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Korelasi Antara Derajat Beratnya Osteoarthritis Lutut dan Cartilage Oligomeric Matrix Protein Serum Andriyasa, Ketut; Putra, Tjokorda Raka
Jurnal Penyakit Dalam Udayana Vol 1 No 2 (2017): Vol. 1 No. 2 (2017) June-December 2017
Publisher : PAPDI BALI

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Prevalence of knee Oateoarthritis (OA) in the community is quite high.  Various attempts have been made to find markers of cartilage damage. One potential marker is Cartilage Oligomerix Matrix Protein (COMP). Based on this, researchers want to know whether there is a correlation between the severities of knee OA with serum concentration of COMP in human. This study is a cross sectional analytic study. The diagnosis of knee OA based on ACR criteria and the degree of knee OA severity is determined based on the Kellgren and Lawrance criteria. COMP patients are checked by using ELISA method. The correlation between the severities of knee OA and serum COMP was analyzed by Spearman correlation test. Level of statistical significance used was p < 0.05. Sixty-six patients included in this study, in which 28 (42,4%) of them were male and 38 (57,6%) were women. The mean age is 63,9 Â± 7.0 years with a range of 50 to 84 years. The severity of knee OA are :  4.5% for grade one, 35.8% grade two, 38.8% grade three and 20.9% at grade 4. The mean serum COMP concentration is 1084,0 ng / mL with range from 575.3 ng / mL to 2278,6 ng/mL. There is a trend of increasingly grade of severity of knee OA, the higher the concentration of serum COMP, but not statistically significant (r = 0.127, p = 0.31). In conclusion, there is no positif correlation that statistically significant between severity of knee OA and  serum COMP concentration.

Hubungan Konsumsi Purin Tinggi Dengan Hiperurisemia: Suatu Penelitian Potong Lintang Pada Penduduk Suku Bali di Kota Denpasar Indrawan, IGNM Budiana; Kambayana, Gede; Putra, Tjokorda Raka
Jurnal Penyakit Dalam Udayana Vol 1 No 2 (2017): Vol. 1 No. 2 (2017) June-December 2017
Publisher : PAPDI BALI

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Latar Belakang: Hiperusemia adalah istilah yang menggambarkan kadar asam urat darah di atas normal. Konsumsi purin tinggi merupakan salah satu faktor yang erat kaitannya dengan hiperurisemia. Tujuan: Penelitian ini bertujuan untuk mengetahui adanya hubungan konsumsi purin tinggi dengan hiperurisemia pada penduduk suku Bali di kota Denpasar. Metode: Penelitian ini adalah studi potong lintang analitik yang dilakukan pada bulan Juli sampai dengan September 2004. Populasi pada penelitian ini adalah penduduk suku Bali yang bertempat tinggal di Kota Denpasar. Sampel ditentukan dengan cara stratified random sampling. Penilaian konsumsi purin dilakukan dengan semi quantitative food frequency questionnaire. Analisis dilakukan dengan tabulasi silang dan regresi logistik. Hasil: Penelitian ini melibatkan 302 orang sampel yang memenuhi kriteria inklusi dengan rata-rata umur 43,35 Â± 16,72 tahun yang terdiri dari 137 (45,4%) laki-laki dan 165 (54,6%) perempuan. Didapatkan prevalensi obesitas 22,51% dan prevalensi hiperurisemia 18,2%. Didapatkan hubungan yang bermakna antara konsumsi purin tinggi (RP 13,27; IK 95% 6,79-25,88; p < 0,001) dan obesitas (RP 3,32; IK 95% 2,11-5,23; p < 0,001) dengan hiperurisemia. Pada analisis multivariat didapatkan faktor risiko independen hiperurisemia adalah konsumi purin tinggi (OR 26,72; IK 95% 11,69-61,04; p < 0,001) dan obesitas ( OR 4,06; IK 95% 1,81-9,12; p = 0,001). Simpulan: Terdapat hubungan yang bermakna antara konsumsi purin tinggi dengan hiperurisemia pada penduduk suku Bali di kota Denpasar.

Kadar interleukin-17 (IL-17) serum berkorelasi dengan rasio receptor activator of NF-ÎºB ligand/osteoprotegerin (RANKL/OPG) pada penderita Sistemik Lupus Eritematosus Tonny, Tonny; Kambayana, Gede; Putra, Tjokorda Raka; Kurniari, Pande Ketut
Jurnal Penyakit Dalam Udayana Vol 2 No 1 (2018): Vol 2 No 1 (2018) January-June 2018
Publisher : PAPDI BALI

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Latar belakang : Proses inflamasi berperan penting dalam patogenesis SLE. Proses inflamasi yang terjadi pada penderita SLE juga akan mempengaruhi diferensiasi osteoklas dan osteoblast. Interleukin-17 (IL-17) merupakan mediator pro-inflamasi yang dihasilkan akibat proses inflamasi sistemik. Peningkatan kadar sitokin pro-inflamasi diketahui mengakibatkan perubahan regulasi RANKL, yang selanjutnya akan mempengaruhi osteoprotegerin (OPG). Peningkatan kadar sitokin pro-inflamasi pada penderita SLE dapat mengakibatkan ketidakseimbangan RANKL/OPG. Tujuan : Mengetahui korelasi antara kadar IL-17 serum dengan rasio RANKL/OPG pada penderita SLE. Metode : Penelitian ini merupakan studi observasional analitik potong lintang yang dilakukan di poliklinik dan bangsal rawat inap. Penyakit Dalam RSUP Sanglah Denpasar, Bali, Indonesia dari bulan Januari-Maret 2018. Penderita SLE berjenis kelamin wanita yang berusia lebih dari 18 tahun dan belum mengalami menopause serta bersedia mengikuti penelitian dengan menandatangani informed consent diikutsertakan dalam penelitian. Kadar IL-17 serum diperiksa dengan menggunakan metode high sensitivity ELISA (Enzyme-linked immunosorbent assay). RANKL diukur menggunakan metode Human sRANKL (TOTAL) ELISA, sedangkan OPG diukur menggunakan metode Human Osteoprotegerin ELISA. Rasio RANKL/OPG didapatkan dari perbandingan antara kadar RANKL dan OPG. Hasil : Penelitian ini melibatkan 68 subyek penelitian. Median umur subyek penelitian yaitu 31,32 (17-54). Kadar IL-17 dan rasio RANKL/OPG pada seluruh subyek yaitu 0,435 (0,23-30,65) dan 70,18 (4,98-1060,46). Didapatkan korelasi yang bermakna antara kadar IL-17 dan rasio RANKL/OPG dengan p=0,010. Dari analisis multivariat didapatkan bahwa kadar IL-17 berkorelasi dengan rasio RANKL/OPG (B=6,554, SE(B)=2,686, p=0,018). Simpulan : Pada penelitian ini terdapat korelasi antara kadar IL-17 serum dengan rasio RANKL/OPG pada penderita SLE.

HUBUNGAN KONSUMSI PURIN DENGAN HIPERURISEMIA PADA SUKU BALI DI DAERAH PARIW ISATA PEDESAAN -, Hensen; Raka Putra, Tjokorda
journal of internal medicine Vol. 8, No. 1 Januari 2007
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. To know theassociation between high purine diet and hyperuricemia, a cross sectional analytic study was conducted on Balinese in Ubudregion between Desember 2006 and January 2007. Sample study was Balinese age of 13 year old or above, agree to participateby informed consent. Descriptive statistic analysis on numeric data presented as mean mean ± SD, nominal and ordinal data inproportion. Inferential statistic analysis with bivariate simple logistic regression was performed and multiple logistic regressionwas used to know the independency of its association. Of 301 eligible samples, mean age was 40.85 ± 14.30 y.o, and 161 orang(53.5%) men and 139 (46.3%) women. Youngest age was 13 y.o and oldest was 85 y.o. Mean of purine consumption was 153.37± 77.83 mg/day and mean uric acid consentration was 5.14 ± 1.44 mg/dl with mean body mass index 22.57 ± 3.17 kg/m2.Prevalence of hyperuricemia on this study was 12%. High purine consumption was significantly associated with hyperuricemiaby analysis of prevalent ratio 22,82; CI 95% : 9.19 ? 56.66; p<0.001. On multivariate analysis with multiple logistic regressionhigh purin consumption also has independent association with hyperuricemia with prevalent ratio (PR) 57.30; IK 95% : 16.56 ?198.24; p < 0,001. Other factors that independently associated with hyperuricemia was obesity (PR : 7.21; IK 95% : 2.30 ? 22.60;p = 0.001), and chronic kidney disease stage 4 (PR : 74.73; IK 95% : 8.19 ? 681.60; p < 0.001). Age, alcohol consumption andchronic kidney disease stage 1 ? 3, hypertension not significantly associated with hyperuricemia in this population. Conclusion:high purine consumption was associated to hyperuricemia.

KORELASI ANTARA KONSUMSI ALKOHOL DAN FRACTIONAL URIC ACID CLEARANCE (FUAC) PADA POPULASI SUKU BALI DI DESA PENGLIPURAN, KUBU, BANGLI Rama Putra, I Made; Raka Putra, Tjokorda
journal of internal medicine Vol. 11, No. 3 September 2010
Publisher : journal of internal medicine

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Hyperuricemia is a term for serum uric acid (UA) level above normal limit, cause by overproduction or underexcretion.Fractional Uric Acid Clearance (FUAC) can determine both conditions. One of many factors affect to FUAC is alcohol.A cross sectional analytic study perform on Balinesse people in Penglipuran Village, to know correlation between alcoholconsumption and FUAC. We arrange a questionaire with anthropometric data, physical and laboratory examinations, to collectdata on September 2009. Blood and urine examinations perform in Laboratorium Klinik Prodia Denpasar. Data was analyzed bycomputer software, result in charactericstic descriptions, Kolmogorov-Smirnov tests for data normality, Spearman!s correlationto analyze dependent variable and independent variable, and multiple linear analysis, with 95% conÞ dent interval (CI) andsigniÞ cance value p < 0.05.Ninety people fulÞ lled inclusions criteria, consist of 30 (33.3 %) female and 60 (66.7%) male. Mean age was 42.40 ± 13.91years, mean UA serum were 5.19 ± 1.40 mg/dl, with 79 people (88.9 %) normouricemia and 11 people (11.1 %) hyperuricemia.Alcohol consumption prevalence was 47.8%. Mean FUAC were 7.92 ± 2.97%. Spearman!s correlation coeÞ cients (r) were -0.24;p = 0.02 between alcohol consumption and FUAC, while Ancova multivariate result none of variable signiÞ cant to FUAC, butalcohol consumption. In conclusion, there is a signiÞ cant correlation between alcohol consumption and FUAC.

HUBUNGAN HIPERURISEMIA DAN FRACTION URIC ACID CLEARANCE DI DESA TENGANAN PEGRINGSINGAN KARANGASEM BALI Kurniari, Pande Ketut; Kambayana, Gde; Raka Putra, Tjokorda
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)

DIAGNOSIS DAN PENATALAKSANAAN ARTRITIS SEPTIK Dary, I Wayan; Raka Putra, Tjokorda
journal of internal medicine Vol. 10, No. 1 Januari 2009
Publisher : journal of internal medicine

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Septic arthritis which caused by bacterial infection is a serious disease and still as challenge to physician because theprognosis has not improved significantly over the past two decades. The route of spread infection to joint through hematogenousor other routes include direct inoculation through joint prosthetic. The most often aetiology is Staphylococcus aureus. The processof native joint infection can be divided into three steps: bacterial colonization, establishing an infection, and induction ofhost inflammatory response. The diagnosis of septic arthritis rests on isolation of the pathogen from joint fluid. If we find classicsign and symptoms associated septic arthritis should not to delay the diagnosis of septic arthritis. Once septic arthritis is suspectedand the proper sample for microbiologic studies are collected, appropriate antibiotic treatment and adequate joint drainage shouldbegin immediately. The aim management of septic arthritis mainly are joint decompression, joint sterilization, and reserve jointfunction. Sterilization joint with empirical antibiotic based on gram stain and co-morbid disease and than adjusted base onbaterial culture result. Antibiotic should be administrated intravenously at least 2 weeks than continued orally. Joint decompressioncan be achieved by a variety methods include closed-needle aspiration, tidal irrigation, arthroscopy, and arthrotomy. Prophylacticuse of antibiotics is controversial for events posing a risk of haematogenous bacterial arthritis through transientbacteraemia. Prognosis of septic arthritis is poor since a permanent reduction in joint function is seen in approximately 30% ofpatients.

KORELASI ANTARA DERAJAT BERATNYA OSTEOARTHRITIS LUTUT DAN CARTILAGE OLIGOMERIC MATRIX PROTEIN SERUM Andriyasa, Ketut; Raka Putra, Tjokorda
journal of internal medicine Vol. 13, No. 1 Januari 2012
Publisher : journal of internal medicine

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Prevalence of knee Osteoarthritis (OA) in the community is quite high. Diagnosis and assessment of severity of knee OAbased on X-ray examination is not so sensitive yet. Various attempts have been made to nd markers of cartilage damage.One potential marker is Cartilage Oligomeric Matrix Protein (COMP). Based on animal studies, the more severity damageof joint cartilage, the more COMP is released. Based on this, researchers want to know whether there is a correlationbetween the severities of knee OA with serum concentration of COMP in human.This study is a cross sectional analyticstudy, whose performed in Outpatient clinic RSUP Sanglah Denpasar. The diagnosis of knee OA based on ACR criteriaand the degree of knee OA severity is determined based on the Kellgren and Lawrance criteria. COMP patients arechecked by using ELISA method. The correlation between the severities of knee OA and serum COMP was analyzed bySpearman correlation test. Level of statistical signicance used was p < 0.05. Sixty-six patients who meet the inclusioncriteria are examined, male was 28 (42.4%), women was 38 (57.6%). The mean age is 63.9 ± 7.0 years. The severity ofknee OA are: 4.5% for grade one, 35.8% grade two, 38.8% grade three and 20.9% at grade 4. The mean serum COMPconcentration is 1084.0 ng/ml. There is a trend of increasingly grade of severity of knee OA, the higher the concentrationof serum COMP, but not statistically signicant (r = 0.127, p = 0.31). In conclusion, there is no positif correlation thatstatistically signicant between severity of knee OA and serum COMP concentration.

HUBUNGAN ANTARA HIPERURIKEMIA DENGAN MICROALBUMINURIA PADA MASYARAKAT DESA LEGIAN KUTA BALI Halim, Abd.; -, Kambayana; Raka Putra, Tjokorda
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.

INSUFFISIENSI KATUP MITRAL PADA SEORANG PENDERITA LUPUS ERITEMATOSUS SISTEMIK Sanjaya, Surya; Kambayana, Gede; Rina, I K; Raka Putra, Tjokorda
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.

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