Purpose: The aim of this study was to assess frequency and risk factors of severe bleeding after proctological surgery requiring hemostatic surgery observed after publication of the French guidelines for anticoagulant and platelet-inhibitor treatment. Methods: All patients who underwent proctological surgery between January 2012 and March 2017 in a referral center were included. Delay, severity of bleeding, and need for blood transfusion were recorded. Patients with severe postoperative bleeding were matched to controls at a 2:1 ratio adjusted on the operator, and the type of surgery. Results: Among the 8,890 operated patients, 65 (0.7%) needed a postoperative hemostatic procedure in an operating room. The risk of a hemostatic surgery was significantly increased after hemorrhoidal surgery compared with other procedures (1.9% vs. 0.5%, P<10–4) and was most frequent after Milligan-Morgan hemorrhoidectomy (2.5%). Mean bleeding time was 6.2 days and no bleeding occurred after day 15. Blood transfusion rate was 0.1%. Treatment with anticoagulants and platelet inhibitors were managed according to recommendations and did not increase the severity of bleeding. The risk of severe bleeding was significantly lower in active smokers vs. non-smokers in univariate (16.9% vs. 36.2%, P=0.007) and multivariate (odds ratio, 0.31; 95% confidence interval, 0.14–0.65) analysis whereas sex, age, and body mass were not significantly associated with bleeding. Conclusion Severe postoperative bleeding occurs in 0.7% of patients, but varies with type of procedure and is not affected by anticoagulant or antiplatelet treatment. These treatments given in accordance with the new guidelines do not increase the severity of postoperative bleeding.

Introduction: ARI (Acute Respiratory Infection) is one of the main causes of death among children under five in many countries worldwide. In Indonesia, 10% of ARI cases occur in East Nusa Tenggara, which is the highest prevalence of ARI in this country, with 90% of them leading to under-five mortality. There are various factors that cause the prevalence of ARI. In East Nusa Tenggara itself, environmental factors are suspected to be the risk factors for this disease. This study aims to analyse the association between environmental factors and the incidence of ARI among children under five years old in East Nusa Tenggara. Methods: A cross-sectional study was conducted by analysing secondary data sets obtained from DHS, with a total of 337 subjects examined in this study. Multivariate logistic regression was applied to investigate the association between ARI and various environmental factors. Results: This study found that the prevalence of ARI among children under five years old in East Nusa Tenggara was 9.04% of all subjects. ARI was significantly associated with the types of residence (OR 2.2, 95%CI 1.1-4.3) and passive smoking status (OR 4.7, 95%CI 1.8-12.4) as its risk factors. In addition, there was strong association between ARI and the types of roof (OR 3.3, 95%CI 1.3-8.9) as its protective factor. Conclusion: Based on the findings of this study, it can be concluded that the incidence of ARI in children under five years old was closely associated with residential area, smoke exposure, and roof materials.

In this study, the asymmetry of the main effects of action, background and tonal frequency during a pitch memory processingwere investigated by means of brain activation. Eighteen participants (mean age 27.6 years) were presented with low andhigh frequency tones in quiet and in noise. They listen, discriminate and recognize the target tone against the final tonein a series of four distracting tones. The main effects were studied using the analysis of variance (ANOVA) with action (towring (rubber bulb) vs. not to wring), background (in quiet vs. in noise) and frequency (low vs. high) as the factors (andlevels respectively). The main effect of action is in the right pre-central gyrus (PCG), in conformation with its contralateralbehavior. The main effect of background indicated the bilateral primary auditory cortices (PAC) and is right lateralized,attributable to white noise. The main effect of frequency is also observed in PAC but bilaterally equal and attributable tolow frequency tones. Despite the argument that the temporo-spectral lateralization dichotomy is not especially rigid asrevealed by the main effect of frequency, right lateralization of PAC for the respective main effect of background clearlydemonstrates its functional asymmetry suggesting different perceptual functionality of the right and left PAC.