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All Journal Medicina E-Jurnal Medika Udayana Media Penelitian dan Pengembangan Kesehatan BULETIN PENELITIAN SISTEM KESEHATAN Medical Journal of Indonesia Sari Pediatri Paediatrica Indonesiana Molecular and Cellular Biomedical Sciences (MCBS) ISM (Intisari Sains Medis) : Jurnal Kedokteran

I Gusti Ngurah Made Suwarba

Bagian/SMF Ilmu Kesehatan Anak RSUP Sanglah, Fakultas Kedokteran Universitas Udayana

Author-ID : 397687

Biochemistry, Genetics & Molecular Biology Decision Sciences, Operations Research & Management Dentistry Environmental Science Health Professions Immunology & microbiology Mechanical Engineering Medicine & Pharmacology Neuroscience Public Health

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Early mannitol administration improves clinical outcomes of pediatric patients with brain edema Sekarningrum, Putu A.; Wati, Dyah K.; Suwarba, IGN Made; Hartawan, I Nyoman B.; Mahalini, Dewi S.; Suparyatha, IB Gede
Medical Journal of Indonesia Vol 27, No 4 (2018): December
Publisher : Faculty of Medicine Universitas Indonesia

Background: Mannitol 20% is used to treat patients with decreased consciousness and as the first line of treatment to reduce intracranial pressure (ICP). However, its application in pediatric patients is still based on minimal evidence. This study was performed to determine the predictive factors of clinical outcomes in pediatric patients with brain edema in the pediatric intensive care unit (PICU).Methods: This prospective cohort study was conducted in the PICU, Sanglah Hospital Denpasar, Bali, Indonesia. The subjects were chosen by consecutive sampling from July 2016 to July 2017. The primary outcome variable was the patient’s clinical outcome. A chi-square test was used to evaluate the association between the timing of mannitol administration and the patient’s clinical outcome. Multivariate analysis was performed on all variables with p≤0.25.Results: Forty-one patients were included in the study, 65% of them were male, 65% had good nutritional status, 90% had non-traumatic brain injury, and 73% had confirmed intracranial infection. The risk of sequelae or death for patients in a coma was 1.8 times greater than that of non-comatose patients (p=0.018; CI 95% 1.119–3.047). Based on the timing of mannitol administration from the onset of decreased consciousness, the risk of sequelae or death in patients who received mannitol after 24 hours was 2.1 times higher than that in patients who received mannitol within 24 hours (p=0.006; CI 95% 1.167–3.779). Based on multivariate analysis, only two variables were associated with the patient’s clinical outcome: pediatric Glasgow coma scale (PGCS) ≤3 (p=0.03) and timing of mannitol administration >24 hours (p=0.01).Conclusion: Early administration (<24 hours) of mannitol and high PGCS are related to favorable outcomes in patients with brain edema in the PICU.

FIRST UNPROVOKED SEIZURE PADA ANAK Melati, Deborah; Suwarba, IGN Made; Sutriani M, Dewi; Kari, Komang
Medicina Vol 45 No 2 (2014): Mei 2014
Publisher : Medicina

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Kejang sangat sering ditemukan pada pasien anak dengan perkiraan kejadian first unprovoked seizuresebesar 2% dan epilepsisebesar 1% pada anak sebelum berusia 16 tahun. First unprovoked seizure adalah kejang yang terjadi tanpa faktor pencetus seperti demam, infeksi sistem saraf pusat, trauma kepala, gangguan metabolik, hipoksia otak, dan obat-obatan.Berulangnya first unprovoked seizure berbeda-beda pada setiap pasien dan dipengaruhi oleh faktor risiko perorangan seperti gambaran EEG epileptiform atau adanya kelainan neurologis sebelumnya.Tatalaksana first unprovoked seizure berupa mengatasi kejang pada saat serangan.Pemberian obat anti-epilepsi pada pasien dengan first unprovoked seizure masih kontroversial.Tujuan utama pemberian obat anti-epilepsi pada pasien dengan first unprovoked seizure adalah mengoptimalisasi kualitas hidup anak dengan mempertimbangkan risiko pemberian obat dan mencegah berulangnya kejang, pemilihan keluarga serta efek samping pemberian obat. [MEDICINA. 2014;45:93-8].

DIAGNOSIS DAN TATA LAKSANA ENSEFALITIS HERPES SIMPLEKS Yuliantini, Tri; Suwarba, IGN Made; Kari, Komang; Mahalini, Dewi Sutriani
Medicina Vol 44 No 3 (2013): September 2013
Publisher : Medicina

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (212.423 KB)

Infeksi Herpes simpleks pada susunan saraf pusat (SSP) merupakan infeksi SSP yang paling beratdan sering berakibat fatal. Angka kejadiannya diperkirakan 1 kasus per 250 000 sampai 500 000orang per tahun, sepertiganya terjadi pada anak-anak. Gejala dan tanda klinis pada fase awal sangattidak khas. Pemberian terapi yang terlambat membawa dampak terjadinya kecacatan permanen.Deteksi virus Herpes simpleks (VHS) di dalam cairan serebrospinal dengan polymerase chain reactionmerupakan modalitas pilihan untuk diagnosis ensefalitis herpes simpleks (EHS). Asiklovir intravenamerupakan obat pilihan pertama. Pengobatan segera diberikan kepada pasien yang dicurigai menderitaEHS, kemudian pengobatan dapat dilanjutkan atau dihentikan sesuai konfirmasi laboratorium atauhasil biopsi otak. Pasien yang tidak diberikan antivirus atau pengobatannya terlambat angkakematiannya cukup tinggi.

Hubungan antara Kebiasaan Sarapan dengan Tingkat Memori pada Siswa Sekolah Dasar Negeri di Kota Denpasar I Putu Hendri Aryadi; Ketut Ariawati; I Gusti Ngurah Made Suwarba
Media Penelitian dan Pengembangan Kesehatan Vol 29 No 3 (2019)
Publisher : Sekretariat Badan Penelitian dan Pengembangan Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22435/mpk.v29i3.1536

Abstract Breakfast is believed to provide many benefits to the growth and development of children, including its memory, but the availability of data that can convince the public regarding this matter is still relatively lacking. This analytic study was conducted to determine the relationship between breakfast habits and memory levels in public elementary school students in the city of Denpasar, with a cross- sectional approach. The research data were primary data obtained from interviews with demographic questionnaire, Breakfast Consumption Habit Questionnaire (BCHQ) for the assessment of chidlren’s habists and Children’s Memory Questionnaire-Revised (CMQ-R) for assessing children’s memory levels. The implementation of study is from May-December 2018 to 16 public elementary schools in Denpasar City. The sample collection technique using cluster random sampling method with a sample size of 399 students. The sample in this study was dominated by male (55.1%) with the majority aged 10 years and above (57.4%). As many as 40.8% of students are classified as malnourished (underweight, overweight, and obese). The economic status of the respondents’ family is dominated by middle class. The majority of the father and mother of each respondents were high school graduates (59.1% and 53.4%), with the most jobs being private employee (39.1%) and not working (30.6%) respectively. More than a third of respondents (37.3%) were not used to have breakfast. Children who are accustomed to breakfast tend to have higher memory levels of 1.737 times more than those are not used to it. Breakfast habits have a significant relationship with the level of memory of children, with a value of p=0.008 (95% CI= 1,153–2,618). Breakfast habits are proven to be a factor that affects the level of memory of children. Further research is needed to find out the specific memory aspect that are affected and the type of breakfast that is most ideal for children development. Abstrak Sarapan dipercaya memberikan banyak manfaat pada tumbuh kembang anak, termasuk memorinya, akan tetapi kesediaan data yang dapat meyakinkan masyarakat terkait hal tersebut masih relatif kurang. Penelitian analitik ini dilakukan untuk mengetahui hubungan antara kebiasaan sarapan dan tingkat memori pada siswa sekolah dasar negeri di Kota Denpasar, dengan pendekatan potong lintang. Data penelitian adalah data primer yang diperoleh dari hasil wawancara dengan kuesioner demografik, Breakfast Consumption Habit Questionnaire (BCHQ) untuk penilaian kebiasaan sarapan anak serta Children’s Memory Questionnaire-Revised (CMQ-R) untuk penilaian tingkat memori anak. Pelaksanaan penelitian yaitu dari bulan Mei-Desember 2018 di 16 Sekolah Dasar Negeri (SDN) di Kota Denpasar. Teknik pengumpulan sampel dengan metode sampling acak klaster dengan jumlah sampel 399 orang siswa. Sampel pada penelitian ini didominasi oleh laki-laki (55,1%), dengan sebagian besar berusia 10 tahun ke atas (57,4%). Sebanyak 40,8% siswa tergolong malnutrisi (underweight, overweight, dan obesitas). Status ekonomi keluarga responden didominasi oleh golongan menengah. Ayah dan ibu dari masing-masing responden sebagian besar adalah lulusan SMA (59,1% dan 53,4%), dengan pekerjaan terbanyak yaitu sebagai pegawai swasta (39,1%) dan tidak bekerja (30,6%) berturut-turut. Lebih dari sepertiga responden (37,3%) tidak terbiasa sarapan. Anak yang terbiasa sarapan cenderung memiliki tingkat memori lebih tinggi 1,737 kali lebih banyak daripada yang tidak terbiasa. Kebiasaan sarapan memiliki hubungan yang bermakna dengan tingkat memori anak, dengan nilai p=0,008 (95% CI=1,153– 2,618). Kebiasaan sarapan terbukti mampu menjadi faktor yang mempengaruhi tingkat memori anak. Penelitian lebih lanjut diperlukan untuk mengetahui aspek memori spesifik yang dipengaruhi dan jenis sarapan yang paling ideal bagi tumbuh kembang anak.

Insidens dan Karakteristik Klinis Epilepsi pada Anak I Gusti Ngurah Made Suwarba
Sari Pediatri Vol 13, No 2 (2011)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp13.2.2011.123-8

Latar belakang.Epilepsi merupakan salah satu penyebab terbanyak morbiditas di bidang saraf anak, yang berdampak terhadap tumbuh-kembang anak. Epilepsi merupakan diagnosis klinis, insidensnya bervariasi di berbagai negara. Elektroensefalografi (EEG) dikerjakan untuk melihat fokus epileptogenik, sindrom epilepsi tertentu, evaluasi pengobatan, dan menentukan prognosis. Pencitraan dilakukan untuk mengetahui adanya fokus epilepsi dan kelainan struktur otak lainnya.Tujuan. Mengetahui insidens dan karakteristik klinis, gambaran EEG dan pencitraan pasien epilepsi di bagian/SMF Ilmu Kesehatan Anak FK UNUD/ RSUP sanglah Denpasar Bali, selama periode Januari 2007- Desember 2010.Metode.Penelitian potong lintang dengan observasi langsung. Data diambil dari setiap pasien yang baru dengan diagnosis epilepsi di Poliklinik Anak dan ruang rawat inap Bagian/SMF Ilmu Kesehatan Anak FK UNUD/RSUP Sanglah Denpasar selama Januari 2007-Desember 2010. Data yang dikumpulkan adalah umur, jenis kelamin, status gizi, gambaran klinis epilepsi, penyakit neurologis penyerta, status tumbuh kembang, riwayat kejang demam, riwayat epilepsi keluarga, gambaran EEG dan pencitraan kepala.Hasil. Ditemukan 276 kasus epilepsi, dengan insidens 5,3%. Sebagian besar laki-laki (56,9%), terbanyak (42%) umur 1â€“5 tahun dan onset tersering umur <1 tahun (46%) kasus. Diagnosis epilepsi umum tonikklonik (62%), dan sindrom epilepsi yang ditemukan spasme infantil 6,9% kasus. Sebagian besar tumbuh kembang normal (75%), riwayat kejang demam sebelumnya 10,1% kasus dan riwayat epilepsi keluarga 13% kasus. Pemeriksaan EEG pertama ditemukan abnormal 42,4% kasus dan pada CT scankepala ditemukan kelainan pada 51,4 % kasus.Kesimpulan.Ditemukan 276 kasus epilepsi, dengan insidens 5,3%, terutama terjadi pada anak laki-laki (56,9%). Sebagian besar (62%) epilepsi umum tonik-klonik. Gambaran EEG pertama kali abnormal pada 42,4% kasus. Pada CT scankepala, ditemukan kelainan pada 51,4 % kasus.

Profil Klinis dan Etiologi Pasien Keterlambatan Perkembangan Global di Rumah Sakit Cipto Mangunkusumo Jakarta I Gusti Ngurah Suwarba; Dwi Putro Widodo; RA Setyo Handryastuti
Sari Pediatri Vol 10, No 4 (2008)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Latar belakang. Perkembangan anak meliputi aspek motorik halus, motorik kasar, bahasa/berbicara, personal sosial, kognitif, dan aktivitas sehari-hari. Keterlambatan perkembangan global (KPG) adalah keterlambatan bermakna pada lebih dari dua domain perkembangan. Etiologi sangat bervariasi, angka kejadian sekitar 1%-3% anak-anak di seluruh dunia, sedangkan di Indonesia sampai saat ini belum pernah dilaporkan.Tujuan. Mengetahui prevalensi, karakteristik, etiologi, dan faktor-faktor yang berhubungan dengan etiologi KPG di RS Dr. Cipto Mangunkusumo Jakarta.Metode. Penelitian retrospektif dilakukan pada 151 anak KPG di Poliklinik Neurologi anak RS Dr. Cipto Mangunkusumo Jakarta pada Januari 2006-Juli 2008. Kriteria inklusi anak didiagnosis KPG, berumur <5 tahun.Hasil. Prevalensi KPG di Poliklinik Neurologi Anak RS Dr. Cipto Mangunkusumo Jakarta pada Januari 2006-Juli 2008 didapatkan pada 151(2,3%) dari 6487 kunjungan. Keluhan terbanyak, belum bisa berjalan dan berbicara 71 (47,1%) kasus, 84 (55,6%) laki-laki, dan rerata umur (21,8 Â± 13,1) bulan. Riwayat kelahiran 33(21,9%) kurang bulan, 45(29,8%) BBLR, 125(79,2%) lahir pervaginam, 46(30,%) tidak segera menangis. Gangguan perkembangan dalam keluarga ditemukan pada 20(13,2%) kasus. Karakteristik klinis 81(53,6%) mikrosefali, 67 (44,4%) kasus gizi kurang dan gizi buruk. Gambaran dismorfik 19 (12,6%) kasus, riwayat kejang 57(37,7%) kasus. Etiologi dapat diidentifikasi pada 97(64,2%) kasus. Lima etiologi terbanyak 33(21,9%) disgenesis cerebral, 18(11,9%) palsi cerebral, 15(9,9%) infeksi TORCH, 11(7,3%) sindrom genetik, dan 7(4,6%) kelainan metabolik kongenital. Analisis bivariat, ditemukan perbedaaan bermakna pada riwayat kejang, jenis kelamin, mikrosefali, dan gambaran dismorfik antara etiologi yang diketahui dan etiologi tidak diketahui dengan p=0,025; 0,016; 0,018; <0,0001. Analisis multivariat, ada hubungan bermakna antara keberhasilan identifikasi etiologi dengan jenis kelamin, mikrosefali, dan gambaran dismorfik dengan p=0,003; <0,0001 dan 0,006.Kesimpulan. Prevalensi keterlambatan perkembangan global di poliklinik anak RS Dr. Cipto Mangunkusumo Jakarta 2,3%. Karakterisitik klinis yang berhubungan bermakna dengan keberhasilan identifikasi etiologi adalah jenis kelamin laki-laki, mikrosefali, dan adanya gambaran dismorpik.

Electroencephalogram abnormalities in full term infants with history of severe asphyxia Susanti Halim; I Gusti Nyoman Made Suwarba; I Made Kardana
Paediatrica Indonesiana Vol 55 No 6 (2015): November 2015
Publisher : Indonesian Pediatric Society

Background An electroencephalogram (EEG) is an electroimaging tool used to determine developmental and electrical problems in the brain. A history of severe asphyxia is a risk factor for these brain problems in infants. Objective To evaluate the prevalence of abnormal EEGs in full term neonates and to assess for an association with severe asphyxia, hypoxic ischemic encephalopathy (HIE), and spontaneous delivery. Methods This cross-sectional study was conducted at the Pediatric Outpatient Department of Sanglah Hospital, Denpasar, from November 2013 to January 2014. Subjects were fullterm infants aged 1 month who were delivered and/or hospitalized at Sanglah Hospital. All subjects underwent EEG. The EEGs were interpreted by a pediatric neurology consultant, twice, with a week interval between readings. Clinical data were obtained from medical records. Association between abnormal ECG and severe asphyxia were analyzed by Chi-square and multivariable logistic analyses. Results Of 55 subjects, 27 had a history of severe asphyxia and 28 were vigorous babies. Forty percent (22/55) of subjects had abnormal EEG findings, 19/22 of these subjects having history of severe asphyxia, 15/22 had history of hypoxic-ischemic encephalopathy (HIE), and 20/22 were delievered vaginally. There were strong correlations between the prevalence of abnormal EEG and history of severe asphyxia, HIE, and spontaneous delivery. Conclusion Prevalence of abnormal EEG among full-term neonates referred to neurology/growth development clinic is around 40%, with most of them having a history of severe asphyxia. Abnormal EEG is significantly associated to severe asphyxia, HIE, and spontaneous delivery.

Outcome of synthetic adrenocorticotropin hormone treatment in children with infantile spasm I Gusti Ngurah Made Suwarba
Paediatrica Indonesiana Vol 51 No 2 (2011): March 2011
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi51.2.2011.94-100

Background Infantile spasms (IS) is an age-spedfic epilepsy syndrome characterized by flexor, extensor, and mixed flexor-extensor spasms which often occur in clusters during the first 2 years of life. IS is often difficult to manage 'With the usual anti-epilepsy drugs (AEDs). Therapy with adrenocorticotropin honnone (ACTH) has been used since 1958. In Indonesia, ACTH usage is still rare.Objective This study aims to examine the effectiveness of ACTH as an anti-epileptic drug in managing IS.Methods This was descriptive retrospective cohort study. Subjects were IS patients who visited the neurology outpatient clinic in Sanglah Hospital, Bali, from January 2007 until June 2010. Each subject received AED(s) plus either ACTH or methylprednisolone for 4ô€†6 weeks.Results There were 19 IS patients over the four year duration of this study. They were mostly boys (11), aged 2 weeks to 17 months, with a mean age at treatment of 9 months. Eighteen patients received poly therapy, while one patient received only phenobarbital as monotherapy. Most patients who received ACTH (13/16) had a seizure-free period, while the 3 that did not receive ACTH continued having seizures. Patients who received ACTHshowed a good response (seizure-free) after 5-13 days therapy and their EEG pattern showed disappearance of burst suppression Mthin 1-2 weeks. ACTH side effects included weight gain and cushingoid appearance. One patient died from pneumonia.Conclusions Diagnosis of IS should be considered in patients pre-senting Mth spasms at less than 6 months old. IS treatment should begin as soon as possible. IS patients responded well to a short course of ACTH therapy.Â

The role of bovine colostrum on recovery time and length of hospital stay of acute diarrhea in infants and children: a double-blind randomized controlled trial IGN Suwarba; Sudaryat S; Hendra S; IKG Suandi; Raka Widiana
Paediatrica Indonesiana Vol 46 No 3 (2006): May 2006
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi46.3.2006.127-33

Background WHO standard treatment for acute diarrhea remainsunsatisfying to the parents of acute diarrhea patients, particularlythe need of medical treatment. Bovine colostrum contains immuneand growth factors that is thought able to neutralize some agentscausing acute diarrhea in infants and children.Objective To evaluate the efficacy of bovine colostrum as adju-vant therapy on recovery time and length of hospital stay for acutediarrhea in infants and children.Methods A double-blind randomized controlled trial was conductedon infants and children with acute diarrhea admitted to SanglahHospital. Treatment group received standard therapy with bovinecolostrums and control group received standard therapy plus pla-cebo. The primary outcomes were achievement of recovery timeand length of hospital stay. Recovery time was determined by thenumber of days needed to achieve defecation frequency <3 times/day and needed to achieve normal stool consistency.Results Seventy infants and children were enrolled. The treatmentgroup significantly achieved recovery time earlier than the control groupin regard to the time of achieving defecation frequency to <3 times/day [2.31 (0.76) vs 3.34 (1.45); mean difference of -1.03; P= 0.001; CI95% -1.58;-0.48] and normal stool consistency [2.40 (0.77) vs 3.43(1.48); mean difference of -1.03; P = 0.001; CI 95% -1.59;-0.46]. Lengthof hospital stay was shorter in the treatment group than the controlgroup [2.89 (0.78) vs 3.94 (1.53); mean difference of -1.05; P= 0.001;CI 95% (-1.3;-0.7)]. No significant difference was found in mean ofbody weight recovery in two groups [0.47 (0.16) vs 0.49 (0.20); meandifference of -0.03; P=0.556; CI 95%: -0.11;0.06]. Age, nutritionalstatus, breastfeeding, and diarrhea before admission did not influ-ence the study outcome.Conclusion Bovine colostrums as an adjuvant in standard therapyfor acute diarrhea in infants and children is effective in regard toachieve earlier recovery time and shorter length of hospital stay

The Effect of Carnitine Supplementation on Blood Ammonia Level in Epilepsy Children Treated with Valproic Acid: A Randomized Controlled Trial I Gusti Lanang Sidiartha; I Gusti Ngurah Made Suwarba; Dyah Kanya Wati; Ida Bagus Subanada
Molecular and Cellular Biomedical Sciences Vol 5, No 1 (2021)
Publisher : Cell and BioPharmaceutical Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21705/mcbs.v5i1.177

Background: Long-term use of valproic acid is associated with a high level of blood ammonia related to carnitine deficiency. This study investigates the effect of carnitine supplementation on blood ammonia levels in children with epilepsy who have been treated with valproic acid for more than six months.Materials and Methods: This was a randomized, double-blind, placebo-controlled trial study where children with epilepsy who were treated with valproic acid were randomly allocated to the carnitine supplementation and control group. All children were followed for month, and then measured for blood ammonia level. Blood ammonia levels of both groups were compared using an Independent t-test with a significant of p<0.05.Results: Total of 32 children with epilepsy were enrolled as subjects in this study, with 16 children in carnitine group, and 16 children in control group. Among the subjects, 50% were male and 50% were female, with a mean age of 6.5 years old. The average duration of epilepsy in the carnitine and control group were 41.7 months and 36.9 months, respectively (p=0.419). The duration of valproic acid therapy in the carnitine and control group were 33.1 months and 27.6 months, respectively (p=0.483). The level of blood ammonia in carnitine and control group were 44.6 mg/dL and 81.4 mg/dL, respectively (p=0.007).Conclusion: The level of blood ammonia in a carnitine group was significantly lower than in a control group. It is recommended to give carnitine supplementation in epileptic children treating with long-term valproic acid.Keywords: ammonia, carnitine, epilepsy, seizure, valproic acid

Co-Authors Anita Purnamayanti Bagus Ngurah Putu Arhana Deborah Melati, Deborah Dewi Sutriani Mahalini Dwi Putro Widodo Dyah Kanya Wati Dyah Kanya Wati Hendra S I Gde Raka Widiana I Gusti Lanang Sidiartha I Gusti Ngurah Agung Jayadhi Widyakusuma I Gusti Ngurah Sanjaya Putra I Made Darma Yuda I Made Kardana I Nyoman Budi Hartawan I Putu Hendri Aryadi Ida Bagus Gede Suparyatha Ida Bagus Subanada Ida Bagus Subanada IKG Suandi Ketut Ariawati Komang Kari Made Gede Dwi Lingga Utama Made Suadnyani Pasek Ni Made Dani Febriansiswanti Ni Nyoman Ayu Semanggiasih Ni Putu Yunik Novayanti Ni Putu Yunik Novayanti Ni Wayan Kurnia Wati Novayanti, Ni Putu Yunik RA Setyo Handryastuti Sekarningrum, Putu A. Sudaryat S Susanti Halim Tri Yuliantini Wati, Dyah K. Wayan Sulaksmana Sandhi Parwata

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