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Rapid Diagnosis and Management of Concomitant Acute Cardiogenic Pulmonary Edema and Community-Acquired Pneumonia Increase Patient Survival Wibowo, Adityo; Saputra, Tetra Arya
Medula Vol 14 No 2 (2024): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v14i2.961

Acute pulmonary edema is a potentially life-threatening complication of cardiac disease that leads to acute respiratory failure. Cardiogenic pulmonary edema affects approximately 80% of patients with acute decompensated heart failure. Acute pulmonary edema caused by heart failure affects nearly a million individuals annually, and the number of cases is growing significantly as the ejection fraction reduces. The clinical presentation can be identified by a sudden onset of dyspnea and a quick accumulation of fluid inside the alveolar and lung interstitial secondary to an increase in hydrostatic pressure. Community-acquired pneumonia (CAP) is the most common respiratory infection caused by a microbial infection of the lung parenchyma and has almost similar clinical characteristics to acute pulmonary edema. The length of stay in hospital will increase nearly two times longer in these concomitant diseases. Comorbidity of cardiogenic lung edema and CAP increase mortality rate by nearly 25% in heart failure patients without early detection and proper management.

Proper Management of Underweight and Anemia in Tuberculosis Patients Increases The Improvement Time During Two-Week Treatment Follow-Up Saputra, Tetra Arya; Wibowo, Adityo
Medula Vol 14 No 5 (2024): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v14i5.991

Tuberculosis (TB) continues to be the leading cause of disease and mortality caused by chronic pulmonary infection. The World Health Organization (WHO) considers that one-third of the global population is infected with Mycobacterium tuberculosis (Mtb). Mycobacterium tuberculosis infection results in persistent lung damage, which is characterized by ongoing inflammation that damages lung tissue. The patient additionally experienced a cough for almost one month, with clear mucous, absence of blood, and mild shortness of breath. Patients had decreases in body weight and loss of appetite for about three weeks. Night sweats appeared within one month. There was no specific complaint of gastrointestinal symptoms. The patient's nutritional management was focused primarily on oral intake, with a total daily consumption of 1690 kcal. The daily protein, carbohydrate, and fat consumption is divided into 42.45 grams of protein, 253.5 grams of carbohydrates, and 37.5 grams of fat. There was no history of food allergy from the patient, therefore we decided not to impose any dietary restrictions. The improvement in body weight was used to monitor the outcome of the nutritional intervention. Nutritional issues have emerged as a significant contributor to an increasing percentage of individuals with low hemoglobin (Hb), influencing TB-related morbidity. The most prevalent causes of anemia in tuberculosis are nutritional deficiencies and malabsorption as a result of appetite loss. Poor intake of food has also been linked to an increased risk of disseminated TB. To improve treatment outcomes, nutritional support should be provided in addition to tuberculosis medicine.

Pneumonia as a Secondary Complication Related to Inhaled Corticosteroid Combination Treatment for Chronic Obstructive Pulmonary Disease with Eosinophilic Phenotype Patient Wibowo, Adityo; Saputra, Tetra Arya
Medula Vol 14 No 8 (2024): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v14i8.1199

Chronic obstructive pulmonary disorder (COPD) is a progressive respiratory condition characterized by chronic inflammation, proteases and antiproteases imbalance, and airway remodeling. Several hypotheses, including immune dysregulation, microbial colonization, and environmental triggers, explain the underlying cause of the deteriorating state and recurrence of exacerbations in COPD. Eosinophils, one of the inflammatory mediators, are involved in about 30% of cases of COPD. In COPD with an eosinophilic phenotype, specific therapy recommendations include inhaled corticosteroids (ICS) combined with a long-acting bronchodilator therapy typically includes the combination of inhaled corticosteroids (ICS) (e.g., fluticasone, budesonide) and a long-acting bronchodilator (LABA) (e.g., formoterol, salmeterol) to improve airflow and reduce inflammation. While ICS therapy is beneficial, side effects of pulmonary infections become more likely as the dose increases, particularly with prolonged use. The risk of pneumonia can be managed through dose optimization and careful patient monitoring.

Challenges In Managing HIV-Associated Co-Infection With Tuberculosis And Suspected Pneumocystis jirovecii pneumonia (PCP): A Case Report. Sinaga, Fransisca T Y; Saputra, Tetra Arya; Choerunnisa, Nida
Jurnal Ilmu Kedokteran dan Kesehatan Vol 12, No 7 (2025): Volume 12 Nomor 7
Publisher : Prodi Kedokteran Fakultas Kedokteran Universitas Malahayati

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/jikk.v12i7.21866

HIV-positive individuals are highly vulnerable to opportunistic infections such as tuberculosis (TB) and Pneumocystis jirovecii pneumonia (PCP), particularly in low-resource, TB-endemic regions. We report a 30-year-old male patient with a history of unprotected multipartner sexual activity, diagnosed with clinical pulmonary TB and HIV infection, who developed progressive dyspnea, hypoxemia, and systemic symptoms over a four-month period. Physical examination revealed signs of pulmonary consolidation and neurologic abnormalities. Laboratory tests showed leukocytosis, hypoalbuminemia, and electrolyte imbalances. Imaging demonstrated bilateral lung infiltrates. The patient received antimicrobial therapy, electrolyte correction, and supportive care. Co-infection of TB and HIV with suspected PCP complicates diagnosis and necessitates an integrated approach. Clinicians must maintain high suspicion for overlapping infections in HIV-positive patients with deteriorating respiratory symptoms. Prompt clinical assessment, empiric therapy, and multidisciplinary management are essential in improving outcomes in resource-limited settings.

PERANAN KURVA DISOSIASI KARBON DIOKSIDA PADA PROSES PERNAFASAN : KAJIAN PUSTAKA Rusmini, Hetti; Lyanda, Apri; Hendarto, Gatot Sudiro; wibowo, adityo; Saputra, Tetra Arya; Morfi, Chicy Widia; Azka, Laisa
Jurnal Ilmu Kedokteran dan Kesehatan Vol 12, No 8 (2025): Volume 12 Nomor 8
Publisher : Prodi Kedokteran Fakultas Kedokteran Universitas Malahayati

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/jikk.v12i8.22216

Karbon dioksida (CO₂) merupakan produk akhir metabolisme aerobik yang memiliki peran vital dalam fisiologi pernapasan dan keseimbangan asam-basa tubuh. Artikel tinjauan ini membahas mekanisme pertukaran CO₂ mulai dari difusi alveolar, transportasi dalam darah (terlarut, sebagai bikarbonat, dan terikat hemoglobin), hingga kurva disosiasi CO₂. Efek Bohr dan Haldane dijelaskan sebagai mekanisme adaptif yang mendukung efisiensi pengangkutan gas respirasi. Selain proses fisiologis normal, artikel ini juga mengulas kondisi patologis yang mengganggu pertukaran CO₂, seperti hipoventilasi, gangguan ventilasi-perfusi, dan difusi terbatas. Pemahaman yang mendalam mengenai dinamika CO₂ memiliki implikasi klinis penting, khususnya dalam penatalaksanaan penyakit seperti PPOK, asma, dan ARDS. Dengan pendekatan ilmiah yang humanis, artikel ini bertujuan memperkuat pemahaman tenaga medis dan pembaca umum terhadap peran esensial CO₂ dalam menjaga homeostasis dan kehidupan.

Indwelling Pleural Catheter in Recurrent Pleural Effusion Due To Congestive Heart Failure: A Case Report Saputra, Tetra Arya; Wibowo, Adityo
Jurnal Ilmu Kedokteran dan Kesehatan Vol 12, No 9 (2025): Volume 12 Nomor 9
Publisher : Prodi Kedokteran Fakultas Kedokteran Universitas Malahayati

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/jikk.v12i9.20318

Pleural effusion commonly appears in congestive heart failure (CHF), caused by raised pulmonary capillary pressure and impaired lymphatic drainage, often resulting in respiratory distress and reduced quality of life. This case report presents the use of an indwelling pleural catheter (IPC) for recurrent pleural effusion in CHF unresponsive to standard therapy. A 42-year-old man with acute decompensated CHF and bilateral pleural effusions presented with worsened dyspnea. Initial thoracentesis and diuretic therapy failed to resolve the effusion, leading to IPC placement for ongoing drainage. IPC insertion resulted in marked symptom improvement, effective fluid management, and shorter hospital stay. The patient was able to continue outpatient care and experienced no major complications. This case demonstrates that IPCs can provide safe and effective symptom control in CHF-related pleural effusions when conventional treatment is inadequate. Individualized strategies, including the use of IPC, may enhance quality of life and reduce hospitalizations in patients with effusions caused by heart failure.

Analysis Success Rate Of BPAL/M Therapy For Drug Resistant Tuberculosis Morfi, Chicy Widya; Soemarwoto, Retno Ariza; Saputra, Tetra Arya; Azka, Laisa; Wibowo, Adityo; Putranta, Naufal Rafif
JKM (Jurnal Kebidanan Malahayati) Vol 11, No 8 (2025): Volume 11 Nomor 8 Agustus 2025
Publisher : Program Studi Kebidanan Fakultas Ilmu Kesehatan Universitas Malahayati

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/jkm.v11i8.22105

Latar Belakang: Tuberkulosis (TB) adalah penyakit yang dapat dicegah dan biasanya dapat disembuhkan. Tuberkulosis menyebabkan sekitar 1,25 juta kematian di dunia pada tahun 2023. Secara global, diperkirakan terdapat 450 ribu kasus baru tuberkulosis multi-drug resistant (MDR) atau tuberkulosis rifampicin resistant (RR) pada tahun 2021. Tantangan dalam pengobatan Tuberkulosis Resisten Obat (TB-RO) diantaranya adalah jangka waktu pengobatan yang lebih lama menggunakan OAT lini kedua dengan berbagai efek samping yang memengaruhi kepatuhan berobat pasien. Oleh karena itu, pengobatan yang lebih singkat dengan lebih sedikit obat sangat dibutuhkan untuk mengatasi tantangan tersebut. Sejak tahun 2022, WHO telah mengumumkan pengobatan dengan paduan Bedaquiline, Pretomanid, Linezolid, dan Moksifloksasin (BPaL/M) untuk mengobati pasien TB-RO selama enam bulan.Tujuan: Mengetahui karakteristik pasien TB-RO dan untuk mengetahui tingkat keberhasilan terapi pada pasien TB-RO yang mendapatkan pengobatan paduan BPaL/M di Rumah Sakit Umum Daerah Dr. H. Abdul Moeloek Provinsi Lampung. Metode: Penelitian dilakukan menggunakan metode observasional dengan penyajian analisis deskriptif.Hasil: Karakteristik penderita tuberkulosis resisten obat terbanyak pada kelompok usia produktif yaitu rentang usia 20–44 tahun dengan jumlah 15 pasien atau sebesar 46%. Kelompok resisten primer dengan jumlah 19 pasien atau sebesar 58%. Karakteristik hasil uji kepekaan obat terbanyak pada kelompok resisten rifampicine dengan jumlah 21 pasien atau sebesar 64%. Median konversi sputum pada akhir pengobatan bulan ke-1, dengan tingkat keberhasilan terapi sebesar 83.9%.Kesimpulan: Paduan BPaL/M menghasilkan konversi sputum yang cepat sehingga sangat efektif dan dapat menjadi pilihan terapi bagi pasien TB RR/MDR/pre-XDR pada fasilitas kesehatan di Indonesia.Saran: Penelitian selanjutnya dapat membandingkan efektifitas terapi paduan BPaL/M, paduan pengobatan 9 bulan, dan paduan pengobatan jangka panjang dalam tingkat keberhasilan dan waktu konversi sputum. Kata Kunci: Keberhasilan Terapi, Paduan BPaL/M, Tuberkulosis Resisten Obat. ABSTRACT Background: Tuberculosis (TB) is a preventable and usually curable disease. In 2023, tuberculosis causes an estimated 1.25 million deaths worldwide. Globally, there are an estimated 450,000 new cases of multi-drug resistant (MDR) tuberculosis or rifampicin resistant (RR) tuberculosis by 2021. Challenges in the treatment of drug-resistant tuberculosis (DR-TB) include a longer treatment period using second-line OAT with various side effects that affect patient treatment adherence. Therefore, shorter treatment with fewer drugs is needed to overcome these challenges. Since 2022, WHO has announced treatment with Bedaquiline, Pretomanid, Linezolid, and Moxifloxacin (BPaL/M) to treat drug-resistant tuberculosis (DR-TB) patients for six months.Purpose: Knowing characteristics of DR-TB patients from 2024 to 2025 and to determine the efficacy of therapy in DR-TB patients who received BPaL/M treatment at Dr. H. Abdul Moeloek General Hospital, Lampung Province.Method: This study was an observational research with descriptive analysis.Result: The characteristics of DR-TB patients were mostly in the productive age group, range 20-44 years with a total of 15 patients or 46%. Primary resistant group with a total of 19 patients or 58%. The characteristics of drug sensitization test results were mostly in the rifampicine resistant group with a total of 21 patients or 64%. Median sputum conversion at the end of first month treatment, with the treatment success rate was 83.9%.Conclusion: BPaL/M regimen has shown rapid sputum conversion, therefore leading to a highly effective treatment option for patients with RR/MDR/pre-XDR TB in health facilities in Indonesia.Suggestions: Future studies might compare the effectiveness of BPaL/M regimen, 9-month regimen, and long-term regimen based on success rate and sputum conversion time. Keywords: Efficacy of Therapy, BPaL/M Regimen, Drug Resistant Tuberculosis.

Epidemiological Patterns Of Lung Adenocarcinoma With Pleural Metastasis: Lessons From RSUD Ahmad Yani Metro Saputra, Tetra Arya; Fitriyah, Fitriyah; Infianto, Andreas; Listiandoko, Raden Dicky Wirawan; Wibowo, Adityo; Sukarti, Sukarti; Morfi, Chicy Widya; Azka, Laisa
JKM (Jurnal Kebidanan Malahayati) Vol 11, No 8 (2025): Volume 11 Nomor 8 Agustus 2025
Publisher : Program Studi Kebidanan Fakultas Ilmu Kesehatan Universitas Malahayati

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/jkm.v11i8.22116

Latar Belakang: Efusi pleura ganas (EPG) merupakan manifestasi stadium lanjut dari berbagai keganasan, paling sering kanker paru, dan berhubungan dengan morbiditas yang tinggi serta prognosis yang buruk. Data epidemiologi menunjukkan bahwa laki-laki dan perokok lebih banyak terdampak, kemungkinan akibat paparan karsinogen dan risiko pekerjaan yang lebih tinggi.Tujuan: Mendeskripsikan karakteristik demografi, distribusi pekerjaan, dan kebiasaan merokok pada pasien dengan diagnosis EPG, serta membahas kemungkinan penyebab dominasi kasus pada laki-laki dan perokok.Metode: Penelitian deskriptif potong lintang dilakukan pada 77 pasien dengan EPG terkonfirmasi secara sitologi atau histopatologi. Data usia, jenis kelamin, pekerjaan, dan riwayat merokok diperoleh dari rekam medis dan dianalisis menggunakan statistik deskriptif.Hasil: Mayoritas pasien berjenis kelamin laki-laki (59,4%) dan berusia >40 tahun (96,9%). Pekerjaan terbanyak adalah petani (37,5%), diikuti oleh pekerja konstruksi (15,6%). Sebagian besar pasien (62,5%) adalah perokok, dengan proporsi perokok berat mencapai 43,8%. Dominasi laki-laki perokok mencerminkan paparan karsinogen terkait tembakau dan debu pekerjaan yang lebih tinggi.Kesimpulan: EPG lebih banyak ditemukan pada laki-laki usia lanjut dengan riwayat merokok signifikan dan pekerjaan berisiko tinggi. Upaya pencegahan sebaiknya difokuskan pada program berhenti merokok dan pengurangan paparan risiko pekerjaan pada kelompok ini.Saran: Untuk mengatasi meningkatnya beban kanker paru-paru, beberapa strategi kunci direkomendasikan. Memperkuat program skrining kanker paru-paru sangat penting, terutama bagi kelompok berisiko tinggi seperti pria di atas 40 tahun, perokok berat, dan individu dengan paparan karsinogen tinggi di tempat kerja. Kata kunci: adenokarsinoma paru, efusi pleura ganas, sitologi cairan pleura, merokok, paparan pekerjaan, Indeks Brinkman. ABSTRACT Background: Malignant pleural effusion (MPE) is a late-stage manifestation of various malignancies, most commonly lung cancer, and is associated with significant morbidity and poor prognosis. Epidemiological data indicate that men and smokers are disproportionately affected, possibly due to higher exposure to carcinogens and occupational hazards.Objective: To describe the demographic characteristics, occupational distribution, and smoking habits of patients diagnosed with MPE, and to discuss possible explanations for the predominance among men and smokers.Methods: A descriptive cross-sectional study was conducted on 77 patients with confirmed MPE. Data on age, gender, occupation, and smoking history were obtained from medical records and analyzed using descriptive statistics.Results: The majority of patients were male (59.4%) and aged >40 years (96.9%). Farming was the most common occupation (37.5%), followed by construction work (15.6%). Most patients (62.5%) were smokers, with heavy smokers accounting for 43.8%. The predominance of male smokers reflects higher exposure to tobacco-related carcinogens and occupational dusts.Conclusion: MPE is more prevalent in older males with significant smoking history and high-risk occupations. Preventive measures should target smoking cessation and reduction of occupational exposures in these groups.SuggeStion To address the rising burden of lung cancer, several key strategies are recommended. Strengthening lung cancer screening programs is crucial, particularly for high-risk groups such as men over 40 years old, heavy smokers, and individuals with high occupational exposure to carcinogens. Keywords : lung adenocarcinoma, malignant pleural effusion, pleural fluid cytology, smoking, occupational exposure, Brinkman Index.

Diagnosis and Management for Pulmonary Tuberculoma Syahruddin, Elisna; Burhan, Erlina; Saputra, Tetra Arya
Respiratory Science Vol. 4 No. 2 (2024): Respiratory Science
Publisher : Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/respirsci.v4i2.107

Pulmonary tuberculoma, prevalent particularly in tuberculosis (TB)-endemic regions, often appears as a solitary nodule of less than 30 mm, or a tumor of more than 30 mm on radiological examinations. It may also present with a combination of abnormalities, such as multiple nodules with infiltration or pleuritis. Benign solitary pulmonary nodules represent up to 25% of all resected solitary pulmonary nodules, with approximately 5-24% of these identified as pulmonary tuberculoma post-surgery. This condition is prevalent particularly in TB-endemic regions, and must be considered while determining the diagnosis, especially for patients at high risk for lung cancer. Modalities for diagnosing pulmonary tuberculoma include chest radiography, USG, CT scan, PET scan and bronchoscopy with transbronchial biopsy. The treatments for pulmonary tuberculoma are anti-TB drugs and surgery. Pulmonary tuberculoma responds poorly to anti-TB drugs and requires long-term treatment. Surgery is performed when the diameter of tuberculoma still increases after adequate anti-TB treatment.

Peningkatan Pengetahuan Mengenai Manajemen Tatalaksana Terhadap Pasien Penyakit Paru Obstruktif Kronik (PPOK) dan Tuberkulosis Paru (TB) Pada Fasilitas Kesehatan Tingkat Pertama (FKTP) di Kabupaten Lampung Tengah Mustofa, Syazili; Herdato, M. Junus Didiek; Morfi, Chicy Widya; Saputra, Tetra Arya; Pratama, Arianda; M., Tria; Putranata, Naufal R.; Sanjaya, Rizki Putra; Erumbia, Ilham Akbar
JPM (Jurnal Pengabdian Masyarakat) Ruwa Jurai Vol. 8 No. 2 (2023): JURNAL PENGABDIAN MASYARAKAT RUWA JURAI
Publisher : FK Unila

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.23960/jpmrj.v8i2.3239

Penyakit utama saluran nafas di Indonesia adalah Paru Obstuktif Kronik (PPOK) dan Tuberkulosis paru ( TB). Jika PPOK merupakan penyakit tidak menular dibidang paru yang merupakan penyakit kronik, maka TB merupakan penyakit menular. Penyakit penyakit ini membutuhkan penanganan yang tidak hanya dilakukan di rumah sakit namun juga harus dimulai dari Fasilitas Kesehatan Tingkat Pertama (FKTP). Dari data yang didapatkan di dinas Kesehatan Kota Lampung Tengah masih banya pasien dengan PPOK dan TB yang masih belum teredukasi dengan baik. Rendahnya tingkat pengetahuan masyarakatdi Lampung Tengah serta dikarenakan kurangnya informasi kesehatan yang mereka terima sehingga solusi yang ditawarkan untuk mengatasi masalah itu dengan dilakukan penyuluhan dan pembaharuan ilmu yang bertujuan untuk meningkatkan pengetahuan, kesadaran, sikap, dan tindakan dokter dalam melakukan penanganan terhadap penyakit PPOK dan TB. Diharapkan dengan diadakan kegiatan penyuluhan ini pengelolaan terhadap penyakit tidak menular bidang paru di Provinsi Lampung pada khususnya Kota Lampung Tengah dapat terkelola dengan baik serta secara tidak langsung dapat meningkatkan derajat kesehatan masyarakat dengan peran dokter dan tenaga kesehatan yang ada di FKTP. Metode yang digunakan dalam kegiatan ini adalah penyuluhan, yang dilanjutkan dengan diskusi. Mitra sasaran dalam kegiatan ini adalah60 orang dokter dan tenaga kesehatan di FKTP Kota Lampung Tengah. Evaluasi keberhasilan pada kegiatan penyuluhan terdiri dari evaluasi awal dan evaluasi akhir. Tim pengabdian masyarakat pada kegiatan ini yaitu dokter spesialis paru dari Departemen Pulmonologi dan Kedokteran Respirasi Fakultas Kedokteran Universitas Lampung, RSUD dr. H. Abdul Moeloek Lampung. Hasil kegiatan ini menunjukkan peningkatan tingkat pemahaman sebesar 30% sehingga keseluruhan peserta memiliki pemahaman baik. Selain itu, terjadi diskusi interaktif yang mengeksplorasi lebih dalam tentang manajemen penyakit PPOK dan TB. Diharapkan promosi kesehatan ini dapat meningkatkan dokter dan tenaga medis di FKTP dalam melakukan manajemen penyakit PPOK dan TB. Kata kunci: PPOK, TB , promosi kesehatan

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