Asian working group for sarcopenia (AWGS) recently introduced “possible sarcopenia” diagnosis for early identification of sarcopenia in the primary healthcare. For initial screening, 3 modalities, i.e. calf circumference (CC) measurement, strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire, and a combination of both (SARC-CalF), are recommended. However, no validation study has been done until now. Therefore, this study aims to evaluate the diagnostic performance of the recommended screening modalities using data from Indonesia. This cross-sectional study included subjects aged ≥ 60 years old who visited primary healthcare in Surabaya, Indonesia. The diagnosis of possible sarcopenia was confirmed with hand-grip strength and repeated chair stand test. Receiver operating characteristic curve analysis was used to evaluate the diagnostic performance. Among 266 subjects, 186 (70%) were diagnosed with possible sarcopenia. Using the recommended cut-off, the area under the curve, sensitivity, and specificity were 0.511, 48.39% and 53.75% for CC, 0.543, 8.60% and 100% for SARC-F, and 0.572, 19.35% and 95% for SACRC-CalF. Our findings indicate that the diagnostic performance of the recommended screening modalities is poor. Multicenter studies from different areas in Indonesia should be done to confirm these findings.

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Insulinoma is a rare entity, in which neuroglycopenia symptoms of recurrent hypoglycemia are often confused with the neuropsychiatric disorder, especially in a patient with hydrocephalus. Hypoglycemia leads to a proinflammatory and procoagulant state, which may worsen the COVID-19 prognosis. We report a case of a 25-year-old woman with an initial presentation of seizure. No previous medical history and drugs were recorded. Intravenous dextrose is administered as low blood sugar was evident but no marked improvement in consciousness was observed.

Acquired hemophilia A (AHA) is a rare condition that affects one in a million people each year, and there are not many diagnostics or therapeutic agents available for treatment due to its rarity. This is a case report of a 61-year-old woman who presented with a spontaneous subcutaneous hematoma and multiple extensive bruises in her extremities. There was no prior history of bleeding disorders, and the laboratory results showed an isolated aPTT prolongation with no correction after mixing studies, and a reduction in FVIII activity level along with a high FVIII inhibitor titer (928BU). Furthermore, the diagnosis of idiopathic AHA was made after other secondary causes had been ruled out, and the patient received human FVIII concentrate instead of bypassing agents due to its availability. The patient still experienced clinical improvement despite using this alternative. AHA is currently managed using both hemostasis agents and inhibitor eradication, and they come with several limitations. Human FVIII concentrate therapy is still an option in situations with limited resources, even though it is not recommended in patients with high inhibitor titer levels.

Previous studies have yielded inconsistent results on whether glycated hemoglobin (HbA1c) and random blood glucose (RBG) are associated with mortality of coronavirus disease 2019 (COVID-19) patients with type 2 diabetes mellitus (T2DM). This study aimed to assess the association of HbA1c and RBG with mortality among COVID-19 patients with T2DM. A retrospective study was conducted on 237 patients with COVID-19 and T2DM (survival (n = 169) and non-survival groups (n = 68)). Data on socio-demography, comorbidities, clinical symptoms, laboratory examination, and mortality were collected. Patients in the non-survival group had an older age range as compared with those in the survival group (60 (52.3–65.0) vs. 56.0 (48.5–61.5) years, p = 0.009). There was no statistical gender difference between the two groups. After matching was done, chronic kidney disease, NLR, d-dimer, procalcitonin, and random blood glucose were higher in the non-survival group compared to the survival group (p < 0.05). HbA1c levels were similar in survivors and non-survivors (8.7% vs. 8.9%, p=0.549). The level of RBG was independently associated with mortality of COVID-19 patients with T2DM (p = 0.003, adjusted OR per 1-SD increment 2.55, 95% CI: 1.36–4.76). In conclusion, RBG was associated with the mortality of COVID-19 patients with T2DM, but HbA1c was not.