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INTRODUCTION: Seborrheic keratoses (SK) are benign epidermal tumors with high sun exposure as a major risk factor. Vitamin D deficiency is also thought to play a role in its pathogenesis. There has been no data regarding SK, calcidiol level, vitamin D intake, and sun index (SI) among people living in coastal areas in Indonesia. OBJECTIVES: To assess the correlation between 1) serum calcidiol levels with SI and vitamin D intake and 2) lesion size with SI and serum calcidiol level among SK patients living in a coastal area. METHODS: This is a cross-sectional study. We performed interviews using the sun index questionnaire and semiquantitative food frequency questionnaire for vitamin D; physical examination; dermoscopy to determine the largest SK lesion size; and measurement of serum calcidiol levels in participants with SK living in Cilincing District, North Jakarta. Spearman correlation test was used to assess the relationship between variables. RESULTS: Thirty-nine participants with SK aged 19-59 years were analyzed. The median of the SK largest diameter, SI, serum calcidiol, and vitamin D intake was 2 (1-10) mm, 3.95 (1.1-23.52), 14.3 (5.25-35.30) ng/ml, and 4.3 (0.1-30.1) mcg/day, respectively. SI and vitamin D intake were not significantly correlated with calcidiol levels. Similarly, SI and calcidiol levels were not significantly correlated with the largest SK lesion size. CONCLUSIONS: We found low calcidiol levels and vitamin D intake in this coastal population. The SI and vitamin D intake had no correlations with calcidiol levels. Furthermore, calcidiol levels and SI had no correlations with the lesion largest diameter.
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Introduction: Successful colorectal surgery is determined based on postoperative mortality and morbidity rates, complication rates, and cost-effectiveness. One of the methods to obtain an excellent postoperative outcome is the enhanced recovery after surgery (ERAS) protocol. This study aims to see the effects of implementing an ERAS protocol in colorectal surgery patients. Methods: Eighty-four patients who underwent elective colorectal surgery at National Tertiary-level Hospital were included between January 2021 and July 2022. Patients were then placed into ERAS (42) and control groups (42) according to the criteria. The Patients in the ERAS group underwent a customized 18-component ERAS protocol and were assessed for adherence. Postoperatively, both groups were monitored for up to 30 days and assessed for complications and readmission. The authors then analyzed the length of stay and total patient costs in both groups. Results: The length of stay in the ERAS group was shorter than the control group [median (interquartile range) 6 (5-7) vs. 13 (11-19), P<0.001], with a lower total cost of [USD 1875 (1234-3722) vs. USD 3063 (2251-4907), P<0.001]. Patients in the ERAS group had a lower incidence of complications, 10% vs. 21%, and readmission 5% vs. 10%, within 30 days after discharge than patients in the control group; however, the differences were not statistically significant. The adherence to the ERAS protocol within the ERAS group was 97%. Conclusion: Implementing the ERAS protocol in colorectal patients reduces the length of stay and total costs.
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Background/Aims: Postoperative complications tend to occur in high-risk populations, including those undergoing major surgery. Surgical site infections (SSI) are some of the most common postoperative complications in laparotomy procedures. Surgery induces a postoperative stress response, triggering an inflammatory process that increases muscle protein proteolysis. Preoperative protein intake increases muscle protein reserves and supports postoperative wound healing and immunity. This study analyzed the association between preoperative protein adequacy and post-elective laparotomy SSI. Methods: A prospective cohort study was conducted on 93 subjects with an adequate protein group of 48 subjects and an inadequate protein group of 45 subjects undergoing elective laparotomy at Dr. Cipto Mangunkusumo Hospital, Jakarta. The protein adequacy was analyzed using an interview method for seven days preoperatively. Patient monitoring was carried out for 30 days postoperatively to assess the complications in the form of SSIs. The association between protein adequacy and SSI was analyzed using a Chi-Square test, and multivariate analysis was performed to assess the factors most associated with post-elective laparotomy SSI. Results: An association was observed between preoperative protein adequacy and post-elective laparotomy SSI (RR 3.413; 95% CI, 1.363-8.549; p=0.004). Multivariate analysis showed that the preoperative protein adequacy and preoperative albumin levels were strongly predictive of the occurrence of SSI. Conclusions: The preoperative protein adequacy and albumin levels were strongly related to predicting the post-elective laparotomy SSI.