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INDONESIA
Jurnal Respirologi Indonesia
Published by Perhimpunan Dokter Paru Indonesia
ISSN : 08537704     EISSN : 26203162     DOI : -
Core Subject : Health,
Health Professions Medicine & Pharmacology
Jurnal Respirologi Indonesia (JRI) is an online and printed scientific publication of the Indonesian Society of Respirology (ISR). The journal is published thrice-monthly within a year (January, April, July and October). The journal is focused to present original article, article review, and case report in pulmonary and critical care medicine.
Arjuna Subject : -
Articles 360 Documents
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The Role of Chemotherapy Status, Absolute Lymphocyte Count and Neutrophil Lymphocyte Ratio as Biomarkers of Candidiasis in Lung Cancer Patients Muhamad Yusuf Musthafa; Iin Noor Chozin; Ungky Agus Setyawan; Teguh Wahyu Sardjono; Noorhamdani AS
Jurnal Respirologi Indonesia Vol 43, No 3 (2023)
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.v43i3.518

Abstract

Background: Gradually, fungal infections are growing and have become a medical concern. Candida species are one of the most common pathogens in immunocompromised patients, such as those with lung cancer causing invasive fungal disease. Early diagnosis of candidiasis is critical for patient care in lung cancer patients. Anti-mannan IgM and IgG biomarkers are used to diagnose candidiasis. This study aims to determine the relationship between chemotherapy status, absolute lymphocyte count, and neutrophil-lymphocyte ratio to antimannan IgM and IgG.Methods: A correlative analytic cross-sectional study was conducted on 37 lung cancer patients with positive candida sputum cultures in Dr. Saiful Anwar Malang Hospital. The 37 patients were examined for total lymphocyte level, neutrophil-lymphocyte ratio, anti-mannan IgM, and IgG. Data analysis used a contingency coefficient to determine the relationship between chemotherapy status, absolute lymphocyte count, and neutrophil-lymphocyte ratio to anti-mannan IgM and IgG.Results: This study showed a positive correlation between chemotherapy status with anti-mannan IgM and IgG, although insignificant (p>0.05). However, there was a significant correlation between total lymphocytes and anti-mannan IgG (p=0.000;α=0.05) and between neutrophil-lymphocyte ratio and antimannan IgM (p=0.004; α=0.05).Conclusion: The study revealed that chemotherapy status, absolute lymphocyte count, and neutrophil-lymphocyte ratio could be a biomarker of candidiasis, so lung cancer patients with a history of chemotherapy, lymphopenia, and increased neutrophil-lymphocyte ratio should consider receiving antifungals earlier. 
C-Arm Fluoroscopy-Guided Bronchoscopic Biopsy for Diagnosing Aspergilloma With Massive Hemoptysis After Pulmonary Tuberculosis: A Case Report Wikamto, Rifka; Ardana, I Dewa Putu; Suhendro, Suhendro
Jurnal Respirologi Indonesia Vol 44, No 2 (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.v44i2.529

Abstract

Background: Aspergilloma usually develops in the pulmonary cavity that already exists, including tuberculosis. The most frequent symptom is hemoptysis. Diagnosis of proven fungal infection requires a tissue sample obtained from a disease location to be subjected to histological examination or culture. A specimen taken using bronchoscopy alone is quite challenging because of its location. In this case, a C-arm fluoroscopy-guided bronchoscopic biopsy may be a solution to get specimens for a proven diagnosis.Case: A 53-year-old male presented to the emergency department following a massive hemoptysis with a previous history of tuberculosis. Chest radiography revealed opacity and hilar restriction in the left upper lobe. A chest CT scan without contrast revealed suspected aspergilloma. The patient underwent a C-arm fluoroscopy-guided bronchoscopy for a biopsy sample. The biopsy sample referred to Aspergillus niger.Discussion: Aspergillus sp. leads to parenchymal damage and causes several symptoms, mostly hemoptysis. Aspergilloma usually develops in the pulmonary cavity that already exists, including those from tuberculosis. The diagnostic effectiveness of bronchoscopy guided by C-arm fluoroscopy for peripheral lung lesions has consistently improved.Conclusion: Aspergilloma usually develops in the pulmonary cavity that already exists, including tuberculosis. The patient came to the emergency department with massive hemoptysis and met all the criteria for diagnosis of proven fungal infection. The diagnosis was made by analyzing biopsy samples, which was taken by C-arm fluoroscopy-guided bronchoscopy.
Bacterial Profile and Antimicrobial Resistance Patterns of Pleural Empyema in Pekanbaru Hospitals Yovi, Indra; Safari, Dodi; Syah, Nur Afrainin; Anggraini, Dewi; Hanifah, Zulfa Nur; Shapira, Vanesya Zahrani; Elliyanti, Aisyah
Jurnal Respirologi Indonesia Vol 44, No 1 (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.v44i1.590

Abstract

Background: Empyema is a problem worldwide due to its high incidence, mortality, and morbidity rates. So, administering antibiotics is mandatory to treat the disease. It should be sensitive to the causal microorganisms and avoid resistant ones for treatment efficacy. This research aimed to determine bacterial profile and antimicrobial resistance, which can be fundamental foundations for clinical practices in the treatment of patients, especially in Pekanbaru.Methods: This was a cross-sectional study from medical records at Arifin Achmad and Eka Hospitals from January 1, 2015, to December 31, 2022, including culture and antibiotic resistance test results with samples from pleural fluid and antibiotic susceptibility test using VITEK 2.0.Results: A total of 197 pleural fluid specimens were obtained. Gram-negative bacteria were found to be the most prevalent at 79.7%, namely Klebsiella pneumoniae (18.5%), Escherichia coli (12.0%), and Pseudomonas aeruginosa (11.0%). Gram-positive bacteria were found at 12.2%, the most common being Staphylococcus aureus (6.1%) and Enterococcus faecalis (2.0%). Antibiotic sensitivity tests for Gram-negative bacteria showed that amikacin and tigecycline were the most sensitive, and Gram-positive bacteria showed the most sensitivity to linezolid, tigecycline, and vancomycin. The resistance of Klebsiella pneumoniae and Escherichia coli to cephalosporins was 18.5% and 75.0%, respectively. The resistance of Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa to carbapenems was 8.0%, 13.0%, and 53.0%, respectively.Conclusion: Gram-negative is the most common microorganism found in pleural empyema. The resistance of multiresistant bacteria to antibiotics is high and requires supervision to apply appropriate antibiotic administration based on local antimicrobial patterns and the need to strengthen antimicrobial stewardship programs. 
Extraction of Foreign Body in Left Main Bronchus with Flexible Optical Bronchoscopy in Asymptomatic Needle Aspiration Patient: A Case Report Antika, Puspa; Jito, Anggar
Jurnal Respirologi Indonesia Vol 44, No 2 (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.v44i2.526

Abstract

Background: Foreign body aspiration is one of the most common respiratory and airway emergencies. The incidence is higher in children and obstruction occurrences are common. The late complications might be fatal when ignored. Bronchoscopy as a gold standard modality in diagnosing and treating this condition, now is widely available, and the emerging flexible optic bronchoscopy (FOB) is more commonly used.Case: A ten-year-old girl with a history of needle aspiration arrived at the ER with an asymptomatic condition. Further investigations reveal leucocytosis and a metal-needle-shaped foreign body found approximately in the left main bronchus via chest x-ray and CT scan. Bronchoscopy with FOB was performed under general anesthesia and LMA and successfully evacuated the needle although the pin had infiltrated the mucosal wall.Discussion: Asymptomatic foreign body aspiration is nearly at the same rate as symptomatic one. Management of difficulties and complications increases the longer the foreign body infiltrates the respiratory tract. Early diagnosis with chest x-ray and CT scan is necessary. Prompt and urgent evacuation of the foreign body is required. The use of FOB is associated with a higher success rate and lower complications. FOB is the best modality choice in this case.Conclusion: The foreign body in the respiratory tract may be asymptomatic. Early and proper diagnosis must be worked out as early management of asymptomatic foreign body aspiration. Early FOB can be used as a modality of choice in this case, preventing further damage to the respiratory tract.
Pneumomediastinum and Spontaneous Subcutaneous Emphysema in COVID-19 Patients Using High-Flow Nasal Cannula (HFNC) Suhadayanti, Rizki; Fatoni, Arie Zainul; Jaya, Wiwi; Asmoro, Aswoco Andyk
Jurnal Respirologi Indonesia Vol 44, No 2 (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.v44i2.448

Abstract

Background: Spontaneous pneumothorax, pneumomediastinum, and subcutaneous emphysema are rare complications that occur without mechanical ventilation, namely 0.81% of all COVID-19 patients. During the COVID-19 pandemic, high-flow nasal cannulas (HFNC) were used to support respiratory failure in critically ill patients. However, there have been no clinical trials explaining its safety and effectiveness. Hypoxemic normocapnic respiratory failure is an indicator of HFNC use. This study reports a case of associated spontaneous subcutaneous pneumomediastinum and emphysema in a COVID-19 patient using HFNC.Case: A 30-year-old male patient came to the hospital with a chief complaint of increasingly severe shortness of breath and confirmed COVID-19. Physical examination revealed a good airway, spontaneous breathing with a frequency of 28 times/minute; SpO2 of 97% with HFNC Flow 60 and FiO2 60%; blood pressure of 102/69 mmHg; and heart rate of 65 beats per minute. On the second day of treatment in the ICU, the patient did not experience desaturation or hypotension. Patent airway, spontaneous breathing, and oxygenation initiated using NRM 10lpm with a target SpO2 of 97%, RR at 30-32x/minute. On the fifth day, desaturation and hypotension were no longer observed.Discussion: Real-Time Reverse Transcriptase (RT)–PCR Diagnostic Panel detects SARS-CoV-2 in respiratory samples. Chest CT scans show viral pneumonia. Subcutaneous emphysema (SE) and pneumomediastinum cause breathing issues. Severe COVID-19 is treated with antivirals, vitamins, and oxygen therapy. Pneumomediastinum or subcutaneous emphysema may occur due to prolonged non-invasive ventilation but is generally self-limited.Conclusion: Clinical improvement was found in COVID-19 patients with pneumomediastinum and spontaneous subcutaneous emphysema using HFNC.
The Overview Side Effects of MDR TB Short Term Regimen for Heart and Kidney Function in MDR TB Patients at H. Adam Malik General Hospital Medan, North Sumatra Diana Santy; Parluhutan Siagian; Bintang YM Sinaga; Putri C Eyanoer
Jurnal Respirologi Indonesia Vol 44, No 1 (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.v44i1.573

Abstract

Background: World Health Organization issued a recommendation for the use of standard 9–11 month Shorter Multidrug-Drug Resistant Tuberculosis (MDR TB) regimen. It will impact the number of patients treated and improve obedience because of the shorter, low cost, and well-tolerated. However, MDR TB drugs allow side effects both mild, moderate and severe. If severe side effects occur, the patient will stop treatment and close monitoring required. An optimal and adequate care of side effects is the key of the successful of MDR TB treatment. The aim of this study was to determine the side effects that occured in the treatment of MDR TB patients with short term regimen (STR) on heart and kidney function at H. Adam Malik General Hospital Medan, North Sumatra.Methods: A case series design with a total of 76 MDR TB patients who underwent a shorter regimen. Samples were obtained from the medical record in the pulmonary isolation inward and MDR TB polyclinic at Adam Malik Hospital, Indonesia. Data were analyzed descriptively to identify changes in heart (Prolong QTc) and kidney function of the nine months treatment.Results: 76 data were collected, the number of male samples was 68.4% and 31.6% were women with the age group of the study subjects being mostly followed by 41-50 years of age. There was a significant increase in value occurred in 4-6 months of treatment related to the side effects of treatment on heart (Prolong QTc) and kidney function.Conclusion: There was a trend to increase the value of heart (Prolong QTc) and kidney function significantly occurred 4-6 months after the patient underwent MDR TB treatment with STR.
Krebs von den Lungen-6 (KL-6) and Surfactant-D as Biomarkers of Interstitial Lung Disease: A Literature Review Fanny Fachrucha; Muhamad Rizqy Fadhillah; Syazatul Syakirin Sirol Aflah
Jurnal Respirologi Indonesia Vol 44, No 1 (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.v43i4.439

Abstract

Interstitial Lung Disease (ILD) is a group of lung diseases characterized by various patterns of lung tissue damage, including inflammation and fibrosis of the lung interstitium, both with known or unknown causes (idiopathic). In establishing the diagnosis of ILD, a comprehensive approach including history-taking, physical examination, and supporting examinations, is needed and managed in a multidisciplinary manner. Biomarkers are diagnostic tools known to be accessible, inexpensive, reproducible, and non-invasive for helping diagnose ILD patients. Growing evidence has supported the idea that many biomarker molecules can detect lung injury in ILD, including Krebs von de lungen-6 (KL-6) and Surfactant D (SP-D). KL-6 and SP-D could be utilized in the detection, disease monitoring, prognostication, and therapeutic responses of ILD patients. This review aimed to discuss several potential Kl-6 and SP-D biomarkers against ILD and discusses their clinical utility.
Interventional Approach on Lung Abscess Audina, Dea Putri; Agustin, Heidy; Reisa, Tina
Jurnal Respirologi Indonesia Vol 44, No 2 (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.v44i2.440

Abstract

Lung abscess is a necrotic liquefaction process containing necrotic debris or fluid from the lung parenchyma tissue, creating a cavity of more than 2 cm caused by bacterial infection. The most common etiology of lung abscess is oral aspiration. With a high incidence of tuberculosis in Indonesia, Mycobacterium tuberculosis may also cause cold abscesses, although rarely reported. Several things can increase the risk of developing a lung abscess, such as oral aspiration, sepsis, and history of previous lung infection. The treatment for lung abscess was classified into two groups, the pharmacology group which uses antibiotics including clindamycin, ampicillin-sulbactam, moxifloxacin, carbapenem, and piperacillin-tazobactam; and the other group is non-pharmacology therapy including drainage which is indicated for patient with a size cavity of more than 6 cm. There are several options for drainage such as percutaneous or endoscopic drainage. Bronchoscopy may serve as a diagnostic and also intervention tool in lung abscess.
The 4T Approach for Smoking Cessation Compliance for Pulmonary Tuberculosis Patients in Persahabatan Referral Hospital Septauli, Kolanda Maria; Susanto, Agus Dwi; Agustin, Heidy; Ginting, Tribowo Tuahta; Taufik, Feni Fitriani
Jurnal Respirologi Indonesia Vol 44, No 1 (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.v44i1.578

Abstract

Background: Smoking increases the risk of tuberculosis infection and affects its treatment success rate and mortality. Most TB patients who smoke quit at the initial diagnosis, but may continue to smoke if the clinical symptoms improve. Studies show that the 4T approach (Tanya, Telaah, Tolong nasehati, and Tindak lanjut) helps smokers quit. The 4T approach was applied in Indonesia as a smoking cessation program for TB patients.Methods: We conducted a randomized controlled trial on 43 male TB patients who smoke. The trial group received a 4T approach consisting of education, counseling, and motivation to quit smoking for three months. The control group received a self-help leaflet. Smoking status, Fagerström nicotine dependence scale, exhaled carbon monoxide level, and peak expiratory flow rate were collected. We observed the subjects at months 1, 2, and 3 after quitting smoking and reported on the Motivation and Minnesota Withdrawal Scale.Results: Smoking cessation levels during months I, II, and III (Continuous Abstinence Rate I, II, and III) were higher in the trial group than in the control group. The trial group had a higher percentage of smoking cessation than the control group: until 4 weeks (66.7% vs. 54.5%), until 8 weeks (57.1% vs. 45.5%), and until 12 weeks (52.4% vs. 45.5%). The control group had higher numbers of smoking relapses (18.2% vs. 14.3%) and still smokers (18.2% vs. 9.5%) after the study. Withdrawal symptoms included an increase in appetite (44.1%), cigarette cravings (6.9%), agitation (2.3%), insomnia (2.3%), and irritability (2.3%). There were no significant differences in the withdrawal scale between groups (P=0.788), but the trial group showed better motivation to stop smoking during CAR II (P=0.043).Conclusion: The 4T approach is effective in maintaining abstinence from smoking among lung tuberculosis patients until months 1, 2, and 3 after quitting. Smoking cessation programs during tuberculosis treatment can help patients quit smoking and reduce relapse.
Non-Severe COVID-19 Complicated by Deep Vein Thrombosis (DVT) Rajabto, Wulyo; Priantono, Dimas
Jurnal Respirologi Indonesia Vol 44, No 2 (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.v44i2.263

Abstract

Background: Coronavirus Disease 2019 (COVID-19) displays various symptoms ranging from asymptomatic to life-threatening. Patients may present with typical respiratory infections or atypical symptoms. Non-severe COVID-19 encompasses mild and moderate cases, characterized by the absence of criteria for severe or critical illness, with mild cases not showing evidence of viral pneumonia or hypoxia and moderate cases maintaining SpO2 levels of at least 90% on room air.Case: We presented a COVID-19 case with the chief complaint of unilateral leg swelling. A 48-year-old male was admitted with the chief complaint of cramps and swelling of the left leg. He had a history of fever, cough, nausea, and vomiting. Laboratory studies showed elevated D-dimer. Doppler ultrasound shows signs of both proximal and distal deep vein thrombosis.  CT pulmonary angiography excluded pulmonary embolism while the lung window image supported the diagnosis of COVID-19 pneumonia. Polymerase chain reaction (PCR) obtained from nasopharyngeal and oropharyngeal swabs confirmed COVID-19 infection.Discussion: We treated the patient with parenteral anticoagulation followed by direct oral anticoagulant upon discharge. The swelling improved as well as the patient’s clinical status. Thromboembolic complications have been credited as the culprit of high mortality in COVID-19. Systemic activation of coagulation in pulmonary and peripheral circulation contributed to life-threatening thrombotic complications. Our patient presented with COVID-19-associated proximal and distal DVT without pulmonary embolism.Conclusion: Prompt diagnosis of COVID-19 infection and acute DVT improves patient care. The hallmark of the management of VTE in COVID-19 patients is treatment with therapeutic dose parenteral anticoagulation followed by oral anticoagulant.

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