Ponpon Idjradinata
Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung
Articles
20
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ANEMIA PADA PENDERITA HIV-AIDS DI POLIKLINIK TERATAI RS HASAN SADIKIN- BANDUNG

journal of internal medicine Vol. 10, No. 3 September 2009
Publisher : journal of internal medicine

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Abstract

The prevalence of anemia in HIV-infection ranging between 1.3 ? 95% depend on the stadium of infection. Anemiamakes bad impact on morbidity and mortality, and anemia is an independent risk factor for death in HIV-infected patients. Across-sectional study has been done in Teratai Clinic Hasan Sadikin Hospital to evaluate the prevalence and the etiology ofanemia between 1 January to 30 June 2008. Inclusion criteria were all patients who signed the informed consent. There were534 patients, 222 were anemic, prevalence of anemia was 41.6% (95% CI: 37.4 ? 45.8%), men 167 (72.2%). 188 were mildanemia (Hb 10 ?12/14 g/dl), 26 moderate anemia (Hb 8 ? 10 g/dl), and severe anemia in 6 patients (Hb < 8 g/dl). Anemia ofchronic disease or anemia of in! ammation were found in 142 (64.5%) cases, zidovudine related anemia 32 (14.5%) cases, ironde" ciency 14 (6.4%), hemolytic anemia 15 (6.8%) cases, thallassemia 8 (3.6%) cases, and megaloblasic 9 (4.1%) cases. All ofanemic patients showed low (< 2) reticulocyt index, high ferritin, low sTfR, and high hs-CRP.

Correlation Between Serum Feritin Level with Delayed Puberty in Thalassemia Major Children

Journal of the Indonesian Medical Association Vol. 60 No. 10 October 2010
Publisher : Journal of the Indonesian Medical Association

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One factor that interferes with optimal growth and development is thalassemia mayor, which requires regular repeated transfusion. The aim of this study was to determine the correlation between feritin serum level with delayed puberty in thalassemia major children. An observational study with case-control design was conducted at Thalasemia Clinic of Hasan Sadikin Hospital Bandung. The subjects of this study were patients with thalassemia major aged 10-18 years visiting the clinic on March to April 2009. Diagnosis of thalassemia was established from medical record. We performed sexual maturity examination using Tanner scala. Feritin serum and sex hormone measurement were analyzed with ECLIA method. Subjects consisted of 30 patients with thalassemia major. Control group were 30 healthy children with same characteristics. Most of thalassemia subjects had delayed puberty (83%). All control group had normal sexual maturity (p<0.001). A group with delayed puberty had higher serum feritin level than normal sexual maturity group. There was correlation between serum feritin level with delayed puberty in patient with thalassemia major (rs= 0.435, p= 0.018). More intervention is needed to prevent high serum feritin level.Keywords: serum feritin level, delayed puberty, thalassemia major

Scoring System for Helicobacter pylori Infection in Children with Recurrent Abdominal Pain

Journal of the Indonesian Medical Association Vol. 62 No. 8 August 2012
Publisher : Journal of the Indonesian Medical Association

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Abstract

Introduction: Helicobacter pylori (H. pylori) infection is estimated to strike half the world’s population. However, the diagnostic tool for H. pylori infection remains expensive and scarce. Thus, a simple diagnostic method is required in places with limited resources. This study aims to assess the diagnostic values of scoring system for H. pylori infection in children presenting with recurrent abdominal pain (RAP). Methods: This is a diagnostic study with a cross sectional design on 196 children aged 6-18 years who presented with RAP. This study was conducted in Bandung, January-November 2009. The scoring system was developed based on a questionnaire on complaints related to H. pylori infection. As the gold standard, a non-invasive examination with high accuracy was used, a serological kit BioM pylori (Mataram local antigen).The diagnostic values were assessed by the area under the receiver operating characteristic (ROC) curve. Result: The prevalence of H. pylori infection in children presenting with RAP is 54.6% (95% CI: 47.6 - 61.6%). After performing bivariate and multivariate analyses, 11 questions were used on the final questionnaire. Based on the ROC curve, a cut-off point of score > 30 was obtained, with a  88.5% sensitivity and 88.2% specificity. Conclusion: The scoring system can be used to predict H.pylori infection in children aged 6-18 years who presented with RAP. Key words: Helicobacter pylori, recurrent abdominal pain, scoring system, children

The Effect of Loaded Sit-to-Stand Exercise with Periodization in Dimension D and E Gross Motor Function Measure Spastic Diplegic Type of Cerebral Palsy

Journal of the Indonesian Medical Association Vol. 62 No. 10 October 2012
Publisher : Journal of the Indonesian Medical Association

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Introduction: Cerebral Palsy is a non progressive disorder of movement and posture on immature brain. Children with celebral palsy will present selective loss of motor control, spasticity, and muscle weakness. Standard protocol in this area is passive range of motion which is not a strengthening exercise. This study aims to observe the influence of periodization loaded sit-tostand exercise for GMFM-88 dimension (D) and (E) of spastic diplegic cerebral palsy.Method: This study examined cerebral palsy of spastic diplegic type with level GMFCS I, II III, aged 7–14 years. Subjects were divided into intervention and control groups. Sit-to-stand exercise with 10 maximal repetition load was given periodically to intervention group then the result was measured on the first and fourth week. While control groups did passive range of motion exercise. All exercises were done three times in a week for seven weeks at their homes.Result: The result showed an increase of motor ability in intervention group in dimension D andE of GMFM-88 higher than to control group (dimension D 17.79 vs 0.82, dimension E scoring: 14.14 vs 1.01).Conclusion: Periodization of loaded sit-to-stand strenghtening exercise are able to improve GMFM-88 dimension D and E in cerebral palsy spastic diplegic are better than control group.J Indon Med Assoc. 2012;62:397-401.Keywords: Cerebral palsy, GMFM-88, Loaded sit-to- stand, Periodization, Maximal Repetition.

Respon Imun terhadap Vaksin Influenza pada Remaja

Jurnal Kedokteran Brawijaya Vol 27, No 2 (2012)
Publisher : Fakultas Kedokteran Universitas Brawijaya

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Abstract

Influenza merupakan penyakit yang mudah menular dengan mortalitas dan morbiditas tinggi serta sering menimbulkan kejadian  luar biasa, epidemi, dan pandemi. Pada anak  sekolah,  influenza menyebabkan  tingginya angka absensi dan remaja merupakan  sumber  penularan  terbesar .  Penelitian  dilakukan  untuk menilai  respons  imun    terhadap  vaksin influenza pada kelompok remaja 12–18 tahunpada bulan Juni–September 2008, di Puskesmas Garuda Bandung. Desain dilakukan dengan  intervensional,  longitudinal, acak sederhana, dan tersamar tunggal. Vaksin  influenza yang mengandung 3 jenis virus A/H1N1, A/H3N2 dan B, disuntikkan intramuskular. Pengambilan darah dilakukan pra dan pasca vaksinasi. Pemeriksaan kadar antibodi dilakukan dengan metode hemaglutinasi inhibisi (HI). Respons imun dinilai berdasarkan nilai serokonversi, dan peningkatan geometric mean titer (GMT). Subjek dibagi 2 kelompok, 69 (52,7%) remaja pertengahan (12–15  tahun) dan 62  (47,3%)  remaja akhir  (16–18  tahun). Semua  subjek  telah mempunyai kadar antibodi protektif HI>1:40 pascavaksinasi. Nilai serokonversi kedua kelompok berbeda bermakna pada pra  (p=0,02) dan pascavaksinasi (p=0,02). Serokonversi  terhadap virus A/H3N2 antara remaja pertengahan dan akhir berbeda bermakna pada pravaksinasi (p=0,02). Pada pra dan pascavaksinasi  terdapat peningkatan GMT bermakna  terhadap ketiga  jenis virus  influenza  (Zw 9,73; 9,19; 9,59 dan p=0,00). Simpulan, vaksinasi influenza pada remaja menghasilkan kadar protektif. Respons imun remaja pertengahan dan akhir  tidak berbeda, namun  remaja pertengahan  tampak   lebih  responsif.Kata Kunci: Influenza,  remaja,  responsimun, vaksin

Mutasi Gen NPHS2 (412C→T, 419delG) dan Manifestasi Klinis Sindrom Nefrotik Resisten Steroid Anak Indonesia

Majalah Kedokteran Bandung Vol 43, No 4 (2011)
Publisher : Fakultas Kedokteran, Universitas Padjadjaran

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AbstrakSindrom nefrotik resisten steroid (SNRS) karena mutasi gen nephrotic syndrome type 2 (NPHS2) mempunyai manifestasi klinis lebih berat dibandingkan dengan SNRS tanpa mutasi gen. Penelitian ini bertujuan untuk mengetahui mutasi gen NPHS2 (412C→T, 419delG) pada SNRS anak Indonesia dan melihat perbedaan manifestasi klinisnya. Penelitian ini berupa observasional potong silang pada 88 penderita SNRS yang diambil secara consecutive admission dari 10 rumah sakit pendidikan di Indonesia, periode September 2006–Desember2007. Analisis mutasi 412C→T dan 419delG diperiksa dengan polymerase chain reaction. Analisis statistik menggunakan multivariat dan uji chi-square. Dari 88 SNRS didapat 58 (66%) mutasi 412C→T dan 69 (78%) mutasi 419delG. Hasil analisis multivariat variabel interval manifestasi klinis (tekanan darah sistol dan diastol, kadar kreatinin serum, usia serangan pertama, dan pertumbuhan) antara kelompok mutasi gen 412C→T, 419delG dan kelompok tanpa mutasi gen didapatkan masing-masing F=0,316; p=0,902 dan F=0,651; p=0,662. Hasil analisis univariat dari variabel nominal manifestasi klinis sebagai berikut: hematuria, p=0,231(0,726); hipertensi, p=0,286 (0,741); usia serangan pertama, p=0,372 (0,304); pertumbuhan skor Z, p=0,087 (0,595), dan kreatinin serum p=0,049 (0,080). Tidak terdapat perbedaan manifestasi klinis antara penderita SNRS dengan mutasi genNPHS2 (412C→T, 419delG) dan penderita SNRS tanpa mutasi gen, kecuali kadar kreatinin serum pada penderita SNRS dengan mutasi gen 412 C→T. [MKB. 2011;43(4):193–8].Kata kunci: Manifestasi klinis, mutasi gen NPHS2 (412C→T, 419delG), sindrom nefrotik resisten steroid NPHS2 (412 C→T and 419delG) Gene Mutation and Their Clinical Manifestation in Indonesian Steroid-Resistant Nephrotic SyndromeSteroid resistant nephrotic syndrome (SRNS) due to nephrotic syndrome type 2 (NPHS2) gene mutation has more severe clinical manifestation than those without mutation. This study was designed to find NPHS2 gene mutation in 412C→T and 419delG in Indonesian SRNS and to see differences in clinical manifestation. The observational cross sectional study was performed on 88 SRNS. Subjects were taken consecutively from 10 teaching hospitalsin Indonesia during September 2006 to December 2007. Analysis for 412 C→T and 419delG mutations were examined by polymerase chain reaction. Multivariate and chi-square-test analysis were used. Of 88 SNRS, 58 (66%) with 412 C→T and 69 (78%) with 419delG mutations. Multivariate analyses for interval variable of clinical manifestations (systolic and diastolic blood pressure, serum creatinin level, age of onset and growth) between SRNS with NPHS2 412C→T, 419delG mutation and SRNS without mutation were F=0.316, p=0.902 and F=0.651, p=0.662, respectively. While univariate analyses for nominal variable of clinical manifestation were as follow: hematuria, p=0.231 (0.726); hypertension, p=0.286 (0.741); age of onset, p=0.372 (0.304); Z-score growth, p=0.087 (0.595) and serum creatinin, p=0.049 (0.08). There is no difference of clinical manifestation between SRNS with NPHS2 412C→T, 419delG mutation and SRNS without mutation, except on serum creatinin in 412C→T mutation. [MKB. 2011;43(4):193–8].Key words: Clinical manifestation, NPHS2 (412C→T, 419delG) gene mutation, steroid resistant nephroticsyndrome

Diet-Induced Changes in Serum Ganglioside Spectrum Patterns in 6-Month-Old Infants

Majalah Kedokteran Bandung Vol 44, No 4 (2012)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Human milk contains higher levels of gangliosides when compared to infant formula. Gangliosides play a role in neuronal growth, migration, maturation, sinaptogenesis, and myelination. Seven of the identified gangliosides (GM1, GM2, GM3, GD3, GD1a, GD1b, and GT1b) are dominant gangliosides with different specific functions. Thus, the aim of the study was to understand the effects of ganglioside-enhanced diet and to compare the spectrum patterns of those seven classes of serum gangliosides in infants consuming standard infant formula (IF group), ganglioside-fortified infant formula (GA group) and exclusive breastfeeding (BF group). This study used liquid chromatography–mass spectrometry (LC-MS) method. This was a prospective study involving 30 infants in IF group, 29 in GA group and 32 in BF group. Subject recruitment was performed using consecutive admission  approach from March 2008 to February 2009 in Bandung. Statistical analyses using Wilcoxon test showed that there was a significant change in the spectrum patterns of GD3, GM1, GM2 and GT1b in IF group; of GD1a, GM1 and GM2 in GA group and of GD1a, GD1b, GM1 and GM3 in BF group. It is concluded that ganglioside-enriched diet extends spectrum patterns of gangliosides especially in seven of them, i.e. GM1, GM2, GM3, GD3, GD1a, GD1b, and GT1b, in 6-month old infants. [MKB. 2012;44(4):240–44]..Key words: Gangliosides, human milk, infants, infant formula, LC-MSPerubahan Pola Spektrum Gangliosida Serum yang Diinduksi Makanan pada Bayi Usia 6 BulanAir susu ibu (ASI) mengandung gangliosida yang kadarnya lebih tinggi dibandingkan dengan susu formula. Gangliosida berperan dalam pertumbuhan, migrasi, maturasi saraf, sinaptogenesis, dan mielinisasi. Tidak kurang dari 100 tipe gangliosida telah ditemukan, tujuh di antaranya (GM1, GM2, GM3, GD3, GD1a, GD1b, dan GT1b) merupakan kelas utama dengan fungsi yang berbeda. Penelitian ini bertujuan untuk mengetahui efek penambahan diet gangliosida serta membandingkan pola spektrum tujuh kelas gangliosida serum tersebut pada bayi yang mengonsumsi susu formula standar (kelompok infant formula/IF), susu formula difortifikasi gangliosida (kelompok GA), dan ASI eksklusif (kelompok breastfeeding/BF). Penelitian ini menggunakan metode liquid chromatography-mass spectrometry (LC-MS) untuk menghitung kadar ketujuh kelas gangliosida tersebut. Penelitian ini adalah penelitian prospektif yang melibatkan 30 bayi kelompok IF, 29 bayi kelompok GA, dan 32 bayi kelompok BF. Perekrutan subjek penelitian dilakukan dengan cara consecutive admission dari bulan Maret 2008 sampai bulan Februari 2009 di Bandung. Analisis statistik tes Wilcoxon menunjukkan perubahan bermakna pada pola spektrum GD3, GM1, GM2 dan GT1b pada kelompok IF; GD1a, GM1, dan GM2 pada kelompok GA; GD1a, GD1b, GM1, dan GM3 pada kelompok BF. Kesimpulan, penambahan diet gangliosida akan meningkatkan 7 spektrum gangliosida yaitu GM1, GM2, GM3, GD3, GD1a, GD1b, dan GT1b pada anak usia 6 bulan. [MKB.2012;44(4):240–44].Kata kunci: ASI, bayi, gangliosida, LC-MS, susu formula DOI: http://dx.doi.org/10.15395/mkb.v44n4.217

Respon Imun terhadap Vaksin Influenza pada Remaja

Jurnal Kedokteran Brawijaya Vol 27, No 2 (2012)
Publisher : Fakultas Kedokteran Universitas Brawijaya

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Abstract

Influenza merupakan penyakit yang mudah menular dengan mortalitas dan morbiditas tinggi serta sering menimbulkan kejadian  luar biasa, epidemi, dan pandemi. Pada anak  sekolah,  influenza menyebabkan  tingginya angka absensi dan remaja merupakan  sumber  penularan  terbesar .  Penelitian  dilakukan  untuk menilai  respons  imun    terhadap  vaksin influenza pada kelompok remaja 12–18 tahunpada bulan Juni–September 2008, di Puskesmas Garuda Bandung. Desain dilakukan dengan  intervensional,  longitudinal, acak sederhana, dan tersamar tunggal. Vaksin  influenza yang mengandung 3 jenis virus A/H1N1, A/H3N2 dan B, disuntikkan intramuskular. Pengambilan darah dilakukan pra dan pasca vaksinasi. Pemeriksaan kadar antibodi dilakukan dengan metode hemaglutinasi inhibisi (HI). Respons imun dinilai berdasarkan nilai serokonversi, dan peningkatan geometric mean titer (GMT). Subjek dibagi 2 kelompok, 69 (52,7%) remaja pertengahan (12–15  tahun) dan 62  (47,3%)  remaja akhir  (16–18  tahun). Semua  subjek  telah mempunyai kadar antibodi protektif HI>1:40 pascavaksinasi. Nilai serokonversi kedua kelompok berbeda bermakna pada pra  (p=0,02) dan pascavaksinasi (p=0,02). Serokonversi  terhadap virus A/H3N2 antara remaja pertengahan dan akhir berbeda bermakna pada pravaksinasi (p=0,02). Pada pra dan pascavaksinasi  terdapat peningkatan GMT bermakna  terhadap ketiga  jenis virus  influenza  (Zw 9,73; 9,19; 9,59 dan p=0,00). Simpulan, vaksinasi influenza pada remaja menghasilkan kadar protektif. Respons imun remaja pertengahan dan akhir  tidak berbeda, namun  remaja pertengahan  tampak   lebih  responsif.Kata Kunci: Influenza,  remaja,  responsimun, vaksin

Hubungan Tipe Thalassemia β serta Polimorfisme c.-582 A>G Promotor Gen HAMP dan Status Besi thalassemia β Berat Baru

Majalah Kedokteran Bandung Vol 47, No 3 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Kelebihan besi merupakan penyebab morbiditas dan mortalitas penderita thalassemia β berat. Terdapat berbagai faktor yang memengaruhi status besi thalassemia β berat. Penelitian ini bertujuan menganalisis  hubungan  tipe thalassemia β serta polimorfisme c.-582 A>G promotor gen hepcidine antimicrobacterial peptide (HAMP) dengan status besi thalassemia β berat baru. Penelitian dengan metode potong lintang dilakukan di Rumah Sakit Dr. Hasan Sadikin/Fakultas Kedokteran Universitas Padjadjaran Bandung selama November–Desember 2012. Subjek penelitian adalah penderita thalassemia β berat yang baru didiagnosis berdasarkan pemeriksaan klinis dan laboratorium. Subjek belum pernah mendapatkan transfusi darah dan memiliki kadar C-reactive protein normal. Status besi dinilai dengan mengukur kadar feritin serum (FS) dan saturasi transferin (ST). Analisis statistik yang digunakan adalah uji-t, Uji Mann-Whitney, dan uji chi-kuadrat. Didapatkan 29 subjek thalassemia β berat baru, 24 thalassemia β mayor dan 5 thalassemia β/HbE berat. Tidak ada perbedaan status besi antara kedua tipe thalassemia β berat baru maupun antara yang mengalami polimorfisme dan yang tidak mengalami polimorfisme c.-582 A>G promotor gen HAMP (p>0,05). Simpulan, tipe thalassemia β berat dan polimorfisme c.-582  A>G promotor gen HAMP tidak berhubungan dengan status besi penderita thalassemia β berat yang baru didiagnosis. [MKB. 2015;47(3):192-98]Kata kunci: Feritin, polimorfisme c.-582 A>G promotor gen HAMP, saturasi transferin, thalassemia β berat Association of β-thalassemia Type and Polymorphisms of c.-582 A>G Promoter HAMP Gene and Iron Status in Newly Diagnosed Severe β-thalassemiaAbstractIron overload is the common  cause of morbidity and mortality in severe β-thalassemia patients. Many factors influence the  iron status in severe β-thalassemia. This study aimed to analyze the association of β-thalassemia type, polymorphism c.-582 A>G promotor hepcidine antimicrobacterial peptide (HAMP) gene,  and  iron  status in newly diagnosed severe β-thalassemia. A cross-sectional study was performed at Dr. Hasan Sadikin General Hospital/Faculty of Medicine, Universitas Padjadjaran Bandung from November to December 2012. Subjects were newly diagnosed severe β-thalassemia patients who were diagnosed based on clinical manifestation and laboratory examination. Subjects had not received any blood transfusion before and had normal CRP level. Transferrin saturation (TS) and serum ferritin (SF) levels indicate iron status. The statistical analysis was performed using t test, Mann-Whitney, and Chi square test. Twenty nine subjects were diagnosed as newly severe β-thalassemia, 24 β-thalassemia mayor and 5 with severe β-thalassemia/HbE. There was no difference in the iron status between the two types of severe β-thalassemia  and  between those with and without polymorphism of c.-582 A>G promotor HAMP gene in  newly  diagnosed severe  β-thalassemia (p>0.05). In conclusiosn, the  β-thalassemia type and polymorphism of c.-582 A>G  promotor HAMP  gene do  not  associate with the iron status  in  newly diagnosed severe β-thalassemia patients.  [MKB. 2015;47(3):192-98]Key words: Ferritin, polymorphism of  c.-582 A>G  promotor HAMP gene, severe β-thalassemia, transferrin ration DOI: 10.15395/mkb.v47n3.599

Perbandingan Status Besi pada Remaja Perempuan Obes dengan Gizi Normal

Sari Pediatri Vol 14, No 2 (2012)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

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Abstract

Latar belakang. Prevalensi obesitas pada remaja cenderung meningkat. Beberapa penelitian menyatakan bahwa terdapat hubungan antara obesitas dan terjadinya anemia defisiensi besi. Anemia defisiensi besi berhubungan dengan kebutuhan yang meningkat sejalan dengan peningkatan berat badan, serta pola makan yang tidak seimbang pada obesitas. Tujuan.Mengukur dan membandingkan status besi yang dinilai berdasarkan pemeriksaan hemoglobin (Hb),reticulocyte hemoglobin content(CHr), dan feritin serum pada remaja perempuan obes dan gizi normal serta penanggulangan sedini-dininya pada remaja dengan defisiensi besi.Metode. Penelitian studi analitik cross-sectionaldi SMP 14, SMP 34, dan SMA 24 Bandung pada bulan November 2011. Subjek penelitian terdiri atas remaja perempuan sehat yang memiliki status gizi normal dan obes berdasarkan standar WHO reference2007 yang diambil secara acak sebanyak 25 orang tiap kelompok. Analisis data menggunakan uji nonparametrik dengan uji Mann Whitney untuk membandingkan status besi yang dinilai berdasarkan pemeriksaan Hb, CHr,dan feritin serum antara kelompok obes dan gizi normal. Dilakukandietary recalluntuk mengetahui asupan makanan pada kedua kelompok penelitian. Kemaknaan ditentukan berdasarkan nilai p<0,05.Hasil. Kadar Hb, CHr, dan feritin serum antara kelompok obes dan gizi normal tidak menunjukkan perbedaan (p>0,05). Obesitas lebih banyak terjadi pada remaja dengan status sosioekonomi lebih tinggi (p=0,039). Terdapat perbedaan asupan protein hewani, protein nabati, besi, dan vitamin C antara remaja perempuaan obes dengan gizi normal yang memiliki nilai p berturut-turut p<0,001; p<0,019; p=0,026 dan p=0,032.Kesimpulan. Tidak terdapat perbedaan status besi remaja perempuan obes dengan gizi normal. Asupan makanan mempengaruhi status besi pada remaja obes dan gizi normal.