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All Journal journal of internal medicine E-Jurnal Medika Udayana Media Kesehatan Masyarakat Indonesia Archives of The Medicine and Case Reports KESANS : International Journal of Health and Science
Anak Agung Ayu Yuli Gayatri
Tropical And Infectious Diseases Division Internal Medicine Department Udayana University/ Sanglah General Hospital
Chemistry Health Professions Medicine & Pharmacology Nursing Physics Public Health

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PERITONITIS BAKTERIAL SPONTAN PADA SIROSIS HATI DAN HUBUNGANNYA DENGAN BEBERAPA FAKTOR RISIKO Ayu Yuli Gayatri, Anak Agung; Wibawa, I Dewa Nyoman
journal of internal medicine Vol. 7, No. 2 Mei 2006
Publisher : journal of internal medicine

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Abstract

Spontaneous Bacterial Peritonitis (SBP) is a frequent and severe complication in cirrhotic patients with ascites. It occursin 10-30% of cases and assosiated mortality rate is 20-40%. Spontaneous Bacterial Peritonitis is diagnosed base on the presence ofa Polymorphonuclear leucocyte count greater than 250/mm3 or positive monomicrobial ascitic fluid culture. The key to successfultreatment of SBP is knowledge of appropriate antibiotic regimen and an understanding of the setting in wich infection develops,particularly those individuals at high risk of infection. This study was conducted to know prevalence of SBP and to evaluatepossible risk faktors for this complication such as: severe cirrhosis (Child C), upper gastrointestinal bleeding, low protein ascites(<1g/dL) and low platelet count (<98.000/mm3). Sixty two consecutive hospitalized patients with cirrhotic and ascites were followup for manifestations of SBP. Prevalence of SBP was 30.6%. Multivariate analysis and Logistic regression showed that onlysevere cirrhosis (Child C) is the risk faktor of SBP. (OR= 5.297; 95% CI=1.036-27.079).
PREVALENSI DAN KARAKTERISTIK GANGGUAN FUNGSI GINJAL PADA PASIEN HIV YANG MENGGUNAKAN TERAPI ARV BERBASIS TENOFOVIR DI RSUP SANGLAH DENPASAR Hanina Mardhatillah; Ni Made Dewi Dian Sukmawati; Anak Agung Ayu Yuli Gayatri
E-Jurnal Medika Udayana Vol 8 No 11 (2019): Vol 8 No 11 (2019): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

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Tenofovir adalah bagian dari terapi ARV lini pertama pada pasien HIV dan diketahui bahwa penggunaan tenofovir menimbulkan gangguan fungsi ginjal. Tujuan penelitian ini adalah mengetahui prevalensi dan karakteristik gangguan fungsi ginjal pada pasien HIV yang menggunakan terapi ARV berbasis tenofovir di RSUP Sanglah Denpasar. Penelitian ini bersifat deskriptif, dengan teknik potong lintang. Penelitian ini menggunakan data sekunder yaitu rekam medis pasien, dengan populasi terjangkau adalah pasien HIV yang menggunakan ARV berbasis tenofovir di Klinik VCT RSUP Sanglah Denpasar. Prevalensi gangguan fungsi ginjal adalah 61,7%, yang dijumpai lebih banyak pada laki-laki (54%) dan memiliki rerata usia 42,06 + 9,13 tahun. Sebagian besar pasien berasal dari Bali (92%), pegawai swasta (50%), SMA (20%) dan pasien sudah menikah (74%). Durasi terapi paling banyak terdapat pada kelompok 12-36 bulan (64%) dan rerata baseline CD4 adalah 132,9 + 115 sel/µL. Selisih penurunan GFR terbagi menjadi tiga kelompok durasi terapi, memiliki rentang yang paling sempit pada kelompok durasi terapi lebih dari 36 bulan dan sebanyak 33 pasien mengalami penurunan terhadap fungsi ginjal dengan tren yang meningkat seiring peningkatan durasi terapi. Kata Kunci: HIV, human immunodeficiency virus, terapi antiretroviral, ARV, tenofovir, TDF, laju filtrasi glomerolus, GFR, gangguan fungsi ginjal, penurunan fungsi ginjal
LUARAN PASIEN DEWASA YANG MENDERITA SEVERE DENGUE DI RUMAH SAKIT UMUM PUSAT SANGLAH, DENPASAR PERIODE JANUARI 2016 – JUNI 2016 I Putu Pande Agus Asmara Widhiana Saputra; Ni Made Dewi Dian Sukmawati; Anak Agung Ayu Yuli Gayatri; I Ketut Agus Somia
E-Jurnal Medika Udayana Vol 8 No 11 (2019): Vol 8 No 11 (2019): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

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Abstract

Infeksi virus dengue merupakan permasalahan global karena tingginya morbiditas dengan mortalitas yang rendah. Terjadi pergeseran insiden penderita dari kalangan anak-anak bergeser ke kelompok usia yang lebih tua di Indonesia. Mortalitas pasien diakibatkan oleh terjadinya komplikasi infeksi dengue dan adanya faktor risiko penyakit kronik mempengaruhi outcome perbaikan klinis penderita. Tujuan penelitian yaitu untuk mengetahui luaran pasien dewasa yang menderita severe dengue di RSUP Sanglah, Denpasar pada Januari 2016-Juni 2016. Penelitian ini adalah penelitian deskriptif cross-sectional retrospektif dilakukan di RSUP Sanglah, Denpasar. Data yang diperoleh berupa data sekunder rekam medis pasien pada Januari 2016 – Juni 2016. Analisis data penelitian menggunakan program SPSS. Hasil penelitian menunjukkan dari 125 pasien, didominasi usia 21-30 tahun (27,2%), jenis kelamin wanita (64%), pasien paling banyak dirawat di bulan april (33,6%), komorbid yang tinggi adalah obesitas (28,8%), koinfeksi yang tinggi adalah demam tifoid (12,8%), antigen NS1 dengue positif pada 11,2% dengan infeksi sekunder dialami oleh sebagian besar kasus (56%), manifestasi pendarahan tersering adalah pendarahan pervaginam (20,8%), kasus berat dengan gangguan hemokonsentrasi (52,8%) dan hipotensi (15,2%), pasien yang memerlukan perawatan ICU (10,4%), komplikasi pendarahan yang berat pada pasien (20%). Rata-rata pasien datang pada fase kritis (hari ke 4,58 ± 1,56), dengan trombosit terendah ((37,89 ± 28,16) x 103/mm3), dan mengalami gejala hemokonsentrasi ((46,64 ± 6,67)%), rerata lama rawat ((4,98 ± 2,63) hari), pasien dengan kehamilan (17,5%), dan kematian pasien (5,6%). Terdapat kasus severe dengue yang mendapatkan perawatan intensif dengan mortalitas selama perawatan yang rendah. Kata kunci: luaran pasien, pasien dewasa, severe dengue
Clinical Features of COVID-19 Patients at Udayana University Hospital During First Three Months of the COVID-19 Pandemic Cokorda Agung Wahyu Purnamasidhi; Ni Made Dewi Dian Sukmawati; Anak Agung Ayu Yuli Gayatri; I Made Susila Utama; I Ketut Agus Somia; Ketut Tuti Parwati Merati; Haruko Akatsu
Media Kesehatan Masyarakat Indonesia Vol. 18 No. 4: DECEMBER 2022
Publisher : Faculty of Public Health, Hasanuddin University, Makassar

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30597/mkmi.v18i4.20235

Abstract

COVID-19 exhibits a wide variety of symptoms, ranging from mild, moderate, severe, and critical respiratory dysfunctions up to death. Therefore, this study aimed to examine the demographic, clinical, and laboratory profile of COVID-19 patients admitted to Udayana University Hospital, Bali, during the first three months of the pandemic. Data were collected from the electronic medical records of 236 patients hospitalized from April to June 2020. The samples had a mean age of 40 years old, and they consisted of 58.50% male. Based on the records, the common clinical characteristics included fever (52.5%) and cough (47.5%), followed by less common traits, such as sore throat (18.2%), dyspnea (10.2%), flu (8.9%), and headache (3.8%). Laboratory results during admission showed an average lymphocyte count of 2.16 ± 2.19 × 109 cells/L and a neutrophil- lymphocyte ratio of 3.02 ± 3.41. The majority of patients were private corporation employees (30.51%), followed by migrant workers (21.19%). Furthermore, a fatality rate of 1.69% was recorded in the study hospital. These results were expected to provide epidemiological knowledge of COVID-19 patients, which can help clinicians to anticipate possible outcomes during treatment.
Relationship of Matrix Metalloproteinase-1 with Clinical and Radiological Features of Pulmonary Tuberculosis Co-infection of Human Immunodeficiency Virus Patients Prayudianto, Roykhan; Ayu Yuli Gayatri, Anak Agung
Jurnal KESANS : Kesehatan dan Sains Vol 3 No 8 (2024): KESANS: International Journal of Health and Science
Publisher : Rifa'Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.54543/kesans.v3i8.291

Abstract

Introduction: The co-infection of pulmonary Tuberculosis (TB) in Human Immunodeficiency Virus (HIV) patients continues to pose a global health challenge. Mycobacterium tuberculosis (Mtb) and HIV can synergize, thereby worsening the condition of patients. Matrix metalloproteinase (MMP) is known to play a role in the pathogenesis of HIV-TB. Clinical and radiological presentations of M. tuberculosis patients show destruction of the extracellular matrix of the lungs involving protease actions, particularly matrix metalloproteinases (MMPs), one of which is MMP-1, resulting in the degradation of the lung's structural fibrils. Objective: The aim of this study is to investigate the relationship between MMP-1 and the clinical and radiological manifestations in the co-infection of pulmonary TB in HIV patients. Method: The research sample comprised 34 individuals. The median age of the study subjects was 41.5 (21 – 67) years, with the majority being <50 years old (64.7%) and male (70.6%). Result and Discussion: The cut-off value for MMP-1 level was determined using ROC curve analysis, where a level of 2.125 pg/mL demonstrated good sensitivity and specificity in predicting clinical symptoms and radiological findings. Mann-Whitney test revealed a significant difference in MMP-1 neko77 between positive and negative groups for both clinical symptoms (p<0.05) and radiological findings (p<0.01). Fisher's Exact test supported the association between MMP-1 levels and clinical symptoms (PR=1.929; CI95%=0.864 – 4.306; p=0.012) as well as radiological findings (PR=5.571; CI95%=0.928 – 33.441; p<0.001). Multivariate analysis indicated that variables other than MMP-1 level did not influence clinical symptoms and radiological findings in this study. Conclusion: In conclusion, MMP-1 levels are associated with clinical symptoms and radiological features of pulmonary TB coinfection in HIV patients. The MMP-1 cutoff level of 2.125 pg/mL increases the risk of clinical symptoms and radiological findings in patients
Unmasking Advanced HIV Infection: A Case of Refractory Thrombocytopenia Misdiagnosed as Immune Thrombocytopenic Purpura Wiratama Hadi Tjuanda; Anak Agung Ayu Yuli Gayatri
Archives of The Medicine and Case Reports Vol. 6 No. 3 (2025): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v6i3.777

Abstract

Thrombocytopenia is a frequent hematological abnormality in individuals with human immunodeficiency virus (HIV) infection and can be the initial presenting sign. Its clinical picture can closely mimic primary Immune Thrombocytopenic Purpura (ITP), leading to diagnostic delays and inappropriate management. This report highlights a case where an HIV diagnosis was revealed during the workup for refractory thrombocytopenia. A 39-year-old female presented with fatigue and gingival bleeding. She had a previous diagnosis of ITP and had been treated intermittently, but the thrombocytopenia repeatedly recurred. Physical examination was notable for oral candidiasis. Laboratory investigations confirmed severe thrombocytopenia with a platelet count of 4,000/µL. Subsequent serological testing was reactive for HIV, with a CD4 count of 136 cells/µL. The patient was managed for severe thrombocytopenia and opportunistic infection, with a plan to initiate antiretroviral therapy. In conclusion, this case underscores the critical importance of including HIV infection in the differential diagnosis for patients presenting with new-onset or refractory thrombocytopenia. Clinical clues, such as opportunistic infections, should prompt immediate HIV screening to ensure timely diagnosis and initiation of definitive therapy, thereby preventing misdiagnosis and improving patient outcomes.
Cerebral Malaria from a Plasmodium falciparum and Plasmodium malariae Co-Infection: A Case Report on a Diagnostic Challenge Vera Akmilia; Anak Agung Ayu Yuli Gayatri; Anak Agung Wiradewi Lestari
Archives of The Medicine and Case Reports Vol. 6 No. 3 (2025): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v6i3.779

Abstract

Severe malaria, primarily caused by Plasmodium falciparum, is a life-threatening medical emergency. Its diagnosis can be significantly complicated by mixed-species infections, where the presence of a less virulent Plasmodium species may mask the true etiological agent of the severe disease, leading to potential delays in appropriate therapy. This report details a case of cerebral malaria where such a diagnostic challenge occurred. An 18-year-old male with a recent travel history to a malaria-endemic area in Indonesia presented with a one-day history of decreased consciousness (Glasgow Coma Scale score of 9) following a week-long febrile illness. The clinical presentation met the World Health Organization's criteria for severe malaria, specifically cerebral malaria. Initial microscopic examination of a peripheral blood smear exclusively identified Plasmodium malariae. However, a concurrently performed rapid diagnostic test (RDT) was positive for both the pan-malarial antigen and the P. falciparum-specific histidine-rich protein 2 (HRP-2) antigen. This critical discordance prompted treatment for severe falciparum malaria with intravenous artesunate and triggered an expert re-evaluation of the blood smears. Subsequent analysis confirmed a co-infection with both P. falciparum and P. malariae. The patient showed significant clinical improvement within three days of initiating appropriate therapy. In conclusion, this case underscores the peril of diagnostic anchoring in severe malaria. Clinical severity must supersede laboratory findings that are incongruent with the patient's condition. The presence of a Plasmodium species other than falciparum on an initial smear does not rule it out as the cause of a severe syndrome. Discordant results between microscopy and RDTs are a critical red flag for mixed infections and mandate immediate, expert parasitological re-evaluation to ensure timely, life-saving treatment.
Co-Authors Anak Agung Wiradewi Lestari Cokorda Agung Wahyu Purnamasidhi Hanina Mardhatillah Haruko Akatsu I Dewa Nyoman Wibawa I Ketut Agus Somia I Made Susila Utama I Putu Pande Agus Asmara Widhiana Saputra Ketut Tuti Parwati Merati Ni Made Dewi Dian Sukmawati Prayudianto, Roykhan Vera Akmilia Wiratama Hadi Tjuanda