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All Journal E-Jurnal Ekonomi Pembangunan Universitas Udayana Majalah Obstetri dan Ginekologi The Indonesian Biomedical Journal Public Health of Indonesia Indonesian Journal of Perinatology
Kusuma, Anak Agung Ngurah Jaya
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Biochemistry, Genetics & Molecular Biology Economics, Econometrics & Finance Health Professions Medicine & Pharmacology Nursing Public Health

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ANALISIS PENGARUH INKLUSI KEUANGAN TERHADAP TINGKAT KEMISKINAN DAN KETIMPANGAN PENDAPATAN MASYARAKAT DI KABUPATEN/KOTA PROVINSI BALI Kusuma, Anak Agung Ngurah Jaya; Indrajaya, I Gusti Bagus
E-Jurnal Ekonomi Pembangunan Universitas Udayana Vol 9 No 5 (2020): VOL 9 NO 5, MEI 2020, PP 963 - 1199
Publisher : E-Jurnal Ekonomi Pembangunan Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (388.002 KB)

Abstract

Financial inclusion (financial inclusion) as all efforts aimed at eliminating all forms of price and non-price barriers to public access in utilizing financial services. This study aims to analyze the effect of financial inclusion on the level of poverty and income inequality in the District / City of Bali Province. This study uses secondary data from 2014 to 2018 with research sites in 9 city districts in Bali Province. Path analysis and sobel test are used to determine the direct effect and indirect effect through intervening variables between independent variables in influencing the dependent variable. The analysis showed that financial inclusion had a negative and significant effect on poverty levels. The level of poverty has a positive and significant effect on income inequality. However, financial inclusion has no significant effect on income inequality. This is due to the development of the banking industry in the province of Bali which is still uneven and concentrated in South Bali. Financial inclusion has an indirect effect on community income inequality through poverty levels. keyword: financial inclusion, level of poverty, income inequality
Healthcare Professional’ Roles Educate Exclusive Breastfeeding: A Qualitative Exploratory Study of Strategies and Challenges Mertasari, Luh; Duarsa, Dyah Paramita; Ani, Luh Seri; Kusuma, Anak Agung Ngurah Jaya; Bakta, I Made
Public Health of Indonesia Vol. 10 No. 3 (2024): July - September
Publisher : YCAB Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36685/phi.v10i3.837

Abstract

Background:The exclusive breastfeeding program has been in place for several years, but its implementation in various countries remains suboptimal. To reduce health risks for both mothers and children, exclusive breastfeeding education should begin as early as possible during pregnancy. Objective:This study aimed to explore models of exclusive breastfeeding education during pregnancy. Method:This study used a qualitative descriptive design with an exploratory approach. The sample included all parties involved in providing exclusive breastfeeding education within the Public Health Centers working areas of Buleleng I, Sukasada I, and II. The participants comprised 35 healthcare professionals, pregnant women, postpartum mothers, and hamlet heads. Data were collected through in-depth interviews using semi-structured interview guidelines until data saturation was reached. Interviews were conducted via video calls and private messages to confirm the transcription results. Results:Thematic analysis identified three main themes: Healthcare professionals’ roles, knowledge, attitudes, and support (including multiple roles, perceptions about exclusive breastfeeding education, and formal motivation and support); Education strategy and mechanisms (encompassing educational strategies, methods, preparation, location, schedule, time allocation, content, stages, media, and effectiveness evaluation); Challenges (such as lack of knowledge, maternal circumstances, and environmental conditions). Conclusion:Public health centers should provide structured education, with midwives playing a key role in promoting exclusive breastfeeding. The delivery of education should remain flexible to accommodate various conditions. Keywords:Breastfeeding; Child; Health knowledge; Midwifery; Postpartum period
Benefits and safety of myomectomy during cesarean section Kusuma, Anak Agung Ngurah Jaya
Majalah Obstetri & Ginekologi Vol. 32 No. 1 (2024): April
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/mog.V32I12024.39-43

Abstract

HIGHLIGHTS 1. Myomectomy during cesarean section is a recommended and safe procedure. 2. This procedure benefits the patient because it avoids a second operation and anesthesia complications and is cost-saving.   ABSTRACT Uterine myoma is a tumor in the uterus that is generally benign. There are many types of uterine myomas. These tumors can grow on the outer wall of the uterus, on the uterine muscle, or it can also be on the inner wall of the uterus. The most frequent kind of uterine tumor is myoma. Uterine myoma mostly occurs in women over thirty years of age. Its prevalence ranges from 5.4% to 77%, with uterine fibroids accounting for up to 5% of pregnancies. The myomectomy procedure is an option for women who still want children but are concerned about the possibility of subsequent surgical intervention. The myomectomy cesarean section is indicated if there were complications related to the myoma in a previous pregnancy. It also avoids the possibility of repeat laparotomy for fibroid removal in the future. Myomectomy surgery should be planned based on fibroids' location, size, and quantity, using suitable imaging. Myomectomy cesarean section can be an option compared to cesarean section without myomectomy, especially if it is performed by experienced surgeons with proper hemostatic techniques and performed in tertiary-level health facilities. This article discusses the details of the benefits and safety of myomectomy during cesarean section so that it might be considered before performing this procedure.
Current preeclampsia prediction model and biomarker Kusuma, Anak Agung Ngurah Jaya
Majalah Obstetri & Ginekologi Vol. 32 No. 3 (2024): December
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/mog.V32I32024.214-222

Abstract

HIGHLIGHTS Most studies report that FMF predictive models involving a combination of maternal factor screening and biomarkers have significantly better detection capacity than risk factor screening alone. All predictive models generally use maternal factors as the basis for calculations and algorithms. Several biomarkers that have been reported in studies to act as elements of prediction models include MAP, UtA-PI, and the ratio of sFlt-1/PlGF level.   ABSTRACT Preeclampsia (PE) is a serious hypertensive disorder that occurs during pregnancy and is often accompanied by proteinuria (excessive protein in the urine), posing significant risks to both maternal and neonatal health worldwide. PE is a leading cause of maternal and neonatal morbidity and mortality and is notably challenging to predict due to its unpredictable nature and steadily rising incidence rates globally. As a result, substantial efforts have been directed toward developing predictive models and identifying biomarkers to assess the risk and progression of PE. However, existing models vary widely in their design, methodologies, and efficacy. Current prediction models recommended by notable organizations, including the National Institute for Health and Care Excellence (NICE), the American College of Obstetricians and Gynecologists (ACOG), the Fetal Medicine Foundation (FMF), and the World Health Organization (WHO), generally involve screening based on maternal characteristics and known risk factors. These include parameters such as maternal age, body mass index (BMI), number of pregnancies and births, blood pressure, and uterine arterial pulse index (UtA-PI). Additionally, biomarkers like mean arterial pressure (MAP), UtA-PI, and the ratio of soluble fms-like tyrosine kinase-1 to placental growth factor (sFlt-1/PlGF) are employed to improve predictive accuracy. Despite the diversity of predictive models and biomarkers, there is no consensus on the optimal model for PE prediction, largely due to the limitations in comparative studies and the challenges involved in cross-study comparisons. However, literature suggests that the FMF model demonstrates superior detection capacity compared to other predictive models.
The application of Mississippi Protocol in superimposed pre-eclampsia patients with class 2 hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome Kusuma, Anak Agung Ngurah Jaya
Majalah Obstetri & Ginekologi Vol. 33 No. 1 (2025): April
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/mog.V33I12025.83-88

Abstract

HIGHLIGHTS The neonatal outcome following pregnancy termination was preterm birth, accompanied by low birth weight and respiratory distress. Following pregnancy termination, laboratory parameters gradually demonstrated improvement over time. Mississippi Protocol therapy was maintained for 4 days after pregnancy termination until both clinical status and laboratory values showed improvement.   ABSTRACT Objective: To describe the implementation of the Mississippi Protocol (MP) in a case of superimposed pre-eclampsia complicated by class 2 HELLP syndrome. Case Report: The patient initially received conservative treatment, including anticonvulsant prophylaxis, antihypertensive agents, and high-dose cortico-steroids, in accordance with the MP. However, during observation, placental abruption and fetal distress were noted. Consequently, an emergency (green code) Caesarean section was performed. Placental abruption is a known complication associated with pre-eclampsia. The neonatal outcome following pregnancy termination was premature birth, low birth weight, and respiratory distress. Following delivery, laboratory parameters gradually improved. MP therapy was continued for 4 days post-delivery until clinical and laboratory indicators normalized. The administration of high-dose corticosteroids in HELLP syndrome is based on its characteristic excessive inflammatory response, which represents the distinctive feature of this case. Corticosteroid therapy is intended to reduce maternal morbidity and mortality and to enhance neonatal outcomes. Conclusion: Careful monitoring and comprehensive management are essential when applying the MP in such cases. The definitive treatment for both pre-eclampsia and HELLP syndrome remains the termination of pregnancy. Further research is required to assess the effectiveness of MP in emergency or complicated scenarios.
Non-Invasive Prenatal Testing with Next Generation Sequencing Methods in Birth Defect Pregnancy: A Pilot Study Suardika, Anom; Kusuma, Anak Agung Ngurah Jaya; Ermayanti, Ni Gusti Ayu Manik; Widiyanti, Endang Sri; Wibawa, I Gusti Ngurah Agung Satria; Silvana, Divika; Budayasa, Anak Agung Gede Raka; Dewi, Ni Nyoman Ayu; Jawi, I Made; Sun, H. Sunny; Tang, Yen-An
The Indonesian Biomedical Journal Vol 17, No 4 (2025)
Publisher : The Prodia Education and Research Institute (PERI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18585/inabj.v17i4.3753

Abstract

BACKGROUND: Identification of cell-free foetal DNA (cffDNA) in maternal blood, combined with next-generation sequencing (NGS) advancement, has paved the way for non-invasive prenatal screening to detect foetal aneuploidies. However, there is limited evidence on its diagnostic accuracy when compared with gold-standard invasive tests specifically in pregnancies complicated by birth defects in Indonesia. This study was conducted to evaluate the precision of non-invasive prenatal testing (NIPT) using NGS and ultrasound findings compared with the established benchmarks of amniocentesis and neonatal karyotyping through G-banding analysis, which is an invasive procedures, in a private laboratory setting for pregnancies with birth defect.METHODS: An observational cohort study involving pregnant women with foetal birth defects in central nervous system, facial, heart, gastrointestinal tract, urinary tract abnormalities and suspected Down Syndrome was conducted. The foetal birth defects were identified in the first trimester with ultrasound screening. Venous blood was drawn from the mother for NGS-based NIPT examination. As a gold standard, amniocentesis or neonatal G-banding karyotyping was conducted.RESULTS: Using G-banding karyotyping as gold standard, the results indicated that NIPT using the NGS method and ultrasound findings achieved 100% sensitivity, 100% specificity, and 100% accuracy in detecting trisomy 13, 18, and 21, as well as foetal sex chromosome abnormalities. Additionally, a case of tetrasomy 9p was identified through G-banding karyotyping, which was associated with multiple clinical abnormalities.CONCLUSION: NIPT with NGS methods and ultrasound findings demonstrated 100% accuracy for the screening of trisomy 13, 18, and 21 in birth defect pregnancy, which is comparable with G-banding analysis as a gold standard. Therefore, this suggest that these approaches offer a safe early detection, highly accurate alternative in high risk setting, compared to invasive procedure in Indonesia where access to such testing may be limited. KEYWORDS: G-banding karyotyping, next generation sequencing, non-invasive prenatal testing
Hypomethylation of the Soluble Fms-like Tyrosine Kinase 1 (sFlt-1) Gene Promoter Region and Elevated sFlt-1 Placental Expression as Risk Factors for Preeclampsia Kusuma, Anak Agung Ngurah Jaya; Darmayasa, I Made; Putra, I Gede Mega; Suardika, Anom; Pangkahila, Evert Solomon; Duarsa, Vidya Saraswati Putri; William, William
The Indonesian Biomedical Journal Vol 17, No 4 (2025)
Publisher : The Prodia Education and Research Institute (PERI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18585/inabj.v17i4.3744

Abstract

BACKGROUND: Preeclampsia significantly contributes to maternal and fetal morbidity and mortality worldwide, marked by an imbalance of angiogenic factors, particularly increased soluble Fms-like tyrosine kinase-1 (sFlt-1), leading to endothelial dysfunction. Epigenetic regulation, including DNA methylation of the sFlt-1 promoter, has been suggested to influence sFlt-1 expression, but the data in Indonesian population are limited. This study was perfmed to determine whether hypomethylation of the sFlt-1 promoter and elevated placental sFlt-1 expression are associated with increased risk of preeclampsia.METHODS: A case-control study was conducted involving 30 women with preeclampsia and 30 normotensive pregnant women. Subjects were selected based on eligibility criteria that included singleton pregnancy and gestational age of ≥37 weeks. DNA methylation of the sFlt-1 promoter was assessed using methylation-specific polymerase chain reaction (PCR), and sFlt-1 expression was measured by enzyme-linked immunosorbent assay (ELISA). Statistical analyses, including Mann-Whitney U, Chi-square tests, Receiver-operating characteristic (ROC) curve analysis, and multivariate logistic regression, were performed to evaluate the relationship between methylation levels, gene expression, and preeclampsia risk.RESULTS: The preeclampsia group had significantly lower methylation levels of sFlt-1 promoter and higher placental sFlt-1 expression (both p<0.001). Hypomethylation of sFlt-1 promoter (adjusted odd ratio (AOR): 21.18; 95% CI: 2.49–179.72; p=0.005), high sFlt-1 expression (AOR: 12.55; 95% CI: 1.95–80.83; p=0.008), and obesity (AOR: 11.15; 95% CI: 2.01–61.78; p=0.006) were identified as independent risk factors for preeclampsia.CONCLUSION: Hypomethylation of sFlt-1 promoter and elevated placental sFlt-1 expression are significant independent risk factors for preeclampsia. These findings suggest that hypomethylation of sFlt-1 promoter and elevated placental sFlt-1 expression may serve as potential epigenetic biomarkers for early detection and targeted intervention in preeclampsia.KEYWORDS: preeclampsia, sFlt-1, gene expression, hypomethylation, placenta, risk factor
Metastatic breast cancer during pregnancy: a case report Widi, Made Yudha Ganesa Wikantyas; Putra, Wayan Artana; Kusuma, Anak Agung Ngurah Jaya; Wiradnyana, Anak Agung Putra; Sanjaya, I Nyoman Hariyasa; Budiana, I Nyoman Gede; Mahayasa, Putu Doster; Marta, Kadek Fajar
Indonesian Journal of Perinatology Vol. 6 No. 1 (2025): (Available online: 1 June 2025)
Publisher : The Indonesian Society of Perinatology, South Jakarta, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/inajperinatol.v6i1.73

Abstract

Introduction: Breast cancer is the most prevalent malignancy among women and a notable comorbidity during pregnancy. Pregnancy-associated breast cancer (PABC) presents unique challenges due to physiological breast changes that complicate early diagnosis. This case report aimed to present a 31-year-old female with a diagnosis of bilateral breast tumors, pleural effusion, and multiple thoracic soft tissue tumors during her second pregnancy, highlighting the complexities and treatment considerations involved. Case presentation: A 31-year-old female patient, referred to Prof. Dr. I. G.N.G Ngoerah General Hospital, Denpasar, was in her second pregnancy at 20-21 weeks of gestation. She presented with bilateral breast lumps, worsening pain, and shortness of breath. Her obstetric history included a previous cesarean delivery and two abortions. Clinical examination revealed pleural effusion and multiple nodules suggestive of metastases. Biopsies confirmed tubular adenoma in the right breast and invasive breast carcinoma in the left breast. Ultrasound and chest x-ray findings indicated metastases to the liver and lungs. The patient was diagnosed with G4P1021 at 20 weeks of gestation with pregnancy-associated bilateral breast cancer and metastases. Conclusion: PABC diagnosis and treatment are fraught with challenges due to the need to balance maternal and fetal health. Delays in diagnosis, limited antenatal care, and the aggressive nature of PABC contribute to poor outcomes. This case underscores the necessity of early detection, prompt multidisciplinary intervention, and tailored treatment strategies to improve PABC patients' prognoses.
Lacticaseibacillus rhamnosus Probiotics Improve Fasting Blood Glucose, HOMA-IR, and Reduce Body Weight in Diabetic Rat Model Suastika, Arresta Vitasatria; Widiana, I Gde Raka; Kusuma, Anak Agung Ngurah Jaya; Fatmawati, Ni Nengah Dwi; Suastika, Ketut; Sujaya, I Nengah
The Indonesian Biomedical Journal Vol 17, No 1 (2025)
Publisher : The Prodia Education and Research Institute (PERI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18585/inabj.v17i1.3525

Abstract

BACKGROUND: Indonesian indigenous probiotics have been found to improve disruptions of tight junctions in the intestinal epithelium and reduce total cholesterol levels. Improvement in the tight junction could decrease the LPS level and further reduce the blood glucose and insulin resistance. The effects of indigenous Indonesian Lacticaseibacillus rhamnosus (Lr) probiotics on glucose metabolism and inflammatory marker levels in diabetic rats was studied to find if these probiotics are suitable as potential supplementation treatment in diabetes.METHODS: Sixteen female Wistar rats were induced with diabetes using streptozotocin and fed a high-fat, high-sucrose diet. The rats were separated into four groups: LrFBB81, LrFSMM22, LrSKG34, and a control group. Each intervention group got daily dosages of 1 mL probiotic suspensions containing 109 CFU/mL cells given orally for 14 days, whereas the control group received saline. Fasting blood glucose (FBG), insulin, homeostatic model assessment for insulin resistance (HOMA-IR), lipopolysaccharide (LPS), and body weight were evaluated.RESULTS: FBG was significantly reduced in LrFSMM22 group (Δ=120.75 mg/dL, p=0.035), while significant reduction was not observed from LrFBB81, LrSKG34, and control groups. No statistically significant differences were found in HOMA-IR before and after intervention in all groups, but Δ HOMA-IR from LrFSMM22 group was reduced more than the control group (-3.90 vs. 2.02, p=0.028). All groups showed no significant differences in LPS level, meanwhile statistically significant reduction in body weight was observed in all probiotic groups, LrFBB81 (Δ=-15.7 gram, p=0.040), LrSKG34 (Δ= -20.43 gram, p=0.006), and LrFSMM22 groups (Δ=-18.33 gram, p=0.037).CONCLUSION: The administration of L. rhamnosus could improve FBG, HOMA-IR, and reduce body weight without suppressing the LPS.KEYWORDS: diabetes, probiotic, Lacticaseibacillus rhamnosus, fasting blood glucose, HOMA-IR, lipopolysaccharide, insulin resistance
Molecular mechanisms and biomarkers of autophagy in early onset preeclampsia: Key genes, pathways, and potential diagnostic/therapeutic targets Kusuma, Anak Agung Ngurah Jaya
Majalah Obstetri & Ginekologi Vol. 33 No. 3 (2025): December
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/mog.V33I32025.262-270

Abstract

HIGHLIGHTS Dysregulated autophagy in trophoblasts contributes to abnormal placentation and impaired spiral artery remodeling in early-onset preeclampsia. Oxidative stress and excessive mitochondrial ROS disrupt the autophagic balance, leading to cellular dysfunction and placental ischemia. Key autophagy-related genes (e.g., BECN1, LC3, ATG5, mTOR, TFEB) may serve as diagnostic or therapeutic targets in early-onset PE. Understanding the autophagy–oxidative stress interaction could inform biomarker development and novel interventions.   ABSTRACT The pathogenesis of preeclampsia (PE) remains incompletely understood, with multiple mechanisms proposed. Among these, dysregulation of autophagy has emerged as a critical factor. Autophagy is essential for implantation, placental development, and pregnancy maintenance. Extravillous trophoblasts (EVTs) invade the decidua and proximal myometrium under hypoxic conditions, and autophagy supports this invasive process. In PE, impaired placentation has been associated with abnormal autophagic activity in trophoblastic cells. Furthermore, oxidative stress and excessive mitochondrial reactive oxygen species (ROS) production contribute to the pathophysiology of PE, potentially driving both insufficient and maladaptive upregulation of autophagy depending on the cellular microenvironment. Thus, PE is characterized not by a uniform increase or inhibition, but rather by disrupted autophagic balance. This review aims to clarify the role of autophagy dysregulation in the pathogenesis of PE.
Co-Authors Anom Suardika Budayasa, Anak Agung Gede Raka Duarsa, Dyah Paramita Duarsa, Vidya Saraswati Putri Endang Sri Widiyanti Evert Solomon Pangkahila I Gde Raka Widiana I Gede Mega Putra I GUSTI AYU MANIK ERMAYANTI I Gusti Bagus Indrajaya I Ketut Suastika I Made Bakta I Made Darmayasa I Made Jawi I Nengah Sujaya I Nyoman Gede Budiana I Nyoman Hariyasa Sanjaya LUH MERTASARI . Luh Seri Ani Marta, Kadek Fajar Ni Nengah Dwi Fatmawati Ni Nyoman Ayu Dewi Putra, Wayan Artana Putu Doster Mahayasa Silvana, Divika Suastika, Arresta Vitasatria Sun, H. Sunny Tang, Yen-An Wibawa, I Gusti Ngurah Agung Satria Widi, Made Yudha Ganesa Wikantyas William Alexander Setiawan Wiradnyana, Anak Agung Putra