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Journal : CURRENT INTERNAL MEDICINE RESEARCH AND PRACTICE SURABAYA JOURNAL

Diagnostic and management problems of chylous effusion in a patient with newly-diagnosed tuberculosis Dicky Febrianto; Usman Hadi
Current Internal Medicine Research and Practice Surabaya Journal Vol. 2 No. 2 (2021): CURRENT INTERNAL MEDICINE RESEARCH AND PRACTICE SURABAYA JOURNAL
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/cimrj.v2i2.28701

Abstract

Tuberculosis (TB) remains a major cause of morbidity and mortality globally. Although TB most commonly affects the lungs, any organ or tissue can be involved. Extra-pulmonary forms of TB are commonly unrecognized or late diagnosed. Chylous effusion, i.e. chylothorax and chylous ascites, which is characterized by the presence of chyle in the pleural and peritoneal cavities, is an uncommon manifestation of extra-pulmonary TB. A 22-year-old male, referred to Dr. Soetomo Hospital with complaints of dyspnea, fever, and abdominal distension. Chest X-ray showed pleural effusion. Analysis of fluid obtained from thoracentesis and paracentesis showed chylothorax and chylous ascites. M. tuberculosis had been found in sputum smear examination. ADA (adenosine deaminase) test was performed on ascites fluid and a positive result was obtained. Chylous effusion in this patient were concluded to be related to TB. Patient was then treated with anti-TB drugs and somatostatin. Chylothorax and chylous ascites improved after treatment with somatostatin for 1 week. Administration of anti-TB drugs was planned to be continued for 9 months. The most common causes of non-traumatic chylous effusion in developing countries are infection of TB and filariasis. Chylous effusion is caused by obstruction or disruption of the lymphatic system. ADA test is a new biomedical method that begins to expand its use in body fluids to diagnose extra-pulmonary TB. Fasting, together with total parenteral nutrition, can decrease the lymph flow and balance metabolic impairment. Somatostatin has been used in the treatment of chylous effusion as it diminishes peristalsis and intestinal absorption of fats as well as decreases portal pressure.
Diagnostic Patterns of Suspected Covid-19 Patients Using Scor Covid-19, PCR Test and Serological Test in Dr. Soetomo Hospital Surabaya, Indonesia Usman Hadi; Bramantono Bramantono; M Vitanata; Musofa Rusli; Brian Eka Rahman; Tripudi Asmarawati; Erika Marfiani; Erwin Astha Triyono
Current Internal Medicine Research and Practice Surabaya Journal Vol. 2 No. 2 (2021): CURRENT INTERNAL MEDICINE RESEARCH AND PRACTICE SURABAYA JOURNAL
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/cimrj.v2i2.28956

Abstract

Objective: To find out the diagnostic pattern of COVID-19 using RT-PCR or a rapid antibody test in the suspected group of patients.Method: The study was conducted inĀ  Dr. Soetomo General Hospital (referral hospital for covid-19, 1500 beds). The study used data on patients with suspected covid-19 who were hospitalized at the Dr. Soetomo General Hospital in Surabaya.Result: There were 200 suspected COVID-19 patients enrolled in this study, the main complaints of cough, fever, dyspnoea, around 69.5%, 75%, and 76.5%, respectively. Although not a common symptom, it seems that anosmia (14%) is typical for COVID-19. Based on this scoring system, a total of 196 patients had a high risk of being infected with COVID-19, and 125 (64%) of them finally showed a positive PCR test. PCR test mostly positive (62.5%), while serological test (rapid immunoglobulin test) mostly nonreactive, but there were no significant differences between PCR and Serological test (p=0.16 OR: 1.5(0.84-71). Furthermore, if we compare the various existing variables, namely the covid-19 score, immunoglobulin rapid test, and radiological examination, only the radiological examination results can be used as a strong predictor of positive PCR results (p=0.005, OR: 1.68 (0.17-16.43).In this study, we found that abnormal chest radiographs are a good parameter for diagnosing COVID-19, (OR: 2.92; 95% CI, 1.34 -6.34).Conclusion: The initial radiological examination combined with the clinical symptoms of Covid-19 is the most important thing to predict the presence of this disease.