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Medica Hospitalia

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Published by RSUP Dr. Kariadi Semarang

ISSN : 23014369 EISSN : 26857898 DOI : https://doi.org/10.36408/mhjcm

Core Subject : Health,

Dentistry Health Professions Medicine & Pharmacology Nursing Public Health

Medica Hospitalia: Journal of Clinical Medicine adalah jurnal ilmiah yang diterbitkan RSUP Dr. Kariadi dan menerima artikel ilmiah dalam bahasa Indonesia dan bahasa Inggris yang diharapkan dapat menjadi media untuk menyampaikan temuan dan inovasi ilmiah dibidang kedokteran atau kesehatan kepada para praktisi dan akedemisi di bidang kesehatan dan kedokteran.

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Articles 584 Documents

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Respiratory Parameter Has A Great Impact in Determining Sepsis Condition in COVID-19 Patients at Saiful Anwar Hospital Malang: Case Report Timuda, Caesar Ensang; Setyawan, Ungky Agus; Djajalaksana, Susanthy
Medica Hospitalia : Journal of Clinical Medicine Vol. 7 No. 1A (2020): Med Hosp
Publisher : RSUP Dr. Kariadi

To describe Sequential Organ Failure Assessment (SOFA) Score parameters which have a great impact in the condition of sepsis in Corona Virus Disease-19 (COVID-19) patients and comorbidities that aggravate the patient's condition, we conducted a prospective cohort study in adult patients with sepsis and confirmed COVID-19 cases. We conducted a prospective cohort study in confirmed COVID-19 patients with sepsis who were admitted at Saiful Anwar Hospital Malang at March 10th–April 21st 2020. Diagnosis of sepsis is based on the Surviving Sepsis Campaign-III criteria. We found 6 COVID-19 confirmed patients with sepsis. There is an increased respiratory parameter in SOFA Score in these patients. Therefore, respiratory parameter of the SOFA score has a great impact in determining sepsis condition among confirmed COVID-19 patients. Keywords: COVID-19, Sepsis, SOFA Score

COVID-19 :Correlation Between CRP and LDH to Disease Severity and Mortality In Hospitalized COVID-19 Patients Tjahyadi, Rizal Muldani; Astuti, Triwahju; Listyoko, Aditya Sri
Medica Hospitalia : Journal of Clinical Medicine Vol. 7 No. 1A (2020): Med Hosp
Publisher : RSUP Dr. Kariadi

Background and Objective:COVID–19 is a newly emerging disease and considered an emergency health problem, worldwide.It has a wide range of clinical features, from mild fever to severe respiratory failure that leads to a higher mortality rate. Previous studies state that CRPhas a very strong positive correlation with the diameter of the lung lesion, and in intensive care patients had a higher level of LDH. This study aims to determine the correlation between CRP, LDH and disease severity and mortality in hospitalized COVID-19 patients. Methods: We conducted a retrospective cohort, a single-center study including 69 laboratory-confirmed patients in our hospital in Malang City, Indonesia from April - June 2020. Result: Subjects consisted of 26 patients (37.7%) in the mild-moderate group and 43 patients in severe group (62.3%).Statistical analysis showed CRP and LDH associated with disease severity (p=0.011 and p<0.001). Analysis of CRPand LDH in survivor and non-survivior group showed that CRP and LDH also asscociated with mortality in hospitalized COVID-19 patients (p=0.034 and 0.002). We also evaluate CRP and LDH with degrees of hypoxemia by assessed P/F ratio. Statistical analysis showed that CRP did not correlate with degrees of hypoxemia (p=0.079) but LDH inverse correlate with degrees of hypoxemia (p<0.001, pearson correlation = -0,489) Conclusion: In our retrospective cohort study demonstrated LDH and CRP can be a crucial indicator to predict severity and mortality for hospitalized COVID-19 patients and LDH may usefull test for predict early identification of patients who become respiratory failure or ARDS. Keywords: COVID-19, LDH, CRP, P/F Ratio

Glioblastoma dengan Deep Vein Thrombosis pada pasien COVID-19: Sebuah Laporan Kasus Tugasworo, Dodik; Kurnianto, Aditya; Retnaningsih, Retnaningsih; Andhitara, Yovita; Ardhini, Rahmi; Priambada, Dody; Daynuri, Daynuri
Medica Hospitalia : Journal of Clinical Medicine Vol. 7 No. 1A (2020): Med Hosp
Publisher : RSUP Dr. Kariadi

Latar belakang: Glioblastoma (GBM) berhubungan dengan peningkatan hiperkoagulabilitas dan peningkatan risiko dari venous thromboembolism (VTE) (termasuk Deep Vein Thrombosis (DVT)). VTE merupakan komplikasi kardiovaskular atau respirasi yang sering ditemukan pada pasien-pasien yang dirawat inap karena COVID-19. Hubungan mengenai VTE pada kasus GBM dan COVID-19 belum pernah dibahas sebelumnya. Laporan kasus ini akan membahas tentang seorang wanita usia 55 tahun dengan GBM dan DVT dengan hasil PCR SARS-CoV-2 positif yang dirawat di RSUP Dr. Kariadi. Laporan kasus: Wanita 55 tahun datang ke rumah sakit dengan nyeri kepala dan nyeri serta bengkak pada tungkai kanan. Pada pemeriksaan laboratorium didapatkan INR 0.92, D-Dimer kuantitatif 46540 ug/L, dan titer fibrinogen kuantitatif 234 mg/dL. Dari USG vena doppler tungkai kanan didapatkan gambaran DVT sepanjang vena tungkai kanan, pada pemeriksaan MRI kepala dan biopsi tumor sesuai dengan gambaran GBM, hasil pemeriksaan foto rontgen thoraks terjadi perburukan gambaran paru, serta pemeriksaan PCR SARS-CoV-2 positif. Pembahasan: Pada pasien ini, kondisi GBM dapat menyebabkan adanya kondisi hiperkoagulabilitas akibat neoangiogenesis, mutase onkogenik, dan aktivitas kronik kaskade koagulasi. Selain itu, infeksi dan inflamasi yang berat berkontribusi dalam berkembangnya DVT, seperti yang ditemukan pada pasien dengan COVID-19 yang parah. Pada pasien rawat inap dengan COVID-19, prevalensi DVT tinggi dan biasanya memiliki outcome yang buruk. Istilah COVID-19 associated coagulopathy (CAC) digunakan untuk menggambarkan perubahan koagulasi pada pasien yang terinfeksi COVID. Simpulan: Peningkatan risiko DVT pada pasien dengan glioblastoma dan infeksi COVID-19 disebabkan hiperkoagulabilitas dan koagulopati akibat sel tumor dan virus SARS-CoV-2. Kata Kunci: glioblastoma, DVT, COVID-19 Introduction: GBM is associated with increased of hypercoagulability and the risk of venous thromboembolism (VTE) (include Deep Vein Thrombosis (DVT)). VTE is a cardiovascular or respiratory complication that is often found in patients with COVID-19. The relationship of VTE in GBM and COVID-19 has not been discussed before. This case report will discuss a 55-year-old woman with GBM and DVT with a positive SARS-CoV-2 treated at Dr. Kariadi Hospital. Case presentation: A 55-year-old woman came to the hospital with cephalgia, pain and redness in the right leg. On laboratory examination, it was obtained INR 0.92, quantitative D-Dimer 46540 ug/L, and quantitative fibrinogen titer 234 mg/dL. Venous doppler USG of right leg showed the imaging of DVT along the venous system in right leg. Head MRI and tumor biopsy showed the imaging of GBM, on the chest X-ray examination showed the deterioration of the lung damage, and positive SARS-CoV-2 with PCR examination. Discusssion: GBM can cause hypercoagulability due to neoangiogenesis, oncogenic mutation, and chronic coagulation cascade activity. In addition, severe infection and inflammation contribute to the development of DVT, as found in patients with severe COVID-19. In hospitalized patients with COVID-19, the prevalence of DVT is high and usually has a poor outcome. The term COVID-19 associated coagulopathy (CAC) is used to describe changes in coagulation in patients infected with COVID-19. Conclusion: Increased risk of DVT in GBM and COVID-19 is because of hypercoagulability and coagulopathy due to tumor cells and SARS-CoV-2 virus. Keywords: glioblastoma, DVT, COVID-19

Evaluasi Dengan High Resolution Computed Tomography (HRCT) Setelah Infeksi Covid-19: Laporan Kasus di Rumah Sakit dr. Kariadi Semarang Satoto, Bambang; Widyasari, Maya Nuriya; Apriansah, Apriansah
Medica Hospitalia : Journal of Clinical Medicine Vol. 7 No. 1A (2020): Med Hosp
Publisher : RSUP Dr. Kariadi

Pendahuluan SARS-CoV-2 merupakan virus RNA yang terutama menginfeksi sel-sel pada saluran napas pelapis alveoli. Virus SARS-CoV-2 yang terhirup mengikat sel epitel di rongga hidung dan mulai bereplikasi. Virus ini menyebar serta bermigrasi ke saluran pernapasan, memicu respons imun bawaan dan pada akhirnya berkembang menjadi Acute Respiratory Distress Syndrome (ARDS). Gambaran ground glass infiltrates dapat terdeteksi pada pencitraan toraks. Pemeriksaan X-ray toraks dan MSCT toraks memegang peranan penting dalam deteksi dan follow up COVID-19. Metode dan Bahan Laporan kasus 2 pasien laki-laki yang terkonfirmasi COVID-19 umur 43 tahun dan 48 tahun dengan keluhan utama sesak napas, batuk dan demam. Pasien pertama mempunyai riwayat perjalanan ke Amerika Serikat 3 minggu sebelum masuk rumah sakit, sedangkan pasien kedua mempunyai riwayat kontak dengan pasien terkonfirmasi COVID-19. Pada pemeriksaan X-ray toraks kedua pasien menunjukkan gambaran konsolidasi disertai air bronchogram pada lapangan paru bilateral yang tampak dominan pada perifer. Berdasarkan pedoman Severe Acute Respiratory Syndrome (SARS) terdahulu, evaluasi dapat dilakukan 2 bulan dan 6 bulan setelah terinfeksi. Dua bulan setelah terinfeksi COVID-19 dilakukan pemeriksaan HRCT toraks dengan hasil normal. Kesimpulan Lesi berupa konsolidasi disertai air bronchogram dengan distribusi yang dominan pada perifer merupakan gambaran radiologis yang khas pada pasien Covid-19 seperti yang ditemukan pada kedua kasus yang dipaparkan dalam artikel ini. Evaluasi sequele dengan pemeriksaan HRCT yang dilakukan 2 bulan pasca penyembuhan menunjukkan gambaran paru paru yang normal, tidak ada infiltrat maupun fibrosis pada kedua pasien tersebut. Kata kunci X-ray toraks, konsolidasi, air bronchogram, COVID-19 Introduction SARS-CoV-2 is an RNA virus that mainly infects cells in the alveoli lining airways. The inhaled virus binds to epithelial cells in the nasal cavity then begins to replicate. This virus spreads, migrates to the respiratory tract, triggering an innate immune response, and develop to Acute Respiratory Syndrome. The ground-glass opacities can be detected in thoracic imaging eventually. Chest X-ray and CT-scan have an important role in the detection and follow-up of COVID-19. Materials and Methods The case report of 2 male patients confirmed COVID-19 aged 43 years and 48 years with major complaints of shortness of breath, coughing, and fever. The first patient had a history of raveling to the United States 3 weeks before hospitalization, while the second patient had a history of contact with a confirmed COVID-19 patient. On chest X-ray examination, both patients showed multiple consolidation with air bronchogram in bilateral lung field which appeared dominant in the periphery. According to the previous Severe Acute Respiratory Syndrome (SARS) guideline, evaluation for patients can be done in two months and six months after firstly infected. Two months after COVID-19 infection, a chest HRCT examination was performed with normal results. Conclusion Consolidation with air bronchogram which dominantly seen in peripheral distribution is a typical radiological picture in COVID-19 patients as found in two cases described in this article. Sequelae evaluation with chest HRCT conducted 2 months after healing showed normal lung appearance with no sign of infiltrates or fibrosis seen in both patients. Keywords: Chest X-ray, consolidation, air bronchogram, COVID-19

Manajemen Perforasi Kornea Pada Pasien Covid-19 Yanuar, Ferdian; Novita, Hera Dwi; Dicky, Herwindo
Medica Hospitalia : Journal of Clinical Medicine Vol. 7 No. 1A (2020): Med Hosp
Publisher : RSUP Dr. Kariadi

Latar Belakang : COVID-19 merupakan masalah kesehatan yang dinyatakan sebagai pandemi oleh WHO. Beberapa penelitian melaporkan tentang hubungan SARS-CoV-2 dengan kelainan pada mata. Pada era pandemi, pengelolaan pasien sakit mata harus hati-hati untuk mencegah penularan petugas medis. Laporan kasus ini menyajikan pengelolaan perforasi kornea pasien terkonfirmasi COVID-19. Metode : Diagnosis ditegakkan berdasarkan anamnesis, pemeriksaan fisik dan oftalmologi dengan pemeriksaan penunjang lainnya. Laporan Kasus : Perempuan berusia 54 tahun dirujuk dengan keluhan keluar darah pada mata kiri sejak 17 jam sebelum sampai RS. Keluhan batuk atau demam 14 hari sebelumnya disangkal. Pada pemeriksaan oftalmologi didapatkan perforasi kornea mata kiri disertai prolaps isi bola mata (iris, vitreus dan choroid). Pada pemeriksaan penunjang didapatkan foto rontgen thorax normal, rapid test covid-19 reaktif dan hasil positif pada PCR dari swab nasofaring. Seluruh staf medis menggunakan alat pelindung diri (APD) tingkat tiga dalam melakukan pemeriksaan fisik maupun penunjang. Dari hasil anamnesis pemeriksaan fisik dan penunjang, pasien didiagnosis dengan perforasi kornea spontan mata kiri dan terkonfirmasi COVID-19. Pasien direncanakan untuk eviserasi mata kiri dengan anestesi umum dan saat tindakan operator dan seluruh staf ruang operasi menggunakan alat pelindung diri (APD) tingkat tiga. Setelah operasi dilakukan, pasien kemudian dirawat di ruang isolasi khusus COVID-19. Swab nasofaring dilakukan ulang sehari setelah operasi dan keesokan harinya. Dua hari setelah operasi, pasien dipulangkan dan isolasi mandiri di rumah Kesimpulan: Laporan kasus ini menunjukkan manajemen perforasi kornea pada pasien terkonfirmasi COVID-19 yang dilakukan sesuai alur khusus termasuk pada pemeriksaan fisik dan penunjang, penegakkan diagnosis oftalmologi dan COVID-19, prosedur pembedahan dan perawatan pasca operasi. Kata Kunci : SARS-CoV-2, Perforasi Kornea, APD, PCR, Eviscerasi Introduction: Corona-Virus-Disease-2019 (COVID-19) is an important health problem that was defined as a pandemic by the World Health Organization (WHO). There are few reports on the association of SARS-CoV-2 with ocular abnormalities. In the pandemic era, management of ocular patients should be more careful to prevent transmission to medical staff. This report presenting the management of corneal perforation in confirmed COVID-19 patients. Method: The diagnosis was established based on history taking, physical and ophthalmology examination with other ancillary tests. Case Report : 54-year-old female patient referred with complaints of left eye bleeding since 17 hours ago. This patient never complaint about cough or fever 14 days before admission. From the ancillary test (complete blood count and chest x-ray are within normal limit, reactive rapid test for COVID-19, positive result of PCR nasopharynx). The patient was diagnosed with spontaneous corneal perforation on the left eye with COVID-19 confirmed. The evisceration procedure with general anesthesia was performed with exceptional precaution. Operator and all operating room staff wear the 3rd level of personal protective equipment (PPE). The surgery was successfully done and the patient then hospitalized in the COVID-19 isolated room. Nasopharynx swab performs the day after surgery and the next day after the first swab. Two days after surgery, the patient was discharged and followed by a self-isolation procedure. Conclusion: This case report presenting corneal perforation management in confirmed COVID-19 patients should be performed under a firm scheme including physical and ophthalmological examinations, ophthalmology and COVID-19 diagnosis enforcement, ancillary test, surgery procedure, post-operative care and also PPE utilization. Keyword : SARS-CoV-2, Corneal Perforation, 3rd level PPE, PCR, Evisceration

Covid-19 dan Koinfeksi Penyakit Parasit Trasia, Reqgi First
Medica Hospitalia : Journal of Clinical Medicine Vol. 7 No. 1A (2020): Med Hosp
Publisher : RSUP Dr. Kariadi

LATAR BELAKANG: Kondisi pandemi, kasus Covid-19 semakin meningkat, manifestasi klinis seperti demam, batuk, diare, muntah, sakit kepala, mialgia dan kelelahan, mungkin sulit untuk membedakan COVID-19 dari spektrum penyakit dengan manifestasi serupa, seperti malaria dan cacingan, terutama di daerah endemik. Di Indonesia belum ada artikel yang membahas Covid-19 dengan koinfeksi malaria dan cacing. TUJUAN: Tujuan penulisan ini adalah menelaah dampak klinis infeksi Covid-19 dengan komorbid infeksi parasit yaitu malaria dan kecacingan. METODE: Penelusuran kepustakaan 154 jurnal, terdapat 4 jurnal yang relevan. DISKUSI: Manifestasi klinis malaria yang parah terjadi karena respon proinflamasi yang meningkat, hal yang sama terjadi dalam banyak kasus COVID-19. Koinfeksi Malaria dan COVID-19 dapat menyebabkan respons pro-inflamasi yang berlebihan, manifestasi klinis lebih parah dan prognosis buruk. Berdasarkan imunopatogenitas dari infeksi cacing di daerah endemis, dikhawatirkan hal tersebut akan meningkatkan keparahan gejala Covid-19 pada pasien dengan koinfeksi cacing. KESIMPULAN: Pada kasus Covid-19 yang diikuti dengan koinfeksi malaria menunjukkan keparahan manifestasi klinis akibat peningkatan respon inflamasi. Diduga bahwa respon imun hospes terhadap cacing akan memberikan dampak klinis yang lebih berat pada kasus Covid-19. Kata kunci: Covid-19, koinfeksi, malaria, cacingan, penyakit parasit BACKGROUND: The condition of the Covid-19 pandemic where the number of cases is increasing. Clinical manifestations such as fever, cough, diarrhea, vomiting, headache, myalgia and fatigue, it may be difficult to distinguish COVID-19 from the spectrum of diseases with similar manifestations, such as malaria and intestinal worms, especially in endemic areas. Indonesia there are no articles discussing Covid-19 with malaria and worm coinfection. OBJECTIVE: The purpose this article is to review the clinical impact of Covid-19 infection with comorbid parasitic infections, in this case malaria and worms. METHOD: Search the literature of 154 journals, there are 4 journals that are relevant DISCUSSION: The severe manifestations of malaria occur because of an increased proinflammatory response, the same thing happens in many cases of COVID-19. Malaria coinfection and COVID-19 can then cause excessive pro-inflammatory responses, severe manifestations and a poor prognosis. In addition, based on immunopathogenicity from worm infections in endemic areas, it is feared that this will increase the severity of Covid-19 symptoms in patients with worm co-infection. CONCLUSION: In the case of Covid-19 followed by co-infection with malaria, it shows the severity of clinical manifestations due to increased inflammatory response. Tobe assumed that the host's immune response to worms will have a more severe clinical impact in the Covid-19 case. Keywords: Covid-19, coinfection, malaria, intestinal worms, parasitic diseases

Pemeriksaan Laboratorium pada Coronavirus Disease 2019 (COVID-19) Yusra, Yusra; Pangestu, Natasha
Medica Hospitalia : Journal of Clinical Medicine Vol. 7 No. 1A (2020): Med Hosp
Publisher : RSUP Dr. Kariadi

Coronavirus Disease 2019 (COVID-19) adalah penyakit yang disebabkan oleh virus SARS-CoV-2. Penyakit ini menyebar dengan cepat, menjadi pandemi, dan telah menginfeksi jutaan penduduk di lebih dari 200 negara dan wilayah serta berdampak pada sosioekonomi masyarakat. Pemeriksaan laboratorium berperan penting dalam manajemen pasien COVID-19 mulai dari penapisan sampai dengan surveilans. Oleh karena itu, studi literatur ini akan membahas tentang pemeriksaan laboratorium pada COVID-19. Kata kunci: COVID-19, SARS-CoV-2, pemeriksaan laboratorium

Karakteristik dan Keluaran Pasien COVID-19 dengan DM di RS Umum Pusat Dr. Kariadi (Tinjauan pasien periode Maret-Juli 2020) Minuljo, Tania Tedjo; Anindita, Yohana Prima Ceria; Seno, Heri Nugroho Hario; Pemayun, Tjokorda Gde Dalem; Sofro, Muchlis Achsan Udji
Medica Hospitalia : Journal of Clinical Medicine Vol. 7 No. 1A (2020): Med Hosp
Publisher : RSUP Dr. Kariadi

Pendahuluan Jawa Tengah merupakan propinsi dengan kasus COVID-19 terbanyak ke-4 di Indonesia (lebih dari 8.000 kasus). RS Umum Pusat Dr. Kariadi (RSDK) sebagai RS rujukan memiliki 436 kasus terkonfirmasi COVID-19 per 10 Juli 2020. Diabetes mellitus (DM) diketahui menurunkan sistem imun dan memperburuk reaksi inflamasi. Karakteristik dan keluaran pasien COVID-19 dengan DM di RSDK belum pernah dilaporkan sebelumnya. Metode Data dari rekam medis RSDK. Diagnosis DM: riwayat DM dan/atau GDS >200 mg/dL atau HbA1c >7%. Diagnosis COVID-19: PCR usapan nasofaring-orofaring positif. Karakteristik dasar: usia, jenis kelamin, keluhan, riwayat kontak, riwayat perjalanan, jenis dan tempat perawatan, lama perawatan, komorbid, serta terapi DM. Pemeriksaan penunjang: GDS, HbA1c, kreatinin, saturasi O2, C-reactive protein (CRP), proklasitonin, D-dimer, dan fibrinogen dikelompokkan berdasarkan keluaran (hidup vs. mati); dilakukan uji beda. Analisis dengan SPSS v.24 (IBM, New York, USA). Hasil Pasien COVID-19 dengan DM periode Maret-10 Juli 2020 sebanyak 42 dari total 436 kasus (9,63%). Pria lebih banyak (59,5%). Kasus terbanyak usia >50 tahun (64,3%). Batuk, demam, dan sesak nafas adalah keluhan tersering. Mayoritas pasien menyangkal riwayat kontak ataupun bepergian (>75%). Hampir separuh perlu perawatan intensif sejak awal (40,5%). Komorbid terbanyak hipertensi. Separuh kasus mendapat insulin. Persentase kematian 42,9% (18 dari 42). Rerata kendali glikemik (HbA1c 9,7%) dan saturasi O2 (Sat O2 90%) buruk. Rerata penanda gangguan koagulasi (D-dimer, fibrinogen) dan inflamasi akut (CRP, prokalsitonin) meningkat, berturut-turut 3937,4 ng/mL; 496,1 mg/dL; 16,6 mg/L; 12 ng/mL. Tidak ada beda bermakna antara kelompok hidup dan mati. Kesimpulan Mortalitas dan morbiditas COVID-19 sangat tinggi pada DM. Hampir seluruh pasien mengalami gangguan koagulasi dan inflamasi akut. Kata kunci: COVID-19, DM, RS Kariadi Introduction Central Java province has the 4th largest cases of COVID-19 in Indonesia with more than 8.000 cases. Dr. Kariadi General Hospital (RSDK) is one of the referral hospital with 436 confirmed cases of COVID-19 until July 10th 2020. Diabetes mellitus (DM) known to decreases the immune system and worsens the inflammatory reaction. The characteristics and outcomes of patients with COVID-19 and DM in the RSDK have not been reported yet. Method Data were taken from the RSDK medical record. Diagnosis of DM: history of diabetes and/or RBG >200 mg/dL or HbA1c >7%. Diagnosis of COVID-19 infection: positive PCR from nasopharyngeal-oropharyngeal smear. Baseline characteristics: age, sex, chief complaints, contact and travel history, type and place of care, duration of treatment, comorbidity, and diabetes treatment options. Laboratory result: RBG, HbA1c, creatinine, O2 saturation, C-reactive protein (CRP), proclasitonin, D-dimers, and fibrinogen were grouped according to patient output (life vs. death) and different tests was performed. Data analysis was performed with SPSS v.24 (IBM, New York, USA). Result The number of patients with COVID-19 and DM was 42 out of 436 cases (9.63%). Men was more prevalent (59.5%). Most cases were >50 years of age (64.3%). Cough, fever, and shortness of breath were the most prevalent chief complaints. The majority of patients denied contact or travel history (>75%). Nearly half of the cases needed intensive care (40.5%) at arrival. Hypertension was the no.1 comorbid. Half cases received insulin therapy. Percentage of death was 42.9% (18 out of 42). Average of glycemic control (HbA1c 9.7%) and O2 saturation (Sat O2 90%) were poor. Coagulation (D-dimer, fibrinogen) and acute inflammatory (CRP, procalsitonin) markers were increased, respectively 3937.4 ng/mL; 496.1 mg/dL; 16.6 mg/L; 12 ng/mL. There was no significant difference between the life and death groups. Conclusion Mortality and morbidity of patients with COVID-19 and DM was very high. Almost all patients suffered from disseminated intravascular coagulation (DIC) and severe acute inflammation. Key words: COVID-19, DM, Kariadi Hospital

Vitamin D dan paparan sinar matahari untuk mencegah COVID-19. Fakta atau mitos ? Mexitalia, Maria; Susilawati, Martvera; Pratiwi, Rina; Susanto, JC
Medica Hospitalia : Journal of Clinical Medicine Vol. 7 No. 1A (2020): Med Hosp
Publisher : RSUP Dr. Kariadi

Latar Belakang : Paparan sinar matahari pada kulit merupakan cara terbaik untuk sintesis vitamin D. Kadar vitamin D yang adekuat dalam tubuh merupakan proteksi terhadap berbagai penyakit seperti penyakit degeneratif, kanker dan juga infeksi saluran napas. Beberapa penelitian menghubungkan kadar vitamin D yang rendah dengan morbiditas dan mortalitas COVID-19. Hal ini menyebabkan fenomena baru pada masyarakat yaitu kebiasaan berjemur. Tujuan : Artikel ini akan membahas tentang metabolisme vitamin D, peran sinar matahari dalam mengaktifkan vitamin D di dalam tubuh, dan peran vitamin D dalam berbagai penyakit, khususnya mekanisme imunitas untuk COVID-19. Diskusi : Vitamin D meningkatkan kekebalan alami seluler terutama dengan cara menginduksi peptida antimikroba, yang meliputi cathelicidin, LL-37, 1,25-dihdroxyvitamin D dan defensins. Selain itu vitamin D akan meningkatkan sekresi hidrogen peroksida pada sel monosit. Pemberian vitamin D dosis tinggi sebanyak 10.000 IU/hari selama beberapa minggu dilanjutkan 5000 IU/hari bermanfaat untuk mencegah COVID-19, walaupun hasilnya masih memerlukan penelitian lebih lanjut. Absorpsi sinar matahari ke dalam tubuh manusia dipengaruhi oleh warna kulit, penggunaan bahan pakaian dan tabir surya , dan luas pajanan. Paparan sinar matahari sebesar satu Minimal Erythemal Dose (MED) pada orang dewasa dapat meningkatkan konsentrasi vitamin D setara dengan suplementasi 10.000 – 25.000 IU. Penelitian pada bayi yang diberi paparan 3 kali seminggu @ 5 menit pada jam 10.00-14.00, dengan paparan 50% area tubuh selama 2 bulan, mendapatkan kenaikan 25(OH)D sebesar 8,9 ng/mL. Simpulan : Vitamin D yang diaktifkan oleh paparan sinar matahari sangat bermanfaat sebagai proteksi berbagai penyakit termasuk juga pada COVID-19, walaupun efektifitasnya masih memerlukan penelitian lebih lanjut. Kata Kunci : COVID-19, vitamin D, paparan sinar matahari Background : The exposured of sunlight on the skin is the best way for vitamin D synthesis. Adequate vitamin D levels are protection against various diseases such as degenerative diseases, cancer and also respiratory infections. Several studies have linked between low vitamin D levels with COVID-19 morbidity and mortality. This causes a new phenomenon in the community, namely sunbathing. Purpose : This review rearticle will discuss about vitamin D metabolism, the role of sunlight in activating vitamin D in the body, and the role of vitamin D in various diseases, specifically the immune mechanism for COVID-19.Discussion : Vitamin D increases cellular innate immunity mainly by inducing antimicrobial peptides, which include cathelicidin, LL-37, 1,25-dihdroxyvitamin D and defensins, and also increase the secretion of hydrogen peroxide in monocyte cells. The administration of high-dose vitamin D of 10,000 IU / day for several weeks followed by 5000 IU / day is useful to prevent COVID-19, although the results still require further research. The sun exposure to activated vitamin D body is affected by skin color, using of clothing and sunscreen, and area of ??exposure. Sun exposure of one Minimum Erythemal Dose (MED) in adults can increase vitamin D concentrations equivalent to 10,000 - 25,000 IU vitamin D supplementation. Study on infants who were given exposure 3 times a week @ 5 minutes at 10:00 to 14:00, with exposure 50% of body surface area for 2 months, increased 25(OH)D of 8.9 ng/mL. Conclusion : Vitamin D which is activated by sun exposure is very useful as protection for various diseases including COVID-19, although its effectiveness still requires further research. Keywords : vitamin D, sun exposure, COVID-19.

Hubungan Tingkat Pendidikan dan Pelatihan dengan Tingkat Pengetahuan Petugas Kamar Jenazah tentang COVID-19 pada Jenazah Iswara, Raja Al Fath Widya
Medica Hospitalia : Journal of Clinical Medicine Vol. 7 No. 1A (2020): Med Hosp
Publisher : RSUP Dr. Kariadi

Latar belakang: Petugas kamar jenazah adalah orang yang paling berisiko terinfeksi COVID-19 dikarenakan kurangnya pengetahuan tentang infeksi tersebut pada jenazah. Tingkat pendidikan dan keikutsertaan dalam pelatihan merupakan hal yang dapat mempengaruhi pengetahuan petugas kamar jenazah. Penelitian ini bertujuan untuk mengetahui hubungan tingkat pendidikan dan pelatihan dengan tingkat pengetahuan petugas kamar jenazah tentang COVID-19 pada jenazah. Metode: Penelitian cross sectional menggunakan desain deskriptif analitik. Subjek penelitian 30 responden petugas kamar jenazah dengan teknik total sampling di Rumah Sakit Umum Bahteramas Provinsi Sulawesi Tenggara, Rumah Sakit Umum Daerah Kota Kendari dan Rumah Sakit Bhayangkara Kendari pada bulan Mei 2020 yang memenuhi kriteria inklusi. Instrumen penelitian menggunakan kuesioner. Pendidikan rendah mencakup lulusan SD, SMP dan SMA, sedangkan pendidikan tinggi mencakup lulusan Akademik, Sekolah Tinggi, Politeknik dan Perguruan Tinggi. Pelatihan dikategorikan dalam pernah dan tidak pernah mengikuti. Pengetahuan baik apabila responden mampu menjawab benar dengan nilai 70–100%, sedangkan pengetahuan buruk apabila responden menjawab benar dengan nilai kurang dari 70%. Data dianalisis menggunakan uji Fisher Exact Test. Hasil: 18 responden memiliki tingkat pendidikan tinggi dan 12 responden memiliki tingkat pendidikan rendah. 16 responden pernah mengikuti pelatihan dan 14 responden tidak pernah mengikuti pelatihan. 23 responden memiliki pengetahuan baik dan 7 responden memiliki pengetahuan buruk. Terdapat hubungan yang signifikan antara tingkat pendidikan dan pelatihan dengan tingkat pengetahuan petugas kamar jenazah tentang COVID-19 pada jenazah, masing-masing dengan nilai p=0.029 dan p=0.031. Simpulan: Terdapat hubungan tingkat pendidikan dan pelatihan dengan tingkat pengetahuan petugas kamar jenazah tentang COVID-19 pada jenazah. Kata Kunci: COVID-19, jenazah, pelatihan, pendidikan, pengetahuan Background: The mortuary officer is the person most at risk of being infected with COVID-19 due to a lack of knowledge about the infection in the corpse. The level of education and participation in training are things that can affect the knowledge of the mortuary officer. The aim of this study is to determine the relationship between the level of education and training with the level of knowledge of the mortuary officer about COVID-19 in the corpse. Methods: This study was cross sectional used a descriptive analytic design. The research subjects were 30 respondents of mortuary officers with total sampling technique at the Bahteramas General Hospital of Southeast Sulawesi Province, Kendari City Regional General Hospital and Bhayangkara Kendari Hospital in May 2020 who met the inclusion criteria. The research instrument was use a questionnaire. Low level education includes graduates from elementary school, junior high school and senior high school, while higher education level includes graduates from Academics, Higher Education, Polytechnic and University. Training is categorized as having and never following. Good knowledge is if the respondent is able to answer correctly with a value of 70–100%, while bad knowledge is if the respondent answers correctly with a value of less than 70%. Data were analyzed using the Fisher Exact Test. Results: 18 respondents had a high level of education and 12 respondents had a low level of education. 16 respondents have attended training and 14 respondents have never attended training. 23 respondents have good knowledge and 7 respondents have bad knowledge. There was a significant relationship between the level of education and training with the level of knowledge of mortuary officers about COVID-19 in the corpse, with p = 0.029 and p = 0.031, respectively. Conclusion: There is a relationship between the level of education and training with the level of knowledge of mortuary officers about COVID-19 in the corpse. Keywords: COVID-19, corpse, training, education, knowledge

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Contact Name
Aziz Alfarisy

Contact Email
medicahospitalia@rskariadi.co.id

Phone
-

Journal Mail Official
medicahospitalia@rskariadi.co.id

Editorial Address
-

Location
Kota semarang,

Jawa tengah

INDONESIA