Ceva Wicaksono Pitoyo

Risk factors for early invasive fungal disease in critically ill patients

Background: The incidence of invasive fungal disease (IFD) is increasing worldwide in the past two to three decades. Critically ill patients in Intensive Care Units are more vulnerable to fungal infection. Early detection and treatment are important to decrease morbidity and mortality in critically ill patients. Objective: Our study aimed to assess factors associated with early IFD in critically ill patients. Materials and Methods: This prospective cohort study was conducted in critically ill patients, from March to September 2015. Total number of patients (74) in this study was drawn based on one of the risk factors (human immunodeficiency virus). Specimens were collected on day 5–7 of hospitalization. Multivariate analysis with logistic regression was performed for factors, with P < 0.25 in bivariate analysis. Results: Two hundred and six patients were enrolled in this study. Seventy-four patients were with IFD, majority were males (52.7%), mean age was 58 years (range 18–79), mean Leons score was 3 (score range 2–5), majority group was nonsurgical/nontrauma (72.9%), and mean fungal isolation was positive on day 5. Candida sp. (92.2%) is the most frquently isolated fungal infection. Urine culture yielded the highest number of fungal isolates (70.1%). Mortality rate in this study was 50%. In multivariate analysis, diabetes mellitus (DM) (P = 0.018, odds ratio 2.078, 95% confidence interval 1.135–3.803) was found as an independent factor associated with early IFD critically ill patients. Conclusion: DM is a significant factor for the incidence of early IFD in critically ill patients.

Combination of bronchoscopic cryoextraction and argon plasma coagulation in treatment of total central airway obstruction caused by giant blood clot formation in massive airway bleeding

Life threatening event due to central airway obstruction caused by very large blood clot formation with profuse on going bleeding its very challenging to manage. Interventional pulmonologist must aware about this situation which can lead to respiratory failure. There are several choices to treat this unlikely situation, in example flexible bronchoscopy with forceps, bronchial lavage, and suction. We present a case with post-surgical tracheostomy bleeding which caused a giant blood clot formation in a disseminated intravascular coagulation due to severe sepsis in end stage renal disease patient, successfully managed with cryoextraction and argon plasma coagulation. Combinations of two endobronchial approaches can give a quick, safe and cost effective lifesaving treatment.

The Prevalence and Factors Associated with Drug-induced Hepatitis in HIV-positive Tuberculosis Patients

Introduction: Tuberculosis (TB) have demonstrated a global increase since 1990 along with the increase of world’s population and the transmission of human immunodeficiency virus (HIV). Anti- tuberculosis drugs are very effective, but it may cause drug-induced hepatitis (DIH). The aim of this study was to assess the prevalence and association of several risk factos with the occurence of drug-induced hepatitis in HIV-positive tuberculosis patients. Method: We conducted a retrospective case-control study based on medical records of HIV-positive TB patients who seek medical attention to HIV Referral Center at Cipto Mangunkusumo Hospital between July 2008 and December 2010. Overall, we enrolled 168 medical records with 42 cases and 126 controls. Chi-square and logistic regression test analysis were conducted for analyzing risk factors of drug-induced hepatitis in HIV-positive tuberculosis patients. Results: Drug-induced hepatitis were found in 42 (8.04%) patients.The prevalence of DIH was highest among 35 (25.2%) male patients, aged < 35 years old in 32 (26.0%) patients, with albumin level < 3.5 g% in 10 (11.2%) patients, body mass index (BMI) < 18.5 kg/m2 in 14 (18.4%) patients, CD4+ count < 100 cells/mm3 in 29 (24.4%) patients, and those who received rifampicin (R), isoniazid (H), and pirazinamid (Z) regiments for their anti-tuberculosis drugs 24 (31.2%) patients. No risk factors were found to have statistically significant association with DIH. Conclusion: The prevalence of DIH is quite high. Although no risk factor was found statistically significant, but evaluation and liver biochemical examination should be carried out regularly in patients with DIH risk factors. Keywords : drug-induced hepatitis, tuberculosis, human immunodeficiency virus