Germ Patterns and Antibiotic Susceptibility in Pregnancy and Labor with Risk of Infections : Pola Kuman dan Sensitivitas Antibiotik pada Kehamilan dan Persalinan dengan Faktor Risiko Infeksi

Objective: To determine the pattern of germs and antibiotic susceptibility tests in pregnant women related to risk factors for infection in preterm PROM cases, the threat of preterm labor, pathological fluor albus, and prolonged labor in Manado city. Method: This study is a cross-sectional descriptive study. A total of 21 samples were obtained, consisting of six preterm PROM cases, five premature contraction cases, five pathological fluor albus cases, and five prolonged labor cases. The study was conducted in Kandou General Hospital and Affiliated Hospitals, Manado. All patients were informed about the study and signed informed consent. Germ pattern and antibiotics susceptibility data were analyzed. Results: Of 21 samples, the detected microorganisms included Staphylococcus aureus (12), Coagulase-negative staphylococcus (2), mixed microorganisms (Staphylococcus aureus + Candida sp, Coagulase-negative staphylococcus + Candida sp), Bacillus sp and Candida sp. The susceptible and safe antibiotics for pregnancy were Ampicillin / Sulbactam and Meropenem. The resistant antibiotics were Ceftriaxone, Tetracycline, and Neomycin. Conclusion: The most common type of bacteria found in pregnant women and women in labor was Staphylococcus aureus. Susceptible and safe antibiotics for pregnancy were Ampicillin / Sulbactam and Meropenem. Keywords: antibiotic sensitivity test, germ pattern, pregnancy and labor infection.   Abstrak Tujuan: Mengetahui pola kuman dan uji sensitivitas antibiotik pada perempuan hamil terkait faktor risiko infeksi pada kasus KPD preterm, ancaman partus prematurus, fluor albus patologis dan partus lama di kota Manado. Metode: Studi ini merupakan studi deskriptif potong lintang. Jumlah sampel yang didapatkan sebesar 21 sampel di mana terbagi pada masing-masing kasus KPD preterm 6 sampel, ancaman partus prematurus 5 sampel, fluor albus patologis 5 sampel dan partus lama 5 sampel. Sampel diambil dari RSUP Prof. Dr. R. D. Kandou Manado dan Rumah Sakit Jejaring di kota Manado yang memenuhi kriteria inklusi dan eksklusi. Semua pasien dijelaskan mengenai prosedur penelitian dan penandatanganan inform consent baru dilakukan pengambilan sampel. Data dianalisis dengan cara deskriptif tentang pola kuman dan uji sensitivitas antibiotik pada kehamilan dan persalinan dengan faktor risiko infeksi. Hasil: Dari 21 sampel, sebaran jenis mikroorganisme diantaranya Staphylococcus areus (12), Staphylococcus non koagulase (2), mikroorganisme campuran (Staphylococcus aureus + Candida sp, Staphylococcus non koagulase + Candida sp), Bacilus sp dan Candida sp. Hasil uji sensitivitas antibiotik yang sensitif dan aman untuk kehamilan di antaranya Ampicillin/Sulbactam dan Meropenem. Hasil uji sensitivitas antibiotik yang resisten adalah Ceftriaxone, Tetracycline dan Neomycin. Kesimpulan: Jenis mikroorganisme paling banyak adalah Staphylococcus aureus. Hasil uji sensitivitas antibiotik yang sensitif dan aman untuk kehamilan di antaranya Ampicillin/Sulbactam dan Meropenem. Kata kunci: infeksi kehamilan dan persalinan, pola kuman, uji Sensitivitas antibioti

Response of External Radiotherapy Alone in Stage IIB – IIIC Cervical Cancer Patients : Respon Radioterapi Eksterna Pasien Kanker Serviks Stadium IIB – IIIC

Objective: To investigate the therapeutic response and toxicity in cervical cancer patients with stage IIB-IIIC who undergo external radiation. Methods: This was a retrospective study using the medical records of the Obstetric Oncology and Radiotherapy Department at Prof. Dr. R. D. Kandou Hospital Manado. The research subjects were stage IIB-IIIC cervical cancer patients who underwent external radiation from September 2016 to December 2020. External radiation was administrated using 60Cobalt. The statistical analysis assessments in this study was carried out using descriptive analysis, while the analysis of the relationship was carried out using the Chi-Square method. The toxicity assessments were carried out from first day started external radiation up until 1 month after the therapy was deemed completed. Results : As many as 413 cervical cancer patients underwent external radiation during the study. However, only 192 cervical cancer patients with stage IIB-IIIC met the inclusion criteria in this study. The complete response to the therapy based on the findings was 65.6%, the partial response was 31.8%, the stable response was 1.6%, and the progressive response was 1%. In statistical analysis there was a significant association between cervical cancer stage and Overall Treatment Time with response to external radiotherapy. However, no significant association between tumor size and histopathological type with response to external radiotherapy. There were hematological toxicity (45.8%), skin toxicity (45.3%), gastrointestinal toxicity (6.3%) and urinary tract toxicity (2.6%). Conclusions: External radiotherapy response was a complete response where there was an association between cervical cancer stage and Overall Treatment Time with response to external radiotherapy, whereas there is no significant association found between the tumor size and histopathological type based on this research's findings. Most toxicity were hematology with complaints of anemia and thrombocytopenia Keywords: cervical cancer, external radiation response, toxicity.   Abstrak   Tujuan: Untuk mengetahui respon terapi dan efek samping pasien kanker serviks stadium IIB-IIIC yang menjalani radioterapi eksterna. Metode: Penelitian ini adalah penelitian deskriptif rektrospektif dengan menggunakan rekam medis Poli Onkologi Kandungan dan Instalasi Radioterapi RSUP Prof. Dr. R. D. Kandou Manado. Subyek penelitian adalah pasien kanker serviks stadium IIB-IIIC yang menjalani radiasi eksterna mulai September 2016 sampai Desember 2020. Radiasi eksterna dilakukan dengan sinar 60Cobalt. Penilaian analisis statistika pada penelitian ini menggunakan analisis deskriptif dan analisis hubungan menggunakan metode Chi Square. Penilaian efek samping dilakukan sejak hari pertama pasien memulai radiasi eksterna sampai 1 bulan setelah dinyatakan selesai menjalani radioterapi eksterna. Hasil: Selama periode penelitian didapatkan 413 pasien kanker serviks yang menjalani radiasi eksterna namun hanya 192 pasien kanker serviks stadium IIB-IIIC yang memenuhi kriteria inklusi pada penelitian ini. Respon terapi komplit sebesar 65,6%, respon terapi parsial sebesar 31,8%, respon terapi tidak berubah sebesar 1,6%, dan respon terapi progresif sebesar 1%. Pada analisis statistik terdapat hubungan bermakna stadium kanker serviks dan Overall Treatment Time dengan respon radioterapi eksterna, dan tidak terdapat hubungan bermakna ukuran tumor dan jenis histopatologi dengan respon radioterapi eksterna. Didapatkan efek samping hematologi (45,8%), efek samping kulit (45,3%), efek samping gastrointestinal (6,3%) dan efek samping traktus urinarius (2,6%). Kesimpulan: Respon radioterapi eksterna berupa complete response dimana terdapat hubungan bermakna antara stadium kanker serviks dan Overall Treatment Time dengan respon radioterapi eksterna. Tidak terdapat hubungan bermakna antara ukuran tumor dan jenis histopatologi. Efek samping terbanyak yaitu hematologi dengan keluhan berupa anemia dan trombositopenia. Kata kunci:  efek samping, kanker serviks, respon radiasi eksterna

Lipid Profile, Blood Glucose Level and Body Mass Index (BMI) in Second Trimester of Pregnancy: Screening with Gestational Diabetes: Profil Lipid, Gula Darah dan Indeks Massa Tubuh (IMT) pada Kehamilan Trimester II: Skrining Kejadian Kehamilan dengan Diabetes Melitus

Abstract Objective: To find out lipid profile data, blood sugar and Body Mass Index in trimester II pregnancy to the incidence of pregnancy with diabetes mellitus. Methods: This study is a cross sectional study. The number of samples obtained was 42 samples where all were taken in the second trimester. Samples taken from RSUP Prof. Dr. R. D. Kandou Manado and networking hospitals around Manado that meet the inclusion and exclusion criteria. All patient patients were explained about the research procedure and the signing of consent information. Blood samples were taken for examination of blood sugar (fasting blood sugar and 2 hours post-prandial blood sugar) and lipid profiles (total cholesterol, HDL, LDL, triglycerides). After the data is collected, it is included in the SPSS version 22.0 program for data analysis. Results: Found 2 subjects (4.76%) who had abnormal fasting blood sugar and found 4 subjects (9.53%) who had abnormal 2-prandial 2-hour blood sugar. For lipid profiles, it was found 16 subjects (38.1%) who had abnormal total cholesterol levels, for LDL there were 13 subjects (30.96%) who had abnormal levels, for HDL there were 4 subjects (11.9%) who had abnormal levels and for triglycerides there were 23 subjects (54.76%) who had abnormal levels. There was a significant negative correlation between LDL cholesterol and fasting blood sugar (p = 0.002; r = - 0.455), and so did total cholesterol with fasting blood sugar (p = 0.047; r = - 0.302). There was a significant correlation between BMI and total cholesterol (p = 0.013; r = 0.371). There was 1 subject (2.38%) diagnosed with gestational diabetes melt and fasting blood sugar at 190 mg / dL, for prandial 2 hours post blood sugar at 309 mg / dL and for triglycerides at 617 mg / dL. Conclusions: Based on this study found the incidence of gestational diabetes mellitus 2.38% of all trimester II pregnancies. There is a positive but not significant correlation between blood sugar and triglycerides, whereas there is no significant relationship between blood sugar and other lipid profiles. There is a positive but not significant correlation of BMI in trimester pregnancy with total cholesterol. Keywords: Blood sugar, Body Mass Index (BMI), lipid profile Abstrak Tujuan: Untuk mengetahui data profil lipid, gula darah dan Indeks Massa Tubuh pada kehamilan trimester II terhadap kejadian kehamilan dengan diabetes melitus. Metode: Studi ini merupakan studi potong lintang. Jumlah sampel yang didapatkan sebesar 42 sampel di mana seluruhnya diambil pada trimester II. Sampel diambil dari RSUP Prof. Dr. R. D. Kandou Manado dan rumah sakit jejaring sekitar Manado yang memenuhi kriteria inklusi dan eksklusi. Semua pasien-pasien dijelaskan mengenai prosedur penelitian dan penandatanganan inform consent baru dilakukan pengambilan sampel darah untuk pemeriksaan gula darah (gula darah puasa dan gula darah 2 jam postprandial) dan profil lipid (Kolesterol total, HDL, LDL, Trigliserida). Setelah data dikumpulkan, maka dimasukkan ke dalam program SPSS versi 22.0 untuk data analisis. Hasil: Ditemukan 2 subjek (4,76%) yang memiliki gula darah puasa abnormal dan ditemukan 4 subjek (9.,53%) yang memiliki gula darah 2 jam postprandial yang abnormal. Untuk profil lipid, ditemukan 16 subjek (38,1%) yang memiliki kadar kolesterol total abnormal, untuk LDL ditemukan sebanyak 13 subjek (30,96%) yang memiliki kadar abnormal, untuk HDL ditemukan 4 subjek (11,9%) yang memiliki kadar abnormal dan untuk trigliserida ditemukan 23 subjek (54,76%) yang memiliki kadar abnormal. Terdapat korelasi negatif signifikan antara kolesterol LDL dengan gula darah puasa (p = 0,002 ; r = – 0,455), dan begitu juga dengan kolestrol total terhadap gula darah puasa (p = 0,047 ; r = – 0,302). Terdapat korelasi signifikan antara IMT dengan kolesterol total (p = 0,013 ;r = 0,371). Terdapat 1 subjek (2,38%) yang terdiagnosis diabetes melitus gestasional di mana gula darah puasa sebesar 190 mg/dL, untuk gula darah 2 jam postprandial sebesar 309 mg/dL dan untuk trigliserida sebesar 617 mg/dL. Kesimpulan: Berdasarkan penelitian ini ditemukan kejadian diabetes melitus gestasional 2,38% dari seluruh kehamilan trimester II. Terdapat korelasi positif tetapi tidak bermakna antara gula darah dengan trigliserida, sedangkan tidak terdapat hubungan bermakna antara gula darah dengan profil lipid lainnya. Terdapat korelasi positif tetapi tidak bermakna IMT pada kehamilan trimester dengan kolestrol total. Kata kunci: gula darah, Indeks Massa Tubuh (IMT), profil lipi

Human Papilloma Virus L1 Gene Methylation as a Potential Biomarker for Precancerous Cervical Lesion: a Preliminary Report

Objective: To determine whether HPV L1 gene methylation can be used in triage of precancerous cervical lesions. The main objective is to determine the genotype of HPV in cervical precancerous lesions and to determine the percentage, the sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio of DNA HPV L1 methylation in precancerous cervical lesions. Methods: A number of 57 samples of paraffin blocks (FFPE) from precancerous lesions and cervical cancer biopsies in the Department of Pathology Faculty of Medicine-Cipto Mangunkusumo General Hospital that had been re-evaluated by the pathologist, underwent extraction of HPV DNA. The genotypes of HPV DNA were examined using primers GP5 / 6 and specific HPV 16, HPV 18 and HPV 52 probes and analyzed by real time PCR. Sequencing was performed on samples with unknown HPV DNA type that were detected using the specific probes to determine the type of HPV. Bisulfite conversion procedure was then performed for the samples that met the inclusion criteria. Results: There were 30 samples (52.6%) with CIN 1, 12 samples (21.1%) CIN 2, 9 samples (15.8%) CIN 3 and 6 samples (10.5%) of cervical cancer. Most of the samples were 36-45 years (35.1%). Of the total 57 samples, 55 samples were successfully extracted and determined the DNA genotyping of HPV (96.5%). HPV 16 infections both in the form of single or multiple was found to be 76.36%. The samples were mostly dominated by co-infection of HPV16 and 18 (49.1%) followed by HPV 16 (24.6%) and HPV 18 (14.0%). Based on the sequencing results there were other types of high risk HPV infection found: HPV 33, HPV 35, HPV 58 and also undeterminate risk HPV 53 and low risk HPV 54. After several procedures of optimization for methylation examination of HPV DNA L1 there was thin band found in electrophoresis procedure in 8 of 42 samples (19%) of HPV 16 after bisulfite conversion but once it was purified there weren’t any band found so we can not proceed to the stage sequencing. Until now we are still in the stage of optimizing the methylation procedure. Conclusion: HPV 16 infection were most commonly found in the form of single or multiple. Co-infection of HPV 16 and 18 were found in the majority of the samples. There were no significant correlation between HPV type and the severity of cervical lesions. Until now, the examination of DNA methylation HPV L1 already obtained eight samples of HPV 16 with a thin band on electrophoresis but the result could not be concluded because it is still in the process of optimization. [Indones J Obstet Gynecol 2017; 5-2: 120-126] Keywords: HPV DNA genotype, L1 gene methylation, precancerous cervical lesion

Roma Index and Adnex Model: which is more Superior in Predicting Epithelial Ovarian Malignancy? Index Roma dan Model Adnex: Manakah yang Lebih Unggul dalam Memprediksi Keganasan Ovarium Epitelial?

Objective: To compare the accuracy of ROMA index andADNEX model in predicting the risk of malignancy in ovariantumour.Methods: This was a prospective analytic study. A total of 37samples were acquired from women of all ages diagnosedwith an ovarian cystic tumour in the Central General HospitalProf. Dr. R. D. Kandou. A CA-125 marker, HE4 marker,menopausal status and ultrasonography (USG) examinationwere obtained, and subsequently compared with the fi nalhistopathological results. The data were analysed by usingthe SPSS statistics software.Results: Thirty-seven women participated in this study. Themean age of participants was 43 years old. The Area UnderCurve (AUC) of the ADNEX was 0.979 with a sensitivity of90.0%, specifi city of 88.2%, negative predictive value of89.8%, and positive predictive value of 80.5%. The AUC ofthe ROMA model was 0.734 with the sensitivity, specifi city,negative predictive value, and positive predictive value of65.0%, 64.7%, 64.8%, and 64.8%, respectively. Both modelsshowed AUC values > 0.50 (p-value < 0.05).Conclusions: The IOTA ADNEX had better accuracy than theROMA model in predicting ovarian epithelial malignancy.The ADNEX model had higher sensitivity and specifi city thanthe ROMA model.Keywords: ADNEX, CA-125, HE4, Ovarian tumour, ROMAAbstrakTujuan: Untuk membandingkan akurasi indeks ROMAdan ADNEX model dalam memprediksi keganasan tumorovariumMetode: Penelitian ini merupakan studi analitik prospektif.Total 37 sampel penelitian didapatkan dari wanita yangdidiagnosa tumor ovarium kistik di RSUP Prof. Dr. R. D.Kandou. CA-125, HE4, status menopause dan pemeriksaanUSG dilakukan, dan dibandingkan dengan hasil histopatologi.Data kemudian dianalisa menggunakan program statistikSPSS.Hasil: Tiga puluh tujuh perempuan yang berpartisipasidalam penelitian ini. Dengan rerata usia 43 tahun. TotalArea Under Curve (AUC) dari IOTA ADNEX adalah 0,979dengan sensitivitas 90,0%, spesifi sitas 88,2%, nilai prediksinegatif 89,8%, dan nilai prediksi positif 80,5%. AUC darimodel ROMA adalah 0,734 dengan sensitivitas, spesifi sitas,nilai prediktif negatif dan nilai predikitif positif 65.0%, 64.7%,64.8%, dan 64.8% berturut-turut. Kedua model menunjukkannilai AUC > 0,50 (nilai p <0,05).Kesimpulan: IOTA ADNEX memiliki akurasi yang lebih baikdibandingkan model ROMA dalam memprediksi keganasanovarium epithelial. ADNEX model memiliki sensitivitas danspesifi sitas lebih tinggi dibandingkan model ROMAKata kunci: ADNEX, CA-125, HE4, ROMA, Tumor Ovarium