PERBEDAAN KECEMASAN DAN KUALITAS HIDUP WANITA MENOPAUSE DI WILAYAH RURAL DAN URBAN

Menopause merupakan proses alamiah pada wanita terkait dengan penuaan. Proses tersebut berdampak terhadap turunnya kualitas hidup atau Quality of Life (QoL) para wanita menopause akibat beragam gejala baik fisik maupun kejiwaan khususnya peningkatan kecemasan. Kecemasan saat menopause dipengaruhi oleh banyak hal seperti ada tidaknya sindrom menopause, tingkat pengetahuan dan wilayah demografi. Penilitian ini bertujuan untuk mengetahui perbedaan derajat kualitas hidup dan tingkat kecemasan pada wanita menopause di wilayah rural dan urban.  Penelitian ini menggunakan desain penelitian observasional analitik dengan pendekatan cross-sectional yang dilakukan di wilayah rural (pedesaan) dan urban (perkotaan). Besar sampel adalah 100 wanita menopause yang tinggal di wilayah rural dan 100 wanita menopause bertempat tinggal di wilayah urban yang dipilih melalui fix disease sampling. Pengambilan data pada penelitian ini menggunakan alat bantu kuesioner yang telah diuji validitas dan reliabilitasnya.  Penelitian menunjukkan bahwa tidak terdapat perbedaan antara tingkat kecemasan antara wanita menopause di wilayah rural dengan urban dengan nilai signifikansi  . Penelitian menunjukkan tidak terdapat perbedaan derajat kualitas hidup antara wanita menopause rural dengan wanita menopause urban, baik pada domain Occupational QoL, Health QoL  Sexual QoL dan  Emotional QoL. Hasil penelitian menunjukkan bahwa tidak terdapat perbedaan tingkat kecemasan dan kualitas hidup pada wanita menopause yang bertempat tinggal di rural dengan wanita menopause yang bertempat tinggal di urban

Factors Affecting Late Infertility Examination

Background:  Infertility is the inability of a couple to get pregnant after 12 months of regular sexual intercourse at least 2-3 times a week with­out using contraception. Delay in the examina­tion will have a bad impact considering that in­creas­ing age will affect the success of the hand­ling of infertility, especially in women so it is neces­sary to know the factors that influence the delay of the initial examination in order to be over­come. This study aims to determine the factors that influence the late infertility examin­ation.Subjects and Method: This was an analytic observational study with a cross sectional design. The study was conducted at Sekar Polyclinic, Dr. Moewardi Hospital, Surakarta, Central Java, from June to August 2019. A sample of 90 out­patients was selected by purposive sampling. The depen­­dent variable was late infertility exami­nation. The independent variables were family sup­port, knowledge, accessibility, and education. The data was collected by medical record and question­­naire. The data were analyzed by a multiple logistic regression.Results: Late infertility examination decreased with strong family support (OR= 0.20; 95% CI= 0.06 to 0.62; p= 0.006), high knowledge (OR= 0.29; 95% CI= 0.09 to 0.92; p= 0.036), good accessibility (OR= 0.18; 95% CI= 0.05 to 0.59; p= 0.005), and high education (OR= 3.41; 95% CI= 0.95 to 12.17; p= 0.059).Conclusion: Late infertility examination decreases with strong family support, high know­ledge, good accessibility, and high education.Keywords: infertility examination, family sup­port, accessibility, knowledgeCorrespondence: Uki Retno Budihastuti. Department of Obstetrics and Gynecology, Dr. Moewardi Hospital,Jl. Kolo­nel Sutarto132, Jebres, Surakarta, Central Java. Email: [email protected]. Mobile: 0812­26­56­140.Journal of Maternal and Child Health (2020), 5(2): 206-212https://doi.org/10.26911/thejmch.2020.05.02.1

Mosaic Form of Turner Syndrome

Objective: To report a case of breast growth disorder in a mosaic form of Turner Syndrome. Turner syndrome is a chromosomal condition characterized by small height and primary ovarian insufficiency that affects one in every 2500 female births. Mosaicism is likely to occur when monosomy X develops in only a few cells during development. The clinical presentation of Turner syndrome mosaicism is atypical, with symptom severity varying based on the number of affected cells. This case discusses issues with secondary sex development, including mild hyperandrogenism, and explores how combination hormonal treatment can aid in enhancing secondary sex development. Method: Case Report. Case: A 21-year-old woman presented with chief complaint of the lack of breast enlargement. She exhibited normal genitalia internally and externally and had a regular menstrual cycle. Karyotyping revealed a mosaic pattern of 45, X/46, XX (1 percent/99%) with normal estradiol levels and elevated testosterone levels (indicating mild hyperandrogenism). The patient underwent two cycles of hormone therapy using Ethinyl Estradiol and Drospirenone, resulting in breast growth progression from Tanner stage 1 to Tanner stage 2. Conclusion: Mosaicism in Turner syndrome is plausible, and the severity of clinical symptoms correlates with the number of defective chromosomes. The presentation of Turner syndrome mosaicism varies, and therapy should be tailored to address specific symptoms. While breast development is observed in some girls with Turner Syndrome, instances of breast growth disorder may occur, involving estrogen activity and estrogen receptor sensitivity. Although the exact cause of impaired breast growth remains unknown, administering estrogen in such cases can improve secondary sexual characteristics. Keywords: mild hyperandrogenism, mosaicism, turner syndrom

Edukasi Skrining COVID-19 pada Program Teknologi Reproduksi Berbantu di Era Pandemi COVID-19

In the era of the coronavirus disease 2019 (COVID-19) pandemic, COVID-19 screening education is essential for the general public, especially for those who undergo assisted reproductive technology (ART) programs. Understanding the preventive measures and precautions of COVID-19 during the treatment process is necessary. Health care staff must also understand the importance of proper COVID-19 screening and control measures. This educational activity is in the form of a YouTube live streaming program that can be followed by the general public, including infertile couples who want to know about infertility, examination procedures, COVID-19 screening guidelines, and the TRB program. Education about COVID-19 screening can minimize stigma and enhance public confidence in the screening procedures. The results of this educational delivery make the general public, especially couples who will undergo the ART program, ready and have the ability to undergo COVID-19 testing, services, and screening. In addition, by providing education and implementing effective screening, we can work together to combat the COVID-19 pandemic and ensure that people receive quality and safe health services

The success rate of intrauterine insemination in sperm preparation swim-up method at room temperature compared to the incubator temperature

HIGHLIGHTS • There were no significant differences in TMSC, sperm motility, sperm morphology, and DFI in sperm preparation using the swim-up method at 27°C and 37°C. However, this study provided an overview of the average improvement of DFI at 27°C compared to 37°C. • There was no significant difference in the pregnancy rate of IUI in sperm preparation using the swim-up method at 27°C and 37°C.   ABSTRACT Objective: This study aimed to determine the effect of temperature during sperm preparation on total sperm motile count (TMSC), sperm motility, sperm morphology, DNA fragmentation index (DFI), and pregnancy rate. Materials and Methods: A quasi-experimental laboratory study with pre- and post-test control group was conducted at Sekar Fertility Clinic, Dr. Moewardi General Hospital, Surakarta, Indonesia. A total of 20 sperm samples from infertile patients were prepared using the swim-up method at 27°C (group 1) and 37°C (group 2). TMSC, motility, morphology, and DFI examinations were performed. In addition, IUI was performed to confirm pregnancy rate. Sperm DNA fragmentation was determined using Sperm Chromatin Dispersion/SpermFunc DNAf test. Sperm DNA fragmentation was characterized by a halo <30% of the volume of the sperm head. Results: Group 1 had mean TMSC of 13.77 ± 9.30, while group 2 had 14.82 ± 8.82; p=0.218. Group 1 had a motility value 82.25+12.77 and group 2 had 82.55 ± 11.69; p=0.968. The morphological value for group 1 was 11.25 ± 5.15 and group 2 was 11.6 ± 5.34; p=0.626. The mean DFI for group 1 was 17.79 ± 10.88 and group 2 was 18.18 ± 12.95; p=0.765. Pregnancy rate in group 1 was 10% and group 2 was 20%; p=1.000. Conclusion: There were no significant differences in TMSC, sperm motility, sperm morphology, DFI, and pregnancy rate in sperm preparation using the swim-up method at 27°C and 37°C

Mucin-1 expression in endometrium is higher in polycystic ovary syndrome than in normal women

Background The polycystic ovary syndrome (PCOS) is caused by endocrine system dysfunction in women. MUCIN-1 (MUC-1) expression is found in endometrial tissues, which leads to implantation process dysfunction because of imbalance of trophoblast adhesion process. This study was conducted to compare endometrial MUC-1 expression between PCOS and normal women considering all existing external variables. Methods This cross-sectional study was conducted in General Hospital Dr. Moewardi Surakarta. Endometrial samples were obtained from 30 infertile PCOS women based on Rotterdam criteria, and 30 normal women. Life style and reproductive data such as age, menstrual problems, menstrual cycle, age at menarche, and BMI were collected. Subjects underwent endometrial biopsy in luteinizing hormone (LH) secretion phase LH + 5 days to LH + 10 days for immunohistochemistry (IHC) of MUC-1 expression. An independent-t and multiple linear regression test were used to analyze the data at significance level of p<0.05. Results Mean MUC-1 expression in the PCOS endometrium (49.66 ± 47.79) was significantly higher than in normal women (7.66 ± 14.55) (p=0.03). Multivariate linear regression model of life style and reproductive variables with MUC-1 showed that PCOS (b=29.54; 95% CI 9.57-49.49; p=0.004) and BMI (b= 29.99; 95% CI 5.91-54.07; p=0.001) significantly increase MUC-1 expression. PCOS (Beta=0.37) was more important than BMI (Beta=0.30) in increasing the MUC-1 expression. Conclusion Expression of MUC-1 levels in the PCOS endometrium was higher than in normal women. This suggests that MUC-1 contributes to the unexplained reproductive failure in PCOS

The Differences of Folliculogenesis between Treated with Letrozole and Letrozole-Electroacupuncture in Women with Polycystic Ovary Syndrome

Background: Polycystic Ovary Syndrome (PCOS) is an endocrine disorder that most often causes infertility. It occurs due to the failure of folliculogenesis, thus causing non-ovulation. Letrozole is a 3rd generation drug of non-ste­roidal aromatase inhibitors, which can increase ovulation rates. Electroacupuncture is the insert­ion and manipu­lation of needles into acupunc­ture points (acu­points) that are selected speci­fically based on the meridian system and con­nected to the electrode stimulator. This study aimed to determine the differences of the effects of letrozole and letrozoleelectroacupuncture (letrozole-EA) on the improve­ment of folliculo­genesis in women with PCOS.Subjects and Method: This was an analytic observational study with a case-control design. This study was conducted at the Gynecology Polyclinic and Sekar Clinic, Dr. Moewardi Hos­pital, Surakarta. A sample of 30 infertile women aged 20-45 years was selected by fixed disease sampling. The criteria of the PCOS were deter­mined based on Rotterdam criteria. The depen­dent variable was the diameter of the follicle. The independent vari­ables were the administration of letrozole and letrozole-EA. Transvaginal ultra­sound of Voluson P6 was used to measure the folliculo­genesis. The data were analyzed by independent t-test.Results: On the second day after treatment, the diameter of the follicles in the letrozole-EA group (mean= 6.92; SD= 1.60) was bigger than the letrozole group (mean=5.66; SD=1.11), and it was statistically significant (p=0.004).Conclusion: Combination of letrozole and letrozole-EA therapy is more effective in increasing follicular diameter development than letrozole therapy only.Keywords: polycystic ovary syndrome, folli­culogenesis, Letrozole, electro-acupunctureCorrespondence: Yulyanti. Department of Obstetrics and Gyneco­logy, Faculty of Medicine, Universitas Sebelas Maret/ Dr. Moewardi Hospital, Surakarta, Cen­tral Java, Indonesia. Email: dr.yulyanti­@gmail­.­com. Seluler: +6285264806570.Indonesian Journal of Medicine (2020), 05(03): 214-223https://doi.org/10.26911/theijmed.2020.05.03.0

The Difference of Endometrial Vascular Endothelial Growth Factor (VEGF) Expression between Polycystic Ovarian Syndrome (PCOS) and Normal Women

Background: Polycystic Ovarian Syndrome (PCOS) is an endocrine disorder in women cha­rac­terized by increased levels of androgens, ovu­la­tory dysfunction, and Polycystic Ovarian Mor­p­ho­logy (PCOM), as well as a combination of clas­sic clinical features. Women with PCOS expe­ri­ence changes in the endometrium and endo­met­rial receptivity markers such as VEGF (Vascular En­dothelial Growth Factor). VEGF increases the per­meability and dilation of endometrial blood vessels which play an important role in imp­lan­ta­tion. This study aimed to analyze the difference of VEGF expression between women with PCOS and nor­mal women.Subjects and Method: This study was a case-con­trol study design conducted at the polyclinic of the Department of Obstetrics and Gynecology, Dr. Moewardi Hospital, Surakarta, Central Java, in July 2020. There were 30 infertile women with PCOS (diagnosis based on Rotterdam criteria, con­sensus 2003) and 30 women without PCOS as the sample of this study. The dependent variable was VEGF expression. The independent variables were age, BMI, family history with PCOS, menar­che, occu­pa­tion, and education. VEGF expression was ob­tained from an endometrial biopsy on days 19-24 of periods. The differences in VEGF exp­res­sion (in %) were analyzed by the Mann-Whitney test. VEGF determinants were analyzed by a mul­ti­ple linear regression.Results: The mean of VEGF expression in wo­men with PCOS (Mean=64.33; SD=44.43) was high­er than in women without PCOS (Mean­= 7.90; SD=8.73) and the result was statistically sig­ni­ficant (p<0.001). PCOS (b=42.09; 95%­CI­=­64.­2­6 to -19.93; p<0.001) and obese (b=38.63; 95%­CI=-63.44 to -13.82; p=0.003) increased VEGF expression.Conclusion: VEGF expression in the endo­met­rium of women with PCOS is higher than normal wo­men.Keywords: VEGF, endometrium, Polycystic Ova­rian SyndromeCorrespondence: Ricky Bernadi Saputra. Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Sebe­las Maret/ Dr. Moewardi Hospital, Sura­karta, Indo­nesia. Telp: 081221161933 Email: ricky­sa­put­[email protected] Journal of Medicine (2020), 05(03): 230-239https://doi.org/10.26911/theijmed.2020.05.03.0