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All Journal BALI MEDICAL JOURNAL (BMJ) Medicina journal of internal medicine INDONESIAN JOURNAL OF BIOMEDICAL SCIENCES E-Jurnal Medika Udayana ISM (Intisari Sains Medis) : Jurnal Kedokteran
Ketut Siki Kawiyana
Departemen Orthopaedi Dan Traumatologi, Fakultas Kedokteran, Universitas Udayana/RSUP Sanglah Denpasar, Bali, Indonesia
Biochemistry, Genetics & Molecular Biology Health Professions Medicine & Pharmacology

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CHANGES OF mRNA CASPASE-3 AFTER FIRST CYCLE OF CHEMOTHERAPY AS BIOMARKER ASSOCIATE TO CHEMOTHERAPY NEGATIVE RESPONSE IN LOCALLY ADVANCED BREAST CANCER Widiana, I. K.; Manuaba, I. B. T. Wibawa; Kawiyana, K. Siki; Yasa, I W. P. Sutirta
BALI MEDICAL JOURNAL Vol 4 No 2 (2015)
Publisher : BALI MEDICAL JOURNAL

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Background: Problems caused by behaviour of biology molecular in locally advanced breast cancer still unpredictable. This study aims to identify the mRNA caspase-3 as a predictive biomarker associated to chemotherapy sensitivity following neoadjuvant chemotherapy (NAC) in patients with locally advanced breast cancer. Methods: Open biopsy before and core biopsy after first cycle neoadjuvant chemotherapy of 62 locally advanced breast cancer patients was analysed for mRNA caspase-3 by Reverse Transcription - Polymerase Chain Reaction (RT-PCR) and this was correlate with response to NAC using American Joint Committee on Cancer (AJCC) creteria. Results: The total mean of mRNA caspase-3 expression before chemotherapy was 12.51±3.03 and after chemotherapy was 11.64±3.13. Negative response to chemotherapy was 44 (70.96%) and positive response was 18 (29.03%). The result of data with Phi and Cramer’s V analysed showed that decrease of mRNA caspase-3 after chemotherapy first cycle as a risk factor to chemotherapy negative response in patients with locally advanced breast cancer was significantly (p = 0.007). Conclusion: Decrease of mRNA caspase-3 after chemotherapy first cycle correlated with chemotherapy negative response in patients with lacally advanced breast cancer.
DEBRIDEMENT WITH FASCIOTOMY ON DIABETIC FOOT REDUCES TUMOR NECROSIS FACTOR ALPHA AND INCREASES VASCULAR ENDOTHELIAL GROWTH FACTOR PLASMA WITH CLINICAL IMPROVEMENT Yasa, K. P.; Siki-Kawiyana, K.; Budhiartha, A.A. G.
BALI MEDICAL JOURNAL Vol 3 No 2 (2014)
Publisher : BALI MEDICAL JOURNAL

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Background: Clinical and animal studies find out any increase of TNF-? and decrease of VEGF level in tissues of diabetic foot ulcers. Levels and abnormal activity of VEGF related to hypoxia and increase of TNF-? in diabetic tissue lead to impaired healing of ulcers. This study aims to determine debridement with fasciotomy simultaneously reduce TNF-? and increases VEGF plasma level and clinical improvement of diabetic foot ulcers. Methods: A clinical study by a randomized pretest - posttest control group design was carried out. Patients were divided into two groups of debridement without fasciotomy as a control group and group of debridement with fasciotomy as the treatment group. Sixty patients of diabetic foot ulcer Wagner II, III, and IV classification met inclusion and exclusion criteria, 28 patients were selected as control group and 32 as treatment group. Clinical improvement of ulcers was observed every week for 4 weeks using the instrument of Leg Ulcer Measurement Tool (LUMT) score. Result: Plasma TNF-? pretest was 422.30±17.05 (pg/ml) on control group and 424.47±12.02 (pg/ml) on treatment group. Plasma TNF-? posttest was 390.91±12.85 (pg/ml) on control group and 290.26±16.42 (pg/ml) on treatment group (p<0.05), with ? TNF-? (pg/ml) was 31,40±17,98 on control group and 134.21±14.50 on treatment group (p<0.05). Plasma VEGF level (pg/ml) pretest was 282.50±11.58 on control group and 286.74±10.19 on treatment group. Plasma VEGF level (pg/ml) posttest was 289.19±21.91 on control group, 338.70±20.11 on treatment group (p<0.05), with ? VEGF (pg/ml) was 15.23±10.73 on control group and 51.96±13.54 on treatment group (p<0.05). There was significant clinical improvement of ulcer on treatment group on 2nd , 3rd, and 4th week of treatment (p<0.05) There was average increase pressure (13-21 mmHg) on all foot compartments of the two groups Conclusion: debridement with fasciotomy simultaneously decreases TNF-? and increases VEGF plasma level accompanied clinical improvement of diabetic foot ulcer. Increase of foot compartment pressure may support phenomenon of microvascular permeability on diabetic patients, therefore fasciotomy on diabetic foot to become rational as adjunct of treatment.
GENOTYPE DIFFERENCE OF –572 G>C AND -174 G>C IL-6 GENE POLYMORPHISM BETWEEN BALINESE POSTMENOPAUSAL WOMEN WITH OSTEOPOROSIS AND WITHOUT OSTEOPOROSIS Yulianto, E.; Astawa, P.; Siki-Kawiyana, and K.
BALI MEDICAL JOURNAL Vol 2 No 3 (2013): Vol.2, No.3, September-December 2013
Publisher : BALI MEDICAL JOURNAL

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Background: Osteoporosis is a silent metabolic disease characterized by diminished bone mass and change in bone microstructure which cause increment of fracture risk. Until now, osteoporosis still becomes one of major health problems around the world. In Indonesia, the incidence of osteoporosis is 25%. Previous study have shown the relation between osteoporosis and IL-6 gene polymorphism at -572G>C and -174 G>C. There are some controversies about the correlation between these polymorphism and osteoporosis because of different result between each study. Genotype G polymorphism at -572 G>C of IL-6 gene has been correlated with lower Bone mineral density (BMD) and Genotype G polymorphism at -174G>C of IL-6 gene has been correlated with higher BMD value. In Indonesia, there are still no study about the association between IL-6 gene polymorphism and osteoporosis. In the future this IL-6 gene polymorphism could be used as a genetic marker for osteoporosis in postmenopausal woman. The objective of this study is to determine the difference of genotype of -572G>C and -174G>C polymorphism of IL-6 gene and osteoporosis in Balinese postmenopausal women. Method: This research design is a case control study. Sample was obtained at orthopedic outpatient clinic of Sanglah General Hospital, Bali-Indonesia from June 2012 until November 2012. The diagnosis of osteoporosis is described as BMD value with T score ? -2.5 SD using DEXA. All sample’s peripheral blood are taken to be isolated for DNA and analyzed for IL-6 gene polymorphism at -572G>C and -174G>C using Real Time PCR. Data obtained was analyzed with chi square test using SPSS. Results: This research found 11 osteoporosis sample from total 52 with no difference sample characteristic between case and control (p > 0.05). Using Chi square test, There was a significant differences between genotype -572 G>C; IL-6 gene polymorphism in Balinese postmenopausal woman with osteoporosis and in Balinese postmenopausal woman without osteoporosis (c2 = 41.85 and p = 0.001) and no significant differences between genotype -174 G>C;IL-6 polymorphism in Balinese postmenopausal woman with osteoporosis and in Balinese postmenopausal woman without osteoporosis(c2 = 0.283 and p = 0.518). This study discovered significant differences between genotype -572 G>C; IL-6 gene polymorphism in Balinese postmenopausal woman with osteoporosis and in Balinese postmenopausal woman without osteoporosis. Conclusion: We concluded that ethnic genetic profile variations affect the role of IL-6 gene polymorphism. In the future, this IL-6 gene polymorphism could be used as risk factor for osteoporosis in Balinese premenopausal woman
MALE TERM NEONATE WITH BLADDER EXSTROPHY–EPISPADIAS COMPLEX Utami Budha, Made Indah Nastiti; Retayasa, I Wayan; Kardana, I Made; *, Bowolaksono; Kawiyana, Ketut Siki
Medicina Vol 40 No 1 (2009): Januari 2009
Publisher : Medicina

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Abstract

Bladder exstrophy is a malformation of the bladder, in which the bladder and related structures are turned inside out. Bladder exstrophy affects one in approximately 50,000 livebirths. Male to female ratio is 2.3 : 1. Epispadias is commonly seen with exstrophy of the bladder. The cause and nature of the faulty development is not yet clear. The diagnosis is generally immediately apparent. Bladder exstrophy is a surgical correctable birth defect. In this case, bladder exstrophy–epispadias complex founded in male term neonate. On inspection was founded bladder everted through a midline lower abdominal wall defect, widening of the pubic symphisis and epispadias. Urology ultrasound revealed absent of the right kidney at right fossa renalis or in pelvic cavity, slight hydronephrosis of left kidney, no appearance of bladder in pelvic cavity. Patient underwent surgery during hospitalized in Sanglah Hospital - Denpasar. This patient was referred to the Congenital Anomaly Team in Dr. Soetomo Hospital - Surabaya because there was wound dehiscence during post operation care.[MEDICINA 2009;40:60-4].
CROSSLINK TELOPEPTIDA C-TERMINAL (CTx) SEBAGAI PETANDA AKTIVITAS SEL OSTEOKLAS PADA OSTEOPOROSIS PASCA MENOPAUSE DEFISIENSI ESTROGEN Kawiyana, I Ketut Siki
journal of internal medicine Vol. 10, No. 2 Mei 2009
Publisher : journal of internal medicine

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Abstract

Osteoporosis occurs due to the increase of active osteoclastic bone resorption activity. This condition favors for bonemass decreased. The examination of Crosslink Telopeptida C-Terminal (CTx)serum concentration is a good indicator to determineosteoclastic bone resorption activity. The finding of that biochemical substance in serum indicates that there is increase ofosteoclast cell activity. The aim of the study was to prove that in estrogen deficient post-menopausal women, the CTxwas higherin the osteoporosis compared than the non-osteoporosis. The study was an analytic-observational study in case-control design,which was done at Sanglah General Hospital, Denpasar. The sample size was 41 case subjects (osteoporosis) and 41 controlsubjects (non-osteoporosis) using paired case-control sample size formula. The t-paired test result were: CTx serum concentrationwas higher significantly in case compared than control (0.60 ± 0.22ng/mL vs 0.46 ± 0.16ng/mL; p = 0.004). Therefore fromthe study we may conclude that: (1) CTx was higher in the osteoporosis compared than the non-osteoporosis in estrogen deficientpost-menopausal women. (2) Osteoclastic bone resoprtion activity was higher in the osteoporosis compared than the non-osteoporosisin estrogen deficient post-menopausal women
INTERLEUKIN-6 YANG TINGGI SEBAGAI FAKTOR RISIKO TERHADAP KEJADIAN OSTEOPOROSIS PADA WANITA PASCAMENOPAUSE DEFISIENSI ESTROGEN Kawiyana, Siki
journal of internal medicine Vol. 10, No. 1 Januari 2009
Publisher : journal of internal medicine

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Abstract

In estrogen deficient post-menopausal women, the decrease of estrogen level in blood is not the sole cause for osteoporosis.Osteoporosis occurs due to the increase of osteoclastic bone resorption activity. OsteoclastÕs number and activity depend onits activating factors such as interleukine-6 (IL-6). The aim of the study was to prove that high IL-6 serum concentration is a riskfactor for osteoporosis. The study was an analytic-observational study in case-control design, which was done at Sanglah GeneralHospital, Denpasar. The sample size was 41 case subjects (osteoporosis) and 41 control subjects (non-osteoporosis) using pairedcase-control sample size formula. The t-paired and McNemartestsresults were: (1). IL-6 concentration was higher significantlyin case compared than control (3.47 ± 1.75 pg/mL vs 2.51 ± 1.13 pg/mL, p=0.001). (2). As risk factor for osteoporosis, using 2.17pg/ml as the cut off point, the IL-6 has significant OR as high as 4 (CI 95%: 1.23 Ð 14.24, p=0.032). From this study we mayderive conclusions as follows: (1). In estrogen deficient post-menopausal women, IL-6 concentration was higher in osteoporosisthan non-osteoporosis. (2). The high IL-6 serum concentration was a risk factor for osteoporosis in estrogen deficient postmenopausalwomen. (3). High IL-6 serum concentration can be used as predictor for osteoporosis in estrogen deficient postmenopausalwomen
OSTEOSARKOMA DIAGNOSIS DAN PENANGANANNYA Kawiyana, Siki
journal of internal medicine Vol. 10, No. 1 Januari 2009
Publisher : journal of internal medicine

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Abstract

Osteosarcoma is the second most common bone malignant neoplasm. Occurs between 5 Ð 30 years old, most oftenbetween 10 Ð 20 years old. It is located at long bone metaphyses which has rapid growth rate, therefore it is most often found inthe knee. Its diagnosis is established based on clinical findings, laboratory examination, radiographic examination such as plain xrayphoto, CT-scan, MRI, bone scan, angiography and biopsy histopathologic examination. The osteosarcoma prognosis dependson its stage and treatment effectivity. The osteosarcoma currently is managed by giving chemotherapy at pre-operative(induction=neoadjuvant chemotherapy) and post-operative (adjuvant chemotherapy). ÓLimb salvageÓ is the expected objective insurgical treatment for osteosarcoma. Post-operative follow up is very crucial in managing patient with osteosarcoma.
OSTEOPOROSIS PATOGENESIS DIAGNOSIS DAN PENANGANAN TERKINI Kawiyana, I Ketut Sik
journal of internal medicine Vol. 10, No. 2 Mei 2009
Publisher : journal of internal medicine

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Abstract

Osteoporosis is a bone metabolic disease, which is characterized by decreased bone mass due to reduced bone matrixand mineral, accompanied by micro architecture derangement of the bone tissue. Hence, in this disorder the bone has the tendencyto fracture due to low bone quality. Cell which responsible for bone formation is osteoblast, whereas osteoclast is responsible forbone resorption. In osteoporosis, bone turn over is abnormalwhichbone resorption is greater than bone formation. Thereforedirect factors for osteoporosis are number and activity of osteoclast in resorbing bone, and they are influenced by mediators andthe mediators depends on estrogen level. Number and activity of osteoclast cell are greater than number and activity of osteoblastcell in osteoporosis. This imbalance causes decreasing bone mass. The pathogenesis of osteoporosis has been discussed by showingthe recent theories related to increase of osteoclast cellÕs differentiation and activity due to: estrogen hormon deficiency,cytokine factor and axial loading. Several means in diagnosing the risks for osteoporosis and itÕs current managements based onitÕs pathogenesis have been mentioned too.
HIGH SERUM CONCENTRATION OF INTERLEUKINE-6 AND RANK-LIGAND AS RISK FACTORS FOR OSTEOPOROSIS IN ESTROGEN DEFICIENCY POST-MENOPAUSAL WOMEN Siki Kawiyana, Ketut; Surya, Gusti Putu; Bakta, Made; Roeshadi, Djoko
INDONESIAN JOURNAL OF BIOMEDICAL SCIENCES Vol. 3, No. 2 Juli 2009
Publisher : Udayana University

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Abstract

Osteoporosis in post-menopausal women is not merely due to deficient estrogenhormone production. The development of osteoporosis is due to increased boneresorption by osteoclasts. The osteoclast’s number and activity is controlled by activatingfactors such as IL-6 and RANK-L. The objective of this study was to determine that highIL-6 and RANK-L serum concentrations are risks for osteoporosis in estrogen deficientpost-menopausal women. The serum concentration of ß-CrossLaps (CTx) was measuredto determine bone resorption rate. This is an observational analytical study using case andcontrol design conducted at Sanglah General Hospital of Denpasar. The sample size wascalculated using the paired case-control study formula. There were 41 osteoporotic and41 non-osteoporotic (control) estrogen deficient post-menopausal women involved in thestudy.Data were analyzed by using the t-paired and McNemar tests. Mean serumconcentration of IL-6 among the osteoporotic women was significantly higher ascompared to that of the controls (3.47±1.75 pg/ml vs 2.51±1.13 pg/ml, p = 0.001). Meanserum concentration of RANK-L among the osteoporotic women was also significantlyhigher as compared to that of the controls (320.66±122.44ng/ml vs 249.94±82.41 ng/ml,p = 0.002). To qualify as risk factors for osteoporosis, the cut-off point for IL-6 was 2.17pg/ml (OR = 4, CI 95%: 1.23-14.24; p = 0.032); the cut-off point for RANK-L was275.165 ng/ml (OR = 8, CI 95%: 1.84-34.79; p = 0.001). Analysis of both high serumconcentration of IL-6 and RANK-L was associated with an odd ratio of 9 (CI 95%: 4,27-18,96, p=0,000). CTx concentration in the osteoporotic women was significantly higherthan in the controls (0.60±0.22ng/ml vs 0.46±0.16ng/ml, p = 0.004).We found that the high IL-6 and RANK-L serum concentrations were risk factorsin estrogen deficient post-menopausal women. CTx being a marker for osteoclastic boneresorption activity, increased in concentration higher in osteoporotic than in nonosteoporoticwomen. The high serum concentrations of IL-6 and RANK-L could be usedas predictors for osteoporosis in estrogen deficient post-menopausal women.
SEBACEOUS CYSTS MINOR SURGERY I Gusti Ayu Agung Laksemi; Sri Maliawan; Ketut Siki Kawiyana
E-Jurnal Medika Udayana vol 2 no 12 (2013):e-jurnal medika udayana
Publisher : Universitas Udayana

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Minor surgery is small surgery or localized example cut ulcers and boils, cyst excision, and suturing. Somethings that need to be considered in the preparation of the surgery is minor tools, operating rooms and operating tables, lighting, maintenance of tools and equipment, sterilization and desinfection equipment, preparation of patients and anesthesia. In general cysts is walled chamber that consist of fluid, cells and the remaining cells. Cysts are formed not due to inflammation although then be inflamed. Lining of the cysts wall is composed of fibrous tissue and usually coated epithelial cells or endothelial. Cysts formed by dilated glands and closed channels, glands, blood vessels, lymph channels or layers of the epidermis. Contents of the cysts wall consists of the results is serum, lymph, sweat sebum, epithelial cells, the stratum corneum, and hair.
Co-Authors A.A. G. Budhiartha, A.A. G. A.A. Gde Oka A.A. Ngr. Agung Wistara Widya AA GN Asmara Jaya Aakash Aakash Anak Agung Wiradewi Lestari Bowolaksono * Djoko Roeshadi E. Yulianto Eka Wiratnaya Gde Rastu Adi Mahartha Gede Agung Krisna Yudha Gusti Putu Surya Herryanto Agustriadi Simanjuntak I Gusti Ayu Agung Laksemi I Gusti Lanang Ngurah Agung Artha Wiguna I Gusti Ngurah Pramartha Wijaya Putra I Gusti Ngurah Wien Aryana I Ketut Suyasa I Made Arya Winangun I Made Bakta I Made Kardana I Wayan Putu Sutirta Yasa I Wayan Retayasa I Wayan Subawa I Wayan Suryanto Dusak I. B. T. Wibawa Manuaba, I. B. T. Wibawa I. K. Widiana, I. K. Ida Bagus Adi Kayana Ivander Purvance K. P. Yasa, K. P. Ketut Gede Mulyadi Ridia Komang Ayu Vitriana Gamayanti Komang Indra Teguh Wisesa Komang Septian Sandiwidayat Made Bramantya Karna Made Indah Nastiti Utami Budha Made Wirabhawa Ni Made Puspa Dewi Astawa Ni Putu Enny Pratiwi Suardi P. Astawa Putu Anda Tusta Adiputra Putu Astawa Putu Indah Budi Apsari Putu Kermawan Sri Maliawan