No abstract

The neutrophil-to-lymphocyte ratio (NLR), an inflammatory marker, was suggested to be predictive of severity and mortality in COVID-19 patients, thus allowing early risk stratification. In this study, we investigated whether NLR levels on admission could predict the severity and mortality of COVID-19 patients. A literature search was conducted on 23 July 2020 to retrieve all published articles, including grey literature and preprints, investigating the association between on-admission NLR values and severity or mortality in COVID-19 patients. The risk of bias was assessed using the Newcastle Ottawa Scale (NOS). A meta-analysis was performed to determine the overall standardized mean difference (SMD) in NLR values and the pooled risk ratio (RR) for severity and mortality with the 95% Confidence Interval (95%CI). Meta-regression analysis was done to identify potential confounders. A total of 38 articles, including 5699 patients with severity outcomes and 6033 patients with mortality outcomes, were included. The meta-analysis showed that severe and non-survivors of COVID-19 had higher on-admission NLR levels than non-severe and survivors (SMD 0.88; 95%CI 0.72-1.04; I2=75% and 1.68; 95%CI 0.98-2.39; I2=99%, respectively). Regardless of the different NLR cut-off values, the pooled mortality RR in patients with elevated vs. normal NLR levels was 2.75 (95%CI 0.97-7.72). Meta-regression analysis showed that the association between NLR levels on admission and COVID-19 severity and mortality was unaffected by age (p=0.236; p=0.213, respectively). High NLR levels on admission were associated with severe COVID-19 and mortality. Further studies need to focus on determining the optimal cut-off value for NLR before clinical use.

Background: The exercise program (EP) demonstrated beneficial effects on survival and morbidity of patients with chronic and stable heart failure (HF), but there were no evidence of safety and benefit when the EP was implemented early.

The studies of neuro-protection and neuro-therapy effects of Acalypha indica Linn. water extract ex vivo on Musculus gastrocnemius frog have already done at three Departments in Faculty of Medicine, University of Indonesia. The experimental studies were done on 2 groups of frog for neuro-protection and neuro-therapy effects. Each group of frog was divided into 7 subgroups of application, 4 samples each. There were 5 subgroups of doses: 5; 10; 15; 20; 25 mg and 2 subgroups as control. Pancuronium bromide 0.2%, 4 mg, was used for a positive control as muscle relaxant. Neuroprotection study was done as follow: ringer-extract-pancuronium bromide, and neuro-therapy study was ringerpancuronium bromide-extract, respectively. The parameters measured in these studies were the electrical activities such as amount and duration (second) of re-polarization; depolarization, resting potential, and the height of spike after electrical stimulation at 5 mV. Neuro-protection effect of extract was determined by the ability of muscle to show the electrical response after incubating with pancuronium bromide for 10 minutes, and after incubating with extract for 10 minutes for neuro-therapy effect. In the dose of 15 mg and 20 mg/mL of A. indica Linn. extract showed better activities than the dose of 25 mg of extract, both as neuro-protection and neuro-therapy effects, but statistically its have not a significant difference. This study should be followed by an in vivo experiment on frog and it would be done in pharmacokinetic and pharmacodynamic studies on other animal models.

Indonesia's health care system relies on non-health professionals called cadres to operate child health promotion programs in the Public Health Center (Puskesmas). Despite this effort, the child malnutrition rate remains high. This study aimed to identify and develop health promotion media that can assist health cadres in promoting child health. This study was divided into three-phase. The first phase was the need assessment using focus group discussion and knowledge, attitude, and practice (KAP); the second phase is video development, which involves medical students, general practitioners, pediatricians, and health promotion experts; and the third phase was video viewing by cadres and post-viewing tests for health cadres. A comparison of pre-test and post-test participants' total scores was performed with the student's T-test. Need assessment showed that the knowledge of the cadres needs improvement and there was a need for proper educational media material that can be used by the Puskesmas. Five videos were produced, four videos were about children's nutritional intake recommendations during four different age groups and one video was about the information and invitation to come to Integrated Health Service Post (Posyandu). There was a significant improvement from pre-test total scores to post-test total scores (p < 0.001). Smartphone application-based educational videos are effective and reliable child health promotion media for Puskesmas staff and parents.