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All Journal Indonesian Journal of Tropical and Infectious Disease Journal of Maternal and Child Health Jurnal Respirologi Indonesia Jurnal Respirasi (JR) Biomolecular and Health Science Journal Indonesian Journal of Clinical Pathology and Medical Laboratory (IJCPML) AKSONA Cerdika: Jurnal Ilmiah Indonesia

Isnin Anang Marhana

Fakultas Kedokteran Universitas Airlangga, Indonesia

Author-ID : 2579289

Humanities Biochemistry, Genetics & Molecular Biology Earth & Planetary Sciences Economics, Econometrics & Finance Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health Social Sciences

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LOW CD4 LYMPHOCYTE COUNT RELATED RISK TO Pneumocystis jiroveci PNEUMONIA IN HIV/AIDS PATIENTS FROM BRONCHOALVEOLAR LAVAGE SPECIMENS USING REAL TIME PCR DETECTION Alicia Margaretta Widya; Ni Made Mertaniasih; Arthur Pohan Kawilarang; Isnin Anang Marhana
Indonesian Journal of Tropical and Infectious Disease Vol. 6 No. 6 (2017)
Publisher : Institute of Topical Disease Universitas Airlangga

HIV and opportunistic infections remain a big problem especially in developing country. Pneumocystis jiroveci pneumonia is a prevalent infection in HIV infected patient with high mortality rate. Diagnosis of Pneumocystis jiroveci pneumonia is mainly based on clinical evidence. Microbiological diagnosis is quite challenging since this microorganism cannot be cultured and is mainly based on microscopic examination. Microscopic examination with special staining is still a gold standard diagnosis for P. jiroveci infection.The objectives of this study was to describe CD4 lymphocyte profile and establish microbiological diagnosis with recent molecular method in PJP suspected HIV positive patients. Fiberoptic bronchoscopy of HIV infected patients with lower respiratory tract infection in Dr. Soetomo general hospital Surabaya were performed to collect bronchoalveolar lavage specimens from December 2016 to April 2017 for identification of Pneumocystis jiroveci using real time PCR assay. Positive samples were then evaluated for microscopic examination with Gommori Methenamine Silver staining for comparison. Patient’s CD4 lymphocyte count were gathered prior of admission. CD4 lymphocyte count from this study were very low with 61% of the patients were below 50 cells/ µL. There were five of total thirteen patients (38,5%) with positive real time PCR assay (MSG gene) and one patient was also positive with GMS staining showing characteristic cysts shape with dark centered area of P. jiroveci. Patient with positive microscopic examination showed no history of prophylactic therapy. Low CD4 lymphocyte count remains a strong risk factor of P. jiroveci pneumonia in HIV/AIDS patients. Real time PCR assay shows high value in detection of P. jiroveci regarding patient’s prophylactic status.

Factors Associated with Acid Fast Bacilli and Sputum Culture Conversion in Patients with Multidrug-Resistant Tuberculosis in Surabaya Naomi Rahmasena; Isnin Anang Marhana; Muhammad Yamin Sunaryo Suwandi; Tutik Kusmiati; Tuksin Jearanaiwitayakul
Biomolecular and Health Science Journal Vol. 4 No. 2 (2021): Biomolecular and Health Science Journal
Publisher : Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/bhsj.v4i2.29763

Introduction: Indonesia is a high incidence country of multidrug-resistant tuberculosis. There are approximately 11,000 MDR TB cases, 2.8% of them are new cases and 16% of them are relapse cases. Although guidelines for MDR-TB are frequently designed, medication freely provided, and centers for treatment duly expanded, studies on time to sputum culture conversion have been very limited in Indonesia. Therefore the aim of the study is to identify risk factors that effect on sputum and culture conversion.Methods: Data on short-term regimen for MDR TB in Dr. Soetomo General Hospital from January 1st – December 31st, 2018 were collected with a total sampling approach, and fulfill the inclusion and exclusion. Data were analyzed by computer software IBM SPSS Statistic 24 for windows. Results: Male is more likely to have delayed sputum conversion and culture conversion but no statistical difference is observed (p>0.05). Smoking history is more likely to have delayed sputum and culture conversion but only in sputum smear test shows a significant difference (p≤ 0.05). Alcohol consumption has delay effect on sputum and culture conversion but there is statistically difference in only culture conversion (p<0.05). The high baseline smear test also affects delay the sputum and culture conversion but only in sputum smear reveals a significant effect (p<0.05).Conclusion: In this present study, we identified sex, smoking history, high bacillary loads as significant factors on sputum conversion. In addition, we revealed that alcohol-consumption history is a significant factor affecting on culture conversion.

CORRELATION BETWEEN ADENOSINE DEAMINASE ACTIVITY IN PLEURAL FLUID AND SERUM OF PATIENTS WITH PLEURAL EFFUSION Pande Putu Ayu Patria Dewi; Aryati Aryati; Leonita Anniwati; Isnin Anang Marhana
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 24, No 2 (2018)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v24i2.1321

Pleural effusion is an abnormal accumulation of fluid in the pleural space resulting from increased production of fluid or decreased resorption of fluid in the pleural space. Pleural effusion can be caused by infectious diseases, malignancies, collagen disease, gastrointestinal disease, heart disease and other causes such as medication. Adenosine Deaminase (ADA) is an enzyme involved in the catabolism of purines. This enzyme can be measured in pleural fluid, serum and other body fluids such as cerebrospinal and ascites fluid. The aim of this study was to analyze the correlation between adenosine deaminase activity in pleural fluid and serum in patients with pleural effusion. This research was an observational study with a cross-sectional design. Examination of ADA activity was performed in pleural fluid and serum. Adenosine deaminase activity was examined using photometric methods (Non-Giusti), using Diazyme reagent by TMS 24i Premium. Subjects were 46 patients with pleural effusion caused by malignancies, tuberculosis and systemic diseases. Mean±SD ADA activity for all pleural effusion samples in serum was 13.037± 8.365 (0.5-34.1) U//L and pleural fluid 30.843± 28.860 U//L (1.3-140.8). No correlation between ADA activity in serum and pleural fluid (r=0.173, p= 0.252) was found in all samples. No correlation between ADA activity in serum and pleural fluis was found in malignancies (r=0.109, p=0.630), tuberculosis (r= 0.366, p=0.123), systemic diseases (r =0.466, p=0.429) and non-tuberculosis group (r=0.126, p=0.532). There was no correlation between pleural fluid ADA activity and serum.

Correlation Between Pleural Fluid GenXpert® and Histopathology Finding of Pleural Biopsy in Tuberculous Pleural Effusion Sheilla Matheos; Isnin Anang Marhana; Anny Setijo Rahaju
Jurnal Respirologi Indonesia Vol 38, No 1 (2018)
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.v38i1.133

Backgrounds: Tuberculosis pleural effusion is the most common extrapulmonary TB after lymphadenitis TB, but a definite diagnosis is still a challenge. Pleural biopsy has historically been the gold standard procedure for the diagnosis of pleural tuberculosis. GenXpert® is a computerize test based in nucleic acid amplification tahat automatically detect MTB and rifampicin resistance. This study aimed to prove the correlation between pleural fluid GenXpert® and histopathological findings of pleural biopsy in patients with pleural tuberculosis. Methods: This study used an observational analytic design with a cross-sectional design conducted in Dr. Soetomo Hospital, Surabaya in March-June 2017. Statistic analysis was using chi square test and contingensi coofisient. The pleural GenXpert® was tested in 23 patients with pleural effusion and their biopsy speciments underwent histopathological analysis. Results: Histopathological findings of pleural biopsy was positive in 4 subjects and pleural fluid GenXpert® resulted positive in 6 subjects. There was significant correlation between pleural fluid GenXpert® and histopathological findings of specimen pleural biopsy in patients with pleural tuberculosis (P=0.040) with moderate strenght (P=0.014). Sensitivity and specificity of pleural fluid GenXpert® were 75.0% dan 84.2% respectively. Conclusions: There was significant correlation between pleural fluid GenXpert® and histopathological findings of pleural biopsy in patients with pleural tuberculosis. (J Respir Indo 2018; 38(1): 1-6)

Relationship Between Expression of MAGE-A3 with The Histopathology in NSCLC Patients Mokhammad Mukhlis; Isnin Anang Marhana
Jurnal Respirologi Indonesia Vol 40, No 2 (2020)
Publisher : Perhimpunan Dokter Paru Indonesia (PDPI)/The Indonesian Society of Respirology (ISR)

Backgrounds: Most patients with lung cancer was diagnosted in advanced stage (around 57%). Those diagnosed at early stage were only 15%. To increase the cure rate and life expectancy, lung cancer detection should be performed early. Melanoma-associated antigen 3 (MAGE-A3) is a testicular cancer antigen and is widely expressed in various types of tumor tissue. MAGE-A3 is expressed in about 35-40% of NSCLC. Previous research reported the expression of MAGE-A3 in lung cancer was 30-50%. To detect tumor antigens, CT antigens of the MAGE family can be detected through real time polymerase chain reaction (RT-PCR). This study aimed to analyze the relationship between MAGE A3 expression and histopathology type from forceps biopsy specimens in NSCLC patients. Methods: This study was a cross-sectional study conducted on 14 patients with lung cancer in September 2018 to February 2019. Subjects underwent force biopsy with guidance from bronchoscopy in the pulmonary surgery room Dr. Soetomo. The analysis used was the Fisher's exact test. Results: There were six subjects with histopathology type of adenocarcinoma (42.9%) and eight subjects (57.1%) with the histopathology of squamous cell carcinoma. Expression of MAGE-A3 was positive in 5 subjects (35.7%). Conclusions: There was no significant relationship between the expression of MAGE-A3 and the type of histopathology. (J Respir Indo. 2020; 40(2): 113-9)

A Comparison of Aerobic Bacterial Culture between BAL and Induced Sputum Method on HIV-AIDS Patient with Bacterial Pneumonia CO-Infection Isnin Anang Marhana; Amir Sholeh
Jurnal Respirologi Indonesia Vol 39, No 1 (2019)
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.v39i1.37

Background: Bacterial pneumonia is the main cause of morbidity and mortality in immunocompromised individuals. The incidence of bacterial pneumonia on HIV patients is 2,3 cases per 100 people per year. On several cases, obtaining sputum sample for cultivation to confirm bacterial pneumonia diagnosis is difficult, thus further work to gain representative sample is necessary. This can be acquired through sputum induction and bronchoscopy. This study aims to compare aerobic bacteria culture result between BAL and induced sputum NaCl 3% method. Method: This is a comparative analytical study which was done in UPIPI dr. Soetomo Hospital Surabaya on HIV-positive patients between 21 – 60 years old with suspected bacterial pneumonia through clinical and radiology findings. All patients went through sputum induction and BAL procedure. The sputum obtained was cultured aerobically to confirm the diagnosis of bacterial pneumonia. Results: There were 26 subjects with average age 40 years old and male majority (73,1%). All patients were present with coughing and breahtlessness as their chief complaint, while the general complaint was coughing with difficulty in excreting sputum. The dominant risk factor is a history of free sex. The radiologic findings were dominated with unilateral infiltrate (73,1%). Most of the FOB imaging results were normal (88,5%). The results of aerobic bacterial culture from sputum induction are: Streptococcus pneumoniae (20%), Pseudomonas aeroginosa (20%), Acinetobacter spp. (20%), while from BAL method: Klebsiella pneumoniae (25%). The different specimen-obtaining method between induced sputum and BAL method has significant result with p= 0,001 (p

Lung Pseudomesothelioma in Patient with Asbestos Exposure: A Case Report Devy Trianne Putri; Isnin Anang Marhana; Dhihintia Jiwangga Suta Winarno
Jurnal Respirasi Vol. 6 No. 2 (2020): May 2020
Publisher : Faculty of Medicine Universitas Airlangga

Background: Pseudomesotheliomatous carcinoma is a rare case of lung cancer with marked pleural extension resembling malignant pleural mesothelioma on diagnostic imaging. One of tool to diagnose lung pseudomesothelioma is by performing thorocoscopy pleural biopsy. Diagnostic thoracoscopy also has a higher sensitivity than pleural fluid cytology and needle biopsy.Case: We report a rare case of pseudomesotheliomatous carcinoma of the lung in a 50-year-old man with asbestos exposure. The patient had complained of dyspnea and chest roentgenogram showed left pleural effusion. Computed tomography (CT) of the chest revealed diffuse irregular left pleural thickening and without a clear initial primary lesion found in both of lung parenchyma, which mimicked pleural mesothelioma. Pleural tissue sampling was performed to obtain definitive diagnosis by video-assisted thoracoscopic surgery. At the operation, the tumor was found to have spread along the pleural surface and primary lesion was not detected in the right lung parenchyma. Immunohistochemically, the tumor was positive for Thyroid Transcription Factor- 1 (TTF-1), but negative for calretinin, P63, and Neuron Specific Enolase (NSE). Final diagnosis was adenocarcinoma of the lung and patient had good clinical response to Gefitinib.Conclusion: Based on the results of clinical studies (images and clinical observations), although pseudomesotheliomatous in patient with asbestos exposure is difficult to distinguish from pleural mesothelioma, we have a case of pseudomesotheliomatous lung diagnosed by a thoracoscopic pleura biopsy. For such cases, thoracoscopic pleural biopsy should be performed at an early stage.

Correlation between FEV1% Predicted and Blood Eosinophils in Patients with Exacerbations of Chronic Obstructive Pulmonary Disease (COPD) Alfian Nurfaizi; Isnin Anang Marhana; Gadis Meinar Sari; Arief Bakhtiar
Jurnal Respirasi Vol. 7 No. 2 (2021): May 2021
Publisher : Faculty of Medicine Universitas Airlangga

Introduction: Chronic obstructive pulmonary disease (COPD) exacerbations are still the leading causes of mortality. Eosinophil counts were recommended in assessing the risk of exacerbations. This additional examination was preferred rather than the pulmonary function test (PFT), which was considered less precise and had vast differences. Therefore, an analysis of the correlation between the FEV1% predicted and blood eosinophil counts were needed as a reference in the diagnosis of COPD exacerbation. This study aimed to determine the correlation between FEV1% predicted and blood eosinophils counts in patients with COPD exacerbations.Methods: This was a retrospective cross-sectional study by analyzing medical records of patients with COPD exacerbations at Dr. Soetomo General Hospital, Surabaya, from 2017 to 2018.Results: The characteristics of patients with exacerbations of COPD consisted of 91.7% male patients. Most of them were in the age group of 61-70 years old, 58.3% were in the private sector, 75% had a high school diploma, and 41.7% had normal body mass index (BMI). The percentage of the FEV1% predicted is directly proportional to the percentage of blood eosinophils with weak and statistically insignificant strength.Conclusion: The FEV1% predicted and blood eosinophil counts had a very weak correlation and statistically insignificant strength. Thus, it could not be used as a reference for diagnosis using one of the variables. Further research is needed with sputum eosinophils and biopsy as consideration for more accurate results.

Right Cerebellar Tuberculosis with Cranial Nerve Palsy in Pulmonary Tuberculosis Patient I Komang Rusgi Yandi; Isnin Anang Marhana
Jurnal Respirasi Vol. 7 No. 2 (2021): May 2021
Publisher : Faculty of Medicine Universitas Airlangga

Introduction: Tuberculosis (TB) is a major public health issue. The most devastating clinical manifestations of TB is Central nervous system (CNS) TB. CNS TB is found approximately in 1% of all patients with active TB, and cerebellar TB is rarely reported. CNS TB can present as meningitis, arachnoiditis, tuberculomas, or the uncommon forms of tuberculous subdural empyema and brain abscess.Case: A 23-year-old patient was reported in October 2018 with signs and symptoms of 2-month history of vertigo, headache, vomiting, weakness, fever, blurred vision, lingual palsy, dysmetria, and decrease of consciousness. The patient had a few months of history of cough, contact with a TB patient, his father, and loss of body weight. On admission, the patient had fever (38.50 C) and Glasgow coma score of 13.Discussion: CNS TB can occur in an immunocompromised patient with malnutrition, whether a child or young adult. The patient in this case had risk factors because he is a young adult and had contact with a patient of TB, his father. Based on epidemiology, clinical signs and symptoms, radiological findings, and the result of AFB-stained sputum, the patient was diagnosed with right cerebellar TB and PTB.Conclusion: The high morbidity and mortality characteristics of CNS TB are very important to note, thus the prompt diagnosis and therapy should be done. The specific therapy of ATD combined with surgery seems to provide a good result. The clinical and radiological findings were used as the evaluation of the medication.

Hubungan Nilai PH Cairan Pleura dengan Hasil Pleurodesis pada Penderita Efusi Pleura karena Keganasan: [Acidity of Pleural Fluid and Pleurodesis in a Patient with Malignant Pleural Effusion] Isnin Anang Marhana; Asep Tri Handoko
Jurnal Respirasi Vol. 3 No. 1 (2017): Januari 2017
Publisher : Faculty of Medicine Universitas Airlangga

Background: Pleural effusion is a frequent complication of advanced stage are obtained in patients with malignancy. Shortness of breath at rest and decreased exercise tolerance are major functional limitations for patients with cancer who develop extensive pleural effusion. Pleural fluid drainage followed by a pleurodesis can reduce the symptoms of shortness of breath and prevent pleural fluid reaccumulation. Unfortunately, pleurodesis attempts fail in 10 to 40% of patients with recurrent pleural fluid and shortness of breath. Low pleural fluid pH can be used as a marker for increased metabolic activity of tumors in intrapleura, and is associated with increasing tumor, and can predict the failure of pleurodesis. The purpose of this study was to prove association between low pleural fluid pH value with failure pleurodesis in patients pleural effusion malignancy. Method: This is an observational study with cross sectional design that is the analysis conducted at Hospital Dr Soetomo in patients pleural effusion malignancy were subjected to pleurodesis for 6 months. Total 11 patients who meet the inclusion and exclusion criteria. Result: The mean value obtained pleural fluid pH 7,3±0,2, based on logistic regression analysis obtained low pleural fluid pH is not significant association with failure of pleurodesis, as shown from the significant value generated wald test is 0,116 where the value is above 0,05. Conclusion: Low pleural fluid pH is not significant association with failure of pleurodesis.

Co-Authors Aâ€™yuni, Zera Qurrota Adhari Ajipurnomo Alfian Nurfaizi Alicia Margaretta Widya Amelia Tantri Anggraeni Amir Sholeh Annisa Nurul Husna Anny Setijo Rahaju, Anny Setijo Arien Dwi Ajeng Adhe Safitri Arthur Pohan Kawilarang Aryati Aryati Asep Tri Handoko Bakhtiar, Arief Budi Prasetyo Desilia Atikawati Devy Trianne Putri Dhihintia Jiwangga Suta Winarno Dominicus Husada Dominicus Husada, Dominicus Dyah Erawati Erni Rosita Dewi Fatih Nugraha Abdillah Fidiana Gadis Meinar Sari I Komang Rusgi Yandi Leonita Anniwati Mohammad Yamin Sunaryo Suwandi Mokhammad Mukhlis Muhammad Rudy Chairudin Naomi Rahmasena Ni Made Mertaniasih Pande Putu Ayu Patria Dewi Paulus Sugianto Retna Dwi Puspitarini Rosyid, Alfian Nur Sheilla Matheos Supiatun.M, Lilis Sri Tuksin Jearanaiwitayakul Tutik Kusmiati Yenny Kusmatuti

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