ABSTRACT
A 25 year old man presented with three days of cough, shortness of breath, and pleuritic chest pain. Initial vital signs in the ED were normal, and exam demonstrated tonsillar erythema without exudate. Labs revealed a leukocytosis of 18.9k/muL, D-dimer of 690 ng/mL, C-reactive protein of 5.7 mg/dL, and lactate elevated to 2.9 mmol/L. High-sensitivity troponin, NT-proBNP, and SARS-CoV-2 RT-PCR were all negative. Presenting electrocardiogram demonstrated PR elevation in aVR with diffuse ST-segment elevation in the inferior and anterolateral leads. Point-of-care echocardiogram demonstrated normal biventricular function without pericardial effusion. CTPA was negative for pulmonary embolism, and he was observed for presumed acute viral pericarditis. Fourteen-hours later, he became febrile to 38.3degreeC, tachycardic to 133 bpm, and hypotensive to 97/65 mmHg with diffuse abdominal pain. Repeat lactate was 9.0 mmol/L. This prompted an emergent CT scan which now showed a new large pericardial effusion and bilateral pleural effusions (Panel A). Repeat echocardiogram confirmed a large circumferential pericardial effusion with early signs of tamponade including right atrial inversion in late diastole (Panel B). Emergent pericardiocentesis yielded 560 mL of brown, purulent fluid (Panel C) with immediate improvement in hemodynamics. Bacterial gram stain and culture grew Haemophilus influenzae (Panel D). Immunodeficiency screening was negative. Transient severe biventricular systolic dysfunction was noted, consistent with sepsis-induced cardiomyopathy. He completed a targeted antibiotic course with partial recovery of his ejection fraction by discharge. Purulent pericarditis is rare in developed countries, and invasive H. influenzae in a young, immunocompetent adult is particularly unusual. This case illustrates the importance of early diagnosis and management of purulent pericarditis given its potential for rapid progression and high mortality. (Figure Presented).
ABSTRACT
BACKGROUND: Indonesia faces serious challenges from a double burden disease caused by changes in people’s lifestyles. Hypertension, stroke, heart disease, and diabetes have taken up a growing share of health expenditure. These diseases are the comorbid of COVID 19 and strongly require routine health monitoring. Health monitoring will greatly develop along with the development of technology and information 4.0. AIM: This study aims to implement the healthy living community movement programs using automatic telehealth machine (ATM) for health checking and education at Politeknik Kesehatan Kemenkes Palu. METHODS: This research method is intervention research. The population were 167 employees of Poltekkes Kemenkes Palu. Sampling process used simple random sampling method with sample size consist of 96 people. The measuring instrument used are ATM device and a questionnaire that has been tested for validity and reliability. Analysis of research data using frequency distribution and bivariate test. RESULTS: The study revealed the characteristic of respondents including gender and age, physical activity was generally good, and fruits intake was also good. The variables that were significantly related to systole were gender and age category (p = 0.03). The variables which were significantly related to diastole were gender (p = 0.02) and age category (p = 0.01). The results revealed that gender, age, physical activity, and fruits intake were not associated with total cholesterol levels. CONCLUSIONS: ATMs can be implemented for health checking and education in healthy living community movement programs.