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.
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Background: In recent years, there have been studies regarding biomarkers for early detection of lung cancer. The expansion of tumor is accompanied by distinct metabolic process product, which results in identifiable changes in the volatile organic compounds (VOC) emission profile. The content of such molecules differs between healthy and lung cancer patients. Furthermore, the expression of Interleukin-17 (IL-17) was linked to the clinical and pathological aspects of lung cancer patients. The aim of this study is to profile the exhaled VOC and the level of IL-17 in the serum of lung cancer patient.Methods: Fourty patients with confirmed lung cancer and 42 healthy subjects as control were gathered for this study. VOC was measured using breath analyzer and sensor array, while IL-17 was measured by ELISA. Statistical analysis was conducted using Kruskal-Wallis test and Spearman correlation test with P<0.05 considered significant.Results: We examined 15 VOCs and found that ethanol (C2H5OH), formaldehyde (CH2O), toluene (C7H8) and ammonia (NH3) in lung cancer patient were increased significantly compared to control (P<0.05; P<0.05; P<0.05 and P=0.001 respectively). However, the level of IL-17 in control subjects was higher (P=0.299) than patients with lung cancer. Conclusion: Ethanol, formaldehyde, toluene and ammonia can potentially be used as biomarkers for lung cancer. However, the role of IL-17 in lung cancer screening still needs further investigations.
To describe Sequential Organ Failure Assessment (SOFA) Score parameters which have a great impact in the condition of sepsis in Corona Virus Disease-19 (COVID-19) patients and comorbidities that aggravate the patient's condition, we conducted a prospective cohort study in adult patients with sepsis and confirmed COVID-19 cases. We conducted a prospective cohort study in confirmed COVID-19 patients with sepsis who were admitted at Saiful Anwar Hospital Malang at March 10th–April 21st 2020. Diagnosis of sepsis is based on the Surviving Sepsis Campaign-III criteria. We found 6 COVID-19 confirmed patients with sepsis. There is an increased respiratory parameter in SOFA Score in these patients. Therefore, respiratory parameter of the SOFA score has a great impact in determining sepsis condition among confirmed COVID-19 patients.
Keywords: COVID-19, Sepsis, SOFA Score
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