I Gde Raka Widiana
Departemen Penyakit Dalam, Fakultas Kedokteran, Universitas Udayana, Denpasar, Indonesia

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Lipid profile in non-insulin dependent diabetes mellitus with microalbuminuria I Gde Raka Widiana, I Gde Raka Widiana
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 26, No 01 (1994)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

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To detennine whether non-insulin dependent diabetes mellitus (NIDDM) patients with microalbuminuria have significant abnormality in lipid profile which could result in increasing the cardiovascular risk, a cross sectional study had been conducted by matching in-patient and out-patient of the Department of Medicine, Dr. Sardjito General Hospital, Yogyakarta between October 1990 to May 1992.NIDDM patients with urinary albumin excretion rates (UAER) of 30 to 300 mg per 24 hours (microalbuminuria, incipient nephropathy) were matched for age and sex with NIDDM patients with UAER below 30 mg per 24 hours (control group). Venous blood samples were taken to determine blood sugar, total cholesterol, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol and triglyceride levels. Sex. age. duration of diabetes, relative body weight, retinopathy and neuropathy were also determined.Four groups of 34 NIDDM with microalbuminuria (17 males and 17 females) were found, and 34 controls (17 males and 17 females) were studied. There were no significant difference in age, duration of diabetes, relative body weight and neuropathy. However, retinopathy was significantly higher in diabetic patient with microalbuminuria. No significant difference was found in LDL-cholesterol (122,58 ± 59,09 mg/di vs. 113,55 ± 42,25 mg/di, p = 0,24) and triglyceride (173.91 ± 89.06 mg/dl vs. 164.69 ± 69.69 mg/di, p = 0.31), fasting blood sugar (202.55 ± 87.01 mg/dl vs. 23061 ± 111.93 mg/dl, p = 0.13) and 2 hours after meal (253.91 + 89.46 mg/di vs. 284.38 + 114.40 mg/di, p = 0.11) in both groups. However HDL-cholesterol levels (35.94 ± 13.65 mg/dl vs. 4.3 ± 12.32 mg/di, p = 0.01) was significantly lower and the ratio of total cholesteroVHDL-cholesterol (6.31 ± 3.08 vs. 4.1 ± 1.13, p = 0.00017) was significantly higher in NIDDM patients with microalbuminuria compared to the control group...Key Words: diabetes mellitus - lipid profile - cholesterol - HDL cholesterol - cardiovascular risk factors
Conservative therapy in chronic renal failure I Gde Raka Widiana, I Gde Raka Widiana
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 27, No 02 (1995)
Publisher : Universitas Gadjah Mada

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Chronic renal failure is still a major health problem in medicine world. An adequate treatment could only retard the progress of renal failure and delay the course toward end-stage renal disease, a condition that requires maintenance dialysis or kidney transplantation.Managable factors should always be identified and promptly treated. Dietary therapy may be able to cope with uremic symptoms, perhaps retards the progress of renal failure and improves nutritional status. All above mentioned will improve morbidity and mortality of the patients. A proper antihypertensive regiment not only protect the kidneys through blood pressure reduction but also gives independent renoprotective effects by improvement of renal hffect and electrolyte balance.emodynamics without negative metabolic effect and electrolyte balance.Key Words: end-stage renal disease -- predialytic phase -- conservative treatment -- dietary management -- hypertension
Pendekatan rasional terapi infeksi saluran kemih pada USILA (usia lanjut) I Gde Raka Widiana, I Gde Raka Widiana
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 28, No 01 (1996)
Publisher : Universitas Gadjah Mada

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Aging may affect functional and structural changes of the urinary tract which modify the response against infection. Sructural changes in elderly such as prostate hypertrophy, urinary tract stone, the use of catheter, and the presence of cystoceles should be treated properly. Attention should be paid on functional abnormalities in elderly including bladder atonia, neurologic defects, and prolonged bed rest. Inadequate immune response in elderly may also play a role in the changes. Those factors make the treatment of urinary tract infections in elderly have to be carried out more radically.Complicated urinary tract infections, infection in males with prostate hypertrophy, and pyelonephritis need prolonged treatment. Recurrent urinary tract infections in female elderly patients need early prophylactic treatment. Doing a culture of the causative microorganisms and a sensitivity test for the appropriate antibiotics should be taken into consideration in the selection of the antibiotics. Flouroquinolones and cephalosporins seem to be drugs of choice in multiresistant and severe casesKey words: urinary tract infections - elderly - functional changes - structural changes - treatment
Microalbuminuria in non-insulin dependent diabetes mellitus: an Indonesian experience Widiana, I Gede R.; Roesli, Rully; Suwitra, Ketut
Medical Journal of Indonesia Vol 7, No 3 (1998): July-September
Publisher : Faculty of Medicine Universitas Indonesia

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Hyperinsulinemia and cardiovascular risk factors in stroke patients Wiyono, Paulus; Rahardjo, Poerwono; Widiana, I Gde R.; Purnama, Purnama
Medical Journal of Indonesia Vol 6, No 1 (1997): January-March
Publisher : Faculty of Medicine Universitas Indonesia

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Glycated Albumin Sebagai Penanda Kontrol Glikemik Pada Penderita Diabetes Melitus Tipe 2 Ake, Anselmus; Saraswati, Made Ratna; Widiana, I Gde Raka
Jurnal Penyakit Dalam Udayana Vol 1 No 1 (2017): JPD Vol. 1 No.1 2017
Publisher : PAPDI BALI

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Latar Belakang: Glycated albumin (GA) merupakan indeks kontrol glikemik yang relatif baru. GA mencerminkan statusglukosa darah yang lebih pendek dibandingkan HbA1C, yakni 2-4 minggu sebelumnya. Tujuan: untuk mengetahuiapakah GA dapat digunakan sebagai penanda kontrol glikemik pada penderita DM tipe 2 (DMT2) dengan mencarisensitivitas, spesifisitas, nilai duga positif (NDP), dan nilai duga negatif (NDN) dari GA. Metode: Penelitian inimerupakan uji diagnostik, studi potong lintang, dilaksanakan di RSUP Sanglah dari Desember 2015 hingga Februari2016 menggunakan sampel 59 pasien DMT2. Kontrol glikemik ditentukan dengan HbA1C, glukosa puasa dan glukosa2JPP (baku emas). Hasil: Didapatkan area under ROC curve GA adalah 0,9135 (91,35%). Didapatkan 5 cut off point GAdimana 2 cut off point menunjukkan kemampuan skrining GA yakni ≥18,7% dan ≥19%, 2 cut off point menunjukkankemampuan diagnostik GA yakni ≥21,4% dan 22,4%, dan 1 cut off point optimal yakni 20,4%. Hasil uji diagnostikdengan menggunakan tabel silang 2x2 pada masing-masing cut off point yaitu GA ≥18,7% sensitivitas 94,7%;spesifisitas 76,2%; NDP 87,8%; NDN 88,9%. GA ≥19% sensitivitas 89,5%; spesifisitas 81%; NDP 89,5%; NDN 81%. GA ≥20,4% sensitivitas 81,6%; spesifisitas 85,7%; NDP 91,2%; NDN 72%. GA ≥21,4% sensitivitas 76,3%; spesifisitas 90,5%;NDP 93,5%; NDN 67,9%. GA ≥22,4% sensitivitas 63,2%; spesifisitas 95,2%; NDP 96%; NDN 58,8%. Berdasarkan ujikorelasi, terdapat hubungan positif kuat antara GA dengan HbA1C, GA dengan glukosa puasa dan GA dengan glukosa2JPP. Kesimpulan: Pemeriksaan GA darah dapat digunakan sebagai modalitas diagnostik dalam menilai kontrolglikemik pada penderita DMT2.
Diagnosis dan tatalaksana renal sel karsinoma Adnyani, Ni Made Dwi; Widiana, I Gde Raka
Jurnal Penyakit Dalam Udayana Vol 2 No 2 (2018): Vol 2 No 2 (2018) July-December 2018
Publisher : PAPDI BALI

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Karsinoma sel renal (KSR) merupakan kanker yang cukup sering terjadi, sekitar 3 sampai 4% kasus di Amerika Serikat, namun di Asia kasusnya cukup jarang. Insiden KSR semakin menigkat dalam beberapa tahun terakhir. Perokok aktif dan pasif seperti juga hipertensi merupakan faktor risiko KSR. Dilaporkan sebuah kasus, perempuan, 61 tahun, dengan Chronic Kidney Disease (CKD) stadium V et causa chronic pyelonephritis (PNC) single kidney, batu ureter 1/3 distal sinistra, hidronefrosis derajat IV ginjal sinistra, adenokarsinoma (Adeno Ca) renal dextra stadium III post radical nefrectomy. Pasca operasi kondisi pasien sempat membaik, produksi urine cukup ± 800 cc/24 jam, dan ada penurunan serum kreatinin. Pasien sempat menjalani beberapa kali hemodialis selama perawatan dan direncanakan hemodialisis regular. Sepuluh hari paska MRS pasien kembali dirawat dengan pneumonia (Health Care Associated Pneumonia) dan diberikan antibiotik empiris, dalam perkembanganya kondisi semakin memburuk dan akhirnya meninggal dengan penyebab kematian syok sepsis. Kasus ini diangkat untuk memperdalam mengenai diagnosis dan tatalaksana seorang penderita dengan renal sel karsinoma sehingga dapat mencegah terjadinya prognosis buruk di kemudian hari.
Faktor determinan kesintasan hidup lebih dari lima tahun pada pasien hemodialisis reguler Sudjana, Karismayusa; Ayu, Nyoman Paramita; Kandarini, Yenny; Widiana, Raka; Sudhana, Wayan; Loekman, Jodi Sidharta; Suwitra, Ketut
Jurnal Penyakit Dalam Udayana Vol 2 No 2 (2018): Vol 2 No 2 (2018) July-December 2018
Publisher : PAPDI BALI

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Latar Belakang: Pasien hemodialisis regular memiliki risiko mortalitas yang lebih tinggi dibandingkan populasinormal. Angka kesintasam hidup lima tahun pasien hemodialisis regular adalah 35,8% namun angka ini bervariasi di tiap populasi dan dipengaruhi berbagai faktor.Tujuan: Penelitian ini bertujuan untuk mengetahui faktor determinan dari kesintasan hidup lebih dari lima tahun pada pasien hemodialisis regular.Metode: Penelitian ini menggunakan metode kasus-kontrol. Data diambil dari Indonesian Renal Registry Report di Rumah Sakit Umum Pusat Sanglah, Denpasar, Bali. 37 pasien yang menjalani hemodialisis regular selama lebih dari 5 tahun dicocokkan dengan 37 pasien yang menjalani hemodialisis regular selama kurang dari 5 tahun, berdasarkan umur. Data dianalisis dengan uji chi-square.Hasil: Prevalensi pasien yang menjalani hemodialisis regular selama lebih dari 5 tahun didapatkan 9,52%. Kamimenganalisa etiologi penyakit ginjal kronik (PGK), jenis kelamin, tekanan darah, anemia, dan status kecukupanhemodialisis. Perbedaan signifikan kedua kelompok didapatkan pada etiologi PGK (p = 0,021) dan anemia  p=0,0). Tidak didapatkan perbedaan signifikan pada jenis kelamin, tekanan darah, dan status kecukupan hemodialisis (p = 0,63, p = 0,64, dan p = 0,34).Simpulan: Penelitian kami menunjukkan bahwa faktor determinan yang berperan signifikan pada kesintasan hidup lebih dari 5 tahun adalah etiologi PGK dan status anemia.
PHACOEMULSIFICATION AND SUTURELESS LARGE-INCISION MANUAL CATARACT EXTRACTION CHANGE CORNEAL SENSIBILITY Anom-Supradnya, I G. N.; Jayanegara, W. G.; Sugiana, I G. N. M.; Raka-Widiana, and I G.
BALI MEDICAL JOURNAL Vol 2 No 3 (2013): Vol.2, No.3, September-December 2013
Publisher : BALI MEDICAL JOURNAL

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Background: Cataract is the leading cause of blindness worldwide, with surgery as a definitive therapy. Incisions may damage the underlying tissue, including loss of corneal sensibility. The purpose of this study was to determine differences in corneal sensibility decreased in patients after phacoemulsification and SLIMCE. Method: This study was a randomized clinical trial assessing changes of corneal sensibility in immature senile cataract patients after phacoemulsification and SLIMCE at Sanglah and Indera Hospital Denpasar, Bali-Indonesia from March to August 2013.  Surgeons and examiners are experienced ophthalmologists. Examiner did not know the initial data subjects. Preoperative assessment of corneal sensibility on the first, eighth, and fifteenth days were assessed postoperative using Cochet-Bonnet aesthesiometer. Statistical analysis was performed by applying mean difference of two independent groups test with repeated measures of multiple comparisons (ANOVA). Samples from each group were 17 eyes. Results: There were significant differences in corneal sensibility on the first day postoperative (33.2 mm), day 8 (-21.5 mm), day 15 (-11.8 mm) in both groups. Decrease in corneal sensibility in both groups was significant (p = 0.001). There was decreasing in corneal sensibility with SLIMCE technique in the first (21.8 mm) and eighth day (45.9 mm). Conclusion: In phacoemulsification technique, corneal sensibility was also decreased in the first (31.8mm) and eighth day (50.6 mm) but returned to preoperative values on day 15 in both groups. Decrease in corneal sensibility during follow-up period is influenced by cataract surgery technique (p = 0.017) and was higher in SLIMCE technique compared with phacoemulsification.
SERUM HOMOCYSTEINE CONCENTRATIONS INVERSELY CORRELATES TO INTIMA-MEDIA THICKNESS OF CAROTID ARTERIES: AN IMPACT TO ENVERSE EPIDEMIOLOGY IN PRE-DIALYTIC CHRONIC KIDNEY DISEASE Raka-Widiana, I G.; Suwitra, K.; Elyshanti, E.; Sutarka, and N.
BALI MEDICAL JOURNAL Volume 2 Number 2, May-August 2013
Publisher : BALI MEDICAL JOURNAL

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Background: In normal population, serum homocysteine (Hcy) is considered as a marker of atherosclerotic and cerebro-cardiovascular diseases.  It is not clear whether this phenomenon also occurs in chronic kidney disease particularly among pre-dialytic population. This study aims to determine relationship between serum Hcy concentrations and carotid arteries intima-media thickness (CA-IMT) of pre-dialytic chronic kidney disease (CKD) patients. Method: A cross-sectional study was carried out on pre-dialytic CKD patients. Morning fasting blood samples were taken for lipid profile, blood sugar, blood urea nitrogen, serum creatinine concentrations. Total fasting serum Hcy concentrations were measured using chemiluminescent assay. CA-IMT of patients were measured by USG B-Mode Logiq-5 (General Electric), with 7.5 MHz linear transducer at both left and right, common and bifurcation of carotid arteries. Results: Ninety (74 males, 16 females) of pre-dialytic patients, age 54 ± 7 years, SBP 137±20 mmHg, DBP 78±13 mmHg, BMI 23.9±4.4 kg/m2 FBS 94±16 mg/dL and 2h pp BS 125±31 mg/dL, total-C 201±65 mg/dL, LDL-C 129±62 mg/dL, HDL-C 40±13 mg/dL, TG 144±81 mg/dL, phosphate 3.8±1.3 mg/dL, calcium 8.7±1.1, and CaXP 32±8, and total serum Hcy 17.11±6.91 µmol/L, e-GFR (CG formula) 36±17 ml/minutes were included in this study.  There were significant negative correlation between Hcy concentrations and left common CA-IMT (r = 0.28; B = -11.01; p = 0.02) and right bifurcation CA-IMT (r =0.26; B = -11.01; p=0.042). While there were a trend of negative correlation between total serum Hcy and right common CA-IMT (r= 0.21; B = -8.27; p=0.10) and left bifurcation CA-IMT (r= 0.20; B=-6.69; p=0.11). Conclusion: There is a negative association between total serum Hcy concentrations and atherosclerotic process in carotid arteries. The inverse relationship may support phenomenon of inverse epidemiology among pre-dialytic CKD patients and seemed that serum Hcy reflects nutritional marker rather than a marker of cardiovascular disease.
Co-Authors A. A. G. Oka, A. A. G. Ade Sinyo Aristantrisna Adnyani, Ni Made Dwi Ake, Anselmus Anak Agung Chris Tedy Pramana Anak Agung Gde Oka Anak Agung Wiradewi Lestari and N. Sutarka Anwar Santoso Arlene Elizabeth Padang Aslesa Wangpathi Pagehgiri Bagus Ari Pradnyana DS Bagus Ngurah Putu Arhana Budi Suprapti Christopher Ryalino Cokorda Bagus Jaya Lesmana Cokorde Istri Yuliandari Krisnawardani Kumbara Dedi Silakarma Desak Putu Puteri Diah Rahtini Dessy Maria Desy Permatasari Dewa Nyoman Putra Adiwinata Dewi Catur Wulandari Djodi Sidartha E. Elyshanti Elizabeth Haryanti Elysanti Dwi Martadiani Feliciano Pinto, Feliciano Firman Parulian Sitanggang Firman Sitanggang Gede Andi Aditya Gede Sukma Pranata Darma Gede Wira Mahadita Gede Wirya Kusuma Duarsa Hendra Koncoro Hendra S Hendra Salim Hizkia Robinson Junsen Lumban Gaol I Dewa Agung Sutanjaya Giri Nugraha I G. N. Anom-Supradnya I G. N. M. Sugiana I Gede Aditya Krishna Santhi I Gede Budhi Setiawan I Gede Hendra Sucipta I Gusti Agung Trisna Windiani I Gusti Ayu Made Juliari I Gusti Kamasan Arijana I Gusti Ngurah Ketut Budiarsa I Gusti Ngurah Made Suwarba I Gusti Rai Putra Wiguna I K. Sudartana I Kadek Agus Setiawan I Ketut Suwiyoga I Ketut Wiargitha I Ketut Widiana I Made Adi Satria Darma I Made Agus Endra Permana I Made Arimbawa I Made Ayusta I Made Kardana I Nengah Wiadnyana Steven Christian I Nyoman Adi Putra I Nyoman Semadi I Nyoman Wiryawan I Putu Budhiastra, I Putu I Putu Gede Budiana, I Putu Gede I Putu Gede Eka Ariawan Suyasa, I Putu Gede Eka Ariawan I Wayan Gede Jayanegara I Wayan Juli Sumadi I Wayan Putu Sutirta Yasa I Wayan Sudhana I Wayan Wita I Wayan Yudiana IBN Mahendra Ida Bagus Gede Suparyatha Ida Bagus Putra Pramana Ida Safitri IKG Suandi Imam Effendi Indira Prawita Martani Inez Kartika Jetty Kalembang Jod Loekman Jodhi S Loekman Jodi Sidharta Loekman Jodi SL K Suwitra K. Suwitra Kadek Budi Santosa Ketu Suwitra Ketut Mulyadi Ketut Putu Yasa Ketut Rina, Ketut Ketut Suarta Ketut Suega Ketut Suwitra Ketut Tuti Parwati Merati Komang Ayu Witarini Luh Gede Yuliadewi NS Luh Yeni Laksmi Luh Yeni Laksmini Made Agus Dwianthara Sueta Made Agus Kusumadjaja Made Asih MADE RATNA SARASWATI . Made Satria Yudha Dewangga Made Widhi Asih Marleen MOCHAMMAD THAHA Moestikaningsih ** Moestikaningsih . Monica Sampurna Ngakan Gede Dwija Hermawan Ni Ketut Putri Ariani Ni Kompyang Rahayu Ni Made Amelia R. Dewi Ni Made Ari Suryathi Ni Made Dharma Laksmi Ni Made Putri Suastari Ni Nyoman Margiani Ni Putu Sriwidyani Ni Wayan Anantika Riani Ni Wayan Winarti NP Veny Kartika Yantie Nyoman Maharmaya Nyoman Paramita Ayu Nyoman Srie Laksminingsih Nyoman Sutarka, Nyoman Oka Udrayana Ommy Agustriadi Pande Made Wisnu Tirtayasa Pande Putu Yuli Anandasari Patriawan, Putu Paulus Wiyono PITIKA ASPR Poerwono Rahardjo Purnama Purnama Putu Astri Novianti Putu Ayu Saraswati Putu Gitanjani Mahadewi Semadhi Putu Nandika Tungga Yudanti Mahardani Putu Novi Handayani Raka-Sudewi A. A. Reny Setya Pratiwi Duarsa Rully Roesli Satrio Ryandi Sianny Herawati Silvester Kristian Taopan Sitanggang, Firman Parulian Soetjiningsih Soetjiningsih Sudaryat S Sudjana, Karismayusa Tianing - Trianto Trianto W Sudhana W. G. Jayanegara Wayan Aryadana Wayan Aryadana Wayan Sudana Wayan Sudhan Wayan Sudhana Wiradharma, Ketut Gede Y. Saskia-Javi Yenny Kandarini Yoga Putra Yuriawantini - Zulfariska, Nony