Anorectal and perineal pain has been described in association with a variety of organic conditions but can also occur under circumstances in which organic disorders are absent and pathophysiology is uncertain. The three most common functional disorders causing anorectal and perineal pain are levator ani syndrome, coccygodynia and proctalgia fugax; Alcock's canal syndrome is also responsible for pain in these areas. We review current concepts about these disorders and the approach to diagnosis and management, and offer a provocative interpretation of the role of psychological factors.

Generalized anxiety disorder (GAD), a common, debilitating condition, involves psychological and physiological dysfunction. Sandplay therapy (SPT), a multisensory treatment modality, has been successfully used to reduce anxiety ratings for individuals suffering from GAD using the Hamilton Anxiety Rating Scale (HAM-A) and the General Anxiety-7 (GAD-7). Because GAD involves sensory processing alterations in the thalamus, which may also be implicated in SPT, it would be beneficial to accompany evaluation with a physiological measurement targeting the thalamus. Using an A-B single-subject design, this case study explores whether clinical improvement in a GAD patient treated with SPT is associated with brain metabolite changes, specifically the N-acetylaspartate to creatine (NAA/Cr) ratio (a measure of neuronal viability) in both thalami using proton magnetic resonance spectroscopy. With no improvement during the waiting period, after 18 sessions of SPT, the participant (female, age 23) showed clinically significant improvement in symptoms of anxiety as measured by the HAM-A and GAD-7, and also showed improved NAA/Cr ratio to the healthy range in the right and left thalamus. The effectiveness of SPT in reducing symptoms of anxiety in this study is consistent with previous findings. The results also suggest an association between clinical improvement and metabolite changes in the thalamus and may underscore the multisensory aspects of SPT as an essential mechanism of change. Future studies regarding interpretation of the NAA/Cr ratio are recommended. Limitations are discussed.

<p><br />Adiksi alkohol adalah suatu fenomena yang berdampak pada perilaku, kognitif, dan fisiologis seseorang yang berkembang setelah berulangkali mengonsumsi minuman beralkohol dan dapat terjadi pada semua kelompok usia. Pengonsumsian alkohol yang berlebihan telah menjadi masalah kesehatan di berbagai negara dan permasalahan ini cenderung mengalami peningkatan dari tahun ke tahun. Berbagai dampak buruk yang diakibatkan oleh adiksi alkohol, baik pada segi fisik, psikologis, hubungan sosial, maupun lingkungan dapat memengaruhi kualitas hidup seseorang. Oleh karena itu, peneliti ingin membuktikan adanya hubungan antara adiksi alkohol dan kualitas hidup. Penelitian ini merupakan penelitian deskriptif analitik dengan desain penelitian potong lintang. Sampel penelitian ini adalah 80 orang pengunjung yang mengonsumsi alkohol di kafe-kafe wilayah Jakarta Selatan pada bulan Mei sampai Juli 2018 yang diambil menggunakan teknik consecutive sampling. Adiksi alkohol dinilai dengan menggunakan kuesioner CAGE dan kualitas hidup dinilai dengan menggunakan kuesioner WHOQOL-BREF versi bahasa Indonesia. Hubungan antara kedua variabel ini dinilai dengan uji analisis statistik Kai-kuadrat. Hasil uji statistik menunjukkan bahwa terdapat hubungan yang bermakna antara adiksi alkohol dan kualitas hidup pada pengunjung kafe-kafe di Jakarta Selatan pada keempat domain WHOQOL-BREF (p=0,000). Hasil penelitian ini menunjukkan bahwa individu dengan adiksi alkohol memiliki risiko lebih besar untuk mengalami perburukan kualitas hidup dibandingkan dengan individu yang tidak mengalami adiksi alkohol, yakni OR=33,696, OR=18,208, OR=31,200, OR=7,737 pada masing-masing domain WHOQOL-BREF. Dapat disimpulkan, terhadap hubungan bermakna antara adiksi alkohol dan kualitas hidup.</p>

Globally, coronary heart disease (CHD) is a leading cause of mortality and morbidity, especially in developing countries. Both marine and plants sources of omega-3 fatty acids has been shown to be beneficial in reducing CHD mortality. Beside of anti-arrhythmic effects, omega-3 has been shown anti-thrombotic and anti-atherosclerotic effect. In 2011, US population spent about 25 billion US dollar for omega-3 supplement; it is projected to be 35 billion US dollar in the year 2016. Several reviews on randomized controlled trial conclude that omega-3 fatty acids reduced plasma triglyceride level consistently in a dose-dependent fashion. Other beneficial effects on blood pressure, endothelial function and high density lipoprotein (HDL) level participate in lowering CHD mortality. American Heart Association (AHA) recommended routine fish consumption as secondary prevention in patient at risk. Omega-3 fatty acids role in primary prevention is inconclusive and need further investigation regarding cost-benefit and bleeding risk.