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"Latar Belakang. COVID-19 merupakan penyakit infeksi dengan manifestasi klinis utama di saluran pernapasan. Selain mempunyai manifestasi klinis pada saluran pernapasan, manifestasi COVID-19 juga ditemukan di saluran gastrointestinal, terutama pada organ hati. Gangguan fungsi hati pada pasien COVID-19 ditandai dengan peningkatan enzim alanine aminotransferase (ALT), peningkatan aspartate aminotransferase (AST), dan peningkatan serum bilirubin. Penelitian ini bertujuan mengetahui perbandingan kesintasan pasien konfirmasi positif COVID-19 yang mengalami gangguan fungsi hati dan mengetahui hubungan gangguan fungsi hati terhadap kesintasan pasien konfirmasi positif COVID-19 di RS Cipto Mangunkusumo.Metode. Penelitian ini menggunakan desain kohort retrospektif. Populasi dalam penelitian ini adalah pasien rawat inap dewasa dengan konfirmasi positif COVID-19 pada periode Oktober 2020 hingga Januari 2021. Analisis untuk mengetahui perbandingan kesintasan pasien konfirmasi positif COVID-19 yang mengalami gangguan fungsi hati. Analisis Cox Regresi Extended digunakan untuk mengetahui hubungan kausal gangguan fungsi hati terhadap kesintasan pasien COVID-19. Hasil dilaporkan dalam bentuk Hazard Rasio dengan Interval Kepercayaan 95%.Hasil. Sebanyak 354 pasien konfirmasi positif COVID-19 masuk dalam penelitian ini. Hasil penelitian menunjukan probabilitas kesintasan kumulatif 30 hari pada pasien COVID-19 lebih rendah pada kelompok pasien dengan adanya gangguan fungsi hati dibandingkan dengan kelompok pasien tanpa adanya gangguan fungsi hati, yaitu sebesar 31,1% vs. 69,4%, nilai p <0,001. Pada 14 hari masa awal pengamatan, terdapat hubungan gangguan fungsi hati yang signifikan terhadap kesintasan pasien konfirmasi positif COVID-19 setelah dikontrol dengan variabel confounder berupa ARDS, D-dimer, dan ventilator. HR adjusted 2,81 (IK 95%: 1,43-5,53, nilai p 0,003). Sementara pada > 14 hari pengamatan, tidak ditemukan adanya perbedaan risiko kematian pada kelompok pasien yang mengalami gangguan fungsi hati dan tidak mengalami gangguan hati. HR adjusted 0,33 (IK 95%: 0,06-1,75), nilai p 0,195.Kesimpulan. Kesintasan pasien COVID-19 lebih rendah pada pasien yang mengalami gangguan fungsi hati. Adanya gangguan fungsi hati yang ditemukan di 14 hari masa awal pengamatan merupakan faktor risiko yang berkontribusi terhadap kesintasan pasien COVID-19.

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Background. COVID-19 is an infectious disease with the main clinical manifestations in the respiratory tract. In addition, manifestations of COVID-19 are also found in the gastrointestinal tract, especially in the liver. Abnormal liver function in COVID-19 patients is characterized by an increasing enzyme alanine aminotransferase (ALT), an increase in aspartate aminotransferase (AST), and an increase in serum bilirubin. This study aims to compare the survival rates of COVID-19 patients with abnormal liver function and to evaluate the association between abnormal liver function with the survival of COVID-19 confirmation positive in Cipto Mangunkusumo Hospital.

Method. This study was a retrospective cohort. The population in this study were inpatients adult with positive confirmation of COVID-19 in the period October 2020 to January 2021. Survival analysis with Kaplan Meier was used to compare the survival of patients with positive confirmation of COVID-19 whose had abnormal liver function. Extended Regression Cox analysis was used to determine the causal relationship of abnormal liver function with the survival of COVID-19 patients. Results were reported in Hazard Ratio with 95% Confidence Interval.

Result. A total of 354 confirmed positive COVID-19 patients were included in this study. The results showed that the cumulative 30-day survival rate in COVID-19 patients was lower in the group of patients with abnormal liver function compared to the group of patients without abnormal liver function (31.1% vs. 69.4%, p value < 0.001). In the early 14 days of observation, there was a significant association of abnormal liver function with the survival of confirmed positive COVID-19 patients after controlling for confounder variables ARDS, D-dimer, and ventilator. HR adjusted 2.81 (95% CI: 1.43-5.53, p value 0.003). While at > 14 days observations, there was no difference in the risk of death in the group of patients with abnormal liver function and without abnormal liver function. HR adjusted 0.33 (95% CI: 0.06-1.75), p value 0.195.

Conclusion. The survival rate of COVID-19 patients was lower in patients with abnormal liver function. The presence of abnormal liver function in the initial 14 days of observation was a risk factor that contributed to the survival of COVID-19 patients."

"Latar belakang: Coronavirus Disease 2019 (COVID-19) adalah penyakit yang disebabkan oleh infeksi virus SARS-CoV-2 dengan gejala ringan hingga berat seperti komplikasi paru dan kematian. Derajat keparahan penyakit merupakan salah satu faktor yang dapat memperberat kondisi pasien yang direncanakan operasi. Karakteristik klinis serta komplikasi pascaoperasi pasien dengan COVID-19 cukup banyak diteliti di negara lain. Namun Indonesia belum memiliki data terkait yang dapat dijadikan panduan dalam menjalani tindakan pembedahan pada pasien dengan COVID-19.Metode: Penelitian ini merupakan kohort retrospektif dengan pengambilan data sekunder pasien COVID-19 yang menjalani pembedahan di RSCM dan RSUI dari Maret 2020 sampai September 2021. Hasil luaran yang dinilai adalah komplikasi paru dan mortalitas.Hasil: Total 458 pasien COVID-19 menjalani pembedahan di RSCM dan RSUI, dengan operasi elektif 62% dan emergensi 38%. Angka kejadian komplikasi paru pascaoperasi sebesar 21,8% dan mortalitas 30 hari pascaoperasi sebesar 26%. Karakteristik klinis pasien yang mengalami komplikasi paru dan mortalitas yaitu berjenis kelamin laki-laki, berusia >65 tahun, memiliki jumlah komorbid dua atau lebih, gejala klinis awal batuk, sesak dan demam, nilai NLR ≥5,9 yang dikategorikan derajat berat COVID-19, gambaran CXR konsolidasi atau opasitas, serta menggunakan ventilasi mekanik praoperasi. Pasien dengan Early Warning Score (EWS) >10 memiliki risiko 2,98 kali lebih besar untuk terjadinya komplikasi paru. Sedangkan risiko terjadinya mortalitas dapat meningkat 31,8 kali pada pasien yang memiliki ASA 3-5 dan 6,91 kali pada penggunaan ventilasi mekanik praoperasi.Simpulan: Pasien COVID-19 yang menjalani pembedahan memiliki risiko terjadinya komplikasi paru dan mortalitas pascaoperasi. Kejadian komplikasi paru memberat pada pasien dengan EWS >10, dan pada mortalitas memberat pada pasien dengan ASA 3-5 serta menggunakan ventilasi mekanik praoperasi. Faktor lain yang turut berperan diantaranya usia, jumlah komorbid, jenis operasi dan penggunaan topangan intraoperasi.

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Background: Coronavirus Disease 2019 (COVID-19) is a disease caused by SARS-CoV-2 infection with mild to severe symptoms such as pulmonary complications and death. The severity of disease is one of the factors that can aggravate the condition of patient who is planned for surgery. The clinical characteristics and postoperative complications of COVID-19 patients have been extensively studied in other countries. However, Indonesia does not yet have relevant data that can be used as a guide for COVID-19 patients in undergoing surgery.

Methods: This study is a retrospective cohort with secondary data collection of COVID-19 patients undergoing surgery at RSCM and RSUI from March 2020 to September 2021. The primary outcomes were pulmonary complications and mortality.

Results: A total of 458 COVID-19 patients underwent surgery at RSCM and RSUI, with 62% elective surgery and 38% emergency. The incidence of postoperative pulmonary complication was 21,8% and 30-day mortality was 26%. Clinical characteristics of patients with pulmonary complications and mortality were male, aged >65 years, had two or more comorbidities, initial symptoms of cough, dyspnea and fever, NLR value ≥5,9 which was categorized as severe COVID-19, consolidated CXR or opacity, and used preoperative mechanical ventilation. Patients with Early Warning Score (EWS) >10 had risk for pulmonary complications about 2,98 times. While, the risk of mortality can increase 31,8 times in patients with ASA 3-5 and 6,91 times in the use of preoperative mechanical ventilation.

Conclusions: COVID-19 patients undergoing surgery are at risk for pulmonary complications and mortality. The incidence of pulmonary complications was severe in patients with EWS >10, and mortality was severe in patients with ASA 3-5 and using preoperative mechanical ventilation. Other factors that play a role include age, number of comorbidities, type of surgery and use of intraoperative support."

"COVID-19 adalah penyakit menular yang disebabkan oleh severe acute respiratory syndrome coronavirus 2. Hingga saat ini kasus COVID-19 semakin bertambah. Meskipun kasus sembuh mencapai angka 96%, hal tersebut harus tetap diwaspadai karena sebagai penyintas masih dapat mengalami gejala yang menetap atau biasa disebut Long COVID. Long Coronavirus Disease (Long COVID) atau Post Acute COVID adalah kondisi pasca infeksi COVID-19 yang berkepanjangan setelah 4 minggu timbulnya gejala awal. Long COVID menjadi ancaman serius bagi para penyintas COVID-19 karena gejala yang menetap dapat membawa dampak buruk dan menganggu aktivitas penderitanya. Tujuan penelitian ini adalah untuk mengetahui factor-faktor yang memengaruhi kejadian Long COVID pada penyintas COVID-19 di Kota Sukabumi. Penelitian ini menggunakan desain penelitian cross sectional, pengambilan data dilakukan dengan menyebarkan kuesioner secara online. Penelitian ini diikuti oleh 267 rseponden dengan kriteria inklusi sudah sembuh dari COVID-19, berdomisili di Kota Sukabumi, dan usia minimal 18 tahun. Hasil penelitian menunjukan proporsi kejadian Long COVID sebesar 47% dengan gejala yang paling sering adalah mudah Lelah (30,7%), sulit berkonsentrasi (14,98%), dan mudah lupa (13,86%). Analisis bivariat menunjukan bahwa terdapat hubugan antara tingkat gejala (P value = 0,001), jenis perawatan (P value = 0,002), dan perokok pasif (P value = 0,020) dengan kejadian Long COVID. Lalu tidak terdapat hubungan yang signifikan antara karakteristik sosiodemografi, status vaksinasi, status merokok, derajat rokok, dan kondisi penyerta.

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COVID-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2. Until now, COVID-19 cases are increasing. Although the number of recovered cases reached 96%, this must still be watched out for because survivors can still experience persistent symptoms or commonly known as Long COVID. Long Coronavirus Disease (Long COVID) or Post Acute COVID is defined as persisten symptoms and/or delayed or long term complications beyond 4 weeks from the onset of symptoms. Long COVID is a serious condition to COVID-19 survivors because persistent symptoms can have a negative impact and disrupt the sufferer's activities. The purpose of this study was to determine the factors that affecting the incidence of Long COVID in COVID-19 survivors in Sukabumi City. This study used a cross-sectional study. Data collection was carried out by distributing online questionnaires. This study was conducted by 267 respondents with inclusion criteria are having recovered from COVID-19, domiciled in Sukabumi City, and a minimum age of 18 years. The results showed the proportion of the incidence of Long COVID was 47% with the most frequent symptoms are tiredness or fatigue (30.7%), difficulty concentrating (14.98%), and forgetful (13.86%). Bivariate analysis showed that there was a relationship between symptom level (P value = 0.001), type of treatment (P value = 0.002), and passive smoking (P value = 0.020) with the incidence of Long COVID. There is no significant relationship between sociodemographic characteristics, vaccination status, smoking status, smoking degree, and comorbidity,"

"Latar Belakang: Coronavirus disease 2019 (COVID-19) adalah penyakit yang sedang menjadi pandemi di dunia saat ini. Kasus COVID-19 semakin meningkat di seluruh dunia, hingga September 2022 tercatat kasus COVID-19 telah menyebar ke 233 negara dengan total kasus terkonfirmasi lebih dari 600.000.000 dan kasus kematian lebih dari 6.500.000. Coronavirus disease 2019 dapat berkembang menjadi kondisi yang berat dan kritis. Terapi sel punca mesenkimal (SPM) sedang dikembangkan sebagai tambahan tata laksana COVID-19 berat melalui potensi imunomodulator. Skor sequential organ failure assessment (SOFA) adalah sistem penilaian yang dapat digunakan untuk mengetahui derajat keparahan penyakit dan memprediksi mortalitas pasien COVID-19. Sampai saat ini, belum terdapat sistem penilaian yang digunakan sebagai parameter untuk mengetahui efikasi pemberian terapi sel punca mesenkimal tali pusat (SPM-TP). Penelitian ini bertujuan untuk mengetahui perbedaan skor SOFA pada pasien pneumonia COVID-19 yang mendapatkan terapi SPM-TP dan plasebo di RSUP Persahabatan.Metode: Desain penelitian ini adalah kohort retrospektif menggunakan data rekam medik pasien, dilakukan di RSUP Persahabatan Juli 2021-September 2022, dengan teknik total sampling. Subjek penelitian adalah pasien pneumonia COVID-19 derajat sedang, berat dan kritis yang mendapat terapi SPM-TP atau plasebo di RSUP Persahabatan bulan Juni 2020-Juli 2021 yang memenuhi kriteria penelitian.Hasil: Didapatkan 29 subjek penelitian yang terdiri dari 13 subjek kelompok perlakuan dan 16 subjek kelompok kontrol. Kedua kelompok memiliki karakteristik dasar yang sama. Perbedaan skor SOFA pada kedua kelompok tidak bermakna secara statistik. Namun, terdapat tren penurunan skor SOFA pada kelompok perlakuan. Perbedaan nilai C-reactive protein (CRP), prokalsitonin (Pct) dan rasio neutrofil limfosit (NLR) pada kedua kelompok tidak bermakna secara statistik. Namun, terdapat penurunan ketiga nilai tersebut pada kelompok perlakuan. Perbedaan lama rawat, pemakaian kanula hidung arus tinggi (KHAT) dan ventilasi mekanis pada kedua kelompok tidak bermakna secara statistik. Proporsi mortalitas lebih rendah pada kelompok perlakuan dibandingkan dengan kelompok kontrol walaupun tidak bermakna secara statistik.Kesimpulan: Tidak terdapat perbedaan bermakna skor SOFA, nilai CRP, nilai Pct, nilai NLR, lama perawatan, lama pemakaian KHAT atau ventilasi mekanis serta mortalitas pada kedua kelompok. Tetapi secara keseluruhan kelompok perlakuan mengalami perbaikan klinis dan laboratorium dibandingkan dengan kelompok kontrol.

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Background: Coronavirus disease 2019 (COVID-19) is a disease that is currently a pandemic in the world. Coronavirus disease 2019 are increasing worldwide, as of September 2022, COVID-19 cases have spread to 233 countries with a total of more than 600,000,000 confirmed cases and more than 6,500,000 deaths. Coronavirus disease 2019 can develop into a severe and critical condition. Mesenchymal stem cell (MSC) therapy is being developed as an adjunct to the management of severe COVID-19 through its immunomodulatory potential. The sequential organ failure assessment (SOFA) score is a scoring system that can be used to determine the severity of disease and predict mortality in COVID-19 patients. Until now, there is no scoring system that is used as a parameter to determine the efficacy of umbilical cord mesenchymal stem cell (UC-MSC) therapy. This study aims to determine the difference in SOFA scores in COVID-19 pneumonia patients who received UC-MSC therapy and placebo at Persahabatan Hospital.

Methods: The design of this study was a retrospective cohort using patient medical record data, conducted at Persahabatan Hospital July 2021-September 2022, with a total sampling technique. The subjects were patients with moderate, severe and critical COVID-19 pneumonia who received UC-MSC or placebo therapy at Persahabatan Hospital in June 2020-July 2021 who met the inclusion criteria.

Results: There were 29 subjects consisting of 13 treatment group and 16 control group. Both groups have the same basic characteristics. The difference in SOFA scores in the two groups was not statistically significant. However, there was a downward trend in SOFA scores in the treatment group. The difference in the value of C-reactive protein (CRP), procalcitonin (Pct) and neutrophil lymphocyte ratio (NLR) in the both group was not statistically significant. However, there was a decrease values ​​in the treatment group. Differences in length of stay, use of high flow nasal cannula (HFNC) and mechanical ventilation in the two groups were not statistically significant. The proportion of mortality was lower in the treatment group compared to the control group although not statistically significant.

Conclusion: There were no significant differences in SOFA, CRP, Pct, NLR, length of stay, length of use of HFNC or mechanical ventilation and mortality in the two groups. However, the treatment group experienced clinical and laboratory improvement compared to the control group."

"Pandemi Covid-19 menimbulkan dampak pada berbagai sektor yang memungkinkan memicu terjadinya gangguan mental emosional (GME) dan penurunan kualitas hidup sehingga pembentukan ketangguhan sangat diperlukan. Studi ini ditujukan unutk menganalisis peranan ketangguhan (individu, keluarga dan komunitas) terhadap GME dan kualitas hidup individu selama pandemi Covid-19 di Jakarta Timur pada gelombang kedua. Studi explanatory sequential mixed-methods dengan pendekatan desain cross sectional dan metode kualitatif dengan desain Rapid Assessment Procedure (RAP). Kualitas hidup diukur menggunakan Indonesian HRQoL, sedangkan GME diskrining menggunakan SRQ pada 300 responden yang terpilih dari teknik multistage cluster sampling. Exploratory qualitative dilakukan pada 2 kelompok FGD dan 3 informan wawancara mendalam, sedangkan explanatory qualitative dilakukan pada 6 kelompok FGD dan 9 informan wawancara mendalam. Masyarakat memahami ketangguhan (individu, keluarga, dan komunitas) sebagai konsep kamampuan menghadapi pandemi dengan memanfaatkan aspek-aspek di sekitar mereka, GME sebagai masalah mental, dan kualitas hidup sebagai kondisi kesehatan. Proporsi GME meningkat dua kali lipat dibandingkan situasi normal. Proporsi kualitas hidup buruk sebanyak 26,30%. Ketangguhan (individu, keluarga, dan komunitas) yang buruk berhubungan terhadap terjadinya GME dan kualitas hidup buruk selama pandemi Covid-19. GME juga berperan terhadap kualitas hidup yang buruk. Peranan ketangguhan individu terhadap GME dan kualitas hidup ditentukan oleh persepsi realistis dengan cara bersyukur, ikhlas, sabar, dan saling menguatkan, menerima keadaan, menerapkan protokol kesehatan, regulasi emosi-kognisi, kemampuan adaptasi, dan optimisme. Peranan ketangguhan individu terhadap GME dan kualitas hidup ditentukan oleh usia pengambil keputusan keluarga, dukungan sosial dan kontrol diri. Peranan ketangguhan komunitas terhadap GME dan kualitas hidup ditentukan oleh kestabilan sistem pendidikan, sistem kesehatan, sistem politik/pemerintahan, dan sistem manajemen pandemi. Ketangguhan keluarga ditemukan paling berperan terhadap kualitas hidup. Sistem pemerintahan yang berkolaborasi dan responsif menentukan kestabilan komponen-komponen ketangguhan komunitas. Oleh karena itu, direkomendasikan untuk memperkuat komponen ketangguhan keluarga dan sistem pemerintahan dalam menghadapi pandemi.

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The Covid-19 pandemic has had an impact on various sectors that may trigger mental emotional disorders (GME) and a decrease in quality of life so that the formation of resilience is urgently needed. This study aimed at analyzing the role of resilience (individual, family and community) on GME and the quality of life of individuals during the Covid-19 pandemic in East Jakarta in the second wave. Explanatory sequential mixed-methods study with a cross-sectional design approach and qualitative methods with a Rapid Assessment Procedure (RAP) design. Quality of life was measured using the Indonesian HRQoL, while GME was screened using the SRQ on 300 respondents selected from the multistage cluster sampling technique. Exploratory qualitative was conducted with 2 FGD groups and 3 in-depth interviews with informants, while explanatory qualitative was conducted with 6 FGD groups and 9 in-depth interviews with informants. Communities understand resilience (individual, family and community) as a concept of being able to deal with a pandemic by utilizing aspects around them, GME as a mental problem, and quality of life as a health condition. The proportion of GME has doubled compared to the normal situation. The proportion of poor quality of life was 26.30%. Poor resilience (individual, family and community) related to the occurrence of GME and poor quality of life during the Covid-19 pandemic. GME also contributed to poor quality of life. The role of individual resilience to GME and quality of life was determined by realistic perceptions by being grateful, sincere, patient, and mutually reinforcing, accepting circumstances, implementing health protocols, emotional-cognition regulation, adaptability, and optimism. The role of individual resilience to GME and quality of life was determined by the age of family decision makers, social support and self-control. The role of community resilience to GME and quality of life was determined by the stability of the education system, health system, political/government system, and pandemic management system. Family resilience was found to have the most effect on quality of life. Collaborative and responsive governance systems determine the stability of the components of community resilience. Therefore, it is recommended to strengthen the components of family resilience and government systems to deal with a pandemic."

"Latar Belakang: Penyakit periodontal merupakan penyakit inflamasi yang memengaruhi jaringan penyangga gigi. Patogen memicu sistem imun bawaan ada jaringan periodontal untuk melepaskan mediator proinflamasi dan sitokin, salah satunya yaitu Prostaglandin E2 (PGE2). Periodontitis diketahui memiliki pengaruh dua arah dengan beberapa penyakit sistemik. salah satunya COVID-19 yang disebabkan oleh virus SARS-CoV-2 yang berkaitan dengan sindrom badai sitokin. Tujuan: Penelitian ini dilakukan untuk melihat korelasi respons imun individu penyintas COVID-19 dalam hal ini mediator inflamasi PGE2 dengan kondisi jaringan periodontal berdasarkan parameter klinis periodontal yaitu BOP, PD, dan CAL. Metode: Desain penelitian potong lintang pada 38 orang subjek dengan membagi dua kelompok subjek berdasarkan riwayat COVID-19. Dilakukan pemeriksaan parameter klinis periodontal BOP, PD, CAL dan pengambilan sampel GCF untuk mengukur kadar PGE2 menggunakan metode ELISA. Analisis data dilakukan dengan SPSS 25 dan GraphPad 10.0.0 Hasil: Terdapat perbedaan kadar PGE2 (p<0,05) antara penyintas dan bukan penyintas COVID-19. Tidak terdapat perbedaan parameter klinis periodontal (p>0,05) antara penyintas dan bukan penyintas COVID-19. Terdapat hubungan linear positif (p<0,05; r>0) antara kadar PGE2 dengan PD dan BOP. Kesimpulan: Kadar PGE2 pada subjek penyintas COVID-19 diindikasikan berkorelasi positif terhadap parameter klinis periodontal PD dan BOP.

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Background: Periodontal disease is an inflammatory condition that affects the supporting tissues of the teeth. In periodontitis, pathogens trigger the innate immune system to release proinflammatory mediators and cytokines in the periodontal tissues, one of which is Prostaglandin E2 (PGE2). Periodontitis is known to have a bidirectional relationship with several systemic diseases, one of them is COVID-19 which caused by the SARS-CoV-2 and associated with a cytokine storm syndrome. Objective: This research is conducted to examine the correlation between the immune response of individuals who have survived COVID-19, specifically the inflammatory mediator PGE2, and the condition of periodontal tissues based on clinical periodontal parameters, namely BOP, PD, and CAL. Methods: The design of this study was cross-sectional on 38 subjects by dividing two groups of subjects based on history of COVID-19. Periodontal clinical parameters BOP, PD, CAL were examined and GCF samples were taken to measure PGE2 levels using the ELISA method. Data analysis was carried out with SPSS 25 and GraphPad 10.0.0. Results: There is a significant difference in PGE2 levels (p<0.05) between former COVID-19 patients and non-COVID-19. No significant differences in clinical periodontal parameters (p>0.05) were found between two groups. A positive linear relationship (p<0.05; r>0) was observed between PGE2 levels and PD, as well as BOP. Conclusions: PGE2 levels in subjects who survived COVID-19 were indicated to be positively correlated with the periodontal clinical parameters of PD and BOP."

"Latar Belakang Penelitian ini meneliti potensi peningkatan resistensi insulin dan obesitas dalam 12 bulan pasca COVID-19 pada penyintas COVID-19 dengan status glikemik beragam. Analisis retrospektif dilakukan untuk mengidentifikasi faktor metabolik dan respons inflamasi yang berkontribusi, termasuk proporsi sel T memori spesifik SARS-CoV-2 yang fungsional dan yang mengalami disfungsi, kadar sitokin, serta polarisasi makrofag. Metode Penelitian kohort ini melibatkan 47 pasien terinfeksi SARS-CoV-2 yang dipantau selama lima periode: fase akut (baseline), bulan ke-1, ke-3, ke-9, dan ke-12 fase konvalesen. Partisipan dikelompokkan menjadi tiga berdasarkan status obesitas dan peningkatan HOMA-IR, yaitu non-obes (NO), obes tanpa peningkatan HOMA-IR (O), dan obes dengan peningkatan HOMA-IR (O-IR). Peningkatan HOMA-IR didefinisikan sebagai rasio HOMA-IR bulan ke-12/bulan ke-1 ≥ 1,21. Pada setiap periode, dilakukan pengukuran komposisi tubuh, kadar kendali glikemik, serta isolasi PBMC. Identifikasi sel T CD4+ dan CD8+ memori spesifik SARS-CoV-2 dilakukan melalui inkubasi PBMC dengan antigen SARS-CoV-2 selama 24 jam. Supernatan hasil inkubasi PBMC dengan antigen digunakan untuk menilai kadar sitokin yang diproduksi dan kecenderungan polarisasi makrofag. Hasil Sebanyak 35,3% pasien non-DM, 75% pasien DM baru, dan 59,1% pasien DM mengalami peningkatan HOMA-IR ≥ 21% dalam 12 bulan pasca COVID-19. Kelompok O-IR tidak mengalami penurunan total lemak tubuh, rasio lemak/otot, dan lingkar perut dalam 12 bulan follow up. Selain itu, kelompok O-IR memiliki proporsi sel T memori spesifik SARS-CoV-2 fungsional lebih rendah, sementara sel yang mengalami disfungsi lebih tinggi, kadar sitokin lebih rendah, tetapi rasio TNF-α/IL-10 lebih tinggi dibandingkan dengan kelompok lain. Supernatan dari PBMC dari kelompok O-IR menurunkan ekspresi IL-10 pada makrofag M2. Sehingga ekspresi IL10 ini tidak mampu menekan ekspresi IL-6 makrofag M1. Kesimpulan Disfungsi sel T memori spesifik SARS-CoV-2 meningkatkan resistensi insulin 12 bulan pasca COVID-19 pada kelompok obes yang tidak mengalami penurunan kadar lemak dan obesitas sentral.

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Background: A retrospective analysis to investigate the increased of insulin resistance and obesity within 12 months after COVID-19 was conducted to identify contributing metabolic factors and inflammatory responses, including the proportion of functional and dysfunctional SARS-CoV-2-specific memory T cells, cytokine levels, and macrophage polarization.

Methods:

This cohort study involved 47 SARS-CoV-2-confirmed patients, who were followed-up at five periods: the acute phase (baseline) and months 1, 3, 9, and 12 of the convalescent phases. Participants were categorized into three groups based on obesity status and increased HOMA-IR: non-obese (NO), obese without HOMA-IR increase (O), and obese with HOMA-IR increase (O-IR). Increased of HOMA-IR was defined as a HOMA-IR ratio of 12th/1st month ≥ 1.21. At each period, body composition and glycemic indices were measure and PBMC was isolated. The PBMC was incubated with SARS-CoV-2 antigen for 24 hours to identify SARS-CoV-2-specific CD4+ and CD8+ memory T cells The PBMC supernatant was used to evaluate cytokine production and macrophage polarization. Results:

A 35.3% of non-DM patients, 75% of newly diagnosed DM patients, and 59.1% of DM patients experienced increased of HOMA-IR ≥21% within 12 months postCOVID-19. The O-IR group did not show a reduction in total body fat, fat-tomuscle ratio, or waist circumference over the 12-month follow-up. Additionally, the O-IR group had a lower proportion of functional SARS-CoV-2-specific memory T cells, a higher proportion of dysfunctional cells, lower cytokine levels, but a higher TNF-α/IL-10 ratio compared to other groups. The PBMC supernatant from the O-IR group reduced IL-10 expression in M2 macrophages, which failed to suppress IL-6 expression in M1 macrophages.

Conclusion:

The dysfunctional SARS-CoV-2 memory T cells may increase the risk of elevated insulin resistance within 12 months post COVID-19, particularly in obese individual who do not experience body fat and central obesity reduction."