The Prevalence and Risk Factors of Constipation in Pregnancy

Objective: To estimate the prevalence of constipation in pregnancy and correlation between gestational age, dietary fiber intake, water comsumption, and physical activity.   Methods: This study used cross-sectional design with samples of 174 healthy pregnant women undergoing antenatal care at Obstetrics and Gynecology Outpatient Clinic RSCM during August - October 2016. Data were collected using questionnaire. Diagnosis of constipation was based on ROME III criteria, dietary fiber is measured using Food Frequency Questionnaire (FFQ), and physical activity was measured using International Physical Activity Questionnaire (IPAQ). Chi-square and Fisher’s exact test were conducted to evaluate the association between variables.   Results: The prevalence of constipation in pregnant women observed in this study was 13.2% (95% CI 8.3-18.1). The most frequent complaints included straining, incomplete evacuation, and anorectal obstruction. Dietary fiber intake was low in 81.03% subject. with average dietary fiber intake of 18.97 gram/day. There was no significant association between constipation and gestational age (OR 4.36, 95%CI 0.51-37.48 for second trimester and OR 2.04, 95%CI 0.25-16.7 for third trimester), dietary fiber intake (OR 0.82, 95%CI 0.28-2.39), water consumption (OR 1.38, 95%CI 0.56-3.41), and physical activity (OR 1.167, 95%CI 0.28-4.87).   Conclusion: Prevalence of constipation in pregnant women is 13.2%. There is no significant correlation between gestational age, dietary fiber intake, water consumption, and physical activity.   Keywords: constipation, pregnant woman, ROME II

Case Management of Pure Gonadal Dysgenesis 46, XY (Sindrom Swyer)

Disorders of sex development (DSD) are medical conditions in which the development of chromosomal, gonadal or anatomic sex varies from normal and may be incongruent with each other. Swyer syndrome is a condition caused by pure gonadal dysgenesis 46,XY, which followed by inadequate anti-mullerian (AMH) production results in maintenance and further development of mullerian duct into uterus. Therefore, many patients who suffer from this condition initially come with chief complaint of primary amenorrhea with insufficient development of secondary sexual characteristics. Patient’s gender orientation commonly is a female, since her brain was not sufficiently exposed with androgen hormone. Management of DSD patients should be based on patient-centered approach. Therefore, overall management of DSD patients should follow according to patient’s perception regarding to her gender orientation. Herein, we reported a case of Swyer syndrome in female aged 29 years with chief complain primary amenorrhea. Chromosomal analysis was 46,XY (20 mataphase), FSH level was 31.5miu/ml, LH 10.8miu/ml, estradiol (E2) <5pg/ml, testosteron total (T) <0.0025ng/ml. Medical management for this patient has the purpose to drive her feminization process in order to improve her physical appearance. However, since there is a great tisk for having gonadal tumor development from intra-abdominal dysgenetic gonad with Y chromosome, this patient has been strongly suggested to have bilateral gonadectomy.&nbsp

The Effectiveness of Phalleria Macrocarpa Bioactive Fraction in Alleviating Endometriosis And/or Adenomyosis Related Pain

The overexpression of estrogen receptor-beta (ER-ß) and the cyclooxygenase-2 (COX-2) enzyme coupled with the absence of expression of progesterone receptors (PR) is critical to thepathogenesis of endometriosis and adenomyosis associated pain.  DLBS1442, a novel bioactiveextract of Phaleria macrocarpa, exerts its action by downregulating the overexpressed ER-ß andCOX-2 products and up-regulating PR gene expression. This pilot study was conducted to evaluatethe effectiveness of DLBS1442 treatment in alleviating endometriosis- and/or adenomyosis-relatedpain. Ten endometriosis and/or adenomyosis patients were recruited consecutively at YasminClinic Dr. Cipto Mangunkusumo General Hospital in January - March 2013. Pain associated withmenses, including pre-menstrual pain, dysmenorrhea, dyschezia and dysuria, was measuredusing the visual analog scale (VAS) at each of the next three menstrual cycles. Patients reportingone or more pain symptoms with a VAS score = 4 were given 100 mg of DLBS1442 three timesdaily for 12 weeks. VAS score reduction was noted in the first post-treatment menstrual cycle(approximately 5.3 weeks after treatment initiation) and VAS scores continued to decline overthe final two cycles. DLBS1442 was effective in alleviating endometriosis- and/ or adenomyosisrelatedpain, as demonstrated by early pain reduction as evaluated using the VAS

Effect of Conditioned Medium of Umbilical Cord-derived Mesenchymal Stem Cells as A Culture Medium for Human Granulosa Cells: an Experimental Study

Background: The umbilical cord-derived mesenchymal stem cells conditioned medium (UC-MSCs-CM) produces secretomes with anti-apoptotic properties, and has the potential to prevent apoptosis of granulosa cells (GC) during controlled ovarian hyperstimulation. Objective: To observe the effect of UC-MSCs-CM on the interaction between proand anti-apoptotic proteins and the influence of growth differentiation factor 9 (GDF9) production in GC. Materials and Methods: UC-MSCs-CM was collected from umbilical cord stem cell culture on passage 4. GC from 23 women who underwent in vitro fertilization were cultured and exposed to UC-MSCs-CM for 24 hr. Then RNA of the GC was extracted and the mRNA expression of BCL-2 associated X (BAX), survivin and GDF9 were analysed using quantitative real-time PCR. The spent culture media of the GC were collected for measurement of insulin growth factor 1 using ELISA. Results: The expression of BAX was significantly different after UC-MSCs-CM exposure (4.09E-7 vs. 3.74E-7, p = 0.02). No significant changes occurred in survivin, BAX/survivin ratio, and GDF9 expression after UC-MSCs-CM exposure (p gt; 0.05). The IGF-1 level of the CM was significantly higher after the CM was used as a culture medium for GC (2.28 vs. 3.07 ± 1.72, p ≤ 0.001). A significant positive correlation was found between survivin and GDF9 (r = 0.966, p ≤ 0.001). Conclusion: IGF-1 produced by UC-MSCs-CM can work in paracrine Fashion through the IGF receptor, which can inhibit BAX and maintain GDF9 production. Moreover, under the influence of UC-MSCs-CM, GC are also capable of producing IGF-1, which can impact GC through autocrine processes. Key words: Conditioned medium, BAX, Survivin, GDF9, IGF-1