SEARCHING THE EVIDENCE

“In COVID-19 patients, is oseltamivir compared to oseltamivir with

azythromicin can decrease length of stay hospitalization?”

“In young woman with solitary thyroid nodule and normal thyroid function,
what is likehood of ultrasound examination in excluding malignancy?”

Disusun Oleh :

dr. Fadel Fikri Suharto 04042722125006

Pembimbing :

dr. Achmad Ridwan, MO, M. Sc

DEPARTEMEN ILMU PENYAKIT DALAM

FAKULTAS KEDOKTERAN UNIVERSITAS SRIWIJAYA

RSUP DR. MUHAMMAD HOESIN PALEMBANG 2021

FADEL FIKRI SUHARTO

04042722125006

Prodi Ilmu Penyakit Dalam Sp-1

Case 1:

Tn. Joko, 59 years old, male, was diagnosed with COVID-19 3 days ago using real time RT-
PCR. He only had mild fever, productive cough, and anosmia. History of hypertension,
T2DM, cardiocerebrovascular events were denied. History of smoking cigars and consuming
liquors were denied. He had a history of travelling from red zone country. As a patient, he
asked you to administered the best possible medication for him as next week he had another
plan for travelling to another red zone countries.

P: Patient with confirmed case COVID-19

I: Oseltamivir

C: Oseltamivir with Azythromicin

O: Length of stay hospitalization

Clinical question?

Is oseltamivir compared to oseltamivir with azythromicin can decrease length of stay

hospitalization in COVID-19 patients?

Search Key:

(“COVID” OR “COVID-19” OR “Novel Coronavirus 2019” OR “2019 N-Cov”) AND

(“oseltamivir” OR “oseltamivir azythromicin”) AND (“hospitalization” OR “length of stay”)
Journal:

Azithromycin in addition to standard of care versus standard of care alone in the treatment of
patients admitted to the hospital with severe COVID-19 in Brazil (COALITION II): a
randomised clinical trial - PubMed (nih.gov)
 Azithromycin in addition to standard of
care versus standard of care alone in the
treatment of patients admitted to the
hospital with severe COVID-19 in Brazil
(COALITION II): a randomised clinical trial
Remo H M Furtado , Otavio Berwanger , Henrique A Fonseca , Thiago D Corrêa , Leonardo R
 1  2  3  4

Ferraz , Maura G Lapa , Fernando G Zampieri , Viviane C Veiga , Luciano C P Azevedo , Regis G
 3  3  5  6  7

Rosa , Renato D Lopes , Alvaro Avezum , Airton L O Manoel , Felipe M T Piza , Priscilla A
 8  9  10  11  11

Martins , Thiago C Lisboa , Adriano J Pereira , Guilherme B Olivato , Vicente C S Dantas , Eveline P
 12  13  14  14  15

Milan , Otavio C E Gebara , Roberto B Amazonas , Monalisa B Oliveira , Ronaldo V P Soares , Diogo D
 16  17  18  18  3

F Moia , Luciana P A Piano , Kleber Castilho , Roberta G R A P Momesso , Guilherme P P

 3  3  3  3

Schettino , Luiz Vicente Rizzo , Ary Serpa Neto , Flávia R Machado , Alexandre B
 3  3  19  20

Cavalcanti , COALITION COVID-19 Brazil II Investigators

 5

Abstract

Background: The efficacy and safety of azithromycin in the treatment of COVID-19

remain uncertain. We assessed whether adding azithromycin to standard of care,
which included hydroxychloroquine, would improve clinical outcomes of patients
admitted to the hospital with severe COVID-19.

Methods: We did an open-label, randomised clinical trial at 57 centres in Brazil. We

enrolled patients admitted to hospital with suspected or confirmed COVID-19 and at
least one additional severity criteria as follows: use of oxygen supplementation of
more than 4 L/min flow; use of high-flow nasal cannula; use of non-invasive
mechanical ventilation; or use of invasive mechanical ventilation. Patients were
randomly assigned (1:1) to azithromycin (500 mg via oral, nasogastric, or intravenous
administration once daily for 10 days) plus standard of care or to standard of care
without macrolides. All patients received hydroxychloroquine (400 mg twice daily for
10 days) because that was part of standard of care treatment in Brazil for patients
with severe COVID-19. The primary outcome, assessed by an independent
adjudication committee masked to treatment allocation, was clinical status at day 15
after randomisation, assessed by a six-point ordinal scale, with levels ranging from 1
to 6 and higher scores indicating a worse condition (with odds ratio [OR] greater
than 1·00 favouring the control group). The primary outcome was assessed in all
patients in the intention-to-treat (ITT) population who had severe acute respiratory
syndrome coronavirus 2 infection confirmed by molecular or serological testing
before randomisation (ie, modified ITT [mITT] population). Safety was assessed in all
patients according to which treatment they received, regardless of original group
assignment. This trial was registered at ClinicalTrials.gov, NCT04321278.
Findings: 447 patients were enrolled from March 28 to May 19, 2020. COVID-19 was
confirmed in 397 patients who constituted the mITT population, of whom 214 were
assigned to the azithromycin group and 183 to the control group. In the mITT
population, the primary endpoint was not significantly different between the
azithromycin and control groups (OR 1·36 [95% CI 0·94-1·97], p=0·11). Rates of
adverse events, including clinically relevant ventricular arrhythmias, resuscitated
cardiac arrest, acute kidney failure, and corrected QT interval prolongation, were not
significantly different between groups.

Interpretation: In patients with severe COVID-19, adding azithromycin to standard

of care treatment (which included hydroxychloroquine) did not improve clinical
outcomes. Our findings do not support the routine use of azithromycin in
combination with hydroxychloroquine in patients with severe COVID-19.
Case 2:

11 year-old girl was evaluated for thyroid solitary nodule. She has been complaining pain on
palpation, other physical findngs were not significant. Thyroid function showed normal
result. Physician was thinking about ultrasound examination.

P: Young woman with solitary thyroid nodule

I: ultrasound examination

C:

O: exclude malignancy

Clinical question?

In young woman with solitary thyroid nodule and normal thyroid function, what is likehood
of ultrasound examination in excluding malignancy?

Search Key:

solitary thyroid nodule AND ultrasound AND malignancy AND diagnosis

Journal:

Routine ultrasound-guided aspiration cytology for evaluation of palpable thyroid nodules in

an endemic area: is it justified?
 Routine ultrasound-guided aspiration cytology for evaluation of palpable
thyroid nodules in an endemic area: is it justified?
K Muruganandham 1, Sarath Chandra Sistla, S Elangovan, Surendra Kumar Verma

Abstract

Purpose: To prospectively evaluate the efficacy of routine ultrasound-guided fine-

needle aspiration cytology (FNAC) of thyroid nodules in an endemic area and to
analyze the factors influencing it.

Methods: Patients with thyroid nodules were randomly subjected to either

conventional palpation-guided fine-needle aspiration cytology (PFNAC) or
ultrasound-guided fine-needle aspiration cytology (USFNAC). The results of cytology
were compared with the final histopathologic diagnosis in 112 patients who had
undergone surgery. The performance of both methods was individually analyzed in
solid nodules, cystic nodules, and solitary and multinodular goitres.

Results: Overall, USFNAC showed a significantly higher sensitivity (83.3% vs 54.6%, p

< .001), positive predictive value (100% vs 85.7%, p < .001), and greater diagnostic
accuracy (96.5% vs 89.1%, p = .052) compared with PFNAC. The sensitivity of
USFNAC was significantly higher compared with that of PFNAC in cystic and complex
nodules (75% vs 50%, p < .001) but not in solid nodules (77.8% vs 75%, p > .05).
USFNAC was more sensitive and more accurate than PFNAC for detection of
malignancy in multinodular goitres (66.7% vs 50%, p < .05; 95.6% vs 86.2%, p < .05,
respectively).

Conclusion: The superiority of "routine" USFNAC over PFNAC is mainly due to its

better performance in cystic nodules and multinodular goitres. Hence, routine
USFNAC can be recommended in areas where such lesions constitute the majority of
thyroid nodules.