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Abstrak :
Coronavirus Disease 2019 adalah penyakit menular yang disebabkan oleh Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Covid-19 telah dinyatakan sebagai pandemik sehingga perlu dilakukan upaya penanggulangan termasuk penguatan fungsi laboratorium yang berfungsi melakukan pemeriksaan spesimen, untuk menjamin kesinambungan pemeriksaan screening spesimen Coronavirus Disease 2019. Penelitian ini bertujuan untuk menganalisis implementasi hierarki pengendalian risiko dalam pencegahan penularan Covid-19 pada pekerja di Laboratorium Biomolekular PT X. Penelitian ini menggunakan metode penelitian kualitatif . Pengumpulan data dilakukan melalui data sekunder, wawancara dan observasi. Penelitian dilakukan dari November 2021-Juli 2022. Hasil penelitian menunjukkan proses kerja di PT. X terdiri enam jenis dari pengambilan sampel hingga pelaporan ke pasien. Masing-masing proses memiliki risiko masing-masing dalam pekerjaannya, dimana risiko tertinggi pada petugas pengambilan sampel. Pengetahuan dan perilaku pekerja terhadap hirarki pengendalian risiko dapat dikatakan sangat baik. Perilaku pencegahan Covid-19 yang dilakukan oleh pekerja di PT. X sudah ada upayanya, seperti mereka paham pentingnya bekerja dengan SOP dan menggunakan alat pelindung diri. PT.X telah mengimplementasikan hirarki pengendalian risiko meliputi pengendalian teknis seperti memberi pembatas dan pengaturan ventilasi, pengendalian administrasi seperti pembuatan SOP dan pengaturan shift kerja, dan penggunaan alat pelindung diri seperti masker, baju gown, sarung tangan, dsb. Terkait implementasi pengendalian risiko pada Laboratorium ada dua hal yang belum terpenuhi yaitu tidak adanya pengelolaan limbah padat B3 dan tidak ada manajemen biosecurity secara mandiri. Adapun saran yang dapat direkomendasikan adalah perlu memberikan edukasi, sosialisasi, maupun pelatihan secara berkala terkait manajemen pengendalian risiko dan melakukan upaya pengelolaan limbah B3 sendiri mengacu pada peraturan kementerian kesehatan untuk keamanaan baik para pekerja dan pelanggan yang berkunjung ke PT.X. ......Coronavirus Disease 2019 is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Covid-19 has been declared a pandemic so it is necessary to take countermeasures including strengthening the laboratory function that functions to examine specimens, to ensure the continuity of the 2019 Coronavirus Disease specimen screening examination. This study aims to analyze the implementation of the risk control hierarchy in preventing the transmission of Covid-19 to workers in Biomolecular Laboratory of PT X. This research uses qualitative research methods. Data was collected through secondary data, interviews and observations. The research was conducted from November 2021-July 2022. The results showed that the work process at PT. X consists of six types from sampling to reporting to patients. Each process has its own risks in its work, where the risk is highest for the sampling officer. Knowledge and behavior of workers on the hierarchy of risk control can be said to be very good. Covid-19 prevention behavior carried out by workers at PT. X has made an effort, as they understand the importance of working with SOPs and using personal protective equipment. PT.X has implemented a risk control hierarchy including technical controls such as providing barriers and ventilation settings, administrative controls such as making SOPs and setting work shifts, and the use of personal protective equipment such as masks, gowns, gloves, etc. Regarding the implementation of risk control in the laboratory, there are two things that have not been fulfilled, namely the absence of B3 solid waste management and no independent biosecurity management. The suggestions that can be recommended are that it is necessary to provide education, socialization, and periodic training related to risk control management and make efforts to manage B3 waste itself referring to the regulations of the ministry of health for the safety of both workers and customers who visit PT.X.

Abstrak :
Pandemi Coronavirus Disease 2019 (COVID-19) merupakan pandemi disebabkan oleh virus SARS-CoV-2. Indonesia diketahui sebagai salah satu negara dengan tingkat infeksi COVID-19 paling tinggi di dunia. Deteksi cepat secara Real Time Reverse Transcription Polymerase Chain Reaction (rRT-PCR) merupakan salah satu langkah yang diperlukan untuk menekan laju penyebaran COVID-19. Kit deteksi BioCore 2019-nCoV Real Time PCR Kit adalah salah satu kit dignosis COVID-19 produksi BioCore. Ltd., Korea Selatan. Kit diagnosis BioCore telah beredar di Indonesia dan perlu diuji keakuratan diagnosis yang dihasilkan untuk menghindari hasil negatif palsu. Pengujian dilakukan menggunakan protokol Penjaminan Mutu Eksternal (PME) Kementerian Kesehatan Indonesia dengan melibatkan 30 sampel uji dan membandingkan hasil uji terhadap kit gold standard CDC dengan gen target N1, N2, dan HRP. Alur kerja penelitian dimulai dari proses pengambilan sampel, ekstraksi RNA, persiapan mastermix, adisi template RNA, dan amplifikasi template dengan metode rRT-PCR. Hasil penelitian menunjukkan adanya amplifikasi pada kontrol yang digunakan, sehingga proses diagnosis dapat dilakukan. Nilai Ct IC kit Biocore dan IC CDC menunjukkan perbedaan signifikan (P 0,05; CI=95%). Gen target SARS-CoV-2 tidak terdeteksi pada kit Biocore dengan nilai Ct>35, serta didapatkan nilai sensitivitas dan spesifisitas analitik kit Biocore berturut-turut sebesar 75% dan 100%. Hasil uji Kit Biocore terhadap pasien terinfeksi COVID-19 di Indonesia tidak memenuhi standar kit diagnosis yang ditetapkan oleh WHO, yaitu memiliki sensitivitas analitik sebesar 95%. Peninjauan ulang primer pada kit Biocore perlu dilakukan untuk memperbaiki mutu kit dalam deteksi awal virus SARS-CoV-2 di Indonesia. ...... The Coronavirus Disease 2019 (COVID-19) pandemic is a pandemic caused by the SARS-CoV-2 virus. Indonesia is known as one of the countries with the highest COVID-19 infection rate in the world. Real Time Reverse Transcription Polymerase Chain Reaction (rRT-PCR) detection is one of the steps needed to accelerate the spread of COVID-19. The BioCore 2019-nCoV Real Time PCR Kit is one of the COVID-19 diagnosis kits produced by BioCore. Ltd., South Korea. The BioCore diagnostic kit has been circulating in Indonesia and needs to be tested for the accuracy of the resulting diagnosis to avoid false negative results. The test was carried out using the External Quality Assurance (PME) protocol of the Indonesian Ministry of Health involving 30 test samples and test results against the CDC gold standard kit with target genes N1, N2, and HRP. The research workflow starts from the sampling process, RNA extraction, mastermix preparation, RNA template addition, and template amplification using the rRT-PCR method. The results showed that there was amplification of the controls used, so that the diagnosis process could be carried out. The Ct values ​​of the Biocore IC kit and the CDC IC showed a significant difference (P 0.05; CI=95%). The SARS-CoV-2 target gene was not detected in the Biocore kit with a Ct value>35, ​​and the sensitivity and analytical specificity of the Biocore kit were 75% and 100%, respectively. The results of the Biocore Kit test on patients infected with COVID-19 in Indonesia do not meet the diagnostic kit standard set by WHO, which has an analytical sensitivity of 95%. Primary review on the Biocore kit needs to be done to improve the quality of the kit in early detection of the SARS-CoV-2 virus in Indonesia.

Abstrak :
Latar Belakang: Aktivasi komplemen dapat menyebabkan respon imun berlebihan dan merupakan salah satu faktor yang berpengaruh terhadap morbiditas serta mortalitas pasien COVID-19. Beberapa penghambat aktivasi komplemen saat ini sedang dipelajari untuk menghambat aktivasi sistem komplemen yang berlebihan pada pasien COVID-19. Resiko, keuntungan, waktu pemberian dan bagian dari sistem yang akan ditargetkan perlu dipertimbangkan pada saat akan menggunakan penghambat komplemen, oleh karena itu telaah sistematis ini dibuat untuk mengambil kesimpulan apakah pemberian terapi penghambat sistem komplemen dapat menurunkan mortalitas pasien COVID-19 yang dirawat di Rumah Sakit berdasarkan penelitian-penelitian yang tersedia. Tujuan: Mengetahui efek pemberian terapi penghambat sistem komplemen terhadap mortalitas pasien COVID-19 yang dirawat di Rumah Sakit. Metode: Dengan menggunakan kata kunci spesifik, dilakukan pencarian artikel potensial secara komprehensif pada PubMed, Embase, Cochrane, dan Scopus database dengan pembatasan waktu 2019 sampai dengan sampai 31 Desember 2022. Protokol studi ini telah diregistrasi di PROSPERO (CRD42022306632). Semua penelitian pemberian terapi penghambat komplemen pada pasien COVID-19 dimasukkan. Analisis statistik dilakukan dengan menggunakan perangkat lunak Review Manager 5.4. Hasil: 5 penelitian memenuhi kriteria dan dimasukkan dalam telaah sistematis serta meta-analisis dengan total 739 pasien COVID-19. Hasil analisis Forest plot menunjukan bahwa pemberian terapi penghambat sistem komplemen menurunkan mortalitas sebesar 28% pada pasien COVID-19 yang dirawat di Rumah Sakit (RR 0,72; 95% CI: 0,46 – 1,14, I2 = 61%, P-value = 0.16). Kesimpulan: Pemberian terapi penghambat sistem komplemen secara statistik tidak signifikan menurunkan mortalitas pada pasien COVID-19 yang dirawat di Rumah Sakit ......Background: Complement activation can cause an exaggerated immune response and is one of the factors that influence the morbidity and mortality of COVID-19 patients. Several complement activation inhibitors are currently being studied to inhibit excessive complement activation in COVID-19 patients. The risks, benefits, time of administration and the part of the system to be targeted need to be considered when using complement inhibition, therefore this systematic review was made to conclude whether the administration of complement system inhibition therapy can reduce the mortality of COVID-19 patients who are hospitalized based on available studies. Objective: To determine the effect of complement system inhibitory therapy on the mortality of hospitalized COVID-19 patients Methods: Using specific keywords, we comprehensively searched the PubMed, Embase, Cochrane, and Scopus databases for potential articles from 2019 to December 31, 2022. The research protocol was registered with PROSPERO (CRD42022306632). All studies administering complement inhibitory therapy to COVID-19 patients were processed. Statistical analysis was performed using Review Manager 5.4 software. Result: 5 studies met the criteria and were included in a systematic review and meta-analysis of a total of 739 COVID-19 patients. The results of the Forest plot analysis showed that administration of complement system inhibitor therapy reduced mortality by 28% in hospitalized COVID-19 patients (RR 0.72; 95% CI: 0.46 – 1.14, I2 = 61%, P -value = 0.16). Conclusion: Providing complement system inhibitor therapy did not statistically significantly reduce mortality in hospitalized COVID-19 patients

Abstrak :
Cases of coronavirus disease 2019 (COVID-19) in Indonesia are still increasing and even higher in the last few weeks. Contact tracing and surveillance are important to locate cases in the community, including asymptomatic individuals. Diagnosis of COVID-19 depends on the detection of viral RNA, viral antigen, or indirectly, viral antibodies. Molecular diagnosis, using real time, reverse transcriptase polymerase chain reaction (RT-PCR), is the common standard method; however, it is not widely available in Indonesia and requires a high standard laboratory. Rapid, point-of-care antibody testing has been widely used as an alternative; however, interpretation of the results is not simple and now it is no longer used by the Indonesian government as a screening test for people travelling between locations. Thus, the rapid antigen detection test (Ag-RDT) is used by the Indonesian government as a screening test for travellers. As a result, many people buy the kit online and perform self-Ag-RDT at home. This raises the question of how safe and accurate it is to perform self-Ag-RDT at home. Before a test is applied, it is suggested to research its sensitivity and specificity, as compared to gold standard, and its limitations. In this article, laboratory diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is discussed, with an emphasis on Ag-RDT and the recommendation to use it properly in daily practice.

Abstrak :
Coronavirus Disease 2019 (COVID-19) adalah penyakit menular yang disebabkan oleh Severe Acute Respiratory Syndrome Coronavirus 2 (SARS- CoV-2). SARS-CoV-2 merupakan coronavirus jenis baru yang belum pernah diidentifikasi sebelumnya pada manusia. Dampak dari penyakit ini adalah menimbulkan pandemik dengan angka kematian yang sangat tinggi diseluruh dunia. Tujuan umum penelitian ini adalah untuk mengetahui hubungan penderita dengan komorbid hipertensi dengan kejadian kematian akibat Covid-19 di Kota Tangerang Selatan tahun 2020-2021. Desain penelitian yang digunakan desain penelitiaan adalah case control dengan pendekatan kuantitatif. Penelitian ini menggunakan data NAR Kota Tangerang Selatan dan cacatan khusus surveilan pada kasus kematian akibat Covid-19 di Kota Tangerang Selatan berjumlah 13.166 yang terdata sampai tanggal 29 Juni 2021. Data yang dapat dianalisa berjumlah 766 data sampel tersebut didapatkan dengan cara Simple Random Sampling. Teknik analisa data yang dilakukan pada penelitian ini bertahap, meliputi analisa univariat, bivariat, stratifikasi dan analisa multivariat yang diolah menggunakan program statistic. Hasil penelitian menunjukkan bahwa proporsi data dengan kematian akibat Covid-19 pada kelompok kasus dengan komorbid hipertensi sejumlah 189 (49,35%) pasien dan yang tidak komorbid pada kasus kematian yaitu 194 (50,65%), sedangkan yang tidak memiliki komorbid hipertensi dan tidak mengalami kematian akibat Covid-19 sebanyak 345 pasien (90,08%), serta yang memiliki komorbid hipertensi dan tidak mengalami kematian sebanyak 38 pasien (9,92%). Hasil analisis uji logistic regression model akhir menunjukkan hubungan yang signifikan antara komorbid hipertensi dengan kejadian kematian akibat covid-19 dengan OR 7,96 (95% CI: 5,19-12,2; p-value: 0,000) yang artinya bahwa komorbid Hipertensi pada kelompok kasus berisiko 7,96 kali lebih tinggi mengalami kematian akibat covid-19 dibanding kelompok kontrol setelah dikontrol dengan variabel umur, pekerjaan, adanya gejala awal dan penyakit lainnya. ......Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). SARS-CoV-2 is a new type of coronavirus that has never been previously identified in humans. The impact of this disease is causing a pandemic with a very high mortality rate throughout the world. The general purpose of this study was to determine the relationship between patients with comorbid hypertension and the incidence of death due to Covid-19 in South Tangerang City in 2020-2021. The research design used was a case control research design with a quantitative approach. This study uses NAR data from South Tangerang City and special surveillance records on cases of death due to Covid-19 in South Tangerang City totaling 13,166 recorded until June 29, 2021. The data that can be analyzed is 766. The sample data was obtained by means of Simple Random Sampling. Data analysis techniques carried out in this study were carried out in stages, including univariate, bivariate, stratification and multivariate analysis which were processed using statistical programs. The results showed that the proportion of data with deaths due to Covid-19 in the group of cases with comorbid hypertension was 189 (49.35%) patients and those who were not comorbid in cases of death were 194 (50.65%), while those without comorbid hypertension and 345 patients (90.08%) did not die from Covid-19, and 38 patients (9.92%) did not experience comorbid hypertension and did not experience death. The results of the final logistic regression test analysis showed a significant relationship between comorbid hypertension and the incidence of death due to covid-19 with an OR of 7.96 (95% CI: 5.19-12.2; p-value: 0.000) which means that comorbid hypertension the case group had a 7.96 times higher risk of dying from COVID-19 than the control group after controlling for variables of age, occupation, presence of early symptoms and have other diseases.

Abstrak :
Latar Belakang: Coronavirus disease 2019 (COVID-19) adalah penyakit infeksi saluran pernapasan yang pertama kali ditemukan di Wuhan. Sejak ditetapkan sebagai pandemi oleh WHO hingga 3 Juli 2021 terdapat sebanyak 183.098.615 kasus terkonfirmasi positif COVID-19 dengan jumlah kematian sebesar 3.964.145 kasus di seluruh dunia. Secara etiologi COVID-19 disebabkan oleh varian coronavirus baru yang dikenal sebagai SARS-CoV-2. Individu yang terinfeksi SARS-CoV-2 sebagian besar mengalami gejala ringan atau asimtomatik. Namun, pada sebagian orang dengan usia lanjut dan mengidap penyakit komorbid manifestasi gejala berat lebih sering ditemui. Salah satu faktor yang berkaitan terhadap manifestasi COVID-19 adalah respons imun host. Molekul sitokin merupakan protein yang berperan untuk mengaktifkan mekanisme perlawanan terhadap virus. Pengetahuan tentang profil imunitas yang diperantarai oleh sitokin dari saluran napas atas masih sangat sedikit sekali yang dipelajari. Penentuan biomarker yang dapat dijadikan penanda keparahan juga perlu untuk diketahui. Metode: Sampel swab NP diperoleh dari pasien terkonfirmasi positif COVID-19. Subjek dibagi menjadi 2 kategori berdasarkan manifestasi COVID-19 gejala ringan dan berat. Kadar sitokin (pg/ml) IL-2, IL-4, IL-10, IL-13, IL-17A, dan GMCSF dianalisis dari sampel swab NP menggunakan Luminex® assay. Hasil: Faktor demografi seperti usia (p=0,024) dan komorbid (p=0,017) secara signifikan berperan dalam menentukan keparahan gejala pada pasien COVID-19. Kadar (pg/ml) IL-2, IL-4, IL-10, IL-13, IL-17A, dan GMCSF antara kedua kelompok pasien COVID-19 gejala ringan dan berat tidak berbeda signifikan. Namun demikian, terdapat kecenderungan bahwa kadar (pg/ml) IL-2, IL-4, IL-13, dan GMCSF meningkat pada kelompok pasien COVID-19 gejala berat. Sedangkan, kadar (pg/ml) IL-10 dan IL-17A cenderung menurun pada pasien COVID-19 yang bergejala berat. Selain itu, rasio antara IL-2/IL-10 secara signifikan (p=0,004) lebih tinggi pada pasien COVID-19 gejala berat. Sebanyak 65,7% pasien COVID-19 dengan gejala berat memiliki nilai rasio IL-2/IL-10 yang tinggi. Kesimpulan: Kadar sitokin (pg/ml) IL-2, IL-4, IL-10, IL-13, IL-17A dan kemokin GMCSF (pg/ml) dari sampel swab NP dapat terdeteksi menggunakan Luminex® assay. Rasio kadar sitokin IL-2/IL-10 dapat dijadikan sebagai kandidat biomarker keparahan infeksi COVID-19 di masa mendatang. ......Background: Coronavirus disease 2019 (COVID-19) is a respiratory tract infectious disease. Since the outbreak in Wuhan, COVID-19 was declared as a pandemic by WHO. Data from July 3rd, 2021, showed that there have been 183,098,615 confirmed positive cases of COVID-19 with a death toll of 3,964,145 worldwide. Etiologically COVID-19 is caused by the new coronavirus known as SARS-CoV-2. The majority of people infected with SARS-CoV-2 experience mild symptoms or even are asymptomatic. However, for some people with older age and having comorbid diseases, severe manifestations are very common. Host immune response is one of the factors which affect disease severity. Playing a vital role in activating the immune system against viruses, cytokine protein can also contribute to the severity. Currently, very little is known about the profile of cytokine-mediated immunity from the upper respiratory tract. This research is aimed to find a potential candidate of biomarkers to predict severity in the early phase of COVID-19 infections. Methods: NP swab samples were obtained from patients who were positively confirmed for COVID-19. Subjects were divided into 2 categories based on the manifestation as mild or severe symptoms of COVID-19. Cytokine levels (pg/ml) of IL-2, IL-4, IL-10, IL-13, IL-17A, and GMCSF were analyzed from NP swab samples using Luminex® assay. Results: Demographic factors such as age (p=0.024) and comorbidities (p=0.017) significantly played a role in determining severity of COVID-19 patients. The levels (pg/ml) of IL-2, IL-4, IL-10, IL-13, IL-17A, and GMCSF between the two groups of patients with mild and severe COVID-19 symptoms were not significantly different. However, there was a tendency that the levels (pg/ml) of IL-2, IL-4, IL-13, and GMCSF to increase in the group of patients with severe COVID-19 symptoms. Meanwhile, levels (pg/ml) of IL-10 and IL-17A tend to decrease in COVID-19 patients with severe symptoms. In addition, the ratio of IL-2/IL-10 was significantly (p=0.004) higher in severe COVID-19 patients. A total of 65.7% of COVID-19 patients with severe symptoms had high values of IL-2/IL-10 ratio. Conclusion: Cytokine levels (pg/ml) of IL-2, IL-4, IL-10, IL-13, IL-17A, and GMCSF from NP swab samples can be detected using the Luminex® assay. The ratio of IL-2/IL-10 cytokine levels can be used as a biomarker candidate to predict severity for COVID-19 infection in the future.

Abstrak :
Latar Belakang : Corona Virus Disease 2019 (COVID 19) merupakan penyakit infeksi yang disebabkan virus Sars Cov 2 yang baru diidentifikasi dan saat ini telah ditetapkan sebagai pandemi. Manifestasi klinis bervariasi dan progresivitas kondisi pasien COVID-19 dapat terjadi setelah satu minggu atau dalam waktu yang tidak dapat ditentukan. Dalam kondisi pandemi COVID-19, tenaga medis perlu untuk menentukan pasien yang harus ditatalaksana terlebih dahulu berdasarkan pertimbangan klinis serta prognosis pasien. Dibutuhkan parameter objektif yang dapat memperkirakan risiko mortalitas untuk memilah prioritas perawatan pasien. Hitung limfosit absolut dan C-reactive protein selama ini digunakan sebagai prediktor mortalitas berbagai penyakit, termasuk infeksi. Perlu ditentukan titik potong dan peran hitung limfosit absolut dan CRP kuantitatif saat admisi sebagai prediktor mortalitas pasien COVID19. Tujuan : Mengetahui titik potong dan peran hitung limfosit absolut dan CRP kuantitatif untuk memprediksi mortalitas pasien COVID 19. Metode : Penelitian kohort retrospektif terhadap 235 pasien probable dan terkonfirmasi COVID-19 di RSCM sejak Maret hingga Juni 2020 dengan metode consecutive sampling. Data yang digunakan adalah data sekunder. Hasil: Sebanyak 235 subjek dianalisis dan didapatkan mortalitas sebesar 27,7%. Titik potong hitung limfosit absolut yang bermakna adalah 977,67 sel/µL dengan nilai AUC sebesar 0.704 (p <0.001 dengan IK 95% 0,624-0,785), sensitivitas 67,69% , spesifisitas 70,0%, NDP 46,32% dan NDN 85,0%. Pada analisis untuk kadar CRP kuantitatif didapatkan nilai AUC sebesar 0.656 (p <0.001 dengan 95%CI 0,578-0,733). Didapatkan nilai titik potong untuk kadar CRP kuantitatif sebesar 88.5 mg/L dengan sensitivitas 52,3% , spesifisitas 68,2%, NDP39,33%, NDN 79,45%. Penggabungan kedua variabel tersebut menghasilkan nilai AUC sebesar 0.737. Keduanya bersifat signifikan meningkatkan risiko mortalitas 4.70 dan 2.34 kali lipat pada pasien COVID-19. Simpulan:Hitung limfosit absolut dan/atau kadar CRP saat admisi dapat digunakan untuk menilai risiko mortalitas pasien COVID-19. ......Background: Coronavirus disease 2019 (COVID-19), an infectious disease caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV2), has been declared as pandemic world wide. Various clinical manifestation and rapid deterioration from mild to severe symptoms , acute respiratory distress syndrome and deaths could occur in the first week of disease. In pandemic setting, physicians need rapid assessment and objective parameters to make clinical decisions to the patient. Absolute lymphocyte count (ALC) and C-reactive protein (CRP) have been used as mortality predictors in various disease. We need to determine cut off and the role of ALC and CRP in predicting mortality risk in COVID-19. Objective : To determine the cut off and role of ALC and CRP as mortality predictors in COVID-19 patients. Methods : A cohort retrospective study with consecutive sampling method. Subjects were adults that fulfilled criteria of probable and confirmed COVID-19 in WHO criteria in RSCM from March to June 2020. Data were obtained from medical record and electronic health record. Analysis was done by using SPSS Statitstic 20.0. Results : A total of 235 subjects were analysed. The cut off of ALC was 977,67 cell/µL (Sn 68.2% ; Sp 70.4%; PPV 46,32%; NPV 85%) with AUC 0.704 (p<0,001 ; 95% CI [0.627—0.786]) and CRP was 88,5 mg/L (Sn 52,3% ; Sp 68,2%; PPV 39,33%; NPV 79,45%) with AUC 0.656 (p<0,001 ; 95% CI [0.572-0.728]). ROC analysis of ALC and CRP showed AUC 0.737 (p<0,001 ; 95% CI [648—0.792]). Adjusted OR of ALC and CRP showed that mortality risk increased 4.70 and 2.34 times by using the cut off. Conclusions : ALC and CRP at admission could be used to determine mortality risk in COVID-19 patients.

Abstrak :
Latar Belakang: Angka mortalitas pasien Coronavirus Disease 2019 (COVID-19) di Indonesia cukup tinggi, salah satu organ yang terlibat dalam memengaruhi tingginya mortalitas ini adalah jantung. Evaluasi ekokardiografi dapat membantu mengidentifikasi secara dini gangguan jantung yang berhubungan dengan mortalitas pasien. Saat ini data kelainan jantung dengan pemeriksaan ekokardiografi pada pasien COVID-19 derajat berat-kritis di Indonesia.Tujuan: Penelitian ini bertujuan untuk mencari hubungan antara kelainan ekokardiografi dengan mortalitas pada pasien COVID-19 derajat berat dan kritis.Metode: Data pasien COVID-19 derajat berat dan kritis di RSCM diambil berdasarkan rekam medis lalu dilakukan analisis data dengan menampilkan tabel deskriptif, analisis bivariat dengan chi-square dan multivariat dengan regresi logistik.Hasil: Dari total 83 pasien, sebanyak 48 pasien (57,8%) meninggal. Kelainan fungsional yang paling banyak ditemukan pada ekokardiografi adalah mPAP yaitu sebanyak 51 pasien (68%) dan gangguan struktural terbanyak adalah remodelling konsentrik ventrikel kiri yaitu 48 pasien (58%). Hasil analisis chi-square terhadap variabel ekokardiografi memperlihatkan bahwa Tricuspid Annular Plane Systolic Excursion (TAPSE) dengan RR 7,29 (IK95%; 0,98 - 54,36), Right Ventricular Systolic Pressure (RVSP) dengan RR 10,21 (IK95%; 1,41 - 74,04), mean Pulmonary Artery Pressure (mPAP) dengan RR 1,44 (IK95%; 1,02 - 2,04), Pulmonary Acceleration Time (PAT) dengan RR 2,36 (IK95%; 1,14 - 4,86), dan Right Atrial Pressure (RAP) dengan RR 3,40 (IK95%; 1,06 - 10,95), memiliki hubungan signifikan dengan mortalitas. Sedangkan Left Ventricular Ejection Fraction (LVEF), disfungsi diastolik ventrikel kiri (E/e’) dan cardiac output (CO) tidak terdapat hubungan yang signifikan. Analisis multivariat dengan regresi logistik menunjukan bahwa variabel ekokardiografi yang secara independen berhubungan dengan mortalitas adalah RVSP dan RAP.Simpulan: Kelainan ekokardiografi yang berhubungan dengan mortalitas pasien COVID 19 derajat berat dan kritis adalah TAPSE, RVSP, mPAP, PAT dan estimasi RAP. ......Background: The mortality rate of Coronavirus Disease 2019 (COVID-19) patient in Indonesia is high and one of the organ that may contribute mortality is heart problem. Echocardiography can help clinician to identify early functional abnormalities and structural defect of heart that may correlates to mortality and patient’s prognosis. Currently, there are limited data in Indonesia about cardiac abnormalities in severe-critically ill COVID-19 patients that evaluated with echocardiography.Objective: This study aims to determine the relationship between echocardiography abnormalities and mortality in severe and critically ill COVID-19 patients.Methods: Severe and critically ill COVID-19 patients data taken from medical records and then analyzed by presenting descriptive table, bivariate analysis using chi square and multivariate analysis using logistic regression.Results: Out of total 83 patients, 48 ​​patients (57.8%) died. The most common functional abnormality found on echocardiography was mPAP found in 51 patients (68%) and the most common structural defect was left ventricular concentric remodeling in 48 patients (58%). The results of chi-square analysis of echocardiographic variables are Tricuspid Annular Plane Systolic Excursion (TAPSE) RR 7,29 (95%CI; 0,98 - 54,36), Right Ventricular Systolic Pressure (RVSP) RR 10,21 (95% CI; 1,41 - 74,04), mean Pulmonary Artery Pressure (mPAP) RR 1,44 (95%CI; 1,02 - 2,04), Pulmonary Acceleration Time (PAT) RR 2,36 (95%CI; 1,14 - 4,86), dan Right Atrial Pressure (RAP) RR 3,40 (95% CI; 1,06 - 10,95)had a significant relationship with mortality. Meanwhile, left ventricular ejection fraction (LVEF), left ventricular diastolic dysfunction (E/e') and cardiac output (CO) had no significant relationship. Multivariate analysis using logistic regression showed that RVSP and RAP were independent variables that correlates to mortality.Conclusions: Echocardiography abnormalities that associated with mortality in severe-critically ill patients are TAPSE, RVSP, mPAP, PAT and estimated RAP

Abstrak :
Skrining penyakit Coronavirus Disease 2019 (Covid-19) pada petugas kesehatan dan non kesehatan rumah sakit merupakan salah satu upaya mencegah penularan Covid-19 di rumah sakit. Siloam Hospitals Group menerapkan tiga komponen skrining Covid-19 pada petugas, yaitu pengkajian gejala klinis, penemuan kontak erat, serta pemeriksaan antibodi Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) secara berkala. Temuan positif pada minimal satu komponen skrining Covid-19 akan ditindaklanjuti dengan pemeriksaan reverse transcription polymerase chain reaction (RT PCR). Meskipun demikian, keterlambatan penemuan kasus konfirmasi Covid-19 pada petugas di tahun 2020 menuntut penilaian terhadap kinerja skrining Covid-19 yang berjalan saat itu. Penelitian ini mengevaluasi kinerja skrining Covid-19 pada petugas di Siloam Hospitals Group pada tahun 2020 melalui analisis kuantitatif hubungan antara masing-masing komponen skrining Covid-19 dengan luaran hasil RT PCR, dilanjutkan dengan analisis kualitatif berdasarkan aspek evaluasi kinerja skrining menurut Wilson dan Jungner (1968). Desain kuantitatif penelitian ini berjenis kasus kontrol dengan memanfaatkan telaah data secara retrospektif. Data kualitatif penelitian ini diperoleh melalui wawancara mendalam terhadap tiga kriteria informan dan telaah dokumen. Penelitian ini menemukan hubungan signifikan antara gejala klinis khas Covid-19 dan antibodi SARS-CoV-2 dengan luaran hasil RT PCR (p < 0,05), namun tidak terdapat hubungan signifikan antara riwayat kontak erat dengan luaran hasil RT PCR (p > 0,05). Gejala klinis merupakan komponen skrining Covid-19 yang menunjukkan kinerja paling baik dalam memperkirakan luaran hasil RT PCR pada kasus Covid-19 bergejala, namun untuk menangkap kasus Covid-19 presimptomatik dan asimptomatik, penemuan kontak erat seharusnya menjadi komponen skrining yang lebih unggul. Kejadian under reporting dan over reporting dalam penemuan kontak erat menyebabkan kasus konfirmasi Covid-19 terlewat untuk didiagnosis dan kasus non kontak erat terlaporkan sebagai kontak erat dengan mayoritas hasil RT PCR negatif. Uji antibodi SARS-CoV-2 memiliki kinerja yang paling buruk karena memberikan yield yang rendah dalam penemuan kasus dan pengambilan keputusan klinis. Penelitian ini menyimpulkan bahwa pengkajian gejala klinis masih direkomendasikan sebagai komponen skrining Covid-19 yang memiliki kinerja baik. Penemuan kontak erat juga masih direkomendasikan sebagai komponen skrining Covid-19 meskipun kinerjanya memerlukan perbaikan. Sebaliknya, pemeriksaan antibodi SARS-CoV-2 berkala tidak lagi direkomendasikan sebagai komponen skrining Covid-19 karena menunjukkan kinerja yang paling buruk. Pemeriksaan berkala antigen SARS-CoV-2 atau pemeriksaan Nucleic Acid Amplification Test (NAAT) lainnya lebih direkomendasikan jika sudah tersedia. ......The Coronavirus Disease 2019 (Covid-19) screening on healthcare and non-healthcare workers is one of the means to prevent Covid-19 transmission within hospitals. Siloam Hospitals Group implements three components for Covid-19 screening on hospitals’ workers which consists of clinical symptoms assessment, contact finding, and serial Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) antibody testing. Positive finding on at least one of Covid-19 screening components will be followed up by reverse transcription polymerase chain reaction (RT PCR) testing. However, delay in Covid-19 confirmed case findings in hospitals’ workers in 2020 period requires assessment regarding Covid-19 screening performance implemented at the time. This study evaluates Covid-19 screening performance in Siloam Hospitals Group’s workers in 2020 through quantitative analysis of correlation between each of the Covid-19 screening components and RT PCR result, followed by qualitative analysis based on Wilson and Jungner’s (1968) principles of screening performance evaluation. The quantitative approach uses case control study design which collects quantitative data retrospectively. Qualitative data is acquired through in-depth interview with informants from three different criteria and through document study. This study finds significant correlation between Covid-19 clinical symptoms and RT PCR result as well as between SARS-CoV-2 antibody result and RT PCR result (p < 0,05), although no significant correlation is found between contact history and RT PCR result (p > 0,05). Clinical symptom is Covid-19 screening component which shows high performance in predicting RT PCR result for Covid-19 symptomatic cases. However, for Covid-19 presymptomatic and asymptomatic caeas, contact tracing should be placed as superior Covid-19 screening component. Under-reporting and over-reporting found in contact tracing implementation cause misdiagnosis of Covid-19 confirmed cases, while non-eligible contacts are reported as eligible contacts with predominant negative RT PCR results on follow up. SARS-CoV-2 antibody testing shows the lowest performance due to its low yield in case finding and clinical decision making. This study concludes that clinical symptoms assessment is still recommended as Covid-19 screening component with high performance. Contact tracing is also recommended to be used as Covid-19 screening component with performance improvement. In contrast, SARS-CoV-2 antibody testing is no longer recommended as Covid-19 screening component due to its low performance. Antigen SARS-CoV-2 or other Nucleic Acid Amplification Test (NAAT) serial testing is more recommended, if available.

Abstrak :
Pandemi Coronavirus disease 19 (Covid-19) berdampak pada komitmen perawat dalam memberikan asuhan keperawatan dan mempengaruhi kualitas asuhan, kepuasan kerja perawat, dan pencapaian tujuan pelayanan keperawatan. Penelitian ini bertujuan mengidentifikasi determinan komitmen perawat dalam memberikan asuhan keperawatan di era pandemi Covid-19. Desain penelitian yang menggunakan pendekatan cross sectional ini melibatkan 221 perawat pelaksana dan ketua tim di dua rumah sakit umum wilayah Kalimantan Barat. Pengambilan sampel dilakukan dengan teknik simple random sampling. Variabel determinan diukur menggunakan kuesioner dalam bentuk google form yang dikumpulkan secara online. Data dianalisis menggunakan regresi linier berganda. Hasil penelitian mendapatkan determinan komitmen perawat dalam memberikan asuhan keperawatan di masa pandemi Covid-19 adalah kecerdasan emosional (p=0,001) dan dukungan atasan ) p=0,009), yaitu setiap penambahan satu poin kecerdasan emosional dan dukungan atasan akan meningkatkan komitmen perawat dalam memberikan asuhan keperawatan sebesar 0,239 kali dan 0,125 kali. Faktor usia, lama kerja, jenis kelamin, tingkat pendidikan, status pernikahan, dan ruangan unit kerja tidak berhubungan dengan komitmen perawat (p> 0,05). Faktor yang paling berhubungan dengan komitmen perawat dalam memberikan asuhan keperawatan adalah kecerdasan emosional. Dari penelitian ini juga didapatkan kemampuan perawat menilai emosi orang lain dan keinginan perawat bertahan pada profesinya merupakan aspek kecerdasan emosional dan komitmen perawat yang masih perlu ditingkatkan. Hasil penelitian ini dapat digunakan sebagai dasar untuk mengembangkan kompetensi kecerdasan emosional perawat dan membuat strategi dukungan atasan untuk meningkatkan komitmen perawat dalam memberikan asuhan keperawatan. ......The Coronavirus disease 19 (Covid-19) pandemic has an impact on the commitment of nurses in giving nursing care and affects the quality of care, nurse job satisfaction, and the achievement of nursing service goals. This study aims to identify the determinants of nurses' commitment in giving nursing care in the era of the Covid 19 pandemic. The research design using a cross sectional approach involved 221 nurses and team leaders at two public hospitals in West Borneo. Sampling was done by simple random sampling technique. The determinant variable was measured using a questionnaire in the form of a google form which was collected online. Data were analyzed using multiple linear regression. The results showed that the determinants of nurses' commitment in giving nursing care during the Covid-19 pandemic were emotional intelligence (p=0.001) and supervisor support (p=0.009), that is, each addition of one point of emotional intelligence and support from supervisor will increase the commitment of nurses in giving nursing care by 0.239 times and 0.125 times. Factors of age, length of work, gender, education level, marital status, and work unit room were not related to nurse commitment (p> 0.05). The factor that is most closely related to the commitment of nurses in giving nursing care is emotional intelligence. From this study, it was also found that the nurse's ability to assess the emotions of others and the nurses's desire to stay in her profession are aspects of emotional intelligence and nurse commitment that still need to be improved. The results of this study can be used as a basis for developing nurses' emotional intelligence competencies and making supervisor support strategies to increase nurses' commitment in giving nursing care.