Pramita Gayatri, Pramita
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Profil Lipodistrofi dan Dislipidemia pada Pasien Prepubertas dengan HIV yang Mendapat Terapi ARV di Rumah Sakit Cipto Mangunkusumo

Sari Pediatri Vol 18, No 1 (2016)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

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Abstract

Latar belakang. Terapi antiretroviral (ARV) kombinasi telah berhasil menurunkan angka morbiditas dan mortalitas pasien HIV, tetapi menimbulkan efek samping jangka panjang berupa sindrom lipodistrofi.Tujuan. Mengidentifikasi adanya lipodistrofi dan dislipidemia pada pasien prepubertas dengan HIV yang mendapatkan terapi ARV jangka panjang.Metode. Penelitian potong lintang dilakukan pada 76 pasien HIV usia prepubertas di Poli Alergi Imunologi RSCM. Pemeriksaan klinis lipodistrofi dilakukan oleh tenaga klinis, tebal lipatan kulit (TLK) triceps dan subscapular, lingkar pinggang serta rasio lingkar pinggang-panggul. Data kadar CD4 awal, status gizi awal terdiagnosis, jenis terapi ARV, dan lama terapi ARV didapatkan dari rekam medis. Subyek juga dilakukan analisis diet, pemeriksaan profil lipid, dan gula darah puasa.Hasil. Subyek prepubertas dengan HIV yang mendapatkan terapi ARV yang mengalami lipodistrofi dan dislipidemia berturut-turut 47% dan 46%. Subyek lipodistrofi berupa lipohipertrofi 35%, lipoatrofi 5%, dan tipe campuran 7%. Mayoritas subyek lipodistrofi memiliki massa lemak tubuh, serta TLK triceps dan subscapular normal. Subyek lipohipertrofi dan tipe campuran seluruhnya memiliki rasio lingkar pinggang-panggul meningkat. Terdapat hubungan yang bermakna antara penggunaan regimen ARV 2NRTI + PI meningkatkan risiko 6,9 kali untuk terjadinya dislipidemia (p=0,001 IK95%: 2,03-23,7) dibandingkan regimen 2NRTI+ NNRTI.Kesimpulan. Prevalensi lipodistrofi dan dislipidemia cukup tinggi pada pasien prepubertas dengan HIV yang mendapatkan terapi ARV. Mayoritas subyek yang mengalami lipodistrofi memiliki massa lemak tubuh, TLK triceps dan subscapular yang normal.

Manfaat Pemberian Probiotik pada Diare Akut

Sari Pediatri Vol 17, No 1 (2015)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

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Abstract

Latar belakang. Beberapa penelitian membuktikan bahwa probiotik bermanfaat pada diare akut dan diharapkan dapat mengurangidurasi dan frekuensi diare serta gejala lain seperti demam sera muntahTujuan. Mengevaluasi kegunaan probiotik pada diare akut berdasarkan bukti ilmiahMetode. Penelusuran pustaka database elektronik : Pubmed, Cochrane, Highwire.Hasil. Dua metaanalisis mengenai efek probiotik terhadap diare akut mendapatkan probiotik secara bermakna durasi diare dibandingkankontrol (-0,67; KI 95%, -0,95 sampai -0,38, p<0,00001) dan mean duration diare berkurang bermakna pada kelompok probiotik(86,4 jam) dan 115,2 jam pada kelompok plasebo (p=0,0001). Uji klinis acak tersamar mendapatkan pemberian probiotik single strainmempersingkat durasi diare dibandingkan pada kelompok probiotik multiple strain (p=0.004). Uji klinis acak tersamar menggunakanprobiotik Lactobacilus GG dengan placebo mendapatkan jumlah hari diare kembali ke konsistensi normal lebih singkat pada kelompokprobiotik (p=0,002), tetapi penelitian di India tidak mendapatkan perbedaan bermakna dalam durasi diare.Kesimpulan. Penelitian terhadap efektifitas pemberian probiotik pada diare akut masih beragam meskipun sebagian besar menunjukkanefektifitas dalam menurunkan lama dan frekuensi diare, hal ini mungkin dipengaruhi oleh strain probiotic yang diberikan.

Hubungan antara Kadar High Density Lipoprotein dengan Derajat Sepsis Berdasarkan Skor Pediatric Logistic Organ Dysfunction

Sari Pediatri Vol 15, No 2 (2013)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

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Abstract

Latar belakang. Sepsis masih merupakan penyebab kematian terbesar di Pediatric Intensive Care Unit (PICU). Peran high density lipoprotein(HDL) pada keadaan sepsis mengikat dan menetralisir lipopolisakarida (LPS), menghambat adhesi molekul dalam kaskade inflamasi, dan sebagai antioksidan.Tujuan. Mengetahui profil HDL pada anak sepsis serta mengetahui hubungan kadar HDL dengan derajat sepsis berdasarkan skor pediatric logistic organ dysfunction (PELOD). Metode.Studi potong lintang pada anak sepsis di PICU Rumah Sakit Cipto Mangunkusumo (RSCM) usia 1 bulan- 18 tahun antara April-Agustus 2011.Hasil. Didapatkan 34 subjek, dengan sebaran terbanyak pada kelompok usia <2 tahun (19/34). Terdapat hubungan antara kematian dengan skor PELOD >20 (p=0,000). Lima dari 7 pasien dengan skor PELOD >20 ditemukan mempunyai kadar HDL rendah (p=1). Tidak didapatkan hubungan yang bermakna antara kematian dengan kadar HDL (p=0,248). Terdapat korelasi lemah berbanding terbalik antara kadar HDL dengan skoring PELOD tetapi tidak bermakna secara statistik (r =-0,304, p = 0,080)Kesimpulan. Pasien sepsis dengan skor PELOD tinggi cenderung memiliki kadar HDL rendah.

Efficacy of oral erythromycin to enhance feeding tolerance in preterm infants

Paediatrica Indonesiana Vol 57 No 3 (2017): May 2017
Publisher : Indonesian Pediatric Society

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Abstract

Background Feeding intolerance is a common condition that affects preterm infants. Erythromycin is a prokinetic agent used to treat feeding intolerance, but its efficacy remains inconclusive.Objective To evaluate the effectiveness of oral erythromycin to enhance feeding tolerance in preterm infants.Methods This prospective, randomized controlled trial in preterm infants was conducted at Sanglah Hospital, Denpasar, Bali, from June 2015 to January 2016. Eligible infants were randomized to receive either 12.5 mg/kg/dose oral erythromycin or a placebo, every 8 hours. The primary outcome was the time to establish full enteral feeding. The secondary outcomes were body weight at full enteral feeding and length of hospital stay.Results Of 62 initial subjects, 3 infants dropped out of the study. Thirty infants were given erythromycin and 29 infants were given placebo. The baseline characteristics of the two groups were similar, with mean of gestational ages of 31.4 (SD 1.7) weeks in the erythromycin group and 32.4 (SD 2.2) weeks in the placebo group. The median times to reach full enteral feeding did not significantly differ between the two groups, with 10 (SD 5.3) days in the erythromycin group vs. 8 (SD 6.5) days in the placebo group (P=0.345). Also, median body weights at full enteral feeding and lengths of hospital stay were not significantly different between the two groups.Conclusion Erythromycin of 12.5 mg/kg/dose every 8 hours as prophylactic treatment does not significantly enhance feeding tolerance in preterm infants. Median body weights at full enteral feeding and length of hospital stay are not significantly different between the erythromycin and placebo groups.

Efficacy of sputum induction from lower respiratory tract in children

Paediatrica Indonesiana Vol 55 No 2 (2015): March 2015
Publisher : Indonesian Pediatric Society

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Abstract

Background Although sputum is a good specimen for variousexaminations, such as cytology and microbiological culture,sputum induction (SI) is not a routine procedure in children.Objective To identify the efficacy of SI to obtain specimen fromlower respiratory tract in children, identify side effects of SI, andthe results of microbiological examination.Methods A cross sectional study was performed in children (aged1 month to 18 years) who underwent SI. Sputum induction wasperformed by inhalation with hypertonic solution, consisted ofsalbutamol for 15 minutes continued with NaCl 3% solutionfor another 15 minutes. Sputum specimens were examined fornumber of alveolar macrophage cell, surfactant protein A (SP-A)concentration, also acid-fast bacili smear, and M. tuberculosisculture, or aerobic microbial culture.Results Forty subjects with lower respiratory tract infectionparticipated in this study, and SI was succesfully performed inall subjects. Youngest subject was 2 month old, the eldest was 16year 7 month old. Median duration of SI was 45 minutes, andmajority of volume was 3 or 4 mL. Side effects were nosebleeds(40%) and vomiting (2.5%). Macrophage alveolar more than 5cells in one specimen was found in 97.5% subjects. Surfactantprotein A examination was performed in 30 specimens, and SP-Awas detected in all specimens (median concentration 264.528 pg/mL). Culture for M. tuberculosis was positive in 1 of 27 subjects,while acid fast bacili smear was negative in all examined subjects.Aerobic microbial culture was positive in 5 of 13 subjects.Conclusions Sputum induction has good efficacy in obtaininglower respiratory tract specimen and it is safe to perform inchildren. Specimen from sputum induction yields good positiveresult for aerobic microbial cultures.