Bambang Supriyatno
Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta

Published : 24 Documents
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Combination Therapy of Acute Asthma Attack in Children

Journal of the Indonesian Medical Association Vol. 60 No. 5 May 2010
Publisher : Journal of the Indonesian Medical Association

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Abstract

Asthma is a respiratory illness which is often encountered. Management of asthma is divided into two groups during an asthma attack and non asthma attack. The objective of managing an asthma attack is to relieve hypoxemia and other symptoms as soon as possible. It also depends on the degree of attack which are mild, moderate, and severe attacks. The combination of beta-2 agonist and ipratropium bromide has a role in asthma attacks both moderate and severe attack; while in mild asthma attacks there are no different from giving a beta-2 agonist alone. There is no significant difference in side effects between combination of beta-2 agonist and ipratropium bromide compared to the beta-2 agonist alone.Keywords: combination therapy, asthma attack, children

Chronic Cough in Children

Journal of the Indonesian Medical Association Vol. 60 No. 6 June 2010
Publisher : Journal of the Indonesian Medical Association

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Abstract

Cough is one of the defense mechanism especially in respiratory system that should have to manage properly. Mechanism of cough depends on the five components, namely cough receptors, afferent nerves, cough centre, efferent nerve, and effectors. Classification of cough divided into two: acute and chronic cough. To determine the etiology one should be considered type, duration, and age incidence of the cough. Management of chronic cough depends on the underlying diseases by considering several factors to find the etiology. In addition to pharmacologic management of such antibiotics, antiinflammatory, bronchodilator, etc; it is necessary to support the management of non-pharmacologic management of a comprehensive in treating chronic cough.Keywords: chronic cough, management, children

Effect of intranasal mometasone furoate administered in children with coexisting allergic rhinitis and asthma towards asthma attacks and lung function

Paediatrica Indonesiana Vol 49 No 6 (2009): November 2009
Publisher : Indonesian Pediatric Society

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Abstract

Background Allergic rhinitis and asthma are allergic manifestations in respiratory tract, which related each other. Intranasal corticosteroid is effective in allergic rhinitis and has benefits in decreasing lower airway reactivity.Objectives To evaluate effectiveness of intranasal mometasonefuroate towards asthma in children aged 6-18 years with coexisting allergic rhinitis and asthma.Methods A one group pretest-posttest ("before and after") study was conducted in Cipto Mangunkusumo Hospital from May to December 2008. Subjects were children aged 6-18 years, with moderate-severe intermittent or persistent allergic rhinitis with coexisting frequent episodic asthma or persistent asthma, and visited outpatient clinic of allergy immunology division or respirology division. Subjects were administered intranasal mometasone furoate 100 J-ig daily only for 8 weeks, without long term administration of oral and inhaled corticosteroid. Improvements in allergic rhinitis and asthma were evaluated using questionnaires and lung function tests.Results There were 35 subjects and four of them dropped outduring the study. There was >50% improvement in allergic rhinitis symptoms after 4 weeks of treatment (P<0.001). This improvement was associated with decreasing in frequency of asthma attack >50% after 8 weeks of treatment (P< 0.001). There was an insignificant improvement in FEY 1 (P=0.51). However, the evaluation of sinusitis was not performed in all subjects, thus may influence the results. During study, there were no side effects observed.Conclusions Intranasal mometasone furoate improves allergicrhinitis and decrease >50% of asthma symptoms, however it is not followed with significant improvement in lung function. No side effects are reported during 8 weeks use of intranasal mometasone furoate.

Pulmonary dysfunction in obese early adolescents

Medical Journal of Indonesia Vol 19, No 3 (2010): August
Publisher : Faculty of Medicine Universitas Indonesia

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Abstract

Aim Obesity leads to various complications, including pulmonary dysfunction. Studies on pulmonary function of obese children are limited and the results are controversial. This study was aimed to determine proportion of pulmonary dysfunction on early adolescents with obesity and to evaluate correlation between obesity degree with pulmonary dysfunction degree.Methods A cross-sectional study was conducted at the Department of Child Health, Medical School, University of Indonesia, from November 2007 to December 2008. Subjects were 10 to 12 year-old adolescents with obesity. Subjects underwent pulmonary function test (PFT) to assess FEV1/FVC, FEV1, FVC, V50, and V25.Results 110 subjects fulfilled study criteria, 83 (75.5%) were male and 27 (24.5%) were female with median BMI 26.7 (22.6-54.7) kg/m2; 92 subjects (83.6%) were superobese. History of asthma and allergic rhinitis were found in 32 (29.1%) and 46 (41.8%) subjects, respectively. 64 (58.2%) subjects had abnormal PFT results consisting of restrictive type in 28 (25.5%) subjects, obstructive in 3 (2.7%), and combined type in 33 (30%). Mean FEV1, FVC, V50, and V25 values were below normal, while mean FEV1/FVC ratio was normal. There was no statistically significant correlation between BMI and PFT parameters. No significant correlation was found between degree of obesity and the severity of pulmonary dysfunction.Conclusions Pulmonary dysfunction occurs in 58.2% obese early adolescents. The most common abnormality was combined type (30%), followed by restrictive (25.5%), and obstructive type (2.7%). There was no correlation between BMI and pulmonary function test parameters. (Med J Indones 2010;19:179-84)Key words: early adolescents, obesity, pulmonary function test

The effects of colloids or crystalloids on acute respiratory distress syndrome in swine (Sus scrofa) models with severe sepsis: analysis on extravascular lung water, IL-8, and VCAM-1

Medical Journal of Indonesia Vol 25, No 1 (2016): March
Publisher : Faculty of Medicine Universitas Indonesia

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Abstract

Background: Acute respiratory distress syndrome (ARDS) is a fatal complication of severe sepsis. Due to its higher molecular weight, the use of colloids in fluid resuscitation may be associated with fewer cases of ARDS compared to crystalloids. Extravascular lung water (EVLW) elevation and levels of interleukin-8 (IL-8) and vascular cell adhesion molecule-1 (VCAM-1) have been studied as indicators playing a role in the pathogenesis of ARDS. The aim of the study was to determine the effects of colloid or crystalloid on the incidence of ARDS, elevation of EVLW, and levels of IL-8 and VCAM-1, in swine models with severe sepsis.Methods: This was a randomized trial conducted at the Laboratory of Experimental Surgery, School of Veterinary Medicine, IPB, using 22 healthy swine models with a body weight of 8 to 12 kg. Subjects were randomly allocated to receive either colloid or crystalloid fluid resuscitation. After administration of endotoxin, clinical signs of ARDS, EVLW, IL-8, and VCAM-1 were monitored during sepsis, severe sepsis, and one- and three hours after fluid resuscitation. Analysis of data using the Wilcoxon test , Kolmogorov-Smirnov test, Mann-Whitney test, unpaired t test.Results: Mild ARDS was more prevalent in the colloid group, while moderate ARDS was more frequent in the crystalloid group. EVLW elevation was lower in the colloid compared to the crystalloid group. There was no significant difference in IL-8 and VCAM-1 levels between the two groups.Conclusion: The use of colloids in fluid resuscitation does not decrease the probability of ARDS events compared to crystalloids. Compared to crystalloids, colloids are associated with a lower increase in EVLWI, but not with IL-8 or VCAM-1 levels.

Gambaran Uji Fungsi Paru pada Diabetes Melitus Tipe 1 Usia 8-18 Tahun

Sari Pediatri Vol 17, No 4 (2015)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

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Abstract

Latar belakang. Uji fungsi paru dapat membedakan kelainan paru obstruktif, restriktif atau campuran antara obstruktif dn restriktif. Namun demikian, sampai saat ini belum ada penelitian tentang dampak DMT1 terhadap paru di Indonesia.Tujuan. Mengetahui gambaran uji fungsi paru pada pasien DMT1 usia 8-18 tahun.Metode. Penelitian potong lintang dilakukan di Poliklinik Endokrinologi dan Respirologi Rumah Sakit Cipto Mangunkusumo (RSCM), serta Laboratorium Prodia pada bulan Januari 2015.Wawancara orangtua dilakukan dan data kadar HbA1c dalam rentang satu tahun terakhir diambil dari rekam medis atau berdasarkan hasil pemeriksaan sebelumnya. Uji fungsi paru dilakukan tiga kali dan diambil salah satu hasil yang terbaik. Kemudian darah subjek diambil untuk pemeriksaan kadar HbA1c dengan metode cation-exchange high pressure liquod chromatography (HPLC).Hasil. Terdapat 35 subjek, terdiri atas 68,6% perempuan. Rerata usia 14±2,7 dan median durasi DM 4 tahun (1,3-10,2). Rerata parameter FEV1  86,8%±14%, FVC 82,7%±12% dan V 25 83,1% ± 26,2%. Median FEV1 /FVC 92,4% (77,6-100) dan V 50 91,5% (41,1-204). Fungsi paru normal dan terganggu didapatkan 19 (54,3%) dan 16 (45,7%) subjek, terdiri atas 10 (28,6%) gangguan restriktif, 2 (5,7%) obstruktif dan 4 (11,4%) subjek campuran. Rerata HbA1c dalam 1 tahun terakhir pada subjek dengan gangguan restriktif 10,3%.Kesimpulan.Nilai parameter uji fungsi paru pasien DMT1 usia 8-18 tahun masih dalam batas normal. Gangguan fungsi paru didapatkan 16 (45,7%) subjek dengan gangguan restriksi terbanyak 10 (28,6%) subjek

Obstructive sleep apnea syndrome pada Anak

Sari Pediatri Vol 7, No 2 (2005)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

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Abstract

Obstructive Sleep Apnea Syndrome (OSAS) adalah suatu sindrom obstruksi total atauparsial jalan nafas yang menyebabkan gangguan fisiologis yang bermakna dengan dampakklinis yang bervariasi. Prevalensi OSAS adalah 0,7 – 10,3%. Beberapa keadaan dapatmerupakan faktor risiko OSAS seperti hipertofi adenoid dan atau tonsil, obesitas,disproporsi sefalometri, kelainan daerah hidung. OSAS pada anak berbeda dengan dewasabaik faktor risiko maupun tata laksananya. Manifestasi klinis OSAS pada anak adalahkesulitan bernafas pada saat tidur, mendengkur, hiperaktif, mengantuk pada siang hari,dan kadang-kadang enuresis. Diagnosis OSAS secara definitif menggunakanpolisomnografi yaitu adanya indeks apnea atau hipopnea lebih dari 5. Sebagai alternatifdiagnosis adalah menggunakan kuesioner Brouillette dkk, observasi dengan video, ataumenggunakan pulse oksimetri. Tata laksana OSAS pada anak adalah pengangkatanadenoid (adenoidektomi dan/atau tonsilektomi). Angka keberhasilannya cukup tinggiyaitu sekitar 75%. Selain itu diet untuk penurunan berat badan pada obesitas, sertapengunaan CPAP (continuous positive airway pressure). Komplikasi yang dapat terjadiadalah gangguan tingkah laku, kelainan kardiovaskular, dan gagal tumbuh.

Faktor-Faktor yang Berhubungan dengan Bronkiolitis Akut

Sari Pediatri Vol 10, No 6 (2009)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

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Abstract

Latar belakang. Terdapat beberapa faktor yang mempengaruhi terjadinya bronkiolitis akut. Seperti halnya usia, jenis kelamin, lahir kurang bulan, berat lahir rendah, jumlah keluarga serumah, status gizi, air susu ibu (ASI), paparan asap rokok, riwayat atopi, dan imunisasi BCG.Tujuan. Untuk mengetahui hubungan antara ASI, paparan asap rokok, riwayat atopi, dan BCG dengan bronkiolitis akut.Metode. Desain potong lintang, data didapat dari rekam medis pasien yang dirawat. Analisis data dengan metode univariat dan multivariat, tingkat kemaknaan α=0,05 (IK95%).Hasil. ASI dan paparan asap rokok tidak berhubungan dengan bronkiolitis akut, sedangkan riwayat atopi pada orangtua, parut BCG, dan jenis kelamin berhubungan dengan bronkiolitis akut{RP 20,41 (IK95% 1,09;333,33), p=0,043, RP 0,23 (IK95% 0,07; 0,79), p=0,019, dan RP 3,42 (IK95% 1,10;10,64), p=0,034)}.Kesimpulan. Riwayat atopi pada orangtua, parut BCG, dan jenis kelamin berhubungan dengan bronkiolitis akut.

Infeksi Respiratorik Bawah Akut pada Anak

Sari Pediatri Vol 8, No 2 (2006)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

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Abstract

Infeksi respiratorik akut dibagi menjadi 2 kelompok besar yaitu infeksi respiratorikatas akut (IRAA) dan infeksi respiratorik bawah akut (IRBA), yang menjadi masalahutama adalah pneumonia dan bronkiolitis. Pneumonia merupakan ancaman baikkesakitan maupun kematian pada bayi khususnya bayi muda. Pengobatan utama adalahpemberian antibiotik yang sesuai dengan penyebabnya. Masalahnya adalah penyebabpneumonia sulit diketahui secara pasti karena tidak dilakukan kultur darah, sehinggapemberian antibiotik hanya berdasarkan empiris. Mengenai manfaat pemberian obatsuportif lain seperti vitamin A, Zn masih memerlukan penelitian lebih jauh. Sementaraitu bronkiolitis yang disebabkan oleh virus terutama RSV (respiratory syncitial virus)masih merupakan kendala bagi kesehatan anak di Indonesia; sehingga pengobatanbronkiolitis masih merupakan perdebatan yang panjang. Penggunaan antibiotik tidakdiperlukan, pemberian anti virus ribavirin, kortikosteroid sistemik, dan pemberianbronkodilator masih memerlukan analisis yang mendalam. Pernah dilaporkanpemberian RSVIG pada kasus yang berat, hasilnya masih belum memuaskan karenatidak berbeda bermakna dengan pemberian albumin disamping pengobatan suportiflainnya.

Penyakit Respiratorik pada Anak dengan HIV

Sari Pediatri Vol 8, No 3 (2006)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

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Abstract

Latar belakang. Kejadian AIDS pada anak meningkat seiring dengan peningkatan kasusdewasa. Gejala dan manifestasi klinis sering tidak khas, sehingga menyebabkanunderdiagnosis. Anak HIV sering datang dengan keluhan yang berasal dari infeksioportunistik, bahkan infeksi oportunistik banyak ditemukan sebagai penyebab kematian.Salah satu infeksi oportunistik yang sering terjadi adalah infeksi respiratorik.Tujuan penelitian. Penelitian ini bertujuan untuk melihat pola penyakit respiratorikpada anak HIV yang dirawat di Bagian Ilmu Kesehatan RS Dr. Cipto Mangunkusumo(RSCM), Jakarta.Metoda. Data berasal dari rekam medis anak HIV tahun 2002-2005. Penelitiandilakukan dengan desain potong lintang. Kriteria inklusi adalah anak usia 0-13 tahun,dengan HIV positif dan menderita penyakit respiratorik. Data yang dicatat meliputiumur, jenis kelamin, faktor risiko, status gizi, parut BCG, diameter uji tuberkulin, riwayatkontak dengan pasien tuberkolosis, kategori HIV, diagnosis penyakit respiratorik,outcome. Data klinis khusus meliputi batuk kronik berulang, demam lama, sesak nafas,laboratorium rutin, foto torak, dan kadar CD4, PCR.Hasil. Sejak Januari 2002-Desember 2005, telah dirawat 85 anak yang terinfeksi HIV,dengan 13 orang (15,2%) di antaranya meninggal. Tiga belas orang (13/35) didiagnosisHIV berdasarkan serologi dan PCR, 24/35 hanya dengan serologi, dan 1/35 orang denganPCR. Sebanyak 38 (44,7%) orang menderita infeksi respiratorik dengan pola penyakit: TB47,3%, pneumonia 44,7%, pneumocytis corinii pneumonia (PCP) 13,1%. Pada penelitianini, didapatkan bahwa 3/38 (7,8%) anak HIV dengan penyakit paru meninggal karenapneumonia berat, dengan 2/3 di antaranya pada kelompok umur 1-5 tahun. Penyebabkematian lainnya adalah PCP 2/38 pasien (5,2%), dan tersangka sepsis pada 2 pasien (5,2%).Kesimpulan. Pada anak HIV, TB merupakan penyakit respiratorik terbanyak, diikutipneumonia, sedangkan penyebab kematian terbanyak adalah pneumonia. Penyakitrespiratorik pada anak HIV dapat menjadi pembuka jalan untuk diagnosis anak HIV.