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All Journal BALI MEDICAL JOURNAL (BMJ) Buletin Udayana Mengabdi E-Jurnal Medika Udayana Jurnal Kedokteran Diponegoro MNJ (Malang Neurology Journal) The Indonesian Biomedical Journal JBN (Jurnal Bedah Nasional) ISM (Intisari Sains Medis) : Jurnal Kedokteran Jurnal Plastik Rekonstruksi Neurologico Spinale Medico Chirurgico Jurnal Ilmu Bedah Indonesia Cermin Dunia Kedokteran Jurnal Neuroanestesi Indonesia Cermin Dunia Kedokteran

I Wayan Niryana

Bagian SMF Ilmu Bedah RSUP Sanglah Fakultas Kedokteran Universitas Udayana

Author-ID : 2936114

Biochemistry, Genetics & Molecular Biology Civil Engineering, Building, Construction & Architecture Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health Other

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Karakteristik kanker payudara usia muda di Subbagian Bedah Onkologi Rumah Sakit Umum Pusat Sanglah tahun 2014-2016 Putu Diahpradnya Oka Partini; I Wayan Niryana; Putu Anda Tusta Adiputra
Intisari Sains Medis Vol. 9 No. 1 (2018): (Available online: 1 April 2018)
Publisher : DiscoverSys Inc.

Latar Belakang: Kanker payudara merupakan jenis kanker yang paling sering terjadi pada wanita. Kasus kanker payudara pada usia muda (dibawah 40 tahun) cenderung memiliki presentase yang lebih rendah diantara usia tua, namun memiliki prognosis yang lebih buruk. Penelitian ini dilakukan untuk mengetahui karakteristik kanker payudara usia muda di Sub Bagian Bedah Onkologi Rumah Sakit Umum Pusat Sanglah tahun 2014-2016 berdasarkan stadium, subtipe, dan jenis histopatologi.Metode: Penelitian ini merupakan penelitian deskriptif dengan desain cross sectional, yang datanya diperoleh dari data register pasien kanker payudara di RSUP Sanglah dan diolah menggunakan aplikasi SPSS.Hasil: Hasil penelitian menunjukkan, jumlah pasien kanker payudara usia muda (<40 tahun) adalah sekitar 72 orang (14%) dari total 514 pasien kanker payudara. Rentang usia muda terbanyak adalah pada rentang usia 35-39 tahun yaitu sekitar 34 orang (47.2%). Stadium kanker payudara usia muda terbanyak adalah stadium IIIB dan IV masing-masing sebesar 19 orang (26.4%). Jenis histopatologi kanker payudara usia muda terbanyak adalah karsinoma duktal invasif sebesar 61 orang (84.7%). Subtipe kanker payudara usia muda terbanyak adalah Luminal B sebesar 31 orang (43.1%).Simpulan: Karakteristik Kanker Payudara Usia Muda di Subbagian Bedah Onkologi Rumah Sakit Umum Pusat Sanglah cenderung mirip dengan penelitian-penelitian yang pernah dilakukan sebelumnya, meskipun beberapa variabel yang menunjukkan angka persentase yang berbeda dengan penelitian-penelitian sebelumnya.

Gambaran stadium dan jenis histopatologi kanker payudara di Subbagian Bedah Onkologi RSUP Sanglah Denpasar tahun 2015-2016 I Gde Made Satya Wangsa Satya Wangsa; I Wayan Niryana; Putu Anda Tusta Adiputra Anda Tusta Adiputra; Ni Putu Ayu Pande Arista Dewi
Intisari Sains Medis Vol. 9 No. 1 (2018): (Available online: 1 April 2018)
Publisher : DiscoverSys Inc.

Latar Belakang: Kanker payudara merupakan suatu penyakit neoplasma yang ganas dimana pada jaringan parekim terdapat pertumbuhan jaringan payudara abnormal yang bersifat infiltratif dan desktruktif serta dapat bermetastase. Tingginya kasus kanker payudara di Indonesia, tidak selalu diikuti oleh penentuan stadium klinis dan histopatologi secara lengkap, padahal penentuan stadium klinis dan histopatologi diperlukan untuk menentukan diagnosis dan tata laksana lebih lanjut. Pengetahuan mengenai gambaran stadium dan jenis histopatologi juga menjadi salah satu indikator penting dalam penentuan prognosis kanker payudara.Metode: Penelitian ini merupakan penelitian deskriptif dengan pendekatan potong lintang (cross-sectional), yang datanya didapatkan dari data rekam medis di RSUP Sanglah dengan subjek penelitian pasien yang terdiagnosis kanker payudara pada tahun 2015-2016 kemudian diolah dan dianalisis dengan bantuan software SPSS.Hasil: Berdasarkan stadium, pasien kanker payudara dengan stadium EBC (Early Breast Cancer) sebanyak 30,08% dengan 2,95% pasien stadium I, 13,39% stadium IIA, 13,73% stadium IIB. Pasien terdiagnosis dengan stadium LABC (Locally Advance Breast Cancer) berjumlah 273 (47,47%) pasien dengan secara berturut-turut 14,78%, 30,95% dan 1,73% pasien stadium IIIA, IIIB dan IIIC. Pada penelitian ini juga tercatat sebanyak 129 (22,43%) pasien dengan kanker payudara yang sudah metastasis (stadium IV). Berdasarkan histopatologi, sebanyak 483 (84%) pasien dengan karsinoma duktal invasif, 61(10,60%) pasien dengan karsinoma lobular invasif, dan 31 (5,40%) pasien dengan karsinoma tipe lain.Simpulan: Hasil penelitian ini didapatkan bahwa pasien yang terdiagnosis kanker payudara di RSUP Sanglah pada tahun 2015-2016 sebanyak 575 pasien dengan stadium kanker payudara terbanyak adalah Locally Advance Breast Cancer (LABC) (Stadium IIIA, IIIB, IIIC) dengan jumlah 273 (47,47%) pasien. Jenis histopatologi kanker payudara terbanyak adalah karsinoma duktal invasif dengan jumlah 483 (84%) pasien.

Profil kepadatan tulang wanita menopause di RSUP Sanglah Denpasar pada tahun 2017 Ellintang Charisma Dewi; IGL Ngr Agung Artha Wiguna; I Wayan Niryana
Intisari Sains Medis Vol. 11 No. 2 (2020): (Available online: 1 August 2020)
Publisher : DiscoverSys Inc.

Background: Bone is a living tissue in the body that will continue to grow. A decrease in bone mass is identified from bone density and changes in bone structure. In addition to the growth process, bone is also regenerated. The process is affected by hormones. However, in menopause, resorption exceeds formation resulting in loss of bone mass and the risk of osteoporosis. Quoted from WHO, there are about 200 million people suffering from osteoporosis worldwide. Osteoporosis prevalence in Indonesia in 2004 reached 19.7%.Aim: The general purpose of this study was to determine profile of bone density in menopause women at General Hospital Sanglah Denpasar in 2017.Methods: This study used a prospective observational design with an interview approach. The research was conducted in Obgyn Polyclinic General Hospital Sanglah in August 2017. Instrument used in the form of Sonost 3000-Quantitative Ultrasound BMD, performed on the bone of calcaneus. Statistical analysis was done using SPSS.Results: The results of 100 samples of menopausal women showed that the average age of the sample was 52.2 years old, the average of last menstrual period was 7 years, most were Balinese ethnic (84%), most had last education status in the form of college (34%), most were not working (42%), and most had history of cervical cancer (49%).Conclusion: The average T-score was -1.7 with the highest proportion of osteopenia, followed by normal bone density and osteoporosis. Menopausal women with osteopenia has the most of normal BMI (37%), while the percentage of menopausal women with osteoporosis is 13%.Â Â Latar belakang: Tulang merupakan jaringan hidup dalam tubuh yang terus menerus akan mengalami pertumbuhan. Penurunan massa tulang diidentifikasikan dari kepadatan tulang dan perubahan struktur tulang. Selain proses pertumbuhan, tulang juga mengalami regenerasi. Proses tersebut dilakukan oleh hormon. Namun pada menopause, resorpsi melebihi pembentukan yang mengakibatkan hilangnya massa tulang dan risiko terjadinya osteoporosis. Dikutip dari WHO, ada sekitar 200 juta orang yang menderita osteoporosis di seluruh dunia. Prevalensi osteoporosis di Indonesia pada tahun 2004 mencapai 19,7%.Tujuan: Tujuan umum penelitian ini adalah untuk mengetahui profil kepadatan tulang wanita menopause di RSUP Sanglah Denpasar pada tahun 2017.Metode: Desain penelitian ini menggunakan rancangan observasional prospektif dengan pendekatan wawancara. Penelitian dilakukan di Poliklinik Obgyn RSUP Sanglah pada bulan Agustus 2017. Instrumen yang digunakan berupa BMD Sonost 3000-Quantitative Ultrasound, yang dilakukan pada tulang calcaneus. Analisa data secara statistik menggunakan SPSS.Hasil: Hasil penelitian dari 100 orang sampel menunjukkan bahwa rata-rata usia sampel wanita menopause yaitu 52,2 tahun, dengan rata-rata riwayat menstruasi terakhir 7 tahun, memiliki suku Bali 84%, dengan status pendidikan terakhir berupa perguruan tinggi sebanyak 34%, tidak bekerja sebanyak 42%, dan memiliki riwayat penyakit terbanyak berupa kanker serviks yaitu 49%.Kesimpulan: Dari hasil T-score, didapatkan rata-rata T-score yaitu -1.7 dengan proporsi terbanyak adalah wanita dengan osteopenia, diikuti dengan kepadatan tulang normal dan osteoporosis. Wanita menopause dengan osteopenia memiliki IMT normal terbanyak (37%), dan wanita menopause dengan osteoporosis memiliki IMT normal sebanyak 13%.

Karakteristik Pasien Melanoma Maligna di Subbagian Bedah Onkologi RSUP Sanglah Tahun 2015-2016 Gusti Ngurah Agung Adi Paramartha; I Wayan Niryana; Putu Anda Tusta Adiputra
Intisari Sains Medis Vol. 10 No. 2 (2019): (Available online: 1 August 2019)
Publisher : DiscoverSys Inc.

Background: Malignant melanoma (MM) is one of the skin malignancies derived from melanocyte cells. It is the most common cause of death, about 75% of all cases of skin cancer. Skin cancer is ranked fourth among the ten most common tumors in Bali.Aim: To know the characteristics of malignant melanoma patients in the sub-section of surgical oncology Sanglah Hospital Year 2015-2016.Method: This study is cross-sectional descriptive research conducted at Sanglah General Hospital in Denpasar. The data obtained in the form of secondary data, patient medical records, as of 2015 till 2016. Data were analyzed using the SPSS program.Result and Conclusion: The results showed that of 11 patients, incidence with the highest proportion of patients with age range 45-59 years number of 4 people (36.3%). The most top gender was women of 6 (54.5%). The highest subtype of Nodular Melanoma (NM) was 7 (63.6%).

The oxidative-stress level determine patientâ€™s outcomes with a severe head injury at Sanglah General Hospital, Denpasar, Indonesia I Made Bagus Wirawan; I Nyoman Golden; I Wayan Niryana
Intisari Sains Medis Vol. 10 No. 1 (2019): (Available online 1 April 2019)
Publisher : DiscoverSys Inc.

Background: In secondary brain injury, oxidative stress will occur due to a balance disorder between pro-oxidants with antioxidants. The antioxidant activity that is often used to assess oxidative stress, such as malondialdehyde (MDA), is superoxide dismutase (SOD) and glutathione peroxidase (GPx). This study aims to evaluate the level of oxidative stress, reflected by the MDA serum level and SOD level to determine the outcomes of patients with severe head injury.Method: A cross-sectional analytic study was conducted among 40 patients with severe head injury within 24 hours post-trauma at Emergency Ward, Surgery Department, Sanglah General Hospital Denpasar from January - June 2017. MDA and SOD levels were assessed using ELISA at Clinical Pathology Laboratory, Sanglah General Hospital. Data were analyzed using SPSS ver. 16 software. Results: This study found significant differences on elevated MDA levels (p-value < 0.05) in patients who died or had a persistent vegetative state, patients with severe disability and those with a good recovery/moderate disability. The statistical analysis also found a significant difference in MDA serum levels among patient with severe disability and patients with a good recovery/moderate disability (P=0,028). Meanwhile, there was no significant correlation between SOD serum levels and patients outcome (P>0.05).Conclusion: Increased MDA serum levels is a significant factor in predicting outcomes of patients with severe head injury.

The understanding of using universal precaution in medical student, ca-assistant and resident in the Faculty of Medicine, Universitas Udayana, Bali-Indonesia Tham Hong Yuan; I Wayan Niryana; Putu Anda Tusta Adiputra; Made Agus Dwianthara Sueta
Intisari Sains Medis Vol. 11 No. 2 (2020): (Available online: 1 August 2020)
Publisher : DiscoverSys Inc.

Introduction: This study was reported that among medical students, Co-Assistant (Co-Ass) and resident, several factors such as the academic overload in addition to the studentsâ€™ non-school activities might contribute to this situation. There is a lack of universal precaution studies among Universitas Udayana students in Bali and in Sanglah Hospital. Thus, the aim of this descriptive study was to examine the understanding of using universal precaution among three categories of students as well as doctors in Universitas Udayana.Method: Study design using a cross sectional model. Data were obtained from 90 current university students and doctors.Result: The highest questionnaire overall scores were obtained was 83 and the lowest scores were 43. The understanding of PPE among medical students, Co-Ass, resident significantly differ in the understanding of PPE (p<0.001). Resident is significantly different (p<0.001) than the other two groups, but there is no significant difference between the Co-Ass and Medical students.Conclusion: This study provides an overall understanding of universal precautions among medical students, Co-Ass and resident in Universitas Udayana. Findings will serve as a basis for future researchers to conduct future intervention studies.

Factors associated with unfavourable outcome after Burr Hole drainage in Subdural Hematoma (SDH) at Sanglah General Hospital, Bali, Indonesia I Gusti Ngurah Purnomo; I Wayan Niryana; Nyoman Golden
Intisari Sains Medis Vol. 11 No. 2 (2020): (Available online: 1 August 2020)
Publisher : DiscoverSys Inc.

Background: Subdural hematoma is a neurosurgical disorder that often occurs in the elderly with simple, relatively fast and minimally invasive surgical therapy, but has a high postoperative mortality rate due to unfavourable outcome. This study aims to evaluate factors associated with unfavourable outcome after burr hole drainage in a subdural hematoma (SDH) at Sanglah General Hospital, Bali, Indonesia.Method: A prospective cohort study was conducted among 60 respondents to determine factors influencing the outcome of patients with subdural hematoma after burr hole drainage.Â The independent variables in this study included age, comorbid factors, trauma onset, GCS, hematoma thickness, and midline shift.Â Dependent variables include the Glasgow Outcome Scale (GOS), which is divided into 2 groups, favourable outcome, and unfavourable outcome. Data were analyzed using SPSS version 17 for Windows.Results: There were 19 respondents (31.7%) had unfavourable outcomes and 41 respondents (68.3%) had favourable outcomes.Â From the bivariate analysis, significant associated risk factors were found in the onset of trauma (p=0.048), GCS (p=0.000), hematoma thickness (p = 0.000), and midline shift (p=0.000).Â From the multivariate analysis, it was found that low GCS was the most dominant risk factor for the unfavourable outcome following burr hole drainage (OR=22.30; 95% CI= 2.22-223.80; p=0.008) Conclusion: This study concludes that low GCS was the most dominant risk factor for unfavourable outcome in patients with subdural hematoma after burr hole drainage

Risk factors and novel prognostic score for predicting the 14-day mortality of severe traumatic brain injury patients Nyoman Golden; Putu Eka Mardhika; Wayan Niryana; I Made Sukarya; I Putu Yuda Prabawa
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Introduction: The mortality of severe traumatic brain injury (TBI) is contributed by the severity of the head injury, associated trauma, and complication during treatment. This study aimed to develop a prognostic scoring system of risk factors that contribute to the 14-day mortality of severe TBI.Methods: This was a prospective cohort study including 105 severe TBI patients recruited consecutively from March to October 2016. Multivariate analysis with logistic regression was performed to determine the most contributing risk factors. The validation of prognostic factor was performed with ROC, sensitivity and specificity analysis.Result: There were five significant risk factors of 14-day mortality, which were age > 60 years old (RR: 15.6, 95% CI: 1.88 â€“ 129.95), hypoxia (RR: 17.78, 95% CI: 2.05 â€“ 154.11), GCS 3 â€“ 5 (RR: 34.71, 95% CI: 6.85 â€“ 175.98), effacement of basal cistern (RR: 12.71, 95% CI: 2.61 â€“ 61.95), and traumatic subarachnoid hemorrhage (tSAH) (RR:7.57, 95% CI: 1.19 â€“ 48.36). The prognostic score ranged from 0 to 6 with the best cut-off point of 1. The best predictive AUC with ROC analysis was 0.817, 81.2% of sensitivity, and 75.0% of specificity.Conclusion: The proposed prognostic score has shown good predictive ability.

Incidence report of traumatic brain injury in Mimika Public Hospital Papua Kevin Kristian Putra; Putu Ayu Indra Shanti Wardani; I Wayan Niryana
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Introduction: Traumatic brain injury is a functional brain disorder caused by an external force, which giving persistent consequences, progressive, long-term care, and rehabilitation might be needed. It is also called a “silent epidemic” due to the increased global incidence rate, socio-economic burden, and quality of life. The major cause of TBI was road traffic injury, fall, and blunt trauma.Methods: This research was conducted with a descriptive research design using a prospective cross-sectional design. The research sampling was using medical records in accordance with inclusion and exclusion criteria from 2018 to 2019.Result: The collected sample was 393 cases. There were 66.16% and 67.18% cases occurred to man and productive age with incidence rate 178.89 in 100.000 people. The major cause of TBI was road traffic injury and intentional injury with 58.52% and 24.17% consecutively. The involvement of alcohol in TBI cases was found in 24.42% of cases. The usage of the helmet was not found in 96.6% of cases of RTI.Conclusion: The majority of TBI patients at Mimika Public Hospital in 2018-2019 occurred in men and in the productive age, which was majorly caused by road traffic injury and intentional injury.

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.

Co-Authors A.A Davyn Anantha Ade-Chandra - Agung Aditya Arnaya Agung Bagus S. Satyarsa Agus Roy Rusly Hariantana Hamid Anne Saputra Bangun, Kristian Gerry Raymond Sinarta Budiarta, Ida Bagus D.P.W. Wardhana Dewa Ayu Wahyu Diantari Dewa Ngurah Suprapta Dewa Putu Wisnu Wardhana Dwijo Anargha Sindhughosa Dwikinta, Made Anindya Ellintang Charisma Dewi Gitari, Ni Made Gunawan, Made Favian Budi Gusti Ngurah Agung Adi Paramartha Hamid, Agus Roy I Gde Made Satya Wangsa Satya Wangsa I Gede Sutawan I Gede Suwedagatha I Gusti Agung Bagus Krisna Wibawa I Gusti Lanang Ngurah Agung Artha Wiguna I Gusti Ngurah Purnomo I Gusti Putu Hendra Sanjaya I Made Bagus Wirawan I Made Jawi I Made Stepanus Biondi Pramantara I Made Suka Adnyana I Made Sukarya I Nyoman Semadi I Putu Eka Widyadharma I Putu Gede Cahya Giartha Putra I Putu Yuda Prabawa I W. Sudarsa I Wayan Putu Sutirta Yasa Ida Bagus Yudha Prasista J Sasongko K.K. Putra Kevin Kristian Putra Koerniawan, Heru Sutanto Kusuma, Gede Febby Pratama LOELITA MARCELIA LUMINTANG, LOELITA MARCELIA Made Agus Dwianthara Sueta Made Indra Erlangga Prathiwindya Made Suka Adnyana Manuaba, Ida Bagus Tjakra Wibawa Mardliyah, Mumtazah Marthinson Andrew Tombeng Melissa Krisanty Moses Kharisma Setyawan Ni Luh Putu Julita Yanti Ni Putu Ayu Pande Arista Dewi Ni Putu Sri Wulandari Ni Putu Sriwidyani Nyoman Golden Nyoman Siska Ananda Prayoga, I Gusti Ngurah Agung Aditya Putu Anda Tusta Adiputra Putu Ayu Indra Shanti Wardani Putu Chandra Wibawa Putu Diahpradnya Oka Partini Putu Eka Mardhika Putu Pramana Suarjaya Raka-Sudewi A. A. S. Awyono Sanjaya, Feliani Sanjaya, Hendra Sianny Herawati Sista Satyarsa, Agung Bagus Sista Sri Maliawan Suryawisesa, Ida Bagus Made Tham Hong Yuan Thomas Eko Purwata Tjokorda Gde Bagus Mahadewa Wibawa, Ida Bagus Adiguna Yasa, I Nyoman Wawan Tirtha

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