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"ABSTRAKLatar belakang : Airway remodelling pada asma juga melibatkan saluran napasperifer dan diduga dapat mempengaruhi alveoli hingga menyebabkan kelainan diparenkim paru Penelitian ini mencoba menemukan kelainan parenkim paru padapasien asma melalui pemeriksaan kapasitas difusi dengan DLCO metode napastunggal.Metode :.Penelitian potong lintang dengan membagi asma berdasarkan derajatkeparahannya dalam dua kelompok besar yaitu asma ringan (intermiten dan persistenringan) dan berat (persisten sedang dan berat). Terdapat 60 subjek yang diambilsecara konsekutif dari pasien asma stabil tanpa komorbid dan berobat di Poli Asma-PPOK RSUP Persahabatan dari Bulan Desember 2015-Mei 2016.Hasil : Nilai rerata DLCO/prediksi pada kelompok asma ringan yaitu 92,74±15,70%dan menurun pada kelompok asma berat yaitu 78,41±14,21%. Beberapa nilaispirometri menunjukkan hubungan positif bermakna dengan nilai DLCO/prediksiyaitu : KVP/prediksi, VEP1/prediksi dan FEF25-75%/prediksi dengan nilai p <0,05.Analisis korelasi menunjukkan KVP/prediksi secara nyata dapat mempengaruhikapasitas difusi pasien asma. Terdapat hubungan bermakna antara kelainan fungsiparu (p 0,004) dan derajat keparahan asma (p 0,000) dengan penurunan nilaiDLCO/prediksi (DLCO/prediksi ≤ 75%).Kesimpulan :.Derajat keparahan asma memiliki hubungan dengan kapasitas difusiparu, semakin berat derajat keparahannya maka semakin menurun kapasitas difusiparu. Penurunan kapasitas difusi menunjukkan bahwa kelainan pada asma tidakhanya terjadi di saluran napas tapi juga mungkin melibatkan parenkim paru.

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ABSTRACTBackground: Airway remodelling in asthma which is involved small airway isthought can affect until alveoli and cause abnormalities in the lung parenchyma Thisstudy tries to find lung parenchymal abnormalities in patients with asthma throughthe examination diffusion capacity with a single breath DLCO method .Methods : A cross-sectional study by dividing asthma based on the degree of severityinto two major groups, namely mild asthma ( intermittent and mild persistent ) andsevere ( persistent moderate and severe ). The amount of each group is 30 subjects ,which is taken consecutively from stable asthma patients without comorbid who isseeking treatment Persahabatan Hospital at December 2015 - May 2016Results : The average value of DLCO /predictions in mild asthma group is 92,74 ±15,70% and decreased in the severe asthma group is 77,45 ± 16,78%. Somespirometry values showed significant positive correlation with the value of DLCO/prediction , namely : KVP /prediction , VEP1 /prediction and FEF25-75 % / predictionwith p < 0.05 . Corellation analysis showed KVP / prediction could dramaticallyaffect the diffusion capacity of asthmatic patients . There is a significant relationshipbetween abnormalities in lung function ( p 0,004) and severity of asthma ( p 0.000 )with a corresponding decrease DLCO / prediction (DLCO / prediction ≤ 75 % )Conclusion : The severity of asthma has a relationship with the diffusion capacity ofthe lungs, increased severity will decrease the diffusion capacity in asthma patient.Decreasing diffusion capacity showed that abnormalities in asthma not only occur inthe respiratory tract but also in the lung parenchyma;"

"ABSTRAKLatar Belakang: Kanker paru dan tuberkulosis TB adalah dua masalah kesehatan di seluruh dunia dengan angka kesakitan dan kematian yang tinggi. Meningkatnya kasus TB aktif dan reaktivasi TB laten pada pasien kanker paru serta dampak buruknya terhadap prognosis pasien memerlukan upaya untuk melakukan deteksi TB laten pada pasien kanker paru. Penelitian ini bertujuan untuk mengetahui berapa besar proporsi TB laten pada pasien kanker paru, karakteristiknya dan hubungan antar keduanya.Metode: Penelitian ini menggunakan desain potong lintang dan sampel dikumpulkan secara consecutivesampling terhadap 86 pasien kanker paru baru terdiagnosis di Rumah Sakit Umum Pusat Persahabatan Jakarta tahun 2015 hingga 2016. Pemeriksaan sputum Xpert MTB/RIF dilakukan untuk menyingkirkan kemungkinan TB aktif. Penentuan TB laten dilakukan dengan pemeriksaan Interferon Gamma Release Assay IGRA menggunakan alat QuantiFERON-TB Gold-in-Tube QFT-GIT .Hasil: Pemeriksaan TB laten mendapatkan hasil IGRA 11 pasien 12,8 , IGRA - 59 pasien 68,6 dan IGRA indeterminate I 16 pasien 18,6 . Karakteristik sosiodemografi pasien kanker paru dengan TB laten adalah 63,6 laki-laki, rerata usia 56 tahun, 36,4 diimunisasi BCG, 9 dengan kontak erat TB, 72,7 dengan riwayat merokok. Karakteristik klinis pasien tersebut 90 memiliki status gizi normal lebih dengan nilai tengah indeks massa tubuh IMT 19,12 18,24-29,26 kg/m2, nilai tengah hitung limfosit total 1856 1197-4210 sel/ul, 9 dengan komorbid diabetes mellitus, 81,8 tumor paru mengenai lokasi khas predileksi TB paru. Jenis kanker terbanyak adalah adenokarsinoma 81,8 dengan stage lanjut 81,8 dan status tampilan umum 2-3 63,6 . Karakteristik yang menunjukkan hubungan bermakna dengan hasil IGRA adalah lokasi tumor yang mengenai daerah lesi khas TB secara radiologis. Hitung limfosit total yang rendah berhubungan dengan hasil IGRA I dengan nilai tengah 999,88 277-1492,60 sel/ul.Kesimpulan: Proporsi TB laten pada pasien kanker paru di RSUP Persahabatan adalah 12,8 . Karekteristik pasien kanker paru yang berhubungan dengan TB laten adalah lokasi tumor yang mengenai daerah lesi khas TB walaupun belum dapat disimpulkan hubungannya secara biologis. Hasil IGRA I pada pasien kanker paru dengan hitung limfosit total yang rendah menunjukkan keterbatasan sensitivitas IGRA dalam mendeteksi infeksi TB laten pada pasien imunokompromais.Kata Kunci : infeksi TB laten, kanker paru, IGRA, hitung limfosit total

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ABSTRACTBackground Lung cancer and pulmonary tuberculosis TB are two major public health problems associated with significant morbidities and mortalities. The increased prevalence of active TB and latent TB reactivation in lung cancer patients and the negative effect of pulmonary TB in lung cancer prognosis underline the need for a through screening of lung cancer patients for latent TB infection LTBI . The aims of this study are to determine the proportion of LTBI in lung cancer patients, their characteristics and the relationship between them.Methods This study used a cross sectional design and sample was collected using consecutive sampling of the 86 newly diagnosed treatment naive lung cancer patients from a referral respiratory hospital, Rumah Sakit Umum Pusat Persahabatan Jakarta in 2015 to 2016. The presence of LTBI was determined by Quantiferon TB Gold In Tube QFT GIT after having Mycobacterium TB not detected result from Xpert MTB RIF sputum test. Demographic characteristics and cancer related factors associated with LTBI were investigated.Results There are 11 patients 12,8 with IGRA result and 16 patients 18,6 with IGRA indeterminate I result. Sociodemographic characteristics of lung cancer patients with latent TB are 63,6 male, mean of age 56 years, 36,4 with BCG immunization, 9 had TB close contacts history, 72,7 with a history of smoking. The clinical characteristics of these patients are 90 had a normal nutritional status with the median body mass index BMI 19,12 18,24 29,26 kg m2, the median of total lymphocyte count is 1856 1197 4210 cells ul, 9 with diabetes mellitus as comorbid, 81,8 of lung tumour located in the typical predilection for pulmonary tuberculosis. Most types of lung cancer are adenocarcinomas 81.8 with advanced stage 81,8 and the WHO performance status of 2 3 63,6 . Characteristics having significant relationship with IGRA results is the tumour located in the typical TB area radiologically. Low total lymphocyte count is associated with indeterminate IGRA results with median 999,88 277 1492,6 cells ul.Conclusion The proportion of latent TB in lung cancer patients is 12,8 . Characteristics of patients with lung cancer associated with latent TB is the location of the tumor lesions typical of the area although it can not be concluded biologically. Having indeterminate IGRA results in lung cancer patients with a low total lymphocyte count showed the limitations of QFT GIT in detecting latent TB infection in immunocompromised patients.Key words latent TB infection, lung cancer, IGRA, total lymphocyte count "

"Latar Belakang: Pajanan terhadap jamur telah diketahui berperan dalam perburukan gejala asma, fungsi paru yang buruk, rawat inap dan kematian. Kolonisasi atau pajanan jamur dapat mencetuskan respons alergi dan inflamasi paru. Sensititasi jamur oleh Aspergillus dapat menyebabkan Allergic Bronchopulmonary Aspergillosis (ABPA) maupun Severe Asthma with Fungal Sensitization (SAFS). Pemeriksaan Immunodiffusion test (IDT) merupakan uji serologi untuk mengetahui terdapatnya antibodi anti-Aspergillus, namun pemeriksaan ini belum banyak digunakan di Indonesia dan perannya terhadap pasien asma belum diketahui.Metode: Penelitian ini adalah penelitian prospektif dengan metode consecutive sampling dan desain potong lintang. Subjek penelitian ini adalah pasien asma yang berobat di Poliklinik Asma Rumah Sakit Persahabatan, Jakarta. Subjek penelitian menjalani pemeriksaan spirometri, Asthma Control Test (ACT) dan serologi antibodi anti-Aspergillus dengan metode IDT Aspergillus menggunakan crude antigen Aspergillus.Hasil: Subjek penelitian ini sebanyak 59 pasien. Sejumlah 49 subjek (83,1%) berjenis kelamin perempuan, 37 subjek (62,7%) berusia ≥50 tahun, 45 subjek (76,3%) berpendidikan SLTA atau lebih, 25 subjek (42,4%) obesitas I, 5 subjek (8,5%) obesitas II dan 11 subjek (18,6%) bekas perokok. Sebagian besar subjek (62,71%) merupakan pasien asma persisten sedang. Asma terkontrol penuh ditemukan pada 7 subjek (11,86%), sedangkan asma tidak terkontrol pada 32 subjek (54,24%). Derajat obstruksi yang terbanyak ditemukan adalah obstruksi sedang pada 31 subjek (52,5%). Nilai %VEP1 ≥80% prediksi setelah uji bronkodilator ditemukan pada 24 subjek (40,7%). Dari 59 sampel darah yang diperiksa, tidak ada yang menunjukkan hasil IDT positif (0%), termasuk subjek yang datang dalam keadaan eksaserbasi dan subjek dengan asma persisten berat.Kesimpulan: Hasil positif pemeriksaan IDT Aspergillus pada pasien asma sebesar 0%. Pemeriksaan IDT Aspergillus tidak dapat digunakan secara tunggal tanpa pemeriksaan lain untuk mendeteksi sensititasi terhadap Aspergillus pada pasien asma dan tanpa validasi terhadap crude antigen Aspergillus yang digunakan.

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Background: Exposure to fungi has been known to play a role in worsening symptoms of asthma, poor lung function, hospitalization and death. Fungal colonization or exposure can trigger an allergic response and lung inflammation. Fungal sensitization by Aspergillus spp. can cause allergic bronchopulmonary aspergillosis (ABPA) or severe asthma with fungal sensitization (SAFS). Immunodiffusion test (IDT) is a serological test to determine the presence of anti-Aspergillus antibodies, but this examination has not been widely used in Indonesia and its role in asthma patients is unknown.Method: This study was a prospective study with consecutive sampling method and cross-sectional design. The subjects were asthma patients treated at Asthma Outpatient Clinic at Persahabatan Hospital Jakarta, Indonesia. Subjects underwent spirometry, Asthma Control Test (ACT) and serology of anti-Aspergillus antibodies examination with the IDT Aspergillus method using crude antigen Aspergillus.Results: The subjects of this study were 59 patients. A total of 49 subjects (83.1%) were females, 37 subjects (62.7%) were ≥50 years old, 45 subjects (76.3%) had high school education level or higher, 25 subjects (42.4%) were obese I, 5 subjects (8.5%) were obese II and 11 subjects (18.6%) were former smokers. Most subjects (62.71%) were moderate persistent asthma patients. Fully-controlled asthma was found in 7 subjects (11.86%), while uncontrolled asthma was found in 32 subjects (54.24%). The highest degree of obstruction found was moderate obstruction in 31 subjects (52.5%). The %VEP1 ≥80% predicted after the bronchodilator test was found in 24 subjects (40.7%). Of the 59 blood samples examined, none showed positive IDT results (0%), including subjects who came in exacerbations and subjects with severe persistent asthma.Conclusion: Positive results of IDT Aspergillus examination in asthma patients were 0%. The Aspergillus IDT examination cannot be used singly without other examinations to detect Aspergillus sensitization in asthmatic patients and without validation of the crude antigen Aspergillus used."

"ABSTRAKLatar Belakang:Penelitian ini merupakan studi awal untuk menetapkan proporsi pneumonitis radiasi pada pasien kanker paru yang mendapat radiasi di RSUP Persahabatan.Metode: Penelitian ini menggunakan desain retrospektif pada pasien kanker paru yang mendapat radiasi di RSUP Persahabatan antara Juni 2013-Juli 2015. Pengambilan data melalui rekam medik dan dilakukan evaluasi ulang foto toraks 1 bulan pasca radiasi.Hasil: Terdapat 33 pasien kanker paru yang memenuhi kriteria inklusi. Karakteristik subyek meliputi usia ≥51 tahun (63,6%), laki-laki (66,7%), riwayat merokok (75,8%), IB sedang (60%), dosis radiasi 300-4000 (60,6%), fraksi radiasi 10-19 (60,6%), tidak mempunyai riwayat kemoterapi (54,5%), kanker paru jenis adenokarsinoma (66,7%) dan stage IV (84,84%). Proporsi pneumonitis radiasi berdasarkan foto toraks sebesar 39,4% yang terdiri dari gambaran hazy ground glass opacities, hazy ground glass opacities dan fibrosis serta fibrosis. Ditemukan perbedaan bermakna antara usia, dosis radiasi dan riwayat kemoterapi dengan kejadian pneumonitis radiasi (p<0,05).Kesimpulan: Proporsi pneumonitis radiasi berdasarkan foto toraks sebesar 39,4%. Terdapat perbedaan bermakna antara usia, dosis radiasi dan riwayat kemoterapi dengan kejadian pneumonitis radiasi.

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ABSTRACTIntroduction: This is a preliminary study to determine proportion radiation pneumonitis in lung cancer patients who got radiaton in Persahabatan Hospital.Method: This was a retrospective study in lung cancer patients who got radiation in Persahabatan Hospital between June 2013 ? July 2015. Interpretation data were from medical record and did reevaluation chest x ray 1 month after radiation.Result: There were 33 lung cancer patients were filled inclusion criteria. Subjects characteristic were age ≥51 years (63,6%), male (66,7%), history of smoking (75,8%), moderate IB (60%), radiation doses 3000-4000 (60,6%), radiation fractions 10-19 (60,6%), had no history of chemotheraphy (54,5%), adenocarcinoma (66,7%) and stage IV (84,84%). Proportion radiation pneumonitis based on chest x ray were 39,4% that include hazy ground glass opacities, hazy ground glass opacitiesand fibrosis and only fibrosis. There were significant differences between age, radiation doses and history of chemotheraphy with proportion radiation pneumonitis (p<0,05).Conclusion: Proportion radiation pneumonitis based on chest x ray are 39,4%. There are significant differences between age, radiation doses and history of chemotheraphy with proportion radiation pneumonitis (p<0,05)."

"ABSTRAKLatar belakang: Kapasitas difusi paru berdasarkan karbon ke sirkulasi pulmoner. Nilai DLCO prediksi pada asma cenderung normal atau sedikit monoksida (DLCO) didesain untuk mengukur laju perpindahan gas CO dari alveolus meningkat sedangkan pada PPOK kapasitas difusi cenderung menurun akibat emfisema. Sindrom tumpang-tindih asma-PPOK dinyatakan sebagai entitas yang unik dengan kombinasi karakteristik asma dan PPOK. Tujuan utama penelitian ini adalah mengetahui nilai DLCO pada pasien tumpang tindih asma- PPOK (TAP) di RSUP Persahabatan Jakarta.Metode: Uji DLCO dengan metode napas tunggal dan beberapa pemeriksaan penunjang lainnya telah dilakukan pada 40 pasien yang terdiagnosis sebagai TAP. Diagnosis TAP pada subjek penelitian ditegakkan menggunakan kriteria pedoman GINA/GOLD 2017. Kriteria akseptabilitas dan reprodusibilitas DLCO napas tunggal dinilai menggunakan kriteria dari ATS/ERS 2017. Hasil uji DLCO disajikan dalam nilai mutlak dan nilai persen prediksi.Hasil: Rerata nilai DLCO mutlak dan %DLCO prediksi yang didapatkan dalam penelitian ini adalah 17.98 ± 5.37 mL/menit/mmHg dan 84.16 ± 18.29%. Jika menggunakan persamaan penyesuaian DLCO berdasarkan kadar hemoglobin didapatkan nilai %DLCO prediksi sedikit meningkat dibanding sebelumnya, 85.17 ± 18.04%. Terdapat 10 subjek (25.0%) yang mengalami penurunan nilai DLCO. Enam diantaranya mengalami penurunan ringan dan empat lainnya mengalami penurunan sedang.Kesimpulan : Rerata nilai DLCO pada subjek TAP di RSUP Persahabatan Jakarta dapat diinterpretasikan normal, lebih menyerupai asma dibandingkan PPOK. Hasil ini juga mengindikasikan kebanyakan pasien TAP dalam penelitian ini tidak mengalami penurunan luas permukaan alveolar yang mengganggu proses difusi.

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ABSTRACTBackground: Diffusing capacity of the lung for carbon monoxide (DLCO) was designed to measure transfer rate of carbon monoxide from alveoli to pulmonary circulation. As we know, DLCO predicted value in asthma proved to be normal or slightly elevated. On contrary it decreased in COPD with emphysematous pattern. Asthma-chronic obstructive pulmonary disease overlap (ACO) declared as a unique entity with combined characteristics between asthma and COPD. The aim of the research is to find out DLCO value of ACO patient in Persahabatan Hospital, Jakarta.Method: We have conducted single-breath DLCO and other required test to 40 patients diagnosed with ACO using GINA/GOLD 2017 guidelines. The acceptability and reproducibility of single-breath DLCO was done according to ATS/ERS 2017 criteria. The result then presented as absolute value and percent predicted value.Results: The mean DLCO of our patient is 17.98 ± 5.37 mL/minute/mmHg with percent predicted value is 84.16 ± 18.29%. Using adjusted DLCO equation for hemoglobin, we found that the value is slightly increased, 85.17 ± 18.04%. However, we found 10 patient (25.0%) with DLCO decrease. Six of them have DLCO predicted value <75% (mild-decrease) and four of them have DLCO predicted value <60% (moderate-decrease).Conclusion: The mean DLCO value of patient with ACO in our hospital can be interpreted as normal, similar with asthma, rather than COPD. It also indicate most of our patient did not have alveolar loss that altering diffusion process."

"ABSTRAK Latar belakang : Penelitian ini merupakan studi awal untuk mengukur kapasitasdifusi paru DLCO-SB ipada pasien PPOK di RSUP Persahabatan Jakarta untukmengetahui prevalens penurunan nilai DLCO pada pasien PPOK.Metode : Penelitian ini menggunakan desain studi potong lintang (cross sectional study) pada pasien PPOK yang berkunjung di Poliklinik Asma-PPOK RSUPPersahabatan Jakarta. Dilakukan uji spirometri dan DLCO pada pasien PPOKyang diambil secara konsekutif antara bulan Mei-Juli 2015. Komorbiditas jugadicatat.Hasil : Uji Spirometri and DLCO dilakukan pada 65 subjek didapatkan 7 subjek (10,8%) termasuk kedalam PPOK Grup A, 19 subjek (29,2%) PPOK Grup B, 21subjek (32,3%) PPOK grup C dan 18 subjek (27,7%) PPOK grup D. rerata usia64,15 (45-89) tahun;rerata VEP1% 46,05%, rerata nilai DLCO 19,42ml/menit/mmHg dan rerata DLCO % adalah 72.00%. prevalens penurunanDLCO pasien PPOK adalah 56,92% (37/65 subjek) sedangkan 28 subjek dengannilai DLCO normal. Ditemukan 15 subjek (23,07%) dengan penurunan ringan, 18subjek (27.69%) penurunan sedang dan 4 subjek (6,15%) dengan penurunan berat.Ditemukan 47 subjek (72,3%) memiliki komorbid. Terdapat hubungan bermaknaantara grup PPOK, derajat spirometri, VEP1, IMT dan komorbiditas dengan nilaihasil uji DLCO. Tidak terdapat hubungan bermakna antara nilai DLCO denganjenis kelamin, umur, riwayat merokok, Indeks Brinkmann, obstruksi-restriksi danlama terdiagnosis PPOK.Kesimpulan : Proporsi penurunan nilai DLCO pada pasien PPOK adalah 56,92%. Terdapat hubungan bermakna antara grup PPOK, derajat spirometri,VEP1, IMT dan riwayat TB dengan nilai hasil uji DLCO. Tidak terdapathubungan bermakna antara nilai DLCO dengan jenis kelamin, umur, riwayatmerokok, Indeks Brinkmann, obstruksi-restriksi, komorbid dan lama terdiagnosisPPOK.ABSTRACT Background and the aim of study : This is a preliminary study to measureDLCO-SB in COPD patients in Persahabatan Hospital. The aim of the study is toknow the magnitude of disturbance in diffusing capacity of the lung in COPDpatients.Methods : This was a cross sectional study in which COPD patients attending COPD-Asthma clinic in Persahabatan Hospital Jakarta were performed spirometryand DLCO-SB consecutively between May 2015?July 2015. Comorbiditiesconditions were also recorded.Results : Spirometry and DLCO-SB measurement were conducted on 65 COPDsubjects of which 7 subjects (10.8%) were COPD Group A, 19 subjects (29.2%)were Group B, 21 subjects (32.3%) were COPD group C and 18 subjects (27.7%)were COPD group D. The mean age was 64.15 (45-89); mean FEV1% was46.05%, mean DLCO measured was 19.42 ml/min/mmHg and the mean DLCO%was 72.00%. The prevalence of decreasing in diffusing capacity of the lung inCOPD patients was 56.92% (37 subjects) While 28 subjects were normal. Therewere 15 subjects (23.07%) with mild decrease in DLCO, 18 subjects (27.69%)were moderate decrease and 4 subjects (6.15%) with severe decrease. 47 subjects(72.3%) had comorbid conditions. There was significant correlation between grupCOPD, GOLD COPD grade, VEP1, BMI and comorbidities with magnitude ofdecreasing DLCO value. There was no correlation between DLCO value with sex,smoking history, Brinkmann index, age, obstruction-mix criteria, length of COPDperiod. Conclusion : The proportion of decreasing in DLCO in COPD patients are56.92%. There is significant correlation among the group of COPD, GOLDCOPD grade, VEP1, BMI and previous TB history with magnitude of decreasingDLCO value. There is no correlation between DLCO value with sex, smokinghistory, brinkmann index, age, obstruction-mix criteria, comorbidities and lengthof COPD period. ;Background and the aim of study : This is a preliminary study to measureDLCO-SB in COPD patients in Persahabatan Hospital. The aim of the study is toknow the magnitude of disturbance in diffusing capacity of the lung in COPDpatients.Methods : This was a cross sectional study in which COPD patients attending COPD-Asthma clinic in Persahabatan Hospital Jakarta were performed spirometryand DLCO-SB consecutively between May 2015?July 2015. Comorbiditiesconditions were also recorded.Results : Spirometry and DLCO-SB measurement were conducted on 65 COPDsubjects of which 7 subjects (10.8%) were COPD Group A, 19 subjects (29.2%)were Group B, 21 subjects (32.3%) were COPD group C and 18 subjects (27.7%)were COPD group D. The mean age was 64.15 (45-89); mean FEV1% was46.05%, mean DLCO measured was 19.42 ml/min/mmHg and the mean DLCO%was 72.00%. The prevalence of decreasing in diffusing capacity of the lung inCOPD patients was 56.92% (37 subjects) While 28 subjects were normal. Therewere 15 subjects (23.07%) with mild decrease in DLCO, 18 subjects (27.69%)were moderate decrease and 4 subjects (6.15%) with severe decrease. 47 subjects(72.3%) had comorbid conditions. There was significant correlation between grupCOPD, GOLD COPD grade, VEP1, BMI and comorbidities with magnitude ofdecreasing DLCO value. There was no correlation between DLCO value with sex,smoking history, Brinkmann index, age, obstruction-mix criteria, length of COPDperiod. Conclusion : The proportion of decreasing in DLCO in COPD patients are56.92%. There is significant correlation among the group of COPD, GOLDCOPD grade, VEP1, BMI and previous TB history with magnitude of decreasingDLCO value. There is no correlation between DLCO value with sex, smokinghistory, brinkmann index, age, obstruction-mix criteria, comorbidities and lengthof COPD period. ;Background and the aim of study : This is a preliminary study to measureDLCO-SB in COPD patients in Persahabatan Hospital. The aim of the study is toknow the magnitude of disturbance in diffusing capacity of the lung in COPDpatients.Methods : This was a cross sectional study in which COPD patients attending COPD-Asthma clinic in Persahabatan Hospital Jakarta were performed spirometryand DLCO-SB consecutively between May 2015?July 2015. Comorbiditiesconditions were also recorded.Results : Spirometry and DLCO-SB measurement were conducted on 65 COPDsubjects of which 7 subjects (10.8%) were COPD Group A, 19 subjects (29.2%)were Group B, 21 subjects (32.3%) were COPD group C and 18 subjects (27.7%)were COPD group D. The mean age was 64.15 (45-89); mean FEV1% was46.05%, mean DLCO measured was 19.42 ml/min/mmHg and the mean DLCO%was 72.00%. The prevalence of decreasing in diffusing capacity of the lung inCOPD patients was 56.92% (37 subjects) While 28 subjects were normal. Therewere 15 subjects (23.07%) with mild decrease in DLCO, 18 subjects (27.69%)were moderate decrease and 4 subjects (6.15%) with severe decrease. 47 subjects(72.3%) had comorbid conditions. There was significant correlation between grupCOPD, GOLD COPD grade, VEP1, BMI and comorbidities with magnitude ofdecreasing DLCO value. There was no correlation between DLCO value with sex,smoking history, Brinkmann index, age, obstruction-mix criteria, length of COPDperiod. Conclusion : The proportion of decreasing in DLCO in COPD patients are56.92%. There is significant correlation among the group of COPD, GOLDCOPD grade, VEP1, BMI and previous TB history with magnitude of decreasingDLCO value. There is no correlation between DLCO value with sex, smokinghistory, brinkmann index, age, obstruction-mix criteria, comorbidities and lengthof COPD period. "

"Latar Belakang: Salah satu jenis kelompok kanker paru yaitu neoplasma neuroendokrin dikelompokan berdasarakan gambaran histopatologi dengan pervalens 20-25% dari seluruh kanker paru. Karsinoid atipikal adalah tumor derajat menengah yang bersifat lebih agresif dari karsinoid tipikal. Karsinoma neuroendokrin paru sel besar dan karsinoma neuroendokrin paru sel kecil (KPKSK) adalah karsinoma derajat tinggi dengan prognosis yang sangat buruk dan memiliki ekspresi PD-L1. Ekspresi PD- L1 pada karsinoma neuroendokrin berhubungan dengan angka tahan hidup pasien. Penelitian ini bertujuan untuk mengetahui proporsi ekspresi PD-L1 pada neoplasma neuroendokrin paru di RSUP PersahabatanMetode: Penelitian ini merupakan penelitian deskriptif potong lintang menggunakan data rekam medis pasien neoplasma neuroendokrin paru yang terdiagnosis secara histopatologi di poliklinik onkologi RSUP Persahabatan. Seluruh status rekam medis pasien neoplasma neuroendokrin paru dari januari 2019 hingga mei 2023 didata. Proses pengumpulan data dilakukan pada bulan januari 2023 hingga agustus 2023. Setelah itu dilanjutkan pemeriksaan imunohistokimia (IHK) PD-L1 menggunakan antibodi 22C3 pada sampel yang memenuhi kriteria inkulsi, lalu dilanjutkan analisis data menggunakan SPSS versi 25.Hasil: Pada penelitian ini terdapat tujuh sampel atau 14% sampel yang memiliki memiliki ekspresi PD-L1 positif dari 50 total sampel. Tendensi karakteristik pasien neoplasma neuroendokrin paru pada penelitian ini yaitu jenis kelamin laki-laki, kelompok usia ≥60 tahun, memiliki riwayat merokok dengan indeks brinkman berat, tidak memiliki riwayat pajanan di lingkungan kerja, tidak memiliki riwayat pengobatan TB paru, tidak memiliki riwayat kanker keluarga dan stage lanjut. Proporsi jenis histopatologi neoplasma neuroendokrin paru dari empat kelompok tersebut yaitu dua sampel (4%) karsinoid tipikal, enam sampel (12%) karsinoid atipikal, 31 sampel (62%) karsinoma neuroendokrin paru sel kecil dan 11 sampel (22%) karsinoma neuroendokrin paru sel besar. Ekspresi PD-L1 positif ditemukan pada 3 kelompok yaitu 1 sampel (16,7%) pada kelompok karsinoid atipikal, 4 sampel (12,9%) pada kelompok karsinoma neuroendokrin paru sel besar dan 2 sampel (18,2%) pada sel kecil. Nilai median overall survival untuk kelompok PD-L1 negatif yaitu 9 bulan (IK 95% 3,9-14 bulan) sedangkan pada kelompok PD-L1 positif median OS 8,5 bulan (IK 95% 4,9-12 bulan) dengan p 0,228.Kesimpulan: Ekspresi PD-L1 positif ditemukan sebesaar 14% dari 50 sampel. Tidak terdapat perbedaan bermakna secara statistik antara faktor-faktor yang memengaruhi ekspresi PD-L1.

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Background: One type of lung cancer group, namely neuroendocrine neoplasms, is grouped based on histopathological features with a prevalence of 20-25% of all lung cancers. Atypical carcinoids are intermediate grade tumors that are more aggressive than typical carcinoids. Large cell lung neuroendocrine carcinoma and small cell lung neuroendocrine carcinoma (SCLC) are high-grade carcinomas with a very poor prognosis and PD-L1 expression. PD-L1 expression in neuroendocrine carcinoma is associated with patient survival. This study aims to determine the proportion of PD-L1 expression in pulmonary neuroendocrine neoplasms at Persahabatan General Hospital.

Method: This study was a cross-sectional descriptive study using medical records of patients with lung neuroendocrine neoplasms diagnosed histopathologically at the oncology polyclinic of Persahabatan General Hospital. All medical records status of lung neuroendocrine neoplasm patients from January 2019 to May 2023 were recorded. The data collection process was carried out from January 2023 to August 2023. After that, the PD-L1 immunohistochemistry examination was continued using the 22C3 antibody on samples that met the inclusion criteria, then continued data analysis using SPSS version 25.

Result: there were seven samples or 14% of the samples had positive PD-L1 expression out of 50 total samples. Characteristics tendency of patients in this study are male, age group ≥60 years, have a history of smoking with a severe Brinkman index, have no history of exposure in the work environment, have no history of pulmonary TB treatment, have no family history of cancer and advanced stage. The proportion of histopathological types of neuroendocrine neoplasms of the lung from the four groups were two samples (4%) typical carcinoid, six samples (12%) atypical carcinoid, 31 samples (62%) small cell lung neuroendocrine carcinoma and 11 samples (22%) lung neuroendocrine carcinoma large cell. Positive PD-L1 expression was found in 3 groups, namely 1 sample (16.7%) in the atypical carcinoid group, 4 samples (12.9%) in the large cell lung neuroendocrine carcinoma group and 2 samples (18.2%) in a small cell. The median overall survival value for the negative PD-L1 group was 9 months (95% CI 3.9-14 months) while in the positive PD-L1 group, the median OS was 8.5 months (95% CI 4.9-12 months) with p 0.228.

Conclusion: Positive PD-L1 expression was found 14% from 50 samples. There was no statistically significant difference between the factors influencing PD-L1 expression."

"Latar Belakang : Asma merupakan penyakit inflamasi kronik saluran napas dengan fungsi bersihan mukosilier yang menurun, maka itu bentuk matur dari spora Aspergillus fumigatus bisa tumbuh dan membuat sensitisasi Aspergillus yang merupakan kondisi awal aspergillosis paru pada asma dan dapat berkembang menjadi Allergic Bronchopulmonary Aspergillosis (ABPA). Penegakkan diagnosis aspergillosis paru didapatkan jika reaksi hipersensitisasi terhadap antigen A.fumigatus positif.Metode : Penelitian ini menggunakan metode potong lintang pada 86 pasien asma yang berobat ke RSUP Persahabatan dengan nilai Asthma Control Test (ACT) ≤ 24. Subjek penelitian dibagi 2 kelompok berdasarkan sensitisasi Aspergillus. Penilaian aspergillosis paru menggunakan pemeriksaan Imunoglobulin E (IgE) spesifik A.fumigatus. Kriteria diagnosis ABPA yang digunakan pada penelitian ini menggunakan kriteria International Society of Human and Animal Mycology (ISHAM) yaitu dua kriteria obligatory (IgE spesifik A.fumigatus dan IgE total) serta 3 kriteria tambahan (IgG spesifik A.fumigatus, eosinofil total, gambaran foto toraks). Pemeriksaan fungsi paru dilakukan pada penelitian ini termasuk spirometri, kapasitas difusi paru karbon monoksida (DLCO) dan nitrit oksida udara ekspirasi (FeNO).Hasil : Proporsi pasien asma tidak terkontrol yang memiliki aspergillosis paru didapatkan 3,5% (3/86) sedangkan proporsi ABPA didapatkan 1,1% (1/86). Terdapat faktor-faktor yang memengaruhi aspergillosis paru pada asma tidak terkontrol, diantaranya adalah nilai IMT (p=0,77), riwayat merokok (p=0,86) dan riwayat TB paru (p=0,03).. Karakteristik imunologi didapatkan nilai median IgE total pada subjek dengan aspergillosis paru 465(22-1690) IU/ml dan nilai median hitung total eosinofil 380 (0-770) sel/µl. Dari penilaian spirometri pada subjek aspergillosis paru didapatkan nilai median KVP 1630(950-2150) ml, nilai rerata KVP%prediksi 70±33,71%, nilai VEP1 1150(470-1240) ml, nilai median VEP1% prediksi 54(24-76)%, nilai rerata VEP1/KVP 59,33±14,57)% serta nilai rerata DLCO 84,67±24,66%. Nilai median FeNO pada asma tidak terkontrol dengan aspergillosis paru pada penelitian ini didapatkan 32 (12-45) ppb.Kesimpulan : Penegakkan diagnosis aspergillosis paru pada pasien asma tidak terkontrol harus dilakukan sejak awal, terutama pada pasien dengan riwayat TB  paru. Hal tersebut dapat mencegah aspergillosis paru pada asma tidak terkontrol berkembang menjadi penyakit ABPA serta kerusakan paru yang permanen.

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Background: Asthma is a chronic airway inflammation with decrease of mucocilliary clearance. The mature form of Aspergillus fumigatus spores could grow in this condition and caused an Aspergillus sensitization as an early progression to allergic bronchopulmonary aspergillosis (ABPA). Pulmonary aspergillosis could be diagnosed from a hypersensitivity reaction to the A. fumigatus antigen.

Methods : This cross-sectional study included 86 asthma patients with Asthma Control Test ACT score ≤ 24 and treated at Persahabatan Hospital Jakarta, Indonesia. Pulmonary aspergillosis was examined using specific immunoglobulin E (IgE) assay of A. fumigatus. The ABPA diagnostic in this study used the International Society of Human and Animal Mycology (ISHAM) criteria, which included two obligatory criteria (A. fumigatus-specific IgE and total IgE) and three additional criteria (A. fumigatus-specific IgG, blood eosinophil count, and thoracic x-ray). Lung function were examined using spirometry, diffusing capacity for carbon monoxide (DLCO), and fraction of exhaled nitric oxide (FeNO).

Results: Uncontrolled asthma patients who had pulmonary aspergillosis was 3.5% (3/86) while the proportion of ABPA was 1.1% (1/86).  A history of prior pulmonary tuberculosis (TB) was correlated with aspergillosis in uncontrolled asthma patients (p=0.03). The median value of total IgE and blood eosinophil count in pulmonary aspergillosis subjects was 465 (22-1690) IU/mL and 380 (0-770) cells/µL, respectively. Spirometry results of pulmonary aspergillosis subjects were median FVC 1630 (950-2150) ml, mean predicted FVC% predicted value 70±33.71%, mean FEV1 1150 (470-1240) ml, median predicted FEV1% 54 (24-24)%, mean FEV1/FVC 59.33±14.57%, and mean DLCO 84.67±24.66%. The median FeNO in uncontrolled asthma with pulmonary aspergillosis in this study was 32 (12-45) ppb.

Conclusion: Diagnosis of pulmonary aspergillosis in patients with uncontrolled asthma should be carried out early, especially in patients with a history of pulmonary TB. This would prevent pulmonary aspergillosis in uncontrolled asthma from developing into ABPA disease and permanent lung damage."