Background and objectivesAtherosclerosis causes reduction of the oxygen supply to structures in the far arterial wall, provoking the release of factors that drive angiogenesis of vasa vasorum, including VEGF. Other studies have revealed the inflammatory response in atherosclerosis and the role of platelet factor 4 (PF4) as an anti-angiogenic chemokine through the inhibition of VEGF. This cross-sectional study aims at measuring the effect of atherosclerosis assessed through carotid intima-media thickness (CIMT) against plasma VEGF levels in patients with post-acute thrombotic stroke.Materials and methodsCIMT was assessed sonographically using GE Logiq S6 with 13 MHz frequency linear probe. VEGF-A plasma levels were measured using enzyme-linked immunosorbent assay (ELISA) method. Differences among variables were compared statistically. The data were analyzed using Pearson correlation.ResultsA total of 25 patients with post-acute thrombotic stroke were identified in days 7 to 90. CIMT thickening was indicated in 88% of patients (1.202 ± 0.312 mm), while an increase in plasma VEGF was identified in all patients (178.28 ± 93.96 ng/mL). There was no significant correlation between CIMT and plasma VEGF levels in patients with post-acute thrombotic stroke (p=0.741). A significant correlation was recognized between CIMT and total cholesterol (p=0.029) and low-density lipoprotein (p=0.018).ConclusionThere were no significant correlations between CIMT and plasma VEGF levels in patients with post-acute thrombotic stroke. However, plasma VEGF increased in patients with thrombotic stroke. CIMT measurement is a promising noninvasive modality to assess the vascular condition of patients with stroke and diabetes, while plasma VEGF cannot specifically assess vascular condition as it can be triggered by ischemic conditions in tissues of the whole body.

Background: Coronavirus disease 2019 (Covid-19) caused by SARS-Cov-2 had been spreading worldwide including Indonesia, but In Indonesia, it was difficult to diagnose confirmation Covid-19 by Polymerase Change Reaction (PCR). and in clinical practice to treat covid-19, Indonesia Health Ministry use term probable covid-19 for patients under observation Covid-19, but study for neurological manifestation on probable Covid-19 is very lacking. Objective: Knowing the neurological manifestation of patient probable Covid-19. Methods: Observational study from Covid-19 medical record and neuro-Covid-19 medical record of all probable Covid-19 hospitalized in the isolation ward of Saiful Anwar Hospital (RSSA) Malang since March-May, 2020 (3 months). Probable Covid-19 criteria were given by Covid-19 task force team based on Health Minister Indonesia criteria. This criterion was based on clinical manifestation (severe upper respiratory symptoms, or mild-severe pneumonia), radiologic examination (lung infiltrate and or chest CT scan), and laboratory examination. Neurological manifestation is based on clinical symptom appeared while patient hospitalized, supported with radiologic and laboratory data which was supervised by neurologist or neurologist resident. All data was inputted to neuro-Covid-19 e-registry on the smartphone application, sent periodically to the data center in Neurology Department RSSA Malang. Results: A hundred and fourteen probable Covid-19 was registered with mean age 34,5 year old and mostly at the young age of 20-50 years (38%). The neurological manifestation was observed in 4 patients (3,4% from all possible Covid-19 patients) with thrombotic stroke as the most common manifestation (50%), followed by myelum tumor (25%) and hypoxia encephalopathy (25%). Stroke patients in probable Covid-19 had old age (72 and 82 years) accompanied by several comorbid such as hypertension, DM and CVA history and Covid symptoms of cough, shortness of breath and fever. Hemiparesis was found improved with aspirin and neurotropic therapy. Patient with myelum tumor had a covid symptom of shortness of breath, cough, and fever with UMN tetraparesis. Previous MRI examination results suspected meningioma. The patient died while hospitalized. Patients with hypoxia encephalopathy admitted with decreased consciousness due to shortness of breath with acidosis respiratory symptoms (pH 7,22 ). This condition improved after oxygenation without focal neurologic deficit. Conclusion:Neurological manifestation in probable Covid-19 was 3,4% of all patients. The most common diagnosis was a thrombotic stroke, followed by myelum tumor, hypoxia encephalopathy, and mortality rate is 25%.

Stroke, in 2014 to mid-2015 is the first cause of death in Indonesia. The condition of stroke patients whose movements are limited is exacerbated by the psychic condition of patients who are unable to communicate pressure will cause obstacles to the healing process of the patient. This research is designed based on the five planes of user experience which are divided into five areas: strategy, scope, structure, skeleton, and surface. This communication board is operated using the patient's fingers so that it is comfortable for everyday activities. The result of Mobile Finger Communication Board implementation shows that application usability level seen from perception and ergonomic point of view shows satisfaction index of the user at the satisfactory level so that it can be said that the system works with the satisfactory result of the users. It is expected that with the Mobile Finger Communication Board which will be used daily to support the healing process of stroke so that the healing rate of stroke is increasing.

Background: A new strain of RNA human coronavirus named SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) was first detected in December 2019 and became pandemic, infected millions of people worldwide, and responsible for a large number of deaths.1 Globally, as of 30th August 2020, there have been 24.822.800 confirmed cases of COVID-19, including 838.360 deaths, reported to WHO.2 SARS-CoV-2 virus can spread from the respiratory to the central nervous system because it has neuroinvasive abilities. Some patients with COVID-19 reported have neurological symptoms, such as anosmia, headache, dizziness, dysgeusia, and impaired consciousness. The information on SARS-CoV-2 recurrence or reinfection is still limited. We report a case of  COVID-19 with stroke manifestation and a history of positive COVID-19 before and possibility reinfection of the disease.Case presentation: A man, 55-years old, came to the emergency department with a medical history of diabetes mellitus on insulin, hypertension, and a history of the acute coronary syndrome. He was first diagnosed with COVID-19 based on his nasopharyngeal swab without any clinical manifestation, then isolated himself in his home. His second and third nasopharyngeal swabs then showed negative results, and he was declared cured of COVID-19 infection. After 13 days, he returned to the emergency department with acute onset left-sided hemiparesis, dysarthria, and left-sided facial drop. The patient denied fevers, cough, nor dyspnea symptoms. His laboratory studies were within normal limits, but his antibody. Anti-SARS-CoV-2 showed a reactive result, confirmed by his nasopharyngeal swab with a positive result, and then he was diagnosed with COVID-19. His chest radiography showed normal results, and his head CT scan showed ischemic in the right insular lobe and ischemic in the right parietal lobe with senile brain atrophy. He was hospitalized in the high care unit for COVID-19 patients on the same day. He received treatment for stroke and COVID-19 infection with supportive care. Five days since admission, the patient spontaneously became hypoxic and somnolence with oxygen saturation 60% at that time, and the patient finally died due to respiratory failure.Conclusion: We report the case possibility of COVID-19 reinfection with clinical manifestation acute onset left-sided hemiparesis, dysarthria, and left-sided facial drop, without any manifestation of COVID-19 like fever, cough, dyspnea nor sore throat, and we diagnosed as stroke attack. The patient showed reactive rapid antibody Anti-SARS-CoV-2 and nasopharyngeal swab with a positive COVID-19. The patient has been diagnosed with COVID-19 one month before admission, his second and third nasopharyngeal swabs then showed negative results, and he cured of COVID-19 infection after that. We hypothesize the manifestation of stroke as a neurological manifestation of COVID-19 without any respiratory manifestation before. Unfortunately, we did not perform specific antibody IgM/IgG testing to differentiate whether this is the disease's reinfection or recurrence.

Objective: Indonesian health workers mostly received three doses of vaccine, using two doses of inactivated viral vaccines, followed by the mRNA vaccine platform for the third dose. This study was conducted to investigate and compare the side effects of three vaccine doses using mRNA and inactivated viral vaccines platform for health workers. Methods: Cross-sectional study was conducted on health workers who received three doses of the COVID-19 vaccine completely and willing to follow the research. Data collected were demographic characteristics, previous disease history, history of COVID-19 infection, and post-vaccination local and systemic side effects. Data was collected based on self-report and analyzed with a confidence level of 95% (p<0.05). Results: Overall, fifty-three participants received three consecutive doses of vaccine, consisting of two doses of inactivated viral vaccine (Sinovac) and followed by one dose of mRNA vaccine platform (Moderna). Post-vaccination side effects were more common after receiving the mRNA vaccine platform at 85% than after receiving the inactivated virus vaccine at 21%, with a significant difference for local swelling and all systemic side effects (p<0.05). After administering the mRNA vaccine platform, local pain, muscle pain, and swelling at the injection site are the most frequent side effects. Patients with a history of COVID-19 infection had more frequent post-vaccination side effects compared to no history of COVID-19 infection (100% vs. 83%), and all of the local and systemic side effects were significantly different (p<0.05). The most common side effects in patients with a history of COVID-19 infection are injection site pain, muscle pain, and swelling. Conclusions: Post-vaccine side effects are mild and more common in mRNA vaccines platform than in inactivated virus vaccines. Post-vaccination side effects were higher in patients with a history of COVID-19 infection compared to naïve patients.