The Correlation of Rapid Antibody Results with SARS-CoV-2 PCR in COVID-19 Patients in Ulin General Hospital Banjarmasin

Introduction: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the cause of clinical disease, better known as COVID-19. The most common method to detect COVID-19 is serological testing of IgM and IgG in response to viral infections using rapid diagnostic test (RDT). Several other guidelines consider polymerase chain reaction (PCR) as the gold standard for diagnosis becausePCR has high sensitivity and specificity values in detecting SARS-CoV-2.Methods: This was a descriptive analytical study. The samples were taken from medical records of COVID-19 patients in Ulin General Hospital Banjarmasin from March to October 2020. Statistical Package for the Social Sciences (SPSS) 16.0 software and Chi-Square test were used for data analysis.Results: From 751 COVID-19 patients, 408 patients (54.32%) had rapid antibody with positive PCR, 132 patients (17.57%) had reactive rapid antibody with negative PCR, 152 patients (20.23%) had non-reactive rapid antibody with positive PCR, and 59 patients (7.85%) had non-reactive rapid antibody with negative PCR. The rapid antibody had sensitivity of 72.85% and specificity of 30.89%. From Chi-Square test, reactive rapid antibody was not correlated with PCR positive results; values of p = 0.320, odds ratio (OR) 1.20.Conclusion: The rapid test antibody could not be recommended as a diagnostic tool. In this study, it was also found that there was no relationship between reactive rapid test results and positive SARS-CoV PCR.

Farmer’s Lung Disease

Occupational lung disease is a lung disease or disorder that occurs due to the inhalation of dangerous particles, mist, vapors, or gases while a person is working. The materials accumulate in the respiratory tract or lungs. The type of lung disease that occurs depends on the size and type of the inhaled material. Substances that cause occupational lung disease are toxic materials called noksa. Noksa is a substance that can cause damage to the anatomical structure of body organs and cause respiratory tract function disorders. The lung disease that many farmers experience is often called farmer's lung disease (FLD). FLD is part of hypersensitivity pneumonitis (HP). HP, also known as extrinsic allergic alveolitis, is a group of lung diseases caused by the inhalation of various antigenic organic materials. The most common cause is exposure to agricultural biological dust derived from straw, mold spores, or other dust. HP can be a secondary reaction due to repeated and prolonged inhalation of specific antigens in sensitive individuals. Diagnosis of FLD is often inaccurate. Many of these cases are diagnosed as idiopathic interstitial lung disease. A complete anamnesis should be performed, especially regarding the history of exposure to moldy hay, previous work, and domestic animals, to determine the existence of a history of exposure to the antigen and to confirm the diagnosis.

Non-Invasive Ventilation in COVID-19 Related Respiratory Failure

Non-invasive ventilation (NIV) refers to the technique of providing mechanical ventilation that does not require definitive airway clearance using an endotracheal tube or tracheostomy. Since its early development in the 1980s, the use of NIV has become increasingly popular in the last three decades. However, its usage on COVID-19 related respiratory failure still lacked guidelines, although several recent studies have shown its benefits. Many aspects, ranging from indications or patient selection, timing to start, understanding the predictor factors of failure, and choosing suitable interfaces, are keys of success for NIV. In principle, each patient has a different condition and should be treated case by case. NIV is not an absolute solution, and intubation can still be the first choice if NIV is deemed less beneficial for the patient.

Candidiasis as Secondary Infection in Post COVID-19: A New Problem?

Introduction: Severe Acute Respiratory Syndrome (SARS-CoV-2) can develop into post COVID-19 with one of its main attentions being secondary infection. Candidiasis as fungal pneumonia is one of secondary infection in post COVID-19. It is hard to diagnose and has high mortality. We present a case of candidiasis as fungal pneumonia in post COVID-19 patient.Case: A 47-year-old woman came to the emergency room with major complaints of dyspnoea and jaundice since her second day at home after being discharged from having COVID-19. She previously finished her COVID treatment and tested negative 2 times. She had severe sepsis and her sputum culture was positive for non-albicans Candida. She received anti-fungal treatment and her condition was getting better and her chest X-ray showed less infiltrates than before.Discussion: Fungal respiratory infections generate concern in the expanding population of immunosuppressed patients like COVID-19 patient. The mortality from COVID-19 associated candidiasis is high (19-40%) as one of fungal infection. Marked immune dysregulation in COVID-19 makes system immune becomes impaired, it also harms lung epithelium. In this patient, diagnosis and treatment were challenging.Conclusion: Post COVID-19 is a condition that should be given more attention, especially when it develops secondary infection. Candidiasis as fungal pneumonia is hard to diagnose and can quickly become severe sepsis and has high mortality. Health practitioners should recognize it as soon as possible and give the best treatment for the patient.

Mesenchymal Stem Cells and Clinical Application in Chronic Lung Diseases

Mesenchymal stem cells are a multipotent mature non hematopoietic stem cells, with characteristics such as ability to self-renew and differentiate in mesodermal, ectodermal, and endodermal pathway. Mesenchymal stem cells also secrete cytokine and immunoreceptor which regulate micro environment in host tissues and angiogenic mediators which are able to improve damaged tissues. Mesenchymal stem cells are obtained from the human body by isolation, culture, proliferation, characterization, and/or differentiation originating from fat cells (adipose), periosteum tissue, and other tissues from the body. Mesenchymal stem cells can be obtained by autologous and allogenic way. Stem cell processing includes isolation, proliferation, differentiation, and temporary storage for clinical application adhering to good drug manufacturing practice. Approach to cell therapy and bioengineering in lung disease is rapidly developing in the last 10 years. In the current era of cell therapy and transplantation, a lot of research has been done to understand and develop mesenchymal stem cells as a therapeutic alternative, particularly in respiratory area.

The Relationship of Chest X-Ray in COVID-19 Patients and Disease Severity in Arifin Achmad General Hospital Riau

Introduction: Coronavirus Disease 2019 (COVID-19) pandemic is caused by SARS-CoV-2 which spreads rapidly throughout the world and causes clinical manifestations in various organs, especially in the lungs. Clinical symptoms arise from asymptomatic, mild, moderate, severe, and critical symptoms in patients with or without comorbid disease. Chest X-ray examination is one of the modalities in the management of COVID-19 which is cheap and easy to do.Methods: This study was performed by analyzing medical record data of confirmed COVID-19 patients from March to December 2020. This study aimed to examine the relationship between chest X-ray and the degree of disease severity.Results: The results showed that from the examined 542 total samples, the highest number was found in the age group of 40-49 years old (23.6%), women (53%), mild degree of COVID-19 (67.9%), normal chest X-ray (54.6%), predominance on the lower zone of the lung, peripheral and bilateral on abnormal chest X-ray, no comorbid (56.3%), hypertensive in comorbid disease (26.6%). There was a significant relationship between chest X-ray and comorbidity towards COVID-19 severity (p = 0.000).Conclusion:Chest X-ray can determine disease severity, therefore it can be used as the first modality for triage and treatment evaluation in COVID-19 patients.

A Rare Case of Primary Pulmonary Amoebiasis without Gastrointestinal Involvement: A Case Report

Introduction: The main pathogen of amoebiasis is Entamoeba histolytica which is very common in tropical and developing countries, where sanitation, hygiene, and low socio-economic status are major problems. The most common site of infection is the intestinal mucosa. For extraintestinal amoebiasis, the most common sites are the liver, followed by the lungs and brain.Case: A 15-year-old male was presented to the ER with chief complaint of breathlessness for the last 10 days, accompanied by productive coughing with dark brown sputum and pain on lower right chest. The patient had fever while the disease progressed. Gastrointestinal symptoms were denied. Physical examination showed lowered breathing sound on the right lung, dullness on lower right chest, and usage of accessory breathing muscles. USG found heteroechoic lesion of 8x7cm in size suspicious of lung abscess, later on confirmed as Entamoeba histolytica found in sputum sample, while abdominal USG showed no abnormality. The patient was admitted for antibiotic therapy and consultation to cardiothoracic surgeon.Discussion: One of the rarest routes of amoebiasis is primary deposition of cysts to the lungs through aspiration. Pulmonary amoebiasis often causes abscess formation, produces brown-colored sputum called “anchovy sauce”. It is notable that we found one of the rarest cases of amoebiasis infection, where there is a pulmonary infection without any intestinal involvement.Conclusion: Whilst infection of primary pulmonary amoebiasis is very rare, it is still an important etiology to put on the differential diagnosis of pulmonary abscess. Therefore, sputum examination or biopsy is required even when there are no gastrointestinal disturbances.

Appendicular Tuberculosis as Manifestation of Gastrointestinal Tuberculosis: A Case Report

Introduction: Gastrointestinal tuberculosis (GI TB) is quite rare with 3% incidence of all extrapulmonary involvement. Appendicular TB may occur in 0.1 - 3% of cases. Diagnosis is often difficult because the patient usually complains about chronic abdominal pain and fever. A definite diagnosis is based on histopathological examination of resected specimens from the appendectomy procedure.Case: We present a 37-year-old male patient admitted to the hospital with chronic abdominal pain, fever, nausea, and loss of body weight. The patient never had a persistent cough, hemoptysis, or night sweating. Physical examination showed pain and muscular rigidity in the right iliac area during palpation with Blumberg's sign and Rovsing's sign positive. Abdomen ultrasound imaging showed an appendicular abscess. The patient underwent appendectomy afterwards with histopathology result showing TB. The patient was treated with first category anti-tuberculosis drugs (ATD).Discussion: Diagnosis of appendicular TB is difficult due to unspecific clinical presentations. Appendicular TB patients often complain of signs and symptoms which are similar to acute appendicitis. These conditions can delay ATD treatment because the definitive diagnosis could be made after histopathological examination.Summary: Appendicular TB is a rare case of extrapulmonary TB. It can present as acute appendicitis. The definitive diagnosis is based on the histopathological examination. It is recommended to check the appendicectomy specimens histopathologically to exclude TB or other diseases.

Exclusive Breastfeeding Duration and Allergic Asthma Severity in Children

Introduction: Asthma is a disease marked by bronchial hyperresponsivity. It is commonly seen in children and often affects their quality of life. Many factors affect asthma, including breastfeeding. Bioactive and immunological components of maternal milk have a protective effect on allergic asthma. However, some studies denied this, stating that it had no significant association to asthma. This study aimed to analyze the correlation between breastfeeding duration and the severity of allergic asthma described by the frequency of asthma attacks, sleep disorder, and activity limitation.Methods: This analytic observational study used a cross sectional approach. The subjects were pediatric outpatients aged 1 – 5 years old with allergic asthma at Pediatric Clinic of Dr. Soetomo General Hospital Surabaya and Private Pediatric Clinic from September 2019 to July 2020. Subjects were assessed based on the history of exclusive breastfeeding duration, frequency of asthma attacks, sleep disorder, and activity limitation through an interview using questionnaire.Results: Through the data obtained from 62 respondents, duration of exclusive breastfeeding showed no significant relation to the frequency of asthma attack (rs = -0.227, p = 0.076), sleep disorder (rs = -0.214, p = 0.095), and activity limitation (rs = -0.055, p = 0.672).Conclusion: There was no correlation between the duration of exclusive breastfeeding and the frequency of asthma attack, sleep disorder, and activity limitation.

Allergic Reaction due to Anti-Tuberculosis Drugs, How to Manage?

Tuberculosis (TB) still becomes a significant health problem in Indonesia. The first-line anti-tuberculosis drug (ATD) is still the most effective TB drug, but it can have some side effects. One of them is allergic skin reactions that can affect a patient's compliance. Allergic reactions due to ATD are found in 4-6% of TB cases and are the third most frequent side effect after gastrointestinal and liver function disorder. All first-line ATD can cause allergic reactions. Allergic reactions due to ATD can be mild, such as itching and reddish rashes, to severe and life-threatening rashes, such as anaphylactic shock, Steven Johnson Syndrome (SJS), and Toxic Epidermal Necrotic (TEN). The most important things in the management are identifying and stopping drugs. It includes drug challenge and desensitization of causing drug. Desensitization must be distinguished from drug challenge or provocation tests, which are diagnostic tools. The proper management of ATD allergic reactions can improve compliance and patient's outcomes.