Gede Kambayana
Departemen Ilmu Penyakit Dalam, FK Universitas Udayana/RSUP Sanglah, Denpasar, Bali, Indonesia

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journal of internal medicine Vol. 12, No. 3 September 2011
Publisher : journal of internal medicine

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Osteoarthritis (OA) is one type of arthritis which commonly found especially in elderly and become the common cause ofdisability in elderly people. Recently known that immunologic respons and homeostasis of cartilage metabolism have animportant role, and MMP-3 as one of degradative enzyme which has a pivotal role in OA patogenesis. Aim of this studyis to determine correlation between level of MMP-3 and radiographic grading of knee OA, in Sanglah Hospital, DenpasarBali. An analytical cross sectional study was carried out in Policlinic Sanglah Hospital, enrolled 76 samples with kneeOA. Of all sample, 32 (42.1%) were males and 44 (57.9%) famales. The mean of MMP-3 serum level is 25.2 ± 20.7ng/ml. Radiographic grading of knee OA based on Kelgren and Lawrence criteria 4 (5.3%) grade 1,29 (38.3%) grade 2,28 (36.8%) grade 3 and 15 (19.7%) grade 4. The mean level of MMP-3 on grade 1 group is (24.7 ng/ml), grade 2 (17.8ng/ml), grade 3 (28.3 ng/ml) and grade 4 is 32.8 ng/ml. Using Spearman!s analyses, there were signiÞ cant correlationbetween MMP-3 and radiographic grading of knee OA (r = 0.25 and p = 0.03).There were signiÞ cant positive correlation between MMP-3 and radiographic grading of knee OA.
journal of internal medicine Vol. 9, No. 3 September 2008
Publisher : journal of internal medicine

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Systemic lupus erythematosus (SLE) is a multisystem inflammatory disease that is often difficult to diagnose and theetiology still unclear. Before the diagnosis can be established, four of eleven clinical and laboratory criteria must be met. Theprogression of SLE is acute fulminant, chronic remision and exacerbation. Prevalens of SLE in the many countries is variouslybetween 2.9 ? 400 per 100.000. SLE usually occur in reproduction period of human (15 ? 40 years old) and female is morecommon than male 5.5 ? 9.0 : 1. Cardiovascular manifestation of SLE is an serious case and increasing of mortality. Pericarditis,miocarditis and fibrinous Libmann-Sacks endocarditis are a common cardiovascular manifestation. Insufficiency of mitral andaorta valve is a rare complication of SLE and usually combination with pulmonal vein congestion and lung edema. We reporteda systemic lupus erythematosus with insufficiency mitral valve in Sanglah hospital because this case is very rare in populationand complicated. Accurate diagnosis of SLE is important because prompt treatment can reduce morbidity and mortality.
journal of internal medicine Vol. 12, No. 1 Januari 2011
Publisher : journal of internal medicine

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Microalbuminuria has been linking to cardiovascular (CV) risk in patients with diabetes or hypertension in unselectedgeneral population. Serum Uric Acid (UA) is an emerging novel risk factor for CV disease. The aim of our study was to evaluatethe correlations between hyperucemia and microalbuminuria in the adult Legian Kuta Village population. We selected eligible136 participants of adult (>18 years old) in Legian Kuta village who agreed to participate. We excluded diabetes mellitus,hypertension, urinary tract infection, and fever. We measured total cholesterol, HDL, LDL-cholesterol, triglyseride, fasting and2-hour post prandial blood sugar, serum creatinine, serum uric acid, systolc-diastolic blood pressure and microalbuminuria(Urinary Albumin/Creatinine Ratio, ACR).The prevalence of hyperuricemia in our study was 16.9 % while microalbuminuria was 5.1 % (ACR 30 ! 299  g/mgcreatinine) and macroalbuminuria 1.5% (ACR > 300  g/mg creatinine). Hyperuricemia and obesity signiÞ cantly correlated withmicroalbuminuria by Bivariate Analysis Spearmanrho correlation r = 0.274, p = 0.001; r = 0.178, p = 0.038 (p < 0.05) respectively.Age, sex, smoking, total cholesterol, LDL, HDL and triglyseride were not signiÞ cantly correlated with microalbuminuria (p >0.05). In a stepwise multiple logistic regression model, hyperuricemia to microalbuminuria remained signiÞ cantly correlatedwith R Square 0.280 and prevalence ratio 7.90; p = 0.013; 95% CI 1.54 ! 40.60. Obesity was not signiÞ cantly correlated withmicroalbuminuria p = 0.161; 95% CI 0.59 ! 23.03. Our study showed hyperuricemia was signiÞ cantly correlated, as independentpredictors to microalbuminuria.
journal of internal medicine Vol. 12, No. 2 Mei 2011
Publisher : journal of internal medicine

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Hyperuricemia is a condition of high consentration of uric acid in the blood. In most epidemiology study hyperuricemiais defined as level uric acid more than 7.0 mg/dl in men and more than 6.0 mg/dl in women. Hyperuricemia can be caused byseveral factors. Regarding the etiology hyperuricemia can be classified as primary, secondary and idiopathic hyperuricemia.Primary hyperuricemia related to genetic factor while secondary hyperuricemia caused by condition or other factors besidesgenetic factor such as high purin consumption, chronic kidney disease, certain drugs, alcohol and hypertension. Hyperuricemiacan be caused by inceased of uric acid metabolism (overproduction), decreased of urine uric acid excretion (underexcretion),or mix of both. Fraction Uric Acid Clearance (FUAC) is one of the method used to differentiate either hyperuricemia caused byoverproduction or underexcretion. The aim of this studi is to determine the prevalence of hyperuricemia, means value of FUACand association between hyperuricemia and FUAC in Tenganan Pegringsingan Karangasem region Bali.A cross sectional analytic study was conducted on Balinesse in Tenganan Pegringsingan Karangasem region. Samplestudy was Balinese at age of 13 years old or above, agree to participate by informed consent. Descriptive statistic analysis onnumeric data presented as mean mean ± SD, nominal and ordinal data in proportion. Pearson?s correlation method is used incomparing the correlation between hyperuricemia and FUAC. Of 100 eligible samples, mean age was 37.20 ± 13.59 y.o, 51(51%) men and 49 (49%) women. Youngest age was 13 y.o and oldest was 69 y.o. Mean of blood uric acid level was 5.69 ± 1.43mg/dl. Prevalence of hyperuricemia on this study was 28%, 21% men and 7% women. Means value of FUAC is 6.41 + 1.99%;6.94 + 2.01% in normal uric acid level and 5.04 ± 1.1% in hyperuricemia. There is close correlation between hyperuricemia andFUAC (r = 0.43; p = 0.00)
journal of internal medicine Vol. 8, No. 2 Mei 2007
Publisher : journal of internal medicine

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Brachial-ankle pulse wave velocity (baPWV) is an indicator of limb arterial stiffness. Dislipidemia is a major risk factorof atherosclerosis and may worsen baPWV by increasing the blood viscosity. This study aims to study the correlations betweenbaPWV and the lipid profile among employees of Sanglah Hospital. Cross sectional analytic study was performed in Sanglahhospital. Pulse wave velocity was measured using an automatic device (Fukuda VS 1000). Lipid profile were taken as well. Datawas expressed in mean + SD, analyzed by t-test compare mean and Pearson correlation by using SPSS 13.0. There were 85patients involved, all subjects were male, age all between 40-56 (mean 47.23 + 5.16) years old. Cholesterol total, LDL-C, HDLC,and triglyceride concentrations varied subject, range (means + SD) as (205.05 + 39.40) mg/dL, (144.26 + 36.85) mg/dL,(45.94 + 8.98) mg/dL, and (151.94 + 64.56) mg/dL, respectively. BaPWV on the right limbs were between (13,31 + 2,14 ) m/sec,on the left limbs were (15,05 + 2,33 ) m/sec. Significant correlations were found between total cholesterol concentration and theleft baPWV (r = 0.222, p = 0.41), while a significant correlation were found on the right side (r = 0.234, p = 0.031). Brachialanklepulse wave velocity is positively correlation with total cholesterol concentration.
Seorang pasien yang menderita sklerosis sistemik konkomitan dengan artritis reumatoid Yuliandari KK, Cok Istri; Kambayana, Gede
Medicina Vol 47 No 3 (2016): September 2016
Publisher : Medicina

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Sklerosis sistemik (SS) dan artritis reumatoid (AR) merupakan penyakit jaringan ikat yang bersifat kronik progresif.Sklerosis sistemik ditandai dengan fibrosis abnormal, sedangkan AR ditandai dengan gangguan pada persendian yangsimetris. Sklerosis sistemik merupakan penyakit yang jarang. Kedua penyakit ini dapat terpisah atau terjadi bersamaanyang disebut denganoverlap syndrome. Kami melaporkan sebuah kasus SS dan AR yang secara konkomitan terjadipada seorang pasien. Wanita, usia 30 tahun, suku bali, yang ditemukan dengan penebalan, penegangan, danpengerasan pada kulit seluruh tubuh yang dialami sejak 4 tahun yang lalu. Pada pasien juga ditemukan deformitas(swan neck deformity) simetris pada sendi jari tangan dan kaki. Anti-topoimerase 1 (anti-scl 70) positif, biopsi kulitmenunjukkan suatu skleroderma, foto manus dan pedis menunjukkan gambaran erosi marginal. Pasien memenuhikriteria diagnosis SS dan AR, dandiberiterapi metroteksat 7,5 mg setiap minggu, denganprognosis dubius ad malam.[MEDICINA.2016;50(3):42-46]Systemic sclerosis (SS) andrheumatoidarthritis (RA) are a chronic and progressive of connective tissue diseases.Systemic sclerosis presented by abnormal fibrosis, whileRA is presented bysymmetrical joint lesion. Systemicsclerosis is a rare case. Systemic sclerosis and RA can affect the patient separately or both can occurred in oneindividual, called overlaps syndrome. We reported a case of SS and RA overlaps syndrome. Athirtyyear old Balinesefemale patient found with a thickening, tightness,andhardening of her skin, occurred since 4 years. We also found theswan neck deformities on her fingers and toessymmetrically. Anti-topoimerase (anti-scl 70) positive, skin biopsyshowed scleroderma, manus and pedis x-ray showed the marginal erosion. The patient fulfilled criteria diagnosis forSS and RA. The patient was given metrotexat 7.5 mg each week, and the prognosis was dubius ad malam.[MEDICINA.2016;50(3):42-46]
Correlation between Severity of Knee Osteoarthritis and Serum Levels of Cartilage Oligomeric Matrix Protein Kambayana, Gede; Kurniari, Pande; Andriyasa, Andriyasa; Putra, T R
Indonesian Journal of Rheumatology Vol 5, No 1 (2014)
Publisher : Indonesian Rheumatology Association

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Background: The sensitivity of radiographic examination in the diagnosis and severity assessment of knee osteoarthritis (OA) is still low. Various attempts have been made to find more reliable indicators of cartilage damage. One potential marker is cartilage oligomeric matrix protein (COMP), a substance that in previous animal studies had been shown to be released in proportion to the extent of joint cartilage damage.Objective: To evaluate the correlation between the severity of knee OA and serum level of COMP in human with normal renal function. Methods: This was a cross-sectional study performed at the outpatient clinic in Department of Internal Medicine, Sanglah Hospital, Denpasar. The diagnosis of knee OA was based on the American College of Rheumatology (ACR) criteria. The degreeof knee OA severity was determined by using the Kellgren-Lawrence criteria, while COMP values were checked by enzyme-linked immunosorbent assay (ELISA) method.Results: Forty five patients who were recruited were examined: 19 (42.2%) were female and 26 (57.8%) were male. The mean age of patients was 64.1±7.1 years. There were 4.4%, 26.7%, 46.7%, and 22.2% patients who had grade 1st, 2nd, 3rd, and 4th degree joint damage based on the Kellgren-Lawrence score, respectively. Mean serum level of COMP was 1081.4 ng/mL. We found a significant correlation ofthe severity of knee OA with serum level of COMP (r = 0.41, p = 0.005).Conclusion: Among the patients in this study, there was a significant correlation between the severity of joint damage in knee OA and serum level of COMP.
Comparison of the prevalence of hyperuricemia in families of patients with and without gouty arthritis among Balinese people Kambayana, Gede; Putra, T R
Indonesian Journal of Rheumatology Vol 3, No 1 (2011)
Publisher : Indonesian Rheumatology Association

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Background: Gout is a metabolic disorder caused by hyperuricemia, which results from changes in uric acid metabolism. Both internal (e.g., genetics) and external factors (e.g., diet, habits, comorbidities) play role in the occurrence of hyperuricemia and the difference of hyperuricemia prevalence in different populations.Objective: To compare the prevalence of hyperuricemia in families of gout and non-gout patients among Balinese people.Methods: This cross-sectional study was carried out at the rheumatology clinic at Sanglah Hospital, Denpasar. Samples were collected using consecutive method and consisted of gout and non-gout patients. Several characteristics (alcohol and purine consumption,medications, blood pressure, body mass index, serum uric acid level, and serum creatinine) in both groups were collected and compared. Family members (fi rstdegree relatives) of patients in each group were also recruited and had their serum uric acid level measured and compared.Results: A total of 46 patients and 116 family members (23 patients and 58 family members in each group) were enrolled. Among gout patients, there was signifi cantlyhigher prevalence of hyperuricemia, serum uric acid level, blood pressure, and serum creatinine; and lower creatinine clearance compared with the non-gout patients. There was signifi cantly higher prevalence of hyperuricemia among families of gout patients comparedwith families of non-gout patients (60.3 vs. 29.3%, respectively; p = 0.001), with a prevalence ratio of 2.06. Mean serum uric acid level of the family members of gout patients were also signifi cantly higher than the family members of non-gout patients (7.24 (SD 1.74) vs. 5.92 (SD 1.63) mg/dL, respectively; p = 0.000).Conclusion: Among Balinese people in this study, significantly higher prevalence of hyperuricemia and mean serum uric acid level was observed in families of gout patients compared with families of non-gout patients.
CASE REPORT : OSTEOARTHRITIS Putu Imayati; Gede Kambayana
E-Jurnal Medika Udayana vol 2 no 7 (2013):e-jurnal medika udayana
Publisher : Universitas Udayana

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Osteoarthritis is a degenerative joint disease in which the affected joint is usually the large joint and unilateral. Prevalence of osteoarthritis in Indonesia, 15.5% in men and 12.7% in women, where the incidence is increasing with age. Osteoarthritis is more common an idiopathic disease or unknown cause although there is also a secondary cause such as trauma, infection, neurological or metabolic disorders. The usual complaints that perceived by osteoarthritis patients is pain in the affected joint, especially after the load on the joint. Therapy in osteoarthritis is usually symptomatic, which include the control of risk factors, physiotherapy and pharmacological.
Korelasi Kadar Serum Leptin dengan Aterosklerosis pada Pasien Systemic Lupus Erythematosus Wanita Manaek, Andi; Kambayana, Gede
Jurnal Penyakit Dalam Udayana Vol 1 No 1 (2017): JPD Vol. 1 No.1 2017
Publisher : PAPDI BALI

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Penyakit kardiovaskular adalah penyebab kematian tertinggi di dunia. SLE diduga berkontribusi kuat mempercepat timbulnya aterosklerosis. Baru-baru ini, banyak bukti ditemukan berhubung dengan efek hormon pada sistem imun termasuk efeknya pada penyakit autoimun. Leptin dikenal sebagai hormon yang menyerupai sitokin dengan aksi pleiotropik dalam memodulasi respon imun. Penelitian yang dilakukan sebelumnya mendapatkan level leptin yang tinggi pada pasien SLE dengan plak aterosklerosis namun berkorelasi lemah dengan carotid Intima Media Thickness (cIMT). Tujuan penelitian ini yaitu untuk mengetahui korelasi serum leptin dengan aterosklerosis pada pasien SLE. Penelitian dilakukan dengan disain analitik potong lintang. Pengambilan sampel dilakukan dengan metode simple sampling. Konsentrasi serum leptin diperiksa dengan menggunakan metode ELISA dan aterosklerosis diperiksa dengan mesin Duplex carotid-intima Doppler Ultrasound oleh satu orang dokter spesialis radiologi. Analisis statistik menggunakan uji korelasi Spearman. Tingkat kemaknaan jika p &lt; 0,05. Sebanyak 54 orang pasien SLE wanita diikutkan dalam penelitian. Rerata kadar serum leptin&nbsp; adalah 203,83 ± 179,06 ng/ml. Pada pasien didapatkan rerata CIMT adalah 0,48 ± 0,12 mm dengan frekuensi yang mendapat plak 5,5% dan tidak plak 92,7%. Terdapat korelasi lemah antara kadar serum leptin dengan aterosklerosis dalam hal ini yaitu CIMT (r = 0,028; p = 0,843) dan plak (r = 0,008; p = 0,955), tetapi secara statistik tidak bermakna (p &lt; 0,05). Pada penelitian ini tidak didapatkan korelasi antara kadar serum leptin dengan aterosklerosis pada pasien SLE wanita.