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All Journal Medical Journal of Indonesia Indonesian Journal of Cancer Sari Pediatri Paediatrica Indonesiana
Djajadiman Gatot
Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta
Health Professions Medicine & Pharmacology

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Peripheral blood and hemoglobin electrophoresis pattern in beta thalassemia major patients receiving repeated blood transfusion Wirawan, Riadi; Setiawan, Santy; Gatot, Djajadiman
Medical Journal of Indonesia Vol 13, No 1 (2004): January-March
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (262.963 KB) | DOI: 10.13181/mji.v13i1.129

Abstract

One hundred and fifteen beta thalassemia major outpatients attending the Thalassemia Center Department of Child Health, Medical School University of Indonesia Dr. Cipto Mangunkusumo General Hospital for routine blood transfusion and hematology examination, participated in this study. There was a negative correlation between the size of the spleen and the peripheral blood parameters. All peripheral blood parameters tend to decrease with the enlargement of the spleen, and the condition is reversed after splenectomy. We observed that hypersplenism starts when the spleen is as big as S (V – VI). The hemoglobin electrophoresis pattern from beta thalassemia major patients receiving repeated blood transfusion did not show a dense HbF fraction, 90 patients showed a normal hemoglobin electrophoresis pattern. A hemoglobin analysis of both parents could be useful to confirm the diagnosis of beta thalassemia major for patients receiving repeated blood transfusion. In order to get a definite diagnosis, a genetic analysis by bio molecular technique is needed. (Med J Indones 2004; 13: 8-16) Keywords: β thalassemia major, hematology parameter, hemoglobin electrophoresis
Hospital based cancer registry in Cipto Mangunkusumo hospital Jakarta Sibuea, Wilfried H.; Mangunkusumo, R. R.; Akbar, Nurul; Widjanarko, Abidin; Gatot, Djajadiman; Windiastuti, Endang; Hamzah, Mochtar; Panigoro, Sonar S.; Prihartono, Joedo; Krisnuhono, Ening; Lisnawati, Lisnawati; Utami, Sri M.S.; Ramli, Irwan; Roezin, Averdi; Pribadi, Sigit; Wilarso, Iik; Nasar, I Made; Cornain, Santoso
Medical Journal of Indonesia Vol 9, No 3 (2000): July-September
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (752.738 KB) | DOI: 10.13181/mji.v9i3.634

Abstract

[no abstract available]
Renal impairment in β thalassemia major patients receiving repeated blood transfusion Wirawan, Riadi; Kusnandar, Simon; Suherli, Abas; Gatot, Djajadiman
Medical Journal of Indonesia Vol 12, No 4 (2003): October-December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (215.146 KB) | DOI: 10.13181/mji.v12i4.114

Abstract

β-thalassemia major is a disease caused by β polypeptide chain synthesis disorder which is inherited in an autosomal recessive manner from both parents and which is marked by little or no β-globin chain synthesis. Treatment for β-thalassemia major patients is by giving repeated blood transfusions, which causes iron accumulation, leading to hemochromatosis. Iron accumulation can occur in various body organ, including the kidneys. The aim of this study was to investigate the existence of renal impairment in β-thalassemia major patients. The subjects of this study were β-thalassemia major patients aged 15 - 28 years old who had received 6 units of packed red cells or more within 6 months. In this study, urine and serum samples of the subjects were taken and examined. Assay of serum iron was performed with Hitachi 737. Results were that 94.7% patients showed an increase in transferrin saturation and 40% of them had hemochromatosis; 73.4% had microalbuminuria; 1.3% had albuminuria and 21.3% had increased urinary β2- microglobulin (β2-m). A total of 78.6% of patients showed renal impairment. Conclusion of this study suggested that glomerular dysfunction happens in an earlier stage of the disease process. The high incidence of microalbuminuria is also attributed to defective ability of the proximal tubular cells to reabsorb protein besides dysfunction of the glomeruli. (Med J Indones 2003; 12: 215-223)Keywords: β-thalasemia major, repeated blood transfusion, renal impairment
Rabdomiosarkoma Pada Anak: Gambaran Klinis di 2 Institusi Rini, Anky Tri; Edhy, Kusumaning; Gatot, Djajadiman; Windiastuti, Endang; Ciputra, Yanto
Indonesian Journal of Cancer Vol 2, No 2 (2008): Apr - Jun 2008
Publisher : "Dharmais" Cancer Center Hospital

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Abstract

Rabdomiosarkoma (RMS) merupakan keganasan jaringan lunak yang banyak terjadi pada anak umur 1 sampai 5 tahun dan remaja. Sekitar 15 % anak dengan RMS datang dalam keadaan metastasis dan prognosisnya tidak ada perbaikan dalam 15 tahun terakhir.Penelitian ini untuk mengetahui keluaran terapi serta pengembangan selanjutnya Penelitian dilakukan secara retrospektif dari data pada catatan medis 30 pasien yang diterapi di RS Cipto Mangunkusumo (RSCM), Jakarta bulan Juni 2000 sampai Juli 2006 dan 11 pasien di RS Kanker Dharmais (RSKD), Jakarta bulan Januari 2003 sampai Desember 2007. Data dikumpulkan untuk melihat gambaran klinis dan keluaran terapi.Terdapat 30 pasien RMS di RSCM tahun 2000-2006 dan 11 di RSKD tahun 2003-2007. Perbandingan antara laki-laki dan perempuan adalah 2:1 (RSCM) dan 1:1,7 (RSKD).Kebanyakan menyerang anak umur antara 1 bulan sampai 5 tahun (43,3 % & 43,5 %) dengan median antara 6-7 tahun. Gambaran patologi terbanyak yaitu embrional (70% & 54,5%). Lokasi primer terbanyak pada bagian kepala dan leher (43,3% & 27,3%). Didapatkan stadium lanjut sebesar 80% & 45,5%. Sebagian besar metastasis ditemukan pada sumsum tulang (85,7% & 33,3%). Keluaran terapi didapatkan yang masih dalam terapi 66,7% & 27,3%, meninggal 30% & 18,2% dan lost to folloiv up 3,3% & 54,5%.RMS kebanyakan didapatkan pada anak umur 1 bulan sampai 5 tahun. Gambaran histologi tipe embrional dan lokasi primer pada kepala dan leher merupakan yang tersering. Pada umumnya, pasien datang dalam stadium lanjut tetapi jika datang pada stadium awal akan memberikan hasil yang lebih baik.Kata kunci: Rabdomiosarkoma, epidemiologi klinik, keluaran terapi.
Rabdomiosarkoma pada Anak: Luaran Klinis pada Pasien yang Mendapat Terapi Gatot, Djajadiman; Windiastuti, Endang
Indonesian Journal of Cancer Vol 5, No 2 (2011): Apr - Jun 2011
Publisher : "Dharmais" Cancer Center Hospital

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (64.148 KB)

Abstract

Latar belakang. Rabdomiosarkoma (RMS) merupakan keganasan jaringan lunak yang banyak terjadi pada anak umur 1 sampai 5 tahun dan remaja. Sekitar 15 % anak dengan RMS datang dalam keadaan metastasis dan prognosisnya tidak ada perbaikan dalam 15 tahun terakhir.Tujuan. Penelitian ini untuk mengetahui gambaran epidemiologi RMS, hasil penanganannya dan luaran klinis untuk pengembangan selanjutnya.Metode. Penelitian dilakukan secara retrospektif dari data pada catatan medis 44 pasien yang diterapi di RS Cipto Mangunkusumo (RSCM), Jakarta bulan Juni 2000 sampai Juli 2008. Data dikumpulkan untuk melihat gambaran epidemiologi klinik dan luaran klinis.Hasil. Terdapat 44 pasien RMS di RSCM selama tahun 2000-2008.. Perbandingan antara laki-laki dan perempuan adalah 2:1 .Kebanyakan menyerang anak umur antara 3 bulan sampai 5 tahun (47,7% ) dengan median antara 6 -7 tahun. Gambaran patologi terbanyak yaitu embrional (65,9% ). Lokasi primer terbanyak pada bagian kepala dan leher (47,7% ). Berdasarkan sistem TNM , didapatkan stadium lanjut sebesar 61,4% . Sebagian besar metastasis ditemukan pada sumsum tulang (74%). Hasil luaran klinis didapatkan yang masih dalam terapi 52,3% , meninggal 36,4% dan lost to follow up 11,3% .Kesimpulan. RMS kebanyakan didapatkan pada anak umur 3 bulan sampai 5 tahun. Gambaran histologi tipe embrional dan lokasi primer pada kepala dan leher merupakan yang tersering. Pada umumnya, pasien datang dalam stadium lanjut tetapi jika datang pada stadium awal akan memberikan hasil yang lebih baik.Kata kunci Rabdomiosarkoma, epidemiologi klinik, luaran klinis
Steroid response as prognostic factor and its correlation with molecular assessment of childhood acute lymphoblastic leukemia Andriastuti, Murti; Gatot, Djajadiman; Wirawan, Riadi; Setiabudy, Rianto; Mansyur, Muchtaruddin; Ugrasena, I Dewa G.
Medical Journal of Indonesia Vol 24, No 4 (2015): December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (387.646 KB) | DOI: 10.13181/mji.v24i4.1177

Abstract

Background: Survival rate of children with acute lymphoblastic leukemia  (ALL) in Indonesia remains low. Risk stratification accuracy is important to improve survival. In developed countries, risk stratification is determined based on gene fusion that is known related to steroid resistency. Steroid response at day-8 correlates with prognosis. The assessment can be applied in centers that cannot perform molecular assessment. This study aims to evaluate whether steroid response correlated to molecular assessment. Methods: A cross-sectional study was performed at Child Health Department, Cipto Mangunkusumo Hospital (January 2013-March 2014), a total of 73 patients were enrolled. Steroid was given for 7 days. Peripheral blast count at day 8 was evaluated, good response if blast count <1000 /µL and poor if  ≥1000 /µL. Fusion gene detection was also performed. The data was analysed using Statistical Package for Social Sciences (SPSS) version 20.0.Results: Fusion gene was detected in 45 patients. In 1–10 years age group, 26/32 (81%) subjects had good response, while 75% in <1 year age group and 7/9 (78%) in ≥10 years age group had poor response. 5/7 (71%) subjetcs had leukocyte count >100,000 /µL and 7/8 (88%) with T-cell showed poor response. Age, leukocyte count, and T-cell were statistically correlated with steroid response (p<0.05). E2A-PBX1 fusion gene was the most common 19/45 (42%), followed by TEL-AML1 17/45 (38%), BCR-ABL 5/45 (17%), and MLL-AF4 1/45 (3%). Four of five subjects (80%) with BCR-ABL and one subject with MLL-AF4 had poor steroid response. On the other hand, 12/19 (63%) with E2A-PBX1 and 13/17 (77%) with TEL-AML1 had good response. There was no correlation between steroid response and molecular assessment.Conclusion: Steroid response correlates with age, leukocyte count, and T-cell  but  not with molecular assessment.
Clinical and ultrasound joint outcomes in severe hemophilia A children receiving episodic treatment in Indonesian National Hemophilia Treatment Center Sari, Teny T.; Chozie, Novie A.; Gatot, Djajadiman; Tulaar, Angela B.M.; Dharma, Rahayuningsih; Sukrisman, Lugyanti; Bardosono, Saptawati; Achmad, Harry R.; Prasetyo, Marcel
Medical Journal of Indonesia Vol 26, No 1 (2017): March
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (648.119 KB) | DOI: 10.13181/mji.v26i1.1494

Abstract

Background: Recurrent joint bleeds leading to arthropathy is the main problem in severe hemophilia children. This study aimed to investigate joint status in severe hemophilia A children receiving episodic treatment in Cipto Mangunkusumo Hospital, Jakarta.Methods: A cross-sectional study was conducted in Cipto Mangunkusumo Hospital as Indonesian National Hemophilia Treatment Center on children (4–18 years) with severe hemophilia A, who previously received episodic treatment, with no history of inhibitor factor VIII. Hemophilia Joint Health Score was evaluated according to HJHS version 2.1 2011. Joint ultrasonography was done for six index joints (bilateral elbows, knees and ankles) using Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) methods. Data of age of first joint bleed, number of target joints and inhibitor factor VIII were obtained from the Pediatric Hemophilia Registry and medical records.Results: There were 59 subjects aged 4 to 18 years. Twenty-nine out of 59 (49.2%) subjects experienced first joint bleed before of 2 years of age. The most common of joint bleeds was a right ankle. Mean total HJHS was 8.71±8.73. Subjects aged 4–10 years showed lower HJHS (4.6±3.7) as compared to subjects aged >10–18 years (12.3±10.3), p<0.001; 95% CI=4.9–13. Mean HEAD-US scores in subjects aged 4–10 years (18.7±5.6) was lower than in subjects aged >10–18 years (28±7.9), p<0.001, 95% CI= -12.9–-5.6.Conclusion: HJHS and HEAD-US scores of severe hemophilia A children receiving episodic treatment aged 4–10 years are lower compared to subjects aged >10–18 years, indicating more severe joint destruction in older children and progressivity of joint damage over time. It is important to start prophylactic treatment to prevent progressivity of joint damage.
Zinc supplementation on cellular immune response in splenectomized thalassemia major Sari, Teny Tjitra; Gatot, Djajadiman; Akib, Arwin AP; Waspadji, Sarwono; Hadinegoro, Sri Rezeki S; Harahap, Alida Roswita; Idjradinata, Ponpon S
Paediatrica Indonesiana Vol 64 No 2 (2024): March 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.2.2024.145-51

Abstract

Background: The immune response of thalassemia patients is different from usual; therefore, thalassemia patients are susceptible to infection. A study at Thalassemia Center in Cipto Mangunkusumo Hospital showed that all thalassemia patients experience zinc deficiency. The decreased cellular immune response is associated with zinc deficiency, whereas splenectomy exacerbates the condition. This study aims to evaluate the improvement of cellular immune response in splenectomized thalassemia major patients after zinc supplementation. Method: Randomized double-blinded controlled trial was conducted on splenectomized thalassemia major patients in 12 weeks period. The inclusion criteria were aged > 12 years and had negative HIV test results. The subject receiving corticosteroids were excluded. Fifty-six subjects were randomly divided into two groups, the zinc group and the placebo group. Between 2 groups, data on zinc serum, T lymphocyte count, CD4+ T lymphocyte count, CD8+ T lymphocyte count, and CD4+/CD8+ ratio were evaluated at the beginning and the end of the study and were analyzed with unpaired t-test, Mann Whitney test, and Wilcoxon Signed Rank test. Result: After zinc supplementation, only 18 of 28 subjects in the zinc group recovered normal zinc serum levels. There were no significant changes after zinc supplementation in all parameters of cellular immune response (p > 0.05) between the two groups. This might be due to the subjects' adherence, which was lower in the zinc group (75.82%) than in the placebo group (83.19%). Conclusion: The effect of zinc supplementation on cellular immune response in splenectomized thalassemia major patients had not been proven yet.
Pengaruh Stimulasi Bermain Ibu terhadap Kadar Brain Derived Neurotrophic Factor dan Perkembangan Psikososial pada Anak Usia 12-18 Bulan Soedjatmiko, Soedjatmiko; Gatot, Djajadiman; Rusmil, Kusnandi; Bardosono, Saptawati; Padmonodewo, Suminarti; Gutama, Gutama; Sitorus, Rita; Dwirestuti, Ratna
Sari Pediatri Vol 27, No 2 (2025)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp27.2.2025.118-25

Abstract

Latar belakang. Penelitian pada tikus dan orang dewasa menunjukkan bahwa stimulasi lingkungan dapat meningkatkan kadar BDNF di hipokampus, korteks, dan amigdala, yang berperan penting dalam proses pembelajaran dan memori. Namun, belum ada publikasi mengenai pengaruh stimulasi pada anak-anak.Tujuan. Penelitian ini bertujuan untuk membuktikan pengaruh stimulasi bermain yang berupa rangsangan visual, auditori, dan emosional oleh ibu terhadap kadar BDNF darah tepi, serta perkembangan kognitif, bahasa, emosi-sosial, dan memori anak.Metode. Sebanyak 80 anak berusia 12–18 bulan yang sehat (divalidasi melalui pemeriksaan fisik, laboratorium, dan psikologis) terlibat dalam penelitian ini. Subjek dibagi secara acak menjadi dua kelompok: kelompok stimulasi (n=40) dan kelompok kontrol (n=40). Stimulasi dilakukan oleh ibu setelah dilatih selama 2 jam oleh tim peneliti, dengan menunjukkan dan membacakan 5 kata, diakhiri dengan pujian dan pelukan; dilakukan tiga kali sehari, empat hari dalam seminggu, selama 8 minggu. Kata-kata diganti bertahap setiap harinya hingga mencapai total 60 kata. Kelompok kontrol tidak menerima stimulasi.Hasil. Terdapat perbedaan bermakna dalam kadar BDNF 24,6% lebih tinggi pada kelompok stimulasi, p<0,01), serta dalam perkembangan bahasa reseptif, emosi-sosial, dan memori anak (p<0,05). Namun, tidak terdapat perbedaan signifikan pada skala kognitif dan bahasa ekspresif (p>0,05).Kesimpulan. Metode stimulasi yang dilakukan tiga kali sehari selama 8 minggu terbukti bermanfaat untuk meningkatkan kadar BDNF serta perkembangan bahasa reseptif, emosi-sosial, dan memori anak usia 12–18 bulan.
Co-Authors Abas Suherli Abidin Widjanarko Achmad, Harry R. Alida R Harahap, Alida R Anak Agung Istri Sri Wiadnyani Andri Maruli T Lubis, Andri Maruli T Angela BM Tulaar anky tri rini, anky tri Arwin A.P. Akib, Arwin A.P. Arwin AP Akib, Arwin AP Averdi Roezin Chozie, Novie A. Dharma, Rahayuningsih Dwirestuti, Ratna Endang Windiastuti Ening Krisnuhono Gutama, Gutama Harahap, Alida Roswita I Dewa Gede Ugrasena I Made Nasar Iik Wilarso Irwan Ramli Joedo Prihartono Kurniadi Husodo, Kurniadi Kusnandi Rusmil Kusumaning Edhy, Kusumaning Lugyanti Sukrisman Marcel Prasetyo Mochtar Hamzah Muchtaruddin Mansyur Murti Andriastuti, Murti Nurul Akbar Padmonodewo, Suminarti Ponpon S Idjradinata R. R. Mangunkusumo Riadi Wirawan Rianto Setiabudy Santoso Cornain Santy Setiawan Saptawati Bardosono Sari, Teny T. Sarwono Waspadji Sigit Pribadi Simon Kusnandar Sitorus, Rita Soedjatmiko Soedjatmiko Sonar S. Panigoro Sri M.S. Utami Sri R.S. Hadinegoro Sri Rezeki S Hadinegoro, Sri Rezeki S Teny T Sari1, Teny T Teny Tjitra Sari, Teny Tjitra Wilfried H. Sibuea Yanto Ciputra, Yanto