Faktor Prognosis Sindrom Syok Dengue pada Anak

Latar belakang. Manifestasi klinis yang bervariasi, patogenesis yang kompleks, dan perbedaan serotipe virus membuat sulit memprediksi perjalanan penyakit dengue. Banyak penelitian yang telah dilakukan tentang faktor prognosis terjadinya sindrom syok dengue (SSD), tetapi semuanya menggunakan pedoman World Health Organization (WHO) tahun 1997. Tujuan. Penelitian ini bertujuan mengetahui faktor-faktor prognosis terjadinya SSD berdasarkan pedoman WHO tahun 2011. Metode. Studi retrospektif menggunakan data rekam medik pasien anak usia 0 sampai <18 tahun dengan diagnosis demam berdarah dengue (DBD), SSD dan expanded dengue syndrome (EDS) yang memenuhi kriteria WHO tahun 2011 di RSCM dari Januari 2013 sampai Desember 2016. Variabel independen, yaitu jenis kelamin, usia, status gizi, infeksi dengue sekunder, leukopenia, nyeri abdomen, perdarahan gastrointestinal, hepatomegali dan kebocoran plasma. Syok merupakan variabel dependen. Analisis multivariat menggunakan analisis regresi logistik. Hasil. Subyek yang memenuhi kriteria penelitian 145 pasien, 52 (35,8%) di antaranya mengalami SSD. Lima dari 52 pasien SSD mengalami syok selama perawatan di rumah sakit. Analisis bivariat yang menghasilkan faktor-faktor signifikan di antaranya, malnutrisi, gizi lebih dan obesitas, perdarahan gastrointestinal, hemokonsentrasi, asites, leukosit ≥5.000 mm3, ensefalopati, peningkatan enzim hati dan overload. Hasil analisis multivariat menunjukkan variabel hemokonsentrasi dan peningkatan enzim hati merupakan faktor prognosis SSD. Kesimpulan. Hemokonsentrasi dan peningkatan enzim hati merupakan faktor prognosis terjadinya SSD

Diphtheria Epidemiology in Indonesia during 2010-2017

Background: in recent years, diphtheria has reemerged in several countries including Venezuela, Yemen, Bangladesh, and Haiti. Similarly, Indonesia also showed an increased number of diphtheria cases in 2010-2017 despite the Diphteria, Tetanus, Pertussis (DTP) immunization program applied in Indonesia for children. This study aimed to evaluate the epidemiology of diphtheria cases which occurred in Indonesia during 2010-2017. Methods: this was a retrospective study of diphtheria cases in Indonesia. The following source of data about diphtheria disease burden and vaccine coverage was obtained from Ministry of Health Republic of Indonesia, Indonesian Pediatric Society and World Health Organization South East Asia Regional Office. Results: the number of diphtheria cases in Indonesia were distributed across 30 provinces with a total of 811 cases in 2011; 1,192 cases in 2012; 296 cases in 2014; and 939 cases in 2017. Based on age group, the highest number of case fatality rate were in age group of 5-9 years old. Diphtheria immunization coverage in Indonesia among children was fluctuated, reported as 67.7 % in 2007, 61.9 % in 2010, 75.6% in 2013 and 61.3% in 2018. In addition to that, the organization of internal medicine has recommend booster of DPT immunization every 10 years for those children that had received complete DPT vaccination during childhood, however this was not applied. As the countermeasure towards this trend, the Ministry of Health implemented three rounds of Outbreak Response Immunization (ORI) targeted for the age group of 0-1-6 months old and 1-18 years old in 2017 and tailor approached for adults that had exposed to cases. Banten, DKI Jakarta and West Java were the first three provinces to implement this program considering their condensed population and high risk of disease transmission. Conclusion: in Indonesia, there was dramatic increase of diphtheria case in 2010-2017, where immunization in children should be reinforced by increasing coverage more than 95% and adult boosted vaccination approaches should be initiated to prevent the spread of these fatal diphtheria diseases in Indonesia

Spatiotemporal variability in dengue transmission intensity in Jakarta, Indonesia.

BACKGROUND: Approximately 70% of the global burden of dengue disease occurs on the Asian continent, where many large urban centres provide optimal environments for sustained endemic transmission and periodic epidemic cycles. Jakarta, the capital of Indonesia, is a densely populated megacity with hyperendemic dengue transmission. Characterization of the spatiotemporal distribution of dengue transmission intensity is of key importance for optimal implementation of novel control and prevention programmes, including vaccination. In this paper we use mathematical models to provide the first detailed description of spatial and temporal variability in dengue transmission intensity in Jakarta. METHODOLOGY/PRINCIPAL FINDINGS: We applied catalytic models in a Bayesian framework to age-stratified dengue case notification data to estimate dengue force of infection and reporting probabilities in 42 subdistricts of Jakarta. The model was fitted to yearly and average annual data covering a 10-year period between 2008 and 2017. We estimated a long-term average annual transmission intensity of 0.130 (95%CrI: 0.129-0.131) per year in Jakarta province, ranging from 0.090 (95%CrI: 0.077-0.103) to 0.164 (95%CrI: 0.153-0.174) across subdistricts. Annual average transmission intensity in Jakarta province during the 10-year period ranged from 0.012 (95%CrI: 0.011-0.013) in 2017 to 0.124 (95%CrI: 0.121-0.128) in 2016. CONCLUSIONS/SIGNIFICANCE: While the absolute number of dengue case notifications cannot be relied upon as a measure of endemicity, the age-distribution of reported dengue cases provides valuable insights into the underlying nature of transmission. Our estimates from yearly and average annual case notification data represent the first detailed estimates of dengue transmission intensity in Jakarta's subdistricts. These will be important to consider when assessing the population-level impact and cost-effectiveness of potential control and prevention programmes in Jakarta province, such as the controlled release of Wolbachia-carrying mosquitoes and vaccination

Pilihan Terapi Empiris Demam Tifoid pada Anak: Kloramfenikol atau Seftriakson?

Demam tifoid pada anak besar (lebih dari usia sepuluh tahun) pada umumnya mempunyai gambaran klinis demam tifoid menyerupai dewasa. Demikian juga derajat berat penyakit akan lebih parah dibandingkan pasien anak yang lebih muda. Oleh karena itu, pengamatan keadaan klinis pasien selama mendapat pengobatan harus dievaluasi dengan cermat terutama mengenai parameter keberhasilan pengobatan seperti keadaan umum, suhu, gejala intestinal, komplikasi baik intra maupun ekstra intestinal, hitung leukosit, fungsi hati, dan asupan cairan serta nutrisi. Pemeriksaan biakan darah terhadap Salmonella typhi merupakan baku emas untuk diagnosis demam tifoid. Walaupun pada saat ini telah terdapat berbagai uji diagnostik cepat (rapid diagnostic test) yang dapat dipergunakan untuk pasien rawat jalan, untuk pasien rawat inap harus dilakukan pemeriksaan biakan Salmonella typhi. Selain untuk menegakkan diagnosis, adanya biakan positif sangat berguna untuk menilai apakah pengobatan empiris yang diberikan saat pertama kali pasien datang ke rumah sakit sudah tepat. Perlu diperhatikan bahwa uji resistensi bakteri harus disertakan pada hasil biakan. Hasil uji resistensi diperlukan dalam menilai antibiotik pilihan alternatif apabila pengobatan empiris tidak seperti yang kita harapkan. Kloramfenikol sampai saat ini masih merupakan pengobatan lini pertama untuk demam tifoid pada anak yang dirawat di Departemen Ilmu Kesehatan RS Cipto Mangunkusumo Jakarta. Namun saat ini banyak dilaporkan adanya keadaan multidrug resistance Salmonella typhi (MDSRT), seperti dilaporkan di Pakistan, Mesir, dan Thailand. Maka untuk kasus MDRST diberikan pilihan pengobatan lini kedua yaitu seftriakson atau kuinolon. Namun karena penggunaan kuinolon masih kontroversi untuk anak mengingat dapat menyebabkan artropati, maka seftriakson menjadi pilihan kedua untuk demam tifoid pada anak

Steatocrit: A Simple Method for Detection Fat Malabsorption

Steatocrlt was determined through microcentrifugation of fecal hemogenate from 45 patients with chronic diarrhoea. In the same patients urine materials were collected to determine fat malabsorption using Lipiodol absorption test. There were 28 male and 17 female patients. Severe malabsorption using steatocrit was detected tn 31 patients (68;9%), while LAT determined severe malabsorption in 34 patients (75.5%). The overall sensitivity was 88.2%, and spesificity was 90.9%. Nutritional status did not influence the sensitivity and spesificity of steatocrit. We propose that this simple semiquantitative test can be used as an alternative method for detecting fat malabsorption particularly in laboratories with limited technical expertise

Qualitative evaluation of antibiotic usage in pediatric patients

Background Antibiotics are among the most commonly prescribed drug for pediatric patients. Inappropriate use of antibiotics can increase morbidity, mortality, patient cost and bacterial antibiotic resistence. Antibiotic uses can be evaluated quantitatively and qualitatively. Objective To qualitatively evaluate antibiotic use in patients using Gyssens algorithm. Methods We performed a descriptive, retrospective study of matient medical records of those admitted to the pediatric ward from January 1 – June 30, 2009. Records were screened for patient antibiotic use, followed by qualitative evaluation using Gyssens algorithm on data from patient who received antibiotic treatment. Results We found 49.2% of subject were prescribed antibiotics. The majority of patients given antibiotics were aged 1 month - 1 year (39.3%). Antibiotic use was categorized by therapy type : empirical, prophylactic, or definitive. We found empirical therapy in 73% of cases, prophylactic in 8%, and definitive in 15%. Cefotaxime was the most common antibiotic used (25.1%), followed by ceftazidime (14%) and cotrimoxazole (1%). 39.6% of subjects were given antibiotics appropriately, while 48.3% were given inappropriately. In 3.3% of patients, antibiotics were given without indication and in 8.8% there was insufficient data. Conclusions Of hospitalized patients receiving antibiotic treatment at the Departement of Child Health, Cipto Mangunkusumo Hospital, 39.6% were given antibiotic appropriately, while 48.3% were given antibiotics inappropriately. Cefotaxime was the most commonly used, as well as most inappropriately given antibiotic

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xiv, 193 hl