The current Covid-19 pandemic has limited all activities outside the home. This condition encourages optimal use technology as an alternative option especially in the implementation of the teaching and learning process. It is not only economic factors that are affected even the education aspect is currently experiencing an adjustment in the learning process. 100% of face-to-face learning is replaced by online systems and assignments system. This research used a descriptive qualitative design, completed by textual and contextual studies. Data collection was carried out through literature study and observations. In this paper, the researchers compare the impact of e-learning and direct learning on the Cello Major course at Universitas Negeri Surabaya during the Covid-19 Pandemic. The results showed that direct learning provided more detailed accomplishments than e-learning, in the Cello Major course. The results of this research focus on four main discussion points. The first is in learning cello technique and the second is the tone production material. The third is the evaluation process of practical learning and the fourth is the duration of learning. All data results were obtained from direct and online practice test periods. Referring to these data, we can compare the level of learning effectiveness especially in Cello Major practice. So, it is necessary to evaluate in the future for adaptation in developing new methods in welcoming life in the new normal era.

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The silhouette sign is a commonly used radiological terminology, useful in diagnosis. The term is a misnomer and the loss of silhouette sign is what is to be mentioned. Whenever there is a loss of silhouette sign in a chest radiograph the differential diagnosis of consolidation, pleural effusion, collapse. etc., needs to be considered.

We report a case of coronavirus disease 2019 (COVID-19) infection in a patient with multiple comorbidities diabetes, hypertension, ischemic heart disease, and chronic liver disease. Although pleural effusion is rarely seen in COVID-19 infection, the presence of which should be interpreted carefully. In this case report, our patient presented with complaints of fever, cough, and dyspnea, and focused clinical examination revealed fullness in the left hemithorax compared to right; reduced chest movements in the left hemithorax and trachea deviated to the right; dullness in the left hemithorax and right infrascapular, infra-axillary, and mammary area; and absent breath sounds in areas where dullness was noted. A chest X-ray done revealed left massive pleural effusion with right mild pleural effusion and pleural fluid analysis on both sides revealed transudate picture; this was also similar to the ascitic fluid analysis that was done in this patient; at this point of time, a computed tomography of the thorax was done to rule out other causes of pleural effusion. Meanwhile, other laboratory investigations revealed evidence of liver cell failure showing hyperbilirubinemia, hypoalbuminemia, and deranged prothrombin time and international normalized ratio (INR) and imaging evidence of cirrhotic liver; the patient was treated accordingly. Therapeutic pleural tapping was done after INR normalized; the patient improved symptomatically. Pleural effusion although is a rare manifestation of COVID-19, the etiologies are varied, it is important for us to consider other possible comorbidities associated in a patient who is hospitalized for acute illness, in this case, the patient had multiple comorbidities such as diabetes, hypertension, ischemic heart disease, and chronic liver disease, and the cause for pleural effusion is attributed to decompensated chronic liver disease and ischemic heart disease. In this case, the acute infection has resulted in the decompensation of his preexisting chronic disease.