Abdurachman Sukadi
Program Pascasarjana Universitas Padjadjaran

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Kadar Calprotectin pada Bayi Kurang Bulan dan Respiratory Distress Syndrome Usman, Ali; Sukadi, Abdurachman; Mose, Johannes C
Global Medical & Health Communication (GMHC) Vol 1, No 2 (2013)
Publisher : Fakultas Kedokteran Universitas Islam Bandung

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Abstrak Calprotectin merupakan peptida antimikrob yang disimpan dalam leukosit sebagai molekul efektor dari respons imun innate. Terdapat infeksi intrauterin/intraamnion berhubungan dengan peningkatan calprotectin, defensin, dan bacterial permeability increasing protein (BPI) secara bermakna di dalam cairan amnion pada persalinan kurang bulan. Penelitian ini bertujuan untuk mengetahui kadar calprotectin pada bayi kurang bulan yang menderita dan tidak menderita respiratory distress syndrome (RDS). Penelitian observasional analitik dilakukan selama periode Maret 2010–Maret 2012 di RS Dr. Hasan Sadikin, RS Advent, RS Al Islam, RS Khusus Ibu dan Anak Kota Bandung, dan RS Ibu Anak Hermina Pasteur, diperoleh sampel sebanyak 60 bayi kurang bulan yang menderita dan tidak menderita RDS masing-masing sejumlah 30 orang. Cairan amnion diambil untuk pemeriksaan kadar calprotectin. Diagnosis RDS dibuat berdasarkan pemeriksaan fisis, skor Downe, dan foto toraks. Didapatkan nilai median kadar calprotectin pada kelompok bayi kurang bulan yang menderita RDS sebesar 3.302,6 sedangkan pada kelompok bayi yang tidak menderita RDS sebesar 7.908,85. Pada Uji Mann-Whitney diperoleh Zm-w=3,063 (p=0,002). Cut-off point (COP) calprotectin >3.395,6 didapatkan jumlah RDS (+) 17 dan RDS (-) 4, sedangkan pada COP calprotectin >3.395,6 jumlah RDS (+) 13 dan RDS (-) 26. Dapat disimpulkan, kadar calprotectin pada bayi yang menderita RDS berbeda  dibandingkan dengan kadar calprotectin pada bayi yang tidak menderita RDS. Kadar calprotectin dapat memprediksi kejadian RDS dengan sensitivitas 56,7%; spesifisitas 86,7%; dan akurasi 71,7%.   Kata kunci: Bayi kurang bulan, calprotectin, respiratory distress syndrome Calprotectin Concentrations in Preterm Neonates and Respiratory Distress Syndrome Abstract Calprotectin is antimicrobial peptides stored in leucocytes, that acts as effector molecules of the innate immune response. Intrauterine or intraamniotic infection was associated with a significant increase in amniotic fluid concentration of calprotectin, defencin and bacterial permeability increasing protein (BPI). The study aims was to explore calprotectin concentrations at preterm neonates with and without respiratory distress syndrome. An observational analytic study was performed during March 2010–March 2012 in Dr. Hasan Sadikin, Advent, Al Islam,  Mother and Child Hermina Pasteur Hospitals Bandung. Subjects were 60 preterm neonates who divided in two groups, 30 neonates with and 30 neonates without RDS. Sixty samples of amniotic fluid were collected to examine calprotectin concentration. The diagnoses of RDS was made based on physical examination, Downe score and chest X-rays. Median value of calprotectin concentrations from preterm neonates with RDS was 3,302.6 and neonates without RDS  was 7,908.85, with Mann-Whitney test Zm-w=3.063 (p=0.002). Cut-off point (COP) of calprotectin 3,395.6 in RDS (+) was 17 and in RDS (-) was 4. Calprotectin in RDS COP >3,395.6 (+) was 13 and RDS (-) was 26. In conclusions, the concentration of calprotectin at RDS (+) is very low and  different with the one at RDS (-). The concentration of calprotectin can be used to predict the incidence of RDS with sensitivity 56.7%, specificity 86.7%, and accuracy 71.7%.   Key words: Calprotectin, preterm neonates, respiratory distress syndrome
Clinical Outcome of Cytomegalovirus Infection on Low Birth Weight Infants Usman, Ali; Sukadi, Abdurachman; Mose, Johannes C
Global Medical & Health Communication (GMHC) Vol 2, No 2 (2014)
Publisher : Fakultas Kedokteran Universitas Islam Bandung

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Abstract Cytomegalovirus (CMV) is a DNA virus and a marker of the herpes virus groups. This virus was found only in human and the infection occurs for a long time. The transmission of CMV infection to fetus/neonates is via congenital infections or perinatal infections. Clinical manifestation of symptomatic CMV infection of the fetus has two presentations, early and second early manifestations. Diagnosis of neonatal CMV infection may be done by serologic test based on detection of IgM of CMV infection. The objective of this study is to asses clinical outcome of CMV infection of low birth weight infants delivery with long term sequelae. An observational study was conducted since March 2010 until December 2011 in Advent and Hermina Pasteur Hospital, all subjects were low birth weight infants (LBWI). The inclusion criterias are all LBWI who were delivered in those hospital or were a referred neonates. The exclusion criterias are major congenital defect, which is not related to congenital CMV infection and neonates’ death before one week of life. Every neonate was examine both their physical and peripher blood count, glucose, Ca.  Liver function test done for neonates with acute hepatitis and titre IgG and IgM CMV serial, head ultrasound serial and head CT scan/MRI used for babies with intracranial bleeding and hydrocephaly.  During the period of this study there were 50 cases of LBWI, consisted of 41 preterm babies, and 30 small for gestational age babies. Clinical manifestation of acute hepatitis were found in 20% subjects, all of them with the  elevation of liver function test. Microcephaly which occured in the first untill three weeks of life were 8%. Ventricular dilatation were 10% in the first week of life and increased up to 48% after three weeks. Cases with intracranial haemorrhage were found in 6% and 10% with cerebral calcification on head while sensorineural hearing loss were 8%. All of LBWI have 100% serorespon immune IgG. IgM CMV reactive only in 12% cases but after 3 weeks increased up to 32%. During neonatal up to infancy period, the prevalence of CMV infection in Bandung is high (12+32%:44%) with long term sequelae which are serious and can be fatal. It is urgent and important to give information about this disease to new couples, every mother and healthcare providers in fetomaternal fields to prevent  CMV infection.  Key words CMV infection, long term sequelae, outcome Abstract Cytomegalovirus (CMV) adalah virus DNA dan termasuk dalam kelompok virus herpes. Virus ini hanya menyerang manusia dan infeksinya berlangsung lama. Penularan CMV pada janin/neonatus dapat melalui infeksi kongenital atau infeksi perinatal. Manifestasi Infeksi CMV pada janin terdiri dari dua bentuk yaitu manifestasi awal dan lanjut. Diagnosis infeksi CMV neonatal ditegakkan dengan tes serologis berdasarkan deteksi IgM CMV. Tujuan penelitian ini adalah menilai keluaran klinis infeksi CMV pada bayi berat lahir rendah dengan gejala sisa. Penelitian observasional telah dilakukan sejak Maret 2010 sampai dengan Desember 2011 di RS Advent dan RS Hermina Pasteur pada semua bayi berat lahir rendah (BBLR). Kriteria inklusi adalah semua BBLR yang lahir di kedua RS maupun merupakan pasien rujukan. Kriteria eksklusi adalah adanya kelainan kongenital mayor yang tidak berhubungan dengan infeksi CMV kongenital dan bayi yang meninggal dalam minggu pertama. Setiap bayi dilakukan pemeriksaan fisik dan laboratorium (hitung darah tepi, kadar glukosa dan kalsium), tes fungsi hati dilakukan pada bayi yang menderita hepatitis akut, pemeriksaan kadar IgG dan IgM CMV serial, USG kepala dan CT scan/MRI kepala pada kasus hidrocefalus dan perdarahan intrakranial. Selama penelitian terdapat 50 kasus BBLR yang terdiri dari 41 bayi prematur, 30 bayi kecil masa kehamilan. Hepatitis akut ditemukan sebanyak 20% yang semuanya disertai peningkatan tes fungsi hati. Mikrosefali yang terjadi sampai usia 3 minggu sebanyak 8%. Dilatasi ventrikular lateralis sebesar 10% pada minggu pertama dan meningkat sebanyak 48% setelah 3 minggu. Perdarahan intrakranial sebanyak 6% dan kalsifikasi serebral 10%. Gangguan pendengaran sebanyak 8%. IgG (+) pada semua BBLR (100%). IgM CMV reaktif hanya 12% tetapi meningkat sebesar 32% setelah usia 3 minggu. Simpulan penelitian ini adalah prevalensi infeksi CMV di Bandung cukup tinggi (12+32%:44%) dengan gejala sisa neurologis yang berat dan fatal selama 6 bulan postnatal, sehingga perlu diberikan informasi mengenai penyakit ini kepada pasangan baru, setiap ibu dan petugas kesehatan di bidang fetomaternal untuk mencegah infeksi ini. Kata kunci: Gejala sisa jangka panjang, Infeksi CMV, keluaran 
Kapasitas Fungsi Intelektual pada Berbagai Kelompok Interaksi Sosial Anak Autis Moekdas, Raddi; Sukadi, Abdurachman; Yuniati, Tetty
Majalah Kedokteran Bandung Vol 42, No 3
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Autis dikelompokkan berdasarkan interaksi sosial dan kapasitas fungsi intelektual. Penelitian ini bertujuan untuk mengetahui hubungan antara kelompok interaksi sosial dan kapasitas fungsi intelektual. Penelitian dilakukan Januari–Maret 2007 pada anak autis di pusat terapi Our Dream dan Indigrow Bandung dengan rancangan hybride selective prevalence. Anak autis dikelompokkan berdasarkan interaksi sosial serta kapasitas fungsi intelektual. Usia dan riwayat terapi perilaku merupakan faktor perancu kelompok interaksi sosial. Uji statistik pada penelitian ini menggunakan Kruskall-Wallis dan Kolmogorov-Smirnov dua populasi. Subjek penelitian yang memenuhi kriteria inklusi berjumlah 99 anak. Kelompok aloof, pasif, aktif tetapi aneh masing-masing sebanyak dua, 31, dan 66 anak autis. Kapasitas fungsi intelektual rendah sebanyak 70 dan tinggi 29 anak autis. Usia £5 dan >5 tahun ditemukan pada 58 dan 41 anak autis (pKW= 0,453). Riwayat pernah dan belum pernah mendapat terapi perilaku ditemukan pada 37 dan 62 anak autis (pKS = 1,00). Didapatkan 70 anak (71%) memiliki kapasitas fungsi intelektual rendah dan 29 anak (29%) dengan kapasitas fungsi intelektual tinggi. Kelompok interaksi sosial berhubungan bermakna dengan kapasitas fungsi intelektual anak autis (p= 0,04). Disimpulkan bahwa kelompok interaksi sosial aloof, pasif dan aktif tetapi aneh berhubungan dengan kapasitas fungsi intelektual rendah dan tinggi. [MKB. 2010;42(3):96-100].Kata kunci: Autis, kapasitas fungsi intelektual, kelompok interaksi sosial Intellectual Functioning in Social Interaction Subgroups of Autism ChildrenAutism classified based on social interaction and intellectual functioning. Aim of this study was to find out the association between social interaction and intellectual functioning. This hybride selective prevalence design study was conducted from January–March 2007 on autism children admitted to therapy center of Our Dream and Indigrow, Bandung. Subjects were classified based on social interaction and intellectual functioning. Age and history of behavior therapy were confounding factors. Data was analyzed using Kruskall-Wallis and two-sample Kolmogorov-Smirnov test. Subjects who fulfilled the inclusion criteria were 99 autism children. Subgroups aloof, passive, and active but odd were two, 31, 66 children, respectively. Low and high functioning were found in 70 and 29 children. Age of £5 and > 5 years were found in 58 and 41 children (pKW = 0.453). Classification of behavioral therapy were 37 and 62 children (pKS = 1.00). The association of social interaction with intellectual functioning autism showed significant value 0.04. In conclusion, this study showed association of social interaction aloof,passive, and active but odd with low and high intellectual functioning. [MKB. 2010;42(3):96-100].Key words: Autism, intellectual functioning, social interaction subgroups DOI: http://dx.doi.org/10.15395/mkb.v42n3.17
Kejadian Atopi pada Bayi Usia 6 Bulan yang Mendapat Kombinasi ASI dan Susu Formula Mengandung Probiotik dan Nonprobiotik Yuniati, Tetty; Sukadi, Abdurachman
Majalah Kedokteran Bandung Vol 43, No 2
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Kelahiran seksio sesarea menyebabkan terlambatnya kolonisasi flora usus sehingga akan meningkatkan kejadian atopi. Probiotik menstimulasi respons imun sehingga akan menurunkan kejadian atopi. Tujuan penelitian ini untuk menentukan apakah terdapat perbedaan kejadian atopi pada bayi yang diberikan kombinasi ASI dengan susu formula yang mengandung probiotik dan tanpa probiotik. Randomized open label clinical trial dilakukan selama periode November 2009 sampai Oktober 2010 terhadap 96 bayi normal, berat badan lahir ≥2.500 g, lahir dengan seksio sesarea di RS Dr. Hasan Sadikin Bandung. Sejak lahir, selama 4 minggu sebanyak 48 bayi diberikan kombinasi ASI dan susu formula probiotik dan 48 bayi sebagai kontrol, selanjutnya pemberian minuman bergantung pada orangtua. Dilakukan pencatatan lama menyusui, jumlah formula, dan faktor risiko atopi. Skin prick test dilakukan pada usia 6 bulan. Diagnosis atopi ditegakkan jika terbentuk wheal ≥4 mm. Analisis statistik dilakukan dengan chi-square untuk data kategori dan uji t untuk data numerik. Lama menyusui, jumlah formula, dan faktor risiko atopi tidak berbeda secara bermakna pada kedua kelompok (p>0,05). Reaksi atopi ditemukan positif pada 4/23 bayi yang mendapat probiotik dan 10/28 bayi tanpa probiotik (p>0,05). Disimpulkan bahwa kejadian atopi tidak berbeda antara kelompok yang diberikan ASI dan susu formula mengandung probiotik dan tidak mengandung probiotik. [MKB. 2011;43(2):55–9].Kata kunci: Atopi, kelahiran seksio sesarea, probiotikAtopic Occurence on Six-month-old Infants between Probiotic Formula-fed and Non Probiotic Formula-fed Healthy Born by Cesarean DeliveryCesarean delivery might delayed the colonization of newborn intestine and increase atopic disorders. Probiotic shown to stimulate immune responses, which has implied in the development of atopic disorders. The aim of the study was to find out the difference of atopic occurence in breastfed infants born by cesarean delivery given probiotic formula and non probiotic formula. Randomized open label clinical trial was performed on 96 healthy infants, birth weight ≥2,500 g, born by cesarean delivery in Dr. Hasan Sadikin Hospital Bandung during November 2009 to October 2010. Since birth, 48 infants were breastfed combined with probiotic formula and 48 infants as control group for 4 weeks and afterwards the feeding pattern depend on the parents. Skin prick test reaction was performed at 6 months old and atopy was diagnosed if the wheal ≥4 mm. Statistical analysis using chi-square and t-test. The duration of daily breastfeeding, amount of formula and risk factor for atopic disorders were not significantly different in both groups (p>0.05). Atopy were positive in 4/23 infants with probiotic and 10/28 infants positive without probiotic. It was not significantly different (p>0.05). Conclusion, the atopic occurence is not different at 6 months-old receiving breastmilk with probiotic and non probiotic formula. [MKB. 2011;43(2):55–9].Key words: Atopy, caesarean delivery, probiotic DOI: http://dx.doi.org/10.15395/mkb.v43n2.45