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Profil Sepsis Anak di Pediatric Intensive Care Unit Rumah Sakit Umum Pusat Sanglah Denpasar - Bali Dyah Kanya Wati; I Nyoman Budi Hartawan; Ida Bagus Gede Suparyatha; Dewi Sutriani Mahalini; I Gusti Ayu Putu Eka Pratiwi; I Made Gede Dwi Lingga Utama
Sari Pediatri Vol 21, No 3 (2019)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp21.3.2019.152-8

Abstract

Latar belakang. Sepsis dan klasifikasinya merupakan kondisi yang mengancam nyawa dengan angka kematian mendekati 10% dari seluruh pasien dengan sepsis dan syok septik Angka kematian ini akan meningkat pada anak dengan minimal satu penyakit komorbid yang menyertai dan mendekati angka 76% berdasarkan jumlah organ yang mengalami disfungsi. Sampai saat ini belum ada data pasti yang menunjukan prevalensi dan karakteristik pasien dengan sepsis di Unit Perawatan Intensif (UPIA) Rumah Sakit Umum Pusat (RSUP) Sanglah Denpasar.Tujuan. Mengetahu prevalensi serta karakteristik pasien dengan sepsis pada pasien anak berusia 0-18 tahun di Unit Perawatan Intensif (UPIA) Rumah Sakit Umum Pusat (RSUP) Sanglah Denpasar tahun 2018.Metode. Penelitian ini merupakan penelitian deskriptif retrospektif dengan menggunakan data rekam medis RSUP Sanglah yang dikumpulkan meggunakan metode purposive sampling dengan kriteria inklusi dan eksklusi.Hasil. Penelitian ini sudah berjalan selama 1 tahun dari bulan Januari 2018 sampai dengan Desember 2018. Sampel yang dikumpulkan sebanyak 28 sampel. Kategori usia bayi tertinggi merupakan sampel yang digunakan, yaitu sebesar 57,1%. Diagnosis terbanyak adalah syok sepsis sebesar 60,7%. Skor pediatric sequential failure assesment (pSOFA) didapatkan dengan rerata sebesar 5,94.Kesimpulan. Prevalensi sepsis di UPIA Rumah Sakit Umum Pusat Sanglah Denpasar pada tahun 2018 didominasi oleh pasien dengan kategori usia bayi (<2 tahun).
Rasio Neutrofil dan Limfosit (NLCR) Sebagai Faktor Risiko Terjadinya Infeksi Bakteri di Ruang Rawat Anak RSUP Sanglah Denpasar I Made Yullyantara Saputra; W Gustawan; MG Dwilingga Utama; BNP Arhana
Sari Pediatri Vol 20, No 6 (2019)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp20.6.2019.354-9

Abstract

Latar belakang. Rasio neutrofil dan limfosit (NLCR) memiliki potensi sebagai prediktor bakteremia pada pasien dengan infeksi yang didapat di masyarakat. Insidensi bakteremia, atau adanya bakteri hidup dalam darah, mencapai sekitar 1% kasus pada populasi. Angka kematian mencapai 25%-30% dan meningkat hingga 50% pada sepsis berat.Tujuan. Untuk mengetahui hubungan rasio neutrofil dan limfosit (NLCR) dengan kejadian infeksi bakteri.Metode. Sebuah studi kasus-kontrol dilakukan dengan meninjau rekam medis di RSUP Sanglah, Denpasar, pada periode Januari 2016 hingga Maret 2018. Data yang diambil adalah usia, jenis kelamin, kadar WBC, Neutrofil, limfosit, monosit, platelet, dan kultur darah. Kemudian dilakukan analisis hubungan antara rasio neutrofil dan limfosit terhadap infeksi aliran darah.Hasil. Selama periode studi didapatkan 98 pasien dengan hasil kultur positif dan 100 pasien dengan hasil kultur negatif. Dari total subjek yang dianalisis, didapatkan 116 (58,5%) subjek laki-laki dan 82 (40,9%) subjek perempuan. Median usia pada kelompok kasus adalah 12 bulan, sedangkan median usia pada kelompok kontrol adalah 24 bulan. Analisis kurva ROC menunjukkan nilai cut-off optimal untuk NLCR adalah 4,67. Rasio odd untuk hubungan antara NLCR dengan kejadian infeksi bakteri adalah 3,24 (95% IK 1,74 – 5,92) dan adjusted odds ratio sebesar 3,49 (95% IK 1,83-6,64).Kesimpulan. Nilai NLCR ≥4,67 merupakan faktor risiko untuk infeksi aliran darah yang berkembang. Hasil ini dapat digunakan sebagai titik potong untuk antibiotik yang awalnya diberikan untuk mencegah prognosis yang buruk (sepsis, kegagalan organ multipel, dan kematian).
Quantitative NS1 antigen and the severity of dengue virus infections Ni Made Adi Purnami; Mohammad Juffrie; Made Gde Dwi Lingga Utama
Paediatrica Indonesiana Vol 55 No 2 (2015): March 2015
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (106.325 KB) | DOI: 10.14238/pi55.2.2015.87-90

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Background Dengue infection is one of the main cause ofmorbidity and mortality in children in Indonesia. Since it is knownthat earlier treatment and supportive therapies can decreased casefatality rate from dengue hemorrhagic fever (DHF), identificationof children who have risks to develop to DHF must be quicklyidentified, mainly in areas of endemic.Objective To find a correlation between increased quantitativesecreted nonstructural protein-1 (sNS1) with clinical course ofsevere dengue infections.Methods This was a cross-sectional study conducted on childrenwith dengue infections in Tropical Infections Division of ChildHealth Department, Sanglah Hospital, Denpasar. Detection ofthe dengue antigen was made by examining sNS1 quantitativeimmuno-assay. Analysis correlation of Spearman test was used tolook the relationship between increased quantitative sNS1 withclinical course of severe dengue infections.Results There was a positive relationship between quantitativesNS1 and clinical course of severe dengue infections with a valueof r = 0.903, P=0.001. Increased sNS1 level had a positivecorrelation with more severe dengue infections.Conclusions Quantitative sNS1 titer has a strong positivecorrelation with clinical course of severe dengue infections.
McIsaac criteria for diagnosis of acute group-A β-hemolytic streptococcal pharyngitis Imanuel Y. Malino; Dwi Lingga Utama; Yati Soenarto
Paediatrica Indonesiana Vol 53 No 5 (2013): September 2013
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (334.966 KB) | DOI: 10.14238/pi53.5.2013.258-63

Abstract

Background The early use of antibiotics for acute upper respiratory infections is controversial because most of these infections are caused by viruses. A strategy is needed to correctly identify the causitive agents of acute pharyngitis, so that antibiotics can be prescribed appropriately.Objective To assess McIsaac criteria for diagnosing acute group-A β-hemolytic streptococcal (GABHS) pharyngitis in children.Methods This diagnostic study was conducted from August 2011 to February 2012, to compare clinical criteria of McIsaac to throat swab culture results as the gold standard for diagnosis. Subjects were children aged 3-14 years who visited the pediatric outpatient clinic or emergency ward at Sanglah Hospital and the pediatric outpatient clinic at Wangaya Hospital.Results There were 550 cases of acute pharyngitis during the study period, with 313 patients aged 3-14 years and 199 patients excluded due to a history of taking antibiotics in the two weeks prior to the hospital visit. Hence, 114 subjects were eligible for the study. GABHS prevalence in this study was 7.9%. McIsaac’s area under the curve (AUC) from receiver operating characteristic (ROC) curve was 78.1%(95%CI 60.3 to 96%, P= 0.005). A McIsaac score ≥4 had a 66.7% (95%CI 49 to 97%) sensitivity, 87.6% (95% CI 81 to 94%) specificity, 31.6% (95 %CI 11 to 52%) positive predictive value (PPV), 96.8% (95%CI 93 to 100%) negative predictive value (NPV), 86.0% accuracy, 5.4 (95% CI 2.7 to 10.7) positive likelihood ratio (LR+) and 0.4 (95% CI 0.2 to 0.9) negative likelihood ratio (LR-).Conclusion A McIsaac criteria total score of <4 is favorable for excluding a diagnosis of GABHS pharyngitis. A McIsaac total criteria score of ≥4 requires further examination to confirm a diagnosis of GABHS pharyngitis.
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

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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 Pearson’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.
The Impact of Flexible Working Hours, Remote Working, and Work Life Balance to Employee Satisfaction in Banking Industry during Covid-19 Pandemic Period Kresna Chandra Putra; Tedo Aris Pratama; Rionaldo Aureri Linggautama; Sekar Wulan Prasetyaningtyas
Journal of Business and Management Review Vol. 1 No. 5 (2020): (Issue-November)
Publisher : Profesional Muda Cendekia Publishing

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47153/jbmr15.592020

Abstract

During the situation like Coronavirus COVID -19 pandemic that happened in 2020, forcing various banking companies to make adjustments and changes to their work system. The flexible working system is one of the most widely used, which has an impact on workers especially during this pandemic conditions. The impact of the change in work system in banking sector is interesting to study, especially since the banking industry in Indonesia still mostly uses conventional work systems. . This study aims to measure the impact of flexible working hours (FWH), remote working (RW), and work life balance (WLB) on employee job satisfaction in the banking industry during the pandemic. In this study, data were collected using quantitative, non-probability, purposive sampling methods via online questionnaires, which were distributed to employees in the banking sector during the pandemic period in Jabodetabek area. With total of 160 respondents who were used to perform analysis using the PLS-SEM method which was carried out with the SMART-PLS software. This study found that in pandemic conditions, achieving WLB conditions will have a positive impact on job satisfaction. The implementation of the RW system itself has a positive impact in helping to achieve the WLB conditions that are felt by banking workers in the Jabodetabek area, in contrast to the FWH system which does not have a similar effect on WLB. In addition, this study also provides an academic basis for the use of flexible working hour and remote working systems to increase job satisfaction, especially in the banking industry.
LINGKUNGAN TEMPAT TINGGAL SEBAGAI FAKTOR RESIKO INFEKSI VIRUS DENGUE PADA ANAK-ANAK Jefry Gilberth Koibur; Agung Bagus Sista Satyarsa; I Wayan Gustawan; I Gusti Ngurah Sanjaya Putra; I Made Dwi Lingga Utama
Indonesian Journal for Health Sciences Vol 5, No 1 (2021): March
Publisher : Universitas Muhammadiyah Ponorogo

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (450.184 KB) | DOI: 10.24269/ijhs.v5i1.2984

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Demam Berdarah Dengue adalah penyakit disebabkan oleh virus dengue yang berkembang pesat di negara dengan iklim tropis seperti Indonesia. Penelitian ini bertujuan untuk mengidentifikasi faktor risiko infeksi virus dengue pada anak-anak di wilayah kerja Puskesmas Denpasar Selatan. Penelitian merupakan penelitian observasional analitikal dengan pendekatan cross-sectional. Data diperoleh dari jawaban reponden terhadap kuesioner yang telah tervalidasi sebelumnya dan selanjutnya data dianalisis secara univariat dan bivariat menggunakan aplikasi statistik yakni SPSS. Terdapat 75 responden yang mengikuti penelitian ini dengan rerata usia yakni 12±3,094 tahun. Karakteristik responden didominasi oleh anak laki-laki (73,3%) dan domisili di perkotaan (68%). Anak-anak lebih banyak tinggal di daerah yang padat penduduk (66,6%) dengan sanitasi lingkungan memadai hanya 45,3% dari total responden. Ditambah lagi, anak-anak memiliki risiko terinfeksi virus dengue dan mengalami demam berdarah pada lingkungan tempat tinggal di perkotaan dengan mobilitas penduduk yang padat (PR: 2,716; IK95%: 2,047-18,067; p: 0,011). Berdasarkan hasil penelitian ini, dapat disimpulkan bahwa lingkungan tempat tinggal menjadi faktor risiko terhadap infeksi virus dengue pada anak-anak, sehingga diperlukan upaya preventif yang terfokus untuk mencegah infeksi virus dengue
Study of knowledge in diarrhea and personal hygiene among students below 10 years old in SD Santo Yoseph 2, Denpasar in 2016-2017 Karthigeyan Manogaran; I Made Gede Dwi Lingga Utama; I Wayan Gustawan
Intisari Sains Medis Vol. 10 No. 2 (2019): (Available online: 1 August 2019)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (351.448 KB) | DOI: 10.15562/ism.v10i2.411

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Background: The lack of basic knowledge of diarrhea and also poor self-hygiene might be the risk factors of diarrhea.Aim: The study aims to identify the knowledge of diarrhea and personal hygiene among student below 10 years old in SD Santo Yoseph 2, Denpasar, Bali. Method: This cross sectional study was conducted on students below 10 years old in SD Santo Yoseph 2, Denpasar. Fifty students participated in this study, and they were divided into two groups. Of total study participants, 25 were from 8 years old, and 25 were from 9 years old. They were asked to fill up a self-administered questionnaire. The variables assessed were their knowledge of diarrhea (definition, etiology, risk factors, sign and symptoms, complications, treatment and management, and prevention) and application of personal hygiene.Result: About 34% of 50 students below 10 years old in SD Santo Yoseph respectively had good knowledge of diarrhea. However, 66% of students had very less knowledge about diarrhea where they get below. For the application of personal hygiene, 24% of students managed to get a good score while 74% of them failed to get a good score. The vast majority had adequate knowledge of the definition of diarrhea. At the same time, the majority of the students was unable to know that dehydration is the complication of diarrhea due to the loss of a large amount of water and salt in the body.Conclusion: Though the overall knowledge in diarrhea and application of hygienic lifestyle among the students were poor, few minorities of the students had a good understanding of both these variables. There is a strong need for early childhood education about knowledge in diarrhea and personal hygiene in school level itself as a method of prevention.
Mean platelet volume count as a risk factor for bloodstream infection in Pediatric Ward Sanglah General Hospital Denpasar, Bali-Indonesia Ni Putu Wirantari; I Wayan Gustawan; Made Gede Dwilingga Utama; Bagus Ngurah Putu Arhana; Ni Nengah Dwi Fatmawati; Ni Made Adi Tarini
Intisari Sains Medis Vol. 11 No. 1 (2020): (Available online: 1 April 2020)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (425.308 KB) | DOI: 10.15562/ism.v11i1.553

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Background: Mean platelet volume (MPV) is a potentially interesting parameter in predicting bacteremia in patients admitted with suspected community-acquired  infections. The incidence of bacteremia, defined as the presence of viable bacteria in the bloodstream, in patients who were being admitted to hospital. Multiple recent studies have confirmed that low-level bacteremia is more common than previously thought, occurring in 38% to 68% of all pediatric patients with a positive blood culture. The mortality rate is 25%–30%, increases to 50% when associated with severe sepsis. The objective of this study is to investigate whether MPV as a risk factor for bloodstream infection.Methods: This was a hospital-based case-control study, review of the medical record from January 2016 until December 2018. We collect age, gender, MPV, platelet and blood culture. We analyze the association between MPV to bloodstream infection.Result: Between January 1st 2016 and December 31st 2018, there were 86 patients with positive blood cultures and 89 negative blood cultures. In the case group, there were 48 (53.9%) male and 41 (46.1%) female subjects, while in the control group there were 63 (73.3%) male and 23 (26.1%) female subjects. The median age for case group was 14 months while the median age for control group was 23 months. From the ROC curve, the optimal cutoff value for MPV was determined as 5.59. The odd ratio determined the relationship between MPV to blood stream infection was 2,26 with 95% CI 1.13-4.52. The adjusted odds ratio was 2.24 95% CI (1.10-4.57). The majority diagnosis was pneumonia (46.1%) in case group then early onset neonatal sepsis (28.1%) and meningitis (7.9%).Conclusion: The MPV ≥5.59 is a risk factor for developed bloodstream infection. This result can be used as a cutoff point to initially administered antibiotic to prevent the worse prognosis (sepsis, multiple organ failure, and death).
Karakteristik infeksi Acinetobacter baumannii pada anak yang dirawat di RSUP Sanglah, Bali, Indonesia periode Januari 2017-Desember 2018 Gusti Ayu Putu Sri Satya Mahayani; I Wayan Gustawan; I Made Gede Dwi Lingga Utama; Ida Bagus Gede Suparyatha; I Made Arimbawa; Ni Made Adi Tarini
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (504.529 KB) | DOI: 10.15562/ism.v11i3.756

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Background: Acinetobacter baumannii is a gram-negative bacterium that can cause nosocomial infections in humans. An increased incidence of A. baumannii infection is accompanied by increased antibiotic resistance and mortality from this bacterial infection. This study aims to determine the characteristic Acinetobacter baumannii infection and the pattern of germ sensitivity of antibiotics in children treated at Sanglah Hospital.Methods: A cross sectional study was conducted in the Pediatric Ward Sanglah Hospital. We performed a retrospective review of medical records from pediatric patients who were proven to have Acinetobacter baumannii infection through microbiological examination from blood culture samples while undergoing treatment in Pediatric Ward Sanglah Hospital from January 2017 to December 2018. Data were analyzed using SPSS version 20 for Windows.Results: A total of 33 pediatric patients were proven to have Acinetobacter baumannii bloodstream infection through microbiological examination. Most of them are males (72.7%) and 57.57% are neonates. Laboratory results obtained mean leukocyte levels 16.2±8.6 x 103/?L, median platelets 113.8 (3.7-464) x 103/?L, and mean procalcitonin 20.0±3.11 ng/ml. The average length of stay before Acinetobacter baumannii infection was 7 days, with the average total length of stay was 29.7 days. Patients who died during treatment were relatively high (45.5%) and 84.8% of them were treated in the intensive care unit, with 30 out of 33 patients infected with A. baumannii multidrug-resistant (MDR). Most patients use medical devices with an average usage time of more than 7 days.Conclusion: Most patients infected by Acinetobacter baumannii are treated in the intensive care unit with a high mortality rate. The A.baumannii bacteria identified were mostly MDR with a history of long-term use of antibiotics and medical devices. Latar Belakang: Acinetobacter baumannii adalah bakteri gram negatif yang dapat menyebabkan infeksi nosokomial pada manusia. Terdapat peningkatan insiden infeksi A. baumannii yang disertai peningkatan kejadian resistensi terhadap antibiotik, serta mortalitas akibat infeksi bakteri ini. Penelitian ini bertujuan untuk mengetahui bagaimana gambaran infeksi Acinetobacter baumannii serta pola sensitifitas kuman terhadap antibiotik pada anak yang dirawat di RSUP Sanglah yang merupakan rumah sakit rujukan di wilayah Indonesia bagian timur.Metode: Studi ini merupakan studi deskriptif dengan pendekatan potong lintang. Studi ini menggunakan data sekunder dari rekam medis pasien anak yang terbukti terinfeksi Acinetobacter baumannii melalui pemeriksaan kultur darah selama dirawat di RSUP Sanglah periode Januari 2017-Desember 2018. Data dianalisis dengan SPSS versi 20 untuk Windows.Hasil: Terdapat 33 pasien dengan kultur darah positif Acinetobacter baumannii. Sebagian besar berjenis kelamin lelaki (72,7%) dan 57,57% merupakan neonatus kurang bulan. Hasil laboratorium didapatkan rerata kadar leukosit 16,2±8,6 x 103/?L, median trombosit 113,8 (3,7- 464) x 103/?L, dan rerata procalcitonin 20,0±3,11 ng/ml. Median lama perawatan sebelum terjadinya infeksi adalah 7 hari dengan rerata lama perawatan 29,7 hari. Pasien yang meninggal selama perawatan cukup tinggi (45,5%) dan 84,8% dari pasien dirawat di ruang intensif dengan 30 dari 33 pasien terinfeksi multidrug resistant (MDR) A. baumannii. Sebagian besar pasien menggunakan alat medis dengan rerata lama pemakaian lebih dari 7 hari.Simpulan: Sebagian besar pasien yang terinfeksi Acinetobacter baumannii dirawat di ruang intensif dengan angka kematian yang cukup tinggi. Kuman A.baumannii yang teridentifikasi sebagian besar bersifat MDR dengan riwayat penggunaan antibiotika serta alat medis dalam jangka waktu lama.