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Andi Kurniadi,1 Dani Setiawan,1 Jessica Kireina,1 Dodi Suardi,1 Siti Salima,1 Febia Erfiandi,1 Mia Yasmina Andarini2 1Department of Obstetrics and Gynecology, Universitas Padjadjaran, Bandung, Indonesia; 2Faculty of Medicine, Universitas Islam Bandung, Bandung, IndonesiaCorrespondence: Andi Kurniadi, Department of Obstetrics and Gynecology, Universitas Padjadjaran, Bandung, Indonesia, Tel +62 812 2028 6197, Email andi.kurniadi@unpad.ac.idBackground: Cervical cancer in pregnancy is rare and its management remains a formidable challenge. Clinical upstaging is a serious concern. Presentation may mimic pregnancy-related conditions, thus delaying diagnosis and leading to an advanced stage at presentation. In addition, concerns regarding chemotherapy safety in pregnancy may hinder its administration. Definitive therapy may also be delayed due to pregnancy.Case Report: A 37-year-old G3P2A0 10– 11 weeks pregnant woman was diagnosed with stage IB2 cervical cancer. We originally planned to perform neoadjuvant chemotherapy with paclitaxel 175mg/m2 and carboplatin 6 AUC every 21 days followed by caesarean section and radical hysterectomy. However, preoperatively, the tumor had grown further and progressed to stage IIB. Postpartum radiotherapy was thus indicated. Lower segmental caesarean section along with bilateral salpingectomy and ovarian transposition were performed. Radiotherapy was administered through external beam radiation therapy and brachytherapy. The patient delivered a small for gestational age male baby with no abnormalities. At 2-month follow-up, the infant appeared generally healthy.Conclusion: Cancer diagnosis during pregnancy adversely impacts women’s physical and psychological states. Symptoms may mimic pregnancy-related conditions, thus delaying diagnosis. Its management involves a multidisciplinary team to protect both maternal and fetal health.Keywords: cervical cancer, pregnancy, cancer in pregnancy, neoadjuvant chemotherapy

Dedy Frianto,1,2 Didik Setiawan,3 Ajeng Diantini,1,4 Auliya A Suwantika1,4 1Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia; 2Faculty of Pharmacy, Universitas Buana Perjuangan, Karawang, Indonesia; 3Faculty of Pharmacy, Universitas Muhammadiyah Purwokerto, Purwokerto, Indonesia; 4Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, IndonesiaCorrespondence: Auliya A Suwantika, Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia, Email auliya@unpad.ac.idBackground: Cervical cancer is the second-highest cause of death in women with cancer, which is mostly caused by human papillomavirus (HPV) infection, specifically HPV 16 and 18. Next to Pap smear and visual inspection with acetic acid, HPV vaccination is highly recommended to support preventive measures.Objective: This study aimed to determine parental acceptance of HPV vaccination in districts with high prevalence of cervical cancer and different levels of household income in West Java, Indonesia by taking several factors into account.Methods: A questionnaire was delivered to 286 parents who met the major inclusion criteria of having daughters at 5th or 6th grade of elementary schools in three selected districts: Bandung, Purwakarta and Karawang. In particular, logistic regression analysis was applied to investigate the correlation of acceptance towards HPV vaccination with sociodemographic factors.Results: Respondents in Bandung, Purwakarta and Karawang were willing to pay for HPV vaccine at a price range of US&dollar; 1.38– 20.69, US&dollar; 0.07– 34.48, and US&dollar; 1.38– 6.90, respectively. In addition, respondents’ spouse was the key person influencing their decision to vaccinate their children.Conclusion: Education level and health beliefs toward cervical cancer have significant correlation (p-value < 0.05) with acceptance towards HPV vaccination.Keywords: HPV vaccination, knowledge, health belief, attitude, willingness to pay

Dedy Frianto,1,2 Didik Setiawan,3 Ajeng Diantini,1,4 Auliya A Suwantika1,4 1Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia; 2Faculty of Pharmacy, Universitas Buana Perjuangan, Karawang, Indonesia; 3Faculty of Pharmacy, Universitas Muhammadiyah Purwokerto, Purwokerto, Indonesia; 4Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, IndonesiaCorrespondence: Auliya A Suwantika, Faculty of Pharmacy, Universitas Padjadjaran, Jl. Raya Bandung-Sumedang Km. 21, Jatinangor, Sumedang, 45363, Indonesia, Email auliya@unpad.ac.idBackground: In countries with limited resources, a targeted HPV vaccination strategy by focusing in selected regions is preferable to be implemented than a nationwide vaccination strategy.Objective: This study aimed to review articles on economic evaluations of HPV vaccination in countries over the world that applied targeted vaccination strategies.Methods: Approximately 1769 articles were obtained from two databases (1242 and 527 articles from PubMed and ProQuest, respectively). The inclusion criteria in this systematic review were studies about full economic evaluations of HPV vaccination in targeted area or sub-national level and written in English. Full-text screening was applied to evaluate the eligibility. Final articles obtained were referred to the Consolidated Health Economic Evaluation Reporting Standard (CHEERS) checklist. Finally, we included only 4 articles that met all inclusion and exclusion criteria.Results: Included studies in this review focused in different targeted regions, such as Punjab State in India, Vientiane in Lao PDR, Southern Vietnam in Vietnam, and Brazilian Amazon in Brazil. From 24 criteria in the CHEERS checklist, all included studies could meet 21 criteria (87.5%). All included studies in this review applied modeling approaches, which can estimate the number of cases and treatment costs averted. Applying various settings, the results of this study showed that HPV vaccination could potentially reduce the number of cervical cancer cases by 20– 72%. Taking cervical cancer screening into account, this study showed that targeted HPV vaccination was cost-effective or even cost-saving.Conclusion: Implementation of HPV vaccination in sub-national level as the initial step before nationwide vaccination is more favorable to be implemented in countries with limited budget.Keywords: cost-effectiveness, cervical cancer, vaccine, immunization, screening

Arto Yuwono Soeroto,1 Dadan Setiawan,2 Nabila Nauli Asriputri,3 Guntur Darmawan,4 Geraldo Laurus,3 Prayudi Santoso1 1Division of Respiratory and Critical Illness, Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia; 2Department of Internal Medicine, Occupational Health General Hospital, Bandung, West Java, Indonesia; 3Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia; 4Department of Internal Medicine, Faculty of Medicine, Krida Wacana Christian University, Jakarta, IndonesiaCorrespondence: Arto Yuwono Soeroto Tel +62 811 246 930Email aysoeroto@yahoo.co.idPurpose: This study aimed to assess the association between vitamin D levels and forced expiratory volume in one second (FEV1), number of exacerbations, and symptoms based on COPD assessment test (CAT) scores in stable COPD patients in Indonesia.Patients and Methods: An observational cross-sectional study was conducted. Subjects were stable COPD patients who were treated at a pulmonary clinic in a tertiary referral hospital in West Java from March to June 2018.Results: Thirty subjects were recruited this study with an average age 62± 8 years. The mean vitamin D level was 20.17± 8.91 ng/mL. Half of the patients had low vitamin D level (< 20ng/mL) (50%). The mean FEV1 (%) predicted value was 37.2± 14. The median exacerbation per year was 1 (0– 5) and symptoms based on CAT score was 14 (3– 34). No correlation was found between vitamin D levels and FEV1 (%) predicted value (r=0.126, p=0.253). Vitamin D level was inversely correlated with number of exacerbations (r=− 0.639, p< 0.001) and CAT (r= − 0.802, p< 0.001).Conclusion: Low level of vitamin D was associated with more frequent exacerbation and higher CAT scores but was not associated with FEV1 (%) predicted.Keywords: COPD, vitamin D, FEV1, CAT score

In this article we discuss the meanings of power that are produced/reproduced in an East Javanese shadow puppet show entitled Ramayana by Ki Sinarto. In Foucauldian perspective, the meanings of power are constantly intertwined with other issues, and in Ki Sinarto’s Ramayana they are closely related to the state, revelation/women, family, and people. Despite the puppeteer’s efforts in doing a 'subversive interpretation' of Ramayana, the Javanese concept of power still ‘overpowers’ his discourse. Addressing the contemporary Indonesian state, Ki Sinarto is propagating the concept of Javanese power from the late Mataram kingdom. He also proposes that women can have a legitimizing power as the bearers of revelation, but the discourse of women as distractors to men’s career still surfaces. Ki Sinarto further pictures the main conflict of Ramayana as a dispute of an aristocratic family instead of woman. Finally, the relations between Javanese people and their leaders are not necessarily straightforward and linear

Cobalt-60 is usually used for calibration standard that nowadays, it hard to fabricated. This research aims to fabricate of Sealed Source 46Sc as alternative Calibration Standard. Sealed source 46Sc radioactivity was 1.17 ± 0.08 µCi, sealed with an aluminum label. Radiation exposure on the surface opened container is 19.27 ± 0.09 µSv/h, a closed is 10.78 ± 0.15 µSv/h and the distance of 1 m from an open container is 4.40 ± 0.04 µSv/h whereas closed has 2.40 ± 0.04 µSv/h. Multi-channel analyzer γ-spectrometry showed the 46Sc gamma spectrum similar with characteristics from standard 60Co source. [ABSTRACT FROM AUTHOR]

Nuclear grade aluminum capsules (AA-1070) was filled with 2 mg, 4 mg, 6 mg of target Sc2O3. The irradiation process of the capsule was performed in the Central Irradiation Position (CIP) G.A Siwabessy research reactor for 58.61 h. At the end of irradiation, 46Sc radioactivity was 26.67; 57.81; 85.48 mCi/capsule. The SS-316 capsule swab test, its was found that 46Sc radioactivity contamination was 2.198 Bq, 0.089 Bq and 0.218 Bq which were declared free of contamination. The gamma energy attenuation test for the thickness of the SS-304 plate, indicating that there is significant relationship between plate thickness and 46Sc gamma energy intensity. [ABSTRACT FROM AUTHOR]

Ballast structures continue to be utilized in Indonesia’s railway system. They are essential for conventional railway lines, which experience high levels of stress and are susceptible to damage from train traffic. This study examined the utilization of a pressure test machine and sieve analysis to determine the abrasion value of ballast made of 60/70 penetration asphalt with a binder and stabilizer material consisting of a mixture of latex and roving fiber. The test results revealed that the compressive strength of the ballast structure was positively affected by the addition of asphalt, latex, and roving fiber. However, when comparing the compressive strengths of the two ballast structures, the ballast structure with 2% asphalt and 3% latex generated superior results to that with 4% asphalt and 1% latex. In other words, asphalt, as opposed to latex, was more effective in protecting ballast material from abrasion.