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Background: Nonalcoholic fatty liver disease is a common cause of chronic liver diseases in developed countries. Ultrasound imaging is widely used in evaluation of liver disease. The alanine transaminase and aspartate transaminase are common laboratory investigations in diagnosing liver diseases. Methodology: A cross sectional study was conducted at the Rizgary and Hawler teaching hospitals from March to 2021 to April 2022 on sample of one hundred and fifty adult patients with non-alcoholic liver fatty disease. After excluding other cause of increasing liver echogenicity, patients were diagnosed as having NAFLD if they have elevated liver enzymes with a report of fatty liver in sonographic evaluation. Results: Mean ALT of patients was (88.3 U/L); 3% of them had normal ALT, 34% of them had ALT of 57-80 U/L, 45.3% of them had ALT of 81-100 U/L and 18.7% of patients had ALT of more than 100 U/L. while and mean AST of NAFLD patients was (28.5 U/L); 10% of them had high AST. The result shows a highly significant association between increasing of ALT level and advanced grading of NAFLD.

Background: Congenital fetal anomalies were defined as any structural defect present at birth. Congenital fetal anomalies are an important causes of neonatal morbidity and mortality in developed and developing countries that affect health care system. Reliable data on these congenital anomalies are still lacking, especially in Indonesia. Objective: This study aims to determine the characteristic profile of congenital fetal anomaly in single tertiary hospital in East Java, Indonesia. Methods: Retrospective cross-sectional by using medical record data of dr. Soetomo General Hospital on January – December 2017. Results: There were 58 cases (4,3%) with fetal congenital anomaly from 1360 deliveries in 2017. The majority of cases were referral cases (51 cases; 88%) and only seven cases were booked cases in obstetric outpatient dr. Soetomo General Hospital. Most of these congenital fetal anomaly cases ( 25 cases / 43,1%) were born from mother with ages 20 – 30 years old. Most cases (34 cases; 58,64%) were diagnosed first at third trimester (gestational age > 28 weeks). There were 36 cases (62%) had active termination of pregnancy. Thirty eight percent (22 cases) were born at 37-42 weeks and majority were born section caesaria. The three highest proportion of organ systems involved in fetal congenital anomalies were those of abdomen (22 cases; 37,9%); head (20 cases; 34,5%); thorax and muskuloskeletal (each 12 cases; 20,7%). Conclusion: The incidence of congenital fetal anomaly in dr. Soetomo Hospital at 2017 was 4,3%. Omphalocele and CTEV were two most common types of congenital fetal anomaly found. Most cases of congenital fetal anomalies have a poor prognosis, 67% cases born died. Further research about risk factors and comprehensive database are needed on cases of congenital anomaly to establish appropriate prevention and management.

Background: Low birth weight (LBW) is defined by infants with birth weight less than 2500 gram, commonly caused by prematurity. Preterm infants are prone to problems such as organ immaturity, neurodevelopmental impairment until behavior disorder. Hypertension on pregnancy and preeclampsia is the most case referred and treated in dr. Soetomo General Hospital as a single tertiary teaching hospital in Surabaya, Indonesia which require early delivery and possess consequences to maternal and perinatal side. Objective: This study aims to determine the incidence and outcome of LBW infants born in dr. Soetomo General Hospital. Methods: Retrospective cross-sectional by using medical record data of dr. Soetomo General Hospital on January 2014 – December 2017. Results: There were 2350 infants with birth weight of 500-2499 gram, in which majority was on the range of 2001-2499 gram (38%.) Hypertension on pregnancy and the complications were the most indication for pregnancy termination that resulted in LBW infants. This study also found that the LBW outcome was linear with birth weight. In addition, the gestational age and five minutes APGAR score also had important role to the LBW outcome. Conclusion: The major cause of LBW infants in dr. Soetomo General Hospital was hypertension on pregnancy. There was a positive trend of survival in infants with birth weight range of 1501-2000 gram.

To compare the level of serum heme oxygenase 1 (HO-1), soluble FMS like tyrosine kinase (sFlt-1), and neonatal outcome in early onset preeclampsia (EO-PE), late onset preeclampsia (LO-PE), and normal pregnancy (NP).In this prospective observational case control study, HO-1 and sFlt-1 levels were measured in blood samples within 24 h of hospital admission. Preeclampsia cases were divided into two groups based on gestational age at delivery: EO-PE (34 weeks) and LO-PE (≥34 weeks). A total of 45 patients were involved in this study.Maternal serum level of sFlt-1 was higher in EO-PE than LO-PE and NP groups (mean ± SD; 14.50 ± 17.12 ng/ml vs 5.20 ± 6.69 ng/ml vs 2.72 ± 1.2 ng/ml [p = 0.020]. Maternal serum level of HO-1 was not different between EO-PE, LO-PE, and NP groups (p = 0.681). Birthweights were significantly lower in the EO-PE group compared with the LO-PE and NP groups (1580 ± 536 g vs 2635 ± 578 g vs 3010 ± 371 g [p = 0.000]). The rate of small for gestational age infant (26.7% vs 6.7% vs 0%; p = 0.046) and perinatal death (20% vs 0 vs 0; p = 0.037) was also significantly higher in EO-PE compared to LO-PE and NP. The maternal sFlt-1 level was negatively correlated with birthweight (p = 0.006; CC = -0.445).This study did not find a correlation between maternal HO-1 levels and sFlt-1 levels. Maternal serum sFLt-1 levels in preeclampsia were higher in EO-PE and were associated with a worse perinatal outcome.

Background Indonesia had the serious challenge of highly maternal mortality over last ten years reflecting the real national health problem. There was 305 maternal death/100.000 deliveries, where 3 major possible cause of PE, PPH and infection persisted. Recently the new comer of diseases was standing tightly behind them: lupus on pregnancy. Material & Method This was a retrospective study from medical records.. Fifty-two cases of Lupus from 4592 pregnancy during 4 years (1.13%) have been observed in DR. Soetomo Teaching Hospital (tertiary hospital) Surabaya, Indonesia from January 2013 through December 2016. Results Sixteen cases of lupus were complicated by PE (30.7%), and 37.5% cases with Lupus Nephritis (that mostly showing increased serum creatinin level > 1.4 mg%). The maternal age were 25–34 years old (62.5%) and 62.5% were multigravida. Almost half cases (43.75%) got flare, leading to 25% early termination, while the remaining casesed (75%) were conservatively managed until 34 weeks gestation. Fetal outcome reported as 11 cases (68.75%) having birthweight > 2 kg, with 37.5% asphyxia (low apgar score). Discussion Pregnancy was discouraged in women affected by SLE, due to the disease becoming more aggresive during pregnancy and a poor pregnancy outcome was frequently reported. During pregnancy, the maternal immune system adapts to allow the growth of a semi-allogenic fetus. Significant immunological changes occur including suppression of type-2 helper cells (Th2), but the upregulation of Th1 cytokines in pregnancy may increase the risk for Th1-mediated diseases. The aboved concept was reflected at our study where most cases were sucessfully managed conservative until 34 weeks gestation and majority baby born with birthweight > 2 kg. Conclusions Our results suggest that lupus women are much more likely to develop worsening maternal spesifically preeclampsia and fetal outcomes when they become pregnant.

The Offshore sandstone reservoirs in Saudi Arabia are characterized by high production potential due to the nature of the reservoir, consisting of clean coarse sand with active bottom water aquifer and in some areas, a gas cap as drive mechanisms. In recent years, horizontal wells have replaced conventional wells due to their improved deliverability and recovery efficiency. The initial completion method selected by Saudi Aramco for the horizontal wells was mainly cased hole cemented with selective perforation strategy. This completion method was troubled by non-uniform flow profiles, which drastically shortened the well production life reducing the benefit associated with the planned horizontal wells. This paper will describe the concept of an innovative openhole completion strategy that has increased well productivity and recovery compared to past horizontal completion methods. The paper will show the evolution starting with the use of openhole completions completed with passive Inflow Control Devices (ICD) allowing production optimization by delivering uniform inflow along the entire horizontal section. The paper continues to discuss the benefits associated with the integration of the passive inflow control system with artificial lift (In situ gas lift and Electrical Submersible Pump (ESP) and finally reveals plans to couple passive inflow control with active intelligent well completion technology for multilateral wells. Actual field data will be presented to validate findings and support conclusions.

In order to compare the effects of two type of long-acting progestogen contraceptive methods with subdermal levonorgestrel (LNG) implants and depot-medroxyprogesterone acetate (DMPA) injections on lipid metabolism, a clinical cohort study was performed by requiring 25 women in each group adopting either LNG implant or DMPA injection method voluntarily. After 6 months of use, serum levels of triglycerides, total cholesterol, HDL-cholesterol and LDL-cholesterol were determined and compared between the two groups of acceptors. The mean of total cholesterol in LNG implant acceptors was significantly lower than that in DMPA injection acceptors. The mean values of HDL-cholesterol in LNG implant acceptors (41.7 +/- 7.7 mg/dl) and in DMPA injection acceptors (45.0 +/- 9.0 mg/dl) were in the normal range without significant difference between the two groups. The mean value of triglycerides did not differ significantly between LNG implant acceptors (77.6 +/- 25.1 mg/dl) and DMPA injection acceptors (91.0 +/- 30.3 mg/dl). Serum concentrations of lipid fractions such as HDL-cholesterol and LDL-cholesterol in LNG implant acceptors were relatively low compared to those in DMPA injection acceptors. Since there was a comparable reduction in both total-and HDL-cholesterol levels in the LNG implant group, the ratio of total-to HDL-cholesterol, which is thought to be a factor in determining the risk of coronary artery disease, remained in the normal range (2 +/- 4.5). This suggests that the use of these two contraceptive methods with progestogens does not alter the risk of development of coronary artery disease.In Indonesia, researchers compared data on 25 women, 18-40 years old, using the subdermal levonorgestrel (LNG) implant (Norplant) with 25 women, 18-40 years old, using the depot-medroxyprogesterone acetate (DMPA) injectable (Depo-Provera) to evaluate the effects of these 2 long acting contraceptive methods on lipid metabolism. (Norplant releases about 30 mcg LNG/day. Each injection of Depo- Provera contains 150 mg DMPA.) Physicians followed the women for 6 months. The mean total cholesterol in the LNG group was much lower than that in the DMPA group (almost 150 vs. about 170 mg/dl; p .05). Mean values of high density lipoprotein (HDL)-cholesterol in the DMPA group and the LNG group fell within the normal range and were not significantly different (41.7 [29-62] vs. 45 [28-56] mg/dl). Even though the mean values of triglycerides and low density lipoprotein (LDL)-cholesterol were higher in the DMPA group, they were not significantly higher than those in the LNG group (91 vs. 77.6 mg/dl and 102 vs. 91.3 mg/dl, respectively). Since both total and HDL-cholesterol levels in the LNG group fell similarly, the ratio of total to HDL-cholesterol fell within the normal range for both groups (3.7 for LNG and 3.8 for DMPA). Nevertheless, both HDL and LDL were relatively lower in the LNG group, indicating that Norplant may have the more acceptable effect on lipid metabolism. Since the ratio of total to HDL-cholesterol may be a determinant of coronary artery disease, and it is within the normal range for both groups, these findings suggest that these 2 long-acting contraceptives do not affect the risk of coronary artery disease.