Poster Session : PS 0593 ; Critical Care Medicine ; Intra-Arterial Heparin Flushing Improve Cerebral Blood Perfusion in Ischemic Stroke Patients: A Report from Cerebrovascular Center Indonesia Army Central Hospital Gatot Soebroto (rspad)

( Agus Terawan Putranto ),( Tugas Ratmono ),( Andri Hidayat ),( Bayu Putera ),( Joko Widodo ),( Lucia Hermiwati ),( Mulyana Mulyana ),( Grace Chandra ),( Gatot S Lawrence Lao ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Indonesian Basic Health Research Study (RISKESDAS) indicate that prevalence of stroke is 12.1%; and is considered as one of the major cause of death in Indonesia. It has been reported that ischemic stroke shown about 80-85% of the total cases. Conventional ischemic stroke management has indicated some major obstacles in the stroke management program; therefore an approach using intra-arterial heparin fi ushing method has been used to overcome the above limitations. Controversy has been around for sometimes, therefore 2 groups of scientifi c forum have been established InaCVF (Indonesia CerebroVascular Forum) and InaDOCAR Prevent (Indonesia DOCAR Prevent) to fi nd out the scientifi c rational in the management of ischemic stroke using intra-arterial heparin fi ushing. The objective of this approach is for recovering the cerebral blood perfusion at the optimal time. Methods: March 2013 - March 2014, there has been 4380 cases of ischemic stroke, and only 2146 (48.9%) undergone intra-arterial heparin fi ushing guided with digital subtracted angiography (3D-DSA). Prior to the heparin-fi ushing procedure, all patients are undergone functional MRI test and the patients are carefully selected for the optimal result. Post procedure, the patients undergone functional MRI. The pre and post functional MRI results are compared to determine the change of cerebral blood perfusion. Results: Of 2146 ischemic stroke patients, undergone intra-arterial heparin fi ushing, none of the patients had severe complication. Sixty-six percent, 32%, and 2% have signifi cant moderate and little improvement respectively. Further biochemical parameters is still under investigation to elucidate the pathomechanism. Conclusions: Intra-arterial heparin fi ushing in patient with ischemic stroke is a promising and effective modality.

Poster Session : PS 0138 ; Neurology : Transcranial Magnetic Stimulation (TMS) Improve Motoric Function in Post-Ischemic Stroke Patients, Indonesia Army Central Hospital Gatot Soebroto (RSPAD)

( Tugas Ratmono ),( Terawan A Putranto ),( Andri Hidayat ),( Bayu Putera ),( Joko Widodo ),( Lucia Hermiwati ),( Mulyana Mulyana ),( Gatot S Lawrence Lao ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Indonesian Basic Health Research Study (RISKESDAS) indicate that prevalence of stroke is 12.1%; and is considered as one of the major cause of death in Indonesia. It has been reported that ischemic stroke shown about 80-85% of the total cases, that continues to be the leading cause of long term disability worldwide. Primarily due to a loss of motor abilities and subsequent impairment in activities of daily living. Transcranial magnetic stimulation (TMS) is a non invasive tool that has been used in addition to other existing diagnostic tools to investigate motor pathophysiology in stroke patients. It has been shown to quantify the corticomotor excitability properties of clinically affected and unaffected muscles. Therefore, the objective of the study is to determine the usefulness of the device to rehabilitate the motoric function of the post-ischemic stroke patients Methods: March 2013 - March 2014, there has been 4380 cases of ischemic stroke, and only 2146 (48.9%) undergone intra-arterial heparin fl ushing guided with digital subtracted angiography (3D-DSA). Prior and post heparin-fl ushing procedure, all patients are undergone functional MRI test and assessment of the motoric function using TMS to examine the resting motor threshold (RMT), the amplitude (A), the latency (L), as well as Central Motoric conduction Time (CMCT) at the lesion and non lesion areas. Results: 2146 ischemic stroke patients, the RMT are 55.60±11.75 to 54.40±8.93 (p=0.52), and 52.78±10.59 to 52.22±8.59 (p=0.794); Amplitude are 1.57±1.76 to 1.7±1.72 (p=0.44), and 1.21±1.36 to 1.8±1.67 (p=0.005); Latency 23.76±4.51 to 23.51±4.36 (p=0.555) and 22.85±3.37 to 22.45±3.95 (p=0.104); and RMT 9.69±3.36 to 9.20±3.78 (p=0.238) and 8.87±2.92 to 8.02±2.58 (p=0.002) at the non lesion and lesion areas respectively. Conclusions: TMS provide a convincing evidence as new modality for post stroke rehabilitation.

Modified Cervicography and Visual Inspection With Acetic Acid as an Alternative Screening Method for Cervical Precancerous Lesions

Gatot Purwoto,Hasra Depiesa Dianika,Andre Putra,Sigit Purbadi,Laila Nuranna 대한암예방학회 2017 Journal of cancer prevention Vol.22 No.4

Background: We compared the diagnostic accuracy between visual inspection with acetic acid (VIA) and modified cervicography as an alternative screening method for cervical precancerous lesions. Methods: A diagnostic cross-sectional study was performed at the outpatient clinic at an Indonesian national referral hospital from February until April 2015. We collected samples from patients who sequentially underwent VIA examination, modified cervicography, and colposcopy. Results: A total of 185 patients were included in this study. Modified cervicography showed positive results in 7.6% of patients, while 7.0% of patients had a VIA positive result. This is compared to 5.4% of patients showing abnormal colposcopy results. From those results, we obtained that sensitivity and specificity of VIA were 96.0% and 90.9%. Meanwhile, sensitivity and specificity of modified cervicography were 97.7% and 90.9%, respectively, compared to colposcopy as a gold standard. Conclusions: Modified cervicography and VIA are reliable tools for cervical cancer screening, with comparable sensitivity and specificity. Modified cervicography can be used as a supplementary tool to improve the documentation of VIA and as an alternative to VIA alone.

Ambidexterity and Leadership Agility in Micro, Small and Medium Enterprises (MSME)’s Performance: An Empirical Study in Indonesia

Gatot KUSTYADJI,Windijarto WINDIJARTO,Ari WIJAYANI 한국유통과학회 2021 The Journal of Asian Finance, Economics and Busine Vol.8 No.7

Ambidexterity and leadership agility have become the most researched topics to analyze their application in companies, especially in this dynamic era. Several researchers have analyzed it in large companies. However, only a few have discussed the two topics simultaneously and at the MSME level. This study aims to analyze the relationship between ambidexterity and leadership agility and innovation capability and performance at MSMEs in Yogyakarta and East Java, Indonesia. This study is analyzed by using quantitative methods with SEM (Structural Equation Model) methods. The data in this study is primary data that is obtained through distributing 230 questionnaires to MSME managers in Yogyakarta and East Java, Indonesia. From 230 questionnaires distributed, 200 questionnaires are returned and completed, so the response rate in this study is 86%. The results in this study indicate that ambidexterity and leadership agility have a significant effect on innovation capability and MSME performance. This study also proved that innovation capability has a significant effect on MSME performance. Therefore, it is recommended for MSME managers to develop ambidexterity and leadership agility so they can create innovation and good performance. In the end, this study has provided findings related to the combination of ambidexterity and leadership agility variables.

English Language Teaching Today: Linking Theories and Practices, by Willy. A. Renandya and Handoyo Puji Widodo (Eds.), Dordrecht, Springer, 2016, 309 pp., $99.99 (US), ISBN 978-3-319-38832-8

Gatot Prasetyo 아시아영어교육학회 2017 The Journal of Asia TEFL Vol.14 No.4

Poster Session : PS 0025 ; Cardiology : Cardiovascular Disease in Under and Lower Middle Income Countries: The Burden of Cytomegalovirus Accelerated Atherosclerosis: Increase Expression of Intercellular Adhesion Molecule-1 (ICAM-1) in Infected Human Endot

( Lawrence Gatot Lao ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Comparing the WHO Report on Noncommunicable Diseases Country Profi les 2011 and 2014, Indonesia proportional percentage of mortality due cardiovascular death has increase from 30% to 37%. yet, the pre-existing underlying burden of chronic infections is still a major obstacle in these countries. Chronic latent infection of cytomegalovirus has been proposed as one of the major burden. Therefore, the objective of this study is to determine increase expression of ICAM-1in human endothelial cells as a mean to cause accelerated atherosclerosis. Methods: Human umbilical vein endothelial cells (HUVEC) were isolated from umbilical cords obtained within 24 to 48 hours of delivery. Endothelial cell purity was assessed by immunohistochemical staining for von Willebrand Factor (factor VIII). The presence of contaminating leukocytes was excluded by staining the cultures with mouse monoclonal antibodies to leukocyte common antigen (LCA) (Dako), monocyte-specifi c antigen (Leu-M5). HUVECs were infected with HCMV strain VHL/E. Viral stocks were taken from a -800C freezer and thawed quickly under lukewarm running tap water. Confl uent monolayers of cultured HUVECs co-culture with viral inoculum. After 85- 90% infectivity has been achieved, the infected endothelial cells are ready to be used for identifi ying the expression of ICAM-1 using monoclonal antibody by Daco, then analyzed with Flow cytometer as well as immunohisto-chemistry analisis. Results: There is increase expression of ICAM-1 in CMV infected endothelial cells as compared to non-infected endothelial cells. Conclusions: Cytomegalovirus might use this approach to accelerate the advancement of atherosclerosis.

FVIII inhibitor surveillance in children with hemophilia A in Indonesia: a report from the Indonesian Pediatric Hematology-Oncology Working Group

Novie Amelia Chozie,Djajadiman Gatot,Bambang Sudarmanto,Susi Susanah,Rini Purnamasari,Pudjo Hagung Widjajanto,Susanto Nugroho,Olga Rasiyanti,Dian Puspitasari,Muhammad Riza,Maria Christina Shanty Laras 대한혈액학회 2022 Blood Research Vol.57 No.4

Background Factor VIII (FVIII) inhibitor diagnosis and surveillance in Indonesia are challenging owing to geographic conditions and the lack of laboratory facilities nationwide for inhibitor assays. This study aimed to determine the prevalence of FVIII inhibitors in children diagnosed with hemophilia A (HA) in Indonesia. Methods A cross-sectional study was conducted in 12 hospitals in eight provinces of Indonesia between 2020 and 2021. Factor VIII inhibitor screening was performed in a central hemostasis laboratory for all children with HA (≤18 yr) who had received a minimum of 10 exposure days to clotting factor concentrates. The FVIII inhibitor titer was determined using the Bethesda assay. Results Children (388) were enrolled in this study, including 219 (56.4%), 131 (33.8%), and 38 (9.4%) with severe, moderate, and mild HA, respectively. The prevalence of children who developed FVIII inhibitors was 37 out of 388 (9.6%). Factor VIII inhibitors were found in 25/219 (11.4%) severe, 11/131 (8.3%) moderate, and 1/38 (2.6%) children with mild HA. Thirteen children had low-titer inhibitors and 24 had high-titer inhibitors, with a median of 9.44 (1.48‒412.0) Bethesda Units. Among 13 children with low-titer inhibitors, eight underwent a confirmation test, of which five tested negative and were classified as transient. A significant difference in annual joint bleeding rate was found between patients with low and high inhibitor titers and those without inhibitors (P <0.001). Conclusion Factor VIII inhibitor prevalence in Indonesia was relatively low. However, the risk factors that may contribute to FVIII inhibitor development among Indonesian patients require further study.

Cervical cancer prevention program in Jakarta, Indonesia: See and Treat model in developing country

Laila Nuranna,Mohamad Farid Aziz,Santoso Cornain,Gatot Purwoto,Sigit Purbadi,Setyawati Budiningsih,Budiningsih Siregar,Alexander Arnold Willem Peters 대한부인종양학회 2012 Journal of Gynecologic Oncology Vol.23 No.3

Objective: The purpose of this study was to describe the implementation of single visit approach or See-visual inspection of the cervix with acetic acid (VIA)-and Treat-immediate cryotherapy in the VIA positive cases-model for the cervical cancer prevention in Jakarta, Indonesia. Methods: An observational study in community setting for See and Treat program was conducted in Jakarta from 2007 until 2010. The program used a proactive and coordinative with VIA and cryotherapy (Proactive-VO) model with comprehensive approach that consists of five pillars 1) area preparation, 2) training, 3) awareness, 4) VIA and cryotherapy, and 5) referral. Results: There were 2,216 people trained, consist of 641 general practitioners, 678 midwives, 610 public health cadres and 287 key people from the society. They were trained for five days followed by refreshing and evaluation program to ensure the quality of the test providers. In total, 22,989 women had been screened. The VIA test-positive rate was 4.21% (970/22,989). In this positive group, immediate cryotherapy was performed in 654 women (67.4%). Conclusion: See and Treat program was successfully implemented in Jakarta area. The Proactive-VO model is a promising way to screen and treat precancerous lesions in low resource setting. Objective: The purpose of this study was to describe the implementation of single visit approach or See-visual inspection of the cervix with acetic acid (VIA)-and Treat-immediate cryotherapy in the VIA positive cases-model for the cervical cancer prevention in Jakarta, Indonesia. Methods: An observational study in community setting for See and Treat program was conducted in Jakarta from 2007 until 2010. The program used a proactive and coordinative with VIA and cryotherapy (Proactive-VO) model with comprehensive approach that consists of five pillars 1) area preparation, 2) training, 3) awareness, 4) VIA and cryotherapy, and 5) referral. Results: There were 2,216 people trained, consist of 641 general practitioners, 678 midwives, 610 public health cadres and 287 key people from the society. They were trained for five days followed by refreshing and evaluation program to ensure the quality of the test providers. In total, 22,989 women had been screened. The VIA test-positive rate was 4.21% (970/22,989). In this positive group, immediate cryotherapy was performed in 654 women (67.4%). Conclusion: See and Treat program was successfully implemented in Jakarta area. The Proactive-VO model is a promising way to screen and treat precancerous lesions in low resource setting.

Prevalence, Age Distribution, and Risk Factors of Visual Inspection With Acetic Acid-Positive From 2007 to 2011 in Jakarta

Laila Nuranna,Nyoman Bagus Donny,Gatot Purwoto,Hariyono Winarto,Tofan Widya Utami,Tricia Dewi Anggraeni,Alexander A.W. Peters 대한암예방학회 2017 Journal of cancer prevention Vol.22 No.2

Background: Cervical cancer is still the second most frequent cancer among Indonesian women, thus screening program is still critically important to prevent it. Visual inspection with acetic acid (VIA) was introduced as a method which is most suitable with Indonesia’s condition compared with the other screening methods. The Female Cancer Program from Jakarta Regional collaborated with Leiden University in 2007 to 2011 has done cervical cancer screening using VIA method, involving 25,406 women spreading across several primary health centers in Jakarta. By using these data, we found out the prevalence, age distribution, and risk factor of VIA positive in Jakarta as a basis to predict the budget and logistics for the next cervical cancer screening and to do an advocating to the Jakarta’s government. Methods: A secondary data analysis was conducted from several areas in Jakarta from 2007 to 2011. VIA test was used as the screening method, and performed by doctors and midwives with technical supervision by gynecologists. Results: From 25,406 women, there were 1,192 cases (4.7%) of VIA test positive. The risk factors that can significantly influence the result of VIA positive were number of marriage, parity, smoking habits, and the use of hormonal contraception with OR 1.51, 1.85, 1.95, and 0.68, respectively. Conclusions: Prevalence of VIA test-positive is 4.7% in Jakarta population. The findings of precancerous lesions and cervical cancers are not only between thirty and fifty years old, but also below the thirty years old and after fifty years old. We suggest that VIA test should be performed to all reproductive age and elder women who are not screened yet.

Quantitative landslide susceptibility mapping at Pemalang area, Indonesia

Oh, Hyun-Joo,Lee, Saro,Soedradjat, Gatot Moch Springer-Verlag 2010 Environmental Earth Sciences Vol.60 No.6