In COVID-19 patients, Interleukin-6 (IL-6) will increase, and the production of antigens will be excessive, which will cause excessive inflammation of the tissues, especially the respiratory tract, which causes fibrosis in the lungs and can lead to death. To analyze IL-6 expression of lung tissue in COVID-19 patient severity. The study is an observational analytic design from July to December 2020. COVID-19 patient severity who died was examined for IL-6 expression on lung tissue. The lung tissue sampling uses the core biopsy method. The total number of samples obtained was 38 samples. Characteristics of patients with a mean age of patients were 48 years, male, the most common chief complaint was shortness of breath, mean symptom onset was 5 days, patient length of stay was 10 days, the most common cause of death was a combination of septic shock and ARDS and the most common comorbid diabetes mellitus. There is an increased WBC, neutrophils, platelets, procalcitonin, CRP, BUN, creatinine serum, AST, ALT, and D-dimer. In this study, the average tissue IL-6 expression was 72.63, with the highest frequency of strong positive 47.4%. An increase in IL-6 expression on lung tissue showed the severity of COVID-19 infection.

Background: The problem of establishing lung tumor diagnostics is a challenge for clinicians, especially pulmonologists, in determining a definitive diagnosis of a lung tumor. Objective: Analyzing the conformity of anatomical pathology results between core needle biopsy (CNB) and fine-needle aspiration biopsy (FNAB) materials in peripheral lung tumors. Methods: A cross-sectional study was conducted from July 2019 to December 2020 with 66 participants. Participants were examined for CNB and FNAB, in which the results of these examinations were compared for conformity. Statistical analysis used the Kappa test with p < 0.05. Result: Most participants' tumor size was >70 mm, with FNAB results showing malignant category (39.5%), non-malignant (40.0%), and undiagnosed (38.9%; p = 0.757). Meanwhile, CNB examination showed a tumor size of >70 mm that was categorized into malignant (40.4%) and non-malignant (33.3%; p = 0.510). Most tumors were located in the right superior lobe that had FNAB results in the malignant (39.5%), non-malignant (30.0%) and undiagnosed (27.8%; p = 0.306) categories. The CNB examination also showed that most tumors were located in the right superior lobe, which had resulted in the category of malignant (34.4%), non-malignant (26.7%), and undiagnosed (75.0%; p = 0.240). Conformity of anatomical pathology results from FNAB and CNB subject such as malignancy category of 35 participants (74.5%), non-malignancy of 7 participants (53.8%) and undiagnosed of 4 participants (16.7%) with an accuracy of 69.69% (Κ = 0.43; p = 0.001). Conclusion: There is a conformity between the anatomical pathology results from FNAB and CNB materials for the diagnosis of lung tumors. CNB showed better results in the detection of anatomical malignancy and specimen adequacy.

Background: Silicosis is one of the most common diseases among all occupational diseases. The main clinical focus on the silicosis complication will be tuberculosis. Case presentation: A 28-year-old male presented with complaints of chronic dry cough, weight loss, decreased appetite, and night sweats. The patient worked in the synthetic leather factory for 7 years and rarely used proper protective equipment. Chest X-ray showed bilateral fibroinfiltrate as a sign of a specific process in the lungs. Thoracic HRCT suggested an infected cystic type of bronchiectasis. Bronchoalveolar lavage from bronchoscopy was performed. The result of the silica spectrophotometric test and GenXpert BAL was both positive for silicosis and tuberculosis, consecutively. The patient has been diagnosed with an occupational lung disease accompanied by tuberculosis complications, namely silicotuberculosis. The patient received tuberculosis therapy and was advised to an early retirement due to disability. Discussion: The duration and level of intensity of exposure, as well as the severity of silicosis, are factors of tuberculosis. The silicosis diagnosis can be made from occupational history or silica exposure, as well as appropriate radiological and histopathological findings. Conclusion: Silicotuberculosis is a disease due to silica exposure, and is often found in TB endemic countries.

Background: COVID-19 is a virus that is spread by aerosol which can cause worsening of hypoxia and bronchoscopy procedures in COVID-19 patients may be considered. Method: The design of this study is a case series reported using the Preferred Reporting of Case Series in Surgery (PROCESS) 2020 Guideline. Data collection was carried out in the period January–April 2021. All participants underwent X-ray examination and blood gas analysis as well as signs of infection before and after bronchoscopy. Result: Three intubated patients with COVID-19 were confirmed from PCR nasopharyngeal swab present with worsening on chest X-ray. All three patients had a normal bronchial wall with some inflammation and thick mucus resulting in lung atelectasis and massive inhomogeneous opacity on chest X-ray. Patients showed improvement on chest X-ray after bronchoscopy intervention. Conclusion: The bronchoscopy procedure can improve the lung function of COVID-19 patients and if it is carried out by medical personnel who pay attention to universal precautions, it will minimize the occurrence of transmission. Highlights:

Introduction: Extraskeletal Ewing's Sarcoma is a rare entity of sarcoma that develops rapidly within soft tissue in any anatomic region, and the symptoms depend on its location. Case presentation: The X-ray examination of a 28-year-old man with shortness of breath, cough, weight loss, and chest pain showed malignant round cell, in which confirmed by immunohistochemical examination. The examination indicated positive Vimentin findings in the cytoplasm and positive FLI-1 in the nuclei of the tumour cells. The diagnosis was consistent with extraskeletal Ewing's sarcoma. The patient submitted to a chest conference and received radiotherapy related to SVCS before debulking surgery. Discussion: The diagnostic challenges associated with Ewing's sarcoma may arise due to its diverse histological spectrum. Further examination is required in order to distinguish Ewing's sarcoma from other tumours, as its radiological specificity is limited. A multimodal approach for treatment and therapy is necessary to highlight the specific requirements of the patient's condition. Conclusion: Imaging modalities including X-rays and thoracic CT scans, supported by histopathological examination and immunohistochemistry, are essential for accurately diagnosing Extraskeletal Ewing's sarcoma. A multimodal approach may be considered as the best treatment for the patient with mediastinal Ewing's sarcoma. Highlights:

Background: Primary spontaneous pneumothorax (PSP) can be caused by a ruptured blep emfisematus subpleural. People who smoke tobacco and marijuana simultaneously arise PSP will be more risky than just smoking tobacco. Pneumothorax in cannabis smokers may occur due to coughing at the time was holding their breath, when they were smoking marijuana. Case: We report the case of 33-year-old woman with recurrent shortness of breath as a result of primary spontaneous pneumothorax in the right hemithorax. The patient’s tobacco and marijuana smokers. Patients had undergone previous pleurodesis. Chest X-ray picture of the lines conveniently indicates lung collapse and air-fluid level in the right hemithorax. Thoracoscopic showed a large bronchopleural fistula. During thoracotomy found one bronkopeural fistula, three large blep, and more than 15 small blep. Then do the suturing of fistula and blep. Patients recover in a short time and in good condition during treatment. Conclusion: Tobacco and marijuana smoking is a risk factor that is synergistic to the occurrence of primary spontaneous pneumothorax. These patients consume both are irregular but have resulted in multiple blep that can rupture and cause a pneumothorax.