Low levels of serum 25(OH)D in women are reported in temperate countries, and increasingly so in tropical countries but few such studies have been reported in Indonesia. This study was aimed at assessing the serum vitamin D status and its associated factors in a sample of Indonesian women Methods: A cross-sectional study was conducted on 156 apparently healthy women during the dry season in North Sumatera. The measurements carried out included exposure to sun's rays, intake of vitamin D food sources, reported physical activity, body fatness (by bioelectrical impedance analysis), and serum 25(OH)D levels (by chemiluminescent immunoassay). Serum 25(OH)D levels were categorised into: deficient(<20 ng/mL), insufficient (20-32 ng/mL), sufficient (32-100 ng/ mL), and normal for tropical countries (54-90 ng/mL). Statistical analysis included Pearson correlation, independent t-test, and one way ANOVA tests. Results: The mean age of the subjects was 35.6±7.7 years, with about 70% working indoors. About half of the women were obese. The majority had low vitamin D intake. More than half had sun ray exposure of less than 1 hour, and moreover, nearly two-thirds of them wore the 'hijab' that covers most parts of their body. The majority of women reported low physical activity level. The mean serum 25(OH)D level of the subjects was 17.71 ng/mL (95% CI: 16.22, 19.34 ng/mL). Of the total, 95% (148) were in the vitamin D deficient-insufficient category, with the remaining 5% in the sufficient category. An association was found between occupation, dietary intake of vitamin D, sun ray exposure, and physical activity levels with serum vitamin D concentrations. Conclusion: The results showed that vitamin D deficiency can occur in women living in a tropical country if they have sun-avoiding lifestyles, work indoors, and have low dietary intake of vitamin D.
Vitamin D ; Women ; Indonesia

Essential thrombocythemia is one of the myeloproliferative neoplasms. Palpable purpura is a rare manifestation that may delay diagnosis and treatment. We report a case of essential thrombocythemia in a 50-year-old man, who presented with recurrent thigh pain for the past one year with nonspecific localized purpura. His full blood count revealed isolated thrombocytosis of 880,000/µL with an impression of myeloproliferative disorder from peripheral blood film. He was referred urgently to the hematology team, which proceeded with a venesection. His condition improved with hydroxyurea. This was a rare case of chronic presentation of myeloproliferative neoplasm detected at a primary care clinic

Introduction: Premature ejaculation (PE) is an important sexual problem among men attending health clinic. Impacts of this condition towards quality of life still require further exploration.Aims: To determine the proportion and determinants for PE and theirs quality of life Methods: A cross-sectional study involving 290 respondents was conducted at a primary health clinic over the period of five months (Nov 2015-March 2016). A self-administrated questionnaire that consisted of socio-demographic questionnaire, clinical characteristics, premature ejaculation diagnostic tool (PEDT) and WHO quality of life (WHOQOL-BREF) was usedResults: The proportion of PE was 33.9% with PE 18.1% (49/271) and probable PE 15.8% (43/271). Multivariate analysis showed that level of education (p=0.002, OR 3.281/95% CI 1.183, 9.101) and hypertension (p=0.047, OR 1.788/95% CI 1.008, 3.170) were the only predictors for PE after controlling self-reported erectile dysfunction, pulmonary and neurological disorder. PE patients had lower median scores quality of life in all four domain namely physical health, psychological, social relationship, environment (all domains with p<0.001).Conclusion: The proportion of men diagnosed with premature ejaculation in this study is high. This condition is possibly associated with level of education and hypertension. Men with PE had lower quality of life in domains of physical health, psychological, social relationship and environment. Hence, it is recommended for PE screening among male attendees to primary health clinic especially those with hypertension and moderate level of education.

Oropharyngeal carcinoma is uncommon cancer compared to other malignancies. It accounts for less than 3% worldwide cancer and classified under the head and neck carcinoma. Patients with locally advanced oropharyngeal malignancy are usually treated with surgery with combination of radiotherapy and chemotherapy. This later required regular follow up especially on supportive care and adaptation to swallowing. Difficulty in swallowing provided burden to the patient and may lead to underlying malnutrition and risk of infection including tuberculosis. This will end up with poor compliance to oral treatment and risk of resistance. Therefore, this case study is illustrating the challenging role of family medicine specialists in managing a case of sputum positive pulmonary tuberculosis with underlying swallowing difficulty from glossectomy and radiotherapy on top of defaulted tongue carcinoma supportive care follow up.