Tuberkulosis Perinatal Bermanifestasi sebagai Tuberkulosis Milier dan Meningitis

Tuberkulosis (TB) perinatal adalah kasus TB yang jarang dilaporkan karena manifestasi klinis tidak spesifik, serta terdapat permasalahan dalam pemeriksaan laboratorium dan radiologis sehingga tidak terdiagnosis. Istilah TB perinatal menjelaskan adanya infeksi Mycobacterium tuberculosis yang terjadi pada masa perinatal baik selama kehamilan, persalinan, maupun pascapersalinan dalam masa neonatus. Seorang bayi laki-laki usia tiga bulan dirujuk ke Emergensi Anak Rumah Sakit Hasan Sadikin dengan riwayat demam lama dan tidak mau menetek. Proses kelahiran tidak ada masalah. Pada pemeriksaan fisis ditemukan letargis, febris, takipnea, dan hepatosplenomegali. Pewarnaan Ziehl Neelsen aspirat lambung menunjukkan basil tahan asam positif. Uji kulit tuberkulin menunjukkan nonreaktif, foto toraks memperlihatkan gambaran milier, dan fungsi lumbal memberikan interpretasi TB meningitis. Berdasarkan penelusuran aktif sumber penularan TB serumah, ternyata ayah dan kakek bayi merupakan sumber penularan. Selain diberikan paduan oral antituberkulosis standar, juga diberikan antibiotik dan prednison. Dalam perjalanan penyakitnya, terjadi syok sepsis serta koagulasi intravaskular diseminata dan bayi meninggal. Dari kultur darah teridentifikasi Staphylococcus haemolyticus. Disimpulkan bahwa walaupun tidak terdapat permasalahan saat kelahiran bayi, diperlukan penelusuran aktif kemungkinan TB perinatal pada keluarga dengan sumber penularan TB positif. Diperlukan kewaspadaan terdapatnya TB pada wanita hamil di negara berkembang dengan jumlah kasus TB tinggi. [MKB. 2010;42(3):135-9].Kata kunci: tuberkulosis perinatal Perinatal Tuberculosis Presenting as Miliary Tuberculosis and MeningitisPerinatal tuberculosis (TB) is rarely reported, because the clinical manifestations are not specific and there is a problem in its laboratory and radiology examination which caused undiagnosed. Perinatal TB is the preferred description that encompasses TB acquired either intra uterine, during or post delivery in early newborn period. A-3- month old baby was transferred to Pediatric Emergency Hasan Sadikin Hospital because of prolong fever and unable to breastfeed. There was no problem with delivery. Lethargic, fever, tachypnea, and hepatosphlenomegali were found on physical examination. Ziehl Neelsen smear of gastric lavage yielded positive acid fast bacilli. Tuberculine test was non reactive, chest x-ray showed a miliary pattern, and cerebral spinal fluid analysis gave tuberculous meningitis interpretation. By active finding, his father and grandfather were detected as a source of TB transmission. In additon to oral antituberculosis regimen, antibiotics and prednison were also given. Septic shock and disseminated intravascular coagulation were occurred during his illness and the baby died. Staphylococcus haemolyticus was identified from blood culture. In conclusion, although there were no problems during labor, active investigation of perinatal TB possibility is required on the family with a source of TB. Caution on TB in pregnant women is necessary at developing country with high rates of TB. [MKB. 2010;42(3):135-9].Key words: Disseminated intravascular coagulation, miliary, meningitis, perinatal tuberculosis DOI: http://dx.doi.org/10.15395/mkb.v42n3.2

Pertussis-like syndrome or pertussis: a delay diagnosis

138-146Статья посвящена основным способам перевода беэквивалентной лексики в британских и американских СМИ. В данной статье приводятся данные по частоте применения тех или иных способов перевода данной лексики, а также результаты анализа распространённости безэквивалентной лексики по частям речи. Нами были рассмотрены 166 лексических единиц из статей американских ("The Washington Post", "The New York Times" и "CNN") и британских СМИ ("BBC", "The Guardian" и "Reuters")

TROMBOEMBOLI PARU PADA ANAK

Tromboemboli paru dapat terjadi akibat adanya obstruksi pembuluh darah paru oleh trombi. Tromboemboli paru jarang didiagnosis dan dilaporkan pada anak, kebanyakan bahkan tidak terdiagnosis sampai setelah dilakukan otopsi. Penyakit yang pada dewasa meningkatkan risiko terjadinya tromboemboli juga berlaku untuk anak dan remaja. Penderita dengan tromboemboli paru biasanya mempunyai penyakit yang mendasari ataupun faktor pencetus, seperti imobilisasi, penggunaan vena sentral, penyakit jantung, trauma, operasi, infeksi, dehidrasi, keganasan, kelainan hematologi, serta kegemukan. Lokasi anatomis trombus vena pada anak berbeda dengan dewasa yaitu pada vena kranialis dan abdominalis, serta seringkali manifestasi klinisnya tidak jelas. Pada anak, tomboemboli paru harus dipertimbangkan pada beberapa keadaan, antara lain dalam mengevaluasi hipertensi paru yang tidak bisa diterangkan penyebabnya, insufisiensi respirasi, dan koagulasi intravaskular diseminata (KID). Pemeriksaan angiografi paru masih merupakan gold-standard untuk mendiagnosis tromboemboli paru dan merupakan pemeriksaan yang invasif. Pemeriksaan non-invasif multidetector helical/spiral computerized tomography scanning yang mempunyai sensitivitas dan spesifisitas tinggi merupakan teknik yang diharapkan dapat menggantikan pemeriksaan angiografi paru. Protokol pengobatan untuk anak masih belum berkembang, tetapi hingga saat ini antikoagulasi merupakan obat yang digunakan untuk mencegah perluasan bekuan dan rekurensi tromboemboli.Kata kunci: Tromboemboli paru, angiografi paru, multidetector helical/spiral computerized tomography scanning, anakPULMONARY THROMBOEMBOLISM IN CHILDRENPulmonary thromboembolism could be happened because of pulmonary vessel obstruction by thrombi. Pulmonary thromboembolism is rarely diagnosed and reported in children, most of them are not diagnosed before autopsy was done. All adult diseases that increase the risk of thromboembolism occur in children and adolescent as well. Patients with pulmonary thromboembolism usually have serious underlying disorders or precipitating factors, such as immobility, central venous catheterization, heart disease, trauma, surgery, infection, dehydration, malignancies, hematologic disorders, and obesity. The anatomic site of venous thrombi in children differs from those in adult, which more likely to involve cranial or abdominal veins, and often asymptomatic. Pulmonary thromboembolism in children should be considered in the evaluation of unexplained pulmonary hypertension, respiratory insufficiency, and disseminated intravascular coagulation. Pulmonary angiography is considered to be the gold-standard for diagnosis of pulmonary thromboembolism, and it is an invasive procedure. Non-invasif procedure multidetector helical/spiral computerized tomography scanning with high sensitivity and specificity is promising technique may replace pulmonary angiography. Although definitive protocols for treatment of pulmonary thromboembolism in children have not been improved yet, but until now anticoagulation drugs is used to prevent clot extension and recurrent thromboembolim.Key words: Pulmonary thromboembolism, pulmonary angiography, multidetector helical/spiral computerized tomography scanning, children DOI: http://dx.doi.org/10.15395/mkb.v41n1.25

The Correlation of Serum Total Testosterone, Sex Hormone Binding Globulin and Free Androgen Index with Athens Insomnia Scale Score in Polycystic Ovary Syndrome

BACKGROUND: Polycystic ovary syndrome (PCOS), a common reproductive endocrinologic disorder in woman, was considered to be related to sleep disturbance. This study is aimed to analyze the correlation between excess androgen markers and Athens Insomnia Scale (AIS) in PCOS.METHODS: This observational, cross-sectional study of PCOS was conducted to 31 subjects to evaluate the correlation between serum total testosterone, sex hormone binding globulin (SHBG) and free androgen index with the incidence of sleep disturbance using AIS. Sleep disturbance was present if the score ≥6. The correlation between excess androgen markers and sleep disturbance was analyzed using Pearson’s coefficient of correlation or Spearman’s rho test. Correlation coefficient more than 0.5 with p6 group was higher than AIS score 0.05). No significant correlation was found between serum total testosterone, SHBG and free androgen index with AIS score. After adjusting for AIS score, there was the moderate positive correlation between serum total testosterone level although not statistically significant (r=0.54, p=0.07).CONCLUSION: The serum total testosterone level might influence the occurrence of sleep disturbance in PCOS.KEYWORDS: PCOS, androgen excess, testosterone, sleep disturbance, Athens Insomnia Scal

Characteristics and Complications of Tuberculous Meningitis Patients with Hydrochepalus Undergone Fluid Diversion in Dr. Hasan Sadikin General Hospital, Bandung

Objective: To describe the clinical characteristics and complications observed in tuberculous meningitis (TBM) patients with hydrocephalus who had undergone fluid diversion management.Methods: This was a cross-sectional descriptive observational study involving 28 TBM patients with hydrocephalus aged 0–5 years who had undergone ventriculoperitoneal shunt or extraventricular drainage in the period of July 2011 to July 2016 in Dr. Hasan Sadikin General Hospital, Bandung. Age, gender, head circumferences, nutritional status, and classical characteristics such as sunset eye, frontal bossing, cracked pot sign, venectation as well as complications such as infection, phlebitis, and exposed shunt documented in the hospital medical records were analyzed.Result: The study discovered that infant group was predominant (21/28). Some of the patients had macrocephalus (7/28) and 18 had good nutrition status (18/28). There were 4 patients with frontal bossing characteristics (4/28) and almost none was found with others classic hydrocephalus characteristics. This study found no complication such as infection, phlebitis, and exposed shunt in TBM patients with hydrocephalus who had undergone fluid diversion therapy in Dr. Hasan Sadikin General Hospital, Bandung.Conclusion: One of the most dominan characteristics of TBM patients with hydrocephalus is frontal bossing. Tuberculous meningitis patients with hydrocephalus in our center did not show any fluid diversion-related complications such as infection, phlebitis, or exposed shunt.Keywords: Tuberculous meningitis, hydrocephalus, fluid diversion DOI: 10.15850/ijihs.v6n1.104

Left to right shunt congenital heart disease as a risk factor of recurrent pneumonia in under five-year-old children: a single centre experience in Bandung Indonesia

Aim Children with congenital heart diseases are at the greater risk of respiratory tract infection such as pneumonia. Recurrent pneumonia is one of the most major challenge for paediatric physicians. The aim of this study is to investigate risk factors of congenital heart diseases to recurrent pneumonia children. Methods This was a retrospective study of under five-year-old children hospitalized in Hasan Sadikin General Hospital Bandung Indonesia from 2015 to 2018. Congenital heart diseases and pneumonia, as well as recurrent pneumonia, were identified. Congenital heart diseases diagnosis with and without pneumonia were reviewed. Results Of 6997 hospitalized children, in 1258 (18.0%) congenital heart diseases were found, of which 232 (18.4%) had recurrent pneumonia. Most of those had left to right (L to R) shunt, 213 (91.8%). Congenital heart diseases in children aged under 1 year, 144 (62%) were more preponderant than in those aged 1–5 years. More than a half, 119 (51.3%) were males. Left to right shunt was documented as having recurrent pneumonia, of which patent ductus arteriosus and ventricular septal defect were the most common type in congenital heart diseases. Ventricular septal defect had a possibility for recurrent pneumonia by 1.551 times, and malnutrition 2.591 times. Conclusion Ventricular septal defect and malnutrition were identified as risk factors for recurrent pneumonia. Those patients require multidisciplinary approach to prevent respiratory complications

Peran Asthma Control Test (ACT) dalam Tata laksana Mutakhir Asma Anak

Asma adalah penyakit kronik yang sampai saat ini belum dijumpai obat yang bisa menyembuhkannya. Maka tidak ada istilah sembuh untuk asma, namun asma dapat terkontrol. Strategi tata laksana asma saat ini lebih menitikberatkan pada mengontrol asma secara klinis daripada menentukan klasifikasi derajat penyakit serta tata laksana serangan akut. Untuk mengontrol asma diperlukan suatu alat sederhana dan praktis yang dapat digunakan dalam praktek sehari-hari dan salah satunya adalah asthma control test (ACT). Untuk anak usia 4-11 tahun, ACT memuat empat pertanyaan yang dapat diisi oleh anak dan tiga pertanyaan yang diisi orangtua apabila skor >20 dinyatakan asma terkontrol. Untuk usia >12 tahun terdapat lima pertanyaan yang diisi oleh anak. Skor 25 berarti asma anak terkontrol total, sedangkan skor 20-24 dinyatakan on target yang berarti asma terkontrol baik tetapi belum mencapai terkontrol total. Apabila skor <20 menunjukkan off target yang berarti asma tidak terkontrol. Setelah asma terkontrol, pengawasan secara berkala tetap diperlukan