Bambang Sutrisna

Care-seeking for fatal illnesses in young children in Indramayu, West Java, Indonesia

To examine patterns of seeking care for gravely ill infants and children, we studied all deaths in children under 5 in 10,000 households in Indramayu, West Java, Indonesia, between July 1, 1991, and Dec 31, 1992. 141 deaths were identified (mortality rate 80.7 per 1000), of which 139 were due to causes other than trauma. No treatment of any kind was sought outside the home for 30 (22%) of the children who died from natural causes, and for 59 (42%) others only a traditional healer or other source of non-western medical advice was consulted. Whether or not a mother sought western medical care was strongly associated with the age of the child, the duration of the terminal illness, the previous attendance of the mother at a community-based maternal-and-child-health facility, and the mothers response to a prospectively asked question about what care should be sought for a hypothetical 1-month-old baby with signs of severe pneumonia. Household income, maternal age, and education, and distance between home and government health post were not associated with whether or not western medical care was sought.

Burden of Nonsteroidal Anti-inflammatory and Antiplatelet Drug Use in Asia: A Multidisciplinary Working Party Report

BACKGROUND & AIMS We established a working group to examine the burden of atherothrombotic and musculoskeletal diseases in Asia and made recommendations for safer prescribing of nonsteroidal anti-inflammatory drugs (NSAIDs) and low-dose aspirin. METHODS By using a modified Delphi process, consensus was reached among 12 multidisciplinary experts from Asia. Statements were developed by the steering committee after a literature review, modified, and then approved through 3 rounds of anonymous voting by using a 6-point scale from A+ (strongly agree) to D+ (strongly disagree). Agreement (A+/A) by ≥ 80% of panelists was defined a priori as consensus. RESULTS We identified unique aspects of atherothrombotic and musculoskeletal diseases in Asia. Asia has a lower prevalence of degenerative arthritis and coronary artery disease than Western countries. The age-adjusted mortality of coronary artery disease is lower in Asia; cerebrovascular accident has higher mortality than coronary artery disease. Ischemia has replaced hemorrhage as the predominant pattern of cerebrovascular accident. Low-dose aspirin use is less prevalent in Asia than in Western countries. Traditional Chinese medicine and mucoprotective agents are commonly used in Asia, but their efficacy is not established. For Asian populations, little is known about complications of the lower gastrointestinal tract from use of NSAIDs and underutilization of gastroprotective agents. Our recommendations for preventing ulcer bleeding among users of these drugs who are at high risk for these complications were largely derived from Asian studies and are similar to Western guidelines. CONCLUSIONS By using an evidence-based, multidisciplinary approach, we have identified unique aspects of musculoskeletal and atherothrombotic diseases and strategies for preventing NSAID-related and low-dose aspirin-related gastrointestinal toxicity in Asia.

Influence of early self-diagnosis and treatment of bacterial vaginosis on preterm birth rate

To assess whether early self‐diagnosis and treatment of bacterial vaginosis (BV) could lower the preterm birth rate among a group of Indonesian women.

Relationship between intra-household food distribution and coexistence of dual forms of malnutrition

BACKGROUND/OBJECTIVES The relationship between food intake and nutritional status has been clearly established. Yet, there are only limited studies on food intake among family members and their nutritional status. The study examined the relationship between intra-household food distribution and coexistence of dual forms of malnutrition (DFM) in the same household. SUBJECTS/METHODS Households with a malnourished child and overweight mother were categorized as DFM. Intra-household food distribution among family members was reported using ratios, which are a measure of individual intakes as compared to all household member intakes adjusted to RDA. RESULTS A 1,899 families were included in the study. The prevalence of DFM was 29.8% (95%CI 26.5-31.2). Children consumed lower amounts of energy (OR 1.34; 95%CI 1.06-1.69, P = 0.011), carbohydrates (OR 1.2; 95%CI1.03-1.61, P = 0.022), protein (OR 1.3; 95%CI 1.03-1.64, P = 0.026), and fat (OR 1.3; 95%CI 1.05-1.66, P = 0.016) than their mothers and other family members. In contrast, mothers consumed more carbohydrates than children and other family members (OR1.24; 95%CI 1.02-1.51, P = 0.03). CONCLUSIONS This study is the first to report on the food distribution among family members and its relationship with occurrence of DFM in Indonesia. The results confirm the occurrence of an unequal food distribution between children and mothers, which increases risk of DFM in the household. The results also demonstrate that nutritional education at the household level is important to increase awareness of the impact of DFM.

The Effects of Curcumin against the Inflammatory Response in Patientswith Acute Coronary Syndrome

Background: The human inflammatory response plays an important role in the pathogenesis of atherosclerosis. An increase in the inflammatory responses notable by the levels of highly sensitive C-Reactive Protein (hsCRP) may be able to predict future cardiovascular events and the prognosis of post-acute coronary syndrome (ACS). In animal experiments and human in-vitro experiments, curcumin has been proved to have anti-inflammatory effects. The effect of curcumin against the inflammatory response in ACS has not been identified. This study observes the effects of curcumin against the human inflammatory responses in patients with ACS. Methods: This multicenter double-blinded placebo controlled randomized trial was located at the Intensive Coronary Care Unit (ICCU) of Cipto Mangunkusumo General Hospital, Persahabatan General Hospital and MMC Hospital in Jakarta, Indonesia. 75 ACS patients were randomized into four groups, with the three intervention group (group I-III) consisting of 15 patients and 30 patients in the placebo group (IV). The participants of this study was randomly allocated curcumin in three different doses, group I was provided 15 mg t.i.d, group II was provided 30 mg t.i.d., group III was provided 60 mg t.i.d, and group IV was provided placebo. Results: In this study, we discovered that group I experienced a significant decrease in the level of hsCRP compared to placebo during the first month (p=0.04). Curcumin in low doses proved to be most effective in reducing the hsCRP levels, rather than moderate- or high doses. Moderate-dose curcumin was in second place, followed by high-dose curcumin. Conclusion: The use of low-dose curcumin in AC patients has significantly reduced the level of hsCRP after one week of use.

Expression of NFkB in Locally Advanced Cervical Cancer and Its Relation to Radiotherapy Response

One of the expected elimination pathways of cancer cells in the process of radiation is apoptosis. Nuclear factor kappa-B (NFkB) is a transcription factor related to the mechanism of apoptosis resistance of a cell, which can affect the post-radiation response. The aim of this study is to assess the relative expression of NFkB in locally advanced cervical cancer and its relation to radiotherapy response. The study was conducted with observational cohort design on January-October 2015. Pre-radiotherapy cervical biopsy specimen was collected from 17 subjects, while only 10 subjects were willing to be taken mid-radiotherapy cervical biopsy specimen. We extracted and analyzed mRNA of NFkB by using qRT-PCR. NFkB relative expression was tested to its correlation with radiotherapy response. This study demonstrated that median of pra-radiotherapy relative expression on subjects with negative response (0.667; SD 0.413) was higher than positive response (0.315; SD 160.298), but not statistically significant (p=0.578). Alteration of mid-radiotherapy NFkB relative expression compared to pra-radiotherapy showed correlation to radiotherapy response. It is concluded that reduced expression of mid-radiotherapy NFkB relative expression plays a role in increasing radiotherapy response. Normal 0 false false false IN X-NONE X-NONE

Model Skoring Untuk Memprediksi Anemia Defisiensi Besi pada Bayi 0-6 Bulan

Latar belakang. Anemia defisiensi besi (ADB) merupakan salah satu masalah kesehatan gizi di Indonesia. Data SKRT tahun 2001 menunjukkan prevalensi ADB pada bayi 0-6 bulan 61,3%. Belum dijumpai pemeriksaan laboratorium sederhana yang dapat memprediksi seorang bayi berusia 0-6 bulan menderita ADB. Tuj uan. Mencari model skoring untuk memprediksi ADB pada bayi 0-6 bulan. Metode. Desain penelitian adalah studi kohort prospektif dengan pembanding eksternal. Ada 211 bayi yang ikut penelitian, terdiri dari 143 bayi yang lahir dari ibu tanpa anemia dan 68 bayi yang lahir dari ibu dengan anemia. Pemeriksaan darah tepi lengkap, gambaran darah tepi, feritin, sTfR dilakukan saat bayi berusia 0 bulan, 1, 2, 3, 4, 5, 6, dan 12 bulan. Diagnosis ADB berdasarkan 1) kadar Hb 14%, 5) Indeks Mentzer >13; 6) Indeks RDW >220. Hasil. Faktor risiko terjadi ADB pada bayi berusia 0-6 bulan adalah diet ibu dan jenis kelamin bayi. Berdasarkan faktor risiko dibuat model skoring dan klasifikasi risiko untuk memprediksi seorang bayi berusia 0-6 bulan akan menderita ADB atau tidak. Kesimpulan. Model skoring untuk memprediksi ADB pada bayi berusia 0-6 bulan dapat digunakan untuk deteksi dini ADB. (