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"Diare merupakan masalah global karena menyebabkan tingginya angka kesakitan dan kematian pada bayi dan anak. Diare yang belangsung 7 - 13 hari disebut diare melanjut, dan akan meningkatkan risiko terjadinya diare persisten 6 kali lebih tinggi.Penelitian ini bertujuan untuk mengkaji faktor-faktor risiko terjadinya diare melanjut pada anak < 2 tahun, membuat dan menerapkan sistem skor untuk memprediksi kejadian diare melanjut, dan mengetahui apakah faktor etiologi diare persisten telah ditemukan pada diare melanjut.Suatu penelitian operasional dengan rancangan nested case control, pada anak < 2 tahun dengan diare akut yang dirawat di ruang rawat inap RSUP Fatmawati. Subjek direkrut dengan metode consecutive sampling pada September 2015 - Maret 2016. Subjek dieksklusi bila mendapat pengobatan imunosupresi, menderita HIV, penyakit metabolik, penyakit keganasan, mengalami disentri, mengalami diare saat dirawat di rumah sakit, ada penyakit penyerta, dan subjek pasca mengalami operasi pada organ saluran cerna. Evaluasi luaran penelitian dilakukan sejak subjek masuk perawatan di rumah sakit sampai subjek pulang rawat.Sebanyak 62 subjek untuk tiap kelompok kasus dan kontrol mengikuti penelitian. Seluruh faktor risiko dianalisis secara bivariat dan multivariat regresi logistik. Faktor risiko terjadinya diare melanjut yang didapatkan adalah riwayat penggunaan antibiotik, defisiensi seng, leukosit tinja, peningkatan kadar AAT tinja dan malnutrisi. Model skor prediksi diare melanjut terdiri dari 2 model. Model 2 lebih dapat diterapkan di fasilitas kesehatan primer. Sensitivitas, spesifisitas, nilai duga positif, nilai duga negatif, rasio kemungkinan positif, dan rasio kemungkinan negatif dari validasi skoring model 2 berturut-turut adalah 73, 95, 94, 76, 14,6, dan 0,28. Area di bawah kurva ROC pada validasi 0,898. Faktor etiologi diare persisten telah ditemukan pada diare melanjut intoleransi laktosa, malabsorpsi lemak, dan infeksi Clostridium difficile .Sebagai simpulan, faktor risiko terjadinya diare melanjut pada anak < 2 tahun dengan diare akut yang berperan paling bermakna adalah riwayat penggunaan antibiotik, defisiensi seng, leukosit tinja, peningkatan kadar AAT tinja dan malnutrisi. Selain itu, faktor etiologi diare persisten telah ditemukan pada diare melanjut, dan model skor yang dibuat dapat dipertimbangkan digunakan dalam praktek klinik sehari-hari.

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Diarrhea has been a global problem since it has high morbidity and mortality rate in infants and children. Diarrhea lasting for 7 ndash 13 days is called prolonged diarrhea, and the risk of progressing into persistent diarrhea will be 6 times higher. The aim of this study was to assess the risk factors for prolonged diarrhea in children below 2 years old, to establish and apply a scoring system to predict the occurence of prolonged diarrhea, and to determine whether the etiologic factor of persistent diarrhea have already been found in prolonged diarrhea. An operational study with a nested case control design, in children 2 years old with acute diarrhea hospitalized in the inpatient wards of Fatmawati Hospital. Subjects were recruited using the consecutive sampling method from September 2015 to March 2016. Subjects were excluded when they were receiving immunosupressive treatment, suffering from HIV, metabolic disease, malignancy, dysentery, just had diarrhea during hospitalization, comorbidities, and had underwent digestive surgery. Evaluation of the research outcome was started when the subject admitted to the hospital until the subject being discharged. The number of subjects included was 62 for each case and control group. All risk factors were analyzed using bivariate and multivariate logistic regression. We found that the risk factors for the occurrence of prolonged diarrhea are history of antibiotic use, zinc deficiency, fecal leukocytes, elevated level of stool AAT, and malnutrition. The prolonged diarrhea prediction score model had 2 models. Model 2 is more applicable in primary health care. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of scoring model 2 validation were 73, 95, 94, 76, 14.6, and 0.28 respectively. The area under the ROC curve for validation is 0.898. The etiologic factor of persistent diarrhea have already been found in prolonged diarrhea lactose intolerance, fat malabsorption, Clostridium difficile infection. In conclusion, the most significant risk factors for prolonged diarrhea in children below 2 years old are the history of antibiotic use, zinc deficiency, fecal leukocytes, elevated levels of stool AAT, and malnutrition. In addition, etiologic factors of persistent diarrhea have already been found in prolonged diarrhea and scoring model can be considered be used in daily clinical practice. "

"Kejadian kolangitis pasca prosedur Kasai (PK) terbukti berhubungan dengan prognosis buruk, dan dilakukannya transplantasi hati dini pada Atresia Bilier (AB). Untuk menyelidiki faktor risiko yang memengaruhi kejadian kolangitis, telah dilakukan penelitian retrospektif pasien AB pasca PK. Suatu penelitian kohort retrospektif, pada anak AB pasca PK yang menjalani perawatan di RSCM. Subjek direkrut dengan metode consecutive sampling pada semua anak usia 0– 18 tahun dengan AB pasca PK sejak Januari 2020 hingga Desember 2023. Beberapa faktor risiko preoperatif pada anak AB yang menjalani PK di antaranya usia saat PK ≥60 hari, infeksi Cytomegalovirus (CMV); kadar gamma-glutamyl transpeptidase (GGT), kadar bilirubin direk, dan kadar alanine aminotransferase (ALT); serta derajat berat fibrosis hati, dan malnutrisi sebelum PK. Faktor-faktor tersebut dikumpulkan dan dianalisis untuk menentukan faktor risiko yang memengaruhi terjadinya kolangitis. Rekam medis yang lengkap dari 82 pasien dievaluasi secara retrospektif. Subjek penelitian sebagian besar perempuan, usia saat menjalani PK berkisar 76 – 90 hari, gizi kurang, dan derajat fibrosis hati F4. Prevalensi kolangitis yang ditemukan 69.5%. Faktor risiko preoperatif kadar ALT dan GGT yang lebih buruk, serta malnutrisi tidak terbukti memengaruhi terjadinya kolangitis pasca PK pada analisis multivariat regresi logistik. Faktor risiko preoperatif kadar ALT dan GGT yang lebih buruk, serta malnutrisi pada anak AB pasca PK tidak terbukti memengaruhi terjadinya kolangitis. Namun kondisi malnutrisi pada pasien sebelum PK cenderung menjadi faktor yang berhubungan dengan kejadian kolangitis pasca PK.

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The occurrence of cholangitis after the Kasai procedure (KP) is linked with a poor prognosis and early liver transplantation in Biliary Atresia (BA). To investigate the risk factors influencing the occurrence of cholangitis, we conducted a retrospective study on BA patients after KP. A retrospective cohort study was conducted on post-KP BA children undergoing treatment at RSCM. Subjects were selected using a consecutive sampling method among all children aged 0–18 years with post-KP BA from January 2020 to December 2023. Several preoperative risk factors in AB children undergoing KP, including age at KP≥60 days, Cytomegalovirus (CMV) infection, gamma-glutamyl transpeptidase (GGT), direct bilirubin, and alanine aminotransferase (ALT), as well as the severity of liver fibrosis and malnutrition before KP, were collected and analyzed to determine the risk factors influencing the occurrence of cholangitis. The complete medical records of 82 patients were evaluated retrospectively. The majority of the research subjects were female. The age at which the KP was carried out ranged from 76 – 90 days, and there were indications of poor nutrition and liver fibrosis at level F4. The prevalence of cholangitis was found to be 69.5%. Preoperative risk factors for worse ALT and GGT levels, as well as malnutrition, were not shown to influence the occurrence of cholangitis after KP in multivariate logistic regression analysis. Although preoperative risk factors for worse ALT and GGT levels, as well as malnutrition in BA children after KP, were not proven to influence the occurrence of cholangitis, malnutrition in patients before KP seems to be associated with the incidence of cholangitis after KP."