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All Journal Paediatrica Indonesiana GIZI INDONESIA Jurnal Manajemen Bisnis Eka Prasetya At-Tajdid : Jurnal Pendidikan dan Pemikiran Islam The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Jurnal Katalisator

Agus Firmansyah

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Author-ID : 2012313

Religion Agriculture, Biological Sciences & Forestry Humanities Chemistry Economics, Econometrics & Finance Education Environmental Science Health Professions Library & Information Science Medicine & Pharmacology Public Health Social Sciences

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Shigellosis in children less than five years in urban slum area: a study at primary health care in Jakarta Junita Elvira; Agus Firmansyah; Arwin A. P. Akib
Paediatrica Indonesiana Vol 47 No 1 (2007): January 2007
Publisher : Indonesian Pediatric Society

Background Shigellosis has a global distribution especially incountries with poor hygiene and sanitation. The most commonmanifestation of shigellosis in children is diarrhea with broadspectrum manifestations from watery diarrhea to classicaldysentery. Appropriate antibiotic management is important toeradicate Shigella spp.Objective To find out shigellosis prevalence and manifestationsand also Shigella spp. resistance pattern in children less than 5years with acute diarrhea in certain district urban slum areas inJakarta.Methods This cross sectional study involved 475 outpatients ofless than 5 years old with acute diarrhea who visited primary healthcares in Jakarta from Julyâ€“ October 2005. Stool for culture andantibiotic resistance test was taken with single rectal swab.Results Shigella spp. was found only in 3 (0.6%) patients. Thesubjects were between 6 to 24 months. Watery diarrhea was foundin 1 subject and so was the classical dysentery manifestation offever and bloody diarrhea. Two strains were found, 2 cases of S.sonnei and 1 case of S. flexneri. They were resistance tocotrimoxazole, tetracycline, and colistine.Conclusion Shigella spp. was not the main cause of acute diarrheain children less than 5 years old. Due to the small number ofcases, we could not find the most common manifestation andresistance pattern of shigellosis in these children.

The benefit of co-trimoxazole treatment in the management of acute watery diarrhea caused by invasive bacterial infection Bobby Setiadi Dharmawan; Agus Firmansyah; Imral Chair
Paediatrica Indonesiana Vol 47 No 3 (2007): May 2007
Publisher : Indonesian Pediatric Society

Background World Health Organization (WHO) states thatantimicrobials are reliably helpful only for children with bloodydiarrhea (probable shigellosis), suspected cholera with severedehydration, and symptomatic infection caused by Giardia lamblia.The benefit of antimicrobial treatment in management of acutewatery diarrhea caused by invasive bacterial infection is still debated.Objective To prove the benefit of co-trimoxazole treatment inthe management of acute watery diarrhea caused by invasivebacterial infection in patients age 2â€“24 months.Methods This was a randomized, double blind clinical trialinvolving infants and children aged 2â€“24 months with acutewatery diarrhea caused by invasive bacterial infection withoutco-morbidity or complications. Invasive bacterial infection wasdefined by fecal leukocytes greater than ten cells (+2) per highpower field on stool. Subjects were assigned to receive either co-trimoxazole or placebo. The duration and frequency of diarrheabetween two groups were compared.Result Of 70 patients (co-trimoxazole, n=35; placebo, n=35),42 (60%) were children aged 12â€“24 months, of whom 61% wereundernourished. Males were affected 1.2 times as much as females.The clinical manifestations were mild-moderate dehydration(64%), mucus in the stool (100%), fever (24%), vomiting (10%),fever with vomiting (56%) and lactose malabsorption (53%).Duration of diarrhea in placebo group (mean 117.0 [SD 28.1]hours) was not significantly different (P=0.43) compared to thatin co-trimoxazole group (mean 122.5 [SD 30.1] hours). Frequencyof diarrhea per day in placebo group (mean 5.23 [SD 1.48] times)was not significantly different either (P=0.37) compared to thatin co-trimoxazole group (mean 5.64 [SD 2.20] times).Conclusion It is concluded that co-trimoxazole therapy providesno benefit to patients with acute watery diarrhea caused byinvasive bacterial infection. This disorder seems to be self-limited.

Natural course of gastroesophageal reflux disease during infancy - six-month follow-up Eka Laksmi Hidayati; Agus Firmansyah; Alan R. Tumbelaka
Paediatrica Indonesiana Vol 47 No 5 (2007): September 2007
Publisher : Indonesian Pediatric Society

Background Very few data have been published about the naturalcourse of gastro-esophageal reflux (GER) symptoms duringinfancy; further, no risk factors of GER disease (GERD) have beenidentified.Objectives To determine the prevalence and natural course ofregurgitation in infancy and factors of gastroesophageal refluxdisease.Methods A cohort of 223 healthy infants who attended IntegratedHealth Services run by local housewife (Posyandu) of Ciputat â€“suburb of Jakarta â€“ between March and November 2005.Information on subjectsâ€™ history of regurgitation and other reflux-related symptoms was obtained by interviewing mother and diaryrecord. Subjects were followed up to age of 1 year irrespective ofthe clinical status.Results At 6 months of age most infants (56.5%) had regurgitation1 to 3 days per week and only 2.7% infants regurgitated daily.Regurgitation 1 to 3 episodes per day was found in 92.8% ofsubjects. The proportion of infants regurgitation decreasedgradually with age; the proportion for the consecutive 6 to 11month was 100%, 65.5%, 33.6%, 14.3%, 3.6% and 1.3%,respectively. At the age of 1 year no infants was found to beregurgitated. Related symptoms included hiccup (58.3%),vomiting (23.3%) and back arching (2.2%). Feeding problemoccurred in 34.1% infants and occurred more likely in infantswho regurgitate daily compared to 4 â€“ 6 day per week (OR 3.5;95%CI 2.2;5.6) and 1 â€“ 3 day per week (OR 1.8; 95%CI 0.6;0.9).Conclusions Regurgitation in infancy disappears spontaneouslywith age. Reflux-related symptoms are hiccup, vomiting and backarching. Feeding problem occurs most likely in infants whoregurgitate daily.

Cryptosporidiosis in children less than three years old in Ciliwung Riverside, Kampung Melayu Village, Jakarta, Indonesia Herbowo A. Soetomenggolo; Agus Firmansyah; Agnes Kurniawan; Partini P. Trihono
Paediatrica Indonesiana Vol 48 No 2 (2008): March 2008
Publisher : Indonesian Pediatric Society

Background Cryptosporidium infection is often found in children,especially children below three years old. Many risk factors canaffect cryptosporidiosis prevalence. At this moment, the prevalenceand risk factors of cryptosporidiosis in children in Jakarta areunknown.Objectives To determine the cryptosporidiosis prevalence, clinicalmanifestations, and risk factors in children below three years old.Methods This cross sectional study involved 474 subjects betweenthe age of 0 to 35 months in Ciliwung riverside, Kampung Melayuvillage, from December 2005 until April 2006. Stool specimenswere examined using modified acid-fast staining. Nutritional statuswas measured based on actual body weight over ideal body weightratio (NCHS-CDC 2000).Results Cryptosporidium cysts were found in stool sample of 10/474 subject (2.1%). Most of the cases used ground water as asource for drinking and washing. All positive cases lived in houseswith bad sanitation, flooded house and 9/10 cases had a crowdedhousehold. Cat and mice were the two most frequently foundanimals around the house. We found five asymptomatic cases andall of the cases were undernourished.Conclusions The prevalence of cryptosporidiosis in this study is2.1%. Due to small number of cases no risk factor could beidentified. Use of groundwater as a water source, bad sanitation,cat and mice around the house, flooded house, crowded householdand undernourishment might be related to cryptosporidiosisprevalence. Half of the infected children were asymptomatic.

The correlation between ferritin level and cardiac dysfunction in patients with thalassemia Fajar Subroto; Bulan Ginting Munthe; Najib Advani; Agus Firmansyah
Paediatrica Indonesiana Vol 43 No 1 (2003): January 2003
Publisher : Indonesian Pediatric Society

Background Patients with b-thalassemia major, long-term trans-fusion, extravasal hemolytic, and increased intestinal absorptionof iron result in systemic iron overload, which may accumulate inmyocardium causing cardiac dysfunctions. Congestive heart fail-ure usually develops in adolescence or early adult years, and pa-tient usually dies within 1 year after the onset of symptoms. There-fore, it is important to detect early signs of cardiac dysfunction inpatient with thalassemia.Objective This study aimed to assess the correlation betweenferritin level and cardiac dysfunction in patients with thalassemia.Methods A cross sectional study was conducted on 62 b-thalas-semic patients (34 males and 28 females) with age ranging from3.5 to 23 years. They received 3,150 â€“ 94,985 mL of blood; withthe serum ferritin level of 812.2 â€“ 12,175 ng/mL. Each patient un-derwent laboratory examinations and clinical cardiac evaluationwith ECG and echocardiography.Results Cumulative blood transfusions correlated well with theserum ferritin values (p=0.001). The serum ferritin level did notshow correlation with deferoxamine (DFO) treatment. ECG exami-nation revealed 5 patients (8.1%) with dysrhythmia, LVH, and heartblock grade II and I. Echocardiography examination showed 18patients (29%) with systolic or diastolic dysfunction. There was nocorrelation between the serum ferritin level and cardiac dysfunc-tions (p=0.640). The serum ferritin prediction value against car-diac dysfunctions could not be established.Conclusion There was no correlation between serum ferritin lev-els with cardiac dysfunctions. In detecting cardiac dysfunctions inthalassemic patients, echocardiography was more sensitive thanECG

Risk factors of coronary heart disease in children and young adults with parental history of premature coronary heart disease Murti Andriastuti; Sudigdo Sastroasmoro; Agus Firmansyah
Paediatrica Indonesiana Vol 43 No 2 (2003): March 2003
Publisher : Indonesian Pediatric Society

Background Morbidity and mortality of coronary heart disease(CHD) are recently increasing. This is related to changes in lifestyle,such as lack of activity and high consumption of fatty diet. Themain cause of CHD is atherosclerosis. The development of ath-erosclerosis takes a long time, is asymptomatic, and might beginin childhood. The important risk factors that have roles in increas-ing the likelihood of atherosclerosis are family history of prematureCHD, hypertension, hyperlipidemia, obesity, smoking and irregu-lar activity.Objective The aim of this study was to find out the prevalence ofCHD risk factors in children and young adults who had parentalhistory of premature CHD.Methods This was a descriptive cross sectional study conductedon offspring of premature CHD patients who were admitted in theintensive cardiology care unit (ICCU) of Cipto MangunkusumoHospital between January 1999 to December 2001 and of prema-ture CHD patients who visited the Cardiology Clinic of the Depart-ment of Internal Medicine, Cipto Mangunkusumo Hospital duringMarch and April 2002. Subjects were aged 12 to 25 year-old.Results Among the subjects, 40% had hyperlipidemia, 8% hadhypertension, 11% were obese, 21% were active smokers, 41%were passive smokers, and 73% had irregular activity. Ninety-sevenpercents subjects had more than 1 risk factors.Conclusions The prevalence of hyperlipidemia, hypertension,obesity, passive smoker, active smoker and irregular activity inchildren and young adults with parental history of premature CHDin this study were higher than those in the normal population.Most had more than 1 risk factor, increasing the likelihood of CHD.A screening test should be performed on children with parentalhistory of premature CHD so that early preventive measures mightbe done to minimize the risk factors

Bowel habits of exclusively breastfed 0-4 month-old babies Edi S Tehuteru; Agus Firmansyah; Bambang Madiyono
Paediatrica Indonesiana Vol 44 No 4 (2004): July 2004
Publisher : Indonesian Pediatric Society

Background Exclusively breastfed newborns have frequent bowelmovements and sometimes watery stool, which parents or doctorsmight think as diarrhea.Objective The aim of this study was to observe the bowel habitsof exclusively breastfed infants.Methods A longitudinal study was done on 100 babies born be-tween November and December 2002 in Cinta Kasih MaternityHospital. The inclusion criteria were fullterm baby, exclusivelybreastfed for 4 months, and informed consent from parents. Ba-bies with problems in organ or nerve that influenced the gastrointes-tinal tract were excluded. Stool frequency, consistency, and colorwere observed.Results The mean stool frequency per day were 3 times in the 1 stweek (95%CI 2.6;3.4), 2 times in the 2 nd week (95%CI 1.7;2.3),1.8 times in the 3 rd week (95%CI 1.5;2.1), and 1.5 times in the 4 thweek (95%CI 1.3;1.7). In the second and third month, it was 1.4times a day and the fourth month, 1.2 times a day. The consis-tency of meconium was soft in the first four days. After that, 18% ofbabies had watery stool, which increased to 30% on day 15-113.In the last week of the fourth month, all babies had soft stool. Meco-nium was black and lasted for 1-3 days. On the fourth day, thestool became yellow. On day 5-14, 6% of babies had green stool,which increased to 12% on day 15-120.Conclusion The first week of the first month was the week whenthe stool frequency was highest compared to the weeks or monthsafter. The consistency of meconium was soft. After it disappeared,most babies had soft stool. Eighteen up to 30% percent of babieshad watery stool. Regarding the color, meconium was black andstayed for 1-3 days. After that, most babies had yellow stool and 6-12% had green stool

A study on the antibiotic resistance of Shigella Pramita G Dwipoerwantoro; Sri P Pulungsih; Nuraini I Susanti; Hartaniah Sadikin; Agus Firmansyah
Paediatrica Indonesiana Vol 45 No 2 (2005): March 2005
Publisher : Indonesian Pediatric Society

Background The hospital morbidity caused by Shigella or dysen-tery ranges between 0.3 to 2.9%. Irrational use of antibiotics causesa persistent diarrhea and may lead to drug resistance.Objectives With various kinds of antibiotics available in Indone-sia at the moment, this study aimed to anticipate the kinds of anti-biotics appropriate for shigellosis and to evaluate the clinical spec-trum of dysentery in children in Indonesia.Method The study involved 50 children diagnosed with dysenteryor dysentery-like syndrome, aged 1 to 12 years, who came to fourdifferent hospitals in Jakarta, from November 2001 to April 2002.Parents were asked for their consent. Interviewers recorded de-tails of the childrenâ€™s history of illness and the physical examina-tions. Stool culture and resistance tests were done.Results Fifty dysentery cases, comprising 30 males and 20 fe-males, 98% aged from 1 to 5 years, came to the four hospitalsduring the study period. Only 24 cases had positive Shigella cul-tures, of which 87% were Shigella flexneri and 17% were Shigellasonnei. The clinical manifestations of shigellosis were bloody stools(83%), mucus in the stool (75%), and watery diarrhea (96%). Fe-ver and tenesmus were absent in 67% and 92% of subjects, re-spectively. Almost 87% of shigellosis cases were resistant tocotrimoxazole; all were sensitive to colistin and most were sensi-tive to nalidixic acid.Conclusion This data suggests that colistin and nalidixic acid aredrugs of choice for dysentery syndrome. The clinical manifesta-tion of dysentery is not always accompanied by bloody stools butmostly incorporates watery diarrhea and mucus in the stool

Clinical manifestations of rotavirus diarrhea in the outpatient clinic of Cipto Mangunkusumo Hospital, Jakarta Teny Tjitrasari; Agus Firmansyah; Imral Chair
Paediatrica Indonesiana Vol 45 No 2 (2005): March 2005
Publisher : Indonesian Pediatric Society

Background Rotavirus is one of the most common cause of acutediarrhea among hospitalized and pediatric outpatients, especiallythose aged 6-24 months. Data of hospitalized children showed thatrotavirus causes severe diarrhea, but data of outpatient children inIndonesia, especially at Cipto Mangunkusumo Hospital Jakarta, islimited.Objective To characterize the clinical manifestations of rotavirusdiarrhea in the pediatric outpatient clinic at Cipto MangunkusumoHospital Jakarta.Methods This was a cross-sectional study, done in July 2003 â€“March 2004. Stool specimens were collected from patients aged6-24 months with diarrhea and tested for rotavirus by ELISA.Result Of the 98 children enrolled, 35 (35.7%) children excretedrotavirus. Rotavirus diarrhea was seen in 43.8% of children aged6-11 months, of whom 37.0% of them were undernourished. Maleswere affected 1.4 times as much as females. The clinical manifes-tations were passage of diarrheic stools more than 10 times a day(58.3%), mild-moderate dehydration (55.8%), cough (51.9%),rhinorhea (46.0%), vomiting (44.8%), fever (41.1%), yellow stools(38.9%), and mucus in the stool (20.0%). The highest prevalenceof rotavirus diarrhea was identified in the combination of diarrhea,fever, vomiting and cough/rhinorrhea (55.3%). Stool analysis re-vealed that the prevalence of rotavirus diarrhea among childrenwith fat malabsorption, lactose malabsorption, and stool leukocyteof +2 were 50.0%, 46.7% and 33.9%, respectively.Conclusion The prevalence of rotavirus diarrhea in the pediatricoutpatient clinic of Cipto Mangunkusumo Hospital, Jakarta was35.7%. The highest prevalence of rotavirus diarrhea was identifiedin the combination of diarrhea, fever, vomiting and cough/rhinorhea(55.3%)

Neonatal birth trauma: incidence and predisposing factors Asril Aminullah; Novik Budiwardhana; Agus Firmansyah
Paediatrica Indonesiana Vol 43 No 6 (2003): November 2003
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi43.6.2003.220-5

Background The incidence of birth trauma and its predisposingfactors at a major teaching hospital in Indonesia had not been reported.Objective To find the incidence of birth trauma, calculate a riskassessment of predisposing factors, to study whether cesareansection lowers birth trauma, and to identify the variety of morbidityand mortality due to birth trauma.Methods The incidence was studied retrospectively from 4843medical records from January 2000 through June 2001 using theICD-10 classification. Birth trauma cases were then included in acase-control study for a risk assessment profile of predisposingfactors with logistic regression analysis.Results Three hundreds and thirty five out of 4843 neonates wereidentified to have birth trauma. Analysis revealed that forcepsextraction (OR=48.29; p<0.01), vacuum extraction (OR=25.37;p<0.01), breech vaginal delivery (OR=3.94; p=0.03), and cesareansection (OR=3.44; p<0.01) were significant risk factors.Macrosomic infant (OR=3.86; p=0.04) was also significant. Birthinjury to face (ICD-10 code P15.4) was the most common finding,followed by cephalhematoma and bruising of the scalp.There was no mortality due to birth trauma.Conclusions The incidence of birth trauma was still high. Cesareansection was found to be one of the risk factors, butcompared to forceps and vacuum extraction, the risk of traumais considered to be more acceptable.

Co-Authors Adi Suryanto B Agnes Kurniawan Alan R. Tumbelaka Anto Apriyanto Arwin A. P. Akib Asri Rasad Asril Aminullah Aswitha Boediharso Azizul Kholis, Azizul Badriul Hegar Bambang Madiyono Bobby Setiadi Dharmawan Bulan Ginting Munthe Daldiyono Harjodisastro Darlan Darwis Deddy S Putra Dion Darius Samsudin Dwirini Retno Gunarti Edi S Tehuteru Eka Laksmi Hidayati, Eka Laksmi Endi Ridwan F M Susanto Fajar Subroto Firdaus H. S. Moeslichan MZ Hardiono D Pusponegoro Hartaniah Sadikin Herbowo A. Soetomenggolo Imral Chair Irene Yuniar, Irene Junita Elvira khafi puddin Lilis D. Hendrawati Mulya Rahma Karyanti, Mulya Rahma Murti Andriastuti, Murti Muzal Kadim Najib Advani Novik Budiwardhana Nuraini I Susanti Nurhayani Partini P Trihono Partini P. Trihono Pramita G D Pramita G Dwipoerwantoro Rina Rahardiani Rio Kurniawan Risatianti Kolopaking Rosalina Dewi Roeslani Rustadi Sosrosumihardjo Septilia Inawati Wanandi Siti Budiati Widyastuti Soedjatmiko Soedjatmiko SRI LESTARI Sri P Pulungsih Sudigdo Sastroasmoro Teny Tjitrasari Tuty Rahayu Umar, Jahja Umi Fahmida Yumidiana Tya Nugraheni Yuri Pratiwi Utami Zakiudin Munasir

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