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Sindrom nefrotik merupakan penyakit ginjal yang sering ditemukan pada anak-anak, dengan insiden 1-3 per 100.000 anak di bawah usia 16 tahun. Sekitar 10-20% anak dengan sindrom nefrotik mengalami sindrom nefrotik resisten steroid (SNRS), dan 10-30% dari kasus ini disebabkan oleh kelainan genetik. Pada SNRS monogenik, terdapat dua jenis yaitu sindromik (dengan gejala ekstra-renal) dan non-sindromik (tanpa gejala ekstra-renal). Penanganan SNRS memerlukan pendekatan klinis yang berbeda tergantung pada etiologi genetiknya. Pemeriksaan genetik, termasuk gen tunggal, panel multigen, dan genomik komprehensif, dapat mengidentifikasi varian patogenik, menetapkan diagnosis yang akurat, menyesuaikan terapi (termasuk penghentian terapi imunosupresan dan pemberian terapi yang lebih spesifik) konseling genetik, serta penanganan komprehensif terhadap manifestasi ekstra-renal terkait. Oleh karena itu, pendekatan klinis yang efektif harus didasarkan pada hasil pemeriksaan genetik untuk pengelolaan yang optimal dan konseling yang lebih tepat.

Abstract Background In light of prolonged hypoxia, children with cyanotic heart disase (CHD) are at a high risk of developing iron deficiency iron deficiency (ID) and iron deficiency anemia (IDA). Reticulocyte hemoglobin equivalent (Ret-He) is a novel and dependable indicator for assessing iron status. However, there has been no previous study regarding cut-off value in pediatric CHD group. The purpose of this study is to assess the role of Ret-He and to establish cut-off points in the diagnosis of iron deficiency and IDA in pediatric cyanotic heart disease. Method This study was conducted in two tertiary hospitals in Jakarta, Indonesia. 59 children with CHD, aged 3 months to 18 years, were enrolled consecutively. To determine iron status, hematological parameters (hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin) and biochemical parameters for iron status (serum ferritin, transferrin saturation) were analysed and compared to Ret-He levels. The receiver operating characteristic (ROC) analysis was performed for the Ret-He cut-off points for ID and IDA. Sensitivity, specificity, positive and negative predictive value were calculated for each cut-off point. Result Normal iron status was identified in 27 (45.8%) subjects, ID in 8 (13.5%) subjects, and IDA 24 (40.7%) subjects. The ID cut-off value for Ret-He is 28.8 pg (sensitivity 75%, specificity 85.2%, PPV 60%, NPV 92%, and AUC 0.828) and the Ret-He cut-off point for IDA is 28.15 pg (sensitivity 75%, specificity 88.9%, PPV 85.7%, NPV 80%, and AUC 0.824). Hemoglobin should be used in conjunction with Ret-He. ID might be detected in this cohort with Ret-He 28.8 pg and hemoglobin > 16,5 g/dL. While Ret-He 28.15 pg or Ret-He 28.15–28.8 pg with hemoglobin 16.5 g/dL could be used to diagnose IDA. Conclusion The reticulocyte hemolgobin equivalent could be utilised as an iron status parameter in pediatric CHD, with a cut-off value of 28.8 pg for ID and 28.15 pg for IDA.

Background Systemic lupus erythematosus (SLE) is a complex disease with various manifestations. Interleukin-6 (IL-6) is a pleiotropic cytokine with a wide range of biological activities which plays an important role in immune regulation and inflammation. Serum level of IL-6 may be used as a parameter of disease activity, especially in pediatric SLE patients with mild disease activity or total remission with conflicting clinical manifestations and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores. Objective To identify the characteristics of serum IL-6 concentration in pediatric SLE with mild disease activities and total remission. Methods This case-control study was performed at the allergy-immunology outpatient clinic, Department of Child Health Dr. Cipto Mangunkusumo Hospital, Jakarta and Dr. Sardjito Hospital, Yogyakarta. Serum IL-6 concentration and disease activity were assessed in all pediatric SLE patients aged 1-18 years old. Disease activity was assessed with SLEDAI scores and serum level of IL-6 was measured by enzyme-linked immunosorbent assay. Results Among 60 subjects included in this study, 30 subjects with mild activities were in the case group and 30 subjects with total remissions were in the control group. There was no difference in serum IL-6 concentration between the case and control group (OR 0.483; 95%CI 0.041to 5.628; P=0.500). In this study, 2 subjects with urinary tract infection had high serum IL-6 concentrations. Conclusion There is no difference in serum IL-6 concentration between pediatric SLE patients with mild disease activities compared to total remissions.

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.

IntroductionWith increased diagnostic capabilities and treatment modalities in the field of primary immunodeficiencies (PID), many pediatric patients survive beyond childhood and experience a change of care to the adult-oriented healthcare system. Unfortunately, the transition pathways for PID are less clearly defined, resulting in deterioration of quality of care in adulthood. Hence, this is the first regional study to address PID clinicians’ opinions on practices and challenges of transition care in 7 Southeast Asia (SEA) countries.MethodsWe adopted a cross-sectional study design through an online survey platform to enquire opinions of transition practices from expert representatives in 7 SEA countries.ResultsRegionally, 3 out 7 countries reported having no practice of transition care. Among cited challenges were reluctant adaptation by patients and caregivers to unfamiliarized adult healthcare systems, inadequate ratio of adult immunologists to patients and lack of facilities for transfer.Discussion and conclusionOur study provides evidence to advocate policy makers on the importance of standardized integration of transition practice towards betterment of transiting PID patients into adulthood.

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.

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. 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.

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.

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.

Seorang anak perempuan berusia 3 tahun dengan gejala klinis anemia berat, hepatosplenomegali, dan memerlukan tranfusi darah teratur. Gejala klinis telah timbul saat pasien berusia 3 bulan. Hapusan darah tepi menunjukkan gambaran hipokrom, mikrositosis, dan anisopoikilositosis. Kadar HbA2 normal, HbF sedikit meningkat, dan terdapat HbBart’s. Ayah dan ibu memiliki gambaran hematologis yang mendekati normal. Analisis DNA menunjukkan dua mutasi non-delesi (mutasi titik) pada gen globin a2 yaitu pada kodon 59 (GGCglisin→GACaspartat) dan IVS2-nt142 (AG→AA). Kasus ini adalah kasus pertama yang ditemukan di Departemen Ilmu Kesehatan Anak RS. Dr. Cipto Mangunkusumo Jakarta yang mempunyai mutasi heterozigot ganda pada kodon 59 dan IVS2-nt142. Gejala klinis thalassemia mayor diakibatkan adanya mutasi kodon 59 yang menghasilkan varian hemoglobin yang tidak stabil (HbAdana) disertai adanya mutasi non-delesi pada IVS2-nt142 yang menyebabkan proses mRNA yang tidak normal.

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.

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].

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.