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Background: COVID-19 is a very dynamic disease. Recently, a new Delta variant caused a significant spike in morbidity and mortality in Indonesia from May to September 2021, inflicting a high burden on healthcare facilities and self-isolation services. This study aims to analyze the impact of comorbidities on the mortality of COVID-19 patients who underwent self-isolation during the stipulated period. Methods: The study was a retrospective cohort, using surveillance data from the DKI Jakarta Health Office. The data was sampled through a total sampling method for the eligible population. A survival analysis was performed using the Kaplan Meier curve and a proportional hazard evaluation was carried out. Multivariate analysis was assessed using Cox-Extended, if violation of proportional hazard assumption is found. Results: The analysis included 15,088 confirmed cases with overall survival of 96.31%. Survival was lower in the group with comorbid, aged ≥60 years, male, and symptomatic (p<0.00). Cox-extended showed a higher risk of mortality in the group with comorbidities at <7th days [aHR3.78(95% CI 2.94-4.87)] and at ≥7th days aHR1,78(IK95%1,412-2,954). Immunological disorder [aHR13,13(IK95%2,79-91,76)] was the most impactful comorbid towards mortality. Conclusion: This study concludes that the risk of mortality during the observational period (30 days) was higher in the comorbid group. Other contributing variables include old age, male gender, and exhibiting symptoms.
Systemic Lupus Erythematosus ( SLE ) is an autoimmune disease that results in inflammation in many organs. The prevalenceof SLE is increasing and the mortality rate was high. Etiology of SLE has not known. However , several risk factors could be expected to affect the incidence of SLE . One of them is a history of drug allergies, especially antibiotics. This study aimed to determine the relationship between antibiotic allergy history and SLE after controlled by family history,other autoimmune disease, age of menarche, and smoking behavior in Dr. Hasan Sadikin Hospital Bandung. This study was conducted from April to July 2014 using case-control design. Cases were women SLE patients who went to Rheumatology Department Dr. Hasan Sadikin Hospital Bandung. Control were a female patient who went to Internist Department with individually matched at the age ( 3 years range ), and region. Data were analyzed with univariate, bivariate , and multivariate conditional logistic regression. The results showed that a history of antibiotic allergy tends to increase the incidence of SLE for 2.34 times ( OR = 2.34 , 95 % CI 0.66 to 8.22 ) after controlled by SLE family history, history of autoimmune, and smoking behavior. For the class of penicillin/cephalosporin, the risk increased to 2.75 times ( OR = 2.75 , 95 % CI 0.65 to 11.59) . Keywords : SLE , antibiotic allergy , matched case-control
Indonesia berpotensi rawan terjadi bencana alam gempa bumi. Kerugian negara akibat bencana alam sejak tsunami Aceh bulan desember tahun 2004 hingga gempa di sumatera barat mencapai 150 triliun lebih. Selain kerugian harta benda gempa mengakibatkan korban jiwa masif, korban luka, dan kerusakan infrastruktur. Dalam kurun waktu 5 tahun terakhir kerugian tersebut terus berulang terjadi hal tersebut diakibatkan oleh karena kegagalan tata kelola. Tata kelola bencana yang baik harus didukung Good Coorporate Governance dan Good Cinical Governance. Bencana gempa bumi di Lombok, Palu, Cianjur dan Turki telah menyebabkan kerusakan infrastruktur kesehatan, menelan korban jiwa massal dan mengakibatkan korban luka berat yang banyak. Korban umumnya adalah kasus patah tulang yang ditangani oleh dokter orthopedi. Pada saat tanggap darurat bencana gempa bumi pertolongan korban menjadi lambat disebabkan oleh beberapa hal antara lain : tenaga medis lokal turut menjadi korban, distribusi logistik terganggu, peran pemerintah dan lembaga non pemerintah dalam komando, koordinasi dan komunikasi antar lembaga kebencanaan belum sepenuhnya terintegrasi dengan regulasi yang ada, akses menuju layanan rujukan kesehatan dan fasilitas kesehatan yang terganggu. Hal tersebut menambah keparahan tata kelola bencana gempa bumi bahkan disertai tsunami, likuifaksi, longsor maupun wabah pandemi. Tujuan dari penelitian ini untuk menyusun model tata kelola darurat orthopedi pada fase tanggap darurat bencana gempa bumi berbasis sistem input proses dan output yang terjadi. Menggunakan multi case study methods di Lombok, Palu, Cianjur dan Turki rancangan penelitian ini disusun melalui lima tahapan penelitian dengan pendekatan kualitatif. Hasil penelitian yang didapat dari hasil analisis kesenjangan menunjukkan bahwa tata kelola pada dimensi karakteristik gempa, faktor eksternal dan resiliensi bangunan fasilitas kesehatan mempengaruhi faktor existing condition yang sudah ada pada tata kelola darurat orthopedi fase tanggap darurat bencana gempa bumi. Konstruksi model dihasilkan dari analisis pengembangan tata kelola lama melalui analisis kesenjangan dari dimensi existing condition dan precondition yang telah dilakukan prediksi acceptancenya berdasar governansi klinis, organisasi dan kebencanaan sebagai rancang bangun adaptive model dari tata kelola bencana yaitu model MELFASSER. Model MELFASSER merupakan penyempurnaan dari tata kelola lama yang disusun dengan memperhitungkan dimensi karakteristik gempa antara lain Magnitude, Epicentrum dan Locations, Fore and After Shock, Side Effect dan juga mempertimbangkan faktor eksternal dan Resiliensi bangunan layanan kesehatan. Hasil temuan ini dikembangkan menjadi ajuan rancangan borang MELFASSE untuk penilaian pemberdayaan local resources dan rekomendasi aktifasi existing condition dan borang RVAHBR untuk penilaian ketahanan gedung faskes sebagai preliminary assessment pada tata kelola darurat orthopedi fase tanggap darurat bencana gempa bumi. borang MELFASSE-R yang disusun diharapkan akan lebih luas pemanfaatannya dan dapat digunakan dengan mudah sesuai dengan kapasitas sumberdaya lokal dalam menyusun rekomendasi aksi selanjutnya pada saat fase tanggap darurat bencana gempa bumi.
Indonesia is prone to potential earthquake natural disasters. State losses due to disasters since the Aceh tsunami in December 2004 to West Sumatra earthquake reached more than 150 trillion rupiah. Apart from significant property lossess, the earthquake resulted in massive loss of life, injuries and infrastructure damages. Over the past 5 years, these losses have continued to occur repeatedly, this is due to failures in governance. Good disaster governance must be supported by Good Corporate Governance and Good Clinical Governance. Earthquake disasters in Lombok, Palu, Cianjur and Turkey lead to many health infrastructures damage, severe mass casualties, and resulted in many serious injuries. Victims of serious injuries most commonly suffer from bone fractures that require treatment by an orthopedic surgeon. During the earthquake response phase, humanitarian aid to victims was slow due to several things, including : local medical personnel became victims, logistics distribution was disrupted, the role of government and non-governmental institution in command, coordination and communication among disasters institution was not fully integrated with existing regulations, access to health referral services and health facilities is disrupted. This increases to the severity of earthquake disaster governance, even accompanied by tsunamis, liquefaction, landslides and pandemic outbreaks. The aim of this research is to establish a model for orthopedic emergency governance in an earthquake disaster response phase based on the process input and output systems. Using multi case study methods in Lombok, Palu, Cianjur and Turkey, this research design was structured through five stages with a qualitative approach. The research results obtained from the gap analysis showed that governance in the dimensions of earthquake characteristics, external factors and resilience of health facility buildings influenced existing condition factors that already established in orthopedic emergency governance during the response phase earthquake disasters. The model generated from development analysis of existing disaster governance through gap analysis of existing conditions dimensions and preconditions whose acceptance predictions have been carried out based on clinical, organizational and disaster governance as a design for an adaptive model of disaster governance, namely the MELFASSER model. The MELFASSER model is an adaptive model from an established existing disaster governance systems in consideration of earthquake characteristics dimensions including Magnitude, Epicenter and Location, Fore and AfterShock, Side effects and also considering External factors and the Resilience of health service buildings. The results of these findings were developed into a proposal to design the MELFASSE form for assessing the empowerment of local resources and recommendations for activating existing conditions and the RVAHBR form for assessing the resilience of health facility buildings as a preliminary assessment in orthopedic emergency management during the earthquake emergency response phase. The proposed MELFASSE-R forms is hopefully will have a broader use and to be easily adapted and carried out by existing local resources as a recommendation for further action in the response phase of an earthquake disaster.