Ovarian cryopreservation and transplantation: A preserving fertility procedure

Cancer is a major health problem in both developed and developing countries. In women, cancer incidence rates increased every year. Developments in treatment modalities and the ability to detect tumours in the early stages increased their survival rate but also raise fertility problems. Those problems are the fertility preservation for patient who have to endure gonadotoxic chemotherapy and or radiation even though they still need their fertility functions. Ovarian cryopreservation and autotransplantation were initially designed to protect and restore reproductive function in patients receiving sterilizing chemotherapy and/or radiotherapy. Other indications including patients undergoing haematopietic stem cell transplantation, autoimmune diseases and those undergoing oophorectomy for non-cancer conditions. Options in cryopreserved ovarian tissues include autotransplantation and xenotransplantation. An orthotopic site or a heterotopic site can be considered for autotransplantation. Xenotransplantation of human ovarian tissue into immunodeficient animals can prevent immunological rejection.  The theoretical advantage of orthotopic grafts is the restoration of normal reproductive function and natural conception after transplantation but application for cancer patients is problematic because of the potential risk of transmission of microscopic metastatic disease. With Xenotransplantantion, the possibility of cancer transmission and relapse can be eliminated because cancer cells cannot penetrate the zona pellucida, and some technical difficulties of in vitro growth and maturation of primordial follicles can be bypassed. But it is still unknown whether conditions for the growth and maturation of human oocytes in an animal host are comparable to those in situ and whether animal pathogens can be transmitted to human tissue with it. Ovarian tissue cryopreservation is the fertility preservation option for prepubertal girls and for women who face thehigh likelihood of diminished ovarian reserve requiring immediate treatment. Its procedure are still within improvement and also in the study of understanding its mechanism. In the future, studies and large clinical trials are still needed to develop better cryoprotectants and cryopreservation protocols and also standardization - optimization transplantation technique

Factors affecting the level of health care worker’s stigmatized and discriminatory attitude towards people living with HIV: A study at the Dr. Zainoel Abidin General Hospital, Banda Aceh, Indonesia

The aim of this study was to identify the level of health care worker`s (HCW) stigmatized and discriminatory (SD) attitude towards people living with HIV (PLHIV) and the factors that influenced this attitude. This research was conducted at the Dr. Zainoel Abidin General Hospital (RSUDZA) in Banda Aceh province of Indonesia. A cross-sectional study design was adopted for this research. Eighty nine HCWs were included in this study and they were selected purposively. Pearson correlation analysis, analysis of variance or independent sample t test analysis was used according to the type of data. We found that the level of SD attitude towards PLHIV in RSUDZA is high. Based on the Least Significant Difference Test, the average score of the answers between nurses and general practitioners and between nurses and medical students was significantly different(p=0.05). Pearson correlation analysis showed that the levels of SD attitude towards PLHIV was positively correlated with age (r=0.219, p=0.04) and irrational fear of HIV transmission (r=0.352, p=0.001) and negatively correlated with knowledge about HIV/AIDS (r=-0.336, p=0.001). Pearson correlation analysis also found that knowledge of HIV/AIDS negatively correlated with the irrational fear of HIV transmission (r=0.382, p=0.000). In addition, the level of SD attitude towards PLHIV was also associated with marital status of HCWs (p=0.020). Gender, education level, religion and the importance of religion in HCW lives wasn`t significantly affect to the level of SD attitude towards PLHIV in HCW. We concluded that the factors that influence the level of SD attitude towards PLHIV among the HCW are age, marital status, knowledge of HIV/AIDS, irrational fear of HIV transmission and HCWs occupations. To reduce SD attitude towards PLHIV among the HCWs, we recommend introducing some program to increase knowledge of HIV/AID

Profile of Cesarean Sections Since the BPJS Era: Profil Seksio Sesarea pada Era BPJS

  Objective: to find out the profile of caesarean section in dr. Zainoel Abidin Hospital since the BPJS era. Methods: This study was a descriptive-observational with retrospective design. The data were obtained in March-April 2017. We collected 3656 data from medical record period January 1st, 2014- December 31st, 2016. Results: The finding showed there were 1669 vaginal deliveries (45,65%) and 1987 caesarean sections (54,35%). The most frequent causes to caesarean sections were induction failure (49,77%), cephalopelvic disproportion (14,33%), pregnancy induced hypertension (11,21%), malpresentation (8,91), and antepartum haemorrhage (4,33%). Conclusion: The incidence of caesarean sections in dr. Zainoel Abidin Hospital since the BPJS era was 54,35%, increased by 13,29% than the year of 2011-2013 (41,06%) with the most frequent cause is induction failure (49,77%). Keywords: Antepartum haemorrhage, BPJS, Caesarean section, Induction failure, Pregnancy induced hypertension, Tertiary referral hospital.   Abstrak Tujuan: Mengetahui profil persalinan seksio sesarea di RSUD dr. Zainoel Abidin Banda Aceh pada era BPJS. Metode: Penelitian deskriptif-observasional dengan desain studi retrospektif. Pengambilan data dimulai dari bulan Maret-April 2017. Sebanyak 3656 data dikumpulkan dari rekam medik periode 1 Januari 2014- 31 Desember 2016. Hasil: Terdapat 1669 kasus persalinan pervaginam (45,65%) dan 1987 kasus seksio sesarea (54,35%). Indikasi terbanyak yang menyertai seksio sesarea adalah gagal induksi (49,77%), cephalopelvic disproportion (14,33%), hipertensi dalam kehamilan (11,21%), malpresentasi (8,91%), dan perdarahan antepartum (4,33%). Kesimpulan: Angka seksio sesarea di RSUD dr. Zainoel Abidin meningkat 13,29% sejak berlakunya BPJS (1 Januari 2014-31 Desember 2016) mencapai 54,35% dibandingkan tahun 2011-2013 (41,07%) dengan indikasi terbanyak gagal induksi (49,77%). Kata kunci: Perdarahan Antepartum, BPJS, Seksio sesarea, Gagal Induksi, Hipertensi dalam kehamilan, RS Rujukan Tersier. &nbsp

HUBUNGAN ASUPAN SUMBER KALSIUM DAN MAGNESIUM DENGAN DERAJAT DISMENORE PRIMER PADA MAHASISWI PROGRAM STUDI PENDIDIKAN DOKTER ANGKATAN 2017

Derajat dismenore primer dipengaruhi salah satunya oleh asupan sumber kalsium dan magnesium yang mempengaruhi kontraksi dan relaksasi otot polos  uterus sehingga memperbaiki aliran darah pada uterus yang telah mengalami hipoksia. Penelitian ini bertujuan untuk mengetahui hubungan antara asupan sumber kalsium dan magnesium dengan derajat dismenore primer pada mahasiswi Pendidikan Dokter angkatan 2017. Penelitian dilakukan di Fakultas Kedokteran Unsyiah dari tanggal 1 sampai 20 November 2018 terhadap 80 mahasiswi dengan desain cross sectional. Metode sampling menggunakan non probability sampling dengan teknik total sampling.Penelitian menggunakan kuesioner karakteristik menstruasi, Numeric Rating Scale untuk mengukur skala nyeri, dan wawancara asupan kalsium dan magnesium menggunakan SFFQ beserta foto makanan.Data asupan diolah menggunakan SQ-FFQ PP13 Microsoft Excel dan dianalisa dengan uji Korelasi Spearman. Hasil analisis didapatkan responden dengan dismenore primer sebanyak 68 mahasiswi (85,0%), dengan derajat ringan sebanyak 29 mahasiswi (36,3%), derajat sedang 30 mahasiswi (37,5%) dan derajat berat 9 mahasiswi (11,3%). Sebanyak 73 mahasiswi (91,3%) memiliki asupan sumber kalsium kurang dan 61 mahasiswi (76,3%) memiliki asupan sumber magnesium kurang. Rata-rata asupan kalsium responden sebanyak 354,3625 mg/hari dan asupan sumber magnesium sebanyak 149,3 mg/hari. Hasil uji KorelasiSpearman antara asupan sumber kalsium dengan derajat dismenore primer menunjukkan p value 0,00 dan rs = -0,401 dan hubungan antara asupan sumber magnesium dengan derajat dismenore primer menunjukkan p value 0,008 dan rs = -0,297. Dapat disimpulkan bahwa semakin kurang asupan sumber kalsium dan magnesium, semakin berat derajat dismenore primer

Morphological Index of Sassone for Predicting Serous Type of Epithelial Ovarium Cancer: Indeks Morfologi Sassone untuk Memprediksi Kanker Ovarium Epitelial Tipe Serous

Objective:  To obtain whether there was a correlation between the Sassone morphological index and CA 125 tumour markers for suspecting epithelial ovarian cancer with serous types.Methods: This research was analysis correlation and diagnostic test using cross-sectional design. This study was conducted in Dr. Zainoel Abidin Hospital, from November 2018 until April 2019. Results: There were 30 samples of patients with suspected malignant ovarian tumours. The Mann-Whitney test has been performed and the results show no relationship between the Sassone morphological index and epithelial ovarian cancer with serous type (p-value 0.627) and there was no correlation between CA 125 tumour marker and epithelial ovarian cancer with serous types (p-value 0.251). The diagnostic test was performed to examine the sensitivity and specificity for the Sassone morphological index in epithelial ovarian cancer with serous type, resulting in 60% and 28%, respectively. In this study, the sensitivity and specificity for CA 125 tumour marker in epithelial ovarian cancer with serous type were 80% and 40%, respectively. Conclusion:  There was no correlation between the Sassone morphological index and CA 125 tumour marker for suspecting epithelial ovarian cancer with serous types. Keywords:  CA 125 tumour marker, 0 epithelial ovarian cancer with serous types, morphological index of Sassone.   Abstrak Tujuan: Untuk mengetahui adakah korelasi antara indeks morfologi Sassone dan penanda tumor CA 125 dalam memprediksi kanker ovarium epitelial tipe serous. Metode: Penelitian ini menggunakan rancangan potong lintang dengan melakukan uji korelasi dan diagnostik.Penelitian dilakukandi RSUD Dr. Zainoel abidin, dalam kurun waktu November 2018 sampai dengan April 2019.Hasil : Selama penelitian didapatkan 30 sampel penderita tumor ovarium suspek ganas. Dilakukan analisis dengan uji Mann-Whitney, didapatkan tidak terdapat hubungan antara indeks morfologi Sassone terhadap kanker ovarium epitelial tipe serous (p-value 0,627) dan tidak terdapat hubungan antara penanda tumor CA 125 terhadap kanker ovarium epitelial tipe serous (p-value 0,251). Kemudian dilakukan uji diagnostik dimana didapatkan nilai sensitivitas, spesifisitas dari indeks morfologi Sassone pada kanker ovarium epitelial tipe serous adalah 60% dan 28%. Sedangkan nilai sensitivitas dan spesifisitas penada tumor CA 125 pada kanker ovarium epitelial tipe serous pada penelitian ini didapatkan 80% dan 40%.Kesimpulan: Tidak ada hubungan antara indeks morfologi Sassone dan penanda tumor CA 125 dalam memprediksi kanker ovarium epitelial tipe serous.Kata kunci: indeks morfologi Sassone, kanker ovarium epitelial tipe serous, penanda tumor CA 12

Complete Heart Block In Pregnancy : A Case Report

Background: Complete heart block occurs due to various pathological conditions that cause an infiltration, fibrosis, or lose the connection from a part of the cardiac conduction system. Complete heart  block in pregnancy is often caused by congenital anomalies. Around 30% cases, complete heart block remain asymptomatic and not detected until adulthood and may present in pregnancy state and puerperium. When the reversible cause of the AV Block cannot be found, the permanent pacemaker or temporary pacemaker may be indicated when the patients show the symptoms. Case Illusration: A-21 year old female, G2P0A1 preterm pregnancy (27-28 weeks) with bradycardia. From electrocardiograph examination revealed Total AV Block with junctional escape rhytym. Transthoracic echocardiogram shows massive tricuspid regurgitation, early phase of peripartum cardiomyopathy and ejection fraction 36-40%. Caesarean section was peformed due to PPROM. A male baby was born with birth weight of 1100 grams, 32 centimeters of body length and APGAR score of 7/9. The baby was died in NICU on day care 4th, with suspected respiratory problem. Conclusion: Complete heart block in pregnancy is a rare condition. This condition could remain asymptomatic and not detected until pregnancy. Multidisciplinary approach, close monitoring of the symptoms and cardiac functions are needed for patients with CHB.Latar Belakang : AV Blok diakibatkan dari berbagai keadaan patologis yang menyebabkan infiltrasi, fibrosis, atau kehilangan koneksi dari suatu bagian sistem konduksi. AV Blok dalam kehamilan sering disebabkan oleh kelainan kongenital. Sekitar 30% kasus, AV Blok kongenital dapat asimptomatik dan tidak terdeteksi sampai masa dewasa dan dapat muncul pada kehamilan dan masa nifas. Apabila penyebab reversibel dari AV Blok tidak ditemukan, maka pacu jantung permanen atau penggunaan pacu jantung temporer dapat diindikasikan apabila pasien memiliki gejala.  Ilustrasi Kasus : Wanita 21 tahun, G2P0A1 gravid preterm (27-28 minggu) dengan bradikardi. Pada pemeriksaan elektrokardiografi dijumpai Total AV Blok dengan irama junctional escape. Pada pemeriksaan echokardiografi menunjukan regurgitasi tricuspid masif, peripartum kardiomiopati, dan fraksi ejeksi 36-40%. Dilakukan seksio sesarea atas indikasi KPD. Lahir bayi laki-laki, BBL 1100 gram, panjang badan 32 sentimeter, Apgar Skor 7/9. Bayi meninggal pada hari keempat rawatan di NICU dengan dugaan permasalahan pernafasan. Kesimpulan: Blok jantung dalam kehamilan merupakan kondisi yang langka. Kondisi ini dapat asimptomatik dan tidak terdeteksi hingga mengalami kehamilan. Pendekatan multidisiplin, pemantauan ketat gejala dan fungsi jantung diperlukan untuk pasien dengan Blok Jantung

Factors Affecting the Level of Health Care Worker's Stigmatized and Discriminatory Attitude Towards People Living with HIV: a Study at the Dr. Zainoel Abidin General Hospital, Banda Aceh, Indonesia

The aim of this study was to identify the level of health care worker`s (HCW) stigmatized and discriminatory (S&D) attitude towards people living with HIV (PLHIV) and the factors that influenced this attitude. This research was conducted at the Dr. Zainoel Abidin General Hospital (RSUDZA) in Banda Aceh province of Indonesia. A cross-sectional study design was adopted for this research. Eighty nine HCWs were included in this study and they were selected purposively. Pearson correlation analysis, analysis of variance or independent sample t test analysis was used according to the type of data. We found that the level of S&D attitude towards PLHIV in RSUDZA is high. Based on the Least Significant Difference Test, the average score of the answers between nurses and general practitioners and between nurses and medical students was significantly different(p=0.05). Pearson correlation analysis showed that the levels of S&D attitude towards PLHIV was positively correlated with age (r=0.219, p=0.04) and irrational fear of HIV transmission (r=0.352, p=0.001) and negatively correlated with knowledge about HIV/AIDS (r=-0.336, p=0.001). Pearson correlation analysis also found that knowledge of HIV/AIDS negatively correlated with the irrational fear of HIV transmission (r=0.382, p=0.000). In addition, the level of S&D attitude towards PLHIV was also associated with marital status of HCWs (p=0.020). Gender, education level, religion and the importance of religion in HCW lives wasn`t significantly affect to the level of S&D attitude towards PLHIV in HCW. We concluded that the factors that influence the level of S&D attitude towards PLHIV among the HCW are age, marital status, knowledge of HIV/AIDS, irrational fear of HIV transmission and HCWs occupations. To reduce S&D attitude towards PLHIV among the HCWs, we recommend introducing some program to increase knowledge of HIV/AID

Molecular Pathogenesis of Preeclampsia: MicroRNA Hypothesis

The discovery of micro RNA (miRNA) in 1993 by Ambros and colleagues has a huge influence in pathogenesis theory, diagnosis and treatment approach of some diseases. Some studies have conducted to seek the association alterations of miRNA expression to incidences and severity of preeclampsia (PE). We have reviewed some studies that conducted to seek the association of miRNA and PE and we discussed the role of various miRNAs in PE pathogenesis. In summary, we have shown that many researchers have given evident that the different placental and plasma miRNA expression is associated with PE. Some studies also identified the novel candidate of miRNAs (and their pathways) that may be of etiologic relevance in the pathogenesis of PE. Base on review, specific miRNA have a role to down regulate of anti apoptosis genes, regulate angiogenics growth factors such as angiogenin, vascular endothelial growth factor (VEGF) B (VEGF-β), cysteine-rich 61 (CYR61), Placental growth factor (PlGF) and VEGF-A that have a role in angiogenesis. miRNA also have a role in survival, migration, and capillary tube formation of HUVEC by targeted of c-kit. Some miRNAs target genes that participate in immunologic dysfunction, cell adhesion, cell cycle, and signaling. miRNA also have a roles in endothelial cell response to hypoxia, cell differentiation, and survival. A miRNA influence calcium signaling through negative regulations of the calmodulin-coding mRNAs, Mef2a and Gata4, mainly in smooth muscle cells that contribute to PE pathogenesis. These investigations provide novel targets for further investigation of the pathogenesis of PE and these differential miRNAs may be potential markers for the diagnosis and provide a potential therapeutic target for PE. Further investigations on posttranscriptional regulation in PE to evaluate biologic effects of identified miRNAs (including confirmations of miRNA and target gene interactions) are neede