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Harahap, Roito Elmina Gogo
Perbandingan uji tapis bayley infant neourodevelopmental screener (BINS) dengan uji tapis Denver II untuk deteksi dini keterlambatan perkembangan bayi usia 3-24 bulan dengan menggunakan baku emas griffith mental development scales
"Anak merupakan aset keluarga, masyarakat, dan bangsa sehingga harus mendapatkan pembinaan jasmani, mental spiritual dan sosia] sejak dini mengingat pada masa lima tahun pertama kehidupan anak merupakan masa keemasan di dalam pembentukan dasar-dasar kepribadian anak. Agar mampu menjadi generasi penerus di masa depan, anak harus dipersiapkan sebaik-baiknya, termasuk proses pertumbuhan dan perkembangannya.
Perkembangan adalah bertambahnya kemampuan dalam struktur dan fungsi tubuh yang lebih kompleks dalam pola yang teratur dan dapat diramalkan, sebagai hasil dari proses pematangan. Di sini menyangkut proses diferensiasi dari sel-sel tubuh, jaringan tubuh, organ-organ dan sistem organ yang berkembang sedemikian rupa sehingga masing-masing dapat memenuhi fungsinya, termasuk perkembangan emosi, intelektual dan tingkah laku sebagai hasil interaksi dengan Iingkungannya.
Penyimpangan perkembangan pada balita tanpa kelainan organik sukar dideteksi dengan pemeriksaan finis secara rutin. Mereka tampak normal namun akan mendapatkan kegagalan pada saat mulai sekolah. Di Amerika didapatkan 12% sampai 16% anak mengalami keterlambatan perkembangan. Di Canada . 16% anak usia 4-5 tahun mengalami keterlambatan perkembangan bicara. Di Thailand 16,3% anak kurang dari 5 tahun mengalami keterlambatan perkembangan. Di Indonesia, penelitian-penelitian terhadap keterlambatan perkembangan pada balita mendapatkan angka yang bervariasi antara 12,8% sampai 28,5%. Oleh karena itu perlu diketahui penyimpangan perkembangan secara dini. Pengetahuan mengenai perkembangan bayi yang normal dan variasinya harus dikuasai agar dapat merencanakan tata Iaksana yang tepat dan dapat membantu pasien dan keluarganya semaksimal mungkin."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2006
T20865
UI - Tesis Membership  Universitas Indonesia Library
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Triana Darmayanti
Struktur dan fungsi jantung pada anak dengan gagal ginjal kronik
"Gagal ginjal merupakan masalah kesehatan anak yang menjadi makin penting oleh karena angka kejadiannya yang cenderung meningkat. Dengan meningkatnya penyediaan sarana dan fasilitas kesehatan dan kemudahan mendapatkan obat-obatan, anak penderita penyakit ginjal akan lolos dari krisis masa akutnya, namun pada sebagian dari mereka kelainan ginjal yang mendasarinya terus berlanjut. Ditambah lagi dengan pemantauan Ianjutan yang tidak akuat, anak penderita penyakit ginjal dapat jatuh dalam keadaan gagal ginjal kronik (GGK).
Pada penelitian di tujuh rumah sakit pendidikan dokter spesialis anak di Indonesia didapatkan GGK pada 2% dari 2889 anak yang dirawat dengan penyakit ginjal (tahun 1984-1988). Di RS Cipto Mangukusumo Jakarta antara tahun 1991-1995 didapatkan angka kejadian GGK sebesar 4,9% dari 688 kasus penyakit ginjal rawat inap dan 2,6% dan 865 kasus rawat jalan, dan meningkat menjadi 58 (13,3%) dari 435 anak yang dirawat dengan penyakit ginjal antara tahun 1996-2000.
Keterlibatan sistem kardiovaskular merupakan hal yang sering ditemukan pada anak dengan penyakit GGK dan gagal ginjal terminal (GGT), dan merupakan penyebab penting morbiditas dan mortalitas. Dari seluruh pasien anak yang meninggal setelah menjalani terapi pengganti ginjal di Eropa tahun 1987 hingga 1990, gangguan kardiovaskular menjadi penyebab kematian pada 51% pasien dialisis dan 37% pasien transplantasi. Angka kematian akibat kelainan kardiovaskular pada anak dengan dialisis 30 kali lebih tinggi dibandingkan dengan populasi umum."
Depok: Universitas Indonesia, 2006
T-Pdf
UI - Tesis Membership  Universitas Indonesia Library
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Nanda Wulandari
Proteinuria asimtomatik pada siswa Sekolah Menengah Pertama di Jakarta = Asymptomatic proteinuria in dolescent students in Jakarta
"[ABSTRAK
Nama Nanda WulandariProgram studi Pendidikan Dokter Spesialis Ilmu Kesehatan AnakJudul Proteinuria asimtomatik pada remaja siswa sekolah menengah pertama di Jakarta Latar belakang Penyakit ginjal dapat terjadi tanpa gejala dan tanda yang jelas dan beberapa di antaranya dapat berkembang menjadi gagal ginjal kronik yang ireversibel Deteksi dini penyakit ginjal pada anak dapat membantu mencegah atau menunda progresivitas penyakit menurunkan jumlah pasien gagal ginjal terminal dan menurunkan angka kesakitan dan kematian Proteinuria asimtomatik dan atau hematuria seringkali merupakan manifestasi awal glomerulonefritis kronik Skrining urin massal untuk mendeteksi proteinuria merupakan salah satu cara terbaik untuk mendiagnosis dini penyakit ginjal Tujuan Mengetahui prevalensi proteinuria asimtomatik pada remaja di Indonesia Metode Penelitian ini menggunakan desain potong lintang pada 485 anak remaja siswa SMP usia 12 14 tahun Skrining proteinuria dilakukan sebanyak 3 kali menggunakan carik celup Anak yang terdapat proteinuria pada pemeriksaan pertama dilakukan pemeriksaan ulang dengan jarak 2 3 minggu Pemeriksaan ketiga dilakukan pada hari yang sama dengan pemeriksaan kedua Pemeriksaan rasio protein kreatinin dari urin sewaktu dilakukan pada anak yang terdapat proteinuria pada pemeriksaan carik celup kedua Proteinuria bila carik celup protein ge 1 dan rasio protein kreatinin 0 2 mg mg Hasil Dari 485 subjek penelitian didapatkan 36 subjek 7 42 dengan proteinuria pada pemeriksaan urin pertama menggunakan carik celup Pada pemeriksaan urin kedua didapatkan 7 subjek yang proteinurianya tetap positif Pada ketujuh orang tersebut dilakukan pemeriksaan rasio protein kreatinin dari urin sewaktu dan didapatkan 3 orang subjek dengan rasio 0 2 mg mg Ketiga orang dengan rasio protein kreatinin 0 2 mg mg proteinnya juga positif pada pemeriksaan urin ketiga menggunakan carik celup dan disebut sebagai proteinuria persisten dengan prevalensi 0 62 Terdapat 5 subjek dengan proteinuria positif pada pemeriksaan urin pertama dan ketiga namun negatif pada pemeriksaan urin kedua dan disebut sebagai proteinuria ortostatik dengan prevalensi 1 03 Subjek dengan proteinuria positif namun tidak mengalami proteinuria persisten ataupun ortostatik disebut sebagai proteinuria transien dengan prevalensi 5 77 Simpulan Prevalensi proteinuria asimtomatik pada remaja usia 12 14 tahun di Jakarta adalah sebesar 7 42 dan prevalensi proteinuria persisten asimtomatik sebesar 0 62 Prevalensi proteinuria ortostatik postural adalah 1 03 Prevalensi proteinuria transien didapatkan sebesar 5 77 Kata kunci proteinuria asimtomatik prevalensi remaja ABSTRACT Name Nanda WulandariStudy Program Pediatrics Residency Training ProgramTitle Asymptomatic proteinuria in adolescent students in Jakarta Background Kidney diseases may develop without obvious symptoms but just with abnormal urinalysis such as asymptomatic proteinuria Glomerulonephritis may further progress insidiously and even develop to end stage renal disease Therefore regular population based urinary screenings of the pediatric population is important With urinalysis asymptomatic children with chronic progressive glomerulonephritis have a chance to be early detected diagnosed and treated Objective To determine the prevalence of asymptomatic proteinuria in adolescents in Indonesia Methods This was a cross sectional study involving 485 children aged 12 14 years conducted to junior high school students Proteinuria was detected on three occasions by dipstick with interval 2 3 weeks between first and second screening The third screening conducted on the same day with second screening Children with proteinuria on second screening examined further for urine protein creatinine ratio Proteinuria if dipstick shows protein ge 1 and urine protein creatinine ratio 0 2 mg mg Results Proteinuria were found in 36 7 42 children in first urine screening with dipstick On second screening there were 7 children who still positive for proteinuria All seven children were tested for urine protein creatinine ratio Three children had urine protein creatinine ratio 0 2 mg mg These three children also had proteinuria in the third specimen and considered persistent proteinuria 0 62 There were 5 children with positive proteinuria in the first and third specimens but no proteinuria in second screening considered as orthostatic proteinuria with prevalence 1 03 Subject with proteinuria but not persistent or orthostatic considered as transient proteinuria with prevalence 5 77 Conclusions The prevalence of asymptomatic proteinuria in adolescent students in Jakarta were 7 42 and the prevalence of asymptomatic persistent proteinuria were 0 62 The orthostatic proteinuria prevalence were 1 03 The transient proteinuria prevalence were 5 77 Keywords asymptomatic proteinuria prevalence adolescent, ABSTRACT Name Nanda WulandariStudy Program Pediatrics Residency Training ProgramTitle Asymptomatic proteinuria in adolescent students in Jakarta Background Kidney diseases may develop without obvious symptoms but just with abnormal urinalysis such as asymptomatic proteinuria Glomerulonephritis may further progress insidiously and even develop to end stage renal disease Therefore regular population based urinary screenings of the pediatric population is important With urinalysis asymptomatic children with chronic progressive glomerulonephritis have a chance to be early detected diagnosed and treated Objective To determine the prevalence of asymptomatic proteinuria in adolescents in Indonesia Methods This was a cross sectional study involving 485 children aged 12 14 years conducted to junior high school students Proteinuria was detected on three occasions by dipstick with interval 2 3 weeks between first and second screening The third screening conducted on the same day with second screening Children with proteinuria on second screening examined further for urine protein creatinine ratio Proteinuria if dipstick shows protein ge 1 and urine protein creatinine ratio 0 2 mg mg Results Proteinuria were found in 36 7 42 children in first urine screening with dipstick On second screening there were 7 children who still positive for proteinuria All seven children were tested for urine protein creatinine ratio Three children had urine protein creatinine ratio 0 2 mg mg These three children also had proteinuria in the third specimen and considered persistent proteinuria 0 62 There were 5 children with positive proteinuria in the first and third specimens but no proteinuria in second screening considered as orthostatic proteinuria with prevalence 1 03 Subject with proteinuria but not persistent or orthostatic considered as transient proteinuria with prevalence 5 77 Conclusions The prevalence of asymptomatic proteinuria in adolescent students in Jakarta were 7 42 and the prevalence of asymptomatic persistent proteinuria were 0 62 The orthostatic proteinuria prevalence were 1 03 The transient proteinuria prevalence were 5 77 Keywords asymptomatic proteinuria prevalence adolescent]"
Fakultas Ilmu Keperawatan Universitas Indonesia, 2015
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library
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Herbowo A. Soetomenggolo
Cryptosporidiosis pada anak usia di bawah tiga tahun di daerah bantaran sungai Ciliwung Kelurahan Kampung Melayu
"Infeksi saluran cerna oleh parasit memiliki angka morbiditas dan mortalitas yang tinggi di seluruh dunia. Angka kejadian infeksi saluran cerna oleh parasit tertinggi didapatkan di negara berkembang dan negara dengan tingkat ekonomi rendah terutama di daerah-daerah tropis. Indonesia sebagai negara tropis dan negara berkembang dengan tingkat ekonomi rendah diperkirakan memiliki prevalensi infeksi saluran cerna oleh parasit yang cukup tinggi. Parasit penyebab infeksi saluran cerna sangat beragam dan penelitian mengenai parasit penyebab infeksi saluran cerna di Indonesia masih sedikit tetapi penelitian yang dilakukan oleh Kang dan kawan-kawan di India mendapatkan infeksi saluran cerna oleh parasit terbanyak disebabkan oleh Giardia (53,8%) dan Cryptosporidium (39,7%).
Cryptosporidium pertama kali ditemukan pada anak imunokompeten berusia 3 tahun pada tahun 1976. Setelah itu Cryptosporidium dilaporkan menimbulkan endemik di daerah Milwaukee pada tahun 1993 yang menginfeksi 400.000 orang. Meskipun telah dilakukan berbagai pencegahan dan kesadaran masyarakat mengenai kebersihan makin tinggi, ternyata angka kejadian cryptosporidiosis yang tercatat di Amerika Serikat tetap tinggi yaitu pada tahun 1999 dilaporkan terdapat 2.769 kasus, tahun 2001 terdapat 3.787 kasus dan pada tahun 2002 terdapat 3.016 kasus.
Beberapa peneliti telah melaporkan kejadian cryptosporidiosis pada penderita acquired immunodeficiency syndrome (AIDS) dan pengidap human immunodeficiency virus (HIV). Seiring dengan meningkatnya angka kejadian AIDS dan pengidap H1V di dunia maka diperkirakan angka kejadian cryptosporidiosis turut meningkat. Di Indonesia sendiri telah dilaporkan peningkatan kasus AIDS mencapai 5823 kasus dan 4333 kasus HIV sehingga diperkirakan angka kejadian cryptosporidiosis juga turut meningkat.
Prevalensi cryptosporidiosis di negara berkembang diperkirakan berkisar 5-20% dan di negara miskin mencapai lebih dari 30%. Cryptosporidium lebih sering menginfeksi anak-anak. Prevalensi tertinggi terjadi pada anak usia di bawah 5 tahun. Perch dkk dalam penelitiannya mendapatkan prevalensi terbanyak pada usia di bawah 3 tahun. Diperkirakan hal ini erat hubungannya dengan status imun anak. Berbagai hal dapat mempengaruhi terjadinya cryptosporidiosis seperti kekurangan air bersih, sanitasi buruk, kepadatan rumah tinggal, banyak hewan di lingkungan perumahan, letak rumah dekat dengan sungai atau peternakan, rumah tinggal yang terkena banjir, musim, serta faktor risiko individu seperti status gizi. Katsumata dan kawan-kawan dalam penelitian yang dilakukan di Surabaya mendapatkan faktor risiko infeksi Cryptosporidium berupa kepadatan rumah tinggal, musim hujan dan rumah tinggal yang terlanda banjir. Saat ini belum terdapat data prevalensi infeksi Cryptosporidium pada anak balita maupun faktor risiko penyakit ini di Jakarta."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2006
T58476
UI - Tesis Membership  Universitas Indonesia Library
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Deasy Grafianti
Efek samping pengobatan antiepilepsi jangka panjang terhadap tubulus ginjal = Side effect of long term antiepileptic drugs on kidney tubules
"[ABSTRAK
Latar belakang: Obat antiepilepsi (OAE), seperti asam valproat (valproic acid,
VPA) dan karbamazepin (carbamazepin, CBZ) sering digunakan dalam jangka waktu
panjang. Obat-obatan tersebut dapat mengganggu fungsi tubulus ginjal. N-acetylbeta-D-glucosaminidase
(NAG) urin merupakan enzim yang dapat dipakai sebagai
marka fungsi tubulus sehingga diharapkan dapat mendeteksi jejas tubulus. Penelitian
mengenai efek nefrotoksik VPA dan CBZ terhadap tubulus menggunakan penanda
NAG urin ini belum pernah dilakukan di Indonesia.
Tujuan: Mengukur indeks NAG (iNAG) urin pada anak epilepsi yang mendapat
VPA dan atau CBZ jangka panjang untuk mendeteksi efek nefrotoksik kedua OAE
tersebut pada tubulus ginjal.
Metodologi: Penelitian ini menggunakan studi potong lintang yang dilakukan pada
Januari-Maret 2015. Subjek penelitian ini adalah 36 anak epilepsi dengan monoterapi
VPA, 14 dengan monoterapi CBZ, 14 dengan kombinasi VPA dan CBZ, rentang usia
3-16 tahun. Pada seluruh subjek dilakukan pemeriksaan kadar kreatinin urin dan
kadar NAG urin. Sebagai nilai acuan kadar NAG urin, dipilih 30 anak sehat dengan
usia yang disesuaikan dengan subjek penelitian. Untuk menghilangkan variabilitas
harian, maka NAG urin dibagi dengan kreatinin urin, menjadi iNAG (satuan U/g
kreatinin). Indeks NAG dikategorikan meningkat bila nilainya lebih dari rerata NAG
+ 2 SD kelompok anak sehat.
Hasil: Rerata iNAG urin pada kelompok anak sehat, monoterapi VPA, monoterapi
CBZ dan kombinasi VPA dan CBZ berturut-turut adalah 3,01; 5,9; 4,07; 6,9. Tiap
kelompok kasus memiliki rerata iNAG urin lebih tinggi dibandingkan anak sehat.
Proporsi kenaikan iNAG urin ditemukan pada 11/ 36 anak dengan monoterapi VPA,
2/14 pada kelompok monoterapi CBZ, dan 9/14 pada terapi kombinasi VPA dan
CBZ.
Simpulan: Pemberian VPA jangka panjang dapat menyebabkan jejas pada tubulus ginjal dengan parameter kenaikan iNAG urin, dan jejas tubulus ini meningkat dengan pemakaian VPA dan CBZ secara kombinasi.ABSTRACT Background: Antiepileptic drugs such as valproic acid (VPA) and carbamazepine
(CBZ) are often used in the long term manner. These drugs may disrupt the function
of the kidney tubules. Urinary N-acetyl-beta-D-glucosaminidase (NAG) is an enzyme
that can be utilised as marker of tubular function and is therefore expected to be
useful in detecting kidney tubular injuries. There have been no studies conducted in
Indonesia on the nephrotoxic effect of VPA and CBZ to tubules using urinary NAG
as marker.
Objectives: To measure urinary NAG index (iNAG) in epileptic children with longterm
use of VPA and CBZ in order to detect their nephrotoxic effects on kidney
tubules.
Methods: This is a cross-sectional study performed on January to March 2015. The
subject includes 36 patients on VPA monotherapy, 14 patients on CBZ monotherapy,
and 14 patients on VPA-CBZ combination therapy with age ranging from 3 to 16
years old. Urine creatinine concentration and urinary NAG values of all the patients
are measured. Thirty age-adjusted healthy children are included in the study for NAG
value reference. To eliminate NAG diurnal variability, iNAG is calculated by
dividing urinary NAG value and urine creatinine concentration. Urinary iNAG values
that fall above the +2 standard deviations from the mean of healthy children are
considered elevated.
Results: Urinary iNAG values of the healthy children, VPA monotherapy, CBZ
monotherapy, and VPA-CBZ comination therapy groups are 3.01; 5.9; 4.07; 6.9 U/g
respectively. Each case group has higher urinary iNAG mean value than the control
group. Urinary iNAG urine increased proportion is found in 11/36 children on VPA
monotherapy, 2/14 children on CBZ monotherapy, and 9/14 children on VPA-CBZ
combination therapy.
Conclusions: Long-term VPA use may cause renal tubular injuries with increased urinary iNAG value as parameter. Tubular injury is increased with the use of VPA and CBZ in combination. ;Background: Antiepileptic drugs such as valproic acid (VPA) and carbamazepine
(CBZ) are often used in the long term manner. These drugs may disrupt the function
of the kidney tubules. Urinary N-acetyl-beta-D-glucosaminidase (NAG) is an enzyme
that can be utilised as marker of tubular function and is therefore expected to be
useful in detecting kidney tubular injuries. There have been no studies conducted in
Indonesia on the nephrotoxic effect of VPA and CBZ to tubules using urinary NAG
as marker.
Objectives: To measure urinary NAG index (iNAG) in epileptic children with longterm
use of VPA and CBZ in order to detect their nephrotoxic effects on kidney
tubules.
Methods: This is a cross-sectional study performed on January to March 2015. The
subject includes 36 patients on VPA monotherapy, 14 patients on CBZ monotherapy,
and 14 patients on VPA-CBZ combination therapy with age ranging from 3 to 16
years old. Urine creatinine concentration and urinary NAG values of all the patients
are measured. Thirty age-adjusted healthy children are included in the study for NAG
value reference. To eliminate NAG diurnal variability, iNAG is calculated by
dividing urinary NAG value and urine creatinine concentration. Urinary iNAG values
that fall above the +2 standard deviations from the mean of healthy children are
considered elevated.
Results: Urinary iNAG values of the healthy children, VPA monotherapy, CBZ
monotherapy, and VPA-CBZ comination therapy groups are 3.01; 5.9; 4.07; 6.9 U/g
respectively. Each case group has higher urinary iNAG mean value than the control
group. Urinary iNAG urine increased proportion is found in 11/36 children on VPA
monotherapy, 2/14 children on CBZ monotherapy, and 9/14 children on VPA-CBZ
combination therapy.
Conclusions: Long-term VPA use may cause renal tubular injuries with increased urinary iNAG value as parameter. Tubular injury is increased with the use of VPA and CBZ in combination. , Background: Antiepileptic drugs such as valproic acid (VPA) and carbamazepine
(CBZ) are often used in the long term manner. These drugs may disrupt the function
of the kidney tubules. Urinary N-acetyl-beta-D-glucosaminidase (NAG) is an enzyme
that can be utilised as marker of tubular function and is therefore expected to be
useful in detecting kidney tubular injuries. There have been no studies conducted in
Indonesia on the nephrotoxic effect of VPA and CBZ to tubules using urinary NAG
as marker.
Objectives: To measure urinary NAG index (iNAG) in epileptic children with longterm
use of VPA and CBZ in order to detect their nephrotoxic effects on kidney
tubules.
Methods: This is a cross-sectional study performed on January to March 2015. The
subject includes 36 patients on VPA monotherapy, 14 patients on CBZ monotherapy,
and 14 patients on VPA-CBZ combination therapy with age ranging from 3 to 16
years old. Urine creatinine concentration and urinary NAG values of all the patients
are measured. Thirty age-adjusted healthy children are included in the study for NAG
value reference. To eliminate NAG diurnal variability, iNAG is calculated by
dividing urinary NAG value and urine creatinine concentration. Urinary iNAG values
that fall above the +2 standard deviations from the mean of healthy children are
considered elevated.
Results: Urinary iNAG values of the healthy children, VPA monotherapy, CBZ
monotherapy, and VPA-CBZ comination therapy groups are 3.01; 5.9; 4.07; 6.9 U/g
respectively. Each case group has higher urinary iNAG mean value than the control
group. Urinary iNAG urine increased proportion is found in 11/36 children on VPA
monotherapy, 2/14 children on CBZ monotherapy, and 9/14 children on VPA-CBZ
combination therapy.
Conclusions: Long-term VPA use may cause renal tubular injuries with increased urinary iNAG value as parameter. Tubular injury is increased with the use of VPA and CBZ in combination. ]"
Fakultas Kedokteran Universitas Indonesia, 2015
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library
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Cahyani Gita Ambarsari
Pemberian besi intravena dosis rumatan untuk mencegah anemia defisiensi besi pada anak dengan penyakit ginjal kronik derajat 5 yang menjalani hemodialisis kronik = Intravenous iron maintenance to prevent iron deficiency anemia in pediatric chronic kidney disease on hemodialysis
"ABSTRAK
Latar Belakang: Defisiensi besi merupakan salah satu penyebab anemia pada anak dengan penyakit ginjal kronik PGK derajat 5 yang menjalani hemodialisis HD regular. Pemberian besi intravena IV dosis loading terbukti bermanfaat mengoreksi kekurangan besi, namun belum ada studi yang baik mengenai manfaat pemberian besi IV dosis rumatan setelah terjadi replesi besi, untuk mempertahankan kadar hemoglobin Hb dan profil besi. Metoda: Disain studi adalah kohort retrospektif menggunakan data rekam medis, pada anak usia ABSTRACT Background Iron deficiency is a common cause of anemia in children with chronic kidney disease CKD on hemodialysis HD . Iron repletion with intravenous IV iron sucrose formulations has been studied in children, however effectiveness of maintenance IV iron regimens has not been reported extensively. Methods We conducted a retrospective cohort study on children with CKD on HD. Medical records were reviewed on all patients at the Children rsquo s Kidney Center, Cipto Mangunkusumo Hospital between January 1, 2015 and May 31, 2016. Patients with normal hemoglobin Hb and iron values were grouped into patients received IV iron sucrose maintenance and patients without IV iron sucrose maintenance. In the first group, patients received 2 mg kg dose of IV iron sucrose once every other week for 2 doses. Laboratory tests for Hb and iron values were recorded twice. First laboratory test was the baseline, shows normal Hb and iron values in both groups. The second laboratory test was taken after 6 weeks of baseline test. Objectives We assessed effects of IV iron sucrose maintenance by the difference in proportions of iron deficiency anemia between two groups based on repeat laboratory test 6 weeks after baseline test. Results During the study period, a total of 74 children had normal Hb and iron values at the beginning of the study. Forty seven patients received IV iron sucrose maintenance and 27 children did not receive IV iron maintenance. Repeat laboratory test 6 weeks after baseline test shows proportion of iron deficiency anemia was 5 47 10.64 in patients with IV iron and 16 27 59.26 in patients without IV iron. Between group difference for proportions was 48.62 P"
Fakultas Kedokteran Universitas Indonesia, 2017
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library
cover
Anisa Rahmadhany
Penggunaan seng topikal pada uji tuberkulin = The use of topical zinc cream in tuberculin test
"Latar Belakang : Diagnosis tuberkulosis pada anak tidak mudah sehingga sering terjadi under diagnosis atau over diagnosis. Uji tuberkulin sebagai penunjang untuk mengetahui infeksi tuberkulosis memiliki angka negatif palsu 10-25%. Mayoritas pasien tuberkulosis anak memiliki kadar seng plasma yang rendah dibanding anak sehat.
Tujuan : Mengetahui efektivitas krim seng topikal untuk meningkatkan diameter indurasi uji tuberkulin pada pasien TB anak.
Metode : Uji klinis tidak tersamar dengan subjek penelitian bertindak sebagai perlakuan dan kontrol (matching) yang berlangsung selama bulan Oktober 2012 hingga Desember 2012. Subjek penelitian merupakan pasien tuberkulosis usia 2- 18 tahun di Departemen IKA RSCM dan Bagian Anak RS Persahabatan yang memenuhi kriteria inklusi dan eksklusi Analisis data penelitian dengan menggunakan uji non parametrik Wilcoxon signed rank test menggunakan SPSS versi 15.
Hasil : Penelitian dilakukan pada 47 subjek. Mayoritas subjek penelitian memiliki status gizi baik (53%), median durasi pengobatan <6 bulan, median usia 72 bulan dan 47% merupakan kelompok usia <5 tahun. Sebanyak 16 subjek memiliki median selisih perbedaan indurasi uji tuberkulin lengan kanan dan kiri sebesar 1 mm (P<0,001) namun secara klinis tidak bermakna. Tiga puluh subjek lainnya tidak memiliki perbedaan indurasi uji tuberkulin lengan kanan dan kiri. Dua puluh subjek (43%) mengalami reaksi Koch setelah penambahan krim seng topikal. Pemberian krim plasebo tidak menyebabkan reaksi Koch.
Simpulan : Pemberian krim seng topikal tidak terbukti bermakna secara klinis dalam meningkatkan indurasi uji tuberkulin dibandingkan krim plasebo.
Background : Diagnosis of tuberculosis in children is difficult, under diagnosis or over diagnosis is commonly happened. Tuberculin test as an important supporting examination for tuberculosis infection has false negative value 10-25%. Majority of children with tuberculosis have lower plasma zinc level than healthy children.
Objective : To evaluate effectiveness of topical zinc cream in augmenting diameter of tuberculin induration among children with tuberculosis.
Methods : Unblinded clinical trial involving subjects matched with themselves was performed between October 2012 until December 2012. Subjects were children with tuberculosis aged 2-18 years old in Child Health Departement Cipto Mangunkusumo Hospital dan Persahabatan Hospital, Jakarta. Data analysis was performed with Wilcoxon signed rank test using SPSS 15 version.
Results : There were 47 subjects recruited in this study. Majority of subjects were well nourished (53%), underwent treatment <6 months (median), aged 72 months (median) and were under-five children (47%). Sixteen subjects showed 1 mm (median) difference of tuberculin induration between zinc arm and placebo arm (P<0,001). This difference is statistically significant but clinically insignificant. Twenty two subjects (43%) had Koch reaction after zinc cream application. Application of placebo cream didn't cause any Koch reaction.
Conclusion: Application of topical zinc cream is clinically insignificant to augment tuberculin induration compared to placebo cream."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2013
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UI - Tesis Membership  Universitas Indonesia Library
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Ayijati Khairina
Urinalisis sebagai uji diagnostik infeksi saluran kemih pada anak berusia 2 bulan hingga 2 tahun dengan gejala demam = Urinalysis as diagnostic tool for urinary tract infection in children aged 2 months 2 years old with febrile as the main symptom / Ayijati Khairina
"ABSTRACT
Latar belakang. Anak berusia 2 bulan - 2 tahun yang menderita infeksi saluran
kemih (ISK) dengan gejala demam perlu mendapat perhatian karena memiliki
risiko kerusakan ginjal, gejala klinis yang tidak spesifik pada traktus urinarius,
serta pengambilan sampel urin yang sulit. Urinalisis merupakan pemeriksaan
penunjang utama pada ISK karena cepat dan tersedia secara luas.
Tujuan. Penelitian ini bertujuan menilai sensitivitas, spesifisitas, nilai duga
positif (NDP), nilai duga negatif (NDN), pretest odds, rasio kemungkinan positif
(RKP), rasio kemungkinan negatif (RKN), post-test odds, dan post-test
probability dari masing-masing komponen urinalisis, yaitu nitrit, esterase leukosit
(EL), leukosituria, bakteriuria beserta gabungannya untuk memprediksi ISK pada
anak berusia 2 bulan hingga 2 tahun dengan gejala demam.
Metode. Penelitian ini merupakan uji diagnostik yang dilakukan di RSCM, RSUD
Tangerang, RSUP Fatmawati, dan RSUD Budhi Asih pada anak berusia 2 bulan -
2 tahun. Kriteria inklusi meliputi pasien dengan kecurigaan ISK, yaitu demam
dengan suhu lebih dari, atau sama dengan 390C, demam lebih dari 2 hari, dan
tidak ditemukan penyebab lain (infeksi saluran pernapasan akut, otitis media akut,
infeksi sistem saraf pusat, dan campak), serta belum mendapat antibiotik dalam 1
minggu terakhir. Kriteria eksklusi meliputi pasien immunocompromise dan
kelainan anatomis pada traktus urinarius. Pengumpulan sampel urin untuk
pemeriksaan urinalisis dan kultur urin menggunakan urine collector.
Hasil. Tujuh puluh lima anak ISK dengan gejala demam memenuhi kriteria
penelitian. Prevalens ISK pada penelitian ini adalah 33%. Hasil positif pada nitrit,
EL, leukosituria, bakteria, dan gabungannya memiliki nilai sensitivitas berturutturut
24%, 68%, 56%, 52%, dan 54%. Nilai spesifisitas nitrit, EL, leukosituria,
bakteria, dan gabungannya berturut-turut 94%, 80%, 86%, 90%, dan 95%. Nilai
NDP nitrit, EL, leukosituria, bakteria, dan gabungannya berturut-turut 66%, 63%,
66%, 72%, dan 75%. Nilai NDN nitrit, EL, leukosituria, bakteria, dan
gabungannya berturut-turut 71%, 83%, 79%, 79%, dan 88%. Nilai RKP nitrit, EL,
leukosituria, bakteria, dan gabungannya berturut-turut 4; 3,4; 4; 5,2; dan 10,3.
Nilai RKN nitrit, EL, leukosituria, bakteria, dan gabungannya berturut-turut 0,8;
0,4; 0,5; 0,5; 0,5; dan 0,5.
Simpulan. Hasil gabungan komponen urinalisis (nitrit, EL, leukosituria, dan
bakteriuria) dapat digunakan untuk menyingkirkan ISK karena mempunyai
spesifisitas dan NDN tinggi, sehingga tidak diperlukan pemeriksaan kultur urin.
ABSTRACT
Background. Children aged 2 months to 2 years old with febrile urinary tract
infection (UTI) need special attention considering kidney complications,
unspecified symptoms, and difficult urine sample collection. Urinalysis was the
main supportive examination for UTI because of its immediate result and
widespread availability.
Objective. To estimate sensitivity, specificity, positive predictive value (PPV),
negative predictive value (NPV), pretest odds, positive likelihood ratio (LR+),
negative likelihood ratio (LR-), post-test odds, and post-test probability on each
urinalysis component, which are nitrite, leukocyte esterase (LE), leukocyturia, and
bacteriuria, and also combination of all four components in predicting UTI among
children aged 2 months to 2 years old with febrile as the main manifestations.
Methods. This is a diagnostic study held in Cipto Mangunkusumo Hospital,
Tangerang Hospital, Fatmawati Hospital, and Budhi Asih Hospital, involving
children aged 2 months to 2 years old. Inclusion criteria are fever with unknown
source (more than or 39⁰C), fever more than 2 days (without acute respiratory
infection, acute otitis media, central nervous system infection, or measles), and no
history of antimicrobial consumption in the past week. Exclusion criteria are
immunocompromised state and urinary tract abnormalities. Urine samples for
urinalysis and urine culture were collected using urine collector for all subjects.
Results. Seventy five children were participating in this study. We found 33%
prevalence of febrile UTI in this study. Sensitivity of nitrite, LE, bacteriuria,
leucocyturia, and all four components were 24%, 68%, 56%, 52%, and 54%. The
specificity of nitrite, LE, bacteriuria, leucocyturia, and all four components were
94%, 80%, 86%, 90%, and 95%. The PPV of nitrite, LE, bacteriuria, leucocyturia,
and all four components were 66%, 63%, 66%, 72%, and 75%. The NPV of
nitrite, LE, bacteriuria, leucocyturia, and all four components were 71%, 83%,
79%, 79%, and 88%. The LR+ of nitrite, LE, bacteriuria, leucocyturia, and all
four components were 4; 3,4; 4; 5,2; and 10,3. The LR- of nitrite, LE, bacteriuria,
leucocyturia, and all four components were 0,8; 0,4; 0,5; 0,5; and 0,5.
Summary. All four components of urinalysis (nitrite, LE, leucocyturia, and
bacteriuria) can be used to exclude UTI because of their high specificity and NPV,
so urinary culture is not needed."
2013
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Hertanti Indah Lestari
Kadar hepsidin untuk menentukan penyebab Anemia pada anak dengan penyakit ginjal kronik = Use of hepsidin to determine the etilogy of anemia in children with chronic kidney disease
"Latar belakang: Anemia penyakit kronik (APK), anemia defisiensi besi, dan anemia campuran dapat terjadi pada penyakit ginjal kronik (PGK). Untuk membedakan ketiganya dengan parameter laboratorium yang biasa diperiksa seperti feritin dan saturasi transferin tidaklah mudah. Hepsidin adalah parameter baru yang diharapkan menjadi panduan tata laksana anemia pada PGK.
Tujuan: Untuk mengetahui kadar hepsidin dan hubungannya dengan derajat PGK, kadar Hb, dan feritin, dan menentukan penyebab anemia pada anak dengan PGK.
Metode: Penelitian ini merupakan penelitian potong lintang pada subyek usia 2-18 tahun dengan PGK yang belum didialisis. Anemia karena hemolitik, perdarahan, infeksi, kadar feritin <30 ng/dL atau >1000 ng/dL, diekslusi. Penderita yang mendapat transfusi darah dan terapi eritropoietin juga diekslusi. Subyek dibagi menjadi Grup I (LFG >60 mL/menit/1,73m2) dan Grup II (LFG <60 mL/menit/1,73m2).
Hasil: Terdapat 29 subyek pada kedua grup. Anemia terjadi pada 34 dari 58 subyek, 24 diantaranya merupakan APK dan 10 merupakan anemia campuran. Kadar hepsidin pada grup II (median 33,4 ng/mL, rentang 13,76-135,15) secara bermakna lebih tinggi dibandingkan grup I (median 12,5 ng/mL, rentang 0,35-34,62). Kadar hepsidin memiliki korelasi positif dengan feritin (p<0,001). Dengan analisis ROC, didapatkan kadar hepsidin >18 ng/mL dapat memprediksi APK. Kadar feritin >99,7 ng/dL dapat memprediksi hepsidin >18 ng/mL (sensitifitas 74,2% dan spesifisitas 70,4%).
Simpulan: Anemia penyakit kronik dengan kadar hepsidin yang meningkat merupakan penyebab anemia yang terbanyak terutama pada derajat PGK yang lebih berat. Kadar feritin >99,7 ng/dL dapat digunakan untuk memprediksi kadar hepsidin >18 ng/mL, sehingga dapat dipakai untuk menentukan penyebab anemia adalah APK.
Background: Anemia in chronic kidney diseases (CKD) can caused by anemia of chronic disease (ACD), iron deficiency, and both (mix anemia). It was not easy to differentiate the etiology of anemia by using usual hematologic measurement such as ferritin and transferrin saturation. Hepsidin is a new parameter which expected to become guideline in management of anemia in CKD.
Objectives: To know hepsidin level and its correlation with glomerular filtration rate, hemoglobin and ferritin level, and to know cutt-off of ferritin to predict hepsidin level.
Methods: This is a cross-sectional study in non-dialyzed children at age 2-18 years old with CKD. Children with signs of infection, anemia caused by haemolytic, bleeding, ferritin level <30 ng/dL or >1000 ng/dL was excluded. Children who get blood transfusions or erythropoietin also excluded. Subjects are divided into Grup I (GFR >60 mL/min/1,73m2) and Grup II (GFR <60 mL/min/1,73m2).
Results: There are 29 subjects in each grup. Anemia occur in 34 of 58 subjects, 24 were ACD dan 10 were mixed anemia. Hepsidin level in grup II (median 33,4, range 13,76-135,15) ng/mL was higher than grup I (median 12,5, rentang 0,35- 34,62) ng/mL (p<0,001). Hepsidin level has positive correlation with ferritin (p<0,001). In ROC analysis, hepsidin level >18 ng/mL can predict ACD. Ferritin level >99,7 ng/dL can predict hepsidin level >18 ng/mL (sensitivity 74,2%, specificity 70,4%).
Conclusions: ACD with high hepsidin level was the most etiology of anemia in children with CKD. Hepsidin level was higher in stage 3-5 CKD compared to milder stage. Feritin level >99,7 ng/dL can predict hepsidin level >18 ng/mL, so can be used to determine that the etiology of anemia was ACD."
Depok: Universitas Indonesia, 2015
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Selli Muljanto
Cedera Tubular pada anak dengan Sindrom Nefrotik Resisten Steroid = Tubular injury in children with steroid resistant nephrotic syndrome
"[ABSTRAK
Lesi tubular lebih sering ditemukan pada sindrom nefrotik resisten steroid (SNRS)
dengan proteinuria masif, yang menyebabkan disfungsi tubulus proksimal. Cedera
tubular dapat pula didiagnosis dengan uji fungsi tubulus, diantaranya adalah fraksi
ekskresi magnesium (FE Mg) dan β2-mikroglobulin (β2M) urin. Tujuan
penelitian ini membandingkan FE Mg dan β2M urin pada SNRS dan SN sensitif
steroid (SNSS) remisi. Penelitian potong lintang dilakukan di Departemen Ilmu
Kesehatan Anak RSUPN Dr. Cipto Mangunkusumo Jakarta, RSUD Ulin
Banjarmasin, RSUP Fatmawati dan RSAB Harapan Kita Jakarta pada Juli sampai
Desember 2015 pada penderita SNRS dan SNSS remisi berusia 2 ? 15 tahun. Pada
subyek diperiksakan kadar β2M urin dan FE Mg. Didapatkan 62 subyek yang
terdiri dari 31 subyek SNRS dan 31 subyek SNSS remisi. Rerata FE Mg pada
SNRS lebih tinggi secara bermakna dibandingkan SNSS remisi (p=0,0065).
Median kadar β2M urin pada SNRS lebih tinggi dibandingkan SNSS remisi (p <
0,001). Peningkatan kadar β2M urin lebih banyak secara bermakna pada SNRS
dibandingkan SNSS (p=0,007). Dengan titik potong 1,64%, peningkatan FE Mg
pada SNRS lebih banyak dibandingkan SNSS remisi (p=0,022). Simpulan: Fraksi
ekskresi Mg dan β2M urin pada SNRS lebih tinggi dibandingkan SNSS remisi.
Terdapat perbedaan proporsi peningkatan FE Mg antara SNRS dan SNSS remisi.
Proporsi peningkatan β2M urin pada SNRS lebih besar dibandingkan SNSS
remisi.
ABSTRACT
Tubular lesions more often found in steroid-resistant nephrotic syndrome (SRNS)
with massive proteinuria, leading to proximal tubular dysfunction. Tubular injury
can also be diagnosed by tubular function test, such as fractional excretion of
magnesium (Mg FE) and urinary β2-microglobulin (β2M). The aim of this study
is to compare the FE Mg and urinary β2M on SRNS and steroid-sensitive
nephrotic syndrome (SSNS) in remission. A cross-sectional study was conducted
in the Department of Pediatrics RSUPN Dr. Cipto Mangunkusumo Jakarta, RSUD
Ulin Banjarmasin, RSUP Fatmawati and RSAB Harapan Kita Jakarta from July to
December 2015. Children aged 2-15 years who either had SRNS or SSNS in
remission were recruited. Fractional excretion of magnesium and urinary β2M
levels were examined. There were 62 subjects consisted of 31 subjects SRNS and
31 subjects SSNS in remission. The mean FE Mg on SRNS was significantly
higher than SSNS in remission (p=0.0065). Median levels of urinary β2M on
SRNS was higher than SNSS remission (p<0.001). Increased levels of urinary
β2M was more significantly in SRNS compared to SSNS (p=0.007). With a cutoff
point of 1.64%, an increased of FE Mg proportion on SRNS was more than
SSNS in remission (p = 0.022). Conclusion: Fractional excretion of Mg and
urinary β2M on SRNS were higher than SSNS in remission. There is a difference
between the increased of FE Mg on SRNS and SSNS in remission. The increased
of urinary β2M on SRNS was higher than SSNS in remission.;Tubular lesions more often found in steroid-resistant nephrotic syndrome (SRNS)
with massive proteinuria, leading to proximal tubular dysfunction. Tubular injury
can also be diagnosed by tubular function test, such as fractional excretion of
magnesium (Mg FE) and urinary β2-microglobulin (β2M). The aim of this study
is to compare the FE Mg and urinary β2M on SRNS and steroid-sensitive
nephrotic syndrome (SSNS) in remission. A cross-sectional study was conducted
in the Department of Pediatrics RSUPN Dr. Cipto Mangunkusumo Jakarta, RSUD
Ulin Banjarmasin, RSUP Fatmawati and RSAB Harapan Kita Jakarta from July to
December 2015. Children aged 2-15 years who either had SRNS or SSNS in
remission were recruited. Fractional excretion of magnesium and urinary β2M
levels were examined. There were 62 subjects consisted of 31 subjects SRNS and
31 subjects SSNS in remission. The mean FE Mg on SRNS was significantly
higher than SSNS in remission (p=0.0065). Median levels of urinary β2M on
SRNS was higher than SNSS remission (p<0.001). Increased levels of urinary
β2M was more significantly in SRNS compared to SSNS (p=0.007). With a cutoff
point of 1.64%, an increased of FE Mg proportion on SRNS was more than
SSNS in remission (p = 0.022). Conclusion: Fractional excretion of Mg and
urinary β2M on SRNS were higher than SSNS in remission. There is a difference
between the increased of FE Mg on SRNS and SSNS in remission. The increased
of urinary β2M on SRNS was higher than SSNS in remission., Tubular lesions more often found in steroid-resistant nephrotic syndrome (SRNS)
with massive proteinuria, leading to proximal tubular dysfunction. Tubular injury
can also be diagnosed by tubular function test, such as fractional excretion of
magnesium (Mg FE) and urinary β2-microglobulin (β2M). The aim of this study
is to compare the FE Mg and urinary β2M on SRNS and steroid-sensitive
nephrotic syndrome (SSNS) in remission. A cross-sectional study was conducted
in the Department of Pediatrics RSUPN Dr. Cipto Mangunkusumo Jakarta, RSUD
Ulin Banjarmasin, RSUP Fatmawati and RSAB Harapan Kita Jakarta from July to
December 2015. Children aged 2-15 years who either had SRNS or SSNS in
remission were recruited. Fractional excretion of magnesium and urinary β2M
levels were examined. There were 62 subjects consisted of 31 subjects SRNS and
31 subjects SSNS in remission. The mean FE Mg on SRNS was significantly
higher than SSNS in remission (p=0.0065). Median levels of urinary β2M on
SRNS was higher than SNSS remission (p<0.001). Increased levels of urinary
β2M was more significantly in SRNS compared to SSNS (p=0.007). With a cutoff
point of 1.64%, an increased of FE Mg proportion on SRNS was more than
SSNS in remission (p = 0.022). Conclusion: Fractional excretion of Mg and
urinary β2M on SRNS were higher than SSNS in remission. There is a difference
between the increased of FE Mg on SRNS and SSNS in remission. The increased
of urinary β2M on SRNS was higher than SSNS in remission.]"
2016
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