Background In patients who are critically ill with COVID-19, multiple extrapulmonary manifestations of the disease have been observed, including gastrointestinal manifestations. Case presentation We present a case of a 65 year old man with severe COVID-19 pneumonia that developed hypercoagulation and peritonitis. Emergent laparotomy was performed and we found bowel necrosis in two sites. Conclusions Although rare, the presentation of COVID-19 with bowel necrosis requires emergency treatments, and it has high mortality rate.

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Introduction: Cleft lips (CL) and cleft palate (CP) are common congenital diseases caused by gene mutation in embriology development of the lips and mouth at 4 weeks of gestation. CL and CP can cause several problems such as difficulty in eating, speaking, abnormality in teeth and mouth development and ear iritation. Adequate treatment is needed to improve patients’ quality of life. Material and Method: This cross sectional study take samples purposively from all parents who joined in cleft charity surgery in Kencana Hospital, Serang, Banten on October 24th 2018. This study identify parents’ knowledge, attitude and behaviour towards CL and CP and analyzed the relationship of parents’ knowledge and attitude towards CL and CP. Statistical analysis used in this study is Fisher method. Result: Ten patients undergo labioplasty surgery, 1 patient undergo labioplasty revision, 5 patients undergo palatoplasty surgery and 10 patients undergo labioandpalatoplasty surgery. The majority of parents’ education background have income < 3,5 million a month 84.6% (22 people), do not have any social insurance 88.5% (23 people) and joined in because of they cannot pay for medical treatment 96,2% (25 people). 6.2% (25 people) have under knowledge, 69.2% (18 people) have good attitude and 84.6% (22 people) have good behaviour toward CL and CP. There is no significant relationship between parents’ knowledge and attitude toward CL and CP P value = 1,00 (P > 0,05). Discussion: Parent's under knowledge is caused by their low educational background and inaccurate information and education provided by medical professional. But, they had a good attitude and behaviour toward CL and CP because they had initiative to look for medical help and treat their children same as other normal one. Although they received inaccurate information and education about cleft disease, all parents looked for medical help and did what they were told by medical professionals. Conclusion: The majority of parents in this study have under knowledge about cleft lips and cleft palate but they are still looking for medical help to treat their children. This charity significantly helps parents whose children have cleft lips, with or without cleft palate, to get treated in that area.

BACKGROUND <br />Burns constitute a severe health problem in many countries. In Indonesia burns rank 4th of all trauma-related diseases and are a burden on the country’s health system. Adequate fluid resuscitation is the initial management of burns that determines the success of treatment. This study aimed to determine the relationship between adequate fluid resuscitation and incidence of acute renal failure in burn patients. <br /><br />METHODS<br />A retrospective study of cross-sectional design was conducted on 30 burn patients who came to the Emergency Unit (ER) from January 2015-December 2017. Medical records were reviewed to examine the data on fluid resuscitation according to the Parkland formula and the laboratory data. Acute renal failure was defined as a creatinine level of more than 2.1 mg/dL after 7 days. Hypoalbuminemia was defined as an albumin level of less than 3.4 g/dL. Fisher’s exact test was used to analyze the data.<br /><br />RESULTS<br />Twenty-two subjects received fluid resuscitation according to the Parkland formula and 8 did not. Twenty-five experienced complications such as acute renal failure (ARF) (13.3%), hypoalbuminemia (46.7%) and a combination of ARF and hypoalbuminemia (23.3%). One person died. Adequate fluid resuscitation was significantly associated with decrease incidence of ARF (p=0.015), but not significantly with hypoalbuminemia (p=0.214) and with mortality (p=0.267).<br /><br />CONCLUSION<br />Adequate fluid resuscitation decreased the incidence of ARF in burn patients. Consensus protocols for initial burn resuscitation and treatment are crucial to avoid the consequences of ARF after burn injury.

BACKGROUND: MicroRNA (miRNA), short noncoding RNA, plays role in various physiological process such as aging through epigenetic regulation of gene expression. miRNA present intracellular as well as extracellular in body fluids. miRNA that present in blood circulatory system is often referred as circulatory miRNA (c-miRNA). A number of studies trying to identify c-miRNAs as biomarker for ageing have been reported, but majority did not yield results that corroborate one with another. This study reports the identification of a differentially expressed c-miRNAs between elderly and youth groups of individuals, the first step in tracking specific miRNAs that play role in physiologic ageing.METHODS: The miRNA expression profiles of grandfathers and grandsons from 2 Javanese families were compared to select 5 miRNA candidates with widest expression difference. The 5 candidates were subjected to validation using quantitative polymerase chain reaction (qPCR) in 11 elderly men and 9 young men of the same ethnicity to identify differentially expressed miRNA between elder and younger male groups in the represented population.RESULTS: Amongst 5 selected c-miRNA candidates, the hsa-miR-376c-3p was validated to be upregulated in the elderly group when compared to the young individuals. Bioinformatic analysis using miRTarBase 7.0, miRTargetLink Human and GeneCards® Human Gene Database suggest the involvement of hsa-miR-376c-3p in pathways relevant with cellular ageing.CONCLUSION: This study showed that hsa-miR-376c-3p in the circulating plasma to be significantly upregulated in a group of elderly Javanese males compared to their younger counterparts. The results of this study warrant further study to elucidate the specific role of hsa-miR-376c-3p in physiologic ageing mechanism.KEYWORDS: circulating, microRNA, miR-376c-3p, elderly, Javanese, male