Acute Respiratory Distress Following Percutaneous Coronary Intervention of Osteal Occlusion of Left Main Coronary Artery.

A man in his late 50s had reduced left ventricle systolic function and hypokinesia of the anteroseptal, anterior, anterolateral, and septal walls. Lung ultrasound demonstrated multiple B-lines in both lung fields. What would you do next?

Predominant aspects of knowledge and practical skills among medical students with online learning during the COVID-19 pandemic era.

BACKGROUND: Social restrictions due to the COVID-19 pandemic have shifted most learning methods into online courses, especially for medical skills education. However, the effects of online courses on medical skill education amongst medical students are still arguable. The study aims to analyse medical students' knowledge, attitude, practice and satisfaction towards medical skills between online and offline courses. METHOD: We performed a case-control study conducted among 533 medical students with online (as a case group, n = 288) and offline courses (as a control group, n = 245). We evaluated three fundamental medical skills, including history taking [HT], lung physical examination [LPE], and heart physical examination [HPE]. We tested the knowledge and skills among students through theory and practical examinations. Students' attitudes and satisfaction were assessed using a validated questionnaire. RESULTS: The scores for knowledge and practical skills among the online group were significantly higher (p = 0.016, p = 0.004, respectively). In comparison, the scores for the students' attitudes and satisfaction were substantially lower (p = 0.000, p = 0.003, respectively) compared to the control group. Most of the students in both groups passed the exam (case vs. control = 81.94%; 83.27%, respectively). Males were the only factor associated with a higher rate of passing the examination (OR 0.42, 95% CI [0.27-0.67], p = 0.000). CONCLUSIONS: Online learning could be an alternative approach on improving student's knowledge and practice towards medical skill especially amidst COVID-19 pandemic, however further consideration on student's attitude and satisfaction are mandatory to achieve appropriate competence as future general practitioner.

Association of TNF-α, TGF-ß1, amphiregulin, IL-2, and EGFR WITH pulmonary fibrosis in COVID-19.

Pulmonary fibrosis is a well-recognized sequela associated with coronavirus disease 2019 (COVID-19), however the mechanism is yet to be clearly understood. The study was designed to evaluate the association of TNF-α, TGF- ß1, amphiregulin, IL-2, and EGFR with pulmonary fibrosis after COVID-19 pneumonia. Non-severe, severe, and critical COVID-19 pneumonia patients were included in this study after the patients agreed and gave written informed consent. Blood samples were analyzed with the ELISA method for cytokine examination. The non-contrast chest CT scan was performed after patients were discharged from hospital. Seventy-nine patients with a mean age of 54 years (57 % men, 43 % women) were fully evaluated. Pulmonary fibrosis was found in 74 patients (93.7 %). Serum levels of TGF-ß1 60.55 pg/mL (11.42-2001.16), TNF-α 13.31 pg/mL (3.54-200.32), EGFR 14.9 pg/mL(6.4-53.6), IL-2 12.41 pg/mL(11-14.13), amphiregulin 156.5 pg/mL (21.7-1234). Serum levels of TNF-α increase according to the severity of clinical classification. A significant association between serum levels of TGF-ß1, TNF- α, and pulmonary fibrosis with rs-0.247, p = 0.027; rs 0.259, p = 0.046 was found. According to this study, TNF-α and TGF-ß1 potentially participate in the process of pulmonary fibrosis in COVID-19.

A case of primary mediastinal seminoma with superior vena cava syndrome and large intracardiac thrombus.

BACKGROUND: Primary mediastinal seminoma is rare, especially with complications of superior vena cava syndrome (VCSS) and large thrombus. CASE PRESENTATION: A 23-years-old Indonesian male complained of dyspnea, phlegm cough, chest pain, and body weight loss. The patient experienced swelling in the face and neck 1 week ago, accompanied by increased jugular venous pressure. Radiological results showed a firm mass in the right area of the mediastinum. Tumor marker and IHC results showed mediastinal seminoma. Electrocardiography showed sinus tachycardia, right axis deviation, and V1-V5 slow R wave progression. Echocardiography showed an intracardiac mass (RA protrusive RV, size 7.2 × 3.8 cm) with an intracardiac thrombus and RV failure. The patient was positioned in a semi-Fowler's position and given furosemide 3 × 20 mg, dexamethasone 3 × 5 mg, and warfarin 1 × 4 mg. Meanwhile, the results of the biopsy revealed a malignant germ cell tumor. When the patient was going to have bronchoscopy and radiotherapy planned, the patient died. DISCUSSION: Reporting primary mediastinal seminoma cases with complications of VCSS and large thrombus has a high risk of mortality, so this report can be used as a review to improve management in future. CONCLUSION: Mediastinal seminoma with complications has a high mortality.

Pulmonary spindle cell carcinoma with hemothorax: A rare case report.

BACKGROUND: Pulmonary spindle cell carcinoma is a type of variant sarcomatoid carcinoma, which is a very rare case. CASE PRESENTATION: A 53-year-old male presented with weakness, 95% oxygen saturation with nasal cannula 3 L/min, asymmetric chest movement, and problem in the right lung (dull to percussion, and low vesicular auscultation). X-ray and CT-Scan supported hemothorax and lung malignancies in the right lung. The patient had a chest drain inserted which confirmed the hemothorax and was transferred to the operating room for emergency thoracotomy to stop the bleeding. Bleeding was still massive so re-thoracotomy and lobectomy were performed. The lung tissue was examined for anatomical pathology, and the results showed spindle cell carcinoma. The patient was given pemetrexed and carboplatin chemotherapy. The patient refused to continue therapy and died 3 months after the first chemotherapy. DISCUSSION: Immunohistochemistry markers are the parameter for diagnosis of pulmonary spindle cell carcinoma that is highly positive for pan-cytokeratin, vimentin, and Ki67. The treatment is similar to other NSCLC, depending on the staging, and may include surgical resection, chemotherapy, and radiotherapy. CONCLUSION: Pulmonary spindle cell carcinoma is very rare and has a poor prognosis, especially in the presence of hemothorax.

Challenges for Healthcare Workers Caring for COVID-19 Patients in Indonesia: A Qualitative Study.

COVID-19 pandemic raises various challenges faced by health workers in hospitals. This study explored strategies for overcoming challenges in caring for COVID-19 patients at hospitals in Indonesia based on healthcare workers' experience. In-depth interviews were employed with 28 healthcare workers (physicians and nurses) who were purposively sampled. Data were collected via phone and analysed using the Colaizzi method. Five following challenges were found: difficulties in working with personal protective equipment (PPE), offline training for handling Covid and using PPE not being implemented evenly for all health workers, physical and psychological fatigue, difficulties in carrying out health education and assessment towards patients and families, and limited resources to cope with the COVID-19 pandemic. Meanwhile, some barriers require support from the government, public and hospital managers. The information gained from research on the strategies for caring for COVID-19 patients can contribute to better preparedness for hospitals and health workers facing the COVID-19 pandemic.

The correlation between self-related adherence, asthma-related quality of life and control of asthma in adult patients.

OBJECTIVES: Medication non-adherence mostly occurs in patients with a wide range of disease severity, including asthma. The aim of the study was to assess the self reported adherence to asthma therapy and investigate the relationship between adherence, asthma control and asthma-related quality of life. METHODS: The study was a cross-sectional study in which participants were recruited from an outpatient department, in one hospital in Surabaya. Patients (aged≥18 years) with asthma who had used any regular asthma medications were included. Standardised questionnaires, including Juniper's Asthma Control Questionnaire (ACQ), Adherence to Refills and Medications Scales (ARMS) and Juniper's Asthma Quality of Life Questionnaire (AQLQ) were used. RESULTS: A total of 82 adults with asthma were recruited in the study. Male participants' mean age was 49.13 ± 14.10 years (n = 23). Approximately 59 participants (72.0%) were females, 30 participants (36.5%) were using Budesonide inhaler, and 73 participants (89.0%) never smoked. The mean of ACQ, AQLQ, and ARMS scores were 1.62 ± 1.19, 4.96 ± 1.24, and 16.98 ± 4.12, respectively. Of 82 patients studied 53 (64.6 %) had "uncontrolled asthma" and more than 85% participants both showed "non adherence" to asthma therapy and nearly 46% of them indicated that their quality of life was affected by asthma. There was a significant association between ACQ and AQLQ (p<0.05), whereas no statistically significant association was found between ACQ and ARMS. CONCLUSIONS: The majority of patients reported non-adherence to asthma medications. Poor controlled asthma has been associated with lower asthma-related quality of life.

Wedge resection on recurrent pneumothorax, failed lung expansion after needle aspiration: A case report.

BACKGROUND: Pneumothorax has several classifications, including based on etiology, location, extent, and degree of collapse as well as by mechanism and type. CASE PRESENTATION: A 61-years-old man with the main complaint of sudden shortness of breath after lifting a birdcage. The complaint worsened, and it was accompanied by nausea, sweating, and decreased vital signs. The patient was in a life-threatening condition with a tension pneumothorax and treated with needle aspiration (NA). On the second day of treatment, a clinical evaluation showed recurrent dyspnea. Lung physical examination and chest X-ray evaluation showed recurrent pneumothorax with subcutaneous emphysema. Installation of chest tube drainages (CTD) with active continuous suction of -20 cmH2O. High-resolution CT (HRCT) showed right pneumothorax with multiple blebs, bullae, and bronchopleural fistula. Video-assisted thoracic surgery (VATS) was carried out to repair bronchopleural fistula (BPF). However, pre-surgery found multiple bullae and multiple fistulas accompanied by adhesion to the chest wall, thus the procedure could not be conducted. As an alternative, thoracotomy was performed, followed by wedge resection and fistula reparation. DISCUSSION: Diagnosis of pneumothorax is based on clinical manifestations. Conservative management by providing oxygen or NA/CTD insertion. Needle aspiration is a simple and alternative treatment and performed for an outpatient indication, whereas CTD requiring hospitalization and is performed by experts. Management aims to restore clinical symptoms, restore lung expansion and prevent a recurrence. CONCLUSION: The choice of thoracoscopy/VATS or thoracotomy needs to be considered according to the indications so that complications do not occur and have a good prognosis.

Efficacy of an Education Session by Pharmacists for Patients With Asthma: Protocol and Design of a Randomized Controlled Trial.

BACKGROUND: Asthma is a chronic disease that requires indefinite long-term therapy. Many approaches have been developed to enable people with asthma to live as normally as possible. In medication therapy management, pharmacists could play important roles in supporting the everyday life of asthmatic patients, such as by providing education therapy management to ensure that patients achieve optimal therapeutic outcomes. A good collaboration between health care practitioners and patients will produce a better system in terms of therapeutic management, which will lead to health care cost savings related to emergency visits. Although the Government has made various efforts to manage asthma in Indonesia, without commitment and support from both patients and health care professionals, the expected outcomes cannot be achieved. OBJECTIVE: This study aims to evaluate the effectiveness of an educational intervention provided by pharmacists compared with that of usual care. METHODS: A randomized controlled trial comparing usual care with an education session by pharmacists is underway. The intervention comprises a one-on-one education session of 60 minutes with a pharmacist comprising information regarding (1) asthma medication that has been used; (2) how to use asthma medication devices correctly; (3) asthma symptoms and how to prevent exacerbation of asthma; and (4) how to manage asthma triggers and environmental control measures. The primary outcome measure is change in asthma control, as measured using the Asthma Control Questionnaire. Secondary outcomes include changes in Asthma Quality of Life Questionnaire score, lung function, asthma-related health visits, days off from work or study, and oral corticosteroid use. Research assistants who are masked to the group allocation will collect outcome data at the baseline and every month for a 3-month period. Informed consent will be sought at enrollment and intention-to-treat analysis will be performed. RESULTS: This study was funded in January 2017 and ethical approval was obtained in June 2017. The enrollment was started in August 2017, and about 72 participants have been enrolled. First results are expected to be submitted for publication in 2019. CONCLUSIONS: This is the first study to evaluate the effectiveness of a pharmacist-guided asthma education session compared with that of usual care in Indonesia. If it is proven effective, this intervention program could improve asthma self-management by patients, which may reduce risks of poorly controlled asthma. This intervention could also be implemented in addition to the current usual care for patients with asthma. TRIAL REGISTRATION: Thai Clinical Trials Registry TCTR20171219001; http://www.clinicaltrials.in.th/index.php? tp =regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=3068 (Archived by WebCite at http://www.webcitation.org/73Ci5eKtv). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/10210.