Pemberian Proton Pump Inhibitor Dibandingkan dengan Antagonis Reseptor-H2 pada Anak dengan Penyakit Refluks Gastrointestinal

Latar belakang. Pada umumnya anak dengan penyakit gastroesofageal refluks (PRGE) diterapi dengan antagonis reseptor H2 (H2RA) atau inhibitor pompa proton (PPI). Keduanya merupakan obat yang tersering diresepkan pada PRGE anak, namun efikasi keduanya masih kontroversi. Tujuan. Untuk mengevaluasi penggunaan PPI dan H2RA pada anak dengan PRGE melalui telaah sajian kasus berbasis bukti. Metode. Pencarian literatur secara sistematik menggunakan instrumen pencari PUBMED, Cochrane, dan Google Scholar. Pencarian dibatasi pada literatur berbahasa Inggris, yang dipublikasi selama 15 tahun terakhir, dan usia pasien 0–18 tahun. Studi dianggap memenuhi syarat bila dilakukan secara randomized-controlled trials, mengevaluasi PPI dan/atau H2RA untuk pengobatan GERD anak. Studi yang hanya berupa abstrak, yang hanya mengevaluasi selain non-klinis, dan laporan kasus diekslusi. Hasil. Studi kohort oleh Ruigomez dkk mencakup 8172 pasien dengan PPI (24 pasien dengan esomeprazole dan 8148 pasien dengan PPI lainnya) dan 7905 dengan H2RA. Karakteristik dasar keduanya serupa, namun anak dengan PPI cenderung lebih tua usianya. Luaran terkait keselamatan sebanyak 92 hanya pada PPI selain esomeprazole. Mattos dkk memperoleh 735 literatur, 23 studi (1598 pasien yang dirandomisasi) yang diikutsertakan dalam review sistematik. Delapan studi membuktikan bahwa PPI dan H2RA cukup efektif mengatasi manifestasi tipikal GERD. Studi lain menunjukkan bahwa omeprazole lebih unggul dibandingkan rantidin dalam pengobatan manifestasi refluks ekstra esofageal. Kesimpulan. Inhibitor pompa proton (PPI) atau H2RA dapat digunakan untuk pengobatan GERD pada anak. Omeprazol lebih unggul dibandingkan ranitidine pada pengobatan manifestasi refluks ekstra esophageal

Detection of Human Group a and C Rotaviruses in Pediatric Patients with Acute Gastroenteritis by Real TIME RT-PCR Assay: a Preliminary Study

Rotavirus causes 25–55% of all hospital admissions for diarrhea and approximately 611.000 deaths every year in developing countries. Clinically, it is not possible to recognize the diarrhea caused by rotavirus and other infections. To know a causative agent of rotavirus gastroenteritis, availability of an accurate diagnosis assay is necessary. Therefore, we developed real time RT-PCR assay (rRT-PCR) assay for confirmation of infections of Group A or C rotaviruses simultaneously. A total of 54 stool samples obtained from pediatric patients (< 5 years old) was used in this study. All samples were tested for Group A rotavirus by Serological rapid test. Result of serological rapid test was compared with rRT-PCR assay to obtain the test accuracies of both assays. Result of this study showed that rates of positive testing for Group A rotavirus by serological rapid test and the rRT-PCR assay were 22.22% and 18.50%, respectively. Forty-two serology-negative specimens for Group A rotavirus were also PCR negative (100% specificity). Two serology-positive specimens for Group A rotavirus was rRT-PCR negative (confirmed by electrophoresis gel); therefore, rRT-PCR assay represents the decrease of 3.70% in the number of specimens that are positive for Group A rotavirus. For Group C rotavirus, all tested samples were no rRT-PCR positive and the results need to be confirmed in the future

Pengaruh Susu yang Mengandung Sinbiotik Terhadap Tumbuh Kembang Anak Balita

Latar belakang. Saat ini semakin banyak susu dengan suplementasi sinbiotik. Beberapa studi menunjukkan bahwa sinbiotik dapat meningkatkan pertumbuhan dan menurunkan morbiditas penyakit infeksi pada anak.  Tujuan. Mengetahui pengaruh susu yang mengandung sinbiotik terhadap tumbuh kembang anak berusia di bawah lima tahun. Metode. Penelusuran pustaka database elektronik: PubMed, Cochrane, Highwire. Hasil. Didapatkan empat studi acak terkontrol yang relevan. Studi pertama menunjukkan kenaikan berat badan pada kelompok sinbiotik yang lebih tinggi (p=0,025), tetapi tidak terdapat perbedaan yang bermakna dalam hal kenaikan tinggi badan dan lingkar kepala, frekuensi dan karakteristik tinja, titer antibodi, serta perkembangan. Studi kedua menunjukkan pada kelompok intervensi terdapat peningkatan kadar IgA total lebih tinggi (p<0,01), efek positif pada berat badan dan tinggi badan, serta angka kejadian infeksi yang cenderung lebih rendah. Studi berikutnya menunjukkan rerata kecepatan kenaikan berat badan pada kelompok intervensi 0,13 kg/tahun lebih tinggi (p=0,02) dan pada analisis multivariat tampak kelompok intervensi mengalami kenaikan berat badan yang lebih tinggi (IK95% 0,006–0,21; p=0,04). Studi terakhir menunjukkan angka kejadian diare, disentri, pneumonia, penyakit berat,infeksi telinga, serta penggunaan antibiotik yang lebih rendah pada kelompok intervensi.  Kesimpulan. Susu yang mengandung sinbiotik memilik kecenderungan efek positif terhadap pertumbuhan dan cenderung menurunkan morbiditas penyakit infeksi pada balita sehat, serta tidak menyebabkan reaksi simpang

Seroepidemiology of Helicobacter pylori in primary school students in Krotek, Cibeber Village, Serang District, Banten, Indonesia

Background Helicobacter pylori infection is a common infection. Risk of infection in rural areas is six times higher than in urban areas. Objectives To study the prevalence of H. pylori infection in primary school students in rural area and its contributing factors. Methods A cross-sectional study was performed in a rural primary school in Serang district, Banten, West Java. Serology of H. pylori was tested using Bio M pylori kit (Mataram, Indonesia). Results Forty two of 125 subjects (33.6%) had positive H. pylori serologies. Bivariate analysis found that the the family habit of eating together from one container increased the infection risk 5.93 times (95% Cl 3.07 to 11.43). Source of drinking water from common river increased the risk 9.88 times (95% CI 3.03 to 32.24). Bed and bedroom sharing increased the risk 1.55 times (95% CI 1.23 to 1.95) and 2.22 times (95% CI 1.65 to 2.99), respectively. Multivariate logistic regression analysis including all variables with P <0.25 showed that the most significant factor contributing to H. pylori infection is common river as family drinking water source (OR 24.97, 95% CI 3.9 to 159.76), followed by family habit of eating together from one container (OR 10.23, 95% CI 3.05 to 34.27), and bed or bedroom sharing (OR 9.48, 95% CI 2.4 7 to 36.38). Conclusion Prevalence of H. pylori infection in rural school students is 33.6%. There are significant associations between H. pylori infection and family habit of eating together from one container, bed sharing with other family members, and family drinking water source from common river

Defisiensi Zinc Sebagai Salah Satu Faktor Risiko Diare Akut Menjadi Diare Melanjut

Latar belakang. Diare masih merupakan penyebab morbiditas dan mortalitas yang cukup tinggi pada anak, dan efeknya akan meningkat pada diare melanjut. Ekskresi yang meningkat dan malnutrisi menimbulkan defisiensi makro dan mikronutrien, defisiensi zinc merupakan salah satu penyebabnya. Tujuan. Mengetahui apakah defisiensi zinc merupakan faktor risiko diare akut menjadi diare melanjut. Metode. Penelitian uji potong lintang dilakukan di RSCM dan tiga rumah sakit umum daerah pada anak usia >1–60 bulan yang mengalami diare akut kurang dari 7 hari. Dilakukan anamnesis, pemeriksaan fisik, dan pemeriksaan kadar zinc serum. Hasil. Analisis dilakukan pada 99 subjek. Usia terbanyak 12-36 bulan, perbandingan laki-laki perempuan 1,3:1. Prevalensi defisiensi zinc adalah 20,2%. Insiden diare melanjut 25,3%. Tidak terdapat hubungan antara defisiensi zinc dengan usia, status nutrisi, riwayat diare berulang, pendidikan ibu, dan pendapatan orangtua. Defisiensi zinc bukan merupakan faktor risiko diare akut menjadi diare melanjut RR 1,82 (IK95% 0,633-5,260; p=0,261). Riwayat diare berulang merupakan faktor risiko diare akut menjadi diare melanjut RR 3,4 kali (IK95% 1,3-9,5; p=0,013). Kesimpulan. Defisiensi zinc bukan merupakan faktor risiko diare akut menjadi diare melanjut. Riwayat diare berulang berisiko untuk terjadinya diare akut menjadi diare melanju

Pola Tata laksana Diare Akut di Beberapa Rumah Sakit Swasta di Jakarta; apakah sesuai dengan protokol WHO?

Pada umumnya penyakit diare akut bersifat self limiting disease sehingga seringkali pasien tidak memerlukan pengobatan spesifik. Tata laksana diare akut dengan berbagai derajat dehidrasi telah dibakukan oleh WHO. Tujuan: Penelitian ini bertujuan untuk menilai pola tata laksana diare akut di luar rumah sakit institusi pendidikan. Metoda: Penelitian deskriptif yang dilakukan secara retrospektif di tiga rumah sakit swasta Jakarta sejak 1 Januari sampai 31 Maret 1999 pada 67 pasien diare akut yang dirawat, berumur 0-24 bulan. Hasil: Didapatkan 37 (55%) anak lelaki dan 30 (45%) anak perempuan menderita diare akut, terdiri dari tanpa dehidrasi 6 (9%) anak, dehidrasi ringan-sedang 52 (78%) anak, dan dehidrasi berat 9 (13%) anak. Proporsi rentang usia 0-6 bulan sebanyak 23 (34%) anak, >6-12 bulan 28 (42%), dan >12-24 bulan 16 (24%). Jumlah pasien diare akut tanpa dan dengan dehidrasi ringan-sedang yang mendapat rehidrasi secara parenteral sebanyak 51 (88%) anak dari 58 anak. Sedangkan sisanya menderita dehidrasi berat diberi cairan rehidrasi parenteral yang dibagi dalam 24 jam. Pada keseluruhan pasien rawat hanya 37 (55%) anak yang mendapat cairan rehidrasi oral (oralit/Pedialyte). Penggunaan antibiotik didapatkan pada 55 (82%) anak dan anti diare pada 32 (48%) anak. Pemberian ASI hanya didapatkan pada 41 (61%) anak, dan di antaranya pemberian ASI dilanjutkan pada 36 (88%) anak, serta dihentikan pada 5 (12%) anak; sedangkan 26 (39%) anak sudah tidak mendapatkan ASI. Dari 51 anak yang menggunakan susu formula, didapatkan pemberian susu formula khusus pada 47 (70%) anak dan pengenceran susu formula pada 2 (3%) anak. Lama rawat rerata 3 hari, dengan kisaran 2 sampai 6 hari, dan 1 anak dirawat lebih dari 7 hari. Kesimpulan: tata laksana diare akut di tiga rumah sakit swasta di Jakarta kurang sesuai dengan panduan/protabel WHO, tampak dari hasil pemakaian CRO hanya pada 50% pasien, antibiotik masih banyak dipakai (90%), dan pemakaian susu formula khusus pada 70% anak. Sedangkan pemberian ASI diteruskan cukup baik, yaitu 88%

Thyroid hormone profile and PELOD score in children with sepsis

Background Thyroid hormonal dysfunction, also known as euthyroid sick syndrome or nonthyroidal illness, can be seen in sepsis. There have been few studies on thyroid hormone dysfunction in septic children, as well as on a relationship between their thyroid hormone profiles and pediatric logistic organ dysfunction (PELOD) scores. Procakitonin (PCT) is one of the sepsis biomarker. Objective To evaluate the thyroid hormone profile in children with sepsis as well as to assess for a correlation between the thyroid levels and PELOD scores, PCT levels, and patient outcomes. Methods This cross-sectional study included children aged 1- 18 years admitted to the pediatric intensive care unit (PICU) with a primary diagnosis of sepsis. PELOD scores and thyroid hormonal levels were assessed once during the first 24 hours after PICU admission. Results Thirty subjects were included in the study. The median values ofT3, free T4, and TSH were 45 (range 17 -133) ng/dL, 0.81 (range 0.3-1.57) ng/dL, and 1.36 (range 0.05-7.78) μIU/L, respectively. The T3, free T4, and TSH levels were decreased in 97%, 50% and 40% of the subjects. There were no significant differences between low and normal to high TSH with regards to the PELOD score (P=0.218), PCT level (P=0.694), or patient outcomes (P=0.55). The risk of death increased by 15 times among the subjects with PELOD score ~20 compared to those with PELOD score <20 (OR 15; 95%CI: 1.535 to 146.545; P=0.012). Conclusion Thyroid hormones are decreased in septic children with the majority having low T3. A high PELOD score is strongly correlated with mortality and can be used as a prognostic parameter for septic children in the PICU, but there is no correlation with decreased TSH

Original Article Intestinal parasitic infection of immunocompromised children with diarrhoea: clinical profile and therapeutic response

Background: Parasitic gastrointestinal infections have been variably reported among immunocompromised adults while data on children have been limited. This prospective cross-sectional study aimed to assess the clinical profile of intestinal parasitic infections among immunocompromised children with diarrhoea and their treatment response. Methodology: Two freshly voided stool samples taken for two consecutive days were examined by direct and formalin-ether concentrated smears. Modified Ziehl-Neelsen staining was used to detect Cryptosporidium, Isospora belli, and Cyclospora cayetanensis. Blastocystis hominis was identified using in vitro culture. Subjects positive for stool parasite(s) received standard therapy according to the aetiology and were evaluated afterward. Results: Forty-two subjects from Jakarta, Indonesia were included in this study, mostly aged one to five years (78%) and HIV infected (52%). Parasites were found in 24/42 (57%) subjects in which B. hominis comprised the largest proportion (23/24 = 96%). Cryptosporidium was identified in two subjects who were HIV infected with CD4 percentages of &lt; 15%. No helminth infestations were found. Parasites were most frequently found in preschool age children (16/23), in those with recurrent or watery diarrhoea (23/24 and 14/18, respectively), and in HIV subjects not receiving antiretrovirals (16/22). Of 13 subjects evaluated for response to a 10-day metronidazole course for B. hominis infection, seven achieved clinical remission and nine had their parasites eradicated. Conclusions: The prevalence of intestinal parasitic infection in immunocompromised children with persistent and/or recurrent diarrhoea i

Detection of Human Group A and C Rotaviruses in Pediatric Patients with Acute Gastroenteritis by Real Time RT-PCR Assay: A Preliminary Study

Rotavirus causes 25&ndash;55% of all hospital admissions for diarrhea and approximately 611.000 deaths every year in developing countries. Clinically, it is not possible to recognize the diarrhea caused by rotavirus and other infections. To know a causative agent of rotavirus gastroenteritis, availability of an accurate diagnosis assay is necessary. Therefore, we developed real time RT-PCR assay (rRT-PCR) assay for confirmation of infections of Group A or C rotaviruses simultaneously. A total of 54 stool samples obtained from pediatric patients (&lt; 5 years old) was used in this study. All samples were tested for Group A rotavirus by Serological rapid test. Result of serological rapid test was compared with rRT-PCR assay to obtain the test accuracies of both assays. Result of this study showed that rates of positive testing for Group A rotavirus by serological rapid test and the rRT-PCR assay were 22.22% and 18.50%, respectively. Forty-two serology-negative specimens for Group A rotavirus were also PCR negative (100% specificity). Two serology-positive specimens for Group A rotavirus was rRT-PCR negative (confirmed by electrophoresis gel); therefore, rRT-PCR assay represents the decrease of 3.70% in the number of specimens that are positive for Group A rotavirus. For Group C rotavirus, all tested samples were no rRT-PCR positive and the results need to be&nbsp;confirmed in the future