Global Retinoblastoma Study Group IMPORTANCE Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale.OBJECTIVES To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. DESIGN, SETTING, AND PARTICIPANTSA total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. MAIN OUTCOMES AND MEASURESAge at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. RESULTSThe cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low-and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI,, and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI,). CONCLUSIONS AND RELEVANCEThis study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs.

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Defekasi merupakan salah satu aktivitas manusia yang harus dilalui di dalam kehidupansehari-harinya. Pola defekasi pada anak sangat bervariasi dan sangat bergantung padafungsi organ, susunan saraf, pola makan, serta usia anak. Menilai pola defekasi padaanak berarti menilai frekuensi defekasi, konsistensi dan warna tinjanya. Berdasarkanpenelitian yang telah dilakukan di beberapa negara di Amerika, Eropa, dan Asia-Pasifikdiketahui bahwa terjadi penurunan frekuensi defekasi sesuai dengan bertambahnya usiaanak, sedangkan perubahan konsistensi dan warna tinja sesuai dengan pola makan. Sejauhini belum pernah dilaporkan tentang pola defekasi pada anak Indonesia.

Background Exclusively breastfed newborns have frequent bowelmovements and sometimes watery stool, which parents or doctorsmight think as diarrhea.Objective The aim of this study was to observe the bowel habitsof exclusively breastfed infants.Methods A longitudinal study was done on 100 babies born be-tween November and December 2002 in Cinta Kasih MaternityHospital. The inclusion criteria were fullterm baby, exclusivelybreastfed for 4 months, and informed consent from parents. Ba-bies with problems in organ or nerve that influenced the gastrointes-tinal tract were excluded. Stool frequency, consistency, and colorwere observed.Results The mean stool frequency per day were 3 times in the 1 stweek (95%CI 2.6;3.4), 2 times in the 2 nd week (95%CI 1.7;2.3),1.8 times in the 3 rd week (95%CI 1.5;2.1), and 1.5 times in the 4 thweek (95%CI 1.3;1.7). In the second and third month, it was 1.4times a day and the fourth month, 1.2 times a day. The consis-tency of meconium was soft in the first four days. After that, 18% ofbabies had watery stool, which increased to 30% on day 15-113.In the last week of the fourth month, all babies had soft stool. Meco-nium was black and lasted for 1-3 days. On the fourth day, thestool became yellow. On day 5-14, 6% of babies had green stool,which increased to 12% on day 15-120.Conclusion The first week of the first month was the week whenthe stool frequency was highest compared to the weeks or monthsafter. The consistency of meconium was soft. After it disappeared,most babies had soft stool. Eighteen up to 30% percent of babieshad watery stool. Regarding the color, meconium was black andstayed for 1-3 days. After that, most babies had yellow stool and 6-12% had green stool

Treatment of children with Acute lymphoblastic leukemia was developing, currently in Indonesia there are several commonly used protocols such as National protocol (Jakarta), WK-LLA 2000 protocol, LLA protocol 2006 and protocol LLA 2013. The purpose of this study to determine the probability of survival 3 years In children with acute lymphoblastic leukemia between protocols 2006 and 2013. This study used a mix method of retrospective cohorts and in-depth interviews. The population in this study were LLA children aged 1–15 years who received protocol 2006 and 2013 in RSKD Jakarta from 2008–2016 is 68 children with research time from April 2016 until June 2016. Data were analyzed using Cox Regression. The result of this study shows that the 3-year survival probability of LLA remission based on the 2006 treatment protocol is 30% and the treatment protocol of 2013 is 27%. A 3-year survival event remission occurred between 2006 and 2013 treatment protocols of HR 1.57 (90% CI 0.577–4,299), but the difference between the two protocols was not statistically significant with p-value 0.456.The results of in-depth interviews were also obtained in protocols 2006 and 2013 in the same principle but there remain some differences between the both of the treatment schedule and doses are cumulatively increased. The conclusions of these two protocols are in principle the same and there is not much difference in inputs and processes.  ABSTRAK Pengobatan pada anak leukemia limfoblastik akut terus dikembangkan. Saat ini, di Indonesia ada beberapa protokol yang lazim digunakan, yaitu protokol Nasional (Jakarta), protokol WK-LLA 2000, protokol LLA 2006, dan protokol LLA 2013. Tujuan studi ini untuk mengetahui probabilitas kesintasan hidup tiga tahun pada anak leukemia limfoblastik akut antara protokol 2006 dan 2013. Studi ini menggunakan mix method, yaitu kohort retrospektif dan wawancara mendalam. Populasi dalam penelitian ini adalah anak LLA usia 1–15 tahun yang mendapatkan protokol 2006 dan 2013 di Rumah Sakit Kanker “Dhramais”/RSKD, Jakarta, dari 2008–2016 sebanyak 68 anak dengan waktu penelitian dari April 2016 sampai Juni 2016. Data dianalisis dengan Cox Regression. Hasil studi menunjukkan probabilitas kesintasan tiga tahun terjadi remisi pada anak LLA berdasarkan protokol pengobatan 2006 sebesar 30% dan protokol pengobatan 2013 sebesar 27%. Peberdaan kesintasan tiga tahun terjadi remisi antara protokol pengobatan 2006 dan 2013 sebesar HR 1,57 (CI 90% 0,577–4,299). Namun, perbedaan antara kedua protokol ini tidak bermakna secara statistik dengan p-value 0,456. Hasil wawancara mendalam juga menunjukkan pada protokol 2006 dan 2013 secara prinsip sama, tetapi tetap ada beberapa perbedaan di antara keduanya, seperti jadwal pengobatan dan dosis secara kumulatif meningkat. Studi ini menyimpulkan bahwa secara prinsip kedua protokol ini sama dan tidak terdapat banyak perbedaan dalam hal input serta proses.