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The risk perception of COVID-19 among the respondents is not encouraging, hence more advocacy and public orientation must be done to curb further spread of COVID-19 in our setting.

The risk perception of COVID-19 among the respondents is not encouraging, hence more advocacy and public orientation must be done to curb further spread of COVID-19 in our setting.

Antibiotic resistance has been a long-debated topic since decades ago. The development of stronger, newer antibiotics, implementation of antibiotic stewardship and revised guidelines remain the main focus of our society to prevent resistancy. But is it really resistancy that cause higher mortality to patients with multidrug resistance (MDR) infections?

We conducted a cohort retrospective study from 2016 to 2019 in our Intensive care unit (ICU). Antimicrobial susceptibility test (AST) results were analyzed for their association with patient mortality outcomes.

Over the four-year period, 381 positive bacterial cultures were analyzed and 51% of them grew MDR pathogens upon their first culture. The overall mortality rate was 19% (38/195), and there was no significant association between MDR and mortality;

0.387. A strong association was however found between patients with medical cases with an OR 1.76; CI 1.76-2.55;

0.003 and those with APACHE scores ≥20 upon admittance to the ICU, OR 1.32; CI 1.68-8.29;

0.001.

Resistancy is not the true cause of mortality. Infection by resistant microbes does not necessarily mean the worst outcome since virulency is the actual cause of pathogenicity, and thus mortality.

Resistancy is not the true cause of mortality. Infection by resistant microbes does not necessarily mean the worst outcome since virulency is the actual cause of pathogenicity, and thus mortality.

Development a granuloma model resembling latent tuberculosis

is needed with a fast and efficient time to be used as an effective therapy. This study aimed to form efficient granulomas, increase cellular immunity and humoral immunity, and evaluate growth on media using recombinant protein antibody Ag38kDa, Rifampicin, and a combination of both. Peripheral Blood Mononuclear Cell (PBMC)

is derived from a healthy individual separated from monocytes and lymphocytes.

Monocytes are matured into macrophages and then combined macrophages and lymphocytes to the Roswell Park Memorial Institute (RPMI) medium. Flow cytometry analysis was used to count the number of cells, and cytokine levels were measured using ELISA. The result from the treatment was planted on the Lowenstein-Jensen medium.

Granulomas-like aggregates was formed after one-day post-infection with

(

). A significant increase in immune response occurred in the number of macrophages, Th1, and Tregs in the combination group compared to the

infection group. The number of Th2 and Th17 cells in the combination group was compared with the control but not significantly. TNF-α cytokine levels increased in the combination group compared to

infection, while in IL-4, we found between all groups, there was no significant difference. Bacterial colonies on culture in the Lowenstein-Jensen medium were only seen in positive controls.

Our study concluded that administration of a combination between Ag38kDa recombinant antibody and rifampicin could inhibit granuloma formation and enhance immune response.

Our study concluded that administration of a combination between Ag38kDa recombinant antibody and rifampicin could inhibit granuloma formation and enhance immune response.

Minangkabau is the majority ethnic group in West Sumatra, Indonesia. West Sumatra is a disaster area, especially earthquakes and the potential for a tsunami. Allele frequency for 21 short tandem repeat locus and genetic variation are not well known. This data is essential for calculating the Paternity Index and Match Probability for forensic identification.

This was an observational study. We analyze the GlobalFiller STR loci in 25 unrelated individuals from Minangkabau ethnic group. The DNA was extracted using a Prefiller kit and amplified with a Global Filler kit by a GeneAmp PCR System, followed by capillary electrophoresis using ABI Prism 3500 Genetic Analyzer. Data analysis was performed by using Easy DNA and FORSTAT software.

We observed 162 alleles with allele frequencies between 0.02 - 0.36. The highest expected heterozygosity and the highest power of discrimination were at the SE33 loci, and the highest match probability was at the D2S441 locus. The Chi-square test showed that all STR loci followed Hardy-Weinberg equilibrium (p > 0.05). All loci were highly polymorphic (PIC > 0.5). The combined discrimination capacity of each locus in the population was 99,999%.

The 21 STR loci are useful for forensic analysis and population genetic studies of the Minangkabau population.

The 21 STR loci are useful for forensic analysis and population genetic studies of the Minangkabau population.

The recognized pattern of cervical lymph node metastasis (CLNM) of papillary thyroid carcinoma involves a stepwise route. Contralateral lymph node skip metastasis is very rare. In addition, the patient in our case report also suffered from a breast carcinoma accompanied by left supraclavicular lymphadenopathy, which made it difficult to distinguish the origin of the CLNM. Based on this case, we recommended that more detailed physical and imaging examinations are needed for patients with uncommon cervical lymphatic metastasis of primary cancer.

A 53-year-old women was admitted to the hospital for a neck mass in the left cervical region that had existed for 2 mo. The neck mass was suspected to be an enlarged lateral LN originating from papillary thyroid microcarcinoma of the contralateral thyroid lobe, according to ultrasound and ultrasound-guided fine needle aspiration biopsy. The patient underwent total thyroidectomy and radical cervical LN dissection. Postoperative pathology confirmed the diagnosis of papillary thyroid microcarcinoma with contralateral lymphatic skip metastasis. Unfortunately, a breast cancer was discovered 4 mo later, which was accompanied by ipsilateral supraclavicular LN metastasis. She accepted neoadjuvant chemotherapy and subsequent left modified radical mastectomy for treatment. The patient is currently receiving postoperative radiotherapy, and no local recurrence was observed in the 6-mo follow-up after surgery.

We present a rare case of papillary thyroid microcarcinoma with contralateral lymphatic skip metastasis and breast cancer with supraclavicular lymphatic metastasis.

We present a rare case of papillary thyroid microcarcinoma with contralateral lymphatic skip metastasis and breast cancer with supraclavicular lymphatic metastasis.

The airways of patients undergoing awake craniotomy (AC) are considered "predicted difficult airways", inclined to be managed with supraglottic airway devices (SADs) to lower the risk of coughing or gagging. However, the special requirements of AC in the head and neck position may deteriorate SADs' seal performance, which increases the risks of ventilation failure, severe gastric insufflation, regurgitation, and aspiration.

A 41-year-old man scheduled for AC with the asleep-awake-asleep approach was anesthetized and ventilated with a size 3.5 AIR-Q intubating laryngeal mask airway (LMA). Air leak was noticed with adequate ventilation after head rotation for allowing scalp blockage. Twenty-five minutes later, the LMA was replaced by an endotracheal tube because of a change in the surgical plan. After surgery, the patient consistently showed low tidal volume and was diagnosed with gastric insufflation and atelectasis using computed tomography.

This case highlights head rotation may cause gas leakage, severe gastric insufflation, and consequent atelectasis during ventilation with an AIR-Q intubating laryngeal airway.

This case highlights head rotation may cause gas leakage, severe gastric insufflation, and consequent atelectasis during ventilation with an AIR-Q intubating laryngeal airway.

Myoepithelial carcinoma (MC) is a clinically rare malignancy, there is controversy regarding its etiology and its biological behavior is not fully elucidated. Extensive surgical resection is the main treatment method. We describe a case of pleomorphic adenoma (PA) with multiple postoperative recurrences after malignant transformation, and the history of the disease in this patient was more than 20 years. Complete resection during the first surgery of PA and long-term postoperative follow-up is necessary.

A 34-year-old male with PA and a history of 5 postoperative recurrences over 21 years, each surgically removed, presented 15 d ago with headache, nasal congestion, protrusion of the right eyeball and loss of vision in the right eye, with progressively worsening symptoms. The patient underwent surgery, and MC was confirmed by pathology examination. A small PA component was locally visible under light microscope. The patient had a recurrence of the tumor 2 mo after surgery and underwent surgical resection.

During the first operation for PA, care should be taken not to rupture the envelope to prevent tumor cell implantation, and when complete resection is not possible due to the anatomical site, postoperative radiotherapy is necessary to control the lesion and prevent infiltration and malignant transformation of the tumor to MC. Computed tomography and magnetic resonance imaging is important for establishing diagnosis and developing a treatment plan.

During the first operation for PA, care should be taken not to rupture the envelope to prevent tumor cell implantation, and when complete resection is not possible due to the anatomical site, postoperative radiotherapy is necessary to control the lesion and prevent infiltration and malignant transformation of the tumor to MC. Computed tomography and magnetic resonance imaging is important for establishing diagnosis and developing a treatment plan.

The incidence of cervical pregnancy is increasing due to the recent widespread application of assisted reproductive technology. Although hysterectomy has been a treatment option, high-sensitivity human chorionic gonadotropin testing and improved accuracy of transvaginal ultrasound imaging have increased possibility of uterine preservation. Fludarabine Dilation and curettage with methotrexate therapy and uterine artery embolization have been reported as treatments with fertility preservation; however, certain disadvantages limit their use.

In our two reported cases, we avoided massive bleeding and immediately resumed infertility treatment using ultrasound-guided local ethanol injection for cervical pregnancies with fetal heartbeats.

This treatment may be a new fertility-preserving option for cervical pregnancy.

This treatment may be a new fertility-preserving option for cervical pregnancy.

Del(5q) is the most common molecular event in myelodysplastic syndrome (MDS), accounting for 10%-15% of cases. Inv(3) is an adverse cytogenetic abnormality observed in less than 1% of MDS patients. Few studies have reported the coexistence of del(5q) and inv(3) in MDS. Therefore, the pathological mechanism, treatment strategy and prognosis of this subtype need to be elucidated.

A 66-year-old woman was admitted to the hospital due to chest tightness and shortness of breath. Combining clinical assessments with laboratory examinations, the patient was diagnosed with MDS containing both del(5q) and inv(3). Considering the deletion of chromosome 5q, we first treated the patient with lenalidomide. When drug resistance arose, we tried azacitidine, and the patient had a short remission. Finally, the patient refused treatment with haematopoietic stem cell transplantation and died of severe infection four months later.

MDS patients with del(5) and inv(3) have a poor prognosis. Azacitidine may achieve short-term remission for such patients.