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A total correction is a preferred treatment for Tetralogy of Fallot patients in every part of the world. However, the mortality in developing countries was as high as 6.9% to 15.3%. This was a retrospective analytic study that analyzed pre and post-operative risk factors that affected mortality on TOF patients that were performed total correction in Indonesia. A total of 47 TOF patients that were performed total correction from January 2016 to September 2019 were enrolled in this study based on the inclusion criteria. Preoperative and post-operative data were obtained from medical records. In this research, the majority of mortality was found in male patients (39.3%), while the female’s rate was lower (36.8%). Overall mortality was 38.3% and one operative death was found. The average age of patients was 84.12 months (12-210 months), whereas the average height (85.56 ± 36.17cm vs. 112.93 ± 21.73) and weight (17.22kg vs. 28.21kg) were lower for mortality patients. Some significant preoperative variables were identified as mortality risk factors such as: age below 60 months (p=0.047), smaller weight and height (p=0.008; p=0.002), abnormal hematocrit (p=0.002), and oxygen saturation below 75% (p=0.018). Significant post-operative risk factors included: temperature above 38.5⁰C (p=0.000), and ventilator time of more than 48 hours (p=0.033). In conclusion, the mortality of TOF patients undergoing a total correction in developing countries was quite high. It was associated with some risk factors, such as younger age, lower weight and height, low oxygen saturation, post-operative fever, and prolonged ventilator time.

BACKGROUND The European system for cardiac operative risk evaluation (EuroSCORE) II is one of the established risk models used to predict mortality after cardiac surgery. However, its application as a mortality predictor for Indonesian adult cardiac surgery is still unknown. This study aimed to examine the validation of EuroSCORE II in predicting the mortality following adult cardiac surgery in Indonesian adults. METHODS This retrospective cohort study collected data from the medical records and the database of the Department of Thoracic Cardiac and Vascular Surgery at Soetomo General Hospital, Surabaya. Data on the EuroSCORE II variables were collected for patients aged >18 years who underwent coronary artery bypass, heart valve, heart tumors, aortic surgeries, or a combination of these surgeries between January 2016 and December 2018. In-hospital mortality prediction was calculated using the online calculator at www.euroscore.org. The calibration of the EuroSCORE II model was conducted using the Hosmer–Lemeshow test, and discrimination analysis was done using receiver operating characteristic (ROC) curves with area under the ROC curve (AUC) calculation. RESULTS A total of 213 patients met the inclusion criteria and were analyzed for this study. Mortality was 8.9%. The predicted and actual mortalities were 1.74% and 8.9%, respectively. The significance (p-value) of the Hosmer–Lemeshow test was 0.55, indicating good calibration. The AUC of ROC curve was 0.85 (95% CI = 0.77–0.92, p<0.001), suggesting good discrimination. CONCLUSIONS EuroSCORE II has a good calibration and discrimination for cardiac surgery in Indonesian adults.

Background Healthcare workers are still the front liners in health care services, and have major roles during the COVID-19 pandemic. In a resource-limited country like Indonesia, it is necessary to provide safe screening and management both for patients and healthcare workers to minimize the transmission. We report our experience in the cardiac surgery department on how to provide safe management during the COVID-19 pandemic. Methods A retrospective observational study was performed in a single-tertiary-center cardiac surgery department in Surabaya and included all patients who underwent cardiac surgery during the first year of the COVID-19 pandemic. We also collected the patients from a 1-year period before the pandemic as the comparison data. Analysis of the patient characteristics, operative data, and postoperative outcome, was performed. This study also provides our experience in changes of admission in the cardiac surgery preoperative system that can be utilized for others. Results A total of 179 patients were admitted to and had cardiac surgery. Of these, 3.80% ( n = 7) were COVID-19 confirmed by a real-time polymerase chain reaction. Five patients were delayed to have cardiac surgery with no mortality or morbidity reported in these patients. During the period after changes of admission procedural in cardiac surgery patients, there were no healthcare workers infected by COVID-19 by patient transmission in our center (0%). Conclusion Our study reported a systematic screening and that possible delay in cardiac surgery appears to be feasible and safe, both for patients and for healthcare workers during the COVID-19 pandemic.

Highlights1. Diabetes mellitus is a category of metabolic disease characterized by uncontrolled hyperglycemia.2. This study revealed no statistically significant differences in total cholesterol, TG, LDL, HDL, or LDL/HDL ratio between amputated and non-amputated DFU patients. AbstractBackground: Diabetic foot ulcers (DFU) are microvascular and macrovascular consequences of diabetes and are associated with neuropathy, vascular disease, and immunosuppression. Increased blood glucose levels may result in the glycosylation of proteins in the nerve cells of the foot, leading to ischemia and cellular disturbances that can damage muscular, sensory, and autonomic neurons. Objective: To compare the lipid profiles of amputated and non-amputated DFU patients. Material and Method: This was a cross-sectional, analytic, retrospective research using total sample approach to analyze the medical records of all diabetes patients admitted to Dr. Soetomo General Academic Hospital between February 2018 and December 2020, with or without amputation. Result: The average age of DFU patients at Dr. Soetomo General Academic Hospital was 55.6 9.4 years, and the majority of patients were female (57%). Diabetic foot ulcers were most prevalent in the age group ≥50 years old (74%), amputated DFU patients had larger mean total cholesterol, TG, LDL, and HDL than non-amputated DFU patients, although the difference was not statistically significant. While the mean LDL/HDL ratio was greater in non-amputated DFU patients, the difference was statistically insignificant. The HDL level was low in 84% of amputated DFU patients, whereas in non-amputated DFU patients it was 81%. Conclusion: This research showed no significant variation in total cholesterol, TG, LDL, HDL, or the LDL/HDL ratio between amputated and non-amputated DFU patients. Most DFU patients with and without amputations had low HDL values.

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Traumatic severe brain injury is a fatal injury, with a mortality rate of up to 50%. About 1.5 million people experience severe brain injury in the United States. There are more than 50,000 deaths and 500,000 incidents of permanent neurological sequelae. About 85% of mortality occurs in the first 2 weeks after the injury. One complication of a severe brain injury is diabetes insipidus. There are no definitive data on the incidence of diabetes insipidus in patients with traumatic severe brain injury of Indonesia so far. In this case report, a male, 45 years old, was taken to the Emergency Installation (IRD) after experiencing a traffic accident 12 hours before being hospitalized. After surgery, the signs of diabetes insipidus was presented by polyuria of 300cc / hour urine production and 149mmol / L hypernatremia, although the immediate administration of desmopressin, the patients clinical and hemodynamic was not shown any improvements. The patient passed away in the days five of treatment in the Intensive Care Unit (ICU). The main treatments for diabetes insipidus in traumatic severe brain injury are adequate rehydration and administration of desmopressin. Adequate hypovolemic, polyuric and hypernatremia corrections are the keys to the successful treatment of diabetes insipidus. Diabetes insipidus in cases of brain injury requires complicated treatment. Therefore, in the case of being handled improperly, it can bring death. ABSTRAKCedera otak berat traumatis adalah cedera fatal, dengan tingkat kematian hingga 50%. Sekitar 1,5 juta orang mengalami cedera otak berat di Amerika Serikat. Terdapat lebih dari 50.000 kematian dan 500.000 insiden gangguan neurologis permanen. Sekitar 85% kematian terjadi dalam 2 minggu pertama setelah cedera. Salah satu komplikasi dari cedera otak yang parah adalah diabetes insipidus. Tidak ada data pasti tentang kejadian diabetes insipidus pada pasien dengan cedera otak traumatis