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All Journal E-Jurnal Medika Udayana E-Journal Obstetric & Gynecology Udayana The Indonesian Biomedical Journal ISM (Intisari Sains Medis) : Jurnal Kedokteran Essential: Essence of Scientific Medical Journal Indonesian Journal of Cancer
Endang Sri Widiyanti
Departemen Obstetri Dan Ginekologi, RSUP Sanglah-Fakultas Kedokteran Universitas Udayana, Denpasar, Bali, Indonesia
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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PERANAN PROCALCITONIN DALAM DIAGNOSTIK INFEKSI INTRAUTERIN Widiyanti, Endang Sri
E-Journal Obstetric & Gynecology Udayana Vol 2, No 5 (2014)
Publisher : E-Journal Obstetric & Gynecology Udayana

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Abstract

Persalinan preterm yang menjadi kelahiran preterm merupakan penyebab utama morbiditas dan mortalitas perinatal di dunia. Komplikasi persalinan preterm terhadap janin dapat melibatkan berbagai sistem organ tubuh, hematologi, endokrin, dan sistem saraf pusat. Dimana komplikasi yang ditimbulkan tentunya akan mengakibatkan dampak merugikan dari segi ekonomi, sosial, dan terutama kualitas hidup janin yang dapat bertahan hidup.1 Penyebab pasti persalinan preterm tidak diketahui, namun infeksi intrauterin dianggap sebagai penyebab terbanyak terjadinya persalinan preterm. Diagnosa infeksi intrauterin pada neonatus sulit ditegakkan oleh karena tanda-tanda klinis yang muncul tidak spesifik, selain itu pemeriksaan laboratorium rutin memiliki sensitifitas yang rendah.2 Procalcitonin (PCT) merupakan prohormon calcitonin yang dihasilkan oleh kelenjar tiroid dan terdiri dari 116 asam amino dengan berat molekul 13kDa protein. PCT tidak selalu dapat dideteksi pada serum orang sehat, namun konsentrasi serum akan meningkat saat terjadi infeksi bakteri, oleh karena itu PCT digunakan sebagai alat diagnostik infeksi bakteri. Konsentrasi serum PCT akan meningkat secara cepat dalam  2-6 jam sebagai respon tubuh terhadap stimulasi endotoksin. Serum PCT memiliki waktu paruh 25-30 jam.32 Dari karakteristik seperti yang tersebut diatas, konsentrasi serum PCT dapat digunakan sebagai penanda sepsis bakterial perinatal. Beberapa penelitian menunjukkan bahwa PCT dapat digunakan sebagai penanda infeksi intrauterin dan terjadinya persalinan preterm. Penggunaan PCT dalam praktek klinis modern terus meningkat, namun hanya sedikit data tentang PCT dalam kehamilan dan atau komplikasi kehamilan dan masa tumbuh kembang, oleh karena itu diperlukan penelitian lebih lanjut mengenai peranan PCT dalam diagnostik infeksi intrauterin dan terjadinya persalinan preterm.
RENDAHNYA KADAR IL-4 SEBAGAI FAKTOR RISIKO TERJADINYA ABORTUS IMINEN Widiyanti, Endang Sri
E-Journal Obstetric & Gynecology Udayana Vol 2, No 5 (2014)
Publisher : E-Journal Obstetric & Gynecology Udayana

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Abstract

Latar belakang : Kehamilan merupakan keadaan patologis fisiologi dimana ekspresi antigen paternal janin di dalam tubuh ibu tentu dapat memicu reaksi penolakan sistem imun maternal. Sistem imun memegang peranan dalam kejadian abortus iminen akibat tidak adanya keseimbangan Th1 dan Th2, yang menyebabkan kehamilan mendapatkan penolakan dari sistem maternal. IL-4 memegang peran yang penting dalam menjaga keseimbangan tersebut.   Tujuan : Untuk mengetahui peran rendanya IL-4 sebagai faktor risiko kejadian abortus iminen.   Rancangan Penelitian : Penelitian ini merupakan studi kasus-kontrol. Dari 60 orang ibu hamil, didapatkan 30 ibu hamil dengan abortus iminen dan 30 dengan kehamilan normal. Dan telah dilakukan pemeriksaan kadar serum IL-4 di bagianoratorium Prodia Denpasar. Dari data yang terkumpul dilakukan pengujian normalitas data dengan Kolmogorov-Smirnov, kemudian dilakukan analisa data dengan independent sample test dengan tingkat kemaknaan ? = 0,05. Untuk mengetahui kadar IL-4 terhadap abortus iminen dipakai uji Chi-Squere.   Hasil : Dari penelitian ini didapatkan kadar rerata IL-4 pada abortus iminen 0,04±0,01 pg/ml lebih rendah dari kehamilan normal dengan kadar rerata IL-4 0,22±0,31 pg/ml. Analisa kemaknaan dengan uji t-independent menunjukkan bahwa nilai t = 3.198 dan nilai p = 0.002. Hal ini berarti bahwa rerata kadar IL-4 pada kedua kelompok berbeda secara bermakna (p < 0,05). Berdasarkan nilai titik potong 0,052 pg/ml, didapatkan bahwa risiko relatif terjadinya abortus iminen adalah 6 kali (RO = 6,42, IK 95% = 2,08-19,76, p=0,001) Kesimpulan : Kadar IL-4 pada abortus iminen berbeda secara bermakna dibandingkan dengan kadar IL-4 kehamilan normal. Dan adanya kadar serum IL-4 yang lebih rendah berisiko terjadinya abortus iminen sebesar 6 kali dibandingkan dengan kadar IL-4 yang lebih tinggi . Kata kunci : Abortus iminen, kehamilan normal, IL-4
KARAKTERISTIK PASIEN KANKER SERVIKS DI RSUP SANGLAH DENPASAR PERIODE 1 JANUARI – 31 DESEMBER 2017 Ni Putu Pramana Saras Utami; I Nyoman Bayu Mahendra; Endang Sri Widiyanti; Jaqueline Sudiman
E-Jurnal Medika Udayana Vol 9 No 4 (2020): Vol 9 No 04(2020): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (285.536 KB) | DOI: 10.24843/MU.2020.V09.i4.P06

Abstract

Cervical cancer is one of the most serious malignancies because of its high incidence and transmission rate, which is around 270.000 female mortality cases occured in 2015 because of cervical cancer and 85% occured in developing countries such as Indonesia. The aim is to knowing the characteristics of cervical cancer patient at Sanglah Denpasar General Hospital during period 1st January – 31st December 2017. This research is descriptive and cross sectional. Sampling technique is total sampling where the research data comes from secondary data which is medical record of cervical cancer patient at Sanglah Denpasar General Hospital during period 1st January – 31st December 2017. The highest incidence of cervical cancer was found in group 41-50 years old as many as 23 people (32.9%), had the highest education level at elementary school as many as 34 people (48.6%), worked as housewife as many as 32 people (45.7%), majority did not have history of smoking as many as 68 people (97.1%) and did not have history of using oral contraceptive as many as 64 people (91.4%), had the age of first marriage in group 20-30 years old as many as 33 people (47.1%), have been married once as many as 67 people (95.7%), have three parity as many as 23 people (32.9%), had squamous cell carcinoma non keratinizing histopathology biopsy type as many as 47 people (67.1%), and first diagnosed with cervical cancer in stadium III B as many as 31 people (44.3%). Keywords : cervical cancer, characteristic, age, education, occupation, smoking history, oral contraceptive use history, age of first marriage, number of marriage, number of parity, histopathology biopsy result, clinical stadium
PROFIL PASIEN PENYAKIT TROFOBLASTIK GESTASIONAL DI RSUP SANGLAH DENPASAR PERIODE 1 JANUARI 2017 SAMPAI 31 DESEMBER 2017 Abi Rafdi Azizi; I Nyoman Bayu Mahendra; Endang Sri Widiyanti
E-Jurnal Medika Udayana Vol 8 No 7 (2019): Vol 8 No 7 (2019): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

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Abstract

Penyakit Trofoblastik Gestasional (PTG) adalah tumor yang dapat ditangani hingga tuntas sebelum mengalami metastase. Tujuan penelitian ini adalah mengidentifikasi karakteristikpasien PTG di RSUP Sanglah Denpasar periode 1 Januari 2017 sampai 31 Desember 2017.Penelitian ini bersifat deskriptif, retospektif. Pengambilan data dengan total sampling danpotong lintang menggunakan rekam medis pasien PTG tahun 2017. Hasil penelitian ini terdapat11 kasus dengan kasus terbanyak pada rentang usia 21-30 tahun dengan 45,5%, kemudian36,4% berasal dari luar Provinsi Bali, dan sebesar 72,7% adalah ibu rumah tangga 45,5%dengan tingkat pendidikan SMA/sederajat. Usia kawin terbanyak pada rentang usia 16-25tahun dengan 54,6%, dan 45,5% dengan paritas satu kali. Sebanyak 81,8% dengan riwayatmola hidatidosa, kemudian 54,6% memiliki jarak kehamilan sebelumnya <4 bulan, lalu 72,7%dengan perdarahan pervaginam. Sebanyak 36,4% dengan kadar ?-hCG <105 mIU/mL,kemudian 45,5% didiagnosis mola hidatidosa komplit dan 72,7% tidak ditemukan metastasedengan stadium I dan sebanyak 72,7% mendapatkan kemoterapi methotrexate. Kata kunci: PTG, mola hidatidosa, serum ?-hCG, penanganan, kemoterapi
LABOR CHARACTERISTICS OF LOW BIRTH WEIGHT BABIES (LBW) AT PUSKESMAS BATURITI I TABANAN 2018-2020 Ni Putu Yoni Prastini Kaesasih; Tjokorda Gde Agung Suwardewa; Endang Sri Widiyanti; Jaqueline Sudiman
E-Jurnal Medika Udayana Vol 11 No 5 (2022): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2022.V11.i5.P02

Abstract

ABSTRAK Kejadian BBLR dapat menyebabkan peningkatan masalah pada sistem metabolik, ginjal, kardiovaskular, dan sistem saraf pada bayi. Penyebab BBLR bersifat multifaktoral dengan faktor penyebab terbanyak berdasarkan penelitian adalah usia ibu dan penyakit yang diderita ibu. Penelitian ini bertujuan untuk mengetahui karakteristik persalinan dengan bayi BBLR di Puskesmas Baturiti I Tabanan tahun 2018-2020. Penelitian ini menggunakan metode deskriptif cross sectional dengan data sekunder. Sebanyak 56 sampel BBLR dilakukan pencatatan berdasarkan kategori BBL bayi, usia ibu, BMI ibu, LiLA, pendidikan ibu, pekerjaan ibu, paritas, riwayat abortus, jarak kelahiran, kadar Hb, jenis kelamin anak, bayi kembar, cara kelahiran/bersalin, dan penolong persalinan, dan kemudian akan dilakukan analisis secara perhitungan jumlah (n), persentase (%), dan proporsi yang ditampilkan dengan tabel deskriptif dan proporsi. Data yang hilang dilakukan penanganan dengan mean substitution menggunakan rata-rata setiap kelompok kategori. Hasil analisis data secara proporsi dari populasi bayi lahir, didapatkan bahwa BBLR terbanyak terjadi pada ibu berumur <20 tahun, BMI 18,5-22,9 kg/m2, LiLA <23,5 cm, tamat diploma, pedagang, ibu nullipara, abortus >1x, kadar Hb <11 g/dL, anak laki-laki, ibu dengan kehamilan ganda, persalinan seksio, dan penolong persalinan adalah bidan/perawat. Dapat disimpulkan bahwa, berdasarkan proporsi populasi sebagian besar hasil penelitian berada pada risiko tinggi BBLR menurut teori yang ada. Kata kunci : BBLR, usia ibu, BMI, LiLA, pendidikan ibu, pekerjaan ibu, paritas, riwayat abortus, jarak kelahiran, kadar Hb, jenis kelamin anak, bayi kembar, cara bersalin, penolong persalinan
Lower Urinary Tract Obstruction (LUTO) pada fetus: laporan kasus Rey Jauwerissa; I Nyoman Hariyasa Sanjaya; Endang Sri Widiyanti; Ryan Saktika Mulyana; Evert Solomon Pangkahila
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (795.836 KB) | DOI: 10.15562/ism.v11i3.796

Abstract

Background: Lower fetal urinary tract obstruction (LUTO) is an abnormality observed during an ultrasound test in the antenatal period in the form of an enlarged fetal bladder. Oligohydramnios, renal cortex dilation, and pulmonary hypoplasia may be caused by obstruction of the lower urinary tract. In the management of LUTO, early diagnosis and assessment as early as possible are very important. The insertion of a shunt from the fetal bladder to the amniotic cavity is one of the therapies for fetal LUTO (vesicoamniotic shunt). This case study aims to determine the management of LUTO in fetuses at Sanglah Hospital, Bali, Indonesia. Case Presentation: A 39-year-old female G3P2002 was referred to the obstetrics and gynecology clinic of Sanglah Hospital with suspected fetal LUTO for 18-19 weeks. There were no complaints or risk factors for LUTO in the past. Physical examination and obstetric examinations were within normal limits. On ultrasound examination, there was a hypohyperechoic image measuring 4.3 x 5.3 cm with the impression of the enlarged bladder, key-hole appearance, oligohydramnios, and bilateral hydronephrosis. Double pigtail installation on the fetus, amnioinfusion, and amniosynthesis was performed for karyotyping. Ten weeks after double pigtail placement, the patient developed premature labor and subsequently gave birth to a baby boy, LBW 1,800 gram, with severe asphyxia, Potter facies, abdominal distension, and leg deformities. Unfortunately, the baby eventually died 1 hour postpartum.Conclusion: Overall, infants have a poor prognosis for fetal LUTO cases. In assessing the effectiveness of treatment, early diagnosis, assessment, and early intervention are very critical. Latar Belakang: Lower Urinary Tract Obstruction (LUTO) pada fetus merupakan suatu kelainan pada periode antenatal berupa pembesaran kandung kemih fetus yang ditemukan pada pemeriksaan USG. Sumbatan saluran kemih bagian bawah tersebut dapat menyebabkan oligohidramnios, pelebaran korteks ginjal, hingga hipoplasia paru. Diagnosis awal dan evaluasi sedini mungkin sangat penting dalam penanganan LUTO. Salah satu penanganan fetal LUTO adalah dengan pemasangan shunt dari vesika urinaria fetus ke rongga amnion (vesicoamniotic shunt). Laporan kasus ini bertujuan untuk mengevaluasi penanganan LUTO terhadap fetus di RSUP Sanglah, Bali, IndonesiaPresentasi Kasus: Seorang perempuan 39 tahun G3P2002 18-19 minggu dirujuk ke poliklinik kebidanan dan kandungan RS Sanglah dengan kecurigaan fetal LUTO. Pada anamnesis tidak didapatkan keluhan maupun faktor risiko LUTO. Pemeriksaan fisis dan pemeriksaan obstetri dalam batas normal. Pada pemeriksaan USG didapatkan gambaran hipohiperekoik berukuran 4,3 x 5,3 cm dengan kesan vesika urinaria membesar, key-hole appearance, oligohidramnios dan hidronefrosis bilateral. Dilakukan tindakan pemasangan double pigtail pada fetus, amnioinfusion serta amniosintesis untuk pemeriksaan karyotyping. Sepuluh minggu setelah pemasangan double pigtail, pasien mengalami partus prematurus imminens dan selanjutnya melahirkan bayi lelaki, BBL 1.800 gram, dengan asfiksia berat, Potter facies, distensi abdomen dan deformitas tungkai. Sayangnya, bayi akhirnya meninggal 1 jam pasca-persalinan.Kesimpulan: Secara keseluruhan kasus fetal LUTO memiliki prognosis yang kurang baik bagi bayi. Diagnosis awal, evaluasi dan intervensi sedini mungkin sangat penting dalam menentukan keberhasilan terapi.
Penanganan inversio uteri: sebuah tinjauan pustaka Endang Sri Widiyanti; I Gede Mega Putra
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 (458.288 KB) | DOI: 10.15562/ism.v13i1.1262

Abstract

Acute uterine inversion is a rare but life-threatening emergency in the field of obstetrics. The main signs and symptoms of acute uterine inversion are bleeding and shock. The accuracy and speed of diagnosis and case management will reduce morbidity and mortality due to uterine inversion. This literature review is expected to increase our knowledge as practitioners in dealing with uterine inversion cases. In principle, there are two goals for the treatment of acute uterine inversion, namely repositioning the uterus and treating the shock that occurs. The success of uterine inversion repositioning is highly dependent on the speed of early detection. The longer the uterus is inverted, the more difficult it will be to reposition it. There are several non-surgical techniques for repositioning the uterus, including: Johnson maneuver, Henderson and Alles maneuver, use of tocolytics, and repositioning with hydrostatic pressure. Surgical procedures can be performed abdominally, namely the Huntington's Procedure, with abdominal repositioning laparotomy and the Haultain's Procedure, with abdominal cervical repositioning-repositioning laparotomy. Kejadian inversio uteri akut merupakan kegawatdaruratan di bidang Obstetri yang jarang terjadi namun mengancam nyawa. Tanda dan gejala utama inversio uteri akut adalah perdarahan dan syok. Ketepatan dan kecepatan diagnosa dan penanganan kasus akan mengurangi morbiditas dan mortalitas akibat inversio uteri. Tinjauan pustaka ini diharapkan dapat menambah pengetahuan kita sebagai praktisi dalam menangani kasus inversio uteri. Pada prinsipnya ada dua tujuan penanganan inversio uteri akut, yaitu reposisi uterus dan penanganan syok yang terjadi. Keberhasilan reposisi inversio uteri sangat tergantung pada kecepatan deteksi dini. Semakin lama uterus terinversi akan semakin sulit melakukan reposisi. Terdapat beberapa teknik non-bedah untuk reposisi inversio uteri, antara lain: manuver Johnson, manuver Henderson dan Alles, penggunaan tokolitik, dan reposisi dengan tekanan hidrostatik. Prosedur pembedahan dapat dilakukan melalui abdominal, yaitu Prosedur Huntington, dengan laparotomi-reposisi melalui abdominal dan Prosedur Haultain, dengan laparotomi- insisi cincin servikalis-reposisi melalui abdominal.
TINGKAT PENGETAHUAN REMAJA MENGENAI KANKER SERVIKS DI DUA SEKOLAH DI KABUPATEN GIANYAR, BALI I Komang Darma Wijaya; I Nyoman Gede Budiana; Ida Bagus Gede Fajar Manuaba; Endang Sri Widiyanti
Essence of Scientific Medical Journal Vol 21 No 2 (2024): Volume 21 No. 2 (Juli - Desember 2023) Essential: Essence of Scientific Medical
Publisher : Kelompok Ilmiah Hippocrates Fakultas Kedokteran Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/essential.v21i2.109356

Abstract

ABSTRACT Cervical cancer become the second highest cancer case in Indonesia which attacks women with a mortality rate of up to 50%. The prevalence of this case has increased in recent years. This cancer, which is caused by infection with the HPV virus, can infect women from the age of 20 until the women is not in their reproductive age. The aim of this study was to determine the level of knowledge of adolescents regarding cervical cancer in two schools in Gianyar Regency. This research is descriptive study with a stratified random sampling method. The data collection method used was by giving questionnaires to students attending SMP Negeri 1 Gianyar and SMA Negeri 1 Gianyar. The questionnaire used consists of 2 aspects, namely knowledge of cervical cancer and knowledge of how to prevent cervical cancer. From this research, 209 respondents were obtained from the two schools, there are 30.14% had a good level of knowledge, 60.29% had a fairly good level of knowledge, and 9.57% had a poor level of knowledge.
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
Incidental Histopathologic Findings of Uterine Leimyosarcoma in a 58-year-old Woman: A Rare Case Report Paskarani, Putu Erika; Hutapea, N. Yuliance Nurhawati; Widiyanti, Endang Sri; Nini, Cheryl; Sinaga, Naomi Juliana
Indonesian Journal of Cancer Vol 19, No 3 (2025): September
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v19i3.1335

Abstract

Introduction: Leiomyosarcoma accounts for (~40–50%) of all uterine sarcomas, but only 1-2% of all uterine malignancies. The incidence of leiomyosarcoma increases with age, reaching its peak in the seventh decade of life. Here, we proposed the importance of macroscopic and microscopic criteria of leiomyosarcoma to ensure clinical diagnosis.Case Presentation: A 58-year-old woman came with vaginal bleeding for 3 weeks before admission to the hospital.  The ultrasonography (USG) examination showed enlargement of the uterus and was clinically diagnosed as a leiomyoma. However, on histopathological examination, a proliferation of anaplastic cells was revealed, forming fasciculi that intersect each other and infiltrate into the connective tissue stroma. Mitosis 15/50 HPF and abnormal mitosis with abrupt coagulative necrosis are easily found. The histopathologic examination concluded that the patient had uterine leiomyosarcoma (pT1a), FIGO stage 1B.Conclusion: Histopathological examination and a clinicoradiological approach are key to identifying leiomyosarcoma. In most cases, although it is confined to the uterus, it has a poor prognosis. Otherwise, this case has a more favorable outcome due to the pathological and clinical stage, with 5-year survival rates of 40 – 70%
Co-Authors Abi Rafdi Azizi Anom Suardika Budayasa, Anak Agung Gede Raka Evert Solomon Pangkahila Hutapea, N. Yuliance Nurhawati I Gede Mega Putra I GUSTI AYU MANIK ERMAYANTI I Komang Darma Wijaya I Made Jawi I Nyoman Gede Budiana I Nyoman Hariyasa Sanjaya Ida Bagus Gde Fajar Manuaba Jaqueline Sudiman Kusuma, Anak Agung Ngurah Jaya Ni Nyoman Ayu Dewi Ni Putu Pramana Saras Utami Ni Putu Yoni Prastini Kaesasih Nini, Cheryl Nyoman Bayu Mahendra Paskarani, Putu Erika Rey Jauwerissa Ryan Saktika Mulyana Silvana, Divika Sinaga, Naomi Juliana Sun, H. Sunny Tang, Yen-An Tjokorda Gde Agung Suwardewa Wibawa, I Gusti Ngurah Agung Satria