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Introduction: European System for Cardiac Operative Risk Evaluation (EuroSCORE) is a scoring system to predict mortality risk after cardiac surgery. EuroSCORE II was introduced to replace and show superiority over EuroSCORE I which tends to overestimate the risk of heart surgery procedures and have a low discrimination ability. Meanwhile, this is the first study to analyze EuroSCORE II as a predictor of mortality and morbidity in Indonesians. Objective: This study aims to analyze EuroSCORE II as a predictor of mortality and morbidity in Indonesians. Materials and Methods: This is a retrospective study using medical records of CABG patients in Dr. Soetomo General Academic Hospital from January 2016 to December 2017. Results and Discussion: Out of 39 Patients who have performed CABG surgery, most were male (89.7%) with the highest age range of 46-65 years (59%). Deceased patients had an average EuroSCORE II of 22.36% and SD±26.97%7%, while 27 patients who survived had an average EuroSCORE II of 6.78% and SD±6.4%. Based on morbidity assessment, EuroSCORE II only accurately predicted the risk of kidney failure and did not properly assess the length of inotropic use, vasopressors, hospitalization time, the risk of arrhythmias, low cardiac output syndrome, Durante-operative bleeding, and the need for blood transfusion. These inaccuracies occurred because the samples that were included varied based on their standard deviation and pattern-less graph. Conclusion: EuroSCORE II is inadequate to predict morbidity and mortality in postoperative patients, therefore, it is considered less effective.

Introduction: Cesarean section is the most common surgical procedure performed in the world and its postoperative pain is still a major issue in several countries. In a low-resource setting, this management poses a challenge for anesthesiologists. Ketamine is the most used anesthetic drug in the world due to its easy access and proven benefits. Objective: This research aims to analyze the effectiveness of low-dose ketamine as postoperative analgesia in cesarean sections conducted in areas with limited medical supplies. Materials and Methods: A Randomized Controlled Trial (RCT) was done from August 2020 to January 2021 with consenting pregnant patients who had undergone cesarean section. The sampled population was randomized to receive either ketamine intravenously or a placebo before the Subarachnoid Block (SAB). Low dose ketamine was divided into three groups 0.15 mg/kg, 0.25 mg/kg, and 0.5 mg/kg. The outcome was divided into primary outcome (pain score after 1-hour post-operation, 2 hours post-operation, 24 hours post-operation, and 48 hours post-operation) and secondary outcome (Apgar Score in the first minute and 5 minutes, hypotension after SAB, sedative effect during operation, postoperative nausea vomiting, time to receive opioid postoperative as rescue analgesia and total opioid uses). Results and Discussion: This study screened 105 patients and recruited 90 patients that were randomized into two groups consisting of 45 patients that received either low-dose ketamine or a placebo. The groups administered ketamine showed a lower pain score in 1 hour (p-value = 0.0037) and 2 hours post-operation (p-value = 0.0037). They also showed that it could prolong the administration of fentanyl (p-value = 0.0003) and lower total fentanyl used (p-value = 0.0008). The groups administered ketamine showed that there was a sedation effect (p-value = 0.0001) that depended on the dosage used. Conclusion: Intravenous ketamine with low doses can reduce pain scores at 1 hour to 2 hours post-operation and shows the need to reduce opioid requirements.

C. glabrata has emerged as a major cause of adaptive resistance to azoles, echinocandins, and multidrugresistant agents. Therefore, an effort is needed to explore natural materials for antifungal activity, one of these natural ingredients is propolis. Propolis extract has chemical compounds such as flavonoids and phenolic acids which have antifungal activity which can inhibit the growth of the Candida glabrata. In this study, propolis was used from Apis mellifera carnica bees. This study aims to determine the antifungal effect of propolis Apis mellifera carnica against clinical isolates of Candida glabrata compared to fluconazole. This study used an in vitro experimental study conducted using the diffusion method. This study was divided into 5 groups, namely negative control (KN), positive control (KP) using fluconazole and treatment (P) with three variants of propolis Apis mellifera carnica extract concentrations, namely 50%w/v (P1), 75%w/v (P2), and 100%w/v (P3). Data analysis used the Kruskal-Wallis test and continued with the Mann-Whiteney test with significance (p<0.05). The average result of the diameter of the inhibitory zone sequentially starting from the smallest is negative control (KN) of 0 mm, P3 of 7.71 mm, P1 of 8.85 mm, P2 of 9.60 mm and the largest is positive control (KP) of 19.08 mm. The concentration of Apis mellifera carnica propolis extract had the greatest antifungal effect at a concentration of 75%w/v and the least at a concentration of 100%w/v. Based on the research above, it can be concluded that the propolis extract of Apis mellifera carnica has an antifungal effect against Candida glabrata but is not better when compared to fluconazole.

Introduction: Coronavirus disease-19 (COVID-19) has become a pandemic that is still ongoing today. This is a new challenge for health workers in handling emergency cases. Several COVID-19 patients arrived at the hospital with severe respiratory problems. Meanwhile, other pathological conditions causing respiratory failure must also be considered, such as pneumothorax. Objective: This study aimed to examine the effective emergency procedures to treat COVID-19 cases with tension pneumothorax. Case report: A 45-year-old male patient arrived with a referral letter from a pulmonologist with a diagnosis of simple pneumothorax and pneumonia. The patient also presented a positive SARS COV-2 PCR test result. The patient complained about a worsening of shortness of breath. A symptom of dry cough for 14 days was also reported. Chest radiograph examination subsequently indicated right tension pneumothorax. In the emergency ward, needle decompression procedure connected to the vial containing sterile intravenous fluids was performed. Re-examination of the chest x-ray demonstrated right pulmonary re-expansion. The patient was monitored and after four days, needle decompression was removed and no chest tube was inserted because complete resolution of the lungs had occurred. Discussion: This case illustrates that tension pneumothorax causes worsening of the patient's condition with COVID-19 diagnosis. In another case of tension pneumothorax in a COVID-19 patient, needle decompression of the 2nd intercostal space and the mid-clavicular line was performed as initial treatment followed by chest tube insertion as definitive treatment. However, in this case, chest tube approach was not carried out because the patient had demonstrated clinical and radiological improvement and a worsening condition had not occurred. Conclusion: Prolonged needle decompression connected to a vial containing sterile intravenous fluids as deep as 2 cm from the water surface is an effective procedure in the management of tension pneumothorax even without the installation of a chest tube.