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All Journal Medicina E-Jurnal Medika Udayana Sari Pediatri Paediatrica Indonesiana Molecular and Cellular Biomedical Sciences (MCBS) Indonesian Journal of Cardiology Indonesian Journal of Global Health research Pediatric Sciences Journal Jurnal Indonesia Sosial Sains Seroja Husada: Jurnal Kesehatan Masyarakat

Eka Gunawijaya

Departemen/KSM Ilmu Kesehatan Anak, Fakultas Kedokteran Universitas Udayana/RSUP Sanglah, Denpasar

Author-ID : 271071

Humanities Astronomy Biochemistry, Genetics & Molecular Biology Chemistry Computer Science & IT Decision Sciences, Operations Research & Management Dentistry Earth & Planetary Sciences Economics, Econometrics & Finance Education Energy Environmental Science Health Professions Immunology & microbiology Languange, Linguistic, Communication & Media Law, Crime, Criminology & Criminal Justice Library & Information Science Materials Science & Nanotechnology Medicine & Pharmacology Neuroscience Nursing Physics Public Health Social Sciences Veterinary

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Korelasi antara Kadar Seng Serum dengan Kadar Interleukin-6 dan Skor PELOD-2 pada Sepsis Defranky Theodorus; Dyah Kanya Wati; I Gusti Ngurah Sanjaya Putra; Ida Bagus Subanada; Eka Gunawijaya; Komang Ayu Witarini; Wayan Gustawan
Sari Pediatri Vol 23, No 4 (2021)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp23.4.2021.262-9

Latar belakang. Sepsis merupakan penyebab utama morbiditas dan mortalitas pada anak dengan penyakit kritis yang dirawat di unit perawatan intensif anak (UPIA). Pada 24 jam sepsis, terjadi penurunan kadar seng serum dan secara bersamaan terjadi peningkatan kadar interleukin-6 (IL-6) dan skor PELOD-2. Hasil sebaliknya terjadi pada 72 jam sepsis.Tujuan. Untuk membuktikan korelasi negatif antara kadar seng serum dengan IL-6 dan skor PELOD-2 pada sepsis.Metode. Penelitian dengan rancangan potong lintang dua kali pengukuran dari Januari - Desember 2019 di UPIA RSUP Sanglah Denpasar. Subjek penelitian adalah anak berusia 29 hari sampai 18 tahun dengan sepsis berdasarkan skor PELOD-2 > 7 menggunakan metode consecutive sampling. Uji korelasi Pearson untuk menilai korelasi bivariat dan uji multivariat menggunakan uji korelasi parsial.Hasil. Empatpuluh subjek memenuhi kriteria inklusi. Rerata kadar seng serum pada 24 dan 72 jam adalah 59,5 Âµg/dl versus 64,2 Âµg/dl. Median IL-6 pada 24 dan 72 jam adalah 8,6 pg/dL versus 4,4 pg/dL, rerata skor PELOD-2 24 dan 72 jam adalah 11,2 versus 11,0. Korelasi Pearson kadar seng serum dengan kadar IL-6 pada 24 dan 72 jam adalah r= -0,078, p= 0,632 versus r= -0,218, p= 0,178. Korelasi Pearson kadar seng serum dengan skor PELOD-2 pada 24 dan 72 jam adalah r= -0,513, p= 0,001 versus r= 0,242, p= 0,132. Analisis korelasi parsial kadar seng serum dengan PELOD-2 pada 24 jam adalah r= -0,493, p= 0,002.Kesimpulan. Terdapat korelasi negatif sedang bermakna pada 24 jam sepsis antara kadar seng serum dengan skor PELOD-2 setelah mengontrol variabel kendali.

Low serum zinc and short stature in children Kadek Wini Mardewi; I Gusti Lanang Sidiartha; Eka Gunawijaya
Paediatrica Indonesiana Vol 56 No 3 (2016): May 2016
Publisher : Indonesian Pediatric Society

Background Short stature/stunting is common in developing countries, and has been used as an indicator of a nationâ€™s general health condition. Short stature increases the risk of metabolic disease, disturbances in cognitive development, infection prevalence, physical as well as functional deficits, and even death. Nutritional factors that frequently cause stunting are low intake of energy, protein, or micronutrients such as iron, vitamin A, and zinc. The role of zinc supplementation in children with short stature has not been well defined. In addition, zinc supplementation should be evaluated in the setting of specific conditions and regions.Objective To assess the association between low serum zinc level and short stature in children.Methods This cross-sectional study was done in a primary health care center at Klungkung I, Klungkung District, from August to September 2013. Children with short and normal stature (as reference group) were enrolled and their serum zinc level was measured, Other risk factors were inquired by questionnaire. Association between low serum zinc level (<65 Âµg/dL) and short stature was analyzed by stepwise multivariable regression analysis; degree of association was presented as odds ratio (OR) and its corresponding confidence interval.Results The prevalence of low serum zinc level in our subjects was 71%. Low serum zinc level was significantly associated with short stature [adjusted OR 16.1; 95%CI 3.1 to 84.0; (P=0.001)]. In addition, the occurrence of low serum zinc was higher in the short stature group (88.5%) compared to the normal stature group (53.8%). We also found that low calorie intake was associated with short stature [adjusted OR 29.4; 95%CI 2.76 to 314.7; (P=0.001)].Conclusion Low serum zinc level appears to be associated with short stature. [Paediatr Indones. 2016;56:171-5.].

Clinical predictors of hypoxemia in pneumonia Eka Gunawijaya; I M Widia
Paediatrica Indonesiana Vol 43 No 5 (2003): September 2003
Publisher : Indonesian Pediatric Society

Background Pneumonia is one of the main causes of death ininfants in developing countries. The device of oxygen saturationmeasurement for detecting hypoxemia is limited in district hospi-tals.Objective The aim of our study was to find the best clinical pre-dictor for hypoxemia that could be used in Indonesia.Methods Between June 2001 until May 2002, the diagnostic testwas performed in 125 infants aged 2â€“12 month-old who sufferedfrom pneumonia. The oxygen saturation measured by pulse oxim-etry was used as the gold standard.Results The samples were divided into two groups, 52 infants withhypoxemia and 73 normal. The base characteristics of both groupswere not statistically different. The prevalence of hypoxemia was41.6%. The best single clinical predictor of hypoxemia was cyano-sis (the sensitivity 92%, specificity 86%, likelihood ratio 6.74, post-test probability 83%), as well as the combination of two clinicalpredictors i.e., cyanosis and nasal flaring. The best combination ofthree clinical predictors was cyanosis, nasal flaring, and refusal todrink (the sensitivity 92%, specificity 86%, likelihood ratio 6.74,post-test probability 81%).Conclusion The combination of cyanosis and nasal flaring isgood enough as a predictor to detect hypoxemia in area with nofacility of oxygen saturation measurement

Highly active antiretroviral therapy and left ventricular diastolic function in children with human immunodeficiency virus infection Ni Made Ayu Agustini; Eka Gunawijaya; Ni Putu Venny Kartika Yantie; Ketut Dewi Kumara Wati; Komang Ayu Witarini; Hendra Santoso
Paediatrica Indonesiana Vol 59 No 3 (2019): May 2019
Publisher : Indonesian Pediatric Society

Background In the past, cardiovascular involvement did not seem to be a common complication of HIV, but in recent years it has been described more frequently. With the advent of highly active antiretroviral therapy (HAART), the symptoms of cardiac disease has changed, as the number of HIV-infected patients with abnormal diastolic parameters has increased significantly, often presenting as symptomatic rather than asymptomatic. Objective To analyze for a possible correlation between HAART duration and left ventricular diastolic function in HIV-infected children. Methods This cross-sectional study was conducted from December 2016 to December 2017 at the Cardiology and Allergy-Immunology Division/Department of Child Health, Universitas Udayana Medical School/Sanglah Hospital, Denpasar, Bali. Subjects with HAART were collected using a consecutive sampling method. The following data were recorded for each subject: age, sex, current stage of HIV, CD4+ level, as well as HAART regimen and duration of use. Transthoracic echocardiography was performed for tissue doppler imaging (TDI) of diastolic function. Spearmanâ€™s test was used to analyze the strength of correlation based on normality test results. Results This study involved 53 subjects, 21 of whom had impaired diastolic function. There was no correlation between HAART duration and diastolic function in children with HIV infection (r= -0.03; P=0.82). Conclusion Diastolic dysfunction is found in children under HAART treatment, but there is no correlation between HAART treatment duration and diastolic dysfunction.

Triiodothyronin (T3) as a parameter of mortality in sepsis patients in the PICU Sri Wahyuni Djoko; Nyoman Budi Hartawan; Bagus Ngurah Putu Arhana; Eka Gunawijaya; Anak Agung Ngurah Ketut Putra Widnyana; Dyah Kanya Wati
Paediatrica Indonesiana Vol 59 No 6 (2019): November 2019
Publisher : Indonesian Pediatric Society

Background Thyroid hormone stimulates the regulation of Î²-adrenergic receptors in order to increase the inotropic effect of the heart myocardium. Euthyroid sick syndrome is a disorder of non-metabolic thyroid function, which is characterized by a decrease in triiodothyronine (T3) levels in patients with non-thyroid systemic disease, such as sepsis. Low serum T3 hormone level is a potentially high-risk factor for mortality from sepsis. Objective To assess for a relationship between decreased serum T3 levels and mortality in pediatric sepsis patients admitted in the PICU. Methods This study used a nested case-control design. The subjects were children aged 1 month-18 years who were diagnosed with sepsis in the pediatric intensive care unit at Sanglah Hospital, Denpasar, Bali, from September 2017 to January 2019. Results A total of 90 children were included, of whom 44 died and 46 survived. Median age was 10.5 (IQR 44) months in subjects who died and 9 (IQR 50) months in those who survived. The majority of subjects in both groups had well-nourished nutritional status. Bivariate analysis revealed that significantly more subjects who died had low serum T3 (â‰¤1 ng/dL), PELOD-2 score â‰¥5, than subjects who survived. Multivariate analysis revealed that serum T3 Â£1 ng/dL (OR 55.1; 95%CI 9 to 334.8; P<0.001) and PELOD-2 score Â³5 (OR 6.5; 95%CI 1.6 to 26.7; P=0.01) were significant risk factors for sepsis mortality. Conclusion Low serum T3 level and high PELOD-2 score are risk factors for death in sepsis.

Electrocardiogram abnormalities in obese adolescents Elizabeth Joan Salim; Eka Gunawijaya; Ni Putu Veny Kartika Yantie
Paediatrica Indonesiana Vol 60 No 1 (2020): January 2020
Publisher : Indonesian Pediatric Society

Background Obesity in adolescents is a known risk factor for cardiovascular disease mortality and sudden cardiac death. Obesity is associated with a wide variety of electrocardiogram (ECG) abnormalities. Objective To assess prevalence and describe the ECG abnormalities in obese adolescents. Methods This cross-sectional study was conducted at Children’s Cardiology Clinic – Integrated Heart Center of Sanglah General Hospital, Denpasar, Bali, by recording ECGs of obese adolescents aged 11-15 years from several junior high schools from December 2016 to April 2017. The inclusion criteria were obese adolescents aged 11 to 15 years, who were willing to participate in the study and provided informed consent. Results A total of 78 ECGs of obese adolescents (60% male) were selected. Subjects’ mean weight and age were 82.6 (SD 15.2) kg and 13.2 (SD 1) years, respectively. Pre-hypertension was found in 25 (32%) subjects, while hypertension was found in 18 (23%) subjects. There were 29 (37%) subjects with abnormal ECGs. Sinus tachycardia was present in 13 (17%) subjects, and sinus arrhythmia was identified in 11 (14%) subjects. Eight (10%) patients experienced prolongation of QTc interval and 5 (6%) patients presented with prolongation of PR interval. There were no shifts of the P wave, QRS wave and T wave axes, changes of P wave morphology, low QRS voltage, T wave flattening, ventricular enlargement, or ST segment changes found in this study. Conclusion The prevalence of cardiac abnormalities based on ECG examination in obese adolescents is 37%, consisting of heart rhythm abnormalities, prolonged PR interval, and prolonged QTc interval.

Cost analysis of congenital heart disease patients who underwent diagnostic catheterization Ni Putu Wirantari; Eka Gunawijaya; Ni Putu Veny Kartika Yantie
Paediatrica Indonesiana Vol 60 No 5 (2020): September 2020
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi60.5.2020.244-52

Background Cardiac catheterization has developed into an important technique for diagnosis and management of congenital heart disease (CHD) patients. Catheterization is expensive and almost all patients who undergo the procedure at Sanglah General Hospital are participants of the Social Insurance Administration Organization (Badan Penyelenggara Jaminan Sosial/BPJS) that uses the Indonesian Case-Based Groups (INA-CBGs) payment system. Objective To determine the characteristics and analyze costs of CHD patients who underwent diagnostic catheterization. Methods This retrospective study used patient medical record data from March 2009 - July 2018 in Sanglah Hospital, Bali. Data collected included CHD type, age, sex, weight, height, nutritional status, length of procedure, complications, hospital rates, and INA-CBG rates. Data analysis was done with SPSS software. Results Of 219 CHD patients who underwent non-intervention catheterization, most had cyanotic CHD. Catheterization intervention in 2018 showed a discrepancy between the INA-CBG rate and hospital rate. The biggest difference was 107%, in patients who underwent mild heart intervention with class 3 of treatment. Conclusion Most subjects are diagnosed with cyanotic CHD especially tetralogy of Fallot and most has already received intervention. There are negative differences between the INA-CBG rates and the hospital real rates for catheterization.

Plasma NT-proBNP and pulmonary to systemic blood flow ratio in congenital heart defects with left-to-right shunts Eko Kristanto Kunta Adjie; Ni Putu Veny Kartika Yantie; Made Gede Dwi Lingga Utama; Eka Gunawijaya; Ketut Ariawati; Ida Bagus Subanada; Anak Agung Ngurah Ketut Putra Widnyana
Paediatrica Indonesiana Vol 60 No 6 (2020): November 2020
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi60.6.2020.310-5

Background Cardiac left-to-right shunts changes to the pulmonary-to-systemic blood flow ratio (Qp/Qs ratio). This ratio can be used to monitor the hemodynamics of the heart. Left-to right-shunts cause the release of amino terminal proB-ty natriuretic peptide (NT-proBNP) that can be utilized as a specific marker for the presence of heart failure in children with congenital heart defects (CHDs). Early intervention such as defect closure in CHD is important to prevent heart failure. Objective To assess for a correlation between the level of NT pro-BNP and Qp/Qs ratio in CHD patients with left-to-right shunts. Methods This cross-sectional, analytical study was conducted in 32 children who underwent cardiac catheterization at Sanglah General Hospital, Denpasar, Bali, and were recruited by consecutive sampling. NT-proBNP levels were measured by ELISA with a two-step sandwich assay system; Qp/Qs ratio using Fick rules. Statistical analyses included Shapiro-Wilk test, descriptive analysis for subject characteristics, and Pearsonâ€™s correlation analysis. A P value of <0.05 was considered to be statistically significant. Age and defect size were analyzed as confounding factors by partial correlation test. Results The correlation value between NT-proBNP and Qp/Qs ratio was r=0.384 (P<0.05), after controlling for age and defect size as cofounding factors. Conclusion There is a weak positive correlation between NT-proBNP levels and pulmonary-to-systemic blood flow ratio in patients with left-to-right shunt, after controlling for age and defect size as confounding factors.

Implementation of Dengue Recurrent Shock Prediction Score in pediatric dengue shock syndrome Armand Setiady Liwan; I Wayan Gustawan; Eka Gunawijaya; Soetjiningsih Soetjiningsih; Ketut Ariawati; I Nyoman Budi Hartawan
Paediatrica Indonesiana Vol 60 No 4 (2020): July 2020
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi60.4.2020.178-85

Background Global morbidities due to dengue viral infection increase yearly. The pediatric mortality rate from dengue shock syndrome (DSS) remains high. Early identification of the risk of recurrent shock may serve to increase awareness and reduce mortality. The Dengue Recurrent Shock Prediction Score (DRSPS) is a tool to predict recurrent shock in children with DSS, but the optimal cut-off point in our population is still unknown. Objective To assess the validity of the DRSPS by determining the optimal cut-off point that can be used in Indonesia Methods This cross-sectional prospective study was done at Sanglah Hospital, Denpasar, Bali, from January 2019. Risk of reccurent shock were classify based on DRSPS in all DSS patient, and they were observed whether they will experienced recurrent shock or not. Results Of 56 children with DSS, 27 subjects had recurrent shock and 29 subjects did not. The optimal DRSPS cut-off point was -189.9 for predicting recurrent shock, with 87.4% area under the curve (AUC), 81.5% sensitivity and 82.8% specificity. Conclusion The optimal cut-off point of DRSPS was -189.9 and it has good validity. The results of this study are expected not only to be used as the basis for further study, but to increase physician awareness in treating DSS patients.

Factors contributing to successful patent ductus arteriosus closure with first pharmacological course I Gusti Ayu Made Dwisri Okadharma; Ni Putu Veny Kartika Yantie; Eka Gunawijaya
Paediatrica Indonesiana Vol 62 No 2 (2022): March 2022
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi62.2.2022.86-90

Background Successful closure of patent ductus arteriosus (PDA) with ibuprofen or paracetamol as the first-line treatment has been reported, but little is known about factors affecting the closure rate. Objective To identify the closure success rate and contributing factors affecting a first course of pharmacological treatment in neonates with PDA. Methods A retrospective study was conducted in infants with isolated PDA treated with either ibuprofen or paracetamol and admitted to our neonatal care unit from January 2017 until June 2020. Included infants had PDA on echocardiography and received ibuprofen or paracetamol therapy as the closure treatment. Oral ibuprofen was given at 10 mg/kg on first day, then 5 mg/kg on the 2nd and 3rd days; while paracetamol was given intravenously 15 mg/kg every 6 hours for 3 days. Echocardiographic evaluation was performed 3 days after first course of treatment. Results In total, 20 of 33 (60.6%) infants achieved PDA closure with the first course of treatment. Earlier age at the start of the first course of treatment (PR 7.7; 95%CI 1.2 to 47.7; P=0.035) and normal birth weight (PR 13.3; 95%CI 2.4 to 72.4; P=0.001) were significant factors contributing to PDA closure. However, PDA size did not affect closure rate (PR 2.0; 95%CI 0.4 to 8.5; P=0.46). Conclusion Pharmacological treatment seems to have a good success rate for PDA closure, with significant positive associations with earlier age at start of treatment and normal birth weight.

Co-Authors AA Sg Mas Meiswaryasti Putra, AA Sg Mas Meiswaryasti Abdul H. S. Adi Purnami, Adi Alvin Alvelino Putra Sutrisna Anak Agung Ayu Dwi Adelia Yasmin Anak Agung Ngurah Ketut Putra Widnyana Anggreini, Faradilla Novita Armand Setiady Liwan Ayu Setyorini Mestika Mayangsari Bagus Ari Pradnyana Bagus Ngurah Putu Arhana Defranky Theodorus Dewangga, Made Satria Yudha Dewi Sutriani Mahalini Dewi, Luh G.A.P. Djoko, Sri Wahyuni Dyah Kanya Wati Eko Kristanto Kunta Adjie Elizabeth Joan Salim Hendra Santoso I Gusti Agung Trisna Windiani I Gusti Ayu Made Dwisri Okadharma I Gusti Lanang Sidiartha I Gusti Ngurah Sanjaya Putra I M Widia I Nyoman Budi Hartawan I Wayan Gustawan Ida Bagus Subanada Kadek Wini Mardewi Ketut Ariawati Ketut Dewi Kumara Wati Ketut Putu Yasa Komang Ayu Witarini Laurentia Utari Wibisono, Laurentia Utari Liwan, Armand Setiady Made Dwi Purnami, Made Dwi Made Gede Dwi Lingga Utama Maharini, Kadek Ni Made Ayu Agustini Ni Nyoman Margiani Ni Nyoman Utami Wijayaswari Pande, Ni Nyoman Utami Wijayaswari Ni Putu Veny Kartika Yanti, Ni Putu Veny Kartika Ni Putu Veny Kartika Yantie, Ni Putu Veny Kartika Ni Putu Wirantari NP Veny Kartika Yantie Pande Putu Yuli Anandasari Putu Ayu Widyanti Ria, Natal Ronaldi, Melissa Soetjiningsih Soetjiningsih Sukmapermata, Bunga Suryani Malik, Suryani Tri Yuliantini Wijaya, Lisa Amelia Yantie , Ni Putu Veny Kartika Yuwono, Elien

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