Latar belakang. Jumlah pasien anak yang berkunjung ke ruang gawat darurat terus mengalami peningkatan setiap tahunnya. Studi mengenai analisis data pelayanan gawat darurat penderita anak dengan ...kegawatan medik dari aspek lama tunggu dan kematian pasien di IGD masih terbatas.Tujuan. Penelitian ini bertujuan untuk mengevaluasi karakteristik dan luaran, serta gambaran epidemiologi dari penderita anak dengan kegawatdaruratan medik yang datang ke IGD anak RSUP Prof Dr. I.G.N.G Ngoerah Denpasar.Metode. Penelitian ini merupakan penelitian deksriptif retrospektif dengan data dari rekam medis pasien anak yang dirawat di IGD RSUP Prof Dr. I.G.N.G Ngoerah pada periode Februari – Juli 2022 menggunakan metode konsekutif sampling. Analisis deksriptif dilakukan dengan program SPSS.Hasil. Total jumlah sampel yang dikumpulkan dalam penelitian ini adalah 867 sampel. Karakteristik dasar pasien anak yang berkunjung ke ruang gawat darurat adalah mayoritas berjenis kelamin laki – laki, berusia 1 – 5 tahun, memiliki status gizi normal, skor pSOFA < 8 (99,7%), kematian dalam 24 jam terjadi pada 1,3% dan lama waktu tunggu pasien di triase setelah diagnosis ditegakkan adalah segera (90,2%). Keluhan utama yang paling sering dijumpai adalah ganggun sistem pernapasan, febris, dan gangguan sistem pencernaan. Diagnosis terbanyak adalah infeksi COVID-19 (10,4%) dan leukemia (10,3%).Kesimpulan. Infeksi COVID-19 masih merupakan diagnosis tersering di IGD, walaupun begitu pasien dengan keganasan (terutama leukemia) memiliki prevalensi yang cukup besar dibandingkan penyakit lainnya pada pasien pediatri yang memerlukan perawatan di IGD. Mayoritas pasien yang datang ke IGD anak RSUP Prof Ngoerah memiliki tingkat keparahan penyakit yang rendah berdasarkan pSOFA dan lama tunggu yang pendek setelah diagnosis ditegakkan. Kematian dalam 24 jam hanya terjadi pada sebagian kecil pasien.
Objective: The aim of this study is to evaluate the clinical, demographic, and diagnostic characteristics of pediatric patients consulting the dermatology department.
Methods: Patients who were ...consulted to the dermatology department from pediatric clinic of XX Hospital between January 2021 and August 2021 were scanned retrospectively. The demographic data of the patients, the pediatric department requesting consultation, their complaints at admission, the reasons for asking for consultation, and the diagnoses they received as a result of the consultation were recorded.
Results: A total of 296 patients, 150 (50.7%) females and 146 (49.3%) males, with a median age of 5.5 years (1.5-10.5 ) were evaluated. The outpatient clinic were seen to have made the most requests for consultation. The most frequent complaints on presentation were seen to be redness of the skin in 168 (56.8%) cases and itching in 36 (12.2%). The five most common diagnoses made as a result of the consultation were unspecified dermatitis in 47 (15.9%) cases, scabies in 34 (11.5%), insect bite in 17 (5.7%), atopic dermatitis in 13 (4.4%), and seborrheic dermatitis in 13 (4.4%). When the diagnoses were examined according to the age groups, unspecified dermatitis was usually seen in the 0-2, 6-11, and 12-18 years age groups and insect bite was more common in the 3-5 years age group.
Conclusion: The establishment of effectively functioning consultation mechanisms not only facilitates a correct diagnosis for the patient and appropriate treatment, but also can shorten the length of hospital stay for pediatric patients and can reduce economic costs.
Amaç: Çalışmamızda pediatri kliniğinden istenen dermatoloji konsültasyonları değerlendirilerek, sonuçlar demografik, klinik ve tanısal yönden ele alınmaya çalışılmıştır.
Materyal-Metod: Ocak 2021 ile Ağustos 2021 tarihleri arasında pediatri kliniğinden istenen dermatoloji konsültasyonları retrospektif olarak değerlendirilmiştir. Hastaların demografik verileri, konsültasyon istenme sebepleri, konsültasyon sonucu verilen tanılar kayıt edilmiştir.
Bulgular: 150'si (50.7%) kadın ve 146'sı (49.3%) erkek olmak üzere 296 hasta değerlendirilmiştir. Ortalama yaş 5.5 yıl (1.5-10.5 ) bulunmuştur. Ayaktan hasta polikliniği en çok konsültasyon istenen çocuk kliniği bölümü olarak görülmüştür. En sık konsültasyon istenme sebebi 168 (56.8%) hastada kızarıklık ve 36 (12.2%) hastada kaşıntı olarak bulunmuştur. Konsültasyon sonrası en sık verilen 5 tanı 47 (15.9%) hastada tanımlanmamış dermatit, 34 (11.5%) hastada skabiyez, 17 (5.7%) hastada haşere ısırığı, 13 (4.4%) hastada atopik dermatit ve 13 (4.4%) hastada seboreik dermatit olarak bulunmuştur. Yaş grupları arasındaki tanılara bakıldığında tanımlanmamış dermatit 0-2, 6-11 ve 12-18 yaş grubunda sık görülürken haşere ısırığı 3-5 yaş grubunda sık olduğu görülmüştür.
Sonuç: Etkin konsültasyon sisteminin temin edilmesi sadece doğru tanı ve tedaviye yardım etmeyip aynı zamanda pediatrik hastaların hastanede kalış sürelerini kısaltıp sağlık harcamalarını azaltarak ekonomik yöndende faydası olacağı aşikardır.
Aim
Hydatid disease (Echinococcosis) is a common zoonosis in countries that are involved in livestock such as our country. Our study aims to evaluate pediatric cases with hydatid disease over the ...last decade in our region and to determine the significance of initial clinical and laboratory findings in distinguishing ruptured hydatid cyst cases.
Materials and Methods
A retrospective analysis was made on demographic characteristics, presenting symptoms, physical examination, laboratory and radiological findings, and treatments of children with hydatid disease who were treated in our hospital and followed up regularly between January 2011 and December 2020.
Results
The study sample of 42 cases included 19 (45.2%) girls, with a median age of 125.5 (34-209) months. The most common symptom was abdominal pain (50%), and the most common physical examination finding was decreased breath sounds (23.8%). Thirty-five (83.3%) patients had single organ involvement and 7 (16.7) patients had multiple organ involvement. Cysts were detected in the right lobe of the liver in 24 (75%) of hepatic hydatid cysts and the left lobe in 7 (58.3%) of pulmonary hydatid cysts. The median size of the cysts was 57.5 (12-140) mm. The initial IHA titer, eosinophil count, eosinophil percentage, and sedimentation value were statistically significantly higher in patients with ruptured cysts than in those without rupture (p= 0.002, p= 0.003, p= 0.003, p= 0.02, respectively).
Conclusions
Initial pathological examination findings and at initial laboratory findings such as high IHA titer, eosinophil count, eosinophil percentage, sedimentation value can be used to distinguish rupture cases.
Amaç
Kist hidatik hastalığı (Echinococcosis) Türkiye gibi hayvancılıkla uğraşan ülkelerde yaygın olan bir zoonozdur. Bölgemizde son 10 yılda görülen çocuk kist hidatik olgularını değerlendirip, rüptüre kist hidatik olgularını ayırt etmede başlangıç klinik ve laboratuvar bulgularının önemini belirlemektir.
Gereç ve yöntem
Ocak 2011-Aralık 2020 tarihleri arasında hastanemizde tedavi edilen ve düzenli olarak takiplere gelen kist hidatikli çocukların demografik özellikleri, başvuru şikayeti, fizik muayene, laboratuvar, radyolojik bulguları ve tedavileri geriye dönük incelendi.
Bulgular
Çalışmaya dahil edilen kırk iki olgunun 19’u kız (%45,2), ortanca yaşları 125,5 (34-209) aydı. En yaygın belirti %50 ile karın ağrısı, en yaygın fizik muayene bulgusu ise %23,8 ile solunum seslerinde azalmaydı. Hastaların 35’inde de (%83,3) tek organ, 7’sinde (16,7) çoklu organ tutulumu vardı. Karaciğer kist hidatiklerinin 24’ünde (%75) kist karaciğerin sağ lobunda, akciğer kist hidatiklerinin ise 7’si (%58,3) sol lobunda tespit edildi. Kistlerin ortanca boyu 57,5 mm (12-140 mm) idi. Rüptüre kisti olan hastalarda başlangıç İHA titresi, eozinofil sayısı, eozinofil yüzdesi ve sedimantasyon değeri rüptür olmayan hastalara göre istatistiksel olarak anlamlı yüksekti (sırasıyla p=0,002, p=0,003, p=0,003, p=0,02).
Sonuç
İlk başvuruda patolojik muayene bulgusu ve yüksek İHA titresi, eozinofil sayısı, eozinofil yüzdesi ve sedimantasyon değeri rüptür olgularını ayırt etmek için kullanılabilir.
To systematically review the impact of antibiotic therapy in the neonatal period on changes in the gut microbiota and/or antibiotic resistance development.
Data sources were PubMed, Embase, Medline ...and the Cochrane Database, supplemented by manual searches of reference lists. Randomized controlled trials (RCTs) and observational studies were included if they provided data on different categories of antibiotic treatment (yes versus no, long versus short duration and/or broad- versus narrow-spectrum regimens) and subsequent changes in the gut microbiota and/or antibiotic resistance development. We evaluated risk of bias using the Cochrane Handbook, adapted to include observational studies. When appropriate, we used the vote-counting method to perform semi-quantitative meta-analyses. We applied the Grades of Recommendation, Assessment, Development and Evaluation approach to rate the quality of evidence (QoE). Study protocol registration: PROSPERO CRD42015026743.
We included 48 studies, comprising 3 RCTs and 45 observational studies. Prolonged antibiotic treatment was associated with reduced gut microbial diversity in all three studies investigating this outcome (very low QoE). Antibiotic treatment was associated with reduced colonization rates of protective commensal anaerobic bacteria in four of five studies (very low QoE). However, all three categories of antibiotic treatment were associated with an increased risk of antibiotic resistance development, in particular MDR in Gram-negative bacteria, and we graded the QoE for these outcomes as moderate.
We are moderately confident that antibiotic treatment leads to antibiotic resistance development in neonates and it may also induce potentially disease-promoting gut microbiota alterations. Our findings emphasize the need to reduce unnecessary antibiotic treatment in neonates.
Resusitasi pediatri bergantung pada berat badan untuk menentukan ukuran alat resusitasi, dosis obat, jumlah cairan, hingga dosis defibrilasi yang dibutuhkan. Berat badan aktual pada kondisi kegawatan ...sering kali sulit diukur sehingga membutuhkan suatu metode prediksi. Mercy method merupakan salah satu modalitas prediksi berat badan berbasis panjang yang dapat digunakan. Tujuan, menganalisis akurasi Mercy method sebagai metode prediksi berat badan pasien pediatri. Metode, dalam penelitian analitik observasional ini dilakukan pengukuran berat badan, panjang lengan, dan lingkar lengan atas tengah pada pasien usia 2 bulan–16 tahun di IRNA Pediatri RSUD Dr. Soetomo periode Desember 2019 hingga Maret 2020. Panjang dan lingkar lengan atas tengah kemudian dikonversi menjadi berat badan prediksi menggunakan Mercy method, lalu dilakukan uji korelasi dengan berat badan aktual. Uji bias dan predictive performance dinilai menggunakan ME, MAPE, RMSE, dan toleransi berat badan hingga 10% dan 20%. Hasil, dari 375 pasien, didapatkan hasil bahwa Mercy method merupakan modalitas yang baik untuk memprediksi berat badan pediatri pada populasi ini (r2=.964; p,000). Hasil uji bias dan predictive performance juga menunjukkan hasil yang baik dengan ME yang rendah, MAPE <10%, RMSE mendekati nol, serta dapat memprediksi berat badan aktual dengan toleransi 20% hingga 97,4%. Simpulan, Mercy method merupakan metode yang akurat untuk memprediksi berat badan pasien pediatri di RSUD Dr. Soetomo Surabaya.
tersendiri. Pipa endotrakeal (ETT) yang terlalu kecil/besar meningkatkan risiko komplikasi. Prediksi ukuran ETT berdasar atas usia merupakan metode yang paling sering digunakan namun ternyata tidak ...selalu tepat pada aplikasinya. Parameter lain seperti diameter subglotis atau diameter kelingking tangan dapat menjadi alternatif untuk memprediksi ukuran ETT pediatri. Tujuan penelitian ini menganalisis dan membandingkan akurasi prediksi ukuran ETT tanpa cuff berdasar berbagai variabel pada pasien pediatri di RSUD Dr Soetomo Surabaya mulai Februari hingga April 2020. Subjek penelitian ini pasien usia 2–9 tahun, PS ASA 1–2 yang akan dilakukan operasi elektif. Saat preoperatif, usia, berat, dan panjang badan dicatat. Saat intraoperatif, diameter kelingking tangan dan diameter subglotis menggunakan USG diukur dan dicatat. ETT yang digunakan adalah ETT tanpa cuff berdasar atas diameter subglotis. ETT dianggap tepat apabila memberikan audible air leak pada tekanan 10–25 cmH2O. Bila ETT terlalu kecil/besar maka dilakukan reintubasi. Tiap-tiap parameter dilakukan uji korelasi, agreement test, serta predictive performance menggunakan MAPE, dan RMSE. Dari 48 pasien, didapatkan hasil bahwa prediksi ukuran ETT tanpa cuff berdasar atas diameter subglotis memiliki akurasi yang paling baik hingga 91,67% (r=0,973, koefisien kappa 0,892; p<0,001, MAPE 0,803%, dan RMSE 0,144). Simpulan, prediksi berdasar atas diameter subglotis merupakan metode yang akurat untuk memprediksi ukuran ETT tanpa cuff pediatri.
Compounding sterile preparation, especially for hospitalized pediatric patients, needs more concern due to dose adjustment. Things to be concerned about are compounding personnel, utilization of ...aseptic technique, and facilitation that affects the quality of sterile preparations. The aims of this study were to observe compounding process and to quality the sterile preparations for hospitalized pediatric patients in “X” Hospital, Semarang City, Indonesia. This research is an observational analitic with incidentally sampling research. Subject in this research was personnel who performed sterile preparations for hospitalized pediatric patients. Results from 114 sterile preparations which were observed in pediatric ward showed that compounding personnel (100%), facilities & infrastuctures, and sterile preparations procedure were not suitable with the Mixing Guideline for injectable drug and cytostatic (2009), hence it could impact the quality of sterile preparations. In addition, even after implementing appropriate solvent, compounding procedures, and aseptic technique had been utilized (100%), the physical incompatibility occurred was 8.77%. The pH of Ceftriaxone and Cefotaxime was similar with those in the literature, but for Omeprazole’s pH and based on sterility test, there were no bacterial growth.
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