID-19 patients. As for the levels of routine investigations carried out in patients with COVID-19, they are a complete blood count (in this study including NLR and platelet values) as well as procalcitonin and D-dimer levels. In this study it was found that elevated NLR, procalcitonin and D-dimer levels had a significant relationship with mortality in critically ill COVID-19 patients.
Keyword : COVID-19 critical ill, comorbid, D-Dimer, procalcitonin

Vol 10 No 2 (2023)

Diagnostic Accuracy and Prediction of COVID-19 Outcome Using Artificial Intelligence Based on Radiological Data, Clinical and Laboratory Parameter at Dr. Sardjito General Hospital, Yogyakarta

Harik Firman Thahadian 1 Ika Trisnawati1 Eko Budiono1 Bambang Sigit Riyanto 1 Heni Retnowulan1 Nur Rahmi Ananda1 Sarah Ulfa 1 Tani Prima Auladina1 Imam Manggalya Adhikara 1 Sumardi
1 Department of Internal Medicine of Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada Yogyakarta
Introduction: The application of the “color heat-map” method through identifying and analyzing chest X-ray images transferred into AI (artificial intelligence) to generate scores. The aim of this research to was to evaluate the diagnostic accuracy of artificial intelligence scores of Chest X-Ray for predicting the clinical outcome of COVID-19 patients and establishing a scoring system using predictor variables based on AI scoring data based on chest X-rays, clinical parameters, and laboratories of COVID-19 patients.
Methods: A retrospective study collected data from hospitalized COVID-19 patients in Dr. Sardjito General Hospital, Yogyakarta, between 2020 and 2022. The data collected is clinical, laboratory parameters, patient outcomes, and values from AI Chest X-Ray readings. Artificial intelligence was used to detect radiographic abnormalities using CAD4COVID-Xray software (Thirona, Nijmegen, Netherlands). Receiver operator curve (ROC) to evaluate the predictive value of the AI probability score and AI Affected Lung Area score. Multiple logistic regression analysis selected some variables to develop the scoring model.
Results: Four hundred forty-nine (449) patients were included in the study: 237 males (52,8%), median age 56 years (IQR = 45-65). ROC analysis shows that the AI probability score (AUC = 0.875, CI 95% 0.801-0.948) and AI ALA score (AUC = 0.836, CI 95% 0.766-0.906) have sufficient discrimination ability to determine the degree of disease severity of COVID-19 confirmed subjects. Multiple logistic regression analysis from clinical, laboratory, and clinical outcomes showed that this scoring system uses seven variables (5 clinical and two laboratory variables) and has a good prognostic ability to predict the severity of COVID-19 patients. Based on the stratification of scoring results, we found that the scoring value of low-risk patients (1-2 points) had a mortality proportion of 7.8.%, moderate risk ((3-5) points) had a mortality proportion of 38.7%, and high-risk ((6-9) points) had a mortality proportion of 76.9%.
Discussion: Using an AI-based score derived from radiographic, clinical, and laboratory parameters may be beneficial to estimate prognosis in confirmed COVID-19 patients.

Vol 10 No 2 (2023)

Thymoma Presenting as Superior Vena Cavaa Syndrome
Putri Indah Permata1, Fauzar2, Roza Kurniati2 Eifel Faheri3
1. Peserta Program Pendidikan Dokter Spesialis Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Andalas,
RSUP Dr. M. Djamil Padang, Indonesia
2. Divisi Pulmonologi, Program Studi Penyakit Dalam, Fakultas Kedokteran Universitas Andalas RSUP Dr. M. Djamil Padang, Indonesia
3. Divisi Hematologi Onkologi Medik, Program Studi Penyakit Dalam, Fakultas Kedokteran Universitas Andalas
RSUP Dr. M. Djamil Padang, Indonesia
Pendahuluan
Timoma adalah neoplasma yang jarang terjadi yang berasal dari sel epitel timus dengan prevalensi 0,5-1,5% dari semua keganasan di Amerika Serikat. Pada 2018-2023 ditemukan 20 kasus pasien timoma yang dirawat di RSUP M Djamil. Gejala klinis dapat berupa nyeri dada, dispnea, batuk, atau sindrom vena kava superior akibat efek pendesakan pada organ yang berdekatan.
Ilustrasi Kasus
Laki-laki, 28 tahun dirawat di Bagian Penyakit Dalam RSUP Dr. M. Djamil Padang mengeluhkan sesak nafas yang hebat sejak 3 hari sebelum masuk RS disertai dengan bengkak pada leher, wajah, dan tangan kanan. Pemeriksaan fisik didapatkan keadaan umum berat, takipneu, dan pemberton sign positif. Pada pemeriksaan laboratorium didapatkan hasil dalam batas normal. Pemeriksaan CT Scan thoraks dengan kontras didapatkan tumor mediastinum anterior yang menekan vena kava superior. Dilakukan pemberian kortikosteroid dan radioterapi cito untuk keadaan emergency sindroma vena kava superior (SVKS). Setelah sesak berkurang, dilakukan pemeriksaan transthoracic needle aspiration (TTNA) dan trans thoracic biopsy (TTB) dengan hasil timoma. Selanjutnya pada pasien dilakukan kemoterapi sebagai terapi primer timoma karena massa tumor yang non-resectable.
Diskusi
Kasus ini menarik karena keberhasilan terapi pada pasien. Radioterapi dapat memberikan perbaikan klinis pada pasien SVKS kemudian dilakukan kemoterapi menggunakan regimen cisplatin, doxorubicin, siklofosfamid karena tumor non-resectable. Pada follow up setelah kemoterapi didapatkan perbaikan klinis dan pengecilan massa tumor pada pasien secara radiologis.
Kesimpulan
Timoma adalah tumor yang jarang dengan mortalitas tinggi. Pengobatan timoma harus dilakukan oleh tim multidisiplin untuk menentukan strategi perawatan yang tepat. Pilihan pengobatan kemoterapi memberikan perbaikan klinis pada pasien dengan massa yang non-resectable
Kata kunci: timoma, SVKS, radioterapi, kemoterapi