Heru Pradjatmo
Bagian Obstetri dan Ginekologi Fakultas Kedokteran Universitas Gadjah Mada Yogyakarta

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MicroRNA-21 as a biomarker for ovarian cancer detection Kartika, Aprilia Indra; Chasanah, Siti Nur; Fitriawan, Akbar Satria; Tanjung, Dewi Sahfitri; Trirahmanto, Addin; Pradjatmo, Heru; Aryandono, Teguh; Haryana, Sofia Mubarika
Indonesian Journal of Biotechnology Vol 23, No 1 (2018)
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ijbiotech.35692

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Ovarian cancer is a lethal disease. One of the problems faced by patients with ovarian cancer is the lack of symptoms in its early stages, which results in it only being detected when it is at an advanced stage. Therefore, there is an urgent need for biomarkers that can predict ovarian cancer precisely. The purpose of this study was to determine the expression of microRNA-21 as a predictive biomarker candidate in both early- and advanced-stage ovarian cancer. This was a cross-sectional study using the blood plasma of 21 healthy control subjects and 37 blood plasma samples from patients with ovarian cancer. Blood plasmas were collected, from which the RNA was isolated. Based on the RNA, the cDNA was synthesized and run through qPCR, the results of which were analyzed using the Livak method. The results showed an upregulation of microRNA-21 in the advanced stage by 2.14 fold compared with the early stage, and 6.13 fold compared with the healthy controls (p < 0.05). The upregulation of microRNA-21 in early-stage ovarian cancer was 2.86 fold compared with the healthy control subjects (p < 0.05). In addition, there was an increase in the expression of microRNA-21 in ovarian cancer by 4.14 fold compared with the healthy controls (p < 0.05). Based on these results, it can be concluded that the expression of microRNA 21 upregulated with the severity of the disease.
Status gizi sebagai faktor prognosis penderita karsinoma endometrium Pradjatmo, Heru; Pahlevi, Deyna Primavita
Jurnal Gizi Klinik Indonesia Vol 10, No 1 (2013): Juli
Publisher : Minat S2 Gizi dan Kesehatan, Prodi S2 IKM, Fakultas Kedokteran UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (216.475 KB) | DOI: 10.22146/ijcn.18838

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Background: In Indonesia, endometrial cancer is the third gynaecologic cancer after cervical and ovarian cancers. Various factors affect the survival of the patients, however, which factors affect the survival of endometrial carcinoma patients in Dr. Sardjito Hospital remain unclear. A research is therefore needed in order to determine the survival and the prognostic factors.Objective: To investigate the prognostic factors that affect the survival of endometrial carcinoma patients who had been admitted to Dr. Sardjito Hospital.Method: The study design was retrospective cohort. The subjects were patients with endometrial carcinoma who were treated in Dr. Sardjito Hospital from 1st of January 2006 until 31st of December 2011. Kaplan-Meier analysis was performed to analyze several factors that influenced the survival of the patients. The differences of survival were analyzed with log rank test while the prognostic factors influencing the survival were analyzed using Cox regression.Results: 68 endometrial carcinoma patients were recruited as the subjects for the study. The median survival of endometrial carcinoma patients 52 months for those on early stage and 17 months on advanced stage (p≤0.01). The prognostic factors affecting survival that has been found statistically and clinically significant was the stage of the disease (p=0.002; HR=6.175; 95% CI=1.1980 to 19.25). Meanwhile, the nutritional status of patients with low, normal, and high BMIs score showed increased survival rate as indicated by the HR values of 1; 0.768; and 0.311 respectively.Conclusion: The prognostic factor that was clinically and statistically significant influenced the survival was the stage of the disease, while the nutritional status of patients was found clinically significant as the prognostic survival of the patients.
Basic principles and diagnostic of colposcopy Pradjatmo, Heru
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 47, No 2 (2015)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2084.426 KB) | DOI: 10.19106/JMedSci004702201506

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ABSTRACTThe colposcope is an optical system that offers illumination and magnifications between 10 and 16 times. Colposcopy is the diagnostic test to evaluate patients with an abnormal cervical cytological smear, abnormal VIA (visual inspection with acetic acid application) or VILI (visual inspection with Lugo’s Iodine application), abnormal appearing cervix and directing biopsies. The colposcopic examination of the cervix starts with “General Assessment” to immediately recognize the level of examination reliability. Examination should assessed for three variables: 1) adequate or inadequate, with the reason given; 2) squamocolumnar junction visibility; and 3) transformation zone type. Colposcopic features and patterns will correspond with underlying specific histological features. The greater the expertise and experience of the colposcopist, the greater the confidence in the assessment of the atypical transformation zone (TZ). For practical purposes, the most important aspect is always the recognition or exclusion of underlying actual invasive disease. The presence or absence of precancerous lesions can confirm with colposcopy.
The impact of hormonal contraceptives on breast cancer patients hospital Dr. Sardjito Awaliyah, Nuratul; Pradjatmo, Heru; Kusnanto, Hari
Berita Kedokteran Masyarakat (BKM) Vol 33, No 10 (2017)
Publisher : Fakultas Kedokteran Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (558.534 KB) | DOI: 10.22146/bkm.22812

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The use of hormonal contraceptives relates with the incidence of breast cancer in Dr. Sardjito Yogyakarta Purpose: This study aimed to determine whether women using the contraceptive pill can cause breast cancer.Methods: A case control study was conducted August to October 2016 with 250 patients.Results: Factors that were associated with breast cancer were: type of pill with adjusted OR = 1.66 (95% CI = 1.21 to 2.28; p = 0.001), duration of consumption with adjusted OR = 2.25 (95% CI = 1.04 to 4.84; p = 0.037), and the period of last hormonal contraception with adjusted OR = 2.41 (95% CI = 1. 15 to 5.05; p = 0.020). This study showed that the use of hormonal contraceptives raises the risk of breast cancer.Conclusion: Women should play an active role in breast cancer prevention programs through early detection and treatment. Health services need to explain the potential risks of hormonal contraceptive.
Status gizi sebagai faktor prognosis penderita karsinoma endometrium Pradjatmo, Heru; Pahlevi, Deyna Primavita
Jurnal Gizi Klinik Indonesia Vol 10, No 1 (2013): Juli
Publisher : Minat S2 Gizi dan Kesehatan, Prodi S2 IKM, Fakultas Kedokteran UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ijcn.18838

Abstract

Background: In Indonesia, endometrial cancer is the third gynaecologic cancer after cervical and ovarian cancers. Various factors affect the survival of the patients, however, which factors affect the survival of endometrial carcinoma patients in Dr. Sardjito Hospital remain unclear. A research is therefore needed in order to determine the survival and the prognostic factors.Objective: To investigate the prognostic factors that affect the survival of endometrial carcinoma patients who had been admitted to Dr. Sardjito Hospital.Method: The study design was retrospective cohort. The subjects were patients with endometrial carcinoma who were treated in Dr. Sardjito Hospital from 1st of January 2006 until 31st of December 2011. Kaplan-Meier analysis was performed to analyze several factors that influenced the survival of the patients. The differences of survival were analyzed with log rank test while the prognostic factors influencing the survival were analyzed using Cox regression.Results: 68 endometrial carcinoma patients were recruited as the subjects for the study. The median survival of endometrial carcinoma patients 52 months for those on early stage and 17 months on advanced stage (p≤0.01). The prognostic factors affecting survival that has been found statistically and clinically significant was the stage of the disease (p=0.002; HR=6.175; 95% CI=1.1980 to 19.25). Meanwhile, the nutritional status of patients with low, normal, and high BMIs score showed increased survival rate as indicated by the HR values of 1; 0.768; and 0.311 respectively.Conclusion: The prognostic factor that was clinically and statistically significant influenced the survival was the stage of the disease, while the nutritional status of patients was found clinically significant as the prognostic survival of the patients.
Perbandingan Skala Nyeri pada Kuretase antara Pemberian Lidokain Paraservikal dan Intraservikal Ksyatria, Yudhistya Ngudi Insan; Pradjatmo, Heru; Emilia, Ova
JURNAL KESEHATAN REPRODUKSI Vol 3, No 1 (2016)
Publisher : IPAKESPRO

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jkr.13872

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Background: Curettage is a gynecological diagnostic and therapeutic procedures. Curettage actions causing sensation of pain although the pain threshold is different for each person. Local anesthesia is an effective choice for various minor gynecological procedures. One of them is paracervical block. Paracervical block reduces pain by blocking nerve impulses across the uterovaginal plexus. Another method is the injection of local anesthetic trough intracervical who works as an anesthetic infiltrating agent, distending the tissue, causing mechanical disruption of nerve impulses. Theoritically, intracervical lidocaine injection will require a lower level of precision than the blockade of peripheral nerves directly, more reliable and reproducible. We measured patient’s pain during curettage usingthe Visual Analogue Scale (VAS). Method: RCT Location of study: Bantul District Hospital, Wonosari District Hospital, and Banjarnegara Distric Hospital. Result and Discussion: The study included 60 patients who got curettage within inclusion criteria. Every time patients came, we performed randomization and divided the patients into two groups, the control group (paracervical) and intervention group (intracervical), 30 subjects each. VAS was measured 5 minute after curettage was started. Characteristics of subjects in curettage frequency, curettage indication, parity and educational level for both groups are equal, did not differ statistically. The results of the mean pain scale (VAS). In the control group was 42,33±16,583 and 34,33±18,880 on the treatment group. Mean difference was 8 mm, with 95% CI -1.124 to 17.124 and p=0.408. The difference was not significant statistically. The intracervical group has mild pain scale (VAS<44 mm) in 27 of 30 patient, compared to 15 of 30 patients in paracervical group. It result in Relative Risk (RR) of 1,532. Conclusion: Intracervical lidocaine injection can be considered as an alternative local anesthetic on curettage. The average pain scale did not differ significantly with paracervical block. And both of it located in VAS < 44mm (mild pain). Intracervical lidocaine injection even have RR= 1,532 compared with paracervical block to produce mild pain scale (VAS < 44 mm). Keywords: curettage; paracervical;intracervical ;VAS 
PRESERVASI FERTILITAS PADA PENDERITA KANKER Pradjatmo, Heru
JURNAL KESEHATAN REPRODUKSI Vol 2, No 3 (2015)
Publisher : IPAKESPRO

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jkr.12656

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PRESERVASI FERTILITAS PADA PENDERITA KANKER*Heru Pradjatmo1ABSTRACTBackground: Young women who survive from cancer as candidates to face reproductive problemsassociated with cytotoxic cancer therapy. Side effects that alter the quality of life becomes unacceptable.Advances in reproductive medicine enables previously infertile women can obtain offspring.Objective: To recognize the effort that can be done to prevent adverse effects on fertility patients due tocancer therapyMethod: Literature studyResult and Discussion: In general, women age 40 years or less with cancer who received chemotherapy tobe likely ovarian function will cease. Studies show that many technique performed before chemotherapyallows women to have babies would be greater. Women prior to treat chemotherapy should be consultedto physicians in the field of reproductive and endocrinology for fertility preservation methods to deal withoncologist who take care the patient. All methods that can be performed should be included in counselingand all counseling and treatment including possible complications should be documented and recorded.Keywords : infertility, chemotherapy, adverse effect, preservationABSTRAKLatar Belakang: Perempuan muda yang survive dari penyakit kanker menjadi kandidat menghadapimasalah reproduksi berkaitan dengan terapi kanker yang bersifat sitotoksik. Sehingga efek samping yangmerubah kualitas kehidupan menjadi tidak dapat diterima. Kemajuan dalam kedokteran reproduksimemungkinkan wanita yang sebelumnya infertil akibat prngobatan penyakit kanker sekarang dapatmemperoleh keturunan.Tujuan: Untuk memahami upaya yang dapat dilakukan untuk mencegah terjadinya efek samping terhadapfertilitas penderita akibat terapi kanker.Metode: Studi literaturHasil dan Pembahasan: Secara umum perempuan penderita kanker sampai umur 40 tahun yangmendapat kemoterapi kemungkinan dapat berhenti fungsi ovariumnya. Studi menunjukkan bahwabeberapa teknik yang dilakukan sebelum kemoterapi memungkinkan wanita memperoleh keturunan lebihbesar. Seharusnya sebelum terapi dikonsulkan ke dokter dibidang reproduksi untuk metode preservasifertilitas dengan kesepakatan ahli onkologi yang menangani. Semua metode yang dapat dilakukan harusdimasukkan dalam konseling. Semua konseling dan pengobatan termasuk komplikasi yang mungkin terjadiseharusnya di dokumentasikan dan dicatat.Kata Kunci: infertilitas, khemoterapi, efek samping, preservasi1 Bagian Obstretika & Ginekologi Fakultas Kedokteran UGM/RSUP Dr. Sardjito Yogyakarta* Dipresentasikan pada seminar in vitro maturation (IVM) in vitro fertilization andlaparoskopic surgery, Yogyakarta, 8-9 November 2013
RASIO ESTRIOL/ ESTRADIOL TINGGI SEBAGAI PREDIKTOR KEBERHASILAN INDUKSI PERSALINAN PADA KEHAMILAN LEWAT WAKTU Adintyo Rahman, Muhammad Nur; Prawitasari, Shinta; Pradjatmo, Heru
JURNAL KESEHATAN REPRODUKSI Vol 2, No 2 (2015)
Publisher : IPAKESPRO

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jkr.12642

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RASIO ESTRIOL/ ESTRADIOL TINGGI SEBAGAI PREDIKTORKEBERHASILAN INDUKSI PERSALINAN PADA KEHAMILANLEWAT WAKTUMuhammad Nur Adintyo Rahman1, Shinta Prawitasari2, Heru Pradjatmo3ABSTRACTBackground: Induction of labor is a common procedure performed at 15-20 % of pregnancies. The mostcommon indication was prolonged pregnancy (70 %). The past decade labor induction rate was increased2-fold as well as the risk of cesarean section. Difficulties to predict the success of induction made predictorsof success of induction widely studied. Predictors can be physical or chemical markers. One of the chemicalmarker is the ratio of estriol to estradiol levels.Objective: To determine the value of the ratio of estriol/ estradiol to predict success of induction of laborin prolonged pregnancy.Method: The design of study are Prospective Cohort. Study two hospitals (Wonosobo District Hospitaland Banjarnegara District Hospital) used in this study from September 10, 2013 until December 31,2013. Blood sampling was drown from the subject before induction to examin the levels of estriol andestradiol the induction which end in vaginal delivery were noted as succesull induction Receiver OperatingCharacteristic (ROC) method in order to determine the sensitivity, specificity, positive predictive value,negative predictive value and Area Under the Curve. Bivariate and multivariate analyzes also used todetermine the correlation between variables.Results and Discussion: This study obtained 76 samples, 69 with successful induction and 7 failed ofinduction. The research got a cut-off was point 35 the sensitivity was 71% value, specificity value of 71%,positive predictive value 49%, negative predictive value was 55.6%. Area Under the was value of 80,7%.Positive likelihood ratio 1,06 and negative likelihood ratio 0,88. Bivariate and multivariate analysis showedthat the ratio of estriol / estradiol ≥ 35 ng / mL significantly associated with successful induction (OR 9,598;95% CI 1,378-66,859) Bishop score was also associated with a significant induction success (OR 13,481;95% CI 1,955 -92,955)Conclusion: This study shows that the proportion ratio of estriol / estradiol in succeed induction groupwere higher (≥ 35) compared with induction failure group (<35).Keywords: prolonged pregnancy, labor induction , estriol/ estradiol ratio, predictorsABSTRAKLatar Belakang: Induksi persalinan adalah prosedur umum yang dilakukan pada 15-20% kehamilan.Indikasi tersering adalah kehamilan lewat waktu (70%). Satu dekade terakhir angka induksi persalinantelah meningkat 2 kali lipat begitu juga dengan risiko seksio sesarea. Keberhasilan induksi sulit diprediksi.Prediktor keberhasilan induksi banyak diteliti baik penanda fisik maupun kimia. Salah satu penanda kimiaadalah rasio kadar estriol terhadap estradiol.Tujuan: Mengetahui nilai rasio kadar estriol estradiol untuk memprediksi keberhasilan induksi padakehamilan lewat waktuMetode: Kohort prospektif. Dua rumah sakit (RSUD Wonosobo dan RSUD Banjarnegara) dipakai dalampenelitian ini dari 10 September 2013 sampai 31 Desember 2013. Subyek yang memenuhi kriteriainklusi dan eksklusi diambil sampel darah sebanyak 5 ml sebelum Induksi untuk diperiksa kadar estrioldan estradiol kemudian dilihat keberhasilan induksinya. Analisis yang digunakan adalah metode ReceiverOperating Characteristic (ROC) untuk dapat mengetahui nilai sensitivitas, spesifitas, nilai ramal positif,nilai ramal negatif dan Area Under Curve. Analisis X2 dan Regresi logistik digunakan untuk mengetahuihubungan antar variabel.Hasil dan Pembahasan: Selama waktu penelitian didapatkan 76 sampel, 69 dengan induksi berhasil dan7 gagal induksi. Dengan cut off point 35, nilai sensitivitasnya 71%, nilai Spesifitas 71%, nilai ramal positif49%, nilai ramal negatif 55,6%. Nilai Area Under Curve sebesar 80.7%. Likelihood ratio positive 1,06 danlikelihood ratio negative 0,88. Hasil analisis multivariat menunjukkan bahwa Rasio estriol/ estradiol ≥ 35berhubungan dengan keberhasilan induksi secara signifikan (RO 9.598; IK 95% 1.378-66.859) Skor Bishopjuga berhubungan dengan keberhasilan induksi secara signifikan (RO 13,481; IK 95% 1.955-92.955)Kesimpulan: Kelompok yang berhasil diinduksi memiliki proporsi rasio estriol/ estradiol yang lebih tinggi(≥ 35) dibandingkan dengan kelompok gagal induksiKata kunci: Kehamilan lewat waktu, induksi persalinan, rasio estriol/ estradiol, prediktor1,2,3 Bagian Obstetri dan Ginekologi Fakultas Kedokteran Universitas Gadjah Mada Yogyakarta
Hubungan Response Time Seksio Sesarea Emergensi Kategori 1 dengan Luaran Perinatal di RSUP Dr.Sardjito Gunawan, Tri; Attamimi, Ahsanudin; Pradjatmo, Heru
JURNAL KESEHATAN REPRODUKSI Vol 5, No 1 (2018)
Publisher : IPAKESPRO

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jkr.37997

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Background: Caesarean section is often applied as a preventif efoort against the continued effects of perinatal asphyxia. The cesarean section (SC) in pregnant woman can be performed in a planned manner with various indications or performed by emergency (emergency) on maternal or fetal indications and or both.Objective: To study the association of response time in category I emergency caesarean section with perinatal outcomes in Dr. Sardjito hospital and the average response time of category 1 emergency cesarean section in Dr. Sardjito hospital.Method: This study uses retrospective cohort. Category 1 CS with an indication of fetal accordance with the inclusion criteria was recorded from 1st January 2012 until 31th July 2016, then we find the response time mean as the cut off point of this study to compare with their perinatal outcomes.Result and Discussion: There were 155 cases out of 386 of emergency CS category 1 met the inclusion criteria during the period 1st January 2012 to 31th July 2016. From the data obtained, the average response time of category 1 emergency CS was 115±52 minutes (35 - 360 minutes). We found no significant differences in perinatal outcomes in the group’s response time ≥115 minutes with a value of p>0.05 on the Apgar score, CPAP, infant mortality, ventilator, NICU care, MAS and HIE than those category 1 emergency CS with a response time <115 minutes. From multivariate analysis, general anaesthesia was statistically significant against perinatal outcomes Apgar score <7 at 5 minutes with (p=0.044). Prematurity in the multivariate analysis was statistically significant against perinatal outcomes Apgar score ≤3 at 1 minute with (p=0.040), Apgar score <7 at 5 minutes with (p=0.025) and the use of CPAP with (p=0.009).Conclusions: Response time category 1 emergency cesarean section in this study did not affect perinatal outcomes. General anesthesia effect on perinatal outcomes Apgar score <7 at 5 minutes, whereas the prematurity effect on perinatal outcomes Apgar score ≤3 at 1 minute, Apgar score <7 at 5 minutes and the use of CPAP.Keywords: category 1 emergency caesarean section, response time, fetal distress
Kepatuhan bidan Puskesmas dalam penerapan antenatal care terpadu berkualitas, deteksi penyakit dan komplikasi pada ibu hamil Sholikhah, Siti; Pradjatmo, Heru; Hakimi, Mohammad
Berita Kedokteran Masyarakat (BKM) Vol 32, No 5 (2016)
Publisher : Fakultas Kedokteran Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (471.435 KB) | DOI: 10.22146/bkm.7314

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Compliance of midwife primary health center in implementation of the antenatal care integrated quality, disease detection and complications in pregnant womenPurpose This research aimed to determine the relationship of midwife’s compliance in the implementation of the antenatal care (ANC) integrated quality with disease detection and complications in pregnant women.MethodsThis research was an observational study with a retrospective cohort design. The sample was midwives who serve pregnant women in a primary health center, involving 125 midwives. The place of research was in 21 health centers throughout Kulon Progo. Research instruments used a questionnaire, with total sampling. Data analysis used: univariable analysis to determine the distribution of the data, bivariable with chi-square tests, multivariable with linear regression tests with 95% CI and significance of p=0.05, and a qualitative analysis.ResultsMidwives compliance to the standard operating procedure has a 35% greater chance of detecting complications and illness in pregnant women than the midwife who did not follow standard operating procedure. Not all midwives in primary health care comply with ANC integrated quality.ConclusionThis study contributes to an understanding that compliance of midwives to ANC integrated quality is important as an effort to detect complications in pregnant women. The health office should establish a team for socialization, supervision, and assistance in the implementation of ANC integrated quality.