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Introduction: ARDS is a type of lung injury that causes inflammation and makes it harder for oxygen to get into the bloodstream. Some treatments have been suggested, such as using less air with each breath, increasing pressure when breathing out, and using special positions or machines to help the lungs. But it's not clear how much these treatments can improve outcomes for patients with ARDS. So far, no studies have looked specifically at whether using more or less mechanical power to help patients breathe affects their chances of survival or other important measures of health. Objectives: This research aimed to investigate how the use of mechanical ventilation affects the likelihood of death in patients who are severely ill with COVID-19. Methods: This study adopts a cross-sectional design and retrospective analysis, observing critically ill patients who are being treated in the Special Isolation Ward of Dr. Soetomo Hospital's intensive care unit. The population for this study consists of critically ill patients who meet the inclusion and exclusion criteria. The research sample is obtained through randomized sampling, where all eligible individuals meeting the criteria are included in the sample size. Results: The study findings reveal a correlation between mechanical ventilation power and mortality among COVID-19 patients with ARDS. The mechanical power of ventilation is identified as a significant variable in this study, with a cut-off point of 17.4. Patients above this cut-off point are at 3.65 times higher risk of death compared to those below it. Moreover, there is evidence of a relationship between the mechanical power of ventilation variable and the P/F Ratio, as a higher mechanical power is associated with a decrease in the P/F Ratio. Conclusions: The study has identified a correlation between the P/F Ratio variable and mortality in COVID-19 patients with ARDS. On the other hand, there is no evidence of a relationship between the compliance variable and mortality in COVID-19 patients with ARDS. © 2023, Journal for ReAttach Therapy and Developmental Diversities. All Rights Reserved.
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Background: COVID-19 has spread rapidly around the world. It is necessary to study lung tissue of postmortem COVID19 patients to determine the molecular alteration particularly the role of IL-6 and IL-17 in causing fatality. Background: This study aims to determine the differences in the expressions of IL-6 and IL-17 in lung tissue of post-mortem COVID-19 patients compared to non-COVID-19 patients. This study also aimed to analyze the correlation between the expressions of IL-6 and IL-17 in lung tissue of post-mortem COVID-19 patients. Methods: This research is an observational analytic study with crosssectional approach. The samples were 15 paraffin blocks of post-mortem lung tissue biopsy of COVID-19 patients, and 15 paraffin blocks of inflammatory lung tissue biopsy or surgery of non-COVID-19 patients. IL-6 and IL-17 expressions were evaluated by immunohistochemical procedure. Result: There was a significant difference in the expression of IL-6 in the COVID-19 group and the non-COVID-19 group with a p-value = 0.001 (p < 0.05). There was a significant difference in the expression of IL-17 in the COVID-19 group and the non-COVID-19 group with p-value = 0.001 (p < 0.05). There was a significant correlation between the expressions of IL-6 and IL-17 in the COVID-19 group, with the Spearman coefficient value (rs) of 0.548 with p = 0.034 (p < 0.05). Conclusion: There are differences in the expression of IL-6 and IL-17 between COVID-19 and non-COVID-19 lung tissue. There is a significant correlation between the expressions of IL-6 and IL-17 in post-mortem lung tissue of COVID-19 patients.
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Introduction: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARSCoV-2) infection, may result in musculoskeletal tissue injury and is assumingly regulated through central and peripheral pathways. Muscle-specific creatinine kinase (CK-MM) is a specific biomarker used to indicate the presence of musculoskeletal tissue damage. This study aimed to investigate the correlation between the levels of CK-MM and the incidence of persistent myalgia in patients with post-COVID-19 syndromes.Methods: A cross-sectional study was conducted among COVID-19 survivors at the Faculty of Medicine and Clinical Pathology Laboratory, Universitas Airlangga, Surabaya from June - August 2022. The degree of pain of the myalgia was assessed using a visual analog scale (VAS), while CK-MM level was measured using a sandwich enzyme-linked immunosorbent assay (ELISA). Pearson correlation test at alpha=0.05 was used to identify the correlation between the levels of CK-MM and the incidence of persistent myalgia in patients with post-COVID-19 syndromes.Results: A total of 84 participants were enrolled in the study and half (50%) of them reported persistent myalgia postCOVID-19 recovery. Fatigue was the patients' most common persistent symptom (63%). Of the total 42 patients with persistent myalgia, more than half (56%) had mild pain intensity (VAS score: 1-3), and almost all of them (41 patients) experienced myalgia during the COVID-19 diagnosis. All the patients with post-COVID-19 myalgia had normal levels of CK-MM (mean: 32.7 ng/mL;range: 12-93 ng/mL), suggesting no musculoskeletal tissue damage. Anova test suggested no significant different of CK-MM levels between those with and without myalgia in patients with post-COVID-19 syndromes p=0.054).Conclusion: There was no significant association between CK-MM levels and the incidence of persistent myalgia in patients with post-COVID-19 syndromes.
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Background: The first COVID-19 case in Indonesia was reported on 2 March 2020. The pandemic has been in 34 provinces in the country since 9 April 2020 and continues to increase, making it a country with the highest number of cases and the highest death rate in Southeast Asia on 17 June 2020 with 1031 new cases and 2067 deaths. Definitive therapy for COVID-19 patients has not been found;however, convalescent plasma is one of the therapeutic options. Based on previous experience with other viral infections, the use of convalescent plasma has been proposed as a passive immunization therapy for patients with acute COVID-19. Aims: This study aimed to evaluate anti-spikes IgM antibody, the correlation between anti-spike's-Receptor Binding Domain (sRBD) IgG antibody and the cycles threshold value of Polymerase Chain Reactions test and outcome after convalescent plasma therapy in severe and critical COVID-19 patients. Methods: This study was an analytic observational study with a prospective cohort design in severe and critical patients who received convalescent plasma therapy for COVID-19. Blood samples and nasopharyngeal swabs were taken from the patient 1 day before and followed on day 1, 2 and 7 after administration of convalescent plasma. A total of 164 serum samples from 41 patients were examined for anti-spike IgM and anti-sRBD IgG antibodies by chemiluminescence method using the ARCHITECT i1000SR system. The SARS-CoV-2 Polymerase Chain Reactions test was carried out on a nasopharyngeal swab. Patient outcomes (recovered or dead) were observed within 30 days from the diagnosis of COVID-19. Results: Anti-spike IgM and anti-sRBD IgG antibodies significantly increased after convalescent plasma therapy (p < 0.001). There was no correlation between increased levels of anti-sRBD IgG antibody and increased cycles threshold value of Polymerase Chain Reactions test (rs = 0.075;p = 0.643). There was no correlation between increased levels of anti-sRBD IgG antibody and patient outcome (rs = 0.327;p = 0.083). Summary/Conclusions: Anti-spike IgM and anti-sRBD IgG antibodies increased after convalescent plasma therapy;however, there was no significant correlation between increase in anti-sRBD IgG, increase in cycles threshold value and patient outcome.
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The purpose of this study was to analyze and determine the cut-off level of sCD25 as a predictor of mortality in COVID-19 patients. In an observational analytic study with a prospective cohort design, the study population was COVID-19 patients who were hospitalized at RIK RSUD Dr. Soetomo Surabaya for the period July 2020-December 2020. Sampling was taken by consecutive sampling, divided into two groups, mild-moderate and severe-critical groups. The examination of sCD25 levels in both groups was carried out on day-0 and day-6 of hospitalization using the sandwich ELISA method. The paired group statistical analysis used the Wilcoxon range test, the unpaired group used the Mann Withney U test. ROC curve analysis to determine the cut off level of sCD25 as a predictor of mortality. There were a total of 83 study patients consisting of 36 patients in the mild-moderate group, 47 patients in the severe-critical group. There was a difference in sCD25 levels between mild-moderate COVID-19 patients who were treated on day-6 compared to day-0, whereas in the severe-critical group there was no difference in sCD25 levels. There was a difference in sCD25 levels in COVID-19 patients between the mild-moderate group by severe-critical. The level of sCD25 with a cut off of 3.14 ng/mL (AUC 0.719, p = 0.001) can be used as a predictor of mortality in COVID-19 patients with a sensitivity of 96.2%, a specificity of 47.4%. Levels of sCD25 >3.14 ng/mL can be used as a predictor of mortality in COVID-19 patients.
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The unknown pneumonia was first found in Wuhan, China in December 2019. A novel corona virus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was isolated from lower respiratory tract swab in infected patient. The disease caused by this novel virus was then named as COVID-19 (Coronavirus Disease 2019). We report a male patient with urticarial lesions, varies on size and shape on the both arms and both legs and diagnosed with COVID-19 confirmed case. He was treated with powdered oral medicine containing combination of lopinavir and ritonavir. He developed urticarial lesions in three hours after administration of the drug. The lesions then dissapeared and resolved after 4 days of treatment using cetirizine. The conclusion of this case is still needed to be proven whether the urticarial lesion is related to COVID-19 or drugs used for COVID-19 therapy. © 2021 Pakistan Association of Dermatologists. All rights reserved.
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Noninvasive ventilation (NIV) is one of the alternative therapies for patients with respiratory failure or acute respiratory distress syndrome to avoid endotracheal intubation and its adverse effects. COVID-19 is a disease attacking respiratory system, inducing hypoxic-type respiratory failure. This case report describes that NIV application is somewhat useful in a number of patients with COVID-19 pneumonia suffering from respiratory failure. Nevertheless, in some cases, endotracheal intubation was done. Meticulous observation on deteriorating clinical and laboratory signs is required to make an immediate decision to switch into invasive ventilator to avoid further worsening. © 2020 Bali Journal of Anesthesiology. All rights reserved.
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SARS-CoV-2 was first isolated in bronchoalveloar lavage (BAL) fluid from three patients with COVID-19 at Jinyintan Hospital in Wuhan, Hubei Province, China. The cases are increasing quickly with global mortality rate of 2.12%. The main cause of COVID-19 death is hypoxic respiratory failure due to acute respiratory distress syndrome (ARDS). Endothelial cell damage has a central role in ARDS pathogenesis and multi-organ failure in COVID-19. The endothelium, under homeostasis condition, is surrounded by mural cells (pericytes), which maintain vascular integrity and barrier function. These cells prevent inflammation by limiting the interaction of endothelial cells with immune cells and platelets and inhibit coagulation by expressing coagulation inhibitors and blood-clotting enzymes and producing glycocalyx. Vascular endothelial glycocalyx has a crucial role in endothelial function and is degraded systemically in elderly conditions and various comorbidities, which can be a potential mechanism for the development of lethal complications from COVID-19. Glycocalyx degradation due to endotheliopathy in SARS-CoV-2 infection causes increased levels of its fragments such as syndecan-1 and hyaluronan in the blood. Data from previous studies showed that the levels of these two biomarkers increased significantly in septic patient and several viral infections such as Kawasaki and dengue. These biomarkers are also markers of organ damage. Therefore, it can be indicated that hyaluronan and syndecan-1 are significant prognostic markers for morbidity and survival in COVID-19 patient. © 2021 Teikyo University School of Medicine. All rights reserved.