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Background: Pneumonia is an infectious disease with high mortality rates despite early diagnosis and adequate treatment. Therefore, the use of biological infection parameters is expected to improve patients' clinical outcome prognostic accuracy. In this study, we proposed a combination of decreased procalcitonin (PCT) and C-reactive protein (CRP) to predict the clinical outcome of severe pneumonia. Methods: This was a prospective cohort study of severe pneumonia patients treated in the single-center Intensive Care Unit (ICU) of Dr. Soetomo General Hospital from December 2023 to February 2024. Subjects who met the inclusion and exclusion criteria were examined for PCT and CRP within the first 24 hours of admission and repeated 96 hours later (day five). Clinical outcomes, including acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), septic shock, and 30-day mortality, were observed. Results: Thirty-five patients were enrolled for this study. Five subjects did not survive until the fifth day, and 30 subjects were eligible for analysis. A decrease of PCT >50% within five days was associated with a reduction of 30-day mortality (p=0.013) and septic shock incidence (p=0.005), whereas the decrease in CRP alone did not show any significant relationship towards any clinical outcome. The combination of a decreased PCT >50% and decreased CRP within five days could increase the prognostic specificity up to 88.9% in predicting 30-day mortality. Conclusion: Decreased PCT by more than 50% within 96 hours may predict the 30-day mortality rate and septic shock incidence in patients with severe pneumonia, while combining it with a decreased CRP expression would elevate prognostic specificity for severe pneumonia. [ABSTRACT FROM AUTHOR]

The natural disaster in pandemic covid-19 will still ongoing in East Java, Indonesia. Apart from the virus pandemic, there are still several potential disasters in that sub-district, namely floods and landslides. Many disasters have occurred resulting in the need for people living in the area to anticipate, especially if the three disasters occur simultaneously. In Malang, this case of sub-district apparatus and the BPBD Malang City has not been able to optimally help restore the condition of the community due to the complexity of conditions that occur in the field. Therefore, the community needs to know their capacity to be able to anticipate if it is two or three will happen. Capacity is a combination of all the forces that exist in a community, social or organizational group that can reduce the impact of disaster risk or impact (UN-ISDR, 2004). The capacity assessment in this study identifies the capitals owned by the community. These capitals include natural, human, physical, financial, and social capital. The five capitals will later be described in the pentagon assets so that it will be known which capacities in the capital are the strengths and weaknesses of the people of Dinoyo and Sukun sub-district

Over 80% of surgical patients experience postoperative pain, which, if inadequately managed, can lead to complications, prolonged rehabilitation, chronic pain, and decreased quality of life. Epidural block and quadratus lumborum block are techniques commonly used for postoperative pain management. This comparative analytic study aimed to analyze the differences in the analgesic effects of quadratus lumborum block and epidural block in uterine surgery at Dr. Soetomo General Hospital. The outcomes assessed were the numerical rating score (NRS) as a pain score and the administration of opioids as an adjuvant analgesic. Statistical analysis employed the Mann-Whitney test and Chi-square test. The study included 32 patients who underwent uterine surgery at Dr. Soetomo General Hospital and met the inclusion and exclusion criteria. Among the patients, 90.6% experienced mild pain, and 9.4% experienced moderate pain. Epidural blocks were performed in 50% of the patients, while quadratus lumborum blocks were performed in the other 50%. Additionally, 9.4% of the patients received opioids as adjuvant analgesics. The Mann-Whitney test revealed no significant difference in NRS between the epidural block and quadratus lumborum block groups (p-value>0.05). However, the Chi-square test indicated a significant difference in NRS between patients who received additional opioids as adjuvant analgesics and those who did not (p-value<0.00). There was no signifi- cant difference in NRS between patients who underwent epidural block and quadratus lumborum block as analgesic techniques. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to compare the efficacy and safety of serratus anterior plane block (SAPB) and thoracic epidural analgesia (TEA) in thoracic region surgery. Materials and Methods: We implemented a systematic search of PubMed, ScienceDirect, SCOPUS, and Web of Science and through gray literature for all randomized controlled trials that compared SAPB, a novel thoracic wall nerve block, and TEA in surgery. The evaluated outcomes included the Visual Analog Scale (VAS), hypotension, and postoperative nausea and vomiting (PONV). Review Manager, version 5.4.1, was implemented for the analysis of statistics. Results: The pooled analysis included six trials that fulfilled the inclusion criteria. In total 384, surgery had received regional blocks (162 – SAPB and 163 – TEA). VAS did not differ significantly between SAPB and TEA, with a mean difference of 0.71, P = 0.08. PONV incidence did not differ significantly between SAPB and TEA (odds ratio = 0.25, P = 0.07). Hypotension incidence was lower in SAPB compared to TEA (odds ratio = 0.10, P = 0.0001). Conclusion: SAPB yielded comparable VAS with TEA in pain management of thoracic region surgery. The incidence of hypotension was lower in SAPB than in TEA. No difference in PONV incidence was observed. SAPB can be a viable alternative to TEA in thoracic region surgery. [ABSTRACT FROM AUTHOR]

Introduction: Evaluating the success rate of regional anesthesia is performed with pinprick test, Bromage score and pain scales, where they act as indicators of success or otherwise of motor, sensory and nociceptive blockade. The sympathetic system is also affected by the regional anesthesia blockade. The present study evaluated the relationship of peripheral venous dilatation and the skin temperature of the block area, to be used as an additional tool. Methodology: An analytic, observational study was conducted in Dr. Soetomo Surabaya Hospital. 18 patients received peripheral nerve block (PNB) and 16 patients received subarachnoid block (SAB). Informed consent was obtained from all the participants. The peripheral venous circumference was measured by using linear probe of Sonosite® M-Turbo ultrasound, before the blocks and then one hour after PNB and SAB to assess the venous dilatation. The peripheral skin temperature was measured with a thermometer (Microlife NC-150 Bluetooth®) infrared thermometer before the blocks, and within the range of 5 min from the zero min after the block until the 30th min. The success rate of the blocks was performed with pain scale (VAS) and absence of motor, sensory and nociceptive response Results: No relationship was found of sex, age, weight and type of block with increased peripheral venous circumference and peripheral skin temperature (p > 0.05). The block's success was associated with the increased peripheral venous circumference and peripheral skin temperature (p ≤ 0.001) in both PNB and SAB blocks. The average PNB block succeeded in 20 min while SAB took only 5 min (p < 0.05) to affect both of the parameters. The delta value of the increased temperature's successful block was 0.7°C in the PNB, and 0.275°C in the SAB group. Conclusions: The success of the peripheral nerve block and the subarachnoid block is associated with an increase in the peripheral venous circumference and in the peripheral skin temperature in the block area. [ABSTRACT FROM AUTHOR]

To evaluate post-caesarean section wound healing on patient given standard analgesia compared with Tranversus Abdominis plane Block (TAP Block) and wound site infiltration based on REEDA scale and platelet Lymphocyte Ratio 72 hours post-caesarean section. A randomized clinical controlled trial study was conducted on 30 post-caesarean section women under spinal anesthesia. Participants were randomly divided into the groups: Standard Analgesia groups (SA), TAP Block groups (TAP), and Wound Site Infiltration groups (Infiltration). Each group received standard analgesia (ketorolac and tramadol) and adjuvant analgesia Ropivacain 0.2% on transversus abdominis space (TAP block group) and wound site infiltration in infiltration group. Wound healing was evaluated based on REEDA Scale and Platelet Lymphocite Ratio (PLR) 72 hours postoperation. There were significant differences on REEDA scale and PLR value between the three groups 72 hours post-caesarean section (P < 0.001). TAP groups had the lowest REEDA Scale (0,2 ±0.422) and PLR value (134.2±18.57) Tranversus abdominis plane block showed the best healing process compared to standard analgesia only and wound site infiltration. [ABSTRACT FROM AUTHOR]