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RISKS FOR PERIPHERAL ARTERIAL DISEASE IN THE ELDERLY WITH TYPE 2 DIABETES MELLITUS : THEIR CORRELATION WITH HIGH SENSITIVITY C-REACTIVE PROTEIN AND ANKLE-BRACHIAL INDEX Ayu Tuty Kuswardhani, Raden; Wita, Wayan; Bakta, Made; Santosa, Anwar
INDONESIAN JOURNAL OF BIOMEDICAL SCIENCES Vol. 3, No. 2 Juli 2009
Publisher : Udayana University

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Abstract

The Indonesian elderly population has been projected to increase up to about four-fold inthree decades (1990-2020). As a consequence of this population trend, the increased prevalence ofdegenerative diseases would be inevitable; this would include the prevalence of peripheral arterialdisease.This study aims to identify the correlation of diverse risk factors, either traditional or nontraditional,with the ankle-brachial index scores, and the correlation of novel non-traditional riskfactor, e.i. high sensitive C-reactive protein with the prevalence of perioheral arterial disease in theelderly, age 60-80 years old, with type 2 diabetes mellitus.Among the 146 elderly patients with type 2 diabetes mellitus, and based on measurement ofthe ABI score, approximately 30.9% of them had PAD. Some traditional and non-traditional riskfactors having a significant correlation with the ankle-brachial index score, were age (r = -0.396, p <0.001 for right ABI; r = -0.509, p < 0.001 for left ABI), supine systolic blood pressure (r= -0.268, p =0.012 for right ABI; r = -0.267, p = 0.013 for left ABI), 2-hour post-prandial blood glucose (r= -0.252, p = 0.018 for right ABI), and hsCRP (r = -0.280, p = 0.011 for right ABI; r = -0.402, p <0.001 for left ABI); whereas other risk factors like obesity based on waist circumference and BMI,non-supine systolic blood pressure, fasting blood glucose, HbA1C, duration of diabetes, plasma lipidsdid not show statistically significant different odd ratios. After linear regression test for risk factorshaving significant correlations with ABI, age and hsCRP were found to influence the ABI scores.Based on a case-control study, risk factors which, to some extent, had statistically significant valuesas risk factors, include older age (? 70 years old; OR = 7.737 [CI = 2.515-23.805]; p < 0.001),relatively high supine diastolic blood pressure (? 90 mmHg; OR = 6.882 [CI = 0.789-60.060]; p =0.048), and high concentration of hsCRP (> 3 mg/L; OR = 4.420 [CI = 1.287-15.181]; p = 0.013).Among these statistically significant risk factors, after logistic regression test analysis, only the age ofthe patient appeared to have significant influence on the prevalence of PAD.In conclusion, this study demonstrates a negative correlation between hsCRP and ABI score;and high levels of hsCRP appeared to be a risk factor for PAD. The age of the patient, however,appeared to be the strongest risk factor for PAD.
THE ROLE OF INTENSIVE INSULIN THERAPY ON SUPEROXIDE DISMUTASE (SOD), TUMOR NECROSIS FACTOR-? (TNF-?), AND INTERLEUKIN-6 (IL-6) ON HYPERGLYCEMIA IN CRITICALLY ILL PATIENTS Wiryana, Made; Suastika, Ketut; Bagianto, Hari; Bakta, Made
INDONESIAN JOURNAL OF BIOMEDICAL SCIENCES Vol. 4, No. 1 Januari 2010
Publisher : Udayana University

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Abstract

Hyperglycemia and insulin resistance are common in critically ill patientsin the ICU, although they have not previously had diabetes. It has been reportedthat pronounced hyperglycemia may lead to complications in such patients, andcause the reactive oxygen species (ROS) production, although controlled trial dataare still lacking. The current debatable issue, focusing on whether the intensiveinsulin therapy, aimed at normalizing blood glucose, may improvepatients?prognosis. Then, the debate is mainly about the time to start the therapy,and target of blood glucose level. Therefore, this research is mainly designed andaimed at knowing the difference between intensive insulin therapy andconventional insulin therapy on the increase of superoxide dismutase (SOD),decrease of cytokine production (TNF-? and IL-6), increase of albumin level, andevent of SIRSThis study was carried out in a randomly pre and post-test control groupdesign, involving 40 adult patients being nursed through the ICU Sanglah hospitalDenpasar. They were randomly assigned to receive intensive insulin therapy, inwhich blood glucose was decreased and maintained at the level between 80-110mg/dl, or conventional insulin therapy in which the insulin was infused only if theblood glucose level exceeded 215 mg/dl, decreased and maintained then at thelevel between 180-200 mg/dl.The result of the study showed that there was (1) significant increase ofSOD mean level (370. 70 vs 98.50 U/gHb, p=0.001); (2) no significant decreaseof TNF-? mean level; (3) significant decrease of IL-6 mean level (10.26 vs 2.25;p=0.023); (4) significant increase of albumin mean level ( 0.62 vs 0.22); (5)significant decrease of SIRS (10 % vs 40 %, p=0.000) on intensive insulin therapygroup compared to conventional insulin therapy group. It can be concluded thatintensive insulin therapy could maintain blood glucose level between 80 ? 110mg/dl, increase SOD level, decrease IL-6 level, increase albumin level, anddecrease SIRS on hyperglycemia in critically ill ICU patients.
THE LACTATE/PYRUVATE RATIO OF METABOLIC MODULATION USING GLUCOSE INSULIN KALIUM AND LACTATE SOLUTION AND THEIR EFFECT ON FUNCTIONAL MECHANICAL RECOVERY OF THE ISOLATED PERFUSED HEART Suranadi, I Wayan; Bakta, Made; Arhya, I Nyoman; Leverve, Xavier
INDONESIAN JOURNAL OF BIOMEDICAL SCIENCES Vol. 3, No. 1 Januari 2009
Publisher : Udayana University

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Abstract

Metabolic modulation with Glucose Insulin Kalium (GIK) solution has beenreally well known in their capacity to improve post ischemic heart function. In this regardGIK intervention on post operative Coronary Artery Bypass Graft (CABG) can improveheart function recovery on reperfusion period (Goldhaber dan Weiss, 1992; Atwell et al.,1997). Post operative CABG intervention with GIK will produce a beneficial effect onthe elevation of heart energy to prevent ionic homeostasis disturbance and reactiveoxygen species (ROS) production that become the basis of reperfusion injury (Silvermandan Stern, 1994; Cross et al., 1995; Taegtmeyer et al., 1997; Opie, 1999; Lazar, 2002;Doenst et al., 2003; Trence et al., 2003).Many efforts have been made to clarify how exactly GIK works to improve postischemic heart function as in CABG. This is crucially done in order to be able to modifythe solution concerned. Although this solution has been clearly proved to improve postischemic heart function, it is not totally free from its adverse effect. Its main side effect isthat it can provoke hyperglycemic state, which contrasts with the tight glucose control incontinuously normal range for the patients who are critically ill.In this study lactate and pyruvate level in the coronary effluent were measuredfrom the isolated heart directly perfused with GIK and lactate. It was shown that thepreischemic lactate level was low and then clearly elevated as soon as the reperfusiontook place due to anaerobic metabolism. In accordance with reperfusion time lactate leveldecreased gradually. In relation with pyruvate level, this substrate evolution looked likethe appearance of lactate but its value was lower if compared with lactate.The recovery in functional mechanical activity of the post ischemic heart seems tobe much more related to the pattern of the evolution of logarithmic lactate/pyruvate ratio(L/P ratio). Logarithmic value of L/P ratio in GIK group increased since the earlyreperfusion period (+40%, p < 0.05), followed by improvement in recovery ofmechanical activity in this group which was significantly higher if compared with thecontrol group. Similar fashion was found in lactate group in regard to the evolution of thelogarithmic value of L/P ratio in this group, where its value was significantly highercompared with the control group. The logarithmic evolution pattern on L/P ratio for thisgroup increased along the reperfusion time (+34% p < 0.05).From the present study, it can be concluded that the recovery of functionalmechanical activity of the post ischemic heart perfused with GIK is through modificationon cellular lactate metabolism.
KADAR FERITIN SERUM DAN HEMOGLOBIN PADA WANITA PASANGAN PENGANTIN BARU DI BALI Ani, Luh Seri; Bakta, Made; Suryadhi, INT; Bagiada, IN
Jurnal Gizi dan Pangan Vol. 5 No. 1 (2010)
Publisher : Food and Nutrition Society of Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (153.011 KB) | DOI: 10.25182/jgp.2010.5.1.26-30

Abstract

Serum ferritin and hemoglobin concentration were used to iron deficiency anemia (IDA) tests over population. The prevalence of IDA prevalence in pregnant women were 18% over the world, 37.5% in Asia, and 46.5% in Bali. The iron supplementation that was administrated during pregnancy did not clinically proven to solve the problems. It was predicted that the IDA was existing before pregnant. So, the body iron store must be prepare before pregnancy period. This research aimed to know the serum ferritin and hemoglobin concentration in the new married women in Bali. The design of this research was descriptive cross sectional study and conducted at 276 new married women by multistage sampling method. Every participant was interviewed for characteristic data and taken blood sample to evaluate serum ferritin and hemoglobin. Serum ferritin and hemoglobin were examined by Immulite 2000 Ferritin and Sysmex SF-3000 and the data were analyzed by descriptive analysis. The mean of serum ferritin and hemoglobin concentration are 29.41±20.36 µg/dl and 11.35±0.92 g/dl. The serum ferritin level proportions 20-29 µg/dl, less than 20 µg/dl, and ?100 µg/dl are 145 (51.9%), 130 (47.1%), and 1(0.4%), eventually. The hemoglobin value <12 g/dl was found in 36.2% population and amount 63.8% population with hemoglobin value ?12 g/dl. According on iron status, the proportion of anemia was23.6%, proportion of iron deficiency was19.2% and proportion of IDA was14.1%. Based on the result, ferritin in the new married women Bali was mostly low level but hemoglobin concentration was mostly normal. Although, they have problem in the proportion of iron deficiency, anemia and iron deficiency anemia, that were 19.2%, 23.6% and 14.1%, respectively.   
THE ROLE OF INTENSIVE INSULIN THERAPY ON SUPEROXIDE DISMUTASE (SOD), TUMOR NECROSIS FACTOR-? (TNF-?), AND INTERLEUKIN-6 (IL-6) ON HYPERGLYCEMIA IN CRITICALLY ILL PATIENTS Wiryana, Made; Suastika, Ketut; Bagianto, Hari; Bakta, Made
INDONESIAN JOURNAL OF BIOMEDICAL SCIENCES Vol. 3, No. 1 Januari 2009
Publisher : Udayana University

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Abstract

Hyperglycemia and insulin resistance are common in critically ill patientsin the ICU, although they have not previously had diabetes. It has been reportedthat pronounced hyperglycemia may lead to complications in such patients, andcause the reactive oxygen species (ROS) production, although controlled trial dataare still lacking. The current debatable issue, focusing on whether the intensiveinsulin therapy, aimed at normalizing blood glucose, may improvepatients?prognosis. Then, the debate is mainly about the time to start the therapy,and target of blood glucose level. Therefore, this research is mainly designed andaimed at knowing the difference between intensive insulin therapy andconventional insulin therapy on the increase of superoxide dismutase (SOD),decrease of cytokine production (TNF-? and IL-6), increase of albumin level, andevent of SIRSThis study was carried out in a randomly pre and post-test control groupdesign, involving 40 adult patients being nursed through the ICU Sanglah hospitalDenpasar. They were randomly assigned to receive intensive insulin therapy, inwhich blood glucose was decreased and maintained at the level between 80-110mg/dl, or conventional insulin therapy in which the insulin was infused only if theblood glucose level exceeded 215 mg/dl, decreased and maintained then at thelevel between 180-200 mg/dl.The result of the study showed that there was (1) significant increase ofSOD mean level (370. 70 vs 98.50 U/gHb, p=0.001); (2) no significant decreaseof TNF-? mean level; (3) significant decrease of IL-6 mean level (10.26 vs 2.25;p=0.023); (4) significant increase of albumin mean level ( 0.62 vs 0.22); (5)significant decrease of SIRS (10 % vs 40 %, p=0.000) on intensive insulin therapygroup compared to conventional insulin therapy group. It can be concluded thatintensive insulin therapy could maintain blood glucose level between 80 ? 110mg/dl, increase SOD level, decrease IL-6 level, increase albumin level, anddecrease SIRS on hyperglycemia in critically ill ICU patients.
HIGH SERUM CONCENTRATION OF INTERLEUKINE-6 AND RANK-LIGAND AS RISK FACTORS FOR OSTEOPOROSIS IN ESTROGEN DEFICIENCY POST-MENOPAUSAL WOMEN Siki Kawiyana, Ketut; Surya, Gusti Putu; Bakta, Made; Roeshadi, Djoko
INDONESIAN JOURNAL OF BIOMEDICAL SCIENCES Vol. 3, No. 2 Juli 2009
Publisher : Udayana University

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Abstract

Osteoporosis in post-menopausal women is not merely due to deficient estrogenhormone production. The development of osteoporosis is due to increased boneresorption by osteoclasts. The osteoclast?s number and activity is controlled by activatingfactors such as IL-6 and RANK-L. The objective of this study was to determine that highIL-6 and RANK-L serum concentrations are risks for osteoporosis in estrogen deficientpost-menopausal women. The serum concentration of ß-CrossLaps (CTx) was measuredto determine bone resorption rate. This is an observational analytical study using case andcontrol design conducted at Sanglah General Hospital of Denpasar. The sample size wascalculated using the paired case-control study formula. There were 41 osteoporotic and41 non-osteoporotic (control) estrogen deficient post-menopausal women involved in thestudy.Data were analyzed by using the t-paired and McNemar tests. Mean serumconcentration of IL-6 among the osteoporotic women was significantly higher ascompared to that of the controls (3.47±1.75 pg/ml vs 2.51±1.13 pg/ml, p = 0.001). Meanserum concentration of RANK-L among the osteoporotic women was also significantlyhigher as compared to that of the controls (320.66±122.44ng/ml vs 249.94±82.41 ng/ml,p = 0.002). To qualify as risk factors for osteoporosis, the cut-off point for IL-6 was 2.17pg/ml (OR = 4, CI 95%: 1.23-14.24; p = 0.032); the cut-off point for RANK-L was275.165 ng/ml (OR = 8, CI 95%: 1.84-34.79; p = 0.001). Analysis of both high serumconcentration of IL-6 and RANK-L was associated with an odd ratio of 9 (CI 95%: 4,27-18,96, p=0,000). CTx concentration in the osteoporotic women was significantly higherthan in the controls (0.60±0.22ng/ml vs 0.46±0.16ng/ml, p = 0.004).We found that the high IL-6 and RANK-L serum concentrations were risk factorsin estrogen deficient post-menopausal women. CTx being a marker for osteoclastic boneresorption activity, increased in concentration higher in osteoporotic than in nonosteoporoticwomen. The high serum concentrations of IL-6 and RANK-L could be usedas predictors for osteoporosis in estrogen deficient post-menopausal women.
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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Abstract

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.