Latar belakang: Diabetes melitus (DM) merupakan kondisi kronis yang memerlukan perawatan medis berkelanjutan serta penanganan dengan strategi multifaktorial. Kacang kedelai diketahui memiliki kandungan isoflavone yang bermanfaat untuk membantu mengendalikan kadar gula darah. Penelitian ini bertujuan untuk mengevaluasi efek pemberian produk olahan kedelai terhadap kadar gula darah puasa dan resistansi insulin. Metode Penelitian: Penelitian ini merupakan penelitian eksperimental dengan subjek penelitian 30 ekor tikus Wistar jantan yang dibagi dalam 5 kelompok, yaitu kelompok tikus normal, kontrol negatif, perlakuan tempe, perlakuan tahu, dan perlakuan tepung kedelai selama 2 minggu. Kadar glukosa darah puasa pada setiap kelompok diperiksa sebelum, sesudah pemberian diet tinggi lemak dan induksi streptozotocin, serta sesudah perlakuan. Nilai HOMA-IR diukur dengan kadar glukosa darah puasa dan kadar insulin setelah induksi diabetes dan sesudah perlakuan. Data penelitian dianalisis secara statistik menggunakan uji MANOVA (p<0,05). Hasil Penelitian: Terdapat pengaruh dari pemberian ketiga bentuk olahan kacang kedelai yaitu tempe, tahu, dan tepung kedelai terhadap kadar glukosa darah puasa dan kondisi resistansi insulin pada tikus model DM tipe 2 yang diinduksi streptozotocin, dengan hasil yang lebih baik adalah pada kelompok yang mendapatkan tempe. Kesimpulan: Pemberian olahan kacang kedelai berupa tempe, tahu, dan tepung kedelai memiliki pengaruh yang signifikan pada perbaikan kadar glukosa darah puasa dan resistansi insulin pada model tikus DM yang diinduksi streptozotocin.
A 59 yrs old male with severe ARDS due to COVID-19 infection was in life threatening ‘cytokine storm’. He had also co-morbids including diabetes mellitus and hypertension. He had come from Grobogan, a red area for COVID-19. Clinical finding indicted systemic inflammatory response syndrome (SIRS) with dyspnea, tachycardia, and high fever. Laboratory tests showed raised leukocyte count, CRP, SGOT/SGPT, blood sugar, PCT, low PaO2/FiO2 ratio. RT PCR showed he was infected by COVID-19. Sputum culture showed Klebsiella infection and CXR showed bilateral pneumonia.
Patient was treated with standard therapy and a combination of tocilizumab for cytokine-storm and helmet CPAP for severe ARDS.
Helmet CPAP has become the first modality for COVID-19 ARDS in some countries but not in Indonesia. We chose helmet CPAP because of the cost efficient, comfortable, and easy operation compared to other modality. We chose tocilizumab because it uses a single dose. Although it is expensive, only one dose is enough and it is effective in blocking the cytokine storm. We found that helmet CPAP and tocilizumab combination in COVID-19 lead severe ARDS could be promising to prevent intubation for patients.
Key words: Helmet CPAP; ARDS; COVID-19; Tocilizumab; Cytokine storm
Citation: Permana SA, Sugiarto A, Thamrin MH, Arifin, Harsini. A promising therapy of tocilizumab and helmet CPAP to prevent intubation for COVID-19 induced severe ARDS: a case report. Anaesth. pain intensive care 2020;24(6):659-663; DOI: 10.35975/apic.v24i6.1409
Received - 17 September 2020, Reviewed – 01 October 2020, Accepted – 6 November 2020
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.