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"[ABSTRAKLatar belakang: Hiponatremia pasca tindakan operasi mayor pada populasi anak merupakan gangguan elektrolit yang sering terjadi. Penggunaan cairan yang belum tepat sering menimbulkan peningkatan kejadian hiponatremia yang berhubungan erat dengan meningkatnya berbagai komplikasi seperti edema otak, kejang, bahkan kematian. Populasi anak merupakan risiko tinggi karena perbandingan jaringan otak dan tulang tengkorak yang lebih besar sehingga ruang yang tersedia saat terjadi edema otak lebih sempit.Tujuan: Mengetahui insidens hiponatremia pada anak pasca tindakan operasi mayor.Metode: Studi retrospektif potong lintang dilakukan terhadap anak usia 1 bulan hingga 18 tahun yang menjalani tindakan operasi mayor dan masuk ruang perawatan intensif. Penelusuran status medik sesuai kriteria inklusi dilakukan sampai jumlah sampel terpenuhi. Pencatatan terhadap subjek yang meliputi data praoperasi, intraoperasi, serta pemantauan pascaoperasi dilakukan. Subjek yang memenuhi definisi hiponatremia (<135 mEq/L) diklasifikasikan sesuai derajat hiponatremia dan dilakukan pencarian lebih lanjut terhadap komplikasi.Hasil : Studi dilakukan terhadap 90 subjek yang terdiri dari 56,7% lelaki, dengan 51,1% memiliki rentang usia 1 bulan hingga 4 tahun. Sebanyak 47,8% subjek menjalani tindakan laparatomi dengan berbagai indikasi. Hampir semua subjek (93,3%) mendapat cairan hipotonik pascaoperasi. Insidens hiponatremia pascaoperasi sebesar 28,9% dengan 11,1% diantaranya merupakan hiponatremia sedang-berat. Rerata kadar natrium pascaoperasi adalah 130,1 ± 4,1 mEq/L dengan rerata total cairan 79,8 ± 27,4 ml/kg. Sebesar 30,9% subjek yang mendapatkan cairan hipotonik pascaoperasi mengalami kejadian hiponatremia dengan rerata lama rawat 5,6 ± 4 hari. Terdapat 1/26 subjek yang mengalami komplikasi berupa kejang dan edema otak.Simpulan: Insidens hiponatremia pasca tindakan operasi mayor di ruang perawatan intensif hampir mencapai 30% dan sebagian besar mendapat cairan hipotonik pascaoperasi. Penelitian lebih lanjut perlu dilakukan untuk mengevaluasi pemberian cairan pascaoperasi yang tepat untuk mencegah hiponatremia.

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ABSTRACTBackground: Hyponatremia is commonly found post major surgery in pediatric population. The use of improper fluid often leads to increasing incidence of hyponatremia which causes complications such as cerebral edema, seizure, and death. Pediatric is a high risk population due to the large ratio between the brain tissue and skull, so that the availability space.Hyponatremia after major surgery in pediatric population is a common electrolyte disorder. The use of improper fluid often lead to increased incidence of hyponatremia which is closely linked to the increasing variety of complications such as cerebral edema, seizures, and even death. Pediatric is high risk population due to the larger comparison of brain tissue and the skull so that the space available in the event of brain edema narrower.Objective: To describe the incidence of hyponatremia in children after major surgery.Methods: A retrospective cross-sectional study was conducted on children aged 1 month to 18 years who underwent major surgery and entered the intensive care ward. The inclusion subjects was traced from medical records. The data was recorded from preoperative, intraoperative, and postoperative monitoring. Subjects who met hyponatremia (<135 mEq/L) were classified according to the severity of hyponatremia and its complications.Results: Ninety subjects were enrolled in this study (56.7% male, 51.1% age 1 month-4 years). There were 47.8% subjects underwent laparotomy with a variety of indications. Almost all subjects (93.3%) received postoperative hypotonic fluid. The incidence of postoperative hyponatremia was 28.9%, while 11.1% among them were moderate-severe hyponatremia. The mean postoperative sodium levels was 130.1 ± 4.1 mEq/L with a mean total fluid 79.8 ± 27.4 ml/kg. There were 30.9% subjects who received hypotonic fluids and experienced hyponatremia with a mean length of stay 5.6 ± 4 days. One of 26 subjects with hyponatremia suffered from seizures and brain edema.Conclusions: The incidence of postoperative hyponatremia in pediatric intensive care reached nearly 30%, and almost all of them received hypotonic fluid. Therefore, further research should be performed to evaluate the appropriate fluid in order to anticipating postoperative hyponatremia, Background: Hyponatremia is commonly found post major surgery in pediatric population. The use of improper fluid often leads to increasing incidence of hyponatremia which causes complications such as cerebral edema, seizure, and death. Pediatric is a high risk population due to the large ratio between the brain tissue and skull, so that the availability space.Hyponatremia after major surgery in pediatric population is a common electrolyte disorder. The use of improper fluid often lead to increased incidence of hyponatremia which is closely linked to the increasing variety of complications such as cerebral edema, seizures, and even death. Pediatric is high risk population due to the larger comparison of brain tissue and the skull so that the space available in the event of brain edema narrower.Objective: To describe the incidence of hyponatremia in children after major surgery.Methods: A retrospective cross-sectional study was conducted on children aged 1 month to 18 years who underwent major surgery and entered the intensive care ward. The inclusion subjects was traced from medical records. The data was recorded from preoperative, intraoperative, and postoperative monitoring. Subjects who met hyponatremia (<135 mEq/L) were classified according to the severity of hyponatremia and its complications.Results: Ninety subjects were enrolled in this study (56.7% male, 51.1% age 1 month-4 years). There were 47.8% subjects underwent laparotomy with a variety of indications. Almost all subjects (93.3%) received postoperative hypotonic fluid. The incidence of postoperative hyponatremia was 28.9%, while 11.1% among them were moderate-severe hyponatremia. The mean postoperative sodium levels was 130.1 ± 4.1 mEq/L with a mean total fluid 79.8 ± 27.4 ml/kg. There were 30.9% subjects who received hypotonic fluids and experienced hyponatremia with a mean length of stay 5.6 ± 4 days. One of 26 subjects with hyponatremia suffered from seizures and brain edema.Conclusions: The incidence of postoperative hyponatremia in pediatric intensive care reached nearly 30%, and almost all of them received hypotonic fluid. Therefore, further research should be performed to evaluate the appropriate fluid in order to anticipating postoperative hyponatremia]"

"ABSTRAKLatar belakang: Thalassemia merupakan kelainan darah yang diturunkan secara autosomal resesif. Sampai saat ini thalassemia belum dapat disembuhkan. Biaya pengobatan yang tinggi serta komplikasi yang banyak pada penyakit ini menyebabkan pentingnya dilakukan tindakan pencegahan untuk menurunkan insidens thalassemia. Tingkat pengetahuan serta sikap remaja yang baik terhadap thalassemia dapat membantu menurunkan insidens penyakit tersebut. Tujuan: 1 Mengetahui proporsi tingkat pengetahuan dan sikap siswa SMA terhadap thalassemia. 2 Menganalisis faktor-faktor yang diduga berhubungan dengan pengetahuan dan sikap siswa SMA terhadap thalassemia pendidikan, pendapatan keluarga, pengalaman pribadi, media massa, akses informasi di pelayanan kesehatan, peran keluarga, peran agama . Metode: Penelitian potong lintang deskriptif analitik dilakukan terhadap siswa kelas 10,11,12 dari 2 SMA negeri dan 2 SMA swasta di Jakarta Pusat sejak Februari 2017 sampai Juni 2017. Pengambilan data dilakukan melalui pengisian kuesioner oleh masing-masing siswa. Hasil: Total subyek yang diteliti adalah 300 siswa SMA. Proporsi tingkat pengetahuan yang baik pada siswa SMA adalah 28,3 dan proporsi sikap positif siswa SMA terhadap thalassemia adalah 60 . Faktor yang memiliki hubungan terhadap pengetahuan yang baik adalah jurusan akademik p=0,019; IK95 1,138-4,166 , paparan media massa p.

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ABSTRACTTitle Factors Related to High Scool Students Knowledge and Attitude of Thalassemia Background Thalassemia is a recessively inherited disorder of haemoglobin synthesis.This disease is not curable. The complications of the disease and the high cost of life long treatment make prevention strategies crucial in the reduction of thalassemia incidences. Good knowledge and positive attitude towards thalassemia can help in reduction the incidence. Objectives 1 to investigate proportion of high school students knowledge and attitudes towards thalassemia. 2 to identify factors related to high school students knowledge and attitudes towards thalassemia education, family income,mass media, information access in healthcare facilities, family and religion role Methods A cross sectional descriptive analitic study conducted on 10th,11th, 12th grade students of 2 public and 2 private high schools in Central Jakarta, since February to June 2017, using a self administered questionnaire. Results Total of study subjects are 300 students. Proportion of good thalassemia knowledge in high scool students is 28.3 and proportion of thalassemia positive attitude is 60 . Factors related to good level of knowledge are academic major p 0.019 CI95 1,138 4,166 , mass media influence p"

"ABSTRAK Latar belakang: Deteksi dini aterogenesis diperlukan untuk mencari faktor risiko gangguan kardiovaskular pada neonatus.Tujuan: 1 mengetahui sebaran nilai ketebalan tunika-intima aorta abdominalis aIMT pada bayi baru lahir; 2 mengetahui hubungan antara status nutrisi maternal dan berat lahir bayi terhadap aIMT bayi baru lahir.Metode: Penelitian potong lintang pada 86 bayi usi 2-3 kali nilai aIMT menggunakan ultrasonografi vaskular bertransduser linear 13 MHz dengan piranti lunak automatis, kemudian diambil nilai reratanya. Rerata aIMT kemudian dihubungkan dengan indeks massa tubuh ibu trimester pertama kehamilan dan berat lahir.Hasil: Rerata aIMT bayi baru lahir di Unit Perinatologi RSCM adalah 0,621 mm 0,110 mm. Tidak ditemukan korelasi antara indeks massa tubuh ibu trimester pertama kehamilan dengan aIMT bayi r = 0,137, p = 0,207 . Tidak ditemukan korelasi antara berat lahir bayi dengan aIMT bayi r = 0,036, p = 0,742 .Simpulan: Rerata aIMT bayi baru lahir di Unit Perinatologi RSCM adalah 0,621 mm 0,110 mm. Tidak didapatkan korelasi antara indeks massa tubuh ibu maupun berat lahir bayi terhadap aIMT bayi baru lahir. Deteksi dini risiko kardiovaskular pada neonatus melalui aIMT belum perlu dilakukan dalam praktik sehari-hari.Kata kunci: nutrisi maternal, risiko kardiovaskular, ketebalan tunika intima-media aorta

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ABSTRACTBackground Early detection of atherogenesis is needed to evaluate cardiovascular risk factors in newborns.Aim 1 knowing aortic intima media thickness aIMT distribution value in newborns 2 evaluate correlation between maternal nutritional status and birth weight to newborn aIMT.Method A cross sectional study was performed in 86 newborns, aged 0 7 days, with median gestational age of 35 weeks. All aIMT subjects were measured using a 13 MHz linear transducer vascular ultrasound with automatic software. Mean aIMT then correlated with first trimester maternal body mass index and birth weight.Results Newborn mean aIMT in Perinatology division Cipto Mangunkusumo Hospital was 0,621 mm SD 0,110 mm . There was no significant correlation between first trimester maternal body mass index and newborns aIMT r 0,137, p 0,207 . There was no significant correlation between birth weight and newborns aIMT r 0,036, p 0,742 .Conclusions Newborn mean aIMT in Perinatology division Cipto Mangunkusumo Hospital was 0,621 mm SD 0,110 mm . There were no correlations between first trimester maternal body mass index and birth weight to newborns aIMT. Early detection of atherogenesis in newborns through aIMT measurement were not recommended for daily practice yet.Keywords Maternal nutrition, newborns cardiovascular risks, aortic intima media thickness"

"Latar belakang: Sepsis neonatorum awitan lambat SNAL , merupakan penyebab morbiditas dan mortalitas terpenting bayi berat lahir rendah di rumah sakit. Klinisnya tidak spesifik sehingga membutuhkan pemeriksaan penunjang untuk mendiagnosisnya. Baku emas kultur darah memiliki nilai diagnostik yang rendah dan hingga kini belum ada penanda infeksi tunggal yang dapat mendiagnosis sepsis neonatorum. Toll-like receptor TLR berperan dalam mengenali patogen dan memulai respon imun. Ekspresi TLR2 dan TLR4 diharapkan dapat menjadi penanda sepsis neonatorum. Tujuan: Mengetahui ekspresi TLR2 dan TLR4 neutrofil dan monosit serta nilai diagnostiknya pada SNAL. Metode: Studi potong lintang pada Mei-Juni 2017 yang melibatkan 52 neonatus >72 jam dengan klinis sepsis. Pemeriksaan darah perifer lengkap, rasio I/T, CRP, PCT, TLR2 dan TLR4 menggunakan flow cytometry dilakukan dan dibandingkan dengan kultur darah. Hasil: Insidens SNAL penelitian ini sebesar 32,6 . Terdapat penurunan ekspresi TLR2 neutrofil maupun monosit pada kasus SNAL. Peningkatan ekspresi TLR4 neutrofil memiliki sensitivitas 88,2 , spesifisitas 20 , dan AUC 0,541. Ekspresi TLR4 monosit memiliki sensitivitas 92,1 , spesifisitas 11,4 , dan AUC 0,528 jika dibandingkan kultur darah. Nilai AUC CRP meningkat hingga lebih dari 0,75 setelah dikombinasikan dengan TLR4. Simpulan: Pada SNAL, ekspresi TLR4 memiliki sensitivitas yang baik namun kurang spesifik. Pemeriksaan TLR4 dapat menunjang nilai diagnostik CRP.

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Background Late onset neonatal sepsis LONS , is the major morbidity and mortality in low birth weight. Unspecific clinical manifestation make laboratory examination is needed to establish the diagnosis. Unfortunately, blood culture as a gold standard has low diagnostic value. While, there is no single infection marker to diagnose neonatal sepsis. TLRs are a sensor to recognize the pathogens and trigger the immune response. Expression of TLR2 and TLR4 are promising to be a septic marker. Aim To know the expression of TLR2 and TLR4 neutrophil and monocyte and their diagnostic value in LONS. Methods A cross sectional study was conducted from May June 2017 which involved 52 neonates 72 hours with clinically sepsis. Complete blood count, I T ratio, CRP, PCT, TLR2 and TLR4 by flow cytometry already done and compared to blood culture. Result The incidence of LONS is 32.6 . There is TLR2 down expression in LONS. Expression of TLR4 neutrophil has sensitivity 88.2 , specificity 20 , and AUC 0.541. While TLR4 monocyte has sensitivity 92.1 , specificity 11.4 , and AUC 0.528. AUC of CRP is increased over to 0.75 after combined with TLR4. Conclusion Expression of TLR4 have good sensitivity but less specific. TLR4 expression could increase the diagnostic value of CRP."

"ABSTRAK Latar belakang. Kelasi besi diduga berperan terhadap penurunan fungsi ginjal pada pasien thalassemia mayor. Data fungsi ginjal pasien thalassemia mayor yang menggunakan kelasi besi oral di Jakarta masih terbatas. Tujuan. Mengetahui penurunan fungsi ginjal pasien thalassemia mayor yang mendapat kelasi besi oral dan faktor yang memengaruhinya. Metode penelitian. Penelitian dilakukan bulan Maret ndash; Juli 2017 pada pasien thalassemia mayor yang mendapat kelasi besi oral tunggal selama minimal 1 tahun. Fungsi ginjal dinilai dengan laju filtrasi glomerulus berdasarkan formula Schwartz revisi Fungsi tubulus ginjal dinilai dengan peningkatan rasio kalsium kreatinin urin hiperkalsiuria . Hasil penelitian. Total subjek sebanyak 54 orang 28 deferipron, 26 deferasiroks . Proporsi LFG menurun pada kelompok deferipron lebih tinggi dibandingkan deferasiroks 53,6 vs 46,2 . Hiperkalsiuria lebih banyak ditemukan pada kelompok deferasiroks dibandingkan deferipron 12,9 vs 3,6 . Penurunan LFG bermakna pada kelompok deferipron tetapi tidak bermakna pada kelompok deferasiroks. Tidak terdapat perbedaan bermakna LFG dan rasio kalsium kreatinin urin antara kelompok deferipron vs deferasiroks p=0,427; p=0,109 . Usia, hemoglobin, rerata hemoglobin, feritin, dosis kelasi besi dan saturasi transferin hanya memengaruhi fungsi tubular ginjal. Simpulan. Terdapat penurunan fungsi ginjal pada pasien thalassemia mayor yang mendapatkan kelasi besi oral. Fungsi ginjal pada thalassemia perlu dinilai berkala meski penurunannya tidak bermakna secara klinis.Kata kunci: Thalassemia, fungsi ginjal, kelasi besi oralABSTRACT Background. Iron chelator can cause renal dysfunction in thalassemia major patients. Data of renal function in thalassemia major patients who receive oral iron chelator are limited. Objective. To determine kidney dysfunction in thalassemia major patients receiving oral iron chelator and its correlating factors. Methods. The study was conducted in March ndash July 2017 on thalassemia major patients treated with single oral iron chelator for at least 1 year. Renal function determined by glomerular filtration rate measured with revised Schwartz formula. Tubular function determined by increased urine calcium creatinine ratio hypercalciuria . Results. Total subjects were 54 28 deferiprone, 26 deferasirox . Proportion of decreased GFR in deferipron group was higher than deferasirox 53,6 vs 46,2 . Hypercalciuria was higher in deferasirox group than deferiprone 12,9 vs 3.6 . Declining of GFR was significant in deferiprone group but not significant in deferasirox group. There was no significant difference of GFR and urinary creatinine calcium ratio in deferiprone vs deferasirox group p 0.427 p 0.109 . Age, hemoglobin level, mean hemoglobin, ferritin, iron chelator dose and transferrin saturation only affecting kidney tubular function. Conclusions. Renal dysfunction was found in thalassemia major patients receiving oral iron chelator. Kidney function in thalassemia major patients should be monitored periodically eventhough the decline was not significant. Keywords Thalassemia, renal function, oral iron chelator"

"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.

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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."

"Pendahuluan: Gejala sindroma nefrotik (SN) adalah proteinuria massif. Penambahan Angiotensin Converting Enzyme Inhibitor (ACEi) atau Angiotensin Receptor Blocker (ARB) membantu menurunkan proteinuria pasien SN yang telah mendapat steroid. Belum ada penelitian mengenai efektivitas dan keamanan kombinasi ACEi+ARB dalam penatalaksanaan pasien SN sensitif steroid (SNSS) relaps sering atau SN dependen steroid (SNDS). Metode: Penelitian kohort retrospektif yang menggunakan data rekam medis anak RSUPN dr. Cipto Mangunkusumo 2014-2018. Hasil: Dari 63 pasien yang dievaluasi, 33 pasien menggunakan ACEi+ARB dan 30 pasien menggunakan ACEi. Tidak terdapat perbedaan bermakna onset tercapainya proteinuria negatif (ACEi+ARB minggu ke-3 vs ACEi minggu ke-4, p=0.125). Tidak terdapat perbedaan bermakna proporsi pasien yang mencapai proteinuria negatif dalam 4 minggu terapi (ACEi+ARB 72.7% vs ACEi 63.3%, RR=1.148; IK95%: 0.815-1.619, p=0.424). Tidak terdapat perbedaan efek samping yang bermakna dalam hal hipotensi, peningkatan ureum dan kreatinin, hiperkalemia dan penurunan laju filtrasi glomerulus. Kesimpulan: Tidak terdapat perbedaan bermakna efektivitas dan keamanan kombinasi ACEi+ARB dibandingkan ACEi sebagai antiproteinuria pada pasien anak SNSS relaps sering atau SNDS.

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Introduction: Symptoms of nephrotic syndrome (NS) is a massive proteinuria. The addition of Angiotensin Converting Enzyme Inhibitors (ACEi) or Angiotensin Receptor Blocker (ARB) can help to reduce proteinuria in NS patients who received steroids. There has been no study on the effectiveness and safety of ACEi+ARB combinations in the management of patients with frequent relapse NS (FRNS) or steroid-dependent NS (SDNS). Method: A retrospective cohort study using data collected from medical record of pediatrics with FRNS or SDNS at Cipto Mangunkusumo Hospital between 2014-2018 was conducted. Results: Out of the 63 patients who were evaluated, 33 patients were in ACEI+ARB while 30 other patients were in ACEi. There was no significant difference in the onset of negative proteinuria (3 weeks in ACEi+ARB vs 4 weeks in ACEi, p=0.125. There was no significant difference in the proportion of patients who achieved negative proteinuria in 4 weeks therapy (ACEi+ARB 72.7% vs ACEi 63.3%, RR=1,148; 95% CI: 0.815-1,619, p=0.424). There was no significant difference between ACEi+ARB and ACEi groups in the occurrence of hypotension, hyperkalemia, increased of creatinine serum, and decreased of glomerular filtration rate. Conclusion: There was no significant difference in the effectiveness and safety of the use of ACEi+ARB compared to ACEi as antiproteinuric in patients with FRNS or SDNS."

"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).

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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)."

"Latar belakang: Anemia defisiensi besi (ADB) merupakan salah satu masalah utama kesehatan dunia, terutama di negara berkembang, dan defisiensi besi (DB) adalah salah satu penyebab tersering anemia pada bayi dan anak. Bayi berat lahir rendah (BBLR) berisiko tinggi mengalami ADB dan dampak kesehatan seperti gangguan pertumbuhan, kekebalan tubuh, kognitif, psikomotor, dan tingkah laku.Tujuan: Mengetahui status besi dan menganalisis berdasarkan asupan nutrisi pada bayi usia kronologis 4 bulan dengan riwayat berat lahir kurang dari 2.500 gram.Metode: Penelitian ini dengan desain potong lintang yang dilakukan pada bayi usia kronologis 4 bulan dengan riwayat berat lahir rendah yang kontrol di poli tumbuh kembang dan pediatri sosial Kiara RSCM, pada bulan April 2020 hingga Juni 2021.Hasil: Sebanyak 67 subyek yang diikutsertakan dalam penelitian, rerata berat lahir 1.723 g, rerata usia gestasi 33,6 minggu, bayi yang medapatkan ASI eksklusif sebanyak 23,9%, ASI predominan 16,4% dan susu formula predominan sebanyak 59,7%. Kadar feritin pada subyek yang mendapatkan ASI eksklusif dan predominan lebih rendah dibandingkan yang mendapatkan susu formula predominan yaitu 46 (2,82-221) µg/L dibandingkan 58,8 (8-488) µg/L dengan nilai p = 0,199. Rasio prevalens bayi yang mendapatkan ASI eksklusif dan predominan mengalami DB dan ADB dibandingkan susu formula adalah 2,286 (IK 95% 1,13-4,621) p = 0,035.              Kesimpulan: Pada penelitian ini prevalens anemia 50,7%, DB 14,9%, dan ADB 13,4%. Subyek yang mendapatkan asupan ASI eksklusif dan predominan memiliki kadar feritin yang cenderung lebih rendah dibandingkan dengan susu formula predominan.

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Background: Iron deficiency anemia (IDA) is one of the main health problems in the world, especially in developing countries, and iron deficiency (ID) is one of the most common causes of anemia in infants and children. Low birth weight (LBW) infants are at high risk of developing IDA and health impacts such as impaired growth, immunity, cognitive, psychomotor, and behavioral.

Methods: This study was a cross-sectional design conducted on infants of chronological age 4 months with a history of low birth weight who was controlled in the growth and development clinic, Kiara Cipto Mangunkusumo Hospital from April 2020 to June 2021.

Result:  A total of 67 subjects were included in the study, the average birth weight was 1.723 g, the mean gestational age was 33.6 weeks, infants who received exclusive breastfeeding were 23.9%, predominantly breastfed 16.4% and predominantly formula milk was 59.7%. Feritin levels in subjects who received exclusive and predominantly breast  milk were lower than those who received predominant formula milk, was 46 (2.82-221) compared to 58.8 (8-488) with p value = 0.199. The prevalence ratio of infants who were exclusively breastfed and predominantly had ID and IDA compared to formula milk was 2.28 (95% CI 1.13-4.621) p = 0.035.

>Conclusion: Prevalence of anemia in this study was 50.7%, ID 14.9%, and IDA 13.4%. Subjects who received exclusive and predominant breast milk tend to have lower ferritin levels compared to predominant formula milk."

"Pembedahan dapat memicu respons stres metabolik yang dapat menimbulkan hiperglikemia. Mekanisme hiperglikemia pascaoperasi dihubungkan dengan resistensi insulin, peningkatan glukoneogenesis, dan glikogenolisis, serta penurunan glucose transporter-4. Hiperglikemia diduga sebagai respons adaptasi fisiologis “fight or flight” tetapi juga dikaitkan dengan peningkatan morbiditas dan mortalitas pascaoperasi. Risiko hiperglikemia pascaoperasi dan potensi bahaya yang ditimbulkan belum banyak disadari oleh para dokter. Penelitian ini bertujuan untuk mengetahui karakteristik pasien pascaoperasi di Pediatric Intensive Care Unit (PICU) di Rumah Sakit Ciptomangunkusumo, insidens hiperglikemia pada anak pascaoperasi, dan faktor-faktor yang memengaruhi hiperglikemia pascaoperasi. Penelitian ini merupakan suatu studi potong lintang terhadap 199 pasien di RSCM yang dirawat di ruang PICU pascaoperasi sepanjang Januari – Desember 2020. Data demografi serta gula darah pascaoperasi diambil dari rekam medis. Kejadian hiperglikemia pascaoperasi dalam 24 jam pertama adalah 42%. Faktor-faktor yang memengaruhi hiperglikemia pascaoperasi pada penelitian ini adalah usia > 60 bulan (rasio odds 1,92 (95% IK 1,08-3,41) p=0,025) dan median durasi operasi>5 jam (p=0,001)

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Surgery can trigger metabolic stress response that can lead to hyperglycemia. Mechanism of postoperative hyperglycemia is associated with insulin resistance, increased gluconeogenesis, and glycogenolysis, and decreased glucose transporters-4. Hyperglycemia is thought to be a physiological “fight or flight” adaptive response but also associated with increased postoperative morbidity and mortality. The risk of postoperative hyperglycemia and the potential dangers that it causes have not been widely realized by doctors. This study aims to determine the characteristics of postoperative patients at the Pediatric Intensive Care Unit (PICU) at Ciptomangunkusumo Hospital (RSCM), incidence of hyperglycemia in postoperative children, related factors of postoperative hyperglycemia. This study is a cross-sectional study of 199 patients at RSCM who admitted in PICU postoperative during January – December 2020. Demographic data and postoperative blood sugar were taken from medical records. The incidence of postoperative hyperglycemia in the first 24 hours was 42%. Related factors of postoperative hyperglycemia in this study were age > 60 months (Odds ratio 1,92 (95% CI 1,08-3,41); p=0,025 and median operative duration > 5 hours (p=0,001)."