ABSTRACT
BACKGROUND: Many studies identified the risk factors and prognostic factors related to in-hospital COVID-19 mortality using sophisticated laboratory tests. Cost and the availability of supporting blood tests may be problematic in resource-limited settings. This multicenter cohort study was conducted to assess the factors associated with mortality of COVID-19 patients aged 18 years and older, based on history taking, physical examination, and simple blood tests to be used in resource-limited settings. METHODS: The study was conducted between July 2020 and January 2021 in five COVID-19 referral hospitals in Indonesia. Among 1048 confirmed cases of COVID-19, 160 (15%) died during hospitalization. RESULTS: Multivariate analysis showed eight predictors of in-hospital mortality, namely increased age, chronic kidney disease, chronic obstructive pulmonary disease, fatigue, dyspnea, altered mental status, neutrophil-lymphocyte ratio (NLR) >= 5.8, and severe-critical condition. This scoring system had an Area-under-the-curve (AUC) of 84.7%. With cut-off score of 6, the sensitivity was 76.3% and the specificity was 78.2%. CONCLUSION: The result of this practical prognostic scoring system may be a guide to decision making of physicians and help in the education of family members related to the possible outcome.
ABSTRACT
Background and Aim: Gastroesophageal reflux disease (GERD) prevalence is increasing worldwide. Teaching is one of the most stressful professions. Stress can be a triggering factor and worsen the symptoms of GERD. The alteration of teaching methods is inevitable due to pandemic (COVID-19). Methods: This is a cross-sectional study, held in January to April 2021. This study were involving 100 teachers in Cipondoh, Kota Tangerang, whom selected by multistage cluster random sample method, and completing the questionnaire using google form application. The GerdQ questionnaire was used to diagnose GERD, while occupational stress assessed using the Teacher Stress Inventory (TSI). All possible risk factors were analysed. Results were analysed using bivariate analysis. Results: Seventy-six per cent of the subjects were male;most of them are 31-40 years old and have more than 5 years of experience in teaching. Most of the teachers are having a moderate occupational stress. The prevalence of GERD was 23%. The result of this study failed to indicate a significant correlation between occupational stress among the teachers and GERD. We found that the statistically significant risk factor of GERD is smoking (p = 0.037, OR = 11.4). Obesity, fat dietary, caffein and (stressful) life events were not significant risk factors of GERD. Conclusion: We didn't find any significant correlation between teacher stress and GERD. Taking into consideration the results of this study, it seems that teachers should be recommended to stop smoking.
ABSTRACT
Up to this point, the coronavirus disease 2019 (COVID-19) pandemic is still ongoing. Some studies with a large number of cases have reported its clinical manifestations, concluding that the disease is a great imitator. Patients may present with symptoms other than the main symptoms of respiratory tract infections, such as diarrhea, abdominal pain, nausea, or vomiting, which may sometimes cause a delayed treatment in managing COVID-19 patients. Reports of various hospitals have also demonstrated gastrointestinal complaints as a clinical manifestation in those patients. The patients may come with gastrointestinal symptoms as their early clinical manifestation, or the gastrointestinal symptoms may be found in hospitalized COVID-19 patients, which indeed can be explained since the SARS-CoV-2, an etiologic agent of COVID-19 infection, can obviously be found along the gastrointestinal tract. Hence, the virus can be found in fecal and anal, and therefore, rectal swabs can be used as a diagnostic tool for COVID-19 infection.
ABSTRACT
Coronavirus disease 19 (COVID-19) which is caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), has been a problem worldwide, particularly due to the high rate of transmission and wide range of clinical manifestations. Acute respiratory distress syndrome (ARDS) and multiorgan failure are the most common events observed in severe cases and can be fatal. Cytokine storm syndrome emerges as one of the possibilities for the development of ARDS and multiorgan failure in severe cases of COVID-19. This case report describes a case of a 53-year-old male patient who has been diagnosed with COVID-19. Further evaluation in this patient showed that there was a marked increase in IL-6 level in blood accompanied with hyperferritinemia, which was in accordance with the characteristic of cytokine storm syndrome. Patient was treated with tocilizumab, a monoclonal antibody and is an antagonist to IL-6 receptor. The binding between tocilizumab and IL-6 receptors effectively inhibit and manage cytokine storm syndrome. Although this case report reported the efficacy of tocilizumab in managing cytokine storm syndrome, tocilizumab has several adverse effects requiring close monitoring. Further clinical randomized control trial is required to evaluate the efficacy and safety of tocilizumab administration in participants with various clinical characteristics and greater number of subjects.