Darto Saharso
Divisi Syaraf Anak, Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Airlangga - RSUD Dr. Soetomo, Jl. Mayjen Prof. Dr. Moestopo 6-8, Surabaya, Indonesia

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Faktor Risiko Kejang Demam Berulang pada Anak Gunawan, Prastiya Indra; Saharso, Darto
MEDIA MEDIKA INDONESIANA 2012:MMI VOLUME 46 ISSUE 2 YEAR 2012
Publisher : MEDIA MEDIKA INDONESIANA

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (195.507 KB)

Abstract

Risk factors of recurrent febrile seizures in childrenBackground: Febrile seizures (FS) are the most common seizure disorder in childhood. Recurrent febrile seizures (RFS) occur in one third of children who experience a first FS. About nine percent had three or more recurrence. Little is known about predictors of recurrence. The aim of this study is to determine the incidence and the risk factors of RFS in children with FS at Dr. Soetomo Hospital Surabaya.Method: This is a cohort prospective study. Data was taken from all children with first FS aged 6 month-old to 5 year-old who were admitted at pediatric ward Dr. Soetomo Hospital from August 2009 to November 2010. They were observed for one year period to ascertain wether FS recurred. Logistic regression statistic was used to analyze those variables including sex, age, body temperature during the fever episode, family history of seizures, diagnosis at the first onset, maternal illness, abnormal delivery and recurrence ofFS.Results: Recurrent FS occured in 65% of the 100 children at one year observation, and 26% of them had further attack. Male to female ratio was 2:1. Thirty-one (77.5%) of subjects were less than 12 months-old. Body temperature ≤38.5OC (OR=5.50, 95%CI, p=0.019) and complex FS (OR 5.03, 95%CI, p=0.025) were related to increase risk of reccurence.Conclusions: The risk of RFS increased with body temperature ≤38.5OC and diagnosed as complex FS at the first FS.Keywords: Children, risk factors, recurrent febrile seizures ABSTRAKLatar belakang: Kejang demam (KD) adalah kasus kejang yang sering dialami anak-anak. KD berulang terjadi pada sepertiga anak yang mengalami KD pertama. Sekitar 9% dari penderita KD mengalami tiga atau lebih kejadian berulang. Hanya sedikit yang diketahui tentang prediktor berulangnya KD. Tujuan penelitian untuk mengetahui angka kejadian KD berulang dan menentukan faktor risiko terjadinya KD berulang pada anak yang mengalami KD di RSUD Dr. Soetomo Surabaya.Metode: Studi kohort prospektif dilakukan pada bulan Agustus 2009 sampai November 2010. Subyek diambil dari anak usia 6 bulan sampai 5 tahun yang menderita KD pertama yang MRS di RSUD Dr. Soetomo. Subyek diamati selama 1 tahun untuk menentukan apakah KD terjadi berulang. Analisis antar variabel jenis kelamin, usia, suhu badan saat terjadi demam, riwayat kejang pada keluarga, diagnosis awal, penyakit ibu, kelahiran yang tidak normal dan kejadian KD berulang, dilakukan dengan regresi logistik.Hasil: KD berulang terjadi 65% pada 100 anak yang diobservasi selama 1 tahun pertama dan 26% mengalami KD lebih dari 2 kali. Rasio laki-laki dibanding perempuan adalah 2:1. Tiga puluh satu (77,5%) anak berusia kurang dari 12 bulan. Faktor risiko suhu badan ≤38,5OC (OR=5,50, 95%CI, p=0,019) dan KD komplikata (OR 5,03, 95%CI, p=0,025) bermakna secara signifikan untuk kejadian berulangnya KD.Simpulan: Risiko KD berulang pada anak meningkat pada suhu badan ≤38,5OC dan diagnosis KD komplikata pada saat KD pertama.
C-REACTIVE PROTEIN (CRP) AS A SUPPORTING MARKER OF ANTIBIOTIC EFFECTIVENESS ON CENTRAL NERVOUS SYSTEM (CNS) INFECTIONS Olevianingrum, Melawati; Yulistiani, Yulistiani; Saharso, Darto; Zairina, Nun
Folia Medica Indonesiana Vol 51, No 3 (2015): July - September 2015
Publisher : Faculty of Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (87.093 KB) | DOI: 10.20473/fmi.v51i3.2821

Abstract

Infection of the central nervous system in pediatric patients have a high mortality as well as acute and chronic neurological sequelae. Signs of the disease are unclear, so cerebrospinal fluid (CSF) test is used as a gold standard for diagnosis, but the investigation has faced many obtacles. Empiric antibiotic therapy is the key factor in reducing morbidity and mortality. Microbiological culture result is obtained within 5-7 days. The effectiveness of empirical antibiotic use is questionable. Therefore, other investigations are conducted to determine the effectiveness of antibiotics by using one marker, the CRP. This study was to analyze CRP level in supporting antibiotic therapy effectiveness in pediatric patients with central nervous system (CNS) infections. A prospective cohort study was conducted to determine the relationship of CRP with other parameters, including clinical, microbiological and laboratory, in pediatric patients with central nervous system infections. Patients meeting blood samples criteria were taken before (H0), the third day (H3) and the fifth day (H5) after antibiotics administration. This study involved 10 patients with central nervous system infections (meningoencephalitis, encephalitis and encephalitis with cerebral edema). Six patients were male, with ages less than a year. Antibiotic treatment effectiveness was associated with improved condition of the patients' CRP level. It was 3.558 ±3.196 before (H0), 3.878±2.813 on the third day (H3) and 3.891±2.204 on the fifth day (H5) after antibiotic administration. Leukocyte levels were 13.680±1.660 before (H0), 17.832±7.213 on the third day (H5), and 10.546±3.671 on the fifth day (H5) after antibiotic administration. Pearson's correlation test analysis performed on CRP and WBC parameters showed H0 p=0.981, CRP and WBC H3 p=0.621, while CRP and WBC H5 obtained significance p=0.644. There was no significant correlation observed between CRP and WBC parameters before and after antibiotic administration. In conclusion, there was no correlation of CRP levels with clinical, laboratory and micobiological parameters in patients with central nervous system infections.
Akurasi Diagnostik Prokalsitonin Sebagai Petanda Serologis untuk Membedakan Infeksi Bakteri dan Infeksi Virus pada Anak Husada, Dominicus; Adnyana, I Gusti Ngurah Twi; Setyoningrum, Retno Asih; Saharso, Darto; Ismoedijanto, Ismoedijanto
Sari Pediatri Vol 13, No 5 (2012)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp13.5.2012.316-23

Abstract

Latar belakang.Deteksi dini infeksi bakteri dan infeksi virus pada anak sangat penting untuk tata laksana antibiotik lebih dini. Prokalsitonin (PCT) merupakan suatu temuan baru sebagai petanda serologis yang bisa dipercaya. Belum banyak informasi tentang akurasi diagnostik PCT untuk spektrum penyakit infeksi di negara berkembang.Tujuan.Melakukan akurasi diagnostik PCT sebagai petanda serologis untuk membedakan infeksi bakteri dan infeksi virus pada anak. Metode.Penelitian prospektif dengan desain potong lintang dilakukan di Departemen Ilmu Kesehatan Anak RSU Dr. Soetomo Surabaya, dari September 2009 sampai November 2010. Pasien dibagi dalam kelompok infeksi bakteri dan infeksi virus (sebagai kontrol). Data demografi, pemeriksaan darah tepi, CRP and PCT dievaluasi. Analisis statistik menggunakan uji studentt dan uji Mann Whitney U dengan interval kepercayaan 95% dan bermakna jika nilai p<0,05. Dilakukan perhitungan sensitivitas, spesifisitas, nilai duga positif (NDP), nilai duga negatif (NDN) dan rasio kemungkinan (RK) Hasil.Di antara 130 pasien yang terkumpul didapatkan 54 sampel untuk tiap kelompok. Ditemukan perbedaan kadar PCT yang bermakna antara kelompok infeksi bakteri dibandingkan infeksi virus (rerata 18,34 dan 0,22 ng/ml, p<0,0001). Dengan menggunakan kadar 0,5 ng/ml sebagai kadar ambang (sesuai penelitian sebelumnya) didapatkan sensitivitas 88,9%, spesifisitas 94,4%, NDP 94,1%, NDN 89,4% dengan RK positif 15,87 dan RK negatif 0,09.Kesimpulan.Prokalsitonin merupakan petanda serologis dengan akurasi diagnostik yang tinggi untuk membedakan infeksi bakteri dan infeksi virus pada anak.
Metode Pemeriksaan Kualitas General move­ ments Meningkatkan Nilai Prediksi Ultrasono­ grafi Kepala untuk Memprediksi Perkembangan Bayi Kurang Bulan dari Ibu Preeklamsia Berat Rochmah, Nur; Suryawan, Ahmad; BN, Moersintowarti; Saharso, Darto; Indarso, Fatimah
Sari Pediatri Vol 14, No 1 (2012)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp14.1.2012.14-8

Abstract

Latar belakang. Kelahiran kurang bulan dan preeklamsia berat merupakan faktor risiko penyimpangan perkembangan. Deteksi dini perkembangan sangat penting. Hal tersebut memberi peluang intervensi awal dengan hasil optimal. Pemeriksaan ultrasonografi kepala mempunyai keterbatasan dalam memprediksi outcome perkembangan bayi kurang bulan. Pemeriksaan general movementslebih murah dan dapat digunakan di negara berkembang dengan sarana diagnostik yang terbatas. Penambahan pemeriksaan kualitas general movementsdapat meningkatkan nilai prediksi dibandingkan dengan pemeriksaan ultrasonografi kepala saja. Tujuan. Melakukan analisis nilai prediksi ultrasonografi kepala, pemeriksaan general movements,dan kombinasi keduanya untuk memprediksi status perkembangan bayi kurang bulan.Metode. Studi longitudinal diagnostik, dilakukan di RS Dr Soetomo Surabaya pada bulan Desember 2009 sampai Juni 2010. Pemeriksaan ultrasonografi kepala dilakukan pada usia 2 minggu pertama, general movementspada usia 52 minggu gestasi, dan status perkembangan dievaluasi dengan Denver II pada usia 4 bulan usia koreksi. Data dianalisis menggunakan SPSS 12.0. Persetujuan kelaikan etik dikeluarkan oleh RS Dr Soetomo, Surabaya. Hasil.Delapan belas bayi kurang bulan (<37 minggu gestasi) mengikuti penelitian.mempunyai nilai sensitivitas (SN), spesivisitas (SP), nilai prediksi positif (NPP), nilai prediksi negatif (NPN), dan likelyhood ratio(LR) ultrasonografi kepala (0,2;1,0;1,0;1;0,50;5,0), sedangkan general movements (0,90;0,75;0,82;0,86;3,60). Kombinasi kedua pemeriksaan tersebut mempunyai nilai prediksi (0,80;0,50;0,67;0,67;1,60). Kesimpulan.Penambahan pemeriksaan kualitas general movementsdapat meningkatkan sensitivitas outcomeperkembangan bayi kurang bulan dibandingkan hanya pemeriksaan ultrasonografi kepala saja.
Seizure increases electroencephalographic abnormalities in children with tuberculous meningitis Gunawan, Prastiya Indra; Saharso, Darto
Universa Medicina Vol 34, No 3 (2015)
Publisher : Faculty of Medicine, Trisakti University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2015.v34.161-167

Abstract

BackgroundTuberculous meningitis (TBM) is a severe intracranial infection with fatal outcomes, permanent disabilities, and electroencephalographic (EEG) abnormalities. Seizures may occur in TBM. The EEG findings in TBM vary according to the site of the inflammatory process. There are few studies describing the EEG patterns and clinical manifestations of TBM. The objective of this study was to investigate the correlation between clinical findings and EEG patterns in children with TBM. MethodsA study of cross-sectional design using medical records was conducted on 12 children with TBM, with their EEG patterns classified as abnormal and normal. Clinical manifestations such as seizures, altered consciousness, headache or fever were collected. A positive cerebrospinal fluids Mycobacterium tuberculosis culture was considered to indicate definitive TBM. Abnormal EEG descriptions were classified into abnormal I, II or III. Correlation between EEG pattern and clinical manifestation were analyzed with Fisher’s exact test. ResultsThe study found cases of 12 children with TBM, the majority presenting with seizures, decreased consciousness and fever. Abnormal EEGs were found in 75% of children and 77% of them showed epileptogenic activities. The EEG results mostly described epileptogenic potentials in the frontotemporal region. There was a significant correlation between EEG abnormality and seizures in children with TBM (p&lt;0.05).ConclusionsThe EEG pattern in children with TBM varies, and EEG abnormalities were more frequently localized in the frontotemporal region. Seizures were associated with EEG abnormalities in children with TBM. EEG abnormalities occurring simultaneously with seizures may predict the occurrence of seizures.
Tuberous sclerosis complex in a child: diagnosis and management Gunawan, Prastiya Indra; Harahap, Aminuddin; Saharso, Darto
Paediatrica Indonesiana Vol 50 No 3 (2010): May 2010
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi50.3.2010.181-6

Abstract

Tuberous sclerosis complex (TSC) is a multisystem, autosomal dominant disorder affecting children and adults, resulted from mutations in one of two genes, TSC1 (encoding hamartin) or TSC2 (encoding tuberin) genes located on chromosomes 9 and 16 respectively.1,2 Synonyms of TSC are Bourneville Pringle syndrome, epiloia, or tuberosclerosis. This disorder is characterized by seizures, mental disability, and small noncancerous tumors on the skin and other body tissues, such as brain, eye, lung, and kidney. The classic triad are seizures, mental retardation, and cutaneous angiofibromas.3
Reducing severe spasticity in cerebral palsy following meningoencephalitis by botulinum toxin Gunawan, Prastiya I.; Saharso, Darto
Medical Journal of Indonesia Vol 26, No 1 (2017): March
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (378.764 KB) | DOI: 10.13181/mji.v26i1.1297

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A 3-year-old boy diagnosed with diplegic cerebral palsy had received Botulinum toxin injection to reduce severe spasticity. There was an improvement of muscles tone and motor function including better ability of limb flexion of the knees and hip, adduction of the hip, flexion of the toes, and plantar flexion of the foot. No side effect was observed after the procedure.
Juvenile myasthenia gravis Gunawan, Prastiya I.; Saharso, Darto
Paediatrica Indonesiana Vol 47 No 5 (2007): September 2007
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi47.5.2007.244-6

Abstract

Parameter Praktis dalam upaya Skrining dan Diagnotis Autism Saharso, Darto; Emy, Emy
Jurnal Kedokteran Brawijaya Vol 18, No 1 (2002)
Publisher : Fakultas Kedokteran Universitas Brawijaya

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Abstract

Autism merupakan penyakit yang banyak dijumpai pada anak dengan angka kejadian berkisar 1 pada 500 anak. Sering tidak diketahui dan tidak terdiagnosis hingga usia prasekolah karena skrining perkembangan anak secara rutin dan skrining khusus untuk autism tidak tersedia. Identifikasi dini, intervensi dini dan intensif selama masa balita usia prasekolah dikatakan mampu memperbaiki hasil akhir autism pada sebagian besar anak-anak. Parameter praktis memberikan rekomendasi spesifik untuk meng identifikasi anak-anak dengan autism.