Elvando Tunggul Mauliate Simatupang

Riau University

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Co-Authors

Indra Yovi

Riau University

Rohani Lasmaria Simbolon

Riau University

Sri Indah Indriani

Riau University

Arya Marganda Simanjuntak

Riau University

Zarfiardy Aksa Fauzi

Universitas Achmad Yani

Andreas Makmur

Riau University

Sri Indah Indriani

Riau University

Dewi Wijaya

Riau University

Dewi Anggraini

Airlangga University

Adelia Pratiwi

Riau University

Cooperative Institutions

Riau University

Universitas Achmad Yani

Pulmonary Associates

Nihon University

Juntendo University

University of Indonesia

Fukujuji Hospital

Grantham Hospital

Airlangga University

Andalas University

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Update on the Global Initiative for Chronic Obstructive Lung Disease (GOLD 2023)

Jurnal Respirologi Indonesia (2024)

Adrianison Adrianison Rohani Lasmaria Simbolon Elvando Tunggul Mauliate Simatupang

The overall increase in morbidity and mortality associated with chronic obstructive pulmonary disease (COPD) is inextricably linked to the concept of Global Initiative for Chronic Obstructive Lung Disease (GOLD) updates. An element of every GOLD update is directed toward policymakers, healthcare professionals, and people in general in order to evaluate the immediate and prolonged consequences of COPD. At this time, international interest is focused on the acceleration of the GOLD 2022 update to GOLD 2023 in an effort to enhance clinical management approaches for COPD, including individualized and comprehensive COPD treatment. The GOLD 2023 update will encompass the following aspects: definition and taxonomy, screening and case identification, diagnosis pathway, pharmacological and non-pharmacological approaches to managing stable COPD, and exacerbation management, as discussed in this review. GOLD 2023 explains that the diagnosis of emphysema has been classified as a pathologic diagnosis, in comparison with GOLD 2022. In the meantime, the clinical and epidemiological diagnosis of COPD is chronic bronchitis. The risk factor for tobacco smoke, which was once thought to be the primary cause of COPD, is described in GOLD 2023, together with the most recent taxonomy that has been developed to identify additional contributing components. The word "GET", which refers to the interaction of three risk factors-gene (G), environment (E), and lifetime (T)-that can cause lung damage and accelerate the aging or development of the lungs, is also linked to the most recent taxonomy of COPD. The switch from the "ABCD" approach to the "ABE" method for diagnosis and management of stable COPD is another significant modification included in the GOLD 2023 update. The number of COPD cases worldwide is expected to rise in the upcoming years as an outcome of long-term exposure to risk factors. Consequently, with the goal of increasing patient survival rates, GOLD 2023 highlights the significance of screening and early case discovery through the provision of non-pharmacological care.

Obstructive lung disease

Gold standard (test)

10.36497/jri.v44i1.451

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Lung Abscess Located in Lesion of Lung Tumor and Multiple Cavities due to Pulmonary Tuberculosis: A Case Report

Jurnal Respirasi (2024)

Sri Indah Indriani Elvando Tunggul Mauliate Simatupang Adityo Wibowo Andreas Makmur Wiwit Ade Fidiawati

Introduction: People with tuberculosis (TB) have an increased risk of pulmonary cancer. They are also disproportionately affected by risk factors like immune suppression, smoking, and alcohol misuse. A lung tumor is reported to have occurred after an episode of TB, but we reported a patient with a lung tumor with co-infection TB and lung abscess at the same time. Case: A 73-year-old man was hospitalized at Arifin Achmad General Hospital, Pekanbaru, with a 3-day history of bloody cough 2-3 times a day, 1-2 tablespoons estimated by the patient for blood from the cough. The patient had a cough with white phlegm in the last 4 months before the bloody cough. The patient also had a fever, night sweats, a limp body, decreased appetite for 6 months, and decreased body weight by 15 kg in the last year. Heterogenic consolidation on the superior lobe of the lung with prominence compression and irregular boundaries in the apex was found. We found an air bronchogram and multiple cavities with air-fluid levels inside the lesion. We also found a satellite nodule in the inferior lung and a mass connected with the chest wall. GeneXpert showed low detection for Mycobacterium tuberculosis. The patient was diagnosed with a left lung abscess, pulmonary TB, left lung tumor T4N2M1a, unspecified type of tumor stage IVA PS2, and osteoporosis. Conclusion: Lung tumors could also be diagnosed with co-infection TB. Proper diagnosis to make sure cancer and TB are co-infected is necessary. Therefore, it will not be just a single disease that is treated.

Bloody

Lung abscess

Productive Cough

Phlegm

10.20473/jr.v10-i.1.2024.55-60

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Successful Autologous Blood Patch Pleurodesis: A Safe and Useful Treatment for Persistent Pneumothorax in Former Pulmonary Tuberculosis and Aspergillosis in Pregnant Women

Malang Respiratory Journal (2024)

Nori Purnama Elvando Tunggul Mauliate Simatupang Zarfiardy Aksa Fauzi Sri Indah Indriani Indra Yovi

Background: Autologous Blood Patch Pleurodesis (ABPP) is one of the treatment options for persistent pleural air leaks especially in patients who are not suitable for surgical intervention. Persistence pneumothorax is defined as pneumothorax of more than five days duration. It is associated with increased morbidity and cost of care. The most widely accepted treatment for it is pleurodesis. Several types of pleurodesis have been proposed, including surgical approaches and the instillation of different chemicals in the intrapleural space. ABPP has proven to be a simple, inexpensive, efficacious and safe method. We present the case of the first patient with Persistent Pneumothorax we have treated Successfully with ABPP. ABPP is currently rarely and uncommonly used, but it provides benefits especially in special conditions with easier, cheaper, and quite effective procedures. Case: A female 35-year-old pregnant women patients with Former Tuberculosis (FTB) come to our hospital with complaints breathlessness and chest pain worsening since 3 days before admitted to our hospital. Chest radiography showed spontaneous pneumothorax with GeneXpert (GE) sputum Mtb Not Detected but there is Aspergillosis from Fungal Culture. Water Sealed Drainage (WSD) was inserted in right pleural for almost 1 month and this patient discharge with pneumostat. One month after that she come again with Persistence Pneumothotax, so that we do the pleurodesis with Blood Patch and get the improvement from clinical status. Antifungals are continued for an initial 4-6 weeks while an outpatient evaluation is conducted. Conclusion: ABPP is a safe, inexpensive and efficacious treatment for persistent pleural air leak. Autologous Blood Patch administration may be considered for patients with Persistent Pneumothorax.

Pleurodesis

Sputum culture

10.21776/ub.mrj.2024.006.01.04

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Giant Intrapulmonary Mature Teratoma with Thoracostomy Intervention: A Rare Case Report

Malang Respiratory Journal (2024)

Sri Indah Indriani Elvando Tunggul Mauliate Simatupang Briliant Bergant Andreas Makmur Ina Farida Rangkuti

Background: Teratoma usually found in mediastinum and rarely found in the lung. Mature teratomas are the most common histological type of germ cell tumours, followed by seminoma. First case reported by Mohr in 1839 and until now only few cases of intrapulmonary teratomas have been reported. Case: A man, 64-years old man, nonsmoker complains of shortness of breath since 6 months and worsened in a week. Patient had history medication for tuberculosis in 2019. Chest Contrast CT-Scan showed hypodense mass and suggestive for benign left lung tumor. TTNA were performed and suggestive for teratoma. Joint conference with several department agree to proceed with thoracostomy. Thoracostomy with wide excision been done to remove the mass and examined for anatomic pathology then confirmed for mature teratoma. During thoracostomy, we cannot removed 100% of the tumor because it adhesive with aorta and parietal pleura. Patient treated in ICU and worsens. Unfortunately, patient passed away four days later. Conclusion: Teratoma is rarely found inside of the lung. Early diagnosis and resection of intrapulmonary teratoma is critical to prevent complications and provide definitive treatment.

Thoracostomy

10.21776/ub.mrj.2024.006.01.06

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How Tuberculosis Scar Could Induce Lung Cancer?

Journal Of The Indonesian Medical Association (2024)

Elvando Tunggul Mauliate Simatupang Arya Marganda Simanjuntak Indra Yovi Rohani Lasmaria Simbolon Sri Melati Munir

In 2022, there will be 10.6 million cases of tuberculosis, which is a serious problem worldwide. Thailand's cohort research after the COVID-19 pandemic found a 7-fold risk of tuberculosis infection in COVID-19 patients, pointing to a probable rise in TB cases. In order to completely eradicate TB, care must be given to patients both before and after infection, guaranteeing public health against TB infection.1,2

10.47830/jinma-vol.73.6-2024-1087

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The Role of Gut Microbiota as a Trigger for Exacerbations in Pulmonary Obstruction Disorder in General

Jurnal Respirasi (2024)

Dewi Wijaya Elvando Tunggul Mauliate Simatupang Yolanda Julia Perel Putri Adelia Pratiwi Dewi Anggraini

Pulmonary diseases can be associated with the gastrointestinal (GI) system, particularly if an infection causes them. This relationship between organs is known as the gut-lung axis (GLA). Skin and mucosal surfaces are associated with microbiota (bacteria, fungi, viruses, macrophages, archaea, protists, helminths), which can trigger an immune response in GLA and serve a role in respiratory diseases. For instance, asthma can be inhibited by a specific antigen that is triggered by probiotics, the microorganisms found in the GI tract. Asthma incidence can be reduced by consuming fiber due to its ability to protect airways from infection. Pattern recognition receptors (PRRs) are the first immune component to identify microbial compounds in GI and lung epithelial cells. The PRRs then induce regulatory T-cell (T-reg) and Th-17 differentiation. Diet, antibiotics, and stress can all influence the structure and function of bacteria. This is known as dysbiosis. Lung microbiota can influence immune cell maturation and homeostasis. If the diversity of lung microbiota decreases, it will affect intestinal microbiota and may result in chronic respiratory disorders such as chronic obstructive pulmonary disease (COPD), asthma, and cystic fibrosis. This literature review explained how the interactions between the intestines and lungs can affect humans’ health and well-being.

10.20473/jr.v10-i.3.2024.257-264

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Current Knowledge of Mycobacterium Other Than Tuberculosis (MOTT) in this Current Era: Definition, Taxonomy, and Diagnose

Respiratory Science (2024)

Sri Indah Indriani Adelia Pratiwi Elvando Tunggul Mauliate Simatupang Arya Marganda Simanjuntak

Globally, Pulmonary Tuberculosis (PTB) remains a health concern, with an annual increase in cases. Indonesia is the second-highest contributor to PTB cases globally, below India, which also saw an increase in cases, particularly after the COVID-19 pandemic. Nontuberculous Mycobacteria (NTM) infections contribute to the increase in PTB cases through misdiagnosis and overlapping conditions. The occurrence of changes in the composition of NTM species in the Mycobacterium genus is the premise for updating the diagnosis of NTM with several supporting examination modalities. Clinical, radiological, and microbiological criteria have been established by the American Thoracic Society (ATS) and Infectious Diseases Society of America (IDSA) for the diagnosis of NTM. The relationship between these three criteria is essential as a guideline for distinguishing infections caused by Mycobacterium tuberculosis (Mtb) from those caused by NTM.

Nontuberculous Mycobacteria

Guideline

Pandemic

Modalities

10.36497/respirsci.v4i3.122

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Silicosis: Mechanisms, Clinical Aspects, and Impacts due to Silica Exposure

Jurnal Respirologi Indonesia (2024)

Indi Esha Siregar Tania Libristina Ambun Suri Afdi Elvando Tunggul Mauliate Simatupang

Silicosis, an occupational lung disease, has significant mortality rates in Indonesia, as reported by Global Health Grove in 2013. The death rate for silicosis stands at 69.3%, with the typical age at death ranging from 40 to 44 years for men and approximately 80 years for women. The pathogenesis of silicosis begins when respirable crystalline silica (RCS) particles enter the airways. These RCS particles bypass the mucociliary defense mechanisms of the respiratory tract and reach the alveoli. Workers frequently exposed to silica are at high risk of developing silicosis, which significantly impacts morbidity and mortality. The diagnosis of silicosis can follow the seven-step principle for determining occupational diseases. Although silicosis is linked to serious conditions such as tuberculosis, autoimmune diseases, and lung cancer, no effective therapy exists. Treatment remains symptomatic, adjuvant, and supportive. To prevent occupational lung diseases, it is essential to involve the government in policy-making for industrial management and workers.

Silicosis

10.36497/jri.v44i3.644

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Profile of Pulmonary Tuberculosis After COVID-19 at Toba District, North Sumatra Province

Jurnal Respirologi Indonesia (2024)

Elvando Tunggul Mauliate Simatupang Arya Marganda Simanjuntak Indra Yovi Rohani Lasmaria Simbolon Zarfiardy Aksa Fauzi

Background: Worldwide cases of pulmonary tuberculosis (PTB) have significantly increased since the COVID-19 pandemic. Indonesia accounted for 6,811,818 of the 767,518,723 cases reported by the World Health Organization. While the Indonesian Ministry of Health reported 824,000 cases, the Global Tuberculosis Report in 2022 reported 10.6 million cases. The pandemic has hampered the goal of eliminating PTB globally, with cases diagnosed after COVID-19 having a 7.15-fold increased risk of contracting the illness.Methods: This cross-sectional study was conducted using total sampling to identify the profile of patients with PTB after having COVID-19 based on age, gender, classification, and type of PTB, as well as the duration of occurrence of PTB after COVID-19. The data collected were from COVID-19 patients from 2020 to 2022, then compared with PTB data. All data were compared to ensure that COVID-19 and PTB patient data were the same.Results: Of the 2544 patients recorded, 29 (1.1%) were infected with PTB after COVID-19 infection. The mean age of patients was 34±18.9 and was dominated by men (68.9%). Most of the cases were drug-sensitive TB (96.6%) and clinically diagnosed TB (55.2%). Age had a statistically significant association with the occurrence of TB cases after COVID-19 infection (P<0.0001). The mean time from the initial diagnosis of COVID-19 to the diagnosis of confirmed TB was approximately 203±34.3 days (6.7 months).Conclusion: After COVID-19, patients have the potential to be infected with TB. Screening former COVID-19 patients can be one solution to finding early cases of PTB.

2019-20 coronavirus outbreak

10.36497/jri.v44i4.716

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Overlapping of Intestinal Tuberculosis with Typhoid Fever as Initial Diagnosis: A Case Report

Malang Respiratory Journal (2024)

Elvando Tunggul Mauliate Simatupang Rohani Lasmaria Simbolon Anwar Bet Andreas Makmur

Background: Extrapulmonary Tuberculosis (ETB) cases have increased to 20-30% of all Pulmonary Tuberculosis (PTB) cases, including Intestinal Tuberculosis (ITB). Overlap between ITB and Typhoid Fever (TF) leads to Diagnostic Delays in ITB. Endoscopic and histopathological examinations are needed as diagnostic support, so comprehensive examination and clinical evaluation are necessary. Accurate diagnosis and management will have significant implications for patient survival. Case: A 23-year-old male patient complained of shortness of breath for three weeks. Previously fever, night shivering, loss of appetite, and weight loss were also experienced. A history of previous hospitalization involving abdominal colic complaints, the patient should be hospitalized twice. Repeated administration of antibiotics with TF diagnosis did not show any clinical improvement. The suspicion of ITB was proven after obtaining positive results from Genexpert (GE) of Faeces and clinical response after Anti Tuberculosis Drugs (ATD) administration. Overall, there were clinical, laboratory and radiological improvements in patients with clinical abdominal colic and fever experienced in the last 2 months. Conclusion: Challenge ATD delivery and GE of Faeces can be used as an indicator of suspects ITB so overlap between ITB and TF can be predicted. A comparative diagnostic study of abdominal colic and recurrent fever should also be extended so that it can be continued with several diagnostic support.

Intestinal infectious diseases

INTESTINAL TUBERCULOSIS

Enteric fever

10.21776/ub.mrj.2024.006.02.03

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