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Introduction: The extraordinary thrombotic manifestations of Corona virus Disease-2019 (COVID-19) caused by Severe Acute Respiratory Syndrome CoV-2 (SARS-CoV-2) virus, presenting as venous and arterial thrombosis have been reported in several literatures, but in this report, we presented a special case of acute limb ischemia in a patient that has been vaccinated by COVID-19 vaccine. Acute limb ischemia (ALI) is defined as decreasing in arterial perfusion of a limb with a threat to viability of the limb and mortality. COVID-19 has been declared as a global pandemic by the WHO. Patients with COVID-19 have abnormalities in blood coagulation parameters and are prone to thromboembolic events. This hypercoagulable state caused by COVID-19 mainly manifests as venous thromboembolism while peripheral arterial involvement is less frequent. Case: A 54-year diabetic and smoker male has already got one dose COVID-19 vaccination came to our emergency unit with severe acute respiratory syndrome and pain, pale and paresthesia of his left leg. There was pneumonia pattern according to chest X-ray and a ground glass opacity in chest CT-scan, he was confirmed infected by COVID-19 according to RT-PCR test. From CT-Angiography we found multiple thrombosis in the distal aorta, superficial femoral artery (SFA), anterior tibial artery (ATA), and posterior tibial artery (PTA) of left lower extremity. Initial treatment we started with unfractionated heparin, oxygenation, intravenous fluid and analgesia. We managed the patient in isolation ward special for COVID-19. We did thrombectomy to save the limb, nevertheless in few days after we performed amputation at the level of talonavicular joint to the distal part of left foot caused by gangrene. Conclusion: Vaccination can protect from COVID-19 if we vaccinated with full dose and our immune system able to create antibody. The condition will be different in immunocompromised condition and we get not full dose vaccination. Covid-19 Patient with Diabetes and smoker could have higher risk to develop acute limb ischemia because of hypercoagulable state. Management of a COVID-19 patient with cute limb ischemia is more complicated and challenging. Although we have already vaccinated life style modification like wearing a mask, social distancing and using hand sanitizer can give us more protection from Covid 19. Keywords: acute limb ischemia, COVID-19 vaccination, heparinization, thrombectomy

A B S T R A C T Introduction. Old age is related to geriatric syndrome where there are several health problems that often occur related to a decrease in body function and an increase in the inflammatory process. Decrease in muscle mass, muscle strength and physical performance will lead to a condition of sarcopenia and frailty syndrome in the elderly. The importance of prevention so that sarcopenia does not occur in the elderly by evaluating the factors that can cause it, one of which is controlling nutritional factors (macro and micro nutrients), such as in research, namely omega-3 macronutrients. The purpose of this study was to determine the correlation between serum omega-3 levels with muscle mass, muscle strength, and physical performance in the elderly community at Moehammad Hoesin Hospital Palembang. Methods. This research is an observational analytic study with a cross-sectional approach which was conducted at the Integrated Geriatric Clinic Internal Medicine RSMH Palembang from November 2019 to November 2020. A sample of 21 people aged> 60 years was examined for muscle mass, muscle strength, physical performance and omega- levels. 3 serums. All data processing and analysis in this study used SPSS version 25 for Windows. Results. Of the 21 subjects, it was found that women were 19 people (90.5%) and 2 men (9.5%). The mean value of muscle mass was 37.65 ± 5.7, hand grip strength was 24.04 ± 5 kg, and walking speed was 6.72 ± 1.8 seconds per 6 meters. There were 11 subjects with low serum omega-3 levels of 485.25 ± 110.19 mg. There was a significant relationship between serum omega-3 levels and muscle mass (p = 0.041) with moderate correlation strength (r = 0.448). Conclusion: Muscle mass has a significant relationship with serum omega-3 levels in the elderly with moderate strength. Meanwhile, muscle strength and physical performance did not have a significant relationship.

A B S T R A C T Introduction Older people tend to have decreased activity and intake of macronutrients and micronutrients that are not in accordance with the body's needs. Research in 2017 on elderly men and women at the Center for Family Compensation (PUSAKA) in Central Jakarta showed that 80.2% of elderly people have vitamin D deficiency. Low serum levels of vitamin D in the body are the initial risk of decreased muscle mass and physical performance in old age. where there is a significant correlation between low serum vitamin D levels in the body with sarcopenia and mortality. The purpose of this study was to determine the correlation of vitamin D levels with muscle mass, muscle strength and physical performance in the elderly community at RSMH Palembang. Methods This research is a study analytic observation with a cross- sectional approach that was carried out at the Integrated Geriatric Clinic Internal Medicine RSMH Palembang from November 2019 to November 2020. A sample of 34 people aged> 60 years were examined for muscle mass, muscle strength, physical performance and serum vitamin D levels. All processing and analysis The data in this study used SPSS version 25 for Windows. Results From 34 subjects, it was found that there were 29 women (85.3%) and 5 men (14.7%). The mean value of muscle mass is38.76 ± 4.1 kg / m2, long runs within 6 meters 6.12± 0.9 m / sec, and hand grip strength 24.9 ± 5.2 kg. It was found that 18 (62.1%) female samples had vitamin D deficiency while 11 (37.9%) samples had vitamin D insufficiency. There was a significant correlation between muscle mass and hand grip strength with vitamin D with weak correlation strength and length of walking with vitamin D with moderate correlation strength.Conclusion There is a significant correlation between muscle mass and grip strength and walking time of 6 meters with vitamin D.