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Expression of p16INK4a Biomarker has a Diagnostic Value in Predicting the Progressivity of Precancerous Cervical Lesion Indarti, Junita
Indonesian Journal of Obstetrics and Gynecology Volume. 34, No. 3, July 2010
Publisher : Indonesian Socety of Obstetrics and Gynecology

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Objective: To evaluate clinical value of p16INK4a biomarker level, by doing p16INK4a immunocytochemistry staining, as a predictor of progressivity of precancerous cervical lesion. Method: Design of this research is case-control study which will be stratified. Research was conducted in Cytology Laboratorium, Gynecology Specialistic Division, Department of Obstetrics and Gynecology, Dr. Cipto Mangunkusumo Hospital from August 2007 to September 2008. Immunocytochemistry examination was conducted in Anatomic Pathology Department, Dr. Hasan Sadikin Hospital. We divided the sample into two categories; patients with and without cervical intraepithelial neoplasia (CIN). This research will evaluate HPV infection and p16INK4a biomarker by doing p16INK4a immunocytochemistry (ICC) staining. Results: We have done immunocytochemistry examination in 130 patients, 26 without CIN and 104 with CIN. Immunocytochemistry cut-off point level is 50, which means value < 50 means low (L) p16INK4a expression and in reverse, value â¥ 50 means high (H) p16INK4a expression. The bivariate analysis of our study were p16INK4a (H) expression has the risk of CIN 1 with OR 8.4, for CIN 2 with OR 13 and for CIN 3 with OR 21, greater than p16INK4a (L) with all p values are significant. ICC p16INK4a (H) expression, age, number of sexual partners, and education are contributory to the risk of progressivity in CIN. The multivariate analysis demonstrates, ICC expression of p16INK4a (H) has a risk (OR) of CIN 1 17.19 times greater than p16INK4a (L); p16INK4a (H) expressionâs OR for CIN 2 is 25.56; and for OR CIN 3 is 37.32. The expression of p16INK4a has a significant p value and high OR, thus ICC expression of p16INK4a is suggested to be included in the algorithm of precancerous cervical lesion guidelines and scoring of probability of CIN as an alternative to HPV DNA considering less cost of the test. In this research, we found a scoring model to determine probability of progressivity in precancerous cervical lesion. Conclusion: The expression of p16INK4a has a diagnostic value in predicting the progressivity of precancerous cervical lesion. [Indones J Obstet Gynecol 2010; 34-3: 125-30] Keywords: p16INK4a expression, immunocytochemistry, predictor of progressivity, precancerous cervical lesion

Effectiveness of Oral Probiotics as Adjuvant Therapy in Reproductive Aged Women with Vaginal Discharge Indarti, Junita; Budidarmo, Utomo
Indonesian Journal of Obstetrics and Gynecology Volume 6. No. 1. January 2018
Publisher : Indonesian Socety of Obstetrics and Gynecology

  Objective: To investigate the efficacy of oral proboiotics and prove the high proportion of cure and satisfaction levels of post-treatment patients with a combination of antimicrobial-probiotic oral Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 compared to a combination of antimicrobial-placebo in the treatment of reproductive aged patients with vaginal discharge in the outpatient obstetrics and gynecologic clinic in Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia and Arifin Achmad Regional Hospital Pekanbaru, Riau, Indonesia. Methods:This was a randomized, double-blind, placebo-controlled trial involving50 subjects consisting of reproductive aged women. Data were collected using syndromic approach, probiotics were given as an adjuvant for standard antimicrobial therapy versus placebo as control, response was recorded 4 weeks later, for cure proportion and satisfaction level. Statistical analysis was performed to assess the variables. Interim analysis with conditional power assesment and futility testing were performed at midway due to insufficient sample size. Research was approved by Ethics Commitee for Health Researches Faculty of Medicine University of Indonesia-Dr. Cipto Mangunkusumo Hospital in March 2016. Results: A total of 50 subjects participated in this study. and analyzed (25 subjects in each group), cure proportion 56%(14) of the treatment and 60%(15)on the control group, with relative risk of 1.1, Chi-square test p value (0.77, 95% CI; 0.57 to 2 , 11). High satisfaction level (score ≥67) was higher in the placebo (52,6%, 10 subjects) compared to probiotic group (47,4%, 9 subjects), p value 0,65 (≥0,05). Conditional power and futility testing curve, revealed Z = -0.2865, conditional power 0.11 to 0.13, and futility index of 0.87 to 0.88, equals to low possibility of statistical significance with full sample size (84). Conclusion: There was no clinical and statistical difference in the proportion of cure rate and the level of satisfaction in patients of probiotics vs placebo groups after treatment for 4 weeks. The initial hypothesis of higher proportion of the cure ratein the treatment group still cannot be excluded, due to insufficient samples. Keywords: bacterial vaginosis, , lactobacillus reuteri RC-14, lactobacillus rhamnosus GR-1, randomized double blind controlled trial, trichomoniasis , vaginal discharge,  vulvovaginal candidiasis.

The Accuration of LiquidBased Cytology and HPV DNA Test Combination as Precervical Cancer Lesion Screening Indarti, Junita; Pratama, Yuven S
Indonesian Journal of Obstetrics and Gynecology Volume. 5, No. 4, October 2017
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To investigate the accuracy of liquid-based cytology, HPV DNA test, and the combination of liquid-based cytologyband HPV DNA test, compared to histopathology as the gold standard of precervical cancer lesion screening. Methods: This was a cross-sectional study. The medical records of patients who came to the Women’s Health Clinic of Dr. Cipto Mangunkusumo Hospital during the period of July 2013 to December 2015 were evaluated. Results: The high risk type HPV DNA is detected in 76% CIN 1, 88.46% CIN 2, and 84.21 CIN 3 in histopathology results. The accuracy of liquid-based cytology; sensitivity 88.54%, specificity35.71%, PPV 75.89%, and NPV 57.69%. The accuracy of HPV DNA; sensitivity 81.25%, specificity 78.57%, PPV 89.66%, and NPV 64.71%. The accuracy of combination: sensitivity 94.79%, specificity 35.71%, PPV 77.12%, and NPV 75%. Conclusion: The addition of HPV DNA test increased the sensitivity from 88.54% to 94.79% because of decreasing of false negative of liquid-based cytology. This thing has showed that the combination of liquid-based cytology and HPV DNA test could the one of the option of precervical cancer lesion screening method, especially in secondary or tertier health center in Indonesia. Keywords: accuracy test, HPV DNA, liquid-based cytology, precervical cancer lesion, precervical cancer lesion screening

Sexually Transmitted Infection in Correlation with Cervical Precancerous Lesion Indarti, Junita; Kurniawan, Riyan H; Nilasari, Hanny
Indonesian Journal of Obstetrics and Gynecology Volume. 3, No. 1, January 2015
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To identify the correlation between sexually transmitted infection and cervical precancerous lesion. Method: The study design is cross‐sectional. Samples were collected by consecutive sampling method until the minimal amount was fulfilled. This study was conducted in the Colposcopy Outpatient Clinic and Cytology Laboratory, Division of Specialistic Gynecology, Department of Obstetrics and Gynecology, Dr. Cipto Mangunkusumo Hospital (RSCM), Jakarta, from September 2008 to March 2009. Laboratory examination for sexually transmitted infection (STI) was performed in Department of Dermatovenereology, RSCM, Jakarta. Patients were grouped into cases and control group. The case group consisted of patients diagnosed with cervical intraepithelial neoplasia (CIN) and the control group consisted of patients without CIN. Sexually transmitted infection was identified and its relationship to CIN was analyzed. Result: We included 130 patients into this study, 25.38% without CIN and 74.62% with CIN. We found that one patient can be infected by up to five types of infection at a time. We also discovered a statistically significant relation between CIN 1 and STI (p=0.028), CIN 2 and STI (p=0.007), and CIN 3 and STI (p=0.013). Conclusion: Based on our study, we discovered a significant relationship between the incidence of STI and CIN. Keywords: cervical intraepithelial neoplasia, cervical precancerous lesion, sexually transmitted infection

Characteristics of Maternal Mortality Cases in a Tertiary Hospital Indarti, Junita; Irawan, Ferry Y
Indonesian Journal of Obstetrics and Gynecology Volume. 4, No.3, July 2016
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To identify the characteristics of maternal mortality cases in a tertiary hospital in Jakarta, including socio-demographic characteristics, previous medical and obstetric history, and patient’s clinical condition on arrival at the hospital. Method: This was a survey to identify the descriptive data of maternal mortality cases through medical records during study period. Manual review of 51 medical records was conducted for 2 years from January 2013 to December 2014 in Department of Obstetrics and Gynecology, Dr. Cipto Mangunkusumo Hospital (RSCM). Result: Of 51 cases of maternal deaths, 46 subjects (90.19%) had nine years of minimum education background. There were two subjects less than 21 years old and another was 42 years old. None of these subjects were using intrauterine device (IUD) or implant as the contraceptive methods where 66.6% subjects with underlying disease never used contraception. Ninety-two percent of subjects did antenatal care (ANC) regularly and 80.4% (41 subjects) of them was done in midwives. There were 14 subjects (29.78%) who had ANC in the first trimester of pregnancy. Severe preeclampsia is the most prevalent complication in pregnancy (26 subjects, 65%), which all (100%) patients arrived at RSCM with HELLP Syndrome. Therefore, preeclampsia was the leading cause of death in RSCM. Conclusion: The characteristics of maternal death in RSCM are prevalent in the group of 25-34 years old with the high school as the educational background. Most of them are multiparity and do not use the long-term contraceptive methods. Preeclampsia is the major cause of maternal death in RSCM. Keywords: maternal mortality, risk factors, tertiary hospital

A Real-time Optoelectronic Device in Screening of Precancerous Cervical Lesion Rahmadhany, Rizky; Indarti, Junita
Indonesian Journal of Obstetrics and Gynecology Volume. 3, no. 2, April 2015
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To obtain the diagnostic values of optoelectronic device for screening of precancerous cervical lesions. Method: We performed a diagnostic study with cross sectional design. Subjects were recruited from Dr. Cipto Mangunkusumo Hospital, from February until December 2013. Subjects were enrolled based on consecutive sampling until the minimum sample was achieved (60 samples). Result: During the study period, 60 patients were enrolled. Sensitivity, specificity, positive predictive value, and negative predictive value of the optoelectronic device were 76%, 95%, 96%, and 64%, respectively. We also investigated diagnostic values of other screening methods, namely citology and colposcopy. Sensitivity and specificity of liquid based cytology were 83% and 63% respectively. The combination of optoelectronic device and liquid based cytology increased the sensitivity to 92.8%. Meanwhile, sensitivity and specificity of colposcopy were 88% and 58%, respectively. Based on Altman criteria, kappa value for optoelectronic device with cytology was 0.35 (fair) and optoelectronic device with colposcopy was 0.45 (moderate). Conclusion: A real-time optoelectronic device might be used as an alternative method in early detection of precancerous cervical lesions, either as a single method or combined with liquid based cytology. Keywords: diagnostic values, optoelectronic device, precancerous cervical lesions

Daily Application of EvidenceBased Medicine Indarti, Junita
Indonesian Journal of Obstetrics and Gynecology Volume. 3, No. 3, July 2015
Publisher : Indonesian Socety of Obstetrics and Gynecology

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Profile of Maternal Referral Cases Indarti, Junita; Ocviyanti, Dwiyana; Aditya, Reyhan
Indonesian Journal of Obstetrics and Gynecology Volume. 4, No. 2, April 2016
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To explore the demography of maternal referral cases in Dr. Cipto Mangunkusumo Hospital (RSCM) along with the accuracy of referral. We also aim to evaluate the types of referral, origin of referral, referring healthcare facility and quality of referring healthcare facility. Method: The design of this study was a cross sectional design which described the accuracy of obstetrics referred cases in Emergency Unit Dr. Cipto Mangunkusumo Hospital from 2013 to 2014. Result: The total referred obstetric cases in 2013 was 1,645 patients. It was consisted of 1,307 appropriate (79.5%) and 338 inappropriate (20.5%) referred cases. Primary healthcare and general hospital were the most often referring cases to RSCM during two consecutive years. The top three cases referred to RSCM in both 2013 and 2014 were preterm premature rupture of membrane (PPROM), continued by severe preeclampsia and preterm labor. Conclusion: The number of referral cases in Indonesia is considered high, particularly in RSCM as the tertiary healthcare facility. There are still a high number of inappropriate referrals originating from primary healthcare facilities, pointing to the fact that the referral system is not running according to design or plan. To improve the quality of referral system, proper monitoring and evaluation of referral should be performed by local health department. [Indones J Obstet Gynecol 2016; 4-2: 64-66] Keywords: maternal case, referral system

Sexually Transmitted Infection in Correlation with Cervical Precancerous Lesion Indarti, Junita; Kurniawan, Riyan H; Nilasari, Hanny
Indonesian Journal of Obstetrics and Gynecology Volume. 3, No. 1, January 2015
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To identify the correlation between sexually transmitted infection and cervical precancerous lesion. Method: The study design is cross‐sectional. Samples were collected by consecutive sampling method until the minimal amount was fulfilled. This study was conducted in the Colposcopy Outpatient Clinic and Cytology Laboratory, Division of Specialistic Gynecology, Department of Obstetrics and Gynecology, Dr. Cipto Mangunkusumo Hospital (RSCM), Jakarta, from September 2008 to March 2009. Laboratory examination for sexually transmitted infection (STI) was performed in Department of Dermatovenereology, RSCM, Jakarta. Patients were grouped into cases and control group. The case group consisted of patients diagnosed with cervical intraepithelial neoplasia (CIN) and the control group consisted of patients without CIN. Sexually transmitted infection was identified and its relationship to CIN was analyzed. Result: We included 130 patients into this study, 25.38% without CIN and 74.62% with CIN. We found that one patient can be infected by up to five types of infection at a time. We also discovered a statistically significant relation between CIN 1 and STI (p=0.028), CIN 2 and STI (p=0.007), and CIN 3 and STI (p=0.013). Conclusion: Based on our study, we discovered a significant relationship between the incidence of STI and CIN. Keywords: cervical intraepithelial neoplasia, cervical precancerous lesion, sexually transmitted infection

A Real-time Optoelectronic Device in Screening of Precancerous Cervical Lesion Rahmadhany, Rizky; Indarti, Junita
Indonesian Journal of Obstetrics and Gynecology Volume. 3, no. 2, April 2015
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To obtain the diagnostic values of optoelectronic device for screening of precancerous cervical lesions. Method: We performed a diagnostic study with cross sectional design. Subjects were recruited from Dr. Cipto Mangunkusumo Hospital, from February until December 2013. Subjects were enrolled based on consecutive sampling until the minimum sample was achieved (60 samples). Result: During the study period, 60 patients were enrolled. Sensitivity, specificity, positive predictive value, and negative predictive value of the optoelectronic device were 76%, 95%, 96%, and 64%, respectively. We also investigated diagnostic values of other screening methods, namely citology and colposcopy. Sensitivity and specificity of liquid based cytology were 83% and 63% respectively. The combination of optoelectronic device and liquid based cytology increased the sensitivity to 92.8%. Meanwhile, sensitivity and specificity of colposcopy were 88% and 58%, respectively. Based on Altman criteria, kappa value for optoelectronic device with cytology was 0.35 (fair) and optoelectronic device with colposcopy was 0.45 (moderate). Conclusion: A real-time optoelectronic device might be used as an alternative method in early detection of precancerous cervical lesions, either as a single method or combined with liquid based cytology. Keywords: diagnostic values, optoelectronic device, precancerous cervical lesions

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