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All Journal Sari Pediatri Paediatrica Indonesiana Jurnal Pendidikan Kedokteran Indonesia: The Indonesian Journal of Medical Education
Bambang Tridjaja AAP, Bambang Tridjaja
Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Indonesia /Rumah Sakit Cipto Mangunkusumo, Jakarta
Health Professions Medicine & Pharmacology Public Health

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Gambaran Tekanan Darah Anak dengan Diabetes Mellitus Tipe 1 di Indonesia Indra W Himawan; Aman B Pulungan; Bambang Tridjaja; Jose RL Batubara
Sari Pediatri Vol 13, No 5 (2012)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (590.871 KB) | DOI: 10.14238/sp13.5.2012.367-72

Abstract

Latar belakang.Salah satu komplikasi jangka panjang diabetes melitus tipe 1 (DM tipe 1) pada anak adalah nefropati diabetik. Lama menderita diabetes serta masa pubertas merupakan faktor yang mempengaruhi terjadi komplikasi tersebut. Kejadian nefropati diabetik pada umumnya akan disertai gejala peningkatan tekanan darah.Tujuan.Mengetahui gambaran tekanan darah anak dengan DM tipe 1 berdasarkan umur, jenis kelamin, lama sakit, dan kadar HbA1c.Metode.Studi observational retrospektif pada register nasional DM tipe 1 UKK Endokrin Anak IDAI sampai tahun 2010. Variabel yang diteliti adalah umur, jenis kelamin, lama sakit, kadar HbA1c, serta tekanan darah sistolik (TDS) dan diastolik (TDD).Hasil.Di antara 177 anak dengan DM tipe 1, 118 (66,7%) perempuan dan 59 (33,3%) laki-laki. Rerata umur saat pertama kali didiagnosis adalah 11,8 tahun. Dijumpai 1 (0,6 % ) anak perempuan yang menderita DM tipe 1 lebih dari 5 tahun mempunyai tekanan darah sistolik dan diastoik di atas persentil 95. Kesimpulan. Sebagian besar tekanan darah anak dengan DM tipe 1, normal. Terdapat 0,6% kasus dengan hipertensi (>95 persentil) yaitu seorang anak perempuan yang telah menderita DM lebih dari 5 tahun
Fungsi Adrenal pada Sepsis di Unit Perawatan Intensif Pediatrik R. Irma Rachmawati; Dwi Putro Widodo; Bambang Tridjaja AAP; Antonius H. Pudjiadi
Sari Pediatri Vol 12, No 6 (2011)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (90.821 KB) | DOI: 10.14238/sp12.6.2011.426-32

Abstract

Latar belakang. Insufisiensi adrenal sering dijumpai pada pasien syok septik dan berhubungan dengankejadian syok refrakter katekolamin dan peningkatan mortalitas.Tujuan. Mengetahui profil fungsi adrenal pada anak yang menderita sepsis di Unit Perawatan IntensifPediatrik RSCM.Metode. Penelitian deskriptif dengan desain potong lintang. Semua subjek menjalani uji stimulasikortikotropin dosis standar. Insufisiensi adrenal (IA) ditegakkan jika respons peningkatan kortisol terhadapuji (􀀧 maks) 􀁤9 μg/dl dan dikelompokkan menjadi absolut (IAA) jika kortisol pra-uji t0 <20 μg/dl danrelatif (IAR) jika t0 􀁴20 μg/dl.Hasil. Tiga puluh anak sepsis (18 laki-laki) diikutsertakan dalam penelitian. usia median adalah 29 (1-153)bulan dan median skor PELOD 12,5 (0-33). Insufisiensi adrenal dijumpai pada 8 (26,7%) pasien (2 IAA and6 IAR), lebih sering pada perempuan (p=0,003), serta cenderung lebih sering pada syok septik (p=0,682).Median t0 32,75 (4,23-378) μg/dl, t30-60 48,20 (16,70-387) μg/dl, dan 􀀧 maks 15,40 (0,90-60,80) μg/dl. Kadar t0 dan t30-60 lebih tinggi pada kelompok syok septik (p=0,03 dan p=0,01) namun tidak berbedaantara subjek dengan dan tanpa IA. Terdapat kecenderungan korelasi positif antara skor PELOD dengant0 dan t30-60 (r=0,7; dan r=0,6; p􀁤0,001). Hipotensi sistolik dijumpai pada seluruh subjek dengan IA dansyok refrakter katekolamin cenderung lebih sering pada kelompok IA (p=0,67). Mortalitas 36,7%, tidakberbeda antara subjek dengan dan tanpa IA.Kesimpulan. Insufisiensi adrenal sering dijumpai pada yang menderita anak sepsis dan harus dipertimbangkanpada kondisi syok septik. Penelitian lanjutan diperlukan untuk menentukan efektivitas terapi steroid.
Komplikasi Jangka Pendek dan Jangka Panjang Diabetes Mellitus Tipe 1 Indra W. Himawan; Aman B. Pulungan; Bambang Tridjaja; Jose R.L. Batubara
Sari Pediatri Vol 10, No 6 (2009)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp10.6.2009.367-72

Abstract

Latar belakang. Diabetes mellitus tipe 1 (DM tipe-1) adalah kelainan metabolik yang disebabkan oleh reaksi autoimun yang menyebabkan kerusakan sel β pankreas dan terjadi pada hampir semua anak yang menderita diabetes. Dalam perjalanan DM tipe-1, sering timbul komplikasi jangka pendek dan jangka panjang.Tujuan. Mengetahui frekuensi komplikasi jangka pendek yaitu ketoasidosis dan jangka panjang yaitu nefropati dan retinopati berdasarkan kontrol metabolik, lama menderita diabetes, dan biaya pengobatan.Metode. Penelitian deskriptif pada 39 pasien yang terdaftar di IKADAR(Ikatan Keluarga Penyandang Diabetes Anak dan Remaja) selama September – Oktober 2007 di Departemen Ilmu Kesehatan Anak Divisi Endokrin FKUI/ RSCM Jakarta dengan melakukan anamnesis, pemeriksaan laboratorium HbA1c, mikroalbuminuria, dan evaluasi mata di poliklinik mata FKUI RSCM.Hasil. Dari 39 pasien yang diteliti antara umur 5-31 tahun, rerata diagnosis diabetes ditegakkan pada umur (9,8±4,1) tahun, HbA1c (10,1±2,3) % dan menderita diabetes selama (5,6±5,8) tahun, dengan dosis insulin yang dipakai (0,9±0,2) IU/kg/hari. Komplikasi yang ditemukan adalah ketoasidosis diabetik selama sakit pada 30 pasien (76,9 %) dan pada 12 minggu terakhir pada 3 pasien (7,9%), mikroalbuminuria pada 3 pasien (7,9%), sedangkan retinopati tidak ditemukan. Rerata pasien memeriksakan HbA1c 3-4 kali pertahun, memeriksa gula darah secara mandiri 1-2 kali/hari dan sebagian besar berobat dengan biaya sendiri.Kesimpulan. Tidak banyak perubahan karakteristik pasien dibandingkan penelitian yang lalu. Rerata kadar HbA1c masih kurang baik dibandingkan dengan rerata HbA1c di negara maju. Di negara maju sudah banyak perubahan pada cara pemberian insulin dan lebih ditingkatkannya perhatian dan pengetahuan pada pasien dan keluarga pasien diabetes.
Kualitas Hidup Anak Epilepsi dan Faktor–Faktor yang Mempengaruhi di Departemen Ilmu Kesehatan Anak FKUI/RSCM Jakarta Winny N Wishwadewa; Irawan Mangunatmadja; Mardjanis Said; Agus Firmansyah; Soedjatmiko, Soedjatmiko,; Bambang Tridjaja
Sari Pediatri Vol 10, No 4 (2008)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp10.4.2008.272-9

Abstract

Latar belakang. Epilepsi merupakan penyakit kronik yang dapat mempengaruhi kualitas hidup anak di masa depan. Saat ini penelitian untuk menilai kualitas hidup anak epilepsi masih terbatas.Tujuan. Melakukan penilaian faktor-faktor klinis, demografi, psikososial dan obat anti epilepsi (OAE) yang mempengaruhi kualitas hidup anak epilepsi dengan menggunakan instrumen Quality of life in childhood epilepsy questionnaire-parent form (QOLCE).Metode. Penelitian dilaksanakan di Poliklinik Neurologi Departemen Ilmu Kesehatan Anak FKUI-RSCM dalam kurun waktu Desember 2007 sampai April 2008. Terkumpul 68 orang responden yang memenuhi kriteria inklusi dengan melakukan wawancara secara langsung oleh peneliti.Hasil. Jumlah serangan kejang dalam 6 bulan terakhir (faktor klinis), usia anak dan jumlah anak dalam keluarga (faktor demografi), kecemasan orang tua (faktor psikososial) mempengaruhi kualitas hidup anak epilepsi. Jumlah obat anti epilepsi (OAE) berkorelasi dengan komponen restriksi fisik pada fungsi fisik yaitu semakin sedikit jumlah OAE semakin tidak dibatasi aktivitas fisiknya.Kesimpulan. Kualitas hidup anak epilepsi dipengaruhi oleh jumlah serangan kejang dalam 6 bulan terakhir, usia anak, jumlah anak dalam keluarga, kecemasan orang tua, dan jumlah OAE. Pengenalan dini terhadap gangguan kualitas hidup pada anak epilepsi dapat memperbaiki kualitas hidup di masa depan.
Prevalence and risk factors for epilepsy in children with spastic cerebral palsy Dedy Rahmat; Irawan Mangunatmadja; Bambang Tridjaja; Taralan Tambunan; Rulina Suradi
Paediatrica Indonesiana Vol 50 No 1 (2010): January 2010
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (308.099 KB)

Abstract

Background Epilepsy in cerebral palsy (CP) is usually difficult to treat and can lead to poor prognosis due to increased risk for motor and cognitive disorders. The prevalence and risk factors of epilepsy in children with CP vary among studies.Objective To determine the prevalence and risk factors for epilepsy in spastic CP.Methods We performed a retrospective study using medical records of patients with spastic CP at the Departement of Child Health, Cipto Mangunkusumo Hospital from January 2003 until December 2008. Prevalence ratio was calculated by comparing the prevalence of epilepsy in subjects with and without risk factors. We excluded patients with metabolic disorder, genetic syndrome, and onset of CP after 3 years of age.Results Two hundred thirty six out of 238 spastic CP patients were analyzed. The mean age at diagnosis of spastic CP was 28.8 months. Male to female ratio was 1.4:1. The prevalence of epilepsy in spastic CP was 39%. The risk factors for epilepsy in spastic CP were central nervous system infection, the ocurrence of seizure in the first year of life, and abnormality of EE G.Conclusions The prevalence of epilepsy in spastic CP is 39%. The risk factors for epilepsy in spastic CP are post central nervous system infection, and ocurrence of seizure in the first year of life. [Paediatr Indones. 2010;50:11-7].
Phenotype and genotype characteristics of Indonesian 21-hydroxylase deficient patients Atiek Widya Oswari; Bambang Tridjaja; Iswari Setianingsih; Taralan Tambunan; Aman B. Pulungan; Jose R. L. Batubara
Paediatrica Indonesiana Vol 47 No 5 (2007): September 2007
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1077.537 KB) | DOI: 10.14238/pi47.5.2007.189-95

Abstract

Background Congenital adrenal hyperplasia (CAH) is the mostcommon cause of ambiguous genitalia in children and 90-95%cases show 21-hydroxylase deficiency. More than 100 mutationshave been described and of these, four mutations have beenfrequently reported in Asia. Those mutations are deletion/largegene conversion (LGC), intron2 splice mutation (I2 splice), pointmutations at codon 172 (I172N) and codon 356 (R356W).Genotyping is very valuable since close correlation observedbetween genotype and phenotype.Objective To identify phenotype and genotype characteristics ofCAH due to 21-hydroxylase deficiency (CAH-21OH) andcorrelation between them.Methods From June to November 2006 we analyzed 37 confirmedCAH-21OH patients treated at the Department of Child Health,Cipto Mangunkusumo Hospital during the period of 1990-2006.Polymerase chain reaction (PCR) followed by restriction fragmentlength polymorphism (RFLP) analysis or amplification-createdrestriction site (ACRS) were performed. We first identified deletion/LGC and I172N mutation that had been mostly reported in saltwasting (SW) and simple virilizing (SV) form patients respectively.Results There were 37 patients, consisted of 6 males and 31females with the ratio 1:5.2. Of those, 25, 10, 2 patients wereSW, SV and non-classic (NC) form, respectively. PCR-RFLP orACRS was performed to detect two mutations in 32 patients (64alleles). Deletion/LGC was found in 6 alleles while I172Nmutations in two. All deletion alleles showed SW phenotype butI172 mutated alleles showed SW and SV phenotype.Conclusion There is a consistent close association betweengenotype and phenotype in our CAH-21OH patients.
Academic achievement of elementary school-aged children with pre-anemic iron-deficiency Paul Wiratama Pardede; Endang Windiastuti; Bambang Tridjaja
Paediatrica Indonesiana Vol 49 No 4 (2009): July 2009
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (106.809 KB) | DOI: 10.14238/pi49.4.2009.209-13

Abstract

Background Relationship between iron deficiency andcognitive function has been investigated in many studies, butthey usually focused on iron deficiency anemia. Brain ironstorage might have already decreased before anemia exist.Objectives To investigate the prevalence of pre-anemic irondeficiencyin school-aged children and to determine whetherthis condition is a risk factor for low academic achievement.Methods A cross-sectional study was conducted on 87 subjectsof znd,6th grade in SDN 04 Petang, Kramat, Senen, Jakartaon August 2008. The subjects underwent peripheral bloodand ferritin serum concentration examinations. Twentyninesubjects who suffered from anemia were excluded. Theremaining 58 subjects were classified into normal body ironstatus group and preanemic iron-deficiency group.Results The prevalence of pre-anemic iron-deficiency in SDN04 Petang, Kramat was 6%. The prevalence ratio to determinewhether pre-anemic iron-deficiency was a risk factor for lowacademic achievement could not be calculated because theminimal sample number required was not reached. There wasno relationship between pre-anemic iron-deficiency and lowacademic achievement for mathematics, Indonesian language,science, and social science.Conclusions The prevalence of pre-anemic iron-deficiency inSDN 04 Petang, Kramat Senen Jakarta was 6%. This studyis not able to determine whether pre-anemic iron-deficiencyis a risk factor for low academic achievement in school-agedchildren; therefore further study with more efforts to detectthe presence of iron deficiency in children with inflammationis needed.
Serological profile and hemolytic disease in term neonates with ABO incompatibility Desiana Dharmayani; Djajadiman Gatot; Rinawati Rohsiswatmo; Bambang Tridjaja
Paediatrica Indonesiana Vol 49 No 4 (2009): July 2009
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (110.423 KB) | DOI: 10.14238/pi49.4.2009.219-23

Abstract

Background Hemolytic disease of the newborn (HDN) due toABO blood type incompatibility is one of the most commoncause of neonatal hyperbilirubunemia that potentially leads tobilirubin encephalopathy. Data on ABO-hemolytic disease of thenewborn (ABO-HDN), especially regarding umbilical cord bloodserological profile, are limited.Objective To identify the serological profile and hemolytic disease in term neonates with ABO incompatibility.Methods This was a cross-sectional descriptive study, conductedat RSIA Budi Kemuliaan Jakarta.Results We found 68 healthy term neonates with ABOincompatibility, nine of them had positive direct antiglobulintest (OAT) result, and 38 subjects had a positive result onOAT with elution method. The highest titer of IgG was 1:8.Hyperbilirubinemia was found in 30 ( 44%) subjects, andABO-HDN was diagnosed in 28 (41 %) subjects. Within thepositive OAT group, eight out of nine subjects had sufferedfrom hyperbilirubinemia and ABO-HDN. Meanwhile, withinthe positive OAT with elution method group; 24 subjects hadsuffered from hyperbilirubinemia with 23 of them having ABOHDN. Based on the chi-square analysis; those with positive OAT with elution method had 3.2 times higher risk of suffering from ABO-HDN. Furthermore, there was a 3.6 times higher risk ofsufferring from hyperbilirubinemia.Conclusion In healthy term neonates with ABO incompatibility,the incidence of ABO-HDN is 41%. OAT serological examinationwith elution method is better than OAT in assessing riskfor hyperbilirubinemia and ABO-HDN.
The prevalence of insulin resistance in patients with β -thalassemia major at Cipto Mangunkusumo Hospital Caroline Mulawi; Bambang Tridjaja; Maria Abdulsalam; Zakiudin Munasir
Paediatrica Indonesiana Vol 43 No 4 (2003): July 2003
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (304.937 KB) | DOI: 10.14238/pi43.4.2003.117-20

Abstract

Background Diabetes mellitus is a common complication in pa-tients with thalassemia major. Iron overload plays an important roleby damaging the pancreatic β-cell and the liver cell, with the con-sequences of insulin deficiency and insulin resistance. Family his-tory of diabetes mellitus is one of the critical factors for the devel-opment of glucose metabolism derangement. However, the patho-genesis of glucose metabolism derangement remains unclear.Objective To evaluate the prevalence of impaired glucose toler-ance, diabetes mellitus, and insulin resistance in patients with β-thalassemia major treated in the Thalassemia Outpatient Clinic,Department of Child Health, Cipto Mangunkusumo Hospital,Jakarta.Methods This was a descriptive cross sectional study conductedin May 2002. Forty-eight subjects aged 10 to 18 years, grouped bytotal volume of transfusions and family history of diabetes mellitus,underwent an oral glucose tolerance test (OGTT), serum transfer-rin saturation, and insulin level examinations. Insulin resistancewas calculated from fasting plasma glucose and insulin concen-trations using the homeostasis model assessment (HOMA).Results One of 48 patients (2%) had impaired glucose toleranceat the age of 17 years. Diabetes mellitus occurred in three of 48patients (6%) at the age of 15.5 years in one patient and 18 yearsin two patients. Family history of diabetes mellitus was found in 2patients with diabetes mellitus and in the only one with impairedglucose tolerance. Insulin resistance was not detected in this study.Conclusion The prevalence of glucose metabolism derangementin patients with thalassemia major was low. No insulin resistancewas found in this study
5-alpha-reductase deficiency: a case report Diana Mettadewi Jong; Aman B Pulungan; Bambang Tridjaja AAP; Jose RL Batubara
Paediatrica Indonesiana Vol 43 No 6 (2003): November 2003
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1279.494 KB) | DOI: 10.14238/pi43.6.2003.234-40

Abstract

The condition of 5-alpha-reductase type 2deficiency (5-ARD) is an inherited disorderresulting in the inability to converttestosterone to dihydrotestosterone(DHT).This disorder was previously termed asfamilial incomplete male pseudohermaphroditism type2, pseudovaginal perineoscrotal hypospadias.Clinical manifestation of 5-ARD is limited to malegenetic. The affected males are usually identifiedas female in childhood but undergo striking virilizationat puberty.While overall incidence for various countries arenot established, increased incidence is reported in theDominican Republic, some highland tribes in NewGuinea, Lebanon and Turkey. This was the firstdocumented case in Cipto Mangunkusumo (CM)Hospital.
Co-Authors Adji Suranto Agus Firmansyah Agus Firmansyah Alvi Lavina Aman B Pulungan Aman B Pulungan Aman B Pulungan Aman B Pulungan Aman B Pulungan Aman B. Pulungan Aman B. Pulungan Aman B. Pulungan Aman B. Pulungan Aman Bhakti Pulungan Aman Pulungan Annang Giri Moelyo Annang Giri Moelyo Annang Giri Moelyo Antonius H. Pudjiadi Ardi Findyartini, Ardi Ari Prayitno Aryono Hendarto Atiek Widya Oswari Caroline Mulawi Dedy Rahmat Desiana Dharmayani Diana Adriani Banunaek Diana Mettadewi Jong Djajadiman Gatot Dwi Putro Widodo Dwi Putro Widodo Endang Windiastuti Erwin P. Soenggono I Wayan Bikin Suryawan Indah S. Widyahening Indra W Himawan Indra W. Himawan Irawan Mangunatmadja Iswari Setianingsih Jose R. L. Batubara Jose RL Batubara Mardjanis Said Maria Abdulsalam Melda Deliana Muzal Kadim Paul Wiratama Pardede Pudjiadi, Antonius Hocky R. Irma Rachmawati Rara Purbasari Rina Triasih Rinawati Rohsiswatmo Rini Sekartini Riza Mansyoer Riza Mansyoer Rulina Suradi Samuel Harmin Soedjatmiko Sudigdo Sastroasmoro Sudung O Pardede, Sudung O Surastusi Nurdadi Suri Nurharjanti H Taralan Tambunan Taralan Tambunan Titis Prawitasari, Titis Windhi Kresnawati Winny N Wishwadewa Yoga Devaera Yulman, Annisa Rahmania Zakiudin Munasir