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How Does Fetal Surgery Impact Long-Term Neurological And Develop- Mental Outcomes In Children With Twin-Twin Transfusion Syndrome? Yunike Putri Nurfauzia; I Made Adi Saputra Wijaya; Mutia Juliana; Lina Haryani; Yahya Nurlianto
The Indonesian Journal of General Medicine Vol. 12 No. 2 (2025): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/zv7crn36

Introduction: Twin-Twin Transfusion Syndrome (TTTS) is a serious complication in monochorionic twin pregnancies caused by unbalanced blood flow through placental vascular anastomoses. Fetoscopic laser surgery has become the primary intervention to improve survival and reduce neurological morbidity. Methods: This review synthesizes data from randomized controlled trials, prospective and retrospective cohort studies conducted over the last decade. Studies included patients undergoing fetoscopic laser surgery with follow-up periods ranging from weeks to years, assessing survival, neurological, and developmental outcomes. Results: Survival rates after fetal laser surgery range from mid-70% to mid-80%, with one trial reporting 67-68% survival without neurodevelopmental impairment at 2 years. Cerebral palsy incidence is low (1-2%), and cognitive or motor impairments occur in 2-8% of survivors. Comparisons between surgical techniques (Solomon vs. standard laser, sequential vs. selective coagulation) show similar survival and neurodevelopmental outcomes. Immediate surgery versus expectant management in early-stage TTTS showed no significant difference in 6-month survival without severe neurologic morbidity (78% vs. 77%). Laser surgery reduces severe cerebral injury compared to no treatment (5% vs. 18%). Discussion: While fetal surgery improves survival and neurological outcomes, challenges such as preterm birth and growth discordance remain. Adjunctive therapies and long-term neurodevelopmental monitoring are essential to optimize care. Conclusion: Fetoscopic laser surgery is effective in managing TTTS, offering improved survival and reduced neurological morbidity. Continued research is needed to refine techniques and adjunctive treatments

What Is The Association Between Long-Term Intrauterine Device (IUD) Use And The Risk Of Developing Uterine Cancer In Women Aged 35-65? Yunike Putri Nurfauzia; I Made Adi Saputra Wijaya; Mutia Juliana; Lina Haryani; Yahya Nurlianto
The Indonesian Journal of General Medicine Vol. 12 No. 2 (2025): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/faa30y69

Introduction: Uterine cancer is a significant health concern, especially among women aged 35-65 years. Intrauterine devices (IUDs), including hormonal levonorgestrel-releasing intrauterine systems (LNG-IUS) and copper IUDs (Cu-IUD), are widely used for contraception and have been investigated for their potential role in reducing uterine cancer risk. Methods: A comprehensive review of studies published in the last decade was conducted, focusing on the association between long-term IUD use and uterine cancer risk in women aged 35-65. Studies included randomized controlled trials, prospective and retrospective cohorts, with follow-up durations ranging from six months to over ten years. Results: Evidence indicates that long-term use of both LNG-IUS and Cu-IUD is associated with a reduced risk of uterine cancer and its precursor lesions. LNG-IUS demonstrated superior efficacy compared to oral progestogens in treating atypical endometrial hyperplasia (AEH) and reducing cancer recurrence. Cu-IUD use was also linked to lower risks of endometrial and cervical cancers. Adverse events were generally mild, with weight gain being the most common side effect, and device-related complications such as expulsion and perforation were rare. Discussion: The protective effects of LNG-IUS are attributed to localized progestin release causing endometrial atrophy, while Cu-IUDs may exert effects through local inflammatory mechanisms. Despite promising findings, age-stratified data remain limited, and further long-term studies are needed. Conclusion: Long-term use of LNG-IUS and Cu-IUD offers effective contraception and a favorable reduction in uterine cancer risk with a good safety profile, supporting their role in preventive strategies for women aged 35-65.

What is the comparative effectiveness of cognitive behavioral therapy versus medical treatment in improving sexual function for women with sexual dysfunction? Yunike Putri Nurfauzia; I Made Adi Saputra Wijaya; Mutia Juliana; Yahya Nurlianto
The International Journal of Medical Science and Health Research Vol. 12 No. 3 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/sndsqr62

Introduction: This review investigates the comparative effectiveness of Cognitive Behavioral Therapy (CBT) versus medical treatments in improving sexual function among adult women diagnosed with sexual dysfunction. Sexual dysfunctions studied include provoked vestibulodynia (PVD), hypoactive sexual desire disorder (HSDD), vaginismus, and related conditions. Methods: Fifteen studies, primarily randomized clinical trials, were analyzed. Interventions included various forms of CBT (couple-based, group-based, mindfulness-based) and medical treatments such as lidocaine, sildenafil, bupropion, and topical steroids. Outcomes measured were sexual function, pain, sexual satisfaction, psychological distress, and relational factors. Results: CBT consistently showed significant improvements in sexual function, psychological well-being, and relationship satisfaction. For example, one study reported a 66% improvement in sexual performance after 12 weeks of CBT, and another showed an 18-point increase in sexual function scores at six months follow-up. Medical treatments provided rapid relief of physiological symptoms like pain and lubrication deficits, with effect sizes sometimes comparable to CBT. However, CBT was more effective in addressing psychological and relational aspects. Discussion: CBT’s holistic approach addresses both physiological and psychological factors, offering longer-lasting benefits and skill development for patients. Medical treatments are advantageous for quick symptom relief and ease of administration. Combined approaches may optimize outcomes. Conclusion: Both CBT and medical treatments are effective, but CBT offers broader and potentially more durable improvements in sexual health. Treatment choice should be individualized based on patient needs and dysfunction type.

What is The Association Between Low Serum Vitamin A Levels and The Risk of Developing Gestational Trophoblastic Disease Yunike Putri Nurfauzia; I Made Adi Saputra Wijaya; Mutia Juliana; Yahya Nurlianto
The International Journal of Medical Science and Health Research Vol. 12 No. 3 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/cbg2nb15

Introduction: Gestational Trophoblastic Disease (GTD) comprises a group of disorders characterized by abnormal trophoblastic proliferation, including hydatidiform mole and gestational trophoblastic neoplasia (GTN). Vitamin A, known for its role in cellular differentiation and immune modulation, has been studied for its potential association with GTD risk and treatment outcomes. Methods: A systematic review of recent studies was conducted, focusing on serum vitamin A levels in GTD patients and the effects of vitamin A supplementation on treatment response. Included studies ranged from cross-sectional analyses to randomized controlled trials involving human subjects diagnosed with various GTD subtypes. Results: Ferraz et al. (2020) reported normal serum vitamin A levels (0.3–0.7 mg/dL) in patients with complete hydatidiform mole, indicating no association between low vitamin A levels and GTD risk. Conversely, Hidayat et al. (2020) demonstrated that vitamin A supplementation (6,000 IU/day) combined with methotrexate chemotherapy in low-risk GTN patients led to a more rapid decline in beta-human chorionic gonadotropin (β-hCG) levels and reduced chemotherapy resistance compared to chemotherapy alone. Discussion: While low serum vitamin A does not appear to predispose to GTD, supplementation may enhance chemotherapy efficacy, possibly through antioxidant and immunomodulatory mechanisms. However, limited sample sizes and study heterogeneity warrant further research. Conclusion: Vitamin A supplementation shows promise as an adjunct therapy in GTD treatment, improving outcomes in select patients, though it is not linked to disease risk. Larger, controlled studies are needed to confirm these findings

What is The Role of Genetic Predisposition in Gestational Trophoblastic Disease ? : A Systematic Review Bangar Parlinggoman Tua; Yahya Nurlianto
The International Journal of Medical Science and Health Research Vol. 13 No. 7 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/egyyrs95

Introduction : Gestational Trophoblastic Disease (GTD) encompasses a spectrum of proliferative placental disorders. While genetic alterations are integral to its pathogenesis, the role of inherited genetic predisposition remains poorly quantified. A significant gap exists between the established use of genetic markers for diagnostics and a comprehensive understanding of heritable risk. This systematic review aims to synthesize the current evidence on the role of genetic predisposition in GTD. Methods : Adhering to PRISMA 2020 guidelines, a systematic literature search was conducted across PubMed, Semantic Scholar, Springer, and Google Scholar. Eligibility criteria focused on studies investigating genetic variants, hereditary factors, or familial clustering in human subjects with any form of GTD. Data on genetic analysis types, specific markers, predisposition findings, and clinical implications were systematically extracted and synthesized. Results : From 11 included studies, the evidence for inherited predisposition was limited and heterogeneous. Strong evidence was confined to recurrent hydatidiform moles, with one systematic review identifying monogenic causes involving genes such as NLRP7, CHRNA1, DYNC2H1, and RYR1. Other studies documented molecular dysregulation in genes like p53 and BCL-2 without quantifying inherited risk. A prominent theme was the diagnostic utility of genetics, with SNP arrays, STR analysis, and cell-free DNA being used for diagnosis and differentiation rather than risk prediction. No high-level evidence for predisposition was identified. Discussion : The evidence confirms a clear heritable, monogenic cause for a subset of patients with recurrent molar pregnancies. However, for sporadic GTD, research has pivoted towards diagnostic applications that improve disease detection and management, rather than establishing quantifiable predisposition risk. While genetic tools for diagnostics are advancing, their application for risk assessment remains limited. Conclusion : The clinical role of genetics in GTD is currently centered on diagnosis rather than risk prediction. While heritable factors are definitive in rare recurrent cases, quantifiable genetic risk for the broader population remains largely unknown. Future research requires large-scale association studies to identify risk alleles and translate molecular insights into prognostic and therapeutic strategies for all forms of GTD.

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