Purpose: We aim to study the level of mental health distress and COVID-19 prevention in practice behaviors among general practitioners (GPs) in Bali, Indonesia, as well as their determinants. Methods: We conducted a cross-sectional online survey. Survey recruitment material was disseminated by purposive snowballing through regional professional association as well as research team's personal acquaintances. The survey measured mental health status by DASS-21 questionnaire and practice behavior by a questionnaire based on WHO recommendations for hand hygiene and PPE use during the COVID-19 pandemic. We conducted multivariate analyses to identify independent determinants for mental health and practice behavior. Results: Analyses included 635 (41.75%) of GPs in Bali. Mental health status was relatively good with prevalence of depression, anxiety, and stress of 13.2%, 19.7%, and 11% respectively, lower than previous studies in Indonesia and elsewhere. Practice behavior, however, was not considerably lower with only 65.4% and 32.1% reported consistent hand hygiene and recommended PPE use respectively. Routine optional PPE use was reported by 23.6% of respondents. Long working hours and fear of COVID-19 was identified as detrimental to mental health while consistent hand hygiene improved it. Meanwhile, workplace, work setting, and fear of COVID-19, were identified as determinants for PPE use. GPs working in primary health centers and private hospitals were also found to have less adherence to hand hygiene protocols. Conclusion: Our results showed relatively good mental health status along with inadequate infection prevention in practice behavior of GPs in Bali, Indonesia. Intervention should be made to improve practice behavior. Determinants of practice behavior identified in this study could help to pinpoint intervention targets.

Duodenal atresia is a congenital emergency abnormality and the most common cause of proximal bowel obstruction in neonates. The duodenum has not developed properly in embryogenesis with a blind end that cannot be seen through gastric contents. The incidence of duodenal atresia is 1/10.000 live births that commonly affects boys than girls. In cases of neonatal bilious vomiting, the first choice imaging modality is plain abdominal radiography. The purpose of this case report is to increase radiologist and pediatrician awareness in duodenal atresia diagnosis through plain abdominal radiography and to minimize radiation in the neonates. We report 3 cases of duodenal atresia found in Sanglah Hospital, Denpasar, in 1 year for the period 2018 -2019.Case 1: A 4-day-old baby girl presented with bilious vomiting in the first 24 hours after birth.Case 2: A 4-day-old baby boy presented with lethargy, weak crying, and groaning after birth. There is no history of passed meconium in the first 24 hours of birth. Case 3: A newborn boy presented with bilious emesis after breastfeeding and nonprojectile. From the 3 cases, a plain abdominal radiograph was examined, and a double bubble sign with no intestinal gas distal was found.

Tumor Cerebellopontine Angle (CPA) merupakan jenis neoplasma terbanyak yang ditemukan di fossa posterior dengan angka kejadian sebesar 5-10% dari seluruh angka kejadian tumor intrakranial. Mayoritas tumor di CPA adalah schwannoma vestibular sebesar 70%-80%, diikuti meningioma 5-12% dan kista epidermoid 2-6%, serta tumor CPA lainnya, yang masing-masing menyumbang sekitar 1%. Angka kejadian tumor ganas atau tumor metastasis hanya 2% dari keseluruhan tumor CPA. Tumor CPA secara klinis tidak spesifik dan gejala yang muncul tidak terkait dengan sifat lesi itu sendiri, tetapi berhubungan dengan struktur neurovaskular atau struktur otak yang terlibat dengan lesi tersebut. Diagnosis mungkin sulit dibuat karena berbagai jenis sel dan asal tumor tersebut. Oleh karena tumor CPA yang berasal dari spektrum yang sangat luas sehingga menjadi tantangan dalam penegakkan diagnosis. Untuk dapat mencakup seluruh spektrum tumor yang berpotensi ditemukan di CPA, maka diperlukan pencitraan neuroimaging terkait yang perlu diketahui oleh ahli radiologi untuk membuat diagnosis yang relevan secara klinis. Melalui pencitraan radiologi tersebut akan dievaluasi lokasi asal dari tumor, bentuk dan margin, kepadatan, intensitas sinyal dan penyangatan kontras dalam menegakkan diagnosis pra operasi yang lebih akurat. Diagnosis dan tatalaksana tumor CPA diharapkan akan semakin baik, seiring dengan berkembangnya teknik imaging, teknik pembedahan mikro dan radiosurgery

It has been known that carotid stiffness is a predilection for stroke. Strain elastography (SE) ultrasound (US) is one of the new modalities which can evaluate carotid artery stiffness by obtaining its tunica intima media strain value. There were no studies that show the carotid artery SE US value in stroke patients, hence become the underlying reason this study was conducted. The aim of this study was to provide an evaluation of carotid artery SE US values in stroke patients.A pair-matched case-control study was conducted on 40 case subjects and 40 controls which met all inclusion and exclusion criteria. Carotid arteries SE US value was obtained through the average of 3 region of interest (ROI) on each intima media layer of 3 level carotid arteries assessed on both sides. Diagnostic accuracy study was analysed to determine the cut off value between stiff and not stiff. Subsequently, bivariate and multivariate analyses were performed.There were 65% male on both groups with mean age 56.7 ± 13.0 on the case group and 53.8 ± 11.8 on the control group. ROC curve analysis showed that all measurement locations were reliable with high numbers (91.03-97.8%). The cut of value of carotid artery stiffness was ≥0.9333 (97.5% sensitivity and 90% specificity). Carotid artery stiffness is a major risk factor of stroke with OR 351 (p value 0.000). Multivariate analysis showed that carotid artery stiffness remained a strong risk factor of stroke (OR 467.89, p value 0,000). Other radiologist can repeat this technique with good interobserver (r = 0.782-0.985) and intraobserver reliability (r = 0.802-0.954).Carotid artery stiffness is a strong risk factor for stroke, with carotid artery stiffness SE US cut off values of ≥0.9333.