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"ABSTRAKBackground: Systemic lupus erythematosus (SLE) is an autoimmune disease that more commonly affects women of childbearing age. It is a multi-organ disease and can involve virtually any organ in the body. Pleural effusion can occurred in 30% of patients with SLE, which may be a result of SLE itself, pulmonary emboli, or end-organ damage such as heart or renal failure. The management of pleural effusions in SLE patient can be challenging because the numerous of potential underlying cause and sometimes effusion recur despite appropriate treatment of primary process. Case Report: We reported 33 years old woman patient admitted to our ED with chief complaint of shortness of breath for last 1 week. Chest X-ray result showed bilateral pleural effusion. Serial pleural fluid analysis consistent with conclusion of transudate fluid. Echochardiograpy showed dilatation of left atrium and ventricle and reduced LVEF 34%. These data suggest congestive heart failure as the cause of pleura effusion. A few days after initial thoracocentesis, the patient become dyspnea again because of reccurent pleural effusion. To relieve the symptom, we did insertion of pigtail catheter connected with mini WSD (Water seal drainage). Conclusion: Pleural effusion is a relatively common clinical presentation of a patient with SLE. Pleural effusions may be a result of SLE itself, pulmonary emboli, or end-organ damage such as heart or renal failure. The management of pleural effusions are mainly to relieve the symptoms and treatment of underlying cause."

"Latar belakang : Fontan merupakan tata laksana tahap final pada penyakit jantung bawaan dengan single ventricle. Salah satu komplikasi pascaoperasi yang meningkatkan lama rawat dan biaya adalah efusi pleura menetap dengan prevalensi 35,8%. Vasodilator paru digunakan untuk menurunkan tekanan arteri pulmonal dan resistensi paru yang berhubungan dengan mekanisme terjadinya efusi pleura. Penelitian ini melihat hubungan lama pemberian vasodilator paru praoperasi terhadap kejadian efusi pleura menetap pascaoperasi Fontan.Metode : Studi kohort retrospektif pada pasien pascaoperasi Fontan di Rumah Sakit Pusat Jantung dan Pembuluh darah Nasional Harapan Kita (RSPJNHK). Saturasi oksigen praoperasi, indeks resistensi paru praoperasi, teknik fenestration, regurgitasi katup sistemik praoperasi, lama pemberian vasodilator paru praoperasi, durasi mesin pintas jantung paru, dan penggunaan klem silang aorta merupakan variabel bebas dan kejadian efusi pleura menetap pascaoperasi merupakan variabel terikat. Pengumpulan data melalui rekam medis pasien di divisi bedah jantung anak RSPJDNHK tahun 2017-2019. Analisis bivariat digunakan untuk menilai hubungan antar variabel.Hasil : Terdapat 93 subjek yang diikutsertakan pada penelitian ini. Penelitian ini menunjukkan tidak ada hubungan bermakna secara statistik antara indeks resistensi paru praoperasi, teknik fenestration, regurgitasi katup sistemik praoperasi dan lama pemberian vasodilator paru praoperasi, durasi mesin jantung paru, dan penggunaan klem silang aorta. Hubungan yang bermakna didapatkan dari variabel saturasi oksigen praoperasi dan tekanan arteri paru praoperasi.Simpulan : Lama pemberian vasodilator paru praoperasi tidak berhubungan dengan efusi pleura menetap pascaoperasi Fontan. Namun secara klinis terdapat 67,4% subjek pada kelompok pemberian vasodilator paru ≥6 bulan tidak mengalami efusi pleura menetap.

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Background: Fontan is final palliative surgery for single ventricle physiology congenital heart disease. Persistent pleural effusion is one of complication which can increase length of stay and cost after surgery. High pulmonary artery pressure and pulmonary resistance are involved in existence of persistent pleural effusion after surgery. Pulmonary vasodilator is one of drug that can decrease pulmonary artery pressure and resistance which can decrease pleural effusion production,

Method : Retrospective cohort was used in this paper. Data was taken from medical record from 2017 to 2019 in pediatric cardiac surgery division of National Cardiovascular Center Harapan Kita Hospital.

Result : there were 93 subjects in this study. Duration of cardiopulmonary bypass, aortic cross clamp, pulmonary artery resistence index, systemic valve regurgitation, duration of pulmonary vasodilator, and fenestration did not have significant correlation statistically to persistent pleural effusion. Preoperative oxygen saturation and pulmonary artery pressure had significant correlation to persistent pleural effusion statistically.

Conclusion : This study showed that duration of preoperative pulmonary vasodilator did not have correlation with persistent pleural effusion after Fontan. Clinically, there is 67,4% on ≥6 month of pulmonary vasodilator group did not have persistent pleural effusion."

"Residensi Keperawatan Medikal Bedah diharapkan mampu menjadi seorang Clinical Care Manajer (CCM) yang bertugas sebagai konsultan keperawatan bagi staf keperawatan dan pemberi terapi keperawatan kepada pasien. Asuhan keperawatan pada kasus kelolaan pasien dengan TB paru klinis dengan efusi pleura dan 30 kasus resume menerapakan pendekatan dengan teori Roy Adaptasi Model (RAM). Dalam penerapan teori ini menunjukan peran perawat untuk membantu pasien dalam beradaptasi melalui stimulus yang diterima, memberikan intervensi baik secara regulator maupun kognator, sehingga pasien adaptif terhadap stimulus tersebut. Pada resume masalah keperawatan yang sering muncul yaitu masalah oksigenasi bersihan jalan nafas tidak efektif. Pada penerapan EBN Terapi Komplementer Acupressure Yuji, Nei Guan Dan Zongfu terhadap Penurunan Dyspnea pada Pasien Tb Paru Di Era Post Covid-19. Proyek inovasi Peningkatan Kemampuan Perawat Dalam Monitoring Pasien Terpasang WSD dan Edukasi Perawatan di Rumah dengan Video” di Rumah Sakit Umum Pusat Persahabatan, Jakarta. Hasil analisis praktik residensi keperawatan didapatkan bahwa asuhan keperawatan dengan menggunakan pendekatan teori Roy membantu pasien untuk beradaptasi terhadap stimulus untuk meningkatakan kesehatan individu. Pada penerapan EBN ada pengaruh Terapi Komplementer Acupressure Yuji, Nei Guan Dan Zongfu terhadap Penurunan Dyspnea pada Pasien Tb Paru. Proyek inovasi dapat meningkatkan pengetahuan perawat tentang Monitoring Pasien Terpasang WSD dan pengetahuan pasien tentang Edukasi Perawatan WSD di Rumah.

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The Medical Surgical Nursing Residency is expected to be able to become a Clinical Care Manager (CCM) who serves as a nursing consultant for nursing staff and provides nursing therapy to patients in the context of providing nursing care. Nursing care in cases managed by patients with clinical pulmonary TB with pleural effusion and 30 resume cases applied the Roy Adaptation Model (RAM) theory approach. cognator, so that the patient is adaptive to the stimulus. The resume founded nursing problem that often arises is the problem of ineffective airway clearance oxygenation. In the application of Yuji Acupressure Complementary Therapy EBN, Nei Guan and Zongfu on Reducing Dyspnea in Pulmonary TB Patients in the Post Covid-19 Era. An innovation project to Improve Nurses' Capabilities in Monitoring WSD Installed Patients and Home Care Education with Video” at the Persahabatan General Hospital, Jakarta. The results of the analysis of nursing residency practice found that nursing care using Roy's theoretical approach helps patients to adapt to stimuli to improve individual health. In the application of EBN there is an effect of Yuji, Nei Guan and Zongfu's Complementary Acupressure Therapy on Reducing Dyspnea in Pulmonary TB Patients. The innovation project can increase nurses' knowledge about WSD Installed Patient Monitoring and patient knowledge about WSD Care Education at Home."

"ABSTRAKLatar Belakang: Efusi pleura merupakan masalah yang sering dijumpai oleh dokter paru. Penelitian ini bertujuan untuk mendapatkan nilai diagnostik biopsi pleura tertutup dan pleuroskopi pada efusi pleura eksudat serta hubungan karakteristik subjek dan karakteristik penyakit dengan hasil diagnostik.Metode : Penelitian ini menggunakan desain potong lintang pada pasien efusi pleura eksudat yang dilakukan tindakan biopsi pleura tertutup atau pleuroskopi. Data diambil dari catatan medis pasien RSUP Persahabatan Jakarta 2013-2015.Hasil : Total 100 subjek yang dibagi menjadi 50 subjek dilakukan biopsi pleura tertutup dan 50 subjek yang dilakukan pleuroskopi. Karakteristik subjek kelompok biopsi pleura tertutup didapatkan 60 laki- laki, rerata usia 48,22 tahun, perokok 58 sedangkan pada kelompok pleuroskopi 52 perempuan, rerata usia 50,66 tahun dan 46 perokok. Nilai diagnostik biopsi pleura tertutup pada efusi pleura eksudat adalah 50 sedangkan nilai diagnostik pleuroskopi lebih tinggi yaitu 82 . Pada kelompok biopsi pleura tertutup secara statistik terdapat perbedaan bermakna antara usia p=0,020 , kadar protein cairan pleura p=0,026 dan karakteristik penyakit p=0,047 terhadap hasil diagnostik.Kesimpulan : Nilai diagnostik pleuroskopi lebih tinggi dibandingkan biopsi pleura tertutup pada pasien efusi pleura eksudat. Usia, kadar protein cairan pleura dan karakteistik penyakit berhubungan dengan hasil diagnostik biopsi pleura tertutup

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ABSTRACTBackground Pleural effusion is a common diagnostic dilemma for the pulmonologist. The aim is to obtain the diagnostic value of closed pleural biopsy and pleuroscopy in exudative pleural effusion and the association of subjects characteristic and the characteristic of the disease with the diagnostic yield.Method This is a cross sectional study in patients with exudative pleural effusion which performed closed pleural biopsy and pleuroscopy. Data retrieved from the medical records of Persahabatan hospital from 2013 ndash 2015.Results A total of 100 subjects were divided into 50 subjects that performed closed pleural biopsy and 50 subjects performed pleuroscopy. Characteristics of closed pleural biopsy subjects were 60 male, mean age was 48,22 years and smokers were 58 while characteristics of pleuroscopy subjects, 52 female, mean age 50,66 years and 46 smokers. Closed pleural biopsy has a diagnostic value of 50 and pleuroscopy at 82 . There was a statistically significant relationship between age p 0,020 , pleural fluid protein level and disease characteristic with diagnostic yield of closed pleural biopsy.Conclusion Pleuroscopy has higher diagnostic value than closed pleural biopsy in patients with exudative pleural effusion. Age, pleural fluid protein levels and disease characteristic are associated with diagnostic yield of closed pleural biopsy."

"Latar Belakang: Persentase kasus pleuritis TB mencapai 20% dari total jumlah kasus TB ekstra paru. Penegakkan diagnosis efusi pleura TB cukup sulit karena tindakan biopsi pleura yang bersifat invasif dan rendahnya sensitivitas pemeriksaan BTA cairan pleura. Adenosine deaminase (ADA) dapat menjadi reference test dengan sensitivitas dan spesifisitas yang tinggi namun ketersediaannya pada pelayanan kesehatan primer masih terbatas.Tujuan: Menganalisis model prediksi diagnosis efusi pleura TBMetode: Studi ini menggunakan metode potong lintang. Penelitian tersebut dilakukan di RSUPN Cipto Mangunkusumo. Variabel independen terdiri dari usia, nyeri dada pleuritik, efusi pleura unilateral, cairan pleura kesan eksudat mononuklear dominan, sitologi malignansi negatif, gambaran ultrasonografi dan rasio netrofil-limfosit darah. ADA ≥35 untuk menentukan efusi pleura TB. Hubungan variabel independen dengan efusi pleura TB dianalisis secara bivariat, secara multivariat, pembuatan kurva ROC dan kalibrasi dengan Hosmer-LemeshowHasil: Didapatkan 91 subjek dengan karakteristik jenis kelamin pria 41 subjek (45,1%) sedangkan wanita 50 subjek (54,9%). Malignansi merupakan komorbid terbanyak dengan 52 subjek (57,1%). Proporsi kelompok efusi pleura TB sebesar 25,3%. Faktor-faktor yang memengaruhi penegakkan diagnosis efusi pleura TB pada penelitian ini adalah gambaran ultrasonografi kompleks OR 5,655 (IK 95% 1,700-18,812), glukosa cairan pleura ≤70 mg/dL OR 11,262 (IK 95% 2,931-43,276) dan cairan pleura eksudat mononuklear dominan OR 8,567 (IK 95% 2,114-34,715). Pada ROC didapatkan AUC 0,841 dengan p<0,001 IK 95% (0,762-0,926). Didapatkan sistem skor dengan nilai cut-off ≥2 dengan probabilitas 92,8%.Simpulan: Faktor-faktor yang memprediksi diagnosis efusi pleura TB adalah gambaran ultrasonografi kompleks, glukosa cairan pleura ≤70 mg/dL dan cairan pleura kesan eksudat mononuklear dominan. Didapatkan sistem skor dengan nilai cut-off ≥2 dengan probabilitas 92,8%.

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Background: Percentage of TPE reach 20% of total EPTB cases. The diagnosis of TPE is difficult due to pleural biopsy procedure invasiveness and acid fast stain low sensitivity. Adenosine deaminase (ADA) can become reference test with high sensitivity and specificity but availability in primary health care is limited.

Objective: Analyze prediction model in diagnosis of tuberculous pleural effusion.

Methods: This study uses a cross-sectional method. The study was conducted at Cipto mangunkusumo Hospital. Independent variables consist of age, pleuritic chest pain, unilateral pleural effusion, glucose pleural fluid ≤70 mg/dL, exudative mononuclear pleural effusion, negative cytology malignancy, ultrasound characteristic and blood neutrophil-lymphocyte ratio. ADA ≥35 suggests TPE. The variaables analyzed bivariately, multivariately, ROC curve and Hosmer-Lemeshow.

Results: There were 91 subjects with characteristic of male 41 subjects (45,1%) and female 50 subjects (54,9%). Malignancy was the most frequent comorbid with 52 subjects (57,1%). Factors associated with TPE diagnosis are complex ultrasound characteristic OR 5,655 (CI 95% 1,700-18,812), pleural fluid glucose ≤70 mg/dL OR 11,262 (CI 95% 2,931-43,276) and exudative mononuclear dominant pleural effusion OR 8,567 (CI 95% 2,114-34,715). In ROC curve conclude AUC 0,841 with p<0,001 CI 95% (0,762-0,926). The result is a scoring system cut-off value ≥2 with probability 92,8%.

Conclusion: Predicted factors of TPE diagnosis are complex ultrasound characteristic, low pleural fluid glucose and exudative mononuclear dominant pleural effusion. The result is scoring system with cut-off value ≥2 with probability 92,8%."

"ABSTRAKPleural effusion is a condition when there is an accumulation of fluid in pleural space. The condition may manifest in breathing impariment by limiting lung expansion space. Pleural effusion is suffered by more than 1.5 million people per year in America. A study held ini Persahabatan Hospital between 2010-2011 found 119 cases of pleural effusion, 42,8% was malignant pleural effusion. Pleural malignancy is the most common indication for thoracocentesis, thus must be considered in massive pleural effusion (MPE). Theraphy for MPE is palliative with the goal being relief of dyspnea. Treatment option for MPA are deteminded by several factors: symptoms and performance status of the patient, the primary tumor type and its response to systematic therapy, and degree of lung re-expansion following pleural fluid removal. In this case, we will present a case of malignant pleural effusion as an illustration in searching of evidence in comparing between pleurodesis and indwelling pleural catheter in management of malignant pleural effusion. "

"ABSTRAKAdenocarcinoma paru merupakan salah satu jenis kanker paru yang sering ditemukan pada pasien. Pada pasien yang mengalami berupa efusi pleura dapat memperburuk prognosis dan mempersulit terapi pasien. Deteksi mutasi genetik penyebab timbulnya sel kanker dapat membantu menentukan terapi yang tepat bagi pasien dengan prognosis yang lebih baik. Metodi genotyping saat ini telah banyak dikembangkan dalam menentukan biormarker sel kanker, salah satunya adalah teknik RFLP Restriction Fragment Length Polymorphism . Penelitian ini bertujuan untuk mendeteksi adanya salah satu mutasi gen yaitu KRAS kodon 12 dan kodon 13 dengan metode RFLP yang relatif lebih sederhana dibanding metode lainnya. Partisipan pada penelitian potong lintang cross section adalah pasien adenocarcinoma paru stage 4 dengan komplikasi efusi pleura. Rentang usia partisipan adalah 28-71 tahun. Sampel yang digunakan pada studi ini berjumlah 28 dan berasal dari efusi pleura yang disimpan pada kertas saring. Hasilnya tidak ditemukan adanya mutasi KRAS kodon 12 dan kodon 13 pada seluruh sampel 0/28 .

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ABSTRACTPulmonary adenocarcinoma is one type of lung cancer that is often found in patients. In patients experiencing pleural effusion may aggravate prognosis and complicate patient therapy. Detection of genetic mutations causing cancer cells can help determine the right therapy for patients with a better prognosis. A current genotyping methodology has been widely developed in determining cancer cell biomarkers, one of which is the RFLP Restriction Fragment Length Polymorphism technique . This study aims to detect the presence of one of the gene mutations KRAS codon 12 and codon 13 with RFLP method is relatively more simple than other methods. Participants in cross sectional study were stage 4 adenocarcinoma patients with complications of pleural effusion. The age range of participants is 28 71 years. The sample used in this study amounted to 28 and came from pleural effusions stored on filter paper. The result was no mutation of KRAS codon 12 and codon 13 on all samples 0 28 ."

"Latar Belakang: Keganasan merupakan salah satu penyebab terbanyak pada efusi pleura, baik sebagai tumor primer di pleura maupun merupakan metastasis dari berbagai tumor di tempat lain. Prognosis efusi pleura maligna pada umumnya buruk dengan survival rata-rata 3-12 bulan. Belum ada suatu model dalam bentuk skoring yang memprediksi mortalitas pasien efusi pleura pada keganasan di IndonesiaTujuan: Mengetahui proporsi mortalitas 90 hari pasien efusi pleura pada keganasan dan mengidentifikasi faktor-faktor yang mempengaruhi mortalitas dan membuat model skoring untuk memprediksi mortalitas 90 hari pasien efusi pleura pada keganasanMetode: Penelitian berupa kohort retrospektif, data diambil dari rekam medik Rumah Sakit Cipto Mangunkusumo secara konsekutif, yaitu pasien yang secara klinis dan dari hasil pemeriksaan penunjang didiagnosis sebagai efusi pleura maligna,Variabel penelitian dikelompokkan menjadi data kategorik dan dilakukan analisis bivariat dengan chi square dan analisis multivariat menggunakan regresi logistik dengan metode backward stepwise sehingga didapatkan model akhir berupa variabel dengan nilai

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Background Malignancy is one of the most common causes of pleural effusion, either as a primary tumor in the pleura or a metastasis of various tumors elsewhere. The prognosis of malignant pleural effusion is generally poor with an average survival of 3 12 months. There is not yet a model in the form of scores predicting mortality of malignant pleural effusion patients in Indonesia.Objective To know the 90 days mortality proportion, to identify factors affecting mortality and also to create a scoring prediction models of 90 days mortality in malignant pleural effusion patientsMethods The study was a retrospective cohort. Data were taken from Cipto Mangunkusumo Hospital rsquo s medical record on a consecutive basis, the diagnosis of malignant pleural effusion was made on the basis of clinical and investigation. The variables of study were grouped into categorical data. Bivariate analysis was performed using chi square and multivariate analysis was performed using logistic regression with backward stepwise method to get the final model in the form of variable with p value "

"Latar belakang: Pemasangan indwelling pleural catheter (IPC) untuk efusi pleura maligna untuk mengeluarkan cairan pleura, memungkinkan paru-paru mengembang dan tercapai autopleurodesis. Di masa lalu, kami mendidik pasien untuk mendrainase kateter hanya ketika mereka merasa sesak, metode di bagian kami sekarang mendrainase kateter pleura yang ada di dalam tubuh secara terus-menerus setiap hari. Studi ini membandingkan autopleurodesis dan tingkat infeksi antara kateter pleural yang didrainase harian dan berkala.Metode: Dilakukan penelitian kohort retrospektif. Subjek dipilih secara konsekutif di mana seluruh subjek yang telah didiagnosis EPM dan terbagi menjadi dua kelompok pasien dengan drainase harian dan drainase berkala. Subjek ditindaklanjuti selama 2 bulan, hasil utama adalah autopleurodesis. Hasil sekunder adalah durasi waktu antara pemasangan kateter pleura dan autopleurodesis serta tingkat infeksi antara dua kelompok. Uji chi-square atau fisher exact digunakan untuk analisis bivariat antara dua kelompok.Hasil: Hasil: Antara Januari 2019 - Mei 2020 ada 56 subyek kasus kateter pleura yang menetap, 31 kasus dengan drainase berkala, 25 subjek dengan drainase harian. Autopleurodesis yang dicapai pada kelompok drainase harian secara signifikan lebih tinggi dibandingkan dengan kelompok drainase berkala (88% vs 22,5%, p = 0,001). Durasi waktu autopleurodesis yang dicapai secara signifikan lebih singkat pada drainase harian dibandingkan dengan drainase berkala (45 hari vs 93 hari, p = 0,000). Tak satu pun dari subyek mengalami infeksi.Simpulan : Drainase IPC harian pada EPM lebih singkat mencapai autopleurodesis daripada drainase berkala. Kekhawatiran tingkat infeksi yang lebih tinggi dalam drainase berkelanjutan dari kateter pleura yang menetap tidak terjadi dalam penelitian ini.

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Background: The indwelling pleural catheter for malignant pleural effusion drains the pleural fluid, allows the lung to expand and autopleurodesis is achieved. In the past time, we educate the patient to drain the catheter only when they feel dyspnea. The trend in our institution is now draining the indwelling pleural catheter daily drainage continuously connected to the bag. This study comparing the autopleurodesis and infection rate between the daily and intermittent drainage of indwelling pleural catheter.

Method: This was a retrospective cohort study. The subjects were selected consecutively. Two group of patients with daily drainage and intermittent drainage in the past time. Subjects were followed up for 2 months, the primary outcome is autopleurodesis. The secondary outcome was time duration between indwelling pleural catheter insertion and removal and infection rate between two groups. The chi-square or fisher exact test is used for bivariate analysis between two groups.

Results: Between January 2019 - Mei 2020 there were 56 subjects of indwelling pleural catheter cases, 31 cases with intermittent drainage, 25 subjects with daily drainage. The autopleurodesis achieved in the daily drainage group was significantly higher compared to the intermittent drainage group (88% vs 22,5%, p=0,001). Time duration of autopleurodesis achieved was significantly faster in the daily drainage compared to intermittent drainage (45 days vs 93 days, p=0,000). None of the subjects had infection.

Conclusions: Continuous drainage of the indwelling pleural catheter is better than intermittent drainage in achieving the autopleurodesis. Concern of higher infection rate in the continuous drainage of indwelling pleural catheter did not happen in the study."