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"ABSTRAKLatar Belakang: Sekitar 9-33% pasien penyakit trofoblas maligna (PTM) yang diobati dengan kemoterapi agen tunggal akan membutuhkan terapi multi agen karena adanya resistensi terhadap obat lini pertama, termasuk metotreksat (MTX), atau efek samping toksisitas. Hingga saat ini, resistensi terapi lini pertama masih menjadi masalah akibat tingkat identifikasi yang masih rendah. Sebelumnya, belum pernah dilakukan penelitian mengenai kadar Beta-HCG sebagai prediktor resistensi pada pasien PTM risiko rendah.Tujuan: Mengetahui nilai prediktif kadar Beta-HCG untuk risiko resistensi metotreksat pada PTM risiko rendah.Metode: Penelitian ini adalah studi analitik potong lintang menggunakan data rekam medis dari 58 subjek. Subjek adalah semua pasien yang terdiagnosis dengan PTM risiko rendah dan diberikan terapi MTX pada bulan Januari 2011 hingga Desember 2016 di RSUPN Dr. Cipto Mangunkusumo. Pengambilan subjek dilakukan secara konsekutif. Subjek dengan data yang tidak lengkap atau adanya riwayat PTM sebelumnya dieksklusi dari penelitian ini.Hasil: Prevalensi resistensi MTX yaitu 32,8%. Tidak ditemukan asosiasi bermakna antara karakteristik demografik (usia, paritas, pekerjaan, dan pendidikan) ataupun karakteristik klinis (riwayat kehamilan, interval antara kehamilan terakhir dan awal kemoterapi, ukuran tumor, riwayat gagal kemoterapi, lokasi dan jumlah metastasis) dengan resistensi MTX. Ditemukan perbedaan bermakna pada kadar Beta-HCG antara kelompok resistensi dan tidak resistensi pada siklus 4 (p<0,001), 6 (p<0,001), dan 8 (p<0,001). Perbedaan bermakna juga ditemukan pada perubahan kadar Beta-HCG dari awal hingga minggu kedua (p<0,001, AUC 0,8). Cut-off penurunan Beta-HCG sebesar 23% memiliki sensitivitas sebesar 78,9% dan spesifisitas sebesar 74,4% untuk memprediksi resistensi MTX.

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ABSTRACT

Background: Approximately 9-33% patients with gestational trophoblastic neoplasia (GTN) treated with single agent chemotherapy would need multi agent chemotherapy, whtether due to resistance to first-line therapy, including methotrexate (MTX), or toxic side effect. Currently, resistance to first-line therapy is still a problem due to low identification rate. To this date, there are no studies regarding Beta-HCG level as a MTX resistance predictor for low risk GTN.

Purpose: Identify the predictive value of Beta-HCG level for the risk of MTX resistance in low risk GTN.

Methods: This was an analytical cross-sectional study using medical records of 58 subjects. Subjects were all patients diagnosed with low risk GTN and given MTX therapy during the period of January 2011 to December 2016 at Cipto Mangunkusumo Hospital. Consecutive sampling was done. Subjects with incomplete data or history of previous GTN were excluded from this study.

Results: The prevalence of MTX resistance was 32,8%. No significant association was found between demographic characteristics (age, parity, job, and education) or clinical characteristics (gestational history, interval between last pregnancy and the start of chemotherapy, tumor size, history of chemotherapy failure, location and number of metastasis) and MTX resistance. A significant difference in the level of Beta-HCG between resistance and non-resistance groups were found on cycle 4 (p<0,001), 6 (p<0,001), and 8 (p<0,001). A significant difference was also found in the change of Beta-HCG from the start to the second week of therapy (p<0,001, AUC 0,8). Beta-HCG decrease cut-off of 23% had the sensitivity of 78,9% and specificity of 74,4% to predict MTX resistance.

Conclusions: The prevalence of MTX resistance was 32,8% in this study. The decrease in Beta-hCG level from the start to the second week of therapy could be used as a MTX resistance predictor in low risk GTN patients."

"ABSTRACTPurposeThe lung allocation score (LAS) has been generally recognized as a contributor to the overall survival in lung transplant candidates. However, donor-related risks have never been taken into consideration in previous research that validated the LAS. This study aimed to determine whether or not the role of the LAS as a predictor of the posttransplant outcome is influenced by the quality of the donor lungs.MethodsWe retrospectively reviewed 108 patients who underwent lung transplantation at Okayama University Hospital since 1998. The cohort was divided into two groups based on the lung donor score (DS; ≤ 4/> 4). Correlations between the LAS and posttransplant outcomes were investigated in both groups.ResultsIn the high-DS group, an elevated LAS was strongly associated with posttransplant PaO2/FiO2 (p = 0.018). However, in the low-DS group, no correlation was found between them. There was no significant difference in the long-term survival according to the LAS in the low-DS group. The LAS effectively predicted the posttransplant outcome only when lungs with DS > 4 were transplanted; the LAS was not reliable if high-quality lungs were transplanted.ConclusionLung transplantation can be feasible and provides a survival benefit even for high-LAS patients if lungs from a low-risk donor are transplanted."

"Penelitian longitudinal prospektif analitik untuk menilai ketepatan prediksi timbulnya penyakit trofoblas ganas melalui sistem penilaian prognosis mola hidatidosa yang dikembangkan oleh NETDC (New England Trophoblast Disease Center) telah dilakukan. Di antara parameter faktor risiko yang dinilai; usia penderita, jenis mola hidatidosa, pembesaran uterus, kadar hCG serum, kista lutein, serta ada-tidaknya komplikasi merupakan factor risiko yang bermakna untuk timbulnya keganasan setelah mola hidatidosa dievakuasi (p=0,032). Penelitian dilakukan pada 50 penderita mola hidatidosa dengan pengamatan lanjutan selama 1 tahun (Januari 2001-Desember 2002) di Bagian Obstetri dan Ginekologi RS Mohammad Hoesin, Palembang. Hasilnya menunjukan prediksi keganasan skor NETDC 50% pada risiko tinggi dan 10% risiko rendah untuk berkembang menjadi ganas (p<0,05). Hasil ini lebih besar dibandingkan dengan nilai yang diajukan WHO yaitu 19-30%. Risiko untuk terjadinya keganasan pasca mola hidatidosa pada kelompok risiko tinggi ialah 9,0 kali lebih tinggi disbanding pada kelompok risiko rendah (CI: 1,769-45,786). (Med J Indones 2004; 13: 40-6)

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A prospective longitudinal analytic study assessing the efficacy of NETDC (New England Trophoblastic Disease Center) prognostic index score in predicting malignancy after hydatidiform mole had been performed. Of the parameter evaluated; age of patients, type of hydatidiform mole, uterine enlargement, serum hCG level, lutein cyst, and presence of complicating factors were significant risk factors for malignancy after hydatidiform mole were evacuated (p<0.032). The study were done on 50 women diagnosed with hydatidiform mole with 1 year observation (January 2001-December 2002) at the Department of Obstetrics and Gynecology, Mohammad Hoesin Hospital, Palembang. The results showed that the NETDC prognostic index score predicted malignancy in 50% of high risk group and 10% in low risk group (p<0.05). This showed a higher number than that found by the WHO (19%-30%). The risk for incidence of malignancy after hydatidiform mole in the high risk group is 9.0 times higher compared to that of the low risk group (CI: 1.769-45.786). (Med J Indones 2004; 13: 40-6)"

"ABSTRAKUntuk mengurangi beban cash flow akibat lambatnya proses pengembalian pajak dan demi menstabilkan likuiditas Pedagang Besar Farmasi (PBF) yang tertekan akibat implementasi program Jaminan Kesehatan Nasional (JKN), maka Kementerian Keuangan menetapkan PBF sebagai Pengusaha Kena Pajak Berisiko Rendah yang berhak atas pengembalian pendahuluan pajak. Tujuan penelitian ini adalah untuk menganalisis kewajiban PPN PBF dan Rumah Sakit Pemerintah (RS Pemerintah) berdasarkan konsep biaya kepatuhan dan menganalisis penerapan pengembalian pendahuluan kelebihan pembayaran pajak bagi PBF berdasarkan Peraturan Menteri Keuangan Nomor 117/PMK.03/2019. Penelitian ini merupakan penelitian kualitatif yang disajikan secara deskriptif. Data yang digunakan dalam penelitian ini diperoleh melalui studi literatur dan wawancara mendalam dengan narasumber yang relevan. Hasil penelitian ini menunjukkan bahwa biaya kepatuhan yang ditanggung PBF atas konsekuensi pelaksanaan Wajib Pungut lebih yang dominan dirasakan adalah biaya waktu dan psikologis. Sementara itu biaya kepatuhan RS Pemerintah relatif lebih rendah karena kewajibannya didorong oleh beberapa faktor pendukung seperti bantuan pihak ketiga sebagai penampung pajak yang memudahkan pemungutan dan penyetoran PPN, dan administrasi penyetoran dan pelaporan berbasis online. Kemudian kebijakan pengembalian pendahuluan direspon baik oleh PBF terbukti dengan meningkatnya realisasi pengembalian pendahuluan pada akhir kuartal 2019. Kebijakan ini dapat membantu cash flow PBF karena mengurangi biaya kepatuhan yang ditanggung akibat proses pemeriksaan yang cukup lama. Kebijakan ini juga tidak mendistorsi penerimaan negara serta meningkatkan kepatuhan Wajib Pajak.

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ABSTRACT

To reduce the burden of cash flow due to the slow process of tax returns and to stabilize the liquidity of Pharmaceutical Wholesalers that are depressed due to the implementation of the National Health Insurance program, the Ministry of Finance has appointed Pharmaceutical Wholesalers as Low Risk Taxable Entrepreneurs entitled to tax return preliminary. The purpose of this study is to analyze the Value Added Tax obligations of Pharmaceutical Wholesalers and Government Hospital based on the concept of compliance costs and to analyze the implementation of the preliminary return on tax overpayments for Pharmaceutical Wholesalers based on the Minister of Finance Regulation Number 117/PMK.03/2019. This research is a qualitative research that is presented descriptively. The data used in this study were obtained through literature studies and in-depth interviews with relevant sources. The results of this study indicate that the compliance costs borne by pharmaceutical wholesalers for the more dominant perceived consequences of implementing compulsory levies are time and psychological costs. Meanwhile, compliance costs for Government Hospitals are relatively lower because their obligations are driven by several supporting factors such as assistance from third parties as tax collectors that facilitate collection and deposit of VAT, and online-based deposit and reporting administration. Then the preliminary return policy was well responded to by Pharmaceutical Wholesalers, as evidenced by the increased realization of preliminary returns at the end of the 2019 quarter. This policy can help with the cash flow of Pharmaceutical Wholesalers because it reduces compliance costs incurred due to the long examination process. This policy also does not distort state revenue and increase taxpayer compliance."