Jose Rl Batubara

Vitamin D profile in healthy children aged 7-12 years old in Indonesia

Background The recent data on the vitamin Dshowed a surprising result, which exhibited in high prevalence of vitamin D deficiency and insufficiency in children and adolescence. Thisnot only occurs in country that lies in high latitude but also in sun rich country. Many factors contributing to this condition, including changing in life style. No data available regarding vitamin D status in healthy children in Indonesiaand this will be the first study addressing this issue.

Jadwal Imunisasi Anak Usia 0 – 18 tahun Rekomendasi Ikatan Dokter Anak Indonesia 2017

Ikatan Dokter Anak Indonesia melalui Satuan Tugas Imunisasi mengeluarkan rekomendasi Imunisasi IDAI tahun 2017 untuk menggantikan jadwal imunisasi sebelumnya. Jadwal imunisasi 2017 ini bertujuan menyeragamkan jadwal imunisasi rekomendasi IDAI dengan jadwal imunisasi Kementerian Kesehatan RI khususnya untuk imunisasi rutin. Jadwal imunisasi 2017 juga dibuat berdasarkan ketersediaan kombinasi vaksin DTP dengan hepatitis B seperti DTPw-HB-Hib, DTPa-HB-Hib-IPV, dan dalam situasi keterbatasan atau kelangkaan vaksin tertentu seperti vaksin DTPa atau DTPw tanpa kombinasi dengan vaksin lainnya. Hal baru yang terdapat pada jadwal 2017 antara lain: vaksin hepatitis B monovalen tidak perlu diberikan pada usia 1 bulan apabila anak akan mendapat vaksin DTP-Hib kombinasi dengan hepatitis B; bayi paling sedikit harus mendapat satu dosis vaksin IPV (inactivated polio vaccine) bersamaan (simultan) dengan OPV-3 saat pemberian DTP-3; vaksin DTPw direkomendasikan untuk diberikan pada usia 2,3 dan 4 bulan. Hal baru yang lain adalah untuk vaksin influenza dapat diberikan vaksin inaktif trivalen atau quadrivalen, vaksin MMR dapat diberikan pada usia 12 bulan apabila anak belum mendapat vaksin campak pada usia 9 bulan. Vaksin HPV apabila diberikan pada remaja usia 10-13 tahun, pemberian cukup 2 dosis dengan interval 6-12 bulan; respons antibodi setara dengan 3 dosis. Vaksin Japanese Encephalitis direkomendasikan untuk diberikan mulai usia 12 bulan pada daerah endemis atau pada turis yang akan bepergian ke daerah endemis. Vaksin dengue direkomendasikan untuk diberikan pada anak usia 9-16 tahun dengan jadwal 0, 6, dan 12 bulan. Dengan pemberian imunisasi sesuai rekomendasi, diharapkan anak-anak Indonesia terlindungi dari penyakit infeksi yang dapat dicegah dengan imunisasi.

Pengobatan Testosteron pada Mikropenis

Mikropenis atau hipogenitalism adalah suatu keadaan penis dengan bentuk normal namun dengan ukuran kurang dari 2.5 SD di bawah rerata menurut umur dan status perkembangan pubertas. Pengukuran penis dilakukan secara fully stretched, menggunakan spatula kayu yang diletakkan sejajar dengan dorsum penis dan ditekan sampai simfisis pubis. Panjang penis adalah jarak dari simfisis pubis sampai ujung glans penis dan tidak dalam keadaan ereksi. Pengobatan mikropenis terhadap 23 anak dengan rerata usia 9.6 tahun dilakukan dengan pemberian testosteron ester intramuskular setiap 3 minggu sebanyak 4 kali. Pasca terapi penis bertambah panjang 85% dibandingkan sebelum terapi. Tidak terlihat adanya pertambahan usia tulang dengan protokol yang digunakan.

Effect of bisphosphonate treatment in osteogenesis imperfecta children in Cipto Mangunkusumo Hospital Jakarta

Results Seventy-seven OI cases (39 male), which were diagnosed at the age of 1 9 years old were recorded. Five patients underwent surgery and three patients died before commencing treatment. Nine patients received intravenous pamidronate and sixteen patients received zolendronic acid therapy. Liver and renal functions, as well as serum electrolyte levels were evaluated before and after treatment. Eight patients reported hyperthermia and three others experienced fatigue, bone pain, and abdominal pain within 24 hours of therapy. Serum calcium level decreased in eight patients. No serious adverse effects were documented.

Association of fat mass and obesity-associated gene rs9939609 variant with early onset obesity among bataknese and Chinese children in Indonesia

Methods We conducted a case control study in ten elementary schools in Medan, North Sumatera, Indonesia. Case group (n=105) were children with early onset obesity and control group (n=55) were normal weight children. The inclusion criteria were Bataknese and Chinese children, aged 6-12 years with early onset obesity. We examined body weight and height, body mass index, waist circumference. Genotyping was performed using a TaqMan assay for rs9939609 polymorphism.

Clinical phenotype and karyotype finding of Turner syndrome in Jakarta.

Turner syndrome (TS) is the most common sex chromosome abnormality of female, occurs in one in 2500 live-born females. TS combines’ characteristic physical features with complete or partial absence of the X chromosomes, frequently accompanied by cell mosaicsm. The aims of this study is to describe the clinical phenotype and karyotype of patient with Turner Syndrome in Jakarta, Indonesia. Data was collected from medical records of the Pediatrics Endocrinology Clinic, Cipto Mangunkusumo Hospital in Jakarta since 2000-2012. Of the 23 cases collected, the mean age at diagnosis was 7.75 years (range 0-15 years). The most common problem that bring patients came to the clinic were short stature (69.6%) and delayed puberty (30.4%). There were 8 patients with concomitant disorders: 4 cardiac abnormalities, 3 with ear disorders, 1 with hypertension. From16 patients who had bone age evaluation, 11 patients showed retarded age. A total of 17 patients had a karyotype 45, X and the rest are mosaics. Our study suggest that the main characteristics of Turner syndrome is a karyotype 45,X with the physical characteristics of short stature and delayed puberty.

Profile of Congenital Hypothyroidism in DR. Cipto Mangunkusumo Hospital

Results There were 40 children with CH included in the study. Boys 12(30 %) and girls 28(70%). Age when diagnosed 0-3 months 4(10%), 3-6 months 2(5%), 6-12 months 9 (22,5%), 1-6 years 20(50%), 6-14 years 5(12,5%). Clinical manifestation: delayed development 27,5%, underweight 17,5%, acute respiratory infection 15%, constipation 12,5%, hypotonia 7,5%, speech delay 5%, short stature 5%, enlarged tongue 2,5%, vomite 2,5%, icteric 2,5%, enlarged lymph node of colli 2,5%. We found suspect down syndrome 4(10%), severe malnutrition 4(10%), short stature 3(7,5%), mental retardation 2(5%).

Relapse in pituitary adenoma after resection

Pituitary adenoma in children is rarely reported. Acromegaly is one of clinical manifestation in GH releasing-pituitary adenoma. Recurrence of clinical manifestation after resection must be evaluated for possibility of pituitary adenoma relapse. N,male,15-yo, came to pediatric endocrinology outpatient clinic with the main complain of acromegaly and decreased of visual field which was getting worse since two weeks before(April11, 2011). He was consulted to ophthalmology and neurosurgery outpatient clinic. MRI with contrast revealed pituitary adenoma. Laboratories results showed TSHS:0.9773(0.35-4.94)uIU/ml, prolactin:0.51(4.04-15.2)ng/ml, testosterone less than 2.50(boys:13-17:28-1110)ng/ml, growth hormone was more than 40,00(>10.0)ng/ml. He was performed transsphenoidal removal cystic tumor. Pathological result showed macroscopic: yellowish cystous mass;0.6x0.4x0.2cm whether microscopic: appropiate to pituitary adenoma, non chromophobe. After surgery, patient was given DDAVP nasal spray 10 microgram/day, L-thyroxin 100 microgram once daily. One year after surgery, patient complaint of acromegaly, decreased visual field, especially in right and left temporal side, cephalgia. On physical examination, body weight was 91.5kg, height was184.5 cm. There was hemianopsia bitemporal. Tanner stage was A2P4G4. MRI with contrast showed pituritary adenoma relapse. Bone age was normal with height percentage based on it is about 96.8%. Tanner Whitehouse showed adult height 186.4cm. Thorax X ray showed heart and lungs were normal. Laboratories results revealed IGF1:1359(237-996)microgram/L, FT4:1(0.89-1.76)ng/dl; TSHS:0.3(0.5-4.94)microIU/ml(12-18yo), testosterone:435.1(28-1110) ng/dl. Working diagnosis was pituitary adenoma relapse post tumor resection, panhypopituitarism, diabetes insipidus. Testosterone 150mg once per month was added. Relapse of pituitary adenoma in children must be considered in the recurrence of clinical manifestations.

Psychosocial problems in children with congenital adrenal hyperplasia in Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Congenital Adrenal Hyperplasia (CAH) is a chronic illness that requires lifelong medication and, in some cases, frequent hospitalizations. This situation will bring psychosocial consequences for the patients and their families. This study aims are to determine the psychosocial problems in children with CAH in Cipto Mangunkusumo Hospital. Data was taken from medical records in Pediatrics Endocrinology Clinic of Cipto Mangunkusumo Hospital, Jakarta, Indonesia during 2007-2012. Out of 96 patients were diagnosed as CAH, 76 patients aged 4-16 years included in this study. Patient’s parents were interviewed by telephone for screening of psychosocial problems using the Pediatrics Symptom Checklist-17 (PSC-17). Patients and their parents were also asked about their expectations in the future. Out of 76 patients, Twenty five patients had 46,XX karyotype, 2 patients had 46,XY karyotype, while 49 patients have no karyotipe data available. Most children were raised in accordance with the results of their karyotype finding. Few parents reported some behaviour problems with their children according to PSC-17. Our study suggests that few children with CAH had a psychosocial dysfunction that might be related to their physical condition. Improving knowledge and encouraging parent to join with CAH support group were important to help families with CAH in Indonesia.

Fluid and electrolyte imbalance related to intracranial abnormality

Background Maintenance of the tonicity of extracellular fluids is crucial for proper cell function. In children and adults, normal blood tonicity is maintained by a coordinated interaction among the thirst, vasopressin, and renal systems. Dysfunction in any of these systems can result in abnormal regulation of blood osmolality, which if not properly recognized and treated, may cause life-threatening dysfunction in neuronal and other cellular activities. The aim of this study is to increased awareness on the possibility of fluid and electrolyte imbalance in patients with intracranial abnormality.