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Latar belakang: Anemia penyakit kronik (APK), anemia defisiensi besi, dan anemia campuran dapat terjadi pada penyakit ginjal kronik (PGK). Untuk membedakan ketiganya dengan parameter laboratorium yang biasa diperiksa seperti feritin dan saturasi transferin tidaklah mudah. Hepsidin adalah parameter baru yang diharapkan menjadi panduan tata laksana anemia pada PGK. Tujuan: Untuk mengetahui kadar hepsidin dan hubungannya dengan derajat PGK, kadar Hb, dan feritin, dan menentukan penyebab anemia pada anak dengan PGK. Metode: Penelitian ini merupakan penelitian potong lintang pada subyek usia 2-18 tahun dengan PGK yang belum didialisis. Anemia karena hemolitik, perdarahan, infeksi, kadar feritin <30 ng/dL atau >1000 ng/dL, diekslusi. Penderita yang mendapat transfusi darah dan terapi eritropoietin juga diekslusi. Subyek dibagi menjadi Grup I (LFG >60 mL/menit/1,73m2) dan Grup II (LFG <60 mL/menit/1,73m2). Hasil: Terdapat 29 subyek pada kedua grup. Anemia terjadi pada 34 dari 58 subyek, 24 diantaranya merupakan APK dan 10 merupakan anemia campuran. Kadar hepsidin pada grup II (median 33,4 ng/mL, rentang 13,76-135,15) secara bermakna lebih tinggi dibandingkan grup I (median 12,5 ng/mL, rentang 0,35-34,62). Kadar hepsidin memiliki korelasi positif dengan feritin (p<0,001). Dengan analisis ROC, didapatkan kadar hepsidin >18 ng/mL dapat memprediksi APK. Kadar feritin >99,7 ng/dL dapat memprediksi hepsidin >18 ng/mL (sensitifitas 74,2% dan spesifisitas 70,4%). Simpulan: Anemia penyakit kronik dengan kadar hepsidin yang meningkat merupakan penyebab anemia yang terbanyak terutama pada derajat PGK yang lebih berat. Kadar feritin >99,7 ng/dL dapat digunakan untuk memprediksi kadar hepsidin >18 ng/mL, sehingga dapat dipakai untuk menentukan penyebab anemia adalah APK.

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Background: Anemia in chronic kidney diseases (CKD) can caused by anemia of chronic disease (ACD), iron deficiency, and both (mix anemia). It was not easy to differentiate the etiology of anemia by using usual hematologic measurement such as ferritin and transferrin saturation. Hepsidin is a new parameter which expected to become guideline in management of anemia in CKD. Objectives: To know hepsidin level and its correlation with glomerular filtration rate, hemoglobin and ferritin level, and to know cutt-off of ferritin to predict hepsidin level. Methods: This is a cross-sectional study in non-dialyzed children at age 2-18 years old with CKD. Children with signs of infection, anemia caused by haemolytic, bleeding, ferritin level <30 ng/dL or >1000 ng/dL was excluded. Children who get blood transfusions or erythropoietin also excluded. Subjects are divided into Grup I (GFR >60 mL/min/1,73m2) and Grup II (GFR <60 mL/min/1,73m2). Results: There are 29 subjects in each grup. Anemia occur in 34 of 58 subjects, 24 were ACD dan 10 were mixed anemia. Hepsidin level in grup II (median 33,4, range 13,76-135,15) ng/mL was higher than grup I (median 12,5, rentang 0,35- 34,62) ng/mL (p<0,001). Hepsidin level has positive correlation with ferritin (p<0,001). In ROC analysis, hepsidin level >18 ng/mL can predict ACD. Ferritin level >99,7 ng/dL can predict hepsidin level >18 ng/mL (sensitivity 74,2%, specificity 70,4%). Conclusions: ACD with high hepsidin level was the most etiology of anemia in children with CKD. Hepsidin level was higher in stage 3-5 CKD compared to milder stage. Feritin level >99,7 ng/dL can predict hepsidin level >18 ng/mL, so can be used to determine that the etiology of anemia was ACD.

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Latar belakang: Kejadian penyakit ginjal kronik (PGK) pada anak berkembang dengan cepat menuju penyakit ginjal tahap akhir (PGTA), yang sering disertai gejala saluran cerna termasuk infeksi Helicobacter pylori (H. pylori). Faktor risiko infeksi H. pylori pada anak PGTA yang menjalani dialisis termasuk status nutrisi, status sosioekonomi, kepadatan lingkungan, tipe dan durasi dialisis. Tujuan: Mengidentifikasi faktor risiko infeksi H. pylori pada anak dengan PGTA yang menjalani dialisis. Metode: Penelitian cross-sectional ini menganalisis data primer pasien anak dengan PGTA yang menjalani dialisis di RSUPN Cipto Mangunkusumo (RSCM) Kiara pada tahun 2023. Hasil: Jumlah subyek penelitian ini adalah 47 anak yang terdiri dari 30 (63,8%) lelaki dan 17 (36,2%) perempuan. Nilai rerata usia adalah 13,15 ± 2,72 tahun. Mayoritas pasien tinggal pada pedesaan (57,4%), menjalani hemodialisis (70,2%) dengan durasi dialisis ≥1 tahun (55,3%), mengalami malnutrisi (51,1%) dengan status sosioekonomi rendah (61,7%), crowding index (CRI) >2 (66%), terinfeksi H. pylori (80,9%), memiliki skor frequency scale for the symptoms of GERD (FSSG) ≥8 (61,7%) dan skor pediatric quality of life inventory (PedsQL) <70 (97,9%). Berdasarkan analisis multivariat, faktor risiko yang berhubungan dengan infeksi H. pylori pada pasien anak dengan PGTA adalah kepadatan lingkungan (p=0,012) dan status sosioekonomi (p=0,048). Kesimpulan: Prevalens infeksi H. pylori pada anak dengan PGTA yang menjalani dialisis adalah sebesar 80,9% dengan reratan usia pasien 13.15 ± 2,72 tahun. Dari hasil analisis multivariat, faktor risiko infeksi H.pylori adalah kepadatan lingkungan (p=0,012) dan status sosioekonomi (p=0,048). Mayoritas pasien memiliki kualitas hidup yang terganggu. ......Background: The incidence of chronic kidney disease (CKD) in children increases rapidly towards end stage renal disease (ESRD) which is often accompanied with gastrointestinal symptoms include Helicobacter pylori (H. pylori) infection. Risk factors for H. pylori infection in ESRD children undergoing dyalisis include poor nutritional and low socioeconomic status, crowded environments, type and duration of dialysis. Objective: To identify risk factors of H. pylori infection in pediatric ESRD patients undergoing dialysis. Methods: This cross-sectional study analyzed primary data on pediatric ESRD patients undergoing dialysis at Dr. Cipto Mangunkusumo National Central Public Hospital in 2023. Results: The number of subjects in this study were 47 children, 30 (63.8%) boys and 17 (36.2%) girls. The mean value for age was 13.15 ± 2,72 years. Most patients lived in rural areas (57.4%), had hemodialysis (70.2%) with duration of ≥1 year (55.3%), had malnutrition (51.1%), with low socioeconomic status (61.7%), crowding index (CRI) >2 (66%), infected by H. pylori (80.9%), had frequency scale for the symptoms of GERD (FSSG) score of ≥8 (61.7%) and pediatric quality of life inventory (PedsQL) score <70 (97.9%). Based on multivariate analysis, the risk factors associated with H. pylori infection in pediatric ESRD patients were environmental density (p=0,012) and socioeconomic status (p=0,048). Conclusion: Prevalence of pediatric ESRD patients who had dialysis that were infected by H. pylori was 80.9% and the age’s average value was 13.15 ± 2,72 years. Based on multivariate analysis, the risk factors for H. pylori infection were environmental density (p=0,012) and socioeconomic status (p=0,048). Most of the patients had low quality of life.

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Latar Belakang. Sebagian anak dengan sindrom nefrotik sensitif steroid (SNSS) akan menjadi sindrom nefrotik relaps sering (SNRS) dan sindrom nefrotik dependen steroid (SNDS). Mereka akan mengalami relaps saat dosis kortikosteroid diturunkan atau dihentikan. Infeksi merupakan salah satu pencetus relaps pada SN. Defisiensi seng plasma ditemukan pada SN fase relaps dan remisi. Akibat defisiensi seng plasma terdapat peningkatan risiko infeksi. Tujuan. Mengetahui rerata kadar seng plasma pada SNRS dan SNDS. Metode. Uji potong lintang dilakukan di Poliklinik Nefrologi Departemen Ilmu Kesehatan anak FKUI/RSCM dan Poliklinik Asoka RSAB Harapan Kita selama bulan Desember 2014 sampai Juni 2015. Subjek adalah penderita SN relaps sering dan dependen steroid usia 5-15 tahun dalam keadaan relaps atau remisi. Pada subjek dilakukan pemeriksaan kadar seng plasma dan albumin. Sebagai kontrol adalah anak sehat yang dipilih secara matching dalam usia. Hasil penelitian. Dalam penelitian ini diikutsertakan 51 subjek yang terdiri dari 23 pasien SN relaps dan 28 SN remisi. Hasil penelitian menunjukkan bahwa pencetus relaps terbanyak adalah ISPA (84,3%). Kadar seng plasma pada SN fase remisi lebih tinggi secara bermakna dibandingkan dengan kadarnya pada SN fase relaps.[46,6 (18,1) vs 67,4 (14,8) ug/dL, P= 0,0001]. Proporsi defisiensi seng plasma pada SN relaps (17/23anak) lebih besar secara bermakna terhadap SN remisi (4/28 anak), P=0,0001. Defisiensi seng plasma merupakan faktor risiko untuk timbulnya relaps pada SNRS dan SNDS [RP 4,05 (IK95% 1,92-8,52),P=0,0001]. Simpulan. Proporsi defisiensi seng plasma pada SN fase relaps lebih besar secara bermakna dibandingkan fase remisi. Rerata kadar seng plasma pada penderita SN relaps lebih rendah secara bermakna dibandingkan SN remisi.

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Background. Fifty percents of children with steroid-sensitive nephrotic syndrome (SSNS) develop frequent relapsers and steroid-dependent nephrotic syndromes. Relapses can occur after corticosteroid therapy was stopped or rapid tappering off the prednisolone dose. Infections are the common causes of relapses in nephrotic syndrome. Low zinc level was found in nephrotic syndrome either in relapse or remission and this might lead to increased risk of infection. Objectives. To analyze the mean of plasma zinc level in frequently relapsing nephrotic syndrome and steroid-dependent nephrotic syndrome. Methods. This cross sectional study was conducted from December 2014 to June 2015 in Nephrology clinic, Child Health Departement, FKUI/RSCM dan Asoka clinic, RSAB Harapan Kita. Fifty-one children aged 5-15 years who either had frequently relapsing nephrotic syndrome or steroid-dependent nephrotic syndrome during remission or relapses were recruited. Twenty-eight healthy children who were matched for age were included as control. Plasma zinc levels and albumin were measured. Results. Among 51 children with nephrotic syndrome, 28 were in remission while 23 were in relapses. Acute respiratory tract infection were the commonest (83,4%) cause triggering relapses. Plasma zinc levels in remission phase of nephrotic syndrome was significantly higher than relapse phase.[46,6 (18,1) vs 67,4 (14,8) ug/dL, P= 0,0001]. Zinc deficiency proportion in nephrotic syndromes during relapses (17/23 children) was significantly higher than remission (4/28 children), P=0,0001. Plasma zinc deficiency was the risk factor of relapses in frequently relapsing nephrotic syndrome and steroid-dependent nephrotic syndrome.[PR 4,05 (CI95% 1,92-8,52),P=0,0001]. Conclusions. Plasma zinc deficiency was significantly higher in nephrotic syndrome during relapses compared to remission. The mean plasma zinc levels in nephrotic syndrome during relapses was significantly lower compared to remission.

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

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Overweight and obesity prevalence in Indonesia is quite high. Recent studies suggest that consumption of infant formula, particularly high protein content, was related to overweight and obesity in children. Therefore, protein content in infant formula was recommended to be lowered. Currently, there is no data on the association between growing-up milk consumption and overweight and obesity in children aged 2-3 years in Indonesia. Objective: To determine the average intake of growing-up milk energy, ratio of growing-up milk calories to the total calories per day, growing-up milk protein, and ratio of growing-up milk protein calories to the total protein calories per day and their relationship with overweight and obesity children aged 2-3 years. Methods: Cross-sectional study was conducted to determine the proportion of overweight and obesity, followed by case-control study to determine the relationship between growing-up milk consumption with overweight and obesity. Overweight and obese subjects were considered as the case group, while normal weight subjects were categorized as control group. Study was conducted in Jakarta since September to December 2018. Three days-food record analysis were performed. Results: A total of 292 subjects with 34 cases and 68 controls. The proportion of overweight and obesity in children aged 2-3 years was 12%. There were significant differences between case and control group in terms of growing-up milk energy intake [516.1 (0 to 1546.7) vs. 238.5 (0 to 1090.4) kcal/day, p<0.001], ratio of growing-up milk calories to total calories per day [41.1 (0 to 83.7) vs 20.8 (0 to 80.7)%, p<0.001], growing-up milk protein [18.9 (0 to 71.7) vs 8.6 (0 to 50.7) g/day, p<0.001], and ratio of growing-up milk protein calories to total protein calories [46.9 (0 to 89.5) vs. 19 (0 to 72.3)%, p<0.001]. Conclusion: Excessive consumption of growing-up milk had significant relationship with overweight and obesity in children aged 2-3 years. 

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Latar Belakang. Obesitas pada anak merupakan masalah kesehatan global. Small dense low density lipoprotein (sdLDL) merupakan salah satu faktor risiko kejadian penyakit kardiovaskular. Peningkatan sdLDL sebagai manifestasi dislipidemi pada remaja dapat terus berlanjut pada usia dewasa dan menyebabkan morbiditas dan mortalitas yang lebih tinggi. Penyebab timbulnya sdLDL pada remaja multifaktor. Tujuan. Mengetahui prevalens sdLDL dan faktor-faktor yang memengaruhi timbulnya sdLDL pada remaja siswa sekolah menengah pertama di Jakarta. Metode. Studi potong lintang pada 97 anak usia 12-15 tahun siswa SMP di Jakarta Pusat pada periode Juni-Juli 2012 dan April-Mei 2014 di Jakarta Timur. Pada subjek penelitian dilakukan pemeriksaan berat badan, tinggi badan, indeks massa tubuh (IMT), massa lemak tubuh (MLT), tekanan darah dan pemeriksaan darah sdLDL. Kriteria obesitas menggunakan IMT ≥P95 berdasarkan usia dan jenis kelamin. Massa lemak tubuh diukur menggunakan Tanita Inner Scan Body Composition Monitor tipe BC-545. Hasil dan pembahasan. Sebanyak 97 remaja obes diikutsertakan dalam penelitian. Prevalens sdLDL terjadi sebanyak 17,2 %. Terdapat hipertensi sebanyak 26,8 %, IMT pada nilai 30-39,9 sebanyak 51,5 % , MLT pada > P98 67 % dan lingkar pinggang > P90 52,5 %. Pada analisis bivariat dengan uji Mann-Whitney dan Kai-kuadrat tidak didapatkan hubungan antara sdLDL dengan faktor-faktor di atas. Simpulan. Prevalens sdLDL pada remaja obes ditemukan sebesar 17,2 %. Tidak ditemukan hubungan antara sdLDL dengan IMT, tekanan darah, MLT dan lingkar pinggang. ...... Background. Childhood obesity is a global health problem. Plasma concentrations of small dense sdLDL are associated with the prevalence of atherosclerosis events. Atherosclerosis has already started to develop in childhood and adolescent obese. Increased sdLDL in adolescent to adult can cause higher morbidity and mortality. Contributing factors of sdLDL in adolescent are multifactorial. Objectives. To know the prevalence of sdLDL in obese adolescents and the affecting factors, such as body mass index, body fat mass, blood pressure and waist circumference. Methods. This was a cross-sectional study performed in obese adolescents, aged 12-15 years old, in several junior high schools in Central and East Jakarta, from May to June 2012 and April to Mei 2014. Physic examination was perfomed, including body mass index, body fat mass, blood pressure and waist circumference. and sd LDL as a blood examination.. Body mass index with the percentile ≥95 according to age and gender was used for obesity criteria, body fat mass was calculated using Tanita Inner Scan Body Composition Monitor Type BC-545. Results. Of 97 obese adolescents in this study, sdLDL was found in 17,2 % subjects. The prevalence of each factors was 26,8 % hypertension, 51,5 % for body mass index at 30-39,9, 67 % for body fat mass >P98 and 52,5 % for central obesity P>P99. Based on bivariate analyse, such as Mann-Whitney and Kai-Kuadrat, there were no correlation between sdLDL and it?s factors. Conclusion. sdLDL has a prevalence of 17,2 % in obese adolescent in this study, with no association found between body mass index, body fat mass, blood pressure and waist circumference.

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Latar belakang. Pemberian cairan intravena pada pasien anak yang menjalani tindakan bedah berfungsi untuk mempertahankan keseimbangan metabolik tubuh. Pemilihan cairan perioperatif yang tidak tepat dapat menimbulkan komplikasi berupa asidosis metabolik, hiponatremia, hipoglikemi, atau hiperglikemia. Tujuan. Mengetahui profil pemberian cairan perioperatif di Rumah Sakit Cipto Mangunkusumo (RSCM) serta pengaruhnya terhadap keseimbangan asam basa serta kadar elektrolit dan gula darah serum. Metode. Studi deskriptif kohort prospektif pada pasien anak (1 bulan ? 18 tahun) yang menjalani tindakan bedah elektif di RSCM. Jenis dan jumlah cairan perioperatif yang diberikan dicatat, serta dilakukan pemeriksaan laboratorium (analisis gas darah, elektrolit dan gula darah serum) sesaat sebelum tindakan bedah, setelah tindakan bedah, serta 6 jam setelah pemberian cairan postoperatif. Hasil penelitian. Dari 61 subyek yang diteliti, 65,6% tidak mendapat cairan preoperatif. Cairan yang paling banyak digunakan sebagai cairan intraoperatif adalah Ringer asetat malat (RAM) yaitu 77% dan cairan postoperatif adalah kristaloid hipotonik (83,6%). Jumlah cairan preoperatif dan postoperatif sebagian besar sesuai formula Holliday-Segar. Subyek yang mendapat cairan preoperatif D10 1/5 NS + KCl (10) lebih banyak mengalami hiponatremia (13,4% vs 5%) dan gangguan kadar gula darah (20% vs 0%) dibandingkan dengan subyek yang tidak mendapat cairan. Asidosis metabolik terjadi pada kelompok cairan intraoperatif RAM (36,2%) maupun Ringer asetat (36,4%). Hiponatremia pasca pemberian cairan postoperatif terjadi pada 57,1% subyek yang tidak mendapat cairan, 44,4% pada kelompok KA-EN3B®, dan 21,9% pada kelompok D10 1/5 NS + KCl (10). Hiperglikemia terjadi pada 15,6% subyek yang mendapat D10 1/5 NS + KCl (10). Simpulan. Pemberian cairan perioperatif di RSCM bervariasi. Angka kejadian hiponatremia pasca pemberian kristaloid hipotonik adalah 13,4 - 44,4%. Hiponatremia dan gangguan kadar gula darah terjadi pada subyek yang mendapat cairan D10 1/5 NS + KCl (10).

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Background. Intravenous fluid in pediatric surgery patients aimed to maintain acid-base balance and also normal serum electrolyte and blood glucose. Inappropriate perioperative fluid management may cause complications such as metabolic acidosis, hyponatremia, hypoglycemia, or hyperglycemia. Objects. To study the profile of perioperative fluid for pediatric patients in Cipto Mangunkusumo Hospital (CMH) and its effects on acid-base balance, electrolyte, and blood glucose. Method. A descriptive prospective cohort study in children aged 1 month to 18 years old who underwent elective surgery in CMH. The intravenous perioperative fluid given to the patients and their amount were recorded. Laboratory examinations were done 3 times (right before surgery, right after surgery, and 6 hours after postoperative fluid was started), which are blood gas analysis, serum electrolyte, and blood glucose. Results. Among 61 subjects, 65,6% did not receive any preoperative fluid. The most common intravenous fluid were Ringer?s acetate malate (RAM) which is 77% as intraoperative fluid and hypotonic crystalloids (83,6%) as postoperative fluid. The amount of preoperative and postoperative fluid was mostly in accordance with Holliday-Segar formula. Subjects who had D10 1/5 NS + KCl (10) as preoperative fluid had more hyponatremia (13,4% vs 5%) and blood glucose disturbance (20% vs 0%) compared to subjects without preoperative fluid. Metabolic acidosis occurred in subjects who had either RAM (36,2%) or Ringer?s acetate (36,4%) as intraoperative fluid. Hyponatremia 6-hours after postoperative fluid occurred in 57,1% subjects without intravenous fluid, 44,4% subjects who had KA- EN3B®, and 21,9% subjects who had D10 1/5 NS + KCl (10). Hyperglycemia occurred in 15,6% subjects who had D10 1/5 NS + KCl (10). Conclusion. There is a variety in perioperative fluid in CMH. Hyponatremia incidence after receiving hypotonic crystalloid is 13,4 - 44,4%. Hyponatremia and blood glucose disturbances occured in subjects who had D10 1/5 NS + KCl (10).

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Latar belakang : Infeksi saluran kemih ISK berulang adalah ISK yang timbul kembali pasca pengobatan, dengan kejadian 40-50 dari ISK pertama. Kekerapan berulangnya ISK meningkatkan komplikasi gagal ginjal kronik. Salah satu faktor penyebab adalah kolonisasi bakteri patogen feses dari saluran cerna di daerah periuretra. Bakteri saluran cerna terdiri dari 3 kelompok, bakteri patogen, komensal dan bakteri menguntungkan. Penelitian membuktikan disbiosis antara bakteri patogen dan menguntungkan berkaitan dengan kejadian penyakit sistemik, namun belum ada penelitian tentang pengaruh hal tersebut pada ISK berulang.Tujuan : Mengetahui kondisi disbiosis yaitu perbedaan proporsi Escherichia coli dan Bifidobacterium sp. saluran cerna pada anak ISK berulang.Metode : Penelitian uji potong lintang pada anak ISK berulang usia 6 bulan sampai dengan

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ABSTRACT
Background Recurrent urinary tract infection UTIr is repeated UTI post antibiotic treatment, with recurrency is 40 50 from the first infection. Recurrency of UTI increases possibility of chronic renal failure as complication. One of the causal factors is colonization of faecal pathogens from gastrointestinal tract in periurethra. Gastrointestinal tract bacteria is divided into 3 groups pathogens, comensal, and beneficial bacteria. Studies proved that imbalance of condition or dysbiosis between pathogens and beneficial bacteria lead to systemic diseases, but there were no studies in UTIr.Objective To know about dysbiosis condition based on proportion differences between gastrointestinal Escherichia coli and Bifidobacterium sp. in UTIr.Methods A cross sectional studies with children with UTIr, aged 6 months old until 18 years old, in Pediatric Departement Cipto Mangunkusumo Hospital as a subject. Healty child which had been matched by sex and age was choosen as a control group. Faecal samples from both groups underwent DNA extractions, using real time PCR method, to look for Escherichia coli and Bifidobacterium sp. amount and proportions.Results There was a total of 25 subjects, 8 32 were classifed as simplex UTI and 17 68 were complex UTI, also 25 healthy children as control. The total amount of Escherichia coli in UTIr compared to control was 1.099.271 vs 453.181 p 0,240. The total amount of Bifidobacterium sp. in UTIr compared to control was 1.091.647 vs 359.336 p 0,148. Escherechia coli proportion in UTIr compared to control was 10,97 vs 4,74 p 0,014 that shown a significant different, while Bifidobacterium sp. 6,54 vs 9,33 p 0,594. In UTIr group, proportion differences beetwen Escherichia coli and Bifidobacterium sp. was 10,97 vs 6,54 p 0,819, while in control group 4,74 vs 9,33 p 0,021 which showed that Bifidobacterium sp. has a significant different. The total amount of Escherichia coli in simplex compared to complex UTIr was 996.004 vs 1.099.271 p 0,798, while amount of Bifidobacterium sp. 835.921 vs 1.196.991 p 0,711. Logarithm of Escherichia coli proportion in simplex and complex UTIr was 5,50 SB 1,45 vs 5,92 SB 0,71 p 0,333, while Bifidobacterium sp. 5,85 SB 0,75 vs 6,04 SB 5,50 p 0,562 showed no significant differences.Conclusions Escherchia coli proportion was higher in UTIr children and Bifidobacterium sp. proportion was higher in healthy children. The proportion of both bacteria was equal in simplex and complex UTIr.

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ABSTRAK
Latar belakang: Talasemia merupakan penyakit kronis yang dapat menganggu kualitas hidup anak, baik karena keparahan penyakitnya maupun pengobatannya yang bersifat jangka panjang. Transfusi darah dan terapi kelasi besi yang diberikan seumur hidup pada anak dengan talasemia memberikan harapan hidup yang sama dengan anak sehat. Kualitas hidup menjadi hal yang penting dengan bertambahnya angka harapan hidup pasien talasemia. Tujuan: Mengetahui kualitas hidup anak dengan talasemia di Pusat Thalassemia departemen ilmu kesehatan anak FKUI-RSCM, Rumah Sakit Umum Daerah Tangerang, dan Rumah Sakit Ibu dan Anak Harapan Kita serta faktor-faktor yang berhubungan. Metode: Penelitian menggunakan rancangan deskriptif dengan analisis potong lintang. Pengambilan sampel dilakukan secara konsekutif pada bulan Januari ndash; Maret 2017. Subyek penelitian adalah anak berusia 2-18 tahun yang datang selama periode penelitian. Penilaian kualitas hidup menggunakan kuesioner baku PedsQL trade; modul generik yang diisi oleh orangtua pasien. Analisis data dengan metode univariat dengan tingkat kemaknaan ?=0,05. Hasil: Terdapat 387 subyek yang mengikuti penelitian, sebaran subyek merata. Nilai rerata total kualitas hidup anak dengan talasemia adalah 76,88 12,92 dengan nilai total pada masing-masing rumah sakit berturut-turut adalah 77,54 RSCM, 81,3 RS Harapan Kita, dan 75,18 RSUD Tangerang. Faktor sosiodemografis dan faktor medis tidak memiliki hubungan bermakna dengan kualitas hidup. Tetapi, seiring bertambahnya usia, kualitas hidup anak semakin menurun, terutama pada domain fungsi sekolah. Simpulan: Lebih dari separuh anak dengan talasemia 72,8 memiliki kualitas hidup yang baik, namun pada domain fungsi sekolah masih memiliki nilai yang rendah.

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ABSTRACT
Background Thalassemia is a chronic condition and affect patient's health related quality of life HRQoL , because of the disease and the effect of treatment. Blood transfusion and chelating agent given for thalassemia children in a lifetime could give a good quality of life compared to healthy children. Assesment is needed to determine and to improve the quality of life in thalassemic patient. Aim To assess the life quality of children with thalassemia in Cipto Mangunkusumo Hospital, Harapan Kita Hospital, and Tangerang Public Hospital as well as affecting factors contributing on it. Method We performed a cross sectional study from January ndash March 2017 in Cipto Mangunkusumo Hospital, Harapan Kita Hospital, and Tangerang Public Hospital. Thalassemia children aged 2 18 years were involved, parents were asked to fill out the PedsQL trade generic score scale version 4.0 questionnaire parent proxy report to assess their quality of life. Result Of the 387 thallasemia patients approached, the distribution of the subject was evenly distributed. The overall mean total score for quality of life in children with thalassemia were 76,88 12,92 each hospital was 77,54 Cipto Mangunkusumo Hospital, 81,3 Harapan Kita Hospital, and 76,88 Tangerang Public Hospital. While The sosiodemographic and medical factors were not significantly affect the HRQoL of the patients. The study reveal that thalassaemia has different impact at different ages especially in school function. Conclusion Thalassemic children have a good quality of life in general 72,8 but the school function still have a low score.Key words thalassemia, children, quality of life, PedsQL.

Abstrak :
Osteogenesis imperfekta (OI) merupakan adalah penyakit genetik kelainan jaringan ikat berupa kerapuhan tulang dan fraktur berulang tanpa adanya trauma yang signifikan. Terdapat berbagai karakteristik klinis yang khas untuk mendiagnosis OI. Terapi bisfosfonat merupakan terapi utama pada OI yang bermanfaat untuk menurunkan insiden patah tulang agar tercapai kualitas hidup yang lebih baik. Penelitian ini bertujuan mengetahui karakteristik klinis dan luaran terapi bisfosfonat pada pasien anak dengan OI di RSCM. Penelitian ini dilakukan secara potong lintang terhadap 71 pasien OI berusia 0-18 tahun di RSCM pada 16-22 November 2020. Data diambil melalui kuesioner daring yang diisi oleh orangtua atau wali. Karakteristik klinis OI mencakup sklera biru (83%) dan patah tulang pada 69 (97%) pasien dengan lokasi paling banyak di tulang femur (66,2%). Hanya terdapat 18 subyek yang sudah melakukan pemeriksaan pendengaran dengan 4 (22%) diantaranya terdapat gangguan pendengaran. Klasifikasi klinis OI paling banyak adalah tipe berat (57%). Enam puluh lima subyek mengalami patahtulang di usia kurang dari 6 tahun termasuk intrauterin dan perinatal. Sebanyak 95,8% subyek mendapatkan terapi bisfosfonat dan hampir seluruhnya diberikan rutin setiap 6 bulan. Terdapat penurunan median kejadian patah tulang sebelum terapi bisfosfonat sebanyak 3,5 kejadian/tahun menjadi satu kejadian/tahun setelah terapi bisfosfonat. Terapi bisfosfonat dapat menurunkan angka kejadian patah tulang setiap tahun. ......Osteogenesis imperfecta (OI) is a genetic disorder of connective tissue causing bone fragility and fractures in the absence of significant trauma. There are many typical clinical features of OI. Bisphosphonate therapy is the main therapy which significantly decreases fracture rate for better quality of life. This study was aimed to observe the clinical features and outcomes of bisphosphonate therapy in pediatric OI patients. A cross sectional study was conducted at Cipto Mangunkusumo Hospital (CMH) in the period of November 16th-22nd 2020. There were 71 patients aged 0-18 years old included for study analysis. Data were obtained from online questionnaire which was filled by their parents or guardians. The clinical features observed were blue sclera (83%) and fractures which occurred in 69 (97%) patients with the most common location was femur (66.2%). There were only 18 patients who underwent hearing examination and 4 of them (22%) had hearing problem. Most patients had severe OI classification (57%). Sixty-five patients had first fracture when their age <6 years old, including intrauterine and perinatal fractures. A total of 95.8% patients had received bisphosphonate therapy and almost all of patients had received treatment every 6 month. There was a decrease in the number of fractures from 3.5 events/year (before bisphosphonate therapy) to 1 event/year after bisphosphonate therapy. The outcome of bisphosphonate therapy was significant in terms of fracture incidence reduction. Bisphosphonate therapy was able to reduce fracture incidence per year.

Abstrak :
Latar belakang: Sindrom Down merupakan kelainan kromosom tersering. Anak dengan SD memiliki beberapa faktor risiko terhadap OSA dengan prevalens di berbagai negara yaitu antara 30-60 , dibandingkan 0,7-2 pada populasi umum. Hingga saat ini belum ada data mengenai OSA pada anak sindrom Down di Indonesia. Tujuan: Mengidentifikasi prevalens OSA pada anak sindrom Down dan menganalisis hubungan antara habitual snoring, obesitas, penyakit alergi di saluran napas, hipertrofi tonsil, dan hipertrofi adenoid sebagai faktor risiko OSA pada anak sindrom Down. Metode: Penelitian potong lintang dilakukan pada anak sindrom Down berusia 3-18 tahun yang tergabung dalam Yayasan POTADS. Penelitian dilakukan di Poliklinik Respirologi IKA FKUI RSCM dari bulan Juli 2016 hingga Juli 2017. Penegakkan diagnosis OSA menggunakan nilai batas AHI 3 pada pemeriksaan poligrafi. Faktor-faktor risiko yang dianggap berpengaruh dianalisis secara multivariat. Hasil: Penelitian dilakukan terhadap 42 subjek dengan hasil prevalens OSA pada anak dengan SD sebesar 61,9 . Sebesar 42,9 merupakan OSA derajat ringan, 14,3 OSA sedang, dan 4,8 OSA berat. Pada analisis multivariat didapatkan faktor risiko yang bermakna yaitu habitual snoring p=0,022 dan PR 8,85; IK 1,37-57 dan hipertrofi adenoid p=0,006 dan PR 12,93; IK 2,09-79 . Simpulan: Prevalens OSA pada anak sindrom Down sebesar 61,9 . Faktor risiko yang bermakna yaitu habitual snoring dan hipertrofi adenoid. ......Background Down syndrome DS is the most common chromosomal disorder. Children with DS have predisposing factors to OSA with prevalence 30 60 , compared with 0.7 2 in the general child population. Until now there is no data about OSA in DS children in Indonesia. Objective To identify the prevalence of OSA in DS and to analyze the effect of habitual snoring, obesity, airways allergic diseases, tonsillar hypertrophy, and adenoid hypertrophy as risk factor for OSA. Method This is a cross sectional study, held in Respirology Clinic of IKA FKUI RSCM Jakarta from July 2016 to July 2017. Subjects in this study were DS children aged 3 18 years who are members of the Foundation POTADS Parents Association of Children with Down Syndrome . OSA was diagnosed by polygraphy examination with cutoff AHI ge 3. The risk factors that are considered important are then analyzed multivariately. Results OSA prevalance among 42 subject are 61,9 . Degree of OSA are 42.9 mild, 14.3 moderate, and 4.8 severe. In the multivariate analysis, the significant risk factor are habitual snoring p 0,022 and PR 8,85 CI 1,37 57 and adenoid hypertrophy p 0,006 and PR 12,93 CI 2,09 79 . Conclusion Prevalence of OSA in DS children is 61,9 . The significant risk factor are habitual snoring and adenoid hypertrophy.