Background: A decrease in hospital visits including neurosurgery cases during the coronavirus disease 2019 (COVID-19) pandemic has been reported by many countries. This study aims to reveal important data regarding the effect that the COVID-19 pandemic has on services, neurosurgical surgery, and inpatients before and during the COVID-19 pandemic. Methods: This comparative study compares neurosurgical services, neurosurgical patients, outpatient visits, and monthly inpatients assessed from January to December 2020 (onset of the pandemic) with those of the same period in 2019. Results: The average number of outpatient visits per month during the pandemic (January to December 2020) was 369 visits per month, compared to 397 visits in the same period in the previous year. The lowest outpatient visits occurred in May 2020 with 227 outpatient visits. There was a decrease in the number of neurosurgical patients in January-December during the pandemic period compared to the same period in 2019. A significant decrease in outpatients during and before the pandemic was noted with P = 0.046 (P < 0.05). Conclusion: There are differences in the number of visits by outpatients, neurosurgical patients, and inpatients during the pandemic compared to the period before the onset of the pandemic.

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.

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.

Rhabdomyosarcoma (RMS) is the third most common solid organ malignancy in children after Wilms tumor and neuroblastoma. It is a highly malignant tumor with local tissue invasion and lymphatic and hematogenous metastases. The main treatment for RMS is complete resection with a combination of chemotherapy and radiotherapy. Here, we present the case of a 2-year-old girl who came to the hospital with a complaint of noisy breathing (Stridor) for the past 2 weeks. Intraoral examination showed an oval mass at the base of the tongue that almost closed the airway, felt soft, and had a bump. A computed tomography scan of the neck was performed, and a solid lesion with clear irregular borders was found in the posterior lingua. Incisional biopsy was performed with histopathological results of embryonal RMS. Two weeks after the biopsy, chemotherapy was performed, and the evaluation after two chemotherapy sessions, the mass size was found to have decreased.

BACKGROUND: In Indonesia, especially in Surakarta, the emergence of the Coronavirus Disease (COVID)-19 pandemic made breast cancer survivors unable to continue their therapy schedule or follow-up due to lockdown rules in their residence area. Some survivors had confirmed COVID-19, or the health services began to limit their treatment of patients. Breast cancer itself is not an emergency case. AIM: This research is to see the behavior patterns of breast cancer survivors in Surakarta using the UNS-CASKQ14 questionnaire, whether there is anxiety about contracting COVID-19 or cancer itself that eliminates the fear of COVID-19. MATERIALS AND METHODS: This cross-sectional study used the Indonesian version of the UNS-CASKQ14 questionnaire on 88 breast cancer survivors through the Google Form application from December 2020 - February 2021. RESULTS: The level of understanding about COVID-19 correlated with the level of education (p 0.019; r 0.429). The level of understanding also correlated with the type of financing (p 0.016; r 0.318). There was a correlation between the level of education and the level of knowledge about the therapeutic program that had to be undertaken (p 0.007; r 0.472). The financing factor used by the respondents to undergo a therapy program also affects them (p 0.028; r 0.248). The behavior of survivors during the pandemic had a statistically significant correlation to the level of education (p 0.032; r 0.313). There was a correlation with the type of financing (p 0.027; r 0.323). CONCLUSION: The high understanding of the COVID-19 pandemic made 97.9% of survivors afraid of contracting COVID-19, thus affected changes in behavior patterns and gave psychological effects in undergoing therapy during the pandemic.