High neutrophils to lymphocytes ratio in maternal blood serum as risk factor for preterm premature rupture of membrane

Background: Neutrophil-to-lymphocyte ratio has been extensively studied as a prognostic factor for various diseases based on systemic inflammation. Premature rupture of membranes is an obstetric problem that does not only occur in term pregnancies but can also occur in preterm pregnancies. One of the main etiologies for premature rupture of membranes is inflammation. Knowing the difference in the NLR between preterm premature rupture of membranes and without PPROM is important to increase understanding of the crucial role of NLR in predicting the incidence of PPROM. Methods:  This analytic case-control study compared NLR values ​​in maternal blood serum between PPROM and without PPROM. This research was conducted in the emergency delivery room and obstetrics and gynecology outpatient clinic at Prof. dr. I.G.N.G. Ngoerah Hospital Denpasar from February to June 2022. Results: A high NLR in maternal blood serum may be a risk factor for PPROM. Patients with a high NLR had a 4.5 times greater likelihood of experiencing PPROM than those with a low NLR (OR=4.5; 95% CI=1.4-13.83; p=0.007). Conclusions: A high NLR in maternal blood serum is a marker of inflammation with an increased risk of 4.5 times for the occurrence of PPROM

The outcome of gynecologic cancer patients with Covid-19 infection: A systematic review and meta-analysis

Background: Cancer is a comorbidity that leads to progressive worsening of coronavirus disease 2019 (Covid-19) with increased mortality. This is a systematic review and meta-analysis to yield evidence of adverse outcomes of Covid-19 in gynecologic cancer. Methods: Searches through PubMed, Google Scholar, ScienceDirect, and medRxiv to find articles on the outcome of gynecologic cancer with Covid-19 (24 July 2021–19 February 2022). The Newcastle-Ottawa Scale tool was used to evaluate the quality of included studies. Pooled odds ratio (OR), 95% confidence interval (CI) and random-effects model were presented. Results: We accepted 51 studies (a total of 1991 gynecologic cancer patients with Covid-19). Covid-19 infection cases were lower in gynecologic cancer vs hematologic cancer (OR 0.71, CI 0.56-0.90, p 0.005). Severe Covid-19 infection and death were lower in gynecologic cancer vs lung and hematologic cancer (OR 0.36, CI 0.16-0.80, p 0.01), (OR 0.52, CI 0.44-0.62, p <0.0001), (OR 0.26, CI 0.10-0.67 p 0.005), (OR 0.63, CI 0.47-0.83, p 0.001) respectively. Increased Covid death was seen in gynecologic cancer vs population with breast cancer, non- Covid cancer, and non-cancer Covid (OR 1.50, CI 1.20-1.88, p 0.0004), (OR 11.83, CI 8.20-17.07, p <0.0001), (OR 2.98, CI 2.23-3.98, p <0.0001) respectively. Conclusion: Gynecologic cancer has higher Covid-19 adverse outcomes compared to non-cancer, breast cancer, non-metastatic, and Covid-19 negative population. Gynecologic cancer has fewer Covid-19 adverse outcomes compared to other cancer types, lung cancer, and hematologic cancer. These findings may aid health policies and services during the ongoing global pandemic. PROSPERO Registration: CRD42021256557 (22/05/21) Keywords COVID-19, Critical care outcome, Female genital neoplasms, Hospitalization, Morbidity, Mortalit

Pelvic Inflammatory Disease (PID) Management in Corona Virus Disease 2019 (COVID-19) Era

Objective: This article aims to review pelvic inflammatory disease management during the coronavirus disease 2019 pandemicMethod: We conducted a search for scientific articles through PubMed and Google Scholar, using the terminologies of “PID AND COVID-19”, “Pelvic Inflammatory Disease”; “Pelvic Inflammatory Disease AND COVID-19”, “PID Management AND COVID-19”, “Pelvic Inflammatory Disease Management AND COVID-19”, and “PID AND Pandemic” in English and Indonesian from 2019-2020.Result: There were a total of 25 scientific articles from PubMed and Google Scholar within 2019-2020 that were included as the source of this reviewConclusion: There is no difference between the management of pelvic inflammatory disease during and before the pandemic. The mode of medical services and follow up tends to be conducted virtually. Technology-based services for pelvic inflammatory disease during the corona virus disease 2019 pandemic are promising and have been proven to be an effective method, therefore virtual-based pelvic inflammatory disease services may be safely applied. However, if there is any indication of emergency found during the telemedicine services, a face-to-face consultation or emergency room visit should be recommended.Key words : COVID-19, Pelvic Inflammatory Disease, SARS-CoV-2Tatalaksana Radang Panggul selama Era Pandemi Virus Corona 2019 (COVID-19)AbstrakTujuan: Melakukan kajian mengenai tatalaksana dari penyakit radang panggul selama pandemi penyakit coronavirus 2019Metode: Kami melakukan pencarian artikel ilmiah melalui PubMed dan Google Scholar menggunakan terminologi “PID AND COVID-19”, “Pelvic Inflammatory Disease”; “Pelvic Inflammatory Disease AND COVID-19”, “PID Management AND COVID-19”, “Pelvic Inflammatory Disease Management AND COVID-19”, and “PID AND Pandemic” dalam Bahasa Inggris dan Indonesia dari tahun 2019-2020. Hasil: Ditemukan sebanyak 25 publikasi ilmiah dari pencarian di PubMed dan Google Scholar pada tahun 2019- 2020 yang digunakan sebagai sumber kajian ilmiah ini.Kesimpulan: Tatalaksana penyakit radang panggul sebelum dan selama pandemi tidak berubah. Metode pelayanan kesehatan dan follow up cenderung dilakukan secara virtual. Pelayanan kesehatan berbasis tekonologi untuk penyakit radang panggul selama pandemi penyakit coronavirus 2019 menjanjikan dan telah terbukti sebagai metode yang efektif, sehingga pelayanan kesehatan untuk penyakit radang panggul secara virtual dapat diaplikasikan secara aman. Jika ditemukan adanya indikasi kegawatdaruratan selama pelayanan telemedicine, pasien sebaiknya melakukan konsultasi tatap muka atau mengunjungi instalasi gawat darurat. Kata kunci: COVID-19, penyakit radang panggul, SARS-CoV-

Analisis Manajemen Tatalaksana Kanker Ginekologi di RSUP Sanglah di Era Pandemi COVID-19

AbstrakPandemi COVID-19 memberikan tantangan tersendiri dalam penanganan kanker, khususnya kanker ginekologi. Kondisi pasien penderita kanker yang telah mengalami immunocompromised baik karena penyakitnya maupun efek samping dari obat-obatan yang diberikan, berpotensi meningkatkan risiko pasien kanker untuk mengalami infeksi COVID-19 berat. Penatalaksanaan utama dari kanker yang bertonggak pada tiga poros yaitu operasi, kemoterapi, dan radioterapi perlu dilakukan adaptasi demi meningkatkan angka survival rate  pada pasien.Management of Gynecological Cancers in the COVID-19 Era: a Persepctive from Sanglah General HospitalAbstractThe COVID-19 pandemic as challenges in dealing with cancer, especially gynaecological cancer. The condition of cancer patients who have experienced immunocompromised due to both the disease and the side effects of the drugs increases the risk of cancer patients to experience severe COVID-19 infection. The management of cancer consists of three axes; surgery, chemotherapy, and radiotherapy, and needs to be adapted to increase patient survival. Key word: COVID-19; chemotherapy; operative; radiotherapy; gynaecological cancer   

Specific Histologic Type of Leiomyoma Related to Estrogen Receptor Expression

Uterine Leiomyoma or fibroid is the most common gynecologic benign neoplasm which arising from monoclonal proliferation of smooth muscle cells in uterine wall. Some specific types of uterine leiomyoma, such ascellular leiomyoma, symplastic leiomyoma, mitotically active leiomyoma andmyxoid leiomyomahave different histomorphology from usual type leiomyoma. It also have wide variety of tumors size, but this study found that no correlation between type of leiomyoma and its size. Additional non-invasive therapy that predominantly developed in leiomyoma include many antagonist agents of estrogenic receptor. So, important to determine of estrogen receptor activity before that hormonal therapy prescription.Histopathology parameter that predict estrogen receptor activity in leiomyoma was not well understood. This study also try to correlate between specific histologic type of leiomyoma and estrogen receptor activity. This study was a retrospective crossectional study which analized by pearson chi-square test with p value &lt; 0.05 and CI 95%. Result: There was significant correlation between specific histologic type of leiomyoma and estrogen receptor expression (p=0.007; p&lt;0.05). &nbsp; Key Words: Leiomyoma, &nbsp;Estrogen Recepto

Profil Penderita Kanker Serviks Berdasarkan Stadium di RSUP Prof. Dr. I.G.N.G Ngoerah Denpasar Bali Periode 1 Januari 2022 – 1 Januari 2023

Kanker serviks merupakan jenis kanker paling umum yang terjadi pada wanita di Indonesia, dengan proporsi sekitar 16% dari seluruh jenis kanker. Tujuan penelitian ini adalah untuk mengidentifikasi profil dan pola distribusi kanker serviks pada wanita di RSUP Prof. I.G.N.G Ngoerah Denpasar selama periode 1 Januari 2022 – 1 Januari 2023. Penelitian ini menggunakan rancangan deskriptif retrospektif dengan menggunakan semua data rekam medis pasien kanker serviks di RSUP Prof I.G.N.G Ngoerah pada periode 1 Januari 2022 – 1 Januari 2023. Untuk memilih sampel, digunakan metode purposive sampling dengan kriteria inklusi yang sesuai, dan data kemudian disajikan dalam bentuk tabel dan grafik. Total kasus baru kanker serviks selama periode 1 Januari 2022 – 1 Januari 2023 adalah 302. Mayoritas penderita kanker serviks memiliki rentang usia 50-60 tahun, yakni sebanyak 103 (34,1%). Bedasarkan data tersebut, sebagian besar subjek penelitian adalah tidak pernah melahirkan, yakni sebanyak 135 (44,7%). Untuk stadium yang paling dominan mengenai pasien wanita kanker serviks adalah stadium IIIB sejumlah 158 orang (52.3%). Sebagian besar pasien kanker serviks di RSUP Prof Ngoerah Desnpasar memiliki rentang usia 50-60 tahun dengan stadium IIIB

Ekspresi Enzim 1 Alfa-Hidroksilase Plasenta yang Rendah sebagai Faktor Risiko Terjadinya Preeklamsia Berat

Abstrak Tujuan: Untuk mengetahui ekspresi enzim 1-alfa-hidroksilase (CYP27B1) pada plasenta yang rendah sebagai faktor risiko terjadinya preeklamsia (PE) berat.Metode: Penelitian ini merupakan studi kasus-kontrol yang tak berpasangan, dengan total sampel 44 kasus dan kontrol. Sampel berupa plasenta yang diproses secara imunohistokimia, untuk melihat ekspresi enzim berdasarkan histoscore kumulatif (H-score) sebagai ekspresi rendah (H-score 200). Regresi logistik ganda digunakan untuk memperkirakan rasio odds yang disesuaikan (OR) dengan interval kepercayaan 95% (95% CI).Hasil: Ekspresi enzim 1alfa-hidroksilase plasenta yang rendah merupakan faktor risiko terjadinya PE berat sebesar sembilan kali lebih tinggi dibandingkan dengan ekspresi enzim 1-alfa-hidroksilase yang tinggi pada plasenta (OR 9,148; IK05% 2,072-40,386, p=0,002).Kesimpulan: Ekspresi rendah 1alfa-hidroksilase plasenta meningkatkan risiko terjadinya PE berat.Low Expression of 1 Alpha-Hydroxylase Enzyme in The Placenta as Arisk Factor for Preeclampsia with Severe FeaturesAbstractObjective: This study aims to determine the low expression of the 1-alpha-hydroxylase (CYP27B1) enzyme in the placenta as a risk factor for severe preeclampsia (PE).Methods: This study is an unpaired case-control study, with a total sample of 44 cases and controls. Samples were placentas that were immunohistochemically processed, to see enzyme expression based on the cumulative histoscore (H-score) as low expression (H-score 200). Multiple logistic regression was used to estimate the adjusted odds ratio (OR) and 95% confidence interval (95% CI).Results: Low placental 1-alpha-hydroxylase expression was a risk factor for severe PE which was nine times higher than placental 1-alpha-hydroxylase expression (OR 9,148; 05% CI 2.072-40,386, p=0.002).Conclusions: Low placental 1alpha-hydroxylase expression increases the risk of severe PE.Key words: 1aplha-hydroxylase, expression, placenta, risk factor, severe preeclampsi

ADMINISTRATION OF AUTOLOGOUS PLATELET RICH PLASMA ON THE IN VITRO FERTILIZATION ANTAGONIST PROTOCOL CAUSED HIGHER EXPRESSION OF INTEGRIN Β3 IN THE ENDOMETRIUM OF WISTAR STRAIN RATS THAN WITHOUT PRP AUTOLOGOUS ADMINISTRATION

Tujuan penentuan pemberian Autologous Platelet-rich plasma (PRP) pada protokol anthogonist In Vitro Fertilization menyebabkan ekspresi integrin β3 pada endometrium tikus galur wistar lebih tinggi dibandingkan tanpa pemberian Autologous PRP. Penelitian ini menggunakan desain eksperimen randomized posttest only control group design menggunakan 40 ekor tikus betina galur Wistar yang dibagi menjadi 2 perlakuan yaitu kelompok perlakuan dengan PRP dan kelompok tanpa PRP dengan simple random sampling. Prosedur penelitian terdiri dari stimulasi ovarium dengan Cetrotide (GnRH anatagonis), pemeriksaan imunohistokimia integrin ß3, dan analisis ekspresi integrin ß3 dengan mikroskop. Data kemudian diuji normalitas dan homogenitas dengan uji Shairo Wilk dan Levene, dan dilanjutkan dengan uji komparasi menggunakan uji Mann whittney dan Chi Square. Rata-rata H-score integrin ß3 diperoleh pada kelompok perlakuan 2,90 dan kelompok kontrol 1,54 dengan P&lt;0,001. Pada kelompok perlakuan ekspresi integrin ß3 kuat – sangat kuat pada semua sampel, dibandingkan dengan kelompok kontrol didapatkan 18 lemah – sedang dan 2 kuat – sangat kuat (P&lt;0,001). Kesimpulannya, pemberian Autologous Platelet Rich Plasma (PRP) pada protokol antagonis Fertilisasi In Vitro menyebabkan ekspresi integrin β3 yang lebih tinggi di endometrium tikus galur wistar. ekspresi integrin ß3 kuat – sangat kuat pada semua sampel, dibandingkan dengan kelompok kontrol diperoleh 18 lemah – sedang dan 2 kuat – sangat kuat (P&lt;0,001). Kesimpulannya, pemberian Autologous Platelet Rich Plasma (PRP) pada protokol antagonis Fertilisasi In Vitro menyebabkan ekspresi integrin β3 yang lebih tinggi di endometrium tikus galur wistar. ekspresi integrin ß3 kuat – sangat kuat pada semua sampel, dibandingkan dengan kelompok kontrol diperoleh 18 lemah – sedang dan 2 kuat – sangat kuat (P&lt;0,001). Kesimpulannya, pemberian Autologous Platelet Rich Plasma (PRP) pada protokol antagonis Fertilisasi In Vitro menyebabkan ekspresi integrin β3 yang lebih tinggi di endometrium tikus galur wistar

The Mechanism and Dynamic Regulation of Epithelial to Mesenchymal Transition in Ovarian Cancer

Objective: To understand the basic mechanism and dynamic regulation that underlies the epithelial-to-mesenchymal transition (EMT) in ovarian cancer (OC) cells. Mechanism: A literature review using evidences from several data bases (i.e., PubMed, EMBASE, Web of Science, Medline, Cochrane, Science Direct, and Google Scholar) were conducted to describe the basic mechanism and dynamic regulation of EMT in OC cells. Finding in Brief: EMT is a complex epigenetic reprogramming orchestrated by specific transcription factors (TFs) and multiple upstream activators and regulators, such as transforming growth factor-β (TGF-β), Wnt, Hedgehog, and Hippo signaling pathways. The net result of this cellular reprogramming is the acquisition of mesenchymal phenotypes with increased invasive and metastatic potential, stemness properties and chemoresistance. Recent studies have demonstrated that EMT activation is the result of dynamic and reciprocal interplay between OC cells and their tumor microenvironment (TME). Cellular or non-cellular component of TME, external factors related to TME such as hypoxia, oxidative stress, mechanical forces, as well as exposure to chemotherapy, all play significant role to EMT induction. Current understanding behind the mechanism of EMT induction in cancer cells have proposed the idea that EMT is not merely a binary process involving a complete conversion from epithelial to mesenchymal state, but rather a dynamic process that encompasses a range of hybrid states, a phenotype that has been referred to as “partial EMT”. Cells with partial EMT have been known to be more apoptosis-resistant and have more tumor-initiating potential as compared to those with complete EMT. Conclusions: Understanding the complex regulatory network that underlies EMT in OC cells is crucial in order to gain insight in developing novel and effective treatment strategies for OC

Preoperative Level of Insulin-Like Growth Factor Binding Protein 2 Predicts The Suboptimal Outcome After Primary Debulking Surgery in Patients with Advance Ovarian Cancer

BACKGROUND: The need for clinically useful biomarkers which can predict the surgical outcome after primary debulking surgery (PDS) in patients with advance ovarian cancer (AOC) is really important. Insulin-like growth factor-binding protein 2 (IGFBP2) is the main binding protein expressed by ovarian cancer cells, which plays a prominent role in promoting proliferation, driving invasion, and suppressing apoptosis. This study was conducted to assess the performance of IGFBP2 in predicting the surgical outcome after PDS in patients with AOC.METHODS: Twenty-four subjects with AOC (Stage IIIc/IV) who underwent PDS were recruited consecutively. Clinicopathologic data were obtained from subjects' medical records. Blood samples were withdrawn form each subject and preoperative level of IGFBP2 were measured using enzyme-linked immunosorbent assay (ELISA). Multivariate analysis was employed to test the performance of multiple predictors of surgical outcome.RESULTS: Eighteen patients (75%) had suboptimal outcome after PDS. Mean IGFBP2 level was significantly higher in the suboptimal group (1157.5±359.9 ng/mL vs. 679.1±504.5 ng/mL, p=0.018). In bivariate model, higher preoperative level of IGFBP2 predict the suboptimal outcome with good accuracy (AUC: 0.796, sensitivity: 83.3%, specificity: 83.3%, p=0.033, optimal threshold level 870 ng/mL). Higher IGFBP2 level was associated with higher risk of suboptimal outcome, although IGFBP2 was not an independent risk factor (adjusted OR: 5.0, 95% CI: 0.43-57.9, p=0.198).CONCLUSION: IGFBP2 is a novel and promising biomarker for surgical outcome prediction following PDS in AOC patients. Since it is predictive for suboptimal outcome, patients with higher preoperative level of IGFBP2 needs more thorough preoperative evaluation as well as meticulous surgical technique to optimize the surgical outcome.KEYWORDS: IGFBP2, advance ovarian cancer, PDS, surgical outcome, predicto