Pneumocystis Pneumonia in Covid-19 Outbreak :A Case Report It's not all about Covid-19

One of the phenomena during the current Covid-19 pandemic is Early Detection of In-Patient Deterioration by public health services, especially general hospitals for early detection patients who admit with respiratory tract infections (RTIs) symptoms. However, there is a risk of misdiagnosis in differential diagnoses. Pneumocytis Carinii Pneumonia (PCP) is an opportunistic infection that can occur in immunocompromised patients. Symptoms that often appear are similar to Covid-19, such as fever, cough, runny nose, dyspnoea, diarrhea or others. It makes some difficulties for early diagnosing PCP infection during Covid-19 pandemic, whereas if it is not early treated it is could be a fatal case. Thus, during Covid-19 pandemic, it is necessary to consider other differential diagnoses in patients with RTIs symptoms or respiratory distress. It can be supported if other characteristic signs are found during clinical examination, especially if the nasopharyngeal and oropharyngeal swab results are negative.

Implementation Of Clinical Pathway For Management Of Copd Exacerbation

Background: The effectiveness for reducing the length of stay and produce better outcomes has been applied with the use of the clinical pathway. In this study, we observe the implementation of clinical pathways (CP) and evaluate their effectiveness in the management of Chronic Obstructive Pulmonary Diseases (COPD) exacerbation in Goenawan Partowidigdo Pulmonary Hospital (RSPG) Cisarua Bogor. Method: This research is a quantitative study with an analytical survey method and cross-sectional design. Data collection was carried out by studying documentation on 304 medical record files from early 2019 to July 2020 and clinical pathway forms. Results: There were differences in clinical outcomes before and after the implementation of CP. The difference in the overall mean length of stay (LOS) using CP were 4 days while the who did not use CP were 6 days. For In-Hospital Mortality (IHM) there was 1 death in the CP group, and there were no deaths in non-CP groups. As for the Readmission Rate (RR), the results of the study showed that the most RR was in the CP group, which were 6 patients (54.5%) in 1st wards, 5 patients (62.5 %) in 2nd wards and 39 patients (70.9%) in 3rd wards. These RR results showed that CP of COPD exacerbation must be evaluated further. The average total hospital rate showed a significant difference between the two clinical methods. The hospital rate variable had a very significant difference between the CP and non-CP methods, with a significant value of = 0.0001. Conclusion: The application of CP can reduce the length of stay (LOS) and the average total hospital rate of patients who are hospitalized for COPD exacerbation. This CP must be evaluated further to reduce the readmission.

Accuracy Between CURB-65 Score and PSI in Determining The Prognosis of Community-Acquired Pneumonia Patients at H. Adam Malik General Hospital, Medan

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

Role of Mesenchymal Stem Cells In Chronic Obstructive Lung Disease

Therapy for Chronic Obstructive Pulmonary Disease (COPD) is currently still not giving effect to tissue repair and regeneration. Chronic Obstructive Pulmonary Disease is still a progressive degenerative disease. Stem cells through their regenerative ability offer a new promising alternative therapy for the management of degenerative diseases including COPD. There have been many studies conducted to determine the safety and efficacy of stem cells in COPD. Published research about stem cells on COPD is still in phase II. Further research is needed on a larger scale before stem cells can be widely applied in the management of COPD. Stem cells are a very promising alternative therapy and are a big leap in the medical world for degenerative diseases including COPD.

Proportion of Lung Hyperinflation In Patients With Persistent Asthma In Persahabatan Hospital Jakarta Using Multiple Breath N2-Washout

Background: In asthma, small airway dysfunction and inflammation may induce significant lung hyperinflation. The aim of the study is to discover the proportion of lung hyperinflation in patient with persistent asthma in Persahabatan Hospital Jakarta. Method: A cross sectional study with descriptive analysis was done in Asthma clinic Persahabatan Hospital from September-November 2016. Forty-five subjects were recruited consecutively. Interview, physical examination, chest x-ray (CXR), spirometry and multiple breath N2-washout (MBW) were performed. Lung hyperinflation was defined as a residual volume /total lung capacity (RV/TLC%) above the upper limit of normal. Results: The proportion of lung hyperinflation in patients with persistent asthma was 17,8% (8 of 45 subjects). Median RV in milliliter was 1230 (570-2860). Median functional residual capacity (FRC) in milliliter was 1730 (970-3990). Median TLC in milliliter was 3310 (2490-6350). Mean RV/TLC ratio was 36,39% (SD±8,86). Mean FRC/TLC ratio was 52,86% (SD ±6,85). There was a significant correlation between forced expiratory volume in 1 second (FEV1%) value with lung hyperinflation with the decline of FEV1 <60% increased the risk of lung hyperinflation by 8,46 (95%CI=1,155-61,98; p=0,036). There were no significant correlation between age, gender, smoking habit, body mass index (BMI), ACT score, the severity of persistent asthma, duration of asthma, duration of steroid inhalation use, exacerbation history in the last 12-months and emphysematous in CXR with lung hyperinflation (p>0,05). Conclusions: The proportion of lung hyperinflation in patient with persistent asthma in Persahabatan Hospital Jakarta is 17,8%. Lung hyperinflation in persistent asthma is associated with the degree of airway obstruction.

Effect of Soluble CD14 Subtype (sCD14ST)/ Presepsin and Lactate Clearance on Mortality Status In Pneumonia Patients With Sepsis

Background: Severe pneumonia accompanied with sepsis could increase death ratio by 7.6%. Lactate clearance is used in assessing the success of early resuscitation in treating sepsis. Presepsin is a biomarker that is sensitive and specific to the bacterial infection that causes sepsis. The purpose of this study was to analyze the effect of presepsin levels and lactate clearance on mortality in pneumonic patients accompanied with sepsis after fourteen day of observation. Methods: Prospective cohort study was done on 42 patients who were admitted to intensive care unit of dr. Saiful Anwar Public Hospital, from March 2019 until May 2019. Blood samples were collected on the first, second, and third day of treatment to measure lactate clearance and presepsin levels. Mortality was observed on the 14th day after admittance. Results: Out of 42 patients, 25 patients lived (59.5%), and 17 patients died (40.5%). Logistic regression analysis performed on the presepsin levels on the third day with a cut-off 957 ng/L had a significant effect on mortality after 14th day (p=0.034). However, presepsin levels on the first day with a cut-off 957 ng/L had no significant effect on mortality (p=0.24). Likewise, the lactate clearance with cut-off 10% did not significantly influence the mortality status (p=0.136). Conclusion: There is a significant effect between presepsin level on the third day in patient mortality, however lactate clearance and presepsin level assessed on the first day had no significant effect on the mortality after fourteen day of observation.

Analysis of Vitamin D Levels on Bronchiectasis Severity

Background: Bronchiectasis is a chronic disease caused by repeated infection and inflammation of the bronchial walls. Vitamin D plays a role secretion of antimicrobial peptide and inhibits release of pro-inflammatory cytokines in the lungs. Vitamin D deficiency is associated with exacerbations, severity and decreased lung function in bronchiectasis. Several studies have found an association between vitamin D levels and bronchiectasis severity. Methods: This study used cross-sectional study design with consecutive sampling method on bronchiectasis patients who enrolled outpatient and inpatient at Wahidin Sudirohusodo hospital in February - May 2020. All research procedures obtained the approval of the Health Research Ethics Commission, Medicine faculty, Hasanuddin University Makassar. Bronchiectasis severity was assessed based on the FACED score (FEV1, Aged, chronic Colonization by Pseudomonas aeuroginosa, radiological Extension of the disease, Dyspnea). Levels of vitamin D serum {25 (OH) D} were checked using the ELISA method. Results: The study subjects were 44 patients, consisting of 61.4% male and 38.6% female. Most of the bronchiectasis patients in this study were mild (77.3%) based on the FACED score, 15.9% moderate and 6.8% severe. As many as 77.3% of patients had vitamin D deficiency and insufficiency as much as 9.1%. All patients with moderate-severe FACED scores had vitamin D deficiency. The correlation between vitamin D levels and FACED scores showed a positive significant with p-value 0.04. Conclusion: Low vitamin D levels are a risk factor for aggravating bronchiectasis severity and have a positive significant correlation between the two.

Proportion of Pneumoconiosis in Limestone Mining Workers In Citatah Village, West Bandung District

Background: Silica, asbestos and coal dust are associated with pneumoconiosis in mining workers. The International Labor Organization (ILO) reports that 30-50% of workers in developing countries are diagnosed with pneumoconiosis. This study aims to identify pneumoconiosis in limestone mining workers in Indonesia. Method: This cross-sectional study involved 73 subjects of limestone mining workers in Citatah Village, West Bandung Regency, Indonesia. Two conclusions were similar from three AIR-Pneumo certified photo readers by blind reading and using the ILO guidelines. Result: Pneumoconiosis was found in 11/73 (15.1%). The median age of the pneumoconiosis group was older than the non-pneumoconiosis group (51 [33-63] vs. 37.5 [18-85] age in years, p = 0.013). All subjects in the pneukoniosis group worked> 6 years (p = 0.001). The highest dust concentration was in the pneumoconiosis group compared to the non-pneumoconisosis group (61.41 ± 103.98 vs. 14.92 ± 55.17 mg / m3, p = 0.030). This study showed that the length of work and the level of dust in the mine were risk factors for pneumoconiosis, although not significant (OR = 14.6, p = 0.999 and OR = 7,171, p = 0.998). Conclusion: The proportion of pneumoconiosis in lime mining workers in this study was 15.1%. Length of work and dust levels in the mine are risk factors for pneumoconiosis; but not meaningful in this study.

New GOLD COPD Guideline 2019: How We Deal with It? (Inhaled Corticosteroid Use and Blood Eosinophil Count)

Background: Blood eosinophils may predict response to inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD), where ICS is recommended in patients at high risk of exacerbations by the Global Initiative for COPD (GOLD) strategy. It can help clinicians to estimate the likelihood of beneficial preventive responses to the addition ICS to regular bronchodilator treatment, and thus can be used as a biomarker in conjunction with clinical assessment when making decisions regarding ICS use. This study aims to compare therapeutic data with blood eosinophil count in COPD patients. Methods: Data were collected from consecutive COPD outpatients in Bukit Asam Medika Hospital starting from March 1st, 2019 until June 30th, 2019 and dr. H. Mohamad Rabain Hospital starting from Oct 1st, 2019 until Dec 27th, 2019. We collected demographics, anthropometrics, smoking history, therapy, dynamic lung volumes, the Medical Research Council scale (MRC), CAT score, and blood eosinophil count. Results: From 57 data collected, 24 (42,1%) patients were having blood eosinophil count ≥300. Patients who have more exacerbation in COPD Group C were 33,3% and 63,2% in COPD Group D. The proportions of ICS-treated COPD Group D patients and blood eosinophil count of <300 and ≥300 was 63,9% and 36,1%, respectively. Conclusion: This study may provide information and characteristic of COPD patient in Indonesia rural area and showed who may have benefit to ICS therapy based on recommendation GOLD COPD 2019. Blood eosinophils counts is a low-cost biomarker and may help clinicians to made decision therapy.

Accuration of Circulating Tumor DNA (ctDNA) in Detection of Epidermal Growth Factor Receptor (EGFR) Mutation in Lung Cancer Patient Type Adenocarcinoma in M Djamil Hospital Padang

Background: ctDNA is an alternative test for detecting mutation of EGFR in lung cancer type adenocarcinoma if the tissue speciment can not be carried out. Sensitivity, specificity and accuration of ctDNA test is stil varied. This study is aimed to acknowledge sensitivity, specificity and accuration of ctDNA in detecting EGFR mutation in patient with lung cancer type adenocarcinoma in M Djamil Hospital. Methods: Design this study a diagnostik test comparing ctDNA to tissue speciment in detection EGFR mutation of 42 patients with lung cancer type adenocarcinoma in M Djamil Hospital. Sample was selected through consecutive technique. Results: Incidence of EGFR mutation in patients with lung cancer type adenocarcinoma from tissue speciment was higher than ctDNA ((42,9% vs 28,6%; p=0,031). There was significant diffierence of EGFR mutation detection between sex, smoking status, and TNM staging based on tissue/cytology examination and ctDNA (p=0,031). EGFR mutation in sitologic test and ctDNA was more likely detected in male patient (66.7% and 58.3%), ex-smoker (50% and 41.7%) and stage IV (88.9% and 91.7%). The results of sensitivity, specificity positive prediction value (PPV) and Negative prediction value (NPV) in ctDNA test to detect EGFR mutation were 66,7%, 100%, 100% dan 80% according to sitology test as gold standard. Furthermore, the ctDNA accuration was measured according to AUC score 0.833 (SE 0,072, CI 95%, 0,693-0,974, p=0.0001). Conclusion: ctDNA test have a good accuration with sensitiviy 66.7% and specificity 100% in detecting EGFR mutation in patients with lung cancer type adenocarcinoma.