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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).
P-Glycoprotein Expression on Patients with Acute Lymphoblastic Leukemia R. Niiruri; I. Narayani; K. Ariawati; S. Herawati
Journal of Health Sciences and Medicine Vol 1 No 1 (2017): JHSM (Febuary 2017)
Publisher : Institute for Research and Community Services Udayana University

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (95.865 KB) | DOI: 10.24843/JHSM.2017.v01.i01.p10

Abstract

Abstract Objective: P-glycoprotein (P-gp) overexpression on neoplastic cells can deteriorate the therapeutic outcome on cancer patients. P-gp plays important role on drug efficacy and toxicity. This research aimed to measure P-gp expression on children with Acute Lymphoblastic Leukemia (ALL) on Sanglah Hospital, Denpasar. Method: Flowcytometry method was used to measure P-gp expression level on Bone Marrow samples from pediatric patients (0-12 years old) who were newly diagnosed with ALL in Sanglah Hospital. P-gp overexpression were based on the percentage of cell stained. Ten percent of P-gp expression were considered as the cut-off value of P-gp overexpression. Result: On this study, 11 samples were obtained with the range value of 56-97% on P-gp expression. Conclusion: All 11 patients had P-gp overexpression.
Gambaran karakteristik kanker anak di RSUP Sanglah, Bali, Indonesia periode 2008-2017 Yohannes Adinatha; Ketut Ariawati
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 (599.292 KB) | DOI: 10.15562/ism.v11i2.638

Abstract

Background: Childhood cancer is estimated to increase every year. Child cancer divided into leukemia and solid tumors. In RSCM Jakarta, the most common cancers are Acute Leukemia, Brain Tumor (10-15%), Retinoblastoma (10-12%), and other malignancies. This study aims to determine the characteristics of childhood cancer at Sanglah General Hospital Denpasar in the period 2008-2017.Method: A cross-sectional retrospective descriptive study was conducted by taking patient's medical records of leukemia and solid tumors data in children admitted to Sanglah General Hospital during 2008-2017. The parameters assessed in this study were the type of cancer in children, age, sex, or residence domicile. Data were analyzed with SPSS software version 17 for Windows.Results: The results obtained 410 pediatric cancer patients during the 2008-2017 time period, which consisted of 240 cases of leukemia (58.5%) and 170 cases of solid tumors (41.5%). Most cases were 0-5 years old (61.5%), males (50.7%), and domiciled in Bali (72.4%). Acute lymphoblastic leukemia (LLA) is the most common hematologic malignancy in children, which occupies 41.0% of total cancers proportion, followed by retinoblastoma (14.0%), malignant lymphoma (9.0%), and neuroblastoma (5.0%).Conclusion: Most cancers in children occur at the age of 0-5 years, male sex, and domicile in Bali. Besides, acute lymphoblastic leukemia (LLA) is the most common hematologic malignancy in children. Latar Belakang: Penyakit kanker anak diperkirakan meningkat setiap tahunnya. Kanker anak secara garis besar dibagi dua, yaitu keganasan darah (leukemia) dan tumor padat. DI RSCM Jakarta, kanker tersering yaitu Leukemia Akut, Tumor Otak (10-15%), Retinoblastoma (10-12%), dan keganasan lainnya.Penelitian ini bertujuan untuk mengetahui karakteristik kanker anak di RSUP Sanglah Denpasar dalam perioder 2008-2017.Metode: Penelitian deskriptif retrospektif potong lintang dilakukan dengan pengambilan data rekam medis pasien leukemia dan tumor padat anak yang menjalani perawatan di RSUP Sanglah Denpasar periode tahun 2008-2017. Parameter yang dinilai pada penelitian ini adalah jenis kanker pada anak, usia, jenis kelamin, maupun domisili tempat tinggal. Data dianalisis dengan piranti lunak SPSS versi 17 untuk Windows. Hasil: Hasil penelitian mendapatkan 410 pasien kanker anak selama rentang waktu 2008-2017 dimana terdiri atas 240 kasus leukemia (58,5%) dan 170 kasus tumor padat (41.5%). Sebagian besar kasus berusia 0-5 tahun (61,5%), berjenis kelamin laki-laki (50,7%), dan berdomisili di Bali (72,4%). Leukemia Limfoblastik Akut (LLA) merupakan keganasan hematologi tersering pada anak dimana menempati proposi 41,0% dari total kanker, diikuti Retinoblastoma (14,0%), Limfoma maligna (9,0%), dan Neuroblastoma (5,0%).Kesimpulan: Sebagian besar kanker pada anak terjadi pada usia 0-5 tahun, berjenis kelamin laki-laki, dan domisili di Bali. Di samping itu, Leukemia Limfoblastik Akut (LLA) merupakan keganasan hematologi anak tersering pada anak.
Hubungan Rasio Neutrofil Limfosit (RNL) terhadap kejadian relaps pada anak dengan sindrom nefrotik di RSUP Sanglah, Bali, Indonesia Wega Upendra Sindhughosa; Gusti Ayu Putu Nilawati; Ni Putu Siadi Purniti; Bagus Ngurah Putu Arhana; Ketut Ariawati; Putu Junara Putra
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 (463.48 KB) | DOI: 10.15562/ism.v11i2.652

Abstract

Background: Nephrotic Syndrome is a disease whose cause is not fully known and has a high relapse rate. The lymphocyte neutrophil ratio is a marker of inflammation in patients with malignancy, infection, and coronary heart disease. This study aims to determine the relationship between Neutrophil Lymphocyte Ratio (NLR) and the occurrence of relapse nephrotic syndrome.Methods: This study was a retrospective analytic observational study with a cross-sectional approach to finding the relationship between increased NLR and the incidence of relapse in patients with nephrotic syndrome at SMF Children's Health Sciences Faculty of Medicine Universitas Udayana/Sanglah General Hospital. Data were taken from medical records of 45 respondents with episodes of relapse or remission from January 2018-January 2019. Data were analyzed using SPSS version 20 for Windows.Results: The results showed that most of the subjects were male (71.1%), aged 1-5 years (51.2%), and aged 4.00 ± 8.50 years in both the relapse and remission groups. However, the infection rate (66.7%) and medication adherence (75.0%) tended to be higher in the relapse group. The analysis of the ROC curve shows the cut-off point of NLR was 2.36 (AUC: 0.521), with a sensitivity of 71.1% and a specificity of 73.3%. There was a significant relationship between the NLR value and the incidence of relapsed nephrotic syndrome in multivariate analysis (adjusted OR: 4.53; 95% CI: 1.68 - 12.22; p = 0.003).Conclusion: This study shows that there is a relationship between an increase in RNL and the incidence of relapse in pediatric nephrotic syndrome patients at Sanglah General Hospital, Bali, Indonesia. Latar belakang: Sindrom Nefrotik merupakan salah satu penyakit yang penyebabnya belum sepenuhnya diketahui dan memiliki angka relaps yang tinggi. rasio neutrofil limfosit merupakan suatu pertanda inflamasi pada pasien yang mengalami keganasan, infeksi dan penyakit jantung koroner. Penelitian ini bertujuan untuk mengetahui hubungan Rasio Neutrofil Limfosit (RNL) dengan terjadinya sindrom nefrotik relaps.Metode: Penelitian ini merupakan penelitian retrospektig observasional analitik dengan pendekatan potong lintang untuk mencari hubungan peningkatan RNL terhadap kejadian relaps pada pasien sindrom nefrotik di SMF Ilmu Kesehatan Anak FK UNUD/Rumah Sakit Umum Pusat Sanglah. Data diambil dari rekam medik terhadap 45 responden dengan episode relaps maupun remisi dari Januari 2018-Januari 2019. Data dianalisis dengan SPSS versi 20 untuk Windows.Hasil: Hasil penelitian menunjukkan bahwa sebagian besar subyek adalah laki-laki (71,1%), berusia 1-5 tahun (51,2%), maupun berusia 4,00±8,50 tahun baik pada kelompok relaps maupun remisi. Akan tetapi angka infeksi (66,7%) maupun ketidak patuhan pengobatan (75,0%) cenderung lebih tinggi pada kelompok relaps. Analisa kurva ROC menunjukkan titik potong RNL sebesar 2,36 (AUC: 0,521) dengan sensitivitas 71,1% dan spesifisitas 73,3%. Terdapat hubungan bermakna antara nilai RNL dengan kejadian sindrom nefrotik relaps pada analisis multivariat (adjusted OR: 4,53; 95%IK: 1,68 – 12,22; p=0,003).Simpulan: Penelitian ini menunjukkan bahwa terdapat hubungan antara peningkatan RNL terhadap kejadian relaps pada penderita sindrom nefrotik anak di RSUP Sanglah, Bali, Indonesia
The determinant factors for Quality of Life (QOL) among children with Acute Lymphoblastic Leukemia (ALL) after induction phase at Sanglah General Hospital, Bali, Indonesia Made Suadnyani Pasek; Ketut Ariawati; Bagus Ngurah Putu Arhana; I Gusti Lanang Sidiartha; I Gusti Ngurah Sanjaya Putra; I Gusti Ngurah Made Suwarba
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 (301.044 KB) | DOI: 10.15562/ism.v11i2.668

Abstract

Background: The Quality of Life (QOL) of patients with acute lymphoblastic leukemia (ALL) is important to be examined. Some determinant factors of the QOL for ALL patients are age, gender, ethnicity, nutritional status, level of income of parents, educational level of parents, and risk groups. This study aims to determine the quality of life score among children with ALL after the induction phase of chemotherapy and to determine determinant factors that are associated with the quality of life of children with ALL.Methods: An observational analytic study using a cross-sectional approach has been conducted among 38 ALL patients to assess the QOL after the induction phase chemotherapy at Sanglah General Hospital. The independent sample T test evaluated comparative values between independent factors. Multivariate analysis was assessed by the General Linear Model ANCOVA. Data were analyzed using SPSS version 20 for Windows.Results: Most of the respondents were age > 5 years old (55.3%), followed by the male (55.3%), well-nourished of nutritional status (55.3%), low parents’ educational status (55.3%), a high income of parents (52.6%), standard risk of stratification (52.6%), and non-Balinese ethnicity (55.3%). The mean score of QOL was 79.37±21.64. The results showed that male gender (95% CI: 2.35-16.04; p=0.010), high income of parents (95% CI: 3.17-22.05; p=0.010), standard risk factors (95% CI: 1.48-16.36; p = 0.020) were significantly related to the QOL of children with ALL.Conclusion: High-income parents, standard risk stratification, and male gender are determinant factors for higher QOL scores of children with ALL after the chemotherapy induction phase.
Hemolytic anemia in a 2-years old caused by Glucose 6 Phosphate Dehydrogenase Deficiency (G6PD): a case report Paulus Arief Budiman; Ketut Ariawati; Anak Agung Ngurah Ketut Putra Widnyana
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 (295.444 KB) | DOI: 10.15562/ism.v12i3.1159

Abstract

Background: Glucose-6-Phosphate-Dehydrogenase (G6PD) deficiency is an enzyme abnormality related to sex chromosomes (x-linked), which is inherited. The activity or stability of the G6PD enzyme decreases, thus causing the breakdown of red blood cells when an individual is exposed to exogenous substances that can cause oxidative damage. This case study aims to describe a rare case of hemolytic anemia caused by glucose 6 phosphate dehydrogenase deficiency in a two-year-old boy. Case Presentation: A two-year-old boy presented with agitated, pale, yellowish eyes and body and projectile vomiting after consuming fava beans. He had a prior history of packed red cell transfusion. Physical examination found the conjunctivae were pale with the icteric sclera. Laboratory examination revealed leukocytosis, moderate normochromic normocytic anemia, increased reticulocytes count, and elevated total and unconjugated bilirubin. Peripheral blood smear examination found microcytes, spherocytes, fragmentocytes, and burr cells. Coomb test was negative with decreased G6PD result. Conclusion: G6PD deficient patients have no symptoms until exposed to oxidizing drugs, infections or after fava beans ingestion which may cause hemolytic anemia and jaundice. Several methods of screening and diagnosis of G6PD can be performed to avoid morbidity and mortality.
Kepuasan Orangtua Pasien Terhadap Pelayanan di Bangsal Anak Sebagai Salah Satu Indikator Keberhasilan Pelayanan RSUP Sanglah di Denpasar Leni Lukman; I Wayan Gustawan; I Wayan Dharma Artana; Ketut Ariawati
Jurnal Penelitian dan Pengembangan Pelayanan Kesehatan Vol. 5 No. 2 (2021)
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 | DOI: 10.22435/jpppk.v5i2.5844

Abstract

Abstrak Peningkatan permintaan pelayanan kesehatan di seluruh Indonesia menuntut rumah sakit pemerintah berbenah untuk mampu memberikan pelayanan terbaik pada masyarakat termasuk di RSUP Sanglah Denpasar, Bali. Penelitian ini bertujuan untuk mengetahui tingkat kepuasan orangtua pasien BPJS terhadap pelayanan di bangsal anak RSUP Sanglah Denpasar. Penelitian ini merupakan penelitian deskriptif analitik dengan pengambilan data dilakukan dengan cara menyebar kuesioner dengan metode SERVQUAL. Model SERVQUAL yang digunakan terdiri dari lima dimensi yaitu: 1) Tangibles, 2) Reliability, 3) Responsiveness, 4) Assurance, dan 5) Empathy. Kuesioner telah melewati uji reliabilitas dan vailiditas. Penelitian ini mengambil sampel secara consecutive sampling yaitu salah satu orangtua dari seluruh pasien anak yang dirawat di Ruang Cempaka 3 pada bulan April sampai September 2020. Analisis gap dan kuadran menggunakan analisis Importance Performance Analysis dengan diagram Cartesian. Dari 151 sampel yang terkumpul, didapatkan perbandingan lelaki banding perempuan 1,25:1. Rata-rata usia pasien adalah 5,75 tahun dengan rata-rata lama perawatan 8,8 hari. Berdasarkan analisis Importance Performance, tidak ada satupun atribut dengan nilai kenyataan lebih tinggi daripada harapan. Dimensi SERVQUAL dengan jumlah gap tertinggi adalah Reliability/keandalan. Pada analisis kuadran didapatkan bahwa seluruh dimensi kecuali dimensi tangibles (nyata) perlu meningkatkan performa. Secara umum, orangtua pasien belum puas terhadap pelayanan di RSUP Sanglah Denpasar khususnya di bangsal Cempaka 3. Kata kunci: kepuasan pasien, pelayanan rumah sakit, pediatri, SERVQUAL Abstract Increasing demand of health care in Indonesia require government hospital to compete in giving the best care. The objective of this study is to determine satisfaction level of BPJS patient parents in Sanglah General Hospital Denpasar. This is an analytical descriptive study using valid and reliable SERVQUAL questionnaire to collect samples. SERVQUAL model consists of 5 dimensions: 1) tangibles, 2) reliability, 3) responsiveness, 4) assurance, and 5) empathy. The questionnaire passed reliability and validity test. Samples were parents of all children admitted to Cempaka 3 Ward from April to September 2020 and were taken consecutively. Gap and quadrant analysis using Importance Performance Analysis and Cartesian Diagram were done. From 151 collected samples, the ratio of boys and girls were 1.25:1. Mean age of samples was 5.75 years old and mean hospital stay was 8.8 days. Based on Importance Performance Analysis, all of the reality value fell below expectation value. SERVQUAL dimension with the highest gap was reliability. In quadrant analysis, all of the dimensions except tangible need improvement. In general, parents of patients was not satisfied with health care in Cempaka 3 ward, Sanglah General Hospital Denpasar. Keywords: patient satisfaction, hospital care, paediatrics, SERVQUAL