BACKGROUND: Exercise tolerance is one of the main impacts of COPD. COPD patients often experience dyspnea and fatigue after doing daily activities using their limb parts, even in simple thing such as lifting or grooming. Nowadays, many pulmonologists concerned in pulmonary rehabilitation to modify some limb training with breathing manoeuvre to get positive impact in stable COPD patient. AIM: The purpose of this study is to examine the impact of this modified upper limb training in lung function, functional capacity, dyspnea scale, and quality of life in patients with stable COPD. METHOD: This was a quasi-experimental study held in 2017 on 22 stable COPD patients (based on GOLD 2018 criteria). Patients were given modified upper limb training with breathing manoeuvre that leads and monitored by a physiotherapist and physician in 10-20 minutes twice a week for 8 weeks. Before and after completed all sessions of training, we measured pulmonary functions test include FEV1 and FVC, functional capacity by 6 MWT, dyspnea scale by mMRC, and quality of life by CAT assessment. Statistical analysis was performed by Wilcoxon and paired t-test. RESULTS: There was an improvement of lung function, both FEV1 (40.7 ± 13.8 to 47.3 ± 14.2; p-value 0.001) and FVC (50.7 ± 14.1 to 54.1 ± 14.7; p-value: 0.207) after training. There was a significant change of functional capacity in 6 MWT mean (277.3 ± 80.8 to 319.1 ± 78.3; p-value: 0.001). There was an improved quality of life after training, measured by decreasing in CAT score (23.9 ± 5.5 to 18.3 ± 5.2; p-value: 0.000). There was no significant change in the mMRC scale (p-value: 0.429) CONCLUSION: There was an improvement of lung function, functional capacity, and quality of life in stable COPD after upper limb training with breathing manoeuvre in stable COPD patients.

As Indonesia’s rifampin resistance testing rates are lower than global testing rates per the 2020 WHO global tuberculosis (TB) report, prevalence of multidrug-resistant TB may be underestimated. Our study aimed to evaluate prevalence and patterns of TB drug resistance (DR) within Indonesia. We conducted a cross-sectional analysis of baseline data collected from 2017–2018 as part of a cohort study of adults with presumed pulmonary TB at 7 DR-TB referral hospitals in Indonesia. Bacteriological examinations (acid-fast bacilli, GeneXpert, sputum culture) and drug-susceptibility testing were performed following the guidelines of the National TB Program. Of 447 participants with complete bacteriological examinations, 312 (69.8%) had positive sputum cultures for Mycobacterium tuberculosis. The proportion of MDR and pre-extensively drug-resistant was higher in previously treated compared with newly diagnosed participants (52.5% [73/139] versus 15% [26/173]). Compared with drug-sensitive case, drug-resistant TB was associated with cavities. Given the difference between rates of DR in TB referral hospitals from our study compared with the WHO survey in 2019 that showed 17.7% and 3.3% DR among previously treated and newly diagnosed participants globally, further characterization of Indonesia’s TB epidemiology in the general population is needed. Strategies, including public policies to optimize case finding, strengthen capacity for resistance testing, and prevent loss to follow-up will be critical to reduce the burden of TB in Indonesia.

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Background: Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). The increase in the number of COVID-19 cases was happening quite quickly and has spread between countries so that COVID-19 has become a pandemic in the world. This study aimed to determine the characteristics of COVID-19 patients at Haji Adam Malik General Hospital Medan. Method: This was a descriptive study. Data were taken from the medical records of 110 hospitalized patients with positive RT-PCR results for COVID-19 from December 2020 to April 2021. The inclusion criteria for the case samples were patients diagnosed with COVID-19 based on RT-PCR and the exclusion criteria were incomplete medical records. Characteristic analysis was carried out using the Kruskal Wallis test. Results: The most common comorbidities found in patients with severe COVID-19 were diabetes mellitus and HIV. The most common comorbidity found in moderate-level COVID-19 patients was pregnant women. The most common chest X-rays finding in severe and critical levels was bilateral infiltrates. Recovered patients were mostly obtained at moderate level, while deceased patients were mostly observed at critical levels. Conclusion: Characteristics of COVID-19 patients at Haji Adam Malik General Hospital were classified based on the degree of disease by age, lymphocyte value, N/L ratio, levels of CRP, D-dimer, procalcitonin, fibrinogen, ferritin, and comorbidities as well as the appearance of infiltrates in both lung fields.

AbstrakTuberkulosis (TB) adalah penyakit menular yang sampai sekarang masih menjadi masalah kesehatan dunia. Vitamin D dapat berperan melawan bakteri Mycobacterium tuberculosis melalui mekanisme cathelicidin intraseluler. Penelitian ini bertujuan mengetahui pengaruh pemberian vitamin D terhadap perbaikan foto toraks pada pasien TB paru beretnis Batak. Sebanyak 42 pasien yang memenuhi kriteria inklusi diambil dari beberapa puskesmas di Kota Medan dan Kabupaten Deli Serdang selama bulan Januari-Juni 2016. Penelitian ini adalah penelitian analitik dengan desain eksperimental murni tersamar tunggal (single-blind randomized controlled trial). Pasien dibagi secara acak menjadi kelompok vitamin D dan kelompok plasebo. Kelompok vitamin D diberikan tablet vitamin D oral 100.000 IU (2,5 mg) sebanyak 4 kali pemberian (minggu ke-0, 2, 4, 6). Kedua kelompok diperiksa kadar vitamin D dan foto toraks sebelum dan sesudah pengobatan selama 8 minggu. Hasil penelitian menunjukkan bahwa kelompok dengan pemberian vitamin D menunjukkan kenaikan kadar vitamin D secara signifikan (p=0,00) dibanding dengan kelompok yang diberi plasebo (0,26). Tidak ada perbedaan yang bermakna pada perbaikan foto toraks (p=0,06) antara kelompok vitamin D dan plasebo, tetapi jumlah subjek yang mengalami perbaikan foto zona paru pada kelompok vitamin D lebih banyak dibanding dengan kelompok plasebo (2:1). Simpulan, pemberian vitamin D tidak memengaruhi perbaikan foto toraks pada pasien TB paru beretnis Batak. Kata kunci: Foto toraks, suku Batak, tuberkulosis, vitamin D The Effect of Vitamin D on Chest X-ray Profile in Batak Ethnicity Pulmonary Tuberculosis Patients AbstractTuberculosis is an infectious disease that is still a global health problem. Vitamin D may play a role in fighting the bacteria Mycobacterium tuberculosis through the mechanism of intracellular cathelicidin. This study aimed to determine the effect of vitamin D on the improvement of chest x-ray in patients with pulmonary tuberculosis from Batak ethnicity. As much as 42 patients who met the inclusion criteria taken from several clinics in Medan City and Deli Serdang District in January to June 2016. This is a analytical study using single-blind randomized controlled trial design. Patients were divided into groups of vitamin D and placebo groups. Vitamin D group was given vitamin D tablet 100,000 IU (2.5 mg) orally 4 times (0, 2, 4, 6 weeks). Levels of vitamin D and chest x-ray before and after 8 weeks of treatment were examined. The results showed that group with vitamin D levels increased significantly (p=0.00) compared to the placebo group (0.26). There was no significant difference in the improvement of thoracic images (p=0.06) between group with vitamin D and placebo groups. However, the number of subjects who experienced improvement of lung zone images in the vitamin D group more than the placebo group (2:1). In conclusion, vitamin D does not affect the improvement of chest x-ray in patients with pulmonary tuberculosis from Batak ethnicity.