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Simatupang, Grace Natalia Adriana
Faktor risiko timbulnya inhibitor faktor VIII pada anak dengan Hemofilia A = The risk factors of factor VIII inhibitor in children with Hemophilia A / Grace Natalia Adriana Simatupang
"ABSTRAK
Latar belakang. Proses timbulnya inhibitor bersifat multifaktorial baik genetik maupun lingkungan. Beberapa studi telah dilakukan untuk mengetahui faktor risiko terbentuknya inhibitor namun masih terdapat kontroversial pendapat. Tidak seperti di negara maju, di Indonesia skrining inhibitor tidak rutin dilakukan karena keterbatasan biaya dan alat sehingga diperlukan suatu penelitian yang dapat dijadikan acuan pemeriksaan inhibitor selektif.
Tujuan. Mengetahui prevalens, karakteristik klinis dan faktor risiko timbulnya inhibitor pada anak dengan hemofilia A di departemen IKA- RSCM.
Metode. Uji potong lintang dilakukan pada anak usia ≤18 tahun dengan perdarahan akut di pusat hemofilia terpadu IKA-RSCM. Pada subjek dilakukan pengambilan darah vena dan dilakukan pemeriksaan inhibitor menggunakan metode Bethesda assay. Orangtua diminta mengisi kuesioner mengenai usia saat pertama kali didiagnosis hemofilia, mendapat terapi faktor VIII, jenis terapi pengganti, derajat hemofilia, jenis perdarahan, dan suku bangsa ibu penderita. Analisis bivariat dilakukan dengan uji Fisher. Analisis multivariat tidak dilakukan karena tidak memenuhi syarat.
Hasil penelitian. Dari 40 subjek penelitian, didapatkan prevalens inhibitor sebanyak 37,5% (15/40) dengan inhibitor high responder sebanyak 3/15 dan low responder 12/15. Median (rentang) usia subjek penelitian adalah 10 (1,5-18) tahun. Median usia saat diagnosis hemofilia pertama kali ditegakkan dan saat pertama kali mendapat terapi faktor VIII pada inhibitor positif adalah 8 dan 9 bulan. Hampir seluruh subjek (39/40) mendapat terapi konsentrat plasma, 11/15 subjek dengan inhibitor positif mendapat terapi pertama kali sebelum berusia 1 tahun, 14/15 subjek merupakan hemofilia berat dan sebagian besar (12/15) mendapat manifestasi perdarahan sendi. Suku bangsa ibu Jawa lebih sering ditemukan pada inhibitor positif (8/15). Tidak ditemukan hasil yang bermakna secara statistik antara faktor risiko dengan timbulnya inhibitor.
Simpulan. Prevalens inhibitor pada penelitian ini sebesar 37,5%. Inhibitor positif lebih sering ditemukan pada penderita hemofilia berat yang mendapat terapi pertama kali sebelum berusia 1 tahun. Penelitian ini tidak berhasil membuktikan faktor risiko bermakna untuk timbulnya inhibitor pada anak dengan hemofilia A.
ABSTRACT
Background. Several factors may influence inhibitor incidence including genetics and environment. Several studies have been conducted to determine the risk factors for inhibitor formation but there is still a controversial opinion. Unlike in developed countries, in Indonesia inhibitor screening is not routinely performed due to limited funds thus required a research that can be used as reference checks selective inhibitors.
Objective. To find out the prevalence, clinical characteristics and risk factors of factor VIII inhibitor in children with hemophilia A in Child Health Department- Cipto Mangunkusumo Hospital
Methods. A cross sectional descriptive study conducted in children aged ≤ 18 years old with acute bleeding at the National Hemophilia Care Center, Cipto Mangukusumo Hospital. All the subjects performed venous blood sampling and the examination of inhibitor using the Bethesda assay. Parents were asked to fill out questionnaires on age at first diagnosis of hemophilia, treated with factor VIII replacement therapy type, degree of hemophilia, types of bleeding, and the patient's mother tribes. Bivariate analysis performed by Fisher's test. Multivariate analysis was not performed because it does not qualify.
Results. Out of 40 children study, showed prevalence inhibitor 37.5% (15/40) with a high responder inhibitor 3/15 and low responders 12/15. Median (range) age of subjects was 10 (1.5 to 18) years. The median age at diagnosis of hemophilia was first established and the first time the subjects get a factor VIII inhibitor therapy positive was 8 and 9 months. Almost all subjects (39/40) treated with plasma concentrates, 11/15 subjects with a positive inhibitor therapy gets first time before age 1 year, 14/15 subjects is severe hemophilia and most (12/15) of them had joint bleeding manifestations. Java native tribes more often found in the positive inhibitor (8/15). No results found a statistically significant association between the risk factors with the onset of inhibitor.
Conclusion. The prevalence of inhibitors in this study was 37.5%. Positive inhibitors was more frequent in patients with severe hemophilia who received therapy for the first time before the age of 1 year old. This study failed to prove significant risk factor for the onset of inhibitors in children with hemophilia A."
Fakultas Kedokteran Universitas Indonesia, 2012
T-Pdf
UI - Tesis Membership  Universitas Indonesia Library
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Saptuti Chunaeni
Upaya Meningkatan Stabilitas Faktor VIII melalui Liofilisasi Produk Minipool Cryoprecipitate untuk Tatalaksana Penderita Hemofilia A di Indonesia = To Improve Stability of Factor VIII with Minipool Cryoprecipitate Lyophilized for Hemofilia a Treatment in Indonesia
"

 

ABSTRAK

 

Nama                        : Saptuti Chunaeni

Program Studi             : Program Doktor Ilmu Biomedik

Judul Disertasi             : Upaya Meningkatan Stabilitas Faktor VIII melalui

  Liofilisasi Produk Minipool Cryoprecipitate

  untuk Tatalaksana Penderita Hemofilia A di Indonesia.

Latar Belakang: Penderita Hemofilia di Indonesia sekitar 2.000 orang tersebar dari Sabang hingga Merauke. Di Jabodetabek, 403 anak penderita hemofilia, 86% hemofilia A dan 54% diantaranya hemofilia A berat. Konsentrat F VIII digunakan untuk terapi sulih Hemofilia A, mahal, harus impor dan tidak selalu tersedia. Kriopresipitat sebagai terapi sulih alternatif, kandungan F VIII sedikit dan pemberiannya untuk segolongan darah. MC cair dari Mesir, dapat meningkatkan kandungan dan keamanan F VIII. Bentuknya cair dan suhu penyimpanan minus 30°C, sehingga perlu ditingkatkan stabilitasnya dengan liofilisasi menjadi MC kering.

Tujuan:Tujuan penelitian ini adalah untuk mengetahui stabilitas dan keamanan MC kering lebih besar atau sama dengan MC cair.

Metode:Liofilisasi MC cair menjadi MC kering dilakukan agar lebih stabil dan dapat disimpan di suhu dingin (2-6°C) dan suhu ruang ( > 25°C). MC kering, ada yang ditambah eksipien (KE+) dan tanpa eksipien (KE-). Dilakukan uji banding stabilitas MC cair dan MC kering pada hari ke 0, 7, 30 dan 240, meliputi pemeriksaan kandungan F VIII, pH, osmolalitas dan kelarutan. Pemeriksaan keamanan MC cair menggunakan flowcytometri dan MC kering dengan hemaglutinasi dan kontaminasi bakteri.  

Hasil:MC Kering tanpa Eksipien (KE-) pada waktu penyimpanan 30 hari (T30) lebih tinggi F VIII-nya dibandingkan MC Kering dengan Eksipien (KE+) dan MC Cair. Namun pada waktu penyimpanan 240 hari (T240) penurunan F VIII pada KE- lebih banyak daripada KE+. Keamanan dengan memeriksa kontaminasi bakteri dan hemaglutinin pada MC kering sama dengan MC cair. 

Kesimpulan:MC kering tanpa eksipen yang disimpan pada suhu dingin dan suhu kamar, stabilitas kandungan F VIII sangat baik pada hari ke 30. Penambahan eksipien yang terlalu banyak, dapat menghancurkan protein yang terkandung di dalamnya. Keamanan MC kering sama dengan MC cair.

Kata kunci: F VIII, Hemofilia A, MC kering, Stabilitas.

ABSTRACT

 

Name                           : Saptuti Chunaeni

Programme of study   :Doctoral Program in Biomedical Science

Title                             :To Improve Stability of Factor VIII with Minipool

 Cryoprecipitate Lyophilized for Hemofilia a Treatment in

 Indonesia

 

 

Background:  There are about 2.000 hemophilia patients in Indonesia. Nowadays in

Jabodetabek alone, there are 403 children hemophilia mostly of 86% hemophilia A and 54% among them are of severe type.

Use of F VIII concetrate as a standard replacement therapy of hemophilia A, is expensive, needs to be imported from overseas and it is not always available. Cryoprecipitate as an alternative replacement therapy contains only a small yield F VIII and is only available for same blood group patients. Liquid minipool cryoprecipitate (MC) from Egypt can increase the F VIII content and safety. The MC, however is liquid and must be stored at – 30oC. Considering this, there is a need to improve the stability of F VIII by lyophilization procedure.

The aim of present study was to determine whether the stability and safety of dry MC was greater or equal to liquid MC.

Materials and Methods:Liquid of MC was lyophilized and was added excipients (KE+) or without excipient (KE-). Liyophilization is carried out to be more stable and can be stored at cold temperatures and room temperature. Tests on the stability on certain days (0, 7, 30 and 240.) including examination of F VIII content, pH, osmolality and solubility. Safety checks using flowcytometry and hemagglutination and bacterial contamination.

Results: Dry MC at T30 was higher in F VIII. At storage T240 the decrease in F VIII at KE- was more than KE +. The safety of a dry MC is the same as a liquid MC.

Conclusion: F VIII at KE- is better on T30. Adding excipients can destroy protein. The safety is the same.

Keywords:  F VIII, Hemophilia A, Lyophilized MC, Stability.

"
Depok: Fakultas Kedokteran Universitas Indonesia, 2020
D-Pdf
UI - Disertasi Membership  Universitas Indonesia Library
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Ayuca Zarry
Faktor risiko pneumonia berulang pada anak = Risk factor of children with recurrent pneumonia
"Latar belakang. Pneumonia masih menjadi penyebab utama kematian anak dan menjadi penyebab anak dirawat inap di negara berkembang. Faktor risiko pneumonia berulang pada anak di negara berkembang sampai saat ini belum diidentifikasi. Penenttuan terapi pada anak dengan pneumonia berulang merupakan tantangan tersendiri sehingga membutuhkan kecermatan dalam anamnesis ke arah faktor risiko dan riwayat penyakit yang mendalam sehingga tata laksana dapat dilakukan secara cepat dan akurat.
Tujuan. Mengetahui faktor- faktor yang memengaruhi kejadian pneumonia berulang pada anak.
Metode. Penelitian potong lintang ini dilakukan pada 237 pasien dengan diagnosis pneumonia berusia 6 bulan-18 tahun yang dirawat di RSCM pada tahun 2022. Proporsi pasien anak dengan pneumonia berulang yang dirawat di RSCM adalah 46,4%. Faktor yang terbukti menjadi risiko pneumonia berulang adalah sindrom aspirasi (PR 1,594; IK 95% 1,214-2,092; p=0,001), pajanan asap rokok (PR 1,549; IK 95% 1,158-2,073; p=0,003), dan tidak ASI eksklusif PR 1,390 (IK 95% 1,006- 1,921 p=0,045). Faktor yang tidak terbukti berhubungan dengan pneumonia berulang adalah prematuritas, penyakit jantung bawaan, riwayat penyakit alergi, tinggal di kawasan padat pemukiman penduduk, konsumsi obat anti epilepsi, imunodefisiensi, obesitas, dan status imunisasi.
Kesimpulan. Proporsi pasien anak dengan pneumonia berulang yang dirawat di RSCM adalah 46,4%. Faktor yang menjadi risiko pneumonia berulang adalah sindrom aspirasi, pajanan asap rokok, dan tidak ASI eksklusif.
Background. Pneumonia is the leading cause of childhood mortality and the most common reason for hospitalization among children living in developing countries. The risk factors for recurrent pneumonia in children in developing countries remain poorly understood. The treatment of children with recurrent pneumonia remains challenging, and therefore accuracy in history taking in the evaluation of risk factors and disease history is warranted to ensure quick and accurate treatment.
Objectives. This study aims to determine the risk factors of recurrent pneumonia in children.
Methods. This cross-sectional study included 237 children between ages 6 months and 18 years old treated in RSCM for pneumonia during the year 2022. This study showed that 46.4% of children in RSCM with pneumonia had a recurrency. Risk factors that were found to be associated with recurrent pneumonia were aspiration syndrome (PR 1.594; IK 95% 1.214-2.092; p=0.001), smoke exposure (PR 1.594; 95% CI 1.158-2.073; p=0.003), and absence of exclusive breastfeeding PR 1.390 (IK 95% 1.006-1.921 p=0.045). Meanwhile prematurity, congenital heart disease, history of allergic diseases, overcrowding, anti-epileptic drug consumption, immunodeficiency, obesity, and incomplete immunization were not found to be associated with recurrent pneumonia.
Results. This study showed that 46.4% of children in RSCM with pneumonia had a recurrency. The most detected risk factors for recurrent pneumonia were aspiration syndrome, smoke exposure, and not given exclusive breastfeeding."
2023
SP-pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Desy Rusmawatiningtyas
Epidemiologi dan faktor risiko mortalitas syok septik pada anak = Epidemiology and mortality risk factor of septic shock in children
"Latar belakang: Syok septik adalah penyebab utama morbiditas dan mortalitas pada anak. Sampai saat ini data epidemiologi dan faktor risiko mortalitas syok septik pada anak masih terbatas.
Tujuan: Mengetahui epidemiologi dan faktor risiko mortalitas syok septik pada anak.
Metode: Penelitian retrospektif dilakukan di RSUP DR. Sardjito dengan mencatat data rekam medis pasien anak dengan diagnosis syok septik periode 1 Nopember 2011 sampai 30 Juni 2014.
Hasil: Didapatkan 136 kejadian syok septik dalam kurun waktu pengambilan data. Median usia pasien adalah 16 bulan, 52.2% berjenis kelamin laki-laki dan 50% kejadian syok septik terjadi di PICU. Median skor awal PRISM III adalah 10 dan median skor awal PELOD adalah 22. Median hari perawatan di PICU adalah 4 hari. Mortalitas sebesar 88.2%. Pada tata laksana awal, 72.8% subyek harus mendapat terapi oksigen dengan ETT, 94,9% subyek mendapat antibiotik dalam waktu 1 jam pertama. Sebanyak 48.5% membutuhkan cairan kristaloid dan koloid dengan median jumlah 40 ml/kgbb. Median waktu yang diperlukan untuk menyelesaikan tata laksana cairan adalah 60 menit. Alasan penghentian terapi cairan resusitasi pada 44.8% subyek adalah karena sudah tidak respon cairan. Tunjangan ventilator mekanik dibutuhkan pada 79.4% dan katekolamin terbanyak yang dibutuhkan adalah dobutamin sebanyak 55.9% subyek. Median waktu tata laksana yang dibutuhkan sampai syok teratasi adalah 8 jam Prosentase fluid overload > 10% ditemukan pada 58.8% subyek. Dari multivariat analisis ditemukan faktor prediktor terjadinya kematian pada syok septik adalah FO >10% OR 6.69 (95% IK 1.35-33.21) dan diperlukannya tunjangan Ventilator Mekanik pada pasien syok septik yang menunjukkan tanda distress respirasi OR 16.38 (95% IK 2.69-99.66).
Simpulan Faktor risiko kematian syok septik pada anak dari penelitian ini adalah fluid overload dan penggunaan ventilator mekanik pada pasien syok septik yang menunjukkan tanda distress respirasi.
Background: Shock is a major cause of morbidity and mortality in children. To date epidemiological data and predictors of mortality of septic shock in children is limited.
Objective: to know the epidemiology and mortality risk factor of septic shock in children.
Methods: A retrospective study was conducted in DR. Sardjito general hospital with medical record data recorded diagnosis of septic shock in children period from 1 november 2011 to June 30, 2014.
Results: A total of 136 septic shock events in the period of data collection. The median age of patients was 16 months, 52.2% male sex and 50% incidence of septic shock occurred in the PICU. Median early PRISM III score was 10 and the median score was 22. The median initial PELOD day care in the PICU was 4 days. A mortality of 88.2%. At the initial steps, 72.8% of subjects received oxygen therapy with ETT, antibiotics within 1 hour of the first was done in 94.9% of subjects. A total of 48.5% in need of crystalloids and colloids with a median amounts of 40 ml / kg. The median time required to complete the administration of fluids is 60 minutes. Reason for termination of resuscitation fluid therapy was 44.8% because had no response to fluid therapy. Mechanical ventilator allowance required at 79.4% and catecholamines most needed is dobutamine as 55.9%. Median time needed to overcome the shock is 8 hours. Percentage of fluid overload> 10% was found in 58.8% of subjects. Multivariate analysis of predictor factors for mortality found in septic shock is FO> 10% OR 6.69 (95% CI 1.35- 33.21) and the need for mechanical ventilaton support in patient with distress respiration OR 16.38 (95% IK 2.69-99.66).
Conclusion: Mortality risk factor of septic shock in children in this research is fluid overload."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014
T-Pdf
UI - Tesis Membership  Universitas Indonesia Library
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Cut Nurul Hafifah, supervisor
Insidens dan faktor risiko pneumonia aspirasi pada anak dengan palsi serebral = Incidence and risk factors of aspiration pneumonia in children with cerebral palsy
"[ABSTRAK
Latar Belakang Masalah saluran napas yaitu pneumonia aspirasi merupakan masalah utama berkaitan dengan kualitas hidup morbiditas dan mortalitas pada anak palsi serebral PS Faktor yang berperan terhadap timbulnya pneumonia aspirasi antara lain adalah kelemahan otot napas gangguan koordinasi menelan refluks gastro esofagus status gizi dan imunitas yang kurang baik Namun hingga kini belum ada data seberapa besar insidens pneumonia aspirasi pada anak dengan PS di Indonesia dan faktor risiko yang berhubungan Tujuan Mengetahui insidens pneumonia aspirasi pada anak dengan PS dan hubungan faktor risiko dengan kejadian pneumonia aspirasi Metode Penelitian ini adalah studi kohort prospektif untuk menilai insidens pneumonia aspirasi dan studi potong lintang untuk menilai faktor risiko pneumonia aspirasi Penelitian ini dilakukan di Ruang Rawat Inap dan Klinik Neurologi Departemen Ilmu Kesehatan Anak Rumah Sakit Cipto Mangukusumo Waktu rekrutmen penelitian 1 Maret 31 Maret 2015 Waktu pengamatan tanggal 1 April 30 September 2015 Terhadap subyek dilakukan anamnesis termasuk penilaian faktor risiko dengan Dysphagia Disorder Survey pemeriksaan fisis dan R ntgen toraks sebagai data awal selanjutnya subyek diamati selama 6 bulan untuk mengevaluasi adanya pneumonia aspirasi Hubungan bivariat antara kejadian aspirasi dan faktor risiko dilakukan dengan uji Fisher dan Mann Whitney sedangkan analisis multivariat dilakukan dengan regresi logistik Hasil Total subjek penelitian adalah 40 anak dengan PS Dua subjek mengalami drop out karena meninggal dunia dan dua subjek loss to follow up sehingga terdapat 36 pasien yang berhasil diamati hingga enam bulan Sebanyak 8 dari 36 22 2 pasien pada penelitian ini mengalami kejadian aspirasi baik silent aspiration 5 5 maupun pneumonia aspirasi secara klinis 19 4 Derajat beratnya PS berhubungan dengan pneumonia dan silent aspiration p 0 040 sedangkan pneumonia dan silent aspiration tidak berhubungan dengan gangguan koordinasi menelan p 0 2 dan status gizi p 0 107 Simpulan Insidens pneumonia aspirasi pada anak PS adalah 22 2 dengan derajat beratnya PS sebagai faktor risiko terjadinya PS ABSTRACT Background Respiratory problems such as aspiration pneumonia are major morbidities and mortalities in children with cerebral palsy and play major role in the quality of life of these children Several risk factors may contribute to these problems including respiratory muscle weakness dysphagia gastro esophageal reflux disease nutrition and immune problem Nevertheless there are still no data on the incidence and risk factors of aspiration pneumonia in children with cerebral palsy in Indonesia Aim To determine the incidence and risk factors of aspiration pneumonia in children with cerebral palsy Method Incidence of pneumonia was studied prospectively and the prevalence of the risk factors was studied as cross sectional Subjects were recruited from March 1st ndash 31st 2015 through Neurology Clinic and Pediatric Ward Cipto Mangukusumo Hospital At baseline we evaluate history physical examination risk factors using Dysphagia Disorder Survey and chest X ray to evaluate the incidence of silent aspiration Subjects were followed up for six months to determine the incidence of aspiration pneumonia Analysis of the risk factors contributing to aspiration pneumonia were tested using Fisher rsquo s exact test and Mann Whitney Multivariate analysis was tested using logistic regression Result A total of 40 children with cerebral palsy were recruited Two subjects died during follow up and two subjects were loss to follow up giving a total of 36 subjects who completed the study Eight out of 36 subjects 22 2 had one or more episodes of aspiration consisting of silent aspiration 5 5 and clinically diagnosed aspiration pneumonia 19 4 Gross motor function was statistically signifant as risk factor of aspiration pneumonia p 0 040 while dysphagia p 0 2 and nutritional status p 0 107 were not associated with pneumonia and silent aspiration Conclusion Incidence of aspiration pneumonia and silent aspiration in children with cerebral palsy is 22 2 with gross motor function as a risk factor ;Background Respiratory problems such as aspiration pneumonia are major morbidities and mortalities in children with cerebral palsy and play major role in the quality of life of these children Several risk factors may contribute to these problems including respiratory muscle weakness dysphagia gastro esophageal reflux disease nutrition and immune problem Nevertheless there are still no data on the incidence and risk factors of aspiration pneumonia in children with cerebral palsy in Indonesia Aim To determine the incidence and risk factors of aspiration pneumonia in children with cerebral palsy Method Incidence of pneumonia was studied prospectively and the prevalence of the risk factors was studied as cross sectional Subjects were recruited from March 1st ndash 31st 2015 through Neurology Clinic and Pediatric Ward Cipto Mangukusumo Hospital At baseline we evaluate history physical examination risk factors using Dysphagia Disorder Survey and chest X ray to evaluate the incidence of silent aspiration Subjects were followed up for six months to determine the incidence of aspiration pneumonia Analysis of the risk factors contributing to aspiration pneumonia were tested using Fisher rsquo s exact test and Mann Whitney Multivariate analysis was tested using logistic regression Result A total of 40 children with cerebral palsy were recruited Two subjects died during follow up and two subjects were loss to follow up giving a total of 36 subjects who completed the study Eight out of 36 subjects 22 2 had one or more episodes of aspiration consisting of silent aspiration 5 5 and clinically diagnosed aspiration pneumonia 19 4 Gross motor function was statistically signifant as risk factor of aspiration pneumonia p 0 040 while dysphagia p 0 2 and nutritional status p 0 107 were not associated with pneumonia and silent aspiration Conclusion Incidence of aspiration pneumonia and silent aspiration in children with cerebral palsy is 22 2 with gross motor function as a risk factor ;Background Respiratory problems such as aspiration pneumonia are major morbidities and mortalities in children with cerebral palsy and play major role in the quality of life of these children Several risk factors may contribute to these problems including respiratory muscle weakness dysphagia gastro esophageal reflux disease nutrition and immune problem Nevertheless there are still no data on the incidence and risk factors of aspiration pneumonia in children with cerebral palsy in Indonesia Aim To determine the incidence and risk factors of aspiration pneumonia in children with cerebral palsy Method Incidence of pneumonia was studied prospectively and the prevalence of the risk factors was studied as cross sectional Subjects were recruited from March 1st ndash 31st 2015 through Neurology Clinic and Pediatric Ward Cipto Mangukusumo Hospital At baseline we evaluate history physical examination risk factors using Dysphagia Disorder Survey and chest X ray to evaluate the incidence of silent aspiration Subjects were followed up for six months to determine the incidence of aspiration pneumonia Analysis of the risk factors contributing to aspiration pneumonia were tested using Fisher rsquo s exact test and Mann Whitney Multivariate analysis was tested using logistic regression Result A total of 40 children with cerebral palsy were recruited Two subjects died during follow up and two subjects were loss to follow up giving a total of 36 subjects who completed the study Eight out of 36 subjects 22 2 had one or more episodes of aspiration consisting of silent aspiration 5 5 and clinically diagnosed aspiration pneumonia 19 4 Gross motor function was statistically signifant as risk factor of aspiration pneumonia p 0 040 while dysphagia p 0 2 and nutritional status p 0 107 were not associated with pneumonia and silent aspiration Conclusion Incidence of aspiration pneumonia and silent aspiration in children with cerebral palsy is 22 2 with gross motor function as a risk factor , Background Respiratory problems such as aspiration pneumonia are major morbidities and mortalities in children with cerebral palsy and play major role in the quality of life of these children Several risk factors may contribute to these problems including respiratory muscle weakness dysphagia gastro esophageal reflux disease nutrition and immune problem Nevertheless there are still no data on the incidence and risk factors of aspiration pneumonia in children with cerebral palsy in Indonesia Aim To determine the incidence and risk factors of aspiration pneumonia in children with cerebral palsy Method Incidence of pneumonia was studied prospectively and the prevalence of the risk factors was studied as cross sectional Subjects were recruited from March 1st ndash 31st 2015 through Neurology Clinic and Pediatric Ward Cipto Mangukusumo Hospital At baseline we evaluate history physical examination risk factors using Dysphagia Disorder Survey and chest X ray to evaluate the incidence of silent aspiration Subjects were followed up for six months to determine the incidence of aspiration pneumonia Analysis of the risk factors contributing to aspiration pneumonia were tested using Fisher rsquo s exact test and Mann Whitney Multivariate analysis was tested using logistic regression Result A total of 40 children with cerebral palsy were recruited Two subjects died during follow up and two subjects were loss to follow up giving a total of 36 subjects who completed the study Eight out of 36 subjects 22 2 had one or more episodes of aspiration consisting of silent aspiration 5 5 and clinically diagnosed aspiration pneumonia 19 4 Gross motor function was statistically signifant as risk factor of aspiration pneumonia p 0 040 while dysphagia p 0 2 and nutritional status p 0 107 were not associated with pneumonia and silent aspiration Conclusion Incidence of aspiration pneumonia and silent aspiration in children with cerebral palsy is 22 2 with gross motor function as a risk factor ]"
Fakultas Kedokteran Universitas Indonesia, 2015
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library
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Eka Intan Fitriana
Faktor risiko late steroid resistance pada anak dengan sindrom nefrotik idiopatik = Risk factors for late steroid resistance in children with idiopathic nephrotic syndrome.
"Latar belakang: Prevalens late steroid resistance (LSR) makin meningkat pada anak dengan sindrom nefrotik idiopatik (SNI). Fungsi ginjal yang menurun dapat memperburuk prognosis LSR. Penelitian terkait mengenai faktor risiko LSR pada anak (SNI) masih terbatas, padahal pengenalan terhadap faktor risiko ini diperlukan untuk deteksi dini dan mengotimalkan terapi.
Tujuan: Mengidentifikasi karakteristik anak yang didiagnosis SNI awitan inisial seperti jenis kelamin, usia awitan SNI, hipertensi, kadar hemoglobin, albumin, ureum, laju filtrasi glomerulus, hematuria mikroskopik dan jangka waktu sejak dinyatakan remisi dan telah menyelesaikan pengobatan inisial terhadap terjadi relaps pertama kali dapat menjadi faktor risiko LSR pada anak dengan SNI.
Metode penelitian: Penelitian kasus-kontrol dengan penelusuran retrospektif yang dilakukan di Departemen Ilmu Kesehatan Anak di FKUI-RSCM, RSUP. Fatmawati dan RSUP. Dr. Mohammad Hoesin periode Maret-Mei 2018 yang terbagi menjadi kelompok LSR dan SNSS. Pengambilan rekam medis anak dengan diagnosis SNI yang melakukan kunjungan pengobatan di poli nefrologi dalam kurun waktu lima tahun terakhir. Faktor risiko dianalisis secara bivariat dan multivariat.
Hasil penelitian: Dilakukan analisis pada 100 anak dengan LSR dan 100 anak dengan SNSS. Anak laki-laki didapatkan lebih banyak daripada anak perempuan pada dua kelompok dengan median usia 4,12 (1,0-17,40) tahun. Faktor yang secara bermakna berpengaruh terhadap kejadian LSR pada anak dengan SNI pada analisis bivariat adalah: kadar ureum ≥ 40mg/dL (OR 1,68; IK 95% 1,45-4,53) dan adanya hematuria mikroskopik (OR 2,45; IK 95% 1,35-4,47).
Simpulan: Faktor risiko yang berperan terhadap kejadian LSR pada anak dengan SNI adalah kadar ureum ≥ 40 mg/dL dan terdapat hematuria mikroskopik.
Background: Prevalence of late steroid resistance (LSR) tends to be increased in children with idiopathic nephrotic syndrome (INS). Renal function deterioration may worsen the prognosis. Previous studies about the risk factors for LSR in children with INS were still limited, while early detection is the most important thing to do proper treatment.
Objectives: to determine whether age of onset, sex, hypertension, hemoglobin level, albumin, ureum, filtration glomerular rate, microscopic hematuria, and first relaps may influence the occurrence of LSR in children with INS. Methods. Case control study with restrospective medical record investigation was performed in INS children who visited to dr. Cipto Mangunkusumo, dr. Fatmawati and dr. Mohammad Hoesin General Hospital, during March-May 2018. Case and control group was children with LSR and sensitive steroid. Bivariate and multivariate analysis to identify significant risk factors.
Results: There were each 100 children with LSR and steroid sensitive. No different of sex ratio in each group with median of age 4,12 (1,0-17,40) years old. Factors which associated significantly with LSR on bivariate analysis were ureum level ≥ 40mg/dL (OR 1,68; IK 95% 1,45-4,53), microscopic hematuria (OR 2,45; IK 95% 1,35-4,47), and glomerular filtration rate (OR 1,43 IK 95% 0,79-2,57). Factors which associated significantly with LSR on multivariate analysis include ureum level ≥ 40mg/dL (OR 2,199; IK 95% 1,19-4,04), microscopic hematuria (OR 2,05; IK 95% 1,08-3,88).
Simpulan: Risk factors associated with LSR in INS are ureum level ≥ 40 mg/dL and microscopic hematuria."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2018
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UI - Tugas Akhir  Universitas Indonesia Library
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Ratu Ayu Dewi Sartika
Faktor risiko obesitas pada anak 5-15 tahun di Indonesia = Risk factors of obesity in children 5-15 years old
"Obesitas merupakan akibat dari keseimbangan energi positif untuk periode waktu yang cukup panjang. Masalah obesitas dapat terjadi pada usia anak-anak, remaja hingga dewasa. Tujuan penelitian untuk mengetahui faktor risiko yang paling berhubungan dengan obesitas pada anak (5-15 tahun), menggunakan sumber data sekunder data Riset Kesehatan Dasar (Riskesdas) tahun 2007. Prevalensi obesitas (persentil >95) pada anak rentang usia 5-15 tahun sebesar 8,3%. Faktor risiko yang paling berhubungan dengan obesitas pada anak usia 5-15 tahun adalah tingkat pendidikan anak setelah dikontrol oleh variabel jenis kelamin, riwayat obesitas ayah, kebiasaan olah raga dan merokok serta asupan protein. Perlu dilakukan upaya pencegahan dan penanggulangan faktor risiko obesitas dengan menanamkan pendidikan kesehatan pada anak sejak usia dini, melalui peningkatan KIE (komunikasi, informasi dan edukasi), seperti gerakan anti rokok, gerakan cinta serat (sayur dan buah) serta membudayakan aktivitas fisik.
Obesity is the result of positive energy balance for long periods of time. The problem of obesity can occur at the age of children, teens to adults. The purpose of this study is to identify the most dominant factor of obesity in children (5-15 years) using Basic Health Research in 2007. The proportion of obesity (percentile >95) in children (5-15 years old) was 8.3%. The risk factor which mostly associated with obesity was the level of education after being controlled by sex, father's obesity, exercise and smoking habits and intake of protein. To overcome obesity problem in children (5-15 years old), it is needed to provide health education for children from an early age through enhanced IEC (Information, Education and Communication) such as anti smoking program, love of fiber (vegetables and fruits) and develop a culture of sport activities."
Depok: Universitas Indonesia, 2011
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Artikel Jurnal  Universitas Indonesia Library
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Satrio Wahyu Fathurrahman
Faktor-faktor risiko terjadinya diare kronik pada anak dengan infeksi HIV di RSCM pada tahun 2014 = Risk factors of chronic diarrhea in children with HIV infection in RSCM in the year 2014 2016
"ABSTRAK
Latar Belakang: Diare kronik meningkatkan risiko kematian serta morbiditas jangka panjang pada anak. Anak dengan infeksi HIV memiliki risiko lebih tinggi terjadi diare kronik. Tujuan: Penelitian ini bertujuan untuk mengetahui gambaran karakteristik, prevalensi, serta faktor risiko yang terkait dengan kejadian diare kronik pada pasien anak dengan infeksi HIV di Rumah Sakit Cipto Mangunkusumo. Faktor risiko yang diteliti ialah usia, status nutrisi, status dehidrasi, status pemberian ASI, fase infeksi HIV, penggunaan obat antiretroviral ARV , kultur tinja, serta sindrom malabsorbsi. Metode: Desain penelitian adalah potong lintang dengan sumber data dari rekam medis pasien departemen anak RSCM dengan infeksi HIV pada tahun 2014-2016. Seluruh data memenuhi kriteria dianalisis. Data dianalisis menggunakan analisis bivariat diikuti analisis multivariat. Hasil: Karena keterbatasan data rekam medis, variabel kultur tinja, sindrom malabsorbsi, serta status pemberian ASI dikeluarkan dari penelitian ini. Prevalensi diare kronik pada pasien anak HIV ialah 12,9 . Analisis multivariat atas 132 data menunjukkan hubungan bermakna antara gizi kurang dan buruk p=0,037, adjusted OR=5,737 dan dehidrasi p=0,026, adjusted OR=6,891 dengan kejadian diare kronik pada pasien anak dengan infeksi HIV. Diskusi: Hasil ini dapat dijelaskan dengan pengaruh imunosupresi dari status gizi yang rendah serta dehidrasi, selain bahwa diare pun dapat menyebabkan dehidrasi serta penurunan status gizi.
ABSTRACT
Introduction Chronic diarrhea increases mortality and other long term morbidities in children. Children with HIV infections are at higher risk of developing chronic diarrhea. Objective This study aims to investigate the characteristics, prevalence, and risk factors of chronic diarrhea in HIV children. Factors analyzed are age, nutritional status, dehydration status, breastfeeding, HIV infection phase, use of antiretroviral ARV drugs, stool culture, and malabsorbtive syndrome. Methods In this cross sectional study data are obtained from medical records of children with HIV infection in Cipto Mangunkusumo Hospital from 2014 until 2016. All data that satisfy the inclusion criteria and are not excluded are analyzed by bivariate followed by multivariate analysis. Results Due to insufficient data on stool culture, breastfeeding, and malabsorbtive syndrome, aforementioned variables are dropped from this study. Data shows that prevalence of chronic diarrhea in children with HIV in CMH is 12.9 . Analysis of 132 data shows that low nutritional status p 0.037, adjusted OR 5.737 and dehydration p 0.026, adjusted OR 6.891 are significantly associated with chronic diarrhea in HIV children. Discussions This finding may be due to the immunosupression caused by low nutritional status and dehydration, also by the fact that diarrhea can also cause a decrease in nutritional status and induce dehydration."
2017
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UI - Skripsi Membership  Universitas Indonesia Library
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Hutomo Laksono
Prevalens dan Faktor Risiko Malnutrisi Pada Anak dengan Kolestasis Kronik di Rumah Sakit Cipto Mangunkusumo = Prevalence and Risk Factor of Malnutrition in Children with Chronic Cholestasis at Cipto Mangunkusumo Hospital
"Anak dengan kolestasis kronik memiliki risiko tinggi mengalami malnutrisi yang memengaruhi pertumbuhan dan perkembangan. Berbagai faktor risiko penyebab malnutrisi pada kolestasis kronik penting untuk diidentifikasi agar penanganan malnutrisi lebih terarah. Tujuan studi ini untuk mengetahui prevalens, profil dan faktor risiko yang memengaruhi malnutrisi pada anak dengan kolestasis kronik. Penelitian ini menggunakan desain potong lintang pada anak kolestasis kronik berusia 3 bulan – 5 tahun di klinik rawat jalan gastrohepatologi RSCM. Dilakukan pemeriksaan antropometri, status gizi, pola asupan nutrisi makronutrien dan mikronutrien dan identifikasi faktor risiko malnutrisi. Kemudian dinilai hubungan antara faktor risiko tersebut dengan status gizi. Dari 94 subyek didapatkan prevalens malnutrisi 53,3%, prevalens stunting 59,6%, prevalens mikrosefali 59,6%. Persentase subyek dengan riwayat rawat inap 71,1%, riwayat puasa 44,7%, asites sedang-masif 38,3% dan perdarahan saluran cerna 11,7%. Jumlah subyek dengan kekurangan asupan makronutrien: asupan kalori 67,1%, asupan karbohidrat 53,2%, asupan protein 13,8%, asupan lemak 77,7% dan asupan MCT 76,6%. Jumlah subyek dengan kekurangan asupan mikronutrien: vitamin A 56,4%, vitamin D 55,3%, vitamin E 21,3%, vitamin K 24,5%, vitamin B1 21,3%, vitamin B2 13,8%, vitamin B6 24,5%, vitamin B12 2,1%, vitamin C15,8%, zat besi 69,1%, seng 87,2%, fosfor 3,2% dan magnesium 66%. Faktor risiko yang memiliki hubungan bermakna dengan malnutrisi pada anak kolestasis kronik adalah perdarahan saluran cerna dan asites sedang-masif  dengan nilai p  0,001 dan 0,025. Tidak terdapat hubungan yang bermakna antara asupan makronutrien, riwayat durasi rawat inap, riwayat durasi puasa dengan malnutrisi pada anak kolestasis kronik. Prevalens dan penyebab malnutrisi pada anak kolestasis kronik cukup tinggi dan bervariasi, dibutuhkan evaluasi status gizi berkala pada anak kolestasis kronik untuk mengatasi dan mencegah malnutrisi. Perdarahan saluran cerna dan asites sedang- masif sebagai faktor risiko yang berpengaruh terhadap malnutrisi harus mendapat penanganan yang komprehensif agar pemberian asupan nutrisi tidak terhambat.

Kata kunci: kolestasis kronik, status gizi, makronutrien, mikronutrien, ascites, perdarahan saluran cerna.

Abstract

Children with chronic cholestasis have a higher risk of malnutrition that affect growth and development in life. There are several risk factors that should be identified and managed to reduce the risk of malnutrition. In this study we want to know the prevalence of malnutrition, the profile and risk factors that are related to malnutrition in children with chronic cholestasis. This cross-sectional study involved children age 3 months to 5 years old at pediatrics gastro-hepatology clinic RSUPN Dr. Cipto Mangunkusumo. Methods include standard anthropometric examination, evaluation of nutritional status, pattern of intake nutrition and identification risk factors that are related to malnutrition. Out of 94 subjects, the prevalence of malnutrition is 53.3%, prevalence of stunting is 59.6% and prevalence of microcephaly is 59.6%. 71.1% had history of hospitalization, 44.7% had history of fasting, 38.3% had moderate and massive ascites, and 11.7% had gastro-intestinal bleeding. Insufficient daily macronutrient intake are as follows: calorie 67.1%, carbohydrate 53.2%, protein 13.8%, lipid 77.7% and MCT 76.6%. Insufficient daily micronutrient intake are as follows: vitamin A 56.4%, vitamin D 55.3%, vitamin E 21,3%, vitamin K 24,5%, vitamin B1 21,3%, vitamin B2 13.8%, vitamin B6 24.5%, vitamin B12 2.1%, vitamin C 15.8% Fe 69.1%, zinc 87.2 %, P 3.2% and Mg 66%. There were significant relationships between gastro-intestinal bleeding (p value of 0.001) and moderate-massive ascites (p value of 0.025) in nutrition status in children with chronic cholestasis. No relationships were observed among insufficient macronutrient intake, duration of hospitalization and duration of fasting with nutrition status in children with chronic cholestasis. The high prevalence of malnutrition in children with chronic cholestasis and the causes of malnutrition are varied. Although some causes have no specific treatment, all children with chronic cholestasis should have periodic nutritional evaluation to optimized macronutrient and vitamin intake. Comprehensive management moderate – massive ascites and gastro-intestinal bleeding are important to prevent malnutrition in children with chronic cholestasis."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2024
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UI - Tesis Membership  Universitas Indonesia Library
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Gendis Ayu Ardias
Faktor-faktor risiko terjadinya epilepsi pada anak dengan Palsi Serebral Tipe Spastik: studi kasus kontrol = Risk factors of epilepsy in children with Spastic Cerebral Palsy: a case control study
"Latar belakang: Palsi serebral (PS) merupakan gangguan permanen pada perkembangan gerakan dan postur tubuh, bersifat non-progresif, dan dapat menyebabkan keterbatasan aktivitas. Gangguan motorik pada PS dapat disertai dengan gangguan fungsi sensasi, persepsi, kognisi, komunikasi dan tingkah laku, masalah muskuloskeletal sekunder, dan berisiko untuk terjadinya epilepsi di kemudian hari. Jenis PS yang diyakini berhubungan erat dengan kejadian epilepsi adalah PS tipe spastik dengan topografi kuadriplegia. Meskipun terdapat beberapa teori yang diyakini menjadi etiologi spesifik epilepsi pada PS spastik, masih sekitar 70% kasus belum diketahui penyebabnya.
Metode: Penelitian ini merupakan studi observasional analitik dengan desain kasus kontrol yang bertujuan untuk menelaah faktor-faktor risiko epilepsi pada PS spastik. Faktor risiko yang terkait kejadian epilepsi pada PS tipe spastik yang akan diteliti adalah mikrosefal, topografi PS spastik, usia pertama kejang < 1 tahun, riwayat kejang periode neonatal, riwayat infeksi SSP di usia < 2 tahun, temuan abnormal CT scan/ MRI, dan temuan abnormal EEG.
Hasil: Sebanyak 103 subjek populasi kasus (PS spastik dengan epilepsi) dan 103 subjek populasi kontrol (PS spastik tanpa epilepsi) diikutsertakan dalam penelitian ini. Analisis univariat hingga multivariat dilakukan menggunakan program statistical package for the social sciences versi 27 (SPSS 27). Faktor risiko dianggap bermakna apabila nilai p<0,05. Penelitian ini menunjukkan bahwa faktor-faktor risiko PS tipe spastik yang paling berperan untuk terjadinya epilepsi pada penelitian ini adalah mikrosefal (p=0,003; OR 3,577; IK 95% 1,559–8,209), topografi PS spastik kuadriplegia dan hemiplegia (p=0,005; OR 6,636; IK 95% 1,797–24,509; dan p=0,006; OR 7,888; IK 95% 1,782–34,914), temuan abnormal CT scan/ MRI (nilai p=0,002; OR 4,153; IK 95% 1,715–10,058), dan temuan abnormal EEG berupa gambaran hipofungsi (p < 0,0001; OR 219,338; IK 95% 40,103–1199,63). Kesimpulan: Mikrosefal, topografi PS spastik kuadriplegia, temuan abnormal CT scan/ MRI, dan temuan abnormal EEG terbukti meningkatkan risiko terjadinya epilepsi pada PS spastik, sedangkan usia kejang pertama < 1 tahun, riwayat kejang neonatal, dan infeksi SSP usia < 2 tahun tidak terbukti meningkatkan risiko terjadinya epilepsi pada PS spastik.
Background: Cerebral palsy (CP) is a permanent and non-progressive disturbance in the development of movement and posture, and causes activity limitations. Motor disturbances in PS can be accompanied by impaired function of sensation, perception, cognition, communication and behaviour, secondary musculoskeletal problems, and the risk of developing epilepsy later in life. The type of CP that is believed to be closely related to the incidence of epilepsy is the spastic type with a quadriplegic topography. Although there are several theories that are believed to be the specific aetiology of epilepsy in spastic PS, the cause is still unknown in about 70% of cases.
Method: This is a case-control study design that aims to examine the risk factors of epilepsi in spastic CP. The risk factors associated with the occurrence of epilepsy that will be involved are microcephaly, topography of spastic CP, age at first seizure <1 year, history of neonatal seizures, history of CNS infection at the age < 2 years, abnormal CT scan/ MRI findings, and abnormal EEG findings.
Result: A total of 103 case population subjects (spastic CP with epilepsy) and 103 control population subjects (spastic CP without epilepsy) were included in this study. Univariate to multivariate analysis was performed using the statistical package for the social sciences version 27 (SPSS 27). Risk factors are considered significant if the p value <0.05. This study showed that the risk factors for epilepsy in spastic CP which were most significant for the occurrence of epilepsy were microcephaly (p=0.003; OR 3.577; 95% CI 1.559 – 8.209), quadriplegia and hemiplegia topography (p=0.005; OR 6.636; 95% CI 1.797- 24.509 and p=0.006; OR 7.888; 95% CI 1.782-34.914), abnormal CT scan/MRI findings (p=0.002; OR 4.153; 95% CI 1.715– 10.058), and hypofunction form of EEG findings (p<0,0001; OR 219.338; 95% CI 40.103–1199.63).
Conclusion: Microcephaly, quadriplegia topography, abnormal CT scan/MRI findings, and abnormal EEG findings have been shown to increase the risk of developing epilepsy in spastic CP. Whereas age of first seizure <1 year, history of neonatal seizures, and CNS infection at age <2 years old were not proven to increase the risk of epilepsy in spastic CP."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2023
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UI - Tugas Akhir  Universitas Indonesia Library
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