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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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POLA KEPEKAAN BAKTERI PADA PASIEN KEGANASAN HEMATOLOGI DI RSUP SANGLAH DENPASAR Rena, Renny A; Suega, Ketut; Bakta, I Made
journal of internal medicine Vol. 11, No. 2 Mei 2010
Publisher : journal of internal medicine

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Abstract

Hematology malignancies patient are particulary susceptible to infection associated with endogen microorganism whichorigin from body or nosocomial from hospital. The most common etiology of infection is gram-positive oral and gastrointestinaltract. A worsening infection can lead patient to severe septic condition and death. In the last decade, many studies found thatspecies of fungi and virus also has an important etiology of infection in hematology malignancies patient.Empirical antibiotic therapy on the ! rst onset of infection of hematology malignancy are very recomended. It has beenproven to decrease morbidity and mortality rate. Empirical antibiotic therapy suitable with the pattern of the microbial in hospitalis an important way to overcome the infection on hematology malignancies patient.A total of 36 patient with hematology malignancy who done the blood culture in Sanglah hospital were consecutivelyrecruited and studied in order to study the pro! le of blood culture in hematology malignancy patient. Within six months 36patients were included, consist of 26 male (72.2%) and 10 female (27.8%). Characteristic of patient are mean of age 42.78 ± 14.25years. Mean of leukosit 45.76 ± 69.32 x 103/ul, mean of neutrophil dan lymphosit consecutively 27.17 ± 55.80 x 103/ul and 10.29± 19.81 x 103/ul. The mean of hemoglobin 8.48 ± 3.26 g/dl, and mean of trombosit 181.21 ± 230.63 x 103/ul. The most commondiagnosis found is Acute Myeloblastic Leukemia (AML) 33.3% and Non Hodgkin Lymphoma 22.2%. The result of blood culturemostly no growth (56.3%). The most microbial isolated from the culture is Coagulase Negative Staphilococcus / CONS (11.1%).Antibiotic susceptibility testing for Coagulase Negative Staphilococcus / CONS shows linezolid and chloramphenicol are themost sensitive.
HUBUNGAN ANTARA BEBERAPA PARAMETER ANEMIA DAN LAJU FILTRASI GLOMERULUS PADA PENYAKIT GINJAL KRONIK PRADIALISIS Paramita Ayu, Nyoman; Suega, Ketut; Raka Widiana, Gede
journal of internal medicine Vol. 11, No. 3 September 2010
Publisher : journal of internal medicine

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Abstract

Anemia is one of chronic kidney disease (CKD) complication and it affects many organs including cardiovascular. Earlydetection and evaluation are important to prevent more serious complications. There is scarce data with regard about correlationbetween anemia and glomerulus ltration rate (GFR) in pradialysis CKD.Aim of this study is to determine correlation between anemia parameters and GFR, also prevalence of anemia in pradialysisCKD in Sanglah Hospital, Denpasar-Bali. An analytical cross sectional study was carried out in Sanglah Hospital. Samples wereselected through simple random sampling.Eighty samples (58 males and 22 females, aged 54 ± 10 years) were included. Prevalence of anemia, serum iron belowthan 50 ug/dl, transferrin saturation below than 20% and erythropoietin below than 5 mIU/ml was 41.3%, 25%, 20%, and 25%respectively. Using Pearson?s analysis, there were signicant correlation between haemoglobin (r = 0.76, p = 0.00) and serumiron (r = 0.29, p = 0.01) with LFG. Using linier regression entering those variables into model, it found formula haemoglobin= 7.63 + 0.13GFR (R-square = 0.58, p = 0.00) and serum iron = 54.71 + 0.48GFR (R-square = 0.08, p = 0.01). There wassignicant correlation between haemoglobin and serum iron with LFG. Forty one percent pradialysis CKD patients had anemiacomplication.
INTERRELASI BESI DENGAN SITOKIN DAN VICE VERSA Suega, Ketut
journal of internal medicine Vol. 13, No. 1 Januari 2012
Publisher : journal of internal medicine

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Abstract

Iron is an essential substance needed for metabolism process, such as for transporting oxygen to the tissues for energyproduction in cells. Iron is also important for transporting electrons in the mitochondria for cell respiration process, andfor synthesizing Deoxyribo Nucleic Acid (DNA). In addition to its role in oxygen transport and metabolic pathways, ironplays a pivotal role in immune function by promoting lymphocyte activation and proliferation. On the other hand, ironover-load can have immune disorders and yet pathogenic microorganism require iron for their growth and proliferation.Therefore iron homeostasis must be maintained through careful regulation of duodenal absorption and recycling of ironstores since human body has no ideal excretory system for iron. Discovery of hepcidin peptide help clarify molecularbased of cellular interaction between duodenal iron absorption capacity and iron stores cells. Hepcidin a putative negativehumoral regulator of iron homeostasis by inhibiting iron absorption and couple with ferroportin preventing iron exportedfrom intracellular iron stores. Hepatic hepcidin expression is increased in iron overload and decreased in iron deciency. Inaddition to regulation by body iron needs, hepcidin is increased during an acute phase respone of inlammation processed.When an in!ammation is initiated, liberation of proin!ammatory cytokine IL-6 stimulate hepcidin expression causingiron absorption and iron release from the macrophage of the reticuloendotheleal system are decreased. Many other studieson humans and experimental animals have shown signicant change of the levels of certain cytokines in iron deciencystate such as IL-2; IL-4; IL-6; IL-10; IL-12; IFN gamma. As summarized, cytokines in!uence iron homeostasis and in theother way iron in!uences activity of cytokines and immune effector mechanism of macrophages, and all these affect thelevel of immune defence against invading pathogens.
RELATIONSHIP OF INFECTION AND GAMMA INTERFERON ( IFN ) OF PLASMA AND LYMPHOCYTE CULTURE SUPERNATANT IN IRON DEFICIENCY ANEMIA PATIENTS WITH INFECTION Suega, Ketut; Bakta, I Made
journal of internal medicine Vol. 10, No. 3 September 2009
Publisher : journal of internal medicine

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Abstract

Iron is an essential nutrient for every living cells because of it role as molecule for transport of oxygen, as well as DNAsynthesis through synthesis of ribonucleotide reductase. Although the underlying mechanism of immune defect in iron deÞ ciencyanemia (IDA) is not clearly understood, multifactor events considered play their contributing roles such as impairment of T-cellproliferation and activities, altered cytokine production of Interleukin-2 (IL-2) and Interferon gamma (IFN ).Cross sectional study was done to asses the relationship of gamma IFN with infection in IDA patients on plasma andlymphocyte culture supernatant of IDA patients. Sixty-four IDA patients treated in Sanglah General Teaching Hospital wererecruited, and 31 (48.4%) out of 64 IDA patients were man and 33 (51.6%) women, have been selected for the study. This studyfound 17 (26.7%) IDA patients with infection, aged 38 ± 14.48 years and 47 (73.3%) IDA patients without infection, with ageaverage of 40.5 ± 14.4 years. The study revealed that there were no differences of cytokine level observed between older andyounger age (upper and below 44.5 years) in IDA patients. Furthermore, no differences of cytokine level were found based ongender between IDA male 10.9 pg/l (8.60 ! 12.65) patients and IDA female patients 10.6 pg/l (7.50 ! 13.43) with Z -0.490,p = 0.624. Nevertheless, signiÞ cant differences were noted between plasma and supernatant of IFN  in IDA patients withinfection when compared to IDA patients without infection (Z = - 2.638, p = 0.008 for plasma IFN ; and Z = -2.569, p = 0.010for supernatant IFN ).The study conclusion is that level of IFN  from plasma and lymphocyte culture supernatant of patient suffered from IDAwith infection is signiÞ cantly lower when compared to IDA patient without infection
INTERLEUKIN -2 ( IL-2 ) AND GAMMA INTERFERON ( IFN ? ) OF LYMPHOCYTE CULTURE SUPERNATANT IN IRON DEFICIENCY ANEMIA PATIENTS WITH INFECTION Suega, Ketut; Bakta, I M; Sudewa D., AAG; Suata, Ketut
INDONESIAN JOURNAL OF BIOMEDICAL SCIENCES Vol. 4, No. 1 Januari 2010
Publisher : Udayana University

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Abstract

Iron is an essential nutrient for every living cells because of it role as molecule fortransport of oxygen, as well as DNA synthesis through synthesis of ribonucleotidereductase. Iron deficiency anemia patients, especially pregnant women and children aremore susceptible to infection because of deterioration of their immune response. This wassupported by findings of decreased in phagocytic activities of white blood cells and Tcelllymphocyte proliferation impairment. Iron deficiency anemia (IDA) patients alsoaffect working capacities hence diminishing working outcomes. Although the underlyingmechanism of immune defect in iron deficiency anemia is not clearly understood,multifactor events considered play their contributing roles such as abnormality ofribonucleotide reductase enzym, impairment of T-cell proliferation and activities, alteredcytokine production of IL-2 and IFN?.The study was done to asses the relationship of IL-2 and gamma IFN withinfection in IDA patients on lymphocyte culture supernatant of IDA patients. Study wasconducted on cross-sectional analytic design. Sixty-four iron deficiency anemia patientstreated in Sanglah General Teaching Hospital were recruited, and 31 (48.4%) out of 64IDA patients were man and 33 (51.6%) women, have been selected for the study. Thisstudy found 17 (26.7%) IDA patients with infection, aged 38 ± 14.48 years and 47(73.3%) IDA patients without infection, with age average of 40.5 ± 14.4 years. Allvariables of data characteristics examined did not indicate any statistical significantdifference between group of IDA patients with infection and those without infection. Theaverage level of hemoglobin between the two groups did not differ statistically. Similarresult was obtained if samples were differentiated into severe (Hb< 7g/dl) and mildanemia. The study also revealed that there were no differences of cytokine level observedbetween older and younger age (upper and below 44.5 years) in IDA patients withinfection and without infection. Furthermore, no differences of cytokine level were foundbased on gender between IDA male 10.9 (8.60 – 12,65) (pg/l) patients and IDA femalepatients 10.6 (7.50 – 13.43) (pg/l) with Z -0.490, p =0.624. Nevertheless, significantdifferences were noted between supernatant of IL-2 and IFN? in IDA patients withinfection when compared to IDA patients without infection (Z= - 2.509, p= 0.012 forsupernatant IL-2; and Z= -2.569, p= 0.010 for supernatant IFN?).The study conclusion is that level of IL-2 and IFN? from lymphocyte culturesupernatant of patient suffered from IDA with infection is significantly lower whencompared to IDA patient without infection. It therefore summarized that lower level ofIL-2 and gamma IFN in patients suffered from iron deficiency impaired their immune response to certain infections therefore this findings support the theory that IDA patientsmore susceptible to get infected.
SEORANG PENDERITA SLE DENGAN EMBOLI PARU AKUT DAN HIPERTENSI PULMONAL (STUDI KASUS) Andisari, Hendrata Erry; Kambayana, Gede; Suega, Ketut
Oceana Biomedicina Journal Vol 3, No 1 (2020): Oceana Biomedicina Journal
Publisher : Universitas Hang Tuah

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (662.233 KB) | DOI: 10.30649/obj.v3i1.31

Abstract

Kondisi Pulmonary embolism (PE) merupakan bagian dari spektrum penyakit yang disebut Venous thromboembolism (VTE).  Seorang pasien dengan keluhan utama batuk yang mengeluarkan dahak berwarna keputihan datang ke RSUP Sanglah, Bali untuk mendapatkan terapi. Riwayat sebelumnya, pasien pernah dirawat inap di RSUP Sanglah tersebut.Saat ini diagnosis akhir pasien ini: SLE on treatment dengan moderate pulmonary hipertension dan suspek emboli paru, suspek pneumonia (HCAP) dengan severe sepsis dan syok sepsis, asidosis metabolik, observasi transaminitis ec reaktif dan hiponatremia kronik asimptomatik hipoosmoler euvolemic cb SIADH. Selanjutnya dilakukan tindakan terapi dan evaluasi terhadap terapi yang diberikan. Kata kunci: SLE, emboli paru akut, hipertensi, studi kasus
KARAKTERISTIK PASIEN LEUKEMIA MIELOID KRONIK DI RUMAH SAKIT UMUM PUSAT SANGLAH DENPASAR TAHUN 2014-2015 Dewa Gede Angga Juliawan; Renny A Rena; Ketut Suega
E-Jurnal Medika Udayana vol 5 no 3(2016):e-jurnal medika udayana
Publisher : Universitas Udayana

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Abstract

CHARACTERISTICS OF CHRONIC MYELOID LEUKEMIA PATIENTS IN SANGLAH HOSPITAL DENPASAR ON 2014-2015In Sanglah Hospital, there are pretty much incidences of chronic myeloid leukemia. There are some characteristic of the patients that can be observed. The treatments are Tyrosine Kinase Inhibitor and Non Tyrosine Kinase Inhibitor. This study use total sampling method. The samples are all patients that had been diagnosed and still seek a medications on 2014-2015. The information are obtained from their medical record, such as gender, age, CML phase, clinical manifestation, history of blood transfusion, Complete Blood Count, BCR ABL qualitative, and medication history.In this study, 41 cases meet inclusion criteria and included as a samples. There are 27 males (65,9%). The mean of age is 38,22±14,09 years old. There are 38 samples (92,7%) in chronic phase, and 3 samples (7,3%) in acceleration phase. Clinical manifestations that have been showed are fever 24 samples (58,5%), decreased body weight 38 samples (92,7%), anemia 34 samples (82,9%), bleeding 15 samples (36,6%), splenomegaly 37 samples (90,2%), and hepatomegaly 11 samples (26,8%). The mean of leukocyte, hemoglobin, and thrombocyte are232,50 x103/µl, 9,25 g/dl, and 436,41x 103/µl. There are 24 samples (58,5%) get blood transfusion. In this study 35 samples (85,4%) have positive BCR ABL qualitative.The medication history areTKI only :13 samples (31,7%), NON TKI only :6 samples (14,6%), and both 22 samples (53,7%).Males is dominant, decreased body weight is the most common clinical manifestation and  most cases is in chronic phase.
PREVALENSI PASIEN ANEMIA APLASTIK YANG DI RAWAT DI POLIKLINIK PENYAKIT DALAM RSUP SANGLAH DENPASAR TAHUN 2014 I B Ketut Hary Ambara Jaya; Renny A Rena; Ketut Suega
E-Jurnal Medika Udayana vol 5 no 1(2016):e-jurnal medika udayana
Publisher : Universitas Udayana

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Abstract

Anemia aplastik (AA) adalah suatu kelainan yang ditandai oleh pansitopenia pada darah tepi dan penurunan selularitas sumsum tulang. Pada keadaan ini jumlah sel-sel darah yang diproduksi tidak memadai. Untuk mengetahui prevalensi orang yang menderita penyakit anemia aplastik di RSUP Sanglah dan Untuk mengetahui prevalensi anemia aplastik non-berat dan berat di RSUP Sanglah. Penelitian ini menggunaan studi deskriptif yang dilakukan pada pasien anemia aplastik di Rumah Sakit Umum Pusat Sanglah Denpasar tahun 2014. Data yang diperoleh pada rekam medis pasien antara lain jenis kelamin, umur, darah lengkap berupa leukosit, hemoglobin, trombosit dan netrofil, dan golongan anemia aplastik. Pada penelitian ini di dapatkan prevalensi sempel pasien sejumlah 10 orang yang memenuhi kriteria inklusi. Dimana jumlah sempel yang paling dominan adalaha perempuan bejumlah 6 orang (60%) dan umur pada pasien anemia aplastik dari rentang 16 – 75 tahun dengan reratanya 47 17.9 tahun. Adapun manifestasi klinis yang didapat pada sampel semua mengalami lemas. Dari awal sampel pasien didiagnosis anemia aplastik melakukan pemeriksaan darah lengkap untuk mengetahui jumlah sel-sel darah yang diproduksi tidak memadai. Hasil dari pemeriksaan laboraturium awal dengan leukosit reratanya 2.65 × 10³/µL, hemoglobin rerata 7.57 g/dL, trombosit rerata 61.89 ×10³/µL, Netrofil rerata 1.10 ×10³/µL. Penggolongan anemia aplastik non berat berjumlah 4 (40%) orang dan berat 6 (60%) orang. Didapatkan prevalensi anemia aplastik di RSUP Sanglah sejumlah 10 orang dimana yang paling dominan adalah perempuan berjumlah 6 (60%) orang. Dari 10 pasien anemia aplasik digolongkan menjadi non berat berjumah 4 orang dan berat berjumlah 6 orang.  
GAMBARAN KARAKTERISTIK PASIEN DEMAM NEUTROPENIA DI RSUP SANGLAH PERIODE JANUARI – OKTOBER 2014 Made Dwi Puja Setiawan; Ketut Suega
E-Jurnal Medika Udayana vol 4 no 2 (2015):e-jurnal medika udayana
Publisher : Universitas Udayana

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Abstract

Tujuan dari penelitian ini adalah untuk mengetahui gambaran karakteristik pasien dan penyakit yang menyebabkan demam neutopenia di RSUP Sanglah periode Januari – Oktober 2014. Penelitian ini merupakan potong lintang deskriptif dengan data yang digunakan bersumber dari data sekunder yang diperoleh dari hasil pencatatan pasien demam neutropenia di RSUP Sanglah periode Januari – Oktober 2014. Dari 54 sampel penelitian, 30 orang (55,6%) berjenis kelamin laki-laki dan 24 orang (44,4%) perempuan, dengan rata-rata umur penderita adalah 24,5 tahun. Usia terbanyak yang mengalami demam neutropenia adalah usia 0-10 tahun. Penyebab terbanyak adalah leukemia limfoblastik akut (LLA) sebanyak 18 (33,3%)  kasus, diikuti oleh kelainan hematologi, tumor, dan penyakit lain. Demam neutropenia terbanyak dialami oleh pasien laki-laki pada usia 0-10 tahun. Sedangkan jenis penyakit yang menyebabkan demam neutropenia terbanyak adalah keganasan hematologi.  
KARAKTERISTIK KLINIS PASIEN CHRONIC MYELOID LEUKEMIA DENGAN TERAPI TYROSINE KINASE INHIBITOR DI RUMAH SAKIT UMUM PUSAT SANGLAH Gabrielle Alexander Kartawan; Ketut Suega; Renny A Rena
E-Jurnal Medika Udayana vol 4 no 9(2015):e-jurnal medika udayana
Publisher : Universitas Udayana

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Abstract

CLINICAL CHARACTERISTICS OF CHRONIC MYELOID LEUKEMIA PATIENTS WITH TYROSINE KINASE INHIBITOR THERAPY IN SANGLAH HOSPITALChronic Myeloid Leukemia (CML) is the most common type of leukemia in Indonesia. Tyrosine Kinase Inhibitor (TKI) is now the main therapy for CML including imatinib and nilotinib. However, data about clinical characteristics and TKI usage in CML patients are still rare in Indonesia. This study aimed to evaluate clinical characteristics, peripheral blood count, complete hematologic response (CHR) and adverse effects of TKI in CML patients in retrospective cross-sectional study method using medical record of CML patients with TKI therapy in RSUP Sanglah. Twenty nine patients met the criteria. All 29 patients were in chronic phase and 19 of them were males. Median age was 36 years. The most common manifestations were weight loss (100%) and splenomegaly (96%). Imatinib was administered in 21 patients and the rest received nilotinib. Before TKI was administered, median WBC was 118.500/mm3, Hb was 9,5 g/dL, and platelet 338.000/mm3. After 3 months of TKI therapy, median WBC was 14.500/mm3, Hb was 10,9 g/dL, and platelet was 124.400/mm3. Within 3 months of TKI therapy, 13 patients (44,8%) achieved CHR. After TKI therapy, 18 (62,1%) patients got nausea and 16 (55,2%) got myalgia. From hematologic side, 11 (37,9%) got anemia and 10 (34,5%) got trombositopenia. In conclusion, splenomegaly was the most notable manifestations of CML. Achievement of CHR within 3 months in this study was low. The most common non-hematologic adverse effect was nausea while the most common hematologic adverse effect was anemia.
Co-Authors AAG Sudewa D. Anak Agung Ngurah Subawa Anak Agung Wiradewi Lestari Andika Budiartha, Putu Gede Andisari, Hendrata Erry Arundina Sanyoto 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 Nyoman Paramita Ayu Ommy Agustriadi Panjaitan, Andi Manaek Hatimbulan 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