Inflammation plays an important role and is involved in all stages of acute ischemic stroke. One of these stages involves the recruitment of leukocytes from the peripheral circulation into the ischemic tissue. Lymphocytes as a subtype of leukocytes are important mediators and can become a predictor of neurological outcome. Several studies have been conducted regarding the correlation between differential lymphocyte counts and acute ischemic stroke. Most of these studies analyzed lymphocyte ratio to other leukocyte subtypes such as neutrophils and monocytes. This study specifically observed the role of lymphocytes as an indicator of the inflammatory response in patients with acute ischemic stroke. This study aimed to observe the correlation among risk factors, infarct location, leukocyte counts, lymphocyte value and neurologic output in acute ischemic stroke patients. Patients and Methods: We observed and analyzed 193 patients' data from medical record which met the inclusion and exclusion criteria with a diagnosis of acute ischemic stroke at the Department of Neurology of Dr. Hasan Sadikin General Bandung. Data were then analysed using appropriate statistical tests. Results: Most patients have more than one risk factor with a leukocyte count of less than 10,000 cell/mm 3 . Infarct was mostly located in subcortical area (basal ganglia), with moderate average NIHSS values at admission and at discharge. The number of lymphocytes decreased in the subject group with more than 10,000 cell/mm 3 leukocytes. Subsequently, data were analyzed using Spearman's test and there was a correlation between NIHSS on admission and lymphocyte depletion. Conclusion:The lymphocyte depletion in patients with leukocytosis is a predictor of poor NIHSS.

Introduction: In patients with Chronic Obstructive Pulmonary Disease (COPD), due to shared-riskfactors, concomitant chronic cardiovascular diseases include Congestive Heart Failure (CHF) arecommon and resulting in increase overall morbidity and mortalit y.Case Report: A female patient, 52 years, came for pulmonary rehabilitation 2 weeks after hospitalizationdue to acute exacerbation of COPD. One week before the exacerbation, she showed symptoms of CHF.Physical examination showed signs of right and left heart failure, oxygen desaturation, and limitedchest expansion. Functional assessment showed disability in self-care, instrumental activities ofdaily living (ADL), deconditioning, depression, and anxiety. Supporting examination confirmed verysevere restriction and obstruction, bronchopneumonia, cardiomegaly, and pulmonary hypertension.Rehabilitation problems include cardiorespiratory, ADL, and psychological problems. The Covid-19pandemic causing prohibition of supervised cardiorespiratory rehabilitation. Home-based exerciseprogram was given for 5 months. Monitoring was done via video call before and after each exercise andthrough analysis of exercise diary. Psychological counseling also given at the beginning of the program.Patient did all of prescribed exercises. At the end, symptoms decreased, patient can do ADL and hobbies,no exacerbation or exercise intolerance, patient does not look anxious and consents to leisure activities.Conclusion: Monitored-home based exercise programs can be used as safely alternative to hospitalbased,if done according to the prescription. However , monitoring by physician is mandatory.Keywords: chronic obstructive pulmonary disease, congestive heart failure, covid-19 pandemic, homebasedexercise, rehabilitation

OBJECTIVE: This review aimed to explore the pathophysiology and rehabilitation management of exercise intolerance in COVID-19 patients. METHODS: We reviewed articles published in 2019-2021 using PubMed, Google Scholar, and CINAHL databases as an electronic database. Data obtained were pathophysiology and rehabilitation management of exercise intolerance in COVID-19 survivors. Types of the article were original articles and systematic or narrative reviews, both published and preprint articles. Articles that were written in English and freely accessible in pdf or HTML format were included. RESULTS: There were 28 articles eligible for this review. Pathophysiology, rehabilitation management, and both pathophysiology and rehabilitation management were explained in 7, 24, and 4 articles, consecutively. DISCUSSION: Exercise intolerance is caused by some pathological processes in the respiratory, cardiovascular, and musculoskeletal systems as a result of systemic inflammation. Fatigue and shortness of breath during the activity were the most common symptom in the early phase of COVID-19 and persisted until the follow-up phase. Hospital admission, especially prolonged use of ventilators and immobilization worsen functional impairment resulting in persistent symptoms. Rehabilitation management begins with a functional assessment consisting of symptom assessment and physical examination of the body systems affected. The goals of rehabilitation management are to increase functional capacity, reduce symptoms, improve the ability to perform daily activities, facilitate social reintegration, and improve quality of life. Exercise is an effective intervention to reach these goals. Several studies recommend breathing, and aerobic exercises, as well as resistance exercises for peripheral and respiratory muscles, to improve symptoms and increase functional capacity.

Introduction: In patients with Chronic Obstructive Pulmonary Disease (COPD), due to shared-risk factors, concomitant chronic cardiovascular diseases include Congestive Heart Failure (CHF) are common and resulting in increase overall morbidity and mortality.Case Report: A female patient, 52 years, came for pulmonary rehabilitation 2 weeks after hospitalization due to acute exacerbation of COPD. One week before the exacerbation, she showed symptoms of CHF. Physical examination showed signs of right and left heart failure, oxygen desaturation, and limited chest expansion. Functional assessment showed disability in self-care, instrumental activities of daily living (ADL), deconditioning, depression, and anxiety. Supporting examination confirmed very severe restriction and obstruction, bronchopneumonia, cardiomegaly, and pulmonary hypertension. Rehabilitation problems include cardiorespiratory, ADL, and psychological problems. The Covid-19 pandemic causing prohibition of supervised cardiorespiratory rehabilitation. Home-based exercise program was given for 5 months. Monitoring was done via video call before and after each exercise and through analysis of exercise diary. Psychological counseling also given at the beginning of the program. Patient did all of prescribed exercises. At the end, symptoms decreased, patient can do ADL and hobbies, no exacerbation or exercise intolerance, patient does not look anxious and consents to leisure activities.Conclusion: Monitored-home based exercise programs can be used as safely alternative to hospitalbased, if done according to the prescription. However , monitoring by physician is mandatory.Keywords: chronic obstructive pulmonary disease, congestive heart failure, covid-19 pandemic, homebased exercise, rehabilitation