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Asthma and COPD comorbidities are expected to exacerbate the clinical manifestations of COVID-19. However, many reported studies show that asthmatic patients infected with COVID-19 do not show severe clinical manifestations, and some are asymptomatic. This literature review aimed to describe COVID-19 in asthmatic patients along with the hypothesis that asthma is a protective factor against COVID-19 infection. Systemic corticosteroids have been shown to reduce the death/mortality rate in patients who are hospitalized due to COVID-19 infection. This is possibly due to the suppression of the immune system against a hyperinflammatory state which can result in further damage from SARS-CoV-2 infection. Mucus hypersecretion, which is one of the hallmarks of asthma, can prevent the SARS-CoV-2 virus from reaching the distal lung and can protect the lungs from pathological processes. The secreted mucus is rich in glycoproteins, such as MUC5AC, which act as the first line of defense against infection. Mucus hypersecretion in asthmatic patients may prevent SARS-CoV-2 from penetrating far enough to gain access to type-2 alveolar cells, which are the cells that predominantly express ACE2 in the lungs. In conclusion, comorbid asthma in patients infected with COVID-19 does not cause adverse clinical manifestations to appear, but on the contrary, it will have a protective effect on patients.

Background: Obesity is one of the risk factors for severe clinical COVID-19. This is because these patients tend to have comorbidities such as metabolic disease and cardiovascular disease. Obesity may result in poor outcomes, such as prolonged hospital stays, higher incidence of ARDS and mortality. The purpose of this study was to determine the correlation between obesity and the outcome of confirmed COVID-19 patients.Methods: This was an analytical study with retrospective cohort design on COVID-19 patients treated in the intensive care unit (ICU)of RSUP Dr. M. Djamil Padang. Data were taken from patients’ medical records between November 2021 and February 2022. The correlation between obesity with length of stay and patient mortality was analyzed using Chi-square test. Odds ratio was also assessed.Results: This study obtained that the characteristics of obese COVID-19 patients were mainly women (54.20%). The most dominant age group was 60-69 years (31.3%). About83.3% of obese patients were found to be clinically critical. Inflammatory markers such as procalcitonin, ferritin, IL-6 and d-dimer were not significantly associated with obesity. Diabetes mellitus was significantly related to the outcome of COVID-19 patients with obesity and without obesity (0.009%). Obesity was not correlated with hospital length of stay of COVID-19 patients, but was significantly associated with length of stay in the ICU [OR 3.67 (95% CI, 1.09-12.35)]. Obesity was significantly associated with mortality [OR 2.84 (95% CI, 1.12-7.18)] and length of conversion for COVID-19 patients in the ICU [OR 30.00 (95% CI, 2.85-31, 61)]. The expansion of adipose tissue both subcutaneously and viscerally which could be observed in obese patients can increase the proinflammatory, prothrombotic, and vasoconstrictive state that might affect the clinical deterioration of COVID-19 patients. This condition also manifests as insulin resistance, hypertension, atherosclerosis, cardiovascular disease and immunocompromised conditions which can generate high mortality rate.Conclusion: Obesity was found to be significantly associated with mortality, conversion time and length of stay for COVID-19 patients in the ICU.

Coronavirus disease 2019 (COVID-19) is a disease caused by a new coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, previously known as 2019-nCoV), which was first identified in Wuhan City, Hubei Province, PRC. The total number of COVID-19 cases worldwide has reached 102 million cases with 54 million cases recovered and 2.3 million cases dead. Handling for this pandemic is still being carried out. In Indonesia, the antiviral drugs used are those that meet the Emergency Use Authorization (EUA) requirements, and are included in the COVID-19 management guidelines issued by the Ministry of Health. Antiviral options used are Oseltamivir, Favifirapir, Remdesivir. Until now, the use of antivirus is still being researched regarding the effectiveness and security of the antivirus used. Oseltamivir is used as an antiviral for COVID-19 with a mild clinical course, Favifirapir is used for mild to moderate clinical cases of COVID-19. For the use of remdesivir in COVID-19 patients with severe and critis clinical conditions.

Sepsis adalah respon inflamasi sistemik terhadap infeksi yang berat. Sepsis merupakan penyebab utama morbiditas dan mortalitas terutama pada usia lanjut, imunocompromised, penderita dengan kondisi kritis. Pneumonia merupakan lesi infeksi primer tersering pada pasien sepsis. Sepsis berat dapat terjadi akibat infeksi yang berhubungan dengan pelayanan kesehatan dan dapat pula diperoleh dari komunitas (Community Acquired Pneumonia). Penelitian melaporkan bahwa 5-10% pasien pneumonia yang dirawat di rumah sakit berkembang menjadi empiema dan angka kematian meningkat secara bermakna dibandingkan pasien pneumonia tanpa empiema. Kejadian infeksi lebih sering terjadi pada pasien dengan diabetes akibat munculnya lingkungan hiperglikemik yang meningkatkan virulensi patogen, menyebabkan terjadinya disfungsi kemotaksis dan aktifitas fagositik, serta kerusakan fungsi neutrofil. Infeksi paru pada diabetes melitus ditandai dengan perubahan pada pertahanan imun host, di seluruh tubuh, dan khususnya secara lokal di paru maupun pada fungsi epitel pernapasan dan motilitas silia. Tatalaksana sepsis pada kasus ini dengan terapi cairan yang adekuat, pemberian antibiotik kombinasi dan segera mengevakuasi pus dari rongga pleura dengan pemasangan chest tube, dan tatalaksana komorbid diabetes melitus dengan protokol drip insulin untuk kontrol glukosa serum.

Multi Drug Resistant Tuberculosis (MDR-TB) merupakan masalah kesehatan di Dunia saat ini. Indonesia termasuk 27 negara dengan high burden MDR TB di dunia, diperkirakan 6800 kasus baru per tahun, 2,8% merupakan kasus baru dan 16% pernah mendapatkan obat anti tuberculosis (OAT) sebelumnya. MDR TB primer terjadi pada pasien yang sebelumnya tidak pernah mendapat pengobatan OAT. Diabetes mellitus merupakan faktor predisposisi dan komorbid yang dapat mempercepat terjadinya penyakit TB dan mempersulit pengobatannya. Tujuan laporan kasus ini untuk melaporkan kasus MDR TB primer pada pasien dengan DM type 2. Kasus pasien laki-laki 58 tahuh dengan gejala batuk produktif dengan sputum kekuningan sejak 2 bulan, keringat malam dan penurunan berat badan. Hasil tes cepat molekuler menunjukkan MTB detected medium dan rifampicin resistant detected. Rontgen toraks infiltrate dan cavitas di apex paru. Pasien denga DM type-2 tidak terkontrol selama 12 tahun dengan HbA1c 10,5 %. Kami menyimpulkan bahwa DM merupakan salah satu konkommitant faktor predisposisi dan komorbid MDR TB primer. Pada pasien dengan DM perlu dilakukan skrining TB dan sebaliknya pasien TB juga perlu dilakukan skrining DM. Terapi MDR TB dengan DM sesuai dengan paduan standar nasional terapi MDR TB dan menjaga kadar gula darah tetap terkontrol.

TB paru merupakan penyakit infeksi yang sering dijumpai di Indonesia. TB paru masih menjadi permasalahan kesehatan di dunia, dengan harapan di tahun 2030 kasus TB paru dapat dieradikasi secara tuntas. Bersamaan dengan kasus TB paru yang belum tuntas, infeksi HIV/AIDS masih cukup tinggi di negara-negara berkembang termasuk Indonesia. Infeksi HIV/AIDS dapat memperberat kondisi klinis pasien TB paru itu sendiri. Mendiagnosis kasus TB paru pada pasien dengan HIV/AIDS pada prinsipnya tidak berbeda dengan kasus TB paru tanpa konfeksi HIV/AIDS. Pemeriksaan standar pada kasus TB paru berdasarkan pemeriksaan mikrobiologi berupa pemeriksaan sputum BTA dan tes cepat molekular untuk mengetahui adanya kuman yang telah resisten terhadap obat rifampisin. Pemeriksaan radiologi tetap diperlukan untuk membantu diagnosis TB paru, terutama pada pasien–pasien yang sukar mengeluarkan sputumnya. Pemeriksaan radiologi juga bermanfaat untuk melihat luasnya lesi paru yang diakibatkan oleh kuman Mycobacterium tuberculosis dan penyakit oportunistik lain yang menyerang paru penderita dengan konfeksi HIV/AIDS. Pemberian obat Anti Retro Viral (ARV) pada kasus ini sebaiknya dimulai dalam waktu 2 minggu setelah pemberian Obat Anti Tuberkulosis (OAT).

Background: Anxiety and depression among COPD patients can lead to physical limitation, lung function deterioration, risk of exacerbation and poor quality of life. This study aims to investigate correlation between anxiety and depression with quality of life among COPD patients Method: This was cross sectional analytic study recruiting COPD patients in Pulmonary outpatient setting in Dr. M. Djamil Central Hospital Padang and Achmad Mochtar Hospital Bukittinggi from January to March 2017. Samples were recruited through consecutive technique (accidental sampling). Result: Results showed from 101 COPD patients, average age was 65,54 + 9,99 years old. Mostly were male 83,17%, basic education 71,29%, low economical status 58,42%, married 81,19%, ex smoker 71,29%, severe Brinkman index 60,40%. There was correlation between gender (p value =0,002) and marital status (p value =0,010) with anxiety and or depression. Severe COPD patients tend to suffer from anxiety, depression, anxiety and depression, as many as 34,78%, 100% and 54,55%, respectively. Most COPD patients who suffered from anxiety and depression had poor quality of life 28,57%. There was correlation between anxiety and or depression with quality of life among COPD patients p-value= 0,005. COPD patients in D group often had poor quality of life 82,14%. There was correlation between COPD population group and quality of life (p-value=0,001). Conclusion: Anxiety and depression could occur in every stage of COPD, especially severe COPD. There was correlation between anxiety and or depression with quality of life so thus COPD treatment should embrace the comorbid factors. (J Respir Indo 2019; 39(2): 121-9)