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Abstrak :
Latar Belakang Prevalensi asma meningkat dalam 30 tahun terakhir dan bervariasi di berbagai negara, komunitas, etnis yang berbeda. Penelitian di Indonesia melaporkan prevalensi asma pada anak dan orang dewasa 6-7 %. identifikasi faktor-faktor risiko seperti faktor keturunan, atopi, urutan kelahiran dalam keluarga, rokok, hewan piaraan, gizi, pola makanan, obesitas dengan kejadian asma perlu untuk menjelaskan variasi tersebut. Sampai saat ini studi prevalensi asma dan identifikasi faktor risiko di daerah pantai dengan jumlah sampel yang besar belum pernah dilakukan di Indonesia. Tujuan Mencari faktor-faktor risiko asma pada anak sekolah usia 13 hingga 18 tahun di Kepulauan Seribu. Metodologi Uji potong lintang dilanjutkan dengan disain kasus kontrol bersarang. Pada responden dibagikan kuesioner yang dikelompokkan berdasar diagnosis asma, pernah asma dan bukan asma. Untuk kelompok asma dalam 12 bulan terakhir, pernah asma dan tidak asma (keiompok kontrol) dipilih secara acak untuk dilakukan uji tusuk kulitlskin prick test. Hasil Telah dilakukan di 15 sekolah (SD, SLTP, SLTA) yang tersebar di Kepulauan Seribu sebanyak 1505 responden terdiri atas 713 laki-laki dan 792 perempuan. Distribusi responden menurut jenis kelamin pada kasus asma dan kontrol tidak terdapat hubungan yang bermakna (IK 95%; 0,54-1,47, p=0,66). Hubungan orang tua menyandang asma dengan kejadian asma pada responden menunjukkan hubungan bermakna. Pada ayah (IK 95%; 6,09-59,9, p=0,001). Pada ibu (IK 95%; 1,23-7,95, p=4,001), Berdasarkan hasil uji tusuk kulit pada kelompok mengi dan kontrol menunjukkan hubungan yang bermakna (D. Pteronyssinus) dengan kejadian asma (p 0,0001). Sedangkan faktor risiko asma lainnya (urutan kelahiran dalam keluarga, rokok, hewan piaraan, dan obesitas) tidak menunjukkan hubungan bermakna dengan kejadian asma. Simpulan PrevaIensi gejala asma pads anak usia 13 hingga 18 tahun di Kepulauan Seribu berdasarkan riwayat mengi = 11,8%, mengi 12 bulan terakhir = 5,4 %. Didapat hubungan bermakna pada orang tua menyandang asma terhadap kejadian asma pada anak. Hasil uji tusuk kulit (D. pteronyssinus) menunjukkan hubungan bermakna dengan kejadian asma.

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Background The prevalence of asthma has been increasing in the last 30 years and varied among different countries, communities and ethnic groups. Study in Indonesia had reported that the prevalence of asthma in children and adults was 6-7%. Identification of risk factors, atopy, smoking, pet, nutrition, dietary pattern, obesity and incidence of asthma are necessary to explain the variation. Up to now, study on the prevalence of asthma and risk factors identification with big sample size in maritime region has never been conducted in Indonesia. Objectives The aim of the study is to determine risk factors of asthma in school children aged 13-18 years old in Kepulauan Seribu. Methods A cross sectional study continued by nested case control was conducted in Kepulauan Seribu in June 2005. All respondents have to fill out questionnaire forms and were grouped based on diagnosis of asthma, history of asthma and no asthma. For the asthma group in last 12 months, history of asthma and no asthma (control group) were selected randomly for skin prick test. Results Data was obtained from 1505 subjects in 15 schools (elementary school, junior high school, senior high school) consisted of 713 boys and 792 girls. The prevalence of asthma in adolescents aged 13 - 18 years old in Kepulauan Seribu based on symptom of wheezing (11.8%), wheezing in the last 12 months (5.4%). Distribution of respondents based on gender found no significant relation between asthma and control group (CI 95%; 0.54-1.47, p=4.66). Subjects with asthma associated significantly with their parents who also had asthma (fathers CI 95%; 6.09-59.9, p=0.04I and mothers CI 95%; 1.23-7.95, p=0.001). Based on skin prick test, we found there was significant relation between alergen (D. Pteronyssinus) with incidence of asthma (p=4.0001), while other risk factors (family size, smoking, obesity, pet) had not showed significant relation with asthma. Conclusions The prevalence of asthma in adolescent aged 13-18 years old in Kepulauan Seribu based on history of wheezing was 11.8%, while symptom of wheezing in 12 month was 5.4%. Subjects with asthma associated significantly with their parents who also had asthma. Skin prick test (D. pteronyssinus) had significant relation with incidence of asthma.

Abstrak :
Latar Belakang: Cutaneous Adverse Drug Reaction (CADR) dapat memengaruhi tatalaksana infeksi TB. Hal ini berdampak pada bukan hanya morbiditas dan mortalitas tapi juga resistensi kuman. Untuk itu, proporsi CADR dan faktor-faktor yang berhubungan pada penggunaan Obat Anti Tuberkulosis (OAT) perlu ditentukan demi tatalaksana pasien yang komprehensif. Tujuan: Mengetahui gambaran kejadian CADR terkait pemberian OAT dalam bentuk proporsi, analisis peran faktor pejamu yang berkaitan dengan kejadian tersebut, dan OAT yang paling sering menimbulkan CADR. Metode: Desain penelitian ini adalah kohort retrospektif dengan menggunakan rekam medik pasien Rumah Sakit Cipto Mangunkusumo selama 1 Januari 2014 hingga 30 Juni 2015. Sampel diperoleh dengan metode konsekutif yang diseleksi berdasarkan kriteria penelitian. Data kemudian dianalisis untuk menilai hubungan antara CADR dengan usia, jenis kelamin, status HIV, status gizi, dan riwayatmlkojuujhjh Adverse Drug Reaction (ADR). Hasil: Proporsi CADR pada pemberian OAT mencapai angka 5,5%. Dari kelima variabel independen, variabel usia (RR=6,510; IK95% 2,036-20,819 p=0,008) dan riwayat ADR (RR=5,174; IK95% 1,500-17,838; p=0,009) berpengaruh terhadap kejadian CADR. OAT yang paling sering menyebabkan kejadian CADR adalah rifampisin. Analisis Cochran Mantel-Haenszel menunjukkan bahwa risiko relatif terjadinya CADR untuk faktor usia adalah 7,267 (IK95% 2,093-25,235 p <0,001) dan risiko relatif terjadinya CADR untuk faktor riwayat ADR adalah 5,880 (IK95% 1,552-22,273 p=0,003). Simpulan: Proporsi kejadian CADR setelah pemberian OAT adalah 5,5%. Variabel usia dan riwayat ADR bermakna secara statistik dan klinis terhadap kejadian CADR. Rifampisin adalah OAT tersering yang menimbulkan CADR. ......Background: Cutaneous Adverse Drug Reaction (CADR) affected the therapy of TB, which impacted not only its morbidity and mortality but also its resistance. Therefore, the incidence of CADR and the factors associated during the administration of Anti Tuberculosis Drugs (ATDs) needed to be determined in order to achieve comprehensive treatment. Objective: To know CADR events on ATD administration by finding the incidence, analyzing the host factors associated with those events, and searching the most common ATD that caused CADR. Methods: This study used retrospective cohort by accessing medical record registered in Cipto Mangunkusumo Hospital from January 1st 2014 until June 30th 2015. Samples were collected consecutively, selected by certain criteria. The data were then analyzed to determine the association between CADR and age, sex, HIV infection, nutritional status, and history of Adverse Drug Reaction (ADR). Results: The incidence of CADR after the administration of ATD was 5.5%. Among the five variables, age (RR=6.510; 95%CI 2.036-20.819, p=0.008) and past history of ADR (RR=5.174; 95%CI 1.500-17.838; p=0.009) were statistically and clinically correlated to CADR. The most frequent drug that triggered CADR was rifampicin. Cochran Mantel-Haenszel showed that the relative risk of CADR according to age was 7,267 (IK95% 2,093-25,235 p <0,001), while the relative risk according to the past history of ADR was 5,880 (IK95% 1,552-22,273 p=0,003). Conclusions: The incidence of CADR after ATDs administration was 5.5%. Age and past history of ADR were significantly associated with CADR. The most common ATD causing CADR was rifampicin.

Abstrak :
Tuberculosis is one of 6 fatal infectious diseases in the world, and causes three million deaths annually. Tuberculosis (TB) is a pulmonary and systemic disease caused by My-cobacterium tuberculosis. TB classification consists of pulmonary and extra-pulmonary TB. TB stimulates both the specific and non-specific immune systems. Disseminated tuberculosis is military lung TB with several extra-pulmonary organ manifestations. The main management for multi-organ TB is the administration of anti-tuberculosis drugs. In pleural effusion due to lung TB, corticosteroid may reduce systemic and local reactions to tuberculoprotein, reduce pleural exudate secretion and fibrosis, as well as reduce deformity of the chest wall and scoliosis that can inflict children. We report a case of a 25 year-old woman who came with a chief complaint of progressive breathing difficulty since 2 days prior to admission. Since } year prior to admission, the patient's abdomen became bloated and there was edema in her legs. Her lost her appetite and weight, and suffered from a mild fever. The patient had a cough with thick whitish sputum. The patient had not menstruated for 7 months. She had a history of liver disease. Physical examination results were as follows: the patient was moderately ill, fully conscious, and had malnutrition. She weighed 37 kg and was 149 tall. Her blood pressure was 100/70 mm Hg, her pulse rate 84 times/minute, her body temperature 37" Celsius, and her respiration rate 18 times per minute. Her conjunctiva were pale. Her right supra-clavicular and mandibular lymph nodes had a diameter of 2 cm, were resilient, mobile, not tender, and had smooth surfaces. Her lung sounds demonstrated weakened vesicular sounds in her left lung, with loud rales in both lungs. Her abdomen was enlarged, distended to 92 cm, with venectations. Her liver and spleen could not be assessed. There was undulation and normal bowel sounds. Her extremities were warm and edematous. Her left inguinal lymph node was enlarged to 1 cm, resilient, well-defined, mobile, and not tender. Her left inguinal lymph node was 5 mm in diameter. Her laboratory results were as follows: Hemoglobin level 9.0 g/dl, Hematocryte level 27 vol%, erythrocyte count 3.66 juta/ul, and leukocyte count 14.500/ul. Her chest x-ray demonstrated milliary tuberculosis. Abdominal ultrasound revealed a congestive liver, exudative peritonitis, and a mass in the spleen. Ascites fluid aspiration revealed exudate fluid. Pathological cytology revealed chronic granulomatous inflammation, with the possibility ofTB, and no signs of malignant cells. Ascites fluid microbiological culture turned out negative. During the first echocardiography, no pericardia! effusion was found, and the ejection fraction was 61%. During the second echocardiography, there was thickening of the walls, and pericardial effusion. Catheterization was attempted, but failed due to cyanosis. Electrocardiography demonstrated low voltage at nodes 1, II, aVR, aVL, aVF. The patient was consulted to the retina subdivision, and no tubercle was found. Problem: disseminated TB with pericarditis, ascites due to exudative peritonitis, anemia, malnutrition, and secondary amenorrhea. The patient's condition improved under treatment ofRHZE 300/300/1000/750mg, 3x1 tablet ofB complex vitamins, 3x10 mg ofprednison, 1x100 mg ofaldactone, and 1x1 tablet of provera. Her difficulty breathing alleviated, her waist diameter was reduced to 76 cm.

Abstrak :
A reduction in lung capacity to oxygenize blood as well as in cardiovascular capacity to distribute blood may cause hypoxemia, which could then lead to tissue hypoxia and cellular death. The aim of oxygen treatment is to supply the minimum oxygen concentration needed to achieve adequate tissue oxygenation. There are various methods that can be used to supply oxygen, and the amount of oxygen requirement could also be calculated. Treatment methods are classified into STOT and LTOT. The benefit of oxygen treatment is increased survival, influence on the blood vessels, improved exercise capacity, and positive influence on the respiratory and neuropsychological systems. As with the case with pharmacological treatment, oxygen should be administered at certain doses to achieve greatest efficacy with the least toxicity.

Abstrak :
Chronic hepatitis B is still a major health problem in Indonesia. Unfortunately, to date, treatment of chronic HBV (Hepatitis B virus) infection had not shown satisfactory result. Monotherapy with alpha interferon or lamivudine have been widely used as treatment of chronic HBV. However, treatment response to Alpha interferon in Asian people was not satisfactory (15% - 20%), while monotherapy with lamivudine was not sufficient to eradicate HBV in chronically infected patients and commonly induce drug resistance. The occurrence of chronic hepatitis B resistant to lamivudine had encouraged development of newer agents such as adefovir, entecavir, emtricitabine and nucleoside analog. New therapeutic strategy using combination therapy should be considered if there is no sufficient response to monotherapy

Abstrak :
Pericardial effusion is the presence of fluid in the pericardial cavity due to secretion from the visceral pericardium. II may be caused by virus, bacteria, fungi, tuberculosis, post-inflammation conditions, auto-reactive processes, neoplasm, renal failure, aortal dissection, and hyperthyroidism. Clinical symptoms may take the form of difficulty breathing, orthopnea, chest pain, dysphagia, hiccups, dysphonia, nausea, and bloated abdomen. Physical examination may portray paradoxal pulse, tachyp-nea, tachycardia, hypotension, and peripheral edema. Radiological findings include enlarged heart, and a heart configuration resembling a water jug. Electrogradiography may demonstrate low voltage, and flat T. We report a case of a 25 year-old male who was admitted with a complaint of difficulty breathing since four days prior to hospitalization. The difficulty breathing was felt since eight months prior to admission. He had undergone aspiration of fluid from the heart, and received anti-tuberculous treatment. There was cough, while sputum, and night sweats. The patient also suffered from malignancy, and was scheduled for chemotherapy