Hasil Pencarian

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Hasil Pencarian

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Annisya Dwi Rianthi
"Latar belakang: Identifikasi dan deteksi dini keterlambatan perkembangan anak sampai usia 3 tahun membutuhkan alat uji penapisan yang sahih dan andal serta mudah diaplikasikan orangtua. Kesahihan dan keandalan ASQ-3 belum teruji di Indonesia sehingga ASQ-3 belum digunakan secara luas sebagai alat uji penapisan perkembangan anak.
Tujuan: Mengetahui kesahihan dan keandalan ASQ-3 bahasa Indonesia sebagai alat uji penapisan keterlambatan perkembangan anak usia 24-36 bulan.
Metode: Penelitian potong lintang ini dibagi menjadi 2 tahap. Tahap pertama yaitu adaptasi transkultural, modifikasi dan tranlasi kuesioner ASQ-3 versi orginal ke bahasa Indonesia. Tahap kedua, kuesioner bahasa Indonesia yang sudah final, diuji ke 30 subyek dari 5 kelompok umur (24,27,30,33,36 bulan). Uji kesahihan dengan menggunakan koefisien korelasi, uji keandalan dengan konsistensi internal dan keandalan inter-rater.
Hasil: Uji kesahihan dengan koefisien korelasi kuat di domain komunikasi usia 24 bulan (0,908), domain motor kasar usia 24 bulan (0,860), domain motor kasar usia 36 bulan (0,865). Uji keandalan dengan Alpha Cronbach ialah baik (0,673-0,825) dengan keandalan inter-rater yang sangat baik (0,916).
Kesimpulan: ASQ-3 bahasa Indonesia sahih dan andal sebagai alat uji penapisan keterlambatan perkembangan anak usia 24-36 bulan.

Background: Identification of children with developmental disabilities is critical step in providing early intervention services. Ages and Stages Questionnaires third edition (ASQ-3), a parent-report questionnaires has been proven to be a valid and reliable screening test and good psychometric properties. This test has not been validated and standardized before in Indonesia.
Aim: To provide the validated and reliability form of the Indonesian version of the Ages and Stages Questionnaires as an appropriate developmental screening tool for evaluation of 24-36 months Indonesian children's development.
Method: Cross sectional study divided into two parts. First part included the adaptation, transcultural, and translation ASQ-3 original version to Indonesian version. Second part, final form of Indonesian ASQ-3 was performed for 30 children from 5 age groups (24,27,30,33,36 months). In order to determine validity of the questionnaires using correlation coefficient, and reliability was measured using internal consistency and intraclass correlation coefficient.
Results: The validity determined by correlation coefficient was very good in communication area at 24 months age (0.908), gross motor at 24 months age (0.860), and gross motor at 36 months age (0.865). The reliability, determined by cronbach's alpha ranged from 0.673-0.825 and the inter-rater reliability was 0.916.
Conclusion: The Indonesian version of the ASQ has appropriate validity and reliability for screening developmental disorders in 24 -36 months children in Indonesia.
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Jakarta: Fakultas Kedokteran Universitas Indonesia, 2018
T55526
UI - Tesis Membership  Universitas Indonesia Library
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Nuraini Irma Susanti
"[ABSTRAK
Latar belakang. Kolitis infeksi adalah proses inflamasi pada usus besar yang disebabkan oleh infeksi bakteri patogen, seperti Shigella, Salmonella, E.coli, dan Campylobacter. Dibuktikan dengan pemeriksaan kultur tinja, tetapi biayanya cukup mahal, perlu waktu dan tidak selalu tersedia di semua fasilitas kesehatan. Rekomendasi WHO jumlah lekosit lebih dari 10 per LPB untuk Shigella disentriae dengan klinis disentri dan merupakan indikasi pemberian antibiotika. Sering ditemukan anak diare dengan lekosit kurang dari 10/LPB tetapi hasil kultur positif bakteri patogen. Mencari hubungan jumlah lekosit tinja dengan kejadian diare yang disebabkan infeksi bakteri patogen yang memerlukan terapi antibiotika.
Tujuan. Mengetahui prevalensi, sebaran bakteri patogen, nilai leukosit mikroskopik tinja pada anak dengan kolitis infeksi bakteri. Mengetahui hubungan leukosit tinja dengan kultur tinja dan pola sensitivitas antibiotika pada kolitis infeksi bakteri.
Metode. Penelitian deskriptif dengan metode potong lintang dan uji diagnostik untuk menilai sensitivitas hitung leukosit tinja untuk mendiagnosis kolitis infeksi bakteri. Penelitian dilakukan di Rumah Sakit Umum Pusat Rujukan Nasional Cipto Mangunkusumo, Jakarta, dari bulan Januari- Juni 2015.
Hasil. Dari 45 subjek penelitian ditemukan kultur positif pada 19 subjek (42,2%). Bakteri terbanyak yang ditemukan adalah E.coli (79%), Salmonella sp. (10,5%), dan C.difficille (10,5%). Pada titik potong ROC ditemukan nilai lekosit >8 per LPB dengan sensitivitas 0,654 dan spesifisitas 0.632. E.coli masih memperlihatkan sensitivitas cukup tinggi terhadap kloramfenikol dan siprofloksasin tetapi tidak terhadap sefiksim. Salmonella sp. sensitif terhadap kloramfenikol, sefiksim, dan seftriakson, sedangkan C. difficile sensitif terhadap Seftriakson.
Simpulan. Pada penelitian ini ditemukan sebanyak 19 (42,2%) subyek penderita diare hasil kultur tinja positif bakteri patogen dan pada titik potong ROC ditemukan nilai lekosit > 8 per LPB dengan sensitivitas 65.4% dan spesifisitas 63.2%. Pada pola sensitivitas antibiotika, E.coli sensitif terhadap kloramfenikol dan siprofloksasin dan Salmonella dan C.difficile sensitif terhadap seftriakson.

ABSTRACT
Background. Infective colitis is an inflammatory process in the colon caused by pathogenic bacterial infection, such as Shigella, Salmonella, E.coli, and Campylobacter. Diagnosis is made by fecal culture, but the cost is relatively expensive, time-consuming, and not readily available in every health facility. WHO recommends that fecal leukocyte more than 10 per HPF for the diagnosis of Shigella disentriae with clinical symptom of dysentriae and indicated for antibiotic treatment. Often there are diarrheic children with leukocyte less than 10/HPF but the culture is positive for pathogenic bacteria. This study would like to look for the relationship between fecal leukocyte and incidence of diarrhea caused by pathogenic bacteria infection that requires antibiotic therapy.
Objective. To study the prevalence, distribution of pathogenic bacteria, leukocyte count in fecal microscopic test in children with bacterial infective colitis. To study the relationship between fecal leukocyte and fecal culture with sensitivity pattern of antibiotics in bacterial infective colitis.
Methods. Descriptive, cross-sectional study and diagnostic test to study the sensitivity of fecal leukocyte count in diagnosing bacterial infective colitis. Study was performed in the Cipto Mangunkusumo Hospital, Jakarta, from January to June 2015.
Results. From 45 study subjects, positive culture was found in 19 subjects (42.2%), and the most common bacteria were E.coli (79%), Salmonella sp. (10.5%), and C. difficille (10,5%). At the ROC we found leukocyte count >8 per HPF as cutoff point with 0.654 sensitivity and 0.632 specificity. E. coli still showed relatively high sensitivity to chloramphenicol and ciprofloxacin, but not to cefixime. Salmonella sp. were sensitive to chloramphenicol, cefixime, and ceftriaxone, while C. difficile were sensitive to ceftriaxone.
Conclusion. In this study there were 19 (42.2%) subjects with diarrhea, with positive fecal culture for pathogenic bacteria. At the ROC cutoff point we found leukocyte count > 8 per HPF with 65.4% sensitivity and 63.2% specificity. On the antibiotic sensitivity pattern, E. coli was sensitive to chloramphenicol and ciprofloxacin, while Salmonella dan C.difficile were sensitive to ceftriaxone, Background. Infective colitis is an inflammatory process in the colon caused by pathogenic bacterial infection, such as Shigella, Salmonella, E.coli, and Campylobacter. Diagnosis is made by fecal culture, but the cost is relatively expensive, time-consuming, and not readily available in every health facility. WHO recommends that fecal leukocyte more than 10 per HPF for the diagnosis of Shigella disentriae with clinical symptom of dysentriae and indicated for antibiotic treatment. Often there are diarrheic children with leukocyte less than 10/HPF but the culture is positive for pathogenic bacteria. This study would like to look for the relationship between fecal leukocyte and incidence of diarrhea caused by pathogenic bacteria infection that requires antibiotic therapy.
Objective. To study the prevalence, distribution of pathogenic bacteria, leukocyte count in fecal microscopic test in children with bacterial infective colitis. To study the relationship between fecal leukocyte and fecal culture with sensitivity pattern of antibiotics in bacterial infective colitis.
Methods. Descriptive, cross-sectional study and diagnostic test to study the sensitivity of fecal leukocyte count in diagnosing bacterial infective colitis. Study was performed in the Cipto Mangunkusumo Hospital, Jakarta, from January to June 2015.
Results. From 45 study subjects, positive culture was found in 19 subjects (42.2%), and the most common bacteria were E.coli (79%), Salmonella sp. (10.5%), and C. difficille (10,5%). At the ROC we found leukocyte count >8 per HPF as cutoff point with 0.654 sensitivity and 0.632 specificity. E. coli still showed relatively high sensitivity to chloramphenicol and ciprofloxacin, but not to cefixime. Salmonella sp. were sensitive to chloramphenicol, cefixime, and ceftriaxone, while C. difficile were sensitive to ceftriaxone.
Conclusion. In this study there were 19 (42.2%) subjects with diarrhea, with positive fecal culture for pathogenic bacteria. At the ROC cutoff point we found leukocyte count > 8 per HPF with 65.4% sensitivity and 63.2% specificity. On the antibiotic sensitivity pattern, E. coli was sensitive to chloramphenicol and ciprofloxacin, while Salmonella dan C.difficile were sensitive to ceftriaxone]"
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2015
T-Pdf
UI - Tesis Membership  Universitas Indonesia Library
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Batubara, Velanie Frida
"Latar belakang: Malnutrisi merupakan masalah utama di negara berkembang dan menimbulkan banyak implikasi dalam tumbuh kembang anak. Malnutrisi sering dikaitkan dengan berbagai penyakit infeksi, salah satunya adalah TB. Terapi medikamentosa berupa pemberian OAT dan nutrisi adekuat diharapkan dapat meningkatkan status nutrisi. Penelitian spesifik yang mengamati perkembangan luaran status nutrisi pada pasien TB anak belum pernah dilakukan di Indonesia.
Tujuan: (1)Mengetahui proporsi status nutrisi awal pasien TB anak dan karakteristiknya (2)Mengetahui perubahan status nutrisi dan perubahan berat badan dengan kesesuaian dosis dan keteraturan minum OAT (3)Mengetahui hubungan keteraturan pengobatan OAT dengan perubahan status nutrisi.
Metode: Penelitian kohort retrospektif dilakukan pada 62 anak dengan penyakit TB dan gizi kurang/buruk usia 1 bulan - 5 tahun yang terdiagnosis pertama kali pada 1 Januari 2010 - 31 Desember 2015. Usia, jenis kelamin, tempat tinggal, jenis TB, lama terapi, efek samping, jalur nutrisi, status nutrisi dan berat badan saat awal diagnosis, bulan ke-2,4,6 dinilai dalam penelitian ini.
Hasil: Proporsi pasien TB anak dengan gizi kurang adalah 53/62 (85,5%). Sebagian besar subyek berusia 2 tahun, lelaki, bertempat tinggal di DKI Jakarta dan sakit TB paru (42,8%). Seluruh subyek mendapat OAT yang sesuai dan hanya 1 subyek yang minum OAT tidak teratur. Sebanyak 45,2% subyek mendapat terapi OAT selama 6 bulan. Efek samping OAT yang ditemukan adalah neuropati perifer (1 subyek), peningkatan SGOT dan SGPT (1 subyek) dan kolestasis (1 subyek). Proporsi subyek yang mendapat nutrisi enteral adalah 15/62 (24,2%). Sebanyak 56/62 (90,3%) subyek dengan dosis OAT sesuai mengalami perbaikan status nutrisi dan 55/61 (90,1%) subyek yang minum OAT teratur mengalami perbaikan status nutrisi. Peningkatan berat badan sebesar 5% tiap 2 bulan dan 17% setelah 6 bulan terapi OAT terjadi pada 97% subyek. Tidak ada hubungan keteraturan pengobatan OAT dengan perubahan status nutrisi (p = 0,161).
Simpulan: Perbaikan status nutrisi terjadi pada 90% subyek. Peningkatan berat badan pada 97% subjek setiap 2 bulan adalah 5% dan 17% pada bulan ke-6 terapi OAT. Tidak terdapat hubungan keteraturan pengobatan OAT dengan perubahan status nutrisi (p = 0,161)

Background: Malnutrition is one of the major problems in developing countries and has many implications in growth and development of children. Malnutrition is always associated with many infection diseases, one of them is tuberculosis. Medical management includes antituberculosis therapy and adequate nutrition are indicated to improve nutritional status. There is no specific study regarding this outcome in Indonesian children.
Aim: (1)To determine the nutritional status proportion of children with tuberculosis and their characteristics (2)To determine nutritional status outcome and body weight gain associated with adequate dosage and regular antituberculosis therapy (3)To identify correlation between regular antituberculosis therapy and nutritional status outcome.
Methods: A retrospective cohort study was performed in 62 children aged 1 month-5 years who have been first diagnosed with tuberculosis from January 2010 to December 2015. Age, sex, lodging, type of tuberculosis, duration of treatment, side effect, nutritional route, nutritional status, body weight at start, 2nd, 4th and 6th month of antituberculosis therapy were evaluated in this study.
Result: The proportion of mild-moderate malnutrition in children with tuberculosis is 53/62 (85.5%). Most of the subjects are 2 years old, male, live in Jakarta and have pulmonary TB (42.8%). All subjects received standard therapy with adequate dosage and only 1 subject did irregular therapy. The duration of treatment is 6 months for 45.2% subjects. The side effects were peripheral neuropathy (1 subject), elevation of transaminase enzymes (1 subject) and cholestasis (1 subject). Subjects received enteral nutrition are 15/62 (24.2%). There are 56/62 (90.3%) subjects with adequate dosage improved nutritional status and 55/61 (90.1%) subjects with regular treatment improved nutritional status after 6 months treatment. Body weight gain in 97% subjects was 5% every 2 months and 17% at the end of the treatment. No correlation between regular antituberculosis therapy and nutritional status outcome (p = 0.161).
Conclusion: Nutritional status improvement was found in 90% subjects. Body weight gain in 97% subjects was 5% in every 2 months and 17% after 6 months of treatment. No correlation between regular antituberculosis therapy and nutritional status outcome (p = 0.161)."
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Depok: Universitas Indonesia, 2016
SP-Pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Gultom, Agatha Febrina Christie
"Latar belakang: Deteksi dini masalah perkembangan anak pada tiga tahun pertama merupakan hal yang penting untuk dilakukan agar dapat segera diberikan intervensi sehingga anak dapat mencapai kemampuan optimalnya. Uji penapisan yang terstandardisasi diperlukan untuk meningkatkan deteksi gangguan perkembangan. ASQ-3 merupakan kuesioner berbasis orangtua yang sudah terbukti memiliki nilai psikometri yang baik. Kesahihan dan keandalan ASQ-3 belum teruji di Indonesia sehingga ASQ-3 belum digunakan secara luas sebagai alat uji penapisan keterlambatan perkembangan anak.
Tujuan: Mengetahui kesahihan dan keandalan ASQ-3 bahasa Indonesia sebagai alat uji penapisan keterlambatan perkembangan anak usia 12-24 bulan.
Metode: Penelitian ini merupakan penelitian potong lintang. Kuesioner ASQ-3 diterjemahkan dan dilakukan adaptasi transkultural untuk menghasilkan kuesioner ASQ-3 bahasa Indonesia. Kuesioner ASQ-3 bahasa Indonesia kemudian diujikan kepada 5 kelompok usia (14, 16, 18, 20, dan 22 bulan) dengan masing-masing berjumlah 35 orang. Uji kesahihan dinilai dengan menggunakan koefisien korelasi, uji keandalan dengan konsistensi internal dan test retest reliability.
Hasil: Kesahihan ASQ-3 bahasa Indonesia kelompok usia 14,16, 18, 20, dan 22 bulan antara total masing-masing domain dengan total skor memiliki korelasi sedang hingga sangat kuat (r = 0,454 – 0,881), kecuali pada domain komunikasi usia 14 bulan yang memiliki korelasi lemah (r = 0,349). Keandalan ASQ-3 dengan penilaian konsistensi internal (Cronbach’s alpha) masing-masing domain berdasarkan kelompok usia menunjukkan keandalan yang baik hingga sangat baik (0,693 – 0,818), sedangkan penilaian dengan metode test retest didapatkan intraclass correlation coefficient (ICC) pada kelompok usia 16, 18, 20, dan 22 bulan didapatkan nilai cukup hingga sangat baik (0,646 – 0,965), namun pada empat domain di kelompok usia 14 bulan didapatkan nilai ICC kurang baik.
Simpulan: ASQ-3 bahasa Indonesia sahih dan andal sebagai alat uji penapisan keterlambatan perkembangan anak usia 12-24 bulan.

Background: Early identification and detection of developmental problems in the first three years is important for facilitating to an early intervention services and maximizing child’s optimal ability. Standardized developmental screening tools are known to improve detection of developmental problems compared to surveillance or clinical judgment alone. Ages and Stages Questionnaires Third Edition (ASQ-3) is a parent-based questionnaire that has been proven to be a valid and reliable screening test. This test has not been validated and standardized before in Indonesia.
Aim: To provide the validity and reliability Indonesian version of Ages and Stages Questionnaires as an appropriate developmental screening tool for children aged 12-24 months.
Method: This cross-sectional study divided into two parts. First, we perform translation and transcultural adaptation to produce the Indonesian version. The final form of Indonesian ASQ-3 then was tested to parents in 5 age groups (14, 16, 18, 20, and 22 months old). Validity of ASQ-3 was assessed using correlation coefficient, meanwhile the reliability was assessed using internal consistency and test-retest reliability.
Results: The validity between domain score and overall score has moderate to very strong correlation (r = 0,454 – 0,881), except the communication domain that has low correlation (r = 0,349). The questionnaire is reliable with Cronbach alpha of 0,693-0,818. The test retest reliability was good (ICC 0,646 - 0,965) in all domain across all groups with exception in 4 domains in 14 months age groups.
Conclusions: The Indonesian version of ASQ has appropriate validity and reliability to screen developmental delay in 12-24 months children in Indonesia.
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Jakarta: Fakultas Kedokteran Universitas Indonesia, 2021
SP-pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Fahreza Aditya Neldy
"Nilai titik potong lingkar lengan atas (LiLA) untuk diagnosis gizi buruk berdasarkan WHO adalah 11,5 cm. Nilai titik potong ini dinilai kurang sensitif dalam menjaring kasus gizi buruk pada balita. Berbagai nilai titik potong LiLA baru diusulkan dengan nilai diagnostik yang lebih baik namun memiliki interval yang lebar, 12 cm-14,1 cm. Saat penelitian ini dilakukan belum ada data mengenai evaluasi nilai titik potong LiLA 11,5 cm dalam diagnosis gizi buruk pada balita di Indonesia. Diperlukan penelitian untuk mengevaluasi nilai diagnostik LiLA dalam diagnosis gizi buruk dan mencari titik potong yang paling optimal pada balita Indonesia. Penelitian ini bertujuan untuk mengetahui nilai diagnostik LiLA dibandingkan dengan indeks BB/TB dalam diagnosis gizi buruk pada balita, mengetahui sensitivitas, spesifisitas, nilai duga positif, nilai duga negatif nilai titik potong LiLA < 11,5 cm dalam diagnosis gizi buruk dan mencari rekomendasi nilai titik potong LiLA yang memiliki nilai diagnostik yang lebih baik untuk skrining balita dengan gizi buruk. Pengambilan subyek penelitian pada studi diagnostik ini dilakukan secara konsekutif pada bulan Januari-Februari 2020 di RSCM dan Puskesmas Cengkareng Jakarta Barat. Penelitian ini melibatkan 421 subyek. Data dasar, jenis kelamin, usia didapatkan melalui wawancara singkat. Pengukuran antropometri berupa berat badan, tinggi badan/panjang badan dan lingkar lengan atas dilakukan oleh peneliti/asisten peneliti yang memiliki realibilitas pengukuran yang baik. LiLA memiliki nilai diagnostik yang tinggi ditandai dengan AUC 0,939 (CI95% 0,903-0,974). Nilai diagnostik LiLA dengan titik potong 11,5 cm memiliki sensitivitas yang rendah. Nilai diagnostik LiLA dengan nilai titik potong 11,5 cm: Se 21% Sp 99,7% NDP 80%, NDN 96%, IY 0,2. Nilai titik potong LiLA 13,3 cm memberikan hasil terbaik dalam identifikasi gizi buruk dengan Se 89%, Sp 87%, NDP 25%, NDN 99% dan IY 0,76. Nilai titik potong LiLA 11,5 cm untuk kasus gizi buruk memiliki sensitivitas yang rendah dan sebaiknya tidak digunakan dalam upaya skrining kasus gizi buruk di masyarakat. Nilai titik potong LiLA 13,3 cm memberikan nilai diagnostik yang lebih baik dalam upaya skrining gizi buruk pada balita usia 6-59 bulan.

World Health Organization recommends 11,5 cm as cut off value of mid-upper arm circumference (MUAC) to diagnose severe acute malnutrition (SAM) in under-five. Many studies indicate that the recommended cut off value is not sensitive to screen severe acute malnutrition cases. Various new cut off values have been proposed with very wide interval, 12-14.1 cm. When this study started there was no available data regarding diagnostic value of MUAC in diagnosing severe acute malnutrition in under-five in Indonesia. Aims of this study are to evaluate diagnostic value of MUAC in diagnosing SAM compare to WHZ index, to evaluate sensitivity, specificity, positive prediction value, negative prediction value of MUAC with 11,5 cm as standard cut off in diagnosing SAM and to find alternative cut off value that may offer better diagnostic performance. This diagnostic study recruits subjects consecutively in January-February 2020 in Cipto Mangunkusumo hospital and Puskesmas Cengkareng. We collected 421 subjects. Demographic data was obtained by using brief conversation. Physical examination and anthropometric measurement were performed by researcher and research assistant that had been trained, evaluated and proven to have excellence reliability. In general, MUAC has excellent diagnostic value to assess SAM in under-five with AUC 0,939 (CI95% 0,903-0,974). The recommended cut off value has low sensitivity. Proportion SAM using WHZ index and MUAC < 11,5 cm are 4,5% and 1,2%. Diagnostic values MUAC using cut off 11,5 cm are Se 21%, Sp 99,7%, PPV 80%, NPV 96% and YI 0,2. By using 13.3 cm as new cut off value, MUAC will have Se 89%, Sp 87%, PPV 25%, NPV 99% and YI 0,76. We conclude that MUAC using 11,5 cm has low sensitivity to detect SAM cases in population, therefore should not be implemented in the community for screening SAM cases. The new cut of value 13,3 cm has better diagnostic value to screen SAM cases in under-fives."
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Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
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UI - Tesis Membership  Universitas Indonesia Library
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Fatima Safira Alatas
"Latar belakang. Translokasi bakteri dari saluran cerna merupakan masalah yang penting dalam terjadinya infeksi pada pasien dengan kolestasis obstruktif serta sirosis hepatis. Pada studi ini kami bermaksud untuk mempelajari komposisi mikrobiota usus dihubungkan dengan malabsorpsi lemak dan gangguan integritas usus pada anak dengan kolestasis kronis. Metode. Sampel feses dari bayi/anak dengan kolestasis dan anak sehat dikumpulkan untuk dilakukan evaluasi terhadap jumlah sel lemak, komposisi mikrobiota usus serta integritas ususnya.
Hasil. Lima puluh tujuh bayi/anak (27 kolestasis dan 30 anak sehat) dilakukan evaluasi. Terdapat perbedaan bermakna pada berat badan, P=0.001; status nutrisi, P=<0.0001; serta konsumsi susu formula dengan bahan dasar middle chain triglyceride, P=<0.0001. Selain itu juga ditemukan bahwa komposisi lemak pada feses serta kadar fecal calprotectin lebih tinggi pada kelompok kolestasis dibandingkan dengan anak sehat, P=<0.0001 dan P=0.021. Sesuai dengan hasil tersebut ditemukan pula perbedaan yang bermakna di antara kedua grup tersebut pada komposisi Bifidobacteria sp. and E. Coli sp., P=0.005.
Kesimpulan. Ditemukan perbedaan yang bermakna pada berat badan, status nutrisi, komposisi lemak feses, kadar fecal calprotectin serta profil mikrobiota usus antara kelompok bayi dengan kolestasis dengan bayi sehat. Diperlukan studi lanjutan untuk mempelajari interaksi antara saluran cerna dan hati pada kolestasis.

Background. Bacterial translocation from the gastrointestinal tract is central to current concepts of endogenous sepsis in obstructif cholestasis and cirrhosis. In this study we evaluate gut microbiota profile and their correlation with fat malabsorption and gut integrity. Methods. We evaluate feces sampels from chronic cholestasis and healthy infants to know their fat malabsorption, gut microbiota composition, and gut integrity, then compare between the 2 groups.
Results. Fifty-seven infants (27 cholestasis and 30 healthy) were evaluated. There were significant difference in mean body weight 7932.39 (SD: 3416.2) VS 11453.3 (SD: 4012.3) grams, P=0.001; nutritional status, P=<0.0001, and middle chain triglyceride dominant infant formula, P=<0.0001. Feces evaluation showed a significant hinger fat composition (+2 and +3), P=<0.0001 and fecal calprotection level in cholestatic groups (81.32 (SD:61.6) VS 47.37 (SD:47.3) microgram/g faeces), P=0.021. In accordance with fecal calprotectin level, there were a significant difference between the 2 groups in composition of Bifidobacteria sp. and E. Coli sp., P = 0.005.
Conclusions. Significant differences were found in body weight, nutritional status, feces fat composition, fecal calprotection level and gut microbiota profile between chronic cholestasis and healthy infants. Further studies needed to evaluate the interaction between gut and liver axis in infants with cholestasis.
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Jakarta: Fakultas Kedokteran Universitas Indonesia, 2015
T-Pdf
UI - Tesis Membership  Universitas Indonesia Library
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Fatimatuzzuhroh
"Latar belakang : Skor PELOD-2 digunakan untuk mengetahui prognosis disfungsi organ pada anak sakit kritis. Hasil skor PELOD-2 terkadang tidak berbanding lurus dengan luaran perawatan sehingga tidak selalu dapat digunakan sebagai prediktor luaran pasien yang dirawat di PICU. Tujuan : Mengetahui profil dan luaran pasien sakit kritis yang dirawat di PICU RSCM berdasar skor PELOD-2. Metode : Penelitian retrospektif dengan mengambil data rekam medis pasien rawat di PICU RSCM, periode Januari-Desember 2018 secara total sampling. Penilaian skor PELOD-2 pada 24 jam pertama perawatan, komorbid dan luaran subjek dicatat dalam rekam medis. Hasil : Diperoleh 477 subjek yang memenuhi kriteria. Pasien sakit kritis yang dirawat di PICU RSCM sebagian besar berjenis kelamin laki (56,4%) dan berusia <1 tahun (27,9%), dengan bedah sebagai diagnosis terbanyak (65%). Sebagian besar pasien memiliki penyakit kronik (70,4%). Nilai median skor PELOD-2 2 untuk pasien hidup dan median skor 8 untuk pasien meninggal. Angka mortalitas adalah 10,7%. Sebagian besar subjek memiliki lama rawat <7 hari (75,5%). Subjek dengan lama rawat >14 hari memiliki median skor PELOD-2 tiga kali lipat dari subjek dengan lama rawat <7 hari. Subjek meninggal memiliki median skor PELOD-2 empat kali lipat lebih tinggi dari subjek hidup. Adanya luaran mortalitas dan lama rawat subjek yang tidak sesuai dengan skor PELOD-2 kemungkinan dipengaruhi oleh status nutrisi dan status imun. Titik potong mortalitas skor PELOD-2 pada penelitian ini adalah >5, dan titik potong mortalitas skor PELOD-2 pasien sepsis >7. Simpulan : Skor PELOD-2 dapat digunakan untuk memprediksi prognosis disfungsi organ yang mengancam kehidupan pada anak tanpa imunosupresi, semakin tinggi skor PELOD-2 akan diikuti peningkatan lama rawat dan mortalitas.

Background: PELOD-2 score is stated can be used to discover prognosis of organ dysfunction in critically ill child. Sometimes PELOD-2 score does not always directly proportional to critically ill child s outcome, therefore sometimes can not be used as outcome and mortality predictor. Objective: To describe critically ill patient s profile and outcome of based on PELOD-2 score. Methods: This descriptive study was retrospective, conducted from January to December 2018 in PICU RSCM by total sampling. Evaluation of PELOD-2 score were performed in the first 24 hours. Subjects comorbid and outcome were stated in medical record. Results: There were 477 subjects that fulfilled the criteria. Most of the subjects were boys (56,4%) and under 1 year of age (27,9%) with surgical were the most common diagnosis (65%). Most of the subject have chronic illness as comorbid (70,4%). Median of PELOD-2 score were 2 for subjects that lived and 8 for subjects that died. Mortality rate is 10,7%. Most of the subjects were stayed in PICU for < 7 days (75,5%). Subjects with length of stay >14 days had median PELOD-2 score 3 times higher than the subjects with length of stay <7 days. Died subjects had median PELOD-2 score 4 times higher than the subjects that lived. The subjects mortality and length of stay that not in accordance with the PELOD-2 score may be influenced by subjects nutritional and immunity status. Mortality cut off point for PELOD-2 score in this study is >5. Mortality cut off point for PELOD-2 for subjects with sepsis is >7 Conclusion: PELOD-2 score is feasible to be used to predict life threatening organ dysfunction in critically ill children without immunosuppression, the higher the PELOD-2 score is equal to higher mortality and longer length of stay."
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Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
T57773
UI - Tesis Membership  Universitas Indonesia Library
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Melita Adiwidjaja
"Defisiensi besi adalah defisiensi mikronutrien yang paling sering ditemui. Jika tidak diobati, dapat menyebabkan anemia defisiensi besi dan gangguan kognitif, terutama pada anak usia sekolah, yang ireversibel. Diagnosis defisiensi besi rumit, tidak praktis, dan mahal. Organisasi AAP merekomendasikan RET-He sebagai pemeriksaan laboratorium untuk skrining defisiensi besi. Tujuan penelitian adalah untuk mencari nilai batasan RET-He untuk skrining status besi pada anak usia 6 – 18 tahun. Studi ini merupakan studi potong lintang terhadap 207 anak sehat usia 6 - 18 tahun di Indonesia. Penelitian ini mencari nilai batasan RET-He untuk skrining status besi, kemudian dibandingkan dengan hemoglobin, mean corpuscular volume, feritin, dan saturasi transferin. Kurva ROC dikerjakan untuk menentukan nilai batasan RET-He untuk skrining status besi dengan menggunakan IBM SPSS versi 22. Pemeriksaan RET-He mendapatkan nilai batasan ≤ 30,3 pg (sensitivitas 100%, spesifisitas 19,7%, NDN 100%, NDP 5,4%) untuk skrining deplesi besi; nilai batasan RET-He ≤ 28,9 pg (sensitivitas 78,9%, spesifisitas 56,2%, NDN 92,2%, dan NDP 28,9%) untuk defisiensi besi; dan nilai batasan RET-He ≤ 27 pg (sensitivitas 75%, spesifisitas 80%, NDN 98,1%, dan NDP 18,7%) untuk anemia defisiensi besi. Peneliti menarik kesimpulan bahwa RET-He dapat digunakan sebagai parameter skrining defisiensi besi dengan nilai batasan ≤ 28,9 pg. Skrining untuk anemia defisiensi besi dapat menggunakan RET-He dengan nilai batasan ≤ 27 pg, namun harus dilakukan dengan parameter lain, seperti Hb. Pemeriksaan RET-He dengan nilai batasan ≤ 30,3 pg tidak dapat digunakan untuk skrining deplesi besi.

Iron deficiency (ID) is the most common micronutrient deficiency in the world. Left untreated, ID will lead to iron deficiency anemia (IDA) and other irreversible consequences. Screening iron deficiency is complex, impractical, and expensive. The AAP recommended RET-He as an alternative laboratory examination to screen ID. The objective is to find RET-He cut-off value to screen for iron status in healthy children, aged 6 – 18 years old. This study is a cross-sectional study of 207 children aged 6 – 18 years old in Indonesia. RET-He was compared with hemoglobin, mean corpuscular volume, ferritin to assess iron status in children. Receiver operating curve was performed to determine the optimal cut-off value for RET-He using IBM SPSS 22. Reticulocyte hemoglobin equivalent with cut-off value ≤ 30.3 pg was established to screen iron depletion (100% sensitivity, 19.7% specificity, 100% NPV, 5.4% PPV); meanwhile RET-He ≤ 28.9 pg to screen iron deficiency (78.9% sensitivity, 56.2% specificity, 92.2% NPV, 28.9% PPV); and RET-He ≤ 27 pg to screen IDA (75% sensitivity, 80% specificity, 98.1% NPV, 18.7% PPV). The researcher concluded that RET-He can be used as an iron deficiency screening parameter with a cut-off value ≤ 28.9 pg. Screening for IDA with RET-He ≤ 27 pg need to be done with other parameters, such as Hb. RET-He ≤ 30.3 pg cannot be used for iron depletion."
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Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
T59203
UI - Tesis Membership  Universitas Indonesia Library
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Ari Prayogo
"Latar belakang: Prevalens infeksi jamur sistemik pada neonatus bervariasi di berbagai negara, di Eropa 0,24% sedangkan di Asia 1,36%. Penelitian di Indonesia menunjukan hasil yang lebih tinggi, prevalens tahun 2005-2008 sebesar 42%. Upaya pencegahan spesifik dengan penggunaan profilaksis anti jamur oral serta pencegahan non spesifik melalui hand-hygyene, asepsis dan antisepsis saat tindakan medis dan kebijakan antibiotik rasional telah dilakukan dalam 5 tahun terakhir untuk menurunkan kejadian infeksi jamur sistemik pada neonatus.
Tujuan: Mengetahui prevalens dan profil klinis infeksi jamur sistemik pada neonatus dalam 5 tahun terakhir.
Metode: Penelitian ini dengan desain potong lintang menggunakan data rekam medis unit perinatologi tahun 2013-2017. Total sampling pada neonatus dengan diagnosis sepsis awitan lambat terduga infeksi jamur sistemik.
Hasil: Prevalens infeksi jamur sistemik pada neonatus dalam 5 tahun terakhir adalah 7,4%, tertinggi pada tahun 2013 (13,3%) dan terus menurun hingga terendah pada tahun 2017 (0%). Spesies penyebab infeksi tersebut adalah C.Albicans (50%), C.Parapsilosis (42,9%), dan C.Tropikalis (7,1%). Manifestasi klinis yang menonjol adalah hipertermia (64,3%), letargi (92,9%) dan kembung (64,3%). Profil laboratorium yang didapatkan adalah leukopenia, trombositopenia disertai peningkatan CRP. Karakteristik lain yang ditemukan pada neonatus dengan infeksi jamur sistemik adalah mempunyai berat lahir rendah (64,3%), menggunakan ventilasi mekanik invasif ≥7 hari (71,4%), akses vaskular sentral ≥7 hari (92,9%), nutrisi parenteral total ≥7 hari (100%), dan menggunakan 4 macam antibiotik sebelum pemeriksaan (57,1%).
Kesimpulan: Terdapat penurunan prevalens infeksi jamur sistemik dalam 5 tahun terakhir. Neonatus dengan kultur jamur positif memiliki manifestasi klinis yang tidak berbeda dengan sepsis akibat sebab lain. Profil klinis lain yang menonjol adalah trombositopenia dan riwayat mendapat tindakan medis invasif.

Background: Prevalence of systemic fungal infection varies across countries, in Europe it's 0.24% and 1.36% in Asia. Research in Indonesia found higher prevalence, in 2005-2008 it was 42%. Specific prevention using oral prophylaxis and non-specific prevention through hand hygiene, aseptic technique for invasive medical procedures and rational use of antibiotics has been done in recent years to reduce the incidence of systemic fungal infection in neonates.
Aim: To know the prevalence and clinical profiles of neonates with systemic fungal infection in the last 5 years.
Method: Using cross-sectional design the data collected from medical records of perinatology unit. Total sampling was done to neonates that admitted between 2013-2017 with the diagnosis of late onset sepsis cause by systemic fungal infection.
Result: The prevalence of systemic fungal infection in neonates was 7.4%, the incidence is dccreasing from 13.3% in 2013 to 0% in 2017. The pathogen identified from the blood cultures are C.Albicans (50%), C.Parapsilosis (42,9%), and C.Tropikalis (7,1%). The most frequent symptoms were hypertermia (64.3%), lethargy (92.9%) and distended abdomen (64.3%). Laboratory profiles that was noted were leukopenia, thrombocytopenia, and increased in CRP. Other characteristic found in this research were low birth weight (64.3%), using invasive mechanical ventilation ≥7 days (71.4%), using central catheter ≥7 days (92.9%), total parenteral nutrition ≥7 days (100%), and using at least 4 kinds of broadspectrum antibiotics (57.1%).
Conclussion: Prevalence of systemic fungal infection is decreasing over the last 5 years. The clinical presentation of neonates with positive fungal blood cultures is difficult to differentiate from that of other serious bacterial infections. Other clinical profiles were thrombocytopenia and history of invasive medical procedures.
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Jakarta: Fakultas Kedokteran Universitas Indonesia, 2018
SP-pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Yuni Astria
"Demam neutropenia pasca kemoterapi adalah morbiditas yang masih tinggi pada anak dengan keganasan. Sejumlah faktor prognostik, pola kuman, penggunaan antibiotik dan antijamur dapat memengaruhi luaran namun penelitian di Indonesia masih terbatas. Penelitian ini bertujuan mengetahui pola kuman, sensitvitas antibiotik serta faktor yang berpengaruh terhadap mortalitas infeksi anak DN. Penelitian ini dilakukan secara kohort retrospektif serta studi desktriptif terhadap 180 pasien (252 episode demam) di RSCM periode 2015-2017. Riwayat medis, pola kuman, sensitivitas antibiotik didata serta faktor prognostik dianalisis menggunakan uji multivariat regresi logistik. Bakteri terbanyak adalah gram negatif 51,5% diikuti gram positif 47,1%%. Golongan jamur terbanyak adalah Candida sp.(82,5%) Sensitivitas antibiotik Klebsiella sp. terutama amikasin (85,71%), Pseudomonas aeruginosa terhadap seftazidim (75%), amikasin dan gentamisin (100%). Staphylococcus sp. terutama amoksiklav dan ampicsulbactam (76.92%). Hampir semua golongan jamur sensitif flukonoazole, ketokonazole, vorikonazole (80-100%). Faktir prognostik yang meningkatkan mortalitas adalah pemasangan vena sentral (RR 1,947; IK95% 1,114-3,402), gizi kurang (RR 1,176;IK95% 1,044-1,325), gizi buruk (RR 1,241;IK95% 0,975-1,579), serta keganasan hematologi (RR 0,87;IK95% 0,788-0,976).

Fever post-chemotherapy neutropenia is still a high morbidity in children with malignancy. A number of prognostic factors, microorganisms, antibiotic and antifungal use can affect outcomes but research in Indonesia is still limited. This study aims to determine the pattern of germs, antibiotic sensitivity and factors that influence the mortality of FN child infections. This study was a retrospective cohort as well as a descriptive study of 180 patients (252 episodes of fever) in RSCM 2015-2017 period. Medical history, microorganisms, antibiotic sensitivity was recorded as well as prognostic factors were analyzed using multivariate logistic regression tests. The most common bacteria was gram negative 51.5% and gram positive 47.1 %%. In the fungus group, Candida sp. was most common (82.5%). Antibiotic sensitivity of Klebsiella sp. mainly amikasin (85.71%), Pseudomonas aeruginosa against seftazidim (75%), amikasin and gentamisin (100%). Staphylococcus sp. mainly amoksiklav and ampicsulbactam (76.92%). Almost all fungi groups was sensitive flukonoazole, ketoconazole, voriconazole (80-100%). Prognostic factors that increase mortality was central venous insertion (RR 1,947; 95%CI 1,114-3,402), wasted (RR 1,176; 95%CI 1,044-1,325), severe malnutrition (RR 1,241; 95%CI 0.975-1,579), and hematological malignancies (RR 0.87; 95%CI 0.788-0.976)."
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2020: Fakultas Kedokteran Universitas Indonesia, 2020
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UI - Tugas Akhir  Universitas Indonesia Library
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