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"Latar belakang: Infeksi SARS-CoV-2 menyebabkan disregulasi sistem imun sehingga memperberat klinis pasien. Penilaian CT dan parameter inflamasi pejamu (neutrofil, limfosit, CRP dan feritin) saat admisi diharapkan membantu klinisi memberi tatalaksana efektif bagi pasien berisiko perburukan.Tujuan: Mengetahui pengaruh nilai CT dan parameter inflamasi pejamu saat admisi terhadap derajat penyakit COVID-19 dalam 14 hari sejak onset gejala.Metode: Studi kohort retrospektif dengan menelusuri rekam medis pasien COVID-19 berusia >18 tahun yang dirawat di RSCM dan RS Medistra pada Juni 2020-Februari 2021. Dilakukan analisis bivariat antara nilai CT, neutrofil, limfosit, CRP, feritin saat admisi dengan keparahan COVID-19, dilanjutkan analisis ROC untuk mendapatkan titik potong optimal. Setelahnya, dilakukan analisis multivariat dan membuat model klinis terbaik menilai kemungkinan keparahan COVID-19.Hasil: Dari 336 subjek didapatkan COVID-19 berat-kritis sejumlah 75,3%. Tidak terdapat hubungan antara nilai CT rendah-sedang dan CT rendah-tinggi terhadap keparahan COVID-19 dengan nilai p masing-masing 0129 dan 0,913, sementara itu terdapat hubungan signifikan antara neutrofil, limfosit, CRP dan feritin terhadap keparahan COVID-19 dengan masing-masing nilai p<0,001. Dari analisis ROC, didapat titik potong optimal neutrofil (>71,5%), limfosit (<18,5%), CRP (>17,2 mg/dL), feritin (270 ng/mL) terhadap terjadinya COVID-19 berat-kritis dalam 14 hari sejak onset gejala. Hasil analisis multivariat menujukkan faktor yang mempengaruhi COVID-19 berat-kritis antara lain neutrofil (aRR 1,850 [IK 95% 1,482-2,311]), limfosit (aRR 1,877 [IK 95% 1,501 – 2,348]), CRP (aRR 2,068 [IK 95% 1,593 – 2,685]), dan feritin (aRR 1,841 [IK 95% 1,438 – 2,357]). Model klinis kombinasi neutrofil, limfosit, CPR dan feritin terhadap COVID-19 berat-kritis memiliki nilai AUC 0,933 (IK 95% 0,902 – 0,963). Kesimpulan: nilai CT tidak mempengaruhi COVID-19 tidak berat dan berat-kritis. Neutrofil, limfosit, CRP, dan feritin saat admisi mempengaruhi terjadinya COVID-19 tidak berat dan berat-kritis Kombinasi neutrofil, limfosit, CRP dan feritin merupakan model klinis terbaik menilai kemungkinan keparahan COVID-19 dalam 14 hari sejak onset gejala.

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Background: SARS-CoV-2 infection leads to immune dysregulation and hyperinflammation, thus potentially exacerbating clinical outcomes. Assessing CT value and host inflammatory parameters such as neutrophils, lymphocytes, CRP, and feritin upon admission may assist clinicians in providing effective management, especially for patient at risk of severe-critical condition.

Objective: To analyze the effect of CT values and host inflammatory parameters upon admission on the severity of COVID-19 within 14 days of symptom onset.

Methods: A retrospective cohort study tracing COVID-19 patient’s medical records aged >18 years admitted to RSUPN Ciptomangunkusumo and RS Medistra from June 2020 to February 2021. Bivariate analysis was conducted between CT values, neutrophils, lymphocytes, CRP, feritin on admission with COVID-19 severity, then ROC analysis to determine the optimal cut off points. Multivariate analysis was performed to control confounding factors. The best clinical model was analyzed for severe-critical outcome within 14 days of symptom onset.

Results: Out of 336 subjects, 75,3% had severe-critical COVID-19. There was no association between low-moderate CT value and low-high CT value with COVID-19 severity, with p value 0,129 and 0,913 respectively. However, there was significant association between neutrophils, lymphocytes, CRP, and feritins with COVID-19 severity, each with p<0.001. ROC analysis determined optimal cut off for neutrophils (>71.5%), lymphocytes (<18.5%), CRP (>17.2 mg/dL), and feritin (270 ng/mL) for the occurrence of severe-critical COVDI-19 within 14 days symptom onset. Multivariate analysis revealed factors influencing severe-critical COVID-19 including neutrophils (aRR 1.850 [95% CI 1.482-2.311]), lymphocytes (aRR 1.877 [95% CI 1.501 – 2.348]), CRP (aRR 2.068 [95% CI 1.593 – 2.685]), and feritin (aRR 1.841 [95% CI 1.438 – 2.357]). Combination of neutrophil, lymphocytes, CRP, and feritin was the best clinical model for severe-critical COVID-19 with AUC value 0.933 (95% CI 0.902 – 0.963).

Conclusion: Neutrophils, lymphocytes, CRP, and feritin value upon admission effect COVID-19 severity within 14 days of symptom onset"

"Latar Belakang: Melihat potensi tingginya jumlah virus didalam rongga mulut, dengan bukti bahwa SARS-CoV-2 ditemukan pada reseptor ACE2, perlu upaya untuk mencegah penularan dari pasien ke praktisi melalui saliva yang terkontaminasi. Virus ini menyebar lebih cepat karena SARS-CoV-2 bereplikasi disaluran pernapasan bagian atas dengan melepaskan patogen yang berpindah dari satu orang ke orang lain saat bersin dan batuk melalui penyebaran pernapasan. Diperkirakan waktu penularan bisa terjadi sebelum gejala muncul (sekitar 2,5 hari lebih awal dari munculnya gejala). Berkumur dengan hidrogen peroksida dapat menghilangkan lapisan permukaan epitel pada mukosa mulut yang diketahui terdapat reseptor ACE2 tempat terikatnya SARS- CoV-2 dan dapat menginaktivasi virus tersebut. Pedoman sementara American Dental Association (ADA) menyarankan penggunaan 1,5% Hidrogen peroksida sebagai pilihan untuk pembilasan mulut preoperatif sebagai obat kumur antiseptik. Nilai cycle threshold yang diperoleh RT – PCR bersifat semi-kuantitatif dan mampu membedakan antara viral load tinggi dan rendah. Tujuan Penelitian: Mengevaluasi perbedaan pengaruh penggunaan obat kumur diantara berkumur hidrogen peroksida 1,5% dan hidrogen peroksida 3% terhadap nilai cycle threshold RT-PCR pada pasien COVID - 19. Metode Penelitian: 42 subjek penelitian diambil dari pasien RSUP Persahabatan yang terinfeksi SARS-CoV-2 sesuai dengan kriteria inklusi dan ekslusi. Setelah dilakukan informed consent, subjek penelitian dibagi menjadi 3 kelompok, yaitu kelompok hidrogen peroksida 1,5%, kelompok hidrogen peroksida 3% dan kelompok kontrol. Subjek penelitian berkumur 30 detik di rongga mulut dan 30 detik di tenggorokan belakang dengan 15 ml sebanyak 3 kali sehari selama 5 hari. Analisis menggunakan nilai cycle threshold pada pemeriksaan RT-PCR pada hari ke-1, hari ke-3 dan hari ke-5 setelah berkumur. Hasil: Terdapat perbedaan bermakna pada hasil uji Friedman dan peningkatan nilai cycle threshold RT-PCR dari awal, hari ke-1, hari ke-3 dan hari ke-5 di keseluruhan kelompok dan masing – masing kelompok perlakuan. Peningkatan tertinggi nilai cycle threshold RT-PCR awal hingga hari ke-1 ditemukan pada kelompok hidrogen peroksida 3%, kemudian antara hari ke-1 hingga ke-3 dan hari ke-3 hingga hari ke-5 ditemukan pada kelompok hidrogen peroksida 1,5%. Kesimpulan: Berkumur hidrogen peroksida 1,5% dan hidrogen peroksida 3% berpengaruh terhadap peningkatan nilai cycle threshold RT-PCR SARS-CoV-2. Kedua konsentrasi hidrogen peroksida 1,5% dan hidrogen peroksida 3% memberikan pengaruh positif dalam menurunkan jumlah virus di rongga mulut, sehingga pilihan penggunaan konsentrasi hidrogen peroksida yang lebih kecil bisa menjadi pilihan untuk digunakan untuk berkumur.

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Background: Given the potential high number of viruses in the oral cavity, with evidence that SARS-CoV-2 is found at the ACE2 receptor, efforts are needed to prevent transmission from patient to practitioner through contaminated saliva. This virus spreads faster because SARS-CoV-2 replicates in the upper respiratory tract by releasing pathogens that are passed from one person to another when sneezing and coughing through respiratory spread. It is estimated that the time of transmission can occur before symptoms appear (about 2.5 days earlier than the onset of symptoms). Mouth rinse and gargling with hydrogen peroxide can remove the epithelial surface layer on the oral mucosa which is known to have ACE2 receptors where SARS-CoV-2 binds and can inactivate the virus. Interim guidelines of the American Dental Association (ADA) recommend the use of 1.5% hydrogen peroxide as an option for preoperative oral rinse as an antiseptic mouth rinse. The cycle threshold value obtained by RT-PCR is semi-quantitative and able to distinguish between high and low viral loads.

Objective: To evaluate the difference in the effect of using mouth rinse between 1.5% hydrogen peroxide and 3% hydrogen peroxide mouth rinse and gargling on the RT-PCR cycle threshold value in COVID-19 patients.

Methods: 42 subjects were patients recruited from Persahabatan General Hospital infected with SARS-CoV-2 according to the inclusion and exclusion criteria. Following informed consent procedure, the research subjects were divided into 3 groups, namely the 1.5% hydrogen peroxide group, the 3% hydrogen peroxide group and the control group. The subjects were instructed to rinse their mouths for 30 seconds and gargle for 30 seconds at the back of the throat with 15 ml of the mouth rinse 3 times a day for 5 days. Analysis of cycle threshold values was carried out using RT-PCR on day 1, day 3 and day 5 after mouth rinse and gargling.

Results: There were significant differences in the results of the Friedman test and an increase in the RT-PCR cycle threshold value starting from the beginning, day 1, day 3 and day 5 in the whole group and each treatment group. The highest increase RT-PCR cycle threshold value at day 1 was found in the 3% hydrogen peroxide group, while the increase between day 1 to 3 and day 3 to day 5 was found in the 1.5% hydrogen peroxide group.

Conclusion: Mouth rinse and gargling with 1.5% hydrogen peroxide and 3% hydrogen peroxide has an effect on increasing the cycle threshold value of the SARS-CoV-2 RT-PCR. Both 1.5% and 3% hydrogen peroxide concentration have a positive effect in reducing the number of viruses in the oral cavity, so the choice of using a lower hydrogen peroxide concentration can be an option to use for mouth rinse and gargling."

"Penelitian mengenai pengaruh remdesivir terhadap perubahan nilai cycle threshold (Ct) atau viral load masih sedikit, memiliki hasil yang berbeda-beda, dan belum pernah dilakukan pada subjek dari Indonesia. Penelitian ini bertujuan untuk mengevaluasi pengaruh remdesivir terhadap perubahan nilai Ct dan keamanannya pada pasien COVID-19 derajat berat. Penelitian dilakukan secara retrospektif dengan desain kohort studi. Subjek penelitian terdiri dari kelompok remdesivir (n=80) dan non remdesivir (n=80). Pengamatan yang dilakukan adalah perubahan nilai Ct sebelum dan sesudah penggunaan antivirus pada gen ORF1ab, E, dan N, kebutuhan oksigenasi, mortalitas, kejadian yang tidak dikehendaki (KTD) dan analisis kausalitas KTD dengan Algoritma Naranjo. Hasil yang ditemukan menunjukkan remdesivir mempengaruhi peningkatan nilai Ct pada pasien COVID-19 derajat berat daripada kelompok non remdesivir, dengan peningkatan pada gen ORF1ab adalah 97,5% vs 83,8% (p=0,005), peningkatan pada gen E adalah 95% vs 81,2% (p=0,013), dan peningkatan gen N adalah 97,5% vs 82,5% (p=0,003). Hasil analisis multivariat, remdesivir mempengaruhi peningkatan gen ORF1ab 7,6 kali (95% CI: 1,600-36,449), gen E 5,1 kali (95% CI: 1,528-17,071), dan gen N 8,9 kali (95% CI: 1,864-42,265). Kebutuhan oksigenasi dan mortalitas kelompok remdesivir menunjukkan persentase yang lebih rendah daripada kelompok non remdesivir (15% vs 22,5%; p=0,311; dan 63,8% vs 70%; p=0,502). KTD lebih banyak terjadi pada kelompok remdesivir daripada kelompok non remdesivir (58,8%, vs 53,8%; p=0,633). Kejadian yang signifikan dan memiliki proporsi yang tinggi pada kelompok remdesivir adalah peningkatan ALT (p=0,037). Hasil penelitian ini dapat disimpulkan bahwa remdesivir mempengaruhi peningkatan nilai Ct, namun menunjukkan terjadinya gangguan fungsi hati yang bermanifestasi pada peningkatan nilai ALT.

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Studies on the effect of remdesivir on changes in the cycle threshold (Ct) values or viral load are still limited with varied results, even have never been conducted on subjects from Indonesia. This study aims to evaluate the effect of remdesivir on changes in Ct values and its safety in severe COVID-19 patients. The study was conducted retrospectively with a study cohort design. Research subjects consisted of remdesivir group (n=80) and non-remdesivir group (n=80). Observations focused on changes in the Ct values before and after antiviral use in the ORF1ab, E, and, N genes, oxygenation requirements, mortality, adverse events (AE), and AE causality analysis using the Naranjo Algorithm. The results showed that remdesivir affected the increase in Ct values in severe COVID-19 patients than the non-remdesivir group, with an increase in the ORF1ab gene was 97.5% vs. 83.8% (p = 0.005), an increase in the E gene was 95% vs 81.2% (p = 0.013), and an increase in the N gene was 97.5% vs 82.5% (p=0.003). The results of multivariate analysis showed that remdesivir increased the ORF1ab gene 7.6 times (95% CI: 1.600-36.449), the E gene 5.1 times (95% CI: 1.528-17.071), and the N gene 8.9 times (95% CI: 1.864-42.265). Oxygenation requirements and mortality in the remdesivir group showed lower percentages than the non-remdesivir group (15% vs 22.5%; p=0.311; and 63.8% vs 70%; p=0.502). AE in the remdesivir group was higher than in the non-remdesivir group (58.8%, vs. 53.8%; p=0.633). A significant event and a high proportion in the remdesivir group was an increase in ALT (p=0.037). The results of this study can be concluded that remdesivir affects the increase in Ct values, but shows the occurrence of impaired liver function which manifests in the increase in ALT values. "

"Latar Belakang: Coronavirus disease 2019 (COVID-2019) disebabkan oleh severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) dan menjadi tantangan karena menyebar luas secara cepat. Jumlah virus SARS-CoV-2 ditemukan tinggi pada awal infeksi di rongga mulut dan saluran pernapasan bagian atas. Tindakan bedah di rongga mulut memiliki potensi tinggi untuk transmisi SARS-CoV-2. American Dental Association (ADA) dan Centers for Disease Control and Prevention (CDC) merekomendasikan berkumur hidrogen peroksida 1,5% atau iodin povidon 0,2% sebelum tindakan medis. Mengurangi jumlah virus di saluran pernapasan bagian atas pada awal infeksi menurunkan keparahan perkembangan penyakit dan risiko transmisi. Nilai cycle threshold (CT) dari hasil pemeriksaan real time reverse transcription polymerase chain reaction (RT-PCR) merepresentasikan secara semikuantitatif viral load. Tujuan Penelitian: Menganalisis pengaruh berkumur iodin povidon 1% dan hidrogen peroksida 3% terhadap nilai CT RT-PCR SARS-CoV-2. Metode Penelitian: 45 subjek penelitian diambil dari pasien Rumah Sakit Umum Pusat Persahabatan yang terinfeksi SARS-CoV-2 sesuai kriteria inklusi dan ekslusi. Subjek penelitian dibagi ke dalam kelompok iodin povidon 1%, kelompok hidrogen peroksida 3%, dan kelompok kontrol. Subjek penelitian berkumur 30 detik di rongga mulut dan 30 detik di tenggorokan belakang dengan 15 ml sebanyak 3 kali sehari selama 5 hari. Analisis nilai CT dilakukan melalui pemeriksaan RT-PCR pada hari ke-1, hari ke-3, dan hari ke-5 setelah berkumur. Hasil: Didapatkan perbedaan bermakna pada hasil uji Friedman dan tampak peningkatan nilai CT RT-PCR mulai dari awal, hari ke-1, hari ke-3, dan hari ke- 5 pada keseluruhan kelompok dan masing-masing kelompok perlakuan. Hasil uji Post- Hoc dengan Wilcoxon menunjukkan perbedaan bermakna pada keseluruhan kelompok hari nilai CT RT-PCR dari keseluruhan kelompok dan kelompok iodin povidon 1%. Perbedaan bermakna sebagian besar kelompok hari nilai CT RT-PCR ditemukan dari hasil uji Post-Hoc dengan Wilcoxon pada kelompok hidrogen peroksida 3% dan kelompok kontrol, kecuali antara hari ke-1 dengan hari ke-3 dan antara hari ke-3 dengan hari ke-5 pada kelompok hidrogen peroksida 3% dan antara hari ke-3 dengan hari ke-5 pada kelompok kontrol. Peningkatan tertinggi nilai CT RT-PCR awal hingga hari ke-1 ditemukan pada kelompok hidrogen peroksida 3%, sedangkan antara hari ke-1 hingga ke-3 dan hari ke-3 hingga hari ke-5 ditemukan pada kelompok iodin povidon 1%. Usia dan jenis kelamin ditemukan tidak memiliki hubungan yang bermakna terhadap perubahan nilai CT RT-PCR. Kesimpulan: Berkumur iodin povidon 1% dan hidrogen peroksida 3% berpengaruh terhadap peningkatan nilai CT RT-PCR SARS-CoV-2. Peningkatan tertinggi nilai CT RT-PCR awal hingga hari ke-1 ditemukan pada kelompok hidrogen peroksida 3%, sedangkan antara hari ke-1 hingga ke-3 dan hari ke-3 hingga hari ke-5 ditemukan pada kelompok iodin povidon 1%.

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Background: Coronavirus disease 2019 (COVID-2019) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and poses a challenge because it can spread rapidly. The number of SARS-CoV-2 was found to be high at the beginning of infection in the oral cavity and upper respiratory tract. Surgery in the oral cavity poses high transmission risk of SARS-CoV-2. The American Dental Association (ADA) and the Centers for Disease Control and Prevention (CDC) recommend the use of mouthrinse either 1.5% hydrogen peroxide or 0.2% povidone iodine before commencing any surgical treatment. Reducing the viral load in the upper respiratory tract at the early of infection may decrease the severity of disease progression and the risk of transmission. The cycle threshold (CT) value from the real time reverse transcription polymerase chain reaction (RT-PCR) examination semi-quantitatively represents the viral load.

Objective: To analyze the effect of mouthrinsing and gargling with 1% povidone iodine and 3% hydrogen peroxide on the CT value of SARS-CoV-2.

Methods: 45 subjects were patients recruited from Persahabatan General Hospital infected with SARS-CoV-2 according to the inclusion and exclusion criteria. The subjects were divided into 1% povidone iodine group, the 3% hydrogen peroxide group, and the control group. The subjects were instructed to rinse their mouths for 30 seconds and gargle for 30 seconds at the back of the throat with 15 mL of the mouthrinse 3 times a day for 5 days. Analysis of CT values were carried out using RT-PCR on day 1, day 3 and day 5 after mouthrinsing and gargling.

Results: Significant differences were found in the results of the Friedman test, and the CT value demonstrated increases from the initial, day 1, day 3 and day 5 in the whole group and each group. The results of the Post-Hoc test with Wilcoxon showed significant differences in the whole day group of the CT value of the whole group and the 1% povidone iodine group. Significant differences in most of the day group were found from the results of the Post-Hoc test with Wilcoxon in the 3% hydrogen peroxide group and the control group, except between day 1 and day 3 and between day 3 and day 5 in the 3% hydrogen peroxide group and between day 3 and day 5 in the control group. The highest increase in the initial CT value until day 1 was found in the 3% hydrogen peroxide group, while the increase between days 1 to 3 and day 3 to day 5 was found in the 1% povidone iodine group. Age and gender showed no significant correlation with changes in CT values.

Conclusion: Mouthrinsing and gargling with 1% povidone iodine and 3% hydrogen peroxide were found to increase the CT value of SARS-CoV-2. The highest increase in the initial CT value until day 1 was found in the 3% hydrogen peroxide group, while between days 1 to 3 and day 3 to day 5 was found in the 1% povidone iodine group."

"Latar Belakang: Coronavirus disease 2019 (COVID-2019) disebabkan oleh severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) dan menjadi tantangan karena menyebar luas secara cepat. Jumlah virus SARS-CoV-2 ditemukan tinggi pada awal infeksi di rongga mulut dan saluran pernapasan bagian atas. Tindakan bedah di rongga mulut memiliki potensi tinggi untuk transmisi SARS-CoV-2. American Dental Association (ADA) dan Centers for Disease Control and Prevention (CDC) merekomendasikan berkumur hidrogen peroksida 1,5% atau iodin povidon 0,2% sebelum tindakan medis. Mengurangi jumlah virus di saluran pernapasan bagian atas pada awal infeksi menurunkan keparahan perkembangan penyakit dan risiko transmisi. Nilai cycle threshold (CT) dari hasil pemeriksaan real time reverse transcription polymerase chain reaction (RT-PCR) merepresentasikan secara semikuantitatif viral load. Tujuan Penelitian: Menganalisis pengaruh berkumur iodin povidon 1% dan hidrogen peroksida 3% terhadap nilai CT RT-PCR SARS-CoV-2. Metode Penelitian: 45 subjek penelitian diambil dari pasien Rumah Sakit Umum Pusat Persahabatan yang terinfeksi SARS-CoV-2 sesuai kriteria inklusi dan ekslusi. Subjek penelitian dibagi ke dalam kelompok iodin povidon 1%, kelompok hidrogen peroksida 3%, dan kelompok kontrol. Subjek penelitian berkumur 30 detik di rongga mulut dan 30 detik di tenggorokan belakang dengan 15 ml sebanyak 3 kali sehari selama 5 hari. Analisis nilai CT dilakukan melalui pemeriksaan RT-PCR pada hari ke-1, hari ke-3, dan hari ke-5 setelah berkumur. Hasil: Didapatkan perbedaan bermakna pada hasil uji Friedman dan tampak peningkatan nilai CT RT-PCR mulai dari awal, hari ke-1, hari ke-3, dan hari ke- 5 pada keseluruhan kelompok dan masing-masing kelompok perlakuan. Hasil uji Post- Hoc dengan Wilcoxon menunjukkan perbedaan bermakna pada keseluruhan kelompok hari nilai CT RT-PCR dari keseluruhan kelompok dan kelompok iodin povidon 1%. Perbedaan bermakna sebagian besar kelompok hari nilai CT RT-PCR ditemukan dari hasil uji Post-Hoc dengan Wilcoxon pada kelompok hidrogen peroksida 3% dan kelompok kontrol, kecuali antara hari ke-1 dengan hari ke-3 dan antara hari ke-3 dengan hari ke-5 pada kelompok hidrogen peroksida 3% dan antara hari ke-3 dengan hari ke-5 pada kelompok kontrol. Peningkatan tertinggi nilai CT RT-PCR awal hingga hari ke-1 ditemukan pada kelompok hidrogen peroksida 3%, sedangkan antara hari ke-1 hingga ke-3 dan hari ke-3 hingga hari ke-5 ditemukan pada kelompok iodin povidon 1%. Usia dan jenis kelamin ditemukan tidak memiliki hubungan yang bermakna terhadap perubahan nilai CT RT-PCR. Kesimpulan: Berkumur iodin povidon 1% dan hidrogen peroksida 3% berpengaruh terhadap peningkatan nilai CT RT-PCR SARS-CoV-2. Peningkatan tertinggi nilai CT RT-PCR awal hingga hari ke-1 ditemukan pada kelompok hidrogen peroksida 3%, sedangkan antara hari ke-1 hingga ke-3 dan hari ke-3 hingga hari ke-5 ditemukan pada kelompok iodin povidon 1%.

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Background: Coronavirus disease 2019 (COVID-2019) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and poses a challenge because it can spread rapidly. The number of SARS-CoV-2 was found to be high at the beginning of infection in the oral cavity and upper respiratory tract. Surgery in the oral cavity poses high transmission risk of SARS-CoV-2. The American Dental Association (ADA) and the Centers for Disease Control and Prevention (CDC) recommend the use of mouthrinse either 1.5% hydrogen peroxide or 0.2% povidone iodine before commencing any surgical treatment. Reducing the viral load in the upper respiratory tract at the early of infection may decrease the severity of disease progression and the risk of transmission. The cycle threshold (CT) value from the real time reverse transcription polymerase chain reaction (RT-PCR) examination semi-quantitatively represents the viral load. Objective: To analyze the effect of mouthrinsing and gargling with 1% povidone iodine and 3% hydrogen peroxide on the CT value of SARS-CoV-2. Methods: 45 subjects were patients recruited from Persahabatan General Hospital infected with SARS-CoV-2 according to the inclusion and exclusion criteria. The subjects were divided into 1% povidone iodine group, the 3% hydrogen peroxide group, and the control group. The subjects were instructed to rinse their mouths for 30 seconds and gargle for 30 seconds at the back of the throat with 15 mL of the mouthrinse 3 times a day for 5 days. Analysis of CT values were carried out using RT-PCR on day 1, day 3 and day 5 after mouthrinsing and gargling. Results: Significant differences were found in the results of the Friedman test, and the CT value demonstrated increases from the initial, day 1, day 3 and day 5 in the whole group and each group. The results of the Post-Hoc test with Wilcoxon showed significant differences in the whole day group of the CT value of the whole group and the 1% povidone iodine group. Significant differences in most of the day group were found from the results of the Post-Hoc test with Wilcoxon in the 3% hydrogen peroxide group and the control group, except between day 1 and day 3 and between day 3 and day 5 in the 3% hydrogen peroxide group and between day 3 and day 5 in the control group. The highest increase in the initial CT value until day 1 was found in the 3% hydrogen peroxide group, while the increase between days 1 to 3 and day 3 to day 5 was found in the 1% povidone iodine group. Age and gender showed no significant correlation with changes in CT values. Conclusion: Mouthrinsing and gargling with 1% povidone iodine and 3% hydrogen peroxide were found to increase the CT value of SARS-CoV-2. The highest increase in the initial CT value until day 1 was found in the 3% hydrogen peroxide group, while between days 1 to 3 and day 3 to day 5 was found in the 1% povidone iodine group."

"Pada akhir tahun 2019 dilaporkan beberapa kasus pneumonia di Wuhan, Cina yang disebabkan oleh Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Penyakit yang ditimbulkan oleh virus ini disebut sebagai coronavirus disease 2019 (COVID-19). Jumlah kasus COVID-19 terus mengalami peningkatan dan penyebarannya terjadi pada seluruh kelompok usia termasuk anak-anak. Pemeriksaan real-time reverse transcription-polymerase chain reaction (rRT-PCR) telah diotorisasi oleh Food and Drug Administration (FDA) dan pada pemeriksaan ini dikenal istilah cycle threshold (Ct). Nilai Ct sering dijadikan acuan dalam menentukan tingkat keparahan penyakit pada anak, akan tetapi masih terdapat kontroversi apakah nilai Ct berhubungan dengan tingkat keparahan penyakit. Penelitian ini bermaksud mencari hubungan bermakna antara nilai Ct khususnya gen ORF1ab dan gen N dengan tingkat keparahan COVID-19 pada anak yang dibagi menjadi tingkat keparahan ringan dan sedang sampai kritis. Didapat 52 responden anak dalam penelitian ini, dengan 24 responden terdeteksi gen ORF1ab dan 49 responden terdeteksi gen N. Rerata nilai Ct gen ORF1ab kelompok ringan (33,5 ± 4,4) lebih tinggi dibandingkan dengan kelompok sedang sampai kritis (31,0 ± 6,0). Median nilai Ct gen N kelompok ringan (34,8 [21,3 – 39,4]) lebih tinggi dibandingkan dengan kelompok sedang sampai kritis (31,7 [19,4 – 38,9]). Tidak didapatkan hubungan bermakna baik antara nilai Ct gen ORF1ab (nilai p = 0,25) maupun gen N (nilai p = 0,159) dengan tingkat keparahan COVID-19 pada anak. Berdasarkan hasil penelitian ini, diperlukan berbagai pertimbangan dalam menginterpretasi nilai Ct.

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At the end of 2019, several cases of pneumonia were reported in Wuhan, China caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The disease caused by this virus is known as Coronavirus Disease 2019 (COVID-19). The number of cases of COVID-19 continues to increase and its spread occurs in all age groups including children. Real-time reverse transcription-polymerase chain reaction (rRT-PCR) has been authorized by the Food and Drug Administration (FDA) and in this method a cycle threshold (Ct) value were obtained. The Ct value is often used as a reference in determining the clinical severity in children, but there is still controversy whether the Ct value is related to the clinical severity. This study intends to find a significant relationship between the Ct values, especially the ORF1ab gene and the N gene, with the COVID-19 clinical severity in children which is divided into mild and moderate to critical severity. There were 52 children in this study, with 24 children have ORF1ab gene detected and 49 children have N gene detected. The mean of ORF1ab gene Ct value in mild group (33.5 ± 4.4) was higher than moderate to critical group (31.0 ± 6.0). The median of N gene Ct value ​​in mild group (34.8 [21.3 – 39.4]) was higher than moderate to critical group (31.7 [19.4 – 38.9]). There was no significant relationship between the Ct value of the ORF1ab gene (p value = 0.25) and the N gene (p value = 0.159) with COVID-19 clinical severity in children. Based on the results of this study, various considerations are needed in interpreting the Ct value."

"Latar Belakang: Pandemi COVID-19 yang saat ini sedang terjadi meningkatkan kesadaran akan risiko penularan di ruang operasi dari virus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Dokter spesialis bedah mulut dan maksilofasial pada khususnya merupakan profesi yang rentan terhadap transmisi SARS-CoV-2 hal tersebut disebabkan karena ruang lingkup pekerjaan yang erat kaitannya dengan reservoir SARS-CoV-2 yaitu rongga mulut dan orofaring. American Dental Association (ADA), Centers for Disease Control and Prevention (CDC) dan petunjuk klinis Kementrian Kesehatan Republik Indonesia menganjurkan berkumur dengan iodin povidon sebelum tindakan kedokteran gigi. Nilai cycle threshold (CT) dari hasil pemeriksaan real time reverse transcription polymerase chain reaction (RT-PCR) merepresentasikan secara semikuantitatif viral load. Tujuan Penelitian: Menganalisis pengaruh berkumur iodin povidon 1% dan iodin povidon 0.5% terhadap nilai CT RT-PCR SARS-CoV-2 dan nilai saturasi oksigen. Metode Penelitian: 42 subjek penelitian diambil dari pasien Rumah Sakit Umum Pusat Persahabatan yang terinfeksi SARS-CoV-2 sesuai kriteria inklusi dan ekslusi. Subjek penelitian dibagi ke dalam kelompok iodin povidon 1%, kelompok iodin povidon 0.5%, dan kelompok kontrol. Subjek penelitian berkumur 30 detik di rongga mulut dan 30 detik di tenggorokan belakang dengan 15 ml sebanyak 3 kali sehari selama 5 hari. Analisis nilai CT dilakukan melalui pemeriksaan RT-PCR pada hari ke-1, hari ke-3, dan hari ke-5 setelah berkumur. Hasil: perbedaan bermakna didapatkan pada hasil uji Friedman dan tampak peningkatan nilai CT RT-PCR mulai dari awal, hari ke-1, hari ke-3, dan hari ke- 5 pada keseluruhan kelompok dan masing-masing kelompok perlakuan. Hasil uji Post- Hoc dengan Wilcoxon menunjukkan perbedaan bermakna pada keseluruhan kelompok hari nilai CT RT-PCR dari keseluruhan kelompok dan kelompok iodin povidon 1%. Perbedaan bermakna sebagian besar kelompok hari nilai CT RT-PCR ditemukan dari hasil uji Post-Hoc dengan Wilcoxon pada kelompok iodin povidon 0.5% dan kelompok iodin povidon 1%. Peningkatan tertinggi nilai CT RT-PCR awal hingga hari ke-1 ditemukan pada kelompok iodin povidon 0.5% sedangkan antara hari ke-1 hingga ke-3 dan hari ke-3 hingga hari ke-5 ditemukan pada kelompok iodin povidon 1%. Usia dan jenis kelamin ditemukan tidak memiliki hubungan yang bermakna terhadap perubahan nilai CT RT-PCR.Peningkatan nilai CT RT-PCR tidak menyebabkan pengaruh terhadap nilai saturasi oksigen. Kesimpulan: Berkumur iodin povidon 1% dan iodin povidon 0.5% berpengaruh terhadap peningkatan nilai CT RT-PCR SARS-CoV-2 dan berkumur dengan iodin povidon 1% atau iodin povidon 0.5% dapat mempertahankan saturasi oksigen dalam rentang normal 96%-99%.

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Background: The current COVID-19 pandemic is raising awareness of the risk of transmission in the operating room from the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Oral and maxillofacial surgeons in particular are professions that are vulnerable to the transmission of SARS-CoV-2, this is because the scope of work is closely related to the SARS-CoV-2 reservoir, namely the oral cavity and oropharynx. The American Dental Association (ADA) and the Centers for Disease Control and Prevention (CDC) and the clinical guidelines of the Ministry of Health Republic of Indonesia recommend gargling with iodine povidon before commencing any surgical treatment. The cycle threshold (CT) value from the real time reverse transcription polymerase chain reaction (RT-PCR) examination semi-quantitatively represents the viral load. Low blood oxygen levels or hypoxia can be defined as a measurable oxygen saturation below 94% in patients without lung disease.

Objective: To analyze the effect of mouthrinsing and gargling with iodine povidone 1% and iodine povidone 0.5% on the CT value of SARS-CoV-2.

Methods: 42 subjects were patients recruited from Persahabatan General Hospital infected with SARS-CoV-2 according to the inclusion and exclusion criteria. The subjects were divided into iodine povidone 1% group, iodine povidone 0.5% group, and the control group. The subjects were instructed to rinse their mouths for 30 seconds and gargle for 30 seconds at the back of the throat with 15 mL of the mouthrinse 3 times a day for 5 days. Analysis of CT values were carried out using RT-PCR on day 1, day 3 and day 5 after mouthrinsing and gargling.

Results: Significant differences were found in the results of the Friedman test, and the CT value demonstrated increases from the initial, day 1, day 3 and day 5 in the whole group and each group. The results of the Post-Hoc test with Wilcoxon showed significant differences in the whole day group of the CT value of the whole group and the iodine povidone 1% group. Significant differences in most of the day group were found from the results of the Post-Hoc test with Wilcoxon in the iodine povidone 0.5% group and the iodine povidone 1%, except between day 1 and day 3 and between day 3 and day 5 in the iodine povidone 0.5% group and between day 3 and day 5 in the control group. The highest increase in the initial CT value until day 1 was found in the iodine povidone 1%. Age and gender showed no significant correlation with changes in CT values. The increasing of CT value of RT-PCR did not cause any effect on oxgen saturation values, the saturation values remain normal.

Conclusion: Mouthrinsing and gargling with iodine povidone 1% and iodine povidone 0.5% had an effect on increasing the CT value of RT-PCR SARS-CoV-2 and also could maintain oxygen saturation in the normal range between 96-99%."

"Rapid swab antigen SARS-CoV-2 merupakan pemeriksaan alternatif dalam mendeteksi SARS-CoV-2. Salah satu faktor yang mempengaruhi pemeriksaan rapid swab antigen SARS-CoV-ialah viral load yang direpresentasikan dengan cycle threshold (CT) pada pemeriksaan rRT-PCR. Hasil CT yang tinggi membuat sensitivitas pemeriksaan rapid swab antigen SARS-CoV-2 rendah. Tujuan utama pada penelitian ialah untuk menentukan nilai CT tertinggi pada pemeriksaan rRT-PCR yang mampu memberikan hasil reaktif pada pemeriksaan COVID-19 Ag (Standard Q SD Biosensor). Penelitian merupakan penelitian observasional dengan metode potong lintang dilakukan pada poliklinik demam RS dr. Cipto Mangunkusumo pada tanggal Juli 2020- Desember 2021. Total subjek dalam penelitian berjumlah 235 terdiri dari 24,7% subjek dengan rRT-PCR SARS-CoV-2 positif dan 75,3% subjek dengan rRT-PCR SARS-CoV-2 negatif. Median CT tertinggi pada pemeriksaan rRT-PCR SARS-CoV-2 yang mampu memberikan hasil reaktif pada pemeriksaan COVID-19 Ag (Standard Q SD Biosensor) ialah 28,22 (13,33- 39,16), sedangkan median CT tertinggi pada COVID-19 Ag (Standard Q SD Biosensor) non-reaktif ialah 34,45 (26,08-39,65). Sensitivitas, spesifisitas, NPV, PPV, dan LR positif dan LR negatif hasil COVID-19 Ag (Standard Q SD Biosensor) pada CT ≤ 40 adalah 63.8%, 99.4%, 89.3%, 97.4%, 112.9, dan 0.4. Pada CT ≤ 33 sensitivitas, spesifisitas, NPV, PPV, dan LR positif dan LR negatif ialah 77.1%, 99.4%, 95.7%, 96.4%, 136.5, dan 0.2 sedangkan pada CT ≤ 25 sensitivitas, spesifisitas, NPV, PPV, dan LR positif dan LR negatif adalah 92.3%, 99.4%, 99.4%, 92.3%, 163.4, dan 0.1. Titik potong CT rRT-PCR SARS-CoV-2 tertinggi ialah 26,06 dengan hasil sensitivitas 100% dan spesifisitas 99,4%. Pemeriksaan COVID-19 Ag (Standard Q SD Biosensor) dapat dipakai untuk keperluan diagnosis, contact tracing atau community surveilance.

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SARS-CoV-2 rapid antigen swab is an alternative test for detecting SARS-CoV-2 infection. One of the factors that influence the examination is viral load, which is represented by the cycle threshold (CT) in the rRT-PCR examination. The higher CT value will result in lower sensitivity of SARS-CoV-2 rapid antigen swab examination. The main objective of the study was to determine the highest CT value in rRT-PCR examination which still able to give reactive results on the COVID-19 Ag test (Standard Q SD Biosensor). The study was a cross-sectional study carried out at the fever polyclinic in dr. Cipto Mangunkusumo Hospital between July 2020 - December 2021. The study consisted of 235 subjects, 24.7% of subjects were SARS-CoV-2 positives and 75.3% of subjects were negative for SARS-CoV-2 infections. Median highest CT value in the SARS-CoV-2 rRT-PCR examination which able to give reactive results on the COVID-19 Ag (Standard Q SD Biosensor) test was 28.22 (13.33-39.16) while the median CT value on the non-reactive COVID-19 Ag (Standard Q SD Biosensor) was 34.45 (26.08-39.65). The sensitivity, specificity, NPV, PPV, and LR positive and LR negative results of COVID-19 Ag (Standard Q SD Biosensor) were 63.8%, 99.4%, 89.3%, 97.4%, 112.9, and 0.4 at CT value ≤ 40. The sensitivity, specificity, NPV, PPV, and LR positive and LR negative at CT value ≤ 33 were 77.1%, 99.4%, 95.7%, 96.4%, 136.5, and 0.2, while at CT ≤ 25 sensitivity, specificity, NPV, PPV, and LR positive and LR negative were 92.3%, 99.4%, 99.4%, 92.3%, 163.4, and 0.1. The cut-off point for the highest CT value was 26.06 with a sensitivity of 100% and a specificity of 99.4%. In conclusion, COVID-19 Ag (Standard Q SD Biosensor) was acceptable for diagnosis, contact tracing or community surveillance."

"Latar Belakang: Infeksi severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) pada pasien lansia sering berkembang menjadi berat dengan tingkat kematian yang tinggi. Tes laboratorium yang dapat digunakan sebagai prediktor keparahan dan kematian COVID-19 tidak spesifik dan sering dijumpai pada kondisi lainnya. Penelitian tentang hubungan antara nilai cycle threshold (CT) awal uji polymerase chain reaction (PCR) dengan kejadian gagal nafas dan kematian saat perawatan pada pasien lansia yang terinfeksi SARS-CoV-2 belum ada. Penelitian yang melaporkan cut-off nilai CT yang dapat digunakan untuk interpretasi atau stratifikasi risiko pada pasien lansia juga belum ada.Tujuan: Membuktikan peran nilai CT awal uji PCR untuk memprediksi kejadian gagal nafas dan kematian saat perawatan pada pasien lansia terkonfirmasi COVID-19.Metode: Penelitian ini merupakan suatu kohort retrospektif yang melibatkan pasien lansia terkonfirmasi COVID-19 yang dirawat di Rumah Sakit Umum Pusat Nasional Dr Cipto Mangunkusumo (RSCM) Jakarta periode Juni 2020 sampai Desember 2021. Kriteria inklusi adalah pasien berusia ≥ 60 yang tahun memiliki diagnosis COVID-19 kasus konfirmasi dan terdapat hasil nilai CT awal uji PCR di dalam rekam medis. Kriteria eksklusi adalah rekam medis tidak ditemukan atau data tidak lengkap, pasien sudah gagal nafas atau meninggal saat datang, pasien pulang paksa atau pindah rumah sakit.Hasil: Penelitian ini melibatkan 543 subyek dengan median usia 67,59 tahun (rentang interkuartil [RIK] 63,12-73,35), sebanyak 55,6% subyek berjenis kelamin laki-laki dan 50,6% subyek memiliki dua atau lebih komorbiditas. Komorbiditas yang paling sering ditemui adalah hipertensi (55,1%), DM (39,6%), penyakit ginjal kronis (15,3%), penyakit jantung koroner (15,1%) dan kanker (10,3%). Median nilai CT awal uji PCR pada kelompok yang mengalami gagal nafas lebih rendah (23,76 vs. 28,07), p<0,001. Cut-off terbaik dari nilai CT awal uji PCR untuk memprediksi gagal nafas adalah 23,8 (sensitivitas 51,0% dan spesifisitas 76,4%). Median nilai CT awal uji PCR pada kelompok yang meninggal lebih rendah (23,55 vs. 28,14), p<0,001. Cut-off terbaik dari nilai CT awal uji PCR untuk memprediksi kematian adalah 25 (sensitivitas 60,3% dan spesifisitas 70,0%).Simpulan: Nilai CT awal uji PCR yang rendah merupakan prediktor tingginya kejadian gagal nafas dan kematian saat perawatan pada pasien lansia terkonfirmasi COVID-19 dengan nilai cut-off 23,8 dan 25 secara berturut-turut.

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Background: Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) in elderly is often severe with a high mortality rate. Laboratory tests are not specific for predicting severity and mortality of COVID-19 and are common in other conditions. There is no study on the relationship between polymerase chain reaction (PCR) cycle threshold (CT) value with respiratory failure and mortality in hospitalized elderly patients with confirmed COVID-19. CT value-based risk stratification or interpretation in elderly is also limited by the absence of CT cut-off values.

Objective: This sudy aims to determine the role of initial PCR CT value to predict respiratory failure and mortality in hospitalized elderly patients with confirmed COVID-19.

Methods: This retrospective cohort study utilised data of elderly inpatients with confirmed COVID-19 in Cipto Mangunkusumo Hospital, Indonesia’s national general hospital from June 2020 to December 2021. The inclusion criterion was complete data of initial PCR CT value in medical records from elderly inpatients aged 60 years and older with confirmed COVID-19. Exclusion criteria were incomplete data or no medical records found, those who had respiratory failure or deceased on arrival, those who was forced dicharged or moved to another hospital.

Results: A total of 543 elderly patients were enrolled in this study. Among all, the median age was 67.59 years (interquartile range (IQR) 63.12-73.35); 55.6% patients were men and 50.6% patients had two or more comorbidities. The common comorbidities were hypertension (55,1%), diabetes mellitus (39,6%), chronic kidney disease (15,3%), coronary heart disease (15,1%) and cancer (10,3%) The median CT value of group with acute respiratory distress syndrome (ARDS) was lower (23.76 vs. 28.07), p<0.001. The best cut-off for predicting ARDS was 23.8 (sensitivity of 51.0% and specificity of 76.4%). The median CT value of non-survivor group was lower (23.55 vs. 28.14), p<0.001. The best cut-off for predicting ARDS was 25 (sensitivity of 60.3% and specificity of 70.0%).

Conclusions: A low PCR CT value is a predictor of high respiratory failure and mortality in hospitalized elderly patients with confirmed COVID-19, the best cut-off was 23.8 and 25 respectively. "

"COVID-19 telah menginfeksi ratusan juta orang dan menyebabkan kematian jutaan orang di seluruh dunia. Vaksinasi diharapkan dapat mengurangi insiden penyakit, tingkat mortalitas, maupun keparahan penyakit. Sehingga peneliti ingin mengetahui seberapa besar efek vaksinasi dalam melindungi pasien COVID-19 terhadap penyakit COVID-19 yang berat dan kematian COVID-19. Penelitian ini merupakan penelitian kohort retrospektif yang menggunakan data dari database NAR COVID-19 dan Dashboard KPCPEN Dinkes Kota Depok mulai tanggal 8 Mei 2020 hingga 20 Februari 2023 yang dianalisis menggunakan regresi logistik. Peneliti menemukan bahwa kelompok usia terbesar adalah usia 31-45 tahun (26,54%) dan terkecil adalah usia ≥ 60 tahun (10,97%). Populasi perempuan lebih besar dibandingkan laki-laki (53,36% vs 46,64%). Kemudian hanya 6.41% orang bekerja sebagai petugas kesehatan. Jumlah orang yang tidak divaksin lebih banyak dibandingkan orang yang divaksin (52,58% vs. 47,42%). Dibandingkan dengan pasien COVID-19 yang tidak divaksinasi, pasien yang divaksin mengalami penurunan risiko dirawat sebesar 45% (periode 1), 43,3% (periode 2), dan 24% (periode 3). Kemudian pasien COVID-19 yang divaksinasi mengalami penurunan risiko mortalitas sebesar 35% (periode 1), 90% (periode 2), dan 33% (periode 3). Sehingga peneliti menyimpulkan bahwa vaksinasi COVID-19 menurunkan risiko dirawat di RS dan mortalitas pasien COVID-19 pada ketiga periode sakit.

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COVID-19 has infected and caused the deaths of millions of people in the world. And vaccination is expected to reduce the incidence, mortality, and severity of the disease. The objective of this research is to discover the effects of COVID-19 vaccination against severe disease and death of COVID-19. This was a retrospective cohort research that utilized data from the COVID-19 NAR database and the Depok City Health Department KPCPEN Dashboard from Mei 8, 2020 to February 20, 2023, and was analysed using logistic regression. We discovered that the largest age group were patients between ages 31-45 years (26.54%) and the smallest was ≥ 60 years (10.97%). There were more female patients than men (53.36% vs. 46.64%). Only 6.41% of patients were healthcare workers, and more patients were unvaccinated than vaccinated (52.58% vs. 47.42%). Compared to the unvaccinated patients, the vaccinated patients experienced a risk reduction of 45% in period 1, 43.3% in period 2, and 24% in period 3. Vaccinated patients also experienced a risk reduction for mortality of 35% in period 1, 90% in period 2, and 33% in period 3. Therefore, we conclude that COVID-19 vaccination reduces the hospitalization and mortality risks for COVID-19 patients in all 3 periods."