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All Journal E-Jurnal Medika Udayana Universa Medicina The Indonesian Journal of Infectious Diseases Indonesian Journal of Kidney and Hypertension The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy
Dewi, Putu Itta Sandi Lesmana
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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KARAKTERISTIK PASIEN KISTA OVARIUM DI RSUP SANGLAH DENPASAR PERIODE JANUARI 2019 - DESEMBER 2019 Dewi, Putu Itta Sandi Lesmana
E-Jurnal Medika Udayana Vol 11 No 1 (2022): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2022.v11.i01.P12

Abstract

ABSTRACT Ovarian cyst is gynecological tumors that are often found in women of childbearing age. The formation of ovarian cyst is influenced by the risk factors such as reproductive age, family history, nulliparous, and hormonal therapy. The purpose of this study is to determine the characteristics of ovarian cyst patients being treated in Sanglah General Hospital. The research design of this study is cross sectional design with retrospective descriptive research. Data were taken by using a total sampling method from the medical records of ovarian cyst patients during the period of January 2019 – December 2019. The research subjects were patients who had been diagnosed with ovarian cyst and recorded in the medical record of Sanglah General Hospital. The patients’ characteristics were described based on age, parity, menstrual status, cyst classification, cyst location, and medical management. The finding of this study is that out of the total sample of 67 medical records of the ovarian cyst patients, there were patients with the majority categories of age at 36-50 years old (37,3%), being dominated by women who had menstruation (67,2%), and mainly found in multiparous women (41,8%). The ovarian cyst was mostly found with benign type (52,2%), which was more common in the right ovary (49,3%). The medical management that was given in Sanglah General Hospital was mostly in the form of operative measures (74,6%). From this study, it can be concluded that ovarian cysts are most often found in women at childbearing age who have experienced menstruation. Ovarian cysts are more common in multiparous women with predominantly benign ovarian cyst type. Ovarian cysts are more common in the right ovary and predominantly performed by surgery. Keywords: Ovarian cyst, characteristics, Sanglah General Hospital
Renal Safety of Tenofovir Alafenamide versus Tenofovir Disoproxil Fumarate for the Treatment of Chronic Hepatitis B Patients: An Evidence-based Case Report Dewi, Putu Itta Sandi Lesmana; Pamungkas, Kadek Mercu Narapati; Mariadi, I Ketut
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 25, No 2 (2024): VOLUME 25, NUMBER 2, August, 2024
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2522024368

Abstract

ABSTRACTBackground: Treatment modalities for chronic hepatitis B infection (CHB) are interferon and antiviral. The most commonly used antiviral is tenofovir disoproxil fumarate (TDF), however it is known to have nephrotoxicity. Recently, a new antiviral tenofovir alafenamide (TAF) has been developed, which also inhibits hepatitis B virus (HBV). This study aimed to compare the renal safety of TAF and TDF.Method: Literature searching was conducted in PubMed/Medline and Cochrane databases, with modified keywords as “chronic hepatitis B”, “tenofovir alafenamide”, “tenofovir disoproxil fumarate”, “renal” with BOOLEAN logic. The articles obtained will be selected and will be carried out for critical appraisal about validity, importance, and applicability.Results: Four studies of double-blind randomized-clinical trials (RCT) were obtained for analysis. The antiviral effects of TAF and TDF groups were not significantly different. The increase in serum creatinine of TAF group was significantly smaller than TDF group in three studies (p 0.05). While one study showed no significant difference (p = 0.32). The decrease in eGFR (estimated-Glomerular Filtration Rate) in the TAF group was smaller than TDF in three studies (p 0.001), whereas one study found an increase in eGFR in the TAF group (p = 0.00034). There were no severe side effects found in both study groups.Conclusion: Based on the scientific evidence obtained, TAF has more renal safety than TDF. Although the antiviral effect is not significantly different.  Keywords: chronic hepatitis B, tenofovir alafenamide, tenofovir disoproxil fumarate, renal function
Correlation of Simple Laboratory Result Parameters to CTP and MELD Scores, and the Diagnostic Role of Simple Laboratory Indexes to Cirrhosis Decompensation Dewi, Ni Nyoman Gita Kharisma; Dewi, Ni Luh Putu Yunia; Dewi, Putu Itta Sandi Lesmana; Pamungkas, Kadek Mercu Narapati; Sindhughosa, Dwijo Anargha; Mariadi, I Ketut
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 25, No 1 (2024): VOLUME 25, NUMBER 1, April, 2024
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/251202427-33

Abstract

BackgroundCirrhosis of the liver is a final condition of all chronic liver diseases. Liver cirrhosis is the leading cause of increasing morbidity and mortality in adults worldwide. Systemic inflammation has been suggested to play an important role in causing progressive liver damage and is one of the leading causes of compensated and decompensated liver cirrhosis.Aim of StudyEvaluate the correlation of neutrophil-lymphocyte ratio (NLR), albumin-bilirubin ratio (ABR), albumin-bilirubin score (ALBI), aspartate aminotransferase to platelet ratio (APRI), albumin-creatinine ratio (ACR), lymphocyte-monocyte ratio (LMR), de ritis ratio to the severity of liver cirrhosis as assessed by CTP score and MELD score. In addition, this study also evaluated the diagnostic ability of NLR, ABR, ALBI, APRI, ACR, LMR, de ritis ratio, and CTP and MELD scores in predicting decompensated liver cirrhosis.MethodWe conducted a cross-sectional study involving patients diagnosed with liver cirrhosis at Prof DR IGNG Ngoerah General Hospital. All patients were diagnosed based on clinical history, physical examination, and investigations. This study enrolled 96 cirrhotic patients regardless of etiology. Laboratory examination results recorded platelets, neutrophils, lymphocytes, monocytes, AST, ALT, albumin, and creatinine. Then NLR, ACR, APRI, LMR, de raitis, ALBI, and ABR are calculated. CTP and MELD scores were calculated by taking data from the patient's medical recordResultOf the 96 patients tested in our study, the majority were male (66). The study found a significant moderate to very strong relationship to the MELD score between ACR, APRI, ALBI, ABR, LMR, WBC, sodium, and albumin. Neutrophil to lymphocyte ratio, ACR, De ritis, APRI, LMR, ALBI, ABR, sodium levels, and albumin have a moderate to very strong significant relationship to CTP score. ACR, De ritis, APRI, LMR, ALBI, ABR, WBC, sodium, and albumin levels with respective cut-offs £ 3.6; ≥ 1.5; ≥ 0.3; £ 2.8; ≥ 0.7; £1.6; ≥ 6.7, £ 136.50, and £ 3.0 can be used to help predict decompensated cirrhosisConclusionIn addition to using the CTP score and MELD score as a tool to predict the severity of liver cirrhosis, data from laboratory examination results in the form of albumin and ABR levels can help establish the diagnosis of decompensated cirrhosis. The sensitivity and specificity of ABR were 96.8% and 75.4% with a cut-off of £  1.6, while albumin levels were 93.5% and 81.5% with an amount off of £  3.0.
Low albumin-to-creatinine ratio: a novel predictor of 90-day mortality in hepatocellular carcinoma with liver cirrhosis Pamungkas, Kadek Mercu Narapati; Dewi, Putu Itta Sandi Lesmana; Dewi, Ni Luh Putu Yunia; Dewi, Ni Nyoman Gita Kharisma; Sindhughosa, Dwijo Anargha; Mariadi, I Ketut
Universa Medicina Vol. 43 No. 3 (2024)
Publisher : Faculty of Medicine, Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2024.v43.313-320

Abstract

BackgroundDespite recent advances in the treatments of hepatocellular carcinoma (HCC), the prognosis of HCC patients remains controversial. Lowered serum albumin in hepatocellular carcinoma, an advanced stage of liver cirrhosis, indicates a worsening condition. Hepatorenal syndrome, marked by increased serum creatinine, is a key mortality indicator. The aim of this study was to determine the serum albumin-to-creatinine ratio (sACR) as a predictor of mortality in patients with HCC and liver cirrhosis. MethodsThis retrospective cohort study included 37 patients with HCC and liver cirrhosis. Patient characteristics, sACR, model of end-stage liver disease (MELD) score, and Child-Turcotte-Pugh (CTP) score were obtained from medical records. The optimal cut-off point for the sACR was determined using receiver operating characteristic (ROC) analysis to evaluate its predictive ability for 90-day mortality. Survival analysis was conducted using the Kaplan-Meier method with a log-rank test, and Cox regression was employed to obtain hazard ratios (HR) to estimate the patient’s prognosis. ResultsA low sACR cut-off of 2.32 was identified. Kaplan-Meier analysis confirmed that sACR met the proportional hazard assumption. sACR <2.32 was a significant predictor of 90-day mortality (HR 6.52; 95% CI 1.80-23.63; p=0.004), comparable to MELD 40 (HR 41.3; 95% CI 1.98-862.90; p=0.016) and CTP category (HR =2.19;95%CI: 0.79-6.06;p=0.131). Conclusion The sACR is a novel predictor of 90-day mortality in HCC patients with liver cirrhosis. Lower sACR is associated with overall survival and may help to design strategies to personalize management approaches among patients with HCC and liver cirrhosis.
Diagnostic Challenges of Weil’s Disease with Acute Kidney Injury: A Case Report and Clinical Review Agustini, Made Priska Arya; Dewi, Putu Itta Sandi lesmana; Lestari, I Dewa Ayu Made Dian; Sunaka, I Wayan
The Indonesian Journal of Infectious Diseases Vol. 11 No. 2 (2025): The Indonesian Journal of Infectious Diseases
Publisher : Rumah Sakit Penyakit Infeksi Prof Dr. Sulianti Saroso

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32667/ijid.v11i2.409

Abstract

Background: Severe leptospirosis or Weil’s disease can cause multi-organ failure, which is characterized by jaundice and acute kidney injury in approximately 10% of cases. Its nonspecific symptoms often lead to misdiagnosis with other acute febrile illnesses, resulting in delayed diagnosis. Case Presentation: A 48-year-old male construction worker presented with fever, headache, myalgia, epigastric pain, nausea, and vomiting for four days without any signs of bleeding. The patient lived and worked at a project site adjacent to rice fields. Physical examination revealed fever, icteric sclera, conjunctival suffusion, and tenderness of the gastrocnemius muscle. Laboratory tests showed leukocytosis, thrombocytopenia, impaired renal function, elevated liver enzymes, hyponatremia, and hypokalemia. The patient was diagnosed with Weill’s disease. He was treated with antibiotics and supportive therapy. Sixteen days after discharge, the patient reported gradual improvement and had resumed normal activities. Discussion:  Patients presenting with acute febrile illness should undergo a comprehensive evaluation, and leptospirosis should be considered when leukocytosis, neutrophilia, and thrombocytopenia are observed in a complete blood count. A detailed history focusing on risk factors and associated symptoms, along with additional diagnostic tests based on the criteria, can help guide the diagnosis. Antibiotic therapy should be initiated immediately in patients with suspected or probable leptospirosis without waiting for serological confirmation. Conclusion: This case highlights the diagnostic challenges of leptospirosis, particularly in resource-limited healthcare settings. Enhancing clinical awareness, improving access to rapid diagnostic tools, and optimizing preventive measures are crucial to reducing morbidity and mortality rates
Validation Study of the Cirrhosis Acute Gastrointestinal Bleeding Score as Predictor Mortality in Patients with Liver Cirrhosis and Upper Gastrointestinal Bleeding Mariadi, I Ketut; Hardian, Harris; Alamsyah, Ajib Zaim; Dewi, Ni Luh Putu Yunia; Dewi, Putu Itta Sandi Lesmana; Dewi, Ni Nyoman Gita Kharisma; Pamungkas, Kadek Mercu Narapati; Somayana, Gde; Wira Nugraha, Komang Agus; Sindhughosa, Dwijo Anargha; bin Abd Rahman, Mohamad Fadli
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 27, No 1 (2026): VOLUME 27, NUMBER 1, April, 2026
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/271202619-26

Abstract

Background: The Cirrhosis Acute Gastrointestinal Bleeding (CAGIB) score was developed as a mortality predictor by integrating a range of clinical and laboratory parameters. This research seeks to validate the efficacy of the CAGIB score in predicting in-hospital mortality among cirrhotic patients experiencing upper gastrointestinal bleeding (UGIB) at Ngoerah Hospital.Methods: This study is a prospective observational study employing a validation test approach. A total of 161 patients diagnosed with liver cirrhosis and upper gastrointestinal bleeding (UGIB) at Ngoerah Hospital were enrolled. Receiver Operating Characteristic (ROC) analysis was utilized to evaluate the prognostic capability of the CAGIB score in predicting mortality and to identify the optimal cutoff point. Validation was conducted by assessing the CAGIB score's sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV).Results: The analysis of the CAGIB score as a predictor of mortality yielded an area under the curve (AUC) value of 0.83, with the optimal cutoff point determined at ≥ -4.66, based on the point farthest from the diagonal line on the ROC curve. The 95% Confidence Interval (CI) ranged from 0.777 to 0.897. Validation testing of the CAGIB score as a predictor of in-hospital mortality demonstrated a sensitivity of 80.8%, specificity of 70.5%, PPV of 69.4%, and NPV of 81.6%.Conclusion: The CAGIB score has been demonstrated to serve as a valid predictor of mortality, exhibiting commendable sensitivity and specificity, along with satisfactory positive and negative predictive values. The optimal cutoff points appropriately reflect the demographic and clinical characteristics of the cirrhosis patient population with UGIB at Ngoerah Hospital
Understanding Readmission Risks in End-Stage Kidney Disease: A Study from Wangaya Hospital Dewi, Ni Nyoman Gita Kharisma; Pratiwi, Made Sindy Astri; Agustini, Made Priska Arya; Dewi, Putu Itta Sandi Lesmana; Fahira, Cindy; Sunaka, I Wayan
Indonesian Journal of Kidney and Hypertension Vol 2 No 3 (2025): Volume 2 No. 3, December 2025
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32867/inakidney.v2i3.206

Abstract

Background: End-stage kidney disease (ESKD) is a growing health burden. Poor patient knowledge and treatment adherence contribute to increased morbidity, as reflected in readmission rates. Objective: This study aimed to identify factors associated with readmission among ESKD patients in Bali. Methods: A retrospective cohort study was conducted at Wangaya Hospital. Adult patients (≥18 years) diagnosed with ESKD, with or without dialysis, between 2022 and 2024 were included. Patients with incomplete records or a solitary kidney were excluded. Bivariate analysis (chi-square test) and multivariate analysis (binary logistic regression) were used to assess associations, with significance set at p <0.05. Results: A total of 199 patients met the inclusion criteria; 61.8% were male, with a median age of 57 years (range: 22–88 years). Readmission rates within and beyond one month were 18.6% and 15.1%, respectively. Reduced eGFR was significantly associated with 30-day readmission (p = 0.041). For readmission beyond 30 days, significant predictors included diabetes mellitus (p = 0.014), neurologic disorders (p < 0.001), and adherence (p = 0.019). Conclusion: eGFR predicts early readmission, while diabetes mellitus, neurological disorders, and treatment adherence influence later readmissions. Identifying these factors is vital for improving patient education and reducing healthcare burdens.
Co-Authors Agustini, Made Priska Arya Alamsyah, Ajib Zaim bin Abd Rahman, Mohamad Fadli Dewi, Ni Luh Putu Yunia Dewi, Ni Nyoman Gita Kharisma Dwijo Anargha Sindhughosa, Dwijo Anargha Fahira, Cindy Gde Somayana Hardian, Harris I Ketut Mariadi Lestari, I Dewa Ayu Made Dian Pamungkas, Kadek Mercu Narapati Pratiwi, Made Sindy Astri Sunaka, I Wayan Wira Nugraha, Komang Agus