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Abstrak :
ABSTRAK
Latar belakang: Sejak dilaporkan pertama kali pada tahun 1981 di Amerika Serikat, penyebaran Acquired Immune Deficiency Syndrome (AIDS) di seluruh dunia termasuk Indonesia terjadi dengan pesat. Saluran pencernaan merupakan target utama infeksi HIV. Enteropati terjadi pada 15-70% kasus anak. Enteropati dapat terjadi walaupun tanpa gejala gastrointestinal. Kondisi enteropati dapat menimbulkan perburukan gejala gastrointestinal, kegagalan pertumbuhan dan menyebabkan pasien mengarah pada wasting. Enteropati dideteksi dengan pemeriksaan alpha 1 antitripsin. Tujuan: (1) Mengetahui proporsi enteropati yang terjadi pada anak dengan AIDS stadium lanjut tanpa gejala gastrointestinal. (2) Mengetahui karakteristik enteropati yang terjadi pada anak dengan AIDS stadium lanjut tanpa gejala gastrointestinal. (3) Mengetahui hubungan antara enteropati dengan usia, status gizi, status imunodefisiensi, jenis dan lama terapi ARV serta lama sakit anak dengan AIDS stadium lanjut tanpa gejala gastrointestinal. Metode: Penelitian potong lintang deskriptif dan analitik yang dilakukan di Poliklinik Alergi Imunologi Departemen Ilmu Kesehatan Anak FKUI- RSCM antara bulan Agustus sampai dengan November 2015 terhadap anak dengan AIDS stadium lanjut berusia 0 - 18 tahun tanpa gejala gastrointestinal. Faktor risiko dianalisis bivariat dan multivariat. Hasil: Total subjek penelitian berjumlah 70 subjek (35 lelaki dan 35 perempuan). Enteropati terjadi pada 31 subjek. Enteropati lebih banyak ditemukan pada anak perempuan, usia >60 bulan, mengalami malnutrisi, tidak ada imunodefisiensi, obat antiretroviral lini kedua dan ketiga, lama pengobatan 0-59 bulan dan lama sakit 059 bulan. Pada analisis bivariat tidak didapatkan faktor risiko yang bermakna. Pada analisis multivariat didapatkan lama sakit 0-59 bulan dengan nilai OR 3,451 (IK95% 1,026-11,610) merupakan faktor risiko yang berperan dalam terjadinya enteropati pada anak dengan AIDS stadium lanjut tanpa gejala gastrointestinal. Simpulan : Proporsi enteropati pada anak dengan AIDS stadium lanjut tanpa gejala gastrointestinal sebanyak 31 dari 70 subjek. Faktor risiko yang berperan adalah lama sakit 0-59 bulan. ABSTRACT
Background: HIV/AIDS is a global pandemic. Digestive tract is a major target for HIV infection. The digestive-absorptive functions are impaired, occurring in 1570% of children. Enteropathy contributes to gastrointestinal manifestation, growth failure and further immune derangement, leading to wasting. The diagnostic approach includes alpha 1 antitrypsin fecal level. Objective: (1) to describe frequency of enteropathy in advanced stages of AIDS children without gastrointestinal manifestation, (2) to describe characteristic of children with advanced stages of AIDS without gastrointestinal manifestation who develop enteropathy, (3) to investigate the role of age, nutritional status, immunodeficiency status, type and duration of antiretroviral therapy, and duration of illness as risk for enteropathy in advanced stages of AIDS children without gastrointestinal manifestation. Methods: A descriptive and analytic cross-sectional study was conducted at Pediatric Allergy-Immunology Outpatient Clinic RSCM between August to November 2015. The inclusion criteria was advanced stages of AIDS children age 0-18 years old without gastrointestinal manifestation. Risk factors were analyzed with bivariate and multivariate analysis. Results: Seventy children fulfilled the study criteria (35 males and 35 females). Thirty-one subjects were diagnosed as enteropathy. Most subjects are female, age >60 month-old, malnutritional status, no immunodeficiency, received second and third line antiretroviral regimen with duration 0-59 months and duration of illness 0-59 months. Bivariate analysis showed that no factor was significantly associated with enteropathy. Based on multivariate analysis, duration of illness 0-59 months is a significant risk factor with OR 3.451 (CI 1.026-11.610). Conclusions: The proportion enteropathy in advanced stages of AIDS children without gastrointestinal manifestation is 31/70. Patients who had been diagnosed as advanced stage of HIV/AIDS for 0-59 months are more likely to develop enteropathy.;Background: HIV/AIDS is a global pandemic. Digestive tract is a major target for HIV infection. The digestive-absorptive functions are impaired, occurring in 1570% of children. Enteropathy contributes to gastrointestinal manifestation, growth failure and further immune derangement, leading to wasting. The diagnostic approach includes alpha 1 antitrypsin fecal level. Objective: (1) to describe frequency of enteropathy in advanced stages of AIDS children without gastrointestinal manifestation, (2) to describe characteristic of children with advanced stages of AIDS without gastrointestinal manifestation who develop enteropathy, (3) to investigate the role of age, nutritional status, immunodeficiency status, type and duration of antiretroviral therapy, and duration of illness as risk for enteropathy in advanced stages of AIDS children without gastrointestinal manifestation. Methods: A descriptive and analytic cross-sectional study was conducted at Pediatric Allergy-Immunology Outpatient Clinic RSCM between August to November 2015. The inclusion criteria was advanced stages of AIDS children age 0-18 years old without gastrointestinal manifestation. Risk factors were analyzed with bivariate and multivariate analysis. Results: Seventy children fulfilled the study criteria (35 males and 35 females). Thirty-one subjects were diagnosed as enteropathy. Most subjects are female, age >60 month-old, malnutritional status, no immunodeficiency, received second and third line antiretroviral regimen with duration 0-59 months and duration of illness 0-59 months. Bivariate analysis showed that no factor was significantly associated with enteropathy. Based on multivariate analysis, duration of illness 0-59 months is a significant risk factor with OR 3.451 (CI 1.026-11.610). Conclusions: The proportion enteropathy in advanced stages of AIDS children without gastrointestinal manifestation is 31/70. Patients who had been diagnosed as advanced stage of HIV/AIDS for 0-59 months are more likely to develop enteropathy.;Background: HIV/AIDS is a global pandemic. Digestive tract is a major target for HIV infection. The digestive-absorptive functions are impaired, occurring in 1570% of children. Enteropathy contributes to gastrointestinal manifestation, growth failure and further immune derangement, leading to wasting. The diagnostic approach includes alpha 1 antitrypsin fecal level. Objective: (1) to describe frequency of enteropathy in advanced stages of AIDS children without gastrointestinal manifestation, (2) to describe characteristic of children with advanced stages of AIDS without gastrointestinal manifestation who develop enteropathy, (3) to investigate the role of age, nutritional status, immunodeficiency status, type and duration of antiretroviral therapy, and duration of illness as risk for enteropathy in advanced stages of AIDS children without gastrointestinal manifestation. Methods: A descriptive and analytic cross-sectional study was conducted at Pediatric Allergy-Immunology Outpatient Clinic RSCM between August to November 2015. The inclusion criteria was advanced stages of AIDS children age 0-18 years old without gastrointestinal manifestation. Risk factors were analyzed with bivariate and multivariate analysis. Results: Seventy children fulfilled the study criteria (35 males and 35 females). Thirty-one subjects were diagnosed as enteropathy. Most subjects are female, age >60 month-old, malnutritional status, no immunodeficiency, received second and third line antiretroviral regimen with duration 0-59 months and duration of illness 0-59 months. Bivariate analysis showed that no factor was significantly associated with enteropathy. Based on multivariate analysis, duration of illness 0-59 months is a significant risk factor with OR 3.451 (CI 1.026-11.610). Conclusions: The proportion enteropathy in advanced stages of AIDS children without gastrointestinal manifestation is 31/70. Patients who had been diagnosed as advanced stage of HIV/AIDS for 0-59 months are more likely to develop enteropathy.

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Latar belakang. Epilepsi fokal merupakan jenis epilepsi terbanyak pada anak. Kemungkinan untuk terjadinya epilepsi intraktabel pada epilepsi fokal lebih besar dibandingkan dengan epilepsi umum. Data mengenai faktor risiko epilepsi fokal intraktabel masih sangat sedikit. Perlu dilakukan penelitian lebih lanjut untuk mengetahui strategi pengobatan dan konseling bagi pasien dan keluarga. Tujuan. (1) mendapatkan frekuensi terjadinya epilepsi intraktabel pada anak dengan epilepsi fokal. (2) mengetahui karakteristik pasien epilepsi fokal yang kontrol ke poliklinik Neurologi Anak. (3) mengetahui apakah usia awitan, etiologi epilepsi, frekuensi awal serangan, status perkembangan motor kasar awal, respon terapi awal, gambaran EEG awal, dan gambaran CT-Scan/MRI kepala dapat memprediksi kemungkinan terjadinya epilepsi intraktabel pada pasien anak dengan epilepsi fokal. (4) mengetahui apakah evolusi status perkembangan motor kasar, dan evolusi EEG epileptiform dapat memprediksi terjadinya epilepsi intraktabel. Metode penelitian. Desain penelitian adalah kohort retrospektif dan dilakukan poliklinik rawat jalan Neurologi Anak di RSCM sejak November 2013 sampai dengan Februari 2014 terhadap anak epilepsi fokal hingga usia 18 tahun, dengan lama pengobatan minimal 6 bulan. Faktor risiko dianalisis bivariat dan multivariat. Hasil penelitian. Angka kejadian epilepsi fokal intraktabel adalah 35 (39%).Usia subjek terbanyak adalah usia>3 tahun sebanyak 81(90%) subjek. Pada analisis bivariat didapat faktor risiko bermakna adalah etiologi kejang simtomatik (OR 6,12 IK95% 2,08-18,04), frekuensi kejang>5x/hari (OR 3,91 IK95% 1,43-10,75), respon awal terapi buruk (OR 233,14 IK95% 27,40-1983,27), EEG awal abnormal (OR 4,51 IK95% 1,82-11,17), MRI abnormal (OR 10,38 IK95% 2,91-37,06), evolusi status perkembangan motor kasar buruk (OR 21,62 IK95% 2,62-178,1), dan evolusi EEG epileptiform buruk (OR 25 IK95% 7,71-81,03). Pada analisis multivariat didapatkan respon awal terapi buruk dengan nilai OR136,00 (IK95% 14,79 sampai 1250,08), dan evolusi EEG epileptiform buruk dengan nilai OR 10,00 (1,68 sampai 59,35) merupakan faktor risiko yang berperan untuk menjadi epilepsi fokal intraktabel. Simpulan. Angka kejadian epilepsi fokal intraktabel sebanyak 39%. Faktor risiko yang berperan adalah respon terapi awal buruk, dan evolusi EEG epileptiform buruk.

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Background. Epilepsy focal is the most common type epilepsy in children. The chance to be intractable epilepsy is higher than general epilepsy. Therefore, study of the risk factors to predict intractable epilepsy is the utmost importance to conduct the treatment strategy and consult the patients and family. Objective. (1) to determine the characteristic focal epilepsy in children (2) to determine the frequency of intractable focal epilepsy (3) to identify and analyze the association of early risk factors including the onset of seizure, frequency of seizure, etiology of epilepsy, gross motor developmental status, the response of antiepileptic drugs, the electroencephalogram (EEG), and magnetic resonance imaging (MRI) / computed tomography (CT) Scan findings with intractable focal epilepsy, (4) to identify and analyze the relationship between the evolution factors including the evolution of EEG epileptiform, and the evolution of gross motor development with intractable focal epilepsy. Methods. Retrospective cohort study was conducted in child neurology outpatient clinics in Cipto Mangunkusumo Hospital Jakarta on November 2013 to February 2014. Inclusion criteria was children with epilepsy focal who was treated with antiepileptic drugs at least 6 month therapy until 18 years old age. Patients with febrile convulsions; central nervous system infections; neurodegenerative, neurometabolic diseases; and catastrophic epileptic syndromes with poor prognosis were excluded from the study. Data were analyzed using the IBM SPSS for Windowsv.17 software (IBM, New York, USA). Results. The proportion of intractable focal epilepsy is 35 (39%). The most of children is >3 years old 81 (90%). Bivariate analysis showed that significantly early risk factors are symptomatic epileptic (OR = 6.12; 95%CI 2.08-18.04), frequency of seizure >5x/day (OR = 3.91; 95%CI 1.43-10,75), gross motor developmental delay (OR = 233.14; 95%CI 27.40-1983.27), early abnormal EEG wave (OR = 4.51; 95%CI 1.82-11.17), abnormal MRI (OR = 10.38; 95%CI 2.91-37.06), poor gross motor developmental evolution (OR = 21.62; 95%CI 2.62-178.1), and poor the EEG epileptiform evolution (OR = 25; 95%CI 7.71-81.03). Multivariate logistic regression analysis revealed that an initial non response to antiepileptic drugs (OR = 136.00; 95%CI 14.79-1250.08), and the poor evolution of EEG epileptiform (OR =10.00; 95%CI 1.68-59.35) were all found to be significant and independent risk factors for intractable focal epilepsy. Conclusion. The present study reveals that the early non response to antiepileptic drugs, and poor of EEG epileptiform evolution are strongly associated with intractable focal epilepsy.

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[ABSTRAK
Latar belakang. Kolitis infeksi adalah proses inflamasi pada usus besar yang disebabkan oleh infeksi bakteri patogen, seperti Shigella, Salmonella, E.coli, dan Campylobacter. Dibuktikan dengan pemeriksaan kultur tinja, tetapi biayanya cukup mahal, perlu waktu dan tidak selalu tersedia di semua fasilitas kesehatan. Rekomendasi WHO jumlah lekosit lebih dari 10 per LPB untuk Shigella disentriae dengan klinis disentri dan merupakan indikasi pemberian antibiotika. Sering ditemukan anak diare dengan lekosit kurang dari 10/LPB tetapi hasil kultur positif bakteri patogen. Mencari hubungan jumlah lekosit tinja dengan kejadian diare yang disebabkan infeksi bakteri patogen yang memerlukan terapi antibiotika. Tujuan. Mengetahui prevalensi, sebaran bakteri patogen, nilai leukosit mikroskopik tinja pada anak dengan kolitis infeksi bakteri. Mengetahui hubungan leukosit tinja dengan kultur tinja dan pola sensitivitas antibiotika pada kolitis infeksi bakteri. Metode. Penelitian deskriptif dengan metode potong lintang dan uji diagnostik untuk menilai sensitivitas hitung leukosit tinja untuk mendiagnosis kolitis infeksi bakteri. Penelitian dilakukan di Rumah Sakit Umum Pusat Rujukan Nasional Cipto Mangunkusumo, Jakarta, dari bulan Januari- Juni 2015. Hasil. Dari 45 subjek penelitian ditemukan kultur positif pada 19 subjek (42,2%). Bakteri terbanyak yang ditemukan adalah E.coli (79%), Salmonella sp. (10,5%), dan C.difficille (10,5%). Pada titik potong ROC ditemukan nilai lekosit >8 per LPB dengan sensitivitas 0,654 dan spesifisitas 0.632. E.coli masih memperlihatkan sensitivitas cukup tinggi terhadap kloramfenikol dan siprofloksasin tetapi tidak terhadap sefiksim. Salmonella sp. sensitif terhadap kloramfenikol, sefiksim, dan seftriakson, sedangkan C. difficile sensitif terhadap Seftriakson. Simpulan. Pada penelitian ini ditemukan sebanyak 19 (42,2%) subyek penderita diare hasil kultur tinja positif bakteri patogen dan pada titik potong ROC ditemukan nilai lekosit > 8 per LPB dengan sensitivitas 65.4% dan spesifisitas 63.2%. Pada pola sensitivitas antibiotika, E.coli sensitif terhadap kloramfenikol dan siprofloksasin dan Salmonella dan C.difficile sensitif terhadap seftriakson.

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ABSTRACT
Background. Infective colitis is an inflammatory process in the colon caused by pathogenic bacterial infection, such as Shigella, Salmonella, E.coli, and Campylobacter. Diagnosis is made by fecal culture, but the cost is relatively expensive, time-consuming, and not readily available in every health facility. WHO recommends that fecal leukocyte more than 10 per HPF for the diagnosis of Shigella disentriae with clinical symptom of dysentriae and indicated for antibiotic treatment. Often there are diarrheic children with leukocyte less than 10/HPF but the culture is positive for pathogenic bacteria. This study would like to look for the relationship between fecal leukocyte and incidence of diarrhea caused by pathogenic bacteria infection that requires antibiotic therapy. Objective. To study the prevalence, distribution of pathogenic bacteria, leukocyte count in fecal microscopic test in children with bacterial infective colitis. To study the relationship between fecal leukocyte and fecal culture with sensitivity pattern of antibiotics in bacterial infective colitis. Methods. Descriptive, cross-sectional study and diagnostic test to study the sensitivity of fecal leukocyte count in diagnosing bacterial infective colitis. Study was performed in the Cipto Mangunkusumo Hospital, Jakarta, from January to June 2015. Results. From 45 study subjects, positive culture was found in 19 subjects (42.2%), and the most common bacteria were E.coli (79%), Salmonella sp. (10.5%), and C. difficille (10,5%). At the ROC we found leukocyte count >8 per HPF as cutoff point with 0.654 sensitivity and 0.632 specificity. E. coli still showed relatively high sensitivity to chloramphenicol and ciprofloxacin, but not to cefixime. Salmonella sp. were sensitive to chloramphenicol, cefixime, and ceftriaxone, while C. difficile were sensitive to ceftriaxone. Conclusion. In this study there were 19 (42.2%) subjects with diarrhea, with positive fecal culture for pathogenic bacteria. At the ROC cutoff point we found leukocyte count > 8 per HPF with 65.4% sensitivity and 63.2% specificity. On the antibiotic sensitivity pattern, E. coli was sensitive to chloramphenicol and ciprofloxacin, while Salmonella dan C.difficile were sensitive to ceftriaxone, Background. Infective colitis is an inflammatory process in the colon caused by pathogenic bacterial infection, such as Shigella, Salmonella, E.coli, and Campylobacter. Diagnosis is made by fecal culture, but the cost is relatively expensive, time-consuming, and not readily available in every health facility. WHO recommends that fecal leukocyte more than 10 per HPF for the diagnosis of Shigella disentriae with clinical symptom of dysentriae and indicated for antibiotic treatment. Often there are diarrheic children with leukocyte less than 10/HPF but the culture is positive for pathogenic bacteria. This study would like to look for the relationship between fecal leukocyte and incidence of diarrhea caused by pathogenic bacteria infection that requires antibiotic therapy. Objective. To study the prevalence, distribution of pathogenic bacteria, leukocyte count in fecal microscopic test in children with bacterial infective colitis. To study the relationship between fecal leukocyte and fecal culture with sensitivity pattern of antibiotics in bacterial infective colitis. Methods. Descriptive, cross-sectional study and diagnostic test to study the sensitivity of fecal leukocyte count in diagnosing bacterial infective colitis. Study was performed in the Cipto Mangunkusumo Hospital, Jakarta, from January to June 2015. Results. From 45 study subjects, positive culture was found in 19 subjects (42.2%), and the most common bacteria were E.coli (79%), Salmonella sp. (10.5%), and C. difficille (10,5%). At the ROC we found leukocyte count >8 per HPF as cutoff point with 0.654 sensitivity and 0.632 specificity. E. coli still showed relatively high sensitivity to chloramphenicol and ciprofloxacin, but not to cefixime. Salmonella sp. were sensitive to chloramphenicol, cefixime, and ceftriaxone, while C. difficile were sensitive to ceftriaxone. Conclusion. In this study there were 19 (42.2%) subjects with diarrhea, with positive fecal culture for pathogenic bacteria. At the ROC cutoff point we found leukocyte count > 8 per HPF with 65.4% sensitivity and 63.2% specificity. On the antibiotic sensitivity pattern, E. coli was sensitive to chloramphenicol and ciprofloxacin, while Salmonella dan C.difficile were sensitive to ceftriaxone]

Abstrak :
Latar Belakang: Beberapa probiotik menunjukkan manfaat dalam mempersingkat durasi dan mengurangi kejadian diare dan dapat meningkatkan status gizi. Namun, informasi mengenai efek jangka panjang pada integritas usus dan pertumbuhan masih terbatas. Metode: Studi tindak lanjut tahun ke-10 ini dilakukan pada 155 remaja usia 11-18 tahun yang pernah mengikuti studi intervensi pemberian susu rendah laktosa yang mengandung kalsium dosis regular (440 mg/hari) sebagai kelompok kontrol, kalsium dosis regular + probiotik Lactobacillus reuteri DSM 17938 (Kelompok Reuteri), dan kalslium dosis regular + probiotik Lactobacillus casei CRL 431 (Kelompok Casei). Tujuan dari penelitian ini adalah untuk mengevaluasi integritas usus, pertumbuhan, dan morbiditas setelah jangka waktu 10 tahun dari subjek penelitian sebelumnya. Integritas usus dinilai dengan memeriksa rasio laktulosa/manitol, dengan nilai cut off untuk integritas usus yang baik adalah ≤ 0,1. Sedangkan status pertumbuhan dinilai menggunakan nilai Z-score TB/U dan IMT/U. Hasil: Rerata usia subjek penelitian adalah 15.3 tahun, dengan nilai median rasio laktulosa manitol adalah 0,23, dengan proporsi untuk status integritas usus buruk sebesar 87,1 %. Rerata nilai Z-score TB/U adalah -1,11, dan rerata nilai Z-score IMT/U adalah -0,15. Terdapat perbedaan yang signifikan nilai Z-score TB/U antara kelompok Casei dibandingkan dengan kontrol (p = 0,045) dan juga antara kelompok Reuterii dibandingkan dengan kontrol (p = 0,034). Tidak terdapat perbedaan yang signifikan dalam status integritas usus, BMIZ, dan morbiditas antara 3 kelompok perlakuan (p = 0,454; p = 0,565; p = 0,086 masing-masing). Kesimpulan: Probiotik pada anak dapat ditoleransi dengan baik dan mendukung pertumbuhan normal hingga remaja. Efek signifikan dari suplementasi probiotik masa kanak-kanak terlihat pada nilai Z-score TB/U, sementara tidak ada efek signifikan pada integritas usus, nilai Z-score IMT/U, dan morbiditas pada remaja. ......Background: Some probiotics showed benefits in shortening the duration and reducing the incidence of diarrhea and may improve nutritional status. However, information on its long-term effects on intestinal integrity and growth is still limited. Method: This 10th year follow-up study was conducted in 155 adolescents aged 11-18 years who had participated in an intervention study given low-lactose milk containing regular-dose calcium (440 mg/day) as a control group, regular calcium dose + probiotic Lactobacillus reuteri DSM 17938 (Reuteri group), and regular doses of calcium + probiotics Lactobacillus casei CRL 431 (Casei group). The objective of the current study was to evaluate gut integrity, growth, and morbidity through 10 years of age in participants from the previous trial study. Gut integrity was assessed by examining the ratio of lactulose/mannitol, with the cut off value for good intestinal integrity is ≤ 0.1. While growth status was assessed using the value of height-for-age Z-score (HAZ) and BMI-for-age Z-score (BMIZ). Results: The average age of the study subjects was 15.3 years, with the median lactulose mannitol ratio was 0.23. Of the 155 adolescents who participated the study, 135 (87.1 %) had poor intestinal integrity. Mean value for HAZ was -1.11, and the mean value for BMIZ was -0.15. There was significant difference in HAZ between Casei group compared to control (p = 0.045) and also between Reuterii group compared to control (p = 0.034). There was no significant difference in intestinal integrity status, BMIZ, and morbidity among 3 treatment groups (p = 0.454; p = 0.565; p = 0,086 respectively). Conclusion: Childhood probiotics are well tolerated and support normal growth until adolescence. Significant effect of childhood probiotic supplementation was seen on HAZ, while no significant effect on intestinal integrity, BMIZ, and morbidity in adolescence.

Abstrak :
Latar Belakang: Low cardiac output syndrome (LCOS) adalah salah satu komplikasi berat yang sering terjadi pascabedah jantung terbuka dengan insidens 25-32%. LCOS dapat terjadi akibat proses inflamasi melalui jalur inflamasi dan komplemen setelah pintas jantung-paru (PJP). Diperlukansuatu marker inflamasi yang dapat memprediksi terjadinya LCOS. Pada penelitian ini dilakukan pemeriksaan rasio neutrofil-limfosit (neutrophil lymphocyte ratio, NLR) yang merupakan marker inflamasi sederhana dan rutin dilakukan, tetapi penggunaannya sebagai prediktor dalam menentukan LCOS belum banyak dilaporkan. Tujuan: Mengetahui peran NLR prabedah dan 0, 4, dan 8 jam pascabedah sebagai prediktor kejadian LCOS pascabedah jantung terbuka anak dengan penyakit jantung bawaan (PJB). Metode: Penelitian menggunakan uji prognostik dengan desain kohort prospektif, dilaksanakan pada 1 Desember 2020 hingga 30 Juni 2021 di cardiac intensive care unit (CICU) Pelayanan Jantung Terpadu (PJT) RSUPN Dr. Cipto Mangunkusumo, Jakarta. Hasil: Dari 90 subyek didapatkan 25 subyek (27,8%) mengalami LCOS. Nilai NLR prabedah berperan dalam memprediksi kejadian LCOS (AUC 70), dengan cut off ≥0,88 (p=0,027) didapatkan sensitivitas dan spesifisitas 64% dan 64,62% (IK 95%, 57-83). Sedangkan NLR 0 jam pascabedah memiliki nilai prediksi yang baik (AUC 81) terhadap kejadian LCOS, dengan cut off ≥4,73 (p<0,0001) didapatkan sensitivitas dan spesifisitas masing-masing 80% (IK 95%, 69-94). Selanjutnya NLR 4 dan 8 jam pascabedah memiliki nilai prediksi yang sangat baik (AUC 97 dan 98) terhadap kejadian LCOS, dengan cut off berturut-turut adalah ≥6,19 (p<0,0001) dan ≥6,78 (p<0,0001) didapatkan sensitivitas dan spesifisitas berturut-turut adalah 92% dan 96% (IK 95%, 92-100), serta 92% dan 96,92% (IK 95%, 94-100). Kesimpulan: NLR prabedah dan 0, 4, dan 8 jam pascabedah terbukti berperan sebagai prediktor kejadian LCOS pascabedah jantung terbuka anak dengan PJB. ......Background: Low cardiac output syndrome (LCOS) is a severe complications that often occurs in children after open heart surgery, with an incidence 25-32%. It can occur as a result of inflammatory response involving the inflammatory and complement pathways after cardiopulmonary bypass (CPB). An inflammatory marker is needed to predict the occurrence of LCOS. In this study, an examination of the neutrophil-lymphocyte ratio (NLR) which is a simple and routine marker of inflammation is carried out, but its use as a predictor in determining LCOS has not been widely reported. Objective. We aimed to explore the role of preoperative and 0, 4, and 8 hours postoperative NLR as a predictor of LCOS after open heart surgery in children with congenital heart disease (CHD). Methods: This study used a prognostic test with a prospective cohort design, was done from 1st December 2020 until 30 th June 2021 at cardiac intensive care unit (CICU) Pelayanan Jantung Terpadu (PJT) RSUPN Dr. Cipto Mangunkusumo, Jakarta. Results: From 90 subjects, 27.8% (25 subjects) had LCOS. Preoperative NLR had a fair predictive value (AUC 70) for the incidence of LCOS, with a cut off value ≥0.88 (p=0.027) having a sensitivity and specificity of 64% and 64.62% (CI 95%, 57-83).While the NLR 0 hours post-operative also had a good predictive value (AUC 81) for the incidence of LCOS, with a cut off value ≥4.73 (p<0.0001) having a sensitivity and specificity of 80% (CI 95%, 69-94), respectively. Furthermore, NLR 4 and 8 hours post-operative had a very good predictive value (AUC 97 and 98) for the incidence of LCOS, with cut off value ≥6.19 (p<0.0001) and ≥6.78 (p<0.0001), having a sensitivity and specificity of 92% and 96% (CI 95%, 92-100), as well as 92% and 96.92% (CI 95%, 94-100). Conclusion: Preoperative and 0, 4, and 8 hours postoperative NLR can be a predictor of LCOS after open heart surgery in children with CHD.

Abstrak :
Pada anak usia sekolah, pertumbuhan linier ditentukan berdasarkan kriteria kurva pertumbuhan WHO/2007 dan CDC/2000 serta persentase tinggi badan menurut Waterlow/1977. Perbedaan kriteria yang digunakan akan menimbulkan perbedaan prevalens perawakan pendek. Penentuan kejar tumbuh anak juga masih mengalami perdebatan karena parameter kejar tumbuh dapat dinilai secara relatif (height-age z-score) dan absolut (height-age-differences). Kejar tumbuh linier yang terutama terjadi dalam 1000 hari pertama kehidupan dinilai dapat terus terjadi hingga usia sekolah. Studi potong lintang dilakukan pada 302 anak usia sekolah di Jakarta Barat. Semua anak diukur tinggi badan sewaktu penelitian dan saat subyek berusia 7 tahun. Perawakan pendek ditentukan dengan menggunakan kriteria WHO/2007, CDC/2000, dan persentase Waterlow/1977. Setiap kelompok usia diukur perbedaan nilai height-age z-score (HAZ) dan height-age-differences (HAD) dalam dua waktu pengukuran yang berbeda untuk melihat kejar tumbuh. Prevalens perawakan pendek pada anak usia sekolah berdasarkan kriteria WHO/2007 adalah 8,55%, berdasarkan CDC/2000 sebesar 13,75%, dan berdasarkan Waterlow/1977 sebesar 7,80%. Nilai Kappa WHO/2007 dan CDC/2000 adalah 0,5, WHO/2007 dan Waterlow/1977 adalah 0,8, sedangkan CDC/2000 dan Waterlow/1977 adalah 0,7. Nilai HAZ anak perempuan adalah -1,78 SD dan anak lelaki -1,44 SD. Nilai HAD anak perempuan adalah -10,83 cm untuk anak lelaki adalah -8,83 cm. Kesesuaian perawakan pendek anak WHO/2007 dan CDC/2000 memberikan hasil yang sama sebanyak 50%, WHO/2007 dan Waterlow/1977 memberikan hasil yang sama sebanyak 80%, sedangkan CDC/2000 dan Waterlow/1977 memberikan hasil yang sama sebanyak 70%. Kesan terdapat kejar tumbuh pada anak usia sekolah di Jakarta Barat berdasarkan adanya perbaikan nilai HAZ dan HAD pada pengukuran kedua dibandingkan dengan pengukuran pertama. ......Linear growth in school children is determined by using WHO/2007 and CDC/2000 growth chart, also height-age persentage as Waterlow/1977 criteria. Those classification resulted in different prevalence of short stature. Linear catch-up growth is considered to continue beyond the first thousand days of life, at least until school age. It could be relatively (height-age z score) or absolutely (height-age difference) assessed. A cross-sectional study was conducted in 302 school age children in West Jakarta. Body height was measured at 7 years old and at the time of study. Short stature was defined by using WHO/2007, CDC/2000, and height-age persentage as Waterlow/1977 criteria. Height-age z score (HAZ) and height age differences (HAD) was measured in each group to assess catch-up growth. The prevalence of short stature in school children was 8.55%, 13.75%, and 7.80%, according to WHO/2007, CDC/2000, and height-age persentage as Waterlow/1977 criteria, respectively. Kappa values were 0.5, 0.8, and 0.7, between WHO/2007-CDC/2000, WHO/2007-Waterlow/1977, and CDC/2000-Waterlow/1977, respectively. HAZ was -1.78 and -1.44 SD in female and male subjects, respectively. HAD was -10.83 and -8.83 cm in female and male subjects, respectively. WHO/2007 and Waterlow/1977 has the highest agreement, while WHO/2007 and CDC/2007 has the lowest agreement. Linear catch-up growth was observed among our subjects as determined by HAZ and HAD improvement compared to the first measurement.

Abstrak :
Latar Belakang: Air susu ibu merupakan nutrisi ideal untuk bayi yang direkomendasikan untuk diberikan secara eksklusif hingga usia 4-6 bulan. Air susu ibu mengandung zat bioaktif yang dapat mempercepat proses maturasi dan menjaga integritas mukosa usus. Pemeriksaan yang bersifat mudah, cepat, non-invasif dan terpercaya untuk menilai integritas mukosa usus yaitu alfa-1 antitripsin (AAT), calprotectin, dan IgA sekretorik (sIgA) feses. Tujuan: Mengetahui perbedaan integritas mukosa usus dengan mengukur kadar AAT, calprotectin dan sIgA feses pada subjek bayi ASI dan susu formula eksklusif (SF) dan mengetahui hubungan antara jenis asupan nutrisi dengan integritas mukosa usus bayi pada usia 4-6 bulan. Metode: Penelitian dilakukan pada bulan Juni-Oktober 2013. Subjek penelitian adalah bayi sehat berusia 4-6 bulan yang datang ke poliklinik anak RS St Carolus Jakarta dan yang bertempat tinggal di Kecamatan Pasar Minggu dan Cempaka Putih Jakarta. Kadar AAT, calprotectin, dan sIgA feses diukur menggunakan metode enzyme-linked immunosorbent assay (ELISA). Analisis statistik dilakukan untuk mencari hubungan pemberian ASI eksklusif dengan integritas mukosa usus dengan uji Kai kuadrat atau Fisher (analisis bivariat). Hasil: Penelitian dilakukan pada 80 subjek (ASI n=40, SF n=40). Tidak didapatkan perbedaan karakteristik yang bermakna pada kedua kelompok. Kelompok ASI memiliki nilai rerata kadar AAT feses yang lebih tinggi secara bermakna (p=0,02). Kelompok SF memiliki kadar calprotectin yang lebih tinggi namun tidak berbeda bermakna (p=0,443) dibanding dengan bayi ASI. Kelompok ASI memiliki median kadar sIgA yang lebih tinggi secara tidak signifikan (p=0,104) dibandingkan dengan bayi SF. Pada penelitian ini didapatkan hubungan yang bermakna antara pemberian nutrisi dengan peningkatan kadar AAT feses bayi ASI. Tidak didapatkan hubungan yang bermakna antara jenis asupan nutrisi dengan penurunan kadar calprotectin (p=0,65) dan peningkatan kadar sIgA feses (p=0,26). Simpulan: Bayi ASI eksklusif menunjukkan integritas mukosa usus yang lebih baik dari bayi SF eksklusif. Kadar AAT lebih tinggi secara signifikan pada bayi ASI eksklusif diduga berkaitan dengan AAT yang diperoleh dari ASI. ......Background: Breastmilk is recognised for its ideal nutritional benefits for babies and has been recommended to be given exclusively for 6 months of life. Breastmilk also known to have bioactive substances that could modulates the gastrointestinal maturation and maintain its mucosal integrity. Markers that are easy, non-invasive and reliable like fecal alpha-1 antitrypsin (AAT), calprotectin, and secretoric imunoglobulin A (sIgA) have been known as marker to asses gut wall integrity. Objective: To determine the difference of gut wall integrity based on fecal AAT, calprotectin, and sIg A level of exclusive breastmilk (BF) and formula feeding (FF) infant at 4-6 month of age. To determine the correlation between feeding type with gut wall integrity. Methods: The study was conducted from June to Oktober 2013. Subjects were babies of 4-6 months old who came to pediatric policlinic at St Carolus hospital, and live in Kecamatan Pasar Minggu and Kecamatan Cempaka Putih, Jakarta. The fecal markers analized with enzyme-linked immunosorbent assay (ELISA) methode. Chi square and Fischer test were used to analyze the correlation between feeding type and gut wall integrity (bivariate analysis). Results: There were 80 babies recruited (BF=40, FF=40). There were no statisticaly difference between the characteristics of two groups. The BF group showed higher fecal AAT level compared to FF group (p=0,02). The FF group showed a higher fecal calprotectin and the BF group had a higher level of fecal sIgA compared to BF group but not statisticaly different (p=0,443, p=0,104). There was significant correlation between fecal AAT level of babies with breastmilk feeding (p=0,02). There were no significant correlation between fecal calprotectin (p=0,65) and sIgA level with the feeding type (p=0,26). Conclusion: The BF babies had better mucosal integrity compared to FF babies. The fecal AAT level were significantly higher in breastmilk feeding babies and related with AAT from breastmilk.

Abstrak :
Bayi prematur memiliki risiko lebih tinggi untuk mengalami gagal tumbuh. Penelitian prospektif ini melibatkan subyek bayi dengan usia koreksi 0−24 bulan dengan riwayat prematur dan berat lahir rendah di RSUPN Dr. Cipto Mangunkusumo. Dilakukan identifikasi status gizi dan identifikasi perlambatan pertumbuhan dan faktor risikonya, kemudian dinilai luaran pertumbuhan pada satu bulan pasca intervensi nutrisi satu bulan. Total subyek yaitu 146 bayi usia koreksi 0−24 bulan dengan riwayat prematur dan BBLR, didapatkan status gizi berupa 84,9% gizi baik, 4,1% gizi kurang, 0,7% gizi buruk, 9,2% gizi lebih, dan 0,7% obesitas; 83,6% BB normal, 11,0% BB kurang, 4,8% BB sangat kurang, dan 0,7% BB lebih; dan 69,9% perawakan normal, 21,9% perawakan pendek, dan 8,2% perawakan sangat pendek. Perlambatan pertumbuhan dijumpai pada 23,3% dengan menggunakan kriteria peningkatan berat badan (BB) di bawah persentil 15 dari peningkatan BB yang diharapkan berdasarkan WHO 2006, dengan median usia koreksi 4,2 bulan, dan pada populasi late premature. Perlambatan pertumbuhan yang disebabkan oleh kurangnya asupan nutrisi yaitu sebesar 41,1%, dan sisanya ditemukan penyebab yang mendasarinya. Faktor risiko yang terkait dengan perlambatan pertumbuhan pada bayi prematur yaitu kurangnya asupan nutrisi sesuai dengan angka kecukupan gizi, usia koreksi 3−6 bulan, dan usia gestasi yang tergolong late premature. Dibandingkan dengan kelompok yang nonadherent, kelompok yang adherent terhadap intervensi nutrisi menunjukkan perbaikan yang bermakna pada seluruh indeks antropometri, baik BB/U, BB/PB, PB/U, maupun LK/U. Sebagai simpulan, dijumpai angka perlambatan pertumbuhan yang tinggi pada populasi bayi prematur khususnya pada usia koreksi 3−6 bulan dan late premature, dengan salah satu faktor risiko yang penting diperhatikan yaitu kurangnya asupan harian. Kepatuhan yang baik terhadap intervensi nutrisi dapat memperbaiki status gizi dan pertumbuhan. ......Preterm and low birth weight (LBW) infants have a higher risk of growth failure. This prospective study involved infants with a corrected age of 0−24 months with a history of prematurity and LBW at RSUPN Dr. Cipto Mangunkusumo. Identification of nutritional status and growth faltering and identification of risk factors were conducted at initial visit, then growth outcomes data was obtained at follow up visit after nutritional interventions. The nutritional status of 146 preterm and LBW infants with corrected age of 0−24 months were 84.9% well nourished, 4.1% undernourished, 0.7% severely undernourished, 9.6% overweight and 0.7% obese; 83,6% normal weight, 11,0% underweight, and 4,8% severely underweight; 69.9% normal stature, 21.9% short stature and 8,2% very short stature. Growth faltering was found in 23.3% infants using the criteria for weight increment below the 15th percentile based on WHO 2006, with median of corrected age of 4.2 months, and mostly happened in late preterm infants. Pure nutritional growth faltering was found in 41.1%, while the rest have underlying causes. Risk factors associated with growth faltering in premature infants are insufficiency of nutritional intake in accordance with recommended dietary allowance, corrected age of 3−6 months and late preterm. Compared with the nonadherent group, children who were adherent with standard behavioral and nutritional interventions showed a higher positive change in z scores for weight-for-age, weight-for-length, length-for-age, and head circumference-for-age. In conclusion, there is a high incidence of growth faltering in preterm and LBW infants, especially at the corrected age of 3−6 months and late preterm population, with an important risk factor is insufficiency of daily nutritional intake. Adherence to standardized nutritional interventions leads to improved nutritional status and growth.

Abstrak :
Latar belakang. Pembuatan stoma dan reseksi usus adalah tindakan pembedahan yang umum dilakukan pada anak dengan masalah bedah di sistem gastrointestinal. Salah satu komplikasi dari pembuatan stoma adalah high output stoma yang menyebabkan perawatan menjadi lebih lama. Tujuan. Penelitian ini bertujuan untuk mengetahui faktor risiko terjadinya high output stoma dan prediktor terhadap lama rawat, lama penggunaan nutrisi parenteral, dan kematian. Metode. Kami melakukan penelitian kohort retrospektif yang dilakukan di rumah sakit tersier rujukan di Indonesia. Subjek adalah pasien anak usia 0 bulan – 18 tahun dengan stoma di usus halus (enterostomi) selama periode Oktober 2019 – Desember 2023. Penelitian tahap I dilakukan pada semua subjek untuk melihat faktor risiko terjadinya high output stoma. Penelitian tahap II dilakukan pada subjek yang mengalami high output stoma untuk menilai prediktor terhadap lama rawat, lama penggunaan nutrisi parenteral, dan kematian. Hasil. Penelitian tahap I melibatkan 64 subjek. Kelompok usia terbanyak adalah usia neonatus (43,8%). Penyakit dasar terbanyak sebagai penyebab pembentukan stoma adalah perforasi intestinal (39,1%). High output stoma terjadi pada 48,4% subjek. Tidak ada faktor risiko teknik pembedahan yang secara signifikan menyebabkan high output stoma. Penelitian tahap II memasukkan 31 subjek yang mengalami high output stoma. Pada semua subjek, panjang usus halus berkorelasi dengan lama rawat (p = 0,033), lama penggunaan nutrisi parenteral (p = 0,032), dan berhubungan dengan kematian (p = 0,041). Kesimpulan. Panjang usus halus yang lebih pendek berhubungan dengan luaran yang lebih buruk pada pembentukan enterostomi pada anak. ......Backgrounds. Stoma creation and intestinal resection are common surgical procedures in children with surgical problems in the gastrointestinal system. One of the complications of creating a stoma is a high output stoma (HOS), which causes more prolonged treatment. Objectives. This study aims to determine the risk factors for HOS and predictors of length of stay, length of use of parenteral nutrition (PN), and death. Methods. We conducted a retrospective cohort study at a tertiary referral hospital in Indonesia. Subjects were pediatric patients aged 0 months – 18 years with a stoma in the small intestine (enterostomy) during the period October 2019 – December 2023. Phase I study was carried out on all subjects to examine at risk factors of HOS. Phase II study was conducted on subjects who experienced HOS to assess predictors of length of stay, length of PN use, and death. Results. Phase I study involved 64 subjects. The largest age group is neonates (43.8%). Intestinal perforation is the most common underlying disease that causes stoma formation (39.1%). There are no risk factors for surgical techniques that significantly cause HOS. Phase II study included 31 subjects who experienced HOS. In all subjects, the length of the small intestine was correlated with length of stay (p = 0.033), duration of PN use (p = 0.032), and was associated with mortality (p = 0.041). Conclusions. Shorter small intestinal length is associated with worse outcomes in enterostomy formation in children.

Abstrak :
Patogenesis sindrom nefrotik resisten steroid (SNRS) dan sindrom nefrotik sensitif steroid (SNSS) belum diketahui secara menyeluruh. Antioksidan seperti enzim glutation peroksidase (GPx) dan kofaktornya yaitu selenium diperkirakan berpengaruh dalam menghambat progresivitas penyakit sindrom nefrotik (SN). Namun sampai saat ini belum ada studi yang menilai peran selenium dalam patogenesis terjadinya SNRS dan SNSS. Penelitian ini bertujuan untuk membandingkan kadar selenium pada pasien SNSS dan SNRS menggunakan studi potong lintang. Penelitian dilakukan pada 81 pasien SNRS dan SNSS berusia 2-18 tahun yang datang ke poliklinik rawat jalan nefrologianak RSUPNCM pada bulan November-Desember 2019 dengan metode consecutive sampling. Hasil penelitan menunjukkan tidak ada perbedaan signifikan antara kadar selenium pada kedua kelompok. Peran selenium sebagai antioksidan terhadap patogenesis SNRS dan SNSS sulit dibuktikan karena patogenesis penyakit ini bersifat multifaktorial. Penelitian lanjutan dengan desain penelitian kasus kontrol dan pengukuran selenium serial diperlukan untuk memastikan hal ini. ......The pathogenesis of steroid resistant nephrotic syndrome (SRNS) and steroid sensitive nephrotic syndrome (SSNS) has not yet been fully known. Antioxidants such as glutathione peroxidase enzyme (GPx) and its cofactor, selenium, are thought to have an effect of slowing down the progress of nephrotic syndrome (NS). However, until now, there are no studies that evaluate the role of selenium in SNRS and SNSS’s pathogenesis. The purpose of this research is to compare the selenium levels of SNRS and SNSS patients using a cross-sectional study. This research was conducted on 81 SNRS and SNSS patients ages 2 to 18, who visited RSUPNCM’s pediatric nephrology outpatient clinic in November 2019 to December 2019, using consecutive sampling method. The result shows that there’s no significant difference in the selenium levels of both groups. Selenium’s role as an antioxidant for the pathogenesis of SNRS and SNSS is hard to prove because it is multifactorial. Advance research using a case-control study and a serial of selenium examination is needed to confirm this.