The rapid spread of the coronavirus disease 2019 (COVID-19) has resulted in significant morbidity and mortality globally. Hydroxychloroquine is one of the medications for eradicating COVID-19. Despite concerns due to its potential cardiac toxicity, hydroxychloroquine is widely used in treating mild and moderate COVID-19 pneumonia. In this case report, we report two cases of Indonesian adult patients with suspected COVID-19 pneumonia who received hydroxychloroquine as part of the medications and experienced deterioration of cardiac conduction which required stopping the drug prematurely. This case report highlights the need for risk stratification, electrocardiogram monitor and QTc evaluation before and during hydroxychloroquine therapy.

Background: Hypertension is a modifiable risk factor of mortality and disabilities around the globe. Its prevalence has been increasing in the last decade without adequate awareness and control in developing countries. Improving hypertension control is an essential strategy to prevent further Hypertension-Mediated Organ Damage. Objective: This study aimed to investigate the effectiveness of Guideline-based educational cards in controlling essential hypertension in East Borneo Primary Health Care. Method: Patients with essential hypertension enrolled in this study from February to April 2019. Patients were given a card that consists of their targetted blood pressure, blood pressure, and treatment changes during visits, lifestyle modifications, and additional information about blood pressure management. The physician orally informed all of the information in the card during the first visit. The patients were evaluated weekly and followed for total duration of four weeks. Pre versus post systolic and diastolic blood pressure were evaluated. Result: In 46 hypertensive patients, the average age was 57 years old, with 72% were females. 54% of patients had a normal Body Mass Index, and 28% were obese. Diabetes Mellitus presented as another comorbidity in 24% of patients, and only 4% of patients were active smokers. Pre-intervention systolic and diastolic blood pressure was 152 ± 12 mmHg and 90 ± 8 mmHg, respectively. Evaluation of post-intervention blood pressure outcomes revealed a significant reduction by 18 mmHg and 9 mmHg in systolic and diastolic blood pressure (p < 0,0001). Conclusion: In conclusion, Guideline-based educational card was an effective strategy in improving blood pressure control and may become a viable approach for other Primary Health Care.

Background: There is a lack of data on modifiable coronary artery disease (CAD) risk factors in the Indonesian population, hindering the implementation of assessments and prevention programs in this population. This study investigated modifiable risk factors for CAD among Indonesians by comparing them between CAD-proven patients and healthy subjects from a similar population. Methods: In this nested, matched case-control study, the cases were patients from a referral hospital in Yogyakarta, Indonesia and the controls were respondents in a population surveillance system in Yogyakarta, Indonesia. The cases were 421 patients who had undergone coronary angiography, showing significant CAD. The sex- and age-matched controls were 842 respondents from the Universitas Gadjah Mada Health and Health and Demographic Surveillance System Sleman who indicated no CAD presence on a questionnaire. The modifiable CAD risk factors compared between cases and controls were diabetes mellitus, hypertension, central obesity, smoking history, physical inactivity, and less fruit and vegetable intake. A multivariate regression model was applied to determine independent modifiable risk factors for CAD, expressed as adjusted odds ratios (AORs).Results: A multivariate analysis model of 1,263 subjects including all modifiable risk factors indicated that diabetes mellitus (AOR, 3.32; 95% confidence interval [CI], 2.09–5.28), hypertension (AOR, 2.52; 95% CI, 1.76–3.60), former smoking (AOR, 4.18; 95% CI, 2.73–6.39), physical inactivity (AOR, 15.91; 95% CI, 10.13–24.99), and less fruit and vegetable intake (AOR, 5.42; 95% CI, 2.84–10.34) independently and significantly emerged as risk factors for CAD.Conclusions: Hypertension, diabetes mellitus, former smoking, physical inactivity, and less fruit and vegetable intake were independent and significant modifiable risk factors for CAD in the Indonesian population.

Background: Hypertension is one of the most common comorbidities reported in patients with malignancy. This population had a higher risk of developing cardiotoxicity. Taxanes is an important therapeutic agent for several malignancies, including breast cancers. Their applicability, however, is limited by cardiotoxicity. The optimal strategy to prevent and manage chemotherapy-related cardiotoxicity (CTRCT) has not yet implemented in clinical practices. Case: A 63 years old breast cancer female patient was planned to be treated with Taxanes for six cycles. On admission, there were no cardiovascular symptoms. The patient had a history of hypertension and no history of myocardial infarction or congestive heart failure (CHF). Baseline transthoracic echocardiogram demonstrated normal left ventricular ejection fraction (LVEF) 66%. She received calcium channel blocker for her hypertension during chemotherapy. After the second cycle, the patient experienced palpitation, and there were no other cardiovascular symptoms. Electrocardiogram showed Left Bundle Branch Block. Echocardiogram revealed LVEF 46% with anteroseptal and inferoseptal hypokinetic. She was suspected as CHF chemotherapy-induced. Taxane was stopped, and she was treated with angiotensin receptor blocker, beta-blocker, and loop diuretic. Two months after therapy, her LVEF revealed partial recovery with LVEF 60% and no reported symptoms. Conclusion: Prophylactic agents targeting pre-existing cardiac risk factor has not been implemented in clinical practice but may soon change. Early detection and prompt management appear crucial to reverse left ventricular dysfunction in cancer patients receiving taxanes, especially in patients with pre-existing hypertension.

Background: The SARS-CoV-2 infection or COVID-19 disease caused significant morbidity and mortality. Early reports showed clinical improvement with hydroxychloroquine (HCQ) and chloroquine (CQ). However, due to the concern of QTc interval prolongation, the strict electrocardiogram monitoring was needed. The use of risk stratification score may help the decision of this monitoring. Aims: The study purpose is to describe the use of Tisdale risk score in patients with COVID-19 who received HCQ/CQ treatment. Methods: This was a prospective observational study. Subjects were patients with the diagnosis of high-probability-COVID-19 and confirmed-COVID-19 receiving HCQ/CQ as one of the treatments. The demographic, medical history and laboratory data were recorded. The Tisdale score was calculated based on baseline parameters and the risk categories were divided into three categories: low risk (score <7), moderate risk (score 7-10) and high risk (score ≥11). The HCQ/CQ daily dose, cumulative dose, time of administration, and duration were recorded. Result: Forty-five subjects were analysed. Most subjects were males (66.7%) at mean age 50.9 years. Most subjects were hospitalized due to severe illness (44.4%). Medical comorbidity was mostly hypertension (31.1%). Most subjects had HCQ treatment (95.6%). Electrocardiogram showed mostly sinus rhythm (97.8%). Mean QTc interval based Bazett formula was 413.1 ms. Tisdale risk categories were low risk (57.8%), moderate risk (31.1%) and high risk (11.1%). Tisdale high risk had significantly lower cumulative dose of HCQ/CQ and shorter duration of HCQ/CQ treatment as compared to Tisdale moderate and low risks counterparts. The premature HCQ/CQ stop occurred in 1 subject (6.7%) with Tisdale moderate risk and 1 subject (6.7%) with Tisdale high risk.  Conclusion: The Tisdale risk score stratification was easily implemented in hospital as a tool to guide in treatment decision and monitoring while dealing with drugs potentially cause QTc prolongation, such as HCQ/CQ, in COVID-19 patients.