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"ABSTRAKLatar Belakang: Pasien cedera kepala sedang (CKS) dan cedera kepala berat (CKB) memerlukan perawatan di rumah sakit sehingga beresiko terkena infeksi nosokomial seperti pneumonia yang dapat memperburuk keluaran. Karena banyaknya faktor yang dapat mempengaruhi keluaran pasien cedera kepala dengan pneumonia, diperlukan suatu sistem skoring untuk menilai derajat keparahan pneumonia.Tujuan: Untuk mengetahui apakah sistem skoring CURB-65 dapat dipakai untuk memprediksi keluaran pasien CKS dan CKB yang mengalami pneumonia.Metode: Penelitian ini merupakan studi prospektif. Subjek penelitian adalah seluruh pasien CKS dan CKB yang dirawat di Rumah Sakit Cipto Mangunkusumo (RSCM) Jakarta selama periode penelitian. Diagnosis pneumonia ditegakkan sesuai kriteria The Center for Disease Control (CDC). Penilaian derajat keparahan pneumonia dilakukan dengan skoring CURB-65. Keluaran yang dinilai adalah hidup atau meninggal.Hasil: Dari 176 pasien CKS dan CKB, terdapat 26 pasien yang menderita pneumonia. Rentang usia subjek penelitian adalah 15 - 71 tahun. Sebagian besar berjenis kelamin laki-laki dan berusia < 65 tahun. Nilai maksimal dari CURB-65 pada penelitian ini adalah 3. Sedangkan nilai yang terbanyak adalah 2. Nilai CURB-65 ditemukan tidak bermakna sebagai prediktor keluaran pasca cedera kepala. Keluaran pasien cenderung dipengaruhi variabel usia, penurunan kesadaran, peningkatan kadar BUN, dan peningkatan frekuensi napas. Diantara 5 pasien yang meninggal, ada 2 pasien yang memiliki nilai CURB-65 = 3, sehingga tampak adanya kecenderungan peningkatan mortalitas pada pasien-pasien dengan nilai CURB-65 = 3.Kesimpulan: Walaupun skoring CURB-65 tidak bermakna sebagai prediktor keluaran pada pasien CKS dan CKB dengan pneumonia, penelitian pendahuluan ini menemukan adanya kecenderungan pengaruh masing-masing komponen CURB-65 (penurunan kesadaran, frekuensi napas, kadar BUN, serta usia) terhadap resiko kematian pasien

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ABSTRACTBackground: Patients with moderate and severe traumatic brain injury (TBI) require hospitalization, therefore they have higher risk in developing nosocomial infections such as pneumonia which can worsen their outcomes. Since there are many factors that can affect outcome of head-injured patients with pneumonia, a scoring system for evaluating the severity of pneumonia is needed.Objective: To know whether the CURB-65 scoring system can be used to predict the outcome of moderate and severe TBI patients who developed pneumonia during hospitalization.Methods: This was a prospective study. The study subjects were all moderate and severe TBI patients who had been hospitalized in Cipto Mangunkusumo Hospital during the research period. Diagnosis of pneumonia was confirmed if the patient fulfiled the criteria from The Center for Disease Control (CDC). The severity of pneumonia was determined by using CURB-65 scoring system. The outcome would either be dead or alive.Results: Of 176 patients with moderate and severe TBI, there were 26 patients who developed pneumonia. The age of the subjects ranged between 15 to 71 years. Most of them were male and over the age of 65. The maximum score of CURB-65 was 3. The mode of CURB-65 score was 2. CURB-65 was shown to be not useful in predicting outcome of head-injured patients with pneumonia. The outcome was seemingly associated with age, loss of consciousness, BUN, and respiratory rate. Among 5 patients who were dead, there were 2 patients who had a CURB-65 score of 3, thus there was a trend of increasing mortality in patients with a CURB-65 score of 3.Conclusions: Although the CURB-65 scoring system was not found to be useful in predicting outcome of moderate and severe TBI patients, this preliminary study have found that there were a tendency that each component of CURB-65 (loss of consciousness, respiratory rate, BUN, age) have some effects on mortality. "

"Latar Belakang : Pneumonia komunitas merupakan satu masalah kesehatan yang besar. Mortalitas akibat pneumonia komunitas masih tinggi, terutama di Indonesia bila dibandingkan dengan negara-negara lain. Skor CURB-65 merupakan sistem skoring yang telah dipakai secara luas, namun memiliki beberapa kekurangan sehingga diperlukan sistem skor baru untuk menilai derajat keparahan pneumonia komunitas. Saat ini telah diperkenalkan sistem skor expanded-CURB-65 yang dinilai dapat lebih baik dalam hubungannya sebagai prediktor mortalitas 30 hari pneumonia komunitas. Tujuan : Menilai performa kalibrasi dan diskriminasi skor expanded-CURB-65 untuk digunakan dalam memprediksi mortalitas 30 hari pasien pneumonia komunitas di Rumah Sakit Umum Pusat Nasional dr.Cipto Mangunkusumo. Metode : Penelitian ini merupakan studi kohort prospektif dengan subyek penelitian pasien pneumonia komunitas yang datang ke IGD, poliklinik paru atau dirawat di ruang rawat RSCM. Keluaran yang dinilai adalah mortalitas pasien dalam 30 hari. Dilakukan penilaian performa diskriminasi skor expanded-CURB-65 menggunakan area under the curve AUC . Performa kalibrasi dinilai dengan plot kalibrasi dan tes Hosmer-Lemeshow. Hasil : 267 pasien ikut serta dalam penelitian ini dengan angka mortalitas 31,5 . Performa kalibrasi ditunjukkan oleh plot kalibrasi skor expanded-CURB-65 dengan r = 0,94 serta uji Hosmer-Lemeshow dengan nilai p = 0,57. Performa diskriminasi skor expanded-CURB-65 ditunjukkan oleh kurva ROC dengan nilai AUC 0,796 IK95 0,74-0,86. Simpulan : Mortalitas meningkat seiring peningkatan kelas risiko expanded-CURB-65. Expanded-CURB-65 menunjukkan performa kalibrasi dan diskriminasi yang baik dalam memprediksi mortalitas 30 hari pasien pneumonia komunitas di Rumah Sakit Cipto Mangunkusumo.

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Background : Community acquired pneumonia is a major health problem. Mortality due to community pneumonia is still high, especially in Indonesia compared to other countries. The CURB 65 score is a widely used scoring system, but has some drawbacks so a new scoring system is needed to assess the severity of community pneumonia. Currently, the expanded CURB 65 scoring system has been assessed better to predict 30 day mortality of community acquired pneumonia.

Aim : To evaluate calibration and discrimination performance of the expanded CURB 65 score in predicting 30 days mortality of community acquired pneumonia patients at the National Center General Hospital dr.Cipto Mangunkusumo.

Method : This study was a prospective cohort study with the study subjects community acquired pneumonia patients who came to the Emergency Room ER , pulmonary polyclinics or hospitalized in RSCM. The assessed outcome was patient mortality within 30 days. Discrimination performance of the expanded CURB 65 score assessed using the area under the curve AUC . Calibration was evaluated with calibration plot and Hosmer Lemeshow test.

Results : 267 patients participated in the study with a mortality rate of 31.5. Calibration plot of expanded CURB 65 score showed r 0,94 and Hosmer Lemeshow test showed p 0,57. Discrimination was shown by ROC curve with AUC 0,796 CI95 0,74 0,86.

Conclusion : Mortality increases with increasing risk class of expanded CURB 65. Expanded CURB 65 showed a good calibration and discrimination performance in predicting 30 day mortality higher in community acquired pneumonia patients in Cipto Mangunkusumo Hospital."

"Latar Belakang: Pneumonia berat masih menjadi masalah kesehatan utama di Indonesia dan dunia. Sistem imun diketahui memiliki peranan penting dalam patogenesis pneumonia, namun tidak banyak studi yang menilai hubungan antara kadar CD4 dan CD8 darah dengan mortalitas akibat pneumonia berat pada pasien dengan status HIV negatif. Tujuan: Mengetahui data hubungan dan nilai potong kadar CD4 dan CD8 darah dengan angka mortalitas 30 hari pada pasien pneumonia berat di RSCM. Metode: Penelitian berdesain kohort prospektif yang dilakukan di ruang rawat intensif RSCM periode Juni-Agustus 2020. Keluaran berupa kesintasan 30 hari, nilai titik potong optimal kadar CD4 dan CD8 darah untuk memprediksi mortalitas 30 hari dan risiko kematian. Analisis data menggunakan analisis kesintasan Kaplan-Meier, kurva ROC dan multivariat regresi Cox.Hasil: Dari 126 subjek, terdapat 1 subjek yang loss to follow up. Mortalitas 30 hari didapatkan 26,4%. Nilai titik potong optimal kadar CD4 darah 406 sel/μL (AUC 0,651, p=0,01, sensitivitas 64%, spesifisitas 61%) dan kadar CD8 darah 263 sel/μL (AUC 0,639, p=0,018, sensitivitas 62%, spesifisitas 58%). Kadar CD4 darah < 406 sel/μL memiliki crude HR 2,696 (IK 95% 1,298-5,603) dan kadar CD8 darah < 263 sel/μL memiliki crude HR 2,133 (IK 95% 1,035-4,392) dengan adjusted HR 2,721 (IK 95% 1,343-5,512). Bila sepsis dan tuberkulosis paru ditambahkan dengan kadar CD4 darah dan CD8 darah, didapatkan nilai AUC 0,752 (p=0,000). Kesimpulan: Kadar CD4 dan CD8 darah memiliki akurasi yang lemah dalam memprediksi mortalitas 30 hari pasien pneumonia berat. Kadar CD4 darah < 406 sel/μL dan kadar CD8 darah < 263 sel/μL memiliki risiko mortalitas 30 hari yang lebih tinggi.

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Background: Severe pneumonia is a major health problem in Indonesia and the world. The immune system is known to play an important role in the pathogenesis of pneumonia, but few studies have assessed the relationship between blood CD4 and CD8 count and mortality from severe pneumonia in patients with negative HIV status.

Objectives: Knowing the correlation data and the cut-off value of blood CD4 and CD8 count with a 30-days mortality rate in severe pneumonia patients at RSCM. Methods. This study is a prospective cohort study conducted at RSCM intensive care rooms from June to August 2020. The outputs were 30-days survival rate, optimal cut-off value for blood CD4 and CD8 count to predict 30-days mortality and mortality risk. Data analysis used Kaplan-Meier survival, ROC curves and multivariate Cox regression analysis.

Results: Of the 126 subjects, there was 1 subject who lost to follow up. The 30- days mortality rate was 26.4%. The optimal cut-off value for blood CD4 count was 406 cells/μL (AUC 0.651, p=0.01, sensitivity 64%, specificity 61%), blood CD8 count was 263 cells/μL (AUC 0.639, p=0.018, sensitivity 62%, specificity 58%). CD4 blood count < 406 cells/μL had a crude HR of 2.696 (95% CI 1.298- 5.603) and blood CD8 count < 263 cells/μL had a crude HR of 2.133 (95% CI 1.035-4.392) with an adjusted HR of 2.721 (CI 95% 1,343-5,512). If sepsis and pulmonary tuberculosis were added to the blood CD4 and CD8 count, the AUC value was 0.752 (p=0.000).

Conclusion: Blood CD4 and CD8 count had poor accuracy in predicting 30-days mortality in patients with severe pneumonia. The group with blood CD4 count < 406 cells/μL and blood CD8 count < 263 cells/μL had a higher risk of 30-days mortality."

"ABSTRAKPendahuluan Infeksi pneumonia nosokomial (PN) merupakan masalah utama di negara berkembang terutama pada pasien yang menjalani bedah jantung dan mendapat perawatan di intensive care unit (ICU). Aspirasi mikroorganisme dari kolonisasi rongga mulut merupakan salah satu faktor risiko PN yang perlu diperhatikan. Tujuan penelitian ini adalah untuk mengetahui dapat tidaknya kondisi rongga mulut menjadi prediktor terjadinya PN. Metode Penelitian ini adalah penelitian kohort prospektif. Subjek penelitian merupakan pasien bedah jantung elektif. Kondisi rongga mulut diwakili oleh oral hygiene index - simplified (OHI-S), decay missing filled - teeth (DMF-T) serta laju aliran saliva tanpa stimulasi (LASTS) diukur pada prabedah dan pascabedah. Terjadinya PN dinilai melalui dua parameter diagnosis yaitu clinical pulmonary infection score (CPIS) dan PN yang didiagnosis berdasarkan pengkajian klinis dokter (diagnosis klinis PN). Hasil Pada penelitian ini didapatkan 35 subyek penelitian yang memenuhi kriteria inklusi selama Desember 2012 hingga Maret 2013. Hasil analisis statistik tidak menunjukkan kemaknaan hubungan antara OHI-S, DMF-T, LASTS dengan CPIS(p=0,420; p=0,268; p=0,949). Demikian pula dengan OHI-S, DMF-T tidak terbukti mempunyai hubungan dengan diagnosis klinis PN (p=0,484; p=0,656). Namun, LASTS mempunyai hubungan signifikan dengan diagnosis klinis PN (p=0,017). Rerata LASTS pascabedah mengalami penurunan bermakna dibandingkan dengan prabedah (p=0,000). Kesimpulan Dalam penelitian ini, kondisi rongga mulut belum dapat terbukti sebagai prediktor terjadinya PN walaupun terdapat hubungan antara LASTS dengan PN yang didiagnosis melalui pengkajian klinis dokter.

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ABSTRACTIntroduction Nosocomial pneumonia (NP) is a major problem in developing countries, particularly in patients undergoing cardiac surgery and who received treatment in the intensive care unit (ICU). Aspiration of oral microorganism colonization is one of the substantial risk factors. The aim of this study was to determine whether the condition of the oral cavity can be a predictor of NP. Methods A cohort prospective study was performed in this study. Subjects are elective cardiac surgery patients. Oral conditions examination defined by oral hygiene index ? simplified (OHI-S), decay missing filled - teeth (DMF-T) and unstimulated salivary flow rate (SFR) was implemented pre-surgery and post-surgery. Diagnosis of NP was evaluated through two parameters. There were clinical pulmonary infection score (CPIS) and clinical assessment of NP. Results There were 35 subjects participating in this study who meet inclusion criteria since December, 2012 to March, 2013. Statistic analyses have not been able to confirm the link between OHI-S, DMF-T, SFR to CPIS (p=0.420; p=0.268; p=0.949). Similarly, relation of OHI-S, DMF-T and clinical NP has not proven (p=0.484; p=0.656). However, SFR was significantly related to clinical assessment of NP (p=0.017). The mean of post-surgery SFR was remarkably lower than pre-surgery (p=0.000). Conclusions In this study, the oral conditions have not been shown to be predictors of the occurrence of PN although there is a link between SFR and clinical assessment of NP."

"Latar Belakang: Pneumonia berat adalah infeksi saluran napas yang masih memiliki angka mortalitas yang tinggi. Pasien pneumonia berat sering kali memerlukan intubasi untuk mencapai ventilasi yang adekuat. Terjadinya kegagalan ekstubasi dapat meningkatkan komplikasi dan mortalitas pada pasien, sehingga pasien dengan risiko gagal ekstubasi perlu dikenali sedini mungkin.Tujuan: Mengetahui faktor yang dapat memprediksi kegagalan ekstubasi pada pasien pneumonia beratMetode: Studi ini merupakan studi kohort retrospektif yang melibatkan pasien dengan pneumonia berat yang terintubasi dan dirawat di ICU/HCU RSCM pada tahun 2015-2019. Data pasien dan hasil pemeriksaan laboratorium diambil dari rekam medis. Analisis bivariat dilakukan dengan uji Chi-square atau uji Fischer, sementara analisis multivariat dilakukan dengan uji regresi cox.Hasil: Sebanyak 192 subjek pasien pneumonia berat dilibatkan dalam penelitian ini. Insidensi kegagalan ekstubasi pada pasien pneumonia berat di RSCM adalah 70,3%, dengan angka mortalitas pada pasien yang mengalami gagal ekstubasi adalah sebesar 85,2%. Dari analisis bivariat, didapatkan usia >60 tahun, merokok, Charlson Comorbidity Index sedang-berat, tidak adanya penyakit neuromuskular, terapi pengganti ginjal, prokalsitonin > 2 ng/mL, dan skor APACHE II ≥25 sebagai variabel yang berhubungan signifikan dengan kegagalan ekstubasi. Selanjutnya, analisis multivariat menemukan bahwa Charlson Comorbidity Index sedang-berat (p=0,002, HR 2,254, IK95% 1,353-3,755), dan prokalsitonin > 2 ng/mL (p<0,001, HR 1,859, IK95% 1,037-3,333) merupakan prediktor independen terhadap kegagalan ekstubasi pada pasien pneumonia berat.Kesimpulan: Faktor-faktor yang secara independen merupakan prediktor kegagalan ekstubasi pada pasien pneumonia berat adalah Charlson Comorbidity Index sedang-berat, dan kadar prokalsitonin > 2 ng/mL.

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Background: Severe pneumonia is a lower respiratory tract infection still presenting with a high a mortality rate. Patients with severe pneumonia often require intubation in order to achieve adequate ventilation. Extubation failure, however, is associated with increased complications and mortality. Therefore, it is crucial to recognize risk factors associated with extubation failure as soon as possible.

Objective: To determine the predictors associated with extubation failure in patients with severe pneumonia

Methods: A retrospective cohort study was conducted, which included patients with severe pneumonia who were intubated in ICU/HCU of Ciptomangunkusumo General Hospital over the period of 2015-2019. Patient characteristics and laboratory values were obtained from medical records. Bivariate analysis was performed with Chi-square or Fischer test, whereas multivariate analysis was performed with cox regression model.

Results: A total of 192 subjects with severe pneumonia was included in this study. Incidence of extubation failure among patients with severe pneumonia was 70,3%, with a mortality rate of 85,2%. Bivariate analyses found that age of >60 years, smoking history, moderate-to-severe Charlson Comorbidity Index, procalcitonin > 2 ng/mL, not having neuromuscular disease, renal replacement therapy, and APACHE II score of ≥25 were significantly associated with extubation failure. In multivariate analysis, moderate-to-severe Charlson Comorbidity Index (p=0,002, HR 2,254, 95% CI 1,353-3,755) and procalcitonin > 2 ng/mL (p<0,001, HR 1,859, 95% CI 1,037-3,333) were found to be independent predictors of extubation failure in patients with severe pneumonia.

Conclusion: Moderate-to-severe Charlson Comorbidity Index and procalcitonin level of > 2 ng/mL were independent predictors of extubation failure in patients with severe pneumonia."

"Pneumonia komunitas adalah penyebab kematian terbesar di Indonesia. Sistem skor PSI dan CURB-65 telah digunakan dalam menentukan keparahan penyakit dan keputusan tempat rawat berdasarkan risiko kematian dalam 30 hari. Tujuan penelitian ini adalah membandingkan sistem skor modifikasi PSI dan modifikasi CURB-65 pada pasien CAP sebagai prediktor mortalitas 30 hari di RS Persahabatan. Penelitian ini adalah kohort prospektif yang dilakukan pada pasien CAP yang dirawat di RS Persahabatan sejak bulan Oktober 2012-Maret 2013. Gejala klinis nilai laboratorium, foto toraks, penyakit penyerta skor PSI dan CURB-65 serta hasil akhir berupa kematian dicatat untuk dianalisis. Selama 30 hari subjek penelitian diikuti. Sebanyak 167 pasien CAP mengikuti penelitian ini didapatkan angka kematian sebesar 18,6%. Sensitivitas PSI sama dengan CURB-65 yaitu sebesar 77,4%. Spesifisitas PSI sedikit lebih tinggi dari pada CURB-65 (58,1% vs 53,7% p < 0,001). Risiko relatif mortalitas berdasarkan PSI pada kelompok risiko tinggi sebesar 3,64 kali dibandingkan kelompok risiko rendah, sedangkan risiko relatif mortalitas berdasarkan CURB-65 pada kelompok risiko tinggi sebesar 3,15 kali dibandingkan kelompok risiko rendah. Skor CURB-65 dapat dipertimbangkan sebagai prediktor mortalitas pada pasien CAP yang di rawat inap.

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Community Acquired Pneumonia (CAP) is the first leading disease with the highest mortality in hospitalized patient in Indonesia. Pneumonia severity assessment systems such as the pneumonia severity index (PSI) and CURB-65 were designed to predict severity of illness and site of care base on 30-d mortality. The purpose of this study is to comparing the PSI with CURB-65 in patient admitted with CAP as predictor 30 days mortality in Persahabatan Hospital, Jakarta. This is a prospective cohort study in hospitalized community acquired pneumonia patients in Persahabatan Hospital since October 2012- Maret 2013. Clinical symptoms, laboratory findings, chest x-ray , comorbidities, score of PSI and CURB-65, 30 days mortality were recorded for analysis. Thirty days mortality outcome were recorded to analysis which score system as the best to predict 30 days mortality. One hundred and sixtty seven patients CAP were studied with an overall 30-d mortality of 18,6%. Sensitivity of PSI were simillar with CURB-65 for predicting patients who died within 30 d (77,4% ; p < 0.001). Specificity of PSI was slighty higher than CURB-65 (58,1% vs 53,7% p < 0,001). Score PSI have risk mortality 3,64 times in high risk group CAP than low risk group CAP. Score CURB-65 have risk mortality 3,15 times in high risk group CAP than low risk CAP. CURB-65 modification was considerable to predict mortality in CAP patients hospitalized."

"Latar Belakang. Pneumonia berat masih menjadi masalah kesehatan utama di Indonesia dan dunia. Sistem imun diketahui memiliki peranan penting dalam patogenesis pneumonia, namun tidak banyak studi yang menilai hubungan antara kadar CD4 dan CD8 darah dengan mortalitas akibat pneumonia berat pada pasien dengan status HIV negatif.Tujuan. Mengetahui data hubungan dan nilai potong kadar CD4 dan CD8 darah dengan angka mortalitas 30 hari pada pasien pneumonia berat di RSCM. Metode. Penelitian berdesain kohort prospektif yang dilakukan di ruang rawat intensif RSCM periode Juni-Agustus 2020. Keluaran berupa kesintasan 30 hari, nilai titik potong optimal kadar CD4 dan CD8 darah untuk memprediksi mortalitas 30 hari dan risiko kematian. Analisis data menggunakan analisis kesintasan Kaplan-Meier, kurva ROC dan multivariat regresi Cox. Hasil. Dari 126 subjek, terdapat 1 subjek yang loss to follow up. Mortalitas 30 hari didapatkan 26,4%. Nilai titik potong optimal kadar CD4 darah 406 sel/μL (AUC 0,651, p=0,01, sensitivitas 64%, spesifisitas 61%) dan kadar CD8 darah 263 sel/μL (AUC 0,639, p=0,018, sensitivitas 62%, spesifisitas 58%). Kadar CD4 darah < 406 sel/μL memiliki crude HR 2,696 (IK 95% 1,298-5,603) dan kadar CD8 darah < 263 sel/μL memiliki crude HR 2,133 (IK 95% 1,035-4,392) dengan adjusted HR 2,721 (IK 95% 1,343-5,512). Bila sepsis dan tuberkulosis paru ditambahkan dengan kadar CD4 darah dan CD8 darah, didapatkan nilai AUC 0,752 (p=0,000). Kesimpulan. Kadar CD4 dan CD8 darah memiliki akurasi yang lemah dalam memprediksi mortalitas 30 hari pasien pneumonia berat. Kadar CD4 darah < 406 sel/μL dan kadar CD8 darah < 263 sel/μL memiliki risiko mortalitas 30 hari yang lebih tinggi.

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Background. Severe pneumonia is a major health problem in Indonesia and the world. The immune system is known to play an important role in the pathogenesis of pneumonia, but few studies have assessed the relationship between blood CD4 and CD8 count and mortality from severe pneumonia in patients with negative HIV status.

Objectives. Knowing the correlation data and the cut-off value of blood CD4 and CD8 count with a 30-days mortality rate in severe pneumonia patients at RSCM.

Methods. This study is a prospective cohort study conducted at RSCM intensive care rooms from June to August 2020. The outputs were 30-days survival rate, optimal cut-off value for blood CD4 and CD8 count to predict 30-days mortality and mortality risk. Data analysis used Kaplan-Meier survival, ROC curves and multivariate Cox regression analysis.

Results. Of the 126 subjects, there was 1 subject who lost to follow up. The 30-days mortality rate was 26.4%. The optimal cut-off value for blood CD4 count was 406 cells/μL (AUC 0.651, p=0.01, sensitivity 64%, specificity 61%), blood CD8 count was 263 cells/μL (AUC 0.639, p=0.018, sensitivity 62%, specificity 58%). CD4 blood count < 406 cells/μL had a crude HR of 2.696 (95% CI 1.298-5.603) and blood CD8 count < 263 cells/μL had a crude HR of 2.133 (95% CI 1.035-4.392) with an adjusted HR of 2.721 (CI 95% 1,343-5,512). If sepsis and pulmonary tuberculosis were added to the blood CD4 and CD8 count, the AUC value was 0.752 (p=0.000).

Conclusion. Blood CD4 and CD8 count had poor accuracy in predicting 30-days mortality in patients with severe pneumonia. The group with blood CD4 count < 406 cells/μL and blood CD8 count < 263 cells/μL had a higher risk of 30-days mortality."

"ABSTRAKPneumonia di Indonesia masih menjadi masalah utama dan angka kematian karenapneumonia masih tinggi. Salah satu masalah keperawatan pada pneumonia adalah gangguanbersihan jalan napas. Inhalasi nebuliser merupakan salah satu pengobatan untukmembersihkan jalan napas. Penelitian ini bertujuan untuk mengetahui faktor yangberhubungan dengan efektivitas proses unhalasi nebuliser. Desain yang digunakan adalahcross sectional dengan 142 sampel. Hasil penelitian dengan regresi logistik didapatkan 2faktor yang berhubungan signifikan yaitu dukungan keluarga (p=0,000) dan caring perawat(p=0,000). Rekomendasi untuk penelitian selanjutnya melihat efektivitas proses terapinebuliser pada pneumonia berdasarkan jenis alat yang digunakan dan dosis obat yangdiberikan.

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ABSTRACTPneumonia is still a major problem and mortality due to pneumonia is still high in Indonesia.One of the nursing problems in pneumonia is a disorder airway clearance. Inhalationnebulizer is one of treatment to clear the airway. This study aim to know factors related to theof the inhalation nebulizer therapy. The design used a cross sectional study with 142 samples.Logistic regression analysis of data found that 2 significant factors related with familysupport (p = 0.000) and caring (p = 0.000). Recommendations for future research look at theeffectiveness of the nebulizer therapy in pneumonia based on the type of equipment used and the doseof drug administered"

"Pemberian pendidikan kesehatan berkaitan erat dengan pengetahuan dan perilaku ibu merawat balita penderita pneumonia di rumah sakit. Penelitian ini bertujuan untuk mengidentifikasi pengaruh pendidikan kesehatan menggunakan media audiovisual terhadap pengetahuan dan perilaku ibu merawat balita penderita pneumonia di rumah sakit di provinsi Nusa Tenggara Barat. Desain dalam penelitian ini menggunakan kuasi eksperimen pretest posttest design with non equivalent control group dengan 32 sampel di RSUP NTB dan RSUD Patut Patuh Patju Lombok Barat secara consecutive sampling. Analisis data menggunakan independent t test, menunjukkan perbedaan yang signifikan dalam aspek pengetahuan dan perilaku ibu merawat balita penderita pneumonia antara kelompok perlakuan dan kelompok kontrol (pengetahuan: p=0,000, α=0,05, Perilaku: p = 0,000, α=0,05). Rekomendasi dari penelitian ini adalah pendidikan kesehatan sebaiknya menggunakan media audiovisual.

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The provision of health education is closely related to the knowledge and behavior of mothers caring for children under five years with pneumonia in the hospital. The aim of this research was to identify the effect of health education using audiovisual media on mother?s knowledge and behavior of mothers caring for children under five years with pneumonia in the hospital in West Nusa Tenggara. This research used quasi experimental pretest posttest design with non equivalent control group. Data was collected from 32 respondents with consecutive sampling technique and was analized with independent t-test. The result showed significant differences between intervention and control groups (knowledge, p value = 0,000, α=0,05, behavior, p value = 0,000, α=0,05). This research recommendates the use of audiovisual media in providing health education."

"Penderita pneumonia yang dirawat di Rumah Sakit Cibabat Cimahi selama periode 2000-2003 sebanyak 1.559 orang, 120 orang diantaranya meninggal dunia CFR=7,71%, sedangkan di Rumah Sakit Hasan Sadikin Bandung selama periode yang sama telah merawat sebanyak 1.792 orang, 112 orang diantaranya meninggal dunia CFR=6,63%.Tingginya CFR penderita pneumonia di kedua rumah sakit tersebut menarik penulis untuk mengadakan penelitian, terutama pada balita yang cukup banyak penderitanya. Studi awal diketahui bahwa pada penderita pneumonia yang tidak meninggal di Rumah Sakit Cibabat terdapat sebanyak 36,5% memiliki gejala tambahan yang tidak lain sebagai penyakit penyerta pneumonia. Bagaimana dengan balita yang meninggal dunia?. Untuk itu penelitian yang penulis lakukan ini adalah untuk mengetahui pengaruh penyakit penyerta terhadap kematian balita akibat pneumonia di Rumah Sakit Cibabat Cimahi dan Rumah Sakit Hasan Sadikin Bandung. Desain penelitian yang digunakan pada penelitian ini adalah kasus kontrol, dengan jumlah sampel sebanyak 170 balita, yang terdiri 85 balita sebagai kasus dan 85 balita sebagai kontrol. Variabelvariabel yang diteliti adalah kematian balita penderita pneumonia sebagai variabel terikat, sedangkan sebagai variabel bebas adalah penyakit penyerta, sianosis, umur, jenis kelamin, status gizi, status imunisasi, status rujukan, kelas perawatan, dan lokasi tempat tinggal. Seluruh variabel yang diteliti bersumber dari data rekam medik di kedua rmah sakit tersebut sejak Januari 2000 sampai bulan Juni 2004.Hasil penelitian menunjukkan bahwa ada pengaruh penyakit penyerta terhadap kematian balita penderita pneumonia di Rumah Sakit Cibabat Cimahi dan Rumah Sakit Masan Sadikin Bandung. Balita penderita pneumonia disertai penyakit penyerta berisiko 3,38 kali dibandingkan dengan balita tanpa disertai penyakit penyerta. (p=0,00, OR=3,38, 95%CI=1,68--6,85). Ada pengaruh sianosis terhadap kematian balita akibat pneumonia, balita penderita pneumonia dengan gejala umum sianosis berisiko 7,42 kali meninggal dunia akibat dibandingkan balita tanpa gejala umum sianosis. (p=0,00, OR=7,42 95%CI=2,97-19,13).Melihat hasil penelitian diatas disarankan dalam menangani balita penderita pneumonia di Rumah Sakit agar lebih mewaspadai adanya penyakit penyerta dan gejala umum sianosis.Daftar Kepustakaan : 57 (1991-2004)

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South-East Asia Region World Health Organization (SEARO-WHO) reported that communicable diseases have caused 40% of 10.5 million of deaths among children under-five year olds in the world. In the 6 SEARO-countries, including Indonesia, it was estimated that about 9 of 10 deaths were caused by pneumonia, diarrhea, measles and malnutrition.

Based on an extrapolation of a result of Household Health Survey in 1992, the mortality rate of pneumonia among under-five children in Indonesia is about 6 per 1,000 under-five children. Therefore it is estimated that among under-five children, 150.000 deaths occur every year due to pneumonia. It means that pneumonia has significantly contributes on death among children, especially in the under-five group.

Cibabat Hospital in Cimahi has treated about 1,559 pneumonia cases during the period of 2000-2003, and among all those cases, 120 patient died (CFR=7.71%). Hasan Sadikin General Hospital in Bandung during the same period has managed 1,792 pneumonia cases with 112 deaths among the treated cases (CFR 6,63%).

There are several factors influencing pneumonia caused mortality, such as a) age (< 2 months), b) socio-economic status, c) malnutrition, d) low birth weight, e) low mother education, f) low health care coverage, g) high house density, h) inadequate immunization, i) contracting chronic diseases.

The objective of this study was to know the effect of underlying diseases on under-five child mortality due to pneumonia in Cibabat Hospital in Cimahi and in Hasan Sadikin General Hospital in Bandung.

The study results showed that there was an effect of underlying diseases on the under-five child mortality caused by pneumonia in both hospitals. An under-five pneumonia case with underlying disease(s) was 3.38 times more likely to cause death as compared to under-five pneumonia case without underlying disease(s). It was also found that cyanosis, as one of the common signs of emergency in pneumonia, also increased the risk of death. A pneumonia case with cyanosis was 7,42 times at risk to cause death than the case without cyanosis.

Based on our study, it is recommended that the medical staffs in the hospitals to be aware of the existing underlying diseases and to conduct integrated case management The medical staffs, as well as the mothers are also suggested to pay attention on the sign of cyanosis. This sign is actually not so difficult to be recognized, although it was frequently ignored. This common sign of cyanosis is important in pneumonia treatment in the field, using several case management approaches, including oxygenation.

The Ministry of Health and its relevant structures are also encouraged to establish the Integrated Management Program of the Under-five Child Sickness, especially related to pneumonia, by providing sufficient health) medical facilities (such as oxygen contractor) in the community health centers and the hospitals.

References: 57 (1991 - 2004)"