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Alan Roland Tumbelaka
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Echocardiographic patterns in asphyxiated neonates Maswin Masyhur; Idham Amir; Sukman Tulus Putra; Alan Roland Tumbelaka
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 (103.392 KB) | DOI: 10.14238/pi49.4.2009.214-8

Abstract

Background Neonatal asphyxia is a disorder in neonates dueto decreased oxygenation (hypoxia) and decreased perfusion toorgans (ischemia). Duration of asphyxia and early managementinfluence the severity of organ dysfunction, including the heart.Objectives To obtain patterns of cardiac abnormality inneonatal asphyxia in Cipto Mangunkusumo Hospital withechocardiography. Design A cross-sectional study was performed on 22 asphyxiated neonates and 22 other non-asphyxiated neonates from March to October 2008. Inclusion criteria were term neonates, Apgar score :S 6 in the first minute for asphyxiated neonates and ?. 7 for normal/non-asphyxiated neonate. Echocardiographic examination was performed before the age of 48 hours.Results There were 7/22 asphyxiated neonates and 1/22 nonaxphyxiated neonate with heart disease (P <0.05). The mostcommon cardiac abnormality found in asphyxiated neonates waspatent ductus arteriosus, followed by atrial septal defect, tricuspid regurgitation, and pulmonary hypertension.Conclusion Cardiac abnormality is significantly found more oftenin asphyxiated than in non-asphyxiated neonates.
The incidence of nontransfusion-transmitted infectious diseases in β thalassemia major patients at Cipto Mangunkusumo Hospital Zakiudin Munasir; Amy Diana Ruth; Alan Roland Tumbelaka
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 (254.821 KB) | DOI: 10.14238/pi43.6.2003.216-9

Abstract

Background The statement that thalassemic children are moreprone to infection than normal children has been accepted as apart of thalassemia literatures for years. Recently this concept hasbeen questioned, and certainly it has impressed the clinicians thatthe incidence of infection in thalassemia in early childhood is re-duced by adequate blood transfusion although this has not beendocumented. However, iron overload favors bacteria to acquireiron necessary for their growth. Excess iron deposit may damageimmune response in thalassemic patients.Objective The aim of this study was to find out whether there wasany increasing episode of nontransfusion-transmitted infectious dis-eases in thalassemic patients.Design Observational, cross sectional study.Setting Thalassemia outpatient clinic at the Department of ChildHealth, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.Patient Two hundreds subjects by consecutive sampling, groupedby their total volume of transfusion into ≥5 liters or <5 liters groups.Results The numbers of patients receiving transfusion ≥5 literswho had 1,2,3,4 and 5 times episodes of influenza in 6-month pe-riod were 69, 20, 3, 2, and 2 out of 173 patients respectively andin patients receiving transfusion less than 5 liters,14/27 had influ-enza for 1-2 times in 6-month period. The incidence of diarrhea inpatients receiving transfusion ≥5 liters was 11.5%, once to twice in6 months and in patients receiving transfusion less than 5 liters, 7/27, 1-2 times in 6 months. There was no difference in the inci-dence of influenza and diarrhea between the two groups.Conclusion It seemed that there was no any increasing incidenceof nontransfusion-transmitted infectious diseases in thalassemicpatients in accordance with total volume of blood transfusions
Splenectomy and its relation to non-transfusion-transmitted infection in thalassemic patients Mururul Aisyi; Alan Roland Tumbelaka; Bulan Ginting Munthe; Bambang Madiyono
Paediatrica Indonesiana Vol 46 No 3 (2006): May 2006
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi46.3.2006.134-8

Abstract

Background Splenectomy has been associated with an increasedsusceptibility to infection. Overwhelming postspelenectomy infec-tion (OPSI) can lead to high mortality. Decreased IgM and tuftsinconcentration on splenectomized patients seems to play a role ininfection’s susceptibility. Many studies have been performed todetermine the risk factors of infection in thalassemic patients.Objective To find out morbidity patterns and risk factors for pre-dicting the likelihood of infection in splenectomized thalassemicpatients.Methods A retrospective cross sectional study was conducted onconfirmed thalassemic children who came to Department of ChildHealth, Cipto Mangunkusumo Hospital within the period of 1973-2003. Splenectomized patients were categorized as cases groupand non-splenectomized patients as control group. Risk factors fordevelopment of common cold and diarrhea were analyzed usingchi-square test with level of significance <0.05.Results A total of 300 thalassemic patients, 100 of them were sple-nectomized, were enrolled in this study. The 15-year-age group orabove is the most common group underwent splenectomy (35%).Common cold is the most common mild infection in both splenec-tomized group (75%) and non-splenectomized (71%). A significantassociation was found between the risk of infection and splenec-tomy in thalassemic patients (OR=3.8;CI=2.2;6.62; P=0.000). As-sociation between time after splenectomy and frequency of com-mon cold in thalassemia was significant (OR=2.85;CI=1.16;7.14;P=0.011). Severe infection and acute diarrhea were considerednot significantly different between the two groups.Conclusion Splenectomy in thalassemia can increase the sus-ceptibility of non-transfusion-transmitted mild infection. Furtherstudy is needed to elaborate this finding
Clinical features of dengue hemorrhagic fever and risk factors of shock event Rismala Dewi; Alan Roland Tumbelaka; Damayanti Rusli Sjarif
Paediatrica Indonesiana Vol 46 No 3 (2006): May 2006
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi46.3.2006.144-8

Abstract

Background Dengue hemorrhagic fever (DHF) can lead to highmorbidity and mortality. Its clinical features vary from time to time.Many studies were performed to determine the risk factors of se-vere dengue infection.Objective To find out clinical features and risk factors for predict-ing the likelihood of shock in DHF.Methods A retrospective cohort study was conducted in all con-firmed DHF children who were hospitalized at the Department ofChild Health, Cipto Mangunkusumo Hospital within the period ofJanuary 1, 2003 until June 30, 2004. Risk factors for developmentof shock were analyzed using chi-square test and multiple logisticregressions with a level of significance of <0.05.Results A total of 101 patients, consisted of 47 males and 54females were enrolled in this study. Mean age was 6.5 (SD 3.6)years, ranged from 5 months to 15 years. About 31.7% patientshad grade III DHF, 30.7% grade II, and 26.7% grade IV (including1 patient with encephalopathy). Shock was more frequent amongpatients aged between 6-10 years, female, under-nourished, bodytemperature <38°C, hematocrit level 46-50 vol%, and platelet count<20 000/ml. During year 2003-2004, there was increased numberof patients who developed shock. Based on univariate analysis,hepatomegaly, high hematocrit value, and thrombocytopenia wereconsidered significantly different. Among those variables analyzedwith multiple logistic regression method, only hepatomegaly andthrombocytopenia were identified as predictors of shock.Conclusion There was an alteration on clinical features of DHFin our hospital in 2003-2004 period compared to the previous years.Hepatomegaly and platelet count <50 000/ml are independent riskfactors of shock among DHF patients
Co-Authors Amy Diana Ruth Bambang Madiyono Bulan Ginting Munthe Damayanti Rusli Sjarif Idham Amir Maswin Masyhur Mururul Aisyi Rismala Dewi Sukman Tulus Putra Zakiudin Munasir