Background: Since March 2020, Coronavirus Disease 2019 (COVID-19) has been declared a pandemic. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) underwent genetic evolution and changes in the nature of the virus, clinical manifestations, and response to treatment. This study aims to determine the profile of hospitalized COVID-19 patients at  Ari Canti Hospital (RSAC), one of the COVID-19 referral hospitals in Gianyar, Bali. Methods: The design was a descriptive cross-sectional retrospective study, using the medical records of confirmed COVID-19 by Real Time Polymerase Chain Reaction (RT-PCR) patients selected by a simple random sampling technique. Results: From 290 samples, the majority of COVID-19 patients treated at RSAC were 60.7% male, in the age range of 50-59 years 26.5%, with severe symptoms 45.8% and recovered 83.4%. The dominant symptoms were fever 85.2%, cough 80%, and shortness of breath 60%. The most common comorbidities were >1 comorbidity, hypertension, and diabetes mellitus. Hematological examination at the first time of hospitalization showed leukopenia (4.8%), lymphopenia (14.5%), thrombocytopenia (12.8%),  and anemia (21.7%). The results also showed an increase in Neutrophil to Lymphocyte ratio (NLR) (31.4%), Platelet to lymphocyte ratio (PLR) (11.7%), Red Cell Distribution Width (RDW) (40.7%), D-Dimer  (73.4% ) dan High sensivity C-Reactive Protein (Hs-CRP)  (66.6%). Most showed bilateral infiltrates on chest x-ray. The most common treatment for COVID-19 at RSAC uses antiviral remdesivir (77.9%), quinolone antibiotics (73.4%), and Low Molecular Weight Heparin (LMWH) (53.4%).  A total of 56.6% of patients received corticosteroid therapy. Conclusion: Patients hospitalized at RSAC mostly showed severe symptoms and recovered. The treament folowing the standard of inpatient treatment for COVID-19 patients.   Latar belakang: Sejak Maret 2020, Coronavirus Disease 2019 (COVID 19) dinyatakan sebagai pandemi. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) mengalami evolusi genetik dan perubahan sifat virus, manifestasi klinis serta respon pengobatan. Penelitian ini bertujuan untuk mengetahui profil pasien COVID-19 yang dirawat di Rumah Sakit Ari Canti (RSAC), salah satu rumah sakit rujukan COVID-19 di Gianyar, Bali Metode: Rancangan penelitian ini adalah cross-sectional deskriptif retrospektif, menggunakan rekam medis pasien terkonfirmasi COVID-19 dengan Real Time Polymerase Chain Reaction (RT-PCR) sejak Juli 2020 - Maret 2022 yang dipilih dengan teknik simple random sampling. Hasil: Dari 290 sampel, mayoritas pasien COVID-19 yang dirawat di RSAC adalah laki-laki 60.7%, berada pada rentang usia 50-59 tahun 26.5%, dengan gejala berat 45.8% dan sembuh 83.4%. Gejala didominasi demam 85.2%, batuk 80%, dan sesak 60%. Komorbid tersering yaitu >1 komorbid, hipertensi, dan diabetes melitus. Gambaran hematologi menunjukkan leukopenia (4.8%), limfopenia (14.5%), trombositopenia (12.8%), dan  anemia (21.7%). Hasil juga menunjukkan peningkatan Neutrophil to Lymphocyte ratio (NLR) (31.4%), Platelet to lymphocyte ratio (PLR) (11.7%), Red Cell Distribution Width (RDW) (40.7%), D-Dimer (73.4% ) dan High sensivity C-Reactive Protein (Hs-CRP) (66.6%). Sebagian besar menunjukkan infiltrat bilateral pada x-ray thorax. Tatalaksana COVID-19 di RSAC tersering menggunakan antivirus remdesivir (77.9%), antibiotik golongan kuinolon (73.4%), dan antikoagulan Low Molecule Weight Heparin (LMWH) (53.4%). Sebanyak 56.6 % pasien mendapat terapi kortikosteroid. Kesimpulan: Pasien COVID-19 yang dirawat di RSAC sebagian besar menunjukkan gejala berat dan sembuh. Terapi yang diberikan mengikuti standar terapi rawat inap pasien COVID-19.

Almost half of the human immunodeficiency virus (HIV)-positive patients are late diagnosed, which is always associated with higher mortality and morbidity due to various opportunistic infections (OI). Thus, recognition of HIV indicator conditions is important for HIV screening. Cluster of differentiation 4 (CD4) counts <200 cells/mm3 are at the highest risk of herpes zoster-related complications, including disseminated herpes zoster (HZ). Oral candidiasis (OC) is a clinical predictor of HIV infection progression. Here we report a 52-year-old female presented with grouped vesicles with bulla on dermatome L2-L4 sinistra and multiple scattering erythematous vesicular rashes on the whole body. White patches on the tongue with painful swallowing and progressive shortness of breath, cough, low-grade fever, and night sweats. She had an unintentional weight loss of 15 kg. Chest radiograph showed infiltrates in the left lung and right para hilar and paracardial fields, negative Xpert MTB/RIF, and patient newly diagnosed with advanced HIV infection (reactive result on provider initiative test and counseling (PITC) with CD4 level was 8 cell/ml). The patient showed improvement after early treatment with antiviral, antifungal, antimicrobial, first-line fixed-dose combination (FDC) tuberculosis, and prophylactic antibiotic.

The prevalence of hymenoptera sting in general population still high. Large local reaction (LLR) is more common manifestation but can also cause anaphylactic shock and loss of consciousness, or even cardiac or respiratory arrest that all is defined as severe systemic sting reaction (SSR). The risk is generally considered low for future SSR in subjects with LLR but need to be considered and recognized immediately. We reported a case of 39-year-old women was stung by a wasp when driving motorcycle and presented to emergency room with anaphylactic shock (fulfill the amended NIAID/FAAN criteria). She also stung by wasp 2 years ago and cause her left upper and lower arms became swollen slowly and improved 3 days later after treatment with allergy drugs. Electrocardiography result refer to sinus bradycardia. Significant laboratory result showed hypokalemia (2.9 mmol/l). Patient treated by injecting epinephrine intramuscularly and glucocorticoids to preventing protracted symptoms and biphasic reactions.

Thrombocytosis is rarely found in patient with chronic liver disease (CLD). The possibility of reactive thrombocytosis could be due to sustained process such as iron deficiency anemia (IDA) because of occult bleeding. Occult bleeding can happen in CLD patient because of portal hypertension gastropathy (PHG) as complication of portal hypertension. A carefully evaluation of anemia can lead to underlying cause of disease, even in limited of supportive evaluation and some other confounding presentation that is thrombocytosis. We report a case of 54 years-old male patient with severe anemia. He had same symptom previously and got transfusion. Peripheral blood smear showed microcytic hypochromic anemia, anisocytosis, and poikilocytosis even pencil cells (pencil cells or cigar cells) with thrombocytosis. No symptom of acute inflammation setting and no clear blood loss was founded. As patient admitted to smoking and heavy alcohol consumption in the past, Ultrasound was performed for screening of underlying disease that cause occult bleeding. Ultrasound of the liver showed generally increased echogenicity suggestive of liver cirrhosis, splenomegaly and minimal ascites. Thus, our patient clinically be suggestive of CLD with portal hypertension that cause PHG.