BACKGROUND: In the global pandemic of the 2019 coronavirus disease (COVID-19), many countries have reported a decrease in visits to hospitals, and health-care systems around the world are reshaping health protocols. Health service and education in orthopedics are also affected although not at the frontline in dealing COVID-19. METHODS: The data from this study collected from several official databases, including the Indonesian Ministry of Health, Central Java provincial government, general hospital, and orthopedic surgery cases. RESULTS: Pandemic COVID-19 started in March 2020 in Indonesia. Surakarta has become one of the epicenters. Health services in the orthopedic department also experienced a decrease cases on all divisions (outpatient clinics, emergency rooms, and inpatients). Mann–Whitney non-parametric comparative test showed significance result in p value operation of orthopedic cases and inpatients (p = 0.016 and p = 0.016; p < 0.05), meanwhile, outpatient visits did not show significance result with p = 0.0509 (p > 0.05). The decrease in the number of cases being treated in the orthopedic service also has an impact on education and training programs. The digital era is one of the choices in the field of education. However, digital resources cannot substitute for direct patient exposure. CONCLUSION: The average number of orthopedic patients during the pandemic period from January to December 2020 decreased compared to visits in the same period in 2019 so that orthopedic services at tertiary and academic referral hospitals experienced a significant decrease in cases. The education and services department must adapt to the policy on educational activities for residents and medical students. The education department and hospital institutions restructured and reorganized resident doctors to continue providing services. The digital era is an option that supports the education process during a pandemic.
Background: Intradural extramedullary spinal tumor (IDEM) is rare compared to all neoplasms of the central nervous system; however, it is the most common type of primary intraspinal neoplasms. Most tumors are meningioma, schwannoma, and neurofibroma. IDEM tumor has a predilection in women with ages ranging from 40-60 years. This study was conducted to describe the outcome of patients with IDEM tumors after surgery in Dr. Moewardi General Hospital from 2019-2022. Methods: This retrospective descriptive study was conducted in 2019-2022. Forty-four patients diagnosed with IDEM tumors and who underwent surgical approach were included. The studied variables include age, pathological diagnosis, intervention, and postoperative follow-up. Results: Most subjects were within the age range of 40-60 years old (52.3%), women (63.6%), and had schwannoma (45.5%), followed by meningioma (25%). Based on gender, both men and women mostly had schwannoma (56.25% and 39.3%, respectively). All subjects underwent tumor excision laminectomy. In the follow-up, most subjects (86.4%) had improved clinical symptoms after surgery. Conclusion: Intradural extramedullary spinal tumors mostly occur in women 40-60 years old, and schwannoma and meningioma are the most frequent types. Laminectomy intervention can provide clinical symptom improvement in most patients.
Thyroid cancer is a thyroid gland malignancy with an increasing incidence, especially in women aged 25-65 years. The tumor, node, and metastases classification serves to determine cancer management. Here, we report the case of 58 years old who came with complaints of lumps in the neck and the left armpit for 2 months. Based on the results of the systemic history, physical examination, and supporting examinations including X-rays, ultrasound, magnetic resonance imaging, and biopsy, a final diagnosis of T4bN1bM1 thyroid papillary cancer (lung) with a left axillary mass, which is cancer thyroid metastases, was given. The management carried out in these patients was chemotherapy with chemotherapy regimens doxorubicin (20 mg/m 2 ) iv and paclitaxel (60 mg/m 2 ) iv once per week, respectively, but unfortunately, the patient died due to respiratory failure. This case report tries to elaborate the chemotherapy effects on neglected thyroid carcinoma metastatic to the axilla so that the clinicians have representation about these effects.
hordoma is a malignant, slow-growing, locally aggressive tumor occurring most commonly in the sacrum (50%) followed by the cranium (30%) and the spine (20%). These tumors arise from the embryonic notochordal remnants, along with the axial skeleton. Of all bone malignancy tumors, it has a prevalence of 1-4%. Chordoma is dominant in the Caucasian population where the prevalence in males is higher than in females with the ratio of males to females ranging from 1.4:1 to 2.4:1. Chordoma manifestations usually appear in the age range 50-60 years. These tumors can also appear at the age of 30-40 years, where 25% of these ages have chordomas on the spine and cranium [1-3]. Chordoma grows on the sacral foramina and blocks the nerve proximally. Posterior tumors tend to invade the muscles around the hip and the sacroiliac joints. Invasion to the anterior is rare due to the strong presacral fascia and the rectum is usually spared. Chordoma metastases occur in 30-40% of patients, where growth is slow and usually occurs after tumor recurrence even years after surgical resection. There have been secondary metastases in the lungs, bones, liver, lymph, soft tissues, and skin [2-4]. The therapeutic management of chordoma ranges from surgery, radiotherapy to chemotherapy. The main treatment options for chordoma management are surgery or resection [1,2,5]. The goal of surgery in the management of chordomas is to eradicate the tumor by maintaining as much function as possible. Chemotherapy is rarely chosen because it has poor sensitivity and is not suitable for sacral chordomas. However, chemotherapy is an option for metastatic chordomas due to its benefit to force the progression of the tumor. We report the case of a 58-year-old male patient with sacral chordoma, where surgery as the mainstay therapy was not chosen and chemotherapy was given to the patient due to the limited facilities available in our hospital.
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