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ABSTRACT: Aim: to obtain characteristics, variations of the type of mass, diagnostic modalities, and mortality factors during hospitalization in patients with mediastinal mass at our institute during a 10-year period. Methods: a case-control study was conducted, by browsing through the medical records of 113 mediastinal mass patients who were treated at Cipto Mangunkusumo Hospital, Jakarta, during a 10-year period (January 2000-December 2009). Factors associated with mortality, i.e; sepsis, septic shock, pneumonia, lung tuberculosis, superior vena cava syndrome, massive pleural effusion, pericard effusion, and respiratory failure were analyzed by logistic regresion multivariate analysis. Results: two hundred and one mediastinal mass patients were diagnosed and treated at our institute, 113 medical records were available to be included in this study. There were 69 males and 44 females with the age range of 18-60 years. One-hundred and seven patients were symptomatic at presentation. Mediastinal tumor was the most common mediastinal mass found among the subjects. The most frequent mass location was in the anteriosuperior compartement. Chest X-ray imaging were able to detect 61 cases of mediastinal mass, while 42 patients underwent thoracotomy (open biopsy) to acquire histopathology diagnosis. The proportion of mortality during hospitalization reached 39.8%. Logistic regression multivariate analysis found sepsis (p=0.000), superior vena cava syndrome (p = 0.000), and massive pleural effusion (p=0.047), were significant factors associated with mortality during hospitalization. Conclusion: the clinical and radiologic features of mediastinal mass patients in our institute showed that mediastinal mass may resemble the symptoms of other diseases. Types and diagnostic modalities performed in our study differs from other studies previously reported in other countries with a high proportion of mortality during hospitalization.
Acta medica Indonesiana 01/2013; 45(1):3-10.
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ABSTRACT: A parapneumonic effusion is the collection of exudative fluid in the pleural space associated with a concurrent pulmonary infection. Parapneumonic effusions account for approximately one-third of all effusions, and about 40% of patients with pneumonia develop a concomitant effusion. Patients with pneumonia who develop an effusion have an increased risk of morbidity and mortality. Some of the excess mortality is due to mismanagement of the parapneumonic effusion. Bacterial and white cell metabolism can rapidly turn a simple exudative parapneumonic effusion into a multiloculated purulent empyema with low pH and high lactate dehydrogenase levels. The optimal approach to treating parapneumonic effusions and pleural empyemas remains controversial. Accepted management consists of systemic antibiotics and drainage of the pleural cavity, which is achieved by either medical chest tube drainage or surgery. Several investigators have studied the efficacy and safety of intrapleural fibrinolytics in the treatment of pleural effusion and empyema. Intrapleural instillation of fibrinolytic agents is undertaken to dissolve fibrinous clots and membranes, to prevent fluid sequestration, and hence to improve drainage. Recombinant deoxyribonuclease has been reported to improve drainage in a single patient who did not respond to fibrinolytic therapy.
Acta medica Indonesiana 07/2012; 44(3):258-64.
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ABSTRACT: Mediastinal tumors are tumors inside the mediastinum, i.e. the cavity between the left and right lungs. Overseas literatures suggest that the most common anterior mediastinal tumors found are lymphoma, thymoma and germ cell tumor. Thymoma accounts for 20% of mediastinal tumor and is the most common anterior mediastinal tumor reaching approximately 50% of all tumors in adults. Ninety percent of all thymomas are located in the anterior mediastinum and some of them occur at the neck region or other mediastinal areas. Surgery still becomes the main treatment followed by adjuvant radiation for invasive thymoma. For inoperable patients, induction chemotherapy followed by a surgical reassessment post-therapy, and adjuvant radiation therapy is generally recommended, in spite of the lacking prospective studies for such treatment. Durable responses can be obtained both in the metastatic and recurrent condition, and various novel therapies are currently being studied.
Acta medica Indonesiana 01/2011; 43(1):74-8.
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ABSTRACT: Although several studies have dealt with the patterns of cytokine production in tuberculosis, little is known about the association between nutrient deficiencies and cytokines in tuberculosis. The objective of this study was to assess the concentration of cytokines related to nutritional status during tuberculosis. In 41 untreated tuberculosis patients and matched healthy controls in an urban hospital in Indonesia, we measured: height and weight, parameters of iron, vitamin A and zinc; and cytokines concentrations in the circulation and production in whole blood cultures. Plasma interleukin-6 (IL-6) and interleukin-1 receptor antagonist (IL-1ra) were significantly higher in patients than in controls. Patients with cavities (n=26) had higher concentrations of IL-6 than patients without cavities (n=15). Body mass index <18.5 kg/m2 was associated with high concentrations of tumor necrosis factor-alpha (TNF-alpha) and IL-6. Anaemia was associated with high concentrations of IL-6 and IL-1ra. Zinc deficiency was associated with high LPS-stimulated production of TNF-alpha and IL-1ra. Marginal plasma retinol concentrations were associated with high concentrations of IL-6 after LPS stimulation. In conclusion, low concentrations of micronutrients in tuberculosis were associated with increased cytokine production. An intervention study would allow causality to be examined.
Asia Pacific Journal of Clinical Nutrition 02/2007; 16(2):218-26. · 1.13 Impact Factor
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ABSTRACT: The results of cross-sectional studies indicate that micronutrient deficiencies are common in patients with tuberculosis. No published data exist on the effect of vitamin A and zinc supplementation on antituberculosis treatment.
Our goal was to investigate whether vitamin A and zinc supplementation increases the efficacy of antituberculosis treatment with respect to clinical response and nutritional status.
In this double-blind, placebo-controlled trial, patients with newly diagnosed tuberculosis were divided into 2 groups. One group (n = 40) received 1500 retinol equivalents (5000 IU) vitamin A (as retinyl acetate) and 15 mg Zn (as zinc sulfate) daily for 6 mo (micronutrient group). The second group (n = 40) received a placebo. Both groups received the same antituberculosis treatment recommended by the World Health Organization. Clinical examinations, assessments of micronutrient status, and anthropometric measurements were carried out before and after 2 and 6 mo of antituberculosis treatment.
At baseline, 64% of patients had a body mass index (in kg/m(2)) < 18.5, 32% had plasma retinol concentrations < 0.70 micromol/L, and 30% had plasma zinc concentrations < 10.7 micromol/L. After antituberculosis treatment, plasma zinc concentrations were not significantly different between groups. Plasma retinol concentrations were significantly higher in the micronutrient group than in the placebo group after 6 mo (P < 0.05). Sputum conversion (P < 0.05) and resolution of X-ray lesion area (P < 0.01) occurred earlier in the micronutrient group.
Vitamin A and zinc supplementation improves the effect of tuberculosis medication after 2 mo of antituberculosis treatment and results in earlier sputum smear conversion.
American Journal of Clinical Nutrition 05/2002; 75(4):720-7. · 6.67 Impact Factor
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Zulkifli Amin
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ABSTRACT: Tuberculosis (TB) is a chronic disease caused by M. tuberculosis. WHO (World Health Organization) 1993 has estimated that one third of world population has been infected by M. tuberculosis bacillus. It is also estimated that 8 million people contract the disease annually and two to three million deaths occur every year due to TB. Major factors that have aggravated the spread of TB are: 1) ineffective TB control programs, leading to the development of multi drug resistant bacilli, 2) co infection with HIV (human immunodeficiency virus) where TB progress rapidly and deadly,3) existence of other co-morbid that need higher expert (Internist etc). Vaccination with BCG does not seem to protect the adult population consistently and effectively from developing pulmonary TB, and has had no significant impact on the global TB epidemiology. Tuberculosis in Indonesia results in high death rate because it is the second highest infection with national prevalence rate of 0.24%. Effective medicine standard of anti-tuberculosis is available, but many obstacles in the program from lack of knowledge among health officers, low consciousness and compliances of person with tuberculosis to carry out the treatment schedule and so on make the success of TB eradication unsatisfied. Clinical appearances of TB are multiple with non-specific symptoms, the cases that are exposed to similar source of infection but will show different clinical consequence from mild to severe. Nevertheless, with the rise of multi drug resistance strains of M. tuberculosis, the spread of HIV infection and the variation of BCG efficacy, the search for more powerful drugs, more effective vaccines, better diagnostics and other intervention strategies have become an urgent goal worldwide. Also written here how to diagnose, choose of category of treatment, cocktail anti TB according the category and some clue in handling problems during treatment.
Acta medica Indonesiana 38(2):109-16.
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ABSTRACT: to compare the vitamin D group of pulmonary tuberculosis patients with a placebo group in terms of clinical improvement, nutritional status, sputum conversion, and radiological improvement.
sixty seven tuberculosis patient visiting the Pulmonary Clinic, of Cipto Mangunkusumo Hospital, Jakarta, from January 1st to August 31st, 2001 were included in this study. The subjects were randomised to receive vitamin D (0.25 mg/day) or placebo in a double blind method, during the 6th initial week of Tb treatment. The rate of sputum conversion, complete blood counts, blood chemistry as well as radiologic examination were evaluated.
there were more male patients than females (39:28), 78.7% were in the productive age group, 71.6% had low nutritional status, 62.4% with low education level, and 67.2% with low income. One hundred percent of the vitamin D group and only 76.7% of the placebo group had sputum conversion. This difference is statistically significant (p=0.002).
the sputum conversion had no correlation with the hemoglobin level, blood clotting time, calcium level, lymphocyte count, age, sex, and nutritional status. There were more subjects with radiological improvement in the vitamin D group.
Acta medica Indonesiana 38(1):3-5.
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Acta medica Indonesiana 38(1):1-2.
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Acta medica Indonesiana 37(2):110-2.
