Mirani Yusrika

Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio as an Early Prognostic Marker in Patients with Ovarian Cancer: A Systematic Review and Meta-Analysis

Presently, ovarian cancer remains the leading cause of death in gynecological malignancies. The survival rate of these patients is low, which might be caused by early metastases and delayed diagnosis. Therefore, it is crucial to investigate novel practical markers that provide early prognostic value which helps construct individualized treatment. A thorough investigation of the neutrophil-lymphocyte ratio (NLR) and lymphocyte ratio (PLR) in ovarian cancer patients was conducted using article selection from PubMed, Cochrane, Science Direct, and Google Scholar databases. The outcomes and hazard ratio (HR) were obtained using Review Manager 5.4, and the 95% Confidence Interval (CI) result was calculated. The chief endpoints of interest in this study include overall survival (OS) and progression-free survival (PFS). Sixteen studies with 3,862 patients were included with a mean age of 50.6 years and a mean follow-up of 45.84 months. Multivariate studies demonstrated that a higher NLR is associated with worse PFS and OS, HR 1.35;95% CI [1.05-1.74] and HR 1.46; 95% CI [1.16-1.83] respectively. Similar results are observed with PLR and poorer PFS and OS, HR 1.62; 95% CI [1.09-2.43] and HR 1.66; 95% CI [1.12-2.46]. Pre-treatment PLR and NLR were found to be prognostic factors in determining PFS and OS in ovarian cancer. High values in pre-treatment PLR and NLR may indicate worse clinical outcomes.

Midwives as the Primary Care Providers: Knowledge, Attitude, Practice, and Skill of Early Detection of Cervical Cancer Using Visual Inspection with Acetic Acid

Cervical cancer is the third most common malignancy in women globally. It is also the leading cause of death for women in Indonesia. When detected at an early precancerous stage, cervical cancer is largely preventable. Early detection with Visual Inspection with Acetic Acid (VIA) is an acceptable, affordable, and safe alternative method in developing countries. Midwives, as primary health care providers, can perform VIA at various health center levels. This study evaluated the knowledge, attitude, practice, and skill of cervical cancer screening with VIA among midwives in Denpasar. A cross-sectional study was conducted among 70 midwives at Public Health Centers in Denpasar, Bali, Indonesia, from July-August 2022. The data were collected using a structured knowledge, attitude, and practice questionnaire. An obstetrician-gynecologist assessed the skills with a standardized checklist. Data were analyzed using univariate, bivariate, and multivariate analysis on SPSS version 26. A level of p<0.05 was considered significant with a prevalence ratio (PR) and 95% confidence interval (CI). Out of all midwives, 42 (60.0%) were knowledgeable, 42 (60.0%) had a favorable attitude, 36 (51.4%) had good practice of VIA, and 54 (77.1%) had competent skills. Knowledge (PR=5.00, 95%CI=1.76-14.16), attitude (PR=2.92, 95%CI=1.08-7.89), and skill (PR=11.90, 95%CI=2.44-57.84) were associated with the practice of VIA. Age group and work experience were strongly associated with the training and skill of VIA. Most midwives in Denpasar were knowledgeable, had a favorable attitude, good practice, and competent skills to perform cervical cancer screening using VIA.

Correlation between Knowledge, Attitude, and Partner Support Towards Visual Inspection with Acetic Acid Test among Women in Denpasar City, Indonesia

Cervical cancer is the fourth most common cancer in women worldwide. Thus a high mortality rate is unavoidable. Visual Inspection with Acetic Acid (VIA) is a practical and inexpensive screening test for detecting cervical cancer. We aim to show the association between knowledge, attitude, and partner support towards VIA practice in women in Denpasar, Bali. The study design was a cross-sectional and analytical observational study conducted at the Public Health Center Denpasar in July-August 2022. The respondents consisted of 90 child-bearing-age women who met the inclusion criteria. The questionnaire consisted of informed consent, demographic characteristics (26 questions), knowledge (20 questions), attitude (22 questions), partner support (11 questions), and practice of VIA (2 questions). The data analysis used the Chi-square test using SPSS ver26. The median age of all respondents was 33 (10) years. The majority of respondents were monogamous (93.03%), had no history of miscarriage (80%), used contraception (56.07%), and the mean age of first sexual intercourse was 20.6 years. Up to 69 women (76.7%) had the VIA Test in the past five years, and 42 women (46.7%) took the test regularly every three years. There is a correlation between knowledge (p=0.001, r =0.334), attitude (p<0.001, r=0.367), and partner supports (p=0.03, r=0.197) toward practicing VIA. The practice of VIA is influenced by the level of knowledge, attitudes, and partner support of the child-bearing-age women in Denpasar. All healthcare professionals and the environment should support and encourage women to perform VIA regularly.