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Kejadian Demam Neutropenia pada Anak dengan Keganasan Sarah Rafika Nursyirwan; Endang Windiastuti
Sari Pediatri Vol 19, No 4 (2017)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp19.4.2017.220-5

Latar belakang. Demam merupakan salah satu manifestasi awal dari infeksi berat, terutama selama periode neutropenia. Infeksi menjadi penyebab utama morbiditas dan mortalitas pada pasien kanker. Data mikroorganisme tersering beserta sensitivitasnya dapat memberikan pola dan menjadi petunjuk tata laksana pasien anak dengan demam neutropenia.Tujuan. Mengetahui kejadian demam neutropenia pada pasien anak dengan keganasan. Metode. Penelitian potong lintang retrospektif dilakukan pada 65 pasien usia 0-18 tahun dengan penyakit keganasan yang dirawat di Departemen Kesehatan Anak, RSCM Jakarta dalam kurun waktu satu tahun sejak 1 April 2015 sampai dengan 30 April 2016. Diagnosis keganasan ditegakkan berdasarkan aspirasi sumsum tulang atau biopsi tumor. Dilakukan pengumpulan dan analisis data kejadian demam neutropenia, kejadian infeksi, serta pola sensitivitas antibiotik dari isolat patogen.Hasil. Keganasan darah (LLA dan LMA) lebih sering ditemukan daripada tumor padat. Dalam satu tahun terjadi 83 episode rawat karena demam neutropenia. Bakteremia tersering disebabkan oleh bakteri Gram positif (6,4%) dibandingkan Gram negatif (5,7%). Hasil kultur dari sampel darah, urin, tinja, sputum, dan apusan luka tersering adalah steril (55,2%). Luaran pasien demam neutropenia yang meninggal tersering didapatkan pada pasien LMA (18,8%), LLA (17,2%), rabdomiosarkoma (12,5%), limfoma maligna non Hodgkin (LMNH) (10%), diikuti tumor padat lainnya. Sensitivitas antibiotik tertinggi didapatkan pada vankomisin.Kesimpulan. kejadian demam neutropenia lebih sering terjadi pada pasien dengan keganasan darah. Patogen ditemukan pada sebagian pasien dengan demam neutropenia. Penyebab terbanyak bakteremia adalah bakteri Gram positif. Sensitivitas antibiotik tertinggi didapatkan pada vankomisin. Data mengenai pola sensitivitas antibiotik terbaru diperlukan untuk pedoman tata laksana pasien demam neutropenia.

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

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.

Survival and prognostic factors of childhood acute lymphoblastic leukemia Emelyana Permatasari; Endang Windiastuti; Hindra lrawan Satari
Paediatrica Indonesiana Vol 49 No 6 (2009): November 2009
Publisher : Indonesian Pediatric Society

Background The treatment protocols of childhood acutelymphoblastic leukemia (ALL) have been improved.Some factors such as age, sex, and nutritional status couldinfluence therapy outcome.Objective To study the survival differences among age, sex,and nutritional status groups in childhood ALL.Methods A retrospective Kaplan-Meier survival analysis ofchildhood ALL was performed in Cipto MangunkusumoHospital since January 1st 1998 until December 31st 2003.We excluded patients aged < 1 years, those with L3 subtype,patients with modified chemotherapy protocol, or withincomplete data.Results A total of 252 patients were analyzed. Overallsurvival of 1-2 year old, > 2-< 10 year old, and 10-18 yearold subjects were 57% (95% CI 38 to 76%), 47% (95% CI40 to 54%), and 35% (95% CI 21 to 49%) respectively (P< 0.05). Five-year -event-free survival (EFS) of 1-2 year old,> 2-< 10 year old, and 10-18 year old subjects were 40%,40%, and 16%, respectively (P <0.05). Overall survival ofmale and female subjects were 46% and 53% respectively(P >0.05). Five-year-EFS of male and female subjects were29% and 45% (P >0.05). Overall survival of well-nourished,undernourished, and malnourished patients were 42%50%and 57% respectively (P >0.05). The five-year-EFS of wellnourished, undernourished, and malnourished subjects were33%,38%, and 51%, respectively (P >0.05).Conclusion Childhood ALL aged 1-2 years had the highestsurvival rate while those of 10-18 year old had the lowest. Therewere no survival rate differences between sex and nutritionalstatus groups.

Intracranial hemorrhage in hemorrhagic disease of the newborn Irawan Mangunatmadja; Rina W Sundariningrum; Hardiono D Pusponegoro; Endang Windiastuti
Paediatrica Indonesiana Vol 43 No 3 (2003): May 2003
Publisher : Indonesian Pediatric Society

Background Hemorrhagic disease of the newborn (HDN) repre-sents a special case of vitamin K deficiency because the four vita-min K-coagulation factors (factors II,VII,IX,X) are already at physi-ologically low levels in the newborn. It responds to vitamin Ktherapy.Objective The aim of this study was to review the incidence, clini-cal manifestation, and outcome of HDN.Methods This was a retrospective cross sectional study on 22patients hospitalized for HDN in the Department of Child Health,Cipto Mangunkusumo Hospital from January 1997 until Decem-ber 2001. Data were obtained from medical records.Results The commonest age group (17 out of 22) was 1â€“3 month-old. Normal delivery was found in 19 patients and only 3 patientsreceived prophylaxis vitamin K. Almost all of them (20 out of 22)were exclusively breastfed. Seizure, pallor, decreased conscious-ness, and bulging of the anterior fontanel were significant clinicalmanifestations found in 21, 21, 13, and 9 patients respectively.Based on brain USG and/or CT scan, intracranial hemorrhage wasfound in 19 patients. Six out of 22 patients died and 7 patientssurvived with handicapConclusion Intracranial hemorrhage due to vitamin K mostly oc-curred at the age of 1 to 3 month-old. The commonest clinical mani-festations were seizure, pallor, decreased consciousness, andbulging of the anterior fontanel. Prevention by giving vitamin K rou-tinely to all newborn babies is recommended

Treatment of childhood acute lymphoblastic leukemia in Jakarta: Result of modified Indonesian National Protocol 94 Djajadiman Gatot; Endang Windiastuti
Paediatrica Indonesiana Vol 46 No 4 (2006): July 2006
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi46.4.2006.179-84

Background Before 1990, the survival rates of childhood acutelymphoblastic leukemia (ALL) patients remained low. In 1994, theHematology Oncology Working Group of the Indonesian PediatricAssociation constructed a national protocol based on standard in-ternational protocol. As the outcome was still not promising, in 1998the protocol was modified by introducing low dose MTX infusion forCNS prophylaxis.Objective To analyze the survival of pediatric ALL patient treated withthe modified protocol in Cipto Mangunkusumo Hospital, Jakarta.Methods A prospective study was carried out to all newly diag-nosed and relapsed children with ALL from January 1998 throughDecember 2004. Patients were stratified into standard risk group(SRG) and high risk group (HRG). HRG met with one of thesecriteria: WBC >50 000/Ã¬l, the presence of CNS involvement, medi-astinal mass, relapse, or L 3 morphology. After completing induc-tion therapy, all patients received low-dose MTX (LDMTX) infusion(500 mg/m 2 ), especially for those aged less than 3 years. If thepatient could not afford LDMTX, cranial irradiation (CRT) was given.Results There were 309 patients, consisted of 190 SRG and 119 HRGpatients. Male to female ratio was 1.8:1. Complete remission wasachieved in 86.3% SRG patients compared with 63.8% in HRG pa-tients (P<0.05). Event-free survival (EFS) rate in SRG and HRG were65.9% (95%CI 59.8; 71.9%) and 40.4% (95%CI 32.5; 48.4%), respec-tively. The overall survival (OS) rates in SRG was 81.2% (95%CI 76.3;86.2%) and in HRG was 56.0% (95%CI 47.8; 64.2%). The overall OSand EFS for both groups were 71.6% (95%CI 67.0; 76.2%) and 59.6%(95%CI 54.5; 64.7%), respectively. Failure of therapy was mostly dueto severe aplasia resulted in bleeding and severe infection. CNS re-lapse was rare in both groups, i.e. 3.1% in SRG and 0.8% in HRG.Conclusion Treatment of ALL using modified national protocol forSRG shows promising results. However, the outcome of HRG pa-tients is still inferior to those reported elsewhere. The use of low-dose MTX infusion can replace the role of cranial irradiation asCNS prophylaxis measure.

Rabdomiosarkoma Pada Anak: Gambaran Klinis di 2 Institusi Anky Tri Rini; Kusumaning Edhy; Djajadiman Gatot; Endang Windiastuti; Yanto Ciputra
Indonesian Journal of Cancer Vol 2, No 2 (2008): Apr - Jun 2008
Publisher : National Cancer Center - Dharmais Cancer Hospital

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 Djajadiman Gatot; Endang Windiastuti
Indonesian Journal of Cancer Vol 5, No 2 (2011): Apr - Jun 2011
Publisher : National Cancer Center - Dharmais Cancer Hospital

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

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