One of the main causes of acute respiratory distress syndrome in coronavirus disease 2019 (COVID-19) is cytokine storm, although the exact cause is still unknown. Umbilical cord mesenchymal stromal cells (UC-MSCs) influence proinflammatory T-helper 2 (Th 2 ) cells to shift to an anti-inflammatory agent. To investigate efficacy of UC-MSC administration as adjuvant therapy in critically ill patients with COVID-19, we conducted a double-blind, multicentered, randomized controlled trial at four COVID-19 referral hospitals in Jakarta, Indonesia. This study included 40 randomly allocated critically ill patients with COVID-19; 20 patients received an intravenous infusion of 1 Â 10 6 /kg body weight UC-MSCs in 100 ml saline (0.9%) solution (SS) and 20 patients received 100 ml 0.9% SS as the control group. All patients received standard therapy. The primary outcome was measured by survival rate and/or length of ventilator usage. The secondary outcome was measured by clinical and laboratory improvement, with serious adverse events. Our study showed the survival rate in the UC-MSCs group was 2.5 times higher than that in the control group (P = .047), which is 10 patients and 4 patients in the UC-MSCs and control groups, respectively. In patients with comorbidities, UC-MSC administration increased the survival rate by 4.5 times compared with controls. The length of stay in the intensive care unit and ventilator usage were not statistically significant, and no adverse events were reported. The application of infusion UC-MSCs significantly decreased interleukin 6 in the recovered patients (P = .023). Therefore, application of intravenous UC-MSCs as adjuvant treatment for critically ill patients with COVID-19 increases the survival rate by modulating the immune system toward an antiinflammatory state.
This study aimed to determine the burden of sepsis with focal infections in the resourcelimited context of Indonesia and to propose national prices for sepsis reimbursement. Methods: A retrospective observational study was conducted from 2013-2016 on cost of surviving and non-surviving sepsis patients from a payer perspective using inpatient billing records in four hospitals. The national burden of sepsis was calculated and proposed national prices for reimbursement were developed. Results: Of the 14,076 sepsis patients, 5,876 (41.7%) survived and 8,200 (58.3%) died. The mean hospital costs incurred per surviving and deceased sepsis patient were US$1,011 (SE AE 23.4) and US$1,406 (SE AE 27.8), respectively. The national burden of sepsis in 100,000 patients was estimated to be US$130 million. Sepsis patients with multifocal infections and a single focal lower-respiratory tract infection (LRTI) were estimated as being the two with the highest economic burden (US$48 million and US$33 million, respectively, within 100,000 sepsis patients). Sepsis with cardiovascular infection was estimated to warrant the highest proposed national price for reimbursement (US$4,256). Conclusions: Multifocal infections and LRTIs are the major focal infections with the highest burden of sepsis. This study showed varying cost estimates for sepsis, necessitating a new reimbursement system with adjustment of the national prices taking the particular foci into account.
Background: In Indonesia, around 400 health workers died due to Covid-19 between June-July 2021, therefore the health workers need to be given further immunity. Health workers were among the first to get a booster shoot. However, they may experience side effects after vaccination. We aimed to describe side effects of Moderna vaccine as a booster in health workers. Methods: A cross sectional study was conducted on health workers who received mRNA Covid-19 vaccine booster (Moderna) at Sulianti Saroso Infectious Disease Hospital, Indonesia and had filled the questionnaire assessing side effects form. We associated the form of the questionnaire assessing side effects from the originating source of hospital immunization unit in September 2021. Results: A total of 101 health workers who received mRNA Covid-19 vaccine booster in Jul-Aug 2021 were included. Most of health worker experienced more than 3 side effects. The side effects were sore arm (100%); chills (72%); fatigue (57%); headache (53%) and fever (51%), other symptoms (28%). The side effects mostly happened a day of receiving a booster shot (61.4%). There was no association between age, gender, comorbid to amount of side effects (P>0.05). Conclusion: Since the public must fulfil the immunization program during pandemic, it is the responsibility of the healthcare provider to inform about the potential side effects and benefits of a new Covid-19 vaccine.
Background: The HIV epidemic remains a public health problem with rising tuberculosis (TB) numbers around the world. Antiretroviral (ARV) therapy (ART) is essential to increase the survival of patients with TB-HIV coinfection. The aim of this study is to investigate the effect of ARV treatment initiation within TB treatment duration for the survival of patients with TB-HIV coinfection. Methods: This is a retrospective cohort study of patients with TB-HIV coinfection and who were ARV naive from Prof. Dr. Sulianti Saroso Infectious Disease Hospital between January 2011 and May 2014 (N = 275). The Kaplan-Meier method, bivariate with the log rank test, and multivariate with the Cox regression were applied in this study. Results: Cumulative survival probability of the patients with TB-HIV coinfection receiving ARV in a year was 81.5%. The death rate in patients with TB-HIV coinfection who received late ART initiation during TB treatment is higher by 2.4 times [adjusted hazard ratio (aHR) = 2.4, 95% confidence interval: 1.3-4.5, p = 0.006] compared with the patients who were in early ART initiation and were thereafter adjusted by the location of Mycobacterium tuberculosis infection. Conclusion: The effect of ART initiation is essential in the intensive phase (2-8 weeks) of anti-TB medication to increase the survival among TB-HIV coinfection group.
AbstrakLatar belakang: Kandidiasis oral banyak dijumpai pada pasien koinfeksi Tuberkulosis-Human Immunodefiency Virus (TB-HIV) dan meningkatkan morbiditasnya. Tujuan penelitian ini untuk mengetahui profil pasien kandidiasis oral pada pasien koinfeksi TB-HIV di RSPI Prof. Dr. Sulianti Saroso.Metode: Penelitian ini merupakan studi deskriptif potong lintang. Data penelitian didapatkan dari status rekam medik pasien kandidiasis oral dengan koinfeksi TB-HIV pada periode Januari 2011 hingga Mei 2014 di RSPI Prof. Dr. Sulianti Saroso. Sampel dalam penelitian ini adalah pasien koinfeksi TB-HIV yang belum mendapat ARV (naive ARV) tetapi telah mendapat OAT yang yang memenuhi kriteria inklusi sebanyak 68 pasien.Hasil: Dari 62 pasien kandidiasis oral dengan koinfeksi TB-HIV yang belum mendapat terapi antiretroviral (ARV) didapat terbanyak laki-laki sekitar 74,6 %, usia produktif kurang dari 40 tahun (82,3%) dan pada stadium III sebesar 61,3 %, stadium IV sebesar 38,7 %. Hasil hitung CD4 terbanyak kurang dari 200 sel/μ. Rata-rata pasien menderita TB paru sebesar 72,6 %.Kesimpulan: Profil pasien kandidiasis oral dengan TB-HIV ditemukan terbanyak pada laki-laki dengan usia produktif pada stadium III dan IV, serta hasil hitung sel CD4 terbanyak kurang dari 200sel/μ.
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