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All Journal BALI MEDICAL JOURNAL (BMJ) Buletin Udayana Mengabdi E-Jurnal Medika Udayana The Indonesian Biomedical Journal JBN (Jurnal Bedah Nasional) ISM (Intisari Sains Medis) : Jurnal Kedokteran Neurologico Spinale Medico Chirurgico Jurnal Ilmu Bedah Indonesia Indonesian Archives of Biomedical Research (InABR) Cermin Dunia Kedokteran Jurnal Neuroanestesi Indonesia Physical Therapy Journal of Indonesia Cermin Dunia Kedokteran

Sri Maliawan

Department Of Neurosurgery, Faculty Of Medicine Udayana University/Sanglah General Hospital, Bali-Indonesia

Author-ID : 2936111

Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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Sulforaphane as a potential therapy for multiple sclerosis: a review article Gede Febby Pratama Kusuma, Pratama Kusuma; Kadek Dede Frisky Wiyanjana; Sri Maliawan
Indonesian Archives and Biomedical Sciences Vol 1 No 2 (2021): Indonesian Archives of Biomedical Research (InABR). 1(2): 2021
Publisher : Konsorsium Ilmu Biomedik Indonesia (KIBI)

Multiple Sclerosis (MS) is a chronic immune-mediated Neuroinflammatory disease that attacks the Central Nervous System (CNS). It creates serious physical disabilities characterized by neuronal injury, demyelination, and axonal loss. Several mechanisms are responsible for the progression of MS, including the infiltration of T-cells from the peripheral to the CNS, the autoreactivity of B-cells that contribute to abnormal regulation of antibodies and antigen presentation, and the assault of Macrophage that lead to inflammation and neuron damage. Additionally, oxidative stress plays a more important role in chronic inflammation of MS. Sulforaphane (SFN) is an isothiocyanate derived from glucoraphanin (GRA) that is found mostly in broccoli. SFN can act as an anti-inflammatory and anti-oxidant agent by activating the Nuclear factor-erythroid 2-(NF-E2-) Related Factor 2 (Nrf2). Nrf2 is expressed in the central nervous system and upregulated in response to inflammation and cerebral insults. Nrf2 binds to the antioxidant response element (ARE) which is a DNA promoter region of genes codifying antioxidant enzymes, which in turn can reduce oxidative stress. Several in vitro and in vivo studies show that SFN can increase the anti-inflammatory and anti-oxidant genes. Thus, SFN is very promising as a potential therapy for MS.

Kranioplasti untuk Kasus Cedera Kepala Wayan Niryana; Dewa Putu Wisnu Wardhana; Heru Sutanto Koerniawan; Sri Maliawan
Cermin Dunia Kedokteran Vol 45, No 8 (2018): Alopesia
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v45i8.635

Seiring kemajuan teknik operasi bedah saraf, jumlah pasien cedera kepala yang mampu selamat pasca kraniektomi dekompresi meningkat signifikan. Pasien-pasien tersebut selanjutnya akan menjalani kranioplasti untuk memperbaiki defek kranium. Keuntungan lain prosedur kranioplasti antara lain: menyediakan proteksi otak, pencegahan atau eliminasi kolapsnya hemisfer otak atau herniasi serebri yang disebut sindrom pasca trepanasi. Hingga saat ini belum ada material ideal untuk kranioplasti.Advances in neurosurgery techniques will increase decompressive craniectomy survivors significantly. These patients will undergo cranioplasty to correct the cranium defects. Cranioplasty has other advantages : to provide brain protection, to prevent or to eliminate brain hemisphere collapse or cerebral herniation called post trephine syndrome. There is no truly ideal material for cranioplasty until now.

Biomechanics Among Various Techniques of the Cervical Laminoplasty Dewa Putu Wisnu Wardhana; Tjokorda Gde Bagus Mahadewa; Sri Maliawan
Neurologico Spinale Medico Chirurgico Supplementary Issue - Conference Abstracts
Publisher : Indoscholar

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

The nature of cervical spine motions consists of multiple components of the cervical spine, intervertebral disc, ligaments, and adjacent facet joints. Cervical spinal stenosis is disabling and this chronic degenerative disorder commonly occurs in middle age-elderly persons. Surgical options for those spinal cord disorders generally are the anterior or posterior approach. Historically, a conventional multi-level laminectomy was performed to decompress the spinal cord but there is a high rate of late biomechanical complications such as segmental instability, and kyphosis. Laminoplasty was developed to relieve the spinal cord compression and maintain the posterior elements. Lately, there are various techniques of the cervical laminoplasty, the biomechanical impact of these techniques will be described.

Spinal Schwannoma as Pregnancy Related Spinal Tumor Kadek Dede Frisky Wiyanjana; Kevin Kristian Putra; Sri Maliawan; I Made Gotra
Neurologico Spinale Medico Chirurgico Vol 2 No 3 (2019)
Publisher : Indoscholar

Spinal schwannoma is the most common benign spinal tumors that originated from peripheral nerve sheath tumors. Male and females are equally affected. Due to hormonal imbalance during pregnancy, it might affect the release of the tumor-growth factor. The symptoms usually start with pain and sensory loss at the spinal cord level. We report a case of thoracolumbar schwannoma with a history of chronic low back pain since post-pregnancy. A Thirty-Seven years old female, suffered chronic low back pain for 3 years since she had a pregnancy. In the last 4 months, she suffered paresis and tingling sensation on the right foot. MRI shown intradural mass at Th 12 – L2. Biopsy, tumor resection, and laminectomy were performed to do the histopathology analysis, resect, and stabilization. Histopathology examination revealed Schwannoma types. The patient was discharged three days after complete tumor resection and stabilization, with an improvement of neurological function. Spinal Schwannoma can occur as a Pregnancy-related spinal tumor (PRST), it can be diagnosed during pregnancy or within a year after delivery. The incidence is rare, therefore proper workup and early examination are needed and followed by careful and considerate treatment.

PENYULUHAN KESEHATAN PENTINGNYA PENGGUNAAN SEAT BELT PADA PEMOBIL UNTUK MENCEGAH TERJADINYA CEDERA TULANG BELAKANG T.G.B Mahadewa; S. Maliawan; N. Golden; I.W. Niryana; D.P.W. Wardhana; S. Awyono; K.K. Putra
Buletin Udayana Mengabdi Vol 21 No 2 (2022): Buletin Udayana Mengabdi
Publisher : Lembaga Penelitian dan Pengabdian kepada Masyarakat

The increased population is followed by an increase quantity of vehicles, therefore increased number of vehicles accidents could happen. Other than mortality rate, other issue that might occur was due to spinal cord injury. Spinal cord injury was not only causing health and medical problem, but socio-economic and psychology morbidity for the patients and family. The general concept of neurosurgery is to applied the principles of science with holistic approach and comprehensively. The comprehensive principle means that the sciences do not only emphasize the curative side, but also on the promotive, preventive and rehabilitative aspects. One of the promotive and preventive aspect that can be done is to provide education to the public about healthy lifestyles so that people can avoid a condition that might cause health morbidity. Bedah Saraf Bersama Masyarakat held by Neurosurgery Residency Programme FK UNUD/Sanglah Hospital is one of the community service activities. In an effort to prevent spinal cord injuries for drivers, the Neurosurgery Residency Programme, FK UNUD/Sanglah Hospital decided to held an interactive talkshow as public health promotion, for the importance of using seatbelts for drivers. The general purpose of this program is to provide information and education, especially in prevention of diseases in the field of neurosurgery to the community. Keywords: Spine, spinal cord injury, public health promotion, seatbelt.

Gangguan pola bangun-tidur setelah cedera kepala Moses Kharisma Setyawan; Sri Maliawan; Tjokorda Gde Bagus Mahadewa; I Wayan Niryana; Dewa Putu Wisnu Wardhana
Intisari Sains Medis Vol. 12 No. 2 (2021): (Available Online: 1 August 2021)
Publisher : DiscoverSys Inc.

Traumatic brain injury is a common trauma. Traumatic brain injury is commonly followed by sleep disorder such as insomnia, hypersomnia and circadian rhythm disturbance. Sleep disorder can cause many complications, including the worsening of the brain injury prognosis. Insomnia occurs in 29% traumatic brain injury patient. Insomnia suspected due injury in inferior frontal, anterior temporal including basal forebrain, also sympathetic nerve hyperactivity. Insomnia increase the risk of stroke, disability and mood disturbance. Hypersomnia occurs in 28% traumatic brain injury patients. Hypersomnia suspected due orexin decrease and injury in sleep promoting area. Hypersomnia suspected related to recovery, less activity time and accident due sleepiness. There are no prevalence data of circadian rhythm disturbance after traumatic brain injury. This disturbance is caused by injury in supra-chiasmatic nucleus and related to global worsening on the patient. Insomnia and circadian rhythm disturbance are highly linked with injury area, but hypersomnia is not particularly linked to any area and only related to orexin decrease. Insomnia and circadian rhythm disturbance are highly related to the worsening condition on the patient, but hypersomnia is associated with recovery and not particularly related to any disturbances. It is hoped that understanding the sleep disorder after traumatic brain injury can rise the alertness of this matter and encourage clinicians to increase the quality of sleep disorder due to traumatic brain injury management. Cedera kepala merupakan salah satu cedera yang umum terjadi. Cedera ini sering diikuti dengan gangguan tidur seperti insomnia, hipersomnia dan gangguan ritme sirkadian. Gangguan ini sering dapat menyebabkan berbagai komplikasi termasuk memperparah penyembuhan cedera kepala. Insomnia setelah cedera kepala terjadi sebanyak 29%. Insomnia diduga disebabkan oleh cedera pada daerah inferior frontal, anterior temporal termasuk basal otak depan, juga peningkatan kerja saraf simpatis. Insomnia meningkatkan resiko stroke, disabilitas dan gangguan suasana hati. Hipersomnia setelah cedera kepala terjadi sebanyak 28%. Hipersomnia diduga akibat penurunan orexin dan akibat kerusakan pada area yang mempertahankan bangun. Hipersomnia diduga berhubungan dengan penyembuhan, waktu tersita akibat tidur dan kecelakaan akibat mengantuk. Belum ada data prevalensi gangguan ritme sirkadian setelah cedera kepala. Gangguan ini disebabkan oleh cedera pada nukleus suprakiasmatik dan sering dikaitkan dengan perburukan kondisi pasien. Insomnia dan gangguan ritme sirkadian sering dihubungkan dengan lokasi tertentu dari cedera, namun hipersomnia berhubungan dengan kadar orexin dan tidak terlalu dikaitkan terhadap area tertentu. Insomnia dan gangguan ritme sirkadian berhubungan dengan perburukan, namun hipersomnia bisa menandakan perbaikan dan tidak berhubungan signifikan dengan gangguan lainnya. Diharapkan dengan memahami gangguan tidur ini dapat meningkatkan kewaspadaan bagi para klinisi dan mendorong untuk penelitian berikutnya sehingga penanganan pasien gangguan tidur akibat cedera kepala dapat menjadi lebih baik.

Faktor risiko yang mempengaruhi outcome pada pasien cedera kepala di RSUP Sanglah, Bali, Indonesia pada tahun 2018-2019 I Gede Sutawan; Sri Maliawan; I Wayan Niryana
Intisari Sains Medis Vol. 12 No. 2 (2021): (Available Online: 1 August 2021)
Publisher : DiscoverSys Inc.

Background: Head injury or capitis trauma is a blunt/sharp force to the head or face resulting in temporary or persistent cerebral dysfunction. From a socio-economic point of view, the prognostic model by looking at baseline data on admission is an important factor in supporting cost-effective clinical decisions. This study aims to evaluate the risk factors that influence outcomes in head injury patients at Sanglah Hospital, Bali, Indonesia, in 2018-2019.Method: Prospective cohort study to see the effect of risk factors for head injury patients (exposure) with the outcome in the form of unfavorable conditions within 7 days. This research was conducted at the Surgery Department and Emergency Room Sanglah Hospital Denpasar- Bali for 6 months from September 2018-February 2019. Data were analyzed using SPSS version 16 for Windows.Results: Some of the factors significantly associated with and risk factors for the unfavorable outcome within 7 days in head injury patients who were treated at Sanglah General Hospital in 2018-2019 were hypotension, initial GCS 3-8, anisocoria pupil reflex, hypoxia, focal lesions, midline shift, and length of time operation ? 6 hours (p<0.05). Hypotensive blood pressure is the most dominant risk factor for the unfavorable outcome within 7 days of head injury patients admitted to Sanglah General Hospital (Adjusted OR: 5.4; 95% CI: 2.47-12.07; p=0.000).Conclusion: Hypotensive blood pressure is the most dominant risk factor for the unfavorable outcome within 7 days of head injury patients treated at Sanglah General Hospital in 2018-2019. Latar belakang: Cedera kepala atau trauma kapitis merupakan kekerasan tumpul/tajam pada kepala atau wajah yang berakibat disfungsi serebral sementara atau menetap. Dari sudut pandang sosioekonomi, model prognostik dengan melihat data awal saat masuk rumah sakit merupakan faktor penting dalam mendukung keputusan klinis yang cost-effective. Penelitian ini bertujuan untuk mengevaluasi faktor risiko yang mempengaruhi outcome pada pasien cedera kepala di RSUP Sanglah, Bali, Indonesia pada tahun 2018-2019Metode: Studi kohort prospektif untuk melihat pengaruh faktor resiko yang dimiliki pasien cedera kepala (exposure) dengan hasil luaran (outcome) berupa kondisi unfavourable dalam 7 hari. Penelitian ini dilakukan di Bagian Bedah FK UNUD/SMF Bedah Saraf RSUP Sanglah, Denpasar-Bali dan Instalasi Rawat Darurat RS Sanglah Denpasar-Bali selama 6 bulan dari bulan September 2018-Februari 2019. Data dianalisis menggunakan SPSS versi 16 untuk Windows.Hasil: Beberapa faktor yang berhubungan secara bermakna dan menjadi faktor risiko terjadinya outcome unfavorable dalam 7 hari pada pasien cedera kepala yang dirawat di RSUP Sanglah tahun 2018-2019 adalah hipotensi, GCS awal 3-8, reflek pupil anisokor, hipoksia, fokal lesi, midline shift, dan lama waktu tindakan operasi ? 6 jam (p<0,05). Tekanan darah hipotensi merupakan faktor risiko yang paling dominan terhadap outcome unfavorable dalam 7 hari pasien cedera kepala yang dirawat di RSUP Sanglah (Adjusted OR: 5,4; 95% IK: 2,47-12,07; p=0,000)Kesimpulan: Tekanan darah hipotensi merupakan faktor risiko yang paling dominan terhadap outcome unfavorable dalam 7 hari pasien cedera kepala yang dirawat di RSUP Sanglah tahun 2018-2019.

Description of hydrocephalus knowledge in pregnant woman at Puskesmas 1 Denpasar Utara Made Indra Erlangga Prathiwindya; I Wayan Niryana; Tjokorda Gde Bagus Mahadewa; Sri Maliawan
Intisari Sains Medis Vol. 13 No. 1 (2022): (Available Online : 1 April 2022)
Publisher : DiscoverSys Inc.

Background: Hydrocephalus is a pathological brain disorder resulting from increased cerebrospinal fluid without or with elevated intracranial pressure resulting in widening of the space where cerebrospinal fluid flows. Maternal environment such as experiencing infection during pregnancy, consuming alcohol and drugs, lifestyle such as obesity, diabetes, or hypertension, and lack of examinations in preparing for prenatal care and low socioeconomic status affect the risk factors for congenital hydrocephalus. The purpose of this study is to to determine awareness and knowledge level among pregnant women towards hydrocephalus. Methods: This descriptive research was conducted with a cross-sectional method using consecutive sampling as a sampling technique. 106 Pregnant Women at Puskesmas I Denpasar Utara was involved in completing the survey regarding Hydrocephalus during this research. For the collecting data using a questionnaire filled directly by each respondent containing 9 questions and then analyzed using the software Statistical Package for the Social Sciences (SPSS). Results: This study was participated by 106 respondents and figured that approximately 84,9% among the total number of respondents have a good knowledge of hydrocephalus while the rest, 15,1% are still at a low level with common characteristics of the respondents, including the age of 24 years old (age group 19-25), multipara (59.4%), with a college education background (45.3%), and working as a housewife (59.4%). Conclusion: This study conveys good knowledge about hydrocephalus in pregnant women, especially those who have a good level of education.

The role of Bone Morphogenetic Protein-2 in craniofacial osteogenesis: A literature review I Gusti Putu Hendra Sanjaya; Sri Maliawan
Intisari Sains Medis Vol. 13 No. 2 (2022): (In Press : 1 August 2022)
Publisher : DiscoverSys Inc.

Bone Morphogenetic Protein (BMP) is a type of growth factor that belongs to the Transforming Growth Factor Beta (TGF-B) group. Bone Morphogenetic Protein-2 (BMP-2) is recognized as one of the first commercially available osteoblast inductors. When new bone is needed, mesenchymal stem cells can develop into osteoblasts, which then implant as osteocytes in the bone, providing additional structure and support. The principal agent that differentiates stem cells into osteoblasts is BMP-2. BMP-2 will be released into the bone matrix or serum in performing their job. BMP-2 activates the SMAD1/5/8 signal via mediating the physiological action of type I and II serine/threoninekine receptors. The active SMAD protein will form a complex with the SMAD4 protein, translocate DNA to the nucleus, and bind to particular genes like Dlx-2/5, Osx, and transcription. According to a recent study, BMP-2 boosts osteogenic growth. BMPs are effective in the treatment of craniofacial defects in current research. The subjects of this paper are the molecular mechanism of BMPs and their involvement in the clinical application of craniofacial deformity patients.

Kranioplasti untuk Kasus Cedera Kepala Wayan Niryana; Dewa Putu Wisnu Wardhana; Heru Sutanto Koerniawan; Sri Maliawan
Cermin Dunia Kedokteran Vol. 45 No. 8 (2018): Dermatologi
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v45i8.744

Seiring kemajuan teknik operasi bedah saraf, jumlah pasien cedera kepala yang mampu selamat pasca-kraniektomi dekompresi meningkat signifikan. Pasien-pasien tersebut selanjutnya akan menjalani kranioplasti untuk memperbaiki defek kranium. Keuntungan lain prosedur kranioplasti antara lain: menyediakan proteksi otak, pencegahan, atau eliminasi kolapsnya hemisfer otak atau herniasi serebri yang disebut sindrom pasca-trepanasi. Hingga saat ini belum ada material ideal untuk kranioplasti. Advances in neurosurgery techniques will increase decompressive craniectomy survivors significantly. These patients will undergo cranioplasty to correct the cranium defects. Cranioplasty has other advantages: to provide brain protection, to prevent, or to eliminate brain hemisphere collapse or cerebral herniation called post trephine syndrome. There is no truly ideal material for cranioplasty until now.

Co-Authors A.A. Gde Oka A.A. Ngr. Agung Wistara Widya AA GN Asmara Jaya AAGN Asmarajaya Agung Bagus S. Satyarsa Andi Asadul Islam Arasy, Mohd Firdaus Astawa N. M., Astawa N. Astawa P., Astawa B. Sinaga D.P.W. Wardhana Dewa Putu Wisnu Wardhana Dian Megasafitri Dwikinta, Made Anindya Eka J. Wahjoepramono Ekaputra Ekaputra, Ekaputra G. I. B Bomba Gatot S. Lowrence, Gatot S. Gde Rastu Adi Mahartha Gede Febby Pratama Kusuma Gede Wirya Kusuma Duarsa Gunawan, Made Favian Budi Hamsu Kadriyan I Dewa Made Sukrama I Gede Sutawan I Gusti Agung Bagus Krisna Wibawa I Gusti Ayu Agung Laksemi I Gusti Kamasan Arijana I Gusti Putu Hendra Sanjaya I Ketut Suyasa I Ketut Wiargitha I Made Arya Winangun I Made Bakta I Made Gotra I Made Jawi I Made Stepanus Biondi Pramantara I Nyoman Semadi I W. Sudarsa I Wayan Gede Artawan Eka Putra I Wayan Niryana I Wayan Putu Sutirta Yasa I. B. Tjakra Wibawa Manuaba Ida Bagus Adi Kayana Ilhamjaya Patellongi Iwan Antara Suryadi Johansyah, Theodorus Kevin Putra K.K. Putra Kadek Dede Frisky Wiyanjana Kadek Dede Frisky Wiyanjana Ketut Putu Yasa Ketut Siki Kawiyana Kevin Kristian Putra Koerniawan, Heru Sutanto Komang Ayu Vitriana Gamayanti L. K. Widnyani Wulan Laksmi L. R. M. Lengkong M Wiryana Made Agus Mahendra Inggas, Made Agus Mahendra Made Indra Erlangga Prathiwindya Made Putri Hendaria Mardliyah, Mumtazah Moses Kharisma Setyawan Ni Ketut Susilawati Ni Luh Putu Julita Yanti Ni Putu Enny Pratiwi Suardi Ni Wayan Ariani Vitriasari Niryana, , I Wayan Nyoman Golden Putu Anda Tusta Adiputra Putu Indah Budi Apsari Putu Pramana Suarjaya Putu Primeriana Nugiaswari Raka-Sudewi A. A. Reni Widyastuti Romdhoni, Achmad Chusnu S. Awyono Satoto D., Satoto Setiawan, I Gede Budhi Sista Satyarsa, Agung Bagus Sista Soetomo, Cindy Thiovany Stanley-Ketting Oliver Suryadi N. T., Suryadi N. Tiffany, Tiffany Tjokorda Gde Agung Senapathi Tjokorda Gde Bagus Mahadewa W. A., W. Wayan Suardana Willy Adhimarta Wiryana M., Wiryana Yutina Himawan

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