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All Journal Sari Pediatri Paediatrica Indonesiana Bioscientia Medicina : Journal of Biomedicine and Translational Research Bioscientia Medicina : Journal of Biomedicine and Translational Research Arkus

Aditiawati Aditiawati

Bagian Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Sriwijaya/RSUP Dr. Mohammad Hoesin, Palembang

Author-ID : 3212429

Religion Humanities Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Neuroscience Social Sciences

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Kelainan Mineral Tulang pada Anak dengan Penyakit Ginjal Kronik Hertanti Indah Lestari; Eka Intan Fitriania; Aditiawati Aditiawati; Minerva Riani Kadir
Sari Pediatri Vol 21, No 5 (2020)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp21.5.2020.282-8

Latar belakang. Penderita penyakit ginjal kronis (PGK) berisiko mengalami abnormalitas mineral, sejalan dengan penurunan laju filtrasi glomerulus (LFG) atau peningkatan stadium PGK. Di Palembang, belum ada laporan mengenai penyakit mineral tulang pada anak akibat penyakit ginjal kronik. Tujuan. Penelitian ini bertujuan mengetahui kejadian penyakit mineral tulang pada anak dengan PGK.Metode. Penelitian potong lintang untuk mengetahui kejadian penyakit mineral tulang akibat PGK, dengan pemeriksaan kadar hormon paratiroid, kadar vitamin D, serta pemeriksaan densitas tulang. Subyek penelitian dibagi menjadi kelompok 1 (PGK stadium 1-2) dan kelompok 2 (PGK stadium 3-5). Hasil. Dari 28 subyek penelitian, rerata usia 10,7 tahun, rasio laki-laki dan perempuan, yaitu 2,5:1. Berdasarkan stadium PGK, 14 subyek dengan stadium 1. Rerata kadar hormon paratiroid pada PGK stadium 3-5 secara bermakna lebih tinggi. Subyek dengan PGK stadium 3-5 memiliki risiko 2x lebih besar mengalami hiperparatiroid. Kejadian defisiensi/insufisiensi vitamin D didapatkan pada 23 subyek (82%). Kejadian defisiensi/insufisiensi vitamin D tidak berbeda bermakna di antara kedua kelompok. Penurunan densitas tulang terjadi pada 8 subyek , 5 diantaranya osteopenia, dan 3 lainnya osteoporosis. Kesimpulan. Semua anak dengan PGK baik stadium 1-2 maupun 3-5 menunjukkan tanda kelainan mineral tulang secara laboratorium dan/atau densitometri.

Akurasi Pemeriksaan HbA1c dalam Mendeteksi Gangguan Toleransi Glukosa pada Anak dan Remaja Obes dengan Riwayat Orang Tua DM Tipe 2 Abdi Wijaya; Aditiawati Aditiawati; Irsan Saleh
Sari Pediatri Vol 17, No 1 (2015)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp17.1.2015.17-20

Latar belakang. Obesitas dengan riwayat orang tua diabetes mellitus (DM) tipe 2 berhubungan dengan gangguan toleransi glukosa,dislipidemia, dan DM. Toleransi glukosa terganggu (TGT) merupakan pertanda awal terjadinya DM tipe 2. Hemoglobin A1c(HbA1c) telah muncul menjadi alat diagnostik untuk mengidentifikasi DM dan subjek yang berisiko menderita DM. Rekomendasiini didasarkan pada data dari orang dewasa yang menunjukkan hubungan antara HbA1c dengan terjadinya DM di kemudian hari.Penelitian yang khusus ditujukan pada populasi anak dan remaja masih sedikit.Tujuan. Mengetahui penggunaan dan titik potong optimal pemeriksaan HbA1c dalam mendiagnosis gangguan toleransi glukosapada anak dan remaja obesitas dengan faktor risiko dibandingkan dengan tes toleransi glukosa oral (TTGO).Metode. Dilakukan uji diagnostik terhadap 40 anak obesitas (Indeks Massa Tubuh menurut umur dan jenis kelamin berdasarkan Zscore WHO 2008 ô€´ +2 SD) usia 10-15 tahun dengan riwayat orang tua DM tipe 2 tahun di Palembang dari Desember 2013 - Februari2014. Pada semua subjek dilakukan pemeriksaan HbA1c dan TTGO.Hasil.Ditemukan dua anak dengan TGT. Dari analisis kurva Receiver Operating Characteristic (ROC) didapatkan titik potong optimalpemeriksaan HbA1c adalah 5,55% dengan nilai sensitivitas 67% dan spesifisitas 20%, area Under the Curve (AUC) diperoleh sebesar79,3% (95% IK 45,7%-100%).Kesimpulan. Nilai pemeriksaan HbA1c >5,55% dianjurkan sebagai alat skrining untuk mengindentifikasi TGT pada anak danremaja obesitas dengan faktor risiko.

Disorder of Sex Development, Mosaic Genetic Disorder 45x, 46xy: A Case Report Awan Nurtjahyo; Asep Nurul Huda; A. Abadi; Aditiawati; Yulisnawati H; Fadil P
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 6 No. 2 (2022): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v6i2.449

Background. Disorder of sex development (DSD) is a congenital disorder associated with interference in chromosomes, gonads, or sexes anatomically. Individual affected with DSD can be recognized since birth due to external genital ambiguity. Sexual chromosome DSD occurred because sexual chromosome numeric or structural disorder. Mosaic karyotype 45X/46XY is among the rare sexual chromosome DSD with incidence less than 1:15,000 live births. DSD individuals are susceptible to stigmatization. This can cause stress, negative emotion, and social isolation. Therefore, DSD individual management should be done as optimal as possible. Case Presentation: Twelve years old girl complaining a bump arose from anterior side of her genital resembles male genital since 4 years prior to admission without micturition and defecation complains. Patient has not experienced menarche. On external genital examination, we found the normal female external genital such as mons pubis, pubic hair, labia majora, labia minora, hymen, perineum, but without clitoris which in this case it is replaced by a glans of penis, arising from anterior commissure of labia majora area, with an urethral estuary. Before the management is done, patient underwent multidiscipline consultations and further examinations. Subsequently, it was approved that the joint conference formation consisting obstetric and gynecology, urologist, and pediatric endocrinologist to determine the optimal management for the patient. Conclusion: In this case, diagnosis was made with history taking, clinical examination, and supporting investigation such as ultrasound imaging and could be followed by biochemistry test, voiding cystourethrography or genitogram to determine next management. Counseling should be done in detail towards the family to know what action is best for the patient. Multidiscipline team was required to get the optimum result either in medical, ethical, or religious point of view. Surgery in this case was considered followed by long term therapy afterwards.

Endocrine Diseases as a Cause of Short Stature in Children Aditiawati Aditiawati
Arkus Vol. 2 No. 1 (2016): ARKUS
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/arkus.v2i1.63

Growth abnormalities of short stature or tall stature are closely related to body disproportion. Humans experience changes in body proportions from infancy to adulthood. This is due to changes in organs and organ systems at each stage of an individual's life. Differences in growth rates in body organs affect differences in body proportions at each stage of an individual's life. This is related to osseous maturation, which is influenced by the endocrine system. There is a change in the ratio of the lower and upper segments according to age and arm span. The combination of low body weight with short stature or a lighter weight-to-height ratio indicates a chronic systemic disorder as a cause of short stature. A combination of short stature and being overweight or an increased ratio of body weight to height are essential clues to the possibility of an endocrine disorder as a cause of short stature.

Growth and Short Stature in Children Aditiawati Aditiawati
Arkus Vol. 3 No. 1 (2017): ARKUS
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/arkus.v3i1.67

Growth is reflected by height can vary between races, sexes, and ages. Impaired growth of children can occur during the growth process that takes place from intrauterine to adulthood. Impaired growth of children such as short stature and high stature, both caused by endocrine and non-endocrine disorders, is a disorder that is often found. Careful clinical examination is needed, which is supported by endocrinological examination to look for aetiology. Bone age examination is an essential radiological examination for growth evaluation. Various attempts were made to optimize the management of children with short stature. Children with normal variations in short stature usually do not need treatment, whereas children with pathological disorders require treatment according to aetiology.

Association between hyperglycemia and organ dysfunction in shock patients Sheila Noberta; Silvia Triratna; Aditiawati Aditiawati; Syarif Husin
Paediatrica Indonesiana Vol 53 No 1 (2013): January 2013
Publisher : Indonesian Pediatric Society

Background Hyperglycemia is an important marker of bothpoor clinical outcomes and high mortality rate in critically illpatients. Glucose toxicity results in cell damage that leads toorgan dysfunction.Objective To evaluate for an association between hyperglycemiaand the incidence of organ dysfunction in shock patients.Methods This cross-sectional study was conducted in thepediatric intensive care unit (PICU) of Dr. Moh. HoesinHospital, Palembang from June to November 2011. Subjectswere consecutively-enrolled, shock patients without a historyof diabetes mellitus. Illness severity and organ dysfunction weredetermined by pediatric risk of mortality (PRISM) III score andpediatric logistic organ dysfunction (PELOD) scores, respectively.Hyperglycemia was defined as a blood glucose level 2: 110 mg/dL.Statistical analysis was performed with SPSS version 15.Results Mean age of subjects was 2.30 (SD 2.93) years. MeanPRISM III score was 15 .11 (SD 5 .63). Prevalence of hyperglycemiawas 80.0%. Mean glucose level was 179.51 (SD 86.84) mgldL.Mean PELOD score was 16.02 (SD 13.87). Organ dysfunction wasobserved in 86.7% of subjects. The most common organ dysfunctionobserved in our subjects was liver dysfunction (73.3%). Therewas a significant association between hyperglycemia and organdysfunction (OR43.750;95%CI 4.036 to474.252, P=0.001). Theblood glucose level cutoff points indicative of organ dysfunction,PRISM III score 2: 8, and PELOD score 2: 20.5 were 114.5 mg/dL, 129 mgldL, and 166 mg/dL, respectively.Conclusion There is an association between hyperglycemia andorgan dysfunction. The upper limit blood glucose level indicative oforgan dysfunction is 114.5 mg/dL. A glucose level of 129 mgldL maybe considered to be a warning to start blood glucose monitoring. Alevel above 166 mgldL may be used to indicate the necessity of startinginsulin therapy intervention.

Insulin therapy for hyperglycemia in critically ill patients Julianti Julianti; Silvia Triratna; Aditiawati Aditiawati; Irfanuddin Irfanuddin
Paediatrica Indonesiana Vol 53 No 5 (2013): September 2013
Publisher : Indonesian Pediatric Society

Background Hyperglycemia in critically ill patients is associated with higher mortality. Insulin therapy may improve outcomes, not only by preventing deleterious effects of hyperglycemia, but by improving the molecular dynamics in organ dysfunction.Objectives To assess the effects of insulin therapy on critically ill patients in an intensive care unit (ICU) setting and the risk of hypoglycemia.Methods An open-label, clinical trial was conducted in the Pediatric Intensive Care Unit (PICU) of Dr. Moh. Hoesin Hospital, Palembang, from November 2011 to March 2012. Subjects were consecutively assigned to receive either regular insulin at a dose of 0.05 U/kg/h if the blood glucose level reached >200 mg%, or standard therapy (control group). Blood glucose levels were measured hourly until they reached 80-110 mg%. Dose adjustments were made when the blood glucose level reached 145 mg%, by reducing the insulin dose to 0.025 U/kg/h. Outcomes of therapy were measured by Pediatric Logistic Organ Dysfunction (PELOD) score improvement, mortality rate and the occurrence of hypoglycemia.Results Forty subjects were enrolled in this study, with 20 subjects assigned to the insulin therapy group and 20 subjects to the standard therapy group. Two subjects, one from each group, were not included in the final analysis due to their deaths within 24 hours. There was no significant difference in distribution of PELOD scores before intervention between the groups (OR=0.5; 95%CI 0.1 to 1.9, P=0.32). However, after intervention, the PELOD scores was significantly lower in insulin therapy group compared to control group (OR 0.2; 95% CI 0.05 to 0.8, P=0.02). In the insulin group after intervention, fewer subjects had scores >20.5 and more subjects had scores â‰¤20.5, indicated a lower risk of organ dysfunction. There was also a significantly lower mortality rate in the insulin group compared to the control group (OR 0.2; 95% CI 0.05 to 0.8, P=0.02). None of the subjects suffered hypoglycemia.Conclusion Insulin is beneficial in improving organ dysfunction and decreasing mortality for critically ill patients.

Utility of hemoglobin A1c to screen for impaired glucose tolerance Edy K. Ginting; Aditiawati Aditiawati; Irfanuddin Irfanuddin
Paediatrica Indonesiana Vol 54 No 4 (2014): July 2014
Publisher : Indonesian Pediatric Society

Background Childhood obesity is associated with an increasedlikelihood for having impaired glucose tolerance, dyslipidemia,and diabetes. Hemoglobin Ale (HbAl c) h as emerged as arecommended diagnostic tool for identifying diabetes and personsat risk for the disease. This recommendation was based on datain adults, showing the relationship between HbAl C and thefuture development of diabetes . However, studies in the pediatricpopulation have been limited and no stan dard values of HbAlclevels in children have been established.Objective To evaluate HbAlc as a test for impaired glucosetolerance in obese children and adolescents and to identify theoptimal HbAlc thresh old level (cut off poin t).Methods We studied 65 obese and 4 overweight children (BMI 2::+ 2 SD for age and gender) aged 10-15 years in Palembang. Allsubjects underwent HbAlc and oral glucose tolerance tests.Results Nineteen out of 69 subjects (28%) had impaired glucosetolerance. Based on the receiver operating characteristic curve,the optimal cut off point of HbAlc related to impaired glucosetolerance as diagnosed by oral glucose tolerance test was found tobe 5.25%, with 63% sensitivity and 64% specificity, 40% positivepredictive value, and 82% negative predictive value. The areaunder the receiver operating ch aracteristic curve was O .68 7(95%CI 0.541-0.833; P < 0.00 1).Conclusion A HbAlc cut off value of 5.25% may be used as ascreening tool to identify children and adolescents with impairedglucose tolerance.

Upper arm circumference measurement for detecting overweight and obesity in children aged 6-7 years Dewi Rosariah Ayu; Aditiawati Aditiawati; Julius Anzar; Erial Bahar
Paediatrica Indonesiana Vol 57 No 1 (2017): January 2017
Publisher : Indonesian Pediatric Society

Background Obesity is a worldwide problem and is associated with increased risk of metabolic syndrome. Nutritional status in children has traditionally been determined by body mass index (BMI) scores, but with limitations. Upper arm circumference measurement may be a better predictor of energy, protein, and fat storage, as well as a simpler method for screening overweight and obesity in children.Objective To determine the diagnostic value of upper arm circumference compared to BMI for detecting overweight and obesity in children aged 6-7 years.Methods This diagnostic study with a cross-sectional design was performed from September to October 2015 at 16 primary schools in Palembang, Indonesia. We measured the heights, weights, and upper arm circumferences, and calculated BMIs of 2,258 children. Receiver-operator characteristic (ROC) curve analysis was used to find an optimal upper arm circumference cut-off point to detect overweight and obesity. Diagnostic value was calculated by using a 2x2 table analysis.Results The prevalences of overweight and obesity were 5.8% and 11.7%, respectively. The optimal upper arm circumference cut-off points for detecting overweight in children aged 6-7 years was 185 mm (sensitivity 88.1% and specificity 78.3%), and for obesity was 195 mm (sensitivity 90.15% and specificity 86.65%). Upper arm circumference had a strong correlation with BMI.Conclusion Upper arm circumference measurement is an accurate method fordistinguishing between normoweight, overweight, and obesity in children aged 6-7 years.

Duration and dose of antiepileptic drugs and serum calcium levels in children Arinta Atmasari; Masayu Rita Dewi; Aditiawati Aditiawati; Masagus Irsan Saleh
Paediatrica Indonesiana Vol 57 No 2 (2017): March 2017
Publisher : Indonesian Pediatric Society

Background Antiepileptic drugs (AEDs) may affect calcium metabolism through several mechanisms. Much evidence has confirmed that carbamazepine and valproic acid, as the most widely used AEDs in epileptic children, leads to decreased serum calcium levels. This effect was suggested to be time and dose dependent. However, correlations between AEDs and calcium levels in Indonesian epileptic children have not been well studied.Objective To investigate possible correlations between total calcium levels and durations of therapy as well as doses of carbamazepine and valproic acid.Methods This analytical, cross-sectional study was performed from March to May 2015 in the Neuropediatric Outpatient Ward of Mohammad Hoesin Hospital, Palembang, South Sumatera. A total of 60 epileptic children taking carbamazepine and or valproic acid monotherapy were included and grouped accordingly. A single blood test was done for every participant to measure total serum calcium level. Correlation between daily dose or duration of AED with calcium level was assess using the Spearman-rho test.Results The mean total serum calcium levels in the carbamazepine and valproic acid groups were 9.48 (SD 0.83) mg/dL and 9.58 (SD 0.63) mg/dL, respectively. There was a statistically significant moderate correlation between the duration of carbamazepine therapy and total calcium level (r = 0.36; P=0.001). The cut-off point for duration of therapy was 23 months. There were no significant correlations between total calcium level and mean daily carbamazepine dose, nor between total calcium level and duration and dose of valproic acid therapy.Conclusion Longer duration of carbamazepine therapy is associated with low total serum calcium level, but carbamazepine dose is not. In addition, duration and dose of valproic acid are not associated with low total serum calcium level.

Co-Authors A. Abadi Abdi Wijaya Achirul Bakri Arinta Atmasari Asep Nurul Huda Awan Nurtjahyo Dewi Rosariah Ayu Dian Puspita Sari Edy K. Ginting Eka Intan Fitriania Erial Bahar Evi Dewiyanti Fadil P Hertanti Indah Lestari Irfanuddin Irfanuddin Julianti Julianti Julius Anzar Masagus Irsan Saleh Masayu Rita Dewi Minerva Riani Kadir Muhammad Irsan Saleh Rachman Indra Jaya Sheila Noberta Silvia Triratna Silvia Triratna Syarif Husin Yenni Riska Zettyana Yulisnawati H Yuwono Yuwono

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