Clinical and treatment factors associated with the mortality of COVID-19 patients admitted to a referral hospital in Indonesia.

Background: Indonesia had the second-highest number of COVID-19 cases and deaths in South-East Asia. We aimed to determine the factors associated with this mortality and the effect of the recommended COVID-19 treatment regimen during the first 10 months of the epidemic. Methods: This was a retrospective cohort study using secondary data from medical records. In total, 689 adult COVID-19 inpatients hospitalized between March and December 2020 were enrolled. Clinical characteristics, laboratory parameters, and treatments were analyzed by survival outcome. Kaplan-Meier statistics were used to estimate survival. Findings: Of the 689 patients enrolled, 103 (14.9%) died. Disease severity was highly associated with mortality (hazard ratio [HR]: 7.69, p < 0.001). Other clinical factors associated with mortality were older age and comorbidities. Based on laboratory parameters, higher procalcitonin and C-reactive protein contents and a neutrophil-to-lymphocyte ratio >3.53 were also linked to mortality. Favipiravir was associated with lower mortality, with adjusted HRs of 0.24 (0.11-0.54) and 0.40 (0.17-0.98) among the mild/moderate and severe cases, respectively. Among patients with severe disease, steroids showed some beneficial effects in the early days of hospitalization. Interpretation: Older age and comorbidities were associated with disease severity and, consequently, higher mortality. Higher mortality after the second week of hospitalization may be related to secondary bacterial infection. Favipiravir showed significant benefit for COVID-19 survival, while steroids showed benefit only in the early days of admission among patients with severe disease. Funding: This research did not receive a specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Knowledge, attitude, and practice of undergraduate medical students in Indonesia on the COVID-19 prevention.

BACKGROUND: Coronavirus Disease 2019 (COVID-19) caused a global pandemic since March 2020. Undergraduate medical students were encouraged to educate Indonesian society about COVID-19. This study aimed to evaluate the knowledge, attitude, and practice of Indonesian students on COVID-19 prevention. METHODS: An online cross-sectional study was conducted online between August 22 and September 2, 2020, with a minimum sample size of 1,068 subjects. The questionnaire was sent to 86 Faculty of Medicine (FoM) in Indonesia. The questionnaire consisted of knowledge, attitude, and practice section, with the scores above median were considered as sufficient knowledge, positive attitude, and positive practice. Association between knowledge, attitude, and practice, which were dependent variables, with gender, year of study, location of FoM, and source of information, which were independent variables, were tested using Chi-Square Test. Correlation among knowledge, attitude, and practice scores was tested using Spearman Rank Test. RESULTS: Among 1,390 participated students, 51.4, 55.7, and 56.3% had sufficient knowledge, positive attitude, and, positive practice, respectively. There were associations between knowledge and gender (p = 0.005), year of study (p = 0.000), location of FoM (p=0.000), and source of information (p = 0.000); between attitude and gender (p = 0.022), year of study (p = 0.004), and source of information (p = 0.015); and between practice and gender (p = 0.000) and source of information (p = 0.000). There were weak correlations between knowledge and attitude (r = 0.246, p<0.001); and between attitude and practice (r = 0.272, p < 0.001). CONCLUSIONS: Half of Indonesian medical students showed sufficient knowledge, positive attitude, and positive practice on COVID-19 prevention. Hence, improvement towards COVID-19 prevention is required.

Effect of increased BMI and obesity on the outcome of COVID-19 adult patients: A systematic review and meta-analysis.

BACKGROUND AND AIMS: Corona virus diseases 2019 (COVID-19) pandemic spread rapidly. Growing evidences that overweight and obesity which extent nearly a third of the world population were associated with severe COVID-19. This study aimed to explore the association and risk of increased BMI and obesity with composite poor outcome in COVID-19 adult patients. METHODS: We conducted a systematic literature search from PubMed and Embase database. We included all original research articles in COVID-19 adult patients and obesity based on classification of Body Mass Index (BMI) and composite poor outcome which consist of ICU admission, ARDS, severe COVID-19, use of mechanical ventilation, hospital admission, and mortality. RESULTS: Sixteen studies were included in meta-analysis with 9 studies presented BMI as continuous outcome and 10 studies presented BMI as dichotomous outcome (cut-off ≥30 kg/m2). COVID-19 patients with composite poor outcome had higher BMI with mean difference 1.12 (95% CI, 0.67-1.57, P < 0.001). Meanwhile, obesity was associated with composite poor outcome with odds ratio (OR) = 1.78 (95% CI, 1.25-2.54, P < 0.001) Multivariate meta-regression showed the association between BMI and obesity on composite poor outcome were affected by age, gender, DM type 2, and hypertension. CONCLUSION: Obesity is a risk factor of composite poor outcome of COVID-19. On the other hand, COVID-19 patients with composite poor outcome have higher BMI. BMI is an important routine procedure that should always be assessed in the management of COVID-19 patients and special attention should be given to patients with obesity.

Report of Two COVID-19 ARDS (CARDS) Cases Who Survived without Intubation and Mechanical Ventilation.

The most severe clinical feature of COVID-19 is Acute Respiratory Distress Syndrome (ARDS) which requires intubation and mechanical ventilation and it occurs in approximately 2.3% of cases. About 94% of of these cases end in death. This case series report two confirmed COVID-19 patients who had met criteria of intubation and mechanical ventilation, but not performed to them. Both patients experienced clinical improvement and recovery. Probably this is due to differences of COVID-19 ARDS (CARDS) with typical or classic ARDS.  CARDS is divided into two phenotypes of type L (Low Elastance) and type H (High Elastance). These different phenotypic also distinguish subsequent pathophysiology and clinical management. These phenotype can be differentiate by chest CT scan. This case series emphasizes the importance of understanding this phenotype so that clinicians can provide more appropriate treatment management and also availability of CT scans in health facilities that manage COVID -19.