Indonesia had the second-highest number of COVID-19 cases and deaths in South-East Asia. We aimed to determine the factors associated with this mortality and the effect of the recommended COVID-19 treatment regimen during the first 10 months of the epidemic. This was a retrospective cohort study using secondary data from medical records. In total, 689 adult COVID-19 inpatients hospitalized between March and December 2020 were enrolled. Clinical characteristics, laboratory parameters, and treatments were analyzed by survival outcome. Kaplan-Meier statistics were used to estimate survival. Of the 689 patients enrolled, 103 (14.9%) died. Disease severity was highly associated with mortality (hazard ratio [HR]: 7.69, p < 0.001). Other clinical factors associated with mortality were older age and comorbidities. Based on laboratory parameters, higher procalcitonin and C-reactive protein contents and a neutrophil-to-lymphocyte ratio >3.53 were also linked to mortality. Favipiravir was associated with lower mortality, with adjusted HRs of 0.24 (0.11-0.54) and 0.40 (0.17-0.98) among the mild/moderate and severe cases, respectively. Among patients with severe disease, steroids showed some beneficial effects in the early days of hospitalization. Older age and comorbidities were associated with disease severity and, consequently, higher mortality. Higher mortality after the second week of hospitalization may be related to secondary bacterial infection. Favipiravir showed significant benefit for COVID-19 survival, while steroids showed benefit only in the early days of admission among patients with severe disease. This research did not receive a specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Background: Conjoined twin management, especially separation surgery, is a complex procedure which requires multidisciplinary work in the perioperative period. This complexity further increased with the COVID-19 pandemic, where social distancing protocols and the general reduction in non-COVID-19-related health-care services added a new dimension to the modern form of teamwork. Methods: This study focused on the process of preparation for conjoined twin separation surgery during the pandemic from March 2020 to May 2022 with pre-pandemic era comparison. We described the decision-making process and the available facilities in terms of equipment, human resources, and the inclusion of information and technology. Results: Among the essential requirements for separation surgery are doctors from various disciplines, pediatric anesthesiologists, nurses from different specialties, radiologists, rehabilitation specialists, nutritionists, pharmacists, psychologists, social workers, public relations, and information and technology staff. The team composition may change depending on the patient’s clinical characteristics and social needs. Surgery preparation consists of a prognostication period, preoperative management, surgery, and discharge. Conclusion: Complex surgery such as conjoined twin separation can be managed effectively by a team of multidisciplinary experts. The application of information technology, to manage changes in multidisciplinary work pre- and post-pandemic, can reduce pandemic-related social restrictions while maintaining effectiveness and increasing efficiency.

Background: The ability to predict the prognosis of a disease and anticipate death is valuable for patients and families especially in an acute care setting for chronically ill patient. Multiple scoring systems are used to measure disease progression and predict hospital mortality in patients with life-threatening illnesses, taking into account acute conditions, catastrophic events, and slow decline. Aim: Our primary aim is to assess palliative performance score (PPS), early warning score (EWS) and local rumah sakit Dr Hasan Sadikin (RSHS) score to predict 14 days in-hospital mortality. Methods: This was a single-center prospective cohort study from November 2022 to April 2023. Patients with World Health Organization category of terminal illnesses were scored using PPS, EWS and RSHS score and were followed up for 14 days in hospital. Multivariate analysis were conducted and The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were used. Results: A multivariable model was calculated using Cox regression. The final model results indicate that EWS (HR: 2.9, 95% CI: 1.1– 7.7) and a decrease in consciousness (HR: 3.6, 95% CI: 1.2– 10.22) were statistically significant in predicting mortality. Discussions: Most patient in the cohort that died had cancer and were admitted in the previous 6 months. Relying solely on single prediction may not provide enough accuracy, within a 14-day timeframe. Therefore, the results of multivariate analysis were not statistically significant due to Several factors contribute to the complexity of this prediction challenge. As a multifaceted disease with varying stages, treatments, and outcomes, cancer presents a diverse landscape of patient experiences. Conclusion: EWS and decreased consciousness are significant predictors of in-hospital mortality. It is crucial in clinical setting to use multiple indicators to predict death and improve patient care.

Lunar New Year and Eid al-Fitr are national holidays, and mass movement of people is seen. Lunar New Year 2020 potentiated the spread of coronavirus disease 2019 (COVID-19), while Eid al-Fitr 2022 was a test for federal management of COVID-19 and the success of the Indonesian vaccination campaign. Analysis of new confirmed cases, hospitalizations and the number of elective surgery cancellations due to positive polymerase chain reaction screening in the pre-operative period provides a snapshot of herd immunity.

Background: In-hospital cardiac arrest (IHCA) is a critical emergency, occurring at rates of 1– 6 events per 1000 hospital admissions, necessitating immediate and efficient resuscitation efforts. This study aims to determine the frequency, demographic characteristics, and outcomes of Code Blue activations in a tertiary teaching hospital in a low-middle-income country. Methods: This retrospective observational study was conducted at in National Referral and Teaching Hospital in a middle income country in Asia, covering data from January 1, 2017, to December 31, 2023. The study included 2184 Code Blue activations, with data on Early Warning Scores (EWS) and palliative scores available from 2021 onwards. Statistical analyses were performed to evaluate the relationship between these scores and patient outcomes. Results: Out of 2184 Code Blue activations, 713 cases included both EWS and palliative scores. The highest number of activations was recorded in 2019 (535 cases), and the lowest in 2021 (152 cases). Calculated incidence where 5.46 per 1000 visits. The return of spontaneous circulation (ROSC) rates ranged from 11% to 27.6%, with an average of 17.7% per year. The mean EWS and palliative scores for Code Blue activations were 9.2 (SD ± 2.3) and 7.8 (SD ± 1.9), respectively. Discussion: The findings highlight trends in IHCA incidence, causes, and outcomes, emphasizing the importance of early identification and management of patients at risk. The study underscores the need for continuous monitoring and early intervention, particularly for patients with high EWS. Additionally, the integration of palliative care considerations into hospital protocols is crucial for improving patient outcomes and resource allocation. Conclusion: Early warning system and palliative care scoring may predict code blue activation and if managed can reduce its number.