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"Latar belakang. Pembuatan stoma dan reseksi usus adalah tindakan pembedahan yang umum dilakukan pada anak dengan masalah bedah di sistem gastrointestinal. Salah satu komplikasi dari pembuatan stoma adalah high output stoma yang menyebabkan perawatan menjadi lebih lama.Tujuan. Penelitian ini bertujuan untuk mengetahui faktor risiko terjadinya high output stoma dan prediktor terhadap lama rawat, lama penggunaan nutrisi parenteral, dan kematian.Metode. Kami melakukan penelitian kohort retrospektif yang dilakukan di rumah sakit tersier rujukan di Indonesia. Subjek adalah pasien anak usia 0 bulan – 18 tahun dengan stoma di usus halus (enterostomi) selama periode Oktober 2019 – Desember 2023. Penelitian tahap I dilakukan pada semua subjek untuk melihat faktor risiko terjadinya high output stoma. Penelitian tahap II dilakukan pada subjek yang mengalami high output stoma untuk menilai prediktor terhadap lama rawat, lama penggunaan nutrisi parenteral, dan kematian.Hasil. Penelitian tahap I melibatkan 64 subjek. Kelompok usia terbanyak adalah usia neonatus (43,8%). Penyakit dasar terbanyak sebagai penyebab pembentukan stoma adalah perforasi intestinal (39,1%). High output stoma terjadi pada 48,4% subjek. Tidak ada faktor risiko teknik pembedahan yang secara signifikan menyebabkan high output stoma. Penelitian tahap II memasukkan 31 subjek yang mengalami high output stoma. Pada semua subjek, panjang usus halus berkorelasi dengan lama rawat (p = 0,033), lama penggunaan nutrisi parenteral (p = 0,032), dan berhubungan dengan kematian (p = 0,041).Kesimpulan. Panjang usus halus yang lebih pendek berhubungan dengan luaran yang lebih buruk pada pembentukan enterostomi pada anak.

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Backgrounds. Stoma creation and intestinal resection are common surgical procedures in children with surgical problems in the gastrointestinal system. One of the complications of creating a stoma is a high output stoma (HOS), which causes more prolonged treatment.

Objectives. This study aims to determine the risk factors for HOS and predictors of length of stay, length of use of parenteral nutrition (PN), and death.

Methods. We conducted a retrospective cohort study at a tertiary referral hospital in Indonesia. Subjects were pediatric patients aged 0 months – 18 years with a stoma in the small intestine (enterostomy) during the period October 2019 – December 2023. Phase I study was carried out on all subjects to examine at risk factors of HOS. Phase II study was conducted on subjects who experienced HOS to assess predictors of length of stay, length of PN use, and death.

Results. Phase I study involved 64 subjects. The largest age group is neonates (43.8%). Intestinal perforation is the most common underlying disease that causes stoma formation (39.1%). There are no risk factors for surgical techniques that significantly cause HOS. Phase II study included 31 subjects who experienced HOS. In all subjects, the length of the small intestine was correlated with length of stay (p = 0.033), duration of PN use (p = 0.032), and was associated with mortality (p = 0.041).

Conclusions. Shorter small intestinal length is associated with worse outcomes in enterostomy formation in children."

"ABSTRAKDiare persisten merupakan masalah kesehatan serius dan sering menyebabkan malnutrisi. Kerusakan mukosa pada diare diduga menyebabkan penurunan hormon sekretin dan kolesistokinin sehingga mengurangi stimulasi ke pankreas dan memperberat diare persisten dan malnutrisi.Penelitian ini bertujuan untuk mengetahui fungsi eksokrin pankreas pada anak diare persisten, anak malnutrisi, mendapatkan nilai referensi pemeriksaan fecal elastase-1 FE-1 anak Indonesia, dan mengetahui kehandalan analisis feses dan steatokrit dalam mendeteksi insufisiensi eksokrin pankreas.Penelitian potong lintang pada tahap pertama dilakukan untuk mendapatkan sebaran nilai FE-1 pada anak normal, membandingkan nilai FE-1 subjek diare persisten dan malnutrisi dengan anak normal, dan mengetahui sensitivitas, spesifisitas, dan kemampuan diskriminasi analisis feses dan steatokrit dalam mendeteksi insufisiensi eksokrin pankreas. Tahap kedua uji klinis dua kelompok paralel tersamar ganda dilakukan untuk menguji efek suplementasi enzim pankreas 8371 USP unit tiga kali sehari selama sebulan pada anak diare persisten. Penelitian dilakukan di 5 Rumah Sakit di Jakarta Januari 2015 minus;Juli 2016 pada anak berusia 6 ndash;60 bulan.Sebanyak 182 anak usia 6 ndash;60 bulan direkrut sebagai subjek yang terdiri dari 31 anak dengan diare persisten, 31 anak dengan malnutrisi, dan 120 anak normal. Nilai cut-off FE-1 yang didapatkan pada penelitian ini adalah 307 mcg/g feses. Terdapat perbedaan bermakna nilai FE-1 antara subjek diare persisten dan anak normal. Tidak ditemukan perbedaan bermakna nilai FE-1 antara subjek malnutrisi dan anak normal. Terdapat perbedaan bermakna lama diare sekitar 7 hari antara kedua kelompok. Kadar FE-1 dan prealbumin antara baseline dan endpoint pada kelompok plasebo dan perlakuan tidak berbeda bermakna. Uji kehandalan masing-masing komponen analisis feses dan steatokrit menunjukkan hasil sensitivitas dalam rentang 5 ndash;32 , spesifisitas 73 ndash;98 , nilai prediksi positif 1 ndash;43 , dan nilai prediksi negatif 87 ndash;89 . Nilai AUC analisis feses dan steatokrit masing-masing adalah 0,664 IK 95 0,539 ndash;0,788 dan 0,501 IK 95 0,372 ndash;0,629 sedangkan AUC gabungan sebesar 0,671.Kesimpulannya, pada penelitian ini didapatkan adanya insufisiensi eksokrin pankreas pada anak dengan diare persisten. Suplementasi enzim pankreas terbukti dapat memperpendek lama diare secara bermakna. Analisis feses dan/atau steatokrit memiliki sensitivitas yang rendah, spesifisitas yang tinggi, dan kemampuan diskriminasi kurang.Kata kunci: anak, diare persisten, fungsi eksokrin pankreas, malnutrisi, suplementasi enzim pankreas

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ABSTRACTPersistent diarrhea is a serious health problem and is closely related to malnutrition. Prolonged mucosal injury in diarrhea is thought to cause reduced secretin and cholecystokinin CCK secretion, which decreases stimulation to the pancreas and further aggravate persistent diarrhea and malnutrition.This research aims to study pancreatic exocrine function in children with persistent diarrhea and children with malnutrition, to obtain reference values of fecal elastase 1 FE 1 in Indonesian children, and to assess the ability of stool analysis and steatocrit in detecting exocrine pancreatic insufficiency.Cross sectional study was done to obtain FE 1 distribution in healthy children, to study FE 1 levels in children with persistent diarrhea and children with malnutrition, and to study the sensitivity, specificity, and discriminative capacity of stool analysis and steatocrit in detecting exocrine pancreatic insufficiency. A randomized, two double blind parallel group, placebo controlled clinical trial was conducted to evaluate the effects of 8371 USP units of pancreatic enzyme replacement therapy PERT 3 times daily for 1 month in children with persistent diarrhea. This study involved children age 6 ndash 60 months in 5 hospitals in Jakarta from January 2015 to July 2016.As much as 182 children 6 ndash 60 months of age consisting of 31 children with persistent diarrhea, 31 children with malnutrition, and 120 healthy children were recruited as subjects. Cut off point of FE 1 in this study was 307 mcg g faeces. Significant difference of FE 1 was found between children with persistent diarrhea and healthy children. The FE 1 difference between subjects with malnutrition and healthy children was not significant. Duration of diarrhea was 7 days significantly shorter in the PERT group. Changes of FE 1 and prealbumin values between baseline and endpoint in placebo and treatment group were found to be statistically insignificant. The diagnostic value of each stool analysis component and steatocrit test showed that the sensitivity was within range of 5 ndash 32 , specificity 73 ndash 98 , positive predictive value 1 ndash 43 and negative predictive value 87 ndash 89 . The AUC values of stool analysis and steatocrit were 0.664 95 CI 0.539 ndash 0.788 and 0.501 95 CI 0.372 ndash 0.629 , respectively, and the combined AUC 0,671.In conclusion, exocrine pancreatic insufficiency was observed in children with persistent diarrhea, and PERT has been proven to significantly shorten the duration of diarrhea by 1 week. Stool analysis and or steatocrit has low sensitivity, high specificity, and low discrimination capacity.Keywords children, exocrine pancreatic function, malnutrition, pancreatic enzyme supplementation, persistent diarrhea"

"Diare merupakan masalah global karena menyebabkan tingginya angka kesakitan dan kematian pada bayi dan anak. Diare yang belangsung 7 - 13 hari disebut diare melanjut, dan akan meningkatkan risiko terjadinya diare persisten 6 kali lebih tinggi.Penelitian ini bertujuan untuk mengkaji faktor-faktor risiko terjadinya diare melanjut pada anak < 2 tahun, membuat dan menerapkan sistem skor untuk memprediksi kejadian diare melanjut, dan mengetahui apakah faktor etiologi diare persisten telah ditemukan pada diare melanjut.Suatu penelitian operasional dengan rancangan nested case control, pada anak < 2 tahun dengan diare akut yang dirawat di ruang rawat inap RSUP Fatmawati. Subjek direkrut dengan metode consecutive sampling pada September 2015 - Maret 2016. Subjek dieksklusi bila mendapat pengobatan imunosupresi, menderita HIV, penyakit metabolik, penyakit keganasan, mengalami disentri, mengalami diare saat dirawat di rumah sakit, ada penyakit penyerta, dan subjek pasca mengalami operasi pada organ saluran cerna. Evaluasi luaran penelitian dilakukan sejak subjek masuk perawatan di rumah sakit sampai subjek pulang rawat.Sebanyak 62 subjek untuk tiap kelompok kasus dan kontrol mengikuti penelitian. Seluruh faktor risiko dianalisis secara bivariat dan multivariat regresi logistik. Faktor risiko terjadinya diare melanjut yang didapatkan adalah riwayat penggunaan antibiotik, defisiensi seng, leukosit tinja, peningkatan kadar AAT tinja dan malnutrisi. Model skor prediksi diare melanjut terdiri dari 2 model. Model 2 lebih dapat diterapkan di fasilitas kesehatan primer. Sensitivitas, spesifisitas, nilai duga positif, nilai duga negatif, rasio kemungkinan positif, dan rasio kemungkinan negatif dari validasi skoring model 2 berturut-turut adalah 73, 95, 94, 76, 14,6, dan 0,28. Area di bawah kurva ROC pada validasi 0,898. Faktor etiologi diare persisten telah ditemukan pada diare melanjut intoleransi laktosa, malabsorpsi lemak, dan infeksi Clostridium difficile .Sebagai simpulan, faktor risiko terjadinya diare melanjut pada anak < 2 tahun dengan diare akut yang berperan paling bermakna adalah riwayat penggunaan antibiotik, defisiensi seng, leukosit tinja, peningkatan kadar AAT tinja dan malnutrisi. Selain itu, faktor etiologi diare persisten telah ditemukan pada diare melanjut, dan model skor yang dibuat dapat dipertimbangkan digunakan dalam praktek klinik sehari-hari.

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Diarrhea has been a global problem since it has high morbidity and mortality rate in infants and children. Diarrhea lasting for 7 ndash 13 days is called prolonged diarrhea, and the risk of progressing into persistent diarrhea will be 6 times higher. The aim of this study was to assess the risk factors for prolonged diarrhea in children below 2 years old, to establish and apply a scoring system to predict the occurence of prolonged diarrhea, and to determine whether the etiologic factor of persistent diarrhea have already been found in prolonged diarrhea. An operational study with a nested case control design, in children 2 years old with acute diarrhea hospitalized in the inpatient wards of Fatmawati Hospital. Subjects were recruited using the consecutive sampling method from September 2015 to March 2016. Subjects were excluded when they were receiving immunosupressive treatment, suffering from HIV, metabolic disease, malignancy, dysentery, just had diarrhea during hospitalization, comorbidities, and had underwent digestive surgery. Evaluation of the research outcome was started when the subject admitted to the hospital until the subject being discharged. The number of subjects included was 62 for each case and control group. All risk factors were analyzed using bivariate and multivariate logistic regression. We found that the risk factors for the occurrence of prolonged diarrhea are history of antibiotic use, zinc deficiency, fecal leukocytes, elevated level of stool AAT, and malnutrition. The prolonged diarrhea prediction score model had 2 models. Model 2 is more applicable in primary health care. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of scoring model 2 validation were 73, 95, 94, 76, 14.6, and 0.28 respectively. The area under the ROC curve for validation is 0.898. The etiologic factor of persistent diarrhea have already been found in prolonged diarrhea lactose intolerance, fat malabsorption, Clostridium difficile infection. In conclusion, the most significant risk factors for prolonged diarrhea in children below 2 years old are the history of antibiotic use, zinc deficiency, fecal leukocytes, elevated levels of stool AAT, and malnutrition. In addition, etiologic factors of persistent diarrhea have already been found in prolonged diarrhea and scoring model can be considered be used in daily clinical practice. "

"Pertumbuhan mukosa usus manusia belum sempurna saat dilahirkan, karena itu usus bayi sering dikatakan sebagai leaky gut. Probiotik diketahui dapat membantu maturasi saluran cerna. Apakah dalam ASI memang terdapat probiotik ataukah suatu kontaminasi, masih diperdebatkan.Penelitian ini bertujuan untuk mengetahui apakah probotik ada dalam ASI bila diberikan suplementasi probiotik pada ibu hamil sejak trimester III dan menyusui, efek terhadap probiotik lain dan IL-8 dalam ASI, IFABP urin dan alfa-1-antitripsin (AAT) serta kalprotektin tinja, saat bayi lahir dan usia tiga bulan, dalam rangka menilai integritas mukosa usus.Dilakukan penelitian uji klinis, paralel dua kelompok dengan randomisasi, samar ganda yang dilakukan di RS Budi Kemuliaan dan klinik-klinik satelitnya sejak Desember 2014 sampai dengan Desember 2015. Jumlah subjek 35 per kelompok. Digunakan probiotikBifidobacterium animalis lactis HNO19 karena bukan merupakan resident bacteria.Lima subjek positif DR10 dalam kolostrum (V0) dan 7 subjek positif saat bayi usia 3 bulan (V3) pada kelompok probiotik. Hasil negatif didapati pada kelompok plasebo. Apusan kulit sekitar payudara negatif pada kedua kelompok. Nilai median IL-8 kelompok probiotik dibanding kelompok plasebo pada V0 dan V3 berturut-turut 2810,1 pg/mL vs. 1516,4 pg/mL (p = 0,327) dan 173,2 pg/mL vs. 132,7 pg/mL (p = 0,211). IFABP V0 dan V3 211,7 ng/mL vs. 842,5 ng/mL (p = 0,243) dan 25,3 ng/mL vs. 25,1 ng/mL (p = 0,466). AAT 136,2 mg/dL vs. 148,1 mg/dL (p = 0,466) dan 24 mg/mL vs. 29,72 mg/mL (p = 0,545). Kalprotektin 746,8 ng/mL vs. 4645,2 ng/mL (p = 0,233) dan 378,6 ng/mL vs. 391,3 ng/mL (p = 0,888).Probiotik DR10 yang diberikan pada ibu hamil sejak trimester III dapat ditemukan dalam kolostrum dan usia 3 bulan pada kelompok probiotik, dan bukan suatu kontaminasi .Tidak terdapat perbedaan bermakna terhadap probiotik lain, kadar IL-8 dalam ASI, IFABP urin, AAT dan kalprotektin tinja pada kelompok probiotik dibanding dengan kelompok plasebo.

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Newborn infants have intestinal hyperpermeability because their gut mucosa is not fully mature yet. It is known that probiotics helps gut maturity. It remains unclear whether probiotics pass through breast milk or whether the positive cultures are the result of contamination. This study aimed to evaluate the effect of probiotic supplementation in pregnant and lactating mothers, with regards to probiotic presence and IL-8

concentration in breast milk, infant urine intestinal fatty acid binding protein (IFABP), as well as fecal ?-1 anti-trypsin (AAT) and calprotectin at birth (V0) and at infant 3

months of age (V3) .

This randomized, controlled trial was double-blind, two parallel groups, probiotic and placebo with 35 subjects in each group. The sudy was done at Budi Kemuliaan Hospital and it’s satellite clinics from December 2014 until December 2015. We used Bifidobacterium

animalis lactis HNO19 (commonly known as DR10) as the supplemental probiotic, as it is not a member of the normal flora.

Probiotik DR10 were found in colostrum at 5 subjects and 7 subjects in V3 breastmilk probiotics group, but none in placebo group. Skin swab of DR10 were negative in both group. Median breast milk IL-8 in probiotic group compare to placebo group at V0 and V3 respectively were 2810.1 pg/mL vs. 1516.4 pg/mL (p = 0.327) and 173.2 pg/mL vs. 132.7 pg/mL (p = 0.211). Infant urine IFABP 211.7 ng/mL vs. 842.5 ng/mL (p = 0.243) and 25.3 ng/mL vs. 25.1 ng/mL (p = 0.466). Infant stool AAT 136.2 mg/dL vs. 148.1 mg/dL (p = 0.466) and 24 mg/mL vs. 29.72 mg/mL (p = 0.545). Stool calprotectin 746.8 ng/mL vs. 4645.2 ng/mL (p = 0.233) and 378.6 ng/mL vs. 391.3 ng/mL (p = 0.888).

Probiotic DR10 were found in colostrum and 3 month-breast milk of women in the probiotic group, but no DR10 in placebo group. However, breast milk IL-8, the presence of other probiotics, and infant gut mucosal integrity were not significantly different between the two groups."