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All Journal BALI MEDICAL JOURNAL (BMJ) Medicina journal of internal medicine E-Jurnal Medika Udayana International Journal of Integrated Health Sciences Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Medical Journal of Indonesia Mutiara Medika: Jurnal Kedokteran dan Kesehatan INDONESIAN JOURNAL OF PHARMACY The Indonesian Biomedical Journal Paediatrica Indonesiana JBN (Jurnal Bedah Nasional) Jurnal Penyakit Dalam Udayana ISM (Intisari Sains Medis) : Jurnal Kedokteran Majalah Patologi Indonesia Ina Kidney Neurologico Spinale Medico Chirurgico Journal of Clinical and Cultural Psychiatry
I Gde Raka Widiana
Departemen Penyakit Dalam, Fakultas Kedokteran, Universitas Udayana, Denpasar, Indonesia
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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PERBANDINGAN VOLUME ALIRAN DARAH FISTULA RADIOCEPHALICA SIDE TO END DANEND TO END Saraswati, Putu Ayu; Semadi, I Nyoman; Widiana, Gde Raka
Medicina Vol 46 No 3 (2015): September 2015
Publisher : Medicina

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Abstract

Hemodialisis merupakan terapi dominan sebagai pengganti fungsi ginjal pada pasien penyakit ginjalkronis. Hemodialisis memerlukan akses vaskular yang baik, dapat bertahan lama dengan komplikasiyang minimal. Fistula radiocephalica merupakan salah satu akses vaskular permanen. Ada empatteknik operasi fistula radiocephalica yaitu side to side, side to end, end to side dan end to end. Teknikterbanyak yang dipakai saat ini adalah side to end dan end to end. Saat ini belum ada data yangmembandingkan volume aliran darah pada kedua teknik tersebut. Penelitian ini adalah uji klinikacak terkontrol buta tunggal. Subjek penelitian adalah pasien penyakit ginjal kronis yang dilakukanoperasi fistula radiocephalica yang dibagi dalam dua kelompok. Kelompok pertama menggunakanteknik side to end dan kelompok kedua menggunakan teknik end to end. Volume aliran darah diukurmenggunakan CDU 4 minggu pasca-operasi. Sampel penelitian ini adalah 60 sampel yang terdiri dari36 (60 %) lelaki dan 24 (40 %) perempuan.Volume aliran darah kelompok side to end adalah 757 ( 389sampai 1125) ml/menit dan kelompok end to end  adalah 854 (534 sampai 1174) ml/menit dan bedavolume aliran darah adalah 97 ml/menit dengan nilai P = 0,074. Komplikasi terjadi pada kelompokside to end sebanyak dua pasien. Beda volume aliran darah pada kedua kelompok tidak bermaknasecara statistik. [MEDICINA 2015;46:141-4].Hemodialysis is the dominant therapy as a replacement for kidney function in chronic kidneydisease patients. Hemodialysis requires good vascular access, can last a long time and minimalcomplications. Radiocephalica fistula is one of the permanent vascular access. There are fourtype of radiocephalica fistula technique: side to side, side to end, end to side, and end to end.Most techniques used today is the side to end and end to end. Currently there is no data thatcompare blood flow volume in both these techniques.This study is single blind randomizedcontrolled trial. Subjects were patients with chronic kidney disease performed radiocephalicafistula surgery divided into two groups. The first group used a technique side to end and thesecond group used a technique end to end. Blood flow volume was measured using Dopplerultrasound 4 weeks postoperatively.The sample was 60 samples consisted from 36 (60%) menand 24 (40%) of women. Blood flow volume group side to end was 757 (389 to 1125) ml / min anda group of end to end was 854 (534 to 1174) ml / min and different volume rate was 97 ml / minwith a value of P = 0.074. Complications occurred in the group side to end by two patients.Bloodflow volume difference in the two groups statistically was not significant. [MEDICINA2015;46:141-4].
THE ASSOCIATION BETWEEN MATRIX METALLOPROTEINASE-9 (MMP-9) WITH HIGH SENSITIVE TROPONIN T (hs-TnT) IN PATIENT WITH ACUTE MYOCARDIAL INFARCTION Suyasa, I Putu Gede Eka Ariawan; Rina, Ketut; Widiana, I Gde Raka
Medicina Vol 46 No 1 (2015): Januari 2015
Publisher : Medicina

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Abstract

Mechanism of acute myocardial infarction (AMI) is previously due to atherosclerotic plaque rupturewith occurs because extra-cellular matrix of plaque fibrous cap destruction or degradation by proteaseenzyme matrix metalloproteinase-9  (MMP-9), which released by macrophage cell.Increased plasmaMMP-9  is  predisposition  factor  of  atherosclerotic  plaque  rupture  in AMI  and  followed  by  acutethrombosis inside coronary artery lumen which caused myocardial ischemic and clinical sign of AMI. Ifthe ischemic process continuous and ongoing that can caused myocardial necrosis which can increasedplasma troponin. High sensitive troponin T (hs-TnT) newly and more sensitive detection of plasmacTn-T  than conventional.The aim of  this study was  to determined  the association between plasmaMMP-9 with hs-TnT in AMI patients.This study was a cross-sectional observational which performedin 62 patients with AMI which enrolled by consecutive sampling at Sanglah Hospital Denpasar fromDecember 2011 until December 2012. MMP-9 and hs-TnT plasma level were measured 48 hours afteronset IMA. Sixty two patients AMI were involved in this study consist of 35 STEMI patients (56.5%)and 27 NSTEMI patients (43.5%), the mean plasma MMP-9 was 23.9 (SD 0.42) ng/mL and hs-TnT was464.7 (SD 39.3) ng/mL.The results of this study were positive correlation between MMP-9 and hs-TnTAMI  patients  (r=  0.507; Y=  -  650.6 +  46.7(X1); P<0.0001);  plasma MMP-9  and  onset  of AMI wereinfluenced to plasma hs-TnT with formulationY = - 815.0 + 46.5(X1)+ 20.7(X2); (â MMP-9=46.5(95%CI: 24.7 to 68.4); P<0.0001; â onset AMI=20.7(95%CI : 2.1 to 39.4); P=0.030) and there was more strongercorrelation betweenMMP-9 and hs-TnT in STEMI group than NSTEMI. [MEDICINA 2015;46:22-27].Mekanisme terjadinya infark miokard akut (IMA) didahului oleh proses ruptur plak aterosklerosisdan diawali dengan destruksi atau degradasi matriks ekstraseluler fibrus cap plak oleh enzim proteaseyang dihasilkan sel makrofag yaitu matrix metalloproteinase-9 (MMP-9). Kadar MMP-9 yang meningkatmerupakan  faktor  predisposisi  terjadinya  ruptur  plak  aterosklerosis  pada  IMA  yang  diikuti  olehproses  trombosis akut pada  lumen arteri koroner yang menyebabkan proses  iskemia miokard dangejala klinis IMA. Proses  iskemia yang tidak teratasi akan mengakibatkan nekrosis miokard yangditandai meningkatnya troponin jantung. Pemeriksaan high sensitive troponin T (hs-TnT) merupakanpemeriksaan kadar  troponin yang  terbaru dan memiliki kemampuan  lebih baik dari pemeriksaantroponin konvensional. Tujuan dari penelitian ini untuk mengetahui hubungan kadar MMP-9 denganhs-TnT plasma pada penderita  IMA. Penelitian  ini merupakan  studi observasional potong  lintangyang dilakukan pada   62 penderita  IMA yang dikumpulkan  secara  consecutive  sampling di RSUPSanglah Denpasar dari Desember 2011 sampai Desember 2012. Kadar plasma MMP-9 dan hs-TnTdiukur 48  jam  setelah awitan  IMA. Dari 62  sampel penelitian yang  terdiri dari 35 pasien STEMI(56.5%) dan 27 pasien NSTEMI (43.5%) didapatkan rerata kadar MMP-9 plasma 23.9 (SB 0.42) ng/mL dan hs-TnT plasma 464.7  (SB 39.3) ng/mL.Hasil penelitian  ini terdapat korelasi positif antaraARTIKEL ASLI  JURNAL  ILMIAH KEDOKTERAN  • 23death in the world,1 approximately30% from all cause of death.2Acutecoronary syndrome (ACS) is one ofcoronary  heart  diseasemanifestation  and  a  seriouscardiovascular emergency.3Basic  pathogenesis  acutemyocardial  infarction  isatherosclerotic  plaque  rupturewith following thrombus formationin coronary artery. The process ofatherosclerotic plaque rupture iscaused  by  protease  enzymereleased  from macrophage  cell,such as matrix metalloproteinase-9 (MMP-9), that cause degradationand fibrous cap rupture and formthrombus with coagulation cascadeactivation.  This  thrombusformation  will  give  clinicalmanifestation of ACS and increaseof troponin levels.4-7Cardiac  troponin  (cTn),cTnTand  cTnI , is a gold standardfor  detection  of  myocardialnecrosis.5,8 Using high  sensitivecardiac  troponin  (hs-cTn),    hs-TnTand hs-TnI, will improve earlydiagnosis  of  acute myocardialinfarction (AMI) significantly andhopefully  will  decrease  falsepositive result.5,9Several  studies  have  beendone  to  compare MMP-9  levelswith hs-TnT in patients with ACS.Kobayashi  et al10  found MMP-9levels increased in acute phase ofACS  as  reflection  of  plaquevulnerability  and hs-TnT  levelsincreased in later phase. Setiantoet al11 in 2011 compared MMP-9levels MMP-9 and troponin-I (cTn-I)  in  ST Elevation MyocardialInfarction (STEMI) and UnstableAngina Pectoris  (UAP)/ Non STElevation Myocardial Infarction(NSTEMI) with result a positivecorrelation  between  increase  ofMMP-9 levels and cTn-I mainly inSTEMI group and stated MMP-9role in myocardial damage severitywith r=0.33 and P=0.003. Thereis  no  research  that  studycorrelation  between  increase  ofMMP-9 levels and hs-TnT in AMIpatients.METHODSThis  study  was  aobservational  study with  cross-sectional design to evaluate MMP-9 levels and hs-TnT levels in AMIpatients at  emergency unit andIntensive  Cardiac  Care Unit(ICCU) Cardiology DepartementUdayana University MedicalSchool/ Sanglah Hospital. Thisstudy was a research tree aboutACS  that  has  been  held  fromDecember  2011 until December2012 and the result became JointStudy of ACS. This study has beenapproved by Ethics Committee ofUdayana University MedicalSchool/Sanglah  HospitalDenpasar. Subjects of this studywere 62 patients with AMI thatfulfilled  inclusion and exclusioncriteria. The  inclusion  criteriawere: 1) all AMI patients age 30-80  years  old  and  treated  atemergency unit and ICCU SanglahHospital,  2)  gave  consent  toparticipate  in  this  study.  Theexclusion criteria were : 1) valvularheart diseases (VHD), 2) congestiveheart  failure  (CHF), 3) acute orchronic  liver disease, 4)  chronickidney disease (CKD) (creatinineclearance < 60 ml/1.73 m2/min),5)  chronic  or acute  infection, 6)sepsis, 7) malignancy, 8) treatedwith  corticosteroid  or    nonsteroidal  anti  inflammatory  orimmunosuppresive  drugs morethan 1 weeks, and  9) stroke. Thisstudy using human MMP-9 ELISAkit  and Roche Elycsys  2010 kitwhich measured  48 hours  afteronset AMI.Analysis  of  correlationbetween MMP-9 with  hs-TnTusing  non-parametric  analysiswith  Spearman  test  (P<0.05).Multivariate  analysis  withmultiple  linear  regression  therelationship  of  the  functionalpredictive value MMP-9 and othersconfounding variable to plasma hs-TnT.  The  last  we  performedANCOVA analysis to determinethe  difference  of  strengthassociation between plasma MMP-9  and  hs-TnT  in  STEMI  orNSTEMI  group. Data  analysisusing SPSS  17 with  significantP<0.05.RESULTSA  total  of  62  samples wereincluded  in  this  study. Matrixmetalloproteinase-9  (MMP-9) andhs-TnT  plasma  levels  48  hoursafter AMI onset were measured.The samples also got  treatmentbased  on  ACS  guideline  fromPERKI 2014.12Subject characteristicsTotal 62 patients with AMIwere included, 50 males (80.6%)and 12 female (19.4%), with meanage 57.9 (SD 10.7) years. Thirtyfive patients were diagnosed withSTEMI  (56.5%) and 27 patientswith NSTEMI (43.5%) with meanonset between 6.74 (SD 3.8) hours.Cholesterol levels were between110-327 mg/dL, LDL levels werebetween 56.3-244.5 mg/dL, HDLkadar MMP-9  dengan hs-TnT  pada  penderita  IMA  dengan  kekuatan  korelasi  sedang  dan  secarastatistik signifikan (r= 0.507; Y= - 650.6 + 46.7(X1); P<0.0001); kadar MMP-9 plasma dan awitan IMAmempengaruhi kadar hs-TnT plasma pada penderita IMA dengan formula persamaan Y = - 815.0 +46.5(X1)+ 20.7(X2); (â MMP-9=46.5(IK 95% : 24.7 sampai 68,4); P<0.0001; â awitan IMA=20.7(IK 95%: 2.1 sampai 39.4); P=0.030).  dan kekuatan hubungan kadar MMP-9 dengan hs-TnT pada kelompokSTEMI lebih besar daripada NSTEMI. [MEDICINA 2015;46:22-27].
KAJIANTEKNOLOGI PIEZO ESWL(EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY) RICHARD WOLF TYPE PIEZOLITH 3000 DIBANDINGKAN ALAT ESWL TYPE YC-9200 ESWL DAN B ULTRASOUND SYSTEM Widiana, I Gde Raka
Medicina Vol 45 No 1 (2014): Januari 2014
Publisher : Medicina

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Abstract

Telah dilakukan kajian teknologi di rumah sakit umum pusat Sanglah untuk menentukan apakah intervensi ESWL baru dibandingkan ESWL lama lebih cost-effective, bila dipakai mengganti alat lamabila ditinjau dari perspektif medik, sosial dan ekonomi. Dilakukan pertemuan yang dihadiri oleh pihak terkait untuk menentukan kajian HTA pada alat ESWL baru. Pertemuan itu dihadiri oleh Ketua HTA, Direktur Medik, Kepala Bidang Pelayanan, Kepala dan Staf Divisi Urologi, dan StafDivisi Radiologi. Pertemuan itu bertujuan untuk menjawab apakah ESWL merek Richard Wolf type Piezolith 3000 dengan system In-line USG, 3000 shock per pasien buatan Jerman dapat menggantiESWL lama buatan Cina type YC-9200 ESWL dan B Ultrasound system. Dilakukan pencarian di internet pada sumber primer dan sekunder MIDLINE, COCHRANE, dan  Highwire. Dengan data dari3 penelitian asli yang didapat dari pencarian, dibuat model pohon keputusan pemakaian piezolith ESWL dibandingkan ESWL lama untuk melihatkemanjuran dan keamanan dibandingkan biaya danaplikasinya pada pasien batu ginjal di rumah sakit Sanglah Denpasar, dengan menilai aspek perspektifm ekonomi dan social, dihasilkan utility benefitrelative sebesar 0.40. Dengan melakukan adjustmentterhadap asumsi umur harapan hidup pasien ( 65 tahun) dengan batu ginjal maka pemakaian ESWL baru ini menghasilkan peningkatan relatif umur harapan hidup pasien sebagai keuntungan ekonomisocial yang dikenal sebagai quality adjusted life years (QALY).Disimpulkan bahwa, ESWL piezoelectric Richard Wolf type Piezolith 3000 dengan system In-line USG, 3000 lebih cost-effective dari perspektifekonomi kesehatan dibandingkan ESWL lama dengan 3 bulan QALY gain dan denganbiaya (cost) 1,5 juta rupiah per bulan QALY gain. [MEDICINA 2014;45:9-12]
seorang penderita tuberkulosis diseminata dengan komplikasi penyakit ginjal kronis Koncoro, Hendra; Kandarini, Yenny; Sudhana, Wayan; Widiana, I Gde Raka
Medicina Vol 47 No 3 (2016): September 2016
Publisher : Medicina

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Abstract

Tuberkulosis diseminata dapat melibatkan berbagai organ dan secara klinis timbul dengan bermacam-macam tanda dan gejala.Penyakit ginjal kronis merupakan salah satu komplikasi yang disebabkan oleh penyebaran hematogenik Mycobacterium tuberculosis ke traktus urogenital. Diagnosis dini dan inisiasi terapi yang tepat merupakan hal penting dalam pencegahan komplikasi lanjut penyakit ini. Dilaporkan sebuah kasus dengan tuberkulosis diseminata yang memperlihatkan keterlibatan paru dan organ ekstra-paru. Kasus ini memperlihatkan tuberkulosis paru, serviks, dan urogenital yang dikonfirmasi dengan pewarnaan sputum basil tahan asam, biopsi serviks, dan biopsi buli buli. Pewarnaan sputum basil tahan asam menunjukkan hasil 3+, sedangkan biopsi serviks dan buli buli menunjukkan radang kronik granulomatosa dengan multinucleated giant cell tipe Langhans. Kadar blood urea nitrogen (BUN) 11 mg/dL dan kreatinin serum 2,58 mg/ dL dengan hidronefrosis ringan kiri pada saat dirawat. Setelah diagnosis ditegakkan, pasien diterapi dengan obat anti-tuberkulosis dan membaik dengan kadar BUN 13,55 mg/ dL dan kreatinin serum 0,9 mg/ dL setelah satu bulan terapi.[MEDICINA.2016;50(3)63-70]
PREVALENSI DAN HUBUNGAN SINDROM METABOLIK DENGAN PENYAKIT GINJAL KRONIK PADA POPULASI DESA LEGIAN, KUTA BALI Ayu, Paramita; Kandarini, Yenny; Widiana, G Raka; Sudhana, W; Loekman, Jodhi S; Suwitra, K
journal of internal medicine Vol. 12, No. 2 Mei 2011
Publisher : journal of internal medicine

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Metabolic syndrome may relate to pathogenesis of chronic kidney disease (CKD). There is scarce data with regard to thatphenomenon in Indonesian general population. We conduct a study to determine the prevalence of metabolic syndrome and itsrelationship with CKD individuals in general population of Legian Village, Bali. An analytical cross sectional study was carriedout in the community of Legian Village, a tourist destination in Bali. Samples were selected through simple random sampling.Two hundred and eighty four samples (117 males and 107 females, aged 46.1 ± 10.02 years) were included. Prevalenceof hypertension, hypertrigliseridemia, hypoHDL-cholesterol, central obesity, impaired fasting glucose (IFG), obese and CKDwas 14.1%, 38.4%, 25%, 18%, 11.6%, 51.8% and 11.6% respectively. Using bivariate analysis, there were strong and significantrelationship between hypertension (OR 2.6, 95%CI 1.12 to 6.19, p = 0.02) and IFG (OR 5.21; 95%CI 2.23 to 12.13, p = 0.00) withCKD. Using multivariate logistic regression entering those components of metabolic syndrome into the model, it was consistentlyfound that hypertension and DM is the associated factors for CKD in the population. There was increasing odds of CKD about1,0-fold every augment of metabolic syndrome components (OR 1.098; 95%CI 0.83 to 1.44). As our conclusion, hypertensionand IFG are associated factor for CKD in general population. Multiple components increased risk factor for CKD.
HUBUNGAN ANTARA PRODUK KALSIUM X FOSFAT SERUM DENGAN PENYAKIT ARTERI PERIFER PADA PASIEN HEMODIALISIS REGULER DI RSUP SANGLAH DENPASAR Wulandari, Dewi Catur; Raka Widiana, I G; SL, Jodi; Sudhana, I W; Suwitra, Ketut
journal of internal medicine Vol. 8, No. 2 Mei 2007
Publisher : journal of internal medicine

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Abstract

Peripheral Arterial Occlusive Disease (PAOD) is common among patients undergoing hemodialysis (HD). In the generalpopulation, DM, male, cigarette smoking, advanced age, hypertension and dyslipidemia are the most important risk factorsfor PAOD. Recently, some studies in patients with regular HD found evidences that PAOD associated with increase of calciumand phosphate serum level and increase of Ca.P product due to secondary hyperparatiroidism. A cross-sectional study was doneon 46 regular HD patients to evaluate prevalence of PAOD among patients who are undergoing regular HD and their associationbetween Ca.P product. Morning fasting plasma were taken for lipid profile, blood sugar, blood urea nitrogen, serum creatinin,albumin level, Ca, inorganic P. Ankle-brachial index (ABI) of blood pressure as measured after dialysis session using Va-SeraVS-100. Fourty six (26 males, 20 females) regular HD patients, age 50.95 ± 9.90 years, duration of HD 27.7 ± 22 months wereincluded in this study. Using ABI < 0.9 as cut off value for the presence of PAOD, 15.2% had PAOD. Means of Ca serum levelwas 9.04 ± 0.76 mg/dl, phosphate serum level was 56.48 ± 23.90 mg/dl. Using 55 or more as cut off value for abnormal concentrationof Ca.P product, 47.7% patients had abnormal Ca.P product. Three of 21 patients with Ca.P 55 had PAOD and 4 of 23patients with Ca.P < 55 had PAOD ( OR 0.79 with 95% CI : 0.15 ? 4.04 for patients with Ca.P < 55 ). Using logistic regression tocontrol Ca and P levels, Ca.P 55 tend to associate with increased risk of PAOD (OR 6.22 ; 95% CI : 0.23 ? 167.71)More than fifteen percent of patients with regular HD had PAOD. More than fourty seven percent of patients had abnormal Ca.P.Patients with Ca.P 55 tend to associated with increased risk of PAOD (OR 6.22 ; 95% CI : 0.23 ? 167.71)
HUBUNGAN ANTARA KADAR LEPTIN DAN ADIPONEKTIN PLASMA PADA PASIEN DENGAN DIALISIS RUTIN Raka Widiana, I Gde; Kandarini, Yenny; Suwitra, Ketut
journal of internal medicine Vol. 9, No. 2 Mei 2008
Publisher : journal of internal medicine

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Leptin and adiponectin (ADPN) are adipokines with respective pro-atherogenic and anti atherogenic properties. In nonrenalpatients, both hyperleptinemia and hypoadiponectinemia are associated with cardiovascular complication. Relationshipsbetween serum leptin and ADPN in patients with dialysis is not consistently reported.Objective of this study is evaluate relationships between serum ADPN and leptin in patients with dialysis. A cross sectionalstudy was performed in and 54 HD and 22 CAPD patients.Seventy six patients were enrolled this study, M/F 41/76, aged 48.4±11.4 year, BMI 21.4±2.7 kg/m2, haemoglobin (Hb)7.9±1.5 mg/dL, blood sugar 94.8±33.5 mg/dL, albumin 4.1±0.4 g/dL, total-cholesterol 177.9±46.3 mg/dL, triglyserida 164.4±104.8mg/dL, SC 14.3±3.8 mg/dL, TNF 14.40±7.43 pg/mL, ADPN 17.6±7.6 µg/mL, leptin 13068±23589 µg/mL (log leptin 3.7±0.59µg/ml). Using Spearmans rho analysis there were negative correlation between log-leptin and ADPN (r= -0.39, p= 0.00), andpositive correlation between log leptin and Hb (r= 0.25, p= 0.04), insulin(r= 0.44, p = 0.00), total-cholesterol (r= 0.34, p = 0.003),triglyserida (r= 0.41, p= 0.00), and BMI (r= 0.41, p= 0.00), but there was no correlation between log-leptin and albumin, bloodsugar, SC and TNF alfa. Using multiple regression to analyze relationship between ADPN and leptin, insulin, Hb, and dialysismodality, we found log leptin independently correlated with ADPN (B= -0.402, p= 0.01, 95%CI B: -1.24 to -0.32). Using multipleregression to analized relationship between ADPN with log-leptin, BMI, total cholesterol, and triglyserida, we found log leptin(beta= -0.3, p= 0.01, 95%CI B: -0.98 to -0.13) and triglyserida independently correlated with ADPN (beta= -0.5, p= 0.00, 95%CIB: -0.008 to -0.003).Serum leptin and triglyseride relate with ADPN. Some metabolic parameters such as insulin resistance, anemia, dialysismodality, nutritional status (BMI and total cholesterol) have indirect relationship with ADPN may be through leptin secretion.
KEJADIAN PERITONITIS PADA PASIEN CONTINUOUS AMBULATORY PERITONEAL DIALYSIS: IDENTIFIKASI MIKROORGANISME DAN SENSITIFITAS ANTIBIOTIK Haryanti, Elizabeth; Kandarini, Yenny; Widiana, I Gde Raka; Sudhana, Wayan; Loekman, Jod; Suwitra, Ketut
journal of internal medicine Vol. 11, No. 2 Mei 2010
Publisher : journal of internal medicine

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Patients treated with Continuous Ambulatory Peritoneal Dialysis (CAPD) are constantly exposed to microbial invasionof the peritoneal cavity and rapid microbiological diagnosis of peritonitis is essential due to Hospitalization and imposes asignicant burden of morbidity. The aims of this study were to enumerate the association between microorganisms, sensitity,and resistence of antibiotic on CAPD patients with clinical peritonitis.We collected data through medical records by the number of CAPD patients with clinical peritonitis from June 2004 untilJune 2009. The study was analysis with one-way ANOVA. We found 23 patients clinical peritonitis out of 77 CAPD patients,with insidence was 14% per-year, aged 14 ? 65 y (15M; 8F). The chronic pyelonephritic was a leading (16/23) cause of endstages renal disease. Each patients underwent HD prior (5 ? 60 months) to CAPD, with survival time was 2 ? 51 months. Out of23 patients, 4 were returned to hemodialisis, 15 were died, due to cardiogenic shock 46.7%. Aseptic peritonitis was 31.3%, andthe common microorganism was staphylococcus 18.8%. Peritoneal !uid test showed mean score of sensitivity were tetracycline22.93, cipro!oxacin 19.36, piperacillin-tazobactam 17.36, thrimetropin/sulfamethoxazole 16.5, fosfomycin 15.78, consecutivelyand the rest were resistent. Staphylococus was strongly related to insidence peritonitis, and tetracycline was the most highlysensitive antibiotic in CAPD patients.
HUBUNGAN ANTARA PERUBAHAN VOLUME DARAH RELATIF DENGAN EPISODE HIPOTENSI INTRADIALITIK SELAMA HEMODIALISIS PADA GAGAL GINJAL KRONIK Agustriadi, Ommy; Suwitra, Ketut; Raka Widiana, Gde; Sudhana, Wayan; Sidharta Loekman, Jodi; Kandarini, Yenny
journal of internal medicine Vol. 10, No. 2 Mei 2009
Publisher : journal of internal medicine

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Abstract

Intradialytic hypotension (IDH) is a common complication in chronic hemodialysis (HD) patients, in turn would increase morbidity and mortality. Relative blood volume changes during HD play a role in IDH episode. Those changes can be assessed by total plasma protein measurement before and after HD. To determine relationship between relative blood volume changes (assessed by percentage of total plasma protein changes during HD) and IDH episode during HD in chronic renal failure, an analytical cross-sectional study was perferomed in 51 patients (28 males and 23 females, age 47.8 ±11.6 years) underwent chronic HD at Hemodialysis Unit of Sanglah Hospital Denpasar. Data were collected during single HD session. Blood pressure was measured every 30 minutes and relative blood volume changes assessed by measuring percentage of total plasma protein changes during HD. Among them, IDH episode experienced in 10 (19.6%) patients. Logistic regression analysis revealed a strong and significant relationship between relative blood volume changes and IDH episode during HD in chronic renal failure (Beta = 0.29; OR = 1.35; CI 95%: 1.1 - 1.6; p < 0.01) and it was found that every 1% changes in relative blood volume, would increase risk of hypotension episode by 35%. This relationship was still strong and significant (Beta = 0.46; OR = 1.58; CI 95%: 1.11 -2.25; p = 0.01) after adjusted by hemoglobin levels, intradialytic body weight changes, use of antihypertensive medi¬cations and diabetes melitus. Using ROC curve, found that optimal cut of point of intradialytic total plasma protein changes to predict an IDH episode during HD was 5.56% with 90.0% sensitivity and 80.5% specificity (95% CI: 0.83-0.99; p < 0.01). Our data revealed a strong and significant relationship between intradialytic relative blood volume changes assessed by intradialytic total plasma protein changes and IDH episode during HD in chronic renal failure.
RELATIONSHIP BETWEEN METHYLENE TETRA HYDRO FOLATE REDUCTASE (MTHFR) GENE POLYMORPHISM AND HYPERHOMOCYSTEINEMIA IN STROKE Raka Widiana, I Gde; -, Tianing; Santoso, Anwar; Ketut Budiarsa, Gusti Ngurah
journal of internal medicine Vol. 8, No. 3 September 2007
Publisher : journal of internal medicine

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Abstract

Cardiovascular disease is a major cause of mortality in Indonesia. Hyperhomocysteinemia (hyper-hcy) isan independent cardiovascular risk factor, which may be due to methylene tetrahydrofolate reductase (MTHFR)deficiency, frequently linked to MTHFR gene mutation. This case-control study examined the relationshipbetween homocysteine (hcy), folate, and vitamin B12 plasma concentrations with C677T mutation of MTHFRgene among 20 haemorrhagic and non-haemorrhagic stroke patients aged 18-55 years, in Sanglah Hospital,Denpasar. 10 age-matched controls were selected via random sampling of 1 of 4 neighbours; all subjects wereBalinese. Hyper-hcy (X2: 5.4; PR: 1.8; 95% CI: 1.0-2.7; p=0.03), hypertension (X2: 13.12; PR 2.66; 95%CI1.41 to 5.02; p=0.00) were associated with increased risk of stroke. There were no significant correlationbetween plasma hcy levels and plasma folate and vitamin B12 levels as co-factors of hcy metabolism. Lowplasma vitamin B12, smoking, alcohol drinking, and hypertension tend to be determinant factors of hyper-hcy.This study found no mutation on 677 from C to T (C677T), however there were substitution in nucleotidesamong stroke and controls, with or without producing chances of amino acids, including: 1) G659A substitutionthat caused changing in amino acid from glutamine to glycine found in 1 stroke patients with hyper-hcy; 2)A660G substitution that cause changing in amino acid from glutamine to glycine found among all controlsubjects and among 3 stroke patients, one of whom had hyper-hcy; and 3) A661G substitution that causechanging in amino acid from lysine to glutamine found in one stroke patients with normo-hcy. Some variationswere also found in nucleotide 659 and 660, however, did not produce changing in amino acid. Whether thissubstitution is a kind of polymorphism that specific to Balinese ethnicity needs a further study to answer.
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 Kamasan Arijana I Gusti Ngurah Ketut Budiarsa I Gusti Ngurah Made Suwarba I Gusti Rai Putra Wiguna I K. Sudartana 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 Asih MADE RATNA SARASWATI . Made Satria Yudha Dewangga Made Widhi Asih Marleen MOCHAMMAD THAHA Moestikaningsih ** Moestikaningsih . Monica Sampurna Ngakan Gede Dwija Hermawan 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