Rationale: Bacterial and fungal infections in Coronavirus Disease-19 (COVID-19) patients have been inadequately investigated and reported thus far. The safety profile of tocilizumab (TCZ) administration in candidemia patient still debatable. Patient concerns: A 54 year-old woman presenting with weakness on the left side of her body was diagnosed with COVID-19. After 7 days of admission, her condition worsened and developed respiratory distress and was having respiratory distress despite standard treatment. Diagnoses: Acute respiratory distress syndrome (ARDS) in COVID 19 was diagnoses based on real time-PCR swab, deterioration of PaO 2 /FiO 2 and increased of acute phase reactants. Interventions: Anti Interleukin–6 (IL-6) was considered to tackle her inflammatory condition. Prior to TCZ administration, blood culture was performed and the result came with Candida tropicalis in the absence of bacterial growth. Outcomes: No major complications associated with intravenous antifungal or TCZ occurred. After 40 days of hospitalization, the patient's clinical condition improved and was finally discharged. Lessons: This case underscores the safety profile of giving TCZ in candidemia as a secondary infection in severe COVID-19 patient.

Background: Gastroesophageal reflux disease (GERD) is caused by reflux of stomach contents into the esophagus and give the typical symptoms as heartburn. The prevalence of GERD was vary around the world. Prevalence of GERD by endoscopy in Jakarta was 22.8%. Limited data exist to determine the prevalence and related factors of gastroesophageal reflux disease (GERD) in the population without alarm symptoms. Validated GERDq questionnaire can be used easily to diagnose GERD in primary health care. This study aims to know the prevalence of GERD and related factors.Method: This cross-sectional study was conducted in adult dyspepsia patients at General Hospital District of Cilincing from January to March 2016. A validated GERDq questionnaire and a single proportion sample size calculation were used. Results: The prevalence of GERD was 49%, in elderly participants the prevalence was 44%. Of the 104 consecutive participants, 33.7% were male and 66.3% were female. The mean age was 47.6 ± 15.4 years old. The rate of GERD was higher in females than in males (53 vs. 40%, p = 0.189), increased as the age of the participants increased (p = 0.059) and also increased as the body mass index (BMI) of the participants increased (p 0.05). GERD was present in 50% of active or former smokers (p 0.05), 33.3% of daily coffee drinkers (p 0.05), 56.2% of active or former alcohol consumers (p 0.05), and 57.4% of daily tea drinkers (p = 0.049).Conclusion: The prevalence of GERD in dyspeptic patient was still high. There is a relation between GERD and tea consumption.

recommend triple therapy, consist of proton pump inhibitor, Amoxicillin, and Clarithromycin, for the first-line therapy of H. pylori infection. Yet, questions remain regarding the optimal duration of triple therapy. For Asia, APAGE and PGI

ABSTRAKPendahuluan. Berdasarkan World Health Organization (WHO), hipertensi berkaitan dengan 7,5 juta kematian di seluruh dunia atau mencapai 12,8% dari semua kematian. Sedangkan berdasarkan Riset Kesehatan Dasar (Riskesdas) 2013 di Indonesia, hipertensi masih menjadi masalah kesehatan utama dengan prevalensi mencapai 26,5 %. Ketidakpatuhan merupakan penyebab utama kegagalan pengobatan hipertensi dan faktor risiko munculnya komorbiditas kardiovaskuler. Belum ditemukan penelitian sebelumnya yang meneliti kepatuhan kontrol pasien di komunitas suburban. Penelitian ini dilakukan untuk menganalisis besarnya prevalensi pasien yang tidak kontrol setelah pengobatan hipertensi.Metode. Penelitian ini merupakan studi retrospektif, melalui penelusuran rekam medis pada pasien yang berobat antara bulan Oktober -Desember 2015.Hasil. Dari 80 pasien yang menjadi subjek penelitian, rerata usia pasien 57,5 ± 11 tahun, didominasi oleh pasien wanita (68,8%). Berdasarkan klasifikasi European Society of Cardiology (ESC) 2013 prevalensi terbesar adalah hipertensi derajat 2 mencapai 40%. Komorbiditas yang paling banyak dijumpai adalah diabetes melitus sebesar 22,5 %. Enam puluh persen pasien mendapatkan 1 jenis obat dan golongan calcium channel blocker merupakan jenis obat yang tersering diberikan. Prevalensi pasien yang tidak kontrol mencapai 63,8 %. Dari analisais bivariate ditemukan hubungan bermakna antara kepatuhan kontrol dengan jumlah obat yang diberikan (Odds Ratio 10,3; IK 95% 3,1), admisi (Odds Ratio 14,6; IK 95% 4,6), dan komorbid (Odds Ratio 4,3; IK 95% 1,6 -11,4) meskipun dalam analisis multivariat variabel komorbiditas tidak ditemukan kemaknaan.Simpulan. Prevalensi ketidakpatuhan kontrol masih tinggi. Diperlukan penelitian lanjutan untuk mengetahui faktor faktor lain yang menjadi penyebab ketidakpatuhan tersebut.

Introduction:This study aimed to review the clinical characteristics and outcomes of COVID-19 patients presented with in-hospital hyperglycemia or pre-existing type 2 diabetes (T2DM). Methods: This is a retrospective study conducted in Fatmawati General Hospital, Indonesia, from March 18th-Apr 30th, 2020. We reviewed medical records of 27 COVID-19 patients presented with either in-hospital hyperglycemia (11, 12.2%) or pre-existing T2DM (16, 17.8%) from a total of 90 confirmed COVID-19 cases admitted in our hospital. Results: Critical conditions occurred in 50% of T2DM and 54.55% of the in-hospital hyperglycemia group. Mortality was documented in 68.75% of T2DM and 81.82% of in-hospital hyperglycemia group. Hypoglycemia, diabetic ketoacidosis, lactic acidosis and ketosis were found in 12.5%, 25%, 18.75%, and 25% of individuals with T2DM, respectively, resulting in a high mortality rate. Meanwhile, diabetes-related complications were rare among the in-hospital hyperglycemia group. However, respiratory failure (45.45% vs. 6.25%) and septic shock (27.27% vs. 6.25%) were more frequent than in the T2DM group. Conclusion:In this preliminary study, a high mortality rate was documented among COVID-19 patients with preexisting T2DM and in-hospital hyperglycemia. In T2DM subjects, diabetes relatedcomplications contributed to a higher mortality rate, while inhospital hyperglycemia group, respiratory failure and septic shock were more frequent.

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Background: Acute-on-chronic liver failure (ACLF) is a syndrome characterized by acute liver decompensation with extrahepatic organ failure in patients with pre-existing liver disease causing high short-term mortality. A good knowledge about characteristics and diagnostic of ACLF will help us to give proper treatment. The aim of this study is to know the profile and characteristics of ACLF patientMethod: Retrospective study was conducted to find patient with ACLF between January 2017-January 2018 at Fatmawati General Hospital.Results: Ten patients were diagnosed with ACLF. Six patients admitted with a chief complaint: unconscious, 2 of them had hematemesis in the course-of-treatment. Three patients were admitted with abdominal pain, and 1 patient with hematemesis-melena. Seven patients had Hepatitis-B infection. Aspartate-transaminase to platelet-ratio index (APRI) values varied (median 8.1;minimum 2.81-maximum 34.67). Hepatic encephalopathy, ascites, and acute renal failure were found in 90% of patients. Jaundice can be found in all patients, with mean values of bilirubin levels in patients undergoing test for bilirubin level were 18.56 mg/dL (9/10). Coagulation disorders were found in 60% of patients undergoing haemostasis test. Four patients were diagnosed with grade 3 ACLF. All ACLF patients eventually died during treatment, including third-degree patients who all died within 7 days. Only 2 patients survived more than 7 days, and 4 patients died within 3 days of treatment. Conclusion: mortality rates of ACLF were very high, and are often found in patients with advanced liver disease characterized by high APRI values. The prognosis is related to the number of organ failures. Central nervous system, kidneys and liver are the organs that are often impaired. Because the current treatment method is still limited, further research is needed, especially on biomarkers for better prevention, diagnosis and treatment.

Background: liver cirrhosis is a global health problem. The mortality rate due to cirrhosis was estimated to achieve 1 million per year worldwide. The aim of this study is to elaborate the characteristics of patients  with liver cirrhosis and factors affecting mortality during hospitalization in Fatmawati General Hospital.Method: The design of this study was retrospective cohort involving patients admitted to the hospital between January and March 2019.Results: Among 41 liver cirrhosis patients, it was found that the average age was 52.9 ±13.8 years old and the percentage of male patients among participants was 75.6%. Patients who died during hospitalization was 12.2%. The average length of stay in hospital was 10.8±6.4 days. Patients were admitted to the hospital with various complaints; the most common complaint was gastrointestinal bleeding in 46.3%, decreased consciousness in 22% and massive ascites in 17.1% patients. Physical examination findings of anaemic conjunctiva, icteric sclera, and shifting dullness were found in 73.2%; 29.3% and 61% patients, respectively. Icteric condition during hospital admission has higher mortality risk with RR 9.6 (95% CI: 1.2-77.8). Approximately 53.7% cirrhosis patients were diagnosed with hepatitis B, while 22% of them  were diagnosed with hepatitis C. Coinfection of hepatitis B and C were found in 4.8% patients, while 29% patients were neither infected with hepatitis B nor C. Based on the laboratory examination, creatinine level 1.3 mg/dL had higher mortality risk with RR 8.3 (95% CI: 1.04-66.7), while natrium level ≤ 125 mmol/L had higher mortality risk with RR 26.4 (95% CI: 3.6-191). Based on Child-Pugh classification, 24.4% patients had Child-Pugh A, while 14.6% had Child Pugh C, and 39% patients could not be classified. The mean Child-Pugh score in this study was 8 ± 2.2. Through the bivariate analysis, we found the association between Child-Pugh classification and mortality; higher classification has higher mortality risk (p = 0.028). Child-Pugh C had mortality risk with RR = 9.5 (95% CI: 1.2-75.1).Conclusion: Liver cirrhosis patients were hospitalized due to the ongoing decompensation. The mortality rate during hospitalization in liver cirrhosis patients was high. Mortality in these patients was associated with icteric condition upon admission, high initial creatinine level, low sodium level, and high Child-Pugh classification.