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All Journal Medicina E-Jurnal Medika Udayana Medical Journal of Indonesia Sari Pediatri Paediatrica Indonesiana Molecular and Cellular Biomedical Sciences (MCBS) Bali Journal of Anesthesiology ISM (Intisari Sains Medis) : Jurnal Kedokteran
Ida Bagus Gede Suparyatha
Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Udayana
Biochemistry, Genetics & Molecular Biology Dentistry Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Other

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Journal : ISM (Intisari Sains Medis) : Jurnal Kedokteran

 1 
Perbedaan pemberian cairan isotonis dan hipotonis terhadap osmolalitas plasma pada penderita gangguan intrakranial akut di RSUP Sanglah, Denpasar, Bali Wayan Sulaksmana Sandhi Parwata; I Nyoman Budi Hartawan; I Gusti Ngurah Suwarba; Ida Bagus Suparyatha; Dyah Kanya Wati
Intisari Sains Medis Vol. 10 No. 1 (2019): (Available online 1 April 2019)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (237.617 KB) | DOI: 10.15562/ism.v10i1.313

Abstract

Background: Acute intracranial disturbance can lead to increased occurrence of cardiovascular activity that will lead to a decrease of sodium reabsorption in the kidney. The proper selection of liquid on acute intracranial disorders can help reduce damage to brain tissue. This study aims to determine differences in plasma osmolality levels in patients with acute intracranial disorders who get isotonic or hypotonic fluid.Methods: A cross-sectional observational study was carried out among 60 patients aged 1 month-12 years who experienced acute intracranial disturbance in Sanglah General Hospital during 2017. The difference in plasma osmolality in each group was tested using Mann-Whitney due to the data were not normally distributed. There was a significant difference in osmolality levels in the group receiving isotonic fluid compared with hypotonic (p <0.001)Results: Males were predominant in the isotonic group (66.7%) and hypotonic (70%). Good nutritional status was found in both groups (90%; 83.33%). Encephalitis is the most common cause of acute intracranial disturbance, namely 14 (46.67%) cases of istononic groups and 12 (40%) cases of hypotonic groups. The median value (IQR) of plasma and sodium osmolality levels that obtained isotonic fluid showed a difference in values of 139(6) mEq/L and 287(20) mOsm/kg H2O in isotonic and 132 (7) mEq/ L and 273(16) mOsm/kg H2O in hypotonic. There was a significant difference in osmolality levels in the group receiving isotonic fluid compared to hypotonic (p<0.001)Conclusion: There are differences in levels of osmolality in patients with acute intracranial disorders who get isotonic fluid compared to groups that get hypotonic fluid.
Gambaran umum berbagai faktor keterlambatan pemberian nutrisi enteral pada pasien anak di Ruang Rawat Intensif Anak, RSUP Sanglah, Denpasar, Bali Ni Luh Sri Apsari; I Gusti Lanang Sidiartha; I Nyoman Budi Hartawan; Dyah Kanya Wati; Ida Bagus Gede Suparyatha
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 (230.525 KB) | DOI: 10.15562/ism.v10i2.314

Abstract

Background: Enteral nutrition is the primary choice in pediatric patients who do not experience gastrointestinal disorders. Many factors inhibit the achievement of enteral nutrition in pediatric patients treated in intensive care. This study aims to determine the overview of various factors that may result in delays enteral nutrition administration in critically ill pediatric patientsMethods: An observational cross-sectional analytic study was carried out on secondary data of medical records among children who were treated in pediatric intensive care unit at Sanglah Hospital throughout 2016. Delay in enteral nutrition was assessed if there was enteral nutrition administration more than 2x24 hours since first admission. Factors assessed include gender, age, PELOD, diagnosis, invasive breathing aids, impaired motility, gastrointestinal bleeding, and hemodynamic instability. Data were analyzed using the SPSS version 20 software program whereas P value <0.05 was considered statistically significant.Results: From the 115 samples, there were 69 (60%) males and 46 (40%) females. About 50 samples (43,5%) experienced delayed enteral nutrition. Significant variables related to the delay in enteral nutrition after multivariate analysis were gastrointestinal motility disorders (p = 0,004, OR 9,082, 95% IK 2,827 – 29,171), and gastrointestinal bleeding (p = 0,0001; OR 14,317; IK 95 % 4,087 – 50,155).Conclusion Intestinal motility disorders and gastrointestinal bleeding are known as a contributing factor in the delay of enteral nutrition administration in PICU Sanglah Hospital, Denpasar, Bali.
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

Abstract

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. 
Validitas modified Pediatric Early Warning System/Score di Rumah Sakit Umum Pusat Sanglah I Made Karma Setiyawan; Dyah Kanya Wati; I Nyoman Budi Hartawan; Ida Bagus Gede Suparyatha; Made Pande Lilik Lestari
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 (440.662 KB) | DOI: 10.15562/ism.v11i3.808

Abstract

Background: Early identification of patient at risk influence the chance of appropriate management and thus patient’s outcome. Pediatric Early Warning System/Score (PEWS) was developed to evaluate patient clinical development while hospitalized. Sanglah General Hospital has implemented PEWS to evaluate early clinical deterioration since 2015 in accordance with quality control program, even though it is not validated yet.Methods: A single-center, cross-sectional analytic observational study was conducted in pediatric ward Sanglah General Hospital in 2019. The scores ranged from 0 to 9 and were assessed in the 6 to 8 hours prior to unplanned intensive care transfer. Cut-off point, sensitivity, and specificity of modified PEWS was obtained in terms of unplanned intensive care transfer.Results: Amongst 200 children at pediatric ward, 22 children (11%) had unplanned intensive transfer. The most common intensive consultation problems were respiratory failure (63.6%), followed by decrease of consciousness (22.8%) and shock (13.6%). Median of time to clinical deterioration occured within 6 days of hospitalization (range, 1- 41). Majority clinical deterioration event was found in hematology oncology group.  The AUC score  was 0,99 (95% CI, 0,99 - 1) with the optimal cut-off point on score ? 4 (sensitivity 95,5% and spesificity 100%).Conclusion: Modified PEWS at Sanglah General Hospital is a valid instrument in identifying early clinical deterioration in children. Prospective clinical evaluation of modified Sanglah General PEWS is needed to determine improvement quality of care and patient outcomes.  Latar Belakang: Identifikasi pasien yang berisiko mengalami perburukan klinis sejak dini dapat mempengaruhi pemberian tatalaksana yang akan meningkatkan luaran. Instrumen Pediatic Early Warning System/Score (PEWS) disusun untuk mengetahui perkembangan klinis dari pasien selama perawatan di rumah sakit. RSUP Sanglah menerapkan deteksi dini perburukan klinis menggunakan instrumen PEWS yang dimodifikasi sejak tahun 2015 dalam menjalankan Gugus Kendali Mutu (GKM), namun belum tervalidasi.Metode: Penelitian observasi analitik, single-center, menggunakan desain potong lintang yang dilakukan di ruang perawatan anak RSUP Sanglah pada tahun 2019. Skor memiliki rentang 0 sampai 9 dan dinilai saat 6-8 jam sebelum terjadinya pemindahan ke perawatan intensif yang tidak terencana. Titik potong, sensitivitas dan spesifisitas skor modified PEWS didapatkan terkait perburukan klinis yang memerlukan perawatan intensif tidak terencana.Hasil: Sebanyak 22 anak (11%) dari 200 anak yang dirawat di ruang perawatan memerlukan perawatan ruang intensif tidak terencana. Penyebab terbanyak dilakukannya konsultasi untuk perawatan intensif adalah gagal napas (63,6%) diikuti oleh penurunan kesadaran (22,8%) dan syok (13,6%). Median waktu terjadinya perburukan klinis didapatkan setelah 6 hari perawatan (rentang, 1- 41). Mayoritas perburukan klinis didapatkan pada kelompok diagnosis hematologi onkologi. Nilai AUC skor modified PEWS RSUP Sanglah didapatkan sebesar 0,99 (IK 95%, 0,99-1) dengan titik potong optimal pada skor ? 4 (sensitivitas 95,5%, spesifisitas 100%).Kesimpulan: Skor modified PEWS RSUP Sanglah merupakan instrumen yang valid dalam mengenali perburukan klinis pada anak sejak awal. Evaluasi klinis secara prospektif menggunakan skor PEWS tersebut diperlukan untuk melihat perbaikan dalam hal kualitas perawatan dan luaran pada pasien.
Co-Authors Alice Indradjaja, Alice Ayu Widyanti Dewi Sutriani Mahalini Dyah Kanya Wati Estina, Vania Catleya Gusti Ayu Putu Sri Satya Mahayani Hendra Salim Hendy Halim I Gde Raka Widiana I Gusti Ayu Putu Eka Pratiwi I Gusti Lanang Sidiartha I Gusti Ngurah Made Suwarba I Gusti Ngurah Sanjaya Putra I Made Arimbawa I Made Bakta I Made Jawi I Made Karma Setiyawan I Nyoman Budi Hartawan I NYOMAN MANTIK ASTAWA I Wayan Gustawan Ida Bagus Subanada Khema Metta Wijaya Luh Putu Diah Virayanti Made Gede Dwi Lingga Utama Made Pande Lilik Lestari Made Wiryana Monica Sampurna Ni Luh Sri Apsari Ni Made Adi Tarini Putu Diah Pratiwi Romy Windiyanto Sekarningrum, Putu A. Siska Permanasari Sinardja Wati, Dyah K. Wayan Sulaksmana Sandhi Parwata