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Kematian maternal merupakan indikator yang menggambarkan status kesehatan wanita dan sebagian besar merupakan kematian yang dapat dicegah. Kematian maternal di Kabupaten Cirebon mengalami peningkatan dari tahun 2014?2015 yaitu dari 49 menjadi 53 kasus. Dibutuhkan data kematian yang lengkap untuk mengkaji penyebab kematian. Pengkajian yang tepat memberikan masukan perbaikan penanganan dan pembuatan kebijakan pada masa mendatang. Tujuan penelitian ini adalah untuk mengidentifikasi dan mengeksplorasi faktor penyebab kematian maternal. Desain penelitian menggunakan sequensial explanatory mixed method. Tahap pertama pengambilan data kuantitatif terhadap 53 data OVM, RMM, dan RMMP, serta rekapitulasi laporan kematian maternal tahun 2015, kemudian dilanjutkan pengambilan data kualitatif melalui indepth interview yang dilakukan pada keluarga (suami/ibu/orang tua/mertua/saudara kandung perempuan) dari ibu yang mengalami kematian, tenaga kesehatan yang terkait dengan kematian maternal, dan penanggungjawab pencatatan dan pelaporan kematian maternal di dinas kesehatan, fasilitas pelayanan kesehatan, dinas kependudukan dan catatan sipil/dinas pemakaman. Penelitian dilakukan di Kabupaten Cirebon pada Bulan Oktober-November 2016. Seluruh kematian maternal telah tercatat dan terlaporkan. Sebagian besarnya merupakan kematian maternal dapat dicegah yang disebabkan oleh multifaktor diantaranya faktor pasien, tenaga kesehatan, dan rujukan 37,5%; faktor pasien dan tenaga kesehatan 29,2%; faktor pasien, sarana prasarana, dan rujukan 14,5%; faktor tenaga kesehatan dan rujukan 8,3%; faktor sarana dan rujukan 6,3%; serta faktor pasien, tenaga kesehatan, sarana prasarana, dan rujukan 4,2%. Kematian maternal yang dapat dicegah disebabkan oleh kontribusi banyak faktor yang saling berkaitan sehingga untuk menurunkan kematian maternal dibutuhkan komitmen dan kerjasama lintas program dan lintas sektoral.

Surgery is the treatment of choice for early-stage cervical cancer, whereas radiation is conducted during all stages where the malignancy remains localized to the pelvis. Various surgical techniques, such as laterally extended parametrectomy, are alternative therapy options for patients with stage II-B and I-B cervical cancer and lymph node metastases. (Pálfalvi and Ungár, 2003) Previously, these patients were referred for radiation therapy or neoadjuvant chemotherapy.

Purpose: The ultimate goal of cytoreduction surgery is the complete removal of all visible tumors (complete cytoreductive surgery) or tumor residues <1 cm (optimal cytoreduction surgery). Following cytoreduction surgery in ovarian cancer, tumor residue is one of the most important prognostic factors. Oncologists strive to be able to predict the outcome of cytoreduction surgery during the presurgical period. The purpose of this study was to assess CCL5 as a modality for determining whether a patient could perform optimal cytoreduction surgery or not. Materials and Methods: This was an observational, analytic, and cross-sectional study of patients with ovarian cancer who underwent surgery at the Dr. Hasan Sadikin Bandung from 2019 to 2020. All of the patients had stage I-IV disease based on the International Federation of Gynecology and Obstetrics (FIGO) score. Results: In total, 72 patients were enrolled in this study, 31 of whom underwent suboptimal cytoreduction surgery and 41 underwent optimal cytoreduction surgery. The mean serum CCL5 level at suboptimal cytoreduction was 70,920.87 ± 36,362.966, while that at optimal cytoreduction was 43,244.95 ± 21,983.887. CCL5, as a predictor of suboptimal cytoreduction surgery, had a sensitivity of 61.3%, a specificity of 68.3%, and an accuracy of 65.7% (p = 0.012). Conclusion: Preoperative CCL5 serum levels can predict suboptimal cytoreduction surgery outcomes in patients with ovarian cancer.

Objective Visual inspection of cervix after acetic acid application (VIA) has been considered an alternative to Pap smear in resource-limited settings, like Indonesia. However, VIA results mainly depend on examiner’s experience and with the lack of comprehensive training of healthcare workers, VIA accuracy keeps declining. We aimed to develop an artificial intelligence (AI)-based Android application that can automatically determine VIA results in real time and may be further developed as a health care support system in cervical cancer screening. Result A total of 199 women who underwent VIA test was studied. Images of cervix before and after VIA test were taken with smartphone, then evaluated and labelled by experienced oncologist as VIA positive or negative. Our AI model training pipeline consists of 3 steps: image pre-processing, feature extraction, and classifier development. Out of the 199 data, 134 were used as train-validation data and the remaining 65 data were used as test data. The trained AI model generated a sensitivity of 80%, specificity of 96.4%, accuracy of 93.8%, precision of 80%, and ROC/AUC of 0.85 (95% CI 0.66–1.0). The developed AI-based Android application may potentially aid cervical cancer screening, especially in low resource settings.

Objective: Low-risk gestational trophoblastic neoplasia (GTN) is generally treated with single agent chemotherapy and methotrexate (MTX) as a first-line therapy. Vitamin A helps to increase trophoblast cell regression, as well as to decrease β-hCG levels. Vitamin A also increases the effectiveness of MTX by inducing more malignant cell death than MTX alone. Therefore, the aim of the current study was to analyze the changes in β-hCG levels in low-risk GTN patients following vitamin A administration. Methods: This study was a randomized clinical trial, which examined initial serum vitamin A and β-hCG levels in GTN patients before and after three cycles of MTX therapy. Patients were given vitamin A supplementation of 6,000 IU (1.8 mg RAEs) per day, and the changes in serum β-hCG were observed after three cycles. Patients were grouped by β-hCG levels (decreased or stagnant). Results: A total of 32 low-risks GTN patients were divided into the intervention group (16 patients who received vitamin A supplementation) and the control group (16 patients who did not receive vitamin A supplementation). In the intervention group, the average initial β-hCG level was 170,949.3 ± 354,452.1 mIU/mL, and the average β-hCG post-cycle level was 1,611.9 ± 3,652.5 mIU/mL. In the control group, the average initial β-hCG level was 178,834.1 ± 2913844.6 mIU/mL, and the average β-hCG post-cycle level was 25,388.5 ± 58,437.7 mIU/mL. Conclusion: In patients with low-risk GTN who underwent MTX chemotherapy, the levels of β-hCG and the incidence of chemo resistance in the intervention group were lower than those in the control group. Older age may also influence the incidence of chemo resistance in GTN patients. Oral administration of 6,000 IU vitamin A could help to reduce β-hCG levels in low-risk GTN patients who receive MTX chemotherapy.

Kanker serviks merupakan jenis kanker terbanyak nomor dua di kalangan perempuan di Indonesia setelah kanker payudara. Kanker serviks dikenal dengan "silent killer" karena perkembangannya yang sulit dideteksi. Metode see and treat dengan pemeriksaan Inspeksi Visual Asam Asetat (IVA) dan tindakan segera jika ditemukan IVA positif menggunakan krioterapi merupakan upaya untuk menurunkan angka kejadian dan mortalitas yang disebabkan kanker serviks. Tujuan penelitian ini adalah untuk melakukan evaluasi pelaksanaan program deteksi dini kanker serviks di Kabupaten Karawang dari dimulainya pelaksanaan program pilot project dari tahun 2007 hingga sekarang. Metode: Desain penelitian menggunakan metode mixed method. Rancangan penelitian kuantitatif dengan metode potong lintang dan rancangan penelitian kualitatif dengan melakukan wawancara dengan panduan open-ended question. Hasil: Dari hasil penelitian variabel yang paling berpengaruh terhadap komponen input adalah sumber daya manusia dan dukungan pemerintah berupa pendanaan, pada komponen proses adalah variabel pelaksanaan dan monitoring evaluasi, sedangkan pada variabel output sasaran target program masih jauh dari yang diharapkan. Kesimpulan: Dapat disimpulkan bahwa program deteksi dini kanker serviks dengan metode see and treat di Kabupaten karawang masih kurang optimal. Dibutuhkan sumber daya manusia yang baik secara kualitas dan kuantitas, ketersediaan sarana dan prasarana, dukungan pemerintah yang optimal, dan sosialisasi masyarakat untuk menunjang keberhasilan program.