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"Background: 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.

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Latar belakang: diagnosis TB paru pada pasien HIV merupakan suatu tantangan karena fitur klinis atau tampilan radiologis yang tidak spesifik. Pasien HIV dengan sel CD4 <200 sel/mL yang terinfeksi M. tuberculosis memiliki kapasitas yang lebih rendah dalam menampung M. tuberculosis, membentuk granuloma, nekrosis, atau kavitas. Kondisi ini disebabkan oleh melemahnya inflamasi yang kemudian mengurangi produksi sputum dan dapat menyebabkan hasil negatif palsu. Penelitian ini bertujuan menilai perbedaan tingkat positivitas basil tahan asam (BTA) dan kultur M. tuberculosis dari sputum non-bronkoskopi dibandingkan dengan sputum bronkoskopi (bronkoalveolar) pada pasien tersangka tuberkulosis (TB) paru HIV dengan CD4≤200 sel/μL.

Metode: penelitian potong lintang dilakukan pada pasien HIV dewasa yang dirawat di Rumah Sakit Hasan Sadikin dengan CD4 ≤200 sel/μL yang disangka memiliki TB paru dengan uji analitik komparatif berpasangan. Semua pasien diminta memberikan dahak secara spontan atau dengan induksi sputum pada hari pertama. Pada hari berikutnya dilakukan pemeriksaan bronkoskopi dengan bilasan bronkoalveolus. Bahan yang diperoleh dari kedua cara diperiksa secara mikroskopis dengan pewarnaan Ziehl Neelsen (ZN) dan kultur M. tuberculosis dengan media padat Ogawa. Positivitas, sensitivitas dan peningkatan sensitivitas BTA dan kultur M. tuberculosis pada kelompok non-bronkoskopik dan bronkoskopik kemudian dibandingkan.

Hasil: terdapat perbedaan tingkat positivitas ZN pada kelompok non-bronkoskopi dibandingkan bronkoskopi yaitu 7/40 (17,50%) vs 20/40 (50,00%) (p<0.001). Perbedaan antara kultur kelompok non-bronkoskopi dengan kelompok bronkoskopi yaitu 16/40 (40,00%) vs 23/40 (57,50%) (p=0,039). Bilasan bronkoalveolus menunjukkan tingkat positivitas pemeriksaan dahak BTA lebih tinggi sebesar 32,5% (dari 17,5% menjadi 50%) dan juga kultur sebesar 17,5% (dari 40,0% menjadi 57,5%)."

"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%."

"Latar belakang: Sepsis sulit dibedakan dengan respon inflamasi non infeksi secara klinis dan kultur darah yang merupakan gold standar diagnosis sepsis memiliki banyak keterbatasan. Presepsin merupakan suatu biomarker baru namun belum banyak data tentang efektifitas penggunaanya pada anak.Tujuan: Mengetahui nilai diagnostik dan prognostik presepsin dibandingkan dengan leukosit, PCT dan CRP pada pasien anak yang dicurigai sepsis

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Method: The latitude cut study was conducted during March-December 2020 at RSCM Jakarta on 56 patients aged 2 months - 10 years with suspicion of sepsis Diagnosis of sepsis is established based on the criteria of sepsis-3 and blood culture. Biomarker examination and PELOD-2 score are performed at the beginning and after 72 hours, mortality assessment is conducted on day 7. Presepsin levels are checked using the PATHFAST® method.

Result: The median value of precessine levels in the proven sepsis group (1183 pg/ml was higher than that of the unproven group of sepsis (369 pg/ml, p=0.001). Precessine has a good diagnostic value (AUC of 0.862), with a cut of 711 pg/ml having a sensitivity of 75.8%, specificity of 82.6%, positive guess value of 86.2% and negative guess value of 70.4%, better than leukocytes, PCT, and CRP. Presepsin levels increased linearly with the severity of sepsis and were moderately correlated with PELOD-2 scores (r=0.548; p=0.001). Survival analysis showed precessine levels of ≥ 1,250 pg/ml were significantly associated with early mortality (HR 6.31; 95%CI; 1.67-23.83; p=0.007). Presepsin levels after 72 hours of antibiotic therapy decreased significantly in the improved sepsis group and increased in the worsening sepsis group.

Inference: Presepsin is a reliable biomarker and can be used to help diagnose sepsis, predict severity, death and evaluate therapies in tertiary hospital services."

"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."

"ABSTRAKLatar belakang Akurasi triple diagnostic USG guided FNAB untuk menentukan keganasan pada kasus nodul tirodi masih belum diketahui. Hal tersebut penting untuk diketahui sehingga tindakan definitif dan jenis operasi dapat ditentukan tanpa harus dilakukan pemeriksaan potong beku.Metode Penelitian dilakukan pada 131 pasien dengan pembesaran kelenjar tiroid pada periode Januari 2014 ndash; Desember 2014 dengan menggunakan desain potong lintang. Penelitian ini menghitung nilai sensitivitas, spesifisitas, nilai prediksi positif, nilai prediksi negatif, akurasi triple diagnostic dengan USG guided FNAB dibandingkan dengan histopatologi.Hasil Hasil penelitian ini menunjukan triple diagnostic yang concordant ganas memiliki sensitivitas 81,17 , spesifisitas 96,55 , nilai prediksi positif 98,57 , nilai prediksi negatif 36,36 , dan akurasi 85,08 .Kesimpulan Tingginya nilai prediksi positif yang didapatkan dalam penelitian ini, sehingga triple diagnostic dapat digunakan untuk terapi definitif tanpa dilakukan pemeriksaan potong beku intra operatif.

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ABSTRACT Background The triple diagnostic accuracy with Ultrasound guided FNAB to determine the risk of malignancy in cases of thyroid nodules remains unknown. It is important to know so that definitive measures and types of operations can be determined without the need for a frozen section. Methods The study was conducted using cross sectional design on 131 patients with thyroid nodule in the period of January 2014 December 2014. This study calculated the values of sensitivity, specificity, positive predictive value, negative predictive value, triple diagnostic accuracy with ultrasound guided FNAB compared with histopathological result.Results This study show triple diagnostic with malignant concordant has sensitivity of 81.17 , specificity of 96.55 , positive predictive value of 98.57 , negative predictive value of36.36 , and 85.08 accuracy.Conclusions The high positive predictive values obtained in this study, show that triple diagnostic can be used for definitive therapy without intraoperative frozen section"

"Background: The prevalence of Helicobacter pylori (H. pylori) infection in the world is quite high, especially in developing countries. Usually the patient shows no specific symptoms and chronic gastritis therefore becomes chronically infected The complication of the injéction is the development of peptic ulcer; which is a predisposing factor for gastric carcinoma. Early diagnosis is an important step to avoid these complications by providing immediate accurate therapy. Methods: In this study the CLO, MIU (Motility Indole Urease) tests and culture were conducted on 131 biopsy samples of the stomach antrum mucous tissue taken from chronic dyspepsia patients from several hospitals in Jakarta. In the CLO test, biopsy tissue was put in a small well agar to be incubated at room temperature. In the MIU test the biopsy tissue sample was submerged in the small MlU tube agar with a depth of approximately 2/3 rds from the surface, and then incubated at room temperature. Another piece of biopsy tissue was cultured micro-aerophylicalty The CLO and MlU tests are considered positive if the color changes from yellow to red and are considered negative if there is no color change within 24 hours. Results: Compared to culture, the CLO test demonstrated 38% sensitivity; 96% specificity, 94% positive predictive value and 52% negative predictive value, whereas the results of the MIU test against culture method showed 76% sensitivity 89% specificity 88% positive predictive value, and 78% negative predictive value. Conclusion: The MIU test that showed high sensitivity and specyficity and thus could be further developed as an alternative diagnostic method for H. pylori infection."

"Conveys the essential knowledge needed to understand the clinical application of imaging technologies. Suitable for radiology residents and students, this title covers various subspecialty areas and imaging modalities as utilized in neuroradiology, chest, breast, abdominal, musculoskeletal imaging, ultrasound, and nuclear radiology "

"ABSTRAKPendahuluanDi Indonesia berdasarkan data dari Badan Registrasi Kanker Indonesia, karsinoma tiroid dengan frekuensi relatif 4,43%, menempati urutan ke 9 dari 10 keganasan yang sering ditemukan. Pada tindakan pembedahan tiroid, umum dilakukan pemeriksaan potong beku intra operatif untuk menentukan keganasan pada lesi tiroid serta menentukan tindakan definitif dan jenis operasi yang akan dikerjakan. Pemeriksaan potong beku itu sendiri memiliki beberapa kelemahan antara lain biaya yang lebih mahal, waktu pembiusan yang lebih lama dengan segala risikonya, serta ketidaksediaan pemeriksaan ini di setiap rumah sakit. Tujuan penelitian ini adalah untuk menilai akurasi pemeriksaan triple diagnostik pada nodul tiroid yang terdiri dari klinis, ultrasonografi, dan aspirasi jarum halus (bajah), yang dibandingkan dengan standar baku emas pemeriksaan histopatologi sehingga nantinya diharapkan triple diagnostik ini saja sudah cukup untuk dapat dipakai dalam merencanakan terapi definitif.MetodaDilakukan pengumpulan data pasien dengan nodul tiroid dari rekam medis dari periode 2010-2011. Dilakukan penghitungan dan penentuan kriteria ganas atau jinak dari masing-masing unsur triple diagnostik, yang terdiri dari data klinis (anamnesis dan pemeriksaan fisik), USG tiroid, dan bajah. Dilakukan analisis uji diagnostik dari triple diagnostik yang dibandingkan dengan pemeriksaan histopatologi pasca operasi sebagai standar baku emas.HasilTerdapat 223 pasien dengan nodul tiroid. Dari jumlah tersebut data rekam medis yang lengkap didapatkan sebanyak 161 kasus. Jenis histopatologi terdiri dari karsinoma papiler (90,3%), folikular (3%), meduler (0,7%), anaplastik (6%). Didapatkan sensitivitas dan spesifisitas dari triple diagnostik pada nodul tiroid sebesar 77 % dan 94 %. Nilai prediksi positif 98%, nilai prediksi negatif 51,6%, dan akurasi sebesar 80,9%. Kombinasi dari pemeriksaan klinis, ultrasonografi dan bajah memberikan probabilitas ganas sebesar 92%.KesimpulanTriple diagnostik belum dapat digunakan sebagai pemeriksaan yang ideal menggantikan pemeriksaan potong beku dalam menangani kasus nodul tiroid, tetapi pada kasus dengan unsur-unsur triple diagnostik yang konkordan ganas memiliki nilai prediksi positif (98%) dan probabilitas ganas (92%) yang tinggi sehingga pada kasus demikian memungkinkan untuk dilakukan tindakan definitif dengan tetap mempertimbangkan sensitifitas dan spesifitas unsur-unsur triple diagnostik pada masing-masing senter

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ABSTRACTBackgroundIn Indonesia, based on data from Indonesian Cancer Registration Council, thyroid carcinoma with relative frequency of 4,43% ranks the ninth from the ten most common cancers in Indonesia. In thyroid surgery, it’s common to perform frozen section examination intraoperatively to determine malignancy and definitive operation. Frozen section has several limitations, for example: higher expense, longer duration of anesthetization, and it’s unavaibility in all hospital. The aim of this research is to evaluate accuracy of triple diagnostic, which is consisted of clinical findings, ultrasonography, dan fine needle aspiration biopsy, compared to golden standard of histopathological result, so that triple diagnostic only is enough to plan definitive treatment in patients with thyroid nodule.MethodData were collected from medical records from the period of 2010-2011. Each element of triple diagnostic was classified into either malignant or benign. Diagnostic test study was performed to analyze triple diagnostic which was compared to post operative histopathological result as a golden standard.ResultsThere were 223 patients with thyroid nodule, but of all there were only 161 cases with complete medical record were compiled. Histopathological reports consisted of papillary carcinoma (90,3%), follicular (3%), medullary (0,7%), anaplastic (6%). Sensitivity and spesifity of triple diagnostic for thyroid nodule were 77% and 94%. Positive predictive value of 98%, negative predictive value of 51,6%, and accuracy of 80,9%. Combination of clinical findings, ultrasonography, and fine needle aspiration biopsy altogether gave probability of malignant of 92 %.Conclusion: Triple diagnostic for thyroid nodule can not be used yet as ideal test to replace golden standard of histopatlogical result, but cases which concordant results of each triple diagnostic’s element have high both positive predictive value (98 %) and malignant probability (92 %). In cases as above, it is still possible to perform definitive operation while still considering both sensitivity and spesifity of all triple diagnostic’s elements in each center."

"Contents : Head and neck -- The central nervous system -- The spinal column and its contents -- The thorax -- The abdomen -- The pelvis -- The upper limb -- The lower limb -- The breast."