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"Angka Kematian Ibu (AKI) dan Angka Kematian Bayi (AKB) merupakan indikator penting dalam menilai kualitas pelayanan kesehatan. Di Indonesia, kedua angka ini masih jauh dari target SDGs. Salah satu cara menurunkan angka kematian maternal dan neonatal adalah melalui sistem rujukan yang efektif. Penelitian ini bertujuan untuk menggambarkan profil rujukan kasus obstetri serta luaran maternal-neonatal di RSCM selama pandemi COVID-19 pada tahun 2021. Penelitian deskriptif observasional ini menggunakan data rekam medis RSCM tahun 2021. Variabel yang dianalisis meliputi usia, pekerjaan, usia kehamilan, gravida, paritas, asal rujukan, indikasi rujukan, COVID-19, metode persalinan, kontrasepsi, kondisi maternal, neonatal, berat bayi, dan skor APGAR. Mayoritas pasien dirujuk ke RSCM berusia 19–35 tahun, ibu rumah tangga, usia kehamilan 29–36 minggu, multigravida, melahirkan ≤1 anak, dan dirujuk dari FKRTL karena keterbatasan NICU. Sebagian besar melahirkan melalui operasi sesar, menggunakan IUD sebagai metode kontrasepsi, dan berada di ruang rawat inap pasca persalinan. Kondisi neonatal menunjukkan berat lahir 1.500–2.500 gram dan skor APGAR 7–10. Penelitian ini menggambarkan karakteristik ibu yang dirujuk beserta luaran maternal-neonatal dan dapat menjadi referensi untuk penelitian serta perbaikan sistem rujukan di masa depan.

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Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR) are key indicators of healthcare quality. In Indonesia, these rates remain far from Sustainable Development Goal (SDG) targets. An effective referral system is essential to reducing maternal and neonatal mortality. During the COVID-19 pandemic, referral cases to higher-level healthcare facilities increased, posing a greater risk of mortality if prompt treatment was not provided. This study aimed to describe the profile of obstetric referral cases and maternal-neonatal outcomes at RSCM during 2021. A descriptive observational method was used to analyze medical records from RSCM, focusing on variables such as age, occupation, gestational age, gravida, parity, referral origin, referral indication, COVID-19 status, maternal condition, delivery method, contraception, neonatal condition, birth weight, and APGAR scores. Most referred patients were aged 19–35, housewives, with a gestational age of 29–36 weeks, multigravida, and having ≤1 child. Referrals predominantly came from secondary or tertiary facilities due to NICU unavailability, and most patients did not have COVID-19. Cesarean section was the common delivery method, and IUD was the preferred contraception. Newborns mostly weighed 1,500–2,500 g, had APGAR scores of 7–10, and required inpatient care. This study highlights the characteristics and outcomes of referred cases, providing insights for improving referral systems and future research."

"Latar belakang: Anak yang menjalani operasi jantung memiliki risiko tinggi yang bermakna terhadap kejadian morbiditas dan mortalitas pasca-bedah. Penggunaan obat-obatan vasoaktif dan inotropik yang tinggi sebagai dukungan hemodinamik pasca-bedah berhubungan dengan luaran yang buruk. Status hemodinamik yang buruk, menyebabkan meningkatnya dukungan obat-obatan vasoaktif dan inotropik yang dibutuhkan. Tujuan: Melihat hubungan skor vasoaktif-inotropik / vasoactive-inotropic score VIS dengan luaran jangka pendek pasien anak pasca-bedah jantung, termasuk kematian, morbiditas, komplikasi berat, dan faktor-faktor risiko yang berhubungan dengan komplikasi berat. Metode: Penelitian ini adalah kohort retrospektif pada 123 anak yang telah menjalani prosedur bedah jantung di cardiac intensive care unit CICU RSUPN Dr Cipto Mangunkusumo Jakarta pada periode Januari sampai Desember 2016. Data demografi, data pra-operasi, intra-operasi, pasca-operasi, mortalitas dan komplikasi diambil dari rekam medis. Skor vasoaktif-inotropik dihitung pada 24 jam pertama, 24 jam kedua dan total 48 jam pasca-bedah dan dianalisis hubungannya dengan komplikasi berat, selain itu juga dicatat faktor-faktor risiko yang berhubungan dengan terjadinya komplikasi berat. Hasil: Selama penelitian didapatkan PJB terbanyak yang dilakukan bedah jantung adalah ventricle septal defect 28,5 dan tetralogy Fallot 34,5. Pada 123 anak yang dilakukan bedah jantung, dijumpai 32 26 anak dengan VIS tinggi. Median VIS 24 jam pertama adalah 12 2-40, median VIS 24 jam kedua adalah 14 3-32, dan median VIS total 48 jam adalah 11 2-29. Obat inotropik yang paling banyak digunakan adalah dopamin 97,6 diikuti oleh milrinon 69,9 .VIS pada 24 jam pertama dengan nilai area di bawah kurva adalah 0,94.VIS yang tinggi berkaitan dengan lama rawat inap di rumah sakit lebih dari 14 hari [OR 4,1 IK 95, 1,4-11,7 ], kematian dalam 30 hari pasca-bedah [OR 44,5 IK 95, 9,3-212,5 ], kejadian henti jantung [OR 57,2 IK 95, 11,9-273,9 ], pemakaian ventilator > 7 hari [OR 25,2 IK 95, 2,9-214,5 ] dan kejadian gagal multi organ [OR 23,3 IK 95, 4,8-113,1 ]. Komplikasi pasca-bedah jantung terjadi sebesar 40 dan komplikasi berat terjadi pada 30 anak 24,4. Komplikasi pasca-bedah jantung terbanyak adalah low cardiac output syndrome pada 48 39. Komplikasi berat meliputi kematian dalam 30 hari pasca-bedah terjadi pada 18 14,6 anak, henti jantung 20 16,3 anak, operasi jantung ulang 5 4,1 anak, dan gagal multi organ 13 10,6 anak. Faktor risiko yang berhubungan dengan meningkatnya komplikasi pasca-bedah jantung yang berat adalah peningkatan kadar laktat darah [OR 7,4 IK 95 2,0-26,9 ], dan skor vasoaktif-inotropik yang tinggi pasca-bedah [OR 30,5 IK 95 7,6-122,3 ]. Kesimpulan: VIS tinggi pasca-bedah jantung, berhubungan bermakna dengan kematian dan komplikasi berat pasca-bedah. VIS 24 jam pertama pasca-bedah jantung merupakan pemeriksaan yang sederhana dalam memberikan informasi berharga tentang luaran pasca-bedah jantung. Faktor risiko yang berhubungan dengan komplikasi berat pasca-bedah jantung adalah peningkatan kadar laktat dan nilai VIS yang tinggi pasca-bedah.

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Background: Children undergoing heart surgery are at high risk for significant post operative morbidity and mortality. The use of high vasoactive and inotropic suport after cardiac surgery was associated with poor outcome. The more severe the hemodynamic state, a higher vasoactive inotropic support were needed.

Objective: To determine the association between vasoactive inotropic support and clinical outcome in children after cardiac surgery, including mortality, complication or morbidity, major complications, and the risk factors associated with major adverse events major complications.

Methods: This is a retrospective analysis of the 123 children who underwent cardiac surgery at pediatric cardiac surgery intensive care unit from January to December 2016. Multiple demographic, pre operative, intra operative, post operative variables were recorded, vasoactive inotropic score VIS were assessed at the first 24 hours, second 24 hours and 48 hours after surgery and was analyzed for association with poor outcomes. Factors associated with the risk of developing major adverse events were also identified.

Results: A total of 123 patients were recruited, 32 26 were administered to high vasoactive inotropic score. Median VIS at first 24 hours, second 24 hours, and 48 hours after cardiac surgery were 12 2 40, 14 3 32, and 11 2 29, respectively. The most widely used vasoactive inotropic agents were dopamine 97,6 and milrinone 69,9. VIS at first 24 hours with area under curve was 0,94. There was a significant association between high VIS and poor outcome in children after cardiac surgery including 30 day mortality OR 44,5 IK 95, 9,3 212,5, prolonged hospital length of stay OR 4,1 IK 95, 1,4 11,7, cardiac arrest OR 57,2 IK 95, 11,9 273,9, prolonged mechanical ventilator support OR 25,2 IK 95, 2,9 214,5, and multiple organ failure OR 23,3 IK 95, 4,8 113,1. The most complication occurred after cardiac surgery was low cardiac output syndrome 39. Further, 30 24,4 of recruited patients had major adverse events major complications, including 30 day mortality in 18 14,6, cardiac arrest in 20 16,3, the need for re operation in 5 4,1, and multiple organ failure in 13 10,6 children. Factors associated with the occurrence of major complications were increase in blood lactate OR 7,4 IK 95 2,0 26,9 and high vasoactive inotropes score after cardiac surgery OR 30,5 IK 95 7,6 122,3.

Conclusion: High vasoactive inotropic score after pediatric cardiac surgery was significantly associated with mortality and other poor outcomes. VIS at first 24 hours after cardiac surgery is a simple clinical tool that can provide valuable information regarding likely length of intubation, hospital stay and poor outcomes. VIS at 24 hours performs better than VIS in the first 48 hours and total 48 hours after surgery in predicting poor short term outcomes. Increase in blood lactate, and high vasoactive inotropes score after cardiac surgery are associated with mortality and other major complications in children after cardiac surgery."

"Prosedur Trombektomi Mekanik (MT) pada stroke iskemik akut telah dilakukan sejak tahun 2017 di RSUPN Dr. Cipto Mngunkusumo. Tujuan dari penelitian ini adalah untuk menentukan ahli radiologi dan hasil klinis MT pada stroke iskemik akut dan faktor terkait lainnya. Studi observasional retrospektif memperoleh pasien telah menjalani MT pada Mei 2017-Desember 2020. Analisis univariat dan multivariat dilakukan untuk mengevaluasi hubungan antara demografi pasien, skor NIHSS pra trombektomi dan hasil seperti pasca trombektomi, skor mTICI pasca trombektomi, dan skor MRS pasca aksi. Dalam pemodelan multivariat p<0,05 digunakan untuk signifikansi statistik. Sebanyak 33 pasien dimasukkan. Pada analisis univariat demografi dan gambaran klinis didominasi oleh laki-laki, dengan rata-rata usia 55,8 tahun, GCS pra tindakan 11,9 hemiparesis, pra tindakan NIHSS 14,52, skor ASPECT 7,36, lokasi oklusi MCA, pemberian alteplase, MRS (90-day modified ranking scale: 3 sampai 6), onset rekanalisasi > 6 jam, MTICI post thrombectomy 2B-3 SICH, dan 39,4% meninggal dunia. Hubungan yang signifikan antara keberhasilan rekanalisasi dan mortalitas, dan waktu onset ke rekanalisasi secara rumit. Trombektomi mekanik di RSUPN Dr. Cipto Mangunkusumo selama 2 tahun terakhir masih memberikan hasil luaran yang buruk.

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The Procedure of Mechanical Trombectomy (MT) in acute ischemic stroke has been done since 2017 in RSUPN Dr. Cipto Mngunkusumo. The aim of this study are to detemining radiologist and clinical  outcome MT in the acute ischemic stroke and the other related factors. The retrospective observational study acquiring patient’s had undergone MT in May 2017-December 2020. Univariate and multivariate analysis were conducted to evaluate the relationship between patient’s demography, NIHSS score pre trombectomy and the outcomes such as post trombectomy, mTICI score post trombectomy, and MRS score post action. In multivariate modelling p<0.05 was used for statistical significance.  A total of 33 patients were included. On univariate analysis demography and clinical description were dominated by men, with 55.8 years age average, GCS pre action 11,9 hemiparesis, NIHSS pre action 14.52, ASPECT score 7.36, MCA occlusion location, given alteplase, MRS (90-day modified rank of scale: 3 to 6), onset to recanalization> 6 hours, MTICI post thrombectomy 2B-3 SICH, and 39.4% passed away. The significance association between recanalization success and mortality, and onset-to-recanalisation time complicationally. Mechanical thrombectomy in RSUPN Dr. Cipto Mangunkusumo for in the recent past 2 year still giving the poor outcomes result. "

"ABSTRAKHipotiroid kongenital (HK) adalah kelainan bawaan yang dapat menimbulkandampak berupa retardasi mental permanen. Pemberian levothyroxine dengan dosis tepat pada usia sedini mungkin, dapat mencegah gangguan pertumbuhan dan perkembangan. Sayangnya, bayi baru lahir tidak menunjukkan gejala HK. Kalaupun ada, berarti sudah ada gangguan pertumbuhan. Perlu skrining hipotiroid kongenital (SHK) untuk menemukan kasus bayi yang menderita HK.Meski sudah dilakukan sejak 2006, baru pada tahun 2014 dikeluarkan Permenkes tentang pelaksanaan SHK di Indonesia. Penelitian evaluasi ekonomi program SHK tahun 2014-2015 ini mencakup analisis biaya skrining dan terapi dini, sedangkan outcome didapat dari systematic review (SR). Asumsi dikembangkan berdasarkan data riil pasien skrining SHK di 2 laboratorium rujukan di Jakarta dan Bandung.Dari total 56.186 bayi yang melakukan skrining, diperoleh 24 pasien positifmenderita HK. Hasil SR menyatakan bahwa semakin dini onset terapi, semakin adekuat dosis inisiasi dan semakin kontinyu terapi dapat memberikan hasil yang baik. Hasil Tersebut berupa pencegahan terhadap komplikasi HK lebih jauh dan perbaikan pada penyimpangan tumbuh kembang.Dari hasil penelitian, didapatkan informasi bahwa baru pada tahun kedua terlihat adanya keuntungan ekonomis SHK. Hal ini berhubungan dengan patologi gejala HK yang umumnya muncul pada usia 3-6 bulan. Orang tua baru mencari pertolongan medis pada tahun kedua dan mengeluarkan lebih banyak biaya. Biaya skrining dan terapi dini menjadi sepadan dibandingkan dengan kerugian yang dapat dicegah akibat gejala gangguan tumbuh kembang.

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ABSTRACTCongenital hypothyroidism (CH) is a congenital disorder that can have an impact in the form of permanent mental retardation. Giving the right dose of levothyroxine at the earliest possible age, can prevent the disruption of growth and development. Newborns do not show symptoms of CH, and unfortunately the symptoms appear in the late period and in many cases it shows growth disorders. The congenital hypothyroidism screening (CHS) program has been implemented to find infant cases with CH, and followed up with treatment.Although it has been made since 2006, Minister of Health just issued the regulation in 2014 on the implementation of CHS in Indonesia. This economic evaluation of the CHS program in 2014-2015 was done using cost analysis, while outcome obtained from the systematic review (SR). The assumptions used in the analysis were developed based on real data from a CHS screening program in two referral laboratories in Jakarta and Bandung. Out of 56.186 screened babies, 24 babies were found as CH positive cases.The result of the SR revealed that the earlier onset of initiation therapy, the more adequate dose and the more continuous therapy given to the patient, the better result will be achieved. It will prevent the patients from severe complications of CH and will improve the quality of thegrowth and development. The study found that the economic benefit is achieved in the second year of CH treatment, since the pathological symptoms generally appear at the age of 3-6 month and parents seek care in the second year. Consequently, cost to treat patients will increase. The cost of screening and early treatment was found worthy as compared to economic loss resulting from growth disorders"

"ABSTRAKPendahuluan: Ensefalitis pada anak lebih sering dijumpai daripada dewasa dan luaran buruk terjadi pada 60% subjek yang terkena. Hingga saat ini belum ada data mengenai profil dan luaran pasien ensefalitis anak di Indonesia.Tujuan: Mengetahui profil dan luaran pasien ensefalitis akut pada anakMetode: Penelitian retrospektif ini menggunakan data rekam medis tahun 2014- 2018 di 3 rumah sakit pendidikan (RSCM, RSU Tangerang, RSUP Fatmawati). Gejala klinis awal, pleositosis CSS, abnormalitas neuroimaging, abnormalitas elektrofisiologis (EEG) dicatat dan luaran dinilai saat pasien pulang/meninggal dan dinyatakan sebagai luaran baik atau buruk.Hasil: Terdapat 657 pasien yang memenuhi kriteria ICD X sesuai kriteria inklusi dari 3 rumah sakit, dan data dari 190 subjek dianalisis dalam penelitian ini. Subjek penelitian didominasi oleh anak usia > 1 tahun (83%). Kejang didapatkan pada 87% subjek yang diteliti dan 80%nya merupakan kejang umum. Defisit neurologis fokal terdapat pada 47% subjek (90 pasien). Pemeriksaan penunjang yang menunjukkan abnormalitas tertinggi adalah EEG (90%). Kriteria diagnostik probable terpenuhi pada 62% subjek. Mortalitas didapatkan pada 23% subjek, dengan proporsi terbanyak berasal dari RSU Tangerang. Kejang fokal dan usia > 1 tahun merupakan faktor risiko yang berperan meningkatkan luaran buruk saat pulang 3 kali lipat (p: 0,006 dan p: 0,03).Simpulan: Profil ensefalitis akut pada anak lebih banyak dijumpai pada usia > 1 tahun, dengan gejala yang sering dijumpai saat awal adalah demam, dan kejang. Pemeriksaan penunjang EEG adalah pemeriksaan tertinggi yang menunjukkan hasil positif pada pasien dugaan ensefalitis. Kejang fokal dan usia > 1 tahun merupakan faktor risiko luaran buruk.

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ABSTRACTIntroduction: Encephalitis in pediatric population is more frequent than adult. The outcome has been reported to have poor prognosis in 60% of cases. No data of peidatric encephalitis in Indonesia has been reported yet.Objectives: Evaluate pediatric acute encephalitis profile and factors that influence its outcome.Methods: This retrospective research used medical records data from year 2014- 2018 in 3 teaching hospitals (RSCM, RSU Tangerang, RSUP Fatmawati). We documented clinical presentation at admission, pleocytosis CSF, neuroimaging abnormality, electrophysiologic abnormality (EEG), and outcome at discharge which classified as good vs. poor outcome.Results: Among 657 patients identified using ICD X in all 3 hospitals, there were a total of 190 subjects included in this study. Eighty three percent of subjects aged > 1 years. Seizure was present in 87% subjects, and 80% of those subjects experienced generalized seizure. Focal neurological deficits was shown in 47% subjects (90 patients). Among investigation, EEG shown positive results in 90% examined subjects, while CT scan were the most prevalent. We found probable diagnostic criteria in majority of subjects (62%). Mortality was 23%, and RSU Tangerang was the major contributor. Focal seizure and age > 1 year were the risk factors associated with 3 times increased risk of poor outcome (p: 0,006 and p: 0,03).Conclusions: Age > 1 year is more prevalent in pediatric acute encephalitis. Among most common clinical presentation are fever and seizure. Abnormal EEG finding in suspected encephalitis cases give the most positive result. Focal seizure and age > 1 year were the risk factors for poor outcome"

"Latar Belakang: Penyakit akibat coronavirus jenis baru (SARS-CoV-2) yang muncul sejak Desember 2019 sudah menjadi pandemi global, termasuk di Indonesia. Hingga saat ini, beberapa negara sudah mempublikasikan laporan terkait penyakit ini. Namun di Indonesia, informasi karakteristik dan luaran pasien dengan COVID-19, terutama pasien yang menjalani perawatan di ruang intensif dengan dan tanpa ventilator berdasarkan sebaran usia masih terbatas. Metode: Studi dilakukan pada pasien dewasa yang dirawat di ruang intensif (HCU dan ICU) RSCM dan RSUI selama Maret – Desember 2020. Data yang dikumpulkan melalui rekam medis meliputi karakteristik dasar pasien, pemeriksaan penunjang laboratorium dan radiologi, terapi, komplikasi, dan luaran. Hasil: Terdapat 682 pasien yang menjalani perawatan di ruang intensif RSCM dan RSUI. Pada semua kelompok usia, sebagian besar pasien adalah pria. Pada kelompok usia muda (18–29, 30–39, 40–49 tahun), mayoritas bergejala awal sesak dan menggunakan suplementasi oksigen dengan nasal kanul (37%, 33%, dan 29,6%). Pada kelompok usia 50–64 tahun suplementasi oksigen terbanyak dengan ventilator invasif (33,5%). Rasio PF terendah sebesar 120 terdapat pada kelompok usia ≥65 tahun, dengan penggunaan ventilator pada 49,7% pasien. Prevalensi komorbid tertinggi terdapat pada kelompok usia ≥65 tahun (95,6%) di antaranya hipertensi, penyakit jantung koroner, diabetes melitus, dan CKD. Koinfeksi bakteri paling banyak terjadi pada kelompok usia 50–64 tahun. Kelompok usia ≥65 tahun memiliki median neutrofil dan D-dimer paling tinggi (4.210 μg/L) serta limfosit paling rendah. Angka komplikasi tertinggi terjadi pada 75,6% pasien kelompok usia ≥65 tahun, dengan komplikasi tersering adalah ARDS (50,9%), syok sepsis (50,3%), dan AKI (38,4%). Angka kematian tertinggi terdapat pada kelompok usia 50–64 dan ≥65 tahun yaitu sebesar 46,9% dan 46,5%. Angka kematian pada kelompok pasien yang menggunakan ventilator lebih tinggi pada semua kelompok usia, dengan persentase mortalitas tertinggi terdapat pada kelompok usia 50–64 tahun yang menggunakan ventilator (74,63%). Kesimpulan: Seiring dengan bertambahnya usia, terdapat peningkatan jumlah pasien dengan komorbiditas (hipertensi, penyakit jantung koroner, diabetes melitus, dan CKD); penurunan parameter fungsi oksigenasi paru; penurunan limfosit; peningkatan jumlah neutrofil, D-dimer, ureum dan kreatinin; dan peningkatan angka kematian. Pada pasien yang dirawat di ruang intensif, mortalitas tertinggi terjadi pada kelompok usia 50–64 tahun dan terutama pada penggunaan ventilator.

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Background: The disease due to the novel coronavirus (SARS-CoV-2) emerging in December 2019 has since become a global pandemic, including in Indonesia. To date, several countries have reported about this disease. However, in Indonesia, limited information was available about the characteristics and outcomes of COVID-19 patients according to age, notably those in intensive care units with and without ventilation.

Methods: The study was conducted on adult patients in the intensive care units (HCU and ICU) of RSCM and RSUI between March – December 2020. Data was collected from medical records, including basic patient characteristics, laboratory and radiology results, treatments, complications, and

outcomes.

Results: A total of 682 patients were treated in the intensive care units of RSCM and RSUI. In all age groups, most patients were male. In younger age groups (18–29, 30–39, 40–49 years), the majority of patients presented initially with shortness of breath and were supplemented with oxygen through nasal cannula (37.0%, 33.0%, and 29.6%). In the age group of 50–64 years, oxygen was supplemented mostly using invasive ventilators (33.5%). The lowest PF ratio of 120 was observed in the age group of 65 years and above, with ventilators being used in 49.7% of the patients. The highest prevalence of comorbidities was found in the age group of 65 years and above (95.6%), among which were hypertension, coronary artery diseases, diabetes mellitus, and CKD. Bacterial co-infection was found primarily in the age group of 50–64 years. The age group of 65 years and above had the highest median neutrophil and D-dimer levels (4.210 μg/L) and the lowest lymphocyte count. The highest complication rate at 75.6% was observed in the age group of 65 years and above, with the most common complications being ARDS (50.9%), septic shock (50.3%), and AKI (38.4%). The highest mortality rates were found in the age groups of 50–64 and 65 years and above, at 46.9% and 46.5% respectively. Mortality was higher in ventilated patients across all age groups, with the highest rate found in the age group of 50–64 years (74.63%).

Conclusion: With increasing age, the following were observed: increased comorbidities (hypertension, coronary artery diseases, diabetes mellitus, CKD); a decline in functional parameters for lung oxygenation; decreased lymphocyte count; increased neutrophil count, D-dimer, urea and creatinine levels; and increased mortality rate. In intensive care unit patients, the highest mortality rate was observed in ventilated patients aged 50–64 years."

"Latar Belakang: Luaran pasien Sindroma Guillain-Barré (SGB) tidak sepenuhnya baik walaupun telah berkembang imunoterapi. Prediksi pasien SGB dengan luaran buruk harus dilakukan sedini mungkin untuk menentukan manajemen selanjutnya di rumah sakit dan perawatan di rumah. Sistem EGOS merupakan salah satu cara untuk memprediksi luaran pasien SGB. Sayangnya, penelitian EGOS selama ini dilakukan di luar negeri yang memiliki kondisi pasien dan lingkungan yang berbeda dengan di Indonesia. Penelitian ini bertujuan mengetahui gambaran luaran pasien SGB melalui skala disabilitas enam bulan pascaawitan dan EGOS di RSUPNCM. Metode: Penelitian ini berdesain potong lintang dengan mengambil data dari rekam medik pasien SGB yang menjalani perawatan inap di RSUPNCM sejak Januari 2010 hingga Desember 2014. Data mengenai karakteristik demografi, klinis, nilai EGOS, dan luaran pasien SGB saat enam bulan pascaawitan dikumpulkan pada penelitian ini. Hasil: Jumlah kasus baru SGB pertahun di RSUPNCM adalah 7,6 kasus. Kasus SGB terjadi di sepanjang tahun dan tidak mengenal musim. Rasio jenis kelamin laki-laki daripada perempuan adalah 1,2 : 1. Rerata usia pasien adalah 39,71 tahun. Varian SGB yang paling sering ditemukan pada penelitian ini adalah AIDP (31,6%), diikuti AMSAN (18,4%), AMAN (15,8%), dan SMF (13,2%). Durasi awitan - RS memiliki median 8,5 hari. Sebanyak 24 pasien mendapat imunoterapi PE, dimana sebanyak 83,3% pasien mendapatkannya pada ≥2 minggu pascaawitan. Proporsi pasien SGB dengan luaran baik sebesar 64,3%. Semakin besar nilai EGOS, maka semakin besar proporsi pasien SGB dengan luaran buruk. Simpulan: Proporsi luaran pasien SGB memiliki kecenderungan tren data yang sejalan dengan prediksi EGOS. Selain itu, proporsi luaran baik pasien SGB dapat lebih ditingkatkan lagi dengan mempercepat diagnosis dan pemberian imunoterapi.

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Background: The outcome of GBS is not completely well, despite of the development of immunotherapy. Patients with poor outcome have to be identified quickly in order to determine next management in hospital and home care planning. Erasmus GBS Outcome Score (EGOS) is a model to predict the outcome of patients at six months after onset. Unfortunately, the EGOS studies were conducted in foreign countries, which have different patient characteristics and environment. This study was conducted to describe the outcome characteristics and EGOS of GBS patients at Cipto Mangunkusumo Hospital.

Method: A cross-sectional study was conducted to collect data from patient medical records who were admitted to the hospital between January 2010 and December 2014. Data collected included demographic and clinical characteristics, EGOS, and outcome of GBS patients.

Results: New cases of GBS in this hospital were 7.6 cases/ year. Male-to-female ratio was 1.2:1. Mean age was 39.71 years old. The most frequent variant was AIDP (31.6%), followed by AMSAN (18,4%), AMAN (15.8%) and MFS (13.2%). Median duration of onset - hospital was 8.5 days. Twenty four patients were treated with plasma exchange, in which 83.3% got these two weeks after onset. Proportion of patients with good outcome was 64.3%. Higher score of EGOS tend to have higher proportion of patients with poor outcome.

Conclusions: The proportion of GBS patient outcome in this study had a same data trend with EGOS. This proportion of patients with good outcome could be improved with early diagnosis and prompt immunotherapy."

"[ABSTRAKLatar Belakang. Tujuan penelitian untuk melihat faktor ibu dan neonatus yang dapat menyebabkan keberhasilan minum pada neonatus yang lahir dari ibu preeklamsi. Intoleransi minum yang tidak disebabkan sepsis seringkali menyulitkan pemberian makan pada neonatus agar tumbuh kembangnya sempurna. Akan diteliti faktor-faktor yang mempengaruhi kemampuan minum.Metode Penelitian. Dengan menggunakan desain potong lintang dan rumus analisis multivariat didapatkan 72 sampel rekam medik dari ibu dan neonatus yang diambil secara consecutive sampling di rekam medik RSCM kemudian dilakukan analisis univariat, bivariat, dan multivariat.Hasil. Karakteristik ibu dan bayi yaitu sebagian besar bayi lahir dari ibu berusia 31-35 tahun, tingkat pendidikan SMA, memiliki anak usia 1-3 tahun, ANC ≥ 4x, cara persalinan bedah kaisar, kriteria preeklamsia berat, nilai SDAU tidak membuat hipoksia. Sebagian besar bayi lahir usia gestasi ≤ 32 minggu, terbanyak berjenis kelamin perempuan. Proporsi bayi yang lahir dengan dengan berat lahir 1000-1500 gram tidak berbeda dengan 1501-2000 gram, terbanyak tidak PJT, terbanyak menggunakan CPAP, dan nilai APGAR menit ke-5 ≥ 7. Analisis multivariat menunjukkan ada 2 faktor yang dapat dijadikan prediktor keberhasilan minum yaitu usia gestasi dan kondisi klinis. Bayi dapat minum full feed dengan median 9,5 hari dengan rentang 3,5-15,5 hari.Simpulan. Faktor keberhasilan minum adalah usia gestasi ˃ 32 minggu dan tidak ditemukan intoleransi klinis.

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ABSTRACTIntroduction. The aim of this study is to observe predictive factors from mothers and neonates for successful feeding. Feeding intolerance can happen without sepsis and becomes worst in the future. Other factors that influence successful feeding will be assessed in this study.Methods. This study is a cross sectional study using secondary data obtained from medical records of 72 subject, recruited with consecutive sampling. Univariate, bivariate, and multivariate analyses were performed in this study.Results. A large proportion of the babies were born from mothers aged 31-35 years old, senior high school graduated, having an 1-3 year-parity interval, giving birth through sectio caesaria delivery, ANC ≥ 4x, and having severe preeclampsia, and non hypoxic SDAU. The most of the babies born at gestational age ≥ 32 weeks and females. The most of the babies born with a birth weight of 1000-1500 grams and 1501-2000 grams weeks were not different, the most babies not IUGR, being assisted with CPAP, having an APGAR score at the 5th minutes ≥ 7. Multivariate analyses revealed the gestational age and clinical symptoms were predictor factors for successful feeding in neonates. Neonates successful feeding in median 9,5 days and range from 3,5 to 15,5 days.Conclusion. Predictor factors for successful feeding in neonates were gestational age more than 32 weeks and the absence of clinical symptoms, Introduction. The aim of this study is to observe predictive factors from mothers and neonates for successful feeding. Feeding intolerance can happen without sepsis and becomes worst in the future. Other factors that influence successful feeding will be assessed in this study.Methods. This study is a cross sectional study using secondary data obtained from medical records of 72 subject, recruited with consecutive sampling. Univariate, bivariate, and multivariate analyses were performed in this study.Results. A large proportion of the babies were born from mothers aged 31-35 years old, senior high school graduated, having an 1-3 year-parity interval, giving birth through sectio caesaria delivery, ANC ≥ 4x, and having severe preeclampsia, and non hypoxic SDAU. The most of the babies born at gestational age ≥ 32 weeks and females. The most of the babies born with a birth weight of 1000-1500 grams and 1501-2000 grams weeks were not different, the most babies not IUGR, being assisted with CPAP, having an APGAR score at the 5th minutes ≥ 7. Multivariate analyses revealed the gestational age and clinical symptoms were predictor factors for successful feeding in neonates. Neonates successful feeding in median 9,5 days and range from 3,5 to 15,5 days.Conclusion. Predictor factors for successful feeding in neonates were gestational age more than 32 weeks and the absence of clinical symptoms]"

"Latar Belakang: Stenosis kanal lumbal SKL merupakan suatu kondisi yang potensial menimbulkan disabilitas dan seringkali ditemukan seiring meningkatnya usia populasi. Studi bertujuan menganalisa hubungan antara luaran klinis pasien SKL dan klasifikasi stenosis berdasarkan MRI. Metode: Studi kohort prospektif ini dilakukan di Rumah Sakit Cipto Mangunkusumo RSCM pada januari hingga juli 2016 melalui metode consecutive sampling. Tiga puluh delapan sampel didapat dan kesemuanya dilakukan tatalaksana pembedahan yang sama yaitu dekompresi dan stabilisasi posterior. Subjek dikategorikan ke dalam 4 kategori berdasarakan pemeriksaan MRI menggunakan klasifikasi Schizas. Pemeriksaan pra dan pasca operasi 3 bulan dan 6 bulan dilakukan menggunakan Visual Analogue Scale VAS, Oswestry Disability Index ODI, Japanese Orthopaedic Association Score JOA and Roland Morris Disability Questionnaire RMDQ. Analisis statistic dilakukan dengan menggunakan program SPSS v19. Hasil: Rata ndash; rata usia dari 38 sampel yang didapatkan adalah 58.92 tahun rentang 50-70 tahun. Terdapat 16 orang laki ndash; laki dan 22 orang perempuan. Sebagian besar pasien diklasifikasikan pada grade C berdasarkan klasifikasi Schizas. Perbaikan skor klinis pada subjek laki ndash; laki didapatkan lebih tinggi dibanding perempuan dan hasilnya didapatkan bermakna pada pengukuran VAS pascaoperasi 6 bulan p=0.003 dan JOA pascaoperasi 3 bulan p=0.029. Tidak ditemukan perbedaan bermakna antara derajat klasifikasi berdasarkan MRI dengan skor perbaikan klinis preoperasi, 3 bulan dan 6 bulan pasca operasi menurut VAS p=0.451, p=0.738, p=0.448, ODI p=0.143, p=0.929, p=0.796, JOA p=0.157, p=0.876, p=0.961 dan RMDQ p=0.065, p=0.057, p=0.094. Simpulan: Terdapat perbaikan klinis setelah dilakukan operasi dekompresi dan stabilisai posterior yang ditandai dengan perbaikan skor VAS, ODI, JOA dan RMDQ pasca operasi 3 dan 6 bulan. Tidak terdapat hubungan antara derajat SKL dengan skor VAS, ODI, JOA dan RMDQ.

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Background: Lumbar canal stenosis LCS is a condition which can potentially cause disability and often discovered within the increasing age of population. The aim of this study was to analyze the correlation between clinical outcome of postoperative patients and classifications that are based from MRI assesments.

Method: This prospective cohort study was carried out a Cipto Mangunkusumo General Hospital from January till july 2016 obtained using consecutive sampling. Thirty eight samples were obtained and all of them were managed with same surgical technique that was decompression and posterior stabilization. Patients were categorized in 4 types based on MRI examination using Schizas Classification. Pre and post treatment 3 month and 6 month assessment of the patients was done according to Visual Analogue Scale VAS, Oswestry Disability Index ODI, Japanese Orthopaedic Association Score JOA and Roland Morris Disability Questionnaire RMDQ. Statistical analysis was performed using statitiscal program for social science SPSS v.19.

Result: From 38 samples that were obtained average age was 58.92 years old range 50 70 years old. There were 16 males and 22 females. Most of patients are classified in type C 21 subjects based on MRI examination. The improvement of clinical score in male subjects were better dan female subjects and significantly different in 6 month postoperative VAS p 0.003 and 3 month postoperative JOA score p0.029. In this study was found that generally VAS, ODI, JOA and RMDQ score improved along follow up time. There was no statistical differences between MRI based classification and clinical outcome in preoperative, 3 and 6 month postoperative according to VAS p 0.451, p 0.738, p 0.448, ODI p 0.143, p 0.929, p 0.796, JOA p 0.157, p 0.876, p 0.961 dan RMDQ p 0.065, p 0.057, p 0.094.

Conclusion: There was clinical improvement after decompression and posterior stabilization in lumbar canal stenosis which were manifested in 3 and 6 months post operation of VAS ODI, JOA and RMDQ score. There was no association between degree of LCS and VAS, ODI, JOA and RMDQ score. "

"ABSTRAKHipotiroid kongenital (HK) adalah kelainan bawaan yang dapat menimbulkandampak berupa retardasi mental permanen. Pemberian levothyroxine dengan dosistepat pada usia sedini mungkin, dapat mencegah gangguan pertumbuhan danperkembangan. Sayangnya, bayi baru lahir tidak menunjukkan gejala HK. Kalaupunada, berarti sudah ada gangguan pertumbuhan. Perlu skrining hipotiroid kongenital(SHK) untuk menemukan kasus bayi yang menderita HK.Meski sudah dilakukan sejak 2006, baru pada tahun 2014 dikeluarkan Permenkestentang pelaksanaan SHK di Indonesia. Penelitian evaluasi ekonomi program SHKtahun 2014-2015 ini mencakup analisis biaya skrining dan terapi dini, sedangkanoutcome didapat dari systematic review (SR). Asumsi dikembangkan berdasarkandata riil pasien skrining SHK di 2 laboratorium rujukan di Jakarta dan Bandung.Dari total 56.186 bayi yang melakukan skrining, diperoleh 24 pasien positifmenderita HK.Hasil SR menyatakan bahwa semakin dini onset terapi, semakin adekuat dosisinisiasi dan semakin kontinyu terapi dapat memberikan hasil yang baik. Hasiltersebut berupa pencegahan terhadap komplikasi HK lebih jauh dan perbaikan padapenyimpangan tumbuh kembang.Dari hasil penelitian, didapatkan informasi bahwa baru pada tahun kedua terlihatadanya keuntungan ekonomis SHK. Hal ini berhubungan dengan patologi gejala HKyang umumnya muncul pada usia 3-6 bulan. Orang tua baru mencari pertolonganmedis pada tahun kedua dan mengeluarkan lebih banyak biaya. Biaya skrining danterapi dini menjadi sepadan dibandingkan dengan kerugian yang dapat dicegahakibat gejala gangguan tumbuh kembang.

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ABSTRACTCongenital hypothyroidism (CH) is a congenital disorder that can have an impact inthe form of permanent mental retardation. Giving the right dose of levothyroxine atthe earliest possible age, can prevent the disruption of growth and development.Newborns do not show symptoms of CH, and unfortunately the symptoms appear inthe late period and in many cases it shows growth disorders. The congenitalhypothyroidism screening (CHS) program has been implemented to find infant caseswith CH, and followed up with treatment.Although it has been made since 2006, Minister of Health just issued the regulationin 2014 on the implementation of CHS in Indonesia. This economic evaluation of theCHS program in 2014-2015 was done using cost analysis, while outcome obtainedfrom the systematic review (SR). The assumptions used in the analysis weredeveloped based on real data from a CHS screening program in two referrallaboratories in Jakarta and Bandung. Out of 56.186 screened babies, 24 babies werefound as CH positive cases.The result of the SR revealed that the earlier onset of initiation therapy, the moreadequate dose and the more continuous therapy given to the patient, the better resultwill be achieved. It will prevent the patients from severe complications of CH andwill improve the quality of thegrowth and development..The study found that the economic benefit is achieved in the second year of CHtreatment, since the pathological symptoms generally appear at the age of 3-6 monthand parents seek care in the second year. Consequently, cost to treat patients willincrease. The cost of screening and early treatment was found worthy as compared toeconomic loss resulting from growth disorders."