Ketut Dewi Kumara Wati
Department Of Pediatrics Faculty Of Medicine Udayana University

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Age and HIV stage at initiation of highly active antiretroviral therapy determine non-reversal of stunting at 3 years of treatment Putu Diah Vedaswari; Ketut Dewi Kumara Wati; I Gusti Lanang Sidiartha; I Gusti Ayu Putu Eka Pratiwi; Hendra Santoso; Komang Ayu Witarini
Paediatrica Indonesiana Vol 58 No 4 (2018): July 2018
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (261.653 KB) | DOI: 10.14238/pi58.4.2018.180-5

Abstract

Background Highly active antiretroviral therapy (HAART) has been reported to improve growth, especially in the first 2 years of treatment. It is not clear whether catch up growth is maintained after 2 years of HAART. Objective To assess growth in stunted children with HIV after 3 years of HAART and analyze possible risk factors for non-reversal of stunting. Methods This study was done from May 2016 to April 2017 to follow children with HIV who started HAART between January 2009 and April 2014, and continued for 3 years. Inclusion criteria were children with HIV, aged < 18 years, compliance to the regimen, and stunting. Exclusion criteria were patients lost to follow up or who died prior to 3 years of HAART. Non-reversal of stunting was defined as HAZ ≤ -2SD after 3 years of HAART. Possible risk factors for non-reversal were analyzed using Chi-square test with P<0.05, as well as risk ratio (RR) and 95% confidence intervals (CI). Results Of 150 HIV-infected pediatric patients, 115 were on HAART and 55 (47.8%) were stunted at HAART initiation. Of the 55 stunted and HAART-treated children, 31 (56.4%) were male. Baseline median age was 3.6 years (interquartile range 0.37-8.48). Non-reversal occurred in 32 (58.2%) subjects. Multivariate Cox regression model analysis showed predictors of non-reversal after 3 years of HAART to be age >2 years (RR 16.05; 95%CI 2.89 to 89.02; P=0.002) and HIV stage III-IV (RR 8.93; 95%CI 1.47 to 54.37; P=0.017). Conclusion HAART initiation at age >2 years and HIV clinical stage III-IV at diagnosis are risk factors for non-reversal of stunting after 3 years of HAART.
Highly active antiretroviral therapy and left ventricular diastolic function in children with human immunodeficiency virus infection Ni Made Ayu Agustini; Eka Gunawijaya; Ni Putu Venny Kartika Yantie; Ketut Dewi Kumara Wati; Komang Ayu Witarini; Hendra Santoso
Paediatrica Indonesiana Vol 59 No 3 (2019): May 2019
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (229.793 KB) | DOI: 10.14238/pi59.3.2019.139-43

Abstract

Background In the past, cardiovascular involvement did not seem to be a common complication of HIV, but in recent years it has been described more frequently. With the advent of highly active antiretroviral therapy (HAART), the symptoms of cardiac disease has changed, as the number of HIV-infected patients with abnormal diastolic parameters has increased significantly, often presenting as symptomatic rather than asymptomatic. Objective To analyze for a possible correlation between HAART duration and left ventricular diastolic function in HIV-infected children. Methods This cross-sectional study was conducted from December 2016 to December 2017 at the Cardiology and Allergy-Immunology Division/Department of Child Health, Universitas Udayana Medical School/Sanglah Hospital, Denpasar, Bali. Subjects with HAART were collected using a consecutive sampling method. The following data were recorded for each subject: age, sex, current stage of HIV, CD4+ level, as well as HAART regimen and duration of use. Transthoracic echocardiography was performed for tissue doppler imaging (TDI) of diastolic function. Spearman’s test was used to analyze the strength of correlation based on normality test results. Results This study involved 53 subjects, 21 of whom had impaired diastolic function. There was no correlation between HAART duration and diastolic function in children with HIV infection (r= -0.03; P=0.82). Conclusion Diastolic dysfunction is found in children under HAART treatment, but there is no correlation between HAART treatment duration and diastolic dysfunction.
Growth of HIV-exposed infants from birth to 6 months in the prevention of mother-to-child transmission program Maria Priskila; Ketut Dewi Kumarawati; Ni Putu Siadi Purniti
Paediatrica Indonesiana Vol 59 No 4 (2019): July 2019
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (281.723 KB) | DOI: 10.14238/pi59.4.2019.183-7

Abstract

Background Human immunodeficiency virus (HIV) infection is a global health issue. Most cases of HIV infection in children are acquired through transmission from HIV-infected mothers. Maternal HIV infection affects infant growth. Objective To evaluate the first six months of growth in HIV-exposed infants born to mothers in the prevention of mother-to-child transmission (PMTCT) program. Methods This prospective cohort study was done in 40 HIV-exposed infants born in Sanglah General Hospital, Bali. Subjects' underwent weight and length measurements at birth and monthly for 6 months. Data analyses used were repeated ANOVA test with Bonferonni post-hoc analysis for normally distributed data and Friedman test with Wilcoxon post-hoc analysis for abnormally distributed data. Correlations between birth weight and length to weight and length at 6 months of age were analyzed with Spearman's test. Results Subjects' mean birth weight was 2,900 (SD 546) grams and median birth length was 48 (range 36-52) cm. Subjects' body weight and length increased monthly throughout the measurement period (P<0.001). There was a strong negative correlation between birth weight and infant weight gain at 6 months of age (r=-0.678), and a moderate negative correlation between birth length and infant length gain at 6 months of age (r=-0.564). Conclusion HIV-exposed infants born to mothers in the PMTCT program have a significant body weight and body length growth in the first 6 months of life, and followed general WHO weight and length curves for age.
Efficacy of high-dose methylprednisolone and cyclophosphamide in childhood-onset systemic lupus erythematosus Putu Ayunda Trisnia; Ketut Dewi KUmara Wati; Komang Ayu Witarini; Ida Bagus Ramajaya Sutawan; Hendra Santoso
Paediatrica Indonesiana Vol 60 No 3 (2020): May 2020
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (208.304 KB) | DOI: 10.14238/pi60.3.2020.117-24

Abstract

Background Systemic lupus erythematosus (SLE) is a chronic, multisystem, autoimmune disease. Untreated SLE often become progressive and lead to increased risk of mortality. Corticosteroid and cyclophosphamide remain the treatment of choice for severe SLE. Disease activity assessed with SLE Daily Activity Index (SLEDAI). Objective To compare the disease activity of childhood-onset severe SLE at the time of diagnosis, after completion of high dose methylprednisolone, and after three month of cyclophosphamide by using SLEDAI. Methods This study was conducted in the Division of Pediatric Allergy and Immunology, Department of Child Health, Udayana University/Sanglah Hospital, Denpasar, Bali. Subjects were SLE patient aged 0-18 years who had severe clinical manifestations. Subject received therapy combination of high dose methylprednisolone and cyclophosphamide every 2 weeks for six doses. SLEDAI score was assessed at the time of diagnosis, after completion of high dose methylprednisolone, and after three month of cyclophosphamide. Results During the study period, 51 children were diagnosed as SLE. Twenty-one subjects were included for analysis. Median SLEDAI score at the time of diagnosis was 23 (range 13-39). SLEDAI score after three months of cyclophosphamide was decreased to 2 (range 0-14). Post hoc analysis with Wilcoxon signed-rank test showed the improvement of SLEDAI score at the time of diagnosis and after three months of cyclophosphamide was statistically significant (Z=-4.016, P<0.0001). Conclusion SLEDAI score reduced after completion of high-dose methylprednisolone and three month of cyclophosphamide therapy.
Cognitive, Motor, and Language Assessment in Children with Human Immunodeficiency Virus Putu Indah Budi Apsari; I Nyoman Supadma; Ketut Dewi Kumara Wati; I Wayan Dharma Artana
Folia Medica Indonesiana Vol. 58 No. 2 (2022): June
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (690.716 KB) | DOI: 10.20473/fmi.v58i2.33871

Abstract

Highlights: HIV-infected children had lower capute scores than normal children. HIV child age range 12-24 months almost suffer delayed speech, and were in suspect criteria was founded.   Abstract: The cognitive, motor and language aspect of HIV-infected children is an important issue affecting their quality of life. The capute scale, divided into Cat and Clams scores, is commonly used to assess children's cognitive, motor, and language functions. This study assessed Cat and Clams’ scores of HIV-infected children. We performed Cat and Clams assessment on 136 children consisting of 68 HIV-infected children and 68 normal children as control aged 0-36 months. The Capute scale examined both groups at the first meeting (first month), and for the rest six months, we evaluated the progress of cognitive, motor, and language development. In the first meeting, we found that HIV-infected children had significantly low capute scores than the control group. The sixth-month Capute score in HIV-infected children was also significantly lower than the control group. HIV-infected children had lower Capute scores than normal children.
Dermatitis atopi pada bayi usia 0-12 bulan kelahiran RSUP Sanglah Denpasar dengan riwayat atopi keluarga antara bulan Desember 2015-Januari 2016 Made Bandem Kenny Wijaya Nugraha; Ketut Dewi Kumara Wati; I Made Kardana
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 (240.987 KB) | DOI: 10.15562/ism.v11i3.205

Abstract

Atopy disease is a genetic predisposition to develop any allergies in person. The example of atopic disease is atopic dermatitis, a chronic residual skin disorder that often occurs in infancy to children with itching, redness, and vesicles on the skin as its symptoms. The causes of atopic dermatitis are a family history of atopy, age, and environmental factors. If the parent or the family has a history of atopy, there will be a chance for the child to has dermatitis atopy in the next time.Aim: This study aims to determine the role of family history in atopy dermatitis’s incidence in infants aged 0-12 months.Method: Total sampling method used in the study obtained 39 samples with a family history of atopy. Anamnesis was conducted to determine the history of atopy which is owned by the samples.Result: It showed that 22 samples had atopy dermatitis and 17 samples didn’t have atopy dermatitis.Conclusion: The results of this study indicated that family history of atopy has a role in atopy dermatitis’s incidence in infants aged 0-12 months. Penyakit atopi merupakan salah satu penyakit genetik yang mengembangkan suatu alergi pada individu. Contoh dari penyakit atopi adalah dermatitis atopi, yaitu penyakit kulit kronik residif yang umumnya terjadi saat usia bayi hingga anak-anak dengan gejala berupa rasa gatal, kemerahan, serta terbentuknya vesikel pada kulit. Pencetus munculnya dermatitis atopi adalah faktor riwayat atopi pada keluarga, faktor usia, dan faktor lingkungan. Apabila orang tua atau keluarga memiliki riwayat atopi, maka semakin besar kemungkinan untuk anak mengalami dermatitis atopi dikemudian hari.Tujuan: Penelitian ini bertujuan untuk mengetahui peran riwayat atopi yang dimiliki keluarga terhadap kejadian dermatitis atopi pada bayi usia 0-12 bulan.Metode: Dari total sampling diperoleh 39 sampel dengan riwayat atopi. Anamesis dilakukan untuk mengetahui riwayat atopi yang dimiliki sampel.Hasil: Hasil anamnesis mendapatkan 22 sampel mengalami dermatitis atopi dan 17 sampel tidak mengalami dermatitis atopi.Simpulan: Riwayat atopi keluarga memiliki peran terhadap kejadian dermatitis atopi pada bayi usia 0-12 bulan.
The risk of atopic dermatitis in post-term gestational age at Sanglah Hospital Denpasar: A preliminary study Made Ardinata; Ketut Dewi Kumara Wati; Wayan Dharma Artana; Hendra Santosa; Komang Ayu Witarini
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 (192.2 KB) | DOI: 10.15562/ism.v10i1.307

Abstract

Backgrounds: Several studies reported that Atopic Dermatitis (AD) increases with gestational age. Prolong dominancy of Th2 activity during gestation might contribute to the risk of atopic disease in infancy or beyond the period. This study aimed to evaluate the risk AD in post-term gestational age.Methods: A prospective observational study was conducted among 73 living births at Sanglah Hospital Denpasar from December 2015 to January 2016 period. Infants were classified into 2 such as exposed (post-term) and non exposed (term and preterm) group. Parents-follow up by phone was carried out in 1 until 2 months interval. The study was finished once AD diagnosed, subject died or lost to follow up. Statistical analysis was carried out using SPSS ver. 20 software whereas P-value > 0.05 was considered significant.Results: About 20 (233%) infants were preterm, 36 (49.3%) a term, and 17 (23,3%) post-term. The median value of follow up duration was 28 (14-35) days. Based on AD, there were total 24 cases which divided into 15(62.5%), 8(33.3%) and 1(4.17%) cases of AD in post-term, aterm, and preterm respectively. The incidence rate of AD in post-term was 88.2% while in non-post-term the incidence rate was 16.1%. The relative risk (RR) of AD in post-term was 5.47 (95% CI 2.94-10.23; P = 0.001)Conclusion: Post-term is 5.47 times more likely to develop AD compared with aterm and preterm infant. In addition, the incidence rate of AD in post-term infant was 88.2% at Sanglah Hospital Denpasar
Predictors of Loss To Follow Up and Mortality Among Children ≤12 Years Receiving Anti Retroviral Therapy during the First Year at a Referral Hospital in Bali Stefanie Juergens; Anak Agung Sagung Sawitri; Ketut Dewi Kumara Wati; I Wayan Gede Artawan Eka Putra; Tuti Parwati Merati
Public Health and Preventive Medicine Archive Vol. 4 No. 2 (2016)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2016.v4.i2.p03

Abstract

Background and purpose: Many HIV-infected children in Bali have started antiretroviral therapy (ART), but loss to follow up (LTFU) is a continuing concern, and the issue of childhood adherence is more complex compared to adults. Methods: This was a retrospective study among cohort of 138 HIV+ children on ART in Sanglah General Hospital, Denpasar, Bali from January 2010 to December 2015. Kaplan-Meier analysis was used to describe incidence and median time to LTFU/mortality and Cox Proportional Hazard Model was used to identify predictors. Variables which were analysed were socio-demographic characteristics, birth history, care giver and clinical condition of the children. Results: Mean age when starting ARV therapy was 3.21 years. About 25% experienced LTFU/death by 9.1 month resulting in an incidence rate of 3.28 per 100 child month. The higher the WHO stage, the higher the risk for LTFU/mortality along with low body weight (AHR=0.90; 95%CI: 0.82-0.99). Conclusion: Clinical characteristics were found as predictors for LTFU/ mortality among children on ART.
Predictors to Achieve Normal Nutrition Status: Longitudinal Study among HIV Children on Antiretroviral Treatment in Bali Haryadi; Anak Agung Sagung Sawitri; Ketut Dewi Kumara Wati; I Wayan Gede Artawan Eka Putra; Ketut Tuti Parwati Merati
Public Health and Preventive Medicine Archive Vol. 4 No. 2 (2016)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2016.v4.i2.p08

Abstract

Background and purpose: Malnutrition is common in children with HIV/AIDS. Antiretroviral therapy (ART) improves the nutritional status; however, information about predictors affecting the changes of nutritional status is limited and inconsistent. Methods: The retrospective survival study analyzed secondary data of 84 undernourished children receiving ART in Sanglah Central Hospital in 2010 to 2015. Demographic, clinical and socio-economic characteristics at ART initiation were linked to the achievement of normal nutritional status (z-score ≥ -2 SD). Kaplan Meier analysis was used to obtain the incidence rate and median time and cox proportional hazards models to identify its predictors. Results: Of the 73.81% of children achieved a normal nutrition status with the incidence of children achieving normal nutritional was 19 per 100 child months, and a median time of 4 months 10 days. Children with birth weight ≥2500 gr (AHR=5.41; 95%CI: 1.76-16.61), without candidiasis (AHR=3.72; 95%CI: 1.27-10.93), Clinical WHO Stage III (AHR=1.6; 95%CI: 1.08-4.24), Clinical WHO Stage II (AHR=4.49; 95%CI: 1.95-10.79) and early ART intiation (AHR=0.91; 95%CI: 0.83-0.98) were predictors to achieve normal nutritional status. Conclusion: Clinical characteristics of children are predictors of achieving a normal nutritional status.
Hubungan Vaksinasi Rotavirus dengan Kejadian Diare pada Anak Usia 6-24 Bulan di Kota Denpasar Widiantari, Ni Made; Cempaka, Putu Mas Vina Paramitha; Nesa, Ni Nyoman Metriani; Karyana, I Putu Gede; Wati, Ketut Dewi Kumara
E-Jurnal Medika Udayana Vol 11 No 2 (2022): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2022.V11.i02.P18

Abstract

Diarrhea constantly becomes an issue of health because of its high mortality and morbidity. Rotavirus infection is known as the predominant cause of acute diarrhea with severe dehydration and hospitalized diarrhea among children less than five years of age. Therefore, rotavirus vaccination is supposed to provide protective effect against the diarrhea cases. The study was implemented to prove the association between rotavirus vaccination and the diarrhea cases among children 6-24 months of age in Denpasar City. The study used an observation cross-sectional analytic design located at private pediatric clinic in Denpasar City and Puskesmas III Denpasar Utara from January to June 2020. The subjects selected by consecutive sampling technique were 104 children 24-36 months of age who divided into vaccinated and unvaccinated groups. The diarrhea cases were measured retrospectively from 6-24 months of age. The study data were derived through questionnaires, processed and analyzed through chi-square and logistic regression test on SPSS. In this study, the percentage of diarrhea cases in the vaccinated group (15,4%) was smaller than the unvaccinated group (36,5%). The statistical test showed PR = 0,42, 95% CI = 0,271-0,654, and p value = 0,001 (p<0,05) which means that rotavirus vaccination was significantly associated with the diarrhea cases and acts as a protective factor. Keywords : Children, Diarrhea, Rotavirus, Vaccination
Co-Authors Ahmad Suryawan Anak Agung Tri Yuliantini Anang Endaryanto Arini Setiawati Ayu Setyorini Mestika Mayangsari Badriul Hegar Bagus Ngurah Putu Arhana BNP Arhana Budi Setiabudiawan Budi Setiabudiawan Cempaka, Putu Mas Vina Paramitha Deborah Melati, Deborah Dewi, Ni Luh Putu Mulia Laksmi Dina Muktiarti, Dina Dyah Kanya Wati Eka Gunawijaya Endy P. Prawirohartono Erfi Prafiantini Eva Jacomina Jemima Sapulete Gusti Ayu Putu Nilawati Hamid H A Haryadi Haryadi - Hendra Santoso Hendra Santoso Hendra Santoso I Gusti Agung Ngurah Sugitha Adnyana I Gusti Ayu Putu Eka Pratiwi I gusti Lanang Sidhiarta I Gusti Lanang Sidiartha I Gusti Ngurah Sanjaya Putra I Ketut Suarta I Made Kardana I N Sartika I Nyoman Budi Hartawan I Nyoman Supadma I Nyoman Supadma I Putu Gede Karyana I Wayan Dharma Artana I Wayan Eka Satriawibawa I Wayan Gede Artawan Eka Putra I Wayan Gede Artawan Eka Putra, I Wayan Gede Artawan Eka I Wayan Gustawan Ida Bagus Krisna Jaya Sutawan Ida Bagus Subanada Irene Irene Johannes Hudyono Juergens, Stefanie Kadek Surya Jayanti, Kadek Surya Ketut Suarta Ketut Tangking Ketut Tuti Parwati Merati Komang Ayu Witarini Luh Putu Ratna Sundari Made Ardinata Made Bandem Kenny Wijaya Nugraha Made lndah Nastiti Utami Budha Maria Priskila Melisa Anggraeni Melva Louisa Merati, Tuti Parwati Metriani Nesa, Ni Nyoman Mohammad Juffrie Nesa, Ni Nyoman Metriani Ni Made Ayu Agustini Ni Nyoman Metriani Nesa Ni Putu Siadi Purniti Ni Putu Veny Kartika Yantie, Ni Putu Veny Kartika NP Veny Kartika Yantie Pande Putu Yuli Anandasari Purwoko, Agus Putu Ayu Widyanti Putu Ayunda Trisnia Putu Diah Vedaswari Putu Indah Budi Apsari Ronaldi, Melissa Roni Naning Sawitri, Anak Agung Sagung Soetjiningsih Soetjiningsih Soetjiningsih Soetjiningsih Stefanie Juergens Suandi IKG Sumadiono Sumadiono Widiantari, Ni Made Widiastari, A.A Ayu Yvan Vandenplas Zakiudin Munasir