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Non-communicable diseases, including cancer, start to become more common in Indonesia. According to the government statement, incidence of malignant diseases increased annually up to 8% in the last decade and these diseases become the seventh leading cause of death in Indonesia. On the basis of the latest Globocan report on cancer incidence in Indonesia, prostate cancer ranks sixth; followed by bladder (12th) and kidney (18th). More than half of patients with kidney cancer are diagnosed in the advanced stage. Besides renal cell carcinoma, there are significant number of people affected with squamous cell and transitional cell carcinoma because of kidney stones. Radical nephrectomy or cytoreductive nephrectomy was the primary treatment, mostly done as an open procedure. Transitional cell carcinoma is the commonest histology type in bladder cancer cases followed by squamous cell carcinoma, which almost always related to bladder stones. Unfortunately, >70% of our cases were diagnosed with muscle invasive bladder cancer, and ∼60% of these patients refused further radical treatment. Incidence of prostate cancer is increasing rapidly and it becomes the third most common cancer in men. However, most of our patients are diagnosed in the advanced stage. Radical prostatectomy or external beam radiotherapy is the treatment of choice in localized disease. Nearly 40% of the elderly patients are treated with primary androgen deprivation therapy. Therefore, it requires more research by the Indonesian urologists and other healthcare providers to diagnose these cancers in earlier stage as well as community education for prevention.

SummaryThe case presented illustrates several important aspects of von Willebrand's disease. Abnormal bleeding after dental extractions may be the first indication that a patient has a bleeding disorder. When replacement therapy is adequate, normal he‐most sis can be expected at the same time of surgery and after surgery. Multiple surgical procedures should be done where feasible. Orthopedic surgeons would probably hesitate to work simultaneously with dentists because of the perceived risk of joint infection secondary to bacteremia associated with dental procedures. However, many other procedures can be performed with success, as in the case reported here. Finally, until the time when virus‐free therapy (without the need of human donors) is available, the exposure of patients to blood components should be minimized by combining procedures and by using treatments such as Stimate whenever possible.

Background: Evidences on dental anxiety scale are essential in dental practice for better service delivery. The main objective of this study was to determine the anxiety level of patients undergoing oral surgical procedures and explore its associated factors.Methods: This was a cross sectional study enrolling 142 patients. Semi structured questionnaire based on Corah's dental anxiety scale was prepared and administered to gather information. Descriptive statistics, chi- square test and independent t- test were used to analyze the data.Results: Sixty nine percent were feeling relaxed in waiting area. Nine patients (6.3%) were afraid of persons in white attire. About 17% reported that they were afraid of sound of dental apparatus. Many participant (81%) expected better outcomes of their dental procedures. When waiting for their procedure at the waiting area, about 50% stated to sense restlessness. Nearly 56% felt unease while waiting at dental chair. Nearly 70 % of cases had less than 7 dental anxiety scale score indicating low anxiety to dental procedures, 23.2% showed moderate anxiety with score of 7 to 9 and 7% showed high anxiety by scoring 10 or more out of score of 15.Average dental anxiety scale scores did not vary as per age differences. The anxiety scores for both sexes were alike.Conclusions: Even though anxiety level was low among the cases undergoing oral surgical procedure, being in waiting area and dental chair raises their apprehension.

Minimum surgical times are positive and often large. The lognormal distribution has been proposed for modeling surgical data, and the three‐parameter form of the lognormal, which includes a location parameter, should be appropriate for surgical data. We studied the goodness‐of‐fit performance, as measured by the Shapiro‐Wilk p‐value, of three estimators of the location parameter for the lognormal distribution, using a large data set of surgical times. Alternative models considered included the normal distribution and the two‐parameter lognormal model, which sets the location parameter to zero. At least for samples with n > 30, data adequately fit by the normal had significantly smaller skewness than data not well fit by the normal, and data with larger relative minima (smallest order statistic divided by the mean) were better fit by a lognormal model. The rule "If the skewness of the data is greater than 0.35, use the three‐parameter lognormal with the location parameter estimate proposed by Muralidhar & Zanakis (1992), otherwise, use the two‐parameter model" works almost as well at specifying the lognormal model as more complex guidelines formulated by linear discriminant analysis and by tree induction.

Anthony K Ma,1 Jun Hui Lee,1 Joshua L Warren,2 Christopher C Teng3 1Yale School of Medicine, New Haven, CT, USA; 2Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA; 3Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USACorrespondence: Christopher C TengDepartment of Ophthalmology and Visual Science, Yale School of Medicine, 40 Temple Street, Suite 1B, New Haven, CT, USATel +1 203-785-3366Fax +1 203-785-6220Email christopher.teng@yale.eduPurpose: To understand the distribution of trabeculectomies, glaucoma drainage implants (GDI) and micro-invasive glaucoma surgeries (MIGS) performed in the United States through geospatial mapping.Methods: We performed an observational cohort study to evaluate glaucoma surgeries in patients age ≥ 65. The most recently released data from Centers for Medicare Part B Carrier Summary Files were queried to determine the number of glaucoma surgeries performed per state during the year of 2017. We created choropleth maps, titled "GlaucoMap", to characterize the rates of various surgeries performed across the United States, defined as the number of procedures performed per 10,000 individuals. A chi-squared analysis was further used to evaluate differences in surgical preferences across geographic region. Standardized residuals (SR) were calculated to determine regional influences on surgical distribution.Results: There were 174,788 glaucoma surgeries performed: 22,862 trabeculectomies (13.1%), 19,991 GDI (11.4%) and 131,935 (75.5%) MIGS. The Northeast had the highest trabeculectomy rate, GDI was highest in the Southeast and MIGS were highest in the Southwest. There was a statistically significant difference in proportional use of conventional surgeries versus MIGS across various regions in the United States (p < 0.0001). Given the high trabeculectomy and GDI rates and relatively low MIGS adoption in the Southeast, we observed a +7.03 SR for conventional surgeries and − 4.01 SR for MIGS. The Southwest and Western states had the highest MIGS rate and contributed +3.29 and +3.24 SR toward disproportional MIGS preference, respectively. The preference for conventional surgeries in the Northeast (SR = +2.93) and MIGS in the Midwest (SR = +0.99) also contribute to the overall differences in glaucoma surgeries across the United States.Conclusion: GlaucoMap is useful for visualizing the distribution of glaucoma surgeries in the United States. The heterogeneity in surgical preferences points to regional differences in glaucoma management.Keywords: glaucoma, MIGS, trabeculectomies, GDI, heatmaps