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All Journal Majalah Kedokteran Bandung Medical Journal of Indonesia
Cissy B. Kartasasmita
Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Padjadjaran Rumah Sakit Dr. Hasan Sadikin Bandung
Medicine & Pharmacology

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Nasopharyngeal bacterial carriage and antimicrobial resistance in underfive children with community acquired pneumonia Kartasasmita, Cissy B.; Duddy, Heda M.; Sudigdoadi, Sunaryati; Agustian, Dwi; Setiowati, Ina; Ahmad, Tri H.; Panigoro, Ramdan
Medical Journal of Indonesia Vol 11, No 3 (2002): July-September
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (227.086 KB) | DOI: 10.13181/mji.v11i3.70

Abstract

Pathogens in nasopharynx is a significant risk factor of pneumonia. According to WHO, isolates to be tested for antimicrobial resistance in the community should be obtained from nasopharyngeal (NP) swabs. The aim of this study is to know the bacterial patterns of the nasopharynx and cotrimoxazole resistance in under five-year old children with community acquired pneumonia. The study was carried out in 4 primary health clinic (Puskesmas) in Majalaya sub-district, Bandung, West Java, Indonesia. All underfive children with cough and/or difficult breathing and classified as having non-severe pneumonia (WHO guidelines) were placed in Amies transport medium and stored in a sterile jar, before taken to the laboratory for further examination, in the same day. During this nine month study, 698 children with clinical signs of non-severe pneumonia were enrolled. About 25.4% (177/698) of the nasopharyngeal specimens yielded bacterial isolates; i.e. 120 (67.8%) were positive for S pneumoniae, 21 for S epidermidis and alpha streptococcus, 6 for Hafnia alvei, 5 for S aureus, 2 for B catarrhalis, and 1(0.6%) for H influenza and Klebsiella, respectively. The antimicrobial resistance test to cotrimoxazole showed that 48.2% of S pneumoniae strain had full resistance and 32.7% showed intermediate resistance to cotrimoxazole. This result is almost similar to the other studies from Asian countries. It seems that H influenza is not a problem in the study area, however, a further study is needed. (Med J Indones 2002; 11: 164-8) Keywords: nasopharyngeal swab, S pneumoniae, cotrimoxazole
Kadar Laktat Darah sebagai Faktor Risiko Mortalitas pada Sepsis Neonatorum Leifina, Nadya; Yuniati, Tetty; Kartasasmita, Cissy B.
Majalah Kedokteran Bandung Vol 45, No 4 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Tolak ukur dini, bedside, dan parameter dapat tersedia di semua fasilitas kesehatan masih diperlukan untuk memantau perubahan metabolisme dan memperkirakan mortalitas pada sepsis neonatorum. Penelitian ini bertujuan mengetahui laktat darah sebagai faktor risiko mortalitas pada sepsis neonatorum. Penelitian berupa kohort prospektif dan dilakukan di RS Dr. Hasan Sadikin Bandung periode September–November 2010 dengan subjek adalah sepsis neonatorum. Pemeriksaan laktat darah menggunakan alat accutrend® lactate Plus yang dilakukan pada awal diagnosis, 12 jam, 24 jam, dan 48 jam pertama perawatan; kemudian dilakukan follow-up sampai penderita meninggal, pulang, atau hidup sampai usia 28 hari pascadiagnosis sepsis neonatorum. Data karakteristik subjek, gejala-gejala klinis, dan hasil pemeriksaan laboratorium dianalisis dengan univariat. Hasil analisis p<0,25 dianalisis dengan regresi logistik. Nilai yang bermakna bersama dengan kadar laktat darah 12 jam dianalisis dengan cox proportional hazard model. Setelah dilakukan observasi terdapat 28 neonatus mengalami kematian dari 69 neonatus yang didiagnosis sepsis neonatorum. Berat badan lahir <2.500 gram (p=0,008), usia kehamilan <37 minggu (p=0,006), retraksi (p=0,010), dan waktu pengisian kapiler ≥3 detik (p=0,042) berhubungan dengan mortalitas. Hiperlaktatemia pada 12 jam meningkatkan risiko mortalitas tiga kali pada sepsis neonatorum (HR 3,062; IK 95%: 1,078–8,700). Kesimpulan penelitian ini adalah hiperlaktatemia 12 jam merupakan faktor risiko mortalitas pada sepsis neonatorum. [MKB. 2013;45(4):199–205]Kata kunci: Faktor risiko, laktat, mortalitas, neonatal, sepsis Blood Lactate Level as Mortality Risk Factor in Neonatal SepsisEarly, bedside, and readily available parameters to observe metabolic changes and predicted mortality in neonatal sepsis is still needed in every health facility. The aim of this study was to explore blood lactate as apossible mortality risk factor in neonatal sepsis. A prospective cohort study was held during the period of September–November 2010 involving newborns diagnosed as suffering from neonatal sepsis in Dr. Hasan Sadikin General Hospital Bandung. Blood lactate was measured with accutrend® lactate Plus at admission and in 2, 24 and 48 hours of hospitalization. We performed univariate analysis on subject characteristics, clinical symptoms, and laboratory examination data. Results with p<0.25 were re-analyzed using logistic regression. Significant results along with the 12 hour blood lactate level were analyzed using cox proportional hazard model. Based on the observation, of the 69 newborns included in this study, 28 died. Statistic analysis showed significant correlation between mortality and birth weight <2,500 gram (p=0.008), gestational age <37 weeks (p=0.006), retraction (p=0.010), and capillary refill time ≥3 seconds (p=0.042). Hyperlactatemia in 12 hours increased the risk for mortality in neonatal sepsis (HR 3.062, CI 95%:1.078–8.700). It is concluded that hyperlactatemia in 12 hours is the risk factor for mortality in neonatal sepsis. [MKB. 2013;45(4):199–205]Key words: Blood lactate, mortality, neonatal, risk factor, sepsis DOI: http://dx.doi.org/10.15395/mkb.v45n4.165
Kematian Akibat Pneumonia Berat pada Anak Balita Wulandari, Diah Asri; Sudarwati, Sri; Suardi, Adi Utomo; Ghrahani D. M., Reni; Kartasasmita, Cissy B.
Majalah Kedokteran Bandung Vol 45, No 1 (2013)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Pneumonia merupakan penyebab utama kesakitan dan kematian pada anak, terutama di negara berkembang. Angka kematian karena pneumonia di negara berkembang 10–15 kali lebih tinggi daripada di negara maju. Penelitian ini bertujuan untuk mengetahui angka kematian dan faktor risiko pada anak balita yang dirawat di rumah sakit karena pneumonia. Penelitian potong lintang ini dilakukan pada anak usia 1–59 bulan yang dirawat di Rumah Sakit Dr. Hasan Sadikin Bandung karena pneumonia periode November 2007─Januari 2009. Tiga ratus delapan belas anak ikut serta dalam penelitian ini. Usia median anak 11‚6 bulan, sebanyak 237 (74‚5%) di antaranya berusia ≤12 bulan. Sembilan puluh tiga (29‚2%) anak didiagnosis pneumonia sangat berat dan 225 (70‚8%) anak pneumonia berat. Dua puluh tiga (7‚2%) penderita meninggal selama perawatan, 20 di antaranya dirawat dengan pneumonia sangat berat (p<0,001; OR 20,274; 95%IK: 5,855–70,197). Kelainan jantung bawaan (p=0,002; OR 5,795; 95%IK: 2,115–15,407) dan leukositosis (≥15.500/mm3; p=0,002; OR 3,879; 95%IK: 1,547–9,727) berhubungan erat dengan kematian. Kuman patogen ditemukan pada 11 dari 23 penderita yang meninggal. Simpulan, kematian karena pneumonia berat masih cukup tinggi. Pneumonia sangat berat, kelainan jantung bawaan, dan leukositosis merupakan faktor risiko yang meningkatkan kematian anak balita dengan pneumonia. [MKB. 2013;45(1):50–5]Mortality Due to Severe Pneumonia in Under-Five Years Old ChildrenPneumonia is one of the leading causes of morbidity and mortality in children, mainly in developing countries with a 10–15 times higher mortality rate than developed countries. The aim of the study was to know the mortality rate and its risk factors among under five years old children who were hospitalized due to severe pneumonia. This cross-sectional study was conducted to 1 to 59 months old children with pneumonia at the Department of Pediatric Dr. Hasan Sadikin Bandung Hospital from November 2007 to January 2009. Three hundred and eighteen children were enrolled in this study. The median age was 11.16 months, and 237 (74.5%) were ≤12 months of age. Very severe pneumonia was diagnosed in 93 (29.2%) and severe pneumonia in 225 (70.8%) children. Twenty three (7.2%) children died during hospitalization, 20 were hospitalized with very severe pneumonia (p<0.001, OR 20.274, 95%CI: 5.855─70.197). Congenital heart disease (p=0.002, OR 5.795, 95%CI: 2.115–15.407) and leucocytosis (≥15,500/mm3, p=0.002, OR 3.879, 95%CI: 1.547–9.727) were significantly associated to the mortality. Pathogenic bacteria were identified in 11 of 23 patients. In conclusions, the mortality of severe pneumonia is still high. Very severe pneumonia, congenital heart disease and leucocytosis are factors that increase mortality among under-five years old children with pneumonia. [MKB. 2013;45(1):50–5] DOI: http://dx.doi.org/10.15395/mkb.v45n1.140
Polimorfisme FokI, BsmI, ApaI, dan TaqI Gen Reseptor Vitamin D pada Kejadian Tuberkulosis Anak Setiabudiawan, Budi; Kartasasmita, Cissy B.; Garna, Herry; Parwati, Ida; Maskoen, Ani Melani
Majalah Kedokteran Bandung Vol 42, No 4
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Tuberkulosis (TB) adalah penyakit infeksi yang disebabkan oleh Mycobacterium tuberculosis. Faktor kuman saja tidak dapat menjadi faktor tunggal dalam kejadian TB. Varian polimorfisme gen reseptor vitamin D (RVD) dianggap penting hubungannya dengan kerentanan dan resistensi terhadap TB. Penelitian ini bertujuan untuk mengetahui peran polimorfisme FokI, BsmI, ApaI, dan TaqI gen RVD terhadap kejadian TB anak. Penelitian observasional analitik dengan rancangan kasus kontrol ini dilakukan di Bagian Ilmu Kesehatan Anak RSUP Dr. Hasan Sadikin Bandung dan Rumah Sakit Umum Cibabat Cimahi sejak Mei 2008–Maret 2009. Sampel terdiri dari 42 anak TB (kelompok kasus) dan 42 anak non-TB (kelompok kontrol) yang memenuhi kriteria penelitian dan diambil secara consecutive sampling. Dilakukan pemeriksaan polimorfisme FokI, BsmI, ApaI, dan TaqI gen RVD. Analisis dengan uji Chi-kuadrat, uji Mann-Whitney, menghitung rasio Odds (OR) dan 95% CI. Kejadian polimorfisme FokI gen RVD pada kelompok kasus TB 66,7% dan kontrol 40,5% (p=0,016) dengan OR (95% CI): 2,94 (1,21–7,16). Kejadian polimorfisme FokI gen RVD untuk kelompok kasus TB adalah 2,94 kali lebih banyak dibandingkan dengan kontrol. Polimorfisme BsmI, ApaI, dan TaqI gen RVD tidak terdapat perbedaan bermakna antara kelompok kasus TB dibandingkan dengan kontrol (p >0,05). Disimpulkan bahwa polimorfisme FokI gen RVD merupakan faktor risiko terjadinya TB anak. [MKB. 2010;42(4):187–94].Kata kunci: Gen reseptor vitamin D, polimorfisme, tuberkulosis anakPolymorphism of FokI, BsmI, ApaI, and TaqI Vitamin D Receptor Gene on Child TuberculosisTuberculosis (TB) is a infection disease caused by Mycobacterium tuberculosis. Mycobacterium tuberculosis itself is not the only factor of TB. Polymorphism of vitamin D receptor (VDR) gene is important on the susceptibility of TB. The aim was to find out the role of FokI, BsmI, ApaI, and TaqI VDR gene polymorphism on child TB. The observational analytic study with case control design was done in RSUP Dr. Hasan Sadikin Bandung and RSU Cibabat Cimahi, May 2008–March 2009. The subjects consisted of 42 children each for case (TB) and control (non TB) group, enrolled by consecutive sampling. The blood was analyzed for polymorphism of FokI, BsmI, ApaI, and TaqI VDR gene. Chi-square test, Mann-Whitney test, to calculate odds ratio (OR) and 95% confidence interval (CI) were used. The incidence of FokI VDR gene polymorphism in TB case group was 66.7% and 40.5% in control group (p=0.016), OR (95% CI): 2.94 (1.21–7.16). The FokI VDR gene polymorphism for TB group was 2.94 times greater than that for control group; while for BsmI, ApaI, and TaqI VDR gene polymorphism, there was no significant difference between TB case and control (p>0.05). It is concluded, FokI VDR gene polymorphism is a risk factor of child TB. [MKB. 2010;42(4):187–94].Key words: Child tuberculosis, polymorphism, vitamin D receptor gene DOI: http://dx.doi.org/10.15395/mkb.v42n4.35
The Association Between Initial Solid Food and Atopy in Children with or without Family History of Atopic Disease Perdana, Nanan Surya; Setiabudiawan, Budi; Kartasasmita, Cissy B.
Majalah Kedokteran Bandung Vol 42, No 1
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Atopic diseases are the most common chronic diseases in childhood. Their incidence has a tendency to increase recently. The tendency of atopy could be triggered by many factors originated in the early life, including early introduction of solid food. To investigate the association between initial solid food and atopy, an analytic comparative study with historical cohort design was conducted from May to June 2006 in Pediatric Department of Hasan Sadikin Hospital Bandung. It was the second phase study of 'allergic prevalence and risk factors identification in the first two years of life'. Out of 800 children in Garuda, Padasuka, and Babakansari Primary Health Care Center who were included in the first phase of the study, 749 children were eligible to continue the second phase of the study, 284 children were randomized into two groups of children with and without family history of atopic disease consisting of 142 children each. They then underwent skin prick test. History of initiation time of solid food were obtained from their parents. To analyze the data chi-square and odds ratio with 95% confidence interval were used. Among 284 children who fullfilled the inclusion criteria, 50% had family history of atopic disease. Atopy was found in 28.2% children, 32.4% with family history of atopic disease and 23.9% without family history of atopic disease. There was no significant correlation between family history of atopic disease and atopy (p=0.113). There was a high risk for atopy related to initial solid food (OR = 4.50, 95%CI = 1.96-10.74, p < 0.001). The difference of atopy was strongly significant between children who had initial solid food at the age of <6 months and at the age of >6 months whether or not the children had family history of atopic disease (p=0.016 and p=0.002). Conclusions: A significant increase in the risk of childhood atopy occured if initial solid food is given at the age of <6 months, whether or not the children have family history of atopic disease.Hubungan antara Waktu Pemberian Makanan Pendamping ASI dan Kejadian Atopi pada Anak dengan atau Tanpa Riwayat Penyakit Atopik dalam KeluargaPenyakit atopik merupakan penyakit kronik yang paling sering ditemukan pada anak. Angka kejadian penyakit atopik cenderung meningkat dari tahun ke tahun. Kecenderungan atopi atau timbulnya penyakit atopik dapat dicetuskan oleh faktor faktor yang berpengaruh di awal kehidupan, salah satunya adalah pemberian makanan pendamping ASI (MP ASI). Untuk mengetahui hubungan antara waktu pemberian MP ASI dan kejadian atopi dilakukan penelitian analitik komparatif dengan rancangan historical cohort. Penelitian dilakukan pada bulan Mei-Juni 2006 di Bagian Ilmu Kesehatan Anak Rumah Sakit Hasan Sadikin Bandung. Penelitian ini merupakan fase kedua dari penelitian “Prevalens alergi dan identifikasi faktor risiko pada dua tahun pertama kehidupan”. Penelitian dilakukan di Puskesmas Garuda, Padasuka, dan Babakansari. Dari 800 anak yang mengikuti fase I, sebanyak 749 anak dapat diteliti pada penelitian fase II. Dengan teknik sampling secara acak terpilih 142 anak, masing-masing dari  kelompok dengan dan tanpa riwayat penyakit atopik dalam keluarga. Selanjutnya dilakukan pemeriksaan uji tusuk kulit dan ditanyakan mengenai riwayat pemberian MP ASI. Analisis statistik yang digunakan adalah uji kai-kuadrat dan Odds ratio dengan IK95%. Dua ratus delapan puluh empat anak memenuhi kriteria inklusi penelitian. Dari jumlah tersebut diperoleh 50% anak dengan riwayat penyakit atopik dalam keluarga. Atopi didapatkan pada 28,2% anak, 32,4% di antaranya dengan riwayat penyakit atopik dan 23,9% tanpa riwayat penyakit atopik dalam keluarga. Tidak terdapat hubungan yang bermakna antara anak dengan riwayat penyakit atopik dalam keluarga dan kejadian atopi (p=0,113). Dua ratus delapan (73,2%) anak mendapat MP ASI pada usia <6 bulan, 76 (26,8%) anak mendapat ASI pada usia >6 bulan. Kejadian atopi berbeda bermakna antara anak yang mendapat MP ASI pada usia <6 bulan dan >6 bulan (OR=4,50; IK95%=1,96-10,47; p<0,001), baik pada kelompok anak dengan riwayat penyakit atopik (OR=3,38; IK95%=1,12-10,86; p=0,016) maupun tanpa riwayat penyakit atopik (OR=6,08; IK95%=1,63-26,72, p=0,002) dalam keluarga. Kesimpulan: Pemberian MP ASI pada usia <6 bulan meningkatkan risiko terjadinya atopi, baik pada kelompok anak dengan atau tanpa riwayat penyakit atopik dalam keluarga.DOI: http://dx.doi.org/10.15395/mkb.v42n1.6 
HUBUNGAN ANTARA ATOPI DENGAN RIWAYAT PENYAKIT ALERGI DALAM KELUARGA DAN MANIFESTASI PENYAKIT ALERGI PADA BALITA Weninggalih, Endah; Kartasasmita, Cissy B.; Setiabudiawan, Budi
Majalah Kedokteran Bandung Vol 41, No 1
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Prevalensii penyakit alergi cenderung meningkat dalam dekade terakhir. Hal ini disebabkan karena faktor genetik dan lingkungan. Faktor genetik dibuktikan dengan riwayat penyakit alergi dalam keluarga. Penyakit alergi merupakan gejala alergi pada individu yang atopi. Penelitian ini bertujuan untuk mengetahui apakah atopi dan riwayat penyakit alergi dalam keluarga merupakan faktor risiko timbulnya manifestasi penyakit alergi. Penelitian dilakukan di Puskesmas Garuda, Babakan Sari dan Padasuka Bandung selama bulan Februari-Maret 2007 dengan rancangan cross sectional. Subjek yang telah mempunyai data hasil uji tusuk kulit (UTK) dan ada tidaknya riwayat penyakit alergi dalam keluarga dilakukan pengisian kuesioner standar The International Study of Asthma and Allergies in Childhood (ISAAC) dan pemeriksaan fisis. Subjek dinyatakan atopi bila hasil UTK positif. Hubungan antara variabel dianalisis dengan metode Ki kuadrat dan rumus Mantel Haenszel untuk mengkontrol confounding variabel. Jumlah subjek sebanyak 260 anak (92%), terdiri dari 130 anak dengan riwayat penyakit alergi dalam keluarga dan 130 anak tanpa riwayat penyakit alergi dalam keluarga. Berdasarkan UTK didapat 70 anak atopi dan 190 anak nonatopi. Manifestasi penyakit alergi terdapat pada 86 anak (33,08%). Manifestasi terbanyak adalah rinitis alergika 41 anak (15,77%),kemudian dermatitis atopik 18 anak (6,92%), dan asma 5 anak (1,92%). Kejadian manifestasi penyakit alergi terdapat pada 57,1% anak atopi dan 24,2% anak nonatopi. Kejadian manifestasi penyakit alergi terdapat pada 41,5% anak dengan riwayat penyakit alergi dalam keluarga dan 24,6% anak tanpa riwayat penyakit alergi dalam keluarga. Atopi mempunyai hubungan yang lebih kuat dengan manifestasi penyakit alergi pada balita, namun riwayat penyakit alergi dalam keluarga juga mempunyai hubungan sehingga merupakan hal yang penting untuk ditanyakan kepada orang tua.Kata kunci: Manifestasi penyakit alergi, atopi, riwayat penyakit alergi dalam keluargaASSOSIATION BETWEEN ATOPY WITH ALLERGIC HISTORY IN THE FAMILY AND ALLERGIC DISEASE IN UNDER FIVE YEAR OLD CHILDRENThere was an increase in prevalence of allergic diseases in the last decade. This was because of genetic and environmental factors. Genetic factor were proven by allergic history in the family. Allergic reaction in individu with atopy determined as allergic disease.The aim of this study was to know whether atopy and family allergic disease were risk factors for the occurrence of allergic disease manifestation. This study was conducted at Garuda, Padasuka and Babakan Sari Primary Health Center in Bandung, Indonesia, during February-March 2007, with cross sectional designed. Subjects with skin prick test (SPT) result and history or no history allergic disease data were questioned by The International Study of Asthma and Allergies in Childhood (ISAAC) and physical examination. Data were analyzed >using chi square and Mantel Haenszel test for confounding variables. A total of 260 (92%) children joined the third phase; consisted of 130 children with family history of allergic and 130 children without family history of allergic. Based of SPT consisted of 70 children with positive results and 190 children with negative results. The incidence of allergic disease was confirmed in 86 (33.08%) children: 41 (15.77%) children with allergic rhinitis, 18 (6.92%) children withatopic dermatitis, and 5 (1.92%) with asthma. Allergic diseases manifestation were confirmed in 57.1% atopy children and 24.2% nonatopy children. Allergic diseases manifestation were confirmed in 41.5% children with and 24.6% children without family history of allergic. Atopy has stronger association with allergic disease manifestation in under five children, but family history of allergic also has association so it's important to ask parents.Key words: Allergic diseases manifestation, atopy, family history of allergic
Co-Authors Adi Utomo Suardi Ani Melani Maskoen Budi Setiabudiawan Diah Asri Wulandari Dwi Agustian Heda M. Duddy Herry Garna Ida Parwati Ina Setiowati Nadya Leifina Perdana, Nanan Surya Ramdan Panigoro Reni Ghrahani D. M. SRI SUDARWATI Sunaryati Sudigdoadi Tetty Yuniati Tri H. Ahmad Weninggalih, Endah