Moewardi General Hospital Research Articles

Profile of Patients with Gaster Perforation at Dr. Moewardi General Hospital Surakarta in The Period of January-December 2018

Introduction: A gastric perforation is a form of hollow digestive organ perforation in which the entire thickness of the stomach wall is injured. Perforation of hollow organs can be suspected based upon the clinical picture, and the diagnosis becomes obvious through an image of free air on imaging performed.
 Methods: Data of patient characteristics were observed retrospectively from medical records of patients diagnosed with gastric perforation between January and December 2018.
 Results: Between January and December 2018, 45 patients with gastric perforation were identified, with data distributed by gender. There were 36 women (80%) and 9 men (20%) in the group. Based on the age group, 32 patients (71%) were distinguished by the age group over 40 years and 13 patients (29 %) under 40 years of age. When viewed from the location of the gastric perforations, it was found that 4 patients (9%) had a perforation in the antrum, 36 patients (80%) in the Prepylorus, and 5 patients (11.2%) in the major curvature. Data on analgesic use revealed 32 patients (71%) had a history of taking analgesics and 13 patients (29%) without a history of taking analgesics.
 Conclusion: In 2018, the majority of gastric perforation patients at Dr. Moewardi Hospital were female (80%), with the highest age group being over 40 years (71%) and the most gastric perforations occurring in the pylori (80%). The number of patients with gastric perforation who had previously used herbs and analgesics was higher (70%) than those who had not. Thus, the results of this retrospective study are consistent with previous research findings and can be used to continue research into the relationships (correlations) between the aforementioned variables.

Profile of Patients with Gaster Perforation at Dr. Moewardi General Hospital Surakarta in The Period of January-December 2018

Introduction: A gastric perforation is a form of hollow digestive organ perforation in which the entire thickness of the stomach wall is injured. Perforation of hollow organs can be suspected based upon the clinical picture, and the diagnosis becomes obvious through an image of free air on imaging performed.
 Methods: Data of patient characteristics were observed retrospectively from medical records of patients diagnosed with gastric perforation between January and December 2018.
 Results: Between January and December 2018, 45 patients with gastric perforation were identified, with data distributed by gender. There were 36 women (80%) and 9 men (20%) in the group. Based on the age group, 32 patients (71%) were distinguished by the age group over 40 years and 13 patients (29 %) under 40 years of age. When viewed from the location of the gastric perforations, it was found that 4 patients (9%) had a perforation in the antrum, 36 patients (80%) in the Prepylorus, and 5 patients (11.2%) in the major curvature. Data on analgesic use revealed 32 patients (71%) had a history of taking analgesics and 13 patients (29%) without a history of taking analgesics.
 Conclusion: In 2018, the majority of gastric perforation patients at Dr. Moewardi Hospital were female (80%), with the highest age group being over 40 years (71%) and the most gastric perforations occurring in the pylori (80%). The number of patients with gastric perforation who had previously used herbs and analgesics was higher (70%) than those who had not. Thus, the results of this retrospective study are consistent with previous research findings and can be used to continue research into the relationships (correlations) between the aforementioned variables.

Profile of Breast Cancer Patients at Dr. Moewardi Surakarta Period March 2016 - March 2018

Introduction: Breast cancer is a heterogeneous disease caused by the interaction of genetic factors and environmental risk factors that lead to the accumulation of progressive genetic and epigenetic changes in breast cancer cells. The incidence of breast cancer in Indonesia is 11% of all cancer incidents. There are many factors that are thought to have an influence on the occurrence of breast cancer, including age, immunohistochemistry, and variable levels of first breast carcinoma at old age.
 Methods: A descriptive retrospective study by taking medical record data about breast cancer at the Dr. Moewardi General Hospital, Surakarta. at the Installation of Medical Records at the General Hospital DR. Moewardi Period February 2016 - February 2018.
 Results: According to the age group of 50 years, 162 patients (54%) and above who had a high risk and under 50 years group were 138 patients (46%). From the results of the study, breast cancer patients with grade 3 were found to be the most with 155 cases (51.67%). Hormonal receptor detection in breast cancer patients showed a high incidence of HER-2-negative patients as many as 172 patients (57.33%). The rest showed positive HER-2 results as many as 128 patients (42.67%). There was a high incidence of negative HER-2 as many as 172 patients (57.33%). The rest showed positive HER-2 results as many as 128 patients (42.67%). Positive HER-2 subtypes (ER-, PR-, HER2 +) were the most common cases, namely 128 cases (42.67%). The magnitude of the correlation (Phi and Cramer) produces the same number, while the contingency coefficient produces a smaller number.
 Conclusion: There is almost no relationship or there is a very weak relationship between age, immunohistochemistry, and variable rates of breast carcinoma, variable rates of breast carcinoma at the occurrence of metastases.

Profile of Breast Cancer Patients at Dr. Moewardi Surakarta Period March 2016 - March 2018

Introduction: Breast cancer is a heterogeneous disease caused by the interaction of genetic factors and environmental risk factors that lead to the accumulation of progressive genetic and epigenetic changes in breast cancer cells. The incidence of breast cancer in Indonesia is 11% of all cancer incidents. There are many factors that are thought to have an influence on the occurrence of breast cancer, including age, immunohistochemistry, and variable levels of first breast carcinoma at old age.
 Methods: A descriptive retrospective study by taking medical record data about breast cancer at the Dr. Moewardi General Hospital, Surakarta. at the Installation of Medical Records at the General Hospital DR. Moewardi Period February 2016 - February 2018.
 Results: According to the age group of 50 years, 162 patients (54%) and above who had a high risk and under 50 years group were 138 patients (46%). From the results of the study, breast cancer patients with grade 3 were found to be the most with 155 cases (51.67%). Hormonal receptor detection in breast cancer patients showed a high incidence of HER-2-negative patients as many as 172 patients (57.33%). The rest showed positive HER-2 results as many as 128 patients (42.67%). There was a high incidence of negative HER-2 as many as 172 patients (57.33%). The rest showed positive HER-2 results as many as 128 patients (42.67%). Positive HER-2 subtypes (ER-, PR-, HER2 +) were the most common cases, namely 128 cases (42.67%). The magnitude of the correlation (Phi and Cramer) produces the same number, while the contingency coefficient produces a smaller number.
 Conclusion: There is almost no relationship or there is a very weak relationship between age, immunohistochemistry, and variable rates of breast carcinoma, variable rates of breast carcinoma at the occurrence of metastases.

Association between Red Cell Distribution Width and Left Atrial Thrombus in Patients with Valvular Atrial Fibrillation

Background: Red cell distribution width (RDW) is a quantitative measure of variability in the size of circulating erythrocytes and previously shown to provide information concerning the prothrombotic status or adverse outcome of cardiovascular disease. Left atrial thrombus (LAT) is commonly detected in patients with valvular atrial fibrillation (VAF) due to rheumatic mitral valve stenosis (RMVS) but there is very limited data regarding the predictive value of RDW for the development of LAT in these patients.
 Aim: To determine the association between RDW and LAT in VAF patients.
 Methods: A total of 58 patients were included in a retrospective observational study between January 2016 to December 2016 in patients who admitted to Dr. Moewardi General Hospital, due to symptomatic VAF. Blood examination and transthoracic echocardiography were performed to all patients. LAT was defined as a fixed or mobile echogenic mass within left atrium (LA) and left atrial appendage (LAA). The RDW was compared between a patient with LAT or without LAT.
 Results: There were 28 patients (mean age: 46.2±13.3 years) in LAT(+) group and 30 patients (mean age: 45.6±11.5 years) in LAT(-) group. RDW was significantly higher in LAT(+) group (14.4±1.8% vs. 13.3±1.5%, p=0.010). The RDW was independent predictor of LAT by multivariate analysis (OR 1.619; p=0.020; 95% CI: 1.079-2.429). The cut-off RDW value for LAT was >13.5% with a sensitivity of 73.3% and a specificity of 64.3% (area under curve=0.700; 95% CI: 0.562-0.838; p=0.009). The prevalence of LAT was significantly higher in patient with an RDW >13.5% than in those with an RDW <13.5 % (64.3% and 35.7%, p=0.002), with prevalence ratio 5.91.
 Conclusion: This study shows that a higher level of RDW has an association with the presence of LAT and an independent risk factor of LAT formation in patients with VAF.

The effect of Mmoringaoleifera leaf extract on mean platelet volume and neutrophil to lymphocyte ratio in lupus

Introduction: No definitive treatment is available for Lupus. Moringaoleiferais one of promisingnovel treatments in Lupus trough anti inflammation and immunosupresion. Mean platelet volume andneutrophil to lymphocyte ratio used to measure degree of lupus activities.
 Objective: Our study wasaimed to identify the effect of Moringaoleiferaextract on the Mean platelet volume and neutrophil to lymphocyte ratio in lupus.
 Methods: This experimental study was conducted in 30 lupus patients,located in the rheumatology clinic at Moewardi General Hospital in January-March 2019. The studygroup was divided into two groups: the treatment research group received 2 grams of moringa extractper day and the placebo group. The study was conducted for 4 weeks and was evaluated when thestudy was completed. MPV and NLR examination using a hemocytometer. Statistical analysis wasperformed using paired T test, independent T-test. The p value was considered significant when the p < 0.05.
 Results: The results showed a decrease in MPV (delta MPV = 4.141; r 0.656; p-0.02) anda decrease in Neurophil to lymfocyte ratio (delta NLR = 4.1391; r 0.489; p-0.04)
 Conclusion: Thestudy demonstrated the effect of Moringaoleiferaleaf extract on reduced Mean platelet volume andneutrophil to lymphocyte ratio in lupus
 Bangladesh Journal of Medical Science Vol.20(1) 2021 p.68-73

Massive Adherent Placenta, Placenta Percreta

Background: Adherent placentas including placenta accreta, increta and percreta are conditions where there is abnormal implantation of all or part of the placenta on the myometrial wall. Massive adherent placenta has high morbidity and mortality rates in both mother and fetus. There is a positive correlation between the incidence of adherent placenta and the increase in cesarean section rates worldwide. Identification of risk factors, antenatal diagnosis, accurate preoperative preparation, multidisciplinary management, and appropriate counseling are the main management of adherent placenta to reduce maternal morbidity. Case Presentation: A woman, G5P3A1, age 36 years pregnant 37 weeks, complained loudly regularly since 6 hours before admission to hospital. There is a history of CS as much as 3x with indications of 2x Premature rupture of the membranes and uterine rupture, as well as a history of curettage (1x). Physical examination showed that the general condition was good, and composting, vital signs were within normal limits. Abdomen palpable single fetus, intrauterine, elongated, head presentation, left back, moderate his (+), FHR 150 x/minute. The results of prenatal sonography examination showed that neither placenta previa nor massive adherent placenta was found. The preoperative diagnosis was inparticular stage I latent phase with a history of SC 3 times. Results: An emergency Caesarean section was performed. Durante surgery showed severe adhesions of the placenta, uterine wall and bladder. The diagnosis of placenta percreta was confirmed, uterine resection was performed on the perreta section, hysterography as well as adhesiolysis and MOW sterilization. The results of the PA examination support the diagnosis of placenta percreta. Conclusion: Massive adherent placenta, placenta percreta was not diagnosed in this case because there were no clinical features or prenatal sonography that supported the diagnosis of placenta percreta. A history of trauma to the uterus due to uterine rupture, history of CS and curettage were risk factors for placenta percreta in this case. The incidence rate of placenta percreta with a history of SC 3 times without placenta previa on the previous sonographic examination was 0.1%. Operative management to manage bleeding and post operative care have been carried out according to the procedure so as to avoid mortality. Keywords: massive adherent placenta, placenta percreta, case report Correspondence: Eric Edwin Yuliantara. Department Obstetrics and Gynecology, Faculty of Medicine Universitas Sebelas Maret/ dr. Moewardi General Hospital Surakarta. Jl Kolonel Sutarto 132, Surakarta, Central Java. Email: edwinericog- @staff.uns.ac.id. Mobile: 08122618769.

Quality of Life in Children with Nephrotic Syndrome at Dr. Moewardi Hospital

Background: Children with chronic disease often have poor quality of life. Nephrotic syn­drome was one of the most common kidney diseases in children with a high number of relapses. Therefore, treatment for nephrotic syndrome might take a long time. Compli­ca­tions from the disease and medications might affect the quality of life of the patient. Subjects and methods: This was a cross sectional, descriptive analytic study. Children aged 5-18 years old who visited the nephrologic outpatient department of Dr Moewardi general hospital from july to September 2020 and fullfilled the inclusion criteria were included in the study. Quality of life was assessed using PedsQL TM 4.0 generic module.The analysis of this research was done by using chi-square and logistic regression. Results: A total of 27 children aged from 5-18 years old participated in this study. Decrease quality of life was reported in 22% based on report from parents. From parent’s report, gender (OR= 0.06; CI95%= 0.01 to 0.66; p= 0.008) was associated with decrease of quality of life in children with nephrotic syndrome. Most of the children had decreased quality of life in the psychososial domain according to parent’s report (OR= 4.70; 95% CI= 1.12 to 19.70; p= 0.026). Conclusion: 22% children with nephritic syn­drome have decreased quality of life. Gender was the risk factors that might contri­bute to the decreased quality of life of children with nephrotic syndrome. Keywords: quality of life, children, nephrotic syndrome Correspondence: Andrew Andy Putra Kartawijaya. Department of Pediatrics, Faculty of Medicine, Universitas Sebelas Maret/ Dr. Moewardi Hospital, Sura­karta. Jl. Kolonel Sutarto 132, Surakarta, Indo­nesia. Mobile: 081314749487. email: ciploe_17­@yahoo.co.uk. Journal of Maternal and Child Health (2021), 06(03): 334-352 https://doi.org/10.26911/thejmch.2021.06.03.09

Gender Differences in Sociademographic Characteristics and Risk Factors Among Condyloma Acuminata Patients in DR. Moewardi General Hospital Surakarta

Condyloma acuminata (CA) known as anogenital wart is the most frequent sexually transmitted infection worldwide. This highly infectious disease is caused by the human papilloma virus, whose its high reccurence rates contribute to direct medical costs, productivity loss and increased psychosocial impact. Thus, the prevention of this viral disease is more important than focusing on its treatment. This cross sectional retrospective study assesed the gender differences in sociodemographic characteristics and sexual risk factors of CA patients. There were 94 newly diagnosed CA patients, 47 males (50%) and 47 females (50%) during the period of January 2013- December 2017. The demographic data were taken from medical record and the additional data about the risk factors were from the questionnaires. Chi-square test was performed to compare between genders and p < 0.05 was considered statistically significant. There was significant difference between genders on all sociodemographic characteristics (age, occupation, education, marrital status) and risk factors (HIV/AIDS infection, condom using, age at the first sexual intercourse, number of lifetime sexual partner, type of intercourse) among CA patients. Our study revealed that male CA patients were mostly single, employed and multipartner, while CA female patients were mostly married, housewives and singlepartners.

The Thyroid Stimulating Hormone and Free Thyroxine Levels in Correlation with Serum Bilirubin in Neonatal Jaundice

Congenital hypothyroidism is known to cause prolonged hyperbilirubinemia in neonates. It also correlates with delayedmaturation of the activity of the uridine diphosphate glucoronosyltransferase (UDPG-T) enzyme. Thus, this study wasperformed to analyze the correlation of TSH and FT4 levels with serum bilirubin in neonatal jaundice. This observationalanalytical study with a cross-sectional approach was conducted on 64 neonatal patients with jaundice in Dr. MoewardiGeneral Hospital, Surakarta during September-November 2019. The data comparison and correlation were analyzed withMann-Whitney and the Spearman test. A p-value of < 0.05 was considered significant with 95% Confidence Interval (CI). Thestudy variables comprised of total bilirubin of 12.7 (6.28-23.5) mg/dL, direct bilirubin of 0.8 (0.30-6.61) mg/dL, indirectbilirubin of 11.87 (3.16-22.94) mg/dL, TSH of 4.4 (0.40-23.06) uIU/L, and FT4 of 22.85±7.4 pmol/L. The TSH and FT4 weremoderately correlated with total bilirubin r=-0.444; p=0.001 and r= -0.467; p=0.001), with indirect bilirubin (r= -0.3362;p=0.03 and r=-0.411; p=0.001) and with direct bilirubin (r= -0.257; p=0.040 and r=0.232; p=0.065), respectively. A moderatecorrelation of TSH and FT4 with total and indirect bilirubin, as well as a weak correlation between TSH and direct bilirubinwere found, while no correlation was found between FT4 and with direct bilirubin. Thyroid function screening isrecommended in neonates with jaundice, due to the importance of thyroid hormones in the function and formation oforgans

The Association of Syphilis Infection and Other Risk Factors with Immunity of Patients with HIV on Anti-Retroviral Therapy

Syphilis infection, age, gender, sexual behaviour, length of HIV infection and length of ARV treatment are suspected to be associated with amount of cluster of differentiation 4 (CD4+)T-cells (CD4+ T-cell) and CD4+ T-cells: CD8+ T-cells ratio (CD4:CD8) of HIV patients on ARV. However, the evidence remains lacking. The aim of this cross-sectional study on April 24th to June 20th, 2019 was to determine the association of syphilis infection and other risk factors (age, gender, sexual behavior, length of HIV infection and ARV treatment) with the immunity of patients with HIV on ARV based on T CD4+ and CD4:CD8, and got factors those have an influence to T CD4+ and CD4:CD8. Seventy-four subjects with age ≥18 years old with HIV on ARV from Voluntary Counselling Test (VCT) Outpatients of Dr. Moewardi General Hospital in Surakarta (DMGHS) had been examined for syphilis, T CD4+ count and CD4:CD8 in Clinical Pathology Laboratory of DMGHS. Other data had been completed from the anamnesis and VCT data system. All data had been processed with SPSS version 21. Multivariate logistic regression following bivariate analysis of the Chi-Square test was used for categorical variables. Bivariate analysis showed a significant association between age, length of HIV infection and length of ARV treatment to T CD4+ count and significant association between sexual behavior, length of HIV infection, and length of ARV treatment to CD4:CD8 (p<0.05). Multivariate analysis showed that the prevalence of CD4≤500 was higher in male Prevalence Ratio (PR)=3.256; p=0.038) than that of female and subjects aged >42 y.o. compared to those aged >18-42 y.o. (PR=3.451; p=0.047). The PR of CD4:CD8<0.3 in anal sex (PR=3.575; p=0.049) was higher than that of vaginal sex. The PR of CD4≤500 (PR=0.271; p=0.020) and CD4:CD8<0.3 (PR=0.125; p=0.001) in subjects with length of HIV >5 years were lower than those in HIV 0-5 years. Age, gender, and length of HIV potentially affect the probability of T CD4+≤500. Sexual behavior and length of HIV potentially affect the probability of CD4:CD8<0.3. Both CD4 and CD4:CD8 ratio must be tested at baseline and follow-up.

The Association of Parathyroid Hormone Related Protein and Vitamin D Level with Serum Calcium Ion in Acute Leukemia Patients

Acute leukemia is bone marrow clonal cell malignancy. One of its complications is hypercalcemia. Parathyroid Hormone-Related Protein (PTHrP) activities involve the regulation of Calcium (Ca) metabolism. Vitamin D is a steroid involved in Ca homeostasis and bone mineralization. This study aimed to analyze PTHrP and vitamin D levels with serum calcium ion in acute leukemia. A cross-sectional study was performed in Clinical Pathology Dr. Moewardi General Hospital Surakarta between July and August 2019, consisting of 41 subjects with new acute leukemia who were diagnosed based on bone marrow puncture and or immunophenotyping result. The cut-off value of Ca ion serum and PTHrP level were determined with a Receiver Operating Curve (ROC). The data were analyzed with a 2x2 table, followed by multivariate logistic regression analysis, and p<0.05 was considered significant. Statistical analysis showed the median age of 25 (2-68) years, 23 (56.10%) ALL, and 18 (43.90%) non-ALL patients. The median of Ca ion and PTHrP were 1.08 (0.84-1.21) mmol/l and 307.52 (20.77-1104.26) pg/mL, respectively. The mean level of vitamin D was 26.45±11.40 ng/mL. Bivariate analysis showed that PTHrP levels ≥ 110.09 pg/mL and vitamin D ≥ 20 ng/mL were related to serum Ca ion ≥ 1.07 mmol/l (PR 4.675; 95% CI: 1.211-18.041; p=0.021 and PR 5.143; 95% CI: 1.279-20.677; p=0.017). Multivariate analysis showed that PTHrP ≥ 110.09 pg/mL and vitamin D ≥ 20 ng/mL were associated with serum Ca ion ≥1.07 mmol/l. There was a significant association between PTHrP, vitamin D level, and serum Ca ion in acute leukemia patients.

A Cohort Study: Caspase-3 As Prognostic Factor of Radiation Therapy in The Advanced Stage of Cervical Cancer (IIB-IIIB) Patients

Background: The treatment of the advanced stage of cervical cancer (stage IIB, IIIB) using internal (brachitherapy) and external radiation therapy raises question in how to determine the prognosis of the disease. The role of caspase 3 in predicting radiation response in the advanced stage of the cervical cancer (stage IIB-IIIB) is still unknown. This study aim to analyze the role of Caspase-3 expression as a prognostic factor of radiotherapy in patients with the advanced stage cervical cancer.Methods: This study is an analytical cohort prospective study from June 2019 to February 2020 in the Department of Obstetrics and Gynecology in association with the Department of Anatomic Pathology of Dr. Moewardi General Hospital, Surakarta, Indonesia involving 40 patients diagnosed with cervical cancer. The staging of cervical cancer was determined using the FIGO 2019 staging system. The Caspase-3 expression level were determined using immunohistochemical examination. The association between the caspase 3 expression and changes of tumor volume is analyzed using chi square and fisher exact test for parametric and non-parametric test, respectively. A p-value of less than 0.05 is considered to be statistically significant.Results: The analysis shows that there is a significant association between the Caspase -3 expression and the changes of tumor volume (p = 0.04). The odds of the changes of tumor volume in the score 3 of the caspase -3 expression is 22.67 times higher than the score 2 of the caspase-3 expression (95%CI, 1.56 - 328.95, p=0.04).Conclusion: Caspase-3 expression has a significant association with the changes in the tumor volume of the advanced stage cervical cancer.

Perendoscopic Placement of Palliative Stent for Obstructive Jaundice Caused by Head of Pancreas Malignancy in Dr Moewardi General Hospital-Surakarta

Pancreatic cancer is difficult to diagnose in early stage. Malignant bile duct obstruction is a severe complication of pancreatic cancer, which can lead to poor outcomes including cholangitis, delayed treatment, reduced quality of life, and increased mortality. Perendoscopic placement of stents is a method widely used in the management of various malignant and benign pancreatico-biliary abnormalities. A 70-year-old woman came to Dr Moewardi General Hospital in Surakarta with the chief complaint of yellowish skin and eyes since one month before hospital admission. Patient was diagnosed with obstructive jaundice due to suspected of advanced stage pancreatic cancer. Subsequently, patient underwent endoscopic retrograde cholangiopancreatography (ERCP) which revealed an intrahepatic and extrahepatic bile ducts dilatation due to pancreatic tumor which infiltrated common bile duct, thus self expandable metallic stent (SEMS) placement was performed. Furthermore, patients received palliative therapy due to inadequate chemotherapy requirement.

Pengaruh Psikokuratif terhadap Kadar VEGF-c, Kortisol dan Skor HADS Pasien Kanker Serviks Stadium Lanjut

Background: Cancer diagnosis and therapy that causes chronic stress, its progression to depression increase cortisol and VEGF-c levels in advanced cervical cancer patientsObjective: To know the VEGF-c, cortisol and HADS level in advanced stage cervical cancer patients who get Psychocurative intervention Method : An experimental study of pretest – posttest controle group design in outpatient oncology clinic and ward of Doctor Moewardi General Hospital. Thirty subjects with advanced cervical cancer were randomly divided into 15 patients in the intervention group, and 15 in control. Psycho-curative intervention 4 times a month, 1 time a week, 60 minutes duration. Before and after intervention, each subject of the two groups was examined levels of VEGF-c, cortisol and HADS scores. Data obtained were analyzed by independent t test, Mann Whitney, Pair t and Wilcoxon with the 19th version of SPSS for Windows.Result and Discussion: Average VEGF-c levels before intervention 9006.53 ± 2181.49, after intervention 5631.20 ± 2071.55, p <0.001. The mean cortisol level before intervention was 12.29 ± 4.36, after intervention 6.71 ± 3.88, p <0.001. The mean HADS Anxiety score before intervention was 14.13 ± 3.02, after intervention 8.47 ± 3.07, p <0.001. Mean Depression HADS scores before intervention 13.80 ± 3.21, after intervention 7.20 ± 2.70, p <0.001.Conclusion : VEGF-c levels, cortisol, HADS anxiety scores and depression in patients with advanced cervical cancer decline after psychocurative intervention. Keywords : Psychocurative; VEGF-c; Cortisol; HADS; Cervical cancer

A cross-sectional study: The correlation of pro-angiogenic factors expression level and epithelial ovarian cancer staging

Background: Cancer is caused by uncontrolled cell growth and angiogenesis as a vital component in tumor growth and metastasis. Angiogenesis provides nutrients needed by cancer cells in order to grow. Angiogenesis is triggered by pro-angiogenic mediators and overexpression of these mediators have been associated with malignant phenotype of ovarian cancer. It is thought that the more advanced tumors have higher tumor cell survival, proliferation, invasion, and angiogenesis, so that it will show higher expression of pro-angiogenesis mediators.Objective: To examine the differences in nerve growth factor (NGF), tyrosin kinase receptor A (TrkA), and vascular endothelial growth factor (VEGF) expression level in different stages of epithelial ovarian cancer.Patients and methods: This is a retrospective cross-sectional study conducted from June to August 2019 in the Department of Obstetrics and Gynecology in association with the Department of Anatomic Pathology of Dr. Moewardi General Hospital, Surakarta, Indonesia. The staging of the epithelial ovarian cancer was determined using the FIGO 2014 staging system. NGF, TrkA, and VEGF expression level were determined using immunohistochemical examination.Results:The samples were 53 formalin-fixed, paraffin-embedded ovary, its adnexa, uterus, and lymph nodes tissue blocks of epithelial ovarian cancer patients. There are statistically significant differences in the proportion of NGF, TrkA, and VEGF level of expression in different stages of epithelial ovarian cancer (p<0.05).Conclusion: There are statistically significant differences in NGF, TrkA, and VEGF level of expression in different stages of epithelial ovarian cancer.

Anogenital Warts Prevalence and Associated Risk Factors among MSM Population in Surakarta, Indonesia

To know anogenital warts prevalence and its correlation with HIV infection in men who have sex with men (MSM) population in Surakarta, Indonesia. To identify risk factors associated with anogenital warts among MSM population in Surakarta, Indonesia.
 This cross-sectional study collects data from MSM population in Surakarta, Indonesia. Patients are MSM who joined monthly mobile clinic held by the health government of Surakarta and those who attend the Voluntary Consultation and Testing Clinic of Dr. Moewardi General Hospital. Risk factors were asked using questionnaire. Physical examination was used to diagnose anogenital warts, and took blood samples for HIV screening.
 From 190 subjects, 25 (13.1%) had anogenital warts, and 17 (8.9%) are HIV positive. Anogenital warts increase the odds of having HIV infection by 5.18 times. Risk factors that contribute to anogenital warts include age 25-34 years old (OR= 3,729) and a history of drug abuse (OR= 7.184).
 This research only uses simple physical examination to diagnose anogenital warts, and the small study subjects may not be representative of general MSM population in Indonesia.
 Age 25-34 years old and history of drug abuse are substantial risk factors for anogenital warts. Having anogenital warts infection increases the odds of acquiring HIV. This study highlights the importance of STD screening especially in high-risk population such as MSM, which currently is still neglected by the Health Department of Indonesia.

Relationship between Anxiety Score and Erythrocyte Sedimentation Rate (ESR) in Hemodialysis Patient

Background: Anxiety in hemodialysis pati­ents often impaired quality of life. Complex interaction between Chronic Kidney Disease (CKD) and anxiety are dynamic and multifac­torial, including socio-economic, lifestyle and biological factors. Biological factors are close­ly related to anxiety in CKD including the im­mune system, inflammatory pathways of dis­orders of Hypothalamic-Pituitary-Adrenal Axis (HPA). Erythrocyte sedimentation rate (ESR) is one of the non-specific inflammatory marker that show the degree of inflammatory reaction, Neutrophil-Lymphocyte Ratio (NLR) and Platelet-Lymphocyte Ratio (PLR) also found as an easy and inexpensive mea­sureable marker to show the degree of inflam­mation. This study aimed to examine rela­ti­onship between anxiety and hematology in­flammation markers in hemodialysis patient. Subjects and Method : This was an obser­vational study with a cross-sectional design. The study was conducted at Dr. Moewardi general hospital, Surakarta, Central Java. A sample of 30 hemodialysis patients was selec­ted for this study. The dependent variables were ESR, NLR, and PLR. The independent variable was anxiety. Anxiety was measured by Taylor Manifest Anxiety Scale (TMAS). Data on ESR, NLR, and PLR, were measured using an assessment from RAND Corpora­tion. The data were analyzed by a multiple linear regression. Results: Anxiety increased NLR and it was marginally significant (b= 0.37; 95% CI= -0.01 to 0.22; p= 0.080). Anxiety decreased ESR and it was statistically significant (b= -0.57; 95% CI= -0.02 to 0.01; p<0.001). An­xiety decreased PLR (b= -0.16; 95% CI= -0.02 to 0.01; p= 0.440) and duration of hemo­dia­lysis (b= -0.27; 95% CI= -0.03 to 0.01; p= 0.167), but they were statistically non-signi­ficant. Conclusion: Anxiety increases NLR. Anxi­ety decreases ESR, PLR, and duration of hemo­dialysis. Keyword s : chronic kidney disease, hemo­dialysis, hematology markers, inflammation Correspondence: Rohmaningtyas Hidayah Setyaningrum. De­partment of Psychiatry, Faculty of Medicine, Universitas Sebelas Maret/ Dr. Moewardi General Hospital, Surakarta, Central Java. Email: astitdr@gmail.com Indonesian Journal of Medicine (2020), 05(02): 109-115 https://doi.org/10.¬26911/theijmed.2020.05.02.03

Age-Related Sensory Impairment and Cognitive Decline in Geriatric

Background: Incidence of sensory impair­ment and cognitive decline were increase with aging, each would give a considerable impact on public health and quality of life especially in geriatric population. Several mechanisms have been proposed to account for the correlation between sensory impairment and cognitive decline and the common mechanisms were sensory deprivation, information degradation, cognitive load, resource allocation and or social isolation. Prolonged reductions in the quality or quantity of sensory input lead to cognitive deterioration due to neuronal atrophy. This study aimed to determine whether age related sensory impairment with cognitive decline. Subjects and Method : This was a cross-sectional study design conducted at geriatric clinic, Dr. Moewardi General Hospital, Sura­karta, from May 31 to July 1, 2018. A sample of 54 elderly aged ≥60 years old was selected by consecutive sampling. The dependent variable was cognitive decline. The independent varia­bles were presbyacusis, presbyastasis, olfactory impairment, diabetes, and hypertension. Pres­bycusis was measured by Pure Tone Audio­metry. Presbyastasis was measured by Dynamic Visual Acuity (DVA) test. Olfactory dysfunction was measured by sniffing test. Cognitive decline was assessed by MoCA-Ina questionnaire. The data were analyzed by Chi-square test. Results: The mean age of subjects was 70.5 years old ranging from 61-81 years old and most of the subjects were females (72.2%). Pure tone audiometry test revealed that 44.4% pati­ents had presbycusis. Dynamic Visual Acuity test showed that 25.9% patients had pres­byas­tasis. Sniffing test revealed that 29.6% patients had olfactory dysfunction. Presbyacusis (OR= 11.9; 95% CI= 1.3 to 105.5; p= 0.008) and olfac­tory dysfunction (OR= 10.8; 95% CI= 1.8 to 61.9; p= 0.002) increased cognitive decline, and they were statistically significant. Presbyas­tasis decreased cognitive decline (or= 0.9; 95% CI= 0.1 to 5.3; p= 0.948), but it was statis­tically non-significant Conclusion: Sensorineural health may serve as a marker of brain aging therefore sensory measures can be used as screening tools for cognitive decline risk. Keyword s : sensory impairment, presbycusis, presbyastasis, olfactory dysfunction, cognitive decline Correspondence: Dewi Pratiwi. Department of Otorhinolaryngo­logy Head and Neck Surgery, Dr. Moewardi Hospital/ Faculty of Medicine, Universitas Sebelas Maret Surakarta, Central Java. Email: pratiwi­dewi81@gmail.com Indonesian Journal of Medicine (2020), 05(02): 153-161 https://doi.org/10.26911/theijmed.2020.05.02.10

Effect of L- Arginin on Placental Hipoxia Inducible Factor -1-Alpha (HIF-1-A) Expression at Preeclampsia Mice Models

Background: Placental hypoxia is one of the theories that cause preeclampsia. In placental hypoxia of preeclampsia, there is an increase of Hipoxia Inducible Factor 1 Alpha (HIF-1-A) expression as a response to hypoxia. L-Arginine administration through the L-Arginine-Nitric Oxide pathway is expected to improve placental hypoxia. This study aimed to examine the effect of L- Arginin on placental HIF-1-A expression at preeclampsia mice models. Subjects and Method: Experimental study with parallel group post-test only design. The study was carried out at the Veterinary Medicine Faculty of Airlangga University. Thirty six preeclampsia mice models were made with intravenous injection 10ng anti-Qa-2 on day 1-4 of pregnancy. They were divided into 2 groups: (1)18 mice without treatment (control) and (2) 18 mice were given L-Arginin 200 mg/kgBW/day on day 7-15 of pregnancy. They were terminated on day 16 then immunohistochemistry examination of HIF-1-A expression was done on the placental samples. The dependent variable was placental Hipoxia Inducible Factor-1-Alpha (HIF-1-A) expression. The independent variables were L-Arginin administration. HIF-1-A expression was measured by H-Score method. The data were analyzed by t-test. Results: The mean of placental HIF-1-A expressions of treatment group was lower (Mean= 7.98; SD=9.35) than control group (Mean=41.95; SD= 32.20), and it was statistically significant (p <0.001). Conclusion: L-Arginin reduces the Placental Hypoxia Inducible Factor Alpha (HIF-1-A) expression on preeclampsia mice model. Keywords: L-Arginine, HIF-1-A, Preeclampsia Correspondence: Nutria Widya Purna Anggraini. Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Sebelas Maret/ Dr. Moewardi General Hospital Surakarta. Jl Kolonel Sutarto 132, Surakarta, Central Java, Indonesia. Email: nutria_dr@staff.uns.ac.id. Mobile: 08122651819. Indonesian Journal of Medicine (2020), 05(03): 191-199 https://doi.org/10.26911/theijmed.2020.05.03.03