Jurnal Respirasi

CYP2A6 Genetic Polymorphism and Nicotine Metabolism of Male Smokers in Indonesia

Chaliza Soliha — 2024-05-31

Introduction: One of the main ingredients in cigarettes is nicotine, which has a significant impact on a person's dependence on cigarettes. Nicotine can be detected in a smoker's urine as a sign that his body is processing nicotine. The important enzyme CYP2A6 is involved in nicotine metabolism. This study aimed to determine the relationship between CYP2A6 genetic polymorphisms and nicotine metabolism among male smokers in Indonesia.

Methods: This study included 100 male smokers who met the inclusion criteria in a cross-sectional design using a consecutive sampling between the ages of 20 and 65 years old. Restrictions fragment length polymorphism (RFLP) of the polymerase chain reaction (PCR) was applied to examine the genetic polymorphism of CYP2A6, and nicotine metabolite levels in urine were examined by high-performance liquid chromatography (HPLC) examination.

Results: This study involved one hundred smokers, and 78 tested positive for the CYP2A6 polymorphism. The CYP2A6 genetic polymorphism and nicotine metabolism were not significantly correlated (p-value > 0.05). Allele *1A and genotype 1B/1B were more common in this study population. The majority of study participants had fast metabolic rates.

Conclusion: No correlation was seen between the genetic polymorphisms of CYP2A6 and nicotine metabolism in Indonesian male smokers. Consequently, it is crucial to conduct future research in diverse populations with larger samples.

D-Dimer and Brixia Score to Mortality in COVID-19 Patients

Silvy Amalia Falyani — 2024-05-31

Introduction: Coronavirus disease 2019 (COVID-19) is a highly contagious severe and acute respiratory syndrome caused by the SARS-CoV-2 virus. A variety of factors can increase a patient's risk of death, including coagulopathy characterized by increased D-dimer levels. Brixia scores could be one of the determinants of COVID-19 severity, as assessed by chest radiographs. This study aimed to analyze chest radiographic severity based on the Brixia score at the degree of coagulation based on D-dimer in mortality of COVID-19 patients who were hospitalized.

Methods: This cohort retrospective study was conducted at Dr. Saiful Anwar General Hospital, Malang, using an observational cross-sectional design. The study included 300 medical records of COVID-19 patients who passed away while hospitalized. The data were analyzed using the Wilcoxon test, and the results were also tested for Spearman correlation to determine the relationship between variables.

Results: Significance results of median D-dimer were found by age and severity of COVID-19 (p-values 0.015 and 0.002), and median Brixia scores by age, gender, severity of COVID-19, and length of treatment (p-values 0.001, 0.001, 0.001, and 0.005). The results were also compared with normal values, which were significant (p = 0.000). Spearman correlation test results between the final D-dimer and the initial Brixia score (p = 0.005).

Conclusion: The research results display a retrospective study of the correlation between D-dimer and Brixia score values and outcomes in COVID-19 patients. Higher D-dimer values and Brixia scores on admission were shown to be associated with mortality.

Comparison of Anxiety Levels in MDR-TB Patients with Individual and Short-term Regimens at Dr. Soebandi Regional General Hospital, Jember, Indonesia

Muhammad Rifqy Alvy Widodo — 2024-05-31

Introduction: Multidrug-resistant tuberculosis (MDR-TB) is a form of TB that shows resistance to both isoniazid and rifampicin. Globally, the number of new MRD-TB cases has continued to rise since 2020. Indonesia is positioned among the top ten countries with the highest incidence of MDR-TB worldwide. Specifically, Jember ranked second in the number of MDR-TB cases in East Java. This study aimed to assess the comparison between the administration of individual MDR-TB regimens and short-term regimens concerning anxiety levels in MDR-TB patients at Dr. Soebandi Regional General Hospital, Jember.

Methods: This was an analytical observational study with a cross-sectional design. It was conducted at Dr. Soebandi Regional General Hospital, Jember, using interviews and medical record data from August to September 2023. The sample size was 69 participants, who were obtained through consecutive sampling. Analysis was performed using the Statistical Package for the Social Sciences (SPSS) and the Chi-Square test for group comparisons.

Results: This study found that 64% of subjects received individual regimens. In the individual regimen group, 80% of subjects reported anxiety. Among the short-term regimen group, 60% of subjects showed no anxiety. The significance value of this study was 0.007 in the Chi-Square test for group differences.

Conclusion: There was a difference in anxiety levels between individual and short-term regimens among MDR-TB patients at Dr. Soebandi Regional General Hospital, Jember. Patients with anxiety were more common in individual regimens compared to short-term regimens.

The Dynamic of Smoking Behavior through the Course of Tuberculosis Illness: A Hospital-Based Study in Medan, Indonesia

Nanda Safira — 2024-05-31

Introduction: Smoking is associated with the prognosis of tuberculosis (TB). The diagnosis of TB in patients who smoke or recently quit smoking can be a pivotal moment that motivates them to continue quitting smoking. However, there is a paucity of information on changes in smoking status among TB patients through the course of the disease. This study presented self-report smoking status during the pre-symptomatic, post-symptomatic, intensive treatment, and continuation treatment phases among TB patients receiving treatment.

Methods: This was a cross-sectional study conducted at four hospitals in Medan, Indonesia, from December 2019 to February 2020. For at least one month, healthcare workers invited TB patients who had received treatment at the hospitals’ TB-Directly Observed Treatment Shortcourse (DOTS) clinics to participate in this study. Trained enumerators collected the data through face-to-face interviews, in which the patients self-reported information on their smoking status at various phases.

Results: Of 285 patients who met the inclusion criteria, 277 gave their consent (97% participation), of whom 146 never smoked in their lifetime. Among 131 ever smokers, 88 (67%) had quit smoking before or during the pre-diagnosis phase, 65 (51.6%) of whom remained quitters throughout the course of the disease. Thirty-eight patients continued to smoke after symptom onset, and more than half of them had stopped smoking by the continuation phase of treatment.

Conclusion: Smoking cessation was relatively common after the appearance of TB symptoms and after diagnosis. However, some patients subsequently relapsed, while others were unable to quit smoking. Social desirability could have influenced the responses and should be considered in interpreting the study findings.

The Effect of Anemia on Prognostic in Patients with Non-Small Cell Lung Cancer Receiving Platinum-Based Chemotherapy

Ulfah Kartikasari — 2024-05-31

Introduction: Lung cancer has the highest incidence and mortality rate, which contributes to approximately 2.2 million cancer cases (11.4%) of total cancers worldwide. More than 70% of lung cancer cases present in the late, non-operable stage. Anemia is one of the conditions that could precipitate cancers and affect the patient’s clinical presentation, including tissue oxygenation, organ function, and quality of life. It could also increase the risk of bleeding, post-operative mortality, and iron absorption rate in the case of ineffective erythropoiesis. All of these could affect the prognostic factor of the cancer. This study aimed to evaluate the effect of the severity of anemia on overall survival (OS) and progression-free survival (PFS) in patients with non-small cell lung cancer (NSCLC) treated with platinum-based chemotherapy.

Methods: This was a retrospective cohort study involving 80 subjects of NSCLC patients treated with platinum-based chemotherapy from January 2018 to December 2020. Subjects were divided into two groups (39 patients in the normal group and 41 patients in the anemia group).

Results: The mean pre-treatment hemoglobin was 10.55 ± 1.25 g/dL in NSCLC patients with anemia. The normal and anemia groups' bone metastasis, OS, and PFS values were significant (p = 0.008; p = 0.002; p = 0.27, respectively). Anemia was significantly related to OS (r = 0.146, p = 0.000) and PFS (r = 0.264, p = 0.000) in NSCLC patients treated with platinum-based chemotherapy.

Conclusion: Higher severity of anemia can reduce OS and PFS in NSCLC patients treated with platinum-based chemotherapy.

Determining Factors for Smoking Habits and FeNO Levels in Male College Student Smokers

Irfan Hasyim Tadjoedin — 2024-05-31

Introduction: Smoking remains a pervasive and persistent health issue in Indonesia. Numerous studies have explored the impact of smoking and fractional exhaled nitric oxide (FeNO) levels on college students. However, none have been conducted in Indonesia. With a substantial number of smokers and teenage smokers in the country, there is a critical need to understand the implications of smoking. This study aimed to enhance the comprehension of the motivations behind smoking habits and, consequently, to devise more effective smoking cessation programs. It specifically sought to elucidate the relationship between smoking habits and exhaled nitric oxide (NO) levels among college students and to explore the reasons why students smoke.

Methods: This study employed analytical and descriptive cross-sectional approaches. We interviewed 124 participants, 30 of whom were randomly selected for FeNO-level testing.

Results: The mean age of the subjects was 20.1 ± 1.54 years. Of these, 48 (38.7%) were enrolled in science and technology programs and 76 (61.3%) in social sciences. The Brinkman index predominantly indicated a mild level of smoking (96.8%), with a moderate level observed in 3.2% of the subjects. The median FeNO level was 12 ppb. According to the Horn questionnaire, the most cited reasons for smoking were pleasure (71%), followed by stress relief (66.1%) and stimulation (38.7%). No significant correlation was found between the Brinkman index and FeNO levels.

Conclusion: The primary factors influencing smoking habits among the subjects were stress relief and the pleasure derived from smoking. No correlation was observed between smoking habits and exhaled NO levels.

Neutrophil-Lymphocyte Ratio and Nutritional Status as Parameters of Sputum Conversion in MDR-TB Before & After 3 Months of Anti-TB Treatment

Putri Maria Regina — 2024-05-31

Introduction: The prolonged duration of tuberculosis (TB) treatment has led to an increase in non-compliance among TB patients undergoing anti-TB treatment, consequently leading to treatment failure and drug resistance, notably multidrug-resistant TB (MDR-TB). Individuals with poor nutritional status may elevate the risk of delayed sputum conversion in MDR-TB patients. The neutrophil-lymphocyte ratio (NLR) represents a laboratory parameter with potential as a prognostic indicator in patients suspected of TB infection.

Methods: This was an analytical study with a cross-sectional design. The sample was drawn from the medical records of MDR-TB patients at Haji Adam Malik General Hospital, Medan, from October 2022 to March 2023 resulting in a total of 83 samples. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) version 25 software, and bivariate analysis was conducted using paired t-test.

Results: Out of 83 MDR-TB patients, 50 (60.2%) were male. Based on nutritional status before three months of anti-TB treatment, the most common nutritional status was normal with 22 individuals (26.5%) and severely underweight with 36 individuals (43.4%). Following three months of anti-TB treatment, the majority had normal, totaling 39 individuals (47%). A total of 67 individuals (80.7%) experienced sputum conversion. The results indicated a significant difference between NLR before and after three months of anti-TB treatment (p = 0.000), as well as a significant difference between nutritional status before and after three months of anti-TB treatment (p = 0.012) at Haji Adam Malik General Hospital, Medan.

Conclusion: Significant differences were observed in NLR and nutritional status before and after three months of anti-TB treatment.

Front Matter Vol 10 No 2, 2024

Front Matter — 2024-05-31

The Role of Macronutrients in Chronic Obstructive Pulmonary Disease: A Review

Anastasia Kristy — 2024-05-31

The incidence of chronic obstructive pulmonary disease (COPD) is rising and is still regarded as one of the challenging medical issues. Regardless of the main relationship between tobacco smoking and toxic particle exposure with COPD, factors like nutritional status also play an important role in COPD progression and outcome, as the factor is an adaptable aspect. Malnutrition, sarcopenia, and obesity are nutritional problems that are often encountered in COPD patients. Macronutrients, namely carbohydrates, fat, and protein, support the adjunctive treatment options for COPD. The ideal dietary pattern includes low carbohydrates, medium fats preferably polyunsaturated fatty acids (PUFA), and high proteins to improve COPD symptoms, preserve muscle mass, and delay disease progression. High carbohydrate intake might also increase the respiratory quotient (RQ) which results in higher carbon dioxide (CO₂) production and oxygen (O₂) demand compared to fat and protein intake. Daily calorie intake should be adjusted to personal nutritional status. Higher calories in malnourished, sarcopenic patients and targeted weight loss in obese patients show improvements in lung function, frequency of exacerbations, and hospitalization rate. In obese individuals with COPD, however, maintaining a slightly higher body mass index (BMI) of 25-30 kg/m² was associated with lower mortality. This literature review summarized the significant role of macronutrients in COPD patients and the practical approach to macronutrient intervention in individuals with different nutritional statuses.

Effectivity of Telemonitoring Toward Quality of Life in Patients with Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review and Meta-Analysis

Ananda Pipphali Vidya — 2024-05-31

Introduction: Chronic obstructive pulmonary disorder (COPD) is the third-leading cause of death worldwide. COPD treatment is essential to manage and attenuate the progression of symptoms. Home-based telemonitoring interventions showed several promises in increasing COPD patients’ quality of life (QoL) and outcomes. However, various results were obtained in recent studies, making a secondary research presence needed to establish clear risks and benefits. This study aimed to analyze the effect of telemonitoring on QoL among COPD patients.

Methods: This study used the Preferred Reporting Items of Systematic Review and Meta-Analysis (PRISMA) reporting guidelines on several databases from February until April 2023. We performed screening and selection, followed by data extraction and quantitative analysis with Review Manager 5.4 Software. The risk of bias assessment was performed using the RoB 2.0 Cochrane tool.

Results: Ten randomized controlled trials (RCTs), mostly low-risk of bias, were included. We found a reduction in Saint George's Respiratory Questionnaire (SGRQ) score (mean difference (MD) -1.13 [95% CI -4.23, 1.97; p = 0.47]) and Hospital Anxiety and Depression Scale (HADS) for anxiety (MD-0.16 [95% Cl -0.96, 0.63; p = 0.69]). There was no significant effect of HADS on depression and EuroQol-5 Dimension (EQ-5D).

Conclusion: This study suggests that telemonitoring improves QoL in COPD patients, especially for SGRQ and HADS anxiety scores. We suggest a larger number of studies to evaluate the effect of telemonitoring on depression and anxiety. We also encourage the integration of telemedicine with the present care system to achieve the best beneficial outcome for patients.

Pregnancy-Related Disorders and Intrauterine Impaired Lung Development

Harry Agustio Zulhadji — 2024-05-31

Various pregnancy-related disorders are known to affect fetal lung development negatively. During pregnancy, chronic nutrition and/or oxygen limitation is known to impede lung maturation and induce airway and lung abnormalities. Structural abnormalities and reduced lung function may be evident immediately after birth, persist, or develop with age. The expansion of the fetal lung, fetal breath movements, fetal lung growth, alveolarization, blood-air barrier, extracellular matrix (ECM), airways, surfactant system, and lung immune function are all affected by nutritional limitations during pregnancy. Gestational hypoxia disrupts fetal lung development, which manifests as morphological and functional pulmonary abnormalities. Additionally, intrauterine growth restriction (IUGR), preeclampsia (PE), exposure to air pollution, and smoking are known to interfere with embryonic lung development. Birth defects, such as bronchopulmonary dysplasia, as well as chronic obstructive pulmonary disease (COPD), can be caused by abnormalities in pregnancy. Adequate nutrition, avoidance of smoking, and watchful monitoring and intervention during pregnancy should be promoted to prevent chronic lung disease of the newborn, child, and adult.

Giant Cell Lung Carcinoma: A Case Report of a Rare Histology Type of Non-Small Cell Lung Cancer

Kadek Sri Adi Putri — 2024-05-31

Introduction: Giant cell carcinoma (GCC) of the lung is a subtype of lung cancer, undifferentiated non-small cell carcinoma, in which there are no features of small cell carcinoma, adenocarcinoma, or squamous cell carcinoma. Due to its aggressive clinical manifestations and peculiar pathological features, GCC of the lung is a highly anaplastic variant of bronchogenic carcinoma.

Case: A 45-year-old woman was clinically suspected of having a lung malignancy, and a biopsy of the right lower lobe pleura and parietal pleura was performed. The histopathology showed hypercellular tumor cell clusters, forming a syncytia-like sheet pattern. Tumor cells were pleomorphic and contained many giant cells that confirmed the diagnosis of GCC. The patient was diagnosed with GCC of the lung, stage IVB, Karnofsky scores 50-60% with malignant pleural effusion, peritoneal metastases, bone metastases, and grade 3 malignant ascites with bacterial peritonitis. The patient passed away due to septic shock caused by bacterial peritonitis. GCC of the lung is one of the aggressive types of lung cancer. GCC has an unusual tendency to metastasize to the gastrointestinal tract. In this case, the patient had an enlarged abdomen since it was known that she had a malignancy that had continued to grow. From the ascitic fluid analysis, a carcinoma was found to be seeding.

Conclusion: The prognosis of GCC of the lung is generally poor. Our case was diagnosed with GCC of the lung that had already spread to the bone, peritoneal, and had grade ascites. The patient's survival rate was generally poor, and she passed away due to bacterial peritonitis without having received any therapy for her cancer.

Sticky Fibrin Adhesion: Enlightenment from a Case of Tuberculous Pleurisy

Budi Yanti — 2024-05-31

Introduction: Tuberculous pleurisy (TP) is the pleural inflammation caused by Mycobacterium tuberculosis (MTB) and a rare manifestation of childhood tuberculosis (TB). It is characterized by a large amount of fibrin, sticky adhesion, and even calcification. Pleural adhesion can significantly affect respiratory function and quality of life. Therefore, early detection, prompt therapy, and drainage of pleural effusion are crucial for preventing pleural adhesion. This case report is intended to enhance clinician awareness regarding avoiding and managing pleural thickening in TP.

Case: A 14-year-old child had shortness of breath, fever for 2 weeks, cough, loss of appetite, and no smoking history. The laboratory results showed anemia and non-reactive human immunodeficiency viruses (HIV), analyzed pleural fluid monocyte showed 72%, and glucose 58%. Adenosine deaminase (ADA) analysis showed a rise above 61 U/L. The tuberculin skin test was negative. The chest X-ray showed right pleural effusion, the chest ultrasonography revealed a right hemithorax echo-free plane, and the computed tomography (CT) scan showed right pleural effusion and pulmonary fibrosis. The thoracoscopy view showed fibrinous adhesion-producing tenting and vascularization in the base without multiple nodules. Water-sealed drainage was performed and produced approximately 3,450 ml with serous xanthochromia. Then the patient was diagnosed with TP and treated with anti-TB drugs and steroids.

Conclusion: Typical TP with fibrinous adhesions is an infrequent condition. This case report highlighted the importance of extensive screening using a thoracoscopy view and ADA analysis in patients with TP, especially in countries with a high TB burden.

Epididymo-Orchitis: A Rare Manifestation of Tuberculosis Infection

Yoshua Ariel Pattiselanno — 2024-05-31

Introduction: Tuberculosis (TB) is caused by Mycobacterium tuberculosis (MTB) and now represents a significant global health concern, with an estimated 10 million people infected with TB in 2022, equivalent to 133 incident cases per 100,000 population. Indonesia faces a substantial burden. The World Health Organization (WHO) estimates 969,000 TB cases, with 717,941 confirmed cases reported. Extrapulmonary TB, contributing to 15% of TB cases, affects various areas such as bones, pleura, lymph nodes, genitourinary system, peritoneum, and meninges. Tuberculous epididymo-orchitis, a rare type of extrapulmonary TB, is characterized by MTB infection in the epididymis or testis.

Case: A 31-year-old male was presented to the Emergency Department of Budi Rahayu General Hospital, Pekalongan, with a fever, bitter taste, body aches, and cough. Initially hospitalized for five days and discharged upon improvement of symptoms, the patient returned with fatigue, cough, and black stools. After being admitted under internist and pulmonary specialist care due to a suspected left lung TB apical lesion, biomolecular testing (GeneXpert) was performed. Consultation with a urologist revealed scrotal pain, prompting further tests including urine acid-fast bacilli (AFB) examination, testicular ultrasound, and aspiration culture. The patient was diagnosed with TB epididymo-orchitis and treated with a Category 1 TB regimen.

Conclusion: TB epididymo-orchitis is a rare case requiring thorough diagnostic evaluation encompassing anamnesis, physical examination, and diagnostic procedures. Early detection and appropriate management are vital in combating this challenging disease.

Back Matter Vol 10 No 2, 2024

Back Matter — 2024-05-31