Hasil Pencarian  ::  Simpan CSV :: Kembali

"Latar belakang. Meskipun vaksin Bacille Calemette-Guerin telah menjadi program vaksinasi wajib di Indonesia, TB pada anak tetap prevalen sehingga penelitian ini akan mengevaluasi jaringan parut BCG dan hubungannya dengan kejadian TB ekstraparu (TB-EP) pada anak. Metode Penelitian. Pengambilan data dilakukan di Rumah Sakit Cipto Mangunkusumo Kiara dengan metode potong-lintang pada populasi anak terdiagnosis TB berdasarkan kriteria WHO dan konsensus IDAI. Hasil. Sebanyak 246 pasien anak dengan jangkauan usia 2 bulan -18 tahun terdiagnosis TB. Sebesar 127 anak (51,6%) mengalami TB-EP, dengan prevalensi TB tulang, KGB dan abdomen secara berurutan 13%, 10,9%, dan 6,6%. Mayoritas pasien TB EP adalah laki-laki (55,2%) dan berada dalam kelompok usia 6-14 tahun (60%). Riwayat kontak dengan kasus TB-EP ditemukan pada 49 kasus (51,5%). Penyakit komorbid penyerta dengan mayoritas keganasan (25,6%) dan infeksi HIV (23,1%) ditemukan pada 21 kasus TB-EP (35%). Status jaringan parut BCG positif ditemukan pada 140 kasus (56,9%). Dari 106 anak tanpa jaringan parut BCG, sebanyak 38 anak (35,8%) memiliki TB paru dan sebanyak 68 anak (64,2 %) memiliki TB-EP. Tidak adanya jaringan parut BCG memiliki hubungan yang bermakna dengan kejadian TB-EP pada anak (p < 0.01) dengan OR: 2,457 (IK95% : 1,46 - 4,131). Kesimpulan. Tingginya kejadian TB-EP pada anak pada proporsi tanpa jaringan parut BCG berhubungan signifikan secara statistik. Upaya vaksinasi BCG yang optimal diperlukan untuk mengurangi morbiditas dan mortalitas TB-EP pada anak di Indonesia.

---

Objectives. Although the Bacille Calmette-Guerin vaccination program is already implemented nationally, childhood TB remains prevalent particularly in Indonesia so this study will evaluate the relationship between BCG vaccination scar and extra pulmonary TB in children.

Methods. Data collection was conducted at Cipto Mangunkusumo Kiara Hospital by cross-sectional method. Children diagnosed with TB according to WHO criteria and IDAI consensus are included in this study.

Results. A total of 246 pediatric patients with a-2 months to 18 years-age range were diagnosed with TB. Extra pulmonary TB was found in 127 children (51.6%), with the most prevalent type: bone, lymph node and abdomen TB sequentially are 13%, 10.9%, and 6.6%. The majority of patients with extrapulmonary TB are male (55.2%) and are in the age group 6-14 years (60%). History of contact with active TB cases was found in 49 out of 95 extrapulmonary cases (51.5%). Comorbidities, predominantly malignancies (25.6%) and HIV infection (23.1%), were found in 21 of 60 extrapulmonary cases (35%). BCG scar was found in 140 cases (56.9%). Of 140 children with BCG scar, 81 children (68.1%) had pulmonary TB and 59 children (42.1%) had extra-pulmonary TB. Of the 106 children without BCG scar, 38 (35.8%) had pulmonary TB and 68 (64.2%) had extra-pulmonary TB. The absence of BCG scar tissue has a significant relationship with extra-pulmonary TB incidence in children (p <0.01) with OR :2.457 (CI95% : 1.46 - 4.131).

Conclusion: The high incidence of extra-pulmonary TB in children in the proportion lacking BCG scar was statistically significant.Thus, an optimal BCG vaccination effort is required to reduce the morbidity and mortality of childhood extrapulmonary TB in Indonesia."

"ABSTRAK Latar belakang: Diare masih merupakan masalah kesehatan masyarakat dinegara berkembang karena morbiditas dan mortalitasnya yang masih tinggi. Diaredapat disebabkan oleh virus, bakteri dan parasit yang penting diketahui untukmemberikan tatalaksana yang tepat, namun saat ini belum ada data mengenaibakteri penyebab diare di Indonesia. Tujuan: Mengetahui gambaran klinis anak dengan diare akut dan mengetahui jenis bakteri enteropatogen penyebab diare akut dengan menggunakan real-timePCR di Rumah Sakit Cipto Mangunkusumo. Metode: Penelitian potong lintang pada anak dengan diare akut berusia 1-15tahun di Rumah Sakit Cipto Mangunkusumo. Hasil: Subyek penelitian ini terdiri dari 60 subyek dengan diare akut. Sebagian besar berusia 1-3 tahun, status gizi baik, berasal dari ibu dengan pendidikansedang dengan status ekonomi keluarga menengah rendah, sebagian besar belummendapat antibiotik sebelum ke rumah sakit tetapi sudah mendapat cairanrehidrasi oral. Gambaran klinis diare akut akibat infeksi bakteri yaitu frekuensidiare ≤5X/hari (p=0,018), tanpa leukositosis feses (p=0,015) dan malabsorpsilemak (p=0,031). Sebaran infeksi bakteri patogen penyebab diare akutberdasarkan real-time PCR sebagai berikut: Campylobacter jejuni 7 subyek,Escherichia coli patogen 17 subyek yang terdiri dari EPEC 9 subyek, EIEC 5subyek dan ETEC 3 subyek. Infeksi bakteri campuran pada subyek sebagaiberikut: EPEC+EIEC 2 subyek , C.jejuni+EPEC 1 subyek, C.jejuni+EPEC+EIEC1 subyek dan C.jejuni+EPEC+ETEC 1 subyek. Simpulan: Sebagian besar diare terjadi pada usia 1-3 tahun dengan status pasiengizi baik dengan status keluarga menengah rendah. Sekitar 48% anak dengandiare akut didapatkan bakteri dari hasil real-time PCR feses dengan proporsiterbanyak yaitu EPEC, diikuti Campylobacter jejuni, EIEC dan ETEC.ABSTRACT Background: Diarrhea is still a public health problem in developing countriesdue to it?s morbidity and mortality. Diarrhea can be caused by viruses, bacteriaand parasites. It is important to know the etiology to provide proper management,but there is currently no data on the bacteria that causes diarrhea in Indonesia. Objective: To characterize the clinical manifestations of children with acutediarrhea and determine the type of enteropathogens bacteria causing acutediarrhea using real-time PCR in Cipto Mangunkusumo Hospital. Methods: This was a cross-sectional study, done in June-November 2015. Stoolspecimens were collected from patients aged 1-15 years with acute diarrhea andtested for bacterial enteropathogens using real-time PCR.Results: Of the 60 children enrolled, mostly aged 1-3 years, good nutritionalstatus, from low income families and secondary education mothers, most have notreceived antibiotics prior to hospital admission but had received oral rehydrationfluids. The clinical features of acute diarrhea caused by bacterial infection isdiarrhea frequency ≤5X / day without fecal leukocytosis and fat malabsorption.From 60 subjects, 29 (48,3%) children excreted bacteria in their feces prooved byreal-time PCR. Distribution of pathogenic bacterial infection causes acute diarrheaby real-time PCR as follows: Campylobacter jejuni 7 subjects, pathogenicEscherichia coli 17 subjects which consists of EPEC 9 subjects, EIEC 5 subjectsand ETEC 3 subjects. Multiple infections in subjects as follows: EPEC+EIEC 2subjects, EPEC+C.jejuni 1 subject, C.jejuni+EPEC+EIEC 1 subject andC.jejuni+EPEC+ETEC 1 subject. Conclusions: Most diarrhea occurs at the age of 1-3 years with good nutritional status of patients with low-medium family status. Approximately 48% of children with acute diarrhea excreted bacteria in their feces prooved by real-time PCRstool with the highest proportion is EPEC, followed by Campylobacter jejuni,EIEC and ETEC.;Background: Diarrhea is still a public health problem in developing countriesdue to it?s morbidity and mortality. Diarrhea can be caused by viruses, bacteriaand parasites. It is important to know the etiology to provide proper management,but there is currently no data on the bacteria that causes diarrhea in Indonesia. Objective: To characterize the clinical manifestations of children with acutediarrhea and determine the type of enteropathogens bacteria causing acutediarrhea using real-time PCR in Cipto Mangunkusumo Hospital. Methods: This was a cross-sectional study, done in June-November 2015. Stoolspecimens were collected from patients aged 1-15 years with acute diarrhea andtested for bacterial enteropathogens using real-time PCR.Results: Of the 60 children enrolled, mostly aged 1-3 years, good nutritionalstatus, from low income families and secondary education mothers, most have notreceived antibiotics prior to hospital admission but had received oral rehydrationfluids. The clinical features of acute diarrhea caused by bacterial infection isdiarrhea frequency ≤5X / day without fecal leukocytosis and fat malabsorption.From 60 subjects, 29 (48,3%) children excreted bacteria in their feces prooved byreal-time PCR. Distribution of pathogenic bacterial infection causes acute diarrheaby real-time PCR as follows: Campylobacter jejuni 7 subjects, pathogenicEscherichia coli 17 subjects which consists of EPEC 9 subjects, EIEC 5 subjectsand ETEC 3 subjects. Multiple infections in subjects as follows: EPEC+EIEC 2subjects, EPEC+C.jejuni 1 subject, C.jejuni+EPEC+EIEC 1 subject andC.jejuni+EPEC+ETEC 1 subject. Conclusions: Most diarrhea occurs at the age of 1-3 years with good nutritional status of patients with low-medium family status. Approximately 48% of children with acute diarrhea excreted bacteria in their feces prooved by real-time PCRstool with the highest proportion is EPEC, followed by Campylobacter jejuni,EIEC and ETEC.;Background: Diarrhea is still a public health problem in developing countriesdue to it?s morbidity and mortality. Diarrhea can be caused by viruses, bacteriaand parasites. It is important to know the etiology to provide proper management,but there is currently no data on the bacteria that causes diarrhea in Indonesia. Objective: To characterize the clinical manifestations of children with acutediarrhea and determine the type of enteropathogens bacteria causing acutediarrhea using real-time PCR in Cipto Mangunkusumo Hospital. Methods: This was a cross-sectional study, done in June-November 2015. Stoolspecimens were collected from patients aged 1-15 years with acute diarrhea andtested for bacterial enteropathogens using real-time PCR.Results: Of the 60 children enrolled, mostly aged 1-3 years, good nutritionalstatus, from low income families and secondary education mothers, most have notreceived antibiotics prior to hospital admission but had received oral rehydrationfluids. The clinical features of acute diarrhea caused by bacterial infection isdiarrhea frequency ≤5X / day without fecal leukocytosis and fat malabsorption.From 60 subjects, 29 (48,3%) children excreted bacteria in their feces prooved byreal-time PCR. Distribution of pathogenic bacterial infection causes acute diarrheaby real-time PCR as follows: Campylobacter jejuni 7 subjects, pathogenicEscherichia coli 17 subjects which consists of EPEC 9 subjects, EIEC 5 subjectsand ETEC 3 subjects. Multiple infections in subjects as follows: EPEC+EIEC 2subjects, EPEC+C.jejuni 1 subject, C.jejuni+EPEC+EIEC 1 subject andC.jejuni+EPEC+ETEC 1 subject. Conclusions: Most diarrhea occurs at the age of 1-3 years with good nutritional status of patients with low-medium family status. Approximately 48% of children with acute diarrhea excreted bacteria in their feces prooved by real-time PCRstool with the highest proportion is EPEC, followed by Campylobacter jejuni,EIEC and ETEC."

"ABSTRACTLatar Belakang: Perbaikan status nutrisi merupakan salah satu indikator penting dalam menilai keberhasilan pengobatan tuberkulosis. Tujuan: Mengetahui hubungan antara jenis tuberkulosis dan penyakit komorbid dengan perbaikan status nutrisi pasien tuberkulosis anak setelah dua bulan pengobatan. Metode: Penelitian potong lintang dilakukan di RSUPN Cipto Mangunkusumo, Jakarta pada Januari-Oktober 2018 dengan melihat data rekam medis dari 207 pasien anak yang terdiagnosis tuberkulosis selama periode 2012-2018. Hasil: Terdapat hubungan bermakna antara jenis tuberkulosis dengan status nutrisi setelah dua bulan pengobatan fase intensif (nilai p = 0,014; IK95% = 0,422-0,914) dengan kesan bahwa pasien TB ekstraparu mengalami peningkatan status nutrisi lebih baik dibanding pasien TB paru. Selain itu, juga didapat hubungan bermakna antara keberadaan penyakit komorbid dengan status nutrisi pasien (nilai p = 0,020; IK95% = 1,063-2,382), pasien tanpa penyakit komorbid mengalami peningkatan status nutrisi lebih baik dibanding pasien TB dengan penyakit komorbid setelah pengobatan fase intensif. Kesimpulan: Jenis TB dan penyakit komorbid berhubungan dengan kondisi status nutrisi pasien selama dua bulan fase intensif pengobatan tuberkulosis. Tatalaksana komprehensif mencakup manajemen terhadap tuberkulosis dan penyakit komorbid, serta suplementasi nutrisi perlu diperhatikan selama fase awal pengobatan pasien tuberkulosis anak.

---

ABSTRACTBackground: Nutritional status improvement constitutes one of an indicator to assess anti tuberculosis treatments success. Objective: This research aims to determine whether the diagnosis of tuberculosis (pulmonary or extrapulmonary) and comorbidities are associated with childrens nutritional status during the first 2-month of tuberculosis treatment. Methods: A cross-sectional study conducted in Cipto Mangunkusumo Hospital, Jakarta in January to October 2018 by reviewing 207 medical records of children diagnosed with tuberculosis from 2012-2018 period of time. Results: Type of TB is associated with nutritional status of children after 2-month intensive phase treatment (p value = 0.014; CI95% = 0.422 to 0.914), children with extrapulmonary TB show better improvement in nutritional status rather than children with pulmonary TB. Comorbidities are associated with nutritional status (p value = 0.020; CI95% = 1.063 to 2.382), tuberculosis children without comorbidities experience better nutritional status improvement rather than those with comorbidities after anti tuberculosis intensive phase treatment. Discussion: Type of TB and comorbidities are significantly associated with nutritional status of tuberculosis children during 2-month intensive phase of anti tuberculosis treatment. Comprehensive treatment including management for tuberculosis and those with comorbidities, along with nutritional supplementation are necessarily maintained during the early phase of treatment in children with tuberculosis."

"Latar Belakang: Uji tuberkulin merupakan pemeriksaan penunjang utama yang membantu diagnosis tuberkulosis anak di Indonesia. Jenis TB yang diderita pasien ternyata dapat mempengaruhi hasil negatif palsu dari uji tuberkulin. Tujuan: Menganalisis hubungan antara hasil uji tuberkulin dan jenis tuberkulosis pasien TB paru dan ekstraparu pada pasien tuberkulosis anak. Metode: Penelitian potong lintang yang dilakukan di Rumah Sakit Cipto Mangunkusumo, Jakarta pada Januari-Oktober 2018 dengan melihat data usia, jenis kelamin, penyakit komorbid, hasil uji tuberkulin, dan jenis tuberkulosis dari formulir TB-01 dan rekam medis dari 230 pasien anak yang terdiagnosis tuberkulosis selama periode 2014-2018. Hasil: Tidak terdapat hubungan bermakna antara hasil uji tuberkulin dengan jenis tuberkulosis (nilai p = 0,607; RR = 0,937; IK95% = 0,729 sampai 1,203). Kesimpulan: Hasil uji tuberkulin tidak berhubungan dengan jenis tuberkulosis yang dimiliki pasien anak. Pada kasus yang diduga mengalami anergi, diagnosis tuberkulosis dapat ditegakkan dengan gambaran klinis pasien, pemeriksaan radiologis, dan hasil uji bakteriologis.

---

Background: Tuberculin skin test is one of the primary diagnostic tools for diagnosing tuberculosis in children. Objective: This research analyse the association between the result of tuberculin skin test and the type of tuberculosis in children with pulmonary and extrapulmonary tuberculosis.

Methods: This research is a cross-sectional study conducted in Cipto Mangunkusomo Hospital, Jakarta in January to October 2018 by reviewing 230 data of age, gender, comorbidities, result of tuberculin skin test, and type of tuberculosis from TB-01 form and medical records of children diagnosed with tuberculosis from 2014 until 2018.

Result: There is no significant correlation between the result of tuberculin skin test and type of tuberculosis in children with pulmonary and extrapulmonary tuberculosis (p value = 0.607; RR = 0.937; CI 95% = 0.729 to 1.203).

Discussion: The result of tuberculin skin test does not have significant correlation with the type of tuberculosis in children with pulmonary and extrapulmonary tuberculosis. In cases with suspected anergy, the diagnosis can be formed by patients clinical features, radiology examination and the result of biological testing."

"Latar BelakangTuberkulosis pada kelompok remaja belum mendapatkan perhatian khusus oleh pemangku kepentingan di dunia. Salah satu faktor risiko terjadinya TB adalah penurunan sistem imun yang dapat ditemukan di penyakit Lupus Eritematosa Sistemik (LES). Peningkatan risiko infeksi TB pada penderita LES mencapai 2—6 kali lipat. Saat ini, penelitian LES-TB di Indonesia belum fokus terhadap usia remaja. Penelitian ini bertujuan untuk mengetahui prevalens TB-LES dan faktor risiko terjadinya TB pada pasien LES.MetodeStudi ini menggunakan uji analitik retrospektif sehingga variabel yang memengaruhi terjadinya TB pada pasien LES dapat diukur. Data didapatkan berdasarkan rekam medis dan hasil diujikan dengan SPSS.HasilDari 100 pasien LES usia remaja, 5 orang menderita TB dan 14 orang terinfeksi TB laten. TB-SLE hanya diderita oleh wanita. Faktor risiko yang meliputi status nutrisi, jenis imunosupresan, dan dosis glukokortikoid tidak ditemukan signifikan terhadap kejadian TB-SLE. Akan tetapi, kelompok usia di atas 15 tahun berisiko mengalami TB hingga 2 kali lipat yang tidak bermakna secara statistik (2.11;95% CI;(0.76-5.80)).KesimpulanPrevalens TB aktif 5% dan prevalens TB keseluruhan adalah 19% pada subjek LES remaja di RSCM. Tidak ditemukan hubungan yang signifikan antara status nutrisi, jenis imunosupresan, usia, dosis glukokortikoid dengan terjadinya TB-SLE. Namun, usia yang lebih mendekati usia dewasa meningkatkan risiko terjadinya TB.

---

Introduction

Tuberculosis in adolescence have not yet been recognized by the stakeholders around the world. One of the risk factors for TB infection is the declining of the immune system which can be caused by Systemic Lupus Erythematosus (SLE). Patients with SLE are at risk for TB infection 2—6 times fold than normal population. There are no studies that focuses on TB on adolescence with SLE. This study purpose is to determine the prevalence of SLE-TB and the risk factors of TB in SLE.

Method

This study uses analytic prospective model to analyze the variables in TB-SLE. Electronic health records are used to be the source of the data. Then, the data will be analyzed using SPSS.

Results

TB-SLE was found only in women. The risk factors that are being analyzed in this study were nutritional status, types of immunosuppressants, glucocorticoid dose, and age. However, there was no significant relation between those risk factors and the prevalence of TB. In this study, we found that the older age group, more than 15 years old, has a higher risk of TB infection but not statistically significant. 2.11;95% CI;(0.76-5.80)).

Conclusion

Active TB prevalence is 5% and the total TB prevalence is 19% in adolescence with SLE at RSCM. Significant relations between nutritional status, types of immunosuppressants,age,glucocorticoid dose and the TB-SLE are not found. However, there was a higher risk in TB infection in patients with age older than 15 years old."

"ABSTRAK Latar belakang: Penyakit refluks gastroesofagus PRGE pada remaja sulit didiagnosis, karena gejala klinis tidak spesifik dan menyebabkan penurunan kualitas hidup. Gastroesofageal reflux disease questionnaire GERD-Q dan pediatric gastroesophageal symptom and quality of life questionnaire PGSQ telah divalidasi dan dikembangkan untuk mengidentifikasi PRGE dan kualitas hidup. Penggunaan GERD-Q dan PGSQ pada populasi remaja sebagian besar tidak diketahui.Tujuan: Untuk memperoleh prevalens dugaan PRGE pada remaja menggunakan GERD-Q dan penilaian kualitas hidup pada remaja yang memiliki GERD-Q positif skor ge; 7 dengan menggunakan PGSQ.Metode: Remaja usia 12-18 tahun di evaluasi menggunakan kuesioner GERD-Q. Remaja yang memiliki skor GERD-Q positif dievaluasi kualitas hidupnya menggunakan PGSQ. Analisis mengenai faktor risiko dugaan PRGE juga dilakukan.Hasil: Pada 520 subjek, rasio laki-laki dan perempuan 1:1,3 dan usia median 13 tahun. Prevalens dugaan PRGE pada remaja menggunakan kuesioner GERD-Q adalah 32,9 . Mengkonsumsi minuman soda memiliki risiko 1,7 kali mengalami dugaan PRGE Interval kepercayaan 95 1,3-2,2, ABSTRACT Background Gastroesophageal reflux disease in adolescent is difficult to diagnose due to nonspecific symptom and often lead to poor quality of life. Gastroesophageal reflux disease questionnaire GERD Q and pediatric gastroesophageal symptom and quality of life questionnaire PGSQ are validated questionnaire that was developed to help identify GERD patients and their quality of life respectively. The application of GERD Q and PGSQ in adolescent population is largely unknown.Aim To obtain suspected GERD prevalence in adolescent using GERD Q and quality of life score assessment in adolescent with GERD Q positive.Methods Adolescent age 12 18 years were evaluated using indonesian version of GERD Q. Adolescents with GERD Q positive were then evaluated their quality of life using Indonesian version of PGSQ. Suspected risk factors of having GERD, which would influence GERD Q result, were also analyzed.Result In 520 subjects, the male to female ratio was 1 1,3 and the median age was 13 years range 12 18 years . Prevalence of GERD in adolescent using GERD Q was 32,9 . Routine soda consumption was 1,7 times more likely to have GERD CI 95 1.3 2.2, p"

"Mortalitas pneumonia anak masih menjadi masalah kesehatan di seluruh dunia hingga saat ini. Bayi dengan penyakit jantung bawaan pirau kiri kanan (PJB L-R) berisiko menderita pneumonia. Data mortalitas pneumonia pada PJB L-R dan faktor-faktor yang memengaruhi belum banyak diketahui. Penelitian kohort retrospektif ini membandingkan mortalitas pneumonia dengan PJB L-R dengan tanpa PJB. Sebanyak 129 subyek dengan rentang usia 1 bulan - 7 tahun dengan diagnosis primer pneumonia, 54 subyek dengan PJB L-R dan 75 subyek tanpa PJB. Proporsi mortalitas pneumonia dengan PJB L-R lebih banyak (57,1%) dan risiko mortalitas lebih besar (OR 2,35; IK 95% 1,06 sampai 5,18) dibandingkan pneumonia tanpa PJB. Status gizi kurang/buruk, pneumonia rekuren, dan pneumonia terkait rumah sakit (HAP) lebih banyak secara signifikan pada pneumonia dengan PJB L-R. Sedangkan, tingkat keparahan dan anemia tidak berbeda bermakna di kedua kelompok. Pneumonia dengan tingkat keparahan berat memengaruhi mortalitas secara bermakna (OR 3,24; IK95% 1,16 sampai 9,08). Pneumonia rekuren, status gizi kurang/buruk, status imunisasi tidak lengkap, anemia, dan HAP tidak terbukti berhubungan dengan mortalitas pneumonia dengan PJB L-R.

---

Childhood pneumonia is still a worldwide problem with high mortality. Infants with left to right shunt congenital heart disease (L-R CHD) are at risk of developing pneumonia. Pneumonias mortality in L-R CHD and its influencing factors are not well known. This retrospective cohort study analyzed mortality of pneumonia with L-R CHD with and without CHD. There were 129 subjects (age range of 1 month up to 7 years 11 months) with pneumonia as the primary diagnosis, consisting of 54 subjects with L-R CHD and 75 subjects without CHD. Mortality rate in children with L-R CHD was higher than those without CHD group (57.1%). The risk of mortality was greater (OR 2.35; 95% CI 1.06 to 5.18) compared to pneumonia without CHD. Moderate to severe malnutrition, recurrent pneumonia, and hospital acquired pneumonia (HAP) are significantly higher in L-R CHD group. Meanwhile, pneumonia severity and anemia were not significantly different in both groups. Severe pneumonia significantly affected mortality (OR 3.24; 95% CI 1.16 to 9.08). Recurrent pneumonia, moderate-to-severe malnutrition, incomplete immunization status, anemia, and HAP have not been proven to be associated with pneumonia mortality with L-R CHD."

"Latar belakang Kemampuan meminta (mand) dan menyebut (tact) adalah kemampuan yang perlu ditingkatkan pada awal terapi verbal behavior pada anak autisme. Metode telehealth oleh orangtua dapat memberikan terapi dini. Tujuan penelitian untuk melihat efektivitas pelatihan yang dilakukan orangtua terhadap peningkatan kemampuan komunikasi awal anak GSA dalam meminta (mand) dan menyebut (tact). MetodeUji klinis acak terkontrol terhadap anak autisme berusia 2-5 tahun. Penilaian kemampuan anak menggunakan instrumen verbal behavior milestones assessment and placement program. Orangtua kelompok perlakuan mendapat modul video pelatihan dan bimbingan dari terapis, sebelum memulai terapi selama 3 bulan pada anak. Penilaian kemampuan ulang dilakukan pada kedua kelompok di akhir periode.HasilTerdapat 40 subyek yang masuk ke dalam level 1 VBMAPP. Skor VB MAPP sesudah pemberian intervensi meningkat dari 13,83 menjadi 24,43. Peningkatan median skor mand 1 menjadi 2 dan median skor tact 1 menjadi 3 (p<0,001). Perbandingan peningkatan median skor mand antara kedua kelompok menunjukkan hasil bermakna (p=0,003). Kenaikan proporsi skor mand dan tact tampak lebih tinggi pada kelompok perlakuan.SimpulanPelatihan mand dan tact oleh orangtua pada anak autisme dengan menggunakan metode telehealth efektif dalam meningkatkan kemampuan anak meminta, dan bermakna secara klinis dalam meningkatkan kemampuan anak menyebut. Metode telehealth dapat diterima oleh orangtua.

---

Background

Mand and tact is a skill in verbal behavior therapy that needs to be improved initially. The telehealth method are helpful for those in rural area. This study aim was to assess effectiveness of telehealth mand and tact training by parents on increasing the child’s mand and tact skill.

Methods

A randomized controlled clinical trial of 2-5 years old children with ASD. Assessment of children's milestones using verbal behavior milestones assessment and placement program. Parents in the intervention group received video modelling and guidance from a therapist before giving therapy for 3 months. Re-assessment was done in both groups at the end of the period.

Results

A total of 40 subjects with ASD in level 1 VBMAPP meet criteria. A significant increase in the VB MAPP score after the intervention, namely 13.83 to 24.43. Mand median score increased from 1 to 2, and the tact, 1 to 3 with p<0.001. Comparison of the increase in the median mand score between the two groups showed significant results (p = 0.003). The increase in the proportion of mand and tact scores was higher in intervention group.

Conclusion

Telehealth mand and tact training by parents for children with ASD effective in improving mand, and clinically meaningful in improving tact. The telehealth method can be accepted by parents."

"Latar belakang: Trakeostomi adalah tindakan membuka leher anterior pada trakea untuk memintas saluran napas atas. Jumlah prosedur trakeostomi anak semakin meningkat setiap tahunnya dan prosedur trakeostomi pada anak dapat mengakibatkan komplikasi intraoperatif, dini  pascaoperatif, dan lanjut pascaoperatif. Tujuan: Mengetahui karakteristik trakeostomi anak, proporsi kejadian komplikasi, sebaran komplikasi dan faktor yang berpengaruh dan hubungannya dengan dua komplikasi yang tersering, sehingga dapat menurunkan angka kejadian komplikasi trakeostomi pada anak. Metode: Penelitian ini merupakan studi potong lintang dari 97 subjek, data yang diambil berupa data sekunder rekam medik manual dan elektronik. Hasil: Karakteristik subjek trakeostomi yang paling sering adalah pada kelompok usia 28 hari-< 12 bulan (42,3%), jenis kelamin laki-laki (56,7%), status gizi baik (64,3%), dengan penyakit dasar masalah jalan napas (29,9%), dua komorbid (26,8%). Penyakit dasar tersering pada indikasi prolong intubasi adalah penyakit paru (n=26), pada indikasi sumbatan jalan napas adalah stenosis subglotis (n=13), dan pada indikasi proteksi jalan napas inadekuat adalah defisit neurologis (n=7). Indikasi trakeostomi terbanyak adalah prolong intubasi (57,7%), sebagian besar subjek dilakukan trakeostomi terintubasi (86,6%). Rata-rata intubasi terlama adalah  lebih dari 7 hari (57,7%), dengan rata-rata 20,1 hari (1─99 hari). Teknik insisi trakea tersering adalah vertical (81,4%), Sebagian besar subjek dilakukan stay suture (66%), dan hanya Sebagian kecil subjek yang dilakukan safety suture (3,1%). Ukuran kanul yang tersering digunakan adalah nomor ≤ 4 (46,4%), dengan jenis kanul terbanyak adalah tanpa balon (74,2%). Waktu penggantian kanul terbanyak adalah dalam jangka waktu lebih dari 3 bulan (27,8%), namun terdapat subjek yang tidak sempat dilakukan penggantian karena meninggal atau sudah dapat dilakukan dekanulasi (31,9%). Tindakan trakeostomi tersering dilakukan di ruang rawat intensif (60,8%). Dekanulasi dilakukan pada 12,4% subjek, dengan rata-rata waktu dekanulasi 212,67 hari. Proporsi komplikasi yang terjadi adalah 41%. Jenis komplikasi yang terbanyak adalah komplikasi lanjut pascaoperatif (25,8%), yaitu oklusi kanul (12,4%), dan dekanulasi spontan (9,3%). Dua komplikasi tersering adalah oklusi kanul (n=14), dan dekanulasi spontan (n=13). Jenis kelamin bermakna secara statistik (p=0,007)  terhadap terjadinya komplikasi trakeostomi anak pada penelitian ini dengan proporsi laki-laki 50% dan perempuan 23,8%. Kelompok umur bermakna secara statistik (p=0,036) terhadap terjadinya komplikasi dekanulasi spontan dengan proporsi 0-12 bulan sebesar 28,57%, 1-< 5 tahun sebesar 14,28%, dan 5-<18 tahun sebesar 0%. Kesimpulan: Proporsi komplikasi trakeostomi pada anak adalah 41%, dengan komplikasi tersering adalah oklusi kanul dan dekanulasi spontan. Kelompok umur bermakna secara statistik terhadap terjadinya dekanulasi spontan, dengan proporsi 0-12 bulan sebesar 28,57%. Perawatan pasca operasi harus dilakukan dengan teliti terutama pada kelompok usia 0-12 bulan

---

Background: Tracheostomy is the act of opening the anterior neck of the trachea to bypass the upper airway. The number of pediatric tracheostomy procedures is increasing every year and tracheostomy procedures in children can result in intraoperative, early postoperative, and late postoperative complications. Objective: To determine the characteristics of pediatric tracheostomy subjects, the proportion of complications, the distribution of complications and relevant factors and their association with the two most common complications, so as to reduce the incidence of pediatric tracheostomy complications. Methods: This study was a cross-sectional study of 97 subjects, the data taken were secondary data from manual and electronic medical records. Results: The most frequent characteristics of tracheostomy subjects were in the age group of 28 days-< 12 months (42.3%), male gender (56.7%), good nutritional status (64.3%), with underlying disease airway problems (29.9%), two comorbidities (26.8%). The most common underlying disease in the indication of prolonged intubation was pulmonary disease (n=26), in the indication of airway obstruction was subglottic stenosis (n=13), and in the indication of inadequate airway protection was neurological deficit (n=7). The most common indication for tracheostomy was prolonged intubation (57.7%), and most subjects underwent intubated tracheostomy (86.6%). The longest average intubation was more than 7 days (57.7%), with a mean of 20.1 days (1─99 days). The most common tracheal incision technique was vertical (81.4%), most subjects had a stay suture (66%), and only a small number of subjects had a safety suture (3.1%). The most commonly used cannula size was number ≤ 4 (46.4%), with the most common cannula type being uncuffed(74.2%). The most common time of cannula replacement was within a period of more than 3 months (27.8%), but there were subjects who did not have time for replacement because of death or could be decanulated (31.9%). Tracheostomy was most commonly performed in the intensive care unit (60.8%). Decanulation was performed in 12.4% of subjects, with an average decanulation time of 212.67 days. The proportion of complications that occurred was 41%. The most common types of complications were late postoperative complications (25.8%), such as cannula occlusion (12.4%), and spontaneous decanulation (9.3%). The two most common complications were cannula occlusion (n=14), and spontaneous decanulation (n=13). Gender was statistically significant (p=0.007) for the occurrence of pediatric tracheostomy complications in this study with a proportion of 50% males and 23.8% females. Age group was statistically significant (p=0.036) to the occurrence of spontaneous decanulation complications with the proportion of 0-12 months by 28.57%, 1-< 5 years by 14.28%, and 5-< 18 years by 0%. Conclusion: The proportion of tracheostomy complications in children was 41%, with the most common complications being cannula occlusion and spontaneous decanulation. Age group was statistically significant for spontaneous decanulation, with the proportion of 0-12 months at 28.57%. Postoperative care should be done carefully especially in the age group of 0-12 months."

"Resusitasi cairan yang berlebihan selama pengobatan awal syok septik pediatri berhubungan dengan komplikasi seperti edema paru dan disfungsi organ. Pada pasien dewasa, penggunaan vasopresor dini dianjurkan untuk mengembalikan perfusi tanpa menyebabkan kelebihan cairan. Namun, penelitian mengenai penggunaan awal norepinefrin (NE) pada anak dengan syok sepsis masih terbatas. Penelitian ini bertujuan untuk menilai pengaruh pemberian NE dini terhadap jumlah cairan resusitasi, kadar laktat, dan kejadian edema paru pada anak dengan syok sepsis. Penelitian ini merupakan uji klinis acak dengan label terbuka yang dilakukan di satu pusat yaitu RS Cipto Mangunkusumo Jakarta pada bulan Maret hingga Mei 2024. Penelitian ini melibatkan 42 pasien anak dengan sepsis. Peserta dibagi secara acak menjadi dua kelompok: kelompok intervensi yang menerima loading cairan dengan tambahan NE dini 0,1 mcg/kg/menit (n=21) dan kelompok kontrol yang mendapat loading cairan sesuai protokol standar (n=21). Parameter jumlah cairan yang diberikan, kadar laktat, edema paru, dan hemodinamik dievaluasi dengan melakukan pemeriksaan klinis serta pemeriksaan USCOM, dan ultrasonografi paru. Hasil penelitian didapatkan bahwa pemberian NE sejak awal resusitasi tidak terbukti mengurangi jumlah cairan resusitasi pada anak dengan syok sepsis yang bermakna, namun tren jumlah cairan resusitasi lebih sedikit pada kelompok perlakuan dibanding kelompok kontrol (p=0,060), Selain itu, juga tidak terbukti adanya perbedaan kadar laktat pasca-pemberian NE dini dibandingkan kontrol [8/21(38%) vs 4/21 (28,6%), p=0,306], serta tidak terbukti adanya perbedaan kejadian edema paru pasca-pemberian NE dini dibandingkan kontrol [7/21 (33%) vs 5/21 (24%); p=0,734]. Sedangkan untuk pengukuran stroke volume index, cardiac index, dan systemic vascular resistancy index, tidak terbukti terdapat perbedaan antara kelompok loading cairan ditambah NE dini dengan kelompok loading cairan saja. Simpulan dari penelitian ini adalah pemberian NE dini tidak terbukti mengurangi jumlah cairan resusitasi pada anak dengan syok sepsis, namun tren jumlah cairan resusitasi lebih sedikit.

---

Excessive fluid resuscitation during initial treatment of pediatric septic shock is associated with complications such as pulmonary edema and organ dysfunction. In adult patients, early use of vasopressors is recommended to restore perfusion without causing fluid overload. However, research on the early use of norepinephrine (NE) in children with septic shock is limited. This study aims to assess the effect of early NE administration on the amount of resuscitation fluid, lactate, and pulmonary edema in children with septic shock. This study was a single-site, randomized, open-label clinical trial conducted at Cipto Mangunkusumo Hospital, Jakarta from March to May 2024. This study involved 42 pediatric patients with sepsis. Participants were divided randomly into two groups: the intervention group received fluid loading with additional early NE 0.1 mcg/kg/minute (n=21), the control group received fluid loading according to standard protocol (n=21) Parameters such as the amount of fluid administered , lactate levels, pulmonary edema, and hemodynamics were evaluated using clinical examination, USCOM, and lung ultrasonography. The research results showed that it was not proven to reduce the amount of resuscitation fluid in children with septic shock, but the trend was that the amount of resuscitation fluid was less in the treatment group than the control group (p=0.060), it was not proven that there was no increase in lactate levels after early NE administration compared to controls [8/21 (38%) vs 4/21 (28.6%), p=0.306], and there was no proven difference in the incidence of pulmonary edema after early NE administration compared to controls [7/21 (33%) vs 5/21 (24%) ; p=0.734]. Meanwhile, measurements of stroke volume index, cardiac index, and systemic vascular resistance index did not prove to be a difference between the fluid loading plus early NE group and the fluid loading only group. The conclusion of this study is that early NE administration is not proven to reduce the amount of resuscitation fluid in children with septic shock, but the trend for the amount of fluid to be less."