Medical waste in hospitals increased during the COVID-19 pandemic. Medical waste management is very important and includes sorting, transporting, weighing, temporarily storing, and handing over waste to third parties. The Muhammadiyah University General Hospital of Malang (RSU UMM) is a referral hospital for COVID-19. This study aimed to evaluate medical waste management at the RSU UMM during the COVID-19 pandemic. This was an observational, retrospective and descriptive study that was conducted from March 2020 until July 2021. The secondary data were taken from the environmental health unit reports at RSU UMM. The collected data included weights of COVID-19 and non-COVID-19 medical waste. Over the study period, there were 1762 COVID-19 patients. The solid waste included disposable waste and personal protective equipment. The medical waste at RSU UMM during the COVID-19 pandemic was more substantial than before the pandemic. The different treatments of medical waste before and during the pandemic were classified by type, weight and frequency of transport. Over the 16 months, 46,649 kg of hospital waste was managed. Keywords: medical waste, COVID-19, weight of waste

Chronic Kidney Disease (CKD) is a clinical condition in which kidney function and/or structure is characterized by irreversible and slow, progressive evolution. CKD cases in Indonesia in 2018 amounted to 3.8% of the total population (713,783 cases). Prevalence of CKD patients with Hepatitis B and/or Hepatitis C at UMM General Hospital has never been reported before. Data were taken from the medical records of UMM General Hospital. Characteristics of the patients were age, gender, aetiology, vascular access and duration of hemodialysis. The results of the laboratory examinations analyzed were HBsAg and Anti-HCV on CKD patients who underwent hemodialysis every 6 months, starting from January 2020. Data were analyzed with descriptive analysis using SPSS v25. The demographic proportion of CKD patients undergoing hemodialysis was highest in the 50-59 year age group (33.8%). Males were more than females (85 patients, 53.1%). The most common aetiology of CKD at UMM General Hospital was caused by hypertension (92 patients, 57.5%). Vascular access mostly used was AV shunt (107 patients, 66.9%). 107 (66.9%) patients had undergone hemodialysis for 1-5 years. In January-June 2022, there were 2 (1.25%) Hepatitis B patients with CKD and 8 (5%) CKD patients with Hepatitis C. The majority of CKD patients at UMM General Hospital were male patients aged 50-59 years, having had hemodialysis for 1-5 years, using AV Shunt, with the most common cause being hypertension. In January-June 2022, there were 1.25% CKD patients with Hepatitis B and 5% CKD patients with Hepatitis C. Keywords: CKD, hemodialysis, Hepatitis B, Hepatitis C

The number of confirmed cases of COVID-19 in East Java is 590,531 (9,41% of total national confirmed cases)\. The death toll in the province is 31,774. Diabetes Mellitus (DM) can cause systemic complications such that COVID-19 patients with DM have a high risk of serious illness and mortality. The characteristics and outcomes of COVID-19 patients with DM at the University of Muhammadiyah Malang General Hospital have never been reported before. Data were taken from medical records at the University of Muhammadiyah Malang General Hospital. The diagnosis of COVID-19 was obtained from a positive PCR swab. DM diagnosis was made by studying the patient history of DM or Random Blood Glucose (RBG) >200 mg/dL or HbA1c >7% sampling. Characteristics of the patients were age, gender, length of treatment, history of DM, and adherence to DM control. The supporting examinations were leukocytes, platelets, O2 saturation, RBG, HbA1c, CRP, and D-dimer, which were grouped into two groups: recovered and dead. Data were analyzed with the SPSS version 28. COVID-19 patients with DM from June 2020 to May 2021 were 206 (23.09%) out of 892 confirmed COVID-19. The majority of cases occurred in men (51.5%) and occurred in the age range of 51-60 years (38.3%). The number of patients who died was 38 (18.4%). The average platelet value was 286,191, the average leukocyte value was 7804, the average oxygen saturation was 90%, the average HbA1c value was 9.4%, the average CRP value was 68.99mg/L, and the average D-dimer value is 13,39ng/mL There was a significant difference in oxygen saturation and D-Dimer between recovered and dead patients. There were no significant differences in the results of other investigations. Keywords: COVID-19, DM, mortality, University of Muhammadiyah Malang General Hospital

Introduction: Hypokalemia is common disorder characterized by low plasma potassium levels (<3.5 mEq / L). Hypokalemia can be caused by genetic disorders. Bartter syndrome and Gitelman syndrome are rare genetic disorders that cause damage to the tubular kidneys. The cause of hypokalemia must be determined by analyzing the diagnosis algorithm of hypokalemia.Case Illustration: A 27-year-old woman was brought to the emergency room with complaints of weakness in both legs since 1 day ago. Obtained a history of chronic hypokalemia since 5 years ago. No history of thyroid disease, and never taking diuretic drugs. The patient is calm. Vital signs: BP: 110/60, regular pulse 88x/minute, temperature: 36.7°C, respiratory rate 14x/minute, oxygen saturation 99% in room air. ECG showed Normal sinus rhythm with normal T wave. Laboratory findings showed severe hypokalemia with plasma potassium 1.7 mEq/L, increased urine potassium (71.1 mmol/24 hours), increased urine sodium 306 mmol/24 hours, and increased urine chloride (342 mmol/24 hours), plasma magnesium levels were normal (1.91 mg/dL). KCl infusion was given to correct electrolyte imbalance condition.Discussion: : Several examinations must be performed to confirm the cause of hypokalemia condition. The diagnosis of this patient was suspected to lead to Bartter syndrome and Gitelman syndrome, because there was an increase in urinary potassium excretion, normotensive conditions, no suspicion of metabolic acidosis, and no symptoms of nausea and vomiting and no history of diuretic drugs usage. Keywords:  Hypokalemia, Bartter syndrome, Gitelman syndrome

COVID-19 can symptomatically and asymptomatically affect patients. Asymptomatic cases have become a particular concern for public health in the COVID-19 pandemic. One of the simple tests for COVID-19 is the complete blood count that can predict systemic inflammation and disease severity. The description of laboratory tests in asymptomatic COVID-19 patients is rarely reported. This study aimed to compare the laboratory test results of both symptomatic and asymptomatic COVID-19 employees of the Muhammadiyah University General Hospital of Malang. Data were taken from medical records. Diagnoses of COVID-19 were confirmed by nasopharynx-oropharynx PCR swab. Patient characteristics included age, gender, and values of hemoglobin, leukocytes, neutrophils, lymphocytes, platelets, NLR and CRP from two different groups: symptomatic and asymptomatic infected employees. There were 104 COVID-19 infected employees at the hospital from April 2020 to February 2021. Female infected employees (52.9%) were more numerous male infected employees. Employees aged 21-30 years accounted for 53.84% of the total cases. The numbers of symptomatic and asymptomatic employees were 10 employees (9.6%) and 94 employees (90.4%), respectively. There was a significant difference between the symptomatic and asymptomatic groups in the numbers of lymphocytes (p = 0.03) and CRP (p = 0.046). There were no significant differences in the other laboratory results. Lymphopenia and increased CRP numbers more often occurred in the symptomatic group compared to the asymptomatic group. Therefore, these parameters can be an indicator for predicting disease severity. However, further research is needed with a bigger sample. Keywords: COVID-19, symptomatic, asymptomatic, Muhammadiyah University General Hospital of Malang