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"Tesis ini bertujuan untuk mengetahui korelasi antara derajat sesak napas dan kualitas hidup terkait kesehatan pada lanjut usia pasca COVID-19. Penelitian ini merupakan studi potong lintang pada pasien lanjut usia pasca perawatan COVID-19 di RSUP Persahabatan. Pengambilan data dilakukan menggunakan aplikasi audio-video Whatsapp dan Zoom. Penilaian sesak napas dilakukan dengan skala sesak Borg (modified Borg dyspnea scale) dan skala sesak modified Medical Research Council (mMRC). Penilaian kualitas hidup terkait kesehatan dilakukan dengan instrumen EQ-5D-5L versi bahasa Indonesia. Pada penelitian ini didapatkan 44 subjek lanjut usia pasca COVID-19. Dari hasil penilaian skala sesak Borg didapatkan adanya sesak napas ringan pada 15,9% pasien dan sesak napas sedikit berat pada 6,8% subjek. Dari hasil penilaian skala sesak mMRC didapatkan nilai mMRC > 1 pada 20,4% subjek. Terdapat korelasi antara skala sesak Borg dengan EQ-5D-5L pada komponen kemampuan berjalan (r=0,42; p<0,01), perawatan diri (r=0,51; p<0,01), rasa cemas/depresi (r=0,52; p<0,01), dan EQ-VAS (p=-0,53; p<0,01). Terdapat korelasi antara skala sesak mMRC dengan EQ-5D-5L pada komponen kemampuan berjalan (r=0,65; p<0,01), perawatan diri (r=0,62; p<0,01), kegiatan yang biasa dilakukan (r=0,69; p<0,01), dan EQ VAS (r=-0,58; p<0,01). Kesimpulan penelitian ini adalah adanya hubungan korelasi positif sedang antara derajat sesak napas dengan komponen perawatan diri dan rasa cemas/depresi. Didapatkan adanya korelasi negatif sedang antara derajat sesak napas dengan nilai EQ VAS.

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This study aims to determine the correlation between the severity of shortness of breath and health-related quality of life in the elderly after COVID-19. This is a cross-sectional study on elderly patients after COVID-19 inpatient treatment at Persahabatan Hospital, Jakarta. Data collection was carried out using the Whatsapp and Zoom audio-video application. Dyspnea severity was assessed using the modified Borg dyspnea scale and the modified Medical Research Council (mMRC) dyspnea scale. Health-related quality of life assessment was carried out with the Indonesian version of the EQ-5D-5L instrument. A total of 44 elderly subjects post COVID-19 were included in this study. From the results of the modified Borg dyspnea scale assessment, it was found that there was mild dyspnea in 15.9% of subjects and somewhat severe dyspnea in 6.8% of subjects. From the results of the mMRC dyspnea scale assessment, the mMRC value more than 1 is found in 20.4% of the subjects. There was a correlation between the modified Borg dyspnea scale and EQ-5D-5L on the components of mobility (r=0.42; p<0.01), self-care (r=0.51; p<0.01), anxiety/depression (r=0.52; p<0.01), and EQ-VAS (p=-0.53; p<0.01). There is a correlation between the mMRC shortness scale and EQ-5D-5L on the components of mobility (r=0.65; p<0.01), self-care (r=0.62; p<0.01), usual activities (r=0.69; p<0.01), and EQ VAS (r=-0.58; p<0.01). There is a moderate positive correlation between the severity of dyspnea with components of self-care and anxiety/depression. There was a moderate negative correlation between the degree of dyspnea and the EQ VAS value."

"Long COVID (disebut juga post acute COVID, Post-COVID-19, Post-COVID-19 syndrome) adalah tanda dan gejala yang masih dialami setelah melewati fase akut COVID-19. Long COVID muncul pada banyak penyintas COVID. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan kejadian Long COVID pada penyintas COVID-19 di Kelurahan Jatisampurna Kota Bekasi. Penelitian ini menggunakan desain penelitia cross-sectional. Penelitian ini diikuti oleh 308 responden, dengan proporsi perempuan 64% dan laki-laki 36%. Hasil penelitian ini menunjukan proporsi kejadian Long COVID sebesar 80,2%. Gejala yang paling banyak dilaporkan adalah kelelahan (64%), brain fog (30.5%), dan batuk kering (21.8%). Analisis bivariat menunjukan bahwa tidak ada hubungan yang signifikan antara umur dan pekerjaan dengan kejadian Long COVID. Namun terdapat hubungan yang signifikan antara jenis kelamin dengan kejadian Long COVID (p= 0,011 OR=2,157) dan komorbid dengan kejadian Long COVID (p=0,006 OR= 2,652).

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Long COVID (also known as post acute COVD, Post-COVID-19, Post-COVID-19 syndroem) are signs and symptoms that are still experienced after passing thorugh the acute phase of COVID-19. Long COVID appears in mancy COVID-19 survivors. This trudy aims to determine the factors associated with the incidence of Long COVID in COVID-19 survivors in Urban Village of Jatisampurna, Bekasi City. This study used a cross sectional research design. This study was followed by 308 respondents, with proportion of female 64% and male 36%. The results of this sstudy show the proportion of the incidence of Long COVID is 80,2%. The most common symptom reported was fatigue (72.8%), brain fog (30.5%), and dry cough (21.8%). Bivariate analysis showed that there is no significant relationship between age and occupation with incidencen of Long COVID. However, there is a significant relationship between gender and the incidence of Long COVID (p=0,011, OR= 2,157) and comorbidity with incidence of Long COVID (p= 0,006, OR= 2,652)."

"Infeksi COVID-19 (Corona Virus Disease 2019) dapat meninggalkan gejala sisa multisistemik (long COVID). Gejala long COVID meliputi kelelahan, sesak napas, batuk, sakit kepala, nyeri otot, dan gangguan kesehatan kognitif atau mental seperti kecemasan atau depresi. Salah satu tata laksana long COVID adalah intervensi rehabilitasi dan telerehabilitasi disarankan sebagai salah satu strategi inovatif. Namun, belum dikembangkan model telerehabilitasi untuk pasien long COVID di Indonesia. Oleh karena itu, perlu dilakukan penelitian yang bertujuan untuk mengembangkan model telerehabilitasi dan menilai efektivitasnya terhadap perbaikan kapasitas fungsional, kualitas hidup, tingkat stres oksidatif dan disfungsi endotel pada pasien long COVID di Indonesia. Penelitian dilakukan di Jakarta pada Juni 2022 hingga Juli 2024. Tahap pertama adalah studi kualitatif pengembangan model telerehabilitasi CoFit Rehab untuk pasien long COVID menggunakan metode Delphi yang melibatkan 24 panelis. Tahap kedua adalah uji randomisasi terkontrol pada 41 pasien long COVID (21 subjek perlakuan dan 20 subjek kontrol) untuk menguji efektivitas model telerehabilitasi yang dikembangkan. Selama 12 minggu, subjek perlakuan menjalani intervensi telerehabilitasi dan subjek kontrol menjalani intervensi rehabilitasi standar. Dilakukan pengukuran parameter kapasitas fungsional (uji jalan enam menit, uji sit-to-stand 30 detik dan uji kekuatan genggam tangan), kualitas hidup (kuesioner EQ-5D-5L versi Indonesia), tingkat stres oksidatif (kadar GSH dan rasio GSH/GSSG) dan disfungsi endotel (kadar mikropartikel endotel CD31+CD42b–). Studi kualitatif mendapatkan model telerehabilitasi. Uji randomisasi terkontrol memperlihatkan peningkatan bermakna jarak tempuh uji jalan enam menit baik kelompok kontrol dan kelompok perlakuan. Peningkatan jarak tempuh uji jalan enam menit lebih besar pada kelompok perlakuan. Ditemukan peningkatan bermakna jumlah repetisi uji sit-to-stand 30 detik, kekuatan genggam tangan, skor VAS EQ-5D-5L yang bermakna pada kelompok perlakuan. Ditemukan penurunan bermakna kadar mikropartikel endotel CD31+CD42b– plasma pada kelompok perlakuan. Tidak terdapat perbaikan bermakna pada parameter lain. Model telerehabilitasi CoFit Rehab terbukti lebih unggul dalam memperbaiki kapasitas fungsional dan fungsi endotel pada pasien long COVID dibandingkan rehabilitasi standar.

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COVID-19 (Corona Virus Disease 2019) infection can result in multisystemic sequelae (long COVID). Commonly reported symptoms include fatigue, shortness of breath, cough, headache, muscle pain, and cognitive or mental health disorders such as anxiety or depression. One of the management for long COVID is rehabilitation intervention and telerehabilitation is suggested as one of the innovative strategies. However, a telerehabilitation model (CoFit Rehab) for long COVID patients has not been developed in Indonesia. This study aims to develop a telerehabilitation model for long COVID patients and assess its effectiveness in improving functional capacity, quality of life, oxidative stress levels and endothelial dysfunction in long COVID patients in Indonesia. This study was done in Jakarta from June 2022 until July 2024. The first stage was a qualitative study to obtain a telerehabilitation model for long COVID patients using the Delphi method that involved 24 panelists. The second stage was a randomized controlled trial on 41 long COVID patients (21 treatment subjects and 20 control subjects) to test the effectiveness of the telerehabilitation model that has been developed. For 12 weeks, treatment subjects received telerehabilitation intervention and control subjects received standard rehabilitation intervention. Functional capacity parameters (six-minute walk test, 30-second sit-to-stand test, and handgrip strength test), quality of life (Indonesian version of the EQ-5D-5L questionnaire), oxidative stress levels (GSH levels and GSH/GSSG ratio) and endothelial dysfunction (concentration of CD31+CD42b– endothelial microparticles) were measured. The qualitative study obtained a telerehabilitation model. Randomized controlled trial showed a significant increase in the six-minute walk test distance in both groups. Compare to the control group, the distance increase in the six-minute walk test was greater in the treatment group. There was a significant increase in the total repetitions of the 30-second sit-to-stand test, handgrip strength, and EQ-5D-5L VAS scores in the treatment group. There was a significant decrease of the endothelial microparticle plasma level (CD31+CD42b) in the treatment group. There was no significant improvement in other parameters. The telerehabilitation model (CoFit Rehab) was shown to be superior in improving functional capacity and endothelial function in long COVID patients compared to standard rehabilitation."

"Latar belakang: COVID-19 menginfeksi semua kelompok umur, namun beban infeksi lebih tinggi dan lebih berbahaya pada kelompok usia lanjut. Pasien yang mengalami infeksi akut COVID-19 juga bisa mengalami gejala menetap yang disebut dengan Sindrom Pasca COVID-19, khususnya pada lansia. Belum ada data yang menunjukkan prevalensi Sindrom Pasca COVID-19 pada lansia di Indonesia dan juga faktor-faktor risiko yang berhubungan dengan kejadian Sindrom Pasca COVID-19 pada lansia.Tujuan: Penelitian ini bertujuan untuk mengetahui seberapa besar prevalensi Sindrom Pasca COVID-19 pada lansia di Indonesia serta meneliti hubungan antara faktor-faktor risiko dengan kejadian Sindrom Pasca COVID-19 dengan menggunakan definisi waktu >4 minggu, >8 minggu, dan >12 minggu.Metode: Penelitian ini merupakan penelitian kohort retrospektif yang menggunakan rekam medis dan wawancara untuk mendapatkan data terkait keberadaan faktor-faktor risiko dan gejala menetap pasca perawatan infeksi akut COVID-19.Hasil: Penelitian ini diikuti oleh 329 pasien lansia (≥60 tahun) yang sempat dirawat akibat COVID-19 di RSCM dan RS Mitra Keluarga Kalideres pada 1 Januari-31 Desember 2021. Prevalensi Sindrom Pasca COVID-19 pada lansia adalah sebesar 31%, 18,24%, dan 10,64% dengan menggunakan definisi waktu >4 minggu, >8 minggu, dan >12 minggu, secara berurutan. Clinical Frailty Scale rawat inap (OR 2,814 [IK 95% 1,172-6,758) dan imobilitas rawat inap (OR 4,767 [IK95% 2,117-10,734]) berhubungan dengan Sindrom Pasca COVID-19 >4 minggu. Selanjutnya, jumlah gejala awal (OR 2,043 [IK95% 1,005-4,153]), konstipasi rawat inap (OR 2,832 [IK95% 1,209-6,633]), imobilitas rawat inap (OR 2,515 [IK95% 1,049-6,026]), dan instabilitas rawat inap (OR 2,291 [IK95% 1,094-4,800) berhubungan dengan Sindrom Pasca COVID-19 >8 minggu. Gangguan pendengaran dan penglihatan follow-up (OR 2,926 [IK95% 1,285-6,665]) dan imobilitas rawat inap (OR 3,684 [IK95% 1,507-9,009]) berhubungan dengan Sindrom Pasca COVID-19 >12 minggu.Kesimpulan: Infeksi akut dengan ≥ 5 gejala, adanya frailty dan sindrom geriatri, khususnya imobilitas saat perawatan, berhubungan dengan Sindrom Pasca COVID-19 pada lansia.

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Background: COVID-19 infects all age groups, but the burden of infection is higher and more dangerous in the elderly. Patients with acute COVID-19 infection can also experience persistent symptoms called Post-Covid-19 Syndrome, especially elderly. No data show the prevalence of Post-Covid-19 Syndrome in the elderly in Indonesia and the risk factors associated with the occurrence of Post-Covid-19 Syndrome in the elderly

Objective: This study aims to determine the prevalence of Post-Covid-19 Syndrome in the elderly in Indonesia and examine the relationship between risk factors and the incidence of Post-Covid-19 Syndrome by using the definition of time > 4 weeks, > 8 weeks. , and >12 weeks.

Methods: This study is a retrospective cohort study that uses medical records and interviews to obtain data regarding risk factors and persistent symptoms after treatment of acute COVID-19 infection.

Results: This study is followed by 329 elderly patients (≥60 years) who had been treated because of COVID-19 at Cipto Mangunkusumo Hospital and Mitra Keluarga Kalideres Hospital from January 1st until December 31st, 2021. the prevalence of Post COVID-19 Syndrome in the elderly was 31%, 18.24%, and 10.64% using the time definition of >4 weeks, >8 weeks, and >12 weeks, respectively. Clinical Frailty Scale during hospitalization scores (OR 2.814 [95% CI 1.172-6.758]) and immobility during hospitalization (OR 4.767 [95% CI 2.117-10.734]) were associated with Post-Covid-19 Syndrome >4 weeks. Furthermore, number of initial symptoms (OR 2,043 [CI95% 1.005-4.153]), constipation during hospitalization (OR 2.832 [CI95% 1.209-6633]), immobility during hospitalization (OR 2,515 [95% CI 1,049-6.026]), and instability during hospitalization (OR 2,291 [CI 95% 1,094-4,800]) was associated with Post-Covid-19 Syndrome >8 weeks. In addition, impairment of visual and hearing during follow-up (OR 2,926 [95% CI 1,285-6,665]) and immobility during hospitalization (OR 3,684 [95% CI 1.507-9,009]) was associated with Post-Covid-19 Syndrome >12 weeks.

Conclusions: Acute infection with ≥ 5 symptoms, frailty, and geriatric syndrome, especially immobility during hospitalization, were associated with Post-Covid-19 Syndrome in the elderly."

"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."