BACKGROUND: Exposure to cigarette smoke may stimulate the inflammatory response and activate polymorphonuclear leukocytes, thus resulting in secretion of cellular proteases. Vitamin D has the potential to modulate the inflammatory response to harmful particles in patients with Chronic Obstructive Pulmonary Disease (COPD). AIM: This study aimed to determine the levels of vitamin D, MMP-9, and TIMP-1 in COPD subjects, healthy smokers and nonsmokers of Indonesian citizens METHODS: Seventy-eight male subjects took part in this study. They comprised three groups, i.e. COPD (n = 26), healthy smokers (n = 25) and healthy non-smokers (n = 27). Serum 25(OHD) levels, MMP-9, and TIMP-1 concentrations measured by electrochemiluminescence binding assay (ECLIA) and enzyme-linked immunosorbent assay (ELISA). RESULTS: The levels of vitamin D in COPD (21.96 ± 6.62ng/mL) and healthy smokers (27.87 ± 7.08 ng/mL) were significantly (p < 0.001) lower compared to that in healthy non-smokers (31.71 ± 9.24 ng/mL). On contrary, the levels of MMP-9 in COPD (11.98 ± 41.54 ng/mL) was significantly (p = 0.003) higher compared to that in healthy smokers (2.23 ± 3.39 ng/mL) and healthy non-smokers (0.89 ± 1.12 ng/mL). Whereas the levels of TIMP-1 in healthy smokers (24.64 ± 57.77 ng/mL) was significantly (p < 0.001) lower compared to that in COPD (58.40 ± 77.53 ng/mL) and healthy non-smokers (46,54 ± 71,48 ng/mL). CONCLUSION: The present study showed the lowest level of vitamin D, the highest level of MMP-9 and TIMP-1 in the COPD subjects.
Background: Community-Acquired Pneumonia (CAP) is an important problem associated with morbidity and mortality. An accurate initial assessment is required before starting management of a CAP patient to determine the prognosis of the patient as early as possible. The CURB-65 score and PSI (Pneumonia Severity Index) are initial assessment scores that can be used. This study aimed to compare the accuracy between the CURB-65 score and the PSI in determining the prognosis in CAP patients at H. Adam Malik General Hospital Medan. Method: A descriptive study was conducted on 76 patients diagnosed with CAP. Each patient was assessed for their CURB-65 score, PSI class and mortality within 30 days of admission. Data were collected through patient medical records diagnosed CAP in 2018 and performed statistical analysis using 2x2 tables. Results: The CURB-65 ≥3 score showed accuracy (71.0%), sensitivity (53.8%), and specificity (89,2%). The CURB-65 ≥ 2 score showed accuracy (75.0%), sensitivity (82.1%), and specificity (67.6%). Meanwhile, the Class IV-V PSI showed accuracy (77.6%), sensitivity (87.2%) and specificity (67.6%). Conclusion: The accuracy of the PSI is higher when compared to the CURB-65 score in determining the prognosis of CAP patients at H. Adam Malik General Hospital Medan. Although PSI is more accurate, CURB-65 is simpler, easier and less expensive to use
Background: COVID-19 (Corona Virus Disease-2019) pandemic has a high mortality rate especially in Medan, Indonesia. Serum albumin and liver function tests are believed to be predictive biomarkers for prognosis in patients with infectious diseases, including COVID-19. This study aimed to investigate the association between the mortality events and severely ill COVID-19 patients' serum albumin and liver enzymes. Method: This is a cross-sectional study using secondary data from the medical records of H. Adam Malik Hospital patients with COVID-19 who were confirmed by RT-PCR from August to December 2020. All patients were analyzed for age, sex, hypoalbuminemia, increased liver enzymes and outcome using Chi-square tests (P<0.05). Results: The average age of severe COVID-19 patients at H. Adam Malik Hospital ranged from 41 to 60 years, with more women prevalence than men. Most of the patients had hypoalbuminemia (84.2%), an increase in AST (59.4)% and ALT (45.5%). There was no significant association between hypoalbuminemia and the disease outcome (P=0.12). There was a significant association between elevated liver enzymes and mortality in severely ill COVID-19 patients (P<0.001). Conclusion: We found that hypoalbuminemia is common in patients with severe COVID-19. However, we found that albumin levels had no association with the patients' mortality rate. Liver enzymes levels appear to be a predictive biomarker for outcomes in COVID-19 patients of H. Adam Malik Hospital. We found that higher ALT and AST levels were associated with significantly higher mortality.
Background: In chronic obstructive pulmonary disease (COPD), bronchodilator therapy using dry powder inhaler (DPI) or a measured dose inhaler (MDI) is more convenient at a lower cost than nebulizer therapy. Mistakes in the use of MDI often occur due to lack of coordination but with the addition of spacers, drawbacks in the use of this MDI can be overcome so that it does not require coordination. Commercial spacers are relatively expensive and not available anywhere while home-made spacers made from bottles of mineral water are very cheap and can be made alone. Study aimed to evaluate the effectiveness of each device, namely a spacer, a home-made spacer and nebulizer.Methods: This study is an experimental study of 62 COPD patients who received bronchodilators using spacers, home-made spacers, and nebulizers. Spirometry is performed for each sample before and after bronchodilator administration to assess FEV1, KVP and changes in VAS dyspnea. The difference in the effectiveness of bronchodilators for various devices in COPD patients was statistically analyzed using the ANOVA test.Results: There were significant differences in the values of VEP1, KVP and VAS dyspnoea after bronchodilator administration through the spacer, home-made spacer and nebulizer (p<0.001), (p=0.002), (p<0.001). The increase in% VEP1 with a nebulizer device was higher than that of a spacer (p=0.001) and the increase in% VEP1 with the nebulizer device was also significantly significant compared to home-made spacer (p<0.001). The increase in% KVP with the nebulizer device was higher than that of home-made spacer (p<0.001), as well as between spacers and home-made spacers and this was significant (p=0.038). The decrease in VAS dyspnoea in patients using nebulizer device than the spacer (p<0.001). Decreasing VAS dyspnoea with nebulizer devices is higher compared to home-made spacers, also gives significant results (p<0.001). There were no differences in the decrease in VAS dyspnoea between spacers and home-made spacers.Conclusions: The administration of bronchodilators by use of three devices (spacers, home-made spacers and nebulizers) can significantly increase the values of FEV1, KVP and VAS dyspnoea. On the use of spacers and home-made spacers, the increase of pulmonary physiological values is not significantly different.
ounds: The cytological and histopathological findings establish the type of lung cancer cells as the definitive diagnosis of lung cancer. This study aimed to determine the characteristics of lung cancer patients in terms of age, mean age, gender, staging, the proportion of lung cancer cells by cytologic examination of Transthoracic Needle Aspiration (TTNA) and histopathologic evaluation from CT-guided core biopsy. Method: This is a descriptive study involving 42 subjects diagnosed with lung cancer at H. Adam Malik Hospital Medan in 2016-2020 that met the inclusion criteria through consecutive sampling. Data was analysed using descriptive statistics for categorical variables. Results: Of 42 study subjects, the 60–71-year age group had the highest percentage of lung cancer (42.9%). Male (71.4%) was higher than female, the most common lung cancer staging was IVA (57.1%), and adenocarcinoma was found to be the most frequent type of lung cancer in both cytology (33.3%) and histopathology (31.0%). Conclusion: We concluded that core biopsy is superior in diagnosing lung cancer compared to TTNA.
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