The Effect of the Intra-Arterial Heparin Flushing (IAHF) Procedure on Hearing Threshold in Sensorineural Hearing Loss Patients.

Background: Sensorineural hearing loss (SNHL) is a frequent problem in Indonesia but its treatment is still limited. This type of hearing loss is related to oxidative stress and decreased vascularization, which can damage the hair cell. The intra-arterial heparin flushing (IAHF) is a procedure that can recover circulation and its agent, namely heparin, also has antioxidant activity. Therefore, the IAHF procedure has the potential to improve hearing function and can be considered an alternative therapy for SNHL. Objective: The study evaluates the effect of the IAHF on hearing improvement based on the difference in hearing threshold values before and after the procedure. Methods: This experimental study used a Pretest-Posttest One-Group Only design. A total of 17 patients with sensorineural hearing loss who met inclusion and exclusion criteria were subjected to pure tone audiometry tests before and 4 hours after the IAHF procedure. The mean difference in hearing threshold was analyzed using paired Students t-test for normally distributed data and Wilcoxon for non-normally distributed data. Results: There was a decrease in the means of hearing threshold in the right and left ear 4 hours after the IAHF procedure. However, based on the paired Students t-test, there was not a significant difference in hearing threshold before and after the procedure (p-value > 0.05). Conclusion: There was hearing threshold improvement 4 hours after the IAHF procedure. This study showed that the IAHF procedure can have a therapeutic effect on sensorineural hearing loss patients.

Association between clinical, laboratory findings and chest CT in COVID-19 in a secondary hospital in Jakarta, Indonesia.

INTRODUCTION: A new emerging infectious disease caused by SARS-CoV-2 has caused a global pandemic. Early diagnosis is essential to prevent and halt the spread of the disease, patient management and isolation. In this study, we aimed to reveal correlations between clinical and laboratory findings with chest CT. METHODS: This in an observational case series single center study in a secondary hospital in Jakarta, Indonesia. Patients were included if they had typical symptoms and positive RT-PCR for SARS-CoV-2. RESULTS: Forty-two patients with positive RT-PCR were included in this study. Typical CT findings were present in 33 (78.6%). We found a positive correlation between patients in whom the imaging was performed after the 4th day of symptoms and chest CT findings (r=0.365 p<0.05). In receiver operating characteristic analysis of this parameter, the area under curve (AUC) was 0.678, and the sensitivity and specificity were 0.96 and 0.44, respectively. CONCLUSIONS: Early diagnosis of COVID-19 is essential to promptly isolate and treat suspected patients. Utilization of chest CT to help diagnosis in this pandemic era needs to be considered by healthcare facilities especially if RT-PCR is limited.

Excess Risk of Lung Cancer Among Agriculture and Construction Workers in Indonesia.

Background: In Indonesia, many occupations and industries involve a variety of hazardous and toxic materials. The ILO estimates that about 21.1% of the tracheal, bronchial, and lung cancer deaths among men were attributable to workplace hazardous substances. This study investigated the relationship between occupations or workplace exposure and the risk of lung cancer in the country. The results will help determine how Indonesia can best mitigate the risk for its workers. Objectives: This case-control study utilizes the Indonesian Standard of Industrial Classification (IndSIC) 2015 with the aim of exploring the risk of lung cancer among Indonesian workers. Methods: The study included patients aged 35 years old or older receiving thoracic CT at the radiology department of Persahabatan Hospital. The cases were histological-confirmed primary lung cancers, while the controls were negative thoracic CT scan for lung cancer. The subjects' job titles and industries were classified according to IndSIC 2015 and blind to the patient's grouping as a case or control. Logistic regression was used to determine the odds ratios for lung cancer among all sections and some divisions or groups of IndSIC 2015. Findings: The mean age was 58.1 (±10.23) years for lung cancer patients and 54.5 (±10.23) years for controls. The majority of subjects (19.6%) worked in Section G (Wholesale and retail trade; repair of motor vehicles and motorcycle). After adjusting for age, gender, level of education, and smoking habit, the risk of lung cancer was nearly three-times higher (OR = 2.8, 95% CI = 1.11-7.02) in workers of Division A01 (crop, animal production, and hunting) and two-times higher (OR = 1.9, 95% CI = 1.05-3.46) in workers of Section F (construction) compared to the workers in other sections or divisions. Conclusions: The excess risk of lung cancer among certain categories of workers confirms the need for improved policy, monitoring, and control of occupational exposure for primary cancer prevention and workers' compensation purposes.

Clinical, Radiological Features and Outcome of COVID-19 patients in a Secondary Hospital in Jakarta, Indonesia.

INTRODUCTION: The numbers of people infected with SARS-CoV-2 in Indonesia especially in Jakarta as the epicenter continue to rise. Limited published clinical data, scarcity and long turn over time of diagnostic testing put clinician in dilemma to make diagnosis. METHODOLOGY: This is an observational case series study from confirmed COVID-19 patient in our hospital from first case admission on 17 March 30 April, 2020. We collected patient's demography, symptoms, comorbidities, therapy, laboratory, chest x-ray and ECG consecutively. RESULTS: Between 17 March 2020 and 30 April 2020, there were 30 confirmed COVID-19 cases, 16 (53.3%) were male. Clinical symptoms were dyspnea in 22 (73.3%) and dry cough 16 (53.3%). Comorbidities were diabetes in 14 (46.6%), hypertension 10 (33.3%) and Coronary Artery Disease (CAD) in 10 (33.3%) patients respectively. Laboratory findings showed lymphopenia in 21 (70%) patients, increased inflammation marker in Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP) and Lactate Dehydrogenase (LDH) 21 (70%), 23 (76.6%) and 12 (40%) patients respectively. Twenty-seven (90%) cases had abnormal Chest X-Ray (CXR) and mostly severe 18 (60%). Descriptive finding for images included consolidation 16 (53.3%) and Ground Glass Opacities (GGO) in 10 (33.3%) patients. CONCLUSIONS: Based on our findings, most cases of COVID-19 admitted in secondary referral hospital were already in moderate to severe stages. This is most likely due to late referral from primary care and unspecific clinical features resemblance of other infectious diseases. Inflammation marker and CXR are cost effective findings and can be used as marker to determine further referral.

Comparison of chest X-ray lesion characteristics of multidrug-resistant tuberculosis and non-tuberculous mycobacterial infection.

PURPOSE: This research aimed to compared chest radiographic characteristics of multidrug-resistant tuberculosis (MDR-TB) and non-tuberculous mycobacteria (NTM) infection, which can be used in early diagnostic screening. MATERIAL AND METHODS: The method of this study was cross-sectional to obtain the relationship between radiographic findings. RESULTS: Among 538 subjects who were positive for TB during screening, 11 (2.04%) had MDR-TB, 147 (27.32%) had drug-sensitive TB, and 380 (70.63%) had NTM infection. The radiographic findings that correlated with MDR-TB were infiltrates (p = 0.010), cavities (p = 0.021), nodules (p = 0.001), and fibrosis (p = 0.010), with the best predictor of MDR-TB lesions being the presence of a nodule. The lesion locations related to MDR-TB were the upper right and left lung (p = 0.00). There were no specific lesions present in NTM infection (p < 0.05) because almost all had a meaningful correlation (p < 0.05), except the presence of a mass. The lesion location related to NTM infection was the medial aspect of the left lung (p = 0.01), and the lesion extent was also correlated (p < 0.05). CONCLUSIONS: Chest X-ray lesion characteristics of MDR-TB show significant correlation among cavities, nodules, and fibrosis. There were no specific lesions that could differentiate NTM infection from MDR-TB; however, the most common lesion location in NTM infection was the medial aspect of the left lung.

Thoracic Radiography Characteristics of Drug Sensitive Tuberculosis and Multi Drug Resistant Tuberculosis: A Study of Indonesian National Tuberculosis Prevalence Survey.

BACKGROUND: Tuberculosis (TB) remains a burden globally, including Indonesia. The primary objective of this study is to reveal the chest radiography characteristic of drug-sensitive TB (DS-TB) and multi-drug resistant TB (MDR-TB) in the Indonesian national tuberculosis prevalence survey 2013-2014. The secondary objective is to explore the correlation and incidence rate of chest radiography lesion of DS-TB and MDR-TB cases. METHODS: This is a cross-sectional retrospective analytical studies with national and regional coverage. Samples were selected by stratified multi-stage clustering sampling technique in a population aged ≥15 years old. The diagnosis of TB was based on culture and GeneXpert tests. RESULTS: There were 147 DS-TB and 11 MDR-TB patients that were analyzed in this study. The nodule is the only type of lesions that distinguish MDR-TB and DS-TB. In multivariate analysis of DS-TB, there were 3 significant chest radiography lesions, i.e infiltrate, cavity and consolidation with odd-ratio (OR) of 14, 13, and 3, respectively. In MDR-TB, the only significant lesion is a nodule, with OR of 19. CONCLUSION: Nodule is the only type of lesions that distinguish MDR-TB and DS-TB. Infiltrate, cavity and consolidation were the types of chest radiography lesions on DS-TB, meanwhile, a nodule was the only significant lesion for MDR-TB.

Chest X-Ray Findings Comparison between Multi-drug-resistant Tuberculosis and Drug-sensitive Tuberculosis.

BACKGROUND: Imaging has a big role in tuberculosis (TB) diagnosis and chest X-ray is preferable because it is available in primary health care and can point out the location, area, and morphology of lesions, such as cavity, consolidation, pleural effusions, and fibrosis. We aimed to compare the chest X-ray findings in multi-drug resistant TB (MDR-TB) and in drug-sensitive TB (DS-TB) cases. METHODS: This is a retrospective cross-sectional study which compares chest X-ray findings of two groups of patients, involving 183 DS-TB patients and 183 MDR-TB patients. Radiologic findings that we analyzed were infiltrate, consolidation, cavity, ground glass opacity, fibrosis, bronchiectasis, calcification, node, atelectasis, bullae, emphysema, and other nonlung parenchymal findings. RESULTS: MDR-TB group have 177 (96%) patients with large lesions, 6 (4%) with medium lesions, and no small lesions. DS-TB group have 55 (30%) patients with small lesions, 78 (43%) with medium lesions, and 50 (27%) with large lesions. Active TB lesions in the forms of infiltrate and ground-glass opacity were more dominant in DS-TB group, whereas consolidation, cavity, fibrosis, bronchiectasis, calcification, node, atelectasis, bullae, emphysema, and other nonlung parenchymal findings, were more dominant in MDR-TB. CONCLUSIONS: There were significant differences in chest X-ray findings between MDR-TB and DS-TB in terms of lesion size and morphology. Recognition of chest X-ray findings could help the physician to differentiate patient with suspected MDR-TB.