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Abstrak :
Latar Belakang. Terapi pembedahan telah menjadi baku emas dalam penutupan defek septum atrium (DSA) sekundum. Prosedur pembedahan mempunyai morbiditas yang terkait dengan torakotomi, pintasan jantung paru, komplikasi prosedur, jaringan parut bekas operasi, dan trauma psikologis. Oleh karena itu, timbul usaha pendekatan transkateter untuk menutup DSA yang bersifat relatif kurang invasif, salah satunya dengan alat Amplatzer septal occluder (ASO). Tujuan. Mengetahui perbandingan hasil penutupan DSA sekundum, komplikasi prosedur, lama rawat di rumah sakit, dan total biaya prosedur antara prosedur transkateter menggunakan ASO dengan prosedur pembedahan. Metode. Penelitian bersifat retrospektif analitik dengan sumber data berupa rekam medis pasien anak dengan DSA sekundum yang datang berobat ke Pelayanan Jantung Terpadu Rumah Sakit dr. Cipto Mangunkusumo dan dilakukan penutupan defek dengan salah satu prosedur dalam periode Januari 2005-Desember 2011. Hasil. Sebanyak 112 kasus anak dengan DSA sekundum masuk dalam penelitian, terdiri dari 70 kasus dengan prosedur pembedahan dan 42 kasus dengan prosedur transkateter. Prosedur pembedahan dan prosedur transkateter mempunyai tingkat keberhasilan yang serupa (98,6% vs 95,2%, p=0,555). Namun prosedur pembedahan mempunyai komplikasi yang lebih banyak dibandingkan prosedur transkateter (60% vs 28,6%, p=0,001, OR 1,61;95%IK,1,19-2,18). Prosedur pembedahan juga mempunyai lama rawat di rumah sakit yang lebih panjang dibandingkan prosedur transkateter (6 hari vs 2 hari, p<0,0001), dan semua prosedur pembedahan membutuhkan perawatan di ruang rawat intensif. Secara keseluruhan prosedur transkateter mempunyai total biaya prosedur yang lebih tinggi dibandingkan prosedur pembedahan (Rp.52.731.680,06 vs Rp.46.994.745,26, p<0,0001), dan biaya pengadaan alat ASO mempunyai porsi sekitar 58% dari total biaya prosedur. Analisis total biaya prosedur tanpa memperhitungkan biaya alat ASO menunjukkan prosedur transkateter mempunyai total biaya yang lebih rendah dibandingkan prosedur pembedahan. Simpulan. Prosedur transkateter dengan ASO mempunyai efektivitas yang sama dengan prosedur pembedahan dalam penutupan DSA sekundum dan mempunyai komplikasi yang lebih sedikit serta lama rawat di rumah sakit yang lebih pendek. Total biaya prosedur transkateter dengan ASO masih lebih tinggi dibandingkan prosedur pembedahan. ...... Background. Surgery has become standard therapy for secundum atrial septal defect (ASD) closure, but it has significant morbidity related to sternotomy, cardiopulmonary bypass, complication, residual scar, and trauma. Non-surgical and less invasive approaches with transcatheter device were developed to occlude ASD. Amplatzer septal occluder (ASO) is one of the commonly used devices in transcatheter closure. Objectives. This study sought to compare efficacy, complication, length of hospital stay, and total cost of secundum ASD closure procedure between transcatheter closure using ASO with surgery. Methods. A retrospective analysis was performed on children with secundum ASD admitted to Cardiology Center of Cipto Mangunkusumo Hospital from January 2005-December 2011. The patients received transcatheter closure with ASO or surgical closure. Data were obtained from medical record. Results. A total of 112 secundum ASD cases were included in study, consisted of 42 cases underwent transcatheter closure and 70 cases underwent surgical closure. The efficacy of both procedur were not statistically different (98.6% vs 95.2%, p=0.555). However, surgery procedure had more complication than transcatheter closure (60% vs 28.6%, p=0.001, OR 1.61;95%CI 1.19 to 2.18). Hospital stay were also significantly longer for surgery procedure than transcatheter closure (6 days vs 2 days, p<0.0001), and all surgical subjects requiring intensive care. Transcatheter closure had mean total cost Rp.52,731,680.06 as compared with Rp.46,994,745.26 for surgery procedure (p<0.0001), and cost of ASO represents 58% of the total cost of transcatheter closure. Mean total cost of transcatheter closure without including cost of device is less costly than surgery procedure. Conclusion. Transcatheter closure using ASO had similar efficacy with surgical closure, complication rate was lower, and the length of hospital stay was shorter. However, transcatheter closure costs were higher compared with surgery procedure.

Abstrak :
Latar Belakang. Cairan rehidrasi oral dan zinc telah menjadi terapi standar dalam tata laksana diare akut pada anak. Probiotik sudah digunakan secara luas pada kasus diare akut pada anak meskipun belum direkomendasikan oleh WHO. Penelitian yang membandingkan penambahan probiotik pada terapi standar masih sangat terbatas. Tujuan. Mengetahui efektivitas pemberian suplementasi probiotik pada terapi standar diare akut. Metode. Penelitian uji klinis acak tersamar ganda dilakukan pada anak usia 6 bulan sampai 36 bulan dengan diare akut tanpa dehidrasi dan dehidrasi ringan sedang, yang dilakukan di kelurahan Kenari, Jakarta Pusat antara bulan Oktober 2011 sampai Februari 2012. Kelompok perlakuan diberikan terapi standar ditambah probiotik Lactobacillus rhamnosus R0011 1.9 x 109 cfu dan Lactobacillus acidophilus R0052 0.1 x 109 cfu, sedangkan kelompok kontrol diberikan terapi standar dan plasebo. Luaran yang dinilai adalah durasi diare dan frekuensi defekasi. Penelitian ini bersifat intention to treat analysis. Hasil. Total 112 subjek masuk dalam penelitian, terdiri dari 56 subjek mendapat terapi standar ditambah probiotik, dan 56 subjek hanya terapi standar. Median lama durasi diare setelah terapi pada kelompok perlakuan yaitu 68,5 jam sedangkan pada kelompok kontrol 61,5 jam (p=0,596). Median frekuensi defekasi pada kelompok perlakuan yaitu 5 kali, sedangkan pada kelompok kontrol 5,5 kali (p=0,795). Simpulan. Pada penelitian ini tidak ditemukan penurunan durasi diare dengan penambahan probiotik pada terapi standar. Meskipun kelompok perlakuan memiliki frekuensi defekasi yang lebih sedikit dibandingkan dengan kelompok kontrol, namun perbedaan tersebut tidak bermakna.

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Background. Oral rehydration solution and zinc have been used as standard therapy for treating acute diarrhea in children. Probiotics are widely used in treatment of acute diarrhea in children, although it has not been recommended by WHO. Studies comparing supplementation of probiotics to standard therapy are still limited. Objectives. To know the efficacy of probiotic supplementation to standard therapy in acute diarrhea. Methods. A randomized double blind clinical trial was performed in children aged 6-36 months with acute diarrhea without dehydration or mild to moderate dehydration in Kenari sub district, central Jakarta, between October 2011 until Februari 2012. Supplemented group was given standard therapy and probiotics Lactobacillus rhamnosus R0011 1.9 x 109 cfu and Lactobacillus acidophilus R0052 0.1 x 109 cfu, while control group was given standard therapy and placebo. The outcomes were duration of diarrhea and frequency of defecation. Stool frequency was recorded daily until resolution of diarrhea. The analysis was based on intention to treat. Results. A total of 112 subjects were included in the study, consisted of 56 subjects in supplemented group and 56 subjects in control group. Median duration of diarrhea in supplemented group was 68,5 hours while in the control group was 61,5 hours (p=0,596). Median frequency of defecation in supplemented group was 5 times, while in the control group was 5,5 times (p=0,795). Conclusion. This study did not find shorter duration of diarrhea with supplementation of probiotics to standard therapy. Although supplemented group had lower frequency of defecation compared to control group, the difference was not significant.