Coronavirus disease 2019 (COVID-19) has emerged as a pandemic across the world. Hypercoagulability status in COVID-19 is one of the causes of complication from severe COVID-19 with a high risk of arterial thrombosis. Acute Limb Ischemia is a vascular emergency caused by sudden decrease in the arterial perfusion. We report the case of a 53-year-old male patient with COVID-19 Pneumonia, diagnosed with Acute Limb Ischemia. From clinical examination, which included anamnesis, physical examination, and laboratory results as well as chest X-rays, a suspicion of Acute Limb Ischemia was found in a patient with COVID-19 pneumonia. The SARS-CoV-2 real time PCR examination showed positive results. In this patient, the diagnosis of Acute Limb Ischemia with Covid-19 Pneumonia was established through a multidisciplinary approach covering the fields of pulmonology, cardiology, and thoracic and cardiovascular surgery. Keywords Acute limb ischemia • ALI • Hypercoagulability • COVID-19 Highlights • The Coronavirus Disease 2019 (COVID-19) is associated with a hyper-coagulability state. • Both arterial and venous thrombosis can occur in COVID-19 associated hypercoagulability state • ALI, a vascular emergency can lead to severe morbidity and mortality.
Introduction: Asthma is heterogenous disease characterized by chronic airway inflammation. COVID-19 pandemic has an impact on health services where telemedicine could provide alternative method to evaluate patient’s condition, reduce risk of infection and disease transmission. The aim of this study is to analysis knowledge, asthma symptoms control and risk factors among the asthmatic patients via telemedicine Methods: Data was obtained from telemedicine of 28 asthmatic patients in the context of community services. Inclusion criteria is stable asthmatic patients who conducted medical interview via videocall application. Cross sectional data were taken including demographic, knowledge of subjects, profile of subjects, and assessment of asthma symptoms control and assessment of poor outcomes. Data were analyzed descriptively and variables were analyzed using chi-square. Results: Subjects consisted of 28 stable asthmatic patients. The average of asthma onset was 17.96 years old. Clinically profile showed that 67.86% subjects were not routinely controlled, 64.29% had never performed pulmonary function test, 67.86% subjects didn’t know the level of asthma control symptoms. Evaluation based on GINA symptoms control only 39.29% were in good control condition, 35.71% were partially controlled and 25% in uncontrolled condition. Use of inhaler device recently or previously prescribed on 67.86% subjects. Evaluation of knowledge about asthma still unsatisfactory, 67.86% subjects didn’t know about their modifiable risk factors, 96.43% didn’t know about written action asthma plan, 60.71% didn’t know about asthma exercise. Self-medication was associated with poor asthma control (p=0,036) and knowledge about modifiable risk factors related to asthma symptoms control (p=0,041). Conclusion: Self-medication is related to uncontrolled asthma and knowledge of modifiable factors is related asthma symptoms control. It is important to educate the patient about the modifiable risk factors of asthma and how to manage it. Patient knowledge about their disease is still lacking, and there is a need for ongoing education to achieve good asthma control. Alternative intervention through telemedicine especially for continuing education and may therapeutic strategies can be performed as an effort to obtain well controlled asthma in community. Telemedicine, particularly in asthma management may benefit as an alternative approach of healthcare service in the context of pandemic era.
Background : Hemoptysis is one of the often symptoms that complained in respiratory disease with fungal Infection. Jakarta reported that prevalency of Invasive Pulmonary aspergillosis is 7,7% and Pneumocystis pneumonia is 14.5%. Lung mycosis is still difficult to diagnosed so the management of therapy is often too late. The risk factors of lung mycosis in these patient are immunocompromised conditions with Diabetes Melitus, history of Tuberculosis treatment and COPD. The diagnosis criteria of systemic/invasive mycosis are proven, probable and possible. Proven criteria diagnosed is based on host factor, clinical finding and mycology whereas possible criteria diagnosed is based on host factor and clinical finding without mycology.Case Report: We report one case at Dr. Saiful Anwar hospital, Man, 43 years old with History of Tuberculosis Treatment and suspected as Lung Mycosis with chef complained hemoptoe recurrent in last 2 months, shortness of breath, cough, right chest pain, fever, night sweating and decrease of body weight 1-2kg in a month. From the physical examination we found percussion dullness and decreased of lung sound in the right upper thorax examination and laboratory results and chest xray there are suspicion of Aspergillosis. The results of XpertMtb/Rif sputum examination obtained that no Mycobacterium tuberculosis, sputum KOH was not found fungus, cytological sputum was obtained as Class II, and in bacterial sputum culture obtained Klebsiella pneumonia. The patient performed a bronchoscopic examination and continued with open thoracotomy surgery and lobectomy.Conclusion: In these patient the diagnosis of lung mycosis with suspicious of Aspergillosis has gone through a multidisciplinary approach covering the pulmonology, radiology, microbiology and anatomical pathology. Collaboration between doctors, researchers, and the pharmaceutical industry is required to resolve the problem of fungal diseases and can increase the profile of these diseases.
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