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"Latar belakang: Endometriosis merupakan kelainan medis yang menimbulkan beberapa komplikasi biologis, psikologis, dan sosial. Tingkat perawatan yang optimal untuk pasien endometriosis disebut sebagai perawatan yang berpusat pada pasien, namun sangat jarang. ENDOCARE adalah kuesioner yang dikembangkan secara sistematis yang menilai semua aspek perawatan endometriosis yang berpusat pada pasien. Kuesioner ini belum banyak digunakan oleh para klinisi di Indonesia. Tujuan: Tujuan dari penelitian ini adalah untuk mengembangkan terjemahan bahasa Indonesia dari kuesioner ENDOCARE. Metode: Dari Juli 2020 hingga Desember 2020, 108 pasien endometriosis dari klinik Dr. Cipto Mangunkusumo di Jakarta, Indonesia, berpartisipasi dalam studi cross-sectional ini. Pasien dengan masalah komunikasi dikeluarkan dari berpartisipasi dalam penelitian ini. Kuesioner ENDOCARE versi bahasa Inggris diterjemahkan ke dalam bahasa Indonesia oleh penerjemah tersumpah dan ahli di bidang kebidanan dan ginekologi sosial, dan kemudian kembali ke bahasa Inggris. Pendekatan PLS-SEM digunakan untuk mengevaluasi validitas dan reliabilitas ENDOCARE versi Indonesia. Hasil: Sebanyak 108 individu berpartisipasi dalam penelitian. Pada 27 dari 38 indikator, nilai outer loading test lebih dari 0,708 7 dari 10 dimensi mencapai Cronbach's Alpha lebih besar dari 0,7 dan reliabilitas komposit antara 0,7 dan 0,95. Tujuh dimensi menunjukkan validitas konstruk dan determinan. Kuesioner ENDocare versi bahasa Indonesia berisi 21 pertanyaan yang mencakup tujuh topik berbeda. Kesimpulan: Kuesioner ENDOCARE versi bahasa Indonesia merupakan instrumen yang valid dan reliabel untuk menilai perawatan endometriosis yang berpusat pada pasien.

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Background: Endometriosis is a medical disorder resulting in several biological, psychological, and social complications. The optimal level of care for endometriosis patients is referred to be patient-centered care, however it is extremely uncommon. The ENDOCARE is a systematically developed questionnaire that assesses all facets of patient-centered endometriosis care. This questionnaire has not yet been utilized by Clinicians in Indonesia. Purpose: The purpose of this study is to develop the Indonesian translation of the ENDOCARE questionnaire. Methods: From July 2020 to December 2020, 108 endometriosis patients from Dr. Cipto Mangunkusumo's clinic in Jakarta, Indonesia, participated in this cross-sectional study. Patients with communication problems were excluded from participating in the study. The English version of the ENDOCARE questionnaire was translated into Indonesian by sworn translators and experts in social obstetrics and gynecology, and then back into English. The PLS-SEM approach was utilized to evaluate the validity and reliability of the Indonesian version of ENDOCARE. Results: A total of 108 individuals participated in the research. On 27 of 38 indicators, outer loading test values were more than 0.708 7 of the 10 dimensions attained a Cronbach's Alpha greater than 0.7 and a composite reliability between 0.7 and 0.95. Seven dimensions demonstrated construct and determinant validity. The Indonesian version of the ENDocare questionnaire contains 21 questions covering seven different topics. Conclusion: The Indonesian version of the ENDOCARE questionnaire is a valid and reliable instrument for assessing patient-centered endometriosis care."

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Latar belakang: Heterogenitas pasien endometriosis terkait presentasi fenotip klinisnya memerlukan standar pengambilan data. Saat ini belum ada standardisasi pengambilan data fenotip klinis pasien endometriosis di Indonesia. Translasi kuesioner klinis WERF-EPHect Clinical Questionnaire (Standard) (EPQ-S) ke dalam Bahasa Indonesia dan validasi kuesioner ini diperlukan untuk mengetahui apakah alat ini dapat digunakan di Indonesia sebagaimana telah digunakan di negara lain dan memastikan bahwa data yang dihasilkan akurat dan andal.

 

Tujuan: Untuk membuat sebuah standar pengambilan data fenotip klinis pasien endometriosis di Indonesia dan untuk mengetahui hasil terjemahan dan validitas kuesioner klinis WERF-EPHect Clinical Questionnaire (Standard) (EPQ-S) yang telah diterjemahkan ke dalam Bahasa Indonesia

 

Metode: Penelitian ini dilakukan dengan metode transkultural adaptasi. Uji validasi ini kuesioner EPHect EPQ-S dilakukan melalui proses forward-backward translation, harmonisasi oleh para expert, cognitive debriefing kepada target kuesoioner serta proofreading dan finalisasi oleh para expert. Penelitian dilakukan di RSCM selama 6 bulan yaitu Januari 2019 sampai Juli 2019.

 

Hasil: Translasi dan validasi isi kuesioner WERF-EPHect Clinical Questionnaire (Standard) Versi Indonesia memiliki 10 tahap termasuk proses persiapan, Forward Translation (translasi maju), proses rekonsiliasi, Backward Translation (translasi balik), review translasi balik, Proses Harmonisasi, proses Cognitive Debriefing, review hasil cognitive debriefing dan finalisasi, proses Proofreading dan laporan Final. Terdapat perbedaan budaya dari negara kuesioner asal termasuk obat-obatan yang tersedia di Indonesia, istilah-istilah medis yang lumrah di Negara asal namun asing di populasi Indonesia, dan penyajian suku ras yang tidak menggambarkan varian suku ras Indonesia.

 

Kesimpulan: Didapatkan kuesioner klinis WERF-EPHect Clinical Questionnaire (Standard) (EPQ-S) versi Bahasa Indonesia dengan isi sesuai kebutuhan pengguna di Indonesia dan dapat diaplikasikan di RSCM, dari 116 butir pertanyaan terdapat 21 butir pertanyaan dalam kuesioner yang harus terpimpin.

 

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Background: The heterogeneity of endometriosis patients related to the presentation of clinical phenotypes requires standard data collection. At present there is no standardization of clinical phenotype data for endometriosis patients in Indonesia. Translation of the WERF-EPHect Clinical Questionnaire (Standard) clinical questionnaire (EPQ-S) into Indonesian language and the validation of this questionnaire is needed to find out whether this tool can be used in Indonesia as it has been used in other countries and ensure that the resulting data is accurate and reliable.

 

Objective: To create a standard for taking clinical phenotype data for endometriosis patients in Indonesia and to find out the translation results and the validity of the WERF-EPHect Clinical Questionnaire (Standard) clinical questionnaire (EPQ-S) that has been translated into Indonesian and has been accurate and reliable.

 

Method: This research was conducted with the transcultural adaptation method. This validation test EPHect EPQ-S questionnaire was carried out through a process of forward-backward translation, harmonization by experts, cognitive debriefing to questionnaire targets and proofreading and finalization by experts. The study was conducted at the RSCM for 6 months, namely January 2019 to July 2019.

 

Results: Translation and validation of the contents of the Indonesian version of the WERF-EPHect Clinical Questionnaire (Standard) questionnaire have 10 stages including the preparation process, Forward Translation, forward reconciliation process, Backward Translation, back translational review, Harmonization Process, Cognitive Debriefing process, reviewing cognitive debriefing and finalization results, Proofreading process and Final report. There are cultural differences from the country of origin of the questionnaire including medicines available in Indonesia, medical terms that are common in the country of origin but unfamiliar in Indonesian population, and the presentation of racial tribes that do not describe variants of Indonesian racial tribes.

 

Conclusion: The WERF-EPHect Clinical Questionnaire (Standard) (EPQ-S) Indonesian version was obtained with contents according to the needs of users in Indonesia and can be applied at the RSCM, out of 116 questions there are 21 questions in the questionnaire that must be guided.

 

Keywords: Translation, Validation, WERF-EPHect Clinical Questionnaire (Standard), Clinical Phenotype, Endometriosis, Indonesia

 

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"Latar belakang. Endometriosis adalah suatu penyakit radang kronik yang dicirikan dengan adanya pertumbuhan jaringan mirip endometrium yang dapat ditemukan pada peritoneum, ovarium, dan septum retrovagina. Penyakit ini merupakan penyakit multifaktorial yang dapat disebabkan oleh faktor genetik dan lingkungan. Selain itu, faktor hormonal diketahui mempengaruhi perkembangan dan klinis endometriosis. Resistensi hormon progesteron merupakah salah satu penyebab terjadinya endometriosis karena sering dihubungkan dengan rendahnya kadar dan aktivitas kerja reseptor hormon progesteron pada endometriosis. Polimorfisme gen reseptor progesteron (PROGINS=progesterone receptor gene polymorphism) diketahui berkaitan dengan risiko endometriosis. Penelitian ini bertujuan untuk mengetahui hubungan polimorfisme gen reseptor progesteron (PR) rs139646398 dengan endometriosis di Indonesia. Metode penelitian. Penelitian cross sectional ini menggunakan 30 sampel jaringan endometriosis ovarium dari wanita penderita endometriosis dan 17 jaringan endometrium dari wanita tanpa endometriosis. Sampel DNA dari subjek diisolasi, dilakukan PCR, diikuti dengan proses elektroforesis, dan dilanjutkan dengan DNA sequencing. Hasil. Hasilnya dianalisis secara statistik dengan uji Fisher. Tidak ditemukan perbedaan yang signifikan frekuensi genotip rs139646398 dari gen PR pada endometriosis ovarium dan kontrol (p=0,638). Penelitian ini menunjukkan tidak adanya hubungan antara polimorfisme gen reseptor progesteron rs139646398 dengan endometriosis di Indonesia. Kesimpulan. Penelitian ini menunjukkan tidak adanya hubungan antara polimorfisme gen reseptor progesteron rs139646398 dengan endometriosis di Indonesia.

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Endometriosis is a chronic inflammatory disease characterized by the growth of endometrial-like tissues that can be found in peritoneum, ovary, and retrovaginal septum. This disease is a multifactorial disease caused by genetic and environmental factors. In addition, hormonal factors are known to influence the development and clinical symptom of endometriosis. Progesterone resistance is one of the causes of endometriosis. It is often associated with low levels or activity of hormone progesterone receptor in endometriosis patients. Progesterone receptor gene polymorphism (PROGINS) is known to be associated with the risk of endometriosis. This study aims to determine the relationship between progesterone receptor (PR) gene polymorphism rs139646398 with endometriosis.

Methods. This cross sectional study used 30 endometriosis ovary samples from women suffered endometriosis and 17 endometrium tissues from women without endometriosis. DNA samples from subjects were isolated, PCR was carried out, then followed by electrophoresis, and continued with DNA sequencing.

Results. The results were statistically analysed by Fisher’s test. There was no statistically significant difference in genotype frequency of rs139646398 of the PR gene in ovarian endometriosis and controls (p=0.638).

Conclusion. This study shows no relationship between progesterone receptor gene polymorphism rs139646398 and endometriosis in Indonesia."

"Latar Belakang: Salah satu hipotesis yang menjelaskan hubungan endometriosis dengan infertilitas adalah endometriosis diyakini menyebabkan gangguan fisiologi ovarium, salah satunya dengan mempengaruhi folikulogenesis yang menyebabkan penurunan kualitas oosit. Oosit memainkan peran penting dalam mengatur dan mendukung pertumbuhan folikel, melalui produksi faktor pertumbuhan oosit. Beberapa faktor pertumbuhan telah diidentifikasi pada oosit manusia, termasuk growth differentiation factor-9 GDF-9 . Namun, sampai saat ini penelitian mengenai ekspresi GDF-9 pada sel granulosa pada wanita infertil dengan endometriosis masih belum banyak dilakukan. Tujuan: Untuk mengetahui ekspresi mRNA GDF-9 pada sel granulosa pasien endometriosis yang menjalani FIV dan untuk mencari adanya korelasi antara ekspresi GDF-9 dengan kualitas oosit. Metode: Penelitian potong lintang ini dilakukan di Klinik IVF Yasmin RSCM dan Klinik Sander B di Jakarta pada bulan Juli 2014 - Juli 2017. Sebanyak 50 sampel terdiri atas 25 wanita dengan endometriosis dan 25 kontrol. Sampel sel granulosa dikumpulkan pada saat petik oosit. Ekspresi mRNA GDF-9 dinilai menggunakan real time PCR. Hasil: Terdapat penurunan jumlah ambilan oosit, jumlah oosit matur dan skor morfologi oosit pada kelompok pasien dengan endometriosis dan bermakna secara statistik. Ekspresi GDF-9 secara kuantitatif lebih rendah pada kelompok endometriosis dibandingkan dengan kontrol 5.05 0.00002 ndash; 3523 ng/ l vs 81.93 1,47 ndash; 32450 ng/ l; p=0,01 . Pada penelitian ini tidak didapatkan korelasi antara ekspresi GDF-9 dan kualitas oosit dari skor morfologi oosit dan laju fertilisasi. Kesimpulan: Ekspresi GDF9 lebih rendah pada kelompok endometriosis dibandingkan kelompok kontrol. Namun, kami tidak menemukan korelasi antara ekspresi GDF-9 dengan kualitas oosit. Dibutuhkan studi dengan besar sampel yang lebih besar untuk mengkonfirmasi apakah perubahan ekspresi GDF-9 memiliki korelasi dengan kualitas oosit serta untuk membuktikan apakah GDF-9 dapat digunakan sebagai penanda molekuler baru untuk memprediksi kompetensi perkembangan oosit.

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Background: One of the hypothesis that explains the association between endometriosis and infertility is that endometriosis is believed to cause ovarian physiology disturbances, one of them by affecting folliculogenesis that cause decreased oocyte quality. The oocyte plays an important role in regulating and promoting follicle growth, by the production of oocyte growth factors. Several growth factors have been identified in human oocytes, including growth differentiation factor-9 GDF-9. However the studies on GDF-9 expression in granulosa cells of infertile women with endometriosis are sparse.

Objective: To investigate the expression of GDF-9 mRNA in granulosa cells of endometriosis patients undergoing IVF and to find the correlation between GDF-9 expression and oocyte quality.

Method: This cross sectional study was done at Yasmin IVF Clinic and dr. Sander B Clinic Jakarta in July 2014 - July 2017. A total fifty samples of 25 womens with endometriosis and 25 controls were included. We collect the granulosa cells sample at the time of oocyte retrieval. GDF-9 mRNA expression were investigated by Real-Time PCR.

Result: The number of oocytes retrieved, mature oocytes and the oocyte morphology score were lower in the group of patients with endometriosis and this was statistically significant. GDF-9 mRNA expression levels was quantitatively lower in endometriosis groups compared to control 5.05 0.00002 ndash; 3523 ng/ l vs 81.93 1,47 ndash; 32450 ng/ l; p=0,01. However, we did not find any correlation between GDF-9 expression levels and oocyte quality from oocyte morphology score and fertilization rate.

Conclusion: GDF9 mRNA level was lower in endometriosis group compared to control group. However, we did not find correlation between individual GDF-9 level and oocyte quality. Large-sample studies were needed to confirm whether the expression of GDF-9 had a correlation with oocyte quality as well as to prove whether GDF-9 could be used as a new molecular marker to predict the oocyte developmental competence."

"Latar Belakang: Kejadian infertilitas di Indonesia 10-15 dari 39,8 juta wanita usia subur. Infertilitas dapat memberi masalah fisik, mental, sosial hingga perceraian. Sekitar 25 -50 perempuan infertil disertai endometriosis dan laparoskopi telah menjadi salah satu pilihan tatalaksananya. Dalam menjalani suatu metode, ahli bedah dan pasangan selalu ingin mengetahui peluang keberhasilan mereka baik dari data praoperasi ataupun intraoperasi. Lee dkk menyatakan keberhasilan kehamilan alamiah pasca laparoskopi secara keseluruhan adalah 41,9 dan tidak berhubungan dengan derajat endometriosis atau temuan laparoskopi atau jenis operasi. Di Indonesia, belum ada studi yang membahas faktor yang paling mempengaruhi keberhasilan kehamilan alamiah pada perempuan yang menjalani metode laparoskopi operatif.Tujuan: Penelitian ini bertujuan untuk mengetahui faktor-faktor apa saja yang mempengaruhi keberhasilan kehamilan alamiah pasca laparoskopi operatif.Metode: Penelitian ini menggunakan desain kohort retrospektif. Dengan total sampling, data diambil dari catatan pasien yang menjalani operasi laparoskopi karena infertilitas dengan endometriosis di RS Cipto Mangunkusumo dan RS Yayasan Pemeliharaan Kesehatan YPK di Jakarta, Indonesia. Analisis data dilakukan dengan perangkat lunak SPSS 20 untuk mengetahui hubungan antara usia, durasi infertilitas, jenis infertilitas, kadar CA-125, ukuran dan bilateralitas endometrioma, perlekatan organ genitalia interna, nodul endometriosis dan patologi tuba dengan keberhasilan kehamilan alamiah dalam 1 tahun pasca laparoskopi operatif.Hasil: Terdapat 70 subjek yang dianalisis. Sebanyak 32 subjek 45,7 hamil dalam satu tahun pasca laparoskopi. Lama infertilitas menggunakan titik potong

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Background and aims The incidence of infertility in Indonesia is 10 15 of the 39.8 million women of childbearing age. It can give physical, mental, social and divorce problems. Approximately 25 50 of infertile women cause by endometriosis. Laparoscopy operative LO has become one of its treatments. In choosing a method, surgeon and couples always want to know the chances of their success either from preoperative or intraoperative data. In Indonesia, there are no studies that address the factors influence the success of natural pregnancy in women undergoing LO methods. This study aims to determine what factors affect the success of natural pregnancy postoperative laparoscopy.Methods This study used a retrospective cohort design. With total sampling, the data were taken from the patient records who underwent laparoscopic operative due to infertility with endometriosis at RS Cipto Mangunkusumo and the Health Care Foundation Foundation YPK in Jakarta, Indonesia. Data analysis was performed with SPSS 20 software to determine the relationship between age, duration of infertility, type of infertility, ca 125 levels, size and bilaterality of endometrioma, internal genital adhesion, endometriosis nodules and tubal pathology with successful natural pregnancy in 1 year after laparoscopic operative.Result There were 70 subjects analyzed. A total of 32 subjects 45.7 were pregnant within one year after laparoscopy. The length of infertility using a "

"ABSTRAKOral health literacy telah menjadi area riset yang populer pada beberapa tahun ini.Namun belum ada instrumen oral health literacy dalam bahasa Indonesia. Tujuanpenelitian ini adalah untuk mengembangkan instrumen oral health literacy danmenguji reliabilitas dan validitasnya. Studi ini menggunakan convenience sampleterhadap mahasiswa Universitas Indonesia yang bersedia mengisi kuesioner dalambentuk e-form. Kuesioner ini mengadaptasi kuesioner HeLD yang telahdikembangkan Jones, 2014 kemudian dilakukan back-translation. Respondenberjumlah 381, 77% diantaranya adalah perempuan. Cronbach’s alpha kuesioner IDHeLDadalah 0,94. ID-HeLD menunjukkan reliabilitas dan validitas yang tinggisebagai instrumen oral health literacy dalam bahasa Indonesia.

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ABSTRACTOral health literacy has become a popular research area in recent years. But there isno instrument for oral health literacy in Bahasa. The purpose of this research is todevelop Oral Health Literacy instruments, test its reliability and validity. This studyused a convenience sample of Indonesia University students willing to fill out aquestionnaire in the form of e-form. This questionnaire adapting the HeLDquestionnaire which has been developed by Jones, 2014 then conducted a backtranslation.The respondents numbered 381, 77% of whom are women. Cronbach'salpha ID-HeLD questionnaire is 0.94. ID-HeLD shows the high reliability andvalidity of the oral health literacy instrument in Bahasa."

"Latar belakang: Peran estrogen pada patofisiologi endometriosis sudah dikenal sejak lama. Namun, belum ada studi yang menganalisis rasio estradiol, estron dan estriol antara wanita dengan dan tanpa endometriosis. Tujuan: Menganalisis kadar estron (E1), estradiol (E2) dan estriol (E3) dalam darah dan rasio E2:E1, E2:E3 dan E1:E3 antara wanita dengan dan tanpa endometriosis. Metode: Penelitian dengan desain potong lintang analitik, dengan 27 wanita dengan endometriosis dan 27 wanita tanpa endometriosis yang memenuhi kriteria inklusi. Sampel didapatkan dari RS Cipto Mangunkusumo dan rumah sakit jejaring lainnya periode Oktober 2012 - April 2013. Kadar metabolit estrogen dalam darah diperiksa dengan uji enzyme-linked immunosorbent (ELISA). Perbandingan data antara dua kelompok dianalisis dengan uji Mann-Whitney. Hasil: Kadar estron ditemukan lebih rendah pada kelompok endometriosis dibandingkan kelompok kontrol (54,66 pg/ml vs 73,52 pg/ml, p 0,229). Demikian pula, kadar estradiol dan estriol lebih rendah pada kelompok endometriosis (29 pg/ml vs 35 pg/ml, p 0,815 dan 1,11 pg/ml vs 1,67 pg/ml, p 0.095, berturut-turut). Rasio E2:E1 lebih tinggi pada kelompok endometriosis (0,51 pg/ml vs 0,38 pg/ml, p 0,164), demikian pula dengan rasio E2: E3 (26,53 pg/ml vs 21,11 pg/ml , p 0,223) dan rasio E1:E3 (58,55 pg/ml vs 50,28 pg/ml, p 0,684). Namun, semua perbedaan itu tidak bermakna secara statistik. Kesimpulan: Kadar estron, estradiol, dan estriol pada wanita dengan kelompok endometriosis lebih rendah dibandingkan pada wanita tanpa endometriosis. Rasio E2: E1, E2: E3 dan E1: E3 lebih tinggi pada kelompok endometriosis. Namun, semua perbedaan itu tidak bermakna secara statistik.

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Background: The role of estrogen in the pathophysiology of endometriosis has been well known. However, no study has observed the ratio of estradiol, estrone, and estriol between women with endometriosis and without endometriosis.

Objectives: To assess the estrone (E1), estradiol (E2) and estriol (E3) blood level and its ratio (E2:E1, E2:E3 and E1:E3) between women with and without endometriosis.

Methods: An analytical cross sectional study with 27 women with endometriosis and 27 women without endometriosis who met the inclusion criteria. The samples were recruited in Cipto Mangunkusumo hospital and other satellite hospitals from October 2012 to April 2013. The blood level of estrogen metabolites was examined by enzyme-linked immunosorbent assay (ELISA). The data comparison between two groups was analyzed by using Mann-Whitney test.

Result: The level of Estrone was found to be lower in endometriosis group compared to this in control group (54,66 pg/ml vs 73,52 pg/ml, p 0.229). Similarly, the level of estradiol and estriol were lower in endometriosis group (29 pg/ml vs 35 pg/ml, p 0.815 and 1,11 pg/ml vs 1,67 pg/ml, p 0.095, consecutively). The E2:E1 ratio was higher in endometriosis group (0,51 pg/ml vs 0,38 pg/ml, p 0.164), as well as E2:E3 ratio (26,53 pg/ml vs 21,11 pg/ml, p 0.223) and the E1:E3 ratio (58.55 vs 50.28, p 0.684). However, all those differences were not statistical significant.

Conclusion: The estrone, estradiol and estriol level in women with endometriosis group was lower compared to these in women without endometriosis group. The ratio E2:E1, E2:E3 and E1:E3 was higher in endometriosis group. However, all those differences were statistically insignificant."

"Dismenorea menimbulkan dampak langsung yang cukup luas baik bagi penderita, keluarga, masyarakat ataupun negara dan bangsa. Masalah yang timbul dikaitkan dengan peningkatan angka absensi sekolah dan pekerjaan, yang berakibat pada penurunan produktivitas dan pada gilirannya akan mempengaruhi perekonomian negara dan bangsa. Pada studi yang pernah dilakukan oleh Park, pada suatu sekolah, menunjukkan 42% siswi harus absen atau tidak dapat beraktivitas karena keluhan dismenorea. Sementara dari penelitian lain yang pernah dilakukan oleh Andersch diteniukan angka absensi antara 34 sampai 50% pada perempuan yang mengalami dismenorea. Dari segi perekonomian Dawood mengemukakan bahwa di Amerika Serikat hampir 600 juta jam kerja yang setara dengan nilai 2 miliar dollar hilang setiap tahunnya akibat dismenorea yang terjadi pada perempuan usia reproduksi. Kerugian yang timbul juga berhubungan dengan jumlah biaya yang dibutuhkan untuk membeli obat dalam mengatasi gejala dismenorea yang timbal.Karena demikian luasnya dampak yang dapat ditimbulkan oleh dismenorea, maka penatalaksanaan yang tepat untuk mengatasi keluhan yang ada sangatlah diperlukan. Penatalaksanaan dismenorea yang dikemukakan pada berbagai kepustakaan meliputi penatalaksanaan non operatif dan operatif. Penatalaksanaan non operatif dapat berupa pemberian obat-obatan anti prostaglandin, kontrasepsi hormonal oral, antagonis kalsium, perangsang adrenoseptor beta, sediaan hormonal, asam lemak Omega 3, vitamin Bl, Magnesium. AIternatif lain yang pernah dikemukakan adalah dengan akupunktur dan transcutaneous electric nerve stimulation (TENS). Sedangkan terapi operatif dapat berupa dilatasi dan kuretase, laparoscopic uterine nerve ablation (LUNA), neurektomi presakral atau histerektomi total.Laparoscopie Uicrosacral Nerve Ablation (LUNA) merupakan tindakan operatif" dengan melakukan pemotongan persarafan uterus pada ligamentum sakrouterina dekat insersionya pada uterus dengan menggunakan teknik pendekatan laparoskopi. Cara ini saat ini menjadi salah satu alternatif dalam mengatasi dismenorea berat yang tidak respon dengan jenis pengobatan lainnya. Dengan pendekatan laparoskopi dan menggunakan suatu electro surgical system dilakukan pemotongan ligamentum sakrouterina pada insersionya dekat di uterus.Pemotongan ligamentum sakrouterina dapat dilakukan secara total/komplit ataupun parsial. Pada penelitian ini seianjutnya teknik pemotongan ligamentum sakrouterina secara total disebut dengan Ablasi Nervus Sakro Uterina per Laparoskopi (ANUL), sedangkan teknik koagulasi ligamentum sakrouterina secara menyeluruh disebut sebagai Koagulasi Ligamentum Sakro Uterina per Laparoskopi (KoLSU).Meskipun dari laporan penelitian di luar negeri efektifitas dan angka keberhasilannya cukup tinggi, namun di Indonesia belum pemah dilaporkan tingkat efektifitas dan keberhasilannya dalam mengatasi dismenorea berat. Oleh karena itu penelitian inl akan meneliti efektifitas kedua teknik tersebut dalam menurunkan keluhan dismenorea, dan sekaligus membandingkannya pada populasi tertentu oraag Indonesia yang menderita dismenorea berat.RUMUSAN MASALAHBelum diketahui perbedaan efektifitas Ablasi Nervus Sakro Uterina per Laparoskopi (ANUL) dengan Koagulasi Ligamentum Sakro Uterina per Laparoskopi (KoLSU ) dalam mengatasi dismenorea berat.TUJUAN PENELITIANTujuan Umum : Menilai dan membandingkan efektifitas ANUL dan KoLSU dalam mengatasi dismenorea berat.Tujuan Khusus:1. Mengetahul karakteristik demografi dan kiinis penderita dismenorea berat.2. Menilai patologi organ pelvik secara laparoskopi pada penderita dismenorea berat."

"Pendahuluan: Endometriosis merupakan suatu kelainan jinak ginekologi yang dapat mengalami transformasi menjadi kanker. Stres oksidatif diduga berperan dalam perkembangan penyakit endometriosis. Gen supresor tumor ARID1A banyak ditemukan termutasi dan inaktif pada kanker ovarium yang berhubungan dengan endometriosis. Tujuan penelitian adalah untuk menganalisis peran stres oksidatif terhadap ekspresi gen supresor tumor ARID1A dalam transformasi endometriosis menjadi ganas. Metoda: Penelitian dimulai dengan 10 sampel jaringan kanker ovarium, 10 sampel endometriosis dan3 jaringan endometrium eutopik sebagai kontrol yang diisolasi mRNA dan proteinnya. Analisis ekspresi gen ARID1A pada tingkat mRNA dilakukan dengan pemeriksaan RT-qPCR dan pada tingkat protein dengan ELISA. Pada sel endometriosis dan kanker ovarium dilakukan analisis stres oksidatif dengan pemeriksaan aktivitas antioksidan MnSOD dan pemeriksaan kadar MDA sebagai salah bukti kerusakan salah satu komponen sel. Setelah itu dilakukan uji eksperimental pada kultur sel endometriosis dan endometrium eutopik sebagai kontrol. Kedua sel kultur diinduksi dengan H2O2 konsentrasi 0 nM, 100 nM, dan 1000 nM. Analisis dilakukan terhadap ketahanan hidup sel, kadar ROS dan ekspresi gen ARID1A pada tingkat mRNA dan protein. Hasil: Efek induksi H2O2 dalam menekan ekspresi gen ARID1A sel endometriosis dan sel endometrium eutopik pada tingkat mRNA dan protein, bermakna, meskipun pada kanker ovarium tidak bermakna pada penelitian ini. Kesimpulan: Stres oksidatif berperan dalam menekan ekspresi gen supresor tumor ARID1A ditingkat mRNA dan protein pada endometriosis.

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Introduction: Endometriosis as a gynecologic benign lesion, can transform itself into cancer. Oxidative stress is considered as an important factor in endometriosis development. Studies found that ARID1A as tumor suppressor gene, was frequently mutated and inactivated in endometriosis associated ovarian cancer. The aim of the study is to analyze the role of oxidative stress on ARID1A expresion in endometriosis malignant transformation.

Methods: This study started with ten samples of ovarian cancer, ten samples of endometriosis, and 3 samples of eutopic endometrioid tissues as control. They were analyzed for the expression of ARID1A by RT-qPCR and ELISA, then analyzed for the activity of MnSOD as antioxidant enzyme and level of malondialdehyde as one of the oxidative stress damage effect evidence on cell's components. The second part of the study was experimental study on cultured eutopic endometrial and endometriosis cells. They were induced by H2O2 of 0, 100, and 1000 nM concentration. Analysis of the expression of ARID1A by RTqPCR and ELISA, and the DCFH-DA for the level of Reactive oxygen species were done.

Result: The impact of the H2O2 induction in repressing ARID1A gene expression on the endometriosis as well on the eutopic endometrium cells are significant, but not on the ovarian cancer in this study.

Conclusion: Oxidative stress has a role in repressing the expression of ARID1A gene at the mRNA and protein levels on the endometriosis."

"ABSTRAK Latar belakang: Endometriosis merupakan kelainan ginekologik yang palingsering ditemukan. Seperti halnya endometrium di uterus juga dapat terjadiberbagai perubahan pada epitel yang melapisi kista endometriosis di ovarium,antara lain metaplasia, hiperplasia, atipia bahkan perubahan ke arah keganasan.Saat ini banyak penelitian yang menghubungkan antara endometriosis dan kankerovarium terutama jenis clear cell dan dikenal dengan istilah endometriosisassociatedovarian carcinoma (EAOC) dan dilaporkan adanya mutasi yangmenginaktifkan gen supresor tumor (ARID1A), sehingga protein BAF250a tidakdiekpresikan pada Clear cell carcinoma (CCC) ovarii.Bahan dan cara: Dilakukan pulasan imunohistokimia ARID1A pada sampel 20kasus endometriosis non atipik, 20 kasus atipik dan 20 kasus CCC ovarii tahun2012 hingga Maret 2015. Dari kelompok kasus CCC didapatkan 9 kasus EAOC.Selanjutnya dilihat adakah perbedaan persentase ekspresi ARID1A padaendometriosis non atipik, atipik, CCC ovarii serta endometriosis disertai CCC(EAOC).Hasil: Pada kelompok kasus endometriosis non atipik, atipik dan CCC adaperbedaan bermakna persentase ekspresi ARID1A (uji Kruskal-Wallis p=0,0035).Selanjutnya dilakukan analisis Post Hoc uji Mann-Whitney dan didapatkanperbedaan bermakna persentase ekspresi ARID1A antara endometriosis non atipikdan atipik dengan CCC ovarii (p=0,001 dan p=0,0015). Pada kelompok kasusendometriosis non atipik, atipik dan endometriosis pada EAOC, didapatkan adaperbedaan bermakna persentase ekspresi ARID1A (Uji Kruskal-Walis p=0,011).Selanjutnya dilakukan analisis Post Hoc uji Mann-Whitney dan ada perbedaanbermakna persentase ekspresi ARID1A antara endometriosis non atipik dan atipikdengan EAOC (p=0,005 dan p=0,008). Kesimpulan: Ekspresi ARID1A pada endometriosis non atipik dan atipik lebihtinggi bermakna dibanding CCC ovarii dan EAOC. Sehingga ekspresi ARID1Akemungkinan dapat digunakan sebagai petanda adanya transformasi ganas padaendometriosis.ABSTRACT Background: Endometriosis is one of the most common gynecologicalabnormalities found. Endometriosis cyst in the ovary also exhibited changes inepithelial cyst just like endometrium in the uterus. Changes in the epithelial cellsalso include metaplasia, hyperplasia, atyphia even changes toward malignancharacteristics. Nowadays, there are some research that linked endometriosis andclear cell ovarian cancer which is known with endometriosis-associated ovariancarcinoma (EAOC) it is reported that there?s a mutation that activated tumorsuppressor gene (ARID1A), so protein BAF250a is not expressed in Clear CellCarcinoma (CCC) in the ovarium.Materials and Methods: Immunohistochemistry staining of ARID1A were donein 20 samples of non-atypical endometriosis, 20 samples of atypicalendometriosis, 20 samples of CCC in the ovarium from the year 2012 until march2015. From the group that experienced CCC we get 9 cases of EAOC. After that,we see if there?s any difference in the percentage of ARID1A expression in nonatypicalendometrosis, atypical endometriosis, CCC in the ovarium andendometriosis with CCC( EAOC).Results: In non-atypical endometriosis, atypical and CCC cases groups there aresignificant differences on the percentage of ARID1A expression (Kruskal-Walistest p=0,0035). Post Hoc analysis were done using Mann-Whitney test and thereare significant differences on ARID1A expression between non-atypical andatypical endometriosis with CCC (p=0,001 and p=0,0015). In non-atypicalendometriosis, atypical and EAOC groups there are significant differences on thepercentage of ARID1A expression (Kruskal-Walis test p=0,011). Post Hocanalysis were done using Mann-Whitney test and there are significant differenceson ARID1A expression between non-atypical and atypical endometriosis withEAOC (p=0,005 and p=0,008).Conclusion: Expression of ARID1A in non atypical and atypical endometriosisare significantly higher compared to ovarian CCC and EAOC. So, we can say thatARID1A may be used as a marker for malignancy transformation inendometriosis.;Background: Endometriosis is one of the most common gynecologicalabnormalities found. Endometriosis cyst in the ovary also exhibited changes inepithelial cyst just like endometrium in the uterus. Changes in the epithelial cellsalso include metaplasia, hyperplasia, atyphia even changes toward malignancharacteristics. Nowadays, there are some research that linked endometriosis andclear cell ovarian cancer which is known with endometriosis-associated ovariancarcinoma (EAOC) it is reported that there?s a mutation that activated tumorsuppressor gene (ARID1A), so protein BAF250a is not expressed in Clear CellCarcinoma (CCC) in the ovarium.Materials and Methods: Immunohistochemistry staining of ARID1A were donein 20 samples of non-atypical endometriosis, 20 samples of atypicalendometriosis, 20 samples of CCC in the ovarium from the year 2012 until march2015. From the group that experienced CCC we get 9 cases of EAOC. After that,we see if there?s any difference in the percentage of ARID1A expression in nonatypicalendometrosis, atypical endometriosis, CCC in the ovarium andendometriosis with CCC( EAOC).Results: In non-atypical endometriosis, atypical and CCC cases groups there aresignificant differences on the percentage of ARID1A expression (Kruskal-Walistest p=0,0035). Post Hoc analysis were done using Mann-Whitney test and thereare significant differences on ARID1A expression between non-atypical andatypical endometriosis with CCC (p=0,001 and p=0,0015). In non-atypicalendometriosis, atypical and EAOC groups there are significant differences on thepercentage of ARID1A expression (Kruskal-Walis test p=0,011). Post Hocanalysis were done using Mann-Whitney test and there are significant differenceson ARID1A expression between non-atypical and atypical endometriosis withEAOC (p=0,005 and p=0,008).Conclusion: Expression of ARID1A in non atypical and atypical endometriosisare significantly higher compared to ovarian CCC and EAOC. So, we can say thatARID1A may be used as a marker for malignancy transformation inendometriosis.;Background: Endometriosis is one of the most common gynecologicalabnormalities found. Endometriosis cyst in the ovary also exhibited changes inepithelial cyst just like endometrium in the uterus. Changes in the epithelial cellsalso include metaplasia, hyperplasia, atyphia even changes toward malignancharacteristics. Nowadays, there are some research that linked endometriosis andclear cell ovarian cancer which is known with endometriosis-associated ovariancarcinoma (EAOC) it is reported that there?s a mutation that activated tumorsuppressor gene (ARID1A), so protein BAF250a is not expressed in Clear CellCarcinoma (CCC) in the ovarium.Materials and Methods: Immunohistochemistry staining of ARID1A were donein 20 samples of non-atypical endometriosis, 20 samples of atypicalendometriosis, 20 samples of CCC in the ovarium from the year 2012 until march2015. From the group that experienced CCC we get 9 cases of EAOC. After that,we see if there?s any difference in the percentage of ARID1A expression in nonatypicalendometrosis, atypical endometriosis, CCC in the ovarium andendometriosis with CCC( EAOC).Results: In non-atypical endometriosis, atypical and CCC cases groups there aresignificant differences on the percentage of ARID1A expression (Kruskal-Walistest p=0,0035). Post Hoc analysis were done using Mann-Whitney test and thereare significant differences on ARID1A expression between non-atypical andatypical endometriosis with CCC (p=0,001 and p=0,0015). In non-atypicalendometriosis, atypical and EAOC groups there are significant differences on thepercentage of ARID1A expression (Kruskal-Walis test p=0,011). Post Hocanalysis were done using Mann-Whitney test and there are significant differenceson ARID1A expression between non-atypical and atypical endometriosis withEAOC (p=0,005 and p=0,008).Conclusion: Expression of ARID1A in non atypical and atypical endometriosisare significantly higher compared to ovarian CCC and EAOC. So, we can say thatARID1A may be used as a marker for malignancy transformation inendometriosis.;Background: Endometriosis is one of the most common gynecologicalabnormalities found. Endometriosis cyst in the ovary also exhibited changes inepithelial cyst just like endometrium in the uterus. Changes in the epithelial cellsalso include metaplasia, hyperplasia, atyphia even changes toward malignancharacteristics. Nowadays, there are some research that linked endometriosis andclear cell ovarian cancer which is known with endometriosis-associated ovariancarcinoma (EAOC) it is reported that there?s a mutation that activated tumorsuppressor gene (ARID1A), so protein BAF250a is not expressed in Clear CellCarcinoma (CCC) in the ovarium.Materials and Methods: Immunohistochemistry staining of ARID1A were donein 20 samples of non-atypical endometriosis, 20 samples of atypicalendometriosis, 20 samples of CCC in the ovarium from the year 2012 until march2015. From the group that experienced CCC we get 9 cases of EAOC. After that,we see if there?s any difference in the percentage of ARID1A expression in nonatypicalendometrosis, atypical endometriosis, CCC in the ovarium andendometriosis with CCC( EAOC).Results: In non-atypical endometriosis, atypical and CCC cases groups there aresignificant differences on the percentage of ARID1A expression (Kruskal-Walistest p=0,0035). Post Hoc analysis were done using Mann-Whitney test and thereare significant differences on ARID1A expression between non-atypical andatypical endometriosis with CCC (p=0,001 and p=0,0015). In non-atypicalendometriosis, atypical and EAOC groups there are significant differences on thepercentage of ARID1A expression (Kruskal-Walis test p=0,011). Post Hocanalysis were done using Mann-Whitney test and there are significant differenceson ARID1A expression between non-atypical and atypical endometriosis withEAOC (p=0,005 and p=0,008).Conclusion: Expression of ARID1A in non atypical and atypical endometriosisare significantly higher compared to ovarian CCC and EAOC. So, we can say thatARID1A may be used as a marker for malignancy transformation inendometriosis."