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Abstrak :
ABSTRAK
Latar belakang. Adanya peningkatan angka kematian anak di negara berkembang, masih tingginya insiden penyakit infeksi bakteri serius (IBS) pada anak, beragamnya variabel klinis yang menjadi faktor risiko terjadinya IBS, model skoring yang ada belum teruji dalam mendeteksi IBS di sarana pelayanan terbatas. Tujuan. Untuk mengetahui validitas Skor RCPCH dalam mendeteksi adanya infeksi bakteri serius pada anak dengan demam serta mencari faktor prediktor terjadinya infeksi tersebut. Metode. Uji diagnostik untuk mengetahui validitas Skor RCPCH dalam mendeteksi adanya infeksi serius pada anak dengan demam dan kohort prospektif untuk mencari faktor prediktor. Baku emas adalah diagnosis akhir sesuai ICD-10. Seluruh pemeriksaan dilakukan secara buta (tersamar). Hasil. Didapatkan 260 subyek penelitian. Tujuh pasien rawat jalan tidak dapat dihubungi sehingga analisis dilakukan pada 253 subyek (97,3%). Laki-laki lebih banyak daripada perempuan dengan rasio 1,14: 1. Kelompok umur lebih banyak didapatkan pada kelompok > 36 bulan (51,4%). Diagnosis IBS didapatkan pada 28,9% subyek dengan diagnosis terbanyak pneumonia (19%). Skor RCPCH mempunyai sensitifitas 58,9%, spesifisitas 86,7%, nilai duga positif 64,2%, nilai duga negatif 83,8%, rasio kemungkinan positif 4,42, rasio kemungkinan negatif 0,47, post test probability 64,23%, area under ROC curve 72,8%. Batuk, sesak napas, mencret, kejang, umur 1-36 bulan, suhu tubuh ≥ 37,50 C, hipoksia, dan takipnea merupakan faktor prediktor terjadinya IBS. Simpulan. Skor RCPCH dapat digunakan untuk memprediksi infeksi bakteri serius pada anak umur 1 bulan–12 tahun. Batuk, sesak napas, mencret, kejang, umur 1-36 bulan, suhu tubuh ≥ 37,50 C, hipoksia, dan takipnea merupakan faktor prediktor terjadinya IBS.

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ABSTRACT
Background. The increase of child mortality in developing country, the high incidence of serious bacterial infection in children, the variety of risk factors of serious infections, current scoring model has not been tested in limited health care centre. Objective. To know the validity of of Royal College of Paediatrics and Child Health (RCPCH) Score to predict serious bacterial infection in children with fever and to find predictor factors of the serious infection. Method. Diagnostic study was used to find validity of RCPCH Score and cohort prospective study to find predictor factors of the serious infection. Gold standard was the latest diagnosis noted on medical record based on ICD-10. All tests were done blind. Results. There were 260 subjects. Seven patients of out-patient department could not be reached so analysis was done on 253 subjects (97.3%). There were more male than female with the ratio of 1.14:1. Age group of >36 months dominated the subject population (51.4%). Serious bacterial infection was found on 28.9% subject with the most diagnosis was pneumonia (19%). Sensitivity of SBI score was 58.9%, specificity was 86.7%, positive predictive value was 64.2%, negative predictive value was 83.8%, positive likelihood ratio was 4.42, negative likelihood ratio was 0.47, post test probability was 64,23%, and area under ROC curve was 72,8%. Cough, dyspnea, diarrhea, seizure, age of 1-36 month, body temperature ≥ 37.50 C, hypoxia, tachypnea were the risk factors for SBI. Conclusion. RCPCH Score can used to predict serious bacterial infection in children aged 1 month- 12 years. Cough, dyspnea, diarrhea, seizure, age of 1-36 months, body temperature ≥ 37.50 C, hypoxia, and tachypnea were the risk factors for SBI

Abstrak :
Latar Belakang: Respons imun berperan pada kerentanan pasien talasemia terhadap infeksi. Defisiensi seng pada talasemia akan memperburuk respons imun. Penelitian ini bertujuan mengetahui profil respons imun pasien talasemia mayor dan pengaruh suplementasi seng dan imunisasi pneumokokus pada respons imun pasien talasemia pasca-splenektomi. Metode: Penelitian dilakukan di Pusat Thalassemia RSCM, Jakarta pada September 2013 ? Februari 2014. Studi observasi dengan metode belah lintang komparatif pada talasemia mayor sehat usia > 12 tahun dan HIV negatif non- dan pasca-splenektomi mendahului studi intervensi dengan metode randomized, double-blinded, controlled trial pada talasemia pasca-splenektomi yang dialokasikan menjadi kelompok seng 1,5 mg/kg/hr maksimum 50 mg, atau plasebo. Dua jenis imunisasi pneumokokus diberikan untuk menguji fungsi limfosit T. Luaran yang diukur adalah respons imun non-spesifik (jumlah dan fagositosis neutrofil) dan respons imun spesifik (kuantitatif dan kualitatif). Respons imun spesifik kualitatif mengukur produksi IgG pneumokokus, IL-2 dan TNF-α pasca pajanan PHA. Hasil Penelitian: Median fagositosis neutrofil kelompok pasca-splenektomi 29,79 (4 sampai 81)% dan kelompok non-splenektomi 55,83 (2 sampai 133)% (p < 0,001). Kelompok pasca-splenektomi mempunyai jumlah netrofil, limfosit total, jumlah limfosit T, jumlah limfosit T CD4+ dan CD8+ yang lebih tinggi dibanding kelompok non- splenektomi. Tidak ada perbedaan respons imun spesifik kualitatif yang bermakna di antara pasien talasemia mayor. Setelah intervensi, hanya 18 dari 28 subjek kadar seng serum kelompok seng yang menjadi normal. Walaupun fagositositosis neutrofil hanya berubah dari 31,36 (4 sampai 81)% menjadi 30,44 (3 sampai 72)% (p = 0,554), namun terdapat kecenderungan perbaikan fagositosis neutrofil pada kelompok seng. Parameter respons imun lainnya tidak menunjukkan perubahan antara kelompok seng dan plasebo selama penelitian 12 minggu (p > 0,05). Simpulan: Terdapat perbedaan respons imun antara pasien talasemia pasca-splenektomi dan non-splenektomi. Belum dapat dibuktikan pengaruh suplementasi seng pada hampir semua parameter respons imun pasien talasemia mayor pasca-splenektomi. Seng mungkin dapat direkomendasikan sebagai suplementasi, tetapi perlu penelitian lanjutan mengenai dosis dan lama pemberian yang tepat untuk perbaikan respons imun pasien talasemia mayor pasca-splenektomi. ...... Introduction: Immune response plays a role in increasing thalassemia patient?s susceptibility to infections. Zinc deficiency in thalassemia patients will alter immune response. The aim of this study is to evaluate immune response of thalassemia major and zinc supplementation effects on immune response quality of post-splenectomy thalassemia major. Methods: This study was conducted at Thalassaemia Centre, Cipto Mangunkusumo Hospital Jakarta on September 2013 ? February 2014. An observational study using comparative cross-sectional method was done in healthy non- and post-splenectomy thalassemia major aged > 12 year and HIV negative. Then, it was followed by an interventional study using randomized, double-blinded, controlled trial, on post- splenectomy subjects, which were assigned to receive 1.5 mg/kg/d maximum 50 mg/d zinc or placebo. Moreover, 2 type of immunization were also administered in order to assess T lymphocyte function. The outcomes were non-specific (neutrophil count and phagocytosis) and specific immune response (quantitave and qualitative). Qualitative specific immune response measured by detecting IgG pneumococcal, IL-2 and TNF-α after PHA exposure. Results: Median of neutrophil phagocytosis on post-splenectomy and non-splenectomy were 29.79 (4 to 81)% and 55.83 (2 to 133)% (p < 0.001). Post-splenectomy subjects have higher neutrophil count, total lymphocyte count, lymphocyte T count, lymphocyte T CD4+ and CD8+ than non-splenectomy. There is no significant difference on qualitative specific immune response among thalassemia major. Following the intervention, only 18 out of 28 subjects of zinc group had normal plasma zinc. There was a trend of neutrophil phagocytosis improvement on zinc group despite a little shifting on those value, from 31.36 (range 4 to 81)% to 30.44 (3 to 72)% (p = 0.554). Other immune response parameters showed no different changes between two groups after 12 weeks supplementation (p > 0.05). Conclusions: There were significant differences on immune response of post- splenectomy and non-splenectomy patients. The significant changes on almost all of immune response parameter after zinc supplementation have not been proved yet. Addition of zinc supplementation may be recommended, but it need further study to evaluate the dose and duration of supplementation to improve immune response in splenectomised thalassemia major patients.