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"Latar belakang: Coronavirus Disease 2019 (COVID-19) adalah penyakit baru. Infeksi saluran napas akibat virus yang disertai infeksi bakteri akan meningkatkan derajat keparahan dan angka mortalitas. Insidens ventilator associated pneumonia (VAP) pada kelompok COVID-19 yaitu 21-64%. Kasus VAP dapat menjadi penyebab tingginya mortalitas pada pasien COVID-19 terintubasi.Metode penelitian : Penelitian ini adalah penelitian retrospektif di RS Persahabatan. Seluruh sampel yang digunakan adalah kelompok pasien COVID- 19 terintubasi >48 jam dalam periode tahun 2020-2022 yang memenuhi kriteria inklusi dan eksklusi.Hasil penelitian : Penelitian ini meliputi 196 data penelitian yang memenuhi kriteria inklusi. Proporsi laki-laki lebih banyak dibandingkan perempuan dan hanya 29% adalah populasi usia lanjut. Proporsi VAP pada COVID-19 terintubasi pada tahun 2020-2022 mencapai 60% dengan VAP rates 92,56. Terdapat dua faktor bermakna terhadap VAP pada pasien COVID-19 terintubasi yaitu penggunaan azitromisin (OR 2,92; IK95% 1,29-6,65; nilai-p 0,01) dan komorbid penyakit jantung. (OR 0.38; IK95% 0,17-0,87; nilai-p 0,023). Proporsi terbesar biakan mikroorganisme aspirat endotrakeal adalah Acinetobacter baumannii (44%), Klebsiella pneumoniae (23%), Escherichia coli (9%).Kesimpulan : Proporsi VAP pada COVID-19 terintubasi adalah 60%. Terdapat hubungan bermakna pada penggunaan azitromisin dan komorbid penyakit jantung sedangkan usia lanjut dan penggunaan steroid tidak memiliki hubungan bermakna terhadap VAP pada pasien COVID-19 terintubasi.

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Background : Coronavirus Disease 2019 (COVID-19) is a novel disease. Viral respiratory infection following bacterial infection could increase the severity and mortality of the disease. The incidence of Ventilator (VAP) in COVID-19 group is 21-64%. VAP might be the leading cause of high mortality in intubated COVID-19 patient.

Methods : This research is a retrospective study at Persahabatan hospital. The collected samples is a group of COVID-19 patient intubated for >48 hours in the period of 2020 to 2022 that meet the inclusion and exclusion criteria.

Results : This study consist of 196 data fulfilling the inclusion criteria. Male proportion much greater than female and only 29% is an elderly population. The proportion of VAP in the period of 2020-2022 is 60% with the VAP rates 92,56. There are two factors significantly affected VAP in intubated COVID-19 patient which are the usage of azitromisin (OR 2,92; CI95% 1,29-6,65; p-value 0,01) and cardiovascular disease comorbidity(OR 0.38; CI95% 0,17-0,87; p-value 0,023). The most abundance proportion of endotracheal aspirate microorganism culture are Acinetobacter baumannii (44%), Klebsiella pneumoniae (23%), and Eschrichia coli (9%).

Conclusion : The proportion of VAP in intubated COVID-19 is 60%. There are significant association of azitromicin usage and cardiovascular comorbidity while elderly and the usage of steroid are not significantly associated to VAP in intubated COVID-19 patient."

"Latar Belakang: Pandemi COVID-19 telah menjadi tantangan besar bagi dunia kesehatan. Tenaga kesehatan merupakan populasi yang sangat rentan tertular dikarenakan tingginya intensitas dan frekuensi pajanan SARS-CoV-2. Risiko penularan meningkat apabila tenaga medis melakukan tindakan yang memicu aerosilisasi, salah satunya adalah intubasi endotrakeal karena tingginya viral load pada saluran napas. Sebanyak 3,2% pasien COVID-19 memerlukan tindakan intubasi endotrakeal dan ventilasi mekanis. Intubasi endotrakeal yang efektif pada pasien COVID-19 penting dilakukan untuk menurunkan mortalitas dan risiko penularan. Penelitian ini bertujuan intuk mengetahui faktor-faktor yang memengaruhi efektivitas intubasi endotrakeal pada pasien terkonfirmasi COVID- 19 di RSUP Persahabatan.Metode: Penelitian ini merupakan penelitian observasional yang menggunakan desain potong lintang yang dilakukan di IGD, ICU Rasmin Rasjid dan ICU PINERE RSUP Persahabatan pada bulan Juni 2021 – Juni 2022. Subjek peneltian ini adalah pasien terkonfirmasi COVID-19 yang dilakukan tindakan intubasi endotrakeal yang memenuhi kriteria inklusi dan eksklusi. Tindakan intubasi endotrakeal dinilai dari observasi rekaman CCTV. Selanjutnya karakteristik subjek, karakteristik intubasi endotrakeal dan faktor-faktor yang memengaruhi intubasi endotrakeal dievaluasi.Hasil: Pada penelitian ini didapatkan 59 subjek penelitian. Proporsi intubasi endotrakeal efektif pada pasien COVID-19 sebesar 20,34%. Median lama waktu tindakan intubasi endotrakeal adalah 38 (19-189) detik. Sebanyak 32 (54,24%) tindakan intubasi endotrakeal dilakukan oleh spesialis anestesi dan 27 (45,76%) oleh PPDS Pulmonologi dan Kedokteran Respirasi. Hasil analisis bivariat didapatkan hasil bermakna secara statistik pada variabel penyakit kardiovaskular+DM (OR 0,24 (IK 95% 0,06-0,91), p=0,028) dan variabel operator (OR 0,07 (IK 95% 0,01-0,62), p=0,004). Hasil analisis multivariat menunjukkan hasil bermakna secara statistik hanya pada variabel operator (adjusted OR 0,06 (IK 95% 0,01-0,60), p=0,016).Kesimpulan: Terdapat hubungan penyakit kardiovaskular+DM dan operator terhadap intubasi endotrakeal efektif pada pasien COVID-19 di RSUP Persahabatan.

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Background: The COVID-19 pandemic has become a major challenge for the healthcare system. Healthcare workers are vulnerable population of COVID-19 transmission due to high intensity and frequency of exposure to SARS-CoV-2. The risk of transmission increases in aerosolization procedure such as endotracheal intubation because of the high viral load in the airways. Approximately 3.2% of COVID-19 patients require endotracheal intubation and mechanical ventilation. Effective endotracheal intubation in COVID-19 patients is important parameter to reduce mortality and the risk of transmission to healthcare workers. This study aims to determine the factors that influence the effectiveness of endotracheal intubation in patients with COVID-19 in National Respiratory Center, Persahabatan Hospital.

Methods: This study is an observational study using a cross-sectional design which was carried out in the emergency department, ICU Rasmin Rasjid and ICU PINERE of National Respiratory Center, Persahabatan Hospital in June 2021 – June 2022. The subjects of this study were COVID-19 patients who underwent endotracheal intubation who met the criteria inclusion and exclusion. The endotracheal intubation procedure was assessed from the observation of CCTV recordings. The characteristics of the subject, the characteristics of endotracheal intubation and the factors that influence endotracheal intubation were evaluated.

Results: In this study, there were 59 subjects. The proportion of effective endotracheal intubation in COVID-19 patients was 20.34%. The median length of time for endotracheal intubation was 38 (19-189) seconds. Among the subjects, 32 (54.24%) endotracheal intubation were performed by anesthesiologists and 27 (45.76%) were performed by Pulmonology and Respiratory Medicine residents. The results of the bivariate analysis showed statistically significant results on the cardiovascular disease + DM comorbid (OR 0.24 (95% CI 0.06-0.91), p=0.028) and operator (OR 0.07 (95% CI 0.01-0.62), p=0.04). The results of the multivariate analysis showed statistically significant results only for operator (adjusted OR 0.06 (95% CI 0.01-0.60), p=0.016).

Conclusion: There is relationship of cardiovascular disease + DM comorbid and operator with effective endotracheal intubation in COVID-19 patients at National Respiratory Center, Persahabatan Hospital."

"Pandemi Covid-19 menjadi tantangan bagi RS UI dalam mengedepankan pelayanan kepada pasien yang bersifat holistik, demi kepentingan dan keselamatan pasien. Case manager merupakan jabatan baru di RS UI, sehingga dianggap masih memiliki banyak celah dalam penerapannya. Peran case manager dirasakan belum optimal di lapangan, terutama oleh klinisi dan manajemen. Tujuan penelitian adalah untuk merumuskan tugas pokok fungsi case manager dalam pelayanan pasien Covid-19, dan mengidentifikasi peran yang telah dilaksanakan oleh case manager. Penelitian ini merupakan penelitian non eksperimental kualitatif, menggunakan pendekatan fenomenologi dengan desain potong lintang. Peneliti menemukan bahwa case manager RS UI belum menjalankan peran sesuai rumusan tugas pokok fungsi case manager yang ada dalam standar akreditasi RS; rumusan tugas pokok fungsi case manager belum sesuai dengan kebutuhan pelayanan pasien Covid-19 di RS UI, sehingga case manager RS UI belum menjalankan peran sesuai rumusan tugas pokok fungsi case manager untuk kebutuhan pelayanan pasien Covid-19 di RS UI. Secara garis besar, terdapat tiga hambatan peran case manager, yaitu hambatan pengorganisasian, hambatan aktivitas, dan hambatan evaluasi. Peneliti merekomendasikan agar tupoksi case manager tetap memenuhi standar akreditasi, dan disesuaikan dengan karakteristik RS. Selain itu, perlu dilakukan penguatan case manager secara kualitas dan kuantitas, agar dapat berperan lebih optimal.

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The Covid-19 pandemic is a challenge for UI Hospital in prioritizing its services to patients that are holistic in nature, for the benefit and safety of patients. Case manager is a new position at UI Hospital, so it is considered that there are still many gaps in its implementation. The role of the case manager is felt to be not optimal in the field, especially by clinicians and management. The purpose of the study was to formulate the main duties and functions of the case manager in the service of Covid-19 patients, as well as to identify the roles that have been carried out by the case manager. This research was a non-experimental qualitative using a phenomenological approach with a cross-sectional design. The researcher found that the case manager of the UI Hospital had not carried out the role according to the formulation of the main duties and functions of the case manager in the hospital accreditation standard; The formulation of the main duties and functions of the case manager was not in accordance with the service needs of Covid-19 patients at the UI Hospital. Therefore, the case manager was considered not to have carried out the roles accordingly for the service needs of Covid-19 patients at the UI Hospital. Thus, in general terms, there are three barriers to the role of the case manager, namely organizational barriers, activity barriers, and evaluation barriers. The researcher recommends that the main duties of the case manager still meet accreditation standards, and are adjusted to the characteristics of the hospital. In addition, it is necessary to strengthen case managers in terms of quality and quantity, so that they can play a more optimal role."

"Latar Belakang. Pandemi COVID-19 yang terjadi sejak akhir tahun 2019 telah menginfeksi puluhan juta orang di di dunia, termasuk di Indonesia. Tes pemeriksaan PCR sebagai tes standar untuk diagnosis merupakan salah satu upaya pencegahan sekunder penting untuk mencegah penyebaran penyakit, mengetahui besar masalah dan pengambilan keputusan segera untuk upaya pencegahan selanjutnya. Adanya jeda waku yang panjang untuk menunda pemeriksaan diagnosis PCR ini berpotensi menimbulkan penyebaran virus yang lebih luas dan kemungkinan kesalahan diagnosis. Tujuan. Mengetahui gambaran jeda waktu diagnosis pasien COVID-19 dan faktor-faktor pasien yang berpengaruh. Metode Penelitian. Penelitian dilakukan dengan Sumber data Rekam Medis pasien rawat inap COVID-19 tahun 2020 di Rumah Sakit Universitas Indonesia dengan pendekatan cross sectional. Total sampling dilakukan dengan menerapkan kriteria inklusi dan eksklusi. Hasil. Dari 254 subjek penelitian, laki-laki lebih banyak (55.1%). Panjang jeda waktu diagnosis di luar fasilitas pelayanan kesehatan median 6 hari, di fasilitas pelayanan kesehatan 1 hari, dan total 7 hari. Jumlah pasien terlambat di luar fasilitas pelayanan ksesehatan lebih banyak dibandingn dengan terlambat di dalam fasilitas pelayanan kesehatan (80.7% vs. 5.7%). Dari uji chi-square, faktor yang berhubungan dengan keterlambatan diagnosis yaitu jenis kelamin (p=0.013), umur (p=<0.01), status perkawinan (p=0.021), pendidikan (p=0.024), riwayat kontak (p=0.031), dan gejala (p=0.003). Kesimpulan. Ada hubungan antara keterlambatan diagnosis COVID-19 dengan beberapa faktor demografi dan faktor penyakit pasien.

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Background. The COVID-19 pandemic that has occurred since the end of 2019 has infected tens of millions of people worldwide, including in Indonesia. PCR test as a standard test for diagnosis is one of the important secondary prevention efforts to prevent the spread of the disease, find out the magnitude of the problem and make immediate decisions for further prevention. This long delay in delaying PCR diagnosis may represent a wider spread of the virus and a possible misdiagnosis. Objective. To find out the description of the time lag in the diagnosis of COVID-19 patients and the factors that influence it Research methods. The study was conducted using Medical Record data sources for COVID-19 inpatients in 2020 at the Universitas Indonesia Hospital with a cross sectional approach. Total sampling was done by applying inclusion and exclusion criteria. Results. Of the 254 research subjects, more men (55.1%). The length of time delay for diagnosis outside health care facilities is a median of 6 days, at a health service facility 1 day, and a total of 7 days. The number of late patients outside health care facilities was higher than those late in health care facilities (80.7% vs. 5.7%). From the chi-square test, factors associated with late diagnosis were gender (p=0.013), age (p=<0.01), marital status (p=0.021), education (p=0.024), contact history (p=0.031), and symptoms (p=0.003). Conclusion. There is a relationship between the delay in the diagnosis of COVID-19 with several demographic factors and patient disease factors."

"COVID-19 atau coronavirus disease 2019 adalah penyakit menular yang memengaruhi sistem organ, terutama sistem pernapasan dan disebabkan oleh virus SARS-CoV-2. Individu yang terinfeksi COVID-19 memiliki tingkat keparahan yang berbeda. Salah satu faktor yang berasosiasi terhadap tingkat keparahan pasien COVID-19 adalah usia. Tingkat keparahan yang tinggi pada kondisi seseorang cenderung mempengaruhi banyaknya treatment yang dibutuhkan, hingga akhirnya juga mempengaruhi waktu yang dibutuhkan seseorang tersebut untuk sembuh. Penelitian ini berfokus pada faktor usia, dimana faktor tersebut diduga menyebabkan perbedaan karakteristik tertentu dari pasien dan durasi rawat yang dibutuhkan oleh pasien COVID-19. Tujuan dari penelitian ini adalah untuk menganalisis perbandingan karakteristik pasien COVID-19 berdasarkan kelompok usia, dan mengidentifikasi bagaimana kaitan usia terhadap durasi rawat pasien COVID-19 hingga mengalami kematian, perbaikan kondisi COVID, dan rawat jalan. Analisis perbandingan karakteristik pasien COVID-19 berdasarkan kelompok usia dilakukan dengan menerapkan metode exploratory data analysis (EDA). Selanjutnya metode EDA dan regression tree diterapkan untuk mengetahui bagaimana kaitan usia terhadap durasi rawat pasien COVID-19 hingga mengalami kematian, perbaikan kondisi, dan rawat jalan. Hasil yang diperoleh pada penelitian ini adalah terdapat kecenderungan perbedaan pada pasien COVID-19 berdasarkan kelompok usia jika dilihat berdasarkan faktor jenis kelamin, durasi rawat, status akhir, gejala, komorbid, komplikasi, dan pengukuran laboratorium darah. Selain itu, usia merupakan pertimbangan utama dalam memperkirakan durasi rawat pasien COVID-19 dengan faktor lainnya adalah hipertensi, klorida, HPR, PWR, MLR dan gejala demam.

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COVID-19 or coronavirus disease 2019 is an infectious disease that affects the organ systems, especially the respiratory system and is caused by the SARS-CoV-2 virus. Individuals infected with COVID-19 have different levels of severity. One of the factors associated with the severity of COVID-19 patients is age. The severity level of a person tends to affect the number of treatments needed, and therefore will affect the time it takes for the person to recover. This study focuses on age, where this factor is suspected to cause differences in certain characteristics of COVID-19 patients and length of hospital stay required by COVID-19 patients. The purpose of this study is to analyse the characteristics comparison of COVID-19 patients by age group, and to identify on how age affects the length of hospital stay for COVID-19 patients to death, improved conditions, or outpatient care. Comparative analysis of the characteristics of COVID-19 patients by age group is done using exploratory data analysis (EDA). Furthermore, EDA and regression tree are used to find out how age is related to the length of hospital stay for COVID-19 patients to death, improved COVID conditions, or outpatient care. The results show that there was tendency of differences in gender, length of hospital stay, clinical outcome, symptoms, comorbidities, complications, and blood laboratory measurements in COVID-19 patients based on age group. In addition, age is a major consideration in estimating the length of hospital stay for COVID-19 patients with other factors such as hypertension, chloride, HPR, PWR, MLR and fever."

"Latar BelakangPandemi COVID-19, yang disebabkan oleh SARS-CoV-2, berdampak global, termasuk di Indonesia, dengan komplikasi utama seperti trombosis terkait peningkatan kadar D- dimer, biomarker pembekuan darah. Kadar D-dimer yang tinggi dikaitkan dengan prognosis buruk, seperti risiko trombosis, lama rawat inap yang lebih lama, dan kematian. Penelitian ini bertujuan mengeksplorasi hubungan antara kadar D-dimer, tingkat keparahan penyakit, dan lama rawat pasien COVID-19 di RSUP Persahabatan.MetodePenelitian ini bersifat observasional-analitis dengan desain potong lintang pada pasien COVID-19 derajat sedang, berat, dan kritis di RSUP Persahabatan, Jakarta, selama Januari–Desember 2021. Data dikumpulkan dari rekam medis dan dianalisis dengan metode consecutive sampling, melibatkan 57 sampel. Penelitian mencakup pengukuran kadar D-dimer, tingkat keparahan penyakit, dan lama rawat inap. Analisis data dilakukan menggunakan SPSS 25.0 dengan uji univariat dan bivariat, termasuk uji Chi-square atau Fisher’s exact untuk memeriksa hubungan antarvariabel.HasilHasil penelitian ini menunjukkan bahwa tidak ada hubungan signifikan antara kadar D- dimer awal dengan tingkat keparahan COVID-19 (p=0,364), meskipun subjek dengan kadar D-dimer ≥500 ng/mL lebih banyak mengalami kondisi sedang dan berat. Di sisi lain, kadar D-dimer yang lebih tinggi (≥500 ng/mL) berhubungan dengan durasi rawat inap yang lebih lama (≥14 hari) dengan p=0,044, menunjukkan perbedaan signifikan antara kadar D-dimer dan lama rawat inap pasien COVID-19.KesimpulanPenelitian ini menunjukkan bahwa tidak ada hubungan signifikan antara kadar D-dimer awal dengan tingkat keparahan COVID-19 (p=0,364), namun kadar D-dimer ≥500 ng/mL berhubungan dengan durasi rawat inap yang lebih lama (≥14 hari) (p=0,044).

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Introduction

The COVID-19 pandemic, caused by SARS-CoV-2, has had a global impact, including in Indonesia, with major complications such as thrombosis associated with elevated D- dimer levels, a biomarker of blood coagulation. High D-dimer levels are linked to poor prognosis, including the risk of thrombosis, prolonged hospital stays, and mortality. This study aims to explore the relationship between D-dimer levels, disease severity, and length of hospitalization in COVID-19 patients at RSUP Persahabatan.

Method

This study is an observational-analytical research with a cross-sectional design conducted on COVID-19 patients with moderate, severe, and critical conditions at RSUP Persahabatan, Jakarta, from January to December 2021. Data were collected from medical records and analyzed using consecutive sampling methods, involving 57 samples. The study includes measurements of D-dimer levels, disease severity, and length of hospitalization. Data analysis was performed using SPSS 25.0 with univariate and bivariate tests, including Chi-square or Fisher’s exact tests to examine the relationships between variables.

Results

The results of this study indicate that there is no significant relationship between initial D-dimer levels and the severity of COVID-19 (p=0.364), although subjects with D-dimer levels ≥500 ng/mL were more likely to experience moderate and severe conditions. On the other hand, higher D-dimer levels (≥500 ng/mL) are associated with longer hospital stays (≥14 days) with a p-value of 0.044, indicating a significant difference between D- dimer levels and the duration of hospitalization in COVID-19 patients.

Conclusion

This study shows that there is no significant relationship between initial D-dimer levels and COVID-19 severity (p=0.364), but D-dimer levels ≥500 ng/mL are associated with longer hospital stays (≥14 days) (p=0.044)."

"Latar BelakangN-asetilsistein (NAC) merupakan kandidat potensial untuk strategi drug repurposing dalam menangani pandemi COVID-19, terutama untuk menurunkan progresi COVID-19 derajat berat yang dapat diprediksi oleh rasio neutrofil-limfosit (RNL). Namun, belum banyak studi yang meneliti hubungan NAC dengan RNL. Oleh karena itu, penelitian ini bertujuan untuk menilai hubungan pemberian NAC dengan RNL pasien COVID-19 derajat berat di RSUP Persahabatan.MetodePenelitian potong lintang dilakukan melalui rekam medis 60 pasien COVID-19 derajat berat di RSUP Persahabatan (mendapat NAC: 30; tidak mendapat NAC: 30). Studi ini meninjau karakteristik subjek penelitian berdasarkan usia, jenis kelamin, komorbiditas, dan riwayat pengobatan lain. Fokus penelitian ini adalah parameter RNL sebelum dan setelah perawatan. Analisis dilanjutkan dengan menilai hubungan pemberian NAC terhadap RNL.HasilSecara keseluruhan, terdapat 60 subjek yang mayoritas terdiri atas laki-laki (53,3%) dengan median usia 54 (23 – 69). Tidak ada perbedaan sebaran jenis kelamin, usia, komorbiditas, dan riwayat pengobatan lain antara kedua kelompok yang bermakna secara statistika. RNL kelompok yang mendapat NAC lebih rendah daripada kelompok yang tidak mendapat, baik sebelum perawatan (6,21 [2,21 – 33,32] vs 6,92 [2,25 – 36,15]) maupun setelah perawatan (5,14 [0,99 – 17,16] vs 5,74 [1,88 – 21,95]), tetapi perbedaan tersebut tidak signifikan secara statistika (p = 0,941; p = 0,451, masing-masing). Pemberian NAC tidak mempengaruhi penurunan RNL secara bermakna (p = 0,060). Adapun perbedaan median perubahan RNL antara dua kelompok tidak ditemukan bermakna (p = 0,460).KesimpulanNAC tidak signifikan secara statistik dalam menurunkan RNL pasien COVID-19 derajat berat.

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Introduction

N-acetylcysteine (NAC) is a potential candidate for drug repurposing strategies in dealing with the COVID-19 pandemic, especially in reducing the development of severe COVID- 19 which can be predicted by the neutrophil-lymphocyte ratio (NLR). However, due to limited research of NAC’s effect on NLR, this study aims to assess their relationship in severe COVID-19 patients at Persahabatan Central General Hospital.

Method

A cross-sectional study from medical records of 60 severe COVID-19 patients at Persahabatan Central General Hospital (received NAC: 30; not received NAC: 30) reviewed the characteristics of the subjects based on age, gender, comorbidities, and other treatment history. This study focused on NLR before and after treatment, assessing the relationship between NAC administration and NLR.

Results

Most of the overall subjects were male (53.3%) with a median age of 54 (23–69). There was no statistically significant difference in the distribution of gender, age, comorbidities, and other treatment history between two groups. Group that received NAC had lower NLR than group that didn’t, both before treatment (6.21 [2.21–33.32] vs 6.92 [2.25– 36.15]) and after treatment (5.14 [0.99–17.16] vs 5.74 [1.88–21.95]), but the difference was not statistically significant (p = 0.941; p = 0.451, respectively). NAC administration did not significantly decrease NLR (p = 0.600). The difference in median changes in NLR between two groups was also not found to be significant (p = 0.460).

Conclusion

NAC did not statistically significant in reducing NLR in severe COVID-19 patients."

"Latar Belakang: COVID-19 menyebabkan penyakit kritis dan kematian dengan manifestasi utama sindrom pernafasan akut. Prediktor kematian pada kasus COVID-19, seperti IL-6 berperan dalam mengatur respon imun dan inflamasi. Pada kasus berat, peningkatan IL-6 dapat menyebabkan sepsis dan kegagalan multi-organ. CRP juga berkontribusi signifikan terhadap peradangan. Keparahan derajat COVID-19 dipengaruhi oleh komorbiditas seperti penyakit kardiovaskular, diabetes melitus tipe II, dan hipertensi. Tocilizumab, penghambat reseptor IL-6 merupakan terapi baru untuk pasien COVID-19 berat dan kritis. Penelitian ini menilai mortalitas pasien COVID-19 berat yang diberikan dan tidak diberikan terapi tocilizumab setelah dikontrol oleh variabel perancu. Tujuan: Menganalisis pengaruh terapi tocilizumab terhadap kematian pada pasien COVID-19 berat. Metode: Desain penelitian kohort retrospektif, menggunakan data rekam medis pasien COVID-19 di ICU RSCM selama dua tahun. Data dianalisis menggunakan SPSS. Hasil: Total 80 subjek, 52 pasien meninggal dan 28 pasien hidup. Mayoritas pasien memiliki CRP tinggi, IL-6 meningkat, serta tidak memiliki komorbid hipertensi, diabetes mellitus tipe II, dan penyakit kardiovaskular. Analisis statistik menunjukkan tidak ada hubungan yang signifikan antara pemberian terapi tocilizumab dan kematian, serta tidak terdapat perancu dalam penelitian ini. Kesimpulan: Pemberian terapi tocilizumab tidak memperbaiki kejadian mortalitas pada pasien COVID-19 berat.

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Background: COVID-19 causes critical illness and death with the main manifestation of acute respiratory syndrome. Predictors of death in COVID-19 cases, such as IL-6, play a role in regulating the immune response and inflammation. In severe cases, increased IL-6 can cause sepsis and multi-organ failure. CRP also contributes significantly to inflammation. The severity of COVID-19 is influenced by comorbidities such as cardiovascular disease, type II diabetes mellitus, and hypertension. Tocilizumab, an IL-6 receptor inhibitor, is a new therapy for severe and critical COVID-19 patients. This study assessed the mortality of severe COVID-19 patients who were and were not given tocilizumab therapy after controlling for confounding variables. Objective: To analyze the effect of tocilizumab therapy on mortality in severe COVID-19 patients. Methods: Retrospective cohort study design, using medical record data of COVID-19 patients in the ICU RSCM for two years. Data were analyzed using SPSS. Results: A total of 80 subjects, 52 patients died and 28 patients survived. The majority of patients had high CRP, increased IL-6, and did not have comorbid hypertension, type II diabetes mellitus, and cardiovascular disease. Statistical analysis showed no significant association between tocilizumab therapy and mortality, and there were no confounders in this study. Conclusion: Administration of tocilizumab therapy does not reducing mortality rates in severe COVID-19 patients."

"Latar Belakang : Infeksi COVID-19 dewasa ini telah diketahui memiliki implikasi jangka panjang meski periode akut telah tertangani, suatu fenomena yang dinamakan long COVID syndrome atau sindrom pasca COVID-19. Patofisiologi dari kejadian ini masih belum diketahui dengan jelas. Studi melaporkan bahwa sindrom pasca COVID-19 melibatkan beberapa organ, diantaranya adalah sistem kardiovaskular. Pemeriksaan nilai LV GLS dan RV LS pada ekokardiografi dinilai akurat dalam mendeteksi disfungsi miokard dan fibrosis endomiokardial. Selain itu, hingga saat ini, data mengenai faktor-faktor saat admisi sebagai prediktor terhadap kejadian sindrom pasca COVID-19 masih terbatas. Tujuan : Mengetahui nilai parameter ekokardiografi LV GLS dan RV LS sebagai penanda disfungsi miokard dan fibrosis jantung serta mengidentifikasi faktor-faktor saat admisi yang berpengaruh terhadap kejadian sindrom pasca COVID-19.Metode : Penelitian ini adalah deskriptif-analisis menggunakan metode potong lintang. Pemilihan subjek dilakukan dengan metode consecutive sampling. Pemeriksaan ekokardiografi termasuk pemeriksaan global longitudinal strain (GLS) dilakukan oleh dua orang observer 4 bulan pasca perawatan rumah sakit. Selanjutnya, analisis multivariat berupa regresi linear dilakukan untuk mengetahui faktor admisi yang berpengaruh terhadap perbedaan nilai GLS pada kelompok penelitian. Hasil : 100 subjek dengan komorbiditas kardiovaskular dan riwayat COVID-19 memenuhi kriteria dan syarat penelitian. Ditemukan nilai penurunan nilai LV-GLS pada kelompok ini. Subjek dengan komorbiditas kardiovaskular tanpa riwayat COVID-19 (n=31, kontrol 1) yang telah melalui proses matching berdasarkan usia, gender, dan faktor resiko, serta subjek sehat (n-31, kontrol 2) sebagai pembanding validitas GLS. Terdapat perbedaan signifikan rerata nilai LV GLS antar 3 kelompok (p<0.05, rerata ±SB -16.17 ± 3.379, -19.48 ± 1.141, -21.48 ± 1.777 berturut-turut untuk kelompok kasus, kontrol 1, kontrol 2), dengan nilai paling rendah pada kelompok kasus. Faktor saat admisi yaitu status CAD memiliki hubungan yang signifikan (p 0.038) dengan penurunan LV GLS pada pasien post covid-19 dengan komorbid kardiovaskular. Kesimpulan : Terdapat penurunan nilai LV GLS yang signifikan pada sindrom pasca COVID-19 disertai komorbiditas kardiovaskular. CAD merupakan prediktor penurunan fungsi maupun fibrosis jantung sebagai manifestasi sindrom pasca COVID-19.

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Background : Recently, COVID-19 infection has been known to have a longer implication, even after the initial acute phase has been managed, a phenomenon termed as long COVID syndrome or “sindroma pasca COVID-19”. The exact pathophysiological mechanism of this event is still unknown. Previous studies reported that long COVID syndrome involves multiple organs, one of which is the cardiovascular system. Measurement of echocardiography LV GLS and RV LS values are reported to be accurate to detect myocardial dysfunction and endomyocardial fibrosis. Moreover, up until now, data regarding admission factors as predictors for long COVID syndrome incidences are still limited.

Objective : Assessing echocardiography LV GLS and RV LS values as a marker for myocardial dysfunction and heart fibrosis and identifying admission factors which may predict the incidence of long COVID syndrome

Methods : This is an observational study with a cross-sectional using a consecutive sampling method. Echocardiography including global longitudinal strain (GLS) measurement was done by two examiners 3 months after initial hospitalization. Multivariate analysis linear regression was subsequently used to investigate admission factors which are associated with differences in GLS measurement.

Results : Total of 100 subjects with cardiovascular comorbidities and prior COVID-19 infection were enrolled. Echocardiography examination showed lower GLS values in this group compared to the normal population. Age, sex and risk factors-matched subjects with cardiovascular comorbidity without a history of COVID-19 (n=31, Control 1) and healthy subjects (n-31, Control 2) were subsequently used as comparisons to validate GLS results. There were significant differences in LV-GLS levels between the three groups, with the lowest values measured in the case group (p<0.05, mean ±SD -16.17 ± 3.379, -19.48 ± 1.141, -21.48 ± 1.777 respectively for case, control 1, and control 2 groups). A history of coronary artery disease upon admission was found to be associated with decreased LV GLS values in recovered COVID-19 patients with cardiovascular comorbidity.

Conclusion : LV GLS values significantly decrease in long COVID syndrome with cardiovascular comorbidities. Having a previous history of CAD upon admission may serve as predictors of deteriorated functions or heart fibrosis as manifestations of long COVID syndrome. "

"Peningkatan angka kasus COVID-19 yang tidak terkendali mengakibatkan fasilitas kesehatan di Indonesia kurang mampu untuk menampung seluruh pasien yang terinfeksi COVID-19. Sementara itu, pasien COVID-19 harus mendapatkan pengobatan dan perawatan. Salah satu upaya untuk yang dilakukan adalah isolasi mandiri bagi pasien tanpa gejala dan bergejala ringan. Penelitian ini dilakukan dengan tujuan mengeksplorasi akses pasien COVID-19 untuk memperoleh obat saat isolasi mandiri di rumah serta kendala yang dialami saat isolasi. Instrumen penelitian menggunakan kuesioner yang dikembangkan oleh peneliti berdasarkan studi literatur dan telah divalidasi dua tahap. Kuesioner disebarkan secara online dan mendapatkan 115 responden sebagai subjek penelitian. Butir pertanyaan kuesioner memuat tentang data sosiodemografi, gambaran keadaan subjek saat melakukan isolasi mandiri, dan aspek – aspek akses obat (aksesibilitas, ketersediaan, keterjangkauan). Sebagian besar responden melakukan isolasi mandiri pada periode Januari – Maret (53,2%). Persebaran responden paling banyak melakukan isolasi mandiri di Jakarta (45,22%). Ditinjau dari persentase tertinggi setiap aspek, 71,3% mengatakan sangat mudah dalam aspek aksesibilitas, 48,7% mengatakan ketersediaan obat cukup baik, dan 41,7% mengatakan harga obat cukup terjangkau. Adapun kendala yang terjadi selama isolasi mandiri, seperti kemacetan lalu lintas sehingga membutuhkan waktu lebih untuk ke fasilitas kesehatan, informasi obat tidak valid, serta harga antivirus mahal dengan ketersediaan yang minim. Uji komparatif dilakukan untuk mengetahui faktor yang mempengaruhi akses obat dan terdapat perbedaan bermakna pada variabel periode COVID-19 (p=0,003). Dari hasil analisis skor akses obat, disimpulkan bahwa akses obat saat isolasi mandiri mudah (89,6%) bagi pasien COVID-19 di Jabodetabek.

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The number of COVID-19 cases that increased uncontrollably cause the health facilities in Indonesia being unable to accommodate all patients infected with COVID-19. Meanwhile, patients must receive treatment and care. One of the efforts to do is self- isolation for asymptomatic patients and mild symptoms. This study was conducted with the aim of exploring the accessibility of COVID-19 patients to obtain medication during self-isolation at home and the obstacles experienced during isolation. The research instrument used a questionnaire developed by the researcher based on a literature study and was validated in two stages. The questionnaire was distributed online and got 115 respondents as research subjects. Questionnaire items contain sociodemographic data, a description of the subject's condition when doing self-isolation, and aspects of drug access (accessibility, availability, affordability). Most of the respondents self-isolated in the January – March period (53.2%). The distribution of respondents who mostly self- isolated in Jakarta (45.22%). Judging from the highest percentage of each aspect, 71.3% said it was very easy in terms of accessibility, 48.7% said the drug availability was quite good, and 41.7% said the price of the medicine was quite affordable. The Obstacles that occur during self-isolation, such as traffic jams that require more time to go to health facilities, invalid drug information, and expensive antivirus prices with minimal availability. A comparative test was conducted to determine the factors that influence drug access and there was a significant difference in the COVID-19 period variable (p=0.003). From the results of the analysis of drug access scores, it was concluded that access to drugs during self-isolation is easy (89.6%) for COVID-19 patients in Jabodetabek."