Hasil Pencarian  ::  Simpan CSV :: Kembali

"ABSTRAKBackground: Systemic lupus erythematosus (SLE) is an autoimmune disease that more commonly affects women of childbearing age. It is a multi-organ disease and can involve virtually any organ in the body. Pleural effusion can occurred in 30% of patients with SLE, which may be a result of SLE itself, pulmonary emboli, or end-organ damage such as heart or renal failure. The management of pleural effusions in SLE patient can be challenging because the numerous of potential underlying cause and sometimes effusion recur despite appropriate treatment of primary process. Case Report: We reported 33 years old woman patient admitted to our ED with chief complaint of shortness of breath for last 1 week. Chest X-ray result showed bilateral pleural effusion. Serial pleural fluid analysis consistent with conclusion of transudate fluid. Echochardiograpy showed dilatation of left atrium and ventricle and reduced LVEF 34%. These data suggest congestive heart failure as the cause of pleura effusion. A few days after initial thoracocentesis, the patient become dyspnea again because of reccurent pleural effusion. To relieve the symptom, we did insertion of pigtail catheter connected with mini WSD (Water seal drainage). Conclusion: Pleural effusion is a relatively common clinical presentation of a patient with SLE. Pleural effusions may be a result of SLE itself, pulmonary emboli, or end-organ damage such as heart or renal failure. The management of pleural effusions are mainly to relieve the symptoms and treatment of underlying cause."

"Latar Belakang: Pneumonia merupakan infeksi paru yang hingga saat ini masih menjadi masalah kesehatan yang serius di seluruh dunia. Mortalitas dan morbiditas terutama didapatkan pada pasien yang mengalami pneumonia berat. Intubasi dan ventilasi mekanik diperlukan pada sekitar 6% pasien pneumonia. Lebih lanjut lagi, kegagalan ekstubasi berhubungan dengan peningkatan mortalitas pneumonia. Proses imunopatologi yang terjadi pada pneumonia berat dikaitkan dengan peningkatan kadar sitokin proinflamasi seperti IL-6 dan IL-17. Studi prognostik yang telah dilakukan saat ini belum dapat menggambarkan jelas peran sitokin tersebut terhadap terjadinya luaran buruk berupa gagal ekstubasi hingga mortalitas yang terjadi pada pasien pneumonia berat. Penelitian ini bertujuan untuk untuk mengetahui peranan proses imunitas lokal dan sistemik melalui pemeriksaan kadar sitokin pada cairan bilasan bronkus dan darah terhadap luaran buruk dari pneumonia berat.Tujuan: Mengetahui hubungan perbedaan kadar IL-6, 1L-17 darah dan cairan bilasan bronkus terhadap status ekstubasi dan mortalitas pada pasien pneumonia berat.Metode: Penelitian ini menggunakan desain kohort prospektif pada 40 pasien pneumonia berat. Subjek yang direkrut adalah pasien yang terintubasi dan menjalani tindakan bronkoskopi di IGD dan ruang intensif RSCM sejak November 2020 hingga Januari 2021. Analisis bivariat dengan uji beda rerata digunakan pada data skala numerik dengan sebaran normal dan uji Mann Whitney dengan sebaran tidak normal. Subjek penelitian diobservasi untuk keberhasilan ekstubasi 20 hari dan mortalitas 28 hari.Hasil: Pada penelitian ini didapatkan proporsi gagal ekstubasi sebesar 80% dan mortalitas sebesar 75%. Etiologi terbanyak pneumonia berat pada penelitian ini adalah virus SARS-CoV-2 (28 subjek). Pada penelitian ini tidak didapatkan perbedaan secara statistik bermakna dari IL-6, IL-17 darah dan cairan bilasan bronkus pada kelompok subjek yang gagal ekstubasi dan yang berhasil ekstubasi. Tidak didapatkan juga perbedaan secara statistik bermakna dari IL-6, IL-17 darah dan cairan bilasan bronkus pada kelompok subjek yang meninggal dan yang hidup.Kesimpulan: Tidak terdapat hubungan perbedaan kadar IL-6, IL-17 darah dan cairan bilasan bronkus terhadap pasien pneumonia berat yang gagal ekstubasi dan berhasil ekstubasi, serta yang meninggal dan yang hidup.

---

Background: Pneumonia is a lung infection which is still a serious health problem worldwide. Mortality and morbidity are mainly found in patients with severe pneumonia. Intubation and ventilation are required in about 6% of pneumonia patients. Furthermore, extubation failure was associated with increased pneumonia mortality. Immunopathological processes that occur in severe pneumonia related to increased levels of proinflammatory cytokines such as IL-6 and IL-17. Prognostic studies have been carried out to the occurrence of adverse outcomes in patients with pneumonia such as extubation failure and mortality, but still little to know about the role of these cytokines. This study aims to determine the role of local and systemic immune processes through examination of cytokine levels in bronchial lavage fluid and blood on the adverse outcome of severe pneumonia.

Objective: The aim of this study was to determine the association of differences in blood and bronchial lavage levels of IL-6, 1L-17 to extubation status and mortality in patients with severe pneumonia.

Methods: This study was a prospective cohort study of 40 patients with severe pneumonia. Subjects in this study are patients who were intubated and underwent bronchoscopy in the emergency room and intensive care unit of Ciptomangunkusumo Hospital from November 2020 to January 2021. Bivariate analysis with the mean difference test was used on numerical scale data with normal distribution and Mann Whitney U test with abnormal distribution. Study subjects were observed for successful extubation of 20 days and mortality of 28 days.

Results: In this study, the proportion of failed extubation was 80% and the mortality rate was 75%. There were various etiologies of severe pneumonia in the study with SARS-CoV-2 being the major causes (28 subjects). In this study, there was no statistically significant difference between brochoalveolar lavage fluid and blood IL-6, IL-17 in based on extubation status. There was also no statistically significant difference between brochoalveolar lavage fluid and blood IL-6, IL-17 based on mortality status.

Conclusions: There was no association of differences in the blood and bronchoalveolar lavage levels of IL-6, IL-17 on patients with severe pneumonia who failed to extubate and successfully extubated, and those who deceased and those who lived."