Wiryawan Permadi

Background: This study was conducted to determine the correlation of anti-Mullerian hormone (AMH) level andantral follicle count (AFC) with oocyte count in women who had received controlled ovarian hyperstimulation in anin vitro fertilization (IVF) program.Materials and Methods: We retrospectively gathered the data of 42 patients who underwent IVF during 2005-2017at Aster Clinic in Dr. Hasan Sadikin Hospital and Bandung Fertility Center Limijati Hospital, Indonesia. Details ofthe subjects such as identity, characteristics, history of illness, history of previous therapy, levels of ovarian reservemarkers examined (AFC and AMH), follicle-stimulating hormone (FSH) dose given, and number of oocytes producedwere recorded.Results: A significant positive correlation between AMH (P≤0.001, r=0.530), AFC (P≤0.001, r=0.687), and AMHAFCcombination (P≤0.001, r=0.652), and the number of oocytes was found at the FSH dose of 225 IU.Conclusion: AFC and AMH are able to reliably predict ovarian response to FSH.

Background: Hyperinsulinemia, a common feature in PCOS, have been found to contribute to metabolic disturbance, such as dyslipidaemia and diabetes mellitus type 2. Oral anti-diabetic medications have been prescribed to alleviate this effect. We sought to fnd whether DLBS3233, an insulin sensitizer, could alleviate dyslipidaemia in women with PCOS with high BMI. Aim: This study aimed to investigate the effect of DLBS3233, an herbal combination of C burmanii and L spesiosa extract, on lipid profle, insulin resistance, and free testosterone of women with PCOS with high BMI. Study Setting and Design: This was a controlled trial conducted in Dr. Cipto Mangunkusumo Hospital, Jakarta, and Dr Hasan Sadikin Hospital, Bandung, Indonesia.Materials and Methods: A controlled trial was conducted on 62 volunteers diagnosed with PCOS according to Rotterdam criteria and exhibited insulin resistance as signifed by HOMA-IR > 2.0; baseline lipid profile (LDL, HDL, Triglyceride and Total cholesterol) and free testosterone concentration were obtained. Participants were given 100 mg of DLBS3233 in the morning, and volunteers were followed up monthly, with laboratory tests conducted at the third and sixth months. Data were analysed through intention-to-treat analysis, separating high BMI (≥25 kg/m2) subjects. Statistical Analysis: Repeated-measures model. Results: DLBS3233 improved lipid profle and insulin sensitivity by reducing triglycerides, HOMA-IR, and free testosterone in subjects with high BMI. Limitations and Implications: The current study does not compare the effect of DLBS3233 with a control group. A larger study with a proper control group would have to be conducted to have more conclusive results. Conclusion: This study showed that DLBS3233 holds promise as a novel therapy to improve lipid profle for women with PCOS.

Objective: PPARγ is a ligand-binding transcription factor that has been reported to be implicated in lipid metabolism, immune function, and cellular growth and differentiation. It has been suspected to play a role in the pathophysiology of preeclampsia, although the mechanism is yet to be elaborated. This study aims to investigate the expression of PPARγ in early onset preeclampsia (EOPE), late onset preeclampsia (LOPE), and normal pregnancy. We conducted this study using primary trophoblastic cell culture incubated with serum from EOPE, LOPE, and normal pregnancy. The expression of PPARγ in these cells was analyzed using Western Blot. Statistical analysis was performed using one-way ANOVA and Bonferroni’s post hoc test. p < 0.05 is considered significant. Results: Serum from normal pregnant women and EOPE did not induce any difference in the expression of PPAR-γ (p > 0.05). In contrast, expression of PPAR-γ was increased in those cells induced by serum from LOPE (p < 0.001). Therefore, we conclude that hypothetically PPAR-γ might play role in the pathophysiology of LOPE but not in EOPE. Other possibility is the activity of PPAR-γ in EOPE is inversely correlated with its expression, therefore the high enzymatic activity of PPAR-γ is tightly regulated by attenuating its expression.

Hypertension in pregnancy is one of causes in maternal mortality in West Bandung District in 2017 and there are 11 mothers (39.28%) of 28 mortality cases, which is in the highest rank. Moreover, this research aimed at analyzing maternal mortality due to hypertension in pregnancy in West Bandung District. This research was qualitative research by utilizing grounded theory approach with constructivism paradigm. Sample of this research was the closest family and health personnels who knew the cronology of maternal mortality and there were 21 people from 8 mortality cases. The sample collection utilized purposive sampling technique. Meanwhile, the instruments of this research were researchers, interview guidance, stationery, and voice recorder. Validity test utilized triangulation technique. Technique of data collection was by in depth interview and the analysis process were by transcription, reduction, coding, categorization, and theme. The result of this research was known that factors, which had contribution against maternal mortality, was such as poor access of health service and it was caused by several things: PONED function that had not been optimal in handling hypertension in pregnancy, poor quality of health service, guidance in handling hypertension in pregnancy that had not been optimal, less optimal information from health service, health personnel’s poor knowledge about hypertension in pregnancy, and delay in referring to hospital. The next factor was unhealthy living behavior, such as mother who had risk of hypertension in pregnancy did not use long-term contraception, underwent quite high failure level in the use of long-term contraception, the mother was a missing patient from the referral, and not sensitive against emergency situation. Besides that, unknown or unexpected factors also became contribution against mortality, such as unclear demographic status; undesirable pregnancy; assuming that dying in pregnancy, having birth, and in postpartum period was martyred. In conclusion, factors that contributed against maternal mortality due to hypertension in pregnancy in West Bandung District were access of health service, healthy living behavior, and unknown even unexpected factors. However, the factors that really impacted against maternal mortality were access of health service and healthy living behavior. Keywords: Maternal mortality, Hypertension in pregnancy

Female genital tuberculosis (FGTB) is a Mycobacterium infection in the reproductive organs which often leads to infertility. FGTB is either asymptomatic or causes uncharacteristic clinical presentations, making an early diagnosis is challenging. Our aims were to evaluate the clinical presentations, the process to confirm the diagnosis and followed-up the patients who had undergone laparoscopy at our center. FGTB has been reported from many countries, but has never been reported from Indonesia. Here we present case studies to document the presence of FGTB in Indonesia. There were three patients admitted to our center; two patients were admitted with irregular menstrual cycle as their chief complaint, while one patient came due to infertility. The results from laparoscopy were suggestive of FGTB; including the presence of caseating granulomas surrounded by epithelioid cells, lymphocytes, plasma cells, and Langhans giant cells. Additionally, PCR testing confirmed presence of MTB. Subsequent to diagnosis, continuous TB medications was administered with excellent clinical outcome in two patients (pregnant in 18 months after under gone laparoscopy). The infertile patient remain in one of the treated patient above. In infertile patients who live in countries where Tuberculosis is an endemic disease, such as Indonesia, a comprehensive history taking, along with ultrasonography results can be used to diagnose FGTB. Confirmation of this diagnosis can be achieved through polymerase chain reactions result. Timely diagnosis and treatment are imperative to prevent any permanent injury to patient’s reproductive organs.