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All Journal Jurnal Kedokteran Brawijaya Jurnal Kesehatan Andalas Majalah Kesehatan FKUB Jurnal Respirologi Indonesia Jurnal Pendidikan Kedokteran Indonesia: The Indonesian Journal of Medical Education Medica Hospitalia Respiratory Science Malang Respiratory Journal

Triwahju Astuti

Bagian Paru Fakultas Kedokteran Universitas Brawijaya / Rumah Sakit Umum Dr. Saiful Anwar Malang

Author-ID : 236121

Biochemistry, Genetics & Molecular Biology Dentistry Education Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health Other

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Immunogenicity Test of ESAT-6/CFP-10 Mycobacterium Tuberculosis (Indonesian Strain) Recombinant Protein Fusion: IFN-γ and CD8+ T Cells Expression in PBMC Culture Anung Sri Handayani; Tri Wahju Astuti; Teguh Rahayu Sartono; Maimun Zulhaidah Arthamin; Fransisca Srioetami Tanoerahardjo
Jurnal Respirologi Indonesia Vol 38, No 4 (2018)
Publisher : Perhimpunan Dokter Paru Indonesia (PDPI)/The Indonesian Society of Respirology (ISR)

Background: BCG vaccination is one way to control tuberculosis (TB) but still poor in efficacy thus new vaccine development is needed. Immunogenicity test is needed in developing new vaccine. The aim of this study was to understand whether the recombinant protein fusion of ESAT-6/CFP-10 Mycobacterium tuberculosis (M. tuberculosis) can stimulate cellular immune response, especially IFN-γ and CD8 + T cell expression in PBMC cultures. Methods: This study was an experimental laboratory research conducted on PBMC cultures of 3 groups of subjects (TB patients, latent TB patients and healthy subjects) at RSUD Dr. Saiful Anwar in April-July 2017. The sample of each groups was 8 subjects. Each groups induced by recombinant protein fusion ESAT-6/CFP-10 M. tuberculosis as a standard protocol and to establish the immunogenicity status. CD8+ T cells IFN-γ expressed by C8+ were measured by flowcytometry. Result: Recombinant protein fusion ESAT-6/CFP-10 can stimulate CD8+ T cells and IFN-γ expressed by CD8+ T cells in all group. The highest stimulation of CD8+ percentage was found in healthy subject (37.533 ± 7.264) and IFN-γ expressed by CD8+ T cells was found in healthy subject (7.908 ± 4.457); There are increase significantly CD8+ T cells (p=0.001) and IFN-γ expressed by CD8+ T cells (p=0.217) not significantly in healthy subject compared in PPD and without antigen. Conclusion: Recombinant protein fusion ESAT-6/CFP-10 M. tuberculosis can stimulate CD8+ T cells and IFN-γ expressed by CD8+ T cells in healthy subject. Recombinant protein fusion ESAT-6/CFP-10 M. tuberculosis potential as a new vaccine candidate. (J Respir Indo. 2018;38: 210-8)

Occupational Asthma in Hospital Healthcare Worker Rahmad Budianto; Tri Wahju Astuti
Jurnal Respirologi Indonesia Vol 40, No 4 (2020)
Publisher : Perhimpunan Dokter Paru Indonesia (PDPI)/The Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/jri.v40i4.126

Occupational asthma is defined as an adult onset of asthma triggered by specific exposures or combinations from the workplace. Occupational asthma is classified into a sensitizer-induced occupational asthma or allergic occupational asthma caused by exposure or sensitization by a causative agents induced by immunological reactions; and irritant-induced occupational asthma or non-allergic occupational asthma caused by agents that are irritative to the airway. Occupational asthma can occur in health workers at hospitals. In the hospital there are various exposure of agents, medicines, and health equipments which can induce the asthma symptoms for health workers. The diagnosis of occupational asthma established by history taking, physical examination, supporting examination (spirometry, bronchial hyper-responsiveness test, exhaled nitric oxide, and immunological tests), and biomarker test. Management of occupational asthma includes principle management by avoiding exposure, pharmacological therapy, and immunotherapy. Precautions taken by primary, secondary (medical surveilance) and tertiary prevention (prevention of disability through worker’s compensation system).

Association of Interleukin-2 (IL-2) Levels With Acid-Fast Bacillus (AFB) Sputum Conversion In Drug-Resistant Pulmonary Tuberculosis Patient Gede Sasmika Suwandi; Yani Jane Sugiri; Tri Wahju Astuti; Harun Al Rasyid
Respiratory Science Vol. 3 No. 1 (2022): Respiratory Science
Publisher : Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/respirsci.v3i1.52

Background: Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis (Mtb) which can be found on multiple organs, but mostly infect the lung. AFB smear is used to diagnose and evaluate therapy response, to show bacterial burden and the patient’s infectious status. Combination of antituberculosis drugs for a long period of time could cause poor compliance and increased risk of resistance. Mtb infection induce immune response and release cytokines, one of which is interleukin-2 (IL-2) that regulate T lymphocyte cell. Higher IL-2 levels is found on patient with high bacterial burdern. This study aims to see the assossciation between IL-2 levels before and 30 days after DR-TB treatment, to see pre and post-treatment IL-2 levels with conversion of AFB smear, and correlation between pre-treatment IL-2 levels and AFB smear. Method: This was a cohort prospective study at RSUD dr Saiful Anwar Malang. Thirty nine DR-TB patients underwent AFB smear before and 30 days after treatment, while IL-2 levels was also measured by Enzym-Linked Immunosorbent Assay (ELISA) technique. Results: The levels of IL-2 before treatment was significantly higher compared to 30 days after treatment (P<0.001). There was no significant IL-2 levels difference between conversion and non-conversion group (P=0.23), and a weak, not-significant correlation between IL-2 levels and AFB smear (r=0.28; P=0.06). Conclusion: The levels of IL-2 was significantly higher before than after treatment and it cannot be used to determine the positivity of acid-resistant bacilli smears in the sputum of patients with DR-TB. The limited timeframe and biomarker in this study raise the possibility to observe IL-2 as well as other biomarkers after intensive phase of TB treatment for future studies.

Hubungan Merokok Dengan Derajat Keparahan Dan Mortalitas Pasien COVID-19 Rawat Inap di RS Saiful Anwar Malang Listyoko, Aditya Sri; Djajalaksana, Susanthy; Astuti, Triwahju
Medica Hospitalia : Journal of Clinical Medicine Vol. 7 No. 1A (2020): Med Hosp
Publisher : RSUP Dr. Kariadi

Latar Belakang: Sejak Desember 2019 ketika pertama kali kasus COVID-19 diidentifikasi di Wuhan, China, SARS-CovV-2 menyebar ke seluruh dunia dan memberikan angka penyebaran infeksi dan mortalitas yang terus meningkat. Merokok memberikan dampak negatif terhadap kesehatan paru. Merokok sampai saat ini diasumsikan merupakan faktor risiko berbagai penyakit paru dan pernapasan seperti PPOK, kanker paru, termasuk pengaruh terhadap sistem pertahanan jalan napas terhadap berbagai mikroorganisme patogen. Prevalensi merokok di Indonesia sangat tinggi, dimana masih sedikit sekali studi yang dilakukan di Indonesia khususnya menilai risiko riwayat merokok terhadap derajat keparahan dan mortalitas pada pasien COVID-19 yang dilakukan rawat inap. Tujuan: Menganalisis riwayat merokok pada pasien COVID-19 yang dirawat di RS rujukan utama dan hubungannya dengan derajat keparahan penyakit dan mortalitas. Metode: Kami melakukan analisis observasional dengan pendekatan cross sectional, single-center, pada 77 pasien terkonfirmasi COVID-19. Data diambil antara bulan April-Juli 2020 pasien yang dirawat di Ruang COVID RS Dr. Saiful Anwar Malang, Indonesia. Uji statistik dipergunakan untuk menilai hubungan riwayat merokok dengan derajat keparahan dan mortalitas. Hasil: Subjek terdiri 77 pasien terkonfirmasi COVID-19 terbagi 2 kelompok yaitu 31 (40,25%) pasien ringan-sedang dan 46 (59,74%) pasien kelompok berat. Subjek dikelompokkan menjadi luaran hidup 52 (68,42%) dan meninggal 24 (31,57%) untuk analisis mortalitas. Analisis statistik menunjukkan riwayat merokok berkaitan dengan derajat keparahan penyakit (p=0,008; OR: 4,75, 95%CI 1,426-15,817) dan mortalitas (p=0,045, OR: 2,821, 95%CI 1,007-7,900) pasien COVID-19 yang dilakukan rawat inap di rumah sakit. Kesimpulan: Merokok berkaitan dengan risiko COVID berkembang ke derajat berat serta mortalitas pada pasien COVID-19 yang dilakukan rawat inap. Kata kunci: COVID-19, Keparahan, Mortalitas, Merokok Background: Since December 2019, when the COVID-19 case was first identified in Wuhan, China, SARS-CoV-2 has spread worldwide and increased the incidence and mortality. To date, smoking is assumed to be a risk factor for various respiratory diseases such as COPD, lung cancer, also influences the airway defense system against various pathogenic microorganisms. The prevalence of smoking in Indonesia is very high where very few studies have been conducted in Indonesia especially assessing the risk of smoking and disease severity and mortality in hospitalized COVID-19 patients. Objective : To determine the risk of smoking history among hospitalized COVID-19 patients in tertiary care referral hospital and its association with disease severity and mortality. Methods: A cross-sectional single-center study was performed of 77 admitted laboratory-confirmed patients in a tertiary hospital in Malang City, East Java, Indonesia from April-July 2020. Statistical analysis was performed to evaluate the association between smoking and disease severity and mortality in COVID-19 patients. Results: A total of 77 patients with laboratory-confirmed COVID-19 were included in our analysis. Subjects divided in the mild-moderate and severe group 31 patients (40,25%) and 46 patients (59,74%) respectively. For mortality analysis, subjects divided into survivor 52 patients (68,42%) and non-survivor 24 patients (31,57%). Statistical analysis determine smoking associated with disease severity (p=0,008; OR : 4,75, 95%CI 1,426-15,817) and mortality (p=0.045, OR : 2,821, 95%CI 1,007-7,900) in hospitalized COVID-19 patients. Conclusion: In our cross-sectional study demonstrated history of smoking associated with disease severity and mortality in hospitalized COVID-19 patients. Keywords: COVID-19, Mortality, Severity, Smoking

COVID-19 :Correlation Between CRP and LDH to Disease Severity and Mortality In Hospitalized COVID-19 Patients Tjahyadi, Rizal Muldani; Astuti, Triwahju; Listyoko, Aditya Sri
Medica Hospitalia : Journal of Clinical Medicine Vol. 7 No. 1A (2020): Med Hosp
Publisher : RSUP Dr. Kariadi

Background and Objective:COVID–19 is a newly emerging disease and considered an emergency health problem, worldwide.It has a wide range of clinical features, from mild fever to severe respiratory failure that leads to a higher mortality rate. Previous studies state that CRPhas a very strong positive correlation with the diameter of the lung lesion, and in intensive care patients had a higher level of LDH. This study aims to determine the correlation between CRP, LDH and disease severity and mortality in hospitalized COVID-19 patients. Methods: We conducted a retrospective cohort, a single-center study including 69 laboratory-confirmed patients in our hospital in Malang City, Indonesia from April - June 2020. Result: Subjects consisted of 26 patients (37.7%) in the mild-moderate group and 43 patients in severe group (62.3%).Statistical analysis showed CRP and LDH associated with disease severity (p=0.011 and p<0.001). Analysis of CRPand LDH in survivor and non-survivior group showed that CRP and LDH also asscociated with mortality in hospitalized COVID-19 patients (p=0.034 and 0.002). We also evaluate CRP and LDH with degrees of hypoxemia by assessed P/F ratio. Statistical analysis showed that CRP did not correlate with degrees of hypoxemia (p=0.079) but LDH inverse correlate with degrees of hypoxemia (p<0.001, pearson correlation = -0,489) Conclusion: In our retrospective cohort study demonstrated LDH and CRP can be a crucial indicator to predict severity and mortality for hospitalized COVID-19 patients and LDH may usefull test for predict early identification of patients who become respiratory failure or ARDS. Keywords: COVID-19, LDH, CRP, P/F Ratio

Analisis Aspek Komorbid dan Demografis dengan Waktu Kematian dan Tingkat Severitas pada Pasien COVID-19 yang Meninggal di Rumah Sakit Saiful Anwar: Analysis of Comorbidity and Demographic Aspects with the Time of Death and Severity of COVID-19 Patients in Saiful Anwar Hospital Munthe, Indra; Astuti, Triwahju; Sartono, Teguh Rahayu
Medica Hospitalia : Journal of Clinical Medicine Vol. 9 No. 2 (2022): Med Hosp
Publisher : RSUP Dr. Kariadi

Latar belakang : Pandemi COVID-19 pada tahun 2020 menyebabkan kematian di seluruh dunia. Hingga bulan Februari 2022, didapatkan 5,84 juta kematian akibat infeksi COVID-19. Sejumlah 1,1% kematian didapatkan pada kasus ringan-sedang, dan 32,5% pada kasus berat-kritikal. Penelitian ini dilakukan untuk mengetahui hubungan antara usia, merokok, pendidikan, pekerjaan, dan komorbid dengan tingkat severitas (ringan, sedang, berat dan kritis) dan waktu kematian (<48 jam dan >48 jam ) pada infeksi COVID-19, serta hubungan antara tingkat severitas penyakit dengan waktu kematian (<48 jam dan >48 jam) pada infeksi COVID-19. Metode : Penelitian dilakukan secara retrospektif dengan 300 sampel di RSSA pada bulan April 2020 hingga bulan September 2021, dengan subjek pasien berusia 18 tahun ke atas yang dirawat karena COVID-19. Data mengenai epidemiologis, klinis, dan komorbid diambil dari rekam medis. Data kategorik dua variabel dianalisis dengan menggunakan Chi Square dan uji Fischer untuk data yang tidak memenuhi kriteria Chi Square. Batas kemaknaan dinyatakan pada p<0,05 dengan interval kepercayaan 95%. Statistik dikerjakan dengan SPSS versi 26. Hasil : Analisis statistik menunjukkan terdapat hubungan yang signifikan antara: usia, merokok, komorbid, tingkat severitas COVID-19 dengan waktu kematian (p<0,001). Tidak terdapat hubungan yang signifikan antara pendidikan dan pekerjaan dengan derajat awal dari COVID-19 dengan waktu kematian (p>0,001). Pembahasan : Pasien dengan usia tua berisiko mengalami mortalitas lebih tinggi diduga terkait dengan fungsi sel T dan sel B, produksi sitokin tipe 2 berlebihan yang menyebabkan terjadinya respon proinflamasi yang berkepanjangan. Penelitian lain menyebutkan bahwa usia, pasien laki-laki, dan perokok aktif merupakan faktor prognosis mortalitas. Gejala berat-kritikal COVID-19 merupakan prediktor independen terjadinya mortalitas. Gejala berat seperti sesak napas dan distres pernapasan berat terkait dengan mortalitas yang lebih tinggi. Simpulan : Terdapat hubungan yang signifikan antara usia, merokok, komorbid dan tingkat severitas dengan waktu kematian. Didapatkan juga tidak adanya hubungan signifikan antara pekerjaan dan pendidikan dengan waktu kematian

EXCITING STUDENT CURIOSITY FOR A FUTURE CAREER: COVID-19 PANDEMIC ELECTIVE COURSE PROGRAM Astuti, Triwahju; Duta, Garinda Alma
Jurnal Pendidikan Kedokteran Indonesia: The Indonesian Journal of Medical Education Vol 12, No 3 (2023): September
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jpki.65692

Background: Medical education disruptions as the impact of COVID-19 pandemic transform the way of Faculty of Medicine, Universitas Brawijaya conducted an elective clerkship program session.Aims: We consider evaluating the purpose and passion of 194 medical students that join the 2 weeks virtual Elective Course Program.Curriculum Discussion: Fifty-two tutors and 56 topics are involved. This integrates e-learning program divided into three Google Classrooms elective program. The survey at the end of program expressed the satisfaction of most of the students (59.7%). The online course programs also describe the future plan for the students. Seventy-one per cent students wish to continue specialization programs soon within a year after graduating and this interest is consistent and tends to grow after fifteen years from now.Conclusion: The enthusiasm to pursue a career seems has not been limited due to the COVID 19 Pandemic.

The Sleep Disorders And Depression Symptoms Among Hospitalized COVID-19 Patients Febriawati, Juwita; Astuti, Triwahju; Djajalaksana, Susanthy; Listyoko, Aditya Sri
Malang Respiratory Journal Vol. 7 No. 2 (2025): Volume 7 No 2, September 2025 Edition
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2025.007.02.06

Introduction: Sleep disorders are found to be associated with hypertension, diabetes, cardiovascular disease and obesity, and can affect quality of life. Evaluation of sleep disorders and risk of depression in hospitalized COVID-19 patients have not been widely studied. The purpose of this study was to identify, evaluate, and analyze of sleep disorders and depression symptoms in hospitalized COVID-19 patients according to their severity and PaO2/FiO2 ratio. Case Report: A total of 35 patients with mild and moderate COVID-19 were given a questionnaire consisting of Epworth Sleepiness Scale (ESS) and Beck Depression Inventory (BDI), which was then analyzed together with the patient's blood gas analysis. Categorical data was compared using Chi Square Test, while the relationship between the continuous variables were measured with Pearson correlation test. A two-sided p value < 0.05 was considered statistically significant. About 42,85% and 62,9% COVID-19 patients were found to have sleep disorders and depression symptoms respectively. There were no significant differences between sleep disorders and the severity of COVID-19 (P=0.118) as well as PaO2/FiO2 ratio (P=0.411). Similarly, depression symptoms was not significantly different according to the severity of COVID-19 and PaO2/FiO2 ratio obtained with P=0.083 and P=0.061 respectively. Correlation test showed no significant correlation between sleep disorders and severity as well as PaO2/FiO2 ratio with r=0,274(p=0,111) and r=0,041(p=0,814) respectively. Likewise, negative correlation was found between depression symptoms and severity of COVID-19 (r=0,218;p=0,258) as well as PaO2/FiO2 ratio (r=0,078, p=0,057). Conclusion: In hospitalized COVID-19 patients, sleep disorders and depression were found, but there was no significant differences and correlation between sleep disorders and depression symptoms with the severity of COVID-19 and PaO2/FiO2 ratio.

Immunocytochemistry as a Diagnostic Procedure of Pleural Mesothelioma Trimurtini, Asih; Astuti, Triwahju; Yudhanto, Hendy Setyo; Erawati, Dini Rachma
Malang Respiratory Journal Vol. 2 No. 02 (2020)
Publisher : Universitaas Brawijaya

Background: Mesothelioma is a primary malignant tumor arising from the mesothelial surface of the pleura, peritoneal, tunica vaginalis, and pericardium. Most cases of mesothelioma originate from the pleura. Most patients have a history of asbestos exposure. A common diagnostic problem is distinguishing mesothelioma from adenocarcinoma since both tumors invade the pleura. Immunocytochemistry of calretinin and TTF-1 can be used to establish the diagnosis of mesothelioma.Case: Male, 56 years old presented with chest pain, shortness of breath, cough, and weight loss since 5 months before hospitalization. The patient had a history of occupational exposure to asbestos for 30 years. The movement and breath sounds were decreased as well as dull upon percussion at the right chest. A chest X-ray revealed a right lung tumor with pleural effusion. Thorax CT scan suggested pleural mass in right hemithorax, infiltration to intercostal muscles, and destruction of the 7th right rib, right perihilar lymphadenopathy, right pleural effusion, and liver nodules according to mesothelioma T4N1M1 Stage IV. Infiltrative stenting of the right and inferior lobe of the right lung, infiltrative and obstructive stenting of the medius lobe suggestive of a chronic malignancy and inflammation were found on FOB. Cytologic examination of pleural fluid, sputum, and Washing-and-brushing of FOB were a class II (no malignant cells). USG-guided transthoracic FNAB revealed adenocarcinoma with differential diagnosis of mesothelioma. Immunocytochemistry with calretinin showed positive results and TTF-1 showed a negative result. These confirmed the diagnosis of pleural mesothelioma T4N1M1 Stage IV. The patient showed a stable response from carboplatin/gemcitabine treatment.Keyword : Mesothelioma, Immunocytochemistry, TTF-1, Calrenitin

Co-Authors Agustin Iskandar Anung Sri Handayani David Christianto Dian Nugrahenny Djajalaksana, Susanthy Duta, Garinda Alma Edy Widjajanto Eko Prasetyo Erawati, Dini Rachma Febriawati, Juwita Fransisca Srioetami Tanoerahardjo Garinda Alma Duta Gede Sasmika Suwandi Harun Al Rasyid Karima, Karima Kristin Indriana Lindayanti Sumali Listyoko, Aditya Sri Maimun Z Arthamin Maimun Zulhaidah Arthamin Maimun Zulhaidah Arthamin, Maimun Zulhaidah Mufidatun Hasanah Munthe, Indra Nunuk Sri Muktiati Nunuk Sri Muktiati Putri Wulan Akbar Rahmad Budianto Ria Siska Myrnasari S, Noorhamdani A Sardjono, Teguh Wahyu Sartono, Teguh Rahayu Sumarno . Suryanti Dwi Pratiwi Teguh Rahayu Sartono Tjahyadi, Rizal Muldani Tri Yudani Mardining Raras Tri Yudani MR Trimurtini, Asih Wibi Riawan Yani Jane Sugiri Yudhanto, Hendy Setyo Zam Zam Firmansyah

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