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Abstrak :
Latar belakang. Gangguan tidur pada remaja memiliki prevalens yang tinggi dan dapat memengaruhi prestasi akademik di sekolah. Namun, sejauh ini di Indonesia, belum terdapat studi yang meneliti prestasi akademik pada remaja dengan gangguan tidur serta faktor yang berhubungan. Tujuan. Penelitian ini untuk mengetahui: (1) prevalens dan pola gangguan tidur berdasarkan SDSC, (2) proporsi murid SMP dengan gangguan tidur yang memiliki prestasi akademik di bawah rerata, (3) hubungan antara: jenis kelamin, motivasi dan strategi belajar, nilai IQ, tingkat pendidikan ibu, tingkat sosial ekonomi keluarga, struktur keluarga, pendidikan di luar sekolah, adanya TV/komputer di kamar tidur, durasi tidur di hari sekolah, perbedaan waktu tidur dan bangun, dan prestasi akademik murid SMP dengan gangguan tidur. Metode. Penelitian potong lintang analitik di lima SMP di Jakarta pada bulan Januari hingga Maret 2013. Skrining gangguan tidur dengan kuesioner Sleep Disturbance Scale for Children dilakukan terhadap 491 orang murid SMP di Jakarta. Murid yang memenuhi kriteria gangguan tidur diminta mengisi kuesioner motivasi dan strategi pembelajaran. Peneliti meminta nilai IQ subjek penelitian. Hasil. Terdapat 129 subjek yang memenuhi kriteria gangguan tidur. Empat orang subjek di drop-out karena tidak memiliki nilai IQ. Prevalens gangguan tidur sebesar 39,7% dengan jenis gangguan tidur terbanyak adalah gangguan memulai dan mempertahankan tidur (70,2%). Sebanyak 47,6% subjek memiliki prestasi akademik di bawah rerata. Sebagian besar subjek perempuan (71%), termasuk sosial ekonomi menengah ke bawah (58,9%), memiliki motivasi dan strategi belajar yang cukup (72,6%), dan mengikuti pendidikan di luar sekolah (87,9%). Tiga belas subjek yang memiliki nilai IQ di bawah rata-rata tidak diikutsertakan dalam analisis bivariat dan multivariat. Berdasarkan uji regresi logistik, faktor yang paling berhubungan dengan prestasi akademik di bawah rerata secara berurutan, yaitu pendidikan di luar sekolah (> 2 jenis, non-akademik), nilai IQ rata-rata, dan jenis kelamin lelaki. Simpulan. Prevalens gangguan tidur pada murid SMP di Jakarta adalah 39,7% dengan jenis gangguan tidur terbanyak adalah gangguan memulai dan mempertahankan tidur. Sebanyak 47,6% subjek memiliki prestasi akademik di bawah rerata. Faktor yang terbukti berhubungan dengan prestasi akademik di bawah rerata adalah pendidikan di luar sekolah (> 2 jenis, non-akademik), nilai IQ rata-rata, dan jenis kelamin lelaki. ...... Background. Sleep disorders are prevalent in adolescents and may influence their academic achievement at school. However, in Indonesia, no research has ever been done to study academic achievement in students with sleep disorders and related factors. Objectives. This study aimed to define: (1) the prevalence of sleep disorders and their patterns based on the SDSC questionnaire, (2) the proportion of junior high school students having low average academic achievement, (3) the relationship between factors; i.e gender, motivation and learning strategies, IQ level, mothers' educational level, socioeconomic level, family structure, non-formal education, TV/computer set inside the bedroom, sleep duration during schooldays, bedtimewakeup time difference; and the academic achievement in junior high school students with sleep disorders. Method. This was an analytical cross-sectional study, performed at five junior high schools in Jakarta between January to March 2013. Screening for sleep disorders, based on the Sleep Disturbance Scale for Children questionnaires, was done in 491 junior high school students. Students who fulfilled the criteria of sleep disorders, were asked to fill in the Motivated Strategies for Learning Questionnaire (MSLQ). The IQ level of each subjects was also measured. Results. There were 129 subjects who fulfilled the sleep disorders criteria. Four subjects were dropped out due to they didn?t have IQ level. The prevalence of sleep disorder in this study was 39.7%, mostly difficulty in initiating and maintaining sleep (70.2%). There were 47.6% subjects had low average academic achievement. As many as 13 subjects had low average IQ level and were not included in bivariate and multivariate analysis. Subjects mostly female (71%), with middle-low income (58.9%), had moderate motivation and learning strategies (72.6%), and attended non-formal education (87.9%). Based on the logistic regression analysis, the most influencing factors to the low average academic achievement are consecutively: the non-formal education ( > 2 types, non-academic), the average IQ level, and male sex. Conclusion. The prevalence of sleep disorders in junior high school students in Jakarta are 39.7%, mostly difficulty in initiating and maintaining sleep. There were 47.6% subjects had low average grade. Factors related to the low average academic achievement are non-formal education ( > 2 types, non-academic), the average IQ level, and male sex.

Abstrak :
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.

Abstrak :
[ABSTRAK
Lesi tubular lebih sering ditemukan pada sindrom nefrotik resisten steroid (SNRS) dengan proteinuria masif, yang menyebabkan disfungsi tubulus proksimal. Cedera tubular dapat pula didiagnosis dengan uji fungsi tubulus, diantaranya adalah fraksi ekskresi magnesium (FE Mg) dan β2-mikroglobulin (β2M) urin. Tujuan penelitian ini membandingkan FE Mg dan β2M urin pada SNRS dan SN sensitif steroid (SNSS) remisi. Penelitian potong lintang dilakukan di Departemen Ilmu Kesehatan Anak RSUPN Dr. Cipto Mangunkusumo Jakarta, RSUD Ulin Banjarmasin, RSUP Fatmawati dan RSAB Harapan Kita Jakarta pada Juli sampai Desember 2015 pada penderita SNRS dan SNSS remisi berusia 2 ? 15 tahun. Pada subyek diperiksakan kadar β2M urin dan FE Mg. Didapatkan 62 subyek yang terdiri dari 31 subyek SNRS dan 31 subyek SNSS remisi. Rerata FE Mg pada SNRS lebih tinggi secara bermakna dibandingkan SNSS remisi (p=0,0065). Median kadar β2M urin pada SNRS lebih tinggi dibandingkan SNSS remisi (p < 0,001). Peningkatan kadar β2M urin lebih banyak secara bermakna pada SNRS dibandingkan SNSS (p=0,007). Dengan titik potong 1,64%, peningkatan FE Mg pada SNRS lebih banyak dibandingkan SNSS remisi (p=0,022). Simpulan: Fraksi ekskresi Mg dan β2M urin pada SNRS lebih tinggi dibandingkan SNSS remisi. Terdapat perbedaan proporsi peningkatan FE Mg antara SNRS dan SNSS remisi. Proporsi peningkatan β2M urin pada SNRS lebih besar dibandingkan SNSS remisi.

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ABSTRACT
Tubular lesions more often found in steroid-resistant nephrotic syndrome (SRNS) with massive proteinuria, leading to proximal tubular dysfunction. Tubular injury can also be diagnosed by tubular function test, such as fractional excretion of magnesium (Mg FE) and urinary β2-microglobulin (β2M). The aim of this study is to compare the FE Mg and urinary β2M on SRNS and steroid-sensitive nephrotic syndrome (SSNS) in remission. A cross-sectional study was conducted in the Department of Pediatrics RSUPN Dr. Cipto Mangunkusumo Jakarta, RSUD Ulin Banjarmasin, RSUP Fatmawati and RSAB Harapan Kita Jakarta from July to December 2015. Children aged 2-15 years who either had SRNS or SSNS in remission were recruited. Fractional excretion of magnesium and urinary β2M levels were examined. There were 62 subjects consisted of 31 subjects SRNS and 31 subjects SSNS in remission. The mean FE Mg on SRNS was significantly higher than SSNS in remission (p=0.0065). Median levels of urinary β2M on SRNS was higher than SNSS remission (p<0.001). Increased levels of urinary β2M was more significantly in SRNS compared to SSNS (p=0.007). With a cutoff point of 1.64%, an increased of FE Mg proportion on SRNS was more than SSNS in remission (p = 0.022). Conclusion: Fractional excretion of Mg and urinary β2M on SRNS were higher than SSNS in remission. There is a difference between the increased of FE Mg on SRNS and SSNS in remission. The increased of urinary β2M on SRNS was higher than SSNS in remission.;Tubular lesions more often found in steroid-resistant nephrotic syndrome (SRNS) with massive proteinuria, leading to proximal tubular dysfunction. Tubular injury can also be diagnosed by tubular function test, such as fractional excretion of magnesium (Mg FE) and urinary β2-microglobulin (β2M). The aim of this study is to compare the FE Mg and urinary β2M on SRNS and steroid-sensitive nephrotic syndrome (SSNS) in remission. A cross-sectional study was conducted in the Department of Pediatrics RSUPN Dr. Cipto Mangunkusumo Jakarta, RSUD Ulin Banjarmasin, RSUP Fatmawati and RSAB Harapan Kita Jakarta from July to December 2015. Children aged 2-15 years who either had SRNS or SSNS in remission were recruited. Fractional excretion of magnesium and urinary β2M levels were examined. There were 62 subjects consisted of 31 subjects SRNS and 31 subjects SSNS in remission. The mean FE Mg on SRNS was significantly higher than SSNS in remission (p=0.0065). Median levels of urinary β2M on SRNS was higher than SNSS remission (p<0.001). Increased levels of urinary β2M was more significantly in SRNS compared to SSNS (p=0.007). With a cutoff point of 1.64%, an increased of FE Mg proportion on SRNS was more than SSNS in remission (p = 0.022). Conclusion: Fractional excretion of Mg and urinary β2M on SRNS were higher than SSNS in remission. There is a difference between the increased of FE Mg on SRNS and SSNS in remission. The increased of urinary β2M on SRNS was higher than SSNS in remission., Tubular lesions more often found in steroid-resistant nephrotic syndrome (SRNS) with massive proteinuria, leading to proximal tubular dysfunction. Tubular injury can also be diagnosed by tubular function test, such as fractional excretion of magnesium (Mg FE) and urinary β2-microglobulin (β2M). The aim of this study is to compare the FE Mg and urinary β2M on SRNS and steroid-sensitive nephrotic syndrome (SSNS) in remission. A cross-sectional study was conducted in the Department of Pediatrics RSUPN Dr. Cipto Mangunkusumo Jakarta, RSUD Ulin Banjarmasin, RSUP Fatmawati and RSAB Harapan Kita Jakarta from July to December 2015. Children aged 2-15 years who either had SRNS or SSNS in remission were recruited. Fractional excretion of magnesium and urinary β2M levels were examined. There were 62 subjects consisted of 31 subjects SRNS and 31 subjects SSNS in remission. The mean FE Mg on SRNS was significantly higher than SSNS in remission (p=0.0065). Median levels of urinary β2M on SRNS was higher than SNSS remission (p<0.001). Increased levels of urinary β2M was more significantly in SRNS compared to SSNS (p=0.007). With a cutoff point of 1.64%, an increased of FE Mg proportion on SRNS was more than SSNS in remission (p = 0.022). Conclusion: Fractional excretion of Mg and urinary β2M on SRNS were higher than SSNS in remission. There is a difference between the increased of FE Mg on SRNS and SSNS in remission. The increased of urinary β2M on SRNS was higher than SSNS in remission.]

Abstrak :
Leukemia limfoblastik akut (LLA) adalah keganasan yang paling sering terjadi pada anak-anak. Angka kesembuhan yang besar terjadi akibat terapi kanker saat ini, namun respon toksik yang terkait dan pembentukan radikal bebas meningkatkan angka kematian akibat pengobatan daripada kematian akibat penyakitnya itu sendiri. Komplikasi kemoterapi meningkatkan rasa ingin tahu dokter untuk mempelajari penggunaan antioksidan sebagai pengobatan tambahan pada kanker. Penelitian ini bertujuan untuk mengevaluasi peran N-asetilsistein ​​(NAS) sebagai terapi antioksidan pada anak-anak dengan LLA SR (standard risk) selama fase induksi kemoterapi, dan kemungkinan peran mereka dalam pencegahan dan pengendalian komplikasi hati terkait dengan penggunaan agen kemoterapi. Sebuah uji klinis acak tersamar tunggal NAS dibandingkan dengan plasebo yang dilakukan pada pasien anak Departemen Ilmu Kesehatan Anak Divisi Hematologi dan Onkologi di Rumah Sakit Cipto Mangunkusumo, Jakarta. Penelitian ini dilakukan pada 11 pasien anak-anak usia mereka berkisar antara 2 dan 10 tahun dengan LLA SR yang menjalani kemoterapi fase induksi dan memenuhi kriteria inklusi. Pasien secara acak dialokasikan ke dalam dua kelompok, NAS atau kelompok plasebo. Mereka dievaluasi secara klinis untuk terjadinya komplikasi dan sampel darah dikumpulkan sebagai parameter laboratorium (plasma malondialdehid (MDA), enzim transaminase, dan bilirubin). Sebanyak 11 subjek dilakukan analisis yang terdiri dari 6 pada kelompok n-asetilsistein dan 5 pada kelompok plasebo. Karakteristik subjek didominasi oleh anak laki-laki dengan status gizi kurang. Kadar rerata MDA cenderung mengalami penurunan, sebanyak tiga subjek dari enam subjek pada kelompok perlakuan dan tiga subjek dari lima subjek pada kelompok plasebo. Insidens peningkatan kadar enzim transaminase sebesar 25%. Tidak terjadi kejadian kolestasis pada subjek penelitian. Pengobatan NAS ​​berdasarkan dosis antioksidan cenderung menurunkan kadar MDA, dan mencegah peningkatan enzim transaminase, dan bilirubin. ......Acute lymphoblastic leukemia (ALL) is the most commonly malignancy in children. Cancer therapies have experienced great success nowadays, yet the associated toxic response and free radicals formation have resulted in significant number of treatment-induced deaths rather than disease-induced fatalities. Complications of chemotherapy increases physicians curiosity to study antioxidant use as adjunctive treatment in cancer. This study aims to evaluate the role of N-acetylcysteine (NAC) as antioxidant therapy in children with ALL during the induction phases of chemotherapy, and their possible role in prevention and control of hepatic complications associated with the use of chemotherapic agents. A randomized single-blind clinical trial of NAC in comparison with placebo conducted in hematology and oncology pediatric patient of Cipto Mangunkusumo Hospital, Jakarta. The study was performed in 11 pediatric patients with ALL with their ages ranging between 2 and 10 years, undergoing induction phase chemotherapy that fulfilled the inclusion criteria consecutively. Patient were randomly allocated into of two groups, NAC or placebo group. They were evaluated clinically for the occurance of complications and blood samples were collected as the laboratory parameters (plasma malondyaldehide (MDA), transaminase enzyme, and bilirubin). A total 11 participants were included in analysis consisted of 6 in n-acetylcysteine group and 5 in placebo group. Characteristics of subject were predominated by boys and moderate malnourished. Mean MDA levels tended to decrease, as many as three subjects from six subjects in the NAC group and three subjects from five subjects in the placebo group. Incidence of increased levels of the transaminase enzyme by 25%. There was no cholestasis events in the study subjects. NAS treatment based on antioxidant doses tends to reduce MDA levels, and prevent the increase in the transaminase enzyme and bilirubin.

Abstrak :
Latar belakang. Dermatitis atopik (DA) merupakan penyakit kulit kronik residif dengan manifestasi utama berupa gatal dan iritasi kulit yang berkepanjangan. Antihistamin oral telah digunakan secara luas untuk mengurangi gatal pada DA namun efektivitasnya masih kontroversial. Setirizin merupakan antihistamin-1 generasi kedua yang digunakan pada penyakit alergi, termasuk gatal yang berhubungan dengan DA. Tujuan. Untuk menilai efektivitas penggunaan setirizin dibandingkan dengan plasebo dalam terapi DA. Metode. Studi klinis acak terkontrol dilakukan selama Agustus 2014 sampai Mei 2015. Subjek yang memenuhi kriteria inklusi usia 6 bulan sampai 15 tahun dengan DA derajat sedang dibagi menjadi kelompok perlakuan dan kelompok kontrol. Kelompok perlakuan diterapi dengan setirizin (0,25mg/kgBB, dua kali sehari untuk pasien < 2 tahun dan sekali sehari untuk pasien > 2 tahun) sedangkan kelompok kontrol mendapat plasebo. Derajat keparahan DA pada kedua kelompok diukur dengan indeks SCORAD dan kekambuhan DA dievaluasi setiap bulan selama 6 bulan. Hasil penelitian. Total 38 subjek penelitian (18 plasebo, 20 setirizin) ikut serta dalam penelitian dan dianalisis dengan per protocol analysis. Karakteristik dasar meliputi usia, jenis kelamin dan riwayat atopi tidak berbeda di kedua kelompok. Derajat keparahan DA berdasarkan indeks SCORAD pada kedua kelompok adalah derajat sedang (kelompok kontrol 31,5 vs kelompok perlakuan 34,75). Selama pengobatan 6 bulan derajat keparahan DA menurun bertahap dengan tidak ada perbedaan bermakna antara kelompok kontrol dan perlakuan (31,5 menjadi 0 vs 34,75 menjadi 0, p=0,200). Kekambuhan DA pada kelompok setirizin tidak lebih rendah daripada kelompok kontrol dengan tidak terdapat perbedaan bermakna (2 dari 17 subjek vs 2 dari 14 subjek, p=1,000). Simpulan. Pengobatan setirizin selama 6 bulan pada anak dengan DA derajat sedang tidak dapat mengurangi kekambuhan maupun derajat keparahan penyakit. ......Background. Atopic dermatitis (AD) is chronic relapsing skin disease, characterized by intense itching and inflammation. Oral antihistamine has been widely used to reduce pruritus of AD but the effectiveness is still controversial. Cetirizine is a second generation H1 selective antagonist that has been used in allergic diseases, including AD-associated pruritus. Objective. To assess the efficacy of cetirizine compared with placebo for the treatment of AD. Method. A randomized clinical controlled trial was performed during August 2014 until May 2015. Eligible patients aged 6 months ? 15 years with moderate AD was divided into treatment group and control group. Treatment group were treated for 6 months with cetirizine (0.25 mg/kg twice daily for patients < 2 years old, once daily for patients > 2 years old), while the control group was given placebo. The severity of AD between both groups was measured by SCORAD index and recurrence was evaluated every month for 6 month-period. Results. A total of 38 subjects (18 with placebo, 20 with cetirizine) participated in this study and a per protocol analysis was performed. The baseline characteristics, including age, gender and atopic history were similar in both groups. The severity of AD according to SCORAD index were moderate (control group 31,5 vs treatment group 34,75). During 6 month-study period, the severity of AD decreased steadily with no statistical differences between placebo and treatment group (31,5 to 0 vs 34,75 to 0, p=0,200). The recurrence of AD in cetirizine group were not lower than control group with no statistical differences (2 from 17 subject vs 2 from 14 subject, p=1,000). Conclusion. Cetirizine treatment in children with atopic dermatitis for 6 month-period cannot reduce reccurence and disease severity of moderate AD.

Abstrak :
Latar belakang : Definisi sepsis tahun 2016 adalah disfungsi organ yang mengancam kehidupan akibat disregulasi imun terhadap infeksi. Skor PELOD 2 digunakan untuk mengetahui disfungsi organ pada anak dengan sakit kritis. Tujuan : Mengetahui validitas skor PELOD 2 pada disfungsi organ yang mengancam kehidupan pada sepsis dan titik potong optimal skor PELOD 2 terhadap luaran terutama mortalitas. Metode : Penelitian dilaksanakan dari Januari sampai April 2017 di ruang intensif RSUPN Cipto Mangukusumo. Pengambilan subjek dengan consecutive sampling dan penilaian skor PELOD 2 dilakukan pada 24 jam pertama. Subjek dipantau untuk mengetahui luaran. Hasil : Diperoleh 52 subjek yang memenuhi kriteria. Nilai diskriminasi skor PELOD 2 adalah 0,85 IK 95 0,745-0,965, kalibrasi dengan Hosmer and Lemeshow test 69,2 p. ...... Background . In 2016, a new definition of sepsis has been created that is a presence of life threatening organ dysfunction cause by a dysregulated host response to infection. PELOD 2 score is stated can be used to discover organ dysfunction in critical ill child. Objective To discover validity PELOD 2 score to know life threatening organ dysfunction and cut off point of toward outcome of sepsis pediatric patient. Methods This cross sectional study was conducted from January to April 2017 in Intensive Care Unit ICU of RSUPN Cipto Mangunkusumo. The selection of subject through consecutive sampling and evaluation of PELOD 2 score were performed in the first 24 hours. Subjects were monitored to know the outcome. Results There were 52 subjects that fulfilled the criteria. Discrimination value of PELOD 2 score was 0.85 95 CI 0.745 0.965 and calibration which was tested by using Hosmer and Lemeshow test 69.2 p.

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Latar belakang: Resistensi antibiotik merupakan ancaman dan tantangan yang harus dihadapi oleh dunia medis saat ini. Penggunaan antibiotik yang tidak tepat dan berlebihan merupakan salah satu faktor yang mempercepat timbulnya resistensi antibiotik. Data di Departemen Ilmu Kesehatan Anak RSCM tahun 2011 menunjukkan penggunaan antibiotik yang tidak tepat sebanyak 48,3 dari total penggunaan antibiotik. Program pengaturan antibiotik di rumah sakit diperlukan untuk mengoptimalkan luaran klinis sekaligus mengendalikan resistensi antibiotik. Salah satu metode yang dapat dilakukan adalah edukasi klinisi. Tujuan: Mengetahui penggunaan antibiotik secara kualitatif dengan menggunakan algoritma Gyssens di ruang perawatan Departemen Ilmu Kesehatan Anak RSCM sebelum dan sesudah intervensi edukasi terhadap PPDS, berupa 1 penggunaan antibiotik yang tepat; 2 penggunaan antibiotik yang tidak tepat. Metode: Studi intervensi dengan melakukan edukasi terhadap PPDS mengenai penggunaan antibiotik, yang terdiri dari kuliah sebanyak lima kali disertai diseminasi kartu pedoman penggunaan antibiotik empiris. Penilaian ketepatan penggunaan antibiotik dilakukan oleh dua orang klinisi berdasarkan rekam medis pasien di ruang perawatan kelas III Departemen Ilmu Kesehatan Anak RSCM, yang terdiri dari periode pra-intervensi 1 Desember 2015 ndash; 29 Februari 2016 dan pasca-intervensi 1 April 2016 ndash; 30 Juni 2016 . Analisis ketepatan penggunaan antibiotik menggunakan algoritma Gyssens. Hasil Penelitian: Jumlah penggunaan antibiotik mengalami penurunan dari 374 menjadi 339 setelah intervensi. Penggunaan antibiotik yang tepat kategori I sebelum intervensi sebanyak 218 58,3 , meningkat menjadi 228 67,3 setelah intervensi p = 0,01 . Penggunaan antibiotik yang tidak tepat terdiri dari: data tidak memadai kategori VI sebelum intervensi 2, setelah intervensi 1; tidak ada indikasi kategori V sebelum intervensi 24, setelah intervensi 11; jenis antibiotik tidak tepat kategori IV sebelum intervensi 56, setelah intervensi 43; durasi tidak tepat kategori III sebelum intervensi 53, setelah intervensi 32; dosis tidak tepat kategori IIa sebelum intervensi 39, setelah intervensi 29; interval tidak tepat kategori IIb sebelum intervensi 23, setelah intervensi 16; serta rute pemberian tidak tepat kategori IIc tidak didapatkan sebelum maupun setelah intervensi. Simpulan: Jumlah penggunaan antibiotik yang tepat mengalami peningkatan secara bermakna sebanyak 9 setelah dilakukan intervensi edukasi. ......Background Antimicrobial resistance is now becoming a global threat and a challenge. Inappropriate and overuse of antimicrobial are factors that accelerate antimicrobial resistance. Study in 2011 at Department of Pediatrics, Cipto Mangunkusumo Hospital CMH shows that inappropriate antimicrobial use is up to 48.3 of total antimicrobial use. Antimicrobial stewardship program is needed in order to optimize clinical outcome and control antimicrobial resistance. Clinicians education is one of the applicable method. Aim To evaluate qualitative antimicrobial use using Gyssens algorithm in pediatric inward unit, Department of Pediatrics, CMH before and after education of residents, including 1 appropriate antimicrobial use 2 inappropriate antimicrobial use. Methods Interventional study by educating pediatric residents regarding antimicrobial use which consisted of five courses and dissemination of empiric antimicrobial therapy guideline cards. Evaluation of antimicrobial use by two independent clinicians based on medical records of class III pediatric inward unit, CMH, during pre intervention period December 2015 - February 2016 and post intervention period April 2016 ndash June 2016. Qualitative analysis was performed using Gyssens algorithm. Results Antimicrobial use decreased from 374 to 339 after intervention. Appropriate antimicrobial use category I before intervention was 218 58.3 , increased to 228 67.3 after intervention p 0.01 . Inappropriate antimicrobial uses consist of insufficient data category VI was 2 before intervention, 1 after intervention no indication category V was 24 before intervention, 11 after intervention inappropriate antimicrobial choice category IV was 56 before intervention, 43 after intervention incorrect duration category III was 53 before intervention, 32 after intervention incorrect dose kategori IIa was 39 before intervention, 29 after intervention incorrect interval category IIb was 23 before intervention, 16 after intervention there was no incorrect route category IIc both before and after intervention. Conclusion Appropriate antimicrobial use increased significantly at 9 after educational intervention.

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Latar belakang: Elektroensefalografi EEG adalah suatu prosedur untuk mendukung diagnosis dan evaluasi pengobatan pada penyakit epilepsi. Perekaman EEG ideal dapat dicapai bila anak mengalami tidur alamiah, yang sampai saat ini masih sulit untuk dilakukan. Melatonin, merupakan hormon tidur alami yang dihasilkan oleh kelenjar pineal, mulai dikembangkan sebagai premedikasi EEG yang diharapkan memiliki efek samping lebih kecil dibanding prosedur deprivasi tidur parsial DTP dan obat sedasi. Tujuan: 1 mengetahui perbandingan awitan tidur, makrostruktur tidur, dan lama tidur pada anak epilepsi yang diberikan melatonin oral dengan yang dilakukan prosedur DTP, 2 mengetahui perbedaan efek samping pemberian premedikasi melatonin dibandingkan prosedur DTP pada anak epilepsi yang direncanakan EEG Metode: Penelitian uji klinik acak tersamar tunggal secara paralel dilakukan pada 76 subyek berusia 1-18 tahun yang melakukan pemeriksaan EEG di Laboratorium Elektrodiagnostik IKA-RSCM selama periode November 2016 ndash; Januari 2017. Seluruh subyek tersebut dibagi menjadi 2 kelompok, satu kelompok diberikan premedikasi melatonin per oral, sedangkan kelompok lainnya dilakukan prosedur DTP. Hasil: Rerata awitan tidur kelompok DTP adalah 42,39 menit sedangkan kelompok melatonin 33,97 menit p le;0,01 . Rerata lama tidur kelompok DTP adalah 22,58 menit, sedangkan kelompok melatonin 25,09 menit p=0,144 . Gambaran makrostruktur tidur p>0,05 dan efek samping prosedur p>0,05 pada kedua kelompok subyek tidak berbeda bermakna. Simpulan: Awitan tidur pada kelompok melatonin lebih cepat dibandingkan kelompok DTP, dengan durasi tidur yang serupa antar 2 kelompok. Makrostruktur tidur kedua kelompok mirip dengan tidur alamiah. Tidak didapatkan perbedaan efek samping antara kelompok DTP dan kelompok melatonin. Melatonin dapat digunakan sebagai premedikasi EEG pada anak untuk praktik sehari-hari.

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Background Electroencephalography EEG is a procedure to support and evaluate therapy in children with epilepsy. Ideally, EEG result can be achieved if the child fell on a natural sleep, but this phase was difficult to gain. Melatonin, a natural sleep hormone that is produced by the pineal gland, was started to developed as a premedication following EEG procedure to produce natural sleep with minimal side effects compared to partial sleep deprivation PSD and other sedative agents. Aim 1 to discover sleep onset, sleep duration, and sleep macrostructure in children with the oral administration of melatonin compared to partial sleep deprivation, 2 to discover side effects of oral melatonin EEG premedication in epilepsy children Method In a parallel single blinded randomized clinical trial, 76 children who were referred to EEG Unit of Cipto Mangunkusumo Hospital from November 2016 to January 2017 were evaluated. The children were randomly assigned into two groups to receive PSD procedure control group and oral melatonin treatment group. Results Mean sleep onset in PSD group was 42.39 minutes, while in melatonin group was 33.97 minutes p le 0,01 . Mean sleep duration in PSD group was 22.58 minutes, while in melatonin group was 25.09 minutes p 0,05 . There were no significant differences in both sleep macrostructure p 0,05 and procedure rsquo s side effects p 0,05 in both groups. Conclusions Sleep onset was more prompt in melatonin group compares to PDS group, while sleep duration was similar between each groups. Both of sleep macrostructures were similar to natural sleep process. There were no significant differences of side effects in both groups. Melatonin can be use as premedication for EEG examination in epilepsy children.