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Sindroma Bartter pada laki-laki berusia 44 tahun: laporan kasus Anak Agung Ayu Lydia Prawita; Anak Agung Wiradewi Lestari; Sianny Herawati; Ni Kadek Mulyantari; Ni Komang Krisnawati; Ekarini Katharina Yunarti Nabu
Intisari Sains Medis Vol. 12 No. 2 (2021): (Available Online: 1 August 2021)
Publisher : DiscoverSys Inc.

Background: Bartter's syndrome is a hereditary condition characterized by polyuria, hypokalemia, metabolic alkalosis with normal or slightly low blood pressure due to loss of sodium and renal hyperplasia. Most Bartter syndrome occurs in children and is very rare in adulthood, with a prevalence of 1 in 1,000,000 populations. This case report aims to evaluate the laboratory aspects of Bartter's syndrome in a 44-year-old man at Sanglah Hospital, Bali, Indonesia.Case Presentation: A 44-year-old male patient complaining of vomiting and weakness. Other complaints such as diarrhea, fever, shortness of breath, stiffness and seizures are denied. The patient's previous medical history, treatment history, and family history were denied. Physical examination showed a general weakness with hypotension and polyuria. On laboratory examination, there was severe hypokalemia, hypocalcemia, hypomagnesemia, increased urinary potassium levels, increased urinary chloride levels, and metabolic alkalosis. To differentiate with Gitelman syndrome, an examination of the ratio of urine calcium and creatinine is performed. In this patient, the urine calcium and creatinine ratio increased, which indicated Bartter's syndrome. Patients receive electrolyte replacement therapy.Conclusion: Bartter syndrome is very rare in adulthood. Several tests are needed to make the diagnosis in accordance with the diagnostic approach of hypokalemia, namely electrolyte examination in urine serum, urine creatinine, and blood gas analysis. Latar Belakang: Sindroma Bartter merupakan suatu kondisi herediter yang ditandai oleh poliuria, hipokalemia, metabolik alkalosis dengan tekanan darah normal atau sedikit rendah karena kehilangan natrium dan hiperplasia ginjal. Sebagian besar sindroma Bartter terjadi pada anak-anak dan sangat jarang terjadi pada usia dewasa dengan prevalensi 1 dalam 1.000.000 populasi. Laporan kasus ini bertujuan untuk mengevaluasi aspek laboratorium sindroma Bartter pada laki-laki berusia 44 tahun di RSUP Sanglah, Bali, Indonesia.Presentasi Kasus: Pasien laki-laki 44 tahun dengan keluhan muntah dan lemas. Keluhan lain seperti diare, demam, sesak nafas, kaku dan kejang tidak ada. Riwayat penyakit sebelumnya, riwayat pengobatan, dan riwayat penyakit pada keluarga disangkal pasien. Pada pemeriksaan fisik didapatkan keadaan umum lemah dengan hipotensi dan poliuria. Pada pemeriksaan laboratorium ditemukan hipokalemia berat, hipokalsemia, hipomagnesemia, peningkatan kadar kalium urine, peningkatan kadar klorida urine, dan alkalosis metabolik. Untuk membedakan dengan sindroma Gitelman dilakukan pemeriksaan rasio kalsium dan kreatinin urine. Pada pasien ini didapatkan hasil rasio kalsium dan kreatinin urine yang meningkat, yang mengindikasikan sindroma Bartter. Pasien mendapatkan terapi penggantian elektrolit .Kesimpulan: Sindroma Bartter sangat jarang terjadi pada usia dewasa. Beberapa pemeriksaan diperlukan untuk menegakkan diagnosis sesuai dengan alur pendekatan diagnostik hipokalemia yaitu pemeriksaan elektrolit pada serum urine, kreatinin urine, dan analisis gas darah.

Disseminated Intravascular Coagulation (DIC) akibat gigitan ular: laporan kasus Ni Komang Krisnawati; Ida Ayu Putri Wirawati; Sianny Herawati; Ni Nyoman Mahartini; Anak Agung Ayu Lydia Prawita; Ekarini Katharina Yunarti Nabu
Intisari Sains Medis Vol. 12 No. 2 (2021): (Available Online: 1 August 2021)
Publisher : DiscoverSys Inc.

Background: Snakebite cases are cases of emergency that are often found in the Emergency Unit, especially in rice fields, forests, plantations and swamps. There is no definitive data on the number of snakebite cases in Indonesia. Morbidity and mortality of snakebite cases are highly dependent on the type of snake species, the number and type of can that enter the body, as well as the availability of anti-snake serum.In these patients were found Disseminated Intravascular Coagulation (DIC) due to snake bites.Case Presentation: A 5-years female patient complained of pain in the right hand due to snakebite about 30 minutes before entering the hospital. The snake is green with a red tail, a triangular head shape and a length of about 30 centimeters, biting the middle finger of the patient's right hand. Swollen redness and pain are felt spreading to the shoulders. Physical examination of compos mentis patients with a pulse rate of 96 times per minute, breath rate of 20 times per minute and temperature of 36.7oC. There was found edema and bullae in digiti III in the right manus region, palpably warm, and there is press pain. In the antebrachial region to the right humerus also found the presence of edema and press pain. Patients with normochromic normositer anemia with thrombocytopenia as well as lengthening of coagulation physiology decreased fibrinogen and increased D-dimer.Conclusion: Snake venom can be hemotoxic, neurotoxic and cytotoxic. Snakebite cases require rapid and comprehensive management to minimize the possibility of disability and death. Latar Belakang: Kasus gigitan ular merupakan kasus kegawatan yang sering dijumpai di Unit Gawat Darurat terutama di daerah area persawahan, hutan, perkebunan dan rawa. Tidak ada data yang pasti mengenai jumlah kasus gigitan ular di Indonesia. Morbiditas dan mortalitas kasus gigitan ular sangat tergantung dari jenis spesies ular, jumlah dan jenis bisa yang masuk ke dalam tubuh serta ketersediaan serum anti bisa ular.Presentasi Kasus: Pada pasien ini ditemukan Disseminated Intravascular Coagulation (DIC) akibat gigitan ular. Pasien perempuan, usia 5 tahun dengan keluhan nyeri pada tangan kanan akibat gigitan ular sejak sekitar 30 menit sebelum masuk rumah sakit. Ular berwarna hijau dengan ekor merah, bentuk kepala segitiga dan panjang sekitar 30 centimeter, menggigit jari tengah tangan kanan pasien. Bengkak kemerahan dan nyeri dirasakan menjalar sampai ke bahu. Pemeriksaan fisik pasien compos mentis dengan laju nadi 96 kali per menit, laju nafas 20 kali per menit dan suhu 36,7oC. Pada regio manus kanan ditemukan adanya edema dan bullae pada digiti III, teraba hangat dan terdapat nyeri tekan. Pada region antebrachii sampai humerus kanan juga ditemukan adanya edema dan nyeri tekan. Pasien mengalami anemia normokromik normositer dengan trombositopenia serta pemanjangan faal koagulasi, penurunan fibrinogen dan peningkatan D-dimer.Kesimpulan: Bisa ular dapat bersifat hemotoksik, neurotoksik dan sitotoksik. Kasus gigitan ular memerlukan penatalaksanaan yang cepat dan komprehensif sehingga dapat meminimalkan kemungkinan kecacatan dan kematian.

Perbandingan kadar Thyroid Stimulating Hormone (TSH) dan kadar Free T4 (FT4) antara metode Fluorescence Immunoassay (FIA) dan metode Electrochemiluminescence Immunoassay (ECLIA) di RSUP Sanglah, Bali, Indonesia Ekarini Katharina Yunarti Nabu; Sianny Herawati; Ni Kadek Mulyantari; Anak Agung Wiradewi Lestari; I Putu Yuda Prabawa
Intisari Sains Medis Vol. 12 No. 2 (2021): (Available Online: 1 August 2021)
Publisher : DiscoverSys Inc.

Background: Diagnostic and therapeutic cases of hyperthyroidism can be identified by examining the levels of Thyroid Stimulating Hormone (TSH) and Free T4 (FT4). There are several examination methods, namely the Fluorescence Immunoassay (FIA) and the Electro-Chemiluminescence Immunoassay (ECLIA) method. This study aims to evaluate the difference in TSH and FT4 level in the FIA method and ECLIA method.Method: This study used observational analytic methods cross sectional design, with 45 samples serum patient with hyperthyroid in January-March 2019. Examine level TSH and FT4 levels with FIA methods (NANO ENTEK FRENDTM) and ECLIA method (Cobas e601 ROCHE). Data were analyzed using SPSS version 17 for Windows.Results: Most of the respondents were aged 25-34 years (28.8%) and female (86.7%). There was no significant difference in the mean TSH level on examination using the ECLIA method (0.60±0.79 mIU/L) and the FIA method (0.63±0.76 mIU/L) (p=0.639). In addition, there was no significant difference in FT4 both in the examination using the ECLIA method (1.67±1.05 ng/dl) and the FIA method (1.69±1.72 ng/dl) (p=0.745).Conclusions: There was no significant difference between TSH and FT4 in both ECLIA and FIA methods. Latar Belakang: Diagnosis maupun pemantauan terapi kasus hipertiroid dapat diketahui dengan pemeriksaan kadar hormon Thyroid Stimulating Hormone (TSH) dan Free T4 (FT4). Terdapat beberapa metode pemeriksaan yaitu metode Fluorescence Immunoassay (FIA) dan metode Electro-Chemiluminescence Immunoassay (ECLIA). Penelitian ini bertujuan untuk mengevaluasi perbedaan kadar TSH dan FT4 metode FIA dan metode ECLIA.Metode: Penelitian ini menggunakan metode observasional analitik dengan desain potong lintang pada 45 sampel serum penderita hipertiroid selama periode Januari-Maret 2019. Dilakukan pemeriksaan kadar TSH dan FT4 dengan metode FIA (NANO ENTEK FRENDTM) dan metode ECLIA (Cobas e601 Roche). Data dianalisis dengan SPSS versi 17 untuk Windows.Hasil: Sebagian besar responden berusia 25-34 tahun (28,8%) dan berjenis kelamin perempuan (86,7%). Tidak terdapat perbedaan bermakna rerata kadar TSH pada pemeriksaan menggunakan metode ECLIA (0,60±0,79 mIU/L) maupun metode FIA (0,63±0,76 mIU/L) (p=0,639). Disamping itu, tidak juga terdapat perbedaan bermakna rerata kadar FT4 baik pada pemeriksaan menggunakan metode ECLIA (1,67±1,05 ng/dl) maupun metode FIA (1,69±1,72 ng/dl) (p=0,745).Kesimpulan: Tidak ada perbedaan yang bermakna antara kadar TSH dan FT4 pada metode ECLIA dan FIA.

Prognostic value of red cell distribution width-to-platelet ratio in mortality of major burn in Sanglah Hospital Bali Nyoman Siska Ananda; I Gusti Putu Hendra Sanjaya; Sianny Herawati; Agus Roy Rusly Hariantana Hamid; I Made Suka Adnyana; I Wayan Niryana
Intisari Sains Medis Vol. 13 No. 1 (2022): (Available Online : 1 April 2022)
Publisher : DiscoverSys Inc.

Introduction: The mortality rate in Sanglah Hospital due to major burns is quite high. The ratio of red cell distribution width (RDW) and platelet (PLT) (RPR) as a prognostic marker of mortality in major burns has never been studied in Indonesia. Calculations of RPR are easy, widely available and cost-efficient.Method: This study was retrospective observational case-control, with 60 patients with major burns consisting of 30 cases and 30 controls. Samples were taken from the Sanglah Hospital Medical Record Unit from April 2019 to April 2021. Cases were samples with mortality after day seven, while controls were samples that survived. RDW and PLT value on day seven are associated with the incidence of mortality.Results: The mean of RPR in the case group was higher than in the control group. RPR mean of the control group was 0.0559, and the case group was 0.0947 (p<0.001). The increase of RPR in the case group was 40.97%. Statistical analysis showed that high RPR was a significant mortality risk factor in patients with major burns (OR = 21.36; p < 0.001).Conclusion: High RPR is a prognostic marker of mortality in major burns at Sanglah Hospital.

Kadar Urine Urea Nitrogen (UUN) sebagai prediktor mortalitas pada pasien luka bakar >20% di RSUP Prof. Dr. I. G. N. G. Ngoerah Denpasar Grace Inriani Rongre; I Gusti Putu Hendra Sanjaya; Agustinus I Wayan Harimawan; Sianny Herawati
Intisari Sains Medis Vol. 13 No. 3 (2022): (In Press 1 December 2022)
Publisher : DiscoverSys Inc.

Background: Urine urea nitrogen (UUN) is an examination of nitrogen balance with the concept of calculating the amount of urea excreted through urine. The amount of urea that comes out of the urine is in line with the amount of protein breakdown in the body and the amount of protein that enters the body. This study aimed to evaluate UUN levels on days 1, 3 and 7 as a predictor of mortality in burn patients >20%. Methods: This study was an observational analytic retrospective study. Data were collected from January 2020 to December 2021. This study used secondary data from medical records of patients with IIAB-III degree burns with burn area > 20% TBSA treated at Prof. Dr. I. G. N. G. Ngoerah General Hospital for 2020-2021. Data were analyzed using SPSS version 21 for Windows. Results: The majority of burn patients were male, about 73.9%. The average age of burn patients is 48.26±15.95 years. On the first examination day, the UUN value was still low (29.4 mg/24 hours). Then on the 3rd day, there was an increase in the average UUN level, namely the maximum value of 61,987 mg/24 hours. Examination on the 7th day showed an increase in line with the previous day, namely the maximum value of 57,489 mg/24 hours. On day 1, the mean UUN value was higher in patients who died, while on days 3 and 7 the mean UUN level in patients with living outcomes was higher than in patients who died, but not significantly (p>0.05). Conclusion: Urine urea nitrogen levels on days 1, 3 and 7 in burn patients >20% at Prof. Dr. I. G. N. G. Ngoerah General Hospital showed an increasing trend. Urine urea nitrogen levels cannot be used to predict mortality in burn patients because the results were insignificant. Latar Belakang: Urin urea nitrogen (UUN) merupakan pemeriksaan keseimbangan nitrogen yang berkonsep pada perhitungan jumlah urea yang dieksresikan lewat urin. Jumlah urea yang keluar bersama urine sejalan dengan jumlah pemecahan protein dalam tubuh serta jumlah protein yang masuk dalam tubuh. Penelitian ini bertujuan untuk mengevaluasi kadar UUN hari ke-1,3, dan 7 sebagai prediktor mortalitas pasien luka bakar >20%. Metode: Studi ini merupakan studi retrospektif analitik observasional. Data dikumpulkan dari Januari 2020 hingga Desember 2021. Studi ini menggunakan data sekunder dari catatan rekam medis pasien luka bakar derajat IIAB-III dengan luas luka bakar > 20% TBSA yang dirawat di RSUP Prof. Dr. I. G. N. G. Ngoerah periode 2020-2021. Data dianalisis dengan SPSS versi 21 untuk Windows. Hasil: Mayoritas pasien luka bakar berjenis kelamin laki-laki yaitu sebesar 73,9%. Usia rata-rata pasien luka bakar yaitu 48,26±15,95 tahun. Pada pemeriksaan hari pertama didapatkan nilai UUN masih rendah (29,4 mg/24 jam). Kemudian pada hari ke-3 didapatkan peningkatan rata-rata kadar UUN yakni nilai maksimum 61.987 mg/24 jam. Pemeriksaan pada hari ke-7 menunjukkan peningkatan yang sejalan dengan hari sebelumnya yakni nilai maksimum 57.489 mg/24 jam. Pada hari ke-1, nilai rerata UUN lebih tinggi pada pasien meninggal, sedangkan pada hari ke 3 dan 7 kadar rerata UUN pasien dengan luaran hidup lebih tinggi dibandingkan pasien yang meninggal, namun tidak bermakna secara signifikan (p>0,05). Simpulan: Kadar UUN pada hari ke-1, 3 dan 7 pada pasien luka bakar >20% di RSUP Prof. Dr. I. G. N. G. Ngoerah menunjukkan adanya trend peningkatan. Kadar UUN tidak dapat dipakai sebagai prediktor mortalitas pada pasien luka bakar karena hasil tidak signifikan.

A child with Down Syndrome and Type 2 Diabetic Mellitus Betti Bettavia Hartama Pardosi; Sianny Herawati; Ni Kadek Mulyantari
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 28, No 3 (2022)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v28i3.1831

Down Syndrome (DS) is one of the common chromosomal disorders that raise mental retardation. It is known that DS patients have an autoimmune disorder affecting the endocrine and non-endocrine organs. It is a rare occurrence of type 2 Diabetes Mellitus (type 2 DM) disease in children with DS. Type 2 DM occurs due to impaired insulin secretion and excessive hepatic glucose production, unlike type 1 DM, caused by the destruction of ß-cells in autoimmune Langerhans. A 10-year-old girl patient was referred from Tabanan Hospital to Sanglah Hospital, Denpasar. Patients were admitted to the hospital with decreased consciousness, treated for four days, and observed in ICU for 2 days. Vomiting twice, no seizures, urinating normally. No significant past medical history was found. Physical examinations showed a typical Mongolian face, short neck, expanded occipital area, small eyes, and a mouth with a prominent tongue. Laboratory data revealed fasting blood glucose of 473 mg/dL and an HbA1C level of 12.6%. Urinalysis showed ketone 3+. The C-peptide test showed a reasonably good ß pancreas cell function. Down syndrome is associated with autoimmune diseases, including type 1 diabetes. The exact number of down syndrome cases with type 2 DM remains unknown; however, it was known that the case is infrequent.

Pancreatitis in Acute Lymphoblastic Leukemia Putu Yudi Adnyani; I Nyoman Wande; Sianny Herawati
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 28, No 3 (2022)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v28i3.1828

Pancreatitis is inflammation of the pancreatic parenchyma and diagnosed based on symptoms of heartburn accompanied by increased levels of pancreatic enzymes. Acute pancreatitis in acute lymphoblastic leukemia in addition to being caused by therapy can also be caused by other factors. 13-year-old female patient with a diagnosis of acute lymphoblastic leukemia complained of heartburn which was felt through to the back. Patients also experience nausea, vomiting, decreased appetite, difficulty in bowel movements, and fever. Physical examination found an increase in body temperature, anemic eyes, multiple neck gland enlargement, and enlargement of the liver. The results of complete blood tests showed leukocytosis, anemia, and thrombocytopenia. The results of examination of bone marrow aspiration show a picture of the bone marrow in accordance with acute lymphoblastic leukemia (ALL-L2). Clinical chemistry tests showed an increase in amylase, lipase, SGOT, BUN, creatinine, LDH, ferritin, calcium, and procalcitonin. The patient has never received chemotherapy for the ALL. Acute pancreatitis in ALL in addition to being caused by administration of leukemia can also be caused by sepsis conditions which are complications of the ALL. ALL patients who experience acute pancreatitis in this case show a poor prognosis.

Red Blood Cell Alloimmunization among the Transfusion Recipients at Sanglah General Hospital, Denpasar, Bali: A Preliminary Study Sianny Herawati; Usi Sukorini; Teguh Triyono
Journal of Global Pharma Technology Volume 10 Issue 07: (2018) July 2018
Publisher : Journal of Global Pharma Technology

Show Abstract | Download Original | Original Source | Check in Google Scholar

Background Red blood cell (RBC) alloimmunization is the formation of alloantibodies among the recipientswhich is related to the frequency of antigen-positive blood transfusion received by the recipient. The difficultyto obtain compatible RBC and a higher risk of hemolytic transfusion reactions due to alloimmunizationbecome a challenge in clinical practice. Objectives: This study aims to analyze the characteristics of RBCalloantibodies in the recipient following transfusion at Sanglah General Hospital, Bali, as a preliminary study.Methods A cross sectional study was conducted among 40 recipients with a history of RBC transfusion atleast 3 times and willing to participate in this study from December 2016 to March 2017 at Sanglah General Hospital. Data were analyzed using SPSS ver. 16 software to determine the prevalence of study. Resultsmost recipients were 46 – 65 years (55%). In addition, most recipients were caused by hematology disorder (57.5%), female (52.5%), and O-Rhesus D positive (52.5%). RBC alloantibodies detected in 5% of recipients,all of them were multiple alloantibodies, such as anti-K antibodies (5%), anti-Kp a (5%), anti-E (2.5%), anti-C w(2.5%), anti-Lu a (2.5%) and anti-M (2.5%). Those alloantibodies only found in 46 – 65 years age group.Conclusion the first preliminary study regarding RBC alloimmunization in Bali was found contributed by anti-K,anti Kp a , anti-E, anti-C w , anti-Lu a , and anti-M. The results suggest that erythrocyte antigen phenotypes can beperformed further, particularly the Kell antigen to prevent alloimmunization. However, future studies withbigger samples are needed to determine the incidence of RBCalloimmunization among transfusion recipients in Bali.Keywords: Alloimmunization, Red blood cells, Transfusion recipients.

Pancreatitis in Acute Lymphoblastic Leukemia Putu Yudi Adnyani; I Nyoman Wande; Sianny Herawati
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 28 No. 3 (2022)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v28i3.1828

Pancreatitis is inflammation of the pancreatic parenchyma and diagnosed based on symptoms of heartburn accompanied by increased levels of pancreatic enzymes. Acute pancreatitis in acute lymphoblastic leukemia in addition to being caused by therapy can also be caused by other factors. 13-year-old female patient with a diagnosis of acute lymphoblastic leukemia complained of heartburn which was felt through to the back. Patients also experience nausea, vomiting, decreased appetite, difficulty in bowel movements, and fever. Physical examination found an increase in body temperature, anemic eyes, multiple neck gland enlargement, and enlargement of the liver. The results of complete blood tests showed leukocytosis, anemia, and thrombocytopenia. The results of examination of bone marrow aspiration show a picture of the bone marrow in accordance with acute lymphoblastic leukemia (ALL-L2). Clinical chemistry tests showed an increase in amylase, lipase, SGOT, BUN, creatinine, LDH, ferritin, calcium, and procalcitonin. The patient has never received chemotherapy for the ALL. Acute pancreatitis in ALL in addition to being caused by administration of leukemia can also be caused by sepsis conditions which are complications of the ALL. ALL patients who experience acute pancreatitis in this case show a poor prognosis.

A child with Down Syndrome and Type 2 Diabetic Mellitus Betti Bettavia Hartama Pardosi; Sianny Herawati; Ni Kadek Mulyantari
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 28 No. 3 (2022)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v28i3.1831

Down Syndrome (DS) is one of the common chromosomal disorders that raise mental retardation. It is known that DS patients have an autoimmune disorder affecting the endocrine and non-endocrine organs. It is a rare occurrence of type 2 Diabetes Mellitus (type 2 DM) disease in children with DS. Type 2 DM occurs due to impaired insulin secretion and excessive hepatic glucose production, unlike type 1 DM, caused by the destruction of íŸ-cells in autoimmune Langerhans. A 10-year-old girl patient was referred from Tabanan Hospital to Sanglah Hospital, Denpasar. Patients were admitted to the hospital with decreased consciousness, treated for four days, and observed in ICU for 2 days. Vomiting twice, no seizures, urinating normally. No significant past medical history was found. Physical examinations showed a typical Mongolian face, short neck, expanded occipital area, small eyes, and a mouth with a prominent tongue. Laboratory data revealed fasting blood glucose of 473 mg/dL and an HbA1C level of 12.6%. Urinalysis showed ketone 3+. The C-peptide test showed a reasonably good íŸ pancreas cell function. Down syndrome is associated with autoimmune diseases, including type 1 diabetes. The exact number of down syndrome cases with type 2 DM remains unknown; however, it was known that the case is infrequent.

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