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Background/aim: The analysis of VOCs through respiration has been used for biomarker analysis for the detection of novel coronaviruses and has found mainly six VOCs by breath analysis by GC-IMS are ethanol, octane, acetone, cluster mixture of acetone/butanone and methanol. Previous research found exhaled methanol concentrations were lower in COVID-19 patients. The aim of this study was to analyze differences in VOC concentration in Covid-19 patients with healthy people. Methods: This Case Control study used 93 confirmed case samples of Covid-19 and 42 healthy people. Demographic and clinical data taken from anamnesis and/or medical records. VOC’s data of respiratory track are taken through the exhalation air in a bag and analyzed with breath analyzer. Statistical analysis was conducted using Mann-Whitney test. Results: VOC compound measured include CO2, C7H8, CH2O, NH4, TVOC, NO2, PM1.0, CO, NH3, and Acetone. Analysis between Covid-19 patients and healthy people showed significant differences in all VOC components CO2 (p=0,000), C7H8 (p=0,000), CH2O (p=0,000), NH4 (p=0,001), TVOC (p=0,000), NO2 (p=0,000), PM1.0 (p=0,000), CO (p=0,000), NH3 (P=0,000), Acetone (p=001). Logistic regression analysis was obtained no meaningful influence on each component of the VOC with covid/healthy people conditions of patients with components CO2 (p=1,000), C7H8 (p=1,000), CH2O (p=0,999), NH4 (p=1,000), TVOC (p=1,000), NO2 (p=1,000), PM1.0 (p=0,999), CO (p=0,999), NH3 (P=0,999), Acetone (p=1,000). Conclusion: There is a significant difference between the VOC results of confirmed COVID 19 patients and healthy people Keywords: breath analyzer, coronaviruses, COVID-19, healthy people, volatile organic component

Background: In recent years, there have been studies regarding biomarkers for early detection of lung cancer. The expansion of tumor is accompanied by distinct metabolic process product, which results in identifiable changes in the volatile organic compounds (VOC) emission profile. The content of such molecules differs between healthy and lung cancer patients. Furthermore, the expression of Interleukin-17 (IL-17) was linked to the clinical and pathological aspects of lung cancer patients. The aim of this study is to profile the exhaled VOC and the level of IL-17 in the serum of lung cancer patient.Methods: Fourty patients with confirmed lung cancer and 42 healthy subjects as control were gathered for this study. VOC was measured using breath analyzer and sensor array, while IL-17 was measured by ELISA. Statistical analysis was conducted using Kruskal-Wallis test and Spearman correlation test with P

Smoking is one of the causes of premature death and disability, and one of the diseases caused by smoking is COPD. Chronic obstructive pulmonary disease (COPD) is a major worldwide leading cause of morbidity, mortality, and disability. It also becomes the serious healthcare system’s economic problem. By knowing the level of public understanding of this disease, we were able to find out what education could be given to increase COPD understanding. This study aims to determine the level of knowledge of high school students about COPD and to evaluate after being given a presentation about COPD. It is a descriptive study. The study had 95 participants and was conducted cross-sectionally. This study was conducted at the Zoom meeting on November 21, 2021. The data collection technique is that respondents filled out a Google Form. The subjects were 95 participants who had undergone COPD education, and there was a statistically significant difference in COPD knowledge before and after it (p0.01). Knowledge of COPD symptoms had the greatest significant influence on education (p0.01) of the COPD knowledge categories assessed.

WHO declared COVID-19 infection as a pandemic since 2020. A rapid noninvasive examination is needed for screening and diagnostic. Exhaled Volatile Organic Compound (VOC) is a sample directly connected to the affected organ, which is the lung, and can be measured as an endogenous volatile marker resulted from oxidative stress. This study aims to analyze differences in VOC concentration in COVID-19 patients with pneumonia and without pneumonia. This Case Control Study used 93 confirmed case samples of COVID-19 and 42 healthy subject. Demographic and clinical data taken from anamnesis and/or medical records. VOC’s data of respiratory track are taken through the exhalation air in a bag and analyzed with breathanalyzer. Statistical analysis was conducted using Mann-Whitney test. In the analysis of confirmed samples of COVID-19 between pneumonia and without pneumonia, co components were found to affect the incidence of pneumonia in confirmed samples of COVID-19 (p=0.003). This conclusion is Components of CO in confirmed COVID-19 have a meaningful effect on an event of pneumonia.

Thymoma is a rare malignancy with an incidence of 0,15 case per 100.000 population and is the most commonly diagnosed anterior mediastinal malignancy. With 12,5% 15-year survival rate, and is often accompanied by autoimmune disease such as myasthenia gravis, pure red blood cell aplasia, and hypogammaglobulinemia, better understanding of factors affecting prognosis is needed to improve patient quality of life and survival.

Introduction: Asthma is heterogenous disease characterized by chronic airway inflammation. COVID-19 pandemic has an impact on health services where telemedicine could provide alternative method to evaluate patient’s condition, reduce risk of infection and disease transmission. The aim of this study is to analysis knowledge, asthma symptoms control and risk factors among the asthmatic patients via telemedicine Methods: Data was obtained from telemedicine of 28 asthmatic patients in the context of community services. Inclusion criteria is stable asthmatic patients who conducted medical interview via videocall application. Cross sectional data were taken including demographic, knowledge of subjects, profile of subjects, and assessment of asthma symptoms control and assessment of poor outcomes. Data were analyzed descriptively and variables were analyzed using chi-square. Results: Subjects consisted of 28 stable asthmatic patients. The average of asthma onset was 17.96 years old. Clinically profile showed that 67.86% subjects were not routinely controlled, 64.29% had never performed pulmonary function test, 67.86% subjects didn’t know the level of asthma control symptoms. Evaluation based on GINA symptoms control only 39.29% were in good control condition, 35.71% were partially controlled and 25% in uncontrolled condition. Use of inhaler device recently or previously prescribed on 67.86% subjects. Evaluation of knowledge about asthma still unsatisfactory, 67.86% subjects didn’t know about their modifiable risk factors, 96.43% didn’t know about written action asthma plan, 60.71% didn’t know about asthma exercise. Self-medication was associated with poor asthma control (p=0,036) and knowledge about modifiable risk factors related to asthma symptoms control (p=0,041). Conclusion: Self-medication is related to uncontrolled asthma and knowledge of modifiable factors is related asthma symptoms control. It is important to educate the patient about the modifiable risk factors of asthma and how to manage it. Patient knowledge about their disease is still lacking, and there is a need for ongoing education to achieve good asthma control. Alternative intervention through telemedicine especially for continuing education and may therapeutic strategies can be performed as an effort to obtain well controlled asthma in community. Telemedicine, particularly in asthma management may benefit as an alternative approach of healthcare service in the context of pandemic era.

Spirometry is a standard diagnostic tool for respiratory diseases. The people who live around the volcanic eruption may have a respiratory problems, both acute and chronic conditions. The aim of this study is to evaluate whether spirometry can be used as a diagnostic tool in the context of disaster in particular volcanic eruption. Data was obtained from medical examination in community services of Semeru volcanic eruption affected community in Pronojiwo, Oro Oro Ombo, Lumajang in last January 2022. Spirometry was performed for the patient who had a respiratory problems. Data was analyzed descriptively to assess lung function test using spirometry and its benefit in the people affected by volcanic eruption. Among the subjects, 77.27% had abnormal findings from the spirometry result. The mean of %VC, % FVC and % FEV1/FVC were 71.49%; 74.58%; 74.39% respectively. The result of spirometry revealed normal, restriction, and obstruction with suggestive restriction 18.18%; 22.73%; 31.82%; 22.73% respectively. The evaluation of spirometry parameters showed that 54.55% was appropriate for clinical diagnosis made by a physician. Our data show that most subjects had an abnormal results from spirometry. Spirometry may be a diagnostic tool can be used in natural disasters, particularly volcanic eruption for assessing respiratory symptoms.

Background:Despite vast amount of completed and ongoing researches, the role of immune system in COVID-19 remains unclear. Widespread lung damage as the result of the disease also often causes pulmonary fibrosis as a sequela. Antioxidant property of N-Acetylcysteine (NAC) has prompted its use as adjuvant therapy in COVID-19, both in immune system regulation and prevention of pulmonary fibrosis. We analyze the role of high dose NAC (>1200 mg/day) in COVID-19 immune response, mediated by major pro-inflammatory COVID-19 cytokines IL-6 and TGF-β, and in preventing subsequent pulmonary fibrosis, predicted by CRP and D-dimer, known parameters of lung damage in COVID-19. Premature increase of TGF-β may play a major role in immune system dysregulation in COVID-19. MethodThis is a non-equivalent experimental study in confirmed COVID patients admitted in our hospital between June 2020 to July 2021. Patients were randomly divided unto NAC and control group, and IL-6, TGF-β, CRP and D-dimer levels were measured at admission and after 7 days of administration of NAC. ResultCompared to control group, there are significant decreases of IL-6, CRP, and D-dimer levels (p=.001, .000, and 0.001, respectively) after NAC administration. TGF-β level increases in both control and NAC group, although not significantly. ConclusionNAC is a beneficial adjunctive therapy in alleviating immune response in COVID-19 as it lowers IL-6 level. NAC also lowers both CRP and D-dimer levels, which suggests that NAC may prevent post COVID-19 pulmonary fibrosis by mitigating lung damage caused by the disease.

Background: Although classified as a rare disease, the global burden of disease study reports showed that interstitial lung disease is ranked 40th in the diseases with high mortality, and its prevalence had increased by 86% since 1990. The most common interstitial lung disease”idiopathic pulmonary fibrosis (IPF)”has low survival rates”2-3 years after diagnosis”and is irreversible. Establishing a definite diagnosis of IPF is very difficult because it needs a multidisciplinary approach, as an establishment based on the description of HRCT and lung biopsy is needed. The goal of therapy is to prevent the progression of fibrosis. Case: We report a case of an adult woman, 46 years old with idiopathic pulmonary fibrosis (IPF) with Probable Usual Interstitial Pneumonia (UIP) pattern at dr. Saiful Anwar Hospital. History taking, physical examination and laboratory and chest Xray examination of the patient found a suspicion of ILD. CT-scan showed fibrosis in both lungs, honeycomb appearance with pulmonary bronchiectasis traction, which fit the description of IPF, and thus suspended the diagnosis of ILD. VATS pulmonary biopsy confirmed the diagnosis of IPF. The patient experienced a decrease in clinical conditions, as her complaint was worsening in the last month, in accordance to the state of acute exacerbations. Conclusion: In this patient, the diagnosis of IPF with Probable UIP pattern was made through a multidisciplinary approach, including the pulmonology, radiology and anatomical pathology department. Keywords: IPF, IPF, Probable UIP Pattern, IPF Diagnosis

Background: Asthma is a chronic inflammatory disease, therefore inhaled corticosteroid (ICS) should be as the cornerstone of asthma treatment. However patients tend to rely on short-acting β2-agonist (SABA) due to immediate symptom relief and underuse ICS, thereby undertreating the underlying inflammation. As part of the multi-country SABA use IN Asthma (SABINA) III study, we aimed to describe SABA prescription patterns and asthma-related clinical outcome in Indonesia.Methods: Cross-sectional study in asthma patients (> 12 years old) during August 2019 – January 2020. Disease characteristic, prescribed asthma treatment in the 12 months before the study visit, and clinical outcomes, were recorded during a single visit and entered into an electronic case report form.Results: Of 219 patients recruited, the mean number of SABA canisters prescribed was 4 canisters per year. SABA over-prescription (≥ 3 canisters/year) seen in 37% patients, and was greater in moderate-to-severe vs mild asthma (40% vs 17.9%). 47.5% of patients had at least 1 severe exacerbation; and 7.3% of patients had ≥3 severe exacerbations, in the past 12 months. Almost half of the patients (40.2%) were prescribed oral corticosteroids (OCS). Overall, the well-, partly, and uncontrolled patients were 41.6%, 37.4%, and 21%, respectively.Conclusion: SABA over-prescription occurs in approximately one third of asthma patients, especially among moderate-to-severe patients and almost half of asthma patients experienced at least 1 severe exacerbation in the previous year. This highlights a public health concern and the need to improve asthma care by aligning with global recommendations including reducing SABA over-reliance in Indonesia

Cardiopulmonary exercise test (CPET) atau uji latih jantung paru merupakan modalitas non-invasif yang digunakan untuk menilai tingkat kebugaran seseorang. Penilaian atas mekanisme pertukaran gas yang terjadi di tahap respirasi secara breath – to - breath akan menggambarkan pertukaran gas di tingkat selular. Pemantauan pertukaran gas ini menjadi parameter dalam menilai tentang kelainan-kelaianan yang menyebabkan terganggunya proses metabolisme aerob di dalam tubuh. Paramater-parameter pada CPET ini membantu klinisi dalam memilah dan menilai faktor penyebab gangguan dypnea atau kelelahan saat aktivitas, apakah gangguan di sisi sistem pernafasan, sistem kardiovaskular, ataukah di sisi muskuloskeletal. Di samping itu, CPET juga menjadi modalitas dalam menentukan prognosis dan kelayakan transplantasi jantung pada klien dengan gagal jantung (heart failure). Penilaian peak VO2 ≥ 14 mL/kg/menit memberikan gambaran cumulative survival yang lebih baik pada pasien gagal jantung, dan O2 pulse ≥ 10 mL/beat menunjukkan event-free survival yang lebih baik.

Mycobacterium tuberculosis is an intracellular pathogen that can replicate in host macrophages. This research examined the medication mechanism of mangosteen peel extract as anti-tuberculosis towards rats infected by Mycobacterium tuberculosis H37Rv. The mangosteen peel has chemical antituberculosis properties, such as xanthone, flavonoid, and tanin. Rats were invected by M. tuberculosis 105 (100 μl) by intratracheal for 4 weeks, then divided into 6 experimental groups: K1 (infected rats were treated by standard feed); K2 (infected rats were treated by INH); P1 (infected rats were treated by INH and extract 100mg/kg BW/day); P2 (infected rats were treated by INH and extract 200mg/kg BW/day); P3 (infected rats were treated by INH and extract 300mg/kg BW/day); and P4 (infected rats were treated by INH and extract 400mg/kg BW/day). INH and extract were administered orally for 4 weeks. On the 29th rats were euthanized to collect the left lung for MDA measurement and germs planting, and the right lung was collected for Hematoxyline eosin preparation. The data was analyzed by SPSS. The mangosteen peel ethanolic extract showed significant differences between treatments towards Tuberculotic rats treated by INH. The MDA level decreased with a value of p=0,000 (p

Introduction: Polycystic lung disease (PLD) is a group of diseases with heterogeneous pathophysiological processes. The demographics and clinical symptoms vary widely. The etiology of PLD is related to neoplasms, genetics, lymphoproliferative disorders, infections, interstitial diseases, smoking, and developmental disorders. In HRCT, cystic, nodular, ground glass opacities and pneumothorax can be found. Tissue biopsy and immunohistochemistry are needed to determine the type of PLD. Age is very influential towards the survival rates, rapid decline in lung function often occurs at a young age, thus, causing long-term complications in the cardiovascular systemCase Description: A 14-years-old woman complained of shortness of breath and cough was diagnosed with Poly cystic lung disease with Lung TB as secondary infection. CT Scan Thorax showed multiple cavities with consolidation, abdominal ultrasound of the ovary found a simple cystic lesion. The patient underwent TB treatment. After evaluation, clinical symptoms improved, but the patient is often absent from school, thus, indicating disruption in quality of life. Spirometry data showed decreased pulmonary function ad modum restriction, and moderate obstruction. The patient is planned to undergo several examinations such as Bodypletysmography, Bronchoscopy, and VATS to obtain tissue samples, so a diagnosis can be made. Considering the age of the patient—who is still young—definitive therapy as a continuation is expected to improve the patient's quality of life.Conclusion: The diagnosis of PLD in the patient still requires further examination. Other tests, such as biopsy followed by immunohistochemical examination, can be used to confirm the type of PLD. Currently, the patient is undergoing TB treatment and routine control to the clinic. Ater treatment, the clinical symptoms alleviated, but shortness of breath is still present, especially felt after walking fast and carrying heavy loads. Spirometry was done as an evaluation of pulmonary function, showing moderate restriction and obstruction. It is clear that PLD affects the quality of life in this patient.

Latar Belakang: Hiperkoagulopati merupakan salah satu komplikasi pada COVID-19. Mekanisme koagulopati pada COVID-19 masih belum diketahui secara pasti, dimana salah satunya adalah peningkatan fibrinogen bebas dalam darah yang merupakan salah satu mekanisme penyebab koagulopati pada COVID-19. Objective: Menganalisis faktor koagulopati pada pasien COVID-19 yang dirawat di rumah sakit dan hubungannya dengan derajat oksigenasi. Metode: Kami melakukan analisis observasional, cross sectional, single-center, pada 25 pasien terkonfirmasi COVID-19. Uji statistik dipergunakan untuk menilai faktor faktor koagulasi seperti fibrinogen, D-dimer, trombosit dan hubungannya dengan derajat keparahan penyakit serta hubungannya dengan derajat oksigenasi yang dinilai dari PaO2/FiO2. Hasil: Subjek terdiri dari 12 pasien (48%) pada kelompok ringan-sedang dan 13 pasien (52%) pada kelompok berat. D-dimer dengan rerata 1,30 mg/L (0,43 mg/L-4,08 mg/L) meningkat pada 11 pasien (91,67%) pada kelompok ringan-sedang dan 11 pasien (84,61%) pada kelompok berat dengan rerata 11,42 mg/L (0,34 mg/L–66,30 mg/L). Fibrinogen dengan rerata 399,73 mg/dL (235,10 mg/dL -529 mg/dL) meningkat pada 7 pasien (58,33%) kelompok ringan sedang dan 10 pasien (76,92%) pada kelompok berat dengan rerata 444,31 mg/dL (284,7 mg/dL–543,0 mg/dL). Analisis statistik menunjukkan D-dimer berkaitan dengan derajat keparahan penyakit (p=0,039) dan fibrinogen berkorelasi terbalik dengan derajat oksigenasi yang dinilai dari PaO2/FiO2 ) (p=0.019; Pearson correlation = -4,67). Kesimpulan: Peningkatan kadar fibrinogen berkorelasi dengan penurunan derajat oksigenasi dan D-dimer berkaitan dengan derajat keparahan penyakit pada pasien rawat inap, diperkirakan peningkatan faktor koagulasi seperti fibrinogen dan D-dimer mungkin merupakan faktor kunci berkembangnya COVID-19 menjadi kondisi yang lebih berat.

Coronavirus disease 2019 (COVID-19) has emerged as a pandemic across the world. Hypercoagulability status in COVID-19 is one of the causes of complication from severe COVID-19 with a high risk of arterial thrombosis. Acute Limb Ischemia is a vascular emergency caused by sudden decrease in the arterial perfusion. We report the case of a 53-year-old male patient with COVID-19 Pneumonia, diagnosed with Acute Limb Ischemia. From clinical examination, which included anamnesis, physical examination, and laboratory results as well as chest X-rays, a suspicion of Acute Limb Ischemia was found in a patient with COVID-19 pneumonia. The SARS-CoV-2 real time PCR examination showed positive results. In this patient, the diagnosis of Acute Limb Ischemia with Covid-19 Pneumonia was established through a multidisciplinary approach covering the fields of pulmonology, cardiology, and thoracic and cardiovascular surgery.

Latar Belakang: Sejak Desember 2019 ketika pertama kali kasus COVID-19 diidentifikasi di Wuhan, China, SARS-CovV-2 menyebar ke seluruh dunia dan memberikan angka penyebaran infeksi dan mortalitas yang terus meningkat. Merokok memberikan dampak negatif terhadap kesehatan paru. Merokok sampai saat ini diasumsikan merupakan faktor risiko berbagai penyakit paru dan pernapasan seperti PPOK, kanker paru, termasuk pengaruh terhadap sistem pertahanan jalan napas terhadap berbagai mikroorganisme patogen. Prevalensi merokok di Indonesia sangat tinggi, dimana masih sedikit sekali studi yang dilakukan di Indonesia khususnya menilai risiko riwayat merokok terhadap derajat keparahan dan mortalitas pada pasien COVID-19 yang dilakukan rawat inap. Tujuan: Menganalisis riwayat merokok pada pasien COVID-19 yang dirawat di RS rujukan utama dan hubungannya dengan derajat keparahan penyakit dan mortalitas. Metode: Kami melakukan analisis observasional dengan pendekatan cross sectional, single-center, pada 77 pasien terkonfirmasi COVID-19. Data diambil antara bulan April-Juli 2020 pasien yang dirawat di Ruang COVID RS Dr. Saiful Anwar Malang, Indonesia. Uji statistik dipergunakan untuk menilai hubungan riwayat merokok dengan derajat keparahan dan mortalitas. Hasil: Subjek terdiri 77 pasien terkonfirmasi COVID-19 terbagi 2 kelompok yaitu 31 (40,25%) pasien ringan-sedang dan 46 (59,74%) pasien kelompok berat. Subjek dikelompokkan menjadi luaran hidup 52 (68,42%) dan meninggal 24 (31,57%) untuk analisis mortalitas. Analisis statistik menunjukkan riwayat merokok berkaitan dengan derajat keparahan penyakit (p=0,008; OR: 4,75, 95%CI 1,426-15,817) dan mortalitas (p=0,045, OR: 2,821, 95%CI 1,007-7,900) pasien COVID-19 yang dilakukan rawat inap di rumah sakit. Kesimpulan: Merokok berkaitan dengan risiko COVID berkembang ke derajat berat serta mortalitas pada pasien COVID-19 yang dilakukan rawat inap. Kata kunci: COVID-19, Keparahan, Mortalitas, Merokok Background: Since December 2019, when the COVID-19 case was first identified in Wuhan, China, SARS-CoV-2 has spread worldwide and increased the incidence and mortality. To date, smoking is assumed to be a risk factor for various respiratory diseases such as COPD, lung cancer, also influences the airway defense system against various pathogenic microorganisms. The prevalence of smoking in Indonesia is very high where very few studies have been conducted in Indonesia especially assessing the risk of smoking and disease severity and mortality in hospitalized COVID-19 patients. Objective : To determine the risk of smoking history among hospitalized COVID-19 patients in tertiary care referral hospital and its association with disease severity and mortality. Methods: A cross-sectional single-center study was performed of 77 admitted laboratory-confirmed patients in a tertiary hospital in Malang City, East Java, Indonesia from April-July 2020. Statistical analysis was performed to evaluate the association between smoking and disease severity and mortality in COVID-19 patients. Results: A total of 77 patients with laboratory-confirmed COVID-19 were included in our analysis. Subjects divided in the mild-moderate and severe group 31 patients (40,25%) and 46 patients (59,74%) respectively. For mortality analysis, subjects divided into survivor 52 patients (68,42%) and non-survivor 24 patients (31,57%). Statistical analysis determine smoking associated with disease severity (p=0,008; OR : 4,75, 95%CI 1,426-15,817) and mortality (p=0.045, OR : 2,821, 95%CI 1,007-7,900) in hospitalized COVID-19 patients. Conclusion: In our cross-sectional study demonstrated history of smoking associated with disease severity and mortality in hospitalized COVID-19 patients. Keywords: COVID-19, Mortality, Severity, Smoking

To describe Sequential Organ Failure Assessment (SOFA) Score parameters which have a great impact in the condition of sepsis in Corona Virus Disease-19 (COVID-19) patients and comorbidities that aggravate the patient's condition, we conducted a prospective cohort study in adult patients with sepsis and confirmed COVID-19 cases. We conducted a prospective cohort study in confirmed COVID-19 patients with sepsis who were admitted at Saiful Anwar Hospital Malang at March 10th–April 21st 2020. Diagnosis of sepsis is based on the Surviving Sepsis Campaign-III criteria. We found 6 COVID-19 confirmed patients with sepsis. There is an increased respiratory parameter in SOFA Score in these patients. Therefore, respiratory parameter of the SOFA score has a great impact in determining sepsis condition among confirmed COVID-19 patients. Keywords: COVID-19, Sepsis, SOFA Score

Backgrounds: Bronchial asthma is a heterogeneous disease characterized with chronic airway inflammation. The level of asthma control is an indicator of asthma management outcomes. It is influenced by a complex immunological mechanism, included the role of IL-13 as a key biomarker of inflammation. We investigate the effect of Poly-Phytopharm (Kleinhovia hospita 100 mg, Curcuma xanthorriza 75 mg, Nigella sativa 100 mg and Ophiocephalus striatus 100 mg) on the level of asthma control tests (ACT) score, blood eosinophils, and serum IL-13 on not fully controlled asthma stable patients. Methods: This study used quasi-experimental pre and post test methods, in 15 stable asthma patients who were not fully controlled at the pulmonary outpatient clinic of Dr. Saiful Anwar General Hospital, Malang. Assessment of ACT score, blood eosinophils, and serum IL-13 are carried out before and after supplementation of Poly-Phytopharm three times a day, two capsules respectively for 12 weeks. The ACT was scored by the investigator by direct questioning of patients, the blood eosinophil was measured with blood analysis, and the IL-13 in serum was detected with qPCR method. Results: There is significant increase of ACT score (18.07±2.57 to 22.06±1.83; P=0.001). In subject with baseline eosinophils ≥300 pg/mL (n=9), there were significant reduction in blood eosinophils (653.15±276.77/µL to 460.66±202.04/µL; P=0.038), and a decrease of serum IL-13 (17.69±9.901 pg/ml to 16.17±12.438 pg/ml; P=0.609). Conclusions: The administration of poly-phytopharm for 12 weeks improves ACT level, decreases blood eosinophils, and decrease serum IL-13 on not fully controlled asthma stable patients. (J Respir Indo. 2020; 40(3): 130-8)

Background: Malignant mixed germ cell tumors account for 13-25% of all non seminoma germ cell tumors, almost all cases were found in males (85%), increased in the third decade, and had an average survival rate of 40-45%. With modern management the average 5-year survival rate can be over 80%.Case Report: We reported a case report in Saiful Anwar Malang Hospital, Indonesia, a young man, 26 years old with an malignant epithelial tumor derived from mediastinal or lung. The CT scan of the chest showed an lobulated solid mass of iso-hipodens on the anterior superior mediastinum, mass encompassing the aortic arch, left pulmonalis artery, subclavian artery. The result from transthoracic FNAB with USG guidance showed an malignant epithelial tumor derived from mediastinal or lung, impression of an adeno squamous carcinoma. The AFP, LDH, and NSE serum level was elevated. Patient underwent a surgical sternotomy and tumor debulking. The biopsy showed an malignant mixed germ cell tumor (yolksac and embrional carcinoma). These were confirming the diagnosis of malignant mixed germ cell mediastinal tumor (yolksac and embrinonal carcinoma). Patient received a combination bleomycin, etoposid, cisplatin 3 series chemoteraphy  and evaluated.Conclusion: Some procedures like biopsy, tumor marker, could differentiate the subtype of mediastinal germ cell tumor. The multimodality treatment by combining surgical therapy (surgical sternotomy and tumor debulking) with chemotherapy could increase the survival rate of patients.

Background: Thymoma is the most common thymus tumor; it covers 30% of the anterior mediastinum mass in adult. Almost half of thymoma does not present with any symptom and is found by accident. In 40% of patients have symptom of myasthenia gravis; other symptoms include chest pain, symptoms of bleeding and compression to other mediastinum’s structures. Ninety percent of thymoma is located in anterior mediastinum.Case: A 42-year-old woman came to Saiful Anwar Hospital with a complaint of difficulty in swallowing since three months before admission. We performed physical examination and chest X-ray AP’ and the result was within normal limit. In USG examination, there was no abnormality. From the laboratory examination, we found leucocytosis and from the CT-scan imaging, we found pocketed pleural effusion sinistra at the postero-inferior part.Based on these findings, we diagnosed (pre-operation diagnosis) this patient as anterosuperior mediastinum tumor: suspect thymoma. The pulmonologist consulted to Surgical Department for surgery. The surgeon performed sternotomy-tumor excision. The result from the vries coup and histopathogical examination was thymoma. FOB after the surgery showed an edema at the right vocal cord (post-extubation). Post-operative chest X-ray showed no mass in antero-superior mediastinum.

Backgrounds: Important finding in the last decades in the field of biology and medicine are micro-RNA (miRNA), including miRNA-126 that are involved in the regulation of interleukin-13 (IL-13) and the T helper 2 cell (Th2) response, the key components of the asthmatic response. The aim of this study is to find the difference in the expression of miRNA-126 and IL-13 serum in fully controlled and not fully controlled groups of stable asthma patients and analyze the relationship between them. Methods: Case-control studies was conducted in 36 stable asthma patients who visited pulmonary outpatient clinic Saiful Anwar Hospital from September 2018 to March 2019. Subjects were divided into 2 groups, each group consisted of 18 fully controlled asthma and 18 not fully controlled asthma patients. The expression of miRNA-126 was measured by the quantitative polymerase chain reaction (q-PCR) and IL-13 using the enzyme-linked immunosorbent assay (ELISA) method. Results: The expression of miRNA-126 was higher in the control group (3.499±2.99) than case group (2.719±2.73), but the difference was not significant (P=0.273). The IL-13 levels were higher in the case group (17.285±9.37) than control group (11.681±5.22), and the difference was significant (P=0.009). However, there was no relationship between the expression of miRNA-126 and IL-13 levels in both groups. Conclusions: There were differences in IL-13 levels, but there were no differences in the expression of miRNA-126 in the two groups. There was no relationship between miRNA-126 expression and IL-13 levels in both groups. (J Respir Indo. 2020; 40(1): 24-32)

Background: The levels of asthma control is an indicator of asthma management outcomes. A complex immunological mechanism influences it. We aimed to investigate the effect of Poly-Phytopharm on the asthma control tests (ACT) score, blood eosinophil levels, and miR-126 relative expressions in asthma patients. Methods: Quasi experimental method is used in 15 stable asthma patients who were not fully controlled at the pulmonary outpatient clinic of Dr. Saiful Anwar General Hospital Malang. Assessment of ACT score, blood eosinophil levels, and miR-126 relative expressions are carried out before and after supplementation of Poly-Phytopharm that consist of Nigella sativa 100 mg, Kleinhovia hospita 100 mg, Curcuma xanthorrhiza 75 mg, and Ophiocephalus striatus 100 mg extract, three times a day, two capsules respectively for 12 weeks. The ACT was scored by the investigator by direct questioning of patients, the blood eosinophil level was measured with blood analysis, and the relative expressions of miR-126 was detected with qPCR. Results: There were significant increase of ACT score (18.07±2.57 to 22.06±1.83, P=0.001), decrease in blood eosinophil levels (653.15±276.15 pg/mL to 460.66±202.04 pg/mL, P=0.038), and enhancement of serum miR-126 relative expressions (1.83±1.89 to 5.89±1.34, P=0.038). Conclusion: The administration of Poly-Phytopharm increases ACT score, decreases blood eosinophil levels and increases serum miR-126 relative expressions in not fully controlled stable asthma patients. (J Respir Indo. 2019; 39(4): 231-7)

Background: Muscle wasting is one of the extrapulmonary manifestation which influence quality of life in Chronic Obstructive Pulmonary Disease (COPD) patients. It caused by imbalance of protein metabolism in skeletal muscle. This study aimed to evaluate the effect of Ophiocephalus striatus extract on neutrophil count, soluble urokinase-type plasminogen activator (suPAR) level, diffusion capacity of lung for carbon monoxide (DLCO) and quality of life in stable COPD patients with muscle wasting. Methods: Clinical pre and post quasi experimental study was conducted to 32 stable muscle-wasted COPD patients from Pulmonary Outpatient Clinic Saiful Anwar Hospital Malang, determined by The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2016, Bioelectrical impedance analysis (BIA) dengan fat-free mass (FFM)

Background: Muscle wasting is one of extrapulmonary manifestations that occur in 20-40% of patients with COPD as a result of an imbalance of protein synthesis and degradation, where it is thought to be a consequence of chronic inflammation. One of the factor that affect muscle wasting is nutritional factor. The purpose of this study is to prove that nutrition therapy can improve inflammation (measured by levels of leptin, adiponectin) further improve muscle wasting and improve the quality of life of patients COPD with muscle wasting. Method: The clinical study design is pre and post auto control quasi experimental in stable COPD patients with comorbid muscle wasting. The experiment was conducted in Pulmonary Outpatient Clinic Dr. Saiful Anwar Hospital and Physiology Laboratory of Medical Faculty Brawijaya University. Chronic obstructive pulmonary disease was diagnosed based on 2014 GOLD criteria. Muscle wasting was diagnosed through examination of the BIA. Levels of leptin and adiponectin was measured using ELISA method, and quality of life was assessed using CAT score. We measured BIA, Leptin, Adiponectin and CAT in 32 COPD patients with muscle wasting, before and after 12 weeks supplementation of Opiocephalus striatus extract 3x1000mg/day. Results: There were significant increased of BMI (p = 0.046), no significant increase of FFMI (p = 0506), a significant decrease in leptin levels (p = 0.000) and a significant increase in adiponectin levels (p = 0.048) and improvement of quality of life (score CAT) (p = 0.000) ) after administration of opiocephalus striatus extract for 12 weeks. Conclusion: Suplementation of Opiocephalus striatus extract for 12 weeks can improve BMI, decrease levels of leptin and increase level of adiponectin resulting in improvement of quality of life in stable COPD patients with muscle wasting.

Tumor Necrosis Factor Alpha (TNF-α) is a pro-inflammatory cytokine that plays a crucial role in COVID-19 disease progression. N-acetylcysteine (NAC) works throughout several GSH-mediated mechanisms and is known to eliminate oxidative stress in acute respiratory distress syndrome (ARDS) in COVID-19. This study aims to analyze the effect of the N-Acetylcysteine as Adjuvant Therapy to reduce TNF-α levels and Increase SpO2/FiO2 ratio in Improving hypoxemia in COVID-19 Patients. This is a quasi-experimental, non-equivalent control group design study. There were 91 subjects selected using non-random sampling, which consisted of 75 patients in the NAC group and 16 patients in the control group. The TNF-α level was measured using the ELISA method, and SpO2/FiO2 ratio was calculated on day 1 (on admission) and day eight after NAC 5000mg/ 72 hours was given. Statistical analysis was conducted using Wilcoxon and Mann-Whitney U Test. There is a significant decrease in TNF-α level in the treatment group (median 1.49±5.22) (p=0.016) compared with the control group (median 1.64±1.99) (p=0.005). The Median SpO2/FiO2 ratio on day 1 is 163.70±69.64 in the control group and 121.49±40.41 in the treatment group (p=0.005). The Median SpO2/FiO2 ratio on day 8 is 249.69±132.26 in the control group and 151.29±59.18 in the treatment group (p=0.001). There is a positive correlation between serum TNF-α level and SpO2/FiO2 ratio after administration of adjuvant therapy NAC (r=0.240, p=0.038). There is a positive correlation and significant decrease of serum TNF-α and SpO2/FiO2 ratio after adjuvant NAC therapy, which improves hypoxemia in COVID-19 patients.

Background Recent evidence suggested that the higher titers of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody from convalescent plasma donors contributed to the clinical improvement in coronavirus disease 2019 (COVID-19) patients. However, the titers of anti-SARS-CoV-2 antibodies varied in each individual, and the precise factors that might govern such variation have not been elucidated. Objectives To assess the factors associated with high titers of anti-SARS-CoV-2 antibody among COVID-19 convalescent plasma (CCP) donors. Methods A cross-sectional study was conducted in Saiful Anwar General Hospital, Malang, Indonesia. Information of interest including demographic characteristics, clinical symptoms, comorbidities, laboratory findings, and the titers of anti-SARS-CoV-2 antibody among COVID-19 CCP donors were collected. The correlation was assessed using multiple logistic regression. Results A total of 50 COVID-19 CCP donors with the titers of anti-SARS-CoV-2 antibody of more than 1:320 and 33 donors with the titers of less than 1:320 were analyzed. Our analysis revealed that CCP donors with history of cough, fever, dyspnea, and pneumonia significantly had higher titers of anti-SARS-CoV-2 antibody compared to asymptomatic donors. Moreover, CCP donors with elevated levels of eosinophils and immature granulocytes and low levels of albumins had higher levels of anti-SARS-CoV-2 antibody. The titer of antibody was not affected by comorbidities of donors. Conclusions CPP donors who had experience of symptomatic COVID-19 with high eosinophils level, high immature granulocytes and low albumin level have higher titers of anti-SARS-COV-2 antibody than those who experienced asymptomatic COVID-19. Our current findings may be used as the additional baseline criteria for selecting the donors of CCP for the management of COVID-19.

Penyakit Paru Obstruktif Kronik (PPOK) adalah penyakit yang ditandai dengan hambatan aliran udara di saluran nafas yang tidak sepenuhnya reversibel. Hambatan aliran udara ini bersifat progresif dan berhubungan degan respon inflamasi paru terhadap partikel gas beracun atau berbahaya [2][16]. Hasil penelitian pada bulan Januari-Desember 2010 menyebutkan bahwa PPOK menduduki urutan ke-3 dari penyakit paru terbanyak yang ada di RS Paru Batu Malang. Sedangkan di RSU Dr. Saiful Anwar Malang menduduki urutan ke-5. The Burden Of Disease Study dibawah naungan WHO menyatakan bahwa pada tahun 2030 PPOK akan menempati peringkat ke-3 penyebab kematian di dunia [5][15][16]. Sebagai solusi terhadap masalah tersebut yaitu dengan membangun sebuah aplikasi pengukur kesehatan fungsi paru manusia memanfaatkan microphone pada smartphone ”. Guna mengetahui gangguan ventilasi paru, monitoring pengobatan, dan menilai perkembangan fungsi paru. Media smartphone dipilih karena memiliki teknologi Microphone API yang digunakan untuk menangkap input berupa rekaman suara hembusan napas pengguna. Dan mayoritas masyarakat telah melilikinya. Dari hasil pengujian validasi dapat disimpulkan bahwa aplikasi pengukur kesehatan paru manusia pada media smartphone berhasil diimplementasikan dengan memanfaatkan teknologi microphone . Dari hasil pengujian akurasi yang dilaksanakan di Rumah Sakit Saiful Anwar Kota Malang dapat disimpulkan bahwa ditemukan selisih akurasi Prediksi Nilai Acuan Normal sebesar FEV1 = 0,11 liter; FVC = 0,152432432 liter; FEV1/FVC = 4,742432432 %. Dan selisih akurasi Hasil Pengukuran sebesar FEV1 = -1,545945946 liter; FVC = -2,892432432 liter; FEV1/FVC = 11,52243243 %. Kata Kunci: Penyakit Paru Obstruktif Kronik, Microphone, Smartphone. ABSTRACT Chronic Obstructive Pulmonary Disease (COPD) is a disease characterized by air flow resistance in the airway that is not fully reversible. This air flow resistance is progressive and, relating to pulmonary inflammatory response to toxic gases or dangerous particles [2] [16]. The results of the study in January-December 2010 states that COPD ranks 3rd from most existing lung disease Pulmonary Hospital Batu Malang. Meanwhile, in Hospital Dr Saiful Anwar-5 ranks. The Burden Of Disease Study under the auspices of the WHO stated that by 2030 COPD will be ranked as the third leading cause of death in the world [5] [15] [16]. As a solution to these problems is to build an application measuring the health of human lung function utilizing a microphone on a smartphone ". In order to determine pulmonary ventilation disorders, treatment monitoring, and assessing the development of lung function. Media Smartphone Microphone technology chosen because it has an API that is used to capture the input of the user breath sound recordings. And the majority of people have melilikinya. From the results of the validation testing can be concluded that the application of measuring the health of the human lung on a smartphone media successfully implemented by utilizing the microphone. Accuracy of test results conducted at Saiful Anwar Hospital Malang can be concluded that the prediction accuracy differences were found Normal Reference Values for FEV 1 = 0.11 liters; FVC = 0.152432432 liters; FEV 1 / FVC = 4.742432432%. And the difference in the accuracy of measurement results for FEV1 = -1.545945946 liter; FVC = -2.892432432 liter; FEV 1 / FVC = 11.52243243%. Keyword: Chronic Obstructive Pulmonary Disease , Microphone, Smartphone.