Background: High Sensitive C-Reactive Protein (hsCRP) is an acute phase protein which may be used as a sensitive marker for increased risk of cardiovascular events in Obstructive Sleep Apnea (OSA) subjects. Methods: This was a cross-sectional study to evaluate hsCRP as a sensitive marker for cardiovascular events in Obstructive Sleep Apnea (OSA) subjects.

Background: Severe manifestation of COVID-19 are identical with significant inflammation and associated with high mortality due to severe hypoxemia. Bronchoscopy’s role in the management of COVID-19 patients is still controversial and minimally evaluatedCase presentation: Our case series reported unique bronchoscopy presentation. Three patients with COVID-19 were confirmed by PCR nasophryngeal swab suddenly complain of progressive dyspnea and impending respiratory failure not respond with oxygen therapy. An emergency bronchoscopy was performed. All three patient had a normal bronchial wall without inflammation and edema but showed significant thick and copious mucus plug resulting in sudden desaturation. Patient showed significant clinical improvement following bronchoscopy intervention showed by clinical and chest x-ray improvement. Conclusion : Deteriorating severe COVID-19 patient can have normal bronchial mucosa in bronchoscopy and showed marked thick and copious mucus plug. Bronchial washing and suction can be a life-saving modality as therapeutic effort. Significant improvements following the bronchial washing and suction was seen. Bronchoscopy should be performed with precaution and sufficient personal protective equipment to prevent infection transmission.

Tuberculosis is still rampant, despite the centuries of efforts to conquer it. Indonesia is host to the third highest TB burden in the world, with an uneven distribution of health care access, and especially to highly sensitive and specific molecular investigations. Rapid and accurate TB diagnosis is crucial for the control of the infection. An AFB smear test is easily accessed and is cost-effective, although there are a number of shortcomings with the approach. We report here on a case of negative acid-fast bacilli (AFB) smear disseminated tuberculosis (TB) in a previously healthy 23year-old Indonesian female who presented to a secondary care facility with pulmonary, pericardial, peritoneal, utero-ovarian, genitourinary and splenic involvement. The clinician chose to start antituberculosis therapy without a positive microbiology and biopsy for bacterial load containment purposes, considering also the patient's clinical and endemic epidemiology. The diagnosis was confirmed with a positive mycobacterial culture after the initiation of anti-tuberculosis therapy. In the present study, we also review the diagnosis of 20 other cases of disseminated tuberculosis reported in other countries.

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Methods and Results:In this retrospective study, we reviewed patients who had undergone surgical(SAVR) or percutaneous(TAVR) aortic valve replacement who had at least 2 echocardiograms >6 months apart prior to the procedure at the Alfred hospital. We also reviewed patients who had known AS with echocardiograms >5 years apart showing minimal progression (<10mmHg gradient rise in 5 years). There were 133 patients (mean age 69.8 years ± 10.6)(Male n=80, Female n=58) with a mean follow-up of 5.6+/-2.9 years. The clinical factors analysed included age, gender, coronary artery disease, calcium, phosphate, estimated Glomerular-Filtration-Rate, diabetes, HbA1c and body mass index. The echocardiographic factors analysed were AVA, transvalvular peak velocity, ejection fraction, fractional shortening and DPI. The fast progressors[mean pressure gradient(MPG) increased by >5mmHg per year] have a smaller initial AVA(1.2cm2+/-0.4) compared with the slow progressors(MPG <5mmHg per year)(1.7cm2+/-0.4), p<0.001. The fast progressors have a lower DPI(0.39+/-0.20) compared to the slow progressors(DPI 0.45+/-0.12), p<0.034. The remaining clinical and echocardiographic factors were not significant. All the fast progressors patients required either SAVR or TAVR while only 49% of the slow progressors patients required AVR.Conclusion: In patients with AS, the initial AVA and DPI predicts fast progression. Patients with mild-moderate AS by gradient but a low AVA or DPI require regular monitoring as they are more likely to progress rapidly to severe AS.http://dx.