Effectiveness of permethrin standard and modified methods in scabies treatment Abstrak Latar belakang: Permetrin adalah obat pilihan untuk terapi skabies tetapi memiliki efek samping eritema, nyeri, gatal dan rasa menusuk. Pengobatan standar dengan mengoleskan permetrin ke seluruh tubuh menimbulkan ketidaknyamanan sehingga timbul pemikiran memodifikasi metode pengobatan skabies dengan cara mengoleskan permetrin di lesi saja diikuti mandi dua kali sehari memakai sabun. Tujuan penelitian ini untuk mengetahui efektivitas permetrin metode standar dibandingkan dengan metode modifikasi dalam pengobatan skabies. Metode: Penelitian eksperimental ini dilakukan di sebuah pesantren, Jakarta Timur dan pengambilan data dilakukan pada bulan Mei-Juli 2012. Diagnosis skabies ditetapkan dengan anamnesis dan pemeriksaan kulit. Subyek positif skabies dibagi menjadi tiga kelompok: satu kelompok metode standar (permetrin dioleskan ke seluruh tubuh) dan dua kelompok modifikasi (permetrin hanya dioleskan di lesi diikuti mandi memakai sabun biasa dan sabun antiseptik). Ketiga kelompok dievaluasi setiap minggu selama tiga minggu berturut-turut. Data diolah dengan SPSS versi 20 dan dianalisis dengan uji Kruskal-Wallis.

Introduction: Opioid-free anesthesia (OFA) is an alternative to Opioid based anesthesia (OBA) which uses multimodal analgesia to replace opioids. However, its feasibility, safety, and exact recommended combination remain debatable. Case Series: We administered OFA in 5 types of elective ophthalmic surgeries under general anesthesia in ASA 1-2 adult patients (evisceration, ocular exenteration, periosteal graft, scleral buckling, vitrectomy, and dacryocystorhinostomy) to assess the feasibility of OFA. We gave preoperative Paracetamol and Pregabalin with Dexmedetomidine as a loading dose (1 mcg/kg in 10 minutes) and maintenance at 0.7 mcg kg-1 per hour. Induction was performed using Propofol 1-2 mg kg-1, Lidocaine 1-1.5 mg kg-1 IV, and Rocuronium. Before the incision, Dexamethasone and Ranitidine were given. Maintenance was done using Dexmedetomidine and Sevoflurane. Fentanyl was used as rescue analgesia if required. Dexmedetomidine was stopped 15-30 minutes before the procedure ended. Metoclopramide and Ketorolac were given as postoperative management. Throughout the procedure, our patients had stable hemodynamics, did not experience life-threatening bradycardia, and did not require rescue analgesia. All patients regained full consciousness and did not experience postoperative nausea and vomiting, emergency delirium, or coughing. Conclusion: Multimodal analgesia was an excellent intraoperative OFA regimen as an alternative to OBA and provided controlled hypotension in ocular surgery. Safe OFA is possible with combined analgesia regimens, strict intraoperative monitoring, and adequate anesthesia depth.

BackgroundThis review determined the effect of prone positioning in changes of partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio, partial pressure of carbon dioxide (PaCO2), mortality rate, ICU length of stay and duration of mechanical ventilation in intubated COVID-19 patients with severe ARDS.MethodsA computer-aided comprehensive electronic bibliographic search from MEDLINE, EMBASE, and Science Direct were conducted. The search comprised the articles written in English and intubated adults (≥ 18 years old) patients with COVID-19. The primary outcome was comparing PaO2/FiO2 ratio between prone and supine position group. Secondary outcomes were PaCO2, ICU discharge, and mortality rate. Review Manager version 5.4 (The Cochrane Collaboration) was used for statistical analyses of the included studies.ResultsA total of 7 articles were determined to be eligible, consisting of 1403 intubated COVID-19 patients with ARDS that showed prone position was associated with a higher PaO2/FiO2 ratio compared to supine position (MD 60.17, 95% CI 46.86 - 73.47; p < 0.00001). Four studies reported the PaCO2 measurement and showed no significant difference between prone and supine position (MD 2.07, 95% CI -2.79 - 6.92; p <0.40). Only two studies reported mortalities, one study had 262 deaths out of 648 patients (40.4%) and one study lost 11 out of 20 patients (55%). One study reported median ICU stay and mechanical ventilation duration (16 days) were significantly longer in prone position group.ConclusionThis meta-analysis showed that prone position improved PaO2/FiO2 ratio in intubated COVID-19 patients with ARDS.