Figure 2 Urticaria involving face, on the right side (a) and left side of the face (b).
Coronavirus Disease 2019 (COVID‐19) is a public health emergency of international concern with increasing cases globally, including in Indonesia. COVID‐19 clinical manifestations ranging from asymptomatic, acute respiratory illness, respiratory failure that necessitate mechanical ventilation and support in an intensive care unit (ICU), to multiple organ dysfunction syndromes. Some patients might present with happy hypoxia, a condition where patients have low oxygen saturations (S pO2 < 90%), but are not in significant respiratory distress and often appear clinically well, which is confusing for the doctors and treatment strategies. Most infections are mild in nature and have a relatively low case fatality rate (CFR); however, critical COVID‐19 patients who need support in ICU have high CFR. We would like to report a case of happy hypoxia in a critical COVID‐19‐positive ICU hospitalized patient who survived from Indonesia.
IntroductionThe COVID-19 pandemic has caused disruptions in educational institutions across the country, prompting medical schools to adopt online learning systems. This study aims to determine impact on medical education and the medical student’s attitude, practice, mental health after 1 year of the Covid-19 pandemic in Indonesia.MethodsThis study utilized a cross-sectional design. An online questionnaire was distributed digitally to 49 medical schools in Indonesia from February–May 2021. A total of 7,949 medical students participated in this study. Sampling was carried out based on a purposive technique whose inclusion criteria were active college students. This research used questionnaires distributed in online version among 49 medical faculties that belong to The Association of Indonesian Private Medical Faculty. Instruments included demographic database, medical education status, experience with medical tele-education, ownership types of electronic devices, availability of technologies, programs of education methods, career plans, attitudes toward pandemic, and the mental health of respondents. Univariate and bivariate statistical analysis was conducted to determine the association of variables. All statistical analyses using (IBM) SPSS version 22.0.ResultsMost of the respondents were female (69.4%), the mean age was 20.9 ± 2.1 years. More than half of the respondents (58.7%) reported that they have adequate skills in using digital devices. Most of them (74%) agreed that e-learning can be implemented in Indonesia. The infrastructure aspects that require attention are Internet access and the type of supporting devices. The pandemic also has an impact on the sustainability of the education program. It was found that 28.1% were experiencing financial problems, 2.1% postponed their education due to this problems. The delay of the education process was 32.6% and 47.5% delays in the clinical education phase. Around 4% student being sick, self-isolation and taking care sick family. the pandemic was found to affect students’ interests and future career plans (34%). The majority of students (52.2%) are concerned that the pandemic will limit their opportunities to become specialists. Nearly 40% of respondents expressed anxiety symptoms about a variety of issues for several days. About a third of respondents feel sad, depressed, and hopeless for a few days.ConclusionThe infrastructure and competency of its users are required for E-learning to be successful. The majority of medical students believe that e-learning can be adopted in Indonesia and that their capacity to use electronic devices is good. However, access to the internet remains a problem. On the other side, the pandemic has disrupted the education process and mental health, with fears of being infected with SARS-CoV-2, the loss of opportunities to apply for specialty training, and the potential for increased financial difficulties among medical students. Our findings can be used to assess the current educational process in medical schools and maximize e-learning as an alternative means of preparing doctors for the future.
Our study confirms that drug resistance, including MDR, observed against all first-line TB drugs was a real threat in the management of TB infection in Indonesia. The resistance pattern identified in this study could assist clinicians in providing appropriate treatment regimen to TB patients and improve their clinical outcome.
ObjectivesFind the discriminant and calibration of APACHE II (Acute Physiology And Chronic Health Evaluation) score to predict mortality for different type of intensive care unit (ICU) patients.MethodsThis is a cohort retrospective study using secondary data of ICU patients admitted to Siloam Hospital of Lippo Village from 2014 to 2018 with minimum age ≥17 years. The analysis uses the receiver operating characteristic curve, student t-test and logistic regression to find significant variables needed to predict mortality.ResultsA total of 2181 ICU patients: men (55.52%) and women (44.48%) with an average age of 53.8 years old and length of stay 3.92 days were included in this study. Patients were admitted from medical emergency (30.5%), neurosurgical (52.1%) and surgical (17.4%) departments, with 10% of mortality proportion. Patients admitted from the medical emergency had the highest average APACHE score, 23.14±8.5, compared with patients admitted from neurosurgery 15.3±6.6 and surgical 15.8±6.8. The mortality rate of patients from medical emergency (24.5%) was higher than patients from neurosurgery (3.5%) or surgical (5.3%) departments. Area under curve of APACHE II score showed 0.8536 (95% CI 0.827 to 0.879). The goodness of fit Hosmer-Lemeshow show p=0.000 with all ICU patients’ mortality; p=0.641 with medical emergency, p=0.0001 with neurosurgical and p=0.000 with surgical patients.ConclusionAPACHE II has a good discriminant for predicting mortality among ICU patients in Siloam Hospital but poor calibration score. However, it demonstrates poor calibration in neurosurgical and surgical patients while demonstrating adequate calibration in medical emergency patients.
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