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BackgroundThe COVID-19 pandemic has encouraged adaptations of learning methods in clinical clerkship. There have been limited reports on the merits of involving medical students in telemedicine. This study, therefore, aims to investigate students’ reflection on what they learned and identify the challenges and benefits of doctor-patient interaction through their experience in a telemedicine-based course.MethodsA 4 week telemedicine-based course for medical students to participate in telemonitoring of COVID-19 patients undergoing self-isolation was conducted. This is a qualitative study using an interpretive phenomenology design to investigate students’ self-reflection on their experiences in monitoring COVID-19 patients. Students were asked to reflect on their experience upon completion of the course through 750–1,000 words essays. A thematic analysis which considers units of meaning based on students’ experiences was completed.ResultsOur study identified four main themes gathered from students’ experiences related to the telemedicine-based course: communication and education, professionalism and professional identity formation, system-based practice, and patient-centered care.ConclusionThe course was part of an integrative effort involving multiple parties to tackle the burden on the nation’s healthcare system during the pandemic. Telemedicine is part of future medical practice which supports the medical curriculum adaptability along with attempts to develop future-proof medical doctors through various clinical learning experiences.

Background: The incidence of coronavirus disease 2019 (COVID-19) is still increasing rapidly, but little is known about the prevalence and characteristics of fatal cases in children in Indonesia. This study aimed to describe the characteristics of children with COVID-19 with fatal outcomes in a tertiary referral hospital in Indonesia. Methods: This cross-sectional study used data collected from the medical records of patients with COVID-19 admitted to Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia from March to October 2020. Results: During the study period, 490 patients were admitted and diagnosed with suspected and probable COVID-19. Of these patients, 50 (10.2%) were confirmed to have COVID-19, and 20 (40%) had a fatal outcome. The fatality rate was higher in patients aged ≥10 years, categorized with severe disease upon admission, PaO2/FiO2 ratio ≤300 mmHg and chronic underlying diseases. The most common clinical manifestations were generalized symptoms, while acute respiratory distress syndrome (8/20) and septic shock (7/20) were the two most common causes of death. Increased procalcitonin, D-dimer, lactate dehydrogenase and presepsin levels were found in all fatal cases. One patient met the criteria of multisystem inflammatory syndrome in children. Conclusion: Our work highlights the high mortality rate in paediatric patients with positive SARS-CoV-2 polymerase chain reaction test. These findings might be related to or co-incided with COVID-19 infection. Further studies are needed to improve understanding of the role of severe acute respiratory syndrome coronavirus-2 in elaborating the mechanisms leading to death in children with comorbidities.

To address inborn errors of immunity (IEI) which were underdiagnosed in resource-limited regions, our centre developed and offered free genetic testing for the most common IEI by Sanger sequencing (SS) since 2001. With the establishment of The Asian Primary Immunodeficiency (APID) Network in 2009, the awareness and definitive diagnosis of IEI were further improved with collaboration among centres caring for IEI patients from East and Southeast Asia. We also started to use whole exome sequencing (WES) for undiagnosed cases and further extended our collaboration with centres from South Asia and Africa. With the increased use of Next Generation Sequencing (NGS), we have shifted our diagnostic practice from SS to WES. However, SS was still one of the key diagnostic tools for IEI for the past two decades. Our centre has performed 2,024 IEI SS genetic tests, with in-house protocol designed specifically for 84 genes, in 1,376 patients with 744 identified to have disease-causing mutations (54.1%). The high diagnostic rate after just one round of targeted gene SS for each of the 5 common IEI (X-linked agammaglobulinemia (XLA) 77.4%, Wiskott–Aldrich syndrome (WAS) 69.2%, X-linked chronic granulomatous disease (XCGD) 59.5%, X-linked severe combined immunodeficiency (XSCID) 51.1%, and X-linked hyper-IgM syndrome (HIGM1) 58.1%) demonstrated targeted gene SS should remain the first-tier genetic test for the 5 common X-linked IEI.

Latar belakang. Lupus eritematosus sistemik merupakan penyakit autoimun sistemik pada jaringan ikat yang bersifat kronik dan progresif, terutama pada anak. Hingga saat ini belum ada diagnosis baku emas, sehingga untuk menegakkan diagnosis dapat menggunakan kriteria The American College of Rheumatology (ACR) tahun 1997 atau The Systemic Lupus International Collaborating Clinics (SLICC) tahun 2012.Tujuan. Mengumpulkan bukti ilmiah perbandingan penggunaan kriteria ACR-1997 dan SLICC-2012 dalam diagnosis lupus eritematosus sistemik pada anak.Metode. Penelusuran literatur secara sistematis secara daring melalui database Pubmed dan Cochrane. Analisis dilakukan menggunakan Review Manager dan model hierarchical summary receiver operating characteristic (HSROC) pada studi meta-analsiis. Kualitas studi dinilai dengan QUADAS-2.Hasil. Satu artikel telaah sistematis dan meta-analisis dan satu artikel studi longitudinal dilakukan telaah kritis. Kualitas kedua studi dinilai baik. Studi oleh Hartman dkk menunjukkan kriteria ACR-1997 lebih dianjurkan sebagai kriteria klasifikasi LES pada anak karena lebih spesifik (94,1% vs 82%) dan menghindari terjadinya positif palsu. Studi kedua oleh Lythgoe dkk menunjukkan SLICC-2012 lebih sensitif (92,9% vs 84,1%) dan secara lebih dini mengklasifikasi pasien anak dengan LES.Kesimpulan. Kriteria SLICC-2012 memiliki sensitivitas yang lebih tinggi dalam klasifikasi LES pada anak tetapi memiliki spesifisitas yang lebih rendah dibandingkan ACR-1997. Namun, SLICC-2012 dapat mengklasifikasi LES lebih dini secara signifikan dibandingkan ACR-1997.

Background While the number of cases of multisystem inflammatory syndrome in children (MIS-C) is increasing, reported cases in Asian countries are still low, particularly in Indonesia. This study aimed to describe the characteristics of patients with MIS-C in a tertiary referral hospital in Indonesia. Methods This is a cross-sectional study with collected data of patients with MIS-C admitted to Dr. Cipto Mangunkusumo from March 2020 to April 2021. Results The first case of MIS-C was detected 5 months after the first reported coronavirus disease 2019 case in Indonesia. Thirteen patients out of 158 positive admitted patients for COVID-19 were diagnosed with MIS-C during the study period. Of these 13 patients, 2 patients (15%) had a fatal outcome. Subjects were predominantly male, and the median age was 7.58 years (IQR 12.3) years. Most patients required mechanical ventilation (7 out of 13 patients) and intubation (8 out of 13 patients). Patients who needed intubation usually needed mechanical ventilation. All inflammatory markers, white blood cells, neutrophil counts, and all coagulation factor parameters (except for normal prothrombin time and activated partial prothrombin time) were elevated. The median time to MIS-C diagnosis was 2 days in the survivor group (n = 11) compared to 8.5 days in the non-survivor group (n = 2). Compared to the non-survivor group, those who survived spent more days in the hospital, received vasopressors earlier, and did not require mechanical ventilation as early as the non-survivors. Conclusions Our work highlights the differences in MIS-C clinical course, treatment, and clinical outcomes between the two groups.

Perinatally HIV-infected adolescents (PHIVA) are an expanding population vulnerable to loss to follow-up (LTFU). Understanding the epidemiology and factors for LTFU is complicated by varying LTFU definitions.Asian regional cohort incorporating 16 pediatric HIV services across 6 countries.Data from PHIVA (aged 10-19 years) who received combination antiretroviral therapy 2007-2016 were used to analyze LTFU through (1) an International epidemiology Databases to Evaluate AIDS (IeDEA) method that determined LTFU as90 days late for an estimated next scheduled appointment without returning to care and (2) the absence of patient-level data for365 days before the last data transfer from clinic sites. Descriptive analyses and competing-risk survival and regression analyses were used to evaluate LTFU epidemiology and associated factors when analyzed using each method.Of 3509 included PHIVA, 275 (7.8%) met IeDEA and 149 (4.3%) met 365-day absence LTFU criteria. Cumulative incidence of LTFU was 19.9% and 11.8% using IeDEA and 365-day absence criteria, respectively. Risk factors for LTFU across both criteria included the following: age at combination antiretroviral therapy initiation5 years compared with age ≥5 years, rural clinic settings compared with urban clinic settings, and high viral loads compared with undetectable viral loads. Age 10-14 years compared with age 15-19 years was another risk factor identified using 365-day absence criteria but not IeDEA LTFU criteria.Between 12% and 20% of PHIVA were determined LTFU with treatment fatigue and rural treatment settings consistent risk factors. Better tracking of adolescents is required to provide a definitive understanding of LTFU and optimize evidence-based models of care.

To ensure that students continued receiving adequate yet safe clinical exposure during the COVID-19 pandemic, the Faculty of Medicine at Universitas Indonesia (FMUI) created the Module of COVID-19 Self-Isolation Monitoring which aims to equip students with the knowledge and skill to monitor confirmed and close contact cases of COVID-19. Module development, divided into four phases: preparation, orientation, implementation, and evaluation phase, started as soon as the delta wave of COVID-19 cases forced medical students to halt their offline clinical rotations. A quantitative secondary data were obtained from student and patient satisfaction questionnaires and on students’ performance and reflection. We analyzed the distribution of module evaluation, the student’s discussion score during the module, the students’ interest in participating as Covid-19 volunteers before and after the module’s deployment, and the correlation between learning outcomes and satisfaction. A total of 372 patients were monitored by 208 students during the 4-week module. The response rates were above 80%, with the majority agreeing that students found this module well-organized and fulfilled their expectations. There was a significant increase in discussion scores from weeks 1 to 4, a significant difference in the proportion of students interested in COVID-19 volunteering before and after the module completion as well as a significant low correlation between the patient’s monitoring score sheet and the reflection essay towards the patient’s satisfaction. We should still improve tutors’ time management, tutors’ provision of triggering questions for critical thinking skills, and tutors’ feedback for students. The module met patient expectations and is expected to assist tutors in providing feedback and examples of doctor–patient communication, thus accelerating students’ competence in patient interaction. Further evaluation is needed regarding knowledge transfer, the impact on community health, and the faculty development program, especially regarding how tutors fulfill their roles as medical educators.

Latar belakang. Artritis idiopatik juvenil (AIJ) sistemik merupakan penyakit inflamasi sistemik yang tidak hanya melibatkan sendi tetapi juga keterlibatan sistemik dan merupakan tipe terberat dari AIJ. Tatalaksana standar yang diberikan sering tidak memberikan respons klinis optimal sehingga meningkatkan morbiditas dan mortalitas. Pemberian agen biologis seperti tocilizumab atau anakinra merupakan pilihan agen biologis untuk tatalaksana AIJ sistemik. Tujuan. Mengumpulkan bukti ilmiah tentang efektivitas pemberian tocilizumab dibandingkan anakinra dalam tatalaksana AIJ sitemik. Metode. Pencarian artikel dilakukan secara daring menggunakan instrumen kata kunci yang sesuai melalui basis data Pubmed, Cochrane dan Google Scholar pada bulan Februari 2022.Hasil. Penelusuran dilakukan dan didapatkan dua artikel dengan kohort retrospektif. Remisi klinis pada kelompok tocilizumab berkisar sekitar 44-45%, sedangkan pada kelompok anakinra berkisar 25-38%. Kesimpulan. Tocilizumab memberikan respons klinis yang lebih baik dibandingkan anakinra dalam tatalaksana AIJ sistemik.

Latar belakang. Infeksi sitomegalovirus (CMV) adalah infeksi oportunistik virus yang tersering pada anak dengan infeksi HIV. Setelah era penggunaan terapi ARV prevalensi infeksi sitomegalovirus pada anak dengan infeksi HIV di negara berkembang belum mengalami penurunan bermakna. Tujuan. Mengetahui prevalensi , karakteristik demografi, manifestasi klinis, terapi, dan luaran infeksi sitomegalovirus pada anak ≤18 tahun dengan infeksi HIV di RSUPN Cipto Mangunkusumo tahun 2003-2018. Metode. Studi retrospektif deskriptif dilakukan terhadap seluruh anak ≤18 tahun dengan infeksi HIV di RSUPN Cipto Mangunkusumo pada tahun 2003-2018. Evaluasi infeksi sitomegalovirus dilakukan terhadap subyek yang memiliki manifestasi klinis sugestif infeksi sitomegalovirus. Hasil. Prevalensi infeksi sitomegalovirus pada anak dengan HIV di RSUPN Cipto Mengunkusumo tahun 2018 adalah 6%, meningkat 5 kali dibandingkan dengan tahun 2007. Total anak yang mengalami ko-infeksi HIV-CMV adalah 36 orang. Sebagian besar subyek adalah lelaki, berusia 49 bulan (rentang 2-191 bulan), belum menggunakan ARV, dengan rerata CD4 382 sel/μL (11%). Manifetasi klinis tersering adalah demam ≥2 minggu, peningkatan enzim transaminase, dan diare kronik. Titer IgM dan IgG reaktif didapatkan pada 22 dan 32 subyek. Materi DNA sitomegalovirus terdeteksi pada 25 subyek. Infeksi sitomegalovirus terbanyak terjadi dalam bentuk sindrom sitomegalovirus (15/36), korioretinitis (9/36), dan hepatitis (6/36). Immune reconstitution syndrome didapatkan pada empat subyek. Seluruh subyek mendapatkan terapi inisial dengan gansiklovir, valgansiklovir, atau kombinasi keduanya. Tidak ada subyek yang meninggal saat terapi inisial, tetapi 11 subyek memiliki morbiditas permanen dengan 9 subyek di antaranya mengalami low vision atau kebutaan. Kesimpulan. Prevalensi infeksi sitomegalovirus pada anak dengan infeksi HIV sebesar 6%. Infeksi sitomegalovirus perlu diwaspadai pada anak HIV dalam keadaan imunosupresi berat yang mengalami demam ≥2 minggu disertai manifestai klinis terkait organ target.

The aim of this prospective study was to investigate the serotypes and antibiotic susceptibility ofS. pneumoniaecarried by children infected with HIV before and after vaccination with the seven-valent pneumococcal conjugate vaccine in Jakarta, Indonesia in 2013. We collected nasopharyngeal swab specimens from 52 children pre-vaccination and 6 months post-vaccination. Serotyping was performed by conventional multiplex polymerase chain reaction and Quellung reaction. The antibiotic susceptibility profile was obtained by disc diffusion. We determined that 27 (52%) and 24 (46%) of the 52 children carriedS. pneumoniaeduring pre- and post-vaccination periods, respectively with the majority of the isolates being non-vaccine type strains (85% pre-vaccination and 75% post-vaccination). Serotypes 34, 6C, and 16F (two strains each) were the most commonly identified serotypes at pre-vaccination. Serotypes 23A (three strains) and 19F (two strains) were the most commonly identified serotypes post-vaccination. In general, isolates were most commonly susceptible to chloramphenicol (88%) and clindamycin (88%), followed by erythromycin (84%), trimethoprim-sulphamethoxazole (69%), tetracycline (61%), and penicillin (59%). In conclusion, serotypes ofS. pneumoniaeisolated from the nasopharynges of children infected with HIV varied and were more likely to be non-vaccine type strains both before and after vaccination.

Background: The Asia Pacific Society for Immunodeficiencies (APSID) conducted nine primary immunodeficiency (PID) Schools in 5 years since inauguration to provide PID care training for early career physicians in Asia Pacific, a region with divergent needs in PID resources and training. Objective: To identify differences in PID patient care resource and training needs across Asia Pacific and propose a corresponding action plan. Methods: The Human Development Index (HDI) indicates the degree of socio-economic development in each country/region. Information related to investigations and learning issues were extracted from the abstracts and personal statements from all Schools and mapped onto resource and training needs. Correlations between HDI and country/region-specific parameters were tested by two-tailed Pearson correlation. Results: A total of 427 abstracts were received in nine Schools between 2015 and 2020, predominantly on immunodeficiencies affecting cellular and humoral immunity. Genetic confirmation was described in 61.8% of abstracts, and its absence negatively correlated with HDI (r = -0.696, p = 0.004). Essential immunologic and genetic tests were not available in 25.4 and 29.5% of abstracts, respectively, and their absence negatively correlated with HDI (r = -0.788, p < 0.001; r = -0.739, p = 0.002). HDI positively correlated with average testing level (r = 0.742, p = 0.002). Cases from medium-HDI countries/regions focused on learning how to investigate a patient for PIDs in cases of severe or atypical infections, whereas those from very-high-HDI countries/regions, from which most faculty members originated, listed hematopoietic stem cell transplantation and gene therapy, newborn screening, and research as learning issues more frequently. Conclusion: There are unique HDI-related PID resource and training needs in each country/region. APSID proposes HDI group-specific strategies to improve PID care and education in her member countries/regions. Further quantitative analysis of needs in PID care in Asia Pacific is needed for lobbying governments to increase their support for PID care and research.

The aim of this prospective study was to investigate the serotypes and antibiotic susceptibility of S. pneumoniae carried by children infected with HIV before and after vaccination with the seven-valent pneumococcal conjugate vaccine in Jakarta, Indonesia in 2013. We collected nasopharyngeal swab specimens from 52 children pre-vaccination and 6 months post-vaccination. Serotyping was performed by conventional multiplex polymerase chain reaction and Quellung reaction. The antibiotic susceptibility profile was obtained by disc diffusion. We determined that 27 (52%) and 24 (46%) of the 52 children carried S. pneumoniae during pre- and post-vaccination periods, respectively with the majority of the isolates being non-vaccine type strains (85% pre-vaccination and 75% post-vaccination). Serotypes 34, 6C, and 16F (two strains each) were the most commonly identified serotypes at pre-vaccination. Serotypes 23A (three strains) and 19F (two strains) were the most commonly identified serotypes post-vaccination. In general, isolates were most commonly susceptible to chloramphenicol (88%) and clindamycin (88%), followed by erythromycin (84%), trimethoprim-sulphamethoxazole (69%), tetracycline (61%), and penicillin (59%). In conclusion, serotypes of S. pneumoniae isolated from the nasopharynges of children infected with HIV varied and were more likely to be non-vaccine type strains both before and after vaccination.

Teaching of adult advanced life support (ALS) using low fidelity simulation (LFS) and high fidelity simulation (HFS) gives different results, that can be caused by cultural background difference among students. This study aims to determine the comparison of HFS and LFS in ALS skill attainment and knowledge improvement on FMUI students. An experimental, randomized, single-blinded study with descriptive and analytic data presentation was conducted. Subjects were 39 FMUI students on the 3rd semester. All subjects had written pretest, lecture, and watched video demonstration. In training session, subjects were divided into two groups: LFS and HFS group. LFS group used ResusciAnne® and HFS group used SIMMAN3G®. There were written posttest and skill examination using SIMMAN3G®. Data collected were skill examination and written test scores. Statistical tests used were unpaired T test and Mann Whitney. The skill score in the LFS group was 47.8(39.1–56.5) and in the HFS group was 65.2(39.1–78.2), p = 0.02. The increase of knowledge score in LFS group was 42,75±13,90 (pretest knowledge score 35,25±9,93, posttest knowledge score 78,00±14,73) and HFS group 45.26±10.99 (pretest knowledge score 34.47±7.80, posttest knowledge score 79,74±10,20), p = 0.53. The use of HFS is better than LFS in attaining adult ALS skill on FMUI students and both methods provide equal result in knowledge improvement.

Lupus eritematosus sistemik (LES) merupakan penyakit kronik yang dapat menyebabkan masalah emosi pada remaja, khususnya perempuan sehingga fokus perawatan pada remaja dengan LES adalah mengatasi gangguan yang dialami secara keseluruhan. Studi ini bertujuan untuk mengetahui masalah emosi pada remaja perempuan dengan LES dan efektivitas pelatihan kecakapan hidup-modul pengelolaan emosi (PKH-MPE) dalam mengatasi masalah emosi. Studi ini menggunakan desain uji klinis teracak dalam 2 grup di RSUPN dr. Cipto Mangungkusumo pada bulan Januari hingga Desember 2019. Subjek adalah 30 remaja perempuan dengan LES yang sudah mendapat terapi dan memiliki skor Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) 0-5. Masalah emosi dinilai dengan Strength and Difficulties Questionnaire (SDQ) pada awal dan 4 minggu pasca perlakuan. Sebanyak 6/30 remaja perempuan memiliki nilai SDQ abnormal pada awal studi. PKH-MPE efektif menurunkan masalah emosi pada kelompok perlakuan dibandingkan kontrol (uji Wilcoxon, p=0,002). Pada kelompok perlakuan terdapat perbaikan total skor SDQ (p=0,001), masalah emosi (p = 0,002), masalah perilaku (p=0,027) dan perilaku hiperaktif (p=0,040) dibandingkan awal studi. PKH-MPE secara bermakna mengurangi keluhan nyeri, kecemasan dan perasaan gugup pada kelompok perlakuan. Disimpulkan PKH-MPE efektif memperbaiki masalah emosi pada remaja perempuan dengan LES, terutama keluhan nyeri, cemas, dan perasaan gugup. Kata kunci: lupus, penyakit kronis, masalah emosi, pelatihan kecakapan hidup, SDQ. Effectiveness of Life SkillsTraining-Emotional Management Module in Female Adolescent with Systemic Lupus Erythematosus Abstract Systemic lupus erythematosus (SLE) is a chronic disease that can cause emotional problems in adolescents, predominantly female thus, the focus of care in adolescents with SLE is to treat the patients holistic. The study aims to assess the emotional problems in female adolescents with SLE and the effect of life skills training-emotional management module in female adolescents with SLE. This study is a randomized clinical trial with no blinding which located in Cipto Mangunkusumo Hospital Jakarta. Thirty female adolescents with treated SLE and had Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score 0-5 were included. Emotional problems were assessed at the beginning of the study and four weeks after intervention. It was found that there were 6/30 subjects with abnormal SDQ at the beginning of the study. Life skills training was found effective in treating emotional problems, compared to control with (Wilcoxon test, p=0.002). Life skill straining was also found effective in improving SDQ score (p=0.001), emotional problem (p=0.002), conduct problems (p=0.027),and hyperactivity (p=0.040) in the intervention group compared to baseline. Life skill straining reduced physical pain, worries, and nervousness in the intervention group. In conclusion, the life skill straining-emotional management module was effective in improving emotional problems in a female adolescent with SLE, especially physical pain, worries, and nervousness. Keywords: SLE, chronic disease, emotional problems, life skills training, SDQ.

Seorang anak perempuan berusia 3 tahun dengan gejala klinis anemia berat,hepatosplenomegali, dan memerlukan tranfusi darah teratur. Gejala klinis telah timbulsaat pasien berusia 3 bulan. Hapusan darah tepi menunjukkan gambaran hipokrom,mikrositosis, dan anisopoikilositosis. Kadar HbA2 normal, HbF sedikit meningkat, danterdapat HbBart’s. Ayah dan ibu memiliki gambaran hematologis yang mendekati normal.Analisis DNA menunjukkan dua mutasi non-delesi (mutasi titik) pada gen globin a2yaitu pada kodon 59 (GGCglisin→GACaspartat) dan IVS2-nt142 (AG→AA). Kasus ini adalahkasus pertama yang ditemukan di Departemen Ilmu Kesehatan Anak RS. Dr. CiptoMangunkusumo Jakarta yang mempunyai mutasi heterozigot ganda pada kodon 59 danIVS2-nt142. Gejala klinis thalassemia mayor diakibatkan adanya mutasi kodon 59 yangmenghasilkan varian hemoglobin yang tidak stabil (HbAdana) disertai adanya mutasinon-delesi pada IVS2-nt142 yang menyebabkan proses mRNA yang tidak normal.

PURPOSE: Antiretroviral monotherapy and treatment interruption are potential strategies for perinatally HIV-infected adolescents (PHIVA) who face challenges maintaining effective combination antiretroviral therapy (ART). We assessed the use and outcomes for adolescents receiving monotherapy or undergoing treatment interruption in a regional Asian cohort. METHODS: Regional Asian data (2001–2016) were analyzed to describe PHIVA who experienced ≥2 weeks of lamivudine or emtricitabine monotherapy or treatment interruption and trends in CD4 count and HIV viral load during and after episodes. Survival analyses were used for World Health Organization (WHO) stage III/IV clinical and immunologic event-free survival during monotherapy or treatment interruption, and a Poisson regression to determine factors associated with monotherapy or treatment interruption. RESULTS: Of 3,448 PHIVA, 84 (2.4%) experienced 94 monotherapy episodes, and 147 (4.3%) experienced 174 treatment interruptions. Monotherapy was associated with older age, HIV RNA >400 copies/mL, younger age at ART initiation, and exposure to ≥2 combination ART regimens. Treatment interruption was associated with CD4 count

Latar belakang. Fomula berbasis isolat protein kedelai banyak digunakan untuk anak-anak dengan alergi susu sapi di Indonesia. Namun, diperlukan penelitian untuk mendapatkan gambaran penerimaan orangtua dan toleransi saluran cerna pada penggunaan formula isolat protein kedelai.Tujuan. Pertama, menentukan penerimaan orangtua terhadap pemberian suatu isolat protein kedelai pada bayi yang diduga mengalami alergi terhadap protein susu sapi. Kedua, mengetahui toleransi saluran cerna pada pemberian susu formula tersebut.Metode. Suatu studi pasca-pemasaran, prospektif, multisenter yang dilakukan di Jakarta, Bandung, Surabaya, Yogyakarta, Solo, dan Denpasar sejak September 2011 sampai April 2012. Subyek berusia antara 6 bulan hingga 1 tahun dengan gejala dugaan alergi terhadap protein susu sapi yang diberikan formula isolat protein kedelai dan diamati selama 4 minggu. Luaran yang diharapkan adalah penerimaan orangtua terhadap pemberian formula isolat protein kedelai dan toleransi saluran cerna terhadap pemberian isolat protein kedelai.Hasil. Diteliti 534 subyek yang dapat dianalisis selama periode penelitian. Mayoritas orangtua (84%) merasa puas dengan formula isolat protein kedelai, 83% orangtua berencana untuk melanjutkan pemberian susu formula karena berkurang (31,5%) dan hilangnya gejala yang diduga akibat alergi susu sapi (32,4%). Gejala klinis yang diduga akibat alergi terhadap protein susu sapi menurun pada setiap kunjungan berikutnya. Tidak ada efek samping serius yang dilaporkan selama periode penelitian.Kesimpulan. Penelitian ini menemukan tingkat penerimaan orangtua dan toleransi saluran cerna yang baik terhadap pemberian formula isolat protein kedelai kepada bayi dengan gejala sugestif alergi terhadap protein susu sapi. Formula isolat protein kedelai cukup aman dijadikan sebagai formula alternatif pengganti pada anak dengan alergi susu sapi.

Latar belakang. Akses terhadap terapi antiretroviral (ARV) semakin mudah saat ini dan membuat angka harapan hidup anak terinfeksi HIV semakin panjang. Dalam penanganan jangka panjang anak terinfeksi HIV, salah satu masalah baru yang timbul adalah gagal terapi dan resistensi obat. Tujuan. Menilai karakteristik pasien anak terinfeksi di RS. Cipto Mangunkusumo yang menggunakan terapi ARV lini kedua dan indikasi penggantian ke terapi ARV lini kedua. Metode. Penelitian kohort pasien anak terinfeksi HIV di RS Cipto Mangunkusumo sejak tahun 2002. Kriteria inklusi adalah pasien anak terinfeksi HIV yang berobat di RS Cipto Mangunkusumo sejak tahun 2002 sampai April 2012 dan menggunakan salah satu obat antiretroviral lini kedua. Data yang diambil adalah data demografis, kada CD4, jumlah virus, stadium klinis, dan kombinasi terapi ARV. Hasil. Empatratus empat pasien anak terinfeksi HIV dan 44 (10,9%) menggunakan terapi antiretroviral lini kedua. Sebagian besar (59,1%) gagal terapi adalah kombinasi antara kegagalan virologi, imunologis, dan klinis. Median usia saat memulai terapi ARV lini kedua 69 (26-177) bulan. Median lama subyek menggunakan terapi ARV lini pertama 9 (13-176) bulan. Seluruh subyek penelitian menggunakan lopinavir/ ritonavir sebagai salah satu obat ARV lini kedua dengan kombinasi terbanyak adalah didanosin, lamivudin, dan lopinavir/ritonavir (40,9%). Efek samping didapatkan pada 2 pasien akibat abacavir. Sebagian besar subyek (19/25) yang diperiksa jumlah virus pada 6-12 sesudah menggunakan ARV lini kedua mempunyai hasil tidak terdeteksi. Kesimpulan. Jumlah pasien yang menggunakan terapi ARV lini kedua tidak terlalu banyak karena deteksi kegagalan terapi masih lebih banyak berdasarkan kegagalan klinis dan imunologis.

Latar belakang. Sindrom Down merupakan kelainan kromosom tersering. Anak dengan sindrom Down (SD) di berbagai negara memiliki beberapa faktor risiko terhadap OSA dengan prevalensii antara 30%-60%, dibandingkan 0,7%-2% pada populasi umum. Hingga saat ini belum ada data mengenai OSA pada anak sindrom Down di Indonesia. Tujuan. Mengidentifikasi prevalensi OSA pada anak sindrom Down dan menganalisis hubungan antara habitual snoring, obesitas, penyakit alergi di saluran napas, hipertrofi tonsil, dan hipertrofi adenoid sebagai faktor risiko OSA pada anak sindrom Down. Metode. Penelitian potong lintang dilakukan pada anak sindrom Down berusia 3-18 tahun yang tergabung dalam Yayasan POTADS. Penelitian dilakukan di Poliklinik Respirologi IKA FKUI RSCM dari bulan Juli 2016 hingga Juli 2017. Penegakan diagnosis OSA menggunakan nilai batas AHI≥3 pada pemeriksaan poligrafi. Faktor- risiko yang dianggap berpengaruh dianalisis secara multivariat. Hasil. Penelitian dilakukan terhadap 42 subjek dengan hasil prevalensi OSA pada anak dengan SD 61,9%. Sebesar 42,9% merupakan OSA derajat ringan, 14,3% OSA sedang, dan 4,8% OSA berat. Pada analisis multivariat didapatkan faktor risiko yang bermakna yaitu habitual snoring (p=0,022 dan PR 8,85; IK 1,37-57) dan hipertrofi adenoid (p=0,006 dan PR 12,93; IK 2,09-79). Kesimpulan. Prevalensi OSA pada anak sindrom Down sebesar 61,9%. Faktor risiko yang bermakna yaitu habitual snoring dan hipertrofi adenoid.

Purpose Feeding tolerance is extremely important in preterm infants. This study aimed to evaluate whether preterm infants receiving Lactobacillus reuteri DSM 17938 would develop fewer symptoms of feeding intolerance. Secondary outcomes were duration of parenteral nutrition, time to reach full feeding, length of hospital stay, sepsis, necrotizing enterocolitis (NEC), diarrhea, and mortality. Methods This double-blind randomized controlled trial of L. reuteri DSM 17938 versus placebo included 94 neonates with a gestational age of 28-34 weeks and birth weight of 1,000-1,800 g. Results Feeding intolerance (vomiting and/or distension) was less common in the probiotic group than in the placebo group (8.5% vs. 25.5%; relative risk, 0.33; 95% confidence interval, 0.12-0.96; p=0.03). No significant intergroup differences were found in proven sepsis, time to reach full feeding, length of hospital stay, or diarrhea. The prevalence of NEC (stages 2 and 3) was 6.4% in the placebo group vs. 0% in the probiotic group (relative risk, 1.07; 95% confidence interval, 0.99-1.15; p=0.24). Mortality rates were 2.1% in the probiotic group and 8.5% in the placebo group, p=0.36). Conclusion The administration of L. reuteri DSM 17938 to preterm infants was safe and significantly reduced feeding intolerance. No significant differences were found in any other secondary outcomes.

Prevalence of allergic diseases is increasing worldwide, including food allergy. It is different between countries because food allergy can vary by culture and population. Prevalence of food allergy in Indonesia is unknown; therefore it is not known yet the burden and impact of food allergy in our population. However, we already start to formulate guidelines for diagnosis and management of food allergy, especially cow's milk allergy.

BACKGROUND The burden of Kaposi sarcoma (KS) in human immunodeficiency virus (HIV)-infected children and adolescents on combination antiretroviral therapy (cART) has not been compared globally. METHODS We analyzed cohort data from the International Epidemiologic Databases to Evaluate AIDS and the Collaboration of Observational HIV Epidemiological Research in Europe. We included HIV-infected children aged

Background Human immunodeficiency virus (HIV) infection is increasing worldwide. One foute of HIV transmission is from mother to child, during pregnancy, delivery or breastfeeding. Prevention of mother􀁂to􀁂child transmission may be an effective strategy to reduce the cases of new HIV infections. Objectives To investigate the incidence of HIV infection in infants born to mothers with HIV and who received prophylactic therapy at birth, as well as to note the outcomes of HIVinfected children in this program. Methods This retrospective study was carried out over a 9􀁂year period, from January 20 03 to December 2011. The participants were HIVexposed infants who attended the HIV clinic, at the Department of Child Health, Cipto Mangunkusumo Hospital, Jakarta. Infants were treated according to the prevention of mother􀁂to􀁂child transmission (PMTCT) protocol at CMH. Parents' and infants' data was recorded. The end point of this study was recording of HIVinfection status in the infants. Results There were 238 infants included in this study. HIV infection was confirmed in 6 (2.5%) infants, while 170 (71.4%) subjects were uninfected, and 62 (26.1%) subjects were lost to follow􀁂up. No subjects who underwent complete PMTCT management were infected. Most subjects were male, full􀁂tenn, and delivered by caesarean section in our hospital. The most frequently observed parental risk factor was intravenous drug use. Maternal antiretroviral therapy (ART) was given during pregnancy in most cases. Morbidities in all subjects were low. Conclusion The PMTCT program at CMH was effective for reducing the number ofHIVinfected infants from mothers with HIY. [Paediatrlndanes. 2012;52:294-9].

The growth benefits of cotrimoxazole during early antiretroviral therapy (ART) are not well characterized.Individuals enrolled in the Therapeutics Research, Education, and AIDS Training in Asia Pediatric HIV Observational Database were included if they started ART at ages 1 month-14 years and had both height and weight measurements available at ART initiation (baseline). Generalized estimating equations were used to identify factors associated with change in height-for-age z-score (HAZ), follow-up HAZ ≥ -2, change in weight-for-age z-score (WAZ), and follow-up WAZ ≥ -2.A total of 3217 children were eligible for analysis. The adjusted mean change in HAZ among cotrimoxazole and non-cotrimoxazole users did not differ significantly over the first 24 months of ART. In children who were stunted (HAZ-2) at baseline, cotrimoxazole use was not associated with a follow-up HAZ ≥ -2. The adjusted mean change in WAZ among children with a baseline CD4 percentage (CD4%)25% became significantly different between cotrimoxazole and non-cotrimoxazole users after 6 months of ART and remained significant after 24 months (overall P.01). Similar changes in WAZ were observed in those with a baseline CD4% between 10% and 24% (overall P.01). Cotrimoxazole use was not associated with a significant difference in follow-up WAZ in children with a baseline CD4%10%. In those underweight (WAZ-2) at baseline, cotrimoxazole use was associated with a follow-up WAZ ≥ -2 (adjusted odds ratio, 1.70 vs not using cotrimoxazole [95% confidence interval, 1.28-2.25], P.01). This association was driven by children with a baseline CD4% ≥10%.Cotrimoxazole use is associated with benefits to WAZ but not HAZ during early ART in Asian children.

Background To better understand the need for paediatric second-line antiretroviral therapy (ART), an ART management survey and a cross-sectional analysis of second-line ART use were conducted in the TREAT Asia Paediatric HIV Observational Database and the IeDEA Southern Africa (International Epidemiologic Databases to Evaluate AIDS) regional cohorts. Methods Surveys were conducted in April 2009. Analysis data from the Asia cohort were collected in March 2009 from 12 centres in Cambodia, India, Indonesia, Malaysia, and Thailand. Data from the IeDEA Southern Africa cohort were finalized in February 2008 from 10 centres in Malawi, Mozambique, South Africa and Zimbabwe. Results Survey responses reflected inter-regional variations in drug access and national guidelines. A total of 1301 children in the TREAT Asia and 4561 children in the IeDEA Southern Africa cohorts met inclusion criteria for the cross-sectional analysis. Ten percent of Asian and 3.3% of African children were on second-line ART at the time of data transfer. Median age (interquartile range) in months at second-line initiation was 120 (78-145) months in the Asian cohort and 66 (29-112) months in the southern African cohort. Regimens varied, and the then current World Health Organization-recommended nucleoside reverse transcriptase combination of abacavir and didanosine was used in less than 5% of children in each region. Conclusions In order to provide life-long ART for children, better use of current first-line regimens and broader access to heat-stable, paediatric second-line and salvage formulations are needed. There will be limited benefit to earlier diagnosis of treatment failure unless providers and patients have access to appropriate drugs for children to switch to.

Background The management of cow’s milk allergy (CMA) is avoidance of cow’s milk as strictly as possible. Extensive hydrolyzed protein and amino acid based formulas are recommended dietary products for treatment of CMA. However, they have some disadvantages, such as bitter taste and high cost. Alternative protein sources from vegetable proteins, such as soy, can be used as milk-substitute. Previous studies showed the prevalence of soy allergy in CMA patients in Western countries ranged between 0 to 63%, but the prevalence in Asia was not greater than 20% and no data about this prevalence in Indonesia. Objectives To determine the proportion of soy protein sensitization in CMA patients and characteristics of CMA patients who were sensitized to soy protein. Methods Fifty seven CMA patients who consumed soy protein were taken their blood sample to examine the soy-specific IgE. Results From 57 CMA patients, we found only 18% of patients who were sensitized to soy protein. Seven out of ten CMA patients who were sensitized to soy protein were under 12 months old. Atopic dermatitis was the most frequent clinical manifestation (8/10) and all of them had family history of atopic diseases. Soy sensitization in IgE-mediated and non-IgE mediated CMA were 6/10 and 4/10, respectively. Conclusions Proportion of soy sensitization in CMA patients in this study was 18%. Soy protein can be used as an alternative for cow’s milk substitute in CMA patients. [Paediatr Indones 2007;47:78-82]