Ketut Putu Yasa
Divisi Bedah Thoraks Kardiovaskular, Fakultas Kedokteran Universitas Udayana, Rumah Sakit Umum Pusat Sanglah, Denpasar, Bali, Indonesia

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Rasio Neutrofil-Limfosit (RNL) dan nilai HbA1c sebagai prediktor amputasi pada pasien kaki diabetik di RSUP Sanglah, Bali, Indonesia Nyoman Maharmaya; Ketut Putu Yasa; I Gde Raka Widiana
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (434.079 KB) | DOI: 10.15562/ism.v11i3.813

Abstract

Background: Amputation is a management that is needed in cases of diabetic foot but is still challenging to predict. In diabetic foot infections, there can be a disturbance in the balance of inflammatory mediators as a cause of tissue damage. Inflammation is assessed by the Neutrophil Lymphocyte Ratio (NLR), and the HbA1c value is associated with an increased risk of amputation. Wagner's classification describes the extent and weight of diabetic foot ulcers.Methods: This study is a predictive diagnostic test on diabetic foot patients who meet the inclusion criteria. Consecutive sampling was conducted from medical records of Sanglah Hospital Denpasar patients from 2017 to 2019. NLR and HbA1c records were taken from the examination before receiving the medical intervention. An analysis using a 2x2 table is used to determine sensitivity and specificity, and a ROC curve analysis to determine the cut-off point with the best sensitivity and specificity. Data were analyzed using SPSS version 20 for Windows.Results: A total of 82 patients met the inclusion criteria with an average age of 57 (46-69) years. There was 43 (52.4%) male and 39 (47.6%) females enrolled in this study. Most diabetic foot samples with Wagner III degree 35 (42.7%) and Wagner IV 34 (41.5%). A total of 31 (37.8%) patients underwent amputation. The ROC analysis showed an NLR cut-off point of 13.67 (AUC=0.617; p=0.078) with a sensitivity of 54.8% and specificity of 66.7%. ROC HbA1c analysis showed a cut-off point of 9.5% (AUC=0.455) with a sensitivity of 45.2% and specificity of 47.1%. Secondary data and operating reliability are limitations in this study, and it makes a lower sensitivity.Conclusion: The results of this study indicate that the Neutrophil-Lymphocyte Ratio (RNL) and the HbA1c value can be used as predictors of amputation in diabetic foot patients at Sanglah General Hospital, Bali, Indonesia.  Latar Belakang: Amputasi merupakan penatalaksanaan yang diperlukan pada kasus kaki diabetik, namun masih sulit untuk diprediksi. Pada infeksi kaki diabetik dapat terjadi gangguan keseimbangan mediator inflamasi sebagai penyebab kerusakan jaringan. Inflamasi dinilai dari Rasio Neutrofil Limfosit (RNL) dan nilai HbA1c dihubungkan dengan meningkatnya resiko amputasi. Klasifikasi Wagner menggambarkan derajat luas dan berat ulkus kaki diabetik.Metode: Penelitian ini adalah uji diagnostik prediktif pada pasien kaki diabetik yang memenuhi kriteria inklusi. Pengambilan sampel dari rekam medis pasien RSUP Sanglah Denpasar secara konsekutif dari tahun 2017 sampai 2019. Pencatatan NLR dan HbA1c diambil dari pemeriksaan sebelum mendapatkan intervensi medis. Kemudian dilakukan analisa menggunakan tabel 2x2 untuk menentukan sensitivitas dan spesifisitas, serta analisa kurva ROC untuk menentukan cut-off point dengan sensitivitas dan spesifisitas terbaik. Data dianalisis dengan SPSS versi 20 untuk Windows.Hasil: Sebanyak 82 pasien memenuhi kriteria inklusi dengan rata-rata umur 57 (46-69) tahun. Terdapat 43 (52,4%) laki-laki dan 39 (47,6%) perempuan dalam penelitian ini. Sebagian besar sampel kaki diabetik dengan derajat wagner III 35 (42,7%) dan wagner IV 34 (41,5%). Sebanyak 31 (37,8%) pasien menjalani amputasi. Dari analisa ROC menunjukkan cut-off point RNL sebesar 13,67 (AUC=0,617; p=0,078) dengan sensitivitas 54,8% dan spesifisitas 66,7%. Analisa ROC HbA1c menunjukkan cut-off point sebesar 9,5% (AUC=0,455) dengan sensitivitas 45,2% dan spesifisitas 47,1%. Data sekunder dan reliabilitas operasi menjadi keterbatasan dalam penelitian ini, sehingga sensitivitasnya rendahKesimpulan: Hasil penelitian ini menunjukkan bahwa Rasio Neutrofil-Limfosit (RNL) dan nilai HbA1c dapat dipergunakan sebagai prediktor amputasi pada pasien kaki diabetik di RSUP Sanglah, Bali, Indonesia
Hubungan antara Platelet Lymphocyte Ratio (PLR) dan Neutrofil Lymphocyte Ratio (NLR) dengan amputasi pasca intervensi endovaskular pada pasien Peripheral Artery Disease (PAD) Rutherford 2–4 di RSUP Sanglah, Bali, Indonesia Ade Sinyo Aristantrisna; Ketut Putu Yasa; I Gde Raka Widiana
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (469.295 KB) | DOI: 10.15562/ism.v11i3.819

Abstract

Background: Endovascular intervention is an effort to reduce amputation number in Peripheral Artery Disease (PAD) patients. The latest studies show a correlation between platelet lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) to the prognosis of PAD. This study aims to evaluate if PLR and NLR can be used to determine the prognosis of PAD patients.Methods: An observational analytic study using a cross sectional approach has been conducted among 56 patients with PAD. The research was conducted in Sanglah Hospital Medical Report room Denpasar, using a patient medical report from January 2014 to December 2018. Variables assessed in this study include NLR, PLR, and ROC analysis to determine the cut-off point used in this study. Data were analyzed using SPSS version 23 for Windows.Results: The ROC analysis results showed that the cut-off point value of 140.5 on the PLR based on the Youden Index had a significant sensitivity level of 75% and a specificity of 64.3% (AUC = 0.739; p = 0.02). While the cut point was 3.14 for the NLR, which had a sensitivity level of 82% and a specificity of 75% (AUC = 0.844; p <0.001). PLR values ? 140.5 had a significant 2.4 times chance of occurrence of amputation after endovascular intervention compared to patients who had PLR values <140.5 (p <0.001; 95% CI = 1.233-4.746). Patients with an NLR ? 3.14 had a 3.9 times chance of having an amputation after the endovascular intervention than patients who had an NLR <3.14 (p <0.001; 95% CI = 1.770 -8.981).Conclusion: High PLR and NLR are associated with the risk of amputation after endovascular intervention in PAD Rutherford 2–4.  Latar Belakang: Salah satu usaha mengurangi angka amputasi pada pasien Periheral Artery Diseasse (PAD) adalah dengan intervensi endovascular. Beberapa studi terbaru menunjukkan adanya hubungan antara Platelet Lymphocyte Ratio (PLR) dan Neutrophil Lymphocyte Ratio (NLR) terhadap prognosis PAD. Penelitian ini bertujuan untuk mengetahui apakah PLR dan NLR dapat dipergunakan untuk menentukan prognosis pasien PAD.Metode: Penelitian observasional analitik dengan pendekatan potong-lintang dilakukan terhadap 56 pasien dengan GAD. Tempat penelitian dilakukan di rekam medik RSUP Sanglah Denpasar. Pengambilan data penelitian adalah rekam medis Januari tahun 2014 sampai dengan Desember 2018. Variabel yang dinilai pada penelitian ini meliputi NLR, PLR, dan analisis ROC untuk menentukan titik potong (cut-off) yang dipergunakan pada penelitian ini. Data dianalisis dengan SPSS versi 23 untuk Windows.Hasil: Hasil analisis ROC menunjukkan bahwa nilai titik potong 140,5 pada PLR berdasarkan Youden Indeks yang memiliki tingkat sensitivitas 75% dan spesifitas 64,3% secara bermakna (AUC=0,739; p=0,02). Sedangkan titik potong 3,14 pada NLR yang memiliki tingkat sensitivitas 82% dan spesifitas 75% (AUC=0,844; p<0,001). Nilai PLR ? 140,5 memiliki peluang 2,4 kali secara bermakna untuk terjadi amputasi pasca intervensi endovaskular dibandingkan dengan pasien yang memiliki nilai PLR < 140,5 (p<0,001; 95% IK=1,233-4,746). Pasien dengan NLR ? 3,14 memiliki  peluang 3,9 kali untuk  terjadi amputasi pasca intervensi endovaskular dibandingkan dengan pasien yang memiliki NLR  <3,14 (p < 0,001; 95% IK=1,770 -8,981).Kesimpulan: PLR dan NLR yang tinggi meningkatkan resiko amputasi pada pasien PAD Rutherford 2-4 yang sudah mendapatkan terapi intervensi endovascular
Pengaruh Ligasi Side Branch Vena Sefalika pada Pembuatan Arteovenous Fistula Radiosefalika Terhadap Laju Aliran Draining Vein pada Pasien Gagal Ginjal Kronis Stadium V di RSUP Prof. Dr. IGNG Ngoerah Aria, Anselmus Danus; Yasa, Ketut Putu; Manuaba, Ida Bagus Putra; Golden, I Nyoman; Sudartana, I Ketut
JBN (Jurnal Bedah Nasional) Vol 8 No 2 (2024): JBN (Jurnal Bedah Nasional)
Publisher : Program Studi Ilmu Bedah, Fakultas Kedokteran Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/JBN.2024.v08.i02.p03

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Tujuan: Mengetahui pengaruh ligasi side branch vena sefalika pada pembuatan arterovenosa fistula radiosefalika terhadap laju aliran draining vein pada pasien gagal ginjal kronis stadium V di RSUP Prof dr. IGNG Ngoerah. Metode: Penelitian observasional analitik dengan rancangan kohort retrospektif ini dilakukan pada Januari 2021 hingga September 2022 di RSUP Prof. dr. IGNG Ngoerah. Pasien gagal ginjal kronis stadium V diinklusi dan dikelompokkan berdasarkan dilakukannya ligasi side branch vena sefalika. Data laju aliran draining vein diambil dari catatan rekam medis. Analisis data yang dilakukan dengan statistik deskriptif dan uji perbandingan proporsi dengan uji chi square. Hasil: Sebanyak 66 subjek penelitian diinklusi dengan masing-masing kelompok sebanyak 33 subjek. Laju aliran dari draining vein pada kelompok ligasi side branch dan bukan ligasi side branch sama dengan median sebesar 150 (100-170) ml/menit. Hasil analisis risiko tidak ditemukan adanya perbedaan bermakna antara kelompok yang dilakukan ligasi side branch dan bukan ligasi side branch (RR=0,17 IK95%= 0,19-1,58, p=0,087). Simpulan: Tidak terdapat pengaruh tindakan ligasi side branch pada vena sefalika terhadap laju aliran draining vein pada pasien gagal ginjal kronis stadium V di RSUP Prof. dr. IGNG Ngoerah.
Peritoneal lavage with sterile water reduces IL-1 levels and postoperative adhesions following laparotomy in rats Fernandi, Ryan; Sudartana, I Ketut; Sueta, Made Agus Dwianthara; Mahayasa, I Made; Yasa, Ketut Putu; Wibawa, I Gusti Agung Bagus Krisna
Sains Medika: Jurnal Kedokteran dan Kesehatan Vol 15, No 1 (2024): June 2024
Publisher : Faculty of Medicine, Universitas Islam Sultan Agung (UNISSULA), Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30659/sainsmed.v15i1.36698

Abstract

Peritoneal lavage with normal saline is common in abdominal surgeries, yet recent studies indicate that it increases intraperitoneal adhesion risks. This study compares the effects of peritoneal lavage with normal saline versus sterile water on interleukin-1 (IL-1) levels and intraperitoneal adhesion following laparotomy in rats. In this post-test control group study, 20 adult Wistar rats were subjected to laparotomy before being randomly divided into two groups to receive either intraperitoneal lavage with normal saline (0.9% NaCl) or sterile water. After 7 days, IL-1 level and degree of adhesion were evaluated. The saline group had higher adhesion levels (4 rats with grade 4, 5 with grade 3, 1 with grade 2) than the sterile water group, which had lower levels (2 rats with grade 3, 5 with grade 2, 3 with grade 1). There was a significant difference in IL-1 levels between the sterile water group (37,111.6 ± 6,535.61 pg/ml) and the normal saline group (57,456.3 ± 10,583.41 pg/ml). There was a significant correlation between IL-1 levels and adhesion grade (p=0.008). Intraperitoneal lavage with sterile water results in significantly lower adhesion grade and IL-1 levels than normal saline, suggesting its potential for reducing postoperative adhesions. Further studies are needed to elucidate the mechanism of reduced adhesion and inflammation associated with sterile water lavage.
Angiography Scores Can Predict Amputation in Diabetic Feet Gede Budhitresna, Anak Agung; Anak Agung Gede Agung Budhi Kesuma; Ketut Putu Yasa
WMJ (Warmadewa Medical Journal) Vol 9 No 1 (2024): May 2024
Publisher : Warmadewa University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22225/wmj.9.1.8802.11-17

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Diabetic foot is a complication of diabetes mellitus, with a risk of amputation. One of the risk factors for amputation is peripheral arterial occlusive disease. Angiography is a diagnostic method used to visualize blood vessels, plan therapeutic actions, and predict prognosis, including the likelihood of amputation. The validity of angiography scores in predicting amputation in diabetic foot patients is assessed. This study is a diagnostic test to determine the validity of angiography scores in predicting amputation in 23 diabetic foot patients at Prof. Dr. I.G.N.G. Ngoerah General Hospital. Data analysis used the Receiver Operator Curve (ROC) and diagnostic tests to obtain the Area Under the Curve (AUC), cutoff point, sensitivity and specificity, Negative Predictive Value (NPV), Positive Predictive Value (PPV), Positive Likelihood Ratio (PLR), and Negative Likelihood Ratio (NLR). The study results showed a cutoff point for angiography scores of 33% with an AUC of 0.9841 (>0.7) for the percent score and a cutoff point of 6 with an AUC of 0.9960 for the total score (>0.7). The sensitivity and specificity of the angiography scores were very good for predicting amputation in diabetic foot, at 92.9% and 88.9% (CI 95%), respectively. With PPV of 92.9% and NPV of 88.9%, the diagnostic value of angiography scores in predicting amputation in diabetic foot patients is supported. This study shows that angiography scores have good validity in predicting amputation in diabetic foot patients.
Mechanical and bioprosthetic valves in young women: a systematic review and meta-analysis of cardiac, maternal, and fetal outcomes Harta, I Komang Adhi Parama; Pertiwi, Putu Febry Krisna; Yasa, Ketut Putu; Sudarma, I Wayan
Journal of Indonesia Vascular Access Vol. 4 No. 2 (2024): Available online : 1 December 2024
Publisher : Indonesian Vascular Access Association (IVAA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/jinava.v4i2.70

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Valve replacement for the heart in young women, particularly those who are pregnant, is challenging. It requires finding the right balance between valve durability, managing anticoagulation, and ensuring positive reproductive outcomes. This systematic review and meta-analysis compared mechanical prosthetic (MP) and bioprosthetic valves (BP) across cardiac, maternal, and fetal outcomes. Nine studies were included following a comprehensive literature search. The analysis revealed MACE involving MP and BP were not significantly different (OR: 1.31, 95% CI: 0.82–2.09, p = 0.26). Thromboembolic events were significantly more frequent in the MP group (OR: 6.59, 95% CI: 3.41–12.74, p < 0.001), while structural valve deterioration (SVD) occurred more often in BP recipients (OR: 0.01, 95% CI: 0.00–0.70, p = 0.03). Maternal outcomes showed a higher risk of pregnancy loss in MP recipients (OR: 4.62, 95% CI: 1.87–11.40, p < 0.001). Preterm delivery was more common went down in the MP group, but it wasn't enough to warrant statistical analysis (OR: 2.20, 95% CI: 0.86–5.58, p = 0.10). For reoperation or redo surgery, MP had lower risk and showed superior results than BP (OR: 0.06, 95% CI: 0.01–0.32, p = 0.001). These findings highlight the complexities involved in choosing between valve types. Although MP valves last longer, they increase the likelihood of thromboembolic events and miscarriage. While improving results for both the mother and the unborn child, BP valves, are prone to structural deterioration, necessitating reoperation. Individualized treatment decisions that consider patient preferences, clinical context, and reproductive plans are essential to optimizing outcomes for young women requiring valve replacement.
Video-assisted thoracoscopic surgery vs. open thoracotomy in the management of empyema: A Meta-analytical perspective Sudarma, I Wayan; Yasa, Ketut Putu; Harta, I Komang Adhi Parama; Pertiwi, Putu Febry Krisna
Journal of Indonesia Vascular Access Vol. 4 No. 2 (2024): Available online : 1 December 2024
Publisher : Indonesian Vascular Access Association (IVAA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/jinava.v4i2.72

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Background: Pleural empyema is a serious condition requiring surgical intervention in advanced stages. This systematic review and meta-analysis compared the outcomes of video-assisted thoracoscopic surgery (VATS) and open thoracotomy in the management of pleural empyema. Method: After performing a systematic search on electronic databases, 15 studies were included with a total of 1,795 patients. Result: The results demonstrated that VATS was associated with significantly shorter chest tube duration (MD: −2.68 days, 95% CI: −4.22 to −1.13, p < 0.001), reduced rates of prolonged air leak (OR: 0.44, 95% CI: 0.26 to 0.74, p = 0.001), and lower total complications (OR: 0.62, 95% CI: 0.44 to 0.87, p = 0.006). Mortality, reoperation rates, and recurrence rates were comparable between VATS and open thoracotomy, indicating similar efficacy for long-term disease resolution. In conclusion, this analysis highlights the advantages of VATS as a minimally invasive approach, particularly in reducing postoperative morbidity and complications. Conclusion: Open thoracotomy remains crucial for complex or advanced cases requiring extensive decortication. The findings underscore the importance of individualized surgical decision-making based on disease stage and patient characteristics.
Successful percutaneous mechanical thrombectomy treatment for a patient with chronic deep vein thrombosis: a case report Maranatha, Maranatha; Yasa, Ketut Putu
Journal of Indonesia Vascular Access Vol. 5 No. 1 (2025): Available online : 1 June 2025
Publisher : Indonesian Vascular Access Association (IVAA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/jinava.v5i1.62

Abstract

Background: This case report details the management of atypical chronic deep vein thrombosis (DVT) in a 24-year-old male. The treatment of DVT is complex and case-dependent; however, most individuals are managed with oral anticoagulation therapy, while complex cases can be treated with advanced interventions. Only a few publications discuss about endovascular procedure of chronic DVT.  This report discusses a singular case of an atypical or complex DVT undergoing a thrombectomy using an Indigo Penumbra system. Case illustration: A 24-year-old male was admitted to the hospital with bilateral leg swollen for 8 years ago. His history was unremarkable, and he was diagnosed with bilateral lower extremities deep vein thrombosis and was routinely administered anticoagulants. Laboratory results showed a significant increase in d-dimer levels. Venography confirmed bilateral deep vein thrombosis in the femoral vein system. He then underwent percutaneous mechanical thrombectomy with the Indigo Penumbra system. Small fragments of white thrombus were collected from the system container. He was discharged 1 day post-operatively and scheduled for further workup. Conclusion: This case report elaborates on a patient with an atypical chronic white thrombus DVT who underwent a thrombectomy after imaging showed extensive thrombotic disease in the right lower extremity. Despite the few publications, percutaneous mechanical thrombectomy using the Indigo Penumbra System showed promising results in chronic DVT.
Efek pemberian beberapa jenis antikoagulan sebagai profilaksis sindrom pasca trombotik setelah DVT (systematic literature review) Ida Bagus Yudharma Indraharsanae; Ketut Putu Yasa
Jurnal Ilmu Kedokteran dan Kesehatan Indonesia Vol. 5 No. 1 (2025): Jurnal Ilmu Kedokteran dan Kesehatan Indonesia
Publisher : Pusat Riset dan Inovasi Nasional

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55606/jikki.v5i2.6836

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This study aimed to evaluate the efficacy of several types of anticoagulants—VKA, LMWH, and DOAC in preventing PTS after DVT through a systematic literature review. The method used involved secondary data search from databases such as PubMed, ScienceDirect, and Google Scholar between 2013–2024, with inclusion criteria including randomized clinical trials and related observational studies. The results showed that DOAC, especially rivaroxaban, significantly reduced the incidence and severity of PTS compared to VKA, with a lower risk of severe PTS. LMWH also showed positive results, although head-to-head evidence with DOAC is still limited. These findings suggest that the type and duration of anticoagulant therapy play an important role in preventing PTS, and encourage the need for further research, especially RCTs between LMWH and DOAC.
Comparing Robotic-Assisted Thoracoscopic Surgery (RATS) vs Video-Assisted Thoracoscopic Surgery (VATS) Approaches for Non-Small Cell Lung Cancer (NSCLC): a Systematic Review and Meta-Analysis Katritama, Arinda Agung; Yasa, Ketut Putu; Tidja, Yonatan Esli Alexander
Journal of Social Research Vol. 2 No. 10 (2023): Journal of Social Research
Publisher : International Journal Labs

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55324/josr.v2i10.1459

Abstract

Video-assisted thoracoscopic surgery (VATS) has demonstrated its efficacy and improved clinical outcomes as an option for early-stage non-small cell lung cancer. The development of robotic-assisted thoracoscopic surgery (RATS) has become the newest alternative to VATS. This study aims to compare VATS and RATS in terms of clinical outcomes. This Systematic Review research used the PRISMA method. RATS is proven to be an alternative with superior results compared to VATS on the Mortality in 30 days parameter (OR 0.59, 95% CI = 0.40, 0.86, I2 : 0%; p<0.006) and transfusion rate (OR = 0.50; 95% CI: 0.27 - 0.92, I2: 6%; p = 0.34). There was no significant difference between the RATS vs VATS procedure in terms of duration of surgery (OR = 0.50; 95%CI: 0.27 - 0.92), and intraoperative complications (OR 1.98, 95%CI: 0.12 - 32.44) and postoperative complications (OR 1.05, 95%CI: 0.93 - 1.19). The parameters of length of stay and chest drain duration in most of the studies show that VATS requires longer treatment time and thoracic drainage time than RATS. RATS can be an alternative to minimally invasive surgery in early-stage lung cancer with a lower risk of death and transfusion requirements than VATS, but there is no difference in the duration of surgery, as well as intraoperative and postoperative complications.