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All Journal journal of internal medicine E-Jurnal Medika Udayana Media Kesehatan Masyarakat Indonesia Journal of Biomedicine and Translational Research PUBLIKASI PENELITIAN TERAPAN DAN KEBIJAKAN Essential: Essence of Scientific Medical Journal
I Made Susila Utama
Tropic And Infectious Disease Division, Internal Medicine Dept, Faculty Of Medicine, Universitas Udayana Prof. I.G.N.G.Ngoerah Hospital
Agriculture, Biological Sciences & Forestry Biochemistry, Genetics & Molecular Biology Economics, Econometrics & Finance Environmental Science Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health Social Sciences

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PENGARUH PEMBERIAN KOMBINASI ANTI RETRO VIRUS LEBIH AWAL TERHADAP MORTALITAS PADA KO-INFEKSI TB-HIV DI RUMAH SAKIT SANGLAH DENPASAR Utama, Susila
journal of internal medicine Vol. 12, No. 2 Mei 2011
Publisher : journal of internal medicine

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Abstract

TB and HIV are closely interlinked. TB is a leading cause of HIV-related morbidity and mortality. Mortality amongpatients with TB-HIV co-infection is known to be high despite the use of effective TB treatment. Many studies have indicatedthat the initiation of Combination Anti Retro Virus (cARV) during TB treatment improves outcomes. The optimal timing forthe initiation of cARV in patients with TB-HIV co-infections remains unclear. The aims of this study is to know the impact ofearly initiation of cARV during TB treatment on mortality in TB-HIV co-infected patients at Sanglah Hospital Denpasar. Cohortretrospective study was conducted from medical record of TB-HIV co-infected patients from June 2004 until August 2009. Theinclusion criteria was TB-HIV co-infected patients with TB treatment earlier than cARV. The cARV treatment was differentiatedinto 2 category, before 2 months of TB treatment (during intensive phase) and after 2 months (maintenance phase). All of thepatients were followed for mortality after one year of cARV treatment. There were 60 TB-HIV co-infected patients, 50 (83.3%)male and 10 female (16.7%). The CD 4 level less than 50 cell/mm3 were 48 (80%) and CD 4 level more than 50 cell/mm3 were 12(20%). The cARV treatment during intensive phase of TB treatment were 20 (33.3%) and cARV treatment after intensive phasewere 40 (66.7%). Mortality after one year cARV treatment were 28.3%. The mortality on cARV treatment after 2 intensive phasewas 32.5% (13 patients) and mortality on ARV treatment during intensive phase was only 20% (4 patients). The odds ratio was1,926 with confidence interval 0.536 ? 6.926. The mortality on the group of CD 4 level less than 50 cell/mm3 was not different.The mortality on ARV treatment after intensive phase were 34.5% and only 21.1% when cARV during intensive phase. Oddsratio was 1.974 with confidence interval 0.515 ? 7.558. The initiation of cARV during intensive phase of TB treatment on TBHIVco-infected patients will decreased mortality in one year of cARV treatment, but statistically not significance. The sameresult was also found in CD 4 less than 50 cell/mm3.
PENGARUH VIRUS HEPATITIS C PADA RESPON CD4 SETELAH 6 BULAN PEMAKAIAN REGIMEN KOMBINASI ANTIRETROVIRUS LINI PERTAMA PADA PASIEN INFEKSI HIV Somia, Agus; Utama, Susila; Parwati, Tuti; Wibawa, I Dewa Nyoman
journal of internal medicine Vol. 11, No. 2 Mei 2010
Publisher : journal of internal medicine

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Abstract

Hepatitis C Viral (HCV) and Human ImmunodeÞ ciency Virus (HIV) infection are global health problems. Co-infectionHIV-HCV in intravenous drug users about 53 99%. Despite very high prevalence of this co-infection, there were controversiesabout impact of hepatitis C virus in CD4 response of HIV patients receiving anti retroviral therapy. We conduct a retrospectivecohort to Þ nd out the impact of hepatitis C virus in CD4 response after 6 months of Þ rst line ART therapy. We collect data fromVCT-CST clinic patient!s record. Inclusion criteria for this study were HIV patients more than 12 years old, receiving Þ rst lineof ART treatment, and with anti HCV result.Sixty two patients enrolled for this study. Twenty eight patients found positive anti HCV and 34 negative anti HCV result.Mean of age was 29 ± 4.44 years old in anti HCV (+) group and 34 ± 7.335 in anti HCV (-) group, male dominant (92.9% and85.3% respectively). There were no signiÞ cant differences in total lymphocyte count, hemoglobine, and transaminases (AST andALT) between the two groups. The increasing of mean CD4 after 6 months ART treatment higher in anti HCV (-) group than inanti HCV (+) group, but statistically not signiÞ cant.
PAJANAN OKUPASI DARI PASIEN TERINFEKSI HIV DI RSUP SANGLAH DENPASAR Somia, Agus; Utama IM, Susila; Parwati Merati, Tuti
journal of internal medicine Vol. 11, No. 3 September 2010
Publisher : journal of internal medicine

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Abstract

Health care personnel who have occupational exposure to blood and some body ! uids or tissues are at risk for HIVinfection. Aim of this study to know about characteristics of occupational exposure to HIV who cares in VCT-CST OutpatientClinic Sanglah Hospital Denpasar. A retrospective descriptive study was done among exposed persons who care in VCT-CSTOutpatient Clinic Sanglah Hospital Denpasar during 1 January 2006 ? 31 December 2007.Total 11 cases occupational exposure occurred in health care places, 9 cases occurrence in Sanglah Hospital and 2 casesoutside Sanglah Hospital. The profession of exposed persons were doctor (45%), medical student (18.2%) and nurse (18.2%).The type of exposure were percutaneous injury (72.7%). Severity of exposures included, 36.4% KP1 (small volume in shorttime), 45.5 % KP2 (large volume and/or long time or percutaneous injury with solid needle, or superfesial laceration), and18.18% KP3 (percutaneous injury with hollow needle, deep injury, visible blood on the device which caused the injury, injurywith needle which had been placed in a source patients artery or vein). HIV-positive class I patients (asymptomatic HIV or alow viral load) was 27.3 % and HIV-positive class II (symptomatic HIV or AIDS, acute seroconversion, or high viral load) was27.3%. about 72% exposed person taken postexposure prophylaxis with combination zidovudine and lamivudine for 4 weeks.Anti HIV status exposed persons at " rst time exposure, 3 month after exposure and 6 month after exposure were negative.We conclude that the most type of exposure were percutaneous with source of exposure each included HIV positive classI dan HIV positive class II. About two third of exposed person taken postexposure prophylaxis with zidovudine and lamivudinecombination. Anti HIV status exposed person a " rst time exposure, 3 month after exposure and 6 month after exposure werenegative.
KELAINAN HEMATOLOGI PADA DEMAM BERDARAH DENGUE 1Ni Made Renny A Rena, 2Susila Utama, 2Tuty Parwati M 1 Divisi Hematologi Onkologi Medik, 2 Divisi Penyakit Tropik dan Infeksi Bagian / SMF Ilmu Penyakit Dalam, FK Unud RSUP Sanglah Denpasar Email: renny_ang@ Renny A Rena, Ni Made; Utama, Susila; Parwati M, Tuty
journal of internal medicine Vol. 10, No. 3 September 2009
Publisher : journal of internal medicine

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Abstract

Dengue infection can cause a unique and complex alteration to the homeostasis mechanism of the body. The underlying of bleeding, as a more frequent clinical manifestation of dengue was based on multiple factors such as thrombocytopenia, thrombopathy, Disseminated Intravascular Coagulation (DIC), prolonged of bleeding time and prothrombin time, decrease of some coagulation factors, hypoÞ brinogenemia and also increasing of Þ brin degradation products. Beside, kinin and bradikinin sytem was also activated. Endothelial dysfunction as one of coagulopathy disorder in dengue infection patients can shown as some clinical manifestation. Antigen antibody complex of dengue, activated the coagulation system, start from Haegeman factor (factor XII become factor XIIa). Therefore, factor XIIa activated the others coagulation factors respectively until Þ brin are produced, Þ brinolysis system are also activated, plasminogen change become plasmin through enzymatic process. Disseminated intravascular coagulation, is an emergency complication of dengue infection, which occur because activation of coagulation system and decreasing of thrombocyte level. Others condition such as shock, hypoxia, and acidosis also thought to be the factors that cause the DIC. Deterioration of all of the hemopoesis system, which are hypoplasia occur on the beginning of the infection and increasing of erythropoesis after Þ fth day of infection. This is caused by direct suppression of the viral and activation of the proinß ammatory cytokines
KARAKTERISTIK PASIEN KO-INFEKSI HIV-HCV DI RSUP SANGLAH DENPASAR Somia, Agus; Utama, Susila; Parwati, Tuti; Wibawa, I Dewa Nyoman
journal of internal medicine Vol. 11, No. 2 Mei 2010
Publisher : journal of internal medicine

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Abstract

Human Immunode! ciency Virus (HIV) and Hepatitis C Virus (HCV) are similar in many respects. Both viruses have asingle stranded RNA genome, both share similar routes of transmission and both cause chronic infection. However, HIV andHCV are also different in the pathogenesis, clinical manifestation and treatment. The aim of this study is to know characteristicof HIV-HCV coinfection patients in Sanglah Hospital. This study was descriptive study. Data based on patients medical recordduring from 1 januari 2004 sampai 31 Desember 2007 at VCT-CST. There were 48 cases HIV-HCV coinfected. 81.6% was male,mean of age of the ! rst anti HIV positive was 29.19 ± 4.63 years old. The risk factor was 75% IVDU. Baseline data showed71.4% suffered from HIV infection stage IV (WHO). The mean of body mass index was 18.78 ± 2.965 kg/m2, the mean of CD4was median of CD 4 was 222.56 ± 155.4 cell/ul, mean WBC was 4.38 ± 7.06 K/ul, mean of TLC was 1.134 ± 0.689 k/ul, meanof Hb was 12.53 ± 2.29 g/dl, Mean of PLT was 247.9 ± 90.11 k/ul, mean of SGOT 62.29 ± 71.91 IU, mean of SGPT was 77.34 ±109.83 IU. HbsAg positif 8.3% and 79.6% with HAART. The mortality rate was 10.8%. Most of HIV-HCV coinfected was male,productive age and the risk factor were IVDU.
FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN KEJADIAN MAKROSITOSIS PADA PASIEN HIV/AIDS YANG MENDAPAT TERAPI ZIDOVUDIN DI RUMAH SAKIT SANGLAH DENPASAR Ridana Wibawa, Ketut; Parwati Merati, Tuti; Somia, Agus; Utama, Susila
journal of internal medicine Vol. 11, No. 1 Januari 2010
Publisher : journal of internal medicine

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Abstract

Zidovudine is a Þ rst line drug used for treating HIV/AIDS patients in Indonesia and has been associated with prolongedsurvival, a reduction in the frequecy and severity of opportunistic infections, transient increases in the number of CD4 Tlymphocytes, and decreases in serum HIV p24 antigen. However prolong use of zidovudine associated with bone marrowtoxicity manifested by macrocytosis until anemic condition which need the transfusion. Some factors has been identiÞ ed canincreasing the bone marrow toxicity like: age, sex, cotrimoxazole, anemic and neutropenia condition, CD4 count < 200 cells/ L,vit B12 and folic acid level.To determine the risk factors correlated with incident of macrocytosis on HIV/AIDS patients treated with zidovudine,an analytical retrospective cross sectional study was done. The patients were selected using WHO criteria and the antiretoviraltherapy as Depkes guideline which zidovudine base with dose 600 mg/day. The age, sex, cotrimoxazole use and CD4 count wereassesed from all the patients by review medical record when the macrocytosis exist.This study included 140 subyects, age arround 19 ! 65 years old, sex male 72 % and female 28%. Cotrimoxazole use as atreatment or prophylaxis for PCP infection is 90% and the median CD4 count is 24.5 cells/ L. The incidence of macrocytosis is54.3% which is 46.4% without anemia and 7.9% present with anemia. The mean MCV value before zidovudine therapy is 86.27fL and elevated to 110.11 fL after zidovudine therapy. The median time of macrocytosis is 5 month. With bivariat analysis wedidn"t Þ nd correlation betwen age, sex, cotrimoxazol use and CD4 count with incident of macrocytosis (age p = 0.935 95% CIOR = 0.963 sex p = 0.800 95% CI OR = 0.846 cotrimoxazol use p = 0.237 95% CI OR = 0.403 and CD4 count p= 0.646 95%CI = 0.997 respectively).This study concluded no correlation betwen age, sex, cotrimoxazol use and CD4 count with incident of macrocytosis onHIV/AIDS patients whom treated with zidovudine. We suggest to routinely monitoring the MCV value every a month in a year,be cause the incidence of macrocytosis cause by toxicity effect of zidovudine to bone marrow is high.
Prevalensi Resistensi ARV Lini Pertama pada Pasien yang Menerima Pengobatan Haart di Klinik HIV RSUP Sanglah Bali Tahun 2014 - 2016 Jessica Santosa; I Made Susila Utama
E-Jurnal Medika Udayana Vol 6 No 10 (2017): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

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Abstract

HIV is a virus that weakens the immune system. HIV can be classified into two genotypes, namely HIV-1 and HIV-2. Genotyping ofHIV-1 can be classified into three groups: group M, N, and O. Therapy for patients with positive HIV today is HAART or Highly ActiveAntiretroviral Therapy at present has much-experienced resistance to first-line. This study is an observational study with a crosssectionalstudy to determine the prevalence of resistance to first-line ARV therapy. The research was conducted from September2014 until January 2016 at the HIV clinic Sanglah Hospital. The data collection is done with a short interview and filling thequestionnaire, as well as secondary data from medical records of patients. Of the 68 samples that follow this study, 9 (13.2%) ofwhom experienced resistance and undergoing treatment with second-line antiretroviral drugs.
KORELASI HASIL BASIL TAHAN ASAM DENGAN KADAR CD4 PADA PASIEN KOINFEKSI HIV-TB DI RSUP SANGLAH DENPASAR Nur Rizky Amaliah; I Made Susila Utama
E-Jurnal Medika Udayana Vol 9 No 9 (2020): Vol 9 No 09(2020): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2020.V09.i9.P17

Abstract

ABSTRAK Tuberkulosis (TB) merupakan infeksi oportunistik yang sering ditemukan pada penderita HIV. TB dan HIV memiliki hubungan yang sangat kompleks. Saat tahap awal infeksi HIV dan kadar CD4 masih di atas 200 sel/mm3, infeksi oportunistik ini dapat terjadi. Tetapi pada kondisi dengan peningkatan supresi imun dapat mempengaruhi kadar CD4, diagnosis TB secara klinis akan menjadi lebih sulit untuk ditegakkan. Penelitian ini dilakukan untuk mengetahui adanya korelasi antara hasil sputum BTA dengan kadar CD4 pada pasien koinfeksi HIV-TB di RSUP Sanglah Denpasar. Jenis penelitian adalah observasional analitik dengan menggunakan design study potong-lintang. Pengambilan sampel dilakukan dengan cara consecutive sampling melalui data rekam medis. Pengambilan data rekam medis dilakukan pada bulan Maret-Juni 2016, diperoleh 175 subyek penelitian yang memenuhi kriteria inklusi. Uji statistik yang digunakan dalam penelitian ini adalah uji chi-square, p bermakna apabila <0,005. Hasil penelitian ini dari 175 subyek penelitian yaitu laki-laki ada 115 (65,7%) dan perempuan 60 (34,3%). Mayoritas kelompok usia yaitu 31-40 tahun (43,4%). Kadar CD4 50-200 sel/?L (50,3%). Dominasi hasil sputum BTA negatif (70,3 %). Uji korelasi hasil sputum BTA dengan kadar CD4 yang menggunakan uji Chi-Square diperoleh nilai p=0,000 yang artinya bahwa terdapat korelasi yang bermakna antara hasil BTA dengan kadar CD4 pada penderita koinfeksi HIV-TB di RSUP Sanglah. Kata kunci: HIV-TB, CD4, Sputum BTA
Potensi Antibodi Anti-PfRH5 Terkonjugasi Nanopartikel Poly(lactide-co-glycolide) acid (PLGA) sebagai Inovasi Vaksin Malaria Falciparum Gde Adit Putra Deva; Agung Bagus Sista Satyarsa; Sang Ayu Arta Suryantari; I Made Susila Utama
Essence of Scientific Medical Journal Vol 17 No 1 (2019): Volume 17 No. 1 (Januari-Juni 2019) ESSENTIAL: Essence Of Scientific Medical Jou
Publisher : Kelompok Ilmiah Hippocrates Fakultas Kedokteran Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/ESTL.2019.v17.i01.p01

Abstract

Malaria Falciparum adalah salah satu penyakit infeksi disebabkan oleh parasit protozoa Plasmodium falciparum yang memiliki morbiditas dan mortalitas terbesar kasus malaria pada manusia. Upaya pencegahan dan penanganan malaria falciparum saat ini masih mendapat hambatan dari resistensi terhadap insektisida dan obat anti-malaria. Untuk itu, perlu adanya metode pencegahan parasit yang bersifat lebih spesifik yakni berupa vaksin dengan target protein parasit. Tinjauan pustaka dilakukan berdasarkan literatur seperti jurnal dan website. Dari 60 jurnal yang ditelaah, 46 jurnal ditemukan sesuai dengan topik bahasan dan digunakan sebagai referensi karya ini. Dalam siklus hidup P.falciparum terjadi fase invasi terhadap eritrosit. Plasmodium falciparum Reticulocyte-binding Protein Homologue 5 (PfRH5) dan basigin (BSG) dari eritrosit adalah pasangan ligan-reseptor esensial dalam invasi eritrosit. Tambahan nanopartikel poly(lactide-co-glycolide) acid (PLGA) sangat penting untuk melindungi komponen vaksin antibodi anti-PfRH5 agar tidak mudah mengalami degradasi yang membantu untuk meningkatkan efikasi kerja vaksin dalam menginhibisi proses invasi oleh merozoit. Karena berperan sebagai target yang penting dalam menginhibisi invasi merozoit, potensi PfRH5 sebagai vaksin malaria sangat signifikan dan spesifik. Potensi PfRH5 juga didukung dengan munculnya respon imun alami yang dapat menghambat pertumbuhan parasit. Respon imun tersebut melibatkan IgG spesifik terhadap PfRH5 yang dapat memberikan efek protektif dengan menghambat terjadinya ikatan antara PfRH5-BSG sehingga proses invasi tidak terjadi. Vaksin malaria (antibody anti-PfRH5 terkonjugasi nanopartikel PLGA) yang spesifik pada merozoit merupakan modalitas pencegahan potensial dalam perkembangan vaksin malaria falciparum. Penelitian lebih lanjut diperlukan untuk mengetahui efikasi dan induksi antibodi pada tubuh oleh anti-PfRH5 masih diperlukan untuk menambah bukti ilmiah.
KAJIAN KEAMANAN PANGAN (FORMALIN, GARAM DAN MIKROBIA) PADA IKAN SEPAT ASIN PRODUKSI INDRALAYA Rinto Rinto; Elmeizi Arafah; Susila Budi Utama
Publikasi Penelitian Terapan dan Kebijakan Vol 3 No 2 (2009): Jurnal Pembangunan Manusia
Publisher : Badan Penelitian dan Pengembangan Daerah Provinsi Sumatera Selatan

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Abstract

The quality and safety of food material was very important for people healthy. Food safety determined by present of material dangerous (physically, chemistry, and microbiology) of food. The purpose of this research was to analyzed food safety (formaldehyde contain, salt, and the present of bacteria) of salt fish. The result showed that salt fish produced and traded in Indralaya was free from formaldehyde. The formaldehyde contain in salt fish was negative. The salt contain in fish was a low salt (13, 4 - 19, 8%). The salt contain standard of salt fish is lower from 20% (SNI 01-0222-1995). The total of bacteria in salt fish was 3, 20 – 3, 92 (Log10). The sensory value of salt fish in producer higher than trader. The conclusion of this research is salt fish from Indralaya is safe to was consume and quality of salt fish in producer higher than trader in Indralaya traditional market.
Co-Authors A.A. Ayu Yuli Gayatri, A.A. Ayu Yuli Agung Bagus S. Satyarsa Agus Somia Agus Somia, Agus Somia Anak Agung Ayu Yuli Gayatri Cokorda Agung Wahyu Purnamasidhi Elmeizi Arafah Gde Adit Putra Deva Haruko Akatsu I Dewa Nyoman Wibawa I Ketut Agus Somia I Made Bakta Jessica Santosa Ketut Ridana Wibawa Ketut Tuti Parwati Merati Made Jawi Ni Made Dewi Dian Sukmawati Ni Made Renny A Rena Nur Rizky Amaliah Rinto . Tuti P Merati, Tuti P Tuti Parwati Tuti Parwati Merati Tuty Parwati M