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All Journal Sari Pediatri Paediatrica Indonesiana ISM (Intisari Sains Medis) : Jurnal Kedokteran
Bagus Ngurah Putu Arhana
Bagian Ilmu Kesehatan Anak FK Universitas Udayana /RSUP Sanglah Denpasar
Biochemistry, Genetics & Molecular Biology Health Professions Medicine & Pharmacology

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Peran Nitrogen Oksida pada Infeksi Eka Gunawijaya; Arhana BNP
Sari Pediatri Vol 2, No 2 (2000)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (314.55 KB) | DOI: 10.14238/sp2.2.2000.113-9

Abstract

Nitrogen oksida (NO) merupakan molekul kimia reaktif, disintesis dari L-Arginin denganbantuan NO synthase (NOS) dan ko-faktor. Aktifitas biologis NO terbatas dekat tempatbiosintesisnya, karena waktu paruh yang singkat. Nitrogen oksida menyebabkan relaksasiotot polos, menghambat agregasi dan adhesi trombosit, serta menghambat proliferasisel. Otot polos yang dipengaruhi ialah otot polos vaskular, traktus respiratorius,gastrointestinal, dan uterus. Relaksasi otot polos vaskular terjadi setelah sintesis sel endotelvaskular, sedangkan yang non vaskular melalui perannya sebagai neurotransmiter nonadrenergik non kolinergik.Dalam proses imunologis, NO dihasilkan oleh sel yang terpapar infeksi. Meliputi selmakrofag, sel neutrofil, sel Kupffer, sel hepatosit, sel astrosit dan mikroglial, sel kondrosit,sel otot polos vaskular, dan sel otot jantung. Pada keadaan infeksi Nitrogen oksidadisintesis dalam jumlah besar. Nitrogen oksida yang dihasilkan bersifat sitotoksik terhadapsel target, mikroorganisme patogen, dan juga pada sel tubuh normal. Inhibitor enzimNOS dan guanilat siklase bisa mengatasi sepsis, tetapi harus diberikan dini sebelumterjadi syok septik berkepanjangan. Inhibitor tersebut meliputi: deksametason, L-NAME,metilin blue, yomogin, aminoguanidin, econazol, dan indometasin. Nitrogen oksida jugaberperan menimbulkan kerusakan jaringan dan organ akibat terapi reoksigenasi padasyok septik yang mengalami hipoksia.
Surveilan Pneumokokus dan Dampak Pneumonia pada Anak Balita Putu Siadi Purniti; Ida Bagus Subanada; I Komang Kari; BNP Arhana; Ida Sri Iswari; Ni Made Adi Tarini
Sari Pediatri Vol 12, No 5 (2011)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp12.5.2011.359-64

Abstract

Latar belakang. Streptococcus pneumonia (SP) adalah penyebab utama meningitis, pneumonia, danbakteremia pada bayi dan anak. Mikroorganisme tersebut adalah penyebab utama kematian yang dapatdicegah dengan imunisasi pada anak usia di bawah lima tahun. Data tentang insiden invasive pneumococcaldisease (IPD) di Indonesia masih terbatas.Tujuan. Mengetahui dampak pneumonia dan IPD pada populasi target di Rumah Sakit Umum PusatSanglah Denpasar, Bali, Indonesia.Metode. Surveilan aktif berbasis rumah sakit, prospektif selama satu tahun pada anak usia 28 hari sampai 60bulan. Seluruh anak yang tinggal dalam area cakupan penelitian, usia 28 hari sampai 􀁤36 bulan mengalamidemam 􀁴39°C atau menderita pneumonia, menunjukkan gejala IPDHasil. Subjek 736 anak dengan median usia 10 bulan (79,2% usia 28 hari sampai <24 bulan). S. pneumoniatidak terdeteksi dari seluruh subjek. Biakan darah dilakukan pada 736 subjek, 125 di antaranya (17,19%)menunjukkan pertumbuhan bakteri. Bakteri yang diisolasi dari biakan darah antara lain Staphylococcus sp 58(46,4%), S. aureus 45 (36,0%), Pseudomonas sp 9 (7,2%), E. coli 3 (2,4%). Diagnosis awal terbanyak adalahpneumonia, 439 (59,7%). Insiden pneumonia 534,2/100000, usia 28 hari - <6 bulan 167,1/100000, danusia 28 hari - <24 bulan 839/100000. Angka insiden tertinggi pneumonia dengan foto dada usia 28 hari - <6bulan yaitu 10,9/100000, dan kelompok usia 28 hari - <24 bulan 19,4/100000. Angka insiden pneumoniadan foto dada dengan CRP 􀁴40 mg/L tertinggi pada kelompok usia 12 bulan - <24 bulan, 82,9/100000.Dilakukan pemeriksaan PCR S. pneumoniae terhadap 106 sampel, terdiri dari kasus meninggal, meningitis,sepsis dan pneumonia berat tidak terdeteksi S. pneumoniaeKesimpulan. Pneumonia mempunyai dampak yang cukup berarti bagi daerah cakupan RSUP Sanglah yangdisebabkan oleh pneumokokus, dan saat ini masih merupakan tantangan.
Rasio Neutrofil dan Limfosit (NLCR) Sebagai Faktor Risiko Terjadinya Infeksi Bakteri di Ruang Rawat Anak RSUP Sanglah Denpasar I Made Yullyantara Saputra; W Gustawan; MG Dwilingga Utama; BNP Arhana
Sari Pediatri Vol 20, No 6 (2019)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp20.6.2019.354-9

Abstract

Latar belakang. Rasio neutrofil dan limfosit (NLCR) memiliki potensi sebagai prediktor bakteremia pada pasien dengan infeksi yang didapat di masyarakat. Insidensi bakteremia, atau adanya bakteri hidup dalam darah, mencapai sekitar 1% kasus pada populasi. Angka kematian mencapai 25%-30% dan meningkat hingga 50% pada sepsis berat.Tujuan. Untuk mengetahui hubungan rasio neutrofil dan limfosit (NLCR) dengan kejadian infeksi bakteri.Metode. Sebuah studi kasus-kontrol dilakukan dengan meninjau rekam medis di RSUP Sanglah, Denpasar, pada periode Januari 2016 hingga Maret 2018. Data yang diambil adalah usia, jenis kelamin, kadar WBC, Neutrofil, limfosit, monosit, platelet, dan kultur darah. Kemudian dilakukan analisis hubungan antara rasio neutrofil dan limfosit terhadap infeksi aliran darah.Hasil. Selama periode studi didapatkan 98 pasien dengan hasil kultur positif dan 100 pasien dengan hasil kultur negatif. Dari total subjek yang dianalisis, didapatkan 116 (58,5%) subjek laki-laki dan 82 (40,9%) subjek perempuan. Median usia pada kelompok kasus adalah 12 bulan, sedangkan median usia pada kelompok kontrol adalah 24 bulan. Analisis kurva ROC menunjukkan nilai cut-off optimal untuk NLCR adalah 4,67. Rasio odd untuk hubungan antara NLCR dengan kejadian infeksi bakteri adalah 3,24 (95% IK 1,74 – 5,92) dan adjusted odds ratio sebesar 3,49 (95% IK 1,83-6,64).Kesimpulan. Nilai NLCR ≥4,67 merupakan faktor risiko untuk infeksi aliran darah yang berkembang. Hasil ini dapat digunakan sebagai titik potong untuk antibiotik yang awalnya diberikan untuk mencegah prognosis yang buruk (sepsis, kegagalan organ multipel, dan kematian).
Rasio IgM/IgG Fase Akut Untuk Menentukan Infeksi Dengue Sekunder Bagus Ngurah Putu Arhana
Sari Pediatri Vol 8, No 1 (2006)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp8.1.2006.2-8

Abstract

Latar belakang. Uji hemaglutinasi inhibisi (HI) memerlukan waktu relatif lama untukmenentukan infeksi dengue primer dan sekunder, karena memerlukan pemeriksaan serumpada fase akut dan konvalesen. Beberapa penelitian dengan menggunakan rasio IgM/IgG untuk menentukan infeksi primer dan sekunder menghasilkan rasio yang berbedabeda.Tujuan. Untuk mengetahui gambaran IgM dan IgG pada infeksi Dengue dan akurasirasio IgM/IgG secara Elisa pada fase akut untuk menentukan infeksi sekunder.Metoda. Dilakukan uji diagnostik pada sampel yang diambil secara berkesinambungan(consecutive sampling) pada 62 anak yang dicurigai menderita demam berdarah dengueantara Juli 2003 sampai dengan Juni 2004, dengan menggunakan rasio IgM/IgG secaraElisa pada fase akut. Uji Hambatan Hemaglutinasi sesuai dengan kriteria WHO sebagaibaku emas.Hasil. Dari 62 anak yang ikut dalam penelitian ini, ditemukan 48 anak dengan infeksisekunder dan 14 anak dengan infeksi primer. Kadar rerata IgG pada anak denganDBD baik syok maupun tidak lebih tinggi secara bermakna daripada demam dengue.Prevalensi infeksi sekunder adalah 77,4%. Cut off point paling baik dari rasio IgM/IgG sebagai prediktor infeksi sekunder adalah < 0,9 (sensitivitas 87,5%, spesifisitas92,9%, rasio kemungkinan 12,3). Prevalensi dari syok pada infeksi sekunder adalah16,7%. Cut off point paling baik dari rasio kadar IgG sebagai prediktor SSD padainfeksi sekunder adalah > 165,0 U/mL (sensitivitas 87,5%, spesifisitas 97,5%, rasiokemungkinan 35,0).Kesimpulan. Kadar rerata IgG pada DBD nonsyok dan DBD syok secara bermaknalebih tinggi daripada demam dengue. Rasio IgM/IgG < 0,9 dapat dipakai sebagaiprediktor infeksi sekunder dan kadar IgG > 165,0 U/mL dapat dipakai sebagai prediktorterjadinya syok pada infeksi sekunder.
Fever and laboratory profiles as predictors of serious bacterial infection in children Ni Putu Veny Kartika Yantie; BNP Arhana; Purnomo Suryantoro
Paediatrica Indonesiana Vol 52 No 6 (2012): November 2012
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (104.745 KB) | DOI: 10.14238/pi52.6.2012.313-6

Abstract

Background There is a debate on the use of high fever \\lith othermorbidities to predict serious bacterial infection (SBI). Bacterialinfection occurs in 3􀁉15% of children with fever of 2: 39°C.Various laboratory parameters including increased C􀁉reactiveprotein (CRP) levels, leukocyte counts, and absolute neutrophilcounts (AN C) have been studied for their usefulness in predictingthe occurrence of SBI, but with varied results. The ability todiscriminate whether a patient has a SBI can lead to improvedpatient management.Objective To evaluate fever of 2: 39°C, leukocyte counts of2: 15,000/mm3, ANC of 2: 1O,000/mm3 and CRP of 2: 10 mgiL aspredictors of SBI in children aged 1 month􀁉 18 years.Methods A case􀁉controlled study was conducted by collectingdata from medical records at Sanglah Hospital, Denpasar. Subjectsin the case group were diagnosed \\lith SBls (bacterial meningitis,bacterial pneumonia, bacteremia or sepsis, urinary tract infections,or bacterial gastroenteritis), and subjects in the control group nonserious bacterial infections (non􀁉SBI). Data was analyzed usingbivariate and multivariate methods \\lith 95% confidence intervalsand a statistical significance value ofP <0.05.Results Sixty subjects were studied, \\lith 30 subjects in the casegroup and 30 in the control group. Baseline characteristics ofsubjects were similar between the two groups. Fever and CRP werepredictors ofSBI [OR8.71 (95% CI 1.61 t046.98), P 􀀁 0.009; andOR 6.20 (95% CI 1.58 to 24.24), P 􀀁 0.012, respectively].Conclusion Fever 2: 39°C and CRP 2: 10 mgiL were significantpredictors of serious bacterial infections in children. [Paediatrrndones, 2012;52:313-6].
Serum transaminase levels and dengue shock syndrome in children Yoga Putra; Bagus Ngurah Putu Arhana; Ida Safitri; Raka Widiana
Paediatrica Indonesiana Vol 54 No 3 (2014): May 2014
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (106.935 KB) | DOI: 10.14238/pi54.3.2014.181-5

Abstract

Background Clinical and biochemical impacts on liverdysfunction, as manifested by an increase in serum transaminaselevels, are common in dengue infection. Howevei; an association ofelevated serum transaminase and dengue shock syndrome (DSS)has n ot been well-established.Objective To assess for an association between serum transaminaselevels and the presence of DSS in children.Methods A nested, case control study was conducted on childrenaged l month to 12 years admitted to Sanglah Hospital whowere diagnosed with dengue infection. Baseline characteristicsand serum transaminase levels were recorded. Patients who wereincluded in the study were observed for the presence of DSS.Those who had DSS were selected as cases, and those who did notdevelop DSS were selected as controls. Data was analyzed usingbivariate and multivariate methods with 95% confidence intervalsand P value <0.05 was considered as statistically significant.Results Ninety-four children were involeved, 4 7 children in thecase group and the other 4 7 were in the control group. Baselinecharacteristics of the subjects were similar between the case andcontrol groups. Serum aspart ate transaminase (AST) level of2:: 128 U/L and alanine transaminase (ALT) of 2: 40 U/L wereassociated with DSS (OR 10; 95%CI 2.3 to 44.4; P=0.002) and(OR 7 .3; 95%CI 1.6 to 32.9; P= 0.009), respectively.Conclusion Elevated AST and ALT levels were associatedwith an increased risk of DSS in children with dengue infection.
The value of IgG to IgM ratio in predicting secondary dengue infection I Putu Gede Karyana; Hendra Santoso; Bagus Ngurah Putu Arhana
Paediatrica Indonesiana Vol 46 No 3 (2006): May 2006
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi46.3.2006.113-7

Abstract

Background The determination of primary or secondary dengueinfection using hemagglutination inhibition (HI) test is time-con-suming. The IgG to IgM ratio which can be obtained earlier wasused by several studies to differentiate secondary from primaryinfection, but they still reported various cut-off points.Objective To find the diagnostic value and best cut off point ofIgG to IgM ratio for predicting secondary dengue infection.Methods This was a prospective study carried out between July2003 and June 2004. Children with suspected dengue hemor-rhagic fever (DHF) were tested for HI during acute and convales-cent phase. The IgG and IgM titer were examined during the acutephase using ELISA method.Results Sixty-two children were recruited, 48 with secondary in-fection and 14 with primary infection. The prevalence of second-ary infection was 77%. The best cut off point of the IgG to IgM ratioto predict secondary infection was >1.1 with sensitivity of 87.5%,specificity 92.9%, likelihood ratio 12.3, and post test probability97.7%.Conclusion The IgG to IgM ratio of >1.1 is a good predictor forsecondary infection
AIDS in a three-year old girl Dyah Kanya Wati; Bagus Ngurah Putu Arhana; Dewi Kumara Wati; Tuti Parwati Merati
Paediatrica Indonesiana Vol 46 No 6 (2006): November 2006
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (236.961 KB) | DOI: 10.14238/pi46.6.2006.281-4

Abstract

The acquired immunodeficiency syndromein children was first recognized in 1982, oneyear after the initial description in adults.WHO estimates that 2 million children hadbeen infected with human immunodeficiency virus(HIV) by the year 2000. Pediatric AIDS threatenschild survival in developing countries. At the endof 1999, 34.3 million individuals were estimated tobe infected globally, of which 1.3 million (3.8%)were children below 15 years old. Until September2005, no children with HIV AIDS in Indonesia wasfound.Approximately 80% of children acquired HIV-1infection from vertical maternal transmission; the restare infected from contaminated blood products,infected organs, breastfeeding, or sexual abuse.Two general patterns of congenital infection arerecognized. Twenty percent of infected infants developearly disease, while the rest progress slowly, developinginto AIDS in adolescents. The most successfulapproach in the management of children with HIVrequires a multidisciplinary team approach.
Effectiveness of PainAway® on hepatitis B intramuscular injection in term neonates: a randomized controlled trial Susilawati Susilawati; Soetjiningsih Soetjiningsih; Bagus Ngurah Putu Arhana; Ida Bagus Subanada
Paediatrica Indonesiana Vol 50 No 4 (2010): July 2010
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi50.4.2010.214-9

Abstract

Background Routine immunization injections are the mostcommon painful procedure in childhood and most of theseinjections are administered in early life. Immunizations can causenegative short- and long-term consequences for children. Childrenwho experience high levels of pain during an immunizationare more likely to have elevated distress level of subsequentinjections.Objective To evaluate the effectiveness of pain away in reducingpain associated with hepatitis B intramuscular injection in termneonates.Methods An open randomized controlled trial on healthy termneonates was conducted between November 2009 and December2009 at Sanglah Hospital in Denpasar, Bali. Subject were selectedrandomized using six-blocked randomization. The sampleswere divided into two groupsto either recieve intramuscularhepatitis B injection using PainAway® and or standard hepatitisB intramuscular injection. The pain response was assessed usingDouleur Aiquedu Noureanu-né(DAN) scale. Mann-Whitney testwas used to analyze the data. The confounding factor that mayhave influenced the pain response was analyzed using multivariateanalysis (ANCOVA).Results Out of 66 subject, DAN scale was significantly lower inintervention group (median 5.0) compared to control (median 7.0)with P < 0.0001. Multivariate analysis showed that the differencein the intervention given was the only variable that influencedthe pain response (P < 0.0001).Conclusion PainAway® can reduce the pain secondary tohepatitis B intramuscular injection on term neonates.
Serum C - Reactive Protein Level and Peripheral Blood Picture in Children with Pneumonia IGL Sidiartha; BNP Arhana; P Suwendra; Sudaryat S
Paediatrica Indonesiana Vol 38 No 3-4 (1998): March - April 1998
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (389.688 KB) | DOI: 10.14238/pi38.3-4.1998.62-7

Abstract

This cross sectional study aimed to determine the relation between serum C-reactive protein (CRP) levels and peripheral blood picture in children with bronchopneumonia, conducted at the Division of Pulmonology, Sanglah Hospital, Denpasar during 3 months (December 1996 to February 1997). Serum CRP levels, hemoglobin, leukocyte count, neutrophil count and ESR values in 30 cases between 1 month and 4.5 years (20 male and 10 female) were measured. Bronchopneumonia was mostly found in < 1 year old (67%) and with male to female ratio of 2:1. High CRP serum level (>12 microgram/ml) was found in 33% of 30 cases. Anemia was found in 37%, leukocytosis in 50%, increase segment neutrophil ratio in 30%, increase of ESR in 40% and increase of body temperature more than 38°C in 4 7% of the cases. Neutrophilia, increase of ESR and increase of body temperature were found statistically significant difference between the positive CRP and negative CRP group. Most bronchopneumonia patients in this study were probably caused by non bacteria. Neutrophilia, higher ESR and higher body temperature could be used as an indicator of bacterial infection besides the increase of serum CRP levels.
Co-Authors Anak Agung Ngurah Ketut Putra Widnyana Djoko, Sri Wahyuni Dyah Kanya Wati Eka Gunawijaya Gusti Ayu Putu Nilawati Harry Mangunsong Hendra Santoso I Gde Raka Widiana I Gusti Lanang Sidiartha I Gusti Ngurah Made Suwarba I Gusti Ngurah Sanjaya Putra I Komang Kari I Made Yullyantara Saputra I Nyoman Budi Hartawan I Putu Gede Karyana I Wayan Gustawan Ida Bagus Subanada Ida Safitri Ida Sri Iswari Ketut Ariawati Ketut Dewi Kumara Wati Ketut Tuti Parwati Merati M. Sholeh Kosim Made Gede Dwi Lingga Utama Made Suadnyani Pasek Ni Made Adi Tarini Ni Nengah Dwi Fatmawati Ni Putu Siadi Purniti Ni Putu Wirantari NP Veny Kartika Yantie P Suwendra Purnomo Suryantoro Putu Junara Putra Soetjiningsih Soetjiningsih Sudaryat S Susilawati Susilawati Wega Upendra Sindhughosa Yoga Putra