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"ABSTRACTPurposeThe lung allocation score (LAS) has been generally recognized as a contributor to the overall survival in lung transplant candidates. However, donor-related risks have never been taken into consideration in previous research that validated the LAS. This study aimed to determine whether or not the role of the LAS as a predictor of the posttransplant outcome is influenced by the quality of the donor lungs.MethodsWe retrospectively reviewed 108 patients who underwent lung transplantation at Okayama University Hospital since 1998. The cohort was divided into two groups based on the lung donor score (DS; ≤ 4/> 4). Correlations between the LAS and posttransplant outcomes were investigated in both groups.ResultsIn the high-DS group, an elevated LAS was strongly associated with posttransplant PaO2/FiO2 (p = 0.018). However, in the low-DS group, no correlation was found between them. There was no significant difference in the long-term survival according to the LAS in the low-DS group. The LAS effectively predicted the posttransplant outcome only when lungs with DS > 4 were transplanted; the LAS was not reliable if high-quality lungs were transplanted.ConclusionLung transplantation can be feasible and provides a survival benefit even for high-LAS patients if lungs from a low-risk donor are transplanted."

"This title covers the use of high-res computed tomography for diagnosis and assessment of diffuse lung diseases. This reference offers a thorough grounding in HRCT interpretation, offering the latest technical and clinical data, including recent advances in the classification and understanding of diffuse lung diseases and their HRCT appearances.Looking for the seminal guide to HRCT and lung abnormalities? Get the newly revised and updated 5th edition of High-Resolution CT of the Lung, the leading reference on the use of high-res computed tomography for diagnosis and assessment of diffuse lung diseases. Written by leading experts in the field, this comprehensive reference offers a thorough grounding in HRCT interpretation, offering the latest technical and clinical data, including recent advances in the classification and understanding of diffuse lung diseases and their HRCT appearances.Features: new: full-color illustrations of histo."

"Aim: to assess the quality of life (QOL) of lung cancer patients.Subject and methods: Twenty-four subjects were interviewed, and questionnaires were filled to evaluate the subjective quality of life of the patients. Objective evaluation was conducted using the Karnofsky Performance Status (KPS). Subjective evaluation included physical, social, and spiritual dimensions. Evaluation was conducted at the time of diagnosis (initial phase, 24 subjects), and reevaluation was conducted during the adaptive phase (21 subjects).Time and place: the Department of Internal Medicine, Faculty of Medicine of the University of Indonesia, Dr. Cipto Mangunkusumo National Central General Hospital and Dharmais Cancer Hospital, Jakarta, from January 2001 to January 2002.Results: At the time of diagnosis 1 subject had poor QOL, 18 (75%) had moderate QOL, and 5 had high QOL. At the reevaluation, 8 had mild QOL and 13 had high QOL.Conclusions: There was a significant increment of quality of life from the time of diagnosis to the second evaluation.Abbreviations: (QOL) quality oflife,(KPS)Karnofsky Perfomance Status"

"Background : The treatment of lung tuberculosis in patient with diabetes mellitus comorbidity is still a major problem because of high incidence rate, unfavourable outcome and failure. In indonesia, there is no specific study about outcome, characteristics and profile patient with this unfavourable outcome.Objectives : To identify the treatment outcome, patient characteristic and patient profile for unfavourable outcome.Methods : This is a retrospective cohort study, analyzing medical record of lung tuberculosis patient with diabetes mellitus comorbidity that treated in Cipto Mangunkusumo Hospital from January 2013 to December 2018. Unfavourable outcome as defined by Tb-DOTS national program consist of subject with failure to treat, death, loss to follow up and transferred out without known of final results. Result : A total of 141 subject enrolled in this study, with median age of subject was 57 years (range 28 to 79 years) and majority subject is male (56.03%), Tb relapse found in 24.11% subject. Outcome of Tb treatment based on National Program was treatment complete in 51.77%, Cure in 1.42%, loss to follow up in 31.91%, transferred out in 14%, and died in 7% subjects. Unfavourable outcome found in 46.81% subject, with majority found in male subject, married, working subject, actively smoking, subject with previous Tb treatment, non-adherence, previously known diabetes, underweight or normoweight subject, reduce eGFR below 60 ml/min/1.73m2, subject with insulin therapy on intensive phase, and poorly controlled diabetes.Conclusion : Unfavourable outcome found in 46,81% subject, will loss to follow up was the highest composition (31.91%)."

"ABSTRACTPurpose: Gastrointestinal complications after lung transplantation (LTx) are an important postoperative morbidity associated with malnutrition and the malabsorption of drugs. We reviewed our experience of managing gastrointestinal complications after LTx.Methods: Between June, 2008 and April, 2017, 160 lung transplants were performed at our institution, as living-donor lobar lung transplants in 77 patients, and as deceased-donor lung transplants in 83. We reviewed, retrospectively, the incidence, type and management of gastrointestinal complications.Results: Among the 160 LTx recipients, 58 (36.3%) suffered a collective 70 gastrointestinal complications, the most frequent being gastroparesis, followed by gastroesophageal reflux disease. Two complications were managed surgically, by Nissen fundoplication for gastroesophageal reflux disease in one recipient and Hartmann's operation for sigmoid colon perforation in one. The other 68 complications were managed medically. Two patients died of complications: one, of aspiration pneumonia caused by gastroparesis; and one, of panperitonitis caused by a gastric ulcer. There were no significant differences in overall survival or chronic lung allograft dysfunction-free survival between the patients with and those without gastrointestinal complications.Conclusions: Gastrointestinal complications are not uncommon in LTx recipients and may be serious; therefore, early detection and appropriate treatment are imperative. Surgical management is required for some complications, but most can be managed medically."

"ASBTRACTPurpose: Airway complications (ACs) after living-donor lobar lung transplantation (LDLLT) could have different features from those after cadaveric lung transplantation (CLT). We conducted this study to compare the characteristics of ACs after LDLLT vs. those after CLT and investigate their impact on outcomes.Methods: We reviewed, retrospectively, data on 163 recipients of lung transplantation, including 83 recipients of LDLLT and 80 recipients of CLT.Results: The incidence of ACs did not differ between LDLLT and CLT. The initial type of AC after LDLLT was limited to stenosis in all eight patients, whereas that after CLT consisted of stenosis in three patients and necrosis in ten patients (p = 0.0034). ACs after LDLLT necessitated significantly earlier initiation of treatment than those after CLT (p = 0.032). The overall survival rate of LDLLT recipients with an AC was significantly lower than that of those without an AC (p = 0.030), whereas the overall survival rate was comparable between CLT recipients with and those without ACs (p = 0.25).Conclusion: ACs after LDLLT, limited to bronchial stenosis, require significantly earlier treatment and have a greater adverse impact on survival than ACs after CLT."

"Latar Belakang: Penyakit paru interstisial (ILD) merupakan salah satu manifestasi sklerosis sistemik (SSc) pada paru dan faktor mortalitas utama SSc. SSc-ILD meningkatkan angka mortalitas 5 tahun pasien SSc sebesar 3 kali lipat. Hampir dua pertiga pasien SSc-ILD dengan kelainan minimal pada high resolution computed tomography (HRCT) toraks memperlihatkan progresivitas signifikan dalam 2 tahun. Model prediksi progresivitas SSc-ILD yang tersedia, yakni GAP (gender, age, and lung physiology) dan SADL (smoking history, age, and diffusion capacity of the lung), terbukti memiliki nilai prognostik yang baik. Model prognostik yang melibatkan parameter HRCT toraks dan Modified Rodnan Skin Score (mRSS) diharapkan dapat membantu seleksi pasien SSc-ILD yang memerlukan pemantauan ketat atau terapi dini untuk mencegah progresivitas.Metode: Studi ini melibatkan pasien SSc-ILD yang menjalani pemeriksaan HRCT toraks awal dan evaluasi di Rumah Sakit Umum Pusat Nasional Dokter Cipto Mangunkusumo pada periode Januari 2016 hingga Desember 2021. Dilakukan volumetri kuantitatif menggunakan piranti lunak 3DSlicer® pada HRCT toraks awal untuk menghasilkan persentase volume paru abnormal, high attenuation area (HAA), dan low attenuation area (LAA) yang selanjutnya dianalisa sebagai faktor prognostik. Pola ILD pada HRCT toraks awal dan nilai mRSS masing-masing subyek diidentifikasi dan dianalisa sebagai faktor prognostik progresivitas SSc-ILD. Progresivitas SSc-ILD dikategorikan menjadi progresif dan non-progresif berdasarkan selisih persentase volume paru abnormal antara HRCT toraks awal dan evaluasi.Hasil: Perbedaan rerata yang bermakna ditemukan pada volume paru abnormal, volume HAA, dan volume LAA, nilai mRSS antara SSc-ILD progresif dan non-progresif (p < 0,001). Berdasarkan receiver operating characteristic curve, ditetapkan nilai titik potong dari masing-masing variabel. Nilai titik potong persentase volume paru abnormal ditetapkan sebesar 32,82% dengan nilai sensitivitas 100% dan spesifisitas 93,8%. Nilai titik potong persentase volume HAA ditetapkan sebesar 19,76% dengan nilai sensitivitas 93,8% dan spesifisitas 93,8%. Nilai titik potong persentase volume LAA ditetapkan sebesar 9,89% dengan nilai sensitivitas 62,5% dan spesifisitas 62,5%. Nilai titik potong mRSS ditetapkan sebesar 18,5 dengan sensitivitas 93,8% dan spesifisitas 100%. Tidak ada perbedaan proporsi pola ILD antara kedua kelompok tersebut (p 0,220).Kesimpulan: Volume paru abnormal > 32,82%, volume HAA > 19,76%, volume LAA > 9,89%, dan/atau nilai mRSS > 18,5 merupakan prediktor progresivitas SSc-ILD. Hasil volumetri kuantitatif abnormalitas paru pada HRCT toraks dan nilai mRSS merupakan faktor prognostik progresivitas SSc-ILD yang mudah diperoleh dan diaplikasikan dalam praktik klinis sehari-hari.

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Background: Interstitial pulmonary disease (ILD) is one of the manifestations of systemic sclerosis (SSc) in the lungs and the main mortality factor of SSc. SSc-ILD multiplies the 5-year mortality rate of SSc patients by 3 times. Nearly two-thirds of SSc-ILD patients with minimal abnormalities in chest high resolution computed tomography (HRCT) showed significant progressivity within 2 years. The available prediction models of SSc-ILD progression, namely GAP (gender, age, and lung physiology) and SADL (smoking history, age, and diffusion capacity of the lungs), have been proven to demonstrate excellent prognostic values. Prognostic models involving chest HRCT parameters and Modified Rodnan Skin Score (mRSS) are expected to aid the selection of SSc-ILD patients who require close monitoring or early therapy to prevent progression.

Method: This study involved SSc-ILD patients who underwent initial and follow-up chest HRCT examination and evaluation at the National Central General Hospital of Doctor Cipto Mangunkusumo in the period from January 2016 to December 2021. Quantitative volumetric measurement was performed using 3DSlicer® software on the initial chest HRCT to yield abnormal pulmonary volume, high attenuation area (HAA) volume, and low attenuation area (LAA) volume percentage which were subsequently analyzed as prognostic factors. ILD patterns in the initial chest HRCT and mRSS values of each subject were identified and analyzed as prognostic factors of SSc-ILD progression. The progression of SSc-ILD is classified into progressive and non-progressive based on the abnormal pulmonary volume percentage difference between the initial and follow-up chest HRCT.

Result: Significant mean differences were found in abnormal lung volume percentage, HAA volume percentage, LAA volume percentage, and mRSS values between progressive and non-progressive SSc-ILD groups (p < 0.001). Based on the receiver operating characteristic curve, the cut-off point value of each variable is determined. The cut-off point value of the percentage of abnormal pulmonary volume was set at 32.82% with a sensitivity value of 100% and a specificity of 93.8%. The cut point value of the HAA volume percentage was set at 19.76% with a sensitivity value of 93.8% and a specificity of 93.8%. The LAA volume percentage cut point value was set at 9.89% with a sensitivity value of 62.5% and a specificity of 62.5%. The mRSS cut-off value was set at 18.5 with a sensitivity of 93.8% and a specificity of 100%. There was no significant in the proportion of ILD patterns between the two groups (p 0.220).

Conclusion: Abnormal lung volume > 32.82%, HAA volume > 19.76%, LAA volume > 9.89%, and/or mRSS value > 18.5 are predictors of SSc-ILD progression. Quantitative volumetric results of pulmonary abnormalities in chest HRCT and mRSS values are prognostic factors of SSc-ILD progression that are easily obtained and applied in daily clinical practice."

"Gangguan respirasi yang berkepanjangan menjadi permasalah baru yang muncul bagi pasien yang telah dinyatakan sembuh dari infeksi Covid 19. Gejala terjadi karena terganggunya compliance paru akibat proses infeksi yang berdampak pada penurunan kapasitas vital paru. Kondisi tersebut dapat dicegah melalui latihan nafas dalam. Latihan nafas dalam bertujuan meningkatkan kemampuan otot-otot pernafasan yang berguna untuk meningkatkan compliance paru, meningkatkan fungsi ventilasi, recovery pasca infeksi, memperbaiki oksigenasasi dan meningkatkan efisiensi batuk. Tujuan dari penelitian ini yaitu mengidentifikasi pengaruh latihan nafas dalam terhadap kapasitas vital paru pada pasien post Covid 19. Sampel dalam penelitian ini berjumlah 40 responden yang dibagi menjadi 20 responden kelompok intervensi dan 20 responden kelompok kontrol. Metode penelitian ini adalah quasi eksperimen pre dan post test nonequivalent control group. Kelompok intervensi diberikan perlakuan latihan nafas dalam dan kelompok kontrol diberkan perlakuan standar dari rumah sakit Hasil penelitian menunjukan terdapat pengaruh latihan nafas dalam terhadap kapasitas vital paru ( p = 0.000) dan terdapat perbedaan yang bermakna nilai kapasitas vital paru antara kelompok intervensi dan kontrol (p = 0.008). Kesimpulan penelitian ini bahwa latihan nafas dalam yang dilakukan tiga hari dengan durasi 45 menit selama dua minggu memiliki pengaruh terhadap perbaikan kapasitas vital paru pasien post Covid 19, sehingga intervensi ini dapat menjadi advance nursing intervension dan sebagai rekomendasi self management untuk memperbaiki fungsi paru pasca infeksi dan mengurangi masalah gejala berkepanjangan yang dialami pasien post Covid 19.

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Prolonged respiratory disorders are a new problem that arises for patients who have been declared cured of Covid 19 infection. Symptoms occur due to disruption of lung compliance due to the infection process which results in a decrease in vital lung capacity. This condition can be prevented through deep breathing exercises. Deep breathing exercises aim to improve the ability of the respiratory muscles to increase lung compliance, improve ventilation function, post-infection recovery, improve oxygenation and increase cough efficiency. The purpose of this study was to identify the effect of deep breathing exercises on vital lung capacity in post-Covid 19 patients. The sample in this study was 40 respondents who were divided into 20 respondents in the intervention group and 20 respondents in the control group. This research method is a quasi-experimental pre and post test non-equivalent control group. The intervention group was treated with deep breathing exercises and the control group was given standard treatment from the hospital. The results showed that there was an effect of deep breathing exercises on vital lung capacity (p = 0.000) and there was a significant difference in the value of vital lung capacity between the intervention and control groups (p = 0.008). The conclusion of this study is that deep breathing exercises carried out for three days with a duration of 45 minutes for two weeks have an effect on improving the vital lung capacity of post-Covid 19 patients, so this intervention can be an advance nursing intervention and as a recommendation for self-management to improve lung function after infection and reduce the problem of prolonged symptoms by post-Covid 19 patients."

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Introduksi: Relaparotomi dini pascatransplantasi hati donor hidup pada anak kerap dihadapkan pada luaran yang lebih buruk dibandingkan dengan pasien pascatransplantasi hati yang tidak memerlukan relaparotomy dini. Penelitian ini dilakukan untuk mengetahui faktor yang berhubungan dengan relaparotomi dini pascatransplantasi donor hidup pada anak

Metode: Penelitian potong lintang ini melibatkan seluruh resipien anak pascatransplantasi donor hidup di RSCM. Berdasarkan data rekam medis, setiap pasien dinilai skor PELD, lama operasi, jumlah perdarahan intraoperasi, warm ischemic time, dan cold ischemic time. Keempat faktor tersebut kemudian dianalisis hubungannya dengan kejadian relaparotomi dini.

Hasil: Terdapat 50 resipien anak pascatransplantasi donor hidup di RSCM dengan median usia subjek 17 bulan (5-61 bulan). Dari 50 subjek, 14 diantaranya memerlukan relaparotomi pascatransplantasi. Setelah dilakukan analisis, dari keempat faktor yang dinilai, hanya jumlah perdarahan intraoperasi yang bermakna secara statistik berhubungan dengan kejadian relaparotomi (p= 0.014).

Konklusi: Perdarahan intraoperasi merupakan salah satu faktor yang memengaruhi kejadian relaparotomi dini pada pasien anak dengan transplantasi hati donor hidup. Akan tetapi perlu diperhatikan faktor lain seperti power penelitian yang dapat memengaruhi hasil dan masih perlu ditingkatkan pada studi ini.

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Introduction: Early relaparotomy post living donor liver transplant in children usually faced with poor outcome compare to liver transplant patient without early relaparotomy. This study aims to identify factors associated with early relaparotomy in children undergone living donor liver transplant.

Methods: This is a cross sectional study including all of the children recipient of living donor liver transplant in Cipto Mangunkusumo Hospital (RSCM). Using the medical records, the PELD score, duration of the operation, total intraoperation blood loss, warm ischemic time, and cold ischemic time were measured. All of these factors were analyzed with the incidence of relaparotomy.

Results: Fifty children recipient of living donor liver transplant in RSCM were included in this study. The median age of the subject was 17 months old (5-61 months old). From 50 subjects, 14 of them were undergone relaparotomy post liver transplant. The total intraoperation blood loss has statistically significant associated with the incidence of relaparotomy (p= 0.014)

Conclusion: Intraoperation blood loss is one of the factors associated with the incidence of relaporotomy in children recipient of living donor liver transplant. Other factors associated with early relaparotomy still need to be explored to improve the power of this study.

 

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"Tuberkulosis adalah penyakit infeksius yang menyebabkan kerusakan pada parenkim paru. Pasien dengan tuberkulosis paru akan terjadi peurunan kapasitas vital paru yang akan menimbulkan compliance paru berkurangnya yang berakibat pada penurunan fungsi paru dan juga kualitas hidup pasien. Masalah diatas perlu dilakukannya tindakan dengan melakukan intervensi yoga pranayama dalam upaya meningkatkan kapasitas vital paru dan kualitas hidup pasien post tuberculosis paru. Tujuan penelitian ini untuk mengetahui Pengaruh latihan yoga pranayama dalam meningkatkan kapasitas vital paru dan kualitas hidup pasien post tuberkulosis Paru. Metode yang digunakan dengan jenis penelitian kuantitatif dengan desain penelitan quasi ekspenmen dengan Pre Test and Post Test With Control Group Design. Jumlah responden yang akan digunakan yaitu sebanyak 60 yang terdiri dari 30 responden kelompok intervensi dan 30 responden kelompok kontrol. Hasil penelitian menunjukan latihan yoga pranayama sebelum dan sesudah intervensi. Selisih perbedaan perubahan nilai kapasitas vital paru setelah intervensi antara kelompok intervensi dan kontrol menunjukan tidak adanya perbedaan yang bermakna (p value 0,236) dan (p value 0,912). Hasil ini menunjukkan bahwa Yoga pranayama efektif dalam meningkatkan kapasitas vital paru. Oleh karena itu, yoga pranayama direkomendasikan dapat menjadi terapi komplementer untuk meningkatkan kapasias vital paru pada pasien post tuberkulosis Paru.

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Tuberculosis is an infectious disease that caused damage of lung parenchyma. Patients with pulmonary tuberculosis experienced of decreasing the lung’s vital capacity which lead to reduce of lung compliance, decreased lung function, and furthermore affecting patient’s quality of life. The problems can be solved by conducting yoga pranayama intervention as an effort to increase the lung vital capacity and also quality of life patient post pulmonary tuberculosis infection.

The purpose of this study was to determine the effect of yoga pranayama practice in increasing lung vital capacity and quality of life patient post-pulmonary tuberculosis infection.

The method was used a quantitative research with a quasi-experimental research design using pre and post test with a control group. This study was used 60 respondent consist of 30 respondent as intervention group and 30 respondent as control group.

This study found that before and after yoga pranayama intervention gave a significant effect on value of the lung vital capacity (p value 0.000). The difference changes value of lung vital capacity after intervention among the intervention and control groups showed that no significant difference (p value 0.236) and (p value 0.912).

These results indicated yoga pranayama was effective to increase the vital capacity of lungs. Therefore, yoga pranayama is recommended as a complementary therapy to increase lung vital capacity on post-pulmonary tuberculosis patients."