Background: Hepatotoxicity is the most serious side effect caused by using oral antituberculosis (OAT) drugs. This study was performed to determine the characteristics of patients who had antituberculosis drug-induced hepatotoxicity (ADIH) among pediatric inpatient with pulmonary tuberculosis. Methods: This was a cross-sectional study with a total sampling of medical records taken from January-December 2012, including pediatric pulmonary tuberculosis inpatients aged <14 years old at the Department of Child Health of Dr. Hasan Sadikin General Hospital Bandung. The inclusion criteria were children with pulmonary tuberculosis who received OAT drugs. Patients with liver disease were excluded. Data on alanine and aspartate aminotransferase were collected and an increased level of serum aminotransferase was designated as hepatotoxicity. Results: In total, 86 medical records were obtained of whom 24 had ADIH, predominantly occurred in girls (71%), aged 5-9 years old (42%) and in the intensive phase of therapy (58%). Elevated serum alanine aminotransferase (58%), aspartate aminotransferase (92%), and bilirubin (0.8%) were found. Malnutrition (46%) was common. The difference indeviation of liver function was statistically significant (p<000) between subjects with and without ADIH. Conclusions: Hepatotoxicity is most prominent in patients with malnutrition, girls aged 5-9 years old and in the intensive phase of therapy. Children with malnutrition during antituberculosis therapy are suggested to have a periodic liver function test monitoring to prevent the development of ADIH.
Latar belakang. Gangguan hati merupakan masalah pada pasien HIV. Sebagian besar pasien HIV dengan gangguan hati tidak menunjukkan gejala sehingga gangguan hati baru diketahui saat pemeriksaan enzim hati. Tujuan. Mengetahui prevalensi dan faktor yang berhubungan dengan hepatotoksisitas pada anak pasien HIV di Rumah Sakit Hasan Sadikin Bandung Metode. Metode penelitian adalah deskriptif analitik dengan rancangan potong lintang. Subjek penelitian berjumlah 52 anak HIV. Dilakukan pengambilan data demografis, antropometri serta pemeriksaan CD4 dengan metode flow cytometri, SGOT dan SGPT dengan metode spektrofotometri UV dengan pyridoxal-5-phosphate. Data yang didapat kemudian dianalisis dengan uji chi square, Fisher exact dan Mann Whitney. Hasil. Usia rata-rata pasien pada penelitian ini yaitu 8,2±3,5 tahun. Dua puluh delapan (54%) subjek penelitian berjenis kelamin laki-laki. Kadar median SGOT, yaitu 28 U/L (15-49 U/L) dan median SGPT yaitu 21 U/L (6-47 U/L). Sebanyak 7 Anak (14%) subjek penelitian didapatkan hepatotoksisitas ringan dengan nilai fungsi hati 1,25-2,5 kali batas atas normal. Faktor yang berhubungan dengan hepatotoksisitas tidak berbeda bermakna. Kesimpulan. Pada anak pasien HIV didapatkan angka kejadian gangguan fungsi hati 14%. Tidak terdapat hubungan kejadian hepatotoksisitas dengan faktor lama terapi antiretroviral, stadium klinis, derajat imunodefisiensi, jenis antiretroviral, terapi kotrimoksazol, terapi antituberkulosis, dan kadar CD4. Sari Pediatri 2017;19(4):214-9Kata kunci: hepatotoksisitas, pasien HIV anak Hepatotoxicity in Human Immunodeficiency Virus Infected Children at Hasan Sadikin Hospital Bandung Lidiyasiska, Adi Utomo Suardi, Anggraini AlamBackground. Abnormal liver function was the most common problem in HIV patients. Most HIV patients with liver disorders show no symptoms so liver disorders are known during liver enzyme tests. Objective. To determine prevalence and factors that influence hepatotoxicity among HIV infected children at Hasan Sadikin Hospital Bandung. Methods. The design of this study was descriptive analytic cross-sectional. A total of 52 HIV children were studied. Demographic and anthropometry data were taken. Blood specimen was collected to determine SGOT, SGPT with spectrophotometry UV with pyridoxal-5-phosphate method and CD4 count with flow cytometry method. The data obtained were then analyzed by chi square, Fisher exact and Mann Whitney test. Results. The mean ages of patients were 8.2±3.5 years. Twenty eight patients were males. Median level of SGOT was 28 U/L (15-49 U/L) and median level of SGPT was 21 U/L (6-47 U/L). Seven patients (14%) had elevated mild liver enzyme abnormalities with one of biomarker 1,25-2,5 upper limit of normal. Factors related to hepatotoxicity did not differ significantly. Conclusions. Prevalence of hepatotoxicity was 14% among HIV children. There was no association of hepatotoxicity with duration of antiretroviral therapy, clinical stage, antituberculosis therapy, cotrimoxazole therapy, types of antiretroviral and CD4 count. Sari Pe...
AbstrakPneumonia merupakan penyebab utama kesakitan dan kematian pada anak, terutama di negara berkembang. Angka kematian karena pneumonia di negara berkembang 10-15 kali lebih tinggi daripada di negara maju. Penelitian ini bertujuan untuk mengetahui angka kematian dan faktor risiko pada anak balita yang dirawat di rumah sakit karena pneumonia. Penelitian potong lintang ini dilakukan pada anak usia 1-59 bulan yang dirawat di Rumah Sakit Dr. Hasan Sadikin Bandung karena pneumonia periode November 2007─Januari 2009. Tiga ratus delapan belas anak ikut serta dalam penelitian ini. Usia median anak 11‚6 bulan, sebanyak 237 (74‚5%) di antaranya berusia ≤12 bulan. Sembilan puluh tiga (29‚2%) anak didiagnosis pneumonia sangat berat dan 225 (70‚8%) anak pneumonia berat. Dua puluh tiga (7‚2%) penderita meninggal selama perawatan, 20 di antaranya dirawat dengan pneumonia sangat berat (p<0,001; OR 20,274; 95%IK: 5,197 Mortality Due to Severe Pneumonia in Under-Five Years Old Children AbstractPneumonia is one of the leading causes of morbidity and mortality in children, mainly in developing countries with a 10-15 times higher mortality rate than developed countries. The aim of the study was to know the mortality rate and its risk factors among under five years old children who were hospitalized due to severe pneumonia. This cross-sectional study was conducted to 1 to 59 months old children with pneumonia at the Department of Pediatric Dr. Hasan Sadikin Bandung Hospital from November 2007 to January 2009. Three hundred and eighteen children were enrolled in this study. The median age was 11.16 months, and 237 (74.5%) were ≤12 months of age. Very severe pneumonia was diagnosed in 93 (29.2%) and severe pneumonia in 225 (70.8%) children. Twenty three (7.2%) children died during hospitalization, 20 were hospitalized with very severe pneumonia (p<0.001, OR 20.274, 95%CI: 5.855─70.197). Congenital heart disease (p=0.002, OR 5.795, 95%CI: 2.115-15.407) and leucocytosis (≥15,500/mm 3 , p=0.002, OR 3.879, 95%CI: 1.547-9.727) were significantly associated to the mortality. Pathogenic bacteria were identified in 11 of 23 patients. In conclusions, the mortality of severe pneumonia is still high. Very severe pneumonia, congenital heart disease and leucocytosis are factors that increase mortality among under-five years old children with pneumonia. [MKB. 2013;45(1):50-5]
Latar belakang. Pasien sindrom nefrotik resisten steroid mengalami hipoeritropoetinemia akibat kehilanganeritropoetin melalui urin dan gangguan pembentukan eritropoetin oleh ginjal. Paparan albumin kronisbersifat toksik dan menginduksi apoptosis sel tubulus ginjal, sementara eritropoetin diproduksi oleh selperitubular ginjal.Tujuan. Menentukan hubungan kadar albumin serum dengan eritropoetin serum pada pasien sindromnefrotik resisten steroid anak.Metode. Penelitian cross-sectional dilaksanakan pada pasien sindrom nefrotik anak resisten steroid dari bulanAgustus–Desember 2013 di unit rawat jalan dan rawat inap RS Dr. Hasan Sadikin, Bandung. Kadar albuminserum diperiksa dengan metoda turbidimetri dan kadar eritropoetin serum dengan metode ELISA. Analisiskorelasi kadar albumin dengan eritropoetin serum dilakukan dengan menggunakan uji Rank Spearman.Hasil. Sembilan belas anak memenuhi kriteria penelitian, 14 subjek laki - laki, dan 5 perempuan dengan usia3–13 tahun. Nilai laju filtrasi glomerulus rerata 147,8+75 ml/menit/1,73 m2, sementara kadar hemoglobin12,1+2,8 g/dL. Nilai median albumin serum 3,8 (0,9–4,6)g/dL dan median eritropoetin serum 7,2 (0,2–39,6)mIU/mL. Tidak terdapat korelasi antara albumin dan eritropoetin serum pada sindrom nefrotik anakresisten steroid (rs=0,123;p=0,615).Kesimpulan. Kadar albumin serum tidak berhubungan dengan kadar eritropoetin serum pada pasiensindrom nefrotik resisten steroid anak.
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