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Satu tahun kesintasan penderita limfoma non-hodgkin berdasarkan klasifikasi histopatologi working formulation Ludirdja, Evan Pratama; Rena, Ni Made Renny Anggreni; Suega, Ketut; Bakta, Made
Jurnal Penyakit Dalam Udayana Vol 2 No 2 (2018): Vol 2 No 2 (2018) July-December 2018
Publisher : PAPDI BALI

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Abstract

Latar belakang: Limfoma Non-Hodgkin (LNH) memiliki manifestasi dan gambaran histologi yang heterogen. Berdasarkan klasifikasi Working Formulation, LNH dibagi menjadi 3, yaitu derajat keganasan rendah, menengah, dan tinggi, yang mencerminkan derajat agresifitas LNH berdasarkan gambaran histopatologiknya. Pada beberapa studi dikatakan LNH tipe indolen cenderung tumbuh lambat dan memiliki kesintasan lebih panjang dibanding tipe yang lebih agresif Tujuan: Membandingkan median kesintasan penderita LNH dari jenis sel B berdasarkan derajat keganasannya sesuai dengan klasifikasi Working Formulation Metode: Penelitian ini menggunakan desain kohort retrospektif, antara bulan Januari 2013 sampai Juli 2017 di RSUP Sanglah Denpasar. Analisis menggunakan Kaplan meier dan seluruh data dianalisis menggunakan SPSS. Hasil: Dari 88 penderita LNH, diambil 38 subyek yang eligible. Dari data didapatkan sebanyak 21 penderita (55,3%) berjenis kelamin laki-laki, dengan gambaran histopatologi terbanyak berupa Diffuse Large Cell (36,8%). Sebanyak 3 penderita (7,9%) termasuk dalam derajat keganasan rendah, 25 penderita (65,8%) termasuk dalam derajat keganasan menengah, dan 10 penderita (26,3%) dengan derajat keganasan tinggi. Median kesintasan pada LNH derajat keganasan rendah di atas 1 tahun (IK 95%), derajat keganasan menengah 271 hari (IK 95%), dan derajat keganasan tinggi 31 hari (0-72,837, IK 95%), dengan nilai p=0,133, namun kelompok dengan derajat keganasan tinggi cenderung memiliki kesintasan yang lebih rendah dibanding 2 kelompok yang lain. Simpulan: Tidak terdapat perbedaan yang signifikan kesintasan penderita LNH dengan derajat keganasan rendah, sedang, dan tinggi.
Kadar hemoglobin awal sebagai faktor prognostik penderita limfoma non-hodgkin (LNH) yang menjalani kemoterapi Winarto, Daniel; Rena, Ni Made Renny A; Adnyana, Wayan Losen; Dharmayuda, Tjokorda Gede; Suega, Ketut; Bakta, I Made
Jurnal Penyakit Dalam Udayana Vol 2 No 2 (2018): Vol 2 No 2 (2018) July-December 2018
Publisher : PAPDI BALI

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Latar belakang: Anemia sering ditemukan pada saat diagnosis awal LNH. Anemia dapat terjadi karena beberapa kondisi, seperti perdarahan terkait LNH dengan atau tanpa anemia defisiensi besi, anemia karena penyakit kronik, infiltrasi sel-sel LNH ke sumsum tulang, anemia hemolitik autoimun maupun anemia terkait kemoterapi. Anemia mempengaruhi perjalanan klinis dan kesintasan pasien-pasien LNH. Tujuan: Penelitian ini bertujuan untuk membuktikan bahwa kadar Hb awal merupakan faktor prognostik penderita LNH yang menjalani kemoterapi.  Metode: Penelitian ini merupakan penelitian kohort retrospektif mulai bulan Januari 2013 sampai bulan September 2017 pada penderita LNH yang menjalani kemoterapi di RSUP Sanglah Denpasar. Hubungan antara kadar Hb dengan skor R-IPI dianalisis menggunakan uji Mann Whitney. Analisis kesintasan menggunakan metode Kaplan Meier dan Cox Proportional Hazard Mode dengan menggunakan software SPSS. Hasil: Dari 88 penderita LNH, dieksklusi 31 penderita, sehingga total sampel sebanyak 57 orang. Dengan menggunakan analisis komparatif Mann Whitney didapatkan perbedaan signifikan pada skor R-IPI antara pasien LNH dengan Hb ≥ 10 g/dl (md=1, n=46) dan kadar Hb < 10 g/dl (md=3, n=11) (z= -2,106; p= 0,035; d= 0,28). Analisis dengan Kaplan Meier, didapatkan penderita dengan kadar Hb<10 gram/dL memiliki kesintasan lebih pendek dibanding penderita dengan kadar Hb≥10 gram/dL (± 255 vs ± 850 hari; p= 0,002; IK 95%) dan  dengan analisis Cox Regression didapatkan Hazard ratio sebesar 4.46 (p= 0,005). Simpulan: Kadar hemoglobin awal dapat digunakan sebagai faktor prognostik mortalitas penderita LNH yang menjalani kemoterapi.
POLYMORPHISM OF VASCULAR ENDOTHELIAL GROWTH FACTOR REGIO PROMOTER C(-634)G AS A RISK FACTOR OF BALINESE TYPE-2 DIABETIC RETINOPATHY Mas-Putrawati, A. A.; Bakta, M.; Suastika, K.; Muhiddin, H. S. Habiba; Niti Susila, N. K.
BALI MEDICAL JOURNAL Vol 4 No 2 (2015)
Publisher : BALI MEDICAL JOURNAL

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Background: Diabetic retinopathy (DR) is one of the complications on diabetic mellitus (DM) patient as a micro vascular retina disorder which caused by a long term of hyperglycemia. This is one of the blindness causes in the world. This research aims to find out Polymorphism of VEGFC(-634)G gene as a risk factor of DR on the Balinese with DM type-2 (DMT2). Method: This study is applying two designs, analytical cross sectional and case control. The case is DMT2 patient with DR(+), DMT2 without DR as control. The sequencing technique was performed to evaluate polymorphism and plasma VEGF levels were determined by ELISA. Results: Cross sectional study (hospital based) came out with quite high number of DR, 57 people of 97 study samples. This study shows the existence of genetic variation on Gen VEGF C(-634)G, with most often genotype of CG (51.5%). Polymorphism C(-634)G as the risk factor of DR (OR=1.815 CI-95%= 1.077-3.057, p=0.025), and high level of VEGF were also significant (QR=3.75 , CI-95% 1.34-10.20, p=0.008). VEGF level with genotype of CG, CC and GG, not found any difference (p=0.245). Logistic regression shows that the most influential variable as the risk factor of DR is VEGF level (p= 0.007), polymorphism gen VEGF C(-634)G (p=0.022) and systolic blood pressure (p=0.023). Conclusions: Polymorphism of VEGF C(-634)G gene and high level of VEGF as the risk factor of DR, and can be used as a reference in handling early stage of DR patient to prevent blindness.
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)
Publisher : BALI MEDICAL JOURNAL

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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
MIELOMA MULTIPEL TIPE IgA: LAPORAN LIMA KASUS Bakta, I Made
journal of internal medicine Vol. 10, No. 2 Mei 2009
Publisher : journal of internal medicine

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Five cases of IgA MM (IgA multiple myeloma) have been reported. All cases showed clinical features of MM ingeneral. Increase of immunogloblulin fraction, characteristically showed M-spike in beta region, associated with high level ofIgA in serum. Plasma cell > 10% in marrow were found, with end-organ lesions, known as CRAB (hypercalcemia, renal failure,anemia and bone lesions). Anemia and bone lesions have been found in all cases. All cases fulfiled diagnostic criteria of Kyle andGreip and International Multiple Myeloma Working Group, as well. Stage III of Durie and Salmon staging system was found inall cases. Only one case could be classified in a newer staging system, International Staging System. Case no. 5 could be classifiedas stage II. Conventional regiment with melphalan and prednison has been given to the cases. Partial remission has been achievedin case no.1, no. 4, and no. 5.It could be concluded that the clinical features of IgA MM are the same as IgG MM. In laboratory findings, M-spike wasfound in beta-region in serum protein electrophoresis (SPE) of all IgA MM cases, other than in gamma-region as in IgG MM. Thelevel of IgA in serum was also higher than IgG.
HUBUNGAN KADAR INTERLEUKIN 6 DENGAN KADAR BESI SERUM PENDERITA ANEMIA PADA PENYAKIT KRONIK Wibawa, I Putu Budi; Bakta, I Made
journal of internal medicine Vol. 9, No. 1 Januari 2008
Publisher : journal of internal medicine

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Anaemia of chronic disease is the second most prevalence after iron deficiency anaemia. It is a commonproblem faced because it decreasing the life quality. The pathofisiology of anaemia of chronic disease is same inmalignancy, chronic infection and chronic inflammation. There is immune driven pathway. Releasedproinflammation cytokine cause hypoferemia and hyperferitinaemia which the result is anaemia. The Objectiveis to determine the correlation of IL-6 with serum iron and haemoglobin in anaemia of chronic disease patien atSanglah General Hospital, Denpasar – Bali. The Cross sectional analytic study performed to search thecorrelation of IL-6 with serum iron and haemoglobin. Descriptive statistical test performed to descript thesample characteristic and the distribution frequency of many variable. Spearman correlation used with p < 0.05is significant. From 25 samples, there are 12 man (48%) and 13 woman (52%). The mean of samples age is49.20 ± 17.95 years old. The most prevalence diagnosis is lung TB, 8 samples (32%). The mean of IL-6 is 39.32± 48.66 pg/mL. The mean of serum iron is 42.48 ± 22.09 ug/mL. The mean of hemoglobin is 10.49 ± 1.47 g/dL.The mean of feritin is 607.62 ± 841,01 ng/mL. The mean of monocyte count is 0,91 ± 0,95 cell/mm3. Thecorrelation of IL-6 with serum iron is not significant (r -0.05, p 0325). The correlation of IL-6 withhaemoglobin is not significant too (r -0.027, p=0.898). There are possibility cause, first, the gradation ofmalignancy, chronic infection, chronic inflammation is not performed. Second, other inflammation cytokine isnot checked. Comorbid disease also may take a place. We conclude the correlation of IL-6 with serum iron andhaemoglobin is not significant.
PERBANDINGAN BEBERAPA METODE DIAGNOSIS ANEMIA DEFISIENSI BESI: usaha mencari cara diagnosis yang tepat untuk penggunaan klinik Suega, Ketu; Bakta, I Made; Adnyan, Losen; Darmayuda, Tjok
journal of internal medicine Vol. 8, No. 1 Januari 2007
Publisher : journal of internal medicine

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Iron deficiency anemia (IDA) is the most widespread public health problems. In 1989 WHO report more than one third ofworlds population suffered from anemia and half of them with iron deficiency anemia. Iron deficiency anemia can cause reducedwork capacity in adults and impact motor and metal devolepment in children and adolescents. It also can increase risk of infection,mother mortality rate, affects cognition in adulescents girls and causes fatique in adult women. IDA may affect visual andauditory functioning and is weakly associated with poor cognitive development in children. The diagnosis of IDA requires properclinical manifestation, laboratory evidence and also others diagnostic test that support iron deficiency. There are some diagnostictests frequently use in clinical practice to diagnose IDA, such as the morphology of erytrosite, examination of serum iron andtotal iron binding capacity, examination of feritin serum, and bone marrow staining. Knowing the best of diagnostic methods canuse in clinical practice and also knowing the profile of IDA, can leads into better management of IDA in population. A diagnostictest was done in order to know the sensitivity and spesifity of erytrosite index, serum iron, TIBC, and feritin serum in dignosticIDA. The study was done at Internal Departement, Sanglah Hospital for 6 months, start from March 2003 until October 2003.The result is Feritin has the best sensitivity (90.6%) and specificity (90.6%) , with cut off point 35.4 µg/l. MCH as erytrosite indexhas sensitivity (84.4%) and specificity (75%) to diagnose IDA, the cut off point is 21.8 pg . Sensitivity and specificity of TIBC is81.3% and 83.8% with cutt off point 282 µg/l. Sensitivity and specificity saturation of transferin is 84.4% and 79.7% with cuttoff point 6%. Serum iron has sensitivity 75.0% and specificity 68.7% with cut off point 17 µg/l.
HUBUNGAN FERITIN SERUM DENGAN KADAR IL-2 PADA PENDERITA ANEMIA DEFISIENSI BESI Losen Adnyan, I Wayan; Bakta, I Made; Suega, Ketut; Darmayuda, Tjok Gde
journal of internal medicine Vol. 8, No. 1 Januari 2007
Publisher : journal of internal medicine

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Iron deficiency anemia is one of the most common single nutrient deficiency in the world, impairs lymphocyte proliferationin humans and laboratory animals. The mechanisms are not fully understood. Cellular iron availability modulates the differentiationand proliferation of Th-1 and Th-2 subsets. Th-1 clones are very sensitive to treatment with antitransferrin receptor antibodies,resulting in inhibition of their DNA synthesis. Th-1-mediated immune effector function may be much more sensitive to changesin iron homeostasis in vivo. Th-1 produce IFN- and IL-2. The effects of iron deficiency on immunity remain controversial. Crosssectional study was performed to determine the relationship between iron status (serum ferritin) and IL-2 production in patientswith iron deficiency anemia. This relationship was assessed in 33 adult patients. Infection, malnutrition, malignancy, acute bleedingand using immunosuppressive medicines were excluded. Iron deficiency anemia was defined by Kerlin et al criteria. Serumferritin was measured by immunometric assay and IL-2 was measured by immunoassay solid phase ELISA. The mean of Hb was6.27 ± 2.19 g/dL, serum ferritin 30.07 ± 49.41, IL-2 2.26 ± 1.30. The most causes of this anemia were chronic bleeding i.e. pepticulcer, ancylostomiasis, menorrhagia, hemorrhoid and hematuria. There was not correlation between serum ferritin and IL-2 (r =0.118; p = 0.512). There was not correlation between Hb and IL-2 too (r = 0.220; p = 0.219). Lack of the correlation may be causedby some conditions i.e. without activated T cell, inadequately controlled the other trace elements or co-morbid diseases. Our datasupport that there is not correlation between serum ferritin, Hb and IL-2 production by lymphocyte without stimulation. Furtherprospective studies are needed to determine relationship between iron status and immune function.
THROMBOSIS DAN USIA LANJUT Bakta, I Made
journal of internal medicine Vol. 8, No. 2 Mei 2007
Publisher : journal of internal medicine

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Thrombosis, venous as well as arterial thrombosis, is the basic pathogenetic mechanism which leads to high morbidityand mortality diseases. The Virchow triad is the basic mehanism of pathogenesis of thrombosis, ie abnormality of vessel wall,disturbances of blood flow, and abnormality of blood coagulation (hypercoagubility state). The risk factors for thrombosis couldbe classified into 3 main categories: situational risk factors, hereditary thrombophilia, and acquired thrombophilia.The incidence of thrombosis is higher in old people, old age is categorised as one of the risk factors of thrombosis. Themechanism of old age in promoting thrombosis is not well understood. It is assumed that in old age there is imbalance betweenprotrombotic and antithrombotic factors, the increase of protrombotic factors are higher than antithrombotic factors.The increaseof coagulation factors (fibrinogen, prothrombin, factor VII, factor VIII, von Willebrand factor, and plasminogen activator inhibitor)were increased in old age population. Recently, the genetic mechanism of age regulation synthesis of factor IX and protein C wasfound.Atherothrombosis is a new concept, in which thrombus deposition occured on an atheromataous plaque. Atherothrombosisgives principal clinical manifestations as coronary artery disease, acute myaocardial infarction and unstable angina, ischaemicstroke, and peripheral arterial disease. Venous thrombosis, especially on deep vein, gives clinical manifestation as deep veinthrombosis (DVT), which is frequently followed by pulmonary emboli (PE). The combination of DVT and PE is known as venousthromboembolism (VTE).The concept of thrombosis management should be based on its pathogenesis. In arterial thrombosis, the main therapy isadministration of antiplatelet drug and anticoagulant to prevent the deposition of thrombus, while thrombolytic or fibrinolyticdrugs are given to dissolve the preformed thrombi. In venous thrombosis antiplatelet drug is not effective.Basically, the treatment of thrombosis in old age is not different from the treatment of thrombosis in general. But in oldpeople the comorbids are more frequent, drug interaction should be taken into special consideration.
POLA KEPEKAAN BAKTERI PADA PASIEN KEGANASAN HEMATOLOGI DI RSUP SANGLAH DENPASAR Rena, Renny A; Suega, Ketut; Bakta, I Made
journal of internal medicine Vol. 11, No. 2 Mei 2010
Publisher : journal of internal medicine

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Hematology malignancies patient are particulary susceptible to infection associated with endogen microorganism whichorigin from body or nosocomial from hospital. The most common etiology of infection is gram-positive oral and gastrointestinaltract. A worsening infection can lead patient to severe septic condition and death. In the last decade, many studies found thatspecies of fungi and virus also has an important etiology of infection in hematology malignancies patient.Empirical antibiotic therapy on the ! rst onset of infection of hematology malignancy are very recomended. It has beenproven to decrease morbidity and mortality rate. Empirical antibiotic therapy suitable with the pattern of the microbial in hospitalis an important way to overcome the infection on hematology malignancies patient.A total of 36 patient with hematology malignancy who done the blood culture in Sanglah hospital were consecutivelyrecruited and studied in order to study the pro! le of blood culture in hematology malignancy patient. Within six months 36patients were included, consist of 26 male (72.2%) and 10 female (27.8%). Characteristic of patient are mean of age 42.78 ± 14.25years. Mean of leukosit 45.76 ± 69.32 x 103/ul, mean of neutrophil dan lymphosit consecutively 27.17 ± 55.80 x 103/ul and 10.29± 19.81 x 103/ul. The mean of hemoglobin 8.48 ± 3.26 g/dl, and mean of trombosit 181.21 ± 230.63 x 103/ul. The most commondiagnosis found is Acute Myeloblastic Leukemia (AML) 33.3% and Non Hodgkin Lymphoma 22.2%. The result of blood culturemostly no growth (56.3%). The most microbial isolated from the culture is Coagulase Negative Staphilococcus / CONS (11.1%).Antibiotic susceptibility testing for Coagulase Negative Staphilococcus / CONS shows linezolid and chloramphenicol are themost sensitive.
Co-Authors - Murtiananingsih, - - Saimi, - A. A. Mas-Putrawati AAG Sudewa D. Adi Purwa Hita, I Putu Gede Alma Lystia Savitri Mahayasa Ambrosius Purba Anisa Hanum Anwar Santosa Ariati, N.N. Arundina Sanyoto Astawa N. M., Astawa N. Astawa P., Astawa Brad Otto Budha K. Claire Ryan Daniel Womsiwor Dewa Nyoman Wirawan Dewa Nyoman Wirawan, Dewa Nyoman Dharmayuda, Tjokorda Gede Dhiancinantyan Windydaca Brata Putri Djoko Roeshadi Duarsa, Dyah Paramita Dwidjayanti, Ni Kadek Candra Dyah Kanya Wati Dyah Pradnya P.D., Dyah Pradnya Dyah Pradnya Paramitha Duarsa Dyah Pradnya Paramitha Duarsa, Dyah Pradnya Paramitha Dyah Pradnyaparamita D, Dyah Pradnyaparamita Ekaputra Ekaputra, Ekaputra Gusti Putu Surya H. S. Habiba Muhiddin, H. S. Habiba Hari Bagianto I Dewa Made Sukrama I Dewa Nyoman Wirawan I Dewa Putu Sutjana I Ketut Agus Somia I Ketut Suastika I Ketut Suyasa I Made Ady Wirawan I Made Damriyasa I Made Duwi Sumohadi I Made Jawi I Made Jawi I Made Sudarmaja I Made Susila Utama I N Agus Bagiada I NYOMAN ADI SURATMA I Nyoman Arhya I Nyoman Budi Hartawan I Nyoman Mangku Karmaya I NYOMAN MANTIK ASTAWA I Nyoman Sutarsa I Putu Budi Wibawa I Putu Gede Adiatmika I Putu Suiraoka I Putu Wantera I Wayan Losen Adnyan I Wayan Losen Adnyana I Wayan Putu Sutirta Yasa I Wayan Suranadi I Wayan Wita Ida Bagus Gede Suparyatha Ida Bagus Komang Ardana Ida Bagus Putra Manuaba Ida Bagus Subanada IN Agus Bagiada IN Bagiada INT Suryadhi INT Suryadhi J. A. Pangkahila Karjono M, Karjono Ketut Siki Kawiyana Ketut Suata Ketut Suega Ketut Suega Ketut Suryana Ketut Tuti Parwati Merati Kusuma, Anak Agung Ngurah Jaya Lesmana, Cokorda Agung Bagus Jaya Levi Anatolia Losen Adnyan Ludirdja, Evan Pratama LUH MERTASARI . Luh Seri Ani Made Jawi Made Krisna Adi Jaya Made Wiryana Manuaba, I.B.P Mirandinha Fortuna Sarmento Madeira, Angie N Adiputra N. Adiputra N. K. Niti Susila, N. K. Ni Made Andrinia Ratih Sri Indarswari Ni Nyoman Yunita Kusuma Bakta Ni Putu Aryati Suryaningsih Nita Fitria P. Astawa Purnamawati, Susy R. A.T. Kuswardhani Rena, Ni Made Renny A Rena, Ni Made Renny Anggreni Renny A Rena Rudi Wisaksana Santosa, I Gusti Ngurah Putra Eka Satoto D., Satoto Sawitri, Anak Agung Sagung Shannon Turnbul Sri Maliawan Sumohadi, I Made Duwi Suryadi N. T., Suryadi N. Sutajaya, I.M. Sutema, Ida Ayu Manik Partha Tirtayasa, K. Tjok Darmayuda Tjok Gde Darmayuda Tjokorda Gde Agung Senapathi Tjokorda Gde Bagus Mahadewa Tjokorda Gde Dharmayuda Tjokorda Gde Dharmayuda Tuti Parwati Merati W. A., W. Winarto, Daniel Wiryana M., Wiryana Wulansari Manuaba, Ida Ayu Ratih Xavier Leverve Yenny Kandarini