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All Journal BALI MEDICAL JOURNAL (BMJ) Medicina Jurnal Kimia (Journal of Chemistry) E-Jurnal Medika Udayana Media Penelitian dan Pengembangan Kesehatan Sari Pediatri Paediatrica Indonesiana Jurnal Penelitian dan Pengembangan Pelayanan Kesehatan ISM (Intisari Sains Medis) : Jurnal Kedokteran Indonesian Journal of Clinical Pathology and Medical Laboratory (IJCPML) Journal of Health Sciences and Medicine
Ketut Ariawati
Bagian Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Udayana/Rumah Sakit Sanglah Denpasar, Bali
Biochemistry, Genetics & Molecular Biology Chemistry Decision Sciences, Operations Research & Management Health Professions Medicine & Pharmacology Neuroscience Public Health

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Peran Suplementasi Seng dalam Menurunkan Intensitas Mukositis Oral Akibat Kemoterapi Fase Konsolidasi pada Anak dengan Leukemia Limfoblastik Akut Manik Trisna Arysanti; Ketut Ariawati; Ida bagus Subanada
Sari Pediatri Vol 23, No 1 (2021)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp23.1.2021.15-22

Abstract

Latar belakang. Mukositis oral merupakan salah satu efek samping kemoterapi yang dapat berdampak buruk terhadap pengobatan kanker. Mikronutrient seng diketahui dapat mempertahankan integritas mukosa oral.Tujuan. Mengetahui efek suplementasi seng dalam menurunkan intesitas mukositis oral akibat kemoterapi.Metode. Uji klinis acak terkontrol tersamar ganda dilakukan pada 40 pasien anak dengan leukemia limfoblastik akut (LLA) yang menjalani kemoterapi fase konsolidasi, dengan membandingkan kejadian dan derajat mukositis oral pada kelompok yang mendapat suplementasi seng atau plasebo. Derajat mukositis oral dievaluasi menggunakan NCI-CTAE versi 3.0. Hasil. Kejadian mukositis oral lebih rendah pada kelompok seng (40%) dibandingkan plasebo (55%), tetapi perbedaan tersebut tidak signifikan (p=0,342). Derajat keparahan mukositis oral lebih rendah secara signifikan pada kelompok seng dibandingkan plasebo (p=0,024; RR 0,306; IK95%;0,089 sampai 1,048). Analisis kesintasan Kaplan-Meier menunjukkan waktu munculnya mukositis oral beserta derajat keparahannya pada kedua kelompok hampir sama sampai minggu kedua, kemudian mulai menurun sampai akhir pengamatan pada kelompok seng. Analisis multivariat Cox Regression menunjukkan variabel akhir sebagai prediktor kuat terhadap kejadian mukositis adalah usia, status gizi, dan kadar seng.Kesimpulan. Pemberian suplementasi seng tidak dapat menurunkan kejadian mukositis oral akibat kemoterapi pada pasien anak dengan LLA, tetapi dapat menurunkan derajat keparahannya bila dibandingkan dengan plasebo.
Karsinoma Hepatoselular pada Anak Usia 11 Tahun NP Veny Kartika Yantie; K Ariawati; IGN Sanjaya
Sari Pediatri Vol 13, No 3 (2011)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp13.3.2011.179-84

Abstract

Karsinoma hepatoselular merupakan tumor epitelial ganas pada hepar dan menempati urutan ketiga tumor hepar terbanyak pada anak. Telah diketahui bahwa terdapat hubungan antara karsinoma hepatoselular dengan infeksi hepatitis B kronik. Gejala awal tidak khas, dapat dikenali setelah tumor mencapai ukuran bermakna yaitu pada stadium lanjut sehingga diagnosis menjadi terlambat. Seorang anak laki-laki, usia 11 tahun dengan masa multilobus pada hepar, berobat dalam stadium lanjut sehingga tidak dapat dilakukan operasi. Dilakukan pencitraan abdomen dengan CT-scandan evaluasi secara mikroskopis untuk memastikan diagnosis karsinoma hepatoselular. Hasil uji serologi terhadap infeksi hepatitis B menandakan hepatitis B kronik. Pasien mendapatkan kemoterapi siklus pertama dengan cisplatin dan doksorubisin. Prognosis pasien buruk, sehingga meninggal setelah satu setengah bulan didiagnosis.
Profil Pertumbuhan, Hemoglobin Pre-transfusi, Kadar Feritin, dan Usia Tulang Anak pada Thalassemia Mayor Arimbawa Made; Ariawati Ketut
Sari Pediatri Vol 13, No 4 (2011)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (238.109 KB) | DOI: 10.14238/sp13.4.2011.299-304

Abstract

Latar belakang. Thalassemia adalah kelainan bawaan sintesis hemoglobin, dan salah satu penyakit monogenetik paling banyak dijumpai. Di Indonesia diperkirakan akan lahir 2500 anak dengan thalassemia mayor setiap tahunnya. Berkat kemajuan penanganan medis, sebagian besar pasien akan mengalami pertumbuhan normal pada masa anak-anak namun selanjutnya akan terjadi gangguan pertumbuhan dan keterlambatan pubertas secara signifikan.Tujuan. Mengetahui gambaran tinggi badan, kecepatan tumbuh, usia tulang, kadar hemoglobin pretranfusi, dan kadar feritin serum pasien thalassemia.Metode. Laporan serial kasus pada anak yang menjalani rawat inap di Sub-bagian Hematologi Bagian Ilmu Kesehatan Anak FK UNUD/RSUP Sanglah Denpasar dari bulan Desember 2010-Februari 2011. Data yang diperoleh disajikan dalam bentuk tabel.Hasil. Limabelas subyek thalassemia mayor, berumur antara 1,9 tahun – 13,5 tahun, 7 laki-laki dan 8 perempuan. Dua anak berumur kurang dari 3 tahun dan 7 anak telah memasuki usia pubertas. Semua pasien telah menjalani terapi kelasi besi deferioksamin namun kualitasnya tidak memadai. Perawakan pendek ditemukan pada 4 anak (26%), semua subjek mempunyai kecepatan tumbuh <5 cm/tahun. Secara klinis satu orang dikategorikan sebagai pubertas terlambat. Kadar hemoglobin rata-rata pre-transfusi dapat dipertahankan ≥8 mg/dl (10), sisanya (5) memiliki hemoglobin rata-rata di bawah 8 mg/dl. Empat anak dengan feritin serum di atas 3000 ng/ml, dan semua subjek mempunyai perawakan pendek. Pada evaluasi radiologi manus sinistra 5 anak memiliki usia tulang terlambat. Kesimpulan. Perawakan pendek didapatkan pada 26% kasus dan semua subjek telah memasuki usia pubertas. Semua subjek mempunyai perawakan pendek dan memiliki kadar feritin serum >3000 ng/ml. Sari Pediatri2011;13(4):299-304.
Reticulocyte hemoglobin content as a predictor of iron deficiency anemia Ni Made Rini Suari; Ketut Ariawati; Nyoman Adiputra
Paediatrica Indonesiana Vol 55 No 3 (2015): May 2015
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (291.762 KB) | DOI: 10.14238/pi55.3.2015.171-5

Abstract

Background Iron deficiency anemia (IDA) is the most common form of anemia in developing countries, such as Indonesia. Iron deficiency anemia in children is a serious problem because it affects their growth and development. Early detection of IDA and subsequent treatment in childhood may prevent future health problems.Objective To assess the use of reticulocyte hemoglobin content (CHr) to detect IDA in children aged 6-60 months.Methods We performed a cross-sectional study to measure the sensitivity and specificity of CHr compared to serum ferritin which is considered to be the gold standard for IDA diagnosis. The study was conducted from September 2011 to March 2013 in children aged 6-60 months who visited the Pediatric Outpatient Clinic, Sanglah Hospital, and Puskesmas II in West Denpasar. Data analysis was performed by 2x2 table. The results were assessed by area under the curve (AUC) and receiver operating characteristic (ROC).Results Of 121 children underwent blood testing during the study period, 69 children were excluded because they did not have hypochromic microcytic anemia, leaving 52 subjects eligible for the study. The prevalence of IDA in this study was 31%. Reticulocyte hemoglobin content (CHr) ≤ 23.1 pg had 88% (95%CI 71 to 100%) sensitivity and 25% (95%CI 11 to 39%) specificity.Conclusion Reticulocyte hemoglobin content < 23.1 pg may be a good predictor of IDA.
Effect of subdural hemorrhage on term infants development - a prospective study Ketut Ariawati; Soetjiningsih Soetjiningsih; I. K. Kari
Paediatrica Indonesiana Vol 47 No 4 (2007): July 2007
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (368.505 KB) | DOI: 10.14238/pi47.4.2007.156-60

Abstract

Background Subdural haemorrhage (SDH) is a common problemin infants under 6 months of age and it has a risk to develop intodevelopmental delay.Objective To evaluate adverse effects of SDH on the developmentof term infants.Methods It was a prospective cohort study carried out on infantsbelow six months of age admitted to Sanglah Hospital due toSDH. Control was healthy term infants born in Sanglah Hospital.Mullen Scales test was performed at the age of 6 and 12 months.Multivariate analysis was conducted to examine the relationshipbetween several independent variabels and developmentaloutcome.Results Sixty six infants were enrolled in this study (33 infantswith SDH and 33 infants without SDH), 52 (79%) were maleand 14 (21%) were female. Mean age was 1.53 (SD 0.75) monthsvs 1.70 (SD 0.73) months. The result of Mullen Scales test at theage of 6 and 12 months showed that very low category was higherin infants with the history of SDH than that in control group.Multivariate logistic regression analysis showed that only SDHcorrelated with Gross Motor and Cognitive Scale delay at theage of 6 months and 12 months (Gross motor 6 months: P=0.01;OR 13.07; 95%CI 2.04;83.84; Gross motor 12 months: P=0.00;OR 23.58; 95%CI 2.87;193.84); (Cognitive 6 months: P=0.00;OR 12.11; 95%CI 2.44;59.90; Cognitive 12 months: P=0.00; OR26.67; 95%CI 3.25;218.86).Conclusion Term infants with history of subdural haemorrhageare associated with increased Gross Motor and Cognitive Scaledelay at the age of 6 and 12 months.
Penelitian Perbedaan Tarif Riil dan INA-CBG’s Penyakit Talasemia di Ruang Perawatan Anak RSUP Sanglah Bali Tahun 2017 Anak Agung Made Wijaya Kusuma; Ketut Ariawati
Jurnal Penelitian dan Pengembangan Pelayanan Kesehatan Vol. 2 No. 2 (2018)
Publisher : Jurnal Penelitian dan Pengembangan Pelayanan Kesehatan (Journal of Research and Development in Health Services)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (436.261 KB) | DOI: 10.22435/jpppk.v2i2.171

Abstract

Abstrak Biaya pengobatan suportif seperti transfusi darah dan kelasi besi seumur hidup pada seorang pasien talasemia sangat besar. Hampir seluruh pasien talasemia di RSUP Sanglah Bali merupakan peserta Badan Penyelenggara Jaminan Sosial (BPJS) yang menggunakan sistem pola pembayaran Indonesia Case Based Groups (INA-CBG’s). Penelitian dilakukan untuk mengetahui perbedaan tarif biaya riil dan INA-CBG’s penyakit talasemia di ruang perawatan anak RSUP Sanglah Bali. Penelitian potong lintang menggunakan desain deskriptif, dilakukan pada bulan Januari sampai dengan Desember 2017. Data dalam penelitian ini terdiri dari data karakteristik dan perbedaan antara tarif riil rumah sakit dengan tarif INA-CBGs penyakit talasemia di ruang perawatan anak RSUP Sanglah. Terdapat 313 kasus rawat inap dari 29 pasien talasemia yang diikutsertakan dalam penelitian. Rumah Sakit Umum Pusat Sanglah mendapat nilai positif Rp 534.784.590 (21,8%) dari selisih total tarif paket INA CBG’s dengan total tarif riil rumah sakit pada tahun 2017. Terdapat perbedaan positif antara tarif riil rumah sakit dengan tarif sesuai INA CBG’s pada perawatan anak dengan talasemia di RSUP Sanglah, yang memberi keuntungan bagi pihak rumah sakit. Kata kunci: talasemia, asuransi, JKN, INA-CBG’s Abstract The cost of supportive treatment such as blood transfusion and lifelong iron chelation in thalassemia patient is very expensive. Almost all thalassemia patients at Sanglah Bali Hospital are participants of Badan Penyelenggara Jaminan Sosial (BPJS) who use Indonesia Case Based Groups (INA-CBG’s) payment system. The study was conducted to determine the discrepancy hospital and INA-CBG’s fare of Thalassemia disease at pediatric ward Sanglah Bali Hospital. Cross sectional study using descriptive design, conducted in January until December 2017. The data in this study consisted of data on the characteristics and differences between the hospitals real cost with INA-CBG’s fare in the child with Thalassemia disease at Sanglah Hospital. There were 313 inpatient cases of 29 thalassemia patients enrolled in the study. Sanglah Hospital received a positive value of Rp 534,784,590 (21.8%) from discrepancy of the INA CBG’s fare with the total real cost of hospitals in 2017. There is a positive discrepancy between hospital and INA-CBG’s fare of Thalassemia disease at pediatric ward which gives benefits to the hospital. Keywords: thalassemia, insurance, JKN, INA-CBG’s
Signet ring cell carcinoma of the colon in a 10 year-old boy Irene Irene; Ketut Ariawati
Paediatrica Indonesiana Vol 51 No 2 (2011): March 2011
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi51.2.2011.116-22

Abstract

Signet ring cell carcinoma (SRCC), a variant of adenocarcinoma, is defined by the presence of more than 50% of tumor cells with prominent intracytoplasmic mucin.1 Primary gastrointestinal malignancies constitute only 1% of pediatric neoplasms and 0.34% take the form of colon carcinoma. It is a very rare disease in persons under 17 years of age, 94% of which is found in children> 9 years of age. [.4 In contrast to adults, approximately50% of colon carcinoma cases in children are the highly malignant mucin'producing adenocarcinoma type.4 The typical signet-ring cell has a large mucin vacuole that fills the cytoplasm and pushes the nuclei to the side, thereby giving the cells their signature histologic appearance.S,6 Carcinoma of the colon during childhood has been associated with familialpolyposis and ulcerative colitis. However, carcinoma arising de novo is the most common type.2,3 Risk factors include a high caloric diet rich in animal fat, sedentary lifestyle, smoking, alcohol consumption, low vegetable fibre consumption, chronic inflammatory bowel disease, ulcerative colitis, Crohn's disease, and polymorphism in key enzymes of injurious compounds.s
Plasma NT-proBNP and pulmonary to systemic blood flow ratio in congenital heart defects with left-to-right shunts Eko Kristanto Kunta Adjie; Ni Putu Veny Kartika Yantie; Made Gede Dwi Lingga Utama; Eka Gunawijaya; Ketut Ariawati; Ida Bagus Subanada; Anak Agung Ngurah Ketut Putra Widnyana
Paediatrica Indonesiana Vol 60 No 6 (2020): November 2020
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi60.6.2020.310-5

Abstract

Background Cardiac left-to-right shunts changes to the pulmonary-to-systemic blood flow ratio (Qp/Qs ratio). This ratio can be used to monitor the hemodynamics of the heart. Left-to right-shunts cause the release of amino terminal proB-ty natriuretic peptide (NT-proBNP) that can be utilized as a specific marker for the presence of heart failure in children with congenital heart defects (CHDs). Early intervention such as defect closure in CHD is important to prevent heart failure. Objective To assess for a correlation between the level of NT pro-BNP and Qp/Qs ratio in CHD patients with left-to-right shunts. Methods This cross-sectional, analytical study was conducted in 32 children who underwent cardiac catheterization at Sanglah General Hospital, Denpasar, Bali, and were recruited by consecutive sampling. NT-proBNP levels were measured by ELISA with a two-step sandwich assay system; Qp/Qs ratio using Fick rules. Statistical analyses included Shapiro-Wilk test, descriptive analysis for subject characteristics, and Pearson’s correlation analysis. A P value of <0.05 was considered to be statistically significant. Age and defect size were analyzed as confounding factors by partial correlation test. Results The correlation value between NT-proBNP and Qp/Qs ratio was r=0.384 (P<0.05), after controlling for age and defect size as cofounding factors. Conclusion There is a weak positive correlation between NT-proBNP levels and pulmonary-to-systemic blood flow ratio in patients with left-to-right shunt, after controlling for age and defect size as confounding factors.
Implementation of Dengue Recurrent Shock Prediction Score in pediatric dengue shock syndrome Armand Setiady Liwan; I Wayan Gustawan; Eka Gunawijaya; Soetjiningsih Soetjiningsih; Ketut Ariawati; I Nyoman Budi Hartawan
Paediatrica Indonesiana Vol 60 No 4 (2020): July 2020
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi60.4.2020.178-85

Abstract

Background Global morbidities due to dengue viral infection increase yearly. The pediatric mortality rate from dengue shock syndrome (DSS) remains high. Early identification of the risk of recurrent shock may serve to increase awareness and reduce mortality. The Dengue Recurrent Shock Prediction Score (DRSPS) is a tool to predict recurrent shock in children with DSS, but the optimal cut-off point in our population is still unknown. Objective To assess the validity of the DRSPS by determining the optimal cut-off point that can be used in Indonesia Methods This cross-sectional prospective study was done at Sanglah Hospital, Denpasar, Bali, from January 2019. Risk of reccurent shock were classify based on DRSPS in all DSS patient, and they were observed whether they will experienced recurrent shock or not. Results Of 56 children with DSS, 27 subjects had recurrent shock and 29 subjects did not. The optimal DRSPS cut-off point was -189.9 for predicting recurrent shock, with 87.4% area under the curve (AUC), 81.5% sensitivity and 82.8% specificity. Conclusion The optimal cut-off point of DRSPS was -189.9 and it has good validity. The results of this study are expected not only to be used as the basis for further study, but to increase physician awareness in treating DSS patients.
NEONATAL ACUTE MYELOID LEUKAEMIA Luh Putu Rihayani Budi; Ketut Ariawati; Sianny Herawati
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 19, No 3 (2013)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v19i3.417

Abstract

Acute myeloid leukaemia (AML) is a. malignant, clonally disease that involves proliferation of blasts in bone marrow, blood, or other tissue. The blasts most often show myeloid or monocytic differentiation. The incidence of AML increases with age, but when neonatal leukaemia does occur, it is paradoxically AML rather than ALL. All the signs and symptoms that present on patient with AML are caused by the infiltration of the bone marrow with leukaemic cells and resulting failure of normal haematopoiesis. Without the normal haematopoietic elements, the patient is at risk for developing life-threatening complications of anaemia, infection due to functional neutropenia, and haemorrhage due to thrombocytopenia. Organomegaly is seen in approximately half of patient with AML due to hepatic and sphlanic infiltration with leukaemic blasts. Prognosis of neonatal leukaemia is poor with the 6-month survival rate is only one third despite aggressive chemotherapy. It has higher mortality rate than any other congenital cancer. The researchers reported two of AML diagnosed cases in neonatal period. The first case, a one-day-old male was referred with respiratory distress and suspect Down syndrome with spontaneous petechiae. The second case, a 17-day-old female presented with bloody diarrhoea and history of hypothyroid. Dysmorphic face and hepatosplenomegalia were found in both of the physical examination. Their complete blood count revealed leukocytosis and thrombocytopenia. Peripheral blood smear revealed myeloblast 30% on the first case and 23% on the second case. Both immunophenotyping revealed the population of blast expressing myeloid lineage (CD33 and CD34).
Co-Authors A.A. Raka Karsana Anak Agung Made Wijaya Kusuma Anak Agung Ngurah Ketut Putra Widnyana Armand Setiady Liwan Bagus Ngurah Putu Arhana Dewi, N.L.P.R. Dewi, Pande Putu Ayu Patria Djajadiman Gatot Eka Gunawijaya Eko Kristanto Kunta Adjie Endang Windiastuti Gusti Ayu Putu Nilawati H Salim I Gusti Lanang Sidiartha I Gusti Ngurah Made Suwarba I Gusti Ngurah Sanjaya Putra I Made Ady Wirawan I Made Arimbawa I Nyoman Budi Hartawan I Nyoman G. Budiana I Nyoman Wande I Putu Hendri Aryadi I Wayan Bikin Suryawan I Wayan Dharma Artana I Wayan Gustawan I Wayan Suradhipa, I Wayan I. K. Kari Ida Bagus Subanada IGN Sanjaya Inna Narayani Irene Irene Kadek Wini Mardewi Komalasari, K. T. Leni Lukman Luh Putu Rihayani Budi Made Gede Dwi Lingga Utama Made Suadnyani Pasek Mahardika Aprilia Iflahah Manik Trisna Arysanti Ni Kd Rintan Listiani Ekayanti Ni Made Intan Pertiwi Ni Made Linawati Ni Made Rini Suari Ni Putu Siadi Purniti Ni Wayan Kurnia Wati, Ni Wayan Kurnia Niruri, R Niruri, R. NP Veny Kartika Yantie Nyoman Adiputra Paulus Arief Budiman Pertiwi, N.M.I. Putu Dita Arsintha Widma Putu Junara Putra R. Niiruri Rasmaya Niruri Rini Noviyani S. Herawati Sagung Chandra Yowani Sianny Herawati Soetjiningsih Soetjiningsih Soetjiningsih Soetjiningsih Utami, A.A.I.A.Y.T Wega Upendra Sindhughosa Yohannes Adinatha