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"ABSTRACTWe conducted this study to establish whether drinking alcohol alters the risk of early-onset colorectal cancer (CRC) in Japanese patients with Lynch syndrome (LS). The subjects were 66 LS patients with pathogenic mutation of mismatch repair genes (MLH1, MSH2, and MSH6) from the nationwide Japanese retrospective multicenter study. Cox proportional hazards modeling was used to investigate the factors correlating with early-onset CRC diagnosis, using clinical data such as gender, tobacco use, alcohol consumption, body mass index, gene mutation (MLH1, MSH2 vs MSH6), and family cancer history. Alcohol was significantly correlated with an increased risk of early-onset CRC [HR 2.44, 95% CI 1.13-5.16 (p = 0.02)], but tobacco use was not [HR 0.8, 95%CI 0.38-1.62 (p = 0.53)]. These findings suggest that alcohol consumption is correlated with an earlier onset of CRC in Japanese patients with LS."

"Tujuan Mikroalbuminuria (MA) adalah prediktor kuat untuk nefropati diabetik serta morbiditas dan mortalitas kardiovaskular pada pasien DM tipe 2. Studi ini bertujuan untuk mengumpulkan informasi mengenai prevalensi dan faktor risiko untuk MA pada pasien Indonesia dengan DM tipe 2.Metode Studi DEMAND adalah survei potong lintang 1 hari mengenai prevalensi MA dan faktor risikonya pada pasien DM tipe 2. Studi ini melaporkan hasil survei yang dilakukan di Puskesmas di Indonesia dari Juni sampai Desember 2003. Pasien hipertensi dan normotensi dewasa laki-laki dan perempuan dengan DM tipe 2 tanpa diketahui adanya proteinuria dan/atau penyakit ginjal diikutsertakan dalam studi. Pasien yang diketahui hamil, sedang haid atau menderita demam akut tidak diikutsertakan dalam studi. Uji albumin urin/kreatinin dilakukan satu kali pada semua pasien.Hasil Seluruhnya ada 770 pasien yang memenuhi syarat untuk dianalisis. Sekitar 80% pasien menderita mikro-/makroalbuminuria, sedangkan insufisiensi ginjal ditemukan pada kira-kira 36% dari 433 pasien yang ada datanya. Target HbA1c (<7%) dicapai hanya oleh 40% dari 118 pasien yang mempunyai nilai HbA1c. Kebanyakan obat anti diabetes yang diresepkan adalah oral (82%), sedangkan insulin digunakan hanya oleh 14% pasien. Target tekanan darah (< 130/80 mmHg) dicapai hanya oleh 9% pasien. Pasien yang menerima antihipertensi 52%, statin 18%, dan aspirin 26%. Antihipertensi yang paling banyak dipakai adalah penghambat RAS (45%), sedangkan diuretik digunakan oleh 7% pasien. Riwayat DM dalam keluarga ditemukan pada 43% pasien, riwayat retinopati 16%, kaki diabetik 9%, dan riwayat merokok pada 20% pasien.Kesimpulan Data ini menunjukkan bahwa Indonesia mempunyai frekuensi penyakit ginjal diabetik asimtomatik yang tertinggi di antara berbagai negara yang ikut studi DEMAND di dunia. Deteksi dini, pemantauan komplikasi vaskular, dan pengobatan multifaktorial yang lebih agresif yang ditujukan untuk proteksi ginjal dan vaskular sangat dibutuhkan untuk pasien Indonesia dengan DM tipe 2.

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AbstractAims Microalbuminuria (MA) is a strong predictor of diabetic nephropathy and cardiovascular morbidity and mortality in patients with type-2 DM. The present study aimed to gather information on the prevalence and risk factors for MA in Indonesian patients with type-2 DM.Methods The DEMAND study was an international open cross-sectional 1-day survey on microalbuminuria prevalence and its risk factors in type-2 diabetic patients. This study reports the results of the Indonesian survey which was performed in primary care practice in Indonesia from June to December 2003. Normotensive or hypertensive adult patients of both genders with type-2 DM without known proteinuria and/or kidney disease were recruited into the study. Patients with known pregnancy, having menstruation or acute fever were excluded. A single urinary albumin/creatinine test was carried out in all patients.Results A total of 770 patients were eligible for analysis. Approximately 80% of the patients had micro-/ macroalbuminuria, while renal insufficiency was detected in about 36% of the 433 patients with available data. Target HbA1c (< 7%) was reached by only 40% of the 118 patients who had HbA1c values. Most antidiabetic treatment prescribed was oral (82%), while insulin was used by only 14% of patients. Goal BP (< 130/80 mm Hg) was achieved in only 9% of patients. The frequency of patients receiving antihypertensives was 52%, statins 18%, and aspirin 26%. The most frequently used antihypertensives were RAS blockers (45%), while diuretics were used in 7 % of the patients. The family history of DM was found in 43% of patients, the history of retinopathy in 16%, diabetic foot 9%, and history of smoking in 20% of patients.Conclusion These data reveal that Indonesia has one of the highest frequencies of silent diabetic kidney disease seen in any national group in the global DEMAND Study. Early detection, monitoring of vascular complications, and more aggressive multifactorial treatment aiming at renal and vascular protection are urgently needed for Indonesian patients with type-2 diabetes."

"Colon polyp is a term used for abnormality from bulging tissue above surrounding colonic mucosal layer. Adenoma polyp was the commonly found polyp that progress to colorectal cancer. Most of those patients was asymptomatic. Undetected and unmanaged polyp was a risk factors of colorectal cancer even."

"ABSTRACTPurpose: Postoperative pneumonia affects the length of stay and mortality after surgery in elderly patients with colorectal cancer (CRC). We aimed to determine the risk factors of postoperative pneumonia in elderly patients with CRC, and to evaluate the impact of laparoscopic surgery on elderly patients with CRC.Methods: We retrospectively investigated 1473 patients ≥ 80 years of age who underwent surgery for stage 0-III CRC between 2003 and 2007. Using a multivariate analysis, we determined the risk factors for pneumonia occurrence from each baseline characteristic.Results: Among all included patients, 26 (1.8%) experienced postoperative pneumonia, and restrictive respiratory impairment, obstructive respiratory impairment, history of cerebrovascular events, and open surgery were determined as risk factors (odds ratio [95% confidence interval], 2.78 [1.22-6.20], 2.71 [1.22-6.30], 3.60 [1.37-8.55], and 3.57 [1.22-15.2], respectively). Furthermore, postoperative pneumonia was more frequently accompanied by increasing cumulative numbers of these risk factors (area under the receiver operating characteristic curve = 0.763).Conclusions: Laparoscopic surgery may be safely performed in elderly CRC patients, even those with respiratory impairment and a history of cerebrovascular events."

"PURPOSE: To identify the possible roles of carcinoembryonic antigen (CEA) testing after liver resection for synchronous colorectal liver metastasis (CLM).METHODS: The subjects of this retrospective study were patients who underwent complete resection of primary tumors and synchronous CLM between 1997 and 2007 at 20 institutions in Japan. We studied the associations between perioperative CEA levels and the characteristics of recurrence.RESULTS: Recurrence was detected during the median follow-up time of 52 months in 445 (73.7%) of the total 604 patients analyzed. A postoperative CEA level >5 ng/ml was an independent predictor, with the highest hazard ratio (2.25, 95% confidence interval 1.29-3.91, P = 0.004). A postoperative CEA level >5 ng/ml had a specificity of 86.2% and a positive predictive value of 84.2% for recurrence. Patients with a high postoperative CEA level had a significantly higher recurrence rate, with a shorter time until recurrence and a higher frequency of multiple metastatic sites than those with a low postoperative CEA level. Among the patients with recurrence, 173 (52.7%) had an elevated CEA level (>5 ng/ml) when recurrence was detected.CONCLUSIONS: A postoperative CEA level >5 ng/ml was an independent predictor of recurrence; however, CEA testing was not a reliable surveillance tool to identity recurrence after liver resection."

"ABSTRAKKeyakinan Pengobatan pada Pasien yang Menjalani Intervensi Coronary Percutaneous: A Cross-Sectional Study. Pasien pasca intervensi koroner perkutan atau percutaneous coronary intervention (PCI) perlu minum obat untuk kesehatannya. Keyakinan terhadap pengobatan berpengaruh pada kepatuhan pasien dalam menjalani rejimen pengobatan. Penelitian ini bertujuan untuk mengidentifikasi keyakinan pengobatan pada pasien yang mengikuti PCI di Indonesia. Penelitian ini menggunakan studi cross-sectional dengan metode convenience sampling. Sebanyak 132 pasien dewasa yang menjalani prosedur PCI berpartisipasi dalam penelitian ini. Penelitian ini menggunakan The Beliefs about Medicines Questionnaire untuk mengidentifikasi keyakinan pasien tentang pengobatan. Mayoritas responden adalah laki-laki (85,6%) dengan usia rata-rata 60 tahun. Keyakinan tentang penggunaan berlebihan secara umum ditemukan sebagai yang tertinggi di antara kategori lainnya yaitu kebutuhan-spesifik, perhatian khusus, dan bahaya umum. Informasi mengenai keyakinan pasien tentang pengobatan akan memberikan pemahaman yang lebih baik bagi penyedia layanan kesehatan tentang perilaku pengobatan pasien setelah prosedur PCI. Pengakuan keyakinan pasien dapat membantu dalam menargetkan program intervensi khusus untuk meningkatkan kepatuhan pasien terhadap pengobatan setelah prosedur PCI."

"Berdasarkan statistik dalam bidang kesehatan menyatakan 40% penduduk Jepang secara biologis rentan terhadap minuman beralkohol karena kurangnya enzim ALDH dalam hati yg berperan untuk menetralkan efek buruk minuman beralkohol. Akan tetapi berdasarkan data WHO yang diambil pada tahun 2003, konsumsi minuman beralkohol oleh masyarakat Jepang tetap tinggi, sekitar 7 liter perkapita pertahun. Artikel ini berupaya meneliti penyebab dan mencoba memahami pola pikir masyarakat Jepang dalam mengkonsumsi minuman alkohol. Penelitian ini diharapkan dapat menjadi gambaran bagi individu maupun negara yang mayoritas non-peminum seperti Indonesia, untuk memahami fenomena tersebut dalam rangka menjalin hubungan dengan masyarakat Jepang. Berdasarkan analisis data dan kasus tentang alkohol yang terjadi di Jepang, tingginya konsumsi minuman beralkohol salah satunya dipengaruhi oleh faktor sosial yaitu terdapat kesadaran kelompok masyarakat Jepang untuk menjaga keharmonian dalam kelompok untuk diterima dan bertahan dalam suatu grup. Dilihat dari hubungan antara manusia, struktur vertikal masyarakat Jepang terdapat konsep sempai dan kohai. Untuk menjaga keharmonian kelompok, kohai menghindari sikap kontra secara langsung dengan senpai. Sehingga ajakan untuk minum alkohol pun sulit untuk ditolak. konsep menjaga keharmonian inilah yang menjadi salah satu faktor yang mendorong masyarakat Jepang untuk mengkonsumsi minuman beralkohol.

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Based on the statistics in the field of health, states that 40% of Japan's population is biologically vulnerable to alcohol because of the lack of ALDH enzymes in the liver that acts to neutralize the bad effects of alcoholic beverages. However, based on WHO data taken in 2003, the consumption of alcoholic beverages by the Japanese people remains high, about 7 liters per capita per year. This article seeks to examine the cause and tryto understand Japanese view in consuming alcohol. This study is expected to be a reference to individual and country that have majority of non-drinkers such as Indonesia, to understand the phenomenon in order to establish a relationship with the people of Japan. Based on data analysis and cases of alcohol that occurred in Japan, the high consumption of alcoholic beverages is influenced by social factors, namely there is awareness of Japanese society to maintain harmony within the group in order to be accepted and survive in the group. Judging from the relationship between humans, the vertical structure of Japanese society have the concepts of sempai and kohai. To maintain the harmony of the group, kohai avoid direct confrontation with Senpai. This make invitation to drink alcohol too hard to reject. The concept of maintaining harmony is one of the factors that encourage the Japanese people to consume alcoholic beverages."

"Tujuan: Kanker serviks masih menjadi kanker terbanyak kedua di Indonesia. Sementara kesadaran untuk deteksi dini dengan inspeksi visual dengan asam asetat (VIA) semakin meningkat, vaksinasi HPV belum menjadi program nasional. Vaksinasi masih efektif pada orang dengan rentang usia 15-26 tahun, dan diberikan dalam 3 dosis. Tujuan penelitian ini adalah untuk menilai pengetahuan, sikap, dan perilaku mahasiswa kedokteran di Jakarta terhadap HPV dan vaksinasi. Desain: survei cross-sectional dibagikan kepada 10 mahasiswa praklinik Fakultas Kedokteran di Jakarta, dari Juli hingga Agustus 2020. Kuisioner yang dibagikan sendiri untuk menilai pengetahuan, sikap, dan perilaku tentang kanker serviks dan vaksinasi. Kuesioner dikumpulkan menggunakan Google Form dan dianalisis menggunakan Aplikasi Stata ver 13 for Mac. Data dianalisis menggunakan chi-square. Hasil: dari 2518 mahasiswa kedokteran, 124 mahasiswa dikeluarkan. Separuh dari mahasiswa akademis yang lebih tua (57,14%) memiliki pengetahuan dan perilaku yang baik tentang kanker serviks dan vaksinasi. Tingkat pengetahuan secara signifikan berhubungan dengan perilaku termasuk status vaksinasi. Namun, 60% dari mahasiswa akademis yang lebih muda memiliki sikap yang baik terhadap kanker serviks dan vaksinasi. Kesimpulan: pengetahuan yang lebih baik berkorelasi dengan perilaku yang lebih baik terhadap kanker serviks dan vaksinasi. Lebih lanjut tentang HPV dan manfaat yang terkait dengan vaksinasi terhadap HPV harus dimasukkan dalam kurikulum di semua tahun sekolah kedokteran.

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Objectives: Cervical cancer is still the second most prevalent cancer in Indonesia. While the awareness for early detection with visual inspection with acetic acid (VIA) has been raising, HPV vaccination has not yet become a national program. Vaccination is still effective in people ranged from 15-26 years old, and administered in 3 doses. The objectives of this research were to assess knowledge, attitude, and behaviour of medical students in Jakarta towards HPV and its vaccination.

Design: a cross-sectional survey was distributed to 10 Faculty of Medicine pre-clinical students in Jakarta, from July to August 2020. A self-administrated questionnaire was distributed to assess the knowledge, attitude, and behaviour regarding cervical cancer and vaccination. The questionnaire was collected using Google Form and analysed using Stata Application ver 13 for Mac. The data was analysed using chi-square.

Results: from 2518 medical students, 124 students were excluded. Half of the older academic students (57,14%) had a good knowledge and behaviour regarding cervical cancer and vaccination. Knowledge level was significantly associated with behaviour including vaccination status. However, 60% of younger academic students had a good attitude towards cervical cancer and vaccination.

Conclusions: better knowledge correlate with a better behaviour towards cervical cancer and vaccination. More about HPV and the benefits associated with vaccination against HPV should be included in the curriculum in all years of medical school."