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Background & Objective: The use of Personal Protective Equipment (PPE) is highly recommended during chest compression in COVID-19 patients, as it can generate aerosols. It was thought that quality of chest compression might be affected by the use of PPE. We compared the quality of chest compression with or without PPE using a mannequin to formulate practical recommendations. Methodology: This observational analytical study used randomised crossover design, and was carried out in Cipto Mangunkusumo National General Hospital from December 2020 to July 2021. After a thorough assessment, a total of 92 samples fulfilled the inclusion and exclusion criteria. The chosen participants were postgraduate residents, and they were asked to do chest compression on a mannequin with (Group-I) and without PPE (Group-II) and with breaks in between. The quality of CPR was measured using feedback tool CPR R Series® Monitor (Zoll Inc., USA). After a break the groups were crossed over and re-evaluated. Results: Sixty-five (35.3%) non-PPE participants did quality compression, but only 16 (8.7%) did quality compression when using PPE (P < 0.001). Effective compression was done by 80 (43.5%) of the non-PPE participants, compared to 61 (33.2%) participants doing the compression effectively when using PPE (P = 0.002). Eighty-two (44.6%) non- PPE participants did adequate compressions compared to 61 (33.2%) participants when using PPE (P < 0.001). Meanwhile, the post-compression fatigue level was 7 (6.00-9.00) when using PPE compared to 5 (3.00-7.00) when not using PPE (P < 0.001). Conclusion: The use of PPE during chest compressions can reduce the quality of compression and increase the level of post-compression fatigue compared to performing chest compressions without PPE. PPE use was also associated with low levels of effectiveness, and adequacy of the chest compression. Abbreviations: PPE - Personal Protective Equipment; CPR – Cardiopulmonary resuscitation; AHA - American Heart Association; ERC - European Resuscitation Council [ABSTRACT FROM AUTHOR]

Background: Mortality predictors are often used for analyzing disease progression as a guide for disease management strategy. The sequential organ failure assessment (SOFA) score is a predictor tool used to analyze organ dysfunction in critically ill patients. This study aimed to validate the SOFA score in predicting 28-day mortality in critically ill Coronavirus disease 2019 (COVID-19) patients. Methods: Subjects included in this study were critically ill, confirmed COVID-19 cases admitted to the intensive care unit (ICU) between March and August 2020. Demographic data, clinical characteristics, and laboratory findings within the first 24 hours of ICU admission were obtained from medical records to compute the SOFA score. The 28-day outcome was recorded as alive or deceased. Validity was analyzed using the area under the curve (AUC), Hosmer-Lemeshow goodness of fit, and bivariate logistic regression. The optimal cut-off point was determined statistically. Result: From the total of 88 subjects in this study, the mortality rate was 39.8%. AUC was 0.971 (confidence interval [CI] 95% 0.943-0.999), and the goodness of fit test by using Hosmer-Lemeshow showed p=0.782. An optimal cut-off point of SOFA score was 6, with a sensitivity of 87% and specificity of 90%. Discussion: SOFA score demonstrated very strong discrimination and good calibration in predicting 28-day mortality on the critical case of COVID-19. Conclusion: The SOFA score is valid for predicting 28-day mortality in the critical case of COVID-19. [ABSTRACT FROM AUTHOR]

Background. Intravitreal silicon oil removal surgery can cause mild-to-moderate postoperative pain and discomfort in most patients. Postoperative pain can be managed by using many methods, including a local anesthetic drug. One of the common local anesthetic drugs is 0.5% bupivacaine. The application techniques also vary, such as subconjunctival application. It was a good alternative for postoperative analgesia in the ophthalmic surgery because of its minimal risks and complications. The purpose of this research was to measure the effectiveness of subconjunctival 0.5% bupivacaine for postoperative analgesia in silicon oil removal surgery. Method. This was a double-blind randomized clinical study in patients undergoing elective intravitreal silicon oil removal surgery at Cipto Mangunkusumo Hospital. Thirty consecutive patients, enrolled from October 2016 to February 2017, were randomized to receive subconjunctival 0.5% bupivacaine or subconjunctival placebo (0.9% NaCl) at the end of the surgery. The primary outcome was the pain score 24 hours after surgery, using a 100 mm Visual Analogue Scale (VAS). Intravenous injection of tramadol 50 mg was given if the VAS >4. Secondary outcomes were the time to first analgesic requirement and the incidence of nausea/vomiting. Statistical analysis was conducted to measure the difference between 24 h pain score in the bupivacaine group (B) and that in the placebo group (NS). Result. The overall 24 hours' postoperative pain score was significantly different between the bupivacaine group and the placebo group (p=0.001). In the 24 hours after surgery, there were only five patients needing additional analgesia in the placebo group. The time to first analgesic requirement was significantly different between the two groups (p=0.042). Nausea/vomiting only happened in the placebo group with proportions 6% and 3%, respectively. Conclusion. Subconjunctival 0.5% bupivacaine was effective for postoperative analgesia in intravitreal silicon oil removal surgery. [ABSTRACT FROM AUTHOR]

Background. Traumatic spinal cord injury is a medical condition which often results in disability and mortality. The most common lesion was cervical level, which is around 60-75% of all cases, where at this level there is a risk of respiratory problems which often require mechanical ventilation. Case report. In the case discussed, a 28-years-old male was referred from other hospital with traumatic cervical spinal cord injury (C5-C6) ASIA score A with a history of falling from a height of 3 meters. The patient underwent decompressive laminectomy on the tenth day of onset, followed by mechanical ventilation. During treatment, the patient received pharmacological therapy, tracheostomy, acupuncture, physiotherapy, and neuromuscular electrical stimulation for ventilator weaning. The patient was hospitalized for 66 days, with mechanical ventilation duration for 32 days. Conclusions. Factors that can influence the duration of ventilation weaning are the level and severity of spinal cord injury, time of transfer to a health facility, and complications related to ventilator installation. Multidisciplinary management, including pharmacological, physiotherapy, acupuncture, surgical, neuromuscular electrical stimulation, can increase the chances and decreasing the duration of mechanical ventilation, and reducing complications related to spinal cord injury and prolonged ventilation. [ABSTRACT FROM AUTHOR]

Objective: Emergence delirium (ED) is a condition that can occur when a child recovers from anaesthesia uncomfortably. ED can potentially injure children and indirectly discomforts parents. Various interventions were carried out to reduce ED, but there is no specific standard that has been established to prevent ED. Dexmedetomidine and midazolam are said to be effective in reducing ED. This study aims to determine the effectiveness of intranasal dexmedetomidine premedication compared to intranasal midazolam to prevent ED in children undergoing eye surgery., Methods: This study was a double-blinded randomised clinical trial. Paediatric patients aged 1-12 years with physical status ASA 1 and 2 who underwent eye surgery under general anaesthesia using sevoflurane inhalation were included in the study. There were 64 children obtained by consecutive sampling who underwent eye surgery in our institution between February and May 2019. The subjects were then randomised into the dexmedetomidine group and the midazolam group. Effectiveness was assessed from ED events, recovery time and post-premedication desaturation events. Data analysis was performed using Chi-square test and Mann-Whitney test., Results: ED incidence in the dexmedetomidine group was 11.18% compared to 28.12% in the midazolam group (P ¼ .109). The recovery time was found to be at a median of 6 minutes for both groups, and no desaturation was found in either group., Conclusion: There is statistically no significant difference between the effectiveness of intranasal dexmedetomidine and midazolam premedication 30 minutes before induction to prevent ED occurrence in children undergoing eye surgery.