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"Latar Belakang: Penggunaan heparin inhalasi pada beberapa penelitian COVID-19memberikan hasil dalam perbaikan klinis pasien, baik dalam menurunkan lama rawat,perbaikan oksigenasi paru, dan mortalitas. Dosis harian total heparin inhalasi yangbervariasi terutama bila diberikan bersamaan dengan antikoagulan sistemik, memilikiresiko komplikasi perdarahan yang memerlukan kajian terhadap keefektifan dankeamanannya.Tujuan: Meneliti keefektifan dan keamanan inhalasi heparin dosis 150,000 IU/haridengan dosis 100.000 IU/hari dinilai dari AaDO2, aPTT dan d-Dimer dalam 7 haripengamatan pada pasien ICU COVID-19.Metode: Penelitian ini merupakan penelitian observasional dengan studi kohortretrospektif menggunakan data sekunder rekam medis pasien ICU COVID-19 bulanSeptember 2020 – September 2021. Terdapat 300 sampel menggunakan consecutivesampling. Pasien dikelompokkan menjadi kelompok heparin dosis 150.000 IU/hari dan100.000 IU/hari. Pencatatan dilakukan dalam 7 hari pengamatan. Uji Statistikmenggunakan uji Mann Whitney untuk menilai tingkat keparahan, Uji Wilcoxon rank testuntuk melihat perbedaan variabel dependen hari pertama dengan hari ketujuh padamasing-masing dosis.Hasil: Heparin inhalasi baik dosis 150.000 IU/hari dan 100.000 IU /hari bermaknamenurunkan AaDO2 pada 7 hari pengamatan (p 0.001). Nilai aPTT tidak memanjangpada kedua kelompok, dan kedua dosis heparin sama- sama menurunkan nilai d-Dimerpada 7 hari pengamatan (p 0.001).Simpulan: Heparin Inhalasi dosis 150.000 IU/hari sama efektif dinilai dari AaDO2, dansama amannya terhadap aPTT dan d-Dimer dibandingkan heparin inhalasi dosis 100.000IU/hari.

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Rationale: The use of inhaled heparin in several COVID-19 studies has resulted in

clinical improvements in patients, both in reducing length of treatment, improving

pulmonary oxygenation, and reducing mortality. The varying total daily dose of inhaled

heparin, especially when given together with systemic anticoagulants, poses a risk of

bleeding complications that require review of its effectiveness and safety.

Objective: To analyze effectiveness and safety of heparin inhalation dosage 150,000

IU/day compare to 100,000 IU/day assessed from AaDO2, aPTT and d-Dimer from 7

days observation in ICU COVID-19 patients with invasive and non-invasive ventilator

patterns.

Methods: An observational cohort retrospective study used secondary data from medical

records ICU COVID-19 patients with invasive and noninvasive ventilator patterns from

September 2020 – September 2021. There were 300 samples using consecutive sampling.

Patients divided into 2 groups, one received dosage 150,000 IU / day heparin inhalation,

the other received heparin inhalation dosage 100,000 IU / day. Recording of the research

from medical records is carried out at 7 days of ICU treatment. Statistical tests were

carried out using Mann Whitney to assess severity, Wilcoxon rank test to see the

difference in dependent variables day 1 and day 7 to dose.

Measurements and Main Results: Heparin inhalation at dose of 150,000 IU/day and

100,000 IU/day both significantly decreased AaDO2 at 7 days of observation (p 0.001).

The aPTT on both groups at 7 days of observation are within normal limits. Both doses

of heparin inhalation decreased d-dimer at 7 days of observation (p 0.001).

Conclusion: Inhaled heparin doses of 150,000 IU/day as effective and as safe as inhaled

heparin doses of 100,000 IU/day."

"PT. Kimia Farma Apotek merupakan anak perusahaan dari PT. Kimia Farma (Tbk). PT. KFA saat ini bertransformasi menjadi healthcare provider company. Dengan keberadaan Apotek Kimia Farma yang tersebar luas di seluruh Indonesia, Apotek Kimia Farma menjadi salah satu tujuan utama masyarakat saat hendak berbelanja Vitamin salah satunya Vitamin D. Apotek Kimia Farma khususnya Apotek Kimia Farma 298 Bendungan Hilir menyediakan berbagai macam kebutuhan suplemen dan starter kit sebagai COVID-19 prevention. Analisis terkait dengan hubungan kasus COVID 19 harian di Jakarta terhadap penjualan Vitamin D di Apotek Kimia Farma 298 Bendungan Hilir penting dilakukan untuk dapat membantu menentukan strategi penjualan Vitamin D di apotek. Tujuan dari penelitian ini yaitu mengetahui hubungan kasus COVID 19 harian di Jakarta terhadap penjualan Vitamin D di Apotek Kimia Farma 298 Bendungan Hilir. Penelitian ini dilakukan untuk menemukan korelasi atau hubungan penjualan Vitamin D dengan peningkatan kasus COVID-19 harian di Jakarta dengan menggunakan analisis korelasi atau uji korelasi. Teknik korelasi yang digunakan dalam penelitian ini adalah Korelasi Pearson Product Moment. Analisis data dalam penelitian ini menggunakan IBM SPSS Statistics 21. Kasus COVID 19 harian di Jakarta dan penjualan Vitamin D di Apotek Kimia Farma 298 Bendungan Hilir menunjukkan adanya korelasi sedang dari kedua variabel. Apabila kasus harian COVID-19 di Jakarta meningkat maka berhubungan dengan peningkatan penjualan Vitamin D di Apotek Kimia Farma 298 Bendungan Hilir dan berlaku sebaliknya karena kedua variable saling mempengaruhi.

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PT. Kimia Farma Apotek is a subsidiary of PT. Kimia Farma (Tbk). PT. KFA is currently transforming into a healthcare provider company. With the existence of Kimia Farma Pharmacies that are widely spread throughout Indonesia, Kimia Farma Pharmacy is one of the main destinations for people when they want to shop for Vitamins, one of which is Vitamin D. Kimia Farma Pharmacy, especially Kimia Farma Pharmacy 298 Bendungan Hilir provides various kinds of supplements and starter kit needs as COVID -19 precautions. Analysis related to the relationship of daily COVID 19 cases in Jakarta to sales of Vitamin D at Kimia Farma 298 Bendungan Hilir Pharmacy is important to be able to help determine the sales strategy of Vitamin D at pharmacies. The purpose of this study is to determine the relationship between daily COVID-19 cases in Jakarta and Vitamin D sales at Kimia Farma 298 Bendungan Hilir Pharmacy. This research was conducted to find a correlation or relationship between Vitamin D sales and an increase in daily COVID-19 cases in Jakarta by using a correlation analysis or correlation test. The correlation technique used in this study is the Pearson Product Moment Correlation. Data analysis in this study used IBM SPSS Statistics 21. Daily COVID-19 cases in Jakarta and sales of Vitamin D at Kimia Farma 298 Bendungan Hilir Pharmacy showed a moderate correlation of the two variables. If the daily cases of COVID- 19 in Jakarta increase, it is related to an increase in Vitamin D sales at the Kimia Farma 298 Bendungan Hilir Pharmacy and vice versa because the two variables influence each other."

"Pengkajian dan pelayanan resep merupakan salah satu pelayanan farmasi klinik di Rumah sakit. Pada pengkajian resep salah satu hal penting yang harus dilakukan adalah menganalisis ketepatan indikasi dan dosis obat. Perbedaan dosis pada pasien anak dibandingkan dewasa karena perbedaan fisiologis yang kemudian berkembang pada perbedaan farmakokinaetik obat. Dosis obat pada anak perlu disesuaikan terlebih dahulu agar efek terapi dapat tercapai dan menghindari ROTD (Reaksi Obat yang Tidak Diinginkan). Ketepatan indikasi dan dosis obat pada resep perlu dianalisis terlebih dahulu oleh Apoteker sebelum obat nantinya diberikan. Dalam melakukan analisis tersebut Apoteker perlu memiliki referensi terpercaya sebagai acuan. Laporan analisis kesesuaian dosis-indikasi obat pasien anak di Rawat Inap Rumah Sakit Universitas Indonesia ini dilakukan dengan menganalisis 5 resep yang dipilih secara acak. Berdasarkanreferensi online database terkait obat seperti Micromedex, medicines.org.uk, Lexicomp, Medscape, panduan tatalaksana IDAI, leaflet obat, maupun referensi terkait lainnya dibuat daftar referensi obat dari obat-obatan yang diresepkan pada pasien anak di rawat inap RSUI selama bulan Juli 2023. Dari daftar tersebut kemudian 5 resep yang sudah dipilih dianalisis kesesuaian indikasi dan dosisnya. Berdasarkan hasil analisi disimpulkan bahwa kelima resep tersebut telah tepat indikasi dan tidak ada obat dengan dosis yang melampaui dosis maksimal, sehingga masih sesuai untuk diberikan pada pasien.

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Prescription review and service is one of the clinical pharmacy services in the hospital. In the assessment of prescriptions, one of the important things that must be done is to analyze the accuracy of indications and drug dosages. The difference in dosage in pediatric patients compared to adults is due to physiological differences which then develop in differences in drug pharmacokinetics. The dose of drugs in children needs to be adjusted first so that the therapeutic effect can be achieved and avoid ROTD (Unintended Drug Reactions). The accuracy of the indication and dose of the drug in the prescription needs to be analyzed first by the pharmacist before the drug is given. In conducting this analysis, pharmacists need to have a trusted reference as a reference. This report on the analysis of the appropriateness of the dose-indication of drugs for pediatric patients in the Inpatient Department of the University of Indonesia Hospital was carried out by analyzing 5 randomly selected prescriptions. Based on drug-related online databases such as Micromedex, medicines.org.uk, Lexicomp, Medscape, IDAI management guidelines, drug leaflets, and other related references, a drug reference list of drugs prescribed to pediatric patients in the hospitalization of RSUI during July 2023 was created. From this list, 5 prescriptions that had been selected were analyzed for the suitability of indications and doses. Based on the results of the analysis, it was concluded that the five prescriptions had the right indication and there were no drugs with doses that exceeded the maximum dose, so they were still suitable to be given to patients."

"Peningkatan angka kasus COVID-19 yang tidak terkendali mengakibatkan fasilitas kesehatan di Indonesia kurang mampu untuk menampung seluruh pasien yang terinfeksi COVID-19. Sementara itu, pasien COVID-19 harus mendapatkan pengobatan dan perawatan. Salah satu upaya untuk yang dilakukan adalah isolasi mandiri bagi pasien tanpa gejala dan bergejala ringan. Penelitian ini dilakukan dengan tujuan mengeksplorasi akses pasien COVID-19 untuk memperoleh obat saat isolasi mandiri di rumah serta kendala yang dialami saat isolasi. Instrumen penelitian menggunakan kuesioner yang dikembangkan oleh peneliti berdasarkan studi literatur dan telah divalidasi dua tahap. Kuesioner disebarkan secara online dan mendapatkan 115 responden sebagai subjek penelitian. Butir pertanyaan kuesioner memuat tentang data sosiodemografi, gambaran keadaan subjek saat melakukan isolasi mandiri, dan aspek – aspek akses obat (aksesibilitas, ketersediaan, keterjangkauan). Sebagian besar responden melakukan isolasi mandiri pada periode Januari – Maret (53,2%). Persebaran responden paling banyak melakukan isolasi mandiri di Jakarta (45,22%). Ditinjau dari persentase tertinggi setiap aspek, 71,3% mengatakan sangat mudah dalam aspek aksesibilitas, 48,7% mengatakan ketersediaan obat cukup baik, dan 41,7% mengatakan harga obat cukup terjangkau. Adapun kendala yang terjadi selama isolasi mandiri, seperti kemacetan lalu lintas sehingga membutuhkan waktu lebih untuk ke fasilitas kesehatan, informasi obat tidak valid, serta harga antivirus mahal dengan ketersediaan yang minim. Uji komparatif dilakukan untuk mengetahui faktor yang mempengaruhi akses obat dan terdapat perbedaan bermakna pada variabel periode COVID-19 (p=0,003). Dari hasil analisis skor akses obat, disimpulkan bahwa akses obat saat isolasi mandiri mudah (89,6%) bagi pasien COVID-19 di Jabodetabek.

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The number of COVID-19 cases that increased uncontrollably cause the health facilities in Indonesia being unable to accommodate all patients infected with COVID-19. Meanwhile, patients must receive treatment and care. One of the efforts to do is self- isolation for asymptomatic patients and mild symptoms. This study was conducted with the aim of exploring the accessibility of COVID-19 patients to obtain medication during self-isolation at home and the obstacles experienced during isolation. The research instrument used a questionnaire developed by the researcher based on a literature study and was validated in two stages. The questionnaire was distributed online and got 115 respondents as research subjects. Questionnaire items contain sociodemographic data, a description of the subject's condition when doing self-isolation, and aspects of drug access (accessibility, availability, affordability). Most of the respondents self-isolated in the January – March period (53.2%). The distribution of respondents who mostly self- isolated in Jakarta (45.22%). Judging from the highest percentage of each aspect, 71.3% said it was very easy in terms of accessibility, 48.7% said the drug availability was quite good, and 41.7% said the price of the medicine was quite affordable. The Obstacles that occur during self-isolation, such as traffic jams that require more time to go to health facilities, invalid drug information, and expensive antivirus prices with minimal availability. A comparative test was conducted to determine the factors that influence drug access and there was a significant difference in the COVID-19 period variable (p=0.003). From the results of the analysis of drug access scores, it was concluded that access to drugs during self-isolation is easy (89.6%) for COVID-19 patients in Jabodetabek."

"Latar belakang: Coronavirus Disease 2019 (COVID-19) adalah penyakit baru. Infeksi saluran napas akibat virus yang disertai infeksi bakteri akan meningkatkan derajat keparahan dan angka mortalitas. Insidens ventilator associated pneumonia (VAP) pada kelompok COVID-19 yaitu 21-64%. Kasus VAP dapat menjadi penyebab tingginya mortalitas pada pasien COVID-19 terintubasi.Metode penelitian : Penelitian ini adalah penelitian retrospektif di RS Persahabatan. Seluruh sampel yang digunakan adalah kelompok pasien COVID- 19 terintubasi >48 jam dalam periode tahun 2020-2022 yang memenuhi kriteria inklusi dan eksklusi.Hasil penelitian : Penelitian ini meliputi 196 data penelitian yang memenuhi kriteria inklusi. Proporsi laki-laki lebih banyak dibandingkan perempuan dan hanya 29% adalah populasi usia lanjut. Proporsi VAP pada COVID-19 terintubasi pada tahun 2020-2022 mencapai 60% dengan VAP rates 92,56. Terdapat dua faktor bermakna terhadap VAP pada pasien COVID-19 terintubasi yaitu penggunaan azitromisin (OR 2,92; IK95% 1,29-6,65; nilai-p 0,01) dan komorbid penyakit jantung. (OR 0.38; IK95% 0,17-0,87; nilai-p 0,023). Proporsi terbesar biakan mikroorganisme aspirat endotrakeal adalah Acinetobacter baumannii (44%), Klebsiella pneumoniae (23%), Escherichia coli (9%).Kesimpulan : Proporsi VAP pada COVID-19 terintubasi adalah 60%. Terdapat hubungan bermakna pada penggunaan azitromisin dan komorbid penyakit jantung sedangkan usia lanjut dan penggunaan steroid tidak memiliki hubungan bermakna terhadap VAP pada pasien COVID-19 terintubasi.

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Background : Coronavirus Disease 2019 (COVID-19) is a novel disease. Viral respiratory infection following bacterial infection could increase the severity and mortality of the disease. The incidence of Ventilator (VAP) in COVID-19 group is 21-64%. VAP might be the leading cause of high mortality in intubated COVID-19 patient.

Methods : This research is a retrospective study at Persahabatan hospital. The collected samples is a group of COVID-19 patient intubated for >48 hours in the period of 2020 to 2022 that meet the inclusion and exclusion criteria.

Results : This study consist of 196 data fulfilling the inclusion criteria. Male proportion much greater than female and only 29% is an elderly population. The proportion of VAP in the period of 2020-2022 is 60% with the VAP rates 92,56. There are two factors significantly affected VAP in intubated COVID-19 patient which are the usage of azitromisin (OR 2,92; CI95% 1,29-6,65; p-value 0,01) and cardiovascular disease comorbidity(OR 0.38; CI95% 0,17-0,87; p-value 0,023). The most abundance proportion of endotracheal aspirate microorganism culture are Acinetobacter baumannii (44%), Klebsiella pneumoniae (23%), and Eschrichia coli (9%).

Conclusion : The proportion of VAP in intubated COVID-19 is 60%. There are significant association of azitromicin usage and cardiovascular comorbidity while elderly and the usage of steroid are not significantly associated to VAP in intubated COVID-19 patient."

"COVID-19 atau coronavirus disease 2019 adalah penyakit menular yang memengaruhi sistem organ, terutama sistem pernapasan dan disebabkan oleh virus SARS-CoV-2. Individu yang terinfeksi COVID-19 memiliki tingkat keparahan yang berbeda. Salah satu faktor yang berasosiasi terhadap tingkat keparahan pasien COVID-19 adalah usia. Tingkat keparahan yang tinggi pada kondisi seseorang cenderung mempengaruhi banyaknya treatment yang dibutuhkan, hingga akhirnya juga mempengaruhi waktu yang dibutuhkan seseorang tersebut untuk sembuh. Penelitian ini berfokus pada faktor usia, dimana faktor tersebut diduga menyebabkan perbedaan karakteristik tertentu dari pasien dan durasi rawat yang dibutuhkan oleh pasien COVID-19. Tujuan dari penelitian ini adalah untuk menganalisis perbandingan karakteristik pasien COVID-19 berdasarkan kelompok usia, dan mengidentifikasi bagaimana kaitan usia terhadap durasi rawat pasien COVID-19 hingga mengalami kematian, perbaikan kondisi COVID, dan rawat jalan. Analisis perbandingan karakteristik pasien COVID-19 berdasarkan kelompok usia dilakukan dengan menerapkan metode exploratory data analysis (EDA). Selanjutnya metode EDA dan regression tree diterapkan untuk mengetahui bagaimana kaitan usia terhadap durasi rawat pasien COVID-19 hingga mengalami kematian, perbaikan kondisi, dan rawat jalan. Hasil yang diperoleh pada penelitian ini adalah terdapat kecenderungan perbedaan pada pasien COVID-19 berdasarkan kelompok usia jika dilihat berdasarkan faktor jenis kelamin, durasi rawat, status akhir, gejala, komorbid, komplikasi, dan pengukuran laboratorium darah. Selain itu, usia merupakan pertimbangan utama dalam memperkirakan durasi rawat pasien COVID-19 dengan faktor lainnya adalah hipertensi, klorida, HPR, PWR, MLR dan gejala demam.

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COVID-19 or coronavirus disease 2019 is an infectious disease that affects the organ systems, especially the respiratory system and is caused by the SARS-CoV-2 virus. Individuals infected with COVID-19 have different levels of severity. One of the factors associated with the severity of COVID-19 patients is age. The severity level of a person tends to affect the number of treatments needed, and therefore will affect the time it takes for the person to recover. This study focuses on age, where this factor is suspected to cause differences in certain characteristics of COVID-19 patients and length of hospital stay required by COVID-19 patients. The purpose of this study is to analyse the characteristics comparison of COVID-19 patients by age group, and to identify on how age affects the length of hospital stay for COVID-19 patients to death, improved conditions, or outpatient care. Comparative analysis of the characteristics of COVID-19 patients by age group is done using exploratory data analysis (EDA). Furthermore, EDA and regression tree are used to find out how age is related to the length of hospital stay for COVID-19 patients to death, improved COVID conditions, or outpatient care. The results show that there was tendency of differences in gender, length of hospital stay, clinical outcome, symptoms, comorbidities, complications, and blood laboratory measurements in COVID-19 patients based on age group. In addition, age is a major consideration in estimating the length of hospital stay for COVID-19 patients with other factors such as hypertension, chloride, HPR, PWR, MLR and fever."

"Latar Belakang. Pandemi COVID-19 yang terjadi sejak akhir tahun 2019 telah menginfeksi puluhan juta orang di di dunia, termasuk di Indonesia. Tes pemeriksaan PCR sebagai tes standar untuk diagnosis merupakan salah satu upaya pencegahan sekunder penting untuk mencegah penyebaran penyakit, mengetahui besar masalah dan pengambilan keputusan segera untuk upaya pencegahan selanjutnya. Adanya jeda waku yang panjang untuk menunda pemeriksaan diagnosis PCR ini berpotensi menimbulkan penyebaran virus yang lebih luas dan kemungkinan kesalahan diagnosis. Tujuan. Mengetahui gambaran jeda waktu diagnosis pasien COVID-19 dan faktor-faktor pasien yang berpengaruh. Metode Penelitian. Penelitian dilakukan dengan Sumber data Rekam Medis pasien rawat inap COVID-19 tahun 2020 di Rumah Sakit Universitas Indonesia dengan pendekatan cross sectional. Total sampling dilakukan dengan menerapkan kriteria inklusi dan eksklusi. Hasil. Dari 254 subjek penelitian, laki-laki lebih banyak (55.1%). Panjang jeda waktu diagnosis di luar fasilitas pelayanan kesehatan median 6 hari, di fasilitas pelayanan kesehatan 1 hari, dan total 7 hari. Jumlah pasien terlambat di luar fasilitas pelayanan ksesehatan lebih banyak dibandingn dengan terlambat di dalam fasilitas pelayanan kesehatan (80.7% vs. 5.7%). Dari uji chi-square, faktor yang berhubungan dengan keterlambatan diagnosis yaitu jenis kelamin (p=0.013), umur (p=<0.01), status perkawinan (p=0.021), pendidikan (p=0.024), riwayat kontak (p=0.031), dan gejala (p=0.003). Kesimpulan. Ada hubungan antara keterlambatan diagnosis COVID-19 dengan beberapa faktor demografi dan faktor penyakit pasien.

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Background. The COVID-19 pandemic that has occurred since the end of 2019 has infected tens of millions of people worldwide, including in Indonesia. PCR test as a standard test for diagnosis is one of the important secondary prevention efforts to prevent the spread of the disease, find out the magnitude of the problem and make immediate decisions for further prevention. This long delay in delaying PCR diagnosis may represent a wider spread of the virus and a possible misdiagnosis. Objective. To find out the description of the time lag in the diagnosis of COVID-19 patients and the factors that influence it Research methods. The study was conducted using Medical Record data sources for COVID-19 inpatients in 2020 at the Universitas Indonesia Hospital with a cross sectional approach. Total sampling was done by applying inclusion and exclusion criteria. Results. Of the 254 research subjects, more men (55.1%). The length of time delay for diagnosis outside health care facilities is a median of 6 days, at a health service facility 1 day, and a total of 7 days. The number of late patients outside health care facilities was higher than those late in health care facilities (80.7% vs. 5.7%). From the chi-square test, factors associated with late diagnosis were gender (p=0.013), age (p=<0.01), marital status (p=0.021), education (p=0.024), contact history (p=0.031), and symptoms (p=0.003). Conclusion. There is a relationship between the delay in the diagnosis of COVID-19 with several demographic factors and patient disease factors."

"Pendahuluan: Deep Vein Thrombosis (DVT) memiliki kecenderungan terus meningkat dengan koinsidensi mortalitas jangka pendek dan morbiditas jangka panjang. COVID-19 dapat menyebabkan hypercoagulable state dan menjadi predisposisi terjadinya DVT. Penelitian ini bertujuan untuk menganalisis hubungan kadar fibrinogen, D-Dimer, dan dosis heparin teraupetik berdasarkan kadar APTT dengan adanya COVID-19 pada pasien DVT. Metode: Desain penelitian komparatif dan kohort prospektif digunakan untuk membandingkan kadar fibrinogen, D-Dimer, dan dosis heparin terapeutik antara pasien COVID-19 dan non COVID-19 yang menderita DVT di RSPN Cipto Mangunkusumo pada bulan Maret 2020 – Maret 2022. Penegakan diagnosis DVT dilakukan dengan pemeriksaan ultrasonografi dan/atau computed tomography angiography (CTA) fase vena. Data variabel utama dan lainnya diperoleh dari rekam medis pasien. Uji T independen atau Mann-Whitney digunakan untuk menganalisis perbedaan nilai variabel antara kedua kelompok. Hasil: Dari total 253 sampel, tidak terdapat perbedaan karakterisitik awal antara kelompok DVT COVID-19 (n=44) dan DVT non COVID-19 (n=209), kecuali pada parameter Wells Score. Kelompok DVT COVID-19 memiliki kadar Fibrinogen, D-Dimer, dan aPTT yang lebih tinggi daripada kelompok DVT non COVID-19, baik sebelum terapi maupun sesudah terapi heparanisasi (semua nilai p =0,000). Pada akhir pengamatan, didapatkan dosis heparin terapeutik pada kelompok DVT COVID-19 lebih tinggi dibanding pada kelompok DVT non COVID-19 (30,00 (20,00-40,00)x103 U vs. 25,00 (20,00-35,00)x103 U, p=0,000). Kesimpulan: Kadar fibriongen, D-Dimer, dan dosis heparin terapeutik pada pasien DVT yang menderita COVID-19 lebih tinggi dibandingkan pada pasien DVT yang tidak menderita COVID-19. Inisiasi pemberian dosis heparin terapeutik dosis tinggi dapat dipertimbangkan pada pasien DVT dengan komorbid COVID-19 dan dipandu oleh hasil pemeriksaan biomarker koagulasi darah.

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Introduction: Deep Vein Thrombosis (DVT) has an increasing trend with a coincidence of short-term mortality and long-term morbidity. COVID-19 can cause a hypercoagulable state and predispose to DVT. This study aims to analyze the relationship between fibrinogen levels, D-Dimer, and therapeutic heparin doses based on APTT levels in the presence of COVID-19 in DVT patients. Methods: A comparative study design and a prospective cohort were used to compare levels of fibrinogen, D-Dimer, and therapeutic heparin doses between COVID-19 and non-COVID-19 patients suffering from DVT at Cipto Mangunkusumo Hospital in March 2020 – March 2022. Diagnosis of DVT was performed by ultrasound examination and/or computed tomography angiography (CTA) venous phase. The primary variable data and others were obtained from the patient's medical record. An Independent T-test or Mann-Whitney was used to analyze the differences in variable values between the two groups. Results: Of 253 samples, there was no difference in initial characteristics between the DVT COVID-19 (n=44) and non-COVID-19 DVT groups (n=209), except for the Wells Score parameter. The COVID-19 DVT group had higher levels of fibrinogen, D-Dimer, and aPTT than the non-COVID-19 DVT group, both before and after heparinization therapy (all p-values = 0.000). At the end of the follow-up period, the therapeutic dose of heparin in the COVID-19 DVT group was higher than in the non-COVID-19 DVT group (30.00 (20.00-40.00)x103 U vs. 25.00 (20.00-35.00)x103 U, p-value=0.000). Conclusion: The levels of fibrinogen, D-Dimer, and therapeutic doses of heparin in DVT patients who have COVID-19 are higher than in DVT patients who do not have COVID-19. Initiation of a higher therapeutic dose of heparin can be considered in DVT patients with comorbid COVID-19 and guided by the results of blood coagulation biomarkers."

"Latar Belakang: Pandemi COVID-19 telah menjadi tantangan besar bagi dunia kesehatan. Tenaga kesehatan merupakan populasi yang sangat rentan tertular dikarenakan tingginya intensitas dan frekuensi pajanan SARS-CoV-2. Risiko penularan meningkat apabila tenaga medis melakukan tindakan yang memicu aerosilisasi, salah satunya adalah intubasi endotrakeal karena tingginya viral load pada saluran napas. Sebanyak 3,2% pasien COVID-19 memerlukan tindakan intubasi endotrakeal dan ventilasi mekanis. Intubasi endotrakeal yang efektif pada pasien COVID-19 penting dilakukan untuk menurunkan mortalitas dan risiko penularan. Penelitian ini bertujuan intuk mengetahui faktor-faktor yang memengaruhi efektivitas intubasi endotrakeal pada pasien terkonfirmasi COVID- 19 di RSUP Persahabatan.Metode: Penelitian ini merupakan penelitian observasional yang menggunakan desain potong lintang yang dilakukan di IGD, ICU Rasmin Rasjid dan ICU PINERE RSUP Persahabatan pada bulan Juni 2021 – Juni 2022. Subjek peneltian ini adalah pasien terkonfirmasi COVID-19 yang dilakukan tindakan intubasi endotrakeal yang memenuhi kriteria inklusi dan eksklusi. Tindakan intubasi endotrakeal dinilai dari observasi rekaman CCTV. Selanjutnya karakteristik subjek, karakteristik intubasi endotrakeal dan faktor-faktor yang memengaruhi intubasi endotrakeal dievaluasi.Hasil: Pada penelitian ini didapatkan 59 subjek penelitian. Proporsi intubasi endotrakeal efektif pada pasien COVID-19 sebesar 20,34%. Median lama waktu tindakan intubasi endotrakeal adalah 38 (19-189) detik. Sebanyak 32 (54,24%) tindakan intubasi endotrakeal dilakukan oleh spesialis anestesi dan 27 (45,76%) oleh PPDS Pulmonologi dan Kedokteran Respirasi. Hasil analisis bivariat didapatkan hasil bermakna secara statistik pada variabel penyakit kardiovaskular+DM (OR 0,24 (IK 95% 0,06-0,91), p=0,028) dan variabel operator (OR 0,07 (IK 95% 0,01-0,62), p=0,004). Hasil analisis multivariat menunjukkan hasil bermakna secara statistik hanya pada variabel operator (adjusted OR 0,06 (IK 95% 0,01-0,60), p=0,016).Kesimpulan: Terdapat hubungan penyakit kardiovaskular+DM dan operator terhadap intubasi endotrakeal efektif pada pasien COVID-19 di RSUP Persahabatan.

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Background: The COVID-19 pandemic has become a major challenge for the healthcare system. Healthcare workers are vulnerable population of COVID-19 transmission due to high intensity and frequency of exposure to SARS-CoV-2. The risk of transmission increases in aerosolization procedure such as endotracheal intubation because of the high viral load in the airways. Approximately 3.2% of COVID-19 patients require endotracheal intubation and mechanical ventilation. Effective endotracheal intubation in COVID-19 patients is important parameter to reduce mortality and the risk of transmission to healthcare workers. This study aims to determine the factors that influence the effectiveness of endotracheal intubation in patients with COVID-19 in National Respiratory Center, Persahabatan Hospital.

Methods: This study is an observational study using a cross-sectional design which was carried out in the emergency department, ICU Rasmin Rasjid and ICU PINERE of National Respiratory Center, Persahabatan Hospital in June 2021 – June 2022. The subjects of this study were COVID-19 patients who underwent endotracheal intubation who met the criteria inclusion and exclusion. The endotracheal intubation procedure was assessed from the observation of CCTV recordings. The characteristics of the subject, the characteristics of endotracheal intubation and the factors that influence endotracheal intubation were evaluated.

Results: In this study, there were 59 subjects. The proportion of effective endotracheal intubation in COVID-19 patients was 20.34%. The median length of time for endotracheal intubation was 38 (19-189) seconds. Among the subjects, 32 (54.24%) endotracheal intubation were performed by anesthesiologists and 27 (45.76%) were performed by Pulmonology and Respiratory Medicine residents. The results of the bivariate analysis showed statistically significant results on the cardiovascular disease + DM comorbid (OR 0.24 (95% CI 0.06-0.91), p=0.028) and operator (OR 0.07 (95% CI 0.01-0.62), p=0.04). The results of the multivariate analysis showed statistically significant results only for operator (adjusted OR 0.06 (95% CI 0.01-0.60), p=0.016).

Conclusion: There is relationship of cardiovascular disease + DM comorbid and operator with effective endotracheal intubation in COVID-19 patients at National Respiratory Center, Persahabatan Hospital."

"Pandemi COVID-19 merupakan tantangan besar yang dihadapi dunia saat ini. Puncak pandemi yang terjadi di Indonesia menjadi tantangan baru dalam tatalaksana pasien COVID-19 di Instalasi Gawat Darurat (IGD) dengan segala keterbatasannya. Modifikasi dilakukan sebagai upaya stabilisasi pasien dengan memperhatikan prinsip penangan oksigenasi pasien COVID-19, yaitu dengan strategi eskalasi dan memaksimalkan penggunaan terapi oksigen non invasif. Studi kasus ini menggambarkan upaya stabilisasi pasien, perempuan berusia 55 tahvun dengan Probable COVID-19 derajat berat yang datang ke IGD dengan saturasi 53% menggunakan simple mask. Berdasarkan hasil pemeriksaan, masalah keperawatan yang diangkat adalah gangguan pertukaran gas. Intervensi keperawatan yang diberikan adalah pemberian terapi oksigen dan pengaturan posisi. Modifikasi dilakukan dengan memberikan terapi oksigen Non-Rebreathing Mask (NRM) dan nasal kanul disertai dengan proning position secara bersamaan. Setelah dilakukan terapi tersebut didapatkan status oksigenasi pasien lebih baik dibandingkan sebelum mendapatkan terapi.

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The COVID-19 pandemic is a major chalenge facing the world today. The peak of pandemic that occurred in Indonesia was a new chalenge in the management of COVID- 19 patients in emergency unit with al its limitations. The modification was carried out as an effort to stabilize the patient by paying attention to the oxygenation principes of COVID-19 patients, namely by escalation strategies and maximizing the use of non- invasive oxygen therapy. This case study describes an effort to stabilize the patient, a 55- year-old female with severe COVID-19 who came to the ED with a saturation of 53% using a simple mask. Based on the examination result, the nursing problem which raised was gas exchange disorders. The intervention which given was providing oxygen therapy and positioning. Modifications were carried out by giving Non-Rebreathing Mask (NRM) and nasal cannula accompanied by a proning position simultaneously. After the therapy, the patient's oxygenation status was better than before receiving the therapy."