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Abstrak :
ABSTRAK
Latar Belakang: Kanker paru dan tuberkulosis TB adalah dua masalah kesehatan di seluruh dunia dengan angka kesakitan dan kematian yang tinggi. Meningkatnya kasus TB aktif dan reaktivasi TB laten pada pasien kanker paru serta dampak buruknya terhadap prognosis pasien memerlukan upaya untuk melakukan deteksi TB laten pada pasien kanker paru. Penelitian ini bertujuan untuk mengetahui berapa besar proporsi TB laten pada pasien kanker paru, karakteristiknya dan hubungan antar keduanya.Metode: Penelitian ini menggunakan desain potong lintang dan sampel dikumpulkan secara consecutivesampling terhadap 86 pasien kanker paru baru terdiagnosis di Rumah Sakit Umum Pusat Persahabatan Jakarta tahun 2015 hingga 2016. Pemeriksaan sputum Xpert MTB/RIF dilakukan untuk menyingkirkan kemungkinan TB aktif. Penentuan TB laten dilakukan dengan pemeriksaan Interferon Gamma Release Assay IGRA menggunakan alat QuantiFERON-TB Gold-in-Tube QFT-GIT .Hasil: Pemeriksaan TB laten mendapatkan hasil IGRA 11 pasien 12,8 , IGRA - 59 pasien 68,6 dan IGRA indeterminate I 16 pasien 18,6 . Karakteristik sosiodemografi pasien kanker paru dengan TB laten adalah 63,6 laki-laki, rerata usia 56 tahun, 36,4 diimunisasi BCG, 9 dengan kontak erat TB, 72,7 dengan riwayat merokok. Karakteristik klinis pasien tersebut 90 memiliki status gizi normal lebih dengan nilai tengah indeks massa tubuh IMT 19,12 18,24-29,26 kg/m2, nilai tengah hitung limfosit total 1856 1197-4210 sel/ul, 9 dengan komorbid diabetes mellitus, 81,8 tumor paru mengenai lokasi khas predileksi TB paru. Jenis kanker terbanyak adalah adenokarsinoma 81,8 dengan stage lanjut 81,8 dan status tampilan umum 2-3 63,6 . Karakteristik yang menunjukkan hubungan bermakna dengan hasil IGRA adalah lokasi tumor yang mengenai daerah lesi khas TB secara radiologis. Hitung limfosit total yang rendah berhubungan dengan hasil IGRA I dengan nilai tengah 999,88 277-1492,60 sel/ul.Kesimpulan: Proporsi TB laten pada pasien kanker paru di RSUP Persahabatan adalah 12,8 . Karekteristik pasien kanker paru yang berhubungan dengan TB laten adalah lokasi tumor yang mengenai daerah lesi khas TB walaupun belum dapat disimpulkan hubungannya secara biologis. Hasil IGRA I pada pasien kanker paru dengan hitung limfosit total yang rendah menunjukkan keterbatasan sensitivitas IGRA dalam mendeteksi infeksi TB laten pada pasien imunokompromais.Kata Kunci : infeksi TB laten, kanker paru, IGRA, hitung limfosit total

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ABSTRACT
Background Lung cancer and pulmonary tuberculosis TB are two major public health problems associated with significant morbidities and mortalities. The increased prevalence of active TB and latent TB reactivation in lung cancer patients and the negative effect of pulmonary TB in lung cancer prognosis underline the need for a through screening of lung cancer patients for latent TB infection LTBI . The aims of this study are to determine the proportion of LTBI in lung cancer patients, their characteristics and the relationship between them.Methods This study used a cross sectional design and sample was collected using consecutive sampling of the 86 newly diagnosed treatment naive lung cancer patients from a referral respiratory hospital, Rumah Sakit Umum Pusat Persahabatan Jakarta in 2015 to 2016. The presence of LTBI was determined by Quantiferon TB Gold In Tube QFT GIT after having Mycobacterium TB not detected result from Xpert MTB RIF sputum test. Demographic characteristics and cancer related factors associated with LTBI were investigated.Results There are 11 patients 12,8 with IGRA result and 16 patients 18,6 with IGRA indeterminate I result. Sociodemographic characteristics of lung cancer patients with latent TB are 63,6 male, mean of age 56 years, 36,4 with BCG immunization, 9 had TB close contacts history, 72,7 with a history of smoking. The clinical characteristics of these patients are 90 had a normal nutritional status with the median body mass index BMI 19,12 18,24 29,26 kg m2, the median of total lymphocyte count is 1856 1197 4210 cells ul, 9 with diabetes mellitus as comorbid, 81,8 of lung tumour located in the typical predilection for pulmonary tuberculosis. Most types of lung cancer are adenocarcinomas 81.8 with advanced stage 81,8 and the WHO performance status of 2 3 63,6 . Characteristics having significant relationship with IGRA results is the tumour located in the typical TB area radiologically. Low total lymphocyte count is associated with indeterminate IGRA results with median 999,88 277 1492,6 cells ul.Conclusion The proportion of latent TB in lung cancer patients is 12,8 . Characteristics of patients with lung cancer associated with latent TB is the location of the tumor lesions typical of the area although it can not be concluded biologically. Having indeterminate IGRA results in lung cancer patients with a low total lymphocyte count showed the limitations of QFT GIT in detecting latent TB infection in immunocompromised patients.Key words latent TB infection, lung cancer, IGRA, total lymphocyte count

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Pendahuluan: Tingginya angka kesakitan dari asma dan biaya pengobatan telah menjadi beban besar bagi masalah kesehatan. Tujuan pengobatan asma adalah tercapainya asma yang terkontrol mendekati fungsi paru normal, tidak ada gejala asma, tidak ada keterbatasan aktifiti dan memburuknya asma. Penggunaan Asthma Control Test ACT , Asthma Symptom Control ASC dan Asthma Control Questionnaire ACQ dapat secara mudah memberitahukan tingkat keterkontrolan asma. Penelitian ini bertujuan untuk melihat kesesuaian antara ketiga kuesioner dalam menilai tingkat keterkontrolan asma di RSUP Persahabatan. Metode: Penelitian dengan desain potong lintang dan analisis deskriptif pada 45 subjek pasien asma di klinik asma PPOK RSUP Persahabatan melalui wawancara dan pengisian kuesioner untuk mengetahui tingkat keterkontrolan asma. Hasil: Tingkat keterkontrolan asma dengan ACT sebanyak 42,2 terkontrol baik, 42,2 terkontrol sebagian dengan ASC dan 42,2 tidak terkontrol berdasarkan ACQ. Terdapat hubungan penggunaan obat kortikosteroid semprot dengan kuesioner ACT p=0,031 . Terdapat hubungan antara pendidikan p=0,047 , kebiasaan merokok p=0,037 dan penghasilan p=0,040 dengan keterkontrolan asma ASC. Terdapat hubungan antara penghasilan p=0,025 dengan kuesioner ACQ. Kesesuaian antara ketiga kuesioner ini dengan nilai kappa 0,877 kesesuaian yang baik. Kesimpulan: Terdapat hubungan antara penggunaan obat kortikosteroid semprot, kebiasaan merokok dan penghasilan pada ketiga kuesioner keterkontrolan asma. Kesesuaian antara ketiga kuesioner terdapat kesesuaian yang baik. ...... Introduction: The high prevalence of asthma and costs of asthma therapy place a considerable burden on health care systems. Asthma attacks and symptoms can be controlled by an appropriate treatment and proper use of medicines. The goals of asthma therapy are to achieve asthma control near normal lung function, absence of asthma symptoms, no activity limitations and no episodes of worsening asthma. The use of Asthma Control Test ACT , Asthma Symptom Control ASC and Asthma Control Questionnaire ACQ can make easier to control asthma. This study rsquo;s purpose is to see the suitability between the three questionnaires in assessing the level of control asthma in Persahabatan Hospital. Methods: Research with cross sectional design and descriptive analysis on 45 subjects of asthma patients in the clinic asthma PPOK RSUP Persahabatan through interviews and filling questionnaires to determine the level of control of asthma. Results: Asthma control rate with ACT was 42.2 well controlled, 42.2 partially controlled with ASC and 42.2 uncontrolled under ACQ. There was association of spray corticosteroid drug use with ACT questionnaire p = 0,031 . There was a relation between education p = 0,047 , smoking habit p = 0,037 and income p = 0,040 with ASC asthma control. There is a relation between income p = 0,025 with ACQ questionnaire. Compatibility between these three questionnaires with a kappa value of 0.877 good suitability. Conclusion: There is an association between the use of spray corticosteroid drugs, smoking habits and income in the three questionnaires of asthma control. The suitability between the three questionnaires has good suitability.

Abstrak :
Pengobatan TB MDR yang berlangsung lama menimbulkan isolasi sosial, kehilangan pekerjaan, efek sosioekonomi dan psikologis jangka panjang pada pasien. Faktor individu, sosial budaya dan lingkungan serta kemungkinan efek samping psikiatri menjadikan pasien TB MDR cenderung mengalami gejala depresi. Depresi dapat mempengaruhi kualitas hidup. Penelitian ini menilai perubahan status depresi dan hubungannya dengan kualitas hidup pasien TB MDR. MetodePenelitian ini menggunakan metode kohort observasional di Poliklinik TB MDR RSUP Persahabatan. Dua puluh sembilan subjek TB MDR dinilai status depresi dan kualitas hidupnya dengan kuesioner Beck Depression Inventory BDI dan WHOQOL BREF sebelum dan setelah 6 bulan pengobatan TB MDR. HasilProporsi pasien depresi sebelum pengobatan sebesar 75,9 22 subjek . Setelah 6 bulan pengobatan TB MDR, 13 orang skor BDInya menurun, 9 orang meningkat dan terdapat 4 orang yang sebelumnya tidak depresi mengalami depresi. Skor WHOQOL BREF mengalami peningkatan pada ranah fisis, psikologis dan peningkatan bermakna pada ranah lingkungan. Pada ranah sosial, skor kualitas hidup mengalami penurunan. Tidak didapatkan hubungan bermakna antara perubahan status depresi dan kualitas hidup. Keterkaitan antara faktor usia, jenis kelamin, tingkat pendidikan, status ekonomi, lama sakit TB dan atau TB MDR serta beratnya merokok dengan depresi tidak dapat dibuktikan pada penelitian ini. KesimpulanSebanyak 22 subjek 75,9 mengalami gejala depresi sebelum memulai pengobatan TB MDR. Setelah 6 bulan, 13 orang gejala depresinya membaik, 9 orang memburuk dan terdapat 4 orang mengalami onset baru depresi. Kualitas hidup ranah fisis, psikologis dan lingkungan mengalami kenaikan.Kata-kata kunci: tuberkulosis multidrug resistant, depresi, kualitas hidup ......IntroductionTreating drug resistant TB MDR TB which requires longer courses resulting in social isolation, loss of employment, and long-term socioeconomic and also psychological impacts for patients. Individual factors, sociocultural and environment condition also psychiatric adverse events lead the patients tend to have depression symptoms. Depression can majorly affects patients rsquo; quality of life. This study assesses the alteration of depression and its rsquo; relation with the quality of life among MDR TB patients. MethodsThis study used observational cohort methods in MDR Outpatients Clinic of Persahabatan Hospital. Twenty nine patients were diagnosed with MDR, measured depression status and the quality of life with Beck Depression Inventory BDI and WHOQOL BREF questionnaire from baseline and after 6 months therapy. ResultsPropotion of depression at baseline is 75,9 22 subjects . After 6 months treatment, the BDI score of 13 subjects were decreased, 9 subjects were increased and there were 4 subjects experienced new onset depression. The WHOQOL BREF improved in physical, psychological and significantly increased in environmental domain. In social domain, it was decreasing. This study didn rsquo;t find relation between depression status changes and the quality of life. The association between age, gender, level of education, economic status, duration of illness and smoking with depression could not be proven by this study. ConclusionsThere are 22 subjects 75,9 have already been depressed at baseline. After 6 months treatment, 13 subjects improving the symptoms, 9 subjects worsening and 4 subjects have experienced new onset depression. The quality of life in physical, psychological and environmental domain have improved.

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ABSTRAK
Latar Belakang: Penyakit infeksi paru menjadi masalah utama kesehatan di Indonesia, termasuk mikosis paru yang disebabkan oleh infeksi, kolonisasi jamur maupun reaksi hipersensitif terhadap jamur. Bronkoskopi sebagai alat diagnostik untuk melihat gambaran lesi endobronkial dan mengambil bahan klinis seperti bronchoalveolar lavage BAL dan bilasan bronkus. Pemeriksaan biakan jamur dari bahan klinis bronkoskopi dapat membantu penegakan diagnosis mikosis paru.Metode: Studi deskriptif potong lintang pada pasien bronkoskopi yang dilakukan pemeriksaan biakan jamur dari BAL dan bilasan bronkus. Jumlah sampel adalah total sampling sejak Januari 2016 sampai dengan Desember 2017. Penelitian dilakukan di SMF Paru RSUP Persahabatan.Hasil: Bahan klinis dari bronkoskopi pada penelitian ini berupa bilasan bronkus sebanyak 67 buah dan BAL sebanyak 21 buah. Dari bahan klinis didapatkan hasil biakan tumbuh jamur sebanyak 35 buah dan tidak tumbuh jamur sebanyak 53 buah.Jenis jamur yang tumbuh adalahCandida sp. dengan spesies terbanyak Candida albicans sebanyak 30 isolat, Candida parapsilosis sebanyak 3 isolat, serta spesies Candida glabratadanCandida tropicalis masing-masing sebanyak 1 isolat.Kesimpulan: Bahan bronkoskopi BAL dan bilasan bronkus dapat digunakan untuk pemeriksaan biakan jamur.Kata Kunci: biakan jamur, bronkoskopi, bronchoalveolar lavage, bilasan bronkus.

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Background: ABSTRACT
Lung infection diseases become health main problem in Indonesia, including lung mycosis caused by infection, fungal colonization or hypersensitivity reaction against the fungal. Bronchoscopy is used as diagnostic tool to see endobronchial lesion and to gain clinical specimens such as bronchoalveolar lavage BAL and bronchial washing. Fungal culture from clinical specimen of bronchoscopy can help diagnosing lung mycosis.Method: Cross sectional descriptive study of bronchoscopy patients with fungal culture assay from BAL and bronchial washing. Total sample is total sampling from January 2016 to December 2017. The study is in Department of Pulmonology and Respiratory Medicine, Persahabatan Hospital, JakartaResult: Clinical specimens from bronchoscopy in this study are 67 samples of bronchial washing and 21 samples of BAL. There are positive fungal growth in 35 samples and no fungal growth in 53 samples.All growing fungal come from Candida sp. with most species come from Candida albicans 30 isolates, followed by Candida parapsilosis 3 isolates, Candida glabrata and Candida tropicalis each one 1 isolate.Conclusion: Bronchoscopy samples of BAL and bronchial washing can be used forfungal culture assay examination.

Abstrak :
Latar Belakang: Pandemi Corona Virus Disease 2019 (COVID-19) yang disebabkan oleh Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) berawal dari Wuhan, Cina sejak Desember 2019. Jakarta menjadi salah satu episentrum pandemic COVID-19 di Indonesia. Data penelitian COVID-19 di Indonesia masih sangat terbatas, sehingga diperlukan penelitian untuk mengetahui karakterisik klinis, radiologis, laboratorium dan derajat klinis. Metode Penelitian: Penelitian ini diambil dari 1070 pasien yang dirawat di Rumah Sakit Darurat Wisma Atlet yang menjalani skrining gejala klinis, radiologi toraks, laboratorium dan serologi SARS-CoV-2kemudian dilanjutkan dengan pemeriksaan swab RT-PCR. Hasil skrining swab RT PCR pada 1070 pasien terdapat 836pasien terkonfirmasiCOVID-19, lalu diskrining dari 836 pasien yang memiliki radiologi toraks dan laboratorium lengkap ada 413 pasien. Hasil Penelitian: Pasien terkonfirmasi COVID-19 derajat ringan-sedang didominasi oleh pasien laki-laki(55,4%) dengan kelompok usia < 60 tahun (91,8%) dan rerata umur 39,94±14,17 tahun. Sebagian besar pasien tidak memiliki komorbid, tetapi komorbid paling banyak adalah hipertensi (4,1%). Derajat klinis pasien yang dirawat paling banyak kasus asimtomatik (46%), sedang (31,5%) dan ringan (22,5%). Gejala yang sering muncul adalah batuk (22,5%), demam (14,3%),sesak napas (6,5%), nyeri tenggorok (5,3%) dan pilek (4,8%). Gambaran radiologis sebagian besar pasien normal (41,9%), sesuai pneumonia (31,5%) dan corakan meningkat (26,6%). Hasil pemeriksaan laboratorium didapatkan limfopenia (10,9%), trombositopenia (1,7%) dan peningkatan NLR (18,4%). Serologi SARS-CoV-2sebagian besar pasien reaktif (48,8%). Sebagian besar pasien dirawat ≥20 hari (63,9%), masa konversi ≥14 hari (52,5%) dan luaran akhir pasien sembuh (99,3%). Terdapat hubungan bermakna antara komorbid dengan lama rawat (p= 0,03) dan lama konversi (p= 0,03), status awal masuk RS dengan lama konversi (p= 0,00) dan lama rawat (p= 0,00). Kesimpulan: Proporsi pasien terkonfirmasi COVID-19 dari keseluruhan pasien yang dirawat sebesar 78,13%, sebagian besar laki-laki dan gambaran radiologis normal. Terdapat kenaikan NLR dan kebanyakan serologi SARS-CoV-2reaktif. Sebagian besar pasien yang dirawat kasus asimtomatik dan luaran akhir perawatannya sembuh. ......Background: Coronavirus disease 2019 (COVID-19) is an ongoing pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) originated from Wuhan, China since December 2019. Jakarta is among of the epicenter of COVID-19 pandemic in Indonesia. Research data on COVID-19 in Indonesia is still very limited while there is an urgent need of disease characterization from the perspective of clinical features, radiological finding, laboratory profile, and severity. Methods: This retrospective cohort study involved 1070 patients treated at an emergency hospital in Jakarta, Indonesia. Patients were screened for their clinical symptoms, radiological finding, laboratory profile, including the SARS-CoV-2 immunoserology, and then proceed with the SARS-CoV-2 RT-PCR examination. The screening resulted in 836 patients were confirmed COVID-19, and 413 patients had a complete medical record to be further studied. Results: The mild-moderate cases were dominated by males (55.4%) of age groups <60 years-old (91.8%). The mean age was 39.94±14.17 years-old. Most subjects presented without comorbidities, although hypertension was common (4.1%). Most subjects were asymptomatic (46%) followed by moderate case (31.5%), and mild case (22.5%). Symptoms were cough (22.5%), fever (14.3%), shortness of breath (6.5%), sore throat (5.3%), and runny nose (4.8%). Radiological findings were normal (41.9%), pneumonia (31.5%), and increased opacity (26.6%). Laboratory tests showed lymphopenia (10.9%), thrombocytopenia (1.7%), and increased NLR (18.4%). The SARS-CoV-2 immunoserology was mostly reactive (48.9%). Length of stay (LoS) was ≥20 days (63.9%), conversion period was ≥14 days (52.5%), and most were recovered (99.3%). There were correlations between existing comorbidities and LoS (p=0.03) and conversion time (p=0.03). There were correlations between initial condition during hospital admission with conversion time (p=0.00) and LoS (p=0.00). Conclusion: The proportion of patients with COVID-19 confirmed from all patients treated was 78.13%, whom male, normal radiological finding, increased NLR, reactive SARS-CoV-2 immunoserology, and asymptomatic predominated. Most of the patients were moderate cases and well recovered.

Abstrak :
Latar Belakang: Kanker paru menjadi penyebab kematian utama akibat keganasan pada laki-laki sebesar 31% dan perempuan sebesar 27%. Pada pasien adenokarsinoma paru dengan mutasi pada exon 20 T790M memberikan respons yang buruk terhadap terapi EGFR-TKI generasi pertama maupun generasi kedua. Tujuan: Mengetahui profil serta angka tahan hidup 1 tahun pasien kanker paru jenis Adenokarsinoma dengan mutasi exon 20 T790M primer. Metode: Penelitian menggunakan desain kohort terhadap pasien-pasien adenokarsinoma paru stadium IV dengan mutasi exon 20 T790M primer dari bulan September 2015 sampai Desember 2017 di RSUP Persahabatan. Variabel yang diteliti adalah karakteristik klinis dan angka kesintasanberdasarkan kurva Kaplan Meier. Hasil analisis dinyatakan berbeda bermakna apabila nilai p<0,05. Hasil: Didapatkan 27 subjek penelitian dengan rerata usia 58,5 tahun dan berjenis kelamin laki-laki (70,6%). Keluhan utama berupa sesak napas (73,5%) dan nyeri dada (55,9%). Mutasi genetik tunggal pada Exon 20 T790M (64,7%), sedangkan mutasi Exon 20 T790M dengan Exon 21 L858R (11,8%) dan mutasi Exon 20 T790M dengan 21 L861Q (8,8%). Organ target metastasis adalah efusi pleura (73,5%), tulang (26,5%) dan otak (20,6%). Angka kesintasan 360 dan 990 hari sebesar 35% dan 20% dengan median kesintasan sebesar 213 hari. Kesimpulan: Mutasi exon 20 T790M pada adenokarsinoma paru memegang peranan penting terhadap kesintasan dan prediktor responsterhadap terapi yang diberikan.

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Background: Lung cancer causes mortality in men (31%) and in women (27%). Lung adenocarcinoma patients with exon 20 T790Mepidermal growth factor receptor(EGFR) mutation showed poor response to the first generation and second generation of EGFR tyrosine kinase inhibitor (TKI) therapy. Purpose: This study aims to reveal the characteristics and one year survival rate of lung adenocarcinoma patients with primary exon 20 T790M EGFR mutations treated at Persahabatan Hospital Jakarta, Indonesia. Methods: The cohort study involved patients with primary exon 20 T790M EGFR mutation between September 2015 to December 2017 in Persahabatan Hospital Jakarta, Indonesia. The survival rate was observed from Kaplan Meier estimator curve and was statistically analyzed. Results: There were 27 subjects with mean age of 58.5 years and were predominated male (70.6%). The most common chief complaints were shortness of breath (73.5%) and chest pain (55.9%). The EGFR mutations detected were exon 20 T790M (64.7%), exon 20 T790M with exon 21 L858R (11.8%) and exon 20 T790M with exon 21 L861Q (8.8%). Metastatic target organs were pleural effusions (73.5%), bone (26.5%) and brain (20.6%). Survival rate of 360 and 990 days was 35% and 20% respectively with median survival rate was 213 days. Conclusion: Exon 20 T790M EGFR mutation in lung adenocarcinoma was revealed to be an important factor in survival and in predicting response to EGFR TKI chemotherapy.

Abstrak :
Latar belakang : Asma memengaruhi sekitar 300 juta orang di seluruh dunia dan menjadi masalah kesehatan global yang serius yang mempengaruhi semua kelompok umur. Asma alergi adalah fenotipe asma yang paling mudah dikenali dan sering dimulai sejak masa anak-anak. Sebagian besar asma alergi berhubungan dengan sensitisasi saluran napas akibat pajanan aeroalergen umum, terutama yang berasal dari tungau debu rumah. Proses inflamasi eosinofilik saluran napas menghasilkan produk akhir berupa nitrit oksida. Kadar nitrit oksida udara ekspirasi (FeNO) merupakan salah satu penanda hayati yang mengukur inflamasi saluran napas dan kadar FeNO yang tinggi pada pasien asma berhubungan dengan inflamasi saluran napas eosinofilik.Penilitian ini bertujuan mengetahui hubungan kadar IgE spesifik Der p dan Der f  dengan kadar FeNO pada pasien asma tidak terkontrol di RSUP Persahabatan. Metode : Penelitian ini merupakan studi potong lintang dengan jumlah sampel 86 subjek pasien asma tidak terkontrol berdasarkan asthma control test di RSUP Persahabatan. Metode pengumpulan subjek dilakukan dengan teknik consecutive sampling. Pemeriksaan IgE spesifik tungau debu rumah menggunakan protia Q96M. Pemeriksaan FeNO menggunakan Bedfont NObreath. Hasil : Dari 86 subjek asma tidak terkontrol didapatkan hasil rerata usia pasien asma tidak terkontrol di RSUP Persahabatan adalah  52,45 + 12,94 tahun, sebagian besar berjenis kelamin perempuan (84,9%).Proporsi pasien asma yang alergi terhadap tungau debu rumah  mencapai 64%. Prorporsi alergi Der p dan Der f 58%, alergi Der p 4,7% dan alergi Der f 1,2%. Median kadar IgE spesifik tungau debu rumah pada pasien asma tidak terkontrol di RSUP Persahabatan adalah 3,94 (0-100) IU/ml untuk Der p dan 4,47 (0-100) IU/ml untuk Der f. Median FeNO pasien asma tidak terkontrol adalah 26 (3-92) ppb. Dilakukan uji korelasi Spearman untuk kadar IgE spesifik dan kadar FeNO pasien asma tidak terkontrol. Terdapat hubungan bermakna antara kadar IgE spesifik Der p (nilai p = 0,009, r = 0,279, uji Spearman) dan Der f (nilai p = 0,001, r = 0,339, uji Spearman) dengan FeNO. Kesimpulan : Terdapat hubungan yang bermakna antara kadar IgE spesifik tungau debu rumah Der p dan Der f dengan FeNO pada pasien asma tidak terkontrol. Namun tingkat korelasi yang didapatkan lemah. ......Background : Asthma affects approximately 300 million people worldwide and is a serious global health problem affecting all age groups. Allergic asthma is the most easily recognized asthma phenotype and often begins in childhood. Most allergic asthma is associated with airway sensitization due to exposure to common aeroallergens, particularly those from house dust mites. The eosinophilic inflammatory process of the airways produces the final product in the form of nitric oxide. Fractional exhaled nitric oxide (FeNO) levels are one of the biomarkers that measure airway inflammation and high FeNO levels in asthma patients are associated with eosinophilic airway inflammation. This study aims to determine the relationship between Dermatophagoides pteronysinnus (Der p) and Dermatophagoides  farinae (Der f) specific IgE levels with FeNO levels in uncontrolled asthma patients at Persahabatan Hospital. Method : This cross sectional study in 86 uncontrolled asthma patients based on asthma control test less than 24 points. The method of collecting subjects was done by consecutive sampling technique. House dust mite specific IgE assay using protia Q96M. FeNO examination using Bedfont NObreath.    Result : From 86 subjects with uncontrolled asthma, the mean age of uncontrolled asthma patients at Persahabatan Hospital was 52.45 + 12.94 years, most of them were female (84.9%). The proportion of asthma patients who were allergic to house dust mites reached 64. %. The proportion of allergy to Der p and Der f 58%, allergy to Der p 4.7% and allergy to Der f 1.2%. The median level of specific IgE for house dust mites in patients with uncontrolled asthma at the Persahbatan Hospital was 3.94 (0-100) IU/ml for Der p and 4.47 (0-100) IU/ml for Der f. The median FeNO of uncontrolled asthmatic patients was 26 (3-92) ppb. Spearman correlation test was performed for specific IgE levels and FeNO levels in patients with uncontrolled asthma. There was a significant relationship between specific IgE levels Der p (p value = 0.009, r = 0.279) and Der f (p value = 0.001, r = 0.339) and FeNO. Conclusion : There is a significant relationship between the levels of specific IgE for house dust mites Der p and Der f with FeNO in patients with uncontrolled asthma. However, the correlation level obtained is weak.

Abstrak :
Latar Belakang: Gagal napas merupakan salah satu komplikasi terbanyak pada COVID-19 dengan mortalitas dan morbiditas yang tinggi. Pasien yang datang ke IGD dengan tanda gawat napas apabila tidak diberikan tatalaksana yang tepat dapat jatuh pada kondisi gagal napas. Tujuan penelitian ini yaitu untuk mengetahui faktor risiko gagal napas pasien probable dan konfirmasi COVID-19 dengan gawat napas di IGD. Metode: Penelitian ini merupakan penelitian kohort prospektif terhadap pasien gawat napas yang datang ke IGD RSUP Persahabatan. Pengambilan sampel dilakukan secara consecutive sampling mulai 1 September 2020 - 31 Oktober 2020. Dilakukan pemeriksaan kesadaran, status respirasi (frekuensi napas, saturasi oksigen), status kardiovaskular (mean arterial pressure, frekuensi nadi) dan penggunaan otot bantu napas kemudian dilakukan observasi apakah terjadi gagal napas dalam 14 hari perawatan. Nilai potong faktor klinis gawat napas ditentukan dengan kurva area under curve (AUC) kemudian dilakukan analisis sensitifitas dan spesifisitas. Kurva receiver operating characteristic (ROC) digunakan untuk memprediksi faktor risiko gagal napas. Analisis multivariat menggunakan uji regresi logistik untuk menilai hubungan faktor klinis gawat napas dengan gagal napas. Nilai p<0.05 dianggap bermakna secara statistik. Hasil: Dari 158 pasien probable dan konfirmasi COVID-19 dengan gawat napas, didapatkan 47(29.7%) pasien gagal napas dalam observasi 14 hari perawatan. Seluruh pasien datang dengan kesadaran penuh Glasgow Coma Scale 15, median frekuensi napas 22x/menit (17-30) dengan nilai potong 20x/menit, pasien dengan frekuensi napas >20x/menit memiliki OR 1,3 (1,08-1,54 IK95%, nilai p <0,01), median frekuensi nadi 89x/menit (60-136) dengan nilai potong 90x/menit, pasien dengan frekuensi nadi >90x/menit memiliki OR 1,04 (1,01-1,06 IK95%, nilai p 0,02), median mean arterial pressure 93 (71-97) dengan nilai potong 74 mmHg, median saturasi oksigen 98% (91-100) dengan nilai potong 91% dan penggunaan otot bantu napas memiliki OR 0,53 (0,04-6,32 IK 95%, nilai p 0,62). Kesimpulan: Pasien gawat napas yang datang ke IGD dengan frekuensi pernapasan >20x/menit dan atau dengan frekuensi nadi >90x/menit memiliki risiko gagal napas. ......Background: Respiratory failure is one of complication in COVID-19, leading to mortality and morbidity. Patient who come to emergency department if didn’t give early treatment they could fall into respiratory failure. The purpose of this study was to evaluate risk factors of respiratory failure in probable and confirmed COVID-19 patients with respiratory distress at emergency department. Method: This is prospective cohort study based on patient with respiratory distress who come to emergency departement of Persahabatan Hospital Jakarta. Sampling was done by consecutive sampling in the period September 2020 until Oktober 2020. We measured clinical factor of respiratory distress that are consciousness, respiratory status (respiratory rate, oxygen saturation), cardiovascular status (mean arterial pressure, heart rate) and accessory muscle use in admission then observed if respiratory failure occur during 14 days. Clinical factors cut-off determine with area under curve (AUC) curve then test the sensitifity and specificity. Receiver operating characteristic (ROC) curve used to predict risk factors of respiratory failure. Multivariate analysis used to search relationship between clinical factors of respiratory distress with occurrence of respiratory failure. P value <0.05 statistically significant. Results: Of 158 probable and confirmed patients with respiratory distress, there are 47 (27%) prevalence of respiratory failure in 14 days observation. Whole patient came with unconsciousness Glasgow Coma Scale 15, median of respiratory rate 22x/minute (17-30) by cut-off 20x/minute, patient with respiratory rate >20x/minute have OR 1.3 (1.08-1.54 IC95%, p<0.01), median of heart rate 89x/minute (60-136) by cut-off 90x/minute, patient with heart rate >90x/minute have OR 1.04 (1.01-1.06 IC95%, p 0.02), median of mean arterial pressure 93 (71-97) by cut-off 74 mmHg, median of oxygen saturation 98% (91-100) by cut–off 91%, accessory muscle use have OR 0.53 (0.04-6.32 IC95%, p 0.62). Conclusion: Patient with respiratory distress who come to emergency department with respiratory rate >20x/minute and or heart rate >90x/minute have a risk of respiratory failure.