The aim of the research is to analyze the differences in the subset of T lymphocytes and NK cells at various degrees of disease severity in order to be used in stratification of patients’ management and to predict outcomes for optimal treatment. The study sample of 123 patients with confirmed COVID-19 was classified based on the degree of severity: 50 patients with mild severity, 34 patients with moderate severity and 39 patients with severe to critical severity who were subjected to complete blood count and T lymphocyte subsets (CD3, CD4, CD8) and NK cells with Flowcytometry. There were significant differences in the number of CD 3 cells (p=0.000), CD4 (p=0.000), CD8 (p=0.000), and NK cells (p=0.000) in the three groups. In the severe to critical group there was a decrease in lymphocytes accompanied by decrease of the number of CD3, CD4, CD8 and NK cells as well as an increase in WBC and neutrophils. Based on the outcome, there were significant differences in the number of CD 3 cells (p=0.000), CD4 (p=0.001), CD8 (p=0.000), and NK cells (p=0.001) between the Discharged and death groups. The decrease in the number of CD3, CD4, CD8 and NK cells indicates a relationship between changes in lymphocyte subsets and the pathogenesis of SARS-CoV-2, namely immune system disorders such as SARS infection. Increased of WBC with a decrease in CD3, CD4, CD8 and NK cell counts are associated with poor patient outcome. A significant decrease in the number of CD3, CD4, CD8 and NK cells in COVID-19 patients with severe to critical and moderate symptoms compared to mild groups and associated with poor patient clinical outcome.

(1) Background: This study is designed to establish thyroid-stimulating hormone (TSH) reference intervals tailored to different neonatal age groups and Indonesian local populations. (2) Methods: Dried blood spot neonatal TSH values, from 1 January 2022 to 31 December 2023, were used to establish the neonatal TSH reference intervals partitioned by sex, gestational age, and ethnic group at different neonatal ages. (3) Results: A significant difference in the reference intervals value was observed in sex, gestational ages, and parental ethnicity groups in different neonatal age subgroups (p < 0.05). Male reference intervals were significantly higher than those of females at all neonatal ages. Late and post-term gestational age categories reference intervals were higher than early and full-term. Among the ethnic groups, Madurese had a higher upper limit TSH reference interval. (4) Conclusions: Our neonatal TSH reference intervals were needed to provide a reference adapted to the local population of Indonesia.

Introduction: Emergency use of molecular rapid test kits approved by the Food and Drug Administration (FDA) includes the Xpert Xpress SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) kit. The rapid molecular test is one of the examinations using the reverse transcription-polymerase chain reaction (RT-PCR) method. Compared to conventional PCR, the examination time is faster, so it is suitable for diagnostic purposes. Objectives: Determining the diagnostic capabilities of the Xpert Xpress SARS-CoV-2 rapid molecular test in detecting the SARS-CoV-2 virus in the Indonesian population. Methods: A cross-sectional study was conducted with consecutive sampling, in which participants were diagnosed with coronavirus disease 2019 (COVID-19) infection using the RT-PCR Abbott M2000 SARS-CoV-2 System. A molecular rapid test examination was carried out using the Xpert Xpress SARS-CoV-2 kit. Assessing the correlation between the cycle threshold (CT) value of Xpert Xpress SARS-CoV-2 and the Abbott M2000 SARS-CoV-2 System using the Pearson and Spearmen test with P<0.05. Results: Molecular rapid test using Xpert Xpress has a compatibility of 100% with RT-PCR using Abbott M2000 SARS-CoV-2 and a sensitivity and specificity value of 100%. The Xpert Xpress SARS-CoV-2 CT value had a significant correlation with the Abbott M2000 SARS-CoV-2 System CT value, with moderate correlation strength for the CT protein E value (r=0.444; P=0.007) and robust correlation for CT value of protein N2 (r=0.829; P<0.001). The negative predictive and positive predictive values were 100% each. Conclusion: The Xpert Xpress SARS-CoV-2 molecular rapid test has a sensitivity and specificity of 100% and can be recommended for diagnosing COVID-19.

Background: Though coronavirus disease (COVID-19) has been designated as a global pandemic, its nature as a viral infection means that it is essentially a self-limiting disease. We studied the application of symptomatic, isolation, relaxation, nutrition and observation (SIRNO) therapy in patients with asymptomatic and mild symptoms of COVID-19 at a rescue hospital in Indonesia. Methods : This is a retrospective cohort study involving 2122 patients who were admitted to Indrapura Field Hospital in Surabaya from 28 May 2020 to 20 September 2020. We analyzed demographic data, clinical signs and symptoms, laboratory data, therapy and clinical outcomes. Result: The total sample of 2122 patients consisted of 1403 male patients (66.12%), and 719 female patients (33.88 %). The most common age range was 26-45 years, at 52.54% (1115 patients). The clinical symptoms of 1121 patients (52.8%) were asymptomatic, 977 patients (46%) had mild symptoms, and 24 patients (0.1%) had moderate symptoms. All patients received the SIRNO therapy method. From a total of 2122 patients, 1930 patients (90.9%) were cured, 181 patients (8.5%) are still being treated, seven patients (0.03%) were referred for indications of desaturation (SpO2 <94%), and four patients (0.01%) were moved to a referral hospital. Until 20 September 2020, the final date studied, there were no patient deaths. Conclusion: The SIRNO method provides excellent results in the management of COVID-19 at a rescue hospital for patients with asymptomatic and mild symptoms. Economic pharmacological research can initiate a follow-up study in order to objectively measure the effectiveness and efficiency of SIRNO treatment methods in patients with asymptomatic, mild symptoms of COVID-19, and the small number of 24 patients (0,.1%) with moderate symptoms.

Preliminary: Libman-Sacks endocarditis (verrucous vegetations, marantic, or nonbacterial thrombotic endocarditis) is a rare cardiac manifestation in SLE. The objective was to describe Libman-Sacks endocarditis in a SLE male patient. Case: A 21-year-old male was admitted to the hospital with shortness of breath, epigastric pain, oral ulcer, discoid lesions, and knee joints pain since 3 months before. He worked as a paper mill employee and was exposed to instruments radiating UV rays for 2 years. Antibiotics initiation was given due to an infective endocarditis suspicion. Vital signs were as follows: temperature 37^oC, heart rate 110beats/minute, respiratory rate 30breaths/minute, blood pressure 100/80mmHg, and SaO₂ 99% with nasal oxygenation. Cardiac examination showed regular rate and rhythm with diastolic murmur at left ICS III and upper left sternal border. Lower extremities showed pitting edema. Laboratory results: hemoglobin 9.6g/dl, RBC 3.6x10⁶/μl, hematocrit 30.8%, WBC 0.88x10³/μl, platelet count 22x10³/μl, BUN 74.0mg/dl, serum creatinine 1.6mg/dl, ESR 24mm/h, CRP 1.2mg/dl, C3 <16.4mg/dl, C4 8mg/dL, ANA test indeterminate (23.84), and anti dsDNA negative (7.4WHOunits/mL). Chest X-Ray showed mitral heart configuration with right ventricle and left atrium enlargement, pneumonia, and right pleural effusion. ECG showed normal sinus rhythm, left ventricular hypertrophy with repolarization abnormality, and prolonged QT wave. A 2-D echocardiogram showed an evidence of vegetation on aortic and pulmonary valve. Discussion: Based on the American College of Rheumatology SLE Criteria, low complement level, and evidence of vegetation on aortic and pulmonary valve, the patient was diagnosed as Libman-Sacks Endocarditis. Conclusion: The diagnosis should be confirmed by antiphospholipid antibodies examination. Key Words: