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Incidence and characteristics of antituberculosis drug-induced hepatotoxicity in children: a preliminary study Bina Akura; Hanifah Oswari; Bambang Supriyatno; Najib Advani
Paediatrica Indonesiana Vol 49 No 6 (2009): November 2009
Publisher : Indonesian Pediatric Society

Background Antituberculosis drugs show good efficacy but haveÂ adverse effects including hepatotoxicity.Objective To find the incidence and characteristics ofÂ antituberculosis hepatotoxicity in children during the first 2Â weeks of therapy.Methods A cohort study was performed in Cipto Mangunkusumo,Â Persahabatan, and Tangerang Hospitals from August 2008Â toMarch 2009. The diagnosis of tuberculosis (TB) based onÂ TB scoring system. Laboratory tests were performed includingÂ transaminase enzymes, bilirubin, y-GT, albumin, ureum, andÂ creatinine before and after 2 weeks of treatment. Patients wereÂ monitored during the first 2 weeks of therapy. Informed consentÂ obtained from the parents.Results Six of 81 subjects had hepatotoxicity reaction. Most ofÂ the patients were 1 to 5 years old (65%) and well nourished (50%). Extrapulmonary tuberculosis found in 67% of cases. Thirty-three percents of patients received four agents. Thirty-three percents of cases received 4 agents combined with other hepatotoxic drugs. Six subjects had hepatotoxicity (1 hepatitis, 2 mixed case, and 3 asymptomatic). Two of 50 children (4%) with pulmonary TB and 4 out of 31 ( 13%) children with extrapulmonary TB had hepatotoxicity reaction. Antituberculosis drug doses were similar between the hepatotoxicity group and control.Conclusions Incidence of antituberculosis hepatotoxicity in thefirst 2 weeks of therapy was 7%, consisted of hepatitis (1 cases),Â mixed (2 cases), and asymptomatic (3 cases). There was noÂ difference in sex as well as in nutritional state distribution found in cases with hepatotoxicity.

Effect of intranasal mometasone furoate administered in children with coexisting allergic rhinitis and asthma towards asthma attacks and lung function Ellen P. Gandaputra; Zakiudin Munasir; Bambang Supriyatno; Jose R. L. Batubara
Paediatrica Indonesiana Vol 49 No 6 (2009): November 2009
Publisher : Indonesian Pediatric Society

Background Allergic rhinitis and asthma are allergic manifestations in respiratory tract, which related each other. Intranasal corticosteroid is effective in allergic rhinitis and has benefits in decreasing lower airway reactivity.Objectives To evaluate effectiveness of intranasal mometasonefuroate towards asthma in children aged 6-18 years with coexisting allergic rhinitis and asthma.Methods A one group pretest-posttest ("before and after") study was conducted in Cipto Mangunkusumo Hospital from May to December 2008. Subjects were children aged 6-18 years, with moderate-severe intermittent or persistent allergic rhinitis with coexisting frequent episodic asthma or persistent asthma, and visited outpatient clinic of allergy immunology division or respirology division. Subjects were administered intranasal mometasone furoate 100 J-ig daily only for 8 weeks, without long term administration of oral and inhaled corticosteroid. Improvements in allergic rhinitis and asthma were evaluated using questionnaires and lung function tests.Results There were 35 subjects and four of them dropped outduring the study. There was >50% improvement in allergic rhinitis symptoms after 4 weeks of treatment (P<0.001). This improvement was associated with decreasing in frequency of asthma attack >50% after 8 weeks of treatment (P< 0.001). There was an insignificant improvement in FEY 1 (P=0.51). However, the evaluation of sinusitis was not performed in all subjects, thus may influence the results. During study, there were no side effects observed.Conclusions Intranasal mometasone furoate improves allergicrhinitis and decrease >50% of asthma symptoms, however it is not followed with significant improvement in lung function. No side effects are reported during 8 weeks use of intranasal mometasone furoate.

Clinical manifestations of childhood asthma persisting until the age of seven Rini Asterina; Sjawitri P Siregar; Bambang Madiyono; Bambang Supriyatno
Paediatrica Indonesiana Vol 44 No 1 (2004): January 2004
Publisher : Indonesian Pediatric Society

Background Asthma is a chronic illness commonly found in chil-dren. We aimed to find out the clinical manifestations of childhoodasthma persisting until the age of seven and the influencing factors.Methods A review was performed at the outpatient clinic of theDepartment of Child Health Cipto Mangunkusumo Hospital Jakarta,from January 1992 to December 2001, on children with asthmawho still had symptoms until the age of seven.Results During the period of 10 years, there were 322 childrenwith clinical symptoms of asthma persisting until the age of 7. Onehundred and forty-six (45.3%) met the inclusion criteria, consistingof 75 (51.4%) boys and 71 (48.6%) girls. The average age was11.7 years. There were 101 (69.2%) patients with rare episodicasthma, 26.0% with frequent episodic asthma, and 4.8% with per-sistent asthma. Age of onset was mostly beyond 3 year-old (51%).Besides asthma, atopic diseases noted in these patients were al-lergic rhinitis in 85 (58.2%) and atopic dermatitis in 42 (28.8%).Logistic regression found that cigarette smoke exposure (adjustedOR 4.72, 95%CI 2.05;10.87, p=0.000), allergic rhinitis (adjustedOR 3.44, 95%CI 1.40;8.45, p=0.007), and atopic dermatitis (ad-justed OR 2.37, 95%CI 1.01;5.72, p=0.048) had significant asso-ciation with the degree of asthma.Conclusion Of 146 children who still had asthma until the age ofseven, there were 69% with rare episodic asthma, 26% with fre-quent episodic asthma, and 4.8% with persistent asthma. Factorspresumably influencing this manifestations were cigarette smokeexposure, allergic rhinitis, and atopic dermatitis

Comparison of peak expiratory flow measurement by Mini-Wright peak flow meter and electronic spirometer in healthy elementary school children Mardjanis Said; Sudigdo Sastroasmoro; Bambang Supriyatno; Yovita Ananta
Paediatrica Indonesiana Vol 44 No 6 (2004): November 2004
Publisher : Indonesian Pediatric Society

Objective This study aims to compare peak expiratory flow mea-surement by peak flow meter and electronic spirometer in healthyelementary school children.Methods This was a cross-sectional study performed in an el-ementary school near Cipto Mangunkusumo hospital (SDNPegangsaan 01). The study group consisted of healthy childrenaged 6-12 year old. Data regarding identity and history of illnesswas taken in each subject. Routine physical examination was per-formed and recorded. Each subject performed lung function testsby means of electronic spirometer AS-7 as well as by Mini-Wrightpeak flow meter. The subject should perform a minimum of threemaneuvers for each method where only the best result was re-corded. Method comparison test to assess agreement betweentwo methods was employed in this study.Results There were 10 males and 15 females enrolled in this study.None of the subjects currently have any respiratory symptoms andsigns. This study found that the mean peak expiratory flow (PEF) byspirometer was 226.8Â±73.13 L/min while by peak flow meter was223.0Â±45.05. Mean difference between spirometer and peak flowmeter measurements is 6.2 with standard deviation of 60.82. Thesevalues resulted in limits of agreement of -115.44 to +127.84 L/min.Conclusions This study finds disagreement between electronicspirometer and Mini-Wright peak flow meter in measuring peakexpiratory flow, therefore these two devices cannot be usedinterchangeably. Mini-Wright peak flow meter still has a role inhome monitoring, but the physician should interpret the resultscarefully.

Comparison of pulmonary functions of thalassemic and of healthy children Mardjanis Said; Sudigdo Sastroasmoro; Djajadiman Gatot; Bambang Supriyatno; Yovita Ananta
Paediatrica Indonesiana Vol 45 No 1 (2005): January 2005
Publisher : Indonesian Pediatric Society

Objectives The aim of this study was to compare some pulmo-nary functions of thalassemic patients and those of normal chil-dren. Factors correlated with lung dysfunction were assessed.Methods This cross-sectional study compared some pulmonaryfunctions of thalassemic patients with those of healthy children.The study was performed in the Department of Child Health, CiptoMangunkusumo Hospital, Jakarta, Indonesia. Pre- and post-trans-fusion hemoglobin levels of the thalassemic subjects were deter-mined. Other data such as chelation therapy and serum ferritinlevels were also obtained. Both thalassemic and control subjectsunderwent routine physical examinations and lung function testsusing an electronic spirometer. Spirometry was repeated threetimes for each subject, and only the best result was recorded.Results Sixty-three thalassemic patients were enrolled, consist-ing of 32 male and 31 female subjects. Healthy subjects consistedof 31 males and 31 females. Most thalassemic patients (46/63)were found to have lung function abnormalities. This was signifi-cantly different from control subjects, of whom most (39/62) hadnormal lung function. Restrictive lung function abnormality was themost common (42/63) observation documented. Serum ferritin lev-els were obtained from 28 male and 29 female thalassemic sub-jects. There was no correlation between percentage from predictedforced vital capacity and serum ferritin levels, whether in male(r=0.191; P=0.967) or female (r =-0.076, P=0.695) thalassemicsubjects.Conclusion Thalassemic patients have significantly lower lungfunction than healthy children. More thalassemic patients had lungfunction abnormalities compared to healthy children. Restrictivedysfunction was the most common finding in the thalassemic group.No correlation was found between lung function and serum ferritinlevels

Characteristics and risk factors of snoring and the prevalence of suspected obstructive sleep apnea in children Bambang Supriyatno; Rusmala Deviani; Alan R Tumbelaka; Evita KB Ifran; Nastiti N Rahajoe
Paediatrica Indonesiana Vol 45 No 1 (2005): January 2005
Publisher : Indonesian Pediatric Society

Background Snoring as a consequence of upper airway obstruc-tion is common in children. Snoring can be considered as normal,but might also reflect a disease such as obstructive sleep apnea(OSA), which is associated with serious morbidities. In Indonesia,data on the characteristics and risk factors of snoring and obstruc-tive sleep apnea is limitedObjectives The aims of this study were to find out the character-istics and risk factors of snoring in children and to determine theprevalence of suspected OSA in snoring children.Methods A cross-sectional study was carried out on children aged5-13 years using parental questionnaires scored according to theBrouilette formula. All children underwent physical examination forweight, height and tonsil size. Adenoid radiology was performedon part of the samples.Results Of the 917 questionnaires distributed, only 658 were com-pleted. The ratio of boys to girls was equal. Obesity was detectedin 18.3% of children, among whom 54.2% snored. Obese childrenwere 2.1 times more likely to snore. Besides obesity, rhinitis andatopy were found to be associated with snoring (PR= , 95%CI ;and PR= , 95%CI ; respectively). Asthma and tonsil hypertrophywere shown not to be predisposing factors of snoring. Childrenwith adenoid hypertrophy were 1.8 times more likely to snore ha-bitually. The prevalence of snoring and suspected OSA in childrenaged 5-13 years were 31.6% and 5.9%, respectively.Conclusion Risk factors of snoring were obesity, adenoid hyper-trophy, atopy and rhinitis. Prevalence of snoring in children age 5-13 years was 31.6% and that of suspected OSA cases was 5.9%.

The use of 4.5% hypertonic saline challenge test in diagnosing asthma in children with chronic recurrent cough Bambang Supriyatno; Dina Medina; Alan R Tumbelaka; Nastiti N Rahajoe
Paediatrica Indonesiana Vol 45 No 3 (2005): May 2005
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi45.3.2005.93-8

Background The 4.5% hypertonic saline (HS) challenge test hasseveral benefits compared to histamine challenge test as gold stan-dard. Saline is an inexpensive non-pharmacological substancewhich is relatively safe. Its mechanism in inducing bronchospasmresembles that of asthma. Moreover, it can easily be made in amodest medical laboratory.Objective To determine the ability of 4.5% HS challenge test com-pared to histamine challenge test in diagnosing asthma in childrenwith chronic recurrent cough (CRC).Methods This study was a diagnostic test on children with CRCaged 6 to 14 years, conducted in outpatient clinic of Department ofChild Health, Cipto Mangunkusumo Hospital, Jakarta. All subjectsunderwent lung function tests. Subjects whose FEV 1 was <80% werediagnosed as asthmatic and underwent the 4.5% HS challenge testonly. Those whose FEV 1 was 80% underwent the histamine chal-lenge test followed by the 4.5% HS challenge test one or two weekslater. Test results were expressed as positive or negative. Based onthe results, we calculated the sensitivity, specificity, predictive val-ues, and likelihood ratios of the 4.5% HS challenge test.Results Forty-five subjects, consisting of 22 boys and 23 girls,were enrolled. The average age of subjects was 9 years old. Atopichistory in the family or in subjects themselves was found in 80% ofsubjects. Eight subjects had FEV 1 of <80%. Forty-four subjectswere diagnosed with asthma based on a baseline FEV 1 of <80%or a positive histamine provocation test. Thirty-seven subjects hada positive 4.5% HS challenge test; all had asthma. Sensitivity andspecificity of the 4.5% HS challenge test were 84.1% and 100.0%,respectively; the positive and negative predictive values were100.0% and 12.5%, respectively. The positive likelihood ratio wasinfinite and negative likelihood ratio was 0.16.Conclusion The 4.5% hypertonic saline challenge test can be usedas an alternative bronchial provocation test in diagnosing asthma inchildren with CRC. Further study with larger sample size is neededfor widespread usage.

The unmet needs of family caregivers in the management of childhood community-acquired pneumonia in Indonesia: a qualitative study Nyimas Heny Purwati; Yeni Rustina; Bambang Supriyatno
Paediatrica Indonesiana Vol 62 No 1 (2022): January 2022
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi62.1.2022.32-6

Background Childhood community-acquired pneumonia (CAP) is one of the leading causes of morbidity and mortality in children under five years of age. Objective To explore the unmet needs of family caregivers of children with community-acquired pneumonia. Methods A qualitative study using in-depth interviews was conducted at one referral hospital located in Jakarta, Indonesia. Convenience sampling was used to select participants. Data were analyzed using qualitative content analysis. Results Ten family caregivers participated in our study. The results of this research are shown in five main themes: (1) the burden of persistent symptoms; (2) exposure to cigarette smoke at home; (3) home remedies as initial treatment; (4) fulfilling the childrenâ€™s nutritional needs; and (5) health promotion needs. The care of children with CAP involves more than antibiotic treatment and vaccines. Conclusion This study found several unmeet needs of family caregivers in caring for children with CAP, particulary pertaining to health promotion and the fulfilment of nutritional needs.

Development, validity, and reliability of a questionnaire on mothers’ knowledge in complementary feeding practices (PI-MPASI) in Indonesia Rini Andriani; Bambang Supriyatno; Aria Kekalih; Damayanti Rusli Sjarif
Paediatrica Indonesiana Vol 63 No 5 (2023): September - October 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar

Background A number of complementary educational feeding modules have been circulating in the community, but mothers have yet to use them optimally. There is an urgent need for an effective educational method on appropriate complementary feeding and an instrument to measure maternal knowledge in proper complementary feeding practices. Objective To develop and assess the validity and reliability of a questionnaire on complementary feeding practices. Methods We conducted a qualitative study to develop a questionnaire followed by a cross-sectional study to test the validity and the reliability of the PI-MPASI questionnaire. The research team designed the PI-MPASI questionnaire through a literature review with a team of experts, based on the evidence-based feeding practice recommendations for infants and toddlers in Indonesia as compiled by the Indonesian Pediatric Society (IPS) in 2015. Content validation was carried out through expert review, whilst the construct validity and the reliability were tested on 110 mothers who met the inclusion criteria. Results In the content validity assessment, an average congruent percentage of 90% was obtained for the sub-themes of time, nutritional adequacy, safety, and feeding responsiveness as the four essential points that mothers should know regarding proper complementary feeding practices. Most of the item scores showed moderate to high correlations with the total score, with reliability test showcasing a good internal consistency (Cronbach's alpha = 0.715). Conclusion This study showed that our questionnaire on mothers’ knowledge in complementary feeding practices (PI-MPASI) is a valid and reliable instrument to assess maternal knowledge on correct complementary feeding practices in Indonesia.

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