Introduction The spectrum of illness and outcomes of coronavirus disease 2019 (COVID-19) patients may vary. This study reports the characteristics of COVID-19 patients in Bali, Indonesia, and evaluates the diagnostic value of their clinical symptoms. Method This observational study was conducted in eight hospitals. The patients were classified as non-severe COVID-19, severe COVID-19, and non-COVID-19. Demographics, clinical, laboratory, and radiologic characteristics, and outcomes of COVID-19 patients were collected. Factors associated with the severity and outcomes were assessed using the chi-squared test or ANOVA when appropriate. We also compared the clinical features of non-severe COVID-19 and non-COVID-19 patients to evaluate the diagnostic accuracy. Results This study included 92 patients: 41 non-COVID-19 and 51 COVID-19 patients, comprising 45 non-severe and six severe cases. The most common symptoms of COVID-19 were cough (47.1%), fever (31.0%), and dyspnea (25.3%). Cough, fatigue, and anosmia have high accuracy, and combining these complaints in clinical diagnostics offered a higher accuracy in predicting COVID-19 patients (60.1%). We found lower lymphocyte counts and interleukin-1R levels and higher levels of C-reactive protein, interleukin-6, and interleukin-8 in severe compared than in non-severe COVID-19 patients. Lactate dehydrogenase was associated with intensive care unit admission and ventilator use, while other markers such as neutrophil-lymphocyte ratio, C-reactive protein, and interleukin-6 were not. Conclusion A battery of symptoms, including cough, fatigue, and anosmia, is likely associated with COVID-19 in Bali. Clinicians should be aware of these symptoms to ensure a prompt diagnostic test for COVID-19, beyond other causes of acute febrile illnesses.

The gold standard for TB still has some drawbacks, such as a long duration for culture examination and the rolated facilities are notalways available in all laboratories. One of methods in diagnosing tuberculosis infection is by immunochromatography (ICT). MYCOTECTB xp (recombinant) is one of serologic tests using immunochromatography principle. MYCOTEC TB xp uses recombinant antigens 38kDa, 16 kDa, 6 kDa and Early Secreted Antigen Target (ESAT-6). This method is expected so far diagnose TB in a short time and has ahigh accuracy. Evaluating the immunochromatography method in detecting antibody by tuberculosis antigen in lung TB patients as willthose with nonTB lung disease (lung tumor, bronchial asthma, pneumonia, chronic obstructive lungdisease). Serum samples of 30 TBpatients in BP4/Karang Tembok Hospital Surabaya and 30 non TB patients in the Dr. Soetomo Hospital Surabaya. Detection of antibodyto tuberculosis antigen was done with MYCOTEC TB xp. In this study found is prond 30 TB patients using MYCOTEC TB xp was positivein 23 samples and negative in 7 samples. From the 30 nonTB patients MYCOTEC TB xp was positive in 4 samples and negative in 26samples. It can be uncloaded so far that the diagnostic sensitivity of MYCOTEC TB xp was 76.7% (23/30) and diagnostic specificity was86.7% (26/30). MYCOTEC TB xp has an intermediate diagnostic sensitivity of 76.7% and a high diagnostic specificity of 86.7%.

HIV & AIDS have become a global problem throughout the world including Indonesia. The incidence is rapidly increasing. Various treatment and efforts have been carried out but until now have not yet been succeeded, the mortality remains high. Examination of CD4+ lymphocyte-T which is carried out to determine the immune status and monitoring the treatment has some limitation. Besides the degradation of CD4+ lymphocyte-T, the increase of the disease progression is also followed by an increase of interleukin-10 as well. The determination of interleukin-10 is expected to be use as an alternative examination if CD4+ lymphocyte-T can not be performed. To analyze the correlation between the levels of plasma interleukin-10 and amount of CD4+ lymphocyte-T in the asymptomatic HIV infected patients. A cross sectional, observational analytical study of 41 patients with HIV infection stage I, has been conducted from March–April 2009, at the Intermediate Infectious Disease Care Unit Dr. Soetomo General Hospital, Surabaya. The diagnosis of HIV patients was based on positive result of HIV test using three (3) different methods. Eight mL venous blood were taken from each patient, 6 mL is put into a heparin tube for the examination of IL-10 plasma with ELISA method and 2 mL is put into a K3EDTA tube for examining the CD4+ lymphocyte-T using flowcytometry. The results showed of plasma IL-10 level and the amount of CD4+ lymphocyte-T, which were analyzed by Pearson correlation test to determine the correlation between the two (2) variabels. The IL-10 levels in HIV patients were 3.80–44.50 pg/mL (mean 18.09 pg/mL, SD 8.84 pg/mL). The amount of absolute CD4+ lymphocyte-T was 5–846 cells/µL (mean 322.07 cells/µL and SD 221.89 cells/µL), while the amount of percentage CD4+ lymphocyte-T was 0.41–29.48% (mean 13.99%, SD 7.62%). Statistical analyzes show a significant negative correlation either between plasma IL-10 level with absolute CD4+lymphocyte-T and plasma IL-10 level with percentage of CD4+ lymphocyte-T, e ach level of r was –0.652 and –0,683. A significant negative correlation was also formed between plasma IL-10 level and the amount of CD4+ lymphocyte-T in the HIV infected patients. In the HIV infected patients, the increase of plasma IL-10 level was followed by a decrease of CD4+ lymphocyte-T.

Background: Myastenia gravis (MG) is a neuromuscular junction disorder that causes significant disability in the patient. Plasmaparesis and thymectomy are some therapeutic modalities in MG patients. Patients with MG of 10-15% had thymoma and 60% occurred thymic hyperplasia. Thymectomy may improve MG outcomes in 54-94% of patients (thymoma cases) or 21-42% of patients (cases of thymic hyperplasia). Plasmaparesis perioperatif still controversial. Case report: The 60-year-old man comes with a complaint both eyelids often close and both hands and feet experience fluctuating weakness, improved at rest. Patients with a history of DM and pulmonary TB. On the physical examination obtained eyelid twitch response and improved ptosis on ice test. Laboratory shows hyperglycemia and thrombocytopenia. Electrophysiological examination supports neuromuscular junction lesions. In thoracic and thoracic rectal images the mediastinal mass was obtained. Patients were diagnosed with myastenia gravis with suspected thyroid mediastinal mass. Treatment given mestinon 60 mg every 8 hours peroral, thymectomy plan, platelet transfusion, and plasmaparesis. Obtained a tumor with a large 10x8x7 cm with adhesions around the organ. Microscopic features support a thymoma A. Patients receive perioperative plasmaparesis 1 series (5x administration) divided, 2 preoperative and 3 postoperative times. The patient used mechanical ventilation for less than 24 hours and no residual symptoms. Conclusion: Myastenia gravis grade IIa (Osserman) with thymoma A performed extended thymectomy. Plasmaparesis given pre and post surgery showed clinical improvement and duration of short ventilator use. Good prognosis associated with mild MG degree, no myastenia crisis. Keywords: myastenia gravis, thymectomy, plasmaparesis