Test, Trace, and Treatment Strategy to Control COVID-19 Infection Among Hospital Staff in a COVID-19 Referral Hospital in Indonesia.

BACKGROUND: COVID-19 infection is caused by a novel coronavirus. One of the most used strategies that can be used to control the spread of COVID-19 is the 3T (test, trace, and treatment) strategy. This study aimed to evaluate the 3T strategy to control COVID-19 infection in a COVID-19 Referral Hospital in Depok, West Java, Indonesia. METHODS: this is a cross-sectional study conducted at the University of Indonesia Hospital. The study was conducted in June 2020 with 742 participants (staff members) using secondary data from polymerase chain reaction (PCR) test results. We presented data in the descriptive form and performed bivariate analysis using the chi-square/Fischer test for categorical data. RESULTS: the PCR test results were positive in 83 (11.1%) participants, with a case-per-tracing ratio of 1:24 and 1:2 in the first and third phases of tracing, respectively. The COVID-19 case graph for the participants decreased along with the implementation of the 3T strategy. The positivity rate in the first phase of tracing was 20% and decreased to 5% in the third phase of tracing. Staff with confirmed positive test results were advised to isolate themselves (hospital or self-isolation). Hospital isolation was found to be associated with the duration of PCR test conversion (p<0.001). CONCLUSION: the 3T strategy is effective for controlling the spread of COVID-19. The strategy should be implemented simultaneously with other health precautions to reduce the risk of spreading infection.

Evaluation of loop-mediated isothermal amplification for detecting COVID-19.

The emergence of SARS-CoV-2 has caused worldwide pandemic of COVID-19. Infection is difficult to diagnose early as some patients remain asymptomatic and may carry this virus to other people. Currently, qRT-PCR is the widely accepted mode for detection. However, the need for sophisticated instrument and trained personnel may hinder its application, especially in remote and facility-lacking areas. Reverse transcription loop-mediated isothermal amplification (RT-LAMP) may serve as a potential approach for detection of SARS-CoV-2 as the resources needed in its application is far less complex than those of qRT-PCR. Herein, we evaluated RT-LAMP based analytical method (COVIDNow), relative to qRT-PCR, in detecting SARS-CoV-2 by using 63 clinical respiratory samples. Based on our finding, COVIDNow exhibited sensitivity and specificity values of 87.5% and 80.6%, respectively. Taken together, RT-LAMP based detection of SARS-CoV-2 by utilizing COVIDNow might serves as a valuable diagnostic tool in the management of global COVID-19 pandemic condition.

The association of apolipoprotein in the risk of ST-elevation myocardial infarction in patients with documented coronary artery disease.

Introduction: Cardiovascular disease (CVD) is the number one cause of death worldwide, in this case, acute coronary syndrome (ACS) or acute myocardial infarction (AMI) that developed from coronary artery disease (CAD). Several risk factors contribute to AMI. Non-modifiable risk factors are age, sex, race, and family history. Modifiable risk factors include dyslipidemia, hypertension, smoking, diabetes mellitus, as well as recent factors that are considered more specific such as homocysteine, lipoprotein a [Lp(a)], high sensitivity C- reactive protein (hs-CRP), and apolipoprotein. This study aimed to determine the role of apolipoprotein as a risk factor for STEMI. Methods: This study combines three epidemiological designs: a descriptive and cross-sectional correlative study with 62 STEMI patients at the National Cardiovascular Center Harapan Kita and a comparative study of 62 STEMI patients and 20 non-ACS CAD patients at the Universitas Indonesia Hospital. Results and conclusion: The descriptive study showed the level of apoB 80.71 ± 28.3, apoA1 104.93 ± 27.8, apoB/apoA1 ratio 0.78 ± 0.22, and Lp(a) 6.85 (1.0-48.1). ApoB moderately correlates with LDLc (p < 0.001; r = 0.571). ApoA1 weakly correlates with HDLc (p = 0.005; r = 0.379). In comparative study, there were significant differences between the STEMI and non-ACS CAD groups on apoA1 (104.93 ± 27.8 vs. 137.48 ± 26.46), apoB/apoA1 ratio (0.78 ± 0.22 vs. 0.59 ± 0.15), and hs-CRP (2.88 [0.4-215] vs. 0.73 [0.15-8.9]). Multivariate analysis showed that the most significant risk factors for STEMI in this study were hypertension for modifiable factors and apoA1 for apolipoprotein. The apoA1 and apoB/apoA1 ratio examination can be suggested for people who have experienced plaque formation and are at risk for myocardial infarction.

Surveillance of Adverse Events Following Immunization (AEFI) after Third Dose Booster Vaccination with mRNA-Based Vaccine in Universitas Indonesia Hospital Health Personnel.

Facing the rising cases of with higher fatalities COVID-19, some countries decided to give the third dose of vaccine as a booster. As of 9 January 2022, 90.31% of health workers in Indonesia have received the third dose vaccine. This study aims to provide an evaluation of adverse events following immunization (AEFI) in a single center in Indonesia to form a basis for ensuring safety for booster administration nationally. A retrospective, cross-sectional study was conducted using an online survey. Demographic data, AEFI complaints, and factors influencing AEFIs were evaluated. In this study, there were a total of 311 subjects were gathered. The most common AEFI symptoms found at onset <24 h to 28 days were pain at the injection site, fever, shoulder pain, and headache. Most of the AEFI severity of <24 h to 28 days post-vaccination was grade 1 (reduced or uninterrupted daily activities). There was a significant correlation between AEFI and several factors, such as the history of drug allergy, exercise after vaccination, age, BMI < 25, history of symptoms after the first and second vaccinations, and history of COVID-19. There was no anaphylactic reaction in this study. Several AEFI should be considered for the third dose of COVID-19 vaccine administration.

The role of clopidogrel resistance-related genetic and epigenetic factors in major adverse cardiovascular events among patients with acute coronary syndrome after percutaneous coronary intervention.

Despite patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) and receiving clopidogrel therapy, some patients still experience major adverse cardiovascular events (MACEs). Clopidogrel resistance, which may be regulated by genetic and epigenetic factors, may play a role in MACEs. This study aimed to determine the association between genetic (CYP2C19 and P2Y12 polymorphisms) and epigenetic (DNA methylation of CYP2C19 and P2Y12 and miRNA-26a expression) factors and their effects on MACEs among post-PCI patients. Post-PCI patients who received a standard dosage of clopidogrel at Harapan Kita Hospital between September 2018 and June 2020 were included in this study. MACEs were observed in patients within 1 year after PCI. Platelet aggregation was assessed using light transmission aggregometry (LTA). DNA methylation of CYP2C19 and P2Y12 was assessed using the bisulfite conversion method. CYP2C19 and P2Y12 polymorphisms and miRNA-26a expression were evaluated using quantitative real-time polymerase chain reaction (qRT-PCR). Among a total of 201 subjects, 49.8% were clopidogrel-resistant, and 14.9% experienced MACEs within 1 year after PCI (death was 7.5%). Hypomethylation of CYP2C19 (p = 0.037) and miRNA-26a upregulation (p = 0.020) were associated with clopidogrel resistance. CYP2C19*2/*3 polymorphisms (p = 0.047) were associated with MACEs in 1 year. This study demonstrated that hypomethylation of CYP2C19 and miRNA-26a upregulation increased the risk of clopidogrel resistance in post-PCI patients, but there was no correlation between clopidogrel resistance and MACEs. However, CYP2C19*2/*3 polymorphisms were the factors that predicted MACEs within 1 year.

Factors Affecting the Self-Isolation Monitoring Program for COVID-19 Patients at the Universitas Indonesia Hospital.

When the outbreak of the COVID-19 delta variant occurred in June 2021, there was a marked increase in Indonesia's number of self-isolated patients. The Universitas Indonesia Hospital provided a One-Stop Service (OSS) to monitor COVID-19 patients on self-isolation. This study was conducted to determine the effectiveness of the self-isolation monitoring performed by hospitals and the factors that determined the outcomes of patients on self-isolation. This study was conducted using a cross-sectional method based on secondary data from electronic medical records. Data analysis was performed by determining the relationship of patient risk factors and characteristics with COVID-19 outcomes. The study found that poorer symptoms, administration of antibiotics, absence of shortness of breath, and normal ALT levels significantly improved the outcome of OSS patients. The study also suggested that during monitoring of patients on COVID-19 self-isolation, chest/thorax radiography is necessary. The self-isolation monitoring program is essential to observe the patient's condition and evaluate the possibility of deteriorating conditions that could lead to admission decisions in the early or middle stages of the program. This will be beneficial during pandemic emergencies.

Evaluation of SARS-CoV-2 Antibody Response Post Third Dose COVID-19 mRNA Vaccination at Universitas Indonesia Hospital.

OBJECTIVE: The longevity of vaccine effectiveness and antibody titer after the Moderna mRNA COVID-19 vaccination booster in healthcare workers in Indonesia is not known. MATERIALS AND METHODS: We performed a prospective observational study of healthcare workers at the Universitas Indonesia Hospital after Moderna mRNA COVID-19 booster vaccination. An Immunology Analyzer with Chemiluminescence Immunoassay (CLIA) test was used to examine Anti SARS-CoV-2 S-RBD levels. Antibody levels were classified into two systems (3 categories, and 2 categories). RESULTS: There were 31 male subjects (75.6%), 33 subjects (80.5%) aged 25-39 years, 17 subjects (41.5%) with overweight BMI, 35 subjects (85.4%) without comorbidities, and 29 subjects without previous history of COVID-19 infection (70.7%) who had antibody titer >1000 AU/ml. There were 27 subjects (65.9%) who had a booster shot ≥6 months after the second vaccination with antibody titer >1000 AU/ml. In this study, there was no significant correlation between antibody titer with factors such as gender, age, BMI, comorbidities, history of COVID-19 infection and time between the 2nd vaccination and booster vaccination. CONCLUSION: There is no significant correlation between antibody titer with factors such as gender, age, BMI, comorbidities, history of COVID-19 infection and time between the 2nd vaccination and booster vaccination.

Increase in the risk of clopidogrel resistance and consequent TIMI flow impairment by DNA hypomethylation of CYP2C19 gene in STEMI patients undergoing primary percutaneous coronary intervention (PPCI).

Clopidogrel resistance is an important risk factor of ischemic event recurrence after optimal antiplatelet therapy. This study aims to investigate the role of CYP2C19 gene DNA methylation as one of the epigenetic factors for the risk of clopidogrel resistance in STEMI patients undergoing PPCI. ST-segment elevation myocardial infarction (STEMI) patients undergoing PPCI were pretreated with clopidogrel, and their platelet function was measured using VerifyNow™ assay. The criteria for high on-treatment platelet reactivity (HPR) were defined according to the expert consensus criteria (PRU >208). DNA methylation of the CYP2C19 gene was performed using bisulfite genomic sequencing technology. Furthermore, clinical, laboratory, and angiographic data including TIMI flow were collected. Among 122 patients, clopidogrel resistance was found in 22%. DNA methylation level percentage was lower in the clopidogrel resistance group (76.7 vs. 88.8, p-value .038). But, the <50% methylation group was associated with increased risk of clopidogrel resistance (OR =4.5, 95%CI =2.1-9.3, p-value = .018). This group was also found to have suboptimal post-PCI TIMI flow (OR =3.4 95%CI =1.3-8.7, p-value =.045). The lower DNA methylation level of the CYP2C19 gene increases the risk of clopidogrel resistance and subsequent poorer clinical outcome.

Acute Ischaemic Stroke Incidence after Coronavirus Vaccine in Indonesia: Case Series.

BACKGROUND: Coronavirus disease-19 (COVID-19) is an infectious disease with high morbidity and mortality rates. Indonesia had reported a 2.8% of mortality rate up to June 2021. CASE PRESENTATION: A strategy to control the virus spreading is by vaccination. The Indonesian Food and Drug Monitoring Agency had approved the use of CoronaVac, an inactivated virus vaccine developed by Sinovac. Most Adverse Events Following Immunization (AEFI) for Corona- Vac are mild, and the most common symptoms are injection-site pain, headache, and fatigue. Neurovascular adverse events, including thrombosis or ischaemic stroke after receiving CoronaVac have not previously been reported. CONCLUSION: Correspondingly, we reported three patients with an Acute Ischaemic Stroke (AIS) after the administration of CoronaVac in our hospital.

The role of lipid profile as a risk factor indicator for ischemic stroke at Cipto Mangunkusumo Hospital, Jakarta.

AIM: to determine the role of low HDL-cholesterol, and high total cholesterol, LDL-Cholesterol and triglyceride as risk factors for ischemic stroke at Dr. Cipto Mangunkusumo Hospital. METHOD: a study was conducted on 76 patients with an age range of 40-70 years. Subjects consisted of 38 post ischemic stroke patients and 38 control subjects with a diagnosis other than stroke. The study sample consisted of serum for lipid profile assessment. Total cholesterol and triglyceride were assessed using enzymatic method, while HDL-cholesterol and LDL-cholesterol using direct homogenous enzymatic method. Statistical analysis was performed using chi-square and multivariate analysis using logistic regression. RESULTS: low HDL-cholesterol was found in ischemic stroke patients and demonstrated a significant difference compared to control subjects (p<0.05). The results of total cholesterol, triglyceride, LDL-cholesterol did not demonstrate a significant difference. The odds ratio (3.09; CI 95%: 1.04; 8.73) demonstrates that low HDL-cholesterol is a risk factor for ischemic stroke. CONCLUSION: a low HDL-cholesterol level is a risk factor for ischemic stroke, with an odds ratio of 3.09, while total cholesterol, triglyceride and high LDL-cholesterol levels were not risk factors for ischemic stroke.

The role of persistent anticardiolipin antibody as risk factor of ischemic stroke.

AIM: To determine the role of persistent ACA and hyperviscosity as risk factor of ischemic stroke. METHODS: A study was conducted on 76 subjects whose age 40 to 70 years. Subjects consisted of 38 patients of post ischemic stroke and 38 controls with diagnosis other than stroke. Fresh blood samples were taken and mixed with EDTA for viscosity examination and serum for ACA IgM and IgG examination. The laboratory examination for persistent ACA IgM and IgG used ELISA method, while viscosity analysis was using viscometer. Statistic analysis used chi-square and multivariate analysis with logistic regression. RESULTS: In this study we found persistent ACA IgG in 25% of case group , and 2.63% in control group. Multivariate analysis showed persistent ACA IgG as risk factor for ischemic stroke with p < 0.05 and OR 14.11 (CI 95%:1.64;121.11). We found persistent ACA IgM in 2.78% of case group and 5.26% in control group. High blood viscosity was found in 15.79% case group and 10.53% in a control group. Statistical analysis showed no significant difference of viscosity (p = 0.740) and persistent ACA IgM (p = 1.000) between case and control group. CONCLUSION: study showed that persistent ACA IgG in stroke ischemic was higher than in control subjects. Blood viscosity examination and persistent ACA IgM did not show significant difference. While persistent ACA IgG with OR 14.11 (CI: 1.64; 121.11) was the risk factor for ischemic stroke. Blood viscosity and persistent ACA IgM were not risk factors for ischemic stroke.