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"ABSTRAKBackground: diagnostic of pulmonary TB in HIV patients is a problem due to non specific clinical features, or radiological appearance. HIV patients with CD4≤200 cells/mL infected with M. tuberculosis have less capacity in containing M. tuberculosis, developing granulomas, casseous necrosis, or cavities. This condition is caused by weakend inflammatory which later reduced sputum production and may cause false negative result. This study aimed to assess differences in the positivity level of acid fast bacilli (AFB) and cultures of M. tuberculosis from non-bronchoscopic sputum (spontaneous and induced sputum) compared to bronchoscopic sputum (bronchoalveolar lavage) in HIV positive patients suspected pulmonary tuberculosis with CD4<200 cells/μL.Methods: this cross sectional study was conducted in adult HIV patients treated in Hasan Sadikin Hospital with CD4≤200 cells/μL suspected with pulmonary tuberculosis by using paired comparative analytic test. All patients expelled sputum spontaneously or with sputum induction on the first day. On the next day, bronchoalveolar lavage (BAL) was performed. The two samples obtained from two methods were examined by AFB examination with staining Ziehl Neelsen (ZN) and cultured of M. tuberculosis on solid media Ogawa on all patients. Positivity, sensitivity and increased sensitivity of AFB and culture of M. tuberculosis in the non bronchoscopic and bronchoscopic groups were compared.Results: there were differences in the positivity level of AFB with ZN staining between non-bronchoscopic and bronchoscopic groups which were 7/40 (17.5%) vs 20/40 (50.0%) (p<0.001). The differences between the cultures of non-bronchoscopic and bronchoscopic groups were 16/40 (40.0%) vs 23/40 (57.5%) (p=0.039). Bronchoscopic sputum increased the positivity level of the ZN AFB examination by 32.5% (from 17.5% to 50.0%) as well as on culture examination by 17.5% (from 40.0% to 57.5%).Conclusion: Bronchoalveolar lavage can improve the positivity level of smears and cultures in patients suspected of pulmonary TB in HIV patients with CD4<200 cells/μL."

"Latar belakang : Bronkoskopi merupakan tindakan penting dalam bidang pulmonologi. Bronkoskopi memiliki peran diagnostik dan terapetik pada pasien perawatan intensif yang tidak dapat ditransport ke tempat pemeriksaan pencitraan. Pasien dalam perawatan intensif dapat terintubasi ataupun tidak. Pasien terintubasi dengan ventilasi mekanis dapat mengalami pneumonia akibat virus, bakteri maupun jamur. Retensi sekresi bronkus dapat menyumbat saluran napas dan meningkatkan risiko infeksi. Metode: Penelitian ini bertujuan untuk mengetahui profil tindakan bronkoskopi pada pasien di Instalasi perawatan intensif (IPI) Rumah Sakit rujukan Respirasi Nasional Persahabatan. Desain penelitian ini yaitu deskriptif dan bersidat retrospektif berdasarkan data pada rekam medik pasien. Penelitian ini dilakukan di IPI RS Persahabatan pada bulan November 2023 sampai Februari 2024 dengan subjek penelitian yaitu pasien di IPI yang menjalani tindakan bronkoskopi pada periode 1 Januari 2022 sampai 31 Juli 2023 yang memenuhi kriteria inklusi. Besar sanpel pada penelitian ini yaitu 113 pasien. Analisis dilakukan pada 70 pasien yang menjalani tindakan bronkoskopi di IPI. Data yang diiperoleh diolah dan dianalisis univariat dengan perangkat lunak SPSS. Hasil : Median umur pasien yang menjalani tindakan bronkoskopi didapatkan 51,5 tahun, jenis kelamin laki-laki dominan (61,95%), dengan perangkat oksigenasi sebelum tindakan bronkoskopi yaitu ventilasi mekanis (90%). Pneumonia merupakan diagnosis penyakit paru terbanyak (50%). Komorbid gangguan sistem kardiovaskular terjadi pada 47,14% pasien. Indikasi tindakan bronkoskopi terbanyak yaitu retensi sputum dan atelektasis (31,43% dan 30%). Modalitas tindakan berupa bronchial toilet pada 98,57% pasien. Analgetik digunakan pada 98,52% pasien. Kombinasi analgetik, sedasi, pelumpuh otot dan ketamin serta kombinasi analgetik dan sedasi paling banyak digunakan. Parameter tanda vital paling banyak ditemukan berupa peningkatan tekanan darah dan nadi sebelum dan sesudah tindakan bronkoskopi. Temuan bronkoskopi berupa stenosis kompresi, mukosa hiperemis dan sekret mukopurulen paling banyak ditemukan. Perbaikan gambaran foto toraks setelah tindakan bronkoskopi pada 35,71% pasien. Belum tercantum dengan jelas data komplikasi dua jam pasca tindakan pada pasien di IPI, namun dan tidak didapatkan perburukan dari parameter tanda vital. Median lama perawatan di IPI pada pasien yang menjalani tindakan bronkoskopi yaitu 12 hari. Angka kesintasan pasien yang menjalani tindakan bronkoskopi di IPI yaitu 52,85%.

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Background : Bronchoscopy is an important procedure in the filed of pulmonology. Bronchoscopy has diagnostic and therapeutic role for intensive care patients who cannot be transported to imaging centre. Patients in intensive care may be intubated or not. Intubated patients with mechanical ventilation can experience pneumonia caused by vruses, bacteria or fungi. Retention of bronchial secretions can obstruct the airways and increase the risk of infection. This study aims to determine the profile of bronchoscopy procedures of patient at intensive care installation at hte Persahabatan National Respiratory Center. Method : The design of thins research is descriptive and retrospektive based on data in the patient’s medical record. This research was conducted at intensive care installation Persahabatan Hospital from November 2023 to February 2024. Subject if this study are patients who underwent bronchoscopy procedures from January 1st 2023 until July 31st 2024 whi met the inclusion criteria. The sample size in this study was 113 patients. Analysis was carried out on 70 patients who underwent bronchoscopy at IPI. The data obtained were processed and analyzed univariately using SPSS software. Result : The median age of patients undergo bronchoscopy was 51.5 years, male gender was dominant (61.95%), with oxygenation devices before bronchoscopy, namely mechanical ventilation (90%). Pneumonia is the most common lung disease diagnosis (50%). Comorbid cardiovascular system disorders occurred in 47,14% of patients. The most frequent indication for bronchoscopy were sputum retention and atelectasis (31,43% and 30%). The modality of bronchoscopy was bronchial toilet in 98.52% of patients. Analgesics were used in 98.52% of patients. Combination of analgetics, sedatiopm, muscle relaxant and ketamine as well as combiantion of analgetics and sedation are most widely used. The most common vital sign parameters found were an increase in blood pressure and pulse before and after bronchoscopy. Bronchoscopy findings in the form of compression stenosis, hyperemic mucosa and mucopurulent discharge were most commonly found in patients undergoing bronchoscopy at IPI. Chest radiograph improvement after bronchoscopy in 35.71% of patients. There were no clear data on two-hours complications after the procedure, however there was no deterioration in vital sign parameters. The median length of stay at IPI for patients undergoing bronchoscopy is 12 days. The survival rate for patients who undergo bronchoscopy at IPI is 52.85%."

"ABSTRAKLatar belakang. Cedera inhalasi dapat terjadi saluran napas atas hingga bawah. Sebagai prediktor diagnosis cedera inhalasi di instalasi gawat darurat IGD masih terbatas pada temuan klinis adanya edema laring pada saluran napas atas. Bronkoskopi sebagai baku emas diagnostik cedera inhalasi belum dapat dilakukan di IGD. Penelitian ini dilakukan untuk mencari hubungan antara temuan klinis edema laring dengan temuan bronkoskopi pada pasien luka bakar dengan cedera inhalasi.Metode. Studi potong lintang retrospektif pada 18 subjek. Di IGD dilakukan laringoskopi untuk menilai adanya edema laring. Hanya subjek yang dilakukan pemasangan selang endotrakeal dan dilakukan bronkoskopi dimasukkan sebagai kriteria inklusi, sedangkan derajat cedera inhalasi dibagi menurut kriteria Chou yang diamati melalui bronkoskopi.Hasil. Subjek terbanyak pria yaitu 16 subjek. Usia berkisar antara 19-56 tahun. Luas luka bakar berkisar antara 5-95 . Dari 14 subjek didapatkan adanya edema laring. Dari 14 subjek yang didapatkan edema laring, 13 subjek terdapat cedera inhalasi. Hubungan antara temuan klinis edema laring dengan adanya cedera inhalasi yang diamati melalui bronkoskopi memiliki nilai sensitivitas 76,4 , spesifitas 0 .Kesimpulan. Adanya edema laring berhubungan dengan cedera inhalasi pada saluran napas bawah meski secara statistik belum signifikan serta belum mampu menunjukkan akurasi derajat cedera inhalasi.

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ABSTRACTBackground. Inhalation injury may occur from the upper until the lower respiratory tract. In the ER, diagnose of inhalation injury only suspected from the presence of laryngeal edema based on laryngoscopy. Bronchoscopy as a gold standard diagnostic of inhalation injury could not been done in the ER. This study was conducted to determine the association between clinical findings of laryngeal edema and bronchoscopic findings in burns which is suspected inhalation injury.Objectives. This study was conducted to determine the association between clinical findings of laryngeal edema and bronchoscopic findings in burns which is suspected inhalation injury.Materials and Methods. A retrospective cross sectional study was conducted in 18 subjects. In the ER laryngoscopy was performed to assess the presence of laryngeal edema. Only subjects which is intubated and bronchoscopy were included as inclusion. The degree of inhalation injury was divided according to the Chou criteria which is observed through bronchoscopy.Results. Subjects most are men 16 subjects. Age ranges from 19 56 years. Burns range between 5 95 . 14 subjects presences larygeal edema. Of the 14 subjects who had laryngeal edema, 13 subjects had inhalation injury. The association between laryngeal edema in the presence of inhaled injury observed through bronchoscopy has a sensitivity value of 76.4 , a specificity of 0 .Conclusions. In this study The presence of laryngeal edema associated with inhalation injury in the lower airway although not statistically significant and has not been able to show the accuracy of the degree of inhalation injury. "

"Pendahuluan: Bronkoskopi adalah tindakan semi operatif yang merupakan prosedur baku emas untuk penegakan jenis dari penyakit kanker paru. Kurangnya pengetahuan seputar persiapan dan tindakan bronkoskopi, kehilangan motivasi untuk melakukan tindakan bronkoskopi dan kecemasan akan prosedur tindakan bronkoskopi kerap kali membuat pasien menunda tindakan tersebut, dan hal ini tentunya dapat mempengaruhi prognosis dari penyakit kanker paru yang sudah buruk. Salah satu alasan pasien menunda tindakan tersebut adalah karena kurangnya pengetahuan akibat tidak tersedia nya media edukasi yang dapat memberikan informasi perihal persiapan dan prosedur tindakan bronkoskopi. Tujuan dari dilakukannya penelitian ini adalah untuk mengetahui pengaruh dari edukasi pre-bronkoskopi berbasis website terhadap pengetahuan, motivasi dan kecemasan pada pasien kanker paru yang akan melakukan tindakan bronkoskopi. Metode: penelitian ini menggunakan desain quasi experiment dengan metode pre test dan post test control group design. Penelitian ini menggunakan 21 responden pada kelompok kontrol dan 21 responden pada kelompok intervensi. Hasil: terdapat perbedaan tingkat pengetahuan, motivasi dan kecemasan yang signifikan pada pasien kanker paru yang akan melakukan tindakan bronkoskopi sebelum dan sesudah diberikan edukasi pre-bronkoskopi berbasis website pada kelompok intervensi dengan nilai signifikan pada α=5% (p<0,05). Rekomendasi: penyempurnaan dari model edukasi pre-bronkoskopi berbasis website agar dapat di aplikasikan sebagai metode edukasi utama dalam memberikan pengetahuan seputar persiapan dan tindakan bronkoskopi.

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Introduction: Bronchoscopy is a semi-operative procedure that is the gold standard procedure for establishing the type of lung cancer. Lack of knowledge about the preparation and procedure of bronchoscopy, loss of motivation to perform bronchoscopy and anxiety about the bronchoscopy procedure often make patients postpone the procedure, and this can certainly affect the prognosis of lung cancer which is already poor. One of the reasons patients postpone the procedure is because of the lack of knowledge due to the unavailability of educational media that can provide information about the preparation and procedure of bronchoscopy. The purpose of this study was to determine the effect of website-based pre-bronchoscopy education on knowledge, motivation and anxiety in lung cancer patients who will undergo bronchoscopy. Method: This study used a quasi-experimental design with a pre-test and post-test control group design method. This study used 21 respondents in the control group and 21 respondents in the intervention group. Results: There was a significant difference in the level of knowledge, motivation and anxiety in lung cancer patients who will undergo bronchoscopy before and after being given website-based pre-bronchoscopy education in the intervention group with a significant value at α = 5% (p <0.05). Recommendation: refinement of the website-based pre-bronchoscopy education model so that it can be applied as the main education method in providing knowledge about bronchoscopy preparation and procedures."

"Latar Belakang: Pneumocystis jirovecii (P. jirovecii) adalah patogen jamur oportunistik yang dapat terdeteksi di saluran napas bawah. Kolonisasi P. jirovecii dapat berkembang menjadi infeksi yang disebut sebagai pneumocystis pneumonia (PCP). Infeksi PCP umumnya terdeteksi di pasien HIV. Pasien tanpa HIV juga dapat mengalami infeksi PCP terutama pada pasien keganasan. Penelitian ini bertujuan untuk mendeteksi kolonisasi P. Jirovecii pada sampel bilasan bronkus dengan pemeriksaan polymerase chain reaction (PCR). Metode: Penelitian ini merupakan penelitian potong lintang dengan deskriptif analitik yang pada pasien terduga kanker paru di RSUP Persahabatan. Subjek penelitian adalah pasien terduga kanker paru yang akan menjalani bronkoskopi sesuai kriteria inklusi. Sampel bilasan bronkus dikirim ke Laboratorium Departemen Parasitologi FKUI untuk ekstraksi DNA dan laboratorium BRIN untuk pemeriksaan PCR konvensional. Penelitian ini menggunakan gen MtLSU dan mTSSU. Hasil: Pada penelitian ini terdapat 72 subjek penelitian. Subjek penelitian terdiri atas 51 laki-laki (70,8%). Rerata usia subjek penelitian adalah 56,6 (9,95) tahun. Subjek penelitian sebagian besar memiliki IMT normal (18,5-22,9 kg/m2). Subjek penelitian sebagian besar adalah perokok baik perokok aktif atau bekas perokok yaitu sebanyak 50 orang (69,4%). Sebanyak 23 orang (31,9%) diantaranya memiliki IB berat (IB >600 batang per tahun). Subjek penelitian yang memiliki riwayat pengobatan TB, baik terkonfirmasi bakteriologis maupun diagnosis klinis, sebanyak 23 orang (31,9%). Sebanyak 26 orang (36,1%) memiliki 1 komorbid sedangkan 10 orang (13,9%) memiliki lebih dari 1 komorbid. Berdasarkan pemeriksaan histopatologi atau sitologi bilasan bronkus, dari 72 subjek penelitian terdapat 50 orang (69,4%) terdiagnosis kanker paru, 15 orang (20,9%) bukan kanker paru, dan 7 orang (9,7%) belum diketahui diagnosisnya. Dari 72 sampel yang diperiksa, tidak ada yang menunjukan hasil PCR positif (0%). Kesimpulan: Proporsi P. Jirovecii yang terdeteksi melalui pemeriksaan PCR pada sampel bilasan bronkus pasien terduga kanker paru sebesar 0%. Pemeriksaan PCR untuk mendeteksi P. Jirovecii tidak disarankan untuk pasien kanker yang baru terdiagnosis dan belum dilakukan pengobatan.

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Background: Pneumocystis jirovecii (P. jirovecii) is an opportunistic fungal pathogen that can be detected in the human lower respiratory tract without signs or symptoms of acute pneumonia or colonization. P. jirovecii colonization can develop into an infection known as pneumocystis pneumonia (PCP). PCP infection is commonly detected in HIV patients. However, patients without HIV can also experience PCP infection, especially in malignant patients. This study aims to detect P. Jirovecii colonization in bronchial lavage samples using polymerase chain reaction (PCR). Methods: This research is a cross-sectional study with descriptive analytics on patients suspected of lung cancer at Persahabatan Hospital. The research subjects were patients with suspected lung cancer who were selected according to the inclusion criteria. Data on clinical, radiological, laboratory and histopathological characteristics were taken from medical records. The patient will have a bronchial lavage sample taken during bronchoscopy for diagnostic purposes. The samples will be examined at the Parasitology Department Laboratory Universitas Indonesia for DNA extraction and the BRIN laboratory for PCR examination. Results: In this study there were 72 research subjects. The research subjects consisted of 51 men (70.8%). The mean age of the research subjects was 56.6 (9.95) years. Most of the research subjects had normal BMI (18.5-22.9 kg/m2). Most of the research subjects were smokers, either active smokers or former smokers, namely 50 people (69.4%). A total of 23 people (31.9%) had severe IB (IB >600 cigarettes per year). There were 23 research subjects who had a history of TB treatment, whether confirmed bacteriologically or clinically diagnosed, as many as 23 people (31.9%). A total of 26 people (36.1%) had 1 comorbid while 10 people (13.9%) had more than 1 comorbid. Based on histopathological or cytological examination of bronchial lavage, of the 72 research subjects, 50 people (69.4%) were diagnosed with lung cancer, 15 people (20.9%) had no lung cancer, and 7 people (9.7%) had no known diagnosis. Of the 72 samples examined, none showed positive PCR results (0%). Conclusion: The proportion of P. Jirovecii detected by conventional PCR examination in bronchial lavage samples from patients suspected of lung cancer was 0%. PCR examination to detect P. Jirovecii is not recommended for cancer patients who have just been diagnosed and have not received treatment."

"Kanker paru memiliki mortalitas tinggi dan sering terdiagnosis pada stage lanjut. Kelainan morfologis sel trakeobronkial dan biomolekuler mendahului proses karsinogenesis. Bronkoskopi gelombang cahaya spektrum sempit (GCSS) dikembangkan untuk meningkatkan akurasi diagnostik. Tujuan penelitian ini adalah untuk mengetahui akurasi diagnostik bronkoskopi GCSS dalam mendeteksi kelainan morfologis sel trakeobronkial dan hubungannya dengan mutasi gen p53.Studi ini merupakan studi diagnostik eksperimental yang dilakukan pada subjek kanker paru yang menjalani prosedur bronkoskopi di RS Persahabatan periode Januari-November 2023. Prosedur bronkoskopi GCSS dan biopsi forseps bronkus dilakukan di lesi non-tumor, dilanjutkan dengan pemeriksaan histopatologi hematoksilin dan eosin (HE), serta pemeriksaan Polymerase Chain Reaction (PCR) sekuensing sanger mutasi p53 pada titik R175L, R248W, dan R273C. Analisis kesesuaian juga dilakukan.Sebanyak 105 subjek diikutsertakan dalam analisis penelitian, dengan dominasi laki-laki, perokok, jenis kanker adenokarsinoma dan stage lanjut. Kelainan morfologis sel trakeobronkial ditemukan pada 34 subjek (32,4%) berupa metaplasi, sel atipik dan sel tumor. Mutasi p53 wild type pada titik R175L, R248W, dan R273C ditemukan pada seluruh jaringan biopsi. Satu jaringan metaplasi dengan mutasi p53 Kodon 267 heterozigot CT dan satu jaringan hiperplasi dengan mutasi p53 Kodon 180 heterozigot GC. Pola vaskular berliku didapatkan sebagai kriteria diagnostik paling baik dibandingkan dengan pola vaskular lainnya dengan area under the curve (AUC) 78,4%; sensitivitas 79,41%; spesifisitas 77,46%; nilai prediktif positif 62,8% dan nilai prediktif negatif 88,7%. Kesesuaian antar pengamat dalam menilai pola vaskular GCSS cukup baik dengan nilai kappa 0,88 (standar eror 0,06; nilai p <0,01). Mukosa edematosa berhubungan dengan pola vaskular berliku pada bronkoskopi GCSS dengan OR 3,6 (IK95% 1,53-8,46; nilai p <0,01). Subjek dengan pola vaskular berliku [OR 21,89 (IK95% 6,50-73,71; nilai p<0,01)] dan subjek dengan IB ³ 600 [OR 5,39 (IK95% 1,62-17,71; nilai p 0,01)] berhubungan dengan kelainan morfologis sel trakeobronkial.

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Lung cancer has high mortality and is often diagnosed at an advanced stage. Additionally, morphological abnormalities of tracheobronchial cells precede the carcinogenesis process and are based on molecular abnormalities. Moreover, Narrow-Band Imaging Bronchoscopy (NBI) has been developed to improve diagnostic accuracy. The objective of this study is to determine the diagnostic accuracy of NBI bronchoscopy in detecting morphological abnormalities of tracheobronchial cells and their relationship with p53 gene mutations.

This study is an experimental diagnostic study conducted on lung cancer subjects undergoing bronchoscopy procedures at RS Persahabatan from January to November 2023. NBI bronchoscopy procedures and bronchial forceps biopsies were performed on non-tumor lesions, followed by haematoxylin and eosin (HE) histopathological examination, as well as Polymerase Chain Reaction (PCR) Sanger sequencing for p53 mutations at the R175L, R248W, and R273C points. Reliability analysis was also performed.

A total of 105 subjects were included in the study analysis, predominantly male, smokers, with adenocarcinoma type cancer and advanced stage. Tracheobronchial cell morphological abnormalities were found in 34 subjects (32.4%), in the form of metaplasia, atypical cells, and tumor cells. Wild type p53 mutations at the R175L, R248W, and R273C points were found in all biopsy tissues. One metaplastic tissue had a p53 Codon 267 CT heterozygous mutation and one hyperplastic tissue had a p53 Codon 180 GC heterozygous mutation. The tortuous vascular pattern was identified as the best diagnostic criteria compared to other patterns with an area under the curve (AUC) of 78.4%; sensitivity 79.41%; specificity 77.46%; positive predictive value 62.8% and negative predictive value 88.7%. Inter-observer agreement in assessing vascular patterns was good with a kappa value of 0.88 (standard error 0.06; p-value <0.01). Edematous mucosa was associated with a tortuous vascular pattern on NBI bronchoscopy with an OR of 3.6 (95% CI 1.53-8.46; p-value <0.01). Subjects with a tortuous vascular pattern (OR of 21.89; 95% CI 6.50-73.71; p-value <0.01) and subjects with IB ≥ 600 (OR of 5.39; 95% CI 1.62-17.71; p-value 0.01) were associated with tracheobronchial cell morphological abnormalities."