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All Journal Medicina E-Jurnal Medika Udayana Medical Journal of Indonesia Sari Pediatri Paediatrica Indonesiana
Eka Gunawijaya
Departemen/KSM Ilmu Kesehatan Anak, Fakultas Kedokteran Universitas Udayana/RSUP Sanglah, Denpasar
Health Professions Medicine & Pharmacology

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Changes in temperature of newborn babies bathed immediately after birth Gunawijaya, Eka; S., Abdul H.
Medical Journal of Indonesia Vol 12, No 2 (2003): April-June
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (203.533 KB) | DOI: 10.13181/mji.v12i2.93

Abstract

In the tropics, bathing full-term newborn babies are routinely done immediately after birth, although it is usually not recommended until 2 – 6 hours of age. Yet, there is no study in Indonesia about hypothermia in newborns bathed immediately after birth. The aim of this study is to determine the influence of bathing the newborn immediately after birth to the body temperature and hypothermia. One hundred and twenty five healthy full-term newborn babies delivered on March 1999 were included and separated into two groups, 59 newborns were bathed immediately after birth and 66 newborns were bathed later. There was no statistical difference between both groups in the mean of birth weight, gestational age, room temperatures, gender, delivery method, and risk of infection. Mean body temperature between both groups were not statistically different on the 0 and the 30th minute after birth. On the other hand, on the 15th minute after birth, the mean body temperature of the immediately bathed group was statistically lower than not immediately bathed group [36.84 (SD 0.25) °C vs 37.02 (SD 0.27) °C, p=0.0001]. On the 15th minute after birth, there were four (6.8%) hypothermic babies (rectal temperature < 36.5°C) in the immediately bathed group and one (1.5%) hypothermic baby in the not immediately bathed group (p=0.134). Conclusion, bathing healthy full-term newborn babies immediately after birth will decrease the body temperature, but hypothermia occurred only in very small numbers which are not statistically significant. (Med J Indones 2003; 12: 73-79)Keywords: hypothermia, newborn baby, bathed immediately after birth
Cardiac catheterization and percutaneus catheter in grown-up congenital heart diseases: single center experience at developing country Dewi, Luh G.A.P.; Yantie, Ni P.V.K.; Gunawijaya, Eka
Medical Journal of Indonesia Vol 27, No 1 (2018): March
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (324.876 KB) | DOI: 10.13181/mji.v27i1.2284

Abstract

Background: Grown-up congenital heart disease (GUCH) patients are unique and challenges especially at developing country. The numbers of diagnostic as well as interventional cardiac catheterization procedures in GUCH patients are growing. The aim of this study was to report the outcome of cardiac catheterization including intervention procedure in GUCH.Methods: The descriptive study was conducted at Sanglah Hospital, Denpasar, Bali, Indonesia. All patients (age of more than 12 years) who underwent cardiac catheterization from 2011 until 2017 were included in this study. Patients, characteristic, types of catheter procedures, immediate complications, and outcomes were documented.Results: A total 54 subjects were included with median age of 23 years and 70% were female. The first symptom that brought patients to hospital is dyspnea 46% and palpitation 32%. Five subjects underwent a diagnostic catheter procedure and 49 (91%) diagnostic and catheter based interventions. Transcatheter interventions procedures included atrial septal defect (ASD) (success rate of 20 per 21), patent ductus arteriosus (PDA) (success rate of 16 per16), ventricular septal defect (VSD) (success rate of  9 per 9), pulmonal stenosis (PS) (success rate of 1 per 2), and aortic stenosis (AS) (success rate of 1 per 1). The complications encountered were transient dysrhythmias in 15 subjects, device embolization in 4 subjects, massive bleeding in 1 subject, and overall mortality in 2 subjects.Conclusion: The number of the catheterization interventions in GUCH was 91% and ASD device closure was the most common procedure. Transcatheter intervention has a high procedural success rates (96%) and low procedural-related complications.
COR TRIATRIATUM SINISTER AT 34 DAYS OLD BOY Purnami, Adi; Gunawijaya, Eka
Medicina Vol 45 No 1 (2014): Januari 2014
Publisher : Medicina

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Abstract

Cor triatriatum merupakan kelainan bawaan yang sangat langka. Pada kelainan ini jaringan ikatfibrus akan membagi atrium kanan atau kiri menjadi 2 bagian. Angka kejadian hanya sebesar 0,1%dari seluruh kelainan jantung bawaan dan biasanya ditemukan bersama-sama dengan kelainanjantung lainnya. Perjalanan klinis tergantung dari hubungan antara bilik atas dengan bilik bawahdari atrium yang terbagi. Bila lubang penghubungnya kecil, keluhan mulai muncul sejak lahir danbiasanya meninggal saat masa bayi. Bila penghubungnya besar, keluhan akan muncul pada usia anakatau dewasa dengan gejala klinis menyerupai stenosis mitral. Kami melaporkan kasus pada bayiusia 34 hari yang datang dengan keluhan sesak napas dan kebiruan pada bibir bila menangis. Diagnosisditegakkan dari klinis, foto dada, dan ekokardiografi. Satu-satunya terapi adalah koreksi melaluipembedahan, tapi kasus meninggal sebelum pembedahan dilakukan. [MEDICINA  2014;45:65-70].
Emboli koroner sebagai komplikasi penutupan defek septum ventrikel transkateter dengan amplatzer duct occluder –II pada pasien berusia 2 tahun Putra, AA Sg Mas Meiswaryasti; Pradnyana, Bagus Ari; Gunawijaya, Eka
Medicina Vol 47 No 2 (2016): Mei 2016
Publisher : Medicina

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Abstract

Sejak pelaporan pertama penutupan defek septum ventrikel (DSV) transkateter pada tahun 1988, tindakan penutupan DSV berbasis pendekatan transkateter ini merupakan alternatif dari penutupan secara pembedahan dengan angka mortalitas dan morbiditas yang dapat diterima dengan hasil yang memuaskan. Beberapa komplikasi tindakan ini yang telah dilaporkan adalah gangguan irama jantung, regurgitasi katup, device embolization, haemolisis, haematoma, dan demam. Emboli koroner merupakan komplikasi peri-prosedural yang jarang terjadi. Kami melaporkan seorang anak perempuan berusia 2 tahun yang menjalani penutupan DSV transkateter dengan menggunakan amplatzer duct occluder-II, saat tindakan tampak elevasi segmen ST lead III dan aVF pada monitor elektrokardiografi. Pemeriksaan aortografi menunjukkan suatu oklusi total pada proksimal arteri koroner kanan, sedangkan arteri anterior descending dan sirkumfleks kiri normal. Intervensi koroner perkutan (IKP) dilakukan untuk evakuasi trombus. Restorasi aliran koroner bagian distal berhasil dilakukan dan pasien membaik tanpa komplikasi. Since the first report of transcatheter ventricular septal defect (VSD) closure in 1988, this catheter-based approach for VSD has been shown to be an alternative to surgical closure with acceptable mortality and morbidity as well as encouraging results. Some of its complications had been reported including heart rhythm disturbances, valvular regurgitation, device embolization, haemolysis, haematoma, and fever. Coronary embolism is a rare peri-procedural complication of this procedure. We reported a 2 year old girl who underwent transcatheter VSD closure using amplatzer duct occluder-II, during the procedure electrocardiography on monitor showed ST elevation in Lead III and aVF. The aortography revealed total occlusion with thrombus at proximal right coronary artery, the left anterior descending and left circumflex arteries were normal. Percutaneus coronary intervention was done for removing the thrombus. Restoration of distal coronary flow was achieved and patient recovery was uncomplicated.
A CHILD WITH TETRALOGY OF FALLOT PRESENTING WITH COMPLICATIONS OF INFECTIVE ENDOCARDITIS, CEREBRAL ABSCESS, AND UNDERNUTRITION Yasmin, AA Ayu Dwi Adelia; Gunawijaya, Eka
Medicina Vol 46 No 1 (2015): Januari 2015
Publisher : Medicina

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Abstract

Tetralogy of Fallot  (TOF)  is a congenital heart disease  that consists of  four anatomical anomalies,namely ventricular septal defect, pulmonary stenosis or obstruction of the right ventricular outflowtract, right ventricular hypertrophy, and overriding aorta. Tetralogy of Fallot is frequently associatedwith complications that could affect morbidity and mortality because of its complex cardiac lesions.Good understanding of the natural history and complications of this disease is very important to guidethe management of patients. We reported a 4-year old girl with classic TOF with complications ofinfective  endocarditis,  cerebral  abscess,  and undernutrition. Despite  optimal medical  therapy,  thepatient?s condition showed no satisfying improvement. Since the parents were refused to take moreaggressive measure by undergoing surgical therapy, so that patient care remains focused on supportiveand palliative aspects. [MEDICINA 2015;46:37-41].Tetralogy of Fallot (TOF) merupakan suatu penyakit jantung kongenital yang terdiri dari empat anomalianatomis, antara lain ventricular septal defect, pulmonary stenosis atau obstruksi pada right ventricleoutflow tract, hipertrofi ventrikel kanan, dan overriding aorta. Tetralogy of Fallot sering disertai denganberbagai  komplikasi  yang  dapat mempengaruhi morbiditas  dan mortalitas  karena  kelainan  inimerupakan kelainan kongenital kardiak yang kompleks. Pemahaman yang baik mengenai perjalananalamiah  dan komplikasi  penyakit  ini  sangat  penting untuk mengetahui  penatalaksanaan  pasien.Kami melaporkan seorang anak perempuan berusia 4 tahun dengan TOF klasik yang juga menderitakomplikasi endocarditis infektif, abses serebral, dan gizi kurang. Walaupun telah memperoleh terapimedikamentosa  yang  optimal,  kondisi  pasien  tidak menunjukkan  perbaikan  yang memuaskan.Orangtua  pasien  telah menolak  pemberian  tindakan  yang  lebih  agresif,  yaitu  dengan  terapipembedahan,  oleh  karena  itu  penatalaksanaan  pasien  lebih  difokuskan  pada  aspek  suportif  danpaliatif. [MEDICINA 2015;46:37-41].
A 44-DAY OLD MALE INFANT WITH THORACOABDOMINAL ECTOPIA CORDIS OF PENTALOGY CANTRELL’S SYNDROME Yuliantini, Tri; Gunawijaya, Eka; Putu Yasa, Ketut
Medicina Vol 44 No 1 (2013): Januari 2013
Publisher : Medicina

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Abstract

Ectopia cordis is a rare and impressive congenital abnormality, occurring in 5.5 to 7.9 per 1 million live births. The defect is characterized by partial or complete displacement of the heart out of the thoracic cavity. This defect require a staged procedure to achieve a complete repair. We reported a 44-day-old male infant presented with symptoms of tachypnea and mild cyanosis since birth. On physical examination, the child looked lethargic with a weak cry. The midline defect extended from the lower margin of the neck to the umbilicus. The sternum was completely bifid, with an inter-ridge distance of 6 cm, through which the heart was protruded for 4-5 cm and the apex pointed anteriorly. The first and second heart sounds were normal with ejection holosystolic murmur. The diagnosis was ectopia cordis. A two dimensional echocardiography showed complete atrioventricular septal defect, which was known as a group of cyanotic congenital heart defect. The infant was referred subsequently to the neonatal intensive care unit with the ventilator support. Historically, the prognosis of this condition is poor. Our patient died before surgery being performed.
DUCTAL STENTING IN PULMONARY ATRESIA NEONATES WITH MULTIPLE CONGENITAL ANOMALIES AND SEPTIC CONDITION Wibisono, Laurentia Utari; Gunawijaya, Eka; Pradnyana, Bagus Ari
Medicina Vol 46 No 1 (2015): Januari 2015
Publisher : Medicina

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Abstract

Neonates with  pulmonary  atresia  usually  appear  normal  at  birth with  pulmonary  circulationmaintained by the presence of a patent ductus arteriosus (PDA). Rapid deterioration will suddenlyocccur  if the duct close. Surgical shunt  is still be used as a standard protocol  in many centers as apalliative procedure. We report a 2 days-old, low birth weight, and mild cyanotic neonate with pulmonaryatresia and PDA accompanied by atresia ani, bladder and cloaca extropy, ambiguous genitalia andsepsis. We decided to perform PDA stenting because our patient have a high surgical shunt risk. Thisprocedure was very  important  to keep  the duct remains open until patient ready  for  total surgicalcorrection. [MEDICINA 2015;46:42-45].Neonatus dengan atresia pulmonal biasanya tampak normal saat lahir dengan adanya patent ductusarteriosus (PDA) yang memelihara aliran darah paru. Kondisi neonatus akan segera memburuk jikaduktus menutup. Pembuatan shunt dengan pembedahan merupakan protokol standar yang masihdikerjakan di banyak pusat kesehatan. Kami melaporkan neonatus berusia 2 hari dengan berat badanlahir rendah dan sianosis ringan dengan diagnosis atresia pulmonal, PDA, atresia ani, ekstropi buli-buli dan kloaka, jenis kelamin ambigu, dan sepsis. Kami memutuskan untuk melakukan pemasanganstent pada PDA karena pasien kami memiliki risiko yang tinggi untuk pembedahan (pembuatan shunt).Tindakan ini sangat penting untuk menjaga duktus tetap terbuka sampai pasien siap untuk dilakukanoperasi koreksi. [MEDICINA 2015;46:42-45].
HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY IN AN 8-MONTH OLD FEMALE INFANT SUSPECTED INFANTILE ONSET POMPE DISEASE Purnami, Made Dwi; Gunawijaya, Eka
Medicina Vol 45 No 2 (2014): Mei 2014
Publisher : Medicina

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Abstract

Hypertrophic cardiomyopathy (HCM) is an autosomal dominant cardiac disorder marked with muscular hypertrophy of the left ventricle, associated obstruction of left ventricular outflow. About 0.2% of all cases worldwide. The majority of patients are asymptomatic, and some present with severe activity- limiting symptoms. The diagnosis of HCM before the age of 2 years is rare and usually discovered by chance, during the investigation of a murmur. Progressive disease characterized by prominent cardiomegaly, cadiomyopathy, hepatomegaly, musle weakness or hypotonia, respiratory distress, feeding difficulties and failure to thrive as presenting sign and symptoms are often referred to infantile Pompe disease. A deficiency of of the enzyme acid alpha glucosidase disease, result in lysosomal accumulation of glycogen in heart and skeletal muscle. Cardiorespiratory failure is the cause of significant morbidity and mortality in the first year of life. We reported a rare case, 8 month-old female with frequent respiratory distress since 2 months before admission. Physical examination showed dyspnea with chest wall retraction, no cyanosis, with grade III systolic murmur at midclavicular line sinistra, ICS IV- V and floopy infant. Chest films showed   pneumonia and cardiomegaly. The echocardiogram demonstrated bi-ventricular and interventricular hypertrophy with left ventricular obstruction. Laboratory finding there was increased levels of glutamic oxaloacetic acid transferase, alanin aminotransferase, and lactate dehydrogenase. Patient was diagnosed with hypertrophic obstructive cardiomyopathy of suspected infantile onset pompe disease. Despite medical treatment with propanolol dan diuretics, there was no significant improvement and she was died after 26th days of treatment in intermediate ward. [MEDICINA 2014;45:108-14]    
KOREA SYDENHAM DAN KARDITIS TERSEMBUNYI PADA SEORANG ANAK PEREMPUAN USIA 9 TAHUN Widyanti, Putu Ayu; Gunawijaya, Eka; Sutriani, Dewi
Medicina Vol 43 No 1 (2012): Januari 2012
Publisher : Medicina

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Abstract

Korea Sydenham adalah bentuk paling umum dari gerakan korea yang diperoleh pada masa kanak-kanak, dan  merupakan salah satu kriteria diagnostik utama demam rematik. Korea Sydenham ditandai dengan gerakan involunter yang menghilang saat tidur, ketidakstabilan emosional, dan hipotonia. Kasus adalah anak perempuan berumur 9 tahun dengan gerakan coreatic (gerakan involunter pada lengan dan kaki). Gerakan tersebut juga ditemukan pada lidah sehingga pasien sulit untuk berbicara. Pasien juga memiliki ketidakstabilan emosi, dan kelemahan otot. Riwayat trauma disangkal.  Pada pemeriksaan fisik ditemukan murmur di daerah apex jantung, holosistolik, derajat  2/6, meniup, dan menyebar sepanjang aksila. Pada echocardiography didapatkan  regurgitasi mitral moderat (MR) dan regurgitasi aorta (AR) karena karditis. Diagnosisnya adalah Korea Sydenham dan karditis. Pasien  diterapi dengan erythomicin 250 mg empat kali sehari selama 10 hari, dan eritromisin 250 mg oral dua kali sehari untuk profilaksis. Untuk terapi simtomatik diberikan haloperidol 2 mg dua kali sehari dan trihexyphenidil 0.5 mg tiga kali sehari. Respon terapi dan prognosis baik. (MEDICINA 2012;43:54-59).
MITRAL VALVE REPLACEMENT AT 11 YEARS OLD GIRL WITH RHEUMATIC MITRAL STENOSIS Malik, Suryani; Gunawijaya, Eka; Yasa, Ketut Putu
Medicina Vol 45 No 2 (2014): Mei 2014
Publisher : Medicina

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Abstract

Rheumatic heart disease (RHD) is the permanent heart valve damage resulting from one or more attacks of acute rheumatic fever (ARF), representing the permanent lesions of the cardiac valve. Rheumatic heart disease’s patient with valvar involvement usually require long term follow-up. The ultimate decision of clinical management or invasive therapy is made on an individual basis. We reported a 11-year-old girl with RHD and severe mitral stenosis whom underwent   mitral valve replacement with mechanical valve. Postoperative echocardiogram showed no mitral regurgitation and we gave anticoagulant to maintain INR of 3-4 by giving warfarin 2mg / kg each day for lifelong to prevent bleeding and thrombosis. [MEDICINA 2014;45:120-6]    
Co-Authors AA Sg Mas Meiswaryasti Putra, AA Sg Mas Meiswaryasti Abdul H. S. Adi Purnami, Adi Alvin Alvelino Putra Sutrisna Anak Agung Ayu Dwi Adelia Yasmin Anak Agung Ngurah Ketut Putra Widnyana Armand Setiady Liwan Ayu Setyorini Mestika Mayangsari Bagus Ari Pradnyana Bagus Ngurah Putu Arhana Defranky Theodorus Dewi Sutriani Mahalini Dewi, Luh G.A.P. Dyah Kanya Wati Eko Kristanto Kunta Adjie Elizabeth Joan Salim Hendra Santoso I Gusti Ayu Made Dwisri Okadharma I Gusti Lanang Sidiartha I Gusti Ngurah Sanjaya Putra I M Widia I Nyoman Budi Hartawan I Wayan Gustawan Ida Bagus Subanada Kadek Wini Mardewi Ketut Ariawati Ketut Dewi Kumara Wati Ketut Putu Yasa Komang Ayu Witarini Laurentia Utari Wibisono, Laurentia Utari Made Dwi Purnami, Made Dwi Made Gede Dwi Lingga Utama Ni Made Ayu Agustini Ni Putu Wirantari NP Veny Kartika Yantie Putu Ayu Widyanti Soetjiningsih Soetjiningsih Sri Wahyuni Djoko Suryani Malik, Suryani Tri Yuliantini