Anom Suardika
Bagian/SMF Obstetri Dan Ginekologi Fakultas Kedokteran Universitas Udayana, RSUP Sanglah, Denpasar-Bali

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Kadar 25(OH)D dan rasio HDL-LDL serum yang rendah sebagai faktor risiko terjadinya preeklamsia dengan gambaran berat Leony Lim; Ketut Suwiyoga; I Wayan Artana Putra; Anak Agung Ngurah Jaya Kusuma; I Gede Mega Putra; Anom Suardika; I Wayan Megadhana
Intisari Sains Medis Vol. 13 No. 1 (2022): (Available Online : 1 April 2022)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (333.198 KB) | DOI: 10.15562/ism.v13i1.1219

Abstract

Background: Preeclampsia is a health problem because it contributes to high rates of maternal and baby morbidity and mortality. The pathogenesis of preeclampsia is still unknown, but vitamin D deficiency and low HDL-LDL serum ratio are thought to play an important role. Therefore, a study was conducted on low 25(OH)D serum level and low HDL-LDL serum ratio as risk factors for preeclampsia with severe features.Methods: This study has a case-control design, conducted at Obstetric and Gynecology emergency room at Sanglah Hospital from January 2020 to June 2020. Subjects were 44 pregnant women, consisting 22 normal pregnant women as controls and 22 pregnant women with preeclampsia with severe features as cases, selected by purposive consecutive sampling and analyzed using SPSS 21.Results: Preeclampsia with severe features was found 5 times higher in pregnant women with low 25(OH)D serum level than in normal pregnant women (OR = 4,91, CI 95% = 1,33-18,21, p = 0,014). Preeclampsia with severe features was found 8 times higher in pregnant women with low HDL-LDL serum ratio than in normal pregnant women (OR = 7,88, CI 95% = 1,96-31,57, p = 0,002).Conclusion: Low 25(OH)D serum level and low HDL-LDL serum ratio are risk factors for Preeclampsia with severe features. Pendahuluan: Preeklamsia merupakan masalah kesehatan karena berkontribusi terhadap tingginya angka morbiditas dan mortalitas ibu dan bayi. Patogenesis preeklamsia sampai saat ini masih belum diketahui secara pasti, namun kadar vitamin D dan rasio HDL–LDL serum yang rendah diduga berperan penting dalam mekanisme terjadinya preeklamsia. Penelitian kemudian dilakukan terhadap kadar 25(OH)D dan rasio HDL-LDL serum yang rendah sebagai faktor risiko terjadinya preeklamsia dengan gambaran berat.Metode : Desain penelitian ini adalah kasus kontrol (case control) yang dilakukan di Instalasi Gawat Darurat Obstetri dan Ginekologi RSUP Sanglah, Denpasar mulai Januari 2020 sampai Juni 2020. Subyek penelitian berjumlah 44 orang ibu hamil, yang terdiri dari 22 ibu hamil normal sebagai kontrol dan 22 ibu hamil dengan preeklamsia dengan gambaran berat sebagai kasus, yang dipilih secara purposive consecutive sampling,  dan dianalisis menggunakan SPSS 21.Hasil: Risiko terjadinya preeklamsia dengan gambaran berat  adalah 5 kali lebih tinggi pada ibu hamil dengan kadar 25(OH)D serum yang rendah dibandingkan ibu hamil normal (OR = 4,91, IK 95% = 1,33-18,21, p = 0,014). Risiko terjadinya preeklamsia dengan gambaran berat adalah 8 kali lebih tinggi pada ibu hamil dengan rasio HDL-LDL serum yang rendah dibandingkan ibu hamil normal (OR = 7,88, IK 95% = 1,96-31,57, p = 0,002).Simpulan : Kadar 25(OH)D dan rasio HDL-LDL serum yang rendah merupakan faktor risiko preeklamsia dengan gambaran berat.
Skor assessment of different neoplasias in the adnexa (ADNEX) untuk memprediksi keganasan ovarium di RSUP Sanglah Denpasar I Nyoman Gede Budiana; Ketut Suwiyoga; Tjokorda Gde Agung Suwardewa; Anom Suardika; Made Bagus Dwi Aryana; Heni Sunyoto
Intisari Sains Medis Vol. 13 No. 1 (2022): (Available Online : 1 April 2022)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/ism.v13i1.1328

Abstract

Introduction: Ovarian cancer is cancer of the female reproductive organs with the highest mortality and is in the third position of female cancer after mammary and cervical cancer. The mortality rate and survival rate of ovarian cancer is mainly determined by the stage at which ovarian cancer is diagnosed. Until now there is no method for early detection of ovarian cancer with good sensitivity and specificity. Assessment of different neoplasias in the adnexa (ADNEX) is a model proposed by international ovarian tumor analysis (IOTA) to help distinguish benign or malignant adnexa tumors.Methods: This study is a observational clinical test to find out the accuracy of ADNEX model to predict ovarian malignancy conducted at the Obstetric and Gynecology Outpatient Ward in Sanglah hospital, Denpasar from November 2019 to April 2020. Consecutive sampling was done and 88 sample was recruited with a diagnosis of ovarian tumors. Then the research sample was sent to the Pathology Anatomy laboratory of Sanglah Hospital for histopathological examination. This result would then be compared to the prediction results of the ADNEX model.Results: 35 samples of benign ovarian tumors and 53 samples of ovarian cancer were found with the ADNEX method. There were 46 samples with malignant tumor both by the ADNEX model and histopathology results, 7 samples of malignant tumor at histopathology result but benign by the ADNEX model, 6 samples of benign tumor according to histopathology but malignant using the ADNEX model, and 29 samples of benign tumor according to histopathology and the ADNEX model. Using cut off of 49,6%, the study reported a sensitivity level of 86.8%, specificity 82.6%, positive predictive value 88.5%, negative predictive value 80.6%, and 85.2% accuracy.Conclusion: The ADNEX model has a high level of specificity, sensitivity and diagnostic accuracy in diagnosing ovarian cancer and can be used in combination with other clinical markers for early detection of malignancy in ovarian tumors.  Pendahuluan: Kanker ovarium merupakan salah satu jenis kanker organ reproduksi wanita dengan mortalitas tertinggi dan berada pada posisi ke-tiga kanker perempuan setelah kanker mammae dan serviks. Angka mortalitas dan survival rate kanker ovarium sangat ditentukan oleh stadium saat kanker ovarium terdiagnosis. Hingga saat ini belum tersedia metode pemeriksaan untuk deteksi dini kanker ovarium dengan sensitivitas dan spesifisitas yang memadai. Assessment of different neoplasias in the adnexa (ADNEX) adalah model yang diajukan oleh International Ovarian Tumor Analysis (IOTA) untuk membantu membedakan tumor adnexa sebagai tumor jinak atau ganas. Metode: Penelitian ini merupakan penelitian observasional uji klinik untuk mengetahui akurasi model ADNEX untuk memprediksi keganasan ovarium yang dilakukan di Poliklinik Kebidanan dan Penyakit Kandungan RSUP Sanglah, Denpasar pada bulan November 2019 hingga April 2020. Sampling dilakukan secara consecutive dan didapatkan 88 orang dengan diagnosis tumor ovarium. Sampel penelitian dikirimkan ke laboratorium Patologi Anatomi RSUP Sanglah dan dilakukan pemeriksaan histopatologi untuk kemudian dibandingkan dengan hasil prediksi dari model ADNEX.Hasil: Dalam penelitian ini didapatkan 35 sampel dengan tumor jinak ovarium dan 53 sampel dengan kanker ovarium dengan menggunakan metode ADNEX. Terdapat 46 sampel dengan hasil pemeriksaan model ADNEX ganas dan hasil pemeriksaan histopatologi ganas, 7 sampel histologi ganas namun model ADNEX jinak, 6 sampel histopatologi jinak namun model ADNEX ganas, dan 29 sampel histopatologi jinak dan model ADNEX jinak. Hasil penelitian memperlihatkan tingkat sensitifitas 86,8%, spesifisitas 82,6%, nilai prediksi positif 88,5%, nilai prediksi negatif 80,6%, dan akurasi 85,2%.Simpulan: Model ADNEX memiliki tingkat spesifisitas, sensitivitas dan akurasi diagnostik yang tinggi dalam mendiagnosis kanker ovarium dan dapat digunakan bersama dengan penanda klinis lain untuk deteksi dini keganasan pada tumor ovarium.
Pengabdian kepada Masyarakat dalam Upaya Pemanfaatan Ubi Ungu untuk Kesehatan Hidup Sehari-hari Jawi, I Made; Sutirta Yasa, I Wayan Putu; Purnamasidhi, Cokorda Agung Wahyu; Pujawan, I Made Naris; Suardika, Anom; Tirtha Yasa, I Nyoman Wawan; Pratiwi, Cokorda Agung; Divasta, I G Mahapraja
Warmadewa Minesterium Medical Journal Vol. 3 No. 3 (2024): September 2024
Publisher : Warmadewa University Press

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Abstract

Abstrak Penelitian tentang umbi ubi jalar ungu memiliki khasiat terhadap kesehatan melalui tingginya kadar antioksidan, antikarsinogenik, dan antiinflamasi. Kandungan antosianin yang cukup tinggi menjadi kunci utamanya. Oleh karenanya, antioksidan yang terkandung di umbi ubi jalar ungu tersebut sangat bermanfaat mencegah penyakit degeneratif. Seiring berjalannya waktu, kesadaran masyarakat mengenai pentingnya hidup sehat mulai meningkat. Solusi yang diterapkan untuk mengatasi permasalahan ini adalah melalui program pengabdian terkait pemanfaatan ubi ungu untuk mencegah penyakit degeneratif pada lansia. Program ini menargetkan 60 masyarakat karang lansia di Desa Celuk, dengan tujuan meningkatkan pengetahuan mereka terkait zat yang terkandung di dalam ubi ungu, cara pengolahan ubi ungu, dan manfaat kesehatan yang diperoleh dari ubi ungu. Metode pelaksanaan kegiatan ini dikemas menarik dengan hiburan, praktek pembuatan jus ubi ungu, sesi diskusi interaktif, dan evaluasi melalui pre-test dan post-test untuk mengukur efektivitas program. Hasil dari program ini menunjukan peningkatan signifikan dalam pengetahuan masyarakat mengenai manfaat dan khasiat ubi ungu untuk kesehatan hidup sehari-hari, dengan rata-rata peningkatan yang didukung oleh hasil uji statistik. Dengan demikian, pengabdian kepada masyarakat dalam upaya pemanfaatan ubi ungu untuk kesehatan hidup sehari-hari dapat meningkatkan kesadaran masyarakat karang lansia terkait pentingnya menjaga kesehatan di usia tua. Diperlukan perluasan cakupan program pengabdian ini ke wilayah-wilayah lain dan mengintegrasikan evaluasi jangka panjang untuk memastikan keberlanjutan kesadaran masyarakat dan perubahan perilaku yang diharapkan. Kata Kunci: Desa Celuk, Lansia, Pengabdian masyarakat, Ubi Ungu Abstract Community Service in an Effort to Utilise Purple Sweet Potato for Daily Living Health Research shows that purple sweet potato tubers have health benefits through high levels of antioxidants, anticarcinogenic, and anti-inflammatory substances. The high anthocyanin content is the main key. Therefore, the antioxidants contained in purple sweet potato tubers are very useful in preventing degenerative diseases. As time goes by, public awareness of the importance of healthy living begins to increase. The solution implemented to overcome this problem is through a community service program related to the use of purple sweet potatoes to prevent degenerative diseases in the elderly. This program targets 60 elderly communities in Celuk Village, with the aim of increasing their knowledge regarding the substances contained in purple sweet potatoes, how to process purple sweet potatoes, and the health benefits obtained from purple sweet potatoes. The method of implementing this activity is packaged attractively with entertainment, practice of making purple sweet potato juice, interactive discussion sessions, and evaluation through pre-test and post-test to measure the effectiveness of the program. The results of this program show a significant increase in public knowledge regarding the benefits and properties of purple sweet potatoes for daily health, with an average increase supported by statistical test results. Thus, community service in efforts to utilize purple sweet potatoes for daily health can increase awareness of the elderly community regarding the importance of maintaining health in old age. It is necessary to expand the scope of this service program to other areas and integrate long-term evaluation to ensure continued community awareness and expected behavioral changes. Keywords: Celuk Village, Elderly Population, Community Service, Purple Sweet Potato.
The Outcome of Ethanol Directed Sclerotherapy for the Management of Endometrioma: A Systematic Review Kamajaya, I Gusti Ngurah Agung Trisnu; Suardika, Anom; Mahayasa, Putu Doster; Budiana, Nyoman Gede; Abhimantra, Gede Bagus Kantwa
Indonesian Journal of Perinatology Vol. 5 No. 2 (2024): (Available online: 1 December 2024)
Publisher : The Indonesian Society of Perinatology, South Jakarta, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/inajperinatol.v5i2.56

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Background and Objectives: Ovarian endometriomas, commonly known as chocolate cysts, are prevalent gynecological conditions associated with chronic pelvic pain and infertility. Current standard treatment, laparoscopic cystectomy, poses risks such as reduced ovarian reserve. Ethanol-directed sclerotherapy has emerged as a minimally invasive alternative aiming to preserve ovarian tissue while treating endometriomas. This systematic review evaluates the outcome of ethanol directed sclerotherapy for the management of endometrioma. Methods: Following PRISMA guidelines, databases including PubMed, EMBASE, and Cochrane were searched in January 2024 using “endometrioma and sclerotherapy.” Inclusion criteria encompassed studies reporting success rate (SR), RR, and pregnancy rate (PR) post-treatment. Nine studies involving 499 patients were analyzed. Results: Ethanol sclerotherapy demonstrated >80% SR in six studies and <30% RR in seven studies, indicating efficacy in reducing recurrence. However, its impact on ovarian reserve remains inconclusive. Pregnancy outcomes were inconsistently reported, with one study achieving 100% PR, while others ranged from 0% to >30%. Variability in techniques, such as ethanol concentration and retention time, likely influenced outcomes. Conclusions: Ethanol sclerotherapy offers a promising alternative to surgery, showing lower RR and potential preservation of ovarian function. Despite these benefits, inconsistencies in procedural protocols and limited data on long-term fertility outcomes necessitate further research. Standardized guidelines and larger cohort studies are essential to establish sclerotherapy's role in endometrioma management, especially for fertility preservation.
Operative treatment for adenomyosis: update on literature review Winata, Gde Sastra; Suardika, Anom; Mahayasa, Putu Doster; Budiana, Nyoman Gede; Kamajaya, I Gusti Ngurah Agung Trisnu
Indonesian Journal of Perinatology Vol. 5 No. 2 (2024): (Available online: 1 December 2024)
Publisher : The Indonesian Society of Perinatology, South Jakarta, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/inajperinatol.v5i2.58

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Adenomyosis, a condition characterized by the presence of endometrial tissue within the myometrium, poses significant challenges in diagnosis and management due to its widespread and infiltrative nature. Operative treatment remains the primary treatment of choice for patients with symptomatic adenomyosis, especially those seeking fertility preservation or uterine conservation. This review explores the latest surgical techniques, emphasizing the balance between effective lesion removal and preservation of uterine function. Techniques such as asymmetric dissection, wedge resection, and various flap methods are discussed, highlighting their role in minimizing the loss of healthy myometrium while preserving uterine integrity. The evolution of laparoscopic and robotic approaches has improved accuracy and recovery, while innovative procedures such as the PUSH operation offer improved structural healing after excision. The choice of technique is guided by preoperative imaging and intraoperative findings, tailored to the extent and location of adenomyosis involvement. This review underscores the importance of individualized surgical strategy in achieving optimal outcomes in the surgical management of adenomyosis.
Role of hypogastric artery ligation in obstetric and gynecological hemorrhage: narrative review Winata, Gde Sastra Winata; Suardika, Anom; Mahayasa, Putu Doster; Budiana, Nyoman Gede; Kamajaya, I Gusti Ngurah Agung Trisnu
Indonesian Journal of Perinatology Vol. 5 No. 2 (2024): (Available online: 1 December 2024)
Publisher : The Indonesian Society of Perinatology, South Jakarta, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/inajperinatol.v5i2.59

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Hypogastric artery ligation (HAL) is a vital surgical intervention for controlling severe pelvic hemorrhage in obstetric and gynecological cases. This narrative review examines the efficacy, safety, and implications of HAL in managing life-threatening hemorrhages, including postpartum hemorrhage (PPH) and gynecological emergencies. HAL is particularly effective in addressing hemorrhage associated with uterine atony, placenta accreta spectrum disorders, and secondary bleeding following hysterectomy or gynecological surgeries. Success rates vary widely, ranging from 33.3% to 89.2%, depending on the indication and clinical scenario. HAL offers significant advantages in fertility preservation, especially in cases where uterine conservation is desired. The procedure has been shown to reduce arterial pulse pressure by 85% and overall blood flow by nearly 50%, enabling effective hemostasis. Despite these benefits, the success of HAL heavily depends on the surgeon's expertise and the timely identification of hemorrhage. While complications such as organ ischemia and collateral vessel injury are rare, their potential underscores the need for meticulous surgical technique and postoperative monitoring. The search strategy for this review included PubMed databases, focusing on articles published up to 2019 with keywords such as "Hypogastric Ligation," "hypogastric ligation gynecology," and "hypogastric ligation obstetric." A total of 262 studies were initially identified, with 8 meeting the inclusion criteria for detailed analysis. These studies highlight HAL's role as a fertility-sparing, cost-effective option for managing severe pelvic hemorrhage, making it an indispensable tool in obstetric and gynecological practice.
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

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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

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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