Hasil Pencarian  ::  Simpan CSV :: Kembali

"ABSTRAKLatar belakang: Vitamin D dianggap berperan dalam patogenesis diabetes melitus tipe 1 (DMT1), memperbaiki kontrol metabolik dan menurunkan risiko terjadinya komplikasi mikrovaskuler.Tujuan: Mengetahui profil kadar vitamin D remaja DMT1 dan hubungan kadar vitamin D dengan retinopati dan nefropati diabetik.Metode: Penelitian potong lintang pada remaja DMT1 usia 11-21 tahun dengan lama sakit minimal satu tahun. Semua subjek dilakukan wawancara menggunakan kuesioner, pemeriksaan fisis lengkap, kadar 25(OH)D, HbA1c, rasio albumin/kreatinin urin, dan fotografi fundus.Hasil: Terdapat 49 subjek, 34 (69,4%) perempuan dan 15 (30,6%) lelaki dengan median lama sakit lima tahun (1-16 tahun). Sebanyak 96% subjek menggunakan insulin basal bolus. Median HbA1c adalah 9,5% (6,3% - 18%). Tidak ada subjek dengan kadar 25(OH)D ≥ 30 ng/mL, 6 subjek (12,2%) dengan kadar 25(OH)D 21-19 ng/mL dan 87,8% memiliki kadar 25(OH)D ≤ 20 ng/mL. Rerata kadar 25(OH)D adalah 12,6 ng/mL (SD ±5,4 ng/mL). Faktor yang berhubungan dengan kadar vitamin D adalah lama pajanan matahari (RP 13,3; 95%IK = 1,8-96, p= 0,019). Jenis pakaian, penggunaan sunblock, IMT, lama sakit, konsumsi susu tidak berhubungan dengan kadar vitamin D. Prevalens retinopati pada penelitian ini adalah 8,2%, mikroalbuminuria 28,5%, dan nefropati 16,3%. Tidak terdapat hubungan bermakna antara kadar vitamin D dengan retinopati, mikroalbuminuria, dan nefropati diabetik.Kesimpulan: Tidak ada remaja DMT1 dengan kadar vitamin D yang cukup dan tidak ada hubungan antara kadar vitamin D dengan retinopati, mikroalbuminuria, dan nefropati diabetik.;Background: Many studies showed that vitamin D involved in the pathogenesis of type 1 diabetes mellitus (T1DM), metabolic control and decreased the risk of microvascular complication.

---

ABSTRACT

Objective: To find out the vitamin D profile in adolescence with T1DM and its association with retinopathy and nephropathy diabetic.

Methods: This was a cross sectional study performed during April to May 2015 involving T1DM adolescence aged 11-21 years old with duration of illness ≥ 1 year. We used questionnaire to know factors associated with vitamin D level. We performed physical examinations, tests for level of 25(OH)D serum, HbA1c, urine albumin/creatinine ratio and fundal photographic.

Results: There were 49 subjects, 34 female (69.4%) and 15 male (30.6%) with median duration of illness was five years (1-16 years). Most of the subjects (96%) were on basal bolus regimen. Median of HbA1c level was 9.5% (range 6.3%-18%). None of the subject had 25(OH)D level ≥ 30 ng/mL, 12.2% with 25(OH)D level of 21-19 ng/mL and 87,8% was ≤ 20 ng/mL. Mean of 25(OH)D level was 12.6 ng/mL (SD ±5.4 ng/mL). Duration of sun exposure was associated with 25(OH)D level (prevalent ratio of 13.3; 95%CI = 1.8-96, p= 0.019); While type of clothing, sunblock, body mass index, milk and juice intake were not associated with 25(OH)D level. Diabetic retinopathy was found in 4 subjects (8.2%), microalbuminuria in 14 subjects (28.5%), and nephropathy in 8 subjects (16.3%). All the subjects who suffered from microvascular complication had 25(OH)D level ≤ 20 ng/mL. None of the subjects with 25 (OH)D > 20 ng/mL suffered had microvascular complication. There was no significant association between vitamin D level with diabetic retinopathy, microalbuminuria, or diabetic nephropathy.

Conclusion: None of the adolescent with type 1 DM had sufficient vitamin D level, and 87.8% had vitamin D deficiency. There was no association between vitamin D level with diabetic retinopathy, microalbuminuria, or diabetic nephropathy."

"Latar Belakang: Hipertensi merupakan salah satu faktor risiko kejadian penyakit kardiovaskular. Hipertensi pada remaja dapat terus berlanjut pada usia dewasa dan menyebabkan morbiditas dan mortalitas yang lebih tinggi. Faktor risiko hipertensi pada remaja multifaktorial. Tujuan: Mengetahui prevalens dan faktor yang memengaruhi kejadian hipertensi pada remaja siswa Sekolah Menengah Pertama (SMP) di Jakarta Pusat. Metode: Studi potong lintang pada 313 anak usia 12-18 tahun siswa SMP. Data riwayat hipertensi dalam keluarga, ras/suku, berat lahir, aktifitas fisis, merokok dan konsumsi alkohol diperoleh dari kuesioner. Pada subjek penelitian juga dilakukan pemeriksaan berat badan, tinggi badan dan tekanan darah. Kriteria hipertensi berdasarkan The Fourth Report of National High Blood Pressure Education Programme Working Group on High Blood Pressure in Children and Adolescent. Hasil: Di antara 313 remaja dengan rerata usia 13,97±1,02 tahun, prevalens hipertensi adalah sebesar 9,6%. Pada analisis bivariat didapatkan hubungan yang bermakna antara riwayat hipertensi dalam keluarga (ayah hipertensi; p = 0,012, IK 95% = 1,20-6,02) dan berat badan lebih/obesitas (p<0,001; IK 95% = 2,99-14,42) dengan hipertensi. Hasil analisis multivariat menunjukkan bahwa berat badan lebih/obesitas mempunyai risiko enam kali mengalami hipertensi dibandingkan remaja dengan berat badan normal. (OR = 6,5; IK 95% = 2,99-14,43). Tidak terdapat hubungan bermakna antara jenis kelamin, berat lahir rendah, ras/suku, aktivitas fisis, dan merokok dengan hipertensi. Simpulan: Prevalens hipertensi pada remaja dalam penelitian ini cukup tinggi. Terdapat hubungan yang bermakna antara riwayat hipertensi dalam keluarga dan berat badan lebih/obesitas dengan hipertensi. Pencegahan berat badan lebih atau obesitas diharapkandapat menurunkan prevalens hipertensi pada remaja.

---

Background: Hypertension in adolescent has been often associated with other cardiovascular risk factors. Contributing factors of hypertension in adolescent are multifactorial.

Objectives: To determine the prevalence of hypertension in Junior High School adolescents in Central Jakarta and its potentially associated factors, such as gender, family history of hypertension, race/ethnic, low birth weight, overweight/obesity, physical activity, smoking, and alcohol consumption.

Methods: A cross sectional study involved 313 children aged 12-18 years, where were randomly selected from Junior High Schools in Central Jakarta, during March – May 2014. Information about family history, race/ethnic, birth weight, physical activity levels, smoking and consumption of alcohol was gathered by questionnaire. Body weigth, heigth and blood pressure were measured. Hypertension was defined according to The Fourth Report of National High Blood Pressure Education Programme Working Group on High Blood Pressure in Children and Adolescent.

Results: The study included 313 adolescents with mean age 13.97±1.02 years. Prevalence of hypertension was 9.6%. Bivariate analysis showed that family history of hypertension (parental hypertension; p = 0.012; CI 95% = 1.20-6.02) and overweight/obesity (p<0.001; CI 95% = 2.99-14.42) were significantly associated with hypertension. The multivariate analysis indicated that overweight/obese adolescents displayed six times more chance of having hypertension than adolescents with light/normal weight (OR = 6.5; CI 95% = 2.99-14.43). Gender, low birth weight, race/ethnic, physical activity, and smoking were not significantly associated with hypertension.

Conclusions: The prevalence of hypertension in the sample studied was high. Overweight/obesity and family history of hypertension were significantly associated with hypertension. The prevention of overweight and obesity can decrease the prevalence of hypertension."

"Latar belakang: Duktus Arteriosus Persisten (DAP) adalah penyakit jantung bawaan yang paling umum terjadi pada bayi prematur. Penutupan DA spontan pada bayi prematur berhubungan langsung dengan maturitas lumen duktus dan sensitivitas DA terhadap kadar prostaglandin E2 (PGE2). Tujuan: Untuk mengetahui korelasi antara kadar prostaglandin E2 (PGE2) dengan ukuran duktus arteriosus persisten (DAP) pada bayi prematur. Metode: Penelitian observasional dengan metode pengukuran berulang atau repeatedmeasure pada bayi yang terdeteksi DAP pada hari ke 2-3 di Rumah Sakit Cipto Mangunkusumo dan Rumah Sakit Fatmawati, Jakarta, dari bulan April-Mei 2014. Diagnosis DAP menggunakan ekokardiografi 2-D dan analisis kuantitatif kadar PGE2 menggunakan sistim immunoassay ELISA. Korelasi antara kadar PGE2 dengan diameter DA secara statistik dievaluasi menggunakan uji Korelasi Pearson. Hasilnya: Tiga puluh tiga bayi prematur {(UG rerata 31 (28-32) minggu, BL rerata 1360 (1000-1500) gram)} yang terdaftar pada penelitian ini. Hampir dua pertiga dari pasien adalah laki-laki. Hampir semua (30 dari 33) subyek mengalami penutupan spontan DA sebelum usia 10 hari. Rerata diameter DA adalah 2,9 (SD 0.5) mm dengan kecepatan maksimum aliran transduktal (DVmax) adalah 0,2 (SD 0,06) cm/detik dan rasio LA/Ao 1,5 (SD 0,2). Masing-masing rerata kadar PGE2 serum pada usia 2-3, 5-7, dan setelah 10 hari adalah 5238,6 (SD 1.225,2), 4178,2 (SD 1.534,5), dan 915,2, (SD 151,6) pg ml. Pada hari ke 2-3 kadar PGE2 serum berkorelasi dengan diameter DA (r = 0,667, p <0,001), tetapi tidak pada hari 5-7 (r = 0.292, p = 0,105) atau hari ke-10 (r = 0.041, p = 0,941). Kesimpulan: Ada korelasi positip yang kuat antara kadar PGE2 dengan diameter DA bayi prematur pada usia 2-3 hari, namun tidak ada korelasi yang bermakna antara kadar PGE2 dengan menetapnya DAP.

---

Background: Persistent ductus arteriosus (PDA) is a congenital heart disease most commonly occuring in premature infants. Spontaneous DA closure in premature infants has been suggested to be associated with the maturity of duct lumen and the sensitivity of DA to prostaglandin E2 (PGE2).

Objectives: To determine the correlation between the serum levels of prostaglandin E2 (PGE2) to the size of a persistent ductus arteriosus (PDA) in premature infants.

Methods: Observational study using repeated measures on premature infants with PDA detected at day 2-3 in Cipto Mangunkusumo Hospital and Fatmawati Hospital, Jakarta, from April-May 2014. Diagnosis of PDA using a 2-D echocardiography and the quantitative analysis of PGE2 levels using immunoassay ELISA system. The correlation between PGE2 level with DA diameter were statistically evaluated using the Pearson Correlation test.

Results: Thirty-three premature infants (median gestational age 31 (28-32) weeks of gestational age, median birth weight 1360 (1000-1500) grams) were enrolled. Almost two thirds of patients were male. Almost all (30 of 33) subjects had spontaneous closure of DA before the age of 10 days. Mean DA diameter was 2.9 (SD 0.5) mm with maximum flow velocity of 0.2 (SD 0.06) cm/sec and LA/Ao of 1.5 (SD 0.2). Mean levels of PGE2 at the age of 2-3, 5-7, and after 10 days were 5238.6 (SD 1225.2), 4178.2 (SD 1534.5), and 915.2 (SD 151.6) pg/ml, respectively. The level of PGE2 level at day 2-3 was correlated with DA diameter (r = 0.667, p < 0.001), but not at day 5-7 (r = 0.292, p = 0.105) or day 10 (r = 0.041, p = 0.941).

Conclusion: There is a quite strong correlation positive between the levels of PGE2 in DA diameter in preterm infants at 2-3 days of age, although the correlation between levels of PGE2 by the persistence of PDA was not significant."

"Tetralogi Fallot (TF) merupakan penyakit jantung bawaan (PJB) sianotik terbanyak. Terapi definitifnya berupa koreksi total melalui operasi jantung terbuka, namun usia terbaik koreksi masih menjadi perdebatan. Operasi saat usia < 3 tahun disebut koreksi dini. Angka kesintasan jangka panjang pasien TF pasca-operasi mencapai 90%. Masalah baru yang muncul adalah gangguan neurodevelopmental yang dapat mempengaruhi kualitas hidup pasien.Tujuan: Mengetahui sebaran pasien TF pasca-operasi jantung terbuka, serta membandingkan perkembangan, kognitif dan kualitas hidup pasien TF pasca-operasi jantung terbuka yang menjalani koreksi dini dibandingkan koreksi terlambat.Metode: 29 subjek kelompok koreksi dini dan 34 subjek kelompok koreksi terlambat dipilih secara konsekutif. Penilaian perkembangan menggunakan Denver II. Tingkat kognitif dinilai dengan the Capute scales dan uji intelegensi Wechsler. Kualitas hidup dinilai dengan laporan PedsQLTM. Perbedaan antar kedua kelompok subjek dianalisis dengan menggunakan uji Kai kuadrat, uji Fischer, dan uji t tidak berpasangan.Hasil: Median usia operasi kelompok koreksi dini adalah 1,8 tahun dan kelompok koreksi terlambat adalah 5,3 tahun. Sebesar 54% subjek menjalani koreksi terlambat. Mikrosefal terjadi pada 15% keseluruhan subjek. Pada kedua kelompok subjek ditemukan masalah perkembangan. Sebesar 75% subjek kelompok koreksi dini memiliki developmental quotient normal. Kelompok koreksi dini memiliki nilai verbal intelligence quotient (IQ) (p 0,002; IK 95% 5,8-24,6) dan full-scale IQ (p0,003; IK 95% 4,7-21,3) yang lebih tinggi dibandingkan kelompok koreksi terlambat. Laporan PedsQLTM anak menunjukkan rendahnya kualitas hidup pada fungsi emosi (p=0,02) dan sekolah (p=0,03) pada kelompok koreksi terlambat.Simpulan: Pasien TF yang menjalani koreksi dini memiliki dan kualitas hidup yang lebih tinggi dibandingkan kelompok koreksi terlambat, sehingga diperlukan sosialisasi usia operasi koreksi dini.

---

Background: Tetralogy of Fallot (TF) is the most common cyanotic congenital heart disease. The definitive treatment is complete repair thru open heart surgery. At present, the most effective age category for repair is still being debated. Complete repair for children who are younger than 3 years is called early repair. Recent technological advancement has allowed the early repair to be performed earlier and improve the survival rate of the patients. However, these survivors risk having neurodevelopmental disorder which affect their health-related quality of life.

Objective: To describe the characteristics of post open heart surgery TF patients and compare the TF patients who undergo early correction to ones who undergo late correction within the aspects of development, cognitive outcomes, and health-related quality of life.

Design : Twenty nine subjects from early correction group and 34 subjects from late correction group were compared in development (Denver development screening II), cognitive outcomes (The Capute scales and Wechsler test), and health-related quality of life (PedsQLTM).

Result : Median age of the subjects in early correction group is 1,8 years and in late correction group is 5,3 years. Fifty five percent undergo late correction. The prevalence of microcephaly is 15%. Developmental delay is found in both group. Seventy five percent of subject who undergo early correction have normal developmental quotient. Early correction group have higher verbal intelligence quotient (IQ) (p=0.002; CI 95% 5.8-24.6) and full scale IQ (p=0.003; CI 95% 4.7-21.3). Child report PedsQLTM showed lower quality of life in late correction group.

Conclusions : Tetralogy of Fallot patients who undergo early correction have higher IQ and better health-related quality of life compared to late correction group. The age of early complete repair (< 3 years) needs to be disseminated."

"Latar belakang. Peningkatan morbiditas dan mortalitas pada bayi baru lahir dengan penyakit jantung bawaan (PJB) kritis berkaitan dengan diagnosis yang terlambat. Skrining pulse oksimetri sebelum bayi baru lahir pulang dari rumah sakit dapat membantu menegakkan diagnosis dini. Pulse oksimeter fingertip diharapkan menjadi alternatif pilihan alat pemeriksaan oksimetri karena murah, mudah, dan dapat digunakan secara luas. Tujuan. Penelitian ini bertujuan menilai sensitivitas, spesifisitas, nilai duga positif (NDP), nilai duga negatif (NDN), rasio kemungkinan positif (RKP), rasio kemungkinan negatif (RKN), pre-test probability, dan post-test probability pemeriksaan pulse oksimetri fingertip dibandingkan oksimetri generasi baru untuk deteksi dini PJB kritis pada bayi baru lahir sebelum pulang dari rumah sakit. Metode. Penelitian ini merupakan uji diagnostik yang dilakukan di Ruang Rawat Gabung RSCM pada semua bayi baru lahir bugar dengan usia gestasi ≥37 minggu dan berusia 24-72 jam. Pemeriksaan pulse oksimetri fingertip dan pulse oksimetri generasi baru dilakukan di tangan kanan (preduktal) dan kaki (postduktal). Subjek dengan saturasi oksigen <95% atau beda saturasi oksigen >3% antara tangan kanan dan kaki memerlukan pemeriksaan lebih lanjut. Ekokardiografi dikerjakan untuk diagnosis pasti. Hasil. Penelitian dilakukan selama enam bulan pada 442 bayi baru lahir bugar. Mayoritas subjek diperiksa pada usia 24-48 jam (59%), median usia gestasi 38 minggu. Terdapat enam subjek dengan kelainan kongenital. Tidak ada subjek dengan riwayat keluarga menderita PJB, didiagnosis PJB saat antenatal maupun melalui pemeriksaan fisis. Perolehan saturasi oksigen preduktal menggunakan dua jenis pulse oksimetri bervariasi secara statistik (Uji Bland-Altman) namun tidak bermakna secara klinis (hasil deteksi negatif 100%). Tidak ada subjek dengan hasil deteksi positif dan didiagnosis PJB kritis melalui pemeriksaan oksimetri. Pemeriksaan pulse oksimetri fingertip pada bayi baru lahir dipengaruhi gerakan bayi (67,6%) dan faktor alat (sinyal tidak terbaca dan hasil tidak stabil) 24,8%. Simpulan. Uji diagnostik pulse oksimetri fingertip dibandingkan generasi baru untuk deteksi dini PJB kritis pada penelitian ini belum dapat dinilai. Pemeriksaan kedua jenis pulse oksimetri tersebut memberikan hasil deteksi yang sama.

---

Background. Late diagnosis in the newborn with critical congenital heart disease (CCHD) is associated with increased morbidity and mortality. Pulse oximetry screening of newborn before hospital discharge can help early diagnosis. Fingertip pulse oximeter is expected to be an alternative option oximetry screening tool because it is affordable, easy, and can be widely used.

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 of fingertip pulse oximetry screening compared to a new generation to detect CCHD in the newborn before hospital discharge.

Methods. This is a diagnostic study held in newborn nursery of Cipto Mangunkusumo Hospital involving asymptomatic newborns aged 24-72 hours and gestational age ≥37weeks. Examination of fingertip and new generation pulse oxymetri was done in right hand (preductal) and foot (postductal). Subject had oxygen saturation <95% or difference of oxygen saturation between right hand and foot >3% requires further investigation. Echocardiography was performed for definitive diagnosis.

Results. The study was conducted during six months in 442 asymtomatic newborns. The majority of subjects were examined at age 24-48 hours (59%) and gestational age 38 weeks. There were six subjects with congenital abnormalities. No subjects with a family history of CHD nor diagnosed through antenatal and physical examination. Obtaining preductal oxygen saturation using two types pulse oximetry varied statistically (Bland-Altman test) but not clinically significant (100% negative detection results). No subject had positive detection result and was diagnosed CCHD through screening oximetry. Newborn examination using fingertip pulse oximetry were affected by movement (67.6%) and tool factors (signal unreadable and unstable results) 24.8%.

Conclusion. Diagnostic test of fingertip compared with new generation pulse oximetry in early detection of CCHD in this study can not be assessed. These two modalities show the same result of detection."