Aging causes many changes in biological processes characterized by progressive and widespread changes associated with increased susceptibility to various diseases. Aging is not a homogeneous process. In contrast, human organs aging at different rates are affected by several factors, including genetic factors, lifestyle, and environmental exposure. Healthy aging remains accompanied by some morphological and functional changes in the respiratory system. During the first two decades of life, the lungs undergo a phase of growth and maturation. Respiratory system achieves maximum function at the age of 20 years for women and 25 years for men. Throughout the rest of life, aging is associated with a progressive decline in pulmonary performance and function. The normal aging of the respiratory system is associated with structural and functional decline in the respiratory system, resulting in increased respiratory work compared to younger subjects and is associated with reduced reserves in cases of acute illness, such as heart failure, infection, or airway obstruction. Pulmonary function decreases slowly throughout life even in healthy people. Disabilities and diseases related to aging are a global problem due to the longevity of life expectancy. An increased proportion of the elderly population is a challenge for doctors because of the clinical complexity of the elderly. A better understanding of change can help diagnose and treat lung disease in the elderly population.

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Empyema is a collection of exudative fluid in the pleural cavity associated with the occurrence of pulmonary infection. Empyema is often caused by complications of pneumonia but can also be caused by infection from elsewhere. Community-aquired pneumonia has an incidence of 8 to 15 per 1000 per year. Forty to 57% of patients with pneumonia, may develop into a parapneumonic effusion. Approximately 5 to 10% of parapneumonic effusions develop into empyema. All patients with parapneumonia and empyema effusions require antibiotic therapy early and adequate. Sterile pleural effusions with PH ≥ 7,20 were observed and protected by adequate antibiotics. Empyema and localized pleural effusions and parapneumonic effusions with PH <7.20 or glucose <60 mg / dL or the presence of germs on positive examination and culture require drainage. Delays in drainage may increase morbidity and mortality rates. Management of empyema depending on the stage, antibiotics or thoracocentesis, thoracostomy, thoracostomy with fibrinolytic therapy, thoracoscopy, dekortication and open thoracotomy.

A real-time reverse transcriptase polymerase chain reaction (RT-PCR) is the gold standard in diagnosis for infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but the false-negative result is the problem in the prevention and control the pandemic of coronavirus disease 2019 (COVID-19). A false-negative of RT-PCR test needs to be evaluated when the patient showed a high clinical suspicion for COVID-19. We report a 36-year-old man with four times negative RT-PCR results, but clinical, radiological (chest X-ray and chest CT scan), and serological examinations showed a high suspicion of COVID-19. History of close contacted with COVID-19 confirmed patient was reported, and the wife of our case was also RT-PCR tested positive for SARS-CoV-2 in the next few days strengthen the COVID-19 diagnosis of our case patient. It is important to use the combination of RT-PCR, chest X-ray, chest CT scan, clinical manifestations, antibodies test, and exposure history of patients to diagnose COVID-19 and decide the early isolation and appropriate treatment.

The innate immune system identifies exogenous threats or endogenous stress through germline-encoded receptors called pattern recognition receptors (PRRs) that initiate consecutive downstream signaling pathways to control immune responses. However, the contribution of the immune system and inflammation to fibrosing interstitial lung diseases (ILD) remains poorly understood. Immunoreceptor tyrosine-based motif-bearing C-type lectin-like receptors (CTLRs) may interact with various immune cells during tissue injury and wound repair processes. Dectin-1 is a CTLR with dominant mechanisms manifested through its intracellular signaling cascades, which regulate fibrosis-promoting properties through gene transcription and cytokine activation. Additionally, immune impairment in ILD facilitates microbiome colonization; hence, Dectin-1 is the master protector in host pulmonary defense against fungal invasion. Recent progress in determining the signaling pathways that control the balance of fibrosis has implicated immunoreceptor tyrosine-based motif-bearing CTLRs as being involved, either directly or indirectly, in the pathogenesis of fibrosing ILD.

Background: Primary resistance is the resistance that occurs in patients who have never received treatment OAT or had ever received  treatment OAT is less than 1 month. The incidence of primary MDR in Central Java in 2006 2.07%. Extrapulmonary TB about 15-20%  of all cases of TB, and TB lymphadenitis is the highest form (35% of all extrapulmonary TB). Patients with decreased immune systems  (SLE) can increase the incidence of TB. Research in Spain get 6x higher TB incidence in patients with SLE. Case: We present the case  of 19 year old woman SLE who received treatment for 11 months whose came with shortness of breath and chronic cough since 2 month  prior to admission. In physical examination we found right and left submandibula lymphonodi enlargement as solid, slightly mobile  nodule with diameter 3 cm. Chest X ray showed lung inflammation which suspicion of specific process and minimal left pleural effusion,  and concluded as pulmonary TB. FNAB confirmed lymphadenitis TB with granulomatous inflammation. One of AFB result is positive  and Gene Xpert is M.tb positive with rifampicin resistant that make this patient categorized as primary MDR TB with lymphadenitis  TB. This patient received Pirazinamid 1500 mg, Ethambutol 800 mg, Kanamicin 750 mg, Levofloxacin 750 mg, Ethionamide 500 mg,  Cicloserin 500 mg, and B6 100 mg. Conclusion: MDR TB in general occur in patients with a history of OAT previous TB (MDR TB  secondary). Primary MDR TB with lymphadenitis tb is a rare case, but can occur on the condition that decreases the immune system,  one of SLE. This involves multiple immune disorders caused by the use of long-term immunosuppressive therapy.

Introduction: Stress is mental health problem that can occur to medical student. Stress distract student’s life from student’s task. This distraction causes ineffective study. Ineffective study could cause lower motivation and probability of educational failure. Methods: This study was a cross-sectional analytic that used pre-clinical medical student in Faculty of Medicine Universitas Airlangga as population. This study used convenience/haphazard sampling as sampling method. The data was taken at Faculty of Medicine Universitas Airlangga from June to August of 2018. The subjects that meet the criteria were subjects who agreed to informed consent. The data was taken using questionnaires. The questionnaires were DASS (Depression Anxiety Stress Scales) and MSLQ (Motivated Strategies of Learning Questionnaire). The data then was examined for normality. Results: A total of 95 medical students were included in this study, 55 subjects were female, mostly aged 21 years old. Most of pre-clinical medical student’s stress level was on normal level (47.5%), while their motivation level was on adequate level (74.7%). Conclusion: There is a correlation between stress level and learning motivation of pre-clinical medical student in Faculty of Medicine Universitas Airlangga

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