Cipto Mangunkusumo Hospital Jakarta Research Articles

A young girl with suspected encephalitis caused by avian influenza A (H5N1) infection in Indonesia

A previously healthy two-year-old girl was admitted to the Emergency Unit of Cipto Mangunkusumo Hospital (CMH) Jakarta, on March 23, 2006 with a deterioration of consciousness since four days before admission. She was referred by a district hospital with a working diagnosis of suspect encephalitis, gastroenteritis, and febrile convulsion. History taken from her parents revealed that since eight days before admission she had a mild fever and cough, without rhinorrhea. Her appetite, defecation and urination were normal. Patient was taken to a clinic, where she was diagnosed as having an upper respiratory tract infection, and was given three kinds of medicine (i.e., antipyretic, expectorant and antibiotic).

Efektifitas Ketepatan Triage Trauma Terhadap Aktivasi Kode Trauma Pada Pasien Trauma Kategori Merah Di Instalasi Gawat Darurat: Literature Review

Emergency trauma can occur at any time, occur everywhere and can be experienced by everyone. The speed and accuracy of relief in trauma emergency conditions, will determine the outcome of the assistance provided. Help for trauma patients in the Emergency Department begins when the triage officer receives the patient. The triage process sorts patients according to the patient's emergency condition using parameters of level of consciousness, respiratory status and circulation status of the patient. An efficient trauma triage system aims to assist health workers in identifying life-threatening conditions, making timely assessments and management priorities that are appropriate to the severity of the patient. Trauma Code Activation is implemented as a system for providing emergency relief in cases of trauma in the red category. In some countries the application of Trauma Team Activation in cases of trauma in the red category is the main one to optimize the initial management of trauma emergency department. Trauma Code Activation at Cipto Mangunkusumo Hospital Jakarta Emergency Department from September 2018 to June 2019 totaled 362 cases, consisting of 34.1% head injuries (7.6% bleeding), 19.3% fractures, 13% burns, 6, 7% politrauma, and there are 3.8% died.

Serum zinc, selenium, iron, and copper levels in pregnant women with fetal growth restriction

Background: Fetal growth restriction is associated with many adverse effects and increases the risk of perinatal mortality by more than ten-fold. Zinc, selenium, iron, and copper have important roles in cell proliferation, inflammation, and oxidative stress which possibly serve as the basis for development of fetal growth restriction. Objective: To compare serum zinc, selenium, iron, and copper plasma levels between normal pregnancies and pregnancies with fetal growth restriction. Materials and Methods: The present was a cross-sectional study conducted at Obstetrics Emergency Unit of Cipto Mangunkusumo Hospital Jakarta from February until May 2017. Normal pregnant women and pregnant women with fetal growth restriction were recruited in this study. Maternal blood samples were taken before labor, and serum zinc, selenium, iron, and copper levels measurements were done. Results: Thirty normal pregnancies and 30 pregnancies with fetal growth restriction were enrolled in this study. Mean serum zinc, selenium, iron, and copper levels in normal pregnancy were 42.07 µg/dL, 69.80 µg/L, 70.50 µg/dL, and 2177 µg/L, respectively. Meanwhile, mean serum zinc, selenium, iron, and copper levels in pregnancy with fetal growth restriction were 43.53 µg/dL, 80.83 µg/L, 106 µg/dL, and 2,133.5 µg/L, respectively. There were significant differences in serum selenium concentrations (p = 0.013) and serum iron concentrations (p = 0.009) between the two groups. There were no significant differences in serum zinc and copper levels between both groups. Conclusion: Serum selenium and iron levels were higher in pregnancies with fetal growth restriction. Conclusion: The present study indicates the significant roles of micronutrients and oxidative stress in the pathophysiology of fetal growth restriction.

A case evaluation of traumatic brain injury in Wahidin Sudirohusodo Hospital, Makassar during January 2016 - December 2017

Introduction: Traumatic Brain Injury is a case that is often encountered in emergency care installation and is one of the leading causes of death in the productive age range. Globally, the Traumatic Brain Injury incident increased sharply, mainly due to the increase in motorized vehicle use. In 2020, the WHO estimated that traffic accidents would be the third-largest cause of disease and trauma in the world. In Indonesia, at Cipto Mangunkusumo Hospital Jakarta shows that the mortality rate is high in patients with severe head injuries with a percentage of 35% -50%. This figure is higher than the international literature standard. This study aims to describe the traumatic brain injury case in Wahidin Sudirohusodo Hospital from January 2016 - December 2017.Methods: This descriptive study report the evaluation of cases of traumatic brain injury patients at Wahidin Sudirohusodo Hospital Makassar, from January 2016 - December 2017. The population and sample are 1217 patients (total sampling).Result: From 1217 samples, most are men (70%), and 30% are women, with age 11-20 years are the most (30%). The most common causes of traumatic brain injury are caused by traffic accidents (89%). The largest group of patients (50%) had a mild head injury (GCS 14-15). From a Head CT scan, the most lesion was epidural hemorrhage (EDH) (26-34%) followed by intracerebral hemorrhage (ICH) (23-28%). About 36% patients were treated by operations and the rest were conservative. Based on the outcomes, about 77% were discharged from a hospital in life and 23% died.  Conclusion: The highest mortality was in severe head injury, about 87% was died (161 of 186 patients with a severe head injury). From the Head CT Scan, about 95% (19 of 20 patients) with IVH lesions were died and followed by ICH lesions as 39% (122 died from 309 patients). Based on the therapy given both surgery and conservative, patients who were discharged from the hospital in life at 77-79% and died 21-23%.

Characteristics of Acute Transfusion Reactions and its related factors in Cipto Mangunkusumo Hospital Jakarta, Indonesia

Latar belakang: Reaksi transfusi akut (RTA) merupakan sekelompok kejadian yang tidak diinginkan akibat pemberian transfusi darah. Manifestasi dari RTA bervariasi dari yang ringan hingga mengancam nyawa. Saat ini, data mengenai reaksi transfusi di Indonesia masih sangat terbatas. Dalam studi ini, kami bertujuan untuk memberikan gambaran mengenai karakteristik RTA dan faktor-faktor yang mempengaruhinya.
 Metode: Studi ini merupakan studi retrospektif yang melibatkan 288 subyek dengan RTA. Studi dilakukan di Rumah Sakit Dr. Cipto Mangunkusumo, dimulai sejak Januari hingga Desember 2017. RTA dikelompokkan berdasarkan sistem tubuh yang mengalami manifestasi, serta derajat manifestasinya.
 Hasil: Sel darah merah merupakan produk darah utama yang ditransfusikan ke subyek, diikuti dengan konsentrat trombosit, plasma segar beku, dan kriopresipitat. Lima gejala utama dari RTA adalah gatal, demam/kenaikan suhu tubuh, menggigil, urtikaria, dan angioedema. Berdasarkan sistem tubuh yang terkena, umumnya RTA bermanifestasi sebagai gejala pada kulit (56.6%). Berdasarkan derajat manifestasinya, RTA umumnya dikategorikan dalam derajat ringan (55.9%). Anak-anak cenderung mengalami manifestasi yang ringan (64.8%) dan utamanya bermanifestasi pada kulit (65.4%). Riwayat transfusi mempengaruhi derajat RTA secara signifikan. RTA derajat sedang dan gejala konstitusional lebih banyak ditemukan pada subyek yang mendapat PRC dibanding produk darah lainnya.
 Kesimpulan: Umumnya RTA bermanifestasi sebagai gejala dermatologi. Hanya sedikit kasus RTA yang disebabkan oleh reaksi inkompatibilitas. Manifestasi dan derajat RTA juga dipengaruhi oleh umur, riwayat transfusi, dan jenis komponen darah. 
 Kata kunci: Transfusi darah, reaksi transfusi akut, riwayat transfuse, usia
 
 Abstract
 
 Background: Acute transfusion reactions (ATRs) are a group of adverse events caused by blood transfusions. Manifestations of ATRs vary from mild to life threatening. At present, data about transfusion reactions in Indonesia are still limited. In this study, we aim to determine the characteristics of ATRs and its related factors.
 Methods: This was a retrospective study of 288 subjects with ATRs. The study was conducted in Cipto Mangunkusumo Hospital, started from January to December 2017. ATRs were categorized based on the body systems affected and degree of manifestations.
 Results: Packed red cells (PRC) was the predominant blood product (51.4%) which was transfused to subjects, followed by thrombocyte concentrate (TC), fresh frozen plasma (FFP), and cryoprecipitate. Five most common predominant symptoms of ATRs were pruritus/itch, febrile/increased temperature, chills, transient urticaria, and angioedema. Based on the affected body systems, the majority of ATRs manifested as dermatologic symptoms (56.6%). Based on the degree of manifestations, the majority of ATRs were categorized as mild degree (55.9%). Children tended to have milder symptoms (64.8%), which mostly manifested as dermatologic symptoms (65.4%). History of transfusion affected the degree of ATR significantly. Moderate degree of ATRs and constitutional symptoms were found more common in subjects who received PRC than other blood products.
 Conclusion: Most of ATRs manifest as dermatologic symptoms, which represent allergic reactions. Only a small portion of ATRs are caused by incompatibility reactions. The manifestation and degree of ATRs are also affected by age, history of transfusion, and type of blood components. 
 Keywords: Blood transfusion, acute transfusion reaction, transfusion history, age

The Correlation of KRAS Gene Expression and P53 Immunoexpression in Colorectal Adenocarcinoma.

BACKGROUND:Colorectal Adenocarcinoma (ADCCR) is the third most cancer not only in the world but also in Indonesia. There were 623 cases of ADCCR at Dr Hasan Sadikin hospital within 2015-2017. Both KRAS and TP53 mutation are known as genes which involve in carcinogenesis through the same pathway, namely the chromosomal instability pathway. In West Java, researches focusing on mutation KRAS and p53 also a correlation between both biomarkers among ADCCR patients are still limited.AIM:Therefore, this research aimed to perceive a correlation between KRAS gene expression with p53 immunoexpression in ADCCR.METHODS:Cross section research design was performed to 62 cases of ADCCR as paraffin block taken from 4 hospitals in West Java, including Dr Hasan Sadikin hospital Bandung, Santosa hospital Bandung, Borromeus hospital Bandung and Syamsudin hospital Sukabumi from January 1st 2014 to 31s November 2018. KRAS mutation gene data taken from secondary data at molecular laboratory in Ciptomangunkusumo Hospital Jakarta and Dr Sardjito Hospital Jogjakarta, while the detection of p53 immunoexpression data using immunohistochemical staining was carried out in the Laboratorium of Anatomical Pathology of Padjadjaran University (Dr Hasan Sadikin Hospital). All data were analysed using Chi-Square test with p-value < 0,05 of significant level then proceeded with Stata ver.11 for windows.RESULTS:The results of this study showed that KRAS gene expressions from 62 sample consist of 39 wild type KRAS (62.39%) and 23 mutant KRAS (37.1%). The p53 immunoexpression consists of 27 negative cases (non-mutant p53) and 35 mutant p53, which includes 10 cases as focal expression (16.33%) and 25 cases as diffuse expressions (40.33%). There is a significant association between KRAS gene expression and p53 immunoexpressions in ADCCR (p = 0.04), with mild positive correlation (Rho 0.28).CONCLUSION:This study concluded that KRAS and p53 mutations are involved in carcinogenesis, and the p53 mutation is a more dominant risk factor than KRAS mutation among West Java people. P53 mutations with diffuse pattern tend to express mutant KRAS while p53 negative and having a focal pattern tend to express wt KRAS.

SLCO1B1 c.388A\u2009>\u2009G variant incidence and the severity of hyperbilirubinemia in Indonesian neonates

ObjectiveIt has been established that genetic factors play a substantial role in the development of neonatal hyperbilirubinemia. The population of Indonesia and other Southeast Asian countries has similar, yet different genetic makeup compared to the rest of Asia. Aside from UGT1A1, variants of SLCO1B1 have also been known to contribute to the severity of neonatal hyperbilirubinemia in Asian populations. Since there has been no report on SLCO1B1 polymorphism in relation with hyperbilirubinemia in Indonesia, this study aims to explore incidence of SLCO1B1*1B polymorphism in Indonesia based on 3 hospitals from different provinces and population, and their association with hyperbilirubinemia severity.MethodsOur study included 88 neonates with mild and moderate-severe hyperbilirubinemia from 3 NICU in hospitals representing homogenous and heterogenous populations: Biak General Hospital Papua, Cipto Mangunkusumo Hospital (Jakarta), and M Yunus Hospital (Bengkulu). We collected samples between November 2016 and September 2017. DNA was obtained from existing samples of the patients from previous studies and were subjected to Polymerase Chain Reaction – Restriction Fragment Length Polymorphism (PCR-RFLP). We analyzed the *1B variant located in exon 5 of SLCO1B1 with TaqI restriction endonuclease. Clinical, demographic, and laboratory data was also collected from medical records and parents’ interviews.ResultsThe most dominant variant of SLCO1B1*1B in our population is the homozygous G/G (68.18%), followed by heterozygous A/G (26.14%), and wild type A/A (5.68%). The heterozygous A/G had an Odds Ratio (OR) of 0.73 (95% CI 0.10–5.2) and homozygous G/G with OR of 0.51 (95%CI 0.08–3.27), both were not significant. Genotypic distribution across the different centers were also similar and not significant. The significant risk factors for moderate-severe hyperbilirubinemia were the population the neonate originated from (p = < 0.001) and the delivery location (p = 0.001), while SLCO1B1*1B was not associated with the different severity of hyperbilirubinemia.ConclusionsSLCO1B1*1B is not associated with higher bilirubin levels among neonates with hyperbilirubinemia in Indonesia. Further study is needed to find other potentially important genetic polymorphisms in the development of severe hyperbilirubinemia in Indonesia.

Age, prostate volume, prostate-specific antigen and prostate-specific antigen density as predictor factors in results of transrectal ultrasonography-guided prostate biopsy

Background: To identify the predictor factors, such as prostate-specific antigen (PSA), age, prostate volume (PV), and PSA density (PSAD) as indications to perform transrectal ultrasonography (TRUS)-guided prostate biopsy in reducing unnecessary biopsies and improving detection rate. Methods: A total of 1232 samples were obtained from the medical records of patients underwent prostate biopsy from January 2008 to December 2013 in Cipto Mangunkusumo Hospital Jakarta. Pre-biopsy data including age, PSA, prostate volume, and PSAD were obtained. The Mann-Whitney U-test and unpaired t-test were conducted on the quantitative variables; a chi-square test was used for qualitative variables. This study also conducted receiver operating characteristic (ROC) curve analysis to determine the cut-off point and the optimum specificity and sensitivity for each variable. Results: Among 1232 patients, 33.5% had a positive biopsy result. The median age and PSA (68 years and 57.45 ng/ml) in the positive biopsy group was higher than in the negative group (65 years and 11.69 ng/ml), p &lt;0.001. PSAD in patients with PSA 4-10 ng/ml, 10-20 ng/ml, and 20 ng/ml (0.20, 0.35, 2.05) in positive group was higher than negative group (0.14, 0.24, 0.53), p &lt;0.001. Those with a positive biopsy result had a lower median PV (42 ml (range, 13.8-208)) compared to those with negative biopsies (55.4 ml) (p &lt;0.001). In ROC curve, PSAD had the highest sensitivity and specificity (81.4% and 82.0%) with a cut-off point of 0.43 ng/ml/ml (p &lt;0.001). Conclusion: The incidence of PCa increased with higher PSA level, older age and lower PV. Utilization of PSAD 0.17 ng/ml/ml as a cut-off point in patients with PSA level between 4-10 ng/ml is recommended to improve PCa detection in Indonesian men.

Factors Related with Complication Following Gastrectomy: Retrospective Analysis based on the Clavien–Dindo Classification System Agi Satria Putranto, Fransisca Jann

Introduction: Gastric cancer represents a global health problem and surgical resection is the only curative treatment option available. The purposes of this study were to retrospactively analyze all post-gastrectomy complications according to severity using Clavien–Dindo classification and to identify factors related to post-operative complications. Methods: The cross-sectional design was used. A total of 35 patients, with complate medical records, who underwent gastrectomy in Cipto Mangunkusumo Hospital Jakarta between January 2007 and December 2017 were retrospectively analyzed for complication and factors related to it were evaluated. Ethical approval No 653/UN2.F1/ETIK/2016. Results: Of the 35 patients underwent gastrectomy at Cipto Mangunkusumo Hospital Jakarta, the median age was 67, and 51,4% were female. Median albumin preoperative was 3,0 g/dL, median intraoperative blood transfusion was 217 mL and median intraoperative blood loss was 500 mL. Most of the patients underwent parsial gastrectomy was 91,4% (n = 32) and total gastrectomy was 8,6% (n = 3). The incidence of severe complications (Stage ≥ IIIa) was 25,7% (n = 9). The causes requiring surgical intervention ware pneumothorax 5,7% (n = 2), intra-abdominal bleeding 2,9% (n = 1), anastomotic leakage 5,7% (n = 2), duodenal stump leak 2,9% (n = 1), septic syok/death 8,5% (n = 3). Age, intraoperative blood transfusion and intraoperative blood loss are positively corelated with complication and statatisticaly significant (p <0,05). Conclusions: Age, intraoperative blood loss and intraoperative transfusion are positively correlated with post-gastrectomy complication based on the Clavien-Dindo classification. Keywords: Clavien-Dindo classification, post-gastrectomy complication, gastrectomy

Neuropathic pain in HIV patients receiving ART without stavudine in an Indonesia Referral Hospital

Lower limb neuropathic pain in HIV patients is a common manifestation of sensory neuropathy (HIV-SN), but can be seen in patients who do not meet standard definitions of HIV-SN. The drug stavudine is a risk factor for HIV-SN, but some patients treated without stavudine experience HIV-SN, and the prevalence and risk factors influencing neuropathic pain in this setting are unknown. A cross sectional study at Cipto Mangunkusumo Hospital Jakarta tested 197 HIV patients treated for >12 months without stavudine. HIV-SN was defined using the AIDS Clinical Trial Group Brief Peripheral Neuropathy Screening Test (ACTG-BPNST). A validated Indonesia translation of Douleur Neuropathique en 4 (DN4) questionnaire was used to assess lower limb neuropathic pain. Nerve conduction studies assessed large nerve fiber function and Stimulated Skin Wrinkle (SSW) tests were performed to assess small nerve fibers. The prevalence of neuropathic pain was 6.6%. BPNST+HIV-SN was diagnosed in 14.2% of the cohort and 38.5% of patients with pain. Use of protease inhibitors and ART duration <2 years associated with neuropathic pain in univariate (p = .036, p = .002, resp.) and multivariable analyses (model p < .001). SSW tests were abnormal in 53.8% of subjects with neuropathic pain and only 25.5% without pain (p = .05). Patients with pain without BPNST+HIV-SN had begun ART more recently than those with both diagnoses. Overall this preliminary study showed that neuropathic pain associated with protease inhibitors and a shorter duration of ART in Indonesian HIV patients, and may be an early symptom of small fiber neuropathy in this context.

Correlation between Pancreatic MRI T2* and Iron Overload in Adult Transfusion Dependent Beta Thalassemia Patients with Growth Retardation: A Single Centre Study in Indonesia

Correlation Between Pancreatic MRI T2* And Iron Overload in Adult Transfusion Dependent Beta Thalassemia Patients With Growth Retardation: A Single Centre Study in IndonesiaFaizal Drissa Hasibuan, MD1,2, Tb. Djumhana Atmakusuma, MD, PhD3,41Department of Internal Medicine, 2Faculty of Medicine Yarsi University Jakarta, Indonesia, 3Medical Hematology - Oncology Division of Internal Medicine Department Cipto Mangunkusumo Hospital, 4Faculty of Medicine Universitas Indonesia, Jakarta, IndonesiaThe prevalence of thalassemia in Indonesia is one of the highest in the world. It is estimated that the prevalence of beta thalassemia carrier is around 3-10%. In 2016, thalassemia center in Cipto Mangunkusumo Hospital (RSCM) Jakarta recorded 9031 patients suffering from major thalassemia in Indonesia. 441 are adult thalassemia patients (age 18 and above) recorded in Kiara thalassemia and hematology-oncology clinics in RSCM. Based on a survey from TIF, endocrine aspect of the thalassemia patients is often ignored by the clinicians. Growth retarded patients are commonly found in the thalassemia clinic in RSCM. Publication regarding the pancreas and its correlation with iron overload in adult beta TDT patients is currently not available in Indonesia. Therefore, the aim of this study was to describe iron overload condition based on the pancreatic MRI T2* and its correlation with beta TDT adult patients who suffer from growth retardation.A cross sectional study was conducted to determine the prevalence of endocrine disorders in adult TDT beta patients, followed by looking for correlation of excess iron load with endocrine function in adult TDT beta patients with growth retardation in adult Thalassemia clinic RSCM Jakarta on December 2017. Patients with HBsAg or Anti HCV positive were excluded. Excess iron is defined as Transferin Saturation (ST) greater than 50% regardless of serum ferritin or serum ferritin (FS) levels greater than 1000 ng/mL regardless of ST or both.The growth retardation is defined as the standing height of the research subject which is lower than the Mid Parental Height (MPH) value of both parents. Pancreatic MRI T2* used magneto avanto Siemens 1,5T with CMR software.We found from 58 patients who followed the study, 32 patients underwent the pancreatic MRI T2* examination with 13 female (40,6%) and 19 male (59,4%). Patients with homozygous beta thalassemia are 16 people (50%) and beta/HbE thalassemia 16 people (50%). The Proportion of low pancreatic MRI T2* values was found to be 87.5%, with moderate hemosiderosis in 13 patients (40.63%) and severe hemosiderosis not found (Table 2). The age range of the study subjects was relatively young with a median age of 21 years. Although the median body weight of study subjects was 42 kg, the median BMI still included in normal range. Excess iron content in this study was assessed with serum ferritin, obtained median 4982.5 ng/mL and transferin saturation with a median of 100%, indicates the subject of research are in a state of excess iron load. This is due to the possibility of inflammation, inadequate use of chelation, hemolysis in thalassemia, hypertransfusion to achieve the target of 12 g/dL for women and 13 g/dL for men. There was no significant correlation between serum ferritin and pancreatic MRI T2* value, nor did a significant correlation between transferrin saturation with pancreatic MRI T2* value (Table 3). In this study, there was a high proportion of subjects with low pancreatic MRI T2* value of 28 subjects (87,5%), divided into 15 mild hemosiderosis (46,87%), 13 moderate hemosiderosis (40,62%) and none of severe hemosiderosis. Our study is the first study which look for the correlation of the excess iron load (serum ferritin and transferrin saturation) with endocrine function in adult TDT beta patients with retardation of growth in Indonesia. This research has limitations. First, it was a cross sectional study so it is not known exactly the beginning of endocrine disorders in the subject . The second limitation, analysis of iron chelation therapy did not do in this study.Finally, we concluded that there was no correlation between pancreatic MRI T2* and iron overload based on serum ferritin and transferrin saturation. Further longitudinal studies in adult TDT patients with thalassemia who have not and have retarded growth were needed. DisclosuresNo relevant conflicts of interest to declare.

Karakteristik Histopatologik dan Imunofenotipik Kanker Payudara di Rumah Sakit Cipto Mangunkusumo Jakarta, Indonesia

&lt;p&gt;Introduction: Breast cancer can be classified into luminal A, luminal B, Her2+, dan basal-like molecular subtype according to genetic profile and immunophenotype. The aim of this study is to assess histopathologic and immunophenotype characteristics of breast cancer in Cipto Mangunkusumo Hospital Jakarta, Indonesia.&lt;br /&gt;Material and methods: This study is a cross-sectional retrospective study. The sample was 2632 breast cancer case in Department of Anatomical Pathology Cipto Mangunkusumo Hospital from the year 2011 until 2015. ER, PR, Her2, Top2 α, and Ki67 immunohistochemical stain was then grouped into luminal A (ER+/PR+/Her2-/Ki67&amp;lt;20%) subtype, luminal B (ER+/PR+/Her2-/Ki67≥20%) subtype, Her2+ (ER-/PR-/Her2+) subtype, and basal-like (ER-/PR-/Her2-) subtype. Kendall’s Tau analysis was done to assess association between sample characteristics and molecular subtype, association between top2α positive and molecular subtype.&lt;br /&gt;Result: The most prevalent to the less prevalent breast cancer molecular subtype was luminal B (43,9%), Her2+ (14,6%), luminal A (14,0%), and basal-like (11,3%). There was a significant association between the tumor stage and breast cancer subtype (p=0,0001). There is also a significant association between Top2α expression and molecular subtype (p=0,0001).&lt;br /&gt;Conclusion: The most prevalent breast cancer molecular subtype was luminal B. There was an association between breast cancer molecular subtype and a higher degree and Top2α expression.&lt;/p&gt;

Clinical, radiological, and histopathological features and prognostic factors of brain tumors in children

Brain tumors are the second leading cause of death among cancers in children. Brain development continues until the age of 3 years; thus, brain tumors have varied clinical, radiological, and histopathological features. This study determined clinical, radiological, and histopathological features and prognostic factors for brain tumors in the pediatrics department of Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital Jakarta in 2010–2015. This retrospective cohort study included 88 children with primary brain tumors treated. Children aged <3 years experienced symptoms such as headaches (63%) and seizures (56%); based on the radiographs, the brain tumors were located mostly in the ventricular cerebrum (25%) and cerebellum (24%); based on the histopathology, the most common types of brain tumor were astrocytomas (31%) and medulloblastomas (25%). Children aged ≥3 years experienced symptoms such as headaches (81%) and impaired vision (65%); based on the radiographs, the brain tumors were located mostly in the cerebellum (24%) and the suprasellar region (10%); based on the histopathology, the most common types of brain tumor were medulloblastomas (21%), astrocytomas (18%), and gliomas (17%). The life expectancy rate for brain tumors was 37%. The most common symptom of a brain tumor was a headache. This study found no prognostic factors for brain tumors in children.

Factors Associated Sexual Dysfunction in Patients Pelvic Organ Prolapse at Dr. Cipto Mangunkusumo and Fatmawati Hospital Jakarta in 2016

Pelvic Organ Prolapse (POP) is a bulge or protrusion of pelvic organs and related segments into or through the vagina. Disturbances in sexual function rarely complained, but from the literature it is known that patients with stage 3–4 prolapse associated with difficulty in achieving an orgasm. This study aims to determine the prevalence of sexual dysfunction in patients with POP and factors associated with sexual dysfunction among them. A cross-sectional design was conducted in Dr. Cipto Mangunkusumo and Fatmawati Hospital Jakarta. All patients who met the inclusion criteria of POP filled out a questionnaire of sexual function index (FSFI-19), then performed univariate analysis of data on the characteristics of the data subject, and bivariate and multivariate analysis to know the relationship between the dependent and independent variables. Of the 82 data, the prevalence of sexual dysfunction in patients with POP reached 57.3%. While most of the patients had experienced menopause POP also with a prevalence of 76.8%. The prevalence of sexual dysfunction in patients who were menopausal POP by 66.7%. From the results of the bivariate analysis, age, menopause, obesity and stage of prolapse were a significant risk factor on the incidence of sexual dysfunction in patients with POP. The variables of age, smoking, menopause, obesity and stage of prolapse, p &lt; 0.25 to be included in the multivariate analysis. From the multivariate analysis, the variables associated with the incidence of sexual dysfunction in patients with POP were age &gt;60 by OR 8 (IK95 2,45–26.12), and obesity (BMI 30 kg/m2) with an OR of 0.30 (CI 95 0.09 to 0.98). Advanced age and obesity are associated with the incidence of sexual dysfunction in patients with POP.

URINARY STONE COMPOSITION ANALYSIS IN INDONESIAN POPULATION: A SINGLE MAJOR CENTRE ANALYSIS

Objective: To evaluate the urinary stone composition of Indonesian population. Material &amp; Methods: This is a retrospective study analyzing total 277 urinary stone, obtained from urinary stone patient that underwent treatment in Cipto Mangunkusumo Hospital Jakarta in period 2000-2013. Results: Urinary stone disease is more common in male, with male : female ratio 1.8 : 1, with both in male and female patient, the incidence are highest at 51-60 years old. Calcium containing stone is predominant in this study with calcium oxalate as the most frequent stone with 61% overall, 43.7% in male and 17.3% in female and founded most frequent in 51-60 years old. Uric acid become the second most common stone after calcium containing stone with 9.0% overall, 6.5% in male and 2.5% in female. Infection associated stone such as struvite is 5.8% and Amonium urate 0.7%. In our study, struvite is founded more in male 3.6% than in female 2.2%. Cystine is a rare stone which is only founded 0.7%, in young age at 21-30 years old. Conclusion: Calcium oxalate is the most frequently stone type in our country as it is worldwide. This study revealed information of stone composition in Indonesian population, that could be beneficial for strategies and management to prevent urinary stone disease and recurrence.

Glaucoma drainage device implantation with adjunctive intravitreal bevacizumab in neovascular glaucoma: 3-year experience.

PurposeTo evaluate the outcome of glaucoma drainage device (GDD) implantation with and without intravitreal bevacizumab (IVB) injection in treating neovascular glaucoma (NVG) at Cipto Mangunkusumo Hospital Jakarta, Indonesia.Patients and methodsThis retrospective study involved 39 eyes with NVG which underwent GDD implantation between 2012 and 2014. Thirty eyes underwent GDD implantation alone (control group) while 9 eyes underwent GDD implantation and IVB injection (IVB group). Visual acuity (VA), intraocular pressure (IOP), number of antiglaucoma medications, and success rate were compared between groups.ResultsThere were no significant differences in preoperative characteristics. On the last visit, VA was 2.6 (0.2–4.0) logMAR in the control group and 2.3 (0.4–4.0) logMAR in the IVB group (P=0.97). In the control group, final VA was significantly worse compared to initial VA (P<0.01), while in IVB group VA was apparently stable (P=0.24). Final IOP was 16.3±10.3 mmHg in the control group and 12.0 (2.0–49.0) mmHg in IVB group (P=0.40). The number of antiglaucoma medications was similar between groups (P=0.57). Surgical success rate in the IVB group (66.7%) was better than the control group (56.7%), but this difference was not statistically significant (P=0.71). Kaplan–Meier survival analysis showed the probability of success 37 months after surgery as 53.6% in the IVB group and 31.6% in the control group. No significant difference was found between the groups (P=0.45).ConclusionIn cases of NVG, GDD combined with IVB could maintain VA compared to GDD alone. However, there were no significant differences in final IOP, number of antiglaucoma medications, and surgical success rate.

Problems of Neonatal Jaundice in Indonesia

This study revealed the incidence of neonatal jaundice in the Dr. Cipto Mangunkusumo Hospital Jakarta to be 32.1%, i.e 42.97% in low birth weight infants and 29.70% in fulllerm infants. No pathological basis was proven in many cases. The factors which may cause pathological jaundice according to the frequency are as follows: infections, anoxia and hypoxia, hemolysis due to G6PD deficiency, multiple factors and hypoglycemia etc. This study also revealed that 69.5% of jaundiced infants had bilirubin concentration of more than 10 mg%. Analysis of the factors showed that most of them were preventable.

The Association of Lipoprotein Changes and the Development of Plasma Leakage in Dengue Infection

There’s interrelationship between infection and lipoprotein. This is a cohort prospective study which conducted November 2010 – February 2011. This study aimed to assess the changes of HDL-C, LDL-C, total cholesterol (TC), triglyceride (TG), in acute and critical phase of dengue infection and its association with plasma leakage. Subjects who had fever 48 hours or less and Dengue NS1 antigen test positive were admitted to Cipto Mangunkusumo Hospital Jakarta. We examined clinical and CBC daily; level of albumin, HDL-C, LDL-C, TC, TG; ultrasound to find ascites and pleural effusion. Among 51 subjects, 21 subjects (41%) had plasma leakage. There were significant lower of HDL-C, LDL-C, and higher TG in critical phase than acute phase. In critical phase, subjects with plasma leakage had a significant lower HDL-C level [26.3 (8.2) vs 33.1 (12.1) mg/dL, p=0.029] but not for LDL-C, TC, and TG. They also had a significantly higher reduction in HDL-C [19.6 (9.1) vs 11.5 (5.8) mg/dL, p<0.0001] and TC [25.1 (20.0) vs 15.2 (14.5) mg/dL, 0.045] over the course of acute to critical phase. Lipoprotein changes during dengue infection were more pronounced among subjects who developed plasma leakage. The higher reduction in HDL-C is associated with the development of plasma leakage. Normal 0 false false false IN X-NONE X-NONE

Clinical manifestations of rotavirus diarrhea in the outpatient clinic of Cipto Mangunkusumo Hospital, Jakarta

Background Rotavirus is one of the most common cause of acutediarrhea among hospitalized and pediatric outpatients, especiallythose aged 6-24 months. Data of hospitalized children showed thatrotavirus causes severe diarrhea, but data of outpatient children inIndonesia, especially at Cipto Mangunkusumo Hospital Jakarta, islimited.Objective To characterize the clinical manifestations of rotavirusdiarrhea in the pediatric outpatient clinic at Cipto MangunkusumoHospital Jakarta.Methods This was a cross-sectional study, done in July 2003 –March 2004. Stool specimens were collected from patients aged6-24 months with diarrhea and tested for rotavirus by ELISA.Result Of the 98 children enrolled, 35 (35.7%) children excretedrotavirus. Rotavirus diarrhea was seen in 43.8% of children aged6-11 months, of whom 37.0% of them were undernourished. Maleswere affected 1.4 times as much as females. The clinical manifes-tations were passage of diarrheic stools more than 10 times a day(58.3%), mild-moderate dehydration (55.8%), cough (51.9%),rhinorhea (46.0%), vomiting (44.8%), fever (41.1%), yellow stools(38.9%), and mucus in the stool (20.0%). The highest prevalenceof rotavirus diarrhea was identified in the combination of diarrhea,fever, vomiting and cough/rhinorrhea (55.3%). Stool analysis re-vealed that the prevalence of rotavirus diarrhea among childrenwith fat malabsorption, lactose malabsorption, and stool leukocyteof +2 were 50.0%, 46.7% and 33.9%, respectively.Conclusion The prevalence of rotavirus diarrhea in the pediatricoutpatient clinic of Cipto Mangunkusumo Hospital, Jakarta was35.7%. The highest prevalence of rotavirus diarrhea was identifiedin the combination of diarrhea, fever, vomiting and cough/rhinorhea(55.3%)

Clinical manifestations of childhood asthma persisting until the age of seven

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