Hematological and Biochemical Parameters at Admission as Predictors for Mortality in Patients with Moderate to Severe COVID-19

BACKGROUND: Timely diagnosis and effective use of available resources are urgent to avoid the loss of time, medical, and technological resources, particularly in COVID-19 pandemic. This study aimed to identify the most dominant predicting factor for mortality in moderate-severe COVID-19 patients.METHODS: This retrospective cohort study included a total of 253 patients diagnosed with moderate-severe COVID-19. The primary outcome measure was mortality during hospitalization. The receiver operating characteristic (ROC) curve was used to determine cut-off points. The data were categorized according to the cut-off points in ROC curve and analyzed using Chi-square and by binary logistic regression test to identify the independent predictors associated with mortality.RESULTS: The mean number of leukocytes (/mu L), neutrophils (%), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), C-reactive protein (CRP, mg/L), and D-dimer (mg/L) in the non-survived group was significantly higher than those of the survived group. Meanwhile, the mean number of platelet count/mu L, absolute lymphocyte count (ALC), in the non-survived group was significantly lower than those of the survived group. CRP level predicted mortality with a cut-off point of >= 8.41 mg/L, sensitivity of 98.1%, and specificity of 72.0% (P = .000).CONCLUSIONS: High leukocyte count, low platelet count, high NLR, high CRP level, and high D-dimer on admission predicted mortality of COVID-19 patients. In addition, CRP was found to be the most dominant predicting factor of mortality in moderate-severe COVID-19 patients.

Dendritic cell-based COVID-19 vaccines: A mini review

Immunotherapy is the latest approach that could offer potential treatments to help fight the 2019 coronavirus disease (COVID-19). This approach can be achieved by several strategies, including dendritic cell-based vaccine therapy. The method of using dendritic cells aims to build a person's immunity against the SARS-CoV-2 virus (the virus that causes COVID-19). In theory, this vaccine works by taking dendritic cells from a person. These cells are then introduced to the antigen of the SARS-COV-2 virus in the laboratory, then injected back into the body in the hope that the dendritic cells that have recognized the virus will trigger an immune response. Several clinical trials are being conducted using the dendritic cell-based vaccine therapy, one of the vaccine candidates known to use a dendritic cell platform developed in Indonesia. The WHO-registered dendritic cell-based COVID-19 vaccine from Indonesia was carried out by AIVITA Biomedical, the Health Research and Development Agency, and the Indonesian Ministry of Health. This article discussed how approved vaccines can trigger innate immunity to enhance long-lasting immunological memory and consider future implications for protecting populations with this vaccine.

Complications and specific considerations in managing newly diagnosed DKA with COVID-19;Challenges in managing DKA with COVID-19 infection

Introduction: New cases of type 1 diabetes (T1D) remain commonly found in Indonesia. One of the most typical presenting symptoms is diabetic ketoacidosis (DKA);approximately 71% of all cases. There has been several reports of the negative association between type 2 diabetes (T2D) and Coronavirus disease (COVID-19) cases in adults, but T1D and COVID-19 cases in children are still scantily studied. Mortality of COVID-19 pediatric case could reach higher than 50% in children below 5 years old. Objectives: Early detection and prompt treatment for DKA, T1D and COVID-19 should be emphasized. Methods: This case described new-onset T1D presented with DKA and severe COVID-19 infection. Results: 7-year-old boy was presented with altered consciousness, epigastric pain, dehydration, dyspnea, history of nocturnal enuresis, polydipsia, and polyphagia. Random blood glucose (BG) was 516 mg/dL, blood ketone 5.2 mmol/L, A1c 15%, pH 6.932, pCO2 16 mmHg, pO2 153.8 mmHg, base excess-26.5 mmol/L, HCO3 3.4 mmol/L, and positive polymerase chain reaction COVID-19 with E gene Cq of 30.66. The patient was treated in isolation PICU as severe DKA with hypovolemic shock and confirmed COVID-19 case;received fluid resuscitation, intravenous insulin with saline and dextrose infusion and remdesivir. The patient had recurring hyponatremia, hyperkalemia, hypophosphatemia, increased coagulation markers, and had catecholamine-resistant shock, and received hydrocortisone from 2 mg/kg/day and subsequently titrated. The patient regained consciousness on the 2nd day of admission, and were stable on the 5th day of admission. The patient's condition improved on day 6 of admission and insulin and hydrocortisone were weaned. COVID-19 PCR test yielded negative result on day 9 of admission. Conclusions: The COVID-19 pandemic presents additional unwanted complications in both clinical and non-clinical aspects of DKA and T1D management. Special considerations should be highlighted considering the comorbidities and medications given in addition to the treatment for DKA.

The effect of the counseling application on the exercise awareness of pregnant women in the COVID-19 pandemic

As a midwife, it is essential to provide information on pregnant women's health problems, including exercise for pregnant women. Providing the information aims that pregnant women will continue to do light movements at home (sports) and the COVID-19 pandemic.This pandemic problem currently happening around the world results in limited outdoor activities for pregnant women. Therefore, we created an application,"Tanya Bidan," addressed to pregnant women. By downloading this Android application, they can see material or videos such as balanced nutrition material for pregnant women, exercise material for pregnant women, the material on breastfeeding techniques for postpartum mothers, and material on implant contraceptive methods on couples of childbearing age. Methods: This type of research was quasi-experimental (one group pre-test and post-test design). This study's sample was 72 pregnant women whose gestation age was 24-42 weeks in the Padongko Community Health Center's work area, conducted from June-February 2021. Pre-test and post-test using a questionnaire on pregnant women's exercise knowledge were used to collect the data. The Wilcoxon test was applied for data analyses.Result: Statistically, the pretest data gained a mean value of 1.01, with a minimum value of 1 and a maximum of 2. At the post-test, the mean value was 2.46, with a minimum of 2 and a maximum of 3. Based on the Wilcoxon test, the a-symp sigh (2 tailed) had a value of 0.000 <0.05.It showsan increase in exercise knowledge during the pre-test and post-test with the "Tanya Bidan" application.Conclusion:The usage of "Tanya Bidan" can effectively increase the knowledge of pregnant women's exercise in the COVID-19 era. © 2021 Turkish Physiotherapy Association. All rights reserved.