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Alan R. Tumbelaka
Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
Health Professions Medicine & Pharmacology

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Journal : Paediatrica Indonesiana

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The proportion of bone mineral density in children with high risk acute lymphoblastic leukemia after 6- and 12-month chemotherapy maintenance phase Mira Christiyani Santoso; Endang Windiastuti; Alan R. Tumbelaka
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 (121.074 KB) | DOI: 10.14238/pi50.6.2010.365-70

Abstract

Background Low bone mineral density (BMD) value is one of the current concerns in acute lymphoblastic leukemia (ALL) patients. Some risk factors including use of chemotherapeutic drugs, nutritional status, phy sical activities, and progression of disease are suspected as the predisposing factors for development of osteopenia and osteoporosis.Objectives To obtain the proportion of BMD z-score, level of calcium ions, and 25 (OH)D3 in children 'With high risk ALL after 6 and 12 months chemotherapy maintenance phase.Methods We conducted a cross-sectional comparative study from May 2008 to May 2010. Subjects were high risk ALL patients aged 5-18 years old who had completed the 6 or 12 months chemotherapy maintenance phase. We measured 25 (OH) D3 level, calcium ion level, and BMD using electro chemi-luminescence immunoassay, ion selective electrode, and dual x-ray absorptiometry, respectively.Results There were 40 subjects who enrolled this study. The incidence of hypocalcemia and vitamin D deficiency were 33/40 and 40/40, respectively. The mean calcium ion levels, 25 (OH)D3 level, and BMD z􀁏score values in six months groups were 1.1 (0.1 SD) mmol/L, 21.3 (2 SD) ng/L, -0.7 (0.8 SD), respectively, while in the 12 months group, the values were 1.1 (0.0 SD) mmol/L, 21(2.2 SD) ng/L, -1.7 (0.6 SD), respectively (P=0.478). Body mass index (BMI) and corticosteroid cumulative dose is correlated \\lith the low BMD values in L1-L4.Conclusion The bone mineral metabolism disorder marked with the low levels of calcium, 25 (OH)D3 and osteopenia was observed in ALL patients who underwent chemotherapy. The proportion of the BMD z-score value, calcium ion level, and 25 (OH) D3 in the two groups were not statistically significant.
Reflux esophagitis in children with feeding problems: A preliminary study Lia Mulyani; Badriul Hegar; Alan R. Tumbelaka; Ening Krisnuhoni
Paediatrica Indonesiana Vol 50 No 5 (2010): September 2010
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (388.663 KB) | DOI: 10.14238/pi50.5.2010.284-90

Abstract

Background Untreated gastroesophageal reflux can cause reflux esophagitis, a condition characterized by damage to the esophageal mucous layer due to exposure to caustic gastric contents. Manifestation of esophagitis in young children include feedingproblems, irritability, and back􀀳arching. Persistent esophagitis may cause growth failure, gastric bleeding, and anemia. Reflux esophagitis should be considered an etiology of feeding problems, especially in children with a history of gastroesophageal reflux during infancy.Objective The purpose of this study is to detennine the prevalence of reflux esophagitis in children with feeding problems.Methods A cros-sectional study was done in November 2007 to April 2008. Children under 5 years of age with feeding problems and a history of regurgitation or vomiting started from age 6 months or more underwent endoscopy and biopsy examinations. Reflux esophagitis was diagnosed based on the Los Angeles classification of endoscopic examination.Results Reflux esophagitis was diagnosed in 18 of 21 children with feeding problems and a history of regurgitation or vomiting. Most subjects were boys aged 12 to36 months. Feeding problems has lasted for more than 6 months, regurgitation or vomitingfor more than 12 months, and suffered from mild malnutrition. Vomiting was observed to be a common symptom in children with reflux esophagitis.Conclusion The prevalence of reflux esophagitis in children with feeding problems and a history of regurgitation or vomiting started from age ≥ 6 months is high, therefore it will influence treatment.
Procalcitonin levels in children aged 3-36 months with suspected serious bacterial infection Tuty Herawaty; Alan R. Tumbelaka; Dwi Putro Widodo; Partini Pudjiastuti Trihono; Darmawan B. Setyanto; Piprim B. Yanuarso
Paediatrica Indonesiana Vol 50 No 5 (2010): September 2010
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (117.386 KB) | DOI: 10.14238/pi50.5.2010.310-5

Abstract

Background Fever in children aged 3-36 months is usually caused by viral infection, however, 11-20% of cases may progress into serious bacterial infection (SBI). A good diagnostic tool is required to detect SBI to reduce mortality and avoid unnecessary use of antibiotics.Objectives To determine procaldtonin (peT) levels, and etiology of bacteremia in febrile children aged 3-36 months old with suspected SBI.Methods A cross-sectional descriptive study was conducted in Cipto Mangunkusumo and Tangerang General Hospital during April-May 2010. Complete blood cells count and acute illness observation score (AIOS) were perfonned on febrile children aged 3-36 months. Subjects meeting the inclusion criteria underwent blood culturing and testing of procalcitonin levels.Results There were 39 children met the criteria. Boys and girls ratio was 1.6 Mth median age of 10 months. Mean of AlOS was 20.5 (4.5 SD) and mean of hemoglobin was 10.2 (SD 2.1) g/dL. Median of leukocyte and absolute neutrophyl count were 18,600/uL and 12,300/uL, respectively. Median of procaldtonin 1.8 (range 0.04-71.60) ng/mL, mean of procalc itonin in bacteremia subgroup 22.60 (SD 27.6) ng/mL and 6.38 in non-bacteremia subgroup (11.0 SB) ng/mL. In children with severely ill appearance, the likelihood of procaldtonin levels ≥2 ng/mL was 8.67 times higher (95%CI 1.66 to 50.56) than in moderately or mildly ill-appearing children. In subjects Mth procalcitonin level of ≥2 ng/mL, the risk of bacteremia was 8.1 times (95% CI 2.9 to 1051.6) higher and the risk of sepsis was 55.47 times higher than in subjects Mth procalcitonin <2 ng/mL (95% CI 1.22 to 68.02). We observed bacteriemia in 11 of 39 subjects (28.2%). The pathogens isolated from these 11 subjects were Klebsiella pneumonia, Staphylococcus aureus, Eschericia coli, Serratia marcesens, Staphylococrus saprophyticus, and Serratia liqueafaciens.Conclusion The proportion of bacteremia in children aged 3-36 months old with suspected serious bacterial infection was 28.2% with no predominant microorganism. Elevated procaldtonin level of ≥ 2 ng/mL was assodated with severe illness apppearance, bacteremia, and sepsis. 
Features of patients with malaria treated at the Department of Child Health Cipto Mangunkusumo Hospital, Jakarta Diana Mettadewi Jong; Hindra Irawan Satari; Sri Rezeki Hadinegoro; Sumarmo Soedarmo; Hardjono Abdoerrachman; Alan R. Tumbelaka
Paediatrica Indonesiana Vol 42 No 9-10 (2002): September 2002
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (210.608 KB) | DOI: 10.14238/pi42.5.2002.217-9

Abstract

Background Malaria is endemic throughout the tropical areas of the world. In Jakarta, one of the cities in Indonesia that has been declared to be free of malaria, malaria was found in 1044 patients from 1974 to 1990. All patients were infected in other areas.Objective To describe the clinical features of malaria in the Department of Child Health, Cipto Mangunkusumo Hospital, Jakarta.Methods A retrospective study was carried out on all patients with malaria treated at the Department of Child Health, Cipto Mangunkusumo Hospital, Jakarta, from January 1995 to December 2000.Results There were 10 inpatients and 5 outpatients with malaria eligible in this study. Most patients (13) were boys, and 8 patients aged 5-9 years. We found falciparum malaria in 5, one of which with cerebral malaria, vivax in 3 patients, and mixed infection in 4 patients. In 3 patients, the type of malaria could not be detected. Three out of the referred patients were referred with the diagnosis of leukemia. Fever, splenomegaly, and pale were found in most patients. All inpatients recovered completely on discharge.Conclusions In malaria-free areas, all patients were infected in other areas and some were referred with misdiagnoses. Malaria should be considered in patients with fever or pale and organomegaly.
Clinical and laboratory features of typhoid fever in childhood Sylvia Retnosari; Alan R. Tumbelaka; Arwin P. Akib; Sri Rezeki Hadinegoro
Paediatrica Indonesiana Vol 41 No 5-6 (2001): May 2001
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (137.445 KB) | DOI: 10.14238/pi41.3.2001.149-54

Abstract

The aims of the study were to review the clinical features of patient with suspected typhoid fever, to obtain features of the blood culture results, Widal, Typhidot tests and to identify the relationship between/prior antibiotic administration with laboratory findings. The study had been conducted since January 1, 1999 till January 31, 2000 with inclusion criteria (1) age of patient was 3 to 14 years, (2) patient with diagnosis of suspected typhoid fever and (3) gave consent to participate in the present study. Thirty-six patients were eligible for this study and the result showed that typhoid fever was encountered more commonly in girls with the most prevalent onset was in age 5 to 9 years and duration of fever was less than 8 days. Gastrointestinal tract disturbance was the most frequent complain after fever. Most patient showed negative results in blood culture examination and Widal test, and gave positive results in Typhidot/Typhidot M test as well. Antibiotic administration tended to influence blood culture and Widal test as to need consideration in evaluation of laboratory results. However, a conclusion still could not be drawn definitively that further study with adequate sample number and positive blood culture as criteria inclusion was needed. 
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.
Co-Authors Arwin A. P. Akib Arwin P. Akib Badriul Hegar Darmawan B. Setyanto Diana Mettadewi Jong Dina S. Daliyanti Dwi Putro Widodo Endang Windiastuti Ening Krisnuhoni Hardjono Abdoerrachman Hindra Irawan Satari Lia Mulyani Mira Christiyani Santoso Partini Pudjiastuti Trihono Piprim B. Yanuarso Sri Rezeki Hadinegoro Sumarmo Soedarmo Sylvia Retnosari Titi S. Sularyo Tuty Herawaty