Peripheral bronchoscopy with the use of thin/ultrathin bronchoscopes and radial-probe endobronchial ultrasound (RP-EBUS) has been associated with a fair diagnostic yield. Mobile cone-beam CT (m-CBCT) could potentially improve the performance of these readily available technologies. We retrospectively reviewed the records of patients undergoing bronchoscopy for peripheral lung lesions with thin/ultrathin scope, RP-EBUS, and m-CBCT guidance. We studied the performance (diagnostic yield and sensitivity for malignancy) and safety (complications, radiation exposure) of this combined approach. A total of 51 patients were studied. The mean target size was 2.6 cm (SD, 1.3 cm) and the mean distance to the pleura was 1.5 cm (SD, 1.4 cm). The diagnostic yield was 78.4% (95 CI, 67.1–89.7%), and the sensitivity for malignancy was 77.4% (95 CI, 62.7–92.1%). The only complication was one pneumothorax. The median fluoroscopy time was 11.2 min (range, 2.9–42.1) and the median number of CT spins was 1 (range, 1–5). The mean Dose Area Product from the total exposure was 41.92 Gy·cm² (SD, 11.35 Gy·cm²). Mobile CBCT guidance may increase the performance of thin/ultrathin bronchoscopy for peripheral lung lesions in a safe manner. Further prospective studies are needed to corroborate these findings.

A 31-year-old female with a history of lupus nephritis on Hydroxychloroquine, Prednisone, and Mycophenolate Mofetil (MMF) for 10 years presented to the hospital for ankle swelling. On day four, she started to have severe, nonbloody, watery diarrhea with abdominal distension and tenderness. Stool PCR was negative forC. difficile.CT abdomen/pelvis showed gaseous distension of the colon without any obstruction. Flexible sigmoidoscopy revealed a normal looking mucosa. Histopathology showed crypt atrophy and increased crypt apoptosis, consistent with MMF colitis. The diarrhea resolved three days after stopping MMF. Although generally well tolerated, diarrhea is a common side effect of MMF. Most cases occur in the first six months of starting MMF. This case is unique because it describes MMF colitis in lupus after more than 10 years. Thus, MMF colitis should be considered as a differential in patients taking it, regardless of the duration of use.

Background: The mortality of severe dengue infections is approximately 23%. In the management of dengue shock syndrome (DSS), aggressive fluid resuscitation is recommended. The primary objective of our study was to assess the factors associated with 30-day mortality in DSS patients.Methods: Adult patients >18 years old, who were admitted with DSS were included. DSS was diagnosed in patients who required vasopressors or had lactic acidosis >4 mmol/L. Patients were divided into three different groups based on cumulative fluid balance at death or extubation: group I (8.0 L).Results: A total of 135 patients with DSS was included, with an overall 30-day mortality of 74.8%. The average Sequential Organ Failure Assessment (SOFA) score on intensive care unit admission was 12.2. Mechanical ventilation was required in 112 patients (83.0%), with 61 patients (45.2%) being intubated without a noninvasive ventilation trial. Respiratory failure was the most common reason for requiring intubation (65 patients, 48.2%). In survivors, the median cumulative fluid balance was 1,493 ml (interquartile range [IQR], 0–4,501 ml), whereas that in the mortality group was 7,797 ml (IQR, 3,700–13,600 ml). On multivariate analysis, SOFA score (odds ratio [OR], 1.220; 95% CI, 1.011–1.472; P=0.038) and having received >8.0 L cumulative fluid balance (OR, 6.682; 95% CI, 1.808–24.689; P=0.004) were associated with increased risk of mortality.Conclusions: DSS patients have high mortality rates. High SOFA scores and >8.0 L cumulative fluid balance may indicate worse outcomes.

Abstraksi   Masyarakat Sumbawa dikenal sebagai masyarakat yang heterogen, karena dihuni oleh penduduk dari berbagai suku, etnis, bahasa dan agama dengan konsekuensi terhadap pembawaan adat-istiadat serta sistem hidup yang berbeda-beda. Kondisi ini adalah salah satu modal utama yang jika disalahgunakan akan bisa berdampak negatif dengan munculnya sentimen-sentimen dan konflik komunal yang bisa merusak sistem kehidupan bermasyarakat. Proses mediasi, arbitrasi dan negosiasi adalah salah satu pendekatan yang digunakan  dalam meresolusi konflik selama ini. Sedangkan masih banyak metode atau pendekatan lain yang dirasa cukup efektif dan kadang terlupakan dalam pendekatan pencegahan dan resolusi konflik yaitu melalui pendekatan Kecerdasan Budaya.Sehingga riset ini, mencoba mengangkat masalah urgensi kecerdasan budaya dalam mencegah dan meresolusi konflik. Adapun masalah yang diangkat dalam penelitian ini adalah: 1).Faktor-faktor apa saja yang bisa menyebabkan terjadinya konflik dalam masyarakat?, 2). Siapa saja yang berperan sebagai struktural, akselerator dan pemakin atau trigger dalam konflik tersebut?, 3). Pendekatan apa saja yang selama ini digunakan dalam upaya mencegah dan menyelesaikan konflik dalam masyarakat oleh pemerintah?, 4). Mengapa kecerdasan budaya sangat penting dalam mencegah dan menyelesaikan konflik tersebut? Metode riset yang digunakan adalah deskriptif-kualitatif.Dengan tujuan agar pengungkapan fenomena di lokasi penelitian secara leluasa memungkin untuk mendapatkan hasil yang maksimal karena data tersebut valid dan dapat dipertanggung- jawabkan secara ilmiah dan rasional. Teknik pengumpulan data yang digunakan ada  yaitu teknik observasi, interview dan dokumentasi. Teknik analisis data dimulai dari proses pengumpulan data, reduksi data, penyajian data, dan keabsahan datayang terdiri dari Derajat kepercayaan (credibility), Keteralihan (transferability), Ketergantungan (dependability), dan Kepastian (comfirmability). Hasil penelitian, bahwa Terjadinya konflik di Kabupaten Sumbawa disebabkan karena adanya faktor Struktural, Akselerator dan Trigger (SAT) konflik, misalnya seperti: masih ada dan kuatnya Political Memory dalam Masyarakat. Serta pentingnya Kecerdasan Budaya dalam mencegah dan menyelesaikan konflik, karena semua aspek-aspek yang ada dalam Kecerdasan Budaya seperti: Pengetahuan, Strategi, Motivasi dan Perilaku ternyata memiliki relevansi dan kemampuan untuk mendorong dan menciptakan suasana yang aman, damai dan harmonis dalam masyarakat sepanjang masyarakat bisa dan mampu menginternalisasikan nilai-nilai tersebut dalam kehidupan sehari-hari. Kata Kunci: Kecerdasan Budaya, Pencegahan, Resolusi, Konflik The Sumbawa community is known as a heterogeneous society, inhabited by people of various ethnic, ethnic, linguistic and religious backgrounds with consequences for different customs and systems of life. This condition is one of the main capital that if misused will be able to negatively impact the emergence of sentiments and communal conflicts that can damage the system of social life. The process of mediation, arbitration and negotiation is one of the approaches used in resolving conflicts over the years. While there are many other methods or approaches that are considered quite effective and sometimes forgotten in the approach of prevention and conflict resolution is through the approach of Cultural Intelligence. So this research, trying to raise the urgency issue of the cultural intelligence in preventing and resolving the conflict. The problems raised in this study are: 1). What factors can cause conflict in society ?, 2). Who actor that acts as a structural, accelerator and trigger or trigger in the conflict ?, 3). What approaches have been used in preventing and resolving the conflict in society by the government ?, 4). Why is cultural intelligence so important in preventing and resolving the conflict? The research method in this research is descriptive-qualitative. The aim of this research that the disclosure of the phenomenon in the research location freely possible to get maximum results because the data is valid and can be accounted scientifically and rationally.Data collection techniques that is used in this research are techniques of observation, interview and documentation. Data analysis techniques start from the process of data collection, data reduction, data presentation, and data validity consisting of credibility, transferability, dependability and comfirmability. The result of the research, that the occurrence of conflict in Sumbawa Regency caused by Structural factor, Accelerator and Trigger (SAT) conflict, for example: there is still and strong Political Memory in Society. As well as the importance of Cultural Intelligence in preventing and resolving of conflicts, as all aspects of Cultural Intelligence such as: Knowledge, Strategy, Motivation and Behavior have the relevance and ability to encourage and create a safe, peaceful and harmonious atmosphere in society as long as society can and able to internalize these values ​​in everyday life. Keywords: Cultural Intelligence, Prevention, Resolution, Conflict