Indonesian Journal of Obstetrics and Gynecology (INAJOG)
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Human Papillomavirus Genotypes and its Prevalence in Normal Population: Genotip Human Papillomavirus dan Prevalensinya pada Populasi Normal
Get PDFObjective: Over 200 types of human papillomavirus (HPV) have been recognized on the basis of DNA sequence. Multiple infection is more prone to be persistent than single infection. The purpose of this study is to assess the variation of HPV types and their prevalence among negative VIA as normal population in Indonesian women.
Method: We processed cervical swabs from 1,214 patients with negative VIA. HPV DNA and its genotypes were detected using PCR based INNO-Lipa HPV DNA test. We also classified whether each infection is single or multiple.
Result: From 1,214 women with negative VIA, 39 (3.21%) samples were positive for HPV DNA. Among them, we detected 19 types of HPV, consisting of 13 types of high-risk HPV, 5 types of low-risk HPV, and 1 type of unknown HPV (type X). The most prevalent type was HPV type 52 (18.31%), followed by type 39 and X with the same proportion (9.86%), and HPV type 16, 18, and 74 (each 8.45%). Of the total 39 HPV-positive samples, 17 (43.6%) showed multiple-type infection and 22 (56.4%) showed single-type infection. The majority of single infection involves high-risk-HPV. The remaining were type 6, 44, 18, 51 and 66, with each single-type infection showing a prevalence of 4.54%. Conclusion: Our study shows that single HPV infection among the negative VIA population are dominated by high-risk type HPV (types 52, 39, 16, and 18). Single infection was more often encountered than multiple infection.
Keywords: HPV DNA, HPV genotypes, multiple infection, negative VIA, single infectio
Progressive Ovarian Cancer with Trocar Site Metastases Resulted from Inadequate Laparoscopy
Get PDFObjective: Discuss the complications of laparoscopic ovarian cystic neoplasms.
Method: Case report A-52 year old female with 2 parities, complained of a lump at anterior abdominal wall during chemothe rapy for clear cell ovarian adenocarcinoma after total hysterectomy and bilateral salphingooophorec tomy by lapa roscopy. The indication was suspected ovarian cancer from solid parts found during ultrasound and CA125 level 169. During previous laparoscopy, the cyst was ruptured, left in abdominal cavity with high C02 pressur e for five hour s and retrieved without a bag.The frozen section examination of the cyst wallwere diagnosed as endometriosis.The physician assured her that the lump was only scar and did not need further evaluation. CA125 level was 557 IV after chemotherapy. PET scan confirmed a 2 ern-diameter mass superior to periton eum and multiple implants intra abdominally.
Result: Adebulking laparotomy was done. Omental cake was found with one part adhered to the right previous trocar insertion site. It was connected to tumor implant size 3x4 em until fat tissue of abdomen wall.Another implant was also found at left para colical area .
Conclusion: Laparoscopy offers advantages such as less bleeding, better visualisation, and enhanced recovery. Some controversies exist in cases with suspicion of malignancy. Pneumoperitoneum might cause seeding of tumor cells. This could be prev ented by using low pressure, avoidance of exsuflation of gas through tro car opening, or by using bags to retrieve operative specimens. Preoperative evaluation of clinical findings, ultra sound, and tumor markers are important to prevent improper surgical management.
Keywords: complication, laparoscopy, metasta ses, ovarian cancer, trocar site
Risk of Malignancy Index is not accurate as a Triage Tool for Ovarian Cancer
Get PDFObjective: To evaluate Risk of Malignancy Index (RMI) as a triage tool for ovarian cancer in Dr. Cipto Mangunkusumo Hospital.
Method: This is a retrospective study conducted from January 2008-December 2012 in patients diagnosed with ovarian mass. Patients admitted for surgery due to ovarian masses were included to this study. RMI 3 score was calculated based on ultrasonography examination in Dr. Cipto Mangunkusumo Hospital, CA-125 test and menopausal status. Patients without final pathological report and incomplete data were excluded from study. Data were analysed using SPSS 20 to evaluate RMI result and final pathlogical report in benign and malignant case.
Result: From 882 patients identified with ovarian masses from cancer registry, only 99 patients aged 17-70 y.o were included in this study. Most of the patients were nully-parity (28.3%), non-menopausal women (60.6%), normal body mass index (40.4%), and with stage IIIC ovarian cancer (33.3%). Ultrasonography examination showed that most of patients had solid mass and ascites (19.2%). Meanwhile, CA-125 showed that patients with <35 U/ml were 10.1% and ≥ 35 U/ml were 89.9%. Patients with RMI scores <200 (benign cases) were 19 cases (19.2%) and ≥ 200 (malignant cases) were 80 cases (80.8%). Meanwhile, patients with benign final pathological report were 23 cases (23.2%) and malignant cases were 76 cases (76.8%). There was no statistical difference in RMI between benign and malignant cases based on final pathological report.
Conclusion: Our study showed that RMI was not accurate as triage tool for ovarian cancer in our hospital. Further investigation and more patients are needed to confirm this study.
Keywords: CA-125, menopausal status, ovarian cancer, risk of malignancy index (RMI), ultrasonography
Changes of Body Mass Index and Lipid Profile in Injectable Depot Medroxyprogesterone Acetate and Levonorgestrel Implant Acceptors: Perubahan Indeks Massa Tubuh dan Profil Lipid pada Akseptor KB Suntik Depot Medroksi Progesteron Asetat dan Implan Levonorgestrel
Get PDFObjective: To determine the comparison of body mass index (BMI) among acceptors of injectable depot medroxyprogesterone acetate (DMPA) with levonorgestrel implant acceptors for 1 year and comparison of lipid profiles between depot medroxyprogesterone acetate acceptors with levonorgestrel implants for 1 year.
Method: This study was conducted at dr. Wahidin Sudirohusodo hospital, Makassar and its satellite hospitals as well as family planning social service cooperation between the National Family Planning Coordinating Board with the Department of Obstetrics and Gynecology Hasanuddin University.
Result: The results showed the increase in BMI of levonorgestrel implant acceptors (1.25 kg/m2) was greater than DMPA acceptors (0.74 kg/m2). HDL cholesterol and triglycerides did not change significantly in either groups. LDL cholesterol was increased in DMPA acceptors (9.63 mg/dl) and decreased in implant acceptors (1.62 mg/dl). Total cholesterol increased in DMPA acceptors at 8.67 mg/dl) while in the levonorgestrel implant acceptors it was decreased by 5.37 mg/dl. Conclusion: Weight gain occured among acceptors of DMPA and implant however the weight gain is more profound among the implant acceptors.
Keywords: body mass index, DMPA, levonorgestrel implant, lipid profil
Prevalence of High-Risk Human Papillomavirus (HPV) among Negative Visual Inspection of Acetic Acid (VIA): Prevalensi Human Papillomavirus (HPV) Risiko Tinggi pada Hasil Inspeksi Visual dengan Asam Asetat (IVA) yang Negatif
Get PDFObjective: Persistence of high-risk HPV infection is known to be the major cause of cervical cancer. It is important to differentiate the genotype of HPV infection, whether it is high, intermediate or low risk. The aim of this study was to assess the prevalence of high-risk HPV types among Indonesian women with negative VIA.
Method: We analyzed cervical swabs from 1,214 patients with negative VIA. By using INNO-Lipa HPV DNA test, we detected the HPV DNA and its genotype.
Result: From the 1,214 women with negative VIA, 48 (3.95%) samples were confirmed to have positive HPV DNA by using PCR and electrophoresis. However, hybridization test were not able to detect HPV genotypes in 9 samples. These 9 samples were tested again with PCR and electrophoresis and resulted in negative HPV DNA. Among the remaining 39 samples (3.21%), we detected 19 types of HPV, consisting of 13 types of high-risk HPV, 5 types of low-risk HPV, and 1 type of unknown HPV (type X).
Conclusion: Among patients with negative VIA, 3.21% was found to be positive for HPV DNA. From this percentage, the prevalence of high-risk HPV is higher than the low-risk and unknown HPV. Therefore we cannot ignore results of negative VIA, particularly in highrisk group, because there is a slight possibility that presence of HPV can be identified, especially the high risk ones which have a tendency to be persistent. We support the importance of HPV DNA test as cervical cancer screening method.
Keywords: cervical cancer, high-risk HPV, negative VI
Low Level of CD4 Increases Risk of Cervical Intraepithelial Neoplasia in HIV-Infected Women: Kadar CD4 yang Rendah Meningkatkan Risiko Neoplasia Intraepitelial Serviks pada Perempuan yang Terinfeksi HIV
No full textObjective: To study the risk of Cervical Intraepithelial Neoplasia (CIN) at higher CD4 levels compared to low CD4 levels in HIV-infected women.
Method: Case-control study of 50 HIV-infected women who meet the inclusion and exclusion criteria and attended Kerti Praja Foundation outpatient clinic, Denpasar, who were then divided into 2 groups, those with CD4 500/mm3 and those with CD4 <500/mm3. Both groups had Pap smear examination done. The collected data was analyzed with Chi-Square test. Odds ratio was calculated to determine the influence of CD4 levels on the incidence of CIN in women infected with HIV.
Result: In this study, three women were found to have CIN out of the 25 women with CD4 500/mm3 and nine women out of the 25 women with CD4 <500/mm3 were positive for CIN. The risk of CIN in HIV-infected women with low CD4 levels was 4.125 times higher than the risk in high levels of CD4 (95% CI = 1.96 - 17.7, p=0.047).
Conclusion: The incidence of CIN in HIV-infected women is associated with the level of immunity, as characterized by levels of CD4. Decreased levels of CD4 in HIV-infected women may increase the risk for CIN incidence by four-fold.
Keywords: CD4, cervical intraepithelial neoplasia, HI
Diagnostic Approach of Abnormal Uterine Bleeding
Get PDFObjective: To introduce and apply PALM-COEIN classification system as standard diagnostic approach of AUB to investigate the etiology.
Method: Three cases willbe discussed. First, Mrs, 45 yo, P3with AUB due to suspected adenomiosis, perform ed total hystere ctomy with histopathology result leiomyoma. Second case. Mrs, 43 yo, P3 with AUB due to suspected adenomiosis, performed total hysterectomy with histop athology result adenomyoma. Third case, Mrs, 48 yo, P3 with AUB due to suspected adenomiosis, perform ed tot al hyst erectomy and bilateral salpingoophorectomy with PA result adenomyosis.
Result: AUB diagnostic approach with PALM-COEIN performed to look for etiology and prevent mistake of etiology ofAUB, such as cancer that must be consider on AUB patient above 40 years old.
Conclusion: This PALM-COEIN classification should become stan dard diagnostic appro ach to investigate the etiology.
Keywords: abnormal uterine bleeding
Complication on Teenage Pregnancy and Related Factors
Get PDFObjective: To evaluate related factors, which contribute to complication of teenage pregnancy. Method: A cross-sectional research by consecutive sampling method was held upon teenager who was having her first pregnancy or had just been having her first child. This research took place at dr. Zainoel Abidin Public Hospital, Banda Aceh, in period of June until November 2012.
Result: By demographic characteristic, we obtained that the majority of complication of teenage pregnancy occur in the age range of 17-19 years old and most are within Sex maturation Rate grade 5. The most common complications are caesarean section, premature rupture of membranes and cephalo-pelvic disproportion. There is a significant relation between antenatal visit conducted in accordance with WHO criteria and economic level with the incidence of complication.
Conclusion: We found significant relation between antenatal visit conducted in accordance with WHO criteria and economic level with the incidence of complication.
Keywords: complications, teenage pregnancy
Difference of Maternal Serum Interleukin-8 in Preterm Labor and Full Term Labor
Get PDFObjective: To determine the difference of maternal interleukin-8
(IL-8) in preterm labor and full term labor.
Method: This is a cross sectional study with 68 samples, 29 subjects
with preterm labor and 39 subjects with full term labor. IL-8 concentration was obtained from blood samples of the subjects, which
were examined at Prodia Laboratory Denpasar. Data was analyzed
using t-test for independent samples with =0.05.
Result: The mean IL-8 level for the preterm labor group was
23.56 10.69 pg/ml and 12.19 5.79 pg/ml for the full term labor
group. Statistical analysis using independent samples t-test showed
that the average IL-8 level of both groups were significantly different
(p=0.001).
Conclusion: We concluded from this study that serum IL-8 concentration in women who had preterm labor is significantly higher in comparison to women who had full term labor.
[Indones J Obstet Gynecol 2014; 4: 185-187]
Keywords: full term labor, interleukin-8, preterm labo
