Chemotherapy for Advanced Colorectal Cancer Among Indonesians in a Private Hospital in Jakarta: Survival When Best Treatment is Given

Background: Survival of colorectal cancer in Indonesia is thought to be shorter due to to several factors, among these: ethnic, nutritional, and the low affordability factors. Aim of this study to assess and evaluate survival in advanced colorectal cancer when given the best drugs available as recommended by International guidelines.Method: A historical cohort study was done in patients with advanced colon or rectal cancer between 2008 and 2010 at Medistra Hospital. Cases were retrieved from medical record data. Subjects were included if they were diagnosed or had a relapse of their disease during the study period and were followed until they died or lost to follow-up. Staging procedure was done using the tumor node metastasis (TNM) system. All patients received the combination of 5-uorouracil (5-FU)/leucovorin (LV), oxaliplatin for 6 cycles (FOLFOX4) as the standard rst-line regimen for metastatic colorectal cancer (mCRC) in Indonesia. Oral capecitabine and targeted therapy such as bevacizumab and cetuximab might were also given, whenever indicated.Results: Nineteen patients (48.7%) died during the study period, while the rest were alive or lost to follow-up. The median overall survival of patients was 18 months (95% CI = 6.98 – 29.02 months). The longest survival was76 months (the patient is still alive when this manuscript was being prepared). Patients with colon cancer tended to live longer than rectal cancer, i.e. 21 vs. 15 months; log-rank p = 0.147. There was no signi cant difference of survival between patients with stage IV disease and relapse cases, i.e. 18 vs. 12 months, log-rank p = 0.807. Conclusion: With proper treatment and access to cytostatics and biologicals, advanced colorectal cancer among Indonesian patients have the same survival rates as patients in more developed countries as reported in the literature

The Growth of Seaweed (Kappaphycus Alvarezii) Cultivated with Long Line and Off Bottom Method on Tita Banda Neira Maluku Coastal Area

This research aimed to know the growth rate of seaweed (Kappaphycus alvarezii) cultivated by using off bottom method and long line method in coastal waters Tita Dwiwarna Village Banda Central of Maluku. It is expected that this research will provide basic information in business of seaweed cultivation to be developed. The methods were off bottom method and long line method that consisted of 2 treatments and 3 replications. Material used was mostly a polyethylene rope as long as 10 meters with the diameter size 5 mm for a mine rope and 3 mm for a span rope. Initial weight of sea weeds which is tied to a span rope 100 gram. The growth data collection was taken simultaneously with water quality data every week. Data were analyzed by using Cohran test to see homogeneity. The homogeneity data were then analyzed by using t-test to see the different between two treatments. The result of the research has shown that seaweed growth was highest in off bottom methods which average weight on the seventh week reached 690 gram. While the growth with long line methods reached the average weight on the seventh week reached only 609.4 gram. Therefore, the best growth of the sea weed was represented by off bottom method

Safety of Annona Muricata Extract Supplementation for Colorectal Cancer Patients

Background: People have used Annona muricata leaves traditionally as tea drinks. Traditional use of A. muricata leaves is as an infusion which is closed to water extract. The potential health benefit of A. muricata tea leaves that is traditionally used for maintaining health which lately is being used by cancer patients. Therefore it is urgent to verify the safety of A. muricata leaves extract. Method: A randomized double blind placebo controlled trial was conducted on 30 colorectal cancer out patients who had undergone primary tumor resection. Twenty eight subjects completed the study, divided into two groups, namely ethanol-soluble fraction of A. muricata leaves water extract (ESFAM) (n = 14), and placebo (n = 14) for 8 weeks. Peripheral blood samples were withdrawn from subjects by venipuncture at baseline and at the end of the study period.Results: The effect on bone marrow can be considered to be safe. The measure in indices of organs function, i.e liver and kidney also showed similar results and within normal range after supplementation. The dose given to the subjects is safe and highly tolerable, as shown by very few (6.7%) of patients complained intolerable adverse effects. Conclusion: This study indicates the safety of ESFAM supplementation

Groundwater resources assessment using numerical model : a case study in low-lying coastal area.

The impacts of climate change and human pressure in groundwater have been greatest threats facing small islands. This paper represents a case study of groundwater responses towards the climate change and human pressures in Manukan Island Malaysia. SEAWAT-2000 was used for the simulations of groundwater response in study area. Simulations of six scenarios representing climate change and human pressures showed changes in hydraulic heads and chloride concentrations. Reduction in pumping rate and an increase in recharge rate can alter the bad effects of overdrafts in Manukan Island. In general, reduction in pumping rate and an increase in recharge rate are capable to restore and protect the groundwater resources in Manukan Island. Thus, for groundwater management options in Manukan Island, scenario 2 is capable to lessen the seawater intrusion into the aquifer and sustain water resources on a long-term basis. The selection of scenario 6 is the preeminent option during wet season. The output of this study provides a foundation which can be used in other small islands of similar hydrogeological condition for the purpose of groundwater resources protection

Influence of Stefan blowing on nanofluid flow submerged in microorganisms with leading edge accretion or ablation

The unsteady forced convective boundary layer flow of viscous incompressible fluid containing both nanoparticles and gyrotactic microorganisms, from a flat surface with leading edge accretion (or ablation), is investigated theoretically. Utilizing appropriate similarity transformations for the velocity, temperature, nanoparticle volume fraction and motile microorganism density, the governing conservation equations are rendered into a system of coupled, nonlinear, similarity ordinary differential equations. These equations, subjected to imposed boundary conditions, are solved numerically using the Runge-Kutta-Fehlberg fourth-fifth order numerical method in the MAPLE symbolic software. Good agreement between our computations and previous solutions is achieved. The effect of selected parameters on flow velocity, temperature, nano-particle volume fraction (concentration) and motile microorganism density function is investigated. Furthermore, tabular solutions are included for skin friction, wall heat transfer rate, nano-particle mass transfer rate and microorganism transfer rate. Applications of the study arise in advanced micro-flow devices to assess nanoparticle toxicity

Cardiac Tamponade Secondary to COVID-19

A 67-year-old female presented with upper respiratory symptoms and was diagnosed with COVID-19. She was found to have a large hemorrhagic pericardial effusion with echocardiographic signs of tamponade and mild left ventricular impairment. Clinical course was complicated by development of Takotsubo cardiomyopathy. She was treated with pericardiocentesis, colchicine, corticosteroids and hydroxychloroquine with improvement in symptoms

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Comparative Analysis of Patient Characteristics in Cardiogenic Shock Studies: Differences Between Trials and Registries

OBJECTIVES: This study sought to evaluate the differences in cardiogenic shock patient characteristics in trial patients and real-life patients. BACKGROUND: Cardiogenic shock (CS) is a leading cause of mortality in patients presenting with acute myocardial infarction (AMI). However, the enrollment of patients into clinical trials is challenging and may not be representative of real-world patients. METHODS: We performed a systematic review of studies in patients presenting with AMI-related CS and compared patient characteristics of those enrolled into randomized controlled trials (RCTs) with those in registries. RESULTS: We included 14 RCTs (n = 2,154) and 12 registries (n = 133,617). RCTs included more men (73% vs 67.7%, P \u3c 0.001) compared with registries. Patients enrolled in RCTs had fewer comorbidities, including less hypertension (61.6% vs 65.9%, P \u3c 0.001), dyslipidemia (36.4% vs 53.6%, P \u3c 0.001), a history of stroke or transient ischemic attack (7.1% vs 10.7%, P \u3c 0.001), and prior coronary artery bypass graft surgery (5.4% vs 7.5%, P \u3c 0.001). Patients enrolled in RCTs also had lower lactate levels (4.7 ± 2.3 mmol/L vs 5.9 ± 1.9 mmol/L, P \u3c 0.001) and higher mean arterial pressure (73.0 ± 8.8 mm Hg vs 62.5 ± 12.2 mm Hg, P \u3c 0.001). Percutaneous coronary intervention (97.5% vs 58.4%, P \u3c 0.001) and extracorporeal membrane oxygenation (11.6% vs 3.4%, P \u3c 0.001) were used more often in RCTs. The in-hospital mortality (23.9% vs 38.4%, P \u3c 0.001) and 30-day mortality (39.9% vs 45.9%, P \u3c 0.001) were lower in RCT patients. CONCLUSIONS: RCTs in AMI-related CS tend to enroll fewer women and lower-risk patients compared with registries. Patients enrolled in RCTs are more likely to receive aggressive treatment with percutaneous coronary intervention and extracorporeal membrane oxygenation and have lower in-hospital and 30-day mortality

Modeling the behavior of radially pinned brick triplets

The continued use of many UK highway and railway masonry arch bridges is dependent upon maintaining robustness as the materials deteriorate over time. A common failure in multi-ring brickwork arches subject to fatigue, is ring separation. This paper offers some early results from an investigation of a ring separation repair technique involving radial pinning. Triplet testing is used to establish and compare the structural behavior of two types of shear reinforcement, which are validated by finite element modelling. Conclusions are drawn which are potentially of significant practical interest to masonry arch bridge owners and assessors