Problems and Strategies of Blood Transfusion in Thalassemia during Covid-19 Pandemic in Indonesia

Transfusion-dependent thalassemia is the most severe form of thalassemia in which patients require a regular blood transfusion to maintain their haemoglobin level. COVID-19 pandemic has disrupted the routine measure in controlling chronic diseases like thalassemia. This study aims to measure the difference in pre-transfusion haemoglobin level and frequency of transfusion before and during pandemics. This retrospective cross-sectional study utilized medical records data of 101 transfusion-dependent thalassemia (TDT) patients treated in Cipto Mangunkusumo Hospital (CMH) from 2019-2021. The dependent variables of this study were pre-transfusion haemoglobin level and transfusion attendance. The pre-pandemic phase was defined from March 30, 2019, to March 29, 2020, whereas the during-pandemic phase was from March 30, 2020, to March 29, 2021. Up to 59.4% of subjects had suboptimal Hb level of < 9.0 g/dL even before the pandemic and it increased to 71.3% during a pandemic. Transfusion frequency of pre-pandemic and during-pandemic phases showed no significant difference (p-value = 0.990). The mean pre-transfusion haemoglobin level before the pandemic was 8.71 g/dL and it decreased to 8.46 g/dL (p-value <0.001). Our study showed poorer control of pre-transfusion Hb levels during the pandemic and decreased transfusion frequency. This puts them at a higher risk of developing many longterm complications.

Mental Wellbeing among Children with Cancer during COVID-19 Pandemic in Indonesia: A Cross-sectional Study

Introduction Coronavirus disease 2019 (COVID-19) has affected both physical and mental aspect of people worldwide, especially the high-risk group such as pediatric cancer patients. Children with cancer were considered both clinically and mentally vulnerable during this pandemic. They were also affected by the self- isolation, quarantine, and social distancing policy taken as a respond to public threat. Objectives To evaluate the impact of social distancing and health protocol during COVID-19 on the mental health profile of children with cancer in Indonesia. Methods A cross-sectional study evaluating the mental health of children with cancer during COVID-19 pandemic was conducted in Cipto Mangunkusumo Hospital, Jakarta, Indonesia from June to September 2020. An online questionnaire was used to collect demographics of parents and children, children's Strength and Difficulties Questionnaire ( SDQ) score, and parents' Self-Reporting Questionnaire (SRQ). SDQ score consists of five subscales, including the emotional symptoms, conduct problems, hyperactivity, peer relationships problems and prosocial behavior. Cancer types were grouped into retinoblastoma, nonretinoblastoma (other solid tumors), and leukemia. Results There were 156 valid responses, consisting of 42 patients with retinoblastoma, 34 patients with nonretinoblastoma ( other solid tumors), and 80 patients with leukemia. Pandemic-related lifestyle changes did not significantly impact emotional or behavioral problems. Children with normal total SDQ (odds ratio [OR]: 473, p = 0.001) and emotional scores (OR: 3.19, p = 0.07) had parents with normal SRQ scores (<6). Leukemia patients with shorter diagnosis period had worse hyperactivity score ( p = 0.01). On the contrary, leukemia inpatients had better prosocial scores than outpatients (p = 0.03). More bilateral retinoblastoma patients (p = 0.04) with longer duration of cancer diagnosis (p = 0.03) faced peer problems.

Management of covid-19 during pregnancy and the postpartum period

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19). The course of COVID-19 in pregnant women, which continues to spread rapidly worldwide, on which many studies and researches are ongoing and has many unknowns, is also controversial. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Neurological Symptoms Common in Covid-19 Patients: A Retrospective Observational Study

In December 2019, a novel coronavirus outbreak spread rapidly all over the world. The virus is known to be neuroinvasive, but much is still unknown. In this study, we aimed to pres-ent the main neurologic symptoms in patients who were diagnosed with coronavirus disease 2019 (COVID-19). The study was conducted retrospectively by phoning 156 patients in Turkey diagnosed with COVID-19 through real-time polymerase chain reaction;only 100 patients could be reached. Data about their demographics, initial symptoms, neurological symptoms, and sleeping habits were collected. During the disease process, 66% had at least one neurological symptom, 55% had central nervous system symptoms, 42% had peripheral nervous system symptoms, and 64% had sleep disturbances and myalgia. Impaired consciousness, smell and taste impairments, and sleep disturbances were significantly higher in patients with positive chest computed tomography imaging (p < 0.05). Neurological symptoms were observed in COVID-19, as in other coronaviruses. Headache in particular was the most common symptom in our population. In patients with respiratory system findings, the detec-tion of certain neurological symptoms such as smell-taste impairments, impaired consciousness, and sleep disorders were more common. We concluded that COVID-19 patients should be approached in a more holistic way, taking the nervous system into account.Copyright © 2022, Dr. Mladen Stojanovic University Hospital. All rights reserved.

Pathogenesis and Management of COVID-19.

COVID-19, occurring due to SARS-COV-2 infection, is the most recent pandemic disease that has led to three million deaths at the time of writing. A great deal of effort has been directed towards altering the virus trajectory and/or managing the interactions of the virus with its subsequent targets in the human body; these interactions can lead to a chain reaction-like state manifested by a cytokine storm and progress to multiple organ failure. During cytokine storms the ratio of pro-inflammatory to anti-inflammatory mediators is generally increased, which contributes to the instigation of hyper-inflammation and confers advantages to the virus. Because cytokine expression patterns fluctuate from one person to another and even within the same person from one time to another, we suggest a road map of COVID-19 management using an individual approach instead of focusing on the blockbuster process (one treatment for most people, if not all). Here, we highlight the biology of the virus, study the interaction between the virus and humans, and present potential pharmacological and non-pharmacological modulators that might contribute to the global war against SARS-COV-2. We suggest an algorithmic roadmap to manage COVID-19.

Seroprevalence of community-acquired atypical bacterial pneumonia among adult COVID-19 patients from a single center in Al Madinah Al Munawarah, Saudi Arabia: A retrospective cohort study.

OBJECTIVES: To investigate the seroprevalence of the community-acquired bacterial that causes atypical pneumonia among confirmed severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) patients. METHODS: In this cohort study, we retrospectively investigated the seroprevalence of Chlamydia pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila among randomly selected 189 confirmed COVID-19 patients at their time of hospital presentation via commercial immunoglobulin M (IgM) antibodies against these bacteria. We also carried out quantitative measurements of procalcitonin in patients' serum. RESULTS: The seropositivity for L. pneumophila was 12.6%, with significant distribution among patientsolder than 50 years (χ2 test, p=0.009), while those of M. pneumoniae was 6.3% and C. pneumoniae was 2.1%, indicating an overall co-infection rate of 21% among COVID-19 patients. No significant difference (χ2 test, p=0.628) in the distribution of bacterial co-infections existed between male and female patients. Procalcitonin positivity was confirmed amongst 5% of co-infected patients. CONCLUSION: Our study documented the seroprevalence of community-acquired bacteria co-infection among COVID-19 patients. In this study, procalcitonin was an inconclusive biomarker for non-severe bacterial co-infections among COVID-19 patients. Consideration and proper detection of community-acquired bacterial co-infection may minimize misdiagnosis during the current pandemic and positively reflect disease management and prognosis.

In Silico Screening of Bioactive Compounds from Syzygium cumini L. and Moringa oleifera L. Against SARS-CoV-2 via Tetra Inhibitors

The global pandemic of COVID-19 has caused disastrous consequences for both humans and the economy. The purpose of this study was to determine the potential of juwet (Syzygium cumini L.) and moringa (Moringa oleifera L.) as inhibitors of RBD spike, helicase, Mpro, and RdRp activity of SARS-CoV-2 with an in-silico approach. Samples were obtained from PubChem and RSCB PDB databases. The drug similarity analysis was determined using Swiss ADME and the Lipinski rule of five. Prediction of antivirus probabilities is carried out with PASS Online. Molecular screening is performed by molecular docking using PyRx. Visualization was used using PyMol and Discovery Studio. The bioactive compounds with the best antiviral potential had the lowest affinity bonds to the target proteins against RBD spike, helicase, Mpro, and RdRp of SARS-CoV-2. Results show that ellagic acid from java plum and myricetin from moringa have the best potential as potential antivirals. However, more research is required to validate the results of these computational predictions.

Association of hematological indices with neurological symptoms in COVID 19 patients

Purpose: The aim of this study was to compare the neurological involvement in Coronavirus 19 (COVID-19) patients with laboratory findings with these cost-free, practical tests. Materials and Methods: Of the 170 patients diagnosed COVID-19, 103 patients could be reached by phone, and neurological symptoms were recorded as three categories. Laboratory tests of the patients and 103 controls whose real-time polymerase chain reaction (RT-PCR) test negative without any chronic disease history and drug use were obtained from the hospital software. Results: White blood cell, neutrophil, lymphocyte, eosinophil, basophil, platelet were lower, monocyte to lymphocyte ratio and platelet to lymphocyte ratio higher in patients than controls. In the group with central nervous system findings, red blood cell and hematocrit counts, in the group with peripheral nervous system findings, lymphocyte and platelet counts and with sleep disturbances and muscle pain group eosinophil counts were lower in patients than those without. Conclusion: COVID-19 patients with neurological symptoms have some hematological abnormalities. The presence of certain hematological findings may be a clue to the emergence of neurological symptoms, and early detection and correction of these hematological abnormalities may be the solution to prevent the development of neurological symptoms in COVID-19.

Low prevalence of community-acquired influenza coinfections among COVID-19 patients in Al-Madinah, Saudi Arabia: A retrospective cohort study.

BACKGROUND: Coinfections with respiratory viruses among SARS CoV-2 patients have been reported by several studies during the current COVID-19 pandemic. Most of these studies designated these coinfections as being hospital-acquired infections; however, there is inadequate knowledge about community-acquired respiratory coinfections among SARS CoV-2 patients. METHODS: In this retrospective cohort study, we investigated the seroprevalence of influenza A, influenza B, and parainfluenza-2 among newly hospitalized patients with confirmed COVID-19 infections (n = 163). The study was conducted during the early phase of the COVID-19 pandemic in Saudi Arabia (from April to October 2020). The patients' serum samples were subjected to commercial immunoglobulin M (IgM) antibody tests against the three aforementioned viruses. RESULTS: Seropositivity for influenza A and B and parainfluenza-2 occurred only in 4.2% (7/163) of COVID-19 patients, indicating simultaneous acute infections of these three viruses with SARS CoV-2 infection. All coinfection cases were mild and misdiagnosed during the care period in the hospital. CONCLUSION: This study highlights the low prevalence of community-acquired respiratory infections among COVID-19 patients in the current pandemic and we discussed the possible factors for this finding. During newly emerging epidemics or pandemics, considering other respiratory viruses circulating in the community is essential to avoid their misdiagnosis and account for their possible negative effects on pandemic disease management and prognosis.

Vitamin D Profile and Disease Activity of Juvenile Idiopathic Arthritis (JIA) During Pandemic Covid-19

Vitamin D (25-Hydroxyvitamin D3 [25(OH)D3]) has an important role in the immune system. This study aimed to assess the relationship between 25-Hydroxyvitamin D3 and disease activity in Indonesian children with Juvenile Idiopathic Arthritis (JIA) during pandemic Covid-19. A 12-week randomized control trial was undertaken at Saiful Anwar Hospital between June and September 2021. JIA patients are divided into two groups. The control group (CG), without supplementation, and the treatment group (TG) got a high dose of oral cholecalciferol 2000 IU/day. Serum levels of 25(OH)D3 were measured using an enzyme-linked immunosorbent assay (ELISA). Comparison between serum 25(OH)D3 levels and JIA subtypes, peripheral blood Creactive protein (CRP), erythrocyte sedimentation rate (ESR), and Juvenile Arthritis Disease Activity Score (JADAS-27 Score) were analyzed using SPSS. There was a significant increase in serum 25(OH)D3 levels in treatment group (mean: 27.38 ± 6.39 ng/ml vs 42.26 ± 10.95 ng/ml;P=0.000). The JADAS-27 score significantly decrease in treatment group (14.60 ± 4.04 vs 6.24 ± 1.96;p= 0.000). Serum 25(OH)D3 showed a significant correlation with the JADAS-27 score. The levels of 25(OH)D3 are significantly decreased in children with JIA. Decreased 25(OH)D3 levels may be associated with the etiopathogenesis of JIA. Vitamin D levels have correlations with disease activity. Adjunctive treatment of cholecalciferol improves the disease activity in JIA patients. © 2022, Brawijaya University. All rights reserved.

An Elderly COVID-19 Patient with Community-Acquired Legionella and Mycoplasma Coinfections: A Rare Case Report.

The combination of severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) infection and other respiratory pathogens is a real challenge for health care systems in terms of diagnosis, treatment, and management. Most of the reported bacterial coinfections among SARS-CoV-2 patients are hospital-acquired infections that occurred after several days of hospitalization. Little is known about the incidence of community-acquired atypical bacterial coinfections with SARS-CoV-2. In this work, we report on a rare case of an elderly SARS-CoV-2 patient with underdiagnosed bacterial coinfections who received care in the medical ward for 23 days then was discharged home. Retrospective serological investigation revealed positivity for Legionella pneumophila and Mycoplasma pneumoniae, indicating double community-acquired atypical bacterial coinfections that were in agreement with clinical manifestations that patients showed at his admission to the hospital. Screening for possible community-acquired respiratory co-pathogens among elderly SARS-CoV-2 patients is critical for effective treatment and management.

COVID-19 with underdiagnosed influenza B and parainfluenza-2 co-infections in Saudi Arabia: Two case reports.

The emerging of the COVID-19 pandemic is currently challenging for the public health system globally. Beyond SARS-CoV-2 pathogenicity, co-infections with recycling respiratory pathogens, whether bacterial, viral, or fungal, might increase disease symptoms, morbidity, and mortality. In this study, we reported two COVID-19 cases in the early phase of the virus spread in Saudi Arabia with underdiagnosed respiratory viruses' co-infections, influenza B and Parainfluenza-2, detected retrospectively. Fortunately, both patients recovered and were discharged home. Underestimation of co-infection among COVID19 patients might lead to hospital stay prolongation and increases morbidity and mortality. Therefore, it is crucial to consider and screen for co-infecting pathogens among COVID-19 patients and those with risk factors.

Serum microRNA signature is capable of predictive and prognostic factor for SARS-COV-2 virulence

Objectives: Coronavirus disease 2019 (COVID-19) is a kind of viral pneumonia which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). MicroRNAs (miRNA) are small non-coding RNAs consisting of 19-25 nucleotides and play a role in post-transcriptional gene regulation. We have focused on serum expression levels of microRNA (miRNA) a novel concept of in host-virus interactions. MicroRNA expression profiles were investigated in serum samples of COVID-19 patients. Materials and methods: The samples were collected from 40 patients diagnosed with COVID-19 patients and from 10 healthy controls. Expression profile of 20 miRNAs were examined using a quantitative real-time polymerase chain reaction (qPCR). Results: Statistically significant expression level differences (p < 0.05) were detected in nine miRNAs in COVID-19 patients and healthy controls. 7 miRNAs (hsa-let-7d, hsa-miR-17, hsa-miR-34b, hsa-miR-93, hsa-miR-200b, hsa-miR-200c, hsa-miR-223) expression levels were found to be significantly decreased and the expression levels of 2 miRNAs (hsa-miR-190a and hsa-miR-203) significantly increased respect to healthy controls. Conclusions: We expect that a miRNA profile can be beneficial for the diagnosis of the COVID-19. Our result revealed that the increase in hsa-miR-190a level may be a prognostic factor related to the COVID-19 disease.

Of mitochondrion and COVID-19.

COVID-19, a pandemic disease caused by a viral infection, is associated with a high mortality rate. Most of the signs and symptoms, e.g. cytokine storm, electrolytes imbalances, thromboembolism, etc., are related to mitochondrial dysfunction. Therefore, targeting mitochondrion will represent a more rational treatment of COVID-19. The current work outlines how COVID-19's signs and symptoms are related to the mitochondrion. Proper understanding of the underlying causes might enhance the opportunity to treat COVID-19.

Evaluation of the Behavior, Anxiety and Stress of University Students in the New Type of Coronavirus Pandemic

Objective: Acute respiratory disease called COVID-19 caused by SARS- CoV-2 caused a pandemic affecting the whole world. Our aim in this study is to evaluate the cleaning behaviors and social behaviors, anxiety and stress situations of university students caused by COVID-19 pandemic. Methods: At the beginning of Covid-19 pandemic;university students were asked questions about their socio- demographic characteristics, their cleaning and social habits, and their level of stress about being infected for themselves and their family members and also a questionnaire was applied which includes a generalized anxiety disorder scale to measure anxiety levels and Impact of Events Scale (IES) to assessing traumatic stress symptoms. Results: It was observed that hand washing behavior increased in 62.4% of 463 participants. The mean of the students' generalized anxiety score was determined as 3.86 +/- 4.86 and 17.5% (n = 81) of all students had high anxiety. The mean scores of the impact of event scale were 14.23 +/- 10.9 and stress points average was found as 5.57 +/- 2.9. Students' stress and anxiety affect their cleaning and social behaviors. In addition, when compared between student groups, anxiety, stress, and the IES and subscales were found to be significantly higher in female students and also in students of faculties other than medical students. Conclusions: The state of anxiety and stress caused by pandemics affecting the whole world on people affects society and human behavior. At the beginning of the Covid 19 pandemic, an increase is observed in university students, especially in handwashing. In addition, other student groups other than medical students and female students are more affected by anxiety, stress and events.

Knowledge of coronavirus disease 2019 (COVID-19) among healthcare providers: a cross-sectional study in Indonesia

Objective: To assess healthcare workers' knowledge of novel coronavirus disease 2019 (COVID-19) in the early phase of the outbreak in Indonesia.