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Purpose of Peeling

To exfoliate the outer layer of the skin to regenerate the facial skin and repair its beauty in a safe manner.

Benefits of Peeling

• Improve skin texture and treat aging skin
• Reduce wrinkles
• Promote skin cells regeneration
• Reduce hyperpigmentation or facial spots
• Lessens the appearance of acne scar

Types of Chemical Peeling

Chemical peeling is divided into 3 based on the depths it targets:

• Light chemical peeling: a superficial chemical peel that targets the exfoliation of the outermost layer of the skin (epidermis). It is most often used to treat fine wrinkles, acne, dry skin, or uneven skin tone.
• Medium chemical peeling: a medium chemical peel that targets the exfoliation of the epidermis up to the outermost dermis (middle layer of the skin). It is used to treat wrinkles, acne scar, and uneven skin tone. This procedure may need to be repeated to reach or maintain the desired result.
• Deep chemical peeling: a deep chemical peel that targets the exfoliation of deeper layer of the skin. Doctors may recommend this to treat deeper acne scar, wrinkles, or pre-cancerous lesion. This is often done only once to reach a certain desired result.

Side Effects of Peeling

• Redness, scabbing, swelling. These are the common side effects that occurs as part of the healing process after peeling. The duration varies from weeks to months depending on the depths of peeling.
• Changes in skin color. The treated skin may become darker (hyperpigmented) or lighter (hypopigmented) than before. Hyperpigmentation may occur in light peeling while hypopigmentation in deep peeling. However, this side effect usually occur in patients with originally darker skin.
• After peeling, there could be bacterial, viral, or fungal infection if the skin is not treated cleanly. For those with herpes, herpetic skin flare-up may occur.
• Although rare, chemical peeling may cause scarring especially on the lower part of the face. Your doctor may give you certain medications for this.

Things to Note Before Chemical Peeling

Before chemical peeling, please consult with your dermatologist first. Your doctor will first review your medical history, do some physical examinations, and discuss the problems and targets that you desire. Then the doctor will decide the regiment for your tailored peeling program. Before chemical peeling, the doctor may tell you to use certain cream and avoid certain medicines / cosmetics.

Chemical Peeling Procedure

Depending on the type of peeling, your doctor will perform different procedures. In general, your doctor will apply chemical solution onto your skin. For deep peeling, the doctor may give you IV fluids and monitor your heart rate. Usually the procedure lasts for 30 – 90 minutes.

Things to Note After Chemical Peeling

1. The treated skin may become red, irritative, or swollen (depending on the depth of the peeling procedure)
2. Avoid rubbing / scratching skin
3. Apply skin cream according to doctor’s instructions
4. Avoid direct sunlight
5. Use sunscreen or moisturizer regularly according to doctor’s instructions
6. Avoid using skin exfoliating products right after peeling
7. Avoid certain cosmetic / make-up products for some time according to doctor’s instructions

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Resources:

https://www.mayoclinic.org/tests-procedures/chemical-peel/about/pac-20393473

https://www.healthline.com/health/beauty-skin-care/chemical-peels-at-home

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FibroScan is a specialized ultrasound machine to scan your liver to measure fibrosis (scarring) and steatosis (fat accumulation) in the liver. This helps your doctor to understand your liver disease. Your doctor may also order other tests to evaluate your liver, such as blood tests, other imaging scans, or biopsies. Your doctor will explain your results during your appointment.

What is a CAP Score?

Your Controlled Attenuation Parameter (CAP) score is a measurement of fat accumulation in your liver for your doctor to further determine your steatosis grade.

The CAP score ranges from 100 to 400 decibels per meter (dB/m). The table below will help you categorize your CAP scores into a certain steatosis grade and the range of percentage of fatty change.

What is your Fibrosis Result?

Your fibrosis result is a quantification of the amount of liver scarring by measuring the stiffness of your liver. The normal fibrosis result ranges from 2 to 6 kilopascals (kPa), while the highest possible result is 75 kPa. Those who have liver abnormalities will have a higher result than normal.

Basically, your doctor will use your fibrosis result and medical history to categorize your fibrosis score.

• Fibrosis score F0 to F1: No liver scarring or mild liver scarring
• Fibrosis score F2: Moderate liver scarring
• Fibrosis score F3: Severe liver scarring
• Fibrosis score F4: Advanced liver scarring (cirrhosis)

Can I estimate my Fibrosis Score using my FibroScan fibrosis result?

The following table shows liver diseases, ranges of fibrosis results, and the matching fibrosis score. Please note that the ranges of fibrosis results in the table are estimates. Your actual fibrosis score (as told by your doctor) may not even match the fibrosis score in the table. This table cannot be used if you have more than one liver disease.

To use the table, firstly find the liver disease that you have on the first column. Then, read across the row to find the range that includes your fibrosis result. Lastly, take a look at the top of that column to find your fibrosis score.

How accurate is my FibroScan result?

In some cases, your liver may actually have less scarring than what the FibroScan fibrosis result says. This may happen if you have:

• Liver inflammation, either caused by recent liver illness or drinking alcohol
• Liver tumor, either benign or cancerous
• Liver congestion (a condition when the liver is too full of blood or other fluids) often correlated with heart failure

Your FibroScan results may also be less accurate if you have:

• Obesity, a body mass index (BMI) higher than 30
• Ascites (fluid accumulation in your abdomen)
• Biliary obstruction (your bile cannot flow out of the liver properly)

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Source: Memorial Sloan Ketterin Cancer Centter

https://www.mskcc.org/cancer-care/patient-education/understanding-your-fibroscan-results

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For Omicron Case Confirmation and Omicron Probable Case

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Urinary incontinence is a medical condition in which you cannot control the flow of your urine. For instance, the urine comes out when you cough or sneeze. Many people think that urinary incontinence is normal with age. However, urinary incontinence is a medical problem that can be managed and treated.^1-3

If left untreated, urinary incontinence can affect emotional, psychological, and social life. Many people with urinary incontinence become uncomfortable in their daily activities as they must frequently go to the toilet.

Types of Urinary Incontinence

There are several types of urinary incontinence:²

1. Stress incontinence: leakage of urine when there is pressure on the bladder, such as when coughing, sneezing, laughing, or lifting something heavy
2. Urge incontinence: leakage of urine due to a sudden urge to urinate. This makes a person feel the need to frequently urinate, including at night.
3. Overflow incontinence: leakage of urine due to incomplete urination
4. Functional incontinence: leakage of urine due to physical disturbances that prevent you from going to the toilet on time, for example having arthritis that you cannot unbutton the pants fast enough.
5. Mixed incontinence: a combination of more than one type of urinary incontinence. The most common combination is stress incontinence and urge incontinence.

Risk Factors

There are several things that increase the risk of urinary incontinence:^2,3

1. Gender – women are more frequent, this is related to pregnancy, childbirth, and menopause. Although men with prostate problems are also at risk.
2. Age – the elderly are more prone to urinary incontinence as the aging of bladder muscle can cause a reduction in its capacity and involuntary muscle contractions
3. Family history – risk increases if a family member has urinary incontinence
4. Bodyweight – being overweight will increase pressure on the bladder and surrounding muscles, causing urine to come out when coughing/sneezing
5. Pregnancy – hormonal changes and increasing gestational age increase the risk to urinary incontinence
6. Childbirth – vaginal delivery and having a greater number of children increase the risk to urinary incontinence
7. Prostate enlargement/cancer – urinary incontinence may occur due to the enlargement of the prostate itself or as a side effect of prostate cancer therapy
8. Obstruction – obstruction of the urinary tract either by tumour or stone
9. Smoking – smoking behaviour can increase the risk of urinary incontinence
10. Other diseases – increased risk in people with diabetes or neurological disorders

Causes of Urinary Incontinence

Causes of temporary urinary incontinence:³

• Drinks: Alcohol, caffeine, soda, sparkling
• Foods: chocolate, chilli, foods high in sugar/acid, citrus fruits
• Artificial sweeteners
• High doses of Vitamin C
• Medications: some high blood pressure medications, muscle relaxants, and sedatives
• Medical problems: urinary tract infection, constipation

Causes of persistent urinary incontinence:³

• Aging and menopause
• Pregnancy and childbirth
• Prostate enlargement/cancer
• Urinary tract obstruction, either by tumour or stone
• Nerve disorders (multiple sclerosis, Parkinson’s, stroke, brain tumour, or spinal cord injury)

Prevention of Urinary Incontinence

Here are some ways to prevent urinary incontinence:³

• Maintain a healthy weight (no excess, no less)
• Pelvic muscle exercises
• Avoid alcoholic beverages, caffeine, and high sugar/acidic foods
• Quit smoking
• Eat more fibrous foods

Management of Urinary Incontinence

• Catheters and urine bags – use a catheter tube that connects the bladder to the urine bag so that the patient can be free to do their daily activities and not be bothered by urinary incontinence²
• HIFEM (High-Intensity Focused Electro-Magnetic) Device – a new therapy using channelled electromagnetic technology to stimulate neuromuscular tissue and strengthen pelvic floor muscles in a non-invasive manner. This new modality is proven to be safe and effective to treat urinary incontinence.¹

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Resources

1. Samuels JB, Pezzella A, Berenholz J, Alinsod R. Safety and Efficacy of a Non-Invasive High-Intensity Focused Electromagnetic Field (HIFEM) Device for Treatment of Urinary Incontinence and Enhancement of Quality of Life. Lasers Surg Med. 2019;51(9):760-766.
2. Urology Care Foundation. Urinary Incontinence. [Internet] Cited on 20 Jan 2022. Available from: https://www.urologyhealth.org/urology-a-z/u/urinary-incontinence.
3. Mayo Clinic. Urinary Incontinence. [Internet] Cited on 20 Jan 2022. Available from: https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/symptoms-causes/syc-20352808.

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Prolotherapy is an injection therapy using a natural irritant solution, most commonly hypertonic dextrose, for chronic musculoskeletal injury. Basically, the injections of small volumes of an irritant solution at multiple painful points (such as ligament and tendon insertions, and in joint spaces) will trigger a local healing process in the injected area. The term prolotherapy comes from an injection therapy called proliferant therapy which was commonly used in 1950.^1,2

Purpose of Prolotherapy

Prolotherapy is meant to reduce joint pain by injecting a natural irritant solution that induces a local healing reaction in the injected area. This irritant solution functions not only as nutrition but also as a trigger to body’s natural capability to repair the damaged tissues.^1-3

Safety and Effectiveness of Prolotherapy

Several studies have confirmed that prolotherapy is a safe alternative to manage joint pain, other than medications. It can also be used in some medical conditions when it is not severe enough that surgery is necessary.^2,3

Many studies showed that prolotherapy is effective in reducing joint pain as it repairs / strengthens the joint tissues. Because prolotherapy relies on the natural capability of the body to heal / regenerate itself, it is believed to improve joint stability and permanently repair joint functions. This is what differentiates prolotherapy from painkillers since painkillers are only temporary.^1-3

Medical Conditions Suitable for Prolotherapy

Several joint-related complains that can be treated with prolotherapy include:^2,3

• Low back pain
• Hip pain
• Knee pain
• Shoulder pain
• Other joint / ligament pain

 The followings are some medical conditions commonly treated with prolotherapy:^2,3

• Knee osteoarthrosis
• Tennis elbow
• Tendonitis (inflammation of the tendon)
• Rotator cuff injury
• Arthritis

Mechanism of Action of Prolotherapy

Prolotherapy involves an injection of irritant solution (like hypertonic dextrose) to the targeted joint area that cause pain. After the injection, this solution will induce a temporary inflammatory reaction in the area. The activated inflammatory cells will come to the injected area and cause a chemical reaction that leads to new cell growth and repair of the damaged joint / tendon / ligament. Along with the tissue repair (healing) process, the joint / tendon / ligament will become more stable and stronger, hence the pain disappears. Thus, a precise injection is crucial in prolotherapy so that it directly targets the area that need the most repair.^1-3

The Procedure of Prolotherapy

Before prolotherapy, a doctor will firstly evaluate the patient. Patients with joint pain due to chronic disease that has reached a certain level of severity may not be suitable for prolotherapy and may be advised to take other alternative therapies. The doctor will perform a physical examination of the joint and evaluate the joint in question with appropriate imaging, such as an X-ray / CT scan to assess its location and severity.

If prolotherapy is recommended, the patient should stop taking anti-inflammatory drugs, both steroids (eg prednisone, methylprednisolone) and non-steroids (eg aspirin, ibuprofen, diclofenac, celecoxib) for 2-3 days before the procedure. This is because these anti-inflammatory drugs can inhibit the effectiveness of prolotherapy.⁴

The prolotherapy procedure begins with sterilization of the injection site with an alcohol swab or other sterile cleaning fluid. Then, hypertonic dextrose solution is injected into several points targeting the joint gaps, tendons, and ligaments that are affected. This procedure can also be performed with ultrasound guidance so that the injection site is more precise.

Frequency of Prolotherapy

The frequency of prolotherapy varies depending on the abnormality / disease and its severity. In general, prolotherapy can be done in about 5 to 6 sessions with an interval of 1-2 weeks between injection sessions. In one session, doctors usually perform several injections at different points around the target joint area. The number of these points depends on how large the area of the affected / abnormal joint.

Side Effects of Prolotherapy

The solution injected is dextrose, so the side effects are minimal as it rarely interacts with other drugs that the patient may be taking. Even if the odds are low, here are some possible side effects:⁴

• Infection at the injection site
• Swelling / pain / redness in the injection site immediately after the procedure
• Fever (if infection occurs)

It is possible for temporary side effects (e.g. swelling/pain) to occur immediately following the procedure, so the affected joint may feel worse before beginning to feel better.⁴

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References

1. Rabago D, Patterson JJ, Mundt M, Kijowski R, Grettie J, Segal NA, et al. Dextrose Prolotherapy for Knee Osteoarthritis: A Randomized Controlled Trial. Ann Fam Med [Internet]. 2013 May 1;11(3):229 LP – 237. Available from: http://www.annfammed.org/content/11/3/229.abstract
2. Distel LM, Best TM. Prolotherapy: A Clinical Review of Its Role in Treating Chronic Musculoskeletal Pain. PM&R [Internet]. 2011 Jun 1;3(6S):S78–81. Available from: https://doi.org/10.1016/j.pmrj.2011.04.003
3. Reeves KD, Sit RWS, Rabago DP. Dextrose Prolotherapy: A Narrative Review of Basic Science, Clinical Research, and Best Treatment Recommendations. Phys Med Rehabil Clin N Am. 2016 Nov;27(4):783–823.
4. Fletcher J. What is prolotherapy and what is it used to treat? Medical News Today. 2017 Dec 17;

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HIFEM is a painless, non-invasive therapy that uses electromagnetic fields to stimulate the pelvic floor muscles in both women and men. HIFEM therapy aims to increase the strength of the pelvic floor muscles so that it can improve medical conditions related to the pelvic floor muscles, such as urinary incontinence to erectile dysfunction.

Medical Conditions HIFEM Can Treat

• Urinary incontinence
  HIFEM can increase pelvic floor muscle strength to treat urinary incontinence

• Post prostatectomy
  After prostatectomy surgery in patients with prostate cancer, urinary incontinence is common. HIFEM therapy can be used to help with this.

• Erectile Dysfunction
  Erectile dysfunction, ejaculation, and orgasm are closely related to pelvic floor dysfunction. HIFEM can increase pelvic floor muscle activity to improve pelvic floor muscle contraction non-invasively.

How HIFEM Works

HIFEM therapy uses a special device that emits an electromagnetic field specifically targeted to the pelvic floor muscles while the patient is sitting, thereby stimulating thousands of pelvic floor muscle contractions during a single therapy session. This can strengthen pelvic floor muscle contractions more effectively and efficiently, compared to conventional pelvic muscle strengthening exercises, such as Kegel exercises alone.

Can I Get HIFEM Therapy?

 HIFEM is a safe and effective therapy for both men and women in increasing pelvic floor muscle strength. However, to determine whether HIFEM therapy is the right choice for your current medical condition, you need to consult a doctor, especially a urologist, first. Your doctor will evaluate your condition to assess whether this therapy is the right way to treat your medical condition.

HIFEM Therapy Procedure

HIFEM therapy at Abdi Waluyo Hospital is done by sitting on a special HIFEM chair. While sitting, the electromagnetic waves from the chair will stimulate your pelvic floor muscles so you can feel the pelvic floor muscles contract during the procedure. This procedure is non-invasive and painless. After therapy, you can immediately carry out your normal activities as usual.

HIFEM Therapy Duration

One HIFEM therapy session lasts about 28 minutes. Most people need about 6 sessions, on a doctor’s schedule.

How Long Does It Take To See Results?

 Although this effect varies from person to person, generally the effects of HIFEM therapy can generally be felt after the first session. This impact is increasingly felt in the following weeks after the therapy session continues.

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Resources

1. Sydney Pelvic Clinic. Emsella is the easy way to strengthen your pelvic floor. [Internet] Cited on 20 Jan 2022. Available from: https://www.sydneypelvicclinic.com.au/physio/emsella-chair/
2. Samuels JB, Pezzella A, Berenholz J, Alinsod R. Safety and Efficacy of a Non-Invasive High-Intensity Focused Electromagnetic Field (HIFEM) Device for Treatment of Urinary Incontinence and Enhancement of Quality of Life. Lasers Surg Med. 2019;51(9):760-766.

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OMICRON VARIANT

The Omicron variant is one of the types of COVID-19 virus designated by WHO as a variant of concern (VoC) which spreads very quickly throughout the world. The variant with code B.1.1.529 was first reported to WHO from South Africa on 24 November 2021.

OMICRON CASES IN JAKARTA

It is still too early to understand the real impact of omicron because there is no comprehensive data yet. However, on January 4, 2022, Deputy Governor of DKI Jakarta, Ahmad Riza Patria, announced that Omicron cases in Jakarta reached 252 cases.¹ To detect this new variant, the Ministry of Health also plans to bring in 15 genome sequencing machines which will be distributed to various regions in Indonesia.²

WHAT DO WE KNOW ABOUT OMICRON?

Spread of the Omicron COVID-19 Virus

The Omicron variant of the COVID-19 virus is likely to spread faster than the other previous COVID-19 variants. According to the CDC, anyone infected with the Omicron variant can transmit the Omicron variant virus to others, even if they are asymptomatic or have been vaccinated.³

The spread of the Omicron Virus in South Africa is much faster than other variants of the COVID-19 Virus. Resource: HE, Xuemei, et al. SARS‐CoV‐2 Omicron variant: characteristics and prevention. MedComm. 2021; 2: 838-845.⁴

Severity of the Omicron COVID-19 Virus

• Based on a study in South Africa, the risk of hospitalization for those infected with omicron variant is lower than that for the previous variants. Also, in hospitalized cases, the risk of developing serious illness is lower than the Delta variant – this may also be due to the high immunity after vaccination.⁵
• A UK study found that the rate of hospitalization for Omicron cases were 2/3 times lower than that for Delta, and 3^rd dose (booster) vaccine may reduce the risk of symptomatic Omicron infection by up to 57% compared to those who did not receive a booster.⁶
• In general, researchers in various parts of the world agree that although typical Omicron cases are generally not as severe as Delta (as seen from fewer hospitalizations compared to the previous Delta wave), the absolute risk of each patient varies depending on several factors, including vaccination status, age, and comorbidities. Thus, it should not be taken lightly since the Omicron variant can also cause death.

Symptoms of Omicron COVID-19

The symptoms of this Omicron variant are similar to those of other COVID-19 variants, although most people can be asymptomatic or experience some mild symptoms that can resolve without hospitalization. Everyone can experience different symptoms from mild to severe, including:^3,7,8

• Most common: sore throat / itching, flu, mild cough
• Fever / chills / chills
• Crowded
• Weak
• Fever / chills / chills
• Flu, colds
• Digestive symptoms: nausea, vomiting, diarrhea
• Aches / pains in various parts of the body
• Loss of the ability to taste and smell

WHAT CAN WE DO?

• Always stick to the health protocols
• Receive complete 2 doses of COVID-19 vaccine + booster (3^rd dose)
• Should you experience any of the above symptoms, immediately consult a doctor and undergo a PCR examination
• Do self-isolation or get treatment according to doctor’s instructions

RESOURCES

1. Singgih Wiryono. Situasi memburuk di Jakarta: Pasien Omicron kini capai 252, kasus aktif COVID-19 meningkat dengan cepat. Kompas: Megapolitan; 05 Jan 2022. Available from: https://megapolitan.kompas.com/read/2022/01/05/08512611/situasi-memburuk-di-jakarta-pasien-omicron-kini-capai-252-kasus-aktif?page=all
2. Update COVID-19: Cegah Omicron, Pemerintah Perketat Karantina. Kemkes: Sehat Negeriku Sehatlah Bangsaku. 27 Des 2021. Available from: https://sehatnegeriku.kemkes.go.id/baca/rilis-media/20211227/0939055/update-covid-19-cegah-omicron-pemerintah-perketat-karantina/
3. Centers for Disease Control and Prevention. Omicron variant: what you need to know. 20 Dec 2021. Available from: https://www.cdc.gov/coronavirus/2019-ncov/variants/omicron-variant.html
4. HE, Xuemei, et al. SARS‐CoV‐2 Omicron variant: characteristics and prevention. MedComm, 2021.
5. Wolter N, Jassat W, Walaza S, Welch R, Moultrie H, Groome M, et al. Early assessment of the clinical severity of the SARS-CoV-2 Omicron variant in South Africa. medRxiv [Internet]. 2021 Jan 1;2021.12.21.21268116. Available from: http://medrxiv.org/content/early/2021/12/21/2021.12.21.21268116.abstract
6. Sheikh A, Kerr S, Woolhouse M, McMenamin J, Robertson C. Severity of Omicron variant of concern and vaccine effectiveness against symptomatic disease: national cohort with nested test negative design study in Scotland. 2021 Dec 22. Available form: https://www.research.ed.ac.uk/en/publications/severity-of-omicron-variant-of-concern-and-vaccine-effectiveness-
7. Doucleff M. What we know about the symptoms – and the severity – of the omicron variant. 2022 Jan 06. Available from: https://www.npr.org/sections/health-shots/2022/01/06/1070622880/what-we-know-about-the-symptoms-and-the-severity-of-the-omicron-variant

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1. Deep Learning Algorithm (FDA-approved), which allows faster multidimensional scan with improved spatial resolution
2. 60% faster scanning time compared to common MRI
3. 70 cm tunnel diameter, further improving patient comfort and experience
4. High resolution, meaning sharper images of all organs for physicians to diagnose with clinical confidence
5. Advanced technology, allowing for up to 8x faster scan time without the necessity for patient repositioning
6. A flexible, light, and comfortable AIR coil (like a blanket), that fit all kinds of body shape
7. Reduced acoustic noise for improved patient comfort.

In accordance with the installation of the new 3T MRI Signa Premier AIR, any imaging services involving 3T MRI machine will not be available from September 26^th until November 20^th 2021. Meanwhile, 1.5T MRI will still operate for 24 hours. For further information and MRI scheduling, please contact 021-3146621 or 0813 8488 8158.

Thank you for your continuous support. We will always be committed to deliver the best quality of care for you.

Sincerely,
Director of Abdi Waluyo Hospital

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Authorization for Moderna Vaccine

Moderna Vaccine is available under Emergency Use Authorization (EUA) by the US Food and Drug Administration (FDA) to prevent COVID-19 on people aged 18 years and above.³

In Indonesia, Moderna vaccine is approved by Badan Pengawas Obat dan Makanan Republik Indonesia (BPOM RI) or Indonesian FDA for emergency use.⁴

Moderna Vaccine Receiver

 Moderna vaccine can be given to people aged 18 years and above.  This vaccine is safe for both pregnant and lactating women. If you have one of the health conditions below, please ask for your doctor’s advice on when to get vaccinated:^1,2

• History of cardiac inflammation (myocarditis, pericarditis, endocarditis) in the past 6 months
• Acute rheumatic fever or rheumatic heart disease
• Dilated cardiomyopathy for people under 30 years old
• Congenital heart disease
• Severe heart failure
• Heart transplant receiver
• History of syncope at previous vaccinations

Administration of Moderna Vaccine

Moderna vaccine is injected into the upper arm for 2 doses. The second dose is administered in 4-6 weeks (around 1 month) after the first dose.^1,2

Contraindication of Moderna Vaccine

 The followings are the contraindications of Moderna vaccine:^1,2

• Anaphylactic (severe allergic reaction) to other mRNA COVID-19 vaccine (e.g. Pfizer, Moderna)
• Anaphylactic to vaccine components including polyethylene glycol / PEG
• History of myocarditis and/or pericarditis after receiving mRNA COVID-19 vaccine (e.g. Pfizer, Moderna)

Benefits of Moderna Vaccine

Several benefits of Moderna vaccine include:^1,2

• Those who received vaccine completely (2 doses) are 94% less likely to get symptomatic COVID-19 compared to those who are not vaccinated
• This vaccine is found effective in elderly aged >65 years old (86%)
• Protection develops around 2 weeks after dose 1 is given although it may not last long. Hence, second dose is necessary for optimal protection although it is not known how long this protection will last.

Side Effects of Moderna Vaccine

Please see your doctor if you have the symptoms* or go to the emergency room immediately if you experience severe allergic reaction** after you leave the vaccination area.

Important Points After Getting Vaccinated with Moderna

After receiving Moderna injection, please note several points below:^1,2

• There is no vaccine which is 100% effective. Thus, we may still get infected with COVID-19 after vaccination.
• It is not known yet how long the protection from Moderna vaccine will last
• It is important to note that COVID-19, although mild or even asymptomatic, can still infect others. Thus, we should continue other preventive measures like physical distancing, hand washing, wearing a face mask, COVID-19 testing and isolation according to government’s regulation.

References

1. Australian Government. COVID-19 Vaccination: Information on Sppikevax (Moderna) COVID-19 Vaccine. Latest update: 7 Sept 2021. Available from: https://www.health.gov.au/sites/default/files/documents/2021/09/covid-19-vaccination-information-on-spikevax-moderna-covid-19-vaccine.pdf.
2. US Food and Drug Administration. Fact Sheet for Receipients and Caregivers Emergency Use Authorization (EUA) of the Moderna COVID-19 Vaccine to Prevent Coronavirus Disease 2019 (COVID-19) in Indiviudals 18 Years of Age and Older. Latest update: 27 Aug 2021. Available from: https://www.fda.gov/media/144638/download.
3. US Food and Drug Administration. Moderna COVID-19 Vaccine. Latest update: 31 Aug 2021. Available from: https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/moderna-covid-19-vaccine.
4. Badan POM. Siaran Pers Tambah Pilihan Jenis Vaksin COVID-19 di Indonesia. Latest update: 7 September 2021. Available from: https://www.pom.go.id/new/view/more/pers/615/Badan-POM-Terbitkan-EUA-Moderna-COVID-19-Vaccine-Sebagai-Vaksin-Pertama-dari-Platform-mRNA.html.
5. Centers for Disease Control and Prevention. Moderna. Latest update: 19 Aug 2021. Available from: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/Moderna.html.

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Facts

80% of cases are usually mild-moderate
15% of cases are severe
5% of cases are critical (must be treated in the ICU)

Increased number of severe cases and death are observed in people with the following comorbidities:

• Heart disease
• Diabetes mellitus
• Chronic pulmonary disease
• Hypertension
• Cancer
• Age >60 years old

Elderly and immunocompromised people are more prone to COVID-19.

Symptoms

Symptoms vary from mild to severe airway infection, such as:

• Fever
• Breathing difficulties
• Coughing
• Sore throat

Mode of Transmission

• This disease can be transmitted between humans
• It is transmitted through droplet when coughing/sneezing
• Air transmission is possible in certain conditions/activities that produce aerosol

Incubation Period

The incubation period ranges from 1 to 14 days, with an average of 5-6 days.

How to Prevent it?

• Always wear a medical mask every time you go out of your house
• Routinely wash your hands with soap and water
• Always maintain a 2-meter physical distance with others
• Do not go out if not necessary
• Avoid crowds
• Healthy lifestyle, get enough rest, balanced diet, mild physical activity, and bask in the sun

References:

1. Pedoman Pencegahan dan Pengendalian Coronavirus Disease (COVID-19) Revisi ke-5. http://covid19.go.id/p/protokol/pedoman-pencegahan-dan-pengendalian-coronavirus-disease-covid-19-revisi-ke-5
2. Protokol Tatalaksana COVID-19. Kementerian Kesehatan. Agustus 2020.

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Narrowing of the spinal canal usually occurs slowly, over many years or decades. The disks become less spongy with aging, resulting in loss of disk height, and may cause bulging of the hardened disk into the spinal canal. Bone spurs may also occur and ligaments may thicken. All of these can contribute to narrowing of the central canal and may or may not produce symptoms.

CAUSES

Spinal stenosis occurs when bulging discs, arthritic spurs, and thickened tissues combine to “compress” the nerves traveling through the spinal canal.

SYMPTOMS 

• Numbness or tingling in a foot or leg.
• Weakness in a foot or leg.
• Pain or cramping in one or both legs when you stand for long periods of time or when you walk, which usually eases when you bend forward or sit.
• Back pain.

DIAGNOSIS

Diagnosis is made by a neurosurgeon based on history, symptoms, physical examination and test results. Imaging studies used may include the following:

• X-ray
• CT scan
• MRI

TREATMENT OPTIONS

Conservative treatments
A combination of time, medications, posture management, stretching and exercise can be helpful to many patients for pain flare-ups. Weight management, nicotine cessation and bone-strengthening endeavors may also be indicated.
Minimally invasive lumbar decompression (MILD) It uses a special tool that glides through a very small portal between the bones. Guided by an X-ray and contrast that is injected during the procedure, the surgeon scrapes out the ligament and widens the spinal canal to reduce nerve roots compression.

Open spine surgery
The goal of spinal stenosis surgery is to permanently decompress the spinal canal.
It works to relieve pressure on spinal nerves, but surgery and anaesthesia may carry increased risk in older patients. The most common procedure is called Decompressive Laminectomy, where the laminae (roof) of the vertebrae is removed to create more space for the nerves.

What are the risks of surgery for spinal stenosis?
Risks of spinal stenosis surgery include nerve injury, infection, bleeding, and stiffness.

What happens after spinal surgery?
Pain may persist for a few days after surgery, requiring the use of pain medications and NSAIDs to reduce swelling. However, your doctor will likely recommend a light form of exercise right after spinal surgery to insure that the back does not stiffen and to reduce swelling.

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This video will show you attitude to minimize risk of Covid 19.

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Please keep safe and be informed about COVID-19 from RS Abdi Waluyo Infectious Disease specialist, Dr.dr. Erni Juwita Nelwan, Sp.PD, KPTI.

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Be smoke-free
Being smoke free is one of the best things you can do to protect your heart. Read more about smoking

Manage your blood cholesterol
Cholesterol is a fatty substance carried in your blood. Your body needs cholesterol to be healthy, but an imbalance of cholesterol in your blood can lead to a heart attack or stroke. Find out more about blood cholesterol and how to manage it

Manage your blood pressure
Blood pressure isn’t usually something you can feel. If it’s too high, it needs to be treated. Read about blood pressure and what you can do to control high blood pressure

Manage diabetes
I’ts important to manage your diabetes to help prevent a heart attack or stroke. For information on managing diabetes, visit the Diabetes Australia website.

Be physically active
Regular, moderate physical activity is great for your heart health. It’s never too late to start and get the benefits. It’s also important to sit less during your day and break up your sitting time. Find out what you can do about getting active and sitting less

Achieve and maintain a healthy weight
Maintaining a healthy weight can reduce the risk of heart disease and other health problems. It can help to know your body mass index and waist measurements and what these mean. Find out how

Enjoy a variety of nutritious foods
Eating a varied diet of healthy foods can help with your weight, blood pressure and cholesterol. Find out more about healthy eating

There are also specific changes you can make to your diet to help prevent heart disease:

• Eat less salt: Reducing your salt intake is good for your blood pressure. Read about salt in your diet and ways to reduce it
• Replace unhealthy fats with healthy fats: Replacing saturated and trans fats with unsaturated fats can reduce your risk of heart disease. Easy ideas for making the switch
• Limit alcohol: Read about alcohol recommendations and tips for cutting down on our drinks page.

Look after your mental health
We know that there can be a greater risk of heart disease for people who have depression, are socially isolated or do not have good social support. Having a good social life with family and friends can help.

Depression is more than feeling sad or low. If you feel depressed for more than two weeks, talk to your doctor, a family member or someone you know well.

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Healthy living involves more than physical health, it also includes mental and emotional health.
Healthy living involves more than physical health, it also includes mental and emotional health.
This article is designed to give tips to readers about how they can improve or augment actions in their life to have a healthy lifestyle; it is not meant to be all inclusive but will include major components that are considered to be parts of a lifestyle that lead to good health. In addition to the tips about what people should do for healthy living, the article will mention some of the tips about avoiding actions (the don’ts) that lead to unhealthy living.

“Healthy living” to most people means both physical and mental health are in balance or functioning well together in a person. In many instances, physical and mental health are closely linked, so that a change (good or bad) in one directly affects the other. Consequently, some of the tips will include suggestions for emotional and mental “healthy living.”

Healthy eating (diet and nutrition)

All humans have to eat food for growth and maintenance of a healthy body, but we humans have different nutrition requirements as infants, children (kids), teenagers, young adults, adults, and seniors. For example, infants may require feeding every 4 hours until they gradually age and begin to take in more solid foods. Eventually they develop into the more normal pattern of eating three times per day as young kids. However, as most parents know, kids, teenagers, and young adults often snack between meals. Snacking is often not limited to these age groups because adults and seniors often do the same.

Tips:

• Eat three healthy meals a day (breakfast, lunch, and dinner); it is important to remember that dinner does not have to be the largest meal.
• The bulk of food consumption should consist of healthy foods, such as fruits, vegetables, whole grains, and fat-free or low-fat milk products.
• Incorporate lean meats, poultry, fish, beans, eggs, and nuts (with emphasis on beans and nuts) into a healthy diet.
• Choose foods that are low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars; look at the labels because the first listed items on the labels comprise the highest concentrations of ingredients.
• Control portion sizes; eat the smallest portion that can satisfy hunger and then stop eating.
• Healthy snacks are OK in moderation and should consist of items like fruit, whole grains, or nuts to satisfy hunger and not cause excessive weight gain.
• Avoid sodas and sugar-enhanced drinks because of the excessive calories in the sodas and sugar drinks; diet drinks may not be a good choice as they make some people hungrier and increase food consumption.
• Avoid eating a large meal before sleeping to decrease gastroesophageal reflux and weight gain.
• If a person is angry or depressed, eating will not solve these situations and may make the underlying problems worse.
• Avoid rewarding children with sugary snacks; such a pattern may become a lifelong habit for people.
• Avoid heavy meals in the summer months, especially during hot days.
• A vegetarian lifestyle has been promoted for a healthy lifestyle and weight loss; vegetarians should check with their physicians to be sure they are getting enough vitamins, minerals, and iron in their diet.
• Cooking foods (above 165 F) destroys most harmful bacteria and other pathogens; if you choose to eat uncooked foods like fruits or vegetables, they should be thoroughly washed with running treated (safe to drink) tap water right before eating.
• Avoid eating raw or undercooked meats of any type.

Tips for special situations:

• People with diabetes should use the above tips and monitor their glucose levels as directed; try to keep the daily blood glucose levels as close to normal as possible.
• People with unusual work schedules (night shifts, college students, military) should try to adhere to a breakfast, lunch, and dinner routine with minimal snacking.
• People who prepare food should avoid using grease or frying foods in grease.
• People trying to lose weight (body fat) should avoid all fatty and sugary foods and eat mainly vegetables, fruits, and nuts and markedly reduce his/her intake of meat and dairy products.
• Seek medical advice early if you cannot control your weight, food intake, or if you have diabetes and cannot control your blood glucose levels.

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