Objectives: To improve the quality of invasive pulmonary aspergillosis (IPA) management for intensive care unit (ICU) patients using a practical diagnostic scoring model. Methods: This nested case-control study aimed to determine the incidence of IPA in 405 ICU patients, between July 2012 and June 2014, at 6 hospitals in Jakarta, Indonesia. Phenotypic identifications and galactomannan (GM) tests of sera and lung excreta were performed in mycology laboratory, Parasitology Department, Faculty of Medicine, Universitas Indonesia in Jakarta, Indonesia. Results: The incidence of IPA in the ICUs was 7.7% (31 of 405 patients). A scoring model used for IPA diagnosis showed 4 variables as the most potential risk factors: lung excreta GM index (score 2), solid organ malignancy (score 2), pulmonary tuberculosis (score 2), and systemic corticosteroids (score 1). Patients were included in a high-risk group if their score was >2, and in a low-risk group if their score was <2. Conclusion: This study provides a novel diagnosis scoring model to predict IPA in ICU patients. Using this model, a more rapid diagnosis and treatment of IPA may be possible. The application of the diagnosis scoring should be preceded by specified pre-requisites.

Humanized Virus Suppressing Factor-variant 13 (hzVSF-v13), a monoclonal IgG4 antibody against vimentin, was investigated in moderate to severe COVID-19 pneumonia through a Phase II study. Patients were randomized to two different IV doses of the test drug or saline with standard of care. Overall, 64 patients were recruited, and 62 entered the efficacy assessment in the full analysis set. Primary endpoint: The clinical failure rate at day 28 was 15.8% for placebo, 9.1% for low-dose hzVSF-v13 and 9.5% for high-dose hzVSF-v13 (not significant). A trend toward better efficacy was shown in several secondary endpoints, with statistical significance between low-dose hzVSF-v13 and placebo in terms of the rate of improved patients on the ordinal scale for clinical improvement (OSCI): 90.0% vs. 52.63% (p = 0.0116). In the severe stratum, the results of low-dose hzVSF-v13 vs. placebo were 90.0% and 22.2% for OSCI (p = 0.0092), 9 days and 14 days for time to discontinuation of oxygen therapy (p = 0.0308), 10 days and 15 days for both time to clinical improvement (TTCI) and time to recovery (TTR) and p = 0.0446 for both TTCI and TTR. Change from baseline of NEWS2 score at day 28 was −3.4 vs. + 0.4 (p = 0.0441). The results propose hzVSF-v13 as a candidate in the treatment of severe COVID-19.

Physiological alterations during pregnancy generate higher risk of pulmonary edema and acute respiratory failure. Respiratory failure occurs in 0.2% pregnancy, particularly in postpartum period. Respiratory failure can be developed by specific conditions related to pregnancy, such as preeclampsia and peripartum cardiomyopathy. We present the case of 34-year-old female, with 36 weeks of pregnancy, that came with shortness of breath since an hour before admitted. Patient also had vaginal discharge in the last two hours before admitted. Fetal movement was active. Shortness of breath was accompanied with cough. Physical examination revealed hypertension (160/110 mmHg) and rales on both lungs. Blood gas analysis showed severe hypoxemia. Patient were intubated and underwent C-section afterwards. Chest x-ray showed heart enlargement. Echocardiography result showed fraction ejection 25%, global hypokinetic, mild mitral and tricuspid regurgitation, with conclusion of peripartum cardiomyopathy. This case illustrates respiratory failure in severe preeclampsia and peripartum cardiomyopathy. This condition leads to acute pulmonary edema that impairs ventilation/perfusion process. Mechanical ventilation can assure adequate oxygen delivery. Non-invasive ventilation (NIV) is well suited to short-term ventilatory support, and avoids the potential complications of endotracheal intubation and the associated sedation. (J Respir Indo. 2017; 37(4): 325-36)

Catamenial pneumothorax is a rare primary spontaneous pneumothorax associated with the menstrual phase and is the most common manifestation of thoracic endometriosis syndrome. We report a case of a 32‐year‐old woman with a history of endometriosis who presented to the emergency ward with a chief complaint of dyspnea and right‐sided chest pain, and a chest X‐ray showed a right pneumothorax. Initial management was by placing a chest tube to expand the right lung. The patient underwent a video‐assisted thoracoscopy and talc pleurodesis, during which we found multiple perforations in the tendinous part of the diaphragm. A partial resection of the tendinous part of the diaphragm was done. Our review indicated that primary spontaneous pneumothorax in women should be suspected as catamenial pneumothorax due to thoracic endometriosis. The gold standard procedure for diagnosis and treatment is surgery. Hormonal therapy is an effective choice to prevent and reduce post‐operative recurrence.

The annual incidence rate of KAD is estimated to be between 4.6 and 8 per 1000 patients with diabetes. Based on the results of the physical examination, the patient was diagnosed as pneumonia with KAD. The mortality rate for community pneumonia on outpatients was 2%, inpatients was 5-20%, more so in patients in intensive care that was more than 50%. The problem in the patient is pneumonia. Resulting in pulmonary dysfunction which causes overload. Infections that can increase morbidity and mortality may be associated with Streptococcus infection (group B, S, pneumonia), Legionella and viral infections (influenza). The most common infections are pneumonia and urinary tract infections which account for between 30% and 50% of cases. Therefore, the choice of empiric antimicrobial therapy in diabetic patients with evidence of staphylococcal pneumonia (consistent with sputum smear results or associated soft tissue infection) should be guided by the prevalence of MRSA in the associated institutions. Respiratory failure is a complication of KAD and increases the mortality rate. and morbidity. Based on the high nasal carriage rate, there is an increased risk of staphylococcal pneumonia infection in diabetic patients. Community pneumonia is acute inflammation due to infection of the lung parenchyma acquired in the community. (J Respir Indo 2018; 38(1): 57-63)