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Abstract Background Dihydroartemisinin–piperaquine (DHA–PPQ) has been adopted as first-line therapy for uncomplicated falciparum malaria in Indonesia since 2010. The efficacy of DHA–PPQ was evaluated in 2 sentinel sites in Keerom District, Papua and Merangin District, Jambi, Sumatra from April 2017 to April 2018. Methods Clinical and parasitological parameters were monitored over a 42-day period following the World Health Organization standard in vivo protocol and subjects meeting the inclusion criteria were treated with DHA–PPQ once daily for 3 days, administered orally. Results In Papua, 6339 subjects were screened through active and passive cases detection. Of the 114 falciparum and 81 vivax cases enrolled, 102 falciparum and 80 vivax cases completed the 42 day follow up, and 12 falciparum and 1 vivax cases were either lost to follow up or withdrawn. Kaplan–Meier analysis of microscopy readings of 102 falciparum cases revealed 93.1% (95% CI 86.4–97.2) as Adequate Clinical and Parasitological Response (ACPR). No delay in parasite clearance nor severe adverse reaction was observed. Recurrent parasites of Plasmodium falciparum were detected in 7 cases and categorized as late treatment failures (LTF) at days 21, 35, and 42 and one of which was reinfected by Plasmodium vivax at day 42. Two cases were confirmed as recrudescent infection and 4 were re-infection. The PCR-corrected DHA–PPQ efficacy for P. falciparum was 97.9% (95% CI 92.7–99.7). Of the 80 cases of P. vivax that were followed up, 71 cases were completely cured and classified as ACPR (88.8%, 95% CI 79.7–94.7) and 9 cases showed recurrent infection at days 35 and 42, and classified as LTF. In Sumatra, of the 751 subjects screened, 35 vivax subjects enrolled, 34 completed the 42 day follow up. Thirty-three cases were completely cured and classified as ACPR (97.1%, 95% CI 84.7–99.9) and 1 recurrent infection was observed and classified as LTF. No delay in parasite clearance nor severe adverse reaction was observed. Analysis of the Pfk13 gene in P. falciparum cases from Papua revealed no mutations associated with artemisinin resistance in the 20 SNPs previously reported. Analysis of the Pfpm2 gene at day 0 and day of recurrence in recrudescent cases revealed the same single copy number, whereas 3 of the 4 re-infection cases carried 2–3 Pfpm2 gene copy numbers. Conclusion Treatment of falciparum and vivax malaria cases with DHA–PPQ showed a high efficacy and safety.

Introduction To achieve the Sustainable Development Goals (SDGs) target 2030, the United Nations (UN) endorsed tobacco use reduction, which is essential in decreasing unnecessary deaths caused by tobacco-induced disease. This study investigates the association between tobacco use and Human Papillomavirus (HPV) infection in clinically normal uterine cervix populations from the SDGs perspective. Methods This study is a 7-year cross-sectional study of a clinically normal uterine cervix population, based on negative Visual Inspection of Acetic Acid (VIA). Subjects were recruited consecutively from the medical records of several public and private health providers in Jakarta. The Statistical Product and Service Solutions (SPSS) for Windows version 20.0 were used to analyze the data. Results A total of 1397 negative VIA subjects were collected, consisting of 4.9% (69/1397) tobacco users, and 95.1% (1328/1397) non-users. HPV-DNA positive were 4.3% (3/69) in the tobacco user group and 3.7% (49/1328) in the non-user group. Statistical analysis showed unadjusted OR was 1.19 (95% CI: 0.36–3.91, p=0.778) and adjusted OR was 1.18 (95% CI: 0.36–3.89, p=0.786). High-risk HPV (hrHPV) infections of tobacco and non-tobacco users’ groups were found in 2/3 and 27/49 (55.1%), respectively. Conclusions This study showed an insignificant statistical association between tobacco use and HPV infection in normal uterine cervix. However, the proportion of hrHPV infection was higher in tobacco users than non-users. From the SDGs perspective, cervical cancer is closely related to tobacco use and poverty. Further study is needed to support this result and evaluate other co-factor role-related cervical cancer history to achieve SDGs in 2030.

Fermented shrimp sausages are prepared spontaneously with Litopenaeus vannamei as raw material. Shrimp is one of the marine sources with rich chitosan as bioactive compounds, antioxidants, vitamin E, and probiotic lactic acid bacteria (LAB) produced by fermentation processes. This study aimed to analyze the variations in antioxidant activity, vitamin E content, total LAB, total pathogenic bacteria, pH, and acceptability of shrimp sausage produced at different fermentation times. A completely randomized experimental design study was performed using four levels of exposure time, including control (0 days), 1, 2, and 3 days. The treatment was conducted spontaneously with 1.2% salt concentration, a drying temperature of 50°C for 3 h, and fermentation at 35°C. The evaluated parameters included the antioxidant activity measured with the radical 2,2-azino-bis (3-ethylbenzothiazoline-6-sulphonic acid) method, vitamin E levels by high-performance liquid chromatography, total LAB with total plate count, and Escherichia coli bacteria by the most probable number method. Salmonella sp. and Staphylococcus aureus were estimated by the identification method. A pH meter was used to assess acidity, and hedonic organoleptic testing was performed for taste, aroma, color, and texture. The results show significant differences in antioxidant activity, vitamin E, and shrimp sausage acceptability at varied fermentation times p≤0.05. However, the best formulation was obtained with the first-day fermented shrimp sausage, as shown by its bioactive content and the level of acceptability.

Penelitian ini bertujuan untuk mengetahui pengaruh interaksi jadwal pemberian pakan secara periodik dan level protein terhadap performan dan gambaran darah itik lokal Sikumbang Jati. Penelitian ini menggunakan 108 ekor DOD umur 14 hari. Metode yang digunakan dalam penelitian ini adalah metode eksperimen yang menggunakan Rancangan Acak Kelompok (RAK) dengan pola Split-plot 3x3 dengan 3 ulangan. Faktor A adalah jadwal pemberian pakan yaitu A1 (pemberian pakan 2 kali dalam sehari), A2 (pemberian pakan 4 kali dalam sehari), A3 (pemberian pakan 6 kali dalam sehari) dan faktor B adalah pemberian level protein 18%, 20%, dan 22%. Parameter yang diukur adalah performan itik (bobot karkas, persentase karkas, dan lemak abdominal) serta gambaran darah (jumlah eritrosit, hemoglobin, dan nilai hematokrit). Hasil penelitian menunjukkan bahwa interaksi terbaik antara jadwal pemberian pakan secara periodik dan level protein adalah pada jadwal pemberian pakan sebanyak 6 kali dan level protein 22% terhadap bobot karkas, sedangkan untuk persentase karkas rata-rata tertinggi adalah jadwal pemberian pakan sebanyak 6 kali dan level protein 22%. Untuk Lemak abdominal menghasilkan interaksi tidak berbeda nyata jumlah eritrosit, kadar hemoglobin, dan hematokrit. Hasil penelitian ini menunjukkan jumlah eritrosit berkisar 1,72-2,21 juta/mm3, kadar hemoglobin berkisar 12,90 -14,94 g/100 ml, dan nilai hematokrit berkisar 48,55%. Kesimpulan penelitian ini jadwal pemberian pakan secara periodik dan level protein adanya interaksi antara bobot karkas dan persentase karkas tetapi tidak berpengaruh pada lemak abdominal dan gambaran darah itik Sikumbang Janti.

A delay on diagnosing Gestational Trophoblastic Neoplasia (GTN) may cause increase of morbidity to the patient. The important things that OBGYN usually forgot is that GTN may develop not only from previous molar gestation (50-60%), but also from abortions or ectopic pregnancy (25-30%) and term or preterm deliveries (10-25%).1,2This can cause a delay on diagnosing that may increase the GTN score from low risk become high risk, such as this case, as follow.

Along with the development of cancer diagnosis and treatment, the life expectancy of women in reproductive age who suffer from cancer are also higher. Women with cancer still have the possibility to be pregnant and have a child during or after completion of therapy. Taking this into consideration, the guideline for contraception in special circumstances like this is needed. After reviewing the safety and effectiveness of contraceptive methods available for women with cancer, The Society of Family Planning urged not to use combination hormonal contraceptives (estrogen and progestin). Hormonal contraceptive use in cancer patients may increase the risk of venous thromboembolism (Level A). T380A IUD, which has a high effectiveness, reversible, long-term, and hormone-free contraception should be considered as the primary choice in patients with breast cancer (Level A). In women who received tamoxifen therapy, the use of IUD containing Levonorgestrel can be considered as a second choice (Level B) because it can decrease the proliferation endometrium. Women with anemia due to chemotherapy may be given contraceptive containing progestin (Level A). Women with osteopenia or osteoporosis after chemotherapy should avoid progestin contraceptive injection (Level A). Currently, there are no data to evaluate the risk of venous thromboembolism in progestin contraceptive use. Further information is also needed to determine the effect of the use of IUD that contains Levonorgestrel against breast cancer recurrence and the effect of hormonal contraceptives on breast cancer in women who received chest wall radiotherapy. Keywords: cancer, contraception, malignancy

Objective: To evaluate the pr eoperative endo metria l cancer risk as a guida nce to choose th e typ e of surg ical approach based on European Society for Medical Oncology guideline (200 9). Method: Cross-sectional study involved 73 endometrial cancer patients of Dr. Cipto Mangunkusumo Hospital, from january 200 6 to December 2012 whi ch obt ain ed from medical record. The inclusion criteria wer e endometr ial cancer pati ents with compl ete D&C, ultr asonographic, and postoperative histopathological rep orts. Endometrial cancer risk of recurren ce was classified acco rding to ESMO 2009 and final diagno sis and stage based on FIGO. Result: From 40 5 patients, only 73 patients had compl ete reports. Most of the them were postmenopaus al (54.8 %), non-nulliparity (79 .9%), and obese (49.5%) women.According to risk of recurren cestratification, low, intermediate and high risk were found in 12 patients, 27 patients, and 34 pati ents. Based on FIGO, there were 60.2% early and 39.8% advanced sta ge. In high risk gro up, rates of advan ced stage wer e prominent compar ed to othe r gro ups. There were 38.3% patients with postoper ativ e positive lymph nod es metastases. Conclusion: Most of th e endometrial cancer patients we re pr eoperatively diagnosed as high risk. The commones t stage after surgical examination were me. High risk of recurrence showed more positive lymph node compared to low or intermediat e risk. Result of preoperative histopathological and myometrial invasion compared to postoper ative results wer e showed to be inconsistent Pat ients with =1/2 myometrial invasion had more positive lymph nodes metastases. Endometrial cancer risks compared to FIGO stage showed the higher the risk, th e more advanced the stage were. Keywords: endometrial cancer, FIGO stage, high risk, histol ogical type, intermediate risk , low risk, lymph node.

Objective: To evaluate Risk of Malignancy Index (RMI) as a triage tool for ovarian cancer in Dr. Cipto Mangunkusumo Hospital. Method: This is a retrospective study conducted from January 2008-December 2012 in patients diagnosed with ovarian mass. Patients admitted for surgery due to ovarian masses were included to this study. RMI 3 score was calculated based on ultrasonography examination in Dr. Cipto Mangunkusumo Hospital, CA-125 test and menopausal status. Patients without final pathological report and incomplete data were excluded from study. Data were analysed using SPSS 20 to evaluate RMI result and final pathlogical report in benign and malignant case. Result: From 882 patients identified with ovarian masses from cancer registry, only 99 patients aged 17-70 y.o were included in this study. Most of the patients were nully-parity (28.3%), non-menopausal women (60.6%), normal body mass index (40.4%), and with stage IIIC ovarian cancer (33.3%). Ultrasonography examination showed that most of patients had solid mass and ascites (19.2%). Meanwhile, CA-125 showed that patients with