Primary urethral carcinoma in female: An extremely rare case series at a single tertiary referral hospital and literature review.

INTRODUCTION AND IMPORTANCE: Primary urethral carcinoma (PUC) is exceedingly uncommon and accounts for 0.02 % of all female cancers and <1 % of female genitourinary tract malignancy. PUC in female usually presents late with a higher disease stage and, hence, has higher cancer-specific mortality. Due to its rarity, the current recommendation for the management of PUC is still unclear. CASE PRESENTATION: This study reports two rare cases of 59-year-old and 65-year-old women with PUC, presenting with chief complaint of hematuria. Urethrocystoscopy and biopsy were performed. Pathology results revealed mucinous adenocarcinoma (AC) and urothelial carcinoma (UC) of the urethra, respectively. Radiological imaging was conducted for staging. Both were diagnosed with cT4N2M0. The first patient underwent anterior pelvic exenteration with bilateral ureterocutaneoustomy (UCS), while the second patient received cisplatin-based chemotherapy before the surgery. Radiological follow-up was planned 3 months after the surgery. CLINICAL DISCUSSION: Both mucinous AC and UC are considered incredibly unusual subtypes, with no defined treatment guidelines. Anterior exenteration with or without neoadjuvant chemotherapy may be opted for advanced PUC affecting the proximal urethra and adjacent organs. Following the previous studies, in this case series, both patients (locally advanced) underwent anterior exenteration. Additionally, the UC subtype received multimodal treatment with neoadjuvant chemotherapy which was shown to improve overall survival. CONCLUSION: In conclusion, PUC is extremely rare, and the choice of management remained various. Long-term follow-up for these patients is mandatory to improve understanding of this incredibly uncommon disease.

Parental Perspectives Regarding Circumcision during the Coronavirus Disease 2019 Pandemic in Indonesia.

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic has rapidly spread worldwide and affected the healthcare system, including the deferral of surgical practice. There are various reactions regarding delayed surgeries, but parental viewpoints towards circumcision remain scarce. In light of the pandemic, this study aimed to evaluate how parents feel about circumcision and the probable determining variables. MATERIALS AND METHODS: This study is a cross-sectional study based on an online questionnaire available from March to April 2022. The factors affecting the decision were analysed using logistic regression. RESULTS: Of 1,218 (26.28%) parents who completed the survey, 879 (18.96%) met the inclusion criteria and were included in this study. Among them, 615 (70.00%) parents agreed to delay circumcision during the COVID-19 pandemic. These respondents were more likely to be non-Muslim (P = 0.01), have no relatives whose work is related to medicine or paramedicine (P = 0.02) and have monthly income equal to or below the regional minimum wage (P = 0.03). After adjusting the potential confounder, non-Muslim religion (odds ratios, 2.87; 95% confidence interval, 1.27-6.49; P = 0.012) was found to be the only independent predictor for agreeing to the deferral of circumcision amid the pandemic. CONCLUSION: Most parents agreed to postpone circumcision due to the fear of COVID-19 exposure. In order to help them feel less apprehensive about this matter, it is important to educate them about the medical benefits of circumcision and the safety of this procedure.

Prevalence of burnout and its associated factors among medical students during COVID-19 pandemic in Indonesia: A cross-sectional study.

Shifting learning process due to COVID-19 has led to increased burnout prevalence among medical students. Thus, this study aimed to assess burnout prevalence and its associated factors among Indonesian medical students during the COVID-19 pandemic. An online cross-sectional study was carried out among medical students in Malang, Indonesia. Burnout was assessed using the Maslach Burnout Inventory-Student Survey tool. Pearson's Chi-square was used to assess significant associations, and binary logistic regression was conducted to evaluate the relationships between the predictor variables and burnout. The difference of each subscale score was evaluated using an independent sample t test. This study analyzed 413 medical students with a mean age of 21.1 ± 1.4 years old. About 29.5% and 32.9% of students reported a high level of emotional exhaustion and depersonalization, respectively, resulting in 17.9% of burnout prevalence. Stage of study was the only sociodemographic factor independently associated with burnout prevalence (odds ratio = 0.180, 95% confidence interval = 0.079-0.410, p-values = 0.000). Preclinical students had significantly higher levels of emotional exhaustion (p-value = 0.004, d = 0.3) and depersonalization (p-value = 0.000, d = 1.1), and lower levels of personal accomplishment (p-value = 0.000, d = -0.5). Around one-sixth of the medical students experienced burnout during the COVID-19 pandemic, with preclinical students being more prone to have burnout. Future study with other adjusted confounding factors is needed to completely understand the issue and obtain immediate interventional strategies to reduce burnout among medical students.

The Prevalence and the Associated Sociodemographic-Occupational Factors of Professional Burnout Among Health Professionals During COVID-19 Pandemic in Malang, Indonesia: A Cross-Sectional Study.

Background: Since 2020, Indonesian health professionals have been affected by burnout as the physiological impact due to the COVID-19 pandemic. Malang has contributed to a substantial number of new daily cases and death rates in East Java, an epicenter of COVID-19 in Indonesia. However, a study about how burnout affected Malang health professionals was never conducted. Objectives: This research aimed to assess the prevalence and factors associated with burnout among health professionals during the COVID-19 pandemic in Malang, Indonesia. Materials and Methods: A cross-sectional study was carried out with an online survey conducted in 5 major hospitals in Malang. We conducted a study about the prevalence rate of burnout in Malang and the association between sociodemographic factors, occupational hazards, and the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). The associations were presented as odds ratio (OR) and 95% confidence interval (CI). Results: We analyzed 1,077 health professionals in Malang. Our result showed that the prevalence of burnout among health professionals in Malang is 22.0%. Respondents under the age of 30 tend to experience a higher level of burnout by 3.4-fold (OR = 3.43, p-value < 0.001), compared with those over the age of 40 years. Our data showed that respondents working longer than 100 h/week tend to experience burnout by 3.8-fold (OR = 3.83, p-value < 0.001). Conclusion: Approximately one-fifth of the health professionals in Malang suffered from burnout during the COVID-19 pandemic, and MBI-HSS subscales are strongly associated with age and work hours.