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ABSTRAK
Latar belakang: Diare akut merupakan masalah kesehatan yang penting dengan morbiditas dan mortalitas yang cukup tinggi. Perubahan komposisi mikrobiota usus pada diare akut ditandai dengan menurunnya komposisi bakteri yang menguntungkan bagi tubuh, yaitu Bifidobacterium dan Lactobacillus, dan peningkatan bakteri patogen seperti Enterobacter dan Clostridium. Kondisi ini disebut disbiosis. Pemberian probiotik pada kasus diare akut dapat mengatasi disbiosis, mempercepat masa penyembuhan, dan mengurangi komplikasi. Sampai saat ini, belum terdapat penelitian di Indonesia mengenai pemberian probiotik untuk mengatasi disbiosis pada diare akut. Tujuan: Membuktikan bahwa terjadi disbiosis pada diare akut, yang dapat diseimbangkan dengan pemberian probiotik. Metode: Studi uji klinis, kontrol plasebo, dilakukan di RSUD Budhi Asih Jakarta, sejak Januari hingga Maret 2018. Penelitian melibatkan 36 orang anak berusia 6-48 bulan yang datang dengan keluhan diare akut. Spesimen tinja diperiksa menggunakan teknik non culture real time PCR untuk mendeteksi jumlah Lactobacillus, Bifidobacterium, Enterobacter, Clostridium dan all bacteria, kemudian dilakukan pemberian probiotik atau plasebo selama 5 hari, kemudian dilakukan pemeriksaan mikrobiota kembali 2-3 minggu kemudian. Hasil: Jumlah bakteri Lactobacillus lebih tinggi pada kelompok diare akut dibandingkan anak sehat yaitu dalam median jarak interkuartil : 1,52x103 1,22x104 vs 6,87x10 2,41x102 p

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ABSTRACT
Background Acute diarrhea is an important health problem with high morbidity and mortality. During acute diarrhea, changes in gut microbiota is marked by decreased of beneficial microbes such as Bifidobacterium and Lactobacillus, and increase of pathogenic bacteria such as Enterobacter and Clostridium, which is also known as dysbiosis. Treatment with probiotic may help to repair dysbiosis, quickens healing time, and decrease complications. Currently there is no research to investigate dysbiosis in acute diarrhea in Indonesia.Objective To prove that there is dysbiosis during acute diarrhea, and can be normalize by giving probiotic.Methods Placebo controlled, unblinded clinical trial was performed in RSUD Budhi Asih, Jakarta from January until March 2018. 36 children age 6 48 months with acute diarrhea were enrolled. Fecal specimen was taken and analyzed using non culture real time PCR to detect the presence of Lactobacillus, Bifidobacterium, Enterobacter, Clostridium, and all bacteria. Children were then given probiotic or placebo for 5 days. Second fecal sample was taken 2 3 weeks afterwards.Results Higher amount of Lactobacillus are observed in children with acute diarrhea vs healthy control with a median interquartile range 1,52x103 1,22x104 vs 6,87x10 2,41x102 p

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Penelitian ini bertujuan untuk mengetahui implementasi clinical pathway pada kasus diare akut dengan proses audit. Jenis penelitian ini adalah kuantitatif dan kualitatif dengan menggunaan konsep operational research dengan metode telaah dokumen, telaah data dan wawancara mendalam. Hasil penelitian didapatkan topik audit adalah implementasi clinical pathway diare akut dengan tujuan menilai kelengkapan pengisian clinical pathway, kepatuhan DPJP, PPJP, Gizi dan Farmasi serta menilai kesesuaian lama hari rawat dengan clinical pathway. Standar penilaian yang digunakan adalah standar nasional yaitu KARS. Hasil pengukuran menunjukkan bahwa kelengkapan pengisian clinical pathway 25 , tidak ditemukan variasi pada pemeriksaan laboratorium, asuhan nutrisi dan asuhan keperawatan, namun pada tata lakasana diare akut masih ditemukan variasi pada obat tambahan sebesar 41 , dan lama hari rawat sudah sesuai yaitu 3,3 hari. Beberapa hal yang perlu rumah sakit lakukan adalah mengembangkan kebijakan terkait clinical pathway, memperbaiki formulir clinical pathway dan sistem sosialisasi, membuat petunjuk teknis clinical pathway, sistem monitoring dan evaluasi, serta menurukan standar lama hari rawat dan diskusi terkait variasi terapi.

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ABSTRACT
This study aims to determine the implementation of clinical pathway of acute diarrhea with the audit process. This type of research is quantitative and qualitative by using operational research concept with document review method, data analysis and in depth interview. The result of the research shows that the audit topic is the implementation of clinical pathway of acute diarrhea with the aim to assessing completeness of clinical pathway, compliance of primary responsible physician, primary responsible nurse, nutrition and pharmacy and assessing the length of stay with clinical pathway. Assessment standard used is the national standard that is KARS. The result of measurement showed that completeness of filling clinical pathway 25 , no variation on laboratory examination, nutrition and nursing care, but still found variation on additional drug 41 , and length of stay was 3.3 day. Some things that hospital need to do is developed policies related to clinical pathway, improve clinical pathway forms and socialization systems, make clinical pathway technical guidance, monitoring and evaluation systems, and reduce standards length of stay and discussion of variations in therapy.

Abstrak :
Diare akut adalah proses defekasi yang lebih sering dari biasanya (>3x sehari) dengan durasi < 14 hari. Salah satu penyebab diare akut adalah infeksi bakteri. Adanya infeksi bakteri ini harus ditangani dengan penggunaan antibiotik spesifik terhadap bakteri penyebab secara rasional. Penelitian ini dilakukan untuk mengevaluasi penggunaan antibiotik pada pasien diare akut di ruang rawat inap anak RSAB Harapan Kita tahun 2016. Evaluasi penggunaan antibiotik dilakukan secara kuantitatif dan kualitatif. Penelitian ini merupakan penelitian deskriptif dengan desain studi cross-sectional. Pengambilan data dilakukan secara retrospektif menggunakan data rekam medis pasien dengan teknik total sampling. Sampel dalam penelitian ini adalah seluruh data pasien anak (usia >1 bulan-12 tahun) yang menderita diare akut di ruang rawat inap anak RSAB Harapan Kita tahun 2016 dengan terapi antibiotik. Penelitian dilakukan terhadap 88 data rekam medis yang memenuhi kriteria inklusi. Kuantitas penggunaan antibiotik terbesar yang dinyatakan dalam satuan PDD adalah seftriakson (152,75) dan DDD/100 pasien/hari terbesar adalah seftriakson (34,56). Antibiotik yang menyusun segmen DU90% adalah seftriakson, sefotaksim, seftizoksim, dan ampisilin sulbaktam. Penggunaan antibiotik untuk terapi diare akut di ruang rawat inap anak RSAB Harapan Kita tahun 2016 90,87% sesuai dengan Formularium Nasional.

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Acute diarrhea is a defecation process which happens more often than usual (3x daily) with duration < 14 days. One of its cause is bacterial infections. This bacterial infection needs to be treated by specific antibiotic against the bacteria and used rationally. This research is done to evaluate the uses of the antibiotic for acute diarrhea patient in child inpatiens room Mother and Child Harapan Kita Hospital of year 2016. The uses of antibiotic evaluation are done quantitatively and qualitatively. This research is a descriptive research with cross-sectional study design. Data collection is done retrospectively using patients medical records and total sampling technique. Sample of this research is all children patients in age interval of >1 month until 12 years old in child inpatiens room in Mother and Child Harapan Kita Hospital of year 2016 which suffer from acute diarrhea and need antibiotic therapy. The research is done for all 88 medical records which fulfill the inclusion criteria. The largest quantity of used antibiotics is expressed in PDD unit is ceftriaxone (152.75) and the largest of DDD/100 patient/day is ceftriaxone (34.56). Antibiotics that composed in DU90% segment are ceftriaxone, cefotaxime, ceftizoxime, and ampicillin sulbactam. The uses of antibiotic against diarrhea in child inpatiens room in Mother and Child Harapan Kita Hospital of Year 2016 is 90.87% corresponds with Formularium Nasional.

Abstrak :
ABSTRAK
Latar belakang: Diare masih merupakan masalah kesehatan masyarakat di negara berkembang karena morbiditas dan mortalitasnya yang masih tinggi. Diare dapat disebabkan oleh virus, bakteri dan parasit yang penting diketahui untuk memberikan tatalaksana yang tepat, namun saat ini belum ada data mengenai bakteri penyebab diare di Indonesia. Tujuan: Mengetahui gambaran klinis anak dengan diare akut dan mengetahui jenis bakteri enteropatogen penyebab diare akut dengan menggunakan real-time PCR di Rumah Sakit Cipto Mangunkusumo. Metode: Penelitian potong lintang pada anak dengan diare akut berusia 1-15 tahun di Rumah Sakit Cipto Mangunkusumo. Hasil: Subyek penelitian ini terdiri dari 60 subyek dengan diare akut. Sebagian besar berusia 1-3 tahun, status gizi baik, berasal dari ibu dengan pendidikan sedang dengan status ekonomi keluarga menengah rendah, sebagian besar belum mendapat antibiotik sebelum ke rumah sakit tetapi sudah mendapat cairan rehidrasi oral. Gambaran klinis diare akut akibat infeksi bakteri yaitu frekuensi diare ≤5X/hari (p=0,018), tanpa leukositosis feses (p=0,015) dan malabsorpsi lemak (p=0,031). Sebaran infeksi bakteri patogen penyebab diare akut berdasarkan real-time PCR sebagai berikut: Campylobacter jejuni 7 subyek, Escherichia coli patogen 17 subyek yang terdiri dari EPEC 9 subyek, EIEC 5 subyek dan ETEC 3 subyek. Infeksi bakteri campuran pada subyek sebagai berikut: EPEC+EIEC 2 subyek , C.jejuni+EPEC 1 subyek, C.jejuni+EPEC+EIEC 1 subyek dan C.jejuni+EPEC+ETEC 1 subyek. Simpulan: Sebagian besar diare terjadi pada usia 1-3 tahun dengan status pasien gizi baik dengan status keluarga menengah rendah. Sekitar 48% anak dengan diare akut didapatkan bakteri dari hasil real-time PCR feses dengan proporsi terbanyak yaitu EPEC, diikuti Campylobacter jejuni, EIEC dan ETEC. ABSTRACT
Background: Diarrhea is still a public health problem in developing countries due to it?s morbidity and mortality. Diarrhea can be caused by viruses, bacteria and parasites. It is important to know the etiology to provide proper management, but there is currently no data on the bacteria that causes diarrhea in Indonesia. Objective: To characterize the clinical manifestations of children with acute diarrhea and determine the type of enteropathogens bacteria causing acute diarrhea using real-time PCR in Cipto Mangunkusumo Hospital. Methods: This was a cross-sectional study, done in June-November 2015. Stool specimens were collected from patients aged 1-15 years with acute diarrhea and tested for bacterial enteropathogens using real-time PCR. Results: Of the 60 children enrolled, mostly aged 1-3 years, good nutritional status, from low income families and secondary education mothers, most have not received antibiotics prior to hospital admission but had received oral rehydration fluids. The clinical features of acute diarrhea caused by bacterial infection is diarrhea frequency ≤5X / day without fecal leukocytosis and fat malabsorption. From 60 subjects, 29 (48,3%) children excreted bacteria in their feces prooved by real-time PCR. Distribution of pathogenic bacterial infection causes acute diarrhea by real-time PCR as follows: Campylobacter jejuni 7 subjects, pathogenic Escherichia coli 17 subjects which consists of EPEC 9 subjects, EIEC 5 subjects and ETEC 3 subjects. Multiple infections in subjects as follows: EPEC+EIEC 2 subjects, EPEC+C.jejuni 1 subject, C.jejuni+EPEC+EIEC 1 subject and C.jejuni+EPEC+ETEC 1 subject. Conclusions: Most diarrhea occurs at the age of 1-3 years with good nutritional status of patients with low-medium family status. Approximately 48% of children with acute diarrhea excreted bacteria in their feces prooved by real-time PCR stool with the highest proportion is EPEC, followed by Campylobacter jejuni, EIEC and ETEC. ;Background: Diarrhea is still a public health problem in developing countries due to it?s morbidity and mortality. Diarrhea can be caused by viruses, bacteria and parasites. It is important to know the etiology to provide proper management, but there is currently no data on the bacteria that causes diarrhea in Indonesia. Objective: To characterize the clinical manifestations of children with acute diarrhea and determine the type of enteropathogens bacteria causing acute diarrhea using real-time PCR in Cipto Mangunkusumo Hospital. Methods: This was a cross-sectional study, done in June-November 2015. Stool specimens were collected from patients aged 1-15 years with acute diarrhea and tested for bacterial enteropathogens using real-time PCR. Results: Of the 60 children enrolled, mostly aged 1-3 years, good nutritional status, from low income families and secondary education mothers, most have not received antibiotics prior to hospital admission but had received oral rehydration fluids. The clinical features of acute diarrhea caused by bacterial infection is diarrhea frequency ≤5X / day without fecal leukocytosis and fat malabsorption. From 60 subjects, 29 (48,3%) children excreted bacteria in their feces prooved by real-time PCR. Distribution of pathogenic bacterial infection causes acute diarrhea by real-time PCR as follows: Campylobacter jejuni 7 subjects, pathogenic Escherichia coli 17 subjects which consists of EPEC 9 subjects, EIEC 5 subjects and ETEC 3 subjects. Multiple infections in subjects as follows: EPEC+EIEC 2 subjects, EPEC+C.jejuni 1 subject, C.jejuni+EPEC+EIEC 1 subject and C.jejuni+EPEC+ETEC 1 subject. Conclusions: Most diarrhea occurs at the age of 1-3 years with good nutritional status of patients with low-medium family status. Approximately 48% of children with acute diarrhea excreted bacteria in their feces prooved by real-time PCR stool with the highest proportion is EPEC, followed by Campylobacter jejuni, EIEC and ETEC. ;Background: Diarrhea is still a public health problem in developing countries due to it?s morbidity and mortality. Diarrhea can be caused by viruses, bacteria and parasites. It is important to know the etiology to provide proper management, but there is currently no data on the bacteria that causes diarrhea in Indonesia. Objective: To characterize the clinical manifestations of children with acute diarrhea and determine the type of enteropathogens bacteria causing acute diarrhea using real-time PCR in Cipto Mangunkusumo Hospital. Methods: This was a cross-sectional study, done in June-November 2015. Stool specimens were collected from patients aged 1-15 years with acute diarrhea and tested for bacterial enteropathogens using real-time PCR. Results: Of the 60 children enrolled, mostly aged 1-3 years, good nutritional status, from low income families and secondary education mothers, most have not received antibiotics prior to hospital admission but had received oral rehydration fluids. The clinical features of acute diarrhea caused by bacterial infection is diarrhea frequency ≤5X / day without fecal leukocytosis and fat malabsorption. From 60 subjects, 29 (48,3%) children excreted bacteria in their feces prooved by real-time PCR. Distribution of pathogenic bacterial infection causes acute diarrhea by real-time PCR as follows: Campylobacter jejuni 7 subjects, pathogenic Escherichia coli 17 subjects which consists of EPEC 9 subjects, EIEC 5 subjects and ETEC 3 subjects. Multiple infections in subjects as follows: EPEC+EIEC 2 subjects, EPEC+C.jejuni 1 subject, C.jejuni+EPEC+EIEC 1 subject and C.jejuni+EPEC+ETEC 1 subject. Conclusions: Most diarrhea occurs at the age of 1-3 years with good nutritional status of patients with low-medium family status. Approximately 48% of children with acute diarrhea excreted bacteria in their feces prooved by real-time PCR stool with the highest proportion is EPEC, followed by Campylobacter jejuni, EIEC and ETEC.

Abstrak :
Diseluruh dunia, setiap tahun ada 12 (dua belas) juta anak meninggal sebelum berusia 5 (lima) tahun, terbanyak pada usia satu tahun pertama. Paling tidak 4-5 juta kematian tersebut disebabkan oleh diare. Di Indonesia diare masih merupakan masalah kesehatan masyarakat karena 40 % kematian di kelompok usia < 2 tahun disebabkan oleh diare. Angka kejadian diare pada tahun 2000 sebanyak 300 kasus per 1.000 orang. Tingginya kejadian penyakit diare ini dapat menyebabkan kerugian yang besar baik bagi masyarakat maupun bagi pemerintah. Namun selama ini informasi tentang jumlah biaya akibat penyakit diare masih kurang, khususnya untuk biaya yang ditanggung keluarga akibat balita menderita diare akut. Informasi ini dapat digunakan dalam advokasi ke penentu kebijakan dalam usaha menururkan angka insiden diare. Pemilihan lokasi penelitian di Puskesmas Kelurahan Tugu Selatan yang berada di Kecamatan Koja Kotamadya Jakarta Utara, disebabkan karena wilayah ini mempunyai tingkat kepadatan tinggi di DKI Jakarta, rata-rata tingkat pendidikan masyarakat yang rendah, sosial ekonomi yang kurang, dan banyak pemukiman kumuh yang sangat berpengaruh terhadap kejadian diare. Penelitian ini bertujuan mendapatkan gambaran tentang biaya yang ditanggung oleh keluarga akibat dan penyakit diare akut pada balita. Penelitian ini difokuskan untuk mendapat gambaran keadaan kerugian biaya bagi penderita yang datang berobat ke puskesmas, karena puskesmas merupakan ujung tombak fasilitas pelayanan kesehatan. Perhitungan biaya dilakukan terhadap biaya langsung, biaya tidak langsung dan biaya peluang dalam penanganan balita diare. Penelitian ini dilakukan terhadap 42 balita yang terkena diare akut dan datang berobat ke Puskesmas Tugu Selatan pada bulan Pebruari 2003. Data primer dikumpulkan langsung dari keluarga balita yang menderita diare akut dengan cara wawancara yang dilakukan pada saat kunjungan kerumah 14 hari setelah balita berobat ke puskesmas. Hasil penelitian ini menunjukkan bahwa rata-rata biaya yang dikeluarkan oleh keluarga apabila ada balita menderita diare sebesar Rp. 28.040 per episodnya. Jika dihitung rata-rata per hari biaya yang dikeluarkan oleh keluarga apabila ada balita menderita diare, yaitu sebesar Rp. 4.210. Komponen biaya tersebut terdiri atas biaya konsultasi sebesar 4,7 %, biaya obat 14,7 %, biaya administrasi 8,4 %, biaya transportasi 6,3 %, biaya konsumsi 5,4 %, biaya peluang 60,6 %. Sehingga tampak komponen biaya yang menyebabkan kerugian biaya terbesar akibat penyakit diare pada balita adalah biaya peluang yaitu sebesar 60,6 %. Dengan hasil yang diperoleh, apabila dilakukan perhitungan kerugian ekonomi yang menjadi beban masyarakat akibat sakit diare di Jakarta Utara didapatkan angka biaya sebesar Rp. 12.072.986.520 setiap tahunnya. Tampak penyakit diare akan memberikan efek memperburuk status sosial ekonomi masyarakat. Sehingga perlu perhatian lebih terhadap pelaksanaan program pemberantasan diare, agar kerugian akibat sakit diare dapat diturunkan. Saran yang disampaikan adalah perlu penelitian perhitungan kerugian biaya akibat diare yang lebih lengkap, meliputi perhitungan kerugian biaya dan pihak pemerintah dan pihak masyarakat, mengingat diare merupakan salah situ penyakit dengan angka kejadian dan kematian yang tinggi. Bagi divas kesehatan perlu melakukan analisis biaya satuan pelayanan kesehatan di puskesmas dan bagi pemerintah daerah Kotamadya Jakarta Utara perlu memberikan perhatian khusus terutama perbaikan sanitasi lingkungan di pemukiman penduduk, karena sangat berpengaruh terhadap penurunan kejadian diare.

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In the whole world, there are 12 (twelve) million children die before five years old in every year; the most is on the beginning of the first year of age. At least 4-5 million of deaths were caused by diarrhea. In Indonesia, diarrhea is still being public health problem because 40% of the death in age group under 2 years old was caused by diarrhea. Diarrhea prevalence in year 2000 was 300 cases per 1000 persons. This high prevalence of diarrhea can cause a big loss to the public and also to the government. But all this time, information about the cost of diarrhea still less, especially for the cost that the family has to bear because of children under five suffering acute diarrhea. This information can be used in advocacy to the policy makers in the way of decreasing diarrhea prevalence. Tugu Selatan Sub district Health Center which located in Koja District North Jakarta being selected as the study location because this area has high population density in DKI Jakarta, low education level rate, low social economic rate, and a lot of slum area that affecting to the diarrhea prevalence. This study is aims at to get the description of financial loss that being a burden of the family as a consequence of diarrhea at children under five. This study being focus to get the description about financial lost of the patient who came to the Health Center, because Health Center is the most important thing in health service facility. Cost calculation was performed to Direct cost, Indirect cost and Opportunity cost in treating diarrhea at children under five. This Study was performed to 42 children under five who have diarrhea and came to Tugu Selatan Health Canter on February 2003. The primary data were collected direct from the family of the children under five who suffering acute diarrhea by interview in their home 14 days after visiting the Health Center. The results of research shows that the average cost that the family spent when children under five suffering diarrhea is Rp. 28.040 in each episode. If we calculate average cost per day, the cost that being spent when children under five suffering diarrhea is Rp. 4.210. Component of the cost consists of 4,7 % Consultation Cost, 14,7 % Medicine Cost, 8,4 % Administration Cost, 6,3 % Transportation Cost, 5,4 % Consumption Cost, 60,6 % Opportunity Cost. So that seen the cost component that cause the biggest financial lost because of diarrhea at children under five is opportunity cost which is 60,6 The extrapolation to prevalence of diarrhea in North Jakarta use prevalence based study, shows that in North Jakarta is Rp. 12.072.986.520 in every year. Obviously diarrhea will make the social economic status in the community worst. It need to pay more attention to the implementation of diarrhea eliminating program, in order to eliminate the financial lost because of diarrhea. Suggestion for farther action is that it needs more complete study about calculation of financial lost caused by diarrhea, including calculation of financial lost in the government and in the community, considering diarrhea is one of disease with high prevalence and mortality rate. For the Health Service it necessary to perform cost analysis health service unit cost in Health Center and for the North Jakarta Municipality territory government need to give special attention especially in environment sanitary improvement in habitant residential, because it affecting a lot to the diarrhea prevalence reduction.

Abstrak :
ABSTRAK Ruang Lingkup dan Cara Penelitian: Akhir-akhir ini banyak dilaporkan tentang kasus diare non spesifik oleh sejawat yang bekerja di klinik. Hal ini mungkin disebabkan oleh adanya infeksi saluran cerna oleh kuman tertentu yang tidak dapat diisolasi dengan prosedur yang lazim dilakukan untuk isolasi dan identifikasi kuman usus patogen aerob. Sejak berkembangnya teknik isolasi dan identifikasi kuman anaerob dan mikroaerofilik yang pesat pada awal tahun 70-an, maka kuman penyebab diare yang dapat diisolasi tidak terbatas pada kuman aerob raja, melainkan juga kuman usus anaerob dan mikroaerofilik. Kuman usus mikroaerofilik (Campylobacter jejuni) yang menimbulkan gangguan pada saluran cerna manusia memberikan gejala klinik yang mirip dengan infeksi kuman usus lainnya. Di berbagai negara C. jejuni merupakan penyebab infeksi saluran cerna pada manusia, dan frekuensinya lebih tinggi dibandingkan dengan frekuensi infeksi oleh Salmonella dan Shigella atau keduanya bersama-sama. Untuk menegakkan diagnosis mikrobiologik infeksi saluran cerna oleh C. jejuni, diperlukan isolasi dan identifikasi dengan cara yang spesifik. Sehubungan dengan permasalahan tersebut di atas, telah dilakukan kerjasama dengan Bagian Anak RSCM/FKUI untuk melakukan pemeriksaan tinja 50 penderita diare akut. Bahan pemeriksaan berupa tinja penderita yang diperoleh dengan rectal toucher. Setiap bahan pemeriksaan dibiak pada agar Campi BAP dalam sui,san mikroaerofilik, pada suhu 42 °C. Teknik isolasi dan identif. ntuk Campylobacter jejuni menurut Skirrow yang telah diuji oleh WHO Scientific Working Group. Hasil dan Resimpulan: Dari 50 anak pria dan wanita yang dirawat di Bagian Anak RSCM 1 FKUI dengan diare akut, berhasil diisolasi 3 (6%) Campylobacter jejuni. Dalam penelitisan ini, peneliti belum berhasil menemukan adanya Campylobacter jejuni dalam bahan pemeriksaan dengan metoda pewarnaan sediaan langsung dari tinja penderita, seperti yang dikemukakan oleh beberapa peneliti di luar negeri.

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ABSTRACT Scope and Method of Study: Recently there are so many cases of non specific diarrhea reported from the colleagues who works on clinical wards. This could happen because there are some kind of microorganism that infected the alimentary tract not possible to isolate by the common procedure usually used to isolate the Enterobacteriaceae. Since the development of anaerobic and microaerophylic isolation and identification techniques in 1970, the diarrhea causing microorganisms that can be isolated not only the aerobic but also the anaerobic and microaerophylic enteric microorganisms. The microaerophylic enteric microorganism (Campylobacter jejuni) that infected the alimentary tract has clinical symptom resemble to another enteric microorganisms infections. In several countries Campylobacter jejuni causing alimentary tract infection more frequent than Salmonella and Shigella or both. To diagnose the Campylobacter jejuni causing diarrhea], need a specific microbiological procedure. According to that problem, joint cooperation had been carried out with the Department of Pediatric RSCM/FKUI to examine 50 children who suffered from acute diarrhea. The specimen to examine is the excrement of the sufferer obtained by rectal toucher. Each specimen inoculated on Campi BAP and incubated in microaerophylic atmosphere at 42°C. Skirrow's technique modified by WHO Scientific Working Group had been used to isolate and identify Campylobacter jejuni. Findings and Conclusions: Campylobacter jejuni had been isolated in 6% out for 50 boys and girls who suffer acute diarrhea being treated in the Department of Pediatric RSCM/FKUI. In this case we could not find Campylobacter jejuni by direct excrement staining method, as reported by others abroad.

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[ABSTRAK
Latar Belakang: Diare akut adalah masalah umum di negara berkembang seperti Indonesia; penyakit ini banyak ditemukan dalam praktek sehari-hari dengan angka morbiditas dan mortalitas yang cukup tinggi. Pada beberapa Rumah Sakit di Jakarta ditemukan bahwa pasien diare akut dewasa mengalami defisiensi kadar seng sebesar 69.3%. Pemberian seng sudah terbukti bermanfaat untuk pengobatan diare akut pada anak. Tujuan: Mengetahui dampak suplementasi seng sebagai terapi alternatif / adjuvant untuk pengobatan diare akut pada pasien dewasa, dengan membandingkan lama berlangsung dan berat-ringan gejala pada kelompok pasien yang diberikan dan yang tidak diberikan suplementasi seng. Metode: Double blind randomized controlled trial dilakukan pada penelitian ini untuk mengetahui efek suplementasi seng terhadap durasi dan gejala gastrointestinal pada pasien diare akut rawat inap di RS Pusat Pertamina di Jakarta selama periode Januari-Desember 2013. Analisis data dilakukan dengan menggunakan uji chi-square (x2) untuk perbandingan durasi diare dan uji general linear model (GLM) untuk menilai tren perubahan gejala penyerta diare. Hasil: Analisis data dari 84 pasien yang dikelola: 30 pasien pria [seng 19, plasebo 11] dan 54 pasien wanita [seng 23, plasebo 31] ~ (p 0.111) memperlihatkan pemberian suplementasi seng bermakna mengurangi durasi diare akut (p 0.027) dan bermakna mengurangi gejala mual (p 0.032). Selain itu ada tren perbaikan pada sebagian gejala penyerta diare akut, seperti sakit perut, frekuensi b.a.b., konsistensi feses, gejala muntah, kembung, dan gangguan aktivitas sehari-hari. Simpulan: Pemberian suplementasi seng bermakna membuat durasi diare akut lebih singkat dan bermakna mengurangi gejala mual, serta perbaikan pada sebagian gejala gastrointestinal.

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ABSTRACT
Background: Acute diarrhea is a common problem in developing countries such as Indonesia; which is found in everyday practice with quite high morbidity and mortality rate. It was revealed in adult acute diarrhea patients in several hospitals in Jakarta the levels of zinc deficiency was 69.3%. Zinc has been proven to be beneficial in the treatment of acute diarrhea in pediatric patients. Objective: To discover the effectiveness of zinc supplementation as an adjuvant therapy in acute diarrhea for adult patients by comparing the duration and the severity of signs and symptoms of acute diarrhea between the zinc and placebo group. Methods: A double blind randomized controlled trial is done to find out about the effect of zinc supplementation to the duration, signs and symptoms on acute diarrheal in hospitalized adults patients in Pertamina Central Hospital in Jakarta from January-December 2013. The data is analyzed using chi-square test (x2) for comparing the duration of diarrhea and general linear model (GLM) to assess trend changes accompanying symptoms of diarrhea. Results: Analysis of the data from 84 patients: 30 males [19 zinc, 11 placebo] and 54 females [23 zinc, 31 placebo] ~ (p 0.111) obtained zinc supplementation significantly reduced the duration of acute diarrhea (p 0.027) and significantly reduce the symptoms of nausea (p 0.032). In addition there is trend of improvement in some acute diarrhea associated symptoms, such as abdominal pain, frequency of diarrhea, stool consistency, vomiting, bloating, and disruption of daily activities. Conclusion: Zinc supplementation significantly reduce the duration of diarrhea, significantly reduce the symptoms of nausea; besides, improving some symptoms accompanying acute diarrhea.;Background: Acute diarrhea is a common problem in developing countries such as Indonesia; which is found in everyday practice with quite high morbidity and mortality rate. It was revealed in adult acute diarrhea patients in several hospitals in Jakarta the levels of zinc deficiency was 69.3%. Zinc has been proven to be beneficial in the treatment of acute diarrhea in pediatric patients. Objective: To discover the effectiveness of zinc supplementation as an adjuvant therapy in acute diarrhea for adult patients by comparing the duration and the severity of signs and symptoms of acute diarrhea between the zinc and placebo group. Methods: A double blind randomized controlled trial is done to find out about the effect of zinc supplementation to the duration, signs and symptoms on acute diarrheal in hospitalized adults patients in Pertamina Central Hospital in Jakarta from January-December 2013. The data is analyzed using chi-square test (x2) for comparing the duration of diarrhea and general linear model (GLM) to assess trend changes accompanying symptoms of diarrhea. Results: Analysis of the data from 84 patients: 30 males [19 zinc, 11 placebo] and 54 females [23 zinc, 31 placebo] ~ (p 0.111) obtained zinc supplementation significantly reduced the duration of acute diarrhea (p 0.027) and significantly reduce the symptoms of nausea (p 0.032). In addition there is trend of improvement in some acute diarrhea associated symptoms, such as abdominal pain, frequency of diarrhea, stool consistency, vomiting, bloating, and disruption of daily activities. Conclusion: Zinc supplementation significantly reduce the duration of diarrhea, significantly reduce the symptoms of nausea; besides, improving some symptoms accompanying acute diarrhea., Background: Acute diarrhea is a common problem in developing countries such as Indonesia; which is found in everyday practice with quite high morbidity and mortality rate. It was revealed in adult acute diarrhea patients in several hospitals in Jakarta the levels of zinc deficiency was 69.3%. Zinc has been proven to be beneficial in the treatment of acute diarrhea in pediatric patients. Objective: To discover the effectiveness of zinc supplementation as an adjuvant therapy in acute diarrhea for adult patients by comparing the duration and the severity of signs and symptoms of acute diarrhea between the zinc and placebo group. Methods: A double blind randomized controlled trial is done to find out about the effect of zinc supplementation to the duration, signs and symptoms on acute diarrheal in hospitalized adults patients in Pertamina Central Hospital in Jakarta from January-December 2013. The data is analyzed using chi-square test (x2) for comparing the duration of diarrhea and general linear model (GLM) to assess trend changes accompanying symptoms of diarrhea. Results: Analysis of the data from 84 patients: 30 males [19 zinc, 11 placebo] and 54 females [23 zinc, 31 placebo] ~ (p 0.111) obtained zinc supplementation significantly reduced the duration of acute diarrhea (p 0.027) and significantly reduce the symptoms of nausea (p 0.032). In addition there is trend of improvement in some acute diarrhea associated symptoms, such as abdominal pain, frequency of diarrhea, stool consistency, vomiting, bloating, and disruption of daily activities. Conclusion: Zinc supplementation significantly reduce the duration of diarrhea, significantly reduce the symptoms of nausea; besides, improving some symptoms accompanying acute diarrhea.]

Abstrak :
Latar belakang: Diare akut masih merupakan masalah kesehatan yang penting dengan angka morbiditas dan mortalitas yang cukup tinggi. Virus merupakan penyebab tersering diare akut pada anak. Diare akut akibat virus akan menyembuh sendiri dan tidak membutuhkan terapi antibiotik. Namun, data dari Kemenkes Indonesia menyebutkan bahwa 85 pasien dengan diare di Jakarta diobati dengan antibiotik. Sampai saat ini, penelitian prevalens dan manifestasi klinis tentang diare akut akibat virus selain rotavirus masih jarang dilakukan. Penelitian tentang prevalens dan gambaran klinis diare akibat virus rotavirus, adenovirus, norovirus dan astrovirus belum pernah dilakukan di Indonesia. Tujuan: Mengetahui proporsi dan manifestasi klinis diare akut yang disebabkan oleh rotavirus, norovirus, adenovirus, dan astrovirus pada anak. Metode: Studi potong lintang dilakukan di RSCM dan RSUD Budhi Asih Jakarta, sejak Februari hingga September 2017. Penelitian melibatkan 100 orang anak berusia 6-36 bulan yang datang dengan keluhan diare akut. Spesimen tinja diperiksa menggunakan rapid test CerTest untuk mendeteksi adanya rotavirus, adenovirus, norovirus dan astrovirus, kemudian dilakukan pemeriksaan analisis tinja untuk menilai terjadinya intoleransi laktosa. Hasil: Diare akut akibat virus didapatkan pada 36 dari 100 anak, terdiri dari rotavirus 74,3 sebagai penyebab tersering, diikuti adenovirus 17,9 , norovirus 5,1 dan astrovirus 2,6 . Tiga spesimen ditemukan terdapat koinfeksi 2 virus. Diare akut akibat virus lebih sering terjadi pada anak berusia kurang dari 24 bulan 73,2 , dan 55,6 diantaranya mengalami gizi kurang. Laki-laki lebih banyak terinfeksi sebesar 1,5 kali dibandingkan perempuan. Muntah merupakan gejala yang bermakna secara statistik terkait diare akut akibat virus ini 66,7 ; p=0,045 . Manifestasi klinis lainnya yaitu diare lebih dari 10 kali per hari 58,3 , dehidrasi 68,8 , batuk 66,7 , pilek 77,8 , demam 88,6 , dan warna tinja kuning hijau 44,4 . Analisis tinja menunjukkan tidak terdapat hubungan yang bermakna secara statistik antara diare akut akibat virus dengan terjadinya intoleransi laktosa pH. ......Background Acute diarrhea remains a major cause of morbidity and mortality in Indonesia and worldwide. Virus is the most common cause of acute diarrhea in children. Viral acute diarrhea is usually self limited, and does not require antibiotic therapy. However, data from Ministry of Health Indonesia reported that 85 of patients with diarrhea in Jakarta are treated with antibiotics. Data on the prevalence and clinical manifestations of viral acute diarrhea other than rotavirus are still limited. Research on prevalence and clinical features of viral diarrhea rotavirus, adenovirus, norovirus and astrovirus has not been done in Indonesia. Objective To know the prevalence of acute diarrhea caused by virus in children and its clinical manifestations. Methods A cross sectional study was conducted at Cipto Mangunkusumo Hospital and Budhi Asih Hospital from February to September 2017. A total of 100 stool specimens were collected from patients aged 6 36 months with acute diarrhea and tested for rotavirus, adenovirus, norovirus and astrovirus by rapid test and then performed for stool analysis. Results Of the 100 specimens, 36 36 were found to be positive for virus causing diarrhea. Rotavirus 74.3 was the most frequently detected, followed by adenovirus 17.9 , norovirus 5.1 and astrovirus 2.6 . Three specimens were found positive by two viruses. Viral diarrhea was seen in 73.2 of children aged under 24 months, of whom 55.6 of them were undernourished. Males were affected 1.5 times as much as females. Vomiting was significantly associated with viral acute diarhhea 66.7 p 0.045 . Other clinical manifestations were passage of diarrheic stools more than 10 times a day 58.3 , dehydration 68.8 , cough 66.7 , rhinorhea 77.8 , fever 80.6 , and yellow greenish stools 44.4 . Stool analysis revealed that there was no statistically significant association between viral diarrhea and lactose intolerance pH

Abstrak :
Telah dilakukan studi penggunaan obat secara rasional, khususnya penggunaan antibiotika pada pasien-pasien infeksi saluran nafas akut dan diare akut di 6 Puskesmas (PKM) di daerah-daerah perkotaan, pinggir kota dan pedusunan di Propinsi Sumatra Selatan. Sampel diambil secara acak sebanyak 15% dan proporsional dengan jumlah pasien berobat jalan di tiap PKM, selama periode 3 bulan (Januari s/d Maret 1997). Karakteristik pasien, diagnosis, dan jumlah serta tipe obat (termasuk obat suntik) dicatat dalam coding sheet” untuk selanjutnya dilakukan analisis. Didapatkan 1781 kasus, dengan jumlah rata-rata obat per resep 2.7; persentase kasus yang diberi suntikan adalah 47%; dan persentase pasien yang mendapat antibiotika adalah 49%. Enam puluh empat persen dari 1277 kasus infeksi saluran nafas atas akut, dan 79% dari 140 kasus diare akut diberi antibiotika. Studi ini menunjukkan bahwa terdapat penggunaan obat yang tidak rasional (berlebihan) yang jelas terlihat pada kasus-kasus infeksi saluran nafas atas akut dan pada kasus-kasus diare akut. (Med J Indones 2004; 14: 44-9)

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Drug utilization study, especially antibiotic usage in therapy of mild acute upper respiratory infections and acute diarrheas has been conducted in six Primary Health Center (PHC) in urban, suburban and rural area in the Province of South Sumatra. We conducted systematic random sampling during which 15% of patients in each PHC were taken. We collected information about drug utilization from medical record of out patient in each PHC for three months period (January to March 1997). We recorded the characteristics of patients, the diagnosis, the number and type of drug (including injection) used. The number of cases studied was 1781, with the average number of drug per prescription being 2.7; the percentage of cases receiving an injection was 43%, and the percentage of cases receiving antibiotic was 48%. Sixty-four percent of 1277 acute respiratory tract infections (common cold), and 79% of 140 cases of acute diarrhea received antibiotic. This study showed that there is overuse or inappropriate use of drugs, especially antibiotic for acute nonspecific diarrhea and mild acute respiratory tract infections. (Med J Indones 2004; 14: 44-9)