ABSTRACT
Background & aims: Vitamin D supplementation as an immunomodulator has been identified as a potential strat-egy to prevent and treat Coronavirus disease 2019 (COVID-19). We aimed to analyze the effect of 10,000 IU vitamin D3 supplementation on 25(OH)D levels on primary clinical out-comes (conversion length), inflammatory markers (Total Lymphocyte Count (TLC), Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR)) and coagulation marker (D-Dimer) in moderate COVID-19 patients at Wahidin Sudirohusodo Hospital, Makassar, Indonesia.Methods: We conducted a single-blind randomized -con-trolled trial on the confirmed moderate COVID-19 patients above 18 years old and low vitamin D status. Each of inter-vention and control groups were supplemented of 10,000 IU and 1000 IU cholecalciferol that taken daily for 2 weeks. Levels of 25(OH)D were analyzed for the primary endpoint (conversion length), then correlated to secondary endpoints (Length of Stay (LOS)), clinical manifestations improvement, and markers TLC, NLR, PLR, and D-Dimer serum, handgrip strength (HGS) as functional capacity measurement, after ad-justed to age, sex, nutritional status based on body mass in- dex (BMI) and Subjective Global Assessment (SGA) tool, co -morbidities, and anti-coagulant administration. Medical nutri-tional therapy was given and presented as energy, protein, carbohydrate, and fat achievement, and vitamin D intake was also calculated.Results: A significant effects was found in 60 samples with pre-intervention vitamin D deficiency (61.7%) and insuffi-ciency (38.3%) status, and 10,000 IU of vitamin D3 supple-mentation could increase 25(OH)D levels within 2 weeks to reach sufficiency status (16.7%). The Vitamin D3 supplemen-tation of 10,000 IU and 1000 IU could significantly increase 25(OH)D levels compared to the control group of 1000 IU (4.61 +/- 5.43 vs.-0.29 +/- 2.72;P <0.0001) and it was correlated to primary clinical outcome, which is length of conversion (6.53 +/- 1.17 vs 10.47 +/- 2.56;P < 0.0001). The increase in HGS (6.61 +/- 3.01 vs. 4.04 +/- 4.44;P = 0.011), LOS (11.63 +/- 2.5 vs. 14.73 +/- 3.45;P = 0.001), and improvement in clinical mani-festations were found to be significant in both groups. We an-alyzed changes the effect of vitamin D supplementation in TLC, NLR, and D-Dimer as marker of coagulopathy associated COVID-19 on both groups that showed were not significant. Positive and significant correlation was only showed on PLR levels after intervention (r=0.368;P=0.045).Conclusion: Supplementation of vitamin D3 10,000 IU in moderate COVID-19 patients had a significant effect on 25(OH)D level, length of conversion, LOS, functional capacity, and PLR levels, but it has negative correlation in TLC, NLR, and D-Dimer levels.This study has been registered in the ClinicalTrial.gov data-base with the identification number NCT05126602.
ABSTRACT
Introduction: The study aimed was to analyze the decrease in BDNF gene levels in unit work, shift work, nutritional status, and stress levels of nurses during the Covid-19 pandemic. The number of patients confirmed by the Covid-19 virus receiving treatment at hospitals in Indonesia has increased significantly. This condition causes increased fatigue that can lead to higher stress on nurses. Low serum levels of brain-derived neurotrophic factor (BDNF) were found in workers with high-stress levels. This stress is triggered by several factors such as sleep disturbances, workload, and conflicts that occur in the workplace. Method: This research used an analytic observational method with a cross-sectional design during July-September 2020 at the Cempaka Putih Islamic Hospital Jakarta, in Central Jakarta, Indonesia. A sample of 89 nurses recruited by the purposive sampling technique who met the inclusion criteria obtained, namely not having a systemic disorder, not suffering from psychiatric disorders, not consuming alcohol, and not smoking. The data were collected using anthropometric measurements and intravenous blood collection to check BDNF gene mRNA expression using real-time PCR. Results: The results showed that the mean BDNF levels on respondents with low, medium, and high-stress levels were 11.68752, 8.65197, and 7.35583, respectively. There was a significant relationship between shift work (P-Value = 0.007) and stress levels (P-value = 0.000) of nurses and decreased BDNF gene's level during the Covid-19 pandemic. However, nutritional status was not significantly (P-Value = 0.163) related to BDNF gene's level.