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Arwin A. P. Akib
Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
Health Professions Medicine & Pharmacology

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Ventricular function and dimensions in children with human immunodeficiency virus infection Rahmat B. Kuswiyanto; Mulyadi M. Djer; Arwin A. P. Akib; Sudigdo Sastroasmoro
Paediatrica Indonesiana Vol 51 No 3 (2011): May 2011
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (131.735 KB) | DOI: 10.14238/pi51.3.2011.149-56

Abstract

Background Prevalence of cardiac complications in children 'With human immunodeficiency virus (HIV) infection have increased, in association 'With the availability of antiretroviral (ARV) therapy and the decrease of opportunistic infections. However, studies on cardiac complications in HIV patients in the various HIV clinical and immunologic categories have been limited. Furthermore, cardiac complications in Indonesian HIVinfected children have never been reported.Objectives To detennine the prevalence of cardiac complications in HIVinfected children and to compare ventricular function and dimensions based on HIV clinical and immunologic categories. Methods A cross􀁍sectional study was done in the Department of Child Health, Cipto Mangunkusumo Hospital, Jakarta between October and December 2009 on 7 4 HIV􀁍infected children aged below 15 years. Children with severe chronic or acute systemic diseases were excluded. Investigations included physical examinations, 12􀁍lead electrocardiography and echocardiographyto assess left ventricular dimension and ventricular function. Cardiac findings among children in different clinical and immunological categories were compared.Results Five children showed left ventricular fractional shortening below 25% and 16 had right ventricular dysfunction. Mean cardiac function and dimension were in the normal range. No differences in cardiac function and dimension, among the clinical HIV category groups (p>0.05) or immunologic suppression status groups (p>0.05) were observed.Conclusion In children 'With HIV infection, the prevalence of left ventricular dysfunction and right ventricular dysfunction was 7% and 22%, respectively. No differences in cardiac function and dimension were found among the different HIV clinical and immunological categories.
Pulse pressure variation and systolic pressure variation in mechanically ventilated children Johnny Nurman; Antonius H. Pudjiadi; Arwin A. P. Akib
Paediatrica Indonesiana Vol 51 No 1 (2011): January 2011
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi51.1.2011.34-40

Abstract

Background In mechanically ventilated patients, changes in breathing patterns may affect the preload, causing stroke volume fluctuation. Pulse pressure variation (PPV) and systolic pressure variation (SPV) are dynamic means of the hemodynamic monitoring in ventilated patients. No study on PPV and SPY in children has been reported to date.Objective To study changes in PPV and SPY values in mechanically ventilated children.Method A descriptive cross􀁏sectional study was done at the Pediatric Critical Care Unit (PICU), Cipto Mangunkusumo Hospital, Jakarta. Subjects were mechanically ventilated children aged > 12 months. Echocardiography was performed in all patients to determine the cardiac index. Arterial pressure was measured by connecting an arterial line to a vital signs monitor. PPV and SPV were calculated using the standard formulas. Bivariate correlation tests were performed between cardiac index and PPV and between cardiac index and SPV. Receiver operator characteristic (ROC) curve analysis was done to determine the optimum PPV and SPV cut-off points to predict normal cardiac index (2:3.5 L/minute/m2).Results Eighteen patients were enrolled in the study, yielding 48 measurements. Mean cardiac index was 2.9 (SD 1-2.6) L/minute/m2. Median PPV was 18.9 (range 4.1-45.5)% and SPV was 12.1 (range 3.8- 18.9)%. We found strong negative correlations between PPY and cardiac index (r= ; p = ) and SPY and cardiac index (r= ; p = ). To predict nonnal cardiac index, the optimum cut-off point was 11.4% for PPV (100% sensitivity, 100% specificity) and 9.45% for SPV (91.7% sensitivity, 100% specificity).Conclusion In mechanically ventilated children, cardiac index is negatively correlated with PPV and SPV.
Influence of Hepatitis B immunization to prevent vertical transmission of Hep-B virus in infants bam from Hep-B positive mother Liza Fitria; Hartono Gunardi; Arwin A. P. Akib
Paediatrica Indonesiana Vol 50 No 6 (2010): November 2010
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (114.709 KB) | DOI: 10.14238/pi50.6.2010.321-5

Abstract

Background Hepatitis B is one of the most common infectious diseases worldv.ide. Indonesia has moderate-high endemicity for hepatitis B infection. Perinatal transmission increases the risk for chronic hepatitis B. Infants from HBsAg-positive mothers should receive hepatitis B immunoglobulin (HBIG) and vaccination within 12 hours of birth, but this practice is not routinely done in Indonesia due to financial constraints.Objectives To detennine the influence of Hep-B immunization on preventing Hepatitis B vertical transmission. Methods A descriptive cohort study was conducted from May 2009 - January 2010. Subjects were term infants born from HBsAg-positive mothers v.ith no history of HBIG administration. They had received complete hepatitis B immunization and 1 month after the last dose were evaluated for HBsAg and anti-HBs. Cord blood was also taken during labor to measure HBsAg.Results There were 22 infants born from HBsAg-positive mother who met the inclusion criteria. HBsAgwas positive in 6 of22 cord blood specimens. There were 15 infants who completed this study. One of 15 infants had positive HBsAg after completed hepatitis B immunization and 12 of 15 infants had protective level of anti-HBs. Effectiveness of hepatitis B immunization to prevent vertical transmission in this study was 70-90%.Conclusion Hepatitis B immunization can prevent vertical transmission of hepatitis B in infants born to mothers who are HBsAg-positive even without administration of HBIG.
Role of laboratory values in determining disease activity in juvenile rheumatoid arthritis Arwin A. P. Akib; Alan R. Tumbelaka; Titi S. Sularyo; Dina S. Daliyanti
Paediatrica Indonesiana Vol 39 No 1-2 (1999): January - February 1999
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi39.1-2.1999.47-55

Abstract

Juvenile rheumatoid arthritis (JRA) is an autoimmune joint disease characterized by supression of disease activity. To confirm clinical criteria in determining disease activity, several laboratory parameters, such as haemoglobm level, leucocyte count, thrombocyte count, erythrocyte sedimentation rate (ESR), C reactive protein (CRP), serum concentration of immunoglobulin and complement are considered important. This retrospective study was undertaken to find out whether the same correlation was also existed our patients trend. Bivariate analysis was used to study 113 episodes of disease activity in 46 patients with JRA from October 1983-0ctober 1997. Each episode of disease activity was clinically classified as either active or inactive according to American Rheumatism Assocation (ARA). It was found that CRP and disease activity correlated significantly (p=O.04). The disease activity was not associated with anemia, leukocytosis, thrombocytosis, increased level of ESR, high serum immunoglobulin concentration, or increased level of complement. Heterogenous origin in 3 types of IRA and limited study subjects may affect these results. In conclusion, besides clinical judgment of disease activity, CRP can be added and used as an objective measure of disease activity.
Profile of Mother's Knowledge and Behavior Toward Stimulation and Their Babies' Development in an Urban Poor Area in Jakarta Titi S. Sularyo; Ulynar Marpaung; Arwin A. P. Akib
Paediatrica Indonesiana Vol 39 No 9-10 (1999): September - October 1999
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (3515.203 KB) | DOI: 10.14238/pi39.9-10.1999.278-86

Abstract

This was a field study carried out in all Posyandus located in Pulo Gadung, a poor urban of East Jakarta, from April until October 1998. Three hundred and fourteen mothers and their babies were recruited. Most of the mothers (67.2%) aged from 20-29 years old, with low education level (42.4%) and a low income (19.4%). Almost all respondents were housewives and the average number of children was two (34.7%). The most important source of information for the respondents was the electronic media. Almost half of mothers behaved well toward stimulation of their babies development (49.4%); however, 64.3% had low knowledge especially about the time baby could sit upright with a good head control. Those who behaved fairly and poorly comprised 35.7% and 15%, respectively. It seems that fine motor sector was neglected. There was no significant association between mother’s knowledge and behavior towards stimulation and the development of their respective babies (p<0.5722). It revealed also that the income per capita had significant association with development of the babies (p=0.033).
Clinical characteristics of hemophilia A patients with hemarthrosis Setyo Handryastuti; Djajadiman Gatot; Arwin A. P. Akib
Paediatrica Indonesiana Vol 42 No 5-6 (2002): May 2002
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (549.373 KB) | DOI: 10.14238/pi42.5-6.2002.101-5

Abstract

Background Hemarthrosis is the most frequent bleeding manifestation of severe hemophilia. Repeated hemarthrosis will cause chronic arthropathy, which results in a physical disability.Objectives To obtain data of clinical characteristics of hemophilia- A patients with hemarthrosis (particularly chronic hemarthrosis) and to know the effect of on-demand therapy on joints of the patients.Methods We evaluated 102 hemophilia A patients in Pediatric Hematology and Oncology Division, Cipto Mangunkusumo Hospital for 6 months beginning from March 2001.Results The number of cases of chronic hemarthrosis was 22%,smaller than previous study (54%). Chronic hemarthrosis mostly occurred in hemophilia A patients who aged between 13-18 years, had severe hemophilia A and frequency of hemarthrosis more than 12 times a year, and also patients who did not receive adequate therapy. The joint which most frequently suffered from hemarthrosis were knee (26%), ankle (23%) and elbow (21%). The critical period for the first hemarthrosis was at the age of 2-12 years, and repeated  hemarthrosis episodes commonly occurred at the age 6-18 yearsowing to the child's increasing physical activities.Conclusion Hemarthrosis can be prevented and anticipated. It is important to notice the critical period when first hemarthrosisand repeated hemarthrosis occur. The certain joints like knee, ankle and elbow must be given more attention due to the risk ofrepeated hemarthrosis.
Co-Authors Alan R. Tumbelaka Antonius H. Pudjiadi Dina S. Daliyanti Djajadiman Gatot Hartono Gunardi Johnny Nurman Liza Fitria Mulyadi M. Djer Rahmat B. Kuswiyanto Setyo Handryastuti Sudigdo Sastroasmoro Titi S. Sularyo Ulynar Marpaung