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Omega Mellyana, Omega
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Stent angioplasti pada anak hipertensi akibat stenosis arteri renalis di RSUP dr. Kariadi Muryawan, Muhammad Heru; Santoso, Antonius Gunawan; Mellyana, Omega
Medica Hospitalia : Journal of Clinical Medicine Vol. 6 No. 2 (2019): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (262.73 KB) | DOI: 10.36408/mhjcm.v6i2.396

Abstract

Background : Renal artery stenosis (RAS) causes 5-10% of all secondary hypertension (HT) in children. Percutaneous transluminal angioplasty (PTA) has proven beneficial for adult patients, but for a children there are varying result. This paper is to report the management of PTA in HT children due to RAS in Dr. Kariadi Hospital. Case report: Nine years 8 months boy with stage II HT since 4 years old, in a good nutritional status, complaints headaches, no family history of hypertension. Treatment with of nifedipine, captopril, valsartan and furosemide has not improved. Four months ago, the patient was treated by the Children's Nephrology and Radiology Division in Dr. Kariadi Hospital for 4 days. initial blood pressure 150/100 mmHg (stage II HT), normal eye examination, heart and kidney function, the angiographic results obtained severe right middle renal artery stenosis.teh stenosis reduced by PTA with dilated balloons up to 30%. One day after the procedure, blood pressure decreased to stage I HT, no complication involved, and the patient was discharged on day 4, with nifedipine, valsartan to control HT and aspilet as anti platelet aggregation. Evaluation 4 months after PTA obtained normal blood pressure. Discussion: HT renovascular children e.c. unilateral RAS performed by PTA has a good prognosis. Unilateral RASre-stenosis rates are less than 30%. Anti-hypertensive therapy is needed after ballooning or angioplasty stents. PTA in Dr. Kariadi Hospital can managed patient to make blood pressure normal. Conclusion: PTA management is an option in children with HT renovasculere.c SAR. Dr. Kariadi Hospital can be a referral to manage the case. Keywords: pediatric hypertension, RAS, PTA, Dr. Kariadi Hospital Latar belakang : Stenosis arteri renalis (SAR) menyebabkan 5-10% dari seluruh hipertensi (HT) sekunder pada anak. Percutaneous transluminal angioplasty (PTA) terbukti bermanfaat untuk pasien dewasa, namun pada anak hasilnya bervariasi. Tujuan makalah ini melaporkan tatalaksana PTA pada anak HT akibat SAR di RSUP dr Kariadi. Laporan kasus : Anak laki laki 9 tahun 8 bulan dengan HTderajatII sejak usia 4 tahun, status gizi baik, keluhan kadang-2 sakit kepala, tidak ada riwayat keluarga hipertensi. Pengobatan nifedipin, kaptopril, valsartan dan furosemid belum membaik. Empat bulan yang lalu pasien di rawat oleh Divisi Nefrologi Anak dan Radiologi di RSUP dr Kariadi selama 4 hari. Tekanan darah saat masuk 150/100 mmHg, pemeriksaan mata, fungsi ginjal dan jantung normal, Hasil angiografi didapatkan stenosis berat arteri renalis kanan pertengahan, dilanjutkan PTA dengan stent post dilatasi dengan balon, stenosis mejadi 30%. Satu hari paska tindakan, tekanan darah menurun menjadi HT derajat I, tidak ada kelainan dan dipulangkan pada hari ke 4, mendapat nifedipin, valsartan dan aspilet sebagai anti agregasi trombosit. Evaluasi 4 bulan paska PTA didapatkan tekanan darah normal. Pembahasan : HT renovaskuler anak e.c.SAR unilateral yang dilakukan PTA mempunyai prognosis baik. Angka re-stenosis SAR unilateral kurang dari 30%. Terapi anti-hipertensi diperlukan setelah pemasangan balon atau stent angioplasti. PTA di RSUP dr Kariadi berhasil membuat tekanan darah menjadi normal. Kesimpulan :Manajemen PTA merupakan pilihan pada anak dengan HT renovaskuler e.c SAR. RSUP dr Kariadi dapat menjadi rujukan dalam tatalaksana kasus tersebut. Kata kunci : hipertensi anak, SAR, PTA, RSUP dr Kariadi
Seorang Anak Perempuan Probable Covid-19 dengan Keterlibatan Ginjal (Laporan kasus) Mellyana, Omega; Latifah, Nur; Trixie, Marcella; Mardiana, Frederika; Anam, Moh Syarofil; Sahyuni, Riza; Wistiani, Wistiani
Medica Hospitalia : Journal of Clinical Medicine Vol. 7 No. 1A (2020): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (379.092 KB) | DOI: 10.36408/mhjcm.v7i1A.480

Abstract

Latar belakang: Kasus Probable Covid-19 adalah kasus penderita dengan gambaran klinis dan pemeriksaan penunjang yang meyakinkan Covid-19 namun tidak terkonfirmasi dengan pemeriksaan real-time polymerase chain reaction (RT-PCR). Kasus probable banyak menimbulkan kekhawatiran karena risiko penularan dan keraguan dalam tata laksana baik bagi dokter, perawat, dan penanggung jawab pasien. Tujuan penulisan artikel ini adalah untuk melaporkan kasus seorang anak dengan probable Covid-19 dan mendiskusikan kemungkinan diagnosis banding lain sebagai pemikiran di tengah pandemi Covid-19 guna pengelolaan pasien yang lebih optimal. Kasus: Anak perempuan 14 tahun 5 bulan dengan keluhan utama batuk selama dua minggu sebelum masuk rumah sakit, disertai demam, diare dan sesak. Selama perawatan, sesak makin bertambah. Tiga hari perawatan ditemukan oliguria, proteinuria, anemia, leukositosis, trombositopenia, hipersegmentasi neutrofil, limfopenia, peningkatan prokalsitonin, hipoalbuminemia dan penurunan fungsi ginjal (51 ml/menit/1,73 m2). Gambaran rontgen dada menunjukkan bronkopneumonia dan kardiomegali. MSCT dada terdapat gambaran konsolidasi dan ground glass appearance (GGO) di kedua paru mendukung ke arah Covid-19. Pada hari perawatan ke 16 anak mengalami gagal nafas, hemoptoe, penurunan kesadaran hingga meninggal. Swab RT-PCR 3 kali negatif (selama perawatan dan post mortem). Ringkasan : Infeksi Covid-19 adalah penyebab infeksi saluran nafas yang serius dan berat. Telah dilaporkan seorang anak perempuan 14 tahun 5 bulan yang meninggal karena Probable Covid-19. Di tengah pandemi Covid-19 ini seorang dokter perlu meningkatkan kewaspadaan yang tinggi terhadap infeksi virus atau bakteri lain untuk memperbaiki tata laksana dan luaran pada penderita. Kata kunci: Covid-19, probable, ground glass opacity, RT-PCR Background: Probable Covid-19 cases are patients with clinical features and convincing investigations for covid-19 but there is not confirmed by real time polymerase chain reaction (RT-PCR). Probable cases raise many concerns because of the risk of transmission and doubt in good management for the doctor / nurse in charge of the patient. The purpose of writing was to report the child with probable Covid-19 and provide a discussion of possible other differential diagnoses as thoughts in the midst of the Covid-19 pandemic for optimal management of sufferers. Case: A girl 14 years 5 months old had a cough for two weeks before admission, accompanied by fever, diarrhea and breathlessness. During treatment, the shortness of breath increased, three days of treatment found oliguria, proteinuria, hematuria, anemia, leukocytosis, thrombocytopenia, neutrophil hypersegmentation, lymphopenia, increased procalcitonin, hypoalbuminemia and decreased renal function (51 ml / min / 1.73 m2). Chest x-ray of bronchopneumonia and cardiomegaly. In the finding of chest computed tomography scan showed consolidation and ground glass appearance (GGO) in both lungs supporting the diagnose of Covid-19. On the 16th day of treatment, the child suffered respiratory failure, hemoptoes, decreased consciousness until death. RT-PCR swabs were 3 times negative (during treatment and post mortem). Summary: Covid-19 is a serious and severe cause of respiratory tract infection. It has been reported that a girl of 14 years and 5 months who died of Probable Covid-19 has been reported. During the Covid-19 pandemic, a doctor may need to increase high awareness of other viral or bacterial infections to improve management and outcome of patients in the future. Key word: Covid-19, Children, Ground Glass Opacity, RT_PCR