Hasil Pencarian  ::  Simpan CSV :: Kembali

"Latar belakang. Peningkatan morbiditas dan mortalitas pada bayi baru lahir dengan penyakit jantung bawaan (PJB) kritis berkaitan dengan diagnosis yang terlambat. Skrining pulse oksimetri sebelum bayi baru lahir pulang dari rumah sakit dapat membantu menegakkan diagnosis dini. Pulse oksimeter fingertip diharapkan menjadi alternatif pilihan alat pemeriksaan oksimetri karena murah, mudah, dan dapat digunakan secara luas. Tujuan. Penelitian ini bertujuan menilai sensitivitas, spesifisitas, nilai duga positif (NDP), nilai duga negatif (NDN), rasio kemungkinan positif (RKP), rasio kemungkinan negatif (RKN), pre-test probability, dan post-test probability pemeriksaan pulse oksimetri fingertip dibandingkan oksimetri generasi baru untuk deteksi dini PJB kritis pada bayi baru lahir sebelum pulang dari rumah sakit. Metode. Penelitian ini merupakan uji diagnostik yang dilakukan di Ruang Rawat Gabung RSCM pada semua bayi baru lahir bugar dengan usia gestasi ≥37 minggu dan berusia 24-72 jam. Pemeriksaan pulse oksimetri fingertip dan pulse oksimetri generasi baru dilakukan di tangan kanan (preduktal) dan kaki (postduktal). Subjek dengan saturasi oksigen <95% atau beda saturasi oksigen >3% antara tangan kanan dan kaki memerlukan pemeriksaan lebih lanjut. Ekokardiografi dikerjakan untuk diagnosis pasti. Hasil. Penelitian dilakukan selama enam bulan pada 442 bayi baru lahir bugar. Mayoritas subjek diperiksa pada usia 24-48 jam (59%), median usia gestasi 38 minggu. Terdapat enam subjek dengan kelainan kongenital. Tidak ada subjek dengan riwayat keluarga menderita PJB, didiagnosis PJB saat antenatal maupun melalui pemeriksaan fisis. Perolehan saturasi oksigen preduktal menggunakan dua jenis pulse oksimetri bervariasi secara statistik (Uji Bland-Altman) namun tidak bermakna secara klinis (hasil deteksi negatif 100%). Tidak ada subjek dengan hasil deteksi positif dan didiagnosis PJB kritis melalui pemeriksaan oksimetri. Pemeriksaan pulse oksimetri fingertip pada bayi baru lahir dipengaruhi gerakan bayi (67,6%) dan faktor alat (sinyal tidak terbaca dan hasil tidak stabil) 24,8%. Simpulan. Uji diagnostik pulse oksimetri fingertip dibandingkan generasi baru untuk deteksi dini PJB kritis pada penelitian ini belum dapat dinilai. Pemeriksaan kedua jenis pulse oksimetri tersebut memberikan hasil deteksi yang sama.

---

Background. Late diagnosis in the newborn with critical congenital heart disease (CCHD) is associated with increased morbidity and mortality. Pulse oximetry screening of newborn before hospital discharge can help early diagnosis. Fingertip pulse oximeter is expected to be an alternative option oximetry screening tool because it is affordable, easy, and can be widely used.

Objective. To estimate sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), pretest odds, positive likelihood ratio (LR+), negative likelihood ratio (LR-), post-test odds, and post-test probability of fingertip pulse oximetry screening compared to a new generation to detect CCHD in the newborn before hospital discharge.

Methods. This is a diagnostic study held in newborn nursery of Cipto Mangunkusumo Hospital involving asymptomatic newborns aged 24-72 hours and gestational age ≥37weeks. Examination of fingertip and new generation pulse oxymetri was done in right hand (preductal) and foot (postductal). Subject had oxygen saturation <95% or difference of oxygen saturation between right hand and foot >3% requires further investigation. Echocardiography was performed for definitive diagnosis.

Results. The study was conducted during six months in 442 asymtomatic newborns. The majority of subjects were examined at age 24-48 hours (59%) and gestational age 38 weeks. There were six subjects with congenital abnormalities. No subjects with a family history of CHD nor diagnosed through antenatal and physical examination. Obtaining preductal oxygen saturation using two types pulse oximetry varied statistically (Bland-Altman test) but not clinically significant (100% negative detection results). No subject had positive detection result and was diagnosed CCHD through screening oximetry. Newborn examination using fingertip pulse oximetry were affected by movement (67.6%) and tool factors (signal unreadable and unstable results) 24.8%.

Conclusion. Diagnostic test of fingertip compared with new generation pulse oximetry in early detection of CCHD in this study can not be assessed. These two modalities show the same result of detection."

"Diagnosis dan tatalaksana batuk kronik berulang (BKB) pada anak masih menjadi masalah karena etiologinya yang beragam. Selain anamnesis dan pemeriksaan finis yang seksama, upaya untuk tatalaksana BKB yang baik memerlukan beberapa pemeriksaan penunjang tergantung dari indikasinya. Salah satu pemeriksaan penunjang pada BKB adalah uji provokasi bronkus yang dapat membuktikan adanya hiperreresponsivitas bronkus (HRB). Stimulus bronkospasmogenik dapat berupa zat farmakologis maupun nonfarmakologis. Golongan zat farmakologis yang sering dipakai adalah histamin dan metakolin sedangkan zat nonfarmakologis diantaranya adalah salin hipertonik (SH) 4,5 %.Histamin dan melakolin adalah baku emas uji provokasi bronkus dianggap cukup balk untuk membedakan subjek asma dan normaL Sensitivitas dan spesifisitasnya sebesar 92-100% dan 92-93%, NDP 29-92%, NDN 92-100%. Dari beberapa penelitian diketahui pula bahwa derajat HRB oleh histamin sesuai dengan derajat asmanya, makin berat asma maka HRB terhadap histamin akin sema kin berat. Namun akhir-akhir ini histamin harganya mahal dan sulit ditemukan di Indonesia karena harus diimport dari luar negeri. Oleh karena itu saat ini dicari alternatif uji provokasi bronkus yang derajat akurasinya setara dengan histamin.Salin hipertonik 4,5% mulai dikenalkan secara luas sejak tahun 1980 terutama di Australia. Zat ini dapat dibuat di laboratorium obat sederhana dari kristal NaCl. Harganya murah dan cara membuatnya pun mudah. Beberapa penelitian sebelumnya mendapatkan nilai spesifisitasriya berkisar antara 92-100% namun sensitivitasnya flushing dari sakit kepala sedangkan salin hipertonik dapat menyebabkan iritasi tengorokan. Nilai reprodusibiiitas kedua uji provokasi terbukti cukup baik.Prevalensi asma pada BKB cukup tinggi berkisar antara 40-6d%. Uji provokasi bronkus yang dilakukan pada pasien BKB tujuannya adalah untuk memastikan diagnosis asma bukan untuk skiring karena biasanya pasien yang berkunjung ke Poliklinik RSCM sudah berobat ketempat lain sebelumnya. Oleh karena itu diperlukan uji diagnosis yang sensitif untuk menegakkan diagnosis dan menentukan tata]aksana yang optimal. Dari latar belakang diatas dapat dirumuskan masalah penelitian yaitu seberapa baik kemampuan SH 4,5% untuk mendiagnosis asma pada anak dengan batuk kronik berulang.TUJUAN PENELITIANTujuan umumMembuktikan bahwa uji provokasi SH 4,5% dapat mengantikan uji provokasi his tamin sebagai uji diagnostik altematif asma pada pasien BKB.Tujuan khusus1. Mengetahui karakteristik pasien BKB yang dilakukan uji provokasi.2. Mengetahui sensitivitas, spesifisitas, nilai duga positif, nilai duga negatif, rasio kemungkinan positif, rasio kernungkinan negatif dari uji provokasi SH 4,5%."

"Mengetahui proporsi gangguan fungsi paru pada remaja jalanan perokok dan hubungan antara perilaku merokok dengan gangguan fungsi paru. Metode: Studi potong lintang pada 317 anak jalanan, usia 10-18 tahun, terdiri dari perokok dan bukan perokok. Uji fungsi paru dilakukan pada subjek dengan menilai FEV1/ FVC, FEV1, FVC, V50 dan V25. Hasil: Subjek perokok sebanyak 182 remaja jalanan (57,4%), sebagian besar merupakan perokok kadang-kadang (53%), lama merokok 1-2 tahun (54%), jenis rokok yang digunakan adalah rokok filter (58%), dan jumlah rokok yang dikonsumsi 1-10 batang per hari (93%). Rerata parameter fungsi paru subjek perokok lebih rendah dibandingkan bukan perokok, dengan perbedaan bermakna pada nilai FEV1 dan FVC (p<0,05). Rerata nilai FEV1 dan FVC subjek perempuan perokok berbeda bermakna dengan bukan perokok, begitupun dengan rerata nilai FVC subjek lelaki (p<0,05). Proporsi gangguan fungsi paru subjek perokok berbeda bermakna dengan bukan perokok (p=0,016). Terdapat hubungan antara jenis rokok dengan gangguan fungsi paru (p<0,001), dimana pengguna rokok kretek paling banyak mengalami gangguan. Terdapat hubungan antara derajat perilaku merokok dengan gangguan fungsi paru (p=0,046). Simpulan: Rerata parameter uji fungsi paru (FEV1 dan FVC) pada remaja jalanan perokok lebih rendah dibandingkan bukan perokok. Proporsi gangguan fungsi paru pada remaja jalanan perokok 26,5%, terdiri dari campuran (16,1%), restriktif (8,2%) dan obstruktif (2,2%). Jenis rokok dan derajat perilaku merokok memiliki hubungan dengan kejadian gangguan fungsi paru.

---

Street children and smoking prevalence are highly increasing. Studies on pulmonary function among adolescent street children smokers are still limited with controversial result.

Objective: To determine proportion of pulmonary dysfunction among adolescent street children smokers and to evaluate relation between smoking behaviour with pulmonary dysfunction.

Methods: A cross sectional study among 317 street children, aged 10-18 years old, including smokers and non-smokers which were recruited consecutively. Subjects undergone pulmonary function test which measured FEV1/ FVC, FEV1, FVC, V50 and V25.

Results: Subject smokers were 182 children, most of them were occasional smokers (53%), smoking period around 1-2 years (54%), using filtered cigarettes (58%), and consuming 1-10 cigarettes per day (93%). Mean pulmonary function parameter values of smokers were lower than non-smokers, significant difference for FEV1 and FVC (p<0.05). Mean FEV1 and FVC between smoking and nonsmoking girls were significant difference, and also mean FVC of boys (p<0.05). There was significant difference in proportion of pulmonary function abnormalities between smokers and non-smokers (p=0.016). There was relation between types of cigarettes with pulmonary dysfunction (p<0.001), the abnormalities mostly impact to kretek smokers. There was relation between smoking behaviour with pulmonary function abnormalities (p=0.046).

Conclusion: Mean pulmonary function parameter values (FEV1 and FVC) of smokers were lower than non-smokers. Pulmonary dysfunction proportion among adolescent street children smokers was 26.5%, consist of combined disorder (16.1%), restrictive (8.2%) and obstructive (2.2%). There was relation between types of cigarettes and smoking behavior with pulmonary function abnormalities."

"ABSTRAKLatar belakang: Laringomalasia merupakan kondisi kelemahan struktursupraglotis saat inspirasi sehingga menyebabkan sumbatan jalan nafas atas danmenimbulkan gejala stridor inspirasi. Stridor semakin memburuk pada posisiterlentang. Penyakit penyerta laringomalasia umumnya adalah reflukslaringofaring (RLF) yaitu 25-68%. RLF adalah pergerakan isi lambung secararetrograd menuju laring-faring, menimbulkan gejala dan tanda klinis yangbervariasi. Pemberian omeperazol dapat memperbaiki gejala regurgitasi danstridor serta memperpendek durasi perjalanan alamiah laringomalasiaTujuan: Mengetahui efektifitas omeperazol pada bayi dan anak denganlaringomalasia, mengetahui prevalensi RLF pada laringomalasia, ada tidaknyaRLF berdasar nilai reflux finding score (RFS) menurut Belafsky dan mengetahuiberat ringan gejala laringomalasia berdasar nilai laryngomalacia symptom score(LSS).Metode: Uji controlled trials pada 65 subyek laringomalasia, dibagi kedalamkelompok 42 subyek yang mendapat omeperazol 2 x 2 mg/kg/bb dan 23 subyekyang mendapat plasebo selama 3 bulanHasil : Kelompok omeperazol dengan gejala berat 58,8% mengalami perbaikandibanding kelompok plasebo 66,7% dengan nilai p = 0,716. Kelompokomeperazol dengan RLF positif 58,3% mengalami perbaikan dibandingkelompok plasebo 75% dengan nilai p = 1.0Simpulan : Prevalensi RLF positif sebesar 24,6% dan gejala berat sebesar 44,6%.Efektifitas pemberian omeperazol selama 3 bulan belum terbukti efektif dibandingplasebo berdasarkan perbaikan nilai LSS, RFS dan status gizi. Namun hasiltersebut hanya berlaku sebagai kesimpulan penelitian pendahuluan karena tidakoptimalnya besar sampel dan randomisasi subyek. Perlu penelitian lanjutan untukmembuktikan efektifitas omeperazol pada perbaikan skor LSS, skor RFS danstatus gizi bayi dan anak dengan laringomalasia

---

ABSTRACTBackground: laryngomalacia is condition of floopy supraglottis stucture inrespiratory that trigger obstruction the upper airway and it causes symptom stridorinspiratory. Stridor can get worse in face up position. In general, the comorbidityof laryngomalacia is laryngopharyngeal reflux (LPR) about 25-68%. LPR is themovement of gaster retrogradely toward laryngopharyngeal and it triggers varioussymptom and clinical sign. The giving of omeperazole can improve the symptomof regurgitation and stridor and shorten the duration of natural disease oflaryngomalaciaObjective: Knowing the effectivity of giving omeperazole to the babies andchildren with laryngomalacia, knowing the prevalance of LPR to thelaryngomalacia, knowing the positibility of LPR based on the value of refluxfinding score (RFS) according to Belafsky and knowing severity of symptomlaryngomalacia based on the value of laryngomalacia symptom score (LSS).Method: Test on controlled trials on 65 samples with laryngomalacia and isdivided into 42 groups that have been given omeperazole 2x2 mg/kg/bw and 23samples that have been given placebo for 3 monthResult: Omeperazol groups with severe symptom showed the improvement of58,8% compared to placebo groups 66,7% with p = 0.716. Omeperazole groupswith RLF positive showed the improvement of 58,3% compared to placebogroups 75 % with p = 1.0Conclusion: The Prevalence of positive LPR based on RFS is 24,6% and withsevere symptom is 44,6%. The effectivity of giving omeperazole for 3 month hasnot proved effective compared to placebo based on the improvement of valueLSS, RFS and nutrition status. However such result is only valid for theconclusion of initial research because the size of samples were not either optimalor randomized. It is necessary to conduct research continution to prove theeffectivity of giving omeperazole on the improvement of LSS score, RFS scoreand nutrition status of babies and children with laryngomalacia"

"Latar belakang: angka kematian akibat pneumonia pada anak masih tinggi. Studi melaporkan bahwa kasus kematian anak yang dirawat di rumah sakit karena pneumonia bervariasi dari 8,7% hingga 47%, lebih dari 70% berlangsung di Afrika dan Asia Tenggara. Banyak dilaporkan pasien datang dengan kondisi yang berat karena keterlambatan penanganan, hingga menyebabkan kematian.Oleh karena itu, studi yang mempelajari faktor risiko kematian pada pneumonia anak  perlu dilakukan.Metode: penelitian ini merupakan studi retrospektif dengan mengambil data rekam medis pasien anak usia 2 bulan sampai 18 tahun yang tercatat sebagai penderita penyakit pneumonia pada periode Juli 2021 – Mei 2022. Faktor yang didata meliputi faktor klinis dan pemeriksaan penunjang yang mendukung diagnosis.Hasil: subyek penelitian didapatkan sebanyak 207 pasien dengan luaran pasca rawat inap meninggal sebanyak 33 (15,9%) pasien dan hidup sebanyak 174 (84,1%) pasien. Hasil analisis multivariat menunjukkan faktor risiko yang berhubungan dengan kematian pneumonia anak adalah kesulitan makan minum (aOR 2,743 IK 95% (1,219-6,172); p 0,012), komorbid keganasan (aOR 2,500 IK 95% (1,094-5,712); p 0,026), takipneu (aOR 2,711 IK 95% (1,263-5,817); p 0,009), hipoksemia (aOR 2,323 IK 95% (1,021-5,284); p 0,041),  dan leukositosis (aOR 2,245 IK 95% (1,038-4,856); p 0,037).Simpulan: pasien pneumonia anak yang mengalami kesulitan makan minum, memiliki komorbid keganasan, takipneu, hipoksemia, dan leukositosis berisiko mengalami kematian.

---

Background: the mortality rate of pneumonia in children still elevated. Studies reported that cases of child mortality in hospitalized patient due to pneumonia vary from 8.7% to 47%, more than 70% from Africa and Southeast Asia. Many patients reported coming with severe conditions due to delays in treatment, causing death. Therefore, research that study the   factors that contribute to  mortality in pediatric pneumonia patients is needed.

Methods: This study is a retrospective study by taking medical records of pediatric patients aged 2 months to 18 years who were diagnosed as pneumonia in the period July 2021 - May 2022. The factors recorded included clinical factors and diagnostic examinations that supported the diagnosis.

Results: this study consisted of 207 pneumonia patients with post-hospital outcomes died as many as 33 (15.9%) patients and lived as many as 174 (84.1%) patients. The results of multivariate analysis showed the risk factors associated with mortality of pediatric pneumonia were difficulty eating and drinking (aOR 2.743 CI 95% (1,219-6,172); p 0.012), comorbid malignancy (aOR 2,500 CI 95% (1.094-5.712); p 0.026), tachypnea (aOR 2.711 CI 95% (1,263-5.817); p 0.009), hypoxaemia (aOR 2.323 CI 95% (1.021-5.284); p 0.041), and leukocytosis (aOR 2,245 CI 95% (1.038-4.856); p 0.037 ).

Conclusion: pediatric pneumonia patients who have difficulty eating and drinking, have comorbid malignancy, tachypnea, hypoxemia, and leukocytosis are at risk of death."

"Latar belakang. Jumlah pasien keganasan anak di Indonesia tertinggi di Asia Tenggara dan pneumonia merupakan komplikasi infeksi tersering serta memiliki luaran yang lebih berat. Namun, hingga saat ini belum ada penelitian mengenai prevalens, karakteristik, dan faktor risiko kejadian pneumonia pada pasien keganasan anak di IndonesiaTujuan. Mengetahui prevalens, karakteristik, dan faktor-faktor yang memengaruhi kejadian pneumonia pada pasien keganasan anak di RSCM.Metode. Penelitian ini merupakan studi deskriptif analitik dengan metode potong lintang retrospektif menggunakan data rekam medis pasien. Subjek yang diteliti ialah seluruh pasien keganasan berusia 1 bulan-18 tahun yang dirawat inap di IGD, PICU, dan bangsal anak RSCM dari Januari 2021 sampai Desember 2023. Faktor risiko yang dianalisis, antara lain usia, jenis keganasan, status imunisasi, status gizi, tipe terapi keganasan, neutropenia, dan riwayat rawat inap ≥ 14 hari.Hasil. Terdapat 162 subjek yang memenuhi kriteria inklusi dan eksklusi dalam penelitian. Prevalens pneumonia pada pasien keganasan anak di RSCM sebesar 43,2% (70/162) subjek, terdiri dari 78,5% (55/70) kasus pneumonia terkait RS dan 21,4% (15/70) kasus pneumonia komunitas. Karakteristik subjek dengan pneumonia, antara lain median usia 5,3 tahun (min-mak 0,2-17,5 tahun), median usia awitan keganasan 4,7 tahun (min-mak 0-17,3 tahun), jenis kelamin lelaki 57,1% subjek, pengidap leukemia 55,7% subjek, imunisasi tidak lengkap 38,6% subjek, status gizi kurang/buruk 54,3% subjek, terapi keganasan berupa kemoterapi 61,4% subjek, neutropenia 65,7% subjek, dan riwayat rawat inap ≥14 hari 34,3% subjek. Profil klinis dan pemeriksaan penunjang pada subjek dengan pneumonia, yakni 37,1% subjek mengalami pneumonia sangat berat, terapi oksigen dengan kecepatan  >6 lpm 40% subjek, 52,8% subjek tidak terdapat leukositosis, kadar CRP meningkat pada 80% subjek, kadar PCT meningkat pada 71,4% subjek, dan rontgen dada kesan sugestif pneumonia pada 82,9% subjek. Hasil analisis multivariat faktor yang memengaruhi kejadian pneumonia dan pneumonia terkait RS adalah status gizi kurang/buruk (AOR 3,24; IK 95% 1,49-7,05; p=0,003 dan AOR 2,98; IK 95% 1,24-7,17; p=0,015), neutropenia (AOR 4,15; IK 95% 1,94-8,84; p<0,001 dan AOR 4,59; IK 95% 1,94-10,86; p<0,001), serta riwayat rawat inap (AOR 8,48; IK 95% 2,63-27,31; p<0,001 dan AOR 12,34; IK 95% 3,71-41,09; p<0,001).Simpulan.Faktor yang memengaruhi kejadian pneumonia, khususnya pneumonia terkait RS pada pasien keganasan anak adalah status gizi kurang/buruk, neutropenia, dan riwayat rawat inap ≥ 14 hari.

---

Background. The number of pediatric malignancies in Indonesia is the highest in Southeast Asia. Pneumonia is the most common infection in childhood cancer and also has more severe outcomes than normal children. However, there has been no research regarding the prevalence, characteristics, and risk factors influencing pneumonia in pediatric patients with malignancy in Indonesia

Objectives. To determine the prevalence, characteristics, and risk factors influencing pneumonia in pediatric patients with malignancy at RSCM.

Method. This research was a descriptive-analytical study with a retrospective cross-sectional design using medical records. The subjects studied were all malignancy patients aged 1 month-18 years who were hospitalized in the ER, PICU, and RSCM pediatric wards from January 2021 to December 2023. The risk factors which studied were age, type of malignancy, immunization status, nutritional status, type of malignancy therapy, neutropenia, and a history of hospitalization ≥ 14 days.

Result. 162 subjects met the inclusion and exclusion criteria in the study. The prevalence of pneumonia in pediatric malignancy patients at RSCM was 43,2% (70/162) subjects, consisting of 78,5% (55/70) cases of hospital-acquired pneumonia and 21,4% (15/70) cases of community-acquired pneumonia. Basic characteristics of the subjects, including median age 5,3 years (min-max 0,2-17,5 years), median age of malignancy onset 4,7 years (min-max 0-17,3 years), male 57,1% subjects, leukemia 55,7% subjects, incomplete immunization 38,6% subjects, malnutrition 54,3% subjects, chemotherapy in 61,4% subjects, neutropenia in 65,7% subjects, and history of hospitalization ≥ 14 days in 34,3% subjects. The clinical profiles and laboratory examinations in subjects with pneumonia, including 37,1% subjects had very severe pneumonia, 40% subjects had oxygen therapy >6 lpm, 52,8% subjects had no leukocytosis, CRP level increased in 80% subjects, PCT level increased in 71,4% subjects, and chest x-ray impression suggestive of pneumonia in 82,9% subjects. Multivariate analyses result of risk factors influencing pneumonia and hospital-acquired pneumonia are moderate/severe malnutrition (AOR 3,24; 95% CI 1,49-7,05; p = 0,003 and AOR 2,98; 95% CI 1,24-7,17; p = 0,015), neutropenia (AOR 4,15; 95% CI 1,94-8,84; p <0,001 and AOR 4,59; 95% CI 1,94-10,86; p <0,001) and history of hospitalization (AOR 8,48; 95% CI 2,63-27,31; p <0,001 and AOR 12,34; 95% CI 3,71-41,09; p <0,001).

Conclusion. Moderate/severe malnutrition, neutropenia, and a history of hospitalization ≥14 days are risk factors for pneumonia, especially hospital-acquired pneumonia in pediatric patients with malignancy."

"Latar belakang: Asma merupakan penyakit kronik yang paling sering dijumpai pada anak. International Study of Asthma and Allergies in Childhood (ISAAC) merupakan kerjasama intemasional yang melakukan studi prevalensi asma dan alergi pada anak di berbagai populasi, dengan menggunakan kuesioner yang telah divalidasi. Tujuan: Mengetahui prevalensi asma pada pada anak kelompok usia 13-14 tahun di Jakarta Timur, derajat berat serangan asma, dan faktor risiko yang memengaruhinya. Metodologi: Penelitian analisis deskriptif pada populasi anak usia 13-14 tahun di Sekolah Menengah Pertama (SMP) di Kotamadya Jakarta Timur Daerah Khusus lbukota (DKI) Jakarta. Waktu penelitian adalah Februari - April 2011. Pengolahan data menggunakan peranti lunak statistical package for social studies version 17.0 for windows PC (SPSS Inc). Analisis faktor risiko dilakukan dengan uji Chi-Square atau uji mutlak Fisher Hasil: Terdapat 562 subyek penelitian, perbandingan laki-laki dan perempuan adalah 1:1,25. Frekuensi kejadian pemah mengi adalah 8,9%; mengi dalarn 12 bulan terakhir 5,2%; asma yang didiagnosis dokter 9,4%. Frekuensi serangan mengi 1-3 kali per-bulan sebesar 3,9%; 4-12 kali per-bulan 1,1%; >12 kali perbulan 0,2%. Serangan mengi yang menyebabkan gangguan tidur sebesar 3%, dan mengi yang menyebabkan terjadi kesulitan bicara 1 ,8%. Tidak ada hubungan jenis kelamin (p=0,821; IK 95% 0,59:0,92), terpapar asap rokok (p=0,735; IK 95% 0,55:2,34), ataupun dermatitis alergi (p=0,054; IK 95% 0,97:4,63), dengan kejadian mengi. Terdapat hubungan bermakna anak pertarna (p=0,015; IK 95% 1,14:3,69), sosio ekonomi (p=0,001; IK 95% 0,02:0,36), dan rinitis alergi (p<0,05; IK 95% 2,5:10,43), terhadap kejadian mengi. Simpulan: Prevalensi asma pada anak usia 13-14 tahun di Jakarta Timur sebesar 12,5%. Faktor risiko kejadian mengi adalah anak pertarna, sosio ekonomi tinggi, dan rinitis alergi. Tidak ada hubungan jenis kelarnin, paparan asap rokok, dan dermatitis alergi terhadap kejadian mengi.

---

Background: Asthma is the most common chronic disease in childhood. International Study of Asthma and Allergies in Childhood (ISAAC) s a unique worldwide epidemiological research programmed to investigate asthma, rhinitis and eczema in children, using standardized questionnaire. Aim: To investigate asthma symptoms prevalence among population 13-14 yearold in East Jakarta, along with the severity and risk factors of asthma. Method: This is an analytical- cross sectional study, conducted from FebruaryApril 2011. Risk factors were analyzed using chi square or Fisher exact test. Result: Sample size is consisted of 562 children. The prevalence of wheeze ever 8.9%; 12-month wheeze 9,4%; asthma physician-diagnosed 9,4%. The prevalence of recureece wheezing as follows: 1-3 times a month 3.9%; 4-12 times a month 1.1 %; > 12 times a month 0,2%. Sleep distubance related wheeze 3%, and speech disorder related wheeze 1.8%. The prevalence of current wheezing did not show differences according to sex (p=0.821; IK. 95% 0.59:0.92), smoke exposure (p=0.735; IK 95% 0.55:234), nor allergic dermatitis (p=0.054; IK 95% 0.97:4.63). But it was significantly higher in children with no sibling (p=O.Ol5; IK 95% 1.14:3.69), high social economy (p=0.001; IK 95% 0.02:0.36), and allergic rhinitis (p<0.05; IK 95% 2.5:10.43) Conclusion: Asthma prevalence in 13-14 year-old in Jakarta Timur is 12.5%. Having no sibling, upper middle social economy level, and allergic rhinitis are wheezing ever risk factors, while sex differences, smoking exposure, and allergic dermatitis are not."

"Pasien anak memiliki risiko untuk mengalami penurunan kondisi klinis secara tiba-tiba hingga berakhir pada kematian. Perburukan klinis dapat dideteksi beberapa jam sebelum terjadinya kondisi serius yang mengancam jiwa sehingga dibutuhan suatu startegi untuk mendeteksi kegawatdaruratan penerapan sistem peringatan dini. Sejak tahun 2014, Rumah Sakit Cipto Mangunkusumo (RSCM) Jakarta menerapkan system skor nursing early warning scoring system(NEWSS) yang disusun berdasarkan modifikasi dari sistem skor serupa pada orang dewasa. Namun beberapa penelitian telah mengembangkan dan memvalidasi suatu sistem skor dengan tujuan yang sama yang digunakan sepsifik untuk pasien bayi dan anak, yakni pediatric early warning score(PEWS). Penelitian ini bertujuan untuk membandingkan PEWS dan NEWSS dalam mengidentifikasi deteriorasi klnis pasien anak yang dirawat di rumah sakit. Penelitian ini dilakukan pada 81 anak yang datang ke instalasi gawat darurat (IGD), diukur skor PEWS dan NEWSS secara bersamaan, kemudian diamati selama 6 jam atau sampai terjadinya deteriorasi klinis. Sebanyak 51 anak mengalami deteriorasi klinis berupa rawat PICU (31 anak), intubasi (14 anak), resusitasi jantung paru (2), dan meninggal (4 anak).Kedua sistem skor, baik NEWSS dan PEWS dapat menilai dan memprediksi kejadian deteriorasi klinis pada anak (NEWSS AUC 0,77; 95% CI 0,68-0,88; p < 0,001 dan PEWS AUC 0,87; 95% CI 0,80-0,95; p < 0,001), serta memiliki spesifisitas yang sama baiknya pada nilai cutt-off5 (0,93; 95% CI 0,77-0,99 vs 0,96; 95% CI 0,82-0,99). Namun, skor PEWS memiliki sensitivitas yang lebih tinggi (0,80; 95% CI 0,66-0,90) dibandingkan dengan NEWSS (0,58; 95% CI 0,44-0,72). Oleh karena itu, sistem skor PEWS lebih baik dibandingkan NEWSS dalam mengidentifikasi deteriorasi klinis pasien anak yang di rawat di rumah sakit.

---

Pediatric patients have a risk of experiencing a sudden decrease in clinical condition until death. Clinical deterioration can be detected several hours before the occurrence of serious life-threatening conditions so that a strategy is needed to detect the emergence of an early warning system. Since 2014, Cipto Mangunkusumo Hospital Jakarta has implemented a nursing early warning scoring system (NEWSS) that was compiled based on a modification of a similar scoring system for adults. However, several studies have developed and validated a score system with the same purpose that is used specifically for infant and pediatric patients, namely pediatric early warning score (PEWS). This study aims to compare PEWS and NEWSS in identifying the clinical deterioration of pediatric patients who are hospitalized. The study was conducted on 81 children who came to the emergency department, measured PEWS and NEWSS scores simultaneously, then observed for 6 hours or until clinical deterioration occurred. A total of 51 children underwent clinical deterioration such as tranfser to pediatric intensive care (31 children), intubation (14 children), cardiac pulmonary resuscitation (2), and death (4 children). Both score systems, NEWSS and PEWS, can assess and predict the incidence of clinical deterioration in children (NEWSS AUC 0.77; 95% CI 0.68-0.88; p <0.001 and PEWS AUC 0.87; 95% CI 0, 80-0.95; p <0.001), and have the same good specificity at a cut-off value of 5 (0.93; 95% CI 0.77-0.99 vs. 0.96; 95% CI 0.82- 0.99). However, the PEWS score has a higher sensitivity (0.80; 95% CI 0.66-0.90) compared to NEWSS (0.58; 95% CI 0.44-0.72). Therefore, the PEWS score system is better than NEWSS in identifying clinical deterioration of pediatric patients treated in hospitals."

"Indonesia memiliki insiden demam tifoid yang cukup tinggi khususnya kelompok usia anak. Namun terdapat keterbatasan penelitian yang mempelajari distribusi demam tifoid pada anak, sehingga perlu dilakukan penelitian karakteristik pasien demam tifoid yang terbukti dengan temuan isolat S.typhi, penanganannya, pola resistensi antibiotik dan serotipe S.typhi yang bersirkulasi di Indonesia.Tujuan: Mengetahui karakteristik pasien demam tifoid, diagnosis dan penanganannya, pola resistensi antibiotik dan serotipe S.typhi pada anak di beberapa daerah di Jakarta.Metodologi: Studi potong lintang dengan total 142 subjek. Evaluasi karakteristik dan uji resistensi antimikroba terhadap 22 subjek demam tifoid yang telah dikonfirmasi dengan kultur darah dan pemeriksaan penunjang Tubex ®TF ≥4, serta flagellin based-PCR pada 22 isolat S.typhi untuk analisis serotipe dengan gen fli-B, fli-C dan aro-C.Hasil: Subjek lelaki lebih banyak daripada perempuan, kelompok usia tertinggi 5-9 tahun dan lama demam sekitar 6-8 hari. Manifestasi klinis demam tifoid yang diamati bervariasi, paling sering diare, mual dan muntah, namun tidak berbeda bermakna dengan penyebab demam yang lain yang memiliki klinis gangguan digestif. Sebagian besar subjek penelitian telah mendapatkan pengobatan sebelumnya (61,3%) namun riwayat pemberian antibiotik tidak diketahui pasti, dengan kecenderungan pemberian terapi golongan sefalosporin lebih banyak daripada antibiotik lini pertama.Pemeriksaan penunjang dengan Tubex ®TF mendeteksi positif 67 subjek (47,2%) dengan sensitivitas 95,2%, spesifisitas 56,1%. Berdasar konfirmasi temuan isolat S.typhi pada kultur darah, hanya 22 subjek (15,5%) yang benar menderita demam tifoid dengan karakteristik pasien secara umum tidak berbeda bermakna dengan pasien bukan demam tifoid. Berdasarkan pemeriksaan Tubex ®TF dan kultur darah, demam tifoid lebih banyak didiagnosis dengan tepat di rumah sakit bila dibandingkan dengan puskesmas. Ditemukan 22 isolat positif gen aro-C, 20 isolat positif gen fli-C H:d, 2 fli-C H:j dan 2 isolat yang sama positif dengan gen fli-B. Serotipe S.typhi yang bersirkulasi, namun tidak ditemukan perbedaan manifestasi klinis, dan semua isolat masih sensitif terhadap kloramfenikol, ampisilin dan kotrimoksazol.Simpulan: Angka kejadian demam tifoid yang didiagnosis pasti dengan konfirmasi kultur darah jauh lebih rendah daripada diagnosis klinis. Penelitian ini menunjukkan bahwa kloramfenikol masih dapat diberikan karena serotipe S.typhi yang ditemukan masih sensitif terhadap semua antimikroba.

---

Indonesia is known with high incidence of typhoid fever, however there are limited studies available to observe this disease burden in children. Thus a study to observe not only characteristic of patients, its clinical manifestation, diagnostic approach and management, but also thorough evaluation needed to evaluate its drug resistance pattern and Salmonella typhi serotypes circulating in Indonesia.Objective: To evaluate characteristics of children with typhoid fever, its diagnostics and management, antimicrobial resistance pattern and serotype S.typhi circulating amongst children in Jakarta.Methods: Descriptive study with 142 subjects clinically diagnosed with typhoid fever. Characterization of 22 subjects with confirmed case typhoid fever based on S.typhi isolate finding in blood culture and confirmation with Tubex®TF ≥4. Evaluation of antimicrobial resistance pattern and Flagellin based-PCR using fli-B, fli-C and aro-C genes to further analyze serotype S.typhi in children.Results: There were more male than female participants in the study. The highest rate age of group observed were 5to 9 years-old. Most subjects had fever between 6-8 days with clinical manifestations varied but mostly related to digestive system such as diarrhea, nausea and vomit, however there was not difference between typhoid and non typhoid in clinical manifestation. Majority of subjects had received antibiotics prior to diagnose (61,3%), however many were oblivious to the type of treatment received, yet many were prescribed Cephalosporine instead of firstline treatments.Tubex ®TF detected 67 cases of typhoid fever (47.2%), sensitivity 95.2%, specificity 56.1%. Only 22 subjects were confirmed case of typhoid fever (15.5%), however all patients yielded similar characteristics to patients in probable case. Based on laboratory assessment tools, doctors in tertiary hospital showed better accuracy in diagnosing patients with suspected typhoid if compared to primary health care one. Meanwhile all isolates showed positive results with aro-C gene controls, 20 showed positive with fli-C H:d genes whereas only 2 with H: j alleles, and 2 yielded positive results for fli-B. No differences were found in clinical manifestation and all serotypes were sensitive to all antimicrobials tested.Conclusions: Confirmed case of typhoid fever is lower in prevalence if compared to probable case in society. Chloramphenicol is still recommended as first drug of choice for typhoid fever since S.typhi isolated in this research did not reveal any resistancy towards first line antibiotics."

"[ABSTRAKLatar belakang : Hiperglikemia kronik pada pasien Diabetes melitus tipe 1 (DMT1) dihubungkan dengan kerusakan jangka panjang, gangguan fungsi dan kerusakan berbagai organ tubuh lain seperti mata, ginjal, saraf, jantung dan pembuluh kapiler. Salah satu gangguan fungsi organ yang sering diabaikan sebagai akibat hiperglikemia adalah faal paru. Uji fungsi paru dapat membedakan kelainan paru obstruktif, restriktif atau campuran antara obstruktif dn restriktif. Uji fungsi paru dengan spirometri tidak dapat dilakukan dengan baik pada anak dibawah usia 7 atau 8 tahun karena memerlukan koordinasi yang cukup sulit. Penelitian tentang dampak DMT1 terhadap paru di Indonesia belum ada sampai saat ini.Tujuan : Mengetahui gambaran uji fungsi paru pada pasien DMT1 usia 8-18 tahun.Metode : Penelitian potong lintang dilakukan di Poliklinik Endokrinologi dan Respirologi Rumah Sakit Cipto Mangunkusumo (RSCM), serta Laboratorium Prodia Salemba pada bulan Januari 2015. Wawancara orangtua dilakukan dan data kadar HbA1c dalam rentang satu tahun terakhir diambil dari rekam medis subjek atau berdasarkan hasil pemeriksaan sebelumnya. Uji fungsi paru dilakukan sebanyak tiga kali dan diambil salah satu hasil yang terbaik. Kemudian subjek menjalani pengambilan darah untuk pemeriksaan kadar HbA1c dengan metode cation-exchange high pressure liquod chromatography (HPLC) di Laboratorium Prodia.Hasil : Tiga puluh lima subjek berpartisipasi dalam penelitian, terdiri dari 68,6% perempuan. Rerata usia 14 ± 2,7 tahun dan median durasi DM adalah 4 tahun (1,3-10,2 tahun). Rerata parameter FEV1 adalah 86,8 ± 14%, FVC 82,7 ± 12% dan V25 83,1 ± 26,2%. Median FEV1/FVC adalah 92,4 % (77,6-100) dan V50 91,5 % (41,1-204). Fungsi paru normal didapatkan pada 19 subjek (54,3%) dan fungsi paru terganggu sebanyak 16 subjek (45,7%), terdiri dari 10 subjek (28,6%) gangguan restriktif, 2 subjek (5,7%) gangguan obstruktif dan 4 subjek (11,4%) gangguan campuran. Rerata HbA1c dalam 1 tahun terakhir pada subjek dengan gangguan restriktif adalah 10,3%. Simpulan : Nilai parameter uji fungsi paru pasien DMT1 usia 8-18 tahun masih dalam batas normal. Gangguan fungsi paru didapatkan pada 16 subjek (45,7%) dengan gangguan restriksi terbanyak yaitu 10 subjek (28,6%).

---

ABSTRACTBackground: Chronic hyperglycemia in patients with type 1 diabetes mellitus (T1DM) is associated with long term functional impairment and damage of several parts of the body, such as eyes, kidneys, nerves, heart, and capillary blood vessels. Among all systems, disorder of pulmonary function due to hyperglycemia is often neglected by physicians. Pulmonary function test could determine whether the lung impairment is obstructive, restrictive, or mixed. Pulmonary function test using spirometry could not be applied to children below 7 or 8 years old because they are not capable to do the test. Until now, research about the effect of T1DM to pulmonary function has never been done in Indonesia.Objective: To obtain pulmonary function test profile in type 1 diabetes mellitus patients aged 8 to 18 years old.Methods: This cross sectional study took place at Endocrinology and Respirology Outpatient Department of Cipto Mangunkusumo Hospital (RSCM) and Prodia Laboratory Service in Salemba in January 2015. Parents of subjects were interviewed for history disease. HbA1c level of recent year was collected from medical records or from previous test results. Pulmonary function test were conducted three times to each subjects and among those three results, the best was chosen as data. Blood samples were collected for HbA1c level measurement. The HbA1c level was measured by cation-exchange high pressure liquod chromatography (HPLC) method in Prodia Laboratory.Results: Thirty five subjects participated in the research, 68.6% of them were female. The average age was 14 ± 2.7 years and the median duration of diabetes melitus was 4 years (1.3-10.2 years). FEV1, FVC, and V25 average was 86.8 ± 14%, 82.7 ± 12%, and 83.1 ± 26.2%, respectively. The median of FEV1/FVC and V50 was 92.4 % (77.6-100) and 91.5% (41.1-204) respectively. Nineteen subjects (54.3%) had normal pulmonary function and among 16 (45.7%) abnormal subjects, 10 (28.6%) had restrictive disorder, 2 (5.7%) had obstructive disorder, and 4 (11.4%) had mixed disorder. Average of HbA1c level of restrictive group was 10.3%.Conclusions: Pulmonary function test parameter profile in type 1 diabetes mellitus patients aged 8 to 18 years old lies in normal range. Pulmonary function disorder was found in 16 subjects (45.7%). Among those 16 subjects, 10 (28.6%) had restriction disorder.;Background: Chronic hyperglycemia in patients with type 1 diabetes mellitus (T1DM) is associated with long term functional impairment and damage of several parts of the body, such as eyes, kidneys, nerves, heart, and capillary blood vessels. Among all systems, disorder of pulmonary function due to hyperglycemia is often neglected by physicians. Pulmonary function test could determine whether the lung impairment is obstructive, restrictive, or mixed. Pulmonary function test using spirometry could not be applied to children below 7 or 8 years old because they are not capable to do the test. Until now, research about the effect of T1DM to pulmonary function has never been done in Indonesia. Objective: To obtain pulmonary function test profile in type 1 diabetes mellitus patients aged 8 to 18 years old. Methods: This cross sectional study took place at Endocrinology and Respirology Outpatient Department of Cipto Mangunkusumo Hospital (RSCM) and Prodia Laboratory Service in Salemba in January 2015. Parents of subjects were interviewed for history disease. HbA1c level of recent year was collected from medical records or from previous test results. Pulmonary function test were conducted three times to each subjects and among those three results, the best was chosen as data. Blood samples were collected for HbA1c level measurement. The HbA1c level was measured by cation-exchange high pressure liquod chromatography (HPLC) method in Prodia Laboratory. Results: Thirty five subjects participated in the research, 68.6% of them were female. The average age was 14 ± 2.7 years and the median duration of diabetes melitus was 4 years (1.3-10.2 years). FEV1, FVC, and V25 average was 86.8 ± 14%, 82.7 ± 12%, and 83.1 ± 26.2%, respectively. The median of FEV1/FVC and V50 was 92.4 % (77.6-100) and 91.5% (41.1-204) respectively. Nineteen subjects (54.3%) had normal pulmonary function and among 16 (45.7%) abnormal subjects, 10 (28.6%) had restrictive disorder, 2 (5.7%) had obstructive disorder, and 4 (11.4%) had mixed disorder. Average of HbA1c level of restrictive group was 10.3%. Conclusions: Pulmonary function test parameter profile in type 1 diabetes mellitus patients aged 8 to 18 years old lies in normal range. Pulmonary function disorder was found in 16 subjects (45.7%). Among those 16 subjects, 10 (28.6%) had restriction disorder., Background: Chronic hyperglycemia in patients with type 1 diabetes mellitus (T1DM) is associated with long term functional impairment and damage of several parts of the body, such as eyes, kidneys, nerves, heart, and capillary blood vessels. Among all systems, disorder of pulmonary function due to hyperglycemia is often neglected by physicians. Pulmonary function test could determine whether the lung impairment is obstructive, restrictive, or mixed. Pulmonary function test using spirometry could not be applied to children below 7 or 8 years old because they are not capable to do the test. Until now, research about the effect of T1DM to pulmonary function has never been done in Indonesia. Objective: To obtain pulmonary function test profile in type 1 diabetes mellitus patients aged 8 to 18 years old. Methods: This cross sectional study took place at Endocrinology and Respirology Outpatient Department of Cipto Mangunkusumo Hospital (RSCM) and Prodia Laboratory Service in Salemba in January 2015. Parents of subjects were interviewed for history disease. HbA1c level of recent year was collected from medical records or from previous test results. Pulmonary function test were conducted three times to each subjects and among those three results, the best was chosen as data. Blood samples were collected for HbA1c level measurement. The HbA1c level was measured by cation-exchange high pressure liquod chromatography (HPLC) method in Prodia Laboratory. Results: Thirty five subjects participated in the research, 68.6% of them were female. The average age was 14 ± 2.7 years and the median duration of diabetes melitus was 4 years (1.3-10.2 years). FEV1, FVC, and V25 average was 86.8 ± 14%, 82.7 ± 12%, and 83.1 ± 26.2%, respectively. The median of FEV1/FVC and V50 was 92.4 % (77.6-100) and 91.5% (41.1-204) respectively. Nineteen subjects (54.3%) had normal pulmonary function and among 16 (45.7%) abnormal subjects, 10 (28.6%) had restrictive disorder, 2 (5.7%) had obstructive disorder, and 4 (11.4%) had mixed disorder. Average of HbA1c level of restrictive group was 10.3%. Conclusions: Pulmonary function test parameter profile in type 1 diabetes mellitus patients aged 8 to 18 years old lies in normal range. Pulmonary function disorder was found in 16 subjects (45.7%). Among those 16 subjects, 10 (28.6%) had restriction disorder.]"