Breast cancer is the most common cancer among women worldwide, with its incidence increasing, particularly in low- and middle-income countries. Breastfeeding has been proposed as a modifiable protective factor, but conflicting evidence exists regarding the relationship between breastfeeding duration and breast cancer risk, warranting further investigation. This meta-analysis, conducted according to the PRISMA guidelines, included observational studies published in English between March 2014 and April 2024 and focused on case‒control and cohort studies. Literature searches were conducted via the EBSCO, PubMed, and Scopus databases. Studies were selected on the basis of the availability of odds ratios (ORs) or relative risks (RRs) with 95
Introduction: Non-Down syndrome acute megakaryocytic leukemia (Non-DS-AMKL) is a rare leukemia. Pediatric acute myeloid leukemia (AML) accounts for only 4—15% of all leukemia cases, while AMKL accounts for only 3-10% of pediatric AML. Most AMKLs are Down syndrome (DS) (> 75%). Diagnostic criteria require a minimum of 20 % blasts in the bone marrow, of the megakaryocytic lineage, in a person without Down syndrome. Flow cytometry in blast cells must reveal expressions of one or more platelet markers (CD41a, CD42b, or CD61). Genetic test differentiates treatment and prognosis. This is the first AMKL report in Indonesia that approaches comprehensive genetic testing. Case Presentation: The patient was a 26-month-old boy who had bruises over his tummy, arm, and legs. He was anemic, having splenomegaly with Schuffner 2, hemoglobin level 9.1 g/dL, leucocyte 7,200/uL, platelet 12,000/uL, erythrocyte sedimentation rate 22 mm/hour. The bone marrow was hemodiluted with 53% blasts dominated by large cells with a high nucleus cytoplasmic ratio, nucleoli were found, irregular fine chromatin, basophilic cytoplasm with prominent cytoplasmic projection/blebs consistent with megakaryoblast. These blasts were expressing CD45 dim, CD36, CD41a, CD33, HLA-DR and CD13 dim. A genetic test using fluorescence in situ hybridization (FISH) and next-generation sequencing (NGS) revealed lysine methyltransferase 2A/KMT2A/MLL positive. Therefore, the patient was confirmed as the Non-DS AMKL with positive KMT2A, which confers a dismal outcome compared to the GATA-binding factor1/GATA1/Erythroid transcription factor mutation. Conclusions: Non-DS AMKL is a challenging diagnosis in terms of morphology, immunophenotypic, signs, symptoms, and genetics. Genetic profile will contribute important scientific understanding to decide and improve AMKL treatment and prognosis, particularly unsatisfactory prognosis AMKL, such as a patient with KMT2Ar/MLL
The prognostic significance of asymptomatic intracranial hemorrhage (aICH) after endovascular thrombectomy (EVT) for acute ischemic stroke remains uncertain. We investigated the association between aICH and clinical outcomes using data from a large prospective registry. We analyzed patients with anterior circulation large-vessel occlusion from the ANGEL-ACT registry (November 2017 to March 2019) who underwent EVT. Patients were categorized into aICH, symptomatic ICH (sICH), and no ICH groups. The primary endpoint was 90-day modified Rankin Scale (mRS) score 0–2, and the safety outcome was death within 90 days. Multivariable logistic regression was performed to identify independent predictors of aICH. Among 1252 eligible patients, 221 (17.7
Background: Cancer-related fatigue is a significant concern for breast cancer patients undergoing chemotherapy, yet Indonesia lacks a culturally validated tool to assess. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Fatige-12 (EORTC QLQ-FA12), which measures physical, emotional, and cognitive fatigue, is available only in English. This study aims to evaluate the validity and reliability of the Indonesian version of the EORTC QLQ-FA12. Methods: A cross-sectional methodological study applied forward-backward translation following Beaton’s guidelines. Pretesting and validation involved 30 and 70 patients, respectively. Psychometric evaluation included content validity, internal consistency, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA). Results: The scale showed strong content validity index (CVI = 0.917) and internal consistency (alpha = 0.905). Although EFA suggested statistical clustering of items, CFA supported the theoretical multidimensional structure of the original instrument. Model fit indices were acceptable (Goodness-of-Fit Index (GFI) = 0.952, Comparative Fit Index (CFI) = 0.930, Tucker Lewis Index (TLI) = 0.904, Standardized Root Mean Square Residual (SRMR) = 0.056), while Root Mean Square Error of Approximation (RMSEA) = 0.098 indicated moderate approximation error. Factor loading ranged from 0.23 to 0.91. Conclusions: The Indonesian EORTC QLQ-FA12 demonstrates satisfactory reliability and acceptable construct validity, preserving the multidimensional fatigue framework. The instrument is suitable for clinical and research assessment of cancer-related fatigue in Indonesian breast cancer patients
Background Treatment response in acute myeloid leukemia (AML) is influenced by multiple biological and molecular mechanisms. High-mobility group box 1 (HMGB-1) is involved in inflammation, autophagy, apoptosis, and immunogenic cell death. This study evaluated associations of baseline circulating miR-181a-3p, miR-181b-5p, ATM, ATR, and HMGB-1 with successful induction response in adults with newly diagnosed AML. Methods This prospective cohort study was conducted at two referral hospitals in Jakarta, Indonesia. Adults with newly diagnosed AML receiving standard D3A7 induction chemotherapy were enrolled consecutively. Baseline miR-181a-3p and miR-181b-5p were quantified using digital polymerase chain reaction, whereas ATM, ATR, and HMGB-1 were measured using enzyme-linked immunosorbent assays before chemotherapy. Successful induction response was assessed by clinical and bone marrow evaluation after induction. Receiver operating characteristic analysis determined an exploratory HMGB-1 cut-off. Associations were evaluated using relative risks (RRs) with 95% confidence intervals (CIs). Results Among 102 patients initiating induction chemotherapy, 25 died during induction or early post-induction care. The biomarker-evaluable cohort comprised 71 patients, of whom 40 (56.3%) achieved a successful response. Baseline miR-181a-3p, miR-181b-5p, ATM, and ATR were not significantly associated with response. HMGB-1 yielded an area under the curve of 0.615 (95% CI, 0.480–0.749). The exploratory cut-off was 28.59 pg/mL, with 65.0% sensitivity and 61.3% specificity. Low HMGB-1 was associated with a lower probability of successful response (RR, 0.620; 95% CI, 0.394–0.975; p = 0.038). In the final clinical-biomolecular model, high HMGB-1 remained associated with successful response after adjustment for platelet count and ATR (adjusted RR, 1.666; 95% CI, 1.092–2.541; p = 0.018). Conclusion Low baseline circulating HMGB-1 was associated with a lower probability of successful induction response in the biomarker-evaluable adult AML cohort. Given its modest discriminatory performance and internally derived cut-off, HMGB-1 should be considered an exploratory complementary biomarker requiring external validation and serial evaluation.
