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All Journal BALI MEDICAL JOURNAL (BMJ) Medicina journal of internal medicine E-Jurnal Medika Udayana International Journal of Integrated Health Sciences Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Medical Journal of Indonesia Mutiara Medika: Jurnal Kedokteran dan Kesehatan INDONESIAN JOURNAL OF PHARMACY The Indonesian Biomedical Journal Paediatrica Indonesiana JBN (Jurnal Bedah Nasional) Jurnal Penyakit Dalam Udayana ISM (Intisari Sains Medis) : Jurnal Kedokteran Majalah Patologi Indonesia Bioscientia Medicina : Journal of Biomedicine and Translational Research Ina Kidney Neurologico Spinale Medico Chirurgico Journal of Clinical and Cultural Psychiatry Bioscientia Medicina : Journal of Biomedicine and Translational Research The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Eduvest - Journal of Universal Studies IJRETINA - International Journal of Retina Ophthalmologica Indonesiana International Journal of Psychology and Health Science
I Gde Raka Widiana
Departemen Penyakit Dalam, Fakultas Kedokteran, Universitas Udayana, Denpasar, Indonesia
Aerospace Engineering Biochemistry, Genetics & Molecular Biology Computer Science & IT Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health Social Sciences

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Effect in Pain Scale of Trocar Insertion, Onset, and Duration of Anesthesia of Subtenon Anesthesia without Premedication Compared with Premedication in Pars Plana Vitrectomy: A Randomized Controlled Trial Andayani, Ari; Agrasidi, Putu Anindya; Sutyawan, I Wayan Eka; Widiana, I Gde Raka; Widnyana, I Made Gede; Pemayun, Cok Istri Dewiyani
International Journal of Psychology and Health Science Vol. 3 No. 2 (2025): International Journal of Psychology and Health Science (April - June 2025)
Publisher : Greenation Publisher & Yayasan Global Research National

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.38035/ijphs.v3i2.810

Abstract

Effect in Pain Scale of Trocar Insertion, Onset, and Duration of Anesthesia of Subtenon Anesthesia without Premedication Compared with Premedication in Pars Plana Vitrectomy: A Randomized Controlled Trial. Background: Pars plana vitrectomy (PPV) has traditionally been performed under general anesthesia. However, in recent years, regional anaesthetic techniques such as subtenon block have gained popularity due to their safety and effectiveness, reducing the risk of severe complications associated with needle-based blocks. Patients and Methods: This randomized controlled trial (RCT) was conducted between November 2023 to March 2024 at a tertiary teaching hospital in Indonesia. A total of 30 patients undergoing vitrectomy were randomized assigned to one of two groups: with premedication or without premedication. The primary outcomes evaluated were the pain scale during trocar insertion, the onset of anesthesia, and the duration of anesthesia. Statistical analyses were performed using the Mann-Whitney U test and ANCOVA. Results: No significant differences were observed between the two groups regarding the pain scale during trocar insertion, the onset of anesthesia, or the duration of anesthesia (p<0.001). However, after adjusting for diagnosis and type of the therapy, the group without premedication demonstrated a significantly longer duration of anesthesia. Conclusion: Subtenon anesthesia without premedication represents a viable alternative for pars plana vitrectomy. It offers practical benefits, such as eliminating the need for fasting and intravenous line placement, while maintaining patient and operator comfort.    
The Temporal Windows of Glycemic Injury: Association of Early and Late First-Week Hyperglycemia with Retinopathy of Prematurity in Low-Birth-Weight Infants Dharmi Lestari, Ni Putu; I Wayan Eka Sutyawan; Putu Junara Putra; I Gde Raka Widiana; Siska; Putu Yuliawati
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i9.1379

Abstract

Background: Retinopathy of prematurity (ROP) is a leading cause of childhood blindness, driven by aberrant retinal vascular development in preterm infants. While hyperglycemia is a recognized risk factor, its impact may vary depending on its timing relative to the biphasic pathogenesis of ROP. This study aimed to generate a hypothesis regarding the differential association of hyperglycemia on postnatal day 1 versus day 7 with the incidence of ROP in a high-risk neonatal population. Methods: We conducted a retrospective, cross-sectional, hypothesis-generating study at Prof. Dr. I.G.N.G. Ngoerah General Hospital. Medical records of 68 preterm (<37 weeks gestation) and low-birth-weight (<2500 grams) infants who underwent ROP screening were reviewed. The exposures of interest were hyperglycemia (blood glucose >125 mg/dL) on postnatal day 1 (D1) and day 7 (D7). The primary outcome was the diagnosis of any stage of ROP. Statistical analysis involved Chi-square tests and exploratory multivariate logistic regression to adjust for select confounders. Results: Of the 68 infants included (mean gestational age 30.5 ± 2.2 weeks, mean birth weight 1447.5 ± 373.0 grams), 11 (16.2%) were diagnosed with ROP. Hyperglycemia was present in 29.4% of infants on D1 and 13.2% on D7. In logistic regression analysis, a strong statistical association was observed between hyperglycemia and ROP for both D1 (Adjusted Odds Ratio [AOR] = 55.7; 95% Confidence Interval [CI]: 5.1–611.0; p=0.001) and D7 (AOR = 74.5; 95% CI: 9.0–613.4; p<0.001). However, the profoundly wide confidence intervals indicate significant statistical instability and imprecision. Conclusion: This study found a strong, albeit statistically imprecise, association between hyperglycemia on both the first and seventh day of life and the incidence of ROP. These findings support the hypothesis that the timing of glycemic dysregulation may be critical, potentially impacting different phases of ROP pathogenesis. The results, while preliminary, underscore the need for larger, prospective studies to confirm these associations and elucidate the role of glycemic control in ROP prevention.
The Temporal Windows of Glycemic Injury: Association of Early and Late First-Week Hyperglycemia with Retinopathy of Prematurity in Low-Birth-Weight Infants Dharmi Lestari, Ni Putu; I Wayan Eka Sutyawan; Putu Junara Putra; I Gde Raka Widiana; Siska; Putu Yuliawati
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i9.1379

Abstract

Background: Retinopathy of prematurity (ROP) is a leading cause of childhood blindness, driven by aberrant retinal vascular development in preterm infants. While hyperglycemia is a recognized risk factor, its impact may vary depending on its timing relative to the biphasic pathogenesis of ROP. This study aimed to generate a hypothesis regarding the differential association of hyperglycemia on postnatal day 1 versus day 7 with the incidence of ROP in a high-risk neonatal population. Methods: We conducted a retrospective, cross-sectional, hypothesis-generating study at Prof. Dr. I.G.N.G. Ngoerah General Hospital. Medical records of 68 preterm (<37 weeks gestation) and low-birth-weight (<2500 grams) infants who underwent ROP screening were reviewed. The exposures of interest were hyperglycemia (blood glucose >125 mg/dL) on postnatal day 1 (D1) and day 7 (D7). The primary outcome was the diagnosis of any stage of ROP. Statistical analysis involved Chi-square tests and exploratory multivariate logistic regression to adjust for select confounders. Results: Of the 68 infants included (mean gestational age 30.5 ± 2.2 weeks, mean birth weight 1447.5 ± 373.0 grams), 11 (16.2%) were diagnosed with ROP. Hyperglycemia was present in 29.4% of infants on D1 and 13.2% on D7. In logistic regression analysis, a strong statistical association was observed between hyperglycemia and ROP for both D1 (Adjusted Odds Ratio [AOR] = 55.7; 95% Confidence Interval [CI]: 5.1–611.0; p=0.001) and D7 (AOR = 74.5; 95% CI: 9.0–613.4; p<0.001). However, the profoundly wide confidence intervals indicate significant statistical instability and imprecision. Conclusion: This study found a strong, albeit statistically imprecise, association between hyperglycemia on both the first and seventh day of life and the incidence of ROP. These findings support the hypothesis that the timing of glycemic dysregulation may be critical, potentially impacting different phases of ROP pathogenesis. The results, while preliminary, underscore the need for larger, prospective studies to confirm these associations and elucidate the role of glycemic control in ROP prevention.
Ethanol 50% as Antidote in Propylene Glycol Due to Antifreeze Ingestion in General Hospital, Bali, Indonesia: Case Report Barimbing, Morris Lintong; Widiana, I Gde Raka
Indonesian Journal of Kidney and Hypertension Vol 2 No 1 (2025): Volume 2 No. 1, April 2025
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32867/inakidney.v2i1.150

Abstract

Propylene glycol intoxication is a medical emergency requiring immediate intervention. It is metabolized by alcohol dehydrogenase into toxic metabolites, such as lactate and pyruvate, which can lead to metabolic acidosis and organ failure. The primary antidote strategy involves inhibiting alcohol dehydrogenase to prevent the formation of these harmful metabolites. This case report highlights a 53-year-old man who accidentally ingested a propylene glycol radiator coolant. He presented with symptoms of nausea, vomiting, and metabolic acidosis, confirmed through laboratory tests. With no fomepizole available—the preferred antidote—the patient was administered ethanol (gin) at a concentration of 50% over 10 minutes until intoxication occurred. Ethanol competes with propylene glycol for alcohol dehydrogenase, thereby preventing the formation of toxic lactate metabolites. The patient recovered without complications after two days of being given oral ethanol and was discharged. Although ethanol use as an antidote for propylene glycol poisoning is limited, this case underscores its potential effectiveness in reducing morbidity and mortality when fomepizole is unavailable. This approach demonstrates the importance of timely intervention in cases of toxic alcohol exposure.
Effect of Tacrolimus Once Daily XR on Variance of Blood Tacrolimus Concentrations in Comparison with Twice Daily Tacrolimus in Kidney Transplant Recipients Widiana, I Gde Raka; Putra, I Made Rama; Wahyuningrum, Stefany Adi
Indonesian Journal of Kidney and Hypertension Vol 2 No 2 (2025): Volume 2 No. 2, August 2025
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32867/inakidney.v2i2.190

Abstract

Background: Variability of tacrolimus concentration in the plasma of recipients is associated with nephrotoxicity, acute rejection, and affects graft survival. Objective: To test the hypothesis that the coefficient variation of plasma tacrolimus in new tacrolimus XR (extended-release) once daily is lower than conventional twice daily. Methods: The study was conducted in two phases. Phase 1, a comparative observational analysis with a single-group crossover, comparing periods of divided-dose treatment with crossover to prolonged-dose treatment. Phase 2, a cross-sectional design, is used to correlate IVP and serum creatinine variation. Results: A total of 19 kidney post-transplant recipients were included. There was a significant difference in blood tacrolimus CoV between XR tacrolimus and divided dose therapy (22.22±7.39% vs 44.32±15.54%, p<0.001). A significant linear correlation was observed between blood tacrolimus CoV and serum creatinine CoV in all patients (r=0.74; r2= 0.54; b=1.15; p<0.001). Subgroup analysis revealed a significant correlation between blood tacrolimus CoV in divided dose tacrolimus therapy subgroup (r=0.58; r2= 0.33; p=0.02) but not in the XR group (r=0.06; r2= 0.004; p=0.84). Multivariate ANCOVA showed serum CoV was associated with CoV of blood tacrolimus (B=0.72; r2= 0.255; p=0.01). Furthermore, XR tacrolimus was associated with lower serum creatinine CoV (B= -20.7; r2=0.20; p=0.02). Conclusion: XR tacrolimus therapy produces significantly lower variance of blood tacrolimus concentrations in kidney transplant recipients. This variance is associated with serum creatinine variance, especially in divided-dose tacrolimus therapy. Serum creatinine variance is linked to variances in blood tacrolimus levels, and XR tacrolimus therapy is associated with lower serum creatinine variance.
Renoprotective Effects of Hydroxychloroquine and Folinic Acid via ET-1 and NLRP3 Modulation in Reducing Tubular Injury in A Rabbit Model of Methanol-induced Acute Kidney Injury Prayuda, Prayuda; Widiana, I Gde Raka; Suega, Ketut; Kandarini, Yenny; Winarti, Ni Wayan; Purwanto, Bambang
The Indonesian Biomedical Journal Vol 17, No 4 (2025)
Publisher : The Prodia Education and Research Institute (PERI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18585/inabj.v17i4.3747

Abstract

BACKGROUND: Methanol intoxication is associated with significant morbidity and mortality, particularly when acute kidney injury (AKI) developed. Emerging evidence implicates Endothelin-1 (ET-1) and Nucleotide-binding domain leucine-rich repeat-containing pyrin receptor 3 (NLRP3) inflammasome in renal injury, but their roles in methanol-induced AKI remain unclear. To date, no studies have examined whether hydroxychloroquine or folinic acid, which are known to modulate ET-1 and NLRP3 signaling, could mitigate renal injury in this setting. This study evaluated their therapeutic effects in a rabbit model of methanol-induced AKI.METHODS: The animals subjects were randomly assigned to four groups: control group receiving aquabidest, folinic acid group receiving 2 mg/kg body weight (BW) intraperitoneal folinic acid, hydroxychloroquine group receiving 30 mg/kg BW oral hydroxychloroquine phosphate, and combination group receiving both folinic acid and hydroxychloroquine at the same dosages. Histopathological evaluation of tubular injury scores and immunohistochemical analysis of ET-1 and NLRP3 expression were then conducted.RESULTS: Expressions of ET-1, NLRP3, and tubular injury scores were significantly lower in the hydroxychloroquine, folinic acid, and combination therapy groups compared to the control group (p<0.001). Expression of ET-1 was lowest in folinic acid group (59.38±0.71%), followed by combination group (62.23±1.98%) and hydroxychloroquine group (62.43±1.81%), compared to control group (72.14±1.02%). Expression of NLRP3 was lowest in combination group (58.94±1.05%), followed by folinic acid and hydroxychloroquine group, which showed equal values (60.57±1.38%), compared to control group (72.15±1.02%). Tubular injury scores were also lowest in combination group (27.07±3.16%), followed by hydroxychloroquine group (45.29±1.75%) and folinic acid group (48.38±2.49%), compared to control group (77.15±1.66%).CONCLUSION: Expression of ET-1 and NLRP3, as well as tubular injury scores, are significantly lower in all treatment groups compared to control, suggesting hydroxychloroquine and folinic acid demonstrated renoprotective effects in methanol-induced AKI, likely through modulation of ET-1 and NLRP3 pathways.KEYWORDS: methanol intoxication, acute kidney injury, hydroxychloroquine, folinic acid, endothelin-1, NLRP3 inflammasome, experimental animal models, rabbits
Apparent Diffusion Coefficient (ADC) Value on Magnetic Resonance Imaging (MRI) in Determining Breast Cancer and Determining Breast Cancer With Locally Advanced Expansion Mahautama, I Gusti Agung Putra; Sitanggang, Firman Parulian; Martadiani, Elysanti Dwi; Widiana, I Gde Raka
Eduvest - Journal of Universal Studies Vol. 5 No. 8 (2025): Eduvest - Journal of Universal Studies
Publisher : Green Publisher Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59188/eduvest.v5i8.52064

Abstract

Breast cancer is the most common malignancy in women and a leading cause of cancer-related deaths in Indonesia. Early detection of the locally advanced stage is crucial for therapy selection and prognosis. This study evaluates the diagnostic value of the Apparent Diffusion Coefficient (ADC) from diffusion-weighted MRI (DWI) in detecting breast cancer and assessing local advancement. A retrospective design was used with 50 patients who underwent breast MRI at Prof. Dr. I.G.N.G Ngoerah Hospital, Denpasar. ADC values were compared with histopathology for cancer confirmation and surgical reports for staging. At a cut-off of 1.088 × 10⁻³ mm²/s, ADC demonstrated excellent performance in distinguishing cancer from non-cancer (sensitivity 100%, specificity 96%, PPV 96.1%, NPV 100%, LR+ 25, LR- 0.0, accuracy 98%). However, for detecting locally advanced disease (cut-off 0.815 × 10⁻³ mm²/s), performance was lower (sensitivity 61.5%, specificity 75%, accuracy 68%). These results emphasize ADC's reliability in diagnosing breast cancer but suggest limitations in staging, highlighting the need for multimodal imaging and clinical assessment integration to improve accuracy and guide treatment decisions.
Co-Authors A. A. G. Oka, A. A. G. Ade Sinyo Aristantrisna Adnyani, Ni Made Dwi Agrasidi, Putu Anindya Ake, Anselmus Anak Agung Chris Tedy Pramana Anak Agung Gde Oka Anak Agung Wiradewi Lestari and N. Sutarka Anwar Santoso Ari Andayani Arlene Elizabeth Padang Aslesa Wangpathi Pagehgiri Ayu, Nyoman Paramita Bagus Ngurah Putu Arhana Bambang Purwanto Barimbing, Morris Lintong Budi Suprapti Christopher Ryalino Cokorda Bagus Jaya Lesmana Dedi Silakarma Desak Putu Puteri Diah Rahtini Desy Permatasari Dewa Nyoman Putra Adiwinata Dewi Catur Wulandari Dharmi Lestari, Ni Putu Djodi Sidartha E. Elyshanti Elizabeth Haryanti Elysanti Dwi Martadiani Erawan, I Gusti Ngurah Agung Tresna Feliciano Pinto, Feliciano Firman Parulian Sitanggang Firman Sitanggang Gede Andi Aditya Gede Sukma Pranata Darma Gede Wira Mahadita Gede Wirya Kusuma Duarsa Handayani, Putu Novi Hendra Koncoro Hendra S Hendra Salim Hizkia Robinson Junsen Lumban Gaol I Dewa Agung Sutanjaya Giri Nugraha I Dewa Nyoman Wibawa I G. N. Anom-Supradnya I G. N. M. Sugiana I Gede Aditya Krishna Santhi I Gede Hendra Sucipta I Gusti Agung Trisna Windiani I Gusti Ayu Made Juliari I Gusti Kamasan Arijana I Gusti Ngurah Ketut Budiarsa I Gusti Ngurah Made Suwarba I Gusti Rai Putra Wiguna I K. Sudartana I Kadek Agus Setiawan I Ketut Suwiyoga I Ketut Wiargitha I Ketut Widiana I Made Adi Satria Darma I Made Agus Endra Permana I Made Arimbawa I Made Ayusta I Made Gede Widnyana I Made Kardana I Nengah Wiadnyana Steven Christian I Nyoman Adi Putra I Nyoman Semadi I Nyoman Wiryawan I Putu Budhiastra, I Putu I Putu Gede Budiana, I Putu Gede I Putu Gede Eka Ariawan Suyasa, I Putu Gede Eka Ariawan I Wayan Eka Sutyawan I Wayan Gede Jayanegara I Wayan Juli Sumadi I Wayan Putu Sutirta Yasa I Wayan Sudhana I Wayan Wita I Wayan Yudiana IBN Mahendra Ida Bagus Gede Suparyatha Ida Bagus Putra Pramana Ida Safitri IKG Suandi Imam Effendi Indira Prawita Martani Inez Kartika Jetty Kalembang Jod Loekman Jodhi S Loekman Jodi Sidharta Loekman Jodi SL Juliari, IGAM K Suwitra K. Suwitra Kadek Budi Santosa Ketu Suwitra Ketut Mulyadi Ketut Putu Yasa Ketut Rina, Ketut Ketut Suarta Ketut Suega Ketut Suwitra Ketut Tuti Parwati Merati Komang Ayu Witarini Kumbara, Cokorde Istri Yuliandari Krisnawardani Luh Gede Yuliadewi NS Luh Yeni Laksmi Luh Yeni Laksmini Made Agus Dwianthara Sueta Made Agus Kusumadjaja Made Asih MADE RATNA SARASWATI . Made Satria Yudha Dewangga Made Widhi Asih Mahadita, Gede Wira Mahardani, Putu Nandika Tungga Yudanti Mahautama, I Gusti Agung Putra Maria, Dessy Marleen MOCHAMMAD THAHA Moestikaningsih ** Moestikaningsih . Monica Sampurna Ngakan Gede Dwija Hermawan Ni Ketut Putri Ariani Ni Kompyang Rahayu Ni Made Amelia R. Dewi Ni Made Ari Suryathi Ni Made Dharma Laksmi Ni Made Putri Suastari Ni Nyoman Margiani Ni Putu Sriwidyani Ni Wayan Anantika Riani Ni Wayan Winarti NP Veny Kartika Yantie Nyoman Maharmaya Nyoman Paramita Ayu Nyoman Srie Laksminingsih Nyoman Sutarka, Nyoman Oka Udrayana Ommy Agustriadi Pande Made Wisnu Tirtayasa Pande Putu Yuli Anandasari Pantjawati, Ni Luh Diah Patriawan, Putu Paulus Wiyono Pemayun, Cok Istri Dewiyani PITIKA ASPR Poerwono Rahardjo Pradnyana DS, Bagus Ari Prayuda, Prayuda Purnama Purnama Putra, I Made Rama Putu Astri Novianti Putu Ayu Saraswati Putu Junara Putra Putu Yuliawati Raka-Sudewi A. A. Reny Setya Pratiwi Duarsa Rully Roesli Sanyoto, Arundina Satrio Ryandi Semadhi, Putu Gitanjani Mahadewi Setiawan, I Gede Budhi Sianny Herawati Silvester Kristian Taopan Siska Sitanggang, Firman Parulian Soetjiningsih Soetjiningsih Sudaryat S Sudjana, Karismayusa Sukmawati, Nurindah Sutyawan, I Wayan Eka Tianing - Trianto Trianto W Sudhana W. G. Jayanegara Wahyuningrum, Stefany Adi Wayan Aryadana Wayan Aryadana Wayan Sudana Wayan Sudhan Wayan Sudhana Wiradharma, Ketut Gede Y. Saskia-Javi Yenny Kandarini Yoga Putra Yuliawati, Putu Yuriawantini - Zulfariska, Nony