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High-Frequency Chest Wall Oscillation versus Conventional Airway Clearance Techniques in Non-Cystic Fibrosis Bronchiectasis: A Meta-Analysis Dzaki Murtadho; Irvan Medison; Deddy Herman
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 4 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i4.1255

Background: Non-cystic fibrosis bronchiectasis (NCFB) is a chronic lung disease characterized by irreversible airway dilation and impaired mucociliary clearance, leading to chronic cough, sputum production, and recurrent infections. This meta-analysis aims to compare the efficacy of high-frequency chest wall oscillation (HFCWO) with conventional airway clearance techniques (CACT) in adults with NCFB. Methods: A systematic search of PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases was conducted from January 2013 to March 2024. Randomized controlled trials (RCTs) comparing HFCWO with CACT (postural drainage, percussion, active cycle of breathing technique, positive expiratory pressure therapy) in adults with NCFB were included. The primary outcomes were a change in forced expiratory volume in one second (FEV1) and sputum weight. Secondary outcomes included quality of life, exacerbation frequency, and adverse events. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Data were pooled using a random-effects model, and heterogeneity was assessed using the I² statistic. Results: Nine RCTs involving a total of 485 participants were included. The meta-analysis showed no statistically significant difference in FEV1 change between HFCWO and CACT (mean difference [MD] 0.05 L, 95% confidence interval [CI] -0.02 to 0.12; I² = 45%). HFCWO was associated with a statistically significant increase in sputum weight compared to CACT. SGRQ total score showed a statistically significant improvement in the HFCWO group compared to CACT (MD -4.21, 95% CI -7.88 to -0.54; I² = 58%). Conclusion: HFCWO may provide a modest benefit in terms of increased sputum clearance and improved quality of life compared to CACT in adults with NCFB. However, there was no significant difference in lung function (FEV1) or exacerbation frequency. The moderate to high heterogeneity in some outcomes suggests that further research is needed to confirm these findings and identify patient subgroups who may benefit most from HFCWO.

Diagnosis And Management Of Pulmonary Tuberculosis In Hiv With Severe Immunodeficiency Rizki, Fitri Amelia; Medison, Irvan; Anggrainy, Fenty
PROFESSIONAL HEALTH JOURNAL Vol. 7 No. 1 (2025): December
Publisher : Pusat Penelitian dan Pengabdian Masyarakat (PPPM) STIKES Banyuwangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.54832/phj.v7i1.1016

The total number of TB cases in Indonesia is 969,000. This figure represents a 17% increase compared to 2020. SITB 2022 data shows there are 15,375 cases of co-infection of pulmonary TB with HIV. The treatment success rate for pulmonary TB co-infection with HIV in Indonesia in 2022 is 71%. This is still far from the national target of 90%.This case report discusses a 33-year-old man with pulmonary TB and TB lymphadenitis with HIV at clinical stage 4. The CD4 count was 10 cells/mm3. The degree of immunodeficiency suffered by this patient is severe immunodeficiency. The management was to administer OAT first, followed by ART within 2 weeks after OAT was administered and well tolerated. OAT was administered for 9 months due to the presence of TB lymphadenitis. Treatment evaluation showed clinical improvement and the patient did not develop IRIS. The incidence of IRIS in patients with TB is 8%-43%. Factors influencing the occurrence of IRIS include the CD4 count at the start of ART.

Management Strategies and Outcomes for Bilateral Pulmonary Hydatid Cysts: A Systematic Review and Meta-Analysis Berliana Islamiyarti Hydra; Irvan Medison; Fenty Anggrainy
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 7 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i7.1342

Background: Bilateral pulmonary hydatid disease presents a complex therapeutic challenge, necessitating careful consideration of surgical timing, approach, and adjuvant medical therapy to optimize patient outcomes while minimizing morbidity. This systematic review and meta-analysis aimed to evaluate the different management strategies and their associated outcomes in patients with bilateral pulmonary hydatid cysts. Methods: A systematic search of PubMed, Embase, Scopus, and Web of Science databases was conducted for studies published between January 2014 and December 2024, reporting on management strategies (one-stage bilateral surgery, two-stage bilateral surgery, medical therapy) and outcomes (postoperative complications, recurrence, mortality, length of hospital stay) in patients with bilateral pulmonary hydatid cysts. Studies were selected based on predefined inclusion and exclusion criteria. Data were extracted by two independent reviewers, and quality assessment was performed using a modified Newcastle-Ottawa Scale. Pooled proportions for outcomes were calculated using random-effects models. Heterogeneity was assessed using the I2 statistic. Results: Seven studies, encompassing a total of 305 patients with bilateral pulmonary hydatid cysts, met the inclusion criteria. The studies varied in design, including retrospective cohorts and prospective case series. Management predominantly involved surgical intervention, with 148 patients (48.5%) undergoing one-stage bilateral surgery and 127 patients (41.6%) undergoing two-stage procedures. Perioperative albendazole was administered to 245 patients (80.3%). The pooled overall postoperative complication rate was 28.7% (95% CI: 21.5%-36.8%; I2=78%). Major complications occurred in 12.1% (95% CI: 8.0%-17.9%; I2=65%). The pooled recurrence rate at a mean follow-up of 38.5 months was 8.5% (95% CI: 5.1%-13.8%; I2=55%). Overall mortality was 2.1% (95% CI: 0.9%-4.5%; I2=0%). Patients undergoing one-stage surgery exhibited a trend towards higher overall complication rates (33.1% vs. 25.2% for two-stage) but shorter total hospital stays. Adjuvant albendazole therapy was associated with a trend towards lower recurrence rates. Conclusion: Surgical management, whether one-stage or two-stage, remains the cornerstone of treatment for bilateral pulmonary hydatid disease, achieving acceptable morbidity and mortality with good long-term control in most patients. Postoperative complications are relatively common, highlighting the complexity of these cases. While one-stage surgery may shorten overall hospital stay, it might be associated with a higher risk of immediate complications. Adjuvant albendazole appears beneficial in reducing recurrence. The choice of surgical strategy should be individualized based on patient status, cyst characteristics, and surgical expertise. Further prospective, comparative studies are needed to delineate optimal management pathways.

Navigating a Therapeutic Triad: A Case of Pulmonary Tuberculosis Complicated by Drug-Induced Liver Injury and Prediabetes Yuni Kartika; Irvan Medison; Dessy Mizarti
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i9.1372

Background: The management of pulmonary tuberculosis (TB) is frequently complicated by adverse drug reactions, with drug-induced liver injury (DILI) being one of the most severe. The clinical challenge is significantly amplified in patients with underlying metabolic disorders such as prediabetes, which can impair immune responses and affect treatment outcomes. This report details the complex management of a geriatric patient presenting with this therapeutic triad. Case presentation: A 67-year-old male with newly diagnosed, drug-sensitive pulmonary tuberculosis developed severe hepatotoxicity ten days after initiating standard first-line anti-tuberculosis therapy. Clinical presentation included jaundice, nausea, and vomiting, with laboratory findings showing a severe hepatocellular injury pattern (SGOT 204 U/L, SGPT 126 U/L) and hyperbilirubinemia (Total Bilirubin 2.6 mg/dL). Concurrently, he was diagnosed with prediabetes (HbA1c 5.9%) and was suffering from severe malnutrition (BMI 15.6 kg/m²). The offending drugs were immediately withdrawn, and supportive therapy was initiated. Following normalization of liver function, a modified anti-tuberculosis regimen was cautiously reintroduced using a stepwise re-challenge protocol that entirely omitted pyrazinamide. Conclusion: The patient was successfully managed with a modified nine-month regimen of isoniazid, rifampicin, and ethambutol, achieving clinical and biochemical stability without recurrence of liver injury. This case highlights that a meticulous, stepwise approach—involving prompt drug withdrawal, supportive care, and a tailored re-challenge protocol—can lead to successful TB treatment outcomes without recurrence of DILI, even in a patient with multiple converging high-risk factors.

Management Strategies and Outcomes for Bilateral Pulmonary Hydatid Cysts: A Systematic Review and Meta-Analysis Berliana Islamiyarti Hydra; Irvan Medison; Fenty Anggrainy
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 7 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i7.1342

Background: Bilateral pulmonary hydatid disease presents a complex therapeutic challenge, necessitating careful consideration of surgical timing, approach, and adjuvant medical therapy to optimize patient outcomes while minimizing morbidity. This systematic review and meta-analysis aimed to evaluate the different management strategies and their associated outcomes in patients with bilateral pulmonary hydatid cysts. Methods: A systematic search of PubMed, Embase, Scopus, and Web of Science databases was conducted for studies published between January 2014 and December 2024, reporting on management strategies (one-stage bilateral surgery, two-stage bilateral surgery, medical therapy) and outcomes (postoperative complications, recurrence, mortality, length of hospital stay) in patients with bilateral pulmonary hydatid cysts. Studies were selected based on predefined inclusion and exclusion criteria. Data were extracted by two independent reviewers, and quality assessment was performed using a modified Newcastle-Ottawa Scale. Pooled proportions for outcomes were calculated using random-effects models. Heterogeneity was assessed using the I2 statistic. Results: Seven studies, encompassing a total of 305 patients with bilateral pulmonary hydatid cysts, met the inclusion criteria. The studies varied in design, including retrospective cohorts and prospective case series. Management predominantly involved surgical intervention, with 148 patients (48.5%) undergoing one-stage bilateral surgery and 127 patients (41.6%) undergoing two-stage procedures. Perioperative albendazole was administered to 245 patients (80.3%). The pooled overall postoperative complication rate was 28.7% (95% CI: 21.5%-36.8%; I2=78%). Major complications occurred in 12.1% (95% CI: 8.0%-17.9%; I2=65%). The pooled recurrence rate at a mean follow-up of 38.5 months was 8.5% (95% CI: 5.1%-13.8%; I2=55%). Overall mortality was 2.1% (95% CI: 0.9%-4.5%; I2=0%). Patients undergoing one-stage surgery exhibited a trend towards higher overall complication rates (33.1% vs. 25.2% for two-stage) but shorter total hospital stays. Adjuvant albendazole therapy was associated with a trend towards lower recurrence rates. Conclusion: Surgical management, whether one-stage or two-stage, remains the cornerstone of treatment for bilateral pulmonary hydatid disease, achieving acceptable morbidity and mortality with good long-term control in most patients. Postoperative complications are relatively common, highlighting the complexity of these cases. While one-stage surgery may shorten overall hospital stay, it might be associated with a higher risk of immediate complications. Adjuvant albendazole appears beneficial in reducing recurrence. The choice of surgical strategy should be individualized based on patient status, cyst characteristics, and surgical expertise. Further prospective, comparative studies are needed to delineate optimal management pathways.

Navigating a Therapeutic Triad: A Case of Pulmonary Tuberculosis Complicated by Drug-Induced Liver Injury and Prediabetes Yuni Kartika; Irvan Medison; Dessy Mizarti
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i9.1372

Background: The management of pulmonary tuberculosis (TB) is frequently complicated by adverse drug reactions, with drug-induced liver injury (DILI) being one of the most severe. The clinical challenge is significantly amplified in patients with underlying metabolic disorders such as prediabetes, which can impair immune responses and affect treatment outcomes. This report details the complex management of a geriatric patient presenting with this therapeutic triad. Case presentation: A 67-year-old male with newly diagnosed, drug-sensitive pulmonary tuberculosis developed severe hepatotoxicity ten days after initiating standard first-line anti-tuberculosis therapy. Clinical presentation included jaundice, nausea, and vomiting, with laboratory findings showing a severe hepatocellular injury pattern (SGOT 204 U/L, SGPT 126 U/L) and hyperbilirubinemia (Total Bilirubin 2.6 mg/dL). Concurrently, he was diagnosed with prediabetes (HbA1c 5.9%) and was suffering from severe malnutrition (BMI 15.6 kg/m²). The offending drugs were immediately withdrawn, and supportive therapy was initiated. Following normalization of liver function, a modified anti-tuberculosis regimen was cautiously reintroduced using a stepwise re-challenge protocol that entirely omitted pyrazinamide. Conclusion: The patient was successfully managed with a modified nine-month regimen of isoniazid, rifampicin, and ethambutol, achieving clinical and biochemical stability without recurrence of liver injury. This case highlights that a meticulous, stepwise approach—involving prompt drug withdrawal, supportive care, and a tailored re-challenge protocol—can lead to successful TB treatment outcomes without recurrence of DILI, even in a patient with multiple converging high-risk factors.

Differences In Interleukin-6 and Liver Enzyme Level Based On Clinical Severity of COVID-19 Patients at Dr. M. Djamil General Hospital, Padang Elsesmita, Elsesmita; Medison, Irvan; Herman, Deddy
Respiratory Science Vol. 5 No. 3 (2025): Respiratory Science
Publisher : Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/respirsci.v5i3.171

Background: COVID-19 pathogenesis involves the release of proinflammatory cytokines and chemokines, known as a "cytokine storm." Interleukin-6 (IL-6) plays a key role in initiating cytokine storms. Cytokine storm causes multiple organ complications. Liver injury affects 14% to 53% of COVID-19 patients and is manifested by increased liver enzymes. This study evaluated differences in IL-6 and liver enzyme levels based on clinical severity in COVID-19 patients. Method: A retrospective cross-sectional study was conducted. COVID-19 patients treated at Dr. M. Djamil General Hospital, Padang, from January 1, 2021, to December 31, 2021, and who met the inclusion and exclusion criteria, were the research subjects. The Kruskal-Wallis test was performed to analyze differences in IL-6, SGOT, and SGPT levels based on clinical severity. Results: Most participants (42.06%) were under 50 years old, half were female (56.15%), obesity was the most common comorbidity (41.39%), and moderate severity was most common (42.06%). The majority of the subjects, 87.47%, had elevated IL-6 levels (≥7 pg/mL). SGOT levels of ≥32 IU/L (46.76%) and SGPT levels of ≥31 IU/L (41.39%) were found in less than half of the subjectsClinical severity was significantly associated with IL-6 levels, resulting in a significant difference in IL-6 levels (P<0.05). The clinical severity of COVID-19 patients at Dr. M. Djamil General Hospital, Padang, resulted in a significant difference in SGOT and SGPT levels (P<0.05). Conclusion: IL-6 levels differed based on clinical severity in COVID-19 patients. SGOT and SGPT levels also differed by clinical severity.

Cultural and Religious Belief Approaches of a Tuberculosis Program for Hard-to-Reach Populations in Mentawai and Solok West Sumatera, Indonesia Machmud, Rizanda; Medison, Irvan; Yani, Finny Fitry
Kesmas Vol. 15, No. 4
Publisher : UI Scholars Hub

Show Abstract | Download Original | Original Source | Check in Google Scholar

Tuberculosis (TB) is a leading public health concern in Indonesia. It ranks second on the list of high-burden TB countries. In West Sumatra, 47% of TB cases are undetected, late diagnosed, and received incomplete treatment because of low-level awareness and knowledge and stigma, especially among the hardest to reach populations. The study aims to identify the best communication channel to reach those who live in vulnerable and remote areas. This study was a qualitative study applying in-depth interviews to the informal leaders, health officers, cultural artists, and religious leaders across districts in Mentawai and Solok Districts, which are remote and had the lowest case detection rates compared with other districts. The questionnaire was prepared with the perception of the channel to identify TB cases. The data were analyzed using the content analysis technique. Involving religious and informal leaders and using traditional music as a communication channel improved the population's awareness of TB symptoms and access to TB testing and treatment, as well as reduced TB-related stigma. This study found that the cultural and religious contexts play a major role in health communication on TB control for hard-to-reach populations in West Sumatera, Indonesia.

Aspergilloma Mimicry of Lung Cancer: A Case Report Bagus HS, Muhammad; Irvan Medison; Dewi Wahyu Fitrina; Dessy Mizarti
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 7 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i7.1018

Background: Aspergilloma and lung cancer have similar risk factors, clinical features, and supporting features. Special supporting examinations are needed to rule out the differential diagnosis of aspergilloma. Case presentation: A 52-year-old male patient with coughing up blood and risk factors for smoking had a chest X-ray and computed tomography scan (CT scan) of the thorax and found a picture of a lung tumor. Bronchoscopy was carried out, and a bronchial lavage culture was carried out for the impression of Aspergillosis, given 1x150 mg of fluconazole for 6 months with improved clinical results and chest radiographs as well as negative sputum culture results. Conclusion: This patient showed the condition of aspergilloma mimicking lung cancer.

Rare Presentation of Non-Tuberculous Mycobacteria: A Case of Lung Infection with Pleural Effusion Ventiani, Nadia; Dewi Wahyu F.; Irvan Medison; Dessy Mizarti
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 11 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i11.1122

Background: Non-tuberculous mycobacteria (NTM) are environmental organisms that can cause pulmonary infections, particularly in individuals with predisposing conditions. While NTM lung disease is increasingly recognized, pleural effusion as a complication remains uncommon, posing diagnostic and therapeutic challenges. This case emphasizes the importance of a high index of suspicion, comprehensive microbiological investigations, and bronchoscopy in the diagnosis of NTM lung disease with pleural effusion. Case presentation: We present the case of a 55-year-old male farmer with a history of smoking, who presented with progressive dyspnea, cough, and constitutional symptoms. Initial investigations suggested tuberculosis, but sputum tests were negative. Chest imaging revealed a right pleural effusion and cavitary lung lesions. Pleural fluid analysis showed an exudative pattern with elevated adenosine deaminase (ADA) but negative for acid-fast bacilli. Bronchoscopy with bronchoalveolar lavage culture yielded Mycobacterium other than tuberculosis (MOTT). The patient was diagnosed with NTM lung disease complicated by pleural effusion and initiated on multidrug therapy. Conclusion: This case highlights the diagnostic challenges of NTM lung disease, particularly when presenting with pleural effusion. A high index of suspicion, comprehensive microbiological investigations, and bronchoscopy are crucial for accurate diagnosis. Prompt initiation of appropriate multidrug therapy is essential for optimal outcomes.

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