Highlights: In the setting of AF in patient with AHF, conventional treatment strategies do not convert the rhythm into sinus rhythm. Newly emerged therapies such as catheter ablation, or atrioventricular node ablation with biventricular pacing might be more beneficial rather than the conventional rhythm and rate control strategies Abstract: Atrial fibrillation (AF) is the most common form of arrhythmia. The prevalence of AF in patients with systolic left ventricular dysfunction and CHF is around 35% in the patient population with NYHA II-IV. In this case, we will discuss a case report of a patient with AF with complications of CHF and Bilateral Pleural Effusion. Case Summary. A female patient, 62 years old, came to the emergency room of dr. Soegiri Hospital with complaints of sudden shortness of breath since morning. There were crackles in the right lung field during the auscultation and the chest x-ray shows cardiomegaly with a CTR> 50% with bilateral effusion and atelectasis. On the electrocardiogram examination performed at the ICCU, an irregular rhythm was obtained with an HR of 100x/minute, with p waves that cannot be distinguished, normal QRS waves, and T waves that cannot be assessed. The patient was diagnosed with congestive heart failure (CHF) with rapid atrial fibrillation (AF) accompanied by complications of bilateral pleural effusion with a differential diagnosis of acute decompensated heart failure (ADHF) with pneumonia and acute lung edema (ALO). Discussion. Patients with AF and CHF have a poorer prognosis than patients with a single diagnosis of AF or CHF alone. A rhythm control strategy consisting of antiarrhythmic drugs and electrical cardioversion in stable patients with AF and CHF adds no benefit to a heart rate control strategy.

Liver cirrhosis is a chronic disease characterized by the presence of fibrosis and regeneration of nodules in the liver, the consequence of which is the development of portal hypertension and liver failure. Usually associated with infectious infectious diseases such as viral hepatitis, alcohol consumption, metabolic syndrome, autoimmune processes, storage diseases, toxic substances and drugs. Major complications include gastrointestinal variceal bleeding, ascites, spontaneous bacterial peritonitis infection, hepatorenal syndrome, hepatic encephalopathy, and hepatocellular carcinoma. A 23-year-old woman comes to the ER, dr. Soegiri Lamongan with complaints of vomiting blood. The patient also complained of black bloody stools. Referred patient from Intan Medika Hospital with the initial complaint of vomiting blood more than 5 times (± equivalent to one medium drinking bottle) four days ago. On examination also found anemic conjunctiva and found splenomegaly. On abdominal ultrasound examination, the liver was shrunken, the edges were obtuse angles, partially irregular, parenchymal echo intensity was heterogeneous, v.hepatica was normal, liver fibrosis staging was 11.81 kPa, no masses or nodules were seen. The conclusion on endoscopic examination was the presence of grade III esophageal varices, congestive gastropathy, and erosive gastritis. Liver cirrhosis is a disease that has various etiologies. Early diagnosis and appropriate treatment in cirrhotic patients with complications is one way to improve patient survival

Introduction: Schizophrenia is a chronic disorder accompanied by prominent hallucinations or delusions. The individual must be ill for at least 6 months and need not be psychotically active during that time. Schizophrenia is classified into several types. Enforcement of the type of diagnosis of schizophrenia can be established through history taking in the patient and family, then a diagnosis is made according to ICD-10. Treatment can be in the form of pharmacological or psychosocial therapy. Case Reports: A 32-year-old male patient came with his family, the patient looked anxious. The patient comes with the main complaint that he is often angry because he often hears voice whispers. The patient also complains of rapid mood changes. According to the family, this has been happening since 2015. He had been on treatment for a while but only got better shortly after that it came back again. Conclusion: Schizophrenia is a psychotic disorder in which the patient does not have contact with reality which is characterized by major disturbances in thoughts and emotions and experiences delusions and hallucinations. Schizophrenia can be treated using antipsychotics and psychosocial. The prognosis of patients with schizophrenia depends on family support.

Introduction: Otitis externa (OE) Circumcrypt is an inflammation accompanied by furuncle growth in the outer ear with or without infection. Circumcrypt OE events are identified with swimmers or other names Swimmer's Ear, because their ears are moist. Circumcrypt OE cases can be distinguished based on the duration of action, namely acute or chronic. Case Reports: A 21-year-old male patient came with complaints of pain in the ear, previously the patient also felt a feeling of fullness in the ear. Previously the patient had a history of swimming and cleaning the ears afterwards. Another complaint is decreased hearing and yellow discharge from the left ear. Conclusion: Otitis externa (OE) Circumcrypt or Swimmer's Ear is an inflammation of the ear caused by bacteria, fungi or their groups that grow in moist places. To make a diagnosis through anamnesis, local status examination and support. OE management can be done with pharmacology and Spooling measures to clean the ear.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines an anxiety disorder as an excessive feeling of fear that occurs in a person that interferes with daily activities. Generalized anxiety disorder causes a person to feel anxious about a wide range of situations and issues. Patients often experience anxiety, feelings of fear and constantly on edge, difficulty concentrating, difficulty sleeping, muscle tension, and frequent irritability. Based on data from the Indonesian Ministry of Health in 2007, there were 450 million people who had to live with mental disorders. The prevalence of adult individuals (aged 18 years and over) and the elderly, there were 11.6% who experienced emotional disorders, such as anxiety and depression. This case report discusses a 20-year-old woman with the main complaint of unclear anxiety, not knowing what to worry about, floating between things she worries about is death, fear of having a serious illness, breakup, fear of losing her job as a content creator, and feeling of being blamed that keeps on coming. Management in the form of giving SSRI antidepressants and psychodynamic psychotherapy is done to try to reinterpret feelings of guilt that often arise as a result of fixation in one phase of their growth and development.