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Background : Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily attacks the respiratory system resulting to a disease called coronavirus disease 19 (COVID-19), several studies also reported the involvement of the central nervous system along the course of the disease, one of which manifest as encephalitis. This study aims to determine the clinical profile, laboratory, and imaging results of encephalitis associated with COVID-19.Methods : Three databases namely, PubMed / Medline, Embase, and Scopus were systematically used in the search for this literature, in order to gather case reports and case series related to COVID-19-associated encephalitis published from January 1, 2019 to July 20, 2020.Result: There were 24 studies with 33 cases included in this review. The most reported neurological symptoms were disorientation / confusion (72.72%), decreased consciousness (54.54%), and seizures (27.27%). The laboratory examination showed an increase in the levels of C-reactive protein (48.48%), lactate dehydrogenase (30.3%), and lymphophenia (27.27%). The brain imaging examination did not show any pathological findings in half of the cases (51.51%). EEG (electroencephalography) showed a generalized decrease in 45.45% of the cases. The CSF analysis showed an increase in the levels of protein (42.42%) and lymphocytosis (24.24%). Positive cerebrospinal fluid polymerase chain reaction (PCR) was only found in 3 cases, while the most widely used pharmacological agent was hyroxychloroquine (48.48%). Intravenous steroids were given in 8 cases, while immunotherapy such as plasmapheresis and intravenous immunoglobulin were given in 10 cases. Fifteen patients were reported to be discharged from the hospital in stable conditions, while four mortality cases were recorded. Conclusion: The clinical, laboratory, and imaging findings in this review supported the hypothesis that the process of cytokine-immune mediated inflammation was the cause of cerebral damage in COVID-19-associated encephalitis, rather than direct invasion. However, due to the limited availabile facilities in this study, further research and examination are needed to confirm the hypothesis

Background Intravenous thrombolysis is the current therapy of choice in patients with acute ischemic stroke (AIS). While highly effective, the rate at which the procedure is employed is low. Studies evaluating the causes withholding thrombolytic treatment in developing nations remain scarce. We aim to determine the factors withholding thrombolytic treatment in AIS patients. Methods This is a retrospective study of AIS patients at Siloam Hospitals Lippo Village, Indonesia, in a 10-month period between April 2019 to February 2020. Patient data were collected from the medical records. Results One hundred and forty-five cases of AIS were found within a 10-month period (April 2019 to February 2020). Thrombolysis was performed in 6.90% of all patients with AIS (21.28% when adjusted for eligible patients with onset ≤ 4.5 h). Prehospital delay exceeding 4.5 h was the most common cause of withholding thrombolytic treatment (68.28% of patients present above 4.5 h or with unknown onset). Among patients presenting ≤ 4.5 h, causes withholding thrombolysis include clinical improvement (35.14%), mild non-disabling symptoms (32.43%), patient/family refusal (18.92%), extensive infarction (5.41%), seizures at onset (2.7%), as well as history of acute bleeding diathesis (2.7%) and gastrointestinal bleeding (2.7%). Conclusions Prehospital delay constitutes the primary obstacle toward receiving thrombolytic therapy for AIS, especially in developing countries. Among patients with onset below 4.5 h, other notable causes include clinical improvement, mild non-disabling symptoms, and patient/family refusal. Of note, the rate of patient/family refusal in our study was much higher compared to previous findings, which may reflect possible socio-economic, communication, or educational issues.

<p><strong>Background: </strong>The main feature of COVID-19 is symptoms of respiratory system disorder, however, there has been an increase in reports of neurological symptoms that appear in COVID-19 patients. Several previous studies have linked SARS-CoV-2 with nervous system damage. Research studying neurological complaints in  confirmed COVID-19 patients in Indonesia is still lacking</p><p><strong>Aim: </strong>To identify neurological, laboratory, and imaging findings in COVID-19 patients with neurological symptoms.</p><p><strong>Methods: </strong>This study was a cross-sectional observational study conducted at Siloam Hospitals Mampang, a COVID-19 referral hospital in South Jakarta. We analyzed medical records of confirmed COVID-19 patients during the period of April - July 2020. The data collected included demographic data, comorbidities, neurological manifestations, laboratory examinations, and neuroimaging.</p><p><strong>Results: </strong>There were 22 confirmed COVID-19 patients with neurological complaints referred to a neurologist. The mean age of patients was 60.4 (SD 15.8) years. The most common neurological complaints were altered mental status (50%), hemiparesis (27.3%), and tremors (22.7%). More than half of the patients (81.8%) had a comorbid condition or past history related to neurological symptoms. Laboratory examination results showed increased NLR (neutrophil-lymphocyte ratio) (50%), anemia (45.5%), and leukocytosis (40.1%). The most common neuroimaging feature was infarct (50%) in the brain CT scan.</p><p><strong>Conclusion: </strong>The neurological complaints in COVID-19 patients are mostly associated with exacerbation of pre-existing comorbidities as a result of the severe inflammatory process triggered by COVID-19. Further research is needed to establish the mechanism of nervous system dysfunction in COVID-19.</p>

Thymectomy is a common procedure performed in cases of myasthenia gravis (MG) with a thymoma or general MG that does not improve with medical therapy. This procedure is usually preceded by plasmapheresis to prevent the occurrence of myasthenic crisis and improve clinical outcome after thymectomy. Early-onset MG has a different phenotype than late-onset MG. So far, the effectiveness of plasmapheresis followed by thymectomy in early-onset MG remains unclear because of the conflicting results of previous studies. We present 5 early-onset MG patients who underwent plasmapheresis followed by thymectomy in the 2007–2020 period. Follow-up was done 1 year after thymectomy. We describe clinical features and postoperative data and evaluate the clinical outcome after thymectomy. Muscle strength was assessed by the Medical Research Council scale. Evaluation of clinical stage before and after thymectomy were carried out with the modified Osserman classification. All patients showed improvement (100%) in the clinical grade of the modified Osserman classification: 3 patients were in the complete remission category and 2 patients were in the improved category. All patients with general weakness experienced improvement in muscle strength at the 1-year evaluation.