Impact of the COVID-19 pandemic on the outcomes of Indonesian chronic disease management program

Background: The Indonesian Government launched chronic disease management program (PROLANIS) with the aim of improving clinical outcomes and preventing disease complications of patients with type 2 diabetes (T2D). During the coronavirus disease 2019 (COVID-19) pandemic, the overwhelmed healthcare system shifted resources away from non-communicable diseases in the attempt to mitigate it. Thus, the implementation of PROLANIS during the COVID-19 pandemic might not be as optimal as before the pandemic era, leading to worse clinical outcomes. This pilot study aims to evaluate the impact of the COVID-19 pandemic on PROLANIS in rural areas by analyzing the changes of metabolic control and renal function parameters.Methods: This study used data from three PROLANIS groups report in rural areas in East Java Province, Indonesia. Study population was PROLANIS participants who came for six-month-evaluation in December 2019 (T0), June 2020 (T1), and December 2020 (T2). Evaluated metabolic control parameters were body mass index (BMI), blood pressure, hemoglobin A1C (HbA1C), total cholesterol (TC), high-density lipid, low-density lipid, and triglyceride (TG), whereas evaluated renal function parameters were blood urea nitrogen, serum creatinine, and urinary albumin. Independent t-test and Wilcoxon signed-rank test were used for statistical analyses. p-value <0.05 was considered statistically significant.Results: Among 52 PROLANIS participants included in the analyses, four metabolic control parameters (BMI, blood pressure, TC, and TG) and all renal function parameters significantly worsened right after the pandemic started but improved 6 months afterwards. Meanwhile, HbA1C continuously worsened throughout the study period, albeit statistically insignificant.Conclusions: The metabolic control and renal function parameters in our study population deteriorates especially in the beginning of the 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/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.</p

HUBUNGAN UMUR, JENIS KELAMIN, DAN TINGKAT PENDIDIKAN DENGAN PENGETAHUAN MASYARAKAT TENTANG PENYAKIT DEMAM BERDARAH DENGUE Kelurahan Gadang Kecamatan Sukun Kota Malang Tahun 2017

Tujuan: Menganalisis adanya hubungan yang signifikan antara umur, jenis kelamin, dan tingkat pendidikan dengan pengetahuan masyarakat tentang penyakit Demam Berdarah Dengue Kelurahan Gadang Kecamatan Sukun Kota Malang Tahun 2017. Metode: Jenis dan rancangan penelitian ini adalah analitik observasional cross-sectional study. Populasi penelitian adalah masyarakat RT 05 RW 02 Kelurahan Gadang Kecamatan Sukun Kota Malang. Besar sampel sebanyak 113 orang. Sampel diambil dengan teknik proportional random sampling. Variabel independen dalam penelitian ini adalah umur, jenis kelamin, dan tingkat pendidikan masyarakat sedangkan variabel dependen adalah pengetahuan masyarakat. Analisis data dengan regresi logistik binominal (α=0,05). Hasil: 1) Ada hubungan yang signifikan (p=0,018) antara kategori umur 20-29 tahun dengan pengetahuan masyarakat tentang Penyakit Demam Berdarah Dengue dengan OR=4,083 (CI=1,276-13,062), 2) Tidak ada hubungan yang signifikan (p=0,625) antara jenis kelamin dengan pengetahuan masyarakat tentang Penyakit Demam Berdarah Dengue, 3) Ada hubungan yang signifikan (p=0,020) antara tingkat pendidikan menengah dengan pengetahuan masyarakat tentang Penyakit Demam Berdarah Dengue dengan OR=3,456 (CI=1,214-9,835). Simpulan: 1) Masyarakat yang berumur 20-29 tahun kemungkinan memiliki pengetahuan yang lebih baik sebesar 4,083 kali dibanding masyarakat yang berumur 50-59 tahun, 2) Tidak ada hubungan yang signifikan antara jenis kelamin dengan pengetahuan masyarakat tentang Penyakit Demam Berdarah Dengue, 3) Masyarakat dengan tingkat pendidikan menengah kemungkinan memiliki pengetahuan yang lebih baik sebesar 3,456 kali dibanding masyarakat dengan tingkat pendidikan rendah. Umur dan tingkat pendidikan memiliki kemungkinan kontribusi sebesar 17,5% terhadap peningkatan pengetahuan seseorang tentang Penyakit Demam Berdarah Dengue sedangkan sisanya sebesar 82,5% disebabkan oleh variabel lain diluar umur dan tingkat pendidika

Clinical Presentation of Nasopharyngeal Carcinoma in East Java,Indonesia

Abstract Background: Nasopharyngeal Carcinoma (NPC) is a rare malignancy throughout most of the world, but the incidence in Southeast Asia is very high. In Indonesia, NPC is the fourth most common malignancy. Among all regions in Indonesia, East Java has the highest incidence. However, there is no detailed study in East Java regarding this malignancy. Aim: To document the clinical presentation of NPC in East Java. Methodology: This was a descriptive study using medical record at Dr. Soetomo General Hospital. Samples were newly diagnosed NPC patients who attended radiotherapy outpatient clinic between January – December 2016. Total sampling method was used in this study. Patients’ characteristic including presented symptoms, chief complaints, clinical staging, and histological subtypes were assessed and evaluated. Results: There were 270 NPC patients registered in radiotherapy outpatients clinic at Dr. Soetomo General Hospital in 2016. Two-thirds of the patients were male. More than half of the patients came to the healthcare service with the chief complaint of lump in the neck. Based on the staging, almost all patients were already in the late stage. Histopathologic findings showed that WHO type 3 was the most common subtypes of NPC.\ Conclusion: Majority of the NPC patients in East Java were already in the advanced stage. Early diagnosis is important for favorable outcome of this disease. Thus, it is important to understand the chief complaint and symptoms in patients with NPCso that the diagnostic delay could be avoided

RADIOTHERAPY EFFECT ON COMPLETE BLOOD COUNT PARAMETER IN PATIENTS WITH NASOPHARYNGEAL CARCINOMA

Abstract Introduction: Nasopharyngeal carcinoma (NPC) is the most common malignant tumor of the nasopharynx. Radiotherapy is a therapy of choice for NPC that has been recognized for a long time and used in various centers of the world. However, radiotherapy is known to still have an adverse effect. It is common practice to evaluate Complete Blood Count (CBC) before, during, and after radiotherapy. However, there has been no study regarding the effect of radiotherapy on all CBC parameters. This study aims to analyze the effect of radiotherapy on CBC in NPC patients before and after radiotherapy treatment. Material and methods: This study was an observational study using secondary data from medical records at the radiotherapy outpatient clinic at Dr. Soetomo General Hospital Surabaya. The subject of this study was patients with NPC who underwent a full cycle of radiotherapy treatment on radiotherapy outpatient clinic in 2016. Patients with incomplete medical records and did not finish the radiotherapy treatment were excluded. A paired T-test and Wilcoxon signed-rank test were used for statistical analysis. Results: There were 105 patients included in this study. Mean Corpuscular Hemoglobin Concentration (MCHC), total leucocyte, lymphocyte, and thrombocyte was significantly decreased after a full cycle of radiotherapy (all p <0.05). Eosinophil, basophil, neutrophil, monocyte, Neutrophil to Lymphocyte ratio (NLR), and Platelet to Lymphocyte ratio (PLR) was significantly increased after a full cycle of radiotherapy (all p <0.05). Conclusion: Radiotherapy had a significant effect on the CBC parameter in NPC patients

The role of oxidative stress markers in Indonesian chronic kidney disease patients: a cross sectional study

Background: Several aspects of chronic kidney disease (CKD) such as the incidence rate and mortality rate are concerning. Oxidative stress contributes to progression and mortality in patients with CKD; however, a specific correlation between several markers of oxidative stress and the estimated glomerular filtration rate (eGFR) and albumin-creatinine ratio (ACR) in the Indonesian population has not been sufficiently described yet. Methods: This study was an analytic observational study with a sample of 56 patients with CKD in Universitas Airlangga Hospital, Surabaya, Indonesia, from December 2019 – March 2020. The markers for oxidative stress investigated were urinary 8-hydroxy-2 deoxyguanosine (8-OHdG), serum symmetric dimethylarginine (SDMA) and asymmetric dimethylarginine (ADMA). The correlations between each variable of oxidative stress and CKD were analyzed using Pearson analysis. Results: There was a positive correlation between 8-OHdG and eGFR (p=0.00, r=0.51); however, there was a negative correlation between 8-OHdG and ACR (p=0.025, r=-0.30). SDMA and eGFR showed a negative correlation (p=0.00, r=-0.648), while SDMA and ACR showed a positive correlation (p=0.03, r=0.349). ADMA showed a negative correlation with eGFR (p=0.00, r=-0.476). There were significantly decreased 8-OHdG but increased ADMA and SDMA as the CKD stage progressed (p=0.001, p=0.00, and p = 0.00, respectively). Higher urine 8-OHdG was detected in patients without history of hemodialysis, whereas ADMA and SDMA showed higher value in patients with hemodialysis (p=0.00, p=0.00, and p=0.004, respectively), patients with history of diabetes mellitus (DM) had higher mean 8-OHdG (p 0.000) yet lower serum ADMA and SDMA (p=0.004 and p=0.003, respectively). Conclusions: In patients with CKD in Indonesia, the markers for oxidative stress 8-OHdG, SDMA, and ADMA are correlated with eGFR and ACR levels. There were also significant difference in 8-OHdG, SDMA, and ADMA levels among CKD stages, between dialysis vs non dialysis, and DM vs non DM patients