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Pleural effusion is an abnormal accumulation of fluid in the pleural space due to an imbalance in increased pleural fluid production and decreased absorption. An ultrasound device can be used to guide the procedure to evacuate the pleural effusion fluid, increasing the procedure's accuracy and lowering the risk of complications. Several calculation methods can be used to calculate the volume of fluid in both an upright sitting position and a supine position. Ultrasound is nearly 100% more accurate than chest X-ray in detecting pleural fluid.

Background: Limestone is sedimentation rocks consist of minerals calcite and aragonite, often contains silica, and fossils, commonly used in building materials. Limestone mining workers are at high risk to pneumoconiosis. Surfactant protein D(SP-D) is part of collectin family, and served as innate immune system of pathogen recognition receptor (PRR). SP-D level were usually increased in fibrotic lung disease. In this study, we sought the serum level of SP-D as marker for early pneumoconiosis in limestone worker in Indonesia.Method: This study was cross-sectional observational study. Participant of the study were 65 limestone workers, willing to participate in this study by signing informed consent, were questionnaire, and blood sample were collected to measure SP-D level by ELISA.Results: This study found that characteristic subjects dominated by male with the median of age was 42 years old and last education mostly elementary school. Majority duration of working 8 hours per day. The limestone mining workers mostly did not wear mask and had normal weight group. Majority limestone mining workers ever smoker, mean SP-D level in limestone workers was (66.3±5.5ng/mL), slightly higher than normal subject. Smoking status, gender, working hour were correlated with higher SP-D level.Conclusion: Although not statistically significant, the SP-D serum levels in limestone mining workers might be used as monitoring for early screening for pneumoconiosis in limestone workers.

Background: Increasing resistance to TB drugs raises the challenge of TB eradication. Miana leaves is Indonesian traditional herbal medicine, have antimicrobial, anti-inflammatory, and immunoregulatory action. Not much is known about the effect of Miana on HIF-1α and ICAM-1, the immunoregulators of infection and inflammation. This study aims to elucidate the effect of Miana on HIF-1α and ICAM-1 in M. tuberculosis (Mtb) infected mice. Materials and Methods: This experimental study used Mtb infected Balb/c mice were divided into 4 groups; group 1 is placebo, group 2 is treated with Rifampicin as Anti TB drug, group 3 is treated with Miana, and group 4 is treated with Miana + Anti TB drug. HIF-1α and ICAM-1 serum levels were analyzed using ELISA. Results: There is a significant difference of mean HIF-1α (p= 0.00, F = 114.21) and ICAM-1 (p= 0.00, F = 113.11) between the four groups after treatment. HIF-1α level is significantly lower in anti TB treatment, Miana, and Miana + anti TB treatment compared to placebo (mean difference (MD) 35,764.67, p=0.00; 29,230.98, p=0.000; 38,489.62, p=0.00, respectively). Furthermore, ICAM-1 level is significantly lower in anti TB treatment, Miana, and Miana + anti TB treatment compared to placebo (MD 95,449.68, p=0.00; 79,509.69, p=0.00; 108,672.83, p=0.00, respectively). Conclusion: HIF-1α and ICAM-1 expression was reduced after Miana administration. Miana can be a potential complement to anti-TB treatment but cannot replace rifampicin as anti-TB drugs.

Background: The 2015 forest fire disaster affected almost 2.6 million hectares of land in Indonesia, and Riau was among the worst. Firefighters were the first responders to deal with the disaster, but a little was known about the influence of extinguishing forest fire activities with their health. This study aimed to evaluate respiratory symptoms and lung function among firefighters 6 months after forest fire exposure.Methods: Interviews were conducted regarding sociodemographic factors, respiratory symptoms, and history of forest fire exposure during the disaster. Spirometry and chest X-ray were also carried out with standard techniques. Statistical analysis was performed based on the existing data. Ninety firefighters participated in this study, most were male with mean age of 33 years old. About 66% were smoker, had been working as firefighters for 2 to 10 years, and had been on extinguishing forest fire duty around 2–5 hours/day during the disaster.Results: All firefighters reported respiratory symptoms after 3 months. Pulmonary function was abnormal in 50% of subjects with mild restrictive characteristic. The analysis showed that body mass index (BMI) and duration of exposure had a significant correlation with pulmonary function abnormality.Conclusion: Pulmonary function was found abnormal in most subjects 6 months after forest fire exposure in Riau.

Background: Coronavirus disease 2019 (COVID-19) may cause dysregulation of the immune system, leading to hyperinflammation. Inflammatory markers can be used to predict in-hospital mortality in COVID-19 patients. This research was aimed to investigate the association between the levels of various inflammatory markers and mortality in COVID-19 patients. Methods: This study was conducted at the Persahabatan National Respiratory Referral Hospital, Indonesia. Blood tests were performed on admission, and C-reactive protein (CRP), procalcitonin (PCT), leukocyte and leukocyte differential counts, and platelet count were measured. The outcome measured was the mortality of hospitalized COVID-19 patients. Statistical analysis methods included the Mann–Whitney U test, receiver operating characteristic (ROC) analysis, and area under the curve (AUC) test. Results: We included 110 patients and compared the laboratory values between survivors and non-survivors. The non-survivor group had significantly higher leukocyte count, lower lymphocyte count, higher CRP and PCT levels, higher neutrophil-to-lymphocyte ratio (NLR), higher platelet-to-lymphocyte ratio (PLR), and lower lymphocyte-to-CRP ratio. As predictors of mortality, AUC analysis revealed that PCT, CRP, NLR, and PLR had AUCs of 0.867, 0.82, 0.791, and 0.746, respectively. Conclusions: Routine and affordable inflammatory markers tested on admission may be useful as predictors of in-hospital mortality in COVID-19 patients requiring hospitalization.

Chest wall syndrome is the most frequent cause of chest pain complained by patients admitted to the physician’s office, in outward as well as in emergency department. It may affect all ages with sex ratio of 1:1 between man and woman. History of illness and sensibility to palpation or tenderness were the keys to the diagnostic approach. Pain was generally moderate, well localized, continuous or intermittent over a number of hours to days or weeks and was amplified by position or movement that was commonly located on the left side of the chest. Chest wall syndrome is usually a common and benign condition, but it leads to anxiety and frequent recurrence. Definitive treatment is not yet confirmed and treatment for the different condition causing isolated musculoskeletal chest pain is poor. Therefore, some options to avoid aggravating physical activities, stretching, and simple analgesics as needed are the best choices of current management.

Background: Coronavirus disease 2019 (COVID-19) is a contagious infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The World Health Organization (WHO) declared this infection a global pandemic in 2020. In addition, various methods have been developed to diagnose COVID-19 rapidly and accurately to reverse transcription-polymerase chain reaction (RT-PCR) as a gold standard method. One of these methods is the detection of volatile organic compounds (VOC) in exhaled breath. Objectives: The aim was to collect and investigate studies on the accuracy of VOC detection as a diagnostic method for COVID-19. Methods: A literature search was performed in five electronic databases, including PubMed, Cochrane Library, ProQuest, EBSCOhost, and Scopus, along with hand searching. The search was conducted in the titles and abstracts of articles using keywords and their equivalent terms, combined with the Boolean operators (OR and AND). The search results were then selected according to the inclusion and exclusion criteria and compatibility with the Population, Intervention, Control, and Outcomes (PICO) framework. Results: Based on the search results, two cross-sectional studies by Wintjens et al. and Ruszkiewicz et al. were selected, which were then critically appraised. Both studies showed good validity. Wintjens et al. reported 86% sensitivity and 54% specificity for their method, with a positive predictive value (PPV) and a negative predictive value (NPV) of 40% and 92%, respectively. Besides, Ruszkiewicz et al., who conducted a study in two different locations, reported 82.4% sensitivity and 75% specificity for their method in Edinburgh (UK), with PPV and NPV of 87.5% and 66.7%, respectively, while they reported 90% sensitivity and 80% specificity in Dortmund (Germany), with PPV and NPV of 45% and 97.8%, respectively. The accuracy of these three methods was 62%, 80%, and 82%, respectively. Conclusions: Detection of VOCs from exhaled breath can be a rapid, cost-effective, and simple method for diagnosing COVID-19. However, the accuracy of this method is still relatively low (62 - 82%) and inconsistent; therefore, it is only recommended for screening.

Background: Traffic policemen are very susceptible to respiratory problems due to the potential for exposure to air pollution. Therefore, this study aimed to assess respiratory health aspects of traffic policemen in Bogor, West Java. Method: Registered traffic policemen in Bogor were evaluated for respiratory symptoms, smoking habits, Fagerström Test for Nicotine Dependence (FTND) Questionnaire, chest x-ray, and spirometry. Air quality measurements were also carried out as a reference. Result: During the study period, the air quality in Bogor was classified as “Good” and below the ambient air pollutant standard. A total of 95 traffic policemen participated with a mean age of 37.3±8.7 years (range 23–57 years), mean Body Mass Index (BMI) of 28.1±4.2 kg/m2, and a length of service of 3-38 years (mean of 12.3 years). Mild pulmonary function impairment was found in 7.4% of subjects. About 61% of subjects had a smoking habit but with a low addiction index (FTND) and exCO. Decreased lung function was correlated to BMI and age (P

Background: There are various microorganisms which caused pneumonia in developing countries such as Indonesia. The diagnosjs of pneumonia is still mainly confirmed by Chest X-ray which is unspecific to determine the etiology of pneumonia due to its low accuracy. On the other hand, the higher accuracy diagnostic tool, Computed Tomography (CT) scan, is not cost-effective. Therefore, an alternative diagnostic tool with high precision, affordability, and user-friendly is highly needed. Lung ultrasound (LUS) is an alternative diagnostic device. This study aims to investigate the diagnostic accuracy level of LUS in diagnosing pneumonia. Methods: Literature-researches was done in five databases namely PubMed/MEDLINE, ScienceDirect, Proquest, Cochrane and EBSCO/MEDLINE using keywords according to the clinical scenario. The articles were appraised with CEEBM worksheet. Results: Four articles met the inclusion and exclusion criteria. Sensitivity of LUS ranged around 85-97% and specificity ranged around 8694%. All appraised articles recommended the use of LUS for its high sensitivity in confirming diagnosjs of pneumonia and other lung diseases, and its favorable bedside use especially for critically ill patients. Lung US was also considered as being more inexpensive with less radiation exposure compared to CT scan or other radiographic imaging. Conclusion: Examination using LUS had a high diagnostic value in confirming the diagnosis of pneumonia.

Background: Silica, asbestos and coal dust are associated with pneumoconiosis in mining workers. The International Labor Organization (ILO) reports that 30-50% of workers in developing countries are diagnosed with pneumoconiosis. This study aims to identify pneumoconiosis in limestone mining workers in Indonesia. Method: This cross-sectional study involved 73 subjects of limestone mining workers in Citatah Village, West Bandung Regency, Indonesia. Two conclusions were similar from three AIR-Pneumo certified photo readers by blind reading and using the ILO guidelines. Result: Pneumoconiosis was found in 11/73 (15.1%). The median age of the pneumoconiosis group was older than the non-pneumoconiosis group (51 [33-63] vs. 37.5 [18-85] age in years, p = 0.013). All subjects in the pneukoniosis group worked> 6 years (p = 0.001). The highest dust concentration was in the pneumoconiosis group compared to the non-pneumoconisosis group (61.41 ± 103.98 vs. 14.92 ± 55.17 mg / m3, p = 0.030). This study showed that the length of work and the level of dust in the mine were risk factors for pneumoconiosis, although not significant (OR = 14.6, p = 0.999 and OR = 7,171, p = 0.998). Conclusion: The proportion of pneumoconiosis in lime mining workers in this study was 15.1%. Length of work and dust levels in the mine are risk factors for pneumoconiosis; but not meaningful in this study.

Background: Ceramics industry workers are often exposed to silica materials from ceramics. The aim of this study was to determine the association between silica exposure withlung function test and chest x-ray (CXR) results of the workers. Methods: This was an analytical study with cross-sectional design conducted in the Ceramic Industry X in Mabar, Medan City. The dust level in the work station was measured using Personal Dust Sampler. Lung function was measured by spirometry and CXR was evaluated using the ILO interpretations. Results: About 35 male workers were included as subjects, divided into 3 working stations namely precompression section of 11 subjects (31.4%), compression section of 13 subjects (37.1%) and 11 subjects (31.4%) in the sintering section. Dust levels in each work location are 24.8, 29.2, and 6.11 respectively. Of all subjects, 9 (25.7%) had respiratory symptoms, 21 (60%) had restriction in lung function and 8 (22.8%) had abnormal CXR (6 pneumoconiosis and 2 tuberculosis). There were no association between dust levels with lung function and CXR (P>0.05), but there was a significant correlation between duration of work with lung function. The FEV1 and FVC values of subjects working

Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases. Occupational exposure as a one of important risk factor that contribute for COPD on nonsmoker patients. Several studies at population consistent showed that COPD correlated with hazards exposure at work place. COPD among workers can decrease quality of life, increase of work impairment, work disability and hospitalitation also increase of abstinentia from work and decrease of work productivity. Prevention were major action to prevent incident and morbidity of COPD among workers. Prevention programs including primary, secondary and tertiary prevention.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a common disease characterized by respiratory symptoms and limited air flow associated with the airways and/or alveolar abnormalities triggered by a significant effect on substances or gases. COPD is the leading of death cause in the world. COPD can be caused by cigarette smoke and biomass. Method: This research is aquantitative method with descriptive analytic and retrospective approach. The samples were 203 COPD patients taken from medical records January 2013-January 2020 at Harum Melati Pringsewu Clinic Lampung Province with statistical test use Analysis Varians (ANOVA) technique. Results: From the characteristics based on type of COPD smoke exposure were clove smokers 127 people (62.6%), filter smokers 3 people (1.5%) and biomass users 73 people (36.0%). The mean lung function COPD patients based on type of smoke exposure were 127 people with clove smokers with average lung function value 55.03%, the lowest value 12.20% and the highest 121.50%. Filter smokers of 3 people with average lung function value 75.07%, the lowest value was 67.00% and the highest 81.41%. Biomass users 73 people with average lung function value 56.91%, the lowest value 19.50% and the highest 149.13%. Comparison the effect clove cigarettes smoke, filter cigarettes and biomass on the pulmonary function of COPD patients obtained P=0.319. Conclusion: There is a decrease lung function in clove smokers, filter smokers and biomass users in COPD patients but not statistically significant difference.

Background: To satisfy growing needs of petrol consumption in big city many new petrol stations has been built. Petrol station attendant is considered to have high risk exposure to dangerous pollutant from motor vehicle emission and petrol fumes, especially while filling up petrol tanks. Combination of those exhaust and petrol fumes is suspected to cause the reduction of lung function. Methods: This research is a cross sectional study in petrol station in Central Jakarta and North Jakarta region between August 2017 and February 2018. A total of 97 petrol station attendants were taken in this research using consecutive sampling technique. The subjects were interviewed with questionnaires, spirometry and chest radiograph. Measurements of sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), ozone (O3), particulate matter 2,5 (PM 2,5) and steam gasoline (benzene) concentrations were performed at the study sites. Results: In this study, 56.7% normal spirometry results, 42.3% abnormalities in the form of restriction, 1% obstruction and none of which experienced mixed disorders of restriction and obstruction. Most subjects (84.6%) did not experience respiratory complaints, 10.3% had a dry cough and 5.1% complained of cough with phlegm. There was a statistically significant association between peak expiratory flow and duration of work (p=0.011), but no significant association with other parameters such as forced vital capacity (FVC), %FVC, forced expiratory volume in the first second (FEV1), %FEV1 and the ratio of FEV1/FVC. Conclusion: Prevalence of lung function abnormalities of petrol station attendant is 43,3% and respiratory symptoms at 15,4% subject.

Indoor air pollution marked with decreased air quality below the set standard. The quality of indoor air is determined by ambient air quality as well as by a harmful substance resulting from the household activity. Indoor air pollution may cause several problems such as sick building syndrome, chronic obstructive pulmonary disease (COPD), asthma, lung cancer, and is responsible for nearly two million death in developing countries. One of the interesting research topics to overcome the indoor air pollution problem is the application of indoor plants. Although there are no established criteria to specify the best indoor plant, several studies have revealed the capability of a particular indoor plant to remove the harmful substances. This paper summarizes important information about indoor air pollution and provides the evidence-based insight of indoor plant usefulness as an alternative way for indoor air remediation.

Background: Chronic obstructive pulmonary disease (COPD) is an important disease worldwide in both high-income and low-income countries. Dust has been known to increase COPD risk. During sweeping activity, sweepers are exposed to dust. The street sweepers are exposed to dust particles, bioaerosols, and various harmful gases. In this study we evaluates the prevalence of COPD among street sweepers in Jakarta Method: This is a cross-sectional study among 153 street sweepers in Jakarta, Indonesia with age more than 40 years old with working period more than 2 years. Subjects were collected by cluster sampling method based on working location correlated with Jakarta regional district area. COPD was diagnosed by using questionnaires of COPD Assessment Test (CAT), The Modified British Medical Research Council (mMRC), spirometry examination based on Pneumobile Project Indonesia, and bronchodilator test if there was obstructive results. Results: A total of 153 subjects was selected for spirometry examination. The prevalence of COPD among street sweepers in Jakarta, Indonesia was 10 of 153 subject (6.5%). Six of them were males (60%), do not use face mask (80%), working years >10 years (70%), smokers (60%), and BMI ≤25 kg/m2 (80%). There was a statistically significant relationship between age and COPD (p˂0,05). Conclusion: Prevalence of COPD among street sweepers in Jakarta is 6.5%. Factor related to the occurrence of COPD is age.

Sejak awal tahun 2020 terjadi peningkatan jumlah kasus infeksi virus COVID-19, yang sebelumnya dikenal dengan nama 2019-nCov. Diketahui hingga bulan Februari 2020 sudah terkonfirmasi lebih dari 70.000 kasus positif infeksi COVID-19. COVID-19 diketahui merupakan virus dari keluarga coronaviridae, yang juga merupakan keluarga dari virus SARS-CoV dan MERS-CoV yang pernah menyebabkan wabah pada tahun 2002 dan 2012 silam. Patogenesis COVID-19 belum diketahui secara pasti, namun diduga mirip dengan patogenesis SARS-CoV dan MERS-CoV. Rerata mortalitas COVID-19 adalah 2.3%, lebih rendah dibandingkan dengan mortalitas SARS-CoV dan MERS-CoV. Outbreak COVID-19 juga diduga dimulai dari sebuah pasar penjualan makanan laut lokal pada musim dingin, lingkungan yang hampir sama pada saat outbreak virus SARS. Pada artikel ilmiah ini akan dibahas secara mendalam mengenai definisi operasional yang dapat dipakai dalam manajemen pasien dengan dugaan infeksi COVID-19. Akan dibahas pula manifestasi klinis dan tata laksana pada pasien dengan dugaan dan konfirmasi infeksi COVID-19.

This study examined inter-observer agreement and diagnostic accuracy in classifying radiographs for pneumoconiosis among Asian physicians taking the AIR Pneumo examination. We compared agreement and diagnostic accuracy for parenchymal and pleural lesions across residing countries, specialty training, and work experience using data on 93 physicians. Physicians demonstrated fair to good agreement with kappa values 0.30 (95% CI: 0.20-0.40), 0.29 (95% CI: 0.23-0.36), 0.59 (95% CI: 0.52-0.67), and 0.65 (95% CI: 0.55-0.74) in classifying pleural plaques, small opacity shapes, small opacity profusion, and large opacities, respectively. Kappa values among Asian countries ranging from 0.25 to 0.55 (pleural plaques), 0.47 to 0.73 (small opacity profusion), and 0.55 to 0.69 (large opacity size). The median Youden's J index (interquartile range) for classifying pleural plaque, small opacity, and large opacity was 61.1 (25.5), 76.8 (29.3), and 88.9 (23.3), respectively. Radiologists and recent graduates showed superior performance than other groups regarding agreement and accuracy in classifying all types of lesions. In conclusion, Asian physicians taking the AIR Pneumo examination were better at classifying parenchymal lesions than pleural plaques using the ILO classification. The degree of agreement and accuracy was different among countries and was associated with background specialty training.

[No abstract available]

Pneumoconiosis is disease that caused by deposition of dust in lung parenchymal with fibrosis was result of it’s reaction. Usually pneumoconiosis diagnose and classified by conventional chest x ray. The International Labour Organization (ILO) described standard system for classified radiograph abnormality of pneumoconiosis based on parenchymal and pleural abnormality. Parenchymal abnormality divided into 2 categories that is small opacities and large opacities. Description steps of chest X ray reading based on ILO classification was technical quality, parenchymal abnormality (shape and size, affected zone and profusion), pleural abnormality (localized, width, extent and severity of calcification) and other abnormality with recorded by symbols (J Respir Indo. 2019; 39: 272-9)

Introduction: The health effects of exposure to environmental tobacco smoke (ETS) using cotinine was a nicotine metabolite detected in urine. This should be recommended as a quantitative measurement of nicotine intake and as biomarker for ETS exposure in humans. Method: We performed a cross-sectional study to 60 ETS-exposed and 58 non ETS exposed adult women in Pasar Rebo area, Jakarta. The urinary cotinine concentrations were measured and analyzed using ELISA method, other informations were collected such as expired CO data, questionnaire regarding smoking habits of the subjects’ family members at home and respiratory health effects occured to subjects. Results: Median of urinary cotinine concentrations in ETS-exposed group were 24.65 ng/ml and 7.30 ng/ml in non-exposed group (P=0.0001). Median of expired CO in ETS-exposed group were 5.00 ppm and 3.00 ppm in non-exposed to ETS group (P=0.0001). Total amount of time (hours/day) in women exposed to ETS in their house was significantly correlated to urinary cotinine concentrations (P=0.037). The respiratory symptoms showed significant correlation with ETS exposure status (P=0.01). Time duration of last exposed to ETS had significant correlation with expired CO (P=0.004). The urinary cotinine concentrations cut-off point was 14.4 ng/ml (sensitivity=75%, specificity=74%, P=0.0001). The expired CO cut-off point was 3.5 ppm (sensitivity=75%, specificity=81%, p=0.0001). Strong and significant correlation was found between expired CO and urinary cotinine (r=0.641, P=0.0001). Conclusion: The urinary cotinine and expired CO concentration were significantly higher in women exposed to tobacco smoke at home than the non-exposed group. Urinary cotinine measurement was a sensitive, non-invasive and effective method to correlate with ETS exposure. (J Respir Indo. 2019; 39(3):140-53)

Background: The workers in the landfill have high risk of health problems. The prevalence of respiratory disorders and lung function increases in waste collection workers. There has been no data on respiratory disorders and lung function in scavengers, especially in Bantar Gebang, Bekasi. Methods: This study used a cross-sectional design to the scavengers who work and live in Ciketing Udik, Bantar Gebang, Bekasi. Conducted in January-March 2015, doing interview with questionnaires, and spirometry examination. Results: The number of samples that suitable with the inclusion criteria are 108 subjects. Respiratory disorders are 92 subjects (85.2%). The respiratory disorders consist of 73 subjects with chronic cough, 65 subjects due to shortness of breath, 57 with phlegm and 19 wheezing. Lung function impairments consist of 18 (16.7%) subjects in the form of mild obstruction 3 (2.8%) subjects, mild restriction 11 (10.2%) subjects and mixed 4 (2.8%) subjects. Results of the analysis show that there is a significant relationship between duration of working with respiratory disorders and lung function impairments. Conclusion: There is respiratory disorders and lung function impairments of the scavengers in Bantar Gebang, Bekasi. (J Respir Indo 2019; 39(2))

Background Tuberculosis (TB) remains a major global health problem, in the top 10 causes of death. As a regulator of the immune response, T-helper (Th) cells activate other lymphocytes from the immune system, such as B cells, to destroy the TB pathogen by releasing CD4 and CD8 Th cells. Diabetes mellitus (DM) is a known cause of developing active pulmonary TB. Few studies have examined the biomolecular expression affecting Mycobacterium tuberculosis (MTB) and multidrug-resistant (MDR) MTB, which are associated with low immunity represented by TB in diabetes and CD4 and CD8 levels. Materials and methods This animal study used a post-test control group design. We performed an experimental study using 30 BALB/c mice, each weighing 25 g. It included six experimental animal groups, of which three had a diabetes condition induced using intraperitoneal streptozotocin, and all were infected with MTB or MDR TB. We evaluated the CD4 and CD8 levels in each group and analyzed the differences. Results We found a significant difference in CD4 and CD8 levels in MTB and MDR TB conditions. Conclusion This study shows that acute infection in experimental mice with MTB and MDR TB with or without diabetes had the highest levels of both CD4 and CD8 cells, which can be a sign of increased cellular immunity in a mice model., Highlights • Tuberculosis (TB) is still a major global health problem. • TB with comorbid diabetes mellitus (DM) are associated with increased CD4 and CD8. • CD4 and CD8 values are increased in animals with DM plus TB infection.

The emergency hospital is intended to prevent transmission of COVID-19 in the community by isolating patients without symptoms, with mild or moderate symptoms. This study evaluated the clinical characteristics and outcomes of COVID-19 patients who were admitted to this facility. This retrospective study reviewed data of patients treated at the National Emergency Hospital Wisma Atlet Kemayoran in Jakarta, Indonesia, from March 23 to April 30, 2020. Patient characteristics (clinical symptoms, laboratory test results, Chest X-Ray, SARS-CoV-2 immunoserology, and RT-PCR results from nasopharyngeal/ oropharyngeal preparations) were compared between severity groups. There were 413 COVID-19 cases analyzed, of which 190 (46%) were asymptomatic, 93 (22.5%) were mild, and 130 (31.5%) were moderate cases. Most asymptomatic cases were male, with young age, and without comorbidity. Mild cases were dominated by female and young patients, while most moderate cases were male and older patients. The number of patients with comorbidities was higher in mild and moderate cases. The patient’s overall outcome was good and did not differ based on the severity of symptoms. Despite the many challenges, patients with moderate symptoms can be safely treated in the emergency hospital.

Coronavirus disease-2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) manifests in a broad clinical spectrum. COVID-19 survivors report various symptoms up to several months after being infected. The purpose of this study was to determine the prevalence of persistent COVID-19 syndrome in Indonesia, the factors that influence the incidence, and the quality of life.This was a cross-sectional study with an online questionnaire conducted in January 2021. Inclusion criteria were: adult Indonesian citizens who had recovered from COVID-19, and were confirmed negative by RT-PCR of nasal swabs or had undergone an isolation period for a minimum of 14 days. Data analysis was performed by the Chi-square test, followed by multivariate analysis with the backward likelihood ratio method.From a total of 385 respondents, 256 (66.5%) experienced persistent COVID-19 syndrome. The most prevalent symptoms were fatigue (29.4%), cough (15.5%), and muscle pain (11.2%). Of the five aspects of quality of life, the most commonly reported aspects were pain/discomfort and anxiety/depression. The risk of persistent COVID-19 syndrome was significantly higher in subjects with older age, comorbidities, higher clinical severity, previous treatment in hospital, presence of pneumonia, and those who had required oxygen therapy. In the multivariate analysis, the most influential factor for the incidence of persistent COVID-19 syndrome was pneumonia (aOR 2.31, 95% CI 1.29-4.11, p0.002).The prevalence of the persistent COVID-19 syndrome in Indonesia was high, which affects the quality of life of COVID-19 survivors. Pneumonia was the main factor that influenced the incidence of persistent COVID-19 syndrome. Further research with a larger sample size and a longer study time is recommended to control COVID-19 and its impact on the health and quality of life of COVID-19 survivors.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that causes coronavirus diseases 2019 (COVID-19). The SARS-CoV-2 is very contagious and nobody is known to be immune to it. The post-infected lung would leave a scar known as fibrosis, a scar tissue. A study from Wuhan, China suggested the development of fibrosis, though it was too early to label these lung changes as irreversible fibrosis in a time range of 3 weeks. The occurrence of fibrosis indicates a chronic infection which greatly contributes to the hallmark symptom of COVID-19 induced ARDS such as shortness of breath and chest pain. However, many of those studies have not yet explained the condition of the patient's lung after total recovery from the COVID-19. This report demonstrates the clinical symptoms, chest CT scan, spirometry, and blood gas analysis of patient after total recovery from the COVID-19 with appearance lung fibrosis.

BackgroundAnalyses of correlates of SARS-CoV-2 infection or mortality have usually assessed individual predictors. This study aimed to determine if patterns of combined predictors may better identify risk of infection and mortalityMethodsFor the period of March 2ndto 10th2020, the first 9 days of the COVID-19 pandemic in Indonesia, we selected all 18 confirmed cases, of which 6 died, and all 60 suspected cases, of which 1 died; and 28 putatively negative patients with pneumonia and no travel history. We recorded data for travel, contact history, symptoms, haematology, comorbidities, and chest x-ray. Hierarchical cluster analyses (HCA) and principal component analyses (PCA) identified cluster and covariance patterns for symptoms or haematology which were analysed with other predictors of infection or mortality using logistic regression.ResultsFor univariate analyses, no significant association with infection was seen for fever, cough, dyspnoea, headache, runny nose, sore throat, gastrointestinal complaints (GIC), or haematology. A PCA symptom component for fever, cough, and GIC tended to increase risk of infection (OR 3.41; 95% CI 1.06-14; p=0.06), and a haematology component with elevated monocytes decreased risk (OR 0.26; 0.07-0.79; 0.027). Multivariate analysis revealed that an HCA cluster of 3-5 symptoms, typically fever, cough, headache, runny nose, sore throat but little dyspnoea and no GIC tended to reduce risk (aOR 0.048; ConclusionsCluster groups and co-variance patterns may be stronger correlates of SARS-CoV-2 infection than individual predictors. Comorbidities may warrant careful attention as would COVID-19 exposure levels.

BACKGROUND Indonesia forest fire in 2015 emitted a huge amount of pollutants into the air. This study was aimed to assess the health consequences of forest fire smoke in healthy residents in Riau during forest fire disaster in 2015. METHODS This cross-sectional study was performed in healthy residents who lived in Pekanbaru, Riau Province, Sumatera, for at least 6 months during forest fire disaster in 2015, and data were taken in October 2015. Questionnaires consisting of respiratory and non-respiratory symptoms were collected. Lung function was assessed by spirometry (MIR II Spirolab™ spirometer, Medical International Research, Italy) and exhaled carbon monoxide (CO) was assessed using piCO+ Smokerlyzer®. Heart rate at rest and oxygen saturation in the room air were measured using Onyx 9591 Pulse Oximeter®. RESULTS A total of 89 subjects were mostly female (75.3%), housewife (37.7%), nonsmoker (86.5%) with mean age of 38.9 years old. The non-respiratory and respiratory symptoms were reported in 84.7% and 71.4% subjects, respectively. Lung function was impaired in 72.6% subjects, mostly with mild obstruction and mild restriction. Exhaled CO was highly detected over normal values (mean [standard deviation] = 32.6 [9.97] ppm) with predicted carboxyhemoglobin (COHb) of 5.74 (1.56). CONCLUSIONS Forest fire smoke exposure increased the respiratory and nonrespiratory symptoms among healthy individuals, which showed impairment in lung function, exhaled CO, and predicted COHb. Long term health effects on healthy individuals exposed to forest fire smoke warrant further evaluation.

Based on calculations of over one million people in the world weighing excessively or known as obesity with body mass index (IMT) 25 kg / m2 or more. Obesity is the cause of morbidity, as is the case in the population of the United States an estimated 400,000 deaths caused due to obesity. Obesity especially abdominal obesity is a significant risk factor for cardiovascular diseases, type 2 diabetes, rheumatoid arthritis and cancer. The relationship between obesity and chronic respiratory illness began to increase and began to be recognized. The World Health Organization (WHO) predicts about 10% of the global population will be obese by 2015. (J Respir Indo 2018; 38(2): 123-33)

Background: Over 43 million Indonesian children who are exposed to cigarette smoke are at risk of having health hazard and morbidities. Aims: The aim of this study is to identify the correlation between cigarette smoke exposure and respiratory complaints, hospitalization, as well as school absence due to respiratory complaints in elementary school-aged Indonesian children. Materials and Methods: A cross-sectional study was conducted in nonsmoking elementary school-aged children. Participants were categorized into the exposed and unexposed groups based on the report of their parents. Questionnaire-retrieved data were analyzed to identify the correlation between cigarette smoke exposure and respiratory complaints, hospitalization, as well as school absence due to respiratory complaints in elementary school-aged children. Results: A total of 128 study participants of nonsmoking children aged 6–12 years (mean 9.8 ± standard deviation 1.6 years) were categorized into 64 children exposed and 64 children unexposed to domestic cigarette smoking. There was a significant correlation between smoking exposure and cough episodes as well as upper respiratory infection in children within the past 12 months. A cough episode of ≥3 times/year was found more prevalent in exposed children compared to the unexposed children (26.6% vs. 9.4%; P < 0.05). Cough ≥3 times/year was found in 50% of children exposed to cigarette smoke of a smoker with a smoking habit of >10 cigarettes/day. There was a correlation between cigarette smoke exposure and hospitalization frequency of ≥1 time(s)/year due to respiratory complaints in children (P < 0.05). Conclusion: Cigarette smoke exposure is correlated with complaints of cough, upper respiratory tract infection, and hospitalization due to respiratory complaints in children.

Background: Cotinine is a major metabolite of nicotine, and its urinary level is an indicator of exposure to cigarette smoke. The present study was aimed at identifying the urinary cotinine level in Indonesian children who were exposed and not exposed to domestic cigarette smoke. Methods: The study was a cross-sectional study in elementary school-aged children who had not smoked. The subjects were categorized into an exposed group and unexposed group based on their exposure status. Data were obtained from a questionnaire and random urinary samples measured using enzyme-linked immunosorbent assay. Results: There were a total of 128 subjects, including 64 children in the exposed group and 64 children in the unexposed group. The median level of cotinine in all subjects was 17.95 ng/ml (with a range of 0.1–158.3 ng/ml). The urinary cotinine level in the exposed group was higher than the unexposed group (median: 30.1 ng/ml vs. 8.45 ng/ml; P < 0.000). There was a correlation between urinary cotinine levels in children exposed to cigarette smoke and the number of cigarettes smoked by the smokers at home (P < 0.05). The optimal cut-off points of urinary cotinine levels in children, which was utilized to evaluate cigarette smoke exposure, was 17.95 ng/ml (81% sensitivity; 81% specificity; P < 0.000). Conclusion: The urinary cotinine level in children exposed to cigarette smoke is higher than children who are not exposed to domestic cigarette smoke. The urinary cotinine level can be used as a noninvasive marker to evaluate cigarette smoke exposure in children.

Seiring masuknya covid-19 ke tanah air yang kemudian menjadi bencana wabah sehingga infeksi meluas secara cepat dengan fatalitas yang terbatas, cukup membuat kewalahan pelayanan kesehatan. Terbitnya Surat Keputusan Konsil Kedokteran Indonesia Nomor 18/KKI/KEP/III/2020 tentang Kewenangan Dokter Penanggung Jawab Penanganan Pasien di Fasilitas Pelayanan Kesehatan Pada Masa Darurat Bencana Wabah Penyakit Akibat Corona Virus Disease 2019 (COVID-19) di Indonesia mengijinkan mobilisasi seluruh tenaga medis dan spesialis baik paru dan non paru di saat pandemi covid guna mencukupi layanan covid, menjadikan dasar bagi RSUP.Persahabatan yang ditunjuk sebagai rumah sakit khusus covid untuk menerapkan hal tersebut.

Background: Scavengers in landfills have high risk to pollution exposure. Carbon monoxide (CO) is one of important pollutants produced by burning process. Exhaled CO levels in scavengers is predicted to increase, caused by pollution exposure in workplace area. There has been no data on exhaled CO levels in scavengers, especially in Bantar Gebang, Bekasi.Methods: This study used cross-sectional design to the scavengers who work and live in Ciketing Udik, Bantar Gebang, Bekasi. This study was conducted in January - March 2015, by doing interviews and giving questionnaires, and conducted exhaled CO test.Results: Total sample was 108 subjects. Exhaled CO test result was 46 subjects (42.6%) had exhaled CO 5-10 ppm, 36 subjects (33.3%) > 10 ppm, and 26 subjects (24.1%) ≤ 4 ppm. Multivariate analysis between exhaled CO levels with characteristics of the subjects found smoking habits were significantly correlated with CO exhalation levels (p=0,000).Conclusion: There were 33.3% scavengers who had exhaled CO > 10 ppm. Smoking habits were the only factor that significantly correlated with CO in scavengers’ exhalation.

Lung cancer during pregnancy is a rare condition. We report a case of 28-year-old nonsmoker female, who was admitted to our hospital with massive left pleural effusion in the 21st week of gestation. Chest radiograph showed total left hemithorax opacity with contralateral mediastinal deviation. Pleural biopsy and cytological examination of pleural fluid revealed adenocarcinoma invasion with positive epidermal growth factor receptor mutation status. Cesarean section was performed at 32 weeks of pregnancy, and targeted therapy was given to this patient after delivery. Computed tomography of the thorax showed a mass lesion in the left hemithorax with liver metastases. Unfortunately, the patient died 10 days after delivery.