Validation of ARISCAT Model Score to Predict Postoperative Pulmonary Complications in Tertiary Referral Hospital in Indonesia

Introduction. There are several prediction model score instruments that can help to assess pulmonary preoperative evaluation and it is believed that ARISCAT model score is very simple to do and have good performance, but not widely used. This score has not been yet validated in Indonesia. This study aimed to assess the performance of discrimination and calibration of ARISCAT score in predicting postoperative pulmonary complication who underwent surgery in a tertiary referral hospital in Indonesia. Methods. A retrospective cohort study was conducted to assess the external validation of ARISCAT scores in the Indonesian population. This study involved patients underwent surgery at Cipto Mangunkusumo Hospital in 2017. Several variables were collected such as age, oxygen saturation, history of pulmonary infection, anemia, type of surgery, duration of operation, emergency surgery, and PPC that observed within 30 days after surgery. Discrimination was assessed by the area under the curve (AUC). Calibration was assessed by the Hosmer-Lemeshow test and calibration plot. Results. Of 428 patients studied, PPC was observed in 32% of patients. Discrimination of ARISCAT score was shown by AUC value of 88.2% (CI 95%; 84.1-92.2%). Hosmer-Lemeshow test showed p=0.052 and calibration plot revealed coefficient r=0.968. Conclusion. ARISCAT model score has good discrimination and calibration performance and can be applied in the Indonesian population

Validation of A2DS2 Score as Predictor of Pneumonia among Patients Hospitalized for Acute Ischemic Stroke

Introduction. Pneumonia is the leading cause of morbidity and mortality in acute ischemic stroke patients admitted to hospital. Thus required a valid scoring system which is easy to apply, to predict and stratify the risk of pneumonia in patients with acute ischemic stroke. This study aimed to assess the performance of calibration and discrimination of A2DS2 score in predicting the incidence of pneumonia in patients with acute ischemic stroke. Methods. A retrospective cohort study was conducted among adult acute ischemic stroke patients who are hospitalized in Cipto Mangunkusumo Hospital, Jakarta. Age, atrial fibrillation, dysphagia, sex (male), and stroke severity (rated with National Institute of Health Stroke Scale/NIHSS) were obtained at the beginning of admission. The subjects were followed up for up to seven days after the onset of ischemic stroke to assess the outcome (pneumonia). Calibration properties of the A2DS2 score were assessed by Hosmer-Lemeshow test and calibration plot. Discrimination properties of the A2DS2 score were assessed by the area under the curve (AUC). Results. A total of 281 subjects were followed up. The incidence of pneumonia in acute ischemic stroke patients was observed in 118 patients (42%). Hosmer Lemeshow test of A2DS2 score showed p = 0,222 and calibration plot showed r = 0,982. Discrimination of A2DS2 score was shown by the AUC value of 0,885 (95% CI 0,845-0,924). Conclusion. The A2DS2 score has a good calibration and discrimination performance in predicting the incidence of pneumonia in patients with acute ischemic stroke

Performance of Xpert MTB/RIF by Using Gastric Lavage Sample in The Diagnosis of Pulmonary Tuberculosis in HIV Patients with Suspected Pulmonary Tuberculosis

Introduction. Xpert MTB/RIF test on gastric lavage sample may improve pulmonary tuberculosis (TB) case finding, but its performance as a diagnostic test for pulmonary TB in HIV-infected adults patients has not been studied widely, including in Indonesia. This study aims to determine the performance of the Xpert MTB/RIF test in diagnosing pulmonary tuberculosis among HIV-infected adult patients with suspected pulmonary tuberculosis by using gastric lavage sample. Method. A cross-sectional study was conducted on adult HIV-infected patients with suspected pulmonary tuberculosis in Cipto Mangunkusumo hospital Jakarta between February 2016 and June 2017. Gastric lavage sample and sputum sample collection were performed for Xpert MTB/RIF test and acif fast bacilli (AFB) smear examination. Results. Among total of 117 subjects, 81 (69,2%) subjects were unable to expectorate sputum. M tuberculosis was detected on Xpert MTB/RIF using gastric lavage samples in 34 (29,1%) subjects, AFB in 4 of 36 sputum samples and 2 of 117 gastric lavage samples. The drug sensitivity test on all 34 Xpert MTB/RIF positive subjects showed no rifampicin resistance. Fifty-one (43.6%) subjects were diagnosed as clinical pulmonary tuberculosis, 26 subjects among them were positive on Xpert MTB/ RIF assay, 4 subjects were smear sputum positive and 1 subject was gastric lavage smear positive. Using clinical diagnosis of pulmonary TB as gold standard, a single Xpert MTB/RIF assay using gastric lavage sample showed sensitivity of 50.98% (95% CI: 36.6-65.25), specificity 87.88% (95% CI: 77,1-94,62), positive predictive value 76,47% (95%CI: 61,67-86,78) and negative predictive value 69,88% (95% CI: 63,36-75.68). Conclusion. Xpert MTB/RIF performed on gastric lavage samples showed sensitivity of 50.98% and specificity 87.88% in clinical diagnosis of pulmonary tuberculosis in HIV-positive patients with pulmonary tuberculosis

Symptomatic Bradycardia Due to Alectinib in a Patient with Advanced Stage of NSCLC

Alectinib is one of the targeted therapies commonly given to patients with advanced non-small cell lung cancer (NSCLC) with mutations in the ALK gene. The most common adverse effects of alectinib are fatigue, constipation, edema, myalgia and anemia. Meanwhile, bradycardia was reported as a very common adverse effect, but generally asymptomatic, unlike the reported patient in this case report. This case report’s purpose is to increase awareness of the possibility of adverse effects due to alectinib administration that require immediate intervention in order to improve the quality of life and patient survival, especially in patients with advanced NSCLC

Lima puluh masalah kesehatan di bidang ilmu penyakit dalam buku kesatu

Gejala dan tanda yang terjadi dapat merupakan manifestasi dari konsi medik yang mendasari atau proses patologik di susunan saraf pusat.xiii, 297 hlm.: ilus.; 24 c

Accuracy of Bedside Lung Ultrasound in Emergency (BLUE) Protocol to Diagnose the Cause of Acute Respiratory Distress Syndrome (ARDS): A Meta-Analysis

Background: There is a stigma that ultrasound cannot be used to see abnormalities in the air-filled organs makes ultrasound rarely used to identify lung abnormalities. This study purpose comparing diagnostic accuracy of BLUE protocol with gold standard for each diagnosis causing acute respiratory failure. Methods: Systematic search was done in 6 databases (Pubmed/MEDLINE, Embase, Cochrane Central, Scopus, Ebscohost/CINAHL dan Proquest) and multiple grey-literature sources for cross-sectional studies. We manually extracted the data from eligible studies and calculated pooled sensitivity, pooled specificity, likelihood ratio (LR) and diagnostic odds ratio (DOR). We follow PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guideline throughout these processes. Results: Four studies has been picked from total 509 studies involved. The results yield parameters indicating BLUE protocol as a reliable modality to diagnose pneumonia with pooled sensitivity 84% (95% CI, 76-89%),  pooled specificity 98%  (95% CI, 93-99%), LR+ 42 (95% CI, 12-147), LR- 0.12 (95% CI, 0.07-0.2) and DOR 252 (95% CI, 81-788), respectively. It also considerably applicable to diagnose pulmonary oedema with pooled sensitivity 89% (95% CI, 81-93%), pooled specificity 94% (95% CI, 89-96%), LR+ 14 (95% CI, 8-25), LR- 0.165 (95% CI, 0.11-0.24), and DOR 116 (95% CI, 42-320), respectively. Conclusion: BLUE protocol has good diagnostic accuracy to diagnose pneumonia and pulmonary oedema. We recommend implementing BLUE protocol as a tool in evaluating cause of ARF

Misleading Diagnosis of Radiological Imaging of COVID-19 Pneumonia During Pandemic Era: Risk on the Existence of CMV Infection

Coronavirus disease 2019 (COVID-19) is an acute respiratory disease which rapidly disseminated due to Severe Acute Respiratory Syndrome CoronaVirus-2 (SARS-CoV-2) virus. Clinical presentations of COVID-19 are fever, non-productive cough, and dyspnea. Although the diagnosis establishment is done by detecting the viral ribonucleic acid (RNA) through reverse transcription-polymerase chain reaction (RT-PCR) method, CT scan has an important role in detection and treatment of COVID-19 especially in high prevalence regions. Chest CT scan has high sensitivity yet low specificity because there are a lot of other pathological spectrums that also present features of COVID-19 such as ground glass opacities (GGO) and consolidation, one of them is CMV infection. The objective of this case report is to raise vigilance towards other diseases that have radiological image similarities with COVID-19, especially in the immunocompromised patients who are susceptible to viral infections like CMV infection so that the delay in the disease treatment can be prevented

The value of anal swab RT-PCR for COVID-19 diagnosis in adult Indonesian patients

Objective This study will test the performance of the anal swab PCR test when compared with the nasopharyngeal swab PCR test as a diagnostic tool for COVID-19.Design An observational descriptive study which included hospitalised suspected, or probable cases of hopitalised COVID-19 patients, conducted in Dr. Cipto Mangunkusumo National Hospital, Ciputra Hospital, Mitra Keluarga Depok Hospital and Mitra Keluarga Kelapa Gading Hospital, Indonesia. Epidemiological, clinical, laboratory and radiology data were obtained. Nasopharyngeal and anal swabs specimens were collected for SARS-CoV-2 RNA detection.Results We analysed 136 subjects as part of this study. The clinical spectrum of COVID-19 manifesation in this study was typical of hospitalised patients, with 25% classified as mild cases, 14.7% in severe condition and 12.5% of subjects classified as having acute respiratory distress syndrome. When compared with nasopharyngeal swab as the standard specimen for reverse transcription polymerase chain reaction (RT-PCR) detection of SARS-CoV-2 antigen, the sensitivity and specificity of the anal swab was 36.7% and 93.8%, respectively. The positive and negative predictive value were 97.8% and 16.5 %, respectively. The performance of the anal swab remained similar when only the subgroup of patients with gastrointestinal symptoms (n=92, 67.6%) was analysed (sensitivity 40% and specificity 91.7%). Out of all the subjects included in analysis, 67.6% had gastrointestinal symptoms. Similarly, 73.3% of patients in the anal swab-positive group had gastrointestinal symptoms. The two most common gastrointestinal symptoms in the subjects’ population were nausea and anorexia.Conclusion Anal swab specimen has low sensitivity (36.7%) but high specificity (93.8%) for detecting SARS-CoV-2 antigen by RT-PCR. Only one additional positive result was found by anal swab among the nasopharyngeal swab-negative group. Anal swab may not be needed as an additional test at the beginning of a patient’s diagnostic investigation and nasopharyngeal swab RT-PCR remains as the standard diagnostic test for COVID-19