Background The coexisting of transposition of the great arteries (TGA) with total anomalous pulmonary venous connection (TAPVC) is one of the rare anomalies. The incidence of coexisting TAPVC and TGA is unknown with very few cases ever reported. Case presentation We reported a case of a 13-month-old female toddler with history of cyanosis. Echocardiography revealed atrioventricular ambiguity with pulmonary atresia, all PVs drain into the innominate vein via vertical vein (VV), ostium secundum atrial septal defect (ASD) and ventricular septal defect (VSD) were observed. The CT scan confirmed co-occurrence of TGA and TAPVC. All four confluence PVs behind the small left atrium (LA), drains into an ascending lateral large VV, coursing to innominate vein without any PV access into LA. The superior vena cava, right atrium and right ventricle (RV) were dilated. The RV is the origin of the aortic root. The aorta continues on the right side, with an arterial connection to the right pulmonary aberrant artery at the level of the aortic arch. Main pulmonary artery originates from LV and appears atretic with only connection to the left pulmonary artery. Large ASD and VSD were identified. Conclusions TGA and TAPVC are a rare combination and should be suspected in mild-cyanotic cases with levocardia with situs solitus. CT angiography is one of the modalities of choice to characterize the vasculature anomalies.

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Background: Intracranial hemorrhage is a complication of head injury. The initial assessment of the consciousness using Glasgow Coma Scale (GCS) shows severity level of head injury since arriving to the hospital. The GCS score is also known to have association with the presence of intracranial bleeding caused by head injury. This finding helps doctor lived in rural area with no facility of computed tomography (CT) scan to predict the intracranial haemorrhage by assessing the level of consciousness correctly using GCS score. Methods: This study is an observational analytic study using a cross-sectional design. The research was conducted in Dr. Moewardi Hospital for 6 months starting from July to October 2020. The population was all patients with head injury and were then examined by CT scan of head. The 61 subjects were established through the inclusion and the exclusion criteria. Results: There were 61 patients in this study. The reliability test of CT-Scan instrument used Kappa-Cohen test which showed the K value of 0.875 with p < 0.001. The finding of moderate-severe head injury (GCS score 3-12) was associated with the increased risk of intracranial bleeding in head CT scan by 20.70 (5.58-76.77) times significantly higher (p < 0.001). Conclusion: There is significant relationship between the patient's level of consciousness represented by Glasgow Coma Scale (GCS) and the intracranial bleeding based on the head CT scan in the patients with head injuries

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Background: Covid-19 vaccination has reached more than 132 million people in Indonesia since its first outbreak in March 2020. However; its effects on immunity are still lack of evidence. Covid-19 cases reached a significant increase in June 2021 and decreased in November 2021. In early 2022; it again recorded an increase. Seeing this phenomenon; this study investigates the differences of Covid-19 Patients’ severity levels over their vaccination status. Objective: This study examines the differences of severity level of chest x-ray imaging in covid-19 patients treated at Dr. Moewardi Hospital in three periods of time. Methods: A total of 89 covid-19 cases were collected from 3 different vaccination status: (1) 30 non-vaccinated patients (group A); (2) 30 patients treated for covid-19 after 1-3 months post-vaccination (group B); (3) 29 treated for covid-19 after more than 6 months post-vaccination (group C). Patients with type-II diabetes mellitus; heart failure or autoimmune disease were excluded. Severity level is based on chest x-ray examination by calculating the Brixia score by 3 examiners. All assessment results were analysed using the Kruskall-Wallis test followed by the Mann-Whitney post-hoc test. Results: A total of 8 male (26.7%) and 22 female (73.3%) patients in group B had lower Brixia scores with mean score 2.94 + 0.25 compared to 29 patients (55% male and 45% female) in group C with mean score 4.90 + 0.27 with a significant difference (p = 0.001). The Brixia score with the highest average was found in group A (non-vaccinated) with mean value 5.77 + 0.31 showing a significant difference from groups B and C (p<0.05). Conclusion: Vaccine administration status showed different Brixia scores; whereas longer duration from vaccination showed higher score. Unvaccinated patients recorded the most severe condition. Booster vaccination is strongly recommended to obtain the best immunity level.