Pengembangan Instrumen Surveilans Ventilator-Associated Events (VAE) Berbasis Algoritme National Healthcare Safety Network (NHSN)

This research aims to develop a Ventilator-Associated Events (VAE) surveillance instrument based on the National Healthcare Safety Network (NHSN) in the intensive care unit (ICU). The method used is Research and Development with stages including literature study, observation evaluation, validity and reliability testing, and focus group discussions (FGD). The research results show that the development of an NHSN-based VAE surveillance instrument in the ICU consists of two sheets, namely the first sheet (patient identity, minimum daily PEEP, and FiO2) and the second sheet (IVAC PVAP criteria). The I-CVI test result is 1.00, and the KR 20 test is 0.96, which means it is valid and reliable. In conclusion, developing an NHSN-based VAE surveillance instrument in the ICU can be applied in hospitals to refine Ventilator-Associated Pneumonia (VAP) surveillance. This can objectively detect complications from using a ventilator due to infection or non-infection.   Keywords: Infection, Instruments, Surveillance, VAE, VA

Acute Pericarditis in Patient with Systemic Lupus Erythematosus: A Case Report

Acute pericarditis is a common disorder caused by inflammation of the pericardium and can occur as an isolated entity or as a manifestation of an underlying systemic disease. The diagnosis of acute pericarditis is established when a patient has at least two of the following symptoms or signs: chest pain consistent with pericarditis, pericardial friction rub, typical ECG changes, or a pericardial effusion of more than trivial size. Systemic Lupus Erythematosus (SLE) is a chronic autoimmune systemic disorder with unknown etio-pathogenesis. Upon the susceptible genetic, hormonal and abnormal immunologic background, the environmental factors may play role as trigger to permit disease development. Cardiovascular complications occur in more than half of the patients with SLE. Pericarditis is the most studied cardiovascular manifestation, although often not evident clinically, and it is included in the American College of Rheumatology (ACR) classification criteria for SLE. We report a clinical case of initially unremarkably findings which progressed to SLE complicated by full-blown acute pericarditis. A brief review of acute pericarditis, including etiology, clinical presentation, ECG criteria, echocardiographic manifestation, and treatment is presented.   Abstrak Perikarditis akut adalah penyakit yang disebabkan oleh inflamasi dari perikard, dapat terjadi sebagai entitas penyakit primer maupun sekunder sebagai manifestasi dari penyakit sistemik yang mendasarinya. Diagnosis perikarditis akut ditegakkan saat pasien mengalami setidaknya dua dari tanda atau gejala berikut: nyeri dada spesifik perikarditis, pericardial friction rub, perubahan EKG tipikal, atau adanya efusi perikard dengan ukuran lebih dari trivial. Lupus Eritematosus Sistemik (LES) adalah penyakit autoimun sistemik kronis dengan etiopatogenesis yang belum diketahui. Adanya kepekaan genetik, latar belakang imunologis abnormal dan hormonal, serta faktor lingkungan memegang peran sebagai pemicu perkembangan penyakit. Komplikasi kardiovaskular terjadi pada lebih dari setengah pasien dengan SLE. Perikarditis merupakan manifestasi kardiovaskular yang paling sering dijumpai, meskipun jarang ditemukan patognomonis secara klinis, dan termasuk dalam kriteria klasifikasi LES menurut American College of Rheumatology (ACR). Berikut kami laporkan kasus dengan presentasi klinis febris dan takikardia yang kemudian mengarah pada LES dengan komplikasi perikarditis akut. Kami sertakan juga ulasan tentang perikarditis akut, termasuk etiologi, presentasi klinis, kriteria EKG, manifestasi ekokardiografis, dan terapi

Healthcare Associated Covid-19 Transmission: Strategies to Prevent

Coronavirus disease 2019 (COVID-19) can cause another problem for healthcare facilities, which is nosocomial transmission. Clinicians performed nosocomial pneumonia prevention vigilantly during the COVID-19 pandemic. To date, the magnitude and risk factors for infection in healthcare environments are unknown in severe acute respiratory syndrome coronavirus 2 transmission. An overwhelming number of COVID-19 infections not only could paralyze the health system but could contribute, above all, to the occasional epidemic of hospital patients and the healthcare workers, along with elevated morbidity and mortality. The COVID-19 increasing case may limit the availability of occupancy rooms in hospitals, so doctors need tools to assess the likelihood of COVID-19 at the initial examination by triage based on epidemiological risks, routine investigations and bedside observation for safe isolation. The specific challenges of COVID-19 exist because this is a new disease with clinical, radiological, and laboratory features that can be variable We review nosocomial transmission of COVID-19. The data indicate that the prevalence of hospital-acquired COVID-19 infection varies. While reports regarding nosocomial transmission or healthcare-associated COVID-19 infection are still growing, several hospitals claim there were none or minimal nosocomial transmission. Infection prevention and control techniques were initially aimed at prompt patient identification, separation and monitoring in compliance with case descriptions. Engineering controls provide proper and efficient ventilation, likely augmented by filtration of pollutants and air disinfection, air recirculation protection, and overcrowding protection. Administrative assistance to reduce the risk of nosocomial severe acute respiratory syndrome coronavirus 2 is introduced with the reduction of choice healthcare services, decanting centers, deployment of isolation facilities, appropriate personal security facilities, coordination of the rapid molecular diagnostic laboratory network, constructive monitoring, and organization of the personnel forum and training. These principal strategies can suppress intra-hospital transmission of COVID-19 if strictly implemented during a pandemic era

Manajemen HIV/AIDS Terkini, Komprehensif, dan Multidisiplin

Penyakit infeksi HIV/AIDS merupakan salah satu masalah kesehatan yang terpenting di dunia termasuk di Indonesia pada khususnya. Perkembangan yang semakin pesat dalam pengetahuan dan riset mengenai penatalaksanaan HIV mengharuskan para tenaga medis maupun paramedis untuk mengikutinya. Majanemen infeksi HIV/AIDS yang terkini, komprehensif, dan multidisiplin penting untuk memperbaiki manajemen pasien dengan infeksi HIV/AIDS beserta masalah-masalah yang menyertainya. Atas dasar inilah, tim penyusun terdorong untuk menerbitkan buku ini

The potency of hematopoietic stem cells (hscs) and natural killer (nk) cells as a therapeutic of sars-cov-2 Indonesia isolates infection by viral inactivation (in vitro Study)

Background: The prevalence of COVID-19 cases in Indonesia as of June 9, 2020, has been confirmed 32.076 positive cases, with 1.923 death cases. The total number of deaths reached 92,941 cases. There has been a recent update on stem cell-based biological, medical therapy as an optional treatment to handling COVID-19 due to its potential viability besides using the prevalent conventional chemical drug therapy. Methods: In this study, in vitro research was conducted to determine the potential of hematopoietic stem cells (HSCs) and natural killer cells (NK cells) against SARS-CoV-2 viruses, which virus isolates were collected in Indonesia. The SARS-CoV-2 virus was planted in rat kidney cells and Vero cells. The cells that had been planted with the virus were given HSCs and NK cells, followed by being evaluated at intervals of 24, 48, and 72 hours. The evaluation was done by collecting cells and supernatant from the cell plate and then determining the viral load using a Polymerase Chain Reaction (PCR) machine. Results: The results showed that the addition of HSCs and NK on cells that had been infected by SARS-CoV-2 resulted in a decrease in viral load within 24 to 72 hours in all variations of Multiples of Infection (MoI) values. Conclusions: The administration of HSCs and NK cells has the potential to eliminate the SARS-CoV-2 virus. Although this study is only an in vitro study, it could be the basis for the development of alternative stem cell-based therapies to tackle COVID-19 cases

Optimal use of tocilizumab for severe and critical COVID-19: a systematic review and meta-analysis

Background: Several studies have revealed the potential use of tocilizumab in treating COVID-19 since no therapy has yet been approved for COVID-19 pneumonia. Tocilizumab may provide clinical benefits for cytokine release syndrome in COVID-19 patients. Methods: We searched for relevant studies in PubMed, Embase, Medline, and Cochrane published from March to October 2020 to evaluate optimal use and baseline criteria for administration of tocilizumab in severe and critically ill COVID-19 patients. Research involving patients with confirmed SARS-CoV-2 infection, treated with tocilizumab and compared with the standard of care (SOC) was included in this study. We conducted a systematic review to find data about the risks and benefits of tocilizumab and outcomes from different baseline criteria for administration of tocilizumab as a treatment for severe and critically ill COVID-19 patients. Results: A total of 26 studies, consisting of 23 retrospective studies, one prospective study, and two randomised controlled trials with 2112 patients enrolled in the tocilizumab group and 6160 patients in the SOC group, were included in this meta-analysis. Compared to the SOC, tocilizumab showed benefits for all-cause mortality events and a shorter time until death after first intervention but showed no difference in hospital length of stay. Upon subgroup analysis, tocilizumab showed fewer all-cause mortality events when CRP level ≥100 mg/L, P/F ratio 200-300 mmHg, and P/F ratio <200 mmHg. However, tocilizumab showed a longer length of stay when CRP <100 mg/L than the SOC. Conclusion: This meta-analysis demonstrated that tocilizumab has a positive effect on all-cause mortality. It should be cautiously administrated for optimal results and tailored to the patient's eligibility criteria

The clinical impact of bacterial co-infection among moderate, severe and critically ill COVID-19 patients in the second referral hospital in Surabaya [version 2; peer review: 2 approved]

Background: Data on the prevalence of bacterial co-infections among COVID-19 patients are limited, especially in our country, Indonesia. We aimed to assess the rate of bacterial co-infections in hospitalized COVID-19 patients and report the most common microorganisms involved and the antibiotic use in these patients. Methods: This study is a retrospective cohort study, among COVID-19 adult patients admitted to Universitas Airlangga Hospital Surabaya from 14 March-30 September 2020. The bacterial infection is defined based on clinical assessment, laboratory parameters, and microbiology results. Results: A total of 218 patients with moderate to critical illness and confirmed COVID-19 were included in this study. Bacterial infection was confirmed in 43 patients (19.7%). COVID-19 patients with bacterial infections had longer hospital length of stay (17.6 ± 6.62 vs 13.31±7.12), a higher proportion of respiratory failure, intensive care treatment, and ventilator use. COVID-19 patients with bacterial infection had a worse prognosis than those without bacterial infection (p<0.04). The empirical antibiotic was given to 75.2% of the patients. Gram-negative bacteria were commonly found as causative agents in this study (n = 39; 70.37%). Conclusion: COVID-19 patients with bacterial infection have a longer length of stay and worse outcomes. Healthcare-associated infections during intensive care treatment for COVID-19 patients must be carefully prevented

The Potency of Hematopoietic Stem Cells (HSCs) and Natural Killer (NK) Cells as A Therapeutic of SARS-CoV-2 Indonesia Isolates Infection by Viral Inactivation (In Vitro Study)

Background: The prevalence of COVID-19 cases in Indonesia as of June 9, 2020, has been confirmed 32.076 positive cases, with 1.923 death cases. The total number of deaths reached 92,941 cases. There has been a recent update on stem cell-based biological, medical therapy as an optional treatment to handling COVID-19 due to its potential viability besides using the prevalent conventional chemical drug therapy. Methods: In this study, in vitro research was conducted to determine the potential of hematopoietic stem cells (HSCs) and natural killer cells (NK cells) against SARS-CoV-2 viruses, which virus isolates were collected in Indonesia. The SARS-CoV-2 virus was planted in rat kidney cells and Vero cells. The cells that had been planted with the virus were given HSCs and NK cells, followed by being evaluated at intervals of 24, 48, and 72 hours. The evaluation was done by collecting cells and supernatant from the cell plate and then determining the viral load using a Polymerase Chain Reaction (PCR) machine. Results: The results showed that the addition of HSCs and NK on cells that had been infected by SARS-CoV-2 resulted in a decrease in viral load within 24 to 72 hours in all variations of Multiples of Infection (MoI) values. Conclusions: The administration of HSCs and NK cells has the potential to eliminate the SARS-CoV-2 virus. Although this study is only an in vitro study, it could be the basis for the development of alternative stem cell-based therapies to tackle COVID-19 cases

An in vitro study of dual drug combinations of anti-viral agents, antibiotics, and/or hydroxychloroquine against the SARS-CoV-2 virus isolated from hospitalized patients in Surabaya, Indonesia

A potent therapy for the infectious coronavirus disease COVID-19 is urgently required with, at the time of writing, research in this area still ongoing. This study aims to evaluate the in vitro anti-viral activities of combinations of certain commercially available drugs that have recently formed part of COVID-19 therapy. Dual combinatory drugs, namely; LopinavirRitonavir (LOPIRITO)-Clarithromycin (CLA), LOPIRITO-Azithromycin (AZI), LOPIRITODoxycycline (DOXY), Hydroxychloroquine (HCQ)-AZI, HCQ-DOXY, Favipiravir (FAVI)-AZI, HCQ-FAVI, and HCQ-LOPIRITO, were prepared. These drugs were mixed at specific ratios and evaluated for their safe use based on the cytotoxicity concentration (CC50) values of human umbilical cord mesenchymal stem cells. The anti-viral efficacy of these combinations in relation to Vero cells infected with SARS-CoV-2 virus isolated from a patient in Universitas Airlangga hospital, Surabaya, Indonesia and evaluated for IC50 24, 48, and 72 hours after viral inoculation was subsequently determined. Observation of the viral load in qRT-PCR was undertaken, the results of which indicated the absence of high levels of cytotoxicity in any samples and that dual combinatory drugs produced lower cytotoxicity than single drugs. In addition, these combinations demonstrated considerable effectiveness in reducing the copy number of the virus at 48 and 72 hours, while even at 24 hours, post-drug incubation resulted in low IC50 values. Most combination drugs reduced pro-inflammatory markers, i.e. IL-6 and TNF-α, while increasing the anti-inflammatory response of IL-10. According to these results, the descending order of effective dual combinatory drugs is one of LOPIRITO-AZI>LOPIRITO-DOXY>HCQ-AZI>HCQ FAVI>LOPIRITO-CLA>HCQ-DOX. It can be suggested that dual combinatory drugs, e.g. LOPIRITO-AZI, can potentially be used in the treatment of COVID-19 infectious diseases

A Randomized, Double-Blind, Multicenter Clinical Study Comparing the Efficacy and Safety of a Drug Combination of Lopinavir/Ritonavir-Azithromycin, Lopinavir/Ritonavir-Doxycycline, and Azithromycin-Hydroxychloroquine for Patients Diagnosed with Mild to Moderate COVID-19 Infections

At the present time, COVID-19 vaccines are at the testing stage, and an effective treatment for COVID-19 incorporating appropriate safety measures remains the most significant obstacle to be overcome. A strategic countermeasure is, therefore, urgently required. Aim. +is study aims to evaluate the efficacy and safety of a combination of lopinavir/ritonavirazithromycin, lopinavir/ritonavir-doxycycline, and azithromycin-hydroxychloroquine used to treat patients with mild to moderate COVID-19 infections. Setting and Design. +is study was conducted at four different clinical study sites in Indonesia. +e subjects gave informed consent for their participation and were confirmed as being COVID-19-positive by means of an RTPCR test. +e present study constituted a randomized, double-blind, and multicenter clinical study of patients diagnosed with mild to moderate COVID-19 infection. Materials and Methods. Six treatment groups participated in this study: a Control group Madministered with a 500 mg dose of azithromycin; Group A which received a 200/50 mg dose of lopinavir/ritonavir and 500 mg of azithromycin; Group B treated with a 200/50 mg dose of lopinavir/ritonavir and 200 mg of doxycycline; Group C administered with 200 mg of hydroxychloroquine and 500 mg of azithromycin; Group D which received a 400/100 mg dose of lopinavir/ritonavir and 500 mg of azithromycin; and Group E treated with a 400/100 mg dose of lopinavir/ritonavir and 200 mg of doxycycline. Results. 754 subjects participated in this study: 694 patients (92.4%) who presented mild symptoms and 57 patients (7.6%) classified as suffering from a moderate case of COVID-19. On the third day after treatment, 91.7%–99.2% of the subjects in Groups A–E were confirmed negative by a PCR swab test compared to 26.9% in the Control group. Observation of all groups which experienced a significant decrease in virus load between day 1 and day 7 was undertaken. Other markers, such as CRP and IL-6, were significantly lower in all treatment groups (p< 0.05 and p< 0.0001) than in the Control group. Furthermore, IL-10 and TNF-α levels were significantly elevated in all treatment groups (p< 0.0001). +e administration of azithromycin to the Control group increased CRP and IL-6 levels, while reduced IL-10 and TNF-α on day 7 (p< 0.0001) compared with day 1. Decreases in ALTand AST levels were observed in all groups (p< 0.0001). +ere was an increase in creatinine in the serum level of the Control, C, D, and E groups (p< 0.05), whereas the BUN level was elevated in all groups (p< 0.0001). Conclusions. +e study findings suggest that the administration of lopinavir/ritonavir-doxycycline, lopinavir/ritonavir-azithromycin, and azithromycinhydroxychloroquine as a dual drug combination produced a significantly rapid PCR conversion rate to negative in three-day treatment of mild to moderate COVID-19 cases. Further studies should involve observation of older patients with severe clinical symptoms in order to collate significant amounts of demographic data