Objective: To determine the use of LLETZ/LEEP to eliminate HPV DNA positive result in patients wi... more Objective: To determine the use of LLETZ/LEEP to eliminate HPV DNA positive result in patients with cervical precancerous lesions at General Hospital dr. Mohammad. Hoesin, Palembang. Methods: A case series with cervical precancerous lesions was undertaken at the Oncology Polyclinic of dr.Mohammad Hoesin Hospital Palembang from January to October 2022. There were 24 samples with positive HPV DNA before LLETZ/LEEP. Samples then checked for HPV DNA after LLETZ/LEEP. The effectiveness of LLETZ/LEEP therapy was analyzed using the Mc Nemar test. Comparison of HPV DNA outcomes (positive or negative) based on procedure, HPV DNA type and histopathological type was analyzed using Fisher Exact and Pearson Chi Square tests. All data were analyzed using SPPS version 22.0. Results: In this study, it was found that the average age of patients with cervical precancerous lesions was 40.25 ± 7.67 years (28-57 years). Based on the diagnosis, 8 samples were found with High-grade Squamous Intraepithelial Lesion (HGSIL) and 16 samples with Low-grade Squamous Intraepithelial Lesion (LGSIL). All samples in this study were housewives and the majority were multiparas (75.0%). History of abortion in the patients in this study was only found in 5 samples (20.8%). The results showed that there were significant differences in the HPV DNA before and after LLETZ/LEEP therapy (p = 0.000). In addition, the results showed that there was no difference in the outcome of HPV DNA based on the procedure (p = 1.000) and the type of HPV DNA (p = 0.643). After LLETZ/LEEP therapy was carried out, it was found that only 1 subject has positive HPV DNA result and the HPV DNA virus found was type 52 and (high risk) and 42 (low risk). Conclusion: It can be concluded that LLETZ/LEEP therapy is effective in eliminating HPV DNA positive results in cervical precancerous lesions
Informatics in Medicine Unlocked 42 (2023) 101360 , 2023
Cervicography visual inspection after acetic acid application (VIA) has been recognized as an alt... more Cervicography visual inspection after acetic acid application (VIA) has been recognized as an alternative early screening in resource-limited settings, such as Indonesia. However, the accuracy of VIA results primarily relies on the examiner's expertise, and due to inadequate and comprehensive training of healthcare workers, the accuracy of VIA is diminishing. Our primary goal was to develop a real time mobile AI-assisted cervicography interpretation system empowered by lightweight model to promptly and autonomously determine precise VIA results. Our custom dataset comprises a substantial collection of 702 subjects from Dr Mohammad Hoesin General Hospital, Indonesia which were classified into two conditions: 418 with abnormal cervixes and 302 as a control. We conducted two experiments: one focused on the detection of the region of interest (RoI) of cervix, and the other on the segmentation of precancerous lesions. In this study, we utilize the object detection approach using the combined You Only Look Once (YOLO) framework. As a result, the proposed model achieves an exceptional mean average precision (mAP) of 99% for RoI cervix detection, while the segmentation of lesions achieves a mAP of 73% and an average intersection over union score of 40%. Furthermore, the model showcases an inference time of 10.4 ms, reflecting its efficiency in processing images and generating results swiftly. We also assessed the model with two oncologist consultants, and the results indicated a satisfactory agreement with a Kappa value of 0.838. The high Kappa value signifies a substantial level of agreement between the model's predictions and the assessments made by the oncologist consultants. This further validates the effectiveness and accuracy of the model in lesion segmentation and highlights its potential utility in clinical settings.
Abstrak
Penelitian longitudinal prospektif analitik untuk menilai ketepatan prediksi timbulnya... more Abstrak
Penelitian longitudinal prospektif analitik untuk menilai ketepatan prediksi timbulnya penyakit trofoblas ganas melalui sistem penilaian prognosis mola hidatidosa yang dikembangkan oleh NETDC (New England Trophoblast Disease Center) telah dilakukan. Di antara parameter faktor risiko yang dinilai; usia penderita, jenis mola hidatidosa, pembesaran uterus, kadar hCG serum, kista lutein, serta ada- tidaknya komplikasi merupakan factor risiko yang bermakna untuk timbulnya keganasan setelah mola hidatidosa dievakuasi (p=0,032). Penelitian dilakukan pada 50 penderita mola hidatidosa dengan pengamatan lanjutan selama 1 tahun (Januari 2001-Desember 2002) di Bagian Obstetri dan Ginekologi RS Mohammad Hoesin, Palembang. Hasilnya menunjukan prediksi keganasan skor NETDC 50% pada risiko tinggi dan 10% risiko rendah untuk berkembang menjadi ganas (p<0,05). Hasil ini lebih besar dibandingkan dengan nilai yang diajukan WHO yaitu 19-30%. Risiko untuk terjadinya keganasan pasca mola hidatidosa pada kelompok risiko tinggi ialah 9,0 kali lebih tinggi disbanding pada kelompok risiko rendah (CI: 1,769-45,786). (Med J Indones 2004; 13: 40-6)
Abstract
A prospective longitudinal analytic study assessing the efficacy of NETDC (New England Trophoblastic Disease Center) prognostic index score in predicting malignancy after hydatidiform mole had been performed. Of the parameter evaluated; age of patients, type of hydatidiform mole, uterine enlargement, serum hCG level, lutein cyst, and presence of complicating factors were significant risk factors for malignancy after hydatidiform mole were evacuated (p<0.032). The study were done on 50 women diagnosed with hydatidiform mole with 1 year observation (January 2001-December 2002) at the Department of Obstetrics and Gynecology, Mohammad Hoesin Hospital, Palembang. The results showed that the NETDC prognostic index score predicted malignancy in 50% of high risk group and 10% in low risk group (p<0.05). This showed a higher number than that found by the WHO (19%-30%). The risk for incidence of malignancy after hydatidiform mole in the high risk group is 9.0 times higher compared to that of the low risk group (CI: 1.769-45.786). (Med J Indones 2004; 13: 40-6)
Keywords: New England Trophoblastic Disease Center (NETDC), gestational trophoblastic tumor, hydatidiform mole, high and low risk.
Introduction. Cervical cancer ranks among the leading causes of death in women worldwide. In Indo... more Introduction. Cervical cancer ranks among the leading causes of death in women worldwide. In Indonesia, the incidence of cervical cancer is particularly high and is expected to rise further in the future. However, a lack of knowledge and fear of the VIA test may be to blame for low screening uptake. This study was conducted to learn about mother's knowledge and attitude toward the VIA test at Puskesmas 5 Ilir Palembang. Methods. This study using descriptive method with cross-sectional design. The total sample size of people who met both inclusion and exclusion criteria is 94. Sociodemographic information, such as education, age, and employment status, is gathered through questionnaires. Results. The results of a study comparing mothers' knowledge and attitudes toward the IVA test by gender with different levels of education found that mothers' knowledge and attitudes were distributed more evenly among those with higher levels of education. Distribution of mothers' kn...
Precancerous screening using visual inspection with acetic acid (VIA) is suggested by the World H... more Precancerous screening using visual inspection with acetic acid (VIA) is suggested by the World Health Organization (WHO) for low–middle-income countries (LMICs). However, because of the limited number of gynecological oncologist clinicians in LMICs, VIA screening is primarily performed by general clinicians, nurses, or midwives (called medical workers). However, not being able to recognize the significant pathophysiology of human papilloma virus (HPV) infection in terms of the columnar epithelial-cell, squamous epithelial-cell, and white-spot regions with abnormal blood vessels may be further aggravated by VIA screening, which achieves a wide range of sensitivity (49–98%) and specificity (75–91%); this might lead to a false result and high interobserver variances. Hence, the automated detection of the columnar area (CA), subepithelial region of the squamocolumnar junction (SCJ), and acetowhite (AW) lesions is needed to support an accurate diagnosis. This study proposes a mask-RCNN ...
Indonesian Journal of Obstetrics and Gynecology, 2016
Objective: To determine the association between BRCA1 gene Q356R (1186A=G) polymorphism and epith... more Objective: To determine the association between BRCA1 gene Q356R (1186A=G) polymorphism and epithelial ovarian cancer incidence. Methods: This study is an observational analytic study with casecontrol study design. All patients diagnosed with epithelial ovarian cancer that were treated in the outpatient clinic and inpatient ward of the Department of Obstetrics and Gynecology, Dr. Mohammad Hoesin Hospital, Palembang who met the inclusion criteria were included in this study. DNA extraction was performed on blood samples, followed by PCR-RFLP process. Results: We obtained the genotype distribution of BRCA1 Q356R (1186A=G) polymorphisms to be QQ genotype (wild-type) on all 50 subjects in the case group (100%) and 50 control subjects (100%). Similarly, all BRCA1 alleles have the Q allele. The results of this study found no polymorphism of the BRCA1 Q356R (1186A=G) in the ovarian cancer and control groups. Conclusion: Polymorphism of BRCA1 gene Q356R (1186A=G) was not significantly assoc...
Objective: To determine the efficacy of neoadjuvant chemotherapy on changes of vitamin A serum in... more Objective: To determine the efficacy of neoadjuvant chemotherapy on changes of vitamin A serum in advanced cervical carcinoma patient. Method: A randomized clinical trial was performed in the Oncology Gynecology Polyclinic and Ward of Dr. Mohammad Hoesin General Hospital, Palembang from September 2019 to September 2020. There were 30 subjects of advanced cervical carcinoma. Vitamin A levels and tumor volume subjects were assessed before and 1 month after 3 cycles of NAC and analyzed using the Paired T Test and Wilcoxon test. The correlation between vitamin A levels and tumor volume was analyzed by using Spearman's Rho test. Data analysis was using SPSS version 22.0. Results: This study showed statistically not significant increase on vitamin A levels after 3 cycles of NAC chemotherapy (p=0.515). However, there was a significantly decrease in tumor volume after 3 cycles of NAC (p=0.000). In addition, there was a moderate negative correlation between tumor size and vitamin A (r=-0...
Objective: To determine the use of LLETZ/LEEP to eliminate HPV DNA positive result in patients wi... more Objective: To determine the use of LLETZ/LEEP to eliminate HPV DNA positive result in patients with cervical precancerous lesions at General Hospital dr. Mohammad. Hoesin, Palembang. Methods: A case series with cervical precancerous lesions was undertaken at the Oncology Polyclinic of dr.Mohammad Hoesin Hospital Palembang from January to October 2022. There were 24 samples with positive HPV DNA before LLETZ/LEEP. Samples then checked for HPV DNA after LLETZ/LEEP. The effectiveness of LLETZ/LEEP therapy was analyzed using the Mc Nemar test. Comparison of HPV DNA outcomes (positive or negative) based on procedure, HPV DNA type and histopathological type was analyzed using Fisher Exact and Pearson Chi Square tests. All data were analyzed using SPPS version 22.0. Results: In this study, it was found that the average age of patients with cervical precancerous lesions was 40.25 ± 7.67 years (28-57 years). Based on the diagnosis, 8 samples were found with High-grade Squamous Intraepithelial Lesion (HGSIL) and 16 samples with Low-grade Squamous Intraepithelial Lesion (LGSIL). All samples in this study were housewives and the majority were multiparas (75.0%). History of abortion in the patients in this study was only found in 5 samples (20.8%). The results showed that there were significant differences in the HPV DNA before and after LLETZ/LEEP therapy (p = 0.000). In addition, the results showed that there was no difference in the outcome of HPV DNA based on the procedure (p = 1.000) and the type of HPV DNA (p = 0.643). After LLETZ/LEEP therapy was carried out, it was found that only 1 subject has positive HPV DNA result and the HPV DNA virus found was type 52 and (high risk) and 42 (low risk). Conclusion: It can be concluded that LLETZ/LEEP therapy is effective in eliminating HPV DNA positive results in cervical precancerous lesions
Informatics in Medicine Unlocked 42 (2023) 101360 , 2023
Cervicography visual inspection after acetic acid application (VIA) has been recognized as an alt... more Cervicography visual inspection after acetic acid application (VIA) has been recognized as an alternative early screening in resource-limited settings, such as Indonesia. However, the accuracy of VIA results primarily relies on the examiner's expertise, and due to inadequate and comprehensive training of healthcare workers, the accuracy of VIA is diminishing. Our primary goal was to develop a real time mobile AI-assisted cervicography interpretation system empowered by lightweight model to promptly and autonomously determine precise VIA results. Our custom dataset comprises a substantial collection of 702 subjects from Dr Mohammad Hoesin General Hospital, Indonesia which were classified into two conditions: 418 with abnormal cervixes and 302 as a control. We conducted two experiments: one focused on the detection of the region of interest (RoI) of cervix, and the other on the segmentation of precancerous lesions. In this study, we utilize the object detection approach using the combined You Only Look Once (YOLO) framework. As a result, the proposed model achieves an exceptional mean average precision (mAP) of 99% for RoI cervix detection, while the segmentation of lesions achieves a mAP of 73% and an average intersection over union score of 40%. Furthermore, the model showcases an inference time of 10.4 ms, reflecting its efficiency in processing images and generating results swiftly. We also assessed the model with two oncologist consultants, and the results indicated a satisfactory agreement with a Kappa value of 0.838. The high Kappa value signifies a substantial level of agreement between the model's predictions and the assessments made by the oncologist consultants. This further validates the effectiveness and accuracy of the model in lesion segmentation and highlights its potential utility in clinical settings.
Abstrak
Penelitian longitudinal prospektif analitik untuk menilai ketepatan prediksi timbulnya... more Abstrak
Penelitian longitudinal prospektif analitik untuk menilai ketepatan prediksi timbulnya penyakit trofoblas ganas melalui sistem penilaian prognosis mola hidatidosa yang dikembangkan oleh NETDC (New England Trophoblast Disease Center) telah dilakukan. Di antara parameter faktor risiko yang dinilai; usia penderita, jenis mola hidatidosa, pembesaran uterus, kadar hCG serum, kista lutein, serta ada- tidaknya komplikasi merupakan factor risiko yang bermakna untuk timbulnya keganasan setelah mola hidatidosa dievakuasi (p=0,032). Penelitian dilakukan pada 50 penderita mola hidatidosa dengan pengamatan lanjutan selama 1 tahun (Januari 2001-Desember 2002) di Bagian Obstetri dan Ginekologi RS Mohammad Hoesin, Palembang. Hasilnya menunjukan prediksi keganasan skor NETDC 50% pada risiko tinggi dan 10% risiko rendah untuk berkembang menjadi ganas (p<0,05). Hasil ini lebih besar dibandingkan dengan nilai yang diajukan WHO yaitu 19-30%. Risiko untuk terjadinya keganasan pasca mola hidatidosa pada kelompok risiko tinggi ialah 9,0 kali lebih tinggi disbanding pada kelompok risiko rendah (CI: 1,769-45,786). (Med J Indones 2004; 13: 40-6)
Abstract
A prospective longitudinal analytic study assessing the efficacy of NETDC (New England Trophoblastic Disease Center) prognostic index score in predicting malignancy after hydatidiform mole had been performed. Of the parameter evaluated; age of patients, type of hydatidiform mole, uterine enlargement, serum hCG level, lutein cyst, and presence of complicating factors were significant risk factors for malignancy after hydatidiform mole were evacuated (p<0.032). The study were done on 50 women diagnosed with hydatidiform mole with 1 year observation (January 2001-December 2002) at the Department of Obstetrics and Gynecology, Mohammad Hoesin Hospital, Palembang. The results showed that the NETDC prognostic index score predicted malignancy in 50% of high risk group and 10% in low risk group (p<0.05). This showed a higher number than that found by the WHO (19%-30%). The risk for incidence of malignancy after hydatidiform mole in the high risk group is 9.0 times higher compared to that of the low risk group (CI: 1.769-45.786). (Med J Indones 2004; 13: 40-6)
Keywords: New England Trophoblastic Disease Center (NETDC), gestational trophoblastic tumor, hydatidiform mole, high and low risk.
Introduction. Cervical cancer ranks among the leading causes of death in women worldwide. In Indo... more Introduction. Cervical cancer ranks among the leading causes of death in women worldwide. In Indonesia, the incidence of cervical cancer is particularly high and is expected to rise further in the future. However, a lack of knowledge and fear of the VIA test may be to blame for low screening uptake. This study was conducted to learn about mother's knowledge and attitude toward the VIA test at Puskesmas 5 Ilir Palembang. Methods. This study using descriptive method with cross-sectional design. The total sample size of people who met both inclusion and exclusion criteria is 94. Sociodemographic information, such as education, age, and employment status, is gathered through questionnaires. Results. The results of a study comparing mothers' knowledge and attitudes toward the IVA test by gender with different levels of education found that mothers' knowledge and attitudes were distributed more evenly among those with higher levels of education. Distribution of mothers' kn...
Precancerous screening using visual inspection with acetic acid (VIA) is suggested by the World H... more Precancerous screening using visual inspection with acetic acid (VIA) is suggested by the World Health Organization (WHO) for low–middle-income countries (LMICs). However, because of the limited number of gynecological oncologist clinicians in LMICs, VIA screening is primarily performed by general clinicians, nurses, or midwives (called medical workers). However, not being able to recognize the significant pathophysiology of human papilloma virus (HPV) infection in terms of the columnar epithelial-cell, squamous epithelial-cell, and white-spot regions with abnormal blood vessels may be further aggravated by VIA screening, which achieves a wide range of sensitivity (49–98%) and specificity (75–91%); this might lead to a false result and high interobserver variances. Hence, the automated detection of the columnar area (CA), subepithelial region of the squamocolumnar junction (SCJ), and acetowhite (AW) lesions is needed to support an accurate diagnosis. This study proposes a mask-RCNN ...
Indonesian Journal of Obstetrics and Gynecology, 2016
Objective: To determine the association between BRCA1 gene Q356R (1186A=G) polymorphism and epith... more Objective: To determine the association between BRCA1 gene Q356R (1186A=G) polymorphism and epithelial ovarian cancer incidence. Methods: This study is an observational analytic study with casecontrol study design. All patients diagnosed with epithelial ovarian cancer that were treated in the outpatient clinic and inpatient ward of the Department of Obstetrics and Gynecology, Dr. Mohammad Hoesin Hospital, Palembang who met the inclusion criteria were included in this study. DNA extraction was performed on blood samples, followed by PCR-RFLP process. Results: We obtained the genotype distribution of BRCA1 Q356R (1186A=G) polymorphisms to be QQ genotype (wild-type) on all 50 subjects in the case group (100%) and 50 control subjects (100%). Similarly, all BRCA1 alleles have the Q allele. The results of this study found no polymorphism of the BRCA1 Q356R (1186A=G) in the ovarian cancer and control groups. Conclusion: Polymorphism of BRCA1 gene Q356R (1186A=G) was not significantly assoc...
Objective: To determine the efficacy of neoadjuvant chemotherapy on changes of vitamin A serum in... more Objective: To determine the efficacy of neoadjuvant chemotherapy on changes of vitamin A serum in advanced cervical carcinoma patient. Method: A randomized clinical trial was performed in the Oncology Gynecology Polyclinic and Ward of Dr. Mohammad Hoesin General Hospital, Palembang from September 2019 to September 2020. There were 30 subjects of advanced cervical carcinoma. Vitamin A levels and tumor volume subjects were assessed before and 1 month after 3 cycles of NAC and analyzed using the Paired T Test and Wilcoxon test. The correlation between vitamin A levels and tumor volume was analyzed by using Spearman's Rho test. Data analysis was using SPSS version 22.0. Results: This study showed statistically not significant increase on vitamin A levels after 3 cycles of NAC chemotherapy (p=0.515). However, there was a significantly decrease in tumor volume after 3 cycles of NAC (p=0.000). In addition, there was a moderate negative correlation between tumor size and vitamin A (r=-0...
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Penelitian longitudinal prospektif analitik untuk menilai ketepatan prediksi timbulnya penyakit trofoblas ganas melalui sistem penilaian prognosis mola hidatidosa yang dikembangkan oleh NETDC (New England Trophoblast Disease Center) telah dilakukan. Di antara parameter faktor risiko yang dinilai; usia penderita, jenis mola hidatidosa, pembesaran uterus, kadar hCG serum, kista lutein, serta ada- tidaknya komplikasi merupakan factor risiko yang bermakna untuk timbulnya keganasan setelah mola hidatidosa dievakuasi (p=0,032). Penelitian dilakukan pada 50 penderita mola hidatidosa dengan pengamatan lanjutan selama 1 tahun (Januari 2001-Desember 2002) di Bagian Obstetri dan Ginekologi RS Mohammad Hoesin, Palembang. Hasilnya menunjukan prediksi keganasan skor NETDC 50% pada risiko tinggi dan 10% risiko rendah untuk berkembang menjadi ganas (p<0,05). Hasil ini lebih besar dibandingkan dengan nilai yang diajukan WHO yaitu 19-30%. Risiko untuk terjadinya keganasan pasca mola hidatidosa pada kelompok risiko tinggi ialah 9,0 kali lebih tinggi disbanding pada kelompok risiko rendah (CI: 1,769-45,786). (Med J Indones 2004; 13: 40-6)
Abstract
A prospective longitudinal analytic study assessing the efficacy of NETDC (New England Trophoblastic Disease Center) prognostic index score in predicting malignancy after hydatidiform mole had been performed. Of the parameter evaluated; age of patients, type of hydatidiform mole, uterine enlargement, serum hCG level, lutein cyst, and presence of complicating factors were significant risk factors for malignancy after hydatidiform mole were evacuated (p<0.032). The study were done on 50 women diagnosed with hydatidiform mole with 1 year observation (January 2001-December 2002) at the Department of Obstetrics and Gynecology, Mohammad Hoesin Hospital, Palembang. The results showed that the NETDC prognostic index score predicted malignancy in 50% of high risk group and 10% in low risk group (p<0.05). This showed a higher number than that found by the WHO (19%-30%). The risk for incidence of malignancy after hydatidiform mole in the high risk group is 9.0 times higher compared to that of the low risk group (CI: 1.769-45.786). (Med J Indones 2004; 13: 40-6)
Keywords: New England Trophoblastic Disease Center (NETDC), gestational trophoblastic tumor, hydatidiform mole, high and low risk.
Penelitian longitudinal prospektif analitik untuk menilai ketepatan prediksi timbulnya penyakit trofoblas ganas melalui sistem penilaian prognosis mola hidatidosa yang dikembangkan oleh NETDC (New England Trophoblast Disease Center) telah dilakukan. Di antara parameter faktor risiko yang dinilai; usia penderita, jenis mola hidatidosa, pembesaran uterus, kadar hCG serum, kista lutein, serta ada- tidaknya komplikasi merupakan factor risiko yang bermakna untuk timbulnya keganasan setelah mola hidatidosa dievakuasi (p=0,032). Penelitian dilakukan pada 50 penderita mola hidatidosa dengan pengamatan lanjutan selama 1 tahun (Januari 2001-Desember 2002) di Bagian Obstetri dan Ginekologi RS Mohammad Hoesin, Palembang. Hasilnya menunjukan prediksi keganasan skor NETDC 50% pada risiko tinggi dan 10% risiko rendah untuk berkembang menjadi ganas (p<0,05). Hasil ini lebih besar dibandingkan dengan nilai yang diajukan WHO yaitu 19-30%. Risiko untuk terjadinya keganasan pasca mola hidatidosa pada kelompok risiko tinggi ialah 9,0 kali lebih tinggi disbanding pada kelompok risiko rendah (CI: 1,769-45,786). (Med J Indones 2004; 13: 40-6)
Abstract
A prospective longitudinal analytic study assessing the efficacy of NETDC (New England Trophoblastic Disease Center) prognostic index score in predicting malignancy after hydatidiform mole had been performed. Of the parameter evaluated; age of patients, type of hydatidiform mole, uterine enlargement, serum hCG level, lutein cyst, and presence of complicating factors were significant risk factors for malignancy after hydatidiform mole were evacuated (p<0.032). The study were done on 50 women diagnosed with hydatidiform mole with 1 year observation (January 2001-December 2002) at the Department of Obstetrics and Gynecology, Mohammad Hoesin Hospital, Palembang. The results showed that the NETDC prognostic index score predicted malignancy in 50% of high risk group and 10% in low risk group (p<0.05). This showed a higher number than that found by the WHO (19%-30%). The risk for incidence of malignancy after hydatidiform mole in the high risk group is 9.0 times higher compared to that of the low risk group (CI: 1.769-45.786). (Med J Indones 2004; 13: 40-6)
Keywords: New England Trophoblastic Disease Center (NETDC), gestational trophoblastic tumor, hydatidiform mole, high and low risk.