Hubungan Perilaku Merokok Terhadap Kualitas Hidup Pasien Penyakit Paru Obstruktif Kronis (PPOK)

COPD mengacu pada serangkaian gangguan di mana aliran udara terbatas karena kelainan saluran napas atau alveolar dan di mana gejala pernapasan bertahan dari waktu ke waktu. Penyakit ini hasil dari kontak yang terlalu lama dengan zat beracun. Ketika peradangan terus-menerus hadir, saluran udara menyempit, mengurangi recoil paru. Berkurangnya partisipasi dalam aktivitas sehari-hari dikaitkan dengan kualitas hidup yang lebih rendah bagi penderita COPD, dan kondisi yang disebutkan di atas dapat berkontribusi pada hal ini. Para peneliti di Rumah Sakit Universitas Airlangga ingin mengetahui seberapa besar dampak merokok terhadap kualitas hidup pasien PPOK. Penelitian ini menggunakan pendekatan penelitian analitik observasional cross-sectional. Pengambilan sampel berturut-turut digunakan untuk memilih 90 peserta yang memenuhi kriteria inklusi dan eksklusi penelitian. Data sekunder dikumpulkan dari rekam medis, sedangkan data primer dikumpulkan melalui kuesioner yang diberikan kepada pasien di Klinik Paru RSUA. Dalam penelitian ini, kebiasaan merokok partisipan dijadikan sebagai variabel bebas. Sementara kualitas hidup menjadi fokus penelitian ini yang merupakan variabel dependen. Uji chi-square dilakukan pada data. Di Rumah Sakit Universitas Airlangga, pasien dengan penyakit paru obstruktif kronik memiliki kualitas hidup yang lebih buruk secara signifikan jika mereka merokok (p=0,023). Oleh karena itu, kecenderungan seseorang untuk merokok berpotensi berdampak negatif pada kualitas hidup mereka jika mereka menderita PPOK. Oleh karena itu diperlukan peningkatan pengetahuan kepada pasien PPOK terkait dengan akibat perilaku merokok kepada kualitas hidup

Increase of lung function usage bronchoscopy in COVID-19 patients: Three case series in Indonesian adult

Background COVID-19 is a virus that is spread by aerosol which can cause worsening of hypoxia and bronchoscopy procedures in COVID-19 patients may be considered. Method The design of this study is a case series reported using the Preferred Reporting of Case Series in Surgery (PROCESS) 2020 Guideline. Data collection was carried out in the period January–April 2021. All participants underwent X-ray examination and blood gas analysis as well as signs of infection before and after bronchoscopy. Result Three intubated patients with COVID-19 were confirmed from PCR nasopharyngeal swab present with worsening on chest X-ray. All three patients had a normal bronchial wall with some inflammation and thick mucus resulting in lung atelectasis and massive inhomogeneous opacity on chest X-ray. Patients showed improvement on chest X-ray after bronchoscopy intervention. Conclusion The bronchoscopy procedure can improve the lung function of COVID-19 patients and if it is carried out by medical personnel who pay attention to universal precautions, it will minimize the occurrence of transmission

The potency of hematopoietic stem cells (hscs) and natural killer (nk) cells as a therapeutic of sars-cov-2 Indonesia isolates infection by viral inactivation (in vitro Study)

Background: The prevalence of COVID-19 cases in Indonesia as of June 9, 2020, has been confirmed 32.076 positive cases, with 1.923 death cases. The total number of deaths reached 92,941 cases. There has been a recent update on stem cell-based biological, medical therapy as an optional treatment to handling COVID-19 due to its potential viability besides using the prevalent conventional chemical drug therapy. Methods: In this study, in vitro research was conducted to determine the potential of hematopoietic stem cells (HSCs) and natural killer cells (NK cells) against SARS-CoV-2 viruses, which virus isolates were collected in Indonesia. The SARS-CoV-2 virus was planted in rat kidney cells and Vero cells. The cells that had been planted with the virus were given HSCs and NK cells, followed by being evaluated at intervals of 24, 48, and 72 hours. The evaluation was done by collecting cells and supernatant from the cell plate and then determining the viral load using a Polymerase Chain Reaction (PCR) machine. Results: The results showed that the addition of HSCs and NK on cells that had been infected by SARS-CoV-2 resulted in a decrease in viral load within 24 to 72 hours in all variations of Multiples of Infection (MoI) values. Conclusions: The administration of HSCs and NK cells has the potential to eliminate the SARS-CoV-2 virus. Although this study is only an in vitro study, it could be the basis for the development of alternative stem cell-based therapies to tackle COVID-19 cases

Optimal use of tocilizumab for severe and critical COVID-19: a systematic review and meta-analysis

Background: Several studies have revealed the potential use of tocilizumab in treating COVID-19 since no therapy has yet been approved for COVID-19 pneumonia. Tocilizumab may provide clinical benefits for cytokine release syndrome in COVID-19 patients. Methods: We searched for relevant studies in PubMed, Embase, Medline, and Cochrane published from March to October 2020 to evaluate optimal use and baseline criteria for administration of tocilizumab in severe and critically ill COVID-19 patients. Research involving patients with confirmed SARS-CoV-2 infection, treated with tocilizumab and compared with the standard of care (SOC) was included in this study. We conducted a systematic review to find data about the risks and benefits of tocilizumab and outcomes from different baseline criteria for administration of tocilizumab as a treatment for severe and critically ill COVID-19 patients. Results: A total of 26 studies, consisting of 23 retrospective studies, one prospective study, and two randomised controlled trials with 2112 patients enrolled in the tocilizumab group and 6160 patients in the SOC group, were included in this meta-analysis. Compared to the SOC, tocilizumab showed benefits for all-cause mortality events and a shorter time until death after first intervention but showed no difference in hospital length of stay. Upon subgroup analysis, tocilizumab showed fewer all-cause mortality events when CRP level ≥100 mg/L, P/F ratio 200-300 mmHg, and P/F ratio <200 mmHg. However, tocilizumab showed a longer length of stay when CRP <100 mg/L than the SOC. Conclusion: This meta-analysis demonstrated that tocilizumab has a positive effect on all-cause mortality. It should be cautiously administrated for optimal results and tailored to the patient's eligibility criteria

The Potency of Hematopoietic Stem Cells (HSCs) and Natural Killer (NK) Cells as A Therapeutic of SARS-CoV-2 Indonesia Isolates Infection by Viral Inactivation (In Vitro Study)

Background: The prevalence of COVID-19 cases in Indonesia as of June 9, 2020, has been confirmed 32.076 positive cases, with 1.923 death cases. The total number of deaths reached 92,941 cases. There has been a recent update on stem cell-based biological, medical therapy as an optional treatment to handling COVID-19 due to its potential viability besides using the prevalent conventional chemical drug therapy. Methods: In this study, in vitro research was conducted to determine the potential of hematopoietic stem cells (HSCs) and natural killer cells (NK cells) against SARS-CoV-2 viruses, which virus isolates were collected in Indonesia. The SARS-CoV-2 virus was planted in rat kidney cells and Vero cells. The cells that had been planted with the virus were given HSCs and NK cells, followed by being evaluated at intervals of 24, 48, and 72 hours. The evaluation was done by collecting cells and supernatant from the cell plate and then determining the viral load using a Polymerase Chain Reaction (PCR) machine. Results: The results showed that the addition of HSCs and NK on cells that had been infected by SARS-CoV-2 resulted in a decrease in viral load within 24 to 72 hours in all variations of Multiples of Infection (MoI) values. Conclusions: The administration of HSCs and NK cells has the potential to eliminate the SARS-CoV-2 virus. Although this study is only an in vitro study, it could be the basis for the development of alternative stem cell-based therapies to tackle COVID-19 cases

An in vitro study of dual drug combinations of anti-viral agents, antibiotics, and/or hydroxychloroquine against the SARS-CoV-2 virus isolated from hospitalized patients in Surabaya, Indonesia

A potent therapy for the infectious coronavirus disease COVID-19 is urgently required with, at the time of writing, research in this area still ongoing. This study aims to evaluate the in vitro anti-viral activities of combinations of certain commercially available drugs that have recently formed part of COVID-19 therapy. Dual combinatory drugs, namely; LopinavirRitonavir (LOPIRITO)-Clarithromycin (CLA), LOPIRITO-Azithromycin (AZI), LOPIRITODoxycycline (DOXY), Hydroxychloroquine (HCQ)-AZI, HCQ-DOXY, Favipiravir (FAVI)-AZI, HCQ-FAVI, and HCQ-LOPIRITO, were prepared. These drugs were mixed at specific ratios and evaluated for their safe use based on the cytotoxicity concentration (CC50) values of human umbilical cord mesenchymal stem cells. The anti-viral efficacy of these combinations in relation to Vero cells infected with SARS-CoV-2 virus isolated from a patient in Universitas Airlangga hospital, Surabaya, Indonesia and evaluated for IC50 24, 48, and 72 hours after viral inoculation was subsequently determined. Observation of the viral load in qRT-PCR was undertaken, the results of which indicated the absence of high levels of cytotoxicity in any samples and that dual combinatory drugs produced lower cytotoxicity than single drugs. In addition, these combinations demonstrated considerable effectiveness in reducing the copy number of the virus at 48 and 72 hours, while even at 24 hours, post-drug incubation resulted in low IC50 values. Most combination drugs reduced pro-inflammatory markers, i.e. IL-6 and TNF-α, while increasing the anti-inflammatory response of IL-10. According to these results, the descending order of effective dual combinatory drugs is one of LOPIRITO-AZI>LOPIRITO-DOXY>HCQ-AZI>HCQ FAVI>LOPIRITO-CLA>HCQ-DOX. It can be suggested that dual combinatory drugs, e.g. LOPIRITO-AZI, can potentially be used in the treatment of COVID-19 infectious diseases

A Randomized, Double-Blind, Multicenter Clinical Study Comparing the Efficacy and Safety of a Drug Combination of Lopinavir/Ritonavir-Azithromycin, Lopinavir/Ritonavir-Doxycycline, and Azithromycin-Hydroxychloroquine for Patients Diagnosed with Mild to Moderate COVID-19 Infections

At the present time, COVID-19 vaccines are at the testing stage, and an effective treatment for COVID-19 incorporating appropriate safety measures remains the most significant obstacle to be overcome. A strategic countermeasure is, therefore, urgently required. Aim. +is study aims to evaluate the efficacy and safety of a combination of lopinavir/ritonavirazithromycin, lopinavir/ritonavir-doxycycline, and azithromycin-hydroxychloroquine used to treat patients with mild to moderate COVID-19 infections. Setting and Design. +is study was conducted at four different clinical study sites in Indonesia. +e subjects gave informed consent for their participation and were confirmed as being COVID-19-positive by means of an RTPCR test. +e present study constituted a randomized, double-blind, and multicenter clinical study of patients diagnosed with mild to moderate COVID-19 infection. Materials and Methods. Six treatment groups participated in this study: a Control group Madministered with a 500 mg dose of azithromycin; Group A which received a 200/50 mg dose of lopinavir/ritonavir and 500 mg of azithromycin; Group B treated with a 200/50 mg dose of lopinavir/ritonavir and 200 mg of doxycycline; Group C administered with 200 mg of hydroxychloroquine and 500 mg of azithromycin; Group D which received a 400/100 mg dose of lopinavir/ritonavir and 500 mg of azithromycin; and Group E treated with a 400/100 mg dose of lopinavir/ritonavir and 200 mg of doxycycline. Results. 754 subjects participated in this study: 694 patients (92.4%) who presented mild symptoms and 57 patients (7.6%) classified as suffering from a moderate case of COVID-19. On the third day after treatment, 91.7%–99.2% of the subjects in Groups A–E were confirmed negative by a PCR swab test compared to 26.9% in the Control group. Observation of all groups which experienced a significant decrease in virus load between day 1 and day 7 was undertaken. Other markers, such as CRP and IL-6, were significantly lower in all treatment groups (p< 0.05 and p< 0.0001) than in the Control group. Furthermore, IL-10 and TNF-α levels were significantly elevated in all treatment groups (p< 0.0001). +e administration of azithromycin to the Control group increased CRP and IL-6 levels, while reduced IL-10 and TNF-α on day 7 (p< 0.0001) compared with day 1. Decreases in ALTand AST levels were observed in all groups (p< 0.0001). +ere was an increase in creatinine in the serum level of the Control, C, D, and E groups (p< 0.05), whereas the BUN level was elevated in all groups (p< 0.0001). Conclusions. +e study findings suggest that the administration of lopinavir/ritonavir-doxycycline, lopinavir/ritonavir-azithromycin, and azithromycinhydroxychloroquine as a dual drug combination produced a significantly rapid PCR conversion rate to negative in three-day treatment of mild to moderate COVID-19 cases. Further studies should involve observation of older patients with severe clinical symptoms in order to collate significant amounts of demographic data

Hubungan Antara Kadar Pge2 Serum Dan Derajat Kepositifan Bta Dahak Pasien Tb Paru Kasus Baru Dan Kambuh

TB masih menjadi permasalahan kesehatan global. Apoptosis makrofag yang terinfeksi Mtb dipicu oleh PGE2. Apoptosis menekan pertumbuhan kuman Mtb, yang akan tampak pada hasil BTA dahak yang merupakan penanda jumlah kuman Mtb. Penelitian ini bertujuan untuk mengetahui hubungan antara kadar PGE2 serum dan derajat kepositifan BTA dahak pasien TB paru kasus baru dan kambuh.Metode Penelitian ini merupakan penelitian analitik observasional yang dilakukan di RSUD Dr.Soetomo. Dilakukan pengukuran kadar PGE2 serum pada 62 pasien TB paru kasus baru dan kambuh dengan hasil BTA dahak positif. Data dianalisis dengan uji statistik menggunakan metode Chi-square dan dihitung koefisien korelasi dengan uji korelasi Spearman. Hasil Dari 62 sampel yang didapat, 9 (14,5%) pasien memiliki kadar PGE2 serum rendah, 39 (62,9%) normal dan 14 (22,6%) tinggi. Nilai median kadar PGE2 serum sebesar 216,95 pg/ml. 26 (41,9%) pasien memiliki derajat kepositifan BTA dahak rendah, 36 (58,1%) memiliki derajat kepositifan tinggi. Hasil analisis statistik menunjukkan terdapat hubungan negatif lemah antara kadar PGE2 serum dan derajat kepositifan BTA dahak yang kurang bermakna secara statistik (r = - 0,015, p-value = 0,79). Kesimpulan Terdapat hubungan negatif lemah antara kadar PGE2 serum dan derajat kepositifan BTA dahak namun tidak bermakna secara statistik. Penelitian ini dapat digunakan sebagai dasar penelitian lebih lanjut dalam memahami peran sistem imun terhadap kuman Mtb

Association between serum PGE2 levels and degree of acid-fast bacilli positivity in sputum of pulmonary tuberculosis patients

Background Mycobacterium tuberculosis that infected apoptotic macrophages is triggered by PGE2. Apoptosis suppresses the growth of Mycobacterium tuberculosis bacteria, which is shown in the results of acid-fast bacilli (AFB) in the sputum that becomes a marker of the number of bacteria. Objective Analyzing the association between serum PGE2 levels and the positivity of AFB in the sputum of tuberculosis patients. Methods A cross-sectional study was carried out from August 2019–July 2020. Serum PGE2 levels and AFB levels in sputum were collected from participants. Data analysis used the Chi-square test and Spearman's correlation with p < 0.05. Results The average participants’ serum PGE2 levels were 446.37 ± 510.27 pg/ml, with a median value of 216.95 pg/ml. Most participants had normal serum PGE2 levels (62.9%). Most participants had a high positivity of AFB in sputum (58.1%). Analysis of the association between serum PGE2 levels and the degree of AFB positivity in sputum obtained r = −0.036 and p-value = 0.780. Conclusion There is a weak negative association between serum PGE2 levels and the degree of AFB positivity in sputum but not statistically significant

An in vitro study of dual drug combinations of anti-viral agents, antibiotics, and/or hydroxychloroquine against the SARS-CoV-2 virus isolated from hospitalized patients in Surabaya, Indonesia

A potent therapy for the infectious coronavirus disease COVID-19 is urgently required with, at the time of writing, research in this area still ongoing. This study aims to evaluate the in vitro anti-viral activities of combinations of certain commercially available drugs that have recently formed part of COVID-19 therapy. Dual combinatory drugs, namely; Lopinavir-Ritonavir (LOPIRITO)-Clarithromycin (CLA), LOPIRITO-Azithromycin (AZI), LOPIRITO-Doxycycline (DOXY), Hydroxychloroquine (HCQ)-AZI, HCQ-DOXY, Favipiravir (FAVI)-AZI, HCQ-FAVI, and HCQ-LOPIRITO, were prepared. These drugs were mixed at specific ratios and evaluated for their safe use based on the cytotoxicity concentration (CC50) values of human umbilical cord mesenchymal stem cells. The anti-viral efficacy of these combinations in relation to Vero cells infected with SARS-CoV-2 virus isolated from a patient in Universitas Airlangga hospital, Surabaya, Indonesia and evaluated for IC50 24, 48, and 72 hours after viral inoculation was subsequently determined. Observation of the viral load in qRT-PCR was undertaken, the results of which indicated the absence of high levels of cytotoxicity in any samples and that dual combinatory drugs produced lower cytotoxicity than single drugs. In addition, these combinations demonstrated considerable effectiveness in reducing the copy number of the virus at 48 and 72 hours, while even at 24 hours, post-drug incubation resulted in low IC50 values. Most combination drugs reduced pro-inflammatory markers, i.e. IL-6 and TNF-α, while increasing the anti-inflammatory response of IL-10. According to these results, the descending order of effective dual combinatory drugs is one of LOPIRITO-AZI>LOPIRITO-DOXY>HCQ-AZI>HCQ-FAVI>LOPIRITO-CLA>HCQ-DOX. It can be suggested that dual combinatory drugs, e.g. LOPIRITO-AZI, can potentially be used in the treatment of COVID-19 infectious diseases