Perbandingan Kesintasan Tiga Tahun pada Anak Leukemia Limfoblastik Akut antara Protokol Pengobatan 2006 dan 2013

Treatment of children with Acute lymphoblastic leukemia was developing, currently in Indonesia there are several commonly used protocols such as National protocol (Jakarta), WK-LLA 2000 protocol, LLA protocol 2006 and protocol LLA 2013. The purpose of this study to determine the probability of survival 3 years In children with acute lymphoblastic leukemia between protocols 2006 and 2013. This study used a mix method of retrospective cohorts and in-depth interviews. The population in this study were LLA children aged 1–15 years who received protocol 2006 and 2013 in RSKD Jakarta from 2008–2016 is 68 children with research time from April 2016 until June 2016. Data were analyzed using Cox Regression. The result of this study shows that the 3-year survival probability of LLA remission based on the 2006 treatment protocol is 30% and the treatment protocol of 2013 is 27%. A 3-year survival event remission occurred between 2006 and 2013 treatment protocols of HR 1.57 (90% CI 0.577–4,299), but the difference between the two protocols was not statistically significant with p-value 0.456.The results of in-depth interviews were also obtained in protocols 2006 and 2013 in the same principle but there remain some differences between the both of the treatment schedule and doses are cumulatively increased. The conclusions of these two protocols are in principle the same and there is not much difference in inputs and processes

Penerapan Solution-Focused Brief Therapy dalam Meningkatkan Self-Esteem pada Remaja Perempuan Penderita Leukemia

The diagnosis of cancer have an impact on physical and psychological development of adolescent. Psychological impact is felt with the emergence of some emotional reactions, such as fear, anxiety, sadness, despair, anger, guilt, and shame. Adolescents who experience physical and psychological impact of the treatment of the cancer will experience problems in self-esteem and body image, that have an impact on the development of adolescent self until early adulthood. The establishment of self-esteem need to occur in adolescence. In adolescence, the individual will develop a positive sense of self so that adolescence is an important period for individuals to establish self-esteem, because at this time many changes occur both physically and emotionally. This study was conducted to help improve self-esteem in young woman with leukimia with solution-focused brief therapy. The participant of this study was two participants adolescent female with early-stage leukimia ALL types for two years. This therapy was conducted in three weeks by researcher herself. Researcher used questionnaries measuring selfesteem and graphics tests before and after the intervention to measure the role of therapy programs. Solution-focused brief therapy used in this study shows no role to improve the self-esteem of adolescent female patients with leukimia. This is because the PA subjects only increased by 2 points and subjects SS increased scores by 10 point

Global Retinoblastoma Presentation and Analysis by National Income Level.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

The global retinoblastoma outcome study : a prospective, cluster-based analysis of 4064 patients from 149 countries

DATA SHARING : The study data will become available online once all analyses are complete.BACKGROUND : Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. METHODS : We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. FINDINGS : The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). INTERPRETATION : This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.The Queen Elizabeth Diamond Jubilee Trust and the Wellcome Trust.https://www.thelancet.com/journals/langlo/homeam2023Paediatrics and Child Healt

Gambaran Tingkat Remisi Pada Leukemia Limfoblastik Akut Setelah Fase Induksi Di Bangsal Kanker Anak RS Kanker Dharmais

Leukemia, khususnya leukemia limfoblastik akut (LLA), adalah jenis keganasan yang paling banyak dijumpai pada anak. Penyakit ini berpotensi untuk disembuhkan dengan cara kemoterapi, namun keberhasilannya ditentukan oleh banyak faktor, di antaranya remisi atau tidaknya anak pasca-kemoterapi fase induksi. Oleh karena itu, tujuan penelitian ini adalah untuk mengetahui gambaran tingkat remisi leukemia limfoblastik akut pasca-kemoterapi fase induksi, termasuk faktor prognostik lainnya di bangsal kanker anak RS Kanker Dharmais (RSKD).Penelitian deskriptif-retrospektif terhadap 69/72 anak dengan LLA dari Januari 2000 Desember 2008 yang diambil dari Bagian Registrasi Kanker Anak SMF Anak RSKD. Hasil penelitian ini menggambarkan bahwa LLA lebih banyak dijumpai pada anak laki-laki (43/69), usia antara 1 sampai < 5 tahun (24/69). Juga dijumpai pada anak yang bertipe L1 (53/69), risiko biasa (38/69), dan memilikiphenotypingsel B (33/36). Gejala dan tanda klinis yang banyak dijumpai adalah demam dan hepatosplenomegali. Menurut hasil laboratorium, paling banyak adalah anak dengan kadar Hb antara 5 sampai < 10 g/dl (45/69) dan kadar trombosit antara 10.000 sampai < 50.000/ul (30/69). Pasien yang remisi pasca-kemoterapi fase induksi sebanyak 50/69 anak, sementara sepertiga lainnya tidak remisi. Pada akhir penelitian ini, 31/69 anak meninggal.Event free survival ratesuntuk ALL di RSKD adalah 38,1%.Sekalipun banyak anak yang mengalami remisi pasca-kemoterapi fase induksi, baik pada pertengahan maupun akhir pengobatan masih banyak yang meninggal. Kiranya hasil penelitian ini dapat menjadi bahan untuk mengevaluasi protokol pengobatan yang masih digunakan, khususnya fase setelah fase induksi

Familial hypophosphatemic rickets: report of a case

Familial Hypophosphatemic Rickets (FHR) was found for the first time by Albright in 1937 and is also called vitamin D resistant rickets. 1-3 It is a disease that can occur through x-linked dominant, autosom dominant, and sporadic inheritance. 1-4 Albright found that most FHR is x-linked dominant type. 3 To distinguish between x-linked dominant and autosom dominant, the family pedigree can not be used, because it may look alike. Usually this disease can be distinguished genetically. The gene that is responsible for x-linked dominant is located in Xp21 while for autosom dominant is in 12p13. 4 Sporadic type can easily be distinguished from the other two. In the family pedigree, there is no other FHR patient besides the patient himself. 3,4 The case that we are about to report was a sporadic type FHR

Pola Defekasi pada Anak

Defekasi merupakan salah satu aktivitas manusia yang harus dilalui di dalam kehidupan sehari-harinya. Pola defekasi pada anak sangat bervariasi dan sangat bergantung pada fungsi organ, susunan saraf, pola makan, serta usia anak. Menilai pola defekasi pada anak berarti menilai frekuensi defekasi, konsistensi dan warna tinjanya. Berdasarkan penelitian yang telah dilakukan di beberapa negara di Amerika, Eropa, dan Asia-Pasifik diketahui bahwa terjadi penurunan frekuensi defekasi sesuai dengan bertambahnya usia anak, sedangkan perubahan konsistensi dan warna tinja sesuai dengan pola makan. Sejauh ini belum pernah dilaporkan tentang pola defekasi pada anak Indonesia

Bowel habits of exclusively breastfed 0-4 month-old babies

Background Exclusively breastfed newborns have frequent bowel movements and sometimes watery stool, which parents or doctors might think as diarrhea. Objective The aim of this study was to observe the bowel habits of exclusively breastfed infants. Methods A longitudinal study was done on 100 babies born be- tween November and December 2002 in Cinta Kasih Maternity Hospital. The inclusion criteria were fullterm baby, exclusively breastfed for 4 months, and informed consent from parents. Ba- bies with problems in organ or nerve that influenced the gastrointes- tinal tract were excluded. Stool frequency, consistency, and color were observed. Results The mean stool frequency per day were 3 times in the 1 st week (95%CI 2.6;3.4), 2 times in the 2 nd week (95%CI 1.7;2.3), 1.8 times in the 3 rd week (95%CI 1.5;2.1), and 1.5 times in the 4 th week (95%CI 1.3;1.7). In the second and third month, it was 1.4 times a day and the fourth month, 1.2 times a day. The consis- tency of meconium was soft in the first four days. After that, 18% of babies had watery stool, which increased to 30% on day 15-113. In the last week of the fourth month, all babies had soft stool. Meco- nium was black and lasted for 1-3 days. On the fourth day, the stool became yellow. On day 5-14, 6% of babies had green stool, which increased to 12% on day 15-120. Conclusion The first week of the first month was the week when the stool frequency was highest compared to the weeks or months after. The consistency of meconium was soft. After it disappeared, most babies had soft stool. Eighteen up to 30% percent of babies had watery stool. Regarding the color, meconium was black and stayed for 1-3 days. After that, most babies had yellow stool and 6- 12% had green stoo

Program Psikososial Di Bangsal Kanker Anak Rumah Sakit Kanker Dharmais

Sekalipun sakit, seorang anak yang sedang dalam pengobatan tetap harus diperhatikan masalah tumbuh kembangnya. Guna memenuhi tuntutan ini, Bangsal Kanker Anak RS Kanker "Dharmais" menggunakan pendekatan psikososial selain dari pendekatan medis tentunya. Diharapkan pendekatan ini mampu memfasilitasi proses tumbuh kembang anak-anak yang mengalami kanker dan harus dirawat untuk waktu yang cukup lama. Tujuan penulisan kasus ini adalah untuk memperlihatkan program psikososial yang dilakukan di RS Kanker "Dharmais".Program psikososial mulai dilakukankan bulan Juli 2006 oleh relawan yang tergabung dalam Community for Children with Cancer. Program-programnya terdiri dari pemberian informasi tentang penyakit dan pengobatan kanker pada anak kepada pasien dan keluarganya, pendampingan saat proses diagnostik dan pengobatan berlangsung, membuat kegiatan untuk pasien seperti playground activity, art therapy, school in hospital, bed side art therapy, dan computer therapy. Kegiatan yang ada menyebabkan anak tidak takut menjalani pengobatan dan memungkinkan mereka untuk tetap dapat bermain layaknya anak-anak yang sehat.Hasil dari pendekatan ini memungkinkan anak ditangani secara holistik dan yang terpenting program ini dapat memfasilitasi proses tumbuh kembang mereka