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.

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.

To reperfuse or not to reperfuse: a case report of Wellens' syndrome with suspected COVID-19 infection.

BACKGROUND: Wellens' syndrome is known to be associated with left anterior descending artery occlusion that could lead to an extensive anterior wall myocardial infarction. Thus, emergency cardiac catheterization is needed. However, during coronavirus disease 2019 (COVID-19) pandemic, it is recommended for hemodynamically stable acute coronary syndrome patients with COVID-19 infection to be treated conservatively in an isolated hospital ward. CASE PRESENTATION: We report an 85-year-old patient with chief complaints of typical, squeezing chest pain in the past 4 h. The patient had a high fever, dyspnea, sore throat, and fatigue for 3 days. He had previously come into contact with COVID-19 positive relatives. The patient was hemodynamically stable and pulmonary auscultation revealed coarse rales in the entire lung. Electrocardiography (ECG) evaluation during the pain episode showed non-specific ST-T changes in lead V2-V5. After sublingual nitrate was administered, ECG evaluation during the pain-free period revealed a biphasic T wave inversion in lead V2 and V3. Laboratory workup showed elevated cardiac marker and leucopenia with neutrophilia and lymphopenia. Rapid immunochromatographic test and initial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription-polymerase chain reaction (RT-PCR) evaluation from nasopharyngeal swab showed negative results. However, radiographic evaluations suggest the diagnosis of COVID-19 infection. While waiting for the second RT-PCR evaluation, the patient was diagnosed with Wellens' syndrome with suspected COVID-19 infection. The patient was treated conservatively according to national guidelines and scheduled for elective cardiac catheterization. On the third day, the patient felt better and insisted on being discharged home. Ten days after discharged, the patient died of myocardial infarction. CONCLUSION: Emergency cardiac catheterization should be done for patient with Wellens' syndrome, regardless of the COVID-19 infection status.

Prevalence of and risk factors for depression, anxiety, and stress in non-hospitalized asymptomatic and mild COVID-19 patients in East Java province, Indonesia.

BACKGROUND: Despite abundant data on mental health during the COVID-19 pandemic, 3 important knowledge gaps continue to exist, i.e., 1) studies from low-/middle income countries (LMICs); 2) studies in the later period of the COVID-19 pandemic; and 3) studies on non-hospitalized asymptomatic and mild COVID-19 patients. To address the knowledge gaps, we assessed the prevalence of and the risk factors for mental health symptoms among non-hospitalized asymptomatic and mild COVID-19 patients in one LMIC (Indonesia) during the later period of the pandemic. METHODS: This cross-sectional study was conducted in September 2020 in East Java province, Indonesia. Study population consisted of non-hospitalized asymptomatic and mild COVID-19 patients who were diagnosed based on reverse transcriptase-polymerase chain reaction results from nasopharyngeal swab. Mental health symptoms were evaluated using the Depression Anxiety Stress Scale-21. RESULTS: From 778 non-hospitalized asymptomatic and mild COVID-19 patients, 608 patients were included in the analysis. Patients' median age was 35 years old and 61.2% were male. Of these, 22 (3.6%) reported symptoms of depression, 87 (14.3%) reported symptoms of anxiety, and 48 (7.9%) reported symptoms of stress. Multivariate logistic regression analysis showed that females were more likely to report symptoms of stress (adjusted odds ratio (aOR) = 1.98, p-value = 0.028); healthcare workers were more likely to report symptoms of depression and anxiety (aOR = 5.57, p-value = 0.002 and aOR = 2.92, p-value = 0.014, respectively); and those with a recent history of self-quarantine were more likely to report symptoms of depression and stress (aOR 5.18, p = 0.004 and aOR = 1.86, p = 0.047, respectively). CONCLUSION: The reported prevalence of mental health symptoms, especially depression, was relatively low among non-hospitalized asymptomatic and mild COVID-19 patients during the later period of the COVID-19 pandemic in East Java province, Indonesia. In addition, several risk factors have been identified.

Recurrent keratoconjunctivitis as the sole manifestation of COVID-19 infection: A case report.

INTRODUCTION: Ocular symptoms are uncommon manifestations of coronavirus disease 2019 (COVID-19) infection. Earlier study reported that dry eye, blurred vision, foreign body sensation, tearing, itching, conjunctival secretion, conjunctival congestion, ocular pain, and photophobia are among the ocular symptoms that could be found in COVID-19 patients. However, there are only a few reports available regarding corneal involvement in this disease. Here we report a case of keratoconjunctivitis as the only symptom of COVID-19 infection. CASE DESCRIPTION: A 27-year-old man who worked as an obstetrics and gynecology resident came to the outpatient clinic with the chief complaints of eye discomfort, foreign body sensation, conjunctival hyperemia, lacrimation, and photophobia in his right eye for the past 3 weeks. Fluorescence test showed a small corneal lesion. The patient was then diagnosed with keratoconjunctivitis. A week after the treatment, all symptoms were resolved. A month later, the patient came to the emergency room with the same eye complaints but with a more severe pain. The fluorescence test showed wider corneal lesion compared to last month. The result from the corneal swab is negative for bacterial or fungal infection, indicating a viral infection. Afterwards, reverse transcriptase polymerase chain reaction test from nasopharyngeal swab was performed and revealed that the patient was positive for COVID-19. CONCLUSIONS: This case report showed that keratoconjunctivitis may occur as the only manifestation of COVID-19 infection. Thus, patient presented with unexplainable eye symptoms should be evaluated for COVID-19 infection.