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All Journal Journal of Biomedicine and Translational Research Indonesian Journal of Obstetrics & Gynecology Science
Inu Mulyantoro
Diponegoro University
Biochemistry, Genetics & Molecular Biology Health Professions Medicine & Pharmacology Public Health

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Unraveling of Diagnosis Odyssey in A Girl with Primary Amenorrhea: A case report Ni Made Indri Dwi Susanti; Inu Mulyantoro; Dik Puspasari; Nurin Aisyiyah Listyasari; Sultana MH Faradz
Journal of Biomedicine and Translational Research Vol 6, No 1 (2020): April 2020
Publisher : Faculty of Medicine, Diponegoro University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jbtr.v6i1.6218

Abstract

ABSTRACT Background:Primary amenorrhea may result from congenital abnormalities in the development of the gonads, genital tract, or external genitalia or from a disturbance within the hypothalamic-pituitary-ovarian axis. Gonadal dysgenesis is a disorder of sex development in which the diagnosis is based on the histology of gonads and is the main cause of primary amenorrhea. Optimal protocol of management for phenotypic female with 46, XY gonadal dysgenesis involves prophylactic gonadectomy at diagnosis.Case Presentation: The patient was referred to our hospital at the age of 15 years old for primary amenorrhea. She was obese with no secondary sex sign. Gynecologic examination revealed a normal vagina and clitoris. Rectal Toucher examination revealed no internal genitalia structure. The laboratory data: FSH levels was above normal range, LH and testosterone levels were within normal range. Pelvic Ultrasonography uterus and vaginal structure and testis were not visualized. Cytogenetic and ARgene analysis found a 46, XY karyotype and no pathogenic variants. On laparoscopy, Mullerian structure and Wolffian remnant structure were identified and biopsies were performed. Based on histopathological examination and immunohistochemical markers of the right and left gonad showed the impression of Malignant Mixed Germ Cell-Sex Cord Stromal Tumor. SRY gene examination was positive.Examination of other DSD gene analysis has not been done. Second laparoscopy for gonadectomy and removal of Mullerian and Wolfiian remnant structure were performed. Conclusion:Chromosomal analysis should become the first line testing in primary amenorrhea followed by advanced molecular test. Multidisciplinary managements recommended for DSD cases.
Randomized Controlled Trial of Tranexamic Acid’s Effect on Bleeding Length: A Study on DMPA Users with Abnormal Uterine Bleeding Who Receive Low-Dose Oral Contraceptive Pill Rabiah Adawiyah; Inu Mulyantoro; Julian Dewantiningrum; Noor Pramono
Journal of Biomedicine and Translational Research Vol 6, No 1 (2020): April 2020
Publisher : Faculty of Medicine, Diponegoro University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jbtr.v6i1.4450

Abstract

ABSTRACTBackground: Contraceptive injection is the most common contraception used in Indonesia. Among the contraceptive injections, depomedroxy progesterone acetate (DMPA) is the most effective method with pregnancy rate of 0,3 pregnancy in 100 women annually. Abnormal uterine bleeding (AUB) is a common side effect occurred in DMPA users which leads to the discontinuation of contraception.Objective: To explore the effect of tranexamic acid on bleeding length for DMPA users with AUB who receive low dose Oral Contraceptive Pills (OCP).Methods: We performed double blind randomized control trial between  two groups to investigate the effect of tranexamic in managing AUB in DMPA users who receive low dose OCP. This study was performed in Dr. Kariadi Hospital Semarang, Indonesia. Forty-four subjects were divided into two groups, equally. Group 1 received 250 mg tranexamic acid four times a day for 5 days and OCP once a day for 28 days, while Group 2 received placebo four times a day for 5 days and OCP once a day for 28 days. Both groups were evaluated for bleeding length during treatment and were analyzed using Mann Whitney for post treatment with tranexamic acid.Results: The mean bleeding length was 5.2±3.62 days and 9.2±6.16 days in group 1 and 2 respectively. These bleeding lengths were significantly different between both groups (p=0.018). The precentage of subjects in whom bleeding was stopped during the first week after initial treatment was significantly higher in  group  1 than group 2 (77,3 % vs 45,5 %, p<0,030).Conclusion: Tranexamic acid significantly reduced the bleeding length in DMPA users who use OCP.
Effect of Metformin on Bcl-2/Bax Expression Ratio and Endometrial Implants: A Mouse Model in Endometriosis Study Inu Mulyantoro; Oktoria Indrapraja; Widjiati Widjiati; Noor Pramono Noerpramana
Journal of Biomedicine and Translational Research Vol 6, No 2 (2020): Augusts 2020
Publisher : Faculty of Medicine, Diponegoro University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jbtr.v6i2.8113

Abstract

Background: Endometriosis is a gynaecological disorder characterised by the presence of endometrial tissue outside the uterine cavity. Apoptosis, regulated by the balance of Bcl-2/Bax, plays an important role in the endometrial improvement. Metformin, an insulin sensitizer that is known to have beneficial effect in the endometriosis treatment, is expected to lower Bcl-2/Bax expression ratio and reduce endometrial implants.Objective: To explore the effect of metformin on the Bcl-2/Bax expression ratio and endometrial implant area of endometriosis-induced mice.Methods: This experimental study used 3-month old 33 BALB/c mice of endometriosis that were randomly and equally divided into three groups (P0, P1, and P2). On the 15th day, the P0 group was first terminated for Bcl-2/Bax examination and the size of endometrial implants. The P1 group was given aquabidest, whereas the P2 group was given metformin 4 mg/day for 14 days. The immunohistochemistry of Bcl-2/Bax expression were performed from cavum abdomen and pelvis peritoneal tissues of the mice and measured by the Remmele Scale Index, whereas the extracted mice’ endometrial implants were analysed with computer tracing method. All data normality test was calculated with Shapiro-Wilk test. The mean difference test of all groups was analysed using the one-way ANOVA test, whereas the mean difference test between groups was completed using the Unpaired T-test (LSD/Least Significance Difference).Results: The Bcl-2/Bax expression ratio and endometrial implant area in the P2 group were significantly lower compared to P0 and P1 (p<0.001). There were no significant differences in the Bcl-2/Bax expression ratio or endometrial implant area in P0 and P1 (p>0.05)Conclusion: Metformin may be a potential effective drug treatment for endometriosis by decreasing Bcl-2/Bax expression ratio and endometrial implants.
Efektivitas Pil Oral Kombinasi Dosis Rendah dalam Pengelolaan Perdarahan Uterus Abnormal pada akseptor DMPA Rabiah Adawiyah; Inu Mulyantoro
Indonesian Journal of Obstetrics & Gynecology Science Volume 2 Nomor 2 September 2019
Publisher : Dep/SMF Obstetri & Ginekologi Fakultas Kedokteran Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1361.126 KB) | DOI: 10.24198/obgynia.v2n2.161

Abstract

Tujuan: Untuk mengeksplorasi Efektivitas Pil Oral Kombinasi (POK) dalam Pengobatan Perdarahan Uterus Abnormal pada akseptor DMPA.Metode: Kami melakukan percobaan untuk menyelidiki efek pil oral kombinasi dosis rendah dalam pengelolaan PUA pada akseptor DMPA. Penelitian ini dilakukan di Rumah Sakit Dr. Kariadi Semarang, Indonesia. Desain penelitian yang digunakan adalah pra eksperimental. Dua puluh dua  akseptor DMPA diberikan terapi POK dosis rendah sekali sehari selama 28 hari (satu siklus), kemudian subjek dievaluasi untuk durasi perdarahan selama perawatan. Variabel bebas dalam penelitian ini adalah pemberian POK dosis rendah dan variabel dependen adalah jumlah hari perdarahan.Hasil: Terdapat penurunan bermakna rata-rata hari perdarahan  pada akseptor DMPA dengan PUA antara sebelum dan sesudah terapi POK dosis rendah dari 22,2(4,48) menjadi  9,2 (6,16) hari  (p=0,0001). Persentase dari subjek penelitian yang pendarahannya berhenti dalam minggu pertama setelah pengobatan adalah sebesar 45,5 %. Hanya terdapat satu orang yang mengeluhkan efek samping berupa pusing dan mual selama pengobatanKesimpulan: Pil Oral Kombinasi Dosis rendah  dapat mengurangi hari perdarahan pada akseptor DMPA Low Dose Oral Contraceptive Pills Efficacy in the Treatment of Abnormal Uterine Bleeding Secondary to DMPAAbstractObjective: To explore the effectivity of  Low Dose Oral Contraceptive Pills (LDOCP) in managing AUB in DMPA users. Method: We performed the study to investigate the effect of LDOCP in managing AUB in DMPA users. This study was performed in Dr. Kariadi Hospital Semarang, Indonesia. The study design is pre experimental. Twenty two subjects received LDOCP once a day for 28 day (one menstrual cycle). Subjects then evaluated for bleeding length during treatment. Independent variable in this study is LDOCP treatment and the dependent variable is the bleeding days.Result: The mean bleeding days in DMPA users with AUB were significantly reduced after LDOCP therapy from 22,2(4,48) days to  9,2 (6,16) days (p=0,0001). The precentage of subjects in whom bleeding was stopped during the first week initial treatment was 45,5 %. The mild side effects, such as dizziness and nausea, were experienced by only one subject.Conclusion : LDOCP significantly reduced  bleeding days in DMPA users with AUBKey words: OCP, PUA, DMPA, bleeding days
Co-Authors Dik Puspasari Julian Dewantiningrum Ni Made Indri Dwi Susanti Noor Pramono Noor Pramono Noerpramana Nurin Aisyiyah Listyasari Oktoria Indrapraja Rabiah Adawiyah Sultana MH Faradz Widjiati w