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All Journal BALI MEDICAL JOURNAL (BMJ) Medicina journal of internal medicine INDONESIAN JOURNAL OF BIOMEDICAL SCIENCES E-Jurnal Medika Udayana The Indonesian Biomedical Journal Jurnal Penyakit Dalam Udayana Oceana Biomedicina Journal ISM (Intisari Sains Medis) : Jurnal Kedokteran Al-Iqra Medical Journal : Jurnal Berkala Ilmiah Kedokteran Oceana Biomedicina Journal Journal of Global Pharma Technology
Ketut Suega
Departemen Penyakit Dalam Fakultas Kedokteran, Universitas Udayana, Rumah Sakit Umum Pusat Sanglah, Denpasar, Bali
Biochemistry, Genetics & Molecular Biology Dentistry Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health

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Satu tahun kesintasan penderita limfoma non-hodgkin berdasarkan klasifikasi histopatologi working formulation Ludirdja, Evan Pratama; Rena, Ni Made Renny Anggreni; Suega, Ketut; Bakta, Made
Jurnal Penyakit Dalam Udayana Vol 2 No 2 (2018): Vol 2 No 2 (2018) July-December 2018
Publisher : PAPDI BALI

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Latar belakang: Limfoma Non-Hodgkin (LNH) memiliki manifestasi dan gambaran histologi yang heterogen. Berdasarkan klasifikasi Working Formulation, LNH dibagi menjadi 3, yaitu derajat keganasan rendah, menengah, dan tinggi, yang mencerminkan derajat agresifitas LNH berdasarkan gambaran histopatologiknya. Pada beberapa studi dikatakan LNH tipe indolen cenderung tumbuh lambat dan memiliki kesintasan lebih panjang dibanding tipe yang lebih agresif Tujuan: Membandingkan median kesintasan penderita LNH dari jenis sel B berdasarkan derajat keganasannya sesuai dengan klasifikasi Working Formulation Metode: Penelitian ini menggunakan desain kohort retrospektif, antara bulan Januari 2013 sampai Juli 2017 di RSUP Sanglah Denpasar. Analisis menggunakan Kaplan meier dan seluruh data dianalisis menggunakan SPSS. Hasil: Dari 88 penderita LNH, diambil 38 subyek yang eligible. Dari data didapatkan sebanyak 21 penderita (55,3%) berjenis kelamin laki-laki, dengan gambaran histopatologi terbanyak berupa Diffuse Large Cell (36,8%). Sebanyak 3 penderita (7,9%) termasuk dalam derajat keganasan rendah, 25 penderita (65,8%) termasuk dalam derajat keganasan menengah, dan 10 penderita (26,3%) dengan derajat keganasan tinggi. Median kesintasan pada LNH derajat keganasan rendah di atas 1 tahun (IK 95%), derajat keganasan menengah 271 hari (IK 95%), dan derajat keganasan tinggi 31 hari (0-72,837, IK 95%), dengan nilai p=0,133, namun kelompok dengan derajat keganasan tinggi cenderung memiliki kesintasan yang lebih rendah dibanding 2 kelompok yang lain. Simpulan: Tidak terdapat perbedaan yang signifikan kesintasan penderita LNH dengan derajat keganasan rendah, sedang, dan tinggi.
Kadar hemoglobin awal sebagai faktor prognostik penderita limfoma non-hodgkin (LNH) yang menjalani kemoterapi Winarto, Daniel; Rena, Ni Made Renny A; Adnyana, Wayan Losen; Dharmayuda, Tjokorda Gede; Suega, Ketut; Bakta, I Made
Jurnal Penyakit Dalam Udayana Vol 2 No 2 (2018): Vol 2 No 2 (2018) July-December 2018
Publisher : PAPDI BALI

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Latar belakang: Anemia sering ditemukan pada saat diagnosis awal LNH. Anemia dapat terjadi karena beberapa kondisi, seperti perdarahan terkait LNH dengan atau tanpa anemia defisiensi besi, anemia karena penyakit kronik, infiltrasi sel-sel LNH ke sumsum tulang, anemia hemolitik autoimun maupun anemia terkait kemoterapi. Anemia mempengaruhi perjalanan klinis dan kesintasan pasien-pasien LNH. Tujuan: Penelitian ini bertujuan untuk membuktikan bahwa kadar Hb awal merupakan faktor prognostik penderita LNH yang menjalani kemoterapi.  Metode: Penelitian ini merupakan penelitian kohort retrospektif mulai bulan Januari 2013 sampai bulan September 2017 pada penderita LNH yang menjalani kemoterapi di RSUP Sanglah Denpasar. Hubungan antara kadar Hb dengan skor R-IPI dianalisis menggunakan uji Mann Whitney. Analisis kesintasan menggunakan metode Kaplan Meier dan Cox Proportional Hazard Mode dengan menggunakan software SPSS. Hasil: Dari 88 penderita LNH, dieksklusi 31 penderita, sehingga total sampel sebanyak 57 orang. Dengan menggunakan analisis komparatif Mann Whitney didapatkan perbedaan signifikan pada skor R-IPI antara pasien LNH dengan Hb ≥ 10 g/dl (md=1, n=46) dan kadar Hb < 10 g/dl (md=3, n=11) (z= -2,106; p= 0,035; d= 0,28). Analisis dengan Kaplan Meier, didapatkan penderita dengan kadar Hb<10 gram/dL memiliki kesintasan lebih pendek dibanding penderita dengan kadar Hb≥10 gram/dL (± 255 vs ± 850 hari; p= 0,002; IK 95%) dan  dengan analisis Cox Regression didapatkan Hazard ratio sebesar 4.46 (p= 0,005). Simpulan: Kadar hemoglobin awal dapat digunakan sebagai faktor prognostik mortalitas penderita LNH yang menjalani kemoterapi.
ROLE OF HEPCIDIN IN MECHANISM OF ANEMIA CHRONIC DISEASE PATIENTS Suega, Ketut
BALI MEDICAL JOURNAL Vol 3 No 2 (2014)
Publisher : BALI MEDICAL JOURNAL

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Background: Anemia chronic disease (ACD) is an anemia found in certain chronic disease states, typically marked by the disturbance of iron homeostasis or hypoferremia. This condition leads to shortage of iron for hemoglobin synthesis but the iron storage in bone marrow is left undisturbed. The discovery of hepcidin and its role in iron metabolism has given new insights in anemia chronic disease management. Consecutive sampling method was applied to choose ACD patients at Sanglah General Hospital, Bali-Indonesia. Questionnaire was constructed to note demographic aspect and disease or clinical condition underlies ACD (inflammation, infection, malignancy and others). Hepcidin, Serum IL-6 and CRP level were measured. Sample size and Path analysis mediation method were used to define hepcidin’s role on mechanism how anemia develop in ACD patients in which the direct and indirect effects of IL-6 and CRP to hemoglobin (Hb) were counted partially or combined through hepcidin mediation variable. The cumulative influence of IL-6, CRP and hepcidin on anemia (Hb) was only 0.12 or about 12% of hemoglobin level was influenced by IL-6, CRP and hepcidin together whereas the other 93% was influenced by another unknown and unclear factors. Hepcidin could be used as a mediation variable for the development of anemia because the direct influence of IL-6 as exogenous factor was less than its indirect influence through hepcidin. It was not proven for CRP as exogenous variable because the direct influence of CRP to hemoglobin was stronger than the influence of CRP through hepcidin.
Pre-Storage Leukoreduced Filtration (PLF) Decrease Soluble Human Leukocyte Antigen-I (sHLA-I) Level in Thrombocyte Concentrate Stored for Five Days Herawati, S.; Sutirta-Yasa, I. W. P.; Suega, K.; Subawa, A. A. N.
BALI MEDICAL JOURNAL Vol 5 No 1 (2016)
Publisher : BALI MEDICAL JOURNAL

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Background: Thrombocyte concentrate is one of the important blood component to improve patient's clinical condition. In order to provide thrombocyte, concentrate with good therapeutic effect, the preparation process and storage condition should be maintained properly. One attempt to maintain good quality of thrombocyte concentrates is by doing Pre-storage Leukoreduced Filtration (PLF) method during preparation of thrombocyte concentrates. The purpose of this study was to determine the effect of PLF on sHLA-I level in thrombocyte concentrates stored for 1, 3 and 5 days. Methods: This is an experimental study with posttest only Control Group design, enrolling 34 thrombocyte concentrates and randomly assigned into PLF Group and Control Group. Results: It was obtained that PLF Group has lower mean sHLA-I level than Control Group stored for 1, 3 and 5 days and statistically significant. Mean sHLA-I level in PLF Group at day 1 is 2,75±0,82 µg/ml and Control Group is 3,66±0,87 µg/ml, which is statistically significant (p < 0,05). Mean sHLA-I level in PLF Group at day 3 is 3,07±0,75 µg/ml and Control Group is 4,05±1,29 µg/ml, which is statistically significant (p < 0,05). Mean sHLA-I level in PLF Group at day 5 is 3,81±0,97 µg/ml and Control Group is 5,61±3,26 µg/ml, which is statistically significant (p < 0,05). Conclusions: It can be concluded that PLF decrease sHLA-I level in thrombocyte concentrates stored for five days compared with Control Groups.
A WOMAN WITH SPORADIC HEMOPHILIA-B DIE BECAUSE OF CEREBRAL BLEEDING: A Rare Case in Bali-Indonesia Suega, Ketut
BALI MEDICAL JOURNAL Vol 4 No 2 (2015)
Publisher : BALI MEDICAL JOURNAL

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Background: Hemophilias are groups of blood clotting disorder caused by deficiency of blood clotting factors which is X-linked recessively inherited and explain why mostly man is the affected victim. But on an extremely rare condition a women can have hemophilia due to several reasons and sporadic hemophilia is used to describe when hemophilia appeared without ascent and decent history of hemophilia. A 38 years old women with a peripheral spontaneous bleeding for two days although an open flap and a cauterization to stop the bleeding has been applied. She was the third child of 7 children in the family, 3 of them were man with normal life and 4 women also have no history of bleeding. Her parent and grand-parent were all dead because of aging problems. She also has 2 sons with ages of 10 and 13 years, respectively, live normally. Results: factor VIII activity 192 seconds (control: 80 seconds), factor IX activity 2 seconds (control: 111 seconds), hence patient was considered suffered from sporadic haemophilia-B due to low level of factor IX 1.8% and bleeding episodes mimicking clinical presentation of classical hemophilia patients while no known history of having hemophiliac family. The different diagnose were Von Willebrand Diisease (VWD), symptomatic carriers, acquired hemophilia. After several admissions and repeatedly bleeding episodes patient died because of intra cerebral bleeding.
Seorang penderita leukemia mieloid kronik dengan komplikasi efusi pleura Jauwerissa, Ria; Suega, Ketut
Medicina Vol 47 No 3 (2016): September 2016
Publisher : Medicina

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Leukemia mieloid kronik (LMK) adalah kelainan mieloproliferatif yang ditandai dengan peningkatan proliferasi sel granulositik, dengan prevalens 20% dari kejadian leukemia. Efusi pleura pada LMK merupakan komplikasi yang jarang ditemukan, dengan patofisiologi yang belum jelas, dan merupakan faktor prognostik yang buruk pada LMK. Kasus adalah lelaki, 24 tahun, didiagnosis dengan LMK transformasi akut dengan komplikasi efusi pleura, diterapi dengan hidroksiurea dan evakuasi cairan pleura. Pasien mengalami komplikasi pneumonia dan meninggal. [MEDICINA.2016;50(3)71-75]
Seorang penderita anemia berat dengan kemungkinan talasemia-? minor kombinasi hemoglobin e Panjaitan, Andi Manaek Hatimbulan; Suega, Ketut
Medicina Vol 47 No 3 (2016): September 2016
Publisher : Medicina

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Talasemia-?disebabkan olehpenurunan sintesis rantai beta dari globin. Hemoglobin E adalah salah satubentuk hemoglobinopatiyangasam amino glutamatnyadigantikan oleh asam amino lisin pada posisi 26 rantaiglobin ?. Kami melaporkan pasien lelaki 26 tahun dengan keluhan lemas badan. Pada pemeriksaan didapatkananemia berat hipokromik mikrositer, splenomegali, kardiomegali, dan peningkatan kadar HbA2 dan HbF.Dalam perawatan, pasien diberikan tranfusi PRC 1 kolf perhari sampai Hb >10 g/dl. Pembuktian hemoglobinE dengan analisis DNA metode PCR tidak dikerjakan karena biaya. Keluhan lemas badan teratasi dengantransfusi PRC. Pasien ini akan mengalami banyak tranfusi darahdengan akibat kelebihan besi padaorganorgantubuh.[MEDICINA.2016;47(3):58-62] ? Thalassemia is caused by decreasing synthesis of beta globin chains. Hemoglobin E is one ofhemoglobinopathies which glutamic amino acid was replaced by lysine amino acid at 26 ? globin chainposition. We reported a male patient 26 years old with complaintsof weakness. On physical examination wefound severe anemia, hipocromic micrositer, splenomegaly, cardiomegaly, and increasing the level of HbA2and HbF. During treatment, patient has got PRC transfusion one bag a day until Hb >10 g/dl. For provinghemoglobin E with DNA analysis and PCR has not be done due to financial problem. The weaknessimprovedby PRC transfusion. This patient will receive a lot of blood transfusion with its complication is iron overloadin the body.[MEDICINA. 2016;47(3):58-62]
SEORANG PENDERITA HAMIL DENGAN LEUKEMIA MIELOID AKUT Sukrawan, Gede; Losen Adnyana, Wayan; Suega, Ketut
journal of internal medicine Vol. 12, No. 2 Mei 2011
Publisher : journal of internal medicine

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Leukemia during pregnancy is extremely rare, the estimate one per100,000 pregnancies each year. Intrauterine growthdisorders have been reported in pregnant women with untreated AML. A pregnant female patient, 28 years old, Balinese, privateemploy came with chief complain fever, sweaty, nausea and vomiting, body weekly, Physical examination: anemic, pale, bloodpressure; 120/80mmHg, pulse 88 x/minute, respiration 20 x/minute, axillary temperature of 36.7 degrees Celsius, heart andlungarenormal, Abdoment: fundus uteri-high processusxipoideus, distention and bowel sounds normal. Laboratory January 14th 2011:leukocyte 63,2 103/ul, Hb 11.7 g/dl, hematocrite 33.6%, MCV 30.7 pg, trombocite 40 103/ul, anatomicalpathology on November26th 2009 with increasing blast dysplasia eritroid series, allowing a leukemia acute. January 16th 2010 chemotherapyAra-C150 mg in 500 ml NaCl 0.9% 24 hours for 7 days and daunorubicine 60 mg IV bolus for 3 days. January 18th 2010 laboratoryresultleukosit 46.2 x 103/ul, Hb 9.2 g/dl, hematocrite 26.3%, MCV 87.4 fl, MCH 30.4 pg and thrombocyte 10 x 103/ul. The patienthad complite remission after chemoterapy and laboratory results on February 12th 2010 were leucocyte 7.02 x 103/ul, Hb 8.6g/dl, hematocrite 25.5%, MCV 74.5 fl, MCH 25.5 and thrombocyte 125 x 103/ul. The baby was born with normal condition withoperation. Acute leukemia in pregnancy should be managed together hematologist, obstetrics-gynaecology and neonatologists.
PARANEOPLASTIC SYNDROMES Suega, Ketut
journal of internal medicine Vol. 12, No. 1 Januari 2011
Publisher : journal of internal medicine

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The term Paraneoplastic Syndromes (PNS) refers to symptoms or signs resulting from damage to organs or tissuesthat are remote from the site of a malignant neoplasm or its metastases. Widely known examples include cancer cachexia,hypercalcemia,Cushing!s syndrome,and Trousseau!s syndrome . A particularly devastating form of paraneoplastic syndromes ia agroup of disorders classiÞ ed as Paraneoplastic Neurological Disorders (PND).The incidence of PNS varies with the neurologicalsyndrome and with the tumor. PNS can occurs in 7 to 10% of all patients with cancer. A paraneoplastic syndrome may resultfrom production and release of antibodies and physiologically active substances, or it may be idiopathic. However, not allparaneoplastic syndromes are associated with these antibodies. Symptoms can be atypical, psychiatric, or even ß uctuating,and PNS should often be in the differential diagnosis of otherwise unexplained neurological syndromes. An internationalpanel of neurologists has established diagnostic criteria that divide patients with a suspected PNS into deÞ nite and probablecategories. These criteria are based on the presence or absence of cancer, the presence of well-characterized antibodies, and thetype of clinical syndrome. Detection of a "well-characterized# paraneoplastic antibody is extremely helpful because it provesthe paraneoplastic etiology of the neurological syndrome. Usually, the paraneoplastic syndromes are divided into the followingcategories: (1) miscellaneous (nonspeciÞ c), (2) rheumatologic, (3) renal, (4) gastrointestinal, (5) hematologic, (6) cutaneous, (7)endocrine, and (8) neuromuscular. Treatment varies with the type and location of the paraneoplastic disorder, consist of treatmentof the underlying tumor, as well as the treatment of the presumptive immune-mediated disorder is based on immunosuppression.Because paraneoplastic syndromes differ widely from individual to individual, prognosis may vary greatly.
DEEP VEIN THROMBOSIS SEBAGAI MANIFESTASI SINDROMA PARANEOPLASTIK DARI KANKER PARU Suega, Ketut
journal of internal medicine Vol. 12, No. 2 Mei 2011
Publisher : journal of internal medicine

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Thrombotic event in patient with cancer is a common feature in contrary to the presentation of thombotic disordersthat part of para neoplastic syndrome as a solely initial symptom of an occult malignancy. The underlying mechanism thatassociating between cancer and thrombosis as well as between cancer and paraneoplastic syndrome is not clearly understoodyet. One of those cancers that frequently associated with paraneoplastic syndrome is lung cancer. We reported a 46 years oldwoman that presents initially because of a swollen left leg and tenderness along the leg. Other examinations within normalfinding including normal chest x ray. In approximately a year later, the patient experiences disturbing cough with blood streak,accompany with shortness of breath. She was also complaining of sharp chest pain especially when taking a deep breath.After several examinations performed such as bronchoscopy with bronchial washing, transthoracal biopsy, sonographic study,echocardiography, chest CT scan, this patient was finally diagnose of having advanced lung malignancy. Histologic finding wascomfirm with adeno carcinoma poorly differentiated. He was treated under 6 concecutive cycles of gemzitabin combined withcarboplatin. Despite completed chemotherapy treatment, she became worst and died because of respiratory failure
Co-Authors AAG Sudewa D. Anak Agung Ngurah Subawa Anak Agung Wiradewi Lestari Andika Budiartha, Putu Gede Andisari, Hendrata Erry Arundina Sanyoto Bambang Purwanto Dewa Gede Angga Juliawan Dewi, Putu Feby Miswari Dharmayuda, Tjokorda Gede Gabrielle Alexander Kartawan Gde Dharmayuda, Tjokorda Gede Kambayana Gede Sukrawan Gede Wira Mahadita Giri Prebawa, I Putu Arya Hendrata Erry Andisari I B Ketut Hary Ambara Jaya I Gde Raka Widiana I Made Bagiada I Made Bagus Ambara Putra I Made Bakta I Made Rama Putra I Wayan I Wayan Losen Adnyan I Wayan Losen Adnyana I Wayan Putu Sutirta Yasa Ida Ayu Cili Swesis Ida Ayu Cili Swesis Jauwerissa, Ria Ketut Suata Losen Adnyan Ludirdja, Evan Pratama Made Dwi Puja Setiawan MADE RATNA SARASWATI . Ni Made Renny A.R Ni Made Renny Anggraeni Rena Ni Putu Nita Wiryandari Ni Wayan Winarti Nyoman Paramita Ayu Ommy Agustriadi Panjaitan, Andi Manaek Hatimbulan Prayuda, Prayuda Putu Cyntia Ratnadi Rena, Ni Made Renny A Rena, Ni Made Renny Anggreni Renny A Rena Renny A Rena Renny A Rena Renny A Rena Renny A Rena Reza Surahmanto S. Herawati, S. Savitri, Putu Dian Hermawati Sari Sianny Herawati Sumohadi, I Made Duwi Suryadinata, Putu Yoga Arya Tjok Darmayuda Tjok Gde Darmayuda Tjokorda Gde Dharmayuda Winarto, Daniel Yenny Kandarini Yunny Sripurnama Sjah