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The novel coronavirus disease-2019 (COVID-19), caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), has become a public health emergency of international concern. The first confirmed COVID-19 case in Indonesia was announced on 2 March 2020, and later on, 11,192 confirmed cases were reported as of 3 May. The World Health Organization has stated that performing a real-time reverse transcription–polymerase chain reaction (RT-PCR) specific for SARS-CoV-2 on specimens from the upper and the lower respiratory tracts, especially nasopharyngeal and oropharyngeal swabs, is the standard diagnostic procedure for COVID-19. In Indonesia, we also use other diagnostic tests, such as rapid antibody tests specific for SARS-CoV-2. Herein, we report an atypical case of COVID-19 and describe the diagnostic process, the clinical course, with progression to severe pneumonia on Week 3 of illness and the case management. We also try to highlight the possibility of false-negative RT-PCR tests.


People over the age of 65 and those suffering from chronic diseases, such as asthma, are part of the risk group for severe acute respiratory syndrome-COV-2 (SARS-CoV-2) infection. In the past, a connection between viral infections and asthma has been presented. Patients with asthma appear to be at risk of contracting viral infections, and also viruses can cause asthma exacerbations. Another concern during this period was about the chronic administration of corticosteroids in asthmatic patients, because of the consideration that corticosteroid therapy would decrease the immunity of these patients, thus increasing the risk of infections, including the infection with SARS-CoV-2. Thus, several questions have emerged about the role of corticosteroid therapy in the development of COVID-19 in patients undergoing corticosteroid treatment. Most guidelines recommend continuing the administration of chronic treatment to this category of patients. At the same time, the health system had to adapt to the situation caused by the COVID-19 pandemic and deviate from the standard methods of managing most chronic diseases and these changes had an impact on these category of patients.


Coronavirus disease 2019 caused by the severe acute respiratory syndrome coronavirus 2 is one of the most pressing health care concerns in 2020. The continually growing number of new cases, the global outspread of the virus and the severity of the disease determined the World Health Organization to declare the outbreak a pandemic.

Twenty per cent of the patients present severe and critical forms that frequently require oxygen supplementation and intensive care unit admission. That is why, to provide optimal care, it is imperative to identify at-risk patients.

Patients with associated chronic diseases are more prone to develop severe and critical forms of the infection. Although the chronic pulmonary obstructive disease is present only in a limited number of coronavirus disease 2019 patients, it is most commonly associated with lung disease and a poor outcome than other comorbidities.


The new pandemic disease Covid-19 compelled all the researchers to investigate for early identification of the potential risk factors. Further, the relation between smoking and infections are well known. The authors are trying to find the epidemiological links, the pathogenic mechanisms and also the impact of this coronavirus on different respiratory chronic diseases, based on the last published data about the consequences of smoking and vaping on consumers.



In the management of chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD), adherence to therapy represents a key to success.


The objective was to increase adherence to treatment through the development of educational intervention (EI) for asthma and COPD, addressed to patients and general practitioners (GPs). The educational programme includes group educational sessions and educational materials and was carried out in five Romanian hospitals. The results were assessed through Test of Adherence to Inhalers (TAI) questionnaire.


Of note, 347 GPs and 435 patients were included. Seventy-six per cent of the GPs considered that the main causes of non-adherence are the disease misunderstanding, difficulty of using inhaled medication, fear of adverse effects, the patient’s conviction that no medicine is useful for his illness and financial nature (20%). Fifty-five per cent of surveyed GPs believed that their patients always or most of the time adhere to inhaled therapy but 57% of the same surveyed GPs checked the inhalation technique of their patients sometimes, rarely or never. Only 44% of the GPs discussed with the pulmonologist about their patient’s disease. Before the EI, only 32% of patients had a good adherence score to therapy; this percentage increases to 57% after EI. The most common reasons for non-adherence were: patient forgets to administer his inhalation medication daily (49%), fear of adverse effects (33%), belief that medication is useless (26%), and fear that inhalation medication affects everyday life of the patient (24%). Nearly half of the patients (47%) give up medication when they feel better. Forty per cent of patients drop off inhalation treatments due to financial reasons. The most influenced behaviours as a result of the EI were psychological component (85%), fear of the adverse events (82%) and social component (79%).


The non-adherence to therapy remains a real problem in asthma and COPD patients in our study group, but EI had positive effects. Extending medical education programmes for patients focused on main reasons of poor adherence, such as forgetting to take medication daily, use of inhalator devices, not understanding their disease, may significantly increase adherence to inhalation treatment.



Neoplastic pericarditis may develop in any type of cancer, but it is found more frequently in lung cancer, breast cancer and lymphoma.


We studied 156 consecutive oncological patients presented with pericardial fluid between 2010 and 2015. Among them, 80 patients were stable, with no indication for pericardial drainage or biopsy, and 76 patients needed surgery to evacuate the pericardium and obtain biopsy.


Echocardiography and computed tomography were essential in evaluating the topography of the pericardial fluid and the haemodynamic effect, and these investigations helped us choose the appropriate surgical procedure. We performed pericardiocentesis, subxiphoid pericardial drainage, left paraxifoidian pericardial drainage, pericardio-pleural window through intercostal video-assisted thoracic surgery (VATS) or through classical thoracic surgery. Twenty-three patients (14.7%) were admitted and treated for cardiac tamponade. The rate of recurrence after pericardial drainage was 3.89%. The immediate survival at 48 h was 97.3%.


Long-term survival in patients with malignancy and drained pericardial effusion is influenced mainly by the type of underlying malignant disease. We observed a better survival in patients without cardiac tamponade. Immediate survival depends on the pericardial shock complication – postoperative low cardiac output syndrome (LCOS) or pericardial decompression syndrome (PDS). The indication for pericardial drainage depends on the quantity of pericardial fluid, presence of tamponade, associated pleural effusion and need for biopsy, offering the maximum possible benefit and safety for the patient.


COVID-19 has been described as the cause for a proinflammatory and hypercoagulable state that induces thrombotic vascular lesions and, in more severe cases, disseminated intravascular coagulation. Increased values of d-dimers are related to the severity of the disease and are associated with worst prognosis. Intensive care studies reported an increased risk of pulmonary embolism and venous thrombosis diseases in COVID-19 compared with the historical control group even in patients who underwent the low-molecular-weight heparin (LWMH) prophylaxis. Patients with COVID-19 who have a stable clinical condition do not require hospitalisation and are treated at home with symptomatic therapy. LWMH is reserved for those with reduced mobility. In this case report, we describe a COVID-19 patient with pulmonary artery thrombosis treated at home.