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Relationship of Tuberculosis Radiographic Manifestation in Diabetic Patients with HbA1c Levels Dana Jauhara Layali; Bintang YM Sinaga; Parluhutan Siagian; Putri Chairani Eyanoer
Jurnal Respirologi Indonesia Vol 39, No 3 (2019)
Publisher : Perhimpunan Dokter Paru Indonesia (PDPI)/The Indonesian Society of Respirology (ISR)

Background: The relationship between diabetes mellitus (DM) and tuberculosis (TB) is a significant health problem and more prominent in developing countries where TB is endemic and DM prevalence increases. The prevalence of pulmonary TB increases with increasing prevalence of DM. Uncontrolled diabetic patients with high hemoglobin (HbA1c) levels cause TB to become more severe and are associated with higher mortality and also have a significant effect on radiological manifestations of pulmonary TB. Methods: The was a case-control study conducted between January to December 2016 at RSUP H Adam Malik, Medan to 43 with TB-DM patients and 41 TB-without DM patients was studied from. Radiological examination with chest radiograph was done in both groups of samples. The HbA1c levels was examined in the TB with DM group. Result: Compared with TB-without DM group, the TB with DM group significantly had far advanced tuberculosis lesions (OR=3.8; 95% CI=1.37-10.47; P=0.01), more atypical lesions atipikal (OR=6.29; 95% CI=2.43-16.25; P

Risk Factors of Prolonged QTc Interval in Patients with Drugs-Resistant Tuberculosis Andika Pradana; Katharine Katharine; Parluhutan Siagian
Jurnal Respirologi Indonesia Vol 42, No 1 (2022)
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.v42i1.274

Background: Drug-Resistant Tuberculosis (DRTB) is still one of the biggest health problems worldwide. In 2016, WHO published new guidelines for DRTB management using 7 second-line drugs that only required 9-11 months of treatment with a higher success rate. Unfortunately, one of the side effects was the possibility of a prolonged QT-c interval on electrocardiography. However, to date there have been no known factors which increased the risk of QTc prolongation in DRTB patients.Methods: This was a retrospective cohort study that analyzed the medical records of 50 DRTB patients who underwent treatment from August 2017 to August 2020 at the DRTB Clinic of Adam Malik Hospital Medan. Statistical analysis was performed using logistic regression to determine the factors which increased the risk of QTc prolongation in DRTB patients.Results: Of the 50 study samples consisting of 40 MDR TB patients, 9 pre-XDR TB patients and 1 XDR TB patient, 14 (28%) subjects were found to have QTc prolongation. There were no correlation between the regimen type (P = 0.51), age (P = 0.40), sex (P = 0.74), nutritional status (P = 0.35) and comorbid diseases (P = 0.31) on the prolongation of QTc interval. Patients receiving clofazimine had a greater percentage (78.6% vs 21.4%) to experience prolonged QTc interval, although not statistically significant (P = 0.41). Conclusion: Treatment regimen, age, sex, nutritional status and comorbid disease were not associated with prolonged QTc interval in DRTB.

The Correlation of Body Mass Index with Sputum Conversion Time in MDR-TB Patients Undergoing Treatment with Short Term Regimen at H. Adam Malik Medan General Hospital Diana Santy; Parluhutan Siagian; Bintang Yinke Magdalena Sinaga; Putri C Eyanoer
Jurnal Respirologi Indonesia Vol 40, No 4 (2020)
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.v40i4.130

Background: It was estimated about 10.4 million incidence of TB cases worldwide, of which 580,000 were MDR TB cases in 2015, however, only 125,000 were successfully found and treated. The World Health Organization (WHO) issued a recommendation of 9-11 month Short Term Regimen (STR) guideline that could provide satisfactory results in terms of successfull outcome, easier to control and also low-cost. The study aimed to analyze the correlation between Body Mass Index (BMI) and sputum conversion time in MDR TB patients undergoing treatment with STR and to determine the final treatment outcome using STR at H. Adam Malik Medan General Hospital, North Sumatra, Indonesia. Methods: This was a case series study of a total 76 MDR TB patients undergoing treatment using STR. Samples were obtained from medical record of the pulmonary isolation ward and MDR TB clinic at H. Adam Malik Medan General Hospital. Data were analyzed descriptively to identify the trend in sputum conversion from nine months of treatment. Results: The number of patients with normal BMI was 51.3% higher than those of low, very low and high BMI. The time to sputum conversion occured in the second month of treatment. All groups of BMI categories experienced conversions and normal BMI was higher in number. At the end of the treatment evaluation, the cure rate was 44.8%, the drop out was 28.9%, the regimen change was15.8%, died 9.2%, and moved 1.3%. Conclusion: There was a significant correlation between BMI and sputum conversion time in MDR TB patients. Good nutritional status was a predictor of treatment success.

Sensitivity Comparison of Pleural Fluid and Serum Neutrophil to Lymphocyte Ratio (NLR) Values in Exudative Pleural Effusion Patients Indra Barata; Zainuddin Amir; Parluhutan Siagian; Putri C Eyanoer; Zulfikar Lubis
Jurnal Respirologi Indonesia Vol 40, No 4 (2020)
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.v40i4.131

Background: Delay in diagnosis and non-compliance to tuberculosis (TB) treatment will increase the risk of MDR TB. WHO recommends GeneXpert as a diagnostic tool, however, the availability is still an obstacle and this tool is not owned by many health facilities. The Neutrophil-Lymphocyte Ratio (NLR) value was thought to be used to estimate the likelihood of TB cases. This study aimed to assess the sensitivity comparison of pleural fluid and serum NLR values in patients with pleural effusion at H. Adam Malik Medan General Hospital. Methods: This was an analytical study with a diagnostic test design, by calculating the sensitivity and specificity of pleural fluid and serum NLR. The sample was calculated by comparing the absolute neutrophil count and the absolute lymphocyte count from both pleural fluid and serum. Results: The sample of this study was 78 patients. In this study, pleural fluid NLR with a cut off value of 2.2 showed a sensitivity of 74% and specificity of 28%, whereas serum NLR with a cut off value of 7.0 produced a sensitivity of 53% and specificity of 68%. Conclusion: The sensitivity of pleural fluid NLR was greater than that of serum, while the specificity of serum NLR was more superior than that of pleural fluid.

The Effect of Vitamin C Supplementation on Chest X-Rayimprovementin Pulmonary Tuberculosis Patients During Intensive Phase in Medan Budi Jefri; Bintang YM Sinaga; Parluhutan Siagian; Putri Chairani Eyanoer
Jurnal Respirologi Indonesia Vol 40, No 2 (2020)
Publisher : Perhimpunan Dokter Paru Indonesia (PDPI)/The Indonesian Society of Respirology (ISR)

Backgrounds: Tuberculosis (TB) is still a public health problem in the world.Vitamin C is a water-soluble micronutrient, protects the host from reactive oxygen and reactive nitrogen intermediates generated during mycobacterial infection, involved in the synthesis of collagen, iron transport, and acts as physiological antioxidant. Vitamin C plays role in killing Mycobacterium tuberculosis by fenton reaction. This study was to determine the effect of vitamin C supplementation on chest X-ray (CXR) improvement in pulmonary TB patients during intensive phase. Methods: This was a quasy experimental study with single blind-randomized controlled trial design. Subjects were divided into 2 groups, first group was pulmonary TB patients treated with anti tuberculosis drugs (ATD) plus vitamin C and the second group was treated with ATD plus placebo. This study was conducted in several public health center in Medan City. The subjects were pulmonary TB patients with positive AFB sputum in intensive phase from December 2017 to May 2018. Data were analized using t-test dependent. Results: From 80 total subjects, 53 males (66%) and 27 females (34%). After 2 months of treatment, improvements in CXR images were found in the ATD plus vitamin C group, about 21 subjects (52.5%) had no more lesions on CXR, while the same condition was found on 15 subjects (37.5%) in the placebo group. Conclusion: Vitamin C supplementation in pulmonary TB provided better improvements of CXR images. (J Respir Indo. 2020; 40(2): 82-7)

Correlation of Hemostatic Parameter with Lung Tumor Marker in Non-Small Cell Lung Cancer Patient with Chemotherapy Ganda M. Leonard Samosir; Parluhutan Siagian; Putri Chairani Eyanoer
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.v38i1.137

Backgrounds: There is a subclinical activation of coagulation and ﬁbrinolysis system in patient with lung cancer. Alterations in hemostatic system are seen frequently in lung cancer correlated with the prognosis of disease. In oncology practice, the use of tumor markers may be helpful in the diagnosis and pathologic classification of tumors. Tumor marker may reflect both, stage of the disease and prognosis. Aim of this research is to asses the correlation of this parameters in patient non-small cell lung cancer with chemotherapy. Methods: This research is an analytic observational with a cross sectional design. The research was conducted at RSUP Haji Adam Malik, Medan from January 1, 2015 to May 31, 2016. Blood test examination was performed to measure the hemostatic parameter (PT, INR, APTT, TT, D-dimer) and serum tumor marker (CEA, Cifra21-1, NSE) of 41 non-small cell lung cancer patients before first cycle of chemotherapy and after fourth or sixth cycles of chemotherapy. Results: The study comprised 41 patients of non-small cell lung cancer (31 adenocarcinoma, 10 squamous cell carcinoma), There were 35 men (85,4%) and 3 women (14,6%) with mean age of 56,7 years. For all patients, we give a platinum based therapy as first line chemotherapy (gemsitabine and carboplatin regimen in 27 patients, paclitaxel and carboplatin in 10 patients, vinorelbine and carboplatin in 4 patients). There is no significant difference of hemostatic parameter and serum tumors marker values before chemotherapy againts after chemotherapy values. And there is a weak negative correlation of hemostatic parameter againts serum tumor marker on non-small cell lung cancer patients with chemotherapy. Conclusion: There is a weak negative correlation of hemostatic parameter againts serum tumor marker in non-small cell lung cancer patients with chemotherapy. (J Respir Indo 2018; 38(1): 33-38)

The Association Between Vitamin D Receptor Gene FokI Polymorphism and Pulmonary Tuberculosis Dina Octafrida Marpaung; Bintang Yinke Magdalena Sinaga; Parluhutan Siagian; Erna Mutiara
Respiratory Science Vol. 2 No. 1 (2021): Respiratory Science
Publisher : Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/respirsci.v2i1.29

Backgrounds: There is a wide range of individual responses to mycobacterium infection. However, the reason why certain people suffers from a disease when they are infected with mycobacterium while others remain healthy is still unknown. Genetic susceptibility is thought to be one of the important explanatory factors for individuals with the risk of developing pulmonary tuberculosis (TB). FokI polymorphism was one of the genetic variations within the vitamin D receptor (VDR) gene associated with pulmonary TB. In the present study, we investigated the association between VDR gene FokI polymorphism and pulmonary TB. Conclusion: There was no significant association between the VDR gene FokI polymorphism and pulmonary TB.

Vitamin C Supplementation Improves Pulmonary Tuberculosis Patients' Sputum Conversion During Intensive Phase Category I Treatment in Medan Elok Ariyani Safitri; Parluhutan Siagian; Bintang Yinke Magdalena Sinaga; Putri Chairani Eyanoer
Respiratory Science Vol. 2 No. 2 (2022): Respiratory Science
Publisher : Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/respirsci.v2i2.30

Background: Many factors influence the success of the acceleration of Acid-Fast Bacilli (AFB) sputum conversion in the treatment of the intensive phase of pulmonary tuberculosis (TB). One of these factors is the nutritional status or nutrition of pulmonary TB patients. Through a fenton reaction, Vitamin C is known to be able to sterilize Mycobacterium tuberculosis. This study aims to determine the effect of giving vitamin C on the conversion of AFB sputum in the intensive phase of pulmonary TB treatment. Method: This study was an inferential, quasi-experimental evaluation of the acceleration of AFB sputum conversion following vitamin C supplementation in patients with category I pulmonary TB. The study group was separated into two groups: 40 TB patients getting Anti Tuberculosis Treatment (ATT) with vitamin C, and 40 TB patients receiving ATT with placebo. Every two weeks, AFB sputum was examined, and vitamin C levels were measured before and after two months of therapy. Results: Conversion of AFB occurred sooner in the vitamin C group of pulmonary TB patients, with as many as 29 patients (72.5%) experiencing conversion of AFB sputum at the end of the second week of therapy, whereas there was no conversion in the placebo group. At the end of the fourth week, all patients (100%) given vitamin C showed AFB sputum conversion, whereas only eight patients (20%) in the placebo group had conversion at the end of the fourth week of treatment. Vitamin C levels increased significantly in the group of pulmonary tuberculosis patients who received vitamin C supplementation. Conclusion: Vitamin C supplementation in the treatment of pulmonary TB can accelerate the conversion of AFB sputum, which is statistically significant.

Characteristics of COVID-19 Patients in Haji Adam Malik General Hospital, Medan, North Sumatera Dyana Destylya; Bintang YM Sinaga; Parluhutan Siagian; Putri Chairani Eyanoer
Respiratory Science Vol. 2 No. 3 (2022): Respiratory Science
Publisher : Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/respirsci.v2i3.53

Background: Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). The increase in the number of COVID-19 cases was happening quite quickly and has spread between countries so that COVID-19 has become a pandemic in the world. This study aimed to determine the characteristics of COVID-19 patients at Haji Adam Malik General Hospital Medan. Method: This was a descriptive study. Data were taken from the medical records of 110 hospitalized patients with positive RT-PCR results for COVID-19 from December 2020 to April 2021. The inclusion criteria for the case samples were patients diagnosed with COVID-19 based on RT-PCR and the exclusion criteria were incomplete medical records. Characteristic analysis was carried out using the Kruskal Wallis test. Results: The most common comorbidities found in patients with severe COVID-19 were diabetes mellitus and HIV. The most common comorbidity found in moderate-level COVID-19 patients was pregnant women. The most common chest X-rays finding in severe and critical levels was bilateral infiltrates. Recovered patients were mostly obtained at moderate level, while deceased patients were mostly observed at critical levels. Conclusion: Characteristics of COVID-19 patients at Haji Adam Malik General Hospital were classified based on the degree of disease by age, lymphocyte value, N/L ratio, levels of CRP, D-dimer, procalcitonin, fibrinogen, ferritin, and comorbidities as well as the appearance of infiltrates in both lung fields.

Comparison of Serum Vitamin C Levels Between Pulmonary Tuberculosis and Healthy Controls in Medan Rizka Helmi; Bintang Yinke Magdalena Sinaga; Parluhutan Siagian; Putri Eyenoer
Jurnal Respirologi Indonesia Vol 42, No 3 (2022)
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.v42i3.364

Background: Pulmonary tuberculosis infection is a high burden, especially in developing country. Vitamin C is a water-soluble micronutrient that contributes to immune defense by supporting avarietyof innate and adaptive immunity. Vitamin C protects the host from reactive oxygen and reactive nitrogen intermediates generated during Mycobacterial infection. Pulmonary tuberculosis patients have lower vitamin C levels because Mycobacterium tuberculosis infection produces reactive oxygen species for replication as well asmetabolism and also because of reduced nutrient intake. Vitamin C as an antioxidant also plays role in killing Mycobacterium tuberculosis by encouraging Fenton reaction.Methods: This is a case control study of serum vitamin C levels in pulmonary tuberculosis patients and healthy controls. Vitamin C levels were measured by ELISA (Enzyme Linked Immunosorbent Assay).Results: The number of subjects was 40 people, divided into 20 subjects of pulmonary tuberculosis as cases and 20 healthy controls, aged between 18–65 years old. Vitamin C levels according to age group were 99.03±38.60 ng/ml and 80.53±27.38 ng/mlfor18–30 years, 84.85±49.69 ng/ml and 82.70±14.93ng/ml for31–40 years, 61.34±25.36 ng/ml and 79.93±22.81 ng/ml for41–50 years, 71.43±18.36 ng/ml and 78.69±54.21 ng/ml for51–65 years. Vitamin C levels of male subjects based on case and control groups were 88.11±42.07 ng/ml and 78.36±28.95 ng/ml while for the female were 73.20±11.56 ng/ml and 83.16±23.77 ng/ml. Mean vitamin C levelin pulmonary tuberculosis patients was 83,64±35,99 ng/ml and in healthy controls was80,22±26,44 ng/ml.Conclusion: There was no significant difference in vitamin C levels between pulmonary tuberculosis patient and healthy people.

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