Colloids Versus Albumin in Large Volume Paracentesis to Prevent Circulatory Dysfunction: Evidence-based Case Report

Large volume paracentesis may cause paracentesis induced circulatory dysfunction (PICD). Albumin is recommended to prevent this abnormality. Meanwhile, the price of albumin is too expensive and there should be another alternative that may prevent PICD. This report aimed to compare albumin to colloids in preventing PICD.Search strategy was done using PubMed, Scopus, Proquest, dan Academic Health Complete from EBSCO with keywords of “ascites”,  “albumin”, “colloid”, “dextran”, “hydroxyethyl starch”, “gelatin”, and “paracentesis  induced  circulatory  dysfunction”. Articles was limited to randomized clinical trial and meta-analysis with clinical question of “In hepatic cirrhotic patient undergone large volume paracentesis, whether colloids were similar to albumin to prevent PICD”.We found one meta-analysis and four randomized clinical trials (RCT). A meta analysis showed that albumin was still superior of which odds ratio 0.34 (0.23-0.51). Three RCTs showed the same results and one RCT showed albumin was not superior than colloids. We conclude that colloids could not constitute albumin to prevent PICD, but colloids still have a role in patient who undergone paracentesis less than five liters

Diagnostic and Therapeutic Approach in Intestinal Tuberculosis

Tuberculosis was still a global health problem. Beside lung, tuberculosis also manifest in other organs, one among them is in abdominal organs. Abdominal tuberculosis was a complex disease with unspecific sign and symptoms so that its diagnostic procedure was not rarely inconclusive. We reported a 24 years old woman with chief complain of worsening abdominal pain in all region, accompanied by nausea, vomiting, bloating, and absent bowel movement. She also had a fresh bloody stool. She had an active pulmonary tuberculosis on initiation phase treatment. Physical examination suggest a bowel obstruction sign with distended abdomen and increase bowel sound. Colonoscopy procedure findings was a mass that obstruct bowel lumen in ileocaecal region, suggest for Malignancy similar to computerized tomography (CT) scan result, but pathlogic result showed an active colitis without any sign of Malignancy. Because of its contradiction, the second colonoscopy was performed and concluded as intestinal tuberculosis, matched with second pathologic examination. Although polymerase chain reaction (PCR) tuberculosis (TB) showed a negative result, a further clinical judgement concluded this as an intestinal tuberculosis case. Patient was finally treated as intestinal tuberculosis with first-line antituberculosis drugs and planned to have colonoscopy evaluation. After general condition was good and obstructive ileus sign was relieved, patient planned for outpatient care

The Changes of Amino Terminal Pro B-type Natriuretic Peptide (NT-proBNP) Concentration and Left Ventricular Ejection Fraction on Doxorubicin Chemotherapy Patients

Introduction. Cancer patients who received chemotherapy regimen containing doxorubicin has been known to have serious side effect in heart, called as cardiotoxicity. The measurement of NT-proBNP proposed to be used as a new parameter to identify and evaluate cardiotoxicity in cancer patients earlier before it has been manifested, superior than measurement of left ventricle ejection fraction (LVEF). The aims of this study to examine the changes of NT-proBNP concentration and LVEF on patients with cancer who receive chemotherapy regimen containing doxorubicin. Methods. The study used pre and post test design to observe the changes of NT-proBNP concentration and LVEF on the patients who receive naïve doxorubicin chemotherapy and after chemotherapy-cycle I to cyce IV at the Ciptomangunkusumo hospital, Jakarta. Echocardiography and NT-proBNP were examined on naïve chemotherapy and after chemotherapy each cycle. Statistical analysis was performed by using two way Anova and Friedman nonparametric test. Results. During the period of October 2007 to June 2008, a total of 29 consecutive patiets receiving doxorubicin chemotherapy regimen CHOP (Cyclophosphamide, doxorubicin, Vincristine, Prednisone and FAC-5 Fluorouracil, doxorubicin, Cyclophosphamide) were collected. The increase of median NT-proBNP concentration between naïve chemotherapy and: post chemotherapy cycle I was 32 pg/mL (12,5-124,6 pg/mL), post chemotherapy cycle II was 135 pg/mL (44-275,2 pg/mL), post chemotherapy cycle III was 275,1 pg/mL (97,8-907,2 pg/mL), post chemotherapy cycle IV was 514,6 pg/mL (80,6-6458,2 pg/mL). With Friedman test, p< 0,000. With Anova two way test, it was found the difference between naïve LVEF and LVEF: post chemotherapy cycle I was 5,1% (p 0,000), post chemotherapy cycle II 8,9% (p 0,000), post chemotherapy cycle III 11,2% (p 0,000), post chemotherapy cycle IV 12,5% (p 0,000). Conclusions. Elevated NT-proBNP concentration and LVEF reduction had been observed in doxorubicin chemotherapy patients

The Role of New Pulmonary Artery Wedge Pressure Formula to Predict Diastolic Dysfunction in Obstructive Sleep Apnea

Background: Heart failure (HF) is a common condition with high morbidity and mortality  in  Obstructive Sleep Apnea (OSA), especially in obese patient. The causes of HF are often abnormal conduction pathways, pump filling and/or heart valves. Right heart catheterization using Swan-Ganz catheter remains the gold standard to determine pulmonary hemodynamics, but it is costly and invasive. Herein, we propose a new formula for non-invasive Pulmonary artery wedge pressure (PAWP) measurement using tissue Doppler echocardiography. The purpose of this research is to explore the correlation between the new formula to calculate PAWP to predict diastolic dysfunction in OSA patients. Methods: A cross-sectional study was conducted in Jakarta, in March until October 2021. Eighty-two subjects were enrolled in the study, consist of 34 females and 48 males. All subjects underwent polysomnography and tissue Doppler echocardiography. Noninvasive measurement of PAWP were obtained from combined assessment of E/e’ and left atrial parameters. Results: Based on 82 subjects included, 66 subjects (80.5%) had obstructive sleep apnea, and 16 subjects (19.5%) did not have it. There was a significant difference in PAWP between patients with and without OSA (p value <0.01). Ten subjects OSA (12.1%) had diastolic dysfunction, while all non-OSA subjects had normal diastolic function, with no statistical significance between two groups (p value = 0.20). Diastolic dysfunction significantly associated with PAWP measured using proposed formula  (R = 0.240, p value = 0.030). Conclusion: The new formula could be used to indirectly calculate PAWP and predict diastolic dysfunction in OSA. Obstructive sleep apnea is associated with elevated PAWP. The increased risk of diastolic dysfunction in OSA, especially in obesity patient may indicate for the risk of cardiovascular morbidities

Pulmonary Artery Wedge Pressure Formula Using Echocardiography Finding

This study aims to introduce a new formula for pulmonary artery wedge pressure (PAWP) derived from the pathophysiology of Velocity A (VA) waves. The current formula is the the Nagueh formula. Left ventricular (LV) filling is described as a velocity A (VA) wave. The VA wave represents the filling rate of the end-diastolic blood phase from the left atrium (LA) to the LV which can be determined on echocardiography. Left ventricular end diastolic pressure (LVEDP) is equivalent to LA pressure and is also equivalent to PAWP. The gold standard method for obtaining PAWP values is right heart catheterization. By measuring the VA waves in the bloodstream, a new PAWP formula is obtained, and the PAWP examination can be validated in research and can be compared with several other PAWP formulas that are currently the world’s standard formula for calculating pulmonary artery wedge pressure (PAWP).The new PAWP formula is obtained from the conversion of the VA wave. This formula could be validated further in research and used in clinical practice

Diagnostic and Therapeutic Approach in Intestinal Tuberculosis

Tuberculosis was still a global health problem. Beside lung, tuberculosis also manifest in other organs, one among them is in abdominal organs. Abdominal tuberculosis was a complex disease with unspecific sign and symptoms so that its diagnostic procedure was not rarely inconclusive. We reported a 24 years old woman with chief complain of worsening abdominal pain in all region, accompanied by nausea, vomiting, bloating, and absent bowel movement. She also had a fresh bloody stool. She had an active pulmonary tuberculosis on initiation phase treatment. Physical examination suggest a bowel obstruction sign with distended abdomen and increase bowel sound. Colonoscopy procedure findings was a mass that obstruct bowel lumen in ileocaecal region, suggest for malignancy similar to computerized tomography (CT) scan result, but pathlogic result showed an active colitis without any sign of malignancy. Because of its contradiction, the second colonoscopy was performed and concluded as intestinal tuberculosis, matched with second pathologic examination. Although polymerase chain reaction (PCR) tuberculosis (TB) showed a negative result, a further clinical judgement concluded this as an intestinal tuberculosis case. Patient was finally treated as intestinal tuberculosis with first-line antituberculosis drugs and planned to have colonoscopy evaluation. After general condition was good and obstructive ileus sign was relieved, patient planned for outpatient care

Detection method of viral pneumonia imaging features based on CT scan images in COVID-19 case study

This study aims to automatically analyze and extract abnormalities in the lung field due to Coronavirus Disease 2019 (COVID-19). Types of abnormalities that can be detected are Ground Glass Opacity (GGO) and consolidation. The proposed method can also identify the location of the abnormality in the lung field, that is, the central and peripheral lung area. The location and type of these abnormalities affect the severity and confidence level of a patient suffering from COVID-19. The detection results using the proposed method are compared with the results of manual detection by radiologists. From the experimental results, the proposed system can provide an average error of 0.059 for the severity score and 0.069 for the confidence level. This method has been implemented in a web-based application for general users. • A method to detect the appearance of viral pneumonia imaging features, namely Ground Glass Opacity (GGO) and consolidation on the chest Computed Tomography (CT) scan images. • This method can separate the lung field to the right lung and the left lung, and it also can identify the detected imaging feature's location in the central or peripheral of the lung field. • Severity level and confidence level of the patient's suffering are measured