The coronavirus disease of 2019 (COVID-19) pandemic is currently a global challenge, with 210 countries, including Indonesia, seeking to minimize its spread. Therefore, this study aims to determine the spatiotemporal spread pattern of this virus in Surabaya using various data on confirmed cases from 28 April to 26 October 2021. It also aims to determine the relationship between pollutant parameters, such as carbon monoxide (CO), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), and ozone (O₃), as well as the government’s high social restrictions policy in Java-Bali. Several methods, such as the weighted mean center, directional distribution, Getis–Ord Gi*, Moran’s I, and geographically weighted regression, were used to identify the spatial spread pattern of the virus. The weighted mean center indicated that the epicenter location of the outbreak moved randomly. The directional distribution demonstrated a decrease of 21 km² at the end of the study phase, which proved that its spread has significantly reduced in Surabaya. Meanwhile, the Getis–Ord Gi* results demonstrated that the eastern and southern parts of the study region were highly infected. Moran’s I demonstrate that COVID-19 cases clustered during the spike. The geographically weighted regression model indicated a number of influence zones in the northeast, northwest, and a few in the southwest parts at the peak of R² 0.55. The relationship between COVID-19 cases and air pollution parameters proved that people living at the outbreak’s center have low pollution levels due to lockdown. Furthermore, the lockdown policy reduced CO, NO₂, SO₂, and O₃. In addition, increase in air pollutants; namely, NO₂, CO, SO₂ and O₃, was recorded after 7 weeks of lockdown implementation (started from 18 August).

Background/Objectives: Our understanding of dexmedetomidine, as an adjuvant to nerve blocks in cancer surgery, is characterized by a current lack of compelling evidence, and it remains unknown whether the potential benefits of use outweigh the risks. The aim of the study was to evaluate the benefit and safety profiles of dexmedetomidine as an adjuvant to nerve blocks in cancer surgery. Methods: Systematic searches were conducted in MEDLINE, ScienceDirect, Cochrane Library, Springer, medRxiv, and Scopus up to 17 May 2024. Risk ratios (RR) for binary outcomes and standardized mean differences (SMDs) for continuous outcomes were quantified. Results: Twenty studies were identified. In breast cancer surgery, the use of dexmedetomidine reduced 24 h total morphine consumption (SMD = −1.99 [95% CI −3.01 to −0.98], p = 0.0001, I2 = 91%, random effects) and prolonged the requirement for morphine rescue analgesia (SMD = 2.98 [95% CI 0.01 to 5.95], p = 0.05, I2 = 98%, random effects). In abdominal cancer surgery, the dexmedetomidine group had lower total sufentanil consumption (SMD = −1.34 [95% CI −2.29 to −0.40], p = 0.005, I2 = 84%, random effects). Dexmedetomidine reduced the VAS score and decreased postoperative nausea and vomiting (PONV). No studies using dexmedetomidine reported serious adverse events. Conclusions: Using dexmedetomidine as an adjuvant to nerve blocks in cancer surgery could lower the VAS pain score and prolong the regional anesthesia duration, which would lead to a decrease in total opioid consumption and possibly contribute to fewer PONV events. Furthermore, the reports of no serious adverse events indicate its good safety profile.

Introduction: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, may result in musculoskeletal tissue injury and is assumingly regulated through central and peripheral pathways. Muscle-specific creatinine kinase (CK-MM) is a specific biomarker used to indicate the presence of musculoskeletal tissue damage. This study aimed to investigate the correlation between the levels of CK-MM and the incidence of persistent myalgia in patients with post-COVID-19 syndromes. Methods: A cross-sectional study was conducted among COVID-19 survivors at the Faculty of Medicine and Clinical Pathology Laboratory, Universitas Airlangga, Surabaya from June - August 2022. The degree of pain of the myalgia was assessed using a visual analog scale (VAS), while CK-MM level was measured using a sandwich enzyme-linked immunosorbent assay (ELISA). Pearson correlation test at α=0.05 was used to identify the correlation between the levels of CK-MM and the incidence of persistent myalgia in patients with post-COVID-19 syndromes. Results: A total of 84 participants were enrolled in the study and half (50%) of them reported persistent myalgia post-COVID-19 recovery. Fatigue was the patients' most common persistent symptom (63%). Of the total 42 patients with persistent myalgia, more than half (56%) had mild pain intensity (VAS score: 1–3), and almost all of them (41 patients) experienced myalgia during the COVID-19 diagnosis. All the patients with post-COVID-19 myalgia had normal levels of CK-MM (mean: 32.7 ng/mL; range: 12–93 ng/mL), suggesting no musculoskeletal tissue damage. Anova test suggested no significant different of CK-MM levels between those with and without myalgia in patients with post-COVID-19 syndromes p=0.054). Conclusion: There was no significant association between CK-MM levels and the incidence of persistent myalgia in patients with post-COVID-19 syndromes.

Introduction: The utilization of pneumatic tourniquets in surgery can help surgeons optimize the surgical field and reduce the amount of bleeding. It can also cause hyperdynamic cardiovascular responses, such as increased blood pressure, mean arterial pressure, and pulse rate, which the administration of analgesia, anti-hypertension, and increased depth of anesthesia cannot correct. Excessive hemodynamic responses can lead to complications due to the utilization of tourniquets, namely increased intracranial pressure and acute heart failure. This study aims to analyze differences in the effects of tourniquet inflation on blood pressure, mean arterial pressure, and pulse rate during the maintenance of anesthesia using a combination of dexmedetomidine and isoflurane compared to that using only isoflurane for patients undergoing lower extremity surgery. Methods: This observational cohort study. The statistical test in this study was conducted using the Shapiro-Wilk test for normality and the Spearman test for correlation. The Chi-Square test was carried out to ensure the characteristics of patients in the two groups. Results: The results showed no significant effects of tourniquet inflation on blood pressure, mean arterial pressure, and pulse rate during the maintenance of anesthesia using a combination of dexmedetomidine and isoflurane. Meanwhile, tourniquet inflation during the maintenance of anesthesia using only isoflurane resulted in significant effects on blood pressure, mean arterial pressure, and pulse rate. The results also indicated significant differences between the effects of tourniquet inflation during the maintenance of anesthesia using a combination of dexmedetomidine and isoflurane and that using only isoflurane on the blood pressure, mean arterial pressure and pulse rate of patients undergoing lower extremity surgery. Conclusion: There are no significant effects of tourniquet inflation during the maintenance of anesthesia using a combination of dexmedetomidine and isoflurane on the blood pressure, mean arterial pressure, and pulse rate of patients undergoing lower extremity surgery.

Background: In recent decades, the study of immunology has evolved rapidly, elucidating the cellular and molecular mechanisms underlying human immunity. Recent studies have shown that high levels of cytokines correlate with the degree of manipulation of brain tissue and lower levels of inflammation in brain tumor surgery are associated with higher safety rates. The use of scalp block in craniotomy surgery is associated with the modulating effect of both local and systemic inflammatory responses. This study aims to analyze the effect of scalp block with 0.5% ropivacaine on IL-6 and NLR in elective craniotomy surgery. Method: A randomized controlled trial (RCT) was conducted at Dr. Soetomo General Hospital Surabaya with a total of 40 patients who underwent elective craniotomy from September to November 2023. Patients were divided into two groups: the scalp block (SB) group and the non-scalp block (non-SB) group. All patients were under general anesthesia and a scalp block was added to the SB group after general anesthesia. IL-6 concentration and NLR count were assessed after general anesthesia (T0), 6 hours after incision (T1), and 24 hours after surgery (T2). Results: IL-6 and NLR levels increased over time and reached their peak at 24 hours after surgery in both groups with IL-6 SB: 83.50 ± 2,289 pg/mL and IL-6 non-SB: 84,638 ± 2.25 pg/ml. NLR SB: 6.80 ± 1.17 and NLR non SB: 7.33 (5.83-8.09). In the comparative test, there was a significant difference in IL-6 and NLR levels at 6 hours after incision (p:<0.001 and p=0.0015), and significant differences in changes IL-6 baseline and 6 hours after incision (∆T0-T1) (P:<0.001). However, there was no significant difference in IL-6 and NLR levels at 24 hours after surgery and no significant difference in the changes between IL-6 baseline and 24 hours after surgery (∆T0-T2), NLR baseline, and 6 hours after incision (∆T0-T1), NLR baseline and 24 hours after surgery (∆T0-T2) between two groups. Conclusion: Scalp block suppresses pro-inflammatory mediators for only 6 hours after incision. It is most effectively used in short procedures, as an adjuvant for the head pinning procedure or incision.

Introduction: Recognition of conus medullaris position, contains lumbosacral plexuses which supply motor and sensory innervation to the whole lower limb, pelvic and perineal areas, is critical to avoid injury due to lumbar procedures, such as spinal anesthesia and lumbar punctures. This study aimed to investigate the position of conus medullaris among Indonesians through magnetic resonance imaging (MRI) of the lumbar spine at Dr. Soetomo General Academic Hospital in order to minimize the risk of conus medullaris trauma. Methods: A retrospective study was conducted to investigate the conus medullaris level and its correlation to gender and age Indonesian patients. The data were collected from lumbar MRI at Dr Soetomo General Academic Hospital during January 2020 and December 2021. The level variations of conus medullaris were recorded and determined as the highest, lowest and most common location descriptively. Results: A total of 257 patients (126 male and 131 female) were included. The highest level of conus medullaris was in T11-T12 vertebrae (five patients). There were 12 patients in T12 vertebrae, T12–L1 in 86 patients, L1 in 62 patients, L1–L2 in 76 patients, and L2 in 12 patients. The lowest level was in between L2 and L3 vertebrae in 4 patients. Gender and age had no association with conus medullaris level. Conclusion: The lowest level of conus medullaris was in between L2 and L3 vertebrae. The lumbar procedure such as punctures should be done below the L3 to avoid conus medullaris puncture trauma.