Jose RL Batubara
Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Indonesia

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Delayed puberty in thalassemia major patients Jose RL Batubara; Arwin Akib; Diah Pramita
Paediatrica Indonesiana Vol 44 No 4 (2004): July 2004
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (418.943 KB) | DOI: 10.14238/pi44.4.2004.143-7

Abstract

Background Delayed puberty is the most common endocrine com-plication in thalassemia major. The main cause of delayed pu-berty in thalassemia major is the failure of the hypothalamic-pitu-itary axis due to iron accumulation in the pituitary.Objectives The purpose of this study was to determine the preva-lence of delayed puberty in β-thalassemia major patients in theDepartment of Child Health, Cipto Mangunkusumo Hospital,Jakarta. This study also evaluated the adequacy of chelationtherapy and determined serum gonadotropin and sex hormonelevels in these patients.Methods Seventy-two patients with β-thalassemia major aged 13-18 years old who visited the Thalassemia Outpatient Clinic of CiptoMangunkusumo Hospital during February-July 2003 were includedin the study. Each subject underwent examinations to determinethe body weight and height, pubertal status, serum iron level, totaliron binding capacity, and the levels of serum LH, FSH, estradiol(in girls) or testosterone (in boys).Results Delayed puberty occurred in 40 of 72 patients (56%). Themajority of patients with delayed puberty showed low levels of se-rum LH, estradiol, and testosterone whereas low levels of serumFSH only occurred in 6 of 21 boys and 11 of 19 girls. Most of thepatients without delayed puberty had normal levels of serum LH,FSH, and estradiol, but 8 of 16 boys showed decreased serumtestosterone levels. Only 3 patients used chelation therapy ad-equately, all of them showed normal puberty.Conclusions The prevalence of delayed puberty in β-thalassemiamajor patients in this study was still high (56%). Periodic examina-tion and recording of pubertal stage need to be done in girls whohave reached 8 years old and boys who have reached 9 years oldso that early detection and management of delayed puberty canbe done.
Practices of growth assessment in children: Is anthropometric measurement important? Jose RL Batubara
Paediatrica Indonesiana Vol 45 No 4 (2005): July 2005
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi45.4.2005.145-53

Abstract

Assessing and monitoring growth iscommon practice in pediatric care, andhealth professionals accept routine growthmonitoring in children as a standardcomponent of community child health servicesthroughout the world. In clinical level, by theseactivities one can detect and intervene while growthfaltering happens. The internationally recommendedway to assess malnutrition at population level is to takeanthropometric measurements. In developedcountries, growth monitoring is an intrinsic part of‘well child’ clinics. As growth is a proxy for childhealth, the child who grows well is generally healthyand illness in a child is usually associated with poorgrowth. Interpretation of child growth is based onanthropometric indicators established in a referencepopulation with cut-off points to differentiate under-and overnutrition, short stature or tall stature,proportionate or disproportionate growth. Practicesof growth monitoring consist of regularly measuringthe weight and height of children, then plotting theinformation on a growth chart to make abnormalgrowth visible. When growth is abnormal, the healthworker does something in concert with the family andas a result of these actions the child receivesappropriate social or medical support, his or hernutrition improves, or a serious condition is diagnosedearlier.
Some aspects of thyroid dysfunction in thalassemia major patients with severe iron overload Cynthia Rindang; Jose R. L. Batubara; Pustika Amalia; Hindra Satari
Paediatrica Indonesiana Vol 51 No 2 (2011): March 2011
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi51.2.2011.66-72

Abstract

Background Severe iron overload due to recurrent transfusions for chronic anemia and inadequate iron chelation therapy in thalassemia major patients result in various complications, including hypothyroidism. Currently, there has been no data on the prevalence of hypothyroidism in thalassemia major patients at the Thalassemia Centers, Department of Child Health, CiptoMangunkusumo Hospital (DCH CMH).Objective To study the prevalence of primary hypothyroidism in thalassemia major patients in the Thalassemia Center, DCH MCH.Methods We performed a cross-sectional, descriptive study. All thalassemia major subjects aged O􀁬18 years with severe iron overload underwent thyroid functionexamination. Primary hypothyroidism was defined as either normal (compensated) or decreased (decompensated) free T4 (FT4) levels, along with elevated sensitive thyroid􀁬stimulatinghonnone (TSH)levels. Results 179 subjects enrolled this study Mth male: female ratio of 1: 1.6. The prevalence of primary hypothyroidism in thalassemia majorpatients Mth severe iron overloadws26.8% (48/179). Of those 48,45 had compensated hypothyroidism and 3 had decompensated hypothyroidism, 25.1% and 1.7% of the total subjects, respectively. Compensated hypothyroidism was observed in 17 subjects aged ≤1O years and in 28 subjects aged> 10 years. All 3 decompensated hypothyroidism cases were> 10 years of age. No relationship was found between the occurrence of primary hypothyroidism and mean pre-tr811sfusion Hb levels (P=0.481, OR 1.30; 95% CI 0.63 to 2.68), elevated serum ferritin levels (P=0.74, OR 0.89; 95% CI 0.46 to 1.75), and compliance to iron chelation therapy (P=0.570, OR 0.76; 95% CI 035 to 1.65). Based on multivariate analysis, only age of <10 year-old (P=O.029, OR 0.469; 95% CI 0.23 to 0.93) was significantly associated Mth primary hypJthyroidism. Further analysis using receiver operator curve (ROC) technique found that age of 8.5 year-old was the cutoff value to predict the risk of hypothyroidism. Conclusion The prevalence of primary hypothyroidism in our study is high. The occurrence of hypothyroidism is associated with age.
Growth diagrams of Indonesian children The nationwide survey of 2005 Jose Batubara; Anna Alisjahbana; Angèle JGMGerver-Jansen; Bachti Alisjahbana; Tony Sadjimin; Yulniar Tasli; Juhariah Juhariah; Angky Tririni; Woro Indri Padmosiwi; Tya Listiaty; Henriette A Delemarre–van de Waal; Willem J Gerver
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/pi46.3.2006.118-26

Abstract

Background Reference curves of growth have been developedin many countries based on cross-sectional data. The World HealthOrganization (WHO) has recommended an international referencewhich is based on the growth standards developed within the UnitedStates during the 1970s. In general these growth references areused in Indonesian pediatric clinics although it is known that thesereferences are not appropriate for this population with a differentethnic background. In order to evaluate reliably Indonesian chil-dren with growth disorders reference standards based on mea-surements in Indonesian children are necessary.Objective To make a standard growth chart for Indonesian chil-dren especially with regards to height, weight, and head circum-ference from a healthy Indonesian infants and children, age 0-18years. This standard charts were compared to CDC growth charts.Methods Weight and height and head circumference were takenfrom children with age ranging from birth up to 18 years. All sub-jects were recruited from 7 different parts of Indonesia. The agegrouping for children from 0-1 years old was based on 3-monthinterval, while for children older than 12 months was based on a 6-month interval. The study was cross sectional.Results There were 34 800 children (17 229 boys and 17 571girls) included in this study with age ranging from 0 up to 18 years.Graphs were presented for weight for age, supine length for age,head circumference for age in male and female infants, and weightfor height and height for age in boys and girls 1-18 years.Comparson of the results of this study with the CDC data werepresented as a graph.Conclusion The standard charts for Indonesian children basedon weight for height, supine length for height and head circumfer-ence for age were presented in graphs for children 0-1 year, weightfor height and height for age for boys and girls 1-18 years old. Allchildren were compared to CDC growth charts and there exists amean difference of -1.47 SDS for boys and -1.43 SDS forgirls.
Effects of a structured educational intervention on metabolic control of type-1 diabetes mellitus patients Bernie Endyarni; Jose RL Batubara; I Boediman
Paediatrica Indonesiana Vol 46 No 6 (2006): November 2006
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (397.339 KB) | DOI: 10.14238/pi46.6.2006.260-5

Abstract

Background Children with type-1 diabetes face not only short-term complications but also long-term microvascular andmacrovascular complications. Therefore, a continuing medical careand education to reach blood glucose near normal range is abso-lutely required. An addition of behavioral educational interventionto intensive diabetes management resulted in improved metaboliccontrol and quality of life.Objective To determine the effects of a structured educationalintervention to parents and patients with type-1 diabetes mellituson their knowledge and patient metabolic control.Methods In this interventional study with pretest-posttest designat Department of Child Health, Medical School, University of Indo-nesia, a total of 21 patients with the age between 8 and 18 yearsand their parents were assigned to follow a structured educationalprogram over period of 6 months. During the 6 intervention ses-sions, some procedures were applied: obtaining HbA1c at initial,3 rd and 6 th month using HPLC procedure, classroom teaching pro-gram, small group discussions, role-playing and pre-posttests.Results The mean HbA1c level in the 21 children and adoles-cents at initial, 3 rd and 6 th month were 10.05% (SD 2.67%), 10.28%(SD 2.23%) and 10.01% (SD 2.67%), which showed no significantchanges (P>0.05). After 6 educational sessions, the result showedsignificant changes in both parents’ (P<0.05) and patients’ knowl-edge (P<0.05). Patients’ diabetes-related knowledge had a mod-erate correlation (r=-0.632; P=0.02) , but parents’ diabetes-relatedknowledge had no significant correlation (r=-0.348; P=0.122) withpatient mean HbA1c level.Conclusion A structured educational intervention used in this studyis able to improve parents’ and patients’ diabetes-related knowl-edge significantly. Patients’ diabetes-related knowledge had a sig-nificant correlation with metabolic control
Knowledge of pediatrician on gastroesophageal reflux/gastroesophageal reflux disease in children: a preliminary study Edward Surjono; Agus Firmansyah; Jose R. L. Batubara
Paediatrica Indonesiana Vol 50 No 6 (2010): November 2010
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (103.711 KB) | DOI: 10.14238/pi50.6.2010.336-9

Abstract

Background Gastroesophageal reflux (OER) is involuntary movement of gastric content into esophagus due to transient lower esophageal sphincter relaxation. This condition usually ignored by physician. Many GER cases have severe complication before properly managed. Ten years after incorporating GER into Indonesia pediatric training curriculum, the knowledge of GER among pediatrician need to be measured.Objectives To measure pediatrician's knowledge of GER/GERD in children.Methods This was a cross sectional study using questionnaire and interview.Result There were 387 respondents who filled the questionnaire and being interviewed. The majority of respondents were between 25-45 years old (33.6%). Respondents who graduated before the year 2000 were 48.3%, and after 2000 were 51.7%. Majority of respondents were general pediatrician (90.2%) and 41.3% working in teaching hospitals Among pediatricians graduated after year 2000,6 6%,5 0.5% and 57.5% could gave more than 80% correct answer to questions about general knowledge, diagnosis and management of GERD as compared to 49.2%, 42.2% and 47% subjects graduated before year 2000. More pediatricians graduated before year 2000 answered the questions on general knowledge, diagnosis and management < 60% correctly compared to those graduated after year 2000 (42.2%, 25.2% and 28.3% vs. 14%,11.5% and 12%, respectively). Fifty five of 160 (34.4%) respondents who working in teaching hospital gave more than 80% correct answer to questions about GERD. Compared to those working in non-teaching hospitals, only 17.6% were able to correctly answer more than 80% of questions.Conclusions Better knowledge about GER/GERD are found among pediatricians graduated after the topics has been introduced to the curriculum and among those practicing in teaching hospitals.
Natural history of premature thelarche: review of 60 girls Jose R. L. Batubara; Adji Suranto; Sudigdo Sastroasmoro; Bambang Tridjaja; Aman B. Pulungan
Paediatrica Indonesiana Vol 41 No 11-12 (2001): November 2001
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (236.352 KB) | DOI: 10.14238/pi41.6.2001.279-83

Abstract

In Indonesia report on the natural history of premature thelarche is very limited. Daily practice requires physicians to have some basic practical knowledge, among others the natural history of premature thelarche, in order to manage these patients properly. We reviewed data of 85 premature thelarche patients who visited our department from January 1989 until December 1998. Only 60 patients met the study criteria. The mean chronological age of the patients at diagnosis was 43.4 months. About half of these patients (31/60) were diagnosed before they were 2 years old. Half of the patients had bilateral breast involvement. The hormonal pattern showed 24/48 follicle stimulating hormone predominant-response. Most patients (33/47) showed normal plasma estradiol level. Bone age analysis was normal in 46/57 patients, and only 9 showed accelerated bone age. Pelvic ultrasonography showed prepubertal reproduction organs in 26/35. Vaginal smears showed signs of estrogenization with various degree of stimulation in 13 patients. At the end of observation the outcome of premature thelarche were: 31 regressed, 19 persisted, 6 had progressive breast development and 4 progressed to central precocious puberty. The initial clinical and laboratory characteristics of those who developed CPP varied. Among 31 premature thelarche patients who regressed, 21 had onset of breast enlargement before age of 2 years. In most of the regressed patients (20/31), regression occurred completely within the first year. Most premature thelarche patients with onset before 2 years will regress within one year after diagnosis. 
Risk factors of stunting in Indonesian children aged 1 to 60 months Rizki Aryo Wicaksono; Karina Sugih Arto; Erna Mutiara; Melda Deliana; Munar Lubis; Jose Rizal Latief Batubara
Paediatrica Indonesiana Vol 61 No 1 (2021): January 2021
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi61.1.2021.12-9

Abstract

Background The Indonesian province of Aceh has a high prevalence of stunting. Identifying risk factors for stunting may help prevention efforts. The Growth Diagrams of Indonesian Children are a specific tool to diagnose stunting in Indonesian pediatric populations. Objective To determine the risk factors of stunting in children aged 1-60 months using the Growth Diagrams of Indonesian Children. Methods This observational, analytic study with case-control design was conducted in the Lawe Alas District, Southeast Aceh, Indonesia to compare prior risk factors exposure between stunted children (cases) and non-stunted children (controls) from January-April 2018. Subjects were children aged 1-60 months and recruited by consecutive sampling. Results The subjects comprised 97 cases and 97 controls, totaling 194 subjects, internal risk factors of stunting were short birth length (OR 2.87; 95%CI 1.24 to 6.61; P=0.011), inadequate calorie intake (OR 2.37; 95%CI 1.32 to 4.27; P=0.004), non-exclusive breastfeeding (OR 3.64; 95%CI 2.01 to 6.61; P<0.001), chronic diarrhea (OR 6.56; 95%CI 3.33 to 13.01; P<0.001) and upper respiratory tract infections (OR 3.47; 95%CI 1.89 to 6.35; P<0.001). External risk factors of stunting were unimproved sanitation (OR 2.98; 95%CI 1.62 to 5.48; P<0.001), unimproved water sources (OR 2.71; 95%CI 1.50 to 4.88; P=0.001), low family income (OR 2.49; 95%CI 1.38 to 4.49; P=0.002), low paternal educational level (OR 2.98; 95%CI 1.62 to 5.48; P<0.001), low maternal educational level (OR 2.64; 95%CI 1.38 to 5.04; P=0.003), and living in households with >4 family members (OR 1.23; 95%CI 0.69 to 2.17; P=0.469). Regression analysis showed that the dominant risk factor of stunting was chronic diarrhea (OR 5.41; 95%CI 2.20 to 13.29; P<0.001). Conclusion The history of chronic diarrhea and non-exclusive breastfeeding are the main risk factors of childhood stunting.
Co-Authors Abdul Latief Adji Suranto Agus Firmansyah 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 B. Pulungan Aman Pulungan Angèle JGMGerver-Jansen Angky Tririni Anies Irawati Anna Alisjahbana Ariani Dewi Widodo Arie Purwana Arry Rodjani Arto, Karina Sugih Arwin Akib Arwin AP Akib Arwin AP Akib Atiek Widya Oswari Bachti Alisjahbana Badriul Hegar Bambang Madiyono Bambang Supriyatno Bambang Tridjaja AAP, Bambang Tridjaja Bambang Tridjaya AAP Bernie Endyarni Medise Budiono Budiono christina olly lada Cissy B. Kartasasmita Corry S Matondang Cynthia Rindang Damayanti R. Sjarif Darmawan B. Setyanto Dhyniek Nurul FLA Diah Pramita Diah Pramita Diana Mettadewi Jong Edward Surjono, Edward Ellen P. Gandaputra Erna Mutiara Evita B. Ifran Evita K. B. Ifran H.F. Wulandari Hanifah Oswari Hardiono D Pusponegoro Hartono Gunardi Hartono Gunardi Harun Alrasyid Damanik Henriette A Delemarre–van de Waal Hindra Irawan Satari Hindra Irawan Satari Hindra Satari I Boediman I Made Arimbawa I Wayan Bikin Suryawan Idham Amir Ilham Wahyudi Indra W Himawan Indra W. Himawan Irfan Wahyudi Iswari Setianingsih Ivena Susanti Juhariah Juhariah Kadim S. Bachtiar Kanadi Sumadipradja Kemas Firman Lamtorogung Prayitno Lanny C. Gultom Lily Rahmawati Ludi Dhyani Melda Deliana Melda Deliana Miswar Fattah Muhammad Faizi Mulyadi Mulyadi Munar Lubis Naela Fadhila Najib Advani Nastiti Kaswandani Nia Kuniati Partini P. Trihono Piprim B Yanuarso Pustika Amalia Pustika Amalia Wahidiyat Rini Andriani Rini Sekartini Rini Sekartini Riza Mansyoer Rizki Aryo Wicaksono Ronny Suwento, Ronny Rosalina Dewi Roeslani Rubiana Sukardi Salimar Salimar Saptawati Bardosono Setyo Handryastuti Siska Mayasari Lubis Soedjatmiko Sri Rezeki Hadinegoro Sudigdo Sastroasmoro Sudigdo Sastroasmoro Sudung O Pardede, Sudung O Taralan Tambunan Tjhin Wiguna Tony Sadjimin Toto Wisnu Hendrarto Tya Listiaty Willem J Gerver Woro Indri Padmosiwi Yulniar Tasli Zakiudin Munasir Zakiudin Munasir