Obesity is an established risk factor for severe coronavirus disease 2019 , but the contribution of overweight and/or diabetes remains unclear. In a multicenter, international study, we investigated if overweight, obesity, and diabetes were independently associated with COVID-19 severity and whether the BMIassociated risk was increased among those with diabetes. RESEARCH DESIGN AND METHODSWe retrospectively extracted data from health care records and regional databases of hospitalized adult patients with COVID-19 from 18 sites in 11 countries. We used standardized definitions and analyses to generate site-specific estimates, modeling the odds of each outcome (supplemental oxygen/noninvasive ventilatory support, invasive mechanical ventilatory support, and in-hospital mortality) by BMI category (reference, overweight, obese), adjusting for age, sex, and prespecified comorbidities. Subgroup analysis was performed on patients with preexisting diabetes. Sitespecific estimates were combined in a meta-analysis. RESULTSAmong 7,244 patients (65.6% overweight/obese), those with overweight were more likely to require oxygen/noninvasive ventilatory support (random effects adjusted odds ratio [aOR], 1.44; 95% CI 1.15-1.80) and invasive mechanical ventilatory support (aOR, 1.22; 95% CI 1.03-1.46). There was no association between overweight and in-hospital mortality (aOR, 0.88; 95% CI 0.74-1.04). Similar effects were observed in patients with obesity or diabetes. In the subgroup analysis, the aOR for any outcome was not additionally increased in those with diabetes and overweight or obesity. CONCLUSIONSIn adults hospitalized with COVID-19, overweight, obesity, and diabetes were associated with increased odds of requiring respiratory support but were not associated with death. In patients with diabetes, the odds of severe COVID-19 were not increased above the BMI-associated risk.

Background: Health care workers (HCWs) are a high-priority group for COVID-19 vaccination for several reasons. Health behavior theory-based studies on the intention or acceptability of COVID-19 vaccination among Indonesian HCWs is lacking. Using an integrated behavioral model, this research sought to identify Indonesian health care workers’ intentions to obtain COVID-19 vaccines. Methods: A countrywide cross-sectional questionnaire-based survey was conducted. The questionnaire was constructed on the basis of IBM (integrated behavioral model) constructs and scored on a seven-point bipolar scale. A hierarchical multivariable regression was used to evaluate the fit of the predictor model as well as the correlations between variables in the study. Results: 3304 people responded to the survey. A model combining demographic and IBM characteristics predicted 42.5 percent (adjusted R2 = 0.42) of the COVID-19 vaccination intention. Vaccination intention was associated with favorable vaccine attitudes, perceived norms, and self-efficacy. Among the determining constructs, behavior belief predicted vaccination intention the best. Being female, being married, having a history of COVID-19 infection, living outside Java Island, and having a low income were all linked to lower vaccination intentions. Conclusions: This study confirms the IBM model’s robustness in predicting health care workers’ intention to vaccinate against COVID-19.

ABSTRAKPendahuluan. Mencapai kontrol asma masih merupakan tujuan yang sulit dicapai sebagian besar pasien meskipun telah tersedia pedoman manajemen asma internasional dan terapi yang terbukti efektif. Tingkat kontrol asma yang rendah diantaranya disebabkan kepatuhan terhadap pengobatan yang rendah. Hingga saat ini faktor-faktor yang berhubungan dengan kepatuhan berobat pasien asma tidak terkontrol masih sedikit diteliti. Penelitian ini bertujuan mengetahui profil kepatuhan berobat pada pasien asma tidak terkontrol dan hubungan antara faktor terkait pasien, faktor terkait penyakit, faktor terkait pengobatan, faktor terkait sosial ekonomi dan faktor terkait sistem pelayanan kesehatan terhadap kepatuhan berobat pasien asma tidak terkontrol Metode. Penelitian potong lintang terhadap pasien asma tidak terkontrol yang datang ke poliklinik alergi dan imunologi RSCM dari bulan Februari 2012 hingga Mei 2012. Semua pasien asma yang memenuhi kriteria dilakukan anamnesis, pemeriksaan fisis lengkap, pengisian kuesioner, tes kontrol asma, tes Beck Depression Inventory dan Asthma General Knowledge Questionnaire. Analisis awal hubungan kepatuhan dengan faktor-faktor yang diteliti menggunakan uji Chisquare. Kemudian dilanjutkan dengan regresi logistik untuk setiap variabel yang bermakna.Hasil. Dari 125 pasien asma tidak terkontrol didapatkan kepatuhan rendah sebesar 56 %. Dilakukan analisis bivariat terhadap faktor-faktor yang berhubungan dengan kepatuhan yaitu usia, pendidikan, pengetahuan asma, penghasilan, depresi, sediaan obat yang digunakan, keyakinan pasien terhadap dokter, asuransi kesehatan dan hubungan keluarga dan didapatkan pengetahuan bermakna dengan p=0,001 (IK 1,789). Kemudian dilakukan regresi logistik didapatkan pengetahuan paling berpengaruh terhadap kepatuhan (p=0,003) dengan OR 6,933 (IK 1,789) Simpulan. Kepatuhan berobat pada pasien asma tidak terkontrol masih rendah dengan pengetahuan merupakan faktor yang berhubungan dengan kepatuhan. Kata kunci. asma, kepatuhan PENDAHULUANAsma merupakan penyakit peradangan kronis pada saluran napas yang diderita lebih dari 300 juta orang didunia.1,2 Secara umum, prevalensi asma cenderung meningkat dari tahun ke tahun baik di negara maju maupun berkembang.2-4 Berdasarkan data di Amerika pada tahun 2009, 1 dari 12 orang (sekitar 25 juta,atau 8% dari populasi) menderita asma. Angka ini merupakan peningkatan dari prevalensi tahun 2001 yaitu 1 dari 14 (sekitar 20 juta, atau 7%). 4Di Indonesia secara nasional prevalensi asma juga meningkat dari 4,2 % tahun 1995 menjadi 5,4 % tahun 2001. Kota Jakarta sendiri memiliki prevalensi gejala asma yang cukup besar yaitu 7,5 % pada tahun 2005. Masalahnya bukan sekedar kenaikan prevalensi semata, tetapi yang tidak kalah penting adalah dampak dari asma itu sendiri. 5Tujuan pengobatan asma adalah untuk mencapai dan mempertahankan kontrol klinis.2-6 Mencapai kontrol asma masih merupakan tujuan yang sulit dicapai oleh sebagian besar pasien. Kenyataan ini terus terjadi meskipun telah tersedianya pedoman manajemen asma internasional selama le...

Pendahuluan. HIV adalah infeksi yang menyerang sistem kekebalan tubuh dengan CD4 sebagai sel targetnya. Ditemukannya Highly Active Antiretroviral Therapy (HAART) diharapkan mampu menurunkan angka morbiditas dan mortalitas HIV. Namun, kenaikan CD4 tidak sama untuk setiap pasien serta terdapat faktor lain yang berhubungan dengan kenaikan CD4 pada pasien HIV.Metode. Studi kohort retrospektif dilakukan pada pasien HIV rawat jalan di Unit Pelayanan Terpadu HIV Rumah Sakit dr. Cipto Mangunkusumo (RSCM) Jakarta selama Mei- Juni 2014.. Data penelitian didapatkan dari rekam medis selama Januari 2004-Desember 2013. Analisis data menggunakan program SPSS dengan uji Mann Whitney, uji Chi Square atau Fisher serta analisis multivariat dengan teknik regresi logistik.Hasil. Sebanyak 818 subjek diikutsertakan pada penelitian ini. Sebanyak 368 (45%) subjek tidak mengalami kenaikan CD4 seperti yang diharapkan. Median CD4 awal sebelum terapi 56 sel/mm3 dan setelah 6 bulan terapi 130 sel/mm3. Terdapat hubungan yang bermakna antara jumlah CD4 awal, infeksi tuberkulosis dan tingkat kepatuhan dengan kenaikan CD4 dengan nilai p masing-masing <0,001, 0,010 dan <0,001. Hasil analisis multivariat didapatkan bahwa jumlah CD4 awal (p<0,001; OR: 0,996; IK 95% 0,995-0,998), tidak patuh minum obat (p<0,001; OR:2,907; IK 95%: 2,162-3,909), dan infeksi tuberkulosis (p=0,021; OR: 1,527; IK 95%: 1,065-2,190) berhubungan dengan kenaikan CD4 pada pasien HIV yang mendapat HAART.Simpulan. Jumlah CD4 awal, kepatuhan minum obat, dan infeksi tuberkulosis mempengaruhi kenaikan CD4 pada pasien HIV yang mendapat Highly Active Antiretroviral Therapy setelah 6 bulan pertama.

Background: The development of Systemic Lupus Erythematosus (SLE) treatment has led the increased of patients survival. Quality of life has became a value based medicine component that should be evaluated in treating SLE. One standardized questionnaire to asses the quality of life in SLE patients is Lupus Quality of Life (Lupus QoL). Currently, in Indonesia, there has not been any spesific questionnaire to asses the quality of life in SLE patients. This study aims to prove that Lupus QoL is valid and reliable to asses the quality of life in SLEpatients in Indonesia.Methods: This study used cross sectional study method. Firstly, we translated the Lupus QoL into Indonesian language, then we tested to 10 respondents. Then, we continued the study with larger sample size. We analyzed the reliability of the test and the re-test result using the interclass coefficient correlation and the internal consistency of the tests using cronbach alpha. Construct validity was evaluated using multi trait scaling analysis and the extrenal validity was evaluated using correlation between domains in short form 36 (SF 36)with Lupus QoL and with disease activity.Results: Data collection was done to 65 SLE patients between October – November 2015 in RSCM. The test has good external validity SF 36 (r=0.38-0.66, p<0.05) and good construct validity (r >0.4; range: 0.44-0.93). The ICC value in one week >0.7 and Cronbach α was>0.7 in each domain. The correlation between lupus QoL and the disease activity was weak and consistentwith other studies.Conclusion: Lupus QoL questionnaire is valid and reliable to asses the quality of life in SLE patients inIndonesia.Key words: Quality of Life, Systemic Lupus Erythematosus, Lupus QoL, Validity, Reliability

Background/Aims: Ramadan fasting creates changes in lifestyle, causing biochemical alterations that affect glucose metabolism and insulin sensitivity. This study aims to assess the impact of Ramadan fasting on glycemic control and Fetuin-A, a glycoprotein that affects insulin resistance, in patients with type 2 diabetes mellitus (T2DM). Materials and methods: This was a prospective study done among 37 patients with T2DM from Internal Medicine Polyclinic in a hospital in Jakarta, Indonesia. Anthropometric data as well as Hemoglobin A1c (HbA1c), Fasting Blood Glucose (FBG), and Fetuin-A levels of the subjects were measured in three time points: before, during, and after Ramadan fasting. A bivariate analysis was done to see the effect of Ramadan fasting on those parameters. Results: Ramadan fasting reduced Fetuin-A levels [median (minimum-maximum), 5.35 (2.91-7.81) vs. 3.22 (2.35-5.60) mg/dl; p ¼ 0.039] four weeks after the end of Ramadan compared to pre-Ramadan. After two weeks of Ramadan fasting, we found a significant reduction in body weight, BMI, FBG, and HbA1c levels which rebounded to baseline level after Ramadan. Conclusion: Ramadan fasting was associated with a significant decrease in Fetuin-A level post Ramadan.

Background. Thalassemia is a hereditary disease, and severe anemia is the main phenotype of major thalassemia. Furthermore, the most important method in the management of this disease is red blood cell transfusion. Regular transfusions administered 1 or 2 times every month improve prognosis and survival. However, there is higher risk of infections and iron overload, especially in transfusion-dependent thalassemia (TDT). Infections are the second leading cause of death in adult TDT, after heart failure. Higher risk of infection is also influenced by multiple blood transfusions which causes alteration in immune response due to alloimmunization, transfusion-related infections, and iron overload. Meanwhile, iron overload in TDT alters both innate and specific immune responses. Furthermore, previous studies have shown the correlation between ferritin with CD4, but this has not been carried out in Indonesia. Therefore, this study aims to determine the correlations between iron overload (serum ferritin and transferrin saturation) and specific immune cells (CD4). Methods. This is a cross-sectional study, and a total number of 64 subjects were examined consecutively. Chest X-ray and blood sera were obtained. The total number of subjects was 64. The seromarkers HBsAg, anti-HCV, and anti-HIV were tested using the ELISA method. Serum ferritin and transferrin saturation was tested using ECLIA, and lymphocyte subsets were analyzed using flowcytometry. Meanwhile, the correlation between variables was determined using Spearman’s test. Results. The results showed that 4.9% subjects were HBsAg positive, 10.7% were anti-HCV positive, and none were anti-HIV positive. There were 4 subjects with lung tuberculosis based on the 41 chest X-ray. Meanwhile, there was a weak negative and insignificant correlation between serum ferritin with CD4 ( p = 0.75 ; r = −0.04) and a weak positive and insignificant correlation between transferrin saturation with CD4 ( p = 0.133 ; r = 0.19). Conclusion. There were no correlations between iron overload (ferritin) and cellular immunity (CD4) in adult transfusion-dependent thalassemia.

Bone loss is one of the emerging extra-articular manifestations of rheumatoid arthritis. TNF-α is the main inflammatory cytokine that can directly increase bone resorption. However, its role in bone formation is still unknown, especially related to secreted frizzled-related protein 1 (SFRP-1), an osteoblast inhibitor. This study examines the correlation between TNF-α and SFRP-1, with a bone turn over marker (CTX and P1NP). This is a cross-sectional study with 38 subjects of premenopausal female patients with RA. This study found that 60.6% of the patients were in remission or low disease activity. The median of TNF-α was 10.6 pg/mL, mean of SFRP-1 was 9.29 ng/mL, mean of CTX was 2.74 ng/mL, and the median of P1NP was 34.04 pg/ml. There is positive correlation between TNF-α and P1NP (r = 0:363, p = 0:026), also between SFRP-1 and P1NP (r = 0:341; p = 0:036). A low level of TNF-?, high level of SFRP-1, high level of CTX, and low level of P1NP in this study indicate a high bone turn over process, with dominant resorption activity in premenopausal female patients with RA.