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All Journal Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Journal of Agromedicine and Medical Sciences Sari Pediatri Jurnal Gizi Klinik Indonesia Medical and Health Journal
Akhmad Makhmudi
Pediatric Surgery Division, Department Of Surgery, Faculty Of Medicine, Universitas Gadjah Mada/ Dr. Sardjito Hospital, Yogyakarta, Indonesia
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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Assessment of the normal anal position index (API) of Indonesian neonates Yudi Suryana; Akhmad Makhmudi
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 50, No 4 (2018)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (379.247 KB) | DOI: 10.19106/JMedScie/005004201807

Abstract

The existing anal position index (API) data appear to vary among the ethnic differences.Until now, however, the normal API has not been studied in Indonesia. This study aimedto determine the normal value of the API in Indonesian newborns This cross-sectionalstudy was conducted on 62 neonates (29 males and 33 females) without any malformationat Pediatric Surgery Division, Department of Surgery, Dr. Sardjito General Hospital,Yogyakarta during the period September to October 2012. The position of the anus wasnumerically defined by the API, which is the ratio of anus-fourchette distance in females and anus-scrotum distance in males to the distance between coccyx and fourchette/scrotum. To make correct measurements, transparent adhesive tape was used longitudinally on midperinum in a way that it covered the anus. Then fourchette/scrotum, anus center and the lower margin of coccyx were marked on it. Distances marked on each tape were then measured with the standard ruler. Relationship between API and other parameters were analyzed. The API values were 0.46±0.05 (95% CI: 0.44–0.48) for newborn males and 0.37±0.07 (95% CI: 0.35–0.39) for newborn females. The difference of API between males and females was significant (p = 0.000). API had no significant correlation with gestational age (p = 0.350) and birth weight (p = 0.650). Our data suggested the API, which is sex dependent, provides a reliable parameter for determining the position of the anus. API has no correlation with gestational age and birth weight. The determination of normal API in older infants is required to determine whether the API is affected by age.
Correlation between clinical findings and patient’s survival rate in congenital duodenal obstruction Chandra Adipurwadi; Akhmad Makhmudi
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 48, No 4 (2016)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (282.043 KB) | DOI: 10.19106/JMedSci004804201602

Abstract

Congenital duodenal obstruction (CDO) is one of the most common anomalies in newborns (0-30 days), and accounting for nearly half of all cases of neonatal intestinal obstruction. Although survival in infants with congenital intestinal obstruction has improved, duodenal obstruction continues to present unique challenges. A retrospective correlational study was used in this study, 49 patients with CDO were analyzed within the years of 2004 to 2009. A chi-square test was used to investigate the correlation between clinical findings (age, weight, gestational age, surgical techniques, comorbidity, and early enteral feeding) and patient’s survival rate. None of clinical findings showed a significant correlation with patient’s survival rate, except comorbidity (sepsis) and early enteral feeding showed a significant correlation with patient’s survival rate (p<0.05). In conclusion, this study revealed that comorbidity (sepsis) and early internal feeding correlated with patients’ survival rate.
Hubungan Kebiasaan Makan dan Status Gizi Terhadap Kejadian Apendisitis pada Anak di Yogyakarta Hanum Atikasari; Akhmad Makhmudi
Sari Pediatri Vol 17, No 2 (2015)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp17.2.2015.95-100

Abstract

Latar belakang. Apendisitis merupakan salah satu penyakit akut abdomen yang sering terjadi dan dilakukan operasi pada anak. Statusgizi dan kebiasaan makan yang tidak baik menyebabkan penurunan respon imun dan peningkatan risiko infeksi pada anak.Tujuan. Mengetahui hubungan kebiasaan makan dan status gizi dengan kejadian apendisitis pada anak di Yogyakarta.Metode. Penelitian observasional dengan rancangan penelitian case control yang melibatkan 114 responden berusia 6-15 tahun yangdibagi menjadi dua kelompok. Kelompok kasus adalah pasien anak pasca operasi apendisitis di RS Khusus Anak 45, RSUP Dr. Sardjito,RS PKU Muhammadiyah Yogyakarta, dan RSKIA Bhakti Ibu, sedangkan kelompok kontrol adalah anak yang belum pernahmenjalani operasi apendisitis dan bertempat tinggal satu wilayah dengan kelompok kasus.Hasil. Kebiasaan makan menunjukkan hubungan bermakna terhadap kejadian apendisitis pada anak p=0,001 (OR=14,87;IK95%:3,28-67,43). Status gizi menunjukkan hubungan bermakna terhadap kejadian apendisitis pada anak p=0,042 (OR=2,60;IK95%:1,02-6,65).Kesimpulan. Terdapat hubungan bermakna antara kebiasaan makan, kebiasaan jajan dan status gizi terhadap kejadian apendisitispada anak di Yogyakarta.
The Performance of Hematological Parameters for Diagnosis of Acute Appendicitis in Children Supangat Supangat; Akhmad Makhmudi; Azka Darajat; Elly Nurus Sakinah; Muhammad Yuda Nugraha; Achmad Ilham Tohari; Tegar Syaiful Qodar; Bagus Wahyu Mulyono
Journal of Agromedicine and Medical Sciences Vol 8 No 1 (2022)
Publisher : Faculty of Medicine, University of Jember

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19184/ams.v8i1.25715

Abstract

Early diagnosis of pediatric appendicitis is still difficult to make and 30-40% of cases do not show typical classic symptoms. The negative appendectomy rate and the risk of perforation reach 20% so that new, easy, inexpensive and accurate additional examination is needed. This study aimed to compare platelet distribution width (PDW) and mean platelet volume (MPV) values of appendicitis and control patients. This study is retrospective case control study. Differences in MPV and PDW levels in patients with appendicitis and controls were analyzed with a t-test and determination of sensitivity, specificity and accuracy of the two markers in appendicitis diagnosis were performed by ROC analysis The mean MPV appendicitis was significantly lower (p <0.05) compared to controls (8.3 ± 1.9; 9.2 ± 1.5) while PDW of appendicitis patients did not differ significantly from controls (10.4 ± 1, 4, 10.7 ± 2.4; p> 0.05). AUC MPV as a diagnostic tool for appendicitis 0.619 with a normal limit of 6.6 fl has a sensitivity of 90% and specificity of 30%. MPV can be used for the diagnosis of appendicitis with a normal limit of 6.6 fl having a sensitivity of 90% and specificity of 30%. There was no significant difference between PDW of appendicitis patients with controls. There was no significant difference between MPV levels of patients with simple appendicitis and complications. Keywords: Appendicitis, MPV, PDW, Platelet
Status gizi pasien bedah mayor preoperasi berpengaruh terhadap penyembuhan luka dan lama rawat inap pascaoperasi di RSUP Dr Sardjito Yogyakarta Susetyowati Susetyowati; Maya Ija; Akhmad Makhmudi
Jurnal Gizi Klinik Indonesia Vol 7, No 1 (2010): Juli
Publisher : Minat S2 Gizi dan Kesehatan, Prodi S2 IKM, FK-KMK UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ijcn.17608

Abstract

Background: Severe malnutrition affects morbidity due to disrupted wound healing and decreased endurance against infection. There are some factors that cause malnutrition in surgical patients. Two major factors are lack of food intake and process of inflammation that cause increase of catabolism and decrease of anabolism. The condition can be identified from the decrease of albumin serum and muscle hypothrophy.Objective: The study aimed to identify impact of nutrition status of preoperative major surgical patients based on Nutritional Risk Index (NRI) indicator to wound healing and post operative length of stay.Method: The study was observational with prospective cohort study design. Nutrition screening was undertaken to the group that met inclusion criteria at the preliminary process of hospitalization using NRI indicator to identify nutrition status of surgical patients. Next, the group was split into two, one with undernourished nutrition status and the other with good nutrition status. Assessment of nutrition status of patients was based on NRI obtained from level of serum albumin and current and usual weight ratio within the last 6 months. Weight assessment was made during early hospitalization or weight within the last 6 months.Result: The result of the study showed there was signifiant association between nutrition status and wound healing and post operative length of stay (p<0.05). The result of logistic regression test showed there was impact of nutrition status to wound healing and post operation length of stay. Patients with undernourished nutrition status based on NRI contributed 4.8 times greater for the prevalence of poor wound healing than those with good nutrition status (95%CI: 1.179-19.880). Patients with undernourished nutrition status based on NRI contributed 5.5 times greater for extended length of stay > 7 days than those with good nutrition status (95% CI:4.701-50.914).Conclusion: There was impact of nutrition status of preoperative major surgical patients based on NRI indicator to wound healing and post operative length of stay.
Mortality Analysis in Neonates with Gastroschisis: A Retrospective Study at Dr. Sardjito General Hospital, Yogyakarta (2007–2012) Herowati, Novita; Agustriani, Nunik; Makhmudi, Akhmad
Medical and Health Journal Vol 5 No 1 (2025): August
Publisher : Fakultas Kedokteran Universitas Jenderal Soedirman

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20884/1.mhj.2025.5.1.17231

Abstract

Background: Gastroschisis is a congenital abdominal wall defect that poses a significant risk of morbidity and mortality in neonates, particularly in low- and middle-income settings. Despite advances in neonatal care and surgical techniques, survival outcomes remain variable and influenced by multiple clinical factors. Objective: To analyze the clinical and laboratory factors associated with mortality among neonates with gastroschisis treated at Dr. Sardjito General Hospital, Yogyakarta, Indonesia, between 2007 and 2012. Methods: This was a retrospective observational study involving 35 neonates diagnosed with gastroschisis. Data were collected from medical records, including birth weight, gestational age, timing of surgery, hemoglobin and platelet levels, albumin status, bowel necrosis, sepsis status, and anatomical characteristics of the abdominal wall defect. Univariate and multivariate logistic regression analyses were performed to identify significant predictors of mortality. Results: The overall mortality rate was high. Sepsis was found to be the only independent predictor of mortality (p = 0.037; OR 14.29; 95% CI: 1.179–173.261). Other factors significantly associated with mortality in univariate analysis included low birth weight (p = 0.043), small defect-to-bowel disproportion (p = 0.020), and postoperative hemoglobin <13 g/dL (p = 0.019). Postoperative thrombocytopenia and bowel necrosis showed a strong trend toward higher mortality but did not reach statistical significance. Gestational age, albumin levels, and timing of surgery were not significantly associated with mortality. Conclusion: Sepsis remains the most critical factor associated with mortality in neonates with gastroschisis. Early infection control, optimal perioperative hematologic management, and timely surgical intervention are essential to improve survival outcomes. These findings highlight the need for standardized protocols and further prospective studies to reduce mortality in this vulnerable population.
Co-Authors Achmad Ilham Tohari Agustriani, Nunik Azka Darajat Bagus Wahyu Mulyono Chandra Adipurwadi Elly Nurus Sakinah, Elly Nurus Hanum Atikasari Herowati, Novita Ija, Maya Maya Ija Muhammad Yuda Nugraha Supangat Supangat Susetyowati Tegar Syaiful Qodar Yudi Suryana