Acta medica Indonesiana
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Acta medica Indonesiana · Oct 2020
ReviewCOVID-19 Vaccines: Current Status and Implication for Use in Indonesia.
The coronavirus disease 2019 (COVID-19) has inflicted catastrophic damages in public health, economic and social stability-putting life globally on hold in 2020 and presumably a year more. Indonesia bears a heavy burden of the pandemic, counting the highest case prevalence and fatality rate in all of Southeast Asia. One hope remains in the groundbreaking universal effort in search of a vaccine against the causative virus SARS-CoV-2, which has shown success unparalleled in human vaccine development thus far. ⋯ The vaccine produced by BioNTech/Pfizer has been deployed to the public as the first ever licensed COVID-19 vaccine. In this review, we will review all of these modalities on their safety and immunogenicity, phase II/III trial results of the nine vaccine candidates and current situation as of 29 December 2020, as well as the implication for use and distribution in Indonesia. COVID-19 vaccine progress, however, is moving exceedingly fast and new advances are unfolding on a daily basis, to which we hope an update to this review can be published in early 2021.
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Cytokine storm in COVID-19 infection is an excessive immune response to external stimuli where the pathogenesis is complex. The disease progresses rapidly and the mortality is high. Certain evidence shows that the severe deterioration of some patients has been closely related to the strong upregulation of cytokine production in SARS-Co-V2 induced pneumonia with an associated cytokine storm syndrome. ⋯ To date, no specific therapeutic drugs are available to treat COVID-19 infection. Preliminary studies have shown that immune-modulatory or immune suppressive treatments might be considered as treatment choices for COVID-19, particularly in severe disease. This article review the pathogenesis and treatment strategies of COVID-19 virus-induced inflammatory storm in attempt to provide valuable medication guidance for clinical treatment.
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In the past 10 years, recent development of targeted therapy in metastatic renal cell carcinoma (mRCC) has provided a new hope and significantly enhanced the prognosis of the disease. Three class of targeted therapy were developed, including multi-targeted tyrosine kinase inhibitors (TKI), the mammalian target of rapamycin (mTOR) complex-1 kinase inhibitors, and the humanized antivascular endothelial growth factor (VEGF) monoclonal antibody. Hence, the objective of this article was to critically examine the current evidence of targeted therapy treatment for patients with mRCC. ⋯ However, the current evidence did not show the best treatment sequencing after first-line TKI failure. In patients with poor-risk clear-cell and non-clear cell mRCC, temsirolimus was the treatment option supported by phase III clinical trial. In addition, several new drugs, nowadays, are still being investigated and waiting for the result of phase II or III clinical trial, and this might change the standard therapy for mRCC in the future.
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Thyroid nodules are frequently found. Although they are often palpable, many are found incidentally during unrelated radiographic studies. ⋯ Clinician suc as an internist/endocrinologist have to classify the nodule, stratify the risk of thyroid cancer, performed a diagnostic work-up, provide medical / non-surgical therapy, select candidates for surgery and provide appropriate follow-up that should last a lifetime. This article provide an up-date review of diagnostic approach and management of thyroid nodules, focusing on current algorithm in lights of the most recent published American Thyroid Association thyroid nodule and differentiated thyroid cancer management guidelines.
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One of the cornerstones of critical care medicine is support of the failing respiratory system. The 2 major components of managing respiratory failure are the acute intervention and the weaning process. Many of the studies to determine the optimal methods of ventilation and weaning have focused on non-invasive positive-pressure ventilation as an alternative to invasive ventilation, with various causes of acute respiratory failure. ⋯ There is improvement in gas exchange, relief of respiratory muscle fatigue, and clinical outcome with reduced morbidity and mortality. Nevertheless, contraindications and failures need to be identified early, as delaying endotracheal intubation is associated with increased morbidity and mortality. Furthermore, although it is common practice to give intubation and mechanical ventilation, complications can result from the intubation process (damage to local tissue) and during the course of ventilation (pneumonia and sinusitis associated with ventilators), prolonging stay in intensive care, length of hospital stay and mortality in selected patients.