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All Journal E-Jurnal Ekonomi Pembangunan Majalah Obstetri dan Ginekologi The Indonesian Biomedical Journal Public Health of Indonesia Indonesian Journal of Obstetrics & Gynecology Science 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.
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.
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.
Promoter Methylation and Low Placental Expression of Metalloproteinase (MMP)-9, Human Leukocyte Antigen (HLA)-G, Vascular Endothelial Growth Factor (VEGF), and Highly Soluble Endoglin (sEng) as Risk Factors for Preeclampsia Kusuma, Anak Agung Ngurah Jaya; Darmayasa, I Made; Mulyantari, Ni Kadek; Mayasari, Ni Nyoman Wistya Tri; Sutandi, Chatrine; Bay, Godefridus Paulo; Nugraha, Cokorda Gde Angga Ary
The Indonesian Biomedical Journal Vol 18, No 1 (2026)
Publisher : The Prodia Education and Research Institute (PERI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18585/inabj.v18i1.3921

Abstract

BACKGROUND: Dysregulated expressions of metalloproteinase (MMP)-9, human leucocyte antigen (HLA)-G, vascular endothelial growth factor (VEGF), and soluble endoglin (sEng) reflect impaired angiogenesis, immune tolerance, endothelial function, and trophoblast invasion that characterize abnormal placental development in preeclamptic (PE) pregnancies. However, the role of promoter methylation of these markers in linking the pathways to altered protein expression remains unclear. Hence, this study compared promoter methylation and placental expression of MMP-9, HLA-G, VEGF, and sEng between women with PE and normotensive pregnancies, and evaluate their diagnostic performance as potential biomarkers.METHODS: This case–control study included 30 women with PE and 30 controls. Placental tissue samples were collected within 15 minutes postpartum. Placental promoter methylation was assessed using methylation-specific polymerase chain reaction (PCR), and protein expression was measured using enzyme-linked immunosorbent assay (ELISA). Group differences were analyzed, diagnostic accuracy was evaluated using receiver operating characteristic (ROC) curves, and associations were expressed as adjusted odds ratios (AOR).RESULTS: Compared with controls, placentas from women with PE significantly showed higher methylation of HLA-G (58.9% vs. 37.3%) and sEng (6.7% vs. 4.1%), and lower methylation of VEGF (30.4% vs. 48.1%) and MMP-9 (36.1% vs. 44.9%). Expression of MMP-9, HLA-G, and VEGF was significantly reduced, while sEng expression was increased in PE. Multivariate analysis identified HLA-G hypermethylation (AOR 5.36), VEGF hypomethylation (AOR 8.55), sEng methylation (AOR 4.57), low expression of MMP-9, HLA-G, and VEGF, and high sEng expression (AOR 4.77) as independent predictors of PE. sEng expression demonstrated the best discrimination (AUC 0.835), followed by sEng methylation (AUC 0.785) and HLA-G methylation (AUC 0.774).CONCLUSION: PE is associated with distinct placental methylation–expression alterations, with sEng- and HLA-G–related markers showing the strongest diagnostic value.KEYWORDS: preeclampsia, DNA methylation, angiogenesis, MMP-9, HLA-G, sEng, placenta, epigenetics
Precision Chromosomal Surgery before Birth: Allele-Specific CRISPR-Cas9 Editing for Trisomy 21 in Perinatal Medicine Sanjaya, I Nyoman Hariyasa; Andonotopo, Wiku; Bachnas, Muhammad Adrianes; Prabowo, Wisnu; Yuliantara, Eric Edwin; Lukas, Efendi; Dewantiningrum, Julian; Pramono, Mochammad Besari Adi; Wiradnyana, Anak Agung Gede Putra; Mulyana, Ryan Saktika; Kusuma, Anak Agung Ngurah Jaya; Pangkahila, Evert Solomon; Gumilar, Khanisyah Erza; Darmawan, Ernawati; Akbar, Muhammad Ilham Aldika; Yeni, Cut Meurah; Aldiansyah, Dudy; Bernolian, Nuswil; Pribadi, Adhi; Anwar, Anita Deborah; Suryawan, Aloysius; Putra, Ridwan Abdullah; Gondo, Harry Kurniawan; Nugraha, Laksmana Adi Krista; Andanaputra, Waskita Ekamaheswara Kasumba; Dharma, Wibisana Andika Krista; Djanas, Dovy; Stanojevic, Milan
Indonesian Journal of Obstetrics & Gynecology Science Volume 9 Number 1 March 2026
Publisher : Dep/SMF Obstetri & Ginekologi Fakultas Kedokteran Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/obgynia.v9i1.965

Abstract

Objective: Trisomy 21 remains the most common live-born aneuploidy and a major contributor to perinatal morbidity. Although prenatal screening, particularly non-invasive prenatal testing (NIPT), has advanced substantially, clinical management offers no corrective options. Emerging allele-specific genome-editing approaches propose targeted removal or silencing of the extra chromosome 21. This review summarizes current evidence and evaluates the translational relevance of these technologies in perinatal medicine.Methods: A narrative review was conducted following PRISMA-aligned procedures. A structured search of PubMed, Scopus, and Web of Science (January 2000–July 2025) identified 1,242 records. After duplicate removal, title/abstract screening, and full-text assessment based on predefined inclusion criteria, 54 studies met eligibility requirements. Data were synthesized across four domains: mechanistic strategies, developmental applicability, translational feasibility, and ethical–regulatory considerations.Results: Allele-specific CRISPR-Cas9 studies demonstrated selective cleavage of the supernumerary chromosome 21 in cellular models, with partial restoration of near-euploid transcriptional patterns. Additional approaches—XIST-mediated silencing and centromere destabilization—provided alternative mechanisms with varying stability and specificity. Evidence remains limited to in vitro systems, with no validated embryo or fetal applications. Key challenges include mosaicism, delivery barriers, individualized SNP targeting, and ethical governance.Conclusions: Allele-specific chromosome editing represents a promising but still experimental direction for future perinatal therapeutics. Current findings justify continued multidisciplinary investigation while emphasizing cautious interpretation and rigorous ethical oversight prior to any clinical translation. Abstrak Tujuan: Trisomi 21 tetap menjadi aneuploidi yang paling sering ditemukan pada kelahiran hidup dan merupakan kontributor utama terhadap morbiditas perinatal. Meskipun skrining prenatal—khususnya non-invasive prenatal testing (NIPT)—telah mengalami kemajuan yang signifikan, penatalaksanaan klinis hingga kini belum menawarkan opsi korektif. Pendekatan pengeditan genom spesifik alel yang mulai berkembang mengusulkan penghilangan atau penghambatan terarah terhadap salinan ekstra kromosom 21. Tinjauan ini merangkum bukti terkini serta mengevaluasi relevansi translasional teknologi tersebut dalam kedokteran perinatal.Metode: Tinjauan naratif dilakukan dengan mengikuti prosedur yang selaras dengan PRISMA. Pencarian terstruktur terhadap PubMed, Scopus, dan Web of Science (Januari 2000–Juli 2025) mengidentifikasi 1.242 rekaman. Setelah penghapusan duplikasi, penyaringan judul/abstrak, dan penilaian teks lengkap berdasarkan kriteria inklusi yang telah ditentukan, sebanyak 54 studi memenuhi persyaratan kelayakan. Data disintesis ke dalam empat domain: strategi mekanistik, aplikabilitas perkembangan, kelayakan translasional, serta pertimbangan etika dan regulasi.Hasil: Studi CRISPR-Cas9 spesifik alel menunjukkan pemotongan selektif terhadap kromosom 21 supernumerari pada model seluler, dengan pemulihan parsial pola transkripsi menuju profil ekspresi gen yang menyerupai kondisi euploid. Pendekatan lain—seperti penghambatan berbasis XIST dan destabilisasi sentromer—menyediakan mekanisme alternatif dengan tingkat kestabilan dan spesifisitas yang bervariasi. Bukti saat ini terbatas pada sistem in vitro, tanpa aplikasi yang tervalidasi pada embrio maupun janin. Tantangan utama meliputi mosaikisme, hambatan pengantaran, kebutuhan penargetan SNP individual, serta tata kelola etis.Kesimpulan: Pengeditan kromosom spesifik alel merupakan arah yang menjanjikan, namun masih bersifat eksperimental bagi terapi perinatal di masa mendatang. Temuan saat ini mendukung keberlanjutan penelitian multidisipliner, sekaligus menekankan perlunya interpretasi yang hati-hati dan pengawasan etika yang ketat sebelum penerapannya dalam praktik klinis.Kata Kunci: Bedah genom janin; CRISPR-Cas9; Penyuntingan gen perinatal; Terapi kromosom; Trisomi 21
Co-Authors Adhi Pribadi Aldiansyah, Dudy Aldika Akbar, Muhammad Ilham Aloysius Suryawan Andanaputra, Waskita Ekamaheswara Kasumba Andonotopo, Wiku Anita Deborah Anwar Bachnas, Muhammad Adrianes Bay, Godefridus Paulo Cut Meurah Yeni Darmawan, Ernawati Dharma, Wibisana Andika Krista Djanas, Dovy Duarsa, Dyah Paramita Efendi Lukas Eric Edwin Yuliantara Evert Solomon Pangkahila Harry Kurniawan Gondo I Gusti Bagus Indrajaya I Made Bakta I Made Darmayasa I Nyoman Gede Budiana I Nyoman Hariyasa Sanjaya Julian Dewantiningrum Khanisyah Erza Gumilar LUH MERTASARI . Luh Seri Ani Marta, Kadek Fajar Mayasari, Ni Nyoman Wistya Tri Ni Kadek Mulyantari Nugraha, Cokorda Gde Angga Ary Nugraha, Laksmana Adi Krista Nuswil Bernolian Pramono, Mochammad Besari Adi Putra, Ridwan Abdullah Putra, Wayan Artana Putu Doster Mahayasa Ryan Saktika Mulyana Stanojevic, Milan Sutandi, Chatrine Widi, Made Yudha Ganesa Wikantyas Wiradnyana, Anak Agung Gede Putra Wiradnyana, Anak Agung Putra WISNU PRABOWO