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Journal : ISM (Intisari Sains Medis) : Jurnal Kedokteran

Validitas nilai CA 19-9 praoperatif dalam memprediksi resektabilitas pada kejadian karsinoma pankreas Kadek Adi Wiguna; Ketut Sudartana; Nyoman Golden
Intisari Sains Medis Vol. 10 No. 1 (2019): (Available online 1 April 2019)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (281.929 KB) | DOI: 10.15562/ism.v10i1.340

Abstract

Latar Belakang: Karsinoma pancreas adalah penyakit dengan median survival rate yang rendah dengan angka resectabilitas yang juga rendah. pasien dengan stadium lanjut hanya kurang dari 10 % dapat di reseksi dengan kriteria margin nol setelah sebelumnya dinyatakan dapat di reseksi dari pemeriksaan CT scan. Tujuan dari penelitian ini untuk mengetahui validitas dari CA 19-9 sebagai prediktor derajat invasive karsinoma pancreas. Metode: rancangan penelitian ini adalah kasus kontrol dengan retrospektif, menelusuri kebelakang data data pasien di rekam medik di RSUP Sanglah Denpasar mulai agustus 2015 sampai agustus 2017. Didapatkan 18 pasien yang memenuhi kriteria inklusi. Hasil: rata rata responden dengan karsinoma pancreas berumur 52 tahun, Kanker pancreas di nyatakan unresectable berdasarkan analisis curva Receiver Operating Characteristic (ROC) AUC (Area Under Curve) sebesar 83,8% (CI 95%: 54,4% - 100, %) Titik potong dari kurva AUC kadar CA 19-9 yaitu 126,76 dengan sensitifitas sebesar 76, 9 % dan spesifitas 80 %. Secara statistic didapatkan CA 19-9 valid sebagai penentu unresektabilitas dengan sensitivitas sebesar 76,9%. Kesimpulan: CA 19-9 merupakan tumor marker yang dapat memprediksi derajat invasi suatu kanker pancreas sehingga diharapkan tindakan lebih tepat dapat segera diambil bila kita mengetahui nilai dari tumor marker ini
The oxidative-stress level determine patient’s outcomes with a severe head injury at Sanglah General Hospital, Denpasar, Indonesia I Made Bagus Wirawan; I Nyoman Golden; I Wayan Niryana
Intisari Sains Medis Vol. 10 No. 1 (2019): (Available online 1 April 2019)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (299.308 KB) | DOI: 10.15562/ism.v10i1.352

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Background: In secondary brain injury, oxidative stress will occur due to a balance disorder between pro-oxidants with antioxidants. The antioxidant activity that is often used to assess oxidative stress, such as malondialdehyde (MDA), is superoxide dismutase (SOD) and glutathione peroxidase (GPx). This study aims to evaluate the level of oxidative stress, reflected by the MDA serum level and SOD level to determine the outcomes of patients with severe head injury.Method: A cross-sectional analytic study was conducted among 40 patients with severe head injury within 24 hours post-trauma at Emergency Ward, Surgery Department, Sanglah General Hospital Denpasar from January - June 2017. MDA and SOD levels were assessed using ELISA at Clinical Pathology Laboratory, Sanglah General Hospital. Data were analyzed using SPSS ver. 16 software. Results: This study found significant differences on elevated MDA levels (p-value < 0.05) in patients who died or had a persistent vegetative state, patients with severe disability and those with a good recovery/moderate disability. The statistical analysis also found a significant difference in MDA serum levels among patient with severe disability and patients with a good recovery/moderate disability (P=0,028). Meanwhile, there was no significant correlation between SOD serum levels and patients outcome (P>0.05).Conclusion: Increased MDA serum levels is a significant factor in predicting outcomes of patients with severe head injury.
Faktor-faktor risiko yang berperan terhadap terjadinya infeksi luka operasi pada pasien post appendectomy di RSUP Sanglah Denpasar Danny Zefanya Mooy; I Gede Suwedagatha; Nyoman Golden
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 (352.851 KB) | DOI: 10.15562/ism.v11i2.714

Abstract

Background: Surgical wound infection (SWI) is one of the three most common hospital-acquired infections, with an average of 14-16% and which is the most common infection in postoperative patients. This study aims to look for factors associated with post-operative wound infection in the appendectomy procedure at Sanglah General Hospital Denpasar.Methods: This study used a retrospective cohort design, which was carried out at the Medical Record Installation Sanglah General Hospital Denpasar, Bali-Indonesia during the January 2017 to September 2018. Data analysis used chi-square tests, relative risk calculations, and logistic regression.Results: This study used 108 respondents, and there were 17 people who experienced SWI, the final analysis using logistic regression showed a diagnosis of perforated appendicitis (RR: 9.57; 95% CI: 2.09-43.64; p = 0.004) and operator guidance resident (RR: 1.75; 95% CI: 1.49-22.3; p = 0.011) is a risk factor for the occurrence of the SWI.Conclusion: The diagnosis of perforated appendicitis is the most important factor in the occurrence of surgical wound infection after appendectomy. Latar Belakang: Infeksi luka operasi (ILO) merupakan salah satu dari tiga infeksi tersering yang didapat di rumah sakit, dengan rata-rata mencapai 14-16% dan yang merupakan infeksi yang paling sering terjadi pada pasien pasca operasi. Penelitian ini bertujuan untuk mencari faktor-faktor yang berhubungan dengan infeksi luka operasi pasca prosedur appendectomy di RSUP Sanglah Denpasar.Metode: Penelitian ini menggunakan rancangan kohort retrospektif, yang dilakukan di Instalasi Rekam Medis RSUP Sanglah Denpasar, Bali-Indonesia selama periode Januari 2017 hingga September 2018. Analisis data menggunakan uji chi-square, perhitungan risiko relatif, dan regresi logistik.Hasil: Penelitian ini menggunakan 108 responden, dan terdapat 17 orang yang mengalami ILO, analisis akhir menggunakan regresi logistik menunjukkan diagnosis appendisitis perforasi (RR: 9,57; IK 95%: 2,09-43,64; p=0,004) dan operator residen bimbingan (RR: 1,75; IK 95%: 1,49-22,3; p=0,011) merupakan faktor risiko terjadinya ILO.Simpulan: Diagnosis appendisitis perforasi merupakan faktor yang paling berperan terhadap terjadinya infeksi luka operasi pasca appendectomy.
Faktor-faktor yang berhubungan dengan terjadinya hipertensi intraabdominal pada pasien dengan peritonitis di RSUP Sanglah Denpasar dari bulan Januari 2017 - Desember 2018 Krishna Kurnia Pratama; Ketut Sudiasa; Nyoman Golden
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 (367.595 KB) | DOI: 10.15562/ism.v11i2.723

Abstract

Background and aim: Peritonitis is an emergency condition in the field of surgery due to its several complications. The most challenging is intraabdominal hypertension which can develop into abdominal compartment syndrome. There are several factors that cause intraabdominal hypertension in patients with peritonitis. This study aims to found factors that are associated with the occurrence of intraabdominal hypertension in peritonitis patients at Sanglah General Hospital in January 2017-December 2018.Method: This research used cross sectional analitic with total sampling technique with 136 peritonitis patients in Sanglah Hospital from Januari 2017 until December 2018 as respondents. Data source obtained from medical report. Bivariat analysis done to find factors related with intraabdominal hypertension in peritonitis patients with chi square method and multivariate analysis with logistic regression.Result: The majority of respondents are male, aged 15-64 years, organs involved in peritonitis in the form of solid organs, peritonitis that occurs through trauma mechanisms, experiencing sepsis, leukocytosis, and not hypoalbumin. Three variables were found to be significantly related they are, peritonitis caused by hollow organ perforation, sepsis condition, and hypoalbumin conditions. Only the sepsis condition has significant relationship with the occurrence of intraabdominal hypertension. Sepsis is 0.262 times more likely to cause intraabdominal hypertension in patients with peritonitis compared to patients without sepsis.Suggestion: Closely monitoring intraabdominal pressure should be carried out, especially in patients with sepsis, hypoalbumin, and those suspected of having perforations in hollow organs and further research is needed with a larger number of samples and more superior research methods. Latar belakang dan tujuan: Peritonitis merupakan kondisi kegawatdaruratan di bidang bedah karena dapat menyebabkan terjadinya beberapa komplikasi salah satu yang terberat adalah hipertensi intraabdominal yang dapat berkembang menjadi sindrom kompartemen abdomen. Terdapat beberapa faktor yang menyebabkan hipertensi intraabdominal pada pasien peritonitis. Penelitian ini bertujuan untuk melihat faktor-faktor yang berhubungan dengan terjadinya hipertensi intraabdominal pada pasien peritonitis di RSUP Sanglah bulan Januari 2017-Desember 2018.Metode: Penelitian analitik cross sectional dilakukan menggunakan teknik total sampling dengan melibatkan 136 responden yang merupakan pasien peritonitis yang dirawat di RSUP Sanglah bulan Januari 2017-Desember 2018. Sumber data berupa rekam medis pasien. Analisis dilakukan untuk melihat faktor yang berhubungan dengan hipertensi intraabdominal pada pasien peritonitis secara bivariat dengan metode chi square dan multivariat dengan regresi logistik.Hasil: Mayoritas responden berjenis kelamin laki-laki, berusia 15-64 tahun, organ terlibat dalam peritonitis berupa organ padat, peritonitis yang terjadi melalui mekanisme trauma, mengalami sepsis, leukositosis, dan tidak hipoalbumin. Tiga variabel ditemukan signifikan berhubungan yakni peritonitis diakibatkan oleh perforasi organ berongga, kondisi sepsis, dan kondisi hipoalbumin. Hanya kondisi sepsis yang memiliki hubungan murni dengan terjadinya hipertensi intraabdominal. Kondisi sepsis berisiko 0,262 kali lebih besar menyebabkan terjadinya hipertensi intraabdominal pada pasien peritonitis dibandingkan dengan pasien yang tidak mengalami sepsis.Saran: Sebaiknya dilakukan pemantauan tekanan intraabdominal secara ketat, terutama pada pasien dengan sepsis, hipoalbumin, dan yang dicurigai mengalami perforasi pada organ berongga serta diperlukan penelitian lanjutan dengan jumlah sampel yang lebih besar serta metode penelitian yang lebih superior. 
Factors associated with unfavourable outcome after Burr Hole drainage in Subdural Hematoma (SDH) at Sanglah General Hospital, Bali, Indonesia I Gusti Ngurah Purnomo; I Wayan Niryana; Nyoman Golden
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 (289.215 KB) | DOI: 10.15562/ism.v11i2.731

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Background: Subdural hematoma is a neurosurgical disorder that often occurs in the elderly with simple, relatively fast and minimally invasive surgical therapy, but has a high postoperative mortality rate due to unfavourable outcome. This study aims to evaluate factors associated with unfavourable outcome after burr hole drainage in a subdural hematoma (SDH) at Sanglah General Hospital, Bali, Indonesia.Method: A prospective cohort study was conducted among 60 respondents to determine factors influencing the outcome of patients with subdural hematoma after burr hole drainage.  The independent variables in this study included age, comorbid factors, trauma onset, GCS, hematoma thickness, and midline shift.  Dependent variables include the Glasgow Outcome Scale (GOS), which is divided into 2 groups, favourable outcome, and unfavourable outcome. Data were analyzed using SPSS version 17 for Windows.Results: There were 19 respondents (31.7%) had unfavourable outcomes and 41 respondents (68.3%) had favourable outcomes.  From the bivariate analysis, significant associated risk factors were found in the onset of trauma (p=0.048), GCS (p=0.000), hematoma thickness (p = 0.000), and midline shift (p=0.000).  From the multivariate analysis, it was found that low GCS was the most dominant risk factor for the unfavourable outcome following burr hole drainage (OR=22.30; 95% CI= 2.22-223.80; p=0.008) Conclusion: This study concludes that low GCS was the most dominant risk factor for unfavourable outcome in patients with subdural hematoma after burr hole drainage
Risk factors and novel prognostic score for predicting the 14-day mortality of severe traumatic brain injury patients Nyoman Golden; Putu Eka Mardhika; Wayan Niryana; I Made Sukarya; I Putu Yuda Prabawa
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 (484.992 KB) | DOI: 10.15562/ism.v11i3.831

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Introduction: The mortality of severe traumatic brain injury (TBI) is contributed by the severity of the head injury, associated trauma, and complication during treatment. This study aimed to develop a prognostic scoring system of risk factors that contribute to the 14-day mortality of severe TBI.Methods: This was a prospective cohort study including 105 severe TBI patients recruited consecutively from March to October 2016. Multivariate analysis with logistic regression was performed to determine the most contributing risk factors. The validation of prognostic factor was performed with ROC, sensitivity and specificity analysis.Result: There were five significant risk factors of 14-day mortality, which were age > 60 years old (RR: 15.6, 95% CI: 1.88 – 129.95), hypoxia (RR: 17.78, 95% CI: 2.05 – 154.11), GCS 3 – 5 (RR: 34.71, 95% CI: 6.85 – 175.98), effacement of basal cistern (RR: 12.71, 95% CI: 2.61 – 61.95), and traumatic subarachnoid hemorrhage (tSAH) (RR:7.57, 95% CI: 1.19 – 48.36). The prognostic score ranged from 0 to 6 with the best cut-off point of 1. The best predictive AUC with ROC analysis was 0.817, 81.2% of sensitivity, and 75.0% of specificity.Conclusion: The proposed prognostic score has shown good predictive ability.
Perbandingan kadar C-reactive protein (CRP) berdasarkan jenis herniotomi dan hubungannya dengan keluaran klinis pada hernia inguinalis indirek anak Giovani Fatrio Odo; I Made Darmajaya; Nyoman Golden
Intisari Sains Medis Vol. 13 No. 2 (2022): (In Press : 1 August 2022)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (337.385 KB) | DOI: 10.15562/ism.v13i2.1430

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Background: Hernia is a protrusion or protrusion of the contents of a cavity through a defect or weak part of the abdominal cavity wall. The standard procedure in the form of herniotomy for indirect inguinal hernias in children can be performed open surgically or laparoscopically. Because there is still a lot of debate about the inflammatory response and outcomes that arise in patients undergoing laparoscopy and open herniotomy, this study was conducted with the aim of evaluating differences in CRP levels in pediatric patients after open herniotomy and laparoscopic herniotomy and their impact on surgical outcomes in the form of wound healing time, length of hospitalization and postoperative pain. Methods: This study is a prospective cohort study using primary data carried out at Sanglah Central General Hospital (RSUP) Sanglah from January to December 2020. Data in the form of gender, the side of the hernia, age, CRP levels, duration of hospitalization, duration of wound healing , postoperative pain scale, duration of surgery, hemoglobin, and BMI were taken from the patient's medical record. After the data was collected, univariate and bivariate analysis was carried out using SPSS 20. Result: A total of 38 patients who were the subjects of this study in the open surgical and laparoscopic groups were 19 subjects each. The mean CRP level in the open surgical group was higher (4.58 ± 1.82 mg/L) than the laparoscopic group (3.53 ± 1.53 mg/L). The duration of hospitalization and wound healing in the open surgical group was found to be longer (1.11 ± 0.32 days; 6.58 ± 0.51 days) when compared to the laparoscopic group (1.05 ± 0.23 days; 4.42 ± 0.51 days). The mean postoperative pain scale measurement results were higher in the open surgical group (2.84 ± 0.77) compared to the laparoscopic group (1.53 ± 0.51). The results showed that there was a statistically significant correlation (p<0.05; p<0.05) with a weak correlation coefficient (r = 0.468; r = 0.457). Conclusion: The laparoscopic technique was found to be superior in terms of the resulting inflammatory response, duration of wound healing, postoperative pain scale, and duration of hospitalization when compared to the open surgery technique. While the duration of hospitalization between the two groups was the same.   Latar belakang: Hernia merupakan protrusi atau penonjolan isi suatu rongga melalui defek atau bagian lemah dari dinding rongga abdomen. Prosedur standar berupa herniotomi pada hernia inguinal indirek anak dapat dilakukan secara open surgical ataupun laparoskopi. Oleh karena masih banyaknya perdebatan mengenai respon inflamasi dan luaran yang timbul pada pasien yang menjalani laparoskopi dan open herniotomy, penilitian ini dilakukan dengan tujuan untuk mengevaluasi perbedaan kadar CRP pada pasien anak pasca open herniotomy dan laparoskopi herniotomi serta dampaknya terhadap luaran operasi berupa lama penyembuhan luka, lama rawat inap serta nyeri paska operasi. Metode: Studi ini merupakan studi kohort prospektif dengan menggunakan data primer yang dilaksanakan di Rumah Sakit Umum Pusat Sanglah (RSUP) Sanglah sejak Januari hingga Desember 2020. Data berupa jenis kelamin, sisi yang mengalami hernia, usia, kadar CRP, durasi rawat inap, lama penyembuhan luka, skala nyeri pasca operasi, durasi operasi, hemoglobin, dan IMT diambil dari rekam medis pasien. Setelah data terkumpul, dilakukan analisis univariat dan bivariat dengan menggunakan SPSS 20. Hasil: Sebanyak 38 pasien yang menjadi subjek penelitian ini dengan kelompok open surgical dan laparoskopi terdapat masing-masing 19 subjek. Rerata kadar CRP pada kelompok open surgical lebih tinggi (4.58 ± 1.82 mg/L) dibandingkan dengan kelompok laparoskopi (3.53 ± 1.53 mg/L). Durasi rawat inap dan penyembuhan luka pada kelompok open surgical didapatkan lebih lama (1.11 ± 0.32 hari; 6.58 ± 0.51 hari) jika dibandingkan dengan kelompok laparoskopi (1.05 ± 0.23 hari; 4.42 ± 0.51 hari). Rerata hasil pengukuran skala nyeri pasca operasi didapatkan lebih tinggi pada kelompok open surgical (2.84 ± 0.77) dibandingkan dengan kelompok laparoskopi (1.53 ± 0.51). Hasil menunjukkan antara kadar CRP dengan variabel durasi penyembuhan luka dan dengan durasi operasi didapatkan korelasi yang bermakna secara statistika (p<0.05; p<0.05) dengan koefisien korelasi yang lemah (r = 0.468; r = 0.457). Simpulan: Teknik laparoskopi ditemukan lebih unggul dalam hal respon inflamasi yang dihasilkan, durasi penyembuhan luka, skala nyeri pasca operasi, dan durasi rawat inap jika dibandingkan dengan teknik open surgery. Sedangkan durasi rawat inap diantara kedua kelompok adalah sama. Kata Kunci: C-reactive protein, open herniotomy, herniotomi laparoskopi, hernia inguinalis indirek, luaran operasi
Faktor risiko kejadian ileus paralitik patologis pasca laparotomi dengan reseksi dan anastomosis pada traktus gastrointestinal Mira Dewi Prawira; Made Agus Dwianthara Sueta; Nyoman Golden
Intisari Sains Medis Vol. 13 No. 3 (2022): (In Press 1 December 2022)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/ism.v13i3.1549

Abstract

Background: Postoperative paralytic ileus is a physiological response of the intestine to surgical stress. However, if this condition lasts more than 3 days, it is pathological. Some factors related to postoperative ileus have been identified, but the results are still confusing. This study aimed to identify risk factors of postoperative ileus following laparotomy for anastomosis and resection of the gastrointestinal tract at Prof. Dr. I.G.N.G. Ngoerah Hospital. Method: This was a retrospective cohort study between January 2019 until July 2020. The subjects were recruited consecutively, which included adult patients who had undergone laparotomic surgery with anastomosis and resection. Data was taken in Prof. Dr. I.G.N.G. Ngoerah Hospital until the needed samples were fulfilled. Data were analyzed using SPSS version 24 for Windows. Result: There were 50 subjects aged from 32 to 74 years old in this study. About 62% of subjects were female. Analysis showed a correlation between postoperative ileus occurrence and Age; it also correlates with the operation duration. Multivariate analysis found that patients aged 65 years and older have a 5.96 greater risk of developing postoperative ileus than younger patients (95% CI 1.55-22.99; p=0.010). This study also found that an operation lasting 180 minutes or more had a 6.14 greater risk of postoperative ileus than a shorter surgery duration (95% CI 1.57-24.05; p=0.009). Conclusion: Age over 65 years old and duration of operation more than 3 hours were associated with postoperative paralytic ileus in adult patients who had undergone laparotomy for anastomosis and resection of the gastrointestinal tract.   Latar Belakang: Ileus paralitik pasca operasi merupakan sebuah respon fisiologis usus terhadap stress pembedahan. Namun ketika ileus yang terjadi berlangsung lebih dari 3 hari maka kondisi ini masuk dalam kondisi patologis. Beberapa faktor sudah diidentifikasi untuk memprediksi kejadian ileus post operasi namun hasilnya masih ambigu. Penelitian ini bertujuan mengetahui faktor risiko ileus paralitik patologis pasca operasi pada populasi pasien laparatomi reseksi dengan anastomosis di RSUP Prof. Dr. I.G.N.G. Ngoerah. Metode: Penelitian ini menggunakan pendekatan kohort retrospektif yang berlangsung sejak Januari 2019 hingga Juli 2020. Pengambilan data dilakukan dengan metode konsekutif sampling pada pasien dewasa. Pengambilan data dilakukan di RSUP Prof. Dr. I.G.N.G. Ngoerah sampai jumlah sampel terpenuhi. Data dianalisis dengan SPSS versi 24 untuk Windows. Hasil: Sebanyak 50 subjek diikutsertakan dalam penelitian ini dengan rentang usia 32 hingga 74 tahun. Sebanyak 62% adalah perempuan. Pada analisis ditemukan adanya hubungan usia dan durasi operasi dengan kejadian ileus post operasi. Pada analisis multivariat ditemukan bahwa usia di atas 65 tahun memiliki risiko mengalami ileus post operasi 5,96 kali lebih besar dibanding usia yang lebih muda (95% IK=1,55-22,99; p=0,010). Selain itu juga ditemukan operasi yang berlangsung selama 180 menit atau lebih memiliki risiko 6.14 kali lebih besar mengalami ileus post operasi dibanding durasi operasi yang lebih singkat (95% IK=1,57–24,05; p=0,009). Simpulan: Usia pasien di atas 65 tahun dan durasi operasi lebih dari 3 jam berhubungan dengan kejadian ileus paralitik patologis paska operasi pada pasien yang menjalani operasi laparotomi dengan reseksi dan anastomosis.