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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

Author-ID : 2937143

Biochemistry, Genetics & Molecular Biology Dentistry Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Other

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Pediatric index of mortality 2 scores in pediatric intensive care unit patients Monica Sampurna; Ida Bagus Suparyatha; I Gede Raka Widiana
Paediatrica Indonesiana Vol 56 No 1 (2016): January 2016
Publisher : Indonesian Pediatric Society

Background Comprehensive care for critically ill children in the pediatric intensive care unit (PICU) is done with the aim of achieving good outcomes. Severe disease in children is characterized by disruption of homeostatic processes, and can be evaluated by mortality scoring methods. There are several mortality scoring methods which can be used to predict mortality in children, the pediatric risk of mortality (PRISM) and pediatric index of mortality (PIM) are the most preferably used among all. The pediatric index of mortality 2(PIM2) is a key mortality prediction model for children receiving treatment in intensive care units, but its use has not been well validated in Indonesia.Objective To evaluate the performance of PIM2 model in PICU patients.Methods This cross-sectional study was conducted on PICU patients at Sanglah Hospital from November 2012 to April 2013. Patients underwent PIM2 scoring during their admission. The predictive ability of PIM2 scoring for patient mortality was analyzed using ROC curve.Results A total of 54 patients were included in this study, of whom 8 (14.8%) died. Discrimination between survival and death was assessed by the area under the receiver operating characteristic curve and found to be 0.81 (95% CI 0.59 to 1.03). Sensitivity was 75 (95%CI 36 to 96)% and specificity was 98 (95%CI 87 to 99)%. The PIM2 cut off value was â‰¥ -0.99.Conclusion The PIM 2 model has a good discriminatory power and calibration for predicting the mortality of children admitted to PICU and therefore is recommended for routine use in clinical practice. [

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.

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.

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 â€“ 29,171), and gastrointestinal bleeding (p = 0,0001; OR 14,317; IK 95 % 4,087 â€“ 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.

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.

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.

Karakteristik Pasien yang Dirawat di Unit Gawat Darurat Anak Rumah Sakit Umum Pusat Prof. Dr. I.G.N.G. Ngoerah Denpasar Dyah Kanya Wati; Ida Bagus Suparyatha; I Nyoman Budi Hartawan; Khema Metta Wijaya
Sari Pediatri Vol 24, No 4 (2022)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp24.4.2022.222-31

Latar belakang. Jumlah pasien anak yang berkunjung ke ruang gawat darurat terus mengalami peningkatan setiap tahunnya. Studi mengenai analisis data pelayanan gawat darurat penderita anak dengan kegawatan medik dari aspek lama tunggu dan kematian pasien di IGD masih terbatas.Tujuan. Penelitian ini bertujuan untuk mengevaluasi karakteristik dan luaran, serta gambaran epidemiologi dari penderita anak dengan kegawatdaruratan medik yang datang ke IGD anak RSUP Prof Dr. I.G.N.G Ngoerah Denpasar.Metode. Penelitian ini merupakan penelitian deksriptif retrospektif dengan data dari rekam medis pasien anak yang dirawat di IGD RSUP Prof Dr. I.G.N.G Ngoerah pada periode Februari – Juli 2022 menggunakan metode konsekutif sampling. Analisis deksriptif dilakukan dengan program SPSS.Hasil. Total jumlah sampel yang dikumpulkan dalam penelitian ini adalah 867 sampel. Karakteristik dasar pasien anak yang berkunjung ke ruang gawat darurat adalah mayoritas berjenis kelamin laki – laki, berusia 1 – 5 tahun, memiliki status gizi normal, skor pSOFA < 8 (99,7%), kematian dalam 24 jam terjadi pada 1,3% dan lama waktu tunggu pasien di triase setelah diagnosis ditegakkan adalah segera (90,2%). Keluhan utama yang paling sering dijumpai adalah ganggun sistem pernapasan, febris, dan gangguan sistem pencernaan. Diagnosis terbanyak adalah infeksi COVID-19 (10,4%) dan leukemia (10,3%).Kesimpulan. Infeksi COVID-19 masih merupakan diagnosis tersering di IGD, walaupun begitu pasien dengan keganasan (terutama leukemia) memiliki prevalensi yang cukup besar dibandingkan penyakit lainnya pada pasien pediatri yang memerlukan perawatan di IGD. Mayoritas pasien yang datang ke IGD anak RSUP Prof Ngoerah memiliki tingkat keparahan penyakit yang rendah berdasarkan pSOFA dan lama tunggu yang pendek setelah diagnosis ditegakkan. Kematian dalam 24 jam hanya terjadi pada sebagian kecil pasien.

Slow 0.9% NaCl Bolus Administration Reduces ANP, MMP-2, and Syndecan-1 Shedding in Septic Shock Rabbit Models Hartawan, I Nyoman Budi; Wiryana, Made; Jawi, I Made; Astawa, I Nyoman Mantik; Bakta, I Made; Subanada, Ida Bagus; Suparyatha, Ida Bagus; Wati, Dyah Kanya
Molecular and Cellular Biomedical Sciences Vol 9, No 2 (2025)
Publisher : Cell and BioPharmaceutical Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21705/mcbs.v9i2.590

Background: The optimal rate for fluid bolus administration in septic shock remains a critical and unresolved question. Rapid bolus administration is commonly practiced but has been linked to elevated levels of atrial natriuretic peptide (ANP), matrix metalloproteinase-2 (MMP-2), and syndecan-1 shedding, potentially exacerbating endothelial glycocalyx damage and increasing vascular permeability. However, the physiological and clinical implications of slower bolus rates have not been thoroughly investigated. This study was conducted to identify safer fluid management practices and improve patient outcomes in septic shock.Materials and methods: A randomized post-test-only control group design was employed, involving 36 male New Zealand rabbits with lipopolysaccharide-induced septic shock. The treatment group received 0.9% NaCl boluses (20 mL/kg body weight) over 20 minutes per bolus (slow bolus), while the control group received the same volume over 5 minutes per bolus (rapid bolus). ANP, MMP-2, and syndecan-1 levels were measured using ELISA 10-15 minutes post-intervention.Results: The median ANP levels in the treatment group (92.86 ng/mL) were significantly lower (p<0.05) than those in the control group (367.32 ng/mL). The mean MMP-2 levels in the treatment group (10.26 ng/dL) were lower than those in the control group (11.43 ng/dL). The median levels of syndecan-1 were also lower in the treatment group (4.31 ng/mL) compared to the control group (5.94 ng/mL).Conclusion: Slow fluid boluses appear to mitigate endothelial damage by reducing ANP, MMP-2, and syndecan-1 shedding. These findings suggest that slower infusion rates may offer a protective advantage in fluid resuscitation, paving the way for updated clinical guidelines.Keywords: fluid bolus, ANP, MMP-2, syndecan-1

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

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