Female 19-year old with severe general neuroparalytic, admitted in intensive care unit with respiratory failure. He suffer from snake bite during night sleeping  2 hours before arrived in emergency unit of RSCM hospital. In early after snake bite, patient complained nausea, dizziness, limb parasthesia then felt uncomfortable eyesight. During observation in emergency unit anti venom serum (AVS) was given immediately 2 vial (10 ml) in 250 ml normal saline for an hour and then 2 vials in 250 normal saline in 3 hours ,but about 3 hours post bitten, patient suffer from ptosis, opthalmoplegia and quadriplegia, respiratory shortness followed by respiratory arrest. We diagnosed it as respiratory failure and neuromotoric paralytic  ec. snake  venom intoxication. After intubation and second   dose AVS, patient moved to ICU for mechanical ventilation support and further treatment. We did CVVHDF for three days,  AVS shcedulles 6 vials in 24 hours for 6 days.  Until 7 days stay in ICU there were neuroparalytic improvement but not progressively and patient still on ventilator. Pasmapharesis then  performed at 8thand 12th day in ICU. Weaning process going on smoothly and patient  extubated at 14th day. Patient discharged from ICU at 16th day with fully aware, normal heart rate and blood pressureand score muscle strength is 4 until 5. We concluded that the neurotoxin venom in this case destructed  vesicles presynaptic of nerve terminalmake resistant  to AVS and neostigmin. We suspect this patient was exposedto high dose and more toxic venom where  released continuously from bite site tissue or lymph circulation to blood and  threaten recovery process. Plasmapharesis improve neuroparalytic and sympathetic overactivity significantlyand decrease lenght of stay in ICU.

Dua jenis coronavirus yang diketahui menyebabkan penyakit yang dapat menimbulkan gejala berat seperti Middle East Respiratory Syndrome (MERS) dan Severe Acute Respiratory Syndrome (SARS). Untuk mengurangi lonjakan kasus Covid-19 adalah memberikan vaksin COVID – 19. Pada survei awal pada mahasiswa-mahasiswi mempunyai permasalahan dengan efikasi tidak terjadinya infeksi setelah vaksinasi. Tujuan penelitian untuk mengetahui tingkat efikasi mahasiswa-mahasiswi FK UISU untuk tidak terinfeksi COVID-19 setelah vaksinasi. Jenis Penelitian yang digunakan adalah bersifat deskriptif dengan metode studi cross-sectional dimana didapatkan sampel 80 orang dari angkatan 2018, 2019, dan 2020 yang diambil dengan metode stratified random sampling yang artinya diambil secara acak berstrata (tingkat) menggunakan uji analisa univariat sehingga dapat disimpulkan bahwa responden dengan efikasi tinggi 42 orang (52,5%), efikasi sedang 33 orang (41,2%) dan efikasi rendah 5 orang (6,3%).

This case report talking about a female 56 yo with Multiple Myeloma (MM) suffer from Pneumonia and Acute Kidney Injury (AKI). MM is haematology cancer produce free light chain that impair renal tubulus, cause anemia, bone lesion and hypercalcemia. This patient came to hospital withsevere pneumonia, acute kidney injury andsevere hypercalcemia. In intensive care unit supported by mechanical ventilation, diuretic, antibiotics administration,haemodialysis,vasoactive agents, bisphosphonat and others.The acitenobacter baumanni was identified from sputum culture and then developed become multidrugs resistant leading to septic syock and multi organs dysfunction and death in two weeks.