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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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PERBEDAAN KEJADIAN ANEMIA PADA PASIEN PENYAKIT GINJAL KRONIK DENGAN DAN TANPA DIABETES MELITUS DI RUMAH SAKIT UMUM PUSAT SANGLAH, DENPASAR– BALI Ni Putu Nita Wiryandari; Ketut Suega; Ni Made Renny Anggraeni Rena
E-Jurnal Medika Udayana vol 4 no 12(2015):e-jurnal medika udayana
Publisher : Universitas Udayana

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Penyakit Ginjal Kronik (PGK) adalah penyebab kematian kesembilan di Amerika Serikat. Prevalensi PGK tinggi, penyebab terseringnya adalah Penyakit Ginjal Diabetik (PGD). Anemia adalah tanda utama gagal ginjal yang mengawali komplikasi lain. Tujuan penelitian ini adalah mengevaluasi perbedaan kejadian anemia pada pasien PGK dengan dan tanpa Diabetes Melitus (DM). Selama Maret-Augustus 2015, penelitian crossectional dilakukan dengan teknik consecutive sampling. Rekam medis sampel PGK dengan dan tanpa DM dievaluasi untuk menilai kadar hemoglobin pada kunjungan pertama. Data dianalisis dengan analisa bivariat. Sampel dalam penelitian ini sebanyak 223 pasien PGK (umur 18-75 tahun, rerata 53.53±11.68) dengan 137 sampel lelaki. Sebanyak 57.4% sampel adalah derajat 5 dan penyebab paling sering adalah PGD (40.4%). Kami mendapatkan mayoritas anemia pada derajat 5 yaitu sebanyak 66.2% untuk PGK dengan DM dan 91.8% untuk PGK tanpa DM (p<0.0001). Antara kedua kelompok, memperlihatakan perbedaan rerata kadar hemoglobin yang signifikan dengan nilai p=0.001 (9.12±2.38 untuk DM vs. 10.17±3.08 untuk tidak DM). Analisis Chi square memperlihatkan secara signifikan (p=0.002) persentase yang lebih tinggi pada PGK dengan DM (68.7% vs. 31.3%). Diabetes Melitus mempengaruhi kejadian anemia pada PGK namun tidak terkait dengan ekspresi yang lebih awal dari anemia itu sendiri. Sehingga anemia secara signifikan lebih sering terjadi pada PGK dengan DM dan tingkat anemia yang lebih parah dibandingkan dengan yang terjadi pada PGK tanpa DM. Kemudian, secara spesifik distribusi anemia secara konsisten lebih tinggi pada derajat 2-4 PGK dengan DM daripada tanpa DM.      
RESPON HEMATOLOGI PASIEN LEUKEMIA MIELOID KRONIK YANG MENDAPAT PENGOBATAN TYROSINE KINASE INHIBITOR SELAMA SETAHUN DI RSUP SANGLAH DENPASAR I Made Bagus Ambara Putra; Renny A Rena; Ketut Suega
E-Jurnal Medika Udayana vol 4 no 12(2015):e-jurnal medika udayana
Publisher : Universitas Udayana

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HEMATOLOGY RESPONSE CHRONIC MYELOID LEUKEMIA PATIENT WHO GETS TYROSINE KINASE INHIBITOR TREATMENT FOR A YEAR IN GENERAL HOSPITAL CENTER SANGLAH DENPASAR Chronic Myeloid Leukemia (CML) is disorder that cause by reciprocal translocation in chromosome 9 and 22, that produce cimeric oncogene called BCR-ABL, which is the product of protein Tyrosine Kinase and cause uncontrolled proliferation of myeloid cell. The objective of this study is to determine the hematologic response of CML patient who received treatment TKI for a year. This study is Retrospective descriptive study which conduct at Sanglah General Hospital from july to November 2015. A total number of 29 patient were study, all of patient were diagnose as CML. Chronic Myeloid Leukemia patient evaluate to determine the hematologic response after use TKI for a year. Evaluate is done from the beginning diagnose, 3 month, 6 month, 9 month, and 12 month. The information obtaining from medical record and interviews. After evaluate, the mean result of leukocyte prior TKI therapy 227.59 ± 22.03 x 103/mm3 be 14.61 ± 3.45 x 103/mm3 after 12 months receive TKI. The mean hemoglobin prior TKI 9.68 ± 0.42g/dL be 12.07 ± 0.42 g/dL after 12 month receive TKI. The mean thrombocyte  prior TKI 458.32 ± 86.35 x 103/mm3 be 276.79 ± 29.68 x 103/mm3 after 12 month receive TKI. From the result of this study can conclude an improvement of hematologic response CML patient who receive TKI for a year. Decrease in the mean leukocyte, an increase in the mean hemoglobin, and decrease in the mean thrombocyte.
HUBUNGAN ANTARA KADAR HEMOGLOBIN DENGAN TINGKAT KEPARAHAN PENYAKIT PASIEN SYSTEMIC LUPUS ERITHEMATOSUS DI RSUP SANGLAH Putu Cyntia Ratnadi; Ketut Suega; Ni Made Renny Anggraeni Rena
E-Jurnal Medika Udayana vol 5 no 2(2016):e-jurnal medika udayana
Publisher : Universitas Udayana

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THE ASSOCIATION BETWEEN HEMOGLOBIN LEVEL WITH DISEASE SEVERITY IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS IN SANGLAH GENERAL HOSPITALSystemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease with a wide spectrum of manifestations. Anemia is one of the hematologic manifestations of SLE that occurred frequently due to suppression of erythropoiesis by the presence of chronic inflammation. Severity of anemia often reflected an underlying condition, including SLE. The lower levels of hemoglobin (Hb), usually related to more severe underlying disease. This study was conducted to determine the association between Hb level with disease severity in patients with SLE. This study was an observational analytic study with cross-sectional study. The sample were SLE patients who treated in Sanglah General Hospital. We observed medical records SLE patients in the period of January-December 2014. The independent variable was severity of SLE and dependent variable was hemoglobin level. Statistic analysis used chi square. Forty one patients aged 17-74 y.o, mean 33.46±11.61 y.o were included in this study. Majority of SLE patients were woman (n=38). Hb level was ranging from 3.00-16.10 g/dl, mean 10.09±2.92 g/dl. Low Hb level was occurred in 29 subjects (70.70%), 9 (31.00%) in mild disease and 20 (69.00%) in severe disease. The association between Hb level with severity of SLE was statistically significant (p<0.05).
KAITAN FAKTOR USIA DAN JENIS KELAMIN TERHADAP KEJADIAN LIMFOMA NON HODGKIN DI RUMAH SAKIT SANGLAH TAHUN 2014 Ida Ayu Cili Swesis; Ketut Suega; Ni Made Renny Anggraeni Rena
E-Jurnal Medika Udayana vol 4 no 9(2015):e-jurnal medika udayana
Publisher : Universitas Udayana

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AGE AND GENDER FACTOR ASSOCIATED WITH NON-HODGKIN LYMPHOMA EVENTS IN SANGLAH HOSPITAL DURING 2014One of the most common types of hematology malignancies is lymphoma malignancies.  Based on the epidemiology Hodgkin's disease is relatively rare compared with nonHodgkin's lymphoma (NHL) in Asia. NHL had increased since 1970 at 5-10% aech year. The purpose of this research is to explained age and gender associated with Non-hodgkin lymphoma proportion in Sanglah Hospital during 2014. The retrospective cross sectional design was used in this research. Sampel were patients who treated in Internal Medicine Sanglah Hospital during 2014. In 2014, there were 152 cases of NHL with male respondents 57.9% (88 people ) and female 42.1% (64 people) treated at Sanglah Hospital. Subjects age ranged from 1-89 y.o, with median age 55 y.o. There were a 46% who have under 55 years of age and 54% over 55. In Chi-square analysis, there was a significant associated between age with NHL incidence in Sanglah Hospital (p <0.05) and no significant associated between the gender with NHL incidence (p> 0.05). The conclusion in this study was the increased age contributes to the rising rates of NHL. However, the incidence of NHL was not clearly associated with gender.
KAITAN FAKTOR USIA DAN JENIS KELAMIN TERHADAP KEJADIAN LIMFOMA NON HODGKIN DI RUMAH SAKIT SANGLAH TAHUN 2014 Ida Ayu Cili Swesis; Ketut Suega; Ni Made Renny Anggraeni Rena
E-Jurnal Medika Udayana vol 5 no 1(2016):e-jurnal medika udayana
Publisher : Universitas Udayana

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Salah satu jenis keganasan yang sering terjadi pada hematologi adalah keganasan limfoma. Berdasarkan epidemiologi Hodgkin lebih jarang terjadi dibandingkan dengan limphoma Hodgkin dan limpoma non hodgkin (LNH) di Asia. Kejadian LNH meningkat mulai tahun 1970 dengan perkiraan sekitar 5-10% pertahun. Penelitian ini bertujuan untuk mengetahui hubungan antara usia dan jenis kelamin terhadap kejadian LNH di Rumah Sakit Sanglah tahun 2014. Penelitian ini menggunakan disain retrospektif cross sectional. Sampel merupakan pasien yang berobat ke Poliklinik penyakit dalam Rumah Sakit Sanglah tahun 2014. Tahun 2014, 152 kasus LNH dengan laki-laki 57,9% (88 orang) dan perempuan 42,1% (64 orang) yang berobat ke Rumah Sakit Sanglah. Umur subjek  1-89 tahun dengan median  55  tahun.  Terdapat  46%  orang  dibawah  55  tahun dan  54% di  atas  55  tahun. Berdasarkan analisis Chi-square terdapat hubungan  yang signifikan antara usia dengan kejadian   LNH di Rumah Sakit Sanglah (p<0,05) dan tidak terdapat hubungan yang signifikan antara jenis kelamin dengan kejadain LNH (p>0,05). Kesimpulan yang didapat pada penelitian ini ditemukan semakin meningkatnya usia kejadian LNH juga meningkat, sedangkan untuk jenis kelamin dengan kejadian LNH tidak terdapat hubungan yang signifikan.  
Soluble Transferrin Receptor and Soluble Transferrin Receptor/Log Ferritin Ratio are Correlated with Iron Status in Regular Hemodialysis Patients Yenny Kandarini; Gede Wira Mahadita; Sianny Herawati; Anak Agung Wiradewi Lestari; Ketut Suega; I Gde Raka Widiana
The Indonesian Biomedical Journal Vol 13, No 2 (2021)
Publisher : The Prodia Education and Research Institute (PERI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18585/inabj.v13i2.1412

Abstract

BACKGROUND: Monitoring of iron status in chronic kidney disease patients is important, however inflammation may hinder its monitoring. Soluble transferrin receptor (sTfR) is an alternative parameter to overcome this issue, whereas ferritin play a part in the inflammation process. Hence, the correlation between the sTfR ratio and the sTfR/log ferritin ratio with conventional iron status parameters in regular hemodialysis patients is necessary to be evaluated.METHODS: A cross-sectional was conducted in the current study. As many as 5 mL of blood (2 mL for sTfR and 3 mL for serum iron and ferritin levels) was collected. sTfR level was the blood-soluble transferrin receptor level measured by the enzyme-linked immunosorbent assay (ELISA). The amount of ferritin and serum iron was determined using the immunochemiluminescent process. To evaluate the correlation, the Pearson correlation test was used.RESULTS: A total of 80 subjects was included in this study. The mean of hemoglobin was 10.25±1.66 g/dL, serum iron was 58.19±26.56 g/dL, and the median ferritin was 520.4 (49.9-3606) ng/mL. The sTfR was significantly associated only with serum iron levels with a correlation coefficient of r=-0.242; p=0.031. The sTfR/log ferritin was significantly associated with serum iron l evels (InSI)(r=-0.255, p=0.022); and transferrin saturation (r=-0.295; p=0.008).CONCLUSION: sTfR/log ferritin has a negative and significant correlation with serum iron levels and transferrin saturation, while sTfR negatively correlated with serum iron levels. sTfR and sTfR/log ferritin may be considered as an alternative iron marker in inflammation setting such as CKD.KEYWORDS: sTfR/log ferritin, iron status, serum iron, ferritin, chronic kidney disease, hemodialysis
Diagnostic Test Equivalent Hemoglobin Reticulocyte in Iron Deficiency Anemia Arundina Sanyoto; Ketut Suega; Losen Adnyana; I Made Bakta
The Indonesian Biomedical Journal Vol 9, No 3 (2017)
Publisher : The Prodia Education and Research Institute (PERI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18585/inabj.v9i3.267

Abstract

BACKGROUND: Diagnosing iron deficiency anemia (IDA) is easy, but also can be complicated in condition with inflammation. A new modality for diagnostic which isn’t influenced with inflammation is needed. The aim of this study is to find the cut-off point and evaluate the accuracy of reticulocyte hemoglobin equivalent (Ret-He) to diagnose IDA using ferritin as the gold standard.METHODS: This study was an observational study with cross-sectional analytical design continued with the diagnostic test conducted in anemic individuals with age 18 years old or above.RESULTS: Eighty-seven patients (41 men and 46 women) were included in this study with mean of hemoglobin 7.42 g/dL, serum iron 42.71 mg/dL, total iron-binding capacity (TIBC) 242.82 mg/dL, ferritin 799 ug/L and Ret-He 23.63 pg. Ret-He with cut-off value 25 pg showed a sensitivity 97.2% (95% CI 83.79-99.85%), specificity 66.67% (95% CI 51.97-78.85%), positive predictive value 67.30% (95% CI 52.77-79.28%) and negative predictive value 97.14% (95% CI 83.38-99.85%).CONCLUSION: Ret-He showed the best sensitivity for detection of IDA and was suggested as the screening test for IDA.KEYWORDS: IDA, Ret-He, diagnostic test
Seorang Penderita SLE dengan Emboli Paru Akut dan Hipertensi Pulmonal (Studi Kasus) Hendrata Erry Andisari; Gede Kambayana; Ketut Suega
Denta Journal Kedokteran Gigi Vol 3 No 1 (2020): Oceana Biomedicina Journal Volume 3 Issue (No) 1 January - June 2020
Publisher : Universitas Hang Tuah

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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.
Seorang Penderita SLE dengan Emboli Paru Akut dan Hipertensi Pulmonal (Studi Kasus) Hendrata Erry Andisari; Gede Kambayana; Ketut Suega
Oceana Biomedicina Journal Vol 3 No 1 (2020): Oceana Biomedicina Journal Volume 3 Issue (No) 1 January - June 2020
Publisher : Universitas Hang Tuah

Show Abstract | Download Original | Original Source | Check in Google Scholar | 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.
Seorang penderita leukemia myeloid akut dengan leukemia kutis: laporan kasus Reza Surahmanto; Ketut Suega
Intisari Sains Medis Vol. 12 No. 1 (2021): (Available online : 1 April 2021)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (597.714 KB) | DOI: 10.15562/ism.v12i1.924

Abstract

Background: Acute leukemia can show multiple manifestations of extramedullary tissue and extramedullary involvement is relatively rare. Patients with leukemia cutis usually coexist with systemic leukemia, but sometimes precede involvement of the bone marrow or peripheral blood. In rare instances, cutaneous leukemia can be an early manifestation of systemic disorders.Case: A 61 year old male, Balinese ethnicity, presented with the main complaint of ulcers on the right groin area near the genitals since one month ago, accompanied by fever and weight loss of about 5 kg in one month. Right and left inguinal lymph nodes were enlarged. In the right inguinal area, a solitary ulcer was seen. Laboratory results showed an increase in white blood cells, anemia, and thrombocytopenia. Bone marrow aspiration showed hematopoietic distribution predominantly of the myeloid series and appears to suppress erythroid series and megakaryocytes. The myeloid series consists of 20% positive maturation blast cells without auer rod. The excisional biopsy of the right inguinal ulcer depicts the dermis showed mature and immature granulocyte infiltration. The patient was diagnosed with matured AML (M2) and leukemia cutis. The patient was planned to be given a chemotherapy regimen but the patient developed complications from pneumonia and passed away.Conclusion: A case of 61 years old man has been reported, with complaints of injuries to the right groin near the genitals and fever. The patient was diagnosed with matured acute myeloid leukemia (M2) and leukemia cutis. Leukemia cutis is an extramedullary involvement of leukemia and is of clinical importance. Latar Belakang: Leukemia akut dapat menunjukkan beragam manifestasi pada jaringan ekstramedula dan keterlibatan ekstramedula relatif jarang terjadi. Pasien dengan leukemia kutis biasanya terjadi bersamaan dengan leukemia sistemik, namun terkadang mendahului keterlibatan dari sumsum tulang atau darah tepi. Pada kasus yang jarang, leukemia kutis dapat menjadi manifestasi awal dari kelainan sistemik.Laporan Kasus: Laki-laki 61 tahun, suku Bali, datang dengan keluhan utama borok pada daerah selangkangan kanan dekat dengan kemaluan sejak satu bulan yang lalu. Keluhan juga disertai demam dan penurunan berat badan sekitar 5 kg dalam satu bulan. Pada inguinal kanan dan kiri didapatkan pembesaran kelenjar getah bening. Pada daerah inguinal kanan tampak ulkus soliter. Hasil lab didapatkan peningkatan sel darah putih, anemia, serta trombositopenia. Aspirasi sumsum tulang menunjukkan sebaran hematopoietik yang didominasi seri myeloid dan tampak menekan seri eritroid serta megakaryosit. Seri myeloid terdiri dari sel blast 20% dengan maturasi positif tanpa auer rod. Hasil biopsi eksisi pada ulkus daerah inguinal kanan menggambarkan jaringan yang terdiri dari epidermis dan dermis. Pada dermis tampak infiltrasi granulosit matur dan imatur. Pasien didiagnosis dengan LMA dengan maturasi (M2) dan leukemia kutis. Pasien direncanakan pemberian regimen kemoterapi namun pasien mengalami komplikasi infeksi pneumonia dan meninggal.Simpulan: Telah dilaporkan kasus laki-laki 61 tahun, dengan keluhan luka pada selangkangan kanan dekat kemaluan serta demam. Pasien didiagnosis leukemia myeloid akut dengan maturasi (M2) dan leukemia kutis. Leukemia kutis merupakan keterlibatan ekstramedula dari leukemia dan memiliki arti penting secara klinis.
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