Estimating the Impact of Vaccination Campaigns on Measles Transmission in Somalia

Somalia is a complex and fragile setting with a demonstrated potential for disruptive, high-burden measles outbreaks. In response, since 2018, Somalian authorities have partnered with UNICEF and the WHO to implement measles vaccination campaigns across the country. In this paper, we create a Somalia-specific model of measles transmission based on a comprehensive epidemiological dataset including case-based surveillance, vaccine registries, and serological surveys. We use this model to assess the impact of these campaign interventions on Somalian's measles susceptibility, showing, for example, that across the roughly 10 million doses delivered, 1 of every 5 immunized a susceptible child. Finally, we use the model to explore a counter-factual epidemiology without the 2019-2020 campaigns, and we estimate that those interventions prevented over 10,000 deaths.

A THOROUGH STUDY AND META-ANALYSIS OF THE PROGNOSTIC RELEVANCE OF THE C-REACTIVE-ALBUMIN RATIO IN ACUTE PANCREATITIS

Although most cases of acute pancreatitis (AP) are minor, severe cases are associated with a substantial risk of death. Acute pancreatitis (AP) is a common illness. Therefore, it is critical to assess AP severity as soon as possible. This review aimed to ascertain the predictive significance of the CRP to albumin ratio in individuals with AP. We searched PubMed, Science Direct, and Cochrane Library electronic databases Until January 2023. Studies that reported the CRP/alb ratio at admission and its relationship to the severity or death of patients with AP were included. Using a random-effects model, we computed the pooled mean difference (MD) and 95% confidence interval (CI). The quality of the included studies was evaluated using the Newcastle-Ottawa scale. This meta-analysis combined data from six trials with a total of 2244 patients. Upon admission, the CRP/alb ratio was higher in patients with severe AP than in those with mild to moderate AP (pooled MD:3.59; 95% CI:2.51-4.68; p<0.00001). Additionally, non-survivor AP patients had a substantially higher CRP/alb ratio than survivor AP patients (pooled MD:2.12; 95% CI:0.43-3.8; p<0.01). Individuals with AP may benefit from a high CRP/ALB ratio as a preliminary indicator of poor prognosis.

COVID-19 Vaccine Acceptance and Hesitancy in Health Care Workers in Somalia: Findings from a Fragile Country with No Previous Experience of Mass Adult Immunization

Coverage of COVID-19 vaccines in Somalia remains low, including among health workers. This study aimed to identify factors associated with COVID-19 vaccine hesitancy among health workers. In this cross-sectional, questionnaire-based study, 1476 health workers in government and private health facilities in Somalia's federal member states were interviewed face-to-face about their perceptions of and attitudes toward COVID-19 vaccines. Both vaccinated and unvaccinated health workers were included. Factors associated with vaccine hesitancy were evaluated in a multivariable logistic regression analysis. Participants were evenly distributed by sex, and their mean age was 34 (standard deviation 11.8) years. The overall prevalence of vaccine hesitancy was 38.2%. Of the 564 unvaccinated participants, 39.0% remained hesitant. The factors associated with vaccine hesitancy were: being a primary health care worker (adjusted odds ratio (aOR) = 2.37, 95% confidence interval (CI): 1.15-4.90) or a nurse (aOR = 2.12, 95% CI: 1.05-4.25); having a master's degree (aOR = 5.32, 95% CI: 1.28-22.23); living in Hirshabelle State (aOR = 3.23, 95% CI: 1.68-6.20); not having had COVID-19 (aOR = 1.96, 95% CI: 1.15-3.32); and having received no training on COVID-19 (aOR = 1.54, 95% CI: 1.02-2.32). Despite the availability of COVID-19 vaccines in Somalia, a large proportion of unvaccinated health workers remain hesitant about being vaccinated, potentially influencing the public's willingness to take the vaccine. This study provides vital information to inform future vaccination strategies to achieve optimal coverage.

Kekuasaan: Determinan Sosial dan Kebudayaan Penyakit Tuberkulosis Paru di Cinangka Serang Banten

The backgrounds of this research are the reality of pulmonary tuberculosis cases in Indonesia which has never been resolved since the colonial era until now, and the ignorance of biomedical experts to the results of medical anthropology research on pulmonary tuberculosis. Therefore, this study tries to get out of the usual themes of medical anthropological research and offer “power” as a new theme in medical anthropological research on pulmonary tuberculosis. The method used is a qualitative method with an ethnographic approach to describe the process of occurrence and transmission of pulmonary tuberculosis. The findings of this research are; (1) the knowledge of society in Cinangka Serang Banten regarding pulmonary tuberculosis is constructed by staff of public health center (puskesmas), as well as personalistic and naturalistic traditional healers, (2) social process, as a form of power implementation, can stimulate, encourage, or even facilitate the biological process of pulmonary tuberculosis, (3) the use of power issue in medical anthropology perspective for the understanding disease is significant as one of the themes in pulmonary tuberculosis research. The effect of these findings is; to stimulate the dynamization of theory and method in medical anthropology; reconstruct the way of thinking in the study of disease; provide a conceptual contribution to overcoming pulmonary tuberculosis.

Single-agent anti-PD-1 or combined with ipilimumab in patients with mucosal melanoma: an international, retrospective, cohort study

BACKGROUND

Mucosal melanoma (MM) is a rare melanoma subtype with distinct biology and poor prognosis. Data on the efficacy of immune checkpoint inhibitors (ICIs) is limited. We determined the efficacy of ICIs in MM, analysed by primary site and ethnicity/race.

PATIENTS AND METHODS

Retrospective cohort study from 25 cancer centres in Australia, Europe, USA and Asia. Patients with histologically confirmed MM were treated with anti-PD1+/-ipilimumab. Primary endpoints were response rate (RR), progression-free survival (PFS), overall survival (OS) by primary site (naso-oral, urogenital, anorectal, other), ethnicity/race (Caucasian, Asian, Other) and treatment. Univariate and multivariate Cox proportional hazard model analyses were conducted.

RESULTS

In total, 545 patients were included: 331 (63%) Caucasian, 176 (33%) Asian and 20 (4%) Other. Primary sites included 113 (21%) anorectal, 178 (32%) urogenital, 206 (38%) naso-oral and 45 (8%) other. 348 (64%) received anti-PD1 and 197 (36%) anti-PD1/ipilimumab. RR, PFS and OS did not differ by primary site, ethnicity/race or treatment. RR for naso-oral was numerically higher for anti-PD1/ipilimumab (40%, 95% CI 29-54%) compared with anti-PD1 (29%, 95% CI 21-37%). 35% of patients that initially responded progressed. Median duration of response (mDOR) was 26 months (95% CI 18-NR [Not Reached]). Factors associated with short PFS were ECOG PS ≥3 (p<0.01), LDH >ULN (p=0.01), lung metastases (p<0.01) and ≥1 previous treatments (p<0.01). Factors associated with short OS were ECOG PS ≥1 (p<0.01), LDH >ULN (p=0.03), lung metastases (p<0.01) and ≥1 previous treatments (p<0.01).

CONCLUSIONS

MM has poor prognosis. Treatment efficacy of anti-PD1+/-ipilimumab was similar and did not differ by ethnicity/race. Naso-oral primaries had numerically higher response to anti-PD1/ipilimumab, without difference in survival. The addition of ipilimumab did not show greater benefit over anti-PD1 for other primary sites. In responders, mDOR was short and acquired resistance was common. Other factors, including site and number of metastases were associated with survival.

Acquired Cystic Kidney Disease: A Hidden Complication in Children on Chronic Hemodialysis

Objective

To determine the frequency of acquired cystic kidney disease (ACKD) in children on chronic hemodialysis.

Material and methods

In this single-center cross-sectional study, 150 children were included who were on chronic hemodialysis for six months. Ultrasound was done to see the renal cysts. Cystic changes that could not fulfill the criteria for ACKD were also noted and analyzed.

Results

The mean age was 14.5 ± 3.5 years, of these 63 (42%) were males. Acquired cysts were detected in 53 (35%) of the patient and 18 patients (12%) had solitary cysts. The distribution of these entities was similar across all age groups. The underlying etiologies in the descending order were unknown 64 (43%), stone disease 31 (21%), each of the congenital anomalies of the kidney and urinary tract, and glomerulonephritis 23 (15%), and others nine (6%). A higher frequency of ACKD was detected in the children on renal replacement therapy for more than two years (33 out of 53 children, 63% with a p-value of 0.004).

Conclusion

The ACKD was found in one-third of our hemodialysis children and its frequency increases with the duration of hemodialysis. This percentage may not reflect the true prevalence as there is a lack of consensus on the definition of ACKD. Periodic assessment of chronic kidney disease patients for the development of ACKD especially on chronic hemodialysis is required to reduce the morbidity.

Performance evaluation of the commercial aquafeeds available in the market of Pakistan on Channa marulius (Sole)

The present study aimed to determine the effect of different levels of protein on the growth, body composition, amino acid profile and serology of Channa marulius fingerlings. The experiment was conducted in ten happas installed in earthen ponds, each stocked with 10 fishes for 90 days. Four commercial fish feeds having 25%, 30%, 32% and 40% crude protein (CP) levels were fed to fish at 3% of their wet body weight three times a day. The results of the study revealed that highest weight gain, feed conversion ratio and survival rate were observed in 30% protein feed. Meanwhile, moisture content was higher in fish fed with 30% CP feed while highest crude protein was recorded in 40% CP fed fish. Lowest fat content was observed in 32% CP feed. Amino acid profile of fish revealed better results in 30% CP feed. Total protein, glucose and globulin were also highest in fish feeding 30% CP feed, while albumin was highest in 40% CP feed. It is concluded that 30% CP feed showed better results in terms of growth, amino acid profile and serological parameters without effecting fish body composition.

Selective use of Peptide Receptor Radionuclide Therapy following comparative imaging of Ga-68 DOTATATE PET/CT against I-131 MIBG scintigraphy in a small Asian cohort of Adult Neuroblastoma

Adult neuroblastoma (AN) is rare with an extremely poor prognosis. No standard therapy exists for this entity and treatment options are limited in recurrent or refractory disease. ¹³¹I-MIBG has been used in combination with myeloablative therapy before autologous bone marrow transplantation or in a salvage therapy setting. However, myelotoxicity is a dose-limiting factor in heavily pre-treated patients and response is not always sustained. Somatostatin receptor scintigraphy and theranostics with radiolabelled somatostatin receptor analogues are becoming more commonplace with the recognition of these receptors in over 90% of neuroblastoma cells. We describe three AN patients assessed for somatostatin receptor status and the novel use of ¹⁷⁷Lu-based peptide recep-tor radionuclide therapy (PRRT) in two of them and a literature review.

Inferiority feeling pada remaja panti asuhan: Bagaimana peranan konsep diri dan dukungan sosial?

AbstractInferiority feeling in adolescents who live in orphanages needs attention because if left unchecked it can cause adolescents to lose their potential. This study intends to examine the role of self-concept and social support on inferiority feelings. Participants in this study were 71 teenagers who were taken purposively from seven orphanages in Surabaya. The research data were taken using the inferiority feeling scale (?=0.874), the self-concept scale (?=0.935), and the social support scale (?=0.938) which were compiled by the researcher himself. The results of data analysis using multiple regression analysis show that self-concept and social support simultaneously have a negative effect on inferiority feeling. Partially both variables also have a significant negative effect on inferiority feeling. The implication of this research is as a basis of reference for caregivers, counsellors or the community in paying attention to the psychological needs of orphaned youth.Keywords: Inferiority Feeling; Self-concept; Social support  AbstrakInferiority feeling pada remaja yang tinggal di panti asuhan perlu mendapatkan perhatian sebab jika dibiarkan dapat menyebabkan remaja kehilangan potensi dirinya. Penelitian ini bermaksud untuk menguji peranan konsep diri dan dukungan sosial terhadap inferiority feeling.  Partisipan dalam penelitian ini sebanyak 71 remaja diambil dengan teknik purposive sampling dari tujuh panti asuhan di Surabaya. Data penelitian diambil menggunakan skala inferiority feeling (?=0,874), skala konsep diri (?=0,935), dan skala dukungan sosial (?=0,938) yang disusun sendiri oleh peneliti. Hasil analisis data menggunakan regresi ganda menunjukkan secara simultan konsep diri dan dukungan sosial memiliki pengaruh negatif terhadap inferiority feeling. Secara parsial kedua variabel juga memiliki pengaruh negatif yang signifikan terhadap inferiority feeling. Implikasi penelitian ini adalah sebagai dasar acuan kepada pengasuh, konselor ataupun masyarakat dalam memperhatikan kebutuhan psikologis remaja panti asuhan.Kata kunci: Dukungan sosial; Inferiority feeling; Konsep diri

Relentless pulsatile tinnitus secondary to dural sinovenous stenosis: is endovascular sinus stenting the answer?

AIM

To assess the efficacy of endovascular venous sinus stenting (EVSS) in treating pulsatile tinnitus (PT) caused by dural venous sinus stenosis (DVSS), and to determine whether it is an adequate remedy in cases with concurrent venous anomalies.

MATERIALS AND METHODS

Seventeen patients (13 female and four male) with PT due to DVSS were treated using EVSS. The trans-stenotic pressure gradient (PG) was measured before and after stenting. The effect of stenting on the tinnitus was evaluated by questioning the patients at day 0, and at 3, 6, and 9 months after stenting.

RESULTS

Except for one patient who continued to complain of PT, all of the patients, including two with concomitant sinus diverticula, described complete resolution of the tinnitus immediately following stenting. The post-stenting PG was significantly lower than the pre-stenting PG (p<0.0001). No procedure related complications occurred and no recurrence was recorded during the follow-up period.

CONCLUSION

EVSS is a safe and successful treatment for PT due to DVSS even in cases with coexistent sinus diverticula.

Utility of the Mansoura Numeroalphabetic Constipation Score in detection of obstructed defaecation syndrome and prediction of the outcome of treatment

AIM

Thorough assessment of obstructed defaecation syndrome (ODS) is imperative for the selection of treatment options. The present study aimed to examine the utility of the Mansoura Numeroalphabetic Constipation Score (MNCS) in distinguishing patients with ODS from healthy control subjects and in predicting the outcome of treatment of ODS.

METHODS

Patients with ODS associated with anterior rectocele and/or rectoanal intussusception were assessed with the MNCS at the first visit to the clinic. All patients were offered conservative treatment for 3 months and patients who improved were continued on conservative treatment for six more months while patients who failed were treated surgically. The MNCS was reassessed at the end of follow-up in both groups. A cohort of healthy controls was compared to ODS patients with regard to age, sex and baseline MNCS.

RESULTS

In all, 124 ODS patients and 53 healthy controls were included. The ODS patients had a significantly higher baseline MNCS than controls (9.5 ± 1.5 vs 0.76 ± 0.71, P < 0.0001). Forty of 124 patients improved after conservative management and showed a significant decrease in MNCS (6.9 ± 1.08 to 3.1 ± 1.2, P < 0.0001). Eighty-four (67.8%) patients failed to respond to conservative measures and were surgically treated, 77 (91.6%) of whom showed significant improvement in symptoms postoperatively while seven (8.4%) failed to improve; the difference in postoperative MNCS between the two groups was significant.

CONCLUSION

The MNCS successfully distinguished ODS patients from controls and was able to predict the outcome of ODS treatment.

Video-based health education to support insulin therapy in diabetes mellitus patients

Background: The improper use of insulin usually leads to some unexpected effects, hence, there is a need for right usage. Lack of knowledge and of understanding are key factors leading to the occurrence of medication errors, which could be avoided with proper education. Therefore, an appealing education alternative, such as video, is needed to improve patient's knowledge and attitudes towards insulin therapy. Design and Methods: One-group pretest and posttest design were conducted on 100 patients with type 2 diabetes mellitus who were receiving subcutaneous insulin therapy at Internal Medicine Unit in Universitas Airlangga Teaching Hospital. The patients filled the provided questionnaires to measure their knowledge and attitudes, before and after watching the video on insulin therapy education. Then, data obtained were analysed with SPSS using Wilcoxon Signed Rank Test Method. Results: Based on the results, there was an increase in the value of the patient's knowledge, with the value of Z=-8.212 and P<0.05. Similarly, there was an increase in the patient's attitudes with the value of Z=-8.234 and P<0.05. Conclusions: Insuline therapy video increases the knowledge and improves the attitude of diabetes mellitus patients towards insulin therapy.

Meningkatkan perilaku prososial pelajar Sekolah Menengah Atas (SMA) melalui pembelajaran karakter: Bagaimana efektivitasnya?

AbstractIncreasing prosocial behavior can help solve social problems that occur in the community. Cultivation of prosocial behavior can be done at school through character learning. This study aims to examine the effectiveness of character learning to improve prosocial behavior in working together, helping and respecting the rights and welfare of others in high school adolescents. The experimental research design used in this study was one group pretest-posttest. Research participants numbered 21 class XI Xin Zhong Surabaya High School students who were selected based on purposive sampling techniques. The research instrument used a prosocial scale compiled by researchers with a reliability coefficient of ? = 0.898. The results of the analysis using Wilcoxon show that character learning is effective for improving the prosocial behavior of high school adolescents. It is recommended that teachers use the character learning module to improve the prosocial behavior of high school adolescents.Keywords: Character learning; Learning effectiveness; Prosocial behavior AbstrakPeningkatan perilaku prososial dapat membantu menyelesaikan permasalahan sosial yang terjadi di masyarakat. Penanaman perilaku prososial dapat dilakukan di sekolah melalui pembelajaran karakter. Penelitian ini bertujuan untuk menguji efektivitas pembelajaran karakter untuk meningkatkan perilaku prososial bekerja sama, menolong dan menghargai hak dan kesejahteraan orang lain pada remaja SMA. Desain penelitian eksperimen yang digunakan dalam penelitian ini adalah one group pretest-posttest.  Partisipan penelitian berjumlah 21 siswa kelas XI SMA Xin Zhong Surabaya yang terpilih berdasarkan teknik purposive sampling. Instrumen penelitian menggunakan skala prososial yang disusun oleh peneliti dengan koefisien reliabilitas sebesar ?= 0,898. Hasil analisis menggunakan Wilcoxon menunjukkan bahwa pembelajaran karakter efektif untuk meningkatkan perilaku prososial remaja SMA. Disarankan agar para guru menggunakan modul pembelajaran karakter untuk meningkatkan perilaku prososial remaja SMA.Kata kunci: Efektivititas Pembelajaran; Pembelajaran Karakter; Perilaku Prososial

Applicability of the Sarculator and MSKCC nomograms to retroperitoneal sarcoma prognostication in an Asian tertiary center

AIM

To study the applicability of 2 common nomograms in retroperitoneal sarcoma patients treated in an Asian tertiary hospital, and to study relapse patterns.

METHODS

Patients from 1st January 2000 to 31st December 2017 were retrospectively analysed. R2 resection from an external institution were ineligible. Harrel's C concordance index and calibration plots were used to assess nomograms' accuracy.

RESULTS

109 patients were eligible, with a median age of 56, median tumour size of 16 cm and median follow up of 44.1 months. Most common subtypes were DDLPS (46.8%), LMS (19.3%) and WDLPS (13.8%). Overall, 81.1% had passed away from sarcoma. Recurrence patterns differed with subtypes; 6.7% of WDLPS and 66.7% of LMS had distant relapses. WDLPS patients had a median sarcoma specific survival of 139 months (122-NA), while the rest had a median SSS of 72.3 months (59.7-NA). The 5-years and 7-year OS were 63.0% (95% CI: 53.6%-74.0%) and 51.6% (41.1%-64.8%) respectively. The 5-years and 7-year DFS were 22.4% (15.5%-32.3%) and 17.5% (11%-27.8%) respectively. The 4-years, 8-years and 12-year SSS were 71.3% (62.7%-81.0%), 51.8% (40.8%-65.8%) and 32.2% (19.7%-52.6%) respectively. The concordance indices for 7-year DFS and OS (Sarculator) were 0.63 and 0.73. The concordance indices for 4-, 8- and 12-year SSS (MSKCC) were 0.64, 0.72 and 0.72.

CONCLUSION

Both nomograms were effective in our cohort. Both nomograms can be further improved by specifying the type of relapse and including a longer-term endpoint for the Sarculator.

Fistulotomy with or without marsupialisation of wound edges in treatment of simple anal fistula: a randomised controlled trial

BACKGROUND

Promotion of healing of the anal wound after fistulotomy may help accelerate recovery and return to work. The present study aimed to assess the effect of marsupialisation of the edges of the laid open fistula track on wound healing after anal fistulotomy for simple anal fistula.

METHODS

This was a prospective randomised trial on patients with simple anal fistula. Patients were randomly assigned to one of two groups; group I underwent anal fistulotomy and group II underwent anal fistulotomy and marsupialisation of the edges of the laid open track. Outcomes of the study were time to achieve complete wound healing, operation time, postoperative pain and complications.

RESULTS

Sixty patients of mean age of 40.8 years with simple anal fistula were randomly divided into two equal groups. No significant differences between the two groups regarding operation time (16.8 vs 18.4 minutes; P = 0.054), postoperative pain score (1.6 vs 1.2; P = 0.22), and complication rates were recorded. Group II achieved complete healing in a significantly shorter duration than group I (5.1 vs 6.7 weeks; P < 0.0001).

CONCLUSION

Marsupialisation of the edges of the laid open fistula track after fistulotomy resulted in quicker wound healing with similar complication and recurrence rates to lay open fistulotomy alone.

Use of Chest X-Ray Examination as a Diagnostic Aid for Detection of Dengue Haemorrhagic Fever

The advantage of a chest X-ray in the RLD position in 15 children with DHF hospitalized at the paediatric ward of the Ternate General Hospital within the period of May-June-July 1990 and June-July 1991 were evaluated. Besides clinical and laboratory assessment to establish the diagnosis of DHF according to the WHO guidelines (1975), child and a haemaglutination-inhibition test was also done to confirm the diagnosis. Chest X-rays in the RLD position found a pleural effusion in 11 out of 15 patients with DHF especially in those with dengue shock syndrome. A positive serological test was always associated with the presence of PE (100%), while this could be shown in only 2 patients with negative test results. It may be concluded that the WHO criteria for the clinical diagnosis of DHF may be confirmed not only by the serological test but also by the presence of PE on chest film in the RLD position and therefore this examination may play an important role in establishing a diagnosis of DHF in a regency hospital.

An Analysis of the Psychosocial, Financial and Emotional Needs of Adolescent and Young Adult Cancer Survivors in Singapore Through Focus Group Discussions

Background: The adolescent and young adult (AYA) population, aged between 15-39 years, is an understudied and medically underserved community of cancer survivors in Singapore. Aim: This study was designed to elicit perspectives on various psychosocial, emotional and financial concerns that the AYA cancer survivors (CS) encountered, in their transition to survivorship. Methods: The AYA CS in the age range of 18-39 years, with at least 6 months to 2 years since diagnosis and/or completion of curative treatment were recruited for this study. Four focus group discussions, which consisted of 2-4 respondents, were conducted within the premises of National Cancer Centre Singapore. Participants were prompted by the facilitator with a series of open-ended questions on themes specific to survivorship, including treatment side-effects, sexual and reproductive health concerns, changes in work or education and survivorship support services. Participants' responses were then transcribed verbatim, and analyzed through qualitative content analysis. Results: Twelve AYA, with a mean (±SD) age of 27.1 (±5.9) years, participated in four focus group discussions. The mean (±SD) number of years since cancer diagnosis was 2.3 (±0.6) years, with majority diagnosed with non-Hodgkin's lymphoma (41.6%) and germ cell tumor (25.0%). AYA CS were greatly affected by physical side-effects such as alopecia, changes in body image, and cognitive changes. There were also emotional concerns including the fear of recurrence, infertility anxieties, poor insurance coverage and lack of career advancement opportunities. Majority expressed that they preferred consulting a specialist rather than a general practitioner for their follow-up care. Conclusion: The AYA CS suffer from a multitude of problems as they transit toward survivorship. Innovative and effective survivorship care models are required to timely address their bio-psychosocial, financial and emotional concerns.

Abdominal rectopexy for the treatment of internal rectal prolapse: a systematic review and meta-analysis

AIM

Internal rectal prolapse (IRP) is a unique functional disorder that presents with a wide spectrum of clinical symptoms, including constipation and/or faecal incontinence (FI). The present review aims to analyse the results of trials evaluating the role of abdominal rectopexy in the treatment of IRP with regard to regarding functional and technical outcomes.

METHOD

A systematic review of the literature for the role of abdominal rectopexy in patients with IRP was conducted. PubMed/Medline, Embase and the Cochrane Central Register of Controlled Trials were searched for published and unpublished studies from January 2000 to December 2015.

RESULTS

We reviewed 14 studies including 1301 patients (1180 women) of a median age of 59 years. The weighted mean rates of improvement of obstructed defaecation (OD) and FI across the studies were 73.9% and 60.2%, respectively. Twelve studies reported clinical recurrence in 84 (6.9%) patients. The weighted mean recurrence rate of IRP among the studies was 5.8% (95% CI: 4.2-7.5). Two hundred and thirty complications were reported with a weighted mean complication rate of 15%. Resection rectopexy had lower recurrence rates than did ventral rectopexy, whereas ventral rectopexy achieved better symptomatic improvement, a shorter operative time and a lower complication rate.

CONCLUSION

Abdominal rectopexy for IRP attained satisfactory results with improvement of OD and, to a lesser extent, FI, a low incidence of recurrence and an acceptable morbidity rate. Although ventral rectopexy was associated with higher recurrence rates, lower complication rates and better improvement of bowel symptoms than resection rectopexy, these findings cannot be confirmed owing to the limitations of this review.

Laparoscopic ventral mesh rectopexy vs Delorme's operation in management of complete rectal prolapse: a prospective randomized study

AIM

Various surgical operations have been devised for the treatment of rectal prolapse, yet no ideal procedure has been described. The present study aims to compare the clinical and functional outcome of laparoscopic ventral mesh rectopexy (LVMR) and Delorme's operation for complete rectal prolapse.

METHOD

Fifty patients with complete rectal prolapse were enrolled in this study. Patients were randomly selected to undergo either LVMR or Delorme's procedure after clinical, manometric and radiological evaluation. Patient characteristics, operative data, postoperative complications, recurrence of rectal prolapse and continence state were evaluated. Patients were followed for a mean duration of 18 months.

RESULTS

Thirty-one (62%) patients were women and 19 (38%) patients were men with a mean age of 39.7 ± 6.9 years. Patients were allocated into two equal groups: LVMR group and Delorme's group. Thirty-three (66%) complained of faecal incontinence preoperatively. Patients were followed for 18 months. There was no major postoperative complication or treatment death. Improvement in continence was reported in 80.9% of patients (83.3% in group 1 vs 71.4% in group 2). Recurrent prolapse was observed in 16% of patients in group 2 and 8% in group 1 (P = 0.66). The operation time was significantly greater in group 1 and the length of stay greater in group 2. There was no difference in the fall of constipation score between the groups.

CONCLUSION

There was no statistically significant difference in the incidence of recurrence of complete rectal prolapse or postoperative improvement of symptoms between the two groups. Hospital stay was longer after Delorme's procedure but the operation time was shorter. Neither procedure proved definite superiority regarding the clinical and functional outcome at 18 months of follow-up.

Motivasi Kerja, Internal Locus Of Control dan Kepuasan Kerja Pada Karyawan Bagian Marketing Dan Supporting di PT X Cabang Surabaya

Research that takes the subject 100 employees at PT. X in Surabaya branch fromand marketing supporting division to find the motivation to work and internal locus ofcontrol and job satisfaction in a correlational study. Data collected through questionnairesand analyzed by multiple regression test. The results show the value of F = 3.449; p =0.0036 (p <0.05), which means that work motivation and internal locus of controlcombination has a significant correlation with employees job satisfaction. It can besaid that the hypothesis that states motivation and internal locus of control on employeesat the marketing and supporting division have a relationship with employee satisfaction,that means it can be accepted. The value of R2 = 0.066 describe motivation and internallocus of control simultaneously have contributed effectively to job satisfaction up to 6.6%and that is a quite low in value. Partial test results of work motivation are t = 2.353; p= 0.021 (p <0.05), which means there is a significant positive correlation between workmotivation and job satisfaction, while the result of internal locus of control are = -0.572;p = 0.568 (p> 0.05), that means there is no correlation between the internal locus ofcontrol and job satisfaction.Keywords : Job satisfaction, work motivation, internal locus of control

JAK-STAT and G-protein-coupled receptor signaling pathways are frequently altered in epitheliotropic intestinal T-cell lymphoma

Epitheliotropic intestinal T-cell lymphoma (EITL, also known as type II enteropathy-associated T-cell lymphoma) is an aggressive intestinal disease with poor prognosis and its molecular alterations have not been comprehensively characterized. We aimed to identify actionable easy-to-screen alterations that would allow better diagnostics and/or treatment of this deadly disease. By performing whole-exome sequencing of four EITL tumor-normal pairs, followed by amplicon deep sequencing of 42 tumor samples, frequent alterations of the JAK-STAT and G-protein-coupled receptor (GPCR) signaling pathways were discovered in a large portion of samples. Specifically, STAT5B was mutated in a remarkable 63% of cases, JAK3 in 35% and GNAI2 in 24%, with the majority occurring at known activating hotspots in key functional domains. Moreover, STAT5B locus carried copy-neutral loss of heterozygosity resulting in the duplication of the mutant copy, suggesting the importance of mutant STAT5B dosage for the development of EITL. Dysregulation of the JAK-STAT and GPCR pathways was also supported by gene expression profiling and further verified in patient tumor samples. In vitro overexpression of GNAI2 mutants led to the upregulation of pERK1/2, a member of MEK-ERK pathway. Notably, inhibitors of both JAK-STAT and MEK-ERK pathways effectively reduced viability of patient-derived primary EITL cells, indicating potential therapeutic strategies for this neoplasm with no effective treatment currently available.

Hubungan Antara Religiusitas dan Dukungan Sosial dengan Kebahagiaan Pelaku Konversi Agama

The purpose of this study was to investigate the relationship between religiosity and social support with happiness among perpetrators of religious conversion. The data was collected from 60 participants who had experienced with religious conversion (muallaf) in Chinese Community. The participants were between 40 and 55 years of age. Data of this study was analysed by using a multiple regression analysisThe results of multiple regression analysis showed F = 20,060 with p = 0, 00 (p < 0, 01), it was revealed that religiosity and social support were found to be highly significant with happiness. Therefore, the result of this study indicated that hypothesis that there is any relationship between religiosity and social support with happiness was accepted. The results of partial correlation analysis were; (1) there was positive correlation between religiosity and happiness (r partial = 0,473, t = 4,056, with p = 0,000 (p<0,01)). It means,by increasing the religiosity, the happiness among perpetrators of religious conversion also will increase and (2) there was no any correlation between social support and happiness among perpetrators of religious conversion(r partial = 0,221 t = 1,715,with p = . 0,092 (p>0, 05)).

Pengaruh Experiential Learning Terhadap Kepercayaan Diri Dan Kerjasama Tim Remaja

Intisari. Penelitian ini akan mengkaji pengaruh Experiential learning terhadap kepercayaan diri dan kerjasama tim remaja. Penelitian ini merupakan penelitian eksperimen yang dilakukan pada siswa VII MTs. Babussalam Kalibening Mojoagung Jombang dengan jumlah subyek 60 orang siswa. Pengumpulan data untuk mengungkap kepercayaan diri menggunakan skala kepercayaan diri dan kerjasama tim ukur dengan skala kerjasama tim, sedangkan Experiential learning diberikan sebagai treatmen pada kelompok eksperimen. Analisis data untuk variabel kepercayaan diri dilakukan dengan analisis Mann-Whitney karena data variabel ini tidak homogen dan analisis untuk variabel kerjasama tim dilakukan dengan uji-t student. Hasil penelitian menunjukkan ada perbedaan kepercayaan diri antara kelompok eksperimen yang mendapat treatment Experiential learning dengan kelompok kontrol yang tidak mendapat treatment pretest-post test  (z = -2,537 ; p =0,011). Pada kerjasama tim ada perbedaan kerjasama tim antara kelompok eksperimen yang mendapat treatment Experiential learning dengan kelompok kontrol yang tidak mendapat treatment pretest-post test (t = 3,009 ; p. = 0,002). Hasil tersebut menunjukkan bahwa Experiential learning berpengaruh terhadap kepercayaan diri dan kerjasama tim  remaja.Kata kunci: Experiential learning, Kerpercayaan diri, dan Kerjsama Tim

Enteropathogenic Escherichia coli (EPEC): Does it have a role in colorectal tumourigenesis? A Prospective Cohort Study

BACKGROUND

Despite the characterization of many aetiologic genetic changes. The specific causative factors in the development of sporadic colorectal cancer remain unclear. This study was performed to detect the possible role of Enteropathogenic Escherichia coli (EPEC) in developing colorectal carcinoma.

PATIENTS AND METHOD

Fresh biopsy specimens have been obtained from the colonic mucosa overlying the colorectal cancer as well as from the colon of the healthy controls. Culture, genotyping and virulence of EPEC were done using (nutrient broth culture, and PCR). Strains biochemically identified as Escherichia coli were selected from the surface of a MacConkey's plate and were serogrouped by slide agglutination tests.

RESULTS

From January 2011 to June 2014, 213 colorectal cancer patients (Group 1) and 248 healthy controls (Group 2) were prospectively enrolled in this study. EPEC was positive in 108 (50.7%) in group 1 and 51 (20.6%) in group 2 (P = 0.0001). A significant difference between both groups was observed regarding serotyping, genotyping (eae gene) and virulence category (P = 0.0001). A significant difference between the 2 subgroups of colorectal cancer cases was observed regarding genotyping (eae, bfb genes) and virulence category.

CONCLUSION

The incidence EPEC was higher significantly in patients with colorectal cancer. E. coli in patients with colorectal cancer significantly differed serotypically and genotypically from the E. coli in normal population. E. coli colonization of the colonic mucosa may be a cause colorectal cancer.

Motivasi Intrinsik, Pola Asuh Orangtua Demokratis dan Kreativitas Anak Sekolah Dasar

Abstrak. This study aims to determine the relationship between intrinsic motivation and democratic parenting parents to elementary school children's creativity. Subject of this study is Fifth grade students of Petra 5 Christian Elementary School to 90 students. The results showedthatthere wasa significant correlation between intrinsic motivation and democratic parenting parents to creativity (F = 4.081top=0.023); partially obtained results indicate that intrinsic motivation correlated significant positive towards creativity(t =2.334top=0.024), while between democratic parental parenting variables and creativity did not show anycorrelation(t =0.774top=0.443).Keywords: intrinsic motivation, democratic parenting parents, and creativity.