Management of bladder exstrophy in an adolescent girl: a case report

Bladder exstrophy (BE) is a very rare congenital abnormality, especially in girls. We reported a 17-year-old girl with protruded bladder and urinary incontinence. Her vaginal orifice appeared stenotic and shifted anteriorly. She had an incomplete labia minora, short perineum, and anterior displacement of the anus. The pelvic radiography showed a pubic diastasis with a manta ray sign, and the ultrasonography examination showed a bicornuate uterus. She had undergone a functional reconstruction surgery with cystectomy, ileal conduit, appendectomy, and vaginoplasty along with the advancement of abdominal flap reconstruction with multiple Z-plasty. Functionally, she was able to urinate through the ileal conduit comfortably, had a regular menstrual cycle with minimal pain, had a wider vaginal canal, and had a smooth blood flow. Aesthetically, she had a good lower abdomen appearance, remained dry, and had an odorless urine. In clinical practice, this rare case report can provide additional knowledge and management of the same cases with effective results.

Determinants of Mental Health and Practice Behaviors of General Practitioners During COVID-19 Pandemic in Bali, Indonesia: A Cross-sectional Study

PURPOSE

We aim to study the level of mental health distress and COVID-19 prevention in practice behaviors among general practitioners (GPs) in Bali, Indonesia, as well as their determinants.

METHODS

We conducted a cross-sectional online survey. Survey recruitment material was disseminated by purposive snowballing through regional professional association as well as research team's personal acquaintances. The survey measured mental health status by DASS-21 questionnaire and practice behavior by a questionnaire based on WHO recommendations for hand hygiene and PPE use during the COVID-19 pandemic. We conducted multivariate analyses to identify independent determinants for mental health and practice behavior.

RESULTS

Analyses included 635 (41.75%) of GPs in Bali. Mental health status was relatively good with prevalence of depression, anxiety, and stress of 13.2%, 19.7%, and 11% respectively, lower than previous studies in Indonesia and elsewhere. Practice behavior, however, was not considerably lower with only 65.4% and 32.1% reported consistent hand hygiene and recommended PPE use respectively. Routine optional PPE use was reported by 23.6% of respondents. Long working hours and fear of COVID-19 was identified as detrimental to mental health while consistent hand hygiene improved it. Meanwhile, workplace, work setting, and fear of COVID-19, were identified as determinants for PPE use. GPs working in primary health centers and private hospitals were also found to have less adherence to hand hygiene protocols.

CONCLUSION

Our results showed relatively good mental health status along with inadequate infection prevention in practice behavior of GPs in Bali, Indonesia. Intervention should be made to improve practice behavior. Determinants of practice behavior identified in this study could help to pinpoint intervention targets.

Case Report: Gastric Wall Thickening: Radiological Diagnostic Challenges in Gastric Malignancy

Gastric abnormalities show nonspecific gastrointestinal symptoms and similarly radiological findings. Intra and extra luminal gastric wall thickening are the most common finding in benign and malignant pathologic process. This aim of this case report was to describe several characteristics such as the location and size of the lesion, involvement of the gastric wall and surrounding structures, calcifications, and contrast enhancement pattern which can assist in radiological diagnosis. Several cases at our institution have similar gastrointestinal complaints, however, there were different lesions characteristic found in contrast enhanced abdominal CT scan. The first case 72-years-old man experienced hematemesis with radiologic finding diffuse gastric mucosal thickening as well as homogenous contrast enhancement but without calcification.  The second case 37-years-old man complaint dizziness and melena with radiologic finding large tumor more than 10 cm in size, amorph calcification and heterogenous contrast enhancement. The last 60-years-old man case experienced melena and hematemesis, from abdominal CT scan showed irregular gastric mucosal thickening with heterogenous contrast enhancement and fat stranding around the lesion, without calcification. Methods used in these cases were contrast-enhanced abdominal CT scan, esophagogastroduodenoscopy (EGD), and biopsy in order to determine the diagnosis. Contrast-enhanced abdominal CT scan plays a vital role in describing the lesion characteristics which affects the determination of treatment options and future prognosis.

Laporan Kasus: Transarterial Chemoembolization (Tace) Sebagai Terapi Pilihan Pada Karsinoma Hepatoselular

Hepatocellular carcinoma (HCC) is the most common primary tumor of the liver and occupies the top 10 most cancers in Indonesia. Men are likely to develop HCC, and 90% cases of HCC develop in the background of chronic liver disease, which associates with hepatitis B and C virus infection. There are numerous treatment options for HCC, however in intermediate-advanced stage, palliative treatment such as transarterial chemoembolization (TACE) and systemic chemotherapy are the management of choice. A 51 years old male with HCC based on history, physical examination, radiology and laboratory result was referred to interventional radiology department for TACE consideration. Barcelona Clinic Liver Cancer (BCLC) B was concluded in this patient after thorough evaluation. There was history of hepatitis B infection, ascites, low albumin level, high AFP, and from Abdominal CT Scan with contrast showed large lobulated mass on the right lobe, without evidence of portal vein thrombosis. TACE was eligible and done using mixed of doxorubicin 50 mg and lipiodol, and embolization using gel foam. After 8 weeks CT evaluation was done and showed increase area of tumor necrosis, while tumor size was stable. Necrosis area expansion is the standard used for evaluating this patient which fell into partial response criteria. TACE is a palliative therapy of choice in accordance with BCLC B recommendation. Evaluation of TACE performance is more optimal by assessing the size of necrosis area compared to mass measurement.