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Journal : Jurnal Respirasi

Terapi ARV pada Penderita Ko-Infeksi TB-HIV Ajmala, Indana Eva; Wulandari, Laksmi
Jurnal Respirasi Vol 1, No 1 (2015): Januari 2015
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (406.585 KB) | DOI: 10.20473/jr.v1-I.1.2015.22-28

Abstract

TB and HIV have a very close relationship since the development of AIDS. Through a significant reduction in cellular immunity, HIV affects the pathogenesis of tuberculosis, thereby increasing the risk of TB in HIV co-infected individuals. In 2006, there were an estimated 9.2 million new TB cases worldwide, there were 710.00 in patients with HIV and 500,000 cases with MDR-TB. Sensitivity to TB associated with cytokine production by T lymphocytes (IFN gamma and TNF are like alpha). During HIV infection, IFN gamma production declined dramatically in line with the decrease in CD4 T lymphocytes This leads to an increased risk of developing reactivation or reinfection Mycobacterium tuberculosis. Clinical symptoms of pulmonary TB in people living with HIV are often non-specific. Clinical symptoms often found are fever and significant weight loss. The other symptoms usually associated with extrapulmonary TB. Antiretrovirals are drugs that inhibit HIV replication. The main priority in patients co-infected with TB-HIV is a start of TB therapy, followed by cotrimoxazole and ARV. ARV treatment recommendation on co-infection tuberculosis is starting ARV therapy to all people living with HIV with active TB, regardless of CD4 cell count. Antiretroviral therapy start as soon as possible after TB treatment can be tolerated, as soon as 2 weeks and no more than 8 weeks. Regimen set by WHO for first-line regimen containing two nucleoside reverse transcriptase inhibitors (NRTIs) plus one non-nucleoside reverse transcriptase inhibitors (NNRTIs). In the co-infection of TB-HIV nucleoside was elected WHO recommended Zidovudine (AZT) or tenofovir disoproxil fumarate (TDF), in combination with lamivudine (3TC) or emricitabine (FTC). For NNRTI, WHO recommends efavirenz (EFV) or nevirapine (NVP).
Problem Penegakkan Diagnostik Pasien dengan Massa di Paru Wulandari, Laksmi; Faot, Nikson Eduard
Jurnal Respirasi Vol 3, No 2 (2017): Mei 2017
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (977.856 KB) | DOI: 10.20473/jr.v3-I.2.2017.41-46

Abstract

Background: Lung cancer are divided into 2 groups; i.e. Small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). About 30% of NSCLC is squamus cell carcinoma and the other is adeno carcinoma. Late diagnosis makes such a high mortality rate. Early diagnosis plays a very important role in the management of therapy. Case: Patients complain of chronic cough more than 6 months, decreased appetite and weight loss. Chest X-ray and CT scan show a density of round shape mass, with firm border and smooth regular edge, also lympnodes enlargement (T2N2Mx) stage IIb. Appearance of lung mass is benign according to clinically and radiologically. FNAB-CT Guiding results are difference each time examination. The first result is squamous cell carcinoma but the last result is teratoma. Discussion: Based on the multidisciplinary discussion on Tumor Board Meeting, the diagnosis was decide as Squamous cell Carcinoma. The choice management of stage IIb lung cancer is surgery (Lobectomy). Histopathology finding post surgery is a Squamus Cell Carcinoma. Patients were then given adjuvant chemotherapy for 4 cycles with Platinum Base regimen paxuscarboplatin with the aim of clearing micrometastase that may still be left behind. The complete respons of platinum based chemotherapy following surgery in early stage of squamous cell carcinoma. Conclusion: Difficulties of lung cancer diagnostic are still the problem in the management of lung mass. Difference of diagnostic makes difference treatment choice. Multidiscipline discussion is needed to decide the diagnostic and treatment judgment.
Tumor Mediastinum Anterior ( Yolk Sac Tumor ) pada Seorang Laki-Laki Dewasa Muda: Sebuah Kasus yang Jarang Risnawati, Risnawati; Wulandari, Laksmi
Jurnal Respirasi Vol 2, No 2 (2016): Mei 2016
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (944.996 KB) | DOI: 10.20473/jr.v2-I.2.2016.45-51

Abstract

Background: Primary mediastinal yolk sac tumor is an extremely rare and highly malignant tumors occuring in children and young adult. They are more common in men. The most common symptoms on ptesentation were dyspnea, chest pain, cought, fever, night sweat, or weight loss. Primary mediastinal tumor are considered to have poor prognosis. Case: A 18- year-old man who presented with shorthness of breath, chest pain, fever, night sweat, and generalized weakness. He had no significant surgical, familiy or social history. The chest X-Ray and computed tomographic scan of the chest showed a large anterior mediasti nal mass. The serum level of alpha- fetoprotein and β-HCG was elevated. The histological examination revealed the finding of yolk sac tumor. This supported the diagnosis of yolk sac tumor. The patient received a combination chemotherapy consisting of cisplatin, etoposide and bleomycin every 3 weeks for total of 4 cycles. Conclusions: Primary mediastinal yolk sac tumor is a rare tumor. The diagnosis should be made not only by morphological studies but the also the patients age and the elevation of serum alpha-fetoprotein. In spite of modern chemotherapy, the prognosis of mediastinal yolk sac tumor remains poor.