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Mortality rate among maintenance hemodialysis (HD) patients with COVID-19 is alarmingly high. In Fatmawati General Hospital, most of HD patients with COVID-19 presented with acute respiratory distress syndrome (ARDS). Hemoperfusion (HP) is a blood purification therapy used to remove cytokines and inflammatory mediators to prevent ARDS worsening and organ failure. We report 6 cases of COVID-19 in maintenance HD patients. HP and HD were performed in two consecutive days when patient developed early ARDS as indicated by inflammatory markers elevation. HP and HD were conducted by using resin-containing cartridge and high-flux dialyzer, respectively, for 4 hours. Improvements in CRP levels, PaO2/FiO2 ratios, and chest X-rays were observed after 2 sessions of HP in most of our patients. Based on our clinical experience, the timing of HP delivery is critical and should be undertaken in the early phase of ARDS, but larger studies are still needed.

Background: COVID-19, caused by SARS-CoV-2 virus, is a novel disease that has not been previously identified. The disease may result in multiple organ impairment leading to death. Liver is also affected by this viral infection. This study aimed to investigate the association of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) with mortality rate in these patients. Method: This is a retrospective cohort study of COVID-19 patients admitted in Fatmawati General Hospital during a period of March-April, 2020. Diagnosis of COVID-19 was established from real time Polymerase chain reaction (RT PCR). Association of AST and ALT levels with mortality was analyzed by using SPSS® version 16.0. Results: Forty-two patients were diagnosed as confirmed case of COVID-19, 52.3% of them were male. Mean age was 54.6±12 years. Median (IQR) value of AST and ALT levels were 55(48) U/L and 39(40) U/L, respectively. AST and ALT was elevated in 71.4% and 42.9%, respectively. Increased levels of AST and ALT 2 times above the upper normal limit (UNL), 2 times ULN, and 5 times ULN were found in 33.3% and 21.4%; 38.1% and 21.4%; 4.8% and 4.8%, respectively. Mortality was recorded in 45.1% of these confirmed cases, 50% occurred within 2 days of hospitalization. Higher mean value of AST is associated with an increased mortality risk (101 ± 147 U/L vs. 82.78 ± 173 U/L; p 0.032). Sub-analysis identified that abnormal AST 2 times above UNL has a higher mortality proportion compared with AST 2 times UNL and normal AST levels (62.5% vs. 50% vs. 16.7%; p 0.05). Mean value of ALT is not associated with mortality (p 0.479). Further sub-analysis found that in patients who succumbed to the disease, abnormal levels of AST and ALT is related to the time of death during hospitalization despite being statistically not significant. Conclusion: Mortality rate of COVID-19 in hospitalized patients remains high. Increased AST levels was significantly associated with higher mortality rate. This finding merit further investigation by incorporating larger sample size to discern the role of these factors’ contribution to mortality in COVID-19.

Aims: As the country with the seventh largest number of People with Diabetes (PWD) in the world, the Coronavirus disease 2019 (COVID-19) pandemic, and the Large Social Scale Restriction (LSSR) policy taken by the Indonesian government to reduce the number of COVID-19 transmissions is estimated to interfere diabetes management and will increase the incidence of diabetes complications. This study aims to determine the difficulties of diabetes management and its impact on diabetes morbidity during the COVID-19 pandemic in Indonesia. Methods: This study is a cross-sectional study using a national scale web survey. This research was conducted in Indonesia enrolling 1124 PWD aged 18 years or older. Diabetes complications are defined as self-assessed incidence of hypoglycemia, or Diabetic Foot Ulcer (DFU), or hospital admission experienced by PWD in Indonesia during the COVID-19 pandemic. The correlation between diabetes management difficulties and diabetes-related complications was measured using a modified cox regression test. Results: Diabetes management difficulties were experienced by 69.8% of PWD in Indonesia. The difficulties include attending diabetes consultation 30.1%, access to diabetes medication 12.4%, checking blood glucose levels 9.5%, controlling diet 23.8%, and performing regular exercise 36.5%. Diabetes-related complications occurred in 24.6% of subjects. Those who had diabetes management difficulties during the COVID-19 pandemic are prone to have diabetes complications by 1.4 times greater (PR: 1.41, 95% CI: 1.09-1.83) than those who did not. Conclusion: The COVID-19 pandemic and LSSR have impact on diabetes management and diabetes-related complications as assessed by PWD in Indonesia.

Coronavirus disease 2019 (COVID-19) is a new infectious disease that spreads very rapidly and therefore, WHO has declared it as a global pandemic disease. The main clinical symptoms found in COVID-19 patients are cough and fever; however, in some cases, diarrhea can be one of the early symptoms. The present case report describes a patient who came with a complaint of diarrhea without fever and she was later confirmed to be positive for COVID-19 during hospitalization. The presence of unspecified initial symptoms calls for greater vigilance from health workers in establishing diagnosis patients with COVID-19.