Garuda - Garba Rujukan Digital

EGFR Mutated Lung Adenocarcinoma with Secondary Glaucoma as Early Manifestation: A Case Report Ida Ayu Jasminarti Dwi Kusumawardani; Venny Singgih; Ni Wayan Candrawati; Putu Yuliawati; Herman Saputra; I Gusti Ayu Sri Mahendra Dwi
Jurnal Respirasi Vol. 7 No. 1 (2021): January 2021
Publisher : Faculty of Medicine Universitas Airlangga

Background: Orbital metastases are rare in pulmonary adenocarcinoma and can be manifested as glaucoma.Case: A 64-year-old male patient complained of swelling, redness, painful and protruded left eye. Physical and radiological examination revealed mass in the right lung, retrobulbar intraconal mass of the left oculi, and metastases in the ribs, liver, brain, and vertebrae. Result of bronchial mucosal biopsy showed adenocarcinoma. Epidermal growth factor receptor (EGFR) mutation examinations detected exon 19 deletions, therefore Gefitinib was given. Left orbital exenteration was performed and obtained a biopsy result of adenocarcinoma metastases.Conclusion: Orbital metastasis occurs by hematogenous pathway due to direct access of systemic circulation to left orbital blood flow. Glaucoma as a symptom of orbital metastases can appear before primary tumor symptoms, because lung cancer often does not show specific symptoms until advanced stage. Definitive treatment consists of targeted therapy and surgical management for metastases.

Pin Point Trachea: A Case Report Ni Wayan Candrawati; Venny Singgih; Ketut Putu Yasa; Ida Bagus Ngurah Rai
Jurnal Respirasi Vol. 8 No. 1 (2022): January 2022
Publisher : Faculty of Medicine Universitas Airlangga

Introduction: Pin point trachea is a rare case. It is caused by tuberculosis (TB) and trauma due to intubation procedure. Main complication of this abnormality is respiratory failure. It can be diagnosed through bronchoscopy. Managements of this abnormality are interventional bronchoscopy and treating the etiology. Surgery is considered if interventional bronchoscopy failed or cannot be performed.Case: A 29-year-old woman came to the emergency room complaining shortness of breath and hoarseness since two months before hospitalized. The patient also experienced cough, decreased body weight and appetite since 7 months earlier. The patient was diagnosed with bacteriologically confirmed TB and anti-TB drug was given. Cough symptom was decreasing but shortness of breath and hoarseness remained after treatment. Physical examination showed decreased vesicular sound and stridor. Bronchoscopy revealed narrow tracheal lumen (pin point) with fibrosis. Thoracic computed tomography (CT) scan showed severe narrowing of tracheal lumen at thoracic vertebrae 1-2. Surgery was performed to cut the fibrotic tissue and tracheostomy was placed at stenosis area.Conclusion: Pin point trachea is a rare case. One of the causes is tracheobronchial TB. The main managements are optimal administration of anti-TB drugs and interventional bronchoscopy or surgery.

Risk Factors and Challenging Management of Lung Adenocarcinoma in Young Adult Women: Case Series Ida Ayu Jasminarti Dwi Kusumawardani; Luh Komang Ayu Widhiaty Karang; Ni Wayan Candrawati; Herman Saputra; Ni Putu Sriwidyani; Nornazirah Binti Azizan
Jurnal Respirasi Vol. 8 No. 2 (2022): May 2022
Publisher : Faculty of Medicine Universitas Airlangga

Introduction: Lung cancer found in young age is relatively rare with a percentage of cases only 1.4% of overall lung cancer cases in the world. Case: We reported two cases of lung adenocarcinoma in young women aged less than 30. The first case was lung adenosquamous carcinoma in a 28-year-old woman, a passive smoker, who had a family history of cancer. She had the mutation of epidermal growth factor receptor (EGFR) exon 19 deletion and received 1st generation of tyrosine kinase inhibitor. Since the patient was diagnosed at advanced stage with poor performance status, she died within 2 months after being diagnosed. The second case was lung adenocarcinoma in a 23-year-old woman. The patient was a passive smoker and had a history of cancer in the family. She was diagnosed at an advanced stage but with good performance status. The patient underwent chemotherapy with Pemetrexed-Platinum in 6 cycles and 15 cycles of radiotherapy. Conclusion: Lung cancer at a young age is more common in non-smoking female with the histopathology type adenocarcinoma. Non-specific early symptoms become a problem in the early enforcement of lung cancer at a young age. Many cancer-related issues occur in young cancer patient such as premature death, increased dependence on parents, difficulty in school and work due to medication, and reproductive disturbance.

Laporan Kasus: Tracheo-Oesophageal Fistula pada Pasien HIV Wayan Evie Frida Yustin; Ni Wayan Candrawati; I Gede Ketut Sajinadiyasa
Health and Medical Journal Vol 4, No 3 (2022): HEME September 2022
Publisher : Universitas Baiturrahmah

Pendahuluan: Fistula tracheoesophageal (TEF) merupakan kasus yang jarang terjadi, tetapi banyak penyebab termasuk imunosupresi akibat infeksi HIV. Human immunodeficiency virus (HIV) dapat menyebabkan peningkatan insidennya. Pemahaman mengenai kondisi HIV ini memungkinkan kita untuk dapat menegakkan diagnosis yang cepat dan akurat, sehingga dapat memberikan pengobatan yang tepat. Laporan kasus: Laki-laki berusia 30 tahun dengan HIV diantar ke RS dengan rasa sakit saat menelan, batuk terus-menerus dengan dahak kuning kecoklatan, dan tersedak saat menelan. Foto toraks menunjukkan atelektasis paru kiri dan bronkiektasis. Endoskopi menunjukkan 2 fistula pada dinding anterior 20 cm dari gigi seri. Bronkoskopi mengkonfirmasi fistula pada trakea posterior pada cincin ke-4 dengan semburan nanah. Jaringan ikat fibrosa dengan sel inflamasi kronis ditemukan pada biopsi trakea. ART, penutupan fistula, dan gastrostomi dilakukan, ditutup 1 tahun kemudian. Setelah itu dilakukan torakotomi pro pneumektomi. Nyeri saat menelan, batuk terus-menerus, dan dahak berwarna kuning kecoklatan merupakan manifestasi dari TEF. Diagnosis dipastikan melalui bronkoskopi yang menunjukkan fistula pada trakea posterior setinggi ring 4 disertai pecahnya sputum. Penatalaksanaan TEF meliputi terapi konservatif atau persiapan pra operasi (TPN, ART, NGT, dan / atau PEG) serta pembedahan. Pembedahan dilakukan untuk menutup fistula dan gastronomi akibat infeksi sebagai etiologinya. Kesimpulan: TEF merupakan komplikasi yang jarang terjadi pada pasien HIV, prognosisnya tidak baik.

Prevalence and Onset of Hepatotoxicity Caused by Anti-Tuberculosis Drugs on Pulmonary TB Patients in Wangaya General Hospital Denpasar – Bali in 2016 Wayan Evie Frida Yustin; Ida Ayu Jasminarti Dwi Kusumawardani; Ni Wayan Candrawati; Ida Bagus Ngurah Rai
Health and Medical Journal Vol 4, No 3 (2022): HEME September 2022
Publisher : Universitas Baiturrahmah

Introduction: As tuberculosis (TB) endemic country, TB becomes a community health problem in Indonesia. Data from the Global TB Report in 2016 showed that Indonesia is the second most country with TB burden after India. WHO and the Ministry of Health issue a TB prevention program based on the End TB Strategy aimed to reduce morbidity, mortality, and disability due to TB. One of the challenges faced in the management of TB is the side effects of the anti-tuberculosis drug. Hepatotoxicity is the most common side effect. Aims: This study aims to determine the prevalence and onset of anti-TB drug-induced hepatotoxicity in TB patients after receiving the anti-TB drug in Wangaya Hospital Denpasar Bali. Method: This study used a cross-sectional method by obtaining secondary data of pulmonary TB patients visiting the pulmonary clinic in Wangaya General Hospital from January to December 2016. Result: Of 77 subjects, fifty-six percent of them were men. The highest prevalence was found in the 41-50 years age group (26.9%), while the lowest was found in the 81-90 years age group (1.2%). Anti-TB drug-induced hepatotoxicity occurred in 6.5% of subjects. The most frequent onset of hepatotoxicity occurred within the second week of medication. Anti-TB drug-induced hepatotoxicity occurred in 6.5% of subjects. The most frequent onset of hepatotoxicity occurred within the second week of medication. Conclusion: Based on this study, we suggest a liver function test before and after two weeks of an anti-TB drug.

Respiratory Travel Medicine Ni Wayan Candrawati
Jurnal Respirasi Vol. 8 No. 3 (2022): September 2022
Publisher : Faculty of Medicine Universitas Airlangga

International tourist arrivals continue to increase over time due to global economic growth, increasing middle class in developing countries, technological advances, innovative business concepts, cost-effective travel, and facilitation of visas. The increase in tourist visits has resulted in health problems due to the trips. Respiratory tract infections are the main reason tourists seek medical care. Respiratory infections occur in 20% of all tourists, almost the same as the incidence of diarrhea. The majority of international inbound tourism involved air travel. Though physiological changes happen in everyone while air travel, people with lung disease are at high risk for significant complications and necessitate a specific risk assessment strategy. A pre-flight evaluation is conducted if there is any uncertainty regarding the patient's fitness for flight and the effect of eligibility to fly. This literature review summarized the important aspect of travel medicine from the respiratory medicine point of view.

Challenging Treatment of Drug-Resistant Tuberculosis during Pregnancy: A Case Report Ni Luh Putu Eka Arisanti; Ni Putu Ayu Widiasari; Ni Wayan Candrawati; Ida Ayu Jasminarti Dwi Kusumawardani; Ida Bagus Ngurah Rai; Made Ary Sarasmita
Jurnal Respirasi Vol. 8 No. 3 (2022): September 2022
Publisher : Faculty of Medicine Universitas Airlangga

Introduction: Globally, drug-resistant tuberculosis (TB) still has a high number of cases. Pregnant women are one of the high-risk populations for TB infection, especially multidrug resistance (MDR)/Rifampicin resistance (RR) TB. Physiological differences in pregnant women and the safety of the fetus make drug resistance TB treatment challenging. Case: A 20-year-old woman was 22 weeks pregnant while undergoing the third month of the late phase for short-regimen. Thus, Kanamycin was one of her early phase treatment combinations during the first trimester of pregnancy. After we consulted with other departments, especially the obstetric department, we decided not to change her regimen. Her chief complaint before treatment was cough with white sputum and fluctuated shortness of breath for two months. The patient only experienced minor side effects in the early treatment phase. The patient was cured of MDR TB on 8 October 2020 at 34 weeks of gestation. Her baby was born on 10 November 2020 at 37 weeks without congenital abnormality. Observation for her baby continued by the pediatric department. The last follow-up of her baby in the middle of 2022 found no abnormality in the child’s growth and development. Conclusion: Drug-resistant TB therapy in pregnant women requires the collaboration of a multidisciplinary team to consider the benefits and risks of the therapy based on gestational age and disease severity.

Interpretasi nilai Cycle Threshold (CT) Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) SARS-CoV-2 pada pasien hamil dengan uji antibodi SARS-CoV-2 positif dan COVID-19 asimtomatik Ni Wayan Candrawati; William Ray Cassidy
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Background: The majority of pregnant women with COVID-19 will be asymptomatic throughout the disease period. SARS-CoV-2 antibody tests were utilized as a screening tool for patients giving birth in a hospital. Cycle Threshold (CT) value in asymptomatic pregnant women may guide patient management and isolation protocol.Methods: Research data were obtained from medical records from March until October 2020 with a total sampling method. Pregnant women with positive SARS-CoV-2 antibody and asymptomatic COVID-19 were included. CT-value based on gene primers were grouped and analyzed by Microsoft Excel 365 for Windows.Results: Twenty-five pregnant women with asymptomatic COVID-19 fulfilled the inclusion criteria. All patients had positive SARS-CoV-2 antibodies. The highest and lowest CT-value for the RdRp gene were 37.91 and 26.90, followed by N-gene (34.37 and 32.16), E-gene (38.36 and 27.60), helicase gene (35.65 and 24.29), ORF1a (35.87 and 26.80), and ORF1ab (41.28 and 27.82).Conclusion: SARS-CoV-2 antibody test is not a recommended screening tool as it can reveal past infection or immunity to SARS-CoV-2. CT-value is incapable of determining COVID-19 severity and infection period. Latar Belakang: Mayoritas pasien COVID-19 dengan kehamilan tidak bergejala sepanjang periode perjalanan penyakit. Uji antibodi SARS-CoV-2 sempat digunakan sebagai alat skrining pasien yang akan melahirkan di rumah sakit. Nilai Cycle Threshold (CT) pada pasien hamil dengan COVID-19 asimtomatik kemungkinan dapat memandu tatalaksana dan isolasi pasien.Metode: Penelitian ini menggunakan data sekunder rekam medis dari bulan Maret hingga Oktober 2020 dengan total sampling. Data pasien hamil dengan uji antibodi SARS-CoV-2 positif dan terkonfirmasi COVID-19 asimtomatik dianalisis. Nilai cycle threshold (CT-value) berdasar primer dikelompokkan dan dianalisis menggunakan Microsoft Excel 365 untuk Windows. Hasil: Sebanyak 25 pasien hamil dengan terkonfirmasi COVID-19 asimtomatik memenuhi kriteria inklusi. Seluruh pasien memiliki hasil tes cepat antibodi SARS-CoV-2 reaktif. Nilai CT tertinggi dan terendah untuk gen RdRp sebesar 37,91 dan 26,9, diikuti dengan gen N (34,37 dan 32,16), gen E (38,36 dan 27,60), gen helicase (35,65 dan 24,29), ORF1a (35,87 dan 26,80), dan ORF1ab (41,28 dan 27,82).Simpulan: Nilai CT tidak dapat digunakan sebagai indikator keparahan gejala dan periode infeksi COVID-19. Pasien hamil dengan COVID-19 asimtomatik tidak harus menjalani isolasi di rumah sakit.

Anosmia dan ageusia sebagai faktor prognosis baik pada pasien COVID-19 rawat inap di RSUP Sanglah Denpasar Senja Decy Ningrum; Ida Bagus Ngurah Rai; I Gede Ketut Sajinadiyasa; Anak Agung Raka Sudewi; Ida Ayu Jasminarti Dwi Kusumawardani; Ni Wayan Candrawati; Ni Luh Putu Eka Arisanti
Intisari Sains Medis Vol. 13 No. 3 (2022): (In Press 1 December 2022)
Publisher : DiscoverSys Inc.

Background: Anosmia and ageusia are early symptoms that are widely reported in COVID 19 patients and are associated with low rates of intensive care and mortality, so the hypothesis arises that anosmia and ageusia can be good prognostic factors in COVID-19 patients. This study aims to examine anosmia and ageusia as prognostic factors in COVID-19 patients. Methods: This study is an observational analytic study with a retrospective cohort design conducted at Sanglah General Hospital Denpasar from January to June 2022. Results: obtained a total of 1048 subjects with 344 subjects experiencing anosmia, 210 subjects experiencing ageusia, and 474 subjects experiencing a combination of anosmia and ageusia. Variable symptoms of anosmia and ageusia were statistically significant predictors for the recovery of COVID-19 patients (p<0.05). The cure rate in the group of patients with symptoms of anosmia was 1.8 times (RR = 1.783, 95% CI = 1.667-1.908) and the group of patients with symptoms of ageusia experienced 1.6 times higher recovery (RR = 1.564, 95% CI = 1.478 -1,655). After adjusting for other variables as confounders, the combination of symptoms of anosmia and ageusia in patients was a significant predictor of recovery for COVID-19 patients by 1.5 times compared to patients who did not experience the combination of symptoms of anosmia and ageusia (ARR = 1.523, 95% CI = 1.245- 1.864, p<0.05). Conclusion: Anosmia, ageusia and the combination of both, indicate protective factors against possible mortality and indicate a good prognosis in COVID-19 patients. Latar belakang: Anosmia dan ageusia merupakan gejala awal yang banyak dilaporkan pada pasien COVID-19 serta dikaitkan dengan tingkat rawat intensif dan mortalitas yang rendah sehingga muncul hipotesis bahwa anosmia dan ageusia dapat menjadi faktor prognosis yang baik pada pasien COVID-19. Penelitian ini bertujuan untuk meneliti anosmia dan ageusia sebagai faktor prognosis pada pasien COVID- 19. Metode: Penelitian ini merupakan studi analitik observasional dengan rancangan kohort retrospektif yang dilakukan di RSUP Sanglah Denpasar pada bulan Januari hingga Juni 2022. Hasil: Didapatkan total 1048 subjek dengan 344 subjek mengalami anosmia, 210 subjek mengalami ageusia, serta 474 subjek mengalami kombinasi anosmia dan ageusia. Variabel gejala anosmia maupun ageusia secara statistik merupakan prediktor signifikan untuk kesembuhan pasien COVID-19 (p<0,05). Tingkat kesembuhan pada kelompok pasien bergejala anosmia mencapai 1,8 kali (RR = 1,783, IK 95% = 1,667-1,908) lebih tinggi dan kelompok pasien bergejala ageusia mengalami kesembuhan 1,6 kali lebih tinggi (RR = 1,564, IK 95% = 1,478-1,655). Setelah disesuaikan dengan variabel lain sebagai perancu, kombinasi gejala anosmia dan ageusia pada pasien menjadi prediktor kesembuhan pasien COVID-19 secara signifikan sebesar 1,5 kali lipat dibandingkan pasien yang tidak mengalami kombinasi gejala anosmia dan ageusia (ARR = 1,523, IK95% = 1,245-1,864, p<0,05). Simpulan: Anosmia, ageusia, dan kombinasi keduanya menunjukkan adanya faktor protektif terhadap kemungkinan mortalitas serta menandakan adanya prognosis yang baik pada pasien COVID-19

Comparison between serum pleural effusion albumin gradient, total protein, lactate dehydrogenase, and erythrocyte count in malignant and non-malignant pleural effusion Victor Nugroho Wijaya; I Gede Ketut Sajinadiyasa; Ni Wayan Candrawati; Ida Ayu Jasminarti Dwi Kusumawardani; Ni Luh Putu Eka Arisanti; I Gusti Ngurah Bagus Artana; Ida Bagus Ngurah Rai
Intisari Sains Medis Vol. 13 No. 3 (2022): (In Press 1 December 2022)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/ism.v13i3.1502

Background: Malignant pleural effusion carries a bad prognosis. Pathologic examination as the gold-standard diagnosis of malignant pleural effusion has sensitivity limitations and may cause delayed diagnosis. Several affordable examinations, such as serum pleural effusion albumin gradient, total protein, lactate dehydrogenase (LDH), and erythrocyte count, might be useful as malignant pleural effusion diagnostic tools. Methods: This is an observational analytic study with a cross-sectional design conducted at Sanglah Central General Hospital in Denpasar from December 2021 to July 2022. Pleural effusion fluid and blood were taken from subjects with malignant and non-malignant pleural effusion. Data were analyzed with SPSS version 25 software for Windows. Results: Total subjects were 47 persons consisting of 26 subjects with malignant pleural effusion and 21 subjects with non-malignant pleural effusion. Results from statistical analysis of malignant and non-malignant pleural effusion were serum pleural effusion albumin gradient median (IQR) 0.91 (0.65) g/dL vs. 1.22 (1.2) g/dL (p=0.129), total protein mean 3.92±0.95 g/dL vs. 3.52±1.67 g/dL (p=0.334), LDH median 535 (840) IU/L vs. 187 (1,016) IU/L (p=0.057), and erythrocyte count median 23,500 (109,250) cells/mm3 vs. 3,000 (11,000) cells/mm3 (p=0.004). The AUC of erythrocyte count from the ROC method was 0.745 (95%CI=0.599-0.890; p=0.004). Using a cut-off point ≥ 4,500 cells/mm3, it had a sensitivity of 80.8%, specificity of 61.9%, and Odds Ratio (OR) of 6.8 (95%CI=1.8-25.4). Conclusion: Erythrocyte count as routine examination showed good validity for diagnosing malignant pleural effusion and expected to reduce diagnosis delay. Meanwhile, albumin gradient, total protein, and LDH delivered no difference.

Title

Found 10 Documents
Search

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Title Search

Found 10 Documents Search

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Title

Found 10 Documents
Search