Hemostatic and liver function parameters as COVID-19 severity markers.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a disease newly discovered in December 2019 which affects coagulation cascade and liver functions. The aim of this study was to investigate the potential of hemostatic and liver function parameters as severity markers in COVID-19 patients. This study was an observational analytic with cohort retrospective design using total sampling method. Data were retrieved from medical record of COVID-19 patients admitted to provincial hospital in Banda Aceh, Indonesia from March 2020 to March 2022. There were 1208 data eligible for the study after applying certain criteria. Mann-Whitney, logistic regression, and receiving operating characteristic (ROC) analyses were used to analysis the data. Thrombocyte count (p<0.001), prothrombin time (p<0.001), activated partial thromboplastin time (p<0.001), D-dimer (p<0.001), fibrinogen (p<0.001), aspartate aminotransferase (p<0.001), and alanine transaminase (p<0.001) significantly increased in severe compared to mild COVID-19 patients. After being adjusted, age (odds ratio (OR); 1.026 (95% confidence interval (CI): 1.016-1.037) was the most significant factor in predicting COVID-19 severity. Fibrinogen (cut-off 526.5 mg/L) was the best parameter associated with COVID-19 severity with 70% sensitivity and 66.4% specificity. Meanwhile, D-dimer (cut-off 805 ng/mL) had a sensitivity of 72.3% and specificity of 66.4%. Combining the parameters resulted in improved sensitivity to 82.0% with a slight decline of specificity to 65.5%. In conclusion, fibrinogen and D-dimer level on admission could be used as biomarkers in predicting COVID-19 prognosis. Routine monitoring and evaluation of laboratory testing especially D-dimer and fibrinogen could be implemented in order to reduce morbidity and mortality rate of COVID-19.

The Effects of Lumbricus rubellus Extract on Staphylococcus aureus Colonization and IL-31 Levels in Children with Atopic Dermatitis.

Background and Objectives: The ineffective combination of corticosteroids and antibiotics in treating some atopic dermatitis (AD) cases has been concerning. The skin barrier defects in AD ease the colonization of Staphylococcus aureus (S. aureus), which results in a rise in interleukin-31 (IL-31). Lumbricus rubellus (L. rubellus) has shown antimicrobial and antiallergic effects but has not been studied yet to decrease the growth of S. aureus and IL-31 levels in AD patients. This study aimed to analyze the effect of L. rubellus extract in reducing S. aureus colonization, the IL-31 level, and the severity of AD. Materials and Methods: A randomized controlled trial (RCT) (international registration number TCTR20231025004) was conducted on 40 AD patients attending Dermatology and Venereology Polyclinic, Mother and Child Hospital (RSIA), Aceh, Indonesia, from October 2021 to March 2022. AD patients aged 8-16 who had a Scoring Atopic Dermatitis (SCORAD) index > 25, with total IgE serum level > 100 IU/mL, and had healthy weight were randomly assigned into two groups: one received fluocinolone acetonide 0.025% and placebo (control group) and one received fluocinolone acetonide 0.025% combined with L. rubellus extract (Vermint®) (intervention group). The S. aureus colony was identified using a catalase test, coagulase test, and MSA media. The serum IL-31 levels were measured using ELISA assay, while the SCORAD index was used to assess the severity of and improvement in AD. Mean scores for measured variables were compared between the two groups using an unpaired t-test and Mann-Whitney U test. Results: A significant decline in S. aureus colonization (p = 0.001) and IL-31 (p = 0.013) in patients receiving L. rubellus extract was found in this study. Moreover, fourteen AD patients in the intervention group showed an improvement in the SCORAD index of more than 35% (p = 0.057). Conclusions: L. rubellus extract significantly decreases S. aureus colonization and the IL-31 level in AD patients, suggesting its potential as an adjuvant therapy for children with AD.

Plasma interleukin 6 as an outcome predictor of traumatic brain injury patients.

Traumatic brain injury is one of the leading causes of death and disability in young adults. Previous studies have suggested that neuroinflammatory process involves the overexpression of interleukin 6 (IL-6); however, data on the predictive ability of IL-6 is limited and conflicting in traumatic head injury patients. The aim of this study was to assess the ability of plasma IL-6 as a predictor of outcome in head injury patients. A cross-sectional study was conducted between June and December 2020 among traumatic head injury patients admitted to Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia. Demographic, clinical data, and IL-6 level were collected and measured on admission. The outcome was assessed by the Glasgow outcome scale extended (GOSE) in the first- and third-month of post-injury. A total of 50 traumatic brain injury patients were recruited of which 54% were male, 64% had mild head injury, 82% had leukocytosis, and 60% had non-bleeding head CT scan. The mean of IL-6 level was 79.32 pg/mL while the GOSE scores ranged from 1 (death) to 8 (upper good recovery). Early IL-6 level (<24 hours post-injury) was significantly correlated with worse outcome in traumatic head injury, though the correlation strength was moderate (p<0.001; r=-0.42). As a predictor, IL-6 yielded the area under curve (AUC) value of 93.5% (p<0.001) and a cut-off point of 46.33 pg/mL. The sensitivity and specificity of this predictor were 87.5% and 95.24%, respectively. In conclusion, early IL-6 level can be used as a predictor for traumatic head injury. Nevertheless, further multi-center study with a bigger sample size is needed to confirm this finding.

Spatial Analysis of Antenatal Care and Low Birth Weight against Neonatal Mortality Rate in Aceh Province, Indonesia.

Background: Similar to Indonesia, Aceh Province also showed a slight decline in neonatal mortality rate. However, the rate is still high compared to other provinces. Efforts to reduce neonatal mortality rate are essential because neonatal deaths contributed up to 71% of all under-five deaths in 2017 in Aceh. Antenatal care and low birth weight are known to be associated with neonatal mortality. The purpose of this study was to map district-level neonatal mortality rate and its determinants (antenatal care and low birth weight) in Aceh to inform policymakers in planning the interventions. Methods: This was a cross-sectional study using publicly available secondary data obtained from Aceh Provincial Health Office. The study used the 2017 data of neonatal mortality rate, percent of 4th antenatal care visit and percent of low birth weight at district level. Thematic maps were produced using ArcMap (V.10.5). The correlation was analyzed using the Spearman rank test. Results: The results indicated the regional variation of neonatal mortality rate across Aceh Province. Districts in the Southern region had lower neonatal mortality rates compared to others. Low birth weight was positively correlated with neonatal mortality rate at district level (Spearman's Rho=0.545, P=0.007). However, the percent of 4th antenatal care visit at district level was not correlated with neonatal mortality rate (Spearman's Rho= -0.35, P=0.097). Conclusion: The study identified regional variations of neonatal mortality rate, low birth weight and ante natal care visit.

Utilization patterns of healthcare facility and estimated expenditure of PLHIV care under the Indonesian National Health Insurance Scheme in 2018.

BACKGROUND: This study analyzed current patterns of service use, referral, and expenditure regarding HIV care under the National Health Insurance Scheme (JKN) to identify opportunities to improve HIV treatment coverage. As of September 2020, an estimated 543,100 people in Indonesia were living with HIV, but only 352,670 (65%) were aware of their status, and only 139,585 (26%) were on treatment. Furthermore, only 27,917 (4.5%) viral load (VL) tests were performed. Indonesia seeks to broaden its HIV response. In doing so, it intends to replace declining donor-funding through better coverage of HIV/AIDS services by its JKN. Thus, this study aims to assess the current situation about HIV service coverage and expenditure under a domestic health-insurance funded scheme in Indonesia. METHODS: This study employs a quantitative method by way of a cross-sectional approach. The 2018 JKN claims data, drawn from a 1% sample that JKN annually produces, were analyzed. Nine hundred forty-five HIV patients out of 1,971,744 members were identified in the data sample and their claims record data at primary care and hospital levels were analyzed. Using ICD (International Statistical Classification of Diseases and Related Health Problems), 10 codes (i.e., B20, B21, B22, B23, and B24) that fall within the categories of HIV-related disease. For each level, patterns of service utilization by patient-health status, discharge status, severity level, and total cost per claim were analyzed. RESULTS: Most HIV patients (81%) who first seek care at the primary-care level are referred to hospitals. 72.5% of the HIV patients receive antiretroviral treatment (ART) through JKN; 22% at the primary care level; and 78% at hospitals. The referral rate from public primary-care facilities was almost double (45%) that of private providers (24%). The most common referral destination was higher-level hospitals: Class B 48%, and Class C 25%, followed by the lowest Class A at 3%. Because JKN pays hospitals for each inpatient admission, it was possible to estimate the cost of hospital care. Extrapolating the sample of hospital cases to the national level using the available weight score, it was estimated that JKN paid IDR 444 billion a year for HIV hospital services and a portion of capitation payment. CONCLUSION: There was an underrepresentation of PLHIV (People Living with HIV) who had been covered by JKN as 25% of the total PLHIV on ART were able to attain access through other schemes. This study finding is principally aligned with other local research findings regarding a portion of PLHIV access and the preferred delivery channel. Moreover, the issue behind the underutilization of National Health Insurance services in Indonesia among PLHIV is similar to what was experienced in Vietnam in 2015. The 2015 Vietnam study showed that negative perception, the experience of using social health insurance as well as inaccurate information, may lead to the underutilization problem (Vietnam-Administration-HIV/AIDSControl, Social health insurance and people living with HIV in Vietnam: an assessment of enrollment in and use of social health insurance for the care and treatment of people living with HIV, 2015). Furthermore, the current research finding shows that 99% of the total estimated HIV expenditure occurred at the hospital. This indicates a potential inefficiency in the service delivery scheme that needs to be decentralized to a primary-care facility.

Acceptance and willingness to purchase a hypothetical COVID-19 vaccine in a region under Shariah law: A cross-sectional study in Aceh, Indonesia.

Vaccines are urgently needed to control the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to determine the acceptance of and willingness to purchase a hypothetical COVID-19 vaccine in the general population of Aceh, a holistic Shariah law implementation province in Indonesia. An online cross-sectional study was conducted using a quota sampling technique between 1 to 24 September 2021. To determine hypothetical vaccine acceptance, respondents were asked if they were willing to accept vaccines with combinations of either 50% or 95% effectiveness and either 5% or 20% risk of adverse effects. Willingness to purchase was assessed by asking whether the participants would pay for such vaccines at certain price points. Logistic regression analysis was used to assess the associated determinants. Out of 377 respondents included in the final analysis, 86.5% were willing to accept a COVID-19 vaccine with 95% effectiveness and 5% adverse effects. The acceptance rate dropped to 45.1% if the risk of adverse effects was 20%. Vaccines with 50% effectiveness and 5% adverse effects were acceptable to 42.2% but the acceptance went down to 17.2% if the risk of adverse effects increased to 20%. Multivariate analysis found that men were twice as likely to accept a vaccine with 95% effectiveness and 5% adverse effects compared to females (aOR: 2.01; 95% CI 1.05-3.86). We found that 156/377 (41.3%) of respondents were willing to purchase a COVID-19 vaccine and of these participants 71.1% were willing to pay between Indonesian Rupiah (IDR) 50,000-150,000 (US$ 3.33-10.00). In conclusion, the acceptance rate of a hypothetical COVID-19 vaccine varied based on effectiveness and the risk of adverse effects.

Spatiotemporal trends in diabetes-related mortality by school district in the state of Michigan, United States.

OBJECTIVES: This study examined the spatiotemporal epidemiological status of diabetes-related death in relation to school district boundaries in the state of Michigan, United States. METHODS: A retrospective observational study was conducted using death records spanning the years 2007-2014 in Michigan, with school districts as the geographic unit of analysis. Geocoding was performed for each death record. Cluster analysis used spatial autocorrelation with local Moran's I, and spatiotemporal analysis used the Space Time Pattern Mining tool in ArcGIS Pro 2.1. RESULTS: The study revealed spatial clusters of high-high locations of diabetes-related mortality rate by school district in Michigan from 2007 to 2014. Spatiotemporal analysis showed grids with intensifying, consecutive, sporadic, and persistent hotspots of diabetes-related death in the Lansing, Royal Oak, Flint City, Berkley, Detroit City, East Lansing, South Lake, and Holt public school districts. These school districts should be prioritized for school-based diabetes prevention programs. CONCLUSIONS: The study demonstrated the presence of various hotspots of diabetes-related deaths within the state of Michigan across the 8-year period of analysis. Understanding spatial and temporal hotspots could further improve our ability to evaluate diabetes burden across both time and space.

Mapping diabetes burden by school-district for school-based diabetes prevention interventions in selected cities in Michigan, USA.

To decrease diabetes morbidity and mortality rates, early interventions are needed to change lifestyles that are often cemented early, making school-based interventions important. However, with limited resources and lack of within-county diabetes data, it is difficult to determine which local areas require intervention. To identify at-risk school districts, this study mapped diabetes prevalence and related deaths by school district using geographic information systems (GIS). The 2010-2014 records of diabetes-related deaths were identified for 13 cities in Michigan, USA. Diabetes prevalence was estimated using the weighted average of population by school district from the '500 Cities Project' of the Centres of Disease Control and prevention (CDC). Prevalence and mortality rates were mapped by school district and the correlation between diabetes prevalence and mortality rate analysed using the Spearman's rank correlation. Years of potential life lost (YPLL) were calculated using a 75-year endpoint. The result indicated there were geographic variations in diabetes prevalence, mortality and YPLL across Michigan. Most census tracts in the cities of Detroit, Flint and downtown Grand Rapids had higher diabetes prevalence and mortality rate with rs (628)=0.52, P<0.005. School districts with high mortality rates also had high prevalence with rs (13)=0.72, P=0.002. Flint City School District showed a higher rate of diabetes prevalence, death and YPLL than others and should thus be considered a priority for diabetes prevention interventions. Using school districts as the geographic spatial unit of analysis, we identified local variation in diabetes burden for targeting school-based diabetes prevention interventions.

Using GIS and death records to inform statewide school-based diabetes prevention interventions in Michigan.

Background: One of modifiable risk factors of diabetes is unhealthy diet which is related to obesity. Individuals with childhood obesity are at higher risk of adulthood obesity. School-based diabetes prevention programs are important to reduce childhood obesity. When resources are limited, evidence-based priority need to be undertaken. However, data related to childhood obesity was not widely available, the study used diabetes-related death records as the proxy of diabetes burden. This study aimed to map and identify geographic variation of diabetes-related mortality rate by school district level in Michigan to be used for policy-relevant information. Design and Methods: This study used death records in Michigan. Diabetes-related mortality rate and years potential life lost (YPLL) was calculated at the school district level. Spatial autocorrelation local Moran's I and geographically weighted regression were used to evaluate spatial pattern of age-adjusted diabetes-related mortality rate by school districts. Results: The age-adjusted diabetes-related mortality rate ranged from 17.0 (95% CI, 8.6-25.5) to 171.3 (95% CI, 135.9-206.7) deaths per 100,000 population. The YPLL per person ranged from 0 to 19.3 years (95% CI, 15.5-23.1). High rates of diabetes-related mortality rate and YPLL clustered in East central and Southeastern region of Lower Peninsula Michigan including Flint, Kearsley, Beecher, Westwood Heights, Detroit, Ecorse, River Rouge, Taylor, Allen Park and Lincoln Consolidated school districts. Conclusions: There was variation in diabetes burden examined by diabetes-related mortality rate and YPLL at the school district level within Michigan State. The high cluster can be prioritized for the intervention programs.

Techno-economic analysis of bio-briquette from cashew nut shell waste.

The implementation of this research consists of 2 (two) aspects: the making and testing of bio-briquettes called technological aspects and economic analysis called economic aspects. Bio-briquettes is made from cashew nutshell waste obtained from Southeast Sulawesi, Indonesia. It is followed by pyrolysis, which is carried out in a simple batch type reactor by heating using liquefied petroleum gas (LPG). The bio-briquettes product has a calorific value of 29.49 MJ/kg, moisture content of 5.3%, ash content of 4.96%, volatile substances content of 17.16%, and carbon content of 72.62%, which meets the universally accepted bio-briquettes standard (SNI 016235-2000), Japanese, English and ISO 17225. The bio-briquettes product is suitable as an energy source. The economic analysis of the cashew nutshell was analyzed to determine its economic feasibility. For the bio-briquettes production capacity in 2,000 tons/year, cashew nut shell-briquettes products can be sold at 1,052,878 USD/year. The total production cost is USD842,304/year. The net profit is of USD147,402/year. The cost of LPG for 2,000 tons/year production capacity is USD954,358/years. The replacement of LPG with cashew seed bio-briquettes tends to help the average household of Muna Regency community to reduce the annual cost by 37.00%. In conclusion, bio-briquettes production's economic feasibility as analyzed from the investment rate is 23.55%, payout time is 3.42 years, and break-even point is 50.09%.

HIV prevalence and risk behaviours among injecting drug users in six indonesian cities implications for future HIV prevention programs.

BACKGROUND: The HIV prevalence among injecting drug users (IDUs) in Indonesia reached 50% in 2005. While drug use remains illegal in Indonesia, a needle and syringe program (NSP) was implemented in 2006. METHODS: In 2007, an integrated behavioural and biological surveillance survey was conducted among IDUs in six cities. IDUs were selected via time-location sampling and respondent-driven sampling. A questionnaire was administered face-to-face. IDUs from four cities were tested for HIV, syphilis, gonorrhoea and chlamydia. Factors associated with HIV were assessed using generalized estimating equations. Risk for sexual transmission of HIV was assessed among HIV-positive IDUs. RESULTS: Among 1,404 IDUs, 70% were daily injectors and 31% reported sharing needles in the past week. Most (76%) IDUs received injecting equipment from NSP in the prior week; 26% always carried a needle and those who didn't, feared police arrest. STI prevalence was low (8%). HIV prevalence was 52%; 27% among IDUs injecting less than 1 year, 35% among those injecting for 1-3 years compared to 61% in long term injectors (p < 0.001). IDUs injecting for less than 3 years were more likely to have used clean needles in the past week compared to long term injectors (p < 0.001). HIV-positive status was associated with duration of injecting, ever been imprisoned and injecting in public parks. Among HIV-infected IDUs, consistent condom use last week with steady, casual and commercial sex partners was reported by 13%, 24% and 32%, respectively. CONCLUSIONS: Although NSP uptake has possibly reduced HIV transmission among injectors with shorter injection history, the prevalence of HIV among IDUs in Indonesia remains unacceptably high. Condom use is insufficient, which advocates for strengthening prevention of sexual transmission alongside harm reduction programs.