Surveillance of Indonesian female sexual function after hysterectomy.

BACKGROUND: Sexual function is one component of quality of life that could be fulfilled by humans. Hysterectomy, which is an operative procedure in women, may cause disturbance in sexual function. AIM: This study aims to determine the surveillance of sexual function after hysterectomy. METHODS: This is a cross-sectional study involving 92 gynecological tumor patients who had undergone a hysterectomy by open laparotomy procedure for at least 3 months. Evaluation of sexual dysfunction using the female sexual function index (FSFI-6) questionnaire, which assesses sexual function in the form of sexual disorder, sexual dysfunction, desire disorders, stimulation, orgasm disorders, and pain. The study was conducted in September-November 2018 in Dr. Cipto Mangunkusumo Hospital, Jakarta. The patients were divided into total and radical hysterectomy groups and whether castration was performed. RESULTS: The total group had 71 total hysterectomy and 21 radical hysterectomy patients. Sexual dysfunction (radical hysterectomy 47.6%, n = 10/21; total hysterectomy 28.2%, n = 20/71; castration 33.8%, n = 24/71; and without castration 28.6%, n = 6/21); orgasmic disorders (total hysterectomy 28.2%, n = 20/71; radical hysterectomy 47.6%, n = 10/21; castration 33.8%, n = 24/71; without castration 28.6%, n = 6/21); and pain disorder (radical hysterectomy 28.6%, n = 6/21; compared with 9.9%, n = 7/71 total hysterectomy). CONCLUSION: No significant differences were found between sexual function after radical hysterectomy and total hysterectomy, as well as between the castration groups. Based on these findings, sexual function is an important reference for health professionals to be considered in conducting counseling before and after surgery.

Pregnancy Profile and Infant Outcomes Among HIV Infected Women Who Delivered in Cipto Mangunkusumo Hospital.

BACKGROUND: HIV infection in pregnancy is a big concern for the future of our nation. The virus can be transmitted to the baby through pregnancy, childbirth and during breastfeeding which rendering to early detection and intervention. The aim of this study was to describe the transmission prevention cascade among our patient. METHODS: this was a retrospective cohort study of HIV vertical transmission. The inclusion criteria was pregnant women with HIV infection who have antenatal care in Cipto Mangunkusumo Hospital from January 2013 up to December 2018. Data was retrieved from medical record, HIV registry and laboratory results. The included data were demographic, risk of infection, obstetrical data, mode of delivery, ARV history, laboratory history in mother and infant. Data was presented as descriptive. RESULTS: there was 138 HIV pregnant women included as study subjects. Most women were at 25-29 years old (39.85%), as housewife (41.30%), with history of more than one sexual partners (50.73%). The subjects was mostly multigravida (77.5%), first visit to RSCM in third trimester (98.6%), with history of antenatal care >4 times (48.6%), singleton fetus (99.3%), and delivered by C-section (84.1%). HIV diagnosis was done during pregnancy (73.53%), and already on antiretroviral (ARV) for more than 6 months (50.7%). There was 78% subjects with CD4 (24% subjects with <200 cells/mL) and 84% with viral load data (36% with viral load >200 copies/uL). Around 72.5% infants born with birth weight 2500-3500g. Almost all infant received ARV prophylaxis (97.9%) and formula feeding. PCR HIV was examined on 16 infant on 6 weeks of age and and 13 on 6 month age. There was 1 infant with viral load results >400 copies/ml which immediately refered to Pediatric HIV clinic. Bivariate analysis showed significant correlation between maternal ARV consumption and infant result at birth (P=0.05). Maternal CD4 level was not significantly correlate with neonatal virology status (P=0.12). CONCLUSION: HIV diagnosis in pregnant women is important, since ARV administration on early pregnancy significantly reduce vertical transmission. ARV prophylaxis protocols is important to prevent HIV infection on infant.

Evidence-based case report: How to deal with unpredicted endometriosis nodule closed to ureter and rectum during laparoscopy.

INTRODUCTION: Endometriosis is characterized by the growth of endometrial-like tissue within and outside the pelvic cavity. Peritoneum nodules invaded more than 5 mm representing the commonest form of deep infiltrating endometriosis nodules might challenge inexperienced operator due to its location near ureter and the rectum. The aim is to provide important steps on how to deal with unexpected peritoneal endometrial nodules located closed to ureter and rectum. PRESENTATION OF CASE: A 43-year-old female underwent laparoscopic cystectomy after being diagnosed to have right endometriosis cyst. The researchers found multiple endometriosis nodules located closed to rectum and ureter after performing cystectomy. A search was conducted on PubMed® with the keywords of "Peritoneal endometriosis nodule" AND "rectovaginal endometriosis nodule" AND "Surgical ablation" OR "Surgical excision" AND "Laparoscopy" AND "Pelvic pain". Reference lists of relevant articles were searched for other possible relevant studies. After selecting the articles, the critical review was performed based on a standardized appraisal form for the treatment study. DISCUSSION: Three eligible studies were appraised to assess the surgery outcome (dyspareunia), based on ablation and excision criteria. The pain was decreased during 6 months of follow up, with no difference in both techniques. The minimal requirement to remove the posterior nodules is knowledge of pelvic retroperitoneal anatomy. CONCLUSION: In all endometriosis cases which require surgery will need to be performed by an experienced operator. If rectovaginal endometriosis nodule was unexpectedly found during intraoperative and recognition of rectum and ureter must be done, knowledge of retroperitoneal anatomy is required.