Introduction: An alteration of cognitive function in geriatrics often occurred after a surgery procedure. To do a surgery, patients would go through the process with anesthesia, whether it is  general or regional anesthesia. We aimed to identify the effect of general and regional anesthesia in increasing the risk of alteration in cognitive function from geriatrics who underwent elective surgery followed by other risks. Material and Method: This observational analytic study has a total sample of 60 patients who aged 60 years or more, and half of the total sample underwent an elective surgery with general anesthesia, whereas the other half with regional anesthesia at Gedung Bedah Pusat Terpadu Dr. Soetomo General Hospital in a range of October – November 2016. The cognitive function of patients was assessed with MMSE which is done in approximately 10 – 15 minutes. Result and Discussion: There was a statistically significant correlation between age and both preoperative MMSE score also the alteration of MMSE score after 3 days in patients with regional anesthesia (P-value = 0.032; 0.044). Also, the correlation between educational status and preoperative MMSE score (P-value = 0.001). There was also a statistically significant difference in alteration of the MMSE score after 3 days between patients with general and regional anesthesia which went through the hypotension phase (P-value = 0.022; 0.003). We identified that both general and regional anesthesia could lead to alteration of MMSE score (P-value = 0.001; 0.02) and there was a statistically significant difference between both of them (P-value = 0.001). Conclusion: Both general and regional anesthesia could lower the cognitive function of geriatrics, especially general anesthesia which happened to have a higher risk to occur. Other factors such as age, educational status, and hemodynamic condition during surgery, had their impacts toward lowering cognitive function in geriatrics.

Severe COVID-19 infection management for a recipient of kidney transplant has debatable prognosis and treatment. We described the case of a COVID-19 infected 70 year old female, previously had renal transplantation in 2017. The patient took immunosuppressive agents as routine drugs for transplant recipient status and received lopinavir/ritonavir, hydroxychloroquine, and dexamethasone daily at the hospitalization. Specific question arises about renal transplant recipients being infected by COVID-19 – whether the infection will get worse compared to those without immunosuppresive agent. In this case, author decided to stop the immunosuppressive agent followed administration of combination lopinavir/ritonavir, hydroxychloroquine, and dexamethasone that gives a good clinical impact change to patient’s condition after once getting worsened and mechanically ventilated. Nevertheless, the assessment of risk and benefit in continuing immunosuppressive drugs is concurrently essential due to the prevention of transplant rejection.

Background: The main concern when treating COVID-19 acute respiratory distress syndrome (ARDS) during high flow nasal cannula (HFNC) is delayed intubation, thus increasing the risk of prior mortality. This study aims to analyze the prognostic ability of the Respiratory Rate Oxygenation (ROX) index as a predictor for intubation and 28-days mortality in COVID-19 patients. Methods: A retrospective analysis of COVID-19 patients admitted to Intensive Care Unit (ICU) Dr. Soetomo General Hospital in Surabaya from July to December 2020 with ARDS. The ROX indices were recorded at the 1st hour, 2nd, 4th, 6th, 12th, 18th, 24th, and 48th hours of treatment in ICU with HFNC. Identification of ROX association with HFNC failure led to intubation and 28-days mortality was through Cox proportional hazards regression. The most specific cut-off of the ROX index for predicting intubation and 28-days mortality was assessed. Result: Among 78 patients who met the inclusion criteria, 26 (33.3%) patients required intubation. Out of 26 patients, six patients were extubated and had survived. The 28-days mortality rate is 20 (25.6%) patients. The ROX index at 12th hours (ROX-12) ≤ 4.85 (AUC 0.857; p<0.001; HR 4.7) and the ROX index at 48th hours (ROX-48) ≤ 5.68 (AUC 0.858; p<0.001; HR 5.4) can accurately predict the need for intubation. ROX-12 ≤ 4.745 is a predictor of 28-days mortality (AUC 0.85, p<0.001; HR 10.2). Conclusion: ROX index predicts the risk of intubation and 28-days mortality especially ROX-12 and ROX-48. Utilization of ROX index for rapid assessment of the respiratory deterioration in COVID-19 is recommended.

Pada sepsis, endothelial glycocalyx (EG), dapat rusak dan luruh melepaskan syndecan-1 ke dalam plasma. Kerusakan EG akan mengganggu mikrosirkulasi, menimbulkan hipoperfusi jaringan, dan meningkatkan kadar laktat. Gangguan profil lipid pada sepsis terjadi karena gangguan metabolisme dan kerusakan langsung hepatosit akibat meluruhnya EG. Penelitian ini bermaksud menganalisis syndecan-1, laktat, dan profil lipid sebagai faktor risiko keparahan dan mortalitas pada pasien sepsis. Penelitian ini adalah penelitian analitik observasional pada 39 pasien dewasa yang memenuhi kritera sepsis-3. Keparahan sepsis diklasifikasikan menjadi sepsis dan syok septik dan ditentukan dalam 6 jam setelah time zero berdasarkan penggunaan vasopresor, kecukupan resusitasi cairan, dan nilai laktat ulangan. Kematian 7 hari dihitung sejak time zero sepsis. Syndecan-1, laktat, dan profil lipid diambil dalam jam pertama setelah time zero dianalisis sebagai faktor risiko keparahan dan mortalitas 7 hari. Analisis data dilakukan dengan uji logistik regresi bivariat dan multivariat. Pada penelitian ini didapatkan 20 pasien dengan sepsis, 19 pasien dengan syok septik. Berdasar atas mortalitas 7 hari, 10 pasien meninggal dan 29 pasien bertahan hidup. Laktat dan syndecan-1 merupakan prediktor keparahan pada sepsis. Laktat merupakan variabel yang lebih superior dibanding dengan syndecan-1 sebagai prediktor keparahan sepsis. Laktat merupakan prediktor untuk mortalitas 7 hari pada pasien sepsis. Simpulan penelitian ini adalah laktat dan syndecan-1 merupakan prediktor keparahan pada sepsis. Laktat merupakan prediktor kematian 7 hari pada sepsis.

Introduction: The incidence of postoperative CABG AKI in Indonesia, one of which is in the city of Surabaya, is known to reach 69.8%. For this reason, this study was prepared with the aim of analyzing the risk factors of Acute Kidney Injury Incidence following coronary artery bypass graft with cardiopulmonary bypass. Method: The study conducted a prospective analytic study on CABG patients with the CPB technique without a history of previous kidney disease at a hospital in Indonesia in the period 2020. Results: Through the results of the study, it was found that 14 people were diagnosed as AKI after surgery, of which 11 were men. On the other hand, it is also known that AKI patients also experience a longer duration of CPB and also lower plasma osmolarity Conclusion: Of all the factors it is known that eGFR is an independent risk factor for AKI.