BACKGROUND: Coronavirus disease 2019 (COVID-19) is a disease related to coronavirus (SARS-CoV-2) which is categorized as Nidovirales order, family beta-coronaviridae. Coronavirus infects mainly the lung as well as other organs out of the lung. Extrapulmonary infection includes neurological infection such as the central nervous system, peripheral nervous system, and musculoskeletal with various symptoms. Recent study reported that 30% of patients had COVID-19-associated skeletal muscle injury. CASE PRESENTATION: A 78-year-old male with a history of stroke and Type 2 diabetes mellitus came to the emergency department with fever, shortness of breath, decrease of consciousness, joints, and muscles pain. Chest X-ray showed a consolidation in the mid-lower of the lung bilaterally, with prominent bronchovascular markings, polymerase chain reaction COVID-19 result comes out with positive 2 times with 10 days interval. The patient is treated with antibiotics, Avigan, azithromycin, and high-dose intravenous Vitamin C. In the 3rd ward day, the patient still has short of breathiness. However, fever and consciousness improve, but still complaining of pain in the shoulder joint, arm muscles, and knee joint. On the 11th inpatient day, the patient obtains full consciousness; dyspnea improved, no fever, however, the patient still complains of muscle and joint pain. At the end of the inpatient period fever, dyspnea and consciousness seem to be improved; however, the patient still complains of pain in the shoulder joint, arm muscles, and knee joint that not improved with an analgesic. The patient comes back to his home in good condition. CONCLUSION: COVID-19 patients may develop musculoskeletal symptoms such as skeletal injury or myalgia, and this is our first case of COVID-19 infection complicated with skeletal muscle injury.

The wake pattern of rest is one of the components of life an under a mind boggling, circadian, homeostatic association including different inherited and neurobiological framework. The rule of rest and mindfulness is the muddled collaborating circadian between subcortical neuromodulators on midbrain, brainstem, operational hub, basal forebrain, thalamus, cortex, physiological, and electrocortical states. two-process model of rest rule a homeostatic cooperation called the S cycle and a circadian collaboration called the C association. The S collaboration tends to an accepted drive to rest that increases constantly during mindfulness, and reduces legitimately during (non-REM) rest. Process C tends to a 24-hour oscillatory assortment in the affinity to rest. These two cycles were shown to anticipate rest time and length and the force of non-REM rest. Over the latest thirty years two models of the rest rule process have filled in as the crucially hypothetical construction in rest. The circadian rhythm bewildering that system controls limits generally through the body, including rest and mindfulness. At the cell level, characteristics proteins to control circadian rhythms however outside the cell level, light-faint regular clock commitment from the plot of retino-hypothalamic moved to the suprachiasmatic center (SCN).

Introduction: Status epilepticus is a neurological condition caused by a failure of body mechanism to terminate the seizures or the onset of abnormal seizure activity resulting in prolonged seizure’s duration for more than five minutes. The available research data on status epilepticus in Indonesia is still limited. The purpose of this study was to determine the profile of patients with status epilepticus at Sanglah General Hospital from 2020 to 2021. Methods: This was a descriptive study with a retrospective approach. The study populations were patients with status epilepticus who were treated at Sanglah General Hospital in 2019-2020 who had no missing data in the medical records. Results: There were 117 patients with status epilepticus, 63 males (53.8%) and 54 females (46.2%). There are 41 patients>60 years (35%), general onset in 63 patients (53.8%), and focal onset in 54 patients (46.2%). Etiology from cerebral was 68 patients (58.1%), followed by metabolic in 28 patients (23.9%). The most common OAE therapy was phenytoin (86.3%) and the longest length of stay status epilepticus patients was 8 days (55.6%). Patients with status epilepticus had leukocytosis (73.5%), increased NLR (66.7%), and decreased mean platelet volume (53.8%). Conclusion: The highest incidence of status epilepticus is in women, above 60 years, general onset type of seizure, and etiology from cerebral. Initial therapy in 117 patients was intravenous diazepam followed by phenytoin for maintenance. NLR increased in most of the patients showing signs of inflammation which further worsened the patient's outcome with a mortality rate of 47%. Keywords: Status epilepticus, seizure duration, anticonvulsant, neutrophil-lymphocyte ratio.