9 research outputs found
COVID-19 and Indonesia
Full text linkCoronavirus disease 2019 (COVID-19) pandemic is an ongoing problem in more than 200 countries in the world. Indonesia has been greatly affected by COVID-19 with case fatality rate (CFR) being 8.9% in the end of March 2020. We have some room for improvement related to the unreadingess of healthcare facility and the major steps taken by the government. It is suggested that the country should have stricter Stay-at-Home notice, suppress the spread by imposing lockdown on a large scale, improve healthcare service, and increase the availability of personal protective equipments (PPE). It is important to avoid an epidemic peak that potentially overwhelms healthcare service by quarantining the case contacts. Lockdown may prolong the epidemic doubling time significantly. Demand of health system is likely to grow since the number of COVID-19 case is likely to rise. Effective procedures for protecting medical staff from infection are essential. Scientific research in Indonesia is also crucial to provide suggestion and recommendation pertinent to COVID-19
Modifiable Risk Factors for Dementia in Indonesia’s Urban Population
Full text linkBackground: Indonesia is one of ten countries in the world with estimated number of dementia case exceeding a million. The number of elderly population living in Indonesian cities has exceeded the number in rural areas, but the country lacks data representing the urban population better related to modifiable risk factors for dementia, prevention of which is crucial. We aimed to identify the modifiable risk factors for dementia in Indonesia’s urban population. Methods: this case-control study used five-year data in Indonesia’s national general hospital by tracing back medical record books of individuals aged 60 years and above in geriatric medicine outpatient clinic to the first hospital visit. Statistical analyses included bivariate and multivariate analyses to adjust for confounding factors appropriately. Results: data from 345 patients suggested that the significant risk factors for dementia were history of smoking (adjusted OR 2.860, 95% CI 1.559-5.246), history of hearing loss (adjusted OR 7.962, 95% CI 3.534-17.941), history of depression (adjusted OR 12.473, 95% CI 2.533-61.417), hypertension (adjusted OR 1.751, 95% CI 1.006-3.048), and diabetes mellitus (adjusted OR 2.561, 95% CI 1.482-4.425). Dementia patients had longer median duration of diabetes mellitus (12 years) than elderly without dementia (9 years) before the diagnosis of dementia. Single point late-life underweight condition and low educational attainment were not associated with dementia in Indonesia’s urban setting. The risk factors for vascular dementia were largely similar to those of dementia. Conclusion: in Indonesian urban population, history of smoking, hearing loss, depression, hypertension, and diabetes mellitus are associated with dementia
Dementia Risk Reduction in Cognitively Normal Elderly Receiving Mediterranean Diet
No full textStudies showed cognitive health improvement with mediterranean diet (MD). It is important to find out the benefit in dementia prevention. Relevant meta-analysis and randomised controlled trials pertaining to MD impact on dementia risk reduction in cognitively normal elderly were collected. The comprehensive search relied on databases Pubmed and Cochrane with keywords MD and dementia. Results of methodological quality assessment of three studies utilising Oxford Centre for Evidence Based Medicine year 2011 tools, showed that the studies were valid and applicable. Neuroprotective effect was different in group with the highest adherence to the diet in study 1 with adjusted hazard ratio (HR) of 0.67 (95% CI 0.52-0.88, p=0.004). In study 2 none were diagnosed with dementia in all three groups receiving MD with extravirgin olive oil (EVOO), diet with nuts, and control group. In comparison with the control group in study 3, number needed to treat (NNT) was 13.29 for group with EVOO (absolute risk reduction/ ARR = 7.5% [95%CI 1.09%-13.95%]) and was 10.79 for group with nuts (ARR = 9.2% [95%CI 2.88%-15.65%]). Long-term MD may be beneficial to reduce dementia rate. Neuroprotective effect is achievable only with the highest adherence (p=0.004). Gado-gado modification in Indonesian diet is desirable. Keywords: dementia, mediterranean diet, risk reduction, prevention. Penurunan Risiko Demensia pada Usia Lanjut Berfungsi Luhur Normal dengan Diet Mediterania Abstrak Diet mediterania dapat mempertahankan fungsi kognitif berdasarkan beberapa penelitian. Manfaatnya terhadap pencegahan demensia perlu diketahui. Studi ini mengumpulkan meta-analisis dan uji acak dengan kontrol mengenai pengaruh diet mediterania terhadap penurunan risiko demensia pada usia lanjut (lansia) dengan fungsi luhur normal. Sumber data elektronik Pubmed dan Cochrane digunakan dengan kata kunci mediterranean diet dan dementia. Hasil dari penilaian kualitas studi dengan metode Oxford Centre for Evidence Based Medicine 2011 terhadap tiga studi terpilih menunjukkan bahwa studi tersebut valid dan dapat diterapkan. Efek neuroprotektif berbeda signifikan pada kelompok dengan tingkat ketaatan tertinggi pada diet mediterania dalam penelitian pertama dengan hazard ratio (HR) 0,67 (95% CI 0,52-0,88, p= 0,004). Pada penelitian kedua, tidak ada yang terdiagnosis demensia pada akhir penelitian pada ketiga kelompok, yakni kelompok diet dengan tambahan minyak zaitun ekstravirgin, kelompok dengan tambahan kacang-kacangan (kelompok 2), serta kelompok kontrol. Mekipun demikian penelitian ketiga menunjukkan number needed to treat (NNT) 13,29 pada kelompok minyak zaitun ekstravirgin (absolute risk reduction/ ARR = 7,5% [95%CI 1,09% - 13,95%]) dan pada kelompok 2 NNT 10,79 (ARR = 9,2% [95%CI 2,88%-15,65%]) dibandingkan kontrol. Diet mediterania jangka panjang dapat menurunkan angka demensia. Efek neuroprotektif hanya dapat dicapai dengan ketaatan tinggi terhadap diet (p=0,004). Pada diet Indonesia, modifikasi gado-gado dapat dipertimbangkan. Kata kunci: demensia, diet mediterania, penurunan risiko, pencegahan
Clinical Profile of Elderly Patients with COVID-19 hospitalised in Indonesia’s National General Hospital
Full text linkLatar BelakangSebanyak 38.6% kasus kematian pasien COVID-19 di Indonesia terjadi di populasi lansia. Data mengenai profil klinis pasien rawat inap lansia dengan COVID-19 masih tidak ada. Padahal kelompok pasien ini adalah pasien risiko tinggi selama pandemi ini yang memerlukan perhatian lebih.MetodeStudi deskriptif ini menggunakan data lengkap pasien lansia dengan COVID-19 yang dirawat inap di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo (RSUPN Cipto Mangunkusumo) dari April hingga akhir Agustus 2020. Data termasuk karakteristik klinis, gejala, komorbiditas, multimorbiditas dan luaran mortalitas pasien.HasilDi populasi pasien lansia (n=44), mayoritas berusia di antara 60-69 tahun (68%), berjenis kelamin laki-laki (66%), dan tidak memiliki riwayat kontak erat dengan pasien COVID-19 sebelumnya (86%). Gejala tersering ialah demam, batuk, dan sesak yang merupakan gejala khas COVID-19, sedangkan penyakit kronis tersering adalah diabetes melitus, hipertensi, dan keganasan. Multimorbiditas ditemukan hanya di 14% pasien lansia, dan para pasien tersebut bertahan hidup pasca infeksi virus SARS-CoV-2. Angka kematian pasien lansia rawat inap dengan COVID-19 di studi ini adalah 23%, dan 90% dari kasus kematian berjenis kelamin laki-laki.KesimpulanPasien laki-laki mendominasi kasus terkonfirmasi dan kasus kematian lansia dengan COVID-19. Gejala khas COVID-19 hanya ditemukan di sekitar setengah pasien penelitian. Pasien yang meninggal dunia memiliki persentase gejala khas lebih tinggi. Gejala tidak khas pun mungkin ditemukan di pasien lansia. Immunosenescence dan fungsi imunoregulasi jenis kelamin tertentu dihipotesiskan memiliki peran penting dalam menyebabkan kematian lansia di studi ini.Kata Kunci: Profil Klinis, Lansia, Pasien Geriatri, COVID-19, Indonesia ABSTRACTBackgroundOlder people contributed to 38.6% of death cases related to COVID-19 in Indonesia. Data regarding clinical profile of hospitalised elderly with COVID-19 in Indonesia were still lacking. Older people are at-risk population in the pandemic, whom we should pay attention to.MethodsThis single centre descriptive study utilised complete data of elderly inpatients with COVID-19 in Indonesia’s national general hospital from April to late August 2020. The data consisted of clinical characteristics, symptoms, comorbidities, multimorbidity, and mortality outcome.ResultsAmong elderly patients (n=44), a majority of patients were aged 60-69 years (68%), were male (66%), and had no history of close contact with COVID-19 patient (86%). The most common symptoms were fever, cough and shortness of breath (classic symptoms of COVID-19), whereas the most common chronic diseases were diabetes mellitus, hypertension, and malignancy. Multimorbidity was only found in 14% of patients, all of whom remained alive following SARS-CoV-2 infection. The death rate among elderly inpatients with COVID-19 in this study was 23%, and male older adults contributed to 90% of death cases.ConclusionMale patients dominated both confirmed cases and death cases among elderly with COVID-19. Classic symptoms of COVID-19 were only found in about half of the study patients. Non-survivors had higher percentage of the classic symptoms of COVID-19 than survivors. Atypical COVID-19 presentations are possible in older adults. We postulated that immunosenescence and sex-specific immunoregulatory function play an important role in causing death in this study cohort. Keywords: Clinical Profile, Elderly, Geriatric Patient, COVID-19, Indonesi
Gastrointestinal Presentation in COVID-19 in Indonesia: A Case Report
Full text linkSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently causing a widespread infection in the world. During the pandemic, physicians may need to raise the index of suspicion earlier in at-risk patients presenting with gastrointestinal symptoms, which are uncommon findings in coronavirus disease 2019 (COVID-19) patients. We report a patient in Indonesia with chest pain and gastrointestinal symptoms who was later confirmed to have SARS-CoV-2 infection after spending days of hospitalisation in the standard ward
KIDNEY INJURY MOLECULE-1 AS AN EARLY AMIKACIN-INDUCED NEPHROTOXICITY MARKER IN PATIENTS WITH SEPSIS HOSPITALIZED IN THE INTENSIVE CARE UNIT
Full text linkObjective: This study sought to determine the correlation between trough plasma amikacin concentrations and urinary normalized kidney injurymolecule-1 (KIM-1) concentrations as an early biomarker of nephrotoxicity in patients with sepsis who are hospitalized in an intensive care unit.Methods: In this pilot study, 12 patients with sepsis were treated with amikacin 1000 mg/day between May 2015 and September 2015. The correlationbetween trough plasma amikacin concentrations measured after the third dose and the elevation of urinary normalized KIM-1 concentrations afterthe third amikacin dose relative to the first/second dose was evaluated.Results: In total, three patients had trough plasma amikacin concentrations exceeding the safe level (>10 μg/ml). Furthermore, eight patientsdisplayed higher normalized KIM-1 concentrations after third dose than after the first/second dose; however, there was no correlation betweentrough amikacin concentrations and the elevation of urinary normalized KIM-1 concentrations (r=0.3, p=0.3).Conclusion: The study results illustrated that short-term treatment with an amikacin dose of 1000 mg/day was generally safe in patients with sepsis
The effectiveness of comprehensive geriatric assessment intervention for older people in outpatient setting: a systematic review / meta-analysis
No full textAbstract Introduction Comprehensive geriatric assessment (CGA) is a multidisciplinary diagnostic and treatment process that identifies a frail older person’s medical, psychosocial, and functional limitations. The effectiveness of CGA in patients admitted to hospitals is well known, but it is still unclear whether those benefits translate to the outpatient setting. Therefore, this study aims to assess the effectiveness of CGA in the hospital outpatient setting. Methods We collected randomized clinical trials comparing CGA and usual care in the outpatient setting for older patients (aged 60 years and above). We used a combination of the keywords and their synonyms in several databases: PubMed, EMBASE Proquest, and the clinical trial registry. Risk of bias (RoB) assessment was done using RoB 2 from Cochrane. GRADE assessment for outcome mortality and hospitalization was also done. Result We found seven articles with a total of 3,254 subjects undergoing CGA in the outpatient clinic. The implementation of CGA is highly varied from center to center. Low-quality evidence demonstrated that CGA did not significantly affect all-cause mortality, patient satisfaction, hospitalization, functional status of basic and instrumental activities of daily living, cognitive, and cost. Very low-quality evidence showed favorable quality of life in CGA group at 3 and 12 months, as reported by individual studies. No difference was found in all studies relating to the risk of hospitalization. Conclusion CGA is a complex intervention and is highly dependent on context. Therefore, a robust conclusion is challenging to make due to the different practices and measurement tools used in the studies. Further research using a guideline for hospital outpatient CGA may be beneficial
Sarcopenia in a Multiethnic State: A Cross-Sectional Data Analysis of Multicentre Indonesia Longitudinal Aging Study
Full text linkBackground: Previous regional studies related to sarcopenia in multiethnic Indonesia suggested inconsistent findings. We aimed to find the prevalence of sarcopenia and its associated factors among Indonesian older adults. Methods: In this cross-sectional analysis, we utilised the data of Indonesia Longitudinal Aging Study (INALAS) from community-dwelling outpatients in eight centres. Statistical analyses included descriptive, bivariate, and multivariate analyses. We categorised older adults into sarcopenia group based on the criteria of the SARC-F questionnaire, namely strength, assistance with walking, rising from a chair, climbing stairs, and falls questionnaire. Results: Among 386 older adults, 17.6% were in sarcopenia group. The prevalence of sarcopenia was found to be the lowest in Sundanese group (8.2%). Following appropriate statistical adjustment, sarcopenia was associated with female sex (OR 3.01, 95% CI 1.34-6.73), dependent functional capacity (OR 7.38, 95% CI 3.26-16.70), frailty (OR 11.82, 95% CI 5.41-25.80), and history of fall (OR 5.17 (95% CI 2.36-11.32). Sarcopenia was not significantly associated with age 70 years and older (OR 1.67, 95% CI 0.81-3.45), Sundanese group (OR 0.44, 95% CI 0.15-1.29), and being at high risk for malnutrition or malnourished (OR 2.98, 95% CI 0.68-13.15). All centenarians had no sarcopenia nor frailty, and 80% of them were Sundanese older adults. Conclusion: One in five Indonesian community-dwelling older adults had sarcopenia, associated with female sex, dependent functional capacity, frailty, and history of fall. Albeit statistically nonsignificant, there may still be link between Sundanese, age 70 years and older, as well as being at high risk for malnutrition, and sarcopenia
Sedentary Lifestyle of Older Adults and Its Associated Factors: A Multicentre Cross-Sectional Study During COVID-19 Pandemic in Indonesia
Full text linkBackground: COVID-19 is here to stay, and humans ought to decide how to adapt. We aimed to describe lifestyle changes during COVID-19 pandemic, and to determine the prevalence and factors associated with sedentary lifestyle among older adults.Methods: We obtained data from community-dwelling older adults aged ≥60 years. We presented the data descriptively and used multivariate analysis to assess the association between Physical Activity Scale for the Elderly (PASE) -based sedentary lifestyle and other variables in several tertiary geriatric centres.Results: Among 601 participants, 21.1% had sedentary lifestyle. Ethnic groups with the highest prevalence of sedentary lifestyle were Minang, Balinese, and Sundanese. Changes related to food intake, body weight, and physical activity were seen in a small proportion of older adults. Sun exposure habit was described. Sedentary lifestyle was associated with less consumption of food (OR 2.59, 95% CI 1.07-6.30), weight loss (OR 3.00, 95% CI 1.64-5.48), and higher intensity of snacking (OR 0.45, 95% CI 0.20-0.99).Conclusion: During COVID-19 pandemic, one out of five older adults had sedentary lifestyle, which was positively associated with less consumption of food and weight loss, and negatively associated with higher intensity of snacking. The prevalence of sedentary lifestyle varied across ethnic groups. Adequate and appropriate food intake may be crucial to keep older adults active, preventing them from entering vicious cycle of malnutrition, sarcopenia, and frailty
