BACKGROUND: Propofol is an intravenous anesthetic used worldwide as an anesthesia induction and maintenance agent. Propofol also used as sedation agent in Intensive Care Unit (ICU). Despite it’s usual anesthesia properties, propofol has an unique pharmacologic characteristic, especially as antioxidant and stress response reduction. These advantages suggested propofol has positive effects when used as an anesthesia agent in surgery or sedation in ICU in conditions when high stress and free radical level are released.CONTENT:Stress response and free radical can be elevated in various conditions including surgery or during care in ICU, especially critical ill patient. Cortisol is a major stress hormone that influences metabolism, cardiovascular and central nervous system, either in acute or chronic phase. Oxidative stress was marked by free radical elevation called Radical Oxygen Species (ROS). Combination of both elements (cortisol and ROS) can worsen patient condition. Propofol with anti-stress and antioxidant properties could be used to reduce stress response and attenuate free radical level in order to improve patient condition.SUMMARY: The anti-stress and antioxidant properties of Propofol are interesting, because these benefits can be added as adjunctive therapy when propofol was used as an anesthetic agent in surgery and a sedation in ICU.KEYWORDS: propofol, stress response, antioxidant
Background Severe acute respiratory syndrome coronavirus 2, the cause of coronavirus disease 2019, has become a global pandemic. Currently, there is no definitive treatment for coronavirus disease 2019. Convalescent plasma therapy has become a potential specific curative method, while vaccines as protection modalities require further work. Case presentation Eight non-intubated Indonesian patients, ages ranging from 40 to 74 years old, with coronavirus disease 2019 confirmed by viral Ribonucleid Acid (RNA) real-time polymerase chain reaction tests were included. Four patients were administered two doses of 200 mL convalescent plasma, and the other four patients were administered one dose of convalescent plasma with an antibody titer of 1:320, within the first 14 days since symptoms occurred. The median times from illness onset to convalescent plasma therapy and from the first day of hospital admission to convalescent plasma therapy were 13 and 6.5 days, respectively. All patients showed improvements in clinical symptoms, laboratory parameters, thorax imaging, negative conversion of polymerase chain reaction results, and decreased oxygen supplementation within 1 week after convalescent plasma therapy. Patients with two convalescent plasma doses tended to have faster recovery than those with one convalescent plasma dose. No severe adverse effects were observed in any patient. Conclusion This is the first case series in Indonesia showing that convalescent plasma therapy is safe and well tolerated and that early convalescent plasma therapy before the patient is intubated could potentially prevent disease progression, increase the recovery rate, and shorten the inpatient time of stay.
Background Hirschsprung’s disease is a congenital disorder identified by the absence of ganglion cells at the Meissner’s plexus of the submucosa and Auerbach’s plexus of the muscularis. This disease can be found in approximately 1 in 5000 live births. It is a congenital disorder that is rarely diagnosed in adults, where 95% of cases are diagnosed in infants aged under 1 year old. Here we present a rare case of adult Hirschsprung’s disease to enrich the body of knowledge in diagnosing adult patients with chronic refractory constipation symptoms. Case report An 18-year-old Indonesian woman came to the general surgery department of Unggul Karsa Medika Teaching Hospital with a defecating problem (constipation) since childhood. There was no history of her passage of meconium. A contrast enema study showed that the sigmoid colon was dilated and the rectum was narrowed, with rectosigmoid index < 1. With these findings, it was suspected that the patient may have ultra-short segment Hirschsprung’s disease. The patient was then referred to the digestive surgery department of referral hospital for surgical treatment. Conclusion In adult patients presenting with history of constipation since childhood, it is necessary to consider the possibility of Hirschsprung’s disease that was not diagnosed in early childhood. Hirschsprung’s disease in adults is usually a short or ultra-short aganglionic segment because it shows relatively mild symptoms. Surgical removal of the aganglionic segment of the gut is the definitive treatment for Hirschsprung’s disease.
Oral candidiasis is an infection in oral cavity caused by Candida albicans. This disease is frequently caused by immunological suppression, which can be local or systemic, caused by immunosuppression due to extremes of age (newborns and the elderly), diseases that impair immunity, such as in infection of human immunodeficiency virus (HIV) or Acquired Immunodeficiency Syndrome (AIDS), long-term systemic steroid use, and long-term systemic antibiotic use. Oral candidiasis could lead to low-intake condition due to swallowing difficulties. This case report aimed to present a patient with severe dehydration due to oral candidiasis that needs to be hospitalized.
Background Psoriasis is a chronic inflammatory skin disease with a strong genetic predisposition and autoimmune pathogenic traits. Psoriasis vulgaris is also called plaque-type psoriasis, and is the most prevalent type. Psoriasis vulgaris is chronic inflammatory disease and characterized by periods of attack and remission. The chronicity of psoriasis vulgaris can affect patient’s quality of life. Case presentation A 33-year-old male came to Unggul Karsa Medika Hospital’s outpatient department with itchy, scaly, red plaques all over his body except his palms, soles, and face. The patient went to the dermatologist because his symptoms were getting worse and worse. Dermatologic examination concludes the lesions as multiple, generalized, discrete, circumscriptive, elevated, dry, regular-discoid erythematous plaques with psoriasiform scales located at the patient’s head, ears, nape, back, chest, belly, both arms and legs. Conclusion The diagnosis of psoriasis vulgaris was made based on history and clinical symptoms, supported by histopathological results. Treatment optimization and transitioning for moderate-to-severe plaque psoriasis include methotrexate or cyclosporine, along with topical therapy and supportive therapy.
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