Background To overcome the several drawbacks of warfarin, non-vitamin K antagonist oral anticoagulants (NOACs) were developed. Even though randomized controlled trials (RCTs) provided high-quality evidence, the real-world evidence is still needed. This systematic review and meta-analysis proposed to measure the safety and efficacy profile between warfarin and NOACs in non-valvular atrial fibrillation (NVAF) patients in preventing stroke. Results We collected articles about the real-world studies comparing warfarin and NOACs for NVAF patients recorded in electronic scientific databases such as Embase, ProQuest, PubMed, and Cochrane. The pooled hazard ratio (HR) and 95% confidence interval (CI) were estimated using the generic inverse variance method. A total of 34 real-world studies, including 2287288 NVAF patients, were involved in this study. NOACs effectively reduced the stroke risk than warfarin (HR 0.77; 95% CI 0.69 to 0.87; p < 0.01). Moreover, NOACs effectively lowered all-cause mortality risk (HR 0.71; 95% CI 0.63 to 0.81; p < 0.01). From the safety aspect, compared to warfarin, NOACs significantly reduced major bleeding risk (HR 0.68; 95% CI 0.54 to 0.86; p < 0.01) and intracranial bleeding risk (HR 0.54; 95% CI 0.42 to 0.70; p < 0.01). However, NOACs administration failed to decrease gastrointestinal bleeding risk (HR 0.78; 95% CI 0.58 to 1.06; p = 0.12). Conclusions In NVAF patients, NOACs were found to be more effective than warfarin at reducing stroke risk. NOACSs also lowered the risk of all-cause mortality, cerebral hemorrhage, and severe bleeding in NVAF patients compared to warfarin.

Indonesia's diversity of natural resources presents an intriguing opportunity for the exploration of potential herbal medicines. Numerous compounds, both purified and crude, have been reported to exhibit antiviral activity. The ACE-2 receptor may be a therapeutic target for SARS-CoV-2 infection. We used a search engine to search for herbal medicines with ACE-2 inhibitory activity to predict the potential inhibition of natural compounds (i.e., theaflavin, deoxypodophyllotoxin, gallocatechin, allicin, quercetin, annonamine, Curcumin, 6-gingerol, and cucurbitacin B) to SARS-CoV2 – ACE-2 complex. We performed molecular docking analysis using the ACE-2 protein target from Protein Data Bank. Protein stabilization was carried out to adjust to the body's physiology, carried out using Pymol by removing water atoms and adding hydrogen atoms. Ligands of active compounds from natural resources were selected and downloaded from the PubChem database, then optimized by Pymol software. The complexes of the tested ligand compounds and ACE-2 receptors, which have a bond strength smaller than the control were selected for analysis.  Theaflavin, Deoxypodophyllotoxin, Gallocatechin, Curcumin, and Cucurbitacin B had a strong bond affinity than the control ligands. Based on our data, deoxypodophylotoxin and Curcumin had the same interaction amino acid residus compare to the control ligand. This study concludes that deoxypodophyllotoxin and Curcumin have the greatest potential to inhibit the formation of the SARS-Cov2-ACE-2 complex; additionally, these compounds exhibit favorable pharmacological and pharmacodynamic properties. It is suggested that additional research be conducted to determine the biological effects of deoxypodopyllotoxin and Curcumin on ACE-2 receptors.

Background Coronavirus disease 2019 (COVID-19) affects health care services. Our aim was to assess health care disruptions, treatment interruptions, and telemedicine reception regarding autoimmune rheumatic diseases (ARDs) in Indonesia. Method A cross-sectional population online-based questionnaire was conducted in Indonesia from September to December 2021. Results A total of 311 ARD patients were included, of whom 81 (26.0%) underwent consultations via telemedicine during the COVID-19 pandemic. The respondents showed increased concern about their susceptibility to COVID-19 (score of 3.9/5). Approximately 81 (26.0%) avoided hospital visits, and 76 (24.4%) stopped taking the medication without medical advice. Respondents’ concerns correlated with their social distancing behaviors (p value 0.000, r 0.458). Respondent concerns, behaviors, and blocked access to the hospital during the pandemic were associated with avoiding hospital visits (p value 0.014; 0.001; 0.045; 0.008). Sex was associated with stopping medication (p value 0.005). In multivariate analysis, blocked access and sex remained significant. Approximately 81 (26%) respondents who used telemedicine services during the COVID-19 pandemic as an alternative medical consultation method showed high satisfaction (3.8/5). Conclusion Health care disruptions and treatment interruptions were affected by patients’ internal and external factors during the COVID-19 pandemic. Telemedicine may be the best option to address barriers to health care access in Indonesia’s rheumatology practice during and after the pandemic situation.

Background: For many people, especially in developing countries, herbal medicine is the most traditional drug choice to treat all diseases including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 infection). Propolis is one of the popular herbal medicine which has various health benefits, particularly antiviral activity. In this molecular docking study, this investigation examined twenty-five kinds of propolis to bind SARS-CoV-2 protein with the main targets of ACE-2 and M-Pro receptors. Method: Propolis ligands were downloaded from PubChem, meanwhile ACE-2 and M-Pro receptors were downloaded from Protein Data Bank. Both ligands and targets were optimized by Pymol. The pharmacokinetic analysis was conducted using SwissADME. Molecular docking was done using PyRx 0.9 and its binding interaction was visualized by Discovery Studio. To predict the potential inhibition, this study compared the ligand-protein complex of propolis to ligands from the previous study. Result: Through the Lipinski rule, only five of twenty-five types of propolis were not qualified for the criterion. The ability to bind protein targets were various between ligands, the highest affinity to ACE-2 receptors were abietic acid, galangin, chrysin, kaempferol and acacetin, respectively. The binding affinity between ligand and M-Pro were seen weaker than ACE-2 receptor, while the strongest were kaempferol, abietic acid, acacetin, galangin and chrysin, respectively. Conclusion: Â Kaempferol is the most potent form of propolis to bind to ACE-2 and M-Pro receptors by assessing the binding affinity and the amount of amino acid residue formation when compared to control ligands. Keywords: ACE-2 receptor, COVID-19, Main protease, Molecular docking, Propolis, SARS-CoV-2

Background: Various treatment strategies to treat AF and reduce its complications have been developed, including anticoagulant administration. Non-Vitamin K antagonist oral anticoagulants (NOAC) are recommended by current guidelines. Different anticoagulants revealed different safety and efficacy characteristic. The real-world evidence-based recommendation is still needed to improve AF management. This study aimed to disclose apixaban safety and efficacy profile compared with warfarin in a real-world population. Methods: We collected data from articles around the world studies comparing Apixaban and Warfarin in NVAF patients recorded online from studies published around 2015 to 2020 that we were taking from a scientific database such as Embase ProQuest, PubMed, and Cochrane based on inclusion criteria. Data analysis was carried out using Review Manager Version 5.4.1 (Cochrane, Copenhagen, Denmark) using Mantel-Haenzel statistical method for categorical data to measure Relative Risk (RR) and 95% Confident Interval (CI). We use a random-effect analysis model if P for heterogeneity (pHet <0.1) and a fixed-effect analysis model if pHet ≥0.1. Results: Apixaban show a benefit in preventing ischemic stroke (RR = 0.51; 95% CI=0.40-0.66; p = <0.00001) ischemic stroke/systemic embolism (RR = 0.63; 95% CI=0.50-0.81; p = <0.0002), and all-cause mortality (RR = 0.54; 95% CI=0.40-0.74; p = <0.0001) relative to Warfarin. Apixaban also show benefit to prevent major bleeding (RR = 0.49; 95% CI=0.41-0.58; p = <0.0001), GI bleeding (RR = 0.46; 95% CI=0.36-0.60; p = <0.0001), and intracranial hemorrhage (RR = 0.45; 95% CI=0.36-0.57; p = <0.0001) relative to Warfarin. Conclusions: Apixaban is over warfarin in efficacy and safety. Apixaban has a safer profile in reducing the risk of major bleeding, GI bleeding, and intracranial hemorrhage in AF patients.