Jurnal Respirasi

Bilateral Multiple Lower Limb Tuberculous Aneurysms in a Pregnant Woman with Drug-Induced Liver Injury due to Tuberculosis Treatment

2025-07-29T11:20:13+07:00

Introduction: Tuberculosis (TB) is a long-term infectious disease caused by Mycobacterium tuberculosis (MTB). It can occur during pregnancy, in which its treatment can cause side effects, such as drug-induced liver injury (DILI). Tuberculous aneurysm due to TB infection is a rare occurrence, which can spread directly and hematogenously from the vascular wall. We report a case of bilateral multiple lower limb tuberculous aneurysms in a pregnant woman with DILI due to TB treatment.

Case: A 27-year-old pregnant woman at 14-15 weeks of gestation presented with painless lumps on the left side of her neck and both ankles. Fine needle aspiration biopsy (FNAB) of the left cervical lymph nodes confirmed tuberculous lymphadenitis. Vascular Doppler ultrasound of both lower limbs revealed multiple aneurysms, suspected to be infected tuberculous aneurysms with intramural thrombi, located on the lateral and anterior aspects of the distal leg extending to the left ankle, compressing the distal posterior and anterior tibial arteries. After one month of category one anti-TB drug (ATD) therapy, the patient developed elevated bilirubin levels (3.76 mg/dL). Following surgical intervention, the anti-TB regimen was resumed, leading to the resolution of the pseudoaneurysms by the fifth month of treatment.

Conclusion: Tuberculous aneurysm in pregnant patients with TB is a rare and potentially life-threatening condition. It is difficult to diagnose, but TB infection should be considered a possible cause in endemic countries. Surgery combined with anti-TB treatment improves outcomes.

Conservative Management of Chest Tube and Ambulatory Water Sealed Drainage in Persistent Pneumothorax due to Tuberculosis

2025-07-29T11:22:02+07:00

Introduction: Pneumothorax is characterized by the presence of air in the pleural cavity, which can result from various pulmonary conditions, including tuberculosis (TB). Conservative management, including the use of chest tubes with ambulatory water-sealed drainage (WSD), offers a viable alternative for patients who are ineligible for surgery or decline surgical intervention. This case report aimed to highlight that all treatment options should be discussed with the patient to determine their primary priority, with consideration for the least invasive option.

Case: A 22-year-old woman with secondary spontaneous pneumothorax due to TB presented with shortness of breath following a cough and was found to have a >2cm lucent area on chest X-ray. Initial management included chest tube insertion and WSD. A persistent pneumothorax was identified after 13 days of admission, and surgery was advised, but the patient declined. Conservative management was continued with ambulatory drainage for a total of 34 days, and management of TB as an underlying disease, and adequate nutritional support. Over the course of a month, clinical symptoms improved, and subsequent evaluations confirmed resolution of the pneumothorax. The chest tube was removed. The patient completed 12 months of anti-TB therapy, was declared cured, and experienced no recurrence of pneumothorax. Conservative management, including ambulatory WSD, effectively manages persistent air leak (PAL) for patients unsuitable for surgery. Ambulatory WSD facilitates mobility, reduces hospital stay, and minimizes complications. Proper patient education, nutritional support, and management of underlying conditions are essential for favorable outcomes.

Conclusion: The management of persistent pneumothorax should be guided by the patient’s clinical condition. Conservative management can yield favorable results, followed by best supportive management.

Disseminated Tuberculosis in An Immunocompetent Patient Presenting with Ptosis and Diplopia: A Case Report

2025-07-29T11:27:01+07:00

Introduction: Tuberculosis (TB) remains a global health burden to this day, with pulmonary TB (PTB) being one of its most common types. A lapse in the host immune response may lead to the dissemination of TB infection, causing extrapulmonary TB (EPTB) that is more difficult to manage, as it frequently shows atypical complaints. However, its manifestations among immunocompetent patients are rarely well-investigated.

Case: A 28-year-old human immunodeficiency virus (HIV)-negative woman presented with a history of chronic progressive bilateral headache, followed by diplopia and ptosis of her left eyelid. She also had classical TB symptoms 3 months prior. She had a history of household tuberculous contact for years, but she was never tested for TB nor given an anti-TB treatment (ATT). Chest X-ray revealed cavities and pleural thickening in the apex of the left lung. Contrast-enhanced magnetic resonance imaging (MRI) of the brain showed multiple intracranial tuberculomas and meningeal enhancement in most brain areas. GeneXpert tests from both sputum and cerebrospinal fluid (CSF) suggested TB infections. She was later diagnosed with simultaneous tuberculous meningoencephalitis (TBME) and PTB. After a 17-day course of oral ATT, streptomycin injection, and intravenous corticosteroid, she was discharged with improved clinical conditions and scheduled for outpatient follow-up until she completed 12 months of ATT.

Conclusion: In immunocompetent patients, disseminated TB is an uncommon occurrence and is frequently characterized by atypical symptoms. Findings from this case emphasize that comprehensive assessment and timely therapeutic intervention are critical for minimizing morbidity and mortality of TB infection.

A Big Data to Discovery: Network Analysis of COPD Research Collaborations from 2000 to 2023

2025-02-26T17:27:06+07:00

Introduction: Collaborative research is critical for advancing knowledge of chronic obstructive pulmonary disease (COPD). Over the last two decades, understanding the structure and evolution of research networks can provide insights into key contributors and trends in international cooperation. This study aimed to analyze the structure and evolution of collaborative networks in COPD research from 2000 to 2023, identifying key researchers and trends in international cooperation using co-authorship network analysis.

Methods: A dataset of 74,024 COPD-related publications indexed in the Web of Science (WoS) Core Collection was analyzed using Python (Version 3.10.5) in PyCharm (Version 2022.1.3). Macro-level metrics (network density, clustering coefficient, components, average path length) and micro-level metrics (degree centrality, closeness centrality, betweenness centrality) were calculated to evaluate collaboration intensity and researcher roles.

Results: The analysis revealed progressive growth in network density (from 0.00023 in 2000-2009 to 0.00020 in 2020-2023) and clustering coefficient (from 0.885 to 0.893), reflecting strengthened collaboration. Notable researchers, including P.J. Barnes (2000-2009), E.K. Silverman (2010-2019), and R.G. Barr (2020-2023), were identified as central figures. Despite improvements, network fragmentation remains a challenge. Many isolated components exist, and average distances between research groups remain infinite across all periods.

Conclusion: Chronic obstructive pulmonary disease research collaboration has grown significantly over the past two decades, driven by key contributors and increasingly cohesive local networks. However, the persistent fragmentation of the global network highlights the need for further integration to enhance knowledge dissemination and innovation. These findings underscore the importance of fostering broader, more inclusive international collaborations.

E-Cigarette or Vaping Use-Associated Lung Injury (EVALI): A Literature Review

2025-02-26T17:45:39+07:00

Electronic cigarettes (e-cigarettes) are electronic tools designed to produce an inhalable aerosol from a liquid solution. Electronic cigarette or vaping use-associated lung injury (EVALI) describes any lung damage linked to the consumption of e-cigarettes or vaping products. The liquids and aerosols from e-cigarettes can include tobacco-related nitrosamines, aldehydes, metals, volatile organic compounds, phenolic compounds, polycyclic aromatic hydrocarbons, tobacco alkaloids from tobacco, flavor additives, and various medicinal compounds. Substantial evidence indicates that substances like propylene glycol, vitamin E acetate (VEA), and heavy metals such as lead and arsenic are significant constituents of e-cigarettes, contributing to lung harm. Patients with EVALI may present with sudden or gradually developing respiratory disease, presenting with non-specific signs, including breathlessness, coughing, chest discomfort, and sometimes coughing up blood. Radiological findings in EVALI are often non-specific. The most commonly observed pattern in EVALI is parenchymal organizing pneumonia (OP), identified in 56% of cases, whereby bilateral dominant ground-glass opacity (GGO) was identified, located in the inferior sections of the lungs or diffusely distributed with varying degrees of consolidation.

The Impact of Viscose Rayon Fiber Exposure on Lung Function

2025-02-26T17:34:20+07:00

Viscose rayon fiber is a semi-synthetic material derived from regenerated cellulose. The cellulose used to make viscose rayon is extracted from natural sources, resulting in fibers that are physically similar to cotton and have characteristics such as softness and high absorbency. The viscose manufacturing process involves chemical modification of cellulose using carbon disulfide (CS₂), which is dangerous if exposed to humans. Carbon disulfide residues, along with endotoxin biological agents present on rayon fibers, can be inhaled into the respiratory tract. This causes oxidative protein damage, which then activates the oxidative stress response. This response ultimately results in the release of oxidants that induce inflammatory mediators, triggering acute or chronic inflammatory reactions in the airways and alveoli, resulting in decreased lung function. A systematic approach is essential for gathering and interpreting relevant data. This approach can be organized into seven steps to diagnose occupational lung diseases. The use of personal protective equipment (PPE) represents the final but most important defense. Recommended PPE includes respirator masks with suitable particle filters, protective eyewear to prevent eye irritation, chemical-resistant gloves to protect the skin from direct contact, and full-body work clothing.

Front Matter Vol 11 No 3, 2025

2025-10-03T11:04:13+07:00

Factors Associated with Outcomes of Acinetobacter baumannii Infection in Ventilator-Associated Pneumonia in the ICU of Dr. Moewardi General Hospital, Surakarta

2025-07-29T10:31:16+07:00

Introduction: Acinetobacter baumannii is a nosocomial pathogen with high mortality rates in intensive care units (ICUs) and is commonly associated with ventilator-associated pneumonia (VAP). Due to declines in physiological and immune functions, A. baumannii can trigger septic shock complications, thereby increasing mortality risk. This study aimed to identify the risk factors associated with outcomes in VAP patients in the ICU of Dr. Moewardi General Hospital, Surakarta.

Methods: This retrospective cohort study was conducted at Dr. Moewardi General Hospital, Surakarta, using patient medical records. Data were analyzed with Chi-square and Mann-Whitney U tests, followed by multiple logistic and linear regression to determine correlations between risk factors and outcomes (recovery, mortality, length of stay/LOS).

Results: This study included 80 patients with VAP caused by A. baumannii. Most patients were under 60 years old (52.5%), had good nutritional status (75%), were on ventilators for less than 10 days (63.75%), and had mild comorbidities (51.25%). Moderate-severe comorbidities (p=0.001) and malnutrition (p=0.005) were significantly associated with increased mortality. In addition, ventilator use ≥10 days was significantly associated with LOS (p<0.001).

Conclusion: Moderate-severe comorbidities and malnutrition were risk factors for mortality in patients with A. baumannii-related VAP, while ventilator use ≥10 days was a risk factor for prolonged hospitalization. Identifying these factors can help medical personnel manage conditions that worsen VAP outcomes and reduce the risk of A. baumannii-related mortality.

Significance Level of Pleural Fluid Tissue Inhibitor Metalloproteinase-1 (TIMP-1) and Glucose Levels as Biomarkers of Malignant Pleural Effusion

2025-07-29T10:36:58+07:00

Introduction: Distinguishing between malignant and non-malignant pleural effusions is often challenging due to overlapping biochemical profiles. Conventional diagnostic methods, including cytology and biopsy, are limited by their invasive nature, high costs, and potential complications. Emerging biomarkers, such as tissue inhibitor of metalloproteinase-1 (TIMP-1) and pleural fluid glucose levels, show promise as alternative diagnostic tools, but their clinical utility requires further validation. This study investigated the diagnostic value of TIMP-1 and pleural fluid glucose levels in differentiating malignant from non-malignant pleural effusions and explored their correlation in malignant cases.

Methods: This cross-sectional analytical study included patients with exudative pleural effusion, categorized as malignant or non-malignant based on cytology and/or biopsy results. Biomarker levels of TIMP-1 and pleural fluid glucose were measured using enzyme-linked immunosorbent assay (ELISA) and biochemical analysis. Diagnostic thresholds for both biomarkers were determined using receiver operating characteristic (ROC) curve analysis.

Results: Among 88 patients studied (33 malignant, 55 non-malignant), pleural fluid glucose levels were significantly lower in malignant cases (55.97 vs. 93.71 mg/dL; p=0.001), while TIMP-1 levels were notably higher (13.88 vs. 13.34 pg/mL; p<0.001). Tissue inhibitor of metalloproteinase-1 demonstrated superior diagnostic accuracy (86.5%) compared to glucose (70.6%) and the combined biomarker model (76.5%), with the sensitivity and specificity of 84.8% and 83.6%, respectively.

Conclusion: Elevated TIMP-1 levels and reduced pleural fluid glucose levels are promising diagnostic biomarkers for malignant pleural effusion (MPE). Tissue inhibitor of metalloproteinase-1 exhibited the highest diagnostic accuracy, highlighting its potential as a non-invasive diagnostic tool in clinical practice.

Factors Predicting the Length of Hospital Stay in Infants with Bronchitis at Bethesda Hospital, Yogyakarta

2025-07-29T10:38:19+07:00

Introduction: Bronchitis is a primary cause of hospitalization in toddlers due to acute respiratory infections (ARI). Hospitalization is particularly necessary in this age group because their immature immune systems render them highly vulnerable to complications such as respiratory failure and secondary infections. Elevated, inflammatory responses reflected by increased leukocyte counts necessitate close clinical monitoring and intensive care to prevent deterioration. Therefore, inpatient care plays a crucial role in ensuring the clinical stability and effective recovery of toddlers with bronchitis. This study analyzed the predictive factors influencing the length of hospital stay in toddlers with bronchitis treated at Bethesda Hospital, Yogyakarta.

Methods: This study employed a quantitative approach using an observational analytic method with a cross-sectional design. Data were collected from 90 medical records of 105 hospitalized toddlers aged 1-59 months due to bronchitis in 2023. Age, sex, nutritional status, hemoglobin (Hb) levels, and leukocyte count were the analyzed variables. The data were analyzed using Chi-square and logistic regression.

Results: Age and leukocyte count were significantly associated with the length of hospital stay (p<0.05). Younger toddlers were more likely to experience prolonged hospitalization (adjusted odds ratio/OR=0.242), while an increased leukocyte count (leukocytosis) elevated the risk of a longer hospital stay (adjusted OR=4.137). Other variables, including sex, nutritional status, and Hb levels, did not significantly influence prolonged hospitalization.

Conclusion: Age and leukocyte count were predictive factors for the length of hospital stay in toddlers with bronchitis at Bethesda Hospital, Yogyakarta, in 2023.

Analysis of Urinary Midkine and Volatile Organic Compound (VOC) Levels Using a Breath Analyzer for Screening and Early Diagnosis of Lung Cancer

2025-07-29T11:13:13+07:00

Introduction: Lung cancer is the leading cause of cancer-related mortality worldwide. Midkine, a heparin-binding growth factor, promotes proliferation, angiogenesis, and metastasis. Volatile organic compounds (VOCs) reflect cellular and molecular changes, aiding in cancer diagnosis. This study explored urinary midkine and VOC profiles as biomarkers for lung cancer screening and early diagnosis.

Methods: A case-control, cross-sectional study was conducted on 20 controls (family members of lung cancer patients) and 20 lung cancer patients who had not received therapy. Volatile organic compounds breath analysis and urinary midkine measurements were performed. Volatile organic compounds, including total volatile organic compounds (TVOCs), ethanol (C2H5OH), formaldehyde (CH2O), toluene (C7H8), acetone (C3H6O), hexane (C6H14), and methane (CH4), were collected from exhaled breath using Tedlar bags and measured with a µβreath analyzer. Meanwhile, urinary midkine levels were determined using the Enzyme-Linked ImmunoSorbent Assay (ELISA) method. Statistical analyses included an independent t-test, Mann-Whitney U test, Spearman correlation, and diagnostic testing with receiver operating characteristic (ROC) analysis.

Results: Urinary midkine levels were higher in lung cancer patients than in controls (330.56±120.50 vs. 282.18±146.28 pg/mL), although not significant (p>0.05). The independent t-test revealed that ethanol levels were significantly elevated in lung cancer patients (p < 0.001), whereas methane levels were not (p > 0.50). Receiver operating characteristic analysis demonstrated sensitivity and specificity: urinary midkine (60%, 60%), ethanol (75%, 75%), and methane (45%, 45%).

Conclusion: Ethanol VOC appears to be a promising non-invasive biomarker for the early detection of lung cancer, whereas elevated urinary midkine levels did not demonstrate significant diagnostic value.

Zinc Intake and Appetite in Patients with Post-Tuberculosis Lung Disease at Persahabatan National Respiratory Referral Hospital, Jakarta

2025-07-30T15:10:00+07:00

Introduction: After completion of pulmonary tuberculosis (TB) treatment, some people may continue to experience respiratory issues that can progress into post-TB lung disease (PTLD). Individuals with PTLD exhibit suboptimal nutritional status. The loss of appetite is a significant factor influencing nutritional status. Zinc plays a role in hunger control. Lack of zinc reduces taste sensitivity and food intake. This study examined the relationship between zinc intake and appetite in patients with PTLD at Persahabatan National Respiratory Referral Hospital, Jakarta.

Methods: This cross-sectional study was conducted at Persahabatan National Respiratory Referral Hospital, Jakarta, from November 2024 to March 2025. Eighty-five adult patients with PTLD were included. Zinc intake was assessed by a semi-quantitative food frequency questionnaire (SQ-FFQ) and analyzed by NutriSurvey software. Appetite was measured using the visual analog scale (VAS) for appetite.

Results: A total of 85 subjects participated in the study, comprising 78.8% males and 21.2% females. The average daily zinc intake was 4.4 mg/day, and 92.9% of the subjects had zinc intake below the recommended dietary allowance (RDA). The average VAS appetite score was 70 mm. A significant positive correlation was found between zinc intake and appetite, indicating that a decrease in zinc intake might result in a reduced appetite (r=0.266, p=0.014).

Conclusion: Zinc intake is positively associated with appetite in patients with PTLD. Therefore, zinc intake monitoring is essential for supporting nutritional recovery and lung function in PTLD.

Age and Diabetes Mellitus Associated with Hematological Disorders and Peripheral Neuropathy in MDR-TB Patients Treated with the BPaL/M Regimen

2025-07-29T11:15:54+07:00

Introduction: Tuberculosis (TB) is a disease with a significant treatment burden. Current multidrug-resistant (MDR)-TB therapy uses the bedaquiline, pretomanid, linezolid, and moxifloxacin (BPaL/M) combination. This combination is effective with a short treatment duration. Linezolid is one of the components of the BPaL/M regimen. However, despite its effectiveness, it has side effects that impact treatment management and success. This study aimed to find the association between characteristics and comorbidities with the incidence of linezolid side effects in patients with MDR-TB treated with the BPaL/M regimen.

Methods: This was a retrospective analytic study of MDR-TB patients receiving BPaL/M combination. Data were collected from medical records and analyzed using Fisher's exact test to analyze the association between patient characteristics and comorbidities with the incidence of linezolid side effects, namely hematological disorders, peripheral neuropathy, and visual disturbances.

Results: There was no significant association between overall patient characteristics and the incidence of linezolid adverse events. However, the results of bivariate analysis showed a significant association in age >50 years old with the incidence of hematological disorders, as well as in patients who have diabetes mellitus (DM) with the incidence of peripheral neuropathy as a side effect of linezolid.

Conclusion: Monitoring of MDR-TB patients aged >50 years old and those with DM to minimize the incidence of side effects during treatment is essential. This effort is expected to support the success of the national TB control and treatment program.

Fungal Profile in Patients with Lung Cancer Receiving First-Line Chemotherapy

2025-07-29T10:42:12+07:00

Introduction: Patients with lung cancer are vulnerable to opportunistic infections, particularly fungal pulmonary infections such as those caused by Aspergillus spp., due to immunosuppression from both the disease and chemotherapy. Despite the clinical significance of these infections, data on their prevalence and associated factors in patients with lung cancer remain limited. This study aimed to determine the prevalence of Aspergillus spp. and identify associated factors in patients with lung cancer who underwent first-line chemotherapy at a national respiratory referral hospital in Indonesia.

Methods: A cross-sectional study was conducted among 50 patients with lung cancer who had completed at least three cycles of chemotherapy. Sputum cultures were performed using Sabouraud dextrose agar (SDA), and serum immunoglobulin G (IgG) antibodies were tested using immunochromatographic assays. Demographic, clinical, and radiological data were collected. Bivariate and multivariate logistic regression analyses were used to identify factors associated with Aspergillus spp. infection.

Results: Aspergillus spp. was detected in 92.0% of patients via sputum culture, with A. niger and A. fumigatus as the most common isolates. Over 30% showed co-colonization with other fungal species, such as Candida. Multivariate analysis revealed that a high Brinkman Index was independently associated with Aspergillus spp. colonization (p<0.05). Serum IgG antibody positivity was low (4%).

Conclusion: There was a high prevalence of Aspergillus spp. colonization among patients with lung cancer undergoing chemotherapy, with smoking history emerging as a key risk factor. Targeted fungal screening is recommended, especially in heavy smokers, to facilitate early detection and improve outcomes.

Back Matter Vol 11 No 3, 2025

2025-10-03T11:05:02+07:00