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"Latar belakang : Penalaran klinik merupakan salah satu kemampuan yang harus dimiliki oleh seorang dokter. FK UMSU telah menerapkan metode problem based learning agar kemampuan berpikir kritis dan keterampilan penyelesaian masalah mahasiswa terbentuk. Sayangnya mahasiswa masih sering kesulitan untuk mengaplikasikan ilmunya saat berhadapan dengan pasien di pendidikan klinik. Penelitian ini bertujuan untuk memberikan masukan terhadap rancangan pengajaran penalaran klinik melalui uji coba metode pengajaran penalaran klinik dengan menggunakan pasien simulasi pada pendidikan kedokteran tahap preklinik. Metode : Desain penelitian adalah eksperimental, dilakukan pada mahasiswa angkatan 2012 FK UMSU dengan jumlah sampel sebanyak 36 orang. Sampel dibagi menjadi dua kelompok melalui randomisasi sistematik. Kelompok intervensi diberi simulasi pengajaran penalaran klinik, sedangkan kelompok kontrol belajar mandiri. Kedua kelompok diberikan pretes dan postes dalam bentuk script concordance test. Persepsi kelompok intervensi terhadap pengajaran dinilai melalui focus group discussion (FGD). Perbedaan rerata pretes dan postes dianalisis secara kuantitatif dengan uji t, sedangkan data FGD dianalisis secara tematik. Hasil : Hasil uji t tidak berpasangan data prestes dan postes menunjukkan bahwa kemampuan penalaran klinik kelompok intervensi tidak lebih baik atau sama dengan kelompok kontrol (perbandingan data pretes yaitu t=0,921; df=34; α=0,363, sedangkan perbandingan data postes yaitu t =-0,249; df=32; α= 0,805). Selain itu, hasil uji t berpasangan menunjukkan bahwa tidak didapatkan perbedaan rerata pretes dan postes antara kelompok intervensi dan kontrol (rerata pretes dan postes kelompok intervensi adalah t=-0,113; df =17; α=0,911, sedangan kelompok kontrol adalah t= -1,231; df= 17; α=0,235). Secara keseluruhan, melalui intervensi dalam penelitian ini tidak ada perbedaan bermakna peningkatan kemampuan penalaran klinik kelompok intervensi setelah diberikan pengajaran penalaran klinik dengan simulasi dibandingkan dengan kelompok kontrol. Hasil analisis FGD menunjukkan bahwa mahasiswa belum memahami konsep penalaran klinik dengan baik. Namun, mahasiswa berpendapat metode pengajaran ini bermanfaat untuk mengajarkan keterampilan penalaran klinik. Adapun hambatan atau kesulitan yang dihadapi saat aplikasi pengajaran adalah kurangnya pengetahuan mahasiswa dan peran pasien simulasi dan fasilitator yang belum maksimal. Secara keseluruhan, mahasiswa menyambut baik metode pengajaran penalaran klinik dengan menggunakan pasien simulasi. Kesimpulan : Mahasiswa yang mendapatkan pengajaran penalaran klinik dengan menggunakan pasien simulasi tidak lebih baik kemampuan penalaran kliniknya dibandingkan dengan mahasiswa yang belajar mandiri. Hal ini dapat terjadi karena keterbatasan penelitian dalam proses simulasi pengajaran. Metode pengajaran penalaran klinik dengan pasien simulasi dapat dilakukan di FK UMSU dengan memperbaiki segala aspek terkait proses pembelajaran di pendidikan tahap preklinik.

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Background: Clinical reasoning is one of the skills that must be achieved by a medical doctor. Faculty of Medicine (FM) UMSU has implemented problem based learning method to develop critical thinking and problem solving skills. Unfortunately, the students still often feel difficult to apply their knowledge when dealing with patients in clinical training. This study aims to provide feedback to the current design of clinical reasoning teaching by testing a method using simulated patients in preclinical phase.

Method: An experimental study was performed among year 2012 students of FM UMSU with the total sample of 36 students. They were divided into two groups through systematic random sampling. The intervention group was given a clinical reasoning teaching method using a simulated patient, while the control group conducted self directed learning. Both groups were given pretest and postest with script concordance test format. The perception toward the teaching method of the intervention group was collected through focus group discussion (FGD). The mean difference between pretest and posttest data was analyzed using the T test, while FGD data was analyzed based on themes emerged strongly and consistently.

Result: The clinical reasoning skills of intervention group was not better or equal to the control group (the comparative of pretest data is t=0,921; df=34; α=0,363, while postest data is t =-0,249; df=32; α= 0,805). There was no difference in the mean of pretest and posttest between intervention and control groups (mean difference between pretest and posttest data of intervention group is t=-0,113; df =17; α=0,911, while control group is t= -1,231; df= 17; α=0,235). Overall, there was no significant difference in increased clinical reasoning skills of intervention group after being given a clinical reasoning teaching using simulated patient compared to the control group. The FGD data showed that students did not understand the clinical reasoning concept well. However, students thought this teaching method was useful for teaching clinical reasoning skills. The barriers encountered during implementation was the lack of knowledge of students and that the role of patients simulated and facilitators are not yet adequate. Overall, students had good perceptions on the clinical reasoning teaching method using simulated patient.

Conclusion: Clinical reasoning skills of students who experienced the clinical reasoning teaching method by using patient simulation were not better than students who studied independently. This was probably due to limitations in the detailed processes of implemented teaching method. The clinical reasoning teaching method using patient simulation can be potentially conducted at FM UMSU by overcoming limitations related to the learning processes."

"Prevalens gizi lebih dan obesitas pada anak di Indonesia masih cukup tinggi. Konsumsi susu formula, terutama tingginya kandungan tinggi protein, berhubungan dengan kejadian gizi lebih dan obesitas pada anak sehingga kadar protein pada susu formula dianjurkan untuk diturunkan. Belum pernah terdapat penelitian di Indonesia mengenai hubungan konsumsi susu pertumbuhan dengan kejadian gizi lebih dan obesitas pada anak.Tujuan: Mengetahui rerata asupan energi, rasio kalori susu pertumbuhan dibandingkan kalori total per hari, protein susu pertumbuhan, dan rasio kalori protein susu pertumbuhan dibandingkan kalori protein total per hari dan hubungannya dengan kejadian gizi lebih dan obesitas pada anak usia 2-3 tahun. Metode: Studi potong lintang dilakukan untuk mengetahui proporsi gizi lebih dan obesitas, dilanjutkan dengan studi kasus kontrol untuk mengetahui hubungan susu pertumbuhan terhadap kejadian gizi lebih dan obesitas dengan matching usia dan jenis kelamin. Penelitian dilakukan di Posyandu Jakarta Pusat dan Timur bulan September hingga Desember 2018. Kelompok kasus merupakan subyek gizi lebih dan obes, sedangkan kelompok kontrol merupakan subyek gizi baik. Subyek menjalani pengukuran antropometri dan penilaian asupan nutrisi menggunakan food record selama 3 hari. Hasil: Sebanyak 292 subyek dengan kelompok kasus 34 subyek dan kelompok kontrol 68 subyek. Proporsi gizi lebih dan obesitas pada anak usia 2-3 tahun sebesar 12%. Terdapat perbedaan bermakna pada asupan energi susu pertumbuhan [516,1 (0-1546,7) vs 238,5 (0-1090,4) kkal/hari, p<0,001], rasio kalori susu pertumbuhan dengan kalori total per hari [41,1 (0-83,7) vs 20,8 (0-80,7)%, p<0,001], protein [18,9 (0-71,7) vs 8,6 (0-50,7) g/hari, p<0,001], dan rasio kalori protein susu pertumbuhan dengan kalori protein total [46,9 (0-89,5) vs 19 (0-72,3)%, p<0,001] antara kelompok kasus dan kelompok kontrol. Kesimpulan: Konsumsi susu pertumbuhan yang berlebih berhubungan dengan kejadian gizi lebih dan obesitas pada anak usia 2-3 tahun.

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Overweight and obesity prevalence in Indonesia is quite high. Recent studies suggest that consumption of infant formula, particularly high protein content, was related to overweight and obesity in children. Therefore, protein content in infant formula was recommended to be lowered. Currently, there is no data on the association between growing-up milk consumption and overweight and obesity in children aged 2-3 years in Indonesia.

Objective: To determine the average intake of growing-up milk energy, ratio of growing-up milk calories to the total calories per day, growing-up milk protein, and ratio of growing-up milk protein calories to the total protein calories per day and their relationship with overweight and obesity children aged 2-3 years.

Methods: Cross-sectional study was conducted to determine the proportion of overweight and obesity, followed by case-control study to determine the relationship between growing-up milk consumption with overweight and obesity. Overweight and obese subjects were considered as the case group, while normal weight subjects were categorized as control group. Study was conducted in Jakarta since September to December 2018. Three days-food record analysis were performed.

Results: A total of 292 subjects with 34 cases and 68 controls. The proportion of overweight and obesity in children aged 2-3 years was 12%. There were significant differences between case and control group in terms of growing-up milk energy intake [516.1 (0 to 1546.7) vs. 238.5 (0 to 1090.4) kcal/day, p<0.001], ratio of growing-up milk calories to total calories per day [41.1 (0 to 83.7) vs 20.8 (0 to 80.7)%, p<0.001], growing-up milk protein [18.9 (0 to 71.7) vs 8.6 (0 to 50.7) g/day, p<0.001], and ratio of growing-up milk protein calories to total protein calories [46.9 (0 to 89.5) vs. 19 (0 to 72.3)%, p<0.001].

Conclusion: Excessive consumption of growing-up milk had significant relationship with overweight and obesity in children aged 2-3 years. "

"Latar belakang: Thalassemia merupakan kelainan hemoglobinopati yang cukup banyak di Indonesia. Terapi utama thalassemia mayor adalah transfusi seumur hidup. Transfusi berulang memiliki efek samping. Salah satunya adalah terbentuknya aloantibodi sel darah merah. Prevalens dan faktor-faktor yang memengaruhi aloantibodi pada pasien thalassemia masih belum ada di Indonesia. Uji Coombs sebagai standar diagnosis merupakan pemeriksaan yang mahal dan hanya tersedia di pusat tertentu. Metode lain yang lebih mudah diperlukan untuk memprediksi terbentuknya aloantibodi tersebut. Tujuan: Untuk mengetahui prevalens aloantibodi sel darah merah di populasi Indonesia dan mendapatkan faktor-faktor yang memengaruhinya. Membuat sistem skoring untuk memprediksikan probabilitas terbentuknya aloantibodi sel darah merah berdasarkan faktor-faktor tersebut. Metode: Analisis terhadap 162 rekam medis subjek yang telah dilakukan uji Coombs di Pusat Thalassemia Jakarta pada tahan 2005-2013. Hasil: Dari 162 subjek didapatkan 31 (19%) subjek memiliki aloantibodi dan 4 (2,4%) subjek menderita AIHA. Jenis aloantibodi terbanyak yang terdeteksi adalah anti-M (29%). Faktor-faktor yang memengaruhi terbentuknya aloantibodi adalah tingginya volume transfusi, jarak antar transfusi, lama transfusi, kadar leukosit dan pajanan PRC biasa. Berdasarkan faktor-faktor risiko tersebut, sistem skoring didisain untuk memprediksi kemungkinan terbentuknya aloantibodi. Kesimpulan: Prevalens aloantibodi pada pasien thalassemia di Indonesia cukup tinggi. Pemberian PRC leukodeplesi pelu direkomendasikan pada pasien dengan transfusi berulang. Prediksi terbentuknya aloantibodi dapat dilakukan melalui sistem skoring terutama di tempat yang tidak tersedia uji Coombs.

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Background: Thalassemia major is a common genetic disease in Indonesia. The principal treatment of thalassemia major is lifelong blood transfusion, which is frequently complicated by alloantibody. Limited data are available on the frequency of RBC alloantibody and factors influencing in major β-thalassemia patients. Coombs test, as a standard tool to diagnose alloantibody, is only available on particular Red Cross Centre. Therefore, it is necessary to find another tool to predict the probability of alloantibody formation.

Aim: To investigate the prevalence of RBC alloantibody among thalassemia major patients in Thalassemia Centre Jakarta. To describe factors influencing RBC alloantibody production and develop scoring system to predict its probability.

Methods: We analyzed the clinical and transfusion records of 162 thalassemia major patients who have been examined for Coombs test. All of the patients were registered in Thalassemia Center, Cipto Mangunkusumo hospital from 2005 until 2013.

Results: Of the 162 subjects, 31 (19%) developed RBC alloantibody and four patients (2,4%) developed autoimmune hemolytic anemia. The most common alloantibody was anti-M (29%).Several factors were found to contribute to high alloantibody rate in this study, including high volume of transfusion, duration of transfusion, white blood count level, transfusion interval, and PRC exposure. From those factors, scoring system has been developed to predict alloantibody formation in thalassemia patients.

Conclusion: We concluded that there is a high rate of RBC alloantibody in major thalassemia patients in our center. We also suggest that leukocyte-poor PRC should be given to all patients with multiple transfusions. In remote area where Coombs test is not available, scoring system can be used to predict the probability of alloantibody formation."

"Latar belakang: Prevalens obesitas pada anak dan remaja di seluruh dunia meningkat secara dramatis. Obesitas pada anak menjadi masalah karena merupakan predisposisi terjadinya obesitas saat dewasa yang berhubungan dengan timbulnya penyakit komorbiditas metabolik. Obesitas ditandai dengan penimbunan jaringan adiposa tubuh secara berlebihan, dan jaringan adiposa tersebut menghasilkan sitokin dan mediator inflamasi yang berperan dalam terjadinya inflamasi subklinis.Tujuan: Untuk mengetahui profil penanda inflamasi subklinis pada anak obes usia 9-12 tahun melalui pemeriksaan sitokin inflamasi (IL-6) dan protein fase akut (CRP dan AGP).Metode: Penelitian deskriptif potong lintang yang dilakukan pada siswa SD yang obes dan non-obes usia 9-12 tahun di Jakarta Selatan yang diizinkan oleh orangtua untuk mengikuti penelitian ini dan bersedia diukur antropometri serta diperiksa laboratorium Interleukin-6 (IL-6), C-reactive protein (CRP), dan alpha-1-acid glycoprotein (AGP).Hasil: Dari 30 anak obes dan 30 anak non-obes didapatkan kadar median IL-6 anak obes lebih tinggi bila dibandingkan dengan anak non-obes dengan nilai 3,09 (1,16-6,49) vs 1,27 (0,51-3,86), kadar median CRP pada kelompok obes lebih tinggi dibandingkan kelompok non-obes dengan nilai 2,25 (0,4-64) vs 0,2 (<0,2- 2,6) dan kadar rerata AGP kelompok obes lebih tinggi dibandingkan kelompok non-obes dengan nilai rerata 93,13 ± 18,29 vs 71 ± 18,89.Simpulan: Inflamasi subklinis telah terjadi pada anak obes berusia 9-12 tahun. Kadar sitokin inflamasi IL-6 lebih tinggi pada anak obes dibandingkan anak non- obes, kadar protein fase akut CRP lebih tinggi pada anak obes dibandingkan anak non-obes, dan kadar penanda AGP lebih tinggi pada anak obes dibandingkan anak non-obes.

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Background: Prevalence of obesity in children and adolescence is dramatically increasing. Obesity in children is an important predisposing factor of adult obesity and correlates with metabolic comorbidities. Obesity is basically an overt body adipose tissue which resulting cytokine and inflammatory mediators. The cytokine and inflammatory mediators play important role in subclinical inflammation.Objective: To describe subclinical inflammatory marker of obese children age 9- 12 years old by examining inflammatory cytokine (Interleukine 6) and acute phase protein (C-reactive protein and Alpha-1-acid glycoprotein).Methods: Cross sectional descriptive study was conducted in elementary school students of obese and non-obese age 9-12 years old in South Jakarta. Antropometric measurements and examination of IL-6, CRP, and AGP were taken from all subjects.Results: Thirty obese and thirty non-obese children were recruited in this study. Obese children showed higher median IL-6 compared to non-obese (3,09 (1,16- 6,49) vs 1,27 (0,51-3,86)), higher median CRP in obese children compared to non-obese (2,25 (0,4-64) vs 0,2 (<0,2-2,6)). Obese children also showed higher mean AGP compared to non-obese (93,13 ± 18,29 vs 71 ± 18,89).Conclusions: Obese children age 9-12 years old have evidence of subclinical inflammation. The subclinical inflammation was based on higher IL-6, CRP, and AGP in obese children compared to non-obese children."

"[ABSTRAKLatar belakang: Epilepsi umum merupakan jenis epilepsi yang sering dijumpai pada anak. Data mengenai faktor risiko epilepsi intraktabel pada anak dengan epilepsi umum masih sangat terbatas. Perlu dilakukan penelitian lebih lanjut untuk mengetahui faktor risiko yang berperan dalam kejadian epilepsi intraktabel sehingga dapat menjadi dasar dalam tata laksana serta edukasi pasien dan orangtua.Tujuan: (1) Mengetahui karakteristik pasien epilepsi umum dan frekuensi terjadinya epilepsi intraktabel pada anak dengan epilepsi umum . (2) Mengetahui apakah usia awitan, tipe kejang, frekuensi awal serangan, status perkembangan motor kasar awal, respon terapi awal, gambaran EEG awal, dan gambaran MRI/CT Scan kepala dapat menjadi faktor risiko terjadinya epilepsi intraktabel pada anak dengan epilepsi umum. (3) Mengetahui apakah evolusi status perkembangan motor kasar, dan evolusi EEG epileptiform dapat menjadi faktor risiko terjadinya epilepsi intraktabel pada anak dengan epilepsi umumMetode: Penelitian kohort retrospektif berdasarkan rekam medis dilakukan di poliklinik rawat jalan neurologi anak Departemen Ilmu Kesehatan Anak FKUI-RSCM dan poliklinik anak swasta RSCM antara bulan September sampai dengan Desember 2014 terhadap anak epilepsi umum usia koreksi 1 bulan hingga 18 tahun, dengan lama pengobatan minimal 6 bulan. Faktor risiko dianalisis bivariat dan multivariat.Hasil: Angka kejadian epilepsi umum intraktabel adalah 21 (21%). Usia subjek terbanyak adalah usia >3 tahun sebanyak 85(83%) subjek. Pada analisis bivariat didapatkan faktor risiko yang bermakna adalah usia awitan kejang <1 tahun (OR 11,4 IK 95% 3,45-37,62), frekuensi awal serangan ≥5 kali/hari (OR 8,5 IK95% 2,90-24,80), respon awal terapi buruk (OR 160 IK 95% 19,12-1339,06), evolusi status perkembangan motor kasar buruk (OR 4,9 IK95% 1,79-13,67) dan evolusi EEG epileptiform buruk (OR 10 IK95%3,25-30,92). Pada analisis multivariat didapatkan respon awal terapi buruk dengan nilai OR 144,3 (IK95% 15,47-1345,59) dan usia awitan kejang < 1 tahun dengan nilai OR 9,6 (IK95% 1,78-51,92) merupakan faktor risiko yang berpern untuk menjadi epilepsi umum intraktabel.Simpulan : Angka kejadian epilepsi umum intraktabel sebanyak 21%. Faktor risiko yang sangat berperan adalah respon terapi awal buruk dan usia awitan kejang <1 tahun.

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ABSTRACTBackground: Generalized epilepsy is the most common type of epilepsy in children. Limited datas of intractable epilepsy risk factors are available at present. Therefore, more studies are needed to investigate the risk factors of intractable epilepsy in order to manage and educate both patients and parents.Objective: (1) to describe characteristic and frequency of intractable epilepsy in children with generalized epilepsy, (2) to investigate the role of age onset of seizure, initial seizure frequency, type of seizure, early gross motor developmental status, early therapeutic response, early EEG description and cerebral MRI/CT scan as risk factors of intractable epilepsy in children with generalized epilepsy, (3) to investigate the role of gross motor developmental status evolution and epileptiform EEG evolution as risk factors of intractable epilepsy.Methods: Retrospective cohort study was conducted at neurology outpatient pediatric RSCM and private outpatient clinic between September to December 2014. The inclusion criteria was generalized epilepsy children age 1 month of corrected age to 18 years old which has been treated with antiepileptic drugs for at least 6 months. Risk factors were analyze with bivariate and multivariate analysis.Results: Prevalence of intractable generalized epilepsy is 21%. Most subject are >3 years old 85(83%) subject. Bivariate analysis showed that age onset of seizure (OR 11,4 CI95% 3,45-37,62), initial seizure frequency ≥5 times/day (OR 8,5 CI 95% 2,90-24,80), non-responder of early treatment (OR 160 CI 95% 19,12-1339,06), unfavorable gross motor development evolution (OR 4,9 CI 95% 1,79-13,67) and unfavorable epileptiform EEG evolution (OR 10 CI 3,25-30,92) are significantly associated with intractable epilepsy. The most important among those risk factors based on multivariate analysis are non-responder of early treatment with OR 144,3 (CI95% 15,47-1345,59) and age onset < 1 year old with OR 9,6 (CI 1,78-51,92).Conclusions: Prevalence of intractable generalized epilepsy is 21%. Non-responder early treatment and age onset of seizure < 1 year old are strongly associated with intractable generalized epilepsy.;Background: Generalized epilepsy is the most common type of epilepsy inchildren. Limited datas of intractable epilepsy risk factors are available at present.Therefore, more studies are needed to investigate the risk factors of intractableepilepsy in order to manage and educate both patients and parents. Objective: (1) to describe characteristic and frequency of intractable epilepsy inchildren with generalized epilepsy, (2) to investigate the role of age onset ofseizure, initial seizure frequency, type of seizure, early gross motor developmentalstatus, early therapeutic response, early EEG description and cerebral MRI/CTscan as risk factors of intractable epilepsy in children with generalized epilepsy,(3) to investigate the role of gross motor developmental status evolution andepileptiform EEG evolution as risk factors of intractable epilepsy. Methods: Retrospective cohort study was conducted at neurology outpatientpediatric RSCM and private outpatient clinic between September to December2014. The inclusion criteria was generalized epilepsy children age 1 month ofcorrected age to 18 years old which has been treated with antiepileptic drugs for atleast 6 months. Risk factors were analyze with bivariate and multivariate analysis. Results: Prevalence of intractable generalized epilepsy is 21%. Most subject are>3 years old 85(83%) subject. Bivariate analysis showed that age onset of seizure(OR 11,4 CI95% 3,45-37,62), initial seizure frequency ≥5 times/day (OR 8,5 CI95% 2,90-24,80), non-responder of early treatment (OR 160 CI 95% 19,121339,06),unfavorablegrossmotordevelopmentevolution(OR4,9CI95%1,7913,67)and unfavorable epileptiform EEG evolution (OR 10 CI 3,25-30,92) aresignificantly associated with intractable epilepsy. The most important amongthose risk factors based on multivariate analysis are non-responder of earlytreatment with OR 144,3 (CI95% 15,47-1345,59) and age onset < 1 year old withOR 9,6 (CI 1,78-51,92). Conclusions: Prevalence of intractable generalized epilepsy is 21%. Nonresponder early treatment and age onset of seizure < 1 year old are strongly associated with intractable generalized epilepsy.;Background: Generalized epilepsy is the most common type of epilepsy inchildren. Limited datas of intractable epilepsy risk factors are available at present.Therefore, more studies are needed to investigate the risk factors of intractableepilepsy in order to manage and educate both patients and parents. Objective: (1) to describe characteristic and frequency of intractable epilepsy inchildren with generalized epilepsy, (2) to investigate the role of age onset ofseizure, initial seizure frequency, type of seizure, early gross motor developmentalstatus, early therapeutic response, early EEG description and cerebral MRI/CTscan as risk factors of intractable epilepsy in children with generalized epilepsy,(3) to investigate the role of gross motor developmental status evolution andepileptiform EEG evolution as risk factors of intractable epilepsy. Methods: Retrospective cohort study was conducted at neurology outpatientpediatric RSCM and private outpatient clinic between September to December2014. The inclusion criteria was generalized epilepsy children age 1 month ofcorrected age to 18 years old which has been treated with antiepileptic drugs for atleast 6 months. Risk factors were analyze with bivariate and multivariate analysis. Results: Prevalence of intractable generalized epilepsy is 21%. Most subject are>3 years old 85(83%) subject. Bivariate analysis showed that age onset of seizure(OR 11,4 CI95% 3,45-37,62), initial seizure frequency ≥5 times/day (OR 8,5 CI95% 2,90-24,80), non-responder of early treatment (OR 160 CI 95% 19,121339,06),unfavorablegrossmotordevelopmentevolution(OR4,9CI95%1,7913,67)and unfavorable epileptiform EEG evolution (OR 10 CI 3,25-30,92) aresignificantly associated with intractable epilepsy. The most important amongthose risk factors based on multivariate analysis are non-responder of earlytreatment with OR 144,3 (CI95% 15,47-1345,59) and age onset < 1 year old withOR 9,6 (CI 1,78-51,92). Conclusions: Prevalence of intractable generalized epilepsy is 21%. Nonresponder early treatment and age onset of seizure < 1 year old are strongly associated with intractable generalized epilepsy., Background: Generalized epilepsy is the most common type of epilepsy inchildren. Limited datas of intractable epilepsy risk factors are available at present.Therefore, more studies are needed to investigate the risk factors of intractableepilepsy in order to manage and educate both patients and parents. Objective: (1) to describe characteristic and frequency of intractable epilepsy inchildren with generalized epilepsy, (2) to investigate the role of age onset ofseizure, initial seizure frequency, type of seizure, early gross motor developmentalstatus, early therapeutic response, early EEG description and cerebral MRI/CTscan as risk factors of intractable epilepsy in children with generalized epilepsy,(3) to investigate the role of gross motor developmental status evolution andepileptiform EEG evolution as risk factors of intractable epilepsy. Methods: Retrospective cohort study was conducted at neurology outpatientpediatric RSCM and private outpatient clinic between September to December2014. The inclusion criteria was generalized epilepsy children age 1 month ofcorrected age to 18 years old which has been treated with antiepileptic drugs for atleast 6 months. Risk factors were analyze with bivariate and multivariate analysis. Results: Prevalence of intractable generalized epilepsy is 21%. Most subject are>3 years old 85(83%) subject. Bivariate analysis showed that age onset of seizure(OR 11,4 CI95% 3,45-37,62), initial seizure frequency ≥5 times/day (OR 8,5 CI95% 2,90-24,80), non-responder of early treatment (OR 160 CI 95% 19,121339,06),unfavorablegrossmotordevelopmentevolution(OR4,9CI95%1,7913,67)and unfavorable epileptiform EEG evolution (OR 10 CI 3,25-30,92) aresignificantly associated with intractable epilepsy. The most important amongthose risk factors based on multivariate analysis are non-responder of earlytreatment with OR 144,3 (CI95% 15,47-1345,59) and age onset < 1 year old withOR 9,6 (CI 1,78-51,92). Conclusions: Prevalence of intractable generalized epilepsy is 21%. Nonresponder early treatment and age onset of seizure < 1 year old are strongly associated with intractable generalized epilepsy.]"

"[ABSTRAKLatar belakang: Obesitas pada anak merupakan predisposisi terjadinya obesitas saat dewasa yang berhubungan dengan timbulnya penyakit ko-morbiditas metabolik. Obesitas ditandai dengan penimbunan jaringan adiposa tubuh secara berlebihan sehingga menghasilkan sitokin dan mediator inflamasi yang berperan dalam terjadinya inflamasi subklinis.Tujuan: Untuk mengetahui profil penanda inflamasi subklinis pada anak obes usia 9-12 tahun melalui pemeriksaan sitokin inflamasi (Interleukin-6) dan protein fase akut (C-reactive protein dan alpha-1-acid glycoprotein).Metode: Penelitian deskriptif potong lintang yang dilakukan pada siswa SD obes dan non-obes usia 9-12 tahun di Jakarta Selatan dan bersedia diukur antropometri serta diperiksa laboratorium IL-6, CRP, dan AGP.Hasil: Dari 30 anak obes dan 30 anak non-obes didapatkan kadar median IL-6 anak obes lebih tinggi bila dibandingkan dengan anak non-obes yaitu 3,09 (1,16-6,49) vs 1,27 (0,51-3,86), kadar median CRP pada kelompok obes lebih tinggi dibandingkan kelompok non-obes, yaitu 2,25 (0,4-64) vs 0,2 (<0,2-2,6) dan kadar rerata AGP kelompok obes lebih tinggi dibandingkan kelompok non-obes, yaitu 93,13 ± 18,29 vs 71 ± 18,89.Simpulan: Inflamasi subklinis telah terjadi pada anak obes berusia 9-12 tahun. Kadar sitokin inflamasi IL-6, kadar protein fase akut CRP dan AGP lebih tinggi pada anak obes dibandingkan anak non-obes.

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ABSTRACTBackground: Obesity in children is an important predisposing factor of adult obesity and correlates with metabolic co-morbidities. Obesity is basically an overt body adipose tissue which resulting cytokine and inflammatory mediators. The cytokine and inflammatory mediators play important role in subclinical inflammation.Objective: To describe subclinical inflammatory marker of obese children age 9-12 years old by examining inflammatory cytokine (Interleukin-6) and acute phase protein (C-reactive protein and alpha-1-acid glycoprotein).Methods: Cross sectional descriptive study was conducted in elementary school students of obese and non-obese age 9-12 years old in South Jakarta. Antropometric measurements and examination of IL-6, CRP, AGP were taken.Results: Thirty obese and thirty non-obese children were recruited in this study. Obese children showed higher median IL-6 compared to non-obese (3,09 (1,16-6,49) vs 1,27 (0,51-3,86)), higher median CRP in obese children compared to non-obese (2,25 (0,4-64) vs 0,2 (<0,2-2,6)). Obese children also showed higher mean AGP compared to non-obese (93,13 ± 18,29 vs 71 ± 18,89).Conclusions: Obese children age 9-12 years old have evidence of subclinical inflammation. The subclinical inflammation was based on higher IL-6, CRP, and AGP in obese children compared to non-obese children.;Background: Obesity in children is an important predisposing factor of adult obesity and correlates with metabolic co-morbidities. Obesity is basically an overt body adipose tissue which resulting cytokine and inflammatory mediators. The cytokine and inflammatory mediators play important role in subclinical inflammation.Objective: To describe subclinical inflammatory marker of obese children age 9-12 years old by examining inflammatory cytokine (Interleukin-6) and acute phase protein (C-reactive protein and alpha-1-acid glycoprotein).Methods: Cross sectional descriptive study was conducted in elementary school students of obese and non-obese age 9-12 years old in South Jakarta. Antropometric measurements and examination of IL-6, CRP, AGP were taken.Results: Thirty obese and thirty non-obese children were recruited in this study. Obese children showed higher median IL-6 compared to non-obese (3,09 (1,16-6,49) vs 1,27 (0,51-3,86)), higher median CRP in obese children compared to non-obese (2,25 (0,4-64) vs 0,2 (<0,2-2,6)). Obese children also showed higher mean AGP compared to non-obese (93,13 ± 18,29 vs 71 ± 18,89).Conclusions: Obese children age 9-12 years old have evidence of subclinical inflammation. The subclinical inflammation was based on higher IL-6, CRP, and AGP in obese children compared to non-obese children.;Background: Obesity in children is an important predisposing factor of adult obesity and correlates with metabolic co-morbidities. Obesity is basically an overt body adipose tissue which resulting cytokine and inflammatory mediators. The cytokine and inflammatory mediators play important role in subclinical inflammation.Objective: To describe subclinical inflammatory marker of obese children age 9-12 years old by examining inflammatory cytokine (Interleukin-6) and acute phase protein (C-reactive protein and alpha-1-acid glycoprotein).Methods: Cross sectional descriptive study was conducted in elementary school students of obese and non-obese age 9-12 years old in South Jakarta. Antropometric measurements and examination of IL-6, CRP, AGP were taken.Results: Thirty obese and thirty non-obese children were recruited in this study. Obese children showed higher median IL-6 compared to non-obese (3,09 (1,16-6,49) vs 1,27 (0,51-3,86)), higher median CRP in obese children compared to non-obese (2,25 (0,4-64) vs 0,2 (<0,2-2,6)). Obese children also showed higher mean AGP compared to non-obese (93,13 ± 18,29 vs 71 ± 18,89).Conclusions: Obese children age 9-12 years old have evidence of subclinical inflammation. The subclinical inflammation was based on higher IL-6, CRP, and AGP in obese children compared to non-obese children., Background: Obesity in children is an important predisposing factor of adult obesity and correlates with metabolic co-morbidities. Obesity is basically an overt body adipose tissue which resulting cytokine and inflammatory mediators. The cytokine and inflammatory mediators play important role in subclinical inflammation.Objective: To describe subclinical inflammatory marker of obese children age 9-12 years old by examining inflammatory cytokine (Interleukin-6) and acute phase protein (C-reactive protein and alpha-1-acid glycoprotein).Methods: Cross sectional descriptive study was conducted in elementary school students of obese and non-obese age 9-12 years old in South Jakarta. Antropometric measurements and examination of IL-6, CRP, AGP were taken.Results: Thirty obese and thirty non-obese children were recruited in this study. Obese children showed higher median IL-6 compared to non-obese (3,09 (1,16-6,49) vs 1,27 (0,51-3,86)), higher median CRP in obese children compared to non-obese (2,25 (0,4-64) vs 0,2 (<0,2-2,6)). Obese children also showed higher mean AGP compared to non-obese (93,13 ± 18,29 vs 71 ± 18,89).Conclusions: Obese children age 9-12 years old have evidence of subclinical inflammation. The subclinical inflammation was based on higher IL-6, CRP, and AGP in obese children compared to non-obese children.]"

"Latar belakang: Penyakit jantung bawaan (PJB) didapatkan pada 40-50% pasien sindrom Down, merupakan penyebab utama morbiditas dan mortalitas. Salah satu manifestasi tambahan lain selain PJB adalah hipertensi pulmoner. Faktor-faktor risiko yang berperan untuk terjadinya PJB, terjadi pada periode perikonsepsi yaitu 3 bulan sebelum kehamilan hingga trimester pertama kehamilan. Beberapa penelitian mengenai faktor risiko PJB yang telah dilakukan memiliki hasil yang tidak konsisten baik dalam populasi sindrom Down sendiri, maupun apabila dibandingkan dengan populasi umum. Tujuan: Mengetahui prevalens PJB dan hipertensi pulmoner, jenis PJB yang banyak didapatkan, dan faktor risiko PJB pada sindrom Down. Metode: Studi potong lintang observational analytic pada pasien sindrom Down berusia ≤5 tahun di RSCM. Data diambil dari wawancara dengan orangtua subyek yang datang langsung ke poliklinik rawat jalan RSCM Kiara, Departemen Rehabilitasi Medis, dirawat di Gedung A RSCM, IGD, perinatologi maupun orangtua dari subyek yang tercatat di rekam medis dengan diagnosis sindrom Down atau memiliki International Classification of Disease (ICD) 10 Q90.9 sejak Januari 2012 hingga Desember 2015. Hasil penelitian: Sebanyak 70 subyek sindrom Down memenuhi kriteria inklusi. Median usia subyek adalah 16,5 bulan. Penyakit jantung bawaan didapatkan pada 47,1% subyek. Defek septum atrium dan duktus arteriosus paten merupakan PJB terbanyak yang didapatkan yaitu masing-masing 30,3%. Penyakit jantung bawaan lain yang didapatkan adalah defek septum atrioventrikel dan defek septum ventrikel yaitu sebesar 18,2 dan 21,2%. Hipertensi pulmoner didapatkan pada 17,1% subyek dengan 10/12 subyek terjadi bersamaan dengan PJB. Usia ibu ≥35 tahun [p= 0,77; OR 0,87 (0,34-2,32)], usia ayah ≥35 tahun [p= 0,48; OR 1,44 (0,52-4,01)], febrile illness [p= 0,72; OR 0,81 (0,25-2,62)], penggunaan obat-obat yaitu antipiretik [p= 0,71; OR 0,60 (0,14-2,82)], antibiotik (p=0,91; OR 1,13 (0,15-8,5)], jamu/obat herbal [p=0,89; OR 0,89 (0,22-3,60)], keteraturan penggunaan asam folat [p= 0,27; OR 0,58 (0,22-1,50)], ibu merokok (p= 0,34), dan pajanan rokok [p= 0,89; OR 0,94 (0,36-2,46)] saat periode perikonsepsi tidak terbukti berhubungan dengan terjadinya PJB pada sindrom Down. Kesimpulan: Faktor risiko lingkungan periode perikonsepsi tidak terbukti berhubungan dengan kejadian PJB pada sindrom Down."

"Latar Belakang: Insufisiensi vitamin D mengenai hampir 50% populasi seluruh dunia. Dua penyebab paling utama defisiensi adalah kurangnya paparan sinar matahari dan asupan nutrisi vitamin D tidak adekuat. Mulai usia 6 bulan, ASI tidak dapat memenuhi seluruh kebutuhan makronutrien dan mikronutrien bayi termasuk juga vitamin D. Penelitian yang mendukung angka kejadian defisiensi dan insufisiensi vitamin D serta mengetahui paparan sinar matahari yang adekuat untuk mencukupi kebutuhan vitamin D harian belum banyak dilakukan di Indonesia, terutama usia 7-12 bulan.Tujuan: Membuktikan pengaruh paparan sinar matahari terhadap kadar vitamin D bayi usia 7-12 bulan.Metode: Uji acak terkontrol dilakukan terhadap 109 subjek berusia 7-12 bulan di Puskesmas wilayah Semarang pada bulan Februari sampai Mei 2019. Dibagi menjadi kelompok intervensi (54 subjek) dan kontrol (55 subjek) dengan kriteria inklusi: tidak memiliki kelainan kongenital maupun penyakit kronik dan orangtua bersedia mengikuti penelitian. Kriteria eksklusi: memiliki status gizi kurang dan gizi buruk, warna kulit selain kuning langsat dan sawo matang, defisiensi vitamin D berat dengan gejala klinis dan mendapat suplementasi vitamin D. Intervensi: paparan sinar matahari selama 5 menit pada pukul 10.00-14.00 tiga kali seminggu selama 2 bulan. Dilakukan pemeriksaan kadar vitamin D awal dan akhir serta food recall.Hasil: Didapatkan hasil angka defisiensi vitamin D sebesar 8,9%. Tidak terdapat perbedaan bermakna untuk kadar vitamin D awal pada kedua kelompok dengan rerata kadar vitamin D 39,1±14,9 ng/ml pada kelompok intervensi dan 38,6±15,4 ng/ml pada kontrol. Setelah 2 bulan, terdapat perbedaan bermakna dengan p=0,005 pada kadar vitamin D kedua kelompok dengan rerata kelompok intervensi 47,9±21,9 ng/ml dan 36,6±13,7 ng/ml pada kontrol. Tidak terdapat perbedaan bermakna untuk asupan vitamin D pada kedua kelompok.Kesimpulan: Paparan sinar matahari pukul 10.00-14.00 selama 5 menit pada 50% luas permukaan badan berpengaruh terhadap peningkatan kadar vitamin D bayi berusia 7-12 bulan.

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Background: Vitamin D insufficiency found in almost 50% of world population. Two main causes of deficiency were less sun exposure and inadequate vitamin D intake. Since 6 months, breastmilk couldnt fulfilled infant s nutrient need including vitamin D. Study supported vitamin D deficiency and insufficiency prevalence and also information about adequate sun exposure needed to maintain daily vitamin D had not been done much in Indonesia, especially aged 7-12 months.Objective: To prove effect of sun exposure on vitamin D levels of infants aged 7-12 monthsMethod: Randomised controlled trial was done to 109 subjects aged 7-12 months in Primary Health care around Semarang city on February until May 2019. Divided to intervention group (54 subjects) and control (55 subjects) with inclusion criteria: no congenital or chronic disease, parents agreed to join the study. Exclusion criteria: moderate or severe malnutrition, skin tone other than yellow or brown, severe vitamin D deficiency with clinical manifestation and received vitamin D supplementation. Intervention : sun exposure for 5 minutes from 10.00-14.00 three times a week for 2 months. Vitamin D level measurement and food recall were done before and after.Results: It is shown that prevalence of deficiency was 8.9%. No significant difference on pre vitamin D levels for intervention group (mean 39.1±14.9 ng/ml) and control (mean 38.6±15.4 ng/ml). After 2 months, there was significant difference between intervention group (mean 47.9±21.9 ng/ml) and control (mean 36.6±13.7 ng/ml) with p=0.005. There was no significant difference for vitamin D intake between two groups.Conclusion: Sun exposure of 50% body surface area at 10.00-14.00 for 5 minutes has an effect to increase vitamin D level of infants aged 7-12 months."

"ABSTRAKLatar belakang: Thalassemia merupakan kelainan genetik terbanyak di dunia, termasuk Indonesia. Pasien thalassemia mayor berisiko mengalami gangguan fungsi neurokognitif akibat anemia kronik dan penumpukan besi. Tujuan: mengetahui prevalens abnormalitas hasil EEG dan tes IQ, menganalisis faktor-faktor yang diduga berhubungan dengan gangguan fungsi neurokognitif pada anak dengan thalassemia mayor usia saat diagnosis, lama transfusi, pendidikan pasien, rerata Hb pra-transfusi, kadar feritin serum, saturasi transferin, dan komplians terhadap obat kelasi besi , serta untuk mengetahui apakah gangguan neurokognitif dapat memengaruhi fungsi sekolah. Metode: Penelitian potong lintang deskriptif analitik antara April 2016-April 2017. Pengukuran tes IQ menggunakan WISC-III. Hasil: Total subyek adalah 70 anak thalassemia mayor berusia antara 9 hingga 15,5 tahun. Prevalens hasil EEG abnormal adalah 60 dan prevalens skor IQ abnormal

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ABSTRACTBackground Thalassemia is the most common hereditary disorders worldwide, including Indonesia. Chronic anemia and iron overload in thalassemia major lead to several risk factors including neurocognitive problems. Aim To investigate the prevalence of abnormal EEG and IQ test, to identify the factors related to neurocognitive function in children with thalassemia major age at diagnosis, years of transfusion, patients education, pre transfusion haemoglobin level, ferritin, transferrin saturation, and compliance to chelation , and to identify whether neurocognitive dysfunction affects child rsquo s school performance. Methods A cross sectional descriptive analitic study. Subjects were recruited from April 2016 April 2017. Cognitive function assessed by the WISC III. Results A total 70 children aged from 9 to 15.5 years old were recruited. The prevalence of abnormal EEG and abnormal IQ score "