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Highlights 1. VCO can accelerate AFB sputum conversion in tuberculosis infection. 2. VCO can decrease SOD levels as a marker of inflammation. Abstract Background: Pulmonary tuberculosis has the potential to raise illness and death rates on a global scale significantly. A low sputum conversion rate for acid-fast bacilli (AFB) and malnutrition are indicators of failure in pulmonary TB treatment. Virgin coconut oil (VCO) contains lauric acid and has antibacterial, antioxidant, and anti-inflammatory effects. Objective: This study aimed to examine the effect of VCO supplementation on sputum AFB conversion rates, superoxide dismutase (SOD) levels, and body mass index (BMI) status of pulmonary TB patients. Material and Methods: This study was an analytic experimental study measuring BMI levels and SOD levels at the Pekauman Community Health Center, Sultan Suriansyah Hospital, and Ulin Hospital, Banjarmasin, Indonesia, between July and September 2023. This study, 40 samples were separated into two groups: the treatment group, which received first-line antithyroid drugs (ATD) with VCO, and the control group, which received first-line ATD and a placebo. Results: Based on the proportion, there was an improvement in the acceleration of BTA sputum conversion, and from the mean BMI and the median value of both groups, there was a decrease in SOD levels after VCO administration. No statistically significant association was found between VCO administration and accelerating the AFB sputum conversion and BMI at the end of the fourth and eighth weeks (p>0.05). Additionally, there was no relationship considered between VCO administration and reducing SOD levels before and after treatment (p>0.05). Conclusion: VCO administration had no relationship with the level of AFB sputum conversion, reduction in SOD levels, and BMI status in pulmonary TB patients.

Introduction: Tuberculosis (TB) remains a global health problem that causes high morbidity and mortality. Based on its classification, TB is divided into drug-sensitive (DS) and drug-resistant (DR). Several risk factors susceptible to TB are malnutrition with low body mass index (BMI), vitamin D deficiency (VDD), and low total lymphocyte count (TLC) related to low immune status. This study aimed to examine the relationship between vitamin D (VD), BMI, and TLC in the TB population in Banjarmasin. Methods: This was an analytic observational study with a cross-sectional design. The total study sample was 42 patients, confirmed by rapid molecular testing, who had not been treated for TB in Banjarmasin from January to May 2023 and met the inclusion and exclusion criteria. Chi-Square and Fisher's exact statistical tests were used to see the relationship between VD, BMI, and TLC in DS TB and DR TB. Results: The median age of DS TB was 38 (24-52) years old, and DR TB was 51 (37-58) years old. Most of the gender was male (24 patients/57.1%). There was a statistically significant difference between VD and BMI in DS TB and DR TB (p = 0.048; p = 0.019). There was a significant relationship between VD and TLC in DS TB and DR TB (p = 0.048). Conclusion: VD and BMI significantly differed in DS TB and DR TB. There was a significant correlation between VD and TLC in TB patients.

Background: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has undergone various mutations of Corona Virus Disease 2019 (COVID-19). The World Health Organization (WHO) has designated B.1.617.2 (Delta) and B.1.1.529 (Omicron) as variants of concern (VOC). Since clinical features and epidemiological characteristics of patients infected with SARS-CoV-2 variants remain largely unknown, especially in Indonesia, this study aimed to identify the clinical characteristics of COVID-19 patients from South Kalimantan, Indonesia. Methods: Data from medical records of COVID-19 patients at Ulin General Hospital Banjarmasin from June 2021 to February 2022 were randomly extracted, containing demographic data, comorbidities, and laboratory data, as well as the type of virus. Results: In total, 32 patients were included, 9 were infected with delta, 14 with probable omicrons, and 9 with non-VOC. Patients in the probable Omicron group were significantly older than other groups (median age 64 years old, range 54–73 years; p=0.049), had hypertension as the dominant comorbidity (85.7%; p=0.039), the onset appeared slightly earlier (median 3 days; range 2-3 days, p=0.062), with no anosmia symptom (p=0.006). Critical illness predominated and mostly survived in all variants but was not statistically significant (p=0.590 and 0.726, respectively). The three variants showed similarities in laboratory findings; hence, statistical analysis suggested that the leucocytes differed significantly (p=0.020). Conclusions: Patients with the likely Omicron variant are much older, have hypertension as their main comorbidity, do not have any symptoms of anosmia, and have higher leukocyte counts compared to other variants.

Corona Virus Disease (COVID-19) is becoming a global pandemic. Indonesia, especially South Kalimantan had recorded increasing cases with a high fatality rate of 3.7%. Information about factors related to outcomesbased on clinical and laboratory features in Indonesia is still limited. Identification of the risk is crucial to determine optimal management and reducing mortality. This retrospective study enrolled 455 adults COVID-19 patients and data were extracted from med-ical records of Ulin General Hospital Banjarmasin.The latter is COVID-19 refer-ral hospital in South Kalimantan between March-November 2020. Demographic data, comorbidities,and laboratory were all collected. Data were compared be-tween survivors and non-survivors. Fisher’s exact test and chi-square wereused to compare categorical variables. The Mann-Whitney U test was used to compare continuous variables. Analysis was continued by multivariate logistic regression then receiver operating characteristic (ROC) curve to determine cut-off value. The multivariate analysis showed that number of comorbidities [odds ratio (OR) 1,339 (95% confidence interval (CI): 1,064-1,685, P = 0,013) was significant risk factor to the outcome. In laboratory, lactate dehydrogenase (LDH) [OR: 1.001, 95% CI: 1,000-1.002, P = 0.001], Ferritin (OR 1.000, CI: 1,000-1.001, P = 0.013), APTT (OR: 1.045, CI: 1.010-1.082, P = 0.012), and D-dimer (OR: 1.188, CI: 1.064 -1.327, P = 0.002) were significant predictor factors but only LDH, ferritin and D-dimer were obtained good AUC 0.731, 0.715, and 0.705, respectively. The cut of the value of LDH was 656.5 U/L, ferritin was 672.18 ng/ml, and D-dimer was 2.28 mg/L. Sensitivity and specificity were 66.7% and 68,0% for LDH, 83,2% and 56,3% for ferritin, and 62,8 and 70,8% for D-dimer. From this research,we re-vealed that the number of comorbidities was a risk factor for death. Elevated LDH, ferritin, and D-dimer could be good predictive factors for poor outcomes, thereby considering theaccelerating management of COVID-19 patients

Background: Corona Virus Disease (COVID-19) has become a global pandemic and has spread to more than 200 countries including Indonesia. South Kalimantan is one of the provinces in Indonesia that has a high COVID-19 mortality rate (case fatality rate 4.1%). Information about characteristic of mortality patients with SARS-CoV-2 infection in Indonesia was limited. The objective of this study to describe clinical characteristics of COVID-19-confirmed deaths at Ulin Regional Hospital Banjarmasin, as a referral hospital in South Kalimantan Methods: Medical records of 108 hospitalized patients dying with COVID-19 between March until August 2020 were collected. The recorded information included gender, age, onset and severity of disease, comorbidities, symptoms, signs, and laboratory findings Results: The 108 confirmed cases of COVID-19 deaths were mostly male (73.1%) aged

Latar Belakang: Corona Virus Disease-19 (COVID-19) merupakan penyakit pandemi yang dapat menyebabkan komplikasi tromboemboli sebagai akibat terjadinya koagulopati dengan insidensi sekitar 16.5-21%. Salah satu patofisiologi koagulopati pada pasien COVID-19 disebabkan oleh proses inflamasi. Peningkatan faktor inflamasi, faktor koagulasi, dan skoring klinis digunakan sebagai prediksi terjadinya komplikasi tromboemboli. Pemberian antikoagulan memiliki peran untuk mencegah terjadinya komplikasi tersebut. Kasus: Pasien laki-laki, 43 tahun, positif COVID-19 dengan skor PADUA = 4, peningkatan D-dimer dan mendapatkan terapi profilaksis antikoagulan. Dalam perawatan hari ke-14, sesak napas memberat, takikardi dan hipoksemia dialami pasien. Didapatkan gambaran Humpton’s hump pada foto toraks dan gambaran elektrokardiography (EKG) pola S1Q3T3 dan corrected QT interval (QTc) 552 mms. Penatalaksanaan pasien dengan ventilasi mekanik dan terapi unfractionated heparin (UFH) dosis terapeutik. Saat pasien bebas dari sedasi, ditemukan kelemahan tubuh bagian kiri. Diskusi: Gejala klinis emboli paru umumnya berupa dispnea/takipnea, takikardi, sianosis, hemoptisis, hipoksemia dengan onset akut. Berdasarkan keparahannya, dibagi menjadi masif, sub-masif, risiko rendah. Gambaran Humpton’s hump pada foto toraks dapat menjadi dugaan terjadi emboli paru. Pemeriksaan computed tomography pulmonary angiogram (CTPA) merupakan standar diagnosisnya, namun EKG dapat digunakan sebagai modalitas kecurigaan emboli dengan gambaran takikardi/takiaritmia, pola S1Q3T3 dan pemanjangan interval QTc. Pemberian antikoagulan sebagai tromboprofilaksis tetap tidak dapat mencegah terjadinya komplikasi tromboemboli seperti terjadinya stroke iskemik, tetapi emboli paru merupakan komplikasi tromboemboli yang paling sering terjadi. Kesimpulan: Evaluasi klinis, EKG secara rutin dan kadar D-dimer dapat menjadi pertimbangan dalam pemberian tromboprofilaksis dan dapat menjadi strategi penapisan awal risiko komplikasi tromboemboli. Pada pasien COVID-19 derajat kritis perlu dipertimbangkan pemberian antikoagulan yang lebih agresif dan menggunakan dosis terapeutik.

Latar Belakang: Corona Virus Disease 2019 (COVID-19) adalah penyakit pandemi yang menjadi masalah global yang melanda seluruh dunia. Manifestasi klinis dan tingkat keparahan penyakit COVID-19 sangat bervariasi. Pada pasien COVID-19 derajat kritis yang memerlukan perawatan di intensive care unit (ICU) telah ditemukan adanya proses badai sitokin yang meningkatkan mortalitas dan morbiditas. Interleukin-6 (IL-6) berperan dalam terjadinya badai sitokin. Kasus: Berikut kami laporkan serial kasus 5 pasien COVID-19 terkonfirmasi positif derajat sedang-kritis yang diberikan tocilizumab (TCZ) sebagai suatu IL-6 inhibitor yang memiliki potensi terapi menurunkan mortalitas dan morbiditas pasien COVID-19 derajat berat-kritis. Pembahasan: Dari 5 pasien yang diberikan TCZ, didapatkan hasil 3 pasien bisa pulang dan 2 pasien meninggal. Terdapat potensi pemberian IL-6 inhibitor karena dari patofisiologi penyakit COVID-19 yang berkaitan dengan IL-6 dan badai sitokin. IL-6 inhibitor dapat menurunkan mortalitas dan morbiditas dengan mencegah terjadinya badai sitokin. Hal ini diukur menggunakan evaluasi onset penyakit, kadar biomarker inflamasi dan gangguan koagulasi yang sering diteliti pada pasien COVID-19 seperti c-reactive protein (CRP), lactate dehydrogenase (LDH), D-Dimer dan ferritin. Kesimpulan: Pemberian TCZ memiliki potensi efek terapeutik jika diberikan pada onset penyakit