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IMMUNE RESPONSE AND COST ANALYSIS OF INTRADERMAL RABIES VACCINATION FOR POST-EXPOSURE PROPHYLAXIS REGIMEN IN HUMAN Budayanti, N. S.; Susilawathi, N. M.; Darwinata, A. E.; Dwija, I. B. P.; Fatmawati, N. D.; Wirasandhi, K.; Subrata, K.; Susilarini, N. K.; Wignall, F. S.; Sudewi, A. A. R.; Mahardika, and G. N. K.
BALI MEDICAL JOURNAL Vol 3 No 1 (2014)
Publisher : BALI MEDICAL JOURNAL

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (229.703 KB)

Background The outbreak of rabies in human in Bali-Indonesia is causing an extraordinary pressure for the government in providing adequate doses of anti-rabies vaccine for post-exposure prophylaxis (PEP). Here, we directly compare the immune response and benefit of the intradermal (ID) protocol for rabies vaccine delivery with the intramuscular (IM) route. Methods: Sixty health workers who were willing to participate in this study have been randomly selected and grouped into ID, IM, and control groups, each with 20 volunteers. The Thai Red Cross ID- and Zangreb IM-protocols have been applied to the respective group. The sera of the volunteers were collected at day 0, week 1, week 3, week 4, month 3, month 6, month 9, and month 12 after the first vaccination. Anti-rabies virus IgG was detected using PlateliaTM Rabies II Kit (Bio-Rad). Results: Anti-rabies IgG could be detected in the ID-group at one week. The ID-vaccine delivery induced a slightly higher maximum antibody titer compared to IM, though not statistically significant (p>0.05). ID vaccination caused less adverse reactions and produces longer lasting protective immune response. Cost minimization analysis (CMA) on the provincial and national PEP data in 2009-2011 shows that the ID-delivery will reduce the total cost for a completed regimen by USD 28.5, and would have saved the Indonesian government budget approximately USD 3.6 and 4.3 million for complete regimens in Bali and Indonesia, respectively. Conclusion: The ID administration of anti-rabies vaccine induces a similar immune response compared to that of intramuscular injection. It also produces longer lasting protective immune response. It offers additional advantages of potential net cost savings as well as decreasing the pressure on vaccine availability due to the high number of dog bite cases.

PROFILAKSIS RABIES NM, Susilawathi; AA, Raka Sudewi
Medicina Vol 40 No 1 (2009): Januari 2009
Publisher : Medicina

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Rabies merupakan penyakit ensefalitis akut yang disebabkan oleh virus RNA, famili Rhabdoviridae, genus lyssavirus. Anjing adalah reservoir utama penularan rabies, puluhan ribu kematian per tahun disebabkan oleh gigitan anjing rabies. Bila seseorang menunjukkan gejala rabies, biasanya selalu fatal. Profilaksis terhadap rabies merupakan tindakan efektif dan aman. Mencuci luka dan vaksinasi segera setelah kontak dengan hewan tersangka rabies dapat mencegah timbulnya rabies hampir 100%. Strategi yang paling efektif untuk mencegah rabies adalah mengurangi penularan rabies pada anjing melalui vaksinasi.[MEDICINA 2009;40:55-9].

Karakteristik Penderita Rabies Paralitik di RSUP Sanglah, Denpasar Ginting, Ernesta; NM, Susilawathi; AA, Raka Sudewi
Cermin Dunia Kedokteran Vol 41, No 11 (2014): Infeksi
Publisher : PT. Kalbe Farma Tbk.

Latar belakang: Ada dua tipe manifestasi klinis rabies pada manusia, yaitu tipe galak dan tipe paralitik. Rabies tipe galak biasanya dapat dengan mudah didiagnosis berdasarkan tanda dan gejalanya yang khas, tetapi diagnosis rabies tipe paralitik sering merupakan dilema bagi klinisi, karena gejalan yang tidak khas dan mirip dengan sindrom Guillain-Barre. Tujuan: Mengetahui karakteristik pasien rabies paralitik di RSUP Sanglah. Metode: Penelitian deskriptif observasional dengan metoda pengumpulan data sekunder dari catatan medis penderita rabies di bangsal perawatan Neurologi RSUP Sanglah dari Januari 2009 â€“ Desember 2010. Hasil: Pada penelitian ini ditemukan 13 (19,69%) kasus rabies paralitik. Gejala prodromal berupa: kesemutan daerah gigitan (69%), demam (46%), mual dan muntah (15%), insomnia dalam 2-5 hari sebelum masuk RS (7%). Gambaran klinis tipe paralitik berupa: paraparesis flaksid simetris (62%), paraparesis flaksid asimetris (15%), monoparesis (15%), fasikulasi (15%), inkontinensia urin (38%), retensi urin (15%), gejala gastrointestinal (distensi abdomen dan ileus paralitik) (53%). Pada stadium akhir (terminal) beberapa gejala klinis khas tipe galak juga muncul, yaitu: gangguan kesadaran berupa fase delirium dan agitasi yang berfluktuasi pada semua penderita (100%), hidrofobia (100%), hipersalivasi (84%), hiperhidrosis (38%), aerofobia (69%), dan fotofobia (7%). Pemeriksaan LCS mendapatkan jumlah sel normal pada 5 pasien dan sel meningkat pada 7(58%) pasien dengan rata-rata jumlah sel 32/mm3. Protein LCS normal pada 4 pasien dan meningkat pada 8(66%) pasien dengan rata-rata 184 mg/dl. Simpulan: Rabies tipe paralitik dan sindrom Guillain-Barre memiliki gejala klinis yang mirip yaitu adanya paralisis flaksid akut yang sering bersifat ascendens. Pada rabies tipe paralitik sering didapatkan beberapa gambaran klinis lain berupa demam, kesemutan di daerah luka gigitan, fasikulasi, inkontinensia urin, progresivitas gejala sangat cepat dan perubahan status kesadaran.Background: Human rabies can present in two clinical forms, furious and paralytic. Diagnosis of furious (encephalitic) form can be made based on typical symptoms and signs. In contrast, paralytic form poses a diagnostic dilemma to distinguish it from Guillain-Barre syndrome. Objective: To describe characteristics of paralytic rabies patients at Sanglah Hospital. Method: This is an observational descriptive study. All data was collected from secondary data from medical records of rabies patients in Neurology ward, Sanglah Hospital from January 2009 â€“ December 2010. Result: There were a total of 13 (19,69%) cases of paralytic rabies. Prodromal symptoms consisted of: paresthesias at the site of healed bite wound (69%), fever (46%), nausea and vomiting (15%), insomnia in about 2-5 days prior to admissions (7%). The clinical features of the paralytic form were: symmetrical flaccid paraparesis (62%), asymmetrical flaccid paraparesis (15%), monoparesis (15%), fasciculation (15%), urinary incontinence (38%), urinary retention (15%), gastrointestinal symptoms (abdominal distention and paralytic ileus) (53%). Particularly all patients showed features of furious rabies in terminal stage: fluctuating consciousness between lucid calm and agitation (100%), hypersalivation (84%), hyperhydrosis (38%), hydrophobia (100%), aerophobia (69%), photophobia (7%). CSF cell counts were normal in 5 patients and increased in 7 (58%) patients with mean cell count of 32 cells/mm3. CSF protein was normal in 4 patients and increased in 8 (66%) patients with mean protein 184 mg/dl. Conclusion: Despite similarities between paralytic rabies and Guillain-Barre syndrome, some clinical features i.e., fever, distal paresthesia, fasciculation, urinary incontinence, rapid progression of symptoms and alteration in sensorium may help clinicians to differentiate rabies from Guillain-Barre syndrome. All paralytic rabies cases showed features of furious rabies in terminal stage.

Gejala Otonom Tidak Spesifik pada Penderita Rabies di RSUP Sanglah, Denpasar Widanta IGN, Putra Martin; NM, Susilawathi; AA, Raka Sudewi
Cermin Dunia Kedokteran Vol 41, No 10 (2014): Hematologi
Publisher : PT. Kalbe Farma Tbk.

Latar belakang: Manifestasi klinis rabies sangat bervariasi. Gejala otonom tidak spesifik ditemukan pada 2/3 kasus terutama pada stadium prodromal menyebabkan misdiagnosis yang memperlambat penanganan rabies. Tujuan: Mengetahui manifestasi gejala sistem saraf otonom tidak spesifik pada penderita rabies di RSUP Sanglah. Metodologi: Penelitian retrospektif dari bulan Januari 2009 â€“ Desember 2010 di RSUP Sanglah Denpasar. Data diperoleh dari catatan medis penderita rabies. Hasil: Ditemukan 13 kasus rabies dengan manifestasi gejala otonom tidak spesifik, terdiri dari 8 kasus tipe galak (61,5%) dan 5 kasus tipe paralitik (38,5%). Pada stadium prodromal gejalanya adalah mual-muntah (38,5%), gangguan miksi (30,8 %), perut kembung (30,8%), nyeri uluhati/perut (15,4%), nyeri dada (15,4%), sesak nafas (53,8) dan diare (7,7%). Gejala sistem otonom pada stadium neurologi akut berupa gangguan miksi (inkontinensia dan retensio urine) (38,5%) dan distensi abdomen (30,8%). Pasien dirawat oleh bagian Ilmu Penyakit Dalam (69,2%), Ilmu Penyakit Anak (15,4%), Ilmu Penyakit Jantung (15,4%) antara 24 jam sampai 48 jam sebelum dikonsulkan ke bagian Ilmu Penyakit Saraf. Simpulan: Manifestasi gejala sistem otonom tidak spesifik sangat bervariasi, dapat ditemukan pada stadium prodromal dan neurologis akut.Background: Clinical manifestations of rabies may be preceded by nonspecific prodromal symptoms in 2/3 cases. This often leads to misdiagnosis resulting in delays in the management of rabies. Objective: To determine the non-specific autonomic nervous system symptoms in rabies patients in Sanglah Hospital. Method: This is descriptive retrospective study from January 2009 - December 2010 in Sanglah Hospital, Denpasar. Data obtained from medical records of rabies patients. Results: During the period, there were 13 cases of rabies with non-specific autonomic nervous system symptoms, 8 cases were furious type (61.5%) and 5 cases paralytic rabies (38.5%). Symptoms at prodromal stage are nausea/vomiting (38.5%), urinary symptoms (30.8%), abdominal distention (30.8%), abdominal/epigastric pain (15.4%), chest pain (15.4 %), shortness of breath (53.8%) and diarrhea (7.7%). The autonomic symptoms at acute neurologic stage were urinary disorders (urinary incontinence and retention) (38.5%) and abdominal distension (30.8%). All patients were treated by other departments between 24 to 48 hours prior to neurological consultation. Those departments were Internal Medicine (69.2%), Pediatrics (15.4%), Cardiology (15.4%). Summary: non-specific autonomic nervous system symptoms of rabies are diverse and complicate the diagnosis. It can occur in a prodromal and acute neurological stage.

Dampak penerapan GSG dimediasi reputasi sekolah terhadap kinerja SMK Swasta di Kota Malang Anak Agung Rai Susilawathi; Umi Muawanah; Ahmad Ahmad
Jurnal Ekonomi Modernisasi Vol. 17 No. 1 (2021): Februari
Publisher : Fakultas Ekonomika dan Bisnis, Universitas Kanjuruhan Malang

Vocational Education is a level of education that develops students' abilities to carry out certain types of work. Vocational High Schools have many expertise programs that adapt to the needs of the existing world of work. Good School Governance (GSG) is very much needed in improving school performance, especially vocational high schools in order to be able to improve school quality. The research objectives were to analyze the effect of GSG on school reputation, to analyze the effect of GSG on school performance, to analyze the effect of school reputation on school performance. This research is a quantitative study that describes the impact of the implementation of GSG mediated by the reputation of the school on the performance of private vocational high schools in Malang. The data used are primary data from 43 private vocational high schools in Malang. The sampling technique used non-probability sampling techniques, namely saturated sampling, with the principal respondents of private vocational high schools in Malang City. Data were analyzed using Path Analysis. The results showed that GSG had a significant effect on school reputation, GSG had a significant effect on school performance, school reputation had a significant effect on school performance, GSG had a significant effect on school performance mediated by school reputation.

UNDERSTANDING LEVEL OF PKK BANJAR PURWA SANTHI BENOA ON MEDICAL MASK WASTE MANAGEMENT AND STRENGTHENING HEALTH PROTOCOLS IN CONTROLLING COVID-19 INFECTION I Komang Hotra Adiputra; Kadek Diana Harmayani; Ni Made Susilawathi; Cokorda Agung Wahyu Purnamasidhi; Komang Ayu Witarini; I Wayan Arya Biantara; I Dewa Made Sukrama; I Gede Purna Weisnawa; Jerry; Putu Kintan Wulandari; Darren Junior; Dewa Ayu Fony Prema Shanti; I Dewa Ayu Agung Warmadewanthi
INDONESIAN JOURNAL OF URBAN AND ENVIRONMENTAL TECHNOLOGY VOLUME 6, NUMBER 1, APRIL 2023
Publisher : Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25105/urbanenvirotech.v6i1.15335

The increase in mask waste and a lack of understanding about the management of single-use mask waste raises the potential for environmental pollution and COVID-19 transmission. Aim: This study aimed to assess the level of understanding of medical mask waste management and strengthening health protocols in controlling COVID-19 infection in Banjar Purwa Santhi, Benoa, Badung Regency. Methodology and Results: A cross-sectional method and descriptive study design were used with a sample of 100 respondents selected via stratified sampling. The research and service activities at Banjar Purwa Santhi Benoa include public campaign and assessment of the level understanding of medical mask waste management. Based on univariate analysis, 91% of respondents know that mask waste contains hazardous and toxic substances. If mask waste is disposed carelessly, 98% of respondents stated that it can pollute the environment, and 98% of respondents also stated that it has the potential to become a means of transmitting COVID-19. However, 85% of respondents disposed of the masks in the household trash. Conclusion, significance and impact study: Respondents had a good level of knowledge about health protocols and mask waste management but have not separated masks from household waste. By holding the community service activity, it is hoped that changes in community behavior will occur.

Headache in healthcare workers related to personal protective equipment use in COVID-19 referral hospital Ida Ayu Sri Wijayanti; Ni Putu Ayu Putri Mahadewi; Putu Gede Sudira; Kumara Tini; Ni Made Susilawathi; I Made Oka Adnyana
Universa Medicina Vol. 42 No. 1 (2023)
Publisher : Faculty of Medicine, Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2023.v42.52-60

BackgroundStudies show that wearing personal protective equipment (PPE) for long periods of time can lead to discomfort such as headaches, which could affect the performance of healthcare workers. The aim of this study was to determine the prevalence and risk factors of headaches related to PPE in healthcare workers at a COVID-19 referral hospital. MethodsA cross-sectional study was conducted involving 174 healthcare workers in a COVID-19 referral hospital in Bali. We conducted interviews using a questionnaire that consisted of three main parts: characteristics of the subjects, PPE usage, and PPE-associated headaches. A multiple logistic regression was used to analyze the data. ResultsThe analysis results showed that the PPE-associated headaches had a prevalence of 63.8% and were gradual in onset, pressure-like in quality (46%), and mild in intensity (80.1%). PPE level III-associated headache was the most common type. The majority of the participants had headaches up to 6 hours after using the protective gear, but improving within 15-30 minutes of removal and/or after pharmacotherapy. A Chi-squared analysis showed a statistically significant association between duration of PPE use, working units, and PPE levels (p<0.05). A logistic regression analysis found a significant relationship between PPE level and headache occurrence (OR=4.826;95%CI: 2.433-9.572; p<0.001). ConclusionThe frequency of PPE-associated headache was high and the PPE level was a risk factor of headache among healthcare workers. Better strategies are needed to reduce the duration of PPE exposure so that the work performance and quality of life of healthcare workers are not significantly affected.

UNDERSTANDING LEVEL OF PKK BANJAR PURWA SANTHI BENOA ON MEDICAL MASK WASTE MANAGEMENT AND STRENGTHENING HEALTH PROTOCOLS IN CONTROLLING COVID-19 INFECTION I Komang Hotra Adiputra; Kadek Diana Harmayani; Ni Made Susilawathi; Cokorda Agung Wahyu Purnamasidhi; Komang Ayu Witarini; I Wayan Arya Biantara; I Dewa Made Sukrama; I Gede Purna Weisnawa; Jerry; Putu Kintan Wulandari; Darren Junior; Dewa Ayu Fony Prema Shanti; I Dewa Ayu Agung Warmadewanthi
INDONESIAN JOURNAL OF URBAN AND ENVIRONMENTAL TECHNOLOGY VOLUME 6, NUMBER 1, APRIL 2023
Publisher : Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25105/urbanenvirotech.v6i1.15335

The increase in mask waste and a lack of understanding about the management of single-use mask waste raises the potential for environmental pollution and COVID-19 transmission. Aim: This study aimed to assess the level of understanding of medical mask waste management and strengthening health protocols in controlling COVID-19 infection in Banjar Purwa Santhi, Benoa, Badung Regency. Methodology and Results: A cross-sectional method and descriptive study design were used with a sample of 100 respondents selected via stratified sampling. The research and service activities at Banjar Purwa Santhi Benoa include public campaign and assessment of the level understanding of medical mask waste management. Based on univariate analysis, 91% of respondents know that mask waste contains hazardous and toxic substances. If mask waste is disposed carelessly, 98% of respondents stated that it can pollute the environment, and 98% of respondents also stated that it has the potential to become a means of transmitting COVID-19. However, 85% of respondents disposed of the masks in the household trash. Conclusion, significance and impact study: Respondents had a good level of knowledge about health protocols and mask waste management but have not separated masks from household waste. By holding the community service activity, it is hoped that changes in community behavior will occur.

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