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"Obstruksi saluran cerna adalah kondisi yang sering memerlukan operasi dan dapat menyebabkan komplikasi serius. Neutrophil-to-lymphocyte ratio (NLR) telah digunakan sebagai indikator inflamasi pada berbagai kondisi medis, namun penelitian mengenai hubungan antara NLR dan obstruksi saluran cerna masih terbatas. Oleh karena itu, penelitian ini bertujuan untuk mengevaluasi peran NLR sebagai prediktor praoperasi yang hemat biaya dan sederhana terhadap mortalitas dan morbiditas pascaoperasi, khususnya infeksi luka operasi pada pasien dewasa dengan obstruksi saluran cerna. Penelitian ini merupakan penelitian potong lintang yang dilakukan pada pasien dewasa dengan obstruksi saluran cerna di Rumah Sakit Cipto Mangunkusumo Jakarta. Sampel penelitian terdiri dari 150 pasien dengan karakteristik dasar yang meliputi jenis kelamin, usia, jenis obstruksi saluran cerna, dan kadar neutrofil dan limfosit. Pasien yang meninggal pascaoperasi memiliki rata-rata NLR yang lebih tinggi (26,50) dibandingkan dengan pasien yang masih hidup (9,77). Analisis multivariat menunjukkan bahwa NLR merupakan faktor prediktif independen untuk morbiditas (OR = 1,37) dan mortalitas pasien (OR = 1,10). Penelitian ini juga mengidentifikasi cut-off nilai NLR praoperasi terbaik untuk menjadi prediktor morbiditas (9,95) dan mortalitas (12,51) pasien obstruksi saluran cerna pascaoperasi dengan sensitivitas dan spesifisitas yang tinggi. Temuan ini menunjukkan bahwa NLR dapat digunakan sebagai indikator yang dapat diandalkan dalam memprediksi hasil operasi pada pasien obstruksi saluran cerna

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Intestinal obstruction is a condition that often requires surgery and can lead to serious complications. Neutrophil-to-lymphocyte ratio (NLR) has been used as an inflammation indicator in various medical conditions, but research on the relationship between NLR and intestinal obstruction is still limited. Therefore, this study aims to evaluate the role of NLR as a cost-effective and simple preoperative predictor of postoperative mortality and morbidity, particularly surgical site infection, in adult patients with intestinal obstruction. This study is a cross-sectional study conducted at Cipto Mangunkusumo Hospital in Jakarta. The study sample consists of 150 adult patients with intestinal obstruction, with baseline characteristics including gender, age, type of intestinal obstruction, and neutrophil and lymphocyte levels. Patients who died postoperatively had a higher average NLR (26.50) compared to those who survived (9.77). Multivariate analysis showed that NLR was an independent predictive factor for morbidity (OR = 1.37) and patient mortality (OR = 1.10). This study also identified the optimal preoperative NLR cut-off values as predictors of morbidity (9.95) and mortality (12.51) in postoperative intestinal obstruction patients, with high sensitivity and specificity. These findings indicate that NLR can be used as a reliable indicator for predicting surgical outcomes in patients with intestinal obstruction."

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

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

"Diare merupakan masalah kesehatan global pada anak balita. Kematian balita akibat diare di dunia mencapai 1,9 juta per tahun. Tindakan pencegahan diare oleh ibu merupakan kunci dalam mengurangi kematian anak akibat diare. Penelitian ini menggambarkan self-efficacy ibu dalam pencegahan diare pada balita di Rowokele, Kebumen. Penelitian ini menggunakan metodologi deskriptif sederhana dengan pendekatan l potong lintang pada 162 partisipan ibu dengan teknik simple random sampling. Instrumen penelitian adalah kuesioner maternal self-efficacy for preventing diarrhea dengan reliabilitas 0,959. Hasil penelitian menunjukkan tingkat self-efficacy terbagi menjadi 3 (tiga) yaitu rendah (63,6%), sedang (12,3%), dan tinggi (24,1%). Hasil ini merekomendasikan bahwa self efficacy ibu perlu ditingkatkan oleh tenaga kesehatan di tingkat masyarakat.

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Mothers Self Efficacy iIn Preventing Diarrhea among an Under-5-Year-Old Child. Diarrhea is a global health problem among an under-5-year-old child. It causes the death for almost 1.9 millions every year. Diarrhea prevention is a key factor in reducing mortality caused by diarrhea. This study aimed to describe maternal self-efficacy for preventing childhood diarrhea in Rowokele, Kebumen. This was a simple descriptive approach study, applied a cross sectional method, and involved 162 partisipants of mother who were gathered using a simple random sampling. A maternal self-efficacy instrument which reliability was 0.959 for preventing childhood diarrhea used in this study. The result shows that mothers have had low self-efficacy (63.6%), middle self-efficacy (12.3%), and high self-efficacy (24.1%). It is recommended that mother?s knowledge of diarrhea should be improved by public health service."

"Penyakit Refluks Gastroesofageal (PRGE) adalah salah satu penyakit anak yang sering terlambat didiagnosis sehingga mengakibatkan gangguan nutrisi dan kognitif di kemudian hari. Tujuan penelitian ini adalah mengetahui prevalensi, gambaran klinis, dan faktor risiko PRGE pada anak yang dilakukan prosedur endoskopi saluran cerna atas di RSCM pada januari 2017 – juli 2018. Penelitian ini menggunakan metode potong lintang dengan mengambil data PRGE yang didiagnosis secara klinis yang dibuktikan dengan pemeriksaan patologi anatomik. Analisis bivariat antara pasien yang terbukti PRGE secara patologi anatomik dan yang tidak dan selanjutnya dilakukan analisis multivariat. Pada penelitian ini ditemukan bahwa prevalensi PRGE pada anak yang dilakukan prosedur endoskopi saluran cerna atas di RSCM adalah 34%, dengan gambaran klinis pada anak PRGE terbanyak pada usia 10–18 tahun (47%), status nutrisi yang baik,lebih,& obesitas (65%), nyeri perut (55%), mual (57%), muntah (65%), nyeri dada (37%), waterbrash (27%) dan halitosis (35%). Tidak terbukti faktor usia, hematemesis, anemia, penyakit komorbid, dan status nutrisi sebagai faktor risiko terjadinya PRGE (P > 0,05) Terdapat beberapa gejala klinis yang cenderung muncul pada anak yang mengalami PRGE yaitu usia 10–18 tahun, status nutrisi baik, lebih, & obesitas, Nyeri perut, mual, muntah, nyeri dada, waterbrash, dan halitosis.

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Gatroesophageal Reflux Disease (GERD) is a pediatric disease that are often late to diagnose and may cause nutritional and cognitive disorder in the future. This research was done to determine the prevalence, clinical manifestations,and risk factors of GERD  in children that undergoes Esophagogastroduodenoscopy from january 2017 – july 2018. This research uses cross sectional method by collecting data of GERD that are clinically diagnosed and proven by anatomical pathology examenation. Bivariate analysis are done between anatomical pathologically proven and unproven patient. Multivariate analysis (logistic regression) are then performed.

This research finds that the prevalence of GERD in children that undergoes esophagogastroduodenoscopy is 34%. Clinical manifestations in children with GERD are children aged 10–18 years old (47%), good,excess,and obese nutritional status (65%), abdominal pain (55%), nausea (57%), vomiting (65%), chest pain (37%), waterbrash (27%), and halitosis (35%). Age, hematemesis, anemia, comorbid condition, and nutritional status are not proven as risk factor of GERD (P > 0,05) There are a few clinical manifestation thaht tends to appear in children with GERD which are Age 10–18, good, excess, and obese nutritional status, abdominal pain, nausea, vomiting, chest pain, waterbrash, and halitosis. "

"Latar belakang: Prevalensi PRGE makin meningkat di Indonesia. Diagnosisnya sendiri masih sulit karena biasa dilakukan hanya berdasarkan gejala klinis yang sifatnya terlalu umum. Selain itu data mengenai gejala klinis PRGE anak di Indonesia masih minim, padahal akibat dari PRGE pada anak cukup mengganggu proses tumbuh kembangnya.Tujuan: Untuk mengetahui gejala klinis apa saja yang sering dan memiliki hubungan bermakna dengan usia dan status gizi pada anak dengan PRGE yang dilakukan endoskopi saluran cerna atas di Departemen IKA RSCM-FKUI.Metode: Penelitian ini menggunakan desain potong lintang (cross-sectional) untuk membandingkan prevalensi gejala klinis PRGE pada anak dan kaitannya dengan usia dan status gizi. Penelitian ini menganalisa 76 anak dengan diagnosis klinis PRGE yang dilakukan esofagogastroduodenoskopi, berusia 2-18 tahun, dan sesuai dengan kriteria inklusi dan eksklusi. Data dianalisa dari rekam medis tahun 2011-2015.Hasil: Anak dengan PRGE paling banyak berjenis kelamin laki-laki (53.9%), berusia sekolah (69.8%), dan berstatus gizi buruk/kurang (40.8%). Secara umum gejala klinis yang paling sering muncul pada anak dengan PRGE adalah muntah (76.3%), nyeri perut (72.4%), mual (63.2%), dan nyeri dada atau heartburn (51.3%). Terdapat hubungan bermakna antara kelompok usia dan gejala klinis berupa nyeri dada atau heartburn (p=0.04) yang lebih sering pada usia sekolah. Kelompok balita secara bermakna mengalami menolak makan (p=<0.0001), nafsu makan berkurang (p=0.002), dan gejala pernapasan (p=0.001). Gejala klinis PRGE berupa nyeri dada atau heartburn (p=0.011) secara bermakna lebih sering terjadi pada gizi lebih/obesitas; dan berat badan menurun lebih sering terjadi pada gizi kurang/buruk (p=0.044).Kesimpulan: Anak dengan PRGE lebih sering terjadi pada usia sekolah dan memiliki gizi buruk/kurang. Terdapat hubungan bermakna antara gejala klinis PRGE pada anak dengan kelompok usia maupun status nutrisi.

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Background: The prevalence of GERD tends to increase in Indonesia. Establishing the diagnosis itself is sometimes not easy since it is usually based only on clinical manifestations which are not specified to GERD only. Information about clinical manifestations of GERD in Indonesia children is still limited.

Objectives: To evaluate which clinical manifestations are frequent and have significant relation with age and nutritional status in Indonesian children with GERD who underwent upper-gastrointestinal endoscopy procedure in the Child Health Department of Cipto Mangunkusumo Hospital - Faculty of Medicine of Universitas Indonesia (RSCM-FKUI).

Methods: Cross-sectional design was used to compare the prevalence of clinical manifestations in children and their relationship with age and nutritional status. This study analyzed 76 children with GERD who underwent esophagogastroduodenos-copy procedure, aged from 2-to-18-years old, and fit the inclusion and exclusion criteria. The data analysed from medical record during the year of 2011-2015.

Results: Children with GERD were mostly male (53%), at school aged (69.8%), and had mild/moderate/severe undernutrition (40.8%). This study revealed that the most frequent clinical manifestations in children with GERD are vomiting (76.3%), stomachache (72.4%), nausea (63.2%), and chestpain or heartburn (51.3%). There was significant different between age groups and clinical manifestations of GERD symptoms such as chestpain or heartburn (p=0.04) which was more frequent in school-aged group. The under-five aged group was significantly had more feeding refusal (p=<0.0001), decreased appetite (p=0.002), and respiratory symptoms (p=0.001) compare to that of school-aged group. The GERD symptoms of chestpain or heartburn was statistically significant more frequent (p=0.011) in over-nutrition/obesity group; whereas losing weight was significantly more frequent (p=0.044) in mild/moderate/severe undernourished group.

Conclusion: Children with GERD are mostly in school-age group and had mild/moderate/severe undernutrition. There was statistically significant different of GERD symptoms between age groups and nutritional status groups."

"Latar belakang: Prevalensi penyakit refluks gastroesofageal (PRGE) cenderung mengalami peningkatan di Indonesia. Kondisi PRGE dapat menimbulkan gangguan pertumbuhan dan perkembangan pada anak. Namun, untuk menentukan diagnosis PRGE masih sulit dilakukan karena gejala yang ditimbulkan tidak spesifik, alat diagnostik yang hanya tersedia di rumah sakit besar dan data epidemiologi di Indonesia masih kurang.Tujuan: Untuk mengetahui gambaran patologi anatomi anak dengan PRGE yang dilakukan pemeriksaan endoskopi saluran cerna atas di Departemen IKA RSCM-FKUI, serta hubungannya dengan kelompok usia dan status gizi.Metode: Penelitian ini menggunakan desain potong lintang (cross-sectional) dengan subjek 76 pasien anak usia 2-18 tahun dengan PRGE yang dilakukan pemeriksaan esofagogastroduodenoskopi yang memenuhi kriteria inklusi. Pengambilan data status rekam medis pasien di Departemen IKA RSCM-FKUI pada Januari 2011 hingga Oktober 2015.Hasil: Pada 76 pasien anak dengan PRGE yang dilakukan endoskopi didapatkan hasil anak lelaki dibandingkan perempuan adalah 4,1:3,5 dengan mayoritas kelompok usia sekolah (70%) dan status gizi malnutrisi (60%). Terdapat perbedaan bermakna pada hasil endoskopi berdasarkan kelompok usia yaitu ditemukannya infeksi H.Pylori pada 24% anak usia sekolah (p=0,013). Hasil endoskopi terkait status gizi secara bermakna (p=0,049) menunjukkan bahwa hiperemis pada lambung lebih banyak ditemukan pada pasien dengan status gizi malnutrisi (45/72 anak) dibandingkan dengan gizi baik (24/72 anak). Kelainan patologi anatomi anak dengan PRGE tidak berbeda antara kelompok usia maupun status gizi.Kesimpulan: Anak yang mengalami PRGE lebih banyak terjadi pada usia sekolah dengan status gizi malnutrisi. Terdapat perbedaan bermakna pada hasil endoskopi anak dengan PRGE berdasarkan kelompok usia dan status gizi. Kelainan patologi anak dengan PRGE tidak berbeda menurut kelompok usia maupun status gizi.

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Background: The prevalence of gastroesophageal reflux disease (GERD) has increased recently in Indonesia. The condition of GERD can impaired growth and development in children. However, to determine diagnosis of GERD is difficult because the symptoms are non-spesific, diagnostic tools are only available in large hospitals, and epidemiological data Indonesia still less.

Aim: To evaluate the anatomical pathology of GERD in children and the correlation according to age group and nutritional status.

Methods: This was a cross-sectional study comparing GERD anatomic pathology findings and its relation to age group and nutritional status. The data were evaluated from 76 subjects aged 2-to-18-years old who underwent esophagogastroduodenos-copy (EGD) that fullfiled inclusion criteria. The data based on the medical record of endoscopic procedure at Child Health Department of Cipto Mangun-kusumo Hospital – Faculty of Medicine of Universitas Indonesia (RSCM-FKUI) from January 2011 to October 2015.

Results: Among 76 children with GERD whom underwent EGD, the boy compare to girl was 4.1:3.5 and most of them (70%) were school-aged chidren with malnutrition (60%). The prevalence of H. pylori infection was 24% and it was significantly higher in school-aged group than under-five group (p=0,013). The macroscopic appearance of endoscopy in relation to nutritional status was significantly (p=0.049) more hyperemic stomach wall in malnutrition group (45/72 children) compare to that of good nutritional status group (24/72 children). The abnormality of upper gastrointestinal pathology was not statistically different (p>0.05) in both aged groups and nutritional status groups.

Conclusion: Children suffered from GERD were more often at school age and had malnutrition condition. There were significant different of endoscopic findings of children with GERD in regards to age groups and nutritional status groups. The abnormality of pathologic findings of GERD in children were not significantly different between age-groups and nutritional status groups."