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Background: Fetal cardiac rhabdomyoma is a rare condition. Case: We report a case with cardiac mass discovered in utero by prenatal ultrasonography at 33 weeks of gestational age. An echogenic round-oval shape mass at the interventricular septum protrudes to left ventricle was observed. Results: After birth, the baby was followed up for 7 months with echocardiography, physical examination, and computerized tomography scan, to rule out anything related to tuberous sclerosis. The prognosis depends on the size, site, number of tumors, and coexisting congenital abnormalities. Management highly depends on the presence of outflow tract obstruction of the heart. However, some cases may regress after birth.

Background: Preterm labor is still become a serious health problem in Obstetric and Perinatology with no sensitive biomarker currently approved. Several studies show that decrease antioxidant activity may play significant role in preterm labor. However, only few studies had been conducted to evaluate blood catalase level in preterm labor and assess its role in preterm labor. Objective: The aim this study was to identify the differences of maternal serum catalase level in preterm labor compared with preterm pregnancy. Methods: An observational analytic cross sectional study was conducted from February to December 2014 using pregnant women with 28-36 weeks' gestational age. Blood catalase level was evaluated by colorimetric method and the data was analyzed by SPPS for Windows 17.0 program. Results: 12 subjects were enrolled and divided into preterm and control group. No significant differences between mean age, gestational age, and parity between preterm and control group. However, blood catalase level was significantly lower in preterm group compared with control group (81.82 ± 20.38 vs 159.38 ± 35.79; p=0.001). Conclusion: Serum maternal catalase level were significantly lower in preterm labor compared with preterm normal pregnancy.

BACKGROUND: Malignant Ovarian Germ Cell Tumors (MOGCT) most commonly occur in young women in the reproductive age group. Timely antenatal diagnosis and treatment of the tumour to enhance maternal and perinatal outcomes are the main challenges confronting the obstetrician and the gyne-oncologist. CASE PRESENTATION: Here we present three cases of pregnancy complicated with MOGCTs. The first case (immature teratoma) was complicated by maternal psychological symptoms consistent with stress and histopathological examination confirmed the diagnosis of premature ovarian failure (POF). The second case (dysgerminoma) preterm labour occurred as an obstetric complication, but the baby was born in good condition without IUGR. The third case (yolk sac tumour) treated with docetaxel (brexel)-carboplatin chemotherapy administration there was no maternal or fetal complication. At the end of the pregnancy and delivery, complete surgical staging and cytoreduction were performed, and no metastases were found. CONCLUSION: Optimal management strategies centre on a multi-disciplinary comprehensive team approach is critical resulting in better outcomes for the mother and the baby by avoiding complications.

Background: Several biomarkers have been investigated as predictors of Premature rupture of membrane (PROM), but these biomarkers have not been applied in clinical practice due to their high cost and complexity. Beta-HCG is thought to be an easy, cost-effective and promising predictor of PROM in clinical practice. This study aims to determine the relationship between beta-hCG level in vaginal washing fluid with the PROM and the cut-off value of beta-hCG level in vaginal washing fluid in predicting the incidence of PROM.Methods: This diagnostic study was conducted in the Sanglah General Hospital, Denpasar, from May to July 2020. The subjects involved in this study are all pregnant women with gestational age ?24 weeks who came with complaints of vaginal discharge and were treated in the delivery room of the Emergency Ward, Sanglah General Hospital. The beta-HCG level was evaluated using the immunoassay method and the ROC curve analysis was performed to determine the beta-hCG level in vaginal washing cut-off point that can predict the incidence of PROM. Data were analyzed using SPSS version 22 for Windows.Results: Thirty-five subjects who met the inclusion and exclusion criteria were involved in this study. The cut-off value of beta-hCG vaginal washing fluid to predict PROM obtained in this study was 118.1 mIU/ml with sensitivity of 95.83%, specificity of 81.81%, PPV of 92.00%, NPV of 90.00%, and accuracy of 91.43% (AUC: 0.947; 95%CI: 0.870-1.000; p<0.001).Conclusion: Beta-hCG level in the vagina washing fluid can be used as a fast and non-invasive predictor of PROM in pregnant women.

Background: Premature rupture of membranes (PROM) is a condition that complicates labor with an unclear pathogenesis. HSP70 is thought to be involved in this pathogenesis process and the presence of HSP in the extracellular compartment reflects tissue damage and induces an immunologic response. Therefore, this study aimed to study the relationship between HSP70 levels in amniotic fluid and the incidence of PROM.Methods: This study used a case-control design in the ER delivery room and the laboratory of Sanglah Hospital, Denpasar. Samples were taken from mothers who gave full term delivery in the emergency room at Sanglah Hospital Denpasar with mothers who gave birth at term with KPD as cases and mothers who gave full term delivery without KPD as controls. Data was taken from medical records and measured levels of HSP70 at the Sanglah Hospital Denpasar Laboratory. Data analysis was performed using the Mann-Whitney test and ROC test.Results: A total of 28 cases and 28 controls were recruited. There were no significant differences in baseline characteristics between cases and controls. The MannWhitney test found significant differences in the mean levels of HSP70, 11.58 (±8.16) ng/mL in controls and 17.15 (±6.51) ng/mL in cases, respectively. ROC analysis found an AUC of 0.737 with an optimal cutoff value of 12.5 ng/mL. An amniotic fluid HSP70 level of more than 12.5 ng/mL was associated with PROM with an OR of 17.33 (95% CI 3.43 - 87.70).Conclusion: High amniotic fluid HSP 70 level is a risk factor for PROM in term pregnancy.  Latar belakang: Ketuban pecah dini (KPD) merupakan suatu kondisi yang mempersulit persalinan dengan patogenesis yang belum jelas. HSP70 dianggap terlibat dalam proses patogenesis ini dan keberadaan HSP di kompartemen ekstraseluler mencerminkan kerusakan jaringan dan menginduksi respon imunologi. Oleh karena itu, penelitian ini bertujuan untuk mempelajari hubungan kadar HSP70 dalam cairan ketuban dengan kejadian KPD.Metode: Penelitian ini menggunakan desain kasus kontrol di ruang bersalin IGD dan Laboratorium RSUP Sanglah Denpasar. Sampel diambil dari ibu yang bersalin cukup bulan di ruang bersalin IGD RSUP Sanglah Denpasar dengan ibu yang melahirkan cukup bulan dengan KPD sebagai kasus dan ibu yang bersalin cukup bulan tanpa KPD sebagai kontrol. Data diambil dari rekam medis dan dilakukan pengukuran kadar HSP70 di Laboratorium RSUP Sanglah Denpasar. Analisis data dilakukan dengan menggunakan uji Mann-Whitney dan uji ROC.Hasil: Sebanyak 28 kasus dan 28 kontrol direkrut. Tidak ada perbedaan yang signifikan dalam karakteristik dasar antara kasus dan kontrol. Uji MannWhitney menemukan perbedaan yang signifikan dalam tingkat rata-rata HSP70, masing-masing 11,58 (± 8,16) ng/mL pada kontrol dan 17,15 (± 6,51) ng/mL dalam kasus. Analisis ROC menemukan AUC 0,737 dengan nilai cutoff optimal 12,5 ng/mL. Tingkat HSP70 cairan ketuban lebih dari 12,5 ng/mL dikaitkan dengan PROM dengan OR 17,33 (95% CI 3,43 - 87,70).Simpulan: kadar HSP 70 cairan amnion yang tinggi merupakan faktor risiko terjadinya KPD pada kehamilan aterm.

Abstract Corona Virus Disease 19 is a contagious infectious disease that has a major impact on all aspects of life. This study explores the factors associated with the need for ventilators use in COVID-19 patients. This cross-sectional study uses secondary data from medical records, taken by total sampling technique, of patients treated at Sanglah Hospital from March 2020 to August 2020. Only complete and clear medical record of patients diagnosed with COVID-19 were analyzed using chi-square and stepwise logistic regression with SPSS for windows 25 software. This study had received ethical approval from the Udayana University independent ethics commission with the number 1839/UN 14.2.2.VII/LT/2020. Patients with aged ≥ 50 years (OR 2.8; 95% CI 1.45—5.54)), BMI > 25 kg/m2 (OR 4.5; 95% CI 1.57—13.03), alcohol consumption history (OR 3.8; 95% CI 1.35—10.81), hemoglobin level <10 g/dl (OR 3.8; 95% CI 1.74—9.15), or WBC ≥ 12.000 (OR 2.3; 95% CI 1.05—5.12), were at higher risk to use ventilator. Gender, smoking history, employment history, length of stay, having comorbidity had no significant difference in the need for a ventilator. The most dominant risk factor causing worsening outcomes of COVID-19 was BMI > 25 kg/m2. Keywords: risk factor, ventilator status, COVID-19, body mass index   Abstrak Corona Virus Disease 19 merupakan penyakit menular yang berdampak besar pada semua aspek kehidupan. Studi ini mengeksplorasi faktor-faktor yang berhubungan dengan kebutuhan penggunaan ventilator pada pasien COVID-19. Penelitian ini merupakan studi potong lintang menggunakan data sekunder dari rekam medis. Pengumpulan data menggunakan teknik total sampling dengan melakukan eksplorasi rekam medis pasien yang dirawat mulai bulan Maret 2020 sampai Agustus 2020 di RSUP Sanglah. Kriteria rekam medis yang digunakan dalam penelitian adalah rekam medis yang lengkap dan jelas dari pasien terdiagnosis COVID-19. Analisis dilakukan secara deskriptif dan analitik menggunakan uji chi-square, dan regresi logistik bertahap dengan software SPSS dari windows versi 25. Penelitian ini telah mendapatkan persetujuan etik dari komisi etik independen Universitas Udayana nomor 1839/UN 14.2.2.VII/LT/2020. Total sebanyak 331 rekam medis yang dianalisis. Pasien berumur ≥ 50 tahun (OR 2,8; 95%CI 1.45-5.54), indeks massa tubuh > 25 kg/m2 (OR 4.5; 95% CI 1.57—13.03), riwayat konsumsi alkohol (OR 3.8; 95% CI 1.35—10.81), kadar hemoglobin <10 g/dl (OR 3.8; 95% CI 1.74—9.15), jumlah lekosit ≥ 12.000 (OR 2.3; 95% CI 1.05—5.12), mempunyai risiko lebih besar untuk menggunakan ventilator selama perawatan. Jenis kelamin, riwayat merokok, riwayat pekerja migran, lama perawatan di rumah sakit, dan komorbiditas tidak berhubungan bermakna dengan penggunaan ventilator. Indeks massa tubuh >25 kg/m2 merupakan faktor risiko paling dominan terhadap perburukan pasien COVID-19 yang dinilai dari penggunaan ventilator selama dirawat di rumah sakit Kata kunci: indeks massa tubuh, penggunaan ventilator, faktor risiko, COVID-19

Background and purpose: Case manager services in inpatient rooms have gained popularity in many hospitals in Indonesia, however there are challenges in its implementation. This study aims to explore ways to optimize the characteristics of the case manager, case management practice and outcome of the case manager in cases in inpatient wards based on the Sanglah Hospital standards.Methods: The study utilized a two-stage Delphi study design, started with a qualitative data collection and followed by a quantitative survey. Data collection was done in May-June 2020 based on the concept of case manager characteristics, practice and outcomes. The qualitative data collection through in-depth interviews involved 9 key informants. It aimed to explore case manager services based on qualifications, competencies, ethical standards, workload, hierarchy and guidelines, implementation of case management and indicators of effectiveness of case management at Sanglah General Hospital. The results of the in-depth interviews with thematic analysis informed the Delphi survey instrument development. The Delphi survey aimed to generate agreement on the characteristic of the case manager, case management practice and outcome of the case manager among 21 expert panelists (case managers) in the inpatient wards of Sanglah Hospital. This Delphi survey was conducted in 3 rounds, the results were analyzed based on the median value and quartile deviation (QD).Results: The three rounds of the Delphi survey showed that there was an agreement regarding the qualifications of the case manager, competency development, mechanism for appointment and placement of case managers, case manager guidelines, organizational structure, job descriptions and authorities, information of the presence and role of case managers, screening indicators according to characteristics of inpatient cases, case management target measurement tools, case manager service evaluation indicators as well as the activity feedback loop.Conclusion: Optimization of the case manager service should focus on aspects of human resources, developing guidelines and work systems as well as evaluation indicators and feedback mechanism.