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All Journal Medicina E-Jurnal Medika Udayana Sari Pediatri Paediatrica Indonesiana ISM (Intisari Sains Medis) : Jurnal Kedokteran Indonesian Journal of Clinical Pathology and Medical Laboratory (IJCPML)
I Made Kardana
Bagian Ilmu Kesehatan Anak, Fakultas Kedokteran Universitas Udayana, RSUP Sanglah, Denpasar
Biochemistry, Genetics & Molecular Biology Health Professions Medicine & Pharmacology Neuroscience

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Gastroschisis: five cases after primary closure at Sanglah General Hospital, Bali, Indonesia Nyoman Gina Henny Kristianti; I Wayan Darma Artana; I Made Kardana; Putu Junara Putra; Made Sukmawati; Kadek Deddy Ariyanta; Made Darmajaya
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 (324.96 KB) | DOI: 10.15562/ism.v11i3.730

Abstract

Background: Gastroschisis is a congenital anterior abdominal wall defect characterized by intra-abdominal organs evisceration without covering the membrane. Several risk factors affect the outcome of a gastroschisis patient. Considering these risk factors might also increase the chance of better prognosis and survival. We report five neonates with gastroschisis after primary closure in Sanglah General Hospital, Denpasar, Bali, in 2017. This case series aims to describe the clinical characteristics and outcome of different babies with gastroschisis managed by primary closure surgery.Case Presentation: Four of our cases were detected during pregnancy with fetal gastroschisis at the age of 32, 19, 23, 25 weeks of gestation, respectively. We reserve cesarean delivery for the patient who did antenatal care in our hospital, but one of our patients was born by spontaneous labor due to lack of antenatal care. Four cases had the primary closure of less than 2 hours and one of them after 10 hours. Good outcome was found in three cases that started enteral feeding on the 7th day after post closure. Other cases started oral feeding on the 3rd day and 12th day—both of them shown poor outcomes. Three cases survive, but two others died because of sepsis.Conclusion: We found poor outcomes in both cases, which neonatal sepsis as a significant cause. One of our cases with poor outcome was referred from another hospital without antenatal care and had a long duration of entering the operating room. Diagnosing these babies in their early prenatal period and transferring them to an experienced medical centre containing multidisciplinary working facilities will contribute to both the mother and the baby's health.
Rasio Mean Platelet Volume (MPV) terhadap hitung trombosit dan Interleukin-6 (IL-6) sebagai prediktor awal kematian pada sepsis neonatal di RSUP Sanglah, Bali, Indonesia I Putu Sidhi Rastu Karyana; Ni Nyoman Mahartini; I Made Kardana
Intisari Sains Medis Vol. 11 No. 2 (2020): (Available online: 1 August 2020)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (335.571 KB) | DOI: 10.15562/ism.v11i2.755

Abstract

Background: Neonatal sepsis is a clinical syndrome in infants aged less than 28 days that arises from a systemic inflammatory response (SIRS) by various infectious causes. Both Interleukin-6 (IL-6) and Mean Platelet Volume (MPV) levels are known to play an important role in worsening neonatal sepsis. This study aims to determine the relationship between MPV ratio to platelet count and IL-6 as an early predictor of death in neonatal sepsis at Sanglah General Hospital, Bali, Indonesia.Methods: This prospective observational cohort study was conducted from November 2019 to February 2020 at Sanglah General Hospital Denpasar, involving 54 pediatric patients diagnosed with neonatal sepsis for less than 28 days. The research samples were collected consecutively. Statistical analysis is the survival analysis, Receiver Operating Characteristic (ROC) curve, linear regression, and Fisher exact test using SPSS software version 20 for Windows.Results: Most of the respondents had an average age of 3.46 ± 7,065 days, followed by male gender (72.22%), SNAD type of sepsis (88.89%), birth weight 2,126.6 ± 794.1 grams, normal birth weight (38.89%), and premature birth (61.11%). The mean MPV level in all subjects was 7.11 ± 1.85 fL, followed by a platelet count (218.511 ± 121.085) cells / µL, MPV / PLT ratio (5.404 ± 5.351), IL-6 levels (215.32 ± 444, 48 pg / mL), and as much as 12.95% died within 28 days of treatment. The results of the survival analysis showed a significant relationship between the MPV value (Cut-off: 6.745 (AUC: 0.650: HR: 4.353; p = 0.033) and the MPV / PLT ratio (Cut-off: 3.73; AUC: 0.690; HR: 4.535; p = 0.033) as an early predictor of mortality in neonatal sepsis at Sanglah General Hospital, Bali, Indonesia.Conclusion: MPV / PLT and MPV ratios can be used as predictors of early mortality within 28 days in patients with clinical neonatal sepsis at Sanglah General Hospital, Bali, Indonesia. Latar Belakang: Sepsis neonatal adalah sindrom klinis pada bayi berumur kurang dari 28 hari yang timbul akibat respon inflamasi sistemik (SIRS) oleh berbagai penyebab infeksi. Kadar Interleukin-6 (IL-6) maupun Mean Platelet Volume (MPV) diketahui berperan penting terhadap perburukan pada sepsis neonatal. Penelitian ini bertujuan untuk mengetahui  hubungan rasio MPV terhadap hitung trombosit maupun IL-6 sebagai prediktor awal kematian pada sepsis neonatal di RSUP Sanglah, Bali, Indonesia.Metode: Penelitian Kohort prospektif observasional dilakukan sejak November 2019 sampai Februari 2020 di RSUP Sanglah Denpasar dengan melibatkan 54 pasien anak yang terdiagnosis sepsis neonatal kurang dari 28 hari. Sampel penelitian dikumpulkan secara konsekutif. Analsis statistik yaitu dengan analisis kesintasan, kurva Receiver Operating Characteristic (ROC), regresi linier, dan tes Fisher exact menggunakan piranti lunak SPSS versi 20 untuk Windows..Hasil: Sebagian besar responden rata-rata berusia 3.46±7.065 hari, diikuti dengan jenis kelamin laki-laki (72,22%), jenis sepsis tipe SNAD (88,89%), berat lahir 2.126,6±794,1 gram, berat badan lahir normal (38,89%), dan lahir prematur (61,11%). Rerata kada MPV pada seluruh subjek adalah 7,11±1,85 fL, diikuti dengan hitung trombosit (218.511±121.085) sel/µL, rasio MPV/PLT (5,404±5,351), kadar IL-6 (215,32±444,48 pg/mL), dan sebanyak 12,95% meninggal dalam 28 hari perawatan.  Hasil analisis kesintasan menunjukkan hubungan bermakna antara nilai MPV (Cut-off: 6,745 (AUC: 0,650: HR: 4,353; p=0,033) dan rasio MPV/PLT (Cut-off: 3,73; AUC: 0,690; HR: 4,535; p=0,033) sebagai prediktor awal kematian pada sepsis neonatal di RSUP Sanglah, Bali, Indonesia.Kesimpulan: Rasio MPV/PLT dan MPV dapat digunakan sebagai prediktor awal kematian dalam 28 hari pada pasien dengan klinis sepsis neonatal di RSUP Sanglah, Bali, Indonesia
Korelasi nilai Homeostasis Model Assesment for Insulin Resistance (HOMA-IR) dan kadar vitamin D pada remaja dengan obesitas di Kota Denpasar, Bali, Indonesia Luh Gede Yuliadewi NS; I Made Arimbawa; Ketut Suarta; I Gde Raka Widiana; Made Kardana; Ni Putu Veny Kartika Yantie; Komang Ayu Witarini
Intisari Sains Medis Vol. 12 No. 3 (2021): (Available online: 1 December 2021)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (363.024 KB) | DOI: 10.15562/ism.v12i3.1193

Abstract

Background: Obesity during adolescence can developed into obesity in adulthood and will increase the risk of metabolic dissease sush as insulin resistance. Recent years the role of vitamin D begin to be connection with insulin resistance. Vitamin D plays a role in regulation of synthesis dan insulin secretions from pancreatic beta cells, increase peripheral and hepatic glucose uptake. In obesity there is decrease in vitamin D bioavailability that causes low levels of vitamin D. This study aimed to proves a correlation between insulin resistance and vitamin D levels in adolescents with obesity.Methods: A observational analytic research with crossestional design has been done in junior and senior high school in Denpasar. Adolescennts performed anthropometric screening covers weight, height, body mass index (BMI), obesity if BMI  > 95th percentile of CDC 2000 curve. Examined vitamin D levels and insulin resistance through calculation of HOMA-IR levels. Sample size calculation with ? 0,05, correlation coefficient (r) set to 0,5 with minimum sampel size 50. Data were analyzed using SPSS versin 17 for Windows.Results: Anthropometric screening performed obtained 135 students (3,3%) with obesity. Mean of vitamin D levels was 18,9 ng/mL, 10 (20 %) classified as vitamin D insufficiency and 39 (78 %) vitamin D deficiencies. The average of HOMA-IR levels 3,84, 24 (48 %) with insulin resistance based on HOMA-IR levels. Correlation coefficient between HOMA-IR levels and vitamin D was obtained – 0,37 (p=0,007). There was significant difference of prevalence of insulin resistance between obese adolescent with vitamin D deficiency compared with insuficiency and suficiency group (OR=5.8; 95%CI=1.1-30.6; p=0.025).Conclusion: This study concluded that There is a moderate negative correlation between HOMA-IR levels and vitamin D in obese adolescents. Latar Belakang: Obesitas pada masa remaja berisiko menjadi obesitas pada masa dewasa dan meningkatkan risiko penyakit metabolik seperti resistensi insulin. Beberapa tahun terakhir peran vitamin D mulai dihubungkan dengan resistensi insulin. Vitamin D berperan dalam regulasi sintesis dan sekresi insulin oleh sel beta pankreas, meningkatkan uptake glukosa perifer dan hepatik. Pada obesitas terjadi penurunan bioavaibilitas vitamin D yang menyebabkan rendahnya kadar vitamin D. Penelitian ini bertujuan untuk membuktikan adanya korelasi antara kadar vitamin D dengan resistensi insulin pada remaja dengan obesitas.Metode: Penelitian ini merupakan penelitian observasional analitik dengan desain potong lintang pada remaja SMP dan SMA di kota Denpasar. Remaja dilakukan skrining antropometri meliputi berat badan, tinggi badan, Indeks Masa Tubuh (IMT). Diagnosis obesitas jika IMT > persentil 95 kurva CDC 2000. Dilakukan pemeriksaan kadar vitamin D darah dan resistensi insulin melalui perhitungan kadar HOMA-IR. Perhitungan besar sampel dengan ? 0,05 ( tingkat kemaknaan 0,95), koefesien korelasi (r) ditetapkan 0,5 dengan jumlah sampel minimal 50. Data dianalisis dengan SPSS versi 17 untuk Windows.Hasil: Skrining antropometri dilakukan pada 135 subyek (3,3%) dengan obesitas. Rerata kadar vitamin D 18,9 ng/mL, dimana 10 ( 20 %) tergolong insufiseiensi vitamin D dan 39 (79%) defisiensi vitamin D. Rerata kadar HOMA-IR 3,84, 24 (48 %) mengalami resistensi insulin berdasarkan kadar HOMA-IR. Besar koefesien korelasi antara kadar HOMA-IR dan kadar vitamin D didapatkan – 0,37 (nilai p 0,007). Terdapat perbedaan bermakna kejadian resistensi insulin antara kelompok remaja obesitas dengan status defisiensi vitamin D dan kelompok dengan status vitamin D pada kelompok sufisien dan insufisien (OR=5,8; 95%IK=1,1-30,6; p=0,025).Kesimpulan: Penelitian ini menyimpulkan terdapat korelasi negatif sedang antara kadar HOMA-IR dan kadar vitamin D pada remaja dengan obesitas.
Tingkat Pengetahuan Ibu Mengenai MP-ASI di Puskesmas Rendang Karangasem Rathasari, Ni Made Dea Adilla; Hartawan, I Nyoman Budi; Kardana, I Made; Sukmawati, Made
E-Jurnal Medika Udayana Vol 12 No 2 (2023): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2023.V12.i02.P04

Abstract

Kualitas seorang anak dipengaruhi oleh nutrisi yang diberikan dalam proses tumbuh kembang. Pada awalnya, nutrisi yang dibutuhkan yaitu Air Susu Ibu (ASI) dan dilanjutkan dengan asupan makanan tambahan yaitu Makanan Pendamping Air Susu Ibu (MP-ASI) mulai usia 6-24 bulan. Keberhasilan dalam mewujudkan MP-ASI didukung oleh pengetahuan ibu. Salah satu faktor yang memengaruhi pengetahuan adalah tingkat pendidikan. Berdasarkan data profil Kesehatan Provinsi tahun 2019, pada bagian cakupan pemerliharaan kesehatan anak mendapatkan hasil bahwa Kabupaten Karangasem merupakan kabupaten terendah dari 9 kabupaten di Bali. Pada studi pendahuluan yang dilakukan di Puskesmas Rendang Karangasem, mendapatkan hasil bahwa ibu belum sepenuhnya mengerti mengenai MP-ASI. Oleh karena itu, diperlukan penelitian untuk mengetahui tingkat pengetahuan ibu mengenai MP-ASI. Penelitian ini bertujuan untuk mengetahui tingkat pengetahuan ibu mengenai MP-ASI di Puskesmas Rendang Karangasem. Desain penelitian ini adalah penelitian potong lintang deskriptif dengan teknik consecutive sampling. Penelitian ini dilakukan di Puskesmas Rendang Karangasem yang dilakukan pada bulan Juni hingga Agustus 2020. Subyek penelitian ini adalah ibu yang memiliki bayi berusia 6-24 bulan yang melakukan pengobatan di Puskesmas Rendang Karangasem dan didapatkan 72 responden yang memenuhi kriteria inklusi. Data penelitian ini adalah data primer yang diperoleh dari kuesioner kemudian diolah menggunakan SPSS versi 20. Dalam analisis univariat dan bivariat didapatkan hasil bahwa sebagian besar tingkat pengetahuan ibu dalam kategori cukup dengan tingkat pendidikan terbanyak yaitu SMP dan pekerjaan sebagai pedagang. Kata kunci : Ibu, MP-ASI, Pengetahuan
Correlation of Pancreatic Stone Protein (PSP) with Procalcitonin in Early-Onset Neonatal Sepsis (EONS) Patients Desak Laksmi; I Nyoman Wande; Anak Agung Ngurah Subawa; Sianny Herawati; Ni Kadek Mulyantari; Ni Nyoman Mahartini; I Made Kardana
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 32 No. 1 (2025)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v32i1.2425

Abstract

Sepsis is defined as a systemic condition that arises from bacterial, viral or fungal infection, associated with hemodynamic changes and clinical findings that cause high morbidity and mortality. Neonatal sepsis that occurs 72 hours after birth is called early-onset neonatal sepsis (EONS). Procalcitonin is secreted by various tissues and is a marker of the acute phase of systemic reactions. Pancreatic stone protein (PSP) is a novel marker for identifying sepsis. High PSP levels are associated with more severe sepsis conditions. This analytical observational study aimed to determine the correlation between PSP levels and procalcitonin levels in patients with EONS. The study was conducted at the Clinical Pathology Laboratory of Ngoerah Hospital, Denpasar and the Integrated Biomedical Laboratory of the Faculty of Medicine, Udayana University from May 2024 to July 2024. The subjects in this study were 48 EONS patients undergoing treatment at Ngoerah Hospital who met the inclusion criteria. The results of the Spearman correlation test revealed a moderate correlation between PSP levels and procalcitonin levels in EONS patients (r = 0.581; p <0.001). Furthermore, multivariate analysis revealed that PSP levels significantly influenced procalcitonin levels after controlling for confounding variables (B = 0.137; 95% CI 0.101-0.174; p <0.001). These findings highlight the potential of PSP as a reliable marker in diagnosing sepsis and suggest that further exploration in this area could enhance our understanding of neonatal sepsis management.
Co-Authors Anak Agung Ngurah Subawa Ariputra -, Ariputra Artana, Wayan Dharma Ayu Ketut Surya Dewi Ayu Setyorini Mestika Mayangsari Bowolaksono * Carissa Lidia Desak Laksmi DIAN SAVITRI Dyah Kanya Wati Ekaputri, Dian Sulistya Franky Luhulima Gusti Ayu Putu Nilawati Hendra Santoso Hendry Raymen Satria Hendy Hendy I Gde Raka Widiana I Gede Deden Susma Sugara I Gede Ketut Aryana, I Gede Ketut I Gusti Agung Ngurah Sugitha Adnyana I Gusti Ayu Putu Eka Pratiwi I Gusti Ngurah Made Suwarba I Made Arimbawa I Nyoman Adipura I Nyoman Budi Hartawan I Nyoman Sartika I Nyoman Wande I Putu Sidhi Rastu Karyana I Wayan Darma Artana I Wayan Dharma Artana I Wayan Dharma Artana, I Wayan Dharma I Wayan Retayasa IB. Mahendra Ida Bagus Agung Winaya Ida Bagus Mudita Ida Bagus Subanada IM Dharmajaya Kadek Deddy Ariyanta Kadek Deddy Ariyanta Kadek Deddy Ariyanta Ketut Dewi Kumara Wati Ketut Siki Kawiyana Ketut Suarta Ketut Suarta Ketut Suarta Komang Ayu Witarini Komang Kari Kristopher May Pamudji Lim, Heriyanto Lufyan, Reddy Luh Gede Yuliadewi NS Made Bandem Kenny Wijaya Nugraha Made Darmajaya Made Darmajaya Made Indah Nastiti Utami Budha Made lndah Nastiti Utami Budha Made Sukmawati Made Widia Markus Gunawan Ni Kadek Mulyantari Ni Luh Gede Wahyuni Suismaya Ni Made Sukewanti Ni Made Sumiartini Ni Nyoman Mahartini Ni Nyoman Mahartini Ni Putu Siadi Purniti Novita Purnamasari Assa Novita Purnamasari Assa NP Veny Kartika Yantie Nyoman Gina Henny Kristianti Putu Junara Putra Putu Junara Putra, Putu Junara Rathasari, Ni Made Dea Adilla Setya Wandita Sianny Herawati Soetjiningsih Soetjiningsih Soetjiningsih Soetjiningsih Soetjiningsih Soetjiningsih Soetjiningsih Soetjiningsih Sukmawati, Made Susanti Halim Wayan Retayasa Wayan Retayasa Wayan Sulaksmana Sandhi Parwata Wijaya, I Made Samitha Yoga Putra