Multisystem Inflammatory Syndrome In Children:Literature Review

The COVID-19 pandemic is yet to be over. Although the number of pediatric patients is relatively small, their clinical manifestations differ from the adult group. Multisystem Inflammatory Syndrome in Children (MIS-C) is one of the most recently discussed clinical manifestations. The clinical features of this case resemble those of Kawasaki disease or toxic shock syndrome with limited diagnostic methods. Patients experience gastrointestinal, mucocutaneous, cardiovascular, hematological, and neurological symptoms. There was also an increase in inflammatory parameters and cardiac disorders, which will also be confirmed by electrophysiological and radiological examinations. Management consists of the administration of immunoglobulins, steroids, and some anti-cytokines. When the patient goes into shock, fluid resuscitation is the mainstay of therapy. Until now, the number of MIS-C patients is relatively small compared to the number of COVID-19 cases, and the number of deaths is very minimal as well

Faktor Risiko Kelahiran Prematur di RSUD Dr. M. Soewandhi Surabaya pada Tahun 2017

Pendahuluan: Autisme merupakan gangguan perkembangan pada anak yang mencakup bidang interaksi sosial, komunikasi dan perilaku. Insidensi dan prevalensi yang cenderung meningkat dengan faktor risiko yang multifaktoral. Penelitian ini bertujuan untuk menganalisis faktor risiko yang berpengaruh pada periode kehamilan, persalinan dan BBL dengan kejadian autisme. Metode: menggunakan desain kasus kontrol dengan melibatkan 50 anak autis (45 anak laki-laki, 5 anak perempuan, sebagian besar (60%) berusia ≤ 5 tahun) dan 50 anak saudara kandung dari anak autis yang normal sebagai kontrol (26 anak laki-laki, 22 anak perempuan dan sebagian besar (58%) berusia ≤ 5 tahun). Untuk menganalisis 12 faktor risiko pada periode (1). Kehamilan (perdarahan antenatal, jarak kehamilan ≤ 13 bulan, usia ibu hamil ≥ 35 tahun, depresi hamil, merokok aktif, perokok pasif), (2). Persalinan (ketuban pecah dini) dan (3). Usia BBL (BBLR, prematur, BBL tidak menangis spontan dan tubuh kebiru-biruan segera setelah lahir dan ikterus). Data primer yang diperoleh dari hasil wawancara semi structured kepada ibu. Hasil: Pada analisis bivariat dengan uji chi square variabel yang bermakna dengan autisme adalah perdarahan antenatal (P<0.001), jarak kehamilan ≤ 13 bulan (P=0.001), usia ibu hamil ≥ 35 tahun (P=0.019) dan ketuban pecah dini (P=0.006). Selanjutnya pada analisis multivariat dengan uji regresi logistik ganda, variabel yang berpengaruh dengan autisme dengan faktor risiko terbesar adalah perdarahan antenatal (P=0.002, OR=6.436), usia ibu hamil ≥ 35 tahun (P=0.033, OR=3,418) dan ketuban pecah dini (P=0.048, OR=4,454). Kesimpulan: Penting dilakukan perencanaan kehamilan terkait usia ibu hamil pencegahan terjadinya komplikasi kehamilan dan persalinan untuk menghindari faktor risiko autisme

Faktor Yang Mempengaruhi Risiko Gangguan Perilaku Anak Dengan Human Immunodeficiency Virus

The number of child HIV patients in Indonesia in 2016 was 1,185 children. In pediatric and adolescent patients with perinatal HIV, the risk of psychological disorders can arise as a direct and indirect result of HIV infection. The direct effect is derived from HIV infection itself and the indirect consequences are caused by things related to HIV status. These problems include emotional, behavioral, cognitive and psychosocial disorders. At present a child's development check is carried out if a problem is suspected and there are no regular inspections. This includes examining the risk of behavioral disorders for children with HIV. Knowing the risk of behavioral disorders in children with HIV aged 6-18 years. The research respondents were outpatients at Poli UPIPI RSUD Dr Soetomo. Patients and guardians who were present were given an explanation and were asked to fill out informed consent as a sign of agreement to become respondents. All patients and guardians who came and met the criteria were taken as research respondents. This research was conducted by filling out a questionnaire regarding risk factors and research instruments. The instrument used was GPPH to assess the risk of behavioral disorders. Statistical analysis with logistic regression showed that the risk factors for hospitalization history (P = 0.031) and parental completeness (P = 0.011) were associated with risk of behavioral disorders. Children who have been hospitalized in the hospital have a possibility of 22,337 times greater risk of behavioral disorders. And children who don't have parents have a 40.586 times greater risk of behavioral disorders. There was a risk of behavioral disorders in children with HIV aged 6-17 years who do not have parents or had been hospitalized

DNA Sequence Analysis Of HB-EGF And CD9 Genes In Diphtheria Carriers And Patients In Indonesia

Abstract. Diphtheria infection is a serious health problem in Indonesia. There is little data regarding the role of human genetic variability on the diphtheria infection. There is also limited information in the literature regarding the comparison between diphtheria patients and carrier state. We aimed to compare the deoxyribonucleic acid (DNA) sequences of heparin binding-epidermal growth factor (HB-EGF) and cluster of differentiation 9 (CD 9) genes between diphtheria carriers and those infected with diphtheria. We searched the databases of the East Java Provincial Health Office and the Main Health Laboratory to identify diphtheria infection patients and carriers aged ≤18 years during 1 January 2012-30 August 2015. Each study participant was interviewed, had anthropometrical measurements obtained and blood was drawn for DNA sequencing of 2 genes coding for receptors and co-receptors of the diphtheria toxin, HB-EGF and CD9, and antibody titers against Corynebacterium diphtheriae. A total of 28 carriers and 97 patients with a history of diphtheria infection during the study period were included in the study. Silent mutations of codon 91 of exon 3 of the HB-EGF gene were found in 5 diphtheria carriers and 21 diphtheria cases, and of codons 171 and 173 of exon 6 of the CD9 gene in 1 carrier and 2 cases. We also found silent mutation of intron 5, position 35719 of the CD9 gene in 16 carriers and 39 cases. Statistical analysis showed no significant differences in the frequencies of mutations of exon 3 of the HB-EGF gene and exons 5 and 6 of the CD9 gene between carriers and cases. However, significantly more carriers had the mutation of intron 5 of the CD9 gene than cases. We concluded the genetic variability of the DT receptors in human was limited

Status gizi dan gambaran klinis penyakit pada pasien HIV anak awal terdiagnosis

Nutritional status and clinical disease of HIV children patients when diagnosed for the first timeBackground: Human immunodeficiency virus (HIV) infection in children can cause nutritional problems. Currently, HIV-infected children are still diagnosed when the disease stage is advanced. Nutritional status is a marker of advanced stage conditions in HIV infection.Objective: To determine the clinical findings of disease and nutritional status of HIV children patients when diagnosed for the first time.Methods: We conducted a cross-sectional descriptive study. The data were taken from the medical record documents of child patients aged 0-18 years with the ICD 10 code B20, who was treated at the Dr. Sardjito Yogyakarta Hospital from 1 January 2004-31 December 2019. Results: There were 191 children diagnosed with HIV, 56% of them were boys. The median age was 34 months (IQR 25: 13 months, IQR 75: 69 months), and 95.5% among those were infected perinatally. There were 77 (40,3%) children who suffered from severe malnutrition and 55 (28.8%) children were moderate acute malnutrition. At the age of 0-60 months among them, there were 49 children (36.3%) suffered from severely underweight, 35 children (25.9%) underweight, 53 (39.3%) severely stunted, 38 (28.1%) stunted, 28 severely wasted (20.7%), and wasted as many as 24 (17.8%). At the age of 5-18 years old, there were 19 (33.9%) and 5 (8.9%) children who suffered from severely wasted and wasted respectively. World Health Organization (WHO) stages 3 and 4 were experienced by 62 (32.5%) and 68 (35.6%) children. As many as 41.3% of children had enlarged lymph nodes, thrush (40.8%), pneumonia (40.8%), and persistent or chronic diarrhea (21.5%). Conclusions: The nutritional status of HIV-infected children at baseline was dominated by underweight and stunted. The most clinical findings of the disease when the child was diagnosed with HIV infection were lymphadenopathy, oral thrush, pneumonia, and persistent or chronic diarrhea

Pediatric Logistic Organ Dysfunction-2, Pediatric Risk Of Mortality-IV And Pediatric Index Of Mortality-3 For Predicting Mortality In Pediatric Surgery Patients With Sepsis

Background: Sepsis and shock septic still is one of the causes of morbidity and mortality that many in pediatric patients. The study is intended to determine the effectiveness of the systems Pediatric Risk of Mortality-IV(PRISM-IV), Pediatric Logistic Organ Dysfunction-2 (PELOD-2) and Pediatric Index of Mortality-3 (PIM-3) in predicting the outcome of patients. Methods: Data were taken from the medical record of patients. Medical records are then evaluated using the inclusion criteria and the criteria for exclusion. Data is processed statistically. Result: The number of survived subjects was 38 patients and the number of deaths was 26 patients. The regression test showed that to a relationship that significant between the value of scoring PRISM-IV against mortality with p 0.001 (p <0.05 CI 95%). The PIM-3 score was analyzed. The regression test showed that there is no significant relationship between the score PIM-3 against mortality with p 0.371 (p <0.05 CI 95%). Test relationship score PELOD-2 against mortality showed that patients who survived had a value score of PELOD 0, whereas the patients who died had a mean score of 3.6 (SD ± 4.5). The results of the test regression showed a significant relationship with p 0.018 ( (p <0.05 CI 95%) with the strength of the relationship R = 0.595. Conclusion: The PELOD-2 and PRISM-IV grading systems are equally good at predicting the outcome of pediatric surgical patients with sepsis. The PELOD-2 system has advantages in specificity and accuracy, while the PRISM-IV system has an advantage in sensitivity

HEMATOLOGY PROFILES AND DISEASE SEVERITY OF PEDIATRIC DENGUE VIRUS INFECTION AT A TERTIARY HOSPITAL IN SURABAYA, INDONESIA

Highlights • Dengue virus infections exhibit a spectrum of clinical manifestations, ranging from asymptomatic cases to severe disease, with the potential for fatalities if not managed effectively. • Hematology factors significantly contribute to the severity of dengue virus infection.   Abstract Background: The escalating incidence of dengue cases in Surabaya, Indonesia, underscores the imperative to comprehend the hematology profiles and disease severity in pediatric patients affected by dengue virus infections (DVI). As the prevalence of DVI continues to surge, understanding the nuanced clinical manifestations becomes paramount for effective management and mitigation of the disease burden. Objective: This study aimed to characterize the hematology profiles and the disease severity of dengue virus infections (DVI) among pediatric patients hospitalized at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia throughout 2019. Material and Method: A retrospective descriptive cross-sectional study was conducted using secondary data from medical records. Pediatric patients aged six months to 18 years were enrolled. A total sampling method comprised 67 patients meeting the inclusion criteria. Result: Severe thrombocytopenia was most commonly observed in dengue hemorrhagic fever (DHF) III cases (36.4%), while leukopenia was predominant in DF cases (42.2%). High hematocrit levels were more prevalent in DHF III cases (27.3%), and high hemoglobin levels were most frequently identified in DHF II and DHF III cases (33% in each case). Significant differences in DVI severity were observed in platelets and hemoglobin levels (p=0.0002 and p=0.0066, respectively) but not in leukocyte and hematocrit levels. Conclusion: Mild thrombocytopenia was prevalent in Dengue Fever (DF), while severe thrombocytopenia was most prevalent in Dengue Hemorrhagic Fever (DHF) grade III. Leukopenia was prominent in DF patients, and platelets and hemoglobin levels varied across severity of DVI. These findings provide insights for improved clinical management and diagnostic criteria refinement

Evaluation of the PaO2/FiO2 Ratio as a Risk Factor for Hypoxemia against Septicemia Mortality in Children who Treated at Dr. Soetomo General Hospital

Background: Severe septicemia can result in impaired oxygen perfusion to the tissues. The PaO2/FiO2 ratio (P/F ratio) is one of the measurement parameters for hypoxemia. This study aims to evaluate the P/F ratio as a risk factor for hypoxemia against septicemia mortality in children. Method: An observational with a prospective cohort design was conducted. Thirty-six patients with septicemia, consisting of 18 patients who living (survivor) and 18 patients who died (non-survivor). The P/F ratio is obtained based on blood gas analysis carried out in the first 24 hours of treatment recorded on medical records and calculated manually. The P/F ratio has an area under the curve (AUC) of 0.83 (95% CI 0.71–0.95) with a cut-off of 226. Septicemia children with P/F ratio < 226 who have a mortality risk of up to 6.9 times (RR 6.9; 95% CI 1.719-27.957; p= 0.005) with sensitivity 72.70%; specificity 72.20%; PPV 76.19%; NPV 68.42%. The mean P/F ratio in the non-survivor group was significantly lower than the survivor group 161.60 (95% CI 1.05) compared to 391.09 (95% CI 2.13); p= 0.005). Conclusion: The P/F ratio can be a risk factor for hypoxemia on septicemia mortality

Correlation between immunization status and pediatric diphtheria patients outcomes in the Sampang District, 2011-2015

Background The number of diphtheria cases recently increased, such that an outbreak was declared in East Java Province, which includes the Sampang District. Immunization completion status is a determining factor for diptheria infection. Objective To investigate for correlations between immunization status and outcomes (severity level, fatality, and complications) of diphtheria patients in the Sampang District. Methods This analytic, cross-sectional study used secondary data from the East Java Provincial Health Office on diphteria patients aged 0-20 years during the 2011-2015 outbreak in the Sampang District and interviews with diphtheria patients in that region. The Diphtheria Research Team of Soetomo Hospital collected data on immunization status, diphtheria severity (mild, moderate, or severe), case fatality (died or survived), and complications in the patients (with or without complications). Spearman’s, Chi-square, and Fisher’s exact tests were used for data analyses, accordingly. Results Seventy-one patients with clinical diphtheria were identified, 17 of whom were confirmed with positive culture results. The case fatality rates were 7% in patients with clinical and 5.9% in confirmed diphtheria. There were no correlations between patient immunization status and severity (P=0.469 clinical, P=0.610 confirmed), or fatality (P=0.618 clinical, P=0.294 confirmed) of diphtheria in the clinical and confirmed diphtheria patients. However, there was a correlation between patient immunization status and the emergence of complications in clinical (P=0.013), but not in confirmed (P=0.620) diphtheria patients. Conclusion There is a correlation between immunization status and complications in clinical diphtheria patients. Such a correlation is not found in confirmed diphtheria cases because none of the patients had complete immunization status