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Abstrak :
Pendahuluan. Infeksi HIV perinatal di anak adalah salah satu masalah kesehatan di Indonesia. Dengan bertambahnya ketersediaan obat antiretroviral, angka kelangsungan hidup pasien HIV mengalami perkembangan. Implikasi dari hal ini adalah pentingnya mengetahui dampak HIV terhadap kognitif pada anak yang telah diberikan terapi antiretroviral tersebut, karena penurunan kecerdasaan diketahui sebagai salah satu manifestasi dari HIV stadium berat. Penelitian ini bertujuan untuk mengetahui hubungan antara tingkat CD4+ awal dan tingkat kecerdasan pada anak HIV yang telah memperoleh terapi antiretroviral. Metode. Penelitian ini menggunakan metode cross sectional dan melibatkan anak-anak dengan infeksi HIV melalui transmisi perinatal yang berusia 5.5-18 tahun. Pasien yang terlibat dalam penelitian telah melakukan pengobatan dengan ART sekurang-kurangnya 6 bulan sebelum penelitian. Data subjek, yaitu termasuk data tingkat CD4+ awal pasien, diambil dari case record form dan rekam medis pasien dan dilakukan pada periode Juli-Agustus 2016 di RSUPN Cipto Mangunkusumo. Pengukuran fungsi kognitif dilakukan menggunakan metode CIDD (Cross- Cultural Intellectual Test or Device). Hasil data akan digambarkan dalam tabel. Peneliti mencari hubungan CD4+ dan tingkat kecerdasan subjek dengan menggunakan uji uni-variat non parametric test for independent samples of Mann-Whitney dan simple correlation test. Uji multi-variat linear regression digunakan untuk mengevaluasi faktor risiko dalam fungsi kognitif anak dengan HIV. Hasil. Jumlah subjek yang terlibat dalam studi ini adalah 76 subjek. Subjek merupakan mayoritas perempuan dengan rata-rata usia 10 tahun, dimana sebagian besar merupakan berusia dibawah 12 tahun. 80.3% subjek dilahirkan spontan dan 83% subjek diberi ASI. Angka prevalensi comorbidities adalah sebagai berikut, malnutrisi (77%), TB (66%), dan diare persisten (55%). Mayoritas subjek diberi diagnosis dengan stadium klinis WHO 4, dan HIV-associated immunodeficiency status berat berdasarkan nilai CD4+ awal. Nilai tengah dari hasil uji kognitif CIDD adalah 17. Hasil dari test korelasi mengungkapkan hubungan positif yang sangat lemah (r = 0.005) dengan uji univariat yang menunjukkan hubungan yang tidak signifikan (p-value > 0.05) antara tingkat CD4+ dan tingkat kecerdasan. Sedangkan, dalam analisa faktor risiko ditemukan bahwa umur subjek memiliiki hubungan signifikan terhadap tingkat kecerdasaan (p-value < 0.05). Kesimpulan. Rendahnya tingkat CD4+ awal tidak menentukkan rendahnya tingkat kecerdasan pada anak terinfeksi HIV perinatal yang telah memperoleh terapi anitretroviral. Ditemukan bahwa faktor risiko yang memiliki hubungan dengan kognitif adalah umur pasien. Penelitian lebih lanjut untuk mengevaluasi mengenai kognitif terhadap remaja dengan infeksi HIV perinatal dapat dilakukan untuk mengetahui efek jangka panjang HIV terhadap fungsi kognitif.

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Preliminary. Perinatal HIV infection in children is one of the health problems in Indonesia. With the increase in the availability of antiretroviral drugs, the survival rate of HIV patients has progressed. The implication of this is the importance of knowing the cognitive impact of HIV on children who have been given such antiretroviral therapy, because the decrease in intelligence is known as one of the manifestations of severe stage HIV. This study aims to determine the relationship between baseline CD4 + levels and intelligence levels in HIV children who have received antiretroviral therapy. Method. This study used a cross sectional method and involved children with HIV infection through perinatal transmission aged 5.5-18 years. Patients involved in the study had been taking treatment with ART at least 6 months before the study. Subject data, including patient baseline CD4 + data, were taken from the patient's case record form and medical record and were carried out in the July-August 2016 period at Cipto Mangunkusumo General Hospital. Cognitive function measurements were performed using the CIDD (Cross-Cultural Intellectual Test or Device) method. The results of the data will be illustrated in the table. Researchers are looking for CD4 + relationship and the level of intelligence of the subjects using the non-parametric non-parametric test for independent samples of Mann-Whitney and simple correlation test. The linear regression multi-variate test was used to evaluate risk factors in cognitive functioning of children with HIV. Results. The number of subjects involved in this study was 76 subjects. Subjects constituted the majority of women with an average age of 10 years, with the majority being under 12 year. 80.3% of subjects were born spontaneously and 83% of subjects were breastfed. The prevalence rates for comorbidities are as follows, malnutrition (77%), TB (66%), and persistent diarrhea (55%). The majority of subjects were given a diagnosis with WHO clinical stage 4, and severe HIV-associated immunodeficiency status based on baseline CD4 + values. The mean value of the CIDD cognitive test results was 17. The results of the correlation test revealed a very weak positive relationship (r = 0.005) with a univariate test that showed an insignificant relationship (p-value> 0.05) between CD4 + level and intelligence level. Meanwhile, in the analysis of risk factors it was found that the age of the subjects had a significant relationship to the level of intelligence (p-value <0.05). Conclusion. The low initial CD4 + level does not determine the low level of intelligence in children infected with perinatal HIV who have received antitretroviral therapy. It was found that the risk factor that has a relationship with cognitive is the patients age. Further research to evaluate the cognitive of adolescents with perinatal HIV infection can be done to determine the long-term effects of HIV on cognitive function.

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

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

Abstrak :
ABSTRAK Latar Belakang: Diare kronik meningkatkan risiko kematian serta morbiditas jangka panjang pada anak. Anak dengan infeksi HIV memiliki risiko lebih tinggi terjadi diare kronik. Tujuan: Penelitian ini bertujuan untuk mengetahui gambaran karakteristik, prevalensi, serta faktor risiko yang terkait dengan kejadian diare kronik pada pasien anak dengan infeksi HIV di Rumah Sakit Cipto Mangunkusumo. Faktor risiko yang diteliti ialah usia, status nutrisi, status dehidrasi, status pemberian ASI, fase infeksi HIV, penggunaan obat antiretroviral ARV , kultur tinja, serta sindrom malabsorbsi. Metode: Desain penelitian adalah potong lintang dengan sumber data dari rekam medis pasien departemen anak RSCM dengan infeksi HIV pada tahun 2014-2016. Seluruh data memenuhi kriteria dianalisis. Data dianalisis menggunakan analisis bivariat diikuti analisis multivariat. Hasil: Karena keterbatasan data rekam medis, variabel kultur tinja, sindrom malabsorbsi, serta status pemberian ASI dikeluarkan dari penelitian ini. Prevalensi diare kronik pada pasien anak HIV ialah 12,9 . Analisis multivariat atas 132 data menunjukkan hubungan bermakna antara gizi kurang dan buruk p=0,037, adjusted OR=5,737 dan dehidrasi p=0,026, adjusted OR=6,891 dengan kejadian diare kronik pada pasien anak dengan infeksi HIV. Diskusi: Hasil ini dapat dijelaskan dengan pengaruh imunosupresi dari status gizi yang rendah serta dehidrasi, selain bahwa diare pun dapat menyebabkan dehidrasi serta penurunan status gizi.

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ABSTRACT Introduction Chronic diarrhea increases mortality and other long term morbidities in children. Children with HIV infections are at higher risk of developing chronic diarrhea. Objective This study aims to investigate the characteristics, prevalence, and risk factors of chronic diarrhea in HIV children. Factors analyzed are age, nutritional status, dehydration status, breastfeeding, HIV infection phase, use of antiretroviral ARV drugs, stool culture, and malabsorbtive syndrome. Methods In this cross sectional study data are obtained from medical records of children with HIV infection in Cipto Mangunkusumo Hospital from 2014 until 2016. All data that satisfy the inclusion criteria and are not excluded are analyzed by bivariate followed by multivariate analysis. Results Due to insufficient data on stool culture, breastfeeding, and malabsorbtive syndrome, aforementioned variables are dropped from this study. Data shows that prevalence of chronic diarrhea in children with HIV in CMH is 12.9 . Analysis of 132 data shows that low nutritional status p 0.037, adjusted OR 5.737 and dehydration p 0.026, adjusted OR 6.891 are significantly associated with chronic diarrhea in HIV children. Discussions This finding may be due to the immunosupression caused by low nutritional status and dehydration, also by the fact that diarrhea can also cause a decrease in nutritional status and induce dehydration.

Abstrak :
ABSTRAK
Latar Belakang: Konstipasi pada anak merupakan masalah kesehatan dengan prevalensi yang cukup tinggi di dunia. Konstipasi pada anak memiliki dampak penurunan kualitas hidup pada orang tua dan anak, serta menimbulkan beban ekonomi untuk segi pelayanan kesehatan. Konstipasi fungsional pada anak bersifat multifaktorial. Faktor-faktor risiko konstipasi anak bervariasi pada setiap tempat. Penelitian ini bertujuan untuk mengetahui faktor-faktor risiko konstipasi fungsional pada anak di Rumah Sakit Cipto Mangunkusumo Jakarta tahun 2013-2016. Metode: Penelitian ini menggunakan data sekunder rekam medis yang terdapat di Departemen Ilmu Kesehatan Anak RSCM dengan desain penelitian potong lintang. Hasil: Hasil penelitian menunjukkan prevalensi konstipasi anak di RSCM adalah 6,85 dengan 84 diantaranya merupakan konstipasi fungsional. Melalui analisis bivariat, didapatkan hasil konsumsi ASI eksklusif p=0,088, status gizi p=1,000, riwayat keluarga p=0,332, urutan anak dalam keluarga p=0,076, dan riwayat toilet training p=1,000 tidak berhubungan bermakna dengan kejadian konstipasi fungsional anak. Pada analisis multivariat dengan menggunakan regresi logistik, didapatkan variabel yang paling berhubungan dan signifikan terhadap konstipasi fungsional anak adalah jenis kelamin OR 6,696; IK95 1,224-36,620; p=0,028. Kesimpulan: Jenis kelamin adalah faktor paling berhubungan terhadap konstipasi fungsional anak, hasil ini berbeda dengan penelitian sebelumnya.

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ABSTRACT
Background Childhood constipation is one of the health problem with high prevalence worldwide. It affects both patients and parents quality of life. It also causes economic burdens especially for health services. Childhood constipation is multifactorial. Risk factors of childhood functional constipation differs from one place to another. This study aimed to determine factors associated with childhood functional constipation in Cipto Mangunkusumo hospital Jakarta year of 2013 2016. Methods This cross sectional study used secondary data from medical records in the Pediatrics Department RSCM. Results The results showed that the prevalence of childhood constipation is 6.85 with 84 among those are functional constipation. Through the bivariate analysis, it was found that exclusive breast milk consumption p 0.088, nutritional status p 1.000, family history p 0.332, the order of children in the family p 0.076, and history of toilet training p 1.000 were not significantly related with childhood functional constipation. On multivariate analysis with logistic regression, it was found that gender was associated with childhood functional constipation OR 6.696 IK95 1.224 36.620 p 0.028 . Conclusion It was found that gender was associated with childhood functional constipation. This result differs from other previous studies.

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ABSTRAK
Indonesia merupakan negara berkembang yang mempunyai peluang besar terhadap mortalitas kejadian diare kronik dengan kultur tinja positif. Penelitian bertujuan untuk mengetahui faktor risiko pada pasien anak diare kronik non HIV dengan kultur tinja positif. Penelitian ini dilakukan dengan menggunakan desain potong lintang menggunakan data rekam medis. Penelitian ini menggunakan sampel sebanyak 45 yang dipilih berdasarkan kriteria inklusi dan eksklusi. Hubungan antar variabel dianalisis menggunakan uji bivariat Chi Square dan Fisher dan analisis multivariat uji Regresi Logistik. Dari hasil uji Chi Square didapatkan faktor risiko dehidrasi dan konsumsi antibiotik terhadap nilai hasil kultur tinja pasien diare kronik, bernilai p=0,027 dan p=0,058. Analisis multivariat uji Regresi Logistik tidak dapat dilakukan karena terdapat jumlah 0 pada data konsumsi antibiotik. Pada akhirnya, dapat disimpulkan bahwa dehidrasi dan pemberian antibiotik merupakan faktor yang berhubungan terhadap diare kronik dengan hasil kultur tinja positif berdasarkan analisis bivariat.

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ABSTRACT
Indonesia is developing country that has big risk of diarrhea mortality. The study aimed to know risk factors of pediatric chronic diarrhea non HIV with positive stool culture The study is conducted by using the analytical observational cross sectional study. The samples used in this study were 45 respondents selected by inclusion exclusion criteria. The relationship between variabels was analyzed by bivariate test Chi Square and multivariate analysis Logistic Regretion. Based on Chi Square test, relationship between stool culture with dehydration and antibiotics as risk factors, sequentiallly p 0.027 and p 0.058. Multivariate analysis Logistic Regretion can not be applied because there is quantity ldquo 0 rdquo in antibiotics use. In the end, the result is dehydration and antibiotics use are factors that correlate with chronic diarrhea with positive stool culture based on result of bivariate analysis.

Abstrak :
Latar belakang: Mikrosporidiosis adalah penyakit infeksi protozoa pada saluran gastrointestinal yang disebabkan oleh Microsporidia. Populasi anak merupakan salah satu kelompok populasi berisiko mengalami mikrosporidiosis karena imunitas yang belum matang. Kerusakan mukosa intestinal terkait mikrosporidiosis tersebut dapat menyebabkan diare kronik, malabsorpsi hingga berat badan menurun terutama pada anak. Namun, mikrosporidiosis kurang terdiagnosis karena gejala klinis tidak spesifik dan pemeriksaan spesifik Microsporidia tidak umum dilakukan. Di Indonesia, infeksi Microsporidia pada anak dengan diare belum pernah diinvestigasi. Untuk mengetahui kerusakan mukosa intestinal akibat mikroposiridosis, pemeriksaan calprotectin feses dapat dilakukan. Penelitian ini bertujuan untuk mengetahui prevalensi mikrosporidiosis intestinal pada anak dengan diare dan hubungannya dengan calprotectin feses positif. Metode: Penelitian ini menggunakan desain potong lintang. Sebanyak 112 sampel feses dikoleksi dari Laboratorium Parasitologi FKUI yang berasal dari pasien anak di RSUPN Cipto Mangunkusumo (RSCM) berusia 0 sampai 18 tahun dengan diagnosis diare. Setiap sampel dipulas dengan pewarnaan trichrome untuk mendeteksi Microsporidia dan dilakukan pemeriksaan calprotectin feses kualitatif. Untuk mendeteksi parasit usus lain, dilakukan pemeriksaan mikroskopik langsung, konsentrasi, kultur Blastocystis, pulasan modifikasi tahan asam, dan pemeriksaan coproantigen Giardia dan Cryptosporidium. Data sekunder terkait diagnosis klinis, status gizi dan demografi, didapatkan dari rekam medis. Analisis statistik dilakukan antara subjek dengan infeksi tunggal Microsporidia dan hasil calprotectin feses. Hasil: Prevalensi mikrosporidiosis intestinal pada anak dengan diare yaitu 42,9%, dimana 50% merupakan infeksi Microsporidia tunggal. Infeksi tunggal Microsporidia terbanyak pada usia bayi 8/24 (33,3%), jenis diare akut 17/24 (70,8%) dan penyakit dasar atresia bilier 7/24 (29,1%). Infeksi pada anak laki – laki 15/24 (62,5%), status gizi baik & kurang sama yaitu sebanyak 8/24 (33,3%). Proporsi calprotectin feses positif pada anak dengan diare dan positif Microsporidia yaitu 14/24 (58,3%). Secara statistik, ditemukannya Microsporidia intestinal tidak berhubungan dengan calprotectin feses. Kesimpulan: Prevalensi infeksi Microsporidia pada anak dengan diare di RSCM tinggi, umumnya pada diare akut dan tidak didapatkan hubungan antara mikrosporidiosis intestinal dengan calprotectin feses. ......Background: Microsporidiosis is protozoan infection in gastrointestinal tract caused by Microsporidia. Children have been identified as a population group at risk of developing microsporidiosis due to their immature immune system. Damage to the intestinal mucosa related to microsporidiosis causes chronic diarrhea, malabsorption and weight loss, especially in children. However, microsporidiosis was underdiagnosed because of the clinical symptoms were not specific and Microsporidia examination was not commonly performed. In Indonesia, Microsporidia infection in children with diarrhea has not been investigated. To determine the intestinal mucosa damage due to microposiridosis, a fecal calprotectin test can be performed. This study aims to determine the prevalence of intestinal microsporidiosis in children with diarrhea and its association with positive fecal calprotectin. Methods: The cross-sectional study design was performed in this research. Stool samples as much as 112 were obtained from the FKUI Parasitology Laboratory from pediatric patients at RSUPN Cipto Mangunkusumo (RSCM) aged 0 to 18 years with a clinical data of diarrhea. Each stool sample was stained with trichrome for Microsporidia detection and a qualitative fecal calprotectin test was performed. To detect other intestinal parasites, direct microscopic examination, concentration, Blastocystis culture, acid-fast modified smear, and Giardia - Cryptosporidium coproantigen examination were also performed. Secondary data related to clinical diagnosis, nutritional status and demographics were obtained from medical records. Statistical analysis was performed between subjects with a single Microsporidia infection and fecal calprotectin results. Results: The prevalence of intestinal microsporidiosis in children with diarrhea was 42.9% and 50% of them were single Microsporidia infections. Population characteristics of intestinal microsporidiosis in children with diarrhea, are mostly found in infants 8/24 (33.3%), acute diarrhea 17/24 (70.8%) and underlying disease of biliary atresia 7/24 (29.1%). Infections in boys were 15/24 (62.5%), good & poor nutritional status in equal number 8/24 (33.3%). The proportion of positive fecal calprotectin in children with diarrhea and Microsporidia positive is 14/24 (58.3%). Statistically, the presence of intestinal Microsporidia is not associated with fecal calprotectin. Conclusion: The prevalence of Microsporidia infection in children with diarrhea at RSCM is high, generally in acute diarrhea and there is no association between intestinal microsporidiosis and fecal calprotectin.

Abstrak :
Sebagian anak epilepsi akan mengalami epilepsi intractabledengan berbagai dampak jangka pendek dan panjang yang dapat menyertainya. Salah satu pilihan terapi epilepsi intractableadalah pemberian obat antiepilepsi (OAE) lini II, namun tidak semua pasien mendapatkan luaran positif berupa terkontrolnya kejang. Hingga saat ini belum ada penelitian di Indonesia yang menilai faktor-faktor prediktor terkontrolnya kejang pada anak dengan epilepsi intractable. Penelitian ini bertujuan untuk menilai luaran klinis serta faktor prediktor terkontrolnya kejang pada anak dengan epilepsi intractableyang mendapatkan OAE lini II. Penilitian ini merupakan penelitian kasus-kontrol dengan menggunakan data retrospektif. Sebanyak 60 pasien anak epilepsi intractable yang terkontrol OAE lini II selama enam bulan (kelompok kasus) dibandingkan dengan 60 pasien yang tidak terkontrol (kelompok kontrol) yang telah dilakukan matchingterhadap usia. Sebanyak 29% dari seluruh anak epilepsi mengalami epilepsi intractabledan hanya 43% di antaranya yang terkontrol dengan OAE lini II. Ada empat faktor prediktor yang dinilai yaitu tipe kejang, frekuensi kejang, perkembangan motorik kasar, serta gambaran electroencephalogram(EEG) awal. Hanya gambaran EEG awal yang memberikan hasil signifikan sebagai prediktor terkontrolnya kejang dalam analisis bivariat dan multivariat dengan nilai rasio odds(OR) 4,28 (95% interval kepercayaan=1,48-12,41) dan p=0,007. Dari hasil ini dapat disimpulkan bahwa gambaran EEG awal yang normal merupakan faktor prediktor positif terhadap terkontrolnya kejang pada pasien anak dengan epilepsi intractable. ......Children with epilepsy might have short- and long-term complications if they progress into intractable epilepsy. Seizure remission in intractable epilepsy are sometimes not achieved even after administering second line anti-epileptic drugs (AED). To this day, there were no studies that evaluate the predicting factors of seizure control in children with intractable epilepsy. This research aimed to evaluate the clinical outcomes and predictors factor of seizure control in children with intractable epilepsy who received second line AED. This research is a case-control study with retrospective data. Sixty children with intractable epilepsy patients who had controlled seizure with second line AED for six months (case group) compared with sixty patients who had uncontrolled seizure (control group) with age-matched selection. There were four factors analyzed include type of seizure, frequency of seizure, gross motoric development, and initial electroencephalogram (EEG) feature. Initial EEG feature had significant result in bivariate and multivariate analysis with odd ratio (OR) 4,28 (95% confident interval 1,48-12,41) and p value 0,007. We can conclude that normal initial EEG feature is a positive predicting factor of seizure control in children with intractable epilepsy.

Abstrak :
ABSTRAK
Pendahuluan: Ensefalitis pada anak lebih sering dijumpai daripada dewasa dan luaran buruk terjadi pada 60% subjek yang terkena. Hingga saat ini belum ada data mengenai profil dan luaran pasien ensefalitis anak di Indonesia. Tujuan: Mengetahui profil dan luaran pasien ensefalitis akut pada anak Metode: Penelitian retrospektif ini menggunakan data rekam medis tahun 2014- 2018 di 3 rumah sakit pendidikan (RSCM, RSU Tangerang, RSUP Fatmawati). Gejala klinis awal, pleositosis CSS, abnormalitas neuroimaging, abnormalitas elektrofisiologis (EEG) dicatat dan luaran dinilai saat pasien pulang/meninggal dan dinyatakan sebagai luaran baik atau buruk. Hasil: Terdapat 657 pasien yang memenuhi kriteria ICD X sesuai kriteria inklusi dari 3 rumah sakit, dan data dari 190 subjek dianalisis dalam penelitian ini. Subjek penelitian didominasi oleh anak usia > 1 tahun (83%). Kejang didapatkan pada 87% subjek yang diteliti dan 80%nya merupakan kejang umum. Defisit neurologis fokal terdapat pada 47% subjek (90 pasien). Pemeriksaan penunjang yang menunjukkan abnormalitas tertinggi adalah EEG (90%). Kriteria diagnostik probable terpenuhi pada 62% subjek. Mortalitas didapatkan pada 23% subjek, dengan proporsi terbanyak berasal dari RSU Tangerang. Kejang fokal dan usia > 1 tahun merupakan faktor risiko yang berperan meningkatkan luaran buruk saat pulang 3 kali lipat (p: 0,006 dan p: 0,03). Simpulan: Profil ensefalitis akut pada anak lebih banyak dijumpai pada usia > 1 tahun, dengan gejala yang sering dijumpai saat awal adalah demam, dan kejang. Pemeriksaan penunjang EEG adalah pemeriksaan tertinggi yang menunjukkan hasil positif pada pasien dugaan ensefalitis. Kejang fokal dan usia > 1 tahun merupakan faktor risiko luaran buruk.

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ABSTRACT
Introduction: Encephalitis in pediatric population is more frequent than adult. The outcome has been reported to have poor prognosis in 60% of cases. No data of peidatric encephalitis in Indonesia has been reported yet. Objectives: Evaluate pediatric acute encephalitis profile and factors that influence its outcome. Methods: This retrospective research used medical records data from year 2014- 2018 in 3 teaching hospitals (RSCM, RSU Tangerang, RSUP Fatmawati). We documented clinical presentation at admission, pleocytosis CSF, neuroimaging abnormality, electrophysiologic abnormality (EEG), and outcome at discharge which classified as good vs. poor outcome. Results: Among 657 patients identified using ICD X in all 3 hospitals, there were a total of 190 subjects included in this study. Eighty three percent of subjects aged > 1 years. Seizure was present in 87% subjects, and 80% of those subjects experienced generalized seizure. Focal neurological deficits was shown in 47% subjects (90 patients). Among investigation, EEG shown positive results in 90% examined subjects, while CT scan were the most prevalent. We found probable diagnostic criteria in majority of subjects (62%). Mortality was 23%, and RSU Tangerang was the major contributor. Focal seizure and age > 1 year were the risk factors associated with 3 times increased risk of poor outcome (p: 0,006 and p: 0,03). Conclusions: Age > 1 year is more prevalent in pediatric acute encephalitis. Among most common clinical presentation are fever and seizure. Abnormal EEG finding in suspected encephalitis cases give the most positive result. Focal seizure and age > 1 year were the risk factors for poor outcome

Abstrak :
Latar Belakang : Air susu ibu merupakan nutrisi ideal untuk bayi. World Health Organization (WHO) telah menganjurkan pemberian ASI eksklusif hingga 6 bulan. Data Survey Demografi dan Kesehatan Indonesia (SDKI) tahun 2003 dan 2007 menunjukkan angka keberhasilan ASI eksklusif di Indonesia secara keseluruhan cenderung menurun. Beberapa penelitian menunjukkan terdapat beberapa faktor yang memengaruhi pemberian ASI eksklusif. Tujuan : Mengetahui proposi bayi IMD yang memperoleh ASI eksklusif, dan mengetahui apakah terdapat hubungan antara antara usia ibu, jumlah paritas, cara persalinan, faktor fisis dan psikis ibu, ibu merokok, tingkat pendidikan ibu, ibu bekerja, pengetahuan ibu tentang ASI eksklusif, status sosial ekonomi keluarga, dukungan keluarga, promosi susu formula, dan konseling ASI dengan pemberian ASI eksklusif pada bayi cukup bulan yang dilakukan IMD. Metode : Penelitian bersifat deskriptif potong lintang analitik dengan pengumpulan data dilakukan melalui wawancara pada bulan Juni hingga September 2012. Subyek penelitian adalah ibu yang memiliki anak berusia 0-6 bulan yang datang ke poliklinik anak RS St. Carolus Jakarta. Data kemudian ditabulasi untuk melihat karakteristik subjek dan proporsi ASI eksklusif. Analisis statistik dilakukan untuk mencari faktor yang berhubungan dangan pemberian ASI ekslusif dengan cara uji Kai kuadrat atau Fisher (analisis bivariat) dan uji regresi logistik (analisis multivariat). Hasil : Penelitian dilakukan pada 120 subjek. Sebagian besar subjek merupakan primipara (56,7%). Sebanyak 65,8% melahirkan secara spontan. Sebanyak 73,3% subjek memiliki tingkat pendidikan tinggi dan 59,2% merupakan ibu bekerja. Sebanyak 45% subjek termasuk ke dalam status sosial ekonomi tinggi, dan sisanya berada di sosial ekonomi rendah (4,2%), dan menengah (50,8%). Sebanyak 77,5% tidak memiliki faktor fisis selama masa menyusui. Pengetahuan yang benar mengenai ASI eksklusif didapatkan pada 85% subjek. Sebagian besar subjek (73,3%) telah memperoleh konseling ASI. Sebanyak 64,2% subjek merasa yakin terhadap kecukupan produksi ASI. Berdasarkan uji regresi logistik, didapatkan faktor yang paling bermakna memengaruhi ASI eksklusif secara berurutan, yaitu faktor psikis ibu, diikuti oleh dukungan keluarga, pengetahuan ibu tentang ASI eksklusif, dan konseling ASI dari petugas kesehatan. ......Background: Breastmilk is recognised for its ideal nutritional benefits for babies. The WHO recommended that infants are exclusively breast-fed for the first 6 months of life. Data from Indonesia Demographic and Health Survey 2003 and 2007 showed that exclusive breastfeeding (EBF) rate in Indonesia tends to decease. Several studied have found some factors that influence breastfeeding practices. Objective: To determine the proportion of exclusive breastfeeding among infant who initiate breastfeeding at birth and study its influencing factors. Those factor are maternal age, parity, method of delivery, physical factor (included sore nipples, inverted papillae, and mastitis), psychological factor, maternal smoking, maternal education, mother’s employment, maternal knowledge about exclusive breastfeeding, socio-economic level, family support on breastfeeding, formula promotion, and counceling about breastfeeding. Methods: A descriptive analytic cross-sectional study was conducted from June to September 2012. Subjects selected by consecutive sampling were mothers with a 6-12 months old child, who came to pediatric policlinic at St Carolus hospital Jakarta. Chi square test and multivariate analyses were used to analyze subjects with logistic regression calculation. Results: There were 120 mothers recruited. The rates of exclusive breastfeeding were 75%. The majority of mothers were primiparous (56,7%) and had normal delivery (65,8%). Of 120 mothers, 73,3% mothers had high level of education, 59,2% mothers were the working mother. Forty five percent mothers had high socio-economic level, 4,2% had low socio-economic level, and 50,8% had middle socio-economic level. Majority of mothers (77,5%) did not have physical factor that inhibit the process of breastfeeding. Adequate knowledge about breastfeeding was found in 85% mothers. Majority of mothers (73,3%) received breastfeeding councelling from the hospital staff. Most of mothers (64,2%) had confidence in ability to breastfeed. Multivariate analyses showed that factors significantly associated with EBF were maternal breastfeeding confidence, good family support, adequate mothers knowledge about EBF, and breastfeeding counseling from the hospital staff. Conclusion: The proportion of EBF in infant who initiated breastfeeding was 75%. Factors that influenced the practice of EBF were pshycological factor, family support, mother’s knowledge about EBF, and counselling from the hospital staff.

Abstrak :
Indonesia memiliki insiden demam tifoid yang cukup tinggi khususnya kelompok usia anak. Namun terdapat keterbatasan penelitian yang mempelajari distribusi demam tifoid pada anak, sehingga perlu dilakukan penelitian karakteristik pasien demam tifoid yang terbukti dengan temuan isolat S.typhi, penanganannya, pola resistensi antibiotik dan serotipe S.typhi yang bersirkulasi di Indonesia. Tujuan: Mengetahui karakteristik pasien demam tifoid, diagnosis dan penanganannya, pola resistensi antibiotik dan serotipe S.typhi pada anak di beberapa daerah di Jakarta. Metodologi: Studi potong lintang dengan total 142 subjek. Evaluasi karakteristik dan uji resistensi antimikroba terhadap 22 subjek demam tifoid yang telah dikonfirmasi dengan kultur darah dan pemeriksaan penunjang Tubex ®TF ≥4, serta flagellin based-PCR pada 22 isolat S.typhi untuk analisis serotipe dengan gen fli-B, fli-C dan aro-C. Hasil: Subjek lelaki lebih banyak daripada perempuan, kelompok usia tertinggi 5-9 tahun dan lama demam sekitar 6-8 hari. Manifestasi klinis demam tifoid yang diamati bervariasi, paling sering diare, mual dan muntah, namun tidak berbeda bermakna dengan penyebab demam yang lain yang memiliki klinis gangguan digestif. Sebagian besar subjek penelitian telah mendapatkan pengobatan sebelumnya (61,3%) namun riwayat pemberian antibiotik tidak diketahui pasti, dengan kecenderungan pemberian terapi golongan sefalosporin lebih banyak daripada antibiotik lini pertama. Pemeriksaan penunjang dengan Tubex ®TF mendeteksi positif 67 subjek (47,2%) dengan sensitivitas 95,2%, spesifisitas 56,1%. Berdasar konfirmasi temuan isolat S.typhi pada kultur darah, hanya 22 subjek (15,5%) yang benar menderita demam tifoid dengan karakteristik pasien secara umum tidak berbeda bermakna dengan pasien bukan demam tifoid. Berdasarkan pemeriksaan Tubex ®TF dan kultur darah, demam tifoid lebih banyak didiagnosis dengan tepat di rumah sakit bila dibandingkan dengan puskesmas. Ditemukan 22 isolat positif gen aro-C, 20 isolat positif gen fli-C H:d, 2 fli-C H:j dan 2 isolat yang sama positif dengan gen fli-B. Serotipe S.typhi yang bersirkulasi, namun tidak ditemukan perbedaan manifestasi klinis, dan semua isolat masih sensitif terhadap kloramfenikol, ampisilin dan kotrimoksazol. Simpulan: Angka kejadian demam tifoid yang didiagnosis pasti dengan konfirmasi kultur darah jauh lebih rendah daripada diagnosis klinis. Penelitian ini menunjukkan bahwa kloramfenikol masih dapat diberikan karena serotipe S.typhi yang ditemukan masih sensitif terhadap semua antimikroba.

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Indonesia is known with high incidence of typhoid fever, however there are limited studies available to observe this disease burden in children. Thus a study to observe not only characteristic of patients, its clinical manifestation, diagnostic approach and management, but also thorough evaluation needed to evaluate its drug resistance pattern and Salmonella typhi serotypes circulating in Indonesia. Objective: To evaluate characteristics of children with typhoid fever, its diagnostics and management, antimicrobial resistance pattern and serotype S.typhi circulating amongst children in Jakarta. Methods: Descriptive study with 142 subjects clinically diagnosed with typhoid fever. Characterization of 22 subjects with confirmed case typhoid fever based on S.typhi isolate finding in blood culture and confirmation with Tubex®TF ≥4. Evaluation of antimicrobial resistance pattern and Flagellin based-PCR using fli-B, fli-C and aro-C genes to further analyze serotype S.typhi in children. Results: There were more male than female participants in the study. The highest rate age of group observed were 5to 9 years-old. Most subjects had fever between 6-8 days with clinical manifestations varied but mostly related to digestive system such as diarrhea, nausea and vomit, however there was not difference between typhoid and non typhoid in clinical manifestation. Majority of subjects had received antibiotics prior to diagnose (61,3%), however many were oblivious to the type of treatment received, yet many were prescribed Cephalosporine instead of firstline treatments. Tubex ®TF detected 67 cases of typhoid fever (47.2%), sensitivity 95.2%, specificity 56.1%. Only 22 subjects were confirmed case of typhoid fever (15.5%), however all patients yielded similar characteristics to patients in probable case. Based on laboratory assessment tools, doctors in tertiary hospital showed better accuracy in diagnosing patients with suspected typhoid if compared to primary health care one. Meanwhile all isolates showed positive results with aro-C gene controls, 20 showed positive with fli-C H:d genes whereas only 2 with H: j alleles, and 2 yielded positive results for fli-B. No differences were found in clinical manifestation and all serotypes were sensitive to all antimicrobials tested. Conclusions: Confirmed case of typhoid fever is lower in prevalence if compared to probable case in society. Chloramphenicol is still recommended as first drug of choice for typhoid fever since S.typhi isolated in this research did not reveal any resistancy towards first line antibiotics.