Pendahuluan: Saat ini COVID-19 masih menunjukkan peningkatan dalam hal prevalensi dan mortalitasnya. COVID-19 mempunyai gejala berupa demam, batuk kering, fatique, dan kemudian berkembang menjadi sesak napas sampai gagal napas dan ARDS. Happy hipoxemia ditemukan pada sebagian pasien yaitu secara subjektif pasien tidak menyatakan adanya sesak, namun didapatkan gangguan oksigenasi. Diperlukan suatu parameter untuk mengevaluasi derajat oksigenasi pada semua pasien COVID-19 yang dapat menjadi prediktor derajat keparahan COVID-19 dan memberikan suatu gambaran untuk rencana tatalaksana lebih lanjut. Objective : Menganalisis hasil pemeriksaan Analisis Gas Darah pada pasien yang dirawat di rumah sakit dan hubungannya dengan derajat keparahan penyakit COVID-19.Metode: Analisis observasional dengan pendekatan cross sectional, single-center, pada 71 pasien terkonfirmasi COVID-19 dilakukan antara bulan April-Juli 2020 pada pasien yang dirawat di Ruang COVID RS Dr. Saiful Anwar Malang, Indonesia. Analisis statistik digunakan untuk menilai hasil analisis gas darah dengan derajat keparahan penyakit. Hasil: Subjek terdiri dari 71 pasien terkonfirmasi COVID-19 terbagi menjadi 2 kelompok, 25 pasien (35,21% ) kelompok ringan sedang dan 46 pasien (64,79%) kelompok berat. Demografis dan karakteristik klinis menunjukkan bahwa usia, riwayat merokok, keluhan sesak dan penggunaan oksigen berhubungan dengan derajat keparahan penyakit (masing masing dengan p<0,05). Analisis gas darah menunjukkan hubungan antara derajat keparahan penyakit dan derajat oksigenasi yang dinilai dari PaO2, SaO2 BGA, PaO2/FiO2 dan original PaO2 (masing masing dengan p<0,05). Kesimpulan: Derajat oksigenasi berhubungan dengan keparahan pasien COVID-19 rawat inap.
Tumor Necrosis Factor Alpha (TNF-α) is a pro-inflammatory cytokine that plays a crucial role in COVID-19 disease progression. N-acetylcysteine (NAC) works throughout several GSH-mediated mechanisms and is known to eliminate oxidative stress in acute respiratory distress syndrome (ARDS) in COVID-19. This study aims to analyze the effect of the N-Acetylcysteine as Adjuvant Therapy to reduce TNF-α levels and Increase SpO2/FiO2 ratio in Improving hypoxemia in COVID-19 Patients. This is a quasi-experimental, non-equivalent control group design study. There were 91 subjects selected using non-random sampling, which consisted of 75 patients in the NAC group and 16 patients in the control group. The TNF-α level was measured using the ELISA method, and SpO2/FiO2 ratio was calculated on day 1 (on admission) and day eight after NAC 5000mg/ 72 hours was given. Statistical analysis was conducted using Wilcoxon and Mann-Whitney U Test. There is a significant decrease in TNF-α level in the treatment group (median 1.49±5.22) (p=0.016) compared with the control group (median 1.64±1.99) (p=0.005). The Median SpO2/FiO2 ratio on day 1 is 163.70±69.64 in the control group and 121.49±40.41 in the treatment group (p=0.005). The Median SpO2/FiO2 ratio on day 8 is 249.69±132.26 in the control group and 151.29±59.18 in the treatment group (p=0.001). There is a positive correlation between serum TNF-α level and SpO2/FiO2 ratio after administration of adjuvant therapy NAC (r=0.240, p=0.038). There is a positive correlation and significant decrease of serum TNF-α and SpO2/FiO2 ratio after adjuvant NAC therapy, which improves hypoxemia in COVID-19 patients.
Background: Interleukin 6 (IL-6) is a cytokine that plays an essential role in lung damage and mortality. Arterial-to-inspired oxygen (PaO2/FiO2) ratio, also known as the Horowitz index, is a measure of hypoxemia in respiratory failure. N-Acetylcysteine (NAC) might be helpful in managing coronavirus disease 2019 (COVID-19) patients by decreasing the cytokine storm, which will lead to a decrease in disease severity. This study aims to analyze the effect of NAC as adjuvant therapy on IL-6 level and PaO2/FiO2 ratio in COVID-19 patients.Methods: This is a quasi-experimental, non-equivalent control group designed study of confirmed COVID-19 patients moderate to critical in Saiful Anwar Hospital Malang. Seventy-five patients received NAC intravenously 5000mg/72 hours as adjuvant therapy for seven days, and 16 subjects in the control group. IL-6 level and PaO2/FiO2 ratio were measured on day one and day 8 in both groups from blood samples. Wilcoxon, Mann-Whitney U Test, and Pearson correlation were conducted for statistical analysis. Results:The decrease in IL-6 level on days 1 to 8 in the NAC group is significantly lower (94.49±253.51) than in the control group (P=0.002). The increase in PaO2/FiO2 ratio from day 1 to day 8 in the NAC group is significantly improving (126.94±76.05), the same as the control group (P<0.001). There is a weak correlation between IL-6 level and PaO2/FiO2 ratio after administration of NAC (r=0.154, P=0.186). Conclusion:There is a significant decrease in IL-6 level after administration of NAC. NAC has no significant effect on hypoxemia in COVID-19 patients.
Background : Lipoid pneumonia is a rare disease and usually reported as sporadic cases. Exogenous lipoid pneumonia is a more common form of lipoid pneumonia. Untypical characteristics makes incidence rate of this cases are often imprecise. The diagnosis is made from a history of lipid containing material aspiration, radiologic imaging, and histopathological examination. There is no treatment of choice because diagnosis of this cases are rarely made. Case Report : We report one case at Dr. Saiful Anwar hospital, a 35 years old man with accidental kerosene ingestion and aspiration. Based on examination of the patient, laboratory results, radiological imaging, and BAL fluid analysis and cytology, diagnosis of exogenous lipoid pneumonia was made. Our treatment of choice was combination of antibiotic, corticosteroid and BAL to manage this patient. After 2 weeks of treatment, there were improvements on clinical and radiological imaging. Conclusion: Exogenous lipoid pneumonia is a rare disease. Using antibiotic, corticosteroid, and BAL through bronchoscopy can be a therapeutic option that provides clinical and radiological improvement. Key words : Lipoid Pneumonia, Exogenous Lipoid Pneumonia, Treatment of Lipoid Pneumonia
<p>There is a correlation between mutation of Epidermal Growth Factor Receptor (EGFR) and lung adenocarcinoma. Unfortunately, examination for EGFR mutation is difficult because surgery must be conducted to obtain the best specimen. Thyroid Transcription Factor-1 (TTF-1) is a marker for lung adenocarcinoma. This observational study took place at Dr. Saiful Anwar Hospital from stored biological materials from 2013-2018. Samples were lung adenocarcinoma patients that undergo EGFR examination. Data then analyzed using Fischer's Exact Test to determine the relationship between EGFR and TTF-1. Specificity/sensitivity value is 0.75/0.90, p: 0.617, odds ratio 0.333 (0.032-3.515). However, Receiver Operating Characteristic (ROC) curve of TTF- 1 show AUC 0.614 (95CI, 0.35- 0.878). TTF-1 examination has a moderate strength in determining EGFR mutation on lung adenocarcinoma patients at Dr. Saiful Anwar Hospital. </p>
INTRODUCTION : Pneumothorax has been reported in minority of COVID-19 cases. Spontaneus Pneumothorax is an uncommon complication of COVID-19. The incidence and risk factors are still unknown. Here we will review where there are challenges with case of Pneumothorax in COVID-19 patients. CASE ILLUSTRATION : We report one case at Dr. Saiful Anwar hospital, a 42 years old man was diagnosed with Spontaneous Pneumothorax and tested positive for COVID-19 via nasopharyngeal swab. Management in this case requires consideration from emergency treatment, risk of virus transmission and the aerolization of the procedure. Invasive procedure such as insertion chest tube and pharmacologic therapy be the treatment in this case. After 2 weeks of treatment, there was improvement on clinical and radiological imaging. DISCUSSION : Various strategies to reduce the risk of exposure to COVID-19 infection on Spontaneus Pneumothorax. This literature discusses about the risk factor that lead to Pneumothorax with COVID-19 and the management of Pneumothorax cases in COVID-19 patients. CONCLUSION: Spontaneous Pneumothorax is a rare complication of COVID-19. Management in this case requires consideration from emergency treatment, risk of virus transmission and the aerolization of the procedure. Key words : Pneumothorax; COVID-19; Chest Tube
Kebiasaan merokok di tempat kerja merupakan suatu masalah yang belum bisa terselesaikan hingga saat ini, meskipun sudah ada peraturan dari pemangku kebijakan terkait larangan merokok serta undang-undang yang mengatur, namun masih banyak di temukan data-data terkait para karyawan yang masih merokok di tempat kerja. Pajanan asap rokok lingkungan di tempat kerja seperti industri marmer meningkatkan risiko terhadap kesehatan dan penyakit paru pada pekerja. Kegiatan pengabdian masyarakat dengan metode ARRIF yang terdiri dari Analisis, Rumusan, Rencana Intervensi, Forum Komunikasi dilakukan sebagai bentuk pemecahan masalah yang terjadi di lingkingan kerja industri marmer Kecamatan Tjampurdarat Kabupaen Tukunganung. Dari 40 respondenn didapatkan jumlah perokok yaitu 22 orang (55%), bekas perokok 5 orang (12,5%) dan sisanya bukan perokok 13 orang. Diantara perokok, 20 orang (90,9%) adalah perokok ringan dan sisanya adalah perokok sedang. Pekerja yang tidak merokok juga terpajan asap rokok lingkungan atau bekerja pada lingkungan dengan polusi udara yang tinggi Intervensi berupa edukasi kesehatan paru dan respirasi dengan melakukan penyuluhan menggunakan media peraga. Edukasi meliputi bahaya rokok, manfaat berhenti merokok dan upaya berhenti merokok.
Background: Foreign body aspiration is common in children (80% in children under 5 years old) and elderly. The ratio in men is higher than in women. Flexible bronchoscopy is often used as a primary procedure in such cases because of its high sensitivity and specificity. However, in some cases, rigid bronchoscopy might be superior. This is a case report about a patient who came with complaints of bloody cough and chest pain after the ingestion of a push-pin nail. The patient underwent both bronchoscopic procedures. Case: A 13-year-old male presented with complaints of sudden bloody coughing accompanied by chest pain in the middle area. Physical examinations were unremarkable, but images of spikes suggestive of a foreign object on the left hilus were found at the chest x-ray. A flexible fiberoptic bronchoscopy was performed immediately. A push-pin nail, located the left main bronchus with a sharp tip embedded in the mucosa and covered by granulation tissue, was identified. Evacuation attempts were unsuccessful. Rigid bronchoscopy was then performed and evacuation was carried out successfully. The patient was then discharged after forty-eight hours of close monitoring. Conclusion: There are two types of bronchoscopy, flexible and rigid. Both have their respective advantages in the handling of patients with foreign bodies. Acquiring skills in operating both types of bronchoscopy are important for a bronchologist.
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