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Profile of Pulmonary Tuberculosis After COVID-19 at Toba District, North Sumatra Province Simatupang, Elvando Tunggul Mauliate; Simanjuntak, Arya Marganda; Yovi, Indra; Simbolon, Rohani Lasmaria; Fauzi, Zarfiardy Aksa
Jurnal Respirologi Indonesia Vol 44, No 4 (2024)
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.v44i4.716

Background: Worldwide cases of pulmonary tuberculosis (PTB) have significantly increased since the COVID-19 pandemic. Indonesia accounted for 6,811,818 of the 767,518,723 cases reported by the World Health Organization. While the Indonesian Ministry of Health reported 824,000 cases, the Global Tuberculosis Report in 2022 reported 10.6 million cases. The pandemic has hampered the goal of eliminating PTB globally, with cases diagnosed after COVID-19 having a 7.15-fold increased risk of contracting the illness.Methods: This cross-sectional study was conducted using total sampling to identify the profile of patients with PTB after having COVID-19 based on age, gender, classification, and type of PTB, as well as the duration of occurrence of PTB after COVID-19. The data collected were from COVID-19 patients from 2020 to 2022, then compared with PTB data. All data were compared to ensure that COVID-19 and PTB patient data were the same.Results: Of the 2544 patients recorded, 29 (1.1%) were infected with PTB after COVID-19 infection. The mean age of patients was 34±18.9 and was dominated by men (68.9%). Most of the cases were drug-sensitive TB (96.6%) and clinically diagnosed TB (55.2%). Age had a statistically significant association with the occurrence of TB cases after COVID-19 infection (P<0.0001). The mean time from the initial diagnosis of COVID-19 to the diagnosis of confirmed TB was approximately 203±34.3 days (6.7 months).Conclusion: After COVID-19, patients have the potential to be infected with TB. Screening former COVID-19 patients can be one solution to finding early cases of PTB.

Argon Plasma Coagulation in Bronchoscopy: A Safe and Effective Treatment for Airway Obstruction Anggi Rizki Utami Nasution; Indra Yovi; Sri Indah Indriani
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 6 (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.v9i6.1293

Background: Airway obstruction can significantly impair a patient's quality of life and even become life-threatening. Traditional treatment options, such as surgery or laser therapy, can be invasive and associated with significant complications. Argon plasma coagulation (APC) has emerged as a minimally invasive alternative for treating airway obstruction. APC uses ionized argon gas to deliver controlled thermal energy, allowing for precise tissue coagulation and ablation. This meta-analysis aims to evaluate the safety and efficacy of APC in treating airway obstruction. Methods: A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science databases. Studies published between 2013 and 2024 that evaluated the use of APC in bronchoscopy for airway obstruction were included. The primary outcomes were the success rate of APC in achieving airway patency and the incidence of complications. Results: Seven studies (n=342 patients) met the inclusion criteria. The pooled success rate of APC in achieving airway patency was 91% (95% CI, 87-94%). The overall incidence of complications was 8% (95% CI, 5-11%), with minor bleeding being the most common. Conclusion: This meta-analysis demonstrates that APC is a safe and effective treatment for airway obstruction. It offers a high success rate in restoring airway patency with a low risk of complications. APC is a valuable tool for pulmonologists in managing patients with airway obstruction.

High-Flow Nasal Cannula versus Non-Invasive Positive Pressure Ventilation in Adults with Acute Hypoxemic (Type 1) Respiratory Failure: A Meta-Analysis of Efficacy, Intubation Rates, and Mortality Muhammad Reza Arifin; Indra Yovi; Sri Indah Indriani
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (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.v9i8.1349

Background: Acute hypoxemic respiratory failure (AHRF), or Type 1 respiratory failure, is a common life-threatening condition characterized by severe impairment in arterial oxygenation. High-flow nasal cannula (HFNC) and Non-Invasive Positive Pressure Ventilation (NIPPV) are two widely used non-invasive respiratory support strategies. However, their comparative effectiveness in adults with Type 1 AHRF remains a subject of ongoing investigation. This meta-analysis aimed to compare the efficacy, intubation rates, and mortality associated with HFNC versus NIPPV in this patient population. Methods: A systematic search of PubMed, EMBASE, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) was conducted for randomized controlled trials (RCTs) published between January 2014 and December 2024. Studies comparing HFNC with NIPPV in adult patients with Type 1 AHRF were included. The primary outcomes were the rate of endotracheal intubation and all-cause mortality (hospital or 28-day). Secondary outcomes included improvement in oxygenation (such as change in PaO2/FiO2 ratio) and length of hospital stay. Two reviewers independently screened studies, extracted data, and assessed the risk of bias using the Cochrane Risk of Bias tool. Meta-analyses were performed using a random-effects model, and results were expressed as Risk Ratios (RR) with 95% Confidence Intervals (CI) for dichotomous outcomes and Mean Differences (MD) for continuous outcomes. Heterogeneity was assessed using the I² statistic. Results: Six RCTs involving a total of 1850 patients (920 in the HFNC group and 930 in the NIPPV group) met the inclusion criteria. The overall risk of bias in the included studies was moderate. There was no statistically significant difference between HFNC and NIPPV in the rate of endotracheal intubation (RR 0.92, 95% CI 0.75-1.13; I²=28%; 6 studies) or all-cause mortality (RR 0.88, 95% CI 0.69-1.12; I²=15%; 6 studies). For oxygenation improvement, assessed by the change in PaO2/FiO2 ratio at 24 hours, data from four studies showed no significant difference between the two groups (MD 5.8 mmHg, 95% CI -8.5 to 20.1 mmHg; I²=45%). Hospital length of stay was also comparable. Subgroup analyses based on underlying etiology (such as pneumonia) did not reveal significant interactions. Conclusion: In adult patients with Type 1 acute hypoxemic respiratory failure, this meta-analysis found no significant difference between HFNC and NIPPV in terms of intubation rates, mortality, or improvement in oxygenation. Both modalities appear to be viable initial non-invasive respiratory support options. The choice between HFNC and NIPPV may depend on patient tolerance, local expertise, resource availability, and specific clinical contexts. Further large-scale, high-quality RCTs are warranted to confirm these findings and explore effects in specific patient subgroups.

Argon Plasma Coagulation in Bronchoscopy: A Safe and Effective Treatment for Airway Obstruction Anggi Rizki Utami Nasution; Indra Yovi; Sri Indah Indriani
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 6 (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.v9i6.1293

Background: Airway obstruction can significantly impair a patient's quality of life and even become life-threatening. Traditional treatment options, such as surgery or laser therapy, can be invasive and associated with significant complications. Argon plasma coagulation (APC) has emerged as a minimally invasive alternative for treating airway obstruction. APC uses ionized argon gas to deliver controlled thermal energy, allowing for precise tissue coagulation and ablation. This meta-analysis aims to evaluate the safety and efficacy of APC in treating airway obstruction. Methods: A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science databases. Studies published between 2013 and 2024 that evaluated the use of APC in bronchoscopy for airway obstruction were included. The primary outcomes were the success rate of APC in achieving airway patency and the incidence of complications. Results: Seven studies (n=342 patients) met the inclusion criteria. The pooled success rate of APC in achieving airway patency was 91% (95% CI, 87-94%). The overall incidence of complications was 8% (95% CI, 5-11%), with minor bleeding being the most common. Conclusion: This meta-analysis demonstrates that APC is a safe and effective treatment for airway obstruction. It offers a high success rate in restoring airway patency with a low risk of complications. APC is a valuable tool for pulmonologists in managing patients with airway obstruction.

High-Flow Nasal Cannula versus Non-Invasive Positive Pressure Ventilation in Adults with Acute Hypoxemic (Type 1) Respiratory Failure: A Meta-Analysis of Efficacy, Intubation Rates, and Mortality Muhammad Reza Arifin; Indra Yovi; Sri Indah Indriani
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (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.v9i8.1349

Background: Acute hypoxemic respiratory failure (AHRF), or Type 1 respiratory failure, is a common life-threatening condition characterized by severe impairment in arterial oxygenation. High-flow nasal cannula (HFNC) and Non-Invasive Positive Pressure Ventilation (NIPPV) are two widely used non-invasive respiratory support strategies. However, their comparative effectiveness in adults with Type 1 AHRF remains a subject of ongoing investigation. This meta-analysis aimed to compare the efficacy, intubation rates, and mortality associated with HFNC versus NIPPV in this patient population. Methods: A systematic search of PubMed, EMBASE, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) was conducted for randomized controlled trials (RCTs) published between January 2014 and December 2024. Studies comparing HFNC with NIPPV in adult patients with Type 1 AHRF were included. The primary outcomes were the rate of endotracheal intubation and all-cause mortality (hospital or 28-day). Secondary outcomes included improvement in oxygenation (such as change in PaO2/FiO2 ratio) and length of hospital stay. Two reviewers independently screened studies, extracted data, and assessed the risk of bias using the Cochrane Risk of Bias tool. Meta-analyses were performed using a random-effects model, and results were expressed as Risk Ratios (RR) with 95% Confidence Intervals (CI) for dichotomous outcomes and Mean Differences (MD) for continuous outcomes. Heterogeneity was assessed using the I² statistic. Results: Six RCTs involving a total of 1850 patients (920 in the HFNC group and 930 in the NIPPV group) met the inclusion criteria. The overall risk of bias in the included studies was moderate. There was no statistically significant difference between HFNC and NIPPV in the rate of endotracheal intubation (RR 0.92, 95% CI 0.75-1.13; I²=28%; 6 studies) or all-cause mortality (RR 0.88, 95% CI 0.69-1.12; I²=15%; 6 studies). For oxygenation improvement, assessed by the change in PaO2/FiO2 ratio at 24 hours, data from four studies showed no significant difference between the two groups (MD 5.8 mmHg, 95% CI -8.5 to 20.1 mmHg; I²=45%). Hospital length of stay was also comparable. Subgroup analyses based on underlying etiology (such as pneumonia) did not reveal significant interactions. Conclusion: In adult patients with Type 1 acute hypoxemic respiratory failure, this meta-analysis found no significant difference between HFNC and NIPPV in terms of intubation rates, mortality, or improvement in oxygenation. Both modalities appear to be viable initial non-invasive respiratory support options. The choice between HFNC and NIPPV may depend on patient tolerance, local expertise, resource availability, and specific clinical contexts. Further large-scale, high-quality RCTs are warranted to confirm these findings and explore effects in specific patient subgroups.

Update on The Current Management of Drug Resistant Tuberculosis (DR-TB) Simbolon, Rohani Lasmaria; Simatupang, Elvando Tunggul Mauliate; Yovi, Indra; Fauzi, Zarfiardy Aksa
Indonesian Journal of Tropical and Infectious Disease Vol. 13 No. 2 (2025)
Publisher : Institute of Topical Disease Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijtid.v13i2.59075

Drug-Resistant tuberculosis (DR-TB) is a global public health threat that requires a comprehensive response from all parties. DR-TB cases are often overlooked and tend to increase every year. Efforts to overcome DR-TB cases began in 2009 with the use of a molecular test, Xpert MTB/Rif, as a diagnostic tool. This has now been developed with the procurement of a molecular test with Xpert MTB/XDR. This diagnostic update also formed the basis of the latest DR-TB classification terminology by not categorizing polyresistance into the DR-TB group. This step is still not in accordance with the low success rate of DR-TB treatment in Indonesia, ranging from 45-50%. The latest DR-TB management recommendations by WHO in 2022 have implemented a 6-month treatment regimen to minimize the occurrence of treatment dropout or patient treatment non-compliance. The BPaLM/BPaL regimen is a shorter-duration oral regimen that is expected to help achieve the End TB 2015-2030 targets. Previously used short-term regimens have now been modified with Ethionamide and Linezolid variants as alternatives for DR-TB management if the BPaLM/BPaL regimen does not meet the criteria for use.

Flexi-rigid Pleuroscopy in Diagnostics of Malignancy: A Narrative Literature Review Salmiyah; Indra Yovi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 2 (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.v8i2.925

Pleuroscopy is a less invasive treatment that allows access to the pleural cavity with the use of both visual and surgical equipment. This technique can be conducted with local anesthesia and mild sedation. Pleuroscopy is a medical procedure used for both diagnosis and treatment in the pleural cavity. Pleuroscopy enables direct observation of the pleural surface, enhancing the safety of procedures such as pleural biopsy, pleural fluid drainage, and pleurodesis. One purpose is to assist in verifying the diagnosis of cancer. This review was aimed to describe the use of flexi-rigid pleuroscopy in malignancy.

Long COVID-19: Multidisciplinary Approach and Pulmonary Fibrosis Sequelae Febrina, Nidya; Yovi, Indra
Respiratory Science Vol. 4 No. 3 (2024): Respiratory Science
Publisher : Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/respirsci.v4i3.140

COVID-19 patients may experience a persistent condition of post-COVID-19 infection, which is known as the long-COVID phenomenon or post-acute sequelae of SARS-CoV-2 infection (PASC) or post-acute COVID-19 syndrome (PACS) with long-term sequelae characteristics that stay after the convalescent period of COVID-19 disease. The most common clinical symptoms found within 5 weeks post-infection were fatigue (12.7%), cough (12.4%), headache (11.1%), loss of sense of taste or smell (10.4%), and muscle pain (8.8%). Women have a slightly higher prevalence than men, with a value of 23.6% and 20.7%, respectively, which are dominated by 35-49 years old (26.8%), 50-69 years old (26.1%), and 25-34 years old (24.9%). Pulmonary fibrosis sequelae in COVID-19 occur due to the destruction of the alveolar epithelium and the formation of active myofibroblast foci, causing excessive accumulation of extracellular matrix in lung tissue. Long COVID management requires a multidisciplinary approach, including health workers and the wider community, as well as systematic assessment management. The recommended therapy includes pharmacological (symptomatic, micronutrients, antibiotics, and anti-inflammatory) and non-pharmacological (medical and psychosocial rehabilitation). This review aims to summarize the long COVID and multidisciplinary approach to improve the patient's quality of life.

Successful Autologous Blood Patch Pleurodesis: A Safe and Useful Treatment for Persistent Pneumothorax in Former Pulmonary Tuberculosis and Aspergillosis in Pregnant Women Purnama, Nori; Simatupang, Elvando Tunggul Mauliate; Fauzi, Zarfiardy Aksa; Indriani, Sri; Yovi, Indra; Hatta, Hariadi; Zulmaeta
Malang Respiratory Journal Vol. 6 No. 1 (2024): March 2024 Edition
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2024.006.01.04

Background: Autologous Blood Patch Pleurodesis (ABPP) is one of the treatment options for persistent pleural air leaks especially in patients who are not suitable for surgical intervention. Persistence pneumothorax is defined as pneumothorax of more than five days duration. It is associated with increased morbidity and cost of care. The most widely accepted treatment for it is pleurodesis. Several types of pleurodesis have been proposed, including surgical approaches and the instillation of different chemicals in the intrapleural space. ABPP has proven to be a simple, inexpensive, efficacious and safe method. We present the case of the first patient with Persistent Pneumothorax we have treated Successfully with ABPP. ABPP is currently rarely and uncommonly used, but it provides benefits especially in special conditions with easier, cheaper, and quite effective procedures. Case: A female 35-year-old pregnant women patients with Former Tuberculosis (FTB) come to our hospital with complaints breathlessness and chest pain worsening since 3 days before admitted to our hospital. Chest radiography showed spontaneous pneumothorax with GeneXpert (GE) sputum Mtb Not Detected but there is Aspergillosis from Fungal Culture. Water Sealed Drainage (WSD) was inserted in right pleural for almost 1 month and this patient discharge with pneumostat. One month after that she come again with Persistence Pneumothotax, so that we do the pleurodesis with Blood Patch and get the improvement from clinical status. Antifungals are continued for an initial 4-6 weeks while an outpatient evaluation is conducted. Conclusion: ABPP is a safe, inexpensive and efficacious treatment for persistent pleural air leak. Autologous Blood Patch administration may be considered for patients with Persistent Pneumothorax.

The Correlation Between Type and Stage of Lung Cancer with The Chronic Obstructive Pulmonary Disease Group at Arifin Achmad Hospital, Pekanbaru Gurning, Andi Sarikawan; Munir, Sri Melati; Yunus, Faisal; Fauzi, Zarfiardy Aksa; Adrianison, Adrianison; Yovi, Indra; Indriani, Sri Indah
Jurnal Respirologi Indonesia Vol 45 No 2 (2025)
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.v45i2.512

Background: The relationship between lung cancer (LC) and chronic obstructive pulmonary disease (COPD) has been extensively studied but is still up for debate. COPD is a molecularly based illness and one of the independent risk factors for lung cancer, particularly squamous cell carcinoma. This study uses spirometry to assess the relationship between the type and stage of LC and COPD in a group of LC patients at Arifin Achmad Hospital. Methods: This cross-sectional study was conducted on lung cancer patients in Arifin Achmad Hospital, Pekanbaru, from June 2022 to December 2022. Based on spirometry examination, patients were grouped according to the degree of COPD. Then, the relationship between the COPD group and the type and degree of cancer was determined. Results: The study involved 52 patients predominantly male (71.2%), aged over 40 years (92.3%), Smokers and former smokers with Severe Brinkman index (69.2%), restrictive lung function (34.6%), COPD group D (40.4%), adenocarcinoma (61.5%), stage IV lung cancer (92,3%) and WHO Performance Status Scale 2 (61.5%). The FEV1/FVC rate in this study was 66.67%. There is a link between the stage of lung cancer and the group of COPD (P=0.001). Conclusion: There is a relation between the stage of LC in the COPD group, which is predominantly with stage IV lung cancer, and group D of COPD.

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