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"Latar Belakang. Anak dengan gangguan neurodevelopmental memerlukan upaya terapi terpadu untuk meningkatkan kualitas hidupnya. Studi ini bertujuan mengetahui pengaruh implantasi eksosom, stimulasi auditori binaural beat, dan terapi konvensional terhadap lima domain BDI-2 pada anak dengan gangguan neurodevelopmental.Metode. Studi kohort retrospektif dengan rekam medis di RSUPN dr. Cipto Mangunkusumo dan RSAB Harapan Kita dilakukan pada anak dengan gangguan neurodevelopmental yang menjalani terapi sejak Januari 2021-April 2023. Subjek dikelompokkan menjadi kelompok perlakuan mendapatkan implantasi eksosom, stimulasi auditori binaural beat, dan terapi konvensional, sedangkan kelompok kontrol hanya mendapatkan terapi konvensional. Luaran yang dinilai yaitu domain perkembangan BDI-2. Analisis univariat dan bivariat dilakukan sesuai kebutuhan.Hasil. Terdapat 25 subjek kelompok perlakuan dan 25 subjek kelompok kontrol. Tidak ada perbedaan karakteristik kedua kelompok sebelum perlakuan, kecuali domain motorik. Terdapat perbedaan usia developmental global maupun lima domain BDI-2 sebelum dan sesudah perlakuan pada kelompok perlakuan dan kontrol dengan median peningkatan usia developmental global masing-masing yaitu 7,5 dan 2,2 bulan. Tampak perbedaan peningkatan usia developmental global dan lima domain setelah perlakuan yang bermakna antara kelompok perlakuan dan kelompok kontrol.Kesimpulan. Implantasi eksosom dan stimulasi auditori binaural beat dapat meningkatkan usia developmental global dan lima domain perkembangan berdasarkan penilaian BDI-2 secara signifikan pada anak dengan gangguan neurodevelopmental.

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Background. Children with neurodevelopmental disorders require integrated therapeutic efforts to improve their quality of life. This study aimed to determine the effect of exosome therapy, binaural beat auditory stimulation, and conventional therapy on five BDI-2 domains in children with neurodevelopmental disorders.

Method. Retrospective cohort study using medical records at dr. Cipto Mangunkusumo National Center General Hospital and RSAB Harapan Kita was conducted for children with neurodevelopmental disorders who underwent therapy from January 2021 to April 2023. Subjects were grouped into a treatment group receiving exosome therapy, binaural beat auditory stimulation, and conventional therapy, while the control group only received conventional therapy. The BDI-2 developmental domains were assessed. Univariate and bivariate analysis were performed as needed.

Results. There were 25 subjects in the treatment group and 25 subjects in the control group. There were no differences in subjects’ characteristics between the two groups before treatment, except for the motor domain. There were differences in global and five BDI-2 domains developmental age before and after treatment in the treatment and control groups with a median increase in global developmental age, respectively, 7.5 and 2.2 months. There were significant differences in the increase of global and five domains developmental age after treatment between the treatment group and the control group.

Conclusion. Exosome therapy and auditory binaural beat stimulation improve global and five domains developmental age significantly based on BDI-2 assessment in children with neurodevelopmental disorders."

"Latar BelakangPandemi COVID-19 telah dinyatakan berakhir oleh World Health Organization sehingga anak- anak dengan gangguan neurologis dan neurodevelopmental perlu untuk beradaptasi kembali. Oleh karena itu, penelitian mengenai adaptasi pascapandemi terkait layanan kesehatan, perkembangan masalah medis anak, hubungan anak dengan keluarga dan teman, perilaku anak, dan masalah yang dihadapi oleh orang tua, pengasuh, dan keluarga dalam penanganan anak perlu dilakukan untuk merancang intervensi dan kebijakan yang mendukung mereka dalam menghadapi situasi serupa di masa depan.MetodePenelitian ini merupakan studi potong lintang pada orang tua atau pengasuh pasien Poliklinik Neurologi Anak RSCM Kiara pada Oktober-November 2023 dengan instrumen penelitian berupa kuesioner yang berisi 48 pertanyaan untuk mengetahui adaptasi pascapandemi COVID-19 terhadap anak-anak dengan gangguan neurologis dan neurodevelopmental. Data disajikan dalam N dan persentase serta rerata dan standar deviasi (jika terdistribusi normal) atau median dan nilai minimum-maksimum (jika tidak terdistribusi normal).HasilJumlah subjek yang terlibat adalah 125 orang, yang didominasi oleh ibu (85,6%), dengan median (min-maks) usia anak 7 (2-17) tahun, dan diagnosis anak didominasi oleh epilepsi (58,3%). Setelah pandemi, sebanyak 54,4% responden mengalami kesulitan layanan kesehatan dalam aspek waktu tunggu rawat jalan dan 56,8% melaporkan adanya perbaikan dalam masalah medis. Mayoritas hubungan anak dengan keluarga adalah baik ketika sebelum dan selama pandemi (48,8%) serta setelah pandemi (49,6%). Terkait hubungan anak dengan teman, selama pandemi, hampir separuh anak tidak melakukan kontak dengan teman-teman mereka (44,8%), tetapi sekarang, mayoritas anak telah kembali bermain secara langsung (62,4%). Terkait perubahan perilaku pascapandemi, sebanyak 43,2% melaporkan relatif sama saja. Sementara terkait masalah yang dihadapi oleh orang tua, pengasuh, dan keluarga dalam penanganan anak, 40,8% menyatakan bahwa tidak ada kesulitan dalam menangani anak-anak mereka setelah pandemi. KesimpulanAdaptasi pascapandemi COVID-19 memberikan dampak pada layanan kesehatan, perkembangan medis anak, perubahan perilaku, dan hubungan dengan teman terhadap anak-anak dengan gangguan neurologis dan neurodevelopmental, meskipun sebagian besar hubungan keluarga tetap baik, dan sebagian besar orang tua melaporkan tidak adanya perubahan signifikan dalam situasi kerja atau tidak ada kesulitan yang dihadapi dalam menangani anak.

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Introduction

The World Health Organization has declared the COVID-19 pandemic over, so children with neurological and neurodevelopmental disorders need to adapt again. Therefore, research on post- pandemic adaptation related to health services, the development of children's medical problems, children's relationships with family and friends, children's behavior, and problems faced by parents, caregivers, and families in treating children needs to be carried out to design interventions and policies that support them in facing similar situations in the future.

Method

This research is a cross-sectional study on parents or caregivers of patients at the Children's Neurology Polyclinic RSCM Kiara in October-November 2023 with a research instrument in the form of a questionnaire containing 48 questions to determine post-COVID-19 pandemic adaptation for children with neurological and neurodevelopmental disorders. Data are presented in N and percentage as well as mean and standard deviation (if normally distributed) or median and minimum-maximum values (if not normally distributed).

Results

The number of subjects involved was 125 people, dominated by mothers (85,6%), with a median (min-max) child age of 7 (2-17) years, and the child's diagnosis was dominated by epilepsy (58,3%). After the pandemic, 54,4% of respondents experienced health service difficulties regarding outpatient waiting times, and 56,8% reported improvements in medical problems. Most children's relationships with their families were good before and during the pandemic (48,8%) and after (49,6%). Regarding children's relationships with friends, during the pandemic, almost half of children had no contact with their friends (44,8%), but now, most children have returned to playing in person (62,4%). Regarding changes in post-pandemic behavior, 43,2% reported that it was relatively the same. Meanwhile, regarding the problems parents, caregivers, and families faced in handling children, 40,8% stated there were no difficulties managing their children after the pandemic.

Conclusion

Post-pandemic COVID-19 adaptation has had an impact on health services, children's medical development, changes in behavior, and relationships with friends for children with neurological and neurodevelopmental disorders; although most family relationships remain good, and most parents report no significant differences in a work situation, or there are no difficulties faced in dealing with children."

"Latar belakang: Gangguan pendengaran merupakan keluhan umum yang sering dirujuk ke spesialis Telinga Hidung Tenggorok (THT), dengan kasus terbanyak di wilayah Pasifik Barat dan Asia Tenggara. Gangguan pendengaran dapat mengganggu kemampuan wicara dan bahasa anak, mengakibatkan kesulitan dalam sosialisasi dan prestasi akademik yang buruk. Implantasi koklea merupakan metode rehabilitasi efektif untuk pasien gangguan pendengaran sensorineural. Terdapat bukti variasi jangkauan komunikasi reseptif pascaimplantasi koklea. Korelasi antara luas penampang nervus koklearis, diameter kanalis auditori interna dan usia saat implantasi terhadap luaran auditori pascaimplantasi koklea diharapkan dapat menjadi parameter kandidat implantasi serta prediktor luaran auditori pascaimplantasi koklea.Metode: Studi korelasi dengan desain cross-sectional. Terdapat 40 sampel yang telah menjalani implantasi koklea. Dilakukan pengukuran luas penampang nervus koklearis pada MRI koklea dan diameter kanalis auditori interna pada HRCT scan tulang temporal pada masing-masing sampel, kemudian dikorelasikan terhadap luaran auditori pascaimplantasi koklea berdasarkan skor CAP-IIHasil: Median luas penampang nervus koklearis sampel 0,52 mm2 (+/- 0,14), median diameter kanalis auditori interna sampel 2,14 mm (+/- 0,35), dan median usia sampel saat implantasi koklea 4 tahun (1-11). Tidak terdapat korelasi antara luas penampang nervus koklearis terhadap luaran auditori pascaimplantasi koklea (r = 0,29; p = 0,075). Tidak terdapat korelasi antara diameter KAI terhadap luaran auditori pascaimplantasi koklea (r = - 0,02; p = 0,929). Tidak terdapat korelasi antara usia saat implantasi terhadap luaran auditori pascaimplantasi koklea (r = 0,07; p = 0,687).Kesimpulan: Tidak terdapat korelasi antara luas penampang nervus koklearis terhadap luaran auditori pascaimplantasi koklea. Tidak terdapat korelasi antara diameter KAI terhadap luaran auditori pascaimplantasi koklea. Tidak terdapat korelasi antara usia saat implantasi terhadap luaran auditori pascaimplantasi koklea. Diperlukan penelitian lanjutan secara prospektif untuk menentukan parameter kandidat implantasi serta prediktor luaran auditori pascaimplantasi koklea.

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Background: Hearing loss is a common complaint that is often referred to an Ear Nose Throat (ENT) specialist, with the most cases occurring in the West Pacific and Southeast Asia regions. Hearing loss can interfere with a child's speech and language skills, resulting in difficulties in socialization and poor academic performance. Cochlear implantation is an effective rehabilitation method for sensorineural hearing loss patients. There is evidence of variation in the range of receptive communication after cochlear implantation. The correlation between cochlear nerve cross-sectional area (CSA), internal auditory canal diameter and age at implantation with postcochlear implantation auditory outcome is expected to be a candidate parameter for implantation as well as a predictor of postcochlear implantation auditory outcome.

Methods: Correlation study with cross-sectional design. There were 40 samples that had undergone cochlear implantation. The cross-sectional area of ​​the cochlear nerve was measured on cochlear MRI and the diameter of the internal auditory canal on the HRCT scan of the temporal bone in each sample, then correlated with the postcochlear implantation auditory outcome based on the CAP-II score.

Results: The median CSA of ​​the cochlear nerve sample was 0,52 mm2 (+/- 0,14), the median diameter of the internal auditory canal sample was 2,14 mm (+/- 0,35), and the median age of the sample at cochlear implantation was 4 years (1- 11). There was no correlation between the cross-sectional area of​​the cochlear nerve and the auditory output after cochlear implantation (r = 0,29; p = 0,075). There was no correlation between KAI diameter and postcochlear implantation auditory output (r = -0,02; p = 0,929). There was no correlation between age at implantation and postcochlear implantation auditory outcomes (r = 0,07; p = 0,687).

Conclusion: There is no correlation between the cross-sectional area of ​​the cochlear nerve and the auditory output after cochlear implantation. There is no correlation between KAI diameter and postcochlear implantation auditory output. There is no correlation between age at implantation and postcochlear implantation auditory outcomes. Further research is needed prospectively to determine the parameters of implantation candidates and predictors of postcochlear implantation auditory outcome."

"Karsinoma hepatoselular memiliki prognosis yang buruk akibat keterbatasan terapi seperti terlambat diagnosis, kurangnya biomarker spesifik, dan ketidakpekaan terhadap agen tumor ini. Imunoterapi berbasis sel NK autologus dengan stimulasi eksosom menjadi modalitas pengembangan imunoterapi berbasis sel NK untuk pasien karsinoma hepatoseluler. Sel NK pasien karsinoma hepatoseluler diisolasi dari darah vena perifer dan eksosom diisolasi dari serum darah donor sehat. Karakterisasi eksosom dengan particle size analyzer dan flow cytometry. Stimulasi eksosom ke sel NK selama 24 jam kemudian evaluasi ekspresi reseptor NKp44, NKp46, NKp30, NKG2D, KIR2D, dan NKG2A serta ekspresi perforin dan granzyme B. Visualisasi interaksi sel NK dengan fraksi sel mononuklear lainnya (CD4, CD8, CD11c, dan CD19) dengan imunofluorens. Ukuran partikel < 100 nm, muatan listrik negatif dan CD63+CD81+ (positif ganda) hasil isolasi eksosom. Terjadi peningkatan ekspresi reseptor NKp44, NKp46, NKp30, NKG2D, penurunan ekspresi NKG2A, serta peningkatan ekspresi perforin dan granzyme B pada sel NK terinduksi eksosom. Tidak ada interaksi sel berupa sinapsis imun antara sel NK terstimulasi eksosom dengan fraksi sel mononuklear lain pasien karsinoma hepatoseluler. Stimulasi eksosom ke sel NK pasien karsinoma hepatoseluler memulihkan kemampuan sitotoksik sel NK.

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Hepatocellular carcinoma has a poor prognosis due to limitations of therapy such as late diagnosis, lack of specific biomarkers, and insensitivity to this tumor agent. Autologous NK cell-based immunotherapy with exosome stimulation is a modality for developing NK cell-based immunotherapy for hepatocellular carcinoma patients. NK cells from hepatocellular carcinoma patients were isolated from peripheral venous blood, and exosomes were isolated from the blood serum of healthy donors. Exosome characterization with a particle size analyzer and flow cytometry. Stimulation of exosomes on NK cells for 24 hours, then evaluation of expression of NKp44, NKp46, NKp30, NKG2D, KIR2D, and NKG2A receptors, as well as perforin and granzyme B expression. Visualization of interactions of NK cells with other mononuclear cell fractions (CD4, CD8, CD11c, and CD19) by immunofluorescence. Particle size < 100 nm, negative electric charge, and CD63+CD81+ (double positive) exosome isolated results. There was increased expression of receptors NKp44, NKp46, NKp30, NKG2D, decreased expression of NKG2A, and increased expression of perforin and granzyme B in exosome-induced NK cells. There was no cell interaction in the form of immune synapses between exosome-stimulated NK cells and other mononuclear cell fractions in hepatocellular carcinoma patients. Stimulation of exosomes into NK cells of hepatocellular carcinoma patients restores the cytotoxic ability of NK cells."

"Terapi Murottal Al Fatihah dan Azan merupakan terapi dengan memperdengarkan Surah Al Fatihah dan Azan sebagai stimulus auditory sensory pada pasien cedera kepala Penelitian ini, bertujuan agar diketahuinya pengaruh stimulasi terapi murottal al fatihah dan azan terhadap pemulihan fungsi kognitif dan perilaku. Menggunakan desain quasi eksperimen pre post test design with control group. sampel sebanyak 24 orang. Kelompok kontrol hanya mendapatkan pengobatan sesuai diprogramkan sedangkan kelompok intervensi selain mendapatkan pengobatan juga diberi stimulasi terapi murottal al-fatihah dan azan 5 kali sehari selama 7 hari. Penilaian pemulihan fungsi kognitif dan perilaku n pada hari ke-3 dan ke-7 dengan menggunakan skala Ranchos Los Amigos Level Cognitive Functioning Scale. Terdapat pengaruh yang signifikan pemulihan fungsi kognitif dan perilaku diantara kelompok intervensi dan control (p value = 0,046). Terapi Murottal Al fatihah dan Azan meningkatkan proses pemulihan fungsi kognitif dan perilaku, sehingga terapi ini disarankan diberikan pada pasien cedera kepala yang mengalami penurunan kesadaran.

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Murottal Al-Fatihah and Azan therapy is an intervention using surah Al-Fatihah and Azan as auditory sensory stimulus in patients with head injury. The research was aimed to know the effect of auditory sensory stimulation on cognitive function and behavior recovery effect. This study was quantitative research using a quasi-experimental with pre-posttest design with control group. This study used 24 respondents. The control group only received treatment according to the usual programme while the intervention group received treatment and also stimulated by murottal al-Fatihah and azan 5 times a day for 7 days. Recovery rate of cognitive function and behavior were evaluated in the first, 3 days and followed at 7 days use Ranchos Los Amigos Levels of Cognitive Functioning Scale. There was a significant effect of cognitive function and behavior recovery between the intervention and control groups (p value = 0.046). Murottal Al Fatihah and Azan therapy improve recovery process of cognitive function and behavior, therefore this therapy can be use for head injury patients with loss of consciousness."

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Abstrak

Bayi berat lahir rendah yang dirawat terpapar dengan berbagai kondisi yang menimbulkan ketidaknyamanan, sehingga dapat memicu respon stres dan gangguan pertumbuhan. Penelitian ini bertujuan untuk mengetahui pengaruh stimulus auditori murottal Qur’an terhadap kenyamanan dan berat badan pada BBLR. Desain penelitian menggunakan pendekatan uji klinis dengan randomisasi yaitu single blind randomized controlled trial secara paralel pada kelompok intervensi dan kontrol dengan melibatkan 52 responden BBLR sesuai kriteria inklusi (masing-masing kelompk 26 responden). Intervensi murottal Qur’an diberikan melalui speaker selama 20 menit/3 jam dengan frekuensi 4 kali setiap hari. Intervensi dilakukan selama 3 hari. Hasil penelitian menunjukkan ada perbedaan bermakna kenyamanan BBLR setelah intervensi murottal Qur’an hari pertama, hari kedua, dan hari ketiga antara kelompok intervensi dan kelompok kontrol (p=0,014; <0,001; <0,001) dan tidak ada perbedaan bermakna berat badan setelah intervensi murottal Qur’an hari pertama, hari kedua, dan hari ketiga antara kelompok intervensi dan kelompok kontrol (p=0,481; 0,481; 0,464). Stimulus auditori murottal Qur’an dapat membantu meningkatkan kenyamanan pada BBLR yang menjalani perawatan di rumah sakit sehingga dapat digunakan sebagai terapi suportif untuk meningkatkan  asuhan perawatan perkembangan pada BBLR dan prematur.

Kata kunci: Murottal Qur’an, Kenyamanan, Berat Badan, Bayi Berat Lahir Rendah    

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Abstract

Low birth weight infants who hospitalized with various conditions which provoke discomfort. This discomfort could trigger stress and growth faltering. This study aimed to determine the influence of holy Qur’an recitation as auditory stimulus toward comfort and weight in low birth weight infants. This study design used clinical test approach with single blind randomized controlled trial in parallel among intervention and control groups with 52 low birth weight infants. The infants were randomly divided in two groups (n=26). Holy Qur’an recitation had given through speaker for 20 minutes/ 3 hours, 4 times a day. Intervention had given for 3 days. Result of this study showed there is significant difference in comfort of low birth weight infant after got holy Qur’an recitation in first, second, third days among intervention and control groups (p=0.014; <0.001; <0.001) and there is no significant difference in weight gain in first, second, and third days among intervention and control groups (p=0.481; 0.481; 0.464). Holy Qur’an recitation can help improve comfort level in low birth weight infants who hospitalized. Holy Qur’an recitation can used as a supportive therapy for increasing nursing care in development among low birth weight infants and premature infants.

Key Words: Holy Qur’an recitation, Comfort, Weight gain, Low birth weight infants

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"Latar belakang: Keterlambatan perkembangan adalah morbiditas jangka panjang akibat prematur dan perdarahan intraventrikel (PIV). Uji Capute scales merupakan alat perkembangan yang praktis dan dapat menegakkan keterlambatan perkembangan. Tujuan: mengetahui luaran keterlambatan perkembangan dengan uji Capute scales pada anak dengan riwayat prematur dan PIV. Metode: Studi potong lintang dilakukan terhadap 96 anak usia koreksi 6-36 bulan di RSCM. Penelitian ini mencari prevalens dan jenis keterlambatan perkembangan dengan uji Capute scales antara kelompok prematur dengan PIV sedang-berat dan kelompok PIV ringan. Analisis dilakukan untuk mengetahui hubungan antara derajat PIV, usia gestasi, berat lahir, apneu of prematurity (AOP), ventilator mekanik dini, resusitasi aktif, dan patent ductus arteriosus (PDA) terhadap keterlambatan perkembangan. Hasil: Prevalens keterlambatan perkembangan pada kelompok anak dengan prematur dan PIV adalah 19,8%. Kelompok anak dengan riwayat prematur dan PIV sedang berat memiliki 2,56 kali mengalami keterlambatan perkembangan umum dibandingkan dengan kelompok prematur dan PIV ringan (IK95% 1,176-5,557; nilai p=0,037). Jenis keterlambatan perkembangan kognitif/visual-motor didapatkan peningkatan risiko tertinggi (rasio prevalens 4,73 (IK95%1,92-11,69; nilai p=0,001) dibandingkan keterlambatan perkembangan bahasa. Analisis multivariat menunjukkan apneu of prematurity (AOP) adalah faktor risiko independen yang berhubungan dengan luaran keterlambatan perkembangan pada kelompok prematur dan PIV (OR 4,01 (IK95%1,37-11,75); nilai p=0,011). Kesimpulan: Derajat PIV berperan sebagai salah satu komorbid yang mempengaruhi luaran keterlambatan perkembangan.

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Background: Neurodevelopmental delay is among one of long-term morbidities for children with history of prematurity and intraventricular hemorrhage (IVH). The Capute scales test is a practical developmental tool with diagnostic value for neurodevelopmental delay. Objective: To investigate neurodevelopmental delay outcome using Capute scales test. Methods: It is a cross-sectional study involving 96 children at 6-36 months corrected age with history of prematurity and IVH in RSCM Jakarta. This study measures prevalence and characteristics of neurodevelopmental delay among children with prematurity and IVH mild-severe IVH group compared with mild IVH group. Analysis was done to determine relationship between IVH grades, gestational age, birth weight, apneu of prematurity (AOP), early mechanical ventilator use, active resuscitation history, and patent ductus arteriosus (PDA) and neurodevelopmental delay. Results: Prevalens of neurodevelopmental delay in children with history of prematurity and IVH is 19,8%. Premature children with mild-severe IVH group showed greatest risk in cognitive/visual-motor delay (PR 4,73 (95%CI 1,92-11,69; p=0,001) than language delay. Multivariate analysis showed AOP is the only independent risk factor related to neurodevelopmental delay in children with history of prematurity and IVH (OR 4,01 (95%CI 1,37-11,75); p=0,011). Conclusion: IVH grades contribute as one of comorbidities which influence neurodevelopmental delay."

"ABSTRAKAnak tuli prelingual akan kehilangan fungsi mendengar dan bicara, sehingga akan berpengaruh pada komunikasi, psikologis, dan kualitas hidup. Implan koklea hadir sebagai alat habilitasi terutama pada anak dengan tuli derajat berat dan sangat berat. Tesis ini akan membahas mengenai data karakteristik anak 6 ndash; 12 bulan pasca implantasi koklea, evaluasi perkembangan auditori dan bicara anak serta faktor-faktor yang mempengaruhi hasil keluaran. Penelitian ini bersifat deskriptif potong lintang, menggunakan metode penilaian berupa pengamatan yang bersifat global yaitu Categories Auditory Performance CAP - II dan Speech Intelligibility Rate SIR . Penelitian ini dilakukan pada 36 subjek, median CAP-II pada anak 6 ndash; 12 bulan pasca implantasi koklea ialah 3 skor minimal 2 - maksimal 7 . Penilaian kemampuan bicara dengan menggunakan metode SIR anak pasca 6 -12 bulan implantasi koklea didapatkan median 2 skor minimal 1 dan maksimal 4 . Median waktu saat evaluasi 8,9 bulan dengan pencapaian 33,3 subjek dalam kategori CAP tinggi skor 5 atau lebih , dan 38,89 subjek yang mencapai kategori SIR tinggi skor 3 atau lebih.

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ABSTRACT

Prelingual deaf children caused the child unable to hear and speak, impacting his or her ability to communicate, psychological growth, and overall life quality of the child. Cochlear implant comes as habilitating device mainly for children with severe and profound deafness. This thesis will discuss and explain in children 39 s characteristic data on 6 ndash 12 months after cochlear implantation, evaluating their speech and auditory development and other influencing factors. This research is descriptive cross sectional study and observe child using global method Categories Auditory Performance CAP II and Speech Intelligibility Rate SIR . This research is conducted on 36 subjects, with median CAP II score of 3 minimum 2 maximum 7 at 6 ndash 12 months post cochlear implantation. Speech ability evaluation using SIR method with median score of 2 minimum 1 maximum 4 . Median hearing age for this study sample was 8,9 months. After 6 12 months cochlear implantation, 33.3 children that reach high CAP scores CAP score of 5 or greater , and only 38.9 reaching high SIR scores SIR score of 3 or greater."

"ABSTRAKLatar belakang : Prevalens terjadinya malnutrisi bervariasi pada berbagai siklus kemoterapi LLA. Penelitian di Malaysia mendapatkan anak LLA pasca-kemoterapi fase induksi cenderung mengalami obesitas atau status gizi lebih. Penyebab malnutrisi pada anak LLA dapat dipengaruhi oleh berbagai faktor. Perubahan status gizi selama kemoterapi dapat memengaruhi luaran kemoterapi.Tujuan: mengetahui faktor-faktor yang memengaruhi perbaikan status gizi anak LLA setelah kemoterapi fase konsolidasi, serta pengaruhnya terhadap luaran kemoterapi, sehingga dapat dipakai sebagai masukan untuk upaya mengatasi malnutrisi pada anak LLA.Metode : Penelitian ini dengan uji retrospektif, di Rumah sakit Cipto Mangunkusumo, selama tahun 2016-2018. Total sampling pada pasien leukemia limfoblastik akut yang terdiagnosis, dan menjalani kemoterapi di RSCM hingga fase konsolidasi.Hasil : Seratus empat puluh satu subyek pasien anak LLA diikutsertakan dalam penelitian ini. Terdapat 69,5% subyek mengalami perbaikan status gizi, dan 30,5% mengalami perburukan status gizi, dengan 60% perburukan ke arah overnutrition pasca-kemoterapi fase konsolidasi. Faktor risiko independen terhadap terjadinya perbaikan status gizi pasca-kemoterapi fase konsolidasi ialah tidak timbulnya efek samping kemoterapi (RR 1,36, 95% IK 1,02 - 1,81). Jenis makanan dan cara pemberian makan tidak memengaruhi perubahan status gizi anak LLA pasca-fase konsolidasi. Terdapat hubungan antara perbaikan status gizi anak LLA pasca-fase konsolidasi dengan kejadian remisi (RR 1,24, 95% IK 1,03 - 1,5).Simpulan : Status gizi pasca-kemoterapi fase konsolidasi mengalami perbaikan dibandingkan sebelum kemoterapi, sedangkan yang mengalami perburukan status gizi cenderung mengalami overnutrition. Perbaikan status gizi anak LLA pasca-kemoterapi fase konsolidasi dipengaruhi oleh tidak timbulnya efek samping kemoterapi. Terdapat hubungan antara perbaikan status gizi anak LLA pasca-kemoterapi fase konsolidasi dengan kejadian remisi.

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ABSTRACTBackground: Acute lymphoblastic leukemia (ALL) is the most common malignancy in childhood. The prevalence of malnutrition varies in phase of ALL chemotherapy. Study in Malaysia showed ALL children after induction phase of chemotherapy tended to be obese or overweight. The causes of malnutrition in ALL children can be influenced by various factors. Changes in nutritional status during chemotherapy can affect the outcome of chemotherapy.Aim: To investigate factors that influence nutritional status improvement of ALL children after consolidation phase, as well as the effect on the outcomes of chemotherapy, so it can be used as an input to overcome malnutrition in ALL children.Method: A retrospective design was performed in Cipto Mangunkusumo Hospital from 2016 until 2018. Total sampling in patients with acute lymphoblastic leukemia who was diagnosed and started chemotherapy at Cipto Mangunkusumo Hospital until the consolidation phase.Result: A total of 141 subjects were included in this study. After consolidation phase, 69.5% of subjects experienced nutritional status improvements, and 30.5% worsened, of which 60% become over nutrition post-consolidation phase. Independent risk factor for the improvement of nutritional status after consolidation phase was the absence of chemotherapy side effects (RR 1.36, 95% CI 1.02 - 1.81). There were no association between type of food and route of feeding with nutritional status improvement of ALL children after consolidation phase. There was association between improvement in nutritional status of ALL children after consolidation phase with the incidence of remission (RR 1.24, 95% CI 1.03 - 1.5).Conclusion: Nutritional status at post-consolidation phase has improved compared to pre- chemotherapy, while those who worsening nutritional status tend to overnutrition. The absence of chemotherapy side effects affects nutritional status improvement of ALL children after consolidation phase. There is a relationship between nutritional status improvement of ALL children after consolidation phase with the incidence of remission."

"Latar belakang : Pemakaian obat anti epilepsi jangka panjang dikaitkan dengan kekerapan terjadinya defisiensi vitamin D,Suplementasi vitamin D dapat meningkatkan kadar 25 OH D sehingga menurunkan angka morbiditasnya. Tujuan : Mengetahui profil vitamin D pada anak epilepsi dan mengetahui efektivitas terapi suplementasi vitamin D. Metode : Analisa before and after pada subjek epilepsi politerapi > 1 tahun dan menggunakan>2 obat, evaluasi pre- dan paska suplementasi vitamin D selama 3 bulan. Hasil penelitian : Dari 51 subjek yang diteliti ditemukan 25 49 subjek sufisien, 19 37,3 pasien insufisien, dan 7 13,7 subjek defisien. Faktor risiko yang memiliki kemaknaan statistik adalah usua pubertas dan prapubertas p=0,004 , busana tertutup p=0,002 ,jenis epilepsi fokal p=0,032 dan frekuensi kejang p=0,047 . Evaluasi pemberian suplementasi vitamin D selama 3 bulan memberikan peningkatan kadar 25 OH D yang bermakna secara statistic p=0,001. Kesimpulan : Diperlukan pemantauan periodic kadar vitamin D pada anak epilepsi dan peranan terapi suplementasi dalam menurunkan angka morbiditasnya.

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Background : in epileptic children, a number of medications are used. Antiepileptic drugs are known to exert deleterious effect on vitamin D metabolism. Reports of vitamin D deficiency associated with anticonvulsant drugs in pediatric patients are conflicting.

Objective : To determine vitamin D status and risk factors in epileptic children and evaluate the effect of vitamin D supplementation.

Methods : A prospective pre and post intervention study was done in 51 epileptic children aged 5 18 years on polytherapy for at least one year in Ciptomangunkusumo Hospital and Bekasi Hospital, over a vitamin D supplementation period of 3 months from January 2017 to May 2017.

Results : Of the 51 patients studied, 25( 49,0%) subjects had sufficient vitamin D levels (>20 ng/mL), 19 ( 37,3%) subjects had insufficient vitamin D levels (12-20 ng/mL), and 7 (13,7 %) subjects had vitamin D deficiency( <12 ng/mL). It was seen that the risk of vitamin D deficiency increased, in the dress used ( full-covered dress) (p=0,002) , pre-pubertal and pubertal age ( p=0,004), focal epilepsy (p=0,032) and in seizure frequency (p=0,047), which was statistically significant. The role of vitamin D supplementation showed beneficial effect in increasing vitamin D level, which was statistically significant( p=0,001).

Conclusion : vitamin D supplementation in epileptic children effectively increases serum 25(OH)D."