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All Journal BALI MEDICAL JOURNAL (BMJ) Buletin Udayana Mengabdi E-Jurnal Medika Udayana The Indonesian Biomedical Journal JBN (Jurnal Bedah Nasional) ISM (Intisari Sains Medis) : Jurnal Kedokteran Neurologico Spinale Medico Chirurgico Jurnal Ilmu Bedah Indonesia Indonesian Archives of Biomedical Research (InABR) Cermin Dunia Kedokteran
Sri Maliawan
Department Of Neurosurgery, Faculty Of Medicine Udayana University/Sanglah General Hospital, Bali-Indonesia
Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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MAXIMIZATION OF DNA DAMAGE TO MGMT(+) EGFR(+) GBM CELLS USING OPTIMAL COMBINATION OF TEMOZOLOMIDE-ANTI EGFR MONOCLONAL ANTIBODY NIMOTUZUMAB Inggas, Made Agus Mahendra; Wahjoepramono, Eka J.; Maliawan, Sri; Islam, Andi Asadul
BALI MEDICAL JOURNAL Vol 4 No 3 (2015)
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Background: Glioblastoma multiforme (GBM) is the most aggressive primary brain tumor in adultswith dismal prognosis due to the unavailability of an effective therapy. Up to now, there had been no definitive studies published on EGFR inhibition therapy as a chemosensitizer for GBM therapy using Temozolomide (TMZ). This study aims to reveal the most effective method and timing to administer TMZ anti EGFR targeted therapy which causes maximal DNA damage on GBM cells. Methods: Various regimens of anti EGFR monoclonal antibody Nimotuzumab (NMZ) was administered in different combinations with TMZ, performed on U87MG MGMT(+) EGFR(+) cells. The effectiveness of the combinations were evaluated by measuring yH2AX levels which reflects the degree of DNA damage. One-way Anova and LSD tests were performed to determine the effects of each treatment with p
HIGH BLOOD LEVELS PROCALCITONIN AS SYSTEMIC IMFLAMATORY RESPONSE SYNDROME PREDICTOR IN SEVERE AND MODERATE HEAD INJURY Sinaga, B.; Mahadewa, T. G. B.; Maliawan, and S.
BALI MEDICAL JOURNAL Vol 3 No 1 (2014)
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Background Numerous studies have shown that procalcitonin (PCT) was not related to degree of trauma. High PCT serum levels have been found in patients with bacterial or fungal infection and also in acute phase of trauma. Currently, there has been no research discussed about changes in serum levels of PCT in particular head injuries and severe head injuries. Moderate and severe head injuries were common trauma cases in Emergency Room (ER) and had high mortality rate. Based on Glasgow Coma Scale (GCS), moderate and severe head injuries were scored between 3 and 13. This research aim to determine whether high blood levels PCT can be used as a predictor of the occurrence of SIRS. Method: A cohort prospective study was applied in this research to determine high blood levels of PCT as a predictor for SIRS in moderate and severe head injury. This study was conducted from June 2013 - August 2013 at Sanglah General Hospital with 40 research subjects. Data was presented in tables and analyzed with Chi Square test at 95% CI and p <0.05% was considered significant. Results: From the 40 samples, there were 34 males (85%) and 6 females (15%), 18 samples (45%) had moderate head injury and 22 samples (65%) had severe head injury. One sample (2.5 %) was 0-10 years old, 15 samples (37.5%) were 10-20 years old, 13 samples (32.5%) were 20-40 years old, 7 samples (17.5%) were 40-60 years old and 4 samples (10%) were>60 years old. PCT levels in the blood obtained on day first were normal in 6 samples (15%) and elevated in 34 samples (85%), SIRS (+) were found in 35 samples (87.5%) and 5 samples (12.5%) were SIRS (-). Using bivariate analysis between PCT levels and SIRS showed p = 0.000 (p < 0.05), and multivariate analysis of the control variables showed no significant correlation between variables with PCT levels. Conclusion: From 40 samples moderate head injury and severe head injury, there were 34 samples (85%) with elevated PCT level on the first day, while 35 samples (87.5%) had SIRS on the third day (p=0,000, CI=95%). Elevated PCT level could be used as a predictor for SIRS in moderate and severe head injury patients.
High Ki-67 and Vascular Endothelial Growth Factor (VEGF) Protein Expression as Negative Predictive Factor for Combined Neoadjuvant Chemotherapy in Young Age Stage III Breast Cancer Sudarsa, I. W.; Manuaba, I. B. Tjakra W.; Maliawan, Sri; Sutirtayasa, I. W. P.
BALI MEDICAL JOURNAL Vol 5 No 2 (2016)
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Background: Breast cancer was, in general, a heterogeneous disease with diverse biological characteristics, types, subtypes and clinical behavior. Its treatment and management need to be personalized and individualized. Breast cancer in young ages, although rare, is usually a unique and more aggressive cancer associated with poorer prognosis. The combination of young age and advanced stages of breast cancer would make this particular breast cancer harder to treat and cure. Unfortunately, majority of Breast Cancer Patients in Bali were in younger ages, and at advanced stages, that the mainstay of treatment was neo adjuvant chemotherapy followed by other treatment modalities. Improve prognosis only, those patients who had had a complete pathological response involving primary tumor and regional lymph nodes in the axilla. Several factors had been studied and contributed to breast cancer response to combined neo-adjuvant chemotherapy. Usually, younger patients, was associated with high proliferation rate represented by Ki-67 and early distant metastasis represented by VEGF, which also had role as prognostic markers. The purpose of this study was to determine whether high Ki-67 and VEGF expression correlate with response to NAC and hence, they would be important predictive factors for response to NAC. Method: This study was a cross-sectional and a nested case-control study of stage III breast cancers affecting patients 40 years of age or less, at Sanglah General Hospital and Prima Medika Hospital, conducted from September 1st, 2012 until March 31st, 2014. Clinical and pathology reports were traced and recorded from both hospitals; routine Immunohistochemistry (IHC) examinations were performed by both pathology labs. Statistical analysis was performed using Chi-Square test, Odds Ratio (OR), and logistic regression analysis with p
ELEVATION OF SERUM C-REACTIVE PROTEIN AS A PREDICTOR FOR SYSTEMIC INFLAMMATORY RESPONSE SYNDROME IN CERVICAL SPINAL CORD INJURY PATIENTS Oliver, Stanley-Ketting; Mahadewa, T. G. B.; Maliawan, and S.
BALI MEDICAL JOURNAL Volume 2 Number 2, May-August 2013
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Objectives: Spinal cord injury has been an important medical issue with high incidence, complications, and mortality rate. For the past 2 decades, there have been a number of researches about the role of inflammatory mediators in trauma patients. However, up to now, there were limited references about the role of CRP as a predictor of SIRS in cervical spinal cord injury. Methods: This was an analytical prospective cohort study of 28 patients to determine the role of increase CRP serum as a predictor for SIRS in cervical spinal cord injury in Sanglah General Hospital, Bali-Indonesia. The data were descriptively analyzed by applying univariate and multivariate analysis to determine the role of increase CRP serum with SIRS in cervical spinal cord injury. Results were considered significant if p < 0.05. Results: From 28 samples collected, 18 samples (64.28%) were male, 12 samples were in >50 years old age group (42,86%), and the most frequent spinal cord injury scale was ASIA A (12 samples, 42,86%). Both univariate and multivariate analysis showed that increased serum CRP and ASIA Score were significant predictors of SIRS in cervical spinal cord injury patients. Conclusion: Increase in serum CRP value can be used as a reliable predictor for SIRS in cervical spinal cord injury patients.
Basic Assesment of Neck Spine Injury -, Sri-Maliawan; Mahadewa, T. G. B
BALI MEDICAL JOURNAL Volume 1, Number 1, January-April 2012
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This study aims to present a review of the basic assessment of spine and spinal cord injury. This is a review of published articles between 1978 and 2005 on the neck spine and spinal cord injury. We present a summary about the basic principles according to the literatures.
Blood hsCRP And PGE2 Content With Clinical Outcome Using Modified Fenestratio-Restorative Spinoplasty Better Than Lamonectomy-Fusion In Lumbar Stenosis Mahadewa, T. B. G.; -, Sri-Maliawan; Raka-Sudewi, A. A.; Wiryana, M
BALI MEDICAL JOURNAL Volume 1, Number 2, May-August 2012
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Objective: Modified Fenestration-Restorative Spinoplasty (MFRS) technique is an alternative to lumbar stenosis treatment, providing the equal decompression comparing with laminectomy techniques, without the implant, less expensive and complication rates. The purpose of this study was to determine which technique gives better inflammation and clinical outcome based on high sensitive C-Reactive Protein biomarker (hsCRP) and Prostaglandin E2 (PGE2), Visual Analog Scale (VAS) of the day 7th postsurgery and ODI scores 3rd month post surgery. Methods: This study design is an experimental pretest-posttest randomized control group design. Results:  This study results showed that the mean levels of hsCRP day 7th postsurgery were differ significantly between MFRS (23,09 ± 15,3 mg/L) compared to LF (39,53 ± 24,4 mg/L). Likewise for the mean levels of PGE2 day 7th postsurgery were differ significantly between MFRS (491,39 ± 528,5 pg/ml) compared to LF (1103,7 ± 1033,6 pg/ml) at the significance level of p <0.05). MFRS clinical outcomes better than LF (p <0.05), for means of VAS value day 7th postsurgery and ODI score 3rd month postsurgery. Perioperative variable analysis shows that MFRS was better than LF in: length of surgery, blood loss, postsurgery Hb and patient length of stay (p<0,05). Conclusions: MFRS technique is an alternative technique of lumbar stenosis treatment better than the LF, in terms of improved levels of hsCRP and PGE2, leading to faster clinical outcomes improvement, less complications and lower costs. MFRS technique should be used as a treatment of lumbar stenosis.
THE ROLE OF RECOMBINANT IL-10 ON THE SERUM LEVEL OF TNF-?, ONE HOUR POST TRAUMATIC BRAIN INJURY OF THE WISTAR RAT Adhimarta, Willy; Islam, Andi Asadul; Maliawan, Sri; Lowrence, Gatot S.; Patellongi, Ilhamjaya
BALI MEDICAL JOURNAL Vol 4 No 1 (2015)
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Background: Brain injury often occurs not only primary brain injury, but often also occur secondary brain injury. Inflammation is a process that occurs immediately after trauma characterized by activation of the mediator substance. TNF-? is a major cytokinee involved in the inflammatory processes that have adverse effects if the serum level are excessive. There needs to be a balance of the inflammatory process in the brain injury so things that harm does not occur. As anti-inflammatory IL- 10 plays an important role in maintaining the balance. The objective of this study is to determine the effect of IL-10 intervention as an anti -inflammatory will decrease the serum level of TNF-? in traumatic brain injury. Material And Method: Experimental Study in the Rattus Wistar rats, post test control group design, male, aged 3-4 months, with body weight (BW) 300-400g, were obtained from the Laboratory Animal Faculty of Medicine, University of Hasanuddin as much as 24 tails, which is the result of breeding. Subjects were divided into four groups, each group of six rats, treated with controlled cortical impact model (Feeney’s weight-drop) of traumatic brain injury. Blood taken with capillary tube in retro-orbita plexus or sinus.This study has approved by ethical clearance for research. Results: Levels of TNF-? group of rats 1 hour post-trauma without administration of recombinant IL-10 (28.58 ± 7.28) pg / mL; was significantly higher (p
REGIONAL ANESTHESIA CONTINUOUS BRACHIAL PLEXUS BLOCK WITH ULTRASONOGRAPHY GUIDANCE A., Senapathi T. G.; M., Wiryana; P., Astawa; M., Astawa N.; S., Maliawan; M., Bakta; T., Suryadi N.; M., Sukrama D.; D., Satoto; B., Mahadewa T. G.; Ekaputra, Ekaputra; A., W.
BALI MEDICAL JOURNAL Vol 4 No 1 (2015)
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Background: Regional anesthesia has an anti-inflammatory effect that blockade the C-fiber hence reduced cytokine production and blocked the activity of the sympathetic nerve fibers. Postoperative pain caused primarily by tissue inflammation and activity of the C-fibers in the manner of reduced the production of cytokines, regional anesthesia may limit the inflammatory response after surgery and severity of postoperative pain. Methods: This study is a clinical experimental study with randomized pre and post test control group design. A total of 24 samples were recruited in this study divided into two groups each consisting of 12 samples. The first group was given regional anesthesia method of continuous brachial plexus block with ultrasound guidance and the second group with general anesthesia method. T-test or Mann Whitney continued multivariate linear regression analysis was performed to analyze the differences in treatment and not because of differences in the initial values with significance level of p
HIGH ARTERIAL BLOOD LACTATE AS SIRS PREDICTOR IN PATIENTS WITH SEVERE HEAD INJURY Lengkong, L. R. M.; Maliawan, S.; Mahadewa, and T. G. B.
BALI MEDICAL JOURNAL Volume 2 Number 2, May-August 2013
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Objectives:  Lactate is one of the prognostic factor for evaluation of clinical severe head injury patients outcome. Lactate is also known as a factor to support diagnostic and prognosis of SIRS cases. Severe head injury is a head traumatic case frequently found in Emergency Units, where some cases result in mortality. Based on Glasgow Coma Scale (GCS), severe head injury is define as a head injury with GCS score between 3 and 8. This study aims to determine whether high arterial blood lactate can be used as predictor that causes the occurrence of SIRS. Method. A Cohort prospective study applied in this research to determine arterial blood lactate as a predictor that causes the occurrence of SIRS. This study was conducted at Sanglah General Hospital Bali-Indonesia from May 2013 to July 2013 with 40 patients who fulfilled the inclusive criteria. Data were presented in tables and analyzed by applying Chi Square Test with CI 95% and p <0.05 was considered significant. Results: From 40 samples, 27 were male (62.5%) and 17 female (37.5%) at the age of 0-10, 2 people (5%), 10-20 years 7 people (17.5%), 20-40 years 14 people (35%), 40-60 years 12 people (30%) and over 60 years 5 people (12.5%). On the first day, patients with normal level blood arterial lactate 2 (5%), and high 38 (95%) causing SIRS (+) 39 (97.5%) and SIRS (-) 1 (2.5%) samples to occur. Using bivariate analysis between arterial blood lactate level and the amount occurrence of SIRS, we obtain p < 0.05 and variable control using multivariate analysis we obtained variable of liver dysfunction that give significant value with level arterial blood lactate with p < 0.05). Conclusion: From 40 samples of Severe head injury, there were 38 (95%) whose blood arterial lactate level increased on the first day, 2 (5%) in normal limit and 39 (97.5%) with SIRS on the third day when p < 0.05) so that high level arterial blood lactate can be used as predictor that causes SIRS to occur.
HIGH SERUM C-REACTIVE PROTEIN AS PREDICTOR OF SYSTEMIC INFLAMATORY RESPONES SYNDROME IN SEVERE HEAD INJURY PATIENTS Bomba, G. I. B; Maliawan, and, S; Mahadewa, T. G. B
BALI MEDICAL JOURNAL Volume 2 Number 1, January-April 2013
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Objectives: Despite the fact that many studies have shown that the role of high sensitivity C-reactive protein (Hs-CRP) in inflammation diseases, the role of this molecule in severe head injury (SHI) has not been understood clearly. Severe head injury was defined as a trauma to the head frequently found in Emergency Units where some cases result in mortality. Severe head injury was defined as Glasgow Coma Scale (GCS) score between 3 and 8. Based on this data, we felt that it was important to determine the role of Hs-CRP as a predictor of SIRS in SHI patients. Method: This was a Cohort prospective study about the role of serum Hs-CRP as a predictor for Systemic inflammatory response syndrome (SIRS) in SHI patients at Sanglah General Hospital, Bali-Indonesia from August 2012 to February 2013. A number of 60 patients fulfilled the inclusive criteria. The data were analyzed descriptively to show the characteristics of the samples and was analyzed using univariate and multivariate analysis to determine the predictor factors for SIRS in SHI patients. A confidence interval of 95% (p < 0.05) was applied. Results: From 60 samples collected, there were 43 males (71.7%) and 17 females (28.3%), the majority age of the samples were 20-40 years old (21 samples, 35%). On the first day 49 samples (81.6%) had elevated serum Hs-CRP levels. Fifty seven samples (95%) had SIRS, and only 3 samples (5%) did not have SIRS. Bivariate analysis between Hs-CRP level and SIRS was significant (p = 0.001). Multivariate analysis showed that pneumonia and high Hs-CRP serum levels were significant predictor factors for SIRS in SHI patients. Conclusion: High serum Hs-CRP levels could be used as a reliable predictor factor for SIRS in SHI patients.
Co-Authors A.A. Gde Oka A.A. Ngr. Agung Wistara Widya AA GN Asmara Jaya AAGN Asmarajaya Andi Asadul Islam Astawa N. M., Astawa N. Astawa P., Astawa B. Sinaga D.P.W. Wardhana Dewa Putu Wisnu Wardhana Dian Megasafitri Eka J. Wahjoepramono Ekaputra Ekaputra, Ekaputra G. I. B Bomba Gatot S. Lowrence, Gatot S. Gde Rastu Adi Mahartha Gede Febby Pratama Kusuma Gede Wirya Kusuma Duarsa Hamsu Kadriyan I Dewa Made Sukrama I Gede Budhi Setiawan I Gede Sutawan I Gusti Agung Bagus Krisna Wibawa I Gusti Ayu Agung Laksemi I Gusti Kamasan Arijana I Gusti Putu Hendra Sanjaya I Ketut Suyasa I Ketut Wiargitha I Made Arya Winangun I Made Bakta I Made Gotra I Made Jawi I Nyoman Semadi I W. Sudarsa I Wayan Gede Artawan Eka Putra I Wayan Niryana I Wayan Putu Sutirta Yasa I. B. Tjakra Wibawa Manuaba Ida Bagus Adi Kayana Ilhamjaya Patellongi Iwan Antara Suryadi K.K. Putra Kadek Dede Frisky Wiyanjana Kadek Dede Frisky Wiyanjana Ketut Putu Yasa Ketut Siki Kawiyana Kevin Kristian Putra Koerniawan, Heru Sutanto Komang Ayu Vitriana Gamayanti L. K. Widnyani Wulan Laksmi L. R. M. Lengkong M Wiryana Made Agus Mahendra Inggas, Made Agus Mahendra Made Favian Budi Gunawan Made Indra Erlangga Prathiwindya Made Putri Hendaria Moses Kharisma Setyawan Mumtazah Mardliyah Ni Ketut Susilawati Ni Luh Putu Julita Yanti Ni Putu Enny Pratiwi Suardi Ni Wayan Ariani Vitriasari Nyoman Golden Putu Anda Tusta Adiputra Putu Indah Budi Apsari Putu Primeriana Nugiaswari Raka-Sudewi A. A. Reni Widyastuti Romdhoni, Achmad Chusnu S. Awyono Satoto D., Satoto Stanley-Ketting Oliver Suryadi N. T., Suryadi N. Tjokorda Gde Agung Senapathi Tjokorda Gde Bagus Mahadewa W. A., W. Wayan Suardana Willy Adhimarta, Willy Wiryana M., Wiryana Yutina Himawan