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All Journal E-Jurnal Medika Udayana Sari Pediatri Paediatrica Indonesiana ISM (Intisari Sains Medis) : Jurnal Kedokteran INDONESIAN JOURNAL OF URBAN AND ENVIRONMENTAL TECHNOLOGY

Komang Ayu Witarini

Departemen Ilmu Kesehatan Anak, Fakultas Kedokteran Universitas Airlangga, RSU Dr Soetomo Surabaya

Author-ID : 3472463

Agriculture, Biological Sciences & Forestry Biochemistry, Genetics & Molecular Biology Chemical Engineering, Chemistry & Bioengineering Civil Engineering, Building, Construction & Architecture Energy Environmental Science Health Professions Medicine & Pharmacology

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KARAKTERISTIK PENDERITA ENSEFALOPATI PADA ANAK DI RUANG GAWAT DARURAT DAN PICU RSUP SANGLAH DENPASAR PADA TAHUN 2018 Luh Putu Putri Sanjiwani; Dewi Sutriani Mahalini; Komang Ayu Witarini; Dyah Kanya Wati
E-Jurnal Medika Udayana Vol 10 No 3 (2021): Vol 10 No 03(2021): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2021.V10.i3.P18

ABSTRAK Ensefalopati pada anak merupakan keadaan darurat pediatri yang menimbulkan tantangan yang cukup besar dalam penanganannya. Meskipun kasus ensefalopati pada anak jarang ditemukan, namun berhubungan dengan morbiditas jangka panjang hingga kematian dan akan mengganggu tumbuh kembang anak di masa mendatang. Penelitian ini dilakukan untuk mengetahui karakteristik ensefalopati pada anak sehingga hasil yang didapatkan bisa digunakan sebagai pedoman oleh klinisi untuk pengembangan penelitian selanjutnya. Penelitian ini merupakan penelitian deskriptif cross-sectional menggunakan data sekunder dari rekam medik dengan 21 pasien ensefalopati pada anak di tahun 2018. Total sampling digunakan dalam penelitian ini dengan mempertimbangkan kriteria inklusi dan kriteria eksklusi. Data dianalisis dengan menggunakan SPSS versi 22. Hasil penelitian menunjukkan Kasus ensefalopati anak di RSUP Sanglah Denpasar Bali tahun 2018 sebagian besar berjenis kelamin laki-laki (66,7%), memiliki nilai tengah usia yaitu 19 bulan dengan nilai tengah lama perawatan di RSUP Sanglah yaitu 8 hari sedangkan perawatan di ruang PICU memiliki nilai tengah yaitu 5 hari, etiologi kasus didominasi oleh metabolik (71,4%) dan sisanya adalah hipertensi, sepsis, hepatikum dan eksemik-hipoksik, sebagian besarnya mengalami gangguan keseimbangan natrium dan klorida serum dan hanya sebagian kecil yang mengalami gangguan kalium serum dan setelah mendapatkan perawatan sebagian besar pasien memiliki prognosis hidup (81%) dan hanya sebagian kecil yang mengalami kematian (19%). Kata Kunci: Karakteristik, ensefalopati, anak.

Evaluasi Penggunaan Metode Prechtl untuk Menilai Kualitas Gerakan Spontan Bayi Muda Sehat: Pengalaman RSU Dr. Soetomo Surabaya Ahmad Suryawan; Komang Ayu Witarini; Risa Etika; Fatimah Indarso; Irwanto Irwanto; Moersintowati B. Narendra; Sylviati M. Damanik
Sari Pediatri Vol 9, No 6 (2008)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Latar belakang. Penilaian kualitas gerakan spontan pada bayi dengan metode â€œGeneral movements (GMs)â€dari Prechtl mempunyai validitas tinggi untuk memprediksi risiko gangguan perkembangan anak. MetodeGMs masih relatif baru di Indonesia, sehingga dibutuhkan evaluasi aspek praktikalnya untuk dapatdiaplikasikan secara optimal.Tujuan. Mengetahui kondisi paling optimal untuk menilai kualitas gerakan spontan bayi muda sehatmenggunakan metode GMs dari Prechtl.Metode. Dilakukan rekaman video secara berurutan pada bayi yang memenuhi kriteria inklusi lahir sehat,cukup bulan, tanpa risiko, dan mendapat persetujuan tertulis dari orangtua, lahir di RSU Dr Soetomo-Surabaya pada kurun waktu Desember 2006-Januari 2007. Teknik perekaman dilakukan sesuai standarisasiPrechtl, dengan berbagai variasi waktu dan kondisi. Analisis video rekaman dilakukan secara persepsiGestalt oleh salah satu peneliti, yang sebelumnya telah mendapat kursus dan sertifikat metode GMs.Parameter aspek praktikal untuk evaluasi digolongkan: optimal dan tidak optimal.Hasil. Tidak didapatkan penolakan dari orang tua untuk seluruh 56 bayi yang memenuhi kriteria inklusi.Tiga (5,4%) video yang tidak dapat dianalisis karena faktor kesalahan teknis perekaman. Kualitas GMslebih optimal untuk dianalisis apabila perekaman dilakukan pada waktu siang hari dibandingkan waktupagi (p=0,026) atau malam (p=0,045), dan dilakukan 30 menit sebelum waktu minum, dibandingkan 30menit sesudahnya (p=0,032). Tingkat kesulitan analisis tidak berbeda bermakna apabila perekamandilakukan di tempat yang khusus dibandingkan dilakukan di boks (p=0,156) atau inkubator (p=0,466).Kesimpulan. Metode Prechtl dapat diterapkan dengan praktis dan optimal apabila pengambilan videodilakukan pada waktu siang hari dan 30 menit sebelum waktu minum. Tempat pengambilan rekamantidak mempengaruhi segi kepraktisannya

Hubungan Jumlah Leukosit serta Kadar Cluster of Differentiation-4 dengan Derajat Keparahan Pneumonia pada Anak dengan Infeksi Human Immmunodeficiency Virus I Nyoman Supadma; Putu Siadi Purniti; Ida Bagus Subanada; Ayu Setyorini Mestika Mayangsari; Ketut Dewi Kumara Wati; Komang Ayu Witarini
Sari Pediatri Vol 19, No 1 (2017)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Latar belakang. Pneumonia merupakan penyebab utama morbiditas dan mortalitas pada anak usia di bawah 5 tahun di seluruh dunia, terutama pada infeksi human immunodeficiency virus (HIV). Parameter yang mudah diukur dan dikerjakan diperlukan untuk memprediksi derajat keparahan pneumonia pada anak dengan HIV.Tujuan. Mengetahui hubungan jumlah leukosit dan kadar CD4 dengan derajat keparahan pneumonia pada anak dengan infeksi HIV.Metode. Penelitian analitik dengan desain potong lintang, dilibatkan 42 anak HIV dengan pneumonia berat dan sangat berat. Pemeriksaan penunjang yang rutin dikerjakan adalah darah lengkap dan kadar CD4.Hasil. Nilai median (minimal-maksimal) kadar CD4 pneumonia sangat berat lebih rendah [19,5 (12,5-26,0)]% dibandingkan dengan pneumonia berat [35,3 (14,0-56,5)]%. Analisis bivariat menunjukkan derajat keparahan pneumonia tidak dipengaruhi oleh jumlah leukosit [RO 0,63 (IK 95% 0,09 sampai 4,23), P=0,63], tetapi dipengaruhi oleh kadar CD4 [RO 0,10 (IK 95% 0,02 sampai 0,46), P=0,01]. Kesimpulan. Kadar CD4 berhubungan dengan derajat keparahan pneumonia pada anak dengan infeksi HIV.

Korelasi antara Kadar Seng Serum dengan Kadar Interleukin-6 dan Skor PELOD-2 pada Sepsis Defranky Theodorus; Dyah Kanya Wati; I Gusti Ngurah Sanjaya Putra; Ida Bagus Subanada; Eka Gunawijaya; Komang Ayu Witarini; Wayan Gustawan
Sari Pediatri Vol 23, No 4 (2021)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp23.4.2021.262-9

Latar belakang. Sepsis merupakan penyebab utama morbiditas dan mortalitas pada anak dengan penyakit kritis yang dirawat di unit perawatan intensif anak (UPIA). Pada 24 jam sepsis, terjadi penurunan kadar seng serum dan secara bersamaan terjadi peningkatan kadar interleukin-6 (IL-6) dan skor PELOD-2. Hasil sebaliknya terjadi pada 72 jam sepsis.Tujuan. Untuk membuktikan korelasi negatif antara kadar seng serum dengan IL-6 dan skor PELOD-2 pada sepsis.Metode. Penelitian dengan rancangan potong lintang dua kali pengukuran dari Januari - Desember 2019 di UPIA RSUP Sanglah Denpasar. Subjek penelitian adalah anak berusia 29 hari sampai 18 tahun dengan sepsis berdasarkan skor PELOD-2 > 7 menggunakan metode consecutive sampling. Uji korelasi Pearson untuk menilai korelasi bivariat dan uji multivariat menggunakan uji korelasi parsial.Hasil. Empatpuluh subjek memenuhi kriteria inklusi. Rerata kadar seng serum pada 24 dan 72 jam adalah 59,5 Âµg/dl versus 64,2 Âµg/dl. Median IL-6 pada 24 dan 72 jam adalah 8,6 pg/dL versus 4,4 pg/dL, rerata skor PELOD-2 24 dan 72 jam adalah 11,2 versus 11,0. Korelasi Pearson kadar seng serum dengan kadar IL-6 pada 24 dan 72 jam adalah r= -0,078, p= 0,632 versus r= -0,218, p= 0,178. Korelasi Pearson kadar seng serum dengan skor PELOD-2 pada 24 dan 72 jam adalah r= -0,513, p= 0,001 versus r= 0,242, p= 0,132. Analisis korelasi parsial kadar seng serum dengan PELOD-2 pada 24 jam adalah r= -0,493, p= 0,002.Kesimpulan. Terdapat korelasi negatif sedang bermakna pada 24 jam sepsis antara kadar seng serum dengan skor PELOD-2 setelah mengontrol variabel kendali.

Assessment of the quality of general movements in newborn infants: a tool to predict developmental disorders at an early age Ahmad Suryawan; Bambang Permono; Komang Ayu Witarini; Risa Etika; Fatimah lndarso; Moersintowarti B. Narendra
Paediatrica Indonesiana Vol 48 No 5 (2008): September 2008
Publisher : Indonesian Pediatric Society

Background Nowadays, quality assessment of general movements(GMs) in infants can be used as a tool to predict developmentaloutcome. Until now, there is no published study in this field inIndonesia.Objectives The aim of this study was to evaluate the quality ofGMs of newborn infants.Methods A prospective study was done at neonatal ward, Dr.Soetomo Hospital in Surabaya, between December 2006 andJanuary 2007. A single supine position video recording of newbornsat GMs preterm and writhing age was made using Precthl's method.Infants were chosen consecutively among singletons above 28week gestational age. The quality of GMs was assessed by meansof Gestalt perception by one of the authors, who had been trainedand certified in GMs. GMs were classified into: normal-optimal,normal-suboptimal, mildly-abnormal, and definitely-abnormal.Correlation tests were used to assess the relationship betweenperinatal conditions and the quality of GMs.Results 106 videos were recorded, and 100 were assessedcompletely. Abnormal GMs were found in both 35 pretermage (normal-optimal 2.9%; normal-suboptimal 28.6%; mildly-abnormal45. 7o/o; definitely-abnormal22.9o/o) and 65 writhing age(3.1 o/o; 41.5%; 41.5%; 13.8%, respectively) (P=0.285). There wasa weak negative correlation between birth weight and the qualityofGMs (r=-0.20, P=0.044).Conclusions The quality ofGMs in Indonesian newborn infants inour study was predominantly abnormal, which puts these infantsat high risk for later developmental disorders. The lower theinfants'birth weight, the more likely for abnormal GMs.

Liver function in children with human immunodeficiency virus infection before and after 6 months of highly active antiretroviral therapy Eva Jacomina Jemima Sapulete; I Gusti Ngurah Sanjaya Putra; Ketut Dewi Kumara Wati; Hendra Santoso; I Putu Gede Karyana; Komang Ayu Witarini; Ni Nyoman Metriani Nesa
Paediatrica Indonesiana Vol 58 No 4 (2018): July 2018
Publisher : Indonesian Pediatric Society

Background Highly active antiretroviral therapy (HAART) has resulted in dramatic decreases in morbidity and improved survival rate in human immunodeficiency virus (HIV)-infected patients. Although the risk of morbidity has decreased, it has been replaced by other long-term complications, such as hepatotoxicity. Hepatotoxicity is often reflected in biochemical abnormalities of liver function, such as elevated levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and aspartate aminotransferase-to-platelet ratio index (APRI). Objective To compare liver function spectrum (AST, ALT, and APRI) in HIV-infected children before and after at least 6 months of HAART. Methods This observational study (before and after) was conducted in pediatric patients with HIV infection who received HAART for at least 6 months at Sanglah Hospital, Denpasar. Data were collected from medical records. Results Forty-nine patients were observed in this study. The mean AST, ALT, and APRI levels before HAART were higher than after at least 6 months of HAART. Anti-tuberculosis treatment and fluconazole therapy were not confounding factors for AST, ALT, and APRI. Conclusion Liver function spectrum enzyme levels of AST, ALT, and APRI are improved after at least 6 months of HAART.

Age and HIV stage at initiation of highly active antiretroviral therapy determine non-reversal of stunting at 3 years of treatment Putu Diah Vedaswari; Ketut Dewi Kumara Wati; I Gusti Lanang Sidiartha; I Gusti Ayu Putu Eka Pratiwi; Hendra Santoso; Komang Ayu Witarini
Paediatrica Indonesiana Vol 58 No 4 (2018): July 2018
Publisher : Indonesian Pediatric Society

Background Highly active antiretroviral therapy (HAART) has been reported to improve growth, especially in the first 2 years of treatment. It is not clear whether catch up growth is maintained after 2 years of HAART. Objective To assess growth in stunted children with HIV after 3 years of HAART and analyze possible risk factors for non-reversal of stunting. Methods This study was done from May 2016 to April 2017 to follow children with HIV who started HAART between January 2009 and April 2014, and continued for 3 years. Inclusion criteria were children with HIV, aged < 18 years, compliance to the regimen, and stunting. Exclusion criteria were patients lost to follow up or who died prior to 3 years of HAART. Non-reversal of stunting was defined as HAZ â‰¤ -2SD after 3 years of HAART. Possible risk factors for non-reversal were analyzed using Chi-square test with P<0.05, as well as risk ratio (RR) and 95% confidence intervals (CI). Results Of 150 HIV-infected pediatric patients, 115 were on HAART and 55 (47.8%) were stunted at HAART initiation. Of the 55 stunted and HAART-treated children, 31 (56.4%) were male. Baseline median age was 3.6 years (interquartile range 0.37-8.48). Non-reversal occurred in 32 (58.2%) subjects. Multivariate Cox regression model analysis showed predictors of non-reversal after 3 years of HAART to be age >2 years (RR 16.05; 95%CI 2.89 to 89.02; P=0.002) and HIV stage III-IV (RR 8.93; 95%CI 1.47 to 54.37; P=0.017). Conclusion HAART initiation at age >2 years and HIV clinical stage III-IV at diagnosis are risk factors for non-reversal of stunting after 3 years of HAART.

Highly active antiretroviral therapy and left ventricular diastolic function in children with human immunodeficiency virus infection Ni Made Ayu Agustini; Eka Gunawijaya; Ni Putu Venny Kartika Yantie; Ketut Dewi Kumara Wati; Komang Ayu Witarini; Hendra Santoso
Paediatrica Indonesiana Vol 59 No 3 (2019): May 2019
Publisher : Indonesian Pediatric Society

Background In the past, cardiovascular involvement did not seem to be a common complication of HIV, but in recent years it has been described more frequently. With the advent of highly active antiretroviral therapy (HAART), the symptoms of cardiac disease has changed, as the number of HIV-infected patients with abnormal diastolic parameters has increased significantly, often presenting as symptomatic rather than asymptomatic. Objective To analyze for a possible correlation between HAART duration and left ventricular diastolic function in HIV-infected children. Methods This cross-sectional study was conducted from December 2016 to December 2017 at the Cardiology and Allergy-Immunology Division/Department of Child Health, Universitas Udayana Medical School/Sanglah Hospital, Denpasar, Bali. Subjects with HAART were collected using a consecutive sampling method. The following data were recorded for each subject: age, sex, current stage of HIV, CD4+ level, as well as HAART regimen and duration of use. Transthoracic echocardiography was performed for tissue doppler imaging (TDI) of diastolic function. Spearmanâ€™s test was used to analyze the strength of correlation based on normality test results. Results This study involved 53 subjects, 21 of whom had impaired diastolic function. There was no correlation between HAART duration and diastolic function in children with HIV infection (r= -0.03; P=0.82). Conclusion Diastolic dysfunction is found in children under HAART treatment, but there is no correlation between HAART treatment duration and diastolic dysfunction.

Efficacy of high-dose methylprednisolone and cyclophosphamide in childhood-onset systemic lupus erythematosus Putu Ayunda Trisnia; Ketut Dewi KUmara Wati; Komang Ayu Witarini; Ida Bagus Ramajaya Sutawan; Hendra Santoso
Paediatrica Indonesiana Vol 60 No 3 (2020): May 2020
Publisher : Indonesian Pediatric Society

Background Systemic lupus erythematosus (SLE) is a chronic, multisystem, autoimmune disease. Untreated SLE often become progressive and lead to increased risk of mortality. Corticosteroid and cyclophosphamide remain the treatment of choice for severe SLE. Disease activity assessed with SLE Daily Activity Index (SLEDAI). Objective To compare the disease activity of childhood-onset severe SLE at the time of diagnosis, after completion of high dose methylprednisolone, and after three month of cyclophosphamide by using SLEDAI. Methods This study was conducted in the Division of Pediatric Allergy and Immunology, Department of Child Health, Udayana University/Sanglah Hospital, Denpasar, Bali. Subjects were SLE patient aged 0-18 years who had severe clinical manifestations. Subject received therapy combination of high dose methylprednisolone and cyclophosphamide every 2 weeks for six doses. SLEDAI score was assessed at the time of diagnosis, after completion of high dose methylprednisolone, and after three month of cyclophosphamide. Results During the study period, 51 children were diagnosed as SLE. Twenty-one subjects were included for analysis. Median SLEDAI score at the time of diagnosis was 23 (range 13-39). SLEDAI score after three months of cyclophosphamide was decreased to 2 (range 0-14). Post hoc analysis with Wilcoxon signed-rank test showed the improvement of SLEDAI score at the time of diagnosis and after three months of cyclophosphamide was statistically significant (Z=-4.016, P<0.0001). Conclusion SLEDAI score reduced after completion of high-dose methylprednisolone and three month of cyclophosphamide therapy.

The risk of atopic dermatitis in post-term gestational age at Sanglah Hospital Denpasar: A preliminary study Made Ardinata; Ketut Dewi Kumara Wati; Wayan Dharma Artana; Hendra Santosa; Komang Ayu Witarini
Intisari Sains Medis Vol. 10 No. 1 (2019): (Available online 1 April 2019)
Publisher : DiscoverSys Inc.

Backgrounds: Several studies reported that Atopic Dermatitis (AD) increases with gestational age. Prolong dominancy of Th2 activity during gestation might contribute to the risk of atopic disease in infancy or beyond the period. This study aimed to evaluate the risk AD in post-term gestational age.Methods: A prospective observational study was conducted among 73 living births at Sanglah Hospital Denpasar from December 2015 to January 2016 period. Infants were classified into 2 such as exposed (post-term) and non exposed (term and preterm) group. Parents-follow up by phone was carried out in 1 until 2 months interval. The study was finished once AD diagnosed, subject died or lost to follow up. Statistical analysis was carried out using SPSS ver. 20 software whereas P-value > 0.05 was considered significant.Results: About 20 (233%) infants were preterm, 36 (49.3%) a term, and 17 (23,3%) post-term. The median value of follow up duration was 28 (14-35) days. Based on AD, there were total 24 cases which divided into 15(62.5%), 8(33.3%) and 1(4.17%) cases of AD in post-term, aterm, and preterm respectively. The incidence rate of AD in post-term was 88.2% while in non-post-term the incidence rate was 16.1%. The relative risk (RR) of AD in post-term was 5.47 (95% CI 2.94-10.23; P = 0.001)Conclusion: Post-term is 5.47 times more likely to develop AD compared with aterm and preterm infant. In addition, the incidence rate of AD in post-term infant was 88.2% at Sanglah Hospital Denpasar

Co-Authors Adiputra, I Komang Hotra Ahmad Suryawan Apsari, Ni Luh Sri Ayu Setyorini Mestika Mayangsari Bambang Permono Biantara, I Wayan Arya Cempaka, Putu Mas Vina Paramitha Cokorda Agung Wahyu Purnamasidhi Darren Junior Defranky Theodorus Dewa Ayu Fony Prema Shanti Dewi Sutriani Mahalini Dewi, Ida Ayu Made Ratna Dyah Kanya Wati Eka Gunawijaya Eka Pratiwi, I Gusti Ayu Putu Eva Jacomina Jemima Sapulete Fatimah Indarso Fatimah lndarso Haning, Joy Aprianis Hendra Santoso Hendra Santoso Hendra Santoso I Dewa Ayu Agung Warmadewanthi I Dewa Made Sukrama I Gde Raka Widiana I Gede Purna Weisnawa I Gusti Ayu Putu Eka Pratiwi I Gusti Lanang Sidiartha I Gusti Ngurah Made Suwarba I Gusti Ngurah Sanjaya Putra I Komang Hotra Adiputra I Made Arimbawa I Made Kardana I Nyoman Budi Hartawan I Nyoman Supadma I Putu Gede Karyana I Wayan Arya Biantara I Wayan Dharma Artana I Wayan Dharma Artana, I Wayan Dharma I Wayan Gustawan I.D.A.A Warmadewanthi Ida Bagus Krisna Jaya Sutawan Ida Bagus Subanada Irwanto, Irwanto Jerry Jerry Junior, Darren Kadek Diana Harmayani Ketut Dewi Kumara Wati Ketut Suarta Luh Gede Yuliadewi NS Luh Putu Putri Sanjiwani Made Ardinata Moersintowarti B. Narendra Moersintowati B. Narendra Ni Made Ayu Agustini Ni Made Susilawathi Ni Nyoman Metriani Nesa Ni Putu Siadi Purniti NP Veny Kartika Yantie Nurliandari, Nia Purwoko, Agus Putu Ayunda Trisnia Putu Diah Vedaswari Putu Junara Putra, Putu Junara Putu Kintan Wulandari Risa Etika, Risa Sampe, Dhea Gracia Eliani Saputra, I Made Yullyantara Setiyawan, I Made Karma Shanti, Dewa Ayu Fony Prema Sindhughosa, Wega Upendra Siska Permanasari Sinardja Sri Widiani, Ni Komang Ayu Sukarta, Ni Kadek Yusthiani Susilawathi, Ni Made Sylviati M. Damanik Wardani, Ni Made Elsa Weisnawa, I Gede Purna Wulandari, Putu Kintan

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