Rationale: Bacterial and fungal infections in Coronavirus Disease-19 (COVID-19) patients have been inadequately investigated and reported thus far. The safety profile of tocilizumab (TCZ) administration in candidemia patient still debatable. Patient concerns: A 54 year-old woman presenting with weakness on the left side of her body was diagnosed with COVID-19. After 7 days of admission, her condition worsened and developed respiratory distress and was having respiratory distress despite standard treatment. Diagnoses: Acute respiratory distress syndrome (ARDS) in COVID 19 was diagnoses based on real time-PCR swab, deterioration of PaO 2 /FiO 2 and increased of acute phase reactants. Interventions: Anti Interleukin–6 (IL-6) was considered to tackle her inflammatory condition. Prior to TCZ administration, blood culture was performed and the result came with Candida tropicalis in the absence of bacterial growth. Outcomes: No major complications associated with intravenous antifungal or TCZ occurred. After 40 days of hospitalization, the patient's clinical condition improved and was finally discharged. Lessons: This case underscores the safety profile of giving TCZ in candidemia as a secondary infection in severe COVID-19 patient.
Introduction:This study aimed to review the clinical characteristics and outcomes of COVID-19 patients presented with in-hospital hyperglycemia or pre-existing type 2 diabetes (T2DM). Methods: This is a retrospective study conducted in Fatmawati General Hospital, Indonesia, from March 18th-Apr 30th, 2020. We reviewed medical records of 27 COVID-19 patients presented with either in-hospital hyperglycemia (11, 12.2%) or pre-existing T2DM (16, 17.8%) from a total of 90 confirmed COVID-19 cases admitted in our hospital. Results: Critical conditions occurred in 50% of T2DM and 54.55% of the in-hospital hyperglycemia group. Mortality was documented in 68.75% of T2DM and 81.82% of in-hospital hyperglycemia group. Hypoglycemia, diabetic ketoacidosis, lactic acidosis and ketosis were found in 12.5%, 25%, 18.75%, and 25% of individuals with T2DM, respectively, resulting in a high mortality rate. Meanwhile, diabetes-related complications were rare among the in-hospital hyperglycemia group. However, respiratory failure (45.45% vs. 6.25%) and septic shock (27.27% vs. 6.25%) were more frequent than in the T2DM group. Conclusion:In this preliminary study, a high mortality rate was documented among COVID-19 patients with preexisting T2DM and in-hospital hyperglycemia. In T2DM subjects, diabetes relatedcomplications contributed to a higher mortality rate, while inhospital hyperglycemia group, respiratory failure and septic shock were more frequent.
Background: Liver resection has been associated with high morbidity and mortality. Improvements in surgical, anesthetic techniques, and multidisciplinary collaborations, can reduce post-surgery complications and mortality. This study aims to provide an overview of the perioperative conditions and the treatments after liver resection.Method: A retrospective study of liver resection surgery between 2019-2020 at Fatmawati Hospital.Results: Of the 11 patients, mean age was 49.7 years, with 63.6% being female and mean BMI was 22 kg/m2, hypertension and diabetes mellitus were found in 18.2% and 18.2% of patients respectively. HBsAg reactive was detected in 36.3%. Based on pathology, HCC was found in 54.5%, while 18.2% were metastatic adenocarcinoma. Postoperative hyperglycemia was observed in 90.9%. Increase in AST and ALT 3 upper limit normal were found in 90% and 72.7% of patients. Mean AST and ALT were 408.3 U/L and 246.18 U/L. Mean urine production at 8-, 16-, 24-, and 48-hours post-operative were 757, 1624, 1880 and 1930 cc. Urine production ≤ 500 cc in the first 8 hours was detected in 44.4% of patients, and elevated creatinine levels 50% post-operative occurred at 11.1%, 22.2%, 22.2% at 16, 24, and 48 hours post-op. Renal support therapy was given to 5 of the 11 patients. D-Dimer levels were increased in all patients.Conclusion: Adequate fluid monitoring and metabolic disorders control such as glucose levels, acute kidney injury, coagulation disorders, and bleeding are important things that need to be considered in the perioperative management of liver resection.
Rationale: Acute respiratory distress syndrome (ARDS) in miliary tuberculosis (TB) remains rare, especially in pregnant women. The role of blood purification is potential in managing ARDS due to miliary TB. Patient concerns: A 36-year-old woman presenting with difficulty breathing 6 hours before admission. She never had any constitutional symptoms due to TB. Diagnoses: ARDS in TB was diagnosed based on the deterioration of PaO 2 /FiO 2 , increased acute phase reactants, positive gene-Xpert, and typical chest x-ray of miliary TB. Interventions: A C-section was performed and followed by continuous venovenous hemofiltration to tackle her inflammatory condition. antituberculosis drugs were given after the transaminases showed declining trends. Outcomes: No major complications associated with continuous venovenous hemofiltration occurred. After 14 days of hospitalization, the patient’s clinical condition improved and was finally discharged. Lessons: This case underscores the potential role of blood purification in ARDS due to miliary TB in pregnancy.
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