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Malang Respiratory Journal
Published by Universitas Brawijaya
ISSN : 27457842     EISSN : 27226492     DOI : https://doi.org/10.21776/ub.mrj
Core Subject : Health, Science, Education,
Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Public Health Other
Malang Respiratory Journal is the official open-access journal of Department of Pulmonology Respiratory Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia. It publishes articles two times per year. It is a peer reviewed publication of Indonesian Pulmonology and Respiratory journals and accepting articles for publication from around the world. MRJ only publishes articles in the English version. The objective of this journal is publishing the selected clinical and basic research relevant to Pulmonology and Respiratory. It covers the following topics such as infection, thoracic oncology, asthma and COPD, interventional pulmonology and respiratory emergency, occupational and environmental pulmonology, and clinical immunology. It is an international journal dedicated to provide new information that could give a new insight for alternative solutions, diagnosis, therapy and prevention for researchers and practitioners in Pulmonology Respiratory Medicine.
Arjuna Subject : Kedokteran - Kedokteran Paru dan Pernafasan
Articles 66 Documents
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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

Abstract

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.
Chronic Obstructive Pulmonary Disease Exacerbation Complicated with Pneumonia and Lung Cancer: An Evidence-based Case Report of Erdosteine Role in the Management of Complex COPD Ilham, Ahmad Fadhil; Rakasiwi, Muhammad Ilham Dhiya; Felim, Ris Raihan; Arfan, Ahmad; Burhan, Erlina
Malang Respiratory Journal Vol. 6 No. 2 (2024): September 2024
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2024.006.02.05

Abstract

Background: Acute exacerbations of chronic obstructive pulmonary disease (COPD) are strongly associated with poor health status and morbidity. Erdosteine is a mucolytic agent that also has anti-inflammatory, antioxidant and antibacterial effects. This case report aims to evaluate the role of erdosteine in the prevention and treatment of acute exacerbations of complex COPD case. Case: A 73-year-old male arrived at the emergency department with an increased difficulty in breathing that had deteriorated over the previous 5 days, and had a history of heavy smoking for more than 40 years. Following a thorough examination, he was diagnosed with acute exacerbation of COPD (Anthonisen criteria type 2) in clinical group E, pneumonia, along with stage IIIA right lung tumor (T4N1Mx), and received erdosteine inhalation as part of his treatment. Discussion: A comprehensive search of journal databases (PubMed, EMBASE, CENTRAL, EBSCO Medline, Scopus, and ProQuest) was conducted using specific keywords, critical appraisal based on the Oxford Center for Evidence-Based Medicine. Article selection resulted in 1 systematic review article for the prevention of acute exacerbations and 1 systematic review article for the management of acute exacerbations of COPD. In patients with stable COPD, administration of erdosteine in the standard COPD regimen significantly reduced the risk of exacerbations (RR=0.65; p=0.01), while in patients with acute exacerbations of COPD, erdosteine increased treatment success (OR=3.2; p<0.0001). Conclusion: Erdosteine may serve as a therapeutic choice for COPD patients in preventing or managing acute exacerbations.
Primary Pre-Extensively Drug-Resistant (Pre-XDR) Tuberculosis with Meningoencephalitis in Nineteen Years Old Young Woman : A Case Report Sugiri, Yani Jane Rosihaningsih; Tantular, Rezki; Falyani, Silvy Amalia; Maulana, Uray Riki Arif
Malang Respiratory Journal Vol. 6 No. 2 (2024): September 2024
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2024.006.02.02

Abstract

Introduction. Mycobacterium tuberculosis (MTB) is continually evolving in order to resist treatment. This has resulted in drug-resistant tuberculosis, which has a greater rate of therapy failure and mortality, as well as the necessity for other ways of disease transmission prevention. Pre-extensively drug-resistant tuberculosis (Pre-XDR TB) is caused by MTB strains that are resistant to isoniazid, rifampicin, and any fluoroquinolone medicines. Case Report. A 19-year-old HIV-negative immunocompetent female presented to our emergency department with dyspnea and severe headache. She also complained of a cough, a low-grade temperature, and weight loss. She has no relevant medical history and has never been exposed to tuberculosis. A chest X-ray revealed infiltrates with cavities and fibrosis in both lungs, while a brain CT suggested meningoencephalitis. We performed a sputum drug sensitivity test and discovered that this patient was resistant to rifampin, isoniazid, levofloxacin, and moxifloxacin. She was later diagnosed with Pre-XDR TB and was given a tailored lengthier regimen that included Bedaquiline, Cycloserin, Linezolide, Clofazimine, and Etambutol. Her symptoms improved significantly as a result of this program. Discussion. Primary pre-XDR TB in an immunocompetent patient is uncommon, and our case is even more unusual due to meningoencephalitis involvement. The treatment of pre-XDR TB requires a personalized regimen that is tailored to the patient's clinical status and comorbidities. The possibility of transmission via a positive contact was raised in this patient, prompting us to conduct a more thorough contact inquiry to prevent future spread. Conclusion. In our region, there is a risk of'silent' drug resistant tuberculosis. Early detection and treatment of such patients are critical to preventing uncontrollable pan-resistant TB. Successful management with cautious contact investigation will minimize the mortality rate and spread rate of drug-resistant TB. Keywords. Drug-Resistant Lung Tuberculosis, Drug-Resistant Meningoencephalitis Tuberculosis
Management of Pneumomediastinum Patients in COVID-19: Rare Cases Santosa, Andrew; Djajalaksana, Susanthy; Listyoko, Aditya; Erawati, Dini
Malang Respiratory Journal Vol. 6 No. 2 (2024): September 2024
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2024.006.02.04

Abstract

Background: Spontaneous pneumomediastinum in patients with confirmed cases of Covid-19 is a very rare clinical finding in the world, especially in Indonesia. This is considered an indication of concern for a more serious medical problem. Aim: This case report discusses the management of COVID-19 patients with pneumomediastinum. Case: A 30 year old man came to the hospital with the main complaint of shortness of breath and cough. The patient was diagnosed with a confirmed case of Covid-19 and received therapy using High Flow Nasal Cannula (HFNC) as a therapeutic modality. After 5 days in the hospital, the patient's shortness of breath felt increasingly severe, and he began to feel chest pain and swelling around the chest area which spread to both sides of his neck. A thorax x-ray examination showed pneumomediastinum and subcutaneous emphysema, then a chest CT scan was performed and the results showed pneumomediastinum which was thought to be caused by esophageal rupture. After we communicated with the Thoracic Surgery Department, conservative therapy was recommended. Conclusion: Covid-19 infection can cause hypoxaemic respiratory failure and acute respiratory distress syndrome, both of which can be deadly. Supplementation of high-flow nasal cannula (HFNC) oxygen therapy can be very beneficial for patients, but can cause dangerous side effects such as pneumomediastinum. Pneumomediastinum (PM) is the presence of open air in the mediastinal cavity. In this case, we suspect that the pneumomediastinum was the result of Covid-19-related alveolar damage and esophageal rupture, and not due to the use of HFNC. Pneumomediastinum complications need to be detected early, so that management can reduce associated morbidity and mortality. Keywords: Pneumomediastinum; COVID-19, HFNC
A Very Rare Case of Pulmonary Lepidic Adenocarcinoma at a Young Age Man Kristy, Anastasia; Putra, Wayan
Malang Respiratory Journal Vol. 6 No. 2 (2024): September 2024
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2024.006.02.06

Abstract

Introduction: Lung cancer remains one of the higher prevalence of cancer and leading cause of death in the world. Smoking and genetic factors are two important etiologies in lung cancer. Adenocarcinoma is the most common type of non-small cell lung carcinoma. Lepidic predominant adenocarcinoma is one type of adenocarcinoma that has a good prognosis. Case Illustration: A 24-year-old male came with chronic cough and chest pain. He had a history of smoking and no prior family history of cancer. Plain chest Xray and Thorax computed tomography (CT) showed pleural effusion and presence of lung mass with suggestion of bone and liver involvement, respectively. The cytology from pleural effusion and bronchial lavage initially found no malignancy cell. Later thoracostomy biopsy and pathology study suggested lepidic adenocarcinoma. Discussion: Lung cancer is still one of the leading causes of death in men. Even though rarely found in young male, patients with a history of smoking or genetic factor with clinical manifestation suggestive chronic respiratory condition with weight loss should be suspected of the diagnosis. Adenocarcinoma, as the most common non-small cell lung carcinoma, could be later divided into several subtypes. Lepidic adenocarcinoma is distinguished by the pathology finding of a large invasion focus of stromal, lymphatic, vascular, or pleural space. Considered one of the most favorable, lepidic predominant adenocarcinoma has a very high rate of 5 year survival when diagnosed early and responds well to lobe resection. Advanced state however has poor outcome due to limited choice of therapy. Promising trial of targeted chemotherapy have been reported and could improve outcome in the future. Conclusion: Lung cancer in young male is a rare disease but should be suspected in those with chronic cough, chest pain and weight loss. The history of smoking and family history are crucial for this suspicion. Lepidic predominant adenocarcinoma has a good prognosis when diagnosed early. Studies in the future could enhance overall survival in these patients.
Cohort Patient Evaluation of Lung Condition 9 Months after Severe Covid 19 Mahendra, Reza Aditya; Rakhma , Sastia; Sugiri, Yani Jane Rosihaningsih; Djajalaksana, Susanthy; Erawati, Dini Rachma
Malang Respiratory Journal Vol. 7 No. 1 (2025): March 2025 Edition
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2025.007.01.02

Abstract

Introduction: COVID-19 is an infection caused by novel coronavirus Serious Acute Respiratory Syndrome (SARS)-CoV-2. About 20% patients with severe symptoms could become critically ill. In this case report, we present a case with severe COVID-19 infection. Case report: Mr. SA, a 54-year-old patient came to the hospital with chief complaint of dry cough. Patient had fever for 2 days and myalgia. Patient had a history of well-controlled hypertension. X-ray examination showed worsening consolidation and CT-scan showed pleural effusion. Patient was treated with convalescent plasma therapy, IVIG, and symptomatic drugs. The patient was diagnosed with confirmed case of severe COVID-19, stage I hypertension, hypercoagulable state, CCS, and grade I obesity. The Evaluation of this patient consist of CT Scan, Lung Function using a Body Plethysmograph that will followed for 9 month after the patient discharged. Conclusion: There had been a few therapeutic options for COVID-19 but no definitive treatment yet. IVIG and convalescent plasma had been used for the treatment of SARS-CoV and MERS-CoV. As such, these treatments were also used in COVID-19 treatment with promising results. Keywords: COVID-19, IVIG, convalescent plasma
Gene Muatatuion Changes in Adenocarcinoma Lung Cancer Patient With Left Pyopneumothorax Nurandhini, Marsha; Suryanti Dwi Pratiwi; Yani Jane R. Sugiri; Dini Rachma Erawati; Hendy Setyo Yudhanto
Malang Respiratory Journal Vol. 7 No. 1 (2025): March 2025 Edition
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2025.007.01.06

Abstract

Introduction: Adenocarcinoma is the most common subtype of lung cancer, around 40% of lung cancer cases worldwide. It’s specific to epidermal growth factor receptor (EGFR) mutation. Lung cancer can be risk factor and increases the mortality rate of pyopneumothorax (12.8% higher in cancer patients). Case Illustration: A 69 year old woman, non smoker, who is diagnosed with lung adenocarcinoma (Exon 18 and 21 mutation) in May 2021 and came to emergency room with complaints of worsening shortness of breath. Cloudy-yellow pleural fluid was drained during thoracocentesis procedure. Imaging study using thorax CT scan showed a left lung mass obliterating bronchial segments 1/2, 3 and left hydropneumothorax. The patient was later diagnosed with pyopneumothorax and thorax drain procedure was performed. Antibiotic therapy was based on culture result. Through a following ctDNA (circulating tumor DNA) test, the mutations change to Exons 19 and 20 T790M. Discussion: Pyopneumothorax in this patient can occur due to disorder in the integrity of the host defense mechanisms, which then develops infection in the pleural cavity. The T790M mutation is found in 50-60% cases that are resistant to tyrosin kinase inhibitors (TKI). Third-generation TKI is main option for this condition, however, platinum-based chemotherapy can be considered, as in the case above, where third-generation chemotherapy cannot be given due to limitation of insurance coverage. Conclusion: Lung cancer can be associated with occurance of pyopneumothorax. Genetic mutation changes can occur due to resistance mechanisms. Giving platinum-based chemotherapy can be considered in such cases. Keywords: lung adenocarcinoma, genetic mutation, pyopneumothorax
Hydrocarbon Pneumonitis After Repeated Exposure and Gasoline Aspiration with Differential Diagnosis Lung Tuberculosis Setiadi, Satya; Rakhma, Sastia; Chozin, Iin Noor; Astuti, Tri Wahyu; Sugiri, Yani Jane R.; Yudhanto, Hendy Setyo; Erawati, Dini Rachma
Malang Respiratory Journal Vol. 7 No. 1 (2025): March 2025 Edition
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2025.007.01.05

Abstract

Introduction: Chemical pneumonitis is an uncommon condition. Hydrocarbon pneumonitis is a kind of chemical pneumonitis. The features of this disease are atypical and may manifest either abruptly or persistently. Lung tuberculosis is an endemic illness in Indonesia, with an estimated 969,000 patients exhibiting diverse characteristics that may resemble chemical pneumonitis. Case Report: A 29-year-old gas station attendant with a history of recurrent exposure to gasoline vapours and episodes of asphyxiation while syphoning gasoline. A thoracic CT scan with contrast reveals several bilateral nodules with a tree-in-bud pattern, suggestive of pulmonary tuberculosis, with chemical pneumonitis as a differential diagnosis. Utilising clinical data, including occupational history, body plethysmography and spirometry results (moderate restrictive), laboratory findings, CT scan pictures, and Volatile Organic Compound analysis (elevated hydrocarbon levels), the patient is diagnosed with hydrocarbon pneumonitis. Discussion: The differential diagnosis was excluded through the analysis of sputum using molecular rapid test, IGRA test, LJ culture, and AFB of bronchial washing fluid. The administration of inhaled corticosteroids is a viable therapeutic option for this situation. Following six months of medication and exposure avoidance, the patient's condition has been improving. The patient was initially diagnosed with suspected lung tuberculosis based on a thoracic CT scan with contrast revealing bilateral multiple nodules exhibiting a tree-in-bud pattern. However, considering the patient's occupational history involving exposure to gasoline vapour and a history of choking on gasoline, the radiological findings ultimately confirmed a diagnosis of hydrocarbon pneumonitis. Case management may be determined by the severity level; however, due to its rarity, no primary treatment option exists. Conclusion: Hydrocarbon pneumonitis is infrequently encountered in comparison to pulmonary tuberculosis. Inhaled corticosteroids are a treatment alternative that yields clinical improvement. This example illustrates those rare diseases, such as hydrocarbon pneumonitis, can mimic pulmonary tuberculosis.
The Difficulty To Distinguishing Between Embryonal Cell Carcinoma In The Anterior Mediastinal And Lung Adenocarcinoma Fahmi, Kristia; Pratiwi, Suryanti Dwi; Setyawan, Ungky Agus
Malang Respiratory Journal Vol. 7 No. 1 (2025): March 2025 Edition
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2025.007.01.04

Abstract

Background: Frequently encountered malignant anterior mediastinal tumors include thymoma, lymphoma and germ-cell tumors. Non-seminomatous germ-cell tumors histologically classified as embryonal-cell carcinoma, choriocarcinoma, yolk sac tumor, teratoma1. Embryonal-cell carcinoma is an exceedingly rare case (8%) of primary mediastinal germ-cell tumors, with poor prognosis. Case Presentation: An 18-year-old-male presented with severe dyspnea, echocardiography revealed pericardial effusion, leading to emergency pericardiocentesis and pigtail catheter insertion, draining a total of 1900 cc serohemorrhagic fluid. Thoracic CT scan+contrast unveiled a big mass (10.6 x 17 x 14.4 cm) in the anterior-middle-left posterior mediastinal, causing compression left main bronchus, encasing the left pulmonary artery and aortic arch. Two challenging Trans-Thoracic Needle Aspiration (TTNA) attempts led to difficulty in distinguishing between Embryonal-cell Carcinoma and Adenocarcinoma. A multidisciplinary discussion leaned toward an Embryonal-cell Carcinoma diagnosis. Due to the patient's worsening state and impracticality of open biopsy, chemotherapy was initiated. The patient improved clinically, achieving stable disease based on RECIST criteria until the third chemotherapy cycle but experienced a decline in their condition after the fourth cycle. Discussion: Embryonal-cell carcinoma of the mediastinal is a rare condition4 with poor prognosis, with the three-year survival rate 47.4% and five-year survival rate 23%5. Achieving precise diagnosis by TTNA is challenging. Open biopsy and histopathological biomarkers play a pivotal role in identifying the cell type and determining appropriate therapy6. The patient initially exhibited favorable response to chemotherapy, which later decline after the fourth cycle. Conclusion: Precise diagnosis of embryonal-cell carcinoma provides certainty in treatment and improve survival rates. Keywords: Embryonal, Adenocarcinoma, Diagnosis
A Young Women With Infected Bronchiectasis and Paraseptal Emphysema Mafisah, Saidah; Sugiri, Yani Jane; Sartono, Teguh Rahayu; Karliasari, Liana
Malang Respiratory Journal Vol. 7 No. 1 (2025): March 2025 Edition
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2025.007.01.03

Abstract

Introduction: Bronchiectasis is defined as an abnormal dilation of the bronchi, usually as a result of chronic airway inflammation and/or infection. Bronchiectasis with non-mycobacterial tuberculosis infection is more common in women. Paraseptal emphysema formed around the pleura or septa in the upper lobe, caused by repeated infections, smoking, or deficiency of the alpha 1 antitrypsin enzyme. Emphysema is more common in men with a history of smoking. Case: A 22 year-old female came with chief complaint of chronic cough. No smoking history. Patient had a history of repeated hospitalizations due to pneumonia. Fungal culture results with no fungal growth and sputum molecular rapid test result is mycobacterium tuberculosis not detected. Achromobacter denitrificans Multiple Drug Resistance was found through bronchial washings culture. Thorax Computed Tomography Scan showed cavities connected to the bronchi with air fluid level (infected bronchiectasis) and air space in upper lobes (paraseptal emphysema). Patient was given definitive antibiotic and clinically improved. Discussion: Bronchiectasis and paraseptal emphysema are caused recurrent lung infections. Bronchiectasis with non-mycobacterial tuberculosis infection is more common in women. In this case, we found infected bronchiectasis and paraseptal emphysema in a young women with no history of smoking but with a history of recurrent pneumonia. Conclusion: Possible causes of bronchiectasis and paraseptal emphysema in this patient was due to recurrent lung infection. The patient had been given definitive antibiotic treatment and clinically improve now. In addition, appropriate and adequate therapy are needed to reduce progression and complications of this disease.

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