Wernicke’s encephalopathy is a rare occurrence in Indonesia because alcohol consumption is very low. However, in Indonesia, Wernicke’s encephalopathy could be triggered by an inadequate intake of thiamine (vitamin B1) due to an extreme diet for several months. It is a case of a 31-year-old male, who presented to the emergency room with a decreased level of consciousness. According to the family, for the last few weeks, he has become less responsive and less attentive. Fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) revealed a unique picture with symmetrical lesions in the bilateral medial thalamus, mammillary bodies, periaqueductal gray matter, and the dorsal surface of the medulla oblongata. Clinically, there is no neck stiffness and no fever. The laboratory results from the blood and cerebrospinal fluid have ruled out meningitis. Treatment with thiamine 200 mg t.i.d. has shown an excellent response and significant clinical improvement. The earlier thiamine substitution treatment is started, the better the outcome because thiamine will prevent further injury to the brain and enhance recovery.

<p><strong>Introduction:</strong> Overseas studies have shown various distributions of breast cancer primary tumor locations based on stages and histopathologic types. Based on them, breast cancer was consistently reported to be found on theleft breast more than the right. Breast cancer laterality was estimated to be one of the determinant factors in prognosis. In Indonesia, there are only a few studies on the laterality of breast cancer, as well as the characteristics that accompany it. The aim of this study is to know the distributions of primary breast cancer tumor locations in Indonesian patients.</p><p><strong>Material and Methods:</strong> A cross-sectional design study was done and the data was collected from Siloam Hospital Lippo Village radiology and pathology anatomy department within the 2014-2018 period. The results were presented using descriptive statistics.</p><p><strong>Results:</strong> A total of 74 breast cancer patients from various ages and stages were enrolled in this study. Based on the histopathological types, 84.2% patients left breast tumors and 72.2% patients with right breast tumors had invasive ductal carcinoma of no special type. Based on quadrants, 50% tumors on the left breast are in the superolateral quadrant, followed by 31.6% in superomedial, 13.2% in inferomedial, and the rest in inferolateral. Conclusion: Most tumors are located in the superolateral quadrant and the most histopathological types are non-specific invasive carcinomas.</p>

BACKGROUND Several studies have reported pediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS) cases with their cardiac manifestations, but only few studies synthesize the cardiovascular characteristics in children with PIMS-TS. However, detecting cardiac abnormalities is crucial in improving patients' outcomes and reducing mortality. This review aimed to summarize the overall symptoms, laboratory, and workup findings in PIMS-TS patients, focusing on cardiovascular manifestations. METHODS We searched 4 medical databases (PubMed, Science Direct, Medline, and Scielo) and 4 preprint databases (Medrxiv, Research Square, SSRN, and Biorxiv). The literature search was done on November 8, 2021. All case reports, case series, cross-sectional studies, cohort studies, and possible clinical trials published from December 2020 onward that studied PIMS-TS on cardiac manifestation (aged 0–18 years) were included. Studies on multisystem inflammatory syndrome in children, animal studies, and studies without full-text availability were excluded. This review was registered in PROSPERO (CRD42021194468). RESULTS 59 studies were included with a total of 698 patients. The most common cardiovascular findings were the presence of cardiogenic shock (37%) and hypotension (8.5%). Almost all laboratory values were deranged. Cardiac computed tomography scan mostly showed normal results (56%), followed by cardiomegaly with pericardial effusion (14%). Electrocardiography showed normal findings (46%), ST-segment abnormalities (32%), and abnormal T wave (12%). Echocardiography findings showed left ventricle dysfunction (40.6%), which can be considered most significant, followed by pericardial effusion together with pericarditis (11.4%) and tricuspid regurgitation (6.9%). CONCLUSIONS This review found various cardiac abnormalities that may develop during PIMS-TS. Due to these findings, we should be more vigilant and not underestimate the consequences in pediatric COVID-19 patients.

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