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Corticosteroid, an immunomodulator agent for treating hyperinflammation, is widely used in severe and critical COVID-19 patients. This study is a retrospective observational cohort clinical study comparing changes in NLR, CRP, and LCR values with and without corticosteroid therapy in critically ill COVID-19 patients. Those samples were chosen due to widespread access and economically sound to be examined repetitively. Samples were collected by total sampling of medical records of patients admitted to the COVID-19 intensive care unit at RSUD Dr Soetomo between March 2020 to July 2021. Inclusion criteria are complete medical records of patients > 18 years with a confirmed COVID-19 diagnosis with severe and/or acute symptoms according to the WHO criteria and receiving corticosteroids (dexamethasone 6 mg/24 h or equivalent dose) for a minimum of 3 days. Patients not receiving corticosteroid treatment were included in the control group. NLR, CRP, and LCR were evaluated on day-0, day-3, day-6, and day-10 after initiation of corticosteroid therapy; in the control group, their hospital admission was designated as day-0. Comorbidities, complications, and other therapies that may affect NLR, CRP, and LCR values are noted. A total of 460 patients were included in the inclusion criteria. The control group had no significant median NLR, CRP, and LCR changes during observation (p-value > 0.05). In the therapy group, there was a significant increase in NLR and LCR and a decrease in CRP (p-value < 0.0001). When compared between control and therapy groups, the median changes in NLR and CRP differed significantly (p-value < 0.05), while significant differences in LCR occurred on days 6 and 10. Corticosteroid increases NLR and LCR and decreases CRP with significant differences between groups. [ABSTRACT FROM AUTHOR]

Background & Objective: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis has always been associated with high morbidity and mortality. Consensus committees of international organizations have recommended packages to reduce the high mortality. We evaluated the 2016 Surviving Sepsis Campaign (SSC) package with 3 and 6-hour sepsis packages and the 2018 SSC with 1-hour sepsis package on the mortality of septic patients who came to a tertiary referral hospital. Methodology: We enrolled 164 retrospective cohort patients in the tertiary emergency referral general hospital resuscitation ward. The patients were followed up for 48 h of observation. Sepsis and septic shock criteria are based on the Third International Consensus Definition of Sepsis and Septic Shock (Sepsis-3) 2016. Patients were divided into 3 groups, based upon compliance with SSC 16 at 3 h, 6 h, and SSC 18 at 1 h, and the mortality was recorded before 48 h and after 48 h. Results: Compliance rates at 1 h (27.4%), 3 h (39.6%), and 6 h (43.3%) were significantly associated with patient mortality (P = 0.001). Population patients who met the criteria for SSC, 73.3% had been referred from peripheral hospitals. The mortality rate was 76 (46.34%) for < 48 h and 37 (22.56%) for more than 48 h. Conclusion: Compliance with sepsis management contributes to improved patient condition and a better prognosis when the Surviving Sepsis Campaign package is adequately implemented. [ABSTRACT FROM AUTHOR]

Background & Objective: COVID-19 took the world by storm, but it also allowed the healthcare professionals to conduct big studies regarding various molecular and biochemical changes produced by the disease. We analyzed the impact of hypoalbuminemia on the severity and 14-day mortality in COVID-19 patients. Methodology: It was an analytical observational, prospective cohort study design. Clinical and laboratory data collection was carried out in the COVID-19 isolation room of Dr. Soetomo Hospital, between July and October 2020. Serum albumin, D-dimer, and interleukin 6 (IL-6) levels were measured on the day of admission. Statistical analysis using Kolmogorov-Smirnov, Mann-Whitney test, regression test, ROC curve, and 14-day risk of mortality were tested using Univariate Cox Regression and Multivariate Cox Regression tests. The Kaplan Meier test was used to analyze life expectancy. Results: Of the 119 study subjects, 71 (59.7%) were categorized as severe, and 48 (40.3%) as not severe. Out of the total, 36 (30.25%) patients expired within 14 days of admission, and 83 (69.75%) survived. Regression analysis showed the effect of age on albumin (P < 0.001), albumin on D-dimer (P = 0.003), albumin on disease severity (P < 0.001), and albumin on 14-day mortality (P < 0.001). Albumin was not significantly associated with IL-6 (P = 0.126). The value of albumin as a predictor of severity was 3.28 g/dL, with a sensitivity of 74.6% and a specificity of 77.1%. Conclusion: The state of hypoalbuminemia affects the disease severity and mortality of COVID-19; albumin is significantly associated with D-dimer. Poor prognosis is expected if the albumin value < 3.28 in geriatric and obese patients with a high 14-days mortality. [ABSTRACT FROM AUTHOR]

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. The lack of up-to-date basic knowledge of pain management, especially among healthcare professionals in Primary Health Care Facilities in Surabaya, often leads to the perception that pain is trivial and consequently inadequately addressed. The objective of this social service activity in pain treatment and basic pain management training is to provide appropriate treatment for the community's pain scale and impart current knowledge on pain management that can be applied in daily practice by healthcare professionals and the general public in Surabaya. This initiative involves two methods: treating pain in non-medical community members and providing basic pain management training for healthcare professionals. Examination and anamnesis are conducted for each patient according to the examination questionnaire, which includes the Pain Questionnaire for Laypersons, the Physical Examination Form for Pain Management Social Service, and the Quality of Life Scoring. The initial examination and anamnesis results will determine whether the patient falls into the acute or chronic pain category, allowing for tailored interventions based on patient grouping. As for the basic pain management training, it is conducted by a pain management consultant, comprising the Socialization of the Pain Management Center, a General Lecture on the New Paradigm of Pain Management in the Community, and a Hands-On Pain Management Workshop for patients in pain. [ABSTRACT FROM AUTHOR]

Background: Response to resuscitative fluid administration is often difficult to assess clinically, especially in critically ill patients, and therefore it is necessary to use tools to evaluate the response. One of the modalities that can be used is ultrasonography to measure the internal jugular vein collapsibility index (IJVCI) during the respiration cycle. Aim: To evaluate the correlation between IJVCI and mean arterial pressure (MAP) in assessing response to resuscitative fluid administration in critically ill patients. Patients and methods: This is an experimental study with pre-post test groups, assessing the response to resuscitative fluid administration in critically ill patients. Results: A total of 28 subjects aged 18-65 years old were included in the inclusion criteria of this study. The average age of subjects was 50.18 years. Twenty-one subjects responded to the administration of 500 ml Ringer's lactate (RL) crystalloid fluid within 30 minutes based on the IJVCI. Subjects were observed in two periods, the pre-test and post-test periods. There was a significant difference in the IJVCI before and after 500 ml of RL between the two groups (p<0.05). As a predictor of IJVCI associated with increased MAP at the cut-off value of 44.40 with a sensitivity of 76.9% and a specificity of 80%. This study showed that IJVCI had a negative correlation with increased MAP (p<0.05). Conclusions: The measurement of the IJVCI can be used to assess the response to resuscitative fluid administration in critically ill patients. [ABSTRACT FROM AUTHOR]

Aim To compare the outcome of sole dexmedetomidine or with other sedative drugs in paediatric patients during magnetic resonance imaging (MRI). Methods Literature was obtained from PubMed and Science-Direct from 2010-2020 using key words: sedation, paediatric, dexmedetomidine, ambulatory, MRI, ketamine, propofol, midazolam. The literature selection was based on Participant, Intervention, Comparators, Outcomes (PICO) analysis. All English full-text and peer-reviewed articles were included. The primary outcome was hemodynamic stability, respiratory compromise, and recovery time. The risk of bias analysis was assessed using Cochrane collaboration Risk of Bias (RoB 2.0). Result Of 106 studies, 17 studies were included with a total 3.430 paediatric patients undergoing MRI. Dexmedetomidine alone provides a more stable hemodynamic but longer recovery time than ketamine, propofol or midazolam. The combination of dexmedetomidine and ketamine provides more stable hemodynamics, especially in the incidence of hypotension and bradycardia, and does not significantly reduce airway configuration more than sole dexmedetomidine or ketamine. Intranasal dexmedetomidine is more recommended than its combination with midazolam. Combining dexmedetomidine with ketamine, propofol or midazolam provides a shorter recovery time. Conclusion A combination of dexmedetomidine with other sedatives such as ketamine, propofol and midazolam is better than sole dexmedetomidine for paediatric sedation during magnetic resonance imaging. [ABSTRACT FROM AUTHOR]

Sepsis and septic shock are some of the causes of morbidity and mortality (50-60%) in pediatric patients treated in intensive care rooms. This study aimed to compare the accuracy of pediatric Sequential Organ Failure Assessment (pSOFA) score combined with anion gap (AG) score to Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score in the assessment of mortality in pediatric septic patients at the Resuscitation Room of Dr. Soetomo Geeneral Academic Hospital, Surabaya, Indonesia. This was a retrospective observational cohort study using pediatric sepsis diagnosis guidelines based on the 2016 Pediatric Sepsis Consensus and medical records between January-December 2018. All data of patients aged 1 month to 16 years with suspected infection at the Resuscitation Room were collected based on predisposing infections, signs of infection, and warning signs. Organ dysfunction was assessed by calculating the pSOFA+AG scores, PELOD-2 scores, and corrected anion gap (cAG) in the first 24 hours. Sepsis mortality was assessed by comparing the results of the pSOFA, pSOFA+AG, and PELOD-2. The results showed 94.9% sensitivity and 70.0% specificity (p<0.0001) in the pSOFA, 89.9% sensitivity and 71.3% specificity (p<0.0001) in the PELOD-2, 79.7% sensitivity and 65% specificity (p<0.0001) in the AG, 79.7% sensitivity and 73.8% specificity (p<0.0001) in the cAG, and 79.3% sensitivity (p<0.0001) in the pSOFA+AG. In conclusion, pSOFA was more sensitive than PELOD-2, while the use of pSOFA+AG was not more sensitive than PELOD-2 in assessing the mortality of pediatric septic patients. [ABSTRACT FROM AUTHOR]

Objective: Coronavirus disease 2019 (COVID- 19) causes a severe impact on patients with comorbidities. Most of them are likely to develop multi-organ dysfunction syndrome (MODS). Serum albumin level is a reliable predictor of severe outcomes in COVID-19 patients. Therefore, this study aimed to investigate the association between serum albumin levels and the risk of developing MODS in COVID-19 patients. Design: A prospective analytical observational study. Setting: A single tertiary referral hospital in Surabaya, Indonesia. Patients and participants: We collected 153 patients from May-June 2021 who were confirmed positive for COVID-19 based on the real-time reverse- transcription polymerase chain reaction (RT-PCR) test aged 19-84 years. Seven patients were excluded due to incomplete data. Therefore, 146 patients were eligible participants. Interventions: Patients underwent the laboratory test during admission. An eight ml of venous blood plasma specimen was taken. The specimen was examined at the Clinical Pathology Laboratory, Diagnostic Center in our hospital using the enzyme-linked immunosorbent assay (ELISA) method. Measurement and results: Of 146 COVID-19 patients ages ranged from 19-84 years old. Almost 83% of patients have developed MODS, and 31.5% of them were non survived. Serum albumin of COVID-19 patients with MODS and non-survivor were lower than those who had good outcomes (2.95±0.39; 2.82±0.40 vs 3.07±0.40; 3.19±0.47 g/dl). We found a significant difference between serum albumin levels and the incidence of MODS and mortality (p=0.001). In multivariate analysis, low serum albumin <3.5 g/dl had a 15 times higher risk of developing MODS in COVID-19 patients (p=0.011). Conclusion: Early hospitalization serum albumin level is an excellent marker for predicting the development of MODS in COVID-19 patients. This first step might help physicians choose an appropriate treatment in the future. [ABSTRACT FROM AUTHOR]