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"Penelitian ini bertujuan mengetahui manifestasi oral, status kesehatan rongga mulut HIV anak dan hubungannya dengan status supresi imun di RSCM. Penelitian potong-lintang terhadap 70 anak HIV yang diterapi HAART di RSCM pada bulan April dan Mei 2014. Hasilnya, frekuensi manifestasi oral rendah. Yang terbanyak lesi SAR minor ditemukan pada 4 anak. Lebih separuh subyek memiliki tingkat kebersihan mulut baik (53,5%). Nilai rerata deft < 6 tahun, nilai DMFTdeft > 6 tahun lebih dari 1 gigi per individu. Tidak dijumpai hubungan antara manifestasi oral dengan supresi imun pada HIV anak yang mendapat terapi HAART.

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The purpose of this cross-sectional study was to determine oral manifestations, oral health status of HIV in children and their relationships with immune suppression status at RSCM. Seventy children treated with HAART at RSCM in April and May 2014 had low frequency of oral manifestations with RAS minor as the frequent lesions consist of 4 lesions. More than half of children had good oral hygiene (53.5%). The mean score of deft < 6 years, DMFT-deft > 6 years were more than 1 tooth per individual.There is no relationship between oral manifestations with immune suppression status of children treated with HAART. "

"Latar Belakang. Cairan rehidrasi oral dan zinc telah menjadi terapi standar dalam tata laksana diare akut pada anak. Probiotik sudah digunakan secara luas pada kasus diare akut pada anak meskipun belum direkomendasikan oleh WHO. Penelitian yang membandingkan penambahan probiotik pada terapi standar masih sangat terbatas.Tujuan. Mengetahui efektivitas pemberian suplementasi probiotik pada terapi standar diare akut. Metode. Penelitian uji klinis acak tersamar ganda dilakukan pada anak usia 6 bulan sampai 36 bulan dengan diare akut tanpa dehidrasi dan dehidrasi ringan sedang, yang dilakukan di kelurahan Kenari, Jakarta Pusat antara bulan Oktober 2011 sampai Februari 2012. Kelompok perlakuan diberikan terapi standar ditambah probiotik Lactobacillus rhamnosus R0011 1.9 x 109 cfu dan Lactobacillus acidophilus R0052 0.1 x 109 cfu, sedangkan kelompok kontrol diberikan terapi standar dan plasebo. Luaran yang dinilai adalah durasi diare dan frekuensi defekasi. Penelitian ini bersifat intention to treat analysis. Hasil. Total 112 subjek masuk dalam penelitian, terdiri dari 56 subjek mendapat terapi standar ditambah probiotik, dan 56 subjek hanya terapi standar. Median lama durasi diare setelah terapi pada kelompok perlakuan yaitu 68,5 jam sedangkan pada kelompok kontrol 61,5 jam (p=0,596). Median frekuensi defekasi pada kelompok perlakuan yaitu 5 kali, sedangkan pada kelompok kontrol 5,5 kali (p=0,795). Simpulan. Pada penelitian ini tidak ditemukan penurunan durasi diare dengan penambahan probiotik pada terapi standar. Meskipun kelompok perlakuan memiliki frekuensi defekasi yang lebih sedikit dibandingkan dengan kelompok kontrol, namun perbedaan tersebut tidak bermakna.

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Background. Oral rehydration solution and zinc have been used as standard therapy for treating acute diarrhea in children. Probiotics are widely used in treatment of acute diarrhea in children, although it has not been recommended by WHO. Studies comparing supplementation of probiotics to standard therapy are still limited.

Objectives. To know the efficacy of probiotic supplementation to standard therapy in acute diarrhea.

Methods. A randomized double blind clinical trial was performed in children aged 6-36 months with acute diarrhea without dehydration or mild to moderate dehydration in Kenari sub district, central Jakarta, between October 2011 until Februari 2012. Supplemented group was given standard therapy and probiotics Lactobacillus rhamnosus R0011 1.9 x 109 cfu and Lactobacillus acidophilus R0052 0.1 x 109 cfu, while control group was given standard therapy and placebo. The outcomes were duration of diarrhea and frequency of defecation. Stool frequency was recorded daily until resolution of diarrhea. The analysis was based on intention to treat.

Results. A total of 112 subjects were included in the study, consisted of 56 subjects in supplemented group and 56 subjects in control group. Median duration of diarrhea in supplemented group was 68,5 hours while in the control group was 61,5 hours (p=0,596). Median frequency of defecation in supplemented group was 5 times, while in the control group was 5,5 times (p=0,795).

Conclusion. This study did not find shorter duration of diarrhea with supplementation of probiotics to standard therapy. Although supplemented group had lower frequency of defecation compared to control group, the difference was not significant."

"ABSTRAKPerkembangan anak merupakan sesuatu yang bersifat multidimensi dan terdiri atas area kognitif, bahasa, fungsi gerak, sosial emosional danperilaku adaptif, masing-masing memiliki nilai tersendiri namun salingberintegrasi. Dua metode stimulasi (Glenn Doman (GD) dan Kemenkes (K))dinilai kualitasnya dalam penelitian ini.Tujuan.Mengetahui pengaruh perbedaan stimulasi metode GD dan K terhadapskor perkembangan bayi usia 6-12 bulan.Metode.Penelitian kohort prospektif pada bayi normal.Skrining perkembanganawal dilakukan menggunakan alat ukur Denver.Pasca 3 bulan intervensi,perkembangan bayi dinilai menggunakan BSID edisi-III yang terlebih dahuludilakukan uji validitas dan reliabilitas.Kualitas stimulasi rumah di nilaimenggunakan alat ukur HOME.Hasil.Skor validitas dari BSID edisi-III adalah 0,964 (kognitif), 0,934 (bahasa),0,822 (gerak) dengan Cronbach Alpha sebesar 0,918 serta reliabilitas test-retest0,846. Subjek yang memenuhi kriteria sebanyak 88 orang, dengan jenis kelaminlaki-laki (61,4%), usia 9-12 bulan (68,2%), status gizi baik (75%). Perbedaanbermakna terdapat pada skor HOME dan semua aspek penilaian perkembanganBSID di kedua grup setelah masa intervensi 3 bulan (p<0,001). Skor grup GDlebih unggul 1 angka dibandingkan K pada skor HOME (p=0,024) and 32 angkalebih unggul pada skor BSID (p=0,002). Faktor jumlah anak bermakna secarastatistik memengaruhi perkembangan dengan risiko relative 3.13 (IK 95% 1.18-8.33, p=0,022).Simpulan.Instrumen BSID edisi-III versi Bahasa Indonesia merupakan alat ukuryang sahih dan andal untuk digunakan pada penelitian ini. Secara umum tidakterdapat perbedaan skor perkembangan bayi usia 6-12 bulan yang mendapatstimulasi metode GD dan K kecuali perkembangan perilaku adaptif.

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ABSTRACTChild development is multi-dimensional and encompasses cognitive, language, sensory-motor, social-emotional, adaptive behavior domains, all ofwhich are interdependent. Two stimulation interventions (Glenn Doman (GD) andKemenkes (K) methods) were conducted in this study.Aims.To investigate the difference in developmental aspects after interventionwith GD and K methods in infants age 6-12 months.Methods. This was a prospective cohort study in normal developmental infants.Developmental screening at enrollment used Denver instrument. Three monthspost intervention, the development was assessed with BSID III, in whichvalidation and reliability test were undertaken as first step. A modified version ofHOME inventory was used as edition to assess home environment.Results.The validity score of BSID-III was 0.964 (cognitive), 0.934 (language),0.822 (motor) with Cronbach alpha of 0.918 and a reliability test-retest of 0.846.There were 88 subjects fulfilled the criteria. Subject mostly were male (61.4%) 9-12 months old (68.2%), normal anthropometric status (75%). The results revealedsignificant differences in HOME score and all aspects of Bayley score in GD andK group after 3 months intervention period (p<0.001). The GD benefited 1 pointcompared with K group in HOME score (p=0.024) and 32 points in Bayley score(p=0.002). Number of children was the most influential factor in infants’development with a relative risk of 3.13 (CI95% 1.18-8.33, p=0.022).Conclusions.The Bahasa Indonesia version of BSID-III was a reliable and validtool for the assessment of this study. There was no difference in developmentalscore at age 6-12 months who had GD and K stimulation methods except foradaptive behavior scale."

"Indonesia mengalami peningkatan obesitas yaitu 12,2% (2007) menjadi 14% (2010). Indeks massa tubuh (IMT) tidak membedakan massa lemak dan massa bukan lemak.Tujuan: Mengetahui obesitas dan korelasi antara massa lemak tubuh dan IMT pada anak 7-12 tahun di Jakarta Pusat.Metode: Penelitian potong lintang analitik cluster random sampling antara Jan-Mar 2016.Hasil: Total subjek adalah 1.333 anak. Obesitas menurut massa lemak subyek lelaki sebesar 21,3%, subyek perempuan sebesar 13,1%. Median massa lemak lelaki 7-12 tahun berturut-turut 18,8,18,6,18,1,18,4,18,6,16,1%. Median massa lemak perempuan 7-12 tahun berturut-turut 23,6,24,23,8,23,7,24,4,25,4%. Korelasi IMT dan massa lemak subyek lelaki r=0,848-0,903, p<0,05, korelasi pada subyek perempuan r=0,717-0,846, p<0,05. Sensitivitas IMT terhadap massa lemak subyek lelaki 90,5%, spesifisitas 96,6%, kappa 0,879, sensitivitas IMT terhadap massa lemak subyek perempuan 88,2%, spesifisitas 92,4%, kappa 0,787 menggunakan P85 dan P95 hasil penelitian.Simpulan: Obesitas menurut massa lemak lelaki adalah 21,3% dan perempuan 13,1%, korelasi IMT dan massa lemak lelaki sangat kuat dan kuat pada subyek perempuan.

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Background: Obesity in Indonesia has increased in number from 12.2% (2007) to 14% (2010). Body mass index does not differentiate between fat mass and non-fat mass.

Aim: To determine the obesity profile and correlation between fat mass and body mass index in children aged 7-12 years old in Central Jakarta.

Methods: A cross sectional analytic study. Subjects were recruited from Jan - March 2016 through cluster random sampling.

Result: A total of 1,333 children were recruited. Obesity by fat mass in male was 21.3% and 13.1% in female. Fat mass median in male aged 7,8,9,10,11,and 12 years consecutively were 18.8,18.6,18.1,18.4,18.6, 16.1%. Fat mass median in female aged 7,8,9,10,11,and 12 years consecutively were 23.6,24, 23.8,23.7,24.4,25.4%. Correlation between BMI and fat mass in male r=0.848-0.903, p<0.05, females r=0.717-0.846, p<0.05. Body mass index sensitivity for fat mass in male was 90,5% and 96.6% specificity with kappa value 0,879, in female sensitivity was 88.2% and 92.4% specificity with kappa value 0.787 using new reference percentile generate from this study (P85 and P95 BMI).

Conclusion: The obesity profile determined by fat mass is 21.3% in males and 13.1% in females and with very strong correlation between BMI and fat mass for males and strong correlation in females."

"Latar belakang: Penyakit Kawasaki adalah penyebab utama penyakit jantung didapat pada anak, yang merupakan suatu vaskulitis sistemik akut. Penyakit ini berhubungan dengan luaran aneurisme arteri koroner, yang dapat dicegah dengan pemberian imunoglobulin intravena (IGIV). Terapi baku emas pada penyakit Kawasaki adalah IGIV dosis tinggi (2 g/kgBB). Namun, IGIV dosis medium (1 g/kgBB) merupakan terapi berbiaya lebih rendah dan mungkin memiliki efikasi yang sama. Melalui penelitian ini, kami mengevaluasi keberhasilan terapi IGIV dosis 1 g/kgBB.Metode: Studi kohort retrospektif multisenter dari data rekam medis dengan total 507 pasien dengan penyakit Kawasaki komplit. Penelitian dilakukan di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo dan Kawasaki Center, Indonesia dari Januari 2012 hingga Januari 2022. Pasien yang mendapatkan terapi IGIV dengan dosis 1 g/kgBB didefinisikan sebagai grup A, dan pasien yang mendapatkan terapi IGIV dengan dosis 2 g/kgBB didefinisikan sebagai grup B. Karakteristik dasar subjek dibandingkan antar-kelompok tersebut; demografi, hasil laboratorium, keterlibatan mukokutan, hari demam saat diberikan IGIV, durasi demam pasca-IGIV, lama rawat, dan temuan aneurisme arteri koroner dari ekokardiografi pada periode follow-up.Hasil: Sebanyak 24 pasien (grup A), mendapatkan IGIV dosis medium (1 g/kgBB). Sementara itu, sebanyak 483 pasien (grup B) mendapatkan IGIV dosis tinggi (2 g/kgBB). Distribusi usia dan jenis kelamin, nilai leukosit dan trombosit, hari demam saat diberikan IGIV, durasi demam pasca-IGIV, dan lama rawat tidak berbeda bermakna antar-kelompok (p >0,05). Semua pasien mengalami keterlibatan mukokutan. Berat badan menurut umur (WAZ) dan nilai CRP antar-kelompok bermakna secara statistik (p <0,05). Aneurisme arteri koroner tidak ditemukan pada pasien di grup A dan pada 9 pasien (1,9%) di grup B pada periode follow-up (p >0,05).Simpulan: Terapi dengan dosis inisial IGIV 1 g/kgBB untuk pasien dengan penyakit Kawasaki menunjukkan keberhasilan yang sama dengan IGIV dosis tinggi (2 g/kgBB). Hal ini dapat menjadi opsi terapi bagi negara berkembang.

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Background: Kawasaki disease (KD), the leading cause of acquired heart disease in children, is an acute childhood systemic vasculitis. It is associated with coronary artery aneurysms (CAA), that could be prevented by intravenous immunoglobulin (IVIG) administration. High-dose IVIG (2 g/kg) is usually given in the treatment of Kawasaki disease (KD). However, medium-dose IVIG (1 g/kg) is a low-cost treatment and may have the same efficacy. We aim to determine whether the treatment with IVIG at an initial dose of 1 g/kg is effective for preventing CAA.

Methods: A multicenter retrospective cohort study was conducted. A total of 507 patients with complete KD who were treated with high-dose and medium-dose immunoglobulin at Cipto Mangunkusumo Hospital and Kawasaki Center, Indonesia from January 2012 to January 2022 were enrolled. Patients treated with a single infusion of medium-dose IVIG (1 g/kg) were defined as group A, and patients treated with high-dose IVIG (2 g/kg) were defined as group B. Patient characteristics were compared between the two groups; demographic features, laboratory findings, mucocutaneous involvement, day of fever, duration of fever after treatment, length of stay, and rates of CAA from echocardiography during the follow-up period.

Results: Medium-dose IVIG was given in 24 patients (group A). High-dose IVIG was given in 483 patients (group B). Age and gender distributions, white blood cell and platelet counts, day of fever when IVIG was administered, duration of fever after IVIG treatment, and length of stay did not differ significantly between the two groups (p >0.05). All patients had mucocutaneous involvement. Median of WAZ was higher in group A (+0,35 vs -0,26; p <0.05). Median of concentrations of C-reactive protein was higher in group B (59,5 mg/L vs 81 mg/L; p <0.05). Coronary artery aneurysms were not found in group A and in 9 patients (1.9%) in group B during the follow-up period (p >0.05).

Conclusion: Treatment of KD with IVIG at an initial dose of 1 g/kg could show the same effectiveness as the high-dose IVIG (2 g/kg) and might be an option for low- and middle-income country.

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"Latar Belakang: Anak jalanan yang jumlahnya terus meningkat, merupakan kelompok berisiko tinggi terhadap berbagai masalah sosial dan kesehatan, namun belum ada informasi tentang pengetahuan, sikap, dan perilaku mereka yang berisiko penularan HIV/AIDS.Tujuan: Mengetahui tingkat pengetahuan dan sikap terhadap HIV/AIDS, serta perilaku berisiko tinggi penularan HIV/AIDS dan faktor yang memengaruhinya pada anak jalanan usia remaja di Jakarta.Metode: Studi kuantitatif (kuesioner yang divalidasi) dan kualitatif (wawancara, focus group discussion, dan observasi) terhadap 100 subjek usia 10-18 tahun yang dipilih secara konsekutif. Analisis statistik menggunakan analisis bivariat (uji kai kuadrat atau uji Fischer) dan multivariat (uji regresi logistik).Hasil: Sebagian besar (85%) subjek memiliki tingkat pengetahuan dan sikap yang masih kurang terhadap HIV/AIDS, 35% subjek belum pernah mendengar istilah HIV/AIDS. Tingkat pendidikan dan status ekonomi keluarga merupakan faktor yang memengaruhi pengetahuan dan sikap terhadap HIV/AIDS. Perilaku risiko tinggi penularan HIV/AIDS melibatkan 27% subjek, risiko sedang 18% subjek, risiko rendah 55% subjek. Sebanyak 17% subjek pernah berhubungan seksual (82,4% tidak pernah menggunakan kondom), 58% perokok; 45% peminum alkohol, 26% pengguna obat-obatan terlarang. Prostitusi dan homoseksualitas juga didapatkan pada anak jalanan. Usia, jenis kelamin, tingkat pendidikan, lama bekerja, jumlah jam kerja, tempat tinggal, frekuensi bertemu orangtua kandung, dan sumber informasi utama merupakan faktor yang memengaruhi tingkat perilaku risiko tinggi.Simpulan: Anak jalanan memiliki tingkat pengetahuan dan sikap yang kurang terhadap HIV/AIDS serta banyak terlibat perilaku berisiko tinggi, sehingga membutuhkan penanganan yang komprehensif dan multidisiplin.

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Background: Street children are increasing and highly vulnerable to many social and health problems, but very little is known about their knowledge, attitudes, and behavior related to HIV/AIDS transmission.

Objectives: To identify level of knowledge, attitudes, and high-risk behavior related to HIV/AIDS transmission among adolescent street children in Jakarta and its related factors.

Methods: Quantitative (validated questionnaire) and qualitative (in-depth interview, focus group discussion, and observation) study were conducted among 100 participants aged 10-18 years old which were recruited consecutively. Statistical analysis was done using bivariate (Chi-square or Fischer tests) and multivariate (logistic regression) analysis.

Results: Most participants (85%) had low knowledge about HIV/AIDS and 35% subjects never heard about HIV/AIDS. Low education level and low socio-economic status increased likelihood of having low knowledge about HIV/AIDS. High-risk behaviors were engaged by 27% participants, moderate risk 18%, low risk 55% participants. Seventeen percent subjects were sexually experienced (82,4% never use condom), 58% smokers, 45% alcohol drinkers, and 26% drug abusers. Prostitution and homosexuality were also prevalent among street children. Factors that increased the likelihood of displaying risky behavior were being male, older age, low education level, being street children more than 5 years, working on the street more than 35 hours a week, living on the street, less contact with parents, and having friend as major source of information.

Conclusions: Street children had low knowledge and attitude toward HIV/AIDS and high engagement on high-risk behavior, thus require comprehensive and multidisciplinary approaches."

"Latar belakang: angka kematian akibat pneumonia pada anak masih tinggi. Studi melaporkan bahwa kasus kematian anak yang dirawat di rumah sakit karena pneumonia bervariasi dari 8,7% hingga 47%, lebih dari 70% berlangsung di Afrika dan Asia Tenggara. Banyak dilaporkan pasien datang dengan kondisi yang berat karena keterlambatan penanganan, hingga menyebabkan kematian.Oleh karena itu, studi yang mempelajari faktor risiko kematian pada pneumonia anak  perlu dilakukan.Metode: penelitian ini merupakan studi retrospektif dengan mengambil data rekam medis pasien anak usia 2 bulan sampai 18 tahun yang tercatat sebagai penderita penyakit pneumonia pada periode Juli 2021 – Mei 2022. Faktor yang didata meliputi faktor klinis dan pemeriksaan penunjang yang mendukung diagnosis.Hasil: subyek penelitian didapatkan sebanyak 207 pasien dengan luaran pasca rawat inap meninggal sebanyak 33 (15,9%) pasien dan hidup sebanyak 174 (84,1%) pasien. Hasil analisis multivariat menunjukkan faktor risiko yang berhubungan dengan kematian pneumonia anak adalah kesulitan makan minum (aOR 2,743 IK 95% (1,219-6,172); p 0,012), komorbid keganasan (aOR 2,500 IK 95% (1,094-5,712); p 0,026), takipneu (aOR 2,711 IK 95% (1,263-5,817); p 0,009), hipoksemia (aOR 2,323 IK 95% (1,021-5,284); p 0,041),  dan leukositosis (aOR 2,245 IK 95% (1,038-4,856); p 0,037).Simpulan: pasien pneumonia anak yang mengalami kesulitan makan minum, memiliki komorbid keganasan, takipneu, hipoksemia, dan leukositosis berisiko mengalami kematian.

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Background: the mortality rate of pneumonia in children still elevated. Studies reported that cases of child mortality in hospitalized patient due to pneumonia vary from 8.7% to 47%, more than 70% from Africa and Southeast Asia. Many patients reported coming with severe conditions due to delays in treatment, causing death. Therefore, research that study the   factors that contribute to  mortality in pediatric pneumonia patients is needed.

Methods: This study is a retrospective study by taking medical records of pediatric patients aged 2 months to 18 years who were diagnosed as pneumonia in the period July 2021 - May 2022. The factors recorded included clinical factors and diagnostic examinations that supported the diagnosis.

Results: this study consisted of 207 pneumonia patients with post-hospital outcomes died as many as 33 (15.9%) patients and lived as many as 174 (84.1%) patients. The results of multivariate analysis showed the risk factors associated with mortality of pediatric pneumonia were difficulty eating and drinking (aOR 2.743 CI 95% (1,219-6,172); p 0.012), comorbid malignancy (aOR 2,500 CI 95% (1.094-5.712); p 0.026), tachypnea (aOR 2.711 CI 95% (1,263-5.817); p 0.009), hypoxaemia (aOR 2.323 CI 95% (1.021-5.284); p 0.041), and leukocytosis (aOR 2,245 CI 95% (1.038-4.856); p 0.037 ).

Conclusion: pediatric pneumonia patients who have difficulty eating and drinking, have comorbid malignancy, tachypnea, hypoxemia, and leukocytosis are at risk of death."

"Latar belakang. Sepsis merupakan salah satu penyebab utama kematian pada pasien sakit kritis. Pada sepsis berat dan melanjut, akan terjadi ketidakseimbangan sitokin inflamasi dan anti-inflamasi. Berbagai penelitian telah mencoba mengungkapkan peran mikronutrien bagi sistem imun, di antaranya adalah zinc. Defisiensi zinc dapat menyebabkan gangguan sistem imun alamiah dan didapat. Namun, sejauh ini di Indonesia, belum terdapat studi yang meneliti interaksi antara defisiensi zinc dengan sistem imun terutama pada sepsis melanjut.Tujuan. Penelitian ini bertujuan untuk mengetahui: (1) profil kadar zinc serum, TNF-α, IL-10, IFN-γ, (2) hubungan antara kadar zinc serum dengan skor PELOD. (3) hubungan antara masing-masing kadar zinc serum, TNF-α, IL-10, IFN-γ dengan luaran sepsis melanjut, (4) korelasi antara kadar zinc serum dengan TNF-α, IL-10, IFN-γ dan rasio TNF-α/IL-10 pada sepsis melanjut.Metode. Penelitian potong lintang di Unit Perawatan Intensif (ICU) Anak RSCM, dengan subjek berusia 1 bulan?18 tahun. Pasien dengan diagnosis sepsis, berlangsung lebih dari 5 hari, memiliki skor PELOD ≥10, tanpa dugaan infeksi HIV, keganasan, dan tidak mendapat suplementasi zinc, dilakukan pemeriksaan kadar zinc serum, TNF-α, IL-10, dan IFN-γ. Dilakukan pemeriksaan kadar zinc serum pada populasi anak non-sepsis (dari pasien yang menjalani toleransi operasi elektif dengan diagnosis non-infeksi dan non-keganasan).Hasil. Sebanyak 23 dari 52 subjek dengan sepsis memenuhi kriteria penelitian. Seluruh subjek memiliki kadar zinc serum yang rendah (median 0,56 μg/dL; 0,06-3,39 μg/dL), berbeda bermakna dengan kelompok kontrol (median 31,13 μg/dL; 21,71-55,57 μg/dL) (p = 0,00). Median kadar TNF-α, IL-10, dan IFN-γ pada penelitian ini berturut-turut adalah 13,73 (1,53-43,59) pg/mL, 5,15 (0,86-52) pg/mL, dan 5,17 (0,16-36,10) pg/mL. Zinc serum tidak berhubungan dengan mortalitas (p=0,186), namun berkorelasi terbalik dengan skor PELOD (r=-0,489, p=0,018). Kadar TNF-α berkorelasi lurus dengan mortalitas sepsis (r=-0,42, p= 0,046), namun IL-10 dan IFN-γ tidak terbukti berhubungan dengan luaran sepsis. Kadar zinc serum cenderung berkorelasi negatif terhadap kadar TNF-α dan IFN-γ, namun tidak berkorelasi dengan kadar IL-10 dan rasio TNF-α/IL-10.Simpulan. Pada anak dengan sepsis melanjut terdapat penurunan kadar zinc serum yang berkorelasi dengan perburukan skor PELOD. Kadar zinc serum yang rendah cenderung berhubungan dengan peningkatan kadar TNF-α dan IFN-γ. Mortalitas pada sepsis melanjut berhubungan dengan peningkatan kadar TNF-α.

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Background. Sepsis is a major cause of mortality in critically ill patients. Imbalance of the inflammatory and antiinflammatory reactions will results in severe and prolonged sepsis. Many researches have showed the role of micronutrients, such as zinc, in immune system. Yet, no research in Indonesia studied the interaction between zinc deficiency and the immune system, particularly in prolonged sepsis.

Objectives. This study was designed to identify: (1) serum zinc, TNF-α, IL-10, and IFN-γ profile in prolonged sepsis, (2) the relationship between serum zinc level and PELOD score in prolonged sepsis, (3) the relationship between serum zinc, TNF-α, IL-10, and IFN-γ with sepsis outcome in prolonged sepsis, (4) the correlation between serum zinc level and TNF-α, IL-10, IFN-γ, TNF-α/IL-10 ratio in prolonged sepsis.

Method. All patients age between 1 month ? 18 years old, with PELOD score ≥10 on >5 days after sepsis onset, and without any immunosupressive underlying disease, admitted to the pediatric intensive care unit from June through November 2012, were eligible for enrollment. After consent, blood samples were collected and pooled for serum zinc, TNF-α, IL-10, and IFN-γ level analysis. A control group consist of pre-operative children were also enrolled to compare the serum zinc level.

Results. Twenty-three out of 52 patients with sepsis were enrolled. All subjects had a low serum zinc level (median 0,56 μg/dL; 0,06-3,39 μg/dL), significantly differ to control group (median 31,13 μg/dL; 21,71-55,57 μg/dL) (p = 0,00). The median level of TNF-α, IL-10, and IFN-γ in this research were 13,73 (1,53-43,59) pg/mL, 5,15 (0,86-52) pg/mL, and 5,17 (0,16-36,10) pg/mL. Serum zinc did not correlate to mortality (p = 0,186), but correlate to PELOD score (r = -0,489, p = 0,018). There were trends toward an increase in the TNF-alpha, IL-10 and IFN-gamma level in the non-survivor group compare to the survivors, but these trends were not significantly different, except for the TNF-alpha level (r = -0.42, p = 0.046). The serum zinc level tend to inversely correlate to TNF-α and IFN-γ level, but not to IL-10 level and TNF-α/IL-10 ratio.

Conclusion. In children with prolonged and severe sepsis, the decrease in serum zinc level is correlate to PELOD score deterioration and tend to correlate with the increase of TNF-α and IFN-γ level, adding a risk toward increase mortality."

"Latar Belakang : Diagnosis tuberkulosis pada anak tidak mudah sehingga sering terjadi under diagnosis atau over diagnosis. Uji tuberkulin sebagai penunjang untuk mengetahui infeksi tuberkulosis memiliki angka negatif palsu 10-25%. Mayoritas pasien tuberkulosis anak memiliki kadar seng plasma yang rendah dibanding anak sehat. Tujuan : Mengetahui efektivitas krim seng topikal untuk meningkatkan diameter indurasi uji tuberkulin pada pasien TB anak. Metode : Uji klinis tidak tersamar dengan subjek penelitian bertindak sebagai perlakuan dan kontrol (matching) yang berlangsung selama bulan Oktober 2012 hingga Desember 2012. Subjek penelitian merupakan pasien tuberkulosis usia 2- 18 tahun di Departemen IKA RSCM dan Bagian Anak RS Persahabatan yang memenuhi kriteria inklusi dan eksklusi Analisis data penelitian dengan menggunakan uji non parametrik Wilcoxon signed rank test menggunakan SPSS versi 15. Hasil : Penelitian dilakukan pada 47 subjek. Mayoritas subjek penelitian memiliki status gizi baik (53%), median durasi pengobatan <6 bulan, median usia 72 bulan dan 47% merupakan kelompok usia <5 tahun. Sebanyak 16 subjek memiliki median selisih perbedaan indurasi uji tuberkulin lengan kanan dan kiri sebesar 1 mm (P<0,001) namun secara klinis tidak bermakna. Tiga puluh subjek lainnya tidak memiliki perbedaan indurasi uji tuberkulin lengan kanan dan kiri. Dua puluh subjek (43%) mengalami reaksi Koch setelah penambahan krim seng topikal. Pemberian krim plasebo tidak menyebabkan reaksi Koch. Simpulan : Pemberian krim seng topikal tidak terbukti bermakna secara klinis dalam meningkatkan indurasi uji tuberkulin dibandingkan krim plasebo.

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Background : Diagnosis of tuberculosis in children is difficult, under diagnosis or over diagnosis is commonly happened. Tuberculin test as an important supporting examination for tuberculosis infection has false negative value 10-25%. Majority of children with tuberculosis have lower plasma zinc level than healthy children.

Objective : To evaluate effectiveness of topical zinc cream in augmenting diameter of tuberculin induration among children with tuberculosis.

Methods : Unblinded clinical trial involving subjects matched with themselves was performed between October 2012 until December 2012. Subjects were children with tuberculosis aged 2-18 years old in Child Health Departement Cipto Mangunkusumo Hospital dan Persahabatan Hospital, Jakarta. Data analysis was performed with Wilcoxon signed rank test using SPSS 15 version.

Results : There were 47 subjects recruited in this study. Majority of subjects were well nourished (53%), underwent treatment <6 months (median), aged 72 months (median) and were under-five children (47%). Sixteen subjects showed 1 mm (median) difference of tuberculin induration between zinc arm and placebo arm (P<0,001). This difference is statistically significant but clinically insignificant. Twenty two subjects (43%) had Koch reaction after zinc cream application. Application of placebo cream didn't cause any Koch reaction.

Conclusion: Application of topical zinc cream is clinically insignificant to augment tuberculin induration compared to placebo cream."

"ABSTRACTLatar Belakang. Sebagai klinisi, dokter diharapkan mampu menegakkan diagnosis etiologi keluhan BKB dengan cepat, tepat, hemat biaya dan tidak hanya bersifat simptomatik belaka. Sayangnya, hingga kini masih sedikit penelitian mengenai etiologi BKB pada anak, padahal setiap pusat pelayanan kesehatan memiliki data etiologi BKB yang berbeda-beda. Perbedaan etiologi ini disebabkan oleh perbedaan definisi yang dianut, batasan usia anak, serta karakteristik dan tingkat pusat pelayanan kesehatan yang menjadi tempat penelitian.Tujuan. Penelitian ini bertujuan untuk mengetahui prevalens keluhan utama BKB pada pasien anak dengan keluhan batuk, tiga etiologi tersering, waktu yang dibutuhkan untuk menegakkan diagnosis etiologi BKB, profil klinis dan pemeriksaan penunjang pada pasien di unit rawat jalan Departemen IKA-RSCM dari bulan Juli 2007 sampai dengan Juli 2013.Metode. Metode penelitian ini adalah deskriptif retrospektif dengan melakukan penelusuran dan analisis data rekam medis pasien berusia 1-18 tahun (12-216 bulan) dengan keluhan utama batuk (ICD 10-R05.0).Hasil. Prevalens BKB dari seluruh subjek dengan keluhan batuk adalah 437 subjek (87,6%), dengan median usia 54 bulan (12-220 bulan). Etiologi spesifik tersering adalah United airway diseases (46,9%), asma (31,7%) dan TB paru (15,4%). Riwayat penyakit dahulu dan keluarga dengan atopi, alergi dan asma membantu penegakan diagnosis. Dari 28 subjek yang tidak mendapat imunisasi BCG, 15 (53,6%) subjek didiagnosis TB paru dan 1 subjek TB milier. Sebanyak 362 (82,9%) subjek yang didiagnosis etiologi batuk pascainfeksi virus, rinitis alergi, asma dan TB paru telah mendapat terapi antibiotik sebelumnya. Median waktu yang dibutuhkan untuk menegakkan diagnosis etiologi BKB adalah 2,5 hari/pasien (0-8 hari/pasien) untuk diagnosis BKB nonspesifik batuk pasca infeksi virus dan diagnosis etiologi spesifik yaitu rinitis alergi adalah 3,7 hari/pasien (0-21hari/pasien), rinosinusitis 4,8 hari/pasien (2-21 hari/pasien), asma 2,5 hari/pasien (0-53 hari/pasien) dan TB paru 6,2 hari/pasien (3-60 hari/pasien). Pemeriksaan penunjang yang banyak dilakukan untuk penegakan diagnosis meliputi uji tuberkulin (84,7%), foto toraks (72,5%), spirometri (14%), dan foto polos sinus paranasal (26,8%).Simpulan. Prevalens BKB mencapai 87,6% dengan etiologi tersering adalah penyakit saluran respiratorik atas, asma dan TB paru. Kata kunci. Batuk kronik berulang (BKB) pada anak,

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ABSTRACTBackground. As clinician, a physician should be able to diagnose the etiology of chronic cough in children, therefore the therapy could be done promptly, precisely, cost-effectively, and not merely symptomatic. Unfortunately, publication on the etiology of chronic cough in children is limited up to now, and every health care centers may have different etiologic data. This differences might be caused by the gaps of chronic cough definition, the child's age restrictions, as well as the characteristics and the level of health care services.Objective. To determine the prevalence of chronic cough in pediatric patients with chief complaints of cough, the three most common etiology, the duration of time to establish the etiology, clinical profiles and supportive investigation in outpatient pediatric unit at CMH from July 2007 to July 2013.Method. A descriptive retrospective analysis was conducted from medical records of patients aged 1-18 years (12-216 months) with a chief complaint of cough (ICD-10 R05.0)Result. Chronic cough prevalence of all subjects with complaints of cough was 87.6% (437 subjects), with a median age of 54 months (12-220 months). The most common specific etiology is upper respiratory tract disease (44.7%), asthma (31.7%%) and pulmonary tuberculosis (15.4%). Past medical history and family with atopy, allergy and asthma aid diagnosis. In 28 subjects who had never received BCG immunization, 15 (53.6%) subjects were diagnosed as pulmonary tuberculosis and 1 subject as miliary TB. Prior antibiotic treatment had been given in 362 (82.9%) subjects that were diagnosed as post viral cough, allergic rhinitis, asthma and pulmonary TB. Median duration of time to diagnose the etiology of nonspesific post viral cough was 2.5 days/patient (0-8 days/patient) and specific etiologic such as allergic rhinitis was 3.7 days/patient (0-21 days/patient), rhinosinusitis in 4.8 days/patient (2-21 days/patient), asthma in 2.5 days/patient (0-53 days/patient) and pulmonary TB in 6.2 days /patient (3 - 60 days/patient). Investigations that commonly done to established the diagnosis were tuberculin test (84.7%), chest Xray (72.5%), spirometer (14%), and plain radiography of paranasal sinuses (26.8%).Conclusion. The prevalence of chronic cough from all subjects with complaints of cough in the outpatient pediatric unit at CMH is 87.6% with the most common etiologies are upper respiratory tract disease, asthma and pulmonary tuberculosis."