Hyperemesis Gravidarum: A Holistic Review and Approach to Etiopathogenesis, Clinical Diagnostic and Management Therapy

Aim: To provide an overview of hyperemesis gravidarum (HG) and to present possible links between factors associated with the pathogenesis of HG also the effectiveness and safety of the nonpharmacologic and pharmacologic options available to treat HG. Background: Although HG incidence is 0.3–2% worldwide, it is the number one cause of hospitalization in the first-trimester pregnancy, costs greatly to one financially, and also reduces the quality of life. This literature review focuses on articles published over the last 7 years to examine current perspectives and recent developments in HG. Review results: Nausea and vomiting are common symptoms during early pregnancy. When vomiting is severe, it is referred to as HG. Despite its high prevalence, it tends to be underestimated. The etiopathogenesis remains unknown, but many risk factors have been determined. Currently, the therapy focused on improving the symptoms while minimizing risks to the mother and fetus. If HG is left untreated, it may lead to significant maternal morbidity and adverse birth outcomes. Conclusion: Hyperemesis gravidarum is a complex and multifactorial condition. The incidence is higher in developing countries rather than in developed countries. Hyperemesis gravidarum can manifest as mild to severe signs and symptoms. The therapy ranges from dietary and lifestyle changes, intravenous fluid rehydration, hospitalization, nonpharmacologic, and pharmacologic treatment. Hyperemesis gravidarum can result as a mild to severe maternal and fetal complications. Keywords: Etiopathogenesis, Hyperemesis gravidarum, Incidence, Outcomes, Treatmen

Analisis Kadar Hemoglobin Tikus Putih Betina (Rattus norvegicus)Sebelum dan Sesudah Intervensi Pemberian Ekstrak Buah Pinang (Areca catechu L.)

Pinang (Areca catechu L.) adalah semacam tumbuhan palem yang tumbuh di daerah Asia, Afrika bagian timur, dan pasifik. Pinang memiliki kandungan berupa tanin, alkaloid, lemak, minyak atsiri, gula dan air. Secara empiris biji pinang dapat mengatasi berbagai jenis penyakit, antara lain mengatur pencernaan, mencegah rasa kantuk, antidepresi bahan kosmetik dan pelangsing, dan bahan baku obat. Penelitian Kaius, dkk. tahun 2009 – 2013 di Madang, Papua New Guinea menilai dampak dari menyirih (pinang dan sirih) memberikan hasil buruk seperti kematian persalinan, berat badan bayi lahir rendah (BBLR, < 2500 g) dan anemia saat persalinan (hemoglobin < 11,0 g / dL). Menurut pengamatan tenaga kesehatan RSUD Merauke, Papua, bahwa sebagian besar kejadian anemia pada ibu hamil terjadi pada ibu yang mengkonsumsi pinang (Areca catechu L.), namun belum ada penelitian secara khusus. Sehingga penelitian ini bertujuan untuk menganalisis kadar hemoglobin tikus putih betina (Rattus norvegicus) sebelum dan sesudah intervensi pemberian ekstrak buah pinang (Areca catechu L.). Penelitian ini dilakukan dengan desain eksperimental laboratorium Pre and Post Control Group Randomized di Unit Pengelola hewan laboratorium (UPHL) Fakultas Kedokteran Hewan Institut Pertanian Bogor (IPB). Hasil penelitian menunjukkan terdapat penurunan kadar Hb yang tidak bermakna pasca 14 hari intervensi : (14,86±0,85), (14,70±0,42), (14,03±0,58), dan (13,62±1,21), namun didapatkan penurunan yang bermakna diantara kelompok penelitian. Disimpulkan terdapat korelasi negatif yang cukup kuat dan bermakna antara penurunan kadar hemoglobin (Hb) dengan intervensi ekstrak pinang selama 14 har

Hubungan Antara Pengetahuan, Sikap dan Praktik Personal Hygiene Organ Genitalia Eksterna Terhadap Kejadian Keputihan Patologis

Keputihan (leukorea, flour albus, vaginal discharge) adalah sekret berlebihan dari vagina selain darah haid, dan tidak disebabkan neoplasma atau penyakit sistemik. Keputihan merupakan masalah kesehatan reproduksi dialami hampir 75% perempuan didunia, paling tidak sekali selama hidupnya. Kurangnya pengetahuan, sikap, dan praktik dalam perawatan vagina diyakini berpengaruh terhadap kejadian keputihan patologis tersebut. Penelitian ini bertujuan untuk mengetahui hubungan pengetahuan, sikap, dan praktik personal hygiene organ genital eksterna terhadap kejadian keputihan patologis pada mahasiswi Fakultas Kedokteran Universitas Kristen Indonesia. Penelitian ini menggunakan desain penelitian analitik korelasional pada 98 mahasiswi. Terdapathubungan yang bermakna (p= 0,000) dan korelasi positif antara tingkat pengetahuan, sikap dan praktik personal hygiene dengan kejadian keputihan patologis. Kata Kunci : keputihan, pengetahuan, sikap, praktik, personal hygiene./Vaginal discharge (leukorrhea, flour albus, vaginal discharge) is excessive discharge from the vagina other than menstrual blood, and is not caused by neoplasms or systemic disease. Leucorrhoea is a reproductive health problem that affects nearly 75% of women in the world, at least once in their lifetime. Lack of knowledge, attitude, and practice in vaginal care is believed to have an effect on the incidence of pathological vaginal discharge. This study aims to determine the relationship between knowledge, attitudes, and personal hygiene practices of external genital organs on the incidence of pathological vaginal discharge in students of the Faculty of Medicine, Christian University of Indonesia. This study used a correlational analytical research design on 98 female students of the Faculty of Medicine, Christian University of Indonesia. It was found a significant relationship (p = 0.000) and a positive correlation between the level of knowledge, attitudes and personal hygiene practices with the incidence of pathological vaginal discharge. Keywords: leucorrhoea, knowledge, attitude, practice, personal hygien

ACE2 Receptors Finding in Placenta with Intrauterine Fetal COVID-19 Infection: A Meta-Analysis

Objective: Association between ACE2 receptors in the placenta and the incidence of intrauterine COVID-19 infection in pregnant women infected with COVID-19 Methods: Systematic review and meta-analysis of placenta in pregnant women with COVID-19 infection, ACE2 receptor in placenta, and RT-PCR of neonates from COVID-19 pregnant women. This study followed the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) protocol. Results: 6 journals meet the inclusion criteria. ACE2 receptors were found in syncytiotrophoblasts 72/72 (100%), cytotrophoblasts 41/72 (56.9%), extravillous trophoblasts 24/72 (33.3%), decidual cells 2/72 (2.7%), villous stromal cells 1/72 (1.3%), and 1/72 stromal cells (1.3%) with the incidence of neonates infected with SARS-CoV-2 from pregnant women with COVID-19 10.5%, odds ratio (OR) between ACE2 receptors and neonates infected with COVID-19 is 1.97 (95%CI 0.05–81.09), the pooled proportion of ACE2 receptor findings in 72 placentas in pregnant women with COVID-19 infection, syncytiotrophoblast 98.3 (95% CI 94.3–99.9), cytotrophoblast 40.3 (95% CI 2.3–88.9), and extravillous trophoblast 35.2 (95% CI 0.2–88.5). Conclusion: Expression of ACE2 receptors is always present in the placenta of pregnant women, and there is an association but non-significant between ACE2 receptors in the placenta and the incidence of COVID-19 intrauterine infection with an odds ratio of 1.97 (95%CI 0.05-81.09). Keywords: COVID-19 infection, Intrauterine, ACE2 receptor placenta/Tujuan: Hubungan antara reseptor ACE2 di plasenta dengan angka kejadian infeksi COVID-19 intrauterine pada ibu hamil yang terinfeksi COVID-19. Metode: Tinjauan sistematis dan meta-analisis plasenta pada ibu hamil COVID-19, reseptor ACE2 pada plasenta, dan hasil uji RT-PCR neonatus dari ibu hamil COVID-19. Penelitian ini mengikuti protokol Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA). Hasil: 6 jurnal memenuhi kriteria. Reseptor ACE2 ditemukan di sinsitiotrofoblas 72/72 (100%), 41/72 sitotrofoblas (56.9%), trofoblas ekstravili 24/72 (33.3%), sel desidua 2/72 (2.7%), sel stroma vili 1/72 (1.3%), dan sel stroma 1/72 (1.3%) dengan insidensi neonatus yang terinfeksi SARS-CoV-2 dari ibu hamil dengan COVID-19 sebanyak 10.5%, odds ratio (OR) antara reseptor ACE2 dan neonatus terinfeksi COVID-19 adalah 1.97 (95%CI 0.05– 81.09), proporsi gabungan penemuan reseptor ACE2 pada 72 plasenta ibu hamil COVID-19, sintiotrofoblas 98.3 (95%CI 94.3 – 99.9), sitotrofoblas 40.3 (95%CI 2.3 – 88.9), dan trofoblas ekstravili 35.2 (95%CI 0.2 – 88.5). Kesimpulan: Ekspresi reseptor ACE2 selalu ditemukan di plasenta ibu hamil, dan terdapat hubungan yang tidak bermakna antara reseptor ACE2 di plasenta dengan kejadian infeksi intrauterine COVID-19 dengan odds ratio 1.97 (95%CI 0.05-81.09). Kata kunci : Infeksi COVID-19, Intrauterine, reseptor ACE2 plasenta

Penyuluhan Vitamin dan Supplemen yang Dibutuhkan Tubuh Lansia di Kelurahan Tidung, Pulau Seribu 17-19 Juni 2022

Pandemic COVID-19 (coronavirus) menyebabkan banyak perubahan dalam kehidupan sehari-hari. Gizi yang baik, sangat penting sebelum, selama dan setelah infeksi. Kecukupan gizi terutama vitamin dan mineral sangat diperlukan dalam mempertahankan sistem kekebalan tubuh yang optimal, sayuran dan buah- buahan merupakan sumber terbaik berbagai vitamin, mineral dan serat. Menurut World Health Organization (WHO), lansia adalah seseorang yang telah memasuki usia 60 tahun ke atas. Di Indonesia mengalami peningkatan jumlah penduduk lansia 18 juta jiwa (7,56 %) pada tahun 2010 menjadi 25,9 juta jiwa (9,7%) pada tahun 2019 dan dapat diperkirakan akan terus meningkat dimana tahun 2035 menjadi 48,2 juta jiwa (15,77%). Lansia memerlukan berbagai macam makanan untuk menjaga keseimbangan gizi, salah satunya untuk menghindari penyakit menular (misal infeksi) dan penyakit tidak menular (misal hipertensi). Lansia secara prinsip sangat memerlukan perlindungan dan pemberian informasi yang benar pada masa pandemik, terutama terkait penjagaan kesehatan mental dan fisik. Menurut data statistik daerah kabupaten kepulauan seribu tahun 2021 terdiri dari 2 kecamatan dan 6 kelurahan. Selama kurun waktu 1 tahun (2019 – 2020), penduduk Kepulauan Seribu mengalami kenaikkan 1,56 persen. Jika dilihat dari penduduk menurut kelompok umur terlihat bahwa komposisi usia produktif (15-64 tahun) hampir dua kali lipat usia tidak produktif ( > 64 tahun/ lansia) yaitu sebesar 66,82 persen. Oleh karena itu, pada kegiatan pengabdian kepada masyarakat (PKM), kami ingin melakukan Penyuluhan Vitamin dan Supplemen Makanan yang dibutuhkan tubuh untuk Lansia (usia diatas 60 Tahun) di Kelurahan P. Tidung, Pulau Seribu pada tanggal 17-19 Juni 2022. Kata Kunci : Pengabdian kepada Masyarakat, Vitamin dan Supplemen, Lansia, Pandemic Covid-19. / The COVID-19 (coronavirus) pandemic has caused many changes in daily life. Good nutrition is very important before, during and after infection. Adequate nutrition, especially vitamins and minerals, is needed in maintaining an optimal immune system, vegetables and fruits are the best sources of various vitamins, minerals and fiber. According to the World Health Organization (WHO), the elderly is someone who has entered the age of 60 years and over. In Indonesia, the number of elderly people increased from 18 million people (7.56%) in 2010 to 25.9 million people (9.7%) in 2019 and can be expected to continue to increase where in 2035 to 48.2 million people (15,77%). The elderly need a variety of foods to maintain a nutritional balance, one of which is to avoid infectious diseases (eg infections) and non-communicable diseases (eg hypertension). In principle, the elderly really need protection and the provision of correct information during a pandemic, especially regarding mental and physical health care. According to statistical data, the Thousand Islands Regency in 2021 consists of 2 sub-districts and 6 urban villages. During the period of 1 year (2019 – 2020), the population of the Thousand Islands experienced an increase of 1.56 percent. If we look at the population by age group, it can be seen that the composition of productive age (15-64 years) is almost double the unproductive age (> 64 years/elderly) which is 66.82 percent. Therefore, in community service activities (PKM), we want to do Vitamin and Food Supplement Counseling for the elderly (over 60 years old) in P. Tidung Village, Pulau Seribu on 17-19 June 2022. Keywords: Community Service; Vitamin and Supplement; elderly; The Covid-19 Pandemic

Forkhead Box P3 Messenger-RNA Expression after Curcuma longa Extract Intervention in Early Pregnant Mice with Toxoplasmosis

Background and Objective: Curcuma longa (C. Longa ) has strong anti-inflammatory effect. This study aims to examine the effect of Curcuma longa extract on Forkhead Box P3 (FOXP3) mRNA expression in early pregnant mice with acute toxoplasmosis. Materials and Methods: This study evaluated 20 early pregnant mice that were divided into 5 groups, four mice in each. Group 1-4 received injections of Toxoplasma gondii tachyzoites. Three days later, G1 and G2 were given orally 125 and 500 mg kgG1/day of Curcuma longa extract, respectively. The G3 was given 60 mg kgG1/day of spiramycin (positive control) and G4 was given 0.2 mL of distilled water (negative control). The G5 underwent no intervention at all. Blood samples were obtained serially (before and 3 days after injection of tachyzoites, 3 and 7 days after intervention) to assess FOXP3 mRNA expression. Results: The FOXP3 mRNA expression increased significantly in G1-G3 3 days after intervention (p<0.05), whereas, FOXP3 mRNA expression decreased significantly (p<0.05) 7 days after intervention and there was no significant difference between these three groups. The FOXP3 mRNA expression in G4 increased significantly 3, 6 and 10 days after tachyzoites injections, while FOXP3 mRNA expression on G5 fluctuated but considered as insignificant (p>0.05). Conclusion: The administration of Curcuma longa extract at a dose of 125 mg kgG1/day for 3 days effectively increased FOXP3 mRNA expression and 7 days administration resulted in decreased FOXP3 mRNA expression in early pregnant mice with acute toxoplasmosis. Key words: FOXP3 mRNA, Curcuma longa , pregnancy, Toxoplasma gondii , spiramyci

Tumor Necrosis Factor-alpha Levels and Histopathology Finding after Intervention with Curcuma longa Extract

Curcuma longa (C. longa) extract has been reported as a potent anti-inflammatory agent. The main objective of this study was to evaluate the effectiveness of Curcuma longa extract to decrease Tumor Necrosis Factor-alpha (TNF-α) and cells damage prevention in early pregnant mice with acute toxoplasmosis. Materials and Methods: This study evaluated 20 early pregnant mice. The mice were divided into five groups (G1-G5). G1-G4 were injected with 10 tachyzoites of Toxoplasma gondii and G5 was not injected. Three days later, G1 and G2 were intervened with C. longa extract dose of 125 mg and 500 mg kg–1/day, respectively. G3 was a positive control and G4 was a negative control. G5 was not intervened. The TNF-α level was examined serially (before and 3 days post tachyzoites injection and 3 and 7 days post-intervention). The placental mice were taken 7 days after intervention for histopathology examination. Results: The TNF-α level increased significantly 3 days after tachyzoites injection (p<0.05) and TNF-α level decreased significantly 3 and 7 days after curcuma longa intervention compared to the negative control (p<0.05). Hemorrhagic and necrotic cells were not found in the group intervened with C. longa extract but it found in the positive and negative control groups were 75 and 100%, respectively. Conclusion: Curcuma longa is effective to suppress TNF-α level and prevent placental cells damage in early pregnant mice with acute toxoplasmosis

Profile of HMGB1 mRNA Expression and TLR4 Protein in BALB/c Mice Model Sterile Injury after Systemic Lidocaine Administration

High mobility group box 1 (HMGB1) is a cytokine proinflamation which contributes to inflammation. HMGB1 physically interacts with toll like receptor 4 (TLR4) to release macrophage cytokines. The aim of this study was to demonstrate the effectiveness of systemic lidocaine administration to inhibit the expression of HMGB1 mRNA and TLR4 protein in mice BALB/c mice with sterile injury. Material and Methods: Twenty adult male BALB/c mice were divided into lidocaine and control groups. A sterile injury is done by closed fracturing the left thigh bone of the mice. The lidocaine group was treated with 2 mg/kgBW lidocaine through tail vein injection after 4 h of sterile injury. The control group was given distilled water therapy as a substitute for lidocaine. Mice blood is extracted from the tail vein before trauma, 4 h after trauma, and 2 h after the administration of lidocaine and distilled water is complete.The HMGB1 mRNA expression was examined by quantitative real-time polymerase chain reaction (qPCR) while the TLR4 protein level was determined with enzyme-linked immunosorbent assay (ELISA) according to the manufacturer’s instructions. Result: The HMGB1 mRNA expression and TLR4 protein levels in BALB/c that sustained inflammation due to a sterile injury was significantly decreased in the lidocaine group (p < 0.00). Conclusion: Administration systemic 2 mg/kgBW of lidocaine is effectively inhibits HMGB1 mRNA and TLR4 protein in mice that sustain inflammation due to a sterile injury