The Covid-19 pandemic has lasted for 1,5 years. There are many patients who suffered from many conditions or symptoms post Covid-19. In this report, we share our experience of caring for a post Covid-19 who suffered from worsening symptoms of breathlessness. Clinicians should be aware of post Covid-19 syndrome, and try to find the underlying cause and solve the problems. A 65year-old man came to Universitas Islam Indonesia Hospital with severe dyspnea 3 months after discharged from hospitalization for Covid-19 diagnosis. Clinical examination showed bilateral massive pleural effusion and was confirmed by chest x-ray. From echocardiography, we found a 42% decrease in ejection fraction of systolic function. After furosemide treatment, there was only marginal improvement. In order to reduce the pleural effusion, we conducted pleural effusion tapping, and we tapped 1200 ml serous discharge from the right pleura and 1100 ml from left pleura. From the laboratory examination we concluded that the discharge was transudation from reduced cardiac function. There was no evidence of bacterial infection nor mycobacterial tuberculosis infection. The patient had diabetes mellitus as comorbidity; however, the blood glucose remained stable and controlled with diet during hospitalization. Follow-up several months after discharge showed that maintenance treatment with diuretic, beta-blocker and Angiotensin II Receptor blocker showed good results and there was no recurrence of pleural effusion. Post Covid-19 symptoms can manifest as severe dyspnea from pleural effusion caused by reduced cardiac function. Several diagnostic tests should be performed to exclude other causes of pleural effusion. The symptom will improve with pleural tapping and administration of diuretic, beta-blocker and Angiotensin II receptor blocker.

ABSTRACT<br /><br />Background: Iodine Defi ciency Disorder (IDD) is a health problem that affects quality of human resources. IDD happens not only due to iodine defi ciency but also other disorders such as goitrogenic substance (thiocyanate), pollutants of heavy metals (Pb) and micronutrient defi ciency (Fe) that inhibit thyroid hormone biosynthesis which cause the sweling of goitre glands.<br /><br />Objective: To identify the association between consumption of iodine, thiocyanate, Fe consumption, status of anemia and Pb and status of IDD in pregnant mothers at Subdistrict of Tabunganen, District of Barito Kuala, Province of Kalimantan Selatan.<br /><br />Method: The study was observational using case control design and quantitative method. Data were obtained through the palpation of goitre glands, measurement of thyroid stimulating hormone (TSH) level using ELISA method, iodine and thiocyanate consumption using food recall 2x24 hours and food frequency questionnaire (FFQ), Fe consumption using FFQ, Hb level using photometric method and Pb level using AAS method. Data were analysed by using chi-square and logistic regression.<br /><br />Result: There was signifi cant association (p&lt;0.05) between consumption of iodine (fi sh) based on FFQ and IDD status (goitre) with OR=3.44 and IDD status (TSH) with OR=8.00. There was no association between consumption of thiocyanate and Fe measured with food recall, FFQ and IDD status (goitre and TSH). There was signifi cant association (p&lt;0.05) between Pb status and IDD status (TSH) with OR=9.35.<br /><br />Conclusion: There was association between iodine consumption based on FFQ (fi sh) and IDD status (goitre) after the control of iodine consumption status (food recall). There was association between iodine consumption status (FFQ) in fi sh together with anemia status and the prevalence of IDD disorder (TSH) after the control of Pb status. <br /><br />KEYWORDS: iodine defi ciency disorder, pregnant mothers, iodine, thiocyanate, Fe, anemia, Pb<br /><br />ABSTRAK<br /><br />Latar Belakang: Gangguan akibat kekurangan yodium (GAKY) merupakan masalah kesehatan yang dapat mempengaruhi kualitas sumber daya manusia. GAKY tidak hanya disebabkan oleh kekurangan yodium, tetapi juga dipengaruhi oleh zat goitrogen(tiosianat), logam berat Pb, dan kekurangan Fe yang menghambat biosintesis hormon dan berakibat pada pembesaran kelenjar gondok.<br /><br />Tujuan: Mengetahui hubungan antara tingkat konsumsi yodium, goitrogen (golongan tiosianat), Fe, serta status anemia dan status Pb dalam darah dengan status GAKY pada ibu hamil di  Kecamatan Tabunganen Kabupaten Barito Kuala Provinsi Kalimantan Selatan.<br /><br />Metode: Penelitian ini merupakan penelitian observasional dengan rancangan case control. Data pembesaran kelenjar tiroid diperiksa denganpalpasi di daerah kelenjar tiroid, kadar TSH dengan metode ELISA, tingkat konsumsi yodium dan tingkat konsumsi tiosianat dengan metode food recall 2 x 24 jam dan food frequency questionnaire  (FFQ), tingkat konsumsi Fe dengan FFQ, kadar Hb dalam darah dengan metode fotometrik, kadar Pb darah dengan metode AAS.Data dianalisis menggunakan chi-square dan logistic regression.<br /><br />Hasil: Ada hubungan signifi kan (p&lt;0,05) antara tingkat konsumsi yodium (ikan laut) berdasarkan FFQ dan status terhadap status GAKY (gondok) dengan OR=3,44 dan status GAKY (TSH) dengan OR=8,00.Tidak ada hubungan antara tingkat konsumsi tiosianat dan Fe yang diukur dengan food recall, FFQ, dan status GAKY (gondok dan TSH). Antara status Pb dan status GAKY (TSH) juga tidak ditemukan adanya hubungan dengan OR=9,35.<br /><br />Kesimpulan: Ada hubungan antara konsumsi yodium berdasarkan FFQ (ikan laut) dan status GAKY (gondok) dan antara konsumsi yodium (FFQ) dengan status anemia dan prevalensi GAKY (TSH).<br /><br />KATA KUNCI: gangguan akibat kekurangan yodium, wanita hamil, yodium, tiosianat, Fe, anemia, Pb

The background of this research is the weaker brand image of the results of SMEs presto milkfish products, and the weak consumer confidence in SMEs presto milkfish products in the city of Semarang. In general, this study aims to determine the effect of brand image and trust on consumer loyalty where the product value as a moderating variable. In particular, this study aims to improve the competitiveness of milkfish presto products. The variables in this study consisted of four variables, namely brand image and trust became independent variables while consumer loyalty became the dependent variable. Then the product value is a moderating variable. Research data collection techniques by distributing questionnaires to consumers of presto milk products in the city of Semarang are systematically arranged with several easy-to-understand answer choices. The distribution of questionnaires was carried out during the period May - August 2017, with a sample of 125 people. Then the data collected through the questionnaire was tested for validity and reliability. Hypothesis testing uses multiple regression analysis and MRA (Moderated Regression Analysis. To get the BLUES regression results (best linear unbiased estimated), the classical assumption test was previously carried out. This research is motivated by the weak brand image of milkfish presto products, as well as the weak consumer confidence in presto milkfish products in Semarang City. In general, this study aims to determine the effect of brand image and trust on consumer loyalty where the product value as a moderating variable. In particular, this study aims to improve the competitiveness of milkfish presto products. The variables in this study consisted of four variables, namely brand image and trust became independent variables while consumer loyalty became the dependent variable. Then the product value is a moderating variable. Research data collection techniques by distributing questionnaires to consumers of presto milk products in the city of Semarang are systematically arranged with several easy-to-understand answer choices. The distribution of questionnaires was carried out during the period May - August 2018, with a sample of 125 people. Then the data collected through the questionnaire was tested for validity and reliability. Hypothesis testing uses multiple regression analysis and MRA (Moderated Regression Analysis. To get BLUES regression results (best linear unbiased estimated), classical assumptions have been tested before. The results show that brand image has a positive and significant effect on loyalty, trusts have a positive effect and significant to loyalty, brand image has a stronger influence on loyalty when driven by product value, trust has a stronger influence on loyalty when driven by value products.

Background: The age of 0–2 years is the golden period because this is period of the fastest development of brain nerve. Breast milk contains iodine which is useful to maximize the process of growth and development of children. Iodine deficiency can also cause cretinism, usually occurring in endemic hyacinth areas such as at Srumbung. Objective: To determine the relationship between iodine intake and establishment of breastfeeding toward the growth and the development of toddler aged 13–23 months in three villages in Srumbung, Magelang City. Methods: This was survey study with cross sectional design. The study was conducted from April to May 2018 in Ngablak, Ngargosoko and Srumbung. The population were 110 toddler aged 13–23 months. Subjects were 86 children and were taken with proportional random sampling. Data of iodine intake, history of breastfeeding, and developmental were collected through interviews, while anthropometric data were obtained through direct measurement. Data were analyzed using Chi Sqare test with CI 95%. Results: The statistical analysis showed the maternal iodine intake and child growth had p =0,350, maternal iodine intake with child development had p=0,170, history of breastfeeding with child growth had p=0,130 and history of breastfeeding with child development had p=0.004. Conclusion: There was no relationship between maternal iodine intake and child growth, maternal iodine intake and child development, and history of breastfeeding and child growth. There was relationship between establishment of exclusive breastfeeding with development.