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Determinan Growth Faltering (Guncangan Pertumbuhan) pada Bayi Umur 2-6 Bulan yang Lahir dengan Berat Badan Normal Dyah Umiyarni Purnamasari; Martha I Kartasurya; Apoina Kartini
MEDIA MEDIKA INDONESIANA 2009:MMI VOLUME 43 ISSUE 5 YEAR 2009
Publisher : MEDIA MEDIKA INDONESIANA

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Growth faltering determinants among 2-6 years old infants born with normal birth weightBackground: Poor growth in infants can be indicated by a decrease in WAZ score, and is started at the age of 3-6 months. Growth faltering can lead to growth failure. Therefore it is important to investigate growth faltering determinants to solve the growth problems.Methods: This case controls study was conducted at Kangkung subdistrict, Kendal district. Cases were the subjects who had growth faltering, and controls were the subjects who had normal growth. Thirty six subjects were included in each group. The determinant variables investigated were non-exclusive breastfeeding, no-colostrum feeding, formula feeding, early complementary food feeding, pacifier used, diarrhea, upper respiratory tract infections and lack of mother’s allocation time for caretaking. Analyses were conducted by bivariate and multivariate logistic regression.Results: Based on the results of bivariate logistic regression analyses, the determinants of growth faltering were: Non-exclusive breastfeeding (OR=3.30; 95%CI:1.15-9.52; PAR=0.61), formula feeding (OR=2.96; 95%CI:1.03-8.53 PAR=0.38), early complementary food feeding at ≤3 months (OR=16; 95%CI: 1.78-143.15) and upper respiratory tract infections (OR=3.35; 95%CI: 1.23-9,10; PAR=0.48). No-colostrum feeding, pacifier used, diarrhea, and lack of mother’s allocation time for caretaking were not the determinants of growth faltering. Multivariate logistic regression analyses showed that non-exclusive breastfeeding (OR=3.43; 95%CI: 1.15-10.17) and upper respiratory tract infections (OR=3.09; 95%CI: 1.09-8.73) were the main determinants of growth faltering.Conclusions: The main determinants of growth faltering among infants aged 2-6 months at Kangkung sub-district were nonexclusive breastfeeding and upper respiratory tract infections. It is recommended to promote exclusive breast-feeding and prevent upper respiratory tract infections among infants.Keywords: Growth faltering, non-exclusive breastfeeding, upper respiratory tract infections, infants, normal birth weight ABSTRAKLatar belakang: Gangguan pada pertumbuhan bayi ditunjukkan dengan penurunan skor Z menurut indeks BB/U, dan pada umumnya dimulai pada umur 2-6 bulan. Gangguan tersebut bila tidak ditangani lebih lanjut akan menjadi growth failure (kegagalan pertumbuhan). Oleh karena itu perlu diketahui faktor determinan growth faltering agar dapat dilakukan pencegahan dan penanggulangan masalah tersebut.Metode penelitian: Penelitian observasional dengan disain penelitian kasus-kontrol, yang dilakukan di Kecamatan Kangkung, Kabupaten Kendal. Subyek adalah bayi yang mengalami growth faltering, dan kontrol adalah bayi yang mengalami pertumbuhan normal. Jumlah subyek masing-masing kelompok kasus dan kontrol adalah 36 subyek. Variabel yang diamati meliputi tidak diberikannya kolostrum, pemberian ASI tidak eksklusif, susu formula, MP-ASI dini, penggunaan kempongan, kejadian diare, ISPA danalokasi waktu asuh ibu. Analisis data dilakukan dengan menggunakan regresi logistik bivariat dan multivariat.Hasil: Berdasarkan analisis regresi logistik bivariat, determinan growth faltering adalah: pemberian ASI tidak eksklusif (OR=3,30; 95%CI: 1,15-9,52; PAR=0,61), susu formula (OR=2,96; 95%CI: 1,03-8,53 PAR=0,38), MP-ASI dini umur ≤3 bulan (OR=16; 95%CI: 1,78-143,15) dan ISPA (OR=3,35; 95%CI: 1,23-9,10; PAR=0,48). Variabel tidak diberikannya kolostrum, penggunaan kempongan, kejadian diare dan alokasi waktu asuh ibu yang kurang bukan merupakan faktor determinan. Analisis regresi multivariat menunjukkan bahwa pemberian ASI tidak eksklusif (OR=3,43; 95%CI: 1,15-10,17) dan kejadian ISPA (OR=3,09; 95%CI:1,09-8,73) merupakan variabel yang paling berpengaruh terhadap kejadian growth faltering.Simpulan: Determinan growth faltering utama pada bayi umur 2-6 bulan di Kecamatan Kangkung adalah Pemberian ASI tidak eksklusif dan kejadian ISPA. Disarankan untuk melakukan penyuluhan tentang pemberian ASI eksklusif dan pencegahan terhadap ISPA pada bayi.

Gambaran IgG dan IgM Anti Phenolic Glycolipid–1 Mycobacterium leprae pada Siswa Pesantren Desa Wringin Jajar Kecamatan Mranggen Kabupaten Demak ES Indrayanti; Yuanita Dian Utama
MEDIA MEDIKA INDONESIANA 2009:MMI VOLUME 43 ISSUE 5 YEAR 2009
Publisher : MEDIA MEDIKA INDONESIANA

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IgG and IgM anti phenolic glycolipid–I mycobacterium leprae in pesantren students of Wringin Jajar village, Mranggen, DemakBackground: Sub clinical leprosy can be detected by IgM sera of anti phenolic glycolipid–I (PGL-1) value more than 600 u/ml. The prevalence data study of IgG and IgM sera anti PGL-I value in Indonesia are limited. Two leprosy patients have been reported on pesantren students of Wringin Jajar village, Mranggen District, Demak Regency.Methods: Enzyme linked immunosorbent assay (ELISA) was done to examine the IgG and IgM anti PGL-1 sera of the 44 pesantren students which have been contact which leprosy patients on Wringin Jajar, Mranggen Distric, Demak Regency.Results: The IgM anti PGL-1 sera value more than 600 u/ml (positive results) were on 33 of 41 students (80.5%), and the IgG anti PGL-1 sera value more than 150 u/ml were positive on 15 students (31.7%).Conclusions: The prevalence of sub clinic leprosy in pesantren students which have been contact with leprosy patients were high. Further studies are needed to preacut clinical leprosy outbreak.Keywords: IgG, IgM Phenolic glycolipid, sub clinical of leprosyABSTRAKLatar belakang: Lepra sub klinik dapat dideteksi dengan nilai IgM serum anti PGL-1 >600 iu/ml. Studi prevalensi serum antiPGL-1 di Indonesia masih terbatas. Dua penderita lepra telah dilaporkan pada siswa pesantren di Desa Wringin Jajar, Kecamatan Mranggen, Kabupaten Demak.Metode: Pemeriksaan nilai serum IgG dan IgM anti PGL-I dengan teknik enzyme linked immunosorbent assay (ELISA) dilakukan terhadap 44 siswa yang telah mengalami kontak dengan penderita lepra di desa Wringin Jajar, Mranggen Kabupaten Demak.Hasil: Hasil nilai IgM serum anti PGL-1 >600 u/ml terdapat pada 33 dari 41 (80,5%) siswa pesantren Desa Wringin Jajar, Kecamatan Mranggen, Kabupaten Demak. Sebaliknya IgG positif >150 u/ml positif pada 15 siswa (31,7%).Simpulan: Prevalensi lepra sub klinik siswa kontak penderita lepra positif di Pesantren Desa Wringin Jajar, Kecamatan Mranggen, Kabupaten Demak cukup tinggi. Studi lebih lanjut amat diperlukan untuk mencegah munculnya lepra secara klinis.

Estimating The Annual Cost of Smoking-Related Diseases in Indonesia Bambang Sutrisna; Lujna Surtidewi; Anwar Jusuf; Ahmad Hudoyo; Dede Kusmana; Budhi Setianto; Endang Purwaningsih
MEDIA MEDIKA INDONESIANA 2009:MMI VOLUME 43 ISSUE 5 YEAR 2009
Publisher : MEDIA MEDIKA INDONESIANA

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Background: Smoking plays a role in the development of chronic diseases and causes substantial negative economic consequences. This study was carried out to estimate the annual cost of smoking-related cardio-cerebrovascular and pulmonary diseases in the population by taking into account the direct costs associated with such co-morbid conditions in Indonesia.Methods: Meta-analysis using the Mix-Programme Software of the data of patients from university medical centers who were active smokers for more than a year and more than 20-pack years or passive smokers for more than a year and diagnosed with Coronary Heart Disease, Myocardial Infarction, Stroke, COPD, Chronic bronchitis, or Lung Cancer had been conducted. Annual direct cost was taken into account using the Decision Analysis Tree Age Pro (=DATA) software; cost data related to health care expenditure were derived from secondary data sources in Jakarta. In addition, Population Attributable Risk (PAR) for each comorbid conditions was calculated based on published epidemiological data from local and international journals.Results: One-hundred and eighty-seven patients (96% male) satisfying the inclusion criteria, were analyzed, of whom confirmed diagnosis of Stroke was amongst 29% of the patients, CHD 16%, Myocardial Infarction 16%, Lung Cancer 15%, COPD 17%, and Chronic Bronchitis 7%. Mean direct annual cost was highest for Lung Cancer (Rp 51.6 million) followed by Myocardial infarction (Rp 38.5 million) and CHD (Rp 37.8 million); PAR for various co-morbid conditions (based on variations in relative risk and smoking prevalence estimates) were: Stroke ~16%-26%, CHD ~17%-27%, MCI ~ 22%-33%, Lung Cancer ~ 17%-26%, COPD ~ 13%-21%, Chronic Bronchitis ~ 42%-59%.Conclusions: Annual cost of smoking-related diseases in Indonesia has been estimated. The highest cost is for Lung Cancer. The highest PAR is for Chronic Bronchitis.Keywords: Smoking-related diseases, Annual cost, Indonesia. ABSTRAKEstimasi pembiayaan per tahun penyakit terkait merokok di IndonesiaLatar belakang: Merokok berkaitan dengan kejadian berbagai penyakit kronis dengan konsekuensi ekonomi berupa biaya yang sangat banyak. Penelitian ini bertujuan untuk mengestimasi biaya dampak merokok pada berbagai kondisi ko-morbid terkait penyakit jantung, otak dan paru di masyarakat Indonesia.Metode: Meta-analisis dengan Mix-Programme software pada data sekunder penderita penyakit jantung iskemik, infark miokard, stroke, COPD, bronkitis kronis atau kanker paru dari Rumah Sakit Pendidikan Jakarta dengan kriteria : perokok aktif lebih 1 tahun dan merokok lebih 20 pak/tahun atau perokok pasif lebih 1 tahun. Cost-analysis dengan Tree Age Pro (=DATA) software dilakukan untuk membandingkan pengeluaran/biaya pengobatan per tahun menurut berbagai ko-morbid. Population Attributable Risk (PAR) untuk kondisi ko-morbid merujuk perhitungan yang ada pada jurnal epidemiologi lokal maupun internasional.Hasil: Seratus delapan puluh tujuh=187 pasien (96% laki-laki) memenuhi kriteria inklusi; diantaranya 29% pasien menderita stroke, 16% penyakit jantung iskemik, 16% infark miokard, 15% kanker paru, 17% COPD, dan bronkitis kronis 7%. Rerata pengeluaran biaya per tahun tertinggi adalah kanker paru (Rp 51,6 juta), diikuti penyakit jantung iskemik (Rp 37,8 juta); dan infark miokard (Rp 38,5 juta). PAR untuk masing-masing kondisi komorbid sebagai berikut: stroke 16-26%, penyakit jantung iskemik 17-27%, infark miokard 22-33%, kanker paru 17- 26%, COPD 13-21%, dan bronkitis kronis 42-59%.Simpulan: Pengeluaran biaya per tahun tertinggi untuk penyakit terkait dampak merokok adalah kanker paru-paru dan bila PAR terbesar pada bronkitis kronis.

Pengaruh Kalsium dan Vitamin D3 Terhadap Stabilitas Tulang Alveolar - Studi pada Tikus Jantan Putih (Rattus Norvegicus) Saifuddin Ali Anwar
MEDIA MEDIKA INDONESIANA 2009:MMI VOLUME 43 ISSUE 5 YEAR 2009
Publisher : MEDIA MEDIKA INDONESIANA

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The effect of calcium and vitamin D3 on alveolar bone stability - The study in white male Rattus Norvegicus rats.Background: Calsium and vitamin D3 play important roles in the development and stability of alveolar bone that hold teeth. Alveolar bone stability is very important for successful outcome of orthodontic and prostodontic treatment.Objective: This study aimed to analyze the effect of calcium and vitamin D3 supplementation on different dosages on the alveolar bone stability.Methods: A post test-only control group design experiment was carried out on white rats (Rattus norvegicus Wistar strain). The treatments were 20% calcium reduction in the diet (P1) and supplentation of 20% (P2); 40% (P3) and 60% (P4) calsium to the standar diet given to control group. Alveolar bone stability was assessed by calcium contents, the number of osteocytes and weight of alveolar bone which were measured by AAS methode, histologic examination using hematoxylin and eosin staining on two microscopic fields of lamella Haversi region of alveolar bone and weighing of upper incisivus region of alveolar bone respectively. Data were analysed using t.test, Anova and LSD. Results: There were no difference on the calcium content of the alveolar bone among the 5 experimental groups (F=0.290, p=0.881). The number of osteocytes were different among as well as between the groups (F=9.685; p=0.000). There were differences of alveolar bone weight among the groups (F=10.901; p=0.000) while the weight were only significantly increase in the groups which given 40% (P3) and 60% (P4) calcium supplements this difference was not occured in the group which given 20% calcium supplements compare to the control group. There was no difference of alveolar weight between P3 and P4 groups.Conclusions: Supplementation of calsium and vitamin D3 20%, 40% and 60% above the standard diet give different result in 2 parameters of bone stability.Keywords: Calcium, vitamin D3, alveolar bone weight.ABSTRAK Latar belakang: Kalsium dan vitamin D3 berperan dalam pembentukan dan stabilitas tulang alveolar yang berfungsi sebagai penyangga gigi. Stabilitas tulang alveolar berperan dalam keberhasilan perawatan ortodontik dan prostodontik. Penelitian ini bertujuan untuk mengkaji perbedaan pengaruh suplementasi kalsium dan vitamin D3 pada berbagai takaran terhadap stabilitas tulang alveolar pada hewan coba.Metode: Dilakukan suatu penelitian eksperimental dengan rancangan the post test-only control group, menggunakan hewan coba tikus putih jantan (Rattus norvegicus galur Wistar). Perlakuan yang diberikan berupa pengurangan kalsium 20% (P1) dan penambahan 20% (P2), 40% (P3) dan 60% (P4) kalsium dalam pakan. Stabilitas tulang alveolar dinilai dengan parameter kadar kalsium, jumlah osteosit dan berat tulang alveolar, yang secara berurutan diukur dengan metoda SSA, dihitung secara histologik dengan pengecatan hematoksilin dan eosin pada dua lapang pandang lamela Haversi regio insisivus atas dan penimbangan tulang alveolar regio incicivus atas. Data di analisis menggunakan uji t, Anova dan LSD.Hasil: Tidak ada perbedaan yang bermakna pada kadar kalsium tulang alveolar di antara 5 kelompok penelitian (F=0,290; p=0,881). Jumlah osteosit berbeda bermakna di antara kelompok dan antara kelompok perlakuan (F=9,685, p=0,000).

Metode RPTLC dan Optimasi Fase Gerak Dalam Penetapan Harga Rm Sebagai Salah Satu Parameter Lipofilisitas Dalam Rancangan Obat Gunardi Gunardi; Ratna Asmah S.; Bambang Tri Purwanto; Edy Sulistyowati; Siti Musinah
MEDIA MEDIKA INDONESIANA 2009:MMI VOLUME 43 ISSUE 5 YEAR 2009
Publisher : MEDIA MEDIKA INDONESIANA

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RPTLC and optimizing mobile phase methods in Rm value determination as one of lipophylicity parameters in drug designBackground: The early process to successfully achieve its target is drug penetration or absorption. Of the three physicochemical parameters i.e, lipophyllicity, electronic and steric parameters, the lipophyllicity parameter is the most reponsible in drug absorption process. The research was aimed to determine retention modified (Rm) value of barbituric acid compound derivatives using RPTLC metod and mobile phase optimizing.Methods: This study was conducted on barbituric acid compound derivatives by using reverse phase thin layer chromatography (RPTLC). Silica Gel GF 254 that had been submerget in the mixture of liquid paraffin and petroleum eter (95:5) was used as a stationary phase. The mixture of polar to non polar solvent was used as mobile phase.Results: Research showed that in this method the most optimum of mobile phase was indicated by methanol and acetic acid mixture in the ratio of (1:9). The resulted Rm values of 5,5-diethylbarbituric acid, 5,5-diallylbarbituric acid, 5-allyl-5-isopropylbarbituric acid, 5-allyl-5-isobuthylbarbituric acid, 5-etil-5-(1-methylbutyl) barbituric acid, 5-(1-cyclohexene-1-yl)-1,5-dimethylbarbituric acid and 5-ethyl-5-phenylbarbituric acid were as follow 0.116; 0.144; 0.162; 0.221; 0.262; 0.187 and 0.199.Conclusions: The most optimum mobile phase in this method was the mixed solvents that had lower polarity, i.e, the mix of methanol and acetic acid in the ratio of (1:9). The H1 , H2 and H3 substituens in barbituric acid nuclei showed, the longer carbon chain, the higher the Rm values, howover the existing of double bond in such substituents will decrease the Rm value.Keywords: RPTLC, mobile phase, Rm value ABSTRAK Latar belakang: Proses awal keberhasilan obat dalam mencapai target adalah penetrasi atau absorpsi. Parameter lipofilisitas paling bertanggung jawab terhadap proses absorpsi obat dibanding parameter elektronik dan stearik. Tujuan penelitian ini adalah penggunaan metode RPTLC dan optimasi fase gerak dalam penentuan harga retention modified (Rm) senyawa turunan asam barbiturat.Metode: Penelitian dilakukan terhadap senyawa turunan asam barbiturat, dengan metoda kromatografi lapis tipis fase terbalik. Digunakan fase diam silika gel GF 254 yang telah dibacem dengan campuran parafin cair dan petroleum eter dengan perbandingan (95:5). Fase gerak yang digunakan dipilih campuran pelarut dari yang sangat polar sampai yang kurang polar.Hasil: Fase gerak yang paling optimum digunakan dalam metode ini adalah campuran metanol dan asam asetat dengan perbandingan (1:9). Harga Rm yang diperoleh secara berturutan, asam 5,5-dietilbarbiturat, asam 5,5-dialilbarbiturat, asam 5-alil-5- isopropilbarbiturat, asam 5-alil-5-isobutilbarbiturat, asam 5-etil-5-(1-metilbutil) barbiturat, asam 5-(1-sikloheksen-1-il) 1,5- dimetilbarbiturat dan asam 5-etil-5-fenilbarbiturat adalah: 0,116; 0,144; 0,162; 0,221; 0,262; 0,187 dan 0,199.Simpulan: Fase gerak yang paling optimum dalam metoda ini adalah bukan fase berair, tetapi berupa campuran pelarut yang mempunyai polaritas rendah, yakni campuran metanol dan asam asetat dengan perbandingan (1:9). Substituen atom H1 , H2 dan H3 pada inti asam barbiturat, menunjukkan makin panjang rantai karbon, makin tinggi harga Rm-nya. Adanya ikatan rangkap pada substituen menurunkan harga Rmnya.

Pola Makan dan Pertumbuhan Bobot Tubuh Tikus yang Diinokulasi Porphyromonas gingivalis Sebelum dan Sesudah Terjadinya Periodontitis Praptiwi Praptiwi; Enik Sulistyowati; Kustiyono Kustiyono
MEDIA MEDIKA INDONESIANA 2009:MMI VOLUME 43 ISSUE 5 YEAR 2009
Publisher : MEDIA MEDIKA INDONESIANA

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Food pattern and body weight growth of rat inoculation by porphyromonas gingivalis before and after periodontitisBackground: The rat model of periodontitis induced by Porphyromonas gingivalis (P. gingivalis) were selected to prove that energy requirement is rising in periodontitis, as well as the body mass erosion that giving influence to growth. This study aimed to get food consumption pattern and the lowest growth of body weight which would give information about time period to deliver nutrients needed to increase body weight to fasten healing.Methods: Experimental study was done using 63 Wistar adult, healthy male rat in Laboratorium Penelitian dan Pengujian Terpadu Gadjah Mada University, Yogyakarta in 2007-2008. The subject study were induced periodontitis by bacterial innoculation using P. gingivalis. The objects of the study were food consumption pattern and growth of body weight. Food consumption pattern was percentage of subject finishing food devided by total subject, before and during periodontitis period. Growth of body weight is mean of increasing body weight of 2 adjacent periodontitis period devided by length of day between the 2 periods.Results: The beginning of subject finishing the food was the time when periodontitis identified by Pathology Anatomic examination. Amount of subject finishing the food was variable according to periodontitis process. The growth of body weight before and during periodontitis was inclining by age. The highest incremental of mean body weight per day was observed before periodontitis until the beginning of periodontitis. The lowest incremental of mean body weight was found between the beginning of periodontitis tochronical period 1, as long as 7 days.Conclusions: The subject study began to finish the food since the beginning of periodontitis. During 7 days period from the beginning of periodontitis to chronical period 1, there was the lowest incremental body weight.Keywords: Periodontitis, food pattern, weight growthABSTRAKLatar belakang: Model tikus yang mengalami periodontitis dengan inokulasi P. gingivalis dipilih untuk membuktikan bahwa kebutuhan energi pada periodontitis meningkat dan terjadi erosi massa tubuh yang mempengaruhi pertumbuhan. Tujuan penelitian adalah diperolehnya pola makan serta pertumbuhan bobot tubuh (BT) terendah, yang akan memberikan gambaran periode waktu pemberian zat-zat gizi untuk meningkatkan bobot tubuh guna mempercepat penyembuhan.Metode: Dilakukan studi eksperimental pada 63 ekor tikus Wistar jantan dewasa di Laboratorium Penelitian dan Pengujian Terpadu Universitas Gadjah Mada Yogyakarta tahun 2007-2008. Subyek studi diinokulasi dengan P. gingivalis hingga terjadi periodontitis. Penilaian periodontitis dengan pemeriksaan Patologi Anatomik dari sediaan jaringan periodontal. Pola makan yaitu persentase subyek dengan pakan habis terhadap keseluruhan subyek studi, sebelum dan selama periodontitis. Pertumbuhan BT adalah rerata bobot tubuh 2 periode periodontitis yang berurutan dibagi lama hari antara 2 periode tersebut.Hasil: Awal pakan habis dimulai dari teridentifikasinya periodontitis melalui pemeriksaan Patologi Anatomik. Besaran subyek dengan pakan habis bervariasi menurut proses periodontitis. Pertumbuhan BT sebelum dan selama periodontitis menunjukkan peningkatan dengan bertambahnya umur. Peningkatan rerata BT per hari menunjukkan nilai tertinggi pada periode sebelum periodontitis ke awal periodontitis. Nilai terendah peningkatan rerata BT terdapat pada awal periodontitis ke periode kronik 1, selama 7 hari.Simpulan: Subyek studi mulai menghabiskan pakan sejak dimulai periodontitis. Selama 7 hari dari awal periodontitis sampai periode kronik 1, terjadi peningkatan rerata BTterendah

Prevalensi Kuman ESBL (Extended Spectrum Beta Lactamase) dari Material Darah di RSUP Dr. Kariadi Tahun 2004-2005 Winarto Winarto
MEDIA MEDIKA INDONESIANA 2009:MMI VOLUME 43 ISSUE 5 YEAR 2009
Publisher : MEDIA MEDIKA INDONESIANA

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Prevalence of Extended-Spectrum  -Lactamases (ESBL)-bacteria of Blood Isolates in Dr. Kariadi Hospital Semarang 2004–2005Background: Prevalence of ESBL bacteria varies among hospitals, which its resistance could be spread to other bacteria; causes infections with a high morbidity and mortality. There were no data of ESBL prevalence and its distribution within Dr. Kariadi hospital wards. Objective of the study were to determine the prevalence, distribution and antibiotic sensitivity pattern of ESBL bacteria in Dr. Kariadi hospital.Methods: Retrospective study was used on laboratory records of in-patients at Clinical Microbiology Laboratory during 2004–2005. Blood culture was inoculated into BACTEC bottle medium, incubated at 370C, isolated, identified and examined for antibiotic susceptibility by Kirby-Bauer method. Inclusion criteria were gram negative bacteria subjected to ESBL screening by cefotaxime, ceftazidime or ceftriaxone disc. Samples without clinical informations were excluded.Results: Four thousand three hundred and fifty blood samples were examined during 2 years periode with culture positive rate was 34.76% consist of gram negative bacteria 59.6% in which ESBL bacteria was 50.6%. ESBL bacteria significantly high recovered from intensive wards. Predominance bacteria were Ps. aeruginosa (50.9%), E. aerogenes (37.5%) and E. coli (8.7%). Sensitivity patterns to meropenem >82.2%, quinolone >65.6% except Ps. aeruginosa 52.5%, fosfomisin >74% except Ps. aeruginosa 15.5%,amikacin >82% except Ps. aeruginosa 20.6%.Conclusions: Bacterial culture positive rate was 34.76% with predominance bacteria was gram negative bacteria (59.6%), in which ESBL detected in 50.6%. The most predominance bacteria were Ps. aeruginosa, E. aerogenes and E. coli. Antibiotic sensitivity patterns mostly sensitive to meropenem, aminoglycocide and quinolone.Keywords: ESBL, intensive wards, meropenem ABSTRAKLatar belakang: Prevalensi kuman ESBL berbeda diberbagai rumah sakit, mempunyai gen penyandi di plasmid yang mudah dipindahkan ke kuman lain dengan morbiditas dan mortalitas tinggi. Di RSUP Dr. Kariadi belum ada data komprehensif tentang prevalensi dan distribusi kuman ESBL. Maksud penelitian untuk memberikan gambaran tentang prevalensi, distribusi dan pola kepekaan kuman ESBL.Metode: Penelitian bersifat retrospektif menggunakan catatan pemeriksaan darah pasien rawat inap yang dikultur menggunakan BACTEC di Laboratorium Mikrobiologi Klinik tahun 2004-2005. Tes kepekaan menggunakan metode Kirby-Bauer. Kriteria inklusi ialah kuman gram negatif yang resisten terhadap salah satu atau lebih dari disk antibiotika cefotaxim, ceftazidime dan cefipim, sedang kriteria eksklusi adalah keterangan klinik yang tidak lengkap.Hasil: Didapat 4.350 sampel, yang tumbuh kuman sebanyak 1.512 (34,76%) terdiri dari kuman gram positif 611 (40,4%) dan kuman gram negatif 901 (59,6%), diantaranya kuman ESBL sebanyak 456 (50,6%). Kuman ESBL di ruang perawatan intensif lebih banyak dibandingkan ruang non-intensif (p=0,00 chi square test). Prevalensinya adalah Ps. aeruginosa (50,9%), E. aerogenes (37,5%), E. coli (8,7%), K. pneumoniae (1,5%), A. baumini (1,1%) dan E. clocae (0,3%). Sensitifitas kuman terhadap antibiotika: meropenem >82,2%, kuinolon >65,6% kecuali Ps. aeruginosa 52,5%, fosfomisin >74% kecuali Ps. aeruginosa 15,5%, amikasin >82% kecuali Ps. aeruginosa 20,6%.Simpulan: Hasil kultur positif 34,76%, kuman ESBL didapatkan 50,9% dengan predominan Ps. aeruginosa, E. aerogenes dan E. coli. Kuman ESBL di ruang perawatan intensif lebih banyak, dengan sensitifitas antibiotika yang masih baik ialah meropenem, aminoglikosida dan kuinolon.

Sindrom Stevens-Johnson dan Nekrolisis Epidermal Toksis di RSUP MH Palembang Periode 2006 - 2008 M. Athuf Thaha
MEDIA MEDIKA INDONESIANA 2009:MMI VOLUME 43 ISSUE 5 YEAR 2009
Publisher : MEDIA MEDIKA INDONESIANA

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Steven-Johnson syndrome and toxic epidermal necrolysis in RSUP MH Palembang in year 2006-2008Background: Stevens-Johnson syndrome (SSJ) and toxic epidermal necrolysis (TEN) are rare, life-threatening, drug-induced cutaneous reactions.Methods: We conducted a retrospective study by gathering 43 SJS, SJS/TEN, and TEN patients data from RSUP MH General Hospital Palembang from 2006-2008. Variable that were evaluated covered the age, gender, incidence, drug causes, and results of medical treatment.Results: The number of SSJ cases was higher than SJS/TEN and TEN cases, most of SSJ patients were in 26-36 year age group (11 patients or 25.5%), with male/female ratio of: 55.8%:44.2%. The use of paracetamol, amoxycilline, tetracycline, cotrimoxsazole, methampirone, ciprofloxacine, and carbamazepine was associated with large increases in the risk of SSJ or TEN. Hospital stays for SSJ was 8.91 ± 5.52 days, and 13.2 ± 3.89 days for SJS/TEN. This retrospective study expressed the high incidence of the SJS inRSUP MH in 2006-2008 period, compared with the incidence reported in the bibliography.Conclusions: Although there were still controvercies in systemic corticosteroid use, this study showed the use of steroid gave satisfactory results.Keywords: Stevens-Johnson syndrome, toxic epidermal necrolysis, drug-induced cutaneous reactions ABSTRAKLatar belakang: Sindrom Stevens-Johnson (SSJ) dan nekrolisis epidermal toksis (NET) ialah reaksi kulit terutama akibat obat yang jarang ditemui dan dapat menyebabkan kematian.Metode: Penelitian dilakukan secara retrospektif dengan mengumpulkan data rekam medik RSUP MH Palembang periode 2006–2008, sebanyak 43 pasien rawat inap yang didiagnosis sebagai SSJ, SSJ/NET, dan NET. Variabel yang dievaluasi meliputi usia, jenis kelamin, angka kejadian penyakit, obat yang menyebabkan penyakit, lama perawatan, dan hasil pengobatan.Hasil: Hasil evaluasi menunjukkan jumlah kasus SSJ merupakan yang terbanyak dibandingkan NE lainnya, usia terbanyak SSJ terdapat pada kelompok usia 26-36 orang (11 orang atau 25,5%), rasio laki-laki/perempuan sebesar: 55,8%:44,2%. Obat yang terbanyak berturut-turut ialah parasetamol, amoksisilin, tetrasiklin, kotrimoksasol, metampiron, siprofloksasin dan karbamazepin. Lama perawatan pasien SSJ ialah 8,9 ± 5,5 dan SSJ/NET 13,2 ± 3,9 hari, dan semua pasien (kecuali yang pulang paksa) sembuh pada evaluasi paska rawat. Penelitian retrospektif ini mengungkap tingginya angka kejadian SSJ di RSUP MH periode 2006-2008, dibandingkan angka kejadian yang dilaporkan dalam kepustakaan. Terdapat perbedaan jenis obat penyebab SSJ di RSUP Palembang dari obat penyebab risiko tinggi yang dilaporkan dalam literatur.Simpulan: Walaupun masih terdapat silang pendapat penggunaan steroid sistemik pada SSJ, penelitian ini menunjukkan pemakaian steroid memberikan hasil yang memuaskan.

Risk Factors for Mortality in Dengue Shock Syndrome (DSS) Catharina Suharti; Tatty E Setiati; Eric CM Van Gorp; Robert J Djokomoeljanto; Moeljono S Trastotenojo; Jos WM van der Meer van der Meer; Wil MV Dolmans
MEDIA MEDIKA INDONESIANA 2009:MMI VOLUME 43 ISSUE 5 YEAR 2009
Publisher : MEDIA MEDIKA INDONESIANA

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Background: Dengue shock syndrome (DSS) is the most severe form of dengue hemorrhagic fever (DHF) and has a high mortality. There are two major pathological changes in DHF determining the severity of disease, plasma leakage and bleeding. Cytokines released during the immune response to dengue virus have been thought to be mediators of the process.Methods: The study involved 50 children with DSS, of whom 13 (26%) died. We investigated which clinical signs and laboratory findings are related to mortality.Results: We found that gastrointestinal bleeding and bilateral pleural effusion were significantly more frequent in non-survivors than in survivors (p<0.02 and p=0.0006, respectively). Also, mean admission levels of thrombin-antithrombin complexes (TATc) and plasminogen activator inhibitor type 1 (PAI-1), activation markers of coagulation and fibrinolysis, respectively, were significantly higher in non-survivors (p=0.004 and p=0.0006, respectively). In regression analysis, bilateral pleural effusion and admission levels of TATc were significantly associated with mortality (p=0.007 and p=0.048, respectively).Conclusions: Our data provide evidence for a relationship of mortality with pleural effusion, a marker of plasma leakage, and coagulation activation, both characteristic pathological changes in dengue shock syndrome.Keywords: Dengue shock syndrome, mortality, risk factor.ABSTRAKFaktor risiko kematian pada demam berdarah dengue dengan sindroma syok (DSS)Latar belakang: DSS merupakan bentuk klinik yang paling berat dari demam berdarah dengue (DBD) dan mempunyai angka kematian yang tinggi. Terdapat dua kelainan patologik utama pada DBD yang menentukan beratnya penyakit, yakni kebocoran plasma dan perdarahan. Sitokine yang dilepas sewaktu terjadi respon imun virus dengue diduga merupakan mediator proses ini.Metode: Studi dilaksanakan pada 50 penderita DSS anak, dimana 13 (26%) diantaranya meninggal. Investigasi dilakukan untuk mencari temuan klinik dan laboratorik yang berhubungan dengan kematian.Hasil: Perdarahan gastrointestinal dan efusi pleura bilateral secara bermakna lebih banyak ditemukan pada penderita yang meninggal dibandingkan dengan penderita yang hidup (berturut-turut p<0,02 dan p=0,0006). Rerata kadar thrombin-antithrombin complexes (TATc) sewaktu masuk rumah sakit dan kadar plasminogen activator inhibitor type 1 (PAI-1) juga merupakan petanda aktivasi koagulasi dan fibrinolisis, secara bermakna (berturut-turut p=0,004 dan p=0,0006) lebih tinggi pada penderita yang meninggal. Pada analisis regresi didapatkan bahwa efusi pleura bilateral dan kadar TATc sewaktu masuk rumah sakit berhubungan bermakna dengan kematian (berturut-turut p=0,007 dan p=0,048).Simpulan: Data dari studi ini membuktikan adanya hubungan antara kematian dan efusi pleura bilateral (suatu petanda kebocoran plasma) dan aktivasi koagulasi dimana keduanya merupakan kelainan patologik khas untuk DSS.

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