CLINICAL PROFILE AND INCIDENCE OF INFECTION IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS AT MEDICAL INPATIENT INSTALLATION, DEPARTMENT OF INTERNAL MEDICINE, DR. SOETOMO GENERAL ACADEMIC HOSPITAL, SURABAYA, INDONESIA IN 2016

Background: Systemic Lupus Erythematosus (SLE) is an autoimmune disease with unknown aetiology. SLE attacks multiple organs with diverse clinical manifestations. Most patients get immunosuppressant therapy that suppresses immune system, causing the body to be susceptible to infection. Objective: to describe clinical manifestations, laboratory abnormalities, and incidence of infections in SLE patients hospitalized at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia in 2016. Materials and Methods: Cross-sectional descriptive observational study used medical records of 273 SLE patients hospitalized at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia in 2016. Results: Clinical manifestations found in this study were malar rash 7.33%, discoid rash 2.93%, oral ulcer 8.42%, allopecia 16.48%, arthritis 26.74%, serositis 13.19%, kidney 35.9%, neurology 24.91%, anemia 73.71%, leucopenia 32.67%, lymphopenia 76.89%, and thrombocytopenia 33.86%. Laboratory abnormalities found in this study were hematology (anemia 73.71%, leucopenia 32.67%, lymphopenia 76.89%, thrombocytopenia 33.86%), kidney function (high serum creatinine levels 39.66%, high BUN levels 41.2%, hypoalbuminemia 62.6%), urine (proteinuria 68.21%, hematuria 51.79%) and liver function (high ALT levels 36.65%, high AST levels 29.86%). Infection occurred in 33.7% patients. The most common infections were pneumonia (70.65%), urinary tract infections (51.09%), and sepsis (35.87%). Conclusion: The most common clinical manifestations experienced by SLE patients are hematological disorder, kidney disorder, and arthritis. Prominent laboratory abnormalities are anemia, lymphopenia, and proteinuria. Infection is a common complication, with the most common types pneumonia, urinary tract infection, and sepsis

Myocarditis and coronavirus disease 2019 vaccination: A systematic review and meta-summary of cases

Vaccination is significant to control, mitigate, and recover from the destructive effects of coronavirus disease 2019 (COVID-19). The incidence of myocarditis following COVID-19 vaccination has been increasing and growing public concern; however, little is known about it. This study aimed to systematically review myocarditis following COVID-19 vaccination. We included studies containing individual patient data of myocarditis following COVID-19 vaccination published between January 1, 2020 and September 7, 2022 and excluded review articles. Joanna Briggs Institute critical appraisals were used for risk of bias assessment. Descriptive and analytic statistics were performed. A total of 121 reports and 43 case series from five databases were included. We identified 396 published cases of myocarditis and observed that the majority of cases was male patients, happened following the second dose of mRNA vaccine administration, and experienced chest pain as a symptom. Previous COVID-19 infection was significantly associated (p < 0.01; OR, 5.74; 95% CI, 2.42–13.64) with the risk of myocarditis following the administration of the first dose, indicating that its primary mechanism is immune-mediated. Moreover, 63 histopathology examinations were dominated by non-infective subtypes. Electrocardiography and cardiac marker combination is a sensitive screening modality. However, cardiac magnetic resonance is a significant noninvasive examination to confirm myocarditis. Endomyocardial biopsy may be considered in confusing and severe cases. Myocarditis following COVID-19 vaccination is relatively benign, with a median length of hospitalization of 5 days, intensive care unit admission of <12%, and mortality of <2%. The majority was treated with nonsteroidal anti-inflammatory drugs, colchicine, and steroids. Surprisingly, deceased cases had characteristics of being female, older age, non-chest pain symptoms, first-dose vaccination, left ventricular ejection fraction of <30%, fulminant myocarditis, and eosinophil infiltrate histopathology

PROFIL KLINIS DAN KEJADIAN INFEKSI PENDERITA SYSTEMIC LUPUS ERYTHEMATOSUS DI IRNA MEDIK SMF ILMU PENYAKIT DALAM RSUD DR. SOETOMO TAHUN 2016

Systemic Lupus Erythematosus adalah penyakit autoimun yang belum diketahui penyebab pastinya. Systemic Lupus Erythematosus menyerang berbagai organ sehingga memiliki beragam manifestasi klinis. Sebagian besar penderita memperoleh terapi imunosupresan yang menekan sistem imun sehingga mengakibatkan tubuh rentan terhadap infeksi. Penelitian ini bertujuan mengetahui manifestasi klinis, kelainan laboratorium, dan gambaran infeksi pada penderita Systemic Lupus Erythematosus di RSUD Dr. Soetomo Tahun 2016. Penelitian observasional deskriptif cross sectional menggunakan rekam medik 273 penderita Systemic Lupus Erythematosus di RSUD Dr. Soetomo tahun 2016. Hasil: manifestasi klinis yang ditemukan berupa malar rash 7.33%, discoid rash 2.93%, ulkus oral 8.42%, rambut rontok 16.48%, arthritis 26.74%, serositis 13.19%, ginjal 35.9%, neurologi 24.91%, anemia 73.71%, leukopenia 32.67%, limfopenia 76.89%, trombositopenia 33.86%. Kelainan laboratorium yang ditemukan adalah hematologi (anemia 73.71%, leukopenia 32.67%, limfopenia 76.89%, trombositopenia 33.86%), fungsi ginjal (kadar serum kreatinin tinggi 39.66%, kadar BUN tinggi 41.2%, hipoalbuminemia 62.6%), urine (proteinuria 68.21%, hematuria 51.79%) dan fungsi hati (kadar ALT tinggi 36.65%, kadar AST tinggi 29.86%). Sebanyak 33.7% mengalami infeksi, dengan infeksi terbanyak adalah pneumonia (70.65%), infeksi saluran kemih (51.09%), dan sepsis (35.87%). Kesimpulan: manifestasi klinis yang paling sering dialami penderita Systemic Lupus Erythematosus adalah hematologi, ginjal, dan arthritis. Kelainan hematologi, fungsi ginjal, fungsi hati, dan infeksi sering ditemukan pada penderita. Jenis infeksi yang paling sering adalah pneumonia, infeksi saluran kemih, dan sepsis

Myocarditis and coronavirus disease 2019 vaccination:A systematic review and meta-summary of cases

Vaccination is significant to control, mitigate, and recover from the destructive effects of coronavirus disease 2019 (COVID-19). The incidence of myocarditis following COVID-19 vaccination has been increasing and growing public concern; however, little is known about it. This study aimed to systematically review myocarditis following COVID-19 vaccination. We included studies containing individual patient data of myocarditis following COVID-19 vaccination published between January 1, 2020 and September 7, 2022 and excluded review articles. Joanna Briggs Institute critical appraisals were used for risk of bias assessment. Descriptive and analytic statistics were performed. A total of 121 reports and 43 case series from five databases were included. We identified 396 published cases of myocarditis and observed that the majority of cases was male patients, happened following the second dose of mRNA vaccine administration, and experienced chest pain as a symptom. Previous COVID-19 infection was significantly associated (p < 0.01; OR, 5.74; 95% CI, 2.42–13.64) with the risk of myocarditis following the administration of the first dose, indicating that its primary mechanism is immune-mediated. Moreover, 63 histopathology examinations were dominated by non-infective subtypes. Electrocardiography and cardiac marker combination is a sensitive screening modality. However, cardiac magnetic resonance is a significant noninvasive examination to confirm myocarditis. Endomyocardial biopsy may be considered in confusing and severe cases. Myocarditis following COVID-19 vaccination is relatively benign, with a median length of hospitalization of 5 days, intensive care unit admission of <12%, and mortality of <2%. The majority was treated with nonsteroidal anti-inflammatory drugs, colchicine, and steroids. Surprisingly, deceased cases had characteristics of being female, older age, non-chest pain symptoms, first-dose vaccination, left ventricular ejection fraction of <30%, fulminant myocarditis, and eosinophil infiltrate histopathology

National Health Insurance-Based Telemedicine Implementation For Hypertension Management In Primary Centres

Hypertension nowadays still becomes one of the severe problems in Indonesia, with a prevalence of 34% in 2018. The complication of hypertension causes the most deaths and disabilities in Indonesia and cost 75% of The Social Security Organizing Agency (BPJS) budget or IDR 15 trillion in 2019. This problem was probably caused by patients' lack of knowledge and limited personnel at the primary health centre (PHC). Telemedicine is a health care provider without any direct contact, which has various methods. Today, telemedicine in Indonesia is growing rapidly along with technology and legal regulation in its implementation, increasing users by 700% in the first year of 2020. Despite the rise of those numbers, telemedicine in PHC is still limited. Recently, the Ministry of Health and various organizations have issued telemedicine regulations at primary level health facilities in collaboration with The Social Security Organizing Agency. This review aims to discuss the current implementation and the potential future of telemedicine-based hypertension management in collaboration with the Social Security Organizing Agency in PHC