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Indonesia has been fighting the COVID-19 pandemic since the beginning of March 2020, and it doesn’t look that the situation is getting better any soon. Besides the country’s current strategies to minimize the rising mortality rate, a novel therapeutic intervention is required. After a thorough search in several databases, we found stem cells to be a likely candidate. Regardless of the general use of stem cells, studies showed positive results regarding the efficacy of using these in lung injuries. Especially, mesenchymal stem cells (MSCs) are known for their easy accessibility and their diverse mechanisms of action, including MSCs immunomodulatory antiviral effect, and its ability to improve lung function. Moreover, some researches perceived these components to be applicable in COVID-19 patients with end stage acute respiratory distress syndrome (ARDS). While randomized clinical trials are still in progress, many case reports show MSCs to be an advantageous alternative to suppress the cytokine storm and help regulate the immune system. This review summarizes the common functions of MSCs and highlights its therapeutic assets to fully tackle this global pandemic. Key word: Mesenchymal Stem Cells; Cell Therapy; COVID-19; SARS-CoV-2; ARDS Abbreviations: COVID-19 – Coronavirus Disease; MSC – Mesenchymal Stem Cell; ARDS – Acute Respiratory Distress Syndrome Citation: Nugraha D, Kloping NA, Yudhawati R, Purwandhono A, Hidayati HB. A current update in COVID-19 associated acute respiratory distress syndrome: Focus on mesenchymal stem cell therapy. Anaesth. pain intensive care 2020;24(6):--- Received: , Reviewed: , Revised: , Accepted:

Background: Spinal cord injury is not only caused by trauma but also by non-trauma, such as spinal epidural abscess (SEA). Tuberculous SEA is a rare infectious disorder, a delayed diagnosis associated with morbidity and mortality. The problems of tuberculous SEA is not only infection but also neurological deficit, axial back pain, pathological fracture, deformity, and socioeconomic and psychogenic problem. There are a few cases of SEA caused by Mycobacterium tuberculosis, mostly caused by Staphylococcus aureus with decreasing body’s defense mechanism caused by a deficiency of vitamin D. This study aimed to evaluate the neurological recovery of non-traumatic spinal cord injury caused by spinal tuberculosis with spinal epidural abscess and vitamin D deficiency that treated with vitamin D as an adjuvant. Case Report: A 31-year-old female came to the orthopedic clinic with paraparesis ASIA grade C, axial back pain, and spinal deformity for three months, with vitamin D levels of 15.5 ng/ml. MRI showed epidural abscess at the level of the 10th-11th thoracic vertebrae, spondylodiscitis of the 10th-11th thoracic vertebrae accompanied by paraspinal abscess of the 8th thoracic vertebrae to the 1st lumbar vertebra. The diagnosis was confirmed by cultured and histopathological examination. The treatment was surgery, followed by anti-TB drugs and daily vitamin D 5000 IU for one year. After one year of follow-up, the patient returned to work without a neurological deficit and axial back pain. Conclusion: This report describes the importance of early diagnosis and proper treatment of spinal cord injury in tuberculous SEA with a deficiency of vitamin D.

Critically ill patients need to be treated quickly, carefully, precisely and comprehensively. Neurological status should be concerned because of the severe impact that occurs if it is not immediately handled, that is permanent disability or death. The neurologic problem like non convulsive seizures may not distinctly clear. It is difficult to assess non-convulsive seizure only by clinical physical examination. Continuous Electroencephalography (cEEG) is a useful to measure electrical brain activity. It could be used to identify seizure, cerebral ischemic, monitor and evaluate the medication, and prognostic of the diseases. This equipment is noninvasive and could give real-time information about the patient condition. The complex procedure and availability of skilled technician and competent reviewer, is the barrier to optimize this tools. Besides the benefit and challenge, cEEG is recommended to be used in critically ill patients’ management. Abbreviations used: ADR – Alpha to Delta Ratio; CBF – Cerebral Blood Flow; cEEG – continuous Electroencephalography; CNS – Central Nervous System; CT – Computed Tomography; DCI – Delayed Cerebral Ischemia; EEG – electroencephalography; GCS – Glasgow Coma Scale; ICU – Intensive Care Unit; MRI - Magnetic Resonance Imaging; NCS – Non-Convulsive Seizures; NCSE – Non-Convulsive Status Epilepticus; PAV – Percent Alpha Variability; PEDs – Periodic Epileptiform Discharges; RAV – Relative Alpha Variability; TBI – Traumatic Brain Injury; TCD – Transcranial Doppler Received: 19 Oct 2018Reviewed: 28 Oct 2018Accepted: 5 Nov 2018 Citation: Purwandhono A, Hidayati HB, Machin A, Islamiyah WR. Continuous electroencephalography (cEEG) monitoring in critically ill patients. Anaesth Pain & Intensive Care 2018;22 Suppl 1:S46-S52

Periodontal disease has been involved in a variety of systemic disorders and suspected as a potential risk factor for fetal growth restriction. Periodontal pathogenic bacteria may actively regulate embryonic development, implantation and placental trophoblast cell invasion. This study aimed to analyze the role of TNF-α, IL-10 and caspase-3 to maintain fetal growth in Porphyromonasgingivalis-infected pregnant rats. Female rats were infected with live-Porphyromonas gingivalis at concentration of 2x109 cells/ml into subgingival sulcus area of the maxillary first molar before and during pregnancy. They were sacrificed on gestational day (GD)-14 and GD20. The weight and length of placentas and fetuses were evaluated. The expression of TNF-α, IL-10 and caspase-3 in macrophages and trophoblast cells were detected by immunohistochemistry. On GD14, TNF-α (R2=0.416;P=0.000) and IL-10 (R2=0.187;P=0.012) had an important role to increase expression of caspase-3 in the placenta, but only TNF-α (R2=0.393;P=0.000 ) was able to increase the expression of caspase-3 on GD20. TNF-α and caspase-3 also had an important role (P<0.000) to decrease fetal weight, fetal length and placental weight on GD14 and GD20, but it was not the case with IL-10 (P>0.000). The increasing expressions of TNF-α and IL-10 did not only enhance immune protection, but also maintained the trophoblast cells survival by regulating expression of caspase-3. Porphyromonas gingivalis infection in maternal periodontal tissue can lead to decrease in placental weight, fetal weight and fetal length which mediated by increasing expression of TNF-α, IL-10 and caspase-3 in the placenta.