Sunartini Sunartini, Sunartini
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Prognostic factors of refractory epilepsy in children

Paediatrica Indonesiana Vol 48 No 5 (2008): September 2008
Publisher : Indonesian Pediatric Society

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Abstract

Background Epilepsy is one of the most common pediatricneurological disorders. Twenty percent of patients will developrefractory epilepsy. Early identification of refractory epilepsy willbe helpful to conduct adequate counseling and selecting patientswho need more intensive investigation and treatment.Objective To identify the clinical characteristics and other factorsthat are related to refractory epilepsy in children.Methods We conducted a case control study in patients of two to18 years old with epilepsy that admitted to Dr. Sardjito Hospital.There were 4 7 children with refractory epilepsy compared with122 subjects who have been one year free of seizure.Results Strong association had been noted between refractoryand several clinical factors: early onset of seizure, high initialseizure frequency, neonatal asphyxia, symptomatic etiology, statusepilepticus, abnormal neurodevelopmental status, and earlybreakthrough seizures after treatment initiation. On multivariateanalysis, more than 20 seizures prior to treatment initiation (OR3.40, 95% CI 1.03 to 11.3), and more than three seizures in thesubsequent six month after treatment initiation (OR 16.02, 95%CI 4.98 to 51.5) were independent prognostic factors related torefractory epilepsy.Conclusion Children who present high frequency seizures atonset and more than 3 breakthrough seizures subsequent to sixmonth after treatment have risks of developing refractory epilepsy.

Tumbuh Kembang Anak Hipotiroid Kongenital yang Diterapi dini dengan Levo-tiroksin dan Dosis Awal Tinggi

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

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Abstract

Latar belakang. Hipotiroid kongenital (HK) adalah penyebab disabilitas intelektual yang bisa dicegah dengan diagnosis dini diikuti dengan pemberian terapi pengganti levo-tiroksin (L-T4). Deteksi dini melalui skrining hipotiroid kongenital (SHK) belum menjadi program rutin pemerintah sehingga kasus HK belum banyak dapat dikelola secara tepat dan berkesinambungan. Tujuan.Mengetahuigambaran pencapaian tumbuh kembang anak dengan HK yang mendapat terapi dengan L-T4 pada usia balita. Metode.Penelitian studi kasus (case study). Pasien HK usia balita yang menjalani terapi LT4 di Poliklinik Endokrin Anak RS Sanglah, RSUD Wangaya Denpasar dan RSUD Karangasem sejak tahun 2006 berdasarkan catatan medik, dianalisis perjalanan penyakit dan terapinya. Dilakukan penilaian tumbuh kembang pada usia balita dengan skala mental dan motor dari Bayley II (BSID II), pertumbuhan dinilai parameter antropometrik berdasarkan WHO Anthro-2005, maturitas tulang dengan bone age. Hasil. Duabelas kasus dianalisis, terdiri dari 4 laki-laki dan 8 perempuan, usia diagnosis antara 3-18 bulan. Lima subyek dengan HK berat, 4 tidak berat, dan 3 disertai sindrom Down secara klinis. Saat diagnosis ditegakkan, rerata TSH awal adalah 130,73 (SB 194,89) uIU/mL dan rerata FT4 0,54 (SB 0,54) ng/dL, dan dengan rerata BBL 2862,50 (SB 487,16) gram. Lima kasus mendapatkan terapi dini dan 7 kasus dengan terapi tidak dini.Kesimpulan.Luaran indeks perkembangan psikomotor lebih baik pada HK permanen yang menggunakan dosis awal tinggi dibandingkan dosis standar. Luaran pertumbuhan mengalami perbaikan setelah pemberian terapi L-T4 berdasarkan parameter antropometri. Percepatan pertumbuhan pada usia balita akan tercapai apabila diterapi sejak dini.

Audit Tata laksana Meningitis Bakterialis pada Anak di RSUP Dr. Sardjito

Sari Pediatri Vol 16, No 2 (2014)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

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Abstract

Latar belakang. Angka kematian dan disabilitas pasien meningitis bakterialis masih cukup tinggi serta berhubungan dengan kualitas pelayanan. Audit medis perlu dilakukan sebagai salah satu upaya meningkatkan patient safety.Tujuan. Mengetahui kesesuaian antara praktik tata laksana meningitis bakterialis pada anak yang dirawat di bangsal anak RSUP Dr. Sardjito dengan pedoman pelayanan medis berdasarkan standar pelayanan medis (SPM) RSUP Dr. Sardjito 2005 dan (Pedoman Pelayanan Medis) PPM IDAI 2010.Metode. Audit retrospektif dengan menggunakan pedoman audit berdasarkan SPM RSUP Dr. Sardjito tahun 2005 dan PPM IDAI tahun 2010. Subjek penelitian adalah anak usia 1 bulan-18 tahun dengan diagnosis meningitis bakterialis yang dirawat di bangsal anak RSUP Dr. Sardjito pada 1 Januari 2011 sampai dengan 31 Mei 2013.Hasil. Terdapat 114 anak dengan diagnosis meningitis bakterialis. Rata-rata lama waktu penanganan di UGD adalah 89 menit dengan median 78 menit. Median lama waktu dilakukannya pungsi lumbal sejak pasien masuk adalah 4,5 jam (rata-rata 13,9 jam, rentang interkuartil 2,3–18,2 jam). Enampuluh dua pasien (54,4%; 95%CI: 49,7-59, 1%) yang mendapatkan antibiotik dosis intrakranial dalam waktu 6 jam sejak pasien masuk. Namun, defisiensi ini tidak terbukti memengaruhi outcome kematian (OR: 0,7; 95%CI: 0,18-3,0; p=0,480) maupun terjadinya sekuel (OR: 1,1; 95%CI: 0,4-2,5; p=0,839). Pemeriksaan uji fungsi pendengaran dengan Brainstem Evoked Respons Audiometri (BERA) hanya dilakukan pada 26/63 (41,3%; 95%CI: 29,1-53,5%) pasien.Kesimpulan. Belum semua kasus tata laksana meningitis bakterialis memenuhi standar mutu sesuai pedoman. Perlu diadakan pelatihan atau workshop tata laksana meningitis bakterialis pada anak di RSUP Dr. Sardjito.

Apert Syndrome

Paediatrica Indonesiana Vol 31, No 11-12 (1991): November 1991
Publisher : Indonesian Pediatric Society

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Abstract

A case of Apert syndrome in a male child of 5 months old hos been reported. The diagnosis was based on the clinical appearance (phenotype) showing acrocephaly and syndactily of both hands and feet, supported by skull rontgenography and ultrasonography.The patient was the third child from normal parents, and the two other children were normal. Apert syndrome is a genetic dominant automal disease; and because there were no other sufferer from the family history, the occurrence of this syndrome has been caused by a new mutation. Symptomatic therapy such as the administration of acetazolamide for hydrocephalus and vitamin suplement to improve his general condition and even physical physiotherapy have been carried out. Genetic counselling to the couple has been provided as well.

Hubungan antara pola konsumsi gluten dan kasein dengan skor CARS (childhood autism rating scale) pada anak ASD (autistic spectrum disorder)

Jurnal Gizi Klinik Indonesia Vol 3, No 1 (2006): Juli
Publisher : Minat S2 Gizi dan Kesehatan, Prodi S2 IKM, Fakultas Kedokteran UGM

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Abstract

Background: The worldwide prevalence of ASD (Autistic Spectrum Disorder) during the last few years is increasing. The association between diet free of gluten and casein and improvement of autistic behaviors is still under questions.Objective: To study the association between the consump6tion of gluten and casein and the score of Childhood Autistic Rating Scale (CARS) in children with ASD (Autistic Spectrum Disorder). The study also aimed at understanding mothers’ attitude toward the diet.Methods: This was a cross sectional study on 10 mothers of children suffering from ASD in a clinic in Yogyakarta, Indonesia. A dietician measured the consumptions of gluten and casein with scored food frequency questionnaire while experts in the clinic measured CARS. In-depth interviews were performed to capture the mothers’ attitude toward the diet.Result: There was a decrease in the mean score of consumption of gluten and casein before and after diagnoses of ASD, mean difference of 156.6 (125.2; 187.9), p<0.001). There was no significant correlation between the consumption score of gluten and casein and the decrease in the score of CARS (r= 0.274, p= 0.82). Mothers thought diet free of gluten and casein was associated with improvement of behaviors.Conclusion: Consumption of gluten and casein decreased after diagnosis of ASD. Mothers think diet free of gluten and casein improved their children’s behaviors.

Hubungan antara pola konsumsi gluten dan kasein dengan skor CARS (childhood autism rating scale) pada anak ASD (autistic spectrum disorder)

Jurnal Gizi Klinik Indonesia Vol 3, No 1 (2006): Juli
Publisher : Minat S2 Gizi dan Kesehatan, Prodi S2 IKM, Fakultas Kedokteran UGM

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Abstract

Background: The worldwide prevalence of ASD (Autistic Spectrum Disorder) during the last few years is increasing. The association between diet free of gluten and casein and improvement of autistic behaviors is still under questions.Objective: To study the association between the consump6tion of gluten and casein and the score of Childhood Autistic Rating Scale (CARS) in children with ASD (Autistic Spectrum Disorder). The study also aimed at understanding mothers’ attitude toward the diet.Methods: This was a cross sectional study on 10 mothers of children suffering from ASD in a clinic in Yogyakarta, Indonesia. A dietician measured the consumptions of gluten and casein with scored food frequency questionnaire while experts in the clinic measured CARS. In-depth interviews were performed to capture the mothers’ attitude toward the diet.Result: There was a decrease in the mean score of consumption of gluten and casein before and after diagnoses of ASD, mean difference of 156.6 (125.2; 187.9), p<0.001). There was no significant correlation between the consumption score of gluten and casein and the decrease in the score of CARS (r= 0.274, p= 0.82). Mothers thought diet free of gluten and casein was associated with improvement of behaviors.Conclusion: Consumption of gluten and casein decreased after diagnosis of ASD. Mothers think diet free of gluten and casein improved their children’s behaviors.

Collaborative Practice Bidang Maternitas pada Tenaga Kesehatan

Jurnal Pendidikan Kedokteran Indonesia: The Indonesian Journal of Medical Education Vol 4, No 1 (2015): MARET
Publisher : Asosiasi Institusi Pendidikan Kedokteran Indonesia

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Abstract

Background: World's current health systems are in a crisis, causing public health needs are not being met. Mother Mortality Rate in Indonesia was still high. It indicated that  maternity care was not optimal yet.  One of solution is an  implementation of interprofessional collaborative practice. Currently, in Indonesian’s hospitals have not seen an equal team collaboration. The objective of this study was to explore the perceptions and acceptance of health workers maternity’s interprofessional collaborative practice in Dr. Sardjito Yogyakarta’s Hospital. Methods: This study was a qualitative  with a phenomenology design. Subjects were nurses, midwives, obstetrics and gynecologist, pharmacists, and nutritionists who had  collaboration experience in obstetrics gynecology department in Dr. Sardjito Yogyakarta’s Hospital, included 10 respondents. Sampling technique used a purposive sampling, while data collection used a Focus Group Discussion and in-depth interviews. Data’s credibility and reliability obtained by triangulation, debriefing, member checking and rich data. Research ethics included an informed consent and ethics committee’s approval. This study was conducted in February-July 2014. Result: Most respondents had a wrong perception of  interprofessional collaboration’s definition. All of respondents accepted if  interprofesional collaboration implemented properly. Data analysis resulted in six categories: perception of health workers about interprofessional collaboration, implementation of interprofessional collaboration in hospital, application of collaboration’s elements in interprofessional collaboration, health workers’s expectations for better collaboration, health workers’s motivation in doing interprofessional collaboration and variation of health workers’s acceptance of interprofessional collaboration. Conclusion: Most of health workers  have not had a correct perception of interprofessional collaborative practice. All health workers accepted if interprofessional collaborative practice applied properly in maternity area in Dr. Sardjito Yogyakarta’s Hospital.  

Comparison of monotherapy effect of phenytoin, carbamazapine and valproic acid in pediatric general tonic clonic and partial epilepsy

Paediatrica Indonesiana Vol 48 No 1 (2008): January 2008
Publisher : Indonesian Pediatric Society

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Abstract

Background Problems on epilepsy do not only depend on thedisease itself but also on management and drug regimens. Drugselection is very important to yield optimal treatment effect andto prevent side effects due to long-term therapy.Objective To determine whether there are any different effectsof monotherapy of phenytoin, carbamazapine, and valproic acidon pediatric general tonic clonic and partial epilepsy.Methods We conducted a historical cohort study on one monthuntil 18-years old children diagnosed as general tonic clonic orparsial epilepsy treated with phenytoin, carbamazapine, or valproicacid routinely for more than two years in Sardjito Hospital fromJanuary 2000 until May 2007. The sample size of each group was41. The main outcome was the time of 12-month remission,whereas the secondary outcomes were withdrawal from treatment,time to remission, side effects and cure rates.Results Valproic acid increased the possibility to achieve 12-monthremission (RR 2.66; 95%CI 1.06;6.65) compared to phenytoin,whereas carbamazapine did not (RR 1.47; 95%CI 0.66;3.28).Survival analysis showed that valproic acid was better thancarbamazapine (P=0.042) and phenytoin (P=0.007). There wereno significant differences among groups in the result of withdrawalfrom treatment, time to remission, and cure variables. The sideeffects of valproic acid seemed less than those of others.Conclusions Valproic acid increases the possibility of 12-monthremission compared to carbamazapine and phenytoin asmonotherapy in pediatric general tonic clonic and partial epilepsywithout increasing side effects. Carbamazapine has similar effectsof therapy to phenytoin.

Sodium channels of SCNIA gene mutations in generalized epilepsy with febrile seizure plus (GEFS+) spectrum related to autism

Paediatrica Indonesiana Vol 50 No 3 (2010): May 2010
Publisher : Indonesian Pediatric Society

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Abstract

Background Mutations in the a-subunit of the first neuronalsodium channel gene SCNIA have been demonstrated forgeneralized epilepsy \\lith febrile seizures plus (GEFS+), severemyoclonic epilepsy in infancy (SMEI), and borderline SMEI(SMEB). SCNIA mutations are also described in patients 'Withpsychiatric disorders such as autism.Objective To identify the mutations of SCNIA gene in patientswith GEFS+ spectrum which may be related to autism.Methods We examined four patients v.ith autism and GEFS+spectrum who were admitted to the Department of Child Health,Sardjito Hospital, Yogyakarta, Indonesia. Diagnosis of autism wasbased on DSM????IV;ICD X criteria. Mutations in SCNIA wereidentified by PCRamplification and denaturing high????performanceliquid chromatography analysis, Mth subsequent sequencing.Results There were four patients, all boys, aged 1.8 year to 7 years.The phenotypes of epilepsy were GEFS+ in one patient, SMEBin one patient and SMEI in two patients. Sequencing analysisrevealed a G????to????A heterozygous transition which was detectedat nucleotide c.4834G>A (p.V1612I ) in exon 25. Other singlenucleotid polymorphisms (SNPs) were c.383 +66T>C in intron 2,c.603-91G>A and c.603-1060> T in intron 4, c.965-21C> T inintron 6, c.1028+21T>Cin intron 7, c.2173G>A in exon 12 andc. 2177-38C>A, c.2177-12delT, c.2176+44C> T in intron 12.Conclusion In this study, we reported the first cases Mth mutationin SCNIA gene in GEFS+ spectrum related to autistic patientsin Indonesian population, which showed a missense mutationp.V16121. [Paediatr lndones. 2010;50:125-32].

Electroencephalogram and clinical manifestations of Rett syndrome in children

Paediatrica Indonesiana Vol 43 No 4 (2003): July 2003
Publisher : Indonesian Pediatric Society

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Abstract

Background Rett Syndrome (RS) is a severe neurodevelopmentaldisorder. Epileptic seizures occur in 80-90%; grandmal, psychomo-tor (complex partial), and focal motor seizures have been reported.The electroencephalogram(EEG) is almost always abnormal.Objective This study aimed to investigate the EEG and clinicalmanifestations of children with RSResults We investigated EEG on 5 patients with RS aged 30–66month. One patient was in clinical stage II and 4 patients in clini-cal stage III. Four patients had history of seizures, however onlytwo patients suffered from epilepsy. The EEG demonstrated slow-ing background activity in occipital region in two patients. In addi-tion, epileptic form activities were observed in 4 of 5 patients.Conclusion We concluded that epileptic spike discharge with orwithout clinical seizures were found in almost all of our RS pa-tients. These paroxysmal discharges suggested the process andthe sequences of cortical involvement. Compelling clinical, neuro-physiological evidences were very important to decide the stageof Rett disorder