Dany Hilmanto
Program Pascasarjana Fakultas Kedokteran Universitas Padjadjaran Bandung
Articles
48
Documents
Clinical Aspects Disparities of Resistant and Non Resistant Nephrotic Syndrome in Children

Journal of the Indonesian Medical Association Vol. 60 No. 12 December 2010
Publisher : Journal of the Indonesian Medical Association

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Abstract

Histopathologically diagnosed nephrotic syndrome (NS) consists of minimal and nonminimal lesions. Minimal lesion nephrotic syndrome (MLNS) is usually called as sensitive steroid nephrotic syndrome (SSNS), and nonminimal lesion nephrotic syndrome (NMLNS) is the same as steroid resistant nephrotic syndrome (SRNS). Histopathologic feature is a gold standard in diagnosing NS, but it is not possible for every patient due to its invasive nature. This study aimed to elucidate the association between several clinical and laboratory manifestations such as nonalbumin protein, cholesterol, hypertension, haematuria, and the response towards SRNS and SSNS. An analytic study was carried on to find out the response of steroid therapy. The sample consisted of two groups with 38 subjects each, collected from the Outpatient and Inpatient setting of the Department of Child Health Hasan Sadikin General Hospital, Bandung, since January 2008 up to September 2009, all of whom were diagnosed with SSNS or SRNS according to the medical records data. Further analysis was done using X2. Logistic regression analysis was done simultaneously to find out the association of several variables, and odds ratio was used to calculate the strength between the variables. There was no difference in nonalbumin protein (p=0.139) and hypertension (p=0.247) of all subjects from both groups. The cholesterol rate was lower in SRNS group compared to those in SSNS group (p<0.05). Both groups showed difference in the incidence of haematuria (p=0.054). Multivariate analysis found out the association between sex, cholesterol rate and nonalbumin protein response towards steroid therapy in NS.Keywords: cholesterol, SRNS, SSNS, nonalbumin protein

Goodpasture’s Syndrome in a 12-Year-old Girl with Massive Hemoptysis and Acute Renal Failure

Journal of the Indonesian Medical Association Vol. 57 No. 9 September 2007
Publisher : Journal of the Indonesian Medical Association

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Abstract

Goodpasture’s syndrome is an autoimmune disease composed of progressive glomerulonephritis, pulmonary hemorrhagic, and finding of anti-GBM antibody. Incidence of the disease is about 1:1 000 000; its highest incidence at the age of 20 – 30 years, and sex ratio between male and female is 4:1. A 12-year-old girl was admitted to Hasan Sadikin Hospital with chief complaint of body swelling for 10 days, preceeded with of weakness, fatigue and paleness for 3 weeks, and bloody cough for 4 days. Before admssion to dr Hasan Sadikin Hospital, the patient was admitted to Dr Slamet Hospital in Garut, and received 2 units of blood transfusion. Physical examination renedled palpebra and extremity swelling, hypertension, and anemia without difficulty of breathing. Laboratory findings showed anemia, increased ureum-creatinin high potasium level, proteinuria and hematuria. Chest X-rays showed diffuse infiltrate. The patient was first diagnosed acute renal failure due to acute nephritic syndrome, and was given intravenous furosemide, kayeksalat and packed red cell transfusion. In the emergency unit, she suffered more massive hemoptysis, breathing difficulty and became paler. After 6 hours in the emergency unit, she suffered hypovolemic shock, bradycardia and apnea. After 15 minutes of rescuscitation, the patient died. The patient is final diagnosed was Goodpasture’s syndrome based on the presence of progressive glomerulonephritis and pulmonary hemorrhagic. Even though there was no proof of anti-GBM, clinical features showed description of Goodpasture’s syndrome.Keywords: Goodpasture’s syndrome, glomerulonephritis, pulmonal bleeding, anti-GBM antibody

Association of Hemoglobin Level Before Transfusion and Iron Chelating Agents with Growth Velocity in Childhood Thalassemia Major

Journal of the Indonesian Medical Association Vol. 57 No. 11 November 2007
Publisher : Journal of the Indonesian Medical Association

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Abstract

The association between thalassemia major and growth retardation has been known, but the factors affect growth velocity remain unclear. The aim of this study was to determine mean hemoglobin level before transfusion and iron chelating agents as risk factors for growth velocity retardation in childhood thalassemia major. The study was conducted from October 2006 to April 2007 at the Clinic of Pediatric Thalassemia Hasan Sadikin Hospital Bandung. The subjects meeting inclusion criteria were examined for the average hemoglobin level (g/dL) and optimalization of iron chelating agents. Afterwards, we performed growth velocity calculation (cm/year). Association of hemoglobin level before transfusion and iron chelating agents with growth velocity were analyzed by odds rasio (OR). Fifty-five subjects of 30 male and 25 female, with ages ranged from 4 years 1 month to 9 years 10 months. Fourteen subjects received transfusion when hemoglobin level was <7 g/dL, and 41 subjects e”7 g/dL. The average iron chelating agents administered was (45±4.95 mg/kgBW); forty-six subjects received inoptimal iron chelating agents and nine subjects optimal. Forty-two subjects had growth velocity retardation (<4.5 cm/year) and 13 subjects had normal growth (e”4.5 cm/year). The association of mean hemoglobin level before transfusion and optimalization iron chelating agents with growth velocity were, respectively, (OR=5.6; p=0.117) and (OR=0.7; p=0.727). It was concluded that mean hemoglobin level before transfusion and iron chelating agents are not significant risk factors for growth velocity retardation in chilhhood thalassemia major.Keywords: Thalassemia major, mean hemoglobin level, growth velocity, risk factor

AB Blood Group as a Risk Factor for Dengue Shock Syndrome in Children

Journal of the Indonesian Medical Association Vol. 58 No. 10 October 2008
Publisher : Journal of the Indonesian Medical Association

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Abstract

Dengue shock syndrome (DSS) was the major cause of mortality in dengue infection. The risk factor of DSS that most studied was viral strain, genetic predisposition, secondary infection, overweight, and age 5-9 years old. The aim of this study is to identify AB blood group as risk factor of DSS in children along with secondary infection, overweight, and age 5-9 years old factors. Cross sectional study with consecutive sampling was performed in children aged one month until 14 years old children with dengue fever (DF), dengue hemorrhagic fever (DHF), or DSS according to 2005 WHO criteria. Blood type was examined by slide test method. Risk factor was analyzed by chi square test (X2) and logistic regression. Based on chi square test (X2), AB blood group is risk factor for DSS (PR 2.306; 95% CI 1.147-4.634; p=0.044). Based on logistic regression analysis, only AB blood group is risk factor of DSS, meanwhile secondary infection, overweight, and age 5-9 years old are not risk factor of DSS. This study conclude that AB blood group is risk factor for DSS in children even along with secondary infection, overweight, and age 5-9 years old factors.Keywords: dengue shock syndrome, AB blood group, risk factor

Fifth Grade Vesicoureteral Reflux in a 9-Year Old Girl

Journal of the Indonesian Medical Association Vol. 59 No. 1 January 2009
Publisher : Journal of the Indonesian Medical Association

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Abstract

Vesicoureteral reflux is retrogard flow of urine from the bladder to the ureter and renal pelvis. The ureter is normally attached to the bladder in an oblique direction, perforating the bladder muscle (detrussor) laterally and proceeding between the bladder mucosa and detrussor muscle, creating a flap valve mechanism that prevents reflux. Reflux occurs when the submucosal tunnel between the mucosa and detrussor muscle is short or absent. The purpose of this case report was to describe how a proper management of urinary tract infection can diminish vesicoureteral reflux complication. A-9-year old girl was admitted to Hasan Sadikin Hospital with chief complaint of unable to hold voiding for 2 months, preceeded by recurrent pain in front of her stomach, vomitus and low grade fever since 20 months before. Physical examination showed she was moderate malnutrition, anemic, no hypertension. Laboratory findings showed anemia, increased serum ureum-creatinin, high potassium level, leucosituria, but negative urine culture. Her urinary tract and kidney ultrasound showed hydronephrosis with bilateral ureter enlargement and cystitis. Her mictiocystourethrography(MCU) showed right vesicoureteral reflux low pressure, 5th grade, with neurogenic bladder, chronic cystitis with diverticulosis. Cystoscopy examination showed hyperemis in bladder mucosa, heavy trabeculae, diverticle (golf hole), there is no mass or stone. The patient is planned to get vesicosistectomy and given prophylactic antibiotic (cefixime), but she never re-coned to hospital.Keywords: vesicoureteral reflux, vesicosistectomy, prophylactic antibiotic

Birth Weight, Age of Onset, and Sex as Risk Factors of Steroid Resistant Nephrotic Syndrome

Journal of the Indonesian Medical Association Vol. 60 No. 11 November 2010
Publisher : Journal of the Indonesian Medical Association

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Abstract

Steroid resistant nephrotic syndrome (steroid resistant NS) might cause a big problem in children, especially in the management and progress of the disease to become a chronic or terminal kidney disease. The major risk factors for steroid resistant nephrotic syndrome are birth weight, age of onset, and sex. This is an analytical retrospective study with case control design, which was held in the Pediatric Departement of Dr. Hasan Sadikin Hospital, Bandung in May-June 2010. The subjects were steroid resistant or steroid sensitive NS patients age 1-14 years old. Data was collected from medical records followed by home visit to find out the history of birth weight and gestational age. Twenty four patients with resistant steroid and 48 with sensitive steroid NS were included in the research. There were 4 patients of steroid resistant NS and 1of sensitive steroid NS with low birth weight term infant [p= 0.022; OR(95% CI):9.4(1.0-89.45)], 14 patients of steroid resistant NS and 11 of sensitive steroid NS with age of onset >6 years [p=0.003; OR(95% CI): 4.7(1.64-3.52)]. Twelve patients of steroid resistant NS and 10 of sensitive steroid NS were females [(p=0.011; OR(95% CI): 3.8(1.315-10.978)]. Recording to the multivariate analysis, low birth weight term infants had the highest OR (8.082), followed by age of onset >6 years (5.112). The three mentioned risk factors potentiate the incidence of steroid resistant NS with coeficient b >1. From this research we can concluded that low birth weigh term infant, age of onset >6 years, and female sex are risk factors for the occurrence of resistant steroid NS.Keywords: steroid resistant nephrotic syndrome, risk factor, low birth weight term infant

Comparison Between Simplified Fencl-Stewart and Figge-Stewart Methods with Henderson-Hasselbach Method in Diagnosis of Metabolic Acidosis

Journal of the Indonesian Medical Association Vol. 60 No. 11 November 2010
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Abstract

Assessment of acid-base balance status and diagnosis of metabolic acidosis can be done using the Henderson-Hasselbalch method. The other method is the method of Stewart. The purpose of this study was to compare the methods of a simplified Fencl-Stewart and Figge-Stewart with the Henderson-Hasselbalch method in the diagnosis of metabolic acidosis. This research was conducted in February to May 2010 at the Children Emergency Unit, Pediatric Intensive Care Unit, Pediatric Inpatient Unit, Neurosurgery Intensive Care Unit, and children who consulted from other departments to Child Health Department, Hasan Sadikin Hospital, Bandung . The study was conducted in children aged 1 month-14 years old who required blood gas analysis and in a state of metabolic acidosis based on the Henderson-Hasselbalch method. Blood gases were also analyzed by simplified Fencl-Stewart method and Figge-Stewart method. It was obtained 60 subjects with metabolic acidosis. Of 35 subjects in the Henderson-Hasselbalch method, there is an increasing anion gap to 37 subjects after correction of “excess base the caused by unmeasured anions” (BEua) based on simplified Fencl-Stewart method, and increased to 41 subjects when corrected for albumin factor based on Stewart-Figge method. Analysis using Cohen’s Kappa coefficient of agreement reached 73.3% and 69.6% (p<0.001), stated that the anion gap based on the Henderson-Hasselbalch method equal favorably with a simplified Fencl-Stewart and Figge- Stewart to identify anion that are not measurable. This study concluded the Henderson-Hasselbalch method, a simplified Fencl-Stewart, and Figge-Stewart can be used to identify unmeasured anions in metabolic acidosis.Keywords: Metabolic acidosis, Henderson-Hasselbalch, simplified Fencl-Stewart, Figge-Stewart

Differences of Serum Ferritin Levels in Children with Thalassemia Major after Deferiprone and Deferoxamine Iron Kelator Administration

Journal of the Indonesian Medical Association Vol. 60 No. 11 November 2010
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Abstract

Routine serum ferritin examination was used to evaluate response of iron chelator in thalassemia major. Iron chelator which was widely used were deferoxamne (DFO) and deferiprone (DFP). Iron loading in thalassemia major patients continued despite iron chelation therapy, so effective and continue iron chelator agent was needed. This study was aimed to know the difference of ferritin serum levels after DFO and DFP therapy in 6, 12, and 18 months. A cross sectional study was performed between May and August 2009 in Hasan Sadikin General Hospital Bandung. Forty eight children with thalassemia major were analyzed. There were statistical differences between DFO or DFP administration (Factor-A) with serum ferritin level (p=0.002) and between 6, 12, 18 months administration time (Factor-B) with serum ferritin level (p<0.001). Interaction between both factors was not significantly different (p=0.645). In conclusion, type and administration time of iron chelator effect in serum ferritin level.Keywords: deferiprone, deferoxamine, ferritin, thalassemia major

Risk Factors for Underweight in Six Month Babies

Journal of the Indonesian Medical Association Vol. 61 No. 11 November 2011
Publisher : Journal of the Indonesian Medical Association

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Underweight among infants is influenced by intrinsic and extrinsic factors. One way toovercome the problem is by exclusive breastfeeding. The purpose of this study was to assess the strength of risk factors (maternal weight gain during pregnancy, early initiation of breastfeeding, exclusive breastfeeding, and history of infectious diseases) and determining the most dominant risk factor on underweight status in infants 6 months of age in the city of Depok. Comparative analytical study was conducted with case-control design. The cases were underweight infants, while the controls are well-nourished infants who was brought to the weighing in the integrated health centre region Pancoran Mas District Public Health Center Depok City, during the period April-May 2011. Chi-square was used to assess risk factors and multiple logistic regression method was used to find the most dominant factor in the state of underweight among children aged 6 months. In a study found 23 cases and 69 controls. The results of multivariable analysis obtained two variables that were risk factors, maternal weight gain that was not according to standards during pregnancy with OR 3.977 (1.102-14.35) p= 0.035 and did not get the early initiation of breastfeeding with OR 5.189 (1.797-14.988) p=0.002, both variables had a model’s accuracy of 79.3%. In conclusions, both variables is a risk factor for the status of underweight among infants aged 6 months, with the most dominant factor is the early initiation of breastfeeding. J Indon Med Assoc. 2011:61;442-6.Keywords: early initiation of breastfeeding, exclusive breastfeeding, infection, underweight, weight gain

Risk Factors of Psychosocial Disorder Patients with Thalassemia Mayor

Journal of the Indonesian Medical Association Vol. 62 No. 2 February 2012
Publisher : Journal of the Indonesian Medical Association

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Introduction: Thalassemia is a chronic disease in which transfusion dependent could affectpsychosocial life. The aim of this study is to observe risk factors for psychosocial disorder.Methods: This was a cross sectional observational analytic study. Subjects were thalassemiaoutpatients aged 4-16 years in April-May 2011 in Dr. Hasan Sadikin General Hospital. Psychosocial disorder was measured by pediatric symptom checklist (PSC) 17. Risk factors include age, female, education, low income of parents, history of psychological disorder in family, and length of the disease. Data were analyzed using chi-square, then logistic regression multivariate analysis.Results: From 96 children, 42 had psychosocial disorder. Bivariate analysis showed aged >10years was 2.7 times risk (OR 2.71, CI95%: 1.51-4.86, p<0.001), length of the diseases >10 years was 6.7 times risk (OR 6.69, CI95%: 1.74-25.75; p<0.001), low education of mothers was 8.8 times risk (OR 8.78, CI95%: 1.32-58.51, p<0.001), low income of parents was 9.7 times risk (OR 9.69, CI95%: 3.22-29.19, p<0.001). Female was not a risk factor (OR 1.16; CI95%: 0.74-1.82, p 0.531). Multivariate analysis showed low income of parents was 14.7 times risk (OR 14.7,  CI95%: 2.65-83.33, p<0.001) and duration of the disease was 55 times (OR 55.622, CI95%: 5.540-558.395, p<0.001).Conclusion: Risk factors of psychosocial disorder in patients with thalassemia major were lowincome parents and length of the disease. J Indon Med Assoc. 2012;62:56-9.Keywords: Psychosocial disorder, risk factors, thalassemia major

Co-Authors Abdurahman Sukadi Adi Utomo Suardi Adjat Sedjati Rasyad Alex Chairulfatah Anita Deborah Anwar Arief Budiman Aris Primadi, Aris Armini, Luh Nik Bestari, Astuti Dyah Budi Handono Budi Setiabudiawan Dadang Hudaya Somasetia Dedi Rachmadi Deni Sunjaya, Deni Dewi Marhaeni Diah Herawati Dian Marta Sari Diana Rosifah, Diana Dida A Gurnida, Dida A Djatnika Setiabudi Dwi Agustian Dwi Prasetyo Elsa Pudji Setiawati Endah Purnawati, Endah Endang Sutedja Enny Harliany Alwi Firman Fuad Wirakusumah Firman Wirakusumah, Firman Fitria Fitria Fitria Prabandari Gizella, Gizella Gizella, Gizella Gurnida, Dida Hadyana Sukandar Hanung, Allania Heda Melinda Nataprawira Henni Djuhaeni Herman Susanto Herry Garna Hilmi Kurniawan Riskawa Hitatami, Esti Husin, Farid Ike MP Siregar, Ike MP Indira Saraswati Indria Astuti Irvan Afriandi Ishak Abdulhak Johanes Cornelius Mose Judistiani, Tina Julianti, Mastiur Julistio TB Djais Juntika Nurihsan, Juntika Karlina, Intan Kurniawati Kurniawati Kusnandi Rusmil Kusumastuti, Ani Lasty Wisata Lelani Reniarti Lestari, Bony Lisbeth Maria Laurentia, Lisbeth Maria Madjid, Tita Madjid8, Tita Husnitawati Marietta Shanti Marina, Henny Meiliany Meiliany Merry Wijaya, Merry Muttaqin, Muhammad Ilham Nanan Sekarwana Nenden Soraya Neneng Syarifah Syafei, Neneng Syarifah Nia Adriani Nita Arisanti Nur Hasanah Nurhalim Shahib Nurhasanah Nurhasanah Oki Suwarsa Ponpon Idjradinata Ponpon S Idjradinata Pramita aswitami, Gusti Ayu Purwana, Hasan Rahayu Rahayu Reza Kurnia Ridha Mustika Zaif, Ridha Mustika Rochmawati, Arva Rosalinna, Rosalinna Sandinirwan, Indra Sari Puspa Dewi, Sari Puspa Setiawan Setiawan Shahib, Muhammad Nurhalim Sianipar, Imelda M.G Suryani, Yani Dewi Tetty Yuniati Thimoty, James Tina Dewi Judistiani Tri Hanggono Achmad Ulfah, Kurniaty Ulfi Ainun Hanifah, Ulfi Ainun Viola Irene Winata Vita Murniati Tarawan Yeliana Kartawinata Yoni Syukriani, Yoni Yudith Setiati Ermaya Yulia Ismail Yulika, Indah Yuni Susanti Pratiwi, Yuni Susanti