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"ABSTRAKPenelitian mengenai asupan karbohidrat dan serat pangan dengan proporsi mikrobiota usus pada anak masih belum banyak di Indonesia. Tujuan penelitian ini untuk mendapatkan profil jumlah asupan karbohidrat dan serat pangan pada anak serta hubungannya dengan mikrobiota usus. Mikrobiota usus yang diperiksa adalah Bifidobacterium spp dan Lactobacillus spp mewakili mikrobiota usus baik serta Eschericia dan Clostridium spp mewakili mikrobiota patogen usus.Studi potong lintang dilakukan pada 68 siswa TK usia 4-6 tahun dilakukan selama Januari-Februari 2017 di Jakarta. Data jumlah asupan energi, karbohidrat, serta serat pangan dikumpulkan dengan menggunakan food recall form selama 2x24 jam. Subjek terdiri dari 33 anak perempuan 48 dan 35 anak lelaki 52 , sebagian besar dengan gizi baik dan perawakan normal. Median asupan energi, karbohidrat, dan serat pangan berturut-turut sebanyak 1230 kalori, 158 gram dan 2,4 gram. Tidak didapatkan hubungan bermakna antara asupan karbohidrat dan serat pangan terhadap proporsi mikrobiota ususAsupan karbohidrat dan serat pangan subjek penelitian ini di bawah angka kecukupan gizi AKG yang dianjurkan untuk usia 4-6 tahun. Perbedaan kandungan prebiotik pada asupan karbohidrat maupun serat pangan subjek penelitian ini, mungkin merupakan penyebab perbedaan hasil penelitian ini dengan penelitian diluar negeri. Data yang didapat diharapkan dapat dipergunakan sebagai dasar untuk penelitian selanjutnya.

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ABSTRACTThere are not many studies in Indonesia related to gut microbiota, especially in relation with carbohydrate and dietary fiber intake. The objectives of this study are to gain profiles on the amount of carbohydrate and dietary fiber intake in children, and its relations with gut microbiota. The gut microbiota being studied are Bifidobacterium spp and Lactobacillus spp, representing the good microbiota, and Eschericia and Clostridium spp as the pathogen gut microbiota.Cross sectional study was conducted on 68 kindergarten students aged 4 6 years old during the period of January ndash February 2017. The data on energy, carbohydrate and dietary fiber intakes were compiled using food recall form for 48 hours. Subjects consisted of 33 girls 48 and 35 boys 52 majority of them are well nourished and normal stature. Median of the energy, carbohydrate and fiber intake were 1,230 calories, 158 gram and 2.4 gram, consecutively. There was no significant relation between carbohydrate and dietary fiber intakes on the composition of gut microbiota.The intake of carbohydrate and dietary fiber for the subjects of this study was below the Daily Dietary Requirement for children aged 4 6 years old. The discrepancy of prebiotic amount on the carbohydrate and fiber intake might impact the results of this study compared with similar studies abroad. However, the acquired data can be used for basis of future studies in this field."

"Latar belakang. Translokasi bakteri dari saluran cerna merupakan masalah yang penting dalam terjadinya infeksi pada pasien dengan kolestasis obstruktif serta sirosis hepatis. Pada studi ini kami bermaksud untuk mempelajari komposisi mikrobiota usus dihubungkan dengan malabsorpsi lemak dan gangguan integritas usus pada anak dengan kolestasis kronis. Metode. Sampel feses dari bayi/anak dengan kolestasis dan anak sehat dikumpulkan untuk dilakukan evaluasi terhadap jumlah sel lemak, komposisi mikrobiota usus serta integritas ususnya. Hasil. Lima puluh tujuh bayi/anak (27 kolestasis dan 30 anak sehat) dilakukan evaluasi. Terdapat perbedaan bermakna pada berat badan, P=0.001; status nutrisi, P=<0.0001; serta konsumsi susu formula dengan bahan dasar middle chain triglyceride, P=<0.0001. Selain itu juga ditemukan bahwa komposisi lemak pada feses serta kadar fecal calprotectin lebih tinggi pada kelompok kolestasis dibandingkan dengan anak sehat, P=<0.0001 dan P=0.021. Sesuai dengan hasil tersebut ditemukan pula perbedaan yang bermakna di antara kedua grup tersebut pada komposisi Bifidobacteria sp. and E. Coli sp., P=0.005. Kesimpulan. Ditemukan perbedaan yang bermakna pada berat badan, status nutrisi, komposisi lemak feses, kadar fecal calprotectin serta profil mikrobiota usus antara kelompok bayi dengan kolestasis dengan bayi sehat. Diperlukan studi lanjutan untuk mempelajari interaksi antara saluran cerna dan hati pada kolestasis.

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Background. Bacterial translocation from the gastrointestinal tract is central to current concepts of endogenous sepsis in obstructif cholestasis and cirrhosis. In this study we evaluate gut microbiota profile and their correlation with fat malabsorption and gut integrity. Methods. We evaluate feces sampels from chronic cholestasis and healthy infants to know their fat malabsorption, gut microbiota composition, and gut integrity, then compare between the 2 groups.

Results. Fifty-seven infants (27 cholestasis and 30 healthy) were evaluated. There were significant difference in mean body weight 7932.39 (SD: 3416.2) VS 11453.3 (SD: 4012.3) grams, P=0.001; nutritional status, P=<0.0001, and middle chain triglyceride dominant infant formula, P=<0.0001. Feces evaluation showed a significant hinger fat composition (+2 and +3), P=<0.0001 and fecal calprotection level in cholestatic groups (81.32 (SD:61.6) VS 47.37 (SD:47.3) microgram/g faeces), P=0.021. In accordance with fecal calprotectin level, there were a significant difference between the 2 groups in composition of Bifidobacteria sp. and E. Coli sp., P = 0.005.

Conclusions. Significant differences were found in body weight, nutritional status, feces fat composition, fecal calprotection level and gut microbiota profile between chronic cholestasis and healthy infants. Further studies needed to evaluate the interaction between gut and liver axis in infants with cholestasis."

"[ABSTRAKLatar Belakang Lemak merupakan sumber energi penting, komponen utama struktur membran sel dan media penyerapan vitamin larut lemak A, D, E, dan K. Lemak adalah nutrisi utama perkembangan otak anak, penting untuk memeriksa malabsorpsi lemak secara akurat dan tepat. RSCM merupakan rujukan pemeriksaan analisis feses, dengan sekitar 840 pemeriksaan mikroskopik lemak per tahun. Pemeriksaan mikroskopik lemak merupakan satu-satunya yang tersedia di laboratorium RSCM untuk pemeriksaan lemak feses.Tujuan Mengetahui kehandalan pemeriksaan mikroskopik lemak pada analisis feses dalam menggambarkan malabsorpsi lemak pada anak.Metode Uji diagnostik kehandalan pemeriksaan mikroskopik lemak menggunakan Sudan III dibandingkan dengan steatokrit dalam mendiagnosis malabsorpsi lemak pada anak usia 6-60 bulan.Hasil Didapatkan 68 sampel yang terdiri dari 41 laki-laki dan 27 perempuan, median usia 14,3 bulan. Konsistensi feses terbanyak adalah lembek (50,0%). Dengan metode mikroskopik didapatkan lemak terbanyak adalah positif satu pada 29 sampel (42,6%). Sensitivitas pemeriksaan mikroskopik lemak didapatkan sebesar 49,15%, spesifisitas sebesar 66,67%, dengan nilai prediksi positif 90,63% dan nilai prediksi negatif 16,67%.Kesimpulan Pemeriksaan mikroskopik lemak memiliki sensitivitas yang tidak terlalu tinggi dalam mendiagnosis malabsorpsi lemak dan perlu dilengkapi dengan metode lain seperti steatokrit.

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ABSTRACTBackground Lipid is a very important source of energy, major component of cell membrane structure and media for absorption of lipid-soluble vitamins A, D, E, and K. Lipid is the major nutrition for brain development, and thus it is important to test lipid malabsorption accurately. RSCM is the referral hospital for fecal analysis, with 840 lipid microscopic examination done each year. This microscopic test is the only method currently available for fecal lipid malabsorption at RSCM laboratory.Objective To know whether the lipid microscopid test as a part of fecal analysis that have been done so far is effective in representing lipid malabsorption in children.Methods Diagnostic test for effectivity of lipid microscopic test using Sudan III compared to steatocrit test in diagnosing lipid malabsorption in children 6-60 months old suspected to have lipid malabsorption.Results Sixty-eight children consisting of 41 boys and 27 girls were included in the study, with median age 14,3 months. The most common stool consistency was mushy (50,0%). Using microscopic method the most frequent group was positive one in 29 subjects (42,6%). Sensitivity of lipid microscopic test was found to be 49,15% with specificity 66,67%, PPV 90,63% and NPV 16,67%.Conclusion The lipid microscopic test has a moderate sensitivity in diagnosing fat malabsorption, and needs to be complemented with other method such as steatocrit., Background Lipid is a very important source of energy, major component of cell membranestructure and media for absorption of lipid-soluble vitamins A, D, E, and K. Lipid is themajor nutrition for brain development, and thus it is important to test lipid malabsorptionaccurately. Cipto Mangunkusumo Hospital (CMH) is a referral hospital for fecal analysis,with 840 lipid microscopic examination done each year. This microscopic test is the onlymethod currently available for fecal lipid malabsorption at CMH laboratory.Objective To know whether the lipid microscopic test as a part of fecal analysis that isperformed routinely so far is effective in representing lipid malabsorption in children.Methods Diagnostic test for effectivity of lipid microscopic test using Sudan III compared tosteatocrit test in diagnosing lipid malabsorption in children 6-60 months old suspected tohave lipid malabsorption.Results Sixty-nine children consisting of 41 boys and 27 girls were included in the study,with median age 14,3 months. The most common stool consistency was mushy (50,0%).Using microscopic method the most frequent group was positive one in 29 subjects (42,6%).Sensitivity of lipid microscopic test was found to be 49,15% with specificity 66,67%, PPV90,63% and NPV 16,67%.Conclusion Lipid microscopic test has a moderate sensitivity in diagnosing fat malabsorption, and needs to be complemented with other method such as steatocrit.]"

"ABSTRAKResusitasi dengan konsentrasi oksigen yang tinggi (100%) pada bayi cukup bulanmeningkatkan angka mortalitas dan morbiditas. Hiperoksia dapat meningkatkan stresoksidatif pada bayi prematur oleh karena kadar anti oksidannya yang rendah. Peningkatanstres oksidatif akan mengakibatkan inflamasi dan berhubungan dengan terjadinya displasiabronkopulmonal dan gangguan integritas usus. Pemberian oksigen yang tinggi juga akanmemengaruhi mikrobiota aerob dan anaerob dalam usus oleh karena oksigen akan berdifusidari mukosa usus ke dalam lumen usus. Belum diketahui berapa kadar FiO2 awal yang tepatpada resusitasi bayi prematur.Penelitian ini bertujuan menelaah dampak perbedaan pajanan konsentrasi oksigen awal padaresusitasi bayi prematur terhadap displasia bronkopulmonal, integritas mukosa, danmikrobiota usus.Penelitian ini merupakan penelitian uji klinis acak terkontrol tidak tersamar di IlmuKesehatan Anak, FKUI-RSCM dan RS Bunda Menteng pada bayi prematur (usia gestasi 25?32 minggu) yang mengalami distres pernapasan yang dirandomisasi untuk diberikanresusitasi dengan FiO2 awal 30% atau 50%. Kadar FiO2 disesuaikan untuk mencapai targetsaturasi oksigen (SpO2) 88?92% pada menit ke-10 dengan menggunakan pulse oxymetry.Luaran primer berupa angka kejadian DBP dan luaran sekunder berupa penanda stresoksidatif (rasio GSH/GSSG dan MDA darah tali pusat dan hari ke-3), penanda gangguanintegritas usus (alpha-1 antitrypsin), dan mikrobiota usus (polymerase chain reaction) padafeses hari 1?3 dan hari ke-7.Selama periode Januari?September 2015, terdapat 84 bayi yang direkrut (masing-masing 42bayi pada kelompok 30% dan 50%). Tidak ada perbedaan bermakna angka kejadian DBPpada kelompok FiO2 30% vs. 50%, yaitu 42,8% vs. 40,5% (intention to treat analysis) dan25% vs. 19,4% (per protocol analysis). Juga tidak ada perbedaan bermakna penanda stresoksidatif (rasio GSH/GSSG dan kadar MDA), kadar AAT, dan mikrobiota usus pada keduakelompok. Mikrobiota anaerob fakultatif lebih tinggi dibandingkan dengan mikrobiotaanaerob pada hari ke-7 pada kedua kelompok.Pada bayi prematur dengan usia gestasi 25?32 minggu yang diresusitasi dengan FiO2 awal30% vs. 50% tidak dijumpai perbedaan yang bermakna angka kejadian DBP, penanda stresoksidatif, gangguan integritas mukosa usus (AAT), dan mikrobiota usus. Oleh karena itu,pemberian FiO2 awal 30% hingga 50% selama resusitasi sama amannya untuk bayi prematur

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ABSTRACTResuscitation with high oxygen levels (100%) in term infants increases mortality andmorbidity rates. Hyperoxia can increase oxidative stress in premature infants due to its lowantioxidant level. The increased oxidative stress will cause inflammation and it is associatedwith the development of bronchopulmonary dysplasia (BPD) as well as intestinaldysintegrity. The administration of high oxygen levels will also affect aerobic and anaerobicintestinal microbiota as the oxygen will diffuse from intestinal mucosa into the lumen. Theappropriate initial FiO2 level during the resuscitation of premature infants has not beenknown.This study aims to analyze an impact on the difference of exposure to initial oxygenconcentration in resuscitation of premature infants against bronchopulmonary dysplasia,mucosal integrity, and intestinal mucosa.The study was an unblinded randomized controlled clinical trial, in Child Health DepartmentUniversity of Indonesia, Cipto Mangunkusumo Hospital, and Menteng Bunda Hospital inJakarta, which was conducted in premature infants (25?32 weeks of gestational age) whoexperienced respiratory distress and were randomized for receiving resuscitation using 30%or 50% initial FiO2. The FiO2 levels were adjusted to achieve target oxygen saturation (SpO2)of 88?92% on the 10th minute using pulse oximetry. The primary outcome was incidence ofBPD; while the secondary outcome was markers of oxidative stress (ratio of GSH/GSSG andMDA in umbilical cord blood and on the 3rd day), intestinal dysintegrity (AAT) andintestinal microbiota (using PCR) found in fecal examination on day 1?3 and on the 7th day.During the period between January and September 2015, there were 84 infants recruited(there were 42 infants in each group of the 30% and 50% FiO2). There was no significantdifference on BPD incidence between 30% and 50% FiO2 groups, i.e. 42.8% vs. 40.5%(intention to treat analysis) and 25% vs. 19.4% (per protocol analysis). There was also nosignificant difference on oxidative stress markers (ratio of GSH/GSSG and MDA levels),AAT levels, and changes of facultative anaerobic and anaerobic microbiota in both groups.However, there was a higher level of facultative anaerobic microbiota compared to anaerobicmicrobiota on the 7th day in both groups.In premature infants with 25?32 weeks of gestational age who were resuscitated using 30%vs. 50% initial FiO2 level, significant differences were found in terms of BPD incidence,oxidative stress markers (ratio of GSH/GSSG and MDA), AAT (intestinal mucosa integrity)and intestinal microbiota. Therefore, it is concluded that the administration of 30% to 50%initial FiO2 are both equally safe for premature infants during resuscitation."

"ABSTRAKRefluks laringofaring (RLF) pada anak merupakan kelainan yang sering ditemukandan dihubungkan dengan peningkatan insidens berbagai penyakit saluran napas dangangguan tumbuh kembang, oleh karena itu diperlukan instrumen diagnosis yang tepatuntuk penatalaksanaanya. Sampai saat ini, instrumen terstandarisasi belum ada,sehingga diperlukan satu cara untuk mendiagnosis secara mudah, murah, nyaman, tidakinvasif namun mempunyai nilai diagnosis tinggi. Pada orang dewasa, RLF sering kalidikaitkan dengan Hipertrofi Tonsil Lingual (HTL) dan keberadaan DNA HumanPapillomavirus (HPV), namun hal ini belum dapat dibuktikan pada anak. Penelitian inibertujuan untuk mendapatkan instrumen diagnostik RLF serta melihat hubungan antaraRLF dan HTL dan keberadaan DNA HPV pada RLF dengan HTL.Penelitian ini merupakan studi potong lintang dengan 3 desain penelitian, yaitu ujidiagnostik kuesioner Skor Gejala Refluks (SGR) dan Skor Temuan Refluks (STR)dibandingkan dengan pHmetri 24 jam, dilanjutkan dengan studi kasus kontrol untukmenilai hubungan RLF dan HTL, serta uji melihat keberadaan HPV DNA pada HTLdengan RLF dengan cara Linear Array genotyping. Kriteria inklusi adalah anak berusia5‒18 tahun, memiliki beberapa keluhan seperti banyak riak di tenggorok, sering nyerimenelan, rasa tersangkut dan mengganjal di tenggorok, mendehem, tersedak, bersuaraserak dan batuk kronik. Kemudian dilakukan pemeriksaan nasofaringolaringoskopiuntuk menilai keadaan faring dan laring dan pemasangan pHmetri. Apabila pasien RLFterdapat HTL derajat 2 dan 3, dilakukan biopsi tonsil lingual untuk menilai keberadaanDNA HPV.Dari hasil penelitian ini, diperoleh satu instrumen baru yang terdiri dari keluhanberdehem, batuk mengganggu dan choking, disertai kelainan pita suara dan edemasubglotik. Instrumen dengan titik potong 4, mempunyai nilai diagnostik yang baikdengan nilai sensitivitas 75%, spesifisitas 76%, Nilai Prediksi Positif 80% dan NilaiPrediksi Negatif 71%. Instrumen baru ini dapat digunakan untuk mendiagnosis RLFpada anak. Tidak terdapat hubungan bermakna antara HTL dengan RLF dan keberadaanHPV DNA tidak terdeteksi pada HTL pasien RLF.

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ABSTRACTLaryngopharyngeal reflux (LPR) is common condition in children which is connectedto the increased incidence of airway problems and a developmental delay, therefore areliable diagnostic tool is required to manage the condition. There is no standardizedinstrument to diagnose LPR yet, consequently, obtaining an instrument which is costeffective, simple, convenient, non-invasive but yield a good diagnostic values(sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value(NPV)) is essential. In adult, LPR is frequently linked to Lingual Tonsil Hypertrophy(LTH) and the presence of HPV DNA in its tissue, however those findings have notbeen confirmed in pediatric population. The aim of this study is to obtain a gooddiagnostic instrument for LPR, to observe the relationship between LPR and LTH andto identify the existence of HPV DNA in LTH of patient with LPR.A diagnostic study was done comparing adult questionaires for LPR i.e. RefluxSymptom Index (RSI) and Reflux Finding Score (RFS) with 24 hour pHmetry, followedby a case control study to determine the relationship between LPR and LTH and acrossectional study to evaluate the existence of HPV DNA with Linear Arraygenotyping in LTH. The inclusion criteria are age between 5‒18 years old, with thecomplain of phleghmy throat, frequent odinophagia, the sensation of lump in the throat,frequent throat clearing, choking episode, hoarseness and chronic cough. Then the patientunderwent nasopharyngolaryngoscopy for laryngeal evaluation followed by pHmetryinsertion. If LPR is confirmed, the biopsy will be taken from LTH, to see the existenceof HPV DNA.A new diagnostic instrument, consists of frequent throat clearing, annoying cough,choking, vocal cords abnormalities, and subglottic edema has been developed and itdemonstrates a good diagnostic outcome. The cut-off is score 4, which produced 75%sensitivity, 76% specificity, 80% NPP, 71% NPN. Therefore, this instrument can beapplied to diagnose LPR in children. Neither a significant relationship between LPR andHTL nor the existence of HPV DNA are demonstrated"