The Correlation Between Surfactant Protein-D (SP-D) Serum Level and Intubation Time on Covid-19 Patients in Indonesia

Abstract : COVID-19 patients with ARDS who are admitted to the ICU needed tracheal intubation and mechanical ventilation, where the tracheal intubation strategy as early as possible with the good protocol ventilation management produce favorable patient outcomes. In performing the intubation needed to consider the right time to produce optimum outcome. The increase of Surfactant Protein-D serum level is a specific indicator of lung injury with severe ARDS and the duration of intubation. From that, the aims of this study to determine the correlation between Surfactant Protein-D (SP-D) and intubation time on COVID-19 patients. This observational analytic research with retrospective cohort design is conducted during March-August period and has obtained the ethics certificate from the Ethical Committee of Dr. Soetomo Surabaya. The examination of Surfactant Protein-D level is conducted on patients who have met the inclusion and exclusion criteria and the intubation time is recorded. In this research obtained 28 patients, where 20 patients are male and 8 patients are female. The comorbid factor that most affect the patient’s condition is Diabetes Mellitus. The average of Surfactant Protein-D serum level is 42,15 ng/ml (SD ± 32,71 ng/ml). The statistics analysis results showed that there is no meaningful correlation between Surfactant Protein-D serum level and intubation time (p: 0,304). In addition, it is also found that the SP-D level results which has no meaningful difference in the group of patients who died and survived (p: 0,159). The examination of Surfactant Protein-D level did not show a meaningful correlation with intubation time on Covid-19 patients

Buku Ajar Ilmu Penyakit Paru

i.257 hal;24 c

Procalcitonin as biomarker of antibiotic effectivity in communityacquired pneumonia

Major therapy for community-acquired pneumonia (CAP) is antibiotics. Procalcitonin used as the measure of antibioticseffectiveness. Procalcitonin is specific biomarker that elevates in acute bacterial infection. This study aimed to analyze procalcitoninas effective antibiotics biomarker in CAP patients hospitalized at Pulmonology Department Dr. Soetomo Teaching Hospital. Thisstudy was performed by cohort prospective data and analyzed by descriptively. Data were assessed at before antibiotics, day 3 andday 5 after antibiotics therapy. Nineteen community-acquired pneumonia were enrolled. Serum procalcitonin before antibiotictherapy , day 3 and day 5 antibiotics therapy in CAP are 0.51+ 0.19 (0.28-0.89) ng/ml, 0.53+ 0.24 (0.08-0.93) ng/ml and 0.43+ 0.24(0.00-0.83) ng/ml. Serum procalcitonin in CAP with sepsis patients are 0.51+ 0.19 (0.28-0.89) ng/ml (before antibiotic therapy),0.40 + 0.26 (0.08-0.74) ng/ml (day 3) and 0.22 + 0.13 (0.00-0.32) ng/ml (day 5). Serum Procalcitonin in CAP with pulmonary TBare 0.52 + 0.18 (0.38-0.83) ng/ml, 0.55 + 0.25 (0.23-0.89) ng/ml dan 0.57 + 0.16 (0.41-0.82) ng/ml. Serum procalcitonin in CAPwith sepsis and pulmonary TB are 0.55 + 0.12 (0.38-0.70) ng/ml, 0.56 + 0.15 (0.42-0.73) ng/ml dan 0.47 + 0.15 (0.33-0.64) ng/ml.Procalcitonin of 60% CAP with sepsis patients, 20% CAP with pleural effusion patients and no patients of CAP with pulmonary TBreach <0.26 ng/ml. In conclusion, procalcitonin is not useful biomarker in CAP. (FMI 2015;51:96-100

Buku Ajar Ilmu Penyakit Paru

viii.265 hlm.; 24 c

Rare concurrent extrapulmonary tuberculous pericarditis and pleuritis accompanied with lung silicosis

Extrapulmonary tuberculosis could affect many organs beside lung airway and parenchyma. The mycobacterium tuberculosis can invade area such as the pleural and pericardium by lymphogenic, hematogenic, or direct infection. Patient with history exposure with silica (SiO2) have a high-risk factor developing tuberculosis or extrapulmonary tuberculosis. Therefore, this study presents a rare case of pulmonary silicosis in a 38 years-old-man with tuberculosis pericarditis and pleuritis. The amount of silica particle found in bronchoalveolar lavage (BAL) was 39,95 ppm SiO2, while the ADA test from the pericardium and pleural fluids was 35.4 U/L and 40.2 U/L, respectively. The patient underwent pericardiocentesis and thoracocentesis, received first-line anti-tuberculosis drugs, and resigned from work. After one month follow-up, the pericardial as well as pleural fluid totally disappeared. This disease can mimic any other disease. Early detection of risk factor for extrapulmonary tuberculosis and perform the right diagnostic and treatment will give a better outcome for the patient

Correlation of inflammatory cytokines on corrected QT interval in rifampicin-resistant tuberculosis patients

Abstract Background: The cases of Rifampicin-Resistant Tuberculosis (RR-TB) in our country have increased every year and RR-TB deaths are thought to be caused by prolongation of the QTc interval due to side effects of anti-tuberculosis drugs. Thus, cytokines are needed to be used as early markers of prolongation of the QTc interval in RR-TB patients. Objective: This study aims to analyze the correlation of inflammatory cytokines on QTc interval in RR-TB patients who received shorter regimens. Methods: This study uses a case-control study with a time series conducted in the period September 2019 to February 2020 in one of the referral hospitals for Tuberculosis in Indonesia. Cytokines levels from blood samples were measured using the ELISA method, while QTc intervals were automatically recorded using an electrocardiography machine. The statistical analysis used was the Chi-square test, Man Whitney test, Independence t-test, and Spearman-rank test with p < 0.05. Results: There was no significant correlation between inflammatory cytokines and QTc prolongation in intensive phase which TNF-α value (6.8 pg/ml; r = 0.207; p = 0.281), IL-1β (20.13 pg/ml; r = 0.128; p = 0.509), and IL-6 (43.17 pg/ml; r = -0.028; p = 0.886). Meanwhile, in the continuation phase, the values for TNF-α (4.79 pg/ml; r = 0.046; p = 0.865), IL-1β (7.42 pg/ml; r = -0.223; p = 0.406), and IL- 6 (40.61 pg/ml; r = -0.147; p = 0.586). Conclusion: inflammatory cytokines (TNF-α, IL-1β, and IL-6) cannot be used to identify QTc interval prolongation in RR-TB patients who received shorter regimens. Keywords: BMI, Body mass index; Ca, Calcium; IL-1β; IL-1β, interleukin-1β; IL-6; IL-6, interleukin 6; K, Potassium; MDR, multidrug resistance; QTc prolongation; RR-TB; RR-TB, Rifampicin-Resistant Tuberculosis; TB, tuberculosis; TNF-α; TNF-α, Tumor necrosis factor alpha; WHO, World Health Organization

The role of C-Reactive protein as an inflammatory marker to predict prolonged QTc interval in rifampicin-resistant tuberculosis patients: A case-control study

Abstract Background long-term use of anti-tuberculosis drugs (ATD) increases the risk of QTc prolongation, while C-reactive protein (CRP) can be used as an inflammatory marker of Mycobacterium tuberculosis infection. Objective: correlation of CRP on the QTc interval in Rifampicin-resistant tuberculosis (RR-TB) patients with the short regimen. Methods An observational study was conducted in Rifampicin-resistant tuberculosis (RR-TB) patients from 2 groups, patients on intensive phase and patients on continuation phase. CRP levels were measured from blood samples and measured automatically using the immunoturbidimetric assay. QTc interval was calculated using electrocardiography. Levels of CRP levels and QTc interval between the 2 groups were analyzed. The statistical analysis used includes the independent t-test, Mann Whitney test, and Rank Spearman test with p = 0.05. Results Forty-five eligible RR-TB patients were included in this study. CRP levels and QTc intervals between 2 groups (intensive and continuation phase) showed significant difference with p < 0.001 but found no significant correlation of CRP levels and QTc interval in both intensive and continuation phase with p = 0.226 and 0.805, respectively. A higher level of CRP strongly indicated the inflammation caused by RR-TB infection at the early phase of the disease, but not correlated with QTc interval in RR-TB patients. Conclusion Levels of CRP and QTc interval do not correlate in RR-TB patients and can not be used to be the marker of QTc prolongation in RR-TB Patients

Moxifloxacin concentration correlate with QTc interval in rifampicin-resistant tuberculosis patients on shorter treatment regimens

Abstract Background: Drug-resistant tuberculosis (DR-TB) continues to be a global threat. Moxifloxacin is one of the components of the shorter treatment regimen which is suspected to increase the risk of QT prolongation, although it is also likely to be the most effective against DR-TB. A study to evaluate the correlation between the concentration of moxifloxacin and QTc interval in RR-TB patients who received shorter regimens is needed. Methods: This was an observational study in 2 groups of RR-TB patients on shorter treatment regimens (intensive phase and continuation phase), contain moxifloxacin with body weight-adjusted dose. Blood samples were collected at 2 h after taking the 48th-hour dose and 1 h before taking the 72nd-hour dose. Results: Forty-five RR-TB patients were included in this study. At 2 h after taking the 48th-hour dose, the mean of QTc interval in intensive phase and continuation phase was 444.38 ms vs. 467.94 ms, p = 0.026, while mean of moxifloxacin concentration in intensive phase and continuation phase was 4.3 µg/mL vs. 4.61 µg/mL, p = 0.686). At 1 h before taking the 72nd-hour dose, both moxifloxacin concentration and QTc interval in intensive phase and continuation showed no significant difference with p-value of 0.610 and 0.325, respectively. At 2 h after taking the 48th-dose, moxifloxacin concentration did not correlate with QTc interval, both in intensive phase (p = 0.576) and in continuation phase (p = 0.691). At 1 h before taking the 72nd-hour dose, moxifloxacin concentration also did not correlate with QTc interval in intensive phase (p = 0.531) and continuation phase (p = 0.209). Conclusions: Our study found that moxifloxacin concentration did not correlate with QTc interval, which indicates the safe use of moxifloxacin on QTc interval. In addition to close monitoring of QTc interval, the clinicians should also consider other variables which potentially increase risk for QTc prolongation in DR-TB patients who received shorter treatment regimens