Severe acute respiratory syndrome coronavirus-2 antibody response after Moderna vaccine booster on healthcare providers.

INTRODUCTION: As an endeavor to control SARS-CoV-2 infection, the Moderna vaccine booster was given to healthcare workers to prevent reinfection and reduce the risk of complications from COVID-19. A heterologous booster vaccine is also thought to provide better protection against the current SARS-CoV-2 variants of concern. However, research that evaluates the effectiveness of the Moderna vaccine booster and the resulting SARS-CoV-2 antibody concentration is needed. OBJECTIVE: To evaluate the concentration of SARS-CoV-2 antibodies after the Moderna vaccine booster and the severity of SARS-CoV-2 infection before and after the Moderna vaccine booster. RESULTS: A total of 93 healthcare providers who received Moderna vaccine booster were included in the study. Examination of antibody concentration 3 months after the booster showed an average concentration of 10081.65 U/mL. There was an increase in antibody concentration before the booster and 3 months after, from a median of 1.7 U/mL to 9540 U/mL. Every subject showed a statistically significant increment of antibody concentration 3 months after the booster (p < 0.01). Thirty-seven (39.8%) subjects received two doses of the Sinovac vaccine and were confirmed to have COVID-19 with the Delta variant. After the booster, 26 (28%) subjects were infected with the Omicron Variant. Among the subjects who received two doses of the Sinovac vaccine and were confirmed with COVID-19, 36 (30.1%) had mild symptoms, and 1 (1.1%) was asymptomatic. CONCLUSIONS: Heterologous Moderna vaccine booster effectively increases antibody response against SARS-CoV-2 variants and shows mild symptoms of COVID-19 infection.

Developing a tool to measure tuberculosis-related stigma in workplaces in Indonesia: An internal validation study.

Workers with tuberculosis (TB) are often stigmatized, negatively impacting their socioeconomic position, mental health, and TB treatment outcomes. There is a dearth of validated tools to assess stigma in the worker population. This study aimed to develop and validate a novel, culturally adapted tool to measure TB-related stigma among workers in Indonesia. We translated, adapted, applied, and internally validated Van Rie's TB-Stigma Scale to the worker population in varying sizes businesses (formal and informal business sectors) in Indonesia. Psychometric evaluation using exploratory and confirmatory factor analyses (EFA and CFA) was performed to check the tool's internal consistency and reliability. The translation and cultural adaptation phases resulted in a final 11-item tool. From 172 participant responses, the EFA found two loading factors relating to responses on isolation and exclusion from the workplace. The CFA confirmed that the developed model had moderate fit with R2 values for each item ranging from 0.37 to 0.84. The tool was reliable (Cronbach's alpha 0.869). This validated, consistent and reliable adapted tool is ready to use in larger scale evaluations of TB-related stigma amongst workers in formal and informal business sectors of Indonesia to develop strategies to eliminate TB-related stigma from the workplace.

Direct healthcare costs associated with management of asthma: comparison of two treatment regimens in Indonesia, Thailand and Vietnam.

OBJECTIVE: Daily inhaled corticosteroid (ICS) and long-acting beta-2-agonist (LABA) combinations comprising either regular maintenance therapy with ICS/LABA plus as-needed short-acting beta-2-agonist (SABA) or ICS-formoterol combinations used as maintenance and reliever therapy (MART) are recommended for moderate asthma. This analysis compares the direct costs of twice-daily fluticasone propionate/salmeterol (FP/salm) and budesonide/formoterol MART in three Southeast Asian countries. METHODS: A literature review identified three randomized trials in patients with asthma (≥ 12 years) comparing regular twice-daily FP/salm with as-needed SABA versus MART in moderate asthma: AHEAD (NCT00242775/17 countries/2309 patients), COMPASS (AstraZeneca study SD-039-0735/16 countries/3335 patients), and COSMOS (AstraZeneca study SD-039-0691/16 countries/2143 patients). Economic analyses, conducted from a healthcare sector perspective (medication costs + healthcare utilization costs), applied unit costs from countries where healthcare costs are publicly available: Indonesia, Thailand and Vietnam. Results are expressed in British pound sterling (GBP/patient/year). RESULTS: Annual exacerbation rates were low and differences between treatment strategies were small (range, FP/salm: 0.31-0.38, MART: 0.24-0.25) although statistically significant in favor of MART. Total average (minimum-maximum) direct costs (in GBP/patient/year) across the three studies were £187 (£137-£284), £158 (£125-£190), and £151 (£141-£164) for those who used FP/salm, and £242 (£217-£267), £284 (£237-£340) and £266 (£224-£315) for MART in Indonesia, Thailand and Vietnam, respectively. On average, total direct costs/patient/year with FP/salm were 22.8%, 44.6% and 43.0% lower than with MART for Indonesia, Thailand and Vietnam, respectively. CONCLUSIONS: In the three countries evaluated, total treatment costs with regular twice-daily FP/salm were consistently lower than with budesonide/formoterol MART due to lower direct healthcare costs.

Brief psychotic disorder in COVID-19 patient with no history of mental illness.

INTRODUCTION: COVID-19 pandemic affects mental health globally. Reports showed the increase of mental illness as a response to the COVID-19 pandemic. However, the correlation between the COVID-19 and mental illness is not fully understood yet. METHODOLOGY: We reported a brief psychotic disorder in a COVID-19 patient with no history of mental illness who was hospitalized in Persahabatan Hospital, Jakarta, Indonesia. RESULTS: Psychotic symptoms appeared five days after COVID-19 onset and laboratory tests showed elevated levels of d-dimer and fibrinogen. CONCLUSIONS: Elevated levels of d-dimer and fibrinogen suggest an ongoing COVID-19-associated coagulopathy that might cause a microdamage in the central nervous system. It might contribute to the manifestation of psychotic symptoms. The correlation between brief psychotic disorder and COVID-19 requires further investigation.

Management of COPD in Asia: A position statement of the Asian Pacific Society of Respirology.

Chronic obstructive pulmonary disease (COPD) is a major disease in Asia. However, how to manage specifically Asian COPD patients has not been proposed. Awareness of COPD is very low and underdiagnosis/undertreatment is common in Asian countries. Low utilization of pulmonary function test and inhalers is also a problem. Moreover, high smoking prevalence and air pollution are barriers to managing Asian patients with COPD. The relatively low body mass index of Asian patients with COPD can increase their risk for experiencing adverse effects from COPD drugs. Physicians should consider the unique features of Asian populations with COPD such as the high prevalence rates of bronchiectasis and tuberculosis-destroyed lungs, biomass smoke exposure and parasitic infection.

Rate of Forced Expiratory Volume in One Second and Forced Expiratory Volume in One Second/Forced Vital Capacity Decline among Indonesian Patients with Chronic Obstructive Pulmonary Disease after a Year of Treatment.

BACKGROUND: The rate of decline in lung function in chronic obstructive pulmonary disease (COPD) patients showed more profound decline than normal individuals. However, a 1-year lung function among Indonesian patients with COPD has not been elucidated. AIM: This study attempted to determine the rate of lung function decline in terms of obstruction variable among COPD patients after a 1-year of treatment. MATERIALS AND METHODS: This retrospective cohort study measures the rate of decline in forced expiratory volume in 1 s (FEV1) and ratio of FEV1 to forced vital capacity (FEV1/FVC) in COPD patients at COPD Outpatient Clinic Persahabatan Hospital after 1-year of treatment. RESULTS: There were 31 COPD patients with the prevalence of 1-year declined FEV1 and FEV1/FVC which were 83.9% and 51.6%, respectively. Among 1-year declined lung function group, there were significant (P < 0.05) decline in FEV1 (121.53 ± 120 ml/year) and in FEV1/FVC (2.75 ± 0.47%). The rate of decline in FEV1 was more prevalent in Group D, while the rate of decline in FEV1/FVC was more prevalent in Group B. No significant associations were found between sex, age, respiratory complaints, smoking history, Brinkman index, type of cigarette, comorbid, educational level, diagnosed age, body mass index, symptoms-based COPD classification, and risk-based COPD classification, with the rate of decline in FEV1 and FEV1/FVC. CONCLUSIONS: Most patients had statistically significant rate of decline in FEV1 and FEV1/FVC within 1-year of COPD treatment. This study recognized an unfavorable prognosis in terms of irreversible deteriorating lung function of COPD patients despite therapeutic management.

The correlation of age and body mass index with the level of both protease MMP3 and anti-protease TIMP-1 among Indonesian patients with chronic obstructive pulmonary disease: a preliminary findings.

OBJECTIVES: Individuals with chronic obstructive pulmonary disease (COPD) are usually > 50 years of age and have a low body mass index (BMI). An imbalance between matrix metalloproteinases (MMPs), including MMP-3, and tissue inhibitor of metalloproteinase 1 (TIMP-1), play a role in tissue degradation of lung extracellular matrix among COPD individuals. The purpose of the present study was to correlate age and/or BMI with salivary levels of MMP-3 and TIMP-1 among Indonesian subjects with COPD. RESULTS: Thirty COPD patients were recruited to undergo thorough physical assessment and saliva collection for evaluating TIMP-1 and MMP-3 levels using commercially available kits enzyme-linked immunosorbent assay method. The mean (standard deviation) participant age and BMI were 60.5 (8.13) years, and 23.1 (4.75) kg/m2, respectively. Furthermore, the mean (standard deviation) of TIMP-1 and MMP3 levels were 23.99 (6.85) ng/mL and 1.81 (1.167) µM, respectively. Age was negatively correlated with MMP-3 (P < 0.05), but not with TIMP-1 levels. Age and BMI were not correlated with TIMP-1 level (P > 0.05). Collectively, this study demonstrated that age has a negative correlation with the protease marker (i.e. MMP-3), but not the anti-protease marker (TIMP-1). BMI was not correlated with either protease/anti-protease marker among Indonesian subjects with COPD.

Molecular Diagnosis of Tuberculosis.

Tuberculosis (TB) is one of the leading causes of adult death in the Asia-Pacific Region, including Indonesia. As an infectious disease caused by Mycobacterium tuberculosis (MTB), TB remains a major public health issue especially in developing nations due to the lack of adequate diagnostic testing facilities. Diagnosis of TB has entered an era of molecular detection that provides faster and more cost-effective methods to diagnose and confirm drug resistance in TB cases, meanwhile, diagnosis by conventional culture systems requires several weeks. New advances in the molecular detection of TB, including the faster and simpler nucleic acid amplification test (NAAT) and whole-genome sequencing (WGS), have resulted in a shorter time for diagnosis and, therefore, faster TB treatments. In this review, we explored the current findings on molecular diagnosis of TB and drug-resistant TB to see how this advancement could be integrated into public health systems in order to control TB.

Comparison of lung function values of trained divers in 1.5 ATA hyperbaric chamber after inhaling 100% oxygen and regular air: a crossover study.

INTRODUCTION: Diving is an activity performed in more than 1 atmosphere absolute pressure (ATA) either underwater or in a hyperbaric chamber. We aimed to compare lung function values of trained divers in 1.5 ATA hyperbaric chambers after inhaling 100% oxygen and regular air. METHODS: This experimental study with crossover design involved 18 trained divers in 1.5 ATA hyperbaric room, which is equivalents to a 5-meter depth. The eighteen subjects as the supplementation group, using oro-nasal mask, inhaled 100% oxygen for 30 minutes followed by a one-day washout period. The subjects were then crossed-over into control group inhaling only regular air for 30 minutes. Lung function test was performed before and after supplementation. RESULTS: In eighteen subjects inhaling regular air, there was a significant difference (p < 0.05) in FEV1/FVC, PEF, FEF25, FEF50, and FEF75. Whereas in eighteen subjects inhaling 100% oxygen, significant difference (p < 0.05) was observed not only in FEV1/FVC, PEF, FEF25, FEF50 and FEF75, but also in FEV1. CONCLUSIONS: There were significant differences in lung function, especially in dynamic volume of trained divers in 1.5 ATA hyperbaric chamber after inhaling 100% oxygen and regular air for 30 minutes; while there were no significant differences in lung capacity (VC and FVC) in the both groups. Lung function returned to normal following supplementation with a 1-day washout period.

Spirometry findings among drug users in the Indonesian National Narcotics and illicit drug Bureau Rehabilitation Center.

BACKGROUND: The increasing prevalence of drug user in Indonesia is affecting the health sectors. The lungs health were affected by the use of the illicit drug. However, lung function among drug users is still unclear. METHODS: This descriptive-analytic study involves 144 drug users who met the inclusion criteria. Chest X-ray was performed to identify the subject with pulmonary tuberculosis to exclude from the study. Subjects were then undergone spirometry test and interviewed using questionnaires. RESULTS: One hundred and forty-four subjects were included in this study. One hundred and twenty-one (84.03%) were male and 128 subjects showed normal lung function. Proportion of abnormal spirometry was 10.4% (n = 15). The restriction was found in ten subjects, and obstruction was found in four subjects. There was significant correlation between the ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC) and age (P = 0.000; r = -0.454, moderate correlation), time of using cannabis (P = 0.01; r = -0.345, weak correlation), time of using methamphetamine inhalation (P = 0.004; r = -0.25, weak correlation), duration of using heroin injection (P = 0.025; r = -0.337, weak correlation), time of using cigarette (P = 0.000; r = -0.365, weak correlation), and the amount of cigarette consumption/day (P = 0.04; r = -0.238, weak correlation). CONCLUSION: This study found that there was a weak correlation between declined FEV1/FVC with a time of smoking, the amount of cigarette consume per day, time of cannabis inhalation, time of methamphetamine inhalation, and time of heroin injection.

Pulmonary Diffusion Capacity for Carbon Monoxide (DLCO) in Indonesian Patients with End-stage Renal Disease.

OBJECTIVES: End-stage renal disease affects all systems in human including the respiratory system. This study aimed to discover the lung diffusion capacity of carbon monoxide (DLCO) in chronic hemodialysis patients and to establish its relation to several demographic and clinical factors as well as spirometry parameters. MATERIAL AND METHODS: This was a cross-sectional study among chronic hemodialysis patients aged .18 years, clinically stable in the last four weeks, without prior history of lung and cardiac disorder. Spirometry and DLCO examination were performed in the span of 24 hours after hemodialysis. OUTCOMES: There were 40 subjects analyzed. Majority of them were males (67.5%), non-smokers (55%), with a median age of 51 years, a mean body mass index of 22.6±3.9 kg/m2, a hemoglobin level of 9.5±1.3 g/dL, a median dialysis adequacy of 1.62 and a hemodialysis duration of 31.5 months. Hypertension was the most common underlying disease. About 20% of subjects had varying degrees of dyspnea. Prevalence of DLCO reduction was 52.5% with mild to moderate degree. Restrictive spirometry pattern was evident in 47.5% of subjects and obstructive pattern in 5%. There was a significant relation between DLCO reduction with smoking history (OR 4.52 [95% CI 1.04-19.6]) and also with restrictive disorder [OR 5.5 (95% CI 1.29-23.8)]. We suspected a lung parenchymal disorder as the cause of lung restriction and diffusion inhibition. CONCLUSIONS: Reduction of lung diffusion capacity in chronic dialysis patients is common, although not accompanied by dyspnea. Risk factors for DLCO reduction are smoking history and restrictive disorder in spirometry.

Pain management in lung cancer.

Lung cancer is the leading cause of cancer-related mortality worldwide. Not only burdened by the limited overall survival, lung cancer patient also suffer from various symptoms, such as pain, that implicated in the quality of life. Cancer pain is a complicated and transiently dynamic symptom that results from multiple mechanisms. This review will describe the pathophysiology of cancer pain and general approach in managing a patient with lung cancer pain. The use of opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and adjuvant analgesia, as part of the pharmacology therapy along with interventional strategy, will also be discussed.

Circulating Tumor Cell and Cell-free Circulating Tumor DNA in Lung Cancer.

Circulating tumor cells (CTCs) are tumor cells that are separated from the primary site or metastatic lesion and disseminate in blood circulation. CTCs are considered to be part of the long process of cancer metastasis. As a 'liquid biopsy', CTC molecular examination and investigation of single cancer cells create an important opportunity for providing an understanding of cancer biology and the process of metastasis. In the last decade, we have seen dramatic development in defining the role of CTCs in lung cancer in terms of diagnosis, genomic alteration determination, treatment response and, finally, prognosis prediction. The aims of this review are to understand the basic biology and to review methods of detection of CTCs that apply to the various types of solid tumor. Furthermore, we explored clinical applications, including treatment monitoring to anticipate therapy resistance as well as biomarker analysis, in the context of lung cancer. We also explored the potential use of cell-free circulating tumor DNA (ctDNA) in the genomic alteration analysis of lung cancer.

A cross-sectional observational study to assess inhaler technique in Saudi hospitalized patients with asthma and chronic obstructive pulmonary disease.

OBJECTIVES: To assess the proportion of critical errors committed while demonstrating the inhaler technique in hospitalized patients diagnosed with asthma and chronic obstructive pulmonary disease (COPD).  METHODS: This cross-sectional observational study was conducted in 47 asthmatic and COPD patients using inhaler devices. The study took place at King Abdulaziz Medical City, Riyadh, Saudi Arabia between September and December 2013. Two pharmacists independently assessed inhaler technique with a validated checklist.  RESULTS: Seventy percent of patients made at least one critical error while demonstrating their inhaler technique, and the mean number of critical errors per patient was 1.6. Most patients used metered dose inhaler (MDI), and 73% of MDI users and 92% of dry powder inhaler users committed at least one critical error.   CONCLUSION: Inhaler technique in hospitalized Saudi patients was inadequate. Health care professionals should understand the importance of reassessing and educating patients on a regular basis for inhaler technique, recommend the use of a spacer when needed, and regularly assess and update their own inhaler technique skills.

Asthma in Asia: Physician perspectives on control, inhaler use and patient communications.

OBJECTIVE: We examined the physician perspectives on asthma management in Asia. METHODS: An online/face-to-face, questionnaire-based survey of respiratory specialists and primary care physicians from eight Asian countries/region was carried out. The survey explored asthma control, inhaler selection, technique and use; physician-patient communications and asthma education. Inclusion criteria were >50% of practice time spent on direct patient care; and treated >30 patients with asthma per month, of which >60% were aged >12 years. RESULTS: REALISE Asia (Phase 2) involved 375 physicians with average 15.9(±6.8) years of clinical experience. 89.1% of physicians reporting use of guidelines estimated that 53.2% of their patients have well-controlled (GINA-defined) asthma. Top consideration for inhaler choice was asthma severity (82.4%) and lowest, socio-economic status (32.5%). Then 54.7% of physicians checked their patients' inhaler techniques during consultations but 28.2(±19.1)% of patients were using their inhalers incorrectly; 21.1-57.9% of physicians could spot improper inhaler techniques in video demonstrations. And 79.6% of physicians believed combination inhalers could increase adherence because of convenience (53.7%), efficacy (52.7%) and usability (18.9%). Initial and follow-up consultations took 16.8(±8.4) and 9.2(±5.3) minutes, respectively. Most (85.1%) physicians used verbal conversations and least (24.5%), video demonstrations of inhaler use; 56.8% agreed that patient attitudes influenced their treatment approach. CONCLUSION: Physicians and patients have different views of 'well-controlled' asthma. Although physicians informed patients about asthma and inhaler usage, they overestimated actual usage and patients' knowledge was sub-optimal. Physician-patient interactions can be augmented with understanding of patient attitudes, visual aids and ancillary support to perform physical demonstrations to improve treatment outcomes.

The Role of Innate and Adaptive Immune Cells in the Immunopathogenesis of Chronic Obstructive Pulmonary Disease.

Chronic obstructive pulmonary disease (COPD) is a chronic and progressive inflammatory disease of the airways and lungs that results in limitations of continuous airflow and is caused by exposure to noxious gasses and particles. A major cause of morbidity and mortality in adults, COPD is a complex disease pathologically mediated by many inflammatory pathways. Macrophages, neutrophils, dendritic cells, and CD8+ T-lymphocytes are the key inflammatory cells involved in COPD. Recently, the non-coding small RNA, micro-RNA, have also been intensively investigated and evidence suggest that it plays a role in the pathogenesis of COPD. Here, we discuss the accumulated evidence that has since revealed the role of each inflammatory cell and their involvement in the immunopathogenesis of COPD. Mechanisms of steroid resistance in COPD will also be briefly discussed.

Continuous positive airway pressure for the treatment of obstructive sleep apnea.

Obstructive sleep apnea (OSA) is a recurrent episode of partial or complete upper airway obstruction during sleep despite ongoing respiratory efforts and is implicated as the risk factor of cardiovascular disease. The OSA syndrome is typified by recurring partial or total occlusion of the pharynx, sleep fragmentation, episodes of gasping, and, eventually, daytime sleepiness. If it is left untreated, OSA syndrome can cause hypertension, coronary artery disease congestive heart disease, insulin resistance and death. In this review, we describe the pathogenesis and diagnosis of OSA. We also focused on the continuous positive airway pressure (CPAP) as the main therapy for OSA. CPAP has been shown to provide benefit for not only respiratory system, but also for cardiovascular system and metabolic system. Finally, we discussed briefly about the issue of adherence of using CPAP that could contribute to lower compliant in patient with OSA.

Depression in patients with stable chronic obstructive pulmonary disease: a cross-sectional study in the national center for respiratory diseases in Indonesia.

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in the world, including Indonesia. It can cause comorbidities such as osteoporosis, heart failure, diabetes, and depression. Depression is a common. Objective: The purpose of this study is to reveal the prevalence of depression in stable COPD patients in Persahabatan Hospital Jakarta and its associated factors. Methods: This is a cross-sectional study in which stable COPD patients who visited COPD Outpatient Clinic in Persahabatan Hospital Jakarta and met the inclusion and exclusion criteria were asked for a history of disease, physical examination, lung function test and underwent Mini International Neuropsychiatric Interview Version (MINI) ICD 10. Results: One hundred and forty-one patients were enrolled in this study. Prevalence of depression was 19.1%. Subjects with moderate-high COPD assessment test (CAT) score ≥ 10 have 14 times higher risk of having depression (p<0.001) compared to subjects with mild CAT score (< 10). There was a statistically significant association between symptoms-based COPD group (p<0.001), smoking status (p<0.007) and Brinkmann index (p<0.026) with depression. We found no statistically significant association between risk-based COPD group (p=0.799) and airflow limitation (p>1.000) with depression. Conclusion: The prevalence of depression in stable COPD patients in Persahabatan Hospital Jakarta was 19.1%. There was a statistically significant association between symptoms-based COPD group, smoking status, and Brinkmann index with depression in stable COPD patients.