Hasil Pencarian  ::  Simpan CSV :: Kembali

"ABSTRAKLatar belakang:Sepsis adalah infeksi bakteri dalam darah yang sangat serius (SBI) karena akan mengancam jiwa. Masih tingginya angka kematian balita karena infeksi berat dan keterbatasan fasilitas di rumah sakit daerah untuk mendiagnosis terjadinya SBI,maka penilaian secara klinis dengan menggunakan standar yang valid dalam menegakkan diagnosis SBI sangat diperlukan.Salah satu metode yang dapat digunakan untuk menilai apakah anak diprediksi menderita SBI adalah dengan skala Acute illness observation scale (AIOS). Peneliti terdahulu menemukan skalaAIOS >8 mempunyai titik potong paling baik, tapi validasi keakuratannya perlu diteliti lebih lanjut. Tujuan:Melakukan validasi menggunakan skala AIOS>8 untuk mendeteksi terjadinya infeksi bakteri serius pada usia 3-36 bulan yang datang dengan demam, dan membandingkannya dengan diagnosis akhir dari dokter spesialis anak.Metode :Uji diagnostik potong lintang dan validasi skor menggunakan tabel dua kali dua, untuk mendapatkan nilai sensitifitas, spesifisitas, nilai duga positif, nilai duga negatif dan rasio kemungkinan positif dan negatif. Hasil penelitian :Dari 143 sampel, subjek penderita SBI sebesar 44(30,77%), proporsi anak laki-laki sama dengan perempuan. dan usia terbanyak adalah 3-12 bulan yaitu 27(61,4%) subjek. Subjek penderita SBI dengan skoring AIOS > 8 sebanyak 41( (93,2%%). Penyakit SBI terbanyak adalah pnemonia 21(47,7%) subjek, diikuti ISK (13,6%), diare bakterial, sepsis dan ensefalitis masing masing (9,1%), selulitis (6,8%) dan meningitis (4,6%) dan penyakit bukan SBI terbanyak adalah ISPA 36(36,4%) subjek. Sensitifitas skor AIOS 95,5% (IK 95%; 84,5-99,4%), spesifisitas 29,3% (IK 95%; 20,6-39,3%), nilai duga positif 37,5% (IK 95%; 34,3-40,9%), nilai duga negatif 93,6% (IK 95%; 78,4-98,3%), rasio kemungkinan positif 1,4 (IK95%; 1,2-1,6), rasio kemungkinan negatif 0,2 (IK95%; 0,04-0,6). AUC(area under receiver operating characteristic curve 0,655 dengan p 0,002 dan IK 95% 0,6-0,8) dapat mendiskriminasi pasien-pasien yang dicurigai SBI dengan baik. Kesimpulan : Penggunaan skala AIOS>8 sangat sensitif untuk mendeteksi terjadinya infeksi bakteri serius pada usia 3-36 bulan.

---

ABSTRACTBack ground. Sepsis is a very serious bacterial infection in the blood (SBI) because it will be life-threatening. The high rates of under-five mortality due to severe infections and limited facilities in local hospitals, a clinical assessment must be use a valid standard to diagnose SBI. One method that can be used to assess whether a child is predicted to have SBI is the scale of the Acute illness observation scale (AIOS). The previous researcher found that the scale of AIOS > 8 has the best cutoff point, but the validation of accuracy needs to be further investigated.. Aim: Validate using AIOS scale> 8 to detect the occurrence of serious bacterial infections at the age of 3-36 months who come with fever, and compare it with the final diagnosis of pediatrician.Method. The cross-sectional diagnostic test and the scoring validation use the two-by-two tables, to obtain sensitivity, specificity, positive predictor, negative predictor and positive and negative probability ratios. Result. Of the 143 samples, the subject of SBI was 44 (30.77%), the proportion of boys was the same as for women. And the most ages were 3-12 months ie 27 (61.4%) subjects. Subjects of SBI patients with AIOS scores > 8 were 41 ((93.2 %%) .The highest SBI disease was pneumonia 21 (47.7%) subjects, followed by UTI (13.6%), bacterial diarrhea, sepsis and encephalitis respectively (9,1%), cellulitis (6.8%) and meningitis (4.6%) and non-SBI disease were mostly ARI 36 (36.4%) subjects, AIOS score sensitivity 95.5% (95% IK; 84,5-99,4%), specificity 29,3% (95% IK, 20,6-39,3%), positive predictive value 37,5% (95% IK, 34,3-40,9% ), A negative predictive value of 93.6% (95% IK, 78.4-98.3%), a positive likelihood ratio of 1.4 (IK95%, 1.2-1.6), a negative likelihood ratio of 0.2 ( IK95%; 0.04-0.6). AUC (area under receiver operating characteristic curve 0.655 with p 0.002 and 95% IK 0.6-0.8) can discriminate well-suspected SBI patients. Conclusion. The use of AIOS scale> 8 is very sensitive to detect serious bacterial infections at 3-36 months of age in area."

"Golongan usia anak merupakan golongan usia yang paling ringan terdampak infeksi COVID-19. Salah satu kemungkinan penyebab keadaan tersebut adalah perlindungan dari efek nonspesifik vaksinasi rutin yang diterima anak sebelumnya. Vaksinasi rutin yang diterima anak dapat memodulasi sistem imun anak terhadap infeksi lain di luar target imunisasi yang dituju melalui mekanisme imunitas heterolog. Bukti-bukti penelitian terdahulu menimbulkan hipotesis antigen vaksin DTP berpotensi menimbulkan imunitas heterolog dengan SARS-CoV-2. Hal ini berdasarkan kemiripan epitop antara antigen SARS-CoV-2 dengan antigen pada vaksin DTP. Belum diketahui bagaimana pengaruh vaksinasi DT booster terhadap respons imun (antibodi S-RBD SARS-CoV-2 dan IFN-ɤ-sel T spesifik SARS-CoV-2) pascavaksinasi COVID-19 inaktif pada anak usia 6–7 tahun. Penelitian ini bertujuan mengetahui pengaruh pemberian vaksinasi DT booster pada anak yang mendapat vaksinasi COVID-19 inaktif terhadap respons imun humoral dan selular anak.Studi potong lintang dilakukan dengan didahului tahapan pengambilan data pada orang tua subjek penelitian di wilayah Senen, Jakarta Pusat. Pengambilan data menggunakan kuesioner yang disebarkan secara luring kepada orang tua melalui guru sekolah anaknya. Dari kuesioner didapatkan data status vaksinasi anak, yang dibedakan dalam 4 kelompok yaitu COVID+/DT+, COVID+/DT–, COVID–/DT+ dan COVID–/DT–, dan diukur antibodi S-RBD, IFN-ɤ-sel T spesifik SARS-CoV-2 dan IgG antidifteri.Hasil penelitian menunjukkan 113 dari 154 subjek penelitian (73,4%) telah memiliki status relative immune terhadap difteri, dengan hasil IgG antidifteri > 0,1 IU/mL. Terdapat imunitas heterolog vaksinasi DT booster terhadap COVID-19 dengan adanya perbedaan bermakna kadar antibodi S-RBD SARS-CoV-2 antara anak yang sudah mendapat vaksin DT booster dibanding yang belum (1182 U/mL vs. 612,5 U/mL, p = 0,026), dan perbedaan bermakna IFN-ɤ-sel T spesifik SARS-CoV-2 pada anak COVID+/DT+ dibanding COVID+/DT– (560,87 mIU/mL vs. 318,03 mIU/mL, p = 0,03). Tidak didapatkan korelasi antara IgG antidifteri dan S-RBD SARS-CoV-2. Selain hasil penelitian data laboratorium, didapatkan pula data keinginan orang tua untuk vaksinasi COVID-19 bagi anaknya adalah sebesar 69,7%.Disimpulkan vaksin DT booster dapat berperan menguatkan respons imun spesifik SARS-CoV-2 pada anak yang menerima vaksin COVID-19 inaktif.

---

Corona Virus Disease 2019 (COVID-19) in children tends to be mild. A possible cause is existing protection from the routine vaccination previously received by children. Routine vaccinations can modulate the child's immune system against other pathogen, presumably through a mechanism of heterologous immunity. Previous research had suggested that the Diphtheria-Tetanus-Pertussis (DTP) vaccine antigen has potential to incite heterologous immunity towards SARS-CoV-2, due to similarities between SARS-CoV-2 epitopes and various epitopes found within the DTP vaccine. It was not known whether the Diphtheria-Tetanus (DT) vaccination could modulate the SARS-CoV-2-specific immune response among children aged 6–7 years who received inactivated COVID-19 vaccine.

This study thus aimed to assess the impact of DT booster immunization in SARS-CoV-2-specific humoral and cellular immune responses among children who received two doses of CoronaVac.

A cross-sectional study was performed on children aged 6–7 years old in the Senen area, Central Jakarta. This study was started with data collection from parents of eligible subjects using questionnaire that was distributed to parents via their children’ school teachers. Based on the collected demographic data and the child's vaccination status, eligible subjects were further screened. The participating subjects were subsequently classified into 4 groups, i.e., COVID+/DT+, COVID+/DT-, COVID-/DT+ and COVID-/DT-. Blood collections were performed to determine anti-diphtheria toxoid antibodies, anti-S-RBD antibodies and SARS-CoV-2-specific T cell-produced IFN-ɤ.

The results showed that 113 of 154 subjects (73.4%) had relative immune-status against diphtheria as the result of the anti–diphtheria toxoid antibodies was > 0.1 IU/mL. There was a heterologous immunity of DT booster and COVID-19 vaccine, as there was significant difference in anti-S-RBD antibody titers between the group with DT booster compared to non-DT booster (1182 U/mL vs. 612.5 U/mL, p = 0.026), and a significant difference in IFN-ɤ concentration between the group of COVID+/DT+ and COVID+/DT- (560.87 mIU/mL vs. 318.03 mIU/mL, p = 0.03). No correlation was found between anti-diphtheria and anti-S-RBD antibodies. In addition, our data indicated that parental intention to vaccinate their children against COVID-19 in the Senen area was 69.7%.

In conclusion, our results suggested that DT booster vaccine might able to enhance SARS-CoV-2-specific immune responses among children who received inactivated COVID-19 vaccine."

"ATS telah banyak digunakan di Indonesia dalam mengobati tetanus. Sejak tahun 2010, penggunaan HTIG sebagai antitoksin semakin meningkat. Tujuan: mengevaluasi perbedaan luaran pada tetanus anak antara yang mendapat ATS dan HTIG. Method: Penelitian retrospektif pada kasus tetanus anak yang dirawat di Rumah Sakit Cipto Mangunkusumo dari 2006-2014. Results: Ada 69 pasien tetanus anak yang menjadi subjek penelitian, dengan kelompok usia terbanyak adalah 1 ? 5 tahun yaitu 53,6 % dan proporsi laki-laki lebih banyak dibanding perempuan (2:1), dengan 59,4 % subyek tidak pernah mendapat imunisasi dasar. Port d‟entree terbanyak adalah OMSK (47,8 %) dan tetanus derajat 3 merupakan diagnosis terbanyak (39,1 %). Semua subjek datang dirawat dengan gejala trismus, disertai kejang rangsang (75,4 %), kaku kuduk dan opistotonus (73,9 %), spasme spontan (69,6 %) dan perut papan 65,2 % subjek. Enam puluh tujuh persen subjek diobati dengan ATS dan 33 % dengan HTIG. Lama rawat subjek yang mendapat ATS 9,98 (SB 4,58) dan HTIG 10,91 (SB 5,88) hari. Subjek yang meninggal di akhir perawatan, pada kelompok ATS 4,4 % dan HTIG 21,7 %. Pada kelompok ATS, trismus terjadi selama 8 hari sejak dirawat, kejang rangsang dan kaku kuduk 3 hari, opistotonus dan perut papan 2 hari serta kejang spontan 1 hari. Sedangkan pada kelompok HTIG, trismus 8 hari, kejang rangsang, kaku kuduk, opistotonus dan perut papan 2 hari serta kejang spontan selama 1 hri. Tidak ada data mengenai risus sardonicus. Harga HTIG satu juta rupiah lebih murah dibanding ATS (Rp 4.414.711,- vs Rp 5.512.724,-) ATS dan HTIG memiliki efektifitas yang sama dalam hal lama rawat, lama terjadinya spasme dan hasil akhir perawatan. Harga HTIG lebih murah dibanding ATS. Disarankan memilih HTIG sebagai pilihan pertama pengobatan tetanus anak dan ATS hanya digunakan bila HTIG tidak dapat diberikan.

---

Background: ATS has been widely used in Indonesia in tetanus management. Since 2010, the use of antitoxin HTIG as increasing.

Aim: To evaluate the differences between the outcomes in pediatric tetanus who received HTIG and ATS.

Method: A retrospective study on pediatric tetanus case who admitted to Cipto Mangunkusumo Hospital since 2006 to 2014.

Results: There were 69 patients with pediatric tetanus as study subjects, with 1-5 years as the largest age group is 53.6% and the proportion of men more than women (2: 1), with 59.4% of the subjects never got primary immunization. The most of port d'entree was CSOM (47.8%) and tetanus grade 3 as most fequent diagnosis (39.1%). All subjects came hospitalized with symptoms of trismus, accompanied spasms excitatory (75.4%), neck stiffness and opisthotonos (73.9%), spontaneous seizures (69.6%) and 65.2% of the subjects belly board. Sixty-seven percent of subjects treated with ATS and 33% with HTIG. Length of stay subjects who received ATS 9.98 (SB 4.58) and HTIG 10.91 (SB 5.88) a day. Subjects who died at the end of hospitalization, the ATS group is 4.4% and and HTIG group is 21.7%. In the ATS group, trismus occurred during the 8 days of hospitalization, a stiff neck and spasms excitatory 3 days, opisthotonos and belly boards 2 days and 1 day of spontaneous seizures. While the group HTIG, trismus 8 days, spasm excitatory, stiff neck, and abdomen board opistotonus 2 days and spontaneous seizures for 1 day. No data on risus sardonicus. Price HTIG one million rupiahs cheaper than ATS (Rp 4,414,711, - vs Rp 5,512,724, -) ATS and HTIG have the same effectiveness in terms of length of stay, duration of occurrence of spasms and outcomes of hospitalization. HTIG price is cheaper than the ATS. HTIG can the first choice treatment of pediatric tetanusr and ATS are only used when HTIG can not be given."

"Latar belakang. Penelitian sebelumnya menjumpai kasus campak sebelum usia imunisasi yang semestinya masih terlindungi karena memiliki maternal antibodi campak yang diperoleh selama dalam kandungan. Besarnya titer yang diterima bayi dipengaruhi faktor ibu dan janin yang nantinya memengaruhi lamanya perlindungan. Tujuan. Mengetahui kadar maternal antibodi campak bayi baru lahir dan menganalisis faktor yang memengaruhinya. Metode. Penelitian potong lintang dilakukan sejak Maret – April 2015 pada bayi baru lahir di RSUD Dr. Zainoel Abidin Banda Aceh. Bayi yang memenuhi kriteria inklusi dan eksklusi dipilih secara consecutive nonprobabality sampling. Dilakukan wawancara terhadap orangtua, pemeriksaan New Ballard Score, dan pengambilan darah tali pusat bayi baru lahir. Uji t digunakan untuk mengetahui rerata titer berdasarkan jenis kelamin, berat badan lahir, usia gestasi, usia ibu, paritas, dan penyakit ibu. Analisis regresi logistik dipakai untuk mencari faktor yang memengaruhi kadar titer antibodi campak. Hasil. Dari 68 bayi dijumpai 64 diantaranya memiliki maternal antibodi campak positif. Rerata titer total adalah (2277,7 ± 1830,7) IU/l, bayi kurang bulan (2061,94 ± 1554,44) IU/l dan (3006,83 ± 1613,79) IU/l untuk bayi cukup bulan. Bayi laki-laki, lahir kurang bulan, berat badan lahir tidak sesuai masa kehamilan, dan ibu dengan penyakit penyerta mempunyai titer lebih rendah namun tidak bermakna secara statistik. Simpulan. Mayoritas bayi memiliki maternal antibodi campak positif dengan rerata titer keseluruhan adalah (2277,7 ± 1830,7) IU/l. Tidak dijumpai variabel yang bermakna memengaruhi titer maternal antibodi campak pada bayi baru lahir.

---

Background. Prior field studies showed cases of measles before the age of immunization when newborn should still be protected by their maternal measles antibody acquired during pregnancy. The amount of titre received by newborn is influenced by maternal and fetal factors which will affect the length of protection.

Objective. To know the level of maternal measles antibody in newborn and to analyze the influencing factors.

Method. A cross sectional study was conducted from March to April 2015 at RSUD Dr. Zainoel Abidin Banda Aceh. Newborns who met the inclusion and exclusion criteria were selected through consecutive nonprobability sampling. The parents were interviewed, the New Ballard Score were examined, and the umbilical cord blood was retrieved. T-test was performed to determine the mean titre by sex, birth weight for gestational age, gestational age, maternal age, parity, and mother with comorbidity. Logistic regression analysis was used to find the factors influenced measles antibody titer.

Results. Sixty four of 68 newborns were found to have positive maternal measles antibodies. The mean total titre was 2277.7 ± 1830.7 IU/l, 2061.94 ± 1554.44 IU/l for preterm and 3006.83 ± 1613.79 IU/l for term babies. Baby boys, preterm, birth weight inappropriate for gestational age, babies whose mother had comorbidity had lower titre, however these findings were not statistically significant.

Conclusion. The majority of newborns had positive maternal measles antibodies with the mean total titre of 2277,7 ± 1830,7 IU/l. There were no significant variables that influenced maternal measles antibody titre in newborns."

"Infeksi dengue masih merupakan masalah kesehatan masyarakat utama di negara tropis dan subtropis di dunia. Indonesia merupakan negara kedua dengan insidens kasus dengue tertinggi. Pada tahun 2011, Indonesia dilibatkan penelitian multi senter vaksin chimeric yellow fever tetravalent dengue vaccine (CYD-TDV) fase III uji klinis. Efektivitas (real world effectiveness/RWE) vaksin dengue setelah sepuluh tahun perlu dievaluasi. Penelitian ini bertujuan menilai kejadian penyakit dengue yang dirawat inap dan bagaimana kadar antibodi netralisasi dengue pasca pemberian vaksin dengue tiga kali di 0, 6 dan 12 bulan di Jakarta setelah 10 tahun, dan pada masa pandemi COVID-19 mengevaluasi kejadian COVID-19 dan kadar titer antibodi netralisasi RBD SARS-CoV-2 pada kelompok yang telah mendapat vaksin dengue dibandingkan kelompok yang tidak mendapat vaksin dengue. Desain penelitian dilakukan secara kohort retrospektif untuk menilai riwayat dengue dan COVID-19 dan potong lintang komparatif dengan menilai antibodi netralisasi terhadap keempat serotipe dengue serta antibodi netralisasi IgG RBD SARS-CoV-2 pada kelompok yang telah diberi vaksin dengue dan kelompok kontrol yang tidak mendapat vaksin dengue di lima puskesmas Senen, Jatinegara, Koja, Tambora dan Pasar Minggu di DKI Jakarta pada Juni sampai Desember 2022. Hasil penelitian menginklusi 419 subjek, terdiri dari kelompok vaksin dengue 207 dan kelompok kontrol (non-vaksin dengue) 212 yang diberi kuesioner dengan subset yang diambil pemeriksaan darah pada kelompok vaksin dengue 79 dan kelompok kontrol 80. Kejadian penyakit dengue rawat inap pada kelompok yang mendapat vaksin dengue CYD-TDV 10/207 dibandingkan kejadian penyakit dengue rawat inap 11/212 pada kelompok yang tidak mendapat vaksin dengue tidak berbeda bermakna secara statistik. Pada usia 12–17 tahun kelompok vaksin dengue CYD-TDV ditemukan rerata median antibodi netralisasi PRNT DENV-1 737,5 (52–5969) l/dil, DENV-2 1373 (0–11000) l/dil, DENV-3 316,5 (25–3662) l/dil dan DENV-4 292,5 (0–1654) l/dil lebih tinggi secara bermakna dari kadar antibodi netralisasi PRNT kelompok non-vaksin dengue, yaitu DENV-1 182 (0–68237) l/dil, DENV-2 703 (0–91558) l/dil, DENV-3 205 (0-36091)l/dil dan DENV-4 109 (0–35812) l/dil, kecuali terhadap DENV-3 tidak berbeda bermakna. Pada kelompok usia 18 tahun atau lebih, kadar antibodi netralisasi PRNT terhadap keempat serotipe dengue tidak berbeda bermakna antar kedua kelompok. Kejadian COVID-19 rawat inap setelah vaksin COVID-19 pada kelompok vaksin dengue 16/207 ditemukan lebih tinggi secara bermakna (p = 0,005) dibandingkan kelompok yang tidak mendapatkan vaksin dengue 4/212. Kadar titer antibodi netralisasi RBD SARS-CoV-2 pada kelompok yang mendapat vaksin dengue CYD-TDV 97,61 (29,55–98,23)U/mL tidak berbeda bermakna (p = 0,477) dengan kadar titer antibodi netralisasi RBD SARS-CoV-2 pada kelompok yang tidak mendapat vaksin dengue 97,21 (22,08–98,23)U/mL.Simpulan: vaksin dengue setelah 10 tahun menunjukkan kadar rerata antibodi dari semua serotipe dengue lebih tinggi secara bermakna pada kelompok usia 12–17 tahun, kecuali tidak bermakna terhadap DENV-3. Kejadian COVID-19 pada kelompok vaksin dengue lebih tinggi dibanding kelompok yang tidak dapat vaksin dengue sehingga antibodi dengue tidak memberi perlindungan terhadap COVID-19.

---

Dengue infection is still a major public health problem in tropical and subtropical countries. Indonesia is second country with highestincidence of dengue cases. In 2011, Indonesia was involved in multi-center research on the chimeric yellow fever tetravalent denguevaccine (CYD-TDV) phase III clinical trial. Real world effectiveness of dengue vaccines after 10 years needs to be evaluated. Thisstudy aims to assess the incidence of hospitalized dengue and evaluate the levels of dengue-neutralizing antibodies after denguevaccine administration three times at 0, 6 and 12 months in Jakarta after 10 years. Besides, to evaluate the incidence of COVID-19and level of SARS-CoV-2 RBD neutralizing antibody titers in dengue vaccine group compared to the non-dengue vaccine group during COVID-19 pandemic. The study design was carried out in a retrospective cohort to assess the history of dengue and COVID-19 and a cross-sectional study to assess the neutralizing antibodies against four dengue serotypes and SARS-CoV-2 IgG RBDneutralizing antibodies in the dengue vaccine group and the control non-dengue vaccine group at five health centers in Senen,Jatinegara, Koja, Tambora and Pasar Minggu in DKI Jakarta from June to December 2022. Results of the study included 419subjects, consisting of 207 in dengue vaccine group and 212 in control group (non-dengue vaccine), with a subset of denguevaccine group of 79 and the control group of 80. Incidence of hospitalized dengue in dengue vaccine group compared non-denguevaccine group was not statistically significant different. At the age of 12–17 years, the CYD-TDV dengue vaccine group had median PRNT neutralizing antibodies titers against DENV-1 737.5 (52–5969) l/dil, DENV-2 1373 (0–11000) l/dil, DENV-3 316.5 (25–3662) l/dil and DENV-4 292.5 (0–1654) l/dil significantly higher than the titers of PRNT neutralizing antibodies in the non-dengue vaccine group, as follow DENV-1 182 (0–68237) l/dil, DENV-2 703 (0–91558) l/dil, DENV-3 205 (0–36091) l/dil and DENV-4 109 (0–35812) l/dil, except for DENV-3 was not significantly different. Meanwhile, in the age 18 years and older, the levels of PRNT neutralizing antibodies against the four dengue serotypes did not differ significantly between the two groups. The incidence of COVID-19 hospitalization after COVID-19 vaccination in the dengue vaccine group 16/207 was found to be significantly higher (p = 0.005) than the group that did not receive the dengue vaccine 4/212. The levels of SARS-CoV-2 RBD neutralizing antibody titers in the group that received the CYD-TDV dengue vaccine was 97.61 (29.55–98.23) U/mL not significantly different (p = 0.477) from the SARS-CoV-2 RBD neutralizing antibody titers in the non-dengue vaccine group 97.21 (22.08–98.23) U/mL. Conclusion: dengue vaccine after 10 years showed that median antibody levels from all dengue serotypes were significantly higher in age 12–17 years, except against DENV-3 was not significantly different. The incidence of COVID-19 in the dengue vaccine group was higher than in the non-dengue vaccine group, therefore dengue antibodies did not provide protection against COVID-19."