Tumor Wilms yang disertai sindroma Cushing - Suatu laporan kasus.

Ectopic ACTH syndrome associated with Wilms tumor is very rare. We reported a case of 6-year-old girl with an abdominal mass and cushingoid appearance. After removal of the mass, which is proved later on to be Wilms tumor by histhopathological study, the Cushings syndrome disappeared. Due to severe side effects, the patient was unable to follow the full course of the post - operative chemotherapy. A year later, the patient returned with recurrence of symptoms, i.e. abdominal mass and Cushings syndrome. Although serum ACTH level was not measured, the symptoms and close association between the tumor and the Cushings syndrome suggested of an ectopic ACTH - secreting Wilms tumor. Key words: ectopic ACTH syndrome - cushingoid appearance - Cushings syndrome - Wilms tumor -abdominal mass Sindroma ACTH ektopik yang menyertai tumor Wilms sangat jarang ditemukan. Dilaporkan sebuah kasus seorang anak perempuan berusia 6 tahun yang datang dengan massa di dalam abdomen dan tanda cushingoid. Setelah massa, yang ternyata kemudian adalah tumor Wilms, diambil gejala sindroma Cushing menghilang. Penderita tidak dapat menyelesaikan kemoterapi pasca bedah karena mengalami efek samping kemoterapi yang berat. Setahun kemudian, penderita kembali karena kambuhnya massa abdomen dan tanda-tanda sindroma Cushing. Meskipun kadar ACTH serum tidak diukur, gejala dan hubungan waktu yang sangat erat antara tumor dengan sindroma Cushing menunJukkan kemungkinan suatu tumor Wilms yang mensekresi ACTH ektopik

Kebiasaan sarapan tidak berhubungan dengan status gizi anak sekolah dasar di Kabupaten Timor Tengah Selatan, Provinsi Nusa Tenggara Timur

ABSTRACTBackground: School age children are the future generation. Improvement the quality of human resources should be done early. One of factors affecting the quality of human resources is the nutritional status. Breakfast contributes in nutritional intake (15-25% RDA). Skipping of breakfast makes the body decreasing of glucose. It makes body to unload supplies of energy from fat tissue and cause of weight reduction.Objectives: To determine the relationship between breakfast habits with the nutritional status of elementary school children in Nusa Tenggara Timur Province.Methods: This was an observational study with cross-sectional design. This study used the secondary data of Alma Ata Centre for Healthy Life and Food (ACHEAF) 2013. The subjects were children from elementary school of classes between II-VI in Amanuban Barat and Kie Subdistrict, Timor Tengah SelatanDistrict with total sample of 313 students. Sample were selected by cluster random sampling technique using computer generated random number software. Data analysis used chi-square test with a confidence interval (CI) of 95% to the level of significance of p<0.05. Analysis by logistic regression was done if itshowed significance result.Results: The proportion of breakfast habits of school children was 82.11%. Most widely consumed breakfast type (78,32%) was rice (rice porridge and rice) and the other (21.68%) were non-rice eating breakfast (bose corn, yam/cassava, boiled bananas, instant noodles, corn porridge, bread/cooky). The contribution of breakfast energy intake is 13.94% RDA and protein intake was 14.4% RDA. There was no relationship between breakfast habits and nutritional status of elementary school children.Conclusions: Breakfast habits was not related with the nutritional status of school children in Amanuban Barat and Kie Sub-district.KEYWORDS: breakfast habits, nutritional status, school childrenABSTRAKLatar belakang: Anak usia sekolah merupakan generasi penerus bangsa. Upaya peningkatan kualitas sumber daya manusia (SDM) harus dilakukan sejak dini. Salah satu faktor yang mempengaruhi kualitas SDM yaitu status gizi. Sarapan memiliki kontribusi dalam memenuhi asupan gizi, menyumbangkan 15-25% AKG. Melewatkan sarapan membuat tubuh kekurangan glukosa sehingga tubuh membongkar persediaan tenaga dari jaringan lemak tubuh dan menyebabkan penurunan berat badan.Tujuan: Mengetahui hubungan kebiasaan sarapan terhadap status gizi anak sekolah dasar di Kabupaten Timor Tengah Selatan Provinsi Nusa Tenggara Timur.Metode: Jenis penelitian ini adalah observasional dengan rancangan cross sectional. Penelitian ini menggunakan data sekunder Alma Ata Centre for Healthy Life and Food (ACHEAF ) 2013. Subjek penelitian adalah anak sekolah dasar kelas II-VI di Kecamatan Amanuban Barat dan Kie, Kabupaten Timor Tengah Selatan dengan total sampel sebanyak 313 siswa. Pengambilan sampel dilakukan dengan teknik cluster random sampling menggunakan software computer generated random number. Analisis data menggunakan uji chi-square dengan confi dence interval (CI) 95% pada tingkat kemaknaan p<0,05 dan hasil analisis data yang bemakna dilanjutkan dengan uji regresi logistik.Hasil: Proporsi kebiasaan sarapan anak sekolah adalah 82,11%. Jenis sarapan yang paling banyak dikonsumsi adalah sarapan beras (bubur nasi dan nasi) sebesar 78,32% dan sebanyak 21,68% mengonsumsi sarapan non-beras (jagung bose, ubi/singkong, pisang rebus, mie instan, bubur jagung, roti/kue). Kontribusi asupan energi sarapan sebesar 13,94% AKG dan asupan protein sarapan sebesar 14,4% AKG. Tidak ada hubungan antara kebiasaan sarapan dengan status gizi pada anak sekolah.Kesimpulan: Kebiasaan sarapan tidak berhubungan dengan status gizi anak sekolah di Kecamatan Amanuban Barat dan Kie.KATA KUNCI: kebiasaan sarapan, anak sekolah, status giz

Paparan iklan junk food dan pola konsumsi junk food sebagai faktor risiko terjadinya obesitas pada anak sekolah dasar kota dan desa di Daerah Istimewa Yogyakarta

ABSTRACTBackground: Increasing prevalence of obesity may be caused by junk food advertised while children are watching television.Preference for foods requested by the children is much infl uenced by junk food advertisement, so that it can affect calori intakeand correlates with obesity. Obesity in children can cause obesity during adulthood and may increase the risk of degenerativedisease, like diabetes and cardiovascular.Objective: To analyze the level of risk exposure to junk food advertising and junk food consumption on the incidence of obesityin primary school children in elementary school children at the area of Yogyakarta Municipality and District of Bantul.Method: This study was an observational study with case-control design. The study population was elementary school childrenin the City of Yogyakarta and Bantul Regency. Cases were elementary school children who were obese, while the controlswere children who were not obese and sat closest the cases regardless of age and sex. Number of subjects for each groupwere 244 (1:1). Obesity was defi ned as BMI / U>95th percentile curves NCHS/CDC. Sampling to fi nd obesity with probabilityproportional to size (PPS) and sampling for cases and controls using random sampling techniques. Univariate analysis ofthe data using frequency distributions, bivariate analysis using Chi-square, and multivariate analysis using multiple logisticregression. Data were analyzed using STATA 11 program with a 95% signifi cance level and nutrisurvey.Result: Bivariate analysis using Chi Square shows the variables that infl uence the incidence of obesity, such as junkfood ads exposure (OR=1.70, 95%CI: 1.17-2.48, and p=0.004), junk food energy intake (OR=1.58, 95%CI:  1.08-2.32and p=0.01), intake of saturated fat junk food (OR=1.74, 95%CI: 1.18-2.56 and p=0.004), sodium intake of junk food(OR=1.83, 95%CI: 1.25-2.69 and p=0.001) and sex (OR=0.58, 95%CI: 0.40-0.85 and p= 0.0035). Multivariate analysiswith logistic regression showed that the variables affect obesity is junk food ads exposure (OR=1.63, 95%CI: 1.13-2.36and p <0.05) and sex (OR=0.62, 95% CI:0.43-0.91 and p<0.05).Conclusion : Exposure to junk food advertising can increase the risk of obesity.KEYWORDS: obesity, ads, junk food, energy, saturated fat, natrium, sucroseABSTRAKLatar Belakang: Peningkatan prevalensi obesitas dapat disebabkan oleh iklan makanan junk food ketika anak menontontelevisi. Pemilihan makanan yang diinginkan oleh anak banyak dipengaruhi oleh iklan tersebut, sehingga mempengaruhiasupan kalori dan berkorelasi dengan obseitas. Obesitas pada anak dapat menyebabkan obesitas saat dewasa dandapat meningkatkan risiko penyakit degeneratif, seperti diabetes dan kardiovaskuler.Tujuan: Untuk mengukur tingkat risiko paparan iklan junk food dan konsumsi junk food terhadap   kejadian obesitaspada anak SD di Kota Yogyakarta dan Kabupaten Bantul.Metode: Penelitian ini merupakan penelitian observasional dengan rancangan kasus-kontrol. Populasi penelitian adalah anak SD di Kota Yogyakarta dan Kabupaten Bantul. Kelompok kasus adalah anak yang mengalami obesitas,sedangkan kelompok kontrol adalah teman sekelas yang tidak mengalami obesitas dan duduk paling dekat di sebelahkanan kasus tanpa melihat umur dan jenis kelaminnya Jumlah subjek untuk masing-masing kelompok sebesar 244(1:1). Obesitas didefi nisikan dengan IMT/U>persentil 95th kurva NCHS/CDC. Pengambilan sampel untuk menemukanobesitas dengan probability proportional to size (PPS) dan pengambilan sampel untuk kasus dan kontrol menggunakanteknik random sampling. Analisis univariat menggunakan distribusi frekuensi, analisis bivariat menggunakan Chi-square,dan multivariat menggunakan regresi logistik ganda. Data dianalisis dengan menggunakan program STATA 11 dengantingkat kemaknaan 95% dan nutrisurvey.Hasil: Analisis bivariat dengan Chi-square menunjukkan variabel yang berpengaruh dengan kejadian obesitas, di antaranyapaparan iklan junk food (OR=1,70, 95%CI:1,17-2,48, dan p=0,004), asupan energi junk food (OR= 1,58,  95%CI:1,08-2,32dan p=0,01), asupan lemak jenuh junk food (OR=1,74 95%CI 1,18-2,56 dan p=0,004), asupan natrium junk food (OR=1,83,95%CI:1,25-2,69 dan p=0,001) serta jenis kelamin (OR= 0,58, 95%CI:0,40-0,85 dan p= 0,0035). Hasil analisis multivariatdengan regresi logistik memperlihatkan variabel yang berpengaruh terhadap obesitas adalah paparan iklan junk food (OR=1,63,95%CI:1,13-2,36 dan nilai p <0,05) dan jenis kelamin (OR=0,62, 95%CI:0,43-0,91 dan p<0,05).Kesimpulan: Paparan iklan junk food dapat meningkatkan risiko terjadinya obesitas.KATA KUNCI: obesitas, iklan, junk food, energi, lemak jenuh, natrium, sukros

The evaluation of formula 100 utilization program towards the nutrtitional status of malnourished children after treatment

ABSTRAKLatar belakang: Persentase balita kurus di Kabupaten Muna sebesar 11,8% dan balita sangat kurus sebanyak 6,3%. Sesuai rekomendasi World Health Organization (WHO), perbaikan status gizi balita gizi buruk dilakukan dengan memperbaiki asupan zat gizi dengan memberikan formula terapi berupa pemberian Formula 100 (F-100), dimana F-100 merupakan makanan yang berbahan dasar susu yang diberikan pada fase transisi dan fase rehabilitasi Tujuan:Mengetahui daya terima F-100 oleh balita gizi buruk dan mengetahui hubungan daya terima F-100 balita gizi buruk dengan perubahan status gizi.Metode:Jenis penelitian ini merupakan penelitian observasional yang menggunakan rancangan kohort prospektif. Sampel penelitian adalah seluruh balita umur 12-24 bulan yang mengalami gizi buruk berjumlah 73 balita yang telah memenuhi criteria inklusi dan eksklusi.Sampel penelitian mendapatkan F-100 selama 5 minggu.Analisis data yang digunakan adalah univariat dan bivariat. Hasil:Sebagian besar subjek (63,08%) termasuk dalam kategori daya terima baik dengan menghabiskan F-100 yang diberikan dan sisanya (36,92%) termasuk dalam kategori daya terima kurang dengan tidak menghabiskan F-100 yang diberikan. Hasil uji Chi Square menunjukan ada hubungan antara daya terima F-100 dengan perubahan status gizi (p=0,02) (RR=2,7, 95% CI=1,07-7,21). Kesimpulan :Terdapat hubungan yang signifikan antara daya terima F-100 denganperubahan status gizibalita (p<0,05). KATA KUNCI: evaluasi, status gizi, F-100ABSTRACTBackground: The total percentage of underweight children in Muna District was 11.8% and the percentage of severe wasted children was 6.3%. As recommended by World Health Organization (WHO),improvement in nutritional status of malnourished children is conductedby improving food supplementation. Giving therapeutic formula 100 (F-100), where F-100 is the food made from dairy products which given in transition and rehabilitation phase. Objectives:To figure out the admission of F-100 by malnourished children and to find out the correlation between F-100 admission from malnourished children and the changing of nutritional status. Methods: This research is an observational study using the design of prospective cohort study. The sample were the whole children aged 12-24 months who suffered malnutrition with the total number up to 73 children who have fulfilled the criteria of inclusion and exclusion. The study sample had received F-100 for 5 weeks. The data analysis used is univariate and bivariate.Results: Most of the subjects are included in the category of well admission (63.08%) by spending given F-100 and the rests are included in the category of less admission (36.92%) by not spending the given F-100. The result of Chi Square Test shows that there is correlation between the admission of F-100 andthe changing of nutritional status (p=0.02) (RR=2.7, 95% CI=1.07-2).Conclusions: There is significant correlation between the admission of F-100 and the changing of children’s nutritional status (p<0.05)KEYWORDS: evaluation, status, nutrition, F-10

Pengaruh Pemberian Makanan Tambahan

ABSTRACT Background: School age is the period of fast child growth so that children need sufficient and balanced nutrition. Nutrition deficiency during school age will cause children to be weak, get tired easily and ailing. Consequently, they are often absent from school and face difficulties to concentrate in their study so that this affects their academic achievement. One way to cope with problem of nutrition deficiency is by supplying complementary food to school children such as snack with nutrition value 3000k for calorie and 5 grams for protein. Objectives: The study was aimed to identifying effect of complementary food supply to concentration of elementary school children Grade V in the working area of Ngemplak II Community Health Center, Sleman District. Methods: This was a quasi experimental research with pre-post test non equivalent control group design. It was conducted in 6 elementary schools of non underdeveloped village of Ngemplak Sub district, Sleman District with as many as 136 school children as samples. Research instruments used were structured questionnaires, microtoise and digital scale. Paired samples test was used to identify effect of complementary food supply to concentration of study, whereas multivariate linear regression test was used to identify relative contribution of independent variable to dependent variable. Results: Nutrition status of respondents was categorized as good. based on Z-Score value of body weight/ height and height/age. In the preliminary study there was significant difference (p>0 001) of average score between morning concentration and afternoon concentration, There was also very significant difference of average score of concentration between treatment and control group in the morning and in the afternoon (

The association of single nucleotide polymorphism (SNP) rs2922126 within ghrelin and growth hormone secretagogue receptor 1a (GHSR1a) gene with insulin resistance in obese female adolescents in Yogyakarta Special Region

Previous study reported that among 79 obese female adolescents in Yogyakarta Special Region, 44 (55.7%) of them have insulin resistance. However, no significant differences on dietary habits and physical activity between the obese female who have insulin resistance and thosewho are insulin sensitive were observed. Therefore, it was thought that genetic factors are involved in the occurrence of insulin resistance. Ghrelin and growth hormone secretagogue receptor (GHSR) genes have been associated with the insulin signaling pathway with implicationsin insulin resistance. The study aimed to analyze the association between SNP (single nucleotid polymorphism) rs2922126 in GHSR1a gene with insulin resistance in obese female adolescents in Yogyakarta Special Region. Seventy eight obese female adolescents who were selected in theprevious study were involved in this study. Secondary data including name of subjects, age, body height, body weight, BMI (body mass index), fasting glucose level, fasting insulin level, waist circumference and HOMA-IR index were obtained from previous study. Polymerase Chai Reaction (PCR) and Restriction Fragment Length Polymorphism (RFLP) methods were used to the genotype analysis of SNP rs2922126. Chi-square test was used to calculate odds ratio on genotype and allele of SNP rs2922126 GHSR1a gene in insulin resistance and insulin sensitive groups. The results showed that A/A genotype individuals in SNP rs2922126 had higher risk to develop insulin resistance, compared to A/T and T/T genotypes individuals (OR: 2.03; 95%CI: 0.54-7.57). However, it was not significantly different (p>0.05). Individuals with A/A genotype and A allele carriers at SNP rs2922126 tended to have a higher value of BMI, fasting glucose level, fasting insulin level, HOMA-IR, and waist circumference compared to other carriers, althoughit was not significant (p>0.05). It can be concluded that SNP rs2922126 in GHSR1a gene is not associated with insulin resistance in obese female adolescents in Yogyakarta Special Region.Keywords: GHSR1a gene - SNP rs2922126 - insulin resistance - female - obes

Faktor-faktor yang berhubungan dengan praktik pemberian ASI eksklusif pada bayi usia 0-6 bulan di Kabupaten Timor Tengah Selatan

Factors associated with exclusive breastfeeding practice among infants aged 0-6 months in Timor Tengah Selatan DistrictBackground: The health profile of Indonesia in 2018 indicated only  68,74% of infants were exclusively breastfed. East Nusa Tenggara is one of the provinces with lower exclusive breastfeeding coverage than national data in 2018 with only 52,67%. A survey in Timor Tengah Selatan district showed that exclusive breastfeeding also decreased from 2015 and 2016 which was 63.3% to 59.1%. Several factors have been known to be associated with exclusive breastfeeding practice, such as mother’s education and occupation, household expenditure, antenatal care history, and husband’s support.Objective: To identify factors associated with exclusive breastfeeding practice among infants aged 0-6 months in Timor Selatan District, East Nusa Tenggara province.Methods: An observational study with a cross-sectional design was conducted among 155 lactating mothers of infants aged 0-6 months. The secondary data from "Study on behavioral analysis and food consumption/dietary practices among children under five, elementary school-age children, pregnant and lactating mother in Timor Tengah Selatan District of East Nusa Tenggara Province” were used. Raw data were collected in July 2012 in Amanuban Barat and Kie subdistrict, Timor Tengah Selatan. The data were analyzed in July-December 2014 using Chi-Square and logistic regression test. Results: Household expenditure, antenatal care location, and subdistrict associated with exclusive breastfeeding practice (p<0.05). Lactating mothers who did prenatal care at primary health care/primary health care satellite/hospital were 3.51 times more likely to breastfeed exclusively (OR=3.51; 95%CI: 1.03-11.9). Household expenditure (OR=0.27; 95%CI: 0.09-0.84) and subdistrict (OR=0.19; 95%CI: 0.05-0.71) had protective effect.Conclusions: A significant association was found between exclusive breastfeeding practice and household expenditure, antenatal care location, and the subdistrict in Timor Tengah Selatan district