Publications by authors named "Joshua Henrina"

18 Publications

  • Page 1 of 1

Tachycardia and Pre-existing Chronic Kidney Disease Are Predictors of the Worse Clinical Outcomes in Patients Recently Hospitalized With Acute Heart Failure.

Cureus 2021 Jun 21;13(6):e15802. Epub 2021 Jun 21.

Cardiology, Siloam Heart Institute/Siloam Hospitals Kebon Jeruk, Jakarta, IDN.

Background: This study aimed to assess the factors contributing to the outcomes of recently hospitalized patients with heart failure (HF).

Methods: A prospective data of 76 adults who were admitted due to acute HF between October 1, 2019 and June 30, 2020 at our center were analyzed. Endpoints included survival and rehospitalization within six months after discharge.

Results: The mean age was 64.9 ± 13.8 years, with a male preponderance (68.4%). Approximately 60.5% of patients had the left ventricular ejection fraction (LVEF) <40%, whereas 26.3% of patients had LVEF ≥50%. Coronary artery disease (75%), arterial hypertension (72.4%), chronic kidney disease (46.1%), and diabetes mellitus (46.1%) were the most frequent comorbidities. Poor compliance (40.8%) and non-cardiac infection (21.1%) were the common precipitating factors for hospitalization. The majority of subjects had severe symptoms, indicated by the frequent need of intensive care unit (43%), high N-terminal prohormone brain natriuretic peptide levels [NT-proBNP; median, 4765 (1539.7-11782.2) pg/mL], and presence of either atrial fibrillation, severe mitral regurgitation, or significant pulmonary hypertension in approximately one-third of cases. Even though in-hospital mortality was relatively low (2.6%), the all-cause mortality and rehospitalization rates in the next six months after discharge were still high, reaching 22.54% and 19.72%, respectively. Further survival analysis showed that tachycardia on admission and pre-existing chronic kidney disease (CKD) resulted in low six-month survival rates among these patients.

Conclusion: After hospital discharge, patients with HF were still exposed to higher risks of death and readmission albeit with the medication addressed. Tachycardia on admission and pre-existing CKD might predict worse outcomes.
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http://dx.doi.org/10.7759/cureus.15802DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8294205PMC
June 2021

Comparing Lung CT in COVID-19 Pneumonia and Acute Heart Failure: An Imaging Conundrum.

Cureus 2021 May 19;13(5):e15120. Epub 2021 May 19.

Cardiology, Siloam Hospital, Jakarta, IDN.

Background Chest computed tomography (CT) provides an effective modality to evaluate patients with suspected coronavirus disease 2019 (COVID-19). However, overlapping imaging findings with cardiogenic pulmonary edema is not uncommon. Reports comparing the chest CT features of these diseases have not been elaborated. Thus, we aimed to show the difference between the low-dose lung CT findings of COVID-19 pneumonia and comparing them to those with acute heart failure (HF). Methods This retrospective analysis enrolled hospitalized patients with COVID-19 (n=10) and acute heart failure (n=9) that exclusively underwent low-dose chest CT scans within 24 hours of admission. Clinical and lung CT characteristics were collected and analyzed. Results The appearance of ground-glass-opacities (GGOs) has been recorded in all individuals in the HF and COVID-19 groups. There was no significant statistical difference between the two groups for rounded morphology, consolidation, crazy paving pattern, lesion distribution, and parenchymal band (P> 0.05). However, diffuse lesions were more frequent in HF cases (55.6% vs. 0%) than in COVID-19 pneumonia, which had a predominantly multifocal pattern. Notably, CT images in HF patients were more likely to have signs of interstitial tissue thickening, such as the interlobular septums, fissures, and peribronchovascular interstitium (55.6% vs 0%, 88.9% vs 20% and 44.4% vs 0%, respectively), as well as cardiomegaly (77.8% vs 0%), increased artery to bronchus ratio (55.6% vs 0%), and pleural effusions (77.8% vs 0%). Conclusions Major overlaps of lung CT imaging features existed between COVID-19 pneumonia and acute HF cases. However, signs of fluid redistribution are clues that favor HF over COVID-19 pneumonia.
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http://dx.doi.org/10.7759/cureus.15120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8212963PMC
May 2021

Diabetes and COVID-19: The past, the present, and the future.

Metabolism 2021 08 11;121:154814. Epub 2021 Jun 11.

Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia; Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia.

Diabetes, one of the most prevalent chronic diseases in the world, is strongly associated with a poor prognosis in COVID-19. Scrupulous blood sugar management is crucial, since the worse outcomes are closely associated with higher blood sugar levels in COVID-19 infection. Although recent observational studies showed that insulin was associated with mortality, it should not deter insulin use in hospitalized patients requiring tight glucose control. Back and forth dilemma in the past with regards to continue/discontinue certain medications used in diabetes have been mostly resolved. The initial fears of consequences related to continuing certain medications have been largely dispelled. COVID-19 also necessitates the transformation in diabetes care through the integration of technologies. Recent advances in health-related technologies, notably telemedicine and remote continuous glucose monitoring, have become essential in the management of diabetes during the pandemic. Today, these technologies have changed the landscape of medicine and become more important than ever. Being a high-risk population, patients with type 1 or type 2 diabetes, should be prioritized for vaccination. In the future, as the pandemic fades, the prevalence of non-communicable diseases is expected to rise due to lifestyle changes and medical issues/dilemma encountered during the pandemic.
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http://dx.doi.org/10.1016/j.metabol.2021.154814DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8192264PMC
August 2021

Co-infection of COVID-19 and recurrent malaria.

J Infect Dev Ctries 2021 05 31;15(5):625-629. Epub 2021 May 31.

Department of Internal Medicine, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Penjaringan, Kota Jakarta Utara, Daerah Khusus Ibukota Jakarta, Indonesia.

In tropical countries, endemic diseases such as malaria can be challenging to distinguish from COVID-19 because of the similarities in presenting symptoms. Here we reported a case of a young soldier with fever and myalgia six days before admission, with non-productive cough, chills, nausea and vomiting, dizziness, and headache for two days. Previously, he had experienced four times of malaria infection. He had a history of positive non-falciparum malaria rapid diagnostic test (RDT) two days before admission. Significant findings were epigastric tenderness, splenomegaly, and severe thrombocytopenia of 36×103 cells / µL. A naso-oropharyngeal swab examination revealed a positive SARS-CoV-2 infection. Consequently, he was hospitalized for 12 days, successfully treated, and discharged without sequelae. Thus, in light of a pandemic, physicians need to raise the suspicion of concurrent COVID-19 infection with other tropical diseases, especially at-risk patients, because malaria and COVID-19 may share similar manifestations. Moreover, further ancillary testing, such as RDT, may be warranted.
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http://dx.doi.org/10.3855/jidc.13793DOI Listing
May 2021

CrossFit-Induced Rhabdomyolysis in a Young Healthy Indonesian Male.

Cureus 2021 Apr 27;13(4):e14723. Epub 2021 Apr 27.

Department of Internal Medicine, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia/Atma Jaya Hospital, Jakarta, IDN.

CrossFit, a high-intensity interval training, keeps growing in trend and is one of the most favorable types of fitness, after wearable technology. However, an excessive workout is detrimental to the human body, particularly the muscle tissue. CrossFit is known to cause exercise-induced rhabdomyolysis, a concerning disease with potentially devastating consequences. Nevertheless, only a few case reports have described this disease, and this is the first case report of such disease in Indonesia to the best of our knowledge. A 27-year-old, previously healthy and active Indonesian male presented with dark urine and myalgia in lower extremities after 720 repetitions of squats three days before admission. His urinalysis showed +1 blood, 2-7 red blood cells/high power field (HPF), but negative protein. Laboratory results showed an increase in creatine phosphokinase (CPK) (54,250 U/L) and LDH (1,670 U/L) levels, consistent with exercise-induced rhabdomyolysis, and serum calcium of 1.87 mmol/L, with normal serum creatinine and BUN level. He was hospitalized for two days and was treated with intravenous hydration therapy. CrossFit-induced rhabdomyolysis is a potentially devastating disease. Apart from prompt diagnosis and treatment, further research regarding the safe number of repetitions for CrossFit training, particularly for lower extremities are needed. Predictors of CrossFit-induced rhabdomyolysis must be sought throughout, and participants' awareness should be increased.
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http://dx.doi.org/10.7759/cureus.14723DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8169014PMC
April 2021

Visceral adiposity, subcutaneous adiposity, and severe coronavirus disease-2019 (COVID-19): Systematic review and meta-analysis.

Clin Nutr ESPEN 2021 06 9;43:163-168. Epub 2021 Apr 9.

Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia. Electronic address:

Background And Aims: Body mass index (BMI) has previously been shown to increase mortality and disease severity in patients with COVID-19, but the pooled effect estimate was heterogeneous. Although BMI is widely used as an indicator, it cannot distinguish visceral from subcutaneous fat. This systematic review and meta-analysis aimed to investigate the association between visceral adiposity, subcutaneous fat, and severe COVID-19.

Methods: We performed a systematic literature search using the databases: PubMed, Embase, and EuropePMC. Data on visceral fat area (VTA), subcutaneous fat area (SFA), and total fat area (TFA) were collected. The outcome of interest was severe COVID-19. We used a REML random-effects model to pool the mean differences and odds ratio (OR).

Results: There were 5 studies comprising of 539 patients. Patients with severe COVID-19 have a higher VTA (mean difference 41.7 cm [27.0, 56.4], p < 0.001; I: 0%) and TFA (mean difference 64.6 cm [26.2, 103.1], p = 0.001; I: 0%). There was no significant difference in terms of SFA between patients with severe and non-severe COVID-19 (mean difference 9.3 cm [-4.9, 23.4], p = 0.199; I: 1.2%). Pooled ORs showed that VTA was associated with severe COVID-19 (OR 1.9 [1.1, 2.2], p = 0.002; I: 49.3%).

Conclusion: Visceral adiposity was associated with increased COVID-19 severity, while subcutaneous adiposity was not.

Prospero Id: CRD42020215876.
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http://dx.doi.org/10.1016/j.clnesp.2021.04.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8032475PMC
June 2021

Proton pump inhibitor on susceptibility to COVID-19 and its severity: a systematic review and meta-analysis.

Pharmacol Rep 2021 Apr 11. Epub 2021 Apr 11.

Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Udayana, Denpasar, Indonesia.

Background: The negative impacts of proton pump inhibitor (PPI), including the risk of pneumonia and mortality, have been reported previously. This meta-analysis aimed to address the current interest of whether the administration of PPI could increase the susceptibility and risk of poor outcome in COVID-19.

Methods: We performed a systematic literature search from PubMed, Embase, EBSCOhost, and EuropePMC databases up until 3 December 2020. The main outcome was composite poor outcome which comprised of mortality and severe COVID-19. Severe COVID-19 in this study was defined as patients with COVID-19 that fulfill the criteria for severe CAP, including the need for intensive unit care or mechanical ventilation. The secondary outcome was susceptibility, based on cohort comparing COVID-19 positive and COVID-19 negative participants.

Results: There were a total of 290,455 patients from 12 studies in this meta-analysis. PPI use was associated with increased composite poor outcome (OR 1.85 [1.13, 3.03], p = 0.014; I 90.26%). Meta-regression analysis indicate that the association does not vary by age (OR 0.97 [0.92, 1.02], p = 0.244), male (OR 1.05 [0.99, 1.11], p = 0.091), hypertension (OR 9.98 [0.95, 1.02], p = 0.317), diabetes (OR 0.99 [0.93, 1.05], p = 0.699), chronic kidney disease (OR 1.01 [0.93, 1.10], p = 0.756), non-steroidal anti-inflammatory drug use (OR 1.02 [0.96, 1.09], p = 0.499), and pre-admission/in-hospital PPI use (OR 0.77 [0.26, 2.31], p = 0.644). PPI use was not associated with the susceptibility to COVID-19 (OR 1.56 [0.48, 5.05], p = 0.46; I 99.7%).

Conclusion: This meta-analysis showed a potential association between PPI use and composite poor outcome, but not susceptibility.

Prospero Id: CRD42020224286.
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http://dx.doi.org/10.1007/s43440-021-00263-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8036156PMC
April 2021

Coffee and tea consumption and the risk of glioma: a systematic review and dose-response meta-analysis.

Br J Nutr 2021 Mar 10:1-9. Epub 2021 Mar 10.

Department of Neurosurgery, Medical Faculty of Pelita Harapan University, Neuroscience Centre Siloam Hospital, Lippo Village Tangerang, Indonesia.

In this systematic review and dose-response meta-analysis, we aimed to assess whether coffee and tea consumption is related to the risk of glioma. We performed a systematic literature search using PubMed, Embase, Scopus and the EuropePMC from the inception of database up until 1 October 2020. Exposures in the present study were coffee and tea consumption, the main outcome was the incidence of glioma. The present study compares the association between the exposure of coffee and tea with the incidence of glioma, and the results are reported in relative risks (RR). There are 12 unique studies comprising of 1 960 731 participants with 2987 glioma cases. Higher coffee consumption was associated with a statistically non-significant trend towards lower risk of glioma (RR 0·77 (95 % CI 0·55, 1·03), P= 0·11; I2:75·27 %). Meta-regression showed that the association between coffee and glioma was reduced by smoking (P= 0·029). Higher tea consumption was associated with a lower risk of glioma (RR 0·84 (95 % CI 0·71, 0·98), P= 0·030; I2:16·42 %). Sensitivity analysis by removal of case-control studies showed that higher coffee consumption (RR 0·85 (95 % CI 0·72, 1·00), P= 0·046; I2:0 %) and higher tea consumption (RR 0·81 (95 % CI 0·70, 0·93), P= 0·004; I2:0 %, Pnon-linearity = 0·140) were associated with lower risk of glioma. Dose-response meta-analysis showed that every one cup of coffee per day decreases the risk of glioma by 3 % (RR 0·97 (95 % CI 0·94, 0·99), P= 0·016, Pnon-linearity = 0·054) and every one cup of tea per day decreases the risk of glioma by 3 % (RR 0·97 (95 % CI 0·94, 1·00), P= 0·048). This meta-analysis showed apparent association between coffee and tea intake and risk of glioma.
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http://dx.doi.org/10.1017/S0007114521000830DOI Listing
March 2021

Clinical Characteristics of De Novo Heart Failure and Acute Decompensated Chronic Heart Failure: Are They Distinctive Phenotypes That Contribute to Different Outcomes?

Card Fail Rev 2020 Mar 19;7:e02. Epub 2021 Feb 19.

Faculty of Medicine, Universitas Pelita Harapan Tangerang, Indonesia.

Heart failure is currently one of the leading causes of morbidity and mortality. Patients with heart failure often present with acute symptoms and may have a poor prognosis. Recent evidence shows differences in clinical characteristics and outcomes between de novo heart failure (DNHF) and acute decompensated chronic heart failure (ADCHF). Based on a better understanding of the distinct pathophysiology of these two conditions, new strategies may be considered to treat heart failure patients and improve outcomes. In this review, the authors elaborate distinctions regarding the clinical characteristics and outcomes of DNHF and ADCHF and their respective pathophysiology. Future clinical trials of therapies should address the potentially different phenotypes between DNHF and ADCHF if meaningful discoveries are to be made.
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http://dx.doi.org/10.15420/cfr.2020.20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7919682PMC
March 2020

Cardiac Manifestations, Treatment Characteristics, and Outcomes of Paediatric Inflammatory Multisystem Syndrome Temporally Associated with Severe Acute Respiratory Syndrome Coronavirus-2: systematic review of case reports and case series.

Prog Pediatr Cardiol 2021 Feb 9:101365. Epub 2021 Feb 9.

Siloam Heart Institute/Siloam Hospital Kebon Jeruk, Jakarta, Indonesia.

Objective: To investigate cardiac manifestations, treatment characteristics, and outcomes of paediatric inflammatory multisystem syndrome (PIMS) temporally associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) (PIMS-TS).

Method: We performed a comprehensive literature search of several databases and qualitatively synthesized findings from studies.

Results: Twenty-six studies were included with 1228 pooled subjects, with a mean age of 8.6 years, which were dominated by male gender (53%), and African ethnicity (31%). 732 (38%) patients were reactive on a serological test, and 457 patients (45%) were positive on SARS-CoV-2 RT-PCR. ST-segment abnormalities were the most common ECG findings (16%, n/N: 34/212). Various markers of troponin and the pooled mean of BNP and NT-pro-BNP levels were elevated. Cardiomegaly and pericardial effusion (21.8%, n/N: 164/751) was the most common chest X-ray findings. In echocardiography, the majority of patients' left ventricular ejection fraction was reduced (59.0%, n/N: 180/305), with pericardial effusion/ pericarditis seen the most (17.44%, n/N: 221/1267), and Z score ≥ 2 in 28% (n/N: 42/139). Cardiac MRI findings were consistent with acute myocarditis. Intravenous immunoglobulin, corticosteroids, and vasoactive drugs were frequently utilized. The mean length of stay was 6 days, with most patients (71%, n/N: 834/1163) were admitted to the ICU. However, the overall prognosis was favourable, with 98% alive (n/N: 1235/1260), and more than 50% of patients experienced recovery of left ventricular systolic functions at discharge (116 out of 206 patients).

Conclusion: PIMS-TS is a rare clinical syndrome associated with a multiorgan system dysfunction, especially acute cardiac injury, and mandates a higher level of care.Nevertheless, when appropriate treatments are available, the cardiac function rapidly reverted to normal in most cases, and it was associated with a favourable outcome in general. Of concern, medium and long-term prognosis remains to be elucidated.
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http://dx.doi.org/10.1016/j.ppedcard.2021.101365DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871802PMC
February 2021

Dyslipidemia Increases the Risk of Severe COVID-19: A Systematic Review, Meta-analysis, and Meta-regression.

J Clin Exp Hepatol 2021 Feb 8. Epub 2021 Feb 8.

Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.

Objective: This systematic review and meta-analysis aimed to evaluate whether dyslipidemia affects the mortality and severity of COVID-19, we also aimed to evaluate whether other comorbidities influence the association.

Methods: A systematic literature search using PubMed, Embase, and EuropePMC was performed on 8 October 2020. This study's main outcome is a poor composite outcome, comprising of mortality and severe COVID-19.

Results: There were 9 studies with 3,663 patients. The prevalence of dyslipidemia in this pooled analysis was 18% (4%-32%). Dyslipidemia was associated with increased composite poor outcome (RR 1.39 [1.02, 1.88], p=0.010; I: 56.7%, p=0.018). Subgroup analysis showed that dyslipidemia was associated with severe COVID-19 (RR 1.39 [1.03, 1.87], p=0.008; I: 57.4%, p=0.029). Meta-regression showed that the association between dyslipidemia and poor outcome varies by age (coefficient: -0.04, p=0.033), male gender (coefficient: -0.03, p=0.042), and hypertension (coefficient: -0.02, p=0.033), but not diabetes (coefficient: -0.24, p=0.135) and cardiovascular diseases (coefficient: -0.01, p=0.506). Inverted funnel-plot was relatively symmetrical. Egger's test indicates that the pooled analysis was not statistically significant for small-study effects (p=0.206).

Conclusion: Dyslipidemia potentially increases mortality and severity of COVID-19. The association was stronger in patients with older age, male, and hypertension.

Prospero Registration Number: CRD42020213491.
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http://dx.doi.org/10.1016/j.jceh.2021.01.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868769PMC
February 2021

BMI and atrial fibrillation recurrence post catheter ablation: A dose-response meta-analysis.

Eur J Clin Invest 2021 Jun 5;51(6):e13499. Epub 2021 Mar 5.

Binawaluya Cardiac Center, Jakarta, Indonesia.

Introduction: The evidence on the association between obesity and atrial fibrillation (AF) recurrence was equivocal. We aimed to evaluate the dose-response relationship between body mass index (BMI) and AF recurrence and adverse events.

Methods: A systematic literature search was conducted using PubMed, Europe PMC, EBSCO, ProQuest and Cochrane Library. Obesity was defined as BMI ≥28 kg/m . The primary outcome was AF recurrence, and the secondary outcome was adverse events. Adverse events were defined as procedure-related complications and cardio-cerebrovascular events.

Results: There were a total of 52,771 patients from 20 studies. Obesity was associated with higher AF recurrence (Odds ratio [OR] 1.30 [95% confidence interval [CI] 1.16-1.47], P < .001; I : 72.7%) and similar rate of adverse events (OR 1.21 [95% CI 0.87-1.67], P = .264; I : 23.9%). Meta-regression showed that the association varies by age (coefficient: -0.03, P = .024). Meta-analysis of highest versus lowest BMI showed that the highest group had higher AF recurrence (OR 1.37 [95% CI 1.18-1.58], P < .001; I : 64.9%) and adverse events (OR 2.02 [95% CI 1.08-3.76], P = .028; I : 49.5%). The linear association analysis for AF recurrence was not significant (P = .544). The dose-response relationship for BMI and AF recurrence was nonlinear (p  < 0.001), the curve became steeper at 30-35 kg/m . For adverse events, an increase of 1% for every 1 kg/m increase in BMI (OR 1.01 [95% CI 1.00-1.02], P = .001), the relationship was nonlinear (p  = 0.001).

Conclusion: Obesity was associated with higher AF recurrence in patients undergoing catheter ablation. High BMI might be associated with a higher risk for adverse events.

Prospero Id: CRD42020198787.
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http://dx.doi.org/10.1111/eci.13499DOI Listing
June 2021

The Effect of Metformin Consumption on Mortality in Hospitalized COVID-19 patients: a systematic review and meta-analysis.

Diabetes Metab Syndr 2020 Nov-Dec;14(6):2177-2183. Epub 2020 Nov 11.

Head, Division of Endocrinology and Metabolism Department of Internal Medicine, Faculty of Medicine, Udayana University. Denpasar, Bali, Indonesia Denpasar, Bali, Indonesia. Electronic address:

Background And Aims: Diabetes is one of the most common comorbidities, and it is associated with poorer outcomes in patients with coronavirus disease 2019 (COVID-19). Preliminary findings showed that mortality was reduced in those who consume metformin compared to those who did not, and given its low cost and widespread availability; metformin is an attractive and potential agent to mitigate excessive risk in diabetic populations.

Methods: Several medical databases (Pubmed, EuropePMC, EBSCOhost, Proquest, Cochrane library) and two health-science preprint servers (preprint.org and Medrxiv) were systematically searched for relevant literature.

Results: Nine studies with 10,233 subjects were included in the qualitative and quantitative synthesis. Meta-analysis showed that metformin is associated with lower mortality in pooled non-adjusted model (OR 0.45 [0.25, 0.81], p = 0.008; I 63.9%, p = 0.026) and pooled adjusted model (OR 0.64 [0.43, 0.97], p = 0.035; I: 52.1%, p = 0.064).

Conclusion: The analysis showed that metformin consumption was associated with lower mortality. Randomized controlled trials are needed to confirm this finding.
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http://dx.doi.org/10.1016/j.dsx.2020.11.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7657016PMC
January 2021

Clinical frailty scale and mortality in COVID-19: A systematic review and dose-response meta-analysis.

Arch Gerontol Geriatr 2021 Mar-Apr;93:104324. Epub 2020 Dec 15.

Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.

Introduction: National Institute for Health and Care Excellence (NICE) endorsed clinical frailty scale (CFS) to help with decision-making. However, this recommendation lacks an evidence basis and is controversial. This meta-analysis aims to quantify the dose-response relationship between CFS and mortality in COVID-19 patients, with a goal of supplementing the evidence of its use.

Methods: We performed a systematic literature search from several electronic databases up until 8 September 2020. We searched for studies investigating COVID-19 patients and reported both (1) CFS and its distribution (2) CFS and its association with mortality. The outcome of interest was mortality, defined as clinically validated death or non-survivor. The odds ratio (ORs) will be reported per 1% increase in CFS. The potential for a non-linear relationship based on ORs of each quantitative CFS was examined using restricted cubic splines with a three-knots model.

Results: There were a total of 3817 patients from seven studies. Mean age was 80.3 (SD 8.2), and 53% (48-58%) were males. The pooled prevalence for CFS 1-3 was 34% (32-36%), CFS 4-6 was 42% (40-45%), and CFS 7-9 was 23% (21-25%). Each 1-point increase in CFS was associated with 12% increase in mortality (OR 1.12 (1.04, 1.20), p = 0.003; I: 77.3%). The dose-response relationship was linear (P=0.116). The funnel-plot analysis was asymmetrical; Trim-and-fill analysis by the imputation of two studies on the left side resulted in OR of 1.10 [1.03, 1.19].

Conclusion: This meta-analysis showed that increase in CFS was associated with increase in mortality in a linear fashion.
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http://dx.doi.org/10.1016/j.archger.2020.104324DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7832565PMC
February 2021

Charlson comorbidity index and a composite of poor outcomes in COVID-19 patients: A systematic review and meta-analysis.

Diabetes Metab Syndr 2020 Nov-Dec;14(6):2103-2109. Epub 2020 Oct 28.

Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Udayana University Denpasar, Bali, Indonesia. Electronic address:

Background And Aims: The ongoing COVID-19 pandemic is disproportionately affecting patients with comorbidities. Therefore, thorough comorbidities assessment can help establish risk stratification of patients with COVID-19, upon hospital admission. Charlson Comorbidity Index (CCI) is a validated, simple, and readily applicable method of estimating the risk of death from comorbid disease and has been widely used as a predictor of long-term prognosis and survival.

Methods: We performed a systematic review and meta-analysis of CCI score and a composite of poor outcomes through several databases.

Results: Compared to a CCI score of 0, a CCI score of 1-2 and CCI score of ≥3 was prognostically associated with mortality and associated with a composite of poor outcomes. Per point increase of CCI score also increased mortality risk by 16%. Moreover, a higher mean CCI score also significantly associated with mortality and disease severity.

Conclusion: CCI score should be utilized for risk stratifications of hospitalized COVID-19 patients.
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http://dx.doi.org/10.1016/j.dsx.2020.10.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7598371PMC
January 2021

Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2: a New Challenge amid the Pandemic.

SN Compr Clin Med 2020 Oct 22:1-9. Epub 2020 Oct 22.

Cardiology and Vascular Department, Padjadjaran University, Jl. Professor Eyckman No. 38, Pasteur, Kec. Sukajadi, Kota Bandung, Jawa Barat 40161 Indonesia.

Initially, SARS-CoV-2 infection had been reported as a relatively mild case in children than in adults. Nevertheless, recent evidence found that a subset of children then developed a significant systemic inflammatory response that resembles atypical/typical Kawasaki's disease (KD) and toxic shock syndrome. This novel clinical syndrome later identified as pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). In contrast with KD, PIMS-TS appears to occur in children at an older age with a predominance of gastrointestinal symptoms, hemodynamic instability, and myocardial dysfunction. However, the exact pathomechanism remains to be understood. Nevertheless, the post-viral immunological reaction is postulated to be the underlying mechanistic underpinnings. The multifaceted nature of the PIMS-TS' course underlines the need for early recognition and multispecialty care and management.
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http://dx.doi.org/10.1007/s42399-020-00602-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7578591PMC
October 2020

Coronavirus Disease of 2019: a Mimicker of Dengue Infection?

SN Compr Clin Med 2020 Jul 13:1-11. Epub 2020 Jul 13.

Department of Internal Medicine, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia / Atma Jaya Hospital, Jl. Pluit Raya No.2, RT.21/RW.8, Penjaringan, Kec. Penjaringan, Kota Jakarta Utara, Daerah Khusus Ibukota Jakarta, 14440 Indonesia.

At the beginning of 2020, the national health system and medical communities are faced with unprecedented public health challenges. A novel strain of coronavirus, later identified as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread globally, marking another pandemic of coronaviruses. This viral disease is responsible for devastating pneumonia, named coronavirus disease of 2019 (COVID-19), and projected to persist until the end of the year. In tropical countries, however, concerns arise regarding the similarities of COVID-19 with other infectious diseases due to the same chief complaint, which is fever. One of the infectious disease of a primary concern is dengue infection, which its peak season is approaching. Others report that there are cases of serological cross-reaction of COVID-19 and dengue infection. In this comprehensive review, we underscore the importance of knowing similar clinical presentations of both diseases and emphasize why excluding COVID-19 in the differentials in the setting of a pandemic is imprudent.
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http://dx.doi.org/10.1007/s42399-020-00364-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356135PMC
July 2020

COVID-19 and misinformation: how an infodemic fuelled the prominence of vitamin D.

Br J Nutr 2021 02 27;125(3):359-360. Epub 2020 Jul 27.

Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.

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http://dx.doi.org/10.1017/S0007114520002950DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7443564PMC
February 2021
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