Background: Mesenchymal stem cells (MSCs) are known to have immunomodulatory, anti-inflammatory, anti-apoptotic, and angiogenesis effects that are useful for relieving inflammation, recovery, and protection of lung tissues in COVID-19 patients. Secretome, a secretory product of MSCs, has several advantages over MSCs. We conducted a study to investigate secretomes’ effectiveness and safety profile as a treatment for severe COVID-19.  Methods: A double-blind, multicenter, randomized, placebo-controlled trial was conducted between February 2021 and July 2021 in three top COVID-19 referral hospitals in the Greater Jakarta area, Indonesia. Eligible subjects (n=40) were randomized in a 1:1 ratio to an intervention group (n=20) and a control group (n=20). The primary outcome of this study was the changes in inflammatory markers and the ratio of inflammatory to anti-inflammatory markers. The secondary outcomes of this study included clinical outcome, laboratory outcome, radiological outcome, RT-PCR result conversion, and safety profile of MSC secretome. Results: Our analysis showed that on the 14th day after placebo administration, IL-6 level in the control group was significantly increased [4.110 (2.403–12.820) at baseline to 13.320 (2.958–33.285) on the 14th day after intervention, p=0.017]. The IL-6/IL-10 ratio in the control group was significantly increased (p=0.036) on the 14th day after placebo administration. We also found that most of the subjects who received placebo had high levels of IL-6 and ferritin (p=0.043) on the seventh day after the intervention. However, we found no significant differences in inflammatory marker levels on the seventh day and 14th day after intervention between both groups. There was no adverse event reported. There were no significant differences in the laboratory outcome, radiology outcome, RT-PCR result conversion, and safety profiles between both groups. Conclusions: MSC secretome can control inflammation in patients with severe COVID-19 and has a good safety profile. MSC secretome is a promising treatment modality for severe COVID-19.

COVID-19 cases are still rising globally in the middle of the tuberculosis epidemic. Several countries have reported TB-COVID-19 coinfection that could pose a double burden in the health care facilities in developing countries. We reported two pulmonary tuberculosis patients coinfected with COVID-19 with an overlapping clinical manifestation of tuberculosis and COVID-19 with a good prognosis at the end of COVID-19 treatment. This paper aims to discuss TB patients' susceptibility against SARS-COV-2 infection, the clinical profile of TB-COVID-19 coinfection, and the disease's prognosis. The clinician should be aware of both common disease symptoms that appear in a patient and should be confirmed and treat promptly.

Background The severe acute respiratory syndrome COVID-19 declared as a global pandemic by the World Health Organization has become the present wellbeing worry to the whole world. The latest development of COVID-19 spread in Indonesia has reached 1.024.298 cases, with 28.855 patients died, updated on January 28, 2021. Unfortunately, these numbers continue to overgrow, and no drug has yet been approved for effective treatment. There is an emergent need to search for possible medications and explore the potential of Indonesian herbal compounds. Ministry of Health Indonesia stated that Psidium guajava can be use as daily nutritional supplement during COVID-19 pandemic. This study aims to determine the potential active constituents in Psidium guajava as an inhibitor for multiple SARS-CoV-2 proteins using molecular analysis. Methods Molecular docking was performed by using Autodocktools 1.5.6. We performed a structure-based virtual screening of fourteen 3D structure of Psidium guajava compounds, three antivirals (lopinavir, remdesivir, and ritonavir) against multiple SARS-CoV-2 proteins. We download the main protease (3CLPro), Papain Like Protease (PL Pro), MPro, Spike and ACE2 as protein target from human against from Protein Data Bank (PDB). We used PyMOL to analyse the interactions between the SARS-CoV-2 proteins and 14 compounds from Psidium guajava and three antiviral (lopinavir, remdesivir and ritonavir) used as positive control. Results Based on the molecular docking analysis, it was found there are two potential compounds that showed higher binding affinity score namely gamma sitosterol and peri-xanthenoxanthene-4,10-dione,2,8-bis (1-methylethyl). Conclusions Gamma sitosterol and peri-xanthenoxanthene-4,10-dione,2,8-bis (1-methylethyl) from Psidium guajava have potential as antiviral candidates for SARS-CoV-2 multiple proteins such as main protease (3CLPro), Papain Like Protease (PL Pro), MPro, Spike and ACE2.

Approximately 1.41 million people die annually due to tuberculosis. One of the main problems in Tuberculosis eradication is the development of resistance to various antibiotics. However, current efforts to detect resistances face challenges such as limited equipment, budget, and time. This evidence-based review investigated loop-mediated isothermal amplification, an alternative molecular diagnostic tool with promising performance and applicability in developing countries, and its use combined with Au-Nanoprobe to detect antibiotic resistance in tuberculosis. The literature search was conducted through four databases (Proquest, EBSCOhost, Scopus, and Pubmed) for useful articles on loop-mediated isothermal amplification and Au-Nanoprobe in detecting tuberculosis and tuberculosis resistance. After filtering the result with inclusion and exclusion criteria, the search produced three papers that best answer the clinical question. Loop-mediated isothermal amplification amplifies a target sequence, and Au-Nanoprobe responds to the DNA specific to the target mutant, producing an observable color change. Loop-mediated isothermal amplification and Au-Nanoprobe showed 100% sensitivity and specificity in detecting rifampicin and isoniazid resistance. Another study investigated its viability to detect tuberculosis and found 98.2% sensitivity and 88.2% specificity. Combining loop-mediated isothermal amplification and Au-Nanoprobe had a shorter time to get results and should also be relatively cheaper because it does not need a high temperature to work and requires less equipment. In conclusion, loop-mediated isothermal amplification and Au-Nanoprobe can be used as an efficient and accurate method to detect isoniazid and rifampicin-resistant tuberculosis strains. The new technology is promising for developing countries due to their high disease burden but facing several healthcare barriers.

Background: Mesenchymal stem cells (MSCs) are known to have immunomodulatory, anti-inflammatory, anti-apoptotic, and angiogenesis effects that are useful for relieving inflammation, recovery, and protection of lung tissues in COVID-19 patients. Secretome, a secretory product of MSCs, has several advantages over MSCs. We conducted a study to investigate secretomes’ effectiveness and safety profile as a treatment for severe COVID-19.  Methods: A double-blind, multicenter, randomized, placebo-controlled trial was conducted between February 2021 and July 2021 in three top COVID-19 referral hospitals in the Greater Jakarta area, Indonesia. Eligible subjects (n=40) were randomized in a 1:1 ratio to an intervention group (n=20) and a control group (n=20). The primary outcome of this study was the changes in inflammatory markers and the ratio of inflammatory to anti-inflammatory markers. The secondary outcomes of this study included clinical outcome, laboratory outcome, radiological outcome, RT-PCR result conversion, and safety profile of MSC secretome. Results: Our analysis showed that on the 14th day after placebo administration, IL-6 level in the control group was significantly increased [4.110 (2.403–12.820) at baseline to 13.320 (2.958–33.285) on the 14th day after intervention, p=0.017]. The IL-6/IL-10 ratio in the control group was significantly increased (p=0.036) on the 14th day after placebo administration. We also found that most of the subjects who received placebo had high levels of IL-6 and ferritin (p=0.043) on the seventh day after the intervention. However, we found no significant differences in inflammatory marker levels on the seventh day and 14th day after intervention between both groups. There was no adverse event reported. There were no significant differences in the laboratory outcome, radiology outcome, RT-PCR result conversion, and safety profiles between both groups. Conclusions: MSC secretome can control inflammation in patients with severe COVID-19 and has a good safety profile. MSC secretome is a promising treatment modality for severe COVID-19.