Hybrid learning as alternative approach to improve Indonesian medical students' attitude towards clinical skills during COVID-19 pandemic.

PURPOSE: Hybrid learning has been chosen as an alternative method in the conduction of clinical skill lectures during coronavirus disease 2019 (COVID-19) pandemic since students need to learn skills applied in emergency situations. This study aims to analyze students' attitudes between hybrid and online learning methods. METHODS: A non-randomized study was conducted between hybrid group (HG) and online group (OG) on three courses (intravenous [IV]-line insertion, nasogastric tube [NGT] insertion, and neonatal resuscitation). We developed a preformed validated questionnaire to assess students' attitudes in five domains (willingness, understanding, capacity, self-efficacy, and intended behavior). The questionnaire was applied at the pre- and post-intervention. RESULTS: A total of 100 participants were included (n=49 in HG, n=51 in OG). Post-course attitudes were significantly higher in online (IV-line, p=0.000; NGT, p=0.000; resuscitation, p=0.000) and hybrid (IV-line, p=0.000; NGT, p=0.000; resuscitation, p=0.000) groups compared to their pre-course. There were no significant differences in post-course attitude between groups (IV-line, p=0.072; NGT, p=0.163; resuscitation, p=0.146). Normalized-gain scores of all subjects were higher in HG (IV-line, p=0.012; NGT, p=0.085; resuscitation, p=0.033). CONCLUSION: In conclusion, hybrid learning could be considered as a better alternative in clinical skill lectures to maximize students' attitudes, especially during COVID-19 pandemic.

Outcomes of the Indonesian Chronic Disease Management Program (PROLANIS) in Patients with Hypertension During the COVID-19 Pandemic in Rural Areas: A Preliminary Evaluation Study.

BACKGROUND The Indonesian Chronic Disease Management Program (PROLANIS) is a government program that aims to improve the health outcomes of patients with chronic diseases, including hypertension. This preliminary study aimed to evaluate the impacts of the coronavirus disease 2019 (COVID-19) pandemic on the health outcomes of hypertension patients in rural areas who were enrolled in PROLANIS. MATERIAL AND METHODS This study used data from 4 PROLANIS groups in East Java province. The data were collected from participants' 6-month evaluations at 3 time points: before the COVID-19 pandemic in December 2019 (T0), during the COVID-19 pandemic in June 2020 (T1), and in December 2020 (T2). Evaluated parameters were body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), low-density lipid (LDL), high-density lipid (HDL), triglyceride (TG), and estimated glomerular filtration rate (eGFR). RESULTS There were 91 patients included in the analyses. Compared to T0, BMI, blood pressure, eGFR, and TC had significantly deteriorated at T1, but LDL, HDL, and TG showed no marked changes. At T2, BMI, DBP, and TC were similar to T0. On the other hand, SBP and eGFR did not improve, while HDL significantly deteriorated. Stratified based on age, worsening of DBP, TC, and LDL at T1 and eGFR at T1 and T2 was only observed in those aged 60 years and older. CONCLUSIONS This preliminary study showed that the health outcomes of hypertension patients in rural areas who were enrolled in PROLANIS were negatively impacted during the COVID-19 pandemic, with the elderly being the most affected.

Risk Factors Associated with Nasopharyngeal Cancer Incidences in Indonesia: A Systematic Review and Meta-Analysis.

OBJECTIVE: To determine the risk factors associated the incidence of NPC, particularly in Indonesia. METHODS: This systematic review and meta-analysis was conducted according to PRISMA statement. Database including PubMed, Scopus, Science Direct, Web of Science, and GARUDA were retrieved. Newcastle-Ottawa scale was used to assess the quality of published study and analyse the risk of bias of included study. Random-effect model and reported pooled Odds Ratio (OR) with 95%CI was carried out in our meta-analysis. RESULTS: A pooled of 7 studies were included in our study which included 764 participants. We found that female gender was not associated with the incidences of NPC (OR 1.45, 95% CI: 0.61-3.45, p=0.40), and smoking was highly increased the incidence of NPC (OR 4.39 95% CI (0.79-24.40), but not statistically significant (p=0.09). Furthermore, salted fish consumption and some HLA alleles were associated with increased risk. CONCLUSION: The incidence of NPC is not associated with female gender nor smoking habits. However, the risk of NPC is higher for those who consume salted fish and have some susceptible HLA alleles. Further investigations in larger studies are needed to confirm these findings.

Predominant aspects of knowledge and practical skills among medical students with online learning during the COVID-19 pandemic era.

BACKGROUND: Social restrictions due to the COVID-19 pandemic have shifted most learning methods into online courses, especially for medical skills education. However, the effects of online courses on medical skill education amongst medical students are still arguable. The study aims to analyse medical students' knowledge, attitude, practice and satisfaction towards medical skills between online and offline courses. METHOD: We performed a case-control study conducted among 533 medical students with online (as a case group, n = 288) and offline courses (as a control group, n = 245). We evaluated three fundamental medical skills, including history taking [HT], lung physical examination [LPE], and heart physical examination [HPE]. We tested the knowledge and skills among students through theory and practical examinations. Students' attitudes and satisfaction were assessed using a validated questionnaire. RESULTS: The scores for knowledge and practical skills among the online group were significantly higher (p = 0.016, p = 0.004, respectively). In comparison, the scores for the students' attitudes and satisfaction were substantially lower (p = 0.000, p = 0.003, respectively) compared to the control group. Most of the students in both groups passed the exam (case vs. control = 81.94%; 83.27%, respectively). Males were the only factor associated with a higher rate of passing the examination (OR 0.42, 95% CI [0.27-0.67], p = 0.000). CONCLUSIONS: Online learning could be an alternative approach on improving student's knowledge and practice towards medical skill especially amidst COVID-19 pandemic, however further consideration on student's attitude and satisfaction are mandatory to achieve appropriate competence as future general practitioner.

Evaluation of Health-Related Quality of Life and Mental Health in 729 Medical Students in Indonesia During the COVID-19 Pandemic.

BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has impacted the health-related quality of life (HRQoL) and mental health worldwide. However, its impact on medical students in Indonesia has not been well documented. This study aimed to evaluate HRQoL and mental health in 729 Indonesian medical students during the COVID-19 pandemic. MATERIAL AND METHODS We conducted a cross-sectional study from 31 August to 30 September 2021. The study instrument was an online questionnaire that was distributed via social media platforms. The 12-item short form version 2 (SF12v2) was used to measure HRQoL, and the 21-item Depression, Anxiety, and Stress Scale (DASS-21) was used to measure mental health. RESULTS From 729 Indonesian medical students included in the analyses, 37.3% had impaired physical component and 66.9% had impaired mental component of HRQoL. The determinants were medical students' island of residence, history of hospitalization, and family member's hospitalization and death due to COVID-19. Concerning mental health, the prevalence of reported symptoms of depression, anxiety, and stress were 45.4%, 65.2%, and 60.9%, respectively. Sex, study method, grade, previous COVID-19 disease severity, comorbidities, previous learning experience, and history of family isolation were identified as the determinants of mental health. CONCLUSIONS This study highlights the adverse effects of COVID-19 on HRQoL and mental health in Indonesian medical students. The results identified key associations, including SARS-CoV-2 infection and comorbidities experienced by the students, the health of their families, including grief following bereavement, and the effects of social isolation during the pandemic.

Filter-based embolic protection device in saphenous vein graft percutaneous intervention: A case report.

Saphenous vein grafts (SVGs) are commonly used in coronary artery bypass graft (CABG) surgery patients. However, SVGs are prone to degradation and occlusion, resulting in poor long-term patency. Percutaneous coronary intervention (PCI) for SVG has been one of the options to treat SVGs disease despite its challenges. Embolic protection device (EPD) use along with proper stent and medications are considered to minimize complications in this procedure. A 61-year-old man, with 4-vessel coronary artery bypass using SVGs and left internal mammary artery (LIMA) 11 years ago, presented with chest pain for more than 3 months. Coronary angiography showed severe stenosis of the SVG to PDA with two lesions, chronic total occlusion in SVG to OM and LIMA to LAD, with patent SVG to D1. He was admitted for elective PCI using drug-eluting stents and distal embolic filter. There were no problems observed, and the procedure was completed with successful stenting in SVG to PDA without any complications. The patient was discharged on dual-antiplatelet therapy along with his previous medication history. PCI is preferred over repeated CABG in high-risk patients, and EPD should be considered whenever technically possible to minimize the risk of distal embolization and thereby improve outcomes in SVG PCI.

Right ventricular dysfunction and pulmonary hypertension in COVID-19: a meta-analysis of prevalence and its association with clinical outcome.

Introduction: Rapid spread of COVID-19 has caused detrimental effects globally. Involvement of the ACE2 receptor has identified COVID-19 as a multi-organ disease. Preliminary studies have provided evidence that cardiac involvement, including right ventricular dysfunction (RVD) and pulmonary hypertension (PH), were found in COVID-19 cases, even in the non-advanced stage. This meta-analysis aims to analyze the prevalence of RVD and PH, and their association with COVID-19 clinical outcome. Material and methods: A systematic data search was conducted through PubMed, medRxiv, ProQuest, Science Direct, and Scopus databases using constructed keywords based on MeSH terms. Any outcomes regarding mortality, severity, ICU admission, and mechanical ventilation usage were analyzed using RevMan v.5.4 and Stata v.16. Results: A total of 16 eligible studies (1,728 patients) were included. Pooled prevalence of RVD in COVID-19 was 19% (95% CI: 13-25%), and PH was 22% (95% CI: 14-31%). RVD was associated with increased mortality (OR = 2.98 (95% CI: 1.50-5.89), p = 0.002), severity (OR = 3.61 (95% CI: 2.05-6.35), p < 0.001), ICU admission (OR = 1.70 (95% CI: 1.12-2.56), p = 0.01), and mechanical ventilation (MV) usage (OR = 1.60 (95% CI: 1.14-2.25), p = 0.007). PH was also associated with increased mortality (OR = 5.42 (95% CI: 2.66-11.060, p < 0.001), severity (OR = 5.74 (95% CI: 2.28-14.49), p < 0.001), and ICU admission (OR = 12.83 (95% CI: 3.55-46.41), p < 0.001). Conclusions: RVD and PH were prevalent in COVID-19 and associated with mortality, severity, ICU admission, and MV usage in COVID-19 patients. Bedside echocardiography examination could be considered as a novel risk stratification tool in COVID-19.

Purulent pericarditis in advanced thymoma: A case report.

Thymoma is the most common primary anterior mediastinum mass with various clinical manifestations, and one of the manifestations is pericardial effusion. While pericardial effusion in thymoma is usually serous, it can become purulent when an infection occurs in a nearby organ, albeit rare. In this report, we present a rare case of a 27-year-old woman who had purulent pericarditis secondary to an advanced thymoma. The patient came to the emergency department with the chief complaints of worsening chest discomfort, non-productive cough, and fever in the past 2 weeks. The patient was diagnosed with thymoma 5 months prior. Based on the examinations, it was discovered that the patient had pericarditis. After the pericardiocentesis was performed and the fluid was examined, the patient was diagnosed with purulent pericarditis secondary to thymoma. The patient was then treated with intravenous antibiotic and pericardial drain. Unfortunately, the patient's condition deteriorated, and the patient died on the fifth day of hospitalization. This case highlights an infrequent but potentially life-threatening complication of thymoma. In addition, thymic pathologies should be included as a rare etiology in the differential diagnosis of purulent pericardial effusion.

Knowledge, attitude, and practice related to the COVID-19 pandemic among undergraduate medical students in Indonesia: A nationwide cross-sectional study.

INTRODUCTION: The potential role of medical students in raising awareness during public health emergencies has been acknowledged. To further explore their potentials as public educators and role models for the communities during the coronavirus disease 2019 (COVID-19) pandemic, this study aims to assess the knowledge, attitude, and practice of these students toward COVID-19. METHODS: An online cross-sectional survey was conducted among undergraduate medical students in Indonesia. Socio-demographics characteristics, social interaction history, information-seeking behavior, as well as knowledge, attitude, and practice toward COVID-19 were collected through a self-reported questionnaire. A p-value of <0.05 indicated statistical significance. RESULTS: Out of 4870 respondents, 64.9% had positive attitude and 51.5% had positive practice toward COVID-19, while only 29.8% had adequate knowledge. Knowledge was slightly positively correlated with attitude and practice (ρ = 0.074 and ρ = 0.054, respectively; both p<0.001), while attitude was weakly correlated with practice (ρ = 0.234, p<0.001). Several factors including age, sex, place of residence, institution type, academic level, family income, history of chronic illness, prior volunteering experience, and perceptual awareness on COVID-19 were significantly associated with either knowledge, attitude, and/or practice toward COVID-19. Furthermore, health institution's and the government's press releases, as well as health expert opinions were deemed as the most reliable sources of COVID-19-related information-yet trivially none of these sources were associated with knowledge, attitude, and practice in the study population. CONCLUSION: Many undergraduate medical students in Indonesia had positive attitude and practice against COVID-19, yet only a few had adequate knowledge. This warrants further interventions to keep them updated with COVID-19 evidence to maximize their potentials in raising public awareness on COVID-19.

Association of calcium channel blocker use with clinical outcome of COVID-19: A meta-analysis.

AIMS: This meta-analysis aims to analyze the association of calcium channel blocker (CCB) use with COVID-19 clinical outcomes. METHODS: PubMed, ProQuest, Science Direct, Scopus, and medRxiv databases were searched systematically in a limited period. The primary outcome was mortality. RESULTS: A total of 119,298 patients from 31 eligible studies were included. Pooled analysis of the random-effect model revealed CCB was not associated with reduced mortality (OR = 1.21 [95%CI: 0.98-1.49], p = 0.08). Interestingly, subgroup analysis in hypertensive patients revealed significantly reduced mortality (OR = 0.69 [95%CI: 0.52-0.91], p = 0.009). CONCLUSION: CCB usage was not associated with the outcome of COVID-19. However, CCB was associated with a decreased mortality rate in hypertensive COVID-19 patients.

Cardioprotective properties of glucagon-like peptide-1 receptor agonists in type 2 diabetes mellitus patients: A systematic review.

BACKGROUND AND AIMS: Cardiovascular disease is one of the main contributors for the mortality in type 2 diabetes mellitus (T2DM) patients. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) had shown cardiovascular benefits which may be advantageous to reduce mortality in T2DM patients. This systematic review focused on analyzing the effects of GLP-1 RAs on cardiovascular outcomes. METHODS: We conducted an extensive search through JSTOR, PubMed, Scopus, EBSCohost, and CENTRAL. All related studies assessing the use of GLP-1 RAs in T2DM patients from inception up to October 2020 were screened. Any cardioprotective properties as the outcomes were obtained. RESULTS: A total of six studies (4 randomized, 2 observational) with a total of 182.205 patients were included in this review. The GLP-1 RAs used were either liraglutide or exenatide in combination with antihypertensive or antilipidemic drugs. All studies showed that GLP-1 RA significantly caused weight loss and improved cardiac functional capacity by increasing left ventricular ejection fraction and reducing end-systolic and end-diastolic left ventricle volume. GLP-1 RA also improved myocardial blood flow without affecting myocardial glucose uptake. However, GLP-1 RA failed to show its effect in reducing blood pressure and improving lipid profiles. CONCLUSIONS: Despite the limited number of studies, consistent data showed that GLP-1 RA has several cardioprotective properties.

Methylene blue for vasoplegic syndrome in cardiopulmonary bypass surgery: A systematic review and meta-analysis.

BACKGROUND: To evaluate the benefit of methylene blue as an adjunct treatment by assessing hemodynamic, morbidity rate, intensive care unit length of stay, and mortality rate outcomes in adult patients with vasoplegic syndrome. METHODS: A systematic search through electronic databases including Pubmed, Embase, Scopus, and Medline for studies assessing the use of methylene blue in patients with vasoplegic syndrome compared to control treatments. The Newcastle-Ottawa Scale tool was used for observational studies, and Jadad Scale was used for controlled trials to assess the risk of bias. RESULTS: This systematic review included six studies for qualitative synthesis and five studies for quantitative synthesis. Pooled analysis revealed that mean arterial pressure, systemic vascular resistance, heart rate, and hospital stay were not statistically significant in methylene blue administration compared to control. However, administration of methylene blue in vasoplegic syndrome patients significantly reduces renal failure (OR = 0.25; 95% CI = 0.08-0.75), development of multiple organ failure (OR = 0.09; 95% CI = 0.02-0.51), and mortality rate (OR = 0.12; 95% CI = 0.03-0.46). CONCLUSION: Adjunct administration of methylene blue for vasoplegic syndrome patients significantly reduces renal failure, multiple organ failure, and mortality.

Willingness to volunteer and readiness to practice of undergraduate medical students during the COVID-19 pandemic: a cross-sectional survey in Indonesia.

BACKGROUND: The question to involve or restrict medical students' involvement in the coronavirus disease 2019 (COVID-19) pandemic response remains contentious. As their state of preparation and perceptions in volunteering during this pandemic have yet to be investigated, this study aims to evaluate Indonesian medical students' willingness to volunteer and readiness to practice during the COVID-19 pandemic. METHODS: A web-based survey was conducted among undergraduate medical students throughout Indonesia. Socio-demographic and social interaction information, in addition to willingness to volunteer and readiness to practice, were obtained using a self-reported questionnaire. The significance level was set at 5%. RESULTS: Among 4870 participants, 2374 (48.7%) expressed their willingness to volunteer, while only 906 (18.6%) had adequate readiness to practice. Male students, students with prior volunteering experience in health or non-health sectors, and students from public universities or living in Central Indonesia (vs Java) had higher scores of willingness and readiness to volunteer. Students from Sumatra also had better preparedness (odds ratio [OR] 1.56, 95% confidence interval [CI] 1.15-2.12, p = 0.004), while the opposite occurred for students from Eastern Indonesia (OR 0.63, 95% CI: 0.44-0.89, p = 0.002)-when compared to students from Java. In addition, compared to students with high family income, students from lower-middle income families were less willing to volunteer (OR 0.76, 95% CI: 0.59-0.98, p = 0.034), though those with low family income had better readiness (OR 1.51, 95% CI: 1.10-2.08, p = 0.011). Shortage of medical personnel, sense of duty, and solicitation by stakeholders were the main reasons increasing the students' willingness to volunteer; whereas contrarily fear for own's health, absence of a cure, and fear of harming patients were the primary factors diminishing their willingness to volunteer. CONCLUSION: Our findings indicated that many Indonesian medical students are willing to volunteer, yet only few of them were ready to practice, indicating that further preparations are required to maximize their potentials and minimize their exposure to hazards. We suggest that their potentials as a firm support system during the pandemic should not be overlooked, and that the integration of relevant courses to the medical curricula are imperative to prepare for future public health emergencies.

Near-Infrared Spectroscopy and Aquaphotomics for Monitoring Mung Bean (Vigna radiata) Sprout Growth and Validation of Ascorbic Acid Content.

Mung bean is a leguminous crop with specific trait in its diet, namely in the form of anti-nutrient components. The sprouting process is commonly done for better nutritional acceptance of mung bean as it presents better nutritional benefits. Sprouted mung bean serves as a cheap source of protein and ascorbic acid, which are dependent on the sprouting process, hence the importance of following the biological process. In larger production scale, there has not been a definite standard for mung bean sprouting, raising the need for quick and effective mung bean sprout quality checks. In this regard, near-infrared spectroscopy (NIRS) has been recognized as a highly sensitive technique for quality control that seems suitable for this study. The aim of this paper was to describe quality parameters (water content, pH, conductivity, and ascorbic acid by titration) during sprouting using conventional analytical methods and advanced NIRS techniques as correlative methods for modelling sprouted mung beans' quality and ascorbic acid content. Mung beans were sprouted in 6 h intervals up to 120 h and analyzed using conventional methods and a NIR instrument. The results of the standard analytical methods were analyzed with univariate statistics (analysis of variance (ANOVA)), and the NIRS spectral data was assessed with the chemometrics approach (principal component analysis (PCA), discriminant analysis (DA), and partial least squares regression (PLSR)). Water content showed a monotonous increase during the 120 h of sprouting. The change in pH and conductivity did not describe a clear pattern during the sprouting, confirming the complexity of the biological process. Spectral data-based discriminant analysis was able to distinctly classify the bean sprouts with 100% prediction accuracy. A NIRS-based model for ascorbic acid determination was made using standard ascorbic acid to quantify the components in the bean extract. A rapid detection technique within sub-percent level was developed for mung bean ascorbic acid content with R2 above 0.90. The NIR-based prediction offers reliable estimation of mung bean sprout quality.